[Vasoprotective effect of effective lipid-lowering therapy in patients with ST-segment elevation myocardial infarction].

AIM: To study the vasoprotective effects of atorvastatin depending on the achievement of the target level of low-density lipoprotein cholesterol (LDL-C) in patients with ST-segment elevation myocardial infarction (STEMI) within 48 weeks of follow-up. MATERIALS AND METHODS: Included were 112 STEMI patients who received atorvastatin 20-40-80 mg. On days 7-9 from the onset of the disease, after 24 and 48 weeks, ultrasound examination of the carotid arteries with RF technology and applanation tonometry were performed, the lipid profile was determined. The patients were divided into groups: group 1 (n=41) of highly effective therapy (HET) - who achieved the target LDL-C after 24 and 48 weeks; group 2 (n=29) in relatively effective therapy (RET) - achieving target values at 24th or 48th week; group 3 (n=42) insufficiently effective therapy (IET) - did not reach the target LDL-C. RESULTS: When examining the carotid arteries in the HET group, the intima-media thickness (IMT) decreased by 10.7-13.1%, the b index - by 14.9-26.3% after 24-48 weeks. In the RET group, the IMT regression was 10.4-13.3%; b index - 23.9% by the 48th week. In the IET group, the b index decreased by the 48th week by 14.3%. According to applanation tonometry in the HET group, the central pressure did not change. In the RET group, systolic pressure in the aorta increased by 10-15.7% after 24-48 weeks, pulse pressure - by 33.9% by the end of observation. With IET, the increase was 8.6-6.8 and 19.8-25.9%, respectively. The odds ratio of developing endpoints in the RET group was 4.7 (95% CI 1.2-26.4; p=0.02), in the IET group - 3.9 (95% CI 1.1-24.8; p=0.03) compared with HET. CONCLUSION: The most pronounced vasoprotective effect and a decrease in cardiovascular risk are associated with the achievement of the target LDL-C throughout the entire treatment period.

[The complex diagnostic of deviation in development of children of the first years of life in conditions of polyclinic].

The comprehensive diagnosis of abnormalities of development of children during the first years of life is one of the most important targets and the first stage of system of early medical care based on the intersectoral interaction of the experts. The health care facilities play paramount role in identifying children at risk, including ones born with signs of perinatal damage of central nervous system. The article presents results of the experimental study of efficiency of common diagnostic methods of development of children during the first years of life in conditions of polyclinic services. The article also proves the necessity of complementing actual diagnostic instruments by new methods of diagnostic based on complex evaluation of main parameters of psychomotor development of children that will result in timely diagnostic and inclusion of children of risk group to the system of early medical care.

[EMBOLIZATION OF BRONCHIAL ARTERIES IN ACUTE PULMONARY BLEEDING IN CHILDREN].

Children with acute pulmonary bleeding (8 cases) due to different pathology of trancheobronchial tree were followed-up at the period from 2008 to 2014. Diagnostic angiography and X-ray endovascular occlusion of bronchial arteries were performed in the case of insufficiency of conservative and endoscopic methods of hemostasis. Microembolic spheres were used for embolization of distal vessels. The embolization coils and micro-coils were applied for occlusion of great vessels. Children (5 cases) were discharged from the hospital after embolization at the terms of 6-12 months. They hadn't any ischemic complications associated with bronchial artery occlusion. The sequelae of main disease caused deaths of 3 other kids. The X-ray occlusion is a low-invasive and highly effective method of arrest of all types of bleeding from pool of bronchial arteries. The method could be applied even in extremely severe condition of the patients.

[Diagnostics and treatment of congenital malformations of the lung and mediastinum in newborn children and infants].

The article presents the experience of treatment of newborn children and infants with congenital malformations of the lung and mediastinum, which required a surgery. Children (138 cases) were treated during recent 18 years. There was a prevalence of full-term infants (73%). Fetal malformations were diagnosed in prenatal period in majority of cases. Computed tomography was the main method of diagnostics after delivery. Children (110 cases) were operated out of 138. Children with extrapulmonary sequestration didn't undergo surgery in case of absence of clinical manifestations. The authors made a conclusion that malformations of the lung and mediastinum should be included in number of differentiated diseases in case of respiratory distress syndrome in newborn children. The indications to early surgery should be the danger of contamination and malignant transformation, presence of intrathoracic tension syndrome in neonatal period.

[Comparative assessment of a calcium antagonist with controlled release of nifedipine and enalapril in arterial hypertension in subjects older than 60 years].

We compared antihypertensive effects and organoprotective action of a calcium antagonist nifedipine RD and angiotensin converting enzyme (ACE) inhibitor enalapril in subjects older than 60 years with systolic diastolic (group 1) and isolated (group 2) I-II degree arterial hypertension. Subgroups of patients receiving nifedipine RD, enalapril, or combination therapy were distinguished. We used ultrasound methods for measurement of parameters of hypertrophy, systolic and diastolic function of the heart, increments of diameter and blood flow velocity in brachial artery during test with reactive hyperemia. Nifedipine RD appeared to be the drug of choice in elderly persons with isolated systolic form of arterial hypertension. Combination of calcium antagonists and ACE inhibitors in resistant hypertension in the elderly lead to achievement of target values of blood pressure and potentiation of organoprotective action of drugs.

[Results of transcatheter closure of the secundum atrial septal defects in children].

Immediate and long-term results of transcatheter closure of defects of interatrial septum (DIAS) with occluder Amplatzer were analyzed. An attempt of transcatheter closure of DIAS was undertaken in 62 children aged from 2 through 17 years (mean age 10.93 +/- 4.57 years), among them there were 19 boys (30%) and 43 girls (70%). Successful implantation of the occluder was fulfilled in 60 patients, but in 2 patients there were failures. Complete occlusion of DIAS by the data of transthoracic echocardiography (TTE) fulfilled immediately after implantation of the occluder was noted in 57 patients (92%), 3 patients had insignificant (1) and small (2) residual flow, in 2 patients--directly through occluder and in 1--along the lower border of the occluder. TTE with Doppler mapping made 24 hour after the procedure has demonstrating the absence of residual flow in 59 patients (98%), including 2 patients out of 3 with a residual shunt immediately after implantation of the occluder. In 1 child there was a negligible shunt left along the lower border of the occluder which disappeared within a month in control TTE. Complications during performing transcatheter closure with DIAS occluder Amplatzer appeared in 3 patients. In 2 patients there was arrhythmia, in 3 patients during implantation of the occluder with diameter 34 mm the right atrial auricle was damaged that required sternotomy and suturing the auricle wound. Long term results were followed up in 40 patients during 1-3 years. None of the patients had residual shunts or erosions of the atrium walls or aorta, or disturbed heart rate.

[The analysis of the SpI (1546G>T) polymorphism of the Col1A1 gene and the FokI (3663T>C) polymorphism of the vitamin D receptor gene in patients with syringomyelia].

The SpI (1546G>T) polymorphism of the CollA1 gene and the FokI (3663T>C) polymorphism of the vitamin D receptor gene have been studied in patients with syringomyelia and controls of different ethnic origin (Tartars, Bashkirs, Russians). Ethnic differences in allele and genotype frequencies have been revealed in the control group. Frequency of the s allele of the CollA1 gene was higher in Russian patients and that of the FokI FF genotype in Tartar patients. The data obtained suggest a possible role of these genes in the pathogenesis of syringomyelia.

Experimental model of syringomyelia in rabbits.

We studied the possibility of reproducing syringomyelia in rabbits by injection of serum from patients with syringomyelia. Clinical signs of syringomyelia and morphological changes in the central nervous system (cavities, dilatation of the cerebrospinal channel, neurodegeneration, gliosis) developed in laboratory animals over 60-120 days. This laboratory model is easily reproducible, stable, and maximally similar to the natural disease, which suggests it for the studies of the pathogenesis and development of new therapeutic methods.

[Antimicrobial activity of natural hypolipidemic compounds].

Antibiotic activity of complex agents of actinomycete and fungal origin was studied in the programme of screening organisms producing substances with hypolipidemic activity. The majority of the agents were shown to be active against Aspergillus niger 137a and Candida albicans ATCC 885-653. Some of the agents were active against bacteria, including acid-fast ones.

[Failures and complications of transcatheter coil occlusion of patent ductus arteriosus]. / Neudachi i oslozhneniia chreskateternoi spiral'noi okkliuzii otkrytykh arterial'nykh protokov.

An analysis of fails and complications of transcatheter coil occlusion of patent ductus arteriosus (PDA) was made. An attempt to close PDA with Gianturco coils was undertaken in 132 patients. Fails were noted in 4 (3.1%) children, 3 of them failed to hold the coil in PDA due to its greater width, and in 1 patient the catheter could not be delivered through a narrow duct. Complications were noted in 9 patients (7%): migration of the coils into the pulmonary artery branches took place in 8 patients, and in 1 patient there appeared haemolysis due to a large residual shunt. Snare-assisted removal of the migrating coils was carried out in 7 children, in 1 girl the coil could not be extracted from the peripheral branch of the left pulmonary artery. In 7 patients reocclusion of PDA was made, in 1 case no reembolization was performed. Haemolysis was liquidated by an additional implantation of the coils in repeated procedure. Risk of fail and complications was associated with great minimal diameter of patent ductus arteriosus.

[The significance of disturbances of draining functions of the azygos vein in pathogenesis of varicose dilatation of the veins of the esophagus and stomach in portal hypertension (experimental-clinical investigation)]. / Znachenie narushanii drenazhnoi funktsii neparnoi veny v patogeneze varikoznogo rasshireniia ven pishchevoda i zheludka pri portal'noi gipertenzii (éksperimental'no-klinicheskoe issledovanie).

Under analysis were the results of investigations on 30 corpses, 25 dogs and of examinations of 187 patients with portal hypertension. In the experiments the disturbances of blood flow in the portal and azygos veins and the veins of the gastroesophageal basin were modeled. It was found that changes of the veins of the esophago-gastric area in diffuse lesions of the liver were already present even if there were no definitely detectable signs of portal hypertension. The experimental osseo-azygography has revealed dilatation of the azygos vein. The findings of examination of the patients admitted with esophago-gastric bleedings allowed detection of 5 degrees of impairments of blood flow along the azygos vein which increased risk of esophgeal-gastric bleedings.

[Biopolymers in urine of patients with syringomyelia]. / Biopolimery mochi bol'nykh siringomieliei.

Urine of patients with syringomyelia was analysed by gel filtration, ion-exchange chromatography and analytical chemistry methods. Increased level of acidic glycoproteins and decreased level glycosaminoglycans levels were found. Patients with syringomyelia had smaller glycosaminoglycans components of proteoglycans than normal subjects.

[Surgical strategy in liver hemangiomas]. / Khirurgicheskaia taktika pri gemangiomakh pecheni.

The authors made an analysis of results of surgical treatment of 129 patients with hepatic hemangiomas and of the 9-year follow-up of these patients. The dynamic care of these patients is recommended in cases of 5 cm diameter hemangiomas and the absence of clinical symptoms. The surgical treatment was necessary but in 10% of such patients. In the majority of such patients embolisation of the hepatic artery is expedient if surgical treatment is necessary. Indications for resection of the liver are restricted.

Experimental morphological analysis of surgical bypassing of the uveal tract.

Histological preparations of eyeball membranes from rabbits subjected to decompression multisclerectomy providing alternative drainage pathway were examined. The procedure was performed with or without application of a 5-fluorouracil-impregnated implant. The use of this implant always resulted in the formation of relatively wide endothelialized transscleral channels and ensured their persistence in the late postoperation period.