[Resistant hypercholesteremia in clinical practice: new insight into the causes and methods of treatment].

Coronary heart disease and other diseases caused by atherosclerosis, take first place among the causes of adult mortality. Leading role in the development of atherosclerosis belongs to violations of cholesterol metabolism. Reducing mortality from ischemic heart disease primarily associated with adequate correction of the lipid metabolism. The research of the possible causes and correction of resistant hypercholesterolemia is done. Determined that some patients with resistant to statins hypercholesteremia and normal or elevated levels of hormones T3 and T4 in the blood have isolated symptoms of hypothyroidism, which may be a manifestation of reducing tissue sensitivity to thyroid hormones. Adding to the statins levothyroxine in daily doses of 25-50 mkg have additional cholesterol reducing action, allowing to achieve target levels of lipoprotein in blood in patients. The use of levothyroxine in low doses in combination with statins is highly effective and economically justified.

[Physical rehabilitation of inpatients with ischemic heart disease].

In modern physical rehabilitation of IHD patients the main tendencies are early activation and elaboration of new safe programs of physical trainings (PhT) improving the hemodynamic indices and increasing physical rehabilitation (PhR) of patients. The aim of the present study was to investigate the effect of bicycle exercise (BE) in the free-load bicycle exercise (FBE) on central hemodynamics and PhR of inpatients with different clinical forms of IHD. 185 patients (99 males and 86 females) aged 46-76 years (mean age of 68.4 +/- 1.6 years), with different clinical forms of IHD, were been examined. The inclusion of IHD cases into complex management is been followed by significant improvement of cardiac pump function--increase of stroke index, ejection fraction (EF) and rise in PhR in all clinical groups. The use of traditional therapy only in management is been followed by merely significant rise in EF (mean--by 19%) and total amount of performed work and microcirculation indices in patients with paroxysmal arrhythmia and stenocardia, less evident than in use of FBE. The absence of complications in our patients permit to recommend the application of this method in IHD inpatients.

[Physical exercises in rehabilitation of patients with coronary heart disease at in-patient stage].

The main directions of state-of-the-art physical rehabilitation of patients with coronary heart disease (CHD) are early activation and development of new harmless programs of physical training (PT), improving indices of central hemodynamics and physical efficiency (PE) of patients. The purpose of the work is to study how bicycle training (BT) by the method of free choice of load (FCL) influence on central hemodynamics and PE of patients with various clinical forms of CHD at in-patient stage of physical rehabilitation. 185 patients with various forms of CHD at the age from 46 to 76 years (average age 68.4 +/- 1.6 years), 99 males and 86 females, were examined. Including of BT by the method of FCL in combined treatment of CHD patients was accompanied by significant improvement of heart pumping ability: increase in beat index, ejection fraction and PE in all clinical groups. Use only traditional therapy leaded to significant improvement only of ejection fraction, volume of performed work and threshold power in patients with paroxysmal atrial fibrillation and angina, but less expressive than with the use of BT. Absence of complication in our patients during treatment makes possible to recommend use of the method for CHD patients at in-patients stage of medical rehabilitation.

[Lipid peroxidation and antioxidant defense in patients with ischemic heart disease: correction with free-load bicycle exercise].

AIM: To study changes in lipid peroxidation-antioxidant defense (LPO-AOD) system in patients with various clinical forms of ischemic heart disease (IHD) in response to free-load bicycle exercise (FBE). MATERIAL AND METHODS: A total of 185 IHD patients aged 46-76 years (mean age 68.4 +/- 1.6 years, 99 males and 86 females) were randomized into two groups. Group 1 consisted of 90 patients who received standard medication and FBE. Group 2 of 95 patients received only standard medication. Thirty four healthy controls entered the control group. Each group was divided into subgroups by a clinical form of IHD. LPO was assessed by plasma levels of lipid peroxide (LP), malonic dialdehyde (MDA), AOD--by total antioxidant activity (TAA) in plasma red cells, activity of superoxide dismutase (SOD) and catalase in red cells. RESULTS: Irrespective of a clinical form of IHD, conventional therapy stimulated AOD and decreased LP by 15.1% (p < 0.05), MDA by 21.4% (p < 0.05), on the average, but still these parameters were higher than in healthy controls. The addition of FBE reduced AOD to the levels of that of healthy controls, enhanced AOD the activation of which depended on a clinical form of IHD. CONCLUSION: FBE elevates antiradical potential of blood in trained patients with different clinical forms of IHD. The highest effect was observed on enzymatic link of the AOD system.

[Bicycle exercise in the free load regimen and hemodynamics in inpatients with ischemic heart disease].

Hypokinesia is not an independent risk factor of ischemic heart disease (IHD) but it contributes to progression of this disease because of a positive correlation with such risk factors as arterial hypertension, dislipoproteinemia, obesity, hyperinsulinism, diabetes mellitus type 2. This dictates the necessity to add exercise to pharmacotherapy of IHD. Combined treatment of IHD including bicycle exercise in the free load regimen significantly improves cardiac pump function--a 32.0 and 34.7% mean rise in stroke index and ejection fraction in patients under 60 years of age, respectively. The above rise does not depend on the initial condition of hemodynamics. There are cases when the increase is the highest in patients with the least baseline indices showing the presence of adaptive reserves which realize in physical training. The patients treated had no complications. Thus, use of the above bicycle exercise in IHD patients can be recommended for hospital rehabilitation.

[Correction of free radical processes in patients with ischemic heart disease using bicycle exercise with free choice of load].

The aim of the study was to examine changes in the system lipid peroxidation-antioxidant defense (LPO-AOD) in patients with ischemic heart disease (IHD) exercising on the bicycle in free load regime. A course of standard medication in IHD patients reduced the level of lipid peroxidation by 15.1% (p < 0.05), on the average, malonic dialdehyde (MDA)--by 21.4% (p < 0.05), but at the end of the treatment these parameters did not reach those of healthy subjects and remained higher than they had. The addition of bicycle exercise in the treatment reduced LPO to the level of healthy subjects. AOD also changed in trained IHD patients: catalase activity rose in the trained patients by 22.6% (p < 0.001), on the average, that of superoxide dismutase--by 19.0% (p < 0.05). Total antioxidant activity of erythrocytes in trained patients rose by 24.0% (p < 0.01), total antioxidant activity of plasma increased by 43.3%. Thus, free bicycle exercise raises antiradical potential of blood in IHD patients. The effect of the exercise was the highest on the enzymes of AOD system.

[Hemodynamic correction in patients with coronary heart disease using individualized physical load in hospital setting].

Early activation and development of new safe physical training programs to improve central hemodynamics and the physical ability of patients are the main tendencies in modern physical rehabilitation of patients with coronary artery disease (CAD). The aim of this study was to investigate the effect of bicycle training (BT) with free choice of load parameters (FLC) on central hemodynamics in patients with various clinical forms of CAD receiving hospital treatment. The participants, 185 patients (99 men and 86 women) aged 46 to 76 (mean age 68+/-1.6), suffering from different clinical forms of CAD, were examined. The inclusion of FLC VT into complex treatment of CAD was associated with a significant improvement of heart pumping ability--an increase in tidal volume index (TVI) and ejection fraction (EF) in all clinical groups. Conventional hospital treatment alone does not have a significant impact on central hemodynamic parameters, and is not associated with a significant EF augmentation.

[Antibiotic sensitivity of opportunistic bacteria isolated from patients]. / Chuvstvitel'nost' k antibiotikam uslovno-patogennykh bakterii, vydelennykh ot bol'nykh.

Sensitivity of 147 Enterobacteria strains isolated from feces of various patients was determined with the method of serial dilutions on solid nutrient media. 8 antibiotics were tested. By genera (species) the microorganisms were arranged in the following order: E. coli (65 strains), Citrobacter (33 strains), E. cloacae (15 strains), Serratia liquefaciens (9 strains), Hafnia (6 strains), Klebsiella (4 strains), Pectobacterium (3 strains), non-identified organisms (13 strains). The majority of the strains were resistant to levomycetin (chloramphenicol), morphocycline, tetracycline and tetraolean and at the same time sensitive to streptomycin, neomycin, monomycin and kanamycin. 18 combinations of resistance were found. Repeated examinations of the specimens from the same patient revealed changes in the species composition of the cultures and subsequently in the antibiotic sensitivity spectrum.