[Acute vestibular disorder in the elderly: stroke or peripheral vestibulopathy]. / Ostroe vestibuliarnoe golovokruzhenie v pozhilom vozraste: insul't ili perifericheskaia vestibulopatiia.

Acute vestibular disorder is a frequent cause of urgent hospitalization in elderly patients. A CNS vascular disorder is often thought to be a cause of vertigo and a patient is diagnosed with stroke or transitory ischemic attack (TIA) or vertebral-basilar insufficiency. Despite the higher risk of cerebrovascular disease in the elderly, stroke and TIA are not the only cause of acute vestibular disorder. Hyperdiagnosis of cerebrovascular diseases in patients with acute vertigo often leads to underdiagnosis of peripheral vestibular disorders that could be successfully treated if timely diagnosed. The differential diagnosis of the lesions of central and peripheral vestibular systems is based on clinical examination of patients with acute vertigo including an analysis of cerebrovascular risk factors, characteristics of vertigo, nystagmus and careful identification of focal neurological symptoms.

[Complex ultrasonic examination in the diagnosis and evaluation of cardiac function in right-ventricular infarction]. / Kompleksnoe ul'trazvukovoe issledovanie v diagnostike i otsenke funktsii serdtsa pri infarkte pravogo zheludochka.

Combined ultrasound investigation (two-dimensional, contrast, Doppler, Mechocardiography) was performed in 32 patients with acute myocardial infarction (AMI). Echo- and electrocardiographic evidence and clinical symptoms suggested AMI of both ventricles in 22 patients. Ten patients with AMI in the left ventricle only made up the control sample. Right cardiac compartments were probed to verify right-ventricular insufficiency. Right-ventricular involvement was confirmed by autopsy in 6 patients. Clinical signs of right-ventricular AMI were detected in 63.6% of second-group patients, and electrocardiographic signs of the same, in 54.6%. Asynergic areas were detected in right-ventricular wall of 90.5% of patients. In cases of right-ventricular AMI, right compartment section area was increased significantly, while right-ventricular evacuation fraction was as significantly reduced. Doppler echocardiography demonstrated a low right-ventricular rapid filling peak rate, as compared to the respective slow filling rate, an indirect indication of right-ventricular AMI. Combined ultrasound investigation is therefore an effective tool for the diagnosis of right-ventricular AMI and assessment of heart performance.

[Changes in the indices of central hemodynamics and myocardial metabolism as affected by plasmapheresis in patients with myocardial infarct]. / Izmeneniia pokazatelei tsentral'noi gemodinamiki i metabolizma miokarda pod vozdeistviem plazmafereza u bol'nykh infarktom miokarda.

Gravitation plasmapheresis (PP) on PF-0.5 fractionator was used in 32 patients with acute myocardial infarction to control blood rheologic disorders. Central hemodynamics and myocardial metabolism were monitored by means of right heart probing and echocardiography. A control group of 7 patients were subjected to "mock PP" with a rheopolyglucin infusion. PP limited manifestations of heart failure, normalized the levels of compounds with high molecular weights which conditioned plasma viscosity, reduced significantly total peripheral and total pulmonary resistance, increased the cardiac index, stroke volume and ejection fraction, and improved regional left-ventricular contractility. Myocardial metabolic studies demonstrated a decline in left-ventricular myocardial ischemia, as evidenced by the arteriovenous difference in lactate levels. It is therefore suggested that PP can be effectively used as part of combined treatment for complicated acute myocardial infarction.

[Effect of gravitation plasmapheresis on central hemodynamics and indices of myocardial metabolism in patients with acute complicated myocardial infarct]. / Vliianie gravitatsionnogo plazmafereza na tsentral'nuiu gemodinamiku i nekotorye pokazateli metabolizma miokarda u bol'nykh ostrym oslozhnennym infarktom miokarda.

A study of 32 patients with complicated acute myocardial infarction, treated with gravitation plasmapheresis during the acute phase of the disease, demonstrated a significant drop in blood concentrations of compounds with high molecular weights (fibrinogen, cholesterol, triglycerides, total protein) as well as a significant activation of the heart's pumping function, while total peripheral resistance declined, as did the degree of myocardial ischemia. This is interpreted as an evidence of positive effect of plasmapheresis on central hemodynamics, myocardial metabolism and clinical course of myocardial infarction in such patients.