[Optimization of digitalis therapy in clinical practice].

In recent years there has been a marked decrease in cardiac glycosides use in patients with heart failure in sinus rhythm and atrial fibrillation. The results of published studies contradict each other. Some of them doubt the favorable effect of digoxin in patients with heart failure; others refute the increase in the lethality and frequency of hospitalizations associated with the use of digoxin. In this regard, we found it important to analyze these reports impartially and reflect modern views on the mechanisms of cardiac glycosides, the pharmacokinetics and the possibility of optimizing digitalis therapy in cardiac practice.

[The clinico-morphological characteristics of glomerulonephritis in infectious endocarditis]. / Kliniko-morfologicheskaia kharakteristika glomerulonefrita pri infektsionnom éndokardite.

Clinicomorphological characteristics of glomerulonephritis in infectious endocarditis (IEGN) were studied in 62 patients (with samples of autopsy material being used in 52 instances). IEGN presents with dissaminated and focal proliferative alterations involving extracapillary and/or tubulointerstitial components, and is characterized by a broad variability of indices for proteinuria, hematuria and cylindruria. In diffuse prolipherative glomerulonephritis the degree of proteinuria and cylindruria appear to be significantly higher than in focal segmental proliferative glomerulonephritis, as is the incidence rate of development of renal insufficiency and its gravity.

[Chromosome aberration levels and their dynamics during the treatment with cytotoxic preparations of patients with primary and lupus glomerulonephritis]. / Urovni aberratsii khromosom i ikh dinamika pri lechenii preparatami tsitotoksicheskogo deistviia u bol'nykh pervichnym i volchanochnym glomerulonefritom.

As many as 96 patients with chronic glomerulonephritis (CGN) and 25 with lupus glomerulonephritis (LGN) were examined for chromosomal aberrations (CA) in peripheral blood lymphocytes in different clinical variants and morphological forms of CGN and LGN as well as for their dynamics under the influence of cytotoxic drugs. In patients with active CGN and LGN, chromosomal instability may develop. The treatment with cyclophosphamide in a dose of 2.0-2.5 mg/kg/day appreciably increases chromosomal instability the level of which rises progressively with the treatment period increase. The treatment with azathioprine in a dose of 1.5-2.0 mg/kg/day is not associated with a noticeable increment of the rate of CA. The studies of the level of CA can be used for estimating CGN and LGN activity. Chronic renal failure did not change the level of CA either in CGN or in LGN. In different morphological forms of glomerulonephritis, the rate of CA was determined by the clinical variant of the disease. In order to reduce potential complications provoked by the treatment with cytotoxic drugs, dynamic studies of the CA rate should be carried out in addition to the conventional tests.

[Minimal change glomerulonephritis in adults]. / Glomerulonefrit s minimal'nymi izmeneniiami u vzroslykh.

Glomerulonephritis with minimal alterations presents one of the most complex problems of nephrology. The authors provide the data on the disease incidence and clinico-laboratory correlations in 33 adult patients, discuss problems of the treatment policy.

[Chromosome aberrations in chronic and lupus glomerulonephritis ]. / Aberratsii khromosom pri khronicheskom i volchanochnom glomerulonefrite.

The levels of aberration of chromosomes in peripheral blood leucocytes were investigated in patients with chronic and lupoid glomerulonephritis considering the clinical variants and morphological forms of the disease. In chronic glomerulonephritis high levels of chromosome aberration were found in patients with nephrotic type; in lupoid glomerulonephritis the frequency of chromosome aberration was higher in patients with active glomerulonephritis. Chronic renal failure did not essentially change the level of chromosome aberration both in chronic and lupoid glomerulonephritis. In different morphological forms of glomerulonephritis the frequency of chromosome aberration was determined by the clinical variant of the disease.

[Diagnosis and treatment of tumors of the small intestine]. / Diagnostika i lechenie opukholei tonkoi kishki.

The authors studied the results of preoperative diagnosis of tumors of the small intestine and the late-term results of operative treatment of malignant new growth in 25 patients. It is shown that the X-ray method allows tumors to be detected in some cases but its possibilities are limited. Signs of ileus prevail in the clinical picture in malignant tumors, while signs of intestinal bleeding prevail in benign tumors. Resection of the intestine with the tumor and regional lymph nodes in sarcomas produces satisfactory results in some cases.

[Effect of sodium hydroxybutyrate on coronary hemodynamics and microcirculation during hypotension caused by blood loss]. / Vliianie oksibutirata natriia na kardiogemodinamiku i mikrotsirkuliatsiiu pri gipotonii, vyzvannoi krovopoterei.

Experiments of 34 dogs were made to study alterations in the cardio- and hemodynamics and microcirculation in the mesenterium during hypotension caused by hemorrhage after intravenous injection of sodium hydroxybutyrate and intravenous re-infusion of heparinized blood under a pressure of 80-120 mm Hg. It was established that single injection of sodium hydroxybutyrate in a dose of 180-200 mg/kg after a 60-minute decrease in the arterial pressure to 40 mm Hg increases pump function of the heart, venous blood returns to the heart, and improves microcirculation. This improvement manifests by the rise in the blood flow rate in the microvessels and in the number of functioning capillaries, and by diminution of red cell aggregation. Favourable effect of the drug is seen within the first minutes after injection and remains unchanged for one hour. Intravenous blood pumping under long-term hypotension is an effective approach to making for the lost blood in the presence of the preceding injection of sodium hydroxybutyrate.