[The experience with the rehabilitation of the patients with paralytic laryngeal stenosis].

This paper is designed to familiarize otorhinilaryngologists with the practical methods applied in the surgical rehabilitation of the patients presenting with paralytic laryngeal stenosis. We report the results of the treatment of 13 patients with this pathology differing in age and duration of the disease following strumectomy. Paralytic laryngeal stenosis was eliminated in 11 of the 13 patients. The favourable prognosis was strongly dependent on the time interval between the development of laryngeal paralysis and the surgical intervention. The total duration of the treatment of different patients varied from 8.5 months to 1.5 years because some of them required corrective surgery.

[On the seeming and real atherogenicity of LDLP-IgG immune complexes in blood plasma and the arterial wall].

LDLP-antibody immune complexes and free LDLP were isolated from the serum and aortal wall of people who had died of myocardial infarction; their atherogenicity was compared on the basis of their capture by mouse peritoneal macrophages. The experiment showed that the capture of serum and aortal autoimmune LDPT-antibody complexes was approximately 2.5 times higher than that of free serum lipoproteins (mostly native ones). However, the capture of free (mostly modified) aortal LDLP was approximately 3.6 times higher than that of aortal immune complexes. According to the data received, the comparative atherogenicity of immune complexes and free lipoproteins can be ranked in the following order: modified LDLP --> modified LDLP-IgG complex --> native LDLP. The study shows that LDLP-antibody immune complexes formed in a rabbit's organism get extremely quickly eliminated from bloodstream, probably due to their active capture by reticuloendothelial system cells. The authors suggest that the formation of antilipoprotein autoantibodies and lipoprotein-antibody complexes is a protective response of the organism to appearance of highly atherogenic modified lipoproteins directed towards the weakening of the atherogenicity of such lipoproteins and the intensification of their elimination from bloodstream.

Inhibition of cholesterol esterification by polyene antibiotics in blood plasma.

The inhibition of the lecithin-cholesterol acyltransferase reaction in human plasma by the polyene antibiotics, levorine and amphotericin B, has been demonstrated by in vitro experiments. It is suggested that the inhibition of the esterification reaction is the result of interaction between polyenes and non-esterified cholesterol.

Effect of high density lipoproteins on permeability of rabbit aorta to low density lipoproteins.

A study was made on the effect of high density lipoproteins (HDL) on the permeability of rabbit aorta to low density lipoproteins (LDL) after intravenous administration of human HDL and human [125I]LDL to normal and hypercholesterolemic rabbits. Evaluation of radioactivity in plasma and aorta has shown that the administration of a large dose of HDL decreased the aorta permeability rate for [125I]LDL on an average by 19% in normal rabbits, and by 45% in rabbits with moderate hypercholesterolemia. A historadiographic study showed that HDL also decreased the vessel wall permeability to [125I]LDL in normal and particularly in hypercholesterolemic animals. The suggestion was made that HDL at very high molar concentration can hamper LDL transportation through the intact endothelial layer into the intima due to the ability of HDL to compete with LDL in sites of low affinity on the surface of endothelial cells.

Accumulation of cholesteryl esters in macrophages incubated with human lipoprotein-antibody autoimmune complex.

The interaction of mouse peritoneal and human pericardial macrophages with lipoprotein (LP)-antibody (Ab) immune complex isolated from the serum of ischemic heart disease (IHD) patients has been studied. It is shown that the Ab of the autoimmune complex belongs to IgG class, and the antigen is the LP with d less than 1.063 g/ml. Incubation of mouse peritoneal macrophages with such complex led to the activation of [14C]oleic acid incorporation into cholesteryl esters by 2.5-2.8-fold, in comparison with the experiments where macrophages were incubated with free apoprotein (apo) B-containing LP isolated from the same serum. Incubation of human pericardial macrophages with autologous LP-Ab immune complex led to the transformation of macrophages into foam cells. These data lead to the conclusion that formation of LP-Ab autoimmune complexes may play an important role in the formation of atherosclerotic lesions of the arteries.

Antioxidative activity of high density lipoproteins in vivo.

The present study consists of experimental and clinical investigations. It was shown that a single intravenous injection of a large dose of human HDL3 (200 mg protein) to rabbits with induced hypercholesterolemia (plasma cholesterol 500-700 mg/dl) was accompanied by a significant elevation of plasma HDL and led to a decrease (P < 0.05) of conjugated dienes and trienes by 20-30% after 6 h. Conjugated dienes remained stable for 24 h after HDL administration. In the clinical investigations a weak but statistically significant negative correlation (r = 0.262; P = 0.006) between HDL cholesterol and the content of conjugated dienes in the plasma of a total group of healthy subjects and patients with coronary heart disease (CHD) was found. The data allowed us to conclude that, in addition to other antioxidative systems, HDL also take part in the protection of plasma lipids from peroxidation.

Lipoprotein-antibody immune complexes. Their catabolism and role in foam cell formation.

Immune complexes consisting of human [125I]LDL or [125I]VLDL and anti-apo B IgG were prepared in vitro. After intravenous administration of these complexes or free LDL to normal rabbits the elimination rate for complexes was 2-3-fold higher than for free lipoproteins. The liver/spleen radioactivity ratio after administration of immune complexes was 34% less than after administration of free lipoproteins. Investigations carried out on the cell cultures have shown that during 4-h incubation the uptake of [125I]LDL-anti-apo B IgG complex by human lung fibroblasts was lower than uptake of free [125I]LDL, whereas mouse peritoneal macrophages took up immune complex more actively than free LDL. During 3 days of incubation of macrophages with LDL-anti-apo B IgG the transformation of macrophages into foam cells was observed. This process was accompanied by almost a 60-fold increase of cholesteryl ester content in the cell. It is suggested that excessive uptake of lipoprotein-antibody complexes by macrophages leading to formation of foam cells may play an important role in atherogenesis.

On the mechanism of cholesterol interaction with apolipoproteins A-I and E.

It is shown that cholesterol may interact with some substances containing the guanidine group (guanidine itself, arginine, metformin and dodecylguanidine bromide) and with arginine-rich proteins--apoproteins A-I and E. In the latter case the interaction produces the formation of cholesterol-apoprotein complexes. Analysis of such complexes has shown that one apo A-I molecule binds 17-22 and one apo E molecule binds 30-35 sterol molecules, which approximately corresponds to the amount of arginine residues in these proteins. Formation of cholesterol-apoprotein complexes has been suggested to occur due to: (1) formation of hydrogen bond and/or ion-dipole interaction between cholesterol hydroxyl and guanidine groups of the apoprotein arginine residues and (2) hydrophobic interaction of the cholesterol aliphatic chain with nonpolar side chains of the amino acids occupying the third position from arginine in the protein molecule.

[The role of the structural organization of apoprotein E in cholesterol binding]. / Rol' strukturnoi organizatsii apoproteina E v sviazyvanii kholesterina.

The ability of some proteins to bind cholesterol was accompanied by a decrease of turbidity of aqueous cholesterol suspensions and correlated with a quantity of arginine residues in them. Maximum clearing of aqueous cholesterol suspensions at the addition of proteins containing equimolar arginine concentrations was observed in the presence of apoproteins E and A-I. Optical rotatory dispersion spectra of apoprotein E, polyarginine and histone H3 have shown the influence of sterol on the secondary structure of apoprotein E only.

[Measurement of dimensional distribution of plasma lipoproteins in human blood]. / Izmerenie raspredeleniia po razmeram lipoproteidov plazmy krovi cheloveka.

Possible application of optical mixing method to the investigations of distribution of lipoprotein (LP) particles according to their dimensions is shown. Sensitivity of the method for discovering changes in these distributions at the incubation of lipoprotein particles under different conditions was revealed. It has been shown in particular that when incubating low density lipoproteins (LDL) with erythrocytes the donor properties of LDL in relation to cholesterol, and when incubating high density lipoproteins (HDL) with these cells a more complicated picture is observed. HDL isolated from hypercholesterolemic plasma show the donor properties, and those isolated from the plasma with normal cholesterol level--the acceptor ones. In both cases a high level of aggregatability for total HDL fraction is observed.

[Cryohemosorption--a method of removal of lipoprotein-antibody immune complexes and other atherogenic substances in patients with atherosclerosis]. / Krioplazmosorbtsiia--metod udaleniia immunnykh kompleksov lipoproteid-antitelo i drugikh aterogennykh substantsii u bol'nykh aterosklerozom.

The efficacy of extracorporeal cryohemosorption was estimated in the treatment of atherosclerotic patients in terms of the autoimmune theory of the pathogenesis of this disease. There was a slight decrease in the plasma levels of total cholesterol and triglycerides, there was over 2-fold reduction in the plasma levels of fibrinogen and fibronectin. All major components of apo B-containing lipoproteins and immunoglobulin G were found as part of the cryoprecipitate. An extremely high concentration of lipid hydroperoxides in the precipitate suggest that cryoprecipitation removes not only autoimmune complexes, but highly-atherogenic peroxide-modified lipoproteins. The three-fold decrease in the levels of lipoprotein-antibody complexes resulted in lower atherogenicity of apo B-containing lipoproteins. It is suggested that the mechanism responsible for beneficial clinical action of cryohemosorption sessions is largely associated with the removal of autoimmune lipoprotein-antibody complexes and peroxide-modified apo B-containing lipoproteins than correction of lipid metabolism.

[Mechanism of lipoprotein and cholesterol transport into the vascular wall]. / O mekhanizmakh transporta lipoproteidov i kholesterina v sosudistuiu stenku

Penetration of radioactive lipoproteins of very low and low density, of free cholesterol and its esters into the aortal wall of rabbits was studied. Close values for ratios between lipids and protein, cholesterol and esterified cholesterol contained in the perfusate's lipoproteins and corresponding lipoprotein fractions separated from normal and atherosclerotic aortas following their perfusion were registered. These findings bear evidence to the fact of atherogenic lipoproteins penetrate the vascular wall in the form of intact particles. Quantitative regularities educed in this connection point to a greater permeability of atherosclerotic aortas to lipoproteins. An analysis of aortal lipids uncombined with lipoproteins showed the ratio between cholesterol and etherified cholesterol to be on the average 5.5 times as high as in the lipoproteins of the aorta and the perfusate. The prevalence of cholesterol in the lipids of the aortal tissue uncombined with lipoproteins points to the existence of other mechanisms governing the entrance of radioactive cholesterol into the vascular wall. Tests in vivo involving intravenous administration of C14-cholesterol yielded the same regularities as "in vitro" experiments.

[Current concepts of the pathogenesis of atherosclerosis in light of the development of N.N. Anichkov's theory (on the centenary of his birth)]. / Sovremennye predstavleniia o patogeneze ateroskleroza v svete razvitiia idei N.N. Anichkova (k 100-letiiu so dnia rozhdeniia).

Aspects of the atherosclerosis pathogenesis connected with the role of lipoproteins and the arterial wall cells in the development of arterial atherosclerotic lesions are reviewed. The key problems of the atherosclerosis patho- and morphogenesis in the light of the development of N. N. Anichkov's ideas are discussed.

[Stereological analysis of the nonspecific endocytotic uptake of lipoproteins by aortic endothelium in the initial stages of experimental atherosclerosis in rabbits]. / Stereologicheskii analiz nespetsificheskogo éndotsitoznogo zakhvata lipoproteidov éndoteliem aorty v nachal'nykh stadiiakh éksperimental'nogo ateroskleroza u krolikov.

Stereological analysis of vesicular transport of low density lipoproteins was performed by electronograms of the aorta endothelium from 42 rabbits in the course of experimental hypercholesterolemia. It was shown that nonspecific endocytosis was activated 1,6 times as compared to control and in some areas of endothelium up to 5-6 times at early stages of experimental hypercholesterolemia.

[Endothelial barrier, foam cells and lipoprotein metabolism in arterial walls (based on experimental arteriosclerosis in rabbits)]. / Endotelial'nyi bar'er, penistye kletki i prevrashcheniia lipoproteidov v stenke arterii (na primere éksperimental'nogo ateroskleroza u krolikov).

The features of impaired permeability of endothelium and increased pinocytosis of endothelial cells in developing experimental atherosclerosis in rabbits are described on the basis of electron microscopy findings. Foam cells of various degrees of vacuolation were recovered from the tissue of atherosclerotic aorta by enzymatic treatment. The stages of smooth muscle cell transformation into foam cells were followed. An analysis of morphological changes occurring in foam cells in response to lipids is given. Interactions of intracellular lipid vacuoles with lysosomes are analysed. Possible causes and modes of impairment of the structure and function of aorta cells in experimental atherosclerosis are discussed.

[Comparative characteristics of the lipoproteins of the human vascular wall and blood plasma]. / Sravnitel'naia kharakteristika lipoproteidov sosudistoi stenki i plazmy krovi cheloveka

Electrophoresis in the polyacrylamide gel and ultracentrifugation with a multistage density gradient demonstrated virtually the whole of the blood plasma lipoproteids spectrum to be contained in the human aortal wall. An immunological identity of the whole beta- and alpha-lipoproteids and also of their individual apoproteins in the aortal wall and blood plasma was ascertained. Moreover, the ratio of etherified cholesterol/total cholesterol in the vascular and plasmatic lipoproteids proved to be quiet close. In determining the content of the summary pre-beta-and beta-lipoproteids in the aortal wall the quantity of the said lipoproteids in atherosclerotic lesions was found several times as high as in a normal aorta, whereas the lipoproteids concentration in an intact aortal wall correlated with the intensity of atherosclerosis in the same aorta. The data obtained bear evidence to a plasmatic origin of lipoproteids in the vascular wall and to their important role in atherogenesis.

[Development of the ideas of N. N. Anichkov at the present stage of our knowledge about atherosclerosis]. / Razvitie idei N. N. Anichkova na sovremennom étape ucheniia ob ateroskleroze

The article discusses the main elements of the infiltrative-combination theory of atherosclerosis, which was formulated and developed by N. N. Anichkov. The further development of the main principles of this theory at the current stage of medical science is elucidated. Analysis of the mechanisms of penetration of lipids into the vascular wall, the role of metabolism of the main substance and plasmic proteins at the initial stages of atherosclerosis shows that the new data obtained are not at variance with the fundamental principles of the N. N. Anichkov's theory but on the contrary, supplement it. Evidences on the role of immune complex of beta-lipoproteid-gamma-globulin in the development of atherosclerosis are also in complete accord with this theory.

[Evaluation of lipid characteristics and indices in ischemic heart disease]. / Otsenka lipidnykh pokazatelei i indeksov pri ishemicheskoi bolezni serdtsa.

A combined population study of 7815 male residents of Moscow and Leningrad, aged 40-59, conducted within the USSR-USA collaborative research programme, has made comparative assessments, on the basis of Anderson-Bakhadur intervals, of 13 lipid parameters and indices as predictors and indicators of coronary disease. Indices based on total cholesterol and alpha-cholesterol measurements were found to be of the greatest informative value. Three coefficients are proposed.

[Hemosorption - a method of rapid elimination of cholesterol from the plasma and its effect on the regression of experimental atherosclerosis]. / Gemosorbtsiia - metod bystrogo udaleniia kholesterina iz plazmy krovi i vliianie ee na regressiiu eksperimental'nogo ateroskleroza u krolikov.

Hemosorption is a method of rapid control of hypercholesterolemia. A study of hemocompatibility of an alumosilicate sorbent which is relatively selective with respect to cholesterol demonstrated a possibility of its being used in hemosorption devices. Rabbits with spontaneous regression of two-month duration were given three hemosorption sessions. A drop in cholesterol and triglycerides was noted after each session. By the end of the experiment, the area of aortal atherosclerotic lesion was reduced twofold as compared to the controls (19% vs. 41%). Rapid regression of diffuse lipid deposits from the surface and marginal zones of the patches was observed. "New" secondary lipid deposits were absent. A possibility of using hemosorption in patients with pronounced hypercholesterolemia is discussed.

[Total cholesterol, triglyceride and alpha-lipoprotein cholesterol levels in the blood of 40- to 59-year-old men in Moscow and Leningrad]. / Uroven' obshchego kholesterina, triglitseridov i al'fa-lipoproteidnogo kholesterina v krovi muzhchin 40-59 let v Moskve i Leningrade.

A population survey of 6.990 males 40--59 years of age living in Moscow and Leningrad was conducted to determine the level of lipids in blood plasma by means of automatic standard biochemical methods. Curves were built of the distribution of the concentration of total cholesterol, triglycerides and alpha-lipoprotein cholesterol, and the average content, the upper levels of the norm (and the lower level of the norm for alpha-lipoprotein cholesterol too) were determined from them. The average content of total cholesterol was 217 mg/100 ml, that of triglycerides 100 mg/100 ml, and that of alpha-lipoprotein cholesterol 50 mg/100 ml. The upper norm levels for total and alpha-lipoprotein cholesterol found by cutting off 10% of the higher values were 270 and 75 mg/100 ml, respectively; the upper norm level for triglycerides (cutting off 5% of the higher values) was 250 mg/100 ml. The lower norm level for alpha-lipoprotein cholesterol (cutting off 10% of the lower values) was 35 mg/100 ml.