[Pulse pressure and target organs damage in elderly patients with arterial hypertension].

For the purpose of determination of the importance of daily pulse pressure (PP-24) as the heart, vessels and kidneys affection marker in elderly patients with arterial hypertension we studied 260 patients of the age of 73.3 +/- 7.3 years. The multiple logistic regression analysis was carried out. The results showed that PP-24 irrespective to systolic or diastolic blood pressure was associated with left ventricular hypertrophy and left ventricular enlargement as well as elevated aortic stiffness and carotid plaque. Morphofunctional changes in peripheral vessels and kidneys were independent on the level of PP-24.

[Dynamics of pulse pressure in orthostatic test: interrelationships with risk factors and involvement of the heart and vessels in elderly patients with arterial hypertension].

We studied dynamics of arterial pulse pressure (APP) during active orthostatic test (AOT) in relation to cardiac and vascular involvement in 198 elderly patients with arterial hypertension. We measured and compared parameters of hemodynamics, rate of detection of risk factors, signs of affection of the heart and vessels in subgroups with elevation of APP (n=50), lowering of APP by more than 10 mm Hg (n=50) and intermediate deviations of APP (n=98) in orthostasis. In patients with elevation of APP during AOT smoking, increased aortic stiffness, history of myocardial infarction were detected more often and risk of development of cardiovascular diseases according to SCORE system was higher than in patients with lowering of APP or absence of its dynamics. Patients with lowering of APP more than 10 mm Hg significantly more often had cerebrovascular disease appearing as history of cerebral strokes and/or transitory ischemic attacks. The conclusion was made about possible significance of orthostatic increment of APP as supplementary marker of cardiovascular risk in elderly patients with arterial hypertension.

[Cardiac arrhythmias during an elective cholecystectomy].

The paper presents systemized literature data on cardiac arrhythmias (CA) associated with cholecystectomies. The authors present an analysis of CA in 101 patients with chronic calculous cholecystitis (CCC), registered before, during and after an elective cholecystectomy (the surgery was performed either through laparotomy or using endovideosurgical technique). The study revealed that cholecystectomy, especially laparatomic one, bore an arrythmogenic effect. Additional predictors of dangerous CA associated with surgical treatment of CCC, were presence of sinus tachycardia, bradycardia, ciliary arrhythmia, changes in the variability of heart rate, and preoperative heart enlargement.

[Development of medical and biological research in Eastern Siberia]. / Razvitie mediko-biologicheskikh issledovanii v Vostochnoi Sibiri.

The impact of the North conditions on the human body has been studied. There are high morbidity and mortality rates, abnormal pregnancy, premature and abnormal labors, and congenital malformations in the newborn. A complex of medical and prophylactic measures has been worked out to protect human health as a result of the studies of the regularities of general and occupational diseases at some enterprises in the Far North, Yakutia, and Buryatia.

[Changes in blood lipid content with aging and genetic studies of ischemic heart disease]. / Vozrastnye izmeneniia soderzhaniia lipidov v krovi i geneticheskie issledovaniia ishemicheskoi bolezni serdtsa

Results are presented on the study of lipid metabolism in normal individuals of different are groups with reference to the hereditary taintness as to ischaelic heart disease, and the results of correlation analysis of the level of some lipid indices of the blood of patients with ischaemic heart disease and of their relatives. In young normal individuals, whose family history is hereditary teinted with ischaemic heart disease, the level of total lipids, cholesterol, cholesterol of beta-lipoproteids, beta-lipoproteids and non-estherified fatty acids was statistically significantly higher than in the control group. In the older age groups, however, this difference becomes insignificant. The blood level of cholesterol and beta-lipoproteids is determined by genetic factors to a higher degree than the level of total lipids. The introduction of a correction factor into the correlation analysis of the above biochemical parameters indicates the changes developing with age in the proportional role of the environmental and genetic factors in the lipid metabolism disorders, the importance of the environmental factors progressively growing.

[Clinical course and necrotic area size in patients with myocardial infarct receiving combined treatment including antioxidants and membrane-protecting agents]. / Klinicheskoe techenie i velichina zony nekroza u bol'nykh infarktom miokarda pod vliianiem kompleksnogo lecheniia s vkliucheniem antioksidantov i membranoprotektorov.

The efficacy of a combination of an antioxidant (alpha-tocopherol) and membrane-protective agents (nicotinamide, a lipase inhibitor and delagil, a phospholipase inhibitor) was evaluated in 25 patients with myocardial infarction in the acute period. The drugs were given no later than 8 hours of the onset of the disease within the first 10 days. Along with necrotic area limitation (by 20.2%) and neurotic myocardium was mass decrease by (34.9%), alpha-tocopherol in combination with nicotinamide and delagil was found to lower the frequency and severity of fatal complications, but fail to affect the incidence of relapses of postinfarction angina.

[Method of quantitative evaluation of the reactivity of the microvessels to vasoactive substances in patients with hypertensive disease]. / Metod kolichestvennoi otsenki reaktivnosti mikrososudov po otnosheniiu k vazoaktivnym veshchestvam u bol'nykh gipertonicheskoi bolezn'iu

A method developed by the authors is described that consists in a quantitative test for the evaluation of the reactivity of the microvessels judging by the degree of changes in the resorption speed of isotopes from a tissue depot. In patients with essential hypertension an increased vascular reactivity was revealed with reference to angiotensin, noradrenalin and serotonin, as well as an increased duration of the effect of angiotensin. The highest vascular reactivity was noted in patients with stage II hypertension who have retained a hyperkinetic type of circulation.

[Effect of membrane protectors on the diastolic function of the heart in patients with acute myocardial infarction]. / Vliianie membranoprotektorov na diastolicheskuiu funktsiiu serdtsa u bo'lnykh ostrym infarktom miokarda.

Apexcardiography was employed to make a noninvasive assessment of left ventricular diastolic function in 80 patients with extensive myocardial infarction. In half the patients, there were impairments in cardiac diastole as manifested by its altered phase structure and some changed parameters indirectly indicating a rise in left ventricular end diastolic pressure and a fall in myocardial relation rates and diastolic compliance. Prior 10-day administration of tocopherol and nicotinamide to 45 patients caused a decrease in the severity of diastolic abnormalities in those in whom the latter had been abnormal. The use of membrane protectors resulted in lower incidence of complications and improved outcome of the disease.

[Physical work capacity among the early manifestations of cerebral atherosclerosis]. / Fizicheskaia rabotosposobnost' pri rannikh proiavleniiakh tserebral'nogo ateroskleroza.

A bicycle ergometric study of 54 males, aged 40-59 years, suffering from atherosclerotic dyscirculatory encephalopathy of Stage I-II and of 57 age-matched healthy males showed a considerable decrease in exercise tolerance of the patients. The fall in their capacity for physical work was attended by an inadequate hemodynamic response toward exercise in the form of a faster increase of the heart rate and a greater elevation of the arterial pressure. It is pointed out that level of exercise and the nature in which it is ensured hemodynamically may serve as additional criteria in assessing the functional potentialities of the cardiovascular system in early manifestations of cerebral atherosclerosis.

[Physical exertion tolerance and the characteristics of hemodynamics in healthy persons depending on its type]. / Tolerantnost' k fizicheskoi nagruzke i osobennosti ee gemodinamicheskogo obespecheniia u zdorovykh liudei v zavisimosti ot tipa gemodinamiki.

Central hemodynamic parameters were studied in 113 normal male subjects, aged 20-59, at rest and during bicycle ergometric exercise, with the help of tetrapolar chest rheography. Capacity for physical exercise was shown to depend on both the age and the basic hemodynamic type. Subjects with hyperkinetic circulation had the greatest, and those with hypokinetic circulation, the smallest capacity for exercise. The evaluation of BP and heart rate patterns, stroke and cardiac indices, and the indicator of heart performance during bicycle ergometry suggested that cardiovascular operation was more economical in normal subjects with eukinetic or hyperkinetic circulation, hence their greater capacity for physical exercise.

[Vascular reactivity and catecholamine excretion in hypertension]. / Sosudistaia reaktivnost' i ékskretsiia katekholaminov pri gipertonicheskoi bolezni.

Increased vascular reactivity to noradrenaline was revealed in patients with Stages I and II hypertensive disease; the reaction to the sympathomimetic agent of indirect action ephedrine remained at the control level. A salt load increased the discrepancy between the level of the reactions to these two agents. It is suggested that processes of catecholamine storage and excretion in the tissues are disturbed in hypertensive disease and that sodium ions probably take part in this process. The daily excretion of noradrenaline was in negative relation with the reactivity to noradrenaline and correlated positively with the reactivity to angiotensin.

[Plasma aldosterone concentration and vascular reactivity in hypertension]. / Kontsentratsiia al'dosterona v plazme perifericheskoi krovi i sosudistaia reaktivnost' pri gipertonicheskoi bole zni.

Aldosterone concentration in peripheral plasma (radioimmune assay) and vascular reactivity (by an original tracer method) were determined in 50 patients with essential hypertension of stages I and II and in 25 healthy males. Aldosterone concentration proved to be elevated in half the patients, mostly in those with stage II of the disease. Vascular reactivity in these patients was increased and the two parameters were in good correlation. In the other group the aldosterone level and vascular reactivity were normal and there was no correlation between these two parameters. It is concluded that in some patients with essential hypertension aldosterone plays a pathogenetic role by increasing vascular reactivity.

[Status of cerebral hemodynamics during measured physical loading in healthy subjects and patients with cerebral atherosclerosis]. / Sostoianie tserebral'noi gemodinamiki v usloviiakh dozirovannoi fizicheskoi nagruzki u zdorovykh i u bol'nykh tserebral'nym aterosklerozom.

The authors analyzed the results of the rheoencephalographic examination of the cerebral hemodynamics under graded exercise (GE) in 42 normal subjects and 60 patients with cerebral atherosclerosis. All individuals were males aged 40-59 years. It was shown that an increase in the blood content of the brain in the process of GE in the patients with cerebral atherosclerosis was significantly lower than in the normal subjects. With a greater volume of the work done the difference became more pronounced. According to the nature of the response to GE the cerebral hemodynamics in the patients was divided into compensated, subcompensated and decompensated types.

[Physical exertion tolerance in patients with ischemic heart disease associated with cerebral arteriosclerosis]. / Tolerantnost' k fizicheskoi nagruzke u bol'nykh ishemicheskoi bolezn'iu serdtsa s soputstvuiushchim tserebral'nym aterosklerozom.

The authors provide the results of a comparative study of exercise tolerance (bicycle ergometry test) in 64 patients with coronary heart disease (CHD) and in 68 patients with associated CHD and cerebral atherosclerosis. During the latter syndrome the working capacity was lowered as a result of less economical work of the circulatory apparatus. In particular, physical loading in such patients was accompanied by marked increment of the heart rate and blood pressure elevation. Increased heart oxygen requirement in the second group patients during exercise was accompanied by more frequent ischemic alterations in the myocardium attended by ST segment depression on the ECG. It is concluded that concomitant cerebral atherosclerosis aggravates the basic pathogenetic mechanisms of CHD, namely the disagreement between myocardium oxygen requirement and supply.

[The clinical significance of leukocyte chemiluminescence in myocardial infarct]. / Klinicheskoe znachenie khemiliuminestsentsii leikotsitov pri infarkte miokarda.

A study was made of the luminol-dependent leukocyte chemiluminescence (LCL) of the whole blood in 45 patients with acute myocardial infarction (AMI). It has been shown that measurement of LCL during the first examination of the patient may play a significant part in the diagnosis of AMI. LCL monitoring is of independent importance for the control of resorption and reparative processes and for the diagnosis of the lingering course and threatened relapse of AMI. The authors provide evidence for the concept of the trigger inclusion of the leukocytic component into the chain of pathophysiological processes in AMI at hours 5-10 since its onset. Derangement of that mechanism may be one of the causes of the lingering and recurrent course of infarction. The treatment of AMI should be carried out with regard to the effect of therapeutic modalities on leukocyte function as well as to the phase of the pathophysiological process.

[Effect of long-term epidural analgesia and nitroglycerin infusion on formation of necrosis zone and clinical course of myocardial infarction]. / Vliianie dlitel'noi épidural'noi anal'gezii i infuzii nitroglitserina na formirovanie zony nekroza i klinicheskoe techenie infrakta miokarda.

AIM: To study effects of long-term morphine-clofelin epidural analgesia and infusion of nitroglycerin on formation of the necrosis focus and the clinical course of acute myocardial infarction (MI). MATERIAL AND METHODS: Ninety patients were examined within the first 12 hours of anterior macrofocal MI. Forty six patients of the study group received long-term morphine-clofelin epidural analgesia and nitroglycerine infusion within the first 24 hours of the disease. Forty-four control patients were anesthetized conventionally with intravenous morphine. Development of MI was assessed with electrocardiotopography and dynamic examination of MV CK in the blood serum. RESULTS: The degree and area of the myocardial lesion were initially similar in the study and control groups. These indices were less in dynamics in the study group. On MI day 5 and 10 myocardial necrosis zone significantly diminished in the study group. CONCLUSION: Long-term epidural analgesia and nitroglycerin infusion provide effective analgesia, localizes the ischemic and necrotic focus, have a good effect on hemodynamics and improve a MI clinical course.

[The detection of early disorders of the heart pumping function in patients with ischemic heart disease by using stress Doppler echocardiography]. / Vyiavlenie rannikh narushenii nasosnoi funktsii serdtsa u bol'nykh ishemicheskoi bolezn'iu serdtsa s pomoshch'iu nagruzochnoi dopplerékhokardiografii.

AIM: To determine potential of loading Doppler echocardiography (DECG) in detection early, subclinical dysfunction of left ventricular pump capacity in patients with ischemic heart disease. MATERIALS AND METHODS: Systolic and diastolic functions of the left ventricle (LV) before and during transesophageal electrocardiostimulation (TEECS) were assessed in 65 patients (55 males and 10 females, mean age 47 +/- 1.3 years) with effort angina functional class I, II and III and 25 control patients. RESULTS: Initial LV systolic function did not differ from control values. In the course of TEECS, LV systolic function declined in accordance with severity of angina and stimulation frequency. Initial LV diastolic function was reduced only in patients with angina class II and III. These changes were more pronounced in the course of TEECS. CONCLUSION: Stress Doppler echocardiography is a reliable tool in detection of early, preclinical impairment of cardiac pump function in patients with ischemic heart disease.

[The effect of prolonged morphine epidural analgesia on the clinical course and size of the necrotic area in patients with an acute myocardial infarct]. / Vliianie prolongirovannoi morfinnoi épidural'noi anal'gezii na klinicheskoe techenie i velichinu zony nekroza u bol'nykh ostrym infarktom miokarda.

The effect of conventional and prolonged epidural analgesia (PEA) with morphine on the clinical course and the size of the focus of necrosis was studied and compared in 60 patients with acute myocardial infarction. In the basic group (n = 30), analgesia was carried out for 7 days with the aid of PEA. In the control group (n = 30), analgesia was performed by intravenous injection of morphine. In both the groups, the clinical course ant the size of the focus of myocardial necrosis were estimated (precordial cartography and detection of creatine phosphokinase made in series). PEA was established to bring about complete analgesia rapidly and safely, which in turn favours noticeable limitation of the focus of necrosis and amelioration of the clinical course of acute myocardial infarction. The effect produced by PEA was considerably higher in all the parameters as compared to that attained with conventional analgesia.

[Arterial hypertension in patients with undifferentiated adrenal tumors]. / Arterial'naia gipertoniia u bol'nykh s nedifferentsiruemymi opukholiami nadpochechnikov.

AIM: To study clinical and laboratory manifestations of hormonal activity in hypertensive patients with undifferentiated adrenal tumors. MATERIAL AND METHODS: 40 patients (19 males and 21 females aged 16-60 years) with undifferentiated adrenal tumors were examined. They were treated surgically. The results of the examination were compared with histological evidence on the resected adrenals. Clinical and laboratory signs of hormonal activity of the tumor were ascertained. RESULTS: Clinical symptoms in patients with adrenal tumors differed from those of typical symptoms of Icenko-Cushing, Cohn syndromes, pheochromocytoma. Hypertension in patients with cortical tumor may arise because of high synthesis of hydrocortisone, in patients with medullary tumor--of catecholamines. However, the level of hormones was not high enough for development of classic syndromes. That's why these tumors were named undifferentiated. CONCLUSION: Adrenal cortical tumors have signs of mixed androgeno-mineral-glucocorticoid activity. In medullary adrenal tumors hypersecretion of catecholamines is associated with cortical hyperfunction.

[Clinical course of acute myocardial infarction and left ventricular function in long-term epidural analgesia]. / Klinicheskoe techenie ostrogo infarkta miokarda i funktsiia levogo zheludochka v usloviiakh dlitel'noi épidural'noi anal'gezii.

The study of 76 patients with macrofocal myocardial infarction (MI) evaluated effects of epidural and standard analgesia on pumping capacity of the left ventricle (LV) and clinical course of MI. The study group consisted of 37 patients exposed to long-term morphine-clopheline epidural analgesia. In the control 39 patients analgesia was induced conventionally (intravenous injection of morphine). Both groups received the same routine treatment. Long-term morphine-clopheline epidural analgesia noticeably improves pumping LV function and clinical course of MI.