Impairment of gaze fixation and holding in patients with neurocirculatory asthenia syndrome and associated vestibular dysfunction.

The study was performed with a hardware-software complex for the monitoring of human motor functions. Saccadic eye movements and vestibulo-oculomotor interactions were studied in patients with neurocirculatory asthenia and associated vertigo. No changes in saccadic eye movements were found in these patients. Abnormalities of cervico-vestibulo-oculomotor interactions were manifested in the impairment of gaze fixation and holding.

Depression and chronic fatigue in the patient with heart disease.

Depression and chronic fatigue are frequently associated with heart disease. They may precede the onset of myocardial infarction, singly or together, and increase the morbidity and mortality of patients with a history of MI. Virtually all such patients have a transient depression, usually accompanied by anxiety, with onset soon after hospitalization. Although this depression is transient and usually abates spontaneously, it frequently warrants therapeutic intervention. Psychosocial and personality factors play a significant role in the recovery of a patient with a cardiac condition. The clinician must be alert for the effects of changing roles within the family and behaviors that may lead to chronic invalidism. Anxiety disorders, often combined with depression, may mimic cardiac disease and may result from it, leading to chronic fatigue and weakness. Proper diagnosis usually leads to considerable improvement. Cardiac drugs, in addition to many others, may produce depression and fatigue that may be misdiagnosed. Often, discontinuing or changing a medication will lead to marked diminution of such symptoms. Observational and listening skills are key ingredients of the "art" of medicine; they can lead to interventions that are not only therapeutic, but which improve the "quality" of life.

[Circadian variability of cardiac arrhythmias in patients with cardiovascular diseases]. / Sutochnaia dinamika aritmii u bol'nykh s zabolevaniiami serdechno-sosudistoi sistemy.

A total of 1063 results of Holter monitoring in patients with cardiovascular diseases were analyzed. There were regularities in the circadian rhythm of arrhythmias with their decreased values at night and increased ones in the daytime, and peak in the morning. The profile of rhythm depends on the pattern of arrhythmia and cardiac disease. The main oscillators are as follows: sleep-awakening, activity-rest patterns, circadian variations in the sympathetic tone, severity of disease, diurnal variations in myocardial oxygen demand, blood pressure, cardiosclerosis. Conduction disturbances were increased during sleep and early in the morning. Thus, the main unfavourable period in arrhythmia disturbances are early morning, pre- and postawakening periods.

[Clinico-physiological and biochemical aspects of artificial stable functional connections in the human brain]. / Kliniko-fiziologicheskie i biokhimicheskie aspekty artifitsial'nykh stabil'nykh funktsional'nykh sviazei mozga cheloveka.

The paper presents the results of clinico-physiological and biochemical studies of artificial functional connections (ASFC-1) of the human brain, formed in parkinsonians in the process of treatment by means of implanted electrodes. Medical activation of ASFC-1 is shown to have an optimizing influence on the mechanisms of intracentral regulation and connected with the latter other brain systems, such influence being reflected in the dynamics of clinical effects and vegetative-humoral activities. It is shown that ASFC-1 may be used for treatment and diagnostic aims in patients with prolonged diseases of the nervous system.

[Sinus extrasystole]. / Sinusovaia ekstrasistoliia

A rare clinical case is described pertaining to a 70-year-old female patient with atherosclerotic cardiosclerosis accompanied by a combination of sinus and ventricular extrasystole. The importance of rhythmography and the criterion of allorhythmia is emphasized as being he indices that help to improve the diagnosis of sinus extrasystole.

[Blood lipid levels in patients with neurocirculatory asthenia of the cardiac type]. / Soderzhanie lipidov krovi u bo'lnykh neirotsirkuliatornoi distoniei kardia'lnogo tipa.

A larger proportion of patients with neurocirculatory dystonia of the cardiac type was found to show atherogenic disturbances of lipid metabolism, the most changes being observed in subjects with the moderate and severe cardiac pain symptom, decreased exercise tolerance, mental disorders and being associated with the traits of a personality. Hypercholesterolemia and hypertriglyceridemia were present in about half of the patients. As for blood lipids, free fatty acids showed higher concentrations to the greatest extent.

[Autonomic disorders in the clinical picture of pathogenetic variants of sclerocystic ovaries]. / Vegetativnye narusheniia v klinike patogeneticheskikh variantov sklerokistoza iaichnikov.

On the basis of examination of the vegetative nervous system in 177 patients with sclerocystic ovaries (SCO) the authors conclude that the clinical picture of the disease is constantly characterized by a clear-cut extragenital symptomocomplex of vegeto-vascular dystonia (a psychovegetative syndrome). The severity and time of its development impart a certain peculiarity to every pathogenetic variant of SCO which may be used for the diagnosis of clinical forms of the disease. SCO are characterized in neuro-psychosomatic terms. It is recommended that psycho- and vegeto-trophic drugs be included into the therapeutic complex.

[Thermography in healthy subjects and in the syndrome of vegetative-vascular dystonia]. / Termografiia v norme i pri sindrome vegetativno-sosudistoi distonii.

The effectiveness and information content of thermography were studied in 20 normal subjects and 40 patients with vegetative vascular dystonia. There were some individuals in the control group who had "thermal amputation" and who also had some specific features of psychovegetative nature. Patients with vegetative vascular dystonia, apart from the syndrome of "thermoamputation" observed in a great number of cases, particularly in neurotic patients, had other types of skin temperature distribution as well. Thus, patients with hypothalamic insufficiency presented with hyperthermia of the distal portions of the extremities and asymmetry.

[Factor analysis of the coagulative-rheological properties of blood and plasma and cerebral and general hemodynamics in patients with the initial forms of cerebrovascular insufficiency]. / Faktornyi analiz koaguliatsionno-reologicheskikh svoistv krovi i plazmy, tserebral'noi i obshchei gemodinamiki u bol'nykh s nachal'nymi formami nedostatochnosti krovosnabzheniia mozga.

Coagulation and rheological, cerebrovascular and total hemodynamic factors were studied and compared in patients with the initial manifestations of brain blood supply insufficiency (IMBBSI) associated with vegetovascular dystonia, essential hypertension and atherosclerosis by means of factor analysis. Interrelations between the parameters under study appeared multiple in nature, possessing a high capacity for differentiation between those conditions. As IMBBSI progressed, namely from vegetovascular dystonia to the hypertonic and atherosclerotic disease forms, there was a rise in the rate of the prognostically unfavourable ++inter-systemic relations between hemostasis and hemodynamics attesting to a certain risk of cerebral ischemias.

[Mechanisms of the development of autonomic regulation disorders in neurogenic syncope in childhood]. / Mekhanizmy formirovaniia vegetativnoi dizreguliatsii pri neirogennykhobmorokakh v detskom vozraste.

Based on a clinico-anamnestic analysis and comparison of the data of comprehensive studies of vegetative nervous system functions it was discovered that in 85 children aged 4 to 14 years suffering from neurogenous syncopes, vegetovascular maintenance of the processes of activation and adaptation turned out insufficient. It is shown that in early childhood, the formation of vegetative dysregulation occurs under the influence of numerous factors, of which the most significant are hereditary predisposition to paroxysms, perinatal pathology, and psychogenic effects. It is established that there are two possible variants of the combination of pathophysiological alterations predetermining the clinical picture and phenomenology of neurogenous syncopes in children.

[Arterial hypotension and the initial manifestations of cerebral circulatory failure]. / Arterial'naia gipotoniia i nachal'nye proiavleniia nedostatochnosti mozgovogo krovoobrashcheniia.

A study was made of the health status of 20 persons examined for the first time 10 years before for a long-term and steady decrease of arterial pressure classified at that period as vegetodystonia of the neurotic character. 71 healthy test subjects served as a reference group. In addition to the clinical examination, a specialized questionnaire was used to examine the status of the vegetative nervous system; the actual mental status and personality traits were investigated by the MIL test modified by F. B. Berezin and M. P. Miroshnikov; the level of reactive and personality anxiousness were estimated with the aid of Spilberger's scale; the life events and changes were assessed as well. It has been revealed that vegetodystonia recorded in the disease history produces no effect on the frequency and times of the appearance of the initial manifestations of cerebral circulatory failure (IMCCF). At the same time the intensity of vegetative disorders in the structure of the clinical manifestations of the IMCCF was higher in persons, in whose disease histories vegetodystonia was recorded.

[Therapeutic effect of antiaggregants in patients with neurocirculatory asthenia with the initial signs of cerebral ischemia]. / Lechebnyi éffekt antiagregantov u bol'nykh vegetativnososudistoi distoniei s nachal'nymi proiavleniiami nedostatochnosti krovosnabzheniia mozga.

Therapeutic effect of antiaggregation drugs in patients with vasoautomomic dystonia with initial signs of insufficient blood supply to the brain. In 43 patients with vasoautonomic dystonia and initial manifestations fo cerebral circulation insufficiency, the effects of aggregation-inhibiting drugs (dipyrodamol, metindol, stugeron, prodectin) on blood coagulation and rheology, platelet aggregation and general hemodynamics were studied. Antiaggregation drugs were shown to be the tools of choice which could be administered with due account of baseline hemostasis and the type of cerebral hemocirculation, and of their selective action on the carotid and vertebrobasilar cerebral vessels.

[Cardiovascular disorders, autonomic disorders and atherogenic dyslipoproteinemias in young women with the sclerotic ovary syndrome]. / Serdechno-sosudistye rasstroistva, vegetativnye narusheniia i aterogennye dislipoproteidemii u molodykh zhenshchin s sindromom sklerokistoznykh iaichnikov.

The authors studied 158 young women with the syndrome of sclerocystic ovaries (SCO) and 40 healthy subjects. The patients showed a high rate of vegetovascular dystonia, predominantly according to the hyperparasympathicotonic type, cardialgia and dyspnea. In 54.5% of the patients lipid metabolism disturbances of the atherogenic nature were elicited, being most pronounced in the hypothalamic-pituitary form of the disease. It is postulated that in cases of the SCO syndrome, the deficit of estrogens and pregnanediol decreases "immunity" of females to the development of atherogenic dyslipoproteinemias while a relative or absolute hyperandrogenia accounts for the transformation of the "female" type of the lipid spectrum into the "male" type with lower levels of cholesterol of high density lipoproteins (LP) and higher levels of TG, and cholesterol of very low density LP and of low density LP. It is recommended that the SCO syndrome should be included into the risk factors for atherosclerosis and coronary heart disease.

[Diagnosis and sanatorium treatment of the initial manifestations of inadequate blood supply to the brain]. / Diagnostika i sanatornoe lechenie nachal'nykh proiavlenii nedostatochnosti krovosnabzhaneiia golovnogo mozga.

The authors studied the parameters of the central and cerebral hemodynamics in 66 males aged 38-58 years who were treated at a health resort for initial manifestations of cerebral circulation insufficiency (CCI). A test with graded exercise (GE) revealed in all patients an increase in the total peripheral vascular resistance (TPVR) which was the greatest in cases of initial manifestations of CCI due to borderline arterial hypertension (AH). In the period of recovery and following the nitroglycerin test the TPVR returned to the initial level in patients with AH and vegetovascular dystonia whereas there was no such decrease in patients with initial cerebral atherosclerosis. Already at the 1st minute of the recovery period following GE patients with atherosclerosis (A) and essential hypertension (EH) presented a considerable increase in the arterial tone (AT) which remained stable even after 10 min of rest. These changes in AT indicated a decrease in the adaptational possibilities of the cerebral hemodynamics and simultaneously made it possible to differentiate them from vegetovascular dystonia when AT increased insignificantly only during the first min after GE and then rapidly returned to the initial level and diminished even more during the nitroglycerin test. The proposed method of comprehensive examination of parameters of the central and cerebral hemodynamics when combined with neuropsychological findings makes it possible not only to improve the diagnosis of diseases responsible for initial manifestations of CCI but also to considerably increase the objectivity of the assessment of the sanatorium treatment.

[The anti-arrhythmic efficacy of sodium valproate]. / Antiaritmicheskaia éffektivnost' natriia val'proata.

The antiarrhythmic efficacy of the anticonvulsant sodium valproate was studied in 22 patients with ventricular premature contraction in the immediate (10-15 days) and late (2-5 months) periods of therapy. The prolong antiarrhythmic effect of the drug was observed in 66% of the patients in whom it was beneficial in the first days of therapy. The results obtained provide strong evidence for the efficacy of sodium valproate in patients with ventricular premature contraction occurring in the presence of neurocirculatory dystonia.

[First experience in clinical trials of the new domestic drug acediprol used in the treatment of cardiac arrhythmias]. / Pervyi opyt klinicheskogo issledovaniia novogo otechestvennogo preparata atsediprola v lechenii narushenii ritma serdtsa.

The antiarrhythmic effect of sodium valproate (acidoprol) on the degree of arrhythmic manifestations was examined in 18 patients with neurocirculatory dystonia (NCD) and 19 with coronary heart disease (CHD). A 24-hour ECG monitoring and recording were performed on emotional stress and exercise. The antiarrhythmic effect of the agent was evaluated by the blind method and placebo. The course of its therapy was found to reduce the frequency of ventricular premature contractions in 14 patients with NCD and to substantially limit or eliminate the arrhythmogenic effect of emotional stress and exercise. In CHD, the antiarrhythmic effect of acedoprol was less, it being shown only by 6 patients, but the effect failed to occur during exercise. However, the arrhythmogenic effect of emotional stress in CHD was significantly limited. Thus, the GAMA-ergic, stress-limiting system activator acedoprol has antiarrhythmic activity in cardiac patients, but its activity is drastically pronounced in NCD and less marked in CHD.

[Headache in autonomic-vascular dystonia]. / Golovnye boli pri vegeto-sosudistoi distonii.

The clinical variants of headaches were observed in 83 patients with autonomic vascular dystonia. The diagnostic table was designed to differentiate between the latter and migraine. Bulbar conjunctiva and retinal microcirculation studies revealed multiple morphological and hemodynamic changes. These were especially marked during painful paroxysms. The substantial increase in red blood cell aggregation rates was observed within the entire headache exacerbation. The data provide grounds for using adrenergic blockers, antiaggregatory and venotonic drugs in these conditions.

[Premorbid characteristics and nature of the mental disorders in patients with neurocirculatory dystonia and heart rhythm disorders (clinico-psychological research)]. / Premorbidnye osobennosti i kharakter psikhicheskikh narushenii u bol'nykh neirotsirkuliatornoi distoniei s narusheniiami ritma serdtsa (kliniko-psikhologicheskoe issledovanie).

Forty-two patients with different types of functional cardiac arrhythmias were examined. Clinico-psychological examination revealed such general and relatively independent of the personality type features as conservatism, predisposition to anxiety reactions, hypochondriac readiness, symptomatic lability, poor self confidence in relation to interpersonal interrelations, poorly expressed ability to dominate with a tendency toward submission. Neurotic reactions and phases were a predominant feature in accentuated (n = 20) and psychopathic persons (n = 10). Slowly progressive schizophrenia and cyclothymia were diagnosed in 8 and 4 cases respectively. Treatment of functional cardiac arrhythmias with lexotan yielded good response in 50% of cases. In cases when lexotan alone failed to be effective, the use of this drug in combination with antiarrhythmic drugs effected good results in 61.8% of the patients.

[Immune status of patients with chronic bronchitis and neurocirculatory asthenia]. / Osobennosti immunnogo statusa bol'nykh khronicheskim bronkhitom s priznakami sindroma vegetativnoi distonii.

AIM: To study changes in immune system of patients with various forms of chronic bronchitis (CB) and neurocirculatory asthenia (NCA). MATERIAL AND METHODS: Neurological and immunological examinations were made in 84 patients with CB exacerbation and 51 control subjects. RESULTS: It was found that 60% of CB patients had NCA. No negative effects of NCA on immune system in CB patients were registered. Suppression of immune system and secondary immunodeficiency occurred more frequently in CB patients without signs of NCA. 40% of CB patients had vagotonic NCA in which immunological disorders manifested most clearly. CONCLUSION: Vegetative disorders in CB patients do not affect immunological system. Functional testing of autonomic nervous system is suggested for prediction of immune system condition.

[Genesis of the cardiac pain syndrome in patients with neurocirculatory dystonia]. / K genezu serdechno-bolevogo sindroma u bol'nykh neirotsirkuliatornoi distoniei.

Palpation of the chest-covering tissues was performed in 150 patients with neurocirculatory dystonia with complaints of pain in the cardiac region. In all the patients painful muscular consolidations of various size, shape and consistency were detected in the thickness of the pectoral muscles and at the sites of their transition into tendons. Direct correlation between the gravity of cardialgia and expression of the muscular pain syndrome was noted. In 98% of cases therapy aimed at the elimination of the muscular pain syndrome (repeated novocaine-hydrocortisone infiltrations) resulted in the correction or a significant decrease in a degree of cardialgia. The results obtained suggested that the cardiac pain syndrome in patients with neurocirculatory dystonia was mainly caused by local changes in the musculotendinous tissues of the chest.