[Prinzmetal angina. Questions of pathogenesis, clinic, diagnosis and treatment].

Current problems of Prinzmetal angina (vasospastic angina, variant angina) considers in this review. Attention is drawn to early diagnosis, which should be comprehensive, taking into account possible atypical courses and the development of complications. The important role of electrocardiographic monitoring (including using implantable recorders) is highlighted. It is emphasized that patients with cardiac arrhythmias, syncope are at high risk of developing sudden cardiac death. In this category of patients, it is recommended to timely determine the indications for implantation of a cardioverter - defibrillator. Authors consider the prospects of using new methods of treatment of angina pectoris.

[Innovative methods-of treatment of cardiac patients in amultidisciplinary hospital].

The article is a report on the conference "Innovative methods of treatment of cardiac patients in a multi-hospital", which took place at the 3rd Central Military Clinical Hospital n.a. A.A. Vishnevskiy and dedicated to the 40th anniversary of the cardiology hospital center. The reports covered achievements, the latest developments introduced into the practice of medical and diagnostic work of the hospital and its affiliates with patients of cardiovascular profile. The advantages of a multidisciplinary hospital in the provision of specialized high-tech medical care difficult, multimorbid patients are showed. To report the possibility of co-temporal methods of effective treatment of a variety of cardiovascular morbidity in military personnel.

[A case of adenovirus infection complicated by gram-negative polymicrobial sepsis: A clinical and morphological observation].

Among respiratory infections, adenovirus infection (ADVI), in the presence of which there may be severe pneumonia that frequently results in a fatal outcome, occupies particular attention. ADVI in patients without immunodeficiency is usually mild and shows a limited extent of injury. At the same time the disease in immunocompromised individuals may be severe, presenting with viremia, evolving sepsis, and high death rates. The paper gives a characteristic example of severe ADVI and its fatal outcome.

[Myocardial infarction in young population].

Description of clinical observation and literature review. Myocardial infarction in patients younger than 45 years is rare, but it is an important clinical, organizational and psychological problem. A case of myocardial infarction in 19-years old patient, who suffered since 6 years from kidney disease, is described. Transmural left-ventricular myocardial infarction has developed on the background of chronic glomerulonephritis, excessive exercise, and traditional risk factors for cardiovascular disease. Coronary venous bypass with the benefit-pleasing outcome is performed. When analysing the literature, the authors emphasize that in comparison with elderly patients, young people have different profiles of risk factors, clinical manfestations and prognosis of myocardial infarction. It is emphasized that kidney chronic disease, regardless the stage, worsen short-term and long-term outcomes of cardiovascular disease. Early stabilization is possible under the condition of risk stratification and-early revascularization, which leads to better clinical outcomes. Particular attention should be given to a comprehensive assessment, it prognostic criteria, risk factor modification, secondary prevention of major and associated diseases, clinical- and -dynamic observation, including patients with asymptomatic course of the disease.

[Bilateral massive pulmonary embolism: clinical observation and literature review].

The description of successful surgical treatment of a patient with bilateral massive pulmonary embolism (with the defeat of the equity and segmental branches), thrombosis of the right atrium and patent foramen ovale is given. The authors emphasize that determining predictors of successful surgical treatment of bilateral pulmonary embolism in a patient with high risk of death are the following: a) operational emergency diagnosis of disease; b) time from the beginning of clinical manifestations till embolectomy (within 1 hour); c) the maximum total removal of blood clots from the pulmonary artery and its branches. Dynamic 12 months observation showed a significant decrease of pulmonary perfusion deficiency, improvement of functional parameters of right heart chambers, absence of thromboembolism relapses.

[C-peptide and its role as a predicator of the cardiovascular complications].

C-peptide is secreted from proinsulin and over the recent decade is considered as an active peptide that leads to different capillary actions and macrovascular complications in patients with type 2 diabetes mellitus. Results of the recent researches showed the C-peptide uptake in the blood vessel walls, in the juxtaglomerular apparatus of malpighian tuft, induction of local inflammation, proliferative effect on mesangial cell. The given effects showed an atherogenic role of C-peptide. Authors consider C-peptide as a possible predicator of cardiovascular complications and mortality in patients with type 2 diabetes mellitus and without diabetes.

[Modern approaches to the problem of comprehensive training of patients with ischemic heart disease combined with type 2 diabetes mellitus which undergo interventional coronary intervention (literature review)].

On the basis of 42 analyzed sources of literature was performed a study about the problem of comprehensive training of patients with ischemic heart disease combined with type 2 diabetes mellitus which undergo interventional coronary intervention. It was noted that disease management programs for patients with associated pathology and comprehensive training of patients with ischemic heart disease combined with type 2 diabetes mellitus, which undergo interventional coronary intervention, are not developed. Therefore, in recent decades there emerged a need for comprehensive training of patients with associated pathology development of relevant structured programs of training, estimation of near and late results of training.

[Melatonin in the system of neurohormonal regulation in man. Part 1].

Part I of this systematic review is devoted to the history of melatonin (MT) studies, mechanisms of MT action, and its clinical importance as a universal modulator of physiological functions applicable to the treatment of numerous disorders, in the first place respiratory diseases. MT participates in regulation of arterial pressure and myocardial contractility, it increases antioxidative potential, plays an important role in regulation of circadian rhythms, sleep and adaptation to jet lag. Antioxidative, antitumorigenic, immunomodulatory, antidepressive, anti-anxiety, and hypnogenic activities of exogenous MT coupled to the absence of toxicity make it an attractive agent for the treatment of many human diseases especially in old age.

[Melatonin: its role in the system of neurohumoral regulation in man. Part 2].

Part 2 of this review concerns the application of melatonin (Mt) to the treatment of aged patients with cardiovascular diseases and other pathology with reference to its genoprotective and anticarcinogenic action. Effects of Mt on the cardiovascular system are underlain by its antioxidative, vasodilating, and sedative activities, the ability to regulate the heart rate and inhibit platelet aggregation. Certain authors report negative correlation between Mt production and blood cholesterol level. Mt was shown to protect from cardiac lesions associated with ischemia and reperfusion. Mt inhibits carcinogenesis and is active at systemic, tissue, cellular and subcellular levels. At the systemic level, Mt decreases hormonal production, stimulates immune activity, and prevents the development of metabolic syndrome. It inhibits cell proliferation and promotes apoptosis of tumour cells but suppresses it the nervous tissue. Mt activates telomerase. It decreases expression of oncogens and interferes with the action of mutagens and clastogens at the genetic level. Extensive studies of Mt protective action in nervous diseases are underway with special reference to spinal cord, brain, neuron and glial cell lesions; experimental cerebral stroke, Parkinson's and Alzheimer's diseases. Similar studies concern the role of Mt in the protection against ionizing radiation, the development of renal pathology, and ophthalmology (glaucoma, cataract). Mt is shown to influence practically all organ systems by inhibiting mutagenesis and maintaining correlation between circadian rhythms of different biological processes throughout human evolution.

[Alternative medicine. Past, present, and future. Part 3].

Part 1 was devoted to general problems of alternative and auxiliary medicine; also, it contained information on evidence-based nutrition practice for patients with cardiovascular diseases. Part 2 highlighted the use of food products, bioactive supplements, micronutrients, and phytotherapy for prevention of cardiovascular diseases. Part 3 is focused on the analysis of certain non-medicamentous methods of alternative medicine and their clinical applications.

[Alternative medicine. Past, present, future. Part 2].

Part 2 highlights the use of food products, bioactive additives, micronutrients, and phytotherapyforprevention of diseases. Many studies demonstrated positive effect of omega-3 PUFA, stanols, sterols, and esterified pargarines, soluble cellulose, controlled alcohol consumption, tea, Mg-enriched dietetic factors, folic acid combined with vitamins B6 and B12 on subjects with the initially enhanced homocysteine level. Garlic is known to reduce blood lipids, hawthorn may be useful at early stages of cardiac insufficiency, ginkgo biloba in arterial and cerebral disorders, horse chestnut for the treatment of peripheral vascular pathology. Results of controlled studies indicate that the use of many foods for prevention of different diseases is currently based on recommendations of individual doctors and needs to be substantiated by evidence-based practice. Physicians treating and educating patients must be well aware of alternative and supplemental therapeutic modalities with the use of foodstuffs, bioactive additives, micronutrients, and phytotherapy.

[Alternative and complementary medicine. Past, present, future. Part 1].

Part 1 highlights general problems of alternative and auxiliary medical treatment and presents the evidence base of dietetic nutrition of patients with cardiovascular diseases. Many studies demonstrated effect of dietetic factors on arterial pressure (AP). It drops with a decrease in body weight due to rational nutrition, reduced salt and alcohol consumption, elevated intake of potassium, and compliance with DASH regimen. Effect of other factors influencing AP is either dual, less significant or inexplicable. Reduction of the burden of cardiovascular diseases requires the development of new strategies including dietary treatment.

[Clinicopathogenetic features of coronary heart disease combined with chronic obstructive pulmonary diseases and efficiency of therapy with trimetazidin].

Based on retrospective analysis of 2446 in-patient cards, autopsy protocols, outpatient medical documentation, prevalence and features of clinical manifestation of cardiorespiratory pathology (CRP): coronary heart disease (CHD) combined with chronic obstructive pulmonary disease (COPD)--1 stage of study, and also (after randomization and forming of main and control groups), efficiency of myocardial cytoprotector trimetazidin (TMZ) at its long-term use (1 year) in combined therapy (2 stage of study): 135 CHD patients (stable exertional angina functional class II-III: 92 and 43 persons respectively) with COPD of medium severe (111 persons) and severe course (24 persons), were studied. It is shown that CRP is prevailed in elder age groups (after 45 years) and noticed in 56.7% CHD patients. More sevenre course with great risk of myocardial infarction with Q wave (twice, p < 0.001), prolongation of painless ischemia (62.4+/-11.5 min/day vs. 22.8+/-11.1 min/day), inclination to complicated rhythm disturbances (38 vs. 21.9, p < 0.05) and earlier clinical manifestations of heart failure (4.3+/-0.6 years earlier, p < 0.001) is typical for CHD with COPD vs. patients without pulmonary pathology. In one year after beginning of treatment with TMZ (35 mg) number of weekly pain attacks was decreased in patients of 1st group vs. 2nd group (at the average -50.8% -29.3% vs. +12.5% +16.6% respectively); significant (p < 0.05) decrease in duration of painless myocardial ischemia was registered. Decrease in number of supraventricular and ventricular extrasystoles (42.7+/-1.48 vs. 20.5+/-1.07 cases in a day, a < 0.0001), significant (p < 0.05) increase in ejection fraction and decrease in left ventricle end-diastolic volume (12.2+/-0.4% E 12.2+/-0.3% respectively), in dimensions of left (10.9+/-0.03%) and right (8.8+/-0.9%) atrium, in risk of development of acute coronary syndrome were noticed in the patients of main group received TMZ. Thus, long-term (not less then 1 year) use of TMZ (35 mg) in combined treatment assists to normalization of cardiovascular indices, decreases cardiovascular complication occurrence, improves disease prognosis and do not has negative side-effects.

[Management of medical aid quality and results of activities of an outpatient clinic].

Results of medical aid provided to 3743 patients aged 30-75 (mean 63.8 +/- 13.4) years during 2005-2007 were analysed to evaluate efficiency of the medical care management system (MCMS) in a large outpatient clinic. Criteria of efficiency were the clinical course and outcome of certain diseases. Major medico-statistical indicators of the quality of medical aid were parameters of hospitalization, inadequate care, discrepancy of diagnoses, etc. Materials for the assessment of MCMS were borrowed from the questionnaires filled up unanimously by health care professionals and patients as requested by a specially developed guideline after their informed consent was obtained.

[Erythropoietin in clinical practice].

In numerous studies, erythropoietin (EP) has been shown to be a "universal" protective tissue cytokine, and EP receptors have been shown to exist in a lot of tissues. The pleiotropic effects of EP (the anti-inflammatory effect, angiogenesis, anti-apoptosis etc.) make clinical application of EP (especially recombinant EP, REP, and EP analogs without erythropoietic activity) promising in different diseases. Possibilities provided by REP application in neurology, cardiology, hematology, oncology, and other clinical areas are being studied intensively. Clinical studies of EP are now solitary, and they should be continued; new EP analogs with specified qualities and selective mechanisms of action should be developed. This review discusses the modern state of EP investigation and possibilities provided by its clinical application.

[Phosphodiesterase inhibitors in clinical practice. The present and the future. Part I].

Type 5 phosphodiesterase inhibitors (5-PDEI), which have been applied as the basic medication for erectile dysfunction, are now being studied in various areas of clinical medicine (pulmonology, cardiology, gastroenterology, gynecology etc.) This systematic literature review is dedicated to 5-PDEI, the state of the problem, the prospects of clinical application of sildenafil, and is based upon 450 literature sources from MEDLINE database (from 1954 to June 2006) and the Cochrane Collaboration database (from 1977 to March 2005) found by key words sildenafil, phosphodiesterase, and 5-PDEI. The issues of physiology and pathophysiology of 5-PDEI, the historical background of their creation, the appropriateness and efficacy of sildenafil in pulmonary arterial hypertension are considered in Part I of the review.

[Multifactor stress-echocardiography in the diagnostics of coronary artery disease at the pre-hospital stage].

The aim of the study was to assess tolerance to and the appropriateness of multi-factor stress-echoCG for the diagnostics of initial stages of coronary artery disease (CAD) in out-patient practice. The subjects of the study were 25 men aged 32 to 51 (mean age 43.2 +/- 4.9 years). Of these patients, 10 men with heartache were suspected to have CAD, and 15 suffered from stage II essential hypertension (EH). In five patients (including four with stage II EH) chest pain which was untypical for stenocardia, was observed, and in five other patients rare attacks of class lexertional stenocardia took place. All the patients underwent stress-echoCG with a combination of two stress agents: transesophageal left ventricular cardiostimulation (TEES) and dipiridamol test (DP). Stress echoCG was positive in eight (32%) of the patients including seven subjects with stenoses of less than 50% of anterior interventricular artery (AIVA) diameter and one patient with stenoses of 50 to 70% of AIVA diameter. Of these patients, 20% (n = 5) had stage II EH. There were no complications or undesirable reactions. The method of multifactor stress-echoCG allowed for the early diagnosis of CAD in 32% of patients, in whom conventional functional diagnostic techniques were of little informative value, including the 20% of patients with stage II EH. Thus, multifactor stress-echoCG (DP+ TEES) is an approachable, informative, and safe method of early CAD diagnostics, which may be recommended for wide application in outpatient departments for a rational selection of patients for further CG and planning therapeutic tactics in CAD patients.

[Clinical significance of echocardiographic techniques of right heart examination].

Study of the role and function of the right heart and the peculiarities of their remodeling in a range of diseases (heart valvular diseases, pulmonary thromboembolism and its complications, cardiomyopathy, combined cardiorespiratory pathology, heart failure, essential hypertension etc.) is of great scientific and practical interest. An optimal right ventricular (RV) examination should be precise, reflect its function objectively, be feasible in everyday clinical practice, and provide accurate prognosis. The last decade has been marked by search for possibilities to evaluate the systolic and diastolic R Vfunction, especially after clinical introduction of Doppler EchoCG. However, publications dedicated to the protocol of EchoCG study of the RV, the normal values of its structure and function, and their clinical interpretation are still rare. The authors of the present work analyze studies on the investigation of the R V and offer a protocol with a method of calculation of EchoCG parameters and their reference values concerning the right heart.

[Clinical and cost-effect results of the activity of the outpatient "Hypertensive Patient School"].

AIM: To analyse clinical and cost efficacy of 6-year (1999-2005) activity of the outpatient "Hypertensive Patient School" (HPS) at the consultative and diagnostic center N 52 of the RF Ministry of Defense. MATERIAL AND METHODS: A total of 232 hypertensive patients followed up for 2 years were divided into two groups: 120 patients of group 1 participated in the education antihypertensive program at HPS and received combined therapy according to chrono = pharmacology; 112 patients did not attend the HPS and were treated conventionally. RESULTS: The lectures at HPS raised awareness of the patients about their disease and its risk factors from 45.8 to 100% (p < 0.05), compliance from 71.7 to 99.2% (p < 0.001), treatment adequacy from 15.8 to 88.3% (p < 0.01), improved quality of life from 13.3 to 95.0% (p < 0.001), finally resulting in reduction of hypertensive crises and hospitalizations from 32.5 to 2.5% (p < 0.01), side effects frequency from 30.8 to 3.3% (p < 0.05). The cost of outpatient management of one patient fell by 3661.0 roubles. CONCLUSION: Learning at HPS prevents complications of essential hypertension, promotes adequate control over systolic and diastolic pressure, improves quality of life, raises cost efficacy of the disease therapy.

[Outpatient self-monitoring of arterial pressure]. / Samostoiatel'noe monitorirovanie arterial'nogo davleniia v ambulatornykh usloviiakh.

Approaches to home self-monitoring of arterial pressure (AP) are reviewed. Such monitoring is cost effective, facilitates adjustment of antihypertensive treatment, assessment of the response. The perspectives of AP self-monitoring lie in learning at "schools for hypertensive patients" that promotes control of hypertension using regular adequate treatment; in design of standards for such monitoring, in perfection of its techniques; in application of monitoring results in cardiovascular research.