[Main ways of improvements of the systems of medical rehabilitation of military servicemen after cardiovascular surgery].

For better improvement of medical rehabilitation referred to effective restoration of functional status of servicemen after cardiovascular surgery it is necessary to introduce standards of medical rehabilitation at all stages of rehabilitation, syndrome-pathologic principle of grouping patients, multidisciplinary organisation of medical activity: cardiologist-physician, specialist of functional diagnostics, specialist of physical therapy, psychotherapist, physical therapeutic, surgeon and specialist of professional rehabilitation. Basic ways of improvement of the system of rehabilitation were organisational technologies of interaction during early and late stages of rehabilitation and persistent control of quality and effectiveness of rehabilitation. Optimization of organisation of late stage of hospitalisation allowed to reduce the average time of rehabilitation to 33,3% and at the same time to improve effectiveness of rehabilitation.

[Evaluation of the efficacy of isosorbide-5-mononitrate in CHF patients unresponsive to isosorbide dinitrate therapy]. / Otsenka éffektivnosti izosorbid-5-moninitrata u bol'nykh IBS, rezistentnykh k terapii izosorbidom dinitratom.

The purpose of this study was to evaluate the antianginal and antiischemic effects of isosorbide-5-mononitrate (Mono Mack) in patents unresponsive to its therapy. Thirty eight patients aged 38 to 70 years who had coronary heart disease (CHD) were followed up. Estimation of the number of daily anginal episodes, 24-hour monitoring, EchoCG, bicycle ergometry, tetrapolar rheocardiography, and self-assessment were made. Prior to the follow-up all the patients were treated with nitrosorbide (80-100 mg/day), beta-blockers, ACE inhibitors, disaggregants, and a complex of physico- and psychotherapies. CHD progression was an indication for the use Mono Mack. Its dose was 20 mg twice a day. Following 18-20 days, the efficiency of its use was evaluated. The treatment yielded a clinical effect in all the patients. The total daily number of anginal episodes decreased from 3.9 to 1.2 times. 24-hour monitoring showed an average decrease in the duration of ST-segment depression from 554 to 245 min a day. There was a significant increase in the patients' physical fitness and a trend for cardiac contractility to increase. They felt all better. With clinical improvement, 5 patients had no changes, as evidenced by instrumental studies. It is concluded that Mono Mack is highly effective with dinitrate tolerance, 1.8-fold decrease in the dose of nitrates, and good interaction with other drugs.