Vol 78, No 12 (2003)

Editorial
Topical problems of interdisciplinary cooperation in the treatment of psychosomaticdisorders
Makolkin V.I., Romasenko L.D.
Terapevticheskii arkhiv. 2003;78(12):1-7
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Alcohol consumption and its link withcardiovascular mortality in 40-59 year old males (data of a21.5 year prospective study)
Alexandri A.L., Konstantinov V.V., Deev A.D., Kapustina A.V., Shestov D.B.
Abstract
Aim. To study contribution of alcohol consumption (AC) to mortality of coronary heart disease (CHD), cerebral stroke (CS), cardiovascular diseases (CVD), overall mortality (OM) in a random population of working males. Material and methods. The results are available of a 21.5 year cohort study of mortality in a random population of 7815 male citizens of Moscow and St-Petersburg aged 40-59 years. Results. The attributive risk of AC for mortality of CHD, CS, CVD and ОМ was 16.6, 14.8, 7.7and 11.9%, respectively. The lowest relative risk to die of CHD, CVD and OM among the cohort studied was observed in males taking alcohol 168.0 ml per week maximum. Conclusion. It is necessary to approach differentially to assessment of AC effects on development of many diseases and further investigations are needed to reveal fine mechanisms of action of different alcohol drinks on human organism.
Terapevticheskii arkhiv. 2003;78(12):8-11
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The state of theleft ventricle of the heart and 24-h profile of arterial pressure in patients with effort angina and episodes of painlessmyocardial ischemia
Mazur E.S., Mazur V.V., Tkhind В., Omar I.
Abstract
Aim. To study association between the state of the left ventricle (LV) of the heart, characteristics of a 24-h profile of arterial pressure (AP) and episodes of painless myocardial ischemia (PMI). Material and methods. Echocardiography, bifurcation 24-h monitoring of AP and ECG were conducted in 137patients with effort angina (EA) receiving clinically effective antianginal therapy. Results. Episodes of PMI at daytime were detected in 33 (24.1%) patients, at day and nighttime in 10 (7.3%) patients. There were significant differences neither by LV state nor by 24-h AP profile in patients free of PMI and those with daytime episodes. Patients with day and night PMI episodes had dilated LV and a decreased fall of night AP. Comparison of the parameters of 24-h AP and ECG monitoring has demonstrated that PMI episodes follow a rise in systolic and diastolic AP. In ischemia systolic and diastolic AP rise. In postischemic period systolic AP lowered while diastolic AP rose higher. Conclusion. Changes in diastolic AP may contribute to both onset and arrest of PMI. Decreased night fall in AP is one of the mechanisms compensating impaired coronary circulation.
Terapevticheskii arkhiv. 2003;78(12):12-15
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The phenomenon ofintermittent myocardial ischemia and myocardial reserve inmyocardial infarction survivors
Volkov V.S., foanov A.P., Elgardt I.A.
Abstract
Aim. To study coronary and myocardial reserves in myocardial infarction survivors (MIS) with consideration of development of intermittent ischemia during transesophageal pacing (ТЕР). Material and methods. 320 MIS were examined 1.5-2 months after myocardial infarction onset. 30 healthy male volunteers served control. Stepwise overdrive ТЕР was made in all the examinees with parallel estimation of central hemodynamics by tetrapolar chest rheography with assessment of systolic and diastolic parameters. Results. In the course of ТЕР, 39.4% MIS developed intermittent ischemia (II) at frequencies HOMO imp/min. II presented as a significantly depressed ST segment on ECG. There was a simultaneous lengthening (1.4-fold) of diastole and a fall (1.5-fold) of end-diastolic pressure in the left ventricle (EDP). At frequencies 140-160 imp/min the length of the diastole shortened while EDP rose. Conclusion. The II phenomenon demonstrates a key role of coronary reserve. Changes in coronary and myocardial reserves during ТЕР in II development are interrelated. They may represent unknown adaptive mechanisms of the myocardium protecting against unfavourable outcomes of ischemic episodes.
Terapevticheskii arkhiv. 2003;78(12):16-18
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EFFECTS OF MEMBRANESTABILIZING MAGNETOLASER THERAPY ON CARDIODYNAMICSIN PATIENTS WITH ISCHEMIC HEART DISEASE
Vasilyev A.P., Senatorov Y.N., Streltsova N.N., Malishevsky M.V., Dubova T.V., Zykova E.L.
Abstract
Aim. To evaluate cardiodynamic changes in response to magnetolaser therapy (MLT) and these changes links with lipid shifts in cell membrane. Material and methods. The study enrolled 50 patients with effort angina (functional class 11-III). Of them, 37 patients were exposed to 10-day courses of MLT, 13 patients were exposed to sham procedures. Before the treatment and 3 months after it measurements were made of lipid peroxidation (LPO) products, structure of erythrocytic membrane and cardiodynamic parameters. Results. MLT resulted in a significant reduction of LPO products, stabilization of cell membrane structure and positive shifts in cardiodynamics. Correlation was found between the above parameters. Conclusion. Improvement of inotropic, diastolic functions of the myocardium and abatement of cardiac remodeling in coronary heart disease patients in response to MLT is realized primarily due to structural stabilization of cell membrane lipid biolayer.
Terapevticheskii arkhiv. 2003;78(12):19-22
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Influence of combined use of nitricbaths and 6-month exercise training on physical performance and extrasystole in patients suffering from coronaryheart disease with stable angina pectoris
Klemenkov S.V., Razumov A.N., Yavisya A.M., Voronin S.S., Kubushko I.V.
Abstract
Aim. To study effects of combined use of general artificial nitric baths and bicycle exercise for 6 months on physical performance (PP) and extrasystole (ES) in patients with coronary heart disease (CHD) and stable angina pectoris (SAP) of functional class I-II. Material and methods. A total of 129 CHD with SAP patients entered the study. Of them, 44 patients received balneotherapy (a course of general artificial nitric baths); 37 patients took the baths and exercised on bicycle ergometer; 48 patients took the baths, exercised on bicycle ergometer in the outpatient clinic and continued the exercises for 6 months. The patients were examined with spiroveloergometry and ambulatory Holter ECG monitoring. Results. The latter group of patients achieved the highest training effect manifesting with increased PP and coronary heart reserve, an antiarrhythmic effect (a 73.3% fall in the mean number of ventricular ESfor 24 hours, a 72.2% one in this number of supraventricular ES). Conclusion. A significant efficacy is shown of combined use of general nitric baths and bicycle exercise with prolongation for 6 months in CHD patients and SAP of functional class I-II with ES.
Terapevticheskii arkhiv. 2003;78(12):23-26
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Short-term clinical results of balloon coronary angioplastyin patients with ischemic heart disease with affection ofthree coronary vessels
Oleinik A.O., Dovgatevsky P.Y., Shitikov I.V., Titkov I.V.
Abstract
Aim. To study a short-term clinical effect of balloon coronary angioplasty (BCA) in patients with affection of three coronary arteries regarding an anginal form and completeness of myocardial revascularization. Material and methods. The study included 80 patients with coronary heart disease (CHD) having three affected major coronary arteries after BCA among them 48patients with stable and 32 patients with unstable angina. The procedures were made using "Polydiagnost C"angiographic complex (Philips, Holland). Results. Overall clinical efficacy of BCA in affection of three coronary arteries was 88.75% (in 71 of 80 patients), no response was observed in 9 of 80 patients (11.25%). The response to BCA was independent of the anginal form. In stable angina there were no differences in clinical efficacy in complete and incomplete functionally-adequate anatomic BCA (91 and 89.6%, respectively). In incomplete anatomic revascularization clinical effect was less (62.5%). In unstable angina a clinical effect of BCA did not depend on the degree of myocardial revascularization. Stenting raised clinical response to BCA in all the patients. Conclusion. The findings demonstrate high clinical efficacy of BCA in affection of three coronary arteries irrespective of an angina form. Incomplete anatomic revascularization in stable effort angina is less effective but can be used if other operations are impossible. If definition of the symptom-causing artery is possible, the intervention should be limited to BCA of this artery to decide on dilation of other arteries later.
Terapevticheskii arkhiv. 2003;78(12):27-31
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Cerebral perfusion in patients with arterial hypertension and chronic vascular pathology of the brain
Geraskina L.A., Suslina Z.A., Fonyakin A.V., Sharypova Т.N.
Abstract
Aim. To examine cerebral perfusion in patients with dyscirculatory encephalopathy and residual disorders of cerebral circulation in arterial hypertension. Material and methods. Duplex scanning of extra- and intracranial arteries, computed tomography of the head were performed in 26 hypertensive patients with chronic vascular pathology of the brain. Cerebral perfusion was studied by the evidence obtained at single-photon emission computed tomography. Results. Impaired segmental perfusion of the brain, primarily of frontal and temporal location, was detected in 88.5% patients. Occlusive lesions of extra- and intracranial arteries were accompanied by significant deterioration of the perfusion while visualization of leukoaraosis was associated with high perfusion in the anterior frontal compartments indirectly pointing to defects in autoregulation of cerebral circulation. It was found that different correlations exist between perfusion of various segments of the brain and systemic arterial pressure. This is explained by functional and hemodynamic heterogenic^ of different brain regions. Conclusion. Specific features of cerebral perfusion in patients with chronic forms of vascular brain pathology should be considered in planning antihypertensive therapy because of the risk of focal hypoxia and even ischemia in an inadequate fall of arterial pressure.
Terapevticheskii arkhiv. 2003;78(12):32-35
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Variants of venousdysfunction in hypertensive patients with different hemodynamic variants of the disease
Khlynova O.V., Tuev A.V., Schekotov V.V.
Abstract
Aim. To identify variants of venous dysfunction in patients with arterial hypertension (AH) in respect of the disease hemodynamic profile. Material and methods. The assessment of central hemodynamics and peripheral venous circulation in the veins of the lower limbs was made in 60 patients with different hemodynamic variants of primary AH. Results. Patients with ejection hypertension were characterized by high extensibility of the peripheral veins and low tolerance to orthostatic loads. In patients with hypertension of resistance venous dysfunction was characterized by signs of venous hypertension in rigidity of the venous wall as well as low and inadequate reactivity of peripheral large vessels. Conclusion. The results of the orthostatic test show different response of venous hemodynamics in patients with hypertension of ejection and resistance. This provides adequate activity of the heart in erect position.
Terapevticheskii arkhiv. 2003;78(12):36-38
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Nifedipine-retard alone and incombination with metoprolol: comparative efficacy andsafety in patients with arterial hypertension
Isaikina O.Y., Gorbunov V.M., Andreeva G.F., Dmitrieva N.A., Martsevich S.Y.
Abstract
Aim. To compare efficacy and safety of nifedipin-retard (cordaflex-retard, Egis, Hungary) used in monotherapy and in combination with metoprolol (egilok, Egis, Hungary) in patients with arterial hypertension (AH). Material and methods. The study included 20 patients with AH stage I-II (12 males, 8 females, mean age 57.3 years, mean duration of the disease 8.6 years). Nifedipin-retard was given in a daily dose 40 mg/day (20 mg twice a day) in monotherapy and 20 mg/day in combination with metoprolol which was administered 50 mg twice a day (a daily dose 100 mg/day). The control examination consisted of a physical examination, measurement of arterial pressure (AP) by Korotkov, registration of heart rate, ECG, 24-h AP monitoring, echocardiography. Results. By 24-h AP monitoring, a 4-week treatment with nifedipin-retard alone resulted in lowering of systolic arterial pressure. The combined treatment produced a more pronounced fall both in systolic and diastolic pressure. Diastolic left-ventricular function improved in combined therapy. Side effects observed in nifedipin-retard monotherapy got much more weaker when this drug combined with metoprolol. Conclusion. Combination of nifedipin-retard with metoprolol provides better clinical response and tolerance than monotherapy with nifedipin-retard.
Terapevticheskii arkhiv. 2003;78(12):39-42
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Administration of enalapril for preparation ofpatients with arterial hypertension to surgical interventions
Proschaev K.I.
Abstract
Aim. To study efficacy of enalapril, ACE inhibitor, in preparation to surgery of hypertensive patients with concomitant surgical diseases. Material and methods. An open controlled randomised study of the action of enalapril preoperative therapy on hemodynamics was made in 55 hypertensive patients aged 36-68 years with surgical abdominal diseases. Results. Before surgery, the study group of 30 patients were given enalapril for a month. The control group of 24 patients received a month therapy with adelphan and papasol. The study group achieved a greater fall in the morning and evening systolic arterial pressure and morning diastolic pressure. These falls allowed elective operative interventions. Intraoperative hyperdynamic reactions, cardiac arrhythmia, intraoperative myocardial ischemia occurred less frequently in the study group. Enalapril provided better intraoperative peripheral blood saturation with oxygen. Conclusion. Enalapril, an АСЕ inhibitor, can be used as a hypotensive drug for preparation of hypertensive patients for elective surgery because it regulates processes providing effective stabilization of arterial pressure, adequate supply of oxygen to peripheral blood.
Terapevticheskii arkhiv. 2003;78(12):43-46
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Dislipidemia treatment with original and generic statins: clinical and cost-effect efficacy, safety
Olbinskaya L.I., Danilogorskaya Y.A.
Abstract
Aim. To compare clinical, cost-effect efficacies and safety of simvastatin Zokor and generic Vasilip in correction of dislipoproteinemia in patients with ischemic heart disease. Material and methods. The original statin Zokor and generic statin Vasilip were given for 8 weeks in a dose 20 mg/day. Results. Vasilip and Zokor demonstrated similar hypolipidemic efficacy and safety, but Vasilip administration was more cost-effective. Conclusion. Simvastatin Vasilip is recommended for wider use in clinical practice because it is clinically and cost effective.
Terapevticheskii arkhiv. 2003;78(12):47-49
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Physicalrehabilitation in combined treatment of inpatients withchronic heart failure
Efremushkin G.G., Antropova O.N., Osipova I.V.
Abstract
Aim. To study action of medication in combination with free-choice bicycle exercise on cerebral and peripheral hemodynamics in patients with chronic heart failure (CHF) of functional class I I-1II. Material and methods. At admission to hospital and at discharge 100 patients with CHF of NYHA functional class (FC) II-III hospitalized for progression of CHF have undergone clinical examination, dopplerechocardiography and biomicroscopy of conjunctival vessels. The patients were randomized into two groups: group 1 of 60 patients received standard drugs and exercised on bicycle: group 2 of 40 patients received standard drugs only. Results. The patients of group 2 achieved better hemodynamic effect, greater lowering of total peripheral vascular resistance. In patients with CHF FC II cardiac output increased due to improvement of left ventricular systolic function (end-systolic and end-diastolic volumes reduced by 20.3 and 38.7%, respectively, ejection fraction increased by 13.7%); in patients with FC III - due to improvement of diastolic function (end-diastolic volume reduced by 8.3%). Bicycle exercise in combined treatment of FC II CHF provides improvement in perivascular and intravascular components of microcirculation by 46.7 and 24.3%, respectively. In FC III CHF intravascular microcirculation improved by 24.3%. Conclusion. Bicycle exercise of patients with CHF of FC II and III used as an adjuvant to standard drugs has an additional positive effect on central hemodynamics and microcirculation.
Terapevticheskii arkhiv. 2003;78(12):50-53
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Lengthening of Q-Tinterval in isoniazid treatment (case report and review of literature)
Makarov L.M., Chuprova S.N., Garipov R.S., Sorokina E.V., Polyakova E.В., Kalinin L.A.
Terapevticheskii arkhiv. 2003;78(12):54-58
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Dorsopathies in therapeutic practice: new prospective modalities
Shostak N.A.
Terapevticheskii arkhiv. 2003;78(12):59-60
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Hypopotassemia
Lukyanchikov V.S., Korolevskaya L.I.
Terapevticheskii arkhiv. 2003;78(12):61-65
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Diagnostic and prognostic significance of D-dimer in internal medicine
Fedotkina Y.A., Dobrovobky А.В., Kropacheva E.S., Titaeva E.V., Panchenko E.P.
Terapevticheskii arkhiv. 2003;78(12):66-68
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Thiotropium bromide in the treatment of chronic obstructive pulmonary disease
Shmelev E.I.
Terapevticheskii arkhiv. 2003;78(12):69-71
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Role of polymorphism of angiotensinconverting enzyme gene in development of metabolic syndrome
Roitberg G.E., Tikhonravov A.V., Dorosh Z.V.
Terapevticheskii arkhiv. 2003;78(12):72-76
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Hepatic failure: current problems of treatment
Chikoteev S.P., Plekhanov A.N., Kornilov N.G., Tovarshinov A.I.
Terapevticheskii arkhiv. 2003;78(12):77-80
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Microalbuminuria: clinical and prognostic value in arterial hypertension
Arakelyants A.A., Zhukova N.V., Ryazanov A.S., Yurenev A.P.
Terapevticheskii arkhiv. 2003;78(12):81-82
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Autoimmune thyroiditis in blood disease
Vinogradova Y.E., Shinkarkina A.P., Poverenny A.M.
Terapevticheskii arkhiv. 2003;78(12):83-91
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Nikitin Yury Petrovich (the 75th anniversary of birth)
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Terapevticheskii arkhiv. 2003;78(12):92-93
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Chebotarev Dmitry Fedorovich (the 95th anniversary of birth)
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Terapevticheskii arkhiv. 2003;78(12):94-94
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