Vol 79, No 1 (2004)

Aim. To estimate prevalence of hypo- and hyperdiagnosis of поп-Q myocardial infacrtion (MI). Material and methods. The results of prehospital diagnosis of MI in 1500 patients examined in 19921996 are reported. Estimation was conducted in different clinico-electrocardiographic and clinico-demographic groups. Results. Non-Q MI occurred in 74.1% cases. Non-Q and Q MI ran atypically in 33.0 and 12.9% patients, respectively (p < 0.01). Hypo- and hyperdiagnosis of Q and non-Q MI was made in 3.8 and 2.1, 17.3 and 35.9%, respectively. In typical and atypical MI hypodiagnosis was made in 13.4 and 21.2% cases, respectively, while hyperdiagnosis was observed in 19.9 and 45.8% (p < 0.01). The MI hyper/hypodiagnosis coefficient was highest in patients under 45 years of age (2.6%) and in repeated MI(2.5). Conclusion. Misdiagnosis of non-Q MI is most essential in epidemiology of missed diagnosis in this disease. High incidence of hypo- and hyperdiagnosis in non-Q MI as well as atypical MI are explained by objective difficulty of prehospital diagnosis in these MI variants and high MI alertness of the doctors in low significance of the disease.

Aim. To assess clinical efficacy of mineral water and perindopril in convalescents after hemorrhagic fever with renal syndrome (HFRS) in outpatient setting. Material and methods. The study covered 113 HFRS convalescents. HFRS was confirmed serologically The patients were divided into three groups: group 1 (n = 50) received no rehabilitation caregroup 2(n= 32) drank mineral water "varzi-yatchi"; group 3 (n = 31) drank mineral water and took perindopril (2 mg/day). Aftertreatment continued for 30-35 days. The effect was assessed by a complex of clinical-laboratory and functional tests for examination of renal functions (Reberg-Tareev, Zimnitsky tests, estimation of uric acid clearance and renal functional reserve, an 18-hour water deprivation test). Results. Mineral water varzi-yatchi and perindopril had a favourable effect on clinical condition and renal functions of HFRS convalescents. Compared to the controls (p < 0.05), they had less severe weakness, lumbar pains, edema of the lower limbs; positive changes in intraglomerular hemodynamics, renal transport of beta2-microglobulin (MG), uric acid transport. Conclusion. It is shown that HFRS convalescents have defective glomerular and tubulointerstitial systems of the kidneys. These disorders demand a differential therapeutic approach. Drinking mineral water improves some tubular functions. The addition of perindopril is necessary in detection of arterial hypertension, impairment of intraglomerular hemodynamics, hyperexcretion of beta2-MG, osmoregulating renal dysfunction.

Aim. To study the role of Helicobacter pylori (HP) persistance in generation of gastric mucosa adenoma. Material and methods. Esophagogastroduodenoscopy with biopsy of the mucosa from the antral portion and body of the stomach was made for diagnosis of HP and morphological changes in 28 patients \ aged 47 to 86 years with gastric adenoma. Results. Chronic gastritis with HP was diagnosed in 57.1% patients. HP contamination was, as a rule, weak (32.1%) or moderate (53.5%). It correlated with activity of inflammatory and dystrophic changes (thefirst degree - 35.7%, the second one - 39.3%; atrophy - 99.6%, metaplasia - 92.8%, respectively). Conclusion. The morphological study revealed a strong correlation between gastric adenomas and HP persistance. As adenomas are characterized by a high risk of malignant transformation and must be removed, it is recommended to eradicate HB infection.

Aim. To evaluate levels of Total cholesterol (TC), HDLP cholesterol, triglycerides (TG), occurrence of hypercholesterolemia (HCE), hypertriglyceridemia (HTG) and low HDLP cholesterol in the Tyumen population. Material and methods. 866 men and women aged 25-64 years have been examined in one-stage cardiological screening within a two-stage epidemiological study of serum lipoproteins by WHO criteria. Results. HCE was registered in 15.6% males and 18.8% females, a low HDLP cholesterol - in 5.3 and 4.2%, HTG - in 5.8 and 4.3% males and females, respectively. A high TC level and HCE occurred more frequently in women over 54 years of age; a low HDLP cholesterol level in insignificant fall in HDLP cholesterol and no age-related changes of this index were found both in males and females; TG were elevated in older males in moderate prevalence of HTG in the population. Conclusion. It is shown that Tyumen population is at high risk of cardiovascular diseases. Further studies are needed to specify targeted preventive programs.

Aim. To evaluate the occurrence of cholelithiasis (CL) diagnosed by routine autopsy and to compare these data with the results of ultrasonographic examination of the general population. Material and methods. Autopsy protocols (n = 1124) from a large general hospital were analysed, and a representative sample of Novosibirsk population (1678 examinees aged 25-64 years) was examined by ultrasonography. Results. Prevalence of CL increased with age and was five-fold higher in females than in males. Both methods showed good concordance. The age-adjusted CL prevalence rates in 25-64 year-old groups was 1.94% in males and 9.53% in females in autopsy series, and 2.16% and 11.16%, respectively, in ultrasonographic study. Conclusion. Routine autopsy may serve as a reliable tool in evaluating prevalence of CL among the population provided the values are gender- and age-standardized.

Aim. To study nicotine dependence (ND) basing on special questionnaires and measurement of CO concentrations in the exhaled air. Material and methods. 350 smokers (318 males and 32 females) aged 20-57 years (mean age 37.1 ± 7.3 years) were studied. ND was assessed by Fagerstrom test (FT), motivation to smoke and to quit tests, smoking history and exhaled CO measurement. In addition, respiratory complaints and ventilation parameters such as peak expiratory flow (PEF) and forced expiratory volume per 1 sec (FEV1) were measured. Results. Mean daily cigarette number was 14.2 ± 7.3; smoking duration 16.3 ± 7.8 years and smokers index 170.9 ± 87.8. Smoking women differed from smoking men in ND, PEF% and FEV1% decline as well as CO level. Exhaled CO was 21.1 ± 9.5ppm, on the average, corresponding to moderate dependence. ND and daily cigarette number produced a direct impact on the exhaled CO level. FT findings directly correlated with the number of daily cigarettes and CO level (mean 3.2 ± 2.3). Among motivation to smoke factors was the demand to release tension. Conclusion. ND varies considerably among smokers by severity. Smoking men and women differ considerably by ND. Along with dependence tests, exhaled CO measurement provides objective verification ofND.

Aim. To study efficacy of sanatorium treatment of aged patients with gastroenterological and locomotor diseases in the heriatric center. Material and methods. 100 patients were investigated for effects of sanatorium treatment on quality of life. Results. Clinical symptoms depended on the patients'age. Patients under 70 years of age had leading symptoms from gastrointestinal organs and locomotor system. These patients were most responsive to rehabilitation measures. In 70-year-olds and older patients cardiovascular and cerebral pathologies are of special importance limiting usage of physiotherapy and necessitating wider application of medicines: hypotensive, antianginal, circulation correcting, etc. The sanatorium stage of rehabilitation creates a positive emotional background in these patients. Conclusion. Sanatorium treatment resulted in improvement of life quality in gerontological patients.