Vol 79, No 8 (2004)

Aim. To evaluate efficacy of hydrogen sulfide (HS) balneotherapy in patients with coronary heart dis- ease (CHD) in conditions of heat discomfort. Material and methods. The study included 72 CHD patients aged 35 to 60 years with stable angina pectoris of the second functional class taking balneotherapy in summer under arid climatic conditions. Before and after balneotherapy the patients were examined with estimation of clinical symptoms, stress bicycle exercise (SBE) parameters, number of nitroglycerine tablets. Results. The balneotherapy resulted in a significant prolongation of SBE (p < 0,0018), in longer time to depression of the ST segment by 1 mm (p < 0,01), to an anginal attack in the course of SBE (p < 0,0036), shorter duration of pain after SBE (p < 0,001), less number of anginal attacks (p < 0,0002) and reduced need in short-acting nitrates (p < 0,0002). Conclusion. In a hot climate of the arid zone use of moderate HS baths raises tolerance of CHD pa- tients to exercise, attenuates clinical manifestations of CHD and, consequently, reduces daily need in nitrates.

Aim. To study effects of long-term morphine-clofelin epidural analgesia and infusion of nitroglycerin on formation of the necrosis focus and the clinical course of acute myocardial infarction (MI). Material and methods. Ninety patients were examined within the first 12 hours of anterior macrofocal MI. Forty six patients of the study group received long-term morphine-clofelin epidural analgesia and nitroglycerine infusion within the first 24 hours of the disease. Forty-four control patients were anes- thetized conventionally with intravenous morphine. Development of MI was assessed with electrocardi- otopography and dynamic examination of MV CK in the blood serum. Results. The degree and area of the myocardial lesion were initially similar in the study and control groups. These indices were less in dynamics in the study group. On MI day 5 and 10 myocardial necrosis zone significantly diminished in the study group. Conclusion. Long-term epidural analgesia and nitroglycerin infusion provide effective analgesia, lo- calizes the ischemic and necrotic focus, have a good effect on hemodynamics and improve a MI clini- cal course.

Aim. To study the effect of corenitek monotherapy for 16 weeks on parameters of 24-h monitoring of arterial pressure, carbohydrate, lipid, purin metabolism in patients with mild and moderate arterial hypertension (AH) and diabetes mellitus (DM) type 2. Material and methods. 20 patients with DM type 2, mild or moderate AH received co-renitek (1-2 tablets a day) for 16 weeks. Before the treatment and 16 weeks later the patients were examined (24h AH monitoring, carbohydrate, lipid, purin, electrolyte metabolism). Results. Co-renitek treatment of DM type 2 patients with hypertension led to a significant lowering of mean systolic and diastolic pressure, improvement of 24-h AP profde and reduction of fasting glucose level. Co-renitek proved to be metabolically neutral in relation to lipid, purin and electrolyte metabolism. Conclusion. Co-renitek is effective and safe antihypertensive drug for treatment of arterial hypertension in patients with diabetes mellitus type 2.

Aim. To evaluate efficacy of use of technological charts (TC) in upgrading management and treatment safety in patients with atrial fibrillation (AF). Material and methods. Two groups of AF patients were compared: 196 patients treated before introduction of TC (group 1) and 431 patients managed according to TC technology (group 2). Results. In group 2 treatment duration reduced from 26.1 to 18.5 days, ^hospitalizations occurred by 6% less frequently, number of unexpected side effects fell 2.5-fold, the rate ofvarfarin prescription for prevention of thromboembolic complications rose from 18 to 64%, the patients were satisfied with the treatment in 97% vs past 79%. Conclusion. TC was a tool of treatment improvement and introduction of the latest clinical recommendations into clinical practice with reference to facilities and staff qualification of an individual hospital without additional financial input.

Aim. To compare efficacy ofatrovent alone and in combination with erespal in patients with chronic bronchitis (CB) and chronic obstructive pulmonary disease (COPD). Material and methods. Of 80 participants of the trial (51 male and 29 female - 63.75 and 36.25%, respectively) who had CB or COPD, 39 patients (28 with CB and 11 with COPD) received 6-month combined treatment with erespal (160 mg/day) and atrovent (160 meg/day) and 41 patients (32 with CB and 9 with COPD) received atrovent monotherapy in the same dosage. Results. Combined therapy produced positive changes in dyspnea, sputum characteristics and its discharge, cough, monotherapy improved sputum discharge and relieved cough; pulmonary ventilation improved in both groups especially in those on monotherapy. CB patients showed low cytosis, percentage and absolute count of neutrophils, absolute count of lymphocytes and eosinophils in induced sputum. In С В patients percentage of lymphocytes reduced while count of macrophages went up. Combined treatment including erespal also promoted a significant fall of serum and sputum TNFa and IL-8 reduction in the sputum. Conclusion. Erespal+atrovent treatment proved more effective than atrovent alone. It is recommended for both CB and COPD patients without marked disorders of external respiration function.

Aim. To specify the risk of severe systemic manifestations and transformation into malignant lymphoma in Sjogren's disease (SD) patients with monoclonal mixed cryoglobulinemia (MMC). Material and methods. A prospective study performed in 1985-1990 included 248 SD patients followed up after the initial detection of monoclonal immunoglobulins (Ig) with serum active rheumatoid factor (RF). The patients' cryoglobulins (CG) were examined. The type of CG was determined by electrophoresis in agarose gel combined with immunofixation and Immunoelectrophoresis with monospecific antisera to heavy and light Ig chains. Biopsies of the lower lip salivary glands and skin were made in all the patients with MMC and 40 patients without CG. The biopsies were studied histologically, histochemically and immunomorphologically. Clinical symptoms and prognosis were studied in all the patients observed in 1985-2000 after the initial diagnosis of MMC. In suspected lymphoma development, histological and immunophenotypical studies of lymph node, bone marrow biopsies, trephine biopsies were made as well as myelograms, Ga-67 scintigraphy, CTofthe thoracic and abdominal cavities. The total of clinical, morphological, immunophenotypical and cytogenetic characteristics of lymphoma was estimated by REAL classification. Results. CG at first examination was detected in 50 (20.2%) of 248 patients with SD. 20 (40%) of 50 patients were diagnosed to have MMC with monoclonal IgM% (19) and IgA (1) in the serum with RF activity. Ten (50%) patients with MMC developed lymphoma after 10.9 ±3.3 years, on the average. In the absence of CG lymphoma developed in 5.5% (p < 0.001). B-cell intoxication in patients with diffuse lymphadenopathy, foci of lymphoid infiltration in the lungs, ulcers of the cms and such indices as stab neutrophilic shift, monocytosis, hypoproteinemia with hypogammaglobulinemia, disappearance of the RF, CG, low CIC level, immunodeficiency of monoclonal Ig and appearance of the protein BJ in the urine are markers of developing large B-cell immunosecreting lymphomas. Highly aggressive diffuse LCL resulted in death of 70% SD patients with MMC; 30% died of immunocomplex cryoglobulinemic vasculitis. 10-15-year survival of SD patients after detection of MMC was 50%, free of CG - 97% (p < 0.001). Conclusion. MMC is a definite serological marker of developing lymphoma and ulcerative-necrotic vasculitis in SD. In detection of MMC in SD patients it is necessary to prescribe early pathogenetically validated treatment before development of life threatening manifestations.

Aim. To characterize effects of interferon alpha (If-a) on functional activity of platelets in patients with chronic viral hepatitis (CVH) and viral hepatic cirrhosis (VHC). Material and methods. Induced platelet aggregation (PA), spontaneous PA, levels of cAMP, cGMP and glycogen in platelets, plasm beta-thromboglobulin (bTG) and activity of thrombocytic factor 4 (TF4) were measured in 95 patients before, 4.5h after the first If-a introduction, after 12 and 24 weeks of If-a treatment. Results. The patients demonstrated low induced PA, intracellular glycogen and high cAMP, b- TG amd TF4. The initial administration of If-a led to normalization of most of functional platelet indices. A 24-h course of If-a therapy normalized platelet functions irrespective of stability of the virusological response. Conclusion. If-a preparations in single and multiple administrations normalize platelet function.