Vol 79, No 12 (2004)

Aim. To study psychoemotional, typological personality characteristics and vegetative status of patients with mechanical complications of acute transmural myocardial infarction (Ml). Material and methods. 107patients with acute transmural Ml were divided into three groups depending on the kind of mechanical myocardial failure (MMF) or its absence. The control group consisted of 20 healthy patients. The patients were examined for psychoemotional and typological features of personality and vegetative tone. Results. Introverts were prevalent among Ml patients with MMF. A psychological picture of the examinees was made. The study group patients displayed vegetative dysfunction syndrome. A cognitive component of high anxiety in patients with postinfarction MMF was specified. Conclusion. A cognitive component of anxiety in patients with acute transmural MI and MMF differs from that of patients with an uncomplicated course of the disease being hardly responsive to conventional therapy. Somatic component of anxiety in such patients manifests with vegetative dysfunction syndrome and demands prescription of beta-adrenoblockers as early as possible.

Aim. To study the effect of exercise on markers of endothelial impairment, platelet activation, thrombin formation, fibrinolysis in patients who survived myocardial infarction (MI) at young age. Material and methods. The levels of fibrinogen (F), Willebrand factor (WF), beta-thromboglobulin (BTG), fragment 1+2 of prothrombin activation (F 1+2), antigen of tissue plasminogen activator (TPA), D-dimer at rest as well as BTG, F 1 = 2, WF, TPA antigen and its activity in treadmill test (TT) were compared in 25 patients younger than 35 years who survived Q-myocardial infarction (Q-MI) > 6 months before (group 1), 10 of whom had unaffected or little affected coronary arteries as shown by coronaroangiography (subgroup Ш) while 15 had stenosing coronary atherosclerosis (subgroup 1A); in 20 patients who had Q-MI at the age of 40-55 years (group 2); in 10 healthy patients under 35 years of age (group 3). Results. Initial concentrations of F, F 1 + 2 and TPA antigen were significantly higher than in healthy subjects. F and TPA antigen were higher in subgroup 1A than in subgroup 1H. D-dimer was higher in group 2 vs 1. TT raised concentration of BTG in all the groups, induced a stable trend of F 1+2 rise in patients of subgroup IE (p = 0.059), raised WF only in group 3, TPA antigen at peak stress in all the patients being in group 1 higher than in healthy controls and in subgroup 1A than in subgroup 1H. TPA antigen was more active at the peak stress in group 1 than in group 2 but the differences became insignificant in analyzing only patients who reached submaximal load by heart rate. Conclusion. Stenosing coronary atherosclerosis in patients after MI at young age is associated with high F and TPA levels. Elevated F 1+2 was registered at exercise test in young patients free of coronary obstruction. TPA levels were raised higher by exercise in patients with stenosing atherosclerosis of the coronary arteries. TPA activity induced by exercise depended more on exercise intensity than on the age of the patients.

Aim. To assess hypotensive efficacy and metabolic neutrality of moxonidine (physiotenz) - a selective agonist of imidasoline receptors - in patients with mild and moderate arterial hypertension (AH) associated with diabetes mellitus (DM) type 2. Material and methods. Follow-up and treatment were conducted in 30 hypertensive diabetics (mean age 52.43 ± 4.65 years). Mean duration of DM and AH was 4.77 ± 2.69 and 6.93 ± 2.98 years, respectively. The study was made of lipid exchange, glycemia, levels of glycosylated hemoglobin (GH), fasting and postprandial immunoreactive insulin. Hypotensive efficacy was examined by 24-h monitoring of arterial pressure after 16 weeks of therapy. Results. Mean 24-h systolic arterial pressure fell by 8.02%, diastolic arterial pressure - by 6.47%. The drug had a good effect on a 24-h profile of arterial pressure: a significant decrease of day and night pressure load index, lowering of initially high 24-h variability of systolic and diastolic arterial pressure, normalization of two-phase profile of arterial pressure. Carbohydrate metabolism improved also: GH, glycemia, immunoreactive insulin decreased. There was a significant trend to a change in qualitative composition of blood lipids - a decrease in lipoproteins atherogenic fractions and a rise in HDLP. Conclusion. Physiotens is a highly effective hypotensive drug for use in mild and moderate AH in DM of type 2.

Aim. To assess detectability of carotid atherosclerosis in patients with coronary heart disease (CHD) and arterial hypertension (AH) by the data of ultrasonic screening, to study location and detectability of atherosclerotic lesion of common carotid arteries, internal carotid arteries, external carotid arteries in correlation with basic disease. Material and methods. Ultrasonic screening of brachyocephalic arteries was made in 469 patients: with CHD (n = 239), AH (n = 230) including patients with concomitant postinfarction cardiosclerosis (PICS) and moderate chronic cerebrovascular failure (CCVF). Results. Ultrasonic angiography detected atherosclerotic carodid artery lesion in patients with CHD and PICS (81.6%) or CCVF (76.9%) or angina pectoris (64.2%). In hypertension subjects carotid artery atherosclerosis was encountered in 28.1%. Conclusion. It is justified to make ultrasonography of carotid arteries in all patients with CHD and AH irrespective of age, gender, underlying clinical diagnosis

Aim. To determine prognostic opportunities of echocardiography (ECG) in infectious endocarditis (IE) basing on the assessment of microbial vegetations size and degree of valvular failure. Material and methods. Of 114 patients with definite IE (72 male, 42 female), 90 ones had primary and 24 secondary endocarditis. The prospective study included all the survivors in the IE active stage -78 patients. Results. Vegetations > 1 cm in size were detected in 50.8%patients, < 1 cm - in 49.2%. Hospital lethality in vegetations > 1 cm and < 1 cm was 25.8 and 16.1%, respectively. Thromboembolism rate was 81 and 64.2%, respectively. One-year survival was 78.7 and 71.4%, two-year survival 66.5 and 61.7%, three-year survival 66.5 and 49.4%, five-year survival - 51.7 and 32.9% in vegetations < 1 cm and > 1 cm, respectively. Valvular regurgitation of the first degree was in 17.5%, of the second degree - in 41.9%, thirdfourth degree - in 36.6% patients. Hospital lethality in mitral valve failure was 32.1%, in aortic and tricuspid failure - 17.8 and 11.4%, respectively. Conclusion. EchoCG was most effective for predicting thromboembolism and cardiac failure. Valvular regurgitation of the third-fourth degree significantly correlates with severe cardiac failure. ECG is less informative for predicting hospital lethality.

Aim. To specify mechanisms of bronchial obstruction in bronchoectasia (BE). Material and methods. Clinical, x-ray, bronchological and spirographic examinations with broncholytic test were made in 26 BE patients aged 16-66 years (14 males, 12 females). The membrane-receptor complex of erythrocytes was based on the effect of adrenoantagonist propranolol on osmotic erythrocytic resistance (obsidan test) and effect of adrenoagonist adrenalin on dynamics of ESR. Results. Allergological anamnesis was detected in 69% of BE patients, hereditary atlergological anamnesis - in 22%, membrane-receptor changes characteristic for atopic condition by obsidan test - in 46%, fractional erythrocytic sedimentation with adrenalin - in 42%. Bronchoobstruction syndrome occurred in 37% cases with mean values FEV1 46 ± 6.2%, MSVS0 17.4 ± 3%, MSV75 14.4 ± 0.9%. The broncholytic test detected a mean increment of FEV, by 12.2 ± 3.1%. Latent bronchospasm was revealed in 33% patients with BE. Conclusion. The correlation analysis suggests that among mechanisms of bronchial obstruction in bronchoectasia, bronchospasm is of great importance especially in allergological anamnesis pathogene- sis of which involves disorders of membrane-receptor complex.

Aim. To estimate platelet and endothelial condition in pregnant women with chronic glomerulonephritis (CGN), prognostic value of these changes and efficacy of acetylsalicylic acid (ASA) and dipiridamol in prevention of unfavourable outcomes of pregnancy in CGN. Material and methods. The examination covered 74 CGN pregnant patients, 14 non-pregnant CGN patients, 11 pregnant women with preeclampsia, 19 healthy pregnant women. The levels offlbronectin, endothelin -1,2, 6-keto-PGFla, thromboxane B/TxB^ secretory beta-thromboglobulin in the blood, activity of intrathrombocytic lactatedehydrogenase (LHG), platelet aggregation. ASA (125 mg/day) was given to 33 CGN pregnant women in combination with dipiridamol (150-225 mg/day). Control group consisted of 32 CGN pregnant women. Results. Content of fibronectin, endothelin, TxB2 and beta-thromboglobulin in blood plasm, aggregation with ADP in CGN pregnant women were higher than in healthy pregnant women and nonpregnant CGN patients. Plasmic 6-keto-PGFla was low. Preeclampsia was accompanied with elevated fibronectin, TxB2 and beta-thromboglobulin, hyperactive LDH. Platelet aggregation was suppressed. Blood beta-thromboglobulin directly correlated with systolic and diastolic arterial pressure, 24-h proteinuria and blood creatinine. Reverse Correlation was seen in blood beta-thromboglobulin with albuminemia, glomerular filtration rate, body mass of the newborn and term of labor. A direct correlation was found between the activity of intrathrombocytic LDH and systolic and diastolic arterial pressure, a weak reverse correlation - between platelet count in capillary blood and systolic pressure, platelet aggregation with ADP and terms of labor. Of the highest prognostic value were the level of beta-thromboglobulin and fibronectin, the activity of intrathrombocytic LDH and platelet aggregation in response to ADP. ASA and dipiridamol reduced the risk of fetal retardation and fetal loss. Conclusion. Pregnant women with CGN have endothelial-thronbocytic dysfunction because of unidirectional influence of both CGN and pregnancy. We think that endothelial-platelet dysfunction connects renal impairment and placental failure in pregnant women with CGN deteriorating a gestational CGN and pregnancy complications. Correction of endothelial-platelet state with ASA and dipiridamol is effective in prevention of fetal retardation and fetal loss in pregnant women with CGN.

Aim. To characterize patients with mixed myeloid neoplasias with proliferation of neutrophils, platelets and eosinophils. Material and methods. Examination and treatment results were analysed for patients with atypical myeloid leukemia (n = 4), myelodysplastic syndrome (MDS, n = 1) and thrombocytosis, MDS and eosinophilia (n = I). The examination included morphological, histological, cytogenetic and molecular tests. Results. One patient with atypical chronic myeloid leukemia was prior diagnosed to have primarily MDS with a typical aberration of chromosome 5. Two other patients had an initial morphological picture of resistant anemia with blast excess, signs of myeloproliferation and extramedullar hemopoiesis. One and two months after the first examination they received transfusions of erythrocytic mass. Just then they were found to have splenomegaly and leukocytosis due to proliferating and maturating forms of neutrophils. The course of the disease in patients with MDS, thrombocytosis and normal karyotype and in patients with MDS, eosinophilia and combined chromosomal breaks including translocation (3;12)(q21;pl3) was characterized by resistance to standard programs of polychemotherapy and transformation into acute myeloblasts leukemia. Conclusion. In some cases atypical CML is a stage of a natural course of MDS. Some MDS variants with eosinophilia and thrombocytosis should be referred to the group of mixed myeloid neoplasias.