Vol 78, No 8 (2003)

Aim. Assessment of clinical and angiographic results of a balloon-expandable steel matrix stent TAIS in patients with atherosclerosis of the coronary arteries with no history of previous interventions in the course of an open non-randomized multicenter trial. Material and methods. The TAIS stent was implanted in 187patients into 199 stenoses. 47% patients had clinical manifestations of unstable angina pectoris. 29% cases were complicated. The length of the stenoses reached 11.3 ± 5.4 mm, 22% stenoses were prolonged. Results. This coronary stenting was effective in 100% cases, neither acute nor subacute thromboses were seen. Myocardial infarction without occlusion of the stent developed in 3 patients. The incidence of cardial complications (death, angina, restenosis, repeated revascularization) in 6 month follow-up was 11.8%. An angiographic control in 6 months was made in 184 patients (194 stenoses). The vascular diameter loss index was 0.40 ± 0.21, a restenosis level - 10.7%. A logistic regression analysis has revealed significant correlations between the length of the stent and a target vascular diameter with subsequent restenosis. Repeated revascularization was performed in all the patients with stent restenosis. After control angiography cardiac complications developed in 13.9% patients. Nine month follow-up registered cardiac complications in 17.6% cases. Conclusion. The TAIS stent was found effective in prevention of thrombosis and restenosis in patients with a relatively high risk of intervention

Aim. To evaluate efficacy and tolerance of a compound drug co-renitec combining an ACE inhibitor enalapril maleate and diuretic hydrochlorothiazide co-renitec taken for 16 weeks in essential hypertension (EH). Material and methods. 28 patients with EH (16 males and 12 females aged 47-74 years) of mean duration 13.1+1.6 years. Blood pressure (Bp) was monitored for 24 hours with the device SL 90207 (SpaceLabs Medical, USA). Microalbuminuria (MAD) was estimated with the use of immunoturbodimetric test. Results. By 24-hour monitoring, co-renitec reduced day BP by 14.9/8.9 ± 3/2 mm Hg, nocturnal BP lowered by 18.6/11.4 ± 3/2 mmHg, pulse pressure also fell. Coefficient T/P was 53.5% for systolic BP (SBP) and 59.6% for diastolic BP (DBP). The target SBP was reached in 77% patients, target DBP -in 69%. Co-renitec significantly decreased MAU, albumines excretion normalized in 46% patients. Conclusion. Co-renitec lowers both day and nocturnal blood pressure, improves 24-h rhythm of BP, has a positive effect on the kidneys. This allows its recommendation as a first-line drug in patients with moderate and severe EH.

Aim. To examine clinical efficiency and safety of moderate hydrogen sulfide (HS) baths in the treatment of hypertensive patients living in arid zones. Material and methods. Sixty patients with stable essential hypertension (EH) of stage I-1 I according to WHO classification living in arid climate took sparing HS baths. Efficiency of the baths was assessed by changes in blood pressure (BP), 24-h monitoring ofBP. Results. It is shown that systolic and diastolic BP after HS balneotherapy fell significantly both in daytime and at night. The 24-h profile of BP improved, heart rate decreased by 4.3%, physiological fluctuations of BP and BP variability were not damaged. Conclusion. Moderate HS baths are recommended for wider use in a hot climate of the arid zone as an effective and safe method of balneotherapy which can be adjuvant to basic medication of EH.

Aim. To study effects of cordaron on central hemodynamics reflecting systolic and diastolic functions of the left ventricle (LV) in patients with a mixed form of chronic cardiac failure - a systolic dysfunction and L V diastolic dysfunction type I. Material and methods. 14 patients with a mixed form of chronic heart failure (CHF) and cardiac arhythmia were followed up for 6 months. All the patients received ACE inhibitors, diuretics, nitrates and, additionally, cordaron in a supporting dose 200-300 mg/day. Control of central hemodynamics was made with echocardiography before, 1, 3 and 6 months of therapy. Results. For 6 months of therapy LV ejection fraction increased by 16%. LV diastolic function improved, primarily, due to a rise of the E max (by 52% for 6 months of therapy). This reflected early diastolic filling of the LV. Improvement of LV diastolic function was associated with heart rate desrease. Conclusion. Cordaron used in addition to ACE inhibitors, diuretics, nitrates improves both systolic and diastolic LV function in patients with a mixed form of CHF.

Aim, To study clinicomorphological efficacy of inhalation glucocorticosteroid budesonide (benacort, Pulmomed, Russia) in bronchial asthma. Material and methods. Twenty patients with bronchial asthma were treated with budesonide. Results. A response to budesonide was manifest to the end of treatment week 1. Budesonide reduced frequency of acute asthma episodes and the need in inhalations of short-acting $2-agonists. The peak expiratory velocity (PEV) rose by 12% in three months, variability of PEV lowered by 13%, in 6 months by 21%o, in 12 months by 31% compared to pretreatment values. In 12 months hypersecretion and thickness of basal membrane decreased. Three-month treatment also reduced eosinophil and lymphocyte epithelial count and cell density of stromal infdtrate in bronchial mucosa. In 12 months cell density of stromal infdtrate diminished. Conclusion. Bronchial asthma treatment with budesonide for 12 months reduces 24 hour rate of acute asthma episodes, the need in the disease exacerbations, improves functional indices of respiration but morphological composition of bronchial mucosa does not normalize completely this showing the necessity of longer budesonide administration

Aim. To study effectiveness of a new psychocorrection method (combined use of neuroleptic trifluoperasine and psychorelaxation therapy using biological feedback) in rehabilitation of patients with longterm pain syndrome provoked by spinal osteochondrosis (SOC) to determine predictors of response to this method of psychocorrection. Material and methods. 132 patients with SOC and associated pain syndrome were examined using pain assessing methods and psychological tests. Results. Psychocorrection including neuroleptic significantly raises the efficacy of SOC treatment and relieves pain, hypochondric fixations and depressive disorders. The reduction of pain syndrome intensity in the course of psychocorrection correlates with attenuation of hypochondric disorders and inclination to fixation. As to predictors of the treatment effect, the strongest relief of pain in psychocorrection was achieved in patients with hypochondric and anxiodepressive disorders. Conclusion. Combined psychocorrection comprising minimal doses of neuroleptic trifluoperasine and psychorelaxation is effective in the treatment of SOC patients with long-term pain syndrome.

Aim. To evaluate efficacy and tolerance ofglivek in chronic myeloid leukemia (CML) in patients who failed interferon-alpha (If-a) preparations. Material and methods. 79 patients in a chronic phase of Ph+CML with hematological and cytogenetic resistance or intolerance of If-a. The response to glivec was assessed by achievement of a complete hematological remission and the cytogenetic effect (the degree of reduction of cell clone Ph+ in bone marrow). Tolerance and safety of the drug was studied by monthly standard clinicohematological tests. Results. Not only a hematological remission (92.4%), but also partial (46.8%) or complete (27.8%) elimination of BCR-ABL±cells were achieved after 12 months of the treatment. Glivec was well tolerated. Hematological toxicity primarily as neutropenia and thrombocytopenia were observed in 54.4 and 42% patients, respectively. Neutropenia of the third degree which made impossible to continue the treatment was observed in 29.1% patients; throbocytopenia of the third degree was registered in 16.5% patients. Among most frequent поп-hematological side effects there were moderate edema, nausea, leg muscle convulsions, weight gain, arthralgias, skin eruption. All the complications were transient, were managed in all cases with only a short-time discontinuation of glivec therapy. Conclusion. High activity of glivec at early stages of CML allows using this drug as a first-line therapy in patients with CML

Aim. To study efficacy of thyroxine (TX) and potassium iodide (PI) in the treatment of benign nodular thyroid lesions (BNTL). Material and methods. 118 patients with BNTL (colloid or colloid hypercellular as shown by thin needle aspiration biopsy, 'cold" or "warm" by scyntigraphy findings) were randomized into two groups: 59 patients were given thyroxin and the other 59 patients PI. The day dose of TX (75-150 meg) was prescribed according to serum concentration of TTH trying to diminish it to 0.5 mIU/l and lower. PI dose was 200 meg/day. Most of the patients were treated for 6 months. The response was evaluated with ultrasound investigation which measured thyroid volume, the size and number of the nodes in it before and in the end of therapy. The treatment was found effective if the dominant node decreased in size by 50% and more compared to pretreatment values. Results. The size of the dominant node decreased by 50% and more in 14 of 59 (23.73%) patients on TX and in 20 of 59 (33.90%) patients on PI. Both TX and PI prevented growth of the dominant node size and number of the nodes in approximately 2/3 cases. TX was more effective in young patients (40.92 ± 3.45 years) vs older ones (47.50 ± 1.46 years, p = 0.047) and patients with colloid nodes. PI was more effective in patients with shorter node existence (3.93 ± 1.21 and 8.59 ± 1.74 months, p = 0.02). TX reduced thyroid volume from 20.42 ± 1.69 to 15.18 ± 1.30 ml (p = 0.001), PI -from 18.34 ± 1.57 to 15.36 ± 1.25 ml (p = 0.001). Conclusion. TX and PI can inhibit or prevent the growth of thyroid benign nodes in approximately 2/3 patients especially in young patients with colloid nodes (TX) and in short existence of the node (PI).

Aim. To study changes in some components of stress-realizing system (SRS) and stress-limiting system (SLS) characterizing compensatory mechanisms in acute disturbance of cerebral circulation (ADCC). Material and methods. The activities of SRS and SLS were assessed in 94 patients by changes in the concentrations of glutamate, aspartate, acid phosphatase for SRS and gamma-aminobutyric acid (GABA) for SLS, respectively. Results. After analysis of clinicobiochemical correlations the following clinical phases were singled out: subcompensation, moderate decompensation, severe decompensation and terminal. The phase conversion depended on quantitative changes of SRS and SLS activity. This enabled characterization of severity in certain time periods. Imbalance was revealed between SRS and SLS because of hyperactivation or hypoactivation of one of the above systems. Conclusion. Imbalance between SRS and SLS converts stress-syndrome from nonspecific link of adaptation into a nonspecific link of the disease pathogenesis.