Vol 79, No 11 (2004)

Aim. To assess diagnostic value of electron-beam computed tomography and multislice computed tomography (EBT and MSCT) for diagnosis of congenital anomalies of coronary arteries (CA). Material and methods. Non-invasive coronary angiography with EBT and MSCT has been performed in 1162 patients. Results. Different anomalies of coronary arteries have been found in 10 (0.9%) patients. Results of EBT and MSCT agreed with those of coronary angiography performed in 8 cases with CA anomalies. Though 720 of 1162 patients had coronary stenoses, no significant atherosclerotic lesions were found in anomalous CA. Conclusion. EBT and MSCT enable non-invasive screening and diagnosis of coronary arteries anomalies.

Aim. To assess efficacy of computed electrocardiotopography (CECT) in diagnosis of myocardial infarction (MI) complicated by a complete block of His' bundle left branch (HBLB). Material and methods. Twenty two patients with a complete block of HBLB have undergone CECT (hardware Rhythm-M, software "Rhythm"and "Heart"). Results. Five patients had no scars. The rest 17 patients had MI. The diagnosis of MI was definite by ECG in 6(35%) patients. In 11 (65%) patients MI diagnosis by ECG was doubtful. Only CECT detected typical for MI changes in the QRS changes. Conclusion. CECT can significantly detect scars in the myocardium in a complete block of HBLB and improves diagnostic potential of ECG.

Aim. To analyse clinical manifestations of congenital pulmonary artery stenosis (CPAS) and right ventricular outlet stenosis (RVOS), development of its diagnosis depending on anatomic variants of heart disease. Material and methods. The data on 539 patients examined with conventional clinical and highly in- formative novel techniques were studied. Results. The analysis of the CPAS and RVOS clinical picture depending on the anatomic variant of the heart disease has shown that clinical symptomatology was of the same type. The data of the tests have some specific features allowing identification of some forms of the heart disease. Conclusion. Diagnostic and prognostic significance of the findings was determined which gave rise to an optimal examination scheme with focus on wider use of highly informative techniques.

Aim. Detection of clinico-paraclinical features of arterial hypertension (AH) in adolescents with different physical constitution including signs of metabolic syndrome (MS). Material and methods. Blood levels of uric acid, cholesterol, triglycerides (TG), high and low density lipoproteins were examined and glucose tolerance test was made in 108 adolescents with arterial hypertension (AH) and different physical constitution (normal, with overweight and obese). Waist and hip distribution of fat was assessed. The control group consisted of JOS healthy adolescents. Results. Most of the hypertensive children had hyperuricemia (HU), some of the patients combined HU with changes in glycemic profde of blood. The above abnormalities were especially evident in patients with MS who were characterized by abdominal obesity, higher blood pressure, subnormal high density lipoproteins, higher triglycerides and total cholesterol in blood, more severe HU and defects in glycemic profde of blood. Conclusion. MS in adolescents may be of genetic origin as well as constitutional HU and insulin resistance may be mutually dependent signs combination of which with other factors presents the whole spectrum of clinical and paraclinical manifestations of MS. Detection of HU and insulin resistance with their correction in a preclinical disease stage (in children and adolescents) may represent a new line in prevention of AH and MS in adults.

Aim. To examine relationships between incidence rate of thromboses in antiphopholipid syndrome and exogenic risk factors (RF) of thrombosis. Material and methods. The trial enrolled 131 patients (105 females and 26 males). They were divided into three groups: 23 patients with systemic lupus erythematosus (SLE, group 1), 63 patients with SLE and antiphospholipid syndrome (APS, group 2), 45 patients with primary APS (PAPS, group 3). Thrombosis RF questionnaire survey was made. Effects of corticosteroids and cyclophosphamide on occurrence of thrombosis were assessed. Results. Such exogenic RF as intake of coffee, fat food, alcohol were not related to thromboses. Hypodynamia was more typical for APS patients (21.3%) than for SLE patients free of APS (8.7%). Overweight for was characteristic for APS patients (49 and 34.7%, respectively). The proportion of smokers was higher in APS patients, though smoking did not provoke thrombotic complications. A direct correlation was found between occlusion and corticosteroids administration, while occlusion and cyclophosphamide treatment correlated inversely. Conclusion. Venous thrombosis RF in patients with APS and PAPS are obesity and treatment with glucocorticosteroids

Aim. To examine relationships between genital prolapse and joint hypermobility (JHM), between GP severity and degree of JHM, to reveal causes of GP in JHM patients. Material and methods. A total of 208 females with GP (meam age 38.9 years) entered the trial. They were divided into three groups by severity of connective tissue dysplasia (CTD): with mild CTD -16.3%, moderate CTD - 35.6% and severe CTD - 48.1%. The following methods of investigation were used: podometric Freedland's technique, ultrasonic investigation of the gall bladder, kidneys, echocardiography, morphological study of platelets, morphological and immunohistochemical study of the ligaments. Results. In GP patients JHM occurred in 41.8% patients. Hypermobility of large joints reaches 38.9%, large - 20.7%. Such associated manifestations of CTD as flatfoot, JHM, deformation of the spine, varicosity, predisposition to vegetovascular dysfunctions, mitral prolapse, arrhythmia, impaired conduction, refraction, gastroptosis, nephroptosis, hernias were observed in 69.2, 46.1, 38, 53.8, 49, 43.3, 38, 19.2, 12, 6.7, 14.4%, respectively. The morphological changes are explained by 40 + 15% type 1-3 collagen loss in the interstitial substance. Severe forms of GP in patients with JHM were ob- served in 84%. 52.4% females with JHM developed severe GP within 3 years after delivery of a child. Most of the examinees carried undifferentiated congenital dysplasias. Conclusion. JHM is a criterion of CTD diagnosis

Aim. To study efficacy of the chondroprotector chondroitin sulphate (structum, Pier Fabr Medicament Production, France) in patients with rheumatoid arthritis (RA) and secondary osteoarthrosis of the knee joints. Material and methods. 15 women with a long history of RA (mean duration 11.9 years) entered an open non-randomized trial of structum. The patients had a severe progressive highly active RA with a definite x-ray stage of the disease. 13 patients had a positive rheumatoid factor (1:80 to 1:1280) and involved knee joints which had been affected for 1 to 10 years (mean 5.3 years). The second x-ray stage was in 8 patients, the third stage of knee joints arthrosis was in 7 ones. A marked pain syndrome in the knee joints upon movement (mean 64.7 mm by VAS) was observed in all the examinees and at rest (mean 28 mm by VAS) in 13 of 15 patients. Structum was given according to a standard scheme: 500 mg 3 times a day for 3 weeks than 500 mg 2 times a day for up to 6 months. Basic drugs for RA were the same for all the observation period. Results. Structum noticeably improved knee joint function (mean Leken's index 12.8, 11.3 and 9.4 scores before the treatment, on treatment month 3 and 6. Movement pain syndrome VAS reduced from 64.7 mm at the strart to 51 mm 3 months and 37.5 mm 6 months later, rest VAS - from 19 to 10.3 and 6.4 mm, respectively. The demand in intraarticular glucocorticoids went down from 52 injections at the start of therapy to 6 after 6 months. Side effects for 6 months were absent. Overall efficacy was good (73.3% and 80%) as judged by the doctors and patients, respectively. After 6 months of therapy control x-rays found no progression of destructive changes in the knee joints (by MRI - in 4 patients). Conclusion. Structum has a marked positive therapeutic effect in patients with severe and long-term course of RA with associated pronounced secondary joint arthrosis.

Aim. To ascertain hypomagnesemia (HM) rate in patients with chronic alcoholism (CA) with alcohol withdrawal syndrome (AWS); correlation between AWS severity and HM rate. Material and methods. Mg in plasm was measured at photometry in 129 CA patients treated in Kaunas Mental Hospital. Results. Plasma Mg in CA patients with A WS was reduced (< 0.749 mmol/l), normal (0.750-1.250 mmol/l) or high (> 1.251 mmol/l) in 28.7, 65.1 and 6.2% patients, respectively. HM was diagnosed in 42.3% with a severe, 19.1% with a moderate and 20.0% with weak AWS. Conclusion. HM in AWS was registered in 28.7% patients. It occurred significantly more frequently (p < 0.05) in patients with a severe AWS. Pathogenetic mechanisms of HM in AWS are described