Vol 83, No 4 (2011)

Fundamental investigations of the role of the endothelium and cell periphery in regulation of vascular tonicity in the last decade of the XX century brought a radical revision of the former conception of circulation. It was discovered that distribution of blood in the arteries depends on operational requirements of the tissues and organs, it is not determined by integrating mechanisms of neuroendocrine regulation. Problems of hemodynamics and microcirculation give rise to much discussion now because neurogenic hypophysis of cardiovascular disease development still has many supporters among medical profession. Progressive disturbances of circulation and hemodynamics may be produced by diseases known as nosological entities for many years. Arterial hypertension often plays a leading role in common polymorbid combinations. It is important to include in basic treatment additional modalities taking consideration of existing at the moment leading risk factors. This involves an individual approach to choice of therapy.

Primary lymphoma of the heart (non-Hodgkin's lymphoma primarily of B-cells affecting first the heart and pericardium) is a rare disease which accounts for 1.3-2.0% of all primary tumors of the heart. A case is reported of a 43-year-old male patient with a cardioverter-defibrillator implanted at the age of 38 years for management of ventricular tachycardia paroxysms and AB-block of the second-third degree. The patient also had hypertrophic cardiomyopathy, moderate pressure gradient on the pulmonary artery valve and pericardial effusion. Later he had two cardiac tamponades (serous punctuate). From the age of 42 years breathlessness, right ventricular wall thickness, right heart pressure and pulmonary artery pressure aggravated. The patient has undergone ballon plastic surgery of the pulmonary artery valve. At the age of 43 computed tomography detected massive tumor of the heart and mediastinum first diagnosed as sarcoma but later specified as lymphoma. Endobronchial biopsy specimens contained the tissue of diffuse large B-cell lymphoma, the liver and lymph nodes were also involved. After the first course of effective polychemotherapy (CHOP) the patient died of mesenterial thrombosis. Diagnostic difficulties and problems of treatment policy are discussed.

Aim. To develop new criteria of gastric and duodenal mucosa image assessment using endoscopic system for narrow band imaging (NBI). Material and methods. Endoscopic and morphological findings were compared in 460 patients with different chronic diseases of the stomach and duodenum. Esophagogastroduodenoscopy was made according to the standard technique by the gastroduodenoscope EVIS EXERA-II GIF H180 (Olympus, Japan) with NBI-system. Biopsy material was studied by standard pathomorphological techniques. Results. The novel system of the visual picture evaluation during conduction of endoscopic investigations in monochromatic light provides higher significance of identification of inflammatory and destructive processes in mucosa including foci of structural alterations, their location and extent. Conclusion. We propose a protocol for description of the endoscopic picture in conduction of examinations with application of the NBI-system of visualization in monochromatic light. It can help physicians to correctly estimate the image and interpret the detected changes.

Aim. To study informative value of 24-h pH monitoring in registration of gastroesophageal and duodenogastroesophageal reflux (GER, DGER) in patients with gastroesophageal reflux disease (GERD) before and after surgical treatment. Material and methods. A total of 39 GERD patients after laparoscopic fundoplication entered the study: 12 (39%) males and 27 (61%) females, mean age 47.6±3.2 years.pH monitoring was made with domestic device Gastroscan-24 before operation and one year after it. Esophagogastroscopy and polypositional roentgenoscopy of the upper gastroduodenal tract were made also before operation and after 1-year follow-up. Results. Before operation, mean pH in the gastric body was 1.7±1.28, De Meester index 40.4±8.91, esophageal acidity index (EAI) 22.3±1.59, the number of acid GER 59.2±9.41, number of DGER 14,3 ± 3,47. After laparoscopic fundoplication - 3.3±1.52, 8.7±5.71 (p < 0.05), 2.5±0.62 (p < 0.05), 24.4±8.6 (p < 0.05), 6.5±3.63, respectively. Five patients (12.8%) examined before the operation had clinicoendoscopic picture of GERD, but normal values of De Meester index and EAI. Conclusion. 24-h pH monitoring can estimate both gastroesophageal and duodenoesophagogastric refluxes, but esophageal and gastric pH monitoring only are not sufficient for decision on treatment policy. Such decision should be taken individually for each patient after the analysis of the results of complete clinical examination, symptoms and the disease history.

Aim. To assess a new method of automatic functional image for estimation of maximal systolic longitudinal strain of left ventricular (LV) myocardium in patients with sigmoid interventricular septum (IVS) with normal LV ejection fraction. Material and methods. Maximal systolic longitudinal strain was compared in patients with sigmoid IVS (SIVS) and in 21 patients of the control group. Results. Compared to controls, patients with SIVS have significantly greater global longitudinal systolic LV strain in two septal segments in the region of sigmoid-shape IVS. Conclusion. Local aggravation of maximal systolic longitudinal LV myocardium strain in SIVS zone can be one of the causes of dynamic obstruction of the efferent LV tract.

Aim. To study efficacy and safety of a new dose and dosage form of proxodolol - a beta-adrenoblocker with alpha1-adrenoblocking activity - in patients with moderate arterial hypertension (AH). Material and methods. A total of 60 patients with verified diagnosis of essential AH of the second degree were randomized into two groups: group 1 (n = 40) received proxodolol, group 2 (n = 20) was given carvedilol. The trial lasted for 89 days. Results. The trial demonstrates that proxodolol is highly effective and safe in the treatment of AH. Conclusion. Proxodolol is effective and safe in hypertension, in a dose 120 mg its activity is the same as carvedilol in a dose 25 mg.

Aim. To ascertain efficacy of modern treatment methods in idiopathic thrombocytopenic purpura (ITP), to characterize basic indications for administration of these methods; perspective trends in ITP therapy. Material and methods. The article presents 20-year experience in observation and treatment of 1000 ITP patients gained from 1988 by the department of standardization of blood disease treatment methods on the basis of a consultative and outpatient department of Hematological Research Center. The results were assessed by conventional ITP treatment lines. Results. First-line therapy - glucocorticoids - provided remission in 70% patients, long-term (60 months and longer) in 14%, prednisolone resistance was in 19% patients.Intravenous immunoglobulin provided a rapid hemostatic effect (in1-2 days) in all the patients. A positive response to treatment was seen in 86% patients but it was short-term (for a year and longer in 27%, resistance to the drug - 14%). Second line treatment -splenectomy - is the most effective treatment: 80% remission, 32% patients had remission for longer than 60 months. Resistance occurred in 6% patients. Ineffectiveness of treatment in 20% patients stimulated the search for new pathogenetic treatment among synthetic analogues of thrombopoietin. Clinical trials proved high efficacy of two of them - eltrombopag and romiplostim (86-87% response), possible maintenance of remission in long-term interrupted administration of low doses. Conclusion. Modern ITP treatment allows a complete management of hemorrhagic syndrome and deep thrombocytopeny in 80% patients with provision of good quality of life and ability to work. Introduction into clinical practice of thrombopoietin analogues improves treatment results including in 20% patients resistant to all treatments in the absence of marked side effects even in long-term 3-year administration of such medication.

A report is presented of a rare case of B-cell non-Hodgkin"s lymphoma and severe exacerbation of cryoglobulinic vasculitis which developed in a female patient with chronic hepatitis C four years after achievement of a persistent virusological response to antivirus treatment. Causes of a specific course of the disease and development of the tumor in the absence of HCV in blood serum are discussed: latent HCV-infection in immune cells with persistent antigenic stimulation of B-lymphocytes, possibility of HCV-independent lymphoproliferation.