Vol 78, No 4 (2003)
- Year: 2003
- Articles: 28
- URL: https://journals.rcsi.science/0040-3660/issue/view/1665
Editorial article
Leading trends in perfection of diagnosis and growing importance of invasive investigation methods
Terapevticheskii arkhiv. 2003;78(4):5-7
5-7
Current diagnostic and therapeutic aspects of symptomatic arterial hypertension of adrenal genesis
Abstract
Aim. To analyse the experience in diagnosis and treatment of arterial hypertension (AH) of adrenal genesis.
Material and methods. A total of 243 patients with adrenal AH (mean age 46.3 ± 3.2 years) were examined. 134 of them had endogenic adrenohypercorticism (EAH), 62 - primary hyperaldosteronism (PHA), 47 - chromaffin tissue tumors (CTT). Diurnal urinary excretion of adrenal hormones (epinephrine, norepinephrine, aldosteron, hydrocortisone) and peripheral blood hormones (aldosteron, renin, hydrocortisone, ACTH) were measured. Topic diagnosis was made with ultrasound, computed tomography, MR-imaging, angiography, adrenal venous sampling and l2JI-MIBG scintigraphy. Results. Adrenalectomy was made in 224 patients (predominantly with tumor lesions). 19 patients (idiopathic hyperaldosteronism, advanced adrenocortical carcinoma) were treated conservatively (calcium antagonists, ACE inhibitors, ATI-receptor blockers, spironolacton). Good results of the surgical treatment were achieved in 60% patients with aldosterone-producing adenoma and adrenal Cushing's syndrome as well as in 80.5% patients with pheochromocytoma. Long-term outcomes depend on hypertension duration, histologic type of the tumor, age and family hypertension history (risk of essential hypertension).
Conclusion. Hypertension of adrenal origin occurs more frequently than it was supposed previously. Its late diagnosis may be due to lack of typical signs and symptoms, insufficient application of novel diagnostic techniques and poor alertness of physicians, ft is recommended to include tests for adrenal hormones in urine and blood and ultrasound investigation of the adrenals in a complex of primary examination of patients with severe refractory hypertension.
Terapevticheskii arkhiv. 2003;78(4):8-15
8-15
Role of electron-beam tomography in diagnosis of patency of aortocoronary and mammarocoronary bypasses (by 3-year follow-up data)
Abstract
Aim. To assess informative value of electron-beam tomography (EBT) and to compare dynamics of occlusive defects of autovenous and autoarterial shunts.
Material and methods. 36 patients with coronary heart disease entered the study. All the patients have undergone coronary artery bypass operation and/or mammarocoronary bypass operation (CABO and MCBO, respectively). For three years after the surgery the patients were annually examined with EBT-shuntography. The contrast agent was injected intravenously in a dose 135-140 ml with the injection rate 3.5-4.0 ml/s. In addition to EBT-shuntography, selective x-ray contrast shuntography was conducted one year after CABO.
Results. By a comparative analysis, EBT sensitivity and specificity in examination of autovenous shunts patency is 100%, in assessment of patency of mammary shunts is 93 and 100%, respectively. The 3-year retrospective analysis has revealed occlusions in 17.1% venous shunts and 2.7% arterial ones in the first year after CABO and MCBO, 5.2 and 2.8% in the second year, respectively, and in 1.8% venous shunts in the third year.
Conclusion. EBT-shuntography is a highly informative non-invasive method of diagnosis of aortocoronary shunts patency.
Terapevticheskii arkhiv. 2003;78(4):15-19
15-19
Assessment of myocardial perfusion in patients with hypertrophic cardiomyopathy in comparison with clinical and echocardiographic data
Abstract
Aim. To study peculiarities of myocardial perfusion in patients with hypertrophic cardiomyopathy (HCMP) in correlation with clinical and echocardiographic data.
Material and methods. 62 patients with HCMP (23 females and 39 males, mean age 44.4 ± 11.2 years, the disease duration 13.0 + 10.4 years) have undergone ECG, 24-h ECG monitoring, echocardiography, perfusion scintigraphy of the myocardium with 99m-TcMIBI at rest and in combination with bicycle ergometry. The patients were divided into two groups: 35 patients of group 1 had moderate left ventricular hypertrophy (the septal thickness in diastole under 20 mm; 27 patients of group 2 had severe hypertrophy (the tickness was over 20 mm).
Results. Dyspnea and syncopal states occurred more frequently in patients from group 2. They also had a higher functional class of heart failure (2.0 ± 0.8 and 1.2 ± 0.7 for group 1 and 2, respectively, p < 0.05). Cardiac performance was significantly higher in patients of group 1. The size of the left atrium, left ventricular myocardium mass, the septal thickness and thickness of posterior wall of the left ventricle, gradient of pressure in the outflow tract of the left ventricle proved higher in patients of group 2. Deep stable defects of myocardial perfusion were detected in 5 (15%) patients of group 1 and 10 (37%) patients of group 2. Transient defects of myocardial perfusion were found in 9 (26%) patients of group 1 and 12 (44%) patients of group 2. The index of myocardial ischemia in group 1 patients was significantly lower than in patients of group 2 (3.5 + 2.2 and 8.3 ± 2.5, respectively, p < 0.05).
Conclusion. Patients with severe hypertrophy of the left ventricle had severe clinical picture, low exercise tolerance, marked hemodynamic changes, more frequent defects of left ventricular perfusion defects compared to patients with moderate hypertrophy of the left ventricular myocardium.
Terapevticheskii arkhiv. 2003;78(4):20-25
20-25
Role of computed angiopulmonography in current diagnosis of pulmonary artery thromboembolism
Abstract
Aim. To study potentialities of tomographic methods in diagnosis of pulmonary artery thromboembolism (PATE).
Material and methods. Electron-beam tomography (EBT) was used for diagnosis in 34 patients (mean age 41.3 ± 16.5 years) suspected of PATE (Imatron C-150 unit, USA). The procedure included standard examination of the lungs and EBT angiopulmonography in intravenous introduction of the contrast agent (80-100 ml, the rate 3-3.5 ml/s).
Results. The pulmonary artery was found to contain thrombi in 56% patients. 18% of PATE patients had pulmonary infarction. A complete coincidence of EBT and scintigraphy was registered in 31% cases, no PATE by both methods was in 19% cases. Angiopulmonography and EBT findings were the same. In 1 case the result of pulmonary scintigraphy was false negative. 24% patients showed symptoms of thrombophlebitis or varicosity of the lower limbs. EBT has detected signs of PATE in 83% of them.
Conclusion. EBT-angiopulmonography is a precise, highly informative поп-invasive method in diagnosis of PATE.
Terapevticheskii arkhiv. 2003;78(4):25-29
25-29
Pilot data on assessment of exercise tolerance, myocardial perfusion and left ventricular contractile function in patients with coronary heart disease treated with bradycardic drugs
Abstract
Цель исследования. Изучение влияния брадикардии при приеме атенолола, дилтиазема и ивабрадина на толерантность к физической нагрузке, перфузию миокарда и сократительную функцию левого желудочка у больных стабильной стенокардией.
Материалы и методы. В исследование включили 7 мужчин (возраст 57 + 2,6 года) с ИБС и стабильной стенокардией II функционального класса, не имеющих признаков сердечной недостаточности и неконтролируемой артериальной гипертонии, с положительными и воспроизводимыми результатами ВЭМ-пробы (ВЭМП) после отмены терапии. Все больные последовательно по 10 дней получали атенолол, дилтиазем и брадикардический агент S16257 (ивабрадин) в дозах, снижающих ЧСС в покое на 20% от исходного уровня (с перерывом между приемами препаратов 5 дней). До начала исследования проводили ВЭМП; перфузионную синхронизированную однофотонную эмиссионную компьютерную томосцинтиграфию (СОЭКТ) миокарда в покое и при пробе с физической нагрузкой. На 10-й день приема каждого из препаратов при достижении планируемой ЧСС выполняли СОЭКТ в сочетании с ВЭМП. Результаты. На фоне приема каждого препарата проходило снижение ЧСС в покое на 22- 24%, что сопровождалось достоверным увеличением продолжительности нагрузки, объема выполненной работы, улучшением перфузии миокарда. Достоверных изменений сократительной функции левого желудочка при исследовании не выявлено.
Заключение. Снижение ЧСС в покое на 20% от исходного уровня на фоне монотерапии препаратами с брадикардическим эффектом сопровождается увеличением толерантности к физической нагрузке и улучшением перфузии миокарда.
Terapevticheskii arkhiv. 2003;78(4):29-33
29-33
Sjogren's syndrome in chronic hepatitis C: clinical features and diagnosis
Abstract
Aim. To examine clinical features of Sjogren's syndrome (SS) and morphological picture of the lesser salivary glands (LSG) in chronic hepatitis С (СНС).
Material and methods. The examination of 42 patients with SS and chronic HCV infection (mean age 44.3 ± 13.7 years) has detected signs of chronic hepatitis and hepatic cirrhosis, respectively, in 31 (71.4%) and 11 (26.2%) patients. "Dry syndrome" was diagnosed by criteria of European SS Study Group. LSG biopsy of the lower lip was conducted in 23 (54.7%) of 42 patients. Results. The "dry" syndrome in CHC ran subclinically in 73.8% patients. Apparent symptoms of SS were seen primarily in middle-aged and aged women with CHC history over 10 years. The first signs of SS occurred in 25 (59.5%) patients 2.9+3.1 years prior to diagnosis of hepatic disease. All the patients had xerostomy. Xerophthalmia was recorded 1.5 times less frequently. In 16 (47.1%) patients with CHC "dry eye" and in 6 (17.6%) patients dry keratoconjunctivitis were detected. Pathohistological changes of LSG were diagnosed in 21 (91.3%) of 23 patients with CHC. In the majority of cases (86.9%) the glands exhibited insignificant inflammatory infiltration and advanced fibrosis. LSG in CHC is characterized by fibrosis prevalence over cell infiltration. 83.3% CHC patients had SS and other extrahepatic lesions. SS was most evident in 28.6% CHC patients with cryoglobulinemia. Conclusion. Registration of SS symptoms in CHC patients depends on targeted examination of patients with chronic HCV infection. The severity of the symptoms correlates directly with the infection duration and age of the patient. LSG lesions in CHC patients with SS are characterized by fibrosis predomination over cell infiltration.
Terapevticheskii arkhiv. 2003;78(4):33-37
33-37
Puncture biopsy in diagnosis of primary mediastinal tumor
Abstract
Aim. To assess the potential of biopsies with the thick cutting needle of anterior mediastinum tumor. Material and methods. Biopsy with the use of the thick cutting needle (Baxter Healthcare Corporation, length 150 mm, thickness 2.5 mm, length of the cutting channel 20 mm) of a primary mediastinal tumor was made in 12 patients.
Results. The findings were the following: 8 cases of primary mediastinal B-cell lymphosarcoma, 1 case of T-cell lymphosarcoma with involvement of the mediastinum, 2 cases of thymic carcinoma, 1 case of pituitary tumor. Mediastinal puncture was controlled by ultrasound which secured accurate position of the needle and safe conduction of the puncture.
Conclusion. Puncture biopsy with the thick cutting needle of anterior mediastinum tumor provides short duration of the diagnostic process and correction of the treatment policy.
Terapevticheskii arkhiv. 2003;78(4):37-40
37-40
Plasmic activity of phospholipid membranes in nephritis
Abstract
Aim. To study activity of plasmic phospholipid membranes (PPM) in patients with chronic nephritis (CN) as regards clinical-laboratory and morphological characteristics of the disease. Material and methods. 10 patients with chronic mesangial glomerulonephritis (CMG) and 4 patients with chronic drug-induced tubulointerstitial nephritis were examined. All the patients had moderate arterial hypertension including 5 patients with CMG combined with nephrotic syndrome. 9 patients had elevated blood creatinine (up to 500 mcmol/l). Measurements were made of routine laboratory indices, blood coagulation andparacoagulation, Willebrand's factor (WF), aggregation time (AT), phospholipid activation of blood coagulation (FABC), morphological indices of activity and sclerosis. Results. In spite of chronic latent intravascular blood coagulation, CN was characterized by apparent lowering of FABC which was more evident in CMG. There was a weak correlation between a FABC fall and the level of proteinuria, lipidemia, AT of platelets, indices of activity. Some parallels exist between creatininemia and activity of PPM. A close reverse relationship was found between FABC and WF, and a direct one between FABC and sclerosis index.
Conclusion. Subnormal PPM activity in CN correlates with organic microthrombi formation and promotes the discussion of both mechanisms of FABC formation disturbances and possible ways of PPM consumption including enhanced diffusion into the mesangium in progressing nephrosclerosis.
Terapevticheskii arkhiv. 2003;78(4):40-44
40-44
Ileocecal valve insufficiency as a visceral manifestation of undifferentiated dysplasia of the connective tissue
Abstract
Aim. To study prevalence of markers of connective tissue dysplasia (CTD) in patients with primary insufficiency of ileocecal valve (PIIV).
Material and methods. The trial included 87 patients (21 men and 66 women aged 13 to 64 years) with irrigoscopy-documented barium reflux into the small intestine. The occurrence of external phenotypical markers of CTD was studied at general examination and antropometry, of visceral ones - at ultrasound investigation of the heart, abdominal organs and the kidneys. The state of the connective tissue was assessed by skin biopsy histology.
Results. PIIVpatients demonstrated a great number of dysembryogenic stigms typical for CTD: asthenic constitution, hypotrophy, chest deformation, foot and spine ligaments weakness, etc. A radial-lacunar type of the iris of the eye was described for the first times among external CTD phenotypical markers. Such visceral CTD markers as mitral prolapse, left ventricular false chorda, gallbladder deformity, nephroptosis occurred in the PIIV patients significantly more frequently. Morphological characteristics of the skin in PIIVpatients were similar to those registered in patients with cardial manifestations of CTD. Conclusion. The above external and visceral phenotypical markers and skin morphology give arguments for referring PHVto signs of CTD. Such position can open new prospects for pathogenetic treatment of PI IV.
Terapevticheskii arkhiv. 2003;78(4):44-46
44-46
Short- and long-term outcomes after implantation of coronary stent "EPHESOS" in patients with stable or unstable angina
Abstract
Aim. An open non-randomized trial was initiated to assess clinical and angiographic results of using the coronary stent "Ephesos" in 457patients with stable or unstable angina pectoris and native coronary affections.
Material and methods. 268 stents have been implanted in 231 patients with stable angina (SA) and 271 stents - in 226 patients with unstable angina (UA). 46% lesions were complicated. The length of stenosis was 12.9 ± 6.7 mm in the group SA and 14.1 ± 7.4 mm in the group UA, 30%? stenoses were long.
Results. Successful stenting was stated in 99%, without cases of acute thrombosis. Non-fatal myocardial infarction took place in hospital in 1.3% of SA patients and in 2.6% of UA patients. Incidence of cardiac complications (death, recurrent angina pectoris, myocardial infarction, restenosis, repeated revascularization) for 6-month follow-up was 15.6% in SA group and 18.1% in UA group. At angiographic control, the index of vascular diameter loss made up 0.22 ±0.2 in SA group and 0.3 ± 0.27 in UA group. Incidence of restenosis was 12 and 14%, respectively. 18-month follow-up found no differences in frequency of complications: 21.6 and 22.6%, in groups SA and UA, respectively. Conclusion. Implantation of the stent "Ephesos" is effective in prevention of thrombosis and restenosis in patients with stable or unstable angina pectoris at high risk of intervention.
Terapevticheskii arkhiv. 2003;78(4):47-51
47-51
Relationships between psychosocial risk factors and coronary heart disease in 25-64-year-old males of Novosibirsk: study on WHO program MONICA
Abstract
Aim. To study correlations between coronary heart disease (CHD) and psychosocial risk factors. Material and methods. CHD affected more frequently workers engaged in hard physical labour, in poorly educated persons; the least CHD morbidity was recorded in managers and highly educated persons. CHD males think of their health much worse than males free of CHD. The former smoked much more before CHD diagnosis, but when CHD comes they quit and reduce smoking much more frequently. This fact explains why smokers are encountered among CHD patients two times less frequently than in CHD-free males. In spite of stronger motivation for adequate diet, CHD males changed their nutrition pattern only in 3.7%. CHD males sleep worse: good sleep was registered in CHD-free males two times more frequently. Psychological risk factors such as personal anxiety, sleep disorders were reported much more frequently in CHD patients proving the fact of social stress involvement in development of CHD. So-called coronary behavior was observed in both groups of males with the same rate. Thus, the coronary behavior is not associated with CHD.
Conclusion. Development of CHD is associated not with the behavior but its components (depression, anxiety, etc.).
Terapevticheskii arkhiv. 2003;78(4):51-54
51-54
Comparative efficacy of lotensin vs Capoten in patients with chronic cardiac failure
Abstract
Aim. To compare clinical response to captopril (capoten) vs benazepril (lotensin) in patients with chronic cardiac failure (CCF) as well as their influence on central hemodynamics, some indices of platelet hemostasis, myocardial ischemia degree, exercise tolerance.
Material and methods. 54 patients with CCF (NYHA FC II and III) entered the trial. 26 patients received captopril (capoten) in a dose 25-75 mg/day (group 1) while 28patients were given benazepril (lotensin) in a dose 5-30 mg/day for 4 weeks (group 2). Group II was treated for the following 24 weeks. The results were assessed with electro- and echocardiography, bicycle exercise test, platelet aggregation measurement and by clinical symptoms.
Results. A positive clinical response was registered to both the drugs which improved the functional class, exercise tolerance, platelet aggregation, reduced the number of arrhythmia and myocardial ischemia episodes. Long-term treatment with lotensin resulted in further improvement of clinical and laboratory indices. Side effects, in which lotensin discontinuation is needed, were absent. Lotensin was more potent than capoten in reducing episodes of ST epression on ECG and episodes of painless myocardial ischemia.
Terapevticheskii arkhiv. 2003;78(4):54-58
54-58
Clinical assessment of primalan (mequitasine) in allergology
Abstract
Aim. To study efficacy of primalan (mequitasine) in the treatment of allergic rhinoconjunctivitis and chronic recurrent urticaria.
Material and methods. The study included 140 patients. Of them, 60 patients had allergic rhinitis, 80 patients had chronic recurrent urticaria. All the patients received primalan (mequitasin) in a dose 10 mg/day (5 mg twice daily or a single dose 10 mg). The disease symptoms and side effects of primalan were assessed for 28 days of the treatment.
Results. Primalan (mequitasin) proved to be highly effective against allergic rhinitis (good and very good response - 76%, satisfactory - 20%) and chronic recurrent urticaria (the response in 90% patients). Good primalan tolerance was reported. Side effects were moderate and did not require the drug withdrawal (sleepiness in 6.6%, dryness of the mucosa in 5%).
Conclusion. Primalan (mequitasin) can be recommended for wide application in therapy of allergic rhinitis and chronic recurrent urticaria.
Terapevticheskii arkhiv. 2003;78(4):58-60
58-60
A case of Ehlers-Danlos syndrome with consecutive formation of aneurysms of the femoral, common carotid arteries and aorta
Terapevticheskii arkhiv. 2003;78(4):60-62
60-62
Cases of transient myocardial ischemia diagnosis in complete His bundle blockades
Terapevticheskii arkhiv. 2003;78(4):62-64
62-64
A case of diagnosis of acute dissecting aneurysm of the thoracic aona complicated by pericarditis
Terapevticheskii arkhiv. 2003;78(4):64-65
64-65
Nodular polyarteritis: diagnostic difficulties
Terapevticheskii arkhiv. 2003;78(4):65-69
65-69
Long-term treatment of multifocal fibrosis
Terapevticheskii arkhiv. 2003;78(4):69-72
69-72
Endophitic esophageal cancer with isolated metastases to the right heart myocardium and massive thrombogenesis in their cavity
Terapevticheskii arkhiv. 2003;78(4):72-74
72-74
Erosive duodenojejunitis and enterogenic sepsis as a complication of celiac disease
Terapevticheskii arkhiv. 2003;78(4):74-76
74-76
Casuistic cases in differentiated diagnosis of gastric cancer
Terapevticheskii arkhiv. 2003;78(4):76-79
76-79
Prenatal diagnosis of congenital and hereditary diseases
Terapevticheskii arkhiv. 2003;78(4):80-84
80-84
Some aspects of laboratory diagnosis of viral hepatitis В and С
Terapevticheskii arkhiv. 2003;78(4):84-86
84-86
Principles of evidence-based medicine in drug therapy of circulatory diseases
Terapevticheskii arkhiv. 2003;78(4):87-90
87-90
Clinical perspectives of using scintigraphy with 123-1-MIBG for assessment of sympathetic nervous system of the myocardium
Terapevticheskii arkhiv. 2003;78(4):90-93
90-93
Vasily Mikhailovich Bogolyubov (the 70th anniversary of birth)
Terapevticheskii arkhiv. 2003;78(4):94-95
94-95
The results of the 26th international congress of the internists in Japan
Terapevticheskii arkhiv. 2003;78(4):95-95
95-95