The Journal of V. N. Karazin Kharkiv National University. Series «Medicine»

11-15

Authors: Derienko T. A., Volkov D. E., Lopin D. A., Yabluchansky M. I.

We observed 131 patients (70 men and 61 women) aged 69,5 ± 11,6 at the annual stage of drug therapy after implantation of pacemakers in the DDD / DDDR modes, VVI / VVIR and CRT-P / CRT-D. Patients were divided into 2 groups – I and II stage of AH. . In each group, the dose rate was defined in major groups of cardiac drugs at every stage of research. The results showed that the dose coefficient of the major groups of cardiac drugs in patients with pacemaker and AH was determined by the stage of AH, what is more AH stage III required higher doses of diuretics and anti-arrhythmic drugs than AH stage II during the hole period of observation. Patients with implanted pacemaker and AH require more careful titration of the major groups of cardiac drugs, taking into account the stage of AH.

23-26

Authors: Onischenko A. I., Nakonechna O. A., Tkachenko A. S., Kalashnik Yu. M.

The content of MCP-1 and MMP-9 in blood serum of patients with chronic polypoid rhinosinusitis was studied. It was found that this pathology led to a significant increase in MCP-1, which is a marker of fibrosis, in blood serum. The compensatory increase in MMP-9, serving as an antifibrotic factor, is much weaker. Such imbalance between profibrotic MCP-1 and antifibrotic MMP-9 indicates a lack of compensatory adaptation mechanisms of fibrolysis activation and contributes to the development of fibrosis in chronic polypoid rhinosinusitis.

34-39

Authors: Tselik N. E., Shmidt O. Y., Martynenko O. V.

The study was carried out to identify the distribution of QTc during ECG AM depending on clinical features of EH in 82 patients. As classified shortened was considered QTс < 320 ms, as normal > 320 ms and < 440 ms, as classified prolonged was considered QTс > 440 ms. Average, maximum and minimum QTc are registered in every patient during ECG AM. The results confirm low probability of short QTc and demonstrate presence of prolonged QTc in every patient during ECG AM. The largest duration of maximal QTc have adulthood male patients with obesity III st., with low and high circadian index, with II stage and mild EH, with for the first time diagnosed EH and with EH lasting more than 10 years, with mild cardiovascular risk, with diffuse cardiosclerosis, with I and II FC and I and IIA st of HF.

45-48

Authors: Babiy O., Kumpan N.

During the past five decades, dramatic progress has been made in the development of curative therapy for hematologic malignancies, including Hodgkin’s Lymphoma (HL). The therapy responsible for this survival can also produce adverse long-term health-related outcomes, referred to as «late effects», which manifest months to years after completion of cancer treatment. The purpose of this report is to pay attention to the problem of late complications, which develop in distant period after combined therapy of HL on example of illustrative clinical case.

55-58

Authors: Dlamini T., Babiy O. G., Kumpan N. V.

Pericarditis is an important diagnosis to consider in a patient presenting with chest pain. This article describes the common features and management of pericarditis in the general practice setting on the example of clinical case. To the cardiologic department was admitted middle aged male. He complained of sharp retrosternal pain, and fever. The survey revealed distinctive features of pericarditis: pericardial friction rub on auscultation, diffuse PR segment depressions on ECG, pericardial effusion on echocardiography, but etiology was not elicit. Most cases are labeled as «idiopathic» because the traditional diagnostic approach often fails to identify the etiology. The presence of febrile fever and neutrophilic leukocytosis indicates that a bacterial etiology take place. Prompt antibacterial and anti-inflammatory treatment led to recovery of the patient. He was completely free of symptoms and had returned to his pre-morbid state.

63-66

Authors: Kaydalova A. O., Abdel Wahhab O. Dzh., Asaje S. D., Belal S. A. S., Lysenko N. V.

Any disease is the result of the interaction of pathologic process and the patient's personality, so the basis of optimal treatment strategy is physician and patient partnership in the fight for recovery and/or the most beneficial progress of chronic diseases with the highest possible quality and life expectancy. The implementation of this postulate is only possible with correct diagnosis, which presents some difficulties in this case. Due to individual approach we were able to find the optimal treatment and not to harm the patient. We recommend for all who works in practical medicine to put into the basis of the treatment, first of all, the patient's personality.

71-75

Authors: Lutsyk M. V., Nesterenko N. I., Tselik N. E., Martymianova L. O.

On the example of the clinical case of newly diagnosed atrial fibrillation, against the background of ischemic heart disease, diagnostic issues, clinical diagnosis, treatment tactics were considered. The emphasis was placed on the importance of lifestyle, the need for outpatient monitoring, timely examination and correction of patient treatment, including surgical intervention.

81-85

Authors: Nayak S. R., Shevchuk M. I., Skokova N. I., Surya Prabha P.

A clinicalcase offemale patientwith obstructive bronchitisafter right-sided bilobectomy due tocongenitalbronchiectasis which developed on the background of suspected genetic predisposition withclinical signs of respiratory failure, butwithout significant disorders by instrumental examination of the of external respiration function.

91-94

Authors: Radchenko A. O., Makienko N. V., Vodyanitska N. A.

In this article is raised the topic of multimorbidity and polypharmacy on the example of a clinical case with the main diagnosis of Ischemic Heart Disease: Systemic atherosclerosis with predominance of coronary arteries sclerosis. Stable angina class III. Hypertensive heart disease III stage 3rd degree. Aortocoronary bypass. Sick sinus syndrome, tachy-brady form. Constant form of atrial fibrillation-flutter. AV node catheter ablation with pacemaker implantation. Infarction pneumonia of the lingual segments of the upper lobe of the right lung. CHF II-B stage with preserved systolic function of the left ventricle (EF LV 53 %). Very high additional cardiovascular risk. Concomitant conditions: Chronic obstructive pulmonary disease: Chronic obstructive bronchitis 2 degrees severity. Chronic pulmonary insufficiency III degree. Obesity III degree. Diabetes mellitus type 2, medium severity, decompensated. Chronic renal failure, III stage. The ongoing therapy is discussed and recommendations are given to minimize it in order to avoid polypharmacy.

99-101

Authors: Sharif B. J. R., Liuta E. A., Oktiabrova I. I.

Heart failure is a common cause of high mortality of patients all over the world. Arising on a background of complicated tonsillitis in patients with congenital heart diseases that significantly impairs the quality of life of patients and worsens the prognosis. Radical remains combined treatment of the patient with the elimination of complications. For example, with clinical case report demonstrates and discusses the results of surgical and therapeutic treatment of heart failure with complications in the early postoperative period in a patient with congenital heart disease (bicuspid aortic valve).

107-118

Authors: Martynenko O. V., Zolochevsky O. O., Allena R.

The review involves clinical and experimental data, constitutive modeling, and computational investigations towards an understanding on how mechanical cyclic loads for long periods of time affect damage evolution in a reconstructed bone, as well as, lifetime reduction of bone graft substitutes after advanced core decompression. The outcome of the integrated model discussed in this paper will be how damage growth in femur after advanced core decompression subjected to mechanical cyclic loading under creep and fatigue conditions may be controlled in order to optimize design and processing of bone graft substitutes, and extend lifetime of bone substitutes.

12-18

Authors: Kopytsya M. P., Petyunina O. V., Vyshnevska I. R., Tytarenko N. V., Hilova Y. V.

Numerous studies confirm worse results in diabetic patients with acute coronary syndrome (ACS) compared with non-diabetic patients. Different mechanisms underlie the adverse outcomes of ACS and diabetes mellitus. In this connection, a special place is occupied by the study of new biomarkers that reflect the complex pathogenic processes in these patients. Purpose: to investigate the role of the biomarker GDF 15 in prognosis of adverse outcomes in type 2 diabetes mellitus (DM2T) patients with ACS. Materials and methods: 73 patients with different forms of ACS were screened. Levels of biomarkers: GDF 15, N-terminal pro brain natriuretic peptide (NT-pro BNP) and C-reactive protein (C-RP) were determined. The follow up period was 1 year. Endpoint was defined as lethal outcome. Results: significant differences in GDF 15 level has been found, prognostic value of GDF 15 was estimated in patients with DM2T, using a ROC-analysis. Threshold level of GDF 15 has been determined as 3894 pg/ml, with sensitivity of 64 % and specificity of 75 %. Conclusion: Patients with ACS and DM2T more often had a history of different cardiovascular diseases and risk factors compared to patients without diabetes. GDF 15 level was significantly higher in patients with ACS who had history of DM2T.

24-28

Authors: Martymianova L. O.

Types and prevalence of ventricular rate (VR), systolic (SBP) and diastolic (DBP) blood pressure (BP) orthostatic reactions (OR) in patients with permanent atrial fibrillation (AF) in general cardiovascular risk groups (GCVR) were studied in 137 patients (73 men and 64 women), aged 66.4 ± 9.9 years. VR was measured by the electrocardiography (ECG) on the computer electrocardiograph «CardioLab 2000» and BP – semi-automatic tonometer Microlife BP2BIO. Changes VR, SBP and DBP in the range of ± 5 % were classified as a lack, an increase of 5 % and more – both positive and decreased by 5 % or more – as a negative OR. GCVR calculated in accordance with the scale of SCORE. Patients were classified into groups of GCVR. Statistical evaluation of the results was performed with the parametric estimate of the mean (M) and standard deviation (sd) and non-parametric Student's T-test and Mann-Whitney test methods. It was found that patients with AF have all three types (positive, absent, negative) OR of VR, SBP and DBP, which are stored in all classes GCVR. Optimizing the management of patients with atrial fibrillation, including with and through modification within the GCVR risk factors should take into account deviations in orthostatic reactions of VR, SBP and DBP.

38-42

Authors: Pochinska M. V.

The changes of functional blood circulation parameters in 19 patients (13 men and 6 women) at the annual stage after cardiac resynchronization (CRT) and drug therapy in pulse pressure classes (PP: I - very low PP - less than 20 mm Hg; II – low PP – from 20 to 40 mm Hg; III – normal PP – from 40 to 60 mm Hg; IV – high PP – from 60 to 80 mm Hg; V – very high – more than 80 mm Hg) were studied. The probability of differences between groups was determined with a Mann-Whitney U-test. Normalization of diastolic blood pressure (DBP), heart rate (HR) and left ventricular ejection fraction (LV EF) in all PP classes, systolic BP (SBP), end-systolic, end-diastolic volumes (ESV, EDV) in the III PP class patients at the annual stage after CRT and drug therapy were showed. The tendency of normalization of SBP in the IV class, posterior wall thickness of LV (PWLV), myocardial mass of LV (MMLV) and no change in interventricular septum thickness (IVS), left and right atrium (LA and RA), right ventricular (RV) sizes in all PP classes indicated the need for more active monitoring, careful selection of stimulation parameters and medical support correction of patients in IV PP class.

48-55

Authors: Shlieienkova H. O.

The high frequency of neurological disorders in children deprived of parental care was demonstrated (94.1 ± 2.2 %). The most commonly the syndrome of statokinetic, mental and pre-speaking retardation was diagnosed (49,2 ± 4,7 %, p < 0,001). High frequency disturbances of mental development and neurological status are accompanied by a reduction in the functional activity of the pituitary-thyroid system and the activation of serotonin. Between levels of thyrotropin and serotonin in the blood serum there is a moderate direct correlation (ρ = 0,56), which may indicate the adaptive increasing of the serotonin system activity, designed to compensate the lack of thyroid effects.

62-67

Authors: Bogun L. V.

The article addresses the problem of amiodarone-induced thyroid dysfunction based in the clinical case. The literature data on the pathogenesis, diagnosis of this disease, as well as management tactics for different variants of amiodarone-associated thyroid dysfunction are shown.

73-78

Authors: Oyeleye L., Saja M., Golubkina E. O., Bogun L. V., Yabluchansky M. I.

A clinical case of a patient with uncontrolled hypertension and polymorbidity. The paced breathing test was made, was found prevalence of low frequency influences at the initial stage and its intensification at the resting stage, growth of the total power of heart rate variability spectrum (TP) with respiratory modulation. The course of the disease worsened the appearance of new-onset atrial fibrillation (registered paroxysm on Holter monitoring); the general deterioration of the patient’s state reflected HRV changes on sinus rhythm tracing - significantly reduced TP growth in response to paced breathing, an increase in LF/HF (ratio of low frequency to high frequency waves), as well as switching to the neurohormonal level of heart rate regulation at the resting stage. After the treatment the growth of TP in response to the test has increased and LF/HF level has decreased.

84-92

Authors: Makharynska O. S., Zhuravka N. V.

Clinical importance of the community-acquired pneumonia clinical course and treatment in patients with diabetes mellitus is discussed in this review. Clinical characteristics, immunological parameters, possible drugs regimen, depending on community-acquired pneumonia severity, and the ability to optimize therapy with antibacterial drugs are considered. The features of the appointment of antibacterial drugs in the step-down antibacterial therapy, peculiarities of pneumonia in patients with diabetes mellitus.

112-124

Authors: Belal S. A. S., Zolotarova T. V., Litvin A. S.

Presented lecture is about management of a serious condition – acute kidney injury (AKI). It is intended for students, general practitioners, family physicians, therapists and those who may face with manifestations of AKI, and on which depends its timely diagnosis and the success of therapy. Definition, epidemiology, risk factors, causes, pathogenesis, classification, symptoms, diagnosis and differential diagnosis, treatment, complications, prognosis and prevention of AKI are described.

10-17

Authors: Golubkina E. O.1, Golubkina O. O.2

Were studied the distribution ratios of ultra-low-frequency, low-frequency and high-frequency components of the heart rate variability (HRV) as an indicator of the state of humoral and autonomic sympathetic and parasympathetic elements in regulation of heart rate in 35 patients with arterial hypertension (AH) aged 59 ± 5 years in the paced breathing test. Evaluation of spectral parameters of HRV was performed with the help of hardware and software «Kardiolab» («HAI-Medica»). Patients were divided into 3 groups according to the degree of power reduction of low-frequency and high-frequency waves of HRV during the transition from spontaneous breathing to paced one: 1st group- less than 5 times; 2nd group – 5–20 times; 3rd group – more than 20 times. Statistical analysis was performed by means of parametric and nonparametric methods using Microsoft Excel 7.0. It was found that in patients with hypertension was observed prevalence of humoral effects in comparison with the sympathetic and parasympathetic parameters. The greater was the contribution of humoral component to the HRV spectrum, the lower was the response of HRV to the respiratory modulation.

23-28

Authors: Petrenko O. V., Martynenko О. V., Yabluchansky M. I.

The frequency characteristics of the clinical signs of arterial hypertension (AH) according to the daily profile type of systolic (SBP), diastolic (DBP) and pulse (PP) blood pressure were studied. The data showed a significant difference in the frequency of occurrence of AH clinical signs, depending on the type of daily profile of SBP, DBP, and PP. It was concluded that in patients with AH determination only SBP daily profile of is not enough, it's necessary to take into account the types of DBP and PP daily profiles also.

32-36

Authors: Voronenko O. S., Brynza M. S., Volkov D. E., Lopin D. O., Martynenko O. V., Yabluchansky M .I.

52 patients (24 male and 28 female) aged 71 ± 8 years, underwent permanent pacemaker implantation were included in the study. Analysis of heart electrical axis (HEA) α angle values distribution was carried out in three dimensions in patience before and after pacemaker (PM) implantation. The data processed in Microsoft Excel with calculation of the average and it’s standard deviation. Significance of differences in data before and after PM implantation was assessed using Friedman ANOVA test and Kendall concordance coefficient. It was found, that α angle values distribution in patients with implanted PM is transformed from a unimodal to bimodal on the permanent cardiac pacing background. It’s assumed, that α angle changes resulting due to right ventricular electrode positioning options during PM implantation. Clarification of the nature of this change requires a special study.

43-47

Authors: Babiy O. G.

The clinical course of myocardial infarction frequently burdened by a variety of complications, which largely determine its scenario and prognosis. Despite advances in the management of this disease, complications can and do occur. These dangers arise from two principal sources: on the one hand, from the local effects of the lesion and the circulatory depression that follows, and, on the other, from the hazards that may attend during active treatment. On example of clinical case is demonstrated severe course of myocardial infarction with development of multiple complications at different stages, but, ultimately, with a favorable outcome. Early, aggressive, and judicious treatment of these complications may substantially decrease the morbidity and mortality associated with this disease.

53-57

Authors: Makharynska O. S., Lebedinska M. M.

Infective endocarditis in intravenous drug abuser is reviewed on the example of clinical case. Clinical examination, the clinical diagnosis, recommendations for surgical treatment, choice of optimal therapy are outlined in patient with infective endocarditis. The features of infective endocarditis in IV drug abused patients were studied.

61-65

Authors: Victor A., Skokova N. I., Petrenko O. V.

A clinical case of chronotherapy of arterial hypertension (AH) with insufficient blood pressure (BP) night decline has described. Patient P., the BP daily means according to ambulatory BP monitoring (ABPM) was 148/84 mmHg, BP circadian rhythm violation with insufficient degree of nocturnal BP reduction. We recommended the patient to change the mode of antihypertensive drug intake from morning to evening in the same dose. After 3 months complete AH control was achieved with normalization of diastolic BP profile.

70-87

Authors: Derienko T. A.

The review is devoted to clinical problems of arterial hypertension (AH) in patients with implanted pacemakers (EKS) and cardiac resynchronization therapy (CRT). Indications for pacemaker implantation and CRT are considered, especially the purpose and effectiveness of angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor antagonists (ARA, sartans), beta-blockers (BAB), diuretics, calcium channel blockers. We prove that the CRT and cardiac pacing and do not cancel, bur modify drug therapy of AH.

9-15

Authors: Kolomytseva I. M.

162 patients (89 men and 73 women) aged 69 ± 10 years were observed at the annual stage of supportive drug therapy after implantation of pacemakers in DDD/DDDR, VVI/VVIR and CRT-P/CRT-D modes. Changes of hemodynamic parameters were taken in consideration according to the functional class of chronic heart failure (CHF FC). Pacemakers implantation and supportive drug therapy led to transference of patients to the lower CHF FC with more significant results in CRT-P/CRT-D mode, normalization of heart rate (HR) in all CHF FC and stimulation modes, systolic (SBP) and diastolic blood pressure (DBP) in DDD/DDDR and CRT-P/CRT-D modes, end-systolic and diastolic volumes (EDV and ESV LV), left ventricular ejection fraction (LVEF) in CHF FC II in all stimulation modes and CHF FC III in DDD/DDDR and VVI/VVIR modes and size of the left atrium (LA) in CHF FC II in all stimulation modes and CHF FC I in VVI/VVIR mode. In thickness of posterior wall and interventricular septum of the left ventricle (LV PW and IVS), the sizes of the right atrium (RA) and right ventricle (RV) significant changes in any of CHF FC were not noticed, which requires drug therapy amplification. KEY WORDS: permanent pacing, сchronic heart failure, functional class of сchronic heart failure, hemodynamic parameters, annual stage, drug therapy

21-24

Authors: Petrenko O. V., Yabluchansky M. I.

The systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure (PP) daily profiles incidence was studied in 53 patients with arterial hypertension. A significant difference in the frequency of occurrence of different types of SBP, DBP and PP daily profile was revealed. In the structure of SBP daily profile «nondipper» and «dipper» types were dominated, DBP - «dipper» and «overdipper» types, PP - «night-picker» type. The conclusion about the need to evaluate not only the SBP circadian pattern, but DBP and PP also to improve the quality of arterial hypertension diagnosis, prognosis and treatment was made. KEY WORDS: ambulatory blood pressure monitoring, systolic blood pressure, diastolic blood pressure, pulse pressure, daily blood pressure

30-33

Authors: Rudenko T. A.

A role of blood glucose levels in the development of interstitial collagen has been studied in 84 patients (53 women and 31 men, average age 60 ± 2.4 years) with coronary heart disease (CHD). All patients were divided into twocomparable groups: a study group including patients with coronary heart disease andtype 2 diabetes mellitus (DM) and a control group consisting of patients with coronary heart disease without DM. All patients received standard medical therapy as recommended by the European Society of Cardiology. The level of blood glucose in both groups was assessed by the standard technique, a degree of interstitial collagen volume fraction (ICVF) was measured using the formula of J. Shirani et al. The data were processed by parametric and nonparametric statistical methods. It has been proved that hyperglycemia in type 2 diabetes contributes to the development of ICVF, the degree of which increases with the rise of blood glucose level. A high level ofICVF in patients with coronary heart disease and diabetes type 2 can be a predictor of myocardial dyssynchrony development and heart failure progression, therefore, a close monitoring and timely correction of changes of blood glucose levelsare recommended to prevent the complication development. ICVF evaluation should become a routine diagnostic method in all patients with type 2 diabetes. KEY WORDS: interstitial collagen volume fraction, type 2 diabetes mellitus, coronary heart disease

41-44

Authors: Tselik N. E., Shevchuk M. I., Martynenko A. V.

The relationship between the duration of the complex QTc ECG and clinical signs of arterial hypertension (AH) in 54 patients (16 men and 38 women) 1-3 degree and I-III stage, mean age 58 ± 18 years, was investigated. 3 classes of QT interval duration were allocated: classified shortened (< 320 ms), normal (> 320 ms and < 440 ms), classified prolonged (> 440 ms). The binomial distribution of frequencies of studied parameters in classes of the QTc interval for alternative criteria was determined. The duration of the QTc interval in the sampling was 350 ms – 490 ms. The proportion of the normal range (> 320 ms and < 440 ms) was 0.85, classified prolonged (> 440 ms) – 0.15. The probability of occurrence of QTc prolongation ECG increased in elderly patients, obesity, abusing of alcohol, mild and moderate degree and stage II AH, diabetes mellitus, atherosclerotic cardiosclerosis, stable angina functional class (FC) II, HF FC III and II A stage. Dependencies of the elongated QTc of ECG from the sex of the patients have not been established. KEY WORDS: arterial hypertension, duration of the QTc interval of ECG

49-56

Authors: Makharynska O. S., Zhuravka N. V.

HMG-CoA reductase inhibitors (statins) are the most prescribed class of drugs in the world. Some authors suggest that positive effects of statins were reported for statins against pneumonia. These positive studies data were counterbalanced by at least one negative prospective cohort study. Where lies the truth? Better understanding the statins influence and their potential role in pathophysiological pneumonia mechanisms is needed because of high quantity of subjects receiving statins with numerous medical conditions significantly associated with increased short-term mortality. KEY WORDS: statins, pneumonia, outcomes, statin effects

11-21

Authors: S. A. S. Belal, N. A. Vodyanitska, M. I. Yabluchansky

Changes of systolic blood pressure (SBP) in biofeedback (BFB) sessions with closed loop of paced breathing (PB) and heart rate variability (HRV) during standard drug therapy of arterial hypertension (AH) was studied. 275 patients with 1-3 degree of AH (143 men and 132 women, mean age 58,55 ± 7,99 years) was divided into two comparable groups: 1 - BFB (139 patients) in investigated PB loop, 2 - control group (136 patients) with BFB without PB. In both groups was performed 10 sessions of BFB. Changes of SBP depending on the stage and degree of AH, gender and age was assessed. BP was measured by the method of Korotkov’s with monometer Microlife BP AG1-20 in same conditions. Data were processed by parametric and nonparametric statistics. It is proved that the use of biofeedback in the loop of PB and HRV significantly (p < 0.01) exceeds in efficiency an isolated drug therapy in control of SBP at any stage and degree of AH in patients of both sexes in all age groups. Extent of the effect increases with the stage and degree of the disease and not related to the sex and age of the patient. Findings allow to recommend this technique in clinical practice.

27-34

Authors: S. O. Dubyna

The norm of morphometric indicators of bone structures of an orbit for population of 96 people at the age of 48,6 ± 3,2 years without pathology of craniofacial area is established by method of a computer tomography. Means, confidence intervals (р = 0,05), correlation and reliability of distinctions in morphometric indicators of a skull and an orbit by groups on types of cranium are defined. In frequency distribution of the studied population by types of cranium brachiocephalic people are 63 %, dolichocephalic – 27% and mesocephalic – 10 %. In groups by types of cranium among linear indicators of an orbit length of a medial wall statistically reliable decreases from dolichocephals to brachiocephals, length of lateral wall, orbital floor and roof and also orbital breadth – from mesocephals to brachiocephals. Orbital height between groups’ types of cranium reliable does not differ. An angle between medial and lateral walls of orbit statistically reliable increases from dolichocephalic persons to brachiocephalic. The interrelation of changes of an angle of orbital entrance inclination and types of cranium is not observed. The number of statistically significant correlations between morphometric indicators of an orbit increases from dolichocephals to brachiocephals at the absence of a reliable difference between them. Average degree correlation is noted only between orbital breadth and lengths of medial wall and orbital floor; orbital depth and lengths of the orbital floor and roof; between lengths of the orbital floor and roof – at brachiocephals, and also between lengths of the orbital floor and roof – at dolichocephals and mesocephals. The conclusion is drawn that when planning reconstructive operations at bone structures of an orbit it is necessary to consider the available distinctions in length of lateral wall, orbital roof and floor, height and breadth and value of an angle between medial and lateral walls by types of cranium.

39-44

Authors: M. S. Maltseva

97 patients (55 men and 42 women) with implanted pacemakers (PM) in DDD/DDDR, VVI/VVIR and CRT modes were investigated. Pacing mode, location of the right ventricular (RV) and left ventricular (LV) electrode, percentage of the right atrium (RA), RV and LV stimulation, percentage of atrial flutter (AFl) and atrial fibrillation (AF), percentage of ventricular tachycardia (VT), base frequency of stimulation, RV and LV electrode impedance, RV and LV electrode stimulus amplitude and duration, RV electrode sensitivity, R-waves sensing, stimulated and detected AV-delay, interventricular delay, the minimum refractory period were evaluated in acute postoperative period (3-5 days) and six months after pacemaker implantation. Patients were divided into classes 1 (normal QTc (320-440 ms)) - 41 (42 %) of the patients) and class 2 (long QTc (> 440 ms)) - 56 (58 %) patients) of QTc interval duration. For data processing were used standard statistical procedures by Microsoft Excel. QTc interval prolongation is most often observed in patients with VVI/VVIR stimulation, normal QTc interval duration – in patients with CRT. The same part of normal and extended QTc interval duration is observed in patients with DDD/DDDR stimulation. Prolonged QTc interval duration is associated with more frequent RV electrode implantation in heart apex, higher percentage of AFl and AF, LV electrode impedance, RV and LV electrodes stimulus amplitude, detected and stimulated AV-delays, minimum refractory period in first six months after PM implantation. Patients with increased QTc interval duration after PM implantation require more intensive monitoring of stimulation parameters and enhancing medication.

49-52

Authors: I. V. Shanina, D. E. Volkov

100 patients (46 – women, 54 − men) 69 ± 7 years old with implanted pacemaker in three QRS complex duration classes (under 120, 120-149, 150 and more ms) were investigated in the early postoperative period, six months and a year of permanent pacing. Basic pacing rate, atrioventricular (AV) delay (stimulated and detected), ventricular threshold, ventricular lead impedance, percentage of ventricular pacing, percentage of atrial fibrillation/flutter time were measured. Basic pacing rate, stimulated and detected AV-delay, as well as the percentage of ventricular pacing were not associated with QRS complex duration classes and had not been changed in observation stages. Ventricular threshold, ventricular lead impedance and the percentage of atrial fibrillation/atrial flutter time in the annual monitoring stage were defined to QRS complex duration class. Ventricular threshold in the first six months of observation was not changed in any QRS complex duration classes and grew at an annual stage in class 3. The impedance of the ventricular lead in the first six months decreased in all classes, it was stabled at the year in classes 2 and 3 and was continued to decline in the class 1. Percentage of atrial fibrillation/flutter time was initially higher in class 3, and was decreased in six month observation stage, however, without reaching the values in classes 1 and 2.

59-62

Authors: E. E. Tomina, E. P. Kamenskaya, P. V. Lebedynets, V. V. Tomakh

The article concerns a clinical case management of patients with polycythemia vera. The data are given from the laboratory and instrumental diagnostic methods, clinical diagnosis, selection of the optimized treatment and modification of the habit of life.

71-80

Authors: O. V. Petrenko

Review devoted to chronotherapy of hypertension. The questions of chronomedicine and chronobiology, biological rhythms, especially circadian regulation of blood pressure, types of daily blood pressure profile violations, the role of de-synchronization of biological rhythms in the development and course hypertension, opportunities to optimize antihypertensive therapy with the method of chronotherapy using alpha- and beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, diuretics, calcium channel blockers and melatonin are contemplated.