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

5-12

Authors: N.I. Yabluchansky

The work was focused on problems of clinical application of ejection fraction. It was proved that ejection fraction may be used in diagnostics only within a complex of other indices of circulation system.

16-23

Authors: A.D. Vizir, V.A. Vizir, A.E. Berezin, A.V. Demidenko

180 people were examined, among them there were 30 healthy persons and 150 persons who were ill with arterial hypertension at the age of 39-63. We found out that 58 of them had essential hypertension , 44 – arterial hypertension with endothelial dysfunction and 48 – cerebroischemic arterial hypertension. The brain blood flow was determined by B-mode and pulse color Doppler. The plasma catecholamin levels were determined by RIA. The evaluation of erythrocyte catecholamin level in red blood cells was performed with the help of a digital image analysis system . The analysis of the obtained results showed that the endothelial dysfunction of extracranial arteries and their structural remodelling of hypertensive patients depended more on the activity of tissue component of simpatho-adrenal system than on catecholamin level in blood plasma. Cerebroischemic arterial hypertension forming is accompanied by damaging mechanisms of interrelation between the plasma catecholamin activity and processes of their transmembrane transportation and intracellular deposition. At the same time the decrease of plasma catecholamins influence on mechanical properties of endothelium is associated with the decrease of endothelium-dependent vasodilation contribution to ensuring adequate cerebral perfusion even under significant hyper sumpathicotonia.

29-34

Authors: G.V. Dzyak, T.V. Kolesnik

The aim of the research was to study clinical effects and acceptability of a new AT1-recepotor blocker – irbesartan (aprovel, Sanofi/BMS). 30 patients with soft and moderate arterial hypertension were examined, the average age of the examined persons is 52,66,1 years old, duration of disease - 9,7 years. The prescribed dose of aprovel was 150 mg per day for 12 weeks, the dose was corrected after 4 weeks of therapy. All the patients passed 24 hours’ blood pressure monitoring ( device of MEDITEX, ABPM, Hungary) before the start of treat-ment and on 4, 8, 12after it. The following indices were analyzed: middle systolic and diastolic blood pressure (24-hours, day, night), variability of blood pressure, hypertension time and square indices. This study showed the efficacy of aprovel monotherapy (the dose made up 150 – 300 mg per day). The preparation causes a stable hypotensive effect, decreasing systolic and diastolic blood pressure after 6 – 8 week of treat- ment. The hypotensive effect of aprovel depends on the dose of the preparation. Aprovel does not influence nor-mal circadian low daily blood pressure rhythm and corrects pathologicone.

39-43

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

The important condition of treatment of the patients with a heart failure (HF) is the normalization of a neu-rogumoral regulation (NGR) under action of medicinal therapy, and first of all, by ACE-inhibitors. Heart rate vari-ability (HRV) is a technique qualitatively estimating work of NGR. The efficiency of enalapril maleat (EM) thera-py of the patients with HF on its influence on clinical parameters and HRV was estimated depending on reaction LF/HF HRV in acute pharmacological assay (APA) with this preparation. Prior to the beginning treatment to the patients was spent APA with EM with registration of parameters HRV before reception and at height of action of a preparation. By its results of the patients have shared into two groups: group 1 with increase LF/HF, and group 2 with decrease LF/HF in APA. Within 3 months all patients received EM, nitroglycerinum and hydrochlorthia-zidum, then estimated changes in a clinical-functional condition of the patients and parameters HRV. The results show, that the clinical efficiency of EM is more effective at of decrease reaction of sympathovagal balance on APA with this preparation, is especial at the persons with III NYHA class. At rising LF/HF on APA results of treatment are less essential. The reaction of ТР in reply to therapy is higher in group of the patients with decrease LF/HF in APA, that reduces risk of development of fatal complications.

48-54

Authors: V.M. Kovalenko

On the basis of the data of clinical examination and echocardiography was studied the functional significance of compensatory myocardial hypertrophy under conditions of physical load test of sportsmen with myocardial hy-pertrophy of the left ventricle or without it and patients with different stages of arterial hypertension. The usage of compensatory myocardial hypertrophy indices for diagnostics of the heart failure was grounded.

61-67

Authors: S.N. Panchuk, V.B. Zhukova, I.A. Bondarenko, H.N. Pasko, I.V. Solovjova

Neurohumoral effects of metoclopramidum on 18 healthy volunteers were studied with the help of heart rate variability technology (HRV) under acute pharmacological test conditions. The obtained results indicated that metoclopramidum decreases the total power of neurohumoral regulation (NHR) mostly by depressing sympathetic activity and least - parasympathetic one. The degree of the preparation effect on HRV indexes was determined by the initial sympathovagal balance of the volunteers. Metoclopramidum did not show the ability to modify the directions of HRV parameter changes in conditions of active tilt test. The preparation effect was limited by more significant deposit decrease of a parasympathetic component with a shift of autonomic balance towards sympathetic influences. The above effect was not determined by the initial values of sympathovagal balance. The determined individuality of the neuroregulatory systems response to metoclopramidum intake requires its preliminary testing in acute pharmacological test. The optimal management of a patient requires planning of the dose and regimen of a medication intake.

73-80

Authors: H. Hutten

Purpose of work: Assessment of the potential of intramyocardial electrograms (IMEGs) for longterm cardiac telemonitoring that is not possible by surface ECG due to the poor reproducibility of these signals. Materials and methods: With the availability of cardiac pacemakers with broad-bandwidth telemetry (0,3-200 Hz) and fractally coated electrodes the monitoring of IMEGs both from the spontaneously beating and the paced heart became possible. These signals have first been utilized to monitor rejection in transplanted hearts. Protocols for standardized clinical examinations have been set up that allow to eliminate errors (e.g. time of day, changes in posture, and stimulation parameters). Tailored software has been developed for signal processing based on event classification, averaging, and parameter extraction. Individual features like anatomy of the heart and respective position of the electrode require that each patient is considered for its own reference. Results: IMEGs can be acquired with excellent longterm reproducibility of signal morphology. In most cases the transitory effects during the post-implant period can appropriately be considered. Regarding reproducibility the IMEGs are superior to surface electrograms. Careful signal processing of the structured morphology of IMEGs supplies information of clinical relevance that can not be obtained from surface electrograms. Ventricular evoked responses (VERs) can be obtained with the same electrode that is used for stimulation. VERs in transplanted hearts do indicate not only acute rejection and infection episodes, but have a high prognostic potential for recipient monitoring. Furthermore, IMEGs monitor information on the hemodynamic situation of the heart, e.g. end-diastolic filling volume, and they can be utilized for AV-setting in patients with cardiomyopathies. Conclusion: Surface electrograms are well established for cardiac routine diagnosis and longterm monitoring, e.g. Holter monitoring. However, thanks to progress in pacemaker technology IMEGs offer another challenging potential for cardiac monitoring including therapy management and risk surveillance that is not accessible with surface electrograms. Computerized evaluation of IMEGs is possible, however requires tailored software that is made available by specialized centers.

84-90

Authors: I. G. Zakharov, O.F. Tyrnov

The task of quantitative verification of untraditional diagnostics methods that use simple indexes (colour and nail form, structure peculiarity of eye iris and etc.) is formulated. The nail lunulae length as a simple index was used to accomplish the task. The conclusion of diagnostic meaningfulness of simple indices is drawn. The nonrandom nature of weekly rhythm in change of nails lunulae length is shown, the presence of weekly rhythm of human functional asymmetry is determined. The present approach allows, in principle, to study other methods of untraditional diagnostics and can be used as an independent research method of organism functioning peculiarities that require long-term regular measuring.

93-97

Authors: I.G. Lesovaya

The information on frequency of chronic non-tumoral sialaden diseases of various groups of the population of the Kharkov region, according to the archive data of the specialized clinic of the Kharkov Medical Postgraduate Academy is submitted in this work.

105-108

Authors: V.P. Maly, O.K. Polukchy, P.V. Nartov

90 patients with diphtheria of stomatopharynx were examined. It was determined that activation of prekal-likreine-kallikreine system took place during the course of disease. Patients with severe forms of the disease, for whose therapy it is necessary to use ingibitors of proteolysis, had the most significant changes.

112-116

Authors: E.D. Khvorostov, I.A. Semenenko

The results of surgical treatment of 14 patients (12 – with blood system diseases, 2 patients with nonparasitic cysts of spleen) were analyzed in the article. The questions of indications to surgical treatment of blood system disease patients and principles of rational transfusion tactics were considered. The methods of laparoscopic spleenectomy, which had been used in the surgical department of Railway clinical hospital of Kharkov since July, 2000, were described and applied in practice. A comparative evaluation of advantages and usage advisability of laparoscopic method use is carried out. Special consideration was given to establishment of indications to splenectomy, preoperative preparation and conducting of postoperative period of. Authors showed, that spleenectomy of blood system disease patients related to operation with increased risk, though laparoscopic spleenectomy that required corresponding experience of a surgeon and technical equipment, was an alternative to open spleenectomy.