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

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.

13-16

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

This study included 30 cases of death among patients at the age of 47 to 83 years who underwent permanent pacing. The estimated factors considered patients’ sex (male, female), age, cause of death, clinical diagnosis, indications, type, the frequency and duration of pacing. Depending on the length of pacing, these deaths were divided into I) acute (from 1 to 7 days), II) sharp (7 to 30 days), III) postimplantation (30 days to 5 years) and IV) remote postimplantation (more than 5 years) periods. The obtained results reveal the fact that more than 2/3 of the deaths occurred in acute and postimplantation periods. The number of deaths pertaining these periods was approximately equal. The rest of the lethal cases, which includes 1/3 of the deaths, falls on the acute and remote postimplantation periods. The number of deaths happened in the acute period was two times less than in the remote postimplantation period. In 2/3 cases the death was caused by the acute heart failure, happening in the acute and sharp periods, correspondently. 1/3 of deaths can be qualified as caused by comorbid pathology, happened in postimplantation and remote postimplantation periods. Patients, who had heart failure in their life-time, have the least favorable prognosis for recovery.

23-27

Authors: K. E. Morozova, R. Basnet, S. A. S. Belal, O. V. Martynenko, M. I. Yabluchansky

To study the effectiveness of biofeedback (BFB) in the closed loop of heart rate variability (HRV) and paced breathing in patients with somatoform autonomic dysfunction (SAD) 20 patients with SAD (14 women and 6 men, mean age 19,53 ± 1,55) were examined. All probationers were divided into two groups comparable for sex and age: 1 – BFB group (15 patients), in which 7 sessions was held and 2 – the comparison group (5 patients), where only two sessions were completed -at the first and seventh day of the study. Additionally, all patients in both groups received diet food (Table № 10 by Pevzner), mebicar, glycine, tiotriazolin. Effectiveness of biofeedback was evaluated by comparing of parameters optimality (O), sensitivity (S), the efficiency (E) and the integral index BQI in both groups. It was determined that biofeedback in the closed loop of HRV and paced breathing allows to optimize the state of the regulatory systems of the body in patients with SAD, moreover the combination of biofeedback sessions in the test loop and medical treatment are significantly better than isolated pharmacological therapy. High effectiveness of biofeedback in closed loop of HRV and paced breathing in patients with SAD allows us to recommend it as independent method of treatment, and as a component of combined therapy of this disease.

33-37

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

In the department of ultrasound, clinical and instrumental diagnosis and minimally invasive technologies 100 patients (46 – women, 54 – men) who underwent permanent pacemaker therapy were examined. The average age was 69 ± 7 years. The indications for pacemaker implantation were: atrio-ventricular block of varying degrees – 66 people (60 %), sick sinus syndrome – 34 patients (30 %). Patients were divided to three classes of QRS complex duration in accordance with Haghjoo M. et al.: 1 – under 119 ms (normal), 2 − 120-149 ms (extended) and more than 150 ms (significantly extended). Permanent pacing with medical support in the first 6 months results in the elimination bradyarrhythmia rhythm disorders without significant changes of functional blood circulation values with systolic blood pressure increase only. Standard antihypertensive therapy consisting of medical support in patients with implanted pacemaker is sufficient to control systolic blood pressure in patients in classes 1 and 2 and insufficient – in class 3 of QRS complex duration. Patients with implanted pacemaker in 3 QRS complex duration class require intensification of antihypertensive therapy.

43-47

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

A clinical case of chronotherapy in hypertension with insufficient degree of nocturnal blood pressure (BP) reduction was described. Patient M., average 24-h BP according to ambulatory blood pressure monitoring was160/98 mm Hg, systolic and diastolic blood pressure profile had non-dipper pattern. Taking into account individual circadian BP profile, the patient was recommended to take antihypertensive drug – lisinopril – at bedtime. As a result of this treatment, after 3 months the target levels and normalization of circadian rhythm of BP were achieved.

52-57

Authors: O. E. Tomina, M. I. Yabluchansky, O. Yu. Bychkova, O. O. Ivleva

Antacids clinical pharmacology is represented according to the international classification of drugs ATC (anatomical-therapeutic-chemical). The article elucidates antacids indications and contraindications, administration details and side effects.

10-15

Authors: O. L. Kulik, O. J. Schmidt, S. A. S. Belal, I. A. Rank

The effectiveness of biofeedback in a closed loop of heart rate variability (HRV) and paced breathing in patients with arterial hypertension was studied. 61 subjects with arterial hypertension (31 females and 30 males, mean age 56.8 ± 6.2 years) were examined. In accordance with the objective of the study all subjects were divided into 2 groups: 1 – biofeedback group (34 subjects) and 2 – the comparison group (27 subjects). 5 biofeedback sessions were performed in biofeedback group. In the comparison group only two biofeedback sessions were performed – at admission and before discharge from the hospital. Efficacy of biofeedback was evaluated by comparing the values of systolic and diastolic blood pressure (SBP and DBP, respectively), heart rate (HR), HRV indices, indicators of optimality (O), sensitivity (S) and efficiency (E) and BQI index at admission and discharge in both groups of patients. The use of biofeedback in arterial hypertension subjects allowed to achieve better control of heart rate, systolic and diastolic blood pressure and improves HRV indices. The positive dynamics of optimality and the integral BQI values indicated a training effect of regulation systems.

21-26

Authors: M. M. Popov, O. V. Ognivenko, T. V. Sevastianova

In this paper we have studied the effectiveness of Polioksidony in the treatment of patients with chronic staphylococcus’s pharyngitis on background. It was found that the inclusion in the complex treatment of patients Polioksidony normalizes biotsinoz oropharyngeal secretions, increases the phagocytic activity of neutrophils and biocide, opsonizing properties serum normalizes the major classes of immunoglobulins in oropharyngeal secretions . Polioksidony has a positive effect on the clinical course of chronic pharyngitis and warns its recurrence, reduces the number of acute respiratory diseases and their complications.

33-37

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

The frequency of beta-blockers, amiodarone, antiplatelet agents (acetylsalicylic acid), anticoagulants (warfarin), statins, angiotensin-converting enzyme inhibitors, diuretics and angiotensin II receptor antagonists prescribing was determined in 114 patients (56 – women, 58 – men) with permanent pacemakers in VVI/VVIR (40 patients), DDD/DDDR (26 patient), cardiac resynchronization therapy (14 patients) and separate group was made up of 34 patients with sinus sick syndrome in DDD/DDDR pacing mode in 3 QRS complex duration classes: 1 – under 119 ms (normal), 2 – 120-149 ms (elongate) and more than 150 ms (significantly elongate). The patients’ average age was 69 ± 7 years. The results showed that the same groups of drugs are being prescribed as in patients with pacemakers as in patients without them. More frequent prescribing of beta-blockers was associated with prevention of the development of possible device-induced arrhythmias and chronic heart failure. More rare appointment acetylsalicylic acid and statins was associated with the lack of attention to therapeutic support. Frequency of prescribing most of used drugs in patients with implanted pacemaker increases with QRS complex duration class.

45-49

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

A clinical case of chronotherapy of arterial hypertension is described. In patient U., according to ambulatory blood pressure monitoring (ABPM) results, 24-h average value was 145 mmHg for systolic blood pressure (SBP) and 88 mmHg for diastolic blood pressure (DBP), DBP circadian rhythm had «over dipper» pattern while SBP circadian rhythm was normal. Taking into account the daily individual BP profile the patient was prescribed antihypertensive drug lisinopril 10 mg in the morning after waking up. As a result of the treatment, after 3 months the target BP levels were achieved, but SBP and DBP pattern have been transformed into «non-dipper» ones. The treatment regimen was modified: patient was recommended daily dose of lisinopril distributed into two doses-5mg in the morningand5mg in the evening before going to bed with the subsequent control by ABPM in 3 months.

74-83

Authors: M. S. Tomin

The review presents the frequency, anatomy, classification, diagnosis, and the most effective open methods of inguinal hernia’s operative therapy in adult patients. These findings are in agreement with the recommendations of the Ukrainian association of surgeons-herniologists and the European European Hernia Society (EHS). The article does not deal with laparoendoscopic options of hernia repair (TAPP and TEP), as they require a separate section in the anatomy of the inguinal region and endoscopic techniques’ volumetric description. Besides, in Ukraine inguinal hernia repair is most frequently performed of open access that causes the topic’s timeliness.

89-94

Authors: I. V. Soldatenko

Clinical pharmacology of diuretics in the international system of ATC (anatomic-therapeutic-chemical) is presented. Classification of this group by the action mechanism and caused effects is provided. Pharmacokinetics and pharmacodynamics features, indications and principles of diuretics usage in clinics are considered. Contraindications, side effects and interaction with other drugs of this group are discussed in detail.

9-16

Authors: V. O. Bubalo

In this article the main results of the sensitivity to antibiotics on S. Typhimurium, S. strains of Salmonella Enteritidis and rare groups that circulate in Ukraine last 10 years were described. The unifying disc-fusion method determined the sensitivity of Salmonella strains to several antibiotics. Resistance to antibiotics of strains of Salmonella was caused by the lack of effective influence of drugs on salmonellosis. The obtained results revealed antibiotics with a strong antimicrobial action and a narrow focus on strains of Salmonella.

23-27

Authors: T. I. Lyadova, О. V. Volobuyeva, Т. V. Sevastyanova, А. N. Savvo

The article presents the results of the study, during which the efficacy of levofloxacin in the treatment of patients with community-acquired pneumonia was evaluated. It was found that levofloxacin is a highly effective treatment for patients with community-acquired pneumonia.

33-40

Authors: M. I. Shevchuck

Studied indicators of heart rate and arterial pressure variability (HRV, AP) in patients with arterial hypertension (AH) in treatment groups of beta -blocker (BB), inhibitors of angiotensinconverting enzyme (IACE) and their combination classes and duration of the QRS complex ECG ≤ 100 and > 100 ms. 138 patients with AH of the 1-2 degrees (60 men and 78 women) at the age of 57 ± 17 years old were examined. Registration and measurement of QRS complex duration and indices of HRV ECG were done on computer electrocardiograph conducted «Cardiolab+». In groups of thera-py classes of ECG QRS complex duration <100 ms and ≥100 ms were derived. Patients were treated with lisinopril in the average daily dose of 20 mg, bisoprolol - 5 mg. Patients were assessed before, after 2 weeks, 1, 6 and 12 months after of therapy. HRV was evaluated TP, VLF, LF, HF, SAP, DAP in groups of IACE, BB and IACE + BB and classes QRS ECG. The data were processed with the help of Microsoft Excel program. In patients with AH in IACE group the best response of HRV indices ontherapy was indicated in the class of ECG QRS complex duration ≤ 100 ms and in group IACE+ B B− > 100 ms. In patients with AH of ECG QRS complex duration ≤ 100 ms in antihypertensive therapy IACE lizinopril is preferable with ECG QRS complex duration > 100 ms – combination of IACE lizinopril and BB bisoprolol.

46-52

Authors: N. T. Vatutin, М. А. Khrystychenko, E. V. Keting

OBJECTIVE: To evaluate the quality of life (QоL) in patients with anxiety and depressive disorders (ADD) and chronic heart failure (CHF) of ischemic origin. METHODS: The study involved 142 patients (85 men and 57 women, mean age 66,4 ± 10,5 years) with CHF NYHA II-IV functional class. To identify anxiety and depression were used Hospital Anxiety and Depression Scale (HADS), the scales of the Spielberger-Hanin and Beck’s, QоL – Minnesota QоL Questionnaire “Living with Heart Failure» (MLHFQ) and the SF-36 questionnaire. RESULTS: ADD prevalence in patients with CHF of ischemic etiology was 78.1 %, with the largest share in the combination of anxiety and depressive disorders. The deterioration of QoL was observed in all patients with CHF, but the most pronounced decrease in its registered patients with a combination of anxiety and depression. The obtained data was processed using the statistical suite Statistica 6.0 for Windows and presented as M ± σ (mean ± standard deviation). CONCLUSIONS: The presence of ADD leads to a significant decrease in QoL of patients with CHF, the most significant of its deterioration observed in the combination of anxiety and depression. The article presents the results of investigation of gastric mucosal microcirculation with the help of laser-Doppler flowmetry in acute phase of duodenal ulcer during 7 and 14-day eradication therapy. The study enabled to obtain some data on effectiveness of the two therapeutic eradication regimens as well as their im-pact on gastric mucosal microcirculation in the process of ulcer defects healing.

57-60

Authors: M. V. Baeva, A. V. Krotenko, L. A. Martimyanova, E. P. Kamenskaya, S. Alshorman

Prinzmetal Angina (synonyms: vasospastic angina, variant angina) in accordance with the definition of, it is caused by coronary artery spasm which occurs during sleep at night, between midnight and early morning and manifested with ST segment elevation on the ECG. Frequent “attachment” to the attacks of a certain period of the sleep period, gives you the opportunity to use chronomedical approaching the treatment of patients suffering from it, as demonstrated by our observation. On the other hand, for adulthood comorbidity is characteristic, and Prinzmetal is no exception, which we wanted to show, studying the clinical case.

66-70

Authors: E. V. Gavrilyuk, Y. Y. Boeva, I. Anyasi, M. S. Maltseva, D .E. Volkov

Clinical case of persistent atrial flutter in combination with comorbid pathology is presented. Clinical diagnosis, choice of optimal interventional and drug therapy are discussed. Catheter ablation was considered as the optimal method for radical treatment of the atrial flutter. A modification of drug therapy is required according to the condition of the patient after the catheter ablation.

83-88

Authors: N. P. Kopytsya, A. V. Kobets

With increasing numbers of patients with acute coronary syndrome (ACS) it is very important to have reliable biomarkers for early diagnostics and treatment. The role of heart-type fatty acid binding protein (H-FABP) is investigated to confirm patients with ACS and to evaluate the long-term prediction of complications and death. H-FABP allows to define myocardial infarction with changes on ECG and without ST elevation, it helps to differentiate unstable angina. H-FABP sensitivity is higher than troponin, myoglobin and other biomarkers, at the same time H-FABP has a high specificity. Increasing of the H-FABP level is an independent prognostic factor in the long-term prediction in patients with suspected ACS. H-FABP definition, especially in combination with other biomarkers, has the important value, when the diagnosis of ACS is difficult against the background of the atypical clinical picture, the absence of typical ECG changes.

98-110

Authors: I. V. Soldatenko

Etiologic, epidemiologic, pathogenic and clinical description of ankylosing spondylitis are discussed in the lectures. Basic approaches to diagnostics, medical treatment and prophylaxis of disease are represented.