Cardiac and plasma activities of marker lysosomal enzymes were studied in Wistar rats with metabolic (epinephrine) and occlusion (ligation of coronary arteries) myocardial infarction. Activity of all examined lysosomal enzymes significantly increased in the myocardium and blood plasma starting from the first day after ligation of the coronary arteries and was accompanied by leukocytic infiltration of the myocardium. Enzyme activity gradually decreased to postoperation day 14. In metabolic infarction leukocytic infiltration and specific activity of lysosomal enzymes rose gradually and attained maximum to postoperation day 14, while the signs of labilization of lysosomal membranes appeared from the first postoperation day. Plasma activity of lysosomal enzymes in metabolic infarction increased smoothly and peaked on day 14.
Aim. To study the influence of brain natriuretic peptide gene polymorphism (polymorphic locus Т-381С) on brain natriuretic peptide serum level and congestive heart failure onset risk and clinical features in patients with coronary heart disease. Methods. 412 patients with congestive heart failure were examined. Genotyping was performed by polymerase chain reaction. Brain natriuretic peptide N-terminal fragment level was assessed by ELISA. The control group included 211 healthy controls with no signs of cardiovascular pathology on examination. Results. In healthy people with C/C genotype the level of brain natriuretic peptide N-terminal fragment was significantly higher in comparison with people carrying T/T genotype. It was found that the T allele and T/T genotype of the T-381C natriuretic peptide gene polymorphic locus was associated with high risk, severity and unfavorable clinical course of congestive heart failure in patients with coronary heart disease. At the same time, the C allele and C/C genotype emerged as a protective factor regarding the risk, severity and clinical course of the disease. Conclusion. T/T genotype carriers of the of the T-381C natriuretic peptide gene polymorphic locus are a special subgroup associated with high risk of congestive heart failure onset and unfavorable clinical course. Therefore these patients with coronary heart disease should be considered as a group requiring an out-patient control and preventive measures targeted on congestive heart failure and premature mortality prevention.
Aim. To develop a method for determination of the differentiated types of hemodynamics based on the data analysis of integral circulation indicators. Methods. The method for determination of the differentiated hemodynamics types was developed based on the data analysis of integral circulation indicators - cardiac output, heart rate, total peripheral vascular resistance and modulus of volume elasticity. The types of hemodynamics - hyperkinetic, eukinetic, hypokinetic - were determined by cardiac output. Tachy-, normo- and bradisistolic subtypes were determined by the heart rate, subtypes with a predominance of vascular resistance and arterial stiffness were determined by the modulus of volume elasticity and total peripheral vascular resistance ratio. Four groups of patients were examined. The first group included 63 patients with I-III degree of arterial hypertension aged 18 to 77 years, mean age 48.9±12.38 (M±σ). The second group - 82 patients with primary hypothyroidism and I-III degree of arterial hypertension aged of 41 to 75 years, 59.8±7.9 years (M±σ). The third group - 33 patients with rheumatoid arthritis and I-III degree of arterial hypertension aged 17 to 67 years, 47.2±8.12 years (M±σ). The control group included 32 healthy volunteers aged 21 to 37 years, 24.7±5.34 years (M±σ). Results. Eukinetic and hyperkinetic circulation types with predominance of peripheral vascular resistance were mostly identified in healthy volunteers. Eukinetic type of hemodynamic with predominance of peripheral vascular resistance is typical for patients with hypothyroidism and arterial hypertension, and for patients with rheumatoid arthritis and arterial hypertension hyperkinetic and eukinetic types with predominance of the arterial system rigidity are characteristic. Eukinetic and hypokinetic circulation types with predominance of both peripheral resistance and arterial stiffness are mostly present in essential hypertension. Conclusion. Developed method of distinguishing the differentiated types of hemodynamics allows determining the hemodynamic heterogeneity in both healthy people and patients with hypertension.
Aim. To determine the optimal size and location of the mini-laparotomic access for the reconstruction of arteries of the aortofemoral segment. Methods. The method of mathematical modeling was used. The parameters of the mini-access were calculated depending on the sex of the patient, as well as for a variety of clinical situations (operations for occlusive disease, for abdominal aortic aneurysm, including the propagation of the aneurysmal dilatation to the iliac arteries). Topography of the aorta and iliac arteries was determined on the basis of computer tomograms of 155 patients (61 of them with an aneurysm of the infrarenal aorta). Results. It was established that for the purpose of creation of an adequate access an incision of 6.8-7.0 cm in length at the level of the umbilicus and above is sufficient during surgery for occlusive disease. No significant gender differences were found. During aortic aneurysm the required length of the mini-laparotomic access is significantly increased up to 7.6 cm (p=0.003), and in cases of propagation of the aneurysmal dilatation on to the common iliac arteries - up to 8.5 cm (p=0.001). In the latter case its location also changes: approximately half of the length of the access incision is located below the umbilicus. Conclusion. Mathematical modeling of the optimal mini-access makes it possible to optimize the use of mini-laparotomy in various clinical situations.
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