FEATURES OF HEMODYNAMICS OF LIVER AND HEART IN PATIENTS WITH VIRAL CIRRHOSIS

To study the peculiarities of hemodynamics of liver and heart Doppler echocardiography, duplex ultrasonography vascular screening in patients with viral cirrhosis were held. It was found that patients with viral cirrhosis have remodeling of viscerogenic hemodynamic, left ventricle myocardium with formation of various variants of its geometry. Disorder of heart ventricles relaxation, presence of moderate pulmonary hypertension are accompanied by more expressed portal hemodynamic disorders. Indices of viscerogenic hemodynamic correlate with geometric characteristics of heart ventricles and pulmonary artery, functional state of left ventricle and hemoglobin saturation with oxygen

PULMONARY HYPERTENSION IN PATIENTS WITH VIRAL CIRRHOSIS

To study the peculiarities of the formation of pulmonary hypertension in patients with viral cirrhosis we carried out tissue Doppler echocardiography, Doppler echocardiography, duplex vascular scanning, research of respiratory function in patients with viral cirrhosis. It was found that pulmonary hypertension in patients with viral cirrhosis was a frequent complication (38 %) and is often moderate. An acceleration of blood flow and dilation of the portal and splenic veins, disturbed longitudinal systolic function of the right ventricle and its relaxation as well as decrease of the respiratory function by the restrictive type are registered in patients with pulmonary hypertension

Influence of Tocolytic Therapy with Hexoprenaline on Heart Rate Variability, Lipid Spectrum and Glycemic Level in Obese Pregnant Women

Background. Obesity is associated with the risk of spontaneous preterm birth. Hexoprenaline is the effective and most widely used tocolytic agent, possessing however a significant number of side effects. The effect of hexoprenaline tocolysis on heart rate variability, lipid spectrum and glycaemia level in obese pregnant women remain unexplored.Aim of the research. To study the effect of tocolytic therapy with hexoprenaline on heart rate variability, lipid spectrum and glycemic level in obese pregnant women.Materials and methods. The study included two groups of pregnant women with threatened preterm labor who received tocolysis with hexoprenaline. One group consisted of 68 obese patients, the other – 72 non-obese pregnant women (control group). Patients underwent Holter monitoring. Fasting serum glucose and lipids spectrum were measured before starting tocolytic therapy and after 24 hours of tocolysis.Results. In obese pregnant women with hexoprenaline infusion, the heart rate, the 24-hours number of supraventricular extrasystoles and ventricular extrasystoles during the day are significantly higher. Frequency domain parameters, very low frequency during the day, low frequency at night and 24-hours high frequency were significantly decreased than in control group. After a day of tocolysis in obese pregnant women, the level of total cholesterol, low density lipoproteins, triglycerides, and glucose significantly increases when compared with the results before therapy. For patients in the control group treated with hexoprenaline, only the concentration of high-density lipoproteins is increased.Conclusion. Obesity in pregnant women receiving hexoprenaline tocolysis is associated with low heart rate variability and an increase in the number of cardiac arrhythmias, as well as lipid disorders and an increase in glucose level

COGNITIVE IMPAIRMENTS AFTER STROKE

Thirty-two patients (mean age 53.912.4 years) with prior stroke were examined to clarify the pattern and degree of cognitive impairments depending on the site of a lesion. A control group comprised 32 subjects (mean age 52.112.9 years) without nervous system pathology. The authors made a complete clinical study to evaluate the neurological and mental status, a standardized interview, and A.R. Luria's neuropsychological tests. The patients with prior stroke were found to have lower values of auditory-verbal short-term and long-term memory, impaired concentration and voluntary attention scope. Mild cognitive disorders were established in middle-aged patients and moderate cognitive disorders of amnestic multifunctional type were in elderly patients. Auditory-verbal memory, visual gnosis, and some speech-related thought functions were impaired when in the involvement of the temporal and posterior frontal lobes in patients with prior stroke in the middle cerebral artery bed. Impaired visual image recognition and lower visual voluntary attention were detected in patients with prior stroke in the anterior and posterior cerebral arteries

Состояние минеральной плотности кости у больных хронической обструктивной болезнью легких

Osteoporosis is one of extrapulmonary features of COPD. This study was aimed to evaluate bone mineral density (BMD) and its correlation to risk factors in patients with COPD. Forty six patients (28 postmenopausal females, 18 males, the average age, 64.3 ± 7.8 yrs) with different COPD stages participated in the study. Fifteen patients have received inhaled corticosteroids (ICS) 500 to 2000 μg of beclomethasone equivalent daily for 5 to 8 yrs. The controls were 38 non COPD patients (35 postmenopausal females, 3 males) comparable to age, smoking history, and co morbidity. BMD was measured in lumbar vertebrae and proximal parts of right and left hips using X ray dual energy absorptiometry. Osteopenia was found in 20 COPD patients (43.48 %) and osteoporosis was in 11 (23.91 %) ones. The mean T criterion in lumbar vertebrae and both femoral necks of COPD patients was significantly lower compared to controls (р = 0.0010–0.0024). BMD in lumbar vertebrae (р = 0.0005–0.006) and femoral necks (р = 0–0,007) was also lower in COPD patients. Lumbar vertebra height did not differ in COPD patients and the controls. We also analyzed sub-groups of severe (FEV1 < 50 %pred.) and mild to moderate COPD patients separately. Those with severe COPD had osteopenia and osteoporosis more often (52.6 % vs 37 % and 36.8 % vs 14.8 %, respectively) and T criterion and BMD in both sites reliably lower. These results suppose a role of hypoxia in development of osteoporosis. Both T criterion and BMD in all sites correlated with body mass index (r = 0,453–0,743, p = 0; and r = 0,425–0,663; р = 0, respectively). There was no correlation between cumulative dose of ICS and BMD. No gender differences of BMD in COPD patients indicated that the loss of BMD in COPD could be relevant to chronic pulmonary disease but not to hormonal disorders. We conclude that loss of BMD is one of the systemic effects of COPD.Одним из внелегочных проявлений ХОБЛ является остеопороз. Целью настоящего исследования явилась оценка состояния минеральной плотности кости (МПК) у больных ХОБЛ и выявление связи с различными факторами риска. В исследовании участвовали 46 больных с различными стадиями ХОБЛ, средний возраст 64,3 ± 7,8 года (28 женщин в менопаузе, 18 мужчин). 15 больных получали ингаляционные глюкокортикоиды (иГК) 500–2000 мкг/сут в пересчете на беклометазон в течение 5–8 лет. Контрольную группу составили 38 пациентов: 35 женщин в постменопаузальном периоде и 3 мужчины, сравнимых по возрасту, стажу курения, наличию и характеру сопутствующих заболеваний, но без ХОБЛ. МПК поясничного отдела позвоночника и проксимальных отделов обеих бедренных костей определяли методом рентгеновской двухэнергетической абсорбциометрии. Остеопения выявлена у 20 (43,48 %) больных, остеопороз — у 11 (23,91 %) больных ХОБЛ. Среднее значение Т критерия в поясничных позвонках и шейках правой и левой бедренных костей у больных ХОБЛ было достоверно ниже, чем в группе контроля (р = 0,0010 — 0,0024). МПК поясничных позвонков (р = 0,0005 — 0,006) и шеек обеих бедренных костей (р = 0—0,007) была ниже у больных ХОБЛ по сравнению с контрольной группой. Высота поясничных позвонков у больных ХОБЛ и в контрольной группе достоверно не отличалась. При выделении группы больных тяжелой ХОБЛ (ОФВ1 , %долж. < 50) получено, что у них остеопения и остеопороз встречались чаще (52,6 % против 37 % и 36,8 % против 14,8 % соответственно), показатели Т критерия и МПК в поясничных позвонках и шейке бедренной кости были достоверно ниже, чем при легкой и среднетяжелой ХОБЛ. Это позволяет предположить роль гипоксии в развитии остеопороза. Показана корреляция между индексом массы тела (ИМТ) и показателями Т критерия в поясничных позвонках и шейке бедренной кости (r = 0,453–0,743, р = 0), МПК поясничных позвонков и шейки бедренной кости и ИМТ (r = 0,425–0,663; p = 0). Не выявлена связь между кумулятивной дозой ИГК и показателями МПК. Отсутствие половых различий в показателях МПК свидетельствует, что потеря МПК у больных ХОБЛ связана именно с хронической легочной патологией, а не с дисгормональными нарушениями. Таким образом, потеря МПК является одним из системных проявлений ХОБЛ

The informative of diagnostic measures in women of reproductive age with ovarian apoplexy

The article discusses diagnostic measures in women of reproductive age with ovarian apoplexy at the base of the regional hospital in the mountains. Yekaterinburg. The study compared the results of a survey of women of reproductive age with ovarian apoplexy of an anemic and painful form. The feasibility of the puncture of the abdominal cavity through the posterior vaginal fornix was evaluated together with transvaginal ultrasound for the selection of treatment tactics for women of reproductive age.Рассмотрена основная проблема современности — оценка прегравидарной подготовки на примере Пермского края. Выявлена роль женского пола в подготовке к зачатию, рождению и содержанию будущего ребенка. Показано, что женщины более ответственно относятся к продолжению здорового рода

The informative of diagnostic measures in women of reproductive age with ovarian apoplexy

The article discusses diagnostic measures in women of reproductive age with ovarian apoplexy at the base of the regional hospital in the mountains. Yekaterinburg. The study compared the results of a survey of women of reproductive age with ovarian apoplexy of an anemic and painful form. The feasibility of the puncture of the abdominal cavity through the posterior vaginal fornix was evaluated together with transvaginal ultrasound for the selection of treatment tactics for women of reproductive age.Рассмотрена основная проблема современности — оценка прегравидарной подготовки на примере Пермского края. Выявлена роль женского пола в подготовке к зачатию, рождению и содержанию будущего ребенка. Показано, что женщины более ответственно относятся к продолжению здорового рода

Experience of the successful treatment with canakinumab of a patient with NLPC4-associated autoinflammatory syndrome with enterocolitis

The article shows the observation of rare NLPC4-associated autoinflammatory syndrome with enterocolitis and familial cold urticaria. Diagnosis is confirmed molecularly-genetically: previously not described mutation c.928C>T in the heterozygous state in NLRC4 gene is discovered by a method of the new generation sequencing. The use of a monoclonal antibody to the interleukin 1 canakinumab provided complete relief of fever and skin and intestinal symptoms in just 1 week of treatment. Later the signs of inflammation have disappeared completely; the patient’s quality of life improved and life-threatening complications were prevented. The above example demonstrates the high clinical efficacy of canakinumab in the patient with NLRC4-associated autoinflammatory syndrome and suggests promising therapeutic use of interleukin 1 blockers in such patients. There were no adverse events during canakinumab therapy

High Efficiency of Kanakinumabum for a Patient with a Late Diagnosed Chronic Infantile Neurological Cutaneous Articular Syndrome (CINCA)

The article presents the monitoring of a severe course of CINCA/NOMID syndrome diagnosed at late stages. The use of monoclonal antibodies to IL 1 — kanakinumabum — in a patient with chronic neurological cutaneous and articular syndrome was successful: fever, cutaneous and pain syndromes were completely stopped, joint contractures decreased after one week of therapy. Laboratory parameters of the child’s disease activity (ESR and CRP) became normal after 8 weeks of treatment. Movements in the affected joints recovered completely after 24 weeks; the audiologist noted an improvement in hearing. The above clinical example demonstrates the high efficiency of kanakinumabum for a patient with chronic neurological cutaneous and articular syndrome, and shows the perspective of therapeutic application of IL 1 blocker for patients with CINCA syndrome including advanced stages of the disease. No adverse effects were noted during kanakinumabum therapy