Experimental studies showed that cannabinoids evoke hypotension and bradycardia, which are the result of the stimulation of the cannabinoid CB1 receptor. Cannabinoid-induced bradycardia is the result of sympatholytic and vagotonic action of cannabinoids.

 

This article presents modern perceptions concerning electrophysiological mechanisms, causes and clinical relevance of ventricular extrasystole. Modern theories of ventricular extrasystole pathogenesis in joint hypermobility syndrome are shown.

 

The article presents the results of the analysis of hemostasis parameters in atrial fibrillation patients with and without anticoagulation therapy with dabigatran etexilate in the perioperative period of the arrhythmia ablation. We evaluated the capabilities of using the conventional indicators of the blood coagulation in atrial fibrillation patients receiving dabigatran etexilate to assess the possible risk of bleeding in the perioperative period of radiofrequency ablation.

 

Endothelial condition is one of the main factors determining the function of the healthy vessels and its change in arterial hypertension (AH). The aim of this study is to evaluate the role of endothelial dysfunction in prognosis of AH. Material and Methods. 918 young adults aged 20–29 years old and normal level of blood pressure (BP) were enrolled in a prospective observational study. The endothelial function was assessed using a brachial reactive hyperemia test with calculation of peak systolic (Vps), maximal terminal diastolic (Ved), time average maximal (TAMX), time average (TAV) blood flow velocity, spectral broadening index (SBI), resistance index (RI), pulsation index (PI), systole-diastolic ratio (SD), intima–media thickness and brachial flow mediated dilation (FMD). Further, the observation period lasted for 5 years. Two groups were chosen according to the level of BP: the 1st group included the patients with AH (BP level 140/90 mm Hg and higher), the 2nd group consisted of the patients with the normal level of BP (lower 140/90 mm Hg). Results. 78 persons were withdrawn from the study for different reasons during observation period. AH was found in 144 participants (18.8%, 95% CI 16.2-21.7%) — group 1, 620 people of group 2 showed normal BP in 620 (81.2%; 95% confidence Interval (CI) 78.3–83.8%). In group 1 FMD was 7.5 (5.3; 9.9)%, in group 2 — 12.3 (10.2; 13.4)% (p<0,05). Based on the data of univariate analysis of male sex (odds ratio (OR) 10.8; 95% CI 7.63–15.28), body mass index (BMI) > 25 kg/m2 (OR 7.17; 95% CI 5.65–9.10), smoking (OR 5.61; 95% CI 4.5–6.98), high normal BP (OR 10.68; 95% CI 6.92– 14.51) and FMD <10% (OR 3.49; 95% CI 2.19–5.57) were significant risk factors of AH. The results of multivariate analysis BMI > 25 kg/m2 , high normal BP and FMD < 10% were independent risk factors. Conclusion. Endothelial dysfunction is an independent risk factor of AH in young patients with initially normal level of AD during 5 years.

 

Background. High prevalence and a poor prognosis of lower-extremity atherosclerotic arterial disease determine intermittent claudication (IC) as a pressing problem. It is known that about 40% of patients with IC can rely only on drug therapy carried out at the microcirculation (MC) level. Thus, the aim of the study is to reveal functional features of MC shifts in patients with IC of different degrees of arterial insufficiency. Material and Methods. The study included 72 male patients with angiographically confirmed obliterating atherosclerosis of the lower extremities, IC stage IIb, ankle-brachial index (ABI)≤ 0.85 and 15 healthy men (mean age 45.0±14.2 years). The patients were divided into 2 groups: group 1 with ABI≥0.55, (n=49) and group 2 with ABI<0.55 (n=23). The groups were matched for age (65.1±6.6 and 68.7±6.1 years), for number of patients with arterial hypertension and concomitant ischemic heart disease. All patients received background therapy including statins, aspirin, and if necessary, antihypertensive drugs. Assessment of skin MC was performed by laser Doppler flowmetry. Results. Analysis of the structure of hemoperfusion fluctuation rhythms showed a significant increase in the amplitude of the neurogenic modulation range in patients of the 2nd group compared to group 1 accounted to 0.72±0.48 perfusion units (pfu) vs 0.48±0.36 pfu, р=0.001, respectively and 0.43±0.26 pfu in healthy subjects, that indicates the dilation of the arterioles. At the same time, the myogenic tonus index indicating the state of precapillary sphincters, was significantly higher in patients of group 2 versus 1 group accounted to 84.9±57.7 units vs 59.0±31.5 units (р=0.015), respectively and 32.5±31.0 units in healthy group (р=0.03) that led to a significant decrease in nutritional blood flow (by 49% and 73%, respectively), increasing blood flow through arteriolo-venular shunts in 1 and 2 groups of patients (by 107.5% and 319%, р=0.002, respectively) and venous congestion causing more severe violation of blood rheology. Conclusion. The data obtained show severe MC disturbances in patients with IC that largely determines the severity and prognosis of the disease.

 

High-resolution magnetic resonance imaging (MRI) plays an important part in the diagnostic process of clarification of indications for operating and planning operative treatment tactics in patients with neurovascular conflict. Due to higher strength of field 3 Tl MR units have better signal to noise ratio and better image quality. The aim of the study is to compare imaging quality in 3 Tl and 1.5 Tl MR units in patients with neurovascular conflict. Material and Methods. 25 patients with neurovascular conflict were examined in 3 Tl and 1.5 Tl MR units using 3D-CISS images. Delimitation and acuity of anatomical structures, quality of images of two devices were compared. During surgical treatment (microvascular decompression of trigeminal nerve) was made a comparison of MR-images with operation findings. Results. Images in 3 Tl MR unit had better signal to noise ratio and anatomical resolution, in a greater degree corresponding with intraoperational findings, including better differentiation of small vascular and neural structures, and also small vascular branches. According to the research data obtained in tomograph 3 Tl, higher degree of trigeminal nerve compression in comparison with the data of tomograph 1.5 Tl was revealed in some patients. Conclusion. To estimate the neurovascular conflict in patients with trigeminal neuralgia it is better to perform CISS-visualization in 3 Tl MR units having higher sensitivity and delicacy to determine the degree of trigeminal nerve root compression and the presence of small vessels in nerve compression zone. The data have shown that 1.5 Tl MR units also allow us to identify the major causalgic vessel or their combination which compress trigeminal nerve root.

 

Aim: to study changes in the parameters of the 24-hour arterial stiffness monitoring in patients with bronchial asthma, chronic obstructive pulmonary disease (СOPD) and asthma–COPD overlap syndrome. Material and Methods. 93 people were involved in the research: 50 patients with COPD, 28 patients with bronchial asthma, 15 patients with asthma–COPD overlap syndrome. The group of control included 24 practically healthy volunteers. Everyone underwent 24-hour blood pressure and arterial stiffness monitoring using BPLab MnSDP-2 monitor («Petr TELEGIN», Russia). Results. In patients with chronic diseases of the respiratory tract, there was a violation of the elastic properties of the arteries. In patients with COPD and asthma–COPD overlap syndrome, significantly higher Aix values were found in comparison with bronchial asthma and controls, and a violation of the daily profile of arterial stiffness was also noted. Patients with asthma and asthma–COPD overlap syndrome have higher (dP/dt)max values compared with patients with COPD and control group. Conclusion. In patients with bronchial asthma, COPD and asthma–COPD overlap syndrome is significantly higher arterial stiffness than in the control group

The aim is to study the clinical and functional characteristics and indicators of blood gas composition in workers with chronic obstructive pulmonary disease (COPD) exposed to the effects of industrial aerosols (IA). Material and Methods. The study included 132 patients with a diagnosis of COPD, stage I, category C; 68 were working in conditions of exposure to IA toxico-chemical action, and 64 people had COPD (comparison group which never worked in conditions of exposure to IA). Patients in both groups were divided into 2 subgroups: subgroup 1 — the duration of exposure to IA did not exceed 10 years, 2 — more than 10 years. Spirography was carried out on the device Care Fusion UK 232 Ltd. carbon monoxide (CO) content in exhaled air was determined using gas analyzer CareFusion Smoke check. Determination of blood oxygen saturation was carried out using pulse oximetry method. The content of the partial pressure of carbon dioxide (pCO2 ) and oxygen (pO2 ) in the venous blood were studied by Astrup method. Results. Most smokers were identified in the group exposed to long-term IA. The lowest values of forced expiratory volume in one second, vital capacity and Tiffeneau index were observed among persons exposed to IA differed significantly (p<0.05) from the control group. The highest values of CO and pCO2 , and pO2 were lowest in the group of patients with COPD in the combination of IA and in smokers. Conclusion. The high frequency and long duration of smoking was found out among the workers exposed to IA. Florid violations of wheeze were detected in individuals exposed to IA. As duration of the production contact with IA increasing, more serious violations of gas exchange are formed in patients with COPD. Keywords: chronic obstructive pulmonary disease, pollutants, industrial enterprise, function of external respiration, dyspnea><0.05) from the control group. The highest values of CO and pCO2 , and pO2 were lowest in the group of patients with COPD in the combination of IA and in smokers. Conclusion. The high frequency and long duration of smoking was found out among the workers exposed to IA. Florid violations of wheeze were detected in individuals exposed to IA. As duration of the production contact with IA increasing, more serious violations of gas exchange are formed in patients with COPD.

 

 

Objective: the study of clinical and biochemical manifestations in pregnant women with chronic viral hepatitis B and C in the third trimester and their relationships with the activity of infectious process. Material and Methods. The study included 50 pregnant women with chronic viral hepatitis (group I), 83 women with chronic viral hepatitis C (group II), and 36 healthy women (group III). Complaints, clinical manifestations, biochemical parameters, and viral load (VL) were evaluated in pregnant women with chronic viral hepatitis. Results. In pregnant women with chronic viral hepatitis in the third trimester compared with healthy pregnant women, higher numbers of complaints and clinical symptoms were recorded. In healthy pregnant women, only heartburn, bloating, and swelling in the legs (8.34%) were observed. Heartburn (p≤0.05), pain in the right hypochondrium (p≤0.05), palmarerythema, and spider veins (p≤0.05) were detected more often in pregnant women with chronic viral hepatitis B compared with those who had chronic viral hepatitis C. Women with chronic viral hepatitis C more often had anxiety (p≤0.05), weakness (p≤0.05), tongue coating (p≤0.05), and swelling in the legs (p≤0.05). Loss of appetite, joint pain, and headache were found only in pregnant women with chronic viral hepatitis C. 92% of women with chronic viral hepatitis В had НВеАgnegative chronic viral hepatitis; women with chronic viral hepatitis C had genotypes 1 and 3 of the virus with the same frequency. In all pregnant women with chronic viral hepatitis, low VL<106 copies/mL occurred predominantly: in 68% of those with chronic viral hepatitis B and 71% of those with chronic viral hepatitis C. Conclusions. Pregnant women with chronic viral hepatitis in the third trimester had more often greater numbers of complaints and clinical manifestations compared with healthy controls. Low VL, НВеАg-negative forms in chronic viral hepatitis В, genotypes 1 and 3 in chronic viral hepatitis C, and reduced total protein and a moderate increase in alanine aminotransferase in pregnant women with chronic viral hepatitis C were predominant. The number of clinical manifestations increased along with an increase in VL.

 

Myocardial infarction complicated by cardiogenic shock is a rare but severe iatrogenic complication of invasive procedures. Damage of microcirculatory vessels; microcirculatory disorder, oedema of pericapillary tissues; embolization by microcrystals of contrast agent and platelet masses; inflammatory reaction in response to histamine release, dysfunctions of the heart’s autonomic nervous system cause “No-reflow” and “Slow-reflow” phenomena which leads to the development of pathological condition. In this case, a choice of interventions tactics depends on physician and is determined individually in each separate case, nevertheless the need of complete myocardial revascularization seems obvious.

 

The article presents a clinical case of inflammatory viral cardiomyopathy flowing by type of acute decompensation of chronic heart failure. Differential diagnosis was carried out with ischemic cardiomyopathy. The diagnosis was verified using standard methods, as well as advanced imaging technology, including 2D-speckle tracking echocardiography, endomyocardial biopsy with immunohistochemical analysis.

Aim: to study the possibility of use of contrast-enhanced echocardiography with SonoVue™ in evaluation of the left ventricle structural features. Here we present clinical case demonstrating the use of second generation ultrasound contrast agent for assessment of the structural features of the left ventricle in patients with coronary artery disease and post-infarction left ventricular aneurysm. In the course of routine ultrasound heart study, there was no clear definition of apical endocardial borders, of left ventricular volume, aneurysm, and the presence and size of the thrombus. Ultrasound contrast agent provided clear visualization of the endocardial borders, allowing for more accurate measurements of volumes, ejection fraction, and size and volume of thrombus. Echocardiography with contrast agents significantly improves the quality of ultrasound images and enhances the diagnostic role of noninvasive diagnostics.

 

The article represents the biography of the famous Russian professor Kostantin N. Vinogradov and his contribution to the development of Russian of pathological anatomy. The author gives a brief review of his scientific, educational, and administrative activities.