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Aim: to compare the capabilities of identifying different types of brain natriuretic peptide (BNP) for the evaluation of renal replacement therapy modalities in patients with decompensated chronic heart failure (CHF)., Subjects and Methods: Patients (31 men and 9 women) aged 30 to 82 years with functional class II-IV CHF in its decompensation phase were examined. The patients were divided into 2 groups. A study group received medical therapy for CHF, such as angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists, verospirone, beta-adrenoblockers, digoxin, loop diuretics (furosemide, diuver, in the doses not exceeding those taken before admission) in combination with renal replacement therapy: slow continuous ultrafiltration (SCUF) or continuous venovenous hemofiltration (CVVHF). A control group had only medical therapy for CHF (intravenous furosemide in the doses doubling those used before admission, i.e., > or =80 mg/day required for an adequate response to the drug--daily urine volume >1 liter). The patients from the study and control groups received furosemide < or =40 mg/day or torsemide < or =20 mg/day after a course of SCUF or CVVHF sessions or intravenous furosemide. There were 4 examination stages [control study points (CSP)]: (1) before study; (2) after CHF compensation achievement (a day before hospital discharge); (3) following 90 days; (4) following 180 days. The plasma concentration of active BNP was measured by enzyme immunoassay; that of the N-terminal fragment of BNP (NT-proBNP) was estimated on an analyzer., Results: There were direct correlations between the content of BNP and that of NT-proBNP) in all CSPs in the patients from both groups. The study group showed a significantly greater weight loss, which was accompanied by a more pronounced reduction in systolic pulmonary artery pressure, pulmonary venous hypertension, hydrothorax elimination, decreased liver size, lower plasma aldosterone concentration, decreased heart size, and higher left ventricular ejection fraction (LVEF). The study group displayed a steady-state reduction in the plasma concentrations of both BNP and NT-proBNP, significant inverse correlations between the lower BNP level and the higher LVEF throughout the follow-up., Conclusion: Extracorporeal dehydration techniques are more effective that intravenous diuretics. The direct correlations between the content of BNP and that of NT-proBNP and between the change in their concentrations during treatment assume the capacity and objectification of diagnosing CHF and its degree, by determining only one of the types of BNP.

Idiopathic (primary) pulmonary hypertension (IPH) is a rare disease of unknown etiology, which is characterized by elevated pulmonary artery pressure, increased total pulmonary vascular resistance, frequently a malignant course with evolving right ventricular decompensation, and a fatal outcome. The diagnosis of IPH is established on the increments in the mean resting and exercise pulmonary artery trunk pressure by more than 25 and more than 30 mm Hg at rest and during exercise, respectively, with a normal pulmonary artery wedge pressure. Endothelin receptor antagonists (ERA) are one of the effective classes of drugs for the treatment of patients with IPH. Bosentan is the first drug from the ERA class that blocks the receptors of both types and that has been recommended by the WHO to treat patients with functional class II-IV pulmonary hypertension. The described case demonstrates the possibility of concomitantly using bosentan in a female patient with IPH shortly after ineffective treatment with a calcium antagonist.

Unlabelled: Slow continuous ultrafiltration (SCUF), continuous veno venous haemofiltration (CVVHF) are alternative to diuretics methods of treatment of patients with chronic heart failure (CHF), edematous syndrome., Methods: Patients of both sexes aged 30-82 years with functional class II-IV CHF were included because of decompensation of CHF. Randomization: experiment - 19 patients, 3-4 component therapy plus SCUF or CVVHF; control - 3-4 component therapy plus intravenous furosemide., Examination: I ñ at baseline, II ñ after compensation of CHF., Results: Delta weight (kg) - experiment -10.1+/-1.08, control -1.92+/-0.83, p=0.00001; Delta left ventricular ejection fraction - experiment +10.09+/-2.26, control +0.52+/-1.14, p=0.0007; pulmonary artery systolic pressure (mm Hg) - experiment -12.32+/-3,43, control -4.05 +/-2.07, p=0.029; Delta 6 min walk test: experiment +304.22+/-39.4, control +91.91+/-23.4, p=0.00003; Delta glomerular filtration rate - experiment -1.16+/-3.23, control +4.44+/-3.68, p=0.85; duration of hospitalization (days) - experiment 17.26+/-1.43, control 17.52+/-1.02, p=0.59. We did not observe complications related to renal replacement therapy., Conclusion: SCUF and CVVHF are safe for patients. In decompensated CHF SCUF and CVVHF provide greater weight reduction and fluid removal than intravenous diuretics, abolish hypervolemia what cause improvement of myocardial contractility.

Aim: To determine informative value of quantitative parameters of orthogonal ECG repolarization phase in diagnosis of left ventricular hypertrophy (LVH) in hypertensive patients., Material and Methods: A total of 210 healthy subjects and 241 hypertensive patients with LVH (LV myocardium mass index > 125 g/m2 in males and > 110 g/m2 in women) comprised two groups--control and test. The study was made of quantitative parameters (components X, Y, Z, modules and angles of azimuth and elevation) of wave T integral vector, wave T maximal vector, ST vector, ventricular gradient; spatial and projection areas of wave T, the angle between integral vectors of spatial waves QRS and T (phi angle)., Results: The test group had reduced X, Y components and elevated vectors, their azimuth and phi angle. Most informative for repolarization were components X of T maximal and integral vectors being as informative as Rx+Sz and Cornel product. The method of multiple regression analysis was used to plot discriminant function taking account of most informative indices of depolarization and repolarization--Rx+Sz and X component of T maximal vector. The area under ROC curve for this function was greater than for the variables alone and Cornel product in both groups (0.90 +/- 0.02 and 0.86 +/- 0.02, p < 0.05 for the control and test group, respectively)., Conclusion: Quantitative parameters of repolarization phase can improve LVG diagnosis in hypertensive patients.

Aim of the study was to analyze dependence of various voltage parameters of QRS complex on increase of left ventricular myocardial mass (LVMM) in samples of men and women with excessive body mass or obesity. We included data from 223 patients with excessive body mass and diagnosis of stage I - II arterial hypertension. ECG was registered in 12 standard leads. Left ventricular hypertrophy (LVH) was certified if according to echoCG data LVMM exceeded 125 g/m2 in men and 110 g/m2 in women. Depending on sex and presence of LVH all patients were divided into 4 groups: M1 (men with LVH, n=74), M2 (men without LVH, n=74), W1 (women with LVH, n=55), anb W2 (women without LVH, n=20). We analyzed amplitudes of all waves of the QRS complex as well as Sokolow-Lyons voltage parameters and the Cornell index. The following intergroup differences were most significant: between groups M1 and M2 - in amplitudes of S waves in chest leads V3, V4; between groups W1 and W2 - in amplitudes of R-waves in limb leads I and aVL, and amplitudes of S-waves in lead III. Increases of the Cornell voltage index were observed both in men and women with LVH. The following criteria had greatest sensitivity at 95% specificity: in men - SV4 > 1,1 mV (34%) and RaVL+SV3 > 2,3 mV (32%); in women - RaVL > 0,8 mV (56%) and RI+SIII > 1,5 mV (56%). Informative power of electrocardiographical diagnosis of LVH can be augmented by the use of different voltage criteria in groups of men and women. In men most informative are chest leads (SV1 - V3, RaVL) while in women - limb leads (RI, RaVL, and SIII). The use of combination parameters RaVL+SV3 > 2,3 mV (in men) and RI+SIII > 1,5 mV (in women) allows to augment sensitivity with unchanged specificity. In patients with excessive body mass voltage the Sokolow-Lyons criterion is not informative. Most significant component of the Cornell voltage criterion in groups of men with excessive body mass is amplitude of SV3, in groups of women - amplitude of RaVL.

Patients with atrial fibrillation taking either indirect anticoagulant acenocumarol or most often prescribed antiaggregant aspirin were followed for 1 year. The results have shown that therapy with acenocumarol lowers content of D-dimer, prevents formation and promotes lysis of left auricular thrombi and lowers risk of development of ischemic stroke in patients with atrial fibrillation and high risk of thromboembolism. Therapy with aspirin in a dose providing maximal suppression of platelet function, does not lower D-dimer levels, does not promote lysis of left auricular thrombi and is inferior to acenocumarol in prevention of ischemic stroke.

Aim: To study efficacy of different ECG criteria of hypertrophy of left ventricular myocardium (LVH) in hypertensive patients with reference to overweight and obesity., Material and Methods: The authors analyse data on 100 patients (42 males and 58 females) aged 19-79 with diagnosis of arterial hypertension stage I-II. ECG was conducted in 12 leads. LVH by ECG was determined according to the following criteria: Sokolov-Lyon (S-L): Sv1+Rv5(v6) > 35 mm; Cornell voltage (Crn V): R avL +Sv3 > 28 mm (> 20 mm for females; Cornell product (Crn P): (RavL+Sv3)xQRSduration > 2440 mm x ms (for females RavL+Sv3 amplitudes + 0.6 mm). To verify L VH by echoCG, the authors used threshold values of left ventricular myocardium mass index (LVMMI) 125 g/m(2) for males and 110 g/m(2) for females. LVMMI was calculated by two methods: LVMM to body surface area (BSA) 2) LVMM to BSA of an ideal figure of a relevant height. Depending on the BMI all the patients were divided into 3 groups: with normal weight (BMI under 25 kg/m2), with overweight (BMI between 25 and 30 kg/m(2)), with obesity (BMI over 30 kg/m(2))., Results: Sensitivity of the criterion Crn-P was the highest. The S-L criterion had the least sensitivity (under 10%) in groups with overweight by more than 25 kg/m(2). In these groups sensitivity of all ECG criteria of L VH depends on some factors: on indexation of LVH by body size, gender and overweight. S-L criterion sensitivity is higher in subgroups of males irrespective of overweight and obesity., Conclusion: Informative value of LVH ECG criteria depends on the method of LVMM indexation by body size, overweight and gender of the patients.

Aim: A detailed description of immune status abnormalities of adult patients with heart arrhythmia either idiopathic or in combination with primary heart disease such as chronic myocarditis and dilated cardiomyopathy (DCMP)., Material and Methods: Eighty two consecutive patients aged 16-57 years admitted to the L.A. Myasnikov Institute of Clinical Cardiology (Moscow) for heart arrhythmia were studied. Among them 35 patients had idiopathic heart arrhythmia (IHA, group 1) with no evidence of any primary heart disease, while other 47 patients (group 2) had heart arrhythmia combined with primary heart disease (chronic myocarditis or DCMP). In group 1 ventricular arrhythmia was recorded in 27 patients (12 cases with ventricular tachyarrhrythmia ?VTA, 15 cases with ventricular extrasystolia- VE). Supraventricular heart arrhythmia was found in 6 patients (3 cases of constantly recurring supraventriccular tachycardia, 2 cases of paroxysmal and 1 with constant atrial fibrillation). The intermittent atrioventricular block of the second-third degree was recorded in 2 patients. The patients of group 2 were divided into subgroups 2a, 2b and 2c. In subgroup 2a (patients with DCMP without signs of heart failure) ventricular arrhythmia was found in 7 patients (VT ? 5, VE ? 2). Supraventricular arrhythmia was recorded in 7 patients 5 of which had constantly recurring supraventricular tachycardia, 1 ? paroxysmal and 1 constant atrial fibrillation. In subgroup 2b (DCMP patients with obvious signs of heart failure) ventricular arrhythmia was recorded in 12 patients, among them 6 had VT and 6 ? VE, 2 ? constant atrial fibrillation). In subgroup 2c (patients with chronic myocarditis) ventricular arrhythmia was in 7 patients (VT ? 5, VE ? 2), constant atrial fibrillation ? in 2, heart conduction abnormalities ? in 3 patients, atrioventricular block of the first or second degree ? in 2, sick sinus syndrome ? in 1. To verify the diagnosis, all the patients have undergone physical examination, blood cell counts and biochemical tests, urine clinical analysis, ECG and ultrasound heart examination as well as 24h ECG monitoring. On demand, bicycle exercise test or treadmill test, coronaroangiography, endomyocardial biopsy and invasive electrophysiological examination were made., Results: Immune status abnormalities found in patients with heart arrhythmia both idiopathic and combined with primary heart diseases such as chronic myocarditis and DCMO correspond to immune defense response during chronic infection. Activation of different anti-infection defense mechanisms was recorded in patients with idiopathic heart rhythm and conductivity abnormalities. Immune deficiency was found in arrhythmia and conductivity abnormalities combined with primary heart diseases (chronic myocarditis or DCMP). A positive correlation exists between the degree of immune defense failure and reduction of myocardial contractility., Conclusion: There exists a characteristic pattern of immune status abnormalities in patients with arrhythmia, both idiopathic or combined with primary heart disease (myocarditis, DCMP). The abnormalities depend on severity of arrhythmia, intensity of inflammatory processes in the myocardium and on the degree of left ventricular contractility dysfunction in patients with primary heart diseases.

Aim: To assess efficacy of different ECG-criteria of left ventricular myocardial hypertrophy (LVH) in hypertensive patients as regards body mass (obesity)., Material and Method: Data on 100 patients (42 males and 58 females, age 19-79 years) with diagnosis of hypertension of the first-second degree were analysed. ECG was registered in 12 leads. LVH was determined by ECG by the following criteria: Sokolov-Lion (S-L): Sv1+Rv5(v6) > 35 mm; Cornell voltage (Crn-V): R avL+Sv3 > 28 mm (> 20 mm for women); Cornell product (Crn-P). According to the body mass the patients were divided into 3 groups: with normal weight, overweight and obesity. Crn = P criterion was most sensitive in all the three groups., Results: In the groups sensitivity of ECG criteria depends on several factors: on the method of indexation and on the gender and body mass index., Conclusion: Informative value of ECG criteria of LVH depends on the method of indexation and on the amount of the excessive body mass.

Thromboembolic complications (cerebral infarction and system embolism) are the most threatening ones in patients with ciliary arrhythmia without valvular lesions. Transoesofhageal echocardiography is the method of choice in detection of left atrial auricle thrombosis, which is the main source of thromboembolism in this category of patients. Primary and secondary prevention of thromboembolic complications in patients with ciliary arrhythmia is a topical problem, still remaining unsolved. Administration of indirect anticoagulants, which are the preparations of choice, demands strict doctor's supervision and continuous laboratory monitoring. The study presents authors' own data, based upon the observation of patients treated with either warfarin or acenocumarol. The paper demonstrates equal efficiency of both cumarine anticoagulants. The frequency of haemorrhagic complications after 12-month therapy with either warfarin or acenocumorol in patients with ciliary arrhythmia without valvular lesions was comparable. Warfarin provided more stable level of anticoagulation and thus long-term warfarin therapy was characterized by lower risk of complication.

Aim: To compare different techniques of calculation of left ventricular myocardial mass (LVMM) by one-, two- and three-dimentional echocardiography (EchoCG) and by MRT., Material and Methods: We calculated LVMM by formulas Penn-cub and modified ASE in one-, two- and three-dimentional EchoCG regimes and MRT; evaluated structural-geometrical characteristics of the left ventricle at various stages of hypertension in 53 hypertensive patients (42 males and 11 females)., Results: Mean LVMM values calculated according to two formulas in one-dimentional regime did not differ significantly but were higher than in two- and three-dimentional regimes. LVMM value according to three-dimentional EchoCG was closer to the results of the summation estimation in MRT., Conclusion: Conventional EchoCG methods of LVMM calculation in M-regime (Penn-cub, ASE) overestimate the results. Most compatible with three-dimentional EchoCG results are those of EchoCG in two-dimentional regime (area-length).

Aim: To study effects of body mass loss due to orlistat on carbohydrate and lipid metabolism, insulin resistance, 24-h profile of arterial pressure (AP), left ventricular myocardial hypertrophy, brain perfusion in patients with metabolic syndrome (MS)., Material and Methods: Thirty middle-aged patients with MS entered the trial. They received orlistat in a dose 120 mg twice a day for 24 weeks. Before and after the treatment the patients' carbohydrate and lipid metabolism, insulin resistance were studied, 24-h monitoring of arterial pressure, echo-cardiography were made. Brain perfusion was studied with single-photon emission computed tomography in 18 patients. Results. All the patients lost much weight. This was accompanied with improved indices of AP profile, metabolism of carbohydrates and lipids, insulin resistance, left ventricular hypertrophy, brain perfusion. Conclusion. Orlistat treatment weakens basic factors of cardiovascular risk.

Aim: To show possibilities of dipolar electrocardiography (DECG) in diagnosis of left ventricular hypertrophy (LVH)., Material and Methods: We made DECG in 151 healthy subjects and 158 hypertensive patients. To characterize DECG quantitatively, we used the integral activation duration index (IADI) calculated as a weighted sum of the areas with different duration of activation, module of the maximal vector QRS, QRSxIADI (IADIM)., Results: In patients with left ventricular myocardial mass index (LVMMI) under 150 g/m2, sensitivity of DECG was 38-49%, in the index over 150 g/m2 sensitivity reached 38-75%, specificity 89-98% compared to healthy examinees and 72-82% compared to hypertensive patients without LVH. The IADIM parameter correlates directly (moderate correlation) with duration of QRS complex and LVMMI., Conclusion: Possibilities of using parameters IADI and IADIM for assessment of electrophysiological myocardial remodeling and their correlation with other methods need further investigations.

Aim: To study the condition of the sympathico-adrenal system (SAS), synthesis of cAMP dependent on beta2-adrenoreceptors and parameters of free radical oxidation in patients with primary pulmonary hypertension (PPH); to examine efficacy of non-selective beta- and alpha1-adrenoblocker carvedilol in PPH patients., Material and Methods: Twenty patients with PPH had 6-minute walk test, ECG monitoring with assessment of heart rhythm variability (HRV). Tests for noradrenalin and adrenalin concentration in blood plasma, cAMP synthesis by blood lymphocytes in basal conditions and under stimulation with isoproterenol and forskolin, free radical oxidation were made initially, 1 and 6 months later. Ten patients received carvedilol in addition to standard therapy, 10 patients served control., Results: PPH patients had higher NA in the blood, low cAMP synthesis, high malonic aldehyde, low activity of glutathionperoxidase, increased activity of superoxidedismutase and catalase of erythrocytes. The most pronounced changes in the above parameters were observed in patients with PPH FC III-IV. HRV declined in progression of cardiac failure. 6-months of combined treatment with carvedilol increased the distance of 6-min walk. Carvedilol had no effect on HRV, it reduced NA, stimulated cAMP synthesis, demonstrated no antioxidant activity., Conclusion: In PPH there is activation of SAS and desensitization of beta2-AR cells, oxidative stress develops. Addition of carvedilol to standard therapy with PPH improves clinical condition due to adrenoblocking properties of the drug.

Aim: To assess efficacy and safety of long-term international normalized ratio (INR) guided therapy with acenocoumarol in patients with nonvalvular atrial fibrillation., Material: Patients (n=100) with nonvalvular atrial fibrillation and at least 1 risk factor of thromboembolic complications., Methods: Ischemic strokes, episodes of systemic thromboembolism and hemorrhagic complications were registered during 3 years of treatment with acenocoumarol (target INR 2.0-3.0)., Results: Annual rates of ischemic strokes, hemorrhagic complications and major bleeding were 0.7, 14.4 and 1.1%, respectively. No episodes of thromboembolism were registered in patients with history of thromboembolic complications. Basing on data collected predictors of bleeding complications in patients with atrial fibrillation during long term treatment with acenocoumarol were elucidated.

The ultrasound contrast medium obtained by the original methods was administered into the left ventricular cavity and myocardium of 12 open-chest dogs by using a catheter. After its administration into the cavity there was its intensive contrast. When the ultrasound contrast was administered into the aortic root, the entire myocardium contrasted, on selective administrations of the contrast into the coronary arteries, the beds supplied by appropriate arteries contrasted. The ultrasound contrast study enabled the areas with impaired perfusion as echo-negative "filling defects" to be detected and mapped. The imaging of myocardial blood flow in tomographic sections and real time allows one to regard it promising for clinical use.

Whether transesophageal echocardiography may be used in the assessment of central hemodynamics has been studied in 40 patients undergoing direct cardiac revascularization in extracorporeal circulation. Changes in the mean values of end diastolic area (EDA) and end-diastolic anteroposterior dimensions, end-systolic myocardial stress (ESMS), anteroposterior size shortening fraction (SF), and area decrease fraction (ADF) of cross left ventricular section are outlined in the paper. It has been indicated that at the beginning of extracorporeal circulation EDA showed, on an average, a 22% decrease (p less than 0.001), after its termination, it practically returned to the baseline values. ESMS remained high at the beginning of the operation, but at the onset of extracorporeal circulation it also dropped by 26% (p less than 0.001), being rather low until the end of the operation. The highest SF and ADF values were observed after termination of extracorporeal circulation. The changes in the parameters in question were found in hypovolemia and decreased myocardial contractility. The application of transesophageal echocardiography along with direct blood pressure monitoring correctly and fully assesses central hemodynamics.

A total of 50 patients with arterial hypertension were examined. Group 1 included 28 patients with renovascular hypertension, 18 of them had unilateral renal artery stenosis, the remaining 10 had bilateral renal artery stenosis. Group 2 consisted of 16 patients with primary aldosteronism. Group 3 comprised 6 patients with pheochromocytoma. The examination was made with echocardiograph. Changes in left ventricular myocardial mass (LVMM) were studied 1 and 6 months after surgical intervention. The maximum hypertrophy was observed in the patients with primary aldosteronism, no changes occurred in any of the groups examined 1 month after surgical management. The LVMM was found to be significantly diminished by 13% in the patients with renovascular hypertension and by 23% in patients with adrenal tumors (pheochromocytoma, aldosteroma).

The paper is concerned with some potentialities of transesophageal echocardiography (TE echoCG) in diagnostic and cardiosurgical practice. Four examples are provided (interatrial septal defect, a new growth in the right atrial cavity, vegetation on the cusps of the aortal valve, left atrial thrombus), illustrating that the use of TE echoCG was of help in the establishment of a correct diagnosis. The method is described as holding promise for observation over heart activity in cardiosurgery. In addition, the authors mark difficulties encountered during interpretation of the data obtained.

The phasic structure of heart activity was explored in 50 patients suffering from symptomatic arterial hypertensions before and after the operative treatment with the aid of impulse Doppler echocardiography. Of these, 28 patients had renovascular hypertension (RVH), 16 primary aldosteronism (PA), and 6 pheochromocytoma of the adrenals. The data obtained were compared with the polycardiographic readings in patients with essential hypertension (EH). As in the case of EH, the period of left ventricular tension, the phase of asynchronous and isometric contraction, and the phase of isometric relaxation became significantly longer in patients with RVH and PA. In the postoperative period, some phases of heart activity return to normal whereas other phases remained altered throughout the entire observation period, which may be due to the disease standing and irreversibility of myocardial alterations. Therefore, Doppler echocardiography is a sufficiently accurate method of estimating phasic activity of the left ventricle, allowing computation of the period of cardiac cycle phases even in the presence of only one lead of the ECG mounted into an ultrasonic outfit.

In 50 patients undergoing direct revascularization of the myocardium, an attempt was made to carry out transesophageal echocardiography. In 5 of them, visualization of the myocardium appeared unsatisfactory, 2 patients were excluded from the investigation in view of the fact that they were operated on in the acute phase of myocardial infarction. Among 43 patients who were entered into the investigation, the areas of abnormal local contractility of the myocardium (AILC) occurred during surgery in 14 (33%). In 3 patients, the newly occurring disorders of local contractility of the myocardium persisted till the end of the operation. In the remaining cases, the presence of the AILC was temporary. The sensitivity of the newly occurring stable AILC in the diagnosis of perioperative myocardial infarction and acute coronary death amounted to 75%, specificity was 100%.

Oxygen and hydrogen polarography has revealed functional changes of the oxygen regimen and hemoperfusion of both involved and apparently intact skin in patients with common psoriasis. These changes developed by stages and their intensity varied. Ethacizine therapy has been effective in 91% of the patients, improving the parameters of the skin capillary blood oxygenation and volumetric rate both during the stationary and progressive forms of the disease.

Regional hemodynamics using plethysmography and tissue oxygen tension at the basal level and during corinfar administration were investigated in 38 patients with heart failure against a background of rheumatic heart valvular diseases, dilatation cardiomyopathy and coronary heart disease. A considerable decrease in regional vascular resistance (RVR) and improvement of tissue oxygenation were noted in persons with a raised basal RVR level. A value of an acute test with corinfar for administration of regular therapy was determined.

A total of 18 patients with chronic congestive heart failure were examined using an acute pharmacological test (25-50 mg of captopril) and during 2-week course treatment. A marked positive effect of the drug was noted in 15 (83.3%) patients. Captopril significantly decreased venous tone by 19.0 +/- 2.4% and by 40.4 +/- 4.1% and regional vascular resistance by 25.7 +/- 1.9% and by 39.4 +/- 2.9% in the acute test and in course treatment, respectively. Microcirculatory indices also improved: there was an increase in tissue oxygenation (PO2 by 38.8 +/- 2.7%), oxygen supply rate and small arteriolar function (more pronounced in course treatment). Platelet aggregation in the captopril acute test was slightly decreased but in course treatment it did not significantly differ from the initial one. A conclusion was made that captopril, mostly in course treatment, decreased venular and arteriolar tone and improved microcirculatory processes making an insignificant effect on platelet aggregation permitting its recommendation for prolonged treatment of patients with chronic congestive heart failure with minimum risk of complications.

Oxygen regimen and hemoperfusion of affected and visually unchanged skin were studied in 35 patients with psoriasis universalis using methods of H and O polarography. Latent disorders of the microcirculatory system detected by functional tests were noted in visually unaffected skin zones. Sharp changes of oxygen regimen and hemoperfusion indices were noted in affected skin, especially during progression of disease. Course therapy with etatsizin at a daily dose of 150 mg resulted in a positive time course of a skin process in 91% of the patients; indices of microcirculation and tissue metabolism were significantly improved.

Daily monitoring of the ECG, catheterization of the pulmonary artery, tetrapolar chest rheography, occlusion plethysmography and polarography were employed to study the antiarrhythmic efficacy and the effects on the central and peripheral circulation of the new antiarrhythmic etmozine and etacyzine. Twenty-two patients with a frequent chronic ventricular premature heart beat (PHB) and clinically marked circulatory failure (CF) were entered into the study. Intake of etmozine (600 to 800 mg daily) and etacyzine (100 to 300 mg daily) over 5 to 6 days exerted a positive antiarrhythmic effect in 52.6 and 83.3% of the patients, respectively. Etmozine did not produce any adverse hemodynamic action, whereas etacyzine brought about an insignificant increase in the stroke and minute volumes of the heart (12.3 and 9.8%, respectively). However, the lack of an increase in the heart rate (HR), diastolic pressure in the pulmonary artery and regional vascular resistance (RVR), and no significant rise of the preload (systolic pressure in the right atrium) and afterload (elevation of the mean arterial blood pressure and RVR) attest to the fact that etacyzine has a negligible adverse hemodynamic action in CF patients. Intravenous injection of etmozine does not elicit any changes in the RVR or in the venous tone. Meanwhile intravenous injection of etacyzine leads to a significant reduction in the RVR (23.3%). The treatment with both etmozine and etacyzine given in courses promotes the improvement of the microcirculation and tissue oxygen metabolism in patients presenting with CF. More pronounced positive shifts in the microcirculation were achieved with etacyzine. Apparently, this bears on a more demonstrable arteriolodilatation effect of the drug.(ABSTRACT TRUNCATED AT 250 WORDS)

The first experience with transesophageal echocardiography (TEE) during diagnostic investigation and cardiac surgery is described. Three examples--atrial septal defect (ASD), formation in the right atrium, thrombus in the left atrium are discussed, when the TEE was useful in the establishment of correct diagnosis. The possibilities provided by TEE in cardiac monitoring are described. Some difficulties in the interpretation of the obtained images are listed.