Vol 1, No 3 (2001)

The review describes the development of cholesterol concept of atherogenesis from the classical investigations of Anichkov and Khalatov [1913], who induced experimental cholesterol atherosclerosis in rabbits, to the present time. The authors of the review have made a conclusion that the cholesterol concept of atherogenesis has not lost its significance on the background of the contemporary data about the presence in blood of different classes of lipoproteins, including antiatherogenic, about participation in atherogenesis of peroxidatively modified low density lipoproteins, of various blood and vessel wall cells, and in addition, of a large number of other factors. What is more, the cholesterol lowering therapy keeps the leading place in the primary and secondary prevention of coronary heart disease events and other clinical manifestations of atherosclerosis, and also in their treatment.

With the purpose of estimation of the left ventricle (LV) papillary-trabecular complex (PTC) influence on its systolic and diastolic functions a clinical-echocardiography examination was executed of 40 able-bodied persons, 83 with idiopathic hypertensia of I stage, 85 with idiopathic hypertensia of II stage, 27 with idiopathic hypertensia of III stage, 65 with ischemic heart disease. The index of LV papillary-trabecular deformation (IPTD) was determined taking into account the modified specific area of papillary muscles and trabeculas in the cross section of a ventricle. The correlation between IPTD and doppler-echocardiography parameters of LV systolic and diastolic functions were analyzed. A conclusion has been made that PTC influences the marked parameters, behaves as morpho-functional skeleton of a ventricle and provides its contractile reserve.

Complex angiologic and neurologic examination, ultrasonic extracranial and intracranial dopplerography were performed in 64 patients with isolated (unilateral) middle atherosclerotic stenosis of the inner carotid artery. Neuropsychological syndrome and steal syndrome of the vertebro-basilar region were homogeneous in the patients with early, acute and chronic forms of ischemic brain disease. Hemisphere neurological symptoms depended on the localization of ishemic brain lesion. Ishemic stroke developed in the region of the inner carotid artery stenosis in 50 % of the patients, in the vertebro-basilar region in 42,8 % of the patients, in the contralateral carotid artery stenosis region in 7,2 % of the patients. 3 types of hemodynamic disorders and those of cerebro-vascular reactivity were determined in the ipsilateral and contralateral middle and posterior cerebral arteries. Carotid endarterectomy was performed in 52 patients and middle stenosis level of inner carotid artery was confirmed. We reveled that the cerebral blood flow decrease and cerebro-vascular reactivity disorders correlated with the frequency of neurological symptoms. Linear blood flow speed reduction and that of cerebro-vascular reactivity on hypoxia (CVR) were unilateral - ipsilateral in the carotid artery region in the patients with the early forms of ischemic brain disease 55,3 ± 11,6 sm/s and 1,10 ± 0,04 respectively. Hemodynamic disorders had systemic character in the patients with acute and chronic forms of ischemic brain disease. We can make the conclusion about hemodynamic significance of the middle stenosis of the inner carotid artery and expedience of the carotid endarterectomy for the prevention of ischemic lesion progression.

The lab-clinical survey of 94 newborn infants of the first week of life was made. The «А» group consisted of newborns with the hypoergic variant of sepsis (17 prematurely born with the gestation over 32 weeks and 11 born at term). The «В» group consisted of newborns with the hyperergic variant of sepsis (16 prematurely born with the gestation over 32 weeks and 27 born at term). 23 newborns with acute pneumonia comprised the group of comparison. Following lab-tests were made: determination of the level of 12 acute phase proteins, circulating immune complexes, IgG, IgM, IgA; STG, TTG, T3, the analysis of leukocyte formulas, four leukocyte indexes of reactivity. On the basis of the obtained results, patterns of 2 lab-clinical variants of the systemic inflammatory response syndrome (SIRS) have been suggested. SIRS pattern in hypoergic variant of sepsis is a deficient state with the prevalence of proteases in the spectrum of mediators on the background of hypothyroidism of septic genesis. SIRS pattern in hyperergic variant of sepsis is a «cytokine storm» with preserved hormonal provision of protein-synthetic processes and immunity.