Vol 7, No 1 (2007)

The problem under review is the role of LDL cholesterol («bad» cholesterol) and of HDL cholesterol («good» cholesterol) in development of atherosclerosis and its dangerous clinical manifestation - coronary heart disease (CHD). Attention is also given to the approaches used in evaluation of the levels of total cholesterol, its lipoprotein fractions and their ratio in the development of CHD.

This research has been undertaken to study dynamics of mortality due to coronary heart disease (CHD) during 8-years period and its connection with morbidity of adults in St. Petersburg with influenza and acute respiratory diseases. The research was made on 34848 fatal cases of CHD from 1993 to 2000. Main statistical documents for choosing the reason of the death were the protocols of autopsy investigation and unified statistic chart of the sectioning that served together as a database. The mortality due to CHD was represented as a continuous time interval of 416 weeks corresponding to 8-years period. It has been revealed that CHD mortality increases in epidemic periods from November to April (6,8% of total mortality) and decreases in intervals May-October (2,1%). Relative medium risk of fatal outcome of CHD was increased 3,5-fold during epidemics of influenza and two-fold during period of increasing of morbidity due to respiratory diseases of unknown etiology. Weekly dynamics of fatal outcomes had no connection with main seasonal factors (temperature, atmosphere pressure, etc.).

CHD-based mortality increases during officially recognized influenza epidemics. Reliable connection with influenza epidemics is typical for aged people of both genders. Effect of infection on the mortality due to CHD may be notable during the period up to two weeks before fatal outcome, the period covering the active invasion of pathogen, receptor binding, colonization, action of exo- and endotoxins.

The autoimmune lipoprotein-antibody complex was isolated from the blood and the vessel wall of man and their high atherogenecity was shown to be mainly due to its citotoxicity and the ability to induce forma­tion of foam cells. However, antilipoprotein antibody suppressed the uptake of modified lipoproteins by macrophages.

It was shown that lipoprotein-antibody immune complexes were very quickly eliminated from circulation probably due to active uptake by cells of the reticuloendothelial system.

A suggestion is put forward that formation of lipoprotein-antibody complexes is likely to be regarded as the immune response to the appearence of highly atherogenic oxidized lipoproteins to decrease athero­genecity of these lipoproteins and to eliminate them from organism as quickly as possible.

Improvement of methods for diagnosis and treatment of ischemic insults is one of the most urgent problems in clinical medicine. It is due to a wide spread and trend to acute stroke (AS). According to WOS data the lethal outcome, occurred as a result of insult, makes the second place in mortality structure not only among old people but among those who are at a working ability age (40-60 y. o.) Besides, inability level in a year after the AS makes 68-82%. In Russia the rate of ischemic insult morbidity reaches 600 cases per 100 000 of citizens and it is yearly increased by 6, 5%. Success in surgical treatment for this disease depends on detection of indications for surgical intervention which are featured by new technique facilities for determining volumetric cerebral blood flow and metabolism in the area of ischemic strokes. Methods of radionuclide diagnosis were used: single photon emission CT, positron emission tomography and proton magnetic resonance spectroscopy. Based on these studies 4 areas of disorders in regional blood flow and metabolism were revealed.

It is established, that in development of a coronary atherosclerosis, participate the immune-mediated mechanisms. In blood of patients with coronary atherosclerosis the maintenance of the basic classes of cytokines (IL-1β, IL-2, IL-6, IL-8, TNF-α) is increased. Development of acute coronary insufficiency is accompanied by additional increase of levels of the data cytokines. The accessory of the cytokine activity to a coronary atherosclerosis is confirmed at studying the maintenance mRNA cytokines in a vascular wall. Thus, in a zone atheromatous (aorta) it is synthesized mainly mRNA IL-2, while in a zone lipomatosis (a beam artery) it is formed nonspecific immune reaction with development of the mRNA IL-1 and IL-6.

It is shown, that for patients with rheumatoid arthritis typically more active defeat of a coronary arteries, in comparison with healthy persons. Chronic immune-mediated process in frameworks of the autoimmune pathology can serve a trigger for accelerated development ischemic heart disease.

General immune-inflammatory mechanisms participating in pathogenesis of the ischemic heart disease and rheumatoid arthritis, allow to spend the certain parallels between atherosclerotic process and autoimmune pathology.

Kidney ischemia is considered as group of kidney diseases (group definition), but it always vascular genesis. Kidney ischemia is evident with urinary syndrome and different level of functional failure of organ. We think that arterial hypertension syndrome at kidney ischemia can be a consequence of hereditary predisposition to arterial hypertension and developing of diffuse (terminal) nephrosclerosis.

Causes of kidney ischemia: arterial hypertension, atherosclerosis, Takayasu’s arteritis, thromboembolism, atheroembolism, aortic and renal artery dissection, vasculitis, microangiopathy, traumas, Kavasaky’s disease etc.

Pathogenesis of kidney ischemia: activation of rennin-angiotensin and urotensin systems, endothelium dysfunction, insulinoresistance. Treatment. Step by step using main groups medicine: diuretics, в-adreno- ceptor blockers, calcium antagonists, vasodilatators and angiotensin-converting enzyme inhibitors. Anticoagulants and antiaggregants are important as well. Modification of aspirin - Cardiomagnil (0,15 - 0,075) is good for long-time preventive therapy. A new antithrombin drug Clopidogrel (0,075/day) decrease risk of ischemic complications better than aspirin.

The purpose of the present work was to disclose the number of the qualitative and quantitative magnetocardiographic (MCG) parameters for evaluation of the effects the breathing and stress tests exerted on the functional myocardial reserve in 30 normal and 10 subjects with old myocardial infarction. Computerized magnetocardiography was fulfilled before (resting subjects), during and after (resting subjects) the Stange test and Valsalva maneuver (7 normal subjects), before and after the standartized knee-bending exercise. The next trends were revealed: an increase in «curvature» of the magnetic field isolines distribution on the magnetic field maps (in the area of the right atrium projection) and the plane summary current of the myocardium of the atrial system in the frontal plane during the breathing tests, related to an increase in the right atrium hydrostatic pressure and hemodynamic reserve volume; predominance of the right atrium and the right ventricle current components in the summary currents of the atria and the ventricles; an increase in a magnetocardiosignal amplitude on the ST segment and the T wave amplitude of the «basic» PQRST magnetocardiocycle after the knee-bending exercise in contractile reserve-positive subjects, as compared with the baseline measurements at rest and the reverse trend in contractile reserve-negative subjects, up to the negative T wave formation. Our results showed that CMCG method allows to evaluate functional hemodynamic and contractile myocardial reserves in a new fashion from the electromagnetic viewpoint by analyzing CMCG parameters, describing interatrial, interventricular and atrio-ventricular interactions.

Purpose of study was to assess the long-term results (up to 23 years) of surgicaf correction of dislipoproteinemia (DLP) using partial ileal bypass (PIB) in 141 patients with CHD. The results suggest, that the lipid correction effect of PIB included the decline of total serum cholesterol, LDL cholesterol, Apo-B lipoprotein, the increase of HDL cholesterol, Apo A-I lipoprotein. PIB provides mandatory, well-marked and life-long lipid correction. Antiatherogenic action of PIB was manifested by clinical improvement of CHD, lower rate of thrombotic complications related to atherosclerosis and lower cardiovascular mortality. The efficacy of partial ileal bypass for secondary prevention of atherosclerosis is obvious in case of elimination of DLP after surgery.

Objective of the study: Analysis of the surgical treatment of patients with ischemic heart disease, operated on working heart, and comparison with the results of operations with artificial circulation during the last 6 years. Conclusions: The use of modern surgical methods of ischemic heart disease treatment allows performing myocardial revascularization on working heart in operations of any degree of complexity. The operations cause minimal lethality and complications in patients with different mortality risk levels and have good immediate and remote results.

Infrarenal aortic aneurysm was resected in 125 patients, 52 of them having undergone the resection of the common iliac artery. Inferior mesenteric artery was implanted into a prosthesis in 17 cases (13,6%), while shunting of one internal iliac artery was performed on 2 patients. Anterograde or retrograde blood flow remained in one or two internal iliac arteries in 90 patients (72%). Average arterial blood pressure in the inferior mesenteric artery and in the internal iliac arteries was over 40 mm Hg in 14 patients (11,2%). 12 patients (9,6%) developed ischemic colitis including 5 cases of intramural ischemic colitis which terminated lethally. Prevention of ischemic colitis should be based on preservation of the blood flow in the internal iliac arteries and/ or inferior mesenteric artery with the help of their implantation.

Here, we summarize the experience of surgical treatment of atherosclerotic lesions of the aorta in its terminal region and of the peripheral arteries, in 136 senior patients with critical ischemia of the lower extremities. We have designed a sequential strategy of examination and risk factor detection, combined with an investigation of other arterial basins. Isolated consecutive and simultaneous «two-story» reconstructions have been evaluated. The efficiency of using endovascular and open operations has been assessed, as well as using endovascular interventions alone in some cases, considering the severe condition of the patient. We demonstrate the superior qualities of an autovein in situ as compared to an allotransplant, especially in reconstructions below the cleft of the knee joint.