[Potential use of exogenous phosphocreatine (neoton) in the combined therapy of cancer complicated with cardiovascular diseases].
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Biomedical subjects
Publications and source records attributed to N B Perepech.
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Twenty patients with NYHA class II-IV heart failure and ejection fraction below 40% received standard therapy (control period) or standard therapy plus open trimetazidine (20 mg t.i.d.) for 3 months in a cross-over design. Therapy with trimetazidine was associated with attenuation of clinical signs of heart failure (average NYHA class 2.90-/+0.10, 2.27-/+0.20 and 2.88-/+0.13, p<0.05, at baseline, after trimetazidine and control period, respectively), improvement of results of 6-minute walk test (average distance 321-/+19, 375-/+20 m, p<0.02, and 303-/+17 m at baseline, after trimetazidine and control period, respectively), increase of left ventricular ejection fraction (from 34.1-/+2.0 to 38.1-/+1.8%, p<0.05) and improvement of quality of life. Thus in patients with heart failure addition of trimetazidine to standard therapy for 3 months produced positive effect on clinical and hemodynamic status, exercise tolerance and quality of life.
AIM: To evaluate neoton therapy effects in acute myocardial infarction (MI) on systolic function of the left ventricle, arrhythmia and clinical symptoms in patients on thrombolytic therapy (TLT). MATERIAL AND METHODS: 106 males with Q-MI entered the study. 47 received treatment without TLT and neoton, 30 patients received TLT with streptokinase preparations, 29 patients were given streptokinase preparations and neoton. Left ventricular systolic function was measured by echocardiography on day 1, 3, 7, 14, 21 and 28; arrhythmia was analysed at Holter monitoring in day 1 and 2 of MI. RESULTS: TLT failed to arrest progression of left ventricular dilation by the end of the hospital stay. Patients given neoton in acute period of MI had no increase in the end systolic and diastolic volumes of the left ventricle in the course of the first months after MI onset. Antiarrhythmic action of neoton manifested on MI day 2. CONCLUSION: Neoton given to MI patients receiving TLT prevents progression of left ventricular systolic dysfunction and establishment of predictors of unfavourable outcome.
The paper presents the results of application of the modified 6-minute walking test for assessment of exercise tolerance in follow-up of patients with ischemic heart disease (IHD) complicated by chronic cardiac failure (CCF). At admission and after 3-4 weeks of treatment 52 IHD patients underwent the walking test and described subjective effects according to modified Borg's questionnaire. The repeated test registered increased walking distance and subjective response. The results of the study confirm validity of using 6-minute walk test in combination with modified Borg questionnaire in routine hospital and outpatient practice as a simple, safe and informative method of control over IHD patients' condition and assessment of their treatment efficacy.
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AIM: To study quality of life (QL) of patients with chronic heart failure (CHF) and QL changes resultant from mildronate therapy. MATERIALS AND METHODS: QL was studied in 30 IHD patients with CHF of NYHA class II-IV, ejection fraction > 45%; 40 IHD patients without CHF and 30 healthy subjects. CHF patients were treated for 30 days with oral mildronate (250 mg 4 times a day). QL was assessed according to the method SF-36 Health Status Survey. RESULTS: QL in CHF patients is much lower than that of the controls. Objective severity of the disease and subjective satisfaction with life do not always coincide. Mildronate in a dose 1 g/day per os may be beneficial for LQ of CHF patients. CONCLUSION: It is thought desirable to include QL in analysis of efficiency of managing patients with CHF. SF-36 is a tool able to follow up changes in QL of CHF patients within a short-term treatment period.
The quality of medical care for patients with ischemic heart disease was assessed for a specialized cardiological clinic and cardiological department of a district hospital. Doctor's errors were most numerous in unstable angina pectoris. However, the number and importance of these errors depended primarily on qualification of the cardiologist. The errors in the specialized clinic were less connected with the errors of previous stages of diagnosis and treatment. The results of the trial allowed design of different educating programs oriented on cardiologists of the clinic and hospital.
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92 patients with ischemic heart disease and severe angina pectoris received either nitro drugs and calcium antagonists (n = 24) or their combination with plasmapheresis (n = 68). The efficacy of the treatment was assessed by the number of anginal episodes, doses of nitro drugs, pre- and posttreatment dynamic ECG readings. It is shown that 75% of the patients benefited from the addition of plasmapheresis to the treatment scheme. According to dynamic ECG, positive effect of plasmapheresis occurred also in painless ischemia.
Echocardiography and integral body rheography were made in 174 patients with macrofocal myocardial infarction (MI) to study hemodynamics at six stages of hospital rehabilitation (MI day 1-28). 97 patients received neoton (4 different scheme) in the acute period of MI. Neoton administration was found to prevent progressive left ventricular dilation and emergence of cardiac insufficiency in subacute period of MI, to reduce the risk of cardiac aneurism, recurrence and postinfarction angina. The response to neoton rises with an increase of its dose on the first day of the disease and lessening of the time span from first symptoms of MI and first neoton injection. An optimal scheme of neoton use is proposed.
12 cardiologists trained as experts in assessment of medical care quality (MCQ) made a computer-assisted expertise of the care rendered to 110 anginal patients. Of these 68 patients had angina of effort (AE) and 42 had unstable angina (UA). This made up 10% of annual number of anginal patients treated in the cardiological clinic in 1996. Medical errors were of the same type in both the groups. Inadequate collection of information, erroneous diagnosis, treatment, continuity occurred in 50, 30, 15 and 5% of all the errors, respectively. Negative effects of the errors were mild (less seriously suffered AE patients), but led to waste of health service resources.
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To evaluate clinicohemodynamic effect of neoton (exogenic phosphocreatine) given in an intravenous course, the drug was added to standard scheme in 53 patients with chronic cardiac failure (6.0 g/day i.v. drip for 5 days or 3.0 g/day for 10 days). 20 control patients received standard therapy alone. A course neoton produced an increase in the ejection fraction, a reduction in end-diastolic and end-systolic left ventricular volumes. It is recommended to include neoton in the scheme of chronic cardiac failure treatment in the dose 3.0 g/day for 10 days.
Central, intracardiac hemodynamics and myocardial contractility were assessed in 97 inpatients with macrofocal myocardial infarction. Of them, 71 received conventional chemotherapy versus 26 patients given additionally intravenous phosphocreatine (neoton). The total dose of neoton 30 g was injected during the course of 6 days following the disease onset. With minimal changes in central hemodynamics, phosphocreatine was found to prevent left-ventricular dilatation and development of congestive heart failure by decreasing preload, to maintain myocardial contractility without reduction.
Echocardiography, integral rheography of the body, Holter monitoring, assessment of oxygen consumption and blood gases were used in examination of 93 patients with macrofocal myocardial infarction (MI). 48 patients received thrombolytic therapy (TT) within 6 hours of MI which in 27 patients implied standard drugs (streptodecase, celiase, avelysin) and new medicine APSAC (21 patients). 45 patients received no TT. It was found that in acute MI period systemic TT prevented a fall in left ventricular performance, promoted advanced oxygen supply due to intensified oxygen extraction by tissues. This fact is attributed to transient changes in blood rheology. Application of APSAC prevented inhibition of myocardial contractility and development of congestive heart failure in subacute MI period. TT patients demonstrated ventricular arrhythmia on MI day 1 more often though by the number of the main arrhythmia types the groups differed insignificantly. Within 1-year postmyocardial infarction period TT patients had less repeat MI and were less frequently diagnosed to develop congestive heart failure.
Left ventricular contractility, central hemodynamics and a clinical course of acute myocardial infarction were investigated in inpatients on systemic thrombolytic therapy and controls. This treatment is shown to diminish the risk of acute left ventricular failure, ventricular fibrillation and atrioventricular block. Furthermore, it prevents inhibition of left ventricular contractility in acute period of the infarction. Subsequently, noticeable differences between the test group and controls disappeared.
Changes in the major parameters of central and intracardiac hemodynamics and body's oxygen supply were examined in 93 patients with massive myocardial infarction in the in-hospital period of the disease. Traditional therapy was given to 71 patients; in addition, phosphocreatine infusions (a course dose being 30 g) were used in 22 patients in acute myocardial infarction. Phosphocreatine therapy failed to substantially affect cardiac pump function, but prevented left ventricular dilation and development of congestive heart failure. The patients receiving phosphocreatine showed an increase in body's oxygen consumption due to its elevated tissue extraction. No adverse effects of phosphocreatine were found.