[Clinical efficacy and safety of administration of loop diuretic torasemide].
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Biomedical subjects
Publications and source records attributed to S V Moiseev.
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The author presents a case of left-sided ischemic renal disease in a patient with diabetes mellitus, who underwent nephrectomy.
AIM: To characterize mechanisms, early markers and clinical signs of renal damage in obesity. MATERIAL AND METHODS: The trial covered 29 males aged under 50 years (mean age 37.7+/-9.3 years) with abdominal obesity having neither carbohydrate metabolism disturbances nor chronic renal disease. All the patients were examined for microalbuminuria (MAU), serum level of leptin. Radionuclide scintigraphy of the kidneys with an acute captopril test, tests for serum concentrations of endothelin-1, homocistein, uric acid, ultrasound dopplerography of the brachial artery for assessment of endothelium-related vasodilation (ERVD) were made in 24 patients. In 9 patients MAU and ERVD were estimated after 3 months of valsartan treatment (80 mg/day). RESULTS: MAU was detected in 62% patients, its rate increasing with elevation of serum leptin and endothelin concentration. Under normal values of creatininemia and GFR, obese patients showed deletion of renal functional reserve (RFR). Patients with low RFR had maximal uricemia and homocysteinemia, serum endothelin-1. Such patients demonstrated also abnormal ERVD. 3-month valsartan intake led to elevation of ERVD and disappearance of MAU. CONCLUSION: Excessive leptin registered in obese patients provoked dysfunction of the endothelium of the intrarenal vessels manifesting with MAU, growth of endothelin-1 serum concentration and disorder of ERVD. This leads to unfavourable changes in filtrating function of the kidneys as seen from gradual deletion of RFR in the absence of hypercreatininemia. Elimination of MAU and ERVD disorders in obesity can be achieved by administration of angiotensin II receptor blockers.
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The case presented for clinical discussion is a patient suffering from ischemic renal disease underlied by renal arterial artherosclerotic stenosis. The article demonstrates a leading role of diagnostic imaging and radiosurgical therapy (balloon dilatation and stenting), and a low effectiveness of conservative treatment.
The purpose of the study was to determine clinical importance of high serum levels of ferritin, fibrinogen and C-reactive protein (CRP) in patients with various forms of coronary heart disease (CHD) such as stable angina, painless myocardial ischemia (PMI) and instable angina (IA). The subjects of the study were 60 patients with CHD, whose clinical variant (stable angina, PMI or IA) had been determined by stress echocardiography. The control group consisted of 20 patients, not suffering from CHD, but having cardiovascular risk factors (arterial hypertension, dyslipoproteinemia, male gender, obesity, elderly age). All patients underwent routine clinical examination and biochemical blood tests. Serum levels of CRP, fibrinogen and ferritin were highest in the patients with IA and significantly differed from those in the control group. The difference in serum iron levels and total iron-binding capacity in serum (TIBC) between the groups were insignificant. Correlations between serum level of iron, TIBC and ferritin level were found neither in CHD patients (r = 0.1) nor in the control group (r = 0.15). No correlation between serum level of ferritin and CRP level was observed in the control group, but in all CHD groups this correlation was significant. The strongest correlation between these values was observed in the patients with IA. Besides, correlations between serum levels of ferritin and CRP (r = 0.46, p < 0.02) and between ferritin and fibrinogen levels (r = 0.39, p < 0.05) were found in the patients with IA. In patients with CHD, especially those who have IA, serum ferritin should be considered among acute phase proteins, reflecting destabilization of atherosclerotic plaque.
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To assess clinical peculiarities of hypereosinophilia (HEP), determine approaches to treatment and differential diagnosis of the disease, we examined 115 patients in 1969-2002. We made clinical, laboratory and virusological tests with detection of markers of hepatitis B and C viruses, biopsy of the liver (n = 3), on demand echocardiography, indirect immunofluoresence and enzyme immunoassay of the serum for antibodies to neutrophil cytoplasm in some patients. We grouped patients by the presence of Churg-Strauss syndrome (n = 70), an asthmatic variant of nodular polyarteritis (n = 22), hypereosinophilic syndrome (Loffler 11, n = 15) and eosinophilic pulmonary infiltrates (n = 8). Asthmatic nodular polyarteritis was characterized by high arterial hypertension, frequent finding of HBV, aneurysms and infarctions of the viscera. Bronchial asthma and medicines intolerance were absent, though cardiac failure and other cardiac pathology is frequent. Thus, definition of 4 clinical groups of patients with HEP allows a differential approach to the disease treatment and prognosis.
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AIM: To determine clinical significance of high concentrations of homocystein, C-reactive protein, fibrinogen in various forms of ischemic heart disease. MATERIAL AND METHODS: Enzyme immunoassay was made to measure serum concentrations of homocystein, C-reactive protein, fibrinogen in 60 patients with ischemic heart disease (IHD) in the form of stable effort angina (n = 20), painless myocardial ischemia (n = 19), unstable angina pectoris (n = 21) and 20 control patients free of IHD. Myocardial ischemia was confirmed at dobutamine stress echocardiography. RESULTS: Serum concentrations of homocysteine, C-reactive protein and fibrinogen were higher in patients with unstable angina than in the other examinees with IHD. A statistically significant correlation exists between homocysteine serum levels and acute phase proteins (C-reactive protein, fibrinogen) in patients with unstable angina. In the other groups it was absent. CONCLUSION: Correlation between serum levels of homocysteine and acute phase proteins in patients with unstable angina suggests a direct participation of this amino acid in destabilization of atherosclerotic plaques and development of acute coronary syndromes.
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