[The current problems of ischemic heart disease].
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Biomedical subjects
Publications and source records attributed to V T Ivashkin.
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The difficulties encountered in differential diagnosis of rheumatic and reactive arthritides are caused by the similarity of the articular syndrome not infrequently seen in both diseases, especially in their acute phases, a high frequency of little manifest forms of rheumocarditis and the rarity of other main manifestations of rheumatic fever as well as by a possibility of myocardial derangement in reactive arthritides. At the same time of paramount diagnostic importance are a detailed study of the disease history, estimation of the epidemic situation, careful clinical assessment of the character and evolution of the articular syndrome, the signs of lesions of the heart, other organs and symptoms, recognition of the symptoms characteristic for diseases of the group of seronegative spondylarthropathies, particularly Reiter's syndrome.
To make the II Marseilles Classification of Pancreatitis more applicable to everyday clinical practice, a new systemic approach is suggested basing on clinical, laboratory, CT and ultrasound evidence. Upon examination of 182 chronic sufferers with pancreatitis, interstitial--edematous, parenchymatous, fibrous--sclerotic (indurative), hyperplastic (pseudotumorous) and cystic variants of the disease were established in 34.6%, 30%, 21.1%, 4.4% and 9.9%, respectively. Clinical features typical for each variant of the disease and most common complications are reviewed.
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There are lack of principle differences between the problems of medical aid during the military and civil disasters, and therefore one can draw a conclusion concerning the validity and necessity of using the experience of military medics in disaster medicine during peace-time. The following aspects are discussed: organization of therapeutic caring of the victims during Chernobyl's AES disaster, earthquake in Armenia and accident in chemical enterprise "Nitrogen" in Jonava. Requirements to the teams for emergency medical service have been formulated with determination of Principles of putting them into practice; the further directions of therapeutic aid improvement are outlined.
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The activity of cAMP-dependent histone kinases (HK) and cAMP-independent casein kinases (CK) as well as cAMP level were assessed in gastric mucosa affected by various forms of gastritis as well as in gastric tumor and adjacent normal tissue. CK activity was higher whereas that of HK and cAMP level were lower in tumor and at a distance of 5-20 cm from its edge as compared to gastritis. CK/HK cAMP ratio in adenocarcinoma was 6 times that in normal tissue and 2-2.5 times that in gastritis. The data obtained and those published earlier suggest the relative increase in cAMP-independent protein phosphorylation with respect to its cAMP-dependent counterpart to be characteristic of human tumors.
The study of immunoglobulins and lysozyme in acute pneumonia patients suffering from acute leukemia and bronchogenic cancer of the lungs elicited impairment of local specific and nonspecific body defences. This fact should be taken into consideration when planning immunotherapy in combined treatment of relevant patients.
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Analysis of the clinical picture in 37 patients with Reiter's syndrome unrelated to venereal urethritis showed that in the majority of cases, it was preceded by acute intestinal infection which occasionally ran an unmarked course. The difficulties in diagnosing Reiter's syndrome were caused in some patients by the fact that in the disease debut, conjunctivitis and urethritis were little manifest and of short duration or occurred at the later stages, especially where the triad was preceded by the provoking factors, such as supercooling and nasopharyngeal infection. Also, in the acute phase of the disease, the patients demonstrated catarrh of the upper respiratory tract, the signs of myocardial injury and some symptoms characteristic of other rheumatological diseases. In this connection attention is drawn to the necessity of inquiring after the patients' health and sensations in doubtful cases, including the elucidation of the epidemiological anamnesis, thorough examination of the patients on admission to hospital and during the treatment to specify both the main and additional signs of Reiter's syndrome, and analysis of the disease course.
Over 5 years the authors followed up 320 patients with gastric ulcer receiving conservative treatment at hospitals or as outpatients, 86 patients operated on before for gastric ulcer, and 58 patients admitted to the surgical hospital for hemorrhage from gastric ulcer. The primary ulcerous form of carcinoma accounted for 9.1% of all gastric ulcers, carcinoma of the gastric stump was diagnosed in 10.4% of patients subjected to resection of the stomach for assumed malignant ulcer. The conservative treatment carried out at hospitals or as outpatients ensured healing of gastric ulcer within a month in 61.8 and 55.1% of the patients, respectively. Nevertheless early relapses (a month after the healing) were recorded in the appropriate groups in 26.4 and 14.9% of the patients. Among gastric ulcer patients followed up for 5 years and receiving the conservative treatment, perforation was recorded in 2.6% and hemorrhage in 4.5% of the patients. The lethality due to resection of the stomach in patients with assumed malignant gastric ulcer amounted to 4-7%. It is evident that there are no serious reasons for supporting the positions of high surgical activity champions in gastric ulcer.
The results of the catamnestic study of case reports and records of postmortem examination of 102 patients with bronchial asthma (BA) aged 47 to 88 years who died at a general hospital during 1976-1988 indicate that in the overwhelming majority of cases, there took place death "with asthma" rather than death "from asthma". At the same time the dominant pathology was coronary heart disease (acute coronary failure, myocardial infarction, progressive heart failure associated with atherosclerotic and postinfarction cardiosclerosis). Emphasis is laid on the fact that according to the autopsy data, the rate of the recognized stenosing atherosclerosis of the coronary arteries considerably exceeded the number of cases of coronary heart disease documented clinically (typical angina pectoris of effort, significant macrofocal myocardial infarction). The characteristic features of the group under observation included an unexpectedly frequent combination of BA and malignant neoplasms (24 cases), including lung cancer in 13 of these cases.
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Sucralfate (55 patients), cimetidine (25 patients), ranitidine (30 patients), antacids and cholinolytics (32 patients) were studied and compared in open clinical trials for the efficacy in the treatment of ulcer disease of the stomach and duodenum. During 5 weeks, ulcers completely healed in 100% of the patients given sucralfate (in 94.5% for 4 weeks), in 90% of the patients treated with ranitidine, in 84% on cimetidine, and in 78% of the patients undergoing treatment with antacids and cholinolytics.