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Forty patients who had had myocardial infarction six months before their entry into the study were examined using perfusion scintigraphy of the myocardium with 201TI. The patients were divided into the test and the control group. The patients of the test group trained intensively for 12 months according to the special programme which contributed to an improvement of myocardial perfusion at rest irrespective of the nature of the previous myocardial infarction and the clinical severity of coronary insufficiency. A considerable enhancement of tolerance to exercise as a result of the training leads to prevention of the ischemic response to the exercise whose earlier level proved to be the threshold.

Myocardial scintigraphic investigation using 201T1 was performed in 36 patients with suspected acute myocardial infarction and 11 clinically normal controls. The scintigrams were assessed visually and using a computer program for semiquantitative assessment of 201T1 distribution across the myocardium. The control subjects' scintigrams show a comparatively even myocardial distribution of the label. Patients with acute myocardial infarction were divided into 2 groups: those with large-focal (28) and small-focal (8) infarctions. All the patients from the large-focal group showed perfusion defects in their scintigrams. Clinical and autopsy diagnoses coincided in all the cases, and the vital scintigraphic pattern correlated with the posthumous localization of the myocardial infarction. However, the method of myocardial scintigraphy with 201T1 in acute myocardial infarction is of low specificity. To improve the differential diagnosis of myocardial infarction, repeated scintigraphy is needed.

The paper discusses the problems of differential diagnosis between varying types of arterial hypertension detected during mass screening of the population. Randomized examination was made in 45% of male population aged 40-59 years. Arterial hypertension was observed in 26.3% of the examinee; 24.5% showed a rise in the arterial pressure for the first time. The methods of investigation available at the city polyclinic allowed the authors to diagnose hypertension in 85.2% of the patients. The results of isotope renography included into the complex of the study enabled them to determine the indications for the method to be used in mass screening of the population for revealing arterial hypertension.

The testosterone content was studied in 50 male patients, who sustained myocardial infarction, on the 1,3--5,10 and 20th day of the disease. Forty seven patients with ischemic heart disease served as controls. The results obtained were analysed in relation to the patients age and the course type of the disease. The testosterone concentration on the 1st day of myocardial infarction was not different from that in the ischemic heart disease patients. Elevation of the testosterone level was observed in the myocardial infarction patients during the acute period of the disease, but its dynamics depended on the course type of the disease. No relationship was revealed between the testosterone level increase and the patients age.

The activity of the pituitary hormones (ACTH, STH, TTH, FSH, LH), the adrenal hormones (cortisol, aldosterone), the kidney hormone (renin), and the thyroid hormones (thyroxine tri-iodthyronine), the thyroxine binding capacity of blood proteins and the activity of the hormones of the pancreas (insulin) and the sex glands (testosterone, estradiol) were studied in 26 males suffering from ischemic heart disease verified by means of selective coronarography and in 20 healthy males with no atherosclerosis of the coronary arteries of the heart. Patients with ischemic heart disease were found to be marked by increased activity in the blood of ACTH, TTH, cortisol, aldosterone, insulin, and estradiol and reduced concentration of STH, thyroxine, and testosterone. These shifts in the activity of the hypothalamo-hypophyseal system and in its subordinate hormonal systems play an important role in the origin of the atherosclerotic process and assosiated ischemic heart disease.

The amount of metabolizing potassium in the body was determined by means of K-42 dilution in 20 normal individuals and in 108 patients with different degrees of cardiac failure and various severity of the oedema syndrome. The amount of metabolizing potassium was found to decrease gradually along with the increase of cardiac insufficiency. Both the absolute amount of the metabolically active fraction of potassium was decreasing, and the content of this cation per 1 kg of body weight. The decrease of the amount of metabolizing potassium in cases of severe circulatory insufficiency did not depend on the severity of the oedema syndrome. With the improvement of the state of the patient and the decrease of congestive manifestations the level of metabolizing potassium tended to rise. Nevertheless, some patients demonstrated a reduction of the metabolically active fraction of potassium. And, vice versa, along with a deterioration of the patient's state and an increase of cardiac insufficiency and elevation of potassium content in the body was sometimes noted.

A program for an automated semiquantitative evaluation of myocardial scintigrams with 201Tl was proposed. Altogether 11 healthy subjects and 34 patients with acute myocardial infarction were examined. The patients have shown a significant decrease (p less than 0.01) in 201Tl accumulation in some segments of the myocardium as compared to the indices of healthy subjects irrespective of myocardial infarction site. The threshold values of reduced indicator accumulation have been deduced for the front straight and front left oblique 45 degrees projections. The proposed program provides for a sufficient accuracy and a good reproducibility of results.

Selective coronarography and pharmacological test with intravenous administration of ergometrin have been carried out in 100 patients. The test permits one to demonstrate the vasospastic form of angina pectoris, which is encountered in patients with different degrees of lesions of the coronary arteries and different tolerance to exercise. Lack of coincidence in localization of ischaemic zones in the myocardium in tests with exercise and intravenous injection of ergometrin according to myocardium scintigraphy with 201Tl points to the possibility of existence of two forms of angina pectoris in the same patient, differing not only in the pathogenetic mechanisms but also in the localization of the ischaemic changes supervening in the myocardium. According to the data of echocardiography during the anginal attack with rise of the ST segment there is a more pronounced dilatation of the left ventricle cavity and decrease of the myocardial contractility than in the anginal attack with depression of the ST segment. In patients with spontaneous angina pectoris and rise of the ST segment corinfar exerted marked antianginal effect. Inderal was ineffective. In patients with angina pectoris and depression of the ST segment there was no difference between the two drugs.

The effect of nitrong on myocardial perfusion in patients with ischemic heart disease was studied by a new method of myocardial perfusion scintigraphy usingd 201Tl. Myocardial scintigraphy with 201Tl, as an informative and atraumatic method, may be used for objective appraisal of the effect of antianginal agents. It is shown that in comparison to a placebo, nitrong causes a favourable effect on perfusion of the myocardium in patients with ischemic heart disease both at rest and under conditions of increased myocardial blood flow induced by physical exercise.

The content of total metabolizing sodium was studied in 74 patients with hypertension of different genesis, using the Na24-isotope dilution technique. Among these patients 31 had essential hypertension, 43--symptomatic hypertension (40--renal, and 3--adrenal). In Stage IB and IIA hypertension, a reduction of the level of total metabolizing sodium and its increased urine excretion were found. At late stages of essential hypertension, like in symptomatic renal hypertension, normal levels of total metabolizing sodium were found, or a slight tendency towards its elevation. In cases of adrenal hypertension (Conn's syndrome, pheochromocytoma) the level of total metabolizing sodium is significantly elevated. No correlation was seen between the levels of total metabolizing sodium, and plasma and erythrocytes sodium. The decrease of total metabolizing sodium at early stages of essential hypertension must be an adaptative reaction of the body, which is proved by the increased urine excretion of sodium.

Scintigraphy of the myocardium with pyrophosphate-99mTc was used in the examination of 45 patients with chronic ischemic heart disease and 3 patients with vegetovascular dystonia. A direct dependence of the character of the scintigram on the anginous attack was revealed. Accumulation of pyrophosphate-99mTc in the myocardium was observed in all patients with the agent injected just before the attack, during the attack or in the first 8 hours after it. Pyrophosphate-99mTc accumulation in the myocardium demonstrated on the scintigrams of the myocardium was less intense but more diffuse and extensive in chronic ischemic heart disease than in the focus of acute myocardial infarction.

Myocardial scintigraphy with 201Tl at rest and under submaximum or threshold stress achieved through bicycle ergometric exercise was used to investigate 31 female patients (14 with coronary disease, 10 with hypertrophic cardiomyopathy, and 7 with cardialgias of varying origins and angiographically unchanged coronary arteries taken as controls). Resting and ergometric-test scintigrams of the controls showed no areas of disordered myocardial perfusion. Thallium distribution in the myocardium was even. All coronary patients showed areas of transitory myocardial ischemia in response to exercise. In all patients with hypertrophic cardiomyopathy, the scintigrams revealed a diminished and hardly visible left-ventricular cavity. Also, their resting scintigrams showed areas of decreased myocardial perfusion, similar to those noted in coronary patients. However, the exercise scintigrams never showed any extension or reduction of thallium uptake defects in patients with hypertrophic cardiomyopathy. Perfusion myocardial scintigraphy with 201Tl can be recommended as an additional method of differential diagnosis between coronary disease and hypertrophic cardiomyopathy in female patients.

Myocardial scintigraphy with pyrophosphate-99mTc-Sn was used as a diagnostic test in 23 patients with different disorders of rhythm and intracardia conduction who were admitted to the department of emergency cardiology of the All-Union Cardiological Scientific Center, Academy of Medical Sciences of the USSR with suspected acute myocardial infarction. Scintigrams were positive in 11 of 12 patients with acute myocardial infarction who were examined in periods of 6 hours of 10 days. One patient examined on the 13th day of the disease had negative scintigrams. In 6 of 11 patients with myocardial infarction not confirmed, the scintigrams were also negative, in 3 other patients positive scintigrams were due to a postinfarction aneurysm. The authors conclude that myocardial scintigraphy with pyrophosphate-99mTc-Sn is an adequate test in the diagnosis of acute myocardial infarction, especially in the examination of patients with disorders of intracardiac conduction.

The work is concerned with the study of the course and efficacy of long-term out-patient treatment of persons with arterial hypertension. The genesis of arterial hypertension was determined more precisely by means of verified objective methods in 194 patients. Hypertensive disease was diagnosed in 57 patients, chronic pyelonephritis with hypertension in 51 patients, and chronic diffuse glomerulonephritis in 86 patients. The function of the kidneys was studied by radioisotope renography. It was established that the dynamics of arterial hypertension and the function of kidneys are directly dependent on the regularity and adequacy of out-patient treatment which makes it possible to arrest the advancement of the disease.

Obsidan effectiveness was examined in 42 coronary patients. Good clinical effect was achieved in 81% of patients with angina of effort and 64% of patients with angina of effort and angina at rest. Exercise tolerance increased in half of the patients. Radionuclide scintigraphy with 201Tl showed a reduction of exercise-induced transitory myocardial ischemia zones, a finding indicative of obsidan favourable effect on coronary microcirculation reserve.

Parametric or the so-called functional images found an application in modern nuclear cardiology for the processing of radiodiagnostic data, particularly those of radionuclide ventriculography. The process of obtaining parametric images incorporates the transformation of digital scintigrams using arithmetic or more complicated mathematical procedures. As a result of it valuable radiodiagnostic parameters on the point of spatious resolution of the digital scintigrams are singled out from the whole complex of scintigraphic information. This method of scintigraphic data processing with obtained parametric images is recommended for a wider use in the other areas of nuclear medicine too.

Thirty-six patients hospitalized because of suspicion for acute myocardial infarction (AMI) were examined within the first 24 hours after symptoms of the disease manifested themselves and during the follow-up on days 5-6 and 28-30. Myocardial perfusion was examined using the technique of perfusion myocardial scintigraphy with 201Tl. In cases of an uncomplicated course of AMI, the scintigrams showed a reduction in the area of perfusion defects (a positive time-course) whereas when the disease progressed the scintigrams reflected a negative time-course expressed in an expansion of the area of perfusion defects. When the scintigrams taken within the first 24 hours of AMI and over the follow-up period showed extensive perfusion defects, the time-course of the disease was severe with a large number of complications, the prognosis being usually poor. The pattern of the thallium scintigraphic picture at various periods of AMI was demonstrated to be heterogeneous. The degree of the perfusion defect, the time-course of its changes during the follow-up can be predictive in relation to the development of circulation insufficiency and mortality.

It has been shown that latent renal diseases are detected by sectoral scintigraphy earlier than by other methods, and the former acquires particular importance when the only sign of disease is arterial hypertension. Early diagnosis of latent pyelonephritis makes this method especially valuable both for the selection of patients for further thorough examination and for the start of adequate therapy. Scintigraphy serves as a reliable criterion for the evaluation of the therapeutic efficacy in patients with chronic pyelonephritis (CP). Changes of scintigraphy parameters coincide quite exactly with the changed level of arterial pressure, concentration and nitrogen clearing function of the kidneys during treatment. This method (sectoral scintigraphy) is very important when used over time in CP patients with chronic renal insufficiency making it possible to detect with a sufficient degree of significance the improvement as well as impairment of renal function which is a crucial point for the choice of further therapeutic tactics.