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The noise of jets formed using conical and lobed nozzles has been measured. The possibility of jet noise reduction by using a lobed nozzle shape has been demonstrated. The localization of noise sources in jets formed using various nozzles has been carried out. A planar 9-beam 54-channel Bruel & Kjaer micro-phone array and Delay-and-Sum Beamforming technique were used. As a result, the position of noise sources in a turbulent jet in one-third octave frequency bands was obtained. The deviation effect of the position of noise sources when using lobed nozzles relative to the standard jet formed by a conical nozzle is demonstrated.

The aim of this work is to study the position of dominant sound sources in a small-scale turbulent jet using the beamforming method. Two nozzles of equivalent diameter and different geometric configurations (conical and chevron) were used to create different initial conditions for the outflow. Based on the analysis of the results obtained, it can be concluded that they are in good agreement with the well-known concepts of the physics of noise generation processes by turbulent jets: higher-frequency sources are generated by smaller-scale turbulent structures located closer to the nozzle edge, which is confirmed by the localization of high-frequency noise sources also closer to the nozzle edge. The chevron nozzles loosen the initial section of the jet, making it less short and thereby facilitating a faster displacement of noise sources to the nozzle edge, as seen when comparing localization maps for conical and chevron nozzles at the same frequencies. The results of localization were compared with the data obtained by other researchers. The results obtained were found to provide confidence in the use of acoustic beamforming to measure the location of the jet noise source with accuracy similar to other methods that have been used in the past.

Objective: To analyze the relationship between the characteristics of respiratory support (RS) for patients with stroke and clinical factors with the number and structure of complications, deaths, and length of stay in the intensive care unit (ICU) and duration of artificial pulmonary ventilation (ALV)., Material and Methods: The Russian multicenter observational clinical study «Respiratory Therapy for Acute Stroke» (RETAS) that enrolled 1289 patients with stroke requiring RS was conducted under the auspices of the All-Russian public organization «Federation of Anesthesiologists and Resuscitators». Indications for ALV, the use of hyperventilation, the maximum level of positive end-expiratory pressure, starting modes of mechanical ventilation, timing of tracheostomy, the incidence of protein-energy malnutrition (PEM) and infectious complications were analyzed. The following scales were used to assess the severity of the condition: the National Institutes of Health Stroke Severity Scale (NIHSS), the Glasgow Coma Scale, the Glasgow Outcome Scale (GOS)., Results: For the group of patients with a stroke severity of more than 20 NIHSS points, the mortality increase was associated with initial hypoxia ( p =0.004), hyperventilation used to relieve intracranial hypertension ( p =0.034), and starting ventilation with volume control (VC) compared with starting pressure-controlled ventilation (PC) ( p <0.001). We found that the use of the instrumental monitoring of intracranial pressure was associated with a decrease in mortality ( p <0.001). The absence of PEM in patients with stroke is associated with a higher probability of a positive outcome (GOS 4 and 5) for the group with NIHSS less than 14 points ( p <0.001). Ventilator-associated tracheobronchitis and ventilator-associated pneumonia were associated with an increase in the duration of ALV, the duration of weaning from the ventilator (for ventilator-associated tracheobronchitis) and the duration of stay in the ICU, and also reduced the chances of favorable outcomes ( p <0.05)., Conclusion: The factors associated with increased mortality in acute stroke are: hypoxemia at the start of ALV, hyperventilation, starting ventilation with VC in comparison with starting ventilation with PC, the use of only clinical methods of monitoring intracranial pressure in comparison with instrumental monitoring. The adverse effect of PEM and infectious complications on the outcome in patients with acute stroke has been proven.

The article describes a rare diagnosis of monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL), due to its veiled by a number of so-called "masks" of enteropathies. A detailed analysis of all clinical, morphological and immunohistochemical data made it possible to establish the correct diagnosis. The revealed pathology is extremely rare in practice, even among specialists in hematology. The article demonstrates the main stages of both a complex diagnosis and an attempt at therapy for this aggressive form of intestinal lymphoma.

Objective: To determine the prognostic aspects of the development of pneumonia in patients with ischemic stroke of various pathogenetic subtypes., Material and Methods: The study enrolled 110 patients (64 men and 46 women), aged 44-95 years, with dysphagia during the acute period of ischemic stroke (IS). The TOAST criteria were used to diagnose the pathogenetic subtype, and the MASA scale was used to determine the presence and severity of dysphagia. To predict the probability of switching to self-feeding from the severity of dysphagia, a non-linear regression method was used using the least squares method., Results: In patients with swallowing disorders in the acute period of IS, pneumonia often developed after 5 days from the onset of clinical manifestations of stroke. In the cardioembolic subtype of IS, the probability of pneumonia in groups with dysphagia severity from 90 to 120 points on the MASA was higher than in the atherothrombotic subtype of IS ( p <0.05)., Conclusion: Patients with cardioembolic stroke subtype are characterized by a worse prognosis for the developing pneumonia compared to patients with atherothrombotic stroke subtype.

Aim: assessment of risk factors, cardiovascular status and intracardiac hemodynamics in patients with multiple myeloma before the start of specific antitumor therapy. Materials and methods: The study included 2 equal groups of patients: the first group - 25 patients with a newly diagnosed diagnosis of multiple myeloma (MM), the comparison group - 25 patients with proven cardiovascular diseases (CVD) (hypertension (HD) and coronary heart disease (CHD)). All patients included in the study underwent standard laboratory diagnostics, instrumental research methods (ECG, Echo-KG, 24-hour Holter monitoring); proven CVD risk factors were also evaluated. Results: When comparing the two groups, it was reliably shown that the state of CVD in patients with MM is comparable to that in patients with proven CVD. In patients from the main group, were revealed significant positive correlations of average strength between indicators of systemic inflammation, the lipid spectrum and intracardiac hemodynamics: between the levels of CRP and triglycerides (r=0,415, p&lt;0,05); between the values of CRP and LDL (r=0,345, p=0,09); CRP and LA volume (r=0,434, p&lt;0,05); CRP and final diastolic volume (r=0,30, p&lt;0,05). At the beginning, a high risk of developing CV- events in patients with MM may be due to cardiac remodeling associated with the activity of systemic inflammation., Conclusion: in view the use of potentially cardiovasculartoxicity drugs for the treatment of multiple myeloma, the assessment of the CV status and consultation with a cardiologist/cardiologist with the selection of the necessary therapy should be obligatory step before starting specific treatment.

Objective: To analyze the treatment of patients with severe stroke requiring respiratory support, and identify predictors of death., Material and Methods: A multicenter observational clinical study «REspiratory Therapy for Acute Stroke» (RETAS) was conducted under the aegis of the «Federation of Anaesthesiologists and Reanimatologists» (FAR). The study involved 14 clinical centers and included 1289 stroke patients with respiratory support., Results: We found that initial hypoxemia in the 28-day period was associated with higher mortality than in absence of hypoxemia (in patients with 20 or more NIHSS scores) (76.22% versus 63.45%, p =0.004). Risk factors for lethal outcome: hyperventilation used to relieve intracranial hypertension compared with group of patients who were not treated with hyperventilation (in patients with 20 or more NIHSS scores) (79.55% versus 72.75%, p =0.0336); volume-controlled ventilation (VC) versus pressure-controlled ventilation (PC) (in patients with 20 or more NIHSS scores) ( p <0.001); use of clinical methods for monitoring ICP in comparison with instrumental ones (87.64% versus 62.33%, p <0.001). It has been proved that the absence of nutritional insufficiency in patients with stroke is associated with a higher probability of a positive outcome (GOS 4 and 5) in comparison with patients with signs of nutritional insufficiency, for the group with NIHSS less than 14 points ( p <0.001)., Conclusions: A group of factors associated with a deterioration in the prognosis of outcomes in patients with stroke who are undergoing ventilation has been identified: hypoxemia at the start of respiratory support, lack of instrumental monitoring of ICP, the use of hyperventilation to correct ICP, ventilation with volume control (VC), as well as the presence of nutritional insufficiency.

Aim      To evaluate the dynamics of indexes of oxidative stress and markers of myocardial injury and dysfunction in patients with aggressive type lymphomas during the antitumor therapy.Material and methods  This study included 75 patients with lymphoproliferative diseases of aggressive type. The main group consisted of 53 patients who received one course of antitumor therapy during the study. The comparison group consisted of 22 patients who have not received any specific treatment so far. Troponin I (TnI), high-sensitivity troponin (hsTnI), heart-type fatty acid binding protein (Н-FAВР), N-terminal pro-brain natriuretic peptide (NT-prоBNP), superoxide dismutase (SOD), and myeloperoxidase (MPO) were measured in patients of both groups at baseline, and in the main group, they were measured at 4 hours after administration of antitumor agents and on completion of the course. Functional status of the cardiovascular system was evaluated by electrocardiography in all patients at baseline and after the course of antitumor treatment and by echocardiography.Results The chemotherapy was associated with increased levels of NT-prоBNP, SOD, and MPO (30.670±15.367 vs. 52.309±25.718 pmo l/l; 1.61±0.135 vs. 1.74±0.193 U/ml; and 507.54±91.51 vs. 742.3±49.01 ng/ml, respectively). The study results indicated activation of oxidative stress on the background of the administered antitumor therapy, progressive myocardial dysfunction, and increased frequency of arrhythmic episodes.Conclusion      The study results allowed identifying NT-prоBNP, MPO, and SOD as important indexes for determining a patient group at high risk of cardiotoxicity during the antitumor treatment.

Aim      To study changes in markers for myocardial direct injury and dysfunction and endothelial dysfunction (ED) indexes in patients with indolent lymphoma during the antitumor treatment.Material and methods  Current antitumor therapy for lymphoma is often associated with cardio- and vasculotoxicity, studying of which is a relevant scientific direction. Markers for myocardial direct injury and dysfunction and ED indexes were studied in patients with indolent lymphomas receiving polychemotherapy (PCT). The study included 77 patients with newly diagnosed indolent type lymphoma. The main group (n=52): mean age, 63.4±2.8 years, 15 (28.8 %) men who had received one course of PCT. The comparison group (n=25): mean age, 61.8±3.7 years, 8 (32 %) men who had not received PCT. Troponin I (TnI), high-sensitivity troponin I (hs-сTnI), heart-type fatty acid binding protein (h-FAВР), and N-terminal pro-B-type natriuretic peptide (NT-prоBNP) were measured in patients of both groups. ED was evaluated by measuring the level of vascular cell adhesion molecule (VCAM) and by assessing the structure and function condition of small blood vessels using photoplethysmography. In both groups, the study parameters were determined at the start of the study (T1) and following the PCT course in the main group; if the PCT schedule included anthracycline antibiotics, the second point (T2) was assessed at 6 h following the drug administration.Results In both groups, the level of NT-proBNP was increased. This increase was significantly more pronounced in the comparison group (49.896±23.228 vs 20.877±8.534 pmol/l, respectively, p=0.011) whereas a tendency to its increase was observed after the PCT course. Before the start of the treatment, laboratory and instrumental signs of ED were noticed: the level of VCAM was 4951±1297 and 3225±757 ng/ml in the comparison group and the main group, respectively (р=0.246); reflection index was &lt;1.8 in 23 (44.2%) patients of the main group and in 16 (64%) patients of the comparison group (р=0.098). During the PTC course, the endothelial function significantly improved; the level of VCAM decreased by 748 ng/ml (p=0.016), which was associated with significant decreases in erythrocyte sedimentation rate by 2.71 mm/h (р=0.027) and lactate dehydrogenase level by 62.38 U/l (р=0.026). Statistically significant decreases in other inflammatory markers (alpha-2-globulin, fibrinogen, C-reactive protein, neutrophil count) were not observed.Conclusion      The level of NT-proBNP showed the highest sensitivity in assessing the cardiotoxic effect of PCT. The dynamics of VCAM level suggested a possible role of the disease itself in the development of ED in this patient group.

Purpose: to study dynamics of indicators of oxidative stress and their role in development of cardiotoxicity in patients with lympho-proliferative diseases at the background of polychemotherapy., Materials and Methods: We included into this study 30 patients with newly detected Non-Hodgkin lymphomas. The control group comprised 15 healthy volunteers. For registration of dynamics of formation of oxygen active forms (OAF), we used highly sensitive chemiluminescence assay. The state of initial stage of lipoperoxidation OAF and radicals of organic compounds) was assessed by dynamics of the leukocyte chemiluminescence. The state of final stage of lipoperoxidation (formation of nonmetabolizing lipid hydroperoxides and other compounds) was assessed by the level of malonic dialdehyde. We also determined indicator of leukocyte chemiluminescence intensity (both basal and zymosan-stimulated). For assessment of the cardiovascular system functional state before and after chemotherapy we used electrocardiography (ECG), echocardiography (EchoCG) and 24-hour ECG monitoring., Results: The data obtained were indicative of increased generation of free radicals by leukocytes during polychemotherapy. After chemotherapy course we detected various types of cardiotoxicity. We noted substantial elevation of frequency of supraventricular and ventricular extrasystoles. There was direct correlation between rate of appearance of supraventricular extrasystoles and level of chemiluminescence of leukocytes (r=0.7; p=0.03). According to data of EchoCG although the left ventricular ejection fraction remained within the normal range during chemotherapy, there was a persistent tendency to its decrease (р&lt;0.001)., Conclusion: In this study we for the first time in patients with Non-Hodgkin lymphomas detected an elevation of level of free radical reactions and lipid peroxidation with simultaneous lowering of antiperoxidative activity of blood plasma and their relation to development of cardiotoxic effects. The results obtained indicate to necessity of search for novel early markers of oxidative stress activation, myocardial injury and disfunction able to help to substantially decrease risk of development of cardiovascular complications during and after chemotherapy.

Understanding mechanisms of chemotherapy cardiotoxicity is an important problem due to the lack of clear understanding of its occurrence. Development of endothelial dysfunction is considered to be one of possible ways in implementation of these side effects. The analysis of endothelin-1 and e-selectin levels in 26  patients with lymphoproliferative diseases before and after the completion of the treatment program was been performed. The results of the study showed normal values of E-selectin level and increased level of endothelin-1 in the whole group of patients before treatment. After completion of chemotherapy program, in the whole group, there was a decrease of these two markers. However, values of level of endothelin-1 with vasoconstrictor effect remained high even after the end of therapy. It is imp ortant that at detailed analysis the dynamics of investigated markers in patients of older age group (median age 64 years) was associated with worsening of endothelial dysfunction.

Aim: To evaluate the efficacy of the training method of rehabilitation of patients with neurogenic dysphagia in ischemic stroke carried out with the use of special nutrient mixtures as part of combination therapy., Material and Methods: The study included 65 patients (35 men and 30 women, aged 45 to 80 years) with dysphagia in the acute period of ischemic stroke. Thirty patients were treated with special binding compounds as part of a combination therapy. Thirty-five patients did not use the mixture. The dynamics of the recovery function of swallowing using PAS (the Penetration-Aspiration Scale) and FEDSS (the Fiberoptic Endoscopic Dysphagia Severity Scale), as well as the transition from tube to independent feeding were studied., Results and Conclusion: The training method of rehabilitation with the help of special nutritional mixtures allows achieving significantly better indicators of restoration of swallowing function assessed with PAS and FEDSS in patients with ischemic stroke and neurogenic dysphagia. This trend is most pronounced in the group of patients with pseudobulbar syndrome. The application of the training method leads to a significantly better transition from tube to independent feeding. Tracheal intubation and mechanical ventilation are an additional factor aggravating swallowing disorders.

The article provides review of possible mechanisms of inhibitor coagulopathies, in particular of acquired hemophilia A. This pathology is an extremely rare disease occurring in 1-2 cases in 1 million per year. In the present study we provide data for two clinical cases of hemophilia A in women. These cases had different development mechanisms, although both women have a newly discovered missense mutation His2026Arg in the VIII factor gene. The matter of main interest is the description of the disease development in the patient with an acquired idiopathic hemophilia A with a possible disease occurrence due to an asymmetric X-chromosome inactivation (lyonization). In this particular case lyonization led to the late manifestation of the hemophilia A carrier's state and development of severe form of the inhibitor-associated acquired hemophilia A. We also discuss therapeutic approaches to these forms of the disease, considering there are no concise protocols for case management due to an extreme rarity of the pathology. Acquainting the clinical personnel working it the different areas of medicine with suchlike inhibitor coagulopathies has a major practical importance.

Background: Literature data on hepcidin (H) level - the main regulator of systemic iron homeostasis in patients with chronic heart failure (CHF) - are contradictory. Relationships of H with markers of inflammation elevated level of which is characteristic of CHF are insufficiently studied. The latter problem remains practically unexplored in elderly and very old patients with CHF., Aim: to study the role of H in formation of anemia of chronic disease (ACD) and iron deficiency anemia (IDA) in elderly and very old patients with CHF., Material and Methods: We examined 65 elderly and very old patients with ischemic heart disease (IHD) (35 with CHF and ACD, 10 with CHF and IDA, 20 without CHF, ACD, and IDA [control group]). H level in blood serum was measured using competitive solid-phase immunoenzyme assay., Results and Discussion: In patients with CHF and ACD mean H levels were significantly high relative to those in patients with CHF and IDA, while in the latter group H levels were insignificantly low relative to those in patients of control group. High H level, high level of inflammatory tests as well as positive correlations between them, and negative correlation between H and hemoglobin (Hb) are indicative of inflammation as a cause of H level elevation, which in turn facilitates development of anemia in elderly and very old patients with CHF and ACD. Low H level, normal levels of inflammatory tests, absence of links between them, as well as absence of correlation between H and Hb are indicative of lack of H role in development of anemia in these patients with CHF and IDA. We did not study influence on development of anemia of each of possible causes (inflammation, decompensation of CHF) separately, therefore contribution of each of them is unknown. The data obtained also do not exclude effect of other not investigated in this work and presently unknown factors. Received by us data indicate to necessity of precise identification of origin of anemia in every case in an elderly or very old patient with CHF with the aim of elimination of its cause and conduct of pathogenetically valid therapy.

Aim: To develop a practical algorithm for the correction of sodium levels and osmolality of blood plasma during the acute period of severe ischemic stroke (IS)., Material and Methods: One hundred and fifty patients with cardioembolic or atherothrombotic stroke, aged from 30 to 80 years, hospitalized in the first 12 h after symptom emergence, were examined. Neurological deficit was assessed with the NIHSS. The monitoring of blood plasma sodium level and osmolality of blood plasma in the 1st and 5th day after stroke as well as of blood circulation volume was performed. The level of antidiuretic hormone (ADH) was measured in patients with hyperosmolar syndrome with hypernatremia., Results and Conclusion: It has been shown that hyponatremia is not an independent predictor of outcome of IS, but requires a diagnostic search of the causes of this condition with subsequent correction of sodium levels. For hypernatremia therapeutic tactics varies depending on the timing of the beginning of IS. A conservative strategy for the correction of hypernatremia to plasma sodium blood levels of 150 mmol/L on the first day of IS and to 155 mg/dL since the third day can be used. If these values are exceeded, the most rapid correction of hypernatremia is necessary.

The Aim: to study and identify the impact of the osmolarity blood plasma level on outcomes atherothrombotic ischemic stroke, and cardioembolic subtype., Materials and Methods: The study included 150 patients with severe ischemic stroke pathogenesis of diferent subtypes. We studied the effect of the of the osmolarity bloodplasma level in the first dayfrom the disease beginning to ischemic stroke prognosis., Results: it is shown that the prognosisfor severe ischemic stroke pathogenesis of different subtypes of the first day disease is unfavorable to the level of blood plasma osmolality 297 mOsml. This cardioembolic ischemic strokes pathogenic subtypes are more severe course and worse prognosis., Conclusion: the osmolarity of blood plasma is an independent predictor of adverse outcome for ischemic stroke pathogenesis of different subtypes.

The authors report a case of rare cardiac involvement in lymphoma, one of the manifestations of which was rhythm and conduction disorders with their resolution after chemotherapy. Also presented are clinical manifestations of heart lesions in lymphoma and modern methods of their diagnostics and treatment.

Aim: To study the prognostic value of disturbances of the water and electrolyte homeostasis in the acute stage of ischemic stroke (II) and their impact on the course and outcome., Material and Methods: Disturbances of the water and electrolyte homeostasis associated with plasma sodium fluctuations were studied in 150 patients with severe II., Results: The poor outcome was associated with plasma osmolarity >297 mOsmol/L and plasma sodium concentration >155 mOsmol/L in the first day of severe II and with >303 mOsmol/L and >161 mOsmol/L, respectively, in the 3rd and 5th days. The prognosis was significantly worse in hypovolemia compared to normo- and hypervolemia., Conclusion: Hypovolemic hyponatremia as a presentation of hyperosmolar syndrome at the onset of severe II can be considered as a relatedly independent predictor of the fatal outcome.

Inhibitory coagulopathy is a rare variant of hemorrhagic syndrome. Acquired hemophilia A is caused by the formation of inhibitors (antibodies) to Factor VIII of the blood coagulation system leading to impaired activation of the key stage of blood clotting (factor X) and development of hemorrhagic syndrome of different severity. Acquired hemophilia A is a rare disease with an incidence of 1.38-1.48 per 1 million population per year. We report a case off severe idiopathic acquired hemophilia A in a 53 year-old woman manifest as skin hemorrhages, subcutaneous and intramuscular hematomas. Hemostatic therapy described in the article resulted in the elimination of hemorrhagic syndrome and complete remission. This case represents a rare disease the knowledge of which can be useful for preventing the development of debilitating complications, and sometimes saving the patient’s life.

Comparative efficacy of neuroprotective preparations: actovegin, cerebrolysin and ceraxon was studied in 73 patients in the most acute phase of ischemic stroke. A control group included 33 patients in the most acute phase of ischemic stroke who received only basic treatment without neuroprotectors. Patient's state was assessed with the NIHSS, the original scale of E.I. Gusev and V.I. Skvortsova and the Barthel index. Ceraxon in daily dosage 2 g and cerebrolysin in daily dosage 10 ml during 10 days after the development of ischemic stroke led to the significantly better regression of neurological symptoms to the 21st day of disease compared to the control group. Barthel index scores did not differ in the groups studied.

On the basis of the research on clinical and prognostic characteristics of the acute period of ischemic stroke, the author has created an algorithm of activities during the first 24 h of the disease. It allows to manage the relocation of the patient in a hospital and to carry out consultative, medical and preventive measures. A software package for optimization the process of decision taking in the management of these patients is suggested.

Aim: Analysis of manifestation of epidemic process of aseptic meningitis and causes of its activation using molecular genetic methods., Materials and Methods: Samples of feces and CSF, nasopharyngeal swabs from 296 patients with aseptic meningitis (AM), as well as 240 samples of drinking water and 6 samples of lake water were studied. Epidemiologic analysis, isolation of enteroviruses in Hep-2 and RD cell cultures, RT-PCR, partial sequencing of 5'NTR and genome region coding VP1 were performed., Results: Marked rise of AM caused by enteroviruses in Nizhny Novgorod during 2001 - 2007 was demonstrated. From August to October 2007, enteroviruses were detected in 93.8% of patients with AM (22.5 per thousand). Seasonal rise of incidence was determined by 9 serotypes of enteroviruses: E30 - 26 cases (53.1%), E7 - 7 (14.3%), E18 - 5 (10.3%), E13 - 3 (6.1%), E9 - 2 (4.0%), CB5 - 3 (6.1%),CA1 - 1 (2.0%), CA9 - 1 (2.0%), CA13 - 1 (2.0%). Serotype E30, represented by two subtypes, dominated. Dominating subtype E30-N1 was closely related with E30 strains isolated in 1994 - 2001 in Europe. Subtype E30-N2 was genetically related with Asian strains isolated in 2000 - 2006. RNA of E7, E9, E13, E18, CB5 viruses and dominating subtype E30-N1 were detected in nasopharyngeal swabs from patients with AM, which can explain rapid and wide spread of these viruses in susceptible population by aspiration route of transmission., Conclusion: Increased incidence of AM in Nizhny Novgorod in 2007 was caused by variant of E30 virus, which was genetically related with strains isolated in European countries in 1997.

The analysis of 650 cases of ischemic stroke in accordance with the TOAST criteria showed that atherothrombotic subtypes of ischemic stroke (p < 0.05) appeared most commonly. Based on the results of the analysis of basic clinical and paraclinical signs in the acute period of ischemic stroke, we worked out two models for the prediction of fatality by severity of atherothrombotic and cardioembolic subtypes which allowed to improve the quality of outcome. In the group of patients with more severe strokes, more favorable outcomes were found for the atherothrombotic pathogenetic variant compared to atherothrombotic stroke (p < 0.05). Synergetic characteristics of the developed models were shown.

Hereditary neutropenia is a rare and poorly known condition leading to severe infectious complications and other pathologies; specifically, it is sometimes associated with the development of tumours. Literature data on clinical manifestations and possible pathogenetic mechanisms of the disease are discussed. A case report of idiopathic neutropenia and concomitant T-cell lymphoma is presented.

Basing on the results of the analysis of the main clinical-paraclinical syndromes of ischemic stroke in its acute period, two integrative analytic-prognostic systems have been designed. These systems improve quality of disease prognosis. More accurate prognosis is achieved by the model, which shows that outcome of ischemic stroke depends both on the initial condition of the disease and on its dynamics in the acutest period. The computerized system of early prognosis of ischemic stroke allows to give a detailed prognosis of complications and outcome of the disease. The use of the computerized system of early prognosis helps to gain the reliable improvement in groups of moderately severe and severe ischemic stroke.

The dynamics of free radical and peroxidation processes in patients with non-Hodgkin lymphomas (NHL) was studied parallel to the evaluation of changes in the functional condition of the cardiovascular system during a course of chemotherapy. Thirty-one patients (17 men; 14 women) aged 30 to 81, were examined. The dynamics of active oxygen forms (AOF) generation was studied using chemiluminiscent technique. The intensity of leucocyte chemiluminiscence (CL) (basal and zimozan-stimulated ones), the blood level of malonic dialdehyde, the antiperoxidation blood plasma activity according to its hydrogen peroxide-induced CL intensity, were measured. The functional condition of the cardiovascular system was evaluated using ECG, EchoCG, and Holter monitoring. The study revealed an increase in AOF generation by leucocytes, which correlated with the severity of the disease. The treatment of the NHL patients with cytostatics was associated with the activation of free radical reactions, which was maximal during the first 24 hours 1 hour after drug administration. Cytostatic therapy was characterized by a cardiotoxic effect, which consisted in an increase in the rate of various arrhythmias and a decrease in the heart contractility. The study demonstrates a direct correlation between the degree of AOF generation growth and the prominence of myocardial lesion signs. The authors conclude that the intensification of free radical reactions under the conditions of cytostatic therapy causes cardiotoxic effects, which requires a course of preventive cardioprotective therapy before chemotherapy is commenced.

Basing on the results of multiple classifications of 70 clinical, paraclinical and anamnestic signs of ischemic stroke with combined cardiac symptomatology, the models predicting clinical outcome in acute period of the disease and an original scale of numerical score have been worked out. It is mathematically proved that the severity of ischemic stroke with combined cardiac symptomatology, scoring 75 and above, inevitably results in progression of fatal outcome. A group of unfavorable clinical predictors was singled out. The periods with high rate of fatal outcome within exacerbation of ischemic stroke and pathogenic types of stroke were studied. It is first-ever shown that a role of cardiac and neurological symptoms in predicting fatal outcome depends on ischemic stroke severity. A relation between the probable fatal outcome and dynamics of severity of stroke with combined cardiac symptomatology within the first 3 days of the disease was also revealed for the first time.

Aim: To determine occurrence and activity of chlamydial infection (CI) as well as activity of free radical processes in clinical course of different forms of ischemic heart disease., Material and Methods: 34 coronary heart disease (CHD) patients entered the study. 23(67.6%) of them had effort angina and unstable angina, 11(32.4%) patients had non-Q myocardial infarction (19 men and 15 women). 14 healthy donors served control. CI was detected with enzyme immunoassay. The examinations were made in exacerbation and 2 weeks later in clinical improvement. Chlamydia pneumoniae infection in the tissues of the aorta and left coronary artery was studied in 15 dead bodies using the polymeric chain reaction. Generation of active oxygen forms by leukocytes was tested by luminol-dependent chemiluminescence method. In addition, the patients and donors were examined for malonic dialdehyde., Results: Titers of IgA and IgG of C. pneumoniae antibodies were high in CHD exacerbation. IgM antibodies were not found in the diagnostic titers. Follow-up values of IgA and IgG titers lowered. C. pneumoniae was found in 12 of 15 autopsy specimens. Basal and stimulated indices of leukocytic generation of active oxygen forms in patients with CHD exacerbation were higher than in donors. Later, the generation declined. Malonic dialdehyde was also elevated in the exacerbation and lowered in clinical improvement. A correlation exists between IgA and IgG antibodies titers and chemiluminescence intensity in CHD exacerbation., Conclusion: In progression of atherosclerotic process including CHD and its exacerbations CI and free radical processes activate. These may be related showing a feasibility of C. pneumoniae involvement in development of atherosclerosis.

A pilot trial of efficiency of enalapril maleate in the treatment of residual pulmonary hypertension was made in 22 patients operated for rheumatic mitral valve defects. Degree I, II and III of pulmonary hypertension was registered in 5, 13 and 4 patients, respectively. Thus, the patients had NYHA functional classes III and IV (22.7 and 77.3%, respectively. Enalapril given for 6 months in a mean daily dose 12.3 +/- 1.57 mg/m2 (5-30 mg a day) normalized pressure in the pulmonary artery in 18.2% of patients. 50% of patients showed hypertension degree I, only one female retained hypertension degree III. To the end of the treatment the functional classes were the following: II--in 68.2%, III--in 27.3% and IV--in 4.5%.

98 patients with isolated rheumatic mitral valve defects of the heart entered the study. Their central hemodynamics was studied intraoperatively before surgical correction of the defect. The results were compared to those provided by conventional noninvasive methods: chest x-ray, ECG, echo-CG, external respiration function test. Correlation analysis using computer intellect PolyAnalyst v.1.01R helped to design a program and practical nomogram which can quantitatively determine the degree of pulmonary hypertension on the basis of digital values of Rv1 wave amplitude (ECG) and right ventricular cavity size (echoCG).

Aim: To study changes in pulmonary hypertension in patients with isolated mitral valvular defects of rheumatic etiology after surgical correction and in the early postoperative period., Materials and Methods: Central hemodynamics in heart chamber probing before operation and intraoperatively were measured in 98 patients with rheumatic mitral defects (41 males, 57 females, mean age 39.5 +/- 8.74). Manometry before and after the defect correction, intraoperative catheterization (cath. Swan-Ganz) for hemodynamics 24-h follow-up were made., Results: After valvular defect correction 90(91%) patients had residual pulmonary hypertension, stage II-III in 41%., Conclusion: Patients operated for rheumatic heart disease complicated by pulmonary hypertension often suffer from residual pulmonary hypertension. This requires pharmacological correction.

The routine methods X-ray study and computed tomography (CT) were compared in a group of patients engaged in fireproof industry. CT yields valuable additional data in early silicotuberculosis, which makes it possible to follow the extent of a silicotuberculous process more completely, to make a better diagnosis of nodal and focal shadows, to identify small decay cavities in the foci and infiltrates. CT is the method of choice in following up patients with silicotuberculosis.

The methodological bases and ways of building and using the new type of the educational computer-aided systems for physicians, the Diagnostic trainer, are discussed in the paper. The user's work on the Diagnostic Trainer proceeds in the form of a game during which the system stimulates clinical cases while the user analyzes them. The Diagnostic Trainer uses its knowledge base for simulations and requires no clinical cases to be prepared beforehand. The Diagnostic Trainer never forces the user to do, but always fixes his/her attention on the available essential points and possible contradictions between the specific clinical case and the user's strategy to make a decision.

The ability of leukocytes to generate active oxygen forms and plasmic levels of malonic dialdehyde as indicators of free radical process activity and that of lipid peroxidation (POL), respectively, were investigated in 50 patients with angina pectoris (20 patients with functional class I-II and 30 patients with functional class III-IV) versus 18 donors. The anginal patients are shown to have enhanced POL and free radical processes which appeared correlated with the disease severity. The authors identify factors intensifying free radical processes in anginal patients: platelet inhibition of leukocytic ability to generate active oxygen forms, changes in plasmic levels of IgM, C-reactive protein, serum iron.

Low-molecular weight peptides prepared according to an original procedure from a cattle heart possess a protecting effect on the myocardium during ischemia. Peptides in doses of 10(-7) g/ml and less improve the indexes of contractility function of the isolated heart after total ischemia and correct respiration warranting cardiomyocytes survival during hypoxia. However, in different models high doses of heart peptides (5 x 10(-6) g/ml and more) are shown to inhibit contractility, to stop respiration, the action of the peptides increasing with myocardial ischemia degree.

The paper is concerned with studies on generation of free radicals by donor leukocytes in plasma rich or poor in platelets. NBT test and chemiluminescence were employed. Platelets are shown to inhibit generation of free radicals. Changes in free radicals generation were studied under stimulation by zymosan and addition of washed platelet fraction. The conclusion is made that platelets inhibit leukocyte generation of free radicals by adsorption factors necessary for this process from plasma.

It has been established that cordialin inhibits selectively succinic acid oxidation and intensifies the exudation of a NADH2 substrate which is energetically more advantageous, and in this way has a favorable effect on energy metabolism, evidence of which is increase of the ATP content in the myocardium. Cordialin correction of the biologic energy of cardiomyocytes in hypoxia and ischemia prevents the accumulation of lipid drops in the cells of the peri-infarction zone, which reflects the high intensity of the processes of fatty acids beta-oxidation. As a result of this glycolysis activation is unnecessary (which is confirmed by high glycogen content, both of a qualitative and quantitative character, in the myocardium and low concentrations of glucose and lactate in the blood) and, consequently, the sequelae of acidosis are prevented.

Cordialin, the agent extracted from the heart, is known to inhibit hyperoxidation of succinic acid, increasing NADH oxidation speed in suspension of cardiomyocytes in hypoxia. Cordialin presence in oxygenated cells' suspension oxidating succinate, doesn't change oxygen consumption speed. The results received may be a theoretical basis for cordialin utilization in therapy of myocardial diseases, associated with hypoxia and ischemia. Cordialin utilization may be recommended for the treatment of acute myocardial infarction and for prolongation of time-period for thrombolytic therapy, treatment of IMD, angina and other pathological states, in which oxygen transport disturbance to myocardium cells occurs.