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Aim. To assess the effectiveness and safety of refralon based cardioversion on the experience of the cardiology department of Orenburg Regional Clinical Hospital.Methods. The archival medical histories of 14 patients with persistent atrial fibrillation (AF) and 2 patients with persistent atrial flutter (AFL) (overall 16 patients), who underwent an attempt to restore sinus rhythm with refralon, were analyzed. The mean age of the patients was 51.7±10.4 years. The mean duration of AF/AFL since its last detection was 8.0±6.5 weeks (from 8 days to 8 months). Fifteen patients had hypertension, 3 of them had coronary artery disease (CAD), and 1 patient had CAD with type 2 diabetes mellitus. One of the patients had lone AF. Before cardioversion, all patients underwent the following examination: clinical and biochemical blood tests, clinical urine tests, electrocardiography (ECG), echocardiography (Echo), transesophageal Echo, Holter ECG, the determination of the level of thyroid-stimulating hormone, thyroxine, electrolytes, including potassium and magnesium.Results. According to Echo, initially, the transverse size of the left atrium in patients was 4.3±0.3 cm. Its increase was noted in 68.7% of patients (from 4.3 to 5.0 cm). Restoration of sinus rhythm after the first step of refralon administration at a dose of 10 μg/kg was achieved in 8 patients, after the second step of administration (total dose 20 μg/kg) - in 5 patients and after the third step (total dose 30 μg/kg) - in 2 patients. In 1 patient, restoration of sinus rhythm was not achieved after the administration of the third bolus. Out of 15 patients with restored sinus rhythm, AF recurrence occurred in three. In one of the patients with successful cardioversion, the sinus rhythm was restored the next day. The duration of the last episode of AF and the size of the left atrium did not significantly affect the effectiveness of cardioversion and amounted to 62±54 days and 4.3±0.35 cm, respectively, in patients with successful cardioversion, and with a recurrence of AF - 34.3±28 days and 4.2±0.35 cm (p=0.2; р=0.6). The efficacy of cardioversion with refralon was 71.4% in patients with AF, and 100% in patients with AFL. No adverse events of refralon were found in patients.Conclusion. At the time of discharge, sinus rhythm was recorded in 12 out of 16 patients (75%). The ineffectiveness of cardioversion with refralon was noted only in patients with AF; in all patients with AFL the sinus rhythm was restored.

To examine microcirculation in patients with systemic lupus erythematosus (SLE) showing clinical signs which may deteriorate hemodynamic indices: arterial hypertension (AH), atherosclerosis, antiphospholipid syndrome (APS).Microcirculatory changes were studied in 63 patients with SLE using biomicroscopy of bulbar conjunctival vessels (Zeiss slit-lamp, 32 times magnification). The following conjunctival indices were estimated: general (GCI), vascular (VCI), intravascular (IVCI), extravascular or perivascular.Microcirculatory changes in SLE patients covered disturbances of microvascular architectonics, microvascular blood flow. VCI, IVCI, GCI were significantly higher than in control subjects: 6.16 +/- 0.31, 3.69 +/- 0.36 and 9.87 +/- 0.57 scores vs 3.20 +/- 0.50; 120 +/- 0.20 and 4.20 +/- 0.50 scores, respectively. The degree of structural changes in the vessels depended on the disease duration while intravascular changes depended on the activity of lupus process. In patients with AH and atherosclerosis microcirculatory disturbances were similar and related to vascular architectonics. In APS there were marked intravascular disorders (IVCI was 7.50 +/- 0.59 scores, GCI was 16.13 +/- 1.41 scores).In SLE patients with AH and/or atherosclerosis microcirculatory changes involved primarily structure of the vascular wall and may be brought about by compensatory-adaptive mechanisms of the microcirculatory bed in high hemodynamic load. Intravascular microcirculatory changes were most pronounced, first of all as sludge-phenomenon, in APS and high SLE activity.

Dynamic scintigraphy (DS) provides qualitative and quantitative assessment of renal circulation in patients with different diseases. Few data are still available on application of DS of the kidneys in patients with systemic lupus erythematosus (SLE). Renal hemodynamics studies with DS are not described in SLE patients with disturbances of renal metabolism and/or antiphospholipid syndrome (APS). We examined renal hemodynamics in SLE patients with renal disease, arterial hypertension, impaired lipid metabolism, APS. We examined 65 patients with confirmed diagnosis of SLE with 99mTc DS and estimated effective renal blood flow. The latter was damaged more in SLE patients with symptoms of renal disorders. Arterial hypertension deteriorated renal hemodynamics. In hypertensive patients with affected kidneys angionephroscintigraphic parameters changed most significantly. Renal hemodynamics in disturbed lipid metabolism was worse than in normal one but the difference was not significant. Angionephroscintigraphy findings were worse in patients with APS than in those with renal lesion and arterial hypertension but free of APS.

To characterize structural-functional state of the heart by means of uni-, two-dimentional and doppler echocardiography in impulse regimen; to evaluate lipid metabolism in patients with scleroderma systematica (SS) and systemic lupus erythematosus (SLE).The examination of 35 SS and 38 SLE patients included clinical examination, echocardioscopy with doppler cardiography, measurements of serum concentrations of total cholesterol, triglycerides, low and high density lipoproteins, atherogenic index.In SS patients central hemodynamics reflects hyperdynamics. In intact contractility, diastolic function of the ventricles is impaired. Elevated atherogenicity of the serum was found in both the groups.According to echocardiography SLE and SS are associated with changes in both intracardiac and central hemodynamics. High atherogenicity of the serum may appear an additional factor of risk of hemodynamic disturbances.

To characterize clinical features of systemic lupus erythematosus (SLE) in persons living under various environmental pollution.Three groups of SLE patients living in the Orenburg region were examined: those exposed to intensive production pollution (n = 35 patients), exposed to mild pollution (n = 15), unexposed to production pollution (n = 25 patients). The pollution intensity was assessed by total aerogenic, water and soil pollution rates.The hair from 69 patients contained 24 chemical elements. More severe clinical symptoms of SLE were registered in patients living in conditions of intensive production pollution. These symptoms' severity directly correlated with the level of heavy metals in the hair of SLE patients and inversely correlated with hair levels of essential chemical elements.Chemical pollutants directly impair organs and tissues of SLE patients and indirectly do this via damaged immune system.

The purpose of our study was to investigate the main parameters of thyroid status in patients with rheumatoid arthritis (RA), as well as particularities of course of this disease depending on of thyroid gland function disorder. Materials and methods. 52 women with RA were examined. The first group consisted of 11 women with subclinical and manifestive hypothyroidism the second one 41 women without thyroid gland function disorder. The group comparison was conducted on main indexes of thyroid gland condition the hormon level, AT-TPO, ultrasonic data, as well as clinical and laboratory RA data. Results. In women with hypothyroidism the systemic manifestations of RA were more often truely diagnosed; DAS28 indexes, ESR, the number ot swollen joints were higher. The high level ot AT-TPO was diagnosed in 54,55% – I group and in 31,7% – II group TTG level was really less in patients receiving synthetic glycocorticoids. Small thyroid gland volume was diagnosed in 23,07% of examined patients. The thyroid gland status indexes in them did not differ from patients with normal thyroid gland volume. Reliable increasing of the peripheral resistance index was revealed in lower thyroid artery according to the ultrasonic study data under the reduced thyroid gland size. Conclusions. High incidence of hypothyroidism and AT-TPO carriage in RA was revealed. Hypothyroidism development is accompanied by high clinic-laboratory RA activity. The reduction of the thyroid gland volumes in RA is possibly stipulated not only by autoimmunal pathology, but also chronic ischemia of the organ in the conditions of immune-complex vasculitis and early atherosclerosis. The TTG level in patients with RA is defined not only by pathology of the thyroid gland, but glycocorticoid therapy as well.

Lupus erythematosus (SLE) and systemic sclerosis (SS). Methods. 45 SLE and 44 SS pts were included. Some of them received antirheumatic drugs in combination with enalapril other were treated with antirheumatic drugs only. The pts were examined before and 6-12 months after the beginning of the treatment. Echocardioscopy and biomicroscopy of bulbar conjunctiva vessels were performed in all cases. Results. Treatment with enalapril improved state of all SLE and SS pts. The drug was well tolerated and provided decrease of dyspnoea and edema as well as blood pressure normalization. Most prominent improvement was evident 12 months after the beginning of enalapril treatment. Reduction of left ventricle myocardium hypertrophy, improvement of its diastolic function and reduction of structural changes of bulbar conjunctiva microcirculation were achieved at that time. Conclusion. Enalapril administration in combination with antirheumatic drugs improves state of SLE and SS pts as well as echocardiography and bulbar conjunctiva vessels biomicroscopy results. It can be recommended for treatment of these diseases.