The aim of this study was comparative evaluation of bisoprolol and enalapril influence on the long-term prognosis, haemodynamic characteristics, neurohumoral status and cytokines activation in asymptomatic chronic heart failure (CHF) patients.

Material and methods. 112 patients aged 44—67 years with ischemic heart disease and CHF of the I functional class with the left ventricle ejection fraction (LV EF) less than 45 %, sinus rhythm and controlled arterial hypertension were enrolled to the study. All patients were randomized into two groups consisting of 56 patients each. The patients of the first group took angiotensin converting enzyme (ACE) inhibitor enalapril in the target daily dose of 20 mg (mean 12.7 ± 1.33 mg), the second group patients took highly selective beta-blocker bisoprolol in the target daily dose of 10 mg (mean 9.1 ± 0.6 mg). As accompanying therapy, the patients of both groups took aspirin (125—250 mg/day), lovastatin (20—40 mg/day), metformin (300—600 mg/day) and hipotiazid (12.4—25.0 mg/day). The patients were observed for 8—12 months (on average 312 ± 42 days). The changes of cardiohaemodynamics indices by means of echocardiography, total number of cardiovascular events during the course of treatment were estimated in all patients. Plasma concentration of cerebral natriuretic peptide (C-NUP), tumor necrosis factor alpha (TNF-α) and C-reactive protein (CRP) levels were examined by ELISA. Angiotensin-2, renin, aldosterone, and norepinephrine plasma levels were assessed by radioimmune assay.

Results. After one year of therapy, 5 lethal outcomes (2.8 %) and 12 cases of hospitalization (6.7 %) were registered in the 1st group, while in the 2nd group, we registered 4 lethal outcomes (2.2 %, p = 0.12) and 6 cases of hospitalization (3.4 %, p < 0.05). The total index of «the number of hospitalizations + the number of lethal outcomes from different causes» was lower (p < 0.05) in the 2nd group of patients. In the course of treatment, the 2nd group of patients manifested substantial decrease of end-diastolic volume (EDV) and end-systolic volume (ESV), while the therapy of the 1st group resulted only in statistically substantial changes of EDV. Statistically substantial increase of LV EF from (39.4 ± 1.15) % to (43.4 ± 1.1) % and the volume velocity of ejection (VE) from (156.3 ± 2.5) ml/s to (168.2 ± 3.3) ml/s (all р < 0.05) were registered in the 2nd group. The decrease of angiotensin-2, aldosterone and C-NUP as well as TNF-α and CRP plasma levels was more pronounced in the 2nd group than in the 1st group of patients (all p < 0.05). At the same time, norepinephrine plasma activity in patients of both groups was comparable.

Conclusions. In case of asymptomatic CHF, the ability of bisoprolol to increase LV EF, improve neurohumoral status of blood plasma and decrease the intensity of cytokines activation exceeded that of ACE inhibitor enalapril, at the same time, contributing to substantial regress of factors of individual unfavorable prognosis: angiotensin-2, aldosterone, C-NUP, CRP and TNF-α.

Keywords: heart failure, neurohumoral status, cytokines activation, haemodynamics, long-term prognosis, treatment, bisoprolol

Aim of work was to determine the effectiveness of the 1st rib transaxillary resection in the surgical treatment of patients with various forms of compressive thoracic outlet syndrome (CTOS) relying on our personal experience and publication data, as well as to optimize the technical aspects of its performance.

Materials and methods. 85 patients with various CTOS forms were treated at Vascular Surgery Department of Zhytomyr Regional Clinical Hospital during the period from 1983 to September, 2005. Uncomplicated forms of CTOS were registered in 53 patients, complicated ones — in 32. 22 patients had arterial, 8 — venous and 2 — neurologic complications. 67 patients underwent surgical treatment (82.7 %). Transaxillary resection of the 1st rib, performed in 42 patients (25 — with uncomplicated forms and 17 — with complicated ones), was considered to be a universal decompressive intervention in the thoracal outlet zone. The above surgery was performed in accordance with Roos classical technique using a set of unique instruments of our own design.

Results and discussions. The mean duration of an isolated transaxillary resection of the 1st rib was 45 minutes. Perioperative complications were diagnosed in 6 % patients (2 pneumothoraxes, 1 brachioplexitis in mild form, 1 wound abscess). No iatrogenic injuries of great vessels or lethal cases were observed. It took on average 17 ± 2.8 days for the upper extremity to restore its function completely. Good and satisfactory longGterm results of treatment were achieved in 92.0 % patients with uncomplicated and 88.2 % patients with complicated CTOS forms.

Conclusions. Under the strict observance of the indications and the technique of surgery, the 1st rib transaxillary resection is an effective method of decompression of thoracic outlet zone in case of various CTOS forms. The use of the suggested instrument set makes it possible to conduct the surgical procedure in a short time with permissible number of intraoperative complications.

Keywords: compressive thoracic outlet syndrome, surgical treatment, transaxillary resection of the 1st rib

Objective. To study the changes of levels of inert metalloproteinase-1 (proMMP-1) and the tissue inhibitor of metalloproteinases-1 (TIMP-1) in the blood plasma as well as their relation to the indices of the structural and functional state of myocardium in patients with essential hypertension (EH), the types of left ventricle remodeling (LV), in particular.

Materials and methods. 69 patients (39 women and 30 men) with I—II stages of arterial hypertension of I—II degree aged (52.3 ± 8.9) years and 20 practically healthy individuals aged (48.1 ± 8.0) years were enrolled in the study. LV end-diastolic diameter (EDD), EDD index (EDDI), end-systolic diameter (ESD), LV posterior wall thickness (PWT), interventricular septum thickness (IVST), LV myocardium mass (LVMM), LV myocardium mass index (LVMMI) were assessed by echocardiography. Types of LV remodeling were determined in accordance with principle of Ganau A.: LV normal geometry (NG) (n = 16), concentric remodeling (CR) (n = 13), concentric hypertrophy (CH) (n = 21) and eccentric hypertrophy (EH) (n = 19). Plasma proMMP-1 and TIMP-1 levels were determined with enzyme-linked immunosorbent assay.

Results. ProMMP-1 plasma level increased in hypertensive patients in comparison with the controls (3.87 ± 0.31 ng/ml versus 1.38 ± 0.18 ng/ml, p < 0.001). ProMMP-1 concentration in NG was — 1.85 ± 0.28, CR — 2.86 ± 0.41, CH — 3.95 ± 0.31, EH — 5.39 ± 0.54 (in comparison with the controls, all p < 0.05—0.001). A positive correlation was revealed between plasma proMMP-1 level and LVMMI (r = 0.67), EDDI (r = 0.66), LVMM (r = 0.57), EDD (r = 0.55), ESD (r = 0.36), IVST (r = 0.40), PWT (r = 0.38) (all p < 0.05). Plasma TIMP-1 concentration was higher in patients with essential hypertension than in the control group (409.23 ± 4.13 ng/ml versus 368.55 ± 7.43 ng/ml) (p < 0.05). Depending on the remodeling type, TIMP-1 levels were as follows: in NG — 396.0 ± 11.3, CR — 402.1 ± 9.5, CH — 412.0 ± 6.2, EH — 422.9 ± 5.7 (in comparison with the controls, all p < 0.05—0.01). Correlation analysis revealed interdependence between plasma concentration of TIMP-1 and LVMMI (r = 0.38, p < 0.05).

Conclusions. The excessive proMMP-1 production in hypertensive patients correlates with LVMMI, LV chamber dimensions and thickness of its posterior wall as well as interventricular septum thickness. The increase of LVMMI value was accompanied by the increase of plasma TIMP-1 concentration. The increase of proMMP-1 and TIMP-1 plasma concentration in hypertensive patients with normal geometry of LV may be considered as an early sign of interstitial fibrosis development in the myocardium.

Keywords: essential hypertension, left ventricular remodeling, matrix metalloproteinase-1, tissue inhibitor metalloproteinases-1, interstitial fibrosis

Objective: clinicopathomorphological analysis of aortic aneurisms in Marfan syndrome (MS).

Materials and methods. 134 patients with MS and aortic aneurisms at the age of 7—64 years (mean age 32.4 ± 4.2 years) were examined. Methods of investigation included Doppler-EchoCG, aortography, coronaroventriculography, pathohistological examination of operative and autopsy materials (coloring by hematoxylin and eosine, van Gison picrofuchsin, by Veigert, alcian blue and toluidine blue).

Results. Aortic aneurisms were diagnosed in all 134 cases of MS: with aortic exfoliation in 49 (36.6 %) and aortic regurgitation in 127 (94.8 %). All patients pathohistologically had lesions of elastic skeleton of aortic wall medium membrane with medionecrosis zones formation (in 51.5 %) and generalized elastolysis (in 37.9 %), dystrophic changes, muscular necrosis, collagenous fascicles collapse.

Conclusions. Clinical manifestation at a young age (20—35 years) is typical for aortic aneurisms in Marfan syndrome. It occurs more often in men, with the tendency to exfoliation (in 36.6 %) and aortic valve insufficiency formation (94.8 %). Lesion of elastic skeleton of aortic wall medium membrane is the base of aortic exfoliation development in Marfan syndrome.

Keywords: Marfan syndrome, medionecrosis, elastolysis, exfoliating aortic aneurysms

The objective of the research was to study the condition of humoral antiendotoxin immunity in myocardial infarction (MI) patients with concomitant diabetes mellitus (DM) in the dynamics of the disease.

Material and methods. 15 patients with uncomplicated Q-wave MI and concomitant type 2 DM aged 49—77 years; 12 non-dia-betics with uncomplicated Q-wave MI aged 38—80 years, 10 type 2 DM patients without acute coronary pathology (ACP) aged 44—75 years, 20 persons without DM and ACP matching by cardio-vascular risk factors to the group of non-diabetic MI patients aged 48 — 73years (comparison group); 64 healthy individuals aged 30—78 years (control group) were enrolled in the study. Antiendotoxin antibodies (anti-ET-Ig) of class A, M and G were measured by enzyme-linked immunosorbent assay on days 2, 7 and 20 of MI.

Results. In DM patients without ACP serum concentrations of anti-ET-IgA (0.135 ± 0.016 versus 0.028 ± 0.001 in controls; p < 0.05) and anti-ET-IgG (0.437 ± 0.026 versus 0.105 ± 0.008 in controls; p < 0.05) were significantly increased, while the levels of anti-ET-IgM were equal to the levels of controls (0.129 ± 0.004 and 0.093 ± 0.004 respectively; p > 0.05). Non-diabetic MI patients had increased levels of anti-ET-IgA on day 2 if compared with the comparison group (0.089 ± 0.021 versus 0.031 ± 0.002; p < 0.05), these levels remaining during the entire period of observation. Anti-ET-IgM levels were profoundly decreased (0.031 ± 0.001 versus 0.102 ± 0.006 in comparison group; p < 0.05) on day 2 of MI. On day 7 of MI the index increased by 55 % in comparison with day 2 (p < 0.05) reaching the level of controls by day 20. Anti-ET-IgG levels increased 1.8-fold on day 2 if compared with those in comparison group (p < 0.05) without any significant dynamics through day 20 of MI. In MI patients with DM serum concentrations of anti-ET-IgA on day 2 (0.118 ± 0.011) and day 7 (0.127 ± 0.017) of MI practically didn't differ from each other and were on the level of diabetics without ACP (0.135 ± 0.016). The index increased 1.8-fold on day 20 in comparison with day 2 (p < 0.05). Anti-EТ-IgM levels in diabetics had the same pattern of dynamics as in non-diabetics but with much smaller amplitude of concentration oscillations (0.071 ± 0.004 on day 2 of MI; 0.075 ± 0.005 on day 7 and 0.101 ± 0.002 on day 20). Levels of anti-EТ-IgG in group of diabetics during all the period of MI (0.222 ± 0.023 on day 2 of MI; 0.233 ± 0.022 on day 7 and 0.297 ± 0.059 on day 20) were much lower than in diabetics without ACP (0.437 ± 0.026; all p < 0.05) and had no substantial dynamics.

Conclusions. The development of MI is accompanied by activation of humoral chain of anti-endotoxin immunity both in diabetics and non-diabetics. DM alters anti-endotoxin humoral immune response in MI patients, which is revealed by the decrease of its intensity, delayed and prolonged activity, as well as by modified trends of different anti-endotoxin antibodies levels dynamic in the process of immune response development.

Keywords: myocardial infarction, diabetes mellitus, endotoxin, antibodies

Studying the role of the internal carotid artery (ICA) in case of progression of cerebral circulation acute and chronic impairments as well as working out the optimal methods of their prophylaxis and treatment is an urgent problem of vascular surgery. At present, the pathological crimpiness (PC) of ICA is the second major cause of chronic cerebral circulation failure (CCCF) development. There are lots of different methods of ICA PC surgical treatment. In course of the operation surgeons are confronted with different complications which may lead to the lethal outcome.

The aim of the research was to determine an optimal surgical method of ICA PC correction based on comparing the intra-operative and post-operative observations with the results of histology of ICA areas resected during the operation.

Material and methods. 197 patients with different variants of ICA PC which caused different degrees of CCCF were operated on at the department of angioneurology, unit of emergency and restorative vessel surgery, Donetsk V.K. Husak Institute of Emergency and Restorative Surgery, Academy of Medical Sciences of Ukraine, in the period from 1999 to 2004. 65 (33.0 %) of them were men, 132 (67.0 %) - women. The age of the patients ranged from 14 to 81 years, mean (55 ± 3.1) years. In the pre-operative period we carried out complex examination which presupposed the detailed neurological inspection ultrasound dupplex scanning with transcranial scanning, spiral computer tomography in vascular regime with the investigation of the brain perfusion, magnetic resonance scan in vascular regime, electroencephalomapping. We performed both intra-operative pathohistological sampling during the resection of ICA PC (54 preparations) and sampling from those who died of different kinds of ischemic stroke (32 preparations). The areas of ICA PC which were resected during the operation as well as the received sectional material underwent histological examination. When studying the histological structure of ICA PC we singled out four zones of ICA with configurational changes: planned anastomosis zone, fore-crimpiness zone, crimpiness zone, post-stenotic dilatation.

Results. The results of the histological study of different ICA zones with configurational changes in patients that underwent surgery were as follows: the ICA wall structure in the planned anastomosis zone was practically normal; the fore-crimpiness zone was characterized by ruptures and the absence of elastic fibers in the media; dysplastic changes of ICA wall and replacement of elastic fibers by connective ones was typical of the PC zone. Irregular hyperplasia, fibrosis and leakage of lipids were present in the intima. In the media we revealed the focal mosaic redistribution of glycosaminoglycans, fuchsinophilia, neo-collagenoses picture (type III collagen was prevalent), mosaic picrinophilia - the evidence of the active fibrosing process. The adventitia was marked with fibrosis process especially pronounced along the small curvature of PC which fixes the artery in the arched position. The constant fixation of the ICA in the arched position lead to the stricture formation as well as the restructuring of the vascular wall with the formation of the pillow-shaped thickening of the post-stenotic dilatation zone. Type IV collagen was revealed in such dilatation areas. The data of the ICA PC histological study and the analysis of complications developed during the operation for their correction allowed claiming that ICA PC redressment without its previous resection and the reimplantation of ICA into common carotid artery with the formation of the new orifice are safer than the resection and redressment of ICA PC with anastomosis of the «end into end» type or with the implantation into the old ICA orifice. 145 patients were operated on using this method. The control examinations of the patients with the obligatory ultrasound investigation in the period of 5 years after the operation didn't reveal any complications in the reconstruction zones.

Conclusions. The safest method of operative treatment of carotid artery pathological crimpiness is its redressment without previous resection and implantation of the internal carotid artery into the common carotid artery with the formation of the new orifice.

Keywords: internal carotid artery, pathological crimpiness, chronic cerebral circulation failure, surgical treatment

The aim was to conduct the comparative analysis of lipid and carbohydrate metabolism indices in myocardial infarction (MI) patients under age 50 depending on the professional health-damaging work and smoking.

Material and methods. 139 MI patients aged 27—62 years (mean 46.5 ± 4.7 years) were enrolled in the study. 127 of them were men and 12 — women. MI with Q-wave was diagnosed in 118 (84.9 %) of them and MI without Q-wave — in 21 (15.1 %). All the patients were divided according to their age and professions. Group (A) consisted of 41 young patients under age 44 (WHO, 1963). Group of 58 patients aged 45—50 years and group — of 40 patients aged 51 and over. Each age group was divided into two professional subgroups. The first one consisted of those who were in contact with xenobiotics; the second group consisted of patients whose professions were not connected with the influence of xenobiotics. Commonly on day (1.4 ± 0.4) since the onset of MI we took venous blood from patients on an empty stomach to determine the serum level of the main lipid metabolism indices (total cholesterol, low-density lipoproteins cholesterol, very low-density lipoproteins cholesterol, high-density lipoproteins cholesterol, triglycerides). The study was performed on FP-901 biochemical analyzer (Finland). The carbohydrate metabolism was estimated by measuring the content of glucosidated hemoglobin HbA1c using the method of K.H. Gabbay et al. of 1979 modification by firm Lakhema.

Results. According to the professional anamnestic data, 27 (65.9 %) patients at young age (A) and 44 (75.9 %) patients aged 45— 50 years (B) had been working for a long time in harmful conditions either immediately or not long before the onset of the disease. In the group of patients under age 44 there were 35 (85.4 %) smokers, in the group of patients aged 45—50 years and over age 51 — 73 (74.7 %). Such risk factors as arterial hypertension (AH) and adiposity were revealed more frequently in MI patients of groups A and B who hadn't worked in harmful conditions. Mean levels of blood lipid spectrum main indices of patients under age 50, constituting the 2nd professional subgroup, were substantially higher than those of the 1st subgroup patients. Among the persons over age 51 in both professional subgroups there were no substantial differences with regard to the spread of the risk factors under study (p>0.05). The proportion of patients with elevated content of HbA1с ≥ 8 % was the smallest among the patients of young age (under 44 years) (A) and the lowest among the patients over age 51 (p < 0.05). On the whole the 1st professional subgroup, irrespective of the age, mostly consisted of patients without carbohydrate metabolism disturbances (81.0 — 88.9 %), mean levels of HbA1c didn't exceed (6.31 ± 1.35) %.

Conclusions. In MI patients under age 50 the influence of xenobiotics is connected with both professional health-damaging work and smoking (in 71.7 % patients). It is associated with substantially smaller atherogenic shifts of lipid metabolism indices and lower, if compared with patients that had no professional contact with xenobiotics, frequency of such risk factors as AH and adiposity. In patients over age 50 the contact with xenobiotics doesn't influence the frequency of the main cardiovascular risk factors.

Keywords: myocardial infarction, young age, xenobiotics, lipid metabolism, carbohydrate metabolism

The aim of the study was to determine the incidence of different kinds of paroxysmal supraventricular arrhythmias (SVA) in patients with acute myocardial infarction (AMI), their effect on the clinical course of the disease and the development of other AMI complications as well as short-term prognosis of the survival of patients.

Material and methods. We assessed the duration of the period from the onset of AMI symptoms to the development of paroxysmal SVA, the number and duration of different SVA, their impact on the clinical course of the disease, hospital mortality, the effect of standard means of early AMI treatment on the development of paroxysmal SVA. Retrospective study of 2,299 case reports of AMI patients consecutively hospitalized in 2000—2002 was conducted. SVA were diagnosed by means of bedside ECG monitoring with in 48 hours after the onset of AMI, ECG registration of arrhythmia symptoms and Holter monitoring of ECG. Representative control group consisted of 155 AMI patients without SVA.

Results and discussion. Paroxysmal SVA was registered in 221 (9.6 %) patients with AMI: in 71.5 % — atrial fibrillation, in 10.9 % — atrial flutter, in 9.0 % — supraventricular (atrial or atrioventricular nodal) tachycardia, in 8.6 % — the combination of different SVA. Sinus rhythm was restored in 88.9 % of those AMI patients who survived and only in 49.2 % of those who later died in hospital. The onset of SVA during the first 24 hours of AMI took place in 49.3 % cases. 62.4 % of patients developed only one SVA paroxysm. The clinical course of AMI was more frequently complicated by recurrent AMI, development of arterial hypertension, acute left ventricular failure and persistent ventricular tachyarrythmias in patients with paroxysmal SVA than in the control group. In-hospital mortality was 26.7 % in AMI patients with SVA and 6.5 % — in patients without SVA.

Conclusions. Early, starting with the pre-hospital period, administration of beta-blockers and angiotensin converting enzyme inhibitors is recommended to all patients who don't have any contra-indications for these preparations. It is aimed at prophylaxis of paroxysmal SVA in AMI patients. Treatment of such patients with digoxin contributed to the development of permanent form of atrial fibrillation.

Keywords: acute myocardial infarction, paroxysmal supraventricular arrhythmias, incidence, clinical course, prognosis, treatment

Endovascular grafting of abdominal aortic aneurism is of one the most technologically advanced methods of treatment. Indications for this procedure are practically the same as in case of regular surgical correction: aneurism diameter more than 4.5 cm, documented aneurism growth, presence of symptoms and complications (embolism, pains, urethral compression, rupture). This report highlights the first case of abdominal aortic aneurism repair with «Excluder» — III generation bifurcational endograft. Preoperative investigations included ultrasound scanning, angiography, computer tomography (CT). These techniques made it possible to choose the right size of the endograft. Computer tomography data determined 49 mm aneurysm diameter and more than 20 mm length of proximal aortic aneurysm neck. Together with a surgical team, we implanted an endograft. The duration of the operation was about 110 minutes while the immediate endovascular stage lasted less than 30 min. On the 6th day after the operation. the patient was discharged from hospital without any complications. In 45 days, the second investigation was conducted. There were no complaints. Ultrasound scanning and spiral computer tomography were carried out. Their results confirmed positive operational effect. No endoleaks were detected.

Keywords: abdominal aortic aneurism, еndovascular grafting

Smoking causes the increased levels of blood inflammation markers (proinflammatory cytokines, fibrinogen, C-reactive protein and others) which are prominent risk factors of cardiovascular diseases. The most significant influence on the association of smoking with cardiovascular pathology is attributed to such genetic factors as -174C→G polymorphism of interleukin-6 gene and ε4 allele of apolipoprotein E gene. Among the environmental factors, obesity has the most considerable effect.

Keywords: atherosclerosis, arterial hypertension, ischemic heart disease, inflammation markers, cytokines, fibrinogen, C-reactive protein, smoking, obesity, polymorphism of genes

The article gives a review of literature dealing with the treatment of chronic heart failure (CHF) with angiotensin-converting enzyme inhibitors (ACEi) according to the guidelines of European Society of Cardiology (ESC) published in the summer, 2005. ACEi are recommended as preparations of the first row for asymptomatic and symptomatic patients with the decreased systolic function of the left ventricle (ejection fraction < 40—45 %). ACEi can be administered not only as the main medication for treating any CHF stages, but also as prophylaxis of its symptoms and development of heart activity decompensation. Only 5 ACEi medications are recommended by ESC for treating patients with CHF (enalapril, captopril, ramipril, trandolaprilum, lisinopril). Enalapril has the biggest of all evidential base of clinical effectiveness and safety.

Keywords: heart failure, left ventricular systolic dysfunction, angiotensin-converting enzyme inhibitors, reduced risk of sudden death, prolongation of life, improvement of quality of life, evidence based medicine