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Issue. Articles

3(27) // 2009





Acute erosive-ulcerous gastroduodenal bleeding among patients with myocardial infarction: influence on hospital mortality, possibilities of prophylaxis and endoscopic treatment

V.G. Mishalov, K.M. Amosova, P.L. Byck, I.M. Leshchishin, L.Yu. Markulan, E.V. Borodin

The aim — to define frequency of acute erosive(ulcerous gastroduodenal bleeding (AEUGB) among patients with myocardial infarction (MI), its influence on hospital lethality, to estimate efficiency of its prophylaxis and endoscopic treatment for such patients.

Methods and subjects. 208 patients with MI complicated by AEUGB were examined. In a control group (141 patient) the prophylaxis of AEUGB was not carried out, and at 67 patients (basic group) peroral reception of omeprazol simultaneously with the combined drug of diosmin/hesperidin in therapeutic doses was used as prophylaxis.

Results and discussion. In default of prophylaxis AEUGB arose up at 3.4 % patients with IM. In both groups the basic sources of bleeding were acute damages of gastro(duodenal mucous membrane (57.3 % and 52.3 % in a control and basic group accordingly). In most cases AEUGB arose up on 2–3 day after beginning of MI. Bleeding from chronic ulcers occurred rarer, but it was more dangerous. By means of endoscopic treatment the active bleeding was stopped at 9 (39.1 %) of patients of control group and at 6 (60 %) patients of basic group. The relapse of bleeding after endoscopic treatment in a control group arose up for 5 (55.6 %) patients and at 2 (33.3 %) patients of basic group. After endoscopic prophylaxis the relapse of bleeding arose up at 24 (32.8 %) patients of control group and at 5 (8.8 %) patients of basic group (p < 0.001). Total frequency of relapses of AEUGB after the endoscopic measures of
treatment and prophylaxis was 30.2 % and 10.4 % in control and basic groups accordingly.

Conclusions. In patients with MI AEUGB arises up at 3.4 % cases and are accompanied with increasing of hospital mortality on 37.7 %. Prophylaxis of AUGB at MI by inhibitors of proton pump simultaneously with diosmin/hesperidin during 10 days diminishes the their frequency at 26.5 %, part of active bleeding (Forrest-I) from 24.0 % to 14.9 % and frequency of relapses of bleeding from 35.4 % to 11.1 %. In patients with IM with the active bleeding endoscopic treatment is effective at 45.5 % cases.

Keywords: myocardial infarction, acute erosive-ulcerous gastroduodenal bleeding, acute damages of gastro-duodenal mucous membrane, endoscopic treatment.



The influence of different salt-reactivity types of blood pressure on the structural and functional features of large arteries in essential arterial hypertension

.. Bobryshev

The aim – to investigate the correlation of large artery function and elasticity features with salt-reactivity types of essential arterial hypertension (EAH).

Methods and subjects. 61 patients with stage and of EAH and 21 healthy volunteers have been examined. To determine the salt-reactivity types of blood pressure we used the acute Saline-Lasix test. Ultrasound scanning was used to study endothelium-dependent and endothelium-independent brachial artery (BA) dilation by D. Celermajer, thickness of the «intima-media» (TIM) complex in the common carotid artery (CCA), its differential Young module (E), aortal distensibility (D), and aortal pulse wave velocity.

Results and discussion. The patients were classified as salt-resistant (n = 26), salt-sensitive (n = 24) and «paradoxical reactive» (n = 11) ones. In salt-sensitive EAH patients, the increase in BA diameter was (2.1 ± 0.9 %) in reactive hyperemia test, which was less (p < 0.05) than in healthy volunteers (13.0 ± 3.3 %), in salt-resistant patients it was (9.3 ± 3.0 %) and in «paradoxical reactive» – (6.1 ± 2.4 %). In salt-sensitive patients, the increase in BA diameter in nitroglycerin test was also less substantial (p < 0.05) than in healthy volunteers (9.3 ± 4.2 % and 16.8 ± 4.5 %), in salt-resistant patients it was (16.0 ± 4.1 %), and in «paradoxical reactive» – (16.4 ± 3.7 %). Indices of the structural and elastic arterial properties differed from the control values ( < 0.05) only in salt-sensitive patients. Thus, in salt-sensitive patients, I complex in the CCA was (0.93 ± 0.16) mm, while in the healthy volunteers it was (0.52 ± 0.11 mm), for CCA was (6.77 ± 1.92) · 105 N/m2 (in healthy volunteers – (4.95 ± 1.13) · 105 N/m2), aortal D was (1.44 ± 1.76) · 105 N/m2 (in healthy volunteers – (3.06 ± 1.57) · 105 N/m2), v aortal was (4.63 ± 0.85) m/s (in healthy volunteers – (3.78 ± 0.95) m/s).

Conclusions. Endothelial dysfunction of BA has been detected in all salt-reactivity types of EAH, with the most degree in saltsensitive patients. Moreover, only this category has impaired elastic properties of large arteries.

Keywords: essential arterial hypertension, salt-reactivity of arterial pressure, endothelial dysfunction, nitric oxide, elastic properties of arteries.



Strategy of complete lower limbs revascularization combination of endovascular and open surgery

Yu.S. Spirin

The aim – application of combined (endovascular and open) procedures in patients with Lerysh’ syndrome and multilevel atherosclerosis of lower limbs in order to achieve complete revascularization.

Methods and subjects. 20 patients with Lerysh’ syndrome and multilevel atherosclerosis of lower limbs who underwent 20 combined procedures were enrolled in this study. All patients were masculine. The age was from 51 till 74 years ( = 65 ± 7.6). Three types of procedures were performed. The first group (7 procedures) – patients after simultaneous mini invasive iliac-femoral bypass and balloon angioplasty of contra lateral iliac arteries. The second one (6 procedures) – patients after simultaneous mini invasive iliac-femoral bypass and balloon angioplasty of femoral-popliteal arterial segment. The third one (7 procedures) – patients after simultaneous balloon angioplasty of iliac arteries and open reconstruction of femoral – popliteal arterial segment. The following points were analyzed: ischemia resolving rate, thrombosis rate in the early postoperative periods, endovascular time and blood loss during endovascular period, hospital mortality.

Results and discussion. Thrombosis in early postoperative period was observed in 1 case (5 %). This was third group’ patient with thrombosis (1st day) of femoral-popliteal arterial segment which led to major amputation. In 19 cases (95 %) positive results were achieved: permeability of all reconstructed segments and ischemia absence. Average time of endovascular procedures was 19 ± 1.9 minutes, and average blood loss during endovascular was 30 ± 5.6 ml. The postoperative mortality was not observed.

Conclusions. Additional application of balloon angioplasty simultaneously with open surgery, in patients with Lerysh’ syndrome and multilevel atherosclerosis of the lower limbs’ arteries, leads to complete lower limbs revascularization without total procedure time and its morbidity increasing. The immediate positive result was achieved in 95 % of cases.

Keywords: atherosclerosis, combined procedures.



Examination of the clinical course and results of acute coronary syndrome without elevation segment ST at patients with aspirin resistance according to the assessment of platelet aggregation with arachidonic acid

K.M. Amosova, N.V. Netjazhenko

The aim – to identify the impact of aspirin resistance according to the assessment of platelet aggregation with arachidonic acid on the clinical course and consequences of acute coronary syndrome without elevation segment ST in the prospective study.

Methods and subjects. in the prospective study included 465 patients with acute coronary syndrome without elevation segment ST, who were hospitalized in the myocardial infarction departments. Of Alexander Hospital, Kyiv from the 1st January 2006 up to the 1st January 2007 and had no exclusion criteria such as presence of a stable elevation of ST segment or acute occurrence of complete blockade of the LBB on ECG, left ventricular acute heart failure (HF), signs of chronic HF IIB-III stages in the classification of Strazhesko–Vasilenko, left ventricle ejection fraction below 45 %, congenital and acquired heart defects, myocarditis, cardiomyopathy, pericarditis, arterial pulmonary hypertension and severe diabetes 1 and type 2, severe chronic diseases of the kidneys and liver with disfunctions and other serious opportunistic diseases that are likely to reduce life expectancy over the next 12 months. Furthermore, this study did not include patients with the initial level of platelets in venous blood < 180 · 109. Clinical observations of patients were carried out within 28 days or before discharge. The frequency of ischemic changes on ECG at rest and severe complications of acute coronary syndrome (atrial fibrillation, ventricular tachycardia or fibrillation) and non-fatal (re-) MI were estimated. Last complication and lethal outcome and their combination were applied as clinical end points. 325 patients (1 group)before the study did not take aspirin or its administration was not systematic, and 140 patients took aspirin in daily doses from 75 to 160 mg (2nd group)for at least the last 6 months before hospitalization. The last group according to results of the definition of 1st degree day and platelet aggregation rate at the laser device analyzer aggregation aggregometry «Solar»-spontaneous and after the addition of arachidonic acid at concentrations of 0.5 mg/ml, was divided into two groups. One (2A) group included patients with not determined aspirin resistance Group 2B included patients with established biochemical aspirin resistance, criteria which, according to data PA Gum and other biochemical criteria as increasing of increasing scale and speed of aggregation after the addition of arachidonic acid at 20 % or more of the original level (spontaneous aggregation).

Results and discussion. According to platelet aggregation with arachidonic acid aspirin resistance detected in 15 of 140 patients from group 2, representing 10.8 %. Patients of all groups were compared by age. Group 2 had more women than 1st, and 2B (with AR)(more than 2A (all p < 0.05). Smoking and obesity in patients of 2nd group observed significantly more frequently than in the 1st group, and diabetes, contrast-less (p < 0.05). With comparative assessment of their frequency in group 2A and 2B it appears that despite the small number of patients with aspirin resistance, the frequency of risk factors, including diabetes was significantly greater than in patients without aspirin resistance (p < 0.05). The frequency of major types of therapy acute coronary syndrome in all three groups was the same and particularly for clopidogrel in group 2B was 6.7 % in group 2A, 7.2 % and 1group – 8, 0 %. In the group with aspirin resistance (2B) compared with group 2A and 1, non-fatal (re)-IM (46.6 % vs 3.2 % and 4.9 %), ventricular fibrillation and ventricular tachycardia (31 % vs. 2.4 % and 1.5 %) and paroxysm of atrial fibrillation (33.3 % vs 5.6 % and 3.4 %, all p < 0.05). Was significantly higher hospital case fatality rate (26.7 % vs 4 % and 1.8 %) and total frequency of death and non-fatal (re) MI (73.3 % vs 7.2 % and 6.8 %, all p < 0.05) ocurred more often.

Conclusions. Biochemical data for aspirin resistance by using aggregation of platelets with arachidonic acid was marked in 10.7 % of patients with acute coronary syndrome without elevation segment ST, who previously took aspirin and it was associated with the increase in hospital mortality for 26.7 %, frequency of non-fatal (re) MI at 46.6 % and total frequency of these events at 73.3 %.

Keywords: acute coronary syndrome, treatment, platelet aggregation.



Peculiarities of peripheral hemodynamics and vasoregulation in patients with sticky platelet syndrome and thrombocytopathy

V.P. Voznyuk

The aim – comparative analysis of endothelium-dependent indices of vasoregulation and peripheral hemodynamics in patients with sticky platelet syndrome (SPS-syndrome) and thrombocytopathy (TP).

Methods and subjects. 15 patients with SPS-syndrome (1st group) and 18 patients with TP (2nd group) were examined. The diagnosis was based on a series of coagulation analyses with definition of aggregation features of platelets, definition of the activity of blood-coagulation factors, evaluation of fibrinolytic activity of blood. The control group consisted of 15 practically healthy persons without pathology of hemostasis, age and gender matched. Brachial arteries (BA) were examined by method of duplex scanning by Technos (Esaote S.p.a., Italy) equipped with 10.5–13.0 MHz linear transducer. Linear and volumetric characteristics of blood flow (diameter of BA, maximal, end diastolic, volumetric blood velocity, endothelial shear stress, mechanical sensitivity of the endothelium) as well as parameters reflecting elastic properties of vascular wall (systolic and diastolic ratio, acceleration time of pulse wave) were determined in spectral Doppler mode. Endothelial shear stress (τ) was calculated using the formula: τ = 4 · η · VPS/D, where η – blood viscosity, VPS – peak systolic velocity of blood flow, D – diameter of BA. The condition of flowmediated dilation (FMD) was studied in the tests with reactive hyperemia according to the method described by D.S. Celermajer. Endothelial mechanosensation (K) or blood vessel wall sensitivity to shear stress, i.e. its ability to dilate, was calculated using the formula: = (∆D/D0)/(∆τ/τ0), where ∆D – the difference between the diameter (D) of brachial artery after conducting the test with reactive hyperemia and initial D of artery (D0), ∆τ – the difference between τ after conducting the test with reactive hyperemia and initial shear stress (τ0).

Results and discussion. In patients of the 1st group the increment of BA diameter at reactive hyperaemia made (9.64 ± 0.26 %), which was substantially lower than the reference indices (p < 0.01). The increment of BA diameter in the 2nd group on the height of sample was also different (p < 0.01) from the reference indices (14.1 ± 0.38 %) and made (10.9 ± 0.64 %). Ved at rest in patients of both groups significantly exceeded (p < 0.01) the similar index in the controls. After conducting the reactive hyperemia test the diastolic blood velocity in patients of both groups slightly increased (p > 0.05), while in the reference group Ved reduced by 3 times (p < 0.05). Initial indices of shear stress in patients of 1st (51.23 ± 4.26) and 2nd groups (55.02 ± 4.62) substantially exceeded the similar reference indices (32.72 ± 4.22) (p < 0.01). At the height of sample in healthy people τ increased by 1.4 times (p < 0.05), while in patients of both groups the index displayed a slight increase (p > 0.05). Mechanosensation index (K) in patients of the 2nd group (0.461 ± 0.015) considerably exceeded (p < 0.01) the similar parameters of healthy subjects (0.345 ± 0.013) and patients of 1st group (0.358 ± 0.027). Increase K in patients with TP can have compensatory value for maintenance of adequate hemostasis. Systolic/diastolic (S/D) ratio in healthy subjects after reactive hyperemia test increased from 4.5 ± 1.34 to 20.0 ± 2.43, while in patients with SPS-syndrome S/D ratio decreased from 27.5 ± 3.68 to 7.65 ± 1.24, and in patients with TP – from 26.6 ± 2.93 to 9.14 ± 1.83. The initial time of acceleration of pulse wave (AT) in patients of both groups considerably exceeded the reference values (p < 0.01). High indices of pulse wave significantly (p < 0.01) exceeding the physiologic values remained in the patients after reactive hyperemia test too. Changes of S/D and AT in patients with SPS-syndrome and TP indicate the signs of pathology of elastic properties of vascular wall at these patients.

Conclusions. The increase of platelet functional activity in patients with SPS-syndrome is associated with reduction of reactive hyperemia, shear stress increase and signs of dysfunction of elastic characteristics of vascular wall on the basis of S/D ratio and acceleration time of pulse wave at duplex scanning of brachial artery. Depression of platelet functional activity is accompanied by signs of activation of peripheral hemodynamics and increase of endothelial mechanosensation of brachial artery. Under conditions of platelet hyper aggregation (SPS-syndrome) changes of peripheral haemodynamics contribute to the activation of hemostasis and have prothrombotic trend. At reduction of platelet functional activity, the peculiarities of peripheral haemodynamics may act as compensators for maintenance of adequate hemostasis.

Keywords: platelet, sticky platelet syndrome, thrombocytopathy, endothelium, peripheral hemodynamics, elastic properties of vascular wall, vasoregulation.



Changes in fatty-acid composition of triglycerides of blood plasma in patients with unstable angina and their dynamics under statin influence

V.G. Lizogub, O.. Artemchuk, T.S. Briuzgina, O.. Voloshina

The aim — to determine the peculiarities of fatty-acid spectrum (FAS) of blood plasma triglycerides (TG) by means of the method of gas chromatography at unstable angina (UA) and the influence of statin treatment on them.

Methods and subjects. 65 patients with UA were included into the study: the 1st group (n = 23) took only the basic therapy, the 2nd group (n = 21) took simvastatin as addition to the basic therapy for 21 days, the 3rd group (n = 21) took atorvastatin. The control groups included 25 practically healthy persons (the 1st group), and 20 patients with stable angina (SA) of II FK (the 2nd group). The patients of the 1st, 2nd, and 3rd groups were the same age, gender and had the same risk factors (smoking), myocardial infarction in the anamnesis, frequency of angina onsets and ECG changes at rest (all p > 0.05). The changes in fatty-acid composition of triglycerides of blood plasma were determined by gas chromatography method before and after treatment.

Results and discussion. The comparative analysis of FAS of blood plasma TG in patients of the 1st and 2nd control groups revealed substantially lower levels of myristinic, palmitinic, margaric, linolenic FA in patients with SA and substantially higher levels of oleic and linoleic higher FA. Before treatment, the patients with UA, as compared to the patients of the 2nd control group, revealed substantially higher levels of myristinic, pentadecanoic, margaric acid, substantially lower levels of palmitinic, stearic, linoleic, arachidonic acid, substantially higher sum of SFA, lower sum of USFA and PSFA. After 21 days of therapy, the patients of the 2nd group had substantially lower level of margaric acid (by 34.5 %), linolenic acid (by 40.5 %), higher levels of arachidonic acid (by 39.29 %), which was not accompanied by changes in SFA, USFA, PSFA. Unlike the patients of the 1st and 2nd groups, the patients of the 3rd group, along with substantial decrease of levels of myristinic acid (by 66.9 %), pentadecanoic acid (by 60.5 %), margaric acid (by 51.7 %), linolenic acid (by 75.7 %), dihomo-γ-linolenic acid (by 61.5 %), substantial increase of levels of oleic acid (by 322.2 %), linoleic acid (by 279.4 %), arachidonic acid (by 53.2 %), manifested substantial changes in SFA, USFA, PSFA ratio, which was accompanied by its normalization.

Conclusions. FAS of blood plasma TG of practically healthy persons has substantial differences from that of patients with SA. It is characterized by lower levels of myristinic, palmitinic, margaric, linolenic FA and substantially higher levels of oleic and linoleic higher FA. FAS of blood plasma TG of patients with UA substantially differs from that of patients with SA by the decrease of levels of palmitinic, stearic, linoleic, arachidonic acids and the increase of levels of myristinic, pentadecanoic, margaric higher FA. Destabilization of coronary blood flow in patients with UA is accompanied by substantial changes in FAS of blood plasma TG. In patients with UA, atorvastatin therapy in the dose of 10 mg/day, unlike simvastatin therapy in the dose of 20 mg/day, leads to substantial quantitative and qualitative changes of blood plasma TG.

Keywords: atherosclerosis, ischemic heart disease, fatty acids, triglycerides.



Influence of fenofibrate therapy on the plasma lipid spectrum and insulin resistance in patients with metabolic syndrome and diabetes mellitus type 2

.I. Mitchenko, V.Yu. Romanov, T.V. Belyaeva, I.V. Chulaevskaya

The aim — to study the influence of fenofibrate on the lipid profile of blood plasma and insulin resistance in patients with metabolic syndrome depending on the presence of diabetes mellitus type 2.

Methods and subjects. 30 women were examined with metabolic syndrome (MS) which was diagnosed by the criteria of ATR III. To estimate the efficiency of Lipofen CR and its possible influence on the insulin sensitivity, 2 clinical groups wereformed: the 1st group consisted of women (mean age (53.2 ± 2.7) years) with MS without of carbohydrate disorders; the 2nd group consisted of 14 women (mean age (55.1 ± 2.9) years) with MS and diabetes mellitus (DM) type 2. According to the data of HOMA-index, insulin resistance (IR) was revealed in all patients of this group. The index was calculated like this: the level of insulin on an empty stomach (U/ml) · glucose of blood on an empty stomach (mmol/l) / 22.5. If HOMA-index exceeded 3, IR was diagnosed. After 12 weeks of treatment, lipid blood spectrum, levels of glucose and insulin on an empty stomach and HOMA-index were determined again.

Results and discussion. The 1st group of patients after 12 weeks of treatment with fenofibrate manifested the increase of level of high density lipoproteins (HDL) and the decrease of triglyceride (TG) level to the normative values in accordance with ATP III criteria of MS (1.30 ± 0.04) and (1.7 ± 0.2) mmol/l), respectively. The patients of the 2th group (with the most serious clinical manifestations) had a tendency to the decline of levels of total cholesterol (CS), TG, low density lipoproteins; however, the target levels of the indicated indexes were not attained. The achievement of target values of lipid profile indexes may need additional correction of carbohydrate disorders, because the presence of IR at patients with DM in the 2nd group can be associated with «diabetic dyslipidemia» whose removal is directly related to the restoration of insulin sensitivity. In 12 weeks the patients of the 2nd group had a tendency to the optimization of carbohydrate exchange that revealed itself as the decline of HOMA-index from 6.8 ± 0.6 to 5.3 ± 0.2. This happened mainly due to the diminishing of hyperinsulinemia, which is the evidence of the optimization of sensitiveness of peripheral tissues to insulin.

Conclusions. The administration of Lipofen CR in the dose of 250 mg/day during 12 weeks for women with MS allowed the achievement of the normal levels of TG and CS of HDL in accordance with the criteria of ATR III. The tendency to the decline of lipidogram indexes was registered in the group of the most seriously ill patients (with MS and DM). At the same time, while taking Lipofen CR, the patients of this group manifested the optimization of sensitivity of peripheral tissues to insulin, which was associated with the decrease of HOMA-index values.

Keywords: fenofibrate, metabolic syndrome, diabetes mellitus, dyslipidemia.



Influence of eprosartan mezylat therapy on structural$geometrical and functional condition of the left ventricle, heart rate variability, cerebral blood flow and platelet aggregation in patients with III degree of arterial hypertension

V.V. Syvolap, E.A. Poznanskaya

The aim — the estimation of eprosartan mezylat influence on the structural-geometrical and functional indexes of the left ventricle (LV), cerebral blood-flow and platelet hemostasis of patients with I–II degree of arterial hypertension.

Methods and subjects. 27 patients with essential hypertension aged from 36 to 86 years were examined. Before and after 6 weeks of treatment with eprosartan mezylat in daily dose of 600 mg, structural-geometrical and functional indexes of the LV, heart rate variability (HRV), cerebral blood flow and adrenalin-induced platelet aggregation were investigated.

Results and discussion. Eprosartan mezylat reduces the systolic arterial pressure (AP) by 29.9 % ( < 0.001), diastolic AP – by 22.3 % ( < 0.001), diminishes the index of the LV myocardium weight by 19.9 % ( < 0.001), does not influence the indexes of cerebral blood flow and adrenalin-induced platelet aggregation.

Conclusions. The treatment of patients with I–II degree of H with eprosartan mezylat during 6 weeks was accompanied by the diminishing of systolic AP, regression of the LV myocardium hypertrophy, the decrease of intramyocardial pressure, the improvement of diastole filling. It produced no changes in the LV volume parameters and did not have substantial influence on the parameters of adrenalin-induced platelet aggregation, spectral parameters of HRV and blood-flow along extracranial and intracranial vessels.

Keywords: arterial hypertension of III degree, eprosartan mesylat, structural-geometrical and functional parameters of left ventricle, cerebral blood flow, platelet hemostasis, heart rate variability.



The statins role in angiopathy treatment in patients with diabetes mellitus type 2

V.G. Mishalov, E.N. Amosova, N.Yu. Lytvinova

The frequency of type 2 diabetes mellitus is growing in the whole world. The main causes of severe pathologies, dysfunctions and mortality associated with diabetes are macro- and microangiopathy that influence different organs. Therefore the diabetic angiopathy treatment is an up(today problem. This article deals with clinical examinations results concerned with efficacy and safety of statin treatment in reduction of vascular complication frequency in patients with type 2 diabetes mellitus.

Keywords: diabetes mellitus type 2, angiopathy, treatment, statins.



Endothelial dysfunction in pathophysiology of vein dsorders and posibilities of its correction by micronized diosmin

S.M. Genyk

Endothelium, according to modern views, is an active endocrine organ diffusely dissipated into all tissues. One of the basic functions of endothelium is balanced removing of regulator substances which determine the integral function of the system of blood circulation. The results of modern researches into pathophysiopathology of venous impairments convincingly demonstrate the key significance of cellular dysfunction in the development and progress of varicose illness. The dysfunction of endothelium of vascular wall, its damage by metabolism products of activated leucocytes, gradual transformation of reparative processes are accompanied with stable changes of structure and function of muscular cells and are the basic links in the pathogeny of venous outflow impairments. The changes of metabolic activity of endothelium are accompanied with the formation and removal into the lumen of capillaries of factor of activity of thrombocyte, cytokines, oxygen radicals and thrombin which stimulate the formation of cell adhesive molecules on the membranes of neutrophils and on the surface of endothelium. Micronized diosmin promotes the correction of abnormal haemorheological indexes and also diminishes the expression of endothelium cells by cell adhesive molecules of leucocytes in micro( and macrocirculation.

Keywords: endothelium, dysfunction, cell adhesive molecules, venous wall, varicose illness, muscular cell, micronized diosmin.

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K. M. Amosova 1, I. I. Gorda 1, A. B. Bezrodnyi 1, G. V. Mostbauer 1, Yu. V. Rudenko 1, A. V. Sablin 2, N. V. Melnychenko 2, Yu. O. Sychenko 1, I. V. Prudkiy 1&a

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