[Cardiorenal syndromes: historical aspects and current challenges]

The article describes major milestones in acknowledgment of pathophysiological relationship between heart and kidneys since Ancient Egypt till our time and history of term "cardiorenal syndrome" (CRS). First references about kidney and heart functions could be dated to 13 BC when Hippocrates mentioned them. In the XIV century Gentile da Foligno proposed a hypothesis about functional interconnection between heart and kidneys. In the XVIII century Richard Bright described the link between myocardial hypertrophy and kidneys diseases. Frederic Justin Collet was the first one who used the term "cardiorenal" in his article in 1903. In Russia, I.I. Stolnikov conducted his experiments about myocardial hypertrophy and kidneys ischemia in 1880. Famous Russian internist, E.M. Tareev, devoted several paragraphs to cardiorenal interactions in his fundamental manuals "Anemia in Bright's disease" (1929) and "Hypertension" (1948). The research on this topic was continued by Tareev's followers: N.A. Mukhin, V.S. Moiseev, more recent successors - Zh.D. Kobalava, S.V. Moiseev, V.V. Fomin, S.V. Villevalde and others. Their contribution resulted in development of first Russian clinical guidelines on cardio and nephroprotection in CRS in 2014. In 2008 consensus of Acute Disease Quality Initiative summarized current experience on CRS. Today, research on controversial classification questions, biomarkers and other aspects of CRS continues.

[Rheumatoid factor: study history and concept evolution]

Rheumatoid factor became the first laboratory marker of rheumatoid arthritis and one of the first serological markers used to recognize the major autoimmune diseases. Details of the discovery with special regard to contribution of E. Waaler and H. Rose are presented in this historical review. Same assays used to exam the rheumatoid factor, its frequency and modern view on diagnostic significance in different diseases are described in this article.

[Osteoarthrosis in the clinic of internal and occupational diseases: differential diagnostic aspects]

Osteoarthritis is a common pathology, which indicates the great medical and social significance of this disease. The article discusses the issues of pathogenesis, risk factors and diagnosis of professional and professionally caused osteoarthritis: the age of onset of the disease, the specifics of work, the localization of joint damage. Differential diagnosis issues are discussed.

Systemic ATTR-amyloidosis, a Rare Form of Internal Organ Damage

The article presents the case report of a rare hereditary form of systemic ATTR-amyloidosis in Russian patient with a discussion of approaches to the diagnosis and treatment of this form, also based on the own experience in the management of such patients. Modern ideas about the pathogenesis of the disease as well as detailed information about the clinical manifestations of amyloid cardiopathy and of other organs are presented. The nature of structural and hemodynamic changes in the heart is discussed on the basis of experience, including own, ultrasound examination of the heart in patients with amyloidosis, especially the article focuses the reader's attention on the true infiltrative nature of transtiretin amyloid cardiopathy in contrast to AL-amyloidosis, in which there is a significant inflammatory component that determines a more unfavorable natural course of AL-amyloidosis of the heart. The article discusses the differential diagnosis of different types of amyloidosis, the diagnostic difficulties associated with weak congophilia of transtiretin amyloidosis and at the same time substantiates the need for morphological verification of the diagnosis. Modern methods of treatment of ATTR-amyloidosis are discussed.

Pneumoconiosises: modern view

The article is devoted to the actual problem - dust diseases of the lungs. The peculiarities of occurrence and course of pulmonary lesions that have a significant place in the overall structure of occupational morbidity are considered. Modern approaches to treatment, diagnostics and prevention issues in pneumoconiosis are discussed.

Arterial hypertension at the workplace: risk factors and the population value

The article presents data of domestic and foreign authors on the relationship between occupational factors and arterial hypertension. The role  of latent arterial hypertension, its frequency in the population, the lesion of the target organs and the prognosis in comparison with normotensive individuals, arterial hypertension of the "white coat" and stable arterial hypertension have been analyzed. Arterial hypertension in the workplace is a form of latent arterial hypertension. The authors review the influence of harmful production factors (physical, chemical), as well as psychosocial stress on the risk of developing arterial hypertension.The risk of developing hypertension in specified groups of workers has been analyzed separately. The place of production-related diseases in modern occupational pathology in the Russian Federation. A wider implementation of measures aimed at early diagnosis and prevention of arterial hypertension in workers is proposed.

From Schönlein-Henoch purpura to IgA-vasculitis: pathogenetic aspects of the disease

Investigation's history and nomenclature's evolution of the IgA-vasculitis are presented in the article. Pathogenesis of the renal and skin damages is discussed in details, particularly abnormalities of the IgA-immunity and systemic endotoxemia. Relevant world's literature is cited.

Bilateral thalamic stroke in patient with patent foramen ovale and hereditary thrombophilia

Patent foramen ovale and hereditary thrombophilia are both known risk factors for ischemic stroke. Artery of Percheron is a rare anatomical variant in which vast areas of the midbrain and thalamus have a single source of blood supply. This case report presents a 45-years old female patient with bilateral thalamic stroke due to Percheron artery occlusion, with a combination of hereditary thrombophilia and patent foramen ovale as the risk factors. Modern approaches to the diagnosis and secondary prevention of this pathology are also discussed herein.

Bilateral thalamic stroke in patient with patent foramen ovale and hereditary thrombophilia

Patent foramen ovale and hereditary thrombophilia are both known risk factors for ischemic stroke. Artery of Percheron is a rare anatomical variant in which vast areas of the midbrain and thalamus have a single source of blood supply. This case report presents a 45-years old female patient with bilateral thalamic stroke due to Percheron artery occlusion, with a combination of hereditary thrombophilia and patent foramen ovale as the risk factors. Modern approaches to the diagnosis and secondary prevention of this pathology are also discussed herein.

From Schönlein-Henoch purpura to IgA-vasculitis: pathogenetic aspects of the disease

Investigation’s history and nomenclature’s evolution of the IgA-vasculitis are presented in the article. Pathogenesis of the renal and skin damages is discussed in details, particularly abnormalities of the IgA-immunity and systemic endotoxemia. Relevant world’s literature is cited.

[Myocardial injury associated with chronic hepatitis C: Clinical types and pathogenetic components]

Heart injury is one of the extrahepatic manifestations of chronic hepatitis C (CHC). The paper gives Russian and foreign authors' data on a relationship between CHC and myocardial injury. It discusses different pathogenetic components (the direct effect of the virus, immunological components), through which hepatitis C virus can induce myocarditis and cardiomyopathies in patients with CHC.

Clinical features of cardiac lesion in patients with generalized sarcoidosis

The article presents a clinical observation of two patients with generalized sarcoidosis. The woman typical granulomatous changes in the lungs and lymph nodes combined with atrial fibrillation, kidney failure and hereditary thrombophilia, men with atherosclerotic coronary arteries, re-myocardial infarction, cholestasis, tubulointerstitial nephritis. The accession of systemic manifestations was accompanied by increase of level of angiotensin-converting enzyme in the blood serum, morphological examination of lung tissue in both cases there were high histological activity of vasculitis and granulomatous inflammation. Extrapulmonary symptoms regressed when conducting immunosuppressive therapy. Discusses modern aspects of diagnosis of sarcoidosis in clinical practice.

[Giant cell arteritis: Genetic and epigenetic aspects]

The paper describes clinical cases in 2 patients (brothers) with giant cell arteritis. It analyzes the genetic and epigenetic aspects of the disease. The data available in the Russian and foreign literature are given.

Occupational factors and a risk of cardiovascular diseases

The paper gives Russian and foreign authors’ data on a relationship between occupational factors and cardiovascular diseases. It considers the impact of psychosocial stress on the risk of hypertension, coronary heart disease, and cardiovascular events in representatives of different professional groups.

[THE INFLUENCE OF CHRONIC HEPATITIS C ON ATHEROSCLEROSIS PROGRESSION]

We analysed the data of domestic andforeign authors on the relationship between hepatitis C and atherosclerosis. The possible role of the former condition as a risk factor of atherosclerosis even in very young patients is due to the properties of hepatitis C virus, mediators of inflammation, and metabolic disorders.

[Not Available]

AIM

To study the rate and types of cardiac involvement, the patterns of cardiovascular events (CVE) and to determine the importance of risk factors for atherosclerosis and the role of noninvasive methods in the diagnosis of cardiovascular diseases in patients with systemic vasculitides (SV).

MATERIALS AND METHODS

Three hundred and twenty-one patients with SV, including 138 (42.8%) with granulomatosis and polyangiitis (Wegener's granulomatosis) (GPA), 79 (24.7%) with Takayasu's arteritis (TA), 55 (17.2%) with polyarteritis nodosa (PAN), and 49 (15.3%) with eosinophilic granulomasis and polyangiitis (EGPA) (Churg-Strauss syndrome), were examined in 1989 to 2011. The clinical manifestations of the disease were studied retrospectively in 153 (47.6%) patients examined in 1989 to 2004 and prospectively in 168 (52.4%) patients examined in 2005 to 2011. The investigators performed EchoCG in the examinees prospectively, myocardial perfusion scintigraphy (PSG) in 92 patients, and multislice spiral computed tomography (MSCT) of coronary vessels in 32. The SCORE scale was employed to study risk factors for CVE. The data of cardiac and vascular morphological examinations were analyzed in 55 patients.

RESULTS

Heart damage as a major visceral injury in SV was detected in 63.3% of the cases with TA, in 70.9% of those with PAN, in 67.3% of those with EGPA, and in 48.5% of those with GPA. CVEs were diagnosed in 51 (15.9%) of the 321 patients. The rate of CVEs turned out to be higher in the patients with EGPA (22.3%) and PAN (18.2%) and slightly below in those with GPA (14.5%) and TA (12.6%). Echocardiography revealed aortic regurgitation in 28.5% of the patients with TA, left ventricular hypertrophy in 47% and diastolic dysfunction in 55% of those with PAN, pericarditis in 16 and 8% of those with EGPA and GPA, respectively; the signs of myocardial dilatation were diagnosed more frequently in EGPA (18.3%) than in other SVs. PSG diagnosed various myocardial perfusion disorders in 59% of the patients with SV; at the same time, focal changes prevailed over diffuse ones in the patients with PAN (45.8%) and EGPA (50%), diffuse ones in those with GPA (42.3%); these disorders being approximately equally frequently found in TA. MSCT revealed coronary calcification in 66% of the patients with GPA, 62.5% of those with EGPA, in 50% of those with PAN, and in 14.3% of those with TA. Postmortem examination displayed atherosclerotic changes in one or more great arteries in 28 (50.9%) of 55 dead patients. Deaths from cardiovascular causes were noted in 18 (30.9%) patients with SV. The causes of death were stated to be an acute cerebrovascular accident in 14.5% of the patients, myocardial infarction in 9.1%, and chronic heart failure in 7.3%.

CONCLUSION

The cardiac manifestations of SV are associated with immune inflammation and concomitant hypertension and atherosclerosis. The combination of traditional RFs for atherosclerosis and SV in the same patient allows the latter to be assigned to a very high CVE risk group. Early heart damage diagnosis using non-invasive methods provides a way of optimizing the further management tactics in patients with SV.

[Severe adverse events from treatment with genetically engineered biological agents in patients with rheumatic diseases]

AIM

To assess the risk of severe adverse events (AEs) within 6 months after treatment with biological agents in patients with rheumatic diseases (RD).

SUBJECTS AND METHODS

The 6-month open-label trial included 107 patients with rheumatoid arthritis, antineutrophil cytoplasmic antibody-associated vasculitides, systemic lupus erythematosus, and other RDs who received genetically engineered biological agents (GEBAs), primarily rituximab (n = 66) and infliximab (n = 31).

RESULTS

The majority of patients were noted to have improvements, including complete and partial remission in 62 (57.9%) and 42 (39.3%), respectively. There were mild or moderate AEs in 22 (20.6%) of the 107 patients, severe AEs in 6 (5.6%): grade IV neutropenia in 2 patients (after the use of rituximab), severe infusion reactions in 2 (after the administration of infliximab and rituximab), and systemic infections in 2 (fatal nocardial sepsis after rituximab treatment and unspecified sepsis after infliximab treatment).

CONCLUSION

The rate of serious AEs, mainly infusion AEs and infections during treatment with infliximab, rituximab, and other GEBAs proved to be relatively low in patients with different RDs. At the same time, the use of biological agents could lower RD activity in the presence of severe visceral injuries refractory to conventional immunosuppressive therapy.

[Signs of hypercoagulation and activation of fibrinolysis in patients with Wegeners's granulomatosis and Schoenlein-Genoch's purpura]

The patients with Wegener's granulomatosis and Schoenlein-Genoch's purpura included in this study were examined in the E.A.M. Tareev Clinic during 2006-2008. They showed signs of hypercoagulation and activation of fibrinolysis, viz. enhanced SFMC, D-dimer and antiphospholipid antibody levels, platelet aggregation. Hypercoagulation correlated with the activity of both Wegeners's granulematosis and Schoenlein-Genoch's purpura.

[Myocarditis and fibroplastic endocarditis in Wegener's granulomatosis]

The paper describes an autopsy case of Wegener's granulomatosis with a rare variant of a cardiac lesion--the concurrence of aortic valvular disease (aortic regurgitation), fibroplastic endocarditis, and complete transverse blockade, followed by pacemaker implantation. The direct cause of death in the female patient was multiple organ dysfunction: progressive chronic heart failure, adult respiratory distress syndrome, acute hepatorenal failure, and pancreonecrosis. The data available in the Russian and foreign literature on investigations dealing with cardiac pathology in patients with Wegener's granulomatosis are analyzed.

[Churg-Strauss syndrome in patients with cardiac problems]

Clinical observations of patients with Churg-Strauss syndrome and cardiac disorders are reported. In one case, both myocardium and endocardium were affected. Severe cardiac insufficiency was the immediate cause of death in one patient. Another observation revealed a benign variant of the disease associated with exudative pericarditis. A review of domestic and foreign literature concerning cardiac pathology in patients with Churg-Strauss syndrome is presented.

[Cardiac lesion in the Churg-Strauss syndrome]

The Churg-Strauss syndrome is a systemic vasculitis, the manifestations of which are asthma, eosinophilia, pulmonary infiltrates, poly- and mononeuropathy, polyserositis. Along with nodular polyarteritis and nonspecific aortoarteritis, the Churg-Strauss syndrome belongs to a group of systemic vasculitis, in the clinical picture of which cardiac lesion is recognized as one of the leading visceral manifestations and may be a common cause of fatal outcomes. In the Churg-Strauss syndrome, cardiac pathology may be associated with the involvement of the endocardium, myocardium, and pericardium. The paper describes a case showing the poor course of the disease in a young female patient in whom the heart is involved in a pathological process with the development of severe heart failure, resulting in death. There is a rare concomitance of diffuse myocardial damage, coronary lesion, and valvular pathology - eosinophilic endocarditis. The diagnosis has been verified on the basis of the data of clinical and additional studies and the results of microscopic studies. The data available in the Russian and foreign literature on cardiac pathology in patients with the Churg-Strauss syndrome are analyzed.

[Clinical significance of echocardiography in patients with systemic vasculitis]

The paper reports results of echocardiographic studies of patients with systemic vasculitis treated at E.M. Tareev Clinic during 1991-2006. The major findings include valve pathology, disturbed regional contractility, exudative pericarditis, systolic and diastolic dysfunction. Most patients examined in 2005-2006 turned out to have enhanced left ventricular systolodiastolic (Tei) index.

[Aortal regurgitation and atrioventricular block III in Wegener's granulomatosis]

The article presents a clinical observation of a female patient suffering from Wegener's granulomatosis with a rare variant of cardiac involvement--a combination of an aortal valvular disease (aortal regurgitation) and total atrioventricular blockade--who later underwent pacemaker implantation. The direct cause of the lethal outcome in this patient was destructive pancreatitis. Data from Russian and foreign literature on cardiac pathology in patients with Wegener's granulomatosis are analyzed.

[Clinical significance of myocardial lesion in antiphospholipid syndrome]

Antiphospholipin syndrome (APLS) is one of the most frequent reasons for arterial and venous thromboses. Primary and secondary APLS can lead to thrombotic process in coronary arteries. The biggest diagnostic difficulties appear in cases of small coronary vasal involvement leading to diffuse myocardial lesion. Perfusion myocardial scintigraphy (MS) allows specification of the character of myocardial changes. Revealing of myocardial changes by means of MS makes it possible to start timely anticoagulative therapy, which significantly improves prognosis and life quality.

[Cardiac lesion in systemic vasculites: manifestations, diagnosis, and treatment]

The article contains analysis of Russian and foreign literature on cardiac lesions in patients with system vasculites (SV). The frequency of cardiovascular involvement in various SV forms was evaluated. These forms include non-specific aortoarteritis, giant-cell arteritis, nodular polyarteritis, Kawasaki disease, Wegener's granulomatosis, eosinophilic vasculitiis, and granulomatosis. The authors consider the variants of coronary arterial, endocardial, myocardial, and pericardial involvement, as well as the role of arterial hypertension and the clinical features of different SV with cardiac lesions. Modern diagnostic techniques (echoCG, perfusion myocardial scintigraphy, multispiral computed tomography, and coronaroangiography) are covered.

[Peripheral hemodynamics in neurocirculatory dystonia]

AIM

To assess the state of peripheral hemodynamics in patients with neurocirculatory dystonia and elucidate its relation to disease duration and clinical presentation.

MATERIAL AND METHODS

Laser doppler flowmetry was used for the study of microcirculation in 25 healthy subjects and 91 patients with neurocirculatory dystonia.

RESULTS

Most healthy subjects (73.7%) had normocirculatory type of microcirculation. Hyperemic type was most frequent (36.7%) in patients with mild neurocirculatory dystonia, while majority (57.4%) of patients with moderate severity and severe neurocirculatory dystonia had congestive-stasical type of microcirculation. Hyperkinetic syndrome predominated in patients with hyperemic type of microcirculation, while hyperventilatory, astenic and asteno-neurotic syndromes were characteristic for those with congestive-stasical type. Moreover patients with congestive-stasical type had longer disease duration.

CONCLUSION

Changes of microcirculation observed in patients with neurocirculatory dystonia evidence for the presence of relationship between clinical signs and disease duration. Patients with congestive-stasical type of microcirculation were characterized by unfavorable course and longer disease duration.

[Complex assessment of efficacy and tolerance of metoprolol CR/ZOK in treating hypertension]

AIM

To study efficacy and tolerance of betaloc ZOK (Astra-Zeneca, UK) in patients with stage I-II (WHO classification) essential hypertension.

MATERIAL AND METHODS

27 patients were enrolled in the study (13 men and 14 women, mean age 40.6 +/- 1.57 years). Complete physical examination, ambulatory blood pressure monitoring, assessment of central hemodynamics, microcirculation were made before the treatment and on the treatment week 8.

RESULTS

Monotherapy with betalok ZOK (50-100 mg/day) resulted in a significant lowering of mean daily, day and night systolic and diastolic arterial pressure. Variability index was reduced, circadian rhythm of blood pressure did not change. 28% had to take diuretics (arifon or hypotiazide).

CONCLUSION

Betaloc ZOK (50-100 mg) is highly effective in patients with mild to moderate essential hypertension.