The list of the most significant social problems for a long time is leaded by the association of type 2 diabetes and ischemic heart disease. Despite the good progress in the diagnosis and treatment of these two pathologies, in case of their interaction some clinical signs acquire atypical course. In patients with comorbid pathology it is characterized by painless, rapidly progressing course of coronary events. In type 2 diabetes mellitus, glucose toxicity and lipotoxicity contribute to myocardial dysfunction, vegetative innervation is disrupted, and specific myocardial damage — diabetic cardiopathy also develops. Diabetes contributes the progression of atherosclerosis and myocardial ischemia, and this increase the severity of the cardiovascular pathology. Understanding the pathogenetic mechanisms of the diabetes effect on the myocardium of patients with ischemic disease allows identifying of key points for the selection of pathogenetic therapy.

The review of data of literature concerning the description of clinical cases of isolated left ventricular apical hypoplasia (LVAH) in 42 patients are presented. left ventricular apical hypoplasia is characterized by 1) a spherical left ventricular with a cut-off tip and a swelling of the interventricular septum to the right in combination with systolic dysfunction of left ventricular; 2) replacement of the myocardium of the upper limb with fat tissue; 3) localization of papillary muscles on the flattened apex of the left ventricular; 4) elongated right ventricle (RV), flowing around the top of the upper left vertex. The course of this condition may be asymptomatic, or manifest as a clinic of biventricular heart failure with high pulmonary hypertension and heart rhythm disturbances.

This article provides an overview of modern methods of treating prolapse of the mitral valve due to degeneration. Medical treatment of patients with mitral valve prolapse is ineffective. Preference in this case should be given to the surgical treatment. It is shown that while choosing tactics of intervention it is important to take into account not only the presence of the pathology itself, but also the initial functional state of the elements of the subvalvular apparatus. So, among the methods of surgical treatment, valve prosthesis in this pathology has significant disadvantages in comparison with reconstructive surgery. A variety of techniques for mitral valve plastic are shown. The advantages and disadvantages of each method are presented.

Introduction. Evaluation of muscle strength of wrist flexors in patients with coronary heart disease can act as a predictor of total muscle strength and influence the prognosis for patients after a previous myocardial infarction, taking into account the rehabilitation program.

The purpose of the study is comparison of clinical anamnestic characteristics of middle-aged men with coronary heart disease with comparable social status, physical activity and body mass index (BMI), depending on the presence of myocardial infarction as well as an assessment of muscle strength of the wrist flexors, bioelectrical impedance analysis and testosterone level.

Material and Methods. The study included men at the age of 58.09±6.85 on average; living in rural areas who were clinically monitored by a cardiologist at the central district hospital: the main group included men 3 months after the first myocardial infarction, the comparison group — patients with stable coronary heart disease. Clinical anamnestic status of all patients was assessed; evaluation of muscle strength of wrist flexors by means of dynamometry, bioelectrical impedance analysis, testosterone test and SF-36 Survey were also carried out.

Results. Middle-aged men (58.09±6.85 years old) living in rural areas who had a similar physical activity, a long anamnesis of hypertension 180 (72; 228) months, coronary heart disease (49.28±12.47 months), anamnesis of coronary artery bypass surgery — CABG (1.2±0.03 years) were more likely to have hereditary cardiovascular diseases (38 vs. 12% , p=0.05) and anamnesis of previous acute disturbance of cerebral circulation (16 vs. 2%, p=0.04) than patients after the first myocardial infarction. The 6-minute walk test was greater in men after the first myocardial infarction (457.07±46.44 vs. 416.64±51.58, р<0.05), they had higher indexes of physical — 70 (55; 80) scale against to 55 scale (25; 65, р<0.02) and social functioning — 75 (62.5; 100) vs. 62.5 (50; 75, p<0.05), energy level was 55 (50; 75) scale to 50 (45; 60) scale (p<0.05) and mental health 62 (52; 77) to 52 (52; 60) scale with (p<0.01). Regardless of the duration of IHD or the presence of the first myocardial infarction, middle-aged men with overweight who had the same correlation of muscle and adipose tissue and testosterone level showed comparable strength of wrist flexors, measured by means of a dynamometer.

The aim of this work is to assess the effect of propafenone on the diastolic function of the left ventricle in hypertensive disease complicated by paroxysmal atrial fibrillation.

Materials and Methods. The study involved 86 patients with hypertonic disease, complicated by the paroxysmal form of atrial fibrillation. All patients underwent echocardiography with the definition of a set of generally accepted morphofunctional parameters. All patients were divided into 2 groups according to their age characteristics: 41–60 years old and over 60 years old. When included in the study, propafenone was administered at a dose of 600 mg to restore the rhythm, then after restoring the rhythm in it was administered at a dose of 450 mg per day during the year of observation.

Results and Conclusions. Propaphenone preserves the diastolic function of the left ventricle at its initial normal values for hypertensive disease complicated by the paroxysmal form of atrial fibrillation in patients aged 41–60 years and over 60 years. The drug does not cause progression of diastolic left ventricle dysfunction with its initial altered parameters in hypertensive disease complicated by paroxysmal atrial fibrillation.

Aims. Based on the data of the Register of new cases of pulmonary arterial thromboembolism (PE) in Tomsk hospitals (2003–2012), to study the development of thromboembolism in patients with atrial fibrillation (AF).

Results. The database of the Register of new cases of hospital PE included data from patients with PE (751 people) who died in the city’s hospitals and underwent autopsy. Among them, 238 patients were identified who had AF before the development of PE (in 185 patients — a permanent form of AF, in 53 — paroxysmal and persistent). Among metabolic disorders, 25% of patients showed obesity of various degrees and 27% had type 2 diabetes. Chronic heart failure 2 stages in the phase of decompensation was diagnosed in 41% of patients. The number of verified cases of PE in persons with AF did not differ significantly from patients without fibrillation and was 40%. According to autopsy data, pulmonary embolism is recognized as the main cause of death in more than half of people with AF (in 131 cases). A massive volume of pulmonary artery disease was detected in 109 patients with AF (46%). Among patients with thromboembolism from the right heart chambers, AF as a whole (regardless of form) was found in 56% of cases, that is, significantly more often than in patients with a source of embolism in the inferior vena cava (14.3%, p=0.005), veins of the lower limbs (27%, p<0.001) and veins of the pelvis (2.6%, p=0.014). Similar relationships were found in persons with chronic AF. For the paroxysmal form of differences between groups with different sources of embolism, it was not possible to identify. According to autopsy data, in patients with atrial fibrillation, the right heart was the source of PE in 121 patients (48%), 85% of them in the right atrial appendage.

The aim of the study is to assess the left ventricle rotation and twist in the first third of the systole in healthy children and adolescents born full-term.

Material and Methods. The analysis was carried out in 108 healthy children aged 5 months to 18 years, born full-term, who belonged to the health groups I–II. Prior to inclusion in the study, nobody has suffered and acute respiratory viral infections in the past 6 months Depending on the age, children and adolescents were divided into the following subgroups: from 5 months to 3 years, 3 to 6 years, 6 to 11 years and over 11 years. On the basis of the sex ratio, the distinguished sub-groups of children did not differ among themselves. Left ventricle rotation is assessed at the level of basal segments, papillary muscles, apex segments and left ventricle twisting in the first third of the systole and towards the end of the systole.

Results. Left ventricle rotation in the first third of the systole at the level of the basal segments was recorded in 75.9% of healthy children who had type I of left ventricle twist and in 29.4% of healthy children with the second type of left ventricle twist. Left ventricle rotation at the level of the apical segments was revealed — in 20.37% of children with type I left ventricle twist. The phenomenon of «lack of left ventricle twist in the first third of the systole» was found in 12.96% of healthy children and adolescents born full-term at the age before 4 years. The presence of this phenomenon did not depend on the type of left ventricle twist at the end of systole, the left ventricle sphericity index at the end of systole and diastole of left ventricle. In the phenomenon of «lack of left ventricle twist in the first third of the systole», the time to the peak rate of left ventricle twist rate in systole is less than 85 ms.

In patients with subarachnoid hemorrhage at a young age, signs of connective tissue dysplasia, including the pathology of the craniovertebral transition and intracranial vessels, have been identified, which affected the severity of the course. The features of the course of vasospasm have been revealed.

Registered interictal epileptiform discharges in adults with idiopathic generalized epilepsy with variable phenotype (261 people) during standard functional tests (hyperventilation and intermittent photic stimulation) before falling asleep, after awakening and during non-REM sleep.

When detecting interictal epileptiform discharges during non-REM sleep, patients with juvenile myoclonic epilepsy were more likely to have interictal epileptiform discharges recorded during photostimulation and hyperventilation in both periods (after awakening and before falling asleep), which may be due to the pathophysiological features of this subtype of the idiopathic generalized epilepsy with a variable phenotype. When detecting interictal epileptiform discharges during nonREM sleep, patients with juvenile absence epilepsy with absences and generalized tonic-clonic seizures were more likely to have interictal epileptiform discharges recorded during hyperventilation in both periods (after awakening and before falling asleep). In patients with idiopathic generalized epilepsy with isolated generalized tonic-clonic seizures the relationship between the recording of interictal epileptiform discharges in non-REM sleep and during functional tests was not detected. The obtained data demonstrate the features of interictal epileptiform discharges distribution in sleep and wake periods with idiopathic generalized epilepsy with a variable phenotype in adults and can be used in the extended Electroencephalography monitoring to refine the idiopathic generalized epilepsy subtype and evaluate the effectiveness of antiepileptic therapy.

The aim of the study was to reveal the peculiarities of the vessels of microvasculature within lamina propria of the bronchial mucosa in smokers with and without chronic obstructive pulmonary disease on the basis of light-optical and ultrastructural analysis of bronchobiopses.

Material and Methods. A morphological study of the bronchial mucosa in smoking patients with chronic obstructive pulmonary disease and without it, with an emphasis on the morphometric analysis vessels of microvasculature was performed. A one-stage study of 115 smokers aged 40 to 60 years (58.3±3.24 years) was made (men predominated — 90.9%).

Results. In the group of smokers with chronic obstructive pulmonary disease, in contrast to the comparison group, signs of vascular remodeling and microcirculation disturbances were revealed which were manifested by endothelial dysfunction, an increase in volume density of connective tissue of lamina propria of bronchial mucosa with predominant perivascular localization, which was accompanied by a decrease in the relative volume of capillaries (p=0.016) and a decrease in the specific volume of micropinocytosis vesicles (p=0.005) and the size of Weibel — Paladi secretory granules (p=0.004) in endothelial cells.

Conclusion. Structural changes of compensatory character without signs of remodeling of vessels of bronchial wall were recorded in group of smokers without chronic obstructive pulmonary disease in bronchus. Morphological signs of endothelial dysfunction, hemodynamic disorders, perivascular fibrosis with reduction of the microvasculature were observed in group of smokers with chronic obstructive pulmonary disease.

The aim of study is to analyse the structure of the heart arrhythmias and interventional procedures methods in Institute of Cardiology (Tomsk) based on the hospital registry. This registry was developed in the Heart Arrhythmias Department. 4716 patients were included in the study in the period from 01.2014 to 12.2016. The structure of heart arrhythmias did not significantly change during this time, except patients with atrial flutter (42 cases in 2014 and 88 cases in 2015, p=0.004). The quantity of procedures was increased (p=0.09) including significant raise in pacemaker implantations (p=0.03) as well as atrial flutter (p=0.004). While the quantity of complications decreased. The treatment results and the level of the inhospital mortality answer international standards.

The clinical case analysis revealed the pressing need for enhanced emergency medical services, in particular, regarding the adequate performance of cardiopulmonary resuscitation in the pre-hospital setting. The analysis is focused on reasonable decision to terminate cardiopulmonary resuscitation. It is revealed that there are significant conflicts in the algorithms, protocols, clinical recommendations and the decree of the Government of the Russian Federation on determining the moment to terminate cardiopulmonary resuscitation with lasting pulseless electrical activity. The conflicting requirements create problems in practical activity of emergency medical services teams, build grounds for expert claims and make an important issue for a comprehensive study. The discussed subject seems to be highly relevant: in case of out-of-hospital deaths, emergency medical services are the only life-saving facility.

The article represents the biography of the famous Russian medicinal chemistry professor Ivan L. Vakulenko and his contribution to the development of Russian medicinal chemistry. The authors give a brief review of his scientific, educational, medical, and social activities.

The article presents the biography of outstanding German urologist, extraordinary surgeon, a scientist and professor of practice Max Nitze and shows his contribution to the clinical urology. The article includes short review of his scientific, educational, medical and social activities.