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Nonspecific aortoarteritis (NAA) is a chronic inflammatory disease that affects the aorta and its branches. The clinical manifestations of this disease are of a great variety and depend on the site of a lesion and the stage of the disease. A wide range of highly informative noninvasive imaging techniques, such as duplex scanning (DS), magnetic resonance imaging (MRI), and computed tomography (CT) of the aorta and its branches, are used to make a more accurate diagnosis and to determine the site and extent of a vascular bed lesion. The given clinical example suggests that CT angiography of the aorta and its branches is a high-precision technique in determining the site of vascular bed lesion in patients with NAA and the pattern and extent of arterial involvement and that it may be used for both the diagnosis of the disease at its developmental stages and the monitoring of the vessels during pathogenetic therapy.

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AIM: To elucidate associations between location and extent of lesions of arterial vascular bed in patients with nonspecific aortoarteritis and presence of various alleles of DRB1 gene of HLA class II in patients of Russian ethnicity. MATERIAL AND METHODS: Ultrasonography, magnetic resonance imaging and computed tomography were used for examination of arteries in 25 patients aged 22-69 years. Genotyping of HLA-DRB1 locus was carried out in all patients and in a group of practically healthy subjects of the same ethnic group (controls). RESULTS AND CONCLUSION: Patients compared with controls had significantly higher frequency of class II alleles of HLA-DRB1 gene which corresponded to serological specificity DR1. Subgroup of patients carriers of DR1 allele had significantly less extensive involvement of arterial vasculature compared with subgroup of carriers of other alleles. The revealed clinical-genetic relationship reflects special features of aortoarteritis in Russian population and evidence for genetic heterogeneity of this disease.

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An examination of 40 healthy persons (80 eyes) enabled a refinement and unification of the ultrasound techniques applicable to investigations of a. ophthalmica, a. and v. centralis retinae, a. ciliaris brevis et longae and of other orbital space vessels. Abilities of various regimes of computer-based sonography, in particular of color energy Doppler mapping, were determined in examinations of capillary choroidal plexuses and of optic-nerve portions neighboring directly on the eyeball. The possibilities of using the three-dimension ultrasound angioreconstruction in examinations of the ocular angioarchitectonics and of the retrobulbar space were evaluated.

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The purpose of the present investigation was to elaborate diagnostic criteria for stenosing of renal arteries according to ultrasonic dopplerography. The investigation included 35 patients suffering from vasorenal hypertension with stenoses of the renal arteries documented by angiography and 63 patients with stage II essential hypertension, who made up the control group. Ultrasonic scanning of the kidneys and dopplerography of the renal arteries were performed with the use of the Acuson-128 ultrasonic system fitted out with a sector transducer operating at a frequency of 3.5 MHz. The authors have devised a method of an ultrasonic study of the renal arteries by means of the posterolateral access. Established criteria for diagnosing stenosis of the renal artery. Among these are a decline of the pulsation index, the resistive index, and the systolic-diastolic velocity ratio as compared to the contralateral artery and nonstenosed renal arteries in the control group patients.

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Myocardial activity was evaluated in 165 individuals between 60 and 82 years of age. Only one parameter, myocardial stress adaptation index (MSAI), was shown to differ significantly between individuals. An earlier diagnosis of coronary heart disease was not confirmed in 43 (26.1%) patients. Myocardial adaptability was quite good (MSAI greater than 7.1) in 98 (60%) patients. There was a direct correlation between plasma potassium levels and ST depression in response to stress, which makes the hypoxic origin of ST depression in the absence of other signs of coronary insufficiency in this category of patients rather questionable.

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The study was performed in 22 patients with ischemic heart disease who underwent direct myocardial revascularization. The functional and structural state of mammary arteries was estimated by the noninvasive Duplex scanning before surgical operation to evaluate the possibility of using them as mammary-coronary bypasses (MCB). Direct blood velocity measurements in the bypasses during aortocoronary bypass (ACB) surgery and MCB were made by ultrasound pulsed Doppler system with a 10 MHz transducer. A method was developed for noninvasive Duplex scanning and evaluation of coronary bypass flow in the postoperative period by using the ultrasound system with 5 a MHz phased array linear transducer, which enabled one to obtain the bypass image in B-mode and the Doppler velocity spectrum inside the bypass.

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A study of possibilities of different ultrasound (US) methods in the estimation of renal blood flow was made in 35 patients with angiographically documented renal artery stenosis. The validity of data obtained with US B-scanning and Doppler technique was estimated by comparison with direct artery diameter and US blood flow measurements made intraoperatively during reconstructive renal artery surgery in 25 patients. It was shown that US Doppler spectral characteristics obtained noninvasively before surgery and intraoperatively were identical. Posterior-lateral approach is optimal for Doppler examination. Differences between Doppler spectrum in the presence and absence of renal artery stenosis (RAS) were revealed. Among the RAS sensitive spectrum waveform characteristics were end-diastolic to peak systolic velocity ratios, pulsatility index, resistance parameter.

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In a study of 46 patients with acute posterior myocardial infarction and different patterns of the necrotic period, anatomical measurements of necrosis weight were compared with the measurements of R wave amplitude and the depth of Q and S waves (the QS complex), recorded from standard leads and precordial mapping, and with serum CPK-MB activity. The results of this comparison suggest that the rate of necrosis formation can be assessed on the basis of variation in the ventricular complex, recorded from standard ECG leads. Electrocardiographic criteria of the severity of the necrotic stage of posterior myocardial infarction and repeated necrosis formation are identified.

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A study of 61 patients with acute left ventricular posterior myocardial infarction examined ventricular complex variations, recorded from standard and precordial leads; in fatal cases, ECG findings were compared with pathoanatomical studies of the heart. Precordial mapping was shown to considerably increase the efficiency of electrocardiographic diagnosis of posterior myocardial infarction, permitting more accurate assessment of the site and spread of the infarction focus. Changes of the ST segment and summary R(V1-V4)20 amplitude may serve as an indicator of the severity of posterior myocardial infarction, and an instrument of early outcome prognosis.

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A study of the relationship between the frequency of labelled pyrophosphate detection in the heart muscle and the incidence of clinical signs of heart failure or angina in 185 postmyocardial-infarction patients demonstrated that the distribution of patients with postinfarction cardiosclerosis among the positive and negative 99mTc-pyrophosphate scintigraphy groups was governed by the presence of heart failure in these patients, a finding suggestive of the scarry fields within the myocardium as the principal cause of myocardial accumulation of labelled pyrophosphate in postinfarction cardiosclerosis. Pyrophosphate accumulation in patients with postinfarction cardiosclerosis can be regarded as an indicator of unfavorable developments, as confirmed by one-year follow-up results in 114 patients.

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The influence of digoxin concentration in blood on its therapeutic effect was studied in 59 patients with chronic circulatory insufficiency and cardiac fibrillation and in 89 patients with chronic circulatory insufficiency and sinus cardiac rhythm. The changes in blood digoxin concentration in patients with cardiac insufficiency complicated by cardiac fibrillation with maintained sinus cardiac rhythm both during the "saturation" period and during maintenance treatment were of the same type. The content of digoxin in the blood does not determine the potency of its therapeutic effect. The optimum therapeutic effect of digoxin in all patients with cardiac fibrillation and signs of cardiac insufficiency persists for quite a long period of time. Continuously used cardiac glycosides lose their inotropic effect in patients with sinus cardiac rhythm.

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The dependence between the severity of cardiac insufficiency and the size of the necrotic lesion of the heart muscle, measured according to the area of 99m Tc-pyrophosphate cumulation and the rate of liberation of the isoenzyme MV creatine phosphokinase into the blood, was studied in 77 patients with myocardial infarction in the acute period of the disease. It was demonstrated that the severity of left ventricular insufficiency is directly dependent on the size of necrosis of the heart muscle. Not only the size of the necrotic focus but also the state of the contractility of the other parts of the myocardium is an important factor determining the origin and severity of cardiac insufficiency.

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Blood concentrations of Digoxin were determined by radioimmuno-assay in 80 patients with different stages of circulatory insufficiency receiving maintenance therapy with Digoxin, 0.25-0.75 mg/day. The range of Digoxin concentration fluctuations is very wide--from 0.25 to 2.4 ng/ml. Some elevation of Digoxin concentration in blood was observed when the dose of the drug was increased, both in different groups of patients, and in the same patients when the maintenance dose was altered. Studies conducted during digitalis intoxication in 4 patients demonstrated different levels of Digoxin concentration in blood--from 0.8 to 2.6 ng/ml. The obtained results permitted to conclude that the concentration of Digoxin in blood has no significance in choosing the optimum therapeutic dose, unless the clinical data are taken into account.

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