Functional state of the hypophysis, adrenal cortex and gonads in patients with gynecomastia]

Patients with gynecomastia revealed simultaneous increase in blood levels of estrogens, glucocorticoids and pituitary (first of all, gonadotropic) hormones associated with a decrease in blood-androgen concentration. Such combination of disturbances may account for hyperplasia of the male breast.     

Labile hypertension in elderly: clinical features, autonomic regulation of circulation, approaches to treatment

Blood pressure in some elderly hypertensive patients is characterized by marked lability. This affects quality of life and may deteriorate prognosis. Conventional anti-hypertensive medication does not lead to stabilization of blood pressure. We call this form of hypertension "labile hypertension of the elderly" (LHE). The aim of the study was investigation of autonomic regulation of blood pressure and of clonazepam effectiveness in patients with LHE. Fifty-six patients with LHE (mean age 67.0 +/- 6.3 years) entered the study (87.5% women). Control group consisted of 38 patients with stable hypertension and 27 normotensives matched by sex and age. The patients and the controls underwent clinical and psychological examinations, regular measurement of blood pressure during one month before and after the treatment, cardiovascular tests and spectral analysis of the heart rate variability. It was found that LHE patients have higher level of anxiety and depression, low standard deviation of RR interval, low normalized LF and HF components and increased normalized VLF component. The cardiovascular tests showed signs of diminished parasympathetic regulation. Clonazepam treatment in a dose 1-2 mg/day brought about a significant stabilization of blood pressure in 82.0% of patients with LHE. Thus, LHE is an original form of hypertension in patients over 60 years old characterized by frequent, short-term, small symptomatic, spontaneous fluctuations of blood pressure with development of both hypertensive and hypotensive reactions. Pathogenesis of LHE is linked with disorders of heart rate autonomic regulation, marked anxiety and depression. Clonazepam stabilizes blood pressure in most LHE cases.     

Psychosomatic ratios and their correction in the autonomic dysfunction of the sinus node

The study was undertaken to examine the ratio of mental to somatic disorders in patients with autonomic sinus nodal dysfunction (ASND) and the capacities of correction of revealed disorders with the atypical benzodiazepine drug clonazepam. Thirty-two patients with ASND were examined. The diagnosis of ASND was verified by 24-hour ECG monitoring and transesophageal atrial pacing, by performing autonomic cardiac block with atropine and obsidan. In addition to physical examination, heart rhythm variability was studied during relaxed and intensive wake; psychological studies using the conventional tests were conducted, and autonomic disorders were explored by means of original scored somatic, hyperventilation) questionnaires. After examination, the patients received a 1.5-to-2-month course of therapy with clonazepam in a daily dose of 1.5-2 mg. The study has revealed that clinical symptomatology in ASND is greatly determined by psychosomatic disorders. ASND was marked by anxious depressions in combination with inadequate peripheral (to a greater extent, sympathetic) neurovegetative exposures with the simultaneous activation of cerebral ergotropic effects. The use of clonazepam in ASND greatly improved its clinical picture, by eliminating, in the overwhelming majority of cases, clinical symptoms, including rhythm and conduction disturbances that are characteristic of ASND.     

The effect of specific transfusion therapy on the level of circulating immune complexes in hemophilia patients]

The level of circulating immune complexes (CIC) was measured in 108 hemophilic patients registered at the Republican Center for Hemophilia Treatment. High levels of CIC were detected in hemophilic patients of different age. The concentrations of CIC were higher in adult patients than in children. Formation of immune complexes in the test groups did not go beyond the framework of the physiological process, for the signs of vasculitis, which is an indispensable component of immunocomplex pathology, could not be identified. Higher levels of CIC in adults were related to a greater number of transfusions made throughout the life, particularly if the annual dose of the preparations infused exceeded 10,000 Units of factor VIII or IX. No significant correlation was established between the rise of CIC levels in the patients' serum and the biochemical alterations in liver function, detected in these patients. Therefore, CIC detected by the authors are not specific and lesions of the liver parenchyma in hemophilic patients are not determined by their presence.     

Severe malaria in children in Papua New Guinea

The clinical features of severe falciparum malaria and risk factors for mortality were studied in 489 children admitted with malaria to Madang Hospital, Papua New Guinea. The most common severe manifestations of malaria were severe anaemia (22%) and coma (16%). Children with severe anaemia were younger than those with coma (median age 2.2 vs. 3.7 years) and had been ill for longer before admission (median 7 vs. 4 days, respectively). Although the clinical features of coma in Madang children with malaria resembled closely those reported in African children, mortality was lower (8% vs. 17-25%, respectively). Overall, 17 (3.5%) children died, most within 12 h of admission. A high level of plasma lactate (> or = 5 mmol/l) was common (20%) and was the major predictor of death in multiple regression analysis. Raised plasma creatinine and decreased plasma bicarbonate were also independent predictors of mortality. Coma was not predictive of death, although a high proportion of children with profound coma died. Investigation of the causes of acidosis in children with malaria is a high research priority. In view of the short time interval between admission and death in many children, emphasis must be placed on the prevention or early recognition and treatment of acidosis in the district health clinic as well as the central hospital.      

Patterns of Depressive Symptoms in Children

PROBLEM: Depressive symptoms in children have been linked to recurrent problems with depression, school problems, and risky health behaviors. Adolescent girls report depressive symptoms three to four times more frequently than adolescent boys. Few studies, however, have examined gender-related depressive symptoms in younger, school-aged children. METHODS: In the present study, gender differences in depressive symptoms in children ages 10-12 years were explored using the Children's Depression Inventory (CDI) with a convenience sample of 122 suburban middle-class public school fifth and sixth graders. FINDINGS: A distinct pattern of depressive symptom expression was found with girls reporting more internalizing and more negative self-esteem, and boys reporting more externalizing and more school problems. CONCLUSION: These findings suggest that despite similarities on a total depressive symptom score, there are distinct gender differences in depressive symptom expression that are identifiable before adolescence and may be associated with normative development.     

Change in activity of angiotensin-converting enzyme in pneumonia and chronic obstructive lung diseases

AIM: To study the activity of angiotensin-converting enzyme (ACE) in patients with pneumonia and chronic obstructive lung diseases (COLD). MATERIAL AND METHODS: Sixty nine patients with pneumonia and 77 with COLD were examined. The activity of ACE in the serum and bronchoalveolar lavage (BAL) and the effects of leukocytic elastase and concentrations of zinc, endogenous inhibitors, and activators were studied. RESULTS: The patients with pneumonia in the acute phase of the disease have been found to have low ACE activity in both blood and BAL. As the inflammatory process comes to an end, ACE activity normalizes. In the patients with COLD, the activity of ACE is primarily decreased at remission. When COLD aggravates, the activity of ACE in blood and BAL increases. In pneumonia and COLD, the changes in ACE activity are more profound in BAL than in blood. CONCLUSION: The only cause of the altered activity of ACE in patients with COLD and pneumonia is a change in the concentration of the enzyme.