Vol 78, No 10 (2003)

Editorial
Chronic cardiac failure andnon-insulin-dependent diabetes mellitus: accidental or regular association?
Mareev V.Y., Belenkov Y.N.
Abstract
Terapevticheskii arkhiv. 2003;78(10):1-10
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Functional state of thesympathico-adrenal system at the stages of developing latecomplications of diabetes mellitus
Balabolkin M.I., Chernyshova Т.Е.
Abstract
Цель исследования. Изучение функционального состояния симпатико-адреналовой системы у больных сахарным диабетом (СД) на этапах формирования поздних осложнений. Материалы и методы. Обследован 81 больной СД: 24 - без признаков поздних осложнений и диабетической автономной нейропатии (ДАН), 20 больных с ДАН, у 8 из которых была непролиферативная ретинопатия и у 6 - нефропатия 1-2-й стадии, 23 больных с ДАН, диабетической ретинопатией и сенсорной полинейропатией, 14 больных с диабетической нефропатией 4-й стадии. Содержание адреналина, норадреналина, дофамина в крови определяли методом жидкостной хроматографии с электрохимической детекцией. Всем больным проведен спектральный анализ сердечного ритма с применением программы "Марс". Результаты. У больных прогрессирование СД сопровождалось дисбалансом автономной нервной системы: повышением тонуса симпатического отдела и снижением тонуса парасимпатического отдела, снижением характеристик мощности центрального регуляторного контура. Отмечена диссоциация между степенью гиперсимпатикотонии и снижением концентрации катехоламинов в крови, связанная со степенью тяжести оагожнений заболевания. Заключение. Диссоциация между повышенным тонусом симпатического отдела автономной нервной системы и снижением концентрации катехоламинов в крови прогностически неблагоприятна и является предиктором развития аритмии и асистолии. Повышение централизации систем управления автономной нервной системы отражает напряжение регуляторных систем и является предиктором срыва адаптации.
Terapevticheskii arkhiv. 2003;78(10):11-16
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Specific functional condition of the autonomic nervous system in patients with diabetes mellitus
Chernyshova Т.Е.
Abstract
Aim. To evaluate prognostic significance of autonomic nervous system (ANS) dysfunction in patients with diabetes mellitus (DM). Material and methods. The examination covered 51 DM type 1 patients aged 18 to 43 years with DM history from 6 months to 31 years. ANS function was assessed by spectral analysis of cardiac rhythm with calculation of indices of rhythm "rigidity", centralization and activity of subcortical centers. Results. DM progression and development of its late complications were accompanied with dissociation of tonicity of the sympathetic and parasympathetic ANS components, augmentation of regulatory systems tension. Evidence was obtained for correlation of relative values of SW1 power with severity of DM (r = 0.88) and its microvascular complications (r = 0.70). Decreased power of MW2(%) in the tilt test predicts development of orthostatic hypotension. Conclusion. Involvement in the regulation of the central contour of ANS management reflects adaptation failure and is prognostically significant.
Terapevticheskii arkhiv. 2003;78(10):17-20
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A lipid profile of blood plasm inpatients with metabolic syndrome and manifest disorder ofcarbohydrate metabolism
Medvedeva I.V., Dorodneva E.F., Pugacheva T.A., Bekhikova L.N., Zhuravleva T.D.
Abstract
Aim. To study specific features of lipid plasm profile in patients with metabolic syndrome (MS) and manifest disorder of carbohydrate metabolism (CM) as well as their relationships with clinical symptoms of MS. Materials and methods. Contents of lipids and apolipoproteins of plasm was measured on an empty stomach in 30 patients (18 females and 12 males) with MS and manifest disorder of CM (diabetes mellitus type 2 at the stage of good and satisfactory compensation of CM without terminal complications). Results. The patients were found to have a subnormal level of HDLP cholesterol, high levels of total cholesterol, LDLP cholesterol and LPa. Hypertriglyceridemia occurred only in 31.4% patients (TG < 200 mg/dl). Mean TG level was 173.69 ± 27.52 mg/dl. TG and diastolic arterial pressure, fasting glycemia and waist circumference significantly correlated. If the WC/TC was 1.0 and higher, И. В. the antiatherogenic plasm factor ~ HDLP cholesterol - significantly lowered. Positive correlation existed between TG and total cholesterol, LDLP cholesterol, apoB, LDLP cholesterol/'HDLP cholester- ol, apoB/apoAl, while negative correlation was seen between TG and HDLP cholesterol levels. Patients with hypertriglyceridemia had significantly higher levels of total cholesterol, LDLP cholesterol, apoB, apoB/apoAl. Conclusion. Plasm levels of TG most significantly reflect severity of basic clinical manifestations of MS: abdominal obesity, arterial hypertension, CM compensation. The presence of hypertriglyceridemia in MS patients can be considered as an indicator of high atherogenic potential of plasm.
Terapevticheskii arkhiv. 2003;78(10):21-24
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Syndrome ofnon-thyroid pathology in patients with cardiovascular diseases (review)
Ametov A.S., Balashova N.V., Gilyarevsky S.R.
Abstract
Terapevticheskii arkhiv. 2003;78(10):25-29
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Psychovegetative relations and clinical course of ischemic heartdisease in females and males
Vein A.M., Syrkin A.L., Ibatov A.D., Syrkina E.A.
Abstract
Aim. To study psychovegetative correlations and clinical course of ischemic heart disease (IHD) in men and women. Material and methods. Personality characteristics (MMPI test), reactive and personal anxiety (Spilberger's questionnaire), severity of depression (Back's questionnaire), vegetative status (vegetative disorders questionnaire), variability of cardiac rhythm (cardiovascular tests) were studied in 60 females and 62 males with IHD. Results. IHD females vs males were characterized by higher neurotization, personal accentuation, more serious anxiety, depression and vegetative disturbances, lower variability of heart rate. IHD in females is more frequent in postmenopause, is characterized by less severe hemodynamically significant coronary stenoses. Conclusion. Emotional disorders make a great contribution to a course of ischemic heart disease.
Terapevticheskii arkhiv. 2003;78(10):30-33
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Experience with ixel (milnaciprane hydrochloride) treatment of poststroke depression
Gekht А.В., Sorokina I.B., Bogolepova A.N., Gudkova A.A.
Abstract
Aim. To evaluate antidepressive efficacy ofixel in patients with poststroke depression (PSD). Material and methods. The study included 59 PSD patients aged 43- 79 years divided into two groups: the test group (31 patients) treated with antidepressive drugs and the control group (28 patients) was not treated with such drugs. The test group took a two-month treatment with oral ixel in a dose 100 mg/day. The neurological status was assessed by Lindmark scale (LS), severity of depression - by Hamilton scale (HS). Results. On ixel treatment day 10-14 the patients felt better, by the treatment day 60 depression disappeared in 60.9%, only borderline conditions were seen in 39.1%. Mean score by HS fell from 15.8 to 5.7. The controls showed moderate reduction of some symptoms of depression, mean score by HS descreased insignificantly (from 14.5 to 13.4). By LS, significant differences between the groups were not registered. Side effects arose in 10 patients, 6 of them withdrew. Conclusion. Ixel is an effective drug against depression in stroke survivors.
Terapevticheskii arkhiv. 2003;78(10):34-37
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Pirazidol treatment ofdepressions in patients with ischemic heart disease
Ivanov S.V., Syrkin A.L., Drobizhev M.Y., Poltavskaya M.G., Baturin K.A., Burlakov A.V.
Abstract
Aim. To study efficacy and safety ofpirazidol administration in depressive patients with ischemic heart disease (1HD). Material and methods. Pirazidol was given in a dose 0.15-0.3 g/day for 4 weeks to 30 IHD patients aged 21-65 years. 21 of them had nosogenic depression, 9 patients had dysthymia. The efficacy of the antidepressive action was assessed by the Hamilton scale. Results. The trend to a decrease in Hamilton scale scores was manifest by the end of the treatment week 2. To the end of the study the overall score median lowered from 17 to 9, most of the patients had the score sum under 11. Side effects were insignificant. In pirazidol combination with beta-blockers, blockers of calcium channels, antiaggregant, diuretic drugs, nitrates and other cardio- and angiotropic drugs unfavorable interactions were not registered. Conclusion. Pirazidol can be effectively used in the treatment of psychosomatic disorders in patients with cardiovascular diseases.
Terapevticheskii arkhiv. 2003;78(10):38-41
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Quality of life in gastroenterology: conception and research policy (a review)
Novik A.A., Ionova T.L., Denisov N.L.
Abstract
Terapevticheskii arkhiv. 2003;78(10):42-45
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Idiopathic thrombocytopenic purpura andgestational process (lecture)
Sokolova M.Y.
Abstract
Terapevticheskii arkhiv. 2003;78(10):46-49
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Gestational arterial hypertension.Mechanisms of formation.Treatment with normodipin
Davidovich I.M., Bloschinskaya I.A., Petrichko T.A.
Abstract
Aim. To study endothelium-dependent vasodilatation (EDVD), plasma endothelin 1,2 (ET-1,2) contents and urinary NO metabolites in normal pregnancy and various kinds of gestoses with evaluation of normodipine effects on blood pressure and ED VD. Material and methods. 59 primigravidas 18-32 years of age (pregnancy terms 34-39 weeks) were divided into three groups. Group 1 consisted of 23 women with arterial hypertension treated with normodipine in 11 of them. In group 2 sixteen pregnant women had edema and group 3 consisted of 20 women with physiological pregnancy. 12 non-pregnant women comprised a control group. Results. In normal pregnancy ET-1,2 content was low while urine NO metabolites levels were high. This contributes to maintaining adequate reaction of the brachial artery in response to the "shiftstress". In women with edema the brachial artery response to short-term occlusion was decreased. In women with both high blood pressure and edema had vascular response paradoxically spastic with a two-fold decrease in blood flow rate, high plasma ET-1.2 contents and low urine NO metabolites levels. Normodipine in gestational arterial hypertension normalizes both blood pressure and EDVD. Conclusion. Endothelial dysfunction is an important factor predisposing to development of arterial hypertension. Monotherapy with normodipine (5 mg/day in a single daily dose) during 3 weeks is effective in controlling gestational hypertension.
Terapevticheskii arkhiv. 2003;78(10):50-53
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Iodine prophylaxis in pregnant women: a comparativeanalysis of different methods efficacy in conditions of goiter endemia
Turovinina Е.F., Suplotova L.A., Khramova E.В., Smetanina S.A.
Abstract
Aim. To assess efficacy of different methods of iodine prophylaxis in pregnant women living in conditions of goiter endemia. Material and methods. Standard clinical, laboratory and device tests for iodine deficiency according to WHO criteria were made in 156 pregnant women living in the territory affected by goiter endemia. Of them, 121 examinees had no thyroid pathology, 35 ones had diffuse euthyroid goiter. All of them received different kinds of iodine prophylaxis. Results. The occurrence of neonatal TTH values over 5 iU/l in neonates born by mothers free of thyroid pathology on potassium iodide prophylaxis when pregnant was 9.1%. This is much lower than in conventional iodine prophylaxis - 17.24% (p < 0.01). A comparative analysis of the efficacy of potassium iodide-200 in pregnant women with diffuse euthyroid goiter and its combination with L-thy roxin has shown that by the effect on lessening frequency of neonatal ТТЯ over 5 Ш/l the above schemes do not differ significantly, thyroid reduction is more prominent in pregnant women on thyroxine with potassium iodide. Conclusion. The index of neonatal TTH is an objective criterium to control efficacy of different methods of iodine prophylaxis in pregnancy.
Terapevticheskii arkhiv. 2003;78(10):54-56
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Lung biopsy in diagnosis of causes of lung involvement in hemoblastosis
Galstyan G.M., Glasko E.N., Gorodetsky V.M., Grzhimolovsky A.V., Danishyan K.I., Demidova I.A., Kaplanskaya I.В., Keselman S.A., Klyasova G.A., Lyubimova L.S., Shulutko E.M., Savchenko V.G.
Abstract
Aim. To ascertain the role of lung biopsy in diagnosis of lung lesions in hemoblastosis (HB) patients. Material and methods. The results of diagnostic biopsies of the lungs obtained from 22 HВ patients are presented. Ten patients had no respiratory insufficiency (RI), twelve patients had RI. The biopsy was transbronchial in 1 case, thoracoscopic in 10 and open in 11 cases. Results. In Rl-free patients lung biopsy was informative in all the cases. The biopsy provided information which allowed therapy modification resulting in improvement of the patient condition. In RI patients biopsy was informative in 8 of 12 patients. Nonspecific changes in the lungs were identified histologically in 2 of 12 patients. In 2 RI patients lung biopsy confirmed the diagnosis made after examination of the bronchoalveolar lavage. Modification of therapy after the biopsy was conducted in 58.3% HB patients with RI. Improvement was seen in 2 of them. 10 of 12 patients with RI died within 1-2 weeks after biopsy. Conclusion. Lung biopsy in HB patients should be obtained only after examination with noninvasive methods and before development of RI as prognosis after lung biopsy in the presence of RI is unfa- vourable. The histological material should be examined for all expected pathogens.
Terapevticheskii arkhiv. 2003;78(10):57-64
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Xeloda (capecitabine) potentialities in the treatmentof cancer patients (review)
Orel N.F.
Abstract
Terapevticheskii arkhiv. 2003;78(10):65-70
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Multiple molecular-genetic defects in a female with mixed hyperlipoproteinemia and earlyischemic heart disease
Malyshev P.P., Stambolsky D.V., Meshkov A.N., Davydova Y.V., Kukharchuk V.V.
Abstract
Aim. Analysis of genes of apolipoprotein E (apoE), LDLP receptor and methylentetrahydrofolate reductase (MTHFR) in a female patient with mixed hyperlipoproteinemia (HLP) and early ischemic heart disease (IHD). Material and methods. A patient with a mixed form of HLP and 5 her relatives were examined genetically. The genotype of apoE and MTHFR was determined using a restrictive analysis of PCR fragments. Conformation of one chain DNA was used to analyse gene of LDLP-receptor with following sequencing of anomalous DNA. Results. The proband had changes in all examined genes: nucleotide replacement of A370T gene of LDLP receptor, nucleotide replacement of MTHFR gene C677T and e2/z2-genotype ofapoE. None of the relatives carried more than one polymorphism by the studied genes. Conclusion. Early IHD in females can be caused by combination of polymorphisms of genes associated with development of atherosclerosis.
Terapevticheskii arkhiv. 2003;78(10):61-74
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Polymorphismof non-coding sites of human mitochondrial genome andprimary disorders of cardiac conduction
Nikulina S.У., Shulman V.A., Vorotnikova Y.V., Puzyrev V.P., Kosyankova Т.V., Golubenko M.V.
Abstract
Aim. Analysis of associations between idiopathic disturbances of cardiac conduction (DCC) and polymorphism of mitochondrial genome. Material and methods. A family examination was performed in 431 probands with various DCC and 1347 relatives of the first, second and third degree of kinship (the study group). All the examinees were divided into four subgroups. These included 158 probands with atrioventricular block (A VB) of various degree and their 518 relatives (subgroup 1); 50 probands with a complete right bundle-branch block (BBB) and their 161 relatives (subgroup 2); 108 probands with a complete left BBB and left anterior branch of the His bundle and their 152 relatives (subgroup 3); 115 probands with sick sinus syndrome (SSS) and their 327 relatives (subgroup 4). The control group consisted of 104 probands without clinical ECG manifestations of cardiac diseases and their 321 relatives. All the examinees have undergone ECG, atropin test, echocardioscopy, electrophysiological examination of the heart and mitochondrial DNA (mDNA). Results. Comparison of the incidence of mDNA D-loop restriction sites in the group of patients with idiopathic DCC and controls has found higher frequency of the Hae III 16517 site in the group of the patients (p = 0.0480). By location of the blocks (atrioventricular and intraventricular), the site occurred more frequently in patients with AVB (86.36%). The variant "+" by the site of Hae III 16517 mDNA was found to associate with disturbances of cardiac conduction, more closely in AVB. Conclusion. Variability of mDNA may be an etiological factor of idiopathic DCC pathogenesis.
Terapevticheskii arkhiv. 2003;78(10):75-77
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Genetic determinants of hereditary thrombophilia in pathogenesis of venous thrombosis
Kapustin S.I., Blinov M.N., Kargin V.D., Filanovskaya L.I., Saltykova N.В., Belyazo O.E., Golovina O.G., Shmeleva V.M., Panshina A.M., Papayan L.P.
Abstract
Aim. To study the role of genetic determinants of hereditary thrombophilia in pathogenesis of various clinical manifestations of venous thrombosis in the citizens of the North-West Region of Russia. Material and methods. Mutations of the genes of factor V (FV Leiden), prothrombin (G20210-A) and polymorphism C677-T in the gene of methylentetrahydrofolate reductase (MTHFR) were detected using polymerase chain reaction (PCR) with a following restriction analysis of PCR product in 183 patients with venous thrombosis (115 with isolated thrombosis of the deep veins and 68 with thromboembolism of the pulmonary artery). Results. It was established that mutation FV Leiden is a significant risk factor of deep vein thrombosis in the legs and postthrombotic disease, but this mutation is weakly associated with pulmonary artery thromboembolism (PAT). An essential PAT risk factor is carriage of the variant prothrombin G20210A. Conclusion. Determination of prothrombotic genotypes is a key factor of treatment efficacy and prevention of life-threatening thromboembolic complications.
Terapevticheskii arkhiv. 2003;78(10):78-79
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Intravenous thrombolytic therapy in myocardial infarction (review)
Staroverov I.I.
Abstract
Terapevticheskii arkhiv. 2003;78(10):80-82
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Clinical and hemodynamic efficacy ofprestarium and its role in the treatment of chronic pulmonary heart
Korneichuk N.N., Butorov I.V., Verbitsky O.N., Butorova V.G., Paraska V.I.
Abstract
Aim. To assess clinical efficiency and safety of ACE inhibitor prestarium (Servier, France) with specification of its effects on central and pulmonary hemodynamics, hepatic blood flow, indications in patients with chronic pulmonary heart (CPH). Material and methods. 42 patients with chronic obstructive bronchitis (COB) complicated by CPH entered the trial. The patients were divided into two groups. Group 1 (n = 26) received standard therapy plus prestarium (2-4 mg/day), group 2 (n = 16) received only standard combined therapy. The examinees have undergone ultrasonic investigation of the heart and liver in Doppler modes, ECG monitoring, examination for external respiration function, lipid peroxidation activity, antioxidant blood defense. Results. Group 1 demonstrated earlier positive response. It was found that improvement in functional class of cardiac failure induced by prestarium and less frequent episodes of arrhythmia directly correlated. Positive changes were stated in central and hepatic hemodynamics, systolic pressure in the pulmonary artery lowered more significantly than in the control group. Conclusion. If COB patients have symptoms of right ventricular failure, they are recommended to take prestarium in a daily dose 0.004g for 4 weeks to improve intracardiac and hepatic hemodynamics, reduce systolic pressure in the pulmonary artery and number of prognostically unfavourable arrhythmic episodes.
Terapevticheskii arkhiv. 2003;78(10):83-86
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Learning diagnostic skills with a computer (as illustrated bydiagnosis of pulmonary artery thromboembolism)
Kuznetsova V.P., Bruk E.I., Larichev O.I., Naryzhny E.V.
Abstract
Aim. To elaborate an innovating computer learning system allowing experienced doctors to share their knowledge with beginning physicians; to apply a computer expert system in teaching interns to detect pulmonary artery thromboembolism (PAT) with emphasis on PAT risk factors and symptoms, on fixation of diagnostic skills. Material and methods. The latest achievements in the field of artificial intellect served the basis for design of OSTELA educational computer system which operates with decisive rules of a highly skilled cardiologist. In this system interns study PAT diagnosis without a direct contact of the teacher with a learner. The computer system and its operation are described. Results. Skills of PAT diagnosis were taught to 48 interns. The number of correct answers to the control test increased by 30%, on the average. Conclusion. The proposed computer learning system OSTELA was successfully tried in clinics (pilot trials) and is recommended for postgraduate education of physicians.
Terapevticheskii arkhiv. 2003;78(10):87-90
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The test for nitric oxide metabolites in the exhaled aircondensate as a method of assessing NO-reactivity of theairways in patients with bronchial asthma
Geltser B.I., Peteshova E.E., Kochetkova E.A., Eliseeva E.V.
Abstract
Aim. To estimate airways NO-reactivity in response to their stimulation with fenoterol in different clinical forms of bronchial asthma (BA). Material and methods. The study included 73 patients with BA: mild disease was in 21, moderate in 24 and severe - in 28 patients. Severe BA patients were divided into two subgroups: with a stable course (n - 15) and unstable course (n = 13). NO-producing function of the airways was estimated by concentration of stable NO-metabolites (mNO)(N02, N03) in exhaled air condensate. Results. Spontaneous NO-producing activity of the airways increases and reaches maximum in severe unstable asthma. Fenoterol-stimulated NO-production was minimal in mild BA while the most significant augmentation of mNO was observed in unstable BA. Basal level of mNO and velocity parameters of external respiration function correlated. Conclusion. Estimation of NO-reactivity of the airways in the test with fenoterol with calculation of the index of airways NO-reactivity provides additional information about respiratory system condition in BA patients which may be used in clinical pulmonology.
Terapevticheskii arkhiv. 2003;78(10):91-94
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A case of Zivert-Kartagener syndrome
Shikhnebiev D.A.
Abstract
Terapevticheskii arkhiv. 2003;78(10):95-96
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