Vol 79, No 1 (2004)

Column of the Editor
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Terapevticheskii arkhiv. 2004;79(1):5-5
Thrombolytic therapy in acute myocardial infarction at prehospital stage
Golikov A.P., Galkin V.A., Elkis I.S., Zhirkov A.M.
Terapevticheskii arkhiv. 2004;79(1):6-7
Prehospital hypo- and hyperdiagnosis of non-Q myocardial infarction
Pankin O.A.
Aim. To estimate prevalence of hypo- and hyperdiagnosis of поп-Q myocardial infacrtion (MI). Material and methods. The results of prehospital diagnosis of MI in 1500 patients examined in 19921996 are reported. Estimation was conducted in different clinico-electrocardiographic and clinico-demographic groups. Results. Non-Q MI occurred in 74.1% cases. Non-Q and Q MI ran atypically in 33.0 and 12.9% patients, respectively (p < 0.01). Hypo- and hyperdiagnosis of Q and non-Q MI was made in 3.8 and 2.1, 17.3 and 35.9%, respectively. In typical and atypical MI hypodiagnosis was made in 13.4 and 21.2% cases, respectively, while hyperdiagnosis was observed in 19.9 and 45.8% (p < 0.01). The MI hyper/hypodiagnosis coefficient was highest in patients under 45 years of age (2.6%) and in repeated MI(2.5). Conclusion. Misdiagnosis of non-Q MI is most essential in epidemiology of missed diagnosis in this disease. High incidence of hypo- and hyperdiagnosis in non-Q MI as well as atypical MI are explained by objective difficulty of prehospital diagnosis in these MI variants and high MI alertness of the doctors in low significance of the disease.
Terapevticheskii arkhiv. 2004;79(1):8-12
Dilated cardiomyopathy in therapeutic and cardiological practice (lecture)
Bart B.Y., Benevskaya V.F.
Terapevticheskii arkhiv. 2004;79(1):12-17
Rehabilitation treatment of convalescents after remorrhagic fever with renal syndrome in the outpatient clinic
Pimenov L.Т., Vasilyev M.Y.
Aim. To assess clinical efficacy of mineral water and perindopril in convalescents after hemorrhagic fever with renal syndrome (HFRS) in outpatient setting. Material and methods. The study covered 113 HFRS convalescents. HFRS was confirmed serologically The patients were divided into three groups: group 1 (n = 50) received no rehabilitation caregroup 2(n= 32) drank mineral water "varzi-yatchi"; group 3 (n = 31) drank mineral water and took perindopril (2 mg/day). Aftertreatment continued for 30-35 days. The effect was assessed by a complex of clinical-laboratory and functional tests for examination of renal functions (Reberg-Tareev, Zimnitsky tests, estimation of uric acid clearance and renal functional reserve, an 18-hour water deprivation test). Results. Mineral water varzi-yatchi and perindopril had a favourable effect on clinical condition and renal functions of HFRS convalescents. Compared to the controls (p < 0.05), they had less severe weakness, lumbar pains, edema of the lower limbs; positive changes in intraglomerular hemodynamics, renal transport of beta2-microglobulin (MG), uric acid transport. Conclusion. It is shown that HFRS convalescents have defective glomerular and tubulointerstitial systems of the kidneys. These disorders demand a differential therapeutic approach. Drinking mineral water improves some tubular functions. The addition of perindopril is necessary in detection of arterial hypertension, impairment of intraglomerular hemodynamics, hyperexcretion of beta2-MG, osmoregulating renal dysfunction.
Terapevticheskii arkhiv. 2004;79(1):17-22
Diagnosis of disturbed lipid and carbohydrate metabolism in hypertensive women in outpatient setting
Polyatykina T.S., Al-sveirki A.D., Poltyrev V.S., Romanenko I.A., Budnikova N.V., Mishina I.E., Ivanova G.V.
Aim. To study lipid and carbohydrate metabolism in young and middle-aged women with essential hypertension (EH). Material and methods. Anthropometric parameters, arterial pressure (AP), glucose tolerance (GT), fasting glucose, immunoreactive insulin (IRI), glycosylated hemoglobin (HbA), total cholesterol (TC), triglycerides (TG), HDLP cholesterol, atherogenic index were estimated in 93 women aged 20 to 50 years with EH stage II. Results. TC was elevated in 75%, HDLP cholesterol - in 52%, TG - in 40% patients. Subnormal HDLP was only in 8% examinees. 6, 4, 21% of 53 examinees had elevated fasting glucose, GT, HbA„ respectively. Hyperinsulinemia was detected in 80%, insulin resistance in 92%. Conclusion. Disturbances of lipid metabolism were identified in more than half of the examined EH women. The HbAt test is more sensitive than GT and fasting glucose tests in detection of abnormal carbohydrate metabolism.
Terapevticheskii arkhiv. 2004;79(1):22-25
Helicobacter pylori and gastric adenoma in outpatient practice
Minushkin O.N., Burdina E.G.
Aim. To study the role of Helicobacter pylori (HP) persistance in generation of gastric mucosa adenoma. Material and methods. Esophagogastroduodenoscopy with biopsy of the mucosa from the antral portion and body of the stomach was made for diagnosis of HP and morphological changes in 28 patients \ aged 47 to 86 years with gastric adenoma. Results. Chronic gastritis with HP was diagnosed in 57.1% patients. HP contamination was, as a rule, weak (32.1%) or moderate (53.5%). It correlated with activity of inflammatory and dystrophic changes (thefirst degree - 35.7%, the second one - 39.3%; atrophy - 99.6%, metaplasia - 92.8%, respectively). Conclusion. The morphological study revealed a strong correlation between gastric adenomas and HP persistance. As adenomas are characterized by a high risk of malignant transformation and must be removed, it is recommended to eradicate HB infection.
Terapevticheskii arkhiv. 2004;79(1):26-28
Specific features of out-of-hospital pneumonia in patients with chronic infantile spinal amyotrophy
Fomina I.G., Marinin V.F., Gorbacheva F.E., Makhnach G.K., Abramova A.A., Solovyeva N.V., Medvedeva I.V.
Terapevticheskii arkhiv. 2004;79(1):28-30
Epidemiological and social aspects of arterial hypertension in young patients (results of in-office study in Smolensk)
Bazina I.В., Bogachev R.S., Kovalev О.I., Ivanteeva T.V., Lifke M.V., Rafeenkova V.S., Shutova E.P.
Terapevticheskii arkhiv. 2004;79(1):31-33
Prevalence of ischemic heart disease, its main risk factors and efficacy of long-term multifactorial prevention at enterprises in some regions of the Russian Federation
Tozhiev M.S., Norbekov M.S., Shestov D.В., Khvan Y.E., Vorobyev A.M., Terebov A.A., Suyundikov S.Т., Marchenko A.M., Kashirina M.L., Klimova M.Y., Makritsa A.N., Bondarenko V.V., Teplyakov V.C., Avdeeva G.P.
Aim. To study prevalence of ischemic heart disease (IHD) and its various clinical forms depending on sex, age, profession including risk factors (RF) and their combination and efficiency of long-term multifactorial active prevention programs at enterprises in several regions of the Russian Federation. Material and methods. 14000 male and 20969 female volunteers were observed in organized groups in three Russian cities (Cheboksary, Pskov, St-Petersburg). 8984 males and 14515 females entered seven groups of outpatient follow-up and active long-term multifactorial prevention during 5-10 years. Results. Risk factor correction produced a significant decrease in mean systolic and diastolic blood pressure, frequency and intensity of smoking, overweight, improved ECG parameters, increased number of the examinees free of risk factors; state of IHD patients improved. Overall mortality, IHD and stroke mortality, number of temporary disability days were significantly less in the prevention group. Conclusion. Active multifactorial "in office" prevention for 5 to 10 years reduced RF prevalence and intensity, quantity of days at sick-leave fell by 48.5%. The presence of IHD and risk factors in both groups increased overall mortality rates and cardiovascular (IHD and stroke) mortality rates at the beginning of the study. The multifactorial prevention of IHD and risk factors resulted in a significant reduction of overall mortality rates as well as cardiovascular mortality rates in groups of active prevention.
Terapevticheskii arkhiv. 2004;79(1):33-38
Prevalence of dyslipidemia in an open population of Tyumen
Akimova E.V., Dracheva L.V., Gakova E.I., Zhuravleva T.D., Olferyev A.M., Gafarov V.V., Kuznetsov V.A.
Aim. To evaluate levels of Total cholesterol (TC), HDLP cholesterol, triglycerides (TG), occurrence of hypercholesterolemia (HCE), hypertriglyceridemia (HTG) and low HDLP cholesterol in the Tyumen population. Material and methods. 866 men and women aged 25-64 years have been examined in one-stage cardiological screening within a two-stage epidemiological study of serum lipoproteins by WHO criteria. Results. HCE was registered in 15.6% males and 18.8% females, a low HDLP cholesterol - in 5.3 and 4.2%, HTG - in 5.8 and 4.3% males and females, respectively. A high TC level and HCE occurred more frequently in women over 54 years of age; a low HDLP cholesterol level in insignificant fall in HDLP cholesterol and no age-related changes of this index were found both in males and females; TG were elevated in older males in moderate prevalence of HTG in the population. Conclusion. It is shown that Tyumen population is at high risk of cardiovascular diseases. Further studies are needed to specify targeted preventive programs.
Terapevticheskii arkhiv. 2004;79(1):38-41
Incidence rate of heart rhythm disorders in rural population of the Krasnoyarsk Territory
Gogolashvili N.G., Novgorodtseva N.Y., Polikarpov L.S., Karpov R.S.
Aim. To evaluate occurrence of heterotopic cardiac arrhythmia in rural population of the Krasnoyarsk Territory. Material and Methods. 1203 persons (474 males, 729 females) aged 16 and older from rural population of the Krasnoyarsk Territory (the response rate 76.1%) filled in the questionnaires, have undergone ECG examination in 12 standard leads with continues registration of 100 cardiocycles in one of the leads. Holter monitoring was conducted in 215 random examinees. Results. By ECG, the population was characterized by supraventricular extrasystole (SVE -8.9%), ventricular extrasystole (VE -6.4%) and cardiac fibrillation (1.5%). Overall, heterotopic disorders of heart rhythm were registered in 14.3% examinees. By Holter monitoring, heterotopic arrhythmia was detected much more often - in 68.4% examinees. SVE and VE occurred in 56.7 and 34.4%, respectively. Paroxysms of supraventricular tachyarrhythmia occurred in 10.2% cases. Conclusion. In the examined population incidence of heterotopic arrhythmia and its variants increased with age. Incidence of heterotopic arrhythmias did not differ statistically between men and women, except VE which was encountered more often in males.
Terapevticheskii arkhiv. 2004;79(1):41-44
Implications of different methods of evaluating prevalence of cholelithiasis in population: postmortem and intravital ultrasonic diagnosis
Reshetnikov O.V., Ryabikov A.N., Shakhmatov S.G., Malyutina S.K., Kurilovich S.A.
Aim. To evaluate the occurrence of cholelithiasis (CL) diagnosed by routine autopsy and to compare these data with the results of ultrasonographic examination of the general population. Material and methods. Autopsy protocols (n = 1124) from a large general hospital were analysed, and a representative sample of Novosibirsk population (1678 examinees aged 25-64 years) was examined by ultrasonography. Results. Prevalence of CL increased with age and was five-fold higher in females than in males. Both methods showed good concordance. The age-adjusted CL prevalence rates in 25-64 year-old groups was 1.94% in males and 9.53% in females in autopsy series, and 2.16% and 11.16%, respectively, in ultrasonographic study. Conclusion. Routine autopsy may serve as a reliable tool in evaluating prevalence of CL among the population provided the values are gender- and age-standardized.
Terapevticheskii arkhiv. 2004;79(1):45-48
A comprehensive assessment of metabolic parameters in obese patients on xenical
Ametov A.S., Demidova T.Y., Tselikovskaya A.L.
Aim. To study effects ofxenical combined with moderately hypocaloric diet on fat tissue mass, carbohydrate and lipid metabolism in patients with metabolic syndrome. Material and methods. The study included 60 patients with body mass index (BMI) over 30 kg/m2, mild and moderate arterial hypertension, dyslipidemia, impaired glucose tolerance (IGT) and diabetes mellitus (DM) type 2. The patients were divided into two groups. 30 patients of group 1 received xenicaf® in a dose 120 mg 3 times a day for 24 weeks. 30 patients of the control group received only the above diet for 24 weeks. The examination included 24-h monitoring of arterial pressure, anthropometric measurements, tests for glycemia, C-peptide, cholesterol, triglycerides (TG), LDLP, HDLP. Results. Group 1 patients reduced their weight by 10.8 + 7.5 kg and fat tissue mass by 9.4 ± 9.2 kg. This was in correlation with improvement of fatty, carbohydrate metabolism, arterial pressure. After 24 weeks of therapy xenical lowered cholesterol by 15%, LDLP cholesterol by 20%, TG by 28%, systolic and diastolic pressure by 5 and 4%. Conclusion. Combination ofxenical with hypocaloric diet can be used in therapy of patients with metabolic syndrome.
Terapevticheskii arkhiv. 2004;79(1):49-53
A comprehensive assessment of nicotine dependence using questionnaires and measurements of carbon monoxide concentration in the exhaled air
Brimkulov N.N., Vinnikov D.V., Cholurova R.A.
Aim. To study nicotine dependence (ND) basing on special questionnaires and measurement of CO concentrations in the exhaled air. Material and methods. 350 smokers (318 males and 32 females) aged 20-57 years (mean age 37.1 ± 7.3 years) were studied. ND was assessed by Fagerstrom test (FT), motivation to smoke and to quit tests, smoking history and exhaled CO measurement. In addition, respiratory complaints and ventilation parameters such as peak expiratory flow (PEF) and forced expiratory volume per 1 sec (FEV1) were measured. Results. Mean daily cigarette number was 14.2 ± 7.3; smoking duration 16.3 ± 7.8 years and smokers index 170.9 ± 87.8. Smoking women differed from smoking men in ND, PEF% and FEV1% decline as well as CO level. Exhaled CO was 21.1 ± 9.5ppm, on the average, corresponding to moderate dependence. ND and daily cigarette number produced a direct impact on the exhaled CO level. FT findings directly correlated with the number of daily cigarettes and CO level (mean 3.2 ± 2.3). Among motivation to smoke factors was the demand to release tension. Conclusion. ND varies considerably among smokers by severity. Smoking men and women differ considerably by ND. Along with dependence tests, exhaled CO measurement provides objective verification ofND.
Terapevticheskii arkhiv. 2004;79(1):53-58
Specific features of the course of duodenal ulcer in bronchial asthma (clinical and pathomorphological aspects)
Chernyavskaya G.M., Pleshko R.I., Beloborodova E.I., Sukhodolo I.V., Plekhanova E.V.
Aim. To study incidence of gastroduodenal ulcer (GDU) in bronchial asthma and clinicomorphological features of ulcer disease in BA in long-term use of systemic corticosteroids (SCS) and without SCS. Material and methods. The trial covered 297 BA patients. They have undergone clinicoendoscopic examination of the gastroduodenal zone (GDZ) for duodenal ulcer with assessment of clinical gastroenterological symptoms and morphological analysis of bipsies of gastric and duodenal mucosa using histological, histochemical and morphometric methods. Results. BA patients were found to have high incidence of duodenal ulcer (21.9%). Morphologically, they had active immune inflammation with hyperergic component. The results of the study did not confirm the opinion about a key role of SCS in development of GDU in BA. Small doses of SCS in patients with BA and GDU do not deteriorate ulcerogenesis. Conclusion. One of the factors determining combination of ulcer disease with В A may be chronic hyperergic inflammation of GDZ mucosa stimulating realization of predisposition to ulcer and its chronic recurrent course.
Terapevticheskii arkhiv. 2004;79(1):58-62
Effects of secondary prevention on quality of life of old patients at local sanatorium of the War Veterans Rehabilitation Center
Geller V.L., Chukreev A.N., Usoltsev В.G., Alexandrov М.V., Sevastiyanova G.I., Gudkov N.V., Bursikov A.V.
Aim. To study efficacy of sanatorium treatment of aged patients with gastroenterological and locomotor diseases in the heriatric center. Material and methods. 100 patients were investigated for effects of sanatorium treatment on quality of life. Results. Clinical symptoms depended on the patients'age. Patients under 70 years of age had leading symptoms from gastrointestinal organs and locomotor system. These patients were most responsive to rehabilitation measures. In 70-year-olds and older patients cardiovascular and cerebral pathologies are of special importance limiting usage of physiotherapy and necessitating wider application of medicines: hypotensive, antianginal, circulation correcting, etc. The sanatorium stage of rehabilitation creates a positive emotional background in these patients. Conclusion. Sanatorium treatment resulted in improvement of life quality in gerontological patients.
Terapevticheskii arkhiv. 2004;79(1):62-65
Biosulin P and biosulin H in the treatment of diabetes mellitus
Dedov I.I., Balabolkin M.I.
Terapevticheskii arkhiv. 2004;79(1):65-68
Hodgkin's lymphoma (lymphogranulomatosis). Present-day terminology
Demina E.A.
Terapevticheskii arkhiv. 2004;79(1):69-73
Impaired tolerance to nutritional fats and its contribution to atherothrombogenesis
Bubnova M.G., Oganov R.G.
Terapevticheskii arkhiv. 2004;79(1):73-78
Role of inflammatory and infectious factors in the development of atherosclerosis
Rebrov A.P., Voskoboi I.V.
Terapevticheskii arkhiv. 2004;79(1):78-82
Anomalous manifestations of human genetics in pathology and perspectives of treatment perfection in diseases of various etiology
Paponov V.D., Paponov V.V., Baidakova G.V., Borisova A.M., Mordovtsev V.N.
Terapevticheskii arkhiv. 2004;79(1):82-87
Medical information-analytical center as an instrument of strategic and everyday planning in health service
Venediktov D.D., Kuznetsov P.P., Nasonov E.L.
Terapevticheskii arkhiv. 2004;79(1):87-89
Chair of outpatient treatment or chair of general medical practice
Bagirova G.G.
Terapevticheskii arkhiv. 2004;79(1):89-90

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