Vol 79, No 2 (2004)


Enterology: achievements and problems

Parfenov A.I.
Terapevticheskii arkhiv. 2004;79(2):5-7
pages 5-7 views

Cytokines in primary biliary cirrhosis (diagnostic and prognostic implications)

Golovanova E.V., Ilchenko L.Y., Tsaregorodtseva Т.M., Serova T.I., Gudkova R.B.


Aim. To study concentrations of serum pro- and anti-inflammatory cytokines (CK), CK correlations with clinicobiochemical activity, diagnostic and prognostic implications in primary biliary cirrhosis (PBC). Material and methods. Enzyme immunoassay has been used to study content of IL-1B, IL-4, IL-6, IL-8, TNF-a, INF-y in peripheral blood of 96 women aged 26 to 82 years (mean age 56.2 ± 12.6 years) with PBC (kits "Protein Contour", "Cytokine", St-Petersburg). The control group consisted of 20 healthy women matched by age. Results. PBC is associated with changes in serum CK content correlating with the disease activity and stage. Elevated levels of proinflammatory IL-6, TNF-a, INF-y and anti-inflammatory IL-4. Conclusion. Definition of the cytokine spectrum in PBC has made a prognostic significance as it allows judging about the disease activity, stage and prognosis.
Terapevticheskii arkhiv. 2004;79(2):8-11
pages 8-11 views

Participation of cytokines and role of biliary-pancreatic reflux in mechanisms of exacerbation and chronicity of recurrent pancreatitis

Zhukova E.N., Shirinskaya N.V., Akhmedov V.A.


Aim. To evaluate the role of some pro- and anti-inflammatory cytokines, acute phase proteins and biliary-pancreatic reflux in pathogenesis of development and recurrence of chronic recurrent pancreatitis (CRP) and alcohol chronic pancreatitis (ACP). Material and methods. IL-8, IL-4, IL-10, TNF-alpha, lactoferrin (LF) and cerruloplasmin were estimated by a standard enzyme immunoassay in 186 CRP and 32 ACP patients. Results. The levels of proinflammatory cytokines, TNF-alpha and IL-8 as well as anti-inflammatory cytokines IL-4 and IL-10 in CRP patients reached their maximum on exacerbation day 5-7 while in ACP - on day 1-2. High cytokines levels correlate with exacerbation severity. In transition to remission, the levels of cytokines and acute phase proteins (lactoferrin, ceruloplasmin) went down. In remission some patients showed episodes of rising IL-8 and TNF-alpha to the level typical for exacerbation but without clinical manifestations. This may point to latent recurrences. TNF-alpha rose in remission most frequently in patients with biliary-pancreatic reflux. Antiinflammatory treatment of duodenitis (papillitis) lowered basal pressure of Oddi's sphincter stopping biliary-pancreatic regurgitation and leading to breaking the pathogenetic chain of CRP exacerbations. Conclusion. Proinflammatory cytokines TNF-alpha and IL-8 promote development of CRP. This should be taken into consideration while planning combined therapy.
Terapevticheskii arkhiv. 2004;79(2):11-14
pages 11-14 views

Age-related comparative characteristics of ulcer disease course

Vakhrushev Y.M., Efremova L.I., Belova E.V., Romanova T.P.


Aim. To study pathogenetic factors underlying development of ulcer disease and its course in different age periods. Material and methods. Clinical, psychoemotional, endoscopic device, biochemical and radioimmunological examinations were used in the study of 283 patients with gastroduodenal ulcer. By age, the patients were divided into four groups: 15-18, 19-35, 36-60 and 61 and older. Results. Some age-specific clinical and endoscopic characteristics were found in the examinees. Risk factors (hereditary predisposition, high gastric juice acidity, the presence of Helicobacter pylori, etc.) occurred almost with the same frequency at different ages. Older patients had deficient defense-protection properties of gastric mucus. Most of the examinees's psycho-emotional state was characterized by moderate reactive and high personality anxiety. In all the age groups reactions of the hormonal system were of the same type - hypophyseo-adrenal hyperfunction and hypophyseo-thyroid hypofunction. Conclusion. The above findings may help in design of differentiated by age therapeutic and diagnostic measures for ulcer patients of different age.
Terapevticheskii arkhiv. 2004;79(2):15-18
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Efficacy of different schemes of antihelicobacter therapy in duodenal ulcer

Kirika N.В., Bodrug N.I., Butorov I.V., Butorov S.I.


Aim. To study clinical efficacy and antihelicobacter activity of combined treatment of duodenal ulcer (DU) with famotidin (qamatel), metronidasol (trichopol) and jozamycin (walpraphen). Material and methods. A total of 96 patients with uncomplicated DU have been treated (mean age 42.5 ± 1.5 years). The examination included standard tests, endoscopy, pH-metry (on the treatment days 1, 15 and 28), biopsies and prints from the antral stomach and its body. The sections were stained by Gimsefor morphological assessment of duodenal mucosa and detection of Helicobacter pylori (HP). Gastric acid-producing function was examined with intragastric pH-metry. The patients were divided into 3 groups: group 1 received monotherapy with famotidin (20 mg twice a day); group 2 received combined treatment with famotidin (40 mg/day), metronidasol (500 mg twice a day), josamycin (300 mg in 3 doses) for a week with following intake of famotidin alone (40 mg/day) for 3 weeks; group 3 received the same treatment plus clarythromycin. Group 1 patients benefited from the treatment but elimination of pain and dyspeptic syndromes was longer than in groups 2 and 3 (p < 0.05). Ulcer healing to treatment day 28 was observed in 71.8, 90.0 and 88.2%, respectively. Side effects occurred in 0, 10 and 16.7% cases, respectively. Conclusion. 1-week schemes of combined treatment with famotidin, metronidasol, josamycin or clarythromycin are highly effective in DU and their side effect rates are not very high.
Terapevticheskii arkhiv. 2004;79(2):18-22
pages 18-22 views

Clinicopathogenetic variants of chronic gastritis

Chernin V.V., Dzhulai G.S.


Aim. To evaluate specific features of the course of chronic gastritis (CG), morphofunctional condition of gastric mucosa, vegetative regulation, adrenergic and cholinergic shifts, histamine metabolism and effects of exogenic and endogenic risk factors in CG patients; to study clinicopathogenetic variants of CG. Material and methods. A total of 311 CG patients aged from 16 to 72 years were studied. They were divided into three groups by their gastric mucosa condition. The control group consisted of 30 healthy donors. The following parameters were studied: visual and histological condition of gastric mucosa, total acidity, the levels of free hydrochloric acid, pepsin, bioelectric gastric activity, general autonomic tonicity, cholinesterase activity. Results. Three clinicopathogenetic variants of the disease have been identified. Variant 1 was characterized by a recurrent course, subjective manifestation of the disease only in exacerbation, surface (primarily antral) mucosal affection, normal or enhanced secretory and motor functions of the stomach, adequate reaction of acid production to caffeine and histamine stimulation, parasympathicotonia, absolute hyperhistaminemia, relative hypoacetylcholinemia, subnormal urinary excretion of adrenalin. Variant 2 manifested with rare recurrences, longer and more severe exacerbations, frequent spontaneous and provoked aggravations, moderate focal atrophy of the mucosa, secretory insufficiency with adequate reaction to histamine and minor to caffeine stimuli, hypomotor gastric dyskinesia, vegetative eutonia, normohistaminemia, absolute hypoacetylcholinemia, subnormal urinary excretion of noradrenaline. Variant 3 runs without definite remissions and exacerbations, with continuous abdominal pain and dyspepsia, frequent spontaneous aggravations, marked extended mucosal atrophy with secretory insufficiency up to achlorhydria, no stimulation of acid production in response to caffeine and histamine, gastric hypomotility, sympathicotonia, absolute hypohistaminemia, hypoacetylcholinemia, normal urinary excretion of catecholamines. Conclusion. The findings expand our knowledge about clinicopathogenetic variants of CG and necessitate new approaches to development of effective methods of CG prevention and treatment.
Terapevticheskii arkhiv. 2004;79(2):22-27
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Comparative efficacy of different therapeutic schemes in gastropathies provoked by nonsteroid anti-inflammatory drugs

Maev I.V., Vyuchnova E.S., Staseva I.V.


Aim. To study efficacy of colloid bismuth subcitrate (de-nol, Yamanuchi) in therapy of gastropathies provoked by nonsteroidal anti-inflammatory drugs (NSAID). Material and methods. 63 patients (38 women and 25 men, mean age 54.2 ± 12.8 years) with rheumatoid arthritis (n = 14), osteoarthrosis (n = 47), gouty arthritis (n = 2) regularly taking NSAID were examined. The patients were randomized into two groups. The patients of the control group 1 received therapy with omeprasol (40 mg/day), patients of group 2 were given omeprasol (40 mg/day) and de-nol (480 mg/day). Results. Epithelization of erosive-ulcerous lesions were observed on the treatment day 28 in 93.9% patients of group 1 and all the patients of group 2. Normalization of the level of prostaglandin E, by the end of the treatment was registered in 57% and 93.3% patients of groups 1 and 2, respectively. Conclusion. Colloid bismuth subcitrate (de-nol) effectively improves the condition of NSAID gastropathy patients, stimulates healing of erosive-ulcerous lesions of gastroduodenal zone in elevation of prostaglandins levels.
Terapevticheskii arkhiv. 2004;79(2):27-30
pages 27-30 views

Comparative efficacy of combined treatment with intron A and pegintron in combination with ribavirin in patients with chronic hepatitis С

Gromova N.I., Bogomolov B.P.


Aim. To investigate the efficacy of combined therapy of patients with chronic hepatitis С (СНС) including intron A, pegintron (preparations of alpha-2b interferon) and ribavirin, and evaluation of the above treatment side effects. Material and methods. 47 СП С patients (38 males and 9 females) were divided into two groups. 22 patients of group 1 received intron A and ribavirin, 25 patients of group 2 were given pegintron and ribavirin for 6-12 months. The examination made before the treatment, during the treatment and after it included clinical, biochemical, virusological blood tests, tests for autoantibodies, thyroid hormones, ultrasound investigation. Results. The response in group 1 was 55%, in group 2 - 72.7%. In group 2, CNS and skin side effects occurred more frequently. After the treatment side effects regressed in 95.8% patients. Conclusion. The pilot experience in Russia confirmed the findings of the foreign investigators on higher efficacy of combined treatment with pegilized interferons (pegintron) and ribavirin vs combination of intron A with ribavirin. It is shown that side effects of the above treatment can be corrected in outpatient medication.
Terapevticheskii arkhiv. 2004;79(2):31-35
pages 31-35 views

Diffuse intestinal angiodysplasia complicated by intestinal hemorrhage and disseminated intravascular coagulation. Difficulties in diagnosis and treatment

Tsodikov G.V., Kazantseva I.A., Morozova N.A., Nikitina N.V., Savov A.M., Banina V.В., Seliverstova T.R.


diffuse intestinal angiodysplasia, disseminated intravascular coagulation, intestinal hemorrhage, diagnosis, treatment
Terapevticheskii arkhiv. 2004;79(2):35-40
pages 35-40 views

Morphofunctional changes in the small intestine in patients with chronic cardiac failure

Arutyunov G.P., Kostyukevich O.I., Serov R.A., Rylova A.K., Korsunskaya M.I., Balanina N.O., Rylova N.V., Pokrovsky Y.A., Voevodina N.Y.


Aim. To study morphological alterations in small intestinal wall in patients with chronic cardiac failure (CCF) of various severity and their relations with functional condition of the small intestine. Material and methods. 63 patients (mean age 58.7 years) entered an open cohort study. By CCF and body mass index (BMI) the patients were divided into 4 groups. Estimation of ejection fraction (EF), BMI and lean body mass (LBM) was made in all the patients as well as functional intestinal activity was assessed by fat excretion and fecal protein. Small intestinal biopsies were made endoscopically for collagen quantitation. Results. A rise in collagen content in the small intestine correlated with severity of CCF. In patients free of CCF relative area of collagen averaged 12.8%, in CCF FC I-II - 16.5%, in CCF FCIIIIV with cachexia - 32.4%. Greater fibrosis of the small intestine corresponded to greater malabsorption. A 3-fold increase in collagen area led to a 2-3-fold growth in protein and fat loss with feces. In CCF, LBM was subnormal while body mass reduction correlated with relative collagen area. Conclusion. Morphofunctional changes of the small intestine developing in parallel with CCF severity lead to a significant loss in basic nutrients, regression of LBM and development of protein-energy insufficiency in patients with CCF.
Terapevticheskii arkhiv. 2004;79(2):40-44
pages 40-44 views

Cerebrocardial disorders in hemorrhagic stroke

Martynov Y.S., Krishna Kumar Oli -., Shuvakhina N.A., Belova L.K., Sokov E.L., Malkova E.V., Nozdryukhina N.V., Borisova N.F., Proskurin V.V.


Aim. To elucidate relationships brain-heart in hemorrhagic stroke depending on the size and location of hematoma and initial state of the heart. Material and methods. Clinical and paraclinical methods were used in acute and rehabilitation periods in 160 patients with hemorrhagic stroke. Results. Symptoms of cerebrocardial syndrome in hemorrhagic stroke include arrhythmias (tachycardia, bradycardia, extrasystole, cardiac fibrillation, sick sinus syndrome), blocks (transient bundlebranch block), myocardial dystrophy, in 1HD - ischemic myocardial disorders up to subendocardial myocardial infarction. Its severity in massive hemispherical hematomas was due to compression of the brain trunk. Conclusion. Pathogenesis of cerebrocardial syndrome rests on impaired central autonomic regulation occurring in stroke.
Terapevticheskii arkhiv. 2004;79(2):44-49
pages 44-49 views

Activity of myocardial sympathico-adrenal system in various volume of viable myocardium in chronic cardiac failure

Kukes V.G., Sychev D.A., Andreev D.A., Golukhova E.Z., Ostroumov E.N., Dmitrieva I.M.


Aim. To estimate sympathetic activity in patients with ischemic heart disease (IHD) complicated by chronic cardiac failure (CCF) depending on the volume of viable myocardium measured by dobutamine stress echocardiography (DSE). Material and methods. Planar myocardial I-231-MIBG scintigraphy and dobutamine stress echocardiography were made in 16 patients (9 males and 7 females) aged 43-75 years with CCF (NYHA class II- III) and ejection fraction under 35%. The ratio maximal MIBG absorption in the left ventricular myocardium to maximal MIBG absorption in the mediastenum (H/M) and lung (H/L) were estimated. Results. By DSE the patients were divided into two groups: responders in whom contractility improved by 4 and more points (9 patients) and non-responders in whom contractility improved by less than 4 scores (7patients). The groups did not differ by clinical and hemodynamic parameters but group 2 patients had significantly lower H/M and H/L than group 1 patients (1.38 ± 0.02 and 1.08 ± 0.06 against 1.61 ± 0.09 and 1.25 ± 0.12, respectively, p < 0.05). A direct correlation was found between MIBG absorption (H/M, H/L) and ejection fraction on minimal dobutamine doses (r = 0.77, p < 0.01; r = 0.87, p < 0.001), gain in ejection fraction (r = 0.77, p < 0.01; r = 0.45, p < 0.05), and inverse correlation between MIBG absorption (H/M, H/L) and dyssynergia index on minimal dobutamine doses (r = -0.80, p < 0.001; r = -0.87, p < 0.0001). Conclusion. Patients with CCF demonstrate a correlation between sympathetic activity and volume of viable myocardium, inotropic reserve.
Terapevticheskii arkhiv. 2004;79(2):49-52
pages 49-52 views

Mechanism of biotropic effects of regional electromagnetic fields in patients with left ventricular ischemic dysfunction

Bardak A.L., Kalyuzhin V.V., Kamaev D.Y., Borodin A.S., Pobachenko S.V., Kolesnik L.I.


Aim. To study the role of disturbed autonomic regulation of the cardiovascular system in formation of the phenomenon ofgeliogeomagnetic sensitivity of patients with left ventricular ischemic dysfunction. Material and methods. 24-h synchroneous monitoring of ECG and electromagnetic situation was made in 11 patients (mean age 49.4 ±0.9 years) who had survived macrofocal myocardial infarction (MI) at least 6 months before and in 15 healthy volunteers. Results. Heart rhythm dispersion, correlation between variations of magnetic field vector component amplitudes and standard deviation of ECG R-R intervals duration in MI survivors were significantly less than in healthy subjects. High conjugacy of heart rhythm dispersion and mean value of R-R intervals (functions synchronization index) was characteristic only for the control group. A 3-week therapy with atenolol provided normalization of the disturbed correlations in 4 patients. Conclusion. Pathogenic geliogeotropic reactions in MI survivors develop because of intra- and intersystemic desynchronisation of the functions mechanism of which is mediated by sympathicoadrenal activation and is correctable by beta,-adrenoblocker atenolol.
Terapevticheskii arkhiv. 2004;79(2):52-54
pages 52-54 views

Effects of berotek nebuliser treatment on external respiration function, bronchial permeability (BP), hemodynamics (HD), acid-alkaline balance (AAB), oxygen saturation (OS) and their circadian chronostructure in elderly patients with chronic obstructive pulmonary disease

Zaslavskaya R.M., Veklenko G.V., Akhmetov K.Z., Teiblyum M.M.


Aim. To study the effects of nebuliser therapy with berotek on clinical symptoms, external respiration function (ERF), bronchial permeability, hemodynamics and their temporal organisation in elderly patients with chronic obstructive pulmonary disease (COPD). Material and methods. The study enrolled 20 COPD patients (mean age 64.9 ± 1.9 years) with obstructive respiratory insufficiency of the second-third degree given nebuliser therapy with berotek as adjuvant to conventional treatment (the study group) and 12 COPD patients (mean age 69.7 ± 2.5 years) given only conventional treatment (the control group). The following parameters were examined: ERF, BP, HD, AAB, OS (SaOJ in venous blood before and after treatment. Chronobiological studies of BP and HD were performed for 7 days at the beginning and end of the study. Results. Berotek efficacy manifested on the treatment day 3 as improvement in the symptoms, IRF, BP, a rise in Sa02 and PaC02 and a fall in PaC02 in venous blood. Orcadian chronostructure of peakflowmetry, systolic and diastolic blood pressure, mean arterial pressure persisted. Circaseptal and circasemiseptal rhythms of BP and HD disappeared. Conclusion. Nebuliser therapy with berotek has a positive effect on clinival symptoms, ERF, BP, gas exchange in the lungs, Sa02, HD and their circadian chronostructure.
Terapevticheskii arkhiv. 2004;79(2):55-57
pages 55-57 views

Degenerative-dystrophic diseases of the locomotor system in metallurgists

Kaisarov G.A., Bagirova V.V.


Aim. To evaluate prevalence of osteoarthrosis (OA) in metallurgists in conditions of high tension of the locomotor system and exposure to industrial pollutants depending on the age, sex and duration of service. Material and methods. Epidemiological survey covered 713 workers (284 females and 429 males) of the Orsko-Khalilovsky Metallurgical Company. OA detection was made basing on screening questionnaire N 1, record N 2 and OA diagnostic criteria designed and tested in the RAMS Rheumatism Institute. Results. Prevalence of OA among workers of the metallurgic company reached 71.6%. 83.5 and 63.8% females and males had degenerative changes in the joints and spine, respectively. This rate got higher with age and duration of service. Combination of OA with osteochondrosis (ОС) was registered in 61.7%, isolated ОС and OA - in 25.0 and 13.3%, respectively. ОС developed most frequently in the lumbar, cervical-lumbar, cervical-thoracic spine while OA was found in the knee, shoulder and hand joints. Conclusion. Workers engaged in metallurgic industry work in conditions of high static-dynamic tension of the osteomuscular system and exposure to industrial chemical and physical hazards. The above risk factors contribute to high OA incidence. With age and longer exposure, both men and women fall ill with OA more frequently and have combined lesions of the spine and peripheral joints: 64.5 and 59.1% for women and men, respectively.
Terapevticheskii arkhiv. 2004;79(2):57-
pages 57- views

Administration of essential phospholipids in persons exposed to chemical industrial pollutants

Shpagina L.A., Bobrov S.V.


Aim. To examine efficacy of the drug essitver-forte in patients with chronic intoxication by a complex of such toxicants as soluble and unsoluble compounds of uranium, lead and mercury. Material and methods. The examination of bilirubin, synthesis of proteins and enzyme production by the liver, activity of free radical lipid oxidation and antioxidant defence was conducted in 42 persons (mean age 66,4 ± 4.2 years) occupationally exposed to chemicals (compounds of uranium, lead and mercury) for 12.6 ± 1.8 years. The patients were divided into two equal groups: patients of group 1 received standard therapy with enterosorbents, cerebral angioprotectors and alpha-tocopherol; patients of group 2 instead of alpha-tocopherol were given essliver-forte (2 capsules twice a day). Results. Patients of group 2 had significantly less frequent complaints for fatigue, anxiety, dyspnea, sleep disorders; improvement was observed in peripheral blood counts, in concentrations of alpha2and gamma-globulins, sulfhydril and catalase activity of erythrocytes; transaminase activity and intensity of saponin hemolysis went down. Conclusion. Essliver-forte is effective in persons occupationally exposed to chemicals.
Terapevticheskii arkhiv. 2004;79(2):63-66
pages 63-66 views

Nutrition, human endoecology, health, diseases. Current views on their relations

Tkachenko E.I.
Terapevticheskii arkhiv. 2004;79(2):67-71
pages 67-71 views

Optimal diagnosis and therapy of gastroesophageal reflux disease

Ivanikov I.O., Isakov V.A., Maev I.V.
Terapevticheskii arkhiv. 2004;79(2):71-75
pages 71-75 views

Classification of cholelithiasis

Ilchenko A.A.
Terapevticheskii arkhiv. 2004;79(2):75-78
pages 75-78 views

Enteropathy induced by nonsteroid anti-inflammatory drugs

Karateev A.E., Nasonova V.A.
Terapevticheskii arkhiv. 2004;79(2):79-82
pages 79-82 views

Medical care requirements after surgery on the stomach and gallbladder

Lazebnik L.В., Kopaneva M.I., Ezhova Т.В.
Terapevticheskii arkhiv. 2004;79(2):83-87
pages 83-87 views

HBeAg-negative chronic hepatitis

Ibragimova M.M., Krel P.E., Abdurakhmanov D.T.
Terapevticheskii arkhiv. 2004;79(2):87-91
pages 87-91 views

Practical aspects of "Heart Protection Studies"

Susekov A.V.
Terapevticheskii arkhiv. 2004;79(2):91-95
pages 91-95 views

Anatoly Sergeevich Loginov (the 80th anniversary of birth)

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Terapevticheskii arkhiv. 2004;79(2):95-96
pages 95-96 views

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