Vol 79, No 8 (2004)

Articles
Cybernetics in cardiology (yesterday, today,tomorrow)
Sidorenko С.I.
Abstract
Terapevticheskii arkhiv. 2004;79(8):1-9
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Experimental and clinical assessment of antioxidant efficacy of multicomponent antioxidant medication
Lankin V.Z., Tikhaze A.K., Konovalova G.G., Lisina M.O., Nezhdanova I.В., Gomboeva S.В., Kukharchuk V.V., Belenkov Y.N.
Abstract
Aim. To study an antioxidant action of antioxidant vitamins (vitamins С, Е and provitamin A) in vitro and in vivo. Material and methods. The study was made of kinetic parameters of copper-initiated free radical oxidation (FRO) of low density lipoproteins (HDLP) in human blood plasm, antioxidant potential of rat liver and myocardium, the level of FRO products in HDLP and activity of glutathione peroxidase in erythrocytes of 31 males aged 40-64 years with coronary heart disease (CHD). Results. An antioxidant action of the combinations alpha-tocopherol+ascorbic acid and alpha-tocopherol+beta-carotin was much more potent than that of each of the component alone. The whole complex of the antioxidants completely suppressed FRO of HDLP in the model system. Feeding rats for 30 days with a complex of antioxidant vitamins and selenium produced a sharp enhancement of the antioxidant potential of the liver and a complete suppression of free radical processes in the myocardium. If this complex was given to CHD patients for 2 months, it sharply reduced the amount of FRO primary and secondary products in blood plasm LDLP in growing activity of erythrocytic selenium-containing glutathione peroxidase. Conclusion. The scheme is proposed for objective experimental assessment of antioxidant efficacy of multicomponent antioxidant medication in laboratory and clinical trials.
Terapevticheskii arkhiv. 2004;79(8):10-14
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Efficacy and safety of hydrogen sulfide balneotherapy in ischemic heart disease in the arid zone
Zunnunov Z.R.
Abstract
Aim. To evaluate efficacy of hydrogen sulfide (HS) balneotherapy in patients with coronary heart dis- ease (CHD) in conditions of heat discomfort. Material and methods. The study included 72 CHD patients aged 35 to 60 years with stable angina pectoris of the second functional class taking balneotherapy in summer under arid climatic conditions. Before and after balneotherapy the patients were examined with estimation of clinical symptoms, stress bicycle exercise (SBE) parameters, number of nitroglycerine tablets. Results. The balneotherapy resulted in a significant prolongation of SBE (p < 0,0018), in longer time to depression of the ST segment by 1 mm (p < 0,01), to an anginal attack in the course of SBE (p < 0,0036), shorter duration of pain after SBE (p < 0,001), less number of anginal attacks (p < 0,0002) and reduced need in short-acting nitrates (p < 0,0002). Conclusion. In a hot climate of the arid zone use of moderate HS baths raises tolerance of CHD pa- tients to exercise, attenuates clinical manifestations of CHD and, consequently, reduces daily need in nitrates.
Terapevticheskii arkhiv. 2004;79(8):15-17
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Dysaggregants effect of platelet aggregation in patients with non-5T segment elevation acute coronary syndrome
Poponina T.M., Kapilevich N.A., Kisteneva I.V., Markov V.A., Novitsky V.V.
Abstract
Aim. To study efficacy of treating patients with acute coronary syndrome (ACS) without ST segment elevation (STSE) with platelet dysaggregation drugs (aspirin, cardiomagnil, clopidogrel). Material and methods. 78 ACS without STSE were randomized into five groups: group 1 patients (n = 17) received no dysaggregants; patients of group 2 (n = 26) received aspirin in the dose 250 mg on the day of admission and then 125 mg/day; group 3 was given cardiomagnil (150 mg on the day of admission and then 75 mg/day, n = 17); group 4 - clopidogrel 75 mg/day (n = 7); group 5 - combination of clopidogrel 75 mg/day with cardiomagnil 75 mg/day (n = 11). All the patients were administered fraxiparin 86 IU/kg sc each 12 hours for 5-8 days. Results. Group 1 patients showed platelet hyperaggregation, platelet aggregation decreased in groups 2, 3 and 4 (6 patients of group 1 were resistant to aspirin). The highest antiaggregation effect was achieved in group 5. Conclusion. Control over antiaggregation treatment in patients with ACS without STSE by monitoring of platelet function open broad opportunities for selection of effective individual therapy.
Terapevticheskii arkhiv. 2004;79(8):18-21
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Effect of long-term epidural analgesia and nitroglycerin infusion on formation of necrosiszone and clinical course of myocardial infarction
Tumak V.N., Dzizinsky A.A.
Abstract
Aim. To study effects of long-term morphine-clofelin epidural analgesia and infusion of nitroglycerin on formation of the necrosis focus and the clinical course of acute myocardial infarction (MI). Material and methods. Ninety patients were examined within the first 12 hours of anterior macrofocal MI. Forty six patients of the study group received long-term morphine-clofelin epidural analgesia and nitroglycerine infusion within the first 24 hours of the disease. Forty-four control patients were anes- thetized conventionally with intravenous morphine. Development of MI was assessed with electrocardi- otopography and dynamic examination of MV CK in the blood serum. Results. The degree and area of the myocardial lesion were initially similar in the study and control groups. These indices were less in dynamics in the study group. On MI day 5 and 10 myocardial necrosis zone significantly diminished in the study group. Conclusion. Long-term epidural analgesia and nitroglycerin infusion provide effective analgesia, lo- calizes the ischemic and necrotic focus, have a good effect on hemodynamics and improve a MI clini- cal course.
Terapevticheskii arkhiv. 2004;79(8):22-24
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A course of coronary heart disease and quality of life in patients with varying depressivestates
Ibatov A.D., Syrkin A.L., Vein A.M., Syrkina E.A., Sulimov V.A., Lomakin V.V.
Abstract
Aim. To study a course of coronary heart disease (CHD) in patients with depressive disorders. Material and methods. The trial included 77 CHD patients aged 39 to 68 years (mean age 54.9 + 0.9 years), 40 (51,9%) of them had myocardial infarction. All the examinees had effort angina of functional class II-IV by criteria of the Canadian Cardiology Association. All the patients have undergone standard clinical examination, stress tests, coronaroangiography (n = 30), assessment of the degree of vegetative dystonia and quality of life. The patients were divided into two groups depending on the depression degree. Results. CHD patients with manifest depression vs those with subclinical depression had a higher level of personality and reactive anxiety. They had neurotic and psychopathological personality alterations associated with more pronounced vegetative disorders. These patients suffered from more severe coronary atherosclerosis, more hospitalizations for the previous year, more myocardial infarctions, lower physical activity and quality of life. Conclusion. CHD patients with manifest depression have lower physical performance and quality of life though this is not confirmed at exercise tests.
Terapevticheskii arkhiv. 2004;79(8):25-27
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Thiaside diuretics in combination with inhibitors of angiotensin-converting enzyme in patients with diabetes mellitus type 2 comorbid with arterial hypertension
Chazova I.E., Mychka V.В., Duishvili D.E.
Abstract
Aim. To study the effect of corenitek monotherapy for 16 weeks on parameters of 24-h monitoring of arterial pressure, carbohydrate, lipid, purin metabolism in patients with mild and moderate arterial hypertension (AH) and diabetes mellitus (DM) type 2. Material and methods. 20 patients with DM type 2, mild or moderate AH received co-renitek (1-2 tablets a day) for 16 weeks. Before the treatment and 16 weeks later the patients were examined (24h AH monitoring, carbohydrate, lipid, purin, electrolyte metabolism). Results. Co-renitek treatment of DM type 2 patients with hypertension led to a significant lowering of mean systolic and diastolic pressure, improvement of 24-h AP profde and reduction of fasting glucose level. Co-renitek proved to be metabolically neutral in relation to lipid, purin and electrolyte metabolism. Conclusion. Co-renitek is effective and safe antihypertensive drug for treatment of arterial hypertension in patients with diabetes mellitus type 2.
Terapevticheskii arkhiv. 2004;79(8):28-31
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Propranolol treatment ofeffort angina in patients with arterial hypotension
Idrisova E.M., Boschenko A.A., Borovkova N.V., Demochko A.V., Chernov V.I., Karpov R.S.
Abstract
Aim. To compare antianginal efficacy and tolerability of propranolol therapy in patients with stable angina pectoris and chronic hypotension (Hpts) and normotensive patients with angina of effort (Npts). Material and methods. A randomized, single-blind, placebo-controlled study was made in 35 Hpts and 38 Npts was made using bicycle exercise tests, echocardiography, stress myocardial scintigraphy with Tl-199. Results. Acute bicycle exercise tests showed high anti-ischemic activity of propranolol in 86% Hpts and 65% Npts. Stable antianginal propranolol effect in 57% Hpts was accompanied with a decrease of myocardial perfusion defect. Secondary resistance or pseudotolerance to an antianginal effect of pro- pranolol was observed in 43% Hpts in 4-12 weeks (vs 0 of Npts; p < 0,01) as evidenced by Tl-199 stress myocardial scintigraphy. Hpts with secondary resistance and pseudotolerance to propranolol had lower control hypotension and bradicardia (p < 0,05), more anginal attacks (p < 0,001). Conclusion. Hpts had rapidly developing secondary resistance and pseudotolerance to propranolol an- tianginal effect, bad tolerability of the drug.
Terapevticheskii arkhiv. 2004;79(8):32-35
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Structure ofthe sinus dysfunction in hypertensive patients
Tuev A.V., Poteshkina N.G., Grigoriadi N.E.
Abstract
Terapevticheskii arkhiv. 2004;79(8):36-37
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Results of midodrin treatment of vasovagal syncope
Kuchinskaya Е.A., Pevzner A.V., Vershuta E.V., Albitskaya K.V., Heimets G.I., Rogoza A.N., Golitsyn S.P.
Abstract
Aim. To elicit efficacy ofmidodrin in patients with vasovagal syncope. Material and methods. 50 patients with recurrent vasovagal syncope documented by head-up tilt tests or bicycle exercise stress tests participated in the study. These tests controlled the effects ofmidodrin if syncopes occurred again in repetition of the tests. In the other patients the effect of the drug was assessed clinically. All the patients received midodrin in daily dose up to 15 mg. Results. Mirodrin effectively prevented syncope in 13 (72%) patients as shown by the tilt test, in 10 (59%) patients as shown by the exercise stress tests and in 14 (93%) patients as controlled clinically. Total efficacy ofmidodrin was 74% (37 of 50 patients). Conclusion. Midodrin demonstrated high efficacy in prevention of vasovagal syncope. Side effects were not serious therefore the drug is well tolerated.
Terapevticheskii arkhiv. 2004;79(8):38-46
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How to manage patients with atrial fibrillation in a general hospital
Nazarenko G.I., Lazebnik L.В., Zamiro T.N., Kashevskaya O.P.
Abstract
Aim. To evaluate efficacy of use of technological charts (TC) in upgrading management and treatment safety in patients with atrial fibrillation (AF). Material and methods. Two groups of AF patients were compared: 196 patients treated before introduction of TC (group 1) and 431 patients managed according to TC technology (group 2). Results. In group 2 treatment duration reduced from 26.1 to 18.5 days, ^hospitalizations occurred by 6% less frequently, number of unexpected side effects fell 2.5-fold, the rate ofvarfarin prescription for prevention of thromboembolic complications rose from 18 to 64%, the patients were satisfied with the treatment in 97% vs past 79%. Conclusion. TC was a tool of treatment improvement and introduction of the latest clinical recommendations into clinical practice with reference to facilities and staff qualification of an individual hospital without additional financial input.
Terapevticheskii arkhiv. 2004;79(8):47-47
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Effective control of a severe exacerbation of bronchial asthma
Makolkin V.I., Ovcharenko S.I., Peredelskaya O.A.
Abstract
Aim. To evaluate effectiveness and safety of nebulizer therapy (NT) with broncholytics and pulmicort suspension (PS) in patients with a severe exacerbation of bronchial asthma (BA). Material and methods. 75patients with a severe BA exacerbation received broncholytic NT with consideration of comorbid pathology and age. Nebulized PS was used as an alternative to systemic glucocorticosteroids (SGCS). NT efficacy was assessed by changes in clinical symptoms, in the peak expiration velocity (PEV) and spirometry parameters. Safety was controlled by 24-h ECG monitoring, pulsoximetry. PS was examined for effect on adrenal cortex, calcium metabolism, oral infection with Candida. Side effects were registered. Results. Clinical improvement was recorded in all the patients. NT reduced the number of additional inhalations of short-acting beta2-agonists 4-5 times, on the average. In the end of NT there was a 4.66% increase in Sa02 vs the initial value (p - 0.04). PEV and FEVl increased. Plasm levels of hydrocortisone and its urine excretion did not lower vs initial values. Conclusion. The results of the study point to efficacy and safety of combined NT with broncholytics and PS in a severe exacerbation of В A.
Terapevticheskii arkhiv. 2004;79(8):48-50
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Efficacy of a complementaryantiinflammatory treatment with erespal in chronic obstructive and non-obstructive bronchitis
Volkova L.I., Budkova A.A., Filonova N.N., Khristolyubova E.I., Kutuzova E.В., Koroleva N.V., Radzivil Т.Т., Aminova Z.R., Chuchalin A.G.
Abstract
Aim. To compare efficacy ofatrovent alone and in combination with erespal in patients with chronic bronchitis (CB) and chronic obstructive pulmonary disease (COPD). Material and methods. Of 80 participants of the trial (51 male and 29 female - 63.75 and 36.25%, respectively) who had CB or COPD, 39 patients (28 with CB and 11 with COPD) received 6-month combined treatment with erespal (160 mg/day) and atrovent (160 meg/day) and 41 patients (32 with CB and 9 with COPD) received atrovent monotherapy in the same dosage. Results. Combined therapy produced positive changes in dyspnea, sputum characteristics and its discharge, cough, monotherapy improved sputum discharge and relieved cough; pulmonary ventilation improved in both groups especially in those on monotherapy. CB patients showed low cytosis, percentage and absolute count of neutrophils, absolute count of lymphocytes and eosinophils in induced sputum. In С В patients percentage of lymphocytes reduced while count of macrophages went up. Combined treatment including erespal also promoted a significant fall of serum and sputum TNFa and IL-8 reduction in the sputum. Conclusion. Erespal+atrovent treatment proved more effective than atrovent alone. It is recommended for both CB and COPD patients without marked disorders of external respiration function.
Terapevticheskii arkhiv. 2004;79(8):51-55
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Vasaprostan treatment of fibrosing alveolitis in patients withpulmonary hypertension
Popova E.N., Bolevich S.В., Litvitsky P.E., Arkhipova D.V., Osipenko V.I., Kogan E.A., Kornev В.М., Mukhin N.A.
Abstract
Aim. To study clinical efficacy of vasaprostan in patients with fibrosing alveolitis (FA) complicated by pulmonary hypertension (PH), its effect on functional activity of platelets and endothelium, intensity of free radical processes. Material and methods. Seven FA patients were examined. They had either idiopathic FA or FA with diffuse diseases of the connective tissues. The following methods were used to assess the effect: standard clinical tests, high resolution computer tomography, Doppler echocardiography, definition of the complex thrombin-antithrombin (TAT) and thrombocytic factor 4 (TF-4). Generation ofoxugen active forms by leukocytes was measured by luminol-dependent chemiluminescence. Morphological verification of the diagnosis was made by the results of open pulmonary biopsies. Results. Vasaprostan reduced pressure in the pulmonary artery from 31,6 ± 2,31 to 19,58 ± 3,90 mm Hg (р < 0,05) and coagulation parameters. TAT decreased after 2 and 8 weeks of treatment from 15,25 ± 4,5 to 5,1 ± 0,33 and 2,4 ± 0,31 pg/ml (p < 0,05). Initially low TF-4 (2,11 ± 0,39pg/ml) elevated to the end of the treatment and reached values close to control (4,37 ± 0,25 pg/ml, p < 0,05). Moreover, vasaprostan enhanced the ability of platelets to inhibit generation of active oxygen forms (from 0,9 ± 0,18 to 1,23 ± 0,16 r.u., p < 0,05) and thus depressed activity of lipid peroxidation. Conclusion. Good effect of vasaprostan on platelet activity, free radical processes validates its use in combined treatment of various FA forms for correction of PH, its complications and as an antifibrogenic agent.
Terapevticheskii arkhiv. 2004;79(8):56-60
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Prognostic implications of mixed monoclonal cryoglobulinemia in Sjogren'sdisease
Vasilyev V.I., Probatova N.A., Varlamova Y.Y., Tupitsyn N.N., Simonova M.V., Safonova T.N., Bozhieva L.A., Shornikova N.S., Logvinenko O.A., Belinin G.Y., Gorodetsky V.R., Radenska-Lopovok S.G.
Abstract
Aim. To specify the risk of severe systemic manifestations and transformation into malignant lymphoma in Sjogren's disease (SD) patients with monoclonal mixed cryoglobulinemia (MMC). Material and methods. A prospective study performed in 1985-1990 included 248 SD patients followed up after the initial detection of monoclonal immunoglobulins (Ig) with serum active rheumatoid factor (RF). The patients' cryoglobulins (CG) were examined. The type of CG was determined by electrophoresis in agarose gel combined with immunofixation and Immunoelectrophoresis with monospecific antisera to heavy and light Ig chains. Biopsies of the lower lip salivary glands and skin were made in all the patients with MMC and 40 patients without CG. The biopsies were studied histologically, histochemically and immunomorphologically. Clinical symptoms and prognosis were studied in all the patients observed in 1985-2000 after the initial diagnosis of MMC. In suspected lymphoma development, histological and immunophenotypical studies of lymph node, bone marrow biopsies, trephine biopsies were made as well as myelograms, Ga-67 scintigraphy, CTofthe thoracic and abdominal cavities. The total of clinical, morphological, immunophenotypical and cytogenetic characteristics of lymphoma was estimated by REAL classification. Results. CG at first examination was detected in 50 (20.2%) of 248 patients with SD. 20 (40%) of 50 patients were diagnosed to have MMC with monoclonal IgM% (19) and IgA (1) in the serum with RF activity. Ten (50%) patients with MMC developed lymphoma after 10.9 ±3.3 years, on the average. In the absence of CG lymphoma developed in 5.5% (p < 0.001). B-cell intoxication in patients with diffuse lymphadenopathy, foci of lymphoid infiltration in the lungs, ulcers of the cms and such indices as stab neutrophilic shift, monocytosis, hypoproteinemia with hypogammaglobulinemia, disappearance of the RF, CG, low CIC level, immunodeficiency of monoclonal Ig and appearance of the protein BJ in the urine are markers of developing large B-cell immunosecreting lymphomas. Highly aggressive diffuse LCL resulted in death of 70% SD patients with MMC; 30% died of immunocomplex cryoglobulinemic vasculitis. 10-15-year survival of SD patients after detection of MMC was 50%, free of CG - 97% (p < 0.001). Conclusion. MMC is a definite serological marker of developing lymphoma and ulcerative-necrotic vasculitis in SD. In detection of MMC in SD patients it is necessary to prescribe early pathogenetically validated treatment before development of life threatening manifestations.
Terapevticheskii arkhiv. 2004;79(8):61-67
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Structum in combined treatmentof low back pain syndrome
Mazurov V.I., Belyaeva I.B.
Abstract
Aim. To assess duration of a clinical response and tolerance ofstructum in patients with low back pain (LBP) and comorbid cardiovascular disease. Material and methods. 25 patients with primary LBP and coronary heart disease (n = 13) and/or essential arterial hypertension (n = 18) were examined and treated for 6 months with structum. Results. To the end of the first treatment months structum significantly relieved pain intensity, spinal motility, increased exercise tolerance. Excellent and good response to structum were observed in 71% patients, no response was in 29%. Tolerance of the drug was good in 23 (92%) patients. The effect persisted for 3 months. СНГ) characteristics did not change while arterial pressure went down noticiably. Conclusion. Structum is highly effective in the treatment of LBP. Its long-term intake had no effect on CHD.
Terapevticheskii arkhiv. 2004;79(8):68-71
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Effects of interferon therapy onfunctional activity of platelets in chronic viral hepatitis andcirrhosis of the liver
Yagoda A.V., Koroi P.V.
Abstract
Aim. To characterize effects of interferon alpha (If-a) on functional activity of platelets in patients with chronic viral hepatitis (CVH) and viral hepatic cirrhosis (VHC). Material and methods. Induced platelet aggregation (PA), spontaneous PA, levels of cAMP, cGMP and glycogen in platelets, plasm beta-thromboglobulin (bTG) and activity of thrombocytic factor 4 (TF4) were measured in 95 patients before, 4.5h after the first If-a introduction, after 12 and 24 weeks of If-a treatment. Results. The patients demonstrated low induced PA, intracellular glycogen and high cAMP, b- TG amd TF4. The initial administration of If-a led to normalization of most of functional platelet indices. A 24-h course of If-a therapy normalized platelet functions irrespective of stability of the virusological response. Conclusion. If-a preparations in single and multiple administrations normalize platelet function.
Terapevticheskii arkhiv. 2004;79(8):72-73
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Ways of modification of food fatsin antiatherogenic diet
Perova N.V., Oganov R.G.
Abstract
Terapevticheskii arkhiv. 2004;79(8):75-78
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Efficacy of low-intensivelaser irradiation in coronary heart disease
Amirov N.В., Abdrakhmanova A.I.
Abstract
Terapevticheskii arkhiv. 2004;79(8):79-81
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The problem ofpreventing vascular restenosis after implantation of a coronary stent
Sumarokov А.В., Samko A.N., Naumov V.G.
Abstract
Terapevticheskii arkhiv. 2004;79(8):82-85
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Thrombotic thrombocytopenic purpura: diagnosis and treatment
Filatov L.В., Spirin A.V.
Abstract
Terapevticheskii arkhiv. 2004;79(8):86-89
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History of the studies of senile aortic stenosis (the100th anniversary of I. Munkeberg's publication)
Egorov I.V.
Abstract
Terapevticheskii arkhiv. 2004;79(8):90-92
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Internal Diseases. Textbook. Ed.A. I. Martynov, N. A. Mukhin, V. S. Moiseev, A. S.Galyavich
Fomina I.G., Marinin V.F.
Abstract
Terapevticheskii arkhiv. 2004;79(8):93-93
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N. M. Kolomoets, V. I. Baksheeva. EssentialHypertension and Coronary Heart Disease
Silvestrov V.P.
Abstract
Terapevticheskii arkhiv. 2004;79(8):94-94
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Alexander Borisovich Zborovsky (the 75th anniversary of birth)
- -.
Abstract
Terapevticheskii arkhiv. 2004;79(8):95-95
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