Vol 79, No 11 (2004)


Bene diagnoscitur, dene curator

Gogin Y.Y.
Terapevticheskii arkhiv. 2004;79(11):5-9
pages 5-9 views

Potentialities of non-invasive diagnosis of coronary arteriesanomalies by means of electron-beam tomography and multislice computed tomography

Veselova T.N., Sinitsyna S.V., Shiryaev A.A., Ternovoi S.K.


Aim. To assess diagnostic value of electron-beam computed tomography and multislice computed tomography (EBT and MSCT) for diagnosis of congenital anomalies of coronary arteries (CA). Material and methods. Non-invasive coronary angiography with EBT and MSCT has been performed in 1162 patients. Results. Different anomalies of coronary arteries have been found in 10 (0.9%) patients. Results of EBT and MSCT agreed with those of coronary angiography performed in 8 cases with CA anomalies. Though 720 of 1162 patients had coronary stenoses, no significant atherosclerotic lesions were found in anomalous CA. Conclusion. EBT and MSCT enable non-invasive screening and diagnosis of coronary arteries anomalies.
Terapevticheskii arkhiv. 2004;79(11):9-14
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Diagnosis of coronary atherosclerosis using stress echocardiography with bicycle exercise

Duplyakov D.V., Emelyanenko V.M., Svetlakova L.P., Goleva S.V., Sysuenkova E.V.


Aim. To determine sensitivity and specificity of stress echocardiography (SEC) in diagnosis of stenosing atherosclerosis of coronary arteries (CA), especially in patients recovered from Q-myocardial infarction. Material and methods. The above sensitivity and specificity were studied in 75 patients (70 males and 5 females; mean age 53.7 ± 7 years) with coronary atherosclerosis (CS). Results. The sensitivity of impaired local contractility index (IL CI) in univessel lesion was 77.8%, in multivessel lesion - 90.4%, specificity - 85.7%. Sensitivity of other parameters studied was for development of an anginal episode 65.4%, increment of ejection fraction under 5% - 63.9%, increased end systolic volume - 61.1 %, depression of ST segment - 48.1 %, increased end diastolic volume 38.9%. A total of 3 parameters had 100% sensitivity: impossible a > 5% rise of EF in response to exercise, an increase of end systolic and diastolic volumes, anginal attack (85.7%), ST depression (78.6%). Conclusion. Hemodynamic parameters must be assessed in the course of SECG for objectiviiation of the result and improvement of its specificity.
Terapevticheskii arkhiv. 2004;79(11):14-19
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Diagnosis of myocardialinfarction complicated by a complete block of His' bundleleft branch as shown by computed electrocardiotopography

Udovichenko I.A., Sukhanova G.I.


Aim. To assess efficacy of computed electrocardiotopography (CECT) in diagnosis of myocardial infarction (MI) complicated by a complete block of His' bundle left branch (HBLB). Material and methods. Twenty two patients with a complete block of HBLB have undergone CECT (hardware Rhythm-M, software "Rhythm"and "Heart"). Results. Five patients had no scars. The rest 17 patients had MI. The diagnosis of MI was definite by ECG in 6(35%) patients. In 11 (65%) patients MI diagnosis by ECG was doubtful. Only CECT detected typical for MI changes in the QRS changes. Conclusion. CECT can significantly detect scars in the myocardium in a complete block of HBLB and improves diagnostic potential of ECG.
Terapevticheskii arkhiv. 2004;79(11):17-23
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Long-term orthostatic and bicycle exercise tests in differential diagnosis of syncopal conditions of unclear origin

Pevzner A.V., Kuchinskaya E.A., Vershuta E.V., Albhskaya K.V., Helmets G.I., Tripoten M.I., Moiseeva N.M., Rogota A.N., Golitsyn S.P.


Aim. To study efficiency of bicycle exercise test and long-term orthostatic test in differential diagnosis of syncopes. Material and methods. The study included 113 patients suffering from recurrent syncopes of unclear origin. Twelve healthy volunteers were selected for assessment of the tests specificity. All the patients and controls were examined by means of long-term orthostatic test (LTOT) and bicycle exercise test (BET). Results. Specificity of both tests was 100%,. In LTOT syncopes were observed in 52(46%) cases, including vasovagal syncopes (51 patients), epileptic seizure (1 patient). BET induced vasovagal syncopes in 54(48%) patients. The results of both tests by inducing syncopes coincided in 30 (26%) cases. In 24(21%o) patients syncopes occurred only in BET while LTOT appeared uninformative. In 21 (18.6%) cases syncopes occurred only in LTOT while BET produced a negative result. 38 (34%) patients had syncopes neither in LTOT nor BET. Both tests induced syncopes in 75 (66%) patients. No complications were observed. Conclusion. LTOT and BET are safe and complementary methods in differential diagnosis of syncopes.
Terapevticheskii arkhiv. 2004;79(11):23-27
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Clinical features and diagnosis of congenital stenosis of the pulmonary artery and right ventricularoutlet tract

Khikmatov A.A., Makhmudov M.M., Zufarov M.M., Babazhanov К.В.


Aim. To analyse clinical manifestations of congenital pulmonary artery stenosis (CPAS) and right ventricular outlet stenosis (RVOS), development of its diagnosis depending on anatomic variants of heart disease. Material and methods. The data on 539 patients examined with conventional clinical and highly in- formative novel techniques were studied. Results. The analysis of the CPAS and RVOS clinical picture depending on the anatomic variant of the heart disease has shown that clinical symptomatology was of the same type. The data of the tests have some specific features allowing identification of some forms of the heart disease. Conclusion. Diagnostic and prognostic significance of the findings was determined which gave rise to an optimal examination scheme with focus on wider use of highly informative techniques.
Terapevticheskii arkhiv. 2004;79(11):27-30
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Arterial hypertension in adolescents with different physical constitution including those with signs of metabolic syndrome

Rovda Y.I., Kazakova L.M., Rovda T.S., Rovda E.Y.


Aim. Detection of clinico-paraclinical features of arterial hypertension (AH) in adolescents with different physical constitution including signs of metabolic syndrome (MS). Material and methods. Blood levels of uric acid, cholesterol, triglycerides (TG), high and low density lipoproteins were examined and glucose tolerance test was made in 108 adolescents with arterial hypertension (AH) and different physical constitution (normal, with overweight and obese). Waist and hip distribution of fat was assessed. The control group consisted of JOS healthy adolescents. Results. Most of the hypertensive children had hyperuricemia (HU), some of the patients combined HU with changes in glycemic profde of blood. The above abnormalities were especially evident in patients with MS who were characterized by abdominal obesity, higher blood pressure, subnormal high density lipoproteins, higher triglycerides and total cholesterol in blood, more severe HU and defects in glycemic profde of blood. Conclusion. MS in adolescents may be of genetic origin as well as constitutional HU and insulin resistance may be mutually dependent signs combination of which with other factors presents the whole spectrum of clinical and paraclinical manifestations of MS. Detection of HU and insulin resistance with their correction in a preclinical disease stage (in children and adolescents) may represent a new line in prevention of AH and MS in adults.
Terapevticheskii arkhiv. 2004;79(11):35-42
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Lisinopril effects on cerebral blood flow and blood rheology in hypertensive patients

Markova L.I., Kuznetsova I.V., Radzevich A.E.


Aim. To access the effect of lisinopril (diroton) on cerebral circulation and blood rheology in patients with arterial hypertension stage II. Material and methods. The trial included 37 patients (16 males, 21 females) with a mean arterial hypertension (AH) history 15.9 ± 5.6 years. Diroton was given in a dose 10-40mg/dayfor 6 months. Cerebral circulation (total cerebral circulation and venous outflow - TCC and VOF) was accessed by means of doppler ultrasonography. Blood and plasm rheology was determined using a rotational viscozymeter ACP-2. Instrumental tests were performed at baseline and at the end of the study. Results. Rheology tests showed that diroton-treated patients achieved a significant decrease in blood viscosity in high, moderate and low shear stress and plasma viscosity, a decrease in platelet aggregation index and an increase in the index of erythrocytic deformability. All these changes were accompanied with a significant fall in fibrinogen and hematocrit. Doppler ultrasound revealed an insignificant increase in TCC and VOF. Conclusion. Diroton significantly improved impaired blood rheology and viscosity in AH patients as well as cerebral hemodynamics in patients with subnormal cerebral circulation and venous outflow at baseline.
Terapevticheskii arkhiv. 2004;79(11):41-43
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Levofloxacin: role and place in the treatment of infections of the lower respiratorytracts

Sinopalnikov A.I., Romanovskikh A.G.
Terapevticheskii arkhiv. 2004;79(11):51-57
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How to diagnose functional (non-ulcerative) dyspepsia (a review)

Маеу I.V., Vyuchnova Y.S., Lebedeva Y.G., Yakimova S.S.
Terapevticheskii arkhiv. 2004;79(11):57-61
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Humoral and cellular adaptation mechanisms in development of intoxication syndrome in patients with acute viral hepatitis

Рак S.G., Volchkova Y.V., Umbetova К.Т.


Aim. To study endotoxin-binding function of blood in patients with acute viral hepatitis (AVH) in the course of the disease. Material and methods. A total of 335 patients with AVH were examined. The titers of IgG antiendotoxin antibodies to glycolipid of Re-chemotype were estimated in enzyme immunoassay (Diaendotox-2 kit), endotoxin-binding activity (EBA) of high density lipoproteins (HDLP) in EIA with the kit Liprobind (Microecos). The number of polymorphonuclear leukocytes (PL) binding lipopolysaccharides were counted by M. Yu. Yakovlev et al. method. For detection of PL binding endotoxin of gram-negative bacteria, kits Endim (Microecos) were used, beta2-microglobulin was estimated by a radioimmunoassay using kits made in Belarus Institute of Bioorganic Chemistry. Registration of chemoluminescence was conducted on chemiluminometer LBK 1251 (Finland) by M. Wilson (1985) method. Results. In moderate AVH at the height of intoxication a low Re-antibodies level was recorded irrespective of the disease etiology. To convalescence this level went up. PL reserves in AVH patients were low except patients with AVH С who had unaffected neutrophil reverves in relation to LPS binding. At the height of AVH, HDLP EBA was very high in all the groups with normalization to convalescence. In VHC high HDLP EBA persisted as long as the disease course. A significant rise of beta2-microglobulin was seen in all the groups of AVH patients, its severity correlating with the degree of the disease severity. Conclusion. One of the leading factors in development of indoxication in AVH patients is a lipopolysaccharide complex of gram-negative intestinal bacteria actively coming into blood flow due to hepatocyte cytolysis. In response to LPS action there appeared a stereotypic adaptation complex of reactions in the form of activation of cellular and humoral immune response.
Terapevticheskii arkhiv. 2004;79(11):61-65
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Invasive streptococcal (group A) infection : outlook on the problem (review)

Briko N.I., Malyshev N.A., Pokrovsky V.I.
Terapevticheskii arkhiv. 2004;79(11):65-68
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Combined antiretroviral therapy with nevirapine of HIV-infected adults

Kravchenko A.V.
Terapevticheskii arkhiv. 2004;79(11):68-71
pages 68-71 views

Antiphospholipid syndrome and exogenic factors ofthromboses risk

Mach E.S., Shirokova I.E., Reshetnyak Т.М., Tikhonova T.М.


Aim. To examine relationships between incidence rate of thromboses in antiphopholipid syndrome and exogenic risk factors (RF) of thrombosis. Material and methods. The trial enrolled 131 patients (105 females and 26 males). They were divided into three groups: 23 patients with systemic lupus erythematosus (SLE, group 1), 63 patients with SLE and antiphospholipid syndrome (APS, group 2), 45 patients with primary APS (PAPS, group 3). Thrombosis RF questionnaire survey was made. Effects of corticosteroids and cyclophosphamide on occurrence of thrombosis were assessed. Results. Such exogenic RF as intake of coffee, fat food, alcohol were not related to thromboses. Hypodynamia was more typical for APS patients (21.3%) than for SLE patients free of APS (8.7%). Overweight for was characteristic for APS patients (49 and 34.7%, respectively). The proportion of smokers was higher in APS patients, though smoking did not provoke thrombotic complications. A direct correlation was found between occlusion and corticosteroids administration, while occlusion and cyclophosphamide treatment correlated inversely. Conclusion. Venous thrombosis RF in patients with APS and PAPS are obesity and treatment with glucocorticosteroids
Terapevticheskii arkhiv. 2004;79(11):71-74
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Immunological features of rheumatoid arthritis in patients infected withviruses of hepatitis В, С and cryoglobulinemia

Balabanova R.M., Shekshina Е.V., Kozlov L.V.


Aim. To specify immunological features of rheumatoid arthritis (RA) associated with hepatitis В, С viruses (HBV, HCV) and cryoglobulinemia (CGE). Material and methods. Four groups of patients with verified RA were examined immunologically: infected with HCV, infected with HBV, with CGE diagnosed by the capillary method, free of HBV, HCV, CGE. CGE was estimated by the spectrophotometry method, functional activity of the complement components - by hemolytic micromethod. Polymerase chain reaction, identification of serological markers of viral hepatitides В and С were conducted with application of commercial kits produced in Russia Results. In RA patients infected with HBV and HCV, functional activity of the complement was significantly reduced. RA patients with hepatitis С and CGE showed hypoactivity of all the complement components. A classic course of RA was associated with elevated levels of CI and C3 components in normal values of Clq, C2, C4 and C5 components. CGE was highest in RA+HCV and RA+CGE groups. Conclusion. The study of immunological features of RA associated with HCV, HBV and CGE is important not only in scientific but also in practical aspect as it indicates the necessity of treating the above conditions with drugs which do not suppress complement system significantly.
Terapevticheskii arkhiv. 2004;79(11):74-77
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Polymorphism ofclinical symptoms of connective tissue dysplasia syndrome

Makolkin V.I., Podzolkov V.I., Rodionov A.V., Sheyanov M.V., Samoilenko V.V., Napalkov D.A.
Terapevticheskii arkhiv. 2004;79(11):77-80
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Dysplasia ofconnective tissue and pregnancy (review)

Klemenov A.V., Tkacheva O.N., Vertkin A.L.


Terapevticheskii arkhiv. 2004;79(11):80-83
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Genital prolapse in women and articular hypermobility in connective tissue dysplasia

Smolnova T.Y., Savelyev S.V., Grishin V.L., Yakovleva N.I.


Aim. To examine relationships between genital prolapse and joint hypermobility (JHM), between GP severity and degree of JHM, to reveal causes of GP in JHM patients. Material and methods. A total of 208 females with GP (meam age 38.9 years) entered the trial. They were divided into three groups by severity of connective tissue dysplasia (CTD): with mild CTD -16.3%, moderate CTD - 35.6% and severe CTD - 48.1%. The following methods of investigation were used: podometric Freedland's technique, ultrasonic investigation of the gall bladder, kidneys, echocardiography, morphological study of platelets, morphological and immunohistochemical study of the ligaments. Results. In GP patients JHM occurred in 41.8% patients. Hypermobility of large joints reaches 38.9%, large - 20.7%. Such associated manifestations of CTD as flatfoot, JHM, deformation of the spine, varicosity, predisposition to vegetovascular dysfunctions, mitral prolapse, arrhythmia, impaired conduction, refraction, gastroptosis, nephroptosis, hernias were observed in 69.2, 46.1, 38, 53.8, 49, 43.3, 38, 19.2, 12, 6.7, 14.4%, respectively. The morphological changes are explained by 40 + 15% type 1-3 collagen loss in the interstitial substance. Severe forms of GP in patients with JHM were ob- served in 84%. 52.4% females with JHM developed severe GP within 3 years after delivery of a child. Most of the examinees carried undifferentiated congenital dysplasias. Conclusion. JHM is a criterion of CTD diagnosis
Terapevticheskii arkhiv. 2004;79(11):83-88
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Vitrum osteomag in prevention of osteoporosis inpostmenopausal women: results of the comparative openmulticenter trial

Benevolenskaya L.I., Toroptsova N.V., Nikitinskaya O.A., Sharapova E.P., Kororkova T.A., Rozhinskaya L.Y., Marova E.I., Dzeranova L.K., Molitvoslovova N.N., Menshikova L.V., Grudinina O.V., Lesnyak О.M., Evstigneeva L.P., Smetnik V.P., Shestakova I.G., Kuznetsov S.Y.


Aim. To investigate efficacy, tolerance and safety of the drug vitrum osteomag one tablet of which contains 600 mg calcium (1500 mg calcium carbonate), 200IU of cholecalcepherol, 40 mg of magnesium, zinc (7.5 mg), copper (1 mg), manganese (1.8 mg) and boron (250 meg) in women with osteopenia for prevention of osteoporosis Material and methods. Л multicenter comparative open trial ofvitrum osteomag influence on mineral bone density (MED), change of pain syndrome in bones, index of calcium-phosphorous metabolism covered 334 postmenopausal women with osteopenia. MBD was measured in low-back spine and proximal part of the hip with DEXA method. All the patients were divided into 3 groups: 125 women taking 2 tablets ofvitrum osteomag daily for 12 months (group 1); 111 women taking 1500 mg calcium carbonate (group 2); 96 women - control group (only observation). Results. Vitrum osteomag relieved pain in the back and joints, had a positive effect on bone density (+1.5%) and proximal parts of the hip (0.6-0.93%) exceeding the effect of calcium carbonate only which preserves the initial MBD in low back spine but does not prevent bone loss in the hip. MBD dynamics in patients given vitrum osteomag differs essentially from one in the control group (from -1.9 to -2.91%) which demonstrates a reliable preventive anti-osteoporotic effect of this medication. The drug increases the level of general and ionized calcium in blood but does not cause hypercalcemia lowering the level of parathormone in blood. The rate of side effects in group 1 was 14,4% and did not differ much from that in group 2 (16.2%). Conclusion. The results of the study allow to recommend vitrum osteomag for prophylaxis of a rapid loss of bone tissue mineral density.
Terapevticheskii arkhiv. 2004;79(11):88-93
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Structum therapy of patients with rheumatoid arthri-tis

Shmidt Y.I., Belozerova I.V., Akhmedzhanov F.M., Soldatov D.G.


Aim. To study efficacy of the chondroprotector chondroitin sulphate (structum, Pier Fabr Medicament Production, France) in patients with rheumatoid arthritis (RA) and secondary osteoarthrosis of the knee joints. Material and methods. 15 women with a long history of RA (mean duration 11.9 years) entered an open non-randomized trial of structum. The patients had a severe progressive highly active RA with a definite x-ray stage of the disease. 13 patients had a positive rheumatoid factor (1:80 to 1:1280) and involved knee joints which had been affected for 1 to 10 years (mean 5.3 years). The second x-ray stage was in 8 patients, the third stage of knee joints arthrosis was in 7 ones. A marked pain syndrome in the knee joints upon movement (mean 64.7 mm by VAS) was observed in all the examinees and at rest (mean 28 mm by VAS) in 13 of 15 patients. Structum was given according to a standard scheme: 500 mg 3 times a day for 3 weeks than 500 mg 2 times a day for up to 6 months. Basic drugs for RA were the same for all the observation period. Results. Structum noticeably improved knee joint function (mean Leken's index 12.8, 11.3 and 9.4 scores before the treatment, on treatment month 3 and 6. Movement pain syndrome VAS reduced from 64.7 mm at the strart to 51 mm 3 months and 37.5 mm 6 months later, rest VAS - from 19 to 10.3 and 6.4 mm, respectively. The demand in intraarticular glucocorticoids went down from 52 injections at the start of therapy to 6 after 6 months. Side effects for 6 months were absent. Overall efficacy was good (73.3% and 80%) as judged by the doctors and patients, respectively. After 6 months of therapy control x-rays found no progression of destructive changes in the knee joints (by MRI - in 4 patients). Conclusion. Structum has a marked positive therapeutic effect in patients with severe and long-term course of RA with associated pronounced secondary joint arthrosis.
Terapevticheskii arkhiv. 2004;79(11):93-95
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Characteristics of erythropoiesis regulation in population living at high altitude

Makeshova А.В., Levlna A.A., Mamukova Y.L., Raimzhanov A.R.


Aim. To study characteristics of iron deficiency anemia (IDA) in native population of high altitude territories. Material and methods. 1300 women living in Tien-Shan areas were examined for serum and erythrocytic ferritins (SF and EF), general iron-binding capacity of the serum, transferrin saturation with iron, transferrin, soluble transferrin receptor (TR), erythropoietin (EP), Hb, erythrocytes, erythrocytic indices. Results. Regulation of erythropoiesis in women living at high altitude is specific, i.e. disagreement between complete depletion of iron (by SF and EF) and normal level of Hb, erythrocytes, EP and TR. Conclusion. It is suggested that in population living at high altitudes (3000 m above the sea level and higher) long-term adaptation to hypoxia gave rise to an original mechanism of erythropoiesis regulation when all coming iron participates in hemoglobin synthesis without iron deposition. Under hypoxic hypoxia regulation of erythropoiesis is directed to prevention of tissue hypoxia.
Terapevticheskii arkhiv. 2004;79(11):95-97
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Hypomagnesemia in patients with chronic alcoholism in thecourse of alcohol withdrawal syndrome

Stasyukinene V.R., Pihinis V.K., Reingardene D.I.


Aim. To ascertain hypomagnesemia (HM) rate in patients with chronic alcoholism (CA) with alcohol withdrawal syndrome (AWS); correlation between AWS severity and HM rate. Material and methods. Mg in plasm was measured at photometry in 129 CA patients treated in Kaunas Mental Hospital. Results. Plasma Mg in CA patients with A WS was reduced (< 0.749 mmol/l), normal (0.750-1.250 mmol/l) or high (> 1.251 mmol/l) in 28.7, 65.1 and 6.2% patients, respectively. HM was diagnosed in 42.3% with a severe, 19.1% with a moderate and 20.0% with weak AWS. Conclusion. HM in AWS was registered in 28.7% patients. It occurred significantly more frequently (p < 0.05) in patients with a severe AWS. Pathogenetic mechanisms of HM in AWS are described
Terapevticheskii arkhiv. 2004;79(11):97-99
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Iatrogeny: role of E. M. Tareev and hisschool in updated understanding of the problem

Ostapenko V.M.
Terapevticheskii arkhiv. 2004;79(11):99-103
pages 99-103 views

Forum of Russian Infectiologists

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Terapevticheskii arkhiv. 2004;79(11):103-104
pages 103-104 views

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