Vol 80, No 12 (2008)

Problems of clinical trials of new drugs as a basis of modern evidence-based medicine
Moiseev V.S., Moiseev V.S.
Terapevticheskii arkhiv. 2008;80(12):5-10
Effects of age-related androgen deficiency on clinicopsychological characteristics of patients with ischemic heart disease
Kravchenko A.Y., Provotorov V.M., Kravchenko A.Y., Provotorov V.M.
Aim. To study prevalence of androgen deficiency and its relations with clinicopsychological disorders in males with ischemic heart disease (IHD). Material and methods. A total of 87 males aged 31-60 years (58 with stable angina of effort FCII- III, 29 with progressive angina of effort) participated in the study. Clinical symptoms of androgen deficiency, severity of anxiety and depression, quality of life were characterized with scales AMS, HADS, D.M. Aronov and V.P. Zaitsev method (2002), respectively. Left ventricular myocardial mass (LVMM) was calculated according to R.Devereux and N. Reichek formula. Results. Symptoms of male sexual hormones deficiency were seen in 67.8% examinees. In the age groups 31-40, 41-50, 51-60 years androgenic deficiency was diagnosed in 50, 85.7 and 82.9% patients, respectively. A direct correlation was found between androgenic deficiency and total cholesterol (R = 0.38), prothrombin index (R = 0.39), LVMM index (R = 0.48), severity of depression (R = 0.71), anxiety (R = 0.5) and inverse correlation - between androgenic deficiency and quality of life (R = -0.69). Conclusion. Young and middle-aged patients with ischemic heart disease have symptoms of androgenic deficiency in 67.8% cases. This fact necessitates screening testing of such patients with AMS questionnaire. Male sex hormones deficiency is associated with high anxiety and depression, while quality of life is subnormal.
Terapevticheskii arkhiv. 2008;80(12):10-13
Antihypertensive and organ-protective action of a 36-week monotherapy with telmisartan in hypertensive patients
Petriy V.V., Sergushkina N.G., Brazhnik V.A., Makolkin V.I., Petry V.V., Sergushkina N.G., Brazhnik V.A., Makolkin V.I.
Aim. To study hypotensive effectiveness and organ-protective properties of telmisartan in patients with essential hypertension (EH). Material and methods. The trial enrolled 33 patients with EH of stage II, blood pressure (BP) elevation of the first and second degree, with ultrasound-diagnosed left ventricular (LV) hypertrophy and/ or increased thickness of intima-media complex (IMC) of the muscular-elastic vessels. The patients received 40-80 mg/day telmisartan monotherapy for 36 weeks. Hypotensive efficacy of the drug was assessed at 24-hr BP monitoring, a protective effect - at echocardiography and ultrasound duplex scanning of the vessels. Results. A 36-week telmisartan monotherapy significantly improved all the analysed parameters of 24-hr BP monitoring. LV myocardial mass reduced by 12.7%, index of this mass - by 12.9%. Overall thickness of intima-media of the muscular-elastic vessels (common carotid and femoral arteries) lowered by 11.9%. Conclusion. Long-term telmisartan monotherapy improves parameters of 24-hr BP monitoring, protects the heart and the vessels against remodeling, promotes reduction of LV hypertrophy and intima-media thickness of muscular-elastic arteries.
Terapevticheskii arkhiv. 2008;80(12):13-16
Comparison of effects of carbohydrate metabolism compensation and atorvastatin treatment on lipid metabolism and C-reactive protein in type 2 diabetes mellitus
Glinkina I.V., Zilov A.V., Mel'nichenko G.A., Roytman A.P., Il'in A.V., Glinkina I.V., Zilov A.V., Melnichenko G.A., Roitman A.P., Ilyin A.V.
Aim. To compare effects of atorvastatin treatment and carbohydrate metabolism compensation on lipid spectrum and a C-reactive protein (CRP) level in patients with type 2 diabetes mellitus (DM). Material and methods. The lipid spectrum was studied in a random sample of 165 patients (66 males, 99 females) with type 2 DM (age median 57 years, duration of the disease 7 years). Out of this sample 26 patients with LDLP cholesterol > 3 mmol/l were randomized into 2 groups. The study group received 20 mg/day atorvastatin for 3 months, the control group received no inhibitors of GMG-Coa-reductase. The patients' blood was tested for glycosylated hemoglobin, aminotransferase, creatinphosphokinase, total, HDLP, LDLP cholesterol. Results. Changes in the lipid spectrum were detected in 98.2% patients, 42.4% of them had combined dyslipidemia: elevated total cholesterol (TC), LDLP cholesterol, triglycerides (TG) and low HDLP cholesterol. After 3 months of therapy both groups demonstrated the same significant lowering of HbA1c. The control group had also elevated level of HDLP cholesterol, unchanged levels of TC, LDLP cholesterol, TG. 3-month therapy with atorvastatin lowered TC from 6.41 to 4.76 mmol/l, LDLP cholesterol from 4.19 to 1.87 mmol/l, TG from 2.69 to 1.62 mmol/l, apo B from 1.64 to 1.13 mg/dl, raised HDLP from 0.99 to 1.21 mmol/l (p < 0.05). CRP fell from 5.65 to 2.33 mg/dl (p = 0.026) irrespective of carbohydrate metabolism compensation (CRP in the control group did not change). Conclusion. More than 98% type 2 diabetics have atherognic impairment of the lipid spectrum. Atorvastatin produces an antiatherogenic effect due to both improvement of the lipid metabolism and CRP level reduction irrespective of the degree of compensation of carbohydrate metabolism in type 2 DM.
Terapevticheskii arkhiv. 2008;80(12):17-22
Architectonics of cell subpopulations of peripheral blood in patients with autoimmune myocarditis: clinical and pathogenetic aspects
Shogenov Z.S., Kekenazde N.N., Vorob'eva S.E., Usik M.P., Elbeik T., Akhmedilova K.A., Mamonova E.E., Matsuura E., Pal'tsev M.A., Suchkov S.V., Shogenov Z.S., Kekenadze N.N., Vorobyeva S.E., Usik M.P., Elbeik T., Akhmedilova K.A., Mamonova E.E., Matsuura E., Paltsev M.A., Suchkov S.V.
Aim. To compare the most significant architectonic parameters of peripheral blood cell subpopulations in patients with different variants of an autoimmune myocarditis (AIM) course and their clinical value in therapeutic practice. Material and methods. Blood cell subpopulations were studied with flow cytometry in 99 blood samples from patients having different AIM variants and myocardiosclerosis as well as in 40 healthy donors. Results. Severe (malignant) AIM was characterized by growing indices of T-/B lymphocyte activation, expression of activation markers on the cells of both differentiation lines, disproportions in composition of subpopulations of the immunoregulatory cells, parallel rise in specific weight of dendritic cells, reduced intensity of apoptosis of autoreactive T-lymphocytes. In benign AIM marked immunopathology was not found. This group can be considered as a separate variant of AIM course necessitating an individual approach to planning pathogenetically sound therapeutic and rehabilitation measures. Conclusion. The study of activation markers expression on peripheral blood cells is superior to the study of endomyocardial biopsies providing a non-invasive method of immunodiagnosis.
Terapevticheskii arkhiv. 2008;80(12):23-28
ECG changes after transcatheter correction of the secondary defect of the interatrial septum with Amplatzer occluder
Abdyzhaparova E.K., Usupbaeva D.A., Dzhishambaev E.D., Dadabaev M.K., Abdyzhaparova E.K., Usupbaeva D.A., Dzhishambaev E.D., Dadabaev M.K.
Aim. To study ECG changes after transcatheter correction of the interatrial defect (IAD) with Amplatzer occluder. Material and methods. Secondary transcatheter IAD correction was made with Amplatzer Septal Occluder (AGA Medical Corporation, USA) in 33 adults (mean age 33.5 ± 2.3 years) and 22 children (mean age 11.2 ± 1.3 years). Short- and long-term outcomes of the defect correction were followed up for 1 to 12 months. Results. Ectopic atrial rhythm registered initially in 2 adult patients was corrected to 1 month after the operation. Normalization or reduction of the electric axis of the heart (EAH) deviation were achieved in 45.5% adults and 66.7% children who had vertical axis or right shift of the axis. Baseline right ventricular hypertrophy (RV1+SV5,6 > 10.5 mm) was diagnosed in 10 adults and 9 children. To the end of the first year after IAD correction this hypertrophy was detected in 5 adults and 3 children (50 and 33.3%, respectively). Blockade of the right bundle of His (complete in 5 cases and incomplete in 23 cases) was diagnosed before treatment in 18 adults and 10 children. To month 12 after the defect correction incomplete blockade persisted only in 2 (11.1%) adults and 1 (10%) child. In 6 months P wave amplitude diminished in adults from 1.9 ±0.12 to 1.7 ± 0.10 mm (p < 0.01), in children - from 1.8 ± 0.07 to 1.6 ± 0.11 mm (p < 0.05). QRS complex duration decreased both in adults and children (from 0.10 ± 0.003 to 0.08 ± 0.004 s, p < 0.01 and from 0.09 ± 0.003 to 0.08 ± 0.002 s, p < 0.05, respectively). In the latter duration of the interval P-Q reduced significantly in 3 months from 0.18 ± 0.005 to 0.17 ± 0.005 s (p < 0.05). Conclusion. ECG changes after transcatheter correction of IAD manifest with normalization of the EAH or reduction of its shift to the right, regress of right ventricular hypertrophy, elimination or reduction of the right bundle of His and absence of significant deterioration of cardiac arrhythmia.
Terapevticheskii arkhiv. 2008;80(12):28-32
Endothelial dysfunction in osteoarthrosis patients: changes in response to teraflex treatment
Rebrov A.P., Kharitonova I.A., Rebrov A.P., Kharitonova I.A.
Aim. To investigate severity of endothelial damage and its function in osteoarthrosis patients, changes in endothelial dysfunction in response to teraflex treatment. Material and methods. Eighty patients with manifest gonarthrosis of stage I-II participated in the trial. They received teraflex for 3 months. Treatment efficacy was estimated by Leken's index, pain in the joints, need in analgetics, treatment efficacy in the opinion of the doctor and patient. Endothelial function was assessed by changes in antithrombogenic properties of vascular walls (anticoagulatory and fibrinolytic activity of the vascular wall), in activity of Willebrand factor, circulating endothelial cells. Examination was made before the treatment, after 1 and 3 months of therapy. Results. A positive effect of teraflex manifested with a significant regress of the Lekken's index, pain syndrome, need in nonsteroidal anti-inflammatory drugs, relief of endothelial damage, improvement of antithrombogenic activity of vascular wall. Conclusion. Teraflex has a manifest symptom-modifying effect, good tolerance, reduces endothelial damage.
Terapevticheskii arkhiv. 2008;80(12):32-37
Lymphocytic-thrombocytic adhesion and production of blood serum cytokines in rheumatic heart disease
Gorbunov V.V., Tsarenok S.Y., Rosin I.V., Gorbunov V.V., Tsarenok S.Y., Rosin I.V.
Aim. To study changes of cytokine production and lymphocytic-thrombocytic adhesion (LTA) in patients with rheumatic heart disease. Material and methods. Concentrations of interleukine-1beta, interleukine-4, tumor necrosis factor alpha in the blood serum and lymphocytic-thrombocytic adhesion by Yu.A. Vitkovsky's method were measured in 84 patients with rheumatic fever and 26 healthy ones. Results. A correlation was found between icreased production of inflammatory cytokines, lymphocytic-thrombocytic adhesion and activation of rheumatic process. Conclusion. A monodirection of changes of inflammatory cytokine production, lymphocytic-thrombocytic adhesion and rheumatic fever activation allows using them as nonspecific diagnostic methods in assessment of inflammation activity.
Terapevticheskii arkhiv. 2008;80(12):37-39
Effects of combined treatment with rosiglitazone and NPH insulin on carbohydrate metabolism in patients with type 2 diabetes mellitus
Kandalintseva O.A., Ametov A.S., Kandalintseva O.A., Ametov A.S.
Aim. To study efficacy and safety of rosiglitazone + NPH insulin combined treatment in patients with type 2 diabetes mellitus (DM). Material and methods. The trial included 43 patients with DM aged 44-75 on NPH insulin. The patients were divided into two groups. The study group received NPH insulin + a single morning dose of 4 mg/day rosiglitazone, the control group received NPH insulin only. The treatment lasted 24 weeks. Results. 24-week therapy in the study group lowered HbA1c from 8.16 ± 0.23 to 6.82 ± 0.18% (p < 0.05), fasting glycemia - from 9.68 ± 0.48 to 6.4 ± 0.32 mmol/l, postprandial glycemia - from 12.3 ± 0.44 to 8.4 ± 0.56 mmol/l, HOMA-IR index - from 7.65 ± 1.12 to 4.26 ± 0.59. In group 2 HbA1c - from 7.84 ± 0.15 to 7.49 ± 0.17 (p < 0.05), from 9.21 ± 0.65 to 8.38 ± 0.50 mmol/l, 11.92 ± 0.53 to 9.97 ± 0.45 mmol/l, 6.77 ± 0.79 to 5.73 ± 0.63. The combined treatment produced positive changes in lipid metabolism: total cholesterol decreased from 6.37 ± 0.36 to 5.67 ± 0.32 mmol/l (p < 0.005), TG - from 2.46 ± 0.64 mmol/l to 1.82 ± 0.46 mmol/l (p < 0.005), LDLP - from 3.99 ± 0.40 to 3.58 ± 0.37 mmol/l. Need in insulin diminished by 10%. Conclusion. Treatment results showed that administration of rosiglitazone in combination with NPH insulin has a good safety and tolerance profile in type 2 DM patients.
Terapevticheskii arkhiv. 2008;80(12):40-44
Clinico-immunological disorders in patients with ischemic heart disease and metabolic syndrome: correction with nebivolol
Teplyakov A.T., Bolotskaya L.A., Vdovina T.V., Stepacheva T.A., Kuznetsova A.V., Teplyakov A.T., Bolotskaya L.A., Vdovina T.V., Stepacheva T.A., Kuznetsova A.V.
Aim. To evaluate clinico-immunological disorders in patients with ischemic heart disease (IHD) and metabolic syndrome (MS), to study an immunocorrective action of nebivolol during 6-month treatment. Material and methods. A total of 54 patients with postinfarction left ventricular dysfunction and chronic cardiac failure of NYHA functional class II-III were divided into two groups: group 1 (n = 24) comprised patients with effort angina FC II-III and impaired glucose tolerance, group 2 (n = 30) consisted of anginal patients associated with type 2 diabetes mellitus (DM). Clinical, laboratory and functional indices were registered before therapy with nebivolol and 6 months after it. Immunological control included determination of the subpopulation composition of lymphocytes, immunoglobulins, circulating immune complexes (CIC), antibodies to cardiolipin (CL), proinflammatory cytokines: IL-1alpha, IL-2, IL-6, IL-8, alpha-interferon, tumor necrosis factor alpha (TNFa). Results. Nebivolol demonstrated good antihypertensive and anti-ischemic cardioprotective efficacy in IHD patients with MS, it did not deteriorate atherogenic dyslipidemia and impaired carbohydrate metabolism. As a good immunocorrector, nebivolol significantly inhibited cytokine overactivation, had a weak effect on dysimmunoglobulinemia, CIC level and expression to CL antibodies. Side effects were not recorded. Conclusion. IHD patients with MS (especially patients with type 2 DM) have manifest immune disorders presenting with overactivation of proinflammatory cytokines with high levels of IgA, IgG, CIC and antibodies to CL in the presence of low immunoregulatory index. Nebivolol provided good control of arterial hypertension, myocardial ischemia, positive changes in immunological indices, improved intracardiac hemodynamics.
Terapevticheskii arkhiv. 2008;80(12):44-52
Hair cell leukemia in young patients
Al'-Radi L.S., Samoylova R.S., Tikhonova L.Y., Dyagileva O.A., Naumova I.N., Kaplanskaya I.B., Varlamova E.Y., Al-Radi L.S., Samoilova R.S., Tikhonova L.Y., Dyagileva O.A., Naumova I.N., Kaplanskaya I.B., Varlamova E.Y.
Aim. To characterize clinical symptoms, course, immediate and long-term treatment results in young patients with hair cell leukemia (HCL). Material and methods. The data on 41 HCL patients were analysed. The diagnosis was made by standard diagnostic protocol for HCL detection. Results. The analysis of the age of 160 HCL patients studied demonstrated high (26%) incidence of HCL at young age. Young patients with HCL had special clinical manifestations and specific long-term outcomes of treatment with standard schemes. Conclusion. Differences in occurrence of recurrences after standard therapy make it necessary to consider young HCL patients as a separate group who need adjuvant treatment to prolong remission.
Terapevticheskii arkhiv. 2008;80(12):53-58
Effects of different treatments on endothelial function in patients with erectile dysfunction and hypogonadism
Mazo E.B., Gamidov S.I., Sotnikova E.M., Mazo E.B., Gamidov S.I., Sotnikova E.M.
Aim. To study effects of different treatments on erectile and endothelial functions in patients with erectile dysfunction (ED) and age-related hypogonadism (HG). Material and methods. The study included 66 males with ED who had clinical and laboratory signs of HG. All the patients were examined using questionnaires (international index of erectile function, AMS), blood hormones tests. Endothelial function was assessed with postcompression tests on the cavernous arteries and blood homocystein assay. All the patients were divided into two matched groups. Group 1 (20 males, mean age 54.6 ± 11.5 years) received androgens only, replacement therapy consisted of testosterone undecanoate (Nebido, Shering) 1000 mg each 10-12 weeks intramuscularly, interval between the first and second injection was 6 weeks. Group 2 (46 males, mean age 53.98 ± 10.03 years) was given combined treatment (androgens and PDE 5 inhibitors), wardenafil (Levitra, Buer Shering Pharma) was used in a dose 20 mg. The treatment lasted 6 months. Results. AMS points decreased in group 1 from 38.3 ± 0.29 to 29.2 ± 0.32 , in group 2 - from 39.02 ± 0.21 to 28.6 ± 0.95, while testosterone rose from 9.86 ± 0.4 to 17.77 ± 0.42 and 9.35 ± 0.25 to 17.21 ± 0.63 nmol, respectively. Homocystein lowering was significantly more manifest in group 2. EF index in group 2 rose from 11.4 ± 0.77 to 25.54 ± 0.25 points versus 11.2 ± 1.01 to 23.95 ± 0.71 points in group 1, improvement of EF in group 2 occurred sooner. Endothelial function by diameter of the cavernous arteries differed after treatment in group 1 and 2 (19.55 ± 2.88 to 39.2 ± 0.84% and 19.51 ± 1.28 to 48.5 ± 1.76, respectively, p < 0.001). Conclusion. Combined therapy improves blood homocistein, acts faster and stronger on endothelial and erectile functions and can be recommended as first line for ED and HG patients.
Terapevticheskii arkhiv. 2008;80(12):59-63
H. pylori in development of allergic diseases in patients with gastroduodenal diseases
Lazebnik L.B., Chernutskaya S.P., Gervazieva V.B., Sukhareva G.V., Lazebnik L.B., Chernutskaya S.P., Gervazieva V.B., Sukhareva G.V.
Aim. To discover relations between allergic diseases and H.pylori infection in patients with gastroduodenal diseases. Material and methods. The study was made of 113 patients (age 22-65, 34 males and 79 females) with chronic gastritis and duodenal ulcer. Of them, 60 patients (group 1) had concomitant allergy (urticaria, bronchial asthma, atopic dermatitis, food allergy, pollinosis), while 53 patients (group 2) had no allergy. H.pylori infection was diagnosed with the respiratory and rapid urease test, histological and cytological tests. Enzyme immunoassay determined total antibodies (AB) to H.pylori in IgG, IgA, IgM classes; IgA-AB in the kits Vector Best (Russia), IgG-AB to H.pylori in the kits of ECOLab (Russia) and total IgE in the kits IgE-EIA (Stavropol). Results. In group 1 total AB to H.pylori were positive in 48 (80%), IgG-AB and IgA-AB to H.pylori in 38(63.3%) and 43 (71.6%) patients, respectively. In elevated concentration of AgG-AB to H.pylori 46 (76.6%) patients had elevated total IgE (mean 364 IU.l). In group 2 total AB to H.pylori were detected in 45 (85.0%) patients, IgG-AB and IgA-AB to H.pylori in 47 (88.6%) and 32 (60. 3%), respectively. Among patients with high level of IgG-AB to H.pylori in the serum high total IgE was only in 35.8% patients. Mean IgE was 250 IU/l. Conclusion. Patients with gastroduodenal diseases associated with H.pylori and allergy and not associated had similar level of total AB to H.pylori, while higher total IgE and specific IgE-AT to H.pylori occurred in the former. Thus, H. pylori infection is associated with allergic (atopic) immune response.
Terapevticheskii arkhiv. 2008;80(12):63-66
An old patient with iron deficient anemia in therapeutic practice
Gorokhovskaya G.N., Petina M.M., Gorokhovskaya G.N., Petina M.M.
Terapevticheskii arkhiv. 2008;80(12):66-68
Evolution of views on ANCA-associated glomerulonephritis
Beketova T.V., Semenkova E.N., Kozlovskaya L.V., Beketova T.V., Semenkova E.N., Kozlovskaya L.V.
Terapevticheskii arkhiv. 2008;80(12):69-73
Cavinton administration in hypertensive encephalopathy
Putilina M.V., Grishin D.V., Putilina M.V., Grishin D.V.
Terapevticheskii arkhiv. 2008;80(12):73-78
Renal damage in HIV infection
Yushchuk N.D., Volgina G.V., Martynov Y.V., Gadzhikulieva M.M., Kocharyan K.A., Yuschuk N.D., Volgina G.V., Martynov Y.V., Gadzhikulieva M.M., Kocharyan K.A.
Terapevticheskii arkhiv. 2008;80(12):78-81
Potekaev S.N., Potekaev S.N.
Terapevticheskii arkhiv. 2008;80(12):82-89
Resistance to desaggregants: causes, clinical implication, methods of diagnosis and correction
Kremneva L.V., Shalaev S.V., Kremneva L.V., Shalaev S.V.
Terapevticheskii arkhiv. 2008;80(12):89-95
N.A. Mukhin, V.S. Moiseeva. Introduction to Internal Medicine
Martynov A.I., Martynov A.I.
Terapevticheskii arkhiv. 2008;80(12):95-96

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