Vol 81, No 4 (2009)

Articles
Diagnosis: clinical problems, rationale, formulation
Gogin E.E., Gogin E.E.
Abstract
Terapevticheskii arkhiv. 2009;81(4):5-7
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Assessment of major artery stiffness: new perspectives of noninvasive diagnosis of coronary atherosclerosis
Orlova Y.A., Kuz'mina A.E., Barinova I.V., Yarovaya E.B., Ageev F.T., Orlova Y.A., Kuzmina A.E., Barinova I.V., Yarovaya E.B., Ageev F.T.
Abstract
Aim. Arterial stiffness is a predictor of atherosclerosis. This study was conducted to develop a method of coronary atherosclerosis severity assessment by means of brachial-ankle pulse wave velocity (baPWV). Material and methods. We measured baPWV in 119 males (age 51.67 ± 7.25) who received coronary angiographic examination (CAG). The baPWV was measured by Vasera VS-1000 (Fukuda Denshi). Results. The patients were divided into two groups by severity of stenosis (group 1 - less than 50% stenosis, group 2 > 50%). The baPWV value was significantly greater in group 2 (n = 98, baPWV 13.15 ± 2.14 m/s, p = 0.004) than that in group 1 (n = 21, baPWV 12.13 ± 1.17 m/s). ROC-curve demonstrated that the best cut-off point of the baPWV for predicting occlusive atherosclerosis was 12.2 m/s. The area under ROC-curve was 0.66 (p = 0.034). An univariate binary logistic regression model demonstrated that only baPWV had a significant odds ratio for coronary stenosis > 50%: 2.68 (95% CI = 1.01-7.15), p = 0.043. Other risk factors were not significantly associated with severity of stenosis. Conclusion. The baPWV significantly reflects the severity of stenosis in middle-aged males opening new perspectives of noninvasive detection of coronary artery atherosclerosis in middle-aged males.
Terapevticheskii arkhiv. 2009;81(4):8-12
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Quantitative repolarization indices in diagnosis of left ventricular hypertrophy in hypertensive patients
Sakhnova T.A., Blinova E.V., Sergakova L.M., Ataullakhanova D.M., Chazova I.E., Sakhnova T.A., Blinova E.V., Sergakova L.M., Ataullakhanova D.M., Chazova I.E.
Abstract
Aim. To determine informative value of quantitative parameters of orthogonal ECG repolarization phase in diagnosis of left ventricular hypertrophy (LVH) in hypertensive patients. Material and methods. A total of 210 healthy subjects and 241 hypertensive patients with LVH (LV myocardium mass index > 125 g/m2 in males and > 110 g/m2 in women) comprised two groups - control and test. The study was made of quantitative parameters (components X, Y, Z, modules and angles of azimuth and elevation) of wave T integral vector, wave T maximal vector, ST vector, ventricular gradient; spatial and projection areas of wave T, the angle between integral vectors of spatial waves QRS and T (phi angle). Results. The test group had reduced X, Y components and elevated vectors, their azimuth and phi angle. Most informative for repolarization were components X of T maximal and integral vectors being as informative as Rx+Sz and Cornel product. The method of multiple regression analysis was used to plot discriminant function taking account of most informative indices of depolarization and repolarization - Rx+Sz and X component of T maximal vector. The area under ROC curve for this function was greater than for the variables alone and Cornel product in both groups (0.90 ± 0.02 and 0.86 ± 0.02, p < 0.05 for the control and test group, respectively). Conclusion. Quantitative parameters of repolarization phase can improve LVG diagnosis in hypertensive patients.
Terapevticheskii arkhiv. 2009;81(4):13-16
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Spectral indices of heart rate variability in patients with vasovagal syncopes according to evidence of 5-min ECG
Vershuta E.V., Pevzner A.V., Ermishkin V.V., Kuchinskaya E.A., Al'bitskaya K.V., Kheymets G.I., Mazygula E.P., Rogoza A.N., Golitsyn S.P., Gorelova O.M., Vershuta E.V., Pevzner A.V., Ermishkin V.V., Kuchinskaya E.A., Albitskaya K.V., Heimets G.I., Mazygula E.P., Rogoza A.N., Golitsyn S.P., Gorelova O.M.
Abstract
Aim. To compare autonomic nervous system activity estimated by power spectral analysis of heart rate variability in patients with vasovagal syncopes and healthy volunteers. Material and methods. Seventeen health volunteers and 25 patients with vasovagal syncope were included in the study. In 16 cases faints were induced by head-up tilt table test (HTT), in 9 cases - by bicycle exercise test (BET). Power spectral analysis of heart rate variability in 5-th min ECG records was performed in supine and upright position while breath was fixed. Results. In supine position the data of low frequency (LF) and high frequency (HF) of spectral power in both groups of patients were significantly higher than in volunteers. During upright the HF of spectral power significantly decreased in patients and volunteers. In upright position LF of spectral power significantly decreased in patients with syncope induced by HTT, did not change in patients with syncope induced by BET, but significantly increased in volunteers. Conclusion. Patients with vasovagal syncope had abnormal autonomic nervous system activity: a high level of parasympathetic influence in supine position and poor reaction of sympathetic nervous system during upright.
Terapevticheskii arkhiv. 2009;81(4):17-21
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Characteristics of autoimmune reactions in chronic cardiac failure of different etiology
Zykov K.A., Tatenkulova S.N., Masenko V.P., Kuznetsova T.V., Rvacheva A.V., Belenkov Y.N., Zykov K.A., Tatenkulova S.N., Masenko V.P., Kuznetsova T.V., Rvacheva A.V., Belenkov Y.N.
Abstract
Aim. To characterize autoimmune reactions in patients with chronic cardiac failure (CCF) of different etiology. Material and methods. Basic markers of immune activation were measured in 43 patients with coronary heart disease stage I-IIB (NYHA FC I-IV) and 44 patients with dilated cardiomyopathy (DCMP) stage I-IIB (NYHA FC I-IV). Antibodies to myocardial tissue were studied with indirect immunofluorescence. Echocardiography was made by standard recommendations with evaluation of systolic and diastolic left ventricular function. Concentrations of C-reactive protein, IgG, IgA, IgM were estimated nephelometrically. Enzyme immunoassay studied serum levels of IL-8, IL-2R, IL-6, IL-18, IL-10, IFN-gamma, endothelin. Results. Patients with DCMP had higher titers of antimyocardial autoantibodies than in coronary heart disease (CHD) reflecting more severe autoimmune inflammation. In CHD endothelial, systolic and diastolic dysfunctions severity correlated with severity of inflammation. Conclusion. Some characteristics of autoimmune reactions in CCF determine severity of the disease course.
Terapevticheskii arkhiv. 2009;81(4):22-27
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Monitoring of 24-h ECG and glucose level for detection of relations between glycemia and QT interval duration in type 1 diabetics
Laptev D.N., Ryabykina G.V., Seid-Guseynov A.A., Laptev D.N., Ryabykina G.V., Seid-Guseinov A.A.
Abstract
Aim. To study correlations between glycemia and duration of ventricular repolarization in children and adolescents with type 1 diabetes mellitus (DM). Material and methods. Parallel monitoring of ECG and glycemia was conducted in 43 type 1 MD patients (age 7-17 years, 12.8 ± 2.7) and 37 healthy children and adolescents. Results. Glycemia under 3 mmol/l and over 19 mmol/l is associated with significantly longer QTc interval compare to other blood glucose levels (437 ms and 447 ms versus 430 ms, p < 0.01). Also, in these glycemia values QTc interval duration over 440 ms (46 and 62% versus 33%; p<0.01) becomes more frequent. In healthy children and adolescents mean duration and frequency of a longer QTc interval were significantly less than in diabetic patients irrespective of glycemia degree in patients with type 1 DM (p < 0.01). A moderate correlation was found between a daily insulin dose and QTc duration (correlation coefficient 0.35, p = 0.02). Conclusion. Glycemia under 3 mmol/l and over 19 mmol/l can prolong QT interval and, therefore, raise the risk of cardiovascular death in patients with type 1 DM.
Terapevticheskii arkhiv. 2009;81(4):28-33
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Case report of a giant mixoma of the left atrium: a clinical course, diagnosis and treatment
Merkulova I.N., Blankova Z.N., Sukhinina T.S., Belokon' E.V., Raskin V.V., Dzemeshkevich A.S., Dzemeshkevich S.L., Merkulova I.N., Blankova Z.N., Sukhinina T.S., Belokon E.V., Raskin V.V., Dzemeshkevich A.S., Dzemeshkevich S.L.
Abstract
Terapevticheskii arkhiv. 2009;81(4):34-39
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Comparative characteristics of immunological tests in differentiation of systemic and integument forms of lupus erythematosus
Romanova N.V., Shilkina N.P., Romanova N.V., Shilkina N.P.
Abstract
Aim. To study immune disorders in cell immunity and cytokine profile in integument lupus erythematosus (ILE) and systemic lupus erythematosus (SLE). Material and methods. Lymphocyte phenotype, oxygen-dependent and non-oxygen-dependent functions of circulating neutrophils and monocytes, serum levels of circulating immune complexes (CIC), cytokines (IL-1beta, IL-4, IL-6, TNFalpha), antibodies to aDNA were studied in 177 patients with lupus erythematosus aged 20-60 years (143 had SLE and 34 ILE) and 33 healthy controls. Results. CIC levels, serum aDNA, IL-1beta and IL-4, oxygen-dependent neutrophil metabolism were higher both in SLE and ILE. Only SLE was characterized by high oxygen stress of monocytes, acid phosphatase and cation proteins in neutrophils and monocytes. Lymphocyte phenotype both in SLE and ILE was characterized by low count of CD3+ lymphocytes and high count of cells with markers of activation and apoptosis. SLE patients had lower count of HLA-DR+ cells and higher count of CD16+ and CD25+ lymphocytes. Conclusion. Identification of metabolic functions of circulating phagocytes, serum cytokines and lymphocyte phenotype can be used for differentiation between SLE and ILE.
Terapevticheskii arkhiv. 2009;81(4):40-43
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Clinical diagnosis of infectious diseases: historical aspects
Bogomolov B.P., Bogomolov B.P.
Abstract
Terapevticheskii arkhiv. 2009;81(4):44-46
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HCV genome variability in acute and chronic viral hepatitis C
Yushchuk N.D., Klimova E.A., Znoyko O.O., Gadzhikulieva M.M., Il'ina E.N., Yashina T.L., Malyshev N.A., Tsyganova E.V., Yuschuk N.D., Klimova E.A., Znoiko O.O., Gadzhikulieva M.M., Ilyina E.N., Yashina T.L., Malyshev N.A., Tsyganova E.V.
Abstract
Aim. To evaluate HCV genome variability in acute and chronic phases of viral hepatitis C. Material and methods. The study of heterogeneity of HCV in acute hepatitis C has detected genetic heterogeneity and variability of individual HCV population circulating in the blood. Significant genetic heterogeneity of HCV was observed in 1b, 2a and 3a genotypes. Variability of HCV did not depend on virus load. Genetic HCV structure changed significantly both in patients with manifest ALT deviations and in normal ALT, mean number of HCV genetic variants in these groups being the same. No significant correlations were found between virus concentration in the patient's blood, its variability and ALT values. Genetic heterogeneity of interferon-sensitive region of gene NS5A subtype 1b HCV was studied in blood of 16 patients with chronic hepatitis C resistant to interferon therapy. Results. It is shown that genetic heterogeneity and variability of an individual HCV population circulating in blood serum can not be a prognostic criterion in assessment of variants of acute hepatitis C course. No mutations in ISDR region were found in 25% of 16 patients studied. 75% cases had 1-3 replacements of amino acid sequences, most frequent mutation was replacements in position 2218 (histidin/arginin). The above results are close to those obtained in Japanese and European populations. Results of ISDR sequence-analysis conducted before treatment may predict efficacy of interferon-alpha2 treatment in an individual patient in future. Large-scale trials are necessary for detection of mutations responsible for resistance to interferon-alpha2 in patients living in Russia.
Terapevticheskii arkhiv. 2009;81(4):47-54
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Characteristics of the cytokine profile and peripheral blood lymphocyte subpopulations in patients with chronic viral hepatitis B and C in respect to severity of morphological changes of the liver
Lazareva A.S., Volchkova E.V., Umbetova K.T., Chulanov V.P., Parkhomenko Y.G., Kiselevskiy M.V., Pak S.G., Lazareva A.S., Volchkova E.V., Umbetova K.T., Chulanov V.P., Parkhomenko Y.G., Kiselevsky M.V., Pak S.G.
Abstract
Aim. To study cytokine concentration in blood serum in spontaneous and NDV- and PGA stimulated production by peripheral blood mononuclear cells (PBMC) and contents of peripheral blood lymphocyte subpopulations when compared with severity of morphological changes of the liver in patients with chronic viral hepatitis B and C (CHB and CHC). Material and methods. A total of 37 patients entered the trial (13 with CHB and 24 with CHC). Concentrations of IFN-alpha, IFN-gamma, TNF-alpha, IL-1beta, IL-4, IL-6 in blood serum in spontaneous and NDV and PGA stimulated PBMC production, content of CD3, CD4, CD8, CD16, CD25, HLADR, CD20, CD38 subpopulations of peripheral blood lymphocytes were examined. Also, puncture biopsy of the liver by Mengini was made with subsequent estimation of the histological activity index by R. Knodell adapted to hepatitis B and C by K. Ishak. Results. Patients with CHB and CHC in minimal activity of the process and insignificant morphological changes in the liver demonstrated a significant fall of NDV induced IFN-alpha production. Patients with highly active hepatitis and maximal morphological changes in the liver had significant lowering of NDV induced production of IFN-alpha, IFN-gamma, TNF-alpha, IL-6 and PGA induced production of TNF-alpha. Conclusion. CHB and CHC patients should be examined not only with estimation of serum cytokines concentration but also NDV and PGA stimulated production of PBMC should be taken into consideration with calculation of immunoregulatory index for prognosis of the disease and choice of adequate therapy.
Terapevticheskii arkhiv. 2009;81(4):55-59
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Norovirus infection in general hospitals for adults
Sagalova O.I., Bryzgalova I.V., Podkolzin A.T., Maleev V.V., Sagalova O.I., Bryzgalova I.V., Podkolzin A.T., Maleev V.V.
Abstract
Aim. To determine the role of noroviruses in the rise of hospital outbreaks of acute intestinal infections (AII), to study clinical and epidemiological aspects of hospital noroviral infection. Material and methods. Routine diagnostic methods and diagnostic tests on the base of polymerase chain reaction (PCR) were used for identification of group A rotaviruses, noroviruses, astroviruses, adenoviruses, salmonella, thermophilic campilobacteria, shigella, enteroinvasive echerichia (EIEC) in 70 adult patients with AII transferred from general hospital to infection hospital in 2003-2007. A part of the strains was typed with primers specific for genetic cluster G2/4. Results. Routine methods failed to identify causes of hospital infection. PCR detected AII etiology in 77.8% patients. Norovirus of the second genotype (G2) was identified as monoinfection in 87.8% verified cases, in association with other agents - in 12.2%. Typed noroviruses belonged to cluster G2/4. Nosocomial norovirus infection was characterized by winter-spring occurrence and a moderate course. Conclusion. An essential role of noroviruses in hospital AII outbreaks in elderly patients in winter-spring is shown.
Terapevticheskii arkhiv. 2009;81(4):60-63
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Treatment of HIV infection in the Russian Federation
Kravchenko A.V., Yurin O.G., Belyaeva V.V., Pokrovskiy V.V., Kravchenko A.V., Yurin O.G., Belyaeva V.V., Pokrovsky V.V.
Abstract
Aim. To study efficacy and safety of highly active antiretrovirus treatment (HAAT) used in the Russian Federation for development of recommendations for HIV infection treatment. Material and methods. A total of 285 patients with chronic HIV infection and 42 patients with acute HIV infection participated in investigation of efficacy and safety of different HAAT schemes in 1997-2008. Efficacy of the treatment was assessed by percentage of the patients who had HIV RNA undetectable by the test system (< 400 copy/ml) after 24-48 treatment weeks, by a mean reduction of HIV RNA in blood plasma and an increase in the number of CD4-lymphocytes in 1 mcl of blood. Results. A 12-year experience in antiretrovirus therapy administration for management of HIV infection is reviewed. Efficacy and safety of Russian antiretrovirus drug Phosphaside in HAAT schemes are shown in patients with both chronic and acute HIV infection. The model of HIV patients consulting before the treatment, psychological support during the treatment, methods of individual and group consulting, conception of the school for patients on HAAT are presented. Recommendations are proposed for administration of antiretroviral therapy and a model of calculation of the number of HIV-infected patients in need of antiretroviral therapy in Russia. Basing on the results of investigations on efficacy and safety of HAAT schemes, the physicians of the National Anti-AIDS Center have developed clinical recommendations, guidelines on the treatment of HIV infection, standards of medical care for HIV-infected patients.
Terapevticheskii arkhiv. 2009;81(4):64-68
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The role of thyroid hypofunction in development of metabolic syndrome
Demidova T.Y., Galieva O.R., Demidova T.Y., Galieva O.R.
Abstract
Aim. To study the role of hypothyroidism and concomitant obesity in the development of metabolic syndrome (MS). Material and methods. We examined 60 women suffering from obesity and hypothyroidism (TTH 22.24 ± 4.031). We studied lipid spectrum, carbohydrate metabolism, BP and insulin resistance, fat tissue distribution, exercise tolerance. Results. According to IDF (2005) criteria the women had: metabolic syndrome (83.4%), newly diagnosed hypothyroidism (95%), decompensated hypothyroidism (90%), subclinical hypothyroidism (65%) after six-month replacement therapy with L-T4 MS symptoms declined. Conclusion. Abnormally high level of TSH may be a component of metabolic syndrome.
Terapevticheskii arkhiv. 2009;81(4):69-72
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Sex- and age-specific characteristics of arterial hypertension prevalence in type 2 diabetes mellitus patients with obesity
Kazymov M.S., Fishman B.B., Veber V.R., Fishman M.B., Kopina M.N., Kuprin P.E., Kazymov M.S., Fishman B.B., Veber V.R., Fishman M.B., Kopina M.N., Kuprin P.E.
Abstract
Aim. To investigate sex- and age-specific characteristics of arterial hypertension prevalence in type 2 diabetics with obesity. Material and methods. Sex- and age-specific features of hypertension prevalence were studied in 6177 (1345 males and 4832 females) type 2 diabetic obese citizens of the Novgorod region. Results. The highest incidence of mild hypertension was found in obesity degrees I and II (50-68%). Prevalence of moderate and severe hypertension reached 20-31 and 4-5%, respectively, in obesity of degree I and II, 15% in males and 11% in females in obesity degree III. Conclusion. In type 2 DM obese patients mild hypertension occurs most frequently. Severe hypertension develops often in males with obesity degree II and III in age groups 50-59 and 60-69 years, in females - in any obesity at the age of 70 and older.
Terapevticheskii arkhiv. 2009;81(4):73-75
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Heart rate variability in migrants to the North with hypertension comorbid with biliary diseases
Daryanina S.A., Pal'tsev A.I., Nikolaev Y.A., Daryanina S.A., Paltsev A.I., Nikolaev Y.A.
Abstract
Aim. To study heart rate variability (HRV) in patients with biliary problems and hypertension depending on duration of their life in the North. Material and methods. A standardized screening of 1014 workers living in Mirny (Yakutia) according to the WHO/CINDI Euro regional committee program was performed. Conclusion. With an increase of duration of living in the North patients with biliary diseases combined with arterial hypertension develop disorders of humoral-metabolic regulation mechanisms, increased parasympathetic activity, imbalance of the autonomic nervous system
Terapevticheskii arkhiv. 2009;81(4):76-78
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Multislice computed tomography of the coronary arteries: current opportunities and perspectives
Ternovoy S.K., Morozov S.P., Nasnikova I.Y., Sil'chenko N.S., Sinitsyn V.E., Likov V.F., Sal'nikov D.V., Ternovoi S.K., Morozov S.P., Nasnikova I.Y., Silchenko N.S., Sinitsyn V.E., Likov V.F., Salnikov D.V.
Abstract
Terapevticheskii arkhiv. 2009;81(4):79-81
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New perspectives of ultrasound investigation
Zubarev A.V., Zubarev A.V.
Abstract
Terapevticheskii arkhiv. 2009;81(4):82-83
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Clinical epidemiology and evidence-based medicine: definitions and correlations
Briko N.I., Briko N.I.
Abstract
Terapevticheskii arkhiv. 2009;81(4):84-86
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Differential diagnosis of specific pulmonary lesions in early syphilis
Krivosheev B.N., Krivosheev A.B., Khavin P.P., Krivosheev B.N., Krivosheev A.B., Khavin P.P.
Abstract
To state the diagnosis of early specific pulmonary disease, it is necessary to obtain clinical and/or serological data to reject manifest secondary or early latent syphilis. The most important differential-diagnostic criterion of early syphilis of the lungs is a rapid effect of specific antisyphilis therapy with further verification of complete resolution of pulmonary lesions. Two case reports are presented.
Terapevticheskii arkhiv. 2009;81(4):87-90
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Valentin Ivanovich Pokrovsky (the 80th anniversary of birth)
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Abstract
Terapevticheskii arkhiv. 2009;81(4):91-92
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Calendar of memorable dates in the history of therapy for 2009
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Abstract
Terapevticheskii arkhiv. 2009;81(4):93-93
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