Vol 83, No 8 (2011)

Articles
Chronic obstructive pulmonary disease: Strategic aspects of treatment
Shmelev E.I., Shmelev E.I.
Abstract
The article characterizes current strategy of treatment of chronic obstructive pulmonary disease (COPD), contains epidemiological data, draws attention to various phenotypes of COPD which determine individual approach to therapy. Individual treatment programs must consider stage of the disease, its progression, comorbid pathology. Pharmacological and non-pharmacological treatment methods are outlined. It is important to give therapists advanced training in COPD diagnosis and treatment.
Terapevticheskii arkhiv. 2011;83(8):5-10
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Immunomodifying effects of macrolides: areas of possible clinical use in pulmonology
Sinopal'nikov A.I., Sinopalnikov A.I.
Abstract
The review is devoted to non-antibacterial effects of macrolides in patients with respiratory diseases: bronchial asthma, bronchoectasis, chronic obstructive pulmonary disease, chronic rhinosinusitis, mucoviscidosis, diffuse bronchiolithiasis, severe flu, posttransplantation obliterating bronchiositis. The discussion covers mechanisms of an immunomodulating action of macrolides. Current data base on non-antibacterial effects of macrolides is analysed.
Terapevticheskii arkhiv. 2011;83(8):10-20
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Current aspects of pathogenetic therapy in tuberculosis
Balasanyants G.S., Sukhanov D.S., Balasanyants G.S., Sukhanov D.S.
Abstract
The review presents principles of pathogenetic therapy in tuberculosis and current trends in pharmacotherapy: immunocorrection, prophylaxis, chemotherapy side effects management. Immunocorrection is illustrated by treatment with drugs of a polyvalent action - glutoxim and cyclopheron. Mechanisms of their immune action are outlined. As to hepatoprotection, remaxol is an effective hepatoprotecting medicine improving energy supply to hepatocytes and their membranes resistance to lipid peroxidation, reactivating enzymes of antioxidant defense. Remaxol has an antioxidant/antihypoxic action, is the most promosing metabolic corrector with hepatoprotective activity.
Terapevticheskii arkhiv. 2011;83(8):21-24
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Amiodaron: decades of administration
Golitsyn S.P., Golitsyn S.P.
Abstract
The review of long-term international clinical experience with amiodaron covers pharmacological properties of the drug, mechanisms of development of its pharmacodynamic effects basing on its action on ionic channels, receptors, impact on thyroid function. Unique pharmacokinetics of amiodaron, high antiarrhythmic efficacy of the drug in supraventricular and ventricular arrhythmia, positive experience in primary and secondary prevention of sudden death are characterized. Amiodaron is effective in patients with atrial fibrillation including those with organic heart disease and chronic cardiac failure. It is safe in relation to different cardiac side effects which are minimal but has some non-cardiac side effects which require control during long-term treatment.
Terapevticheskii arkhiv. 2011;83(8):25-33
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Prolongation of enoxaparin therapy to one month promotes recanalization of occlusively thrombosed deep veins
Vorob'eva N.M., Panchenko E.P., Ermolina O.V., Balakhonova T.V., Dobrovol'skiy A.B., Titaeva E.V., Khasanova Z.B., Postnov A.Y., Kirienko A.I., Vorobyeva N.M., Panchenko E.P., Ermolina O.V., Balakhonova T.V., Dobrovolsky A.B., Titaeva E.V., Khasanova Z.B., Postnov A.Y., Kirienko A.I.
Abstract
Aim. To compare effects of prolongation of the treatment with therapeutic doses of enoxaparin to 1 month on recanalization of occlusively thrombosed deep veins (OTDV) of the limbs with results of standard therapy with unfractionated heparin (UFH). Both treatments were followed by warfarin administration. Material and methods. Thirty patients were selected from 111 patients with a history of deep vein thrombosis (DVT) and/or pulmonary artery embolism according to the following criteria: the presence of occlusive thrombosis of one deep vein minimum; the absence of DVT for 12 months of follow-up. Patients of group 1 (n = 15) received standard therapy (UFH for at least 5 days) with switch to warfarin. Patients of group 2 (n = 15) received therapeutic doses of enoxaparin (1 mg/kg each 12 hours) for 30 days minimum with switch to warfarin. Follow-up was 12 months. Ultrasonic duplex angioscanning of the limbs was made at baseline, 1, 3, 6 and 12 months after treatment start. Results. After follow-up month 1, 3 and 6 number of patients with occlusive DVT was significantly less in group 2. All the patients given enoxaparin achieved recanalization of OTDV within 3 months of treatment. OTDV recanalization was not achieved in 20% patients of group 1 even 12 months after treatment start. Conclusion. Prolongation of enoxaparin treatment to 1 month followed by warfarin treatment is superior to standard UFH treatment followed by warfarin in providing recanalization of OTDV within 3 months of treatment. Moreover, this treatment predicts persistence of recanalization within 12 months of anticoagulant therapy.
Terapevticheskii arkhiv. 2011;83(8):33-37
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Modern conceptions of an uric acid role in development of essential hypertension
Polovitkina O.V., Oshchepkova E.V., Dmitriev V.A., Titov V.N., Polovitkina O.V., Oschepkova E.V., Dmitriev V.A., Titov V.N.
Abstract
The article deals with current studies on the role of uric acid (UA) in development of cardiovascular diseases. The results of large prospective trials are presented which have revealed a pathogenetic role of UA in development of essential hypertension. Clinical trials demonstrated elevated concentrations of UA in hypertensive patients. Experimental evidence suggests UA involvement in the processes of nonspecific inflammation, oxidant stress, endothelial dysfunction. It is shown that elevated UA levels in blood serum lead to affection of target organs.
Terapevticheskii arkhiv. 2011;83(8):38-41
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Helicobacter pylori: what schemes of eradication are essential today?
Maev I.V., Samsonov A.A., Golubev N.N., Maev I.V., Samsonov A.A., Golubev N.N.
Abstract
Current approaches to treatment of Helicobacter pylori infection, basic international recommendations, problems of growing H. pylori resistance to antibiotics are reviewed. Much attention is given to prospects of new eradication schemes, for example combinations based on bismuth tripotassium dicitrate and successive treatment schedules.
Terapevticheskii arkhiv. 2011;83(8):41-44
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Diagnosis and treatment of gastroesophageal reflux disease
Trukhmanov A.S., Trukhmanov A.S.
Abstract
The lecture presents modern interpretation of the term "gastroesophageal reflux disease" (GERD) and Montreal classification of this disease with emphasis on non-erosive reflux disease and risk to develop Barret's esophagus which is a widely prevalent precancer condition frequently transforming into esophageal adenocarcinoma. Description is given of GERD causes, mechanisms of development, diagnostic and differential diagnostic signs of the disease, a high risk of bronchial asthma in GERD patients, basic treatment principles including healthy way of life, pharmacotherapy (antacids, alginates, prokinetics, proton pump inhibitors, etc.).
Terapevticheskii arkhiv. 2011;83(8):44-48
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Current methods of diagnosis and monitoring of a systemic amyloidosis course
Rameev V.V., Kozlovskaya L.V., Malinina E.A., Serova A.G., Kogarko I.N., Kogarko B.S., Lyubimova N.V., Rameev V.V., Kozlovskaya L.V., Malinina E.A., Serova A.G., Kogarko I.N., Kogarko B.S., Lyubimova N.V.
Abstract
Aim. To determine clinical significance of measuring blood levels of protein precursors of AA- and AL-amyloidosis - SAA and immunoglobulin free light chains (ILC), respectively. Material and methods. SAA concentrations were studied with ELISA in 43 rheumatoid arthritis (RA) patients including complicated with reactive AA-amyloidosis (n = 31). Inflammation activity and its severity were studied (indices Li, richi, HAQ, DAS4). A modern quantitative nephelometric method Freelite estimated ILC levels in 31 patients with AL-amyloidosis. Results. Patients with RA complicated with AA-amyloidosis and free of it had a strong correlation between blood serum SAA concentration and activity of joint disease. Elevated SAA concentrations to 160 mg/l (normal 10 mg/l) were detected in many patients with clinical remission of the joint syndrome. Significal inhibition of AA-amyloidosis progression was seen only in SAA concentration drop under 60 mg/l. For AL-amyloidosis patients ILC fall by less than 3 normal value means a 6-time increase in chances of a favourable outcome. Conclusion. Monitoring of blood levels of proteins precursors of AA- and AL-amyloidosis is a key factor in prognosis of the disease and treatment efficacy.
Terapevticheskii arkhiv. 2011;83(8):48-54
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The role of lipid disbolism in kidney disease in metabolic syndrome associated with obesity
Kryachkova A.A., Savel'eva S.A., Kutyrina I.M., Kryachkova A.A., Savelyeva S.A., Kutyrina I.M.
Abstract
Aim. To study the role of lipid metabolism impairment in renal disease in patients with metabolic syndrome associated with obesity. Material and methods. Lipid metabolism was studied in 77 patients with metabolic syndrome (MS) aged from 17 to 63 years (mean age 48±9 years). Lipid abnormalities were analysed in groups of patients with different degree of obesity: group 1 - body mass index (BMI) 25-29.9 kg/m2 (n = 13), group 2 - BMI 30-39.9 kg/m2 (n = 49), group 3 - BMI > 40 kg/m2 (n = 15), and in groups of patients with different insulin resistance (IR) : group 1 - HOMA-IR < 2; n = 12; group 2 - HOMA-IR 2 - 4; n = 27; group 3 HOMA-IR > 4; n = 32). Correlation between plasma lipid composition abnormalities and markers of renal disease were studied with correlation analysis. Results. Lipid disbolism in MS patients was characterized with elevated level of triglycerides, total cholesterol (TC), VLDLP cholesterol, low level of HDLP cholesterol. A significant relationship was detected between defective blood lipid composition and renal dysfunction: rise of microalbuminuria, proteinuria, creatinin, inhibition of glomerular filtration rate. Conclusion. The changes found characterize lipid metabolism disorder as an independent factor of kidney disease in patients with MS.
Terapevticheskii arkhiv. 2011;83(8):54-58
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Correction of atherogenic dyslipidemia with honey, pollen and bee bread in patients with different body mass
Kas'yanenko V.I., Komisarenko I.A., Dubtsova E.A., Kasianenko V.I., Komisarenko I.A., Dubtsova E.A.
Abstract
Aim. To assess efficacy of treatment of patients with atherogenic dyslipidemia (ADL) with beekeeping products (honey, pollen, bee bread). Material and methods. ADL parameters were examined in 157 patients (64 males and 93 females) aged 39 to 72 (mean age 61,7 + 8,5 years) with ADL. Products of beekeeping were given in the absence of allergy and individual resistance to honey, pollen, bee bread. The patients were divided into four groups: patients on hypolipidemic diet only, on diet and honey or pollen, on bee bread, combined treatment - diet, honey, pollen. Results. A significant hypolipidemic effect was registered in patients taking honey in combination with pollen (total cholesterol decreased by 18,3 %, LDLP cholesterol by 23,9 %) and bee bread (total cholesterol decreased by 15,7 %, LDLP cholesterol by 20,5 %). Conclusion. Improvement of blood lipid composition in taking honey and pollen in overweight (body mass index - BMI 25 - 30) and obese (BMI over 30) patients occurs only in loss of body mass.
Terapevticheskii arkhiv. 2011;83(8):58-62
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Progress in gene therapy
Glazkova D.V., Bogoslovskaya E.V., Shipulin G.A., Pokrovskiy V.I., Glazkova D.V., Bogoslovskaya E.V., Shipulin G.A., Pokrovsky V.I.
Abstract
Recent progress in gene therapy, current status of investigations in this area of experimental medicine are reviewed. Much attention is given to gene-therapeutic approaches the efficacy of which is proved in clinical trials.
Terapevticheskii arkhiv. 2011;83(8):62-69
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Therapy of acute massive blood loss in a hemophiliac male: case report
Bulanov A.Y., Shulutko E.M., Karpov E.E., Polyanskaya T.Y., Mishin G.V., Morozov S.A., Kalinin N.N., Tochenov A.V., Yatskov K.V., Zorenko V.Y., Sampiev M.S., Bulanov A.Y., Shulutko E.M., Karpov E.E., Polyanskaya T.Y., Mishin G.V., Morozov S.A., Kalinin N.N., Tochenov A.V., Yatskov K.V., Zorenko V.Y., Sampiev M.S.
Abstract
A case is reported of management of massive intraoperative blood loss in a male patient with severe hemophilia. Extirpation of hip pseudotumor with one-stage osteosynthesis with an intramedullary joint-pin in a 43 year old male patient was accompanied with 7.5 l blood loss. The infusion-transfusion therapy (ITT) contained transfusion media about 1/3 of the total volume, fresh-frozen plasma and erythrocyte-containing media were used 1:1. Infusion solutions consisted of balanced polyelectrolytic solutions, hydroxyethylated starches 130/0.4, hyperchaes. Intraoperative normovolemic hemodilution and reinfusion of wound blood were made (CellSaver). ITT target markers were standard hemodynamics control tests. Hemostasis monitoring was conducted with thromboelastography. Complex ITT based on modern principles of clinical transfusiology provided a complete and safe compensation of massive intraoperative blood loss in a patient with severe hemophilia.
Terapevticheskii arkhiv. 2011;83(8):70-73
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Reforms of practical medicine in the course of the first scientific revolution (the XVII century 1770s). Communication 2: development and introduction of a new therapeutic-diagnostic conception
Stochik A.M., Zatravkin S.N., Stochik A.M., Zatravkin S.N.
Abstract
Reforms in practical medicine in the course of the first scientific revolution are described. This period indicates a rise of a principally novel therapeutic-diagnostic conception. Main lines of this conception are presented and consequences of its introduction are analysed.
Terapevticheskii arkhiv. 2011;83(8):74-78
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Asfold Ivanovich Parfenov the 75-th anniversary of birth
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Abstract
Terapevticheskii arkhiv. 2011;83(8):79-80
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