Vol 83, No 10 (2011)


Current facilities of radical surgical treatment of cancer patients with comorbid severe cardiovascular diseases

Davydov M.I., Akchurin R.S., Gerasimov S.S., Davydov M.I., Akchurin R.S., Gerasimov S.S.


Till recently, radical surgery was contraindicated in cancer patients with severe cardiovascular diseases, palliative or symptomatic treatment was preferred. Current literature data and experience gained in the N.N. Blokhin Russian Cancer Research Center show that modern methods of examination and surgical treatment of severe comorbid cardiovascular diseases give cancer patients a chance of radical operation for cancer providing the best short- and long-term results of treatment.
Terapevticheskii arkhiv. 2011;83(10):5-10
pages 5-10 views

Small intestinal tumors as a cause of chronic iron deficiency anemia

Voytsekhovskiy V.V., Khaustov A.F., Pivnik A.V., Wojciechowski V.V., Khaustov A.F., Pivnik A.V.


A brief update literature review on different methods of diagnosis of small intestinal tumors indicates angiography, videointestinoscopy and positron-emission tomography as most sensitive methods in diagnosis of intestinal tumors. A case of a small intestinal tumor is reported (a male of 46 years of age with chronic iron deficiency anemia) which was diagnosed with videointestinal camera and was confirmed histologically as adenocarcinoma). The patient was successfully operated and is now on chemotherapy.
Terapevticheskii arkhiv. 2011;83(10):11-18
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Incidence of solid tumors in patients with chronic lymphocytic leukemia exposed to radiation after Chernobyl accident

Abramenko I.V., Belous N.I., Kryachok I.A., Martina Z.V., Gudzenko N.A., Fedorenko Z.P., Kutsenko L.B., Dyagil' I.S., Chumak A.A., Bazyka D.A., Bebeshko V.G., Abramenko I.V., Belous N.I., Kryachok I.A., Martina Z.V., Gudzenko N.A., Fedorenko Z.P., Kutsenko L.B., Dyagil I.S., Chumak A.A., Bazyka D.A., Bebeshko V.G.


Aim. To study incidence of solid tumors in patients who developed chronic lymphocytic leukemia (CLL) after exposure to ionizing radiation after the Chernobyl accident. Material and methods. After analysis of data on all CLL male patients living in Kiev registered in the National Cancer Register of Ukraine in 1991-2008, these patients were divided into two groups. Group 1 consisted of 56 Chernobyl rescuers exposed to ionizing radiation, group 2 - of 684 patients without history of Chernobyl-related radiation. Results. Solid tumors were detected in 14 cases in group 1 and 74 cases in group 2 (p = 0.001). Risk to develop solid tumors in group 1 was significantly higher (OR 3.29 in 95% CI from 1.61 to 6.62). Conclusion. The conclusion made needs further verification on wider data base.
Terapevticheskii arkhiv. 2011;83(10):18-22
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Iron metabolism regulatory mechanisms in initial leukocytosis in patients with acute leukemia

Makeshova A.B., Levina A.A., Mamukova Y.I., Parovichnikova E.N., Savchenko V.G., Makeshova A.B., Levina A.A., Mamukova Y.I., Parovichnikova E.N., Savchenko V.G.


Aim. To study levels of hepsidine (Hp), hypoxia-inducible factor-1alpha (HIF-1α), erythropoietin (EP) and ferritin in patients with acute leukemia (AL), effects of protein fractions of homogenate of blastic cells (BC) on regulatory proteins studied. Material and methods. Depending on leukocyte count in the onset of AL, 70 patients with first ever diagnosed AL were divided into two groups: group 1 - 17 patients with leukocyte count > 30109/l, group 2 - 53 patients with leukocyte count < 30109/l. Serum and leukocyte parameters were studied before treatment, during the treatment with cytostatic drugs, in the course of myelotoxic agranulocytosis (MTA), after normalization of hemograms. EP was detected with enzyme immunoassay, serum and leukocyte ferritin - with radioimmunoassay; HIF-1α, Hp - sandwich enzyme immunoassay using monospecific antisera and monoclonal antibodies against relevant antigens. Leukocytes were isolated in ficol and verografin solutions density gradient. Chromatographic division of the protein fractions in 3 patients with leukocytosis in AL onset and leukocytes of 3 donors was made by the method of preparative isoelectrofocusing of BC and leukocytes on LKB colon (Sweden). Effects of these fractions were studied on 11 plasma samples from hematological patients and 4 plasma samples from patients with normal hemopoiesis. Results. Leukocytosis patients with initial AL have serum ferritin, Hp and HIF-1α levels about 2-5 times lower than patients without leukocytosis. Cytostatic treatment raises an HIF-1α level in BC about 15-fold (85.8±24.5 pg/ml), in the study group - 3-fold (15.2±3.3 pg/ml). The highest EP levels were seen in MTA. It is detected that protein fractions isolated from leukocytes of patients with leukocytosis in the disease onset raise HIF-1α content irrespective of HIF-1α presence in the fraction. Patients free of hematological diseases have no changes of the above proteins. Conclusion. Great difficulties exist in ferritin and Hp levels between AL patients with leukocytosis in the onset of the disease and without of leukocytosis. The study of leukocytes suggests that tumor cells of such patients contain compounds which can regulate production of HIF-1α, Hp and ferritin.
Terapevticheskii arkhiv. 2011;83(10):22-27
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Heterogenicity of type 2 diabetes mellitus: clinical characteristics of 4 subtypes

Asfandiyarova N.S., Asfandiyarova N.S.


Aim. To characterize clinically subtypes of type 2 diabetes mellitus (DM2) depending on lymphocyte reaction to insulin. Material and methods. DM2 patients (n = 357) were divided into 4 groups: DM2a - direct response of lymphocytes to insulin (RLI) detected in lymphocyte blasttransformation reaction, ICA+; DM2b - indirect RLI detected at inhibition of cells with receptors to histamine with cimetidin, ICA+; DM2c - indirect RLI detected at inhibition of cells synthetizing prostaglandin with indometacine, ICA -; DM2d - the absence of RLI, ICA - . Results. DM2a patients were characterized by 5-year need in insulin, development of microangiopathy. DM2b patients - by overweight, combination of micro- and macroangiopathy, high risk of stroke, myocardial infarction, diabetic foot, need in insulin. DM2c patients had classic DM2, they were not in need of insulin at early stages of the disease, with typical development of macroangiopathy. DM2d patients had pancreatogenic DM. Conclusion. Application of the immunological criterion (type of RLI) differentiates DM2 patients with different course, prognosis. They need different treatment.
Terapevticheskii arkhiv. 2011;83(10):27-31
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Taurin in combined treatment of metabolic syndrome and diabetes mellitus

Ametov A.S., Kochergina I.I., Doskina E.V., Abaeva B.S., Elizarova E.P., Ametov A.S., Kochergina I.I., Doskina E.V., Abaeva B.S., Elizarova E.P.


In addition to information on the prevalence, etiology and pathogenesis of metabolic syndrome and type 2 diabetes mellitus, the role of insulin resistance, lipotoxicity, hyperglycemia and glucose toxicity in development complications of metabolic syndrome and diabetes mellitus, the article presents evidence from multicenter clinical trials of taurin/dibicor efficacy in the treatment of metabolic syndrome, diabetes mellitus, cardiovascular complications, diabetic retinopathy. It is demonstrated that taurin/ dibicor has a positive effect on insulin resistance and body mass in obesity, on carbohydrate and lipid metabolism, on cell membranes, blood pressure, acuity of vision. Taurin/dibicor protects against macro- and microvascular diabetic complications, improves vision, cardiovascular system condition, quality and duration of life.
Terapevticheskii arkhiv. 2011;83(10):31-36
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Clinical implication of endothelial dysfunction in patients with essential arterial hypertension and urate dysbolism with renal damage

Stakhova T.Y., Pulin A.A., Severova M.M., Shovskaya T.N., Minakova E.G., Oleynikova E.B., Lebedeva M.V., Stakhova T.Y., Pulin A.A., Severova M.M., Shovskaya T.N., Minakova E.G., Oleinikova E.B., Lebedeva M.V.


Aim. To study correlations between severity of hyperuricemia, endothelial dysfunction (ED) and arterial atherosclerosis (AS). Material and methods. A total of 50 patients with essential hypertension of degree I-II free of associated clinical conditions entered the trial. The study group consisted of 40 patients with hyperuricemia, the control group - of 10 patients with normal blood serum levels of uric acid. Results. The study group patients versus controls had significantly higher albuminuria (93.5±1.7 and 60.7±2.2 mg/l; p < 0.001), plasmic concentration of endotheline-1 (6.8±0.3 and 4.9±0.2 pg/ml; p < 0.001)and thickness of the intima-media complex of the common carotid artery (1.36±0.02 and 1.1±0.04; p < 0.001). All the indices correlated directly and significantly. Conclusion. Patients with arterial hypertension of the first-second degree with persistent elevated levels of uric acid in blood serum had significantly higher levels of ED markers: albuminuria, plasmic endothelin concentration. Hyperuricemia and ED in such patients lead to more active progression of atherosclerotic vascular lesion.
Terapevticheskii arkhiv. 2011;83(10):36-40
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Low-dose combination of perindopril arginine with indapamide in correction of metabolic syndrome

Kseneva S.I., Borodulina E.V., Semiglazova T.A., Kulakova N.V., Tarasova I.V., Udut V.V., Kseneva S.I., Borodulina E.V., Semiglazova T.A., Kulakova N.V., Tarasova I.V., Udut V.V.


Aim. To study ways of realization of pleiotropic effects of treatment with low-dose combination of perindopril arginine with indapamide in hypertensive patients with metabolic syndrome (MS). Material and methods. Thirty hypertensive patients with MS received low-dose combined drug noliprel A (Servier, France). In weak hypotensive effect noliprel A forte was used. An antihypertensive (by the data of 24-h blood pressure monitoring), sympatholytic (by the levels of ACTH and cortisol in blood plasma, by variability of the heart rate)and metabolic effects of the drug were assessed after 3 weeks, 3 and 6 months of treatment.Carbohydrate metabolism was studied by glucose and insulin blood levels before meal and after it. Lipid and purin metabolism were assessed by enzyme method, leptin levels - by enzyme immunoassay. Results. 24-h blood pressure monitoring registered a stable regular blood pressure lowering, target blood pressure was achieved in 78.6% patients. Blood ACTH concentration significantly reduced showing a sympatholytic action of the drug.Parameters of lipid, carbohydrate and purin metabolism changed insignificantly. Positive changes were seen in anthropometric indices, leptin tended to decrease. Changes in these parameters, sympatholytic and hypotensive effects depended on plasmic levels of leptin. Conclusion. A fixed low-dose combination of perindopril arginine with indapamide in a stable hypotensive effect and metabolic neutrality influences some key components of MS including hyperactivity of sympathic autonomic nervous system component and hyperleptinemia.
Terapevticheskii arkhiv. 2011;83(10):40-45
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Lozartan potential in hyperuricemia correction

Nedogoda S.V., Nedogoda S.V.


Recently, much attention of medical professionals is directed to correlations between hyperuricemia, arterial hypertension, metabolic syndrome and renal affection because of the evidence that elevated blood level of uric acid raises the risk of cardiovascular complications not only in arterial hypertension and metabolic syndrome but also in diabetes mellitus type 2, coronary heart disease, congestive heart failure and renal dysfunction. Administration of uricosuric medication in hyperuricemia and goat has contraindications in some cases. A number of trials show a corrective action of lozartan. Other blockers of receptors to angiotensin II has no such effect.
Terapevticheskii arkhiv. 2011;83(10):45-48
pages 45-48 views

Primary immunodeficiency in adults: total variable immune deficiency clinical manifestations, immunological and genetic defects, treatment

Karaulov A.V., Sidorenko I.V., Androsov V.V., Kapustina A.S., Karaulov A.V., Sidorenko I.V., Androsov V.V., Kapustina A.S.


The most prevalent form of primary immunodeficiency with a total defect of antibody production in adults is common variable immunodeficiency (CVID). Compared to other forms of primary immunodeficiency, CVID is characterized by later onset of clinical manifestations represented by infectious, autoimmune and malignant diseases. To avoid development of complications and patient incapacitating, it is necessary to make an early diagnosis and initiate regular replacement therapy with intravenous immunoglobulins.
Terapevticheskii arkhiv. 2011;83(10):49-54
pages 49-54 views

Comorbid anxiety disorders and quality of life in patients with an artificial cardiac pacemaker

Iskenderov B.G., Petrova E.V., Maksimov D.B., Kameneva O.A., Iskenderov B.G., Petrova E.V., Maximov D.B., Kameneva O.A.


Aim. To investigate correlations between anxiety disorders, quality of life (QoL)and patient's age, mode, duration and course of cardiac pacing(CP). Material and methods. Examination covered 134 patients (75 females and 59 males) with artificial pacemaker (APM). It included psychological testing with Hospital Anxiety and Depression Scale (HADS), QoL study with questionnaire MOS-SF-36. Results. APM implantation caused anxiety disorders in 80.6% patients, 51.5% had clinical symptoms of anxiety. An physiological and frequency-adaptive modes of PC, at the age under 50, in the absence of ECS complications frequency and severity of anxiety disorders are the lowest. Staged changes in the course of anxiety disorders were seen after primary APM implantation and in uncomplicated PC. APM implantation, irrespective of PC mode, significantly increased physical and mental parameters of QoL in patients under 50 years of age as well as mental health parameters in patients over 70. Conclusion. It is necessary to conduct psychological testing in APM patients and their psychic rehabilitation for improvement of QoL.
Terapevticheskii arkhiv. 2011;83(10):54-58
pages 54-58 views

Correction of hypoxia and its aftereffects in patients with acute cerebral insufficiency due to acute poisoning

Shilov V.V., Batotsyrenov B.V., Aleksandrov M.V., Vasil'ev S.A., Shilov V.V., Batotsyrenov B.V., Alexandrov M.V., Vasilyev S.A.


Aim. To examine efficacy of a substrate antihypoxic drug reamberine in patients with cerebral insufficiency (CI)caused by severe forms of acute poisoning. Material and methods. The study enrolled 60 patients (38 males, 22 females; mean age of the males 34.7±2.6 years, of the females - 28.4±3.2 years)admitted to the intensive care unit of St-Petersburg city center for treatment of acute poisoning for acute CI as a result of severe acute poisoning with neurotropic substances. The patients were divided into 2 groups matched by age, gender and severity of poisoning: group 1 (n = 32) received reamberin and standard treatment; group 2 (n = 28) received standard treatment alone. Results. The addition of reamberin to intensive treatment of acute CI alleviated severity of CI, enhanced recovery of functional activity of the brain, significantly reduced tissue hypoxia. All these positive effects improved clinical course of acute CI as shown by a shorter stay in the state of coma (reduction from 55±2.2 to 33±2.6 hours, shorter stay in the intensive care unit (reduction from 69.1±3.6 to 53.4±4.3 hours), reduced cost of the treatment. Conclusion. In severe poisoning with neurotropic substances reamberin enhances correction of CI and increases tissue oxygen utilization.
Terapevticheskii arkhiv. 2011;83(10):58-61
pages 58-61 views

Hypogonadism and cardiovascular diseases in men

Gamidov S.O., Tazhetdinov O.K., Iremashvili V.V., Gamidov S.I., Tazhetdinov O.K., Iremashvili V.V.


The article analyses correlation between low levels of sex hormones in men (male hypogonadism) and cardiovascular diseases. It was believed for a long time that androgens have adverse effect on cardiovascular system. It is shown that, on the contrary, hypogonadism indirectly raises the risk of cardiovascular diseases via various components of metabolic syndrome. Moreover, correction of male hypogonadism with testosterone preparations may have a positive effect on risk factors of vascular complications including fat reduction , normalization of blood pressure, correction of dyslipidemia. Pharmacologically, testosterone undecanoate for intramuscular injections (nebido) is a good form. This drug can provide a stable physiological testosterone level for about 12 weeks after injection.
Terapevticheskii arkhiv. 2011;83(10):61-67
pages 61-67 views

Antiplatelet drugs and gastrointestinal disorders: when and how effective are inhibitors of proton pump?

Drapkina O.M., Korneeva O.N., Drapkina O.M., Korneeva O.N.


Antiplatelet drugs are essential in current treatment of coronary heart disease (CHD) but they have an adverse action - damage to gastrointestinal mucosa. Long-term administration of several medicines in CHD patients makes possible interaction of some drugs. Clinical trials show that proton pump inhibitors (PPI) reduce frequency of recurrent gastrointestinal bleedings in patients of high cardiological risk on antiplatelet therapy. In prescription of PPI to CHD patients at high risk of gastropathy, it is necessary to consider both efficacy and safety of the drug.
Terapevticheskii arkhiv. 2011;83(10):68-71
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Anthracycline cardiomyopathy

Anokhin V.N., Chushkin M.I., Kolganov A.V., Anokhin V.N., Chushkin M.I., Kolganov A.V.


Anthracycline antibiotics are highly effective in the treatment of cancer, but their cardiotoxicity limits use of these antibiotics. A cardiotoxic action of anthracyclines provokes development of dilated cardiomyopathy with or without symptoms of cardiac insufficiency (CI). Anthracyclines have a long-term cardiotoxic action, therefore, with time, the rate of cardiomyopathy development increases. Follow-up echocardiography is an optimal method for assessment of cardiac function. Such parameters as left ventricular ejection fraction and the degree of the anteroposterior shortening are most essential. Cardiac failure symptoms are managed in the same way as in other pathology.
Terapevticheskii arkhiv. 2011;83(10):72-76
pages 72-76 views

From classification medicine to clinical medicine (the end of the XVIII century 1870s). Communication 2. The first stage of clinical medicine development: introduction of the method of clinico-anatomic correlations

Stochik A.M., Zatravkin S.N., Stochik A.M., Zatravkin S.N.


The first stage of clinical medicine development is analysed which covers the period from early 1800s to middle 1870s. Considered are basic research achievements associated with introduction of the method of clinico-anatomic correlations into practical medicine.
Terapevticheskii arkhiv. 2011;83(10):76-79
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Alexey Petrovich Golikov

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Terapevticheskii arkhiv. 2011;83(10):80-80
pages 80-80 views

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