Vol 83, No 10 (2011)

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.

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.

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.

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.

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.

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.

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.

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.