Vol 84, No 1 (2012)


Current principles of cholelithiasis prophylaxis in the practice of district physician

Galkin V.A., Galkin V.A.


The key task of the district physician is staged diagnostic search and clinical detection of functional disorders - conduction of laboratory tests and device investigations ( in cholelithiasis patients - ultramicroscopic investigation of bile, x-ray methods, ultrasonography) to initiate prophylactic-therapeutic measures (medico-social, pharmacological and therapeutic-dietary).
Terapevticheskii arkhiv. 2012;84(1):5-7
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Subjective sleep characteristics, apnea episodes and day drowse in patients with systolic cardiac failure: potential of clinicofunctional outpatient examination

Rostorotskaya V.V., Ivanov A.P., El'gardt I.A., Rostorotskaya V.V., Ivanov A.P., Elgardt I.A.


Aim. To characterize sleep apnea (SA) in patients with systolic cardiac failure (SCF) using respiratory monitoring, sleep quality and diurnal drowse questionnaires. Material and methods. A total of 358 SCF outpatients with SA episodes were examined: 24 hour ECG and respiration monitoring, an analysis of diurnal drowse questionnaire survey, apnea and snoring self-appraisal. Results. Significant SA episodes were registered in 15.1% of 358 patients (SA index 5 and more per hour). The episodes occurred significantly more frequently in patients with overweight and had high sensitivity and specificity. However, no correlation was found with severity of diurnal drowse, sleep duration and age. SA risk was relatively high in patients with a history of snoring and nocturnal sleep apnea (2.95-2.79). The significance of the latter rose to 9.12-8.81 in SCF patients with normal myocardial mass index. Conclusion. Subjective and objective sleep characteristics, except diurnal drowse, can be used for risk stratification in SCF patients with SA.
Terapevticheskii arkhiv. 2012;84(1):8-11
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The role of day hospital in optimization of medical care for patients of a therapeutic department of an outpatient clinic

Gulyaev P.V., Stanke A.A., Vikhrova T.V., Ostrovskikh G.Y., Gulyaev P.V., Stanke A.A., Vikhrova T.V., Ostrovskikh G.Y.


Day hospital (DH) provides consultations and treatment for all referred patients according to standards of medical care quality. DH has facilities for therapeutic and gastroenterological patients. Treatment in DH is performed according to current standards which cover basic treatment of the diseases (documented medicines, duration of treatment). Efficacy of DH's use of the Standards of Diagnosis and Therapy of Acid-Dependent Diseases associated with Helicobacter pylori (standards of Moscow consensus) is used as illustration. As a result of treatment in DH 93% outpatients resumed their jobs, improvement occurred in 96.7% patients, a complete response was seen in 23%, 1.9% cases failed treatment. Most DH patients (83%) were satisfied with treatment given in DH and think it a convenient replacement of hospital stay.
Terapevticheskii arkhiv. 2012;84(1):12-14
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Visits to the doctor because of illness or injury of the students of vocational schools who consume or do not consume psychoactive substances (comparative aspects)

Yurgaytene D.P., Shopagene D.S., Andreev V.A., Jurgaitiene D.P., Sopagiene D.S., Andreyev V.A.


Aim. To elucidate what impact has the use of different narcotic drugs, alcohol and tobacco on the health of students and the risk of injuries. Material and methods. We carried out a questionnaire survey of the first year students from all six vocational schools of Klaipeda (Lithuania) in 2004, 2006 and 2008. A total of 912 students (507 boys and 405 girls, mean age 17.5 years) were surveyed with an anonymous questionnaire. The findings were analysed with computer soft SPSS (SPSS 16.0 for Windows). Results. The results showed that the use of any psychoactive substances is damaging to health, especially injection and club narcotic drugs. Adolescents addicted to any psychoactive substances more often than non-addicts visited doctor due to illness or injury during the last 12 months. Conclusion. Adolescents on illegal drugs, especially boys on injectable narcotic drugs and girls on club drugs were at twice higher risk for disease or injury (odds ratio - OR - 3.39, 95% confidence interval -CI - 1.25 to 9.19, p=0.016 and OR -2.38, CI - 1.35 to 4.20, p=0.003, respectively). Tobacco and alcohol consumption did not significantly increase this risk with the exception of tobacco smoking girls. We think it happened because these two addictions are widely spread among large part of the boys from the vocational schools.
Terapevticheskii arkhiv. 2012;84(1):15-18
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Optimal rehabilitation of patients with coronary heart disease in outpatient setting

Korzhenkov N.P., Kuzichkina S.F., Shcherbakova N.A., Kukhaleishvili N.R., Yarlykov I.I., Korzhenkov N.P., Kuzichkina S.F., Scherbakova N.A., Kukhaleishvili N.R., Yarlykov I.I.


The problem of invalid rehabilitation in Russia is an important state task and dictates necessity of design of an effective state program of primary prevention of cardiovascular diseases. Common global practice of medico-social model is based on complex detailed medico-social aid. Rehabilitation of post-myocardial infarction patients consists of three phases (stages): hospital, posthospital (readaptation) and postreconvalescent (supportive). The program includes physical, psychological and pharmacological rehabilitation. Departments of readaptation and medico-social rehabilitation provide effective conduction of all kinds of rehabilitation. The Moscow North-East Regional Administration has a rich experience in organization of departments of readaptation and medico-social rehabilitation. The departments practice an individual approach to the patients and work in a close contact with bureaus of medico-social commission of experts. Management of patients by cardiologist, rehabilitation specialist and outpatient clinic's physicians provides uninterrupted staged rehabilitation, timely correction of pharmacotherapy, early patient referral to invasive investigations and treatment of coronary heart disease. A course of rehabilitative measures lasts 2 months. Setting up departments of medico-social rehabilitation in outpatient clinics provides more effective use of money assigned by the state for social support of invalids.
Terapevticheskii arkhiv. 2012;84(1):18-22
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Assessment of the quality of medical assistance for patients with acute ST elevation coronary syndrome for 2009-2010 in regions of the Russian Federation participating in the "vascular program" (by the data of the Russian ACS Register)

Oshchepkova E.V., Dmitriev V.A., Gridnev V.I., Dovgalevskiy P.Y., Oschepkova E.V., Dmitriev V.A., Gridnev V.I., Dovgalevsky P.Y.


Aim. To assess quality of medical assistance for patients with acute ST elevation coronary syndrome (aSTeCS) for the period from 2009 to 2010 in 23 administrative regions of the Russian Federation (RF) realizing the "vascular program". Material and methods. We analysed management of aSTeCS patients treated in the regional vascular centers and/or primary vascular departments of 23 administrative regions of the RF for the period from January 1, 2009 to January 1, 2011. Mean age of the patients was 64 (56-75) years, 65.8% were males. For the above period computer medical information was available for 45407 acute coronary syndrome (ACS) patients, of them the diagnosis of aSTeCS was in 17514 patients. Results. We found that most aSTeCS patients seek medical advice late, prehospital aspirin was prescribed only in 50-60% cases. Thrombolytic therapy (TLT) was performed, on the average, in 22 and 27% cases in 2009 и 2010, respectively. A definite positive trend in TLT administration in 2009-2010 was seen only in 5 regions. In 2010 г. frequency of TLT conduction was below the evarage for all the sample in 8 regions of the RF. Procedures of urgent percutaneous coronary intervention (UPCI) in 2009 were made, on the average, in aSTeCS patients, in 2010 г. - in 22,6 %. A positive trend in application of UPCI in aSTeCS patients was registered in 9 RF regions. The number of UPCI procedures under 100 in 2010 was seen in 5 RF regions. Conclusion. ACS Register provided data on application of high-tech treatment and pharmacotherapy in 2009 и 2010 in medical institutions of 23 RF regions realizing "vascular program".
Terapevticheskii arkhiv. 2012;84(1):23-29
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Effects of anomalous rise of air temperature on population mortality

Chazov E.I., Boytsov S.A., Chazov E.I., Boitsov S.A.


Global climate warming for the last 10 years actualized the problem of mortality rise in some European countries in anomalous summer heat. Russia faced this problem in July-August 2010 when extreme heat entailed a significant elevation of mortality in 31 regions of the country primarily due to coronary heart disease and cerebrovascular diseases. The analysis of foreign researches has shown that old age and living in cities are leading risk factors of death in anomalous heat. Experience of the European countries and USA evidences that stay in conditioned apartments and early referral for medical assistance are most effective death preventive measures in heat.
Terapevticheskii arkhiv. 2012;84(1):29-36
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Systolic and diastolic intraventricular asynchrony of the left ventricular myocardium in patients with pacemaker

At'kov O.Y., Popova E.Y., Gorokhova S.G., Atkov O.Y., Popova E.Y., Gorokhova S.G.


Aim. To study intraventricular asynchrony and effects of pacemaker implantation on asynchrony severity in patients with rhythm and conduction disorders. Material and methods. The study of 46 patients with cardiac arrhythmia (atrial fibrillation, sick sinus syndrome, AB-block of the third degree) included such examinations as echocardiography, tissue dopplerography (PWTDI) before pacemaker implantation and 7 days after it. Electromechanic systolic and diastolic myocardial asynchrony was assessed by intraventricular heterogeneity index (IHb, IHm, TSD) in 8 segments of the left ventricle (LV) at the basal and mean levels. Values obtained in examination of 32 healthy volunteers were considered normal. Results. Parameters of systolic and diastolic asynchrony in patients with cardiac arrhythmia significantly differ from normal ones. Basal LV diastolic asynchrony was detected in 41-48% patients, systolic one - in 62-100%, systolodiastolic - in 41% cases. Pacemaker implantation into the right heart significantly reduces LV systolic asynchrony while diastolic one was unaffected in an early postoperative period. The best sensitivity in detection of systolic asynchrony is achieved with TsSD index. Informative value of diastolic asynchrony parameters is much less than of the systolic one. Conclusion. Indices of systolic asynchrony (TsSD, IhbS, IhmS) can be used for heart condition control after pacemaker implantation.
Terapevticheskii arkhiv. 2012;84(1):36-40
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Successful treatment of massive thrombosis of the vena cava inferior with nephrоtic syndrome and chronic bilateral pulmonary artery thromboembolism in a patient with genetic thrombophilia

Blagova O.V., Dzemeshkevich S.L., Kozlovskaya N.L., Nedostup A.V., Sarkisova N.D., Frolova Y.V., Raskin V.V., Dzemeshkevich A.S., Abugov S.A., Skipenko O.G., Shilov E.M., Sedov V.P., Gagarina N.V., Sinitsyn V.E., Mershina E.A., Volkova E.Y., Blagova O.V., Dzemeshkevich S.L., Kozlovskaya N.L., Nedostup A.V., Sarkisova N.D., Frolova Y.V., Raskin V.V., Dzemeshkevich A.S., Abugov S.A., Skipenko O.G., Shilov E.M., Sedov V.P., Gagarina N.V., Sinitsyn V.E., Mershina E.A., Volkova E.Y.


A case is reported of a 23-year-old male patient who developed, after severe blunt injury of the lumbar region, massive thrombosis of the vena cava inferior (VCI), both renal veins, bilateral pulmonary artery thromboembolism (PATE), nephrоtic syndrome (NS). In spite of anticoagulant therapy, the condition of the patient progressively aggravated for 1.5 year: thrombosis involved the ileac and femoral arteries on the right, thrombus floated in the right atrium with PATE recurrent episodes, pulmonary hypertension reached 120 mm Hg with formation of decompensated cor pulmonale, proteinuria and hypoalbuminemia deteriorated, anasarca edema developed. Multigenic thrombophilia was diagnosed (1 homozygous and 5 heterozygous mutations). A radical one-stage operation was successful: thromboectomy from the VCI, right ileac and left renal veins, thrombendarterectomy from the pulmonary arteries, suture of the interatrial septum defect, installation of cava-filter. After the operation pulmonary pressure lowered to 40-45 mm Hg, right heart volume normalized, immunosuppressive therapy with prednisolone and cyclosporine led to nephropathy remission. The discussion covers mechanisms and factors (including genetic) of thrombosis progression, correlations between intravascular thrombosis, NS and chronic glomerulonephritis (possible NS development due to bilateral thrombosis of the renal veins and nephropathy role in thrombosis progression), approaches to conservative and surgical treatment of such patients. Global experience in conduction of pulmonary thrombendarterectomy and thrombectomy from VCI is reviewed (one-stage operations were not described earlier).
Terapevticheskii arkhiv. 2012;84(1):41-47
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Hypertension in pregnant women - a novel cardiorenal continuum

Gaysin I.R., Gaisin I.R.


Aim. To investigate cardiorenal correlations in pregnant patients with arterial hypertension. Material and methods. Risk factors (RF), initial stages, progression, and final stage of both cardiovascular disease (CVD) and chronic kidney disease (CKD) were analysed in a cohort of 159 pregnant women with hypertensive disorders versus a cohort of 32 healthy pregnant controls. Cardiorenal continuum factors were investigated in patients with different ways of gestational hypertension (HT) diagnosis: 13 with isolated clinic HT (ICHT), 11 - isolated ambulatory HT (IAHT), and 18 - HT found by all three blood pressure (BP) measurement modalities (clinic, ambulatory, and home BP). Results. A novel cardiorenal continuum exists in pregnant women with HT where chronic HT (essential HT) on the one hand and pre-eclampsia on the other hand may lead through the common RF and initial stages (subclinical organ damage) to the stage of progression (CVD, CKD) and to the final stage (cardiovascular events and renal failure). The number of RF, signs of subclinical organ damage, and total cardiovascular risk progressively increase from the condition of being normotensive on clinic, home, and 24-hour definitions to the condition of being found hypertensive by one, two and all three BP measurement methods, forming the continuum "healthy pregnant women - ICHT - IAHT - gestational HT" in which each item is almost the same as the ones next to it but the last is very different from the first. Conclusion. Assessment of the cardiorenal state in all pregnant women allows to compose the cline "healthy pregnants - gestational HT - stage I essential HT - stage II essential HT - pre-eclampsia - essential HT with superimposed pre-eclampsia" with growing risk of CVD and CKD and a potential danger of cardiovascular events (complications) and chronic renal failure.
Terapevticheskii arkhiv. 2012;84(1):48-53
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Perspectives of molecular visualization in cardiology

Sergienko V.B., Samoylenko L.E., Sergienko V.B., Samoilenko L.E.


The lecture concerns prospects of molecular visualization in cardiology. The term molecular visualization, its aims and problems are characterized. Methods of molecular visualization involve such non-invasive techniques as ultrasonic investigation, optic visualization, MR tomography, x-ray CT, radionuclide examinations (single photon emission computed tomography and positron-emission tomography). The scope of the above methods and their limits in visualization of biomarker target molecules in different pathological processes on the molecular level, cardiovascular diseases (CVD) are outlined. The discussion covers various methodological approaches to molecular visualization of the processes associated with development and progression of atherosclerosis, visualization of atherosclerotic plaques of a high risk underlying myocardial infarction or stroke, thrombosis, inflammation, apoptosis, cardiac failure; with myocardial regeneration after myocardial infarction, angiogenesis and other conditions as well as assessment of effect of novel target approaches to CVD treatment. For each of the processes (atherosclerosis, thrombosis, angiogenesis, apoptosis, gene expression and other pathological conditions) biomarker target molecules are considered. Optimal among them are molecular targets with established biological and clinical significance, target-receptors or enzymes, contrast substances, molecular probes tropic to biomarker molecular targets having adequate affinity and pharmacodynamics which allows molecular visualization in clinical setting. The investigators are faced with many unsolved problems which can be studied with methods of molecular visualization.
Terapevticheskii arkhiv. 2012;84(1):54-61
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New guidelines for hypertension in Russia - a priority of combined treatment

Karpov Y.A., Karpov Y.A.


This review provides an analysis of the results of Russian and foreign clinical trials that have shown a high antihypertensive efficacy and tolerability of combined medications containing fixed doses of perindopril and indapamide.
Terapevticheskii arkhiv. 2012;84(1):61-64
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Renal affection in gout

Egorov I.V., Tsurko V.V., Egorov I.V., Tsurko V.V.


The study of the problem of impairment of the kidneys in gout is important because investigation of gout nephropathy specifies the role of hyperuricemia (a known risk factor) in development of renal damage, on the one side, and emphasizes the role of early detection of hyperuricemic genesis of nephropathy allowing prognosis improvement due to administration of uricostatic treatment, on the other side. Earlier data on tubulointerstitial lesion are now supplied with information on essential glomerular damage due to endothelial dysfunction in the presence of insulin resistance often associated with gout.
Terapevticheskii arkhiv. 2012;84(1):65-68
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From classification medicine to clinical medicine (the end of the XVIII century - 1870s). Communication 5. Reforms in therapy in 1840s-1860s

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


Reforms of therapy in 1840-1860s are considered: development of the methods of objective assessment of efficacy of some methods of treatment, appearance of experimental pharmacology, introduction of anasthesia.
Terapevticheskii arkhiv. 2012;84(1):69-73
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