Vol 84, No 8 (2012)


Pathogenetic treatment for chronic constipation

Parfenov A.I.


The investigations conducted in the past decade have offered better insight into the basic mechanisms of chronic constipation (CC), among other things, its association with large bowel (LB) transit and anorectal function. Intestinal dyskinesia, slow transit of the intestinal contents (inert LB), and impaired defecation due to pelvic floor dyssynergia play a leading role in the pathogenesis of primary constipation. Its treatment should be similar to that for CC. Motility regulators correcting LB dyskinesia are given to treat functional constipation and constipation-predominant irritable bowel syndrome. Enteral pro-kinetic agents are effective in treating the inert LB. The possibilities of biofeedback therapy should be used to treat dyssynergic defecation.
Terapevticheskii arkhiv. 2012;84(8):4-9
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Optimization of cell therapy in patients with inflammatory bowel diseases

Lazebnik L.B., Kniazev O.V., Parfenov A.I., Ruchkina I.N., Shcherbakov P.L., Khomeriki S.G., Konopliannikov A.G.


Aim. To elaborate optimal cell culture administration regimens to enhance the efficiency of anti-inflammatory therapy for inflammatory bowel diseases. Subjects and methods. Three groups of patients with chronic continuous or chronic recurrent ulcerative colitis (UC) were formed according to the treatment option: 1) 15 patients with UC, in whom mesenchymal stromal cells (MSC) were thrice administered for a month at a one-week interval; 2) 20 patients with UC who received MSC once; 3) 20 patients with UC who had standard anti-inflammatory therapy with 5-aminosalycilic acid (5-ASA) preparations and glucocorticosteroids (GCS). The clinical activity of UC was evaluated using the Rachmilewitz index; its endoscopic pattern was assessed with the Mayo index. UC histological specimens were scored using the Gebs scale. To ascertain the duration of remission, the authors used the Kaplan-Maier survival curve method and calculated relative risk (RR) and odds ratio with 95% confidence intervals.Results. Following 12 months, allogeneic bone marrow (BM) MSC transplantation performed thrice during a month caused the greatest reduction in the Rachmilewitz clinical activity index, Mayo endoscopic activity index, and Gebs pathohistological index in patients with UC as compared to those who had underwent one transplantation or received 5-ASA preparations and GCS (p<0.05). The duration of remission also depended on the chosen therapy option for UC and the frequency of cell culture administration: the longer duration was recorded in patients who were infused thrice with allogeneic BM MSC. Conclusion. In the patients who had undergone one MSC administration, the risk of recurrent UC was higher than in those who had received MSC thrice during a month (a 2-year follow-up) and comparable with the RR of recurrent UC in the patients receiving only 5-ASA preparations, GCS, and/or immunosuppressants.
Terapevticheskii arkhiv. 2012;84(8):10-17
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Specific features of hypolipidemic therapy in patients with abdominal ischemic disease

Oĭnotkinova O.S.


Aim. To evaluate the efficiency and safety of combined drug therapy incorporating Ursofalk (Dr Falk Pharma GmbH, Germany) and a low-dose statin on the clinical course of the disease and blood lipid composition parameters in high-risk patients with abdominal ischemic disease (AID) and hepatic ischemic steatosis resulting from atherosclerotic lesion of the abdominal aorta (AA) and its unpaired visceral branches (UVB). Subjects and methods. One hundred and thirty-nine patients (95 (68.3%) men and 44 (31.7%) women, aged 18-87 years) with AID and ischemic hepatopathy were examined and treated. AID in the examinees was verified by color duplex scanning and computed tomographic angiography of AA UVB, as well as by X-ray contrast aortography. The patients were treated with Ursofalk 10-15 mg/kg/day in combination with atorvastatin 10-20 mg/day. Results. Due to the combination therapy, abdominal pains became less significant in the majority of patients and disappeared in some subjects. The same positive changes were also observed in the signs of intestinal dysfunction. There was an improvement in blood lipid composition parameters. No substantial weight changes were noted in the patients during the treatment. No adverse reactions occurred due to the combined use of Ursofalk and atorvastatin.Conclusion. It is reasonable to co-administer urosofalk and statins as an agent of hypolipidemic therapy in patients with AID concurrent with disseminated atherosclerosis and dyslipidemia that is accompanied by fatty infiltration of the liver with elements of fibrosis in 90% of cases and that is a pre-stage of steatohepatitis.
Terapevticheskii arkhiv. 2012;84(8):18-21
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The efficiency and safety of adalimumab treatment in patients with active rheumatoid arthritis unresponsive to standard therapy: Russian national study results

Karateev D.E., Nasonov E.L., Luchikhina E.L., Mazurov V.I., Salikhov I.G., Shmidt E.I., Shostak N.A.


Aim. To confirm the efficacy and safety of adalimumab (ADA) added to the standard antirheumatic therapy performed in patients with rheumatoid arthritis (RA) of moderate and high activities.Subjects and methods. The open-labeled multicenter study enrolled 100 adult patients (11 men, 89 women; mean age 50.9±11.1 years) with active RA according to the ACR criteria (1987) despite their treatment with disease-modifying antirheumatic drugs, the average number of which in the history was 2.1 per man. At baseline, DAS28 CRP was as many as 6.2±0.84 scores; C-reactive protein (CRP) was 37.1±34.7 mg/l. In accordance with the indications officially registered in the European Union and the Russian Federation, ADA was given in a dose of 40 mg 2 weeks. Before administration of the drug, every patient underwent screening examination for tuberculosis, which used a tuberculin test and chest X-ray. The screening covered a period of the treatment up to 24 weeks and its subsequent period within 70 days after administration of the last dose of ADA in order to study its safety. Results. DAS28-CRP scores decreased from 6.14±0.86 (at baseline) to 3.39±1.1 (by the end of the study). At 12 weeks, 22% of the patients achieved a low RA activity (DAS28-CRP ≤3.2 scores); 14% achieved clinical remission ((DAS28-CRP ≤2.6 scores); at 24 weeks, these were 37 and 25% of the patients, respectively. There were differences in effectiveness in terms of the baseline disease activity. At 24 weeks, ACR20, ACR50, and ACR 70 responses were achieved in 88, 67, and 26% of the patients, respectively. The HAQ functional index reduced from 1.9±0.6 (at baseline) to 1.081±0.64 (at 12 weeks) and 1.04±0.68 (at 24 weeks) scores. Twenty-four patients were recorded as having 40 adverse reactions (AR), including only one severe AR (septic arthritis). There were no cases of tuberculosis. Conclusion. The Russian multicenter study demonstrated the high clinical efficacy of ADA in patients with the moderate and high activity of RA unresponsive to standard therapy, as well as its satisfactory safety.
Terapevticheskii arkhiv. 2012;84(8):22-28
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Markers of endothelial activation in rheumatoid arthritis

Shilkina N.P., Iunonin I.E., Vinogradov A.A., Butusova S.V.


Aim. To study relationships between endothelial activation parameters and inflammatory activity markers in patients with rheumatoid arthritis (RA). Subjects and methods. Fifty-three RA patients aged 19 to 62 years were examined. A control group comprised 28 apparently healthy individuals. The markers of endothelial activation, the parameters of RA activity, and their relationship were studied. Results. There was an elevation in the level of interleukin-8 (IL-8) to 413 (295; 547) pg/ml as compared to the control group 208 (207; 212) pg/ml. In the RA group, the concentration of soluble vascular cell adhesion molecule 1 (sVCAM-1) increased up to 1929 (1297.6; 2739.6) ng/ml whereas in the control group it was 750 (734; 762) ng/ml (p<0.001). In the patients with RA, the concentration of von Willebrand factor antigen (vWFAg) reached 1.4 (0.8; 1.9) IU/ml; in the control group, it was 0.6 (0.3; 0.8) IU/ml. In the RA group, the level of desquamated endotheliocytes (DE) was higher than that in the control group. Positive correlations were found between the markers of vascular endothelial activation and those of inflammation. There was a positive correlation between C-reactive protein (CRP), rheumatoid factor (RF), sVCAM-1, and DE. Significant positive correlations were observed between DAS28 and the inflammatory markers RF and CRP (R=0.66; p<0.05 and R=0.4; p<0.05) and the endothelial activation markers sVCAM-1 and vWFAg (R=0.8; p<0.05 and R=0.3; p<0.05, respectively). Conclusion. The patients with RA had elevated IL-8, sVCAM-1, and vWFAg levels. Enhanced RA activity resulted in endothelial damage.
Terapevticheskii arkhiv. 2012;84(8):29-32
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Efficiency of use of autologous activated serum in coxarthrosis

Noskov S.M., Shirokova L.I., Snigireva A.V., Parulia O.M., Dybin S.D.


Aim. To evaluate the clinical efficiency of using autologous conditioned (activated) serum (ACS) versus hyaluronic acid (HA) in coxarthrosis (CA). Subjects and methods. Two groups of patients (n=54) who were matched for age, sex, and disease duration and had a valid diagnosis of CA were examined. During 3 weeks, Groups 1 and 2 patients received intra-articular therapy with ACS or synocrome forte (Croma Pharma, Sоtex), respectively, for 3 weeks. A 12-month follow-up evaluated the magnitude of pain, by using the visual analog scale (VAS, mm), the functional index WOMAC and general health, by applying the EQ-VAS scale. Results. The only benefit of HA was found to be more functional improvement as detected by the WOMAC index (-21.8%; t=2.56) at an early (1-month) follow-up. After 3 months, the patients in the ACS group were recorded to have the maximum VAS pain intensity reduction that was 76.5% greater than that (t=4.31) in the HA group. The clearest advantages of ACS therapy were traced 6 months after treatment. Conclusion. The use of ACS may be a real alternative to that of HA derivatives in achieving good clinical outcomes in patients with CA. After ACS administration, there was a long-term preservation of achieved positive results.
Terapevticheskii arkhiv. 2012;84(8):33-36
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Role of matrix metalloproteinase-9 in the pathogenesis of osteoporosis in patients with chronic obstructive pulmonary disease

Kochetkova E.A., Ugaĭ L.G., Maĭstrovskaia I.V., Buria K.A., Nevzorova V.A.


Aim. To determine a relationship between matrix metalloproteinase-9 (MMP-9) activity and its tissue inhibitors TIMP-1 and 2, tumor necrosis factor-α (TNF-α), bone mineral density (BMD), and bone exchange in chronic obstructive pulmonary disease (COPD). Subjects and methods. Seventy-six patients with COPD and 20 healthy volunteers were examined using dual-energy X-ray absorptiometry n the lumbar spine (LII-LIV) and femoral neck (FN). The serum levels of MMP-9, TIMP-1 and TIMP-2, TNF-α, and Β-Crosslaps (ΒCL) were measured. Results. There was a higher MMP-9 level in COPD than that in the controls ((383.8±54.2 and 137.6±31.4 pg/ml, respectively; p<0.01). The levels of TIMP-1 and TIMP-2 were not different from those in the control group. An inverse correlation was found between forced expiratory volume in one second (FEV1) and MMP-9 concentration (r= -0.59; p=0.002) and a positive correlation with smoking index (r=0.47; p=0.04). There was an inverse correlation between MMP-9 concentration and BMD in both LII-LIV and FN (r= -0.67; p<0.001 and r= -0.61; p<0.01, respectively) and a direct correlation with ΒCL (r=0.53; p=0.04). An inverse correlation was established between TNF-α and T index in both LII-LIV (r =-0.54; p<0.01) and FN (r= -0.48; p<0.01). At the same time, the level of TNF-α directly correlated with the bone resorption marker ΒCL (r=0.53; p=0.002) and MMP-9 (r=0.57; p=0.003). Conclusion. Elevated MMP-9 levels may play an important role in type I collagen degradation, giving rise to enhanced bone resorption in COPD.
Terapevticheskii arkhiv. 2012;84(8):37-40
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Characteristics of the latent period of sensorimotor reactions in middle-aged and elderly outpatients with asthma during long-term treatment with inhaled glucocorticosteroids

Gutnik B.I., Zits S.V., Maksimova A.V.


Aim. To study a relationship of the characteristics of simple and complex visual sensorimotor reactions to asthma controllability in middle-aged and elderly outpatients during disease-modifying antirheumatic drug therapy with beclomethasone, fluticasone, or budesonide in average and high daily doses. Subjects and methods. Eighty middle-aged and elderly patients with asthma were examined. The level of asthma control, the main parameters of external respiratory function, and the characteristics of simple and complex visual sensorimotor reactions were assessed. Results. Uncontrolled asthma was observed in more than 50% of the asthmatic patients in the outpatient setting. Moderate linear relationships were found between the main physiological parameters and the level of the standard asthma control test. Conclusion. In the patients with controlled asthma, the latent periods of simple and complex visual sensorimotor reactions were significantly shorter than in those with poorly controlled asthma.
Terapevticheskii arkhiv. 2012;84(8):41-44
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Outpatient evaluation of the immediate and delayed effects of the abnormally hot summer of 2010 on the course of cardiovascular disease

Ageev F.T., Smirnova M.D., Galaninskiĭ P.V.


Aim. To retrospectively evaluate the immediate and delayed effects of the abnormally hot summer of 2010 on the course of cardiovascular disease (CVD). Subjects and methods. The study enrolled 188 patients with CVD, who had visited a polyclinic for advice in the past 2 weeks of January 2011. In addition to general clinical examination, all the patients were proposed to fill out the Hospital Anxiety and Depression Scale questionnaires concerning their quality of life, by applying the visual analog scale during their visit and (retrospectively) in the abnormal hot period (AHP). The questions were concerned with the location of the patient during the heat wave, his/her health status, the duration of a working day, the number of hypertensive crises (HC), calls to medical emergency teams (MET), and visits to a doctor, the pattern of therapy, etc. The authors estimated the following outcomes (endpoints): acute myocardial infarction, acute cerebrovascular accident, admissions for CVD, MET calls, the number of disability days, HC, and unplanned visits to the doctor, which occurred during the heat wave or in the period September to December 2010. Results. There was a worse quality of life during AHP. The patients living in the green zone (of a city, town, or a rural area) better experienced the abnormal heat. Male sex and overweight were associated with better abnormal heat tolerance; high anxiety, age, and living on high floors were with its worse tolerance. Conclusion. It is necessary to conduct large-scale prospective randomized studies, the results of which will yield objective information, which will be able to give patients scientifically sound recommendations how to behave during AHP.
Terapevticheskii arkhiv. 2012;84(8):45-51
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Impact of cardiac resynchronization therapy on survival in patients with ischemic and non-ischemic cardiomyopathy in clinical practice

Kuznetsov V.A., Vinogradova T.O., Enina T.N., Kolunin G.V., Kharats V.E., Pavlov A.V., Krinochkin D.V., Belonogov D.V., Gorbatenko E.A., Efimova I.A.


Aim. To compare the impact of cardiac resynchronization therapy (CRT) on survival in patients with ischemic and non-ischemic cardiomyopathy (CMP) in clinical practice. Subjects and methods. The study enrolled 206 patients with NYHA Functional Class II-IV chronic heart failure (CHF) and a left ventricular ejection fraction of ≤35, including 107 patients implanted with CRT devices in combination with continuous drug therapy (DT). Among the 107 patients, 48 were diagnosed as having non-ischemic CMP (NCMP), 59 as coronary heart disease (CHD). The other 99 patients (12 with NCMP and 87 with CHD) were on DT only. Later on the patients from both groups were divided into subgroups according to the treatment policy of CHF: CRT + DT or DT only. The mean follow-up period was 24±18.1 months. Results. The Kaplan-Meier survival analysis revealed that overall survival in the patients on CRT + DT was significantly higher than in those on DT (70 and 49%, respectively; p=0.004). Analysis of the chosen treatment policy in the NCMP subgroup showed no significant differences in survival rates in the patients receiving CRT + DT or DT (74 versus 78%, respectively; p=0.5). At the same time, the survival rates in the CHD patients on CRT + DT were significantly higher than those in the DT subgroup (68 versus 44%; p=0.04). Conclusion. CRT significantly reduces overall mortality in patients with CHF in clinical practice. Our findings indicated that this effect was achieved mainly in patients with CHD, rather than in those with NCMP.
Terapevticheskii arkhiv. 2012;84(8):52-56
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Long-term results of treatment for T-cell lymphoblastic lymphomas

Vinogradova I.E., Chernova N.G., Kaplanskaia I.B., Zingerman B.V., Mangasarova I.K., Krasil'nikova B.B., Kravchenko S.K.


Aim. To define the efficiency of the GMALL 2002 program for the treatment of patients with T-cell lymphoblastic lymphomas (T-LBL). Subjects and methods. Twenty-five patients with a verified diagnosis of T-LBL were examined. Male/female ratio was 19:6; median age was 33 (range 16-67) years. There was a preponderance of patients with the generalized stages of the diseases: 2, 5, and 18 with Stages II, III, and IV, respectively. Mediastinal lesion was found in 20 (80%) of the 25 patients. Their treatment was performed according to the GMALL 2002 program and similar CHOP courses. Analysis was made in 2 groups that were not different in their clinical and morphological characteristics. Group 1 consisted of 17 of the 25 patients treated according to the GMALL programs; Group 2 comprised 8 patients who had similar CHOP and other chemotherapy regimens. Results. In Group 1, 15 (88%) patients achieved a complete clinical and hematological remission and 2 (12%) patients died in the first stages of the treatment. No relapses were noted. The median survival had not been achieved; 5-year overall survival was 88±8%. In Group 2, three patients were alive; 2 completed their treatment; 5 (63%) patients died from treatment failures. The median survival was 23±18%; 5-year overall survival was 45%. Conclusion. The findings suggest that the GMALL 2002 programs are highly effective in treating patients with T-LBL at the first stage of treatment.
Terapevticheskii arkhiv. 2012;84(8):57-60
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Complex chromosome damages in patients with recurrent acute leukemias after allogeneic hematopoietic stem cell transplantations

Gindina T.L., Mamaev N.N., Barkhatov I.M., Solomonova I.S., Semenova E.V., Zubarovskaia L.S., Morozova E.V., Rudnitskaia I.V., Popova M.A., Alekseev S.M., Uspenskaia O.S., Bondarenko S.N., Afanas'ev B.V.


Aim. To study the pattern of complex chromosome damages (CCD) in acute leukemias (AL) and their place in the development of post-transplant recurrences (PTR) of AL. Materials and methods. Cytogenetic and partially molecular biological studies of bone marrow cells were conducted in 10 patients with PTR. Of them, 6 patients were diagnosed as having acute lymphoblastic leukemia (ALL), including T-ALL and Ph-positive ALL in 2 and 4 patients, respectively; and 4 patients had acute non-lymphoblastic leukemia (ANLL), including one case secondarily induced by previous polychemotherapy (PCT) and irradiation. The standard G-band staining technique complemented by multicolor fluorescence in situ hybridization in one of the cases was used. Results. It was shown that CCD had the similar pattern in 4 patients before transplantation and in PTR, progressed in 4 more patients, was absent or unnoticed in the early stage of the disease. The other recurrent chromosomal abnormalities that are worthy of notice are as follows: a) the presence of two Ph chromosomes in the cells of two of the 4 patients with Ph+ ALL; b) the frequent involvement of chromosome pairs 9, 19, 5, and 7 into the numerical and structural rearrangements. Conclusion. The important feature of PTR of AL is cellular CCDs, a portion of which is clearly related to previous PCT and may be of pathogenetic value for the development of recurrences.
Terapevticheskii arkhiv. 2012;84(8):61-66
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Evaluation of the efficiency and safety of therapy with a combination of sulfonylurea derivatives and insulin sensitizers for type 2 diabetes mellitus

Goncharenko O.N., Ametov A.S., Isakova M.R.


Aim. To evaluate the efficiency and safety of early combination therapy with sulfonylurea derivatives (SUD) and insulin sensitizers in patients with type 2 diabetes mellitus (T2DM). Subjects and methods. Forty patients (31 women and 9 men; mean age 57.7±0.9 years) with decompensated T2DM (НbА1с 8.16±0.27%), a mean body mass index of 32.7±0.7 kg/m2, who received glimepiride, were examined. The duration of T2DM was 3.3±0.4 years. The patients had concomitant cardiovascular diseases (CVD). Coronary heart disease and hypertensive disease (HD) were treated; the doses of the agents were not adjusted during the study. For T2DM compensation, all the patients were given insulin sensitizers (rosiglitazone 4 mg) in addition to glimepiride. The treatment lasted 24 weeks. Carbohydrate and lipid metabolic parameters, insulin resistance, body weight, structural and functional parameters, and heart rate were estimated before and after the treatment. Results. During the combination therapy, there were decreases in the level of НbА1с from 8.16±0.27 to 6.84±0.15%, fasting blood glucose from 8.89±0.35 to 6.77±0.16 mmol/l, postprandial blood glucose from 8.66±0.24 to 7.761±0.20 mmol/l, HOMA index from 5.88±0.70 to 3.75±0.44. The rate of hypoglycemic reaction reduced. Sugar-lowering therapy was observed to have, on average, a positive impact on blood lipid composition and cardiovascular parameters in the group. Echocardiography (EchoCG) identified a group of patients with negative cardiac structural and functional changes. Conclusion. The combination therapy with SUD and insulin sensitizers was stated to be effective in maintaining the reached blood glucose level, reducing the risk of hypoglycemic reactions, and positively affecting lipid metabolism. The therapy resulted in cardiovascular improvement only in patients without obvious signs of CVD while it caused negative EchoCG changes (transformation of concentric to eccentric left ventricular hypertrophy) in patients with a long-term (more than 7 years) history of HD and pronounced cardiac structural and functional alterations.
Terapevticheskii arkhiv. 2012;84(8):67-71
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Experience with ebrantil used in patients with resistant arterial hypertension in chronic kidney disease

Semenova R.I., Musina N.S.


Summary. Aim. To evaluate the clinical efficacy of ebrantil used in patients with resistant arterial hypertension (RAH) in Stage III-V chronic kidney disease (CKD). Subjects and methods. Sixty-five patients with Stage III-V CKD and RAH (systolic blood pressure (SBP) 215.7±4.0 mm Hg and diastolic blood pressure (DBP) 114.6±2.3 mm Hg) were followed up. The patients received intravenous ebrantil (urapidil) in a dose of 25 mg for 5 days and then were switched to its oral use as 30-60-mg capsules twice daily for 12 weeks. Results. The intravenous infusion caused a significant fall in SBP and DBP by 23.6 and 16.7%, respectively, within 60-90 min. A steady-state antihypertensive effect was achieved on days 5-7 (SBP and DBP was lowered to 146.8±6.1 and 95.6±5.3 mm Hg, respectively; p<0.05). After 12 weeks of the therapy, SBP was 144.4±6.3 mm Hg and DBP was 93.3±4.1 mm Hg (p<0.05). Conclusion. The use of ebrantil in patients with CKD and RAH produces an effective BP without marked adverse reactions.
Terapevticheskii arkhiv. 2012;84(8):72-74
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Antidote therapy for acute carbon monoxide poisoning

Il'iashenko K.K., Belova M.V., Kashtanova I.S.


Aim. To evaluate the antidote properties of acizol in acute carbon monoxide poisoning (ACMP). Subjects and methods. The study included 70 patients with ACMP. Of them 35 patients received a package of medical measures, which involved 6% acizol solution injected in a dose of 1 ml on hospital admission and an hour later. The efficacy of acizol was evaluated using clinical and laboratory studies. Results. Just an hour after acizol injection, there was an average 2-fold reduction in the blood concentration of carboxyhemoglobin as compared to the baseline levels. Consciousness recovered 1.5 times more quickly than in the control group. The clinical efficacy of acizol was supported by positive laboratory tests. Conclusion. The use of acizol in ACMP assists in increasing the rate of detoxification and positively affects some blood laboratory parameters.
Terapevticheskii arkhiv. 2012;84(8):75-77
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Single-photon emission computed tomography in the diagnosis of myocardial perfusion abnormalities in patients with rheumatoid arthritis: Preliminary data

Shul'gin D.N., Olisaeva D.R., Fomicheva O.A., Popkova T.V., Sergienko V.B.


Increased cardiovascular morbidity and mortality in patients with rheumatoid arthritis (RA) may be attributed to the fact that a systemic inflammation existing in this disease may trigger the development of atherosclerosis. 99mTc-MIBI (4,2-methoxyisobutyl isonitrile) is a compound that permits myocardial perfusion to be visualized and has been proposed for the evaluation of the latter in patients with RA. Analysis of the results of the studies revealed transient myocardial ischemia areas in patients who did not take methotrexate while those who used it were found to have diminished perfusion areas that were, however, clinical insignificant.
Terapevticheskii arkhiv. 2012;84(8):78-80
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Introduction to preventive and predictive medicine: past experience and future reality

Suchkov S.V., Rose N., Notkins A., Golubnichaia O., Herrath M.v., Legg M., Marshall T.


The active practical introduction of the achievements of genomics, proteomics, metabolomics, and bioinformatics brought about a fundamental change in views on the role and place of medicine in the structure of healthcare at the turn of the 1980s-1990s, by giving impetus to the development of the radically new health care area - preventive, predictive, and personalized medicine (PPPM). The main goals of PPM are to recognize disease signs at the stage of subclinical pathology with d the identification of targets suitable for drug-based prevention for drug-based prevention and to make pharmacorrection of the disturbances identified aimed at the drug-based prevention to promote the suppression of pathological process at the subclinical stage.
Terapevticheskii arkhiv. 2012;84(8):81-85
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Primary sclerosing cholangitis: present views of its pathogenesis, diagnosis and treatment

Aleksandrova E.A., Avdeev V.G., Burnevich É.Z., Arion E.A.


Primary sclerosing cholangitis (PSC) is a chronic slowly progressive cholestatic liver disease characterized by non-purulent destructive inflammation and sclerosis of the extra- and intrahepatic bile ducts, leading to secondary biliary cirrhosis. The etiology of the disease is unknown; however, bacterial and genetic factors are presumed to be implicated. In 66-84% of cases, PSC is accompanied by inflammatory bowel diseases, such as ulcerative colitis and Crohn's disease. The diagnosis of PSC is based on the clinical presentation of the disease and on the data of magnetic resonance imaging or endoscopic retrograde cholangiography. The treatment of PSC has not been developed; there is evidence that ursodeoxycholic acid reduces cholestasis. Orthotopic liver transplantation is indicated at the stage of decompensated liver cirrhosis.
Terapevticheskii arkhiv. 2012;84(8):86-90
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Diabetes mellitus is an independent risk factor for cardiovascular disease

Ametov A.S., Kulidzhanian N.K.


Type 2 diabetes mellitus (T2DM) is one of the most common chronic diseases, the incidence of which tends to grow steadily. The great social importance of diabetes mellitus is determined by disability and deaths from late vascular events. So the risk for cardiovascular disease (CVD) and the cardiovascular safety of glucose-lowering therapy for T2DM are a multidisciplinary and multi-faceted problem. Its solution requires a comprehensive approach to controlling the risk factors of CVD and assessing hypoglycemic therapy in the context of cardiovascular safety. The paper shows the bases of CVD pathogenesis and contains the results of numerous international clinical trials evaluating the efficiency and safety of current glucose-lowering therapy (metformin and cardioprotective drugs, the action of which is based on their incretin effect).
Terapevticheskii arkhiv. 2012;84(8):91-94
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Cough: Differential diagnosis and differentiated treatment

Sinopal'nikov A.I., Kliachkina I.L.


The review presents an update on the determination of the causes and mechanisms of acute and chronic cough. It assesses the concept of productive and non-productive cough (acute cough, chronic cough), its duration in different diseases of the lung, upper and lower respiratory tract, pulmonary embolism, gastroesophageal reflux disease, pharyngolaryngeal reflux, and during treatment with angiotensin-converting enzyme inhibitors. Information is given on treatment policy for cough in different diseases.
Terapevticheskii arkhiv. 2012;84(8):95-102
pages 95-102 views

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