Vol 84, No 10 (2012)

Editorial
Cancer service modernization is the most important area in the systemic improvement of cancer care to the population of Russia
Chissov V.I.
Abstract
The paper presents data on planned measures to modernize our cancer service, one of the key areas of public health modernization, the main goal of which is to maximally ensure the citizens' right to have accessible and qualitative medical care. To adequately finance the field and to set up a current legislative base will give rise to the reorientation of the cancer service to priorities for primary prevention and active detection of malignancies, to an improvement of quality of life in cancer patients; to the formation of the populations' positive and integral awareness of health and healthy society, to the rational use of available manpower resources and inventory of all health facilities, which is extremely important under current conditions.
Terapevticheskii arkhiv. 2012;84(10):4-8
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Early erythropoietin deficiency in diabetic kidney lesion
Shestakova M.V., Martynov S.A., Kutyrina I.M., Il'in A.V., Arbuzova M.I., Dedov I.I.
Abstract
Aim. To evaluate the renal production of erythropoietin (EPO) in relation to filtration function in patients with diabetic kidney lesion. Subjects and methods. The investigation enrolled 183 patients with types 1 and 2 diabetes mellitus (DM), of whom 128 were diagnosed as having diabetic kidney lesion. Serum EPO levels were measured by enzyme immunoassay. Patients who had a glomerular filtration rate (GFR) of below 15 ml/min/1.73 m2 and received erythropoiesis-stimulating agents were excluded from the investigation. Results. The mean serum EPO levels in the patients with diabetic kidney lesion did not vary with the presence of absence of anemia, the degree of albuminuria, or GFR. A physiological inverse relationship was found between the level of EPO and that of hemoglobin in the blood of the patients with DM without kidney disease and in those with renal lesion and GFR ≥60 ml/min/1.73 m2. The magnitude of the association of the values increased as GFR was higher. The level of EPO was found to be unassociated with hemoglobin in patients with GFR <60 ml/min/1.73 m2. Conclusion. In the patients with diabetic kidney lesion, serum EPO concentrations did not depend on the stage of chronic kidney disease and the degree of albuminuria in spite of more severe anemia as renal failure progressed. These patients showed inadequate EPO production just in early diminished renal filtration function.
Terapevticheskii arkhiv. 2012;84(10):9-13
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Cytokine gene polymorphism in type 2 diabetes mellitus in the Europeoid women of Russia
Konenkov V.I., Korolev M.A., Shevchenko A.V., Lapsina S.A., Koroleva E.A., Zonova E.V., Prokof'ev V.F.
Abstract
Aim. To study the distribution of genotypes in the cytokine genes and their combinations with immunoregulatory activity in patients with type 2 diabetes mellitus (T2DM) and in healthy women. Subjects and methods. 586 Europeoid women from the eastern regions of Russia, including 374 healthy women aged 23-68 years and 212 women aged 28-69 years with T2DM complicated and uncomplicated by osteoporosis, were examined. Seven polymorphisms located in the promoter regions of the interleukin (IL) gene: TNF-α at positions С-863А, G-308A, G-238A, IL1B T-31C, IL6 G-174C, IL10 C-592A, VEGFA С-2578А were investigated. Restriction analysis of amplification products was applied. Results. There were high associations of the predisposition and resistance to the development of T2DM with a number of polylocus cytokine genotype combinations having pro- and anti-inflammatory, angiogenic, and immunoregulatory activities. The association of the cytokine genes with T2DM was found to be mediated in nature through a relationship of the genotypes to the high or low production of regulatory cytokines and to different factors of regulation of lipid and carbohydrate metabolisms, inflammation, and bone remodeling. Conclusion. The high odds ratio and high specificity of the detected genetic combinations allow one to hope that they will be clinically used as predictors.
Terapevticheskii arkhiv. 2012;84(10):14-22
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The degree of alexithymia in type 2 diabetes mellitus patients and its association with medical and demographic parameters
Sapozhnikova I.E., Tarlovskaia E.I., Madianov I.V., Vedenskaia T.P.
Abstract
Aim. To study the degree of alexithymia (an inability to understand and to express emotions verbally) and its relationship to medical and demographic parameters in patients with type 2 diabetes mellitus (DM) versus control group individuals. Subjects and methods. 265 patients with type 2 DM and 65 gender- and age-matched control individuals were examined. The degree of alexithymia was rated by the 26-Item Toronto Alexithymia Scale (TAS-26). Survey, anthropometry, and laboratory tests were made. Results. Carbohydrate metabolism was decompensated in the majority of the patients with DM; its complications were detected in most cases. The patients with type 2 DM compared with the controls had higher alexithymia levels; significant alexithymia was more frequently recorded (47.2% versus 21.5%; р<0.001). In patients with type 2 DM, the degree of alexithymia correlated positively with depression and DM complications (with depression in the control group) and negatively with higher education and compensated carbohydrate metabolism. Conclusion. Higher alexithymia in the patients with type 2 DM was associated with decompensated carbohydrate metabolism and the presence of complications.
Terapevticheskii arkhiv. 2012;84(10):23-27
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The incidence of postoperative myocardial infarction and the left ventricular function in patients with type 2 diabetes mellitus after recanalization of chronic coronary occlusions
Petrenko I.V., Petrenko O.A., Popova M.A., Mamedova S.I., Urvantseva I.A.
Abstract
Aim. To study the effects of intracoronary administration of the ischemic preconditioning (IP) trigger adenosine on the reduced incidence of percutaneous coronary intervention (PCI)-associated myocardial infarction (MI) and left ventricular (LV) systolic and contractile function in patients with type 2 diabetes mellitus (DM) during recanalization of chronic coronary occlusions (CCO). Subjects and methods. The patients were divided into 4 groups: 1) 45 patients without DM who received intracoronary placebo infusion; 2) 51 patients without DM who had 10 mg intracoronary adenosine during PCI; 3) 34 patients with type 2 DM who had intracoronary adenosine during PCI; 4) 37 with type 2 DM who received intracoronary placebo. Troponin I and the MB fraction of creatine phosphokinase were measured an hour before and 18-24 hours and 5 days after PCI. The authors estimated the incidence of PCI-associated MI according to the ESC/ACCF/AHA/WHF (2007) criteria and the time course of changes in LV ejection fraction (EF) and end-systolic volume (ESV) and end-diastolic volume, impaired LV local contractility index (ILVLCI) in 167 patients with CCO 1 day and 1 and 12 months after PCI. Results. There was an improvement in myocardial systolic and contractile function after recanalization and stenting for CCO. The intracoronary adenosine groups showed significantly reduced incidence of PCI-associated MI, increased LV EF, and decreased LV ESV and ILVLCI as compared to the placebo groups. Conclusion. The intracoronary injection of the IP trigger adenosine is an effective and safe method to improve LV systolic and contractile function in patients with CCO and type 2 DM.
Terapevticheskii arkhiv. 2012;84(10):28-32
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Transcranial physical methods for correction of neuroendocrine and cerebral disorders in adolescent girls with obesity
Bolotova N.V., Aver'ianov A.P., Dronova E.G., Raĭgorodskiĭ I.M., Levit S.V.
Abstract
Aim. To evaluate the efficiency of combined central and local physiotherapeutic procedures in correcting neuroendocrine and menstrual disorders in pubertal girls (PG) with obesity. Subjects and methods. Eighty-seven PGs, including 67 with different levels of obesity and 20 healthy non-obese girls, were examined. The hormonal profile, lipidogram, and fasting insulin and glucose levels were studied. Body mass index (BMI) and waist and hip circumferences were estimated. The functional state of the central nervous system was studied by electroencephalography. The parameters of the autonomic nervous system were estimated by cardiointervalography. The PGs with obesity were divided into 2 groups: a study group (SG) (n=40) and a control group (CG) (n=27). The healthy PGs (n=20) formed a comparison group. The SG patients received bitemporal transcranial magnetic therapy in combination with frontomastoid transcranial electrostimulation, as well as myoelectrostimulation of the anterior abdominal wall, by transferring the area of stimulation from right to left hypochondrium. A course consisted of 10-15 daily sessions. CG had placebo physioprocedures (with disconnected electrodes). Results. After 6-month treatment, SG and CG showed average reductions in BMI by 5.9 and 2.5 kg/m2, respectively. Lipidograms normalized in 70%; menstrual cycles were restored in 25 of 30 patients with impaired cycles in SG and in 1 of 22 in CG. Hormonal profiles were significantly improved in 62.5% of the patients in SG and unchanged in CG. Conclusion. The high efficiency of combined (central and local) physiotherapeutic procedures is likely to be due to the normalization of pituitary-ovarian relationships and enables one to recommend the proposed procedure in a rehabilitation program for PGs with obesity and reproductive system disorders.
Terapevticheskii arkhiv. 2012;84(10):33-36
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Role of methyltetrahydrofolate reductase (MTHFR) gene polymorphism in the development of ischemic stroke in the dwellers of the Kyrgyz Republic
Kudaĭbergenova N.T., Moldotashev I.K., Aldashev A.A., Mukhanova A.K.
Abstract
Aim. To study the role of MTHFR gene polymorphism in patients with ischemic stroke (IS) in the Kyrgyz Republic. Subjects and methods. Molecular genetic testing of C677T polymorphism in the MTHFR gene was carried out in 107 Kyrgyz patients with prior IS. The patients were grouped according to the severity of motor impairments and the level of blood pressure (BP). The MTHFR C677T polymorphism was genotyped by polymerase chain reaction (PCR) using specific primers, followed by restriction of the resultant PCR products with the enzyme Hinf I. Results. Severe motor impairments measured by the Scandinavian stroke scale was associated with the higher detection rate of the mutant TT genotypes of C677T polymorphism in the MTHFR gene (0.05 and 0.14; p<0.04). As compared with stroke and normal BP, the development of stroke with high BP was associated with the presence of the mutant TT genotypes of C677T polymorphism in the MTHFR gene (1.9% versus 9.1%; p<0.04). Conclusion. The increased detection rate of the mutant TT genotypes of C677T polymorphism in the MTHFR gene is associated with severe motor impairments (p<0.04) in patients with IS and with the development of stroke during high BP.
Terapevticheskii arkhiv. 2012;84(10):37-41
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Fibrinogen concentration in the evaluation of safety and efficiency of thrombolytic therapy in patients with ischemic stroke
Liang O.V., Kochetov A.G., Shamalov N.A., Anisimov K.V., Ramazanov G.R., Arkhipkin A.A., Novozhenova I.V., Kustova M.A., Podshivalov D.S., Egorov V.O., Skvortsova V.I.
Abstract
Aim. To identify and investigate threshold fibrinogen concentrations as predictors of hemorrhagic transformation (HT), fatal outcome (FO), and the efficiency of thrombolytic therapy (TLT) in patients with ischemic stroke (IS). Subjects and methods. One hundred and eighty-one patients with IS were examined; all the patients received TLT. Fibrinogen concentrations were determined by the Clauss method on admission, immediately after TLT, and daily during the first 7 days of observation; the efficacy of thrombolysis was evaluated using the NIH stroke scale every day, the Rankin scale, and the Barthel Index on days 14 and 21.Results. The patients with a fibrinogen concentration of below 330 mg/dl showed the lowest frequency of asymptomatic HT (AHT) as hemorrhagic stroke (HS) type 1 in the absence of clinically worsening HT (CWHT), as well as FO and the highest rate of good functional recovery. Those with a fibrinogen concentration of 330-385 mg/dl most commonly displayed AHT as HS types 1 and 2 equally frequently, as well as the highest frequency of a positive effect according to the criteria for good and/or satisfactory functional recoveries. The fibrinogen concentration range of 385-423 mg/dl compared to the above range was characterized by an increased risk for AHT as HS type 2, for CWHT as equally distributed parenchymal hematoma types 1 and 2, by higher death rates and less chance of functional recovery. The elevated fibrinogen concentration above 423 mg/dl was accompanied by high death rates and CWHT as parenchymal hematoma type 2 and the higher frequency of poor outcome in the evaluation of functional recovery. Conclusion. The revealed three threshold fibrinogen concentrations of 330, 385, and 423 mg/dl allow one to predict HS, FO, and the efficiency of TLT in patients with IS.
Terapevticheskii arkhiv. 2012;84(10):42-47
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Alginates in the treatment of postgastroresection reflux esophagitis
Ianova O.B., Kim V.A., Treĭman E.V.
Abstract
Aim. To evaluate the efficacy of alginates in the treatment of postgastroresection reflux esophagitis. Subjects and methods. Thirty-four post-Billroth II distal gastrectomy patients with reflux esophagitis and without erosive and ulcerative lesions of the gastric stump and anastomosis, who had received geviscon monotherapy for 6 weeks, were examined. Their symptoms and the data of esophagogastroduodenoscopy and impedance pH monitoring were assessed to control treatment results. Results. There was statistically significant relief of the subjective (heartburn and bitter taste in the mouth) and objective symptoms of the disease and the reflux esophagitis in geviscon-treated patients. Conclusion. Geviscon is the drug of choice for treating reflux esophagitis in patients after partial distal gastrectomy provided that the acid-forming function of the gastric mucosa is minimally preserved.
Terapevticheskii arkhiv. 2012;84(10):48-50
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Use of remaxol in the combination therapy of post-withdrawal disorders in alcoholic patients with comorbid liver damage
Bokhan N.A., Abolonin A.F., Ankudinova I.É., Kurgak D.I., Mandel' A.I.
Abstract
Aim. To evaluate the efficacy of Remaxol used to treat post-withdrawal disorders in alcoholic patients with comorbid liver damage. Subjects and methods. The authors assessed the severity of clinical parameters, such as pathological craving and anhedonia, biochemical parameters (bilirubin, alanine aminotransferase (ALT), and aspartate aminotransferase (AST)) in 120 patients aged 30-60 years in the stage of remission formation. The patients were divided into two groups: 1) 62 patients received Remaxol; 2) 58 persons took placebo (a comparative group). Results. The use of the drug caused an accelerated reduction in somato-autonomic symptoms and a decrease in affective strain and manifestations of anxiety with disactualization of a pathological alcohol craving ideator. The patients receiving remaxol showed a prompt improvement in some biochemical parameters: the levels of total and direct bilirubin halved; in Group 1, the multiplicity of a decrease in ALT and AST activities was 2.5 and 2.2 times versus 1.38 and 1.47 in Group 2. After the course of therapy, the symptoms of anhedonia diminished by 5.2 times in Group 1 and only by 2.4 times in Group 2. Conclusion. The positive changes induced by remaxol incorporated into the combination treatment are due to the polymodal effect of the drug on metabolic mechanisms in both the nervous system and liver. This double action promotes the increased efficiency of treatment and the creation of conditions for remission.
Terapevticheskii arkhiv. 2012;84(10):51-55
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Current approach to therapy for male infertility in patients with varicocele
Gamidov S.I., Ovchinnikov R.I., Popova A.I., Tkhagapsoeva R.A., Izhbaev S.K.
Abstract
Aim. To improve the results of treatment for male infertility in patients with varicocele and to evaluate the efficiency of microsurgical varicocelectomy performed by the same surgeon in a large group of patients. Subjects and methods. 1127 infertile males aged 22 to 52 years (mean 29.6±9.2 years) with varicocele were examined. An analysis of the patients' presenting complaints, collection of history data, examinations, spermogram studies, mixed agglutination reaction (MAR) test, ultrasonography and Doppler study of the scrotum, estimation of blood hormone and inhibin B levels, and genetic studies (karyotype, azoospermia factor (AZF), cystic fibrosis gene) were done. The analysis excluded 193 patients with other causes of infertility. 728 patients underwent uni- and bilateral microsurgical subinguinal varicocelectomy according to the Marmar procedure modified by the authors, 107 had spermatogenesis stimulation (clomiphene citrate, vitamins A and E, selenium, L-carnitine, pentoxifylline, antioxidants) for 3-6 months; 56 patients were untreated. The follow-up period was 3-12 months depending on the efficiency of treatment. Control examination was made every 3 months. Results. After microsurgical varicocelectomy, there were increases in the concentration of spermatozoa from 8.8±7.2 to 23.2±7.9 mln/ml and their active motility from 7.2±5.4 to 31.2±5.2% (category A); the proportion of abnormal sperm forms (Kruger morphology) reduced from 95.4±5 to 87.8±8.3%. The patients with azoospermia (n=39), spermatozoa appeared in 46.2% of cases; 52.8% of the patients with complete teratozoospermia (n=36) exhibited morphologically normal sperm postoperatively (unlike the results of treatment in the comparison groups). Higher sperm concentrations were observed after both microsurgical varicocele and empirical stimulation of spermatogenesis in 69.9 and 29.9% of the patients, respectively. Spontaneous conception occurred in the partners of 47.1% of the males after microsurgical varicocele, 21.5% of those after drug stimulation, and 3.6% of those untreated. Conclusion. Microsurgical varicocele is the most effective and safe treatment option for male infertility in patients with varicocele. Its effect far exceeds the results of drug stimulation of spermatogenesis and those of the follow-up. It lies in a rapid and significant improvement in spermatogenic parameters just 3-6 months after surgery and further continues to increase. This gives rise to spontaneous pregnancy in about 50% of the infertile couples within a year postsurgery. Microsurgical varicocele may be recommended not only as the gold standard surgical treatment for varicocele, but also for the therapy of male infertility in these patients. At the same time, prior to surgical treatment for varicocele, one should rule out all other causes of male infertility and female factor (particularly tubal one).
Terapevticheskii arkhiv. 2012;84(10):56-61
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Use of Furamag to prevent inflammatory complications during endoscopic operations in patients with benign prostatic hyperplasia and urolithiasis
Neĭmark A.I., Simashkevich A.V.
Abstract
Aim. To improve surgical results in patients with benign prostatic hyperplasia (BPH) and urolithiasis (UL) and to evaluate the efficacy of Furamag used as an agent to prevent infectious and inflammatory complications. Subjects and methods. Seventy-two patients with BPH (n=36; Group 1) and UL (n=36; Group 2) were examined. Within each group, the patients were divided into two subgroups: A) those in whom no preventive measures were taken during endoscopic operations; B) those who received Furamag as a preventive agent. The preventive efficacy was evaluated from the urine microbial spectrum and renal microcirculatory values. Results. The preventive use of Furamag could achieve better urine sanitation, normalize renal microcirculatory values, and reduce the incidence of postoperative complications. Conclusion. The use of Furamag to prevent intravesical obstruction (IVO) during transurethral prostatic resection and UL reduces the incidence of IVO, results in less noticeable renal microcirculatory disorders, and accordingly assists in lowering the incidence of postoperative complications.
Terapevticheskii arkhiv. 2012;84(10):62-64
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Correction of psychoemotional status in patients with chronic bacterial prostatitis
Kuz'menko V.V., Kuz'menko A.V., Kurnosova N.V.
Abstract
Aim. To comparatively analyze the efficiency of combination treatment in patients with chronic prostatitis. Subjects and methods. Psychometric and psychological methods, such as the Hamilton depression rating scale and the Hamilton anxiety rating scale, determination of the types of an attitude toward illness, and the personality rating questionnaire, were used to examine 80 men with chronic bacterial prostatitis (CBP) who were allocated to 2 groups. A study group received levofloxacin in combination with adaptol for 10 days; a control group had antibacterial therapy only. Results. The patients receiving adaptol were ascertained to have a more evident normalization of mental disorders, as shown by the scales, as lower scores: 4.9±0.6 for irritability, 5.7±0.6 for reactive aggression, 5.1±0.7 for shyness, and as a higher score (up to 5.2±1.3) for sociability (p<0.05). There was a pronounced reduction in diurnal mood variations, which is indicative of relief of anxiety and depressive disorders . Conclusion. The use of adaptol in a dose of 500 mg thrice daily for 10 days as part of the combination treatment of patients with an exacerbation of CBP permits correction of the mental status and improves the quality of life of patients in a shorter period of treatment.
Terapevticheskii arkhiv. 2012;84(10):65-68
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Clinical and immunological aspects of extracorporeal photochemotherapy for psoriasis and psoriatic arthritis
Molochkov V.A., Kil'diushevskiĭ A.V., Molochkov A.V., Karzanov O.V., Iakubovskaia E.S., Fedulkina V.A.
Abstract
Aim. To evaluate the clinical efficiency of extracorporeal photochemotherapy (EPCT) in the treatment of psoriasis (Ps) and Ps associated with psoriatic arthritis (PsA). Subjects and methods. Ninety-three patients with different forms of psoriasis were examined. A study group (SG) comprised 52 patients who were treated with EPCT; a control group (CG) included 41 patients. All the patients received pharmacotherapy generally accepted for these diseases. The SG patients were given additionally EPCT (the patient took 8-methoxypsoralen in a dose of 0.6 mg/kg 1.5-2 hours before the procedure). Mononuclear cells were isolated from the patients' blood in the intermittent-line mode on a Haemonetics MCS+ cell separator. The cell suspension was irradiated with ultraviolet light A (λ=320-400 nm) on a JULIA irradiator at 10-15 ml/min for 30 min and reinfused in the patient. The course of therapy consisted of 4 sessions performed on alternate days. Results. A varying positive effect was obtained in 49 (94%) SG patients; the mean PASI scores fell from 19.7±3.4 to 6.7±2.1 (p<0.05). The DAS reflecting the activity of PsA reduced on average from 3.35±0.7 to 2.16±0.5 (p<0.05), which corresponded to the change of PsA activity from moderate to weak. In CG, the positive effect was less pronounced in 27 (66%) patients, the PASI scores dropped on average from 19.2±3.7 to 12.2±3.1 (p<0.05), DAS in patients with PsA decreased from 3.24±0.8 to 2.95±0.7 (p<0.05). Conclusion. EPCT showed a high efficiency in patients with psoriasis and Ps associated with PsA; the immunological studies demonstrated the pathogenetic direction of the technique.
Terapevticheskii arkhiv. 2012;84(10):69-74
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Free radical processes in the pathogenesis of involutional skin changes
Manturova N.E., Silina E.V., Stupin V.A., Smirnova G.O., Bolevich S.B.
Abstract
Aim. To study the role of free radical processes (FRP) in the development of involutional skin changes and their correction. Subjects and methods. One hundred and twenty patients aged 18 to 74 years with various degrees of involutional facial and cervical skin changes were examined. Clinical and laboratory assessments were made over time. The oxygen and lipid peroxidase parameters of FRP were estimated; objective and subjective visualization, Doppler flowmetry of the facial skin, and colorimetric study of the skin color spectrum were done. Results. The imbalance between oxygen and lipid peroxide components of FRP was found to increase with advancing age. These processes correlate with the severity of involutional skin changes and objectify the early use of energy-correcting therapy (ECT). The incorporation of ECT with cytoflavin positively affects FRP values and clinical and instrumental findings of involutional facial and cervical skin changes, by improving microcirculation. The patients with first-second degree involutional skin changes achieved the best results. Conclusion. The findings permit cytoflavin to be recommended as one of the components of therapy aimed to stabilize intradermal exchange processes as part cosmetic manipulations in aesthetic medicine.
Terapevticheskii arkhiv. 2012;84(10):75-78
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The specific features of the clinical picture and course of familial dilated cardiomyopathy
Kurbanov N.A., Kurbanov R.D., Abdullaev T.A.
Abstract
Aim. To study prevalence, clinical and hemodynamic features, and life prognosis in patients with familial dilated cardiomyopathy (DCM). Subjects and methods. Two hundred and forty-four patients with DCM were examined during the period 2000 to 2010. According to their medical history records and the results of clinical and functional studies, familial cardiomyopathy was diagnosed in 29 (11.8%) of 244 patients. For comparative assessment, the authors formed two groups: 1) 29 patients with the familial form of DCM and 2) 83 patients with its sporadic form. Their examination included ECG, Holter ECG monitoring, 6-minute walk test, X-ray cardiometry, coronarography, and life prognosis assessment. Results. It has been established that the prevalence of the familial form of DCM accounts for 11.9% and is, unlike its non-familial form, associated with younger age; it is maternally inherited in one third of cases and characterized by the development of complete atrioventricular block in some patients. Conclusion. Investigating the life prognosis of the patients has shown that the familial form and age less than 30 years are characterized by a rapidly progressing course accompanied by a significant increase in death rates within the first 12 follow-up months.
Terapevticheskii arkhiv. 2012;84(10):79-85
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Use of the mucoregulator ascoril for respiratory diseases
Shmeleva N.M.
Abstract
The paper deals with the use of the combined mucoregulatory drug ascoril in pulmonological care. Due to its multicomponent composition, the drug has mucoregulatory properties that combine a bronchodilator effect and an ability to dilute sputum and to synthesize the surfactant. The mechanism of action of each ascoril component is analyzed; the results of basic experimental and clinical studies on the use of the drug are given. A wide range of indications, such as respiratory system diseases, for ascoril use is demonstrated.
Terapevticheskii arkhiv. 2012;84(10):86-90
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Blood pressure variability and risk for complications in arterial hypertension
Ostroumova O.D.
Abstract
The lecture gives the definition and lists the types of blood pressure variability. It considers the importance of different types of blood pressure variability as an independent risk factor of complications in arterial hypertension. There is an update on the impact of antihypertensive drug therapy on blood pressure variability.
Terapevticheskii arkhiv. 2012;84(10):91-97
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A current model for predicting the risk of cardiovascular diseases in patients with type 2 diabetes mellitus
Biriukova E.V.
Abstract
Type 2 diabetes mellitus (T2DM) is a severe progressive disease complicating the development of micro- and macrovascular complications that result in early disability, including that in able-bodied persons, a reduction in the patients' life, and its worse quality. The author discusses the new scale developed according to the results of the ADVANCE trial for predicting the cardiovascular risk in patients with T2DM which may be used widely in these patients to estimate the risk of cardiovascular events and as a tool to assist in determining the intensity of treatment. She considers current approaches to treating T2DM, by using the results of the ADVANCE trial.
Terapevticheskii arkhiv. 2012;84(10):98-102
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Sexual dysfunction induced by antidepressants and antipsychotics
Lisitsyna O.G., Ansseau M., Gernay P., Pitchot W., Bertrand W.
Abstract
The interest in sexual dysfunction induced by psychotropic drugs has increased considerably in recent years because of the new-generation antidepressants (AD) and antipsychotics (AP) being put into medical practice. These drugs are widely used to treat not only depression and schizophrenia, but also anxiety and affective disorders. Other, additional indications for the use of antidepressants are appetite disorders, premenstrual syndrome, chronic pain, etc. Neuroleptics are administered to treat resistant depressions, aggressiveness, impulsivity, and alcoholism. Impaired sexual functioning due to AD and AP lowers quality of life in patients and increases the risk of their refusing treatment, the result of which is a phenomenon associated with the occurrence of recurrent mental illnesses. There are few scientific data on the nature and prevalence of sexual dysfunctions induced by these medications. This topic is universally underestimated as it is rarely touched upon by specialists during their consultations. The aim of the review is to show the side effects of AP and AD on the sexual sphere, to compare different classes of the drugs, and to propose possible management strategies to correct these undesirable effects.
Terapevticheskii arkhiv. 2012;84(10):103-108
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Melatonin and metabolic syndrome: Is there their association?
Dzherieva I.S., Volkova N.I., Rapoport S.I.
Abstract
The basis for the current view of the mechanisms for regulating metabolic processes is the hypothesis proposed by the United Kingdom scientists E. Scott and P. Grant that evolutionary fixed adaptation to seasonal environmental changes is impaired. Under the hypothesis, impairment in seasonal and circadian rhythms is the key condition for the occurrence of obesity, arterial hypertension (AH), and type 2 diabetes mellitus. The diseases of civilization, namely obesity, insulin resistance, and AH, are a direct result of chronic metabolic disturbance due to light pollution.
Terapevticheskii arkhiv. 2012;84(10):109-112
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Carbohydrate metabolic disturbances and obstructive sleep apnea syndrome
Oleĭnikov V.É., Sergatskaia N.V.
Abstract
The paper analyzes an association between obstructive sleep apnea syndrome (OSAS) and carbohydrate metabolic disturbances. It presents the data of clinical trials that consider OSAS as a risk factor of type 2 diabetes mellitus (T2DM). The most important factors influencing the progression of carbohydrate metabolic disturbances in patients with OSAS are analyzed. Whether OSAS can be corrected as a modifiable risk factor in patients with T2DM is considered.
Terapevticheskii arkhiv. 2012;84(10):113-118
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Dorsopathy in the elderly: pathobiology and multimodality therapy in clinical practice
Tsurko V.V.
Abstract
The lecture considers the most common causes of dorsopathy in elderly patients, by taking into account pathobiology, age markers, and aging processes. It discusses the general issues in the management of elderly patients, including advice on exercise and treatment; particular emphasis is placed on vitamin B group-containing xefocam and neurobion.
Terapevticheskii arkhiv. 2012;84(10):119-124
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