Vol 85, No 10 (2013)

AIM: To evaluate the efficiency and safety of two treatment regimens using ramipril or losartan in combination with hydrochlorothiazide (HCT) and amlodipine in grade 1-2 arterial hypertension (AH)/MATERIAL AND METHODS: The prospective, international, multicenter, randomized, open-label, controlled trial with parallel groups included 347 AH patients in Russia (n=166), Croatia, and Ukraine. The follow-up was 12 weeks in patients not receiving antihypertensive therapy (AHT) and 13 weeks in those who had previously received AHT with regard to a washout period. The basis for two treatment regimens was ramipril or losartan. If no target blood pressure (BP) was achieved, amlodipine or HCT was added at week 4 and a third antihypertensive drug (AHD) was used 8 weeks later/RESULTS: At the inclusion, clinical BP was 157.64/95.5 mm Hg in 332 (61%) AH patients aged 55.9±11 years. At week 4 of monotherapy with ramipil 5 mg or losartan 50 mg, BP was reduced to 141.9/87.4 mm Hg. Addition of a second AHD further lowered BP to 131.8/81.9 mm Hg (to 127.6/79.7 at 12 weeks of treatment; p<0.001). After 4 weeks of treatment with ramipril 5 mg or losartan 50 mg, 35% of the patients achieved target BP. At weeks 8 and 12, double or triple AHT increased the number of patients achieving the target level up to 75 and 94%, respectively. When losartan was used as monotherapy, about one third of the patients achieved target BP; 20 and 22% of the patients required the addition of a second AHD (HCT and amlodipine, respectively). Only 10% of the patients needed to take a combination of three AHDs. Nearly one third of the patients achieved target BP during monotherapy with losartan or ramipril. Double AHT involving ramipril or losartan in combination with the diuretic or amlodipine was used in 18 and 20% and in 22 and 24% of the patients, respectively. 28 and 19% of the patients received triple therapy including ramipril or losartan, amlodipine, and HCT. The most common adverse reactions were dizziness (2.4%), fatigue (1.8%), and coughing (1.2%)/CONCLUSION: In the patients with grades 1-2 AH, the treatment regimens using basic therapy with ramipril or losartan proved to be highly effective and allowed target BP to be achieved in 94% of cases. Both treatment regimens were comparable in view of safety; slight side effects occurred rarely (in less than 2.5% of the patients) and required that the treatment should not be discontinued.

AIM: To comprehensively study hemostasis pathology and its association with the laboratory markers and mediators of inflammation in patients with metabolic syndrome (MS)/MATERIAL AND METHODS: One hundred and eleven patients with type 2 diabetes mellitus, who were diagnosed as having MS, were examined. Vascular-platelet and secondary hemostases and anticoagulant and fibrinolytic systems were evaluated, by performing the complete clinical, laboratory, and instrumental study accepted in a specialized endocrinology clinic. The blood concentrations of high-sensitivity C-reactive protein and proinflammatory cytokines were determined in all the patients with MS and control persons (n=50)/RESULTS: It was found that in patients with MS, hemostasis pathology that might be classified as the combined form of a prethrombotic state, which was caused by different types of a constellation of vascular-platelet and plasma hemostases, as well as physiological anticoagulant deficiency, was linked to the laboratory markers and mediators of subclinical inflammation/CONCLUSION: In the patients with MS, subclinical systemic inflammation is of substantial importance for the mechanisms of a prethrombotic state.

AIM: To study the frequency of pathoanatomic and some clinical signs of dilated cardiomyopathy (DCM) in schizophrenic patients (SPs)/MATERIAL AND METHODS: Autopsy records were studied in 838 SPs treated at a psychiatric hospital in 1952 to 2007. The records were used to select DCM cases (n=74) and sudden deaths (n=101) and to examine 339 electrocardiograms (ECG). The 2006-2007 information obtained in the dissecting rooms of three Tver hospitals (1413 sections) was analyzed/RESULTS: DCM was absent (neuroleptics were not used) before 1956. With the application of neuroleptics, the diagnosis of DCM cases significantly increased and its rate was 14.2% among the dead SPs. DCM might be a cause of sudden death in 21.8% of SPs. The rate of pathological ECG signs noticeably increased with the longer use of neuroleptics. In the hospital-wide network, the detection rate for DCM was 0.5% of the autopsies/CONCLUSION: The use of neuroleptics, in SPs in particular, may lead to the development of DCM.

AIM: To study the experience in managing patients with acute promyelocytic leukemia (APL) diagnosed in different periods of pregnancy/MATERIAL AND METHODS: Nine women with APL were treated in 1998-2013. When APL was diagnosed in the first trimester of pregnancy, the latter was terminated (n=1); when its diagnosis was made in the second trimester, chemotherapy (CT) followed by delivery (D) was performed (n=3); when it was done in the third trimester, D followed by CT was done in relation to gestational age (n=2) or these were performed at a later gestational age (n=1). APL was treated in 5 and 1 patients according to the AIDA protocol and the 7+3 plus ATRA one, respectively/RESULTS: All the patients with APL achieved remission after the first cycle of induction CT; 5 of the 6 patients did at the moment of delivery; one patient underwent emergency delivery during cytopenia after the cycle. The gestational age at delivery after CT was 34 (34-40) weeks. Spontaneous term labor occurred in 2 patients at an obstetric hospital. Cesarean section was made in 4 of the 6 patients. All babies were born alive, healthy, and without developmental abnormalities. Their age at the time of analyzing the results was 2.5 months to 15 years. Four of the 9 patients are presently alive. Late recurrences occurred in 3 (33%) patients. The median overall survival is 26 (0.25-128) months; the median relapse-free survival is 17.5 (0-127) months/CONCLUSION: APL treatment in pregnant women, which is aimed at saving two lives, is effective and reasonable.

AIM: To compare the efficiency of using different interventional procedures for a barren marriage in case of secretory azoospermia (SAS)/MATERIAL AND METHODS: The trial enrolled 110 patients aged 25 to 54 years with SAS. The levels of sexual hormones were determined; ovarian punch biopsy was performed/RESULTS: Decreased volume of the ovaries was noted in 85.3% of the patients; diffuse or focal changes in their parenchyma were seen in 65.7%. There was an increase of follicle-stimulating hormone levels and a reduction in testosterone ones. Hyperestrogenemia was identified in 26.5% of the patients. The level of inhibin B was lower in all the patients. The efficiency of standard testicular sperm extraction for cryopreservation was achieved in 28.7% of the patients and that of a microsurgical technique was in 56.7%. The wives of 37 out of the 57 patients included in an assisted reproductive technology program were more than 12 weeks pregnant after 95 intracytoplasmic sperm injection cycles/CONCLUSION: The microsurgical technique is most effective in achieving the successful treatment of patients with azoospermia in order to prevent male infertility.

The review considers the relationship between obesity and erectile dysfunction (ED). Obesity is associated with the high prevalence of ED; however, the pathophysiological link between these conditions has yet to be adequately investigated. Visceral obesity leads to the enhanced activity of inflammatory responses and, thus, endothelial dysfunction and decreased plasma testosterone levels, which favors the development of hypogonadism and increases the risk of vascular diseases. Endothelial dysfunction and androgen deficiency in turn give rise to ED.

The review considers disturbed metabolism of vitamins, minerals, and protein in patients following bariatric surgery. The positive effect of the surgery is proven; however, postresection syndromes that may further occur determine not only a patient follow-up, but also timely therapeutic interventions to prevent hypovitaminoses, anemia, and mineral metabolic disturbances. There are conflicting data on the incidence of these abnormalities. No guidelines for their treatment and prevention have been elaborated.

Headache associated with sexual activity (HASA) is a common and benign form of primary headache in most cases and has a favorable prognosis. However, even a single episode of primary headache is a cause for an immediate and thorough examination to rule out the secondary nature of cephalgia. The paper considers the pathogenesis, differential diagnosis, and principles in the treatment of patients with this disease.

Tracheal diverticula (TD) are a rare congenital or acquired condition. The diagnosis of TD is based on the data of multislice spiral computed tomography and fibrotracheal bronchoscopy. DTs are most frequently located in the right, may be solitary or multiple, uni- or multilocular. Uncomplicated DTs generally have no characteristic clinical features. Their symptoms can arise from the compression of adjacent organs or the addition of secondary bacterial infection and most commonly appear as cough. Differential diagnosis is mainly made with pharyngeal and laryngeal cysts and pharyngoesophageal diverticula. Asymptomatic TDs usually require no treatment. Surgical TD excision is possible in case of compression of adjacent organs and infection.