Vol 89, No 4 (2017)

Editorial
Direct oral anticoagulants in atrial fibrillation patients aged 75 years or older: Efficacy and safety balance
Fomin V.V., Svistunov A.A., Napalkov D.A., Sokolova A.A., Gabitova M.A.
Abstract
Atrial fibrillation (AF) is one of the most common heart rhythm disorders in the population. Researchers revealed a direct relationship between their incidence and a patient’s age long ago. One of the most challenging issues of clinical practice in patients with AF is anticoagulant therapy used in the so-called very elderly patients aged 75 years and older when age itself is a risk factor for developing both thromboembolic and hemorrhagic events due to anticoagulants, regardless of the mechanism of action of the latter. However, scientific data regarding the treatment and prevention of thromboembolic events in elderly and senile patients with AF are very scarce and often uninformative. The data from the EURObservational Research Programme-Atrial Fibrillation Registry Pilot Phase (EORP-AF Pilot) and the randomized clinical studies RELY, ROCKET AF, ARISTOTLE, and AVERROES were analyzed to identify the most safe and most effective anticoagulant for elderly patients (over 75 years). Relying on the analyses of literature data, the authors propose an algorithm based on clinical characteristics for choosing the anticoagulant for patients older than 75 years.
Terapevticheskii arkhiv. 2017;89(4):4-7
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Subtraction CT angiopulmonographic assessment of the vascular bed and lung perfusion in patients with chronic thromboembolic pulmonary hypertension: A pilot study
Veselova T.N., Demchenkova A.Y., Martynyuk T.V., Danilov N.M., Ternovoy S.K., Chazova I.E.
Abstract
Aim. To evaluate the vascular bed and lung perfusion in patients with chronic thromboembolic pulmonary hypertension (CTEPH) by computed tomography (CT) and to compare the severity of pulmonary arterial (PA) thrombotic lesions concurrent with parenchymal perfusion disorders with angiopulmonographic findings and clinical and hemodynamic characteristics. Subjects and methods. In the period from November 2015 to May 2016, 22 patients (7 men, 15 women) aged 27 to 67 years with a verified diagnosis of CTEPH were examined using an Aquilion ONE VISION Edition 640 (Toshiba Medical Systems, Japan) CT scanner with a 320-row detector. Perfusion defect in this study was evaluated with the new software allowing one to combine contrast and contrast-free images by a subtraction method. CT data analysis included visual assessment of the vascular bed and lung parenchyma and quantitative assessment with perfusion map construction and semi-automatic determination of the obstruction index (OI) and perfusion defect index (PDI). OI was compared with PDI and mean LA pressure according to the data of right heart catheterization and 6-minute walk test. Results. A statistically significant correlation was found between OI and PDI in patients with CTEPH (Pearson r=0.56; p=0.0065). There were no relationships between mean LA pressure and vascular perfusion indices (OI and PDI) or between vascular perfusion parameters and 6-minute walk test results. Conclusion. CT angiopulmonography in conjunction with pulmonary perfusion assessment (within one study) allows evaluation of the severity of vascular lesions and perfusion disorders and determination of the efficiency of treatment in patients with CTEPH.
Terapevticheskii arkhiv. 2017;89(4):8-14
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The diagnostic value of measuring the momentary blood flow reserve versus non-invasive methods to detect myocardial ischemia in assessing the functional significance of borderline coronary artery stenoses
Darensky D.I., Gramovich V.V., Zharova E.A., Ansheles A.A., Sergienko V.B., Mitroshkin M.G., Atanesyan R.V., Matchin Y.G.
Abstract
Aim. To estimate the diagnostic value of measuring the momentary blood flow reserve (MBFR) versus the surrogate non-invasive standard (SNS) for myocardial ischemia verification (MIV) (a combination of stress echocardiography and single-photon emission computed tomography). Subjects and methods. The investigation enrolled 50 patients with stable angina in the presence of chronic coronary heart disease (CHD) or suspected CHD, in whom coronary angiography (CA) revealed borderline coronary stenoses (50—70% lumen diameters). The examination algorithm had two options. In one option, when included in the study, patients had already CA results not older than 1 month, and MBFR was measured 4—7 days after non-invasive stress tests. In the other option, MBFR in the area of borderline coronary artery stenosis was measured simultaneously with CA; and the noninvasive stress tests were carried out in the following week. A total of 74 coronary stenoses were examined. Results. SNS for MIV was positive in 14 (28%) patients. When comparing with the non-invasive methods of myocardial ischemia verification, the area under the ROC curve for MBFR was 0.961±0.019 (95% confidence interval, 0.888—0.992). The optimal cut-point was 0.92, which is corresponded by a sensitivity of 100% and a specificity of 84%. Conclusion. When compared with SNS for MIV, the method for measuring MBFR has a high diagnostic accuracy.
Terapevticheskii arkhiv. 2017;89(4):15-21
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Impact of shock-wave therapy on the clinical and functional status of patients with coronary heart disease
Matskeplishvili S.T., Borbodoeva B.M., Asymbekova E.U., Rakhimov A.Z., Akhmedyarova N.K., Kataeva K.B., Buziashvili Y.I.
Abstract
Aim. To study of the impact of shock-wave therapy (SWT) on the functional status of patients with coronary heart disease (CHD). Subjects and methods. Thirty-four CHD patients (including 33 men) with left ventricular (LV) asynergic segments, as evidenced by echocardiography (EchoCG), were examined. Their mean age was 60.1±1.76 years. All the patients received a SWT cycle according to the standard scheme. The patient examination protocol involved EchoCG, dobutamine EchoCG, treadmill exercise EchoCG, and tissue Doppler EchoCG, which were performed at baseline, immediately and one month after the end of a SWT cycle. Results. Following a SWT cycle, all the patients were noted to have a significant decrease in mean angina pectoris and heart failure functional classes and in the frequency of daily intake of nitrates. EchoCG showed that at baseline the LV ejection fraction (EF) was 51.1±1.02%; end- diastolic volume index, 71.5±3.6 ml/m2; end-systolic volume index, 34.4±2.2 ml/m2. According to exercise EchoCG, the tolerance threshold was 6.4±0.1 Меts (Bruce protocol); the total exercise time of 5.05±0.23 min was achieved in an average of 75.2±1.32%. Immediately and one month after a SWT cycle, there was an increment in EF from 51.1±1.02 to 55±0.8 and 57±1.7%, respectively; a substantial increase in the tolerance threshold to 8.17±0.24 and 9.45±0.34 Меts, as compared to the baseline values. The exercise time increased up to 6.41±0.17 and 7.7±0.29 min immediately and one month after SWT, respectively. The increment in EF in response to exercise was 8.54±2.12, 14±1.5, and 16±1.2% at baseline, immediately and one month after SWT, respectively. Moreover, myocardial relaxation and diastolic function improved. Conclusion. Shock-wave therapy in patients with CHD is accompanied by their improved functional status, which is manifested by increased tolerance threshold and exercise duration, a rise in rest and exercise LV EF, better relaxation of LV, and its diminished stiffness.
Terapevticheskii arkhiv. 2017;89(4):22-28
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Long-term results of different approaches to revascularization in non-ST-segment elevation acute coronary syndrome and multiple coronary atherosclerosis
Ganyukov V.I., Tarasov R.S., Neverova Y.N., Kochergin N.A., Barbarash O.L., Barbarash L.S.
Abstract
Aim. To assess the long-term results of different approaches to treating patients with non-ST-segment elevation acute coronary syndrome (NSTE ACS) and multivessel coronary artery disease (MVCAD). Subjects and methods. A total of 150 patients with NSTE ACS, in whom coronary angiography revealed MVCAD, were examined. The patients were divided into 3 groups according to the selected treatment policy: 1) percutaneous coronary intervention (PCI) (n=91 (60.6%)); 2) coronary artery bypass grafting (CABG) (n=40 (26.6%)); and 3) only medical treatment (n=9 (6%)). The mean follow-up was 27.6±3.5 months. Results. The medical treatment policy in this patient sample demonstrates the worst results, with the majority of cardiovascular events developing in the hospital period. PCI in patients with NSTE ACS and multiple coronary atherosclerosis has a number of objective limitations in this patient sample, leading to suboptimal treatment outcomes Conclusion. The use of CABG or PCI as a myocardial revascularization technique in patients with NSTE ACS and MVCAD is characterized by a comparable satisfactory survival in the hospital and long-term follow-up periods. 12% of patients do not receive revascularization due to the extremely high risk from any of coronary blood restoring methods, which results in very many deaths largely occurring during the hospital period.
Terapevticheskii arkhiv. 2017;89(4):29-34
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Vascular permeability and intravascular erythrocyte aggregation in young people after smoking cessation
Sirotin B.Z., Korneeva N.V.
Abstract
Aim. To study the parameters of microcirculation and permeability of the microvessels in young people who have ceased smoking. Subjects and methods. The study enrolled 35 healthy young adults (male to female ratio, 20:15; mean age, 21.71±0.46 years) who had stopped smoking 1 month to 10 years (mean 2.63±0.43 years) ago. The compared group consisted of 16 smokers (male to female ratio, 6:10; mean age, 21.62±0.72 years) and 29 non-smokers (male to female ratio, 8:21; mean age, 21.62±0.48 years). Computer-assisted video biomicroscopy of the bulbar conjunctiva was performed. When the results were assessed, attention was drawn to a change in the degree and extent of intravascular erythrocyte aggregation (IVEA) and vessel wall permeability. Results. As compared to the smokers, those who had quit smoking showed a decrease in the degree of IVEA in the arterioles (p1=0. 044, van der Waerden test), its prevalence in the central, transitional, and perilimbar regions (p1<0.0001), and a decline in the number of conjunctival areas that exhibited IVEA (2.2 and 3.437; p1=0.0002). Those who had given up smoking versus the smokers were found to have more rarely local foci of conjunctival edema (formation of veils; p1=0.0217). Conclusion. In the young people who have ceased smoking versus the smokers, IVEA decreases and miscovascular permeability restores.
Terapevticheskii arkhiv. 2017;89(4):35-38
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Structural features of the lipid bilayer of the red blood cell membrane in people with isolated hypercholesterolemia without coronary artery disease and in patients with coronary artery disease
Vasilev A.P., Streltsova N.N., Lystsova N.L.
Abstract
Aim. To identify the specific features of modifying the lipid composition of the red blood cell membrane in people with isolated hypercholesterolemia without coronary heart disease (CHD) and in CHD patients with different functional classes of angina pectoris. Subjects and methods. 92 men with Functional Class II—IV stable angina, 22 men with isolated hypercholesterolemia (HC) without CHD, and 18 healthy men with normal cholesterol levels were examined. Blood plasma cholesterol levels were determined in all the examinees. The erythrocyte membrane was examined for the levels of lipid peroxidation (LPO) products, free cholesterol, calcium, and phospholipid fractions and for the activity of Na+/K+-, Mg2+- and Ca2+-ATPases; a bicycle exercise test was carried out. Results. As compared with persons with normal blood cholesterol levels, the examinees with HC without CHD were found to have higher levels of LPO products, lower levels of readily oxidizable phospholipid fractions, decreased activity of membrane-bound Na+/K+-, Mg2+-, and Ca2+-ATPases, and elevated concentrations of free cholesterol and calcium in the red blood cell membrane. Having the pronounced activity of free radical oxidation, the patients with CHD were detected to have deeper similar structural changes in the cell membrane, which became more severe with a larger number of affected coronary arteries. Conclusion. The findings suggest that the lipid structure of the cell membrane undergoes changes associated with its functional depression just at the preclinical stage of atherogenesis. Biomembrane structural modification in patients with angina pectoris progresses in proportion to the number of affected coronary arteries, by limiting the functional reserve of the cell and whole body.
Terapevticheskii arkhiv. 2017;89(4):39-44
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Disaccharidase deficiency and functional bowel diseases
Parfenov A.I., Akhmadullina O.V., Sabelnikova E.A., Belostotsky N.I., Kirova M.V., Khomeriki S.G., Bykova S.V.
Abstract
Aim. To elucidate the role of intestinal carbohydrases (glucoamylase, maltase, sucrose, and lactase) in the etiology and pathogenesis of functional bowel diseases (FBD). Subjects and methods. 74 patients (36 men and 38 women) aged 18 to 50 years with FBD were examined. According to Rome IV criteria (2016), there was diarrhea-predominant irritable bowel syndrome (IBS) in 21 patients, functional diarrhea (FD) in 33, constipation-predominant IBS in 6, functional constipation (FC) in 4, and mixed IBS in 10. The activity of carbohydrases in the small intestine mucosa (SIM) was investigated by the Dahlquist method modified by Trinder in the duodenal biopsy specimens obtained during esophagogastroduodenoscopy. Results. Lactase deficiency was identified in 87.8% of the patients; maltase deficiency in 48.6%; sucrose deficiency in 51.3%; and glucoamylase deficiency in 85.1%. The activity of all the investigated enzymes was reduced in 23 (31.1%) patients with FBD; deficiency of 1—3 carbohydrases was found in 47 (63.5%). Normal enzymatic activity was established in 4 (5.4%) patients. Conclusion. In the majority of patients with FBD, the intestinal symptoms are caused by the decreased activity of SIM carbohydrases. Therefore, disaccharidase deficiency associated with an established damaging agent (nonsteroidal anti-inflammatory drugs, antibiotics, acute intestinal infections, etc.) should be considered to be a more precise diagnosis.
Terapevticheskii arkhiv. 2017;89(4):45-52
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Comparative characteristics of patients with gastroesophageal reflux disease in the age aspect
Denisova O.A., Livzan M.A., Denisov A.P.
Abstract
Aim. To compare the characteristics of patients with gastroesophageal reflux disease (GERD) by age groups, a wide range of clinical signs, including life-of-quality (QOL) indicators, and instrumental findings. Subjects and methods. A total of 110 patients aged 18 to 86 years with GERD were examined in accordance with the standard protocol. Two groups with equal numbers of patents were formed. A study group included elderly and senile patients and a control group consisted of young and adult ones. Results. The elderly patients with GERD were observed to have a number of age-related clinical features and age-unrelated symptoms. The scores in the scales characterizing the physical health component and those in the general health and vital activity scales were markedly decreased in patients older than 60 years of age. No age-related statistically significant differences were found in the esophageal, gastric, and duodenal mucosae. Daily pH-metry in the elderly showed indirect evidence for esophageal hypomotor dyskinesia in the predominance of alkaline refluxes. Conclusion. The cohort of elderly patients with GERD was ascertained to have statistically significant clinical characteristics, and QOL and pH-metry indicators, which will be able to improve methods for diagnosis and early prevention in this age group.
Terapevticheskii arkhiv. 2017;89(4):53-56
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Differentiation therapy for non-acidic gastroesophageal reflux disease
Lishchuk N.B., Simanenkov V.I., Tikhonov S.V.
Abstract
Aim. To investigate the clinical and pathogenetic features of the non-acidic types of gastroesophageal reflux disease (GERD) and to evaluate the impact of combined therapy versus monotherapy on the course of this disease. Subjects and methods. The investigation enrolled 62 patients with non-acidic GERD. The follow-up period was 6 weeks. The patients were divided into 2 groups: 1) weakly acidic gastroesophageal refluxes (GER); 2) weakly alkaline GER. Then each group was distributed, thus making up 4 groups: 1) 19 patients with weakly acidic GER who received monotherapy with rabeprazole 20 mg/day; 2) 21 patients with weakly acidic GER had combined therapy with rabeprazole 20 mg and itopride; 3) 8 patients with weakly alkaline GER who received ursodeoxycholic acid (UDCA) monotherapy; and 4) 14 patients with weakly alkaline GER who had combined therapy with UDCA and itopride, The clinical symptoms of the disease, the endoscopic pattern of the upper gastrointestinal tract (GIT) mucosa, histological changes in the esophageal and gastric mucosa, and the results of 24-hour impedance pH monitoring were assessed over time. Results. During differentiation therapy, the majority of patients reported positive clinical changes and an improved or unchanged endoscopic pattern. Assessment of impedance pH monitoring results revealed decreases in the overall number of GERs, the presence of a bolus in the esophagus, and the number of proximal refluxes. These changes were noted not only in patients taking proton pump inhibitors (PPIs), but also in those treated with UDCA monotherapy or combined PPI and prokinetic therapy. Conclusion. A differentiated approach to non-acidic GER treatment contributes to its efficiency. Adding the prokinetic itomed (itopride hydrochloride) to PPI therapy in a patient with weakly acidic GER enhances the efficiency of treatment, by positively affecting upper GIT motility. The mainstay of therapy for GERD with a predominance of weakly alkaline refluxes is UDCA, the combination of the latter and the prokinetic can exert a more pronounced effect on the clinical and endoscopic pattern and upper GIT motility.
Terapevticheskii arkhiv. 2017;89(4):57-63
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Psychoemotional and autonomic states in patients with cholelithiasis
Vakhrushev Y.M., Khokhlacheva N.A., Sergeeva N.N.
Abstract
Aim. To investigate the psychoemotional and autonomic states of patients with biliary system diseases and to determine their significance in the development of cholelithiasis. Subjects and methods. A total of 396 patients with stage 1 cholelithiasis were examined. The results of hepatobiliary ultrasonography, multifractional duodenal probing, followed by macroscopic, microscopic, and biochemical examinations of bile (the total concentration of bile acids and cholesterol, by subsequently calculating the cholate-cholesterol ratio) were used to verify the diagnosis. The functional state of the hepatobiliary system was evaluated by dynamic echocholecystography and dynamic hepatobiliscintigraphy. To characterize the emotional state, the investigators applied indicators of the motivational sphere and orientation of an individual and his/her mental state, such as reactive anxiety, personal anxiety, the levels of depression and neuroticism, and intra-, extraversion. The autonomic state was determined from autonomic tone, autonomic reactivity, and autonomic support. Results. Biliary lithogenesis was found to be related to psychoemotional and autonomic states. In cholelithiasis, there was an increase in reactive and personal anxiety and a predominance of diminished parasympathetic and perverted sympathetic autonomic reactivity. The signs of emotional instability and autonomic dystonia were shown to increase with age and the degree of an autonomic response depended on the severity of mental and emotional disorders. Conclusion. The results of these comprehensive studies can reveal new pathophysiological patterns of lithogenic bile formation and enhance our understanding of the pathogenesis of cholelithiasis.
Terapevticheskii arkhiv. 2017;89(4):64-68
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Chronic constipation in the practice of a therapist: Features of therapy for comorbidity
Svistunov A.A., Osadchuk M.A., Butorova L.I., Tokmulina G.M.
Abstract
Aim. To evaluate the clinical efficacy of laxatives with different pharmacological effects in the combination therapy in patients with chronic constipation (CC) concurrent with obesity, hypertensive disease, and type 2 diabetes mellitus (DM). Subjects and methods. A total of 110 people (45 men, 65 women) aged 45 to 72 years with CC in the presence of concomitant diseases: grade 1 or 2 hypertensive disease + obesity + type 2 DM. The investigators determined the severity of abdominal pain syndrome and flatulence, by indicating the mean frequency of defecations per week and fecal consistency according to the Bristol stool scale; anthropometric parameters; serum biochemistry tests; and serum lipoprotein phenotyping. Quality of life was assessed by the SF-36 questionnaire. The patients were divided into 3 groups according their use of agents: 1) dietary fiber (psyllium); 2) osmotic laxatives (disaccharides); 3) osmotic laxatives (polyethylene glycol). Results. The patients taking psyllium to treat constipation showed an increasing frequency of defecations and normalization of stool consistency. Incorporating psyllium into combination therapy was accompanied by a significant decrease in the levels of total cholesterol and low-density lipoprotein cholesterol. A similar trend was observed for serum triglycerides. The patients receiving combination therapy including other laxatives displayed no significant differences between lipid metabolic parameters at the beginning and after the end of treatment. Conclusion. The whole complex of properties of psyllium (Mucofalk) can be fully realized in patients with comorbidity and chronic constipation, which is accompanied not only by the normalization of bowel emptying, but also by marked positive changes in the main lipid metabolic parameters and by a reduction in overweight.
Terapevticheskii arkhiv. 2017;89(4):69-74
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Emotional impairments and their correction in patients with migraine
Chutko L.S., Surushkina S.Y., Yakovenko E.A., Anisimova T.I., Sergeev A.V.
Abstract
Aim. To study emotional impairments in patients with migraine and to evaluate the efficiency of Noophen therapy for this pathology. Subjects and methods. 63 patients aged 18 to 45 years with migraine without aura were examined. 56 patients used prophylactic antimigraine therapy: Group 1 (n = 26) received metoprolol and Group 2 took metoprolol in combination with Noophen. Results. The patients with migraine had a significantly higher level of alexithymia than the controls. Concomitant anxiety disorders were found in 47 (74.6%) cases. The study provided evidence that the treatment was highly effective in Group 2 that exhibited a more pronounced decrease in pain intensity, a greater reduction in the levels of anxiety, and more vital activity. Conclusion. The results of this study allow a conclusion that emotional impairments are implicated in the pathogenesis and clinical presentations of migraine and that it is appropriate to use Noophen for the treatment of this pathology.
Terapevticheskii arkhiv. 2017;89(4):75-79
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A case of primary diagnosis of patent ductus arteriosus at the age of 75 years
Sumarokov A.B., Bedimogova S.S., Nekrutman E.A., Epifanova O.N., Veselova T.N., Atanesyan R.V., Blinova E.V., Sakhnova T.A., Korobkova I.Z., Fateeva L.V., Martynyuk T.V.
Abstract
The paper describes a case of primary diagnosis of functioning patent ductus arteriosus in a 75-year-old female patient.
Terapevticheskii arkhiv. 2017;89(4):86-90
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Stable high interleukin-17A concentration in patients with ankylosing spondylitis treated with tumor necrosis factor-α inhibitors during a year
Gaydukova I.Z., Rebrov A.P., Aparkina A.V., Khondkaryan E.V.
Abstract
Aim. To assess changes in the concentration of interleukin-17A (IL-17A) in patients with ankylosing spondylitis (AS) treated with tumor necrosis factor-α (TNFα) inhibitors during a year. Subjects and methods. Examinations were made in 30 patients (22 (73.3%) men) aged 38.35±9.19 years with AS (modified New-York criteria, BASDAI ≥4.0; AS duration, 11.4±9.6 years) and in 20 healthy individuals (12 (60%) men) aged 40.1±7.7 years) (a control group). All the patients were treated with infliximab (remicade, MSD) 5 mg/kg body weight during a year according to the recommended regimen. BASDAI and ASDAS were calculated; C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and TNFα and IL-17A concentrations were measured before and 52±2 weeks after TNFα inhibitors treatment. BASDAI/ASDAS improvement, ESR and CRP decreases; ASAS20/40 responses, ASAS partial remission, and an ASDAS improvement were estimated. Results. In the patients with AS, the concentrations of TNFα and IL-17A were higher than those in the healthy individuals (p < 0.000). Twelve (40%) AS patients treated with TNFα inhibitors achieved ASAS partial remission. The average estimated back pain, ASDAS and BASDAI scores, and CRP and ESR substantially reduced (p<0.000 for all). The concentration of TNFα decreased from 17.8±7.6 to 7.3±3.2 pg/ml (p<0.000). The IL-17A level was 28.4±14.4 and 32.1±12.2 pg/ml before and after the treatment, respectively. The baseline level of IL-17A was lower in the patients with AS who had achieved remission than that in those who had not (p=0.01). Conclusion. The improvement due to one-year AS treatment with TNFα inhibitors is not associated with the reduction of IL-17A concentrations. In the patients who failed to achieve ASAS partial remission, the baseline and final serum concentrations of IL-17A were higher than in those who achieved the remission.
Terapevticheskii arkhiv. 2017;89(4):80-85
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Osteoprotegerin is a new marker of cardiovascular diseases
Verbovoy A.F., Tsanava I.A., Mitroshina E.V., Sharonova L.A.
Abstract
Osteoprotegerin (OPG) is a glycoprotein that is a representative of the tumor necrosis factor-α receptor superfamily. Information about the possible role of OPG in the development of cardiovascular diseases has begun to appear in the literature in recent years. This review discusses the role of increasing the level of OPG in the development and progression of atherosclerosis and as a consequence of coronary heart disease and chronic heart failure.
Terapevticheskii arkhiv. 2017;89(4):91-94
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Asymptomatic atherosclerosis of the brachiocephalic arteries: Current approaches to diagnosis and treatment
Kopylov F.Y., Bykova A.A., Shchekochikhin D.Y., Elmanaa K.E., Dzyundzya A.N., Vasilevsky Y.V., Simakov S.S.
Abstract
Acute cerebrovascular accident (ACVA) and transient ischemic attack are among the leading causes of morbidity, disability, and mortality in the Russian Federation and the world. Ischemic strokes account for 70—80% of all ACVAs, with 20—30% of them being associated with stenotic atherosclerosis of the brachiocephalic arteries (BCA). The paper describes modern views on the problem of asymptomatic BCA atherosclerosis and considers the possibilities of identifying risk groups among the patients with asymptomatic atherosclerosis of the BCA.
Terapevticheskii arkhiv. 2017;89(4):95-100
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New opportunities for the prevention of gastric cancer
Maev I.G., Kazyulin A.N.
Abstract
The approvals and provisions of the Management of Helicobacter pylori infection-the Maastricht V/ Florence Consensus Report and those of the Kyoto Global Consensus Conference on H. pylori-associated gastritis, concerning with the primary and secondary prevention of gastric cancer (GC), unambiguously suggest that H. pylori infection is the most important risk factor of GC. Accordingly, the basis for the primary and secondary prevention of GC is the optimization of H. pylori eradication therapy. The clear direct relationship of the risk of GC to the severity and extent of atrophic gastritis, intestinal metaplasia and dysplasia and no reversal of intestinal metaplasia and dysplasia in the presence of H. pylori eradication presume that gastroprotective agents should be used for primary and secondary prevention. Experimental and clinical findings can lead to the conclusion that rebamipide is a highly effective and safe agent for the primary and secondary prevention of GC in patients with and without H. pylori infection, by optimizing anti-Helicobacter therapy, its anti-inflammatory effect and ability to restore the cellular structure of the gastric epithelium.
Terapevticheskii arkhiv. 2017;89(4):101-109
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Cryoglobulinemic vasculitis in chronic hepatitis C: Genetic aspects
Artemova M.G., Abdurakhmanov D.T.
Abstract
Cryoglobulinemia (CG) is detected in more than 50% of patients with chronic hepatitis C (CHC); however, only 15—25% of them develop cryoglobulinemic vasculitis (CV) that is a systemic vasculitis due to the formation of immune deposits, which affects small (less than medium-sized) vessels and which is frequently fatal for the patient. The causes of CG only in some patients with CHC and the pathogenesis of CV remain unstudied; however, the accumulated data allow one to identify the special contribution of the patient’s genetic factors to the development of the disease. The paper considers the genetic aspects of the development of CG and CV in CHC.
Terapevticheskii arkhiv. 2017;89(4):110-114
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Langerhans cell histiocytosis: Skin diseases and visceral lesions
Elkin V.D., Sedova T.G., Kopytova E.A., Plotnikova E.V.
Abstract
Langerhans cell histiocytosis (LCH) is a rare clonal proliferative disorder that belongs to class I histiocytoses and is characterized by infiltration of one or many organs by Langerhans cells to form granulomas. The literature analysis could identify a lot of etiological, pathogenetic, and trigger factors and mechanisms for LCH development, which determine the diversity of the clinical picture and course of the disease. The clinical manifestations of LCH are very variable and depend on the severity of lesions and the age of patients. In addition to skin lesions, there is involvement of one or more visceral organs. Difficulties in diagnosing the disease lead to statistical variations of LCH in different countries of the world and require more attention by physicians of all specialties.
Terapevticheskii arkhiv. 2017;89(4):115-120
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