No 1 (2009)

Basic principles of medical aid for patients with a hypertensive crisis
Galkin V.A., Tereshchenko S.N., Galkin V.A., Tereschenko S.N.
Terapevticheskii arkhiv. 2009;(1):5-6
National program "Health" and optimization of quality and training of internists at the outpatient care chair
Gulyaeva S.F., Gulyaev P.V., Gulyaeva S.F., Gulyaev P.V.
Terapevticheskii arkhiv. 2009;(1):7-11
Social issues of medical care for old outpatients with chronic cardiac failure
Nechaeva G.I., Temnikova E.A., Borid'ko G.I., Solodnikova L.D., Nechaeva G.I., Temnikova E.A., Boridko G.I., Solodnikova L.D.
Aim. To assess efficacy of therapeutic medical education in the field of chronic cardiac failure (CCF) of social workers taking care of old persons on home nursing. Material and methods. 87 social workers filled in a special questionnaire before and after training in management of old persons with CCF. Results. Initial knowledge of the social workers about CCF was insufficient, especially their education was poor in CCF symptoms, medication, diet, regime, hospital and outpatient treatment, possible assistance from social personnel. Therapeutic training improved medical knowledge of the social workers. Conclusion. Therapeutic education of social workers improves their knowledge about outpatient treatment of old patients with CCF and understanding of a social worker behavior with old CCF outpatients.
Terapevticheskii arkhiv. 2009;(1):12-15
Community-acquired pneumonia with atypical (mycoplasmic and chlamydial) infection
Trubnikov G.V., Polyakova I.G., Butakova L.Y., Trubnikov G.V., Polyakova I.G., Butakova L.Y.
Aim. To perfect prehospital diagnosis of community-acquired pneumonia (CAP) of atypical etiology (mycoplastic - Mp and chlamydial - Ch). Material and methods. Routine clinical examinations, sputum seeding, enzyme immunoassay were made in 214 patients admitted to therapeutic departments of two large Barnaul hospitals. Results. Mp CAP was diagnosed in 21.5%, Ch CAP - in 12.1%, combination - in 7.0% patients. Sputum seeding was made in 67 patients. Of them 41.8% patients were found to have bacterial infection. Atypical infection combined with bacterial in 44.1% patients. The above combination was more frequent in patients with Ch CAP than with Mp CAP (58.8 and 29.7%, respectively). Bacterial flora was detected in 39.1% CAP patients without atypical infection. A retrospective analysis of case histories in respect of prehospital stage discovered that CAP patients with atypical infection are characterized by more frequent contact with patients with acute respiratory viral infection and workers of services sector. CAP arises primarily in autumn and winter with morbidity correlating with acute respiratory diseases morbidity. Conclusion. CAP with atypical infection is characterized with prodromal period, late visit to the doctor, late hospitalization, late x-ray verification of the disease especially in Ch CAP. Mp CAP is more prevalent in young patients, Ch CAP occurs most frequently in young, presenile and senile patients. The presence of the prodromal period in CAP patients with atypical infection is the cause of mistakes in outpatient diagnosis. Instead of CAP such patients are often diagnosed to have acute respiratory viral infection (54.5%) or exacerbation of chronic bronchopulmonary disease (15.9%).
Terapevticheskii arkhiv. 2009;(1):16-20
Left ventricular remodeling in patients with chronic renal failure on outpatient hemodialysis
Romasheva E.P., Davydkin I.L., Romasheva E.P., Davydkin I.L.
Aim. To study left ventricular remodeling (LVR) in patients with end-stage renal disease (ESRD) treated by hemodialysis (HD). Material and methods. A total of 122 patients with ESRD were examined: 21 patients with predialysis ESRD (group 1), 37 patients treated by HD for 4 hours thrice a week (group 2), 64 patients treated by HD for 5 hours thrice a week (group 3). All the patients have undergone echocardiography. Blood serum hemoglobin, urea, creatinine, albumin, calcium, phosphates, PTH were measured. URR and Kt/V were calculated in patients of group 2 and 3. Results. LVM and ILVM were significantly higher in patients of group 2, excentric geometry predominated (63.2%). Conclusion. Prolongation of HD procedure from 4 to 5 hours thrice a week positively influences left ventricular remodeling and increases the survival of ESRD patients treated by HD.
Terapevticheskii arkhiv. 2009;(1):21-24
Cutaneous syndrome in practice of the gastroenterologist of the outpatient clinic
Ivanov O.L., Novoselov A.V., Novoselov V.S., Ivanov O.L., Novoselov A.V., Novoselov V.S.
Terapevticheskii arkhiv. 2009;(1):25-28
Outpatient dual-energy x-ray osteodensitometry in diagnosis of early disorders of mineral bone density and monitoring of postmenopausal osteoporosis treatment
Rubin M.P., Rubin M.P.
Aim. To improve quality of densitometric diagnosis of abnormal bone tissue mineral density (BTMD) in postmenopausal women using the results of densitometry of two adjacent lumbar vertebra and proximal regions of both femoral bones. Material and methods. Densitometry (dual-energy x-ray absorptiometry) was made on densitometer Lunar Prodigy in 7731 women: 969 under 50 years of age, 3081 - aged 50-65 years (early postmenopause) and 3681 - aged 65 years and older. BTMD data were analysed with the system MEDIALOG. Results. In postmenopause metabolic disorders of bone tissue are detectable with a standard analysis of the results of dual x-ray osteodensitometry in about 2/3 (72.14%) patients (at the stage of osteopeny in 33.13% and osteoporosis - in 39.01%). Diagnostic efficiency in consideration of the T-criterion in the adjacent lumbar vertebra in comparison to the integral value LI-LIV rises in 50-65 year old women in osteoporosis by 7.27% and in osteopeny - by 8.31%; in women over 65 years of age by 10.11 and 3.62%, respectively. Diagnostic value rises in comparison of the results of bilateral examination of the femoral bones with the results of unilateral (left-sided) investigation in women over 50-65 years in osteoporosis by 1.46%, osteopenia - by 1.10%, in women over 65 years - by 3.51 and 2.26%, respectively. Densitometric picture is not permanent, osteoporosis runs in 2 stages. Conclusion. For early diagnosis of postmenopausal osteoporosis most informative is the analysis of BTMD by three areas: lumbar spine LI-LIV, adjacent vertebra LI-LII, LII-LIII, LIII-LIV and necks of both femoral bones.
Terapevticheskii arkhiv. 2009;(1):29-35
An optimal approach to regular check-up of gastroenterological patients with acid-dependent diseases
Gulyaev P.V., Gulyaev P.V.
Aim. To optimize principles of gastroenterological care management in outpatient clinics and monitoring of medical service quality for patients with acid-dependent gastroenterological disease (ADGED) in the group of poor health patients for making decisions to optimize diagnosis, treatment and prophylaxis in outpatient setting. Material and methods. Regulated standards were used in examination of 448 ADGED patients. Optimisation of outpatient medical care for poor health patients was conducted basing on the 3-level model of the consulting-diagnostic process. Results. Among patients who suffer from ADGED most seriously 57.3% had H. pylori infection. Such patients benefited more from antihelicobacter treatment. Conclusion. Increasing number of patients with severe ADGED is explained by poor compliance with measures of prevention, healthy life style, treatment including antihelicobacter, low adaptation of gastric mucosa. Prophylaxis in ADGED patients should become a leading direction in medical care for such patients.
Terapevticheskii arkhiv. 2009;(1):36-40
Clinical significance of biliary sludge
Il'chenko A.A., Ilchenko A.A.
Terapevticheskii arkhiv. 2009;(1):41-42
Nonpharmacological therapy of duodenal ulcer in elderly patients
Il'nitskiy A.N., Proshchaev K.I., Zhernakova N.I., Zezyulin P.N., Ilnitsky A.N., Proschaev K.I., Zhernakova N.I., Zezyulin P.N.
Aim. To validate principles and policy of non-pharmacological treatment of duodenal ulcer (DU) with onset at old age, to study medico-social efficacy of DU non-pharmacological treatment. Material and methods. The study was made of 234 cases of DU in patients aged 61-65 years (mean age 63.2 years). DU was diagnosed in them at an old age. Results. Non-pharmacological treatment of old DU patients was performed at three stages: outpatient basic treatment, inpatient rehabilitation with nonpharmacological methods, sanatorium remission and nonspecific resistance consolidation. Conclusion. Nonpharmacological measures by 3-stage scheme have higher medico-social efficacy compared to one-stage management.
Terapevticheskii arkhiv. 2009;(1):43-46
Role of the district therapist in detection and treatment of diffuse euthyroid goiter
Troshina E.A., Mazurina N.V., Galkina N.V., Troshina E.A., Mazurina N.V., Galkina N.V.
Terapevticheskii arkhiv. 2009;(1):47-47
Density-specific distribution of erythrocytes in different types of anemia
Shukhrina E.S., Nesterenko V.M., Kolodey S.V., Tsvetaeva N.V., Ermakova T.A., Nikulina O.F., Kolosheynova T.I., Ataullakhanov F.I., Shukhrina E.S., Nesterenko V.M., Kolodey S.V., Tsvetaeva N.V., Ermakova T.A., Nikulina O.F., Kolosheinova T.I., Ataullakhanov F.I.
Aim. To study density-specific distribution of erythrocytes (DSDE) in different types of anemia. Material and methods. DSDE was determined in anemic patients by fractionation of the whole blood in hematocritic capillaries in the presence of mixtures of dimethyl- and dibutylphthalates with known density. Results. Parameters are proposed which characterize DSDE changes typical for each type of anemia: mean erythrocyte density (MED) - mean density of total erythrocytic population; DSDE width (W) - a characteristic of erythrocytic population heterogeneity; light fraction of erythrocytes (LEF) - % of the cells with density less than 1.086 g/ml (hypochromic cells and reticulocytes); dense fraction of erythrocytes (DEF) - % of cells with density over 1.112 g/ml (hyperchromic cells forming as a result of erythrocyte dehydration). DSDE parameters for different types of anemia differed: reduced MED was typical for iron deficiency anemia (IDA) and paroxysmal nocturnal hemoglobinuria (PNH), increased DEF was seen in microspherocytic anemia (MSA), autoimmune hemolytic anemia (AHA), deficiency of glucose-6-phosphate dehydrogenase, increased LEF was observed in reticulocytosis in all anemia types except MSA, DSDE W was larger in MSA, AHA, PNA. Conclusion. DSDE is determined by proportion of erythropoiesis and sequestration of erythrocytes as well as pathological impacts leading to impairment of membrane permeability for cations and erythrocytic metabolism. Informative value of DSDE parameters makes them effective for diagnostic screening of anemias and control over course of different diseases.
Terapevticheskii arkhiv. 2009;(1):48-51
Enhancement of coagulation caused by transfusion of artificial plasma-replacement solutions
Sinauridze E.I., Bulanov A.Y., Shcherbakova O.V., Gorbatenko A.S., Ataullakhanov F.I., Sinauridze E.I., Bulanov A.Y., Scherbakova O.V., Gorbatenko A.S., Ataullakhanov F.I.
Aim. To investigate hemostasis disorders caused by massive blood transfusions of artificial plasma replacing solutions (PRS). Material and methods. Two groups of patients were examined: 7 healthy volunteers without blood loss (group 1) and 11 healthy donors of bone marrow with intraoperative blood loss 1-2 l (group 2). Five patients of group 1 received transfusion of 12 ml/kg hydroxyethyl starch (HES) 130/0.4, two patients of group 1 received transfusion of modified gelatine solution (gelofusin). All of them received infusions (1-1.5 l) of crystalloid PRS (1-2 l) and infusion of one of colloid PRS (6-HES, 5 - gelofusin). Estimated hemodilution in group 1 was 1.17 ± 0.01 times, in group 2 it varied from 1.3 to 2.7 times (mean 1.78 ± 0.4 times). Hemostasis was studied by clot growth rate (for groups 1 and 2), endogenic thrombin potential and parameters of thromboelastography (for group 2) in plasm samples obtained before, 2.24 and 48 hours after infusion of colloid PRS. Results. For both groups spatial clot growth rate 2 hours after hemodilution was high. Then it fell and reached baseline level 48 hours after PRS infusion. Endogenic thrombin potential and thromboelastography data (for group 2) changed by the same pattern. A hypercoagulation effect of gelofusin on parameters of thromboelastography and clot growth rate was higher than of HES 130/04. Conclusion. Moderate hemodilution with PRS in vivo causes hypercoagulation which persisted longer than volemic effect of PRS.
Terapevticheskii arkhiv. 2009;(1):52-55
Some behavioral risk factors of cardiovascular diseases in middle-aged males
Akimova E.V., Kuznetsov V.A., Gafarov V.V., Gakova E.I., Smaznov V.Y., Kayumova M.M., Pushkarev G.S., Akimova E.V., Kuznetsov V.A., Gafarov V.V., Gakova E.I., Smaznov V.Y., Kayumova M.M., Pushkarev G.S.
Aim. To study prevalence and instensity of smoking in middle-aged male population of Tyumen, follow-up changes in smoking during monitoring, fat and cholesterol content in diet. Material and methods. Two cardiological screenings were performed during 5-year monitoring of Tyumen population: basic smoking study in 25-64-year old males and second screening with 24-hour diet control in the groups of 35-54 year old males. Results. Smoking prevalence in Tyumen males was moderate while intensity was high in all age groups. The proportion of males who quitted smoking was small. For 5 years the number of nonregular smokers in 45-54 year old males, of those who never smoked, hard smokers rose, while number of persons who smoked a small number of cigarettes diminished. Diet of the studied population was nonrational with mean caloric value but animal fat excess. Conclusion. The diet of the examinees contained high amount of fat, saturated fatty acids, mono- and polyunsaturated fatty acids, food cholesterol. The proportion of smokers was high.
Terapevticheskii arkhiv. 2009;(1):56-60
Family and polygenic hypercholesterolemia: similarities and differencies by long-term follow-up
Lipovetskiy B.M., Lipovetsky B.M.
Aim. Detection and analysis of similarities and differences in patients with family and polygenic hypercholesterolemia (FHCE and PHCE). Material and methods. The study included 100 patients with FHCE and 80 PHCE patients with LDLP cholesterol level at least 4.3 mmol/l (170 mg/dl). Results. The patients differed by age, gender, severity of hypercholesterolemia, clinical symptoms. Half of PHCE patients had myocardial infarction, 18% had angina pectoris, 29% cerebrovascular events. The disease was asymptomatic in 19% FHCE patients, 33% had myocardial infarction, 15% - angina pectoris, 12% - cerebrovascular events, 9% - aortic problems. Total mortality in both groups was similar - 32 and 33%. Long-term treatment with statins reduced lethality twice both in FHCE and PHCE. Adequate statin therapy prolonged life of the patients by 11 years, on the average. Conclusion. Regular treatment of patients with hypercholesterolemia reduces lethality and prolong their life span.
Terapevticheskii arkhiv. 2009;(1):61-63
Genetic determinants of cardiovascular remodeling n Urbek patients with essential hypertension
Eliseeva M.R., Srozhidinova N.Z., Khamidullaeva G.A., Abdullaeva G.Z., Eliseeva M.R., Srozhidinova N.Z., Khamidullaeva G.A., Abdullaeva G.Z.
Aim. To study distribution of the incidence of polymorphic markers of the genes ACE (I/D), ANG (M235T), AT1R (A1166C), CYP11B2 (T344C) in patients with essential hypertension (EH) of Uzbek nationality; to determine carriage of gene combinations with detection of most unfavourable combinations associated with severity of cardiovascular remodeling. Material and methods. We examined 172 Uzbek males with EH of the second-third degree, mean age 49.4 ± 7.8 years, mean duration of EH 6.5 ± 5.1 years. Polymorphism I/D, A1166C, M235T, T344C of genes ACE, AT1R, ANG, CYP11B2, respectively, was revealed in all the patients. The control group consisted of 60 Uzbek males matched by age. We performed echocardiography, duplex scanning of carotid arteries, dopplerography of the brachial artery, IEMA measurement of the level of vascular adhesion molecule VCAM-1S in blood serum, microalbuminuria in Micral-test. We isolated genome DNA, amplified polymorphic gene regions and analysed products of polymerase chain reaction. Results. Distribution of polymorphic markers of the genes ACE, CYP11B2, ANG, AT1R in EH Uzbek patients corresponds to this in Europeans. In most cases (95.4%) there was primarily combined carriage of "destroying" alleles of the genes of renin-angiotensin-aldosteron system associated with synergetic impact on development of left ventricular hypertrophy (LVH) and vascular remodeling; combination of alleles D+235T is most unfavourable in relation to severity of LVH, vasoregulatory endothelial dysfunction and is associated with the highest thickness of intima-media complex of the carotid artery. The role of 235T allele of ANG gene is most important in development of LVH. Conclusion. Severity of vasoregulatory endothelial dysfunction is associated with carriage of both 235T allele of ANG gene and 1166C allele of AT1R gene, in the latter case aggravated by significant adhesion of vascular endothelium. Progression of atherosclerotic affection of the carotid arteries is associated more with carriage of D allele of ACE gene.
Terapevticheskii arkhiv. 2009;(1):64-69
Effects of metabolic syndrome on the phenomenon of electrophysiological atrioventricular conduction curve gap in the course of programmed transesophageal pacing
Provotorov V.M., Glukhovskiy M.L., Provotorov V.M., Glukhovsky M.L.
Aim. To examine electrophysiological characteristics of the phenomenon of the atrioventricular curve gap (ACG) in patients with metabolic syndrome (MS). Material and methods. The study included patients aged over 15 years with ACG. Electrophysiological characteristics of this phenomenon were compared in 55 patients with MS (by NCEP ATP III 2001 criteria) and 47 free of MS. Patients with coronary heart disease and/or diabetes mellitus were not included. Results. MS was associated with increased gaps and their duration. Gap distribution by the curve in MS-free patients was extreme. Most gaps occurred in the zone close to effective refractory period of atrioventricular connection. In MS this phenomenon occurred along the whole curve. Conclusion. MS influences characteristics of ACG. This must be taken into consideration in conduction of electrophysiological test.
Terapevticheskii arkhiv. 2009;(1):70-71
Wolf-Parkinson-White syndrome: stratification of syncope risk factors
Abdrakhmanov A.S., Abdrakhmanov A.S.
Aim. To evaluate risk factors of syncopes in patients with Wolf-Parkinson-White syndrome (WPWS) using transesophageal pacing (TEP). Material and methods. 82 WPWS patients were divided into two groups: the study group (n = 46) with syncopes and presyncopes, the control group (n = 36) without syncopes. The groups were matched by sex and age. TEP protocol included two stages: before radiofrequency ablation (RFA) and on day 2 after RFA (control test). Results. Highly significant differences between the groups were detected only in induction of ortodromic tachycardia. In patients of the study group the cycle duration (CD) was 317 ± 38.9 ms, in the control group - 365.25 ± 96.3 ms (R = 0.003), heart rate - 197.7 ± 15.03 vs 167.3 ± 31.65 per 1 min (R = 0.003), heart rate - 197.7 ± 15.03 vs 167.3 ± 31.65 per 1 min (R = 0.0001), ventricular interval - 122.5 ± 17.5 and 153.1 ± 44.4 ms (R = 0.0001). A correlation was found between syncope risk and baseline heart rate, CD, Venkebach point, antegrade effective refractory period of additional atrioventricular connection, ventriculoatrial interval during tachycardia, WPWS manifestation, atrial fibrillation, arrhythmia history. Conclusion. The detected electrophysiological changes allow early detection of patients at high syncope risk among WPWS patients and reduction of sudden cardiac death risk in these patients.
Terapevticheskii arkhiv. 2009;(1):72-75
Correlations between bone mass density and osteoporosis risk factors in postmenopausal women
Bulgakova S.V., Davydkin I.L., Boulgakova S.V., Davydkin I.L.
Aim. To analyse correlations between bone tissue mineral density (BMD) and risk factors of osteoporosis. Material and methods. Correlation between bone mass density measured by dual-energy x-ray absorptionmetry (DEXA) and risk factors (RF) of osteoporosis (fractures in relatives, early menopause, fractures in patients, low weight and low food calcium consumption) was studied in 1115 postmenopausal women (mean age 64.24 ± 3.92). Results. A decrease of BMD with age, even without RF leads to osteopenia at the age over 70 years. The presence of almost all RF (except low calcium consumption) often combines with osteopenia, two RF - fractures in the patients, low weight - are associated with osteoporosis. Conclusion. The above correlation helps make decisions on treatment policy in outpatients.
Terapevticheskii arkhiv. 2009;(1):76-78
Hypertensive encephalopathy: problem of the therapist (cardiologist) or neurologist?
Oshchepkova E.V., Oschepkova E.V.
Terapevticheskii arkhiv. 2009;(1):79-83
Blockers of platelet glycoprotein IIb/IIIa-receptors in the treatment of acute coronary syndrome and in transcutaneous coronary interventions
Fettser D.V., Preobrazhenskiy D.V., Batyraliev T.A., Sidorenko B.A., Aytach V., Fettser D.V., Preobrazhensky D.V., Batyraliev T.A., Sidorenko B.A., Aitach V.
Terapevticheskii arkhiv. 2009;(1):84-86
The role of parathyroid hormone in regulation of homeostasis of bone and hemopoietic tissues
Svinareva D.A., Svinareva D.A.
Terapevticheskii arkhiv. 2009;(1):87-90

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