Vol 79, No 11 (2004)
- Year: 2004
- Articles: 26
- URL: https://journals.rcsi.science/0040-3660/issue/view/1700
Editorial
Bene diagnoscitur, dene curator
Terapevticheskii arkhiv. 2004;79(11):5-9
5-9
Potentialities of non-invasive diagnosis of coronary arteriesanomalies by means of electron-beam tomography and multislice computed tomography
Abstract
Aim. To assess diagnostic value of electron-beam computed tomography and multislice computed tomography
(EBT and MSCT) for diagnosis of congenital anomalies of coronary arteries (CA).
Material and methods. Non-invasive coronary angiography with EBT and MSCT has been performed
in 1162 patients.
Results. Different anomalies of coronary arteries have been found in 10 (0.9%) patients. Results of
EBT and MSCT agreed with those of coronary angiography performed in 8 cases with CA anomalies.
Though 720 of 1162 patients had coronary stenoses, no significant atherosclerotic lesions were found
in anomalous CA.
Conclusion. EBT and MSCT enable non-invasive screening and diagnosis of coronary arteries anomalies.
Terapevticheskii arkhiv. 2004;79(11):9-14
9-14
Diagnosis of coronary atherosclerosis using stress echocardiography with bicycle exercise
Abstract
Aim. To determine sensitivity and specificity of stress echocardiography (SEC) in diagnosis of stenosing
atherosclerosis of coronary arteries (CA), especially in patients recovered from Q-myocardial infarction.
Material and methods. The above sensitivity and specificity were studied in 75 patients (70 males and
5 females; mean age 53.7 ± 7 years) with coronary atherosclerosis (CS).
Results. The sensitivity of impaired local contractility index (IL CI) in univessel lesion was 77.8%, in
multivessel lesion - 90.4%, specificity - 85.7%. Sensitivity of other parameters studied was for development
of an anginal episode 65.4%, increment of ejection fraction under 5% - 63.9%, increased
end systolic volume - 61.1 %, depression of ST segment - 48.1 %, increased end diastolic volume
38.9%. A total of 3 parameters had 100% sensitivity: impossible a > 5% rise of EF in response to exercise,
an increase of end systolic and diastolic volumes, anginal attack (85.7%), ST depression
(78.6%).
Conclusion. Hemodynamic parameters must be assessed in the course of SECG for objectiviiation of
the result and improvement of its specificity.
Terapevticheskii arkhiv. 2004;79(11):14-19
14-19
Diagnosis of myocardialinfarction complicated by a complete block of His' bundleleft branch as shown by computed electrocardiotopography
Abstract
Aim. To assess efficacy of computed electrocardiotopography (CECT) in diagnosis of myocardial infarction (MI)
complicated by a complete block of His' bundle left branch (HBLB).
Material and methods. Twenty two patients with a complete block of HBLB have undergone CECT
(hardware Rhythm-M, software "Rhythm"and "Heart").
Results. Five patients had no scars. The rest 17 patients had MI. The diagnosis of MI was definite by
ECG in 6(35%) patients. In 11 (65%) patients MI diagnosis by ECG was doubtful. Only CECT detected
typical for MI changes in the QRS changes.
Conclusion. CECT can significantly detect scars in the myocardium in a complete block of HBLB and
improves diagnostic potential of ECG.
Terapevticheskii arkhiv. 2004;79(11):17-23
17-23
Long-term orthostatic and bicycle exercise tests in differential diagnosis of syncopal conditions of unclear origin
Abstract
Aim. To study efficiency of bicycle exercise test and long-term orthostatic test in differential diagnosis
of syncopes.
Material and methods. The study included 113 patients suffering from recurrent syncopes of unclear
origin. Twelve healthy volunteers were selected for assessment of the tests specificity. All the patients
and controls were examined by means of long-term orthostatic test (LTOT) and bicycle exercise test
(BET).
Results. Specificity of both tests was 100%,. In LTOT syncopes were observed in 52(46%) cases, including
vasovagal syncopes (51 patients), epileptic seizure (1 patient). BET induced vasovagal syncopes
in 54(48%) patients. The results of both tests by inducing syncopes coincided in 30 (26%) cases.
In 24(21%o) patients syncopes occurred only in BET while LTOT appeared uninformative. In 21
(18.6%) cases syncopes occurred only in LTOT while BET produced a negative result. 38 (34%) patients
had syncopes neither in LTOT nor BET. Both tests induced syncopes in 75 (66%) patients. No
complications were observed.
Conclusion. LTOT and BET are safe and complementary methods in differential diagnosis of syncopes.
Terapevticheskii arkhiv. 2004;79(11):23-27
23-27
Clinical features and diagnosis of congenital stenosis of the pulmonary artery and right ventricularoutlet tract
Abstract
Aim. To analyse clinical manifestations of congenital pulmonary artery stenosis (CPAS) and right
ventricular outlet stenosis (RVOS), development of its diagnosis depending on anatomic variants of
heart disease.
Material and methods. The data on 539 patients examined with conventional clinical and highly in-
formative novel techniques were studied.
Results. The analysis of the CPAS and RVOS clinical picture depending on the anatomic variant of
the heart disease has shown that clinical symptomatology was of the same type. The data of the tests
have some specific features allowing identification of some forms of the heart disease.
Conclusion. Diagnostic and prognostic significance of the findings was determined which gave rise to
an optimal examination scheme with focus on wider use of highly informative techniques.
Terapevticheskii arkhiv. 2004;79(11):27-30
27-30
Blood leukocytosis as an indicator of risk ofischemic heart disease and its exacerbations (review)
Terapevticheskii arkhiv. 2004;79(11):30-35
30-35
Arterial hypertension in adolescents with different physical constitution including those with signs of metabolic syndrome
Abstract
Aim. Detection of clinico-paraclinical features of arterial hypertension (AH) in adolescents with different
physical constitution including signs of metabolic syndrome (MS).
Material and methods. Blood levels of uric acid, cholesterol, triglycerides (TG), high and low density
lipoproteins were examined and glucose tolerance test was made in 108 adolescents with arterial hypertension
(AH) and different physical constitution (normal, with overweight and obese). Waist and
hip distribution of fat was assessed. The control group consisted of JOS healthy adolescents.
Results. Most of the hypertensive children had hyperuricemia (HU), some of the patients combined
HU with changes in glycemic profde of blood. The above abnormalities were especially evident in patients
with MS who were characterized by abdominal obesity, higher blood pressure, subnormal high
density lipoproteins, higher triglycerides and total cholesterol in blood, more severe HU and defects in
glycemic profde of blood.
Conclusion. MS in adolescents may be of genetic origin as well as constitutional HU and insulin resistance
may be mutually dependent signs combination of which with other factors presents the whole
spectrum of clinical and paraclinical manifestations of MS. Detection of HU and insulin resistance
with their correction in a preclinical disease stage (in children and adolescents) may represent a new
line in prevention of AH and MS in adults.
Terapevticheskii arkhiv. 2004;79(11):35-42
35-42
Lisinopril effects on cerebral blood flow and blood rheology in hypertensive patients
Abstract
Aim. To access the effect of lisinopril (diroton) on cerebral circulation and blood rheology in patients
with arterial hypertension stage II.
Material and methods. The trial included 37 patients (16 males, 21 females) with a mean arterial
hypertension (AH) history 15.9 ± 5.6 years. Diroton was given in a dose 10-40mg/dayfor 6 months.
Cerebral circulation (total cerebral circulation and venous outflow - TCC and VOF) was accessed by
means of doppler ultrasonography. Blood and plasm rheology was determined using a rotational viscozymeter ACP-2.
Instrumental tests were performed at baseline and at the end of the study.
Results. Rheology tests showed that diroton-treated patients achieved a significant decrease in blood
viscosity in high, moderate and low shear stress and plasma viscosity, a decrease in platelet aggregation
index and an increase in the index of erythrocytic deformability. All these changes were accompanied
with a significant fall in fibrinogen and hematocrit. Doppler ultrasound revealed an insignificant
increase in TCC and VOF.
Conclusion. Diroton significantly improved impaired blood rheology and viscosity in AH patients as
well as cerebral hemodynamics in patients with subnormal cerebral circulation and venous outflow at
baseline.
Terapevticheskii arkhiv. 2004;79(11):41-43
41-43
Exacerbated chronic obstructive pulmonary disease: current trends in diagnosis and treatment (review)
Terapevticheskii arkhiv. 2004;79(11):42-51
42-51
Levofloxacin: role and place in the treatment of infections of the lower respiratorytracts
Terapevticheskii arkhiv. 2004;79(11):51-57
51-57
How to diagnose functional (non-ulcerative) dyspepsia (a review)
Terapevticheskii arkhiv. 2004;79(11):57-61
57-61
Humoral and cellular adaptation mechanisms in development of intoxication syndrome in patients with acute viral hepatitis
Abstract
Aim. To study endotoxin-binding function of blood in patients with acute viral hepatitis (AVH) in the
course of the disease.
Material and methods. A total of 335 patients with AVH were examined. The titers of IgG antiendotoxin
antibodies to glycolipid of Re-chemotype were estimated in enzyme immunoassay (Diaendotox-2
kit), endotoxin-binding activity (EBA) of high density lipoproteins (HDLP) in EIA with the kit
Liprobind (Microecos). The number of polymorphonuclear leukocytes (PL) binding lipopolysaccharides
were counted by M. Yu. Yakovlev et al. method.
For detection of PL binding endotoxin of gram-negative bacteria, kits Endim (Microecos) were used,
beta2-microglobulin was estimated by a radioimmunoassay using kits made in Belarus Institute of
Bioorganic Chemistry. Registration of chemoluminescence was conducted on chemiluminometer LBK
1251 (Finland) by M. Wilson (1985) method.
Results. In moderate AVH at the height of intoxication a low Re-antibodies level was recorded irrespective
of the disease etiology. To convalescence this level went up. PL reserves in AVH patients were
low except patients with AVH С who had unaffected neutrophil reverves in relation to LPS binding. At
the height of AVH, HDLP EBA was very high in all the groups with normalization to convalescence.
In VHC high HDLP EBA persisted as long as the disease course. A significant rise of beta2-microglobulin
was seen in all the groups of AVH patients, its severity correlating with the degree of the
disease severity.
Conclusion. One of the leading factors in development of indoxication in AVH patients is a lipopolysaccharide
complex of gram-negative intestinal bacteria actively coming into blood flow due to hepatocyte
cytolysis. In response to LPS action there appeared a stereotypic adaptation complex of reactions
in the form of activation of cellular and humoral immune response.
Terapevticheskii arkhiv. 2004;79(11):61-65
61-65
Invasive streptococcal (group A) infection : outlook on the problem (review)
Terapevticheskii arkhiv. 2004;79(11):65-68
65-68
Combined antiretroviral therapy with nevirapine of HIV-infected adults
Terapevticheskii arkhiv. 2004;79(11):68-71
68-71
Antiphospholipid syndrome and exogenic factors ofthromboses risk
Abstract
Aim. To examine relationships between incidence rate of thromboses in antiphopholipid syndrome and
exogenic risk factors (RF) of thrombosis.
Material and methods. The trial enrolled 131 patients (105 females and 26 males). They were divided
into three groups: 23 patients with systemic lupus erythematosus (SLE, group 1), 63 patients with
SLE and antiphospholipid syndrome (APS, group 2), 45 patients with primary APS (PAPS, group 3).
Thrombosis RF questionnaire survey was made. Effects of corticosteroids and cyclophosphamide on
occurrence of thrombosis were assessed.
Results. Such exogenic RF as intake of coffee, fat food, alcohol were not related to thromboses. Hypodynamia
was more typical for APS patients (21.3%) than for SLE patients free of APS (8.7%). Overweight
for was characteristic for APS patients (49 and 34.7%, respectively). The proportion of smokers
was higher in APS patients, though smoking did not provoke thrombotic complications. A direct correlation
was found between occlusion and corticosteroids administration, while occlusion and cyclophosphamide
treatment correlated inversely.
Conclusion. Venous thrombosis RF in patients with APS and PAPS are obesity and treatment with
glucocorticosteroids
Terapevticheskii arkhiv. 2004;79(11):71-74
71-74
Immunological features of rheumatoid arthritis in patients infected withviruses of hepatitis В, С and cryoglobulinemia
Abstract
Aim. To specify immunological features of rheumatoid arthritis (RA) associated with hepatitis В, С viruses
(HBV, HCV) and cryoglobulinemia (CGE).
Material and methods. Four groups of patients with verified RA were examined immunologically: infected
with HCV, infected with HBV, with CGE diagnosed by the capillary method, free of HBV,
HCV, CGE. CGE was estimated by the spectrophotometry method, functional activity of the complement
components - by hemolytic micromethod. Polymerase chain reaction, identification of serological
markers of viral hepatitides В and С were conducted with application of commercial kits produced
in Russia
Results. In RA patients infected with HBV and HCV, functional activity of the complement was significantly
reduced. RA patients with hepatitis С and CGE showed hypoactivity of all the complement
components. A classic course of RA was associated with elevated levels of CI and C3 components in
normal values of Clq, C2, C4 and C5 components. CGE was highest in RA+HCV and RA+CGE
groups.
Conclusion. The study of immunological features of RA associated with HCV, HBV and CGE is important
not only in scientific but also in practical aspect as it indicates the necessity of treating the
above conditions with drugs which do not suppress complement system significantly.
Terapevticheskii arkhiv. 2004;79(11):74-77
74-77
Polymorphism ofclinical symptoms of connective tissue dysplasia syndrome
Terapevticheskii arkhiv. 2004;79(11):77-80
77-80
80-83
Genital prolapse in women and articular hypermobility in connective tissue dysplasia
Abstract
Aim. To examine relationships between genital prolapse and joint hypermobility (JHM), between GP
severity and degree of JHM, to reveal causes of GP in JHM patients.
Material and methods. A total of 208 females with GP (meam age 38.9 years) entered the trial. They
were divided into three groups by severity of connective tissue dysplasia (CTD): with mild CTD -16.3%,
moderate CTD - 35.6% and severe CTD - 48.1%. The following methods of investigation
were used: podometric Freedland's technique, ultrasonic investigation of the gall bladder, kidneys,
echocardiography, morphological study of platelets, morphological and immunohistochemical study of
the ligaments.
Results. In GP patients JHM occurred in 41.8% patients. Hypermobility of large joints reaches
38.9%, large - 20.7%. Such associated manifestations of CTD as flatfoot, JHM, deformation of the
spine, varicosity, predisposition to vegetovascular dysfunctions, mitral prolapse, arrhythmia, impaired
conduction, refraction, gastroptosis, nephroptosis, hernias were observed in 69.2, 46.1, 38, 53.8, 49,
43.3, 38, 19.2, 12, 6.7, 14.4%, respectively. The morphological changes are explained by 40 + 15%
type 1-3 collagen loss in the interstitial substance. Severe forms of GP in patients with JHM were ob-
served in 84%. 52.4% females with JHM developed severe GP within 3 years after delivery of a child.
Most of the examinees carried undifferentiated congenital dysplasias.
Conclusion. JHM is a criterion of CTD diagnosis
Terapevticheskii arkhiv. 2004;79(11):83-88
83-88
Vitrum osteomag in prevention of osteoporosis inpostmenopausal women: results of the comparative openmulticenter trial
Abstract
Aim. To investigate efficacy, tolerance and safety of the drug vitrum osteomag one tablet of which contains
600 mg calcium (1500 mg calcium carbonate), 200IU of cholecalcepherol, 40 mg of magnesium,
zinc (7.5 mg), copper (1 mg), manganese (1.8 mg) and boron (250 meg) in women with osteopenia for
prevention of osteoporosis
Material and methods. Л multicenter comparative open trial ofvitrum osteomag influence on mineral
bone density (MED), change of pain syndrome in bones, index of calcium-phosphorous metabolism
covered 334 postmenopausal women with osteopenia. MBD was measured in low-back spine and proximal
part of the hip with DEXA method. All the patients were divided into 3 groups: 125 women taking
2 tablets ofvitrum osteomag daily for 12 months (group 1); 111 women taking 1500 mg calcium carbonate
(group 2); 96 women - control group (only observation).
Results. Vitrum osteomag relieved pain in the back and joints, had a positive effect on bone density
(+1.5%) and proximal parts of the hip (0.6-0.93%) exceeding the effect of calcium carbonate only
which preserves the initial MBD in low back spine but does not prevent bone loss in the hip. MBD dynamics
in patients given vitrum osteomag differs essentially from one in the control group (from -1.9
to -2.91%) which demonstrates a reliable preventive anti-osteoporotic effect of this medication. The
drug increases the level of general and ionized calcium in blood but does not cause hypercalcemia
lowering the level of parathormone in blood. The rate of side effects in group 1 was 14,4% and did not
differ much from that in group 2 (16.2%).
Conclusion. The results of the study allow to recommend vitrum osteomag for prophylaxis of a rapid
loss of bone tissue mineral density.
Terapevticheskii arkhiv. 2004;79(11):88-93
88-93
Structum therapy of patients with rheumatoid arthri-tis
Abstract
Aim. To study efficacy of the chondroprotector chondroitin sulphate (structum, Pier Fabr Medicament
Production, France) in patients with rheumatoid arthritis (RA) and secondary osteoarthrosis of the
knee joints.
Material and methods. 15 women with a long history of RA (mean duration 11.9 years) entered an
open non-randomized trial of structum. The patients had a severe progressive highly active RA with a
definite x-ray stage of the disease. 13 patients had a positive rheumatoid factor (1:80 to 1:1280) and
involved knee joints which had been affected for 1 to 10 years (mean 5.3 years). The second x-ray
stage was in 8 patients, the third stage of knee joints arthrosis was in 7 ones. A marked pain syndrome
in the knee joints upon movement (mean 64.7 mm by VAS) was observed in all the examinees and at
rest (mean 28 mm by VAS) in 13 of 15 patients. Structum was given according to a standard scheme:
500 mg 3 times a day for 3 weeks than 500 mg 2 times a day for up to 6 months. Basic drugs for RA
were the same for all the observation period.
Results. Structum noticeably improved knee joint function (mean Leken's index 12.8, 11.3 and 9.4
scores before the treatment, on treatment month 3 and 6. Movement pain syndrome VAS reduced from
64.7 mm at the strart to 51 mm 3 months and 37.5 mm 6 months later, rest VAS - from 19 to 10.3
and 6.4 mm, respectively. The demand in intraarticular glucocorticoids went down from 52 injections
at the start of therapy to 6 after 6 months. Side effects for 6 months were absent. Overall efficacy was
good (73.3% and 80%) as judged by the doctors and patients, respectively. After 6 months of therapy
control x-rays found no progression of destructive changes in the knee joints (by MRI - in 4 patients).
Conclusion. Structum has a marked positive therapeutic effect in patients with severe and long-term
course of RA with associated pronounced secondary joint arthrosis.
Terapevticheskii arkhiv. 2004;79(11):93-95
93-95
Characteristics of erythropoiesis regulation in population living at high altitude
Abstract
Aim. To study characteristics of iron deficiency anemia (IDA) in native population of high altitude
territories.
Material and methods. 1300 women living in Tien-Shan areas were examined for serum and erythrocytic
ferritins (SF and EF), general iron-binding capacity of the serum, transferrin saturation with
iron, transferrin, soluble transferrin receptor (TR), erythropoietin (EP), Hb, erythrocytes, erythrocytic
indices.
Results. Regulation of erythropoiesis in women living at high altitude is specific, i.e. disagreement between
complete depletion of iron (by SF and EF) and normal level of Hb, erythrocytes, EP and TR.
Conclusion. It is suggested that in population living at high altitudes (3000 m above the sea level and
higher) long-term adaptation to hypoxia gave rise to an original mechanism of erythropoiesis regulation
when all coming iron participates in hemoglobin synthesis without iron deposition. Under hypoxic
hypoxia regulation of erythropoiesis is directed to prevention of tissue hypoxia.
Terapevticheskii arkhiv. 2004;79(11):95-97
95-97
Hypomagnesemia in patients with chronic alcoholism in thecourse of alcohol withdrawal syndrome
Abstract
Aim. To ascertain hypomagnesemia (HM) rate in patients with chronic alcoholism (CA) with alcohol
withdrawal syndrome (AWS); correlation between AWS severity and HM rate.
Material and methods. Mg in plasm was measured at photometry in 129 CA patients treated in Kaunas
Mental Hospital.
Results. Plasma Mg in CA patients with A WS was reduced (< 0.749 mmol/l), normal (0.750-1.250
mmol/l) or high (> 1.251 mmol/l) in 28.7, 65.1 and 6.2% patients, respectively. HM was diagnosed
in 42.3% with a severe, 19.1% with a moderate and 20.0% with weak AWS.
Conclusion. HM in AWS was registered in 28.7% patients. It occurred significantly more frequently
(p < 0.05) in patients with a severe AWS. Pathogenetic mechanisms of HM in AWS are described
Terapevticheskii arkhiv. 2004;79(11):97-99
97-99
Iatrogeny: role of E. M. Tareev and hisschool in updated understanding of the problem
Terapevticheskii arkhiv. 2004;79(11):99-103
99-103
Forum of Russian Infectiologists
Terapevticheskii arkhiv. 2004;79(11):103-104
103-104