Vol 79, No 12 (2004)
- Year: 2004
- Articles: 27
- URL: https://journals.rcsi.science/0040-3660/issue/view/1701
Editorial
Immune system and gastrointestinal diseases
Terapevticheskii arkhiv. 2004;79(12):5-9
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Psychovegetative aspects of mechanic failure of the cardiac muscle in an acute period oftransmural myocardial infarction
Abstract
Aim. To study psychoemotional, typological personality characteristics and vegetative status of patients
with mechanical complications of acute transmural myocardial infarction (Ml).
Material and methods. 107patients with acute transmural Ml were divided into three groups depending
on the kind of mechanical myocardial failure (MMF) or its absence. The control group consisted
of 20 healthy patients. The patients were examined for psychoemotional and typological features of
personality and vegetative tone.
Results. Introverts were prevalent among Ml patients with MMF. A psychological picture of the examinees
was made. The study group patients displayed vegetative dysfunction syndrome. A cognitive component
of high anxiety in patients with postinfarction MMF was specified.
Conclusion. A cognitive component of anxiety in patients with acute transmural MI and MMF differs
from that of patients with an uncomplicated course of the disease being hardly responsive to conventional
therapy. Somatic component of anxiety in such patients manifests with vegetative dysfunction
syndrome and demands prescription of beta-adrenoblockers as early as possible.
Terapevticheskii arkhiv. 2004;79(12):9-12
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Assessment of myocardial viability and recovery ofthe left ventricular function in postmyocardial infarction patients
Abstract
Aim. To evaluate prognostic significance of myocardial viability (MV) depending on treatment policy
in postmyocardial infarction (PMI) patients.
Material and methods. The study included 196 patients (172 males, 24 females, age 30-75, mean
age 53 ± 8.6 years). Standard stress dobutamine echocardiography was made 14 ± 6 days (8-21
days) after macrofocal MI. Reperfusion therapy was made in 138 (70%) patients. X-ray contrast coronary
angiography was performed in all the patients as the criterion of the immediate effect of reperfusion
was achievement of residual stenosis of Ml-related coronary artery < 50%. Late after Ml
(18 ± 7 months after Ml) a comparative analysis of the left ventricular function was made in three
groups of patients depending on the clinical response to the treatment. MV criterion was based on a
fall in the index of infarction zone wall movement (IZWM) under low-dose dobutamine stress test reflecting
contractile reserve of the infarction zone (CR). Left ventricular function recovery was judged
by a decrease in initial IZWM index 18 months later vs the initial IZWM 14 days later. Thus contractile
reversibility of the infarction zone (CRIZ) was determined. LV function was also assessed by
the index of left ventricular end diastolic volume (L VED V), by the index of left ventricular end systolic
volume (LVESV), left ventricular ejection fraction (LVEF).
Results. 18 months after MI, CRIZ was higher in group 1 (after effective reperfusion) and group 3 (after
myocardial revascularization) compared to group 2 (medication only): 0.33 ± 0.01, 0.39 ± 0.02
and 0.23 ± 0.01, respectively. LVEDV and LVESV in group 1 and 3 diminished while LVEF increased.
LVEDV in group 2 remained elevated though EF rose considerably.
Conclusion. Recovery of LV contractile function depends much on reestablishment of adequate myocardial
perfusion by reperfusion therapy or myocardial revascularization. Chronic myocardial hypoperfusion
leads to LV remodeling. CRIZ proved a significant prognostic criterion of the IZWM index 18
months after MI only in patients given effective reperfusion therapy.
Terapevticheskii arkhiv. 2004;79(12):12-17
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Effects of exercise on markers of hemostatic activation inyoung survivors of myocardial infarction
Abstract
Aim. To study the effect of exercise on markers of endothelial impairment, platelet activation,
thrombin formation, fibrinolysis in patients who survived myocardial infarction (MI) at young age.
Material and methods. The levels of fibrinogen (F), Willebrand factor (WF), beta-thromboglobulin
(BTG), fragment 1+2 of prothrombin activation (F 1+2), antigen of tissue plasminogen activator
(TPA), D-dimer at rest as well as BTG, F 1 = 2, WF, TPA antigen and its activity in treadmill test
(TT) were compared in 25 patients younger than 35 years who survived Q-myocardial infarction (Q-MI) > 6
months before (group 1), 10 of whom had unaffected or little affected coronary arteries as
shown by coronaroangiography (subgroup Ш) while 15 had stenosing coronary atherosclerosis (subgroup 1A);
in 20 patients who had Q-MI at the age of 40-55 years (group 2); in 10 healthy patients
under 35 years of age (group 3).
Results. Initial concentrations of F, F 1 + 2 and TPA antigen were significantly higher than in
healthy subjects. F and TPA antigen were higher in subgroup 1A than in subgroup 1H. D-dimer was
higher in group 2 vs 1. TT raised concentration of BTG in all the groups, induced a stable trend of F
1+2 rise in patients of subgroup IE (p = 0.059), raised WF only in group 3, TPA antigen at peak
stress in all the patients being in group 1 higher than in healthy controls and in subgroup 1A than in
subgroup 1H. TPA antigen was more active at the peak stress in group 1 than in group 2 but the differences
became insignificant in analyzing only patients who reached submaximal load by heart rate.
Conclusion. Stenosing coronary atherosclerosis in patients after MI at young age is associated with
high F and TPA levels. Elevated F 1+2 was registered at exercise test in young patients free of coronary
obstruction. TPA levels were raised higher by exercise in patients with stenosing atherosclerosis of
the coronary arteries. TPA activity induced by exercise depended more on exercise intensity than on
the age of the patients.
Terapevticheskii arkhiv. 2004;79(12):17-23
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A clinical courseof coronary heart disease after pacemaker implantation andoptimization of the pacing regime
Abstract
Aim. To study effects of pacemaker implantation on the course of coronary heart disease (CHD) with
stable angina pectoris and choice of optimal regimen of pacing.
Material and methods. A total of 154 CHD patients with a pacemaker were examined. All the patients
had angina of effort of functional class 11-IV.
Results. The symptoms of the disease improved in 72 (46.8%) patients (group I): the number of anginal
attacks decreased, exercise tolerance increased, the dose of antianginal medicines went down.
Pain attacks became more frequent, response to nitroglycerin changed in 30 (19.5%) patients of group
2. This was explained by 1.5-2-fold enhancement of heart rate by pacemaker raising myocardial oxygen
consumption and psychocardial syndrome. In 52 (33.8%) patients of group 3 anginal attacks
characteristics did not change.
Conclusion. To optimize coronary reserve, frequency of electroimpulses must be reprogrammed to adjust
to afunctional class of angina and chronic cardiac failure as well as pacing regime. In particular,
low coronary reserve demands optimal frequency of 55-65 imp/min while congenital cardiac failure -75-85 imp/min.
Terapevticheskii arkhiv. 2004;79(12):23-27
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The role of hypersympathycotony in development of arterial hypertensionin patients with metabolic syndrome: potential of pathogenetically sound therapy
Abstract
Aim. To assess hypotensive efficacy and metabolic neutrality of moxonidine (physiotenz) - a selective
agonist of imidasoline receptors - in patients with mild and moderate arterial hypertension (AH) associated
with diabetes mellitus (DM) type 2.
Material and methods. Follow-up and treatment were conducted in 30 hypertensive diabetics (mean
age 52.43 ± 4.65 years). Mean duration of DM and AH was 4.77 ± 2.69 and 6.93 ± 2.98 years, respectively.
The study was made of lipid exchange, glycemia, levels of glycosylated hemoglobin (GH),
fasting and postprandial immunoreactive insulin. Hypotensive efficacy was examined by 24-h monitoring
of arterial pressure after 16 weeks of therapy.
Results. Mean 24-h systolic arterial pressure fell by 8.02%, diastolic arterial pressure - by 6.47%.
The drug had a good effect on a 24-h profile of arterial pressure: a significant decrease of day and
night pressure load index, lowering of initially high 24-h variability of systolic and diastolic arterial
pressure, normalization of two-phase profile of arterial pressure. Carbohydrate metabolism improved
also: GH, glycemia, immunoreactive insulin decreased. There was a significant trend to a change in
qualitative composition of blood lipids - a decrease in lipoproteins atherogenic fractions and a rise in
HDLP.
Conclusion. Physiotens is a highly effective hypotensive drug for use in mild and moderate AH in DM
of type 2.
Terapevticheskii arkhiv. 2004;79(12):27-32
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Practical prevention and treatment of cardiovascular diseases in patients with diabetesmellitus type 2 in an endocrinological department
Abstract
Aim. To analyse retrospectively quality of medical correction of modified risk factors (RF) and treatment
of cardiovascular diseases (CVD) in patients with diabetes mellitus type (DM) 2 admitted to specialized
endocrinological departments.
Material and methods. Analysis of medication policy of CVD RF was made retrospectively for 250
patients treated in endocrinological departments of Moscow hospital in 2003.
Results. Arterial hypertension, coronary heart disease were diagnosed in 93.2 and 87.2% examinees.
History of myocardial infarction and brain stroke was in 8.4 and 6% patients. Statins were prescribed
in 2.4% cases. Examination for dyslipidemia was not satisfactory. ACE inhibitors were prescribed in
71.2% patients. Aspirin was prescribed (18%) primarily by the cardiologist.
Conclusion. Quality of medical prophylaxis of CVD RF in DM type 2 patients in the departments does
not satisfy modern clinical recommendations.
Terapevticheskii arkhiv. 2004;79(12):32-36
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Carotid atherosclerosis detectability in patients with coronary heart diseaseand arterial hypertension
Abstract
Aim. To assess detectability of carotid atherosclerosis in patients with coronary heart disease (CHD)
and arterial hypertension (AH) by the data of ultrasonic screening, to study location and detectability
of atherosclerotic lesion of common carotid arteries, internal carotid arteries, external carotid arteries
in correlation with basic disease.
Material and methods. Ultrasonic screening of brachyocephalic arteries was made in 469 patients:
with CHD (n = 239), AH (n = 230) including patients with concomitant postinfarction cardiosclerosis
(PICS) and moderate chronic cerebrovascular failure (CCVF).
Results. Ultrasonic angiography detected atherosclerotic carodid artery lesion in patients with CHD
and PICS (81.6%) or CCVF (76.9%) or angina pectoris (64.2%). In hypertension subjects carotid artery
atherosclerosis was encountered in 28.1%.
Conclusion. It is justified to make ultrasonography of carotid arteries in all patients with CHD and
AH irrespective of age, gender, underlying clinical diagnosis
Terapevticheskii arkhiv. 2004;79(12):36-39
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Vasoregulating activity of the endothelium and pulmonary hypertension
Abstract
Aim. To examine vasoregulating endothelial activity in patients with bronchial asthma (BA) with pulmonary
hypertension (PH) and free of PH.
Material and methods. A total of 62 BA patients aged between 19 and 52 entered the trial. They were
divided into two groups: 44 with PH and 18 free of it. The control group consisted of 35 healthy sub-
jects. Vasoregulating activity of the vascular wall was studied by tests with reactive hyperemia (endothelium-dependent
dilation) and 0.05 mg nitroglycerin (endothetium-dependent dilation).
Results. It was found that BA patients with PH have a dilated brachial artery, abnormal endotheliumdependent
vasodilation of the brachial artery. The artery is low sensitive to shift tension. These changes
in functional activity of brachial artery endothelium in BA patients with PH are associated with impaired
pulmonary hemodynamics, right ventricular diastolic dunction.
Terapevticheskii arkhiv. 2004;79(12):39-44
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Echocardiography - prognosis of the course of infectious endocarditisand long-term survival in this disease
Abstract
Aim. To determine prognostic opportunities of echocardiography (ECG) in infectious endocarditis (IE)
basing on the assessment of microbial vegetations size and degree of valvular failure.
Material and methods. Of 114 patients with definite IE (72 male, 42 female), 90 ones had primary
and 24 secondary endocarditis. The prospective study included all the survivors in the IE active stage -78 patients.
Results. Vegetations > 1 cm in size were detected in 50.8%patients, < 1 cm - in 49.2%. Hospital lethality
in vegetations > 1 cm and < 1 cm was 25.8 and 16.1%, respectively. Thromboembolism rate
was 81 and 64.2%, respectively. One-year survival was 78.7 and 71.4%, two-year survival 66.5 and
61.7%, three-year survival 66.5 and 49.4%, five-year survival - 51.7 and 32.9% in vegetations < 1
cm and > 1 cm, respectively. Valvular regurgitation of the first degree was in 17.5%, of the second degree - in 41.9%,
thirdfourth degree - in 36.6% patients. Hospital lethality in mitral valve failure
was 32.1%, in aortic and tricuspid failure - 17.8 and 11.4%, respectively.
Conclusion. EchoCG was most effective for predicting thromboembolism and cardiac failure. Valvular
regurgitation of the third-fourth degree significantly correlates with severe cardiac failure. ECG is less
informative for predicting hospital lethality.
Terapevticheskii arkhiv. 2004;79(12):44-48
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Clinical response to "Gincor-Fort" in the treatment of chronic venous insufficiency invaricosity
Abstract
Aim. Assessment of clinical efficacy and tolerance of the drug Ginkor-Fort in patients with chronic venous
insufficiency (CVI) in varicosity in compensation stage.
Material and methods. Thirty patients with compensated CVI free of trophic ulcers of the legs received
Ginkor-Fort 1 capsule twice a day for one month. The efficacy of the drug was assessed by subjective
appraisal of the patients, physical examination data and results of repeated measurements of
the leg at the malleolus level.
Results. A course of Ginkor Fort produced a considerable improvement in 27 (90%) patients. Improvement
of the condition occurred in 3 (10%) patients. Side effects were absent, the treatment was
well tolerated. All the patients completed a one-month Ginkor-Fort course.
Conclusion. Ginkor Fort is a highly effective and safe flebotonic drug. Its high anti-inflammatory, anesthetic,
lymphodraining and flebotonic effects noticeably and rapidly raise life quality of patients with
varicosity.
Terapevticheskii arkhiv. 2004;79(12):48-51
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Bronchoobstructive syndrome in bronchoectasias
Abstract
Aim. To specify mechanisms of bronchial obstruction in bronchoectasia (BE).
Material and methods. Clinical, x-ray, bronchological and spirographic examinations with broncholytic test
were made in 26 BE patients aged 16-66 years (14 males, 12 females). The membrane-receptor
complex of erythrocytes was based on the effect of adrenoantagonist propranolol on osmotic
erythrocytic resistance (obsidan test) and effect of adrenoagonist adrenalin on dynamics of ESR.
Results. Allergological anamnesis was detected in 69% of BE patients, hereditary atlergological anamnesis - in 22%,
membrane-receptor changes characteristic for atopic condition by obsidan test - in
46%, fractional erythrocytic sedimentation with adrenalin - in 42%. Bronchoobstruction syndrome
occurred in 37% cases with mean values FEV1 46 ± 6.2%, MSVS0 17.4 ± 3%, MSV75 14.4 ± 0.9%.
The broncholytic test detected a mean increment of FEV, by 12.2 ± 3.1%. Latent bronchospasm was
revealed in 33% patients with BE.
Conclusion. The correlation analysis suggests that among mechanisms of bronchial obstruction in
bronchoectasia, bronchospasm is of great importance especially in allergological anamnesis pathogene-
sis of which involves disorders of membrane-receptor complex.
Terapevticheskii arkhiv. 2004;79(12):51-53
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Phenomenon of hyperexpression of rybosomiccistrons in bone marrow hemopoietic elements in bronchialasthma
Abstract
Aim. To study expression of ribosomic cistrons (RC) of bone marrow hemopoietic elements (BMHE) in
bronchial asthma (BA).
Material and methods. A total of 37 bronchial asthma (BA) patients were examined. Of them, 20
ones had allergic BA (ABA) and 10 - nonallergic BA (NABA). Seven patients received systemic glucocorticoid
hormones (SGH). Control included cells of bone marrow from 7 healthy donors. Transcription
and maturation of pre-rRNA in BMHE were analysed using bone marrow samples obtained
during the sternal puncture (a modified method of Howell and Black).
Results. RC activity was high. It depended on BA variant and the disease phase. In ABA high RC activity
persisted in remission. GCH suppress RC activity rise. The maximal effect of GCH suppressive
action was seen in myeloid lineage, minimal - in erythroid one. The effect is absent in more mature
erythroid cells and bone marrow lymphocytes.
Conclusion. The phenomenon of RC activity rise in myeloid, erythroid and lymphoid lineages of the
bone marrow of BA patients may reflect contribution of the bone marrow to formation of BA pathogenesis.
Terapevticheskii arkhiv. 2004;79(12):53-58
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Endothelium and platelets in pregnant women with chronicglomerulonephritis and therapeutic efficacy of acetylsalicylicacid and dipiridamol
Abstract
Aim. To estimate platelet and endothelial condition in pregnant women with chronic glomerulonephritis (CGN),
prognostic value of these changes and efficacy of acetylsalicylic acid (ASA) and dipiridamol
in prevention of unfavourable outcomes of pregnancy in CGN.
Material and methods. The examination covered 74 CGN pregnant patients, 14 non-pregnant CGN
patients, 11 pregnant women with preeclampsia, 19 healthy pregnant women. The levels offlbronectin,
endothelin -1,2, 6-keto-PGFla, thromboxane B/TxB^ secretory beta-thromboglobulin in the blood,
activity of intrathrombocytic lactatedehydrogenase (LHG), platelet aggregation. ASA (125 mg/day)
was given to 33 CGN pregnant women in combination with dipiridamol (150-225 mg/day). Control
group consisted of 32 CGN pregnant women.
Results. Content of fibronectin, endothelin, TxB2 and beta-thromboglobulin in blood plasm, aggregation
with ADP in CGN pregnant women were higher than in healthy pregnant women and nonpregnant
CGN patients. Plasmic 6-keto-PGFla was low. Preeclampsia was accompanied with elevated fibronectin,
TxB2 and beta-thromboglobulin, hyperactive LDH. Platelet aggregation was suppressed.
Blood beta-thromboglobulin directly correlated with systolic and diastolic arterial pressure, 24-h proteinuria
and blood creatinine. Reverse Correlation was seen in blood beta-thromboglobulin with albuminemia,
glomerular filtration rate, body mass of the newborn and term of labor. A direct correlation
was found between the activity of intrathrombocytic LDH and systolic and diastolic arterial pressure,
a weak reverse correlation - between platelet count in capillary blood and systolic pressure, platelet
aggregation with ADP and terms of labor. Of the highest prognostic value were the level of beta-thromboglobulin
and fibronectin, the activity of intrathrombocytic LDH and platelet aggregation in response
to ADP. ASA and dipiridamol reduced the risk of fetal retardation and fetal loss.
Conclusion. Pregnant women with CGN have endothelial-thronbocytic dysfunction because of unidirectional
influence of both CGN and pregnancy. We think that endothelial-platelet dysfunction connects
renal impairment and placental failure in pregnant women with CGN deteriorating a gestational
CGN and pregnancy complications. Correction of endothelial-platelet state with ASA and dipiridamol
is effective in prevention of fetal retardation and fetal loss in pregnant women with CGN.
Terapevticheskii arkhiv. 2004;79(12):58-64
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Antibodies to cyclic citrullinized peptide in rheumatoid arthritis
Abstract
Aim. To estimate a diagnostic value of antibodies to cyclic citmllinized peptide (CCP) in rheumatoid
arthritis (RA).
Material and methods. The study was made of 85 RA patients. Of them, 48 patients had early RA,
i.e. of 8 month and less duration. The control group consisted of 35 patients with non-differentiated
arthritis (NBA) and 8 healthy donors. Concentrations of CCP antibodies, rheumatoid factor (RF)
IgM and RF IgA were measured with enzyme immunoassay (EIA).
Results. The level of CCP antibodies in RA patients (76.3 ± 43.8; median 100.0 U/ml) was significantly
higher than in NDA patients (25.1 ± 43.9; median 0.8 U/ml; p < 0.05) or in donors
(0.38 ± 0.36; median 0.2 U/ml; p < 0.05). A correlation was found between the CCP antibodies level
and that ofRF IgM (/ = 15.4; p = 0.001) and RF IgA (/ = 10.3; p = 0.001). Sensitivity (82%)
and specificity (90%) of CCP antibodies in RA diagnosis was higher than these parameters for RF
IgM and IgA (78%o, 86%> and 72%, 83%, respectively). Simultaneous tests for CCP antibodies, RF
IgM and RF IgA led to a 93% specificity. CCP antibodies were detected in 50% patients seronegative
by RF IgM and in 62% patients seronegative by IgA. Detection of CCP antibodies was closely associated
with early RA (x2 = 30.8;p = 0.0001).
Conclusion. The EI A for CCP antibodies is a sensitive and specific serological test for early RA diagnosis.
Terapevticheskii arkhiv. 2004;79(12):64-68
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Clinical biological features of mixed myeloiddiseases
Abstract
Aim. To characterize patients with mixed myeloid neoplasias with proliferation of neutrophils, platelets
and eosinophils.
Material and methods. Examination and treatment results were analysed for patients with atypical
myeloid leukemia (n = 4), myelodysplastic syndrome (MDS, n = 1) and thrombocytosis, MDS and
eosinophilia (n = I). The examination included morphological, histological, cytogenetic and molecular
tests.
Results. One patient with atypical chronic myeloid leukemia was prior diagnosed to have primarily
MDS with a typical aberration of chromosome 5. Two other patients had an initial morphological picture
of resistant anemia with blast excess, signs of myeloproliferation and extramedullar hemopoiesis.
One and two months after the first examination they received transfusions of erythrocytic mass. Just
then they were found to have splenomegaly and leukocytosis due to proliferating and maturating forms
of neutrophils. The course of the disease in patients with MDS, thrombocytosis and normal karyotype
and in patients with MDS, eosinophilia and combined chromosomal breaks including translocation
(3;12)(q21;pl3) was characterized by resistance to standard programs of polychemotherapy and transformation
into acute myeloblasts leukemia.
Conclusion. In some cases atypical CML is a stage of a natural course of MDS. Some MDS variants
with eosinophilia and thrombocytosis should be referred to the group of mixed myeloid neoplasias.
Terapevticheskii arkhiv. 2004;79(12):68-73
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A case of effective use of alemtuzumab in a male patient with T-cell lymphoma
Terapevticheskii arkhiv. 2004;79(12):73-75
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Neurohumoral aspects of energy metabolism regulation
Terapevticheskii arkhiv. 2004;79(12):75-78
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Efficacy and tolerance of stepwise therapy withmovalis in rheumatic diseases
Terapevticheskii arkhiv. 2004;79(12):78-81
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Chronic obstructive pulmonary disease in combination with cardiovascular diseases: treatment with inhalatory cholinolytic drugs1
Terapevticheskii arkhiv. 2004;79(12):81-83
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Current pathogenetic model of rheumatoid arthritis and its role inclinical practice
Terapevticheskii arkhiv. 2004;79(12):83-88
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Carvedilol(dilatrend) treatment in cardiac failure
Terapevticheskii arkhiv. 2004;79(12):88-90
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An adverse effect of amiodaron on the skin
Terapevticheskii arkhiv. 2004;79(12):93-97
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Low-molecular heparins in the treatment of non-iT elevation acute coronary syndrome
Terapevticheskii arkhiv. 2004;79(12):90-93
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Cardiovascular status in patients with hypothyroidosis in the elderly
Terapevticheskii arkhiv. 2004;79(12):97-100
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Rating system in medical education
Terapevticheskii arkhiv. 2004;79(12):100-102
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The textbook by V. I.Pokrovsky, S. G. Pak, N. I. Briko, В. К. Danilkin "Infectious Diseases and Epidemiology". Control Tests for Self-Education. Supplement for the text book
Terapevticheskii arkhiv. 2004;79(12):102-103
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