Vol 78, No 8 (2003)
- Year: 2003
- Articles: 24
- URL: https://journals.rcsi.science/0040-3660/issue/view/1890
Editorial article
How we treat patients withcardiovascular diseases in real clinical practice
Terapevticheskii arkhiv. 2003;78(8):5-12
5-12
Efficacy and safety of the TAIS coronary stent implantation: nine monthmuticenter study
Abstract
Aim. Assessment of clinical and angiographic results of a balloon-expandable steel matrix stent TAIS
in patients with atherosclerosis of the coronary arteries with no history of previous interventions in the
course of an open non-randomized multicenter trial.
Material and methods. The TAIS stent was implanted in 187patients into 199 stenoses. 47% patients
had clinical manifestations of unstable angina pectoris. 29% cases were complicated. The length of the
stenoses reached 11.3 ± 5.4 mm, 22% stenoses were prolonged.
Results. This coronary stenting was effective in 100% cases, neither acute nor subacute thromboses
were seen. Myocardial infarction without occlusion of the stent developed in 3 patients. The incidence
of cardial complications (death, angina, restenosis, repeated revascularization) in 6 month follow-up
was 11.8%. An angiographic control in 6 months was made in 184 patients (194 stenoses). The vascular
diameter loss index was 0.40 ± 0.21, a restenosis level - 10.7%. A logistic regression analysis has
revealed significant correlations between the length of the stent and a target vascular diameter with
subsequent restenosis. Repeated revascularization was performed in all the patients with stent restenosis.
After control angiography cardiac complications developed in 13.9% patients. Nine month follow-up
registered cardiac complications in 17.6% cases.
Conclusion. The TAIS stent was found effective in prevention of thrombosis and restenosis in patients
with a relatively high risk of intervention
Terapevticheskii arkhiv. 2003;78(8):12-17
12-17
Effects of a compound drug pumpan on exercise tolerance and clinicalcourse of ischemic heart disease
Abstract
Aim. To study effects of the drug pumpan on exercise tolerance and myocardial ischemia induced by
exercise in patients with ischemic heart disease of functional class II-III.
Material and methods. The study included 30 patients with various forms of ischemic heart disease
(myocardial infarction, coronary artery bypass grafting) having stable effort angina of functional class
II-III.
Results. The addition of a compound drug pumpan to a standard antianginal therapy reduced the
number of anginal attacks and ST depression at bicycle exercise test.
Conclusion. Pumpan is an adjuvant medication in conduction of antianginal therapy in ischemic heart
disease patients with stable angina of effort of functional class II-III.
Terapevticheskii arkhiv. 2003;78(8):17-21
17-21
Co-renitek treatment of patients withmoderate and severe forms of hypertensive disease
Abstract
Aim. To evaluate efficacy and tolerance of a compound drug co-renitec combining an ACE inhibitor
enalapril maleate and diuretic hydrochlorothiazide co-renitec taken for 16 weeks in essential hypertension (EH).
Material and methods. 28 patients with EH (16 males and 12 females aged 47-74 years) of mean
duration 13.1+1.6 years. Blood pressure (Bp) was monitored for 24 hours with the device SL 90207
(SpaceLabs Medical, USA). Microalbuminuria (MAD) was estimated with the use of immunoturbodimetric test.
Results. By 24-hour monitoring, co-renitec reduced day BP by 14.9/8.9 ± 3/2 mm Hg, nocturnal BP
lowered by 18.6/11.4 ± 3/2 mmHg, pulse pressure also fell. Coefficient T/P was 53.5% for systolic BP
(SBP) and 59.6% for diastolic BP (DBP). The target SBP was reached in 77% patients, target DBP -in 69%.
Co-renitec significantly decreased MAU, albumines excretion normalized in 46% patients.
Conclusion. Co-renitec lowers both day and nocturnal blood pressure, improves 24-h rhythm of BP,
has a positive effect on the kidneys. This allows its recommendation as a first-line drug in patients with
moderate and severe EH.
Terapevticheskii arkhiv. 2003;78(8):21-26
21-26
Diroton effects on 24-h fluctuations of arterial pressure as shown bymonitoring in hypertensive patients with polycythemia vera
Abstract
Aim. To study the data of 24-h monitoring of blood pressure (MBP) and effects of an ACE inhibitor
lisinopril (diroton) in hypertensive patients with polycythemia vera (PV).
Material and methods. 20 patients with arterial hypertention of degree II and III with PV aged 41 to
77 years. Mean duration of AH and PV was 11.8 ± 2.2 and 2.0 ± 0.2 years, respectively. Diroton
was given as monotherapy in a single morning dose 10-40 mgfor 4 weeks. 24-h MBP was made before
the treatment and on the 4th week of the treatment. In addition to standard estimations, hour-tohour
double product (DP) was estimated.
Results. After 4 weeks of diroton therapy there was a 12.2%, 9.5%, 25% and 15.4% fall in mean 24-h systolic
blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), DP, respectively.
A positive effect was registered on variability and 24-h profile of BP. A response was achieved in 85%
patients. The target level of mean 24-h blood pressure < 135/85 mm Hg was achieved in 65%, and
10% fall in SBD and/or &BP in 20% patients. ACE inhibitors' side effect - severe dry cough - was
not encountered.
Conclusion. PV aggravates arterial hypertention. Monotherapy with diroton effectively controls BP in
hypertensive patients with PV in a 4-week course intake in a single morning dose and is well tolerated
Terapevticheskii arkhiv. 2003;78(8):26-32
26-32
Clinical efficiency and tolerance of hydrogensulfide balneotherapy in hypertensive patients living in theclimate of arid zone
Abstract
Aim. To examine clinical efficiency and safety of moderate hydrogen sulfide (HS) baths in the treatment
of hypertensive patients living in arid zones.
Material and methods. Sixty patients with stable essential hypertension (EH) of stage I-1 I according
to WHO classification living in arid climate took sparing HS baths. Efficiency of the baths was assessed
by changes in blood pressure (BP), 24-h monitoring ofBP.
Results. It is shown that systolic and diastolic BP after HS balneotherapy fell significantly both in
daytime and at night. The 24-h profile of BP improved, heart rate decreased by 4.3%, physiological
fluctuations of BP and BP variability were not damaged.
Conclusion. Moderate HS baths are recommended for wider use in a hot climate of the arid zone as
an effective and safe method of balneotherapy which can be adjuvant to basic medication of EH.
Terapevticheskii arkhiv. 2003;78(8):32-35
32-35
Use of clonazepam for treatment of patients with paroxysmal atrial fibrillation regarding their psychovegetative status
Abstract
Aim. To study the efficacy of clonazepam in patients with paroxysmal atrial fibrillation (PAF) with
reference to their psychovegetative status.
Material and methods. 50 patients with PAF of non-rheumatic origin entered the study group, 20
healthy examinees served control. All of them were examined using a clinicocardiological, cliniconeurological
tests; their autonomic nervous system, emotional sphere, sleep disorders were studied before
and after clonazepam treatment in a dose 0.5 mg 2 times a day for 30 days.
Results. A positive effect of clonazepam was noted in 20 (80%) patients with PAF, less frequent paroxysms
occurred in 12 (48%) patients, in 5 patients they stopped, 12 (48%) patients tolerated the paraxysms
better. The paroxysms became shorter in 10 (40%) patients, 10 (40%) patients felt better in the
postparoxysmal period. A marked relief of psychovegetative syndrome, improvement of activity, mood
and quality of sleep were noted in all the patients.
Conclusion. Clonazepam is recommended for patients with PAF to improve antiarrhythmia therapy
Terapevticheskii arkhiv. 2003;78(8):35-39
35-39
Effect of cordaron on systolicand diastolic functions of the left ventricle in patients with amixed form of chronic cardiac failure and cardiac arrhythmias
Abstract
Aim. To study effects of cordaron on central hemodynamics reflecting systolic and diastolic functions
of the left ventricle (LV) in patients with a mixed form of chronic cardiac failure - a systolic dysfunction
and L V diastolic dysfunction type I.
Material and methods. 14 patients with a mixed form of chronic heart failure (CHF) and cardiac arhythmia
were followed up for 6 months. All the patients received ACE inhibitors, diuretics, nitrates
and, additionally, cordaron in a supporting dose 200-300 mg/day. Control of central hemodynamics
was made with echocardiography before, 1, 3 and 6 months of therapy.
Results. For 6 months of therapy LV ejection fraction increased by 16%. LV diastolic function improved,
primarily, due to a rise of the E max (by 52% for 6 months of therapy). This reflected early diastolic filling
of the LV. Improvement of LV diastolic function was associated with heart rate desrease.
Conclusion. Cordaron used in addition to ACE inhibitors, diuretics, nitrates improves both systolic
and diastolic LV function in patients with a mixed form of CHF.
Terapevticheskii arkhiv. 2003;78(8):39-43
39-43
Efficacy and safetyof different p-blockers in patients with isolated systolic hypertension, associated with diabetes mellitus and obstructive pulmonary diseases
Abstract
Aim. To compare efficacy and safety of atenolol, methoprolol and bisoprolol, as the most usable Гз-blockers,
in patients with isolated systolic arterial hypertension (ISAH) and concomitant diabetes mellitus (DM)
and/or chronic obstructive pulmonary disease (COPD).
Material and methods. Forty two patients with ISAH and coronary heart disease, 30 patients with
these diseases associated with DM and 32 patients with associated COPD were randomized into three
groups. Group 1 received atenolol in a dose 25 mg twice a day, group 2 - metoprolol tartrate in a
dose 25-50 mg twice a day, group 3 - bisoprolol in a single dose 5-10 mg/day. All the patients
were examined before the treatment and in 8 weeks. Arterial pressure was assessed at 24-h monitoring
(ABPM-04 unit, Mediteck, Hungary) and quality of life (QL) was estimated by DISS Disability
Scale. In addition, blood glucose was measured in patients with concomitant DM, external respiration
function (ERF) was studied before and after the treatment in patients with concomitant COPD.
Results. In all ISAH patients there was a significant fall of systolic arterial pressure and heart rate. 2
hours after intake of atenolol and methoprolol blood glucose lowered significantly in diabetics as well
as peak volume expiration velocity in patients with COPD. In the bisoprolol group ERF and blood glucose
in DM and COPD patients remained unchanged. Atenolol deteriorated QL by the "job" and "social life"scales,
methoprolol - by the scale "job" while bisoprolol improved the above parameters.
Conclusion. The results of bisoprolol treatment are better than those of methoprolol and atenolol treatment
of hypertensive patients with concomitant DM and COPD.
Terapevticheskii arkhiv. 2003;78(8):43-48
43-48
Clinicomorphological assessment of budesonide efficiency in patients with bronchial asthma
Abstract
Aim, To study clinicomorphological efficacy of inhalation glucocorticosteroid budesonide (benacort,
Pulmomed, Russia) in bronchial asthma.
Material and methods. Twenty patients with bronchial asthma were treated with budesonide.
Results. A response to budesonide was manifest to the end of treatment week 1. Budesonide reduced
frequency of acute asthma episodes and the need in inhalations of short-acting $2-agonists. The peak
expiratory velocity (PEV) rose by 12% in three months, variability of PEV lowered by 13%, in 6
months by 21%o, in 12 months by 31% compared to pretreatment values. In 12 months hypersecretion
and thickness of basal membrane decreased. Three-month treatment also reduced eosinophil and lymphocyte
epithelial count and cell density of stromal infdtrate in bronchial mucosa. In 12 months cell
density of stromal infdtrate diminished.
Conclusion. Bronchial asthma treatment with budesonide for 12 months reduces 24 hour rate of acute
asthma episodes, the need in the disease exacerbations, improves functional indices of respiration but
morphological composition of bronchial mucosa does not normalize completely this showing the necessity
of longer budesonide administration
Terapevticheskii arkhiv. 2003;78(8):48-51
48-51
CLINICOMORPHOLOGICAL CHANGES OF THE LIVER IN ATHEROGENIC DYSLIPIDEMIAAND IN THE TREATMENT WITH STATINS
Abstract
Aim. To evaluate clinicofunctional and morphological changes in the liver of patients with atherogenic
dyslipidemia and in the course of treatment with statins.
Material and methods. A general clinical examination, biochemical hepatic tests, determination of
blood lipid spectrum, markers of viral hepatites B, C, G, TT, ultrasound hepatic imaging of the liver
of bile ducts, punch biopsy of the liver were made in 60 patients (38 females and 22 males) at the age
of 39 to 70 years with atherogenic dyslipidemia (ADL).
Results. Biochemical tests showed high activity of transaminases (1.5-2 times higher than normal) in
16 patients, hyperbilirubinemia in 12 patients, dyslipidemia of type Hb-III in all the examinees. Ultrasound
investigation of the liver has found fat dystrophy in 58, cholesterosis of the gallbladder in 32,
cholelithiasis in 17 patients. Histological examination of the liver evidenced for marked fat dystrophy
of hepatocytes, perihepatocellular and periportal fibrosis, moderate portal and periportal hepatitis. 22
of 54 patients treated with statins appeared to have morphological signs of drug damage to the liver.
Conclusion. ADL patients' livers are characterized by signs of non-alcoholic steatohepatitis. In its
presence statins treatment leads to development of drug-related hepatic disorder - statin hepatitis.
Therefore, hypolipidemic drugs in non-alcoholic steatohepatitis must be used individually or alternative
treatments should be tried.
Terapevticheskii arkhiv. 2003;78(8):51-55
51-55
Effects of combined psychocorrectionon dynamics of pain syndrome and psychological status ofpatients with spinal osteochondrosis
Abstract
Aim. To study effectiveness of a new psychocorrection method (combined use of neuroleptic trifluoperasine
and psychorelaxation therapy using biological feedback) in rehabilitation of patients with longterm
pain syndrome provoked by spinal osteochondrosis (SOC) to determine predictors of response to
this method of psychocorrection.
Material and methods. 132 patients with SOC and associated pain syndrome were examined using
pain assessing methods and psychological tests.
Results. Psychocorrection including neuroleptic significantly raises the efficacy of SOC treatment and
relieves pain, hypochondric fixations and depressive disorders. The reduction of pain syndrome intensity
in the course of psychocorrection correlates with attenuation of hypochondric disorders and inclination
to fixation. As to predictors of the treatment effect, the strongest relief of pain in psychocorrection
was achieved in patients with hypochondric and anxiodepressive disorders.
Conclusion. Combined psychocorrection comprising minimal doses of neuroleptic trifluoperasine and
psychorelaxation is effective in the treatment of SOC patients with long-term pain syndrome.
Terapevticheskii arkhiv. 2003;78(8):55-59
55-59
Use of venofer for correction of iron deficiency in patients on programmed hemodialysis
Abstract
Aim. To study iron metabolism in patients on programmed hemodialysis (PH) in oral and intravenous
administration of iron drugs; to compare clinical and financial results of using such drugs.
Material and methods. A two-stage trial studied iron metabolism in 158 PH patients on replacement
therapy with erythropoetin. They received correction of iron deficiency with oral drugs (stage I) and
venofer (stage II).
Results. The study of iron metabolism has found its deficiency in 2/3 patients receiving oral iron: absolute (48%)
and relative (20%). Administration of venofer led to a 2-fold increase in the number of
patients with normal iron metabolism. The target Hb and Ht were achieved in 2.5 times more patients
than before venofer treatment. The dose of erythpoetin in such cases was reduced by 40%. Side effects
were not observed. The week cost of venofer treatment per patient was tower by 22.5$ than the cost of
treatment with oral iron drugs.
Conclusion. Venofer correction of iron deficiency in PH patients is more effective both clinically and
financially than use of oral iron preparations.
Terapevticheskii arkhiv. 2003;78(8):59-62
59-62
Therapeutic efficacy of imatinibmesilate (glivek) in chronic phase of myeloid leukemia
Abstract
Aim. To evaluate efficacy and tolerance ofglivek in chronic myeloid leukemia (CML) in patients who
failed interferon-alpha (If-a) preparations.
Material and methods. 79 patients in a chronic phase of Ph+CML with hematological and cytogenetic
resistance or intolerance of If-a. The response to glivec was assessed by achievement of a complete
hematological remission and the cytogenetic effect (the degree of reduction of cell clone Ph+ in bone
marrow). Tolerance and safety of the drug was studied by monthly standard clinicohematological tests.
Results. Not only a hematological remission (92.4%), but also partial (46.8%) or complete (27.8%)
elimination of BCR-ABL±cells were achieved after 12 months of the treatment. Glivec was well tolerated.
Hematological toxicity primarily as neutropenia and thrombocytopenia were observed in 54.4
and 42% patients, respectively. Neutropenia of the third degree which made impossible to continue the
treatment was observed in 29.1% patients; throbocytopenia of the third degree was registered in 16.5%
patients. Among most frequent поп-hematological side effects there were moderate edema, nausea, leg
muscle convulsions, weight gain, arthralgias, skin eruption. All the complications were transient, were
managed in all cases with only a short-time discontinuation of glivec therapy.
Conclusion. High activity of glivec at early stages of CML allows using this drug as a first-line therapy
in patients with CML
Terapevticheskii arkhiv. 2003;78(8):62-68
62-68
Incidence and characteristics of complications in aplastic anemia patients treated with antilymphocytic globulin
Abstract
Aim. To examine frequency and characteristic features of complications arising in administration of
domestic antilymphocytic globulin (ALG) in patients with aplastic anemia (AA).
Material and methods. From 1980 to 2000 125patients with AA were treated with ALG made in Russia.
Two and three courses of ALG were performed in 25 and 8 patients, respectively.
Results. The treatment was complicated most often with allergic reactions (AR) observed in 42.4% patients,
hemorrhagic syndrome (HS) and infectious complications (1С). Goat ALG was more allergic
than rabbit ALG (46.2 vs 34.6%, respectively). If the second course was made with ALG of the same
kind, AR occurred in 37.5% patients while ALG of the different kind produced complications only in
11.8% patients. HS was recorded in 37.3% patients , its frequency was unrelated to ALG kind and
was not severe (71.2%). 1С occurred in 16.5% patients, their occurrence was also unrelated to the
ALG kind and were of the first degree in 63.6%.
Conclusion. Domestic ALG often results in AR. To reduce frequency and severity of complications in
ALG treatment, it is recommended to use long intravenous infusions (12-18 h) and change ALG kind
in subsequent ALG courses.
Terapevticheskii arkhiv. 2003;78(8):68-72
68-72
Efficacy of thyroxine and potassium iodide in benign nodularlesions of the thyroid
Abstract
Aim. To study efficacy of thyroxine (TX) and potassium iodide (PI) in the treatment of benign nodular
thyroid lesions (BNTL).
Material and methods. 118 patients with BNTL (colloid or colloid hypercellular as shown by thin
needle aspiration biopsy, 'cold" or "warm" by scyntigraphy findings) were randomized into two groups:
59 patients were given thyroxin and the other 59 patients PI. The day dose of TX (75-150 meg) was
prescribed according to serum concentration of TTH trying to diminish it to 0.5 mIU/l and lower. PI
dose was 200 meg/day. Most of the patients were treated for 6 months. The response was evaluated
with ultrasound investigation which measured thyroid volume, the size and number of the nodes in it
before and in the end of therapy. The treatment was found effective if the dominant node decreased in
size by 50% and more compared to pretreatment values.
Results. The size of the dominant node decreased by 50% and more in 14 of 59 (23.73%) patients on
TX and in 20 of 59 (33.90%) patients on PI. Both TX and PI prevented growth of the dominant node
size and number of the nodes in approximately 2/3 cases. TX was more effective in young patients
(40.92 ± 3.45 years) vs older ones (47.50 ± 1.46 years, p = 0.047) and patients with colloid nodes.
PI was more effective in patients with shorter node existence (3.93 ± 1.21 and 8.59 ± 1.74 months,
p = 0.02). TX reduced thyroid volume from 20.42 ± 1.69 to 15.18 ± 1.30 ml (p = 0.001), PI -from
18.34 ± 1.57 to 15.36 ± 1.25 ml (p = 0.001).
Conclusion. TX and PI can inhibit or prevent the growth of thyroid benign nodes in approximately 2/3
patients especially in young patients with colloid nodes (TX) and in short existence of the node (PI).
Terapevticheskii arkhiv. 2003;78(8):72-76
72-76
TREATMENT OF PATIENTS WITH VISCERAL CANDIDIASIS
Abstract
Aim. To study effectiveness of antimycotic medication with flucostat in patients with visceral candidiasis.
Material and methods. Diagnosis of bronchopulmonary, gastrointestinal, urogenital candidiasis was
verified microbiologically in 152 patients aged 20 to 78 years. Candidiasis was treated with flucostat:
50 mg and 150 mg capsules per os and solution (100-50 ml) intravenously by dropper.
Results. The response was achieved in 140 (92.1%) patients: cure - in 107 (70.4%), improvement in 33 (21.7%),
mycological sanation - in 125 (82.2%) patients.
Conclusion. Cure of chronic diseases complicated by mycotic infection is not always achieved after
mycotic sanation. Some symptoms of severe chronic pathology persist and require long-term symptomatic
treatment.
Terapevticheskii arkhiv. 2003;78(8):76-78
76-78
CHANGES IN ADAPTATION-COMPENSATION PROCESSES IN THE COURSE OF ACUTEISCHEMIC STROKE (CLINICOBIOCHEMICAL CORRELATIONS)
Abstract
Aim. To study changes in some components of stress-realizing system (SRS) and stress-limiting system
(SLS) characterizing compensatory mechanisms in acute disturbance of cerebral circulation (ADCC).
Material and methods. The activities of SRS and SLS were assessed in 94 patients by changes in the
concentrations of glutamate, aspartate, acid phosphatase for SRS and gamma-aminobutyric acid
(GABA) for SLS, respectively.
Results. After analysis of clinicobiochemical correlations the following clinical phases were singled out:
subcompensation, moderate decompensation, severe decompensation and terminal. The phase conversion
depended on quantitative changes of SRS and SLS activity. This enabled characterization of severity
in certain time periods. Imbalance was revealed between SRS and SLS because of hyperactivation
or hypoactivation of one of the above systems.
Conclusion. Imbalance between SRS and SLS converts stress-syndrome from nonspecific link of adaptation
into a nonspecific link of the disease pathogenesis.
Terapevticheskii arkhiv. 2003;78(8):78-81
78-81
Improved prognosis of generalized AL-amyloidosis ina patient with multiple myeloma treated according to theVAD scheme
Terapevticheskii arkhiv. 2003;78(8):81-83
81-83
Current approaches to treatment of chronic obstructive pulmonary diseases
Terapevticheskii arkhiv. 2003;78(8):83-88
83-88
Diet of patients with chronic cardiac failure: solved and unsolved problems of nutritional support
Terapevticheskii arkhiv. 2003;78(8):88-92
88-92
Amiodaron-induced thyroid dysfunction: pathogenesis, diagnosis, treatment
Terapevticheskii arkhiv. 2003;78(8):92-96
92-96
Meloxicam: intramuscular administration inrheumatology
Terapevticheskii arkhiv. 2003;78(8):96-98
96-98
2003 calendar of anniversaries in the history of therapy
Terapevticheskii arkhiv. 2003;78(8):98-99
98-99