Vol 82, No 1 (2010)
- Year: 2010
- Articles: 21
- URL: https://journals.rcsi.science/0040-3660/issue/view/1893
Editorial article
Influenza and acute respiratory viral infections. A role of a polyclinic therapist in timely diagnosis and treatment
Abstract
The paper emphasizes a role of a local therapist in the timely detection and treatment of acute respiratory viral infections. It shows a certain difficulty in the differential diagnosis of acute respiratory disease and influenza. Attention is given on a need for a well-defined program to correct drug therapy, regimen, and diet at home. Indications for hospitalization are specified.
Temporary disability periods are determined depending on the patient's general condition, age, and occupation.
The significance of the currently available methods for nonspecific and specific prevention is shown.
Terapevticheskii arkhiv. 2010;82(1):5-7
5-7
Factors contributing to gallstone formation and their interaction
Abstract
Aim: to study factors contributing to gallstone formation and to elucidate their relationship.
Subjects and methods. The examination of 230 patients with various hepatobiliary abnormalities used dynamic ultrasonic cholecystography, multifractional duodenal intubation, followed by a microscopic study and determination of the physicochemical properties of bile. Enzyme immunoassay was employed to measure the peripheral blood levels of gastrin, insulin, T3, T4, thyroid-stimulating hormone, cortisol, and growth hormone.
Results. All the patients were found to have signs of an early (gallstone pre-formation) stage of cholelithiasis. Decreased emptying of the gallbladder and its hypotonia and altered bile physicochemical properties were ascertained to be poor predictors of possible gallstone formation.
Conclusion. Correlation analysis has shown the important role of hormonal factors in the formation of lithogenic bile.
Terapevticheskii arkhiv. 2010;82(1):8-11
8-11
Methodological approaches to the expert appraisal of therapeutic care quality in chronic cholecystitis
Abstract
Aim: to develop a technology for assessing the quality and consequences of medical care in chronic noncalculous cholecystitis by an expert - a therapist, a gastroenterologist.
Materials and methods. One hundred and ninety-three cases of expert appraisal of medical care quality in chronic noncalculous cholecystitis were analyzed. The expert appraisal of the quality of medical care was carried out by comparing with that of the reference - the standard for the diagnosis and treatment of chronic noncalculous cholecystitis. To detect the defects correlated with the negative consequences of medical care, the authors calculated statistical criteria for assessing an association between the indices of accumulated informative value and the consequences of rendered medical care.
Results. According to the assessed quality of medical care, the patients were divided into two groups: 1) 163 patients with negative consequences of delivered medical care; 2) 30 patients with its positive consequences (a control group). The identified drawbacks that significantly determined negative outcomes had a certain distribution in the groups by their frequency. The analysis provided calculations of the accumulated informative value index for each case individually for the processes of diagnosis and treatment, by drawing up the boundaries of proper and improper medical care delivered to patients with chronic noncalculous cholecystitis.
Conclusion. The formulated criteria of positive consequences of medical care are oriented to the differential diagnosis of biliary tract pathology, to differentiated approaches to treatment analysis, and to the likely outcomes of exposure to medical and diagnostic actions on the pathological process, which allows an expert to predict its further dynamics and consequences of rendered medical care. The algorithmized expert appraisal of cases of medical care delivery makes it possible to objectivize the opinion and conclusions of an expert.
Terapevticheskii arkhiv. 2010;82(1):12-15
12-15
Role of a local therapeutic service in the timely identification, treatment, and rehabilitation of patients with coronary heart disease
Abstract
Local polyclinic therapists' long experience in timely identifying, treating and rehabilitating patients with coronary heart disease (CHD) is analyzed. A local therapist's attention is given to different course types - the clinical manifestations of CHD. The principles of continuity in the work of a therapist and a hospital: possibilities of extrahospital treatment are denoted; indications for hospitalization are specified. Rehabilitative measures include psychotherapy sessions in addition to drug, dietary, and exercise therapies.
Continuity in the work of a therapeutic unit and a sociomedical expert commission contributes to the elaboration of clearer criteria for determining the degree of working capacity loss.
Terapevticheskii arkhiv. 2010;82(1):15-18
15-18
18-24
The clinical efficiency and safety of iodide-bromine balneotherapy in patients with coronary heart disease concurrent with chronic obstructive pulmonary disease
Abstract
Aim: to evaluate the efficiency of iodide-bromine balneotherapy (IBB) in patients with coronary heart disease (CHD) concurrent with chronic obstructive pulmonary disease (COPD).
Subjects and methods. Sixty-six patients with CHD, Functional Class II stable angina on exertion concurrent with mild and moderate COPD were examined. Group 1 included 36 patients with CHD concurrent with mild and moderate COPD (a study group); Group 2 consisted of 30 patients (a control group). The groups were matched for age, gender, and concomitant abnormality. The patients from both groups undergone a complex clinical and instrumental study (clinical and biochemical study, echocardiography, 24-hour ECG monitoring, EchoCG, external respiration function (ERF) test. In both groups, CHD and COPD were treated by the generally accepted standards, Group 1 patients were additionally given IBB at a water temperature of 37°C; the concentration of iodine and bromine was 10-15 and 30-40 m/l, respectively; the duration was 10-15 min for 2 consecutive days, followed by a rest day or every second day; the course comprised 10-12 sessions.
Results. After the course of IBB, there were significant reductions in the number of anginal attacks and the dose of nitrates weekly, the number of episodes of supraventricular and ventricular premature contractions, producing no impact on the cardiac conduction system. The duration of silent myocardial ischemia and the degree of ST-segment depression significantly reduced. No significant changes were obtained in the control group. ERF examination confirmed the safety of IBB used in patients with CHD and COPD.
Conclusion. IBB has a beneficial antiischemic activity in patients with CHD concurrent with COPD, without producing a negative impact on ERF.
Terapevticheskii arkhiv. 2010;82(1):24-27
24-27
Efficacy of ivabradine in combination therapy for complicated acute coronary syndrome in patients with type 2 diabetes mellitus
Abstract
Aim: To study the effect of ivabradine (coraxan, Servier) as part of combination therapy on the clinical manifestations of acute left ventricular failure (ALVF) in Braunwald class II-IIIB unstable angina in patients with type 2 diabetes mellitus (T2DM).
Subjects and methods. Thirty-six T2DM patients (mean age 56 ± 4.3 years) with a diagnosis of acute coronary syndrome were examined. Eighteen healthy individuals were examined as an age- and gender-matched control group. Metabolic, hemodynamic, and electrophysiological parameters were studied in all the patients on hospital stay days 1 and 5.
Results. Ivabradine used in combination therapy for unstable angina caused reductions in the clinical manifestations of ALVF, heart rate, the number of myocardial ischemic episodes. In the ivabradine-treated patients, left ventricular ejection fraction showed a significant trend for increase. No adverse reactions were recorded.
Conclusion. Ivabradine therapy demonstrated antiischemic and antianginal efficiencies and a good tolerability, without leading to the development of tolerance and without being followed by the development of the withdrawal syndrome.
Terapevticheskii arkhiv. 2010;82(1):27-31
27-31
Analysis of the gene polymorphism of matrix metalloproteinase-2 and -9 in patients with coronary heart disease
Abstract
Aim. To analyze the gene polymorphisms of matrix metalloproteinase-2 and -9 in patients with coronary heart disease (CHD).
Materials and methods. The influence of single nucleotide polymorphism in the promoter region of the gene of matrix metalloproteinase (MMP)-2 at position -1306 and that of MMP-9 at position -1562 on the development of complications was studied in 181 patients with atherosclerosis by the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis of amplification products.
Results. A significant genotype increase with enhanced MMP-9 gene transcriptional activity was found in the patients aged 55 years inclusively who had been diagnosed as having myocardial infarction as compared with an older age group and, on the contrary, a rise in the MMP-2 genotype with a high promoter activity in the older age group.
Conclusion. The findings suggest that the functional polymorphism in the promoter region of the MMP-2 and MMP-9 genes plays a certain role in the development of acute coronary events.
Terapevticheskii arkhiv. 2010;82(1):31-34
31-34
Evaluation of fludarabine-containing regimens versus immunochemotherapy for chronic lymphOCYtic leukemia
Abstract
Aim. to analyze the efficacy of RFC (rituximab, fludarabine, and cyclophosphan), FCM (fludarabine, cyclophosphan, and mitoxantrone), and FC (fludarabine and cyclophosphan) treatment programs in patients with chronic lymphocytic leukemia (CLL) in an open-labeled comparative controlled investigation.
Materials and methods. The paper presents the authors' results of treatment in patients with progressive CLL in 2002 to 2007. The study included 229 patients, of them 78 patients received the RFC program, 72 had the FCM program, and 79 had the FC one.
Results. With the use of RFC, a clinically significant therapeutic effect was obtained in 96% of the patients, a complete remission (CR) was in 80% of the primary patients and in 53% of the pretreated patients. When the FCM program was applied, a positive response was noted in 93% of the patients, CR was seen in 75 and 42% of the primary and pretreated patients, respectively. In the treatment of FC, the total effect was 80%, CR was in 41 and 14% of the primary and pretreated patients, respectively.
Conclusion. Comparative analysis of an objective response to therapy has indicated that the effectiveness of the RFC significantly exceeds that of the FCM and FC programs, without enhancing toxicity, which allows he RFC regimen to be regarded as the program of choice in therapy for CLL.
Terapevticheskii arkhiv. 2010;82(1):35-39
35-39
Regulation of erythropoiesis in patients with suppressed hematopoiesis during mountain climatic treatment
Abstract
Aim. to estimate the regulation of erythropoiesis and the coagulation system in patients with suppressed hematopoiesis in a mountain hospital (3200 m above sea level).
Subjects and methods. The investigation included 12 patients with aplastic anemia (AA) and 10 with idiopathic thrombocytopenic purpura (ITP). Blood was received at a Bishkek hospital, then on days 20 and 40 of stay in the mountains. The authors studied erythropoietin (EPO) by enzyme immunoassay (Protein Contour kit, Russia), serum ferritin (SF) by immunoradioassay (Immunotech kit, Czech Republic), hypoxia-inducible factor-1α (HIF-1α), homocysteine (HC), hepcidin, endothelin (ET), and thrombomodulin (TM) by sandwich enzyme immunoassay, by applying monospecific antisera and monoclonal antibodies against relevant antigens (IDG Int Inc, USA).
Results. On staying in the mountains, there was a gradual increase in the content of hemoglobin in patients with AA and ITP. On day 40, in keeping with higher hemoglobin (Hb) levels, both groups showed a decrease in HIF-1α concentrations to the normal values (from 8.2 to 4.5 pg/ml). Due to the anemic syndrome, baseline EPO was increased by 5-7 times in the patients from both groups. On days 20-40, the content of EPO showed a 1.3-2.5-fold increase. In AA, HC was almost 3 times greater than the normal values; in ITP, it was 1.5-fold increased. On day 20 and during the patients' stay in the mountains, the level of HC remained in the normal range in both groups.
Conclusion. Hypoxic hypoxia positively affects a number of hematological parameters, by normalizing erythropoiesis (Hb, EPO, and HIF-1α), iron metabolism (SF), and the coagulation system (HC, ET, and TM).
Terapevticheskii arkhiv. 2010;82(1):39-42
39-42
Brachial artery responsiveness in patients with systemic lupus erythematosus and scleroderma systematica
Abstract
Aim. to evaluate brachial artery (BA) endothelial vasomotor function in patients with systemic lupus erythematosus (SLE) and scleroderma systematica (SDS), by using noninvasive studies.
Subjects and methods. Sixty-five patients, including 25 with SLE, 20 with SDS, and 20 with atherosclerosis (AS) obliterans of lower extremity peripheral arteries, were examined. A control group consisted of 30 apparently healthy individuals matched with the study groups for gender and age. The ultrasound technique described by D. Celermajer, et al. was employed to evaluate endothelium-dependent vasodilation (EIVD). Endothelium-independent vasodilation (EIVD) was assessed by the nitroglycerin test. The coefficient of BA susceptibility (CS) to reactive hyperemia was calculated.
Results. In all study patient groups EDVD values were significantly lower (7.3 ± 1.35% in SLE, 6.91 ± 0.9% in SDS, and 7.64 ± 1.9% in AS; p < 0.05) than in the controls (11.23 ± 1.1%). An adequate vascular bed response was found in 5 (20%) patients with SLE and in 2 (10%) patients with SDS. A paradoxical vasoconstrictor response to reactive hyperemia was encountered in 9 (36%) patients with SLE, 11 (55%) with SDS. In all the study groups, the patients had normal EIVD with lower CS. In SLE and SDS, CS was decreased than that in the controls. The impaired BA responsiveness in SLE and SDS significantly correlated with the duration and activity of the disease, Raynaud's syndrome, capillaritides, mean blood pressure, renal lesions, as well as with the laboratory values of the activity of inflammation and blood lipid composition.
Conclusion. In SLE and SDS, there was a reduction in EDVD and EIVD, as well as paradoxical vasoconstriction. CS is an independent indicator of endothelial dysfunction with the normal values of EIVD. Impaired BA responsiveness was associated with the course of systemic inflammation and severe lesion of organs.
Terapevticheskii arkhiv. 2010;82(1):43-46
43-46
Significance of the markers of endothelial dysfunction and hemorheological disorders for assessing the activity and prognosis of chronic glomerulonephritis
Abstract
Aim. to define the clinical value of changes in blood rheological properties and renal endothelial function in patients with hematuric and nephritic forms of chronic glomerulonephritis (CGN) and to ascertain whether the indices under study can be applied to assess the activity (progression) of nephritis and used as a prognostic criteria.
Subjects and methods. Sixty-one patients, including 30 with hematuric nephritis (Group 1) and 31 with nephrotic nephritis (Group 2), were examined. A control group consisted of 12 healthy individuals. The rheological properties of blood, such as its viscosity; kinetics of spontaneous aggregation and disaggregation of red blood cells in shear flow; their deformability; urinary excretion of functionally active von Willebrandt factor (WF), a plasminogen activator inhibitor type 1 (PAI-1); urine total fibrinolytic activity (UTFA), activity of urinary urokinase-type plasminogen activator (UPA) were studied.
Results. The patients with CGN were found to have signs of impaired blood rheological properties (increased viscosity, an accelerated rapid phase of erythrocyte aggregation, increased strength of erythrocyte aggregates) and vascular endothelial dysfunction in the microcirculatory bed, among other factors, increased urinary excretion of functionally active WF, PAI-1, which correlated with the activity of CGN. Data were obtained on the negative impact of the level of urinary PAI-1 excretion, red blood cell aggregation on the prognosis of CGN regardless of its form, the markers of endothelial damage/ activation. Low urokinase activity and decreased red blood cell deformability in parallel with higher diurnal proteinuria are of poor prognostic value for hematuric nephritis.
Conclusion. The findings illustrate two ways of the involvement of the endothelium in the mechanisms contributing to the development of tubular interstitial fibrosis, namely: endothelial dysfunction and as a substrate that links the processes of immune inflammation, hemorheology, and fibrinolysis/proteolysis in the kidney. The regularities revealed by clinical and laboratory comparison suggest that the indices under study may be used to determine the prognosis of the disease and may serve as a basis for the application of treatments aimed at correcting the detected disorders.
Terapevticheskii arkhiv. 2010;82(1):47-51
47-51
Role of free radical oxidation in the development of cardiovascular events in chronic renal failure
Abstract
Aim. to refine a role of free radical oxidation (FRO), anemia, and endothelial dysfunction in the development of cardiovascular events in patients with chronic renal failure (CRF) at different stages of the disease.
Subjects and methods. Eighty-six patients, including 46 (53%) women and 40 (47%) men with Stages II-IV CRF, were examined. The patients' mean age was 43.6 ± 14 years. Echocardiography, measurements of the blood levels of hemoglobin, albumin, cholesterol, and uric acid, and determination of blood electrolytic composition were made. Blood creatinine concentrations in the group averaged 0.3 mmol/l. Glomerular filtration rate (GFR) calculated from the Cockroft-Goult formula averaged 33.96 ± 13 ml/min; the duration of CRF was 9.3 ± 1.6 years. Anemia was detected in 46 (53%) patients. Iron metabolism was estimated from serum ferritin levels. Special studies involved determination of FRO - malondialdehyde (MDA) and the activities of catalase and superoxide dismutase (SOD) in plasma and serum. The plasma concentrations of endohelin-1 (ET-1), thromboxane A2, and prostacyclin were measured by radioimmunoassay.
Results. The higher concentrations of MDA and the decreased activities of catalase and SOD, i.e. FRO, correlated with the progression of renal failure. There were also increases in the levels of ET-1 and thromboxane A2 and a reduction in the concentration of prostacyclin as blood creatinine levels elevated. Left ventricular hypertrophy was found in 43 (50%) of the 86 patients. Its severity depended on the decrease of creatine phosphokinase and the severity of anemia and arterial hypertension. There was a stable correlation between the changes in left ventricular myocardial mass, MDA levels, and catalase and SOD activities.
Conclusion. The higher level of MDA and the lower activities of catalase and SOD in patients with CRF, which correlate with diminished renal function, confirm that the disease is closely associated with FRO, that, by aggravating anemia and endothelial dysfunction, affects the magnitude of morphological and functional changes in the cardiovascular system in patients with CRF patients.
Terapevticheskii arkhiv. 2010;82(1):51-56
51-56
Diagnosis of cryptococcal encephalitis in a patient with mature B-cell lymphoblastic leukemia
Abstract
Fungal meningoencephalitides are one of the most menacing infectious complications in hematologic cancer patients in the presence of myelotoxic agranulocytosis. Due to diagnostic difficulties, mortality in these cases can be as high as 100%. The causative agent of cryptococcosis is Cryptococcus neoformans; damage to the brain arachnoid membranes and substance is diagnosed in 70-90% of cases. Unlike bacterial meningitis, the meningeal symptoms typical of cryptococcal meningoencephalitis are not characteristic.
The paper gives a case of successful treatment for cryptococcal meningoencephalitis in the presence of agranulocytosis, the diagnosis of which is based on the detection of abnormal MR signal foci by magnetic resonance imaging and identification of the cryptococcal antigen - glucuronoxylomannan in spinal fluid.
Terapevticheskii arkhiv. 2010;82(1):56-58
56-58
The Faculty Therapy Clinic in the formation of clinical teaching of internal medicine: on the occasion of the 250th anniversary of the I. M. Sechenov Moscow Medical Academy
Abstract
The V. N. Vinogradov Faculty Therapy Clinic of the Imperial Moscow University (IMU) (then Moscow State University - I. M. Sechenov Moscow Medical Academy) was opened under this name in 1846 simultaneously with the Surgery Clinic on Rozhdestvenka Street. The paper shows the continuity of the idea for bedside clinical teaching, whose need was clearly realized just by S. G. Zybelin and which was first done in practice by his follower and the first Director of the Clinical Institute, IMU, F. G. Politkovsky, as well as that of specific forms of implementing of this idea. It is shown that just early internal medicine teaching provided the principles that were stated by M. Ya. Mudrov and that subsequently formed the basis of a course taught at the Department of Faculty Clinic. The original teaching of a theoretical course without a clinic one at the Department of Particular Pathology and Therapy, which was stipulated by the 1835 Charter, gradually lost its importance as clinical teaching was formed. The succession of the Clinical Institute and the Faculty Clinic was also shown in the staff: the director of the newly-opened Clinic and Therapy Department Professor was A. I. Over, M. Ya. Mudrov's favorite disciple and the last Director of the Clinical Institute; the adjuvant teacher at the Therapeutic Department of the Clinical Institute was K. Ya. Mlodzeyevsky. This all permits the V. N. Vinogradov Faculty Therapy Clinic to be regarded a competent descendant of the first clinical institutes. In conclusion, there is a clinical analysis of division of an internal medicine course into faculty and hospital courses at the present stage and prospects for teaching therapy are discussed.
Terapevticheskii arkhiv. 2010;82(1):58-63
58-63
Duodenal intubation: present view (on the occasion of the 100th anniversary of duodenal intubation)
Abstract
The paper presents the proceedings on the Symposium on the Occasion of the 100th Anniversary of Duodenal Intubation" at the 9th Congress of the Scientific Society of Gastroenterologists of Russia. Particular emphasis is laid on the significance of the clinical and experimental studies-based scientific discovery made by V. A. Galkin and A. S. Chechulin - the Galkin-Chechulin effect (the 1957 priority) for the detection and treatment of prestone stages of cholelithiasis. The steps for improving the bile examination techniques at duodenal intubation (V. A. Galkin, L. S. Korzyuk, V. A. Maksimov, A. A. Ilyechenko) are described. Duodenal intubation as the method of choice for bile examination is proposed to be included into the mandatory diagnostic standards.
Terapevticheskii arkhiv. 2010;82(1):63-64
63-64
Chronic gout: causes, clinical manifestations, treatment
Abstract
Why chronic gout, that is mostly a well diagnosed and controlled disease if it is timely and systematically treated with allopurinol, becomes a topical public health problem following 50 years after the introduction of pathogenetic therapy with xantine oxidase inhibitors is under consideration. The principles of rational therapy for chronic gouty arthritis are outlined.
Terapevticheskii arkhiv. 2010;82(1):64-68
64-68
Arterial stiffness as a predictor of cardiovascular events in coronary heart disease
Abstract
To date, there is much evidence confirming that impaired arterial elastic properties have a direct impact on prognosis in patients with chronic renal failure, arterial hypertension, or diabetes mellitus in the general population and in the elderly. At the same time, in most cohort studies the manifestations of coronary heart disease (CHD) constitute about two thirds of developed cardiovascular events (CVE); the value of arterial stiffness after CHD manifestations has not been conclusively ascertained. There are various opinions on the mechanism and pattern of this association. Rigidity of large vessels may be a marker of cardiac artery lesion, on the one hand, and promote deterioration of myocardial ischemia in the presence of coronary atherosclerosis, on the other. This review of literature discusses the pathogenetic and clinical aspects of the impact of stiffness of the great vessels on the development of CVE.
Terapevticheskii arkhiv. 2010;82(1):68-73
68-73
73-77
Aleksandr Grigor'evich Chuchalin (k 70-letiyu so dnya rozhdeniya)
Terapevticheskii arkhiv. 2010;82(1):78-79
78-79
Ukazatel' statey, opublikovannykh v zhurnale "Terapevticheskiy arkhiv" v 2009 g.
Terapevticheskii arkhiv. 2010;82(1):79-84
79-84