Vol 17, No 12 (2015)
Articles
Treatment of patients with hypertension: how to achieve results and increase commitment
Abstract
Arterial hypertension in industrialized countries, including Russia, has the highest contribution to the mortality from cardiovascular disease. The main goal of treatment is to maximize its long-term reduction in cardiovascular risk, which is achieved, along with the correction of modifiable risk factors, conduct adequate antihypertensive therapy based on organo and metabolic neutrality drugs. Target blood pressure level can be achieved earlier appointment combined antihypertensive therapy, including in the form of fixed combinations (FC). One of these is the FC Concor AM containing bisoprolol and amlodipine, which has shown high clinical efficiency, good adherence and the minimum number of side effects, not only in patients with hypertension, but also with a combination of hypertension with other comorbid conditions.
Consilium Medicum. 2015;17(12):8-12
8-12
Ateroskleroz - bolezn' pecheni
Abstract
22-25 сентября в Москве состоялся Российский национальный конгресс кардиологов. Обширная программа национального конгресса предлагала широкий выбор мероприятий: заседания, круглые столы, научные сессии, симпозиумы, на которых обсуждались научные и практические вопросы кардиологии, предлагались меры как по снижению смертности от ССЗ, так и их профилактике. Печень играет центральную роль в транспорте как экзогенного ХС, так и эндогенных ЛП». При нарушении процессов транспорта ХС в периферические ткани и обратного его захвата в печень наблюдается развитие гиперхолестеринемии и как следствие - атеросклероза. Рассмотреть влияние процессов, происходящих в печени, на состояние сердечно-сосудистой системы О.М.Драпкина предложила на модели неалкогольной жировой болезни печени (НАЖБП).
Consilium Medicum. 2015;17(12):13-14
13-14
Neotlozhnaya terapiya paroksizmal'nykh takhiaritmiy
Abstract
При выборе методов терапии нарушений ритма сердца важное значение имеет клиническая картина: если пароксизмальная тахиаритмия сопровождается тяжелыми гемодинамическими нарушениями (отек легких, сердечная астма, снижение артериального давления и др.), необходимо применять электрические технологии: электроимпульсная терапия, электрокардиостимуляция. При выборе антиаритмического препарата следует учитывать:вид аритмии;действенность антиаритмика и его побочные реакции;состояние сократительной функции миокарда;наличие или отсутствие дополнительных путей предсердно-желудочкового проведения;функцию синусового узла, состояние проводящей системы сердца;продолжительность тахиаритмии, основное заболевание и др.
Consilium Medicum. 2015;17(12):15-16
15-16
17-18
Medikamentoznaya profilaktika aritmiy serdtsa: voprosy effektivnosti i bezopasnosti, komorbidnost'
Abstract
В.Л.Дощицин сделал акцент на безопасность антиаритмическихпрепаратов (ААП). Докладчик подчеркнул, что основными проблемами аритмологии становятся суправентрикулярные аритмии, существенно влияющие на качество жизни, и внезапная аритмическая смерть.
Consilium Medicum. 2015;17(12):18-19
18-19
Principles of selection of a fixed combination antihypertensive agents
Abstract
Hypertension remains the cornerstone of the cardiovascular continuum. An increasing number of patients receiving combination antihypertensive therapy to achieve target blood pressure, expanding indications for combination therapy at the onset of treatment. Constantly growing market of fixed combinations (FC) of antihypertensive drugs. The article gives an overview of the FC, registered in the Russian Federation, discussed the clinical situation for the purpose of the pre-emptive or other FC. A more detailed analysis of FC, including angiotensin receptor blocker II, and diuretics, in particular, discusses the benefits of FC, including angiotensin receptor blocker II azilsartan and thiazide diuretic chlorthalidone.
Consilium Medicum. 2015;17(12):20-27
20-27
Statin therapy and the risk of developing diabetes: the debate continues
Abstract
Despite the fact that statin therapy has proven diabetogenic impact, its benefits for cardiovascular prognosis in patients with high and very high risk of cardiovascular complications significantly outweigh the risk associated with the possibility of the development of diabetes mellitus (DM). The article presents an analytical review of the results of clinical studies in recent years on the study of the problems associated with taking statins, diabetes and hyperglycemia; provides guidelines for the prevention of diabetogenic effects of this therapy and discussion data that require further study.
Consilium Medicum. 2015;17(12):28-35
28-35
Modern antiplatelet therapy in patients at high cardiovascular risk
Abstract
This literature review examines the available evidence base and recommendations for the use of basic antiplatelet agents used in clinical practice. Data on the current understanding on the use of acetylsalicylic acid (ASA) for primary prevention of cardiovascular events is reviewed. We discuss the step-wise approach to the individual assessment of benefits from the use of ASA in primary prevention, proposed by the Working Group on Thrombosis of the European Society of Cardiology.
Consilium Medicum. 2015;17(12):36-39
36-39
Crohn's disease and the adhesive-invasive Escherichia coli:pathogenetic parallels
Abstract
Crohn's disease (CD) is a multisystem disease characterized by transmural granulomatous inflammation with segmental lesion of any part of the gastrointestinal tract. Its etiology is complex and based on an irrational aggressive immune response to the components of the gut microbiota in genetically predisposed individuals. In this review the article presents data on changes in bowel dysbiotic associated with CD. The role of the adhesive and invasive Escherichia coli as a potential factor involved in the development of CD.
Consilium Medicum. 2015;17(12):40-43
40-43
Modern look at cardiac manifestations of gastroesophageal reflux disease
Abstract
In the recent past, cardiac manifestations of gastroesophageal reflux disease (GERD), including chest pain and heart rhythm disturbances was the subject of many publications. However, the classification of GERD, adopted at the World Congress of Gastroenterology in Montreal in 2005, refers chest pain to typical (not extra-esophageal) manifestations of the disease. Cases of cardiac arrhythmia are not considered as a syndrome associated with GERD.The probable causes of chest pain (CP) in GERD include esophageal smooth muscle spasm in response to irritation by refluctate its mucosa, visceral hypersensitivity and ischemic pain associated with atherosclerotic vascular disease process. In the latter case the CP is not a direct consequence of GERD. However, this pathology has common risk factors with coronary artery disease (CAD), which results in their comorbidity (prevalence of GERD is higher among patients with CAD than in the general population). Furthermore, there is data that irritation of esophageal mucosa by refluctate is able to cause reflex spasm of the coronary arteries, which is accompanied by ischemic manifestations on the electrocardiogram and the typical clinical symptoms of angina. ThatЂs why distinguishing ischemic and esophageal kinds of pain may be difficult.Gastroesophageal reflux is able to be a trigger of cardiac rhythm and conduction disturbances. Among mechanisms may be imbalance of autonomic influences on the heart, including viscero-visceral reflexes caused by irritation of the esophagus and mediated via the vagus nerve; inflammatory process, which is able to spread from the esophageal wall to the adjacent left atrium wall; and the mechanical compression of the anterior left atrium wall by food passing through the esophagus.Thus, the modern classification of GERD does not assume the presence of cardiac syndrome among extra-esophageal manifestations of the disease. Ischemic pain and cardiac arrhythmias associated with GERD should be considered from the standpoint of comorbidity.
Consilium Medicum. 2015;17(12):44-49
44-49
The destruction and rebuilding of the extracellular matrix in the pathogenesis of acute focal cerebral ischemia
Abstract
The review presents the current view of the part of matrix metalloproteinases (MMPs) in the pathogenesis of ischemic stroke. It describes the main types of MMP, the function of which is related to the exchange of connective tissue matrix in normal and pathological conditions. Describe the role of MMPs in the development of atherothrombosis. It is shown that one of the factors that lead to the damage of plaque, is to increase the IMF, particularly pronounced in the most vulnerable areas of plaque - the shoulder. On the other hand, revealed the properties of MMP strengthen tire atherosclerosis plaque. Transmitted by the level of circulating MMP-9 is associated with the progression of atherosclerosis and the risk of cardiovascular events. The results of experimental and clinical studies on the role of MMP-9 in acute cerebral ischemia are generalized. Shown to increase MMP-9 in the first hours of acute ischemia in the lesion and in peripheral blood serum. Presents the multidirectional action of MMP-9 in the pathogenesis of acute focal cerebral ischemia. Described the group of drugs acting on the level of MMP-9.
Consilium Medicum. 2015;17(12):50-54
50-54
Tuberculosis of the spine: radiodiagnosis
Abstract
Tuberculosis of the spine is 50-60% of cases of all forms of osteoarticular tuberculosis. The leading role in the diagnosis of destructive bone changes in tuberculous lesions of the spine is played by ray examination methods. Due to the fact that each of these methods has its advantages and disadvantages it requires a clear approach in the diagnosis of tuberculous lesions of the spine. It should be noted that at the moment in the presence of a large hardware base requires a comprehensive clinical and diagnostic approach, which would allow a rational design algorithm of examination of patients with suspected tuberculous lesion of the spine, improve the quality of diagnosis and optimized treatment strategy.
Consilium Medicum. 2015;17(12):55-59
55-59
Varicose veins: 20 years later
Abstract
The article presents information on developments in the diagnosis and treatment of varicose veins (VV) over the past 20 years. When covering new data on the pathogenesis and classification of diseases, methods of drug therapy, compression therapy, phleboscleroobliteration. Much attention is paid to the issues of modern surgical treatment of VV using minimally invasive endovascular embolization and thermal techniques. The author presents tactical approaches in the treatment of the VV, which combine a combination of different treatments depending on the class of chronic venous insufficiency. The issues of phlebotropic and surgical treatment of pelvic VV are also covered.
Consilium Medicum. 2015;17(12):60-63
60-63
High doses of trospium chloride in patients with overactive bladderdue to neurologic disease. The multicenter observational program RESOURCE
Abstract
In a multicenter observational programs RESOURCE were included 324 (181 female and 143 male) patients with overactive bladder due to neurologic disease. The average age of patients was 59.4±0.7 years (23 to 94). The purpose of research was to evaluate the efficacy and safety of high doses of trospium chloride in patients with overactive bladder due to neurologic disease. According to the study it was found that 11 patients stopped treatment because of severe side effects, 8 preferred dose of trospium chloride 15 mg/day, 25 - 30 mg/day, 155 - 45 mg/day, 115 - 60 mg/day, 7 - 75 mg/day, 2 - 90 mg/day and 1 - 120 mg/day. There was no direct proportional relationship between increasing doses of trospium chloride, and improving symptoms of urgent and frequent urination. Thus, an individual approach in dose selection trospium chloride in patients with neurogenic overactive bladder can be quite effective and safe measure to achieve optimal clinical outcome with a good safety profile.
Consilium Medicum. 2015;17(12):64-67
64-67
Dermatologist's role in the early diagnosis of oncologic diseases
Abstract
Listed skin signs of a possible combination of developing cancer are listed here. The role of the dermatologist in the early diagnosis of cancer for timely referral to specialists, thereby improving the forecast life of the patient is underlined.
Consilium Medicum. 2015;17(12):68-72
68-72
The association between gastroesophageal reflux disease and interstitial lung fibrosis in systemic sclerosis
Abstract
Systemic sclerosis (SSc) is a rare autoimmune connective tissue disease characterized by thickening of the skin and multiple organ involvement. Gastroesophageal reflux disease (GERD) is a common disease manifestation of SSc, as well as interstitial lung disease (ILD), the latter is the main cause of SSc related mortality. Several studies broached the issue of a potential association of GERD with SSc-ILD and indicated that microaspiration of gastric acid may cause inflammation consecutively leading to lung fibrosis. The aim of this review is to recapitulate current evidence for a link between GERD and ILD in SSc patients and emphasize the necessity of early diagnosis and treatment in order to hopefully slow down the progression of mortality driving SSc-ILD.
Consilium Medicum. 2015;17(12):73-76
73-76