This article deals with debatable problems of etiology, pathogenesis, and classification of hypertensive disease including essential kypertension, hypertonic crisis and methods of treatment of these conditions.This article deals with debatable problems of etiology, pathogenesis, and classification of hypertensive disease including essential kypertension, hypertonic crisis and methods of treatment of these conditions.
Gulyaev NI, Korovin AE, Kusay AS
… +1 more, Nevorotin AI
Klin Med (Mosk)
· 2015 · PMID 26669035
Over the last 10 years, calcifying nanoparticles (CNP) have attracted attention as structures detected. together with many other nanostructures in biopsies from patients operated for the correction of aortic valve malfor...Over the last 10 years, calcifying nanoparticles (CNP) have attracted attention as structures detected. together with many other nanostructures in biopsies from patients operated for the correction of aortic valve malformations. The results of the present work performed with the use of high-resolution transmission and scanning electron microscopes agree on the whole with the data of other authors. Some new findings include CNP adhesion to collagen fibers and specifically-shaped, shallow invaginations or craters at their surface. The possible pathophysiological mechanisms that promote involvement of CNP in the development of the disease are considered.
Skipskiy IM, Efimov NW, Remizov AS
… +1 more, Miroshnikov BI
Klin Med (Mosk)
· 2015 · PMID 26669034
We report a case of iatrogenic lesion of the lungs in a 61 year old patient following simultaneous subtotal resection and plastic surgery of esophagus using a gastric stem with the removed cardial portion along with subt...We report a case of iatrogenic lesion of the lungs in a 61 year old patient following simultaneous subtotal resection and plastic surgery of esophagus using a gastric stem with the removed cardial portion along with subtotal mediastinal lympho-dissection for the treatment of 2 x 1 cm T2NoMO tumour in the middle third of esophagus. The patient's medical history contained no evidence of previous pulmonary pathology, preoperative chest X-ray study revealed neither focal nor infiltrative changes in the lungs. On day 5 after extensive surgical intervention with the use of a parenteral beta-lactam antibiotic, the patient developed acute respiratory distress the symptoms of which increased wavelike during the next 4.5 weeks in association with subfebrility, leukocytosis, enhanced ESR and large shaded areas in the lungs. These conditions were regarded as signs of pneumonia that required the application of increasingly more powerful beta-lactam antibiotics. All these symptoms became less apparent and completely disappeared within 2 days and 1 week respectively after withdrawal of the antibiotics and prescription of parenteral prednisolone. It confirmed the iatrogenic origin of lung lesions regarded by the authors as recurring acute respiratory distress syndrome caused by beta-lactam antibiotics.
Mikhina MS, Molashenko NV, Troshina EA
… +4 more, Orlova EM, Sozaeva LS, Eystein SH, Breivik S
Klin Med (Mosk)
· 2015 · PMID 26669033
Autoimmune polyglandular syndrome is a primary autoimmune disorder affecting two or more peripheral endocrine glands and responsible for their incompetence. It is frequently combined with various organ-specific non-endoc...Autoimmune polyglandular syndrome is a primary autoimmune disorder affecting two or more peripheral endocrine glands and responsible for their incompetence. It is frequently combined with various organ-specific non-endocrine diseases. Patients with this pathology need life-long replacement therapy and dynamic observation by endocrinologists and other specialists to monitor the effectiveness of the treatment and detect new components of the disease. We report a variant of type 1 autoimmune polyglandular syndrome. Special emphasis is laid on the importance of succession of actions of endocrinologists and specialists in related medical disciplines dealing with children and adult patients.
Some 30-40 years ago, ulcer disease was treated with the use of a large amount of medications having different mechanisms of action. This approach is now substituted by a well-defined algorithm including courses of antis...Some 30-40 years ago, ulcer disease was treated with the use of a large amount of medications having different mechanisms of action. This approach is now substituted by a well-defined algorithm including courses of antisecretory therapy and eradication of Helicobacter pylori. Much attention is given to the optimization of the schemes of eradication therapy and prevention of erosive and ulcerative lesions of the stomach and duodenum associated with pharmacotherapy.
Fesenko OW, Sinopal'nikov AI, Shvaiko SN
… +2 more, Tret'yakova LN, Pavlova IV
Klin Med (Mosk)
· 2015 · PMID 26669031
Severe community-acquired pneumonia implies the necessity of its early differential diagnostics from a wide range of nosological forms requiring not only therapeutic but also surgical treatment. The authors consider the...Severe community-acquired pneumonia implies the necessity of its early differential diagnostics from a wide range of nosological forms requiring not only therapeutic but also surgical treatment. The authors consider the causes of hypodiagnostics of community-acquired pneumonia and illustrate difficulties of differential diagnosis of this condition by concrete examples.
Trubnikova OA, Mamontova AS, Syrova ID
… +3 more, Kukhareva IN, Maleva OV, Barbarash OL
Klin Med (Mosk)
· 2015 · PMID 26669030
The aim of the study was to evaluate the neuropsychological status of patients with type 2 diabetes mellitus (DM2) before and I year after coronary bypass surgery performed under conditions of artificial circulation. It...The aim of the study was to evaluate the neuropsychological status of patients with type 2 diabetes mellitus (DM2) before and I year after coronary bypass surgery performed under conditions of artificial circulation. It included 114 patients (54 with and 60 without DM2). Prior to surgery, the patients with DM2 had positive characteristics of neurodynamics and attention. They deteriorated 1 year after coronary bypass surgery, but improved in the patients without DM2.
Sclerosis is a final substrate and outcome of structural lesions of different organs and tissues in various pathological conditions, such as hypertensive disease, coronaty heart disease, chronic obstructive pulmonary dis...Sclerosis is a final substrate and outcome of structural lesions of different organs and tissues in various pathological conditions, such as hypertensive disease, coronaty heart disease, chronic obstructive pulmonary disease, systemic lupus erythematosus, rheumatoid arthritis, systemic scleroderma, etc. Not infrequently it as a determinant of severity and unfavourable outcome of the disease. Elucidation of general patterns of the development of sclerosis requires an integrated approach to the systemic analysis of clinical, genetic, biochemical, and morphological characteristics whereas a local analysis reveals peculiarities of formation of sclerosis in individual patients. Such combination permits to use methods of predictive-preventive personified medicine for planning the treatment of sclerosis.
Zhdanov KW, Zakharenko SM, Kovalenko AN
… +2 more, Semenov AV, Fusin AY
Klin Med (Mosk)
· 2015 · PMID 26669028
The data on the prevalence of disease caused by Ebola virus, biological features of its pathogen, character of the epidemiological process, pathogenesis and clinical symptoms are presented. The disease is characterized b...The data on the prevalence of disease caused by Ebola virus, biological features of its pathogen, character of the epidemiological process, pathogenesis and clinical symptoms are presented. The disease is characterized by suppression of protective immunological mechanisms and systemic inflammatory reaction accounting for the lesions of vascular endothelium, hemostatic and immune systems. It eventually leads to polyorgan insufficiency and severe shock. Lethality amounts to 50%.
This paper summarizes results of the investigations into the influence of antioxidants on the clinical picture of bronchial asthma. This disease is known to be accompanied by hyperactivation of lipid peroxidation. The us...This paper summarizes results of the investigations into the influence of antioxidants on the clinical picture of bronchial asthma. This disease is known to be accompanied by hyperactivation of lipid peroxidation. The use of antioxidants permits to correct free-radical oxidation (peroxidation) and enhances effectiveness of control over clinical symptoms. Moreover they more effectively improve external [Russian word: see text] than conventional therapy.
Modern views of the strategy for the treatment of the main gastroenterological diseases during pregnancy are considered. Peculiarities of the clinical course of digestive tract pathologies are discussed with reference to...Modern views of the strategy for the treatment of the main gastroenterological diseases during pregnancy are considered. Peculiarities of the clinical course of digestive tract pathologies are discussed with reference to the influence of exacerbation of their chronic forms on fetus development. The most common gastroenterological pathologies include gastroesophageal reflux disease, gastric and duodenal disorders, acute and chronic pancreatitis, acalculous and calculous cholecystitis, hepatitis of autoimmune and other etiology, liver cirrhosis, intestinal inflammation. Possibilities of pharmacotherapy and its specific features in pregnant women are discussed including cases of exacerbation of chronic conditions.
Mravyan SR, Shuginin IO, Pronina VP
… +5 more, Budykina TS, Mikhailova IS, Popov VV, Khorikova EN, Stepanova EA
Klin Med (Mosk)
· 2015 · PMID 26596064
A case of primary infectious endocarditis with the lesion of mitral valve in a pregnant woman is reported The diseases was caused by meticillin-resistant Staphylococcus aureus. Special attention is given to inefficiency...A case of primary infectious endocarditis with the lesion of mitral valve in a pregnant woman is reported The diseases was caused by meticillin-resistant Staphylococcus aureus. Special attention is given to inefficiency of beta-lactame antibiotics against this infection and beneficial effect of daptomycin therapy. This observation confirms literature data about high frequency of thromboembolic complications of S aureus-induced infectious endocarditis due to the production of various coagulases and von Willebrand factor-binding protein by these microorganisms. An increase of coagulation caused by S. aureus is mediated through activation of prothrombin, factor XIII, and fibrin-binding fibronectin. It requires prescription of direct thrombin inhibitor pradax that proved to yield good results in the treatment of our patient. It is concluded that infectious endocarditis in pregnant women is characterized by an atypical clinical picture due to impaired immunity associated with rapid progression of the process after delivery, high frequency of thromboembolic and DIC syndromes.
Poteklzin NP, Sarkisov KA, Orlov FA
… +3 more, Alatortseva IA, Starovoitova LM, Drozdova IN
Klin Med (Mosk)
· 2015 · PMID 26596063
The obesity dependence of selected clinical and instrumental characteristics of 10 male patients with arterial hypertension (AH) was evaluated Group I included 79 patients with grade II hypertensive disease (HD), normal...The obesity dependence of selected clinical and instrumental characteristics of 10 male patients with arterial hypertension (AH) was evaluated Group I included 79 patients with grade II hypertensive disease (HD), normal body weight and waist circumference. Group 2 comprised 61 patients with grade II HD and abdominal obesity. Patients of both groups showed high frequency of left ventricular (LV) hypertrophy (59.2 and 73.8% respectively). Concentric LV hypertrophy prevailed in group I and eccentric hypertrophy in group 2. 24 hr ECG monitoring showed that signs of relative coronary insufficiency were recorded more frequently in group 2 and cardiac rhythm disturbances in group I.
AIM: to study effectiveness of a fixed combination of perindopril arginine and amlodipine besylate for the treatment of arterial hypertension with concomitant chronic cardiac insufficiency and signs of chronic kidney dis...AIM: to study effectiveness of a fixed combination of perindopril arginine and amlodipine besylate for the treatment of arterial hypertension with concomitant chronic cardiac insufficiency and signs of chronic kidney disease Materials and methods: 53 (44.9%) patients aged 64.5±8.2 yr with signs of chronic kidney disease (CKD) were selected from 118 subjects with grade II-III essential AH and chronic cardiac insufficiency They had an increased blood cystatin C level (mean 1.4±0.3 mg/l) and/or decreased glomerular filtration rate (GFR) calculated by 3 formulas: 77.6±15.9 (MDRD), 79.3±17.1 (CKD-EPI) and 57.7±15.2 ml/min/1. 73 m3 (from cystatin C level). Fixed combinations of perindopril arginine and amlodipine besylate (5/5, 5/10, 10/10 mg) were used to treat the patients. Their effectiveness was evaluated 2 months after the onset of therapy based on results of AP measurement, 24 hr AP monitoring, assessment of clinical conditions and 6 min walk test. Blood creatinine, urea and cystatin C levels and GFR were measured. RESULTS: Target AP was achieved in 82.6% of the patients. Systolic AP (SAP) decreased significantly from 172±11.2 to 135.7±8.2 mmHg (p<0.01), diastolic AP (DAP)from 110±6.9 to 85.3±7.2 mm Hg (p<0.5). Mean daily SAP and DAP decreased by 14.7 and 14.4% respectively. SAP and DAP load also decreased Clinical conditions estimated in terms of the CCI functional class improved (a decrease from 6.2±1.1 to 4.2±1.3 scores (p<0.01)). Tolerance of physical activity increased from 157.2±12.6 to 320.4±32.2 m (p<0.05). Blood cystatin C level decreased and GFR increased. CONCLUSION: The fixed combination of perindopril arginine and amlodipine besylate ensures high therapeutic effect in patients with arterial hypertension and concomitant chronic cardiac insufficiency having signs of chronic kidney disease.
Nagaitseva SS, Shvetsov MY, Lukshina LP
… +4 more, Burba SV, Garpishchenko AG, Gerasimov AN, Shilov EM
Klin Med (Mosk)
· 2015 · PMID 26596061
AIM: to estimate the prevalence of newly-diagnosed chronic kidney disease (CKD) and its risk factors in patients of a therapeutic clinic, to evaluate the importance of GFR calculation using the CKD-EPI formula. Materials...AIM: to estimate the prevalence of newly-diagnosed chronic kidney disease (CKD) and its risk factors in patients of a therapeutic clinic, to evaluate the importance of GFR calculation using the CKD-EPI formula. Materials and methods: the study included 275 patients (275 (31.1%) men and 610 (68.9%) women) aged 18-89 (mean 59.5 13.95) years. GFR of 60ml/min/l.73 m3 or signs of kidney lesions were diagnosed as CKD. Possible risk factors of CKD were elucidated based on the results of a questionnaire that provided information on complaints, metabolic disorders, family histoty compliance with a healthy lifestyle. Arterial pressure and serum creatinine level were measured, BMI and GFR calculated in all patients. RESULTS: Medical histories of 58% of the 885 patients contained signs of CKD. Among the remaining 372 (42%) ones, 7.2% had proteinuria and 20.1% GFR of 60ml/min/1. 73/m3. The prevalence of newly diagnosed CKD was 27.3%. The use of the CKD-EPI formula allowed to diagnose CKD in 18% of the patients having the serum creatinine level within normal values. The overall prevalence of CKD in the study group was 14%. CONCLUSION: the prevalence of newly diagnosed CKD in patients of a therapeutic clinic was 2 7.3%. The use of the CKD-EPI formula facilitates diagnostics of CKD.