Klinicheskaia Meditsina[JOURNAL]
Sun
200 papers
[PROSPECTS FOR CLINICAL APPLICATION OF STATINS IN GASTROENTEROLOGY].
Svistunov AA, Osadchuk MA, Kireeva NV
Klin Med (Mosk) · 2016 · PMID 27522720
We present the analytical review of non-cardial effects of statins used in gastroenterology with the data illustrating their high antibacterial activity as exemplified by combined therapy of conditions associated with He...
We present the analytical review of non-cardial effects of statins used in gastroenterology with the data illustrating their high antibacterial activity as exemplified by combined therapy of conditions associated with Helicobacter pylori infection. Special emphasis is laid on anti-inflammatory and oncoprotective mechanisms of statin action that are successfully made use of for the treatment of liver, pancreas, gallbladder, and biliary system diseases. Prophylactic aspects of statin application to overcome an addiction to fast food are discussed.
[MODERN MEANS FOR THE TREATMENT OF ATRIAL FIBRILLATION IN DIABETIC PATIENTS].
Kucherenko OD, Brek VV, Shelest BA … +1 more , Kovaleva YA
Klin Med (Mosk) · 2016 · PMID 27522719
The authors discuss modern approaches to the treatment of atrial fibrillation with reference to diabetic patients. The studies carried out thus far showed the importance of differential anti-arrhythmic therapy taking acc...
The authors discuss modern approaches to the treatment of atrial fibrillation with reference to diabetic patients. The studies carried out thus far showed the importance of differential anti-arrhythmic therapy taking account of the clinical form of ciliary arrhythmia. The possibility of surgical and preventive treatment (up-stream therapy) is demonstrated.
[V.I. GEDROITS, A SURGEON AND A FOLLOWER OF CESARE ROUX OF LAUSANNE].
Blokhina NN
Klin Med (Mosk) · 2016 · PMID 27459767
The paper overviews personality formation of the woman surgeon Vera Ignat'evna Gedroits (1870-1932), a follower of the world-famous Cesare Roux of Lausanne.
The paper overviews personality formation of the woman surgeon Vera Ignat'evna Gedroits (1870-1932), a follower of the world-famous Cesare Roux of Lausanne.
[HYPEREOSINOPHILIC SYNDROME ASSOCIATED WITH SEPSIS DUE TO PAECILOMYCES FUNGI DISSEMINATED INTO THE LIVER].
Akhunov VM, Akhunova AM, Lavrent'eva TP
Klin Med (Mosk) · 2016 · PMID 27459766
A 49 year old woman with signs of chronic sepsis, hepatomegaly, and high eosinophil count was under long-term examination including consultations with an oncologist, parasitologist, and hematologist, diagnostic laparotom...
A 49 year old woman with signs of chronic sepsis, hepatomegaly, and high eosinophil count was under long-term examination including consultations with an oncologist, parasitologist, and hematologist, diagnostic laparotomy, and studies of liver biopsies. Seeding blood samples onto Saburo's medium resulted in the growth of Paecilomyces variotii Bainier colonies. Counting mature spherules of the fungus revealed 59000 spherules per 1 mcl compared with the normal value of 1000-6000 which suggested paecilomycotic etiology of sepsis. The histological study of liver biopsies demonstrated hemorrhagic foci and eosinophilic infiltrates around fungal spherules. The clinical recovery of the patient was achieved after 3 courses of pulsed terbinafine therapy (500 mg/d every other day for 14 days during a month) in combination with vitamins and i/v infusion of 100 ml of a fluconazole solution (2 mg/ml) every third day (10 procedures during a course of therapy).
[OSGOOD-SCHLATTER DISEASE].
Shamov IA
Klin Med (Mosk) · 2016 · PMID 27459765
Osgood-Schlatter disease is a specific disorder related to osteochondropathies that affects young subjects and is localized in the tuberositas tibiae. The disease frequently develops after injuries including loading ones...
Osgood-Schlatter disease is a specific disorder related to osteochondropathies that affects young subjects and is localized in the tuberositas tibiae. The disease frequently develops after injuries including loading ones. It is apparent as gradual swelling of the knee joint(s) that becomes painful. Pain increases during walking, lower limb flexion an extension or stair climbing but may die down at rest. Diagnostics is based on the clinical picture. Radiodiagnostic methods my be helpful but their efficacy is inferior to that of clinical examination. Anti-inflammatory and chondroprotective therapy, immobilization of the affected joint, controlled exercises, and balneotherapy are indicated.
[EFFECT OF CORTEXIN ON THE QUALITY OF LIFE IN THE EARLY REHABILITATIVE PERIOD AFTER HEMISPHERIC ISCHEMIC STROKE].
Belova LA, Mashin VV, Abramova VV … +2 more , Proshin AN, Ovsyannikova AN
Klin Med (Mosk) · 2016 · PMID 27459764
AIM: To study the neuroprotective effect of a repeated course of low dose cortexin therapy on the quality of life in the early rehabilitative period after hemispheric ischemic stroke (IS). MATERIALS AND METHODS: 90 patie...
AIM: To study the neuroprotective effect of a repeated course of low dose cortexin therapy on the quality of life in the early rehabilitative period after hemispheric ischemic stroke (IS). MATERIALS AND METHODS: 90 patients were divided into group 1 treated with cortexin (10 mg i/m twice daily (morning and afternoon) in addition to basal treatment, group 2 given the repeated course of the same treatment, and control group (basal therapy alone). The standard SF-36 questionnaire was used to assess the quality of life. RESULTS: Treatment of patients following acute hemispheric ischemic stroke with cortexin (10 mg i/m twice daily) and the repeated course of the same treatment after 10 days resulted in the accelerated and more complete normalization of the quality of life in the early rehabilitation petriod (starting from days 21-27 days after the onset of disease) than in the patients given a single course of cortexin therapy or basal treatment alone.
[AGE-SPECIFIC PECULIARITIES OF CLINICAL PICTURE AND EVOLUTION OF ACUTE CHOLECYSTITIS].
Balayan GZ
Klin Med (Mosk) · 2016 · PMID 27459763
The problem of acute cholecystitis is now becoming ever more urgent bearing in mind a rise in morbidity and poor treatment results especially in elderly patients. Hence, the importance of studying age-specific peculiarit...
The problem of acute cholecystitis is now becoming ever more urgent bearing in mind a rise in morbidity and poor treatment results especially in elderly patients. Hence, the importance of studying age-specific peculiarities of clinical picture and evolution of this condition. The present study included 1273 patients with acute cholecystitis divided in 2 groups. It was shown that patients of advanced age more frequently suffer complicated cholecystitis. It is concluded that patients aged 60 years and more make up a high-risk group characterized by mildly manifest clinical symptoms and hospitalization at the late stages of the disease.
[MULTIDISCIPLINARY TEAM APPROACH FOR DIABETIC FOOT PATIENTS IN AN OUT-PATIENT CLINIC].
Komelyagina EY, Volkovoy AK, Sanbanchieva NI … +3 more , Zaichikova MF, Maksimov NV, Antsiferov MB
Klin Med (Mosk) · 2016 · PMID 27459762
AIM: To assess the effectiveness of multidisciplinary team approach in daily practice of diabetic foot. MATERIALS AND METHODS: 376 diabetic patients (446 ulcers) treated in a diabetic foot department in 2014 were examine...
AIM: To assess the effectiveness of multidisciplinary team approach in daily practice of diabetic foot. MATERIALS AND METHODS: 376 diabetic patients (446 ulcers) treated in a diabetic foot department in 2014 were examined. All patients were screened for diabetic peripheral polyneuropathy and blood insufficiency of lower extremities in order to diagnose the type of diabetic foot ulcer: neuropathic or neuroischemic. Patients were treated by a multidisciplinary team. The number of healed ulcers, minor and major amputations was analyzed. RESULTS: 80% of diabetic foot ulcers were neuropathic with normal blood supply, 20% had signs of ischemia. 77.8% of the ulcers healed in the general group during the study period. 13 amputations (2.9%) were done in the study group: 7 minor amputations (1.6%), 2 below the knee (0.4%), and 4 above knee (0.9%). Two patients died from cardiovascular events (0.4%). The comparative analysis of outcomes of neuropathic and neuroischemic ulcers showed that 84% of neuropathic ulcers healed. Minor amputations were done in 1% of the cases, no major amputations were performed. In patients with neuroischemic ulcers, 60% of them healed, minor amputations were made in 3.4% of cases (2.3% below knee, 4.6% above knee). CONCLUSION: The majority of diabetic ulcers in the study group were neuropathic with normal blood supply. The main risk factor of major amputations is ischemia of the affected limb. The multidisciplinary team approach in daily practice of the diabetic foot department of an out-patient clinic is instrumental in healing ulcers and minimizing the risk of major amputations.
[THE INFLUENCE OF ADIPONECTIN AND LEPTIN LEVELS ON MYOCARDIAL REMODELING IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND GOUT].
Sharonova La, Verbovoj Ae, Canava La … +1 more , Verbovaja N
Klin Med (Mosk) · 2016 · PMID 27459761
BACKGROUND: There is a growing number of patients with type 2 diabetes mellitus. As a component of the metabolic syndrome, type 2 diabetes is often associated with hyperuricemia and gout. These diseases worsen prognosis...
BACKGROUND: There is a growing number of patients with type 2 diabetes mellitus. As a component of the metabolic syndrome, type 2 diabetes is often associated with hyperuricemia and gout. These diseases worsen prognosis of concomitant cardiovascular disorders. PURPOSE: To assess the relationship between adiponectin and leptin levels and echocardiographic parameters in patients with type 2 diabetes mellitus, gout, and a combination thereof. MATERIALS AND METHODS: The study involved 30 men aged 41 to 70 years divided into 3 groups. The first group included 10 patients with type 2 diabetes, the second one 10 patients with gout, and the third group consisted of 10 men with a combination of type 2 diabetes and gout. In all patients the levels of glucose, immunoreactive insulin, HOMA-IR, adiponectin, and leptin were measured. All patients underwent echocardiography. RESULTS: The study revealed hyperglycemia in patients with type 2 diabetes and its combination with gout. Patients of all three groups had increased insulin resistance, insulin and leptin levels, decreased concentration of adiponectin. The thickness of interventricular sepum in systole and diastole, posterior wall of the left ventricle in diastole, myocarduial mass of the left ventricle, the size of the left atrium and the right ventricle increased in patients of all three groups. CONCLUSION: The study demonstrated compensatory hyperinsulinemia and insulin resistance, hypoadiponectinemia, hyperleptinemia, left ventricular hypertrophy, diastolic dysfunction, and intact ventricular contractility in patients with type 2 diabetes, gout, and their combination. Hypoadiponectinemia and hyperleptinemia play a role in remodeling of myocardium in these patients.
[CLINICAL AND PATHOGENETIC PECULIARITIES OF DEVELOPMENT OF ENDOTHELIAL DYSFUNCTION].
Mamaeva MG, Demko IV, Salmina AB … +5 more , Sobko EA, Malinovskaya NA, Kraposhina A Yu, Gordeeva NV, Solov'eva IA
Klin Med (Mosk) · 2016 · PMID 27459760
The purpose of the study was to examine the relationship between functional parameters, arterial rigidity, lipid profile, markers of systemic inflammation and endothelial dysfunction in patients with COPD and COPD + coro...
The purpose of the study was to examine the relationship between functional parameters, arterial rigidity, lipid profile, markers of systemic inflammation and endothelial dysfunction in patients with COPD and COPD + coronary heart disease. We examined 110 subjects divided into 3 groups. G group 1 included 40 patients with severe and very severe COPD, group 2 consisted of 40 patients with severe and very severe COPD + coronary artery disease, the control group was comprised of 30 healthy volunteers. We studied parameters of respiratory function, the level of blood oxygenation, the main characteristics of arterial rigidity plasma lipid, TNF-α, CRP, fibrinogen, sPECAM-1 levels and the expression of CD38/ADP-ribosylcyclase in peripheral blood lymphocytes. The study revealed increased rigidity of the central arteries in the patients of groups 1and 2 regardless of the duration of observation and the presence of coronary artery disease, as evidenced by the increase of the pulse wave velocity in the aorta. Patients of both groups had elevated levels of TNF-α, CRP and fibrinogen indicating systemic inflammatory response. Taken together, the enhanced expression of CD38 in peripheral blood lymphocytes, elevated concentration of soluble CD31 (sPECAM-1) in both groups related to bronchial obstruction and neutrophil elastase activity as well as increased rigidity of the vascular bed gives evidence that the CD38 and sCD31 relationship plays a role in the formation of endothelial dysfunction, and dysregulation of vascular tone in COPD patients. Disorders of lipid metabolism combined with increased rigidity of the vascular wall, elevated levels of markers of systemic inflammation and endothelia dysfunction, suggest that patients with COPD are at risk of cardiovascular events.
[NERVOUS SYSTEM LESIONS ASSOCIATED WITH RELAPSING POLYCHONDRITIS: ANALYSIS OF ORIGINAL OBSERVATIONS].
Chernyak VI, Savel'ev A I, Men'shikova IV … +1 more , Pogromov AP
Klin Med (Mosk) · 2016 · PMID 27459759
Three clinical cases are described including two of relapsing polychondritis with lesions in the central and peripheral nervous system (one of long-standing aseptic lymphocytic meningitis and one of cranial neuropathy of...
Three clinical cases are described including two of relapsing polychondritis with lesions in the central and peripheral nervous system (one of long-standing aseptic lymphocytic meningitis and one of cranial neuropathy of 2, 5, 7, and 8 pairs) and the third case of the optic nerve lesion with amblyopia. The two former cases were successfully treated with high doses of corticosteroids, the third one with moderate doses of the same medications. The data from the current literature concerning variants of clinical manifestations, methods for diagnostics and treatment of neurologic manifestations of relapsing polychondritis are discussed.
[DELAYED CORONARY SURGERY FOR THE TREATMENT OF ACUTE MYOCARDIAL INFARCTION WITH ELEVATED ST SEGMENT].
Gazaryan GA, Gazaryan GG, Evstratova SG … +3 more , Grigor'yan KS, Chepkiy DA, Golikov AP
Klin Med (Mosk) · 2016 · PMID 27459758
To develop algorithms of reperfusion therapy (RT) based on the assessment of the initial risk of death determining the priority use of delayed transdermal coronary surgery (TCS) unavailable in the early period. We compar...
To develop algorithms of reperfusion therapy (RT) based on the assessment of the initial risk of death determining the priority use of delayed transdermal coronary surgery (TCS) unavailable in the early period. We compared effectiveness of different strategies for the treatment of 1245 patients with acute myocardial infarction (MI) and elevated ST segment in 2003-2007 including various TCS modalities at recommended time (n = 88), delayed TCS within 24-72 hr after the onset of MI (n = 194), thrombolytic therapy without subsequent TCS (n = 275), and conservative therapy (N = 688). The general and cardiovascular lethality was evaluated among 474 patients 5 years after discharge. The results suggest that unavailability of TCS in recommended time in case of enhanced risk of death does not exclude the possibility of its delayed application. TCS 24-72 hr after the onset of MI prevents complications and the fatal outcome the frequency of which remains high remains high not only in the early but also in the late post-infarction period. Delayed TCS can be effectively used to treat patients in case of their late admission or referral from other hospitals where X-ray endovascular methods for the treatment of acute MI are not used.
[TYPE 2 DIABETES MELLITUS AND DEPRESSION].
Kravchenko AY, Esaulenko IE, Sahnenko VV … +2 more , Budnevskyj AV, Podvygyn SN
Klin Med (Mosk) · 2016 · PMID 27459757
The clinical significance of type 2 diabetes mellitus is not confined to metabolic disorders. A serious problem is also affective pathology that occurs in the majority (30-70%) of patients. However, diagnostics and corre...
The clinical significance of type 2 diabetes mellitus is not confined to metabolic disorders. A serious problem is also affective pathology that occurs in the majority (30-70%) of patients. However, diagnostics and correction of anxiety and depressive disorders associated with diabetes are often given insufficient attention. Many studies showed relationship between affective disorders and low adherence to the prescribed treatment resulting in general deterioration of clinical prognosis of diabetes. This review article describes the basic mechanisms behind the interrelation of affective disorders and diabetes. The role of persistent subclinical inflammation in diabetes and depression is discussed. The influence of emotional stress on the activation of the hypothalamic-pituitary-adrenal axis on the overproduction of cortisol is emphasized. The similarity of some structural changes in the brain tissue in diabetes and depression is discussed. Effect of endocrine disruption in the emotional sphere is demonstrated. Mechanisms responsible for the development of diabetes and its complications provoked by depression are considered.
[NEWS IN ETIOLOGY AND PATHOGENESIS OF IRRITATED BOWEL SYNDROME].
Sheptulin AA, Vize-Khripunova MA
Klin Med (Mosk) · 2016 · PMID 27459756
The concept of irritated bowel syndrome as a complex of functional disorders that can not be explained by organic changes and are totally due to intestinal motility and visceral sensitivity needs revision. The developmen...
The concept of irritated bowel syndrome as a complex of functional disorders that can not be explained by organic changes and are totally due to intestinal motility and visceral sensitivity needs revision. The development of this syndrome also depends on a number of pathogenetic and etiological factors, such as inflammation of intestinal mucosa, changes of its permeability, previous infection, altered microflora, gene polymorphism, and food hypersensitivity.
[META-ANALYSIS OF CLINICAL STUDIES ON THE USE OF STATINS FOR PREVENTION OF ATRIAL FIBRILLATION SOON AFTER CORONARY BYPASS SURGERY].
Bokeriya OL, Akhobekov AA, Shvarts VA … +2 more , Glushko LA, Le TG
Klin Med (Mosk) · 2016 · PMID 27459755
BACKGROUND: Atrial fibrillation (AF) develops in the early postoperative period in each third patient undergoing coronary bypass surgery (CBPS). Multifactorial pathogenesis of postoperative AF is unclear. The concept of...
BACKGROUND: Atrial fibrillation (AF) develops in the early postoperative period in each third patient undergoing coronary bypass surgery (CBPS). Multifactorial pathogenesis of postoperative AF is unclear. The concept of postoperative inflammation as a potential basic mechanism of this condition has been implied in many studies. Pre- and postoperative treatment with antiinflammatory statins proved beneficial as a means for reducing the frequency of AF. MATERIALS AND METHODS: The meta-analysis is based on the results of 15 clinical studies carried out in the last 15 years. They included 9369 patients of whom 5598 (59.75%) used statins and 3771 (49.25%) did not receive them. The following endpoints were evaluated in the early postoperative periods: fiequency of AF, overall lethality, frequency of cerebral circulation disorders and myocardial infarction. Odds ratio (OR) and 95% CI were calculated, levels of inflammation markers before and after surgery and duration of hospitalization were determined. RESULTS: Statins decreased the frequency of AF soon after CBPS (OR 0,481 at 95% CI 0,345-0,672; p = 0,000), they did not influence overall lethality (OR 0,837 at 95% CI 0,501-1,399: p = 0,497) and frequency of myocardial infarction (OR 1,001 at 95% CI 0,702-1,426; p = 0,997), but decreased frequency of cerebral circulation disorders (OR 0,067 at 95% Cl 0,037- 0,121; p = 0,000). Also, they reduced duration of hospitalization and serum levels of inflammation markers. CONCLUSION: Results of clinical studies available to date leave no doubt that statins produce anti-inflammatory and anti-arrhythmic effects. Meta-analysis of relevant studies confirmed on the whole the positive role of statin therapy prior to CBPS.
[WILSON-KONOVALOV'S DISEASE IN TWO SISTERS: DIFFERENCES IN THE CLINICAL PICTURE AND SUCCESSFUL THERAPY].
Ignatova TM, Solov'eva O V, Arion EA … +2 more , Balashova MS, Rozina TP
Klin Med (Mosk) · 2016 · PMID 27172728
Wilson-Konovalov's disease is a rare genetic pathology of copper metabolism that in the first place affects liver and CNS. Due to autosomal-recessive inheritance of this condition, it most frequently occurs in sibs. We r...
Wilson-Konovalov's disease is a rare genetic pathology of copper metabolism that in the first place affects liver and CNS. Due to autosomal-recessive inheritance of this condition, it most frequently occurs in sibs. We report a case of Wilson-Konovalov's disease in two sisters differing in its clinical course: severe abdominal variant in the younger sister and largely neurologic form in the elder one. This observation demonstrates clinical variability of Wilson-Konovalov's disease, the possibility of its late clinical manifestation (at the age 45 years), the necessity of examination of all sibs of a proband regardless of age, and the possibility of radical improvement of prognosis even when the disease is diagnosed at the stage of decompensated liver cirrhosis.
[CLINICAL ASPECTS OF SEPTIC ENCEPHALOPATHY].
Fesenko OV, Sinopal'nikov AI, Filatov VV … +2 more , Danishevsky SV, Styrt EA
Klin Med (Mosk) · 2016 · PMID 27172727
Septic encephalopathy is a form of general cerebral dysfunction caused by a systemic inflammatory reaction. Its investigation encounters enormous difficulties for the lack of reliable biological markers of neuronal lesio...
Septic encephalopathy is a form of general cerebral dysfunction caused by a systemic inflammatory reaction. Its investigation encounters enormous difficulties for the lack of reliable biological markers of neuronal lesions and methods for the evaluation of consciousness in severely ill patients. Hence, the importance of correct clinical interpretation of the character and magnitude of CNS activity. Examples are presented demonstrating the difficulty of interpreting disorders in CNS activity associated with evere community-acquired pneumonia.
[PNEUMOCOCCAL VACCINE IN ADULTS REDUCES THE RISK OF INFECTIONS CAUSED BY STREPTOCOCCUS PNEUMONIAE].
Belocerkovskaja JG, Romanovskih AG, Styrt EA
Klin Med (Mosk) · 2016 · PMID 27172726
Streptococcus pneumoniae is a major cause of severe disease worldwide, particularly in the risk population. Two pneumococcal vaccines are currently available for specific prevention of pneumococcal infections among adult...
Streptococcus pneumoniae is a major cause of severe disease worldwide, particularly in the risk population. Two pneumococcal vaccines are currently available for specific prevention of pneumococcal infections among adults in Russia: a 23-valent pneumococcal polysaccharide vaccine (PPSV23) and a 13-valent pneumococcal conjugate vaccine (PCV13). The article describes modern views on the effectiveness and safety of two pneumococcal vaccines in adults with underlying medical conditions and adults aged ≥ 65 years and provides current recommendations for routine use of PPSV23 and PCV13 among persons included in the risk group.
[ANEMIC SYNDROME IN PATIENTS WITH COMMUNITY-ACQUIRED PNEUMONIA].
Budnevsky AV, Esaulenko IE, Ovsyannikov ES … +3 more , Labzhaniya NB, Voronina EV, Chernov AV
Klin Med (Mosk) · 2016 · PMID 27172725
Community-acquired pneumonia remains a most widespread acute infectious disease of socio-economic significance all over the world. Up to 30% of the patients present with anemia responsible for the unfavourable prognosis...
Community-acquired pneumonia remains a most widespread acute infectious disease of socio-economic significance all over the world. Up to 30% of the patients present with anemia responsible for the unfavourable prognosis and elevated mortality. Not infrequently, anemia is not diagnosed during the hospital stay und therefore remains uncorrected. Severe anemia results in enhanced hypercapnia and slowed maturation of red blood cells in the bone marrow which facilitates the development of ischemic syndrome. Hepcidin, a mediator of inflammation and iron-regulatory hormone, plays an important role in the clinical course of community-acquired pneumonia. Hepsidin production increases during inflammation; it suppresses erythtropoiesis and depletes the iron depot leading to so-called anemia of inflammation. Hypoxia and anemia activate erythtropoiesis, and the released erythropoietin inhibits hepsidin production. During pneumonia resolution, hepsidin promotes recovery from anemia by activating iron absorption. The curreni literature contains few data on the use of hepcidin as a diagnostic marker of anemia. The necessity oftreating anemia in patients with pneumonia under hospital conditions is a matter of discussion. Direct involvement of hepcidin in iron metabolism creates a prerequisite for the treatment of anemia. Medicamental suppression of its activity by stimulating erythtropoiesis can facilitate normalization of iron metabolism and restoration of hemoglobin level.
[HYPERTENSIVE CRISIS: MODERN VIEW OF THE PROBLEM AND OPTIMIZATION OF DIAGNOSTIC AND THERAPEUTIC MODALITIES].
Kryukov EV, Potekhin NP, Fursov AN … +3 more , Chernetsov VA, Chernov SA, Zakharova EG
Klin Med (Mosk) · 2016 · PMID 27172724
The data collected by Burdenko Military Hospital indicate that in the 1980s hypertensive crisis (HC) occurred in roughly 30% of the patients with AH. This value fell down to 16% by 2012, with a rise in the number of unco...
The data collected by Burdenko Military Hospital indicate that in the 1980s hypertensive crisis (HC) occurred in roughly 30% of the patients with AH. This value fell down to 16% by 2012, with a rise in the number of uncomplicated crises from 46 to 62%. Analysis of the causes behind these changes showed that half of the patients simply experienced an elevated arterial pressure with minimal clinical symptoms. The decrease in the number of complicated cases from 54 to 39% is doubtful bearing in mind that ICD-10 gives the status of nosological entities to complications of hypertensive crisis (stroke, myocardial infarction, etc.) but not to the HC syndrome proper requiring urgent hospitalization; due to this hypertensive crisis itself tends to be disregarded and not included in statistics. HC with acute clinically significant lesions of target organs requires intensive care or resuscitation using infusion of vasodilators and loop diuretics to stabilize arterial pressure. In case of uncomplicted HC and aggravation of hypertensive disease, the medications of choice are oral short-acting ACE inhibitors and imidazoline receptor agonists.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe