Окончание. Начало читайте в Томе 6, номере 2(28)-2016 г.

Окончание. Начало читайте в Томе 6, номере 2(28)-2016 г.

The present review of the literature reflects issues of the colchicine’s pharmacological properties and mechanism of action. The authors provided the results of a number of scientific studies dedicated to the effects of colchicine on the cardiovascular pathology.

Mitral valve prolapse (MVP) is a congenital heart disease, fairly widespread in the population (2-8%). It rarely has complications, but they are serious and include sudden cardiac death (SCD), risk of which rises twofold from 0.2-0.4% cases by MVP. Most deaths are observed among young healthy women. This work is a review of literature dedicated to connection between MVP and SCD designed to explore possible predicts of SCD within patients suffering from MVP and to determine the subset of patients. A conclusion has been made that the connection between MVP and SCD is realized through life-threatening ventricular arrhythmias (VT, VF). The most common site of arrhythmias origin is the inferobasal left ventricular wall. A high-risk subset of patients is determined as young adult women with a midsystolic click at auscultation, bileaflet involvement of the mitral valve, T-wave abnormalities on inferior leads (II, III, aVF) and frequent complex ventricular ectopic activity. Such patients require more intensive disease management of ventricular arrhythmias including consideration of surgical treatment.

Gallstone disease (GSD) affects about 10% of the population, while in recent years it has gained a steady growth trend. In the structure of risk factors of gall stone formation are age and gender characteristics. In women, this is a multiple pregnancy and birth — relative risk (RR) is 4,62, body mass index more than 26 — RR 4,57, failure to observe principles of a balanced diet — RR 3,94. In men, the importance of physical inactivity — RR 4,25, an increase of atherogenic coefficient — RR 3,87 and burdened by GSD genetics — RR 2,05. Clinical manifestations of gallstone disease among people of young age are attacks of biliary colic, often wearing a protracted with jaundice. For people of elderly and senile age is characterized by a latent period of GSD, manifested by dull pain. Such a flow acquires a GSD in the stone stage, culminating, as a rule, a cholecystectomy. Successful prevention is only possible in the early (documeny) stage GSD. In the diagnosis of early stages of gallstone disease by ultrasound (detection of biliary sludge) and study the physicochemical properties of the cystic and hepatic bile. In the review contemporary data on the possibility of conservative treatment and prevention of gallstone disease.

Disease, with exanthema, pose a significant differential diagnostic difficulty for physicians multidisciplinary hospitals and require the consultation of an infectious disease physician. The article highlights the problem of early diagnostics of acute infectious diseases proceeding with exanthema. The analysis of quality of diagnostics of infectious disease on the outcomes of the consultative infectious ambulance team for 2013-2014.

Objective of the research: to assess the comparative efficiency and long-term results of treatment of rheumatic arthritis (RA).

Materials and methods: 80 RA patients have been examined. Of those, 40 patients (Group I) were administered with NSAIDs: Diclofenac 150 mg (daily dose), GCS: Prednisone 10 mg (daily dose), group II — 40 patients received NSAIDs, GCS and DMARDs: Methotrexate 10 mg (weekly dose). Dynamics of RA activity was assessed by DAS28 score at the beginning of the treatment course, then after 10 days, 6 months and 12 months, respectively, taking into account the radiological stage of the disease.

Results: a comparative study of the effectiveness of therapy in dynamics immediately after in-patient treatment showed a decrease of the DAS28 score: RA patients with X-ray stage 1 by 3,4% in group I (not treated with DMARDs) and 6,4% in the group II (treated with DMARDs), compared to their first day in the clinic; X-ray stage 2: group I — 4,2%, group II — 8,5%; X-ray stage 3: reduction in DAS28 index in both groups was approx 1,8%. After 6 months of treatment a decrease in DAS28 in patients with X-ray stage 1 amounted to 6,7% and 12,9%, X-ray stage 2 — 8,3% and 6,3%, X-Ray stage 3 — 1,8% and 6,8% for two groups, respectively. After 12 months of treatment a decrease in DAS28 in patients with X-ray stage 1 amounted to 10,0% and 22,5%, X-ray stage 2 — 12,5% and 14,9%, X-Ray stage 3 — 7,1% and 13,7% for both groups, respectively.

Conclusions: our research of the DMARDs effect on DAS28 score includes basic manifestations of immune and inflammatory process clearly showed the target effect of DMARDs on the rheumatoid process in dynamics of observation within 12 months. A study of the effectiveness of therapy in patients with RA showed significant efficacy of DMARDS in combination therapy with an analysis of the efficiency based on DAS28 score until stable remission of the disease.

It was performed the evaluation of the clinical efficacy of taurine in the treatment of postinfarction cardiosclerosis (PIC). 57 patients (mean age 60,2 ± 14,3 years) with evidence of PIC and angina. When incorporated into standard therapy taurine showed a statistically significant improvement (compared to placebo) subjective performance status patients, normalize echocardiographic indices (increase of the ejection fraction) and laboratory parameters (reducing the concentration of total cholesterol, triglycerides, low density lipoprotein). The changes revealed clinical and instrumental parameters are stored for 3 months after receiving taurine. It is recommended to add taurine in a daily dose of 750 mg to standard therapy in patients with postinfarction cardiosclerosis with a view to its potentiating effect by improving the metabolic processes in the myocardium.

Coronary heart disease (CHD) is a major cause of mortality. Morphological substrate of CHD in most cases is atherosclerosis, which is based on structural genes polymorphism eNOS and AGTR2. The aim of the study was to study the prevalence of eNOS and AGTR2 genes in patients with coronary artery disease and the association of these genes with coronary heart disease. The study involved 187 patients aged 36 to 86 years (62,2±11,2) with different forms of CHD: stable and unstable angina, myocardial infarction and 45 people without CHD. Determination of gene polymorphisms was performed by real-time PCR analyzer of nucleic acids IQ 5 Bio-Rad. Statistical analysis was performed using Statistica 10.0. The study revealed a significant difference between the incidence of homozygous AA allelic variant gene AGTR2 group of patients with myocardial infarction and the comparison group; polymorphic variant AA AGTR2 gene is associated with earlier onset of coronary artery disease; It found that carriers of the polymorphic variant gene GA AGTR2 beginning statistically CHD occurred significantly later than in carriers of alleles GG and AA; age CHD debut TT allele carriers of the eNOS gene is associated with an earlier onset of the disease and statistically significantly different from the age of first CHD in carriers of alleles of polymorphic variants of GG and GT; revealed a positive correlation between the polymorphic allele AGTR2 gene with the presence of arterial hypertension in patients with coronary artery disease; It determined that the T allele carriers of the polymorphic gene eNOS is associated more early onset of hypertension, found the association of the polymorphic allele gene AGTR2 the need to use higher doses of ACE inhibitor — perindopril.

Purpose of the study. To carry out a comparative description of the clinical and biochemical parameters at patients with cirrhosis of an alcoholic genesis (CP-HGA) and cirrhosis of mixed etiologies — CP-HGM (HСV+ alcohol).

Materials and methods. The study involved 62 patients with cirrhosis of different etiologies, who carries out clinical, immunogenetic and biochemical studies.

Results. Patients with the 3d genotype and low viral load were registered with cirrhosis of mixed etiologies (HСV+ alcohol). At the cirrhosis Class B for Child-Pugh basic data biochemical parameters were similar in patients with CP-HGA and CP-HGM, but ALT and AST activity, which are significantly higher than observed in patients with CP-HGM. At dismissal, ALT and GGT activities were detected significantly higher in patients with CP-HGM than the CP-HGA. At the cirrhosis Class C for Child-Pugh the baseline, reflecting cholestasis — is total bilirubin, GGT and alkaline phosphatase and were detected significantly higher in the CP-HGA, than with CP-HGM significantly reduced, and thore is no differences between the groups to be discharged from the hospital, in addition to the activity of GGT, which it remained significantly higher in the CP-HGA, than with CP-HGM. Cytolytic activity of enzymes (ALT, AST) during the entire period of the disease was observed significantly higher normal values and did not depend on the CP etiology.

Conclusion decision. The maximum rate of change of the basic biochemical parameters is observed in patients with cirrhosis of mixed etiologies Class B for Child-Pugh and at the cirrhosis of an alcoholic genesis — in patients with cirrhosis Class C.

Research objective. To define features of a course of dissecting aortic aneurysm now.

Materials and methods. 11 clinical records of the patients with the established diagnosis of dissecting aortic aneurysm who have come to Regional clinical hospital of Saratov for 2015 are analysed.

Results. Along with traditional risk factors, such as the male, existence of arterial hypertension are revealed also additional risk factors, in particular, regular heavy lifting. Gender features in localization of dissecting aortic aneurysm are defined: at men more often of dissecting aortic aneurysm of an aorta is localized in the abdominal aorta, at women in the thoracic region.

Conclusions. Additional risk factor of stratification of dissecting aortic aneurysm in the thoracic region at women is the systematic raising of weights.

The article deals with modern concepts of etiopathogenesis, clinic, diagnosis and treatment of hypoparathyroidism. Pathophysiological mechanisms of clinical symptoms are described. The paper contains the analyzis of autoimmune hypoparathyroidism clinical case.