[Efficacy and safety of micronized purified flavonoid fraction (MPFF) in treatment of venous diseases in geriatric patients]. / Éffektivnost' i bezopasnost' MOFF pri lechenii zabolevanii ven u gerontologicheskikh patsientov.

Analysed herein is the experience with micronized purified flavonoid fraction (MPFF) in treatment of geriatric patients with decompensated forms of chronic venous diseases. A total of 218 geriatric patients were examined and treated. Of these, 132 patients had trophic disorders (C4-C6 class), including 40 patients found to have venous trophic ulcers (VTU). Therapeutic policy consisted in wound cleansing, application of topical antiseptics, hydroalginate dressing, stimulation of regenerative processes by therapy with MPFF at a dose of 1,000 mg daily. The microcirculatory blood flow was examined by means of laser Doppler flowmetry. By the end of a 4-week course of comprehensive treatment, 31 of 40 patients were found to have elevated microcirculation index to 16.9±2.1 perfusion units, suggesting improved perfusion of the lower-limb skin. Venous trophic ulcers completely epithelialized in 9 patients and decreased by half of their initial area in 22 patients. Repeat assessment of cardiac activity showed a decreased functional class of chronic heart failure in 9 of 17 patients with healed VTU. Assessing safety of phlebotrophic therapy revealed neither adverse reactions nor decompensation of accompanying diseases during the whole follow-up period.

[Ormond's disease complicated by infectious endocarditis].

A case of retroperitoneal fibrosis (Ormond's disease) is reported. It is known to be usually diagnosed at the late stages of renal complications Urinary infection ended in infectious endocarditis caused by E. faecium showing multiple resistance to antibiotics. Moderate immunosuppressive and modern antibacterial (daptomycin) therapy ensured remission of both Ormond's diseases and endocarditis.

[Comparative efficacy of infliximab and adalimumab in patients with rheumatoid arthritis].

We compared the efficacy of recombinant infliximab and adalimumab in patients with severe and moderately severe rheumatoid arthritis. Infliximab produced rapid anti-inflammatory effect in the early period of therapy whereas adalimumab ensured more stable reduction of clinical and laboratory parameters of activity.

[Effectiveness and safety of losartan and its combination with amlodipine in therapy of arterial hypertension].

AIM: To estimate effectiveness and safety of losartan and its combination with amlodipine in therapy of arterial hypertension. MATERIALS AND METHODS: The study based at 6 clinical centres was conducted in two stages. All 160 patients with grade I-II AH (103 women and 57 men aged 54 ± 12 yr) participated in stage 1 of the study and patients of centre No 1 (n = 100) in stage 2. Losartan was used at a dose of 50-100 mg/24 h for 8 weeks (stage 1) and thereafter from week 9 to 26 (stage 2) in combination with amlodipine (5-10 mg/24 hr) if the desired AP level (< 140/90 mmHg) was not achieved. The following parameters were measured: systolic and diastolic AP (SAP and DAP) (office measurement and 24-hr monitoring), pulse wave propagation rate (PWPR), left ventricle mass index (LVMI), thickness of intima-media complex (IMT), blood biochemistry, tolerability of therapy and its side effects. RESULTS: Losartan alone decreased SAP and DAP from 150 ± 11/91 ± 7 to 132 ± 12/81 ± 8 mm Hg (office measurement) and from 144 ± 10/86 ± 9 to 128 ± 12/76 ± 10 mm Hg (24-hr monitoring); heart rate decreased fom 74 ± 8 to 70 ± 8/min (p < 0.05). SAP and DAP in 66 patients who completed stage 2 was 122 ± 6/73 ± 6 mm Hg or significantly lower than before therapy (147 ± 9/87 ± 9) (p < 0.001). Mean daily decrease of SAP and DAP according to 24-hr monitoring decreased from 144 ± 10 to 128 ± 12 and from 86 ± 9 to 76 ± 10 mm Hg respectively (p < 0.001). The target AP value was reached in 73% of the cases (99 out of 136 patients) after stage 1 and in 95% cases (63 out of 66) after stage 2. The values of LVMI (105 ± 23 and 98 ± 26 g/m2), PWPR from 16 ± 2.1 to 13 ± 3.5 m/s (p < 0.05), IMT (0.76 ± 0.16 and 0.80 ± 42 mm), and microalbuminuria (11.0 ± 1.7 and 8.6 ± 0.7 mg/24 hr) before and after completion of stage 2 were not significantly different in 66 patients (p > 0.05). Biochemical parameters of blood did not appreciably change. The safety profiles of both drugs were on the whole positive. Deaths and adverse reactions were absent barring clinically insignificant side effects in 28 of the 160 patients (17.5%). CONCLUSION: Losartan and amlodipine are effective and safe agents for AH therapy.

[Daptomycin in the treatment of infectious endocarditis].

Overcoming polyresistance of pathogens of infectious endocarditis (IE) is only possible through the use of new antibiotics, such as daptomycin, that was successfully used in 4 patients. The clinical features of endocarditis caused by Enterococcus faecalis resistant to penicillin, gentamicin, and streptomycin are described. Cases of IE with negative blood cultures and a failure of previous antibacterial therapy are considered. The literature data on the use of daptomycin in IE caused by oxacillin-resistant S. aureus are presented along with the information on valve prosthetics, peculiarities of IE in pregnant women and patients on hemodialysis.

[Novel endoscopic terminology: NBI visualization].

AIM: To develop new criteria of gastric and duodenal mucosa image assessment using endoscopic system for narrow band imaging (NBI). MATERIAL AND METHODS: Endoscopic and morphological findings were compared in 460 patients with different chronic diseases of the stomach and duodenum. Esophagogastroduodenoscopy was made according to the standard technique by the gastroduodenoscope EVIS EXERA-II GIF H180 (Olympus, Japan) with NBI-system. Biopsy material was studied by standard pathomorphological techniques. RESULTS: The novel system of the visual picture evaluation during conduction of endoscopic investigations in monochromatic light provides higher significance of identification of inflammatory and destructive processes in mucosa including foci of structural alterations, their location and extent. CONCLUSION: We propose a protocol for description of the endoscopic picture in conduction of examinations with application of the NBI-system of visualization in monochromatic light. It can help physicians to correctly estimate the image and interpret the detected changes.

[Atrophic gastritis as a pre-cancer gastric condition: a new view of the old problem].

The aim of the work was to study the relationship between structural changes in gastric mucosa affected by atrophic gastritis and inflammation associated with Hp infection. Endoscopic examination and NBI-visualization were used to assess distribution and severity of inflammation in 500 patients with different gastric pathologies. Histological material was studied to detect Hp. Structural changes of metaplastic type most frequently occurred in patients with atrophic gastritis (72 of 81, 88.9%), surface and erosive gastritis (13 or 3.5% and 16 or 14.3% respectively), p < 0.001. Hp infection and inflammatory-destructive changes showed no apparent trends. Mucosal changes characteristic of atrophy were only rarely accompanied by marked inflammation (14.8%) and were either mild (21%) or moderately severe (64.2%). It suggests that atrophy of gastric mucosa should be regarded as independent condition while the term atrophic gastritis should be used only in case of association between atrophy and inflammation confirmed by microscopic studies.

[Chronic duodenitis: new aspects of endoscopic diagnosis with the use of NBI-technology].

The study was designed to evaluate the scope of applications of the new digital videoendoscopic NBI-technology for the diagnosis of chronic duodenitis (CD), the prevalence and clinical manifestations of this pathology. Of 287 patients with CD, 102 were examined using a GIF-H180 EVIS Exerall apparatus (Olympus, Japan) equipped with the NBI system. Control patients were examined with conventional fiber-optic and videoendoscopes GIF-Q49 and GIF-Q160 EVIS Exeral (Olympus, Japan). Evaluation encompassed endosopic signs of inflammation, its spread, and severity. It was shown that manifestations of inflammation of duodenic mucosa correlated with the endoscopic picture in the NBI regime and results of histological studies. The use of the NBI-technique in routine oesophagogastroduodenoscopy of patients with CD enhances efficiency of detection of even mild inflammatory reactions in duodenal mucosa from 20 to 72.5% (P < 0.05).

[Endoscopic diagnosis of erosive and ulcerative lesions in the stomach and duodenum using NBI technology].

The study was designed to assess the value of a new NBI-based digital videoendoscopic system for the diagnosis of erosive and ulcerative lesions in the stomach and duodenum of 136 patients in comparison with 185 ones examined with the use of conventional fiber-optic and videoendoscopes. Patients of group 1 were examined using a GIF-H180 EVIS Exera-I apparatus ("Olympus", Japan), controls with GIF-Q40 and GIF-Q160 EVIS Exera-II endoscopes ("Olympus", Japan). Endoscopic signs of inflammation, its extent and severity were recorded. NBI endoscopy revealed perifocal inflammatory changes associated with ulcerative lesions in the stomach and duodenum as spots of different tones of blue. This method allowed for the detection of lesions not visualized by conventional techniques. The use of NBI technology for routine endogastroduodenoscopy in patients with erosive and ulcerative lesions in the stomach and duodenum improves visualization of even minor changes in gastric and duodenal mucosa (p < 0.05).

[Potentialities of digital videoendoscopic diagnosis of Helicobacter infection in chronic inflammatory diseases of the stomach and duodenum].

The aim of the study was to evaluate efficiency of a new endoscopic diagnostic tool based on the NBI-technology for the detection of Helicobacter pylori (Hp) content. A total of 294 patients with chronic inflammatory diseases of the stomach and duodenum were examined for the assessment of severity and extent of inflammatory processes. Staining intensity of gastric and duodenal mucosa in the NBI regime was shown to correlate with the degree of inflammation. Gastric metaplastic foci could be visualized due to their deep blue staining. Their distribution was unrelated to Ph occurrence and content. It is concluded that the use of the NBI technology for routine oesogastroduodenoscopy improves visualization of inflammatory changes in gastric and duodenal mucosa.

[Efficiency of new NBI technology for endoscopic examination of patients with chronic gastritis].

The aim of this work was to compare efficiency of a new digital endoscopic system in combination with the NBI technology and routine endoscopic examination of patients with chronic gastritis. 181 of the 831 patients with different forms of chronic gastritis were examined with a GIF-H180 Evis Exera-II apparatus (Olympus, Japan) coupled to the NBI system. The control group comprised 650 patients examined using conventional GIF-Q160 and GIF-Q160 Evis Exera-I fiberscopes (Olympus, Japan). Signs of inflammation, its severity and extent were evaluated. Significant correlation was revealed for the first time between inflammation of gastric mucosa, type of gastritis, endoscopic picture in the NBI regime, and results of histologic studies. Inflammation foci and sites of intestinal metaplasia were found to produce characteristic images in which they had different shades of lilac and deep blue respectively. Distribution of the stained foci corresponded to that of inflammation and/or metaplasia. It is concluded that the use of the NBI technology in routine oesophagogastroduodenoscopy improves diagnosis of intestinal metaplasia to 80-100% (p = 0.000).

[Infective endocarditis in patients on program hemodyalisis].

Ten (1.8%) out of 558 patients with end-stage chronic renal failure on program hemodialysis developed infective endocarditis (IE). The average length of hemodialysis before IE was 17.0 +/- 14.5 months. The main cause of IE was infection of the site of vascular approaches. The diagnosis was difficult; Duke criteria modified by J. Li et al. (2000) allowed evidenced diagnosis of IE only in 30% of cases, while modified criteria offered by the authors did it in 50% of cases. The article discusses rational antibacterial therapy. Hospital lethality in IE is as high as 50%.

[Glucocorticosteroids in bacterial endocarditis: is it beneficial or harmful?]. / Gliukokortikosteroidy pri infektsionnom éndokardite: vred ili po'lza?.

AIM: Analysis of results of treatment of infectious endocarditis (IE) with glucocorticosteroids in combination with antibiotics. MATERIAL AND METHODS: 128 IE patients received antibiotics (control group). Glucocorticosteroids were added to antibiotics in 44 IE patients (study group). RESULTS: Valvular replacement, congestive heart insufficiency, thromboembolic complications, suppression of cellular and humoral immunity occurred more frequently in patients of the study group. CONCLUSION: It was found that glucocorticosteroids affect IE negatively, especially in the dose 30 mg/day and higher. Glucocorticosteroids are indicated in allergic reactions to the antibacterial drugs, severe renal damage (proteinuria < 1 g/l), myocardial defects; contraindicated in non-eradicated IE causative agent, in recurrent IE.

[Septic endocarditis--a predictable or unpredictable disease? Clinico-immunologic aspects]. / Septicheskii endokardit--predugotovannoe ili nepredskazuemoe zabolevanie? Kliniko-immunologicheskie aspekty.

Based on an analysis of the clinical picture of 248 cases of septic endocarditis, disorders in the immunologic status (reduction in the E-RFC, EAC-RFC counts, absolute count of Ea-RFC, significant rise of immunoglobulins of all classes, hypocomplementemia in 37.5% of patients, increase in the titer of circulating immune complexes in 86% of patients) the authors discuss the causes (virulence of the causative agent, immunodeficiency) that favour the development of septic endocarditis.

[The mechanisms of the development and diagnosis of myocardial infarct in septic endocarditis]. / Mekhanizmy razvitiia i diagnostika infarkta miokarda pri septicheskom éndokardite.

Based on the clinical, instrumental and biochemical findings, out of 104 patients with septic endocarditis 11 (10.6%) were diagnosed to have myocardial infarction. It was provoked by coronary artery embolism, the covering of the coronary artery ostium by vegetation from the aortal cusp, a decrease of perfusion pressure in atherosclerosis stenosed coronary arteries because of marked insufficiency of the aortal cusp. In more than half the cases, the clinical picture of myocardial infarction was atypical, painless. Echocardiographic demonstration of the vegetations near the coronary artery ostium permits forecasting the possibility of its covering with vegetation, the threat of the occurrence of acute coronary insufficiency, which may appear an additional indication for heart valve replacement.

[Invasive treatment methods in therapy and angiogenic sepsis]. / Invazivnye metody lecheniia v terapii i angiogennyi sepsis.

In 1850 patients with intravenous catheters, intravenous shunts and fistulas sepsis developed in 0.43%. Infection of the catheters and shunts was more frequent than sepsis development. The growth of microorganisms (Staphylococcus aureus, Gram-negative microbes) was noted during a bacteriological study of 300 removed catheters in 27.7%. Angiogenic sepsis was caused by Staphylococcus aureus. Peculiarities of the clinical picture of angiogenic sepsis were discussed. Its early diagnostic signs were described. Immunological changes in the patients with angiogenic sepsis were evaluated. The problems of pathogenesis and prevention of angiogenic sepsis were given due attention.

[Neurological complications of infectious endocarditis]. / Nevrologicheskie oslozhneniia infektsionnogo éndokardita.

Of 204 patients with infectious endocarditis (IE) treated in the hospital in 1980-2000, 43(21.2%) developed neurological complications. These were: ischemic stroke (72.1%), hemorrhagic stroke (9.3%), both (7%), abscess and subarachnoidal hemorrhage (2.3% for each), meningitis (7%), toxic encephalopathy (11.6%). Neurological complications of IE arose prior to treatment and within the first week of antibacterial therapy in 63% cases, more frequently in the left carotid territory. Neurological complications in IE debute manifested acutely, pareses were more frequent than paralyses, with elevated temperature, low hemoglobin and red cell levels, leukocytosis. MRT detected 8 +/- 4.6 foci in the brain, CT--2 +/- 1.1, on the average. Lethality of IE patients with neurological complications reached 58.1% and was significantly higher than in those without such complications (14.9%, p < 0.001). Overall acturial survival 1 year after the discharge from the hospital was 94.4%, 5-year survival--61.1%, 10-year survival--11%.

[Transesophageal echocardiography in diagnosis of infectious endocarditis]. / Chrespishchevodnaia ékhokardiografiia v diagnostike infektsionnogo éndokardita.

Transthoracic and transesophagal echocardiography (TT EChG and TE EChG) were performed in 43 patients with infectious endocarditis (IE). Sensitivity and specificity of TE EChG in detection of vegetations were higher (92 and 75%, 81 and 50% for TE EChG and TT EChG, respectively). Vegetations and thromboembolism were unrelated. With TE EChG, morphologically verified perforations of valvular cusps were revealed 3 times more frequently than with TT EChG. Along with detection of vegetations and dysfunction of the prosthetic valve, an essential diagnostic marker of IE of the artificial valve is visualization of paraprosthetic fistulas in 2 of 5 patients. Indications for TT and TE EChG and techniques of their performance are described. TT EChG is used in screening for IE. TE EChG is conducted in complications of IE.

[The current course and treatment of infectious endocarditis]. / Sovremennoe techenie i lechenie infektsionnogo éndokardita.

Clinical study of 172 patients treated in the Burdenko Military Hospital for subacute infectious endocarditis in 1980-1996 compared with 192 cases in 1950-1979. Contemporary course of the disease is attended by a few symptoms, primordiality and single-valve affection. On the grounds of antibiotics sensitivity of the most prevalent infection agents discovered in 1996, the article develops some schemes of antibacterial therapy for Streptococcus, Enterococcus and staphylococcal etiology of disease. Rational antibiotic therapy together with surgery measures reduced lethality to 14.3% for Streptococcus endocarditis, to 16.7%--for Enterococcus and to 34.4%--for Staphylococcus.

[Urgent problems of medical aid in infectious endocarditis]. / Aktual'nye voprosy meditsinskoi pomoshchi pri infektsionnom éndokardite.

The authors analyze the incidence of infectious endocarditis (IE), the influence of diagnostic time on the lethality, the significance of surgical treatment. The main ways of further improvement of IE patient therapy are defined. They include the training of medical staff, centralization of the patients in the military medical institutions of the center by transfer from the districts after making the diagnosis in order to conduct the adequate medicamentous and appropriate surgical treatment.