Vol 83, No 8 (2011)

The article characterizes current strategy of treatment of chronic obstructive pulmonary disease (COPD), contains epidemiological data, draws attention to various phenotypes of COPD which determine individual approach to therapy. Individual treatment programs must consider stage of the disease, its progression, comorbid pathology. Pharmacological and non-pharmacological treatment methods are outlined. It is important to give therapists advanced training in COPD diagnosis and treatment.

The review presents principles of pathogenetic therapy in tuberculosis and current trends in pharmacotherapy: immunocorrection, prophylaxis, chemotherapy side effects management. Immunocorrection is illustrated by treatment with drugs of a polyvalent action - glutoxim and cyclopheron. Mechanisms of their immune action are outlined. As to hepatoprotection, remaxol is an effective hepatoprotecting medicine improving energy supply to hepatocytes and their membranes resistance to lipid peroxidation, reactivating enzymes of antioxidant defense. Remaxol has an antioxidant/antihypoxic action, is the most promosing metabolic corrector with hepatoprotective activity.

Aim. To compare effects of prolongation of the treatment with therapeutic doses of enoxaparin to 1 month on recanalization of occlusively thrombosed deep veins (OTDV) of the limbs with results of standard therapy with unfractionated heparin (UFH). Both treatments were followed by warfarin administration. Material and methods. Thirty patients were selected from 111 patients with a history of deep vein thrombosis (DVT) and/or pulmonary artery embolism according to the following criteria: the presence of occlusive thrombosis of one deep vein minimum; the absence of DVT for 12 months of follow-up. Patients of group 1 (n = 15) received standard therapy (UFH for at least 5 days) with switch to warfarin. Patients of group 2 (n = 15) received therapeutic doses of enoxaparin (1 mg/kg each 12 hours) for 30 days minimum with switch to warfarin. Follow-up was 12 months. Ultrasonic duplex angioscanning of the limbs was made at baseline, 1, 3, 6 and 12 months after treatment start. Results. After follow-up month 1, 3 and 6 number of patients with occlusive DVT was significantly less in group 2. All the patients given enoxaparin achieved recanalization of OTDV within 3 months of treatment. OTDV recanalization was not achieved in 20% patients of group 1 even 12 months after treatment start. Conclusion. Prolongation of enoxaparin treatment to 1 month followed by warfarin treatment is superior to standard UFH treatment followed by warfarin in providing recanalization of OTDV within 3 months of treatment. Moreover, this treatment predicts persistence of recanalization within 12 months of anticoagulant therapy.

Current approaches to treatment of Helicobacter pylori infection, basic international recommendations, problems of growing H. pylori resistance to antibiotics are reviewed. Much attention is given to prospects of new eradication schemes, for example combinations based on bismuth tripotassium dicitrate and successive treatment schedules.

Aim. To determine clinical significance of measuring blood levels of protein precursors of AA- and AL-amyloidosis - SAA and immunoglobulin free light chains (ILC), respectively. Material and methods. SAA concentrations were studied with ELISA in 43 rheumatoid arthritis (RA) patients including complicated with reactive AA-amyloidosis (n = 31). Inflammation activity and its severity were studied (indices Li, richi, HAQ, DAS4). A modern quantitative nephelometric method Freelite estimated ILC levels in 31 patients with AL-amyloidosis. Results. Patients with RA complicated with AA-amyloidosis and free of it had a strong correlation between blood serum SAA concentration and activity of joint disease. Elevated SAA concentrations to 160 mg/l (normal 10 mg/l) were detected in many patients with clinical remission of the joint syndrome. Significal inhibition of AA-amyloidosis progression was seen only in SAA concentration drop under 60 mg/l. For AL-amyloidosis patients ILC fall by less than 3 normal value means a 6-time increase in chances of a favourable outcome. Conclusion. Monitoring of blood levels of proteins precursors of AA- and AL-amyloidosis is a key factor in prognosis of the disease and treatment efficacy.

Aim. To assess efficacy of treatment of patients with atherogenic dyslipidemia (ADL) with beekeeping products (honey, pollen, bee bread). Material and methods. ADL parameters were examined in 157 patients (64 males and 93 females) aged 39 to 72 (mean age 61,7 + 8,5 years) with ADL. Products of beekeeping were given in the absence of allergy and individual resistance to honey, pollen, bee bread. The patients were divided into four groups: patients on hypolipidemic diet only, on diet and honey or pollen, on bee bread, combined treatment - diet, honey, pollen. Results. A significant hypolipidemic effect was registered in patients taking honey in combination with pollen (total cholesterol decreased by 18,3 %, LDLP cholesterol by 23,9 %) and bee bread (total cholesterol decreased by 15,7 %, LDLP cholesterol by 20,5 %). Conclusion. Improvement of blood lipid composition in taking honey and pollen in overweight (body mass index - BMI 25 - 30) and obese (BMI over 30) patients occurs only in loss of body mass.

A case is reported of management of massive intraoperative blood loss in a male patient with severe hemophilia. Extirpation of hip pseudotumor with one-stage osteosynthesis with an intramedullary joint-pin in a 43 year old male patient was accompanied with 7.5 l blood loss. The infusion-transfusion therapy (ITT) contained transfusion media about 1/3 of the total volume, fresh-frozen plasma and erythrocyte-containing media were used 1:1. Infusion solutions consisted of balanced polyelectrolytic solutions, hydroxyethylated starches 130/0.4, hyperchaes. Intraoperative normovolemic hemodilution and reinfusion of wound blood were made (CellSaver). ITT target markers were standard hemodynamics control tests. Hemostasis monitoring was conducted with thromboelastography. Complex ITT based on modern principles of clinical transfusiology provided a complete and safe compensation of massive intraoperative blood loss in a patient with severe hemophilia.