No 7 (2012)

Minimal hepatic encephalopathy in liver cirrhosis requires special psychometric methods for its detection. Its presence significantly reduces the quality of life of patients with chronic diffuse liver diseases. The article discusses the early use of pathogenetic therapy for the correction of minimal hepatic encephalopathy aiming to prevention an obvious encephalopathy, improvement of quality of life of cirrhotic patients and their survival.

At present, hepatic steatosis and insulin resistance are recognized as a factors of progression of chronic hepatitis C, which may be metabolic (metabolic syndrome), and viral origin (infection with genotype 3 HCV). It is important that hepatic steatosis and insulin resistance significantly impair the results of antiviral therapy for chronic hepatitis C. In this regard, treatment of hepatic steatosis and correction of insulin resistance are essential mechanisms for prevention of rapid progression of chronic hepatitis C and increase of frequency of sustained virologic response to antiviral therapy.

Arterial hypertension (AH) on the background of hyperaldosteronemia and decreased plasma renin activity (PRA) is etiologically linked to a wide range of tumors and non-neoplastic changes in the adrenal cortex. The treatment of hypertensive patients with low-renin hyperaldosteronism depends on the form of the disease diagnosed. Aldosteroma or unilateral (primary) adrenal hyperplasia require a surgical treatment. In idiopathic aldosteronism, pharmacological antihypertensive therapy with mineralocorticoid receptor antagonists (spironolactone, eplerenone) is effective. In patients with a rare form of familial hyperaldosteronism type 1, the use of low-dose glucocorticoids provides a correction of the clinical manifestations of disease. Differential diagnosis of hyperaldosteronism form allows to justify the appropriate method of treatment and overcome the refractory AH.

The article discusses the potentials for use of different cholinolytics, including hyoscine butylbromide (Buscopan), for the treatment of chronic abdominal pain in functional gastrointestinal disorders. It is emphasized that the Buscopan with proven efficacy and safety profile is indicated for patients with functional gastrointestinal disorders, accompanied by smooth muscle spasms; Buscopan has a pronounced antispasmodic effect at the first stage of contraction of muscle fiber, relieves abdominal pain, reduces the secretion of digestive glands, does not have central anticholinergic action and is well tolerated during long-term use.

Alcoholic liver disease (ALD) remains the leading cause of complicated diseases of this organ and high mortality worldwide. In economically developed countries, cirrhosis is one of the leading causes of death in the working-age adults. Etiology of cirrhosis can not be determined approximately in 10-35 % of patients. Such observations are referred to as cryptogenic cirrhosis. In fact, alcohol may be the cause of these cirrhoses. Dependence on alcohol and alcohol withdrawal syndrome are rarely observed in most patients with ALD that allows them to drink alcohol in large quantities for many years. Until the formation of cirrhosis, subclinical course of ALD is very typical for these patients. Therefore, timely treatment and prevention of cirrhosis are impossible. The ademetionine (Heptral) is drug of choice for the treatment of ALD. Treatment schemes with ademetionine are determined by the current stage of ALD (alcoholic steatosis, alcoholic hepatitis and alcoholic cirrhosis).

The article presents the analysis of results of one year's follow-up of 1922 patients with type 2 diabetes mellitus within the framework of the observational program "Efficacy of Galvus Met in real-life clinical practice of endocrinologist." In general, the 12-month treatment with Galvus Met (vildagliptin + metformin) provided clinically significant improvement in glycemic control with good tolerability. More than 96% of patients expressed satisfaction with the therapy and desire to continue therapy in the future. In addition, treatment had a positive effect on body weight and blood pressure.

Diabetes mellitus (DM) occupy the one of the leading places among the immediate causes of death along with cardiovascular and oncologic diseases; therefore, resolution of issues related to the problem of diabetes is delivered on the national level in many countries. Type 2 diabetes mellitus (DM2) is a heterogeneous disease, developing as a result of a combination of congenital and acquired factors. Algorithms of specialized medical care for DM patients (Issue 5, 2011, Moscow) include new approaches to drug therapy of DM2. Thus, the use of dipeptidyl peptidase-4 inhibitors (DPP-4i) is recommended since the beginning of treatment and at all subsequent stages. This article presents materials of discussion held in the VIII Moscow City Congress of the Endocrinologists (13-14 March, 2012). The discussion addressed the following issues: how start of oral therapy of DM2 with DPP-4i and its intensification should be guided; what important additional effects DPP-4i have; what prospects DPP-4i have in the future?

The article presents data on the prevalence of one of the most common pain syndromes - vertebrogenic back pain. The etiology, pathogenesis, diagnosis and treatment of this pathological condition are considered. The place of non-steroidal anti-inflammatory drugs, including meloxicam, in the treatment of vertebrogenic back pain is discussed.

The article considers the etiology and pathogenesis of acute pharyngitis emerging within acute viral infection; clinical picture of the different variants of the disease is discussed in detail. The most dangerous form of pharyngitis is β-hemolytic group A Streptococcus (Streptococcus pyogenes)-associated pharyngitis requiring antibiotic therapy. The advisability of use of topical drugs with anti-inflammatory and analgesic properties, like Strepsils Intensive, in acute pharyngitis is discussed.

Urolithiasis is the actual problem of modern urology. Surgical methods of treatment allow to remove the concretions from different parts of urinary tract, but do not solve the problem of stone formation in patients. In the management of patients with urolithiasis, prevention remains a poorly studied area. The article discusses various aspects of drug prevention of recurrence of urolithiasis with etidronic acid.

The article considers the results of clinical study which enrolled 36 patients (15 men and 21 women) with erosive ulcerative lesions of stomach and duodenum, associated with Helicobacter pylori, who were treated within 10 days with esomeprazole 20 mg 2 times a day + amoxicillin 1000 mg 2 times daily + clarithromycin 500 mg 2 times a day + bismuthate tripotassium dicitrate 240 mg 2 times a day. In addition, the comparison group included 32 patients with exacerbation of duodenal ulcer disease associated with H. pylori, treated with classic triple eradication first line therapy: omeprazole + amoxicillin + clarithromycin for 7 days. The effectiveness of eradication therapy in the study group and control group was 94.4 and 71.8% respectively. The findings indicate improving the efficiency of classical scheme of first-line eradication therapy with inclusion bismuth preparation (quadrupletherapy) and esomeprazole as a basic proton pump inhibitor, and the prolongation of treatment up to 10 days. This scheme can be recommended as first-line therapy, especially in a population of individuals with high Helicobacter pylori resistance to clarithromycin.