No 11 (2012)

The article presents the current view on sarcoidosis, which is not rare disease now. Today, instead of a pulmonary disease with intrathoracic lymphadenopathy and/or pulmonary dissemination, sarcoidosis is regarded as a multiorgan, multisystem granulomatosis with difficult predictable course. The approaches to the treatment of different variants of sarcoidosis, including use of systemic steroids, essential phospholipids, N-acetylcysteine, methotrexate, etc., are discussed.

Sore throat is acute non-specific infectious-allergic disease with local manifestations in the Waldeyer's ring. Palatine tonsils are the most frequent localization, therefore, sore throat is usually refers to acute inflammation of the tonsils or acute tonsillitis. In routine practice, drug therapy includes the use of antibacterial, nonsteroidal anti-inflammatory, and desensitizing preparations, symptomatic medications, and topical therapy.

Constipation is a frequent clinical syndrome, which occurs in approximately 20 % of the population. In recent decade, studies have contributed to a better understanding of the basic mechanisms of chronic constipation (CC), in particular its relationship to colonic transit and anorectal function. Many possible causes that affect the occurrence of constipation (metabolic, deficiency of fiber, medicines) should be taken into account during examination of the patient, and anorectal pathology should be excluded. Functional CC consists of three subtypes: slow-transit constipation, dyssynergic defecation and irritable bowel syndrome with predominance of constipation. Rome criteria are a useful guideline for the diagnosis of functional constipation. Treatment should be based on evidence-based diagnosis of CC variants. Enterokinetic agents such as prucalopride and lubiprostone should be used in the treatment of an inert colon. Advantages of biofeedbacktherapy should be used in the treatment of dyssynergic defecation.

In patients, exacerbation of COPD is one of the most frequent causes of seeking emergency medical care. Among bacteria, nontypeable Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis play the most important role in the exacerbation of COPD. Current guidelines recommend the use of antibiotics in patients with more severe COPD exacerbations of, and suggest new approaches to the treatment based on phenotyping of COPD exacerbations and measurement of biomarkers. For the treatment of uncomplicated exacerbations of COPD, the use of modern macrolides, cephalosporins is recommended, and for the treatment of complicated exacerbations - amoxicillin/clavulanate or respiratory fluoroquinolones (moxifloxacin, levofloxacin).

The article discusses the problem of dyscirculatory encephalopathy (DEP), a chronic cerebrovascular disease, characterized by multifocal or diffuse brain damage with complex of neurological and neuropsychological manifestations. Data for etiology and pathogenesis, morphological and clinical manifestations of disease, diagnostic criteria and treatment guidelines for DEP are presented.

The combination of history of alcohol consumption and liver steatosis, according to different authors, may occur in 50 % of cases. Clear differentiation of acute alcoholic hepatitis (AAH) and nonalcoholic steatohepatitis (NASH) is not always possible, because these conditions are often combined in clinical practice. This clinical example illustrates the “crossing" of the two hepatic diseases, which can be mutual confounders for two pathological processes - AAH and NASH. Currently, for a comprehensive treatment of the AAH and NASH, well-studied and safe combination of ornithine, ademetionine, pentoxifylline, metformin, ursodeoxicholic acid and thioctic acid (Thiogamma) should be used. Taking into account the participation of thioctic acid in antioxidant protection, administration of Thiogamma can be considered as reasonable treatment for all patients with metabolic syndrome and toxic liver injury.