No 14 (2012)

In the structure of causes of fever of unknown origin in elderly, rheumatic diseases are one of the leading cause, unless infectious diseases and cancer. In turn, Horton’s arteritis (giant-cell arteritis, temporal arteritis) plays a special role among rheumatic diseases, because it is the most common vasculitis of elderly people. The combination of inflammatory blood changes and the newly appeared headache involves a wide diagnostic search, while this combination of symptoms is indicative of the presence of temporal arteritis. The clinical observation of patient with temporal arteritis, who was observed for a long time with diagnosis of fever of unknown origin, as well as an overview of the literature on the diagnosis and treatment of Horton's arteritis are presented.

The present review is devoted to the use of long-chain ы-3 polyunsaturated fatty acids (ы-3 PUFA) in the treatment and secondary prevention of atherosclerosis and dyslipidemia. The results of large-scale clinical trials are analyzed; meta-analyses showing a beneficial effect of ы-3 fatty acids in atherosclerosis, especially after myocardial infarction, for the correction of dyslipoproteinemia and reduction of arrhythmic episodes are presented.

Biochemistry of muscle contraction, the physiological roles of magnesium orotat, the relationship between magnesium deficiency and cramps are considered; characteristics of magnesium therapy and synergistic effect of magnesium and one of its pharmacological carriers - orotic acid - are discussed.

The article considers the mechanisms of pain syndromes developing in degenerative lesions of the spine, including neck pain (cervicalgia). Based on the current view on the main pathogenetic mechanisms of these pain syndromes, guidelines for treatment of this group of patients are formulated. In particular, the combination therapy is justified, including nonsteroidal anti-inflammatory drugs (lornoxicam, etc.) and complex B vitamin preparations, such as Neurobion, etc.

Recent advances in molecular biology of atherosclerosis revealed a new understanding of the pathophysiology of coronary heart disease, which allowed the development of new methods of treatment aimed to relieving patient’s suffering and to modify the course of illness. This overview presents the tactics of antianginal therapy in patients with chronic coronary heart disease in terms of interest of practitioners.

The disturbances of redox processes, metabolism and energy supply at the cellular level are developed in many diseases of the central and peripheral nervous system. Actovegin, a highly purified deproteinized hemoderivative of calf blood, is widely used in the treatment of these diseases due to providing complex effects on cells. It was found that in cells of different origin, Actovegin increases glucose uptake and improves the oxygen uptake. This allows activating the energy processes in the cell and affecting its functional metabolism. It is emphasized that Actovegin is of great interest for neurological practice as a drug for the therapy of diseases whose pathogenesis is associated with hypoxia, ischemia and oxidative stress.

The article presents the results of evaluation of the effectiveness of combined antihypertensive therapy, including в-blocker bisoprolol and its combination with angiotensin converting enzyme inhibitors and calcium antagonists during surgery of the genitourinary system in patients with combined urological and cardiac pathology. It is shown that the administration of this combination of drugs in urological patients with arterial hypertension before the upcoming operation (especially lithotripsy) allows to achieve target levels of blood pressure in most cases. Article is supplemented by brief literature review on в-blockers, and the role of this group of drugs in the treatment of cardiovascular diseases.

Retrospective study of medical records of all patients who lived in the service area of Syktyvkar outpatient department № 3 and were treated at the SI “Cardiologic dispensary" of Komi Republic from 2003 to 2010 with a diagnosis of myocardial infarction (MI) was performed. The study included 1071 patients, 46.3% of women; mean age - 63,7 ± 12,8 years. In average, women were 9 years older than men (70,2 and 61,0 years, p < 0,0001) and they more often had comorbidities; as adjusted for age, they had no increased risk of in-hospital mortality compared with men. Only main groups of drugs were used in the treatment; women often required diuretic and antiarrhythmic therapies. It was noted that в-blockers, angiotensin-converting enzyme (ACE) inhibitors, and calcium antagonists have a protective properties irrespective of sex. The use of thrombolysis has not significantly reduced in-hospital mortality only in men under 75 years old and women under 65 years old; benefits of thrombolytic therapy (TLT) was not revealed in the older age groups. This study of MI patients identified protective role of в-blockers, ACE inhibitors, and calcium antagonists regardless of sex; advantages of TLT in MI patients - men over 75 and women over 65 years old - was not proven.