No 17 (2012)

In recent years, the number of scientific papers on the diagnosis and treatment of iron deficiency regardless of the presence of anemia in patients with cardiovascular diseases is increased. In cardiology practice this approach came from the field of nephrology, since many diagnostic and therapeutic approaches to the treatment of anemia and/or iron deficiency were evaluated in patients with chronic renal failure and often concomitant chronic heart failure. Results of recent studies highlighted in this review led to the question of the recognition of iron deficiency as independent risk factor for worsening prognosis of patients with cardiovascular diseases, and, therefore, as therapeutic target not related to anemia.

The article discusses the reasons for the development of postcholecystectomy disorders, pathophysiological rationale for definition of postcholecystectomy syndrome and methods of correction of pathological conditions developing after removal of the gallbladder.

Discovery of the role of Helicobacter pylori as a major etiologic factor in the development of chronic gastritis (CG) has led to the creation of new ideas on the clinical and morphological features of the disease. Pathogenetic relationship between CG and duodenal ulcer, MALT-lymphoma of the stomach and gastric cancer is firmly established; numerous therapies are developed. Unfortunately, debates on the topic “Is this microbe pathogen or saprophyte, or what are the differences between CG and functional dyspepsia?" are continued in our scientific literature. Such a complex of uncertainty in terms of CG leads to the high prevalence of the CG in Russia and the not always effective and timely treatment of this disease. The article reveals the pathogenic nature of CG and its role in the mechanisms of gastric carcinogenesis. Variants of prognosis in natural history of the disease are discussed; the basic algorithms of its diagnosis and treatment are presented.

Causes of endothelial dysfunction in chronic heart failure (CHF) are diverse and are associated with a long-term hemodynamic overload conducting arteries, hyperactivation of the renin-angiotensin-aldosterone and sympathetic-adrenal system, which manifests itself a perversion of endothelial dilating response to ordinary stimuli. The aim of the work was to study the structure of endothelial function in patients with chronic heart failure of ischemic etiology during therapy with rosuvastatin. The study found that patients with maladaptive remodeling and CHD, there is a marked vascular remodeling, which manifests itself by a sharp decline in vasoregulating endothelial function. In patients receiving rosuvastatin at a daily dose of 20 mg in patients with chronic heart failure of ischemic etiology in 3 months is a significant improvement in vasoregulating endothelial function, lipid profile and structural parameters of functional cardiac remodeling.

The comparison of clinical efficacy and safety of the bisoprolol and its generic drug in patients with arterial hypertension (AH) and patients with exertional angina was performed. In total, 30 patients with 1-2 degree I-II stage AH were evaluated (median age - 47 years). Patients were randomized into the groups receiving original bisoprolol (Concor ®, Merck KGaA, Germany) and its generic (Bidop ®, Gedeon Richter, Hungary), which were administered at the initial dose of 5 mg/day. After 6 weeks of treatment and 2 weeks of washout period, drug was replaced with an alternative preparation, and then treatment was continued for up to six weeks. Blood pressure (BP), heart rate (HR), adverse events were recorded initially, at the 2 nd and the 6 th week of therapy; results of self-monitoring of blood pressure were analyzed at the same time points. At baseline and at 6 weeks, 24-hour blood pressure monitoring was performed. 6-week treatment has significantly decreased office blood pressure on 23,0/10,5 mm Hg in the group of the original bisoprolol, and on 21,2/10,0 mm Hg in the generic group; intergroup differences were nonsignificant. Target blood pressure (< 140/90 mm Hg) was achieved in 71,4 % of patients in the first group, and in 64,3 % of patients in the second group (p =0,57). The degree of heart rate fall also not differed and was 11,8 and 10,1 bpm, respectively. According to the data of self-monitoring and 24-hour blood pressure monitoring, unidirectional and comparable in intensity changes of mean blood pressure and heart rate were revealed. In another fragment of study including 18 patients with stable exertional angina, it was shown that both drugs have a similar antianginal effects, reducing the signs of ischemia. It is concluded that of the original bisoprolol Concor and its generic Bidop have a clinical equivalence in safety, antianginal and antihypertensive effects.

The article considers the problem of acute rhinitis (AR), in which most common cause is a viral infection. Pathogenic mechanisms of AR associated with the violation of the ciliated epithelium and depression of mechanisms of local protection of upper respiratory tract are discussed. In AR, given the morphological and functional disorders in the nasal cavity and the clinical manifestations of the disease (nasal obstruction, rhinorrhea), the use of decongestants for rapid reduction of swelling, restoration of patency of the nasal passages and improvement of nasal breathing, is appropriate and pathogenetically justified component of treatment.

The article considers the potentials for the use of alginates in relieving the symptoms of dyspepsia and gastroesophageal reflux disease (GERD). Among the drugs, special place is given to Gaviscon and Gaviscon forte, which are based on sodium alginate. The basic mechanisms of action of alginates differing from those of the “classical" antacids are described. Information about the effectiveness of Gaviscon and Gaviscon forte in the treatment of GERD, dyspepsia and their symptoms is presented. The place of alginates in the treatment of some acid-related diseases and dyspepsia is discussed.

Complex treatment of chronic venous insufficiency is directed to a number of pathogenic processes responsible for the progression of varicose vein disease. They include elimination of edema, and the impact on various components of the blood coagulation system, improvement of microcirculation, and normalization of metabolic processes. The use of conservative treatment (medication, elastic compression) allows to lessen swelling, reduce pain, and has a good cosmetic effect.

The article is devoted to one of the main groups of drugs used in cardiology, - β-blockers (BB), in particular bisoprolol. Indications and contraindications for the use of BB, the principles of transition from monotherapy to combined therapy of arterial hypertension (AH) are presented. Particular attention is paid to the drug Bisogamma ®, a cardioselective BB without intrinsic sympathomimetic activity, which acts selectively on β-adrenergic receptors, and its antihypertensive effect is based on the reduction of cardiac output, inhibition of renin secretion by the kidneys. A multicomponent antihypertensive effect of Bisogamma® against the background of metabolic neutrality allows to recommend this cardioselective BB for the treatment of hypertensive patients with with obesity, disorders of blood lipid and glycemic profiles, and with chronic obstructive pulmonary disease.

The article considers the mechanisms of development of arterial hypotension (AH); the classification of its forms is presented, current approaches to the treatment of hypotension are discussed. It is emphasized that medical treatment is not necessary in case of physiological hypertension and hypotension without unwellness. In other cases, maintenance of perfusion in vital organs, and timely diagnosis and treatment of underlying disease - the cause of reduction in blood pressure - are required. The most common errors in the treatment of AH are discussed.