No 19 (2014)

Amyloid beta-related CNS vasculitis is one of the most rear types of primary CNS vasculitis. Recurrent hemorrhagic and ischemic strokes, epilepsy, severe cognitive decline are referred to be the main features of the disease. Pathological findings often include vasculitic transmural, often granulomatous, inflammatory infiltrates along with hemorrhages and amyloid-beta deposits seen in the meninges and in the brain. We describe the clinical course, radiologic and pathologic findings of a 33-year-old man with amyloid beta-related CNS vasculitis manifested in peripheral right facial nerve paralysis. During following three years, recurrent debilitating hemorrhagic, ischemic strokes and epilepsy were observed. Brain and meninges biopsy revealed granulomatous destructive angiitis with diffuse and local vessel amyloid-beta deposits in the meninges and brain tissue. ABRA was diagnosed and treatment with three PRED 1500 mg IV pulses followed by 75 mg orally and CYC 1400 mg IV every four weeks began. Such aggressive treatment suppressed inflammation and prevented the patient from radiologic progression.

This article describes mental disorders in mild cognitive impairment and dementia; diagnostic criteria and approaches to the differential diagnosis, as well as difficulties in qualifying of mild cognitive impairment and various forms of dementia are discussed. Some groups of drugs used in the treatment of disorders accompanied by cognitive impairment are emphasized, and approaches to the treatment of these conditions are proposed.

To date, the treatment of rheumatoid arthritis (RA) has some success. The emergence of new diagnostic criteria 2010 for RA, implementation of the principles of controlled treatment in practice - strategy of treatment of RA to achieve the goal, the emergence of new forms of previously used disease modifying anti-rheumatic drugs (DMARDs) and new generation preparations (genetically engineered biological agents and the targeted synthetic DMARDs - tofacitinib), allows to approach to personalized treatment of RA and the prevention of adverse outcomes. The widespread introduction of the subcutaneous form of methotrexate into clinical practice, a highly effective drug in relation to the activity and progression in early RA, well tolerated for a long time, allows to achieve the goal for most patients after 6-12 months of therapy using the principles of controlled treatment.

Vitamin D is hormone involved in maintaining antitumor immunity. The article presents a comprehensive molecular and physiological model of antitumor effects of vitamin D. The data of evidence-based medicine, showing that long-term intake of vitamin D3 at doses of 800-1000 IU/day significantly reduces the risk of breast cancer, rectal cancer, and mortality from other forms of cancer, are discussed.

The efficiency of endovasal laser obliteration (EVLO) as a radical method of treatment of varicose vein disease of the lower extremities was evaluated. A comparative analysis of the results of treatment of 85 patients with chronic venous insufficiency (CVI) functional classes C2-C3 according to CEAR classification is presented; in the complex treatment, such techniques as surgical phlebectomy and EVLO were applied. As phlebotonics, Aescusan - a drug with antioxidant, antiedemic, capillaroprotective and venotonic actions - was used. It is shown that EVLO is characterized by less severe post-traumatic tissue changes and a higher quality of life of patients in the postoperative period. EVLO and phlebectomy in combination with the use of aescusan during pre- and postoperative periods have shown similar efficacy in relieving CVI symptoms, but only in cases where the diameter of the venous trunk, which undergoes exposure, does not exceed 1 cm.

In neurological patients, erectile dysfunction (ED) develops as a consequence of both central nervous system disorders and psychogenic causes. 10-19% of organic erectile dysfunction has neurogenic nature. Traumatic brain injury, stroke, Parkinson's disease and multiple sclerosis often lead to the development of ED, significantly reducing the quality of life of these patients. Erectile dysfunction in neurological patients is often combined with depression, decreased libido, ejaculation and orgasm disorders. The variety of drugs used for the correction of neurogenic ED allows to individualize the therapy.