No 20 (2017)

Adhesive process of the peritoneum is considered a natural peritoneal response to the absolute majority of surgical interventions on the abdominal cavity and pelvic organs. The most serious complication of the adhesive process of the peritoneum is the variant of adhesive bowel obstruction developing in 40% of all forms of ileus. The delay in treatment is invariably accompanied by an increase in endogenous intoxication, intra-abdominal hypertension, and intestinal dysfunction, which contributes to the development and progression of the multiple organ dysfunction syndrome. When studying the pathogenesis of development and the course of adhesive ileus, it is necessary to distinguish the syndrome of intra-abdominal hypertension as one of the key factors in the development of multiple organ failure. There is a direct relationship between the timely diagnosis of acute bowel obstruction, the shortest resolution of paresis and the restoration of the natural passage with a reduction in the incidence of complications (including postoperative) and mortality in this pathology. Determination of the degree of intra-abdominal hypertension and monitoring of the parameters of intra-abdominal pressure in patients with acute bowel obstruction provides timely application of the necessary spectrum of therapeutic measures, including the proper volume of surgical intervention.

The most effective drugs used in the treatment of Parkinson’s disease (PD), levodopa and dopamine receptor agonists, can lead to the development of impulsive-compulsive disorders (ICDs). Neurostimulation (NS) conducted to patients with complications of pharmacotherapy that are resistant to correction, has a dual effect on ICDs. On the one hand, the NS allows reducing the dose of prescribed dopaminergic drugs, which can reduce the severity of behavioral disorders in the postoperative period. On the other hand, there are several data on the increase or even occurrence of ICDs after surgery. This literature review considers various effects of the NS of subthalamic nucleus on ICDs in patients with PD.

Cardiovascular diseases of atherosclerotic origin make a significant contribution to morbidity and mortality in the Russian Federation. Hypercholesterolemia is the leading risk factor for the development of coronary artery disease. The metabolism of low-density lipoproteins (LDL) depends on the activity of the enzyme - proprotein convertase subtilisin/kexin type 9 (PCSK9). A new class of drugs -monoclonal antibodies - inhibits PCSK9 and leads to a marked decrease in LDL cholesterol. An extensive evidence base characterizes ehvolocumab as a safe and effective hypolipidemic agent, which helps to reduce the high risk of developing cardiovascular complications. The use of evolocoumab in patients with clinically significant atherosclerosis and lack of achievement of the target LDL cholesterol levels despite the maximum tolerated therapy with statins with or without ezetimibe, with familial heterozygous and homozygous hypercholesterolemia, and with statin intolerance is justified.

The article presents the results of the evaluation of the frequency of muscle symptoms and their interrelations with biochemical markers of muscle damage in persons on statin therapy in the presence or absence of compensated hypothyroidism. The three groups of 40 women in each group were compared. The main group included patients with compensated hypothyroidism receiving statin therapy. Control groups included persons without thyroid pathology with statin therapy and patients with compensated hypothyroidism without statin therapy. The characteristics of muscle pain and weakness were assessed according to standard questionnaires, and biochemical markers of muscle damage. Muscle pain (p=0.0006) with typical localization for statin-induced myopathy (SIM) was more often observed in the main group, with greatest negative impact on daily motor activity in the form of walking ability (p=0.0033), and there was a significant increase in creatinine phosphokinase levels (p=0.012). Reliable direct correlations of muscle pain with the levels of biochemical markers of myopathies and the duration of use of statins was found only in the main group. In both control groups, muscle symptoms were closely related to the presence of concomitant pathology (vertebrogenic syndromes, chronic venous insufficiency). As a result of the study, it was revealed that patients with compensated hypothyroidism receiving statin therapy have increased frequency of muscle pain with typical for SIM localization, pathogenetically associated with myocyte damage. There is a need to monitor clinical and biochemical signs of muscle tissue damage in patients with compensated hypothyroidism receiving statins.

The effect of bromodihydrochlorophenylbenzodiazepine on extrapyramidal disorders, which appeared as side effects of antipsychotic therapy in 57 patients with paranoid schizophrenia, was evaluated. The reducing effect of phenazepam on Parkinsonian syndromes, dystonic and dyskinetic disorders, and akathisia was obsereved.