No 11 (2011)

In the article are analyzed the role of disturbances the nourishments in the pathogenesis of chronic pancreatitis. It is shown that the scarcity of the micro- and of macros-nutrient is one of the important factors of development and/or redoubling of the course of disease. The data of epidemiological, clinical and biochemical and experimental data of those making it possible are cited to make a conclusion about the connection of the disturbances of nourishment with chronic pancreatitis with the carcinogenesis of the pancreas. Some debatable questions of substitute fermentation therapy are described.

The article analyzes the current concepts of the clinic, pathogenesis and treatment of alcoholic liver disease. The guiding principles of treatment of alcoholic liver disease are total abstinence, nutrition correction, and the use of essential phospholipids, Heptral and preparations with a pronounced anti-inflammatory activity.

The article describes current understanding of the pathogenesis and clinical course of cystic fibrosis (CF). The modern treatment options for cystic fibrosis using Pulmozyme® (dornase alfa), a purified solution of recombinant human deoxyribonuclease 1, produced by the pancreas and other tissues, are discussed. The results of evaluation of safety and efficacy of dornase alfa in 108 children of different age groups with moderate and severe disease observed in the Russian Center of Cystic Fibrosis are presented. It is emphasized that in addition to mucolytic effect, dornase alfa has a number of nonmucolitic effects, such as reduction of neutrophil elastase and interleukin-8 concentrations in the sputum of patients with mucoid Pseudomonas aeruginosa, and inhibition of the formation of mucoid Pseudomonas aeruginosa biofilms determining antibiotic resistance and immune response. It was found that the intranasal administration of Pulmozyme in CF patients with chronic rhinosinusitis is effective.

The article discusses the approaches to the management of patients with acute respiratory viral infections (ARI) in therapeutic practice. The basic rules for examination and treatment of ARI patients that should predetermine physicians/general practitioners actions are presented. Treatment success is largely determined by a careful interpretation of clinical data, identification of risk factors for complications, as well as rational symptomatic therapy.

The review is dedicated to the problems of diagnosis and treatment of early rheumatoid arthritis (RA). Some new diagnostic criteria for RA (ACR/EULAR, 2010), recommendations for the management of patients with early arthritis, and basic principles of therapy of this disease by synthetic disease-modifying anti-rheumatic drugs and biologics are presented. It is emphasized that basic therapy is most effective in the early stage of RA, especially the first 3 months of the onset of the disease. The basis of management of patients with early RA is the close monitoring of the adequacy of the treatment (at least 1 time in 3 months) with subsequent correction of treatment, if necessary.

Based on data from the register of patients with acromegaly in Moscow Region, study have assessed the proportion of patients receiving treatment with somatostatin analogues (SA) as a primary or secondary treatment, as well as doses of medication, and treatment efficacy. At the beginning of 2011, there was information on 128 of the 140 registered patients with acromegaly. 79 (61,7 %) patients were treated with SA (Sandostatin LAR). Indications for drug therapy were following: 1) absence of clinical and hormonal remission after treatment - in 35 of 79 (44,3 %) patients (neurosurgical treatment - 20, radiation therapy - 6, combined neurosurgical and radiation therapy - 9 patients); 2) first-line therapy - 44 of 79 (55,7 %) patients. In 42 of 79 (53,1 %) patients with inadequate biochemical control against the background of use of Sandostatin LAR at a dose of 20 mg for 6-12 months, the dose was increased to 30 mg; further, in 31 (39,2 %) patients with unachieved target levels of growth hormone (GH) and insulin-like growth factor type-1 (IGF-1) against the background of therapy with a dose of 30 mg for 6-12 months, the dose was increased to 40 mg. The frequency and/or intensity of adverse events were not increased. Thus, 31/79 (39,2 %) patients with acromegaly have received Sandostatin LAR at a dose 40 mg, 11 (13,9 %) - at a dose 30 mg, 33 (41,8 %) - at a dose 20 mg, and 4 (5,1 %) patients received drug at a dose 10 mg. Complete remission of acromegaly (GH and IGF-1 target levels) was achieved in 19 of 33 (57,6 %), 6 of 11 (54,5 %) and 10 of 31 (32,2 %) patients treated with Sandostatin LAR in doses of 20, 30 and 40 mg, respectively. In addition, the achievement at least one target (GH or IGF-1) was observed in another 10 of 33 (30,3 %), 4 of 11 (3,2 %) and 9 of 31 (29 %) patients in these treatment groups. Increase of the dose of the SA to 30 and 40 mg allowed to achieve full control of GH and IGF-1 levels in other 6 and 10 patients, respectively. Overall, among all patients receiving drug treatment with SA at doses ranging from 10 to 40 mg, achievement at least one target was observed in 62 of 79 (78,5 %), and complete remission of acromegaly was documented in 39 of 79 (49,4 %) patients. Thus, drug therapy is an important part of treatment of patients with acromegaly. The use of high doses of Sandostatin LAR (30 or 40 mg) is safe and lead to increase of proportion of patients with acromegaly who have reached complete remission.