Vol 33, No 1 (2016)

Articles
SOME ASPECTS OF INFUSION THERAPY FOR SURGICAL PATIENTS DEPENDING ON BIOLOGICAL AGE
Karamova R.F., Khasanov A.G., Nafikova R.A., Bakirov S.K., Sendik A.I., Iskandarova I.I.
Abstract
Aim. The aim of the study was to investigate the differences in the volume of infusion therapy taking into consideration patients’ passport and biological age. Materials and methods. Biological age of 110 surgical patients treated at the City Clinical Hospital № 8 was determined using A.G. Gorelkin, B.B. Pinkhasov method. The method is based on the calculation of the equation, assessing correlation between the constitution markers and the age. The main parameters, required for the calculation are the following: body mass (kg), height when standing (m), waist and femur circumference (cm). It is also necessary to know patient ‘s chronological age to 0,1 year. Results. Biological age of surgical patients in 45,9 % of cases appeared to be higher than the chronological one. Thus, infusion therapy in the pre-, intra- and postoperative periods as well as daily liquid requirement of the body should be determined taking into account an individual BA. Conclusions. It is necessary to estimate BA for administration of an adequate volume of infusion therapy in different periods of patient’s management, and further, for choosing surgical technique and assessing resuscitation risk. It will heighten the quality of the conducted treatment and reduce the recovery period.
Perm Medical Journal. 2016;33(1):6-10
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DIAGNOSIS AND TREATMENT OF EXTRATESTICULAR LIPOMAS
Prokhorov A.V.
Abstract
Aim. The aim of the study was to improve the quality of diagnosis and treatment of extratesticular lipomas (EL). Materials and methods. Retrospective analysis of 4 EL cases observed at Moscow City Clinical Urological Hospital № 47 and City Clinical Hospital № 57 over the period from 1995 to 2015 was carried out. Among the X-ray methods for EL diagnosis, high resolution ultrasound investigation (> 7,5 MHz) and high pole magnetic resonance tomography (MRT) (1,5T) were used. Results. The patients’ mean age was 41,3 ± 30,6 years. EL was placed in the spermatic cord and the testicle membranes (2 cases), in the epididymis head and tail (2 cases). A single localization of EL was observed in 3 cases, combination of EL with multiple lipomatosis - in 1 case. The sizes of EL averaged 25,8 ± 17,2 mm (11,1 ± 12,7 cm3). EL caused pain and discomfort in the groin and scrotum in 2 cases, lateral course - in the rest cases. Spermatic cord and testicle membrane El were self-revealed, epididymis EL - with US. When palpating, EL was detected in the form of a tumor mass of the soft-elastic consistence, when carrying out US and MRT with suppression of signal from fat - in the form of an encapsulated mass of fatty density. EL diagnosis was verified in 3 cases after the surgery. The outcome of diseases was favorable in all patients. Differential diagnosis of EL with different surgical and urological diseases of the groin-scrotum region is discussed in the paper. Clinical case of spermatic cord membrane EL is reported. Conclusions. Despite typical radiation signs of EL, a reliable differentiation between EL and the other tumors of groin-scrotum region using clinical and radiation methods is not always possible. In such cases, taking into account patients’ complaints (pain, discomfort, cosmetic defect), the method of choice for treatment of EL is a surgical one - enucleation of EL followed by pathomorphological verification.
Perm Medical Journal. 2016;33(1):11-19
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TREATMENT OF DYSTROPHIC BONE CYSTS IN CHILDREN USING COMBINED DECOMPRESSION TECHNIQUE
Shelyakhin V.E.
Abstract
Aim. The aim of the study was to demonstrate the efficiency of surgical treatment of dystrophic bone cysts in children and adolescents using the technique of combined decompression. Materials and methods. Thirty six children aged 3-17 years, who had been operated for dystrophic bone cysts of different localization, underwent treatment. Clinical picture, roentgenological, radiothermometric and cytological methods of examination were considered. The principle of combined decompression technique for the treatment of bone cysts is presented. Results. The analyzed results indicated that use of combined decompression technique for the treatment of dystrophic bone cysts in children reduces the terms of treatment without complications and relapses available. In 69 % of patients, excellent and good results were obtained already in a year after the onset of treatment. Two years after the onset of treatment, excellent and good results were obtained in 91 % of patients. Conclusions. The above technique influences the basic pathogenetic links of the development of dystrophic bone cysts that proves its efficiency.
Perm Medical Journal. 2016;33(1):20-27
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ROLE OF COLLAGEN SYNTHESIS AND DEGRADATION SEROMARKERS, STRUCTURAL-FUNCTIONAL HEART PARAMETERS IN PROGNOSIS OF ATRIAL FIBRILLATION AMONG PATIENTS WITH PREMATURE VENTRICULAR EXCITATION SYNDROMES
Tuev A.V., Vasilets L.M., Khlynova O.V., Krivaya A.A., Parshakova O.A., Shumovich I.V.
Abstract
Aim. The aim of the study was to optimize the diagnosis and prognosis of developing arrhythmias in this cohort and to reveal the possible role of fibrous matrix disturbance in development of arrhythmia. Materials and methods. The main group included 43 patients with premature ventricular excitation syndromes (WPW phenomenon, WPW syndrome), the comparison group - 15 practically healthy persons of the similar age. The mean age of patients belonging to the main group was 25,3 ± 9,15 years. All the groups were comparable by gender distribution ( p = 0,45, Fisher criterion) and age ( p = 0,27, U-criterion). Results. The greatest matrix metalloproteinase-9 (MMP-9) indices were assessed in patients with WPW syndrome - 96,1 ± 33,2 ng/ml, with WPW phenomenon - 54,3 ± 21,8 ng/ml; p = 0,0003). Practically healthy persons had minimum MMP-9 values - 27,4 ± 10,9 ng/ml ( p = 0,00014; p = 0,000002). Maximum values of tissue inhibitor of matrix metalloproteinases (TI MP-1) are presented in WPW phenomenon group and practically healthy persons (418,5 ± 69,8 ng/ml and 461,7 ± 72,2 ng/ml; p = 0,27). In patients with WPW syndrome, TIMP-1 was reliably lower - 341,1 ± 90,1 ng/ml ( p = 0,002; p = 0,00012). Procollagen type 1 carboxyterminal propeptide (PICP) level in patients with WPW syndrome was 179,9 ± 76,2 ng/ml, with WPW phenomenon - 97,8 ± 31,7 ng/ml ( p = 0,00014). All patients, included into the study, significantly differed from practically healthy persons by PICP level - 69,4 ± 23,9 ng/ml ( p < 0,05, U -criterion). Statistical processing of material showed reliable differences between extracellular matrix status indices depending on WPW syndrome and phenomenon, as well as presence or absence of AF paroxysms against the background of ventricular preexcitation. Conclusions. Changes in fibrous matrix, namely, increase in MMP-9, PICP concentrations and decrease in TIMP-1was registered. WPW syndrome is characterized by significant dysbalance of collagen synthesis and degradation seromarkers than WPW phenomenon. The studied seromarkers of fibrosis, probably, participate in formation of rhythm disturbance of the heart with actual syndromes available.
Perm Medical Journal. 2016;33(1):28-34
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ORTHOPEDIC REHABILITATION EFFICIENCY IN POSTINSULT PATIENTS
Schekolova N.B., Bronnikov V.A., Zinoviev A.M., Sklyannaya K.A.
Abstract
Aim. The aim of the study was to specify the locomotor system disorders in postinsult patients, to assess the efficiency of orthopedic rehabilitation. Materials and methods. Examination of 122 postinsult patients was carried out. There were 65 men (53,28 %) and 57 (46,72 %) women. The mean age was 60,42 ± 1,19 years. Orthopedic status and pain syndrome were assessed. Statics and walking patterns were studied. To determine vegetative function, Credo index (CI) and stress level (SL) were calculated by special formulas. Results. In the clinical picture of primary motor disorders, the most significant were musculo-tonic disorders. Joint contractures were detected in all the examined patients. Pelvic, crural, feet, vertebral asymmetry was registered. Gonarthrosis was revealed in 35 (28,67 %) patients, coxarthrosis - in 45 (36,89 %). Combination of degenerative-dystrophic changes in the spinal column and joints was noted in 38 (31,15 %) patients. Seventy three (59 %) patients had the elevated stress level. Modern materials for immobilization were used; orthopedic apparatuses for walking and orthopedic footwear were produced to liquidate contractures. Orthopedic rehabilitation of postinsult patients was carried out by means of modern equipment using robotic technique. Reduced pain syndrome and leg spasticity was observed. Conclusions. The changed set pattern was characterized by normalization of the position of the body mass center in the frontal plane. Walking was distinguished by improvement of joint functioning. Normalization of bioelectric muscular activity was registered.
Perm Medical Journal. 2016;33(1):35-41
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DIAGNOSTIC VALUE OF SEROTONIN NEUROMEDIATOR AND NEURONSPECIFIC ENOLASE DETERMINATION IN ACUTE PERIOD OF TICK-BORNE ENCEPHALITIS
Sumlivaya O.N.
Abstract
Aim. The aim of the study was to estimate the informative level of changes in blood platelet serotonin and neuronspecific enolase among patients with different forms of tick-borne encephalitis in its acute period. Materials and methods. Forty four patients with acute course of tick-borne encephalitis were examined in dynamics of disease: 35 patients with nonparalytic and 9 - with paralytic forms. All patients experienced determination of blood platelet serotonin and enolase concentrations using the method of immune-enzyme analysis. The control group consisted of 15 healthy persons. Results. During the peak of infection, the platelet serotonin level in paralytic form was reliably lower than in nonparalytic one ( p < 0,05) and it has not been restored in the period of early reconvalescence. On the contrary, in nonparalytic form, by the end of infectious process its value increased. During the first days of disease, the elonase concentration in all the cases of tick-borne encephalitis was within the norm. In the period of early reconvalescence, no changes in enolase content among patients with nonparalytic form were established, whereas its index ( p < 0,05) increased in paralytic form. Conclusions. The study of platelet serotonin concentration in the acute period of tick-borne encephalitis is more informative than determination of blood enolase level and can serve as an early prognostic marker of the development of paralytic form.
Perm Medical Journal. 2016;33(1):42-47
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LESION OF VISUAL ORGAN IN HIV-INFECTED PATIENTS OF PERM KRAI
Gavrilova T.V., Shmagel N.G., Chereshneva M.V.
Abstract
Aim. The aim of the study was to analyze the ophthalmic pathology in HIV-infected patients of Perm Krai. Materials and methods. Medical documentation of 224 patients, registered at Perm Regional Center for Prevention and Control of AIDS as well as patients treated at ophthalmological departments of Perm, was analyzed. Results. Changes in the visual organ were detected in 92 persons on 151 eyes (41 % of all the examined patients). There were 61,96 % of men and 38,04 % of women; the mean age was 33,37 ± 8,08 years. The most frequently occurring pathologies were retinal mioangiopathy (58,29 %), seldom - uveitis (9,27 %), cataract (7,28 %), retinitis, blepharitis - 3,97 % each, conjunctivitis, optic neuritis - 2,65 % each, uveoneuritis - 1,32 %, orbit phlegmon, hyposphagma - 0,67 % each; visual injuries: apple contusion - 3,97 %, eyelid wounds - 3,31 %, penetrating eye wound - 1,32 %. Conclusions. Visual lesion more often occurred in subjects with decreased level of CD4-cells; most of them did not receive antiretroviral therapy, mainly those with severe ophthalmic pathology. Ophthalmologists should be especially careful to HIV-infected patients.
Perm Medical Journal. 2016;33(1):48-52
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ENDOTHELIAL DYSFUNCTION AND SYSTEMIC INFLAMMATION AS SEVERITY STRATIFICATION FACTORS OF CROHN’S DISEASE
Stepina E.A.
Abstract
Aim. The aim of the study was to determine the functional activity of endothelium in patients with Crohn’s disease (CD), and to assess its dependence on the severity of disease attack. Materials and methods. Sixteen patients diagnosed CD in the exacerbation phase and those with first diagnosed forms of disease were examined. The control group enclosed 11 practically healthy persons. The blood serum vasculoendothelial growth factor (VEGF) level, plasma desquamated endotheliocytes (DEC) number, as well as microalbuminuria (MAU) level were studied as the markers of endothelial dysfunction (ED). Results. Among CD patients, increased concentrations of ED markers as compared with the control group were revealed. A reliable correlation between the ED indices and the degree of severity of the disease was obtained. Positive correlation between the VEGF, DEC and MAU levels and the systemic inflammation markers (ESR, SRP, fibrinogen and alpha-2-globulin) was found. A mathematical model allowing to predict the degree of severity of CD attack was developed. Conclusions. Endothelial dysfunction, which is expressed by the increased VEGF, DEC and MAU levels, was detected in CD patients. ED indices directly depend on the serum markers of systemic inflammation. Thus, VEGF, DEC and MAU values can serve as a criterion for CD attack severity.
Perm Medical Journal. 2016;33(1):53-58
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STUDY OF INFLUENCE OF TECHNOLOGICAL FACTORS ON QUALITATIVE INDICES OF FLUOXETIN TABLETS AND CAPSULES
Yuriyeva I.N.
Abstract
Aim. The aim of the study was to choose the way and to select the regime of graining, to investigate the influence of fractional composition, relative humidity and pressing pressure on the qualitative indices of tablets and capsules of the drug fluoxetin. Materials and methods. Technological properties of materials and qualitative indices of tablets and capsules were determined using the generally accepted methods. Results. Experimental data regarding the influence of technological factors on the qualitative indices of fluoxetin tablets and capsules of the selected composition assessed by means of mathematical planning of experiment with the method of Latin squire 4×4 are presented in the paper. The obtained values were used to approve this technology in manufacturing. Conclusions. The way and regime of graining was selected. It was established that fractional composition should contain the dust fraction (0,16 mm and less) - not more than 20 %; the residual humidity of granulated substance of the mixture for pelletization and capsulation should be not more than 1,5 % and the pressure for tablet pressing - within the range of 60 MPa to 120 MPa.
Perm Medical Journal. 2016;33(1):59-65
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SPLENOPID AND RONCOLEUKIN EFFICIENCY AND APPLICATION FOR TREATMENT OF PUO-INFLAMMATORY AND IMMUNODEFICIENT DISEASES
Styazhkina S.N., Sitnikov V.A., Ledneva A.V., Klimentov M.N., Akimov A.A.
Abstract
Aim. The aim of the study was to estimate the efficiency of the drugs splenopid and roncoleukin for the treatment of a severe purulo-necrotic pathology in patients of Izhevsk Regional Clinical Hospital № 1. Materials and methods. The results of treatment of 125 patients with severe purulo-septic pathology of the abdominal cavity and retroperitoneal space are presented in the paper. All patients were divided into 2 groups: group 1 (50 persons) took “Splenopid”, group 2 (60 persons) - “Roncoleukin”. The control group included 15 persons, who experienced traditional methods of treatment. The patients’ status was assessed by toxicological, immunological and biochemical indices. Results. Among the patients taking splenopid, positive dynamics in immunological status was detected at the days 4-7. In the control group, all cellular immunity indices were below the norm. The patients receiving roncoleukin had positive immunological dynamics at the days 3-5, which was accompanied by the activation of initially decreased cellular component of the immune system. Conclusions. A high activity of these drugs was stated in different degrees of immunological deficiency, in treatment of pyoinflammatory diseases of the abdominal cavity, small pelvis organs, septic states. The cellular and humoral immunity indices in the group of patients receiving ronkoleukin are higher that can prove its greater efficiency.
Perm Medical Journal. 2016;33(1):66-70
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DEVELOPMENT OF COMPOSITION AND TECHNOLOGY OF CALCIUM-CONTAINING DRUG CAPSULES
Yuriyeva I.N., Vdovina G.P., Koryukina I.P.
Abstract
Aim. The aim of the study was to develop the composition and technology of calcium-containing drug capsules. Materials and methods. To optimize the choice of capsule composition, the method for mathematical planning of the experiment, Latin squire 3x3, was used. The experiment results were processed with mathematical methods of statistical and variance analysis using Dunkan, Fisher criterion, and generalized desired function. Technological properties and qualitative indices of capsules were determined by the generally accepted methods. Results. On the basis of the analysis of technological properties of substances and model capsules, it is necessary to use humid granulation and to add auxiliary substances (correcting substances, stickers and antifrictional substances) for avoiding the detected disadvantages and receiving qualitative capsules. Different compositions containing reactants such as calcium carbonate, ascorbic acid, vitamin D and auxiliary substances were formed. The influence of auxiliary substances, residual humidity and fractional composition of the granulated substance on technological parameters of the quality of mixtures and capsules of the chosen composition was studied. Conclusions. An optimal composition and rational technology of the drug “Calcium DS - Medisorb” is chosen; the corresponding size of solid gelatin capsules is selected that permitted to approbate this technology in production.
Perm Medical Journal. 2016;33(1):71-78
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ASSESSMENT OF NEW NONNARCOTIC ISOQUINOLINE DERIVATIVE ANALGESIC, COMPOUND G-104, FOR PRESENCE OF CONCOMITANT AND UNWANTED EFFECTS TYPICAL FOR ANALGESICS
Zenkova E.A., Vdovina G.P., Burlutskaya A.A., Danilova V.K.
Abstract
Aim. The aim of the study was to assess the effect of a new nonnarcotic analgesic, compound G-104, on the motor activity, coordination of movements, muscular tonus and respiratory function of white rats, when introduced in a wide range of doses comparing to the registered analgesics. Materials and methods. The effect on mice tonus was evaluated using the horizontally tightened wire, coordination of movements was studied with the device Rotarod, graphic registration of respiratory movements - by means of the system PowerLab 4/35 and the computer program LabChart 8. The number of respiratory movements per minute was calculated, the cases of pathological respiratory forms were taken into account. The motor activity was studied using the device “Open field”. Results. A new native analgesic G-104 does not influence the muscular tonus of white rats in the dose of UN50 unlike Tramadol and Ketorolac causing irreversible hypotonus in 50-100 % of experimental animals. The compound G-104, as well as the comparison drugs Tramadol and Ketorolac, has no effect on coordination of movements. No changes in spontaneous motor activity after chronic introduction of G-104 in the device “Open field” were revealed. A new analgesic G-104 does not alter the frequency and amplitude of white rats’ respiratory movements when introduced in the dose of UN50 as compared with the background indices. Conclusions. The compound G-104, when introduced in the dose of UN50, does not influence the muscular tonus and coordination of movements in white rats unlike the analgesics Tramadol and Ketorolac causing hypotonus in therapeutic doses. The compound G-104 does not alter the spontaneous motor activity in the device “Open field”. A new analgesic G-104 does not depress respiration in white rats when introduced in the dose of UN50.
Perm Medical Journal. 2016;33(1):79-84
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ROLE OF NURSES IN REHABILITATION OF PATIENTS AFTER CARDIOSURGICAL OPERATIONS
Ivanova O.V., Gladkov S.V., Kasimovskaya N.A.
Abstract
Aim. To study the role of nursing staff in rehabilitation of patients after cardiosurgical operations. Materials and methods. Sociological survey was carried out among 250 patients after high-technology surgeries by the profile of cardiovascular surgery. Results. The main form of nurses’ activity is the process of organization and practical realization of physician’s instructions. Physician is a person responsible for organizing and carrying out rehabilitation measures, that is “brain center” of the program but nursing staff - its hands, “active force” of rehabilitation process as a whole. The share of nurses’ activity in patients’ care following the cardiosurgical operations prevailed (74 %), the share of physician’s competence in solving patients’ problems during the postoperative period after the cardiovascular operations was 26 %. Conclusions. The role of nursing staff included into the multidisciplinary rehabilitation team for solving patients’ problems in the postoperative period is very significant.
Perm Medical Journal. 2016;33(1):85-91
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ANALYSIS OF DRUG ASSORTMENT FOR PAIN SYNDROME ARREST IN ELDERLY PATIENTS RENDERED ACUTE CARE
Chereshneva N.D., Smirnov A.V., Soloninina A.V., Pushkareva A.S.
Abstract
Aim. The aim of the study was to investigate the drugs used by emergency teams for arresting pain syndrome in elderly patients. Materials and methods. The study was conducted on the basis of State Budgetary Institution of the Republic Mari El “Republican Clinical Hospital for War Veterans” using the method of content-analysis of emergency cards. Emergency cards of 153 patients over sixty were studied. Results. It was established that 41,8 % of men and 58,2 % of women addressed for acute care. The mean age of patients was 84,3 ± 4,26 years. For all kinds of pain, there were administered 51alalgetics, 26 adjuvants and 76 other drugs. It was stated during the study that 9,2 % of drugs were administered with violation of application instructions. It was detected that out of 40 cases of ketorolac administration, 10 (25 %) were irrational. The most common error is combined administration with acetylsalicytic acid (6 cases). Conclusions. It is necessary to increase the level of knowledge of emergency team specialists regarding the problems of rational administration of drugs for pain syndrome arrest taking into account patients’ old age and possible medicamentous interactions.
Perm Medical Journal. 2016;33(1):92-96
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TECHNIQUES FOR MANAGEMENT OF DRUGS APPLICATION PROCESSES AT MEDICAL CENTERS OF EDUCATIONAL INSTITUTIONS
Kozlova M.S.
Abstract
Aim. The aim of the study was to develop the techniques for the management of processes of using drugs at medical centers of educational institutions. Materials and methods. The work of 62 medical centers of educational institutions was analyzed with the method of sample interview by means of questionnaire and situation analysis. So as to model the processes, the method of functional modeling IDEF0 was used. Results. The methodology of technique for management of drugs application processes at medical centers of educational institutions is presented by the author. It includes analysis of the existing conditions of using drugs at medical centers, determination of the main processes of using drugs, modeling of these processes in IDEF0 notation. Conclusions. The developed techniques for the management of drugs application processes at medical centers of educational institutions allow raising the quality of first medical and sanitary aid rendered to students.
Perm Medical Journal. 2016;33(1):97-102
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DIFFICULTIES IN DIAGNOSIS OF NONRHEUMATIC MYOCARDITIS. CLINICAL OBSERVATION
Kiryanova N.V., Babushkina G.D., Mikhailovskaya L.V., Borodina E.N., Babushkina L.V., Kiryanova T.V., Shavrin A.P.
Abstract
Clinical picture of myocarditis is nonspecific, in some cases it is difficult to diagnose and induces a large number of errors. Therefore, differential diagnosis is of great importance for management of inflammatory myocardial damages.
Perm Medical Journal. 2016;33(1):103-110
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HEREDITARY ANGIONEUROTIC EDEMA IN 18 YEAR-OLD PATIENT
Zhadova T.A., Zaikina M.V., Tuev A.V.
Abstract
The problem of isolated angioedemas is a difficult problem of clinical allergology, their prevalence needs further studies. Hereditary angioedema occurs rarely and makes not more than 2% of all angioedema cases, in the total population hereditaty angioedema is detected with the rate of 1:10000-1:1500000 persons. There are three forms of this disease: type I hereditary angioedema, type II hereditary angioedema and estrogen-dependent edemas (type III). The first two forms are conditioned by genetically deterministic absolute or relative deficit of C1-inhibitor, in the third form its concentration and function are not changed. Hereditary angioedemas, unfortunately, are incurable for today in spite of achievements of current medicine. However, in case of full anamnesis available, target diagnosis and timely onset of treatment it is possible to have a significant positive dynamics in the course of disease. In medical science there is a poor experience regarding this nosology that motivated us to publish a report on such a rare clinical case.
Perm Medical Journal. 2016;33(1):111-115
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REFRACTORY ARTERIAL HYPERTENSION AND PROBLEMS OF THERAPY
Schekotov V.V.
Abstract
Resistant arterial hypertension (RAH) occurs with frequency of 10 % to 30 % of cases depending on RAH definition and arterial hypertension (AH) population. To a certain extent, RAH prevalence depends on inclusion into the group of pseudoresistant or real RAH. In the present paper the problems of real RAH are under consideration. Modern definition of RAH is attributed mainly to ambulatory patients, treated by three-or four component program including diuretic. Spironolactone was established to be of great significance in RAH treatment, much more exceeding bisoprolol and doxazosin. Recently, clinical studies regarding the procedure of renal arteries denervation and carotid arteries stimulation were carried out. The uncontrolled studies showed high efficiency of these procedures during three years, whereas the controlled studies are doubtful in respect of their effect.
Perm Medical Journal. 2016;33(1):116-123
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