Vol 18, No 2 (2016)


Diagnosis and treatment of chronic cerebral ischemia

Fedin A.I.


The definition of chronic cerebral ischemia (CCI). There was a special role in the pathogenesis of ischemic cascade CCI and disorders of cerebral microcirculation. Presented is the disease diagnostic algorithm. Clinical manifestations CCI considered depending on the severity of the pathological process. Particular attention is paid to vascular cognitive impairment of varying severity. An original adapted for ambulatory practice quantitative scale of CCI. Treatment of patients with CCI is discussed on the basis of the pathogenesis of the disease. The methods of antihypertensive and lipid-lowering therapy, the purpose cerebrovascular, antiplatelet, neurometabolic agents and antioxidants.
Consilium Medicum. 2016;18(2):8-12
pages 8-12 views

Hyperhomocysteinemia and C677T MTHFR gene polymorphism in patients with ischemic stroke at the age of 50 years

Kimelfeld E.I., Koltsova E.A., Petrova E.A., Tupitsyna T.V., Slominskiy P.A., Limborskaya S.A.


Evaluation of homocysteine levels with different pathogenetic variants of ischemic stroke (IS), as well as the influence of the C677T polymorphism in the MTHFR gene on the risk of ischemic stroke in patients Slavic population under the age of 50 years. A total of 90 young patients (71 men, 19 women, mean age - 42.3±6.7 years) with atherothrombotic, lacunar and AI unknown etiology in terms from 1-3 up to 21 days after the development of AI. All patients underwent magnetic resonance/computer tomography of the brain, duplex scanning of brachiocephalic arteries, echocardiography, the study of antibodies to phospholipids, coagulation and platelet aggregation, homocysteine, clinical and biochemical blood, rheumatic tests, determination of the C677T polymorphism of the MTHFR gene. It was revealed that inpatients with atherothrombotic stroke before the age of 50 years was significantly increased levels of homocysteine compared to other pathogenic variants (p<0.001, ANOVA). Not a statistically significant difference between the average level of homocysteine in different genotypes of polymorphic loci for C677T MTHFR gene, however, revealed a weak trend in the higher level of homocysteine in patients with T/T- genotype (p=0.099). Analysis of polymorphic locus C677T MTHFR gene showed that this polymorphism does not affect both the risk of ischemic stroke in general (p>0.05), as well as some of its pathogenic variants in patients under the age of 50 years.
Consilium Medicum. 2016;18(2):13-17
pages 13-17 views

Reperfusion therapy in ischemic stroke in the vertebrobasilar system

Tolmachev A.P., Anisimov K.V., Shamalov N.A.


Ischemic stroke in the vertebrobasilar system (VBS) is characterized by a high rate of mortality and the significant rate of disability in survivors. Implementation of reperfusion therapy in patients with localization of the lesion in the SVD in some cases is a safe and effective outside the 4.5-hour time frame. Actively developing current methods of endovascular treatment of acute ischemic stroke, provide additional opportunities to increase the frequency of recanalization and, as a consequence, improve the degree of functional recovery in this patient group.
Consilium Medicum. 2016;18(2):18-21
pages 18-21 views

Features of the spectrum and the concentration of the products of purine and pyrimidine metabolism in thrombolytic therapy in patients with ischemic stroke

Lyang O.V., Fedorov V.N., Kochetov A.G., Shamalov N.A., Stakhovskaya L.V.


Relevance. The disorders of energy metabolism, as a first response of brain tissue to ischemia, characterized by a change in the spectrum of purine and pyrimidine compounds, which are part of makroergic compounds and their metabolites. The aim of this work was to determine the spectrum and concentrations of purine and pyrimidine metabolism in patients with ischemic stroke (IS) before thrombolytic therapy (TLT).Materials and methods. The study included 24 patients (18 men and 6 women) with hemispheric IS, all was held TLT. All patients before the TLT was determined 18 range of purine and pyrimidine bases by the method of chromatography-tandem mass spectrometry (HPLC-MS/MS).Results. The spectral features of purine and pyrimidine bases in patients with a fatal outcome (FO) in the acute period of IS before TLT is the absence in serum of adenosine, desoxyadenosine, xanthine. The concentration of orotic acid in acute periodof IS associated with non-lethal hemorrhagic transformation (HT) and FO. The concentration of orotic acid less 2.29 mmol/l was associated with risk of developing, and above 90.6 mmol/l with non-lethal presence of HT, i.e. with a high probability of survival.
Consilium Medicum. 2016;18(2):22-26
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Hemorrhagic transformation of cerebral infarction in the post-stroke period (clinical observation)

Gudkova V.V., Gubskiy L.V., Gubskiy I.L., Panov G.V., Volkova N.N., Nikogosova A.K., Logunova T.A., Gutsaliuk A.G., Poderina V.P., Kimelfeld E.I., Usanova E.V.


The article presents the literature on clinical and radiological predictors of hemorrhagic transformation of cerebral infarction, the ambiguity of stroke prognosis and outcome in bleeding in the development zone of ischemia. Presented are the clinical and tomographic observations - massive asymptomatic petechial hemorrhages with a favorable outcome in an elderly patient with recurrent cardioembolic stroke. Noting the complexity of antithrombotic therapy in secondary prevention of stroke in this situation.
Consilium Medicum. 2016;18(2):27-30
pages 27-30 views

Post-stroke spasticity

Khasanova D.R., Agafonova N.V., Starostina G.K., Krylova L.V.


A number of patients, despite the early start of rehabilitation measures (special packing, drug therapy, massage, physiotherapy), formed early post-stroke spasticity. Early development of spasticity in the arm post-stroke pain aggravates shoulder syndrome, which occurs in 20-40% of patients, impairs recovery of motor function, leading to the formation of contractures, affecting the overall process to restore the function and quality of life. One of the widely used treatment technologies for spasticity is Botulinum. Experience in the use of botulinum toxin type A in patients with post-stroke spasticity diagnosed early hand in the acute and early rehabilitation phase of stroke (up to 3 months from the onset of the disease) has shown efficacy of botulinum-based therapy as an integrated approach to treatment in conjunction with standard methods of early neurorehabilitation. It has been found that the use of botulinum toxin preparations helped to reduce the degree of spasticity and pain significantly reduced shoulder syndrome. The optimal dose of botulinum toxin type A was 1/2 of the average recommended dose.
Consilium Medicum. 2016;18(2):31-36
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The dynamics of neurophysiological signs of segmental and suprasegmental motor conduction at patients with myelopathy and cerebral stroke

Kovrazhkina E.A., Stahovskaya L.V., Razinskaya O.D.


Introduction: The damaged axons of the central nervous system (CNS) of adults, cause severe and non treatable functional disorders as a consequence of the inability of the CNS unlike the peripheral nervous system repair damaged nerve fibers. Embryonic axons of the central nervous system are reduced, but the regenerative response of adult neurons becomes insolvent. Myelin and myelin-producing oligodendrocytes CNS axons are able to inhibit the growth of, respectively, the long-term preservation of myelin in the damaged area can inhibit axonal regeneration.Objective: To study the dynamics of axonal damage and mielinopatii on segmental and suprasegmental levels in patients with myelopathy and cerebral stroke.Methods: The study involved 340 patients with myelopathy of different levels (70% of the effects of spinal spinal injuries and 30% of nontraumatic myelopathy origin) - the main group, the comparison group consisted of 30 patients with cerebral hemispheric stroke. Status of segmental evaluated by electromyographic, suprasegmental - transcranial magnetic stimulation. The patients were examined twice: when applying for a rehabilitation course in the dynamics of 2-3 months.Results: Initial examination in the study group showed no significant differences in the severity and axon - myelinopathy with varying severity of neurological deficit. In a studyin dynamics in patients with improvement in functional status (for FIM scale) was found, significant (p<0.05) myelopathy of great severity at the segmental and suprasegmental levels of persisting in repeated studies (in patients without the dynamics on the scale of severity of FIM myelopathy with repeated surveys decreased). For patients with functional impairment revealed significantly greater (p<0.05) axonopathy severity and significantly (p<0.05) lower severity myelopathic changes. Similar changes were found in patients with stroke: when examining the dynamics in patients with a better recovery (Rankin Scale) found lower severity of axonal and large - myelopathic changes.Conclusion: The CNS lesions observed increase in myelopathic changes in segmental and suprasegmental level, the re-testing of patients with improvement in functional status, and in patients with deterioration of functional capacity, on the contrary, - reduced severity of myelopathy.
Consilium Medicum. 2016;18(2):37-43
pages 37-43 views

Moderate cognitive disorders

Pilipovich A.A.


The article is dedicated to the problem of moderate cognitive disorders, their spreading, etiology, pathogenesis features, diagnostic principles, and therapy. The data on the therapeutic efficacy of treatment by Pronoran, the agonist of dophamine receptors is also stated.
Consilium Medicum. 2016;18(2):44-49
pages 44-49 views

Features of treatment of pain in the lower back in patients with contraindications for nonsteroidal anti-inflammatory drugs

Podymova I.G., Danilov A.B.


The paper deals with treatment of pain in the lower back. Particular attention is paid to the mechanism of action of non-steroidal anti-inflammatory drugs (NSAIDs), which are presented in detail with their side effects. The possibilities of treatment of pain in patients who have contraindications to NSAIDs purpose are also discussed.
Consilium Medicum. 2016;18(2):50-52
pages 50-52 views

Facet syndrome: causes, clinical features, diagnosis and treatment

Isaykin A.I., Kuznetsov I.V., Kavelina A.V., Ivanova M.A.


Currently accepted biopsychosocial model of pain in the back, in which the isolated biological component with the identification of anatomic source of pain as well as psychological and social components that contribute to the emergence and maintenance of back pain. The group of patients with non-specific low back pain is not uniform, which requires a differentiated approach to the treatment. The most common sources of back pain are diseased discs, facet joints, sacroiliac joint, muscle spasm, but the definition of the main source of pain is difficult due to the lack of validity of the test used. Facet (facet joints) are the only typical synovial joints of the spine. In the development of the pathology attaches importance to several factors: micro and makrotravmatizatsii, enhancing the load on the joints when disc degeneration, inflammatory lesions in the form of arthritis, similar to other peripheral lesions of synovial joints. Possible mechanisms of pain include stretching of the joint capsule, synovial folds infringement (meniscoids) between the joint surfaces, and compression of the spine osteophytes and joint inflammation in the development of secondary muscle spasm. Facetogenic pain is prevalent in older age groups, more often in women with a higher body mass index. There is no correlation between morphological changes in the facet joints and back pain. The combination of positive and negative test, taking intoaccount the patient's clinical symptoms and complaints can help to identify the main source of pain. "The gold standard" diagnosis is to conduct diagnostic blockade with local anesthetics, performed under the supervision of the neuroimaging with a reduction in pain for at least 70-80%. Treatment of the facet syndrome is carried out according to the general principles of treatment of non-specific back pain using medical methods and non-pharmacological treatment. Drug treatment in the early stages includes a choice of preparations purpose of nonsteroidal antiinflammatory drugs and muscle relaxants.Several studies have shown the effectiveness and safety of baclofen in the treatment of acute and chronic back pain. With the ineffectiveness of 3 months it is recommended to use different versions of blockades and radiofrequencies of facet denervation.
Consilium Medicum. 2016;18(2):53-61
pages 53-61 views

Treatment of chronic pain in the joints and back combined preparationsof chondroitin sulfate and glucosamine hydrochloride

Alekseeva L.I., Sharapova E.P.


Treating osteoarthritis (OA) and pain in the lower back (LBP) directed primarily to the symptoms of the disease, i.e. to reduce pain and improve functional condition of the joints and spine, which achieved a combination of non-pharmacological and pharmacological methods. appointed by nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics, muscle relaxants and other drugs, which do not completely eliminate the symptoms to reduce pain in patients with OA and LBP. However, in patients receiving NSAIDs significantly increased risk of adverse reactions from the gastrointestinal tract, cardiovascular system, kidneys and other organs - this is especially important when comorbid conditions in older patients - that may limit the appointment of a number of drugs. Appointment of a combination of glucosamine and chondroitin sulfate, which has anti-inflammatory and analgesic activity may be useful in the treatment of OA and LBP with regard to the role of inflammation in the pathogenesis of LBP, and structurally modifying properties can be realized with the defeat of the facet joints, has a definite place in the structure of the BNS. However, opinions about the use of these drugs, particularly chondroitin sulfate and glucosamine, is ambiguous. In Russia it was held open multicentre observational prospective study of the effectiveness of this combination in the treatment of knee OA and non-specific LBP in outpatient practice.Analysis of the results of these studies showed a significant decrease in pain, stiffness, improved functional index at Oswestry LBP and WOMAC - in OA, as well as reducing the daily requirement of NSAIDs. There were also marked by good tolerability and high security products.
Consilium Medicum. 2016;18(2):62-67
pages 62-67 views

The differential diagnosis of neurological disorders in patients with arterial hypertension

Vakhnina N.N.


Arterial hypertension (AH) is one of the most common vascular diseases. Among the target organs of hypertension more often and earlier than others the brain suffers. The main feature of brain lesions in hypertension are cognitive impairment (CI), the structure of which is dominated by disorders of attention, control functions and visual-spatialgnosis and praxis. Typically vascular disorders accompanied by CI anxiety-depressive spectrum, which are combined with the overall pathophysiology of CI as fronto-subcortical dysfunction. At the same time such neurological disorders, such as headache and dizziness, in hypertension is rarely caused by the underlying disease. Most often hypertensive headaches are different versions of the primary headache, and dizziness associated with peripheral vestibular disorders. The nosological structure of Headache and dizziness in hypertensive patients as a whole repeats the representation of different types of these disorders in the general population.
Consilium Medicum. 2016;18(2):68-73
pages 68-73 views

Mild to moderate cognitive impairment: current issues of diagnosis and treatment in primary health care

Trukhan D.I., Mazurov A.L.


The varied scope of medical diagnostic procedures and the expansion of capacity of medical care, including cases of cognitive impairment, in primary health care, suggests need for screening of cognitive impairment and inclusion of drugs with neuroprotective and nootropic action into the arsenal of medicines of first contact physician.
Consilium Medicum. 2016;18(2):74-80
pages 74-80 views

Complex treatment of patients with diabetic polyneuropathy

Kamchatnov P.R., Evzelman M.A.


Diabetes mellitus is a common disease, one of the complications which becomes diabetic polyneuropathy (DPN). DPN is shown in motor and sensory disorders, and neuropathic pain is becoming an important reason for the decline in quality of life. The defeat of the autonomic nervous system in the cash flow associated with the risk of life-threatening conditions (stroke, severe heart rhythm disturbances) and the onset of death. The possibilities of application thioctic acid drug (Octopilen®) as a means of pathogenetic therapy of DPN. The data on the effectiveness of gabapentin (Convalis®) for the relief of pain in DPN.
Consilium Medicum. 2016;18(2):81-84
pages 81-84 views

Chronic cerebrovascular disease: diagnosis and treatment questions

Shchukin I.A., Lebedeva A.V., Burd S.G., Fidler M.S., Shikhkerimov R.K., Ismailov A.M., Bolotov A.V., Belgusheva M.K.


In the article the basic questions of clinic, diagnosis and treatment of chronic cerebral ischemia (CCI). The results of the observation program "Fezam (piracetam + cinnarizine) for the correction of moderate cognitive and asthenic disorders in patients with HIM", during which found that Fezam has a beneficial effect against mild cognitive impairment, asthenic disorders, light and moderate emotional disturbances. The positive impact of the combination on the severity of asthenic disorders and emotional disorders is dose dependent - the best effect is achieved by using high-dose Fezam (2 capsules 3 times a day), duration 90 days. Younger patients (50 to 64 years) respond to high- dose therapy Fezam better than patients older age category (65-80 years).
Consilium Medicum. 2016;18(2):85-94
pages 85-94 views

Combined therapy of neurasthenia in general medical practice

Dobrushina O.R., Medvedev V.E.


In the course of pilot naturalistic comparative trial, the authentic data were obtained that inclusion of polyvitaminic complex into complex therapy of neurasthenia contributes to reduction of severity of psychopathological symptoms.
Consilium Medicum. 2016;18(2):95-99
pages 95-99 views

Nimesulide: efficacy and safety

Kotova O.V., Akarachkova E.S.


Nimesulide is a non-steroidal anti-inflammatory drug (NSAID) effective in treating a variety of diseases associated with inflammation and pain, including acute pain in primary dysmenorrhea. Nimesulide is now available on the market since 1985.According to the degree of selectivity to the isoforms of cyclooxygenase (COX) nimesulide refers to drugs which inhibit predominantly COX-2. The article presents data on the efficacy and safety of nimesulide.
Consilium Medicum. 2016;18(2):100-103
pages 100-103 views

Small vessel disease: pathogenic subtypes and possible therapeutic strategies

Esin R.G., Esin O.R., Khairullin I.K.


In this review the clinical and neuroimaging criteria states are united in a group of diseases of small vessels of the brain, and unlike the therapeutic possibilities of their treatment for the prevention of progression of neurological symptoms, cognitive impairment from other causes of acute and chronic brain ischemia. The authors examine the potential of a new form of release - dispersible tablets vinpocetine (Cavintonum comfort) as a drug that can have an impact on different pathogenetic factors contributing to the progression of small vessel disease.
Consilium Medicum. 2016;18(2):104-108
pages 104-108 views

Clinical and pharmacological aspects of the use of vitamin D: from the known facts to look for new targets

Klimova O.Y., Berdnikova N.G., Kazakov R.E.


Vitamin D not only occupies an important place in the regulation of calcium-phosphorus homeostasis, but also has many "non-bone" effects. Revealed in epidemiological studies the link between vitamin D deficiency and the development of various diseases is currently under study in randomized clinical trials. Severity of clinical effects of vitamin D may be dependent on the genetic polymorphism of VDR (vitamin receptors D), over - expressed in the 40 target tissues. For the prevention and treatment of vitamin D- deficient conditions and insolation recommended application of vitamin D, in particular, its active metabolite alfacalcidol is used.
Consilium Medicum. 2016;18(2):109-116
pages 109-116 views

Sleep disorders in anxiety disorders: clinical aspect and therapy

Yastrebova V.V., Yastrebov D.V.


The article presents basic characteristics of sleep disorders. Typological variants of clinical forms of symptomatic and reactive insomnia are proposed. The authors present an algorithm for diagnosis of insomnia of various origins and provide recommendations for their medication therapy. The review of the efficacy, tolerability and safety of principal hypnotic drugs is presented. The results of clinical application of a new anxiolytic Afobazole for the treatment of insomnia in anxiety disorders are included.
Consilium Medicum. 2016;18(2):117-123
pages 117-123 views

Current recommendations for the treatment of osteoarthritis

Chichasova N.V.


The article presents the current national and international guidelines on the management of patients with osteoarthritis. Given the high multimorbid patients with osteoarthritis, presented data on the prevention of complications of drug therapy and worsening current comorbidities. Showing analgesic and anti-inflammatory capabilities symptom-modifying slow-acting medications (symptomatic slow-acting drug for osteoarthritis - SYSADOA) in the treatment of osteoarthritis. The data of domestic and foreign authors on the effectiveness of the combined preparations of SYSADOA group.
Consilium Medicum. 2016;18(2):124-133
pages 124-133 views

Osteoporosis and sarcopenia in patients with rheumatoid arthritis: the ways to prevent musculoskeletal loss

Muradyants A.A., Shostak N.A., Kondrashov A.A., Timofeev V.T.


Rheumatoid arthritis (RA) is one of the most common and serious chronic immunoinflammatory diseases, leading to early disability of patients and the high levels of premature mortality. Patients with RA along with osteoporosis and osteopenia have shown significant reductions in muscle mass of sarcopenia and/or cachexia.Musculoskeletal loss in RA causes a high risk of falls and fractures, which significantly worsens the prognosis. In the article the basic pathogenetic mechanisms of the development of osteoporosis and sarcopenia in RA risk factors, as well as the main approaches to treatment and prevention of bone and muscle loss in RA patients are covered.
Consilium Medicum. 2016;18(2):134-140
pages 134-140 views

What can be an alternative to non-steroidal anti-inflammatory drugs for the control of acute musculoskeletal pain in a patient with a history of myocardial infarction and gastrointestinal bleeding?

Karateev A.E.


Fast and most complete pain relief is the most important problem in the treatment of patients with non-specific back pain, osteoarthritis and rheumatic pathology of periarticular soft tissues. The modern concept of analgesic therapy involves anintegrated approach to the use of drugs and treatments that affect the various links in the pathogenesis of pain. It means, that the first here are the non-steroidal anti- inflammatory drugs (NSAIDs). However, NSAIDs can cause dangerous complications, so their use is severely restricted with serious comorbid diseases of the gastrointestinal tract and is contraindicated at high cardiovascular risk - for example, in patients with symptomatic ischemic heart disease, myocardial infarction and stroke. This review discusses analgesics that may be a safer alternative to NSAIDs in this situation. Such preparation may be considered as flupirtine, an analgesic drug with an original mechanism of action, has proven its effectiveness and safety compared with NSAIDs and opioids in a series of well-designed clinical trials.
Consilium Medicum. 2016;18(2):141-149
pages 141-149 views

The use of complex homeopathic preparation for the treatment of degenerative diseases of joints and spine (review)

Kavalerskiy G.M., Silin L.L.


The article provides an overview of the use of homeopathic medicine for the treatment of degenerative diseases of joints and spine using Target® T. These diseases take the 1st place on the prevalence of diseases of the musculoskeletal system. Standard therapy with non-steroidal anti-inflammatory drugs - NSAIDs (including COX-2 inhibitors), accompanied by a large number of complications, particularly erosive and ulcerative lesions of the gastrointestinal tract. In light of this growing importance of alternative methods of use, particularly antihomotoxical therapy.Target® T is a multi-drug, which includes minerals, herbal and biological ingredients. It has chondroprotective and chondrostimulative, anti-inflammatory, analgesic, regenerating and immunostimulatory effects. It includes sulfur, which takes part in the synthesis of structural components of cartilage tissue. The drug helps produce synovial fluid, thus improving the functional characteristics of a joint and cartilage metabolism.Animal studies indicate a weakening of the articular cartilage erosion after treatment with Target® T. Several studies have shown effectiveness as intraarticular and oral form of the drug for the treatment by Target® T of osteoarthritis of different localization. It is also relevant for applications in the form vertebrology paravertebral injections or in tablet form. Perhaps a combination of the drug with Target® T as a homeopathic medication Traumeel® S, and with hondroprotektorami with small doses of NSAIDs.The works, which shows the high efficiency of these combinations. Target® T can be used with success in the practice not only of traumatologist orthopaedist, but also a surgeon, neurologist, internist, arthrology, rheumatology and hematology.
Consilium Medicum. 2016;18(2):150-156
pages 150-156 views

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