Vol 19, No 2-2 (2017)


Treatment of cognitive disorders in patients with chronic cerebral ischemia

Soloveva E.Y.


The article discusses the concept of chronic cerebral insufficiency failure, manifested by a progressive multifocal disorder of brain functions of varying severity, the results of experimental and clinical studies of the extract of ginkgo biloba, which proved the possibility of the drug to quickly and effectively influence the various links in the pathogenesis of cognitive impairment.
Consilium Medicum. 2017;19(2-2):7-12
pages 7-12 views

Features electrokinetic properties of red blood cells in patients with chronic brain ischemia

Badalyan K.R., Fedin A.I., Vasilenko I.A.


Objective of the study - to detect diagnostic criteria for chronic brain ischemia based on analysis of electrokinetic properties of peripheral erythrocytes. Materials and methods. Material for the study was based on the erythrocytes of venous blood 95 patients with chronic brain ischemia, the reference group consisted of 54 healthy donors. To perform electrophoretic cell analysis of erythrocytes was used the shorthand method of computer microelectrophoresis. Results. Data analysis revealed with the increasing severity of the disease increased the share of fixed erythrocytes, decreased the electrophoretic mobility of cells and decreased the heterogeneity of the analyzed populations in the amplitude oscillations of erythrocytes. When analyzing the thickness of the intima-media complex, it was found that with the progression of the atherosclerotic process the rate of movement of erythrocytes in the electric field also decreases. Conclusion. Thus, indicators of the electrokinetic activity of erythrocytes (the share of fixed erythrocytes, the average amplitude of their vibrations and its deviation, electrophoretic mobility and its deviation) can serve as criteria for the severity of chronic brain ischemia.
Consilium Medicum. 2017;19(2-2):13-18
pages 13-18 views

How to help patients diagnosed with "vegetovascular dystonia"?

Golovacheva V.A., Parfenov V.A.


A large number of patients are diagnosed with "vegetovascular dystonia" (VSD), which does not exist as a separate nosology in the International Classification of Diseases of the 10th revision and is discussed only in Russian medicine. Under the mask of the VSD, various neurological diseases (primary headaches, vestibulopathies, insomnia, neurogenic syncopes), mental disorders (anxiety disorder, depression, somatoform disorder) and a number of somatic diseases can be concealed. The article deals with the tactics of managing patients with emotional disorders (most common in the practice of a neurologist) - panic disorder and depression. Discusses their own experience in managing patients with primary headaches under the mask of the VSD. The effectiveness of the use of cognitive-behavioral therapy, antidepressants and Teralygen® (alimamazine) in the treatment of patients with emotional disorders is considered.
Consilium Medicum. 2017;19(2-2):19-26
pages 19-26 views

Endothelial dysfunction in patients with chronic cerebral ischemia in atherosclerotic stenosis of the internal carotid arteries

Starykh E.V., Baranova O.A., Tsoi I.V.


The aim of the study was to study endothelial function in patients with chronic cerebral ischemia in atherosclerotic stenosis of the internal carotid arteries (ICA). Materials and methods. A total of 69 patients were examined. Evaluation of the function of the endothelium was carried out using the photoplethysmographic method by the non-invasive diagnostic complex AngioScan-01 (Fiton). Along with this, a study was made of molecules of intercellular adhesion of VCAM and E-selectin. Results. Progression of neurological symptoms was revealed as the degree of stenosis of the internal carotid arteries increased, which was reflected in an increase in disorders of cranial nerves, motor, sensitive and autonomic systems. The increase in neurologic symptoms was accompanied by a decrease in the visco-elastic properties of the aorta, increased stiffness of large arteries, increased tonus of small resistive arteries and dysfunction of the endothelium in large and small muscle arteries. The highest values of E-selectin and vCAM were observed in patients with atherosclerotic lesions of the internal carotid arteries up to 30%. Conclusion. Violation of endothelial function in small resistive and in large conductive arteries is observed in patients with different degrees of stenosis of the ICA, starting with stenoses up to 30%. The processes of vascular inflammation are most pronounced at the initial stages of atherosclerotic stenosis of the ICA.
Consilium Medicum. 2017;19(2-2):27-31
pages 27-31 views

The practice of treating back pain

Karneev A.N.


The article discusses the problem of diagnosing and treating pain in the back, the need for timely differentiation of vertebrogenic and nonvertebrogenic causes of its occurrence, an individual and complex approach to analgesic treatment, taking into account the phase of the pathological process. Data on the high effectiveness of the therapeutic effect of dexketoprofen on the mechanisms of dysregulation in the treatment of exacerbation of pain in the back of various etiologies are presented.
Consilium Medicum. 2017;19(2-2):32-36
pages 32-36 views

Visual-diagnostic aphasia mirage

Scherbakova M.M.


In neurological clinic, there are difficulties in differential diagnosis of speech disorders, which are similar to the aphasia syndrome, but are not the true aphasia. They are provoked by different groups of diseases: conversion neurotic disorder, mental disorders, dementia, etc. Systemic practical observation of these forms of speech pathologies made it possible to determine the characteristic signs of false aphasias: 1) absence of the primary (starting) mechanism; 2) gradual development of speech disorders; 3) fluctuation of symptoms; 4) violation of non-verbal contact; 5) Variable changes in the structure of the personality as a whole.
Consilium Medicum. 2017;19(2-2):37-40
pages 37-40 views

Complex therapy of anxiety states in patients with somatic profile

Shavlovskaya O.A.


There is a close relationship between the development of anxious, depressive and other neurotic disorders and brain specific S-100 protein. Tenoten composition includes a release-active antibodies to brain specific S-100 protein (RAA S-100). The efficiency of destination Tenoten in complex therapy of anxiety disorders in patients of somatic profile in the dose of 1-2 tablets 3 times a day, 4 weeks therapy course. The initial decrease in anxiety level observed after 2 weeks of therapy. Tenoten antianxiety effect is not inferior such anxiolytic as tofisopam and antidepressants as clonazepam and phenazepamum.
Consilium Medicum. 2017;19(2-2):41-44
pages 41-44 views

Patient with diabetic polyneuropathy on an outpatient visit

Zakharov V.V., Sosina V.B.


Diabetes mellittus leads to different disorders of peripheral nervous system, but the most prevalent one is chronic predominantly sensory symmetrical distal polyneuropathy. It is developed in 30-50% of patients and significantly decreases quality of life because of neuropathic pain, other unpleasant sensations and autonomic insufficiency. Appropriate metabolic control decrease the risk of neuropathy development especially in diabettismellittis type 1. Antioxidant therapy with a-lipoic acid is also proven from pathogenetic position and had shown efficacy with regard to diminish of neurological symptoms. Symptomatic therapy of neuropathic pain includes antidepressants and anticonvulsants.
Consilium Medicum. 2017;19(2-2):45-51
pages 45-51 views

The possibility of using nimesulide in patients with lumbar pain

Kamchatnov P.R., Evzelman M.A., Chugunov A.V.


The questions of efficacy and safety of treatment of patients with lumbar pain syndrome are considered. Information on possible undesirable side effects of therapy, causes and risk factors for their development is given. Details of the possible use of nimesulide (Nise®) in patients with lumbar pain are analyzed in detail. The results of modern studies on the safety of its use are presented, in particular, with respect to the gastrointestinal tract, cardiovascular system, and liver. A conclusion is made about the advisability of using the drug in patients with lumbar pain; To minimize the risk of side effects, a detailed assessment of the clinical picture, taking into account the likelihood of drug interactions, strict adherence to recommendations for the use of the drug should be carried out.
Consilium Medicum. 2017;19(2-2):52-57
pages 52-57 views

Contemporary strategy of differential diagnosis and treatment of carpal tunnel syndrome (clinical study)

Samartsev I.N., Rashidov N.A., Zhivolupov S.A., Vorobieva M.N.


Carpal tunnel syndrome (CTS) is of the most prevalent diseases of peripheral nervous system (86.7% of all tunnel syndromes). Despite this fact diagnosis and treatment of this pathology is a great challenge. The aim of the study was to optimize the diagnosis and treatment of CTS. Materials and methods. 126 patients with CTS were divided into 2 groups. Therapy of the main group (n=60) included basic scheme (local steroid injection - LSI, splinting, vitamins B, gabapentin) and cholinesterase inhibitor ipidacrine (Ipigrix®). Therapy of the control group (n=66) was limited by the basic scheme. The total duration of the observation period was 60 days. The effectiveness of treatment was evaluated according to the analysis of NRS, QuickDASH and nerve conduction studies’ (NCS) results. Results. The “flick sign” turned out to be the most specific (93.2%) and sensitive manifestation of CTS. Ipigrix administration allowed to significantly reduce (p<0.05) severity of sensory of motor disturbances, enhance physical function of the upper limb in patients of CTS which correlated with positive changes of NCS-parameters (predominantly in sensor fibers). We have also estimated the clinical prediction rules (CRPs): duration of CTS less than 3 mths, lack of severe thenar atrophy, amplitudes of recorded n. medianus motor response >5.5 ms, motor conduction velocity >51.6 m/s, total reduction of sensory disturbances after 1st LSI, ipidacrine administration. The presence of all 6 CRP’s predicts good effect of conservative treatment (lack of pain, QuickDASH≤10 points) in almost 90% of CTS patients. Conclusions. Verification of CTS should be based on diagnostic value of clinical signs and tests. Therapy of CTS must be regulate by CRP’s and indications for surgery. Ipidacrine (Ipigrix®) should be included in basic scheme of CTS conservative treatment.
Consilium Medicum. 2017;19(2-2):58-66
pages 58-66 views

The level of antibodies to elastin in patients with systemic scleroderma, depending on the clinical variants of the disease

Paramonova O.V.


The aim of the study was to investigate the relationship between the level of antibodies to elastin and the presence of certain clinical and immunological variant of systemic scleroderma. Methods. For the determination of antibodies to elastin used indirect variant of enzyme-linked immunosorbent assay. By this method we examined 42 patients of systemic scleroderma. Result. Analysis of the results showed that a statistically significant increase in the concentration of antibodies to elastin are also detected in the group of patients with lesions of the joints and fibrosis. Conclusion. Thus, these indicators can be used for objective diagnosis, they not only allow to verify the disease but also to predict the nature of its course, clinical option and select the optimal therapeutic strategy.
Consilium Medicum. 2017;19(2-2):67-69
pages 67-69 views

Acute and chronic pain: from the symptom to understanding of patient's life

- -.


9-11 февраля 2017 г. в Москве в рамках 13-й междисциплинарной конференции «Вейновские чтения» прошел симпозиум «Острая и хроническая боль: от симптома к осмыслению жизни пациента». Тема боли - одна из актуальных проблем современного общества: боль способна не только значительно менять качество жизни человека, в ряде случаев она способна лишить его жизни, борьба с ней приводит к существенным финансовым затратам. О причинах, механизмах развития и современных методах лечения боли шла речь в докладах симпозиума, прочитанных ведущими российскими экспертами: доктором медицинских наук, профессором Ан.Б.Даниловым, доктором медицинских наук, профессором А.В.Наумовым, доктором медицинских наук, профессором И.Г.Козловым, доктором медицинских наук, профессором Ал.Б.Даниловым.
Consilium Medicum. 2017;19(2-2):70-74
pages 70-74 views

Epidemiologic characteristics of cerebrovascular disease in Tyumen district in 2007-2016

Lebedeva D.I., Brynza N.S., Nemkov A.G., Njamcu A.M., Andreeva O.V., Orlova A.S., Akarachkova E.S.


Aim - to evaluate the epidemiology of cerebrovascular disease (CVD) in urban and rural population of Tyumen district. Patients and methods. An evaluation of CVD epidemiology in Tyumen district was performed based on the statistical data of Department of Health of Tyumen district in 2007-2016. Regions of Tyumen district were divided into 3 groups according to population characteristics: group 1 - rural population, group 2 - urban population and group 3 - mixed population. An evaluation of population dynamics in Tyumen district was performed in each group, including birthrate and mortality; epidemiologic characteristics of CVD with incidence, morbidity and mortality in absolute and proportion ate numbers per population unit. Results. During the evaluated 10-year period an increase of urban and mixed population was observed, along with a decrease of rural population. Mortality was significantly lower in urban population, whereas in rural population mortality exceeded birth rate in 2007-2009 and 2015-2016. An increase of CVD incidence, coupled with decrease of morbidity and mortality both in urban and rural population was observed. Conclusion. Our findings demonstrate the importance of evaluation of epidemiologic characteristics of CVD in Tyumen district to develop measures aimed at the prevention and treatment efficacy improvement.
Consilium Medicum. 2017;19(2-2):75-78
pages 75-78 views

Ethical dilemmas of modern neurosurgery

Likhterman B.L., Likhterman L.B., Mogila V.V., Spiru M.A.


The purpose of the work is to reveal the features of neuroethics and new contradictions that have arisen in modern neurosurgery in close connection with its technology. Material and methods. The literature on neuroethics, the 20-year experience of the authors and individual samples of neurosurgical patients with acute traumatic injuries (in particular, 170 patients with intracerebral hematomas and focal brain injuries) and chronic subdural hematomas (400 patients) were analyzed to identify ethical problems and their pathways solutions. Results. Systematized factors of humanization and dehumanization of neurosurgery. New contradictions have arisen due to the widespread use in neurosurgery of methods of neuroimaging: fetishization of visual data and ignoring the patient's clinic and personality; The abundance of sophisticated technologies and the lack of generalized concepts; The professional duty of the doctor and commercial temptations; The sanctity of life and the quality of life, and a number of others. It shows how dilemmas arise that are fraught with threats of atrophy of clinical thinking, hypokylia, and distancing the doctor from the patient. Conclusion. Resolution of contradictions in modern neurosurgery must be based on the interests of both the patient and society. This requires a combination of a highly professional neurosurgeon with a priority of ethical and humanitarian values at all stages of his training and activities.
Consilium Medicum. 2017;19(2-2):79-84
pages 79-84 views

Undesirable effects of non-steroidal anti-inflammatory drugs: possible options for resolving the situation

Kotova O.V., Akarachkova E.S.


Non-steroidal anti-inflammatory drugs (NSAIDs) have many serious, potentially life-threatening adverse reactions or adverse events, but still belong to the most widely prescribed and used medications worldwide. In developed countries, these drugs are received by 20-30% of the elderly, among whom about 30% of the elderly are forced to take these drugs, despite the presence of risk factors for the development of adverse events, both from the gastrointestinal tract and the cardiovascular system. The article describes the side effects of NSAIDs. An alternative NSAID treatment for patients in need of analgesic therapy is suggested, flupirtine (Nolodatak). Flupirtine belongs to a fundamentally new class of drugs for the treatment of pain syndromes, it is a selective activator of neuronal potassium channels. Flupirtine is a non-opioid analgesic, which has an antispastic effect on the striated muscle. Nolodactak is produced by the company Akrikhin (capsules 100 mg) and bioequivalent to the original flupirtin (capsules 100 mg - Pliva Krakow, Pharmaceutical Plant AO, Poland).
Consilium Medicum. 2017;19(2-2):85-90
pages 85-90 views

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