Vol 18, No 2 (2016)

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.

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.

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.

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.

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.

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.

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.

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).

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.

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.

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.

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.