Vol 20, No 1 (2014)

The article presents the results of sample survey of patients with pyoinflammatory pathology of ENT organs and physicians-otorhinolaryngologists. The study data testify the necessity of increasing level of medical awareness of patients with pyoinflammatory pathology of ENT organs. The survey of physicians-otorhinolaryngologists established that majority of them assume as needed to enhance their advanced professional training including the issues of treatment of patients with pyoinflammatory diseases.

The chronic disease of kidneys is one of leading causes of premature death and loss of faculty. The article deals with analysis of succession in treatment of nephrology patients involving physicians of different specialties. The evaluation of effect of time of visit of patients with pre-dialysis chronic disease of kidneys to nephrologist on cardiovascular lethality and premature survival of patients on chronic dialysis according data of the Moscow municipal nephrologic register. On the basis of analysis of outcomes of treatment of 9038 patients it is earnestly proved that early appointment to nephrologist condition both better survival of patients on the substitution kidney therapy and lower indicators of lethality at early period of dialysis treatment. According data of multi-factorial analysis the early, prior to 1 year and more to dialysis, registration to nephrologist is a factor of benevolent prognosis of dialysis treatment. Whereas, late, from 3 months to 1 year, and very late, less than 3 months, to dialysis registration at nephrologist was related to increase of relative risk of death up to 31% and 42% correspondingly. The resolution of problem of late detection of patients with chronic disease of kidneys and untimely registration at nephrologist is possible at the expense of following comprehensive measures: increase of awareness of physicians of all specialties about the role of chronic disease of kidney; application of regular screening of chronic disease of kidney in groups of high risk; support of needed succession in treatment of nephrologic patients at the expense of timely appointment to nephrologist based on accepted criteria; development of nephrologic service, primarily out-patient service, in all regions of Russia. The early detection of diseases of kidneys, their proper therapy and timely appointment to nephrologist provide the best prognosis in treatment of patients. The article presents list of diseases to be obligatory screened annually to detect chronic disease of kidneys. The criteria of obligatory appointment of patient to consultation of nephrologist are discussed too.

The sampling of 500 women during period of perimenopause and with risk factors of cardiovascular diseases were examined. The examination of patients considered demographic information, medical histiry data and presence of concomitant diseases. The profile of arterial blood pressure, anthropometric measurement and laboratory analyses were determined. The total ten-year risk of cardiovascular complications was evaluated according to SCORE scale. The relationship of highly sensitive C-reactive protein with main risk factors of development of cardiovascular diseases was analyzed according to Ridker model. It is demonstrated that women in period of pre-menopause and early menopause have extremely unfavorable profile of risk factors of cardiovascular diseases. However, risk of cardiovascular diseases calculated according SCORE system refer to high risk category (more that 5%) only 28.5% of female patients. The anti-hypertension therapy received 69.2% of women, but only 34.8% achieved target level of arterial blood pressure. Among female patients with dyslipidemia only 44.8% received hypolipidemic therapy and only in 23.2% of women achieved full control of dyslipidemia. The analysis of association of highly sensitive C-reactive protein with other risk factors of atherosclerosis established that the most close correlation between risk factors and highly sensitive C-reactive protein occurs in patients with arterial hypertension stage III. The patients with arterial hypertension of stage I and II the correlation is less close or even unreliable. This fact testifies the most diagnostic and prognostic significance of evaluation of level of highly sensitive C-reactive protein in patients with arterial hypertension of stage I and II.

The treatment of wounds using local negative pressure is one of the newest techniques to accelerate and to optimize process of healing and also to reduce expenses to treatment. The negative pressure stimulates proliferation of granulation tissue, support continuous evacuation of exudation and effectively cleans wound surface. The application of the technique of local negative pressure in treatment of patients with purulent septic complications of endocorrection of scoliosis demonstrated that in all cases of application of local negative pressure under preservation of endocorrector purulent septic process was arrested and no recurrence was detected during the time period from 6 months to 5 years.

The article presents evaluation of effectiveness of education program for patients with prosthetic cardiac valves based on the principle of continuity of in-patient and out-patient stages of monitoring of patients. The main group included 144 patients trained in school for patients with prosthetic cardiac valves. The control group included 50 patients with prosthetic cardiac valves and without education program training. Against the background of education the study established statistically significant increase of life quality, compliance to treatment, awareness of patients of issues of anticoagulant therapy and prevention of prosthetic infectious endocarditis, physical and psychological rehabilitation. The analysis of application of educational program revealed the positive relationship between mean level of knowledge of patients and integral indicator of compliance to treatment and physical and psychological components of health as well.

The article considers effect of substitutive therapy of hypothyroidism on the risk factors of development of atherosclerosis and rigidity of arteries in women with arterial hypertension in state of menopause. The sampling included 60 female patients in menopause with arterial hypertension and suffering with hypothyroidism (20 patients with overt hypothyroidism and 40 patients with sub-clinical hypothyroidism). The therapy with L-T4 (L-Thyroxine, Berlin Chemie) was prescribed to female patients with overt hypothyroidism. The female patients with sub-clinical hypothyroidism were randomized on group with L-T4 therapy and group without therapy. In all female patients the level of arterial blood pressure, TSH, free T4, free T3, total cholesterol and triglycerides were assessed initially and after 6 months of treatment. The velocity of pulse wave was measured using the “shoulder-ankle” mode and cardiac ankle vessel index was determined too. In female patients with overt hypothyroidism and sub-clinical hypothyroidism against the background of L-T4 therapy a significant decrease of level of TSH (overt hypothyroidism group — 11.15 (9.0; 19.8) vs. 4.87 (2.58; 6.84), p<0.02; sub-clinical hypothyroidism group — 6.87 (5.73; 8.98) vs. 3.6 (2.3; 4.4), p=0.01). In female patients with sub-clinical hypothyroidism and without L-T4 therapy the dynamics of levels of TSH, free T4 was not detected. The decrease of systolic arterial pressure was detected only in female patients with overt hypothyroidism and against the background of L-T4 therapy. The reliable decrease of content of total cholesterol and TSH was detected only in female patients with overt hypothyroidism against the background of L-T4 therapy. In female patients with overt hypothyroidism and sub-clinical hypothyroidism against the background of L-T4 therapy was detected decrease of velocity of pulse wave (overt hypothyroidism group - 13.75 (13; 14.9) vs. 12.9 (12.2; 14.2); p<0.02; sub-clinical hypothyroidism group — 15.0 (12.9; 15.9) vs. 13.9 (13; 15.0); p=0.032). In female patients with sub-clinical hypothyroidism L-T4 therapy was attended by decrease of level of cardiac ankle vessel index (8.5 (7.5; 9.7) vs. 7.9 (7.25; 8.85); p<0.02). In female patients with both overt hypothyroidism and sub-clinical hypothyroidism, the compensation of function of thyroid against the background of L-T4 therapy was attained by significant amelioration of indicators of arterial rigidity. In female patients with overt hypothyroidism L-T4 therapy also results in amelioration of indicators of lipid specter.