The methods of traditional medicine in outpatient polyclinic practice

Some 7950 patients have been treated at the traditional medicine department of the Consulting and Diagnostic Center N52, 2/3rds of them came after long and unsuccessful medicamental treatment. Psychotherapy, manual therapy and acupuncture-reflex methods were successful in 86-93% of cases. They are recommended for local clinics provided that the latter are properly equipped and stuffed.     

Platelet adhesion and thrombus formation on subendothelium in platelets deficient in glycoproteins IIb-IIIa, Ib, and storage granules

Patients whose platelets are deficient in glycoprotein (GP) Ib, IIb- IIIa (thrombasthenia), or granule substances (storage pool deficiency, SPD) were studied to define further the properties of platelets that mediate platelet adhesion and thrombus formation on subendothelium. Both nonanticoagulated and citrated blood were exposed to everted, de- endothelialized rabbit vessel segments under controlled flow conditions and shear rates varying from 650 to 3,300 sec-1. Morphometry was used to measure platelet thrombus dimensions and the percentage of the subendothelial surface covered with contact (C) or spread (S) platelets. Adhesion was defined as C + S. The results in SPD demonstrated (1) reduced thrombus dimensions in delta-SPD (pure dense granule deficiency) in proportion to the magnitude of the dense granule defect; (2) an even greater reduction in thrombus dimensions in patients with combined deficiencies of alpha and dense granules (alpha delta-SPD); and (3) impaired platelet adhesion at several conditions in alpha delta-SPD and, in delta-SPD, a hematocrit-dependent impairment of adhesion in citrated blood at 2,600 sec-1. In thrombasthenia, platelets were present as a monolayer on the subendothelial surface in both nonanticoagulated and citrated blood, indicating an absolute requirement for GPIIb-IIIa in promoting platelet-platelet interaction at all shear rates and perfusion times. Two types of abnormalities in platelet-vessel wall interactions were observed. In nonanticoagulated blood, the percentage of platelets in the C phase was consistently increased at all shear rates, but C + S values were normal. These observations indicate that platelets deficient in GPIIb-IIIa do not spread normally on the subendothelial surface exposed to nonanticoagulated blood. With citrated blood, the C + S value in thrombasthenia was reduced at both 800 and 2,600 sec-1, as in von Willebrand's disease, and a similar degree of reduction (about 50%) was observed in normal blood treated with a monoclonal antibody to GPIIb- IIIa. The findings, together with theoretical considerations, are consistent with an hypothesis that GPIIb-IIIa mediates the spreading of platelets on subendothelium following the initial attachment through GPIb and that GPIIb-IIIa may be considered an adhesion site on the platelet membrane. Abnormalities of GPIIb-IIIa may, depending on the conditions of study, result in either increased values of C platelets or decreased values of C + S. The results of the study further suggest that a complex interaction of platelet granule factors and membrane GP mediate platelet adhesion and thrombus formation.     

Postoperative course of ischemic heart disease in patients with various reconstructive procedures on the coronary vessels

The study was aimed at evaluation of a clinicofunctional condition of patients with ischemic heart disease (IHD) operated on the coronary vessels as well as features of postoperative course of the disease to design relevant therapeutic and prophylactic measures. The analysis was made of rehabilitation and long-term (up to 60 months) outcomes of cardiosurgical operations. Features of rehabilitation were studied in groups of patients after coronary artery bypass grafting (CABG), creation of a mammarocoronary bypass combined with CABG and transcutaneous transluminal coronary angioplasty. To assess the results of cardiovascular patients rehabilitation, to study long-term results of cardiosurgical operations and compare conditions of patients after different cardiac operations, the parameter of "double product" is proposed under loading of 50 W. Three periods of postoperative run of the disease were identified: improvement with maximal physical performance of the patient, clinicopsychological stabilization, functional depletion and development of IHD complications.     

Learning of patients with ischemic heart disease after operations on the coronary arteries at the "School-Club for Coronary Patients"

Such learning programs as "School-club for Coronary Patients" SCCP) are very important for rehabilitation of outpatients with coronary heart disease (CHD) after reconstructive operations on the coronary vessels. The authors summarize pilot experience gained in the activity of the SCCP at the Consulting and Diagnostic Center set up in 2000. The group of lecturers included a cardiologist, a urologist-andrologist, a physiotherapist, a phytotherapist and others. Participation of a dietitian is desirable. The activity of the SCCP aimed at explanation of the role of risk factors in development and progression of CHD, of the mechanisms of action of the most effective medicines applied in the treatment of CHD and arterial hypertension, teaching CHD patients current methods of non-drug therapy, activation of motivation for successful treatment. The curriculum is designed for 12 lessons which covers information on the structure and function of the cardiovascular system, causes of the onset and progression of CHD, principles of CHD treatments, methods of health restoration after myocardial infarction and operations on the coronary vessels. The response to the questionnaires filled in by the learners who have undergone reconstructive surgery on the coronary vessels show that the number of the learners taking the prescribed drugs regularly raised from 77.1 to 95.8%. The recommended doses were followed by 64.6% instead of 18.8%. The diet was kept by 52.1% patients instead of 29.2%. The number of exercising CHD patients raised from 12.5 to 58.3%. It is evident that training of CHD patients after surgery on the coronary vessels or MI in SCCP is an essential method to improve quality of treatment, prevention of complications, the disease prognosis. This experience should be widely introduced into the practice of outpatient departments.     

Rupture of thoracic aorta aneurysm 6 years after endoprosthetic surgery

A case of 6-year stay of a nitinol stent in the lumen of atherosclerotic aneurysm of the descending thoracic aorta is reported. Problems of the prosthesis integration into the organism, nitinol are activity and toughness as well as causes of the aneurysm rupture are discussed. Literature data on endovascular treatment of the aortic aneurysm including in the beginning of its rupture and in old persons with grave concomitant diseases are presented.     

Screening for abnormal glucose tolerance in adolescents with polycystic ovary syndrome

Insulin resistance is common in adults with polycystic ovary syndrome (PCOS). Although recent data demonstrate that insulin resistance is present in the early stages of PCOS, the prevalence of insulin resistance in adolescents with PCOS has not been determined. Likewise, the prevalence of impaired glucose tolerance (IGT) or type 2 diabetes mellitus (DM) in adolescent cohorts has not been established. In this study we sought to obtain preliminary data regarding the prevalence of IGT and DM in adolescents with PCOS and to assess the ability of screening tests to predict these abnormalities within this population. Twenty-seven adolescents with PCOS underwent oral glucose tolerance tests. Plasma glucose and insulin levels were obtained at baseline, and glucose was measured 2 h after a 75-g glucose challenge. The 2-h plasma glucose level was used to categorize subjects as having IGT or the provisional diagnosis of DM. Eight of our 27 subjects had IGT, and 1 had previously undiagnosed DM. These abnormalities were seen among lean and obese subjects. Fasting plasma glucose levels and simple measures of insulin resistance were suboptimal predictors of IGT and DM within our cohort. As in adults, our results indicate that adolescents with PCOS are at increased risk for IGT and DM and that the 2-h plasma glucose level after an oral glucose challenge appears to be the most reliable screening test for these abnormalities. Our results need to be corroborated by future studies that determine the prevalence of abnormalities in glucose tolerance among large populations of adolescents, both with and without PCOS. However, as DM may be preventable by lifestyle modifications, we would recommend that adolescents with PCOS undergo periodic screening for abnormal glucose tolerance using 2-h postchallenge plasma glucose levels.     

Alternative hospital forms of medical care in Russia and abroad

According to the available statistical data 80% of the patients begin and complete treatment in polyclinic. Now it becomes necessary to use more widely the low-expensive hospital-substitutive technologies, i.e. the day hospital and the hospital at home. Since 1989 the day hospital containing 10 beds and with two shift system functions on the base of RF MD CDC N 52. The bed turnover is not less than 3, 5, the mean bed/day is 12. 1500 patients are treated every year, among them 63% are therapeutic, 26% are surgical and 10.4% are neurological patients. More than 40% of those who need the hospital treatment are treated here. In the hospital at home 71% are the patients with diseases of lower extremity vessels, 12.5%--with trauma, 9.45%--with cardiovascular pathology and 6.3%--with respiratory diseases. Compared with the hospital beds the savings amount to 60-70%.     

Effect of homolymph on some elements of antioxidants in peripheral blood of lung cancer patients]

The influence of homolymph and of that incubated with chemopreparations on in vitro activity of antioxidants of blood was compared to establish a possible mechanism of effective application of homolymphochemotherapy for locally advanced tumors of the lung. As a result of homolymph injection into the blood, mainly non-enzymatic systems of antioxidant defense by lymphocytes were affected. This was probably due to their being disposed of in the course of host-against-transplant reaction to heterogenous antigens of donor lymph. Neutrophil functional activity was shown to pick up again as homolymph and chemotherapeutic drugs interacted with blood. A possible therapeutic effect of homolymph and chemopreparations on blood may be alleviating lung tumor suppression of granulocytes.     

Change in neoadjuvant chemotherapy could alter the prognosis of patients with pancreatic adenocarcinoma: A case report

BACKGROUNDNeoadjuvant treatment has become a standard of care for borderline or locally advanced pancreatic cancer and is increasingly considered even for up-front resectable disease. The aim of this article is to present the case of a 62-year-old patient with locally advanced pancreatic adenocarcinoma who was successfully treated with gemcitabine plus nab-paclitaxel after the failure of the first line treatment.CASE SUMMARYComputerized tomography scan and magnetic resonance imaging demonstrated a nodular lesion of ill-defined limits in the body of the pancreas, measuring approximately 4.2 cm × 2.7 cm, with an infiltrative aspect. The tumor had contact with the superior mesenteric vein, splenomesenteric junction and the proximal segment of the splenic artery, causing focal reduction of its lumens. Due to vascular involvement, neoadjuvant chemotherapy treatment with eight cycles of “folinic acid, 5-fluorouracil, irinotecan and oxaliplatine” (FOLFIRINOX) were performed. At the end of the cycles, surgery was performed, but the procedure was interrupted due to finding of lesions suspected of metastasis. Gemcitabine plus nab-paclitaxel was then successfully used for neoadjuvant treatment with subsequent R0 surgical resection.CONCLUSIONGemcitabine plus nab-paclitaxel may be effective as an alternative regimen when FOLFIRINOX fails as the first line of treatment, suggesting the need for further studies to identify which patients would benefit from each type of therapeutic approach.