[New possibilities in antibacterial treatment of intra-abdominal infections caused by multiresistant microflora]. / Novye vozmozhnosti antibakterial'noi terapii intraabdominal'nykh infektsii, vyzvannykh polirezistentnoi mikrobnoi floroi.

AIM: To determine the place of new drugs with activity against multidrug resistant strains of microorganisms in the treatment of complicated intraabdominal infections. MATERIAL AND METHODS: The incidence and distribution of pathogens isolated from intra-abdominal specimens in patients with intra-abdominal infections are analyzed. RESULTS: The current situation on the growth of resistant strains among pathogens causing intra-abdominal infections is rewied. New combined drugs for the treatment of multidrug resistant infections - ceftolozane/tazobactam and ceftazidim/avibactam plus metronidazole, has been suggested. Their potential role in empiric and targeted antibacterial treatment of complicated intraabdominal infections is defined. CONCLUSION: Taking into consideration local monitoring data and risk factors of multi resistant strains Ceftolozane/tazobactam in combination with metronidazole can be used in empiric regime of treatment. Due to the high activity on carbapenem resistant strains of Klebsiella pneumonia and the lack of alternatives, it is advisable to use Ceftazidim/avibactam for the targeted therapy.

Partial clinical response to anakinra in severe palmoplantar pustular psoriasis.

BACKGROUND: Palmoplantar pustular psoriasis is a clinical psoriasis variant characterised by a high impact on quality of life and poor response to biologics approved for plaque type psoriasis.The recombinant interleukin-1 (IL-1) receptor antagonist anakinra has been recently used for the treatment of isolated refractory cases of generalised pustular psoriasis with contrasted results. OBJECTIVES: To report the clinical response in two patients treated with anakinra as salvage therapy in two patients with severe palmoplantar pustular psoriasis refractory to currently available antipsoriatic systemic therapies. METHODS: Anakinra was given subcutaneously at the daily dose of 100 mg, and clinical response was evaluated using the palmoplantar psoriasis area and severity index (PPPASI). RESULTS: Only partial and transient responses were observed in both patients, who had to stop anakinra due to lack of efficacy and to side effects. CONCLUSION: Anakinra appears to provide only partial clinical improvement in refractory palmoplantar pustular psoriasis. Prospective clinical studies on larger populations are warranted to investigate more accurately both efficacy and safety of IL-1-inhibiting strategies in pustular psoriasis.

[Relapsing annular erythema following streptococcal throat infection in an adult patient: Adult erythema marginatum associated with rheumatic fever]. / Erythème annulaire récidivant après angine streptococcique : érythème marginé rhumatismal de l'adulte.

BACKGROUND: Erythema marginatum is one of the main Jones diagnostic criteria for rheumatic fever. However, since it rarely occurs in industrialized countries, this diagnosis is seldom suspected, especially in adult patients. CASE REPORT: We report a case of an annular facial eruption associated with fever and polyarthralgia seen twice in a 30-year-old woman following episodes of streptococcal throat infection. DISCUSSION: This case report underlines the fact that the rheumatic fever has not completely disappeared in the highly developed countries. Dermatologists should be careful not to overlook its clinical manifestations and should be vigilant about potential cardiac complications.

[Selection of therapy with nitrates in patients with stable effort angina: results of comparative study of common isosorbide dinitrate and long acting preparation of isosorbide-5-mononitrate].

AIM: To assess efficacy and tolerability of a novel drug form of isosorbide-5-mononitrate in patients with ischemic heart disease and stable effort angina as compared with common isosorbide dinitrate pills. MATERIAL AND METHODS: Patients with stable class II-III effort angina (n=30) were included into a randomized crossover study in which they received isosorbide dinitrate (nitrosorbide, 10-20 mg t.i.d.) and long acting isosorbide-5-mononitrate (ephox-long, 50-100 mg o.d.) for 3 weeks each. Efficacy of treatment was assessed by clinical data and treadmill exercise tests. Questionnaires were used for registration of frequency and intensity of attacks of headache. RESULTS: The use of both isosorbide dinitrate and 5-mononitrate was associated with significant improvements of exercise tolerance however effect of mononitrate lasted longer. Nitroglycerine requirement diminished during first week of use of both drugs and remained on this level by the end of 3-rd week of treatment with mononitrate but substantially rose by the end of treatment with dinitrate. Number of attacks of headache increased during first week of treatment with both drugs, became even higher by the end of use of dinitrate and decreased by the end of use of mononitrate. CONCLUSION: Long acting form of isosorbide-5-mononitrate ephox-long taken once daily provides sufficient antianginal effect throughout a day and is better tolerated than nitrosorbide preparation of isosorbide dinitrate with moderately prolonged activity.

[Effects of long-acting calcium antagonists--amlodipine and diltiazem in patients with stable angina of effort: comparative randomized controlled trial]. / Izuchenie deistviia dvukh antagonistov kal'tsiia prolongirovannogo deistviia--amlodipina i diltiazema u bol'nykh stabil'noi stenokardiei napriazheniia: dannye sravnitel'nogo randomizirovannogo issledovaniia.

AIM: To compare effectiveness of two long-acting calcium antagonists--amlodipin and diltiazem--in patients with ischemic heart disease (IHD) and stable angina of effort (SAE). MATERIAL AND METHODS: 31 IHD patients with SAE entered the double blind randomized trial. The patients received either amlodipin (5-10 mg once a day) or diltiazem (120-180 mg twice a day) for 4 weeks. Selection of the effective single dose and control over the drug effectiveness in regular intake was carried out using treadmill tests made at the height of the drug activity (peak effect) and before taking the next dose (end effect). RESULTS: 1 patient quitted the trial because of frequent anginal attacks while amlodipin administration. Both drugs showed positive effect in relation to exercise tolerance, peak effect of diltiazem was significantly higher than that of amlodipin, the end effect was the same. Amlodipin increased the heart rate at rest while diltiazem insignificantly decreased it. Amlodipin induced side effects more often, all of them were typical for dihydropiridin calcium antagonists. CONCLUSION: Amlodipin and diltiazem of prolonged action have pronounced antianginal effect, diltiazem being more effective and less toxic.

[Comparison of carvedilol and atenolol efficacy in patients with stable effort angina]. / Sravnenie éffektivnosti karvedilola i atenolola u bol'nykh so stabil'noi stenokardiei napriazheniia.

AIM: To compare effectiveness of carvedilol--beta-adrenoblocker with vasodilating action--with atenolol which is beta-adrenoblocker having no vasodilating activity in coronary heart disease (CHD) patients with stable effort angina. MATERIAL AND METHODS: The trial entered 28 CHD patients with a history of myocardial infarction (MI). All the patients had no contraindications to beta-adrenoblockers, had positive exercise tolerance test. After the control period of 7-10 days the patients received either carvedilol (14 patients) or atenolol (14 patients) in a mean daily dose 20.5 mg (6.25 to 50 mg) and 25.9 mg (12.5 to 100 mg), respectively, twice a day. The course of the treatment took 4 weeks. The effect was evaluated at treadmill exercise test. RESULTS: Both drugs diminished heart rate, carvedilol was less effective in this respect. Both drugs significantly prolonged time of exercise to the anginal attack and ST depression by 1.0 mm. Side effects arose in 6 and 4 patients, respectively. CONCLUSION: Carvedilol and atenolol are equally effective in the treatment of stable effort angina.

[Spirapril - a new long-acting ACE inhibitor: efficacy and safety in patients with arterial hypertension in combination with diabetes mellitus and impaired kidney function]. / Spirapril - novyi ingibitor angiotenzinprevrashchaiushchego fermenta dlitel'nogo deistviia: éffektivnost' i bezopasnost' u bol'nykh arterial'noi gipertoniei v sochetanii s sakharnym diabetom i narushennoi funktsiei pochek.

AIM: To examine effectiveness and safety of quadropril. MATERIAL AND METHODS: Changes in blood pressure (BP), heart rate (HR), levels of glucose, potassium and creatinine, creatinine clearance were studied in 120 patients (48 males and 72 females, mean age 60.6 +/- 0.7 years) with mild to moderate arterial hypertension (AH) with average duration 13.8 +/- 0.7 years. The patients were divided into 3 groups: with AH (n = 40), AH + noninsulindependent diabetes mellitus (DM) (n = 43), AH and nephropathy (n = 37). 8-week treatment was performed with a standard dose of 6 mg/day (1 tablet of quadropril). Control examinations were made 2, 4 and 8 weeks after the treatment. RESULTS: After 8 weeks of treatment a decrease in systolic blood pressure in AH group was 24.0 +/- 3.0 mm Hg and in diastolic blood pressure 16.3 +/- 1.3 mm Hg (P < 0.001). In the group with DM this decrease was 22.4 +/- 2.8 mm Hg and 15.7 +/- 1.4 mm Hg (p < 0.001), respectively. In the group with nephropathy this decrease was 26.4 +/- 2.4 and 16.5 +/- 1.3 mm Hg (p < 0.001), respectively. Heart rate changed significantly only in diabetics: from 75.1 +/- 1.7 to 72.9 +/- 1.3 beats/min. Biochemical parameters in the hypertensive and diabetic patients did not change significantly. In the nephropathy group there was a significant decrease in creatinine and increase in creatinine clearance. Their level of glucose and potassium changed insignificantly. CONCLUSION: The treatment with quadropril results in a significant decrease in blood pressure, does not influence parameters of carbohydrate metabolism, improves nitrogen eliminating function of the kidneys.

[Comparative study of spirapril (quadropril) and amlodipine efficacy. Results of randomized trial in patients with mild to moderate arterial hypertension]. / Sravnitel'noe izuchenie éffektivnosti spiraprila (kvadropril) i amlodipina. Rezul'taty randomizirovannogo issledovaniia u bol'nykh miagkoi i umerennoi arterial'noi gipertoniei.

AIM: To compare in the non-blind randomised parallel study the efficiency of quadropril and amlodipine in the treatment of mild to moderate arterial hypertension. MATERIAL AND METHODS: A total of 80 patients (57.6 +/- 1.0 years) were included in this study. The patients were randomised in two groups, 40 patients each. Patients of group 1 received monotherapy with quadropril, while those of group 2 were treated with amlodipine. The treatment duration was 8 weeks in both groups. Quadropril was given in a fixed dose of 6 mg once daily. The initial dose of amlodipine was 5 mg/day. In case of insufficient effect the dose was elevated to 10 mg/day. The efficacy was evaluated by changes in blood pressure (BP) measured at rest. Moreover, in 50 randomly chosen patients 24-h monitoring of BP was performed at the start and end of the treatment. RESULTS: In the quadropril group baseline systolic BP reached 158.6 +/- 2.1 mm Hg, diastolic BP--101.8 +/- 0.8 mm Hg, heart rate was 74.3 +/- 1.6 beats/min. In the amlodipine group baseline systolic BP was 159.9 +/- 2.4 mm Hg, diastolic BP--101.8 +/- 1.0 mm Hg, heart rate was 71.3 +/- 1.0 beats/min. Systolic BP decreased at the end of quadropril therapy to 138.5 +/- 2.2 mm Hg, diastolic BP to 88.1 +/- 1.4 mm Hg. No significant change of the heart rate was observed. Under 5 mg of amlodipine systolic BP decreased to 137.9 +/- 2.5 mm Hg and diastolic BP to 87.1 +/- 1.6 mm Hg. Heart rate increased to 73.3 +/- 2.2 beats/min. Under therapy with 10 mg amlodipine systolic BP decreased to 145.9 +/- 3.8 mm Hg, diastolic BP to 89.7 +/- 3.4 mm Hg. Heart rate increased to 77.3 +/- 4.0 beats/min (p < 0.01). The hypotensive effect of quadropril remained stable while the effect of amlodipine decreased by the 8th week of therapy (p < 0.01). Side effects were observed significantly more often in the amlodipine group, then in the quadropril group. The main quadropril side effect was cough. Side effects observed in the amlodipine group were edemas, tachycardia, weakness. CONCLUSION: Both quadropril and amlodipine demonstrated a comparable antihypertensive effect although in 11 of 40 patients in the amlodipine group a dose increase was necessary and tolerability of quadropril was better.

[The calcium antagonists diltiazem and nifedipine: a comparison of their efficacy in single and long-term use in patients with stable stenocardia of effort]. / Antagonisty kal'tsiia diltiazem i nifedipin: sravnenie éffektivnosti pri odnokratnom i dlitel'nom primenenii u bol'nykh stabil'noi stenokardiei napriazheniia.

AIM: To compare efficacy of diltiazem and nifedipine in single dose and long-term treatment. MATERIALS AND METHODS: A randomised double-blind cross-over study enrolled 17 patients suffering from coronary heart disease (CHD) with stable angina of effort (SAE). For 1 month, each patient received diltiazem and nifedipine (60-90 mg 4 times a day and 20-30 mg 4 times a day, respectively). The effect was assessed by the pharmacodynamic test after the initial dose and in the end of each treatment course. RESULTS: In 14 eligible patients both drugs reduced the number of SAE attacks and nitroglycerin tablets, diltiazem efficiency being somewhat higher. Single doses of diltiazem and nifedipine produced the same action. In long-term treatment nifedipine effect became shorter, diltiazem effect did not change. Before the morning dose of nifedipine (11.5 hours after the previous dose) exercise tolerance of this drug worsened. This may be due to withdrawal syndrome. As to diltiazem, its exercise tolerance improved. CONCLUSION: In long-term treatment of CHD with SAE diltiasem is more effective and safe than nifedipine.

[Molsidomine and isosorbide dinitrate: a comparative trial of tolerance in long-term intake by IHD patients with stable angina of effort]. / Molsidomin i izosorbida dinitrat: sravnitel'noe izuchenie razvitiia tolerantnosti pri dlitel'nom prieme u bol'nykh IBS so stabil'noi stenocardiei napriazheniia.

Potential tolerance to isosorbide dinitrate (ID) and molsidomine (M) was studied in 18 ischemic heart disease (IHD) patients with stable angina of effort entered in a double blind cross-over trial. Each drug was administered for 3 weeks 4 times a day in individual effective dose. Single doses of ID and M were similar by effectiveness, but after 3 weeks of regular intake their efficacy fell, ID becoming less potent than M. For ID, tolerance after long-term intake manifested in 7 out of 18 patients, for M--in 5 out of 18. Complete tolerance was registered in 3 of 18 and 1 of 18 patients, respectively. Thus, tolerance is possible for the two drugs, but for M it is less pronounced.

[Autonomic disorders in parkinsonism]. / Vegetativnye narusheniia pri parkinsonizme.

The authors analyze the clinical and paraclinical manifestations of vegetative disorders in parkinsonism. It is shown that vegetative disorders are relatively independent of motor parkinsonism manifestations and run their course by the type of concomitant sympathetic and parasympathetic insufficiency. Injury to the segmental and suprasegmental mechanisms of motor control underlies vegetative disorders. The role of segmental and suprasegmental disorders in degenerative diseases of the nervous system with marked vegetative manifestations is analyzed and compared.

[The clinical and computed tomographic criteria of the diagnosis of multiple systemic cerebral atrophy with progressive autonomic insufficiency (the Shy-Drager syndrome)]. / Klinicheskie i komp'iuterno-tomograficheskie kriterii diagnostiki mnozhestvennoi sistemnoi atrofii mozga s progrssiruiushchei vegetativnoi nedostatochnost'iu (sindroma Shaia--Dreidzhera).

Based on clinical and CT examination of 3 patients with Shy-Drager syndrome and the reported data, differential diagnosis of the given diseases is under discussion. Shy-Drager syndrome is characterized by CT signs of progressive atrophy of the pons and cerebellum with no essential changes in the supratentorial brain structures. The authors support a proposal to use the term "multiple systemic atrophy" for designation of the disease entity that includes both Shy-Drager syndrome and sporadic patterns of olivopontocerebellar and strionigral degenerations in which the disease debuts by motor disorders of the extrapyramidal and cerebellar nature rather than by vegetative disturbances.

[Cardiovascular tests in various forms of pathology]. / Kardiovaskuliarnye proby pri nekotorykh formakh patologii.

Quantitative estimation of the status of the autonomic nervous system is a research priority in neurology. One of the approaches to its solving lies in the use of cardiovascular tests. The authors brief the mechanisms of the tests, provide their standards. Show the characteristic patterns of the cardiovascular tests in different diseases of both organic and psychogenic nature. Taking into consideration the simplicity, accessibility, and noninvasive nature of the tests, it is recommended that the cardiovascular tests may be employed for estimating the status of the autonomic nervous system in a wide range of diseases of both neurological and somatic origin.

[The concept of "ganglionitis" in the modern science of the autonomic nervous system]. / Kontseptsiia "ganglionita" v sovremennoi vegetologii.

The authors review the concept of vegetative "ganglionitis" formed in the Soviet literature in the 40-60s. Consider the etiological, clinical and diagnostic aspects thereof. Provide the modern concepts of the clinical manifestations related to the lesions of the paravertebral sympathetic ganglia. Relate some hypotheses concerning the origin of painful phenomena within the framework of the syndrome of reflex sympathetic dystrophy. Indicate that verified lesions of the sympathetic ganglia are associated with well-defined clinical symptoms which absolutely differ in their appearance from the reported descriptions of "ganglionitis", which are unjustifiedly widely used in the Soviet literature over the recent decades. The conclusion is made about the necessity of reviewing the outdated concepts of the pathology of the vegetative sympathetic ganglia from the standpoint of the modern concept of peripheral vegetative insufficiency.

[Autonomic disorders in Parkinson disease]. / Vegetativnye rasstroistva pri parkinsonizme.

The authors provide the clinical and laboratory findings regarding the vegetative nervous system in 60 patients with parkinsonism and in 11 healthy volunteers. It has been found that parkinsonism is necessarily associated with vegetative disorders which are pronounced to a greater degree in right-handed patients and bilateral clinical manifestations of the syndrome.

[Primary generalized amyloidosis with the progressive autonomic insufficiency syndrome]. / Pervichnyi generalizovannyi amiloidoz s sindromom pregressi- ruiushchei vegetativnoi nedostatochnosti.

The paper is concerned with a case of primary generalized amyloidosis characterized by the presence of a well-defined syndrome of progressive vegetative failure within the framework of neurologic complications of amyloidosis.