[The specific features of gout in the elderly].

AIM: To determine the specific feature of gout at its onset in the elderly. SUBJECTS AND METHODS: The investigation included 100 patients (74 men and 26 women) with primary gout on the basis of the criteria proposed by S. Wallace et al. (1977). The patients were divided into 2 groups: 1) 51 patients aged over 60 years; 2) 49 patients aged less than 60 years. In Groups 1 and 2, the mean age at gout onset was 66.1 +/- 4.8 and 41.6 +/- 10.0 years, respectively. A comparative retrospective analysis was made to analyze the detection rate for the site of onset gout, the pattern of arthritis, the number of tophus forms, the use of diuretics, small-dose acetylsalicylic acid (ASA), comorbidities, such as hypertension, type 2 diabetes mellitus (T2DM), obesity, chronic renal failure, coronary heart disease, chronic heart failure, and prior myocardial infarction. RESULTS: The disease duration in both groups averaged 8 years. In Groups 1 and 2, first metatarsophalangeal joint arthritis was diagnosed at its onset in 77 and 61%, respectively. In these groups, chronic arthritis was also diagnosed in 19 (37%) and 19 (39%). Examinations revealed tophi in 21 and 37% of cases in Groups 1 and 2, respectively. The administration of diuretics was recorded in 25 (49%) and 17 (35%) patients in these groups. Group 1 patients took low-dose ASA more frequently than Group 2 ones (19 (37%) and 7 (14%) patients, respectively; p = 0.013). Hypertension was identified in 23 (45%) examinees in Group 1 and 17 (40%) ones in Group 2. Both groups were matched for the number of patients with obesity (41 and 43%) and for that of patients with T2DM (15 and 10%, respectively). There were significant differences between the compared groups in the incidence of coronary heart disease, myocardial infarction, and chronic heart disease. CONCLUSION: The patients' age of gout onset does not affect substantial differences in the clinical features of gout with its comparable duration in the young and elderly patients. The main clinical features of gout are unique to both young and elderly patients. Cardiovascular diseases are more common at gout onset in the elderly.

[Interaction of the neurohumoral and immune mechanisms of progression of myocardial damage].

The review summarizes data on the interference of the neuroendocrine and immune mechanisms of myocardial remodeling. It shows a role of the effectors of the renin-angiotensin-aldosterone (aldosterone and angiotensin II) and sympathoadrenal (noradrenaline) systems in the activation of macrophages, the production of proinflammatory cytokines and inflammatory cell chemoattractants. It is noted that proinflammatory cytokines in turn promote the activation of these neuroendocrine systems. Natriuretic peptides exert an anti-inflammatory effect, but their production can be activated by proinflammatory cytokines.

[Economic assessment of efficacy of vasaprostan treatment of critical lower limbs ischemia]. / Ekonomicheskaia otsenka éffektivnosti primeneniia vazaprostana pri kriticheskoi ishemii nizhnikh konechnostei.

AIM: To estimate cost-effect efficacy of vasaprostan treatment of inpatients with arterial chronic obliteration (ACO) with critical ischemia of the lower limbs (Fonten stage III-IV). MATERIAL AND METHODS: Case histories of 105 ACO patients with critical ischemia of the lower limbs (mean age 65 +/- 11.8 years) were analysed to compare efficacy and cost of the "typical practice" of hospital treatment of such patients with prognostic cost of basaprostan treatment using drug-cost modeling. RESULTS: The cost-effect analysis comparing efficacy of "typical practice" and vasaprostan treatment showed that in "typical practice" amputations of the limb are inevitable in 41% while vasaprostan treatment reduces the percentage of the operations to 8.6-12% (according to the literature); overall cost of the "typical" treatment for 105 patients reached 3,909,222 roubles while relevant prognostic cost of vasaprostan treatment made up 4,407,162-4,570,653 roubles. Thus, vasaprostan treatment is characterized by less expense per 1 case of the limb amputation prevention vs "typical practice". CONCLUSION: The models used demonstrated that vasaprostan treatment is more cost-effective than "typical practice".

[Infectious complications in patients in the terminal stages of chronic renal insufficiency]. / Infektsionnye oslozhneniia u bol'nykh s terminal'noi stadiei khronicheskoi pochechnoi nedostatochnosti.

Characteristics of infectious complications were investigated in 112 patients at the terminal stage of renal insufficiency treated by programme hemodialysis. High frequency of sepsis (32.4 per cent), urinary tract infections (27.7 per cent), respiratory tract infections (26.4 per cent) and tuberculosis (5.6 per cent) was stated. The lethal outcomes of the infectious complications averaged 20.3 per cent.

[Clinical trials of ofloxacin in sequential use (intravenous and oral) in patients with serious hospital infection]. / Klinicheskoe izuchenie ofloksatsina pri posledovatel'nom primenenii (vnutrivenno i vnutr') u bol'nykh s ser'eznymi gospital'nymi infektsiiami.

Fifteen patients with severe hospital infections such as postoperative pneumonia or intraabdominal sepsis were treated with ofloxacin in a dose of 400 mg once a day for 7 to 14 days (11 days at the average). The drug was administered intravenously for the first 3-5 days and then orally till the end of the treatment course. The clinical effect was observed in 14 patients (93 per cent) and the positive bacteriological effect was stated in 11 out of 13 patients (85 per cent). Before the treatment 18 microbial cultures were isolated from the patients. 94 per cent of them was susceptible to ofloxacin. The isolates of Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa were the most frequent. The treatment resulted in the eradication of 15 cultures (83 per cent). The adverse reactions were observed in 3 patients but only in 1 of them they were for certain due to the drug use. All the adverse reactions were insignificant or moderate and did not require the treatment discontinuation. The trials showed that ofloxacin was a highly efficient agent useful in the empirical monotherapy of patients with severe hospital infection.

[Lomefloxacin pharmacokinetics in patients in the terminal stage of chronic renal insufficiency, undergoing treatment with programmed hemodialysis]. / Farmakokinetika lomefloksatsina u bol'nykh v terminal'noi pochechnoi nedostatochnosti, nakhodiashchikhsia na lechenii programmnym gemodializom.

The most frequent complications in patients with the terminal stage of chronic renal insufficiency are infections of various severity. The problem of the antibacterial therapy choice is especially urgent because of a high frequency of antibiotic resistant strains and the necessity to correct the treatment regimens in regard to the severity of the renal failure. The pharmacokinetics of lomefloxacin, a new fluoroquinolone, was studied in the treatment of patients with the terminal stage of chronic renal insufficiency treated by programmed hemodialysis. Lomefloxacin was administered orally in a dose of 400 mg at an interval of 48 hours 24 hours prior to the hemodialysis application. There was observed a decrease in the maximum serum concentration of the drug by comparison to that in healthy persons which could be due to slow absorption of the drug and hyperhydration in the patients because of anuria. In the treatment of such patients it is necessary to provide high serum concentrations of lomefloxacin attainable by using higher single doses of the drug.

[Intensive therapy of DIC-syndrome in patients with acute renal insufficiency caused by long-term crush syndrome]. / Intensivnaia terapiia DVS-sindroma u bol'nykh s ostroi pochechnoi nedostatoch-nost'iu, obuslovlennoi sindromom dlitel'nogo sdavleniia.

Impairment of parenchymatous organs, primarily kidneys, responsible for their dysfunction in crush syndrome results in many respects from disseminated intravascular coagulation (DIC). It is also associated with hemorrhagic complications. It is demonstrated that treatment modalities aimed at arrest of DIC syndrome (plasmapheresis, heparin, dysaggregation drugs, transfusions of large amounts of fresh frozen plasma) stopped bleeding and septic shock in 12 patients with crush syndrome following the earthquake in Armenia (1988).

[Plasmapheresis in dermatology]. / Plazmaferez v dermatologii.

Overall 105 patients with different dermatoses were placed under observation. The patients received plasmapheresis (PA) treatment. PA was tolerated well by the majority of the patients, with the method efficacy amounting to 96%. PA eliminated disseminated intravascular coagulation which was initially seen in the majority of the patients, led to the normalization of hemostasis and microcirculation. At the same time PA exerted an immunocorrective action which showed up by a decrease of the most parameters of humoral and cellular immunity, the level of CIC, complement activity with a simultaneous rise of the phagocytic index, which may attest to macrophagal system activation.

[The results of using pseudoplasmapheresis in bronchial asthma (a preliminary report)]. / Rezul'taty primeneniia lozhnogo plazmafereza pri bronkhial'noi astme (predvaritel'noe soobshchenie).

The authors provide the results of the treatment of 15 patients with infectious bronchial asthma by plasmapheresis (PA). All the patients received PA in accordance with the techniques developed by the authors. These techniques simulate standard procedures using a plasticized container and a refrigerator centrifuge. As a result of the studies carried out, it has been concluded that the clinical efficacy of false PA is similar to that of routine PA as regards the clinical manifestations of bronchial asthma. Apparently, the elimination effect and the effect of red blood cells plasma withdrawal are of no material importance in the mechanism by which PA influences bronchial asthma. The psychosomatic causes, effects of temporary blood loss, blood contact with polymeric materials, and the influence of temporary blood cooling may be under discussion.

[Relation between arterial hypertension and disorder of erythrocyte deformability in patients with chronic renal failure]. / O sviazi mezhdu arterial'noi gipertoniei i narusheniem deformiruemosti éritrotsitov u bol'nykh s khronicheskoi pochechnoi nedostatochnost'iu.

A total of 29 patients with chronic renal insufficiency (CRI) were investigated. Noticeable disorder of erythrocytic deformability (ED) was detected in half of them. The expression of arterial hypertension showed correlation with a degree of ED disorder. A possibility of the main role of ED disorder in the development and progression of arterial hypertension was discussed. ED disorder was found to correlate with a degree of expression of laboratory signs of the DIC-syndrome and was practically unassociated with the blood level of creatinine.