[TREATMENT OF THROMBOTIC COMPLICATIONS IN THE INJURED PERSONS IN POLYTRAUMA].

Comparative results of treatment of thrombotic complications in the injured persons with combined trauma of trunk in two groups were adduced. The scheme of prophylax3 is and treatment of thrombotic complications was proposed; application of this scheme have permitted to reduce their rate in 5 times, from 54.5 to 11.2%.

[Sudden hearing loss: our experiences in treatment with vasoactive and corticosteroid therapy].

INTRODUCTION: Sudden hearing loss is a clinical entity of ambiguously defined aetiology manifested by hearing loss of more than 30 dB on three contiguous frequencies occurring within 72 hours. The lack of standard therapy protocol led to the use of variety of different therapies, thus making difficult objective quantification of their effect. OBJECTIVE: The aim of the study was to present our experience in the treatment of sudden hearing loss with administration of vasoactive and corticosteroid therapy. METHODS: Our research included 59 hospitally treated patients with a sudden hearing loss. During the period 1995-2004, 37 patients were treated using vasoactive agents (xanthinol nicotinate and pentoxifylline), and from 2004-2009, 22 patients were treated using parenteral corticosteroids (dexamethasone). All patients had unilateral sensorineural hearing loss of different level at frequencies from 500-4000 Hz, while other diagnostic procedures (laboratory tests, internist and neurology examinations, X-ray) were within normal limits. Evaluation of therapy effect was done by follow-up of hearing threshold changes and subjective complaints. RESULTS: The results showed that full recovery was achieved in patients with a mild and not fully severe hearing loss, with the majority of those (73%) under corticosteroid treatment. In these patients recovery was also achieved more rapidly. A partial recovery of hearing was detected in patients with hearing loss of more than 80 dB, and mostly in patients treated with corticosteroids. CONCLUSION: Although statistical evaluation does not indicate significant differences between the application of vasoactive drugs or corticosteroids, clinical findings support advantages of corticosteroid therapy. Treatment of hearing loss, although controversial, requires change of some up-to-now used agents. Advantages should go in favour of contricosteroids.

[Peyronie's disease: comparative results of conservative treatment].

Long-term clinical experience with conservative treatment of Peyronie's disease has demonstrated that clinical efficacy of this therapy comprises maily anesthesia while erectile problems are not solved. Introduction of the drugs into the fibrous plaque is not adequate and hard to perform. Some drugs affect only some components of pathogenesis. For stabilization of the process it is recommended to use transdermal electrophoresis or phonophoresis. The search for new effective drugs and methods continues.

[Sudden hearing loss--our experience in treatment with vasoactive therapy].

INTRODUCTION: A specific title "sudden hearing loss" refers to illness which is characterized by a sudden, rapid sensoneural hearing loss mostly in one ear without obvious causes, accompanied with dizziness, and without vestibular symptomatology. It is defined as a hearing loss for more than 30 dB on 3 or more successive frequencies which appear in 72 hours. OBJECTIVE: The main goal of our paper was to estimate success of implementation of vasoactive method in patients with sudden hearing loss of senso-neural type in different ranges in hospital conditions. METHOD: Our research covered 37 patients hospitalized because of a sudden hearing loss of sensoneural type in different ranges. Diagnosis, in all patients, was established by clinical ORL examination, audiology and vestibular examination. R including CT and MR, neurological, internist and laboratory examinations were used in order to exclude other aetiology. In monitored patients, we started treatment with vasoactive therapy, ampules of xanthinol nicotinate (one ampule of 2 ml, 300 mg) or ampules of pentoxiphylline (one ampule of 5 ml, 100 mg) in form of infusions with addition of vitamins with an everyday gradual increase of dosage up to 12 ampules of xanthinol nicotinate and up to 5 ampules of pentoxiphylline. Then we started with an everyday decrease of dosage down to the first one. RESULTS: After the complete curing protocol, we found out that in patients with light and medium senso-neural damages of hearing sense (23 or 62%), hearing recovery was complete. In patients with heavy damage of hearing (9 or 24%), partial success was evidenced. The most difficult cases, with complete hearing loss, heavy buzzing and vertiginous problem (5 or 14%) responded to therapy, so buzzing and vertiginous problems disappeared but hearing was not improved. CONCLUSION: Usage of vasoactive medicaments in hospital conditions in treatment of sudden hearing loss gives good results and it is the closest to aetiological therapy.

[Pathogenetic basis for using prodectin and teonicol, redergin and aescuzan in complex treatment of chronic gastritis]. / Patogeneticheskie osnovy primeneniia prodektina i teonikola, redergina i éskuzana pri kompleksnom lechenii khronicheskogo gastrita.

The study of the microvessels in bioptates of gastric mucosa and micro haemocirculation in the conjunctiva of 254 patients with chronic gastritis revealed that exacerbation of the gastric process is going on the background of hard terminal bloodstream disorders. They have the generalized character and picture of the typical chronic relapsing trombohaemorrhagic syndrome. The use of Prodectin (250 mg), Teonicolum (150 mg), Redergin (1 tab.) and Aescuzan (25 dr.) 4 times per day during 3 weeks helps to eliminate the microcirculatory disorders and exacerbation of the chronic gastritis.

Drug monitoring studies as a method of analyzing response criteria.

Two multicenter drug monitoring studies are presented. Some methodological problems are dealt with and the validity of such studies is discussed in terms of differential indication. In a first study (Lehmann et al., 1993) the results of a 12-week xanthinol niacinate treatment (500 to 3000 mg daily) in a cohort of 10,134 outpatients suffering from cerebrovascular insufficiencies were recorded systematically by nonreactive evaluation methods. The therapy was found to be most successful in patients with the target symptoms vertigo, tiredness, lack of concentration, affective disorder, and disturbances of vigilance and vitality. The most frequent side-effects were flush or heat sensations in 9.1% of the patients and gastrointestinal complaints in 3.3%. In a second study (Klieser et al., 1994) we systematically collected data from 219 patients with Major Depressive Disorder during five weeks of treatment with fluoxetine (20 mg daily). The results showed that depressively inhibited, anxious patients with a depression of minor severity, who showed a relatively marked improvement within the first week of treatment, profited the most from this therapy. The first study was designed to use nonreactive evaluation methods. Correlation analyses helped to identify the types of patient with a good response to treatment. The second study was organized on the model of conventional controlled pharmacological studies with the application of commonly used scales. The differential indication was to be inferred from the uni- and multivariate comparison of responders and nonresponders. In the light of these two studies, the problems of target definition, sample design, target variables, practicability, statistical analysis, and validity are discussed.

[The efficacy of using antiaggregants in chronic glomerulonephritis with grade-I chronic kidney failure]. / Efektivnist' vykorystannia antyahrehantiv pry khronichnomu hlomerulonefryti z I stupenem khronichnoï nyrkovoï nedostatnosti.

Both short-term and long-term effectiveness of xantinole nicotinate as well as trentale and combinations thereof with dipyridamole has been demonstrated in patients with chronic glomerulonephritis presenting with grade 1 chronic renal insufficiency, which fact can be accounted for by their vasoactive and antiaggregant actions. Particular regimens have been developed to treat the medical condition in question with the above drug preparations, comparative evaluation was done of their effects on the clinical course of the illness as well as on the effective renal plasma flow, concentration of nitrogenous remainder in blood and urine, concentration of medium size molecules in blood. It is advisable that antiaggregants be administered long term (from several months to several years).

[Characteristics of lymphocytic enzyme status of the newborn after metabolic therapy of pregnant women]. / Osobennosti fermentnogo statusa limfotsitov novorozhdennykh pri metabolicheskoi terapii u beremennykh.

The enzymatic synthetic activity of peripheral blood lymphocytes was changed in the newborns whose mothers suffered from habitual miscarriages and were administered courses of metabolic therapy as part of combined pathogenetic treatment (basis therapy). Metabolic therapy brought about positive shifts which manifested by a reliable activation of succinate dehydrogenase and alpha-glycerophosphate dehydrogenase, this, in its turn, creating favorable conditions for the functioning of the mother-placenta-fetus metabolic system and being conductive to a better adaptation of the newborns in the early neonatal period. Metabolic therapy brought about a twofold reduction of the incidence of fetal hypoxia and hypotrophy.

Drug monitoring study (phase IV) of xantinolnicotinate (Complamin) in general practice.

For 30 years, xantinolnicotinate has been on the market for the treatment of impaired brain function, i.e., organic brain syndromes of various etiologies. Controlled double-blind phase-III clinical trials have shown that xantinol-nicotinate is an effective drug in the treatment of dementia. Nevertheless, it is also important to assess xantinolnicotinate under routine treatment conditions in order to learn what type of patient is preferably treated, which ADRs can be observed how often, and whether the efficacy claimed by phase III studies can still be seen under routine treatment conditions. Theoretically, the more complex treatment situation in routine practice could lead to major changes in the selection of patients, the type and frequency of ADRs, or efficacy. The treatment of 10,134 patients was monitored in a treatment observation study. Results show that target illnesses are not cases of 'pure dementia', but more complex cases, in which multimorbidity plays an important role, so that the older term 'cerebrovascular insufficiency' seems more appropriate to describe this group of patients. Another interesting group is made up of younger patients suffering from a variety of psycho-organic syndromes. The assessment of therapeutic efficacy, e.g., with the SCAG, shows highly significant improvements during treatment, which are well comparable to those reported in controlled studies. The success of treatment was most expressed in the target symptoms "dizziness", "fatigue", "disturbance of concentration", "affective disorders", and "disturbance of vigilance and vitality". In 87% of these cases, no adverse drug reactions were reported.(ABSTRACT TRUNCATED AT 250 WORDS)

Role of xanthinol nicotinate in the revival of monkeys subjected to acute haemorrhagic shock.

The therapeutic potential of xanthinol nicotinate in the revival of anaesthetised monkeys subjected to acute blood loss was investigated. The arterial pressure was lowered to 40 +/- 5 mmHg by rapid arterial bleeding and was maintained at this level for 2 h. Shed blood was then returned through infusion, to the animals. Animals alive at the end of 72 h observation period were considered as survivors. The test drug was infused 1/2 h prior to and 1/2 h, 1 h, 1 1/2 h and 2 h after the onset of oligaemic hypotension. The animals which received normal saline instead of test drug were treated as control. The physiological and biochemical parameters recorded prior to and after the onset of oligaemic hypotension were heart rate, pulse pressure, electrocardiogram, electroencephalogram (EEG), lactic acid, creatine phosphokinase, urea and glucose. The results showed tachycardia, narrowing of pulse pressure, depression of ST segment with occasional T inversion, slowing of EEG with increase in amplitude, rise in blood lactic acid, creatine phosphokinase, urea and glucose. The magnitude of these responses were proportional to the duration and severity of shock. These changes were markedly attenuated in the drug treated group. Enhancement of survival was observed in drug treated groups as compared to control. It was 10 per cent in control as against 60, 86, 71, 57 and 50 per cent in the groups which received the test drug 1/2 h prior to and 1/2 h, 1 h, 1 1/2 h and 2 h after the onset of oligaemic hypotension. It is concluded that the beneficial effect of the drug in the revival of monkeys subjected to acute haemorrhagic shock may be due to better maintenance of tissue perfusion.

[Disorders of organic hemodynamics of the liver and their correction in suppurative cholangitis]. / Narusheniia organnoi gemodinamiki pecheni i ikh korrektsiia pri gnoinom kholangite.

The blood flow in the portal vein and hepatic artery was studied by means of ultrasonic Doppler flow measurement to investigate organic and regional hemodynamics of the liver in purulent cholangitis. The blood flow in the portal vein was found to be significantly diminished in patients with acute cholangitis and hepatic failure. Hepatic microcirculation was studied on a experimental model of obstructive jaundice and obstructive purulent cholangitis in rats by polarographic measurement of hydrogen clearance. Considerable reduction of the volume rate of the local blood flow was noted, and the degree of the reduction was related to the severity and duration of the disease. Decompression of the biliary tract by external drainage improved the local blood flow rate which, however, diminished again in prolonged external drainage. The use of pharmacological agents for correction of microcirculation in decompression of the biliary tract led to total and rapid correction of the volume rate of the local blood flow.

[The correction of microcirculatory disorders in patients with circulatory encephalopathy]. / Korrektsiia narushenii mikrotsirkuliatsii u bol'nykh s distsirkuliatornoiéntsefalopatiei.

The state of microcirculation was studied by bulbar biomicroscopy in 18 healthy persons and 53 patients with dyscirculatory encephalopathy before and after treatment with vasoactive drugs (xanthinol nicotinate, Cavinton, Sermion). It was found that the microcirculation changes depended on the stage of the disease. It was found that the above drugs produced a positive effect on the microcirculation, the values of which normalized by the end of the course of treatment, especially after their direct administration.

[Effect of xanthinol niacinate on the autoimmunity and capillary permeability in patients with stable stenocardia]. / Vliianie ksantinol-nikotinata na sostoianie autoimmuniteta i pronitsaemost' kapilliarov u bol'nykh so stabil'noi stenokardiei.

A three-month antianginal therapy with long-acting nitrates and xanthinol nicotinate given in various daily doses have shown that there is a positive clinical effect, a reduction in the level of immune complexes and IgG in most patients, which is followed by a decrease in capillary permeability and dienic conjugate levels both in erythrocytes and plasma.

[The use of antioxidants and preparations improving the microcirculation in the surgical treatment of cancer of the lung in elderly patients]. / Primenenie antioksidantov v preparatov, uluchshaiushchikh mikrotsirkuliatsiiu, pri khirurgicheskom lechenii raka legkogo u bol'nykh pozhilogo vozrasta.

The effectiveness of antioxidants and preparations improving microcirculation in surgical treatment of 118 elderly patients with pulmonary cancer was studied. The use of antioxidants of tocopherol acetate and retinol acetate in combination with complamin has proved to be the most effective. Reduction in the incidence of cardiovascular and pulmonary complications after the operation was noted.

Treatment of intermittent claudication with antiplatelet agents.

In a double-blind study, 296 patients with intermittent claudication (Fontaine stage II) were treated with 250 mg ticlopidine twice daily, 500 mg aspirin every third day plus 75 mg dipyridamole three times daily, or 300 mg xanthinol nicotinate three times daily for 6 months. Ticlopidine and aspirin/dipyridamole, but not xanthinol nicotinate, improved platelet aggregation, reduced beta-thromboglobulin, platelet factor IV and fibrinopeptide A concentrations, and increased antithrombin III concentrations and red blood cell filterability. No changes in lipid profiles, platelet count or fibrinogen were recorded following any treatment. The doppler systolic blood pressure ratio was improved in patients treated with ticlopidine or aspirin/dipyridamole, but not with xanthinol nicotinate. It is concluded that antiplatelet treatment is useful for the treatment of limb arteriopathy.

Efficacy of xantinolnicotinate in patients with dementia.

Activation of cerebral metabolism and improvement of microcirculation by influencing rheological parameters are claimed to be the underlying pharmacological principles responsible for the efficacy of xantinolnicotinate. This dual mechanism of action led the authors to perform a double-blind, randomized, placebo-controlled study in patients with mild to moderate dementia (DSM III), characterized by a score of 40-90 on the Sandoz Clinical Geriatric Scale (SCAG), with a separate randomization for patients with Multi-Infarct Dementia (MID) and Senile Dementia of Alzheimer Type (SDAT). It was calculated that 150 patients would have to be recruited for each group. Allocation to the respective group (MID or SDAT) was based on the Hachinski Ischemic Score and computer tomogram. Preceded by a 2-week placebo run-in period, a 12-week treatment period followed with either 3 x 1 g xantinolnicotinate (Complamin) or placebo. Prior to the study, the physician's rating of the global therapeutic effect from the clinical global impression (CGI) was designated as the primary criterion of efficacy. Secondary efficacy criteria were SCAG, the BGP nursing rating, and, as psychometric variables, tests from the Nuremberg Psychogeriatric Inventory (NAI). The improvement compared to placebo was statistically significant for the CGI in both treatment groups (p less than 0.0001) and hence independent of etiology. Concerning the nurses' rating (BGP), apart from a marginally statistically significant difference for the factor "need of help" in the SDAT group, no remarkable changes were registered during treatment. However, in the SCAG the differences between verum and placebo were significant (MID p less than 0.0002; SDAT p less than 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

[The dynamic changes in the regional volumetric cerebral blood flow and local vascular reactivity in acute craniocerebral trauma in animals with alloxan diabetes]. / Dinamika izmenenii regionarnogo ob''emnogo mozgovogo krovotoka i mestnoi sosudistoi reaktivnosti pri ostroi cherepno-mozgovoi travme u zhivotnykh s alloksanovym diabetom.

The authors studied the condition of regional volumetric cerebral blood flow and local vascular reactivity in experimental mild and moderate craniocerebral trauma in 31 animals with alloxan diabetes and in 29 animals with isolated brain injury. It is shown that alloxan diabetes aggravates cerebral vascular disorders occurring in injury to the skull and brain. Vasoactive agents Cavinton and xantinol nicotinate promote regression of the changed cerebral blood flow.

[Clinical variants of Wegener's granulomatosis]. / K voprosu o klinicheskikh variantakh granulematoza Vegenera.

A female patient is described, suffering from a lingering superficial form of Wegener's granulomatosis. The disease has been diagnosed on the basis of its prolonged (7 yrs) relatively benign course, isolated involvements presenting as skin and nasal mucosa ulcers, hard palate and nasal septum defect, and histologic shifts (necrotizing paling granulomas, combined with vasculitis). Low prednisolone doses have been quite effective in therapy of this condition.