[Expert approaches to chronic kidney disease].

Expert approaches to chronic kidney disease. The basic symptoms that indicate the presence of chronic kidney disease (CKD) are analysed. The authors present the modem classification of CKD, the characteristics of its stages, and requirements for the formulation of a diagnosis. The author's interpretation of the articles of the Regulations on military-medical examination, which are carried out survey of citizens subject to an initial statement on the military registration, conscription and reservists who have given pathology, is given. The necessity of the unification of expert approaches in military-medical and medical-social examination.

[THE INFLUENCE OF ABDOMINAL OBESITY ON LEFT VENTRICULAR MYOCARDIALREMODELING IN PATIENTS WITH ARTERIAL HYPERTENSION].

The obesity dependence of selected clinical and instrumental characteristics of 10 male patients with arterial hypertension (AH) was evaluated Group I included 79 patients with grade II hypertensive disease (HD), normal body weight and waist circumference. Group 2 comprised 61 patients with grade II HD and abdominal obesity. Patients of both groups showed high frequency of left ventricular (LV) hypertrophy (59.2 and 73.8% respectively). Concentric LV hypertrophy prevailed in group I and eccentric hypertrophy in group 2. 24 hr ECG monitoring showed that signs of relative coronary insufficiency were recorded more frequently in group 2 and cardiac rhythm disturbances in group I.

[Emergency state of health by arterial hypertension].

Emergency state of health by arterial hypertension. According to the Burdenko Main Military clinical hospital at the present time the frequency of crisis hypertensive heart disease is 16% from the total number of all patients with this nosology. Rapid relief of hypertensive crisis should be provided for patients' status assessment from the position of development of fatal complications. Herewith the main task when treating hypertensive crisis is not normotension, but reduction of blood pressure to safe level, taking into account potential risk of hypotonia and hypoperfusion in case of too aggressive hypotensive therapy. The main factor of hypertensive crisis development is the absence of compliance. The authors gave recommendations on treatment of complicated and non-complicated forms of hypertensive crisis, and provided indications for hospitalization.

[New approaches to the diagnosis, treatment and rehabilitation of military personnel, military pensioners and their family members with arterial hypertension].

The article considers new approaches to diagnosis, treatment and rehabilitation of patients with arterial hypertension (AH) applied to the Ministry of Defence contingent. For the medical service of the Armed Forces the problem is relevant because of the significant labor losses, high level of dismission, morbidity and mortality of this disease. In the assessment of the patients limitation of life should be considered a variant AH, the stage, availability and seventy of the organ damage, severity and reversibility of complications, the incidence and severity of hypertensive crises, the effectiveness of treatment, comorbidity, education, occupation, the presence of contra-types and conditions of military service or labor. Military medical expertise of soldiers with AH uses the classification of degrees of arterial hypertension of 2010 and a three-stage-classification hypertonic disease created by the World Health Organization, 1996.

[Evolution of treatment options for hypertension].

In the early 20th century hypertension became a medical problem because of the prevalence. The process of clinical research of the etiopathogenesis of hypertension is associated with a scientific and technical progress and state of medical science at every historical stage. The first stage (end of the 19th century--beginning of the 20th (century) was characterised by a research of hypertension and monitoring of its natural history. The second stage (early--mid 20th century) was characterised by attempts to influence on the natural history of hypertension. The basis of the attempts was neurohumoral concept. The third stage (end of 50s--beginning of 70s)--was characterised by the application of angiotensin-converting enzyme inhibitor, calcium channel blocker and thiazide diuretic along with beta-adrenergic blockers. The fourth stage (end of 20th century--beginning of 21st) was characterised by discovery of the renin-angiotensin-aldosterone system, development of complex treatment options for hypertension, based on stratification of risk factors of cardiovascular complication. Clinical picture of hypertension haven't changed significally during the last 100 years. Cerebral and cardiac manifestations of hypertension remain dominat in 21st century as well as in 20th century. In the beginning of 21st century such systems as eyes and kidneys are not affected by the hypertension. Hypertension remains the main cause of progression of cardiac muscle and vessel wall structural changes.

[Cutaneous-visceral interplay in patients with systemic lupus erythematosus].

Systemic lupus erythematosus (SLE) remains a challenging medical problem. The integral approach to the analysis of underlying pathogenetic processes allows identifying main symptom complexes of SLE and establishing relationship between skin lesions and activity of the disease. We examined 84 patients with SLE (84% women), their mean age was 42.3 +/- 2.3 yr duration of SLE 6.5 +/- 1.2 yr. The subacute and chronic SLE variants were diagnosed in 30 (36%) and 54 (64%) patients respectively. Grade 1 and 2-3 inflammatory process occurred in 53 (63%) and 31 (37%) patients respectively. Symptom complexes "systemic inflammation", "butterfly rash", "wrist petechiae", "enanthema of the oral mucous membrane", and other lesions were regarded as the markers of SLE activity. The relationship of lupus-cheilitis and facial erythema with polyserositis and pericarditis ("visceral pathology-cardiovascular lesions") requires instrumental examination of pericardium, pleural and abdominal cavities in the patients with the above skin symptoms for diagnostics of polyserositis. At the same time, the presence of teleangiectasia on the wrists (symptom complex "visceral pathology-renoparenchymatous lesions") requires thorough examination of the renal function. The presence of erythema at the major joints, mesh livedo, and Raynaud's syndrome (symptom complex "musculoskeletal disorders") implies specialized examination of the locomotor apparatus.

[Systemic lupus erythematosus: correlation of cutaneous manifestations with disease activity].

Results of treatment of 84 patients with systemic lupus in specialized units of the Main Military Clinical Hospital n. a. N.N.Burdenko erythematosus are performed. Subacute variant of the disease was diagnosed in 36% of patients, chronic - 64%. Active inflammation grade 1 was observed in 63% of patients, 2-3rd class - 37%. Between changes in the skin and the degree of inflammatory activity, variant of the disease set a definite relationship. The data obtained allowed to propose a diagnostic algorithm in systemic lupus erythematosus in order to optimize the therapeutic effects.

[Peculiarities of myocardium remodeling in patients with ischemic heart disease and arterial hypertension].

Increase of arterial pressure and the complications connected to it remain one of the main problems of modern medicine. Presence at the patient of an arterial hypertensia is connected to the highest risk of the accelerated development of a cardiovascular pathology. Therefore the big attention is given studying of processes remodelling a myocardium at hypertonic illness and ischemic illness of heart. However the question is not investigated, whether there are also what features of process remodelling at a combination of these two diseases for one patient. The purpose of research was studying features remodelling a myocardium at essential arterial hypertensia (with presence and without chronic ischemic illness of heart) and interrelations of changes of geometry of heart with an opportunity of development of cardiovascular complications.

[Medical case of successful therapy of polymyositis by high doses of glucocorticoid].

Questions of diagnostics and treatment of dermatomyositis-polymyositis in literature are contradictory character. They have scanty description of peculiarities of course of this pathology by men of young and certain age, and character of complications, connected with long ingestion of corticosteroid agents. Medical case, done in the article, is of great interest undoubtedly. By reason of using corticosteroid agents, the patient get a complex of specific complications, but pains in muscles, fever, arthralgia, weakness have disappeared. There was made a decision about speeded decreasing of dose of hormonal agent to 8 mg per day for the term pf 3 months in alternative session with parallel ingestion of disaggregants. On this base was marked epilosis of bioptic damage, was achieved recanalization of deep viens of left leg, was normalized carbohydrate metabolism, generalclinic analyze of blood, transaminase level, body weight was decreased. Now-days it's marked a clinical-laboratorial remission, not requiring a supplying corticosteroid therapy.