Klinicheskaia meditsina
-
Klinicheskaia meditsina · Jan 2006
Review[Polymyalgia rheumatica and giant-cell temporal arteritis].
The article is dedicated to the contemporary concept of the prevalence, etiology, and pathogenesis of polymyalgia rheumatica and Horton's disease. The author analyzes the features of the pain syndrome, arthritis, fever, and other manifestations of the disease. ⋯ Polymyalgia rheumatica is treated with prednisolone. The stages of glucocorticoid therapy, the rules of adjustment and lowering prednisolone doses, combined therapy with glucocorticoids and cytostatics, the effectiveness of therapy, and the prognoses are described in detail.
-
Klinicheskaia meditsina · Jan 2006
Review[Treatment of arterial hypertension after ischemic cerebral stroke].
Lethality associated with secondary cerebral stroke is higher than in primary one. Data on the clinical course of arterial hypertension after stroke are contradictory. In recent years, the risk of a repeated ischemic stroke has been considered to be in a direct correlation with both systolic and diastolic blood pressure (BP), while the optimal BP level differs depending on the type of the stroke. ⋯ At the same time, various antihypertensive drug classes were directly compared only in MOSES study. As far as secondary stroke prevention is concerned, differences between these classes suggest the existence of other than hypotensive mechanisms of their action. The presence of carotid atherosclerosis may compromise cerebral perfusion and predispose the patient to a second stroke, when a hypotensive effect is achieved.
-
Klinicheskaia meditsina · Jan 2006
Review[Somatostatin analogues in treatment of gastrointestinal and pancreatic neuroendocrine tumors].
Clinical application of natural somatostatin is limited due to its short effect (the half-life of the preparation is less than 3 min), and a rebound effect after its administration. For these reasons, synthetic analogues of somatostatin, among which sandostatin (octreotide acetate) was the first one, were developed. Other cyclic analogues with similar sensitivity and activity profile, such as lanreotide (somatulin), somatostatin-14, and SOM 230, have been developed as well. ⋯ Other syndromes, which should be treated with octreotide, include ectopic secretion of adrenocorticotropic hormone in Cushing syndrome, oncogenic osteomalacia, and hypercalciemia resulting from ectopic secretion of parathyroid-like peptide. In patients with an advanced carcinoid syndrome, the starting dose of sandostatin (ocreotide) is 150 mcgr administered three times a day in hypordermic injections during 10 to 14 days, after which sandostatin LAR is administered in a dose of 20 mg once a month. Sandostatin is usually administered for the life-term of the patient, exept cases of intractable adverse effects or the development of total insensitivity.