DEGENERATIVE SPINE INJURY ASSOCIATED WITH BACK PAIN: MORPHOGENETIC ASPECTS

Degeneration of the intervertebral disk (IVD) is a pathological process resulting from an interplay between genetic and environmental factors causing structural and functional damage of the IVD and neighboring structures. It is the first stage of degenerative cascade in the vertebral motion segment. Initiation and progression of IVD degenerative processes traditionally involves several factors: inadequate mechanical load, decreased diffusion of nutrients through the arch laminae, and genetic factors playing a significant role in the development  of degenerative changes. Three categories of candidate genes whose coding variants are associated with different forms of degenerative changes in the IVD are identified, a conceptual model of genetic interactions in degenerative disease of the disk is developed. The study  of the role of structural changes in back pain genesis, evaluation of risk factors allow to optimize the tactics of patient care and find new therapeutic solutions preventing disease progression

Дорсопатии - новый взглядна проблему диагностики и лечения

The paper shows the newest aspects of the diagnosis and treatment of the most important varieties of dorsopathies: inflammatory spondylopathies and spondylosis.В статье отражены новейшие аспекты диагностики и лечения важнейших разновидностей дорсопатий - воспалительных спондилопатий и спондилеза

HIP AND BUTTOCKS PAIN SYNDROME — LOOK OF THE INTERNIST

Differential approach to the diagnosis of diseases associated with pain in the hips and buttocks is presented in this lecture

Дегенеративное поражение позвоночника: представления о болезни, подходы к терапии(собственные данные)

An open-labeled randomized study of the efficacy and safety of Piascledine-300 in combination with nonsteroidal anti-inflammatory drugs (NSAIDs) versus the latter was conducted in 2 matched groups of patients with lower back pain associated with spondylarthrosis. During combined therapy using Piascledine, there was a reduction in the pain syndrome particularly with the longer administration of the drug. The use of Piascledine in spondylarthrosis showed its clinical efficacy in 89,2% of patients: the indices of lumbago substantially reduced and spinal function improved, which was associated with the good tolerability of the drug.Проведено открытое рандомизированное исследование эффективности и безопасности Пиаскледина-300 в комбинации с нестероидными противовоспалительными препаратами (НПВП) в сравнении с НПВП в 2 параллельных группах пациентов с болью в нижней части спины, ассоциированной со спондилоартрозом. На фоне комбинированной терапии с использованием Пиаскледина наблюдалось уменьшение выраженности болевого синдрома, особенно по мере увеличения длительности приема препарата. Применение Пиаскледина при спондилоартрозе показало его клиническую эффективность у 89,2% больных: значительно снизились показатели болевого синдрома в спине, улучшилось функциональное состояние позвоночника, что сочеталось с хорошей переносимостью препарата

Pathology of the shoulder joint and soft tissues: clinical variants, current capabilities of pathogenesis-directed therapy

Pain syndrome in the shoulder occurs in every 5th adult and is the 2nd most frequent reason for seeking primary medical care among all musculoskeletal disorders. Group of local causes of pain syndrome in the shoulder area. The starting point for differential search is patient’s age. For persons younger than 40, the most common causes are joint instability (dislocations / subluxations), as well as mild damage of the rotator cuff muscles due to injury. Patients older than 40 have an increased risk of severe chronic disorders of the above-mentioned muscles, adhesive capsulitis, and osteoarthritis of the shoulder joint. Treatment of shoulder joint and soft tissue pathology is nosological in nature and has to be justified by pathogenesis. Chondroreparants are a new class of pharmaceuticals based on hyaluronic acid modified by low molecular weight compounds using solid-phase stabilization. During physical stabilization (mechanosynthesis) of hyaluronic acid, chemical crosslinkers are not used, which leads to high tolerability and safety. Modified hyaluronic acid in Hyalrepair formulas has a number of structural features leading to its slower biodegradation in the tissues. Chondroreparant Hyalrepair-10 consists of hyaluronic acid, ascorbyl phosphate, zinc, cysteine, and glutathione; Hyalrepair- 2 consists of hyaluronic acid, ascorbyl phosphate, L-proline, L-lysine, and glycine. Use of intra-joint and periarticular injection of hyaluronic acid can be an effective approach in combination pathogenesis-directed therapy of the shoulder and soft tissues

HYPERTENSION IN POSTMENOPAUSAL WOMEN: POSSIBILITIES OF COMBINATION THERAPY

Objective – to study the efficacy and safety of Tenoten in the combination therapy of hypertension in early postmenopausal women.Subjects and methods. The study enrolled 60 early postmenopausal women with grade I–II hypertension. A study group included 30 women who took Tenoten during antihypertensive therapy (AHT); a control group comprised 30 women who received AHT only.Results. Tenoten could achieve additional improvement of 24-hour blood pressure (BP) monitoring data in the postmenopausal hypertensive women. Tenoten was found to have a positive effect on general health, activity, and mood and to alleviate the symptoms of autonomic dysfunction and anxiety.Conclusion. Tenoten that is able to alleviate the manifestations of anxiety and autonomic dysfunction, to exert a positive effect on bloodpressure values, and to improves health, mood, and social activity should be used in addition to AGT.</p

Heart myxoma under the mask of interstitial lung lesion: a difficult case from practice

The aim of the investigation was to describe a clinical case of the development of interstitial lung lesions in a 57-year-old man with a large left atrial myxoma, which had a reverse development after myxomectomy.Materials and methods. Patient V., 57 years old, was hospitalized in the therapeutic department of the City Clinical Hospital No. 1 named after N. I. Pirogov in connection with bilateral polysegmental pneumonia. A month before hospitalization, he underwent an outpatient examination for progressive dyspnea. Myxoma of the heart was diagnosed. Due to the progression of respiratory failure and the appearance of fever, he was hospitalized. Amidst the multistage antibiotic therapy, there was a torpid course of lung pathology with syndromes of bilateral dissemination and “ground glass”, bilateral lymphadenopathy of the mediastinum, high pulmonary hypertension, and systemic inflammatory reaction syndrome. Thromboembolism of the branches of the pulmonary artery, tuberculosis, sepsis, infective endocarditis, neoplastic processes of pulmonary and other localization were excluded.Results. The clinical picture corresponded to interstitial lung lesions within the framework of paraneoplastic syndrome in heart myxoma. It was decided to urgently carry out myxomectomy.Conclusion. The clinical case demonstrates the development of a rare variant of paraneoplastic syndrome in left atrial myxoma, which was suspected during the patient’s treatment for bilateral polysegmental pneumonia. The progression of the pulmonary lesion was explained by active interstitial inflammation and was supported by the immunological activity of the heart tumor.The performed myxomectomy, despite the persisting syndrome of systemic inflammatory reaction and infiltration of the lung tissue, led in 2 weeks to complete resolution of interstitial lung lesions and pulmonary hypertension, which confirmed the causal relationship between myxoma of the heart and involvement in the pathological process of the lungs

Цервикалгия: ревматологические аспекты

The paper presents the rheumatological aspects of the neck pain syndrome and the current view of the management and treatment of patients with cervicalgias.Представлены ревматологические аспекты синдрома боли в шее, а также современный взгляд на ведение и лечение пациентов с цервикалгиями

Остеоартрит суставов кистей: патогенез, диагностика, подходы к терапии

Osteoarthritis (OA) is a widespread disease accompanied by persistent joint damage with obvious functional failure, which leads to early disability in patients. In OA, different groups of joints are involved in the pathological process. Hand joints are one of the classical sites of OA. The paper discusses the role of mechanical load, genetic factors, and sex hormone deficiency in the development of the disease. The treatment policy includes a set of non-pharmacological, pharmacological, and surgical methods.Остеоартрит (ОА) – широко распространенное заболевание, сопровождающееся стойким поражением суставов с выраженной функциональной недостаточностью, что приводит к ранней инвалидизации больных. При ОА в патологический процесс вовлекаются различные группы суставов. Одной из классических локализаций ОА являются суставы кистей. Обсуждается роль механической нагрузки, генетических факторов, дефицита половых гормонов в развитии заболевания. Лечебная тактика включает сочетание нефармакологических, фармакологических и хирургических методов