ПРОШЛОЕ И НАСТОЯЩЕЕ САНКТ-ПЕТЕРБУРГСКОГО НАУЧНО- ИССЛЕДОВАТЕЛЬСКОГО ИНСТИТУТА СКОРОЙ ПОМОЩИ ИМЕНИ И.И. ДЖАНЕЛИДЗЕ (К 85-ЛЕТИЮ ОСНОВАНИЯ)

The article gives materials on the development of the St. Petersburg Research Institute of Emergency Medicine named after I.I Dzhanelidze. This modern multidisciplinary center of emergency and urgent medicine takes leading positions on many directions of medical science development.В статье представлены материалы по истории развития Санкт-Петербургского научно-исследовательского института скорой помощи имени И.И. Джанелидзе, современного многопрофильного центра экстренной и неотложной медицины, занимающего лидирующие позиции по многим направлениям развития медицинской науки

Estimation of risk of repeated operative interventions of patients with a widespread peritonitis

Research objective: to study application possibility peritonitis scales, for definition of risk of repeated operative interventions at patients with a widespread peritonitis. It is spent retrospective kogort research with the analysis of 189 case records of patients with a peritonitis. Middle age of patients of 48+0,5 (16-81), among them of 54,5 % of men. The estimation of weight of patients was spent on scale APACHE II, weight organs infringements on scale SOFA, weight intraabdominal infections on Manhejmsky peritonials to an index, to an index relaparotomie and to an index of a belly cavity. The result of research has shown, that in a choice of tactics of surgical treatment of a widespread peritonitis definition of weight of a condition of the patient on scale APACHE II and weights abdominal pathological process by means of an index of a belly cavity is optimum.Цель исследования: изучить возможность применения перитониальных шкал для определения риска повторных оперативных вмешательств у пациентов с распространенным перитонитом. Проведено ретроспективное когортное исследование с анализом 189 историй болезни пациентов с перитонитом. Средний возраст пациентов 48+0,5 (16-81) лет, среди них 54,5% мужчин. Оценка тяжести состояния пациентов проводилась по шкале APACHE II, тяжести органных нарушений по шкале SOFA, тяжести интраабдоминальной инфекции по Манхеймскому перитониальному индексу, прогностическому индексу релапаротомии и индексу брюшной полости. Результат исследования показал, что оптимальным в выборе тактики хирургического лечения распространенного перитонита является определение тяжести состояния пациента по шкале APACHE II и тяжести абдоминального патологического процесса с помощью индекса брюшной полости

Management of patients after ischemic stroke. Use of citicoline

In ischemic stroke (IS) patients, preventive actions against recurrent IS are required on a permanent basis, including lifestyle changes, medication therapy (antihypertensive, antiplatelet and statin drugs) and, in some patients, surgical treatment (carotid endarterectomy, or stenting). Depending on the type of the neurological disorder, various rehabilitation programs are indicated which in most cases require physical and mental activation of the patient and can be combined with various medicines (treatment of spasticity, depression, cognitive impairment). Results of multicenter, placebo-controlled studies on the efficacy and safety of citicoline (Ceraxon) for IS are presented. Citicoline is said to have a definite advantage over other drugs commonly used in this country for acute IS and in the recovery period

Treatment approach for managing low back pain

Low back pain is one of the most frequent causes of seeking doctor's aid and temporary disability of patients. The leading role in the examination belongs to clarification of complaints, medical history, quick physical and neurological examination which help to exclude presence of a specific disease, and in most cases there is no need for instrumental examination. Information about benign nature of the disease, high probability of quick recovery, benefits of adhering to an active lifestyle, use of pain relieving nonsteroidal anti-inflammatory drugs (NSAIDs) and muscle relaxants could be of great value for patients with acute nonspecific back pain. To ensure efficacy, treatment for chronic non-specific back pain should be multidisciplinary and include physical therapy, cognitive-behavioral therapy, optimization of drug therapy. In case of discogenic radiculopathy, epidural corticosteroids and anesthetic could also be effective, and only a small proportion of patients need surgical treatment. The article provides the authors' findings on the efficacy and safety of NSAIDs, such as meloxicam (Movalis), for managing low back pain

How to effectively treat migraine attacks

Migraine is one of the most common causes of disability of young and middle-aged people. Many patients with migraine are not satisfied with drugs used for the treatment. Rational approach to the treatment of migraine and effective relief of migraine attacks are discussed. Medicines for the treatment of migraine attacks and their evidence-based efficacy are analyzed. The efficacy and safety in relieving migraine of Excedrin containing 250 mg acetylsalicylic acid, 250 mg paracetamol and 65 mg caffeine, are described

Early diagnosis and treatment of Alzheimer's disease

There is an overview of literature devoted to the early diagnosis and treatment of Alzheimer's disease (AD). Medication and non-medication treatment methods for AD are discussed. The efficacy of psychosocial and behavioral therapies and cognitive training for patients with AD is highlighted. The efficacy of central acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine) and memantine in improving cognitive function, behavior and activities of daily living in oatient with AD is highlighted. The article tells about the efficacy of donepezil (Alzepil) at different stages of the disease in patients with AD and rationality of its use at 10 mg daily to achieve the best possible effect. Early diagnosis and effective treatment of patients with AD could significantly enhance the quality of life not only for patients but also for their closest relations

Triptans in treatment of migraine

Migraine is one of the most common neurological disease that manifests itself in severe headache attacks. It is one of the most widespread causes of disability in young and middle-aged people. Almost all patients (98%) are in need of relief of migraine attacks. Prescription-free analgesics are most commonly used, with only 9-10% of patients satisfied with the effect of therapy. A much better effect is demonstrated by triptans - anti-migraine medications which, unfortunately, are rarely used in this country. The article discusses the basic principles of the use of triptans. Eletriptan is noted as one of the most effective and well-tolerated triptans in the treatment of migraine. The clinical efficacy and safety of eletriptan are demonstrated

Modern aspects of diagnosis and treatment of chronic cerebral ischemia. Application of naftidrofuryl

Chronic cerebral ischemia (CCI) is one of the most common diagnoses in the national neurology, which is now completely absent in most countries and to a certain extent corresponds to vascular cognitive impairment (VCI) in modern foreign literature. The literature data and author's findings on the diagnosis and treatment of CCI are presented. Other diseases may often clinically simulate CCI (anxiety and depressive disorders, primary headaches, peripheral vestibulopathy, Alzheimer's disease) which unfortunately are poorly diagnosed in clinical practice, so patients do not receive effective treatment. Treatment of patients with CCI (VCI) should be focused on managing risk factors for stroke (cessation of smoking and alcohol abuse, sufficient physical activity), normalization of blood pressure (antihypertensive agents), reduction of blood cholesterol levels (statins), antithrombotic therapy (antiplatelet agents and anticoagulants), and administration of drugs that enhance cognitive function. There are findings on the use of naftidrofuryl (Dusopharm) in patients with cognitive impairment

Depression in neurological practice: prevalence, diagnosis, treatment standards and new options for pharmacotherapy

Depression is the third most common cause of disability in the world's population. Depressive disorders are widespread in patients observed by psychiatrists, neurologists, as well as general practitioners. Comorbid depression worsens the course and prognosis of somatic and neurological diseases. Training, psychotherapy and pharmacotherapy form the basis of the current approach in the treatment of depression. Over the past several decades, the common pharmacological treatments for depression have been antidepressants with different mechanisms of action. However, antidepressant therapy has several disadvantages. The therapeutic effect of antidepressants occurs only 2--4 weeks after the start of treatment. Limitations in the use of antidepressants are not seldom due to contraindications or persistent side effects. Meanwhile, about 2/3 of patients taking antidepressants do not achieve the clinical effect, hence the need to find a drug which could be associated with a better antidepressant efficacy. Acetyl-L-carnitine is an active L-carnitine metabolite with antidepressive action, good tolerability and safety. The article tells about pre-clinical trials of acetyl-L-carnitine (ALC) in cell-based models and animal models, the results of randomized, placebo-controlled studies of ALC efficacy in the treatment of depression and depressive symptoms

Prognosis and prevention of cardioembolic stroke in patients with atrial fibrillation

The article is a review of literature on the prognosis and prevention of stroke in patients with atrial fibrillation (AF). It is noted that the simple CHA2DS2-VASc calculator is a good predictor of the risk of stroke in AF. Oral anticoagulants are recommended to patients with one or more risk factors for stroke according to CHA2DS2-VASc. There is data from large randomized trials showing that new oral anticoagulants (dabigatran, rivaroxaban, apixaban) can be as good as or better than warfarin in significantly reducing the risk of stroke, and are associated with lower risk of serious, particularly intracranial, bleeding. Positive experience related to the use of dabigatran (Pradaxa®), in a dose of 150 mg or 110 mg twice in patients with AF, is described. The introduction of new anticoagulants into the national neurological practice which do not require international normalized ratio control, will ensure wider use of anticoagulant therapy in patients with AF and reduce the incidence of cardioembolic stroke