Гастроэзофагеальная рефлюксная болезнь относится к числу наиболее частых нозологических форм в гастроэнтерологии. Лекция освещает во-просы патогенеза заболевания, рассматривает диагностические и лечебные подходы, дает алгоритмы ведения пациентов и дифференцированного применения лекарственных средств. Ключевые слова: гастроэзофагеальная рефлюксная болезнь, рефлюкс-эзофагит, пищевод Барретта, ингибиторы протонной помпы, альгинат, про-кинетики. Для цитирования: Вовк Е.И., Седякина Ю.В., Шамуилова М.М. и др. Гастроэзофагеальная рефлюксная болезнь в практике терапевта поликлиники: terra incognita. Consilium Medicum. 2020; 22 (8): 9–26. DOI: 10.26442/20751753.2020.8.200317
The efficacy of isosorbide dinitrate (ISDN) and nitroglycerin was studied in 115 patients with acute transmural myocardial infarction admitted to the Coronary Care Unit not later than 12 h after the onset of chest pain: 58 patients not later than 2 h after the onset of chest pain, 49 after 3–6 h and 8 patients in the period of 6–9 h. There were 69 men and 45 women, mean age 62.4 ± 0.9 years. The duration of the preceding clinically evident coronary artery disease was in 12 patients 1 year, in 29 2–3, in 22 4–5 and in 16 patients 6 years or more. In 36 cases the chest pain of acute infarction was the first presentation of coronary artery disease. Thirty-seven patients had a previous myocardial infarction. Fifty patients had concomitant systemic hypertension. The patients were divided into 3 groups depending on the type of therapy received: group I, receiving anticoagulants only, served as control; patients of groups II and III received, in addition to the anticoagulants, intravenous ISDN or nitroglycerin, respectively. The patients were monitored for recurrent chest pain, electrocardiographic changes, clinical parameters and cardiac enzyme changes. ISDN, at a dose of 10 mg/h over the first 3 days of infarction, had marked antianginal effect, limited the dimensions of the necrotic area, reduced the number of ischemic relapses and the development of heart failure. Compared to nitroglycerin, ISDN exerted a more prolonged action (up to 12 h), did not affect heart rate and blood pressure, and had a marked antiarrhythmic effect. This last finding widens the indications for the use of ISDN in patients with myocardial infarction.
Aim.To investigate the association between periodontal hemodynamic disturbances and systemic endothelial dysfunction (ED); to assess the effectiveness of various toothpastes for periodontal disease prevention in patients with nicotine dependence.Material and methods.In total, 120 young individuals aged 22—28 years were divided into 2 groups, according to the presence or absence of nicotine dependence. All participants underwent ED assessment with the EndoPAT device. Microcirculation (MC) was assessed with the high-frequency Doppler ultrasound system MinimaxDoppler-K. Patients with nicotine dependence were divided into 2 subgroups. Subgroup A was recommended to use the R.O.C.S. toothpaste Anti-Tobacco (WDS Laboratories) twice a day, while Subgroup B participants were recommended to use the toothpaste Colgate Advanced Whitening with polishing micro-crystals (ColgatePalmolive Poland) twice a day.Results.Significant between-group differences were observed for reactive hyperemia index and augmentation index. ED severity was higher in smoking participants. Velocity and volume parameters of periodontal MC were lower in smokers. The use of each specialized toothpaste was associated with improved periodontal MC, decreased prevalence of periodontal pathology-related complaints, reduced periodontal pocket depth, and decreased periodontal index values; however, the Anti-Tobacco toothpaste was more effective.Conclusion.Young smokers demonstrated а more severe ED and disturbed periodontal MC, which manifested in a more advanced periodontal disease.
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