Aim. To estimate in a 12-month study mortality and frequency of recurrent cardiovascular events, dynamics of neurological deficit and endothelial dysfunction in patients with the first-time ischemic stroke treated with simvastatin 40 mg/day in acute period of the disease. Materials and methods. The efficacy of high-dose simvastatin (40 mg/day) therapy initiated in acute stage of ischemic stroke was evaluated in 12-month comparative randomized study. Patients of the first group (n=97) received standard stroke therapy, and patients of the second group (n=86) also received standard treatment and simvastatin additionally. Combined endpoint (cardiovascular death + recurrent cardiovascular events + necessity of readmission), dynamics of neurological status and endothelial function were considered. Results. Primary combined endpoint was achieved in 66 cases in the first group (68.04%) and in 47 (54.65%) in the second one (p=0.043). Neurological status evaluated by National Institutes of Health Stroke Scale (NIHSS), Mini-Mental State Examination (MMSE) scale, and Scandinavian scales had a faster positive dynamics in patients receiving simvastatin. The same patients revealed more intense and quick decrease in desquamated plasma endotheliocytes. Conclusion. Simvastatin 40 mg/day prescribed along with neuroprotective and antihypertensive treatment in acute stage of ischemic stroke leads to lowering of recurrent cardiovascular events number, positive dynamics of neurological status, regression of endothelial dysfunction reflected by significant decrease in number of circulating desquamated endotheliocytes.

Острые нарушения мозгового кровообращения (ОНМК) являются важнейшей медико-социальной проблемой [1][2][3][4][5][6]. На долю ишемического инсульта (ИИ) приходится 70-85% всех случаев ОНМК. ИИ являет-ся серьезной угрозой для жизни и требует огромных ор-ганизационных усилий и финансовых затрат на лече-ние и реабилитацию пациентов [7,8].Важнейшим достижением, определившим совре-менное состояние ангионеврологии и подходы к про-филактике цереброваскулярных заболеваний, стала кон-цепция гетерогенности инсульта [9]. В эксперимен- Цель. Оценить в открытом 12-месячном проспективном рандомизированном наблюдении смертность, частоту повторных кардиоваскулярных событий, динамику нев-рологического дефицита, эндотелиальной дисфункции и функционального состояния почек у пациентов с впервые возникшим ишемическим инсультом полушарной локализации после назначения симвастатина 40 мг/сут в остром периоде болезни. Материал и методы. Включено 210 пациентов старше 18 лет (95 мужчин и 115 женщин) в острейшем периоде ишемического инсульта. Пациенты были рандоми-зированы в две группы. В группе 1 (n=105) проводили стандартное лечение ишемического инсульта. В группе 2 (n=105) в дополнение к стандартной терапии инсульта был назначен симвастатин 40 мг/сут. Период наблюдения составил 12 мес. Проводили мониторинг показателей липидного спектра, числа циркулирующих в крови клеток десквамированного эпителия, скорости клубочковой фильтрации (СКФ) по MDRD, а также неврологического статуса пациентов (Скандинавская шкала, MMSE, NIHSS). Результаты. Смертность за период наблюдения в группах 1 и 2 составила 18,1% и 15,2%, соответственно. Комбинированная конечная точка была достигнута в 60,9% и 46,6% случаях, соответственно (р=0,037). В группе 1 показатели липидного спектра существенно не менялись, а в группе 2 отмечено значимое снижение их уров-ней. Положительная динамика неврологического статуса отмечалась в обеих группах наблюдения, однако, наиболее выраженные позитивные изменения были отмечены в группе 2. Снижение десквамированных эндотелиоцитов в группе 2 составило 45,7%, а в группе 1 -13,3% (p=0,00001). В группе 2 выявлено значимое повыше-ние СКФ. Заключение. Длительная терапия симвастатином в комплексе с нейропротекторной и антигипертензивной терапией у пациентов с острым ишемическим инсультом приводит к уменьшению количества клинически значимых событий, улучшению функции эндотелия, неврологического статуса и прогноза. Aim.To evaluate in open 12 month prospective, randomized study the mortality and recurrent cardiovascular events rate, dynamics of neurological deficit, endothelial dysfunction and renal function in patients with the first ischemic stroke of hemispheric localization after prescription of simvastatin 40 mg daily in the acute stage of the disease. Material and methods. Patients (n=210) above 18 years of age (95 men and 115 women) with acute ischemic stroke were included into the study. Patients were randomized into two groups. Patients of the group 1 (n=105) received standard treatment for ischemic stroke. Patients of the group 2 (n=10...

The article presents a modern classification of contrast media, the advantages and disadvantages of radiographic contrast media. The most important adverse events ofcontrast media such as hypersensitivity reactions, thyroid dysfunction andcontrast-induced nephropathy are discussed.

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Purpose: To assess the changes in eye optics and visual functions depending on the level of blood sugar and glycated hemoglobin (HbA1c) in insulin-dependent type 2 diabetes mellitus (IPSD) patients with excessive body weight, who receive long-term insulin therapy. Material and methods. 32 patients (64 eyes), of which 84.4 % were women and 15.6 % men, with insulin-dependent diabetes mellitus (IPSD) but without severe general diabetic complications or concomitant eye pathology were monitored ophthalmologically for 3 years. The average duration of insulin therapy was 6 years. The average age of the patients was 60.94 ± 1.04 years; average weight, 89.1 ± 14.8 kg; average height, 163.8 ± 7.3 cm; average body mass index, 31.3 ± 4.8 kg/m2. The level of blood glucose level was determined daily with individual Accu-Check and/or OneTouch select glucometers, supplemented by scheduled monthly examinations with an endocrinologist. The level of glycated hemoglobin (HbA1c) was determined once every 3–6 months. Vision was measured by international requirements for patients with diabetes using the ETDRS (Early Treatment Diabetic Retinopathy Study Research Group) system with an ESV-3000 device. To assess lens transparency, the international Lens Opacities Classification System III (LOCS III) was used. Glycaemia level was monitored by the patients themselves with the help of individual blood glucose meters and by endocrinologists in scheduled monthly checkups. HbA1c level was measured once every 3 to 6 months.Results. Over the follow-up period, the subjective visual acuity slightly deteriorated. The anterior segment remained practically unchanged, the vitreous body showed a destruction increase, the state of the retina remained stable and conformed to that of nonproliferative diabetic retinopathy. The glucose level showed a significant drop, while the level of glycated hemoglobin HbA1c practically remained constant. The LOCS III criteria showed an increased clarity of the lens nucleus (NO), a worse transparency of cortical layers (C) deteriorated; the NC nucleus colour and P parameters of the posterior subcapsular layer practically remained the same. Conclusions. According to our data, during the development of diabetic cataracts in patients with type 2 IPSD, NO of the lens changes first followed by C changes (they become worse). With the normalization of glycemia level, diabetic retinopathy does not progress, the NO of the lens can improve, and the NC and P do not change. Normalization of glycemia is not a retarding factor for the already existing changes in C or the state of the vitreous. HbA1c is a marker and trigger for possible lens changes in patients with type 2 diabetes and prolonged insulin therapy. HbA1с is effective for tracking the dynamics of changes in the eye in these patients. The fact that the positive correlation of HbA1c and C at follow-up start changed to the negative correlation toward the end of the study indicates a disruption in lens state compensation and does not cancel the negative dynamics of state C even with a decrease in the level of HbA1c.