A nonspecific back pain is in the vast majority of all possible cases of dorsopathies. The sources of back pain may be myogenic dysfunction, intervertebral disc pathology or osteoarthritis of the archicular (facet) joints of the spine, including myofascial pain syndrome. A differentiated approach to the treatment of spondylarthrosis is still an unsolved problem. The article discusses important issues of integration of non-drug treatment methods and drug therapy of nonspecific back pain in patients with facet syndrome. Special attention is paid to SYSADOA group chemicals, in particular chondroitin sulfate (mucosat). These drugs have proven analgesic and anti-inflammatory effects and also are able to improve the structure of the cartilaginous tissue, slowing the progression of the disease.

The aim of the present work was to study the efficacy of L-carnitine in patients with stage 1–2 chronic cerebral ischemia (CCI). A comparative, parallel clinical trial included 60 patients (22 men, 38 woman, aged 41–74, mean 61.2 ± 8.2 years) with established diagnoses of stage 1–2 chronic cerebral ischemia. All patients received basal treatment for CCI including antihypertensive and antiaggregant agents. Group 1 included 20 patients given 1000 mg of L-carnitine per day (the biologically active additive Carnitone). Group 2 (20 patients) received the agent at a dose of 2000 mg/day. Group 3 (control group) received only basal treatment. Courses of treatment lasted 60 days. The frequency of complaints of weakness, reduced work capacity, memory degradation, headache, vertigo, and unsteadiness of gait decreased after completion of treatment. Statistically significant differences after treatment were seen in terms of the total MMSE points scores and in the “concentration of attention” and “memory” subscales; as compared with the baseline level, the durations of working with all five tables in the Schulte test decreased. Data from the asthenia MFI-20 questionnaire in patients of the study groups showed decreases in the levels of total, physical, and mental asthenization, with increases in activity and motivation level. The agent was found to have a dose-dependent effect.

OBJECTIVETo assess the severity of asthenic syndrome (AS) in chronic brain ischemia (CBI) in primary health care settings.MATERIAL AND METHODSThe study included 1170 patients with brain ischemia, aged 45-65 years, treated with phenotropil in dose 100 mg during 2 and 3 months. Clinical examination and MFI-20 subscales were administered. RESULTS AND СONCLUSION: The high incidence of asthenic syndrome was observed across all MFI-20 subscales. The decrease in asthenic syndrome severity was significant already in the end of the first month of treatment with phenotropil. Such dynamics maintained to the end of the second and third month of treatment. More than 2-fold decrease in the severity of asthenia symptoms was achieved in all subgroups 3 months after treatment. More rapid and apparent decrease in asthenic syndrome was observed in younger patients.

Platelets play a key role in the development of thrombotic lesions. Urgent action to prevent platelet activation affecting the process of fibrin polymerization and slowing clot formation.

We studied the effect of deproteinized hemoderivative of calf blood, thioctic acid and vinpocetine with piracetam on the endothelial function in patients with chronic cerebral ischemia stage III. After pharmacological treatment, there was the improvement in the endothelium properties of both large and small blood vessels. The index of occlusion that characterized the function of small vessels reached normal values while the phase shift did not approach to the reference values. This notion indicates that in cerebral atherosclerosis small arteries initially are subject to alterations to a lesser extent compared to the arteries of large and medium caliber. The most effective medicines of those used for the correction of endothelial dysfunction are deproteinized hemoderivative of calf blood and thioctic acid.

The purpose of this study is to investigate the effectiveness of L-carnitine treatment in patients with dodementia stage chronic cerebral ischemia. In parallel comparative clinical study included 60 patients (22 men and 38 women aged 42 to 74 years), the average age of the patients was 61.2±8.2 years. All patients received basic treatment, including antihypertensive and antiplatelet drugs. The first group consisted of 20 patients who received 1000 mg of L-carnitine per day (bilology supplement karniton). In the second group (20 patients), the drug was administered to 2000 mg per day. In the third (the control group) was carried out only basic therapy. The course of treatment was 60 days. After treatment significantly reduced the frequency of complaints of weakness, decreased performance, memory loss, headache, dizziness, unsteadiness of gait. Statistically significant differences after treatment revealed in the MMSE total score and subtests "focus" and "memory", compared to the baseline reduced the running time with all 5-tables in the test Schulte. According to questionnaire fatigue MFI-20 the main group level decreased overall, physical and mental asthenia, increased activity and the level of motivation. Revealed a dose-dependent effect of the drug.

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Summary. The study was aimed at investigation of nitric oxide (NO) metabolism including total and separate concentrations of stable NO metabolites (nitrate anions and nitrite anions) and 3-nitrotirosine concentration in stable chronic obstructive pulmonary disease (COPD) and in COPD with concomitant chronic cerebral ischemia (CCI). The study involved 55 patients aged 51 to 67 years divided into 2 groups: 28 patients with COPD II–III stage (the 1st group) and 27 patients with COPD II–III stage and concomitant CCI II–III stage (the 2nd group). The control group included 25 healthy non-smoking volunteers. A significant increase in nitrate anion concentration and in the total nitrite and nitrate concentration was found in the blood of patients of both groups compared to the controls. A statistically significant inverse relationship was found between the blood nitrite anion concentration and FEV1 (r = –0.77; p < 0.05) in COPD patients. These results demonstrate that changes in NO metabolism related to nitrous stress could emerge even in stable COPD. In co-existing COPD and CCI, changes in these biomarkers could be also related to functional particularities of nitrite reductase apart from the nitrous stress.

This article is devoted to the studying of blood flow in cerebral arteries and endothelial function at various stages of chronic cerebral ischemia in cerebral atherosclerosis. While reducing the linear velocity of blood flow, ultrasound scans showed a reduction of visco-elastic properties of the aorta and endothelial dysfunction in large muscular arteries, which correlated with the thickness of the intima-media of the carotid arteries. The data obtained show the reduction of linear blood flow velocity in ultrasonic scanning and the reduction of visco-elastic properties of the aorta, as well as endothelial dysfunction in large muscular arteries. It was found that the most sensitive among the parameters studied in atherosclerosis of the arteries of the brain is a phase shift in occlusive sample. It is determined by the influence of nitric oxide on the smooth muscle cells of the arterial wall of large muscular arteries. It is possible a pharmacological correction of endothelial dysfunction in the large vessels of muscular type of atherosclerosis in patients with chronic cerebral ischemia.

Data of literature on the role of inflammation factors in the pathogenesis of stroke are presented. The study of myeloperoxidase level in the early acute phase of ischemic stroke and dynamics of this parameter after the antioxidant treatment with the α-lipoic acid preparation berlition was carried out. It has been shown that the activation of systemic inflammation and related oxidative stress recorded in the early acute phase of brain infarction needs pharmacological treatment. Neuroprotective action of α-lipoic acid related to the prevention of damaging effect of free radicals on cell membranes and reduction of oxidative stress intensity is a pathogenetic explanation for using its preparations in ischemic brain lesions. The decrease in plasma myeloperoxidase content after the treatment with berlition may consider as a criterion of its efficacy.

Recent studies showed that activation of free oxygen radicals and the resulting stress play a key role in the development of brain vascular lesions related to hypertensive disease and atherosclerosis leading to chronic cerebral ischemia. To recall, activation of oxidative stress precedes chronic cerebral ischemia and stroke. Therefore, detection of stress markers may be a step toward the development of a new method for the identification of groups at high risk of stroke among patients with the unfavourable course of cerebral ischemia. This study was focused on the relationship between lipid and protein peroxidation products and clinical manifestations of the disease.

One hundred and twenty-one patients (mean age 64.13 +/- 8.43 years) with the diagnosis of chronic cerebral ischemia were examined. Somatic and neurological examinations, biochemical blood test, plasma homocysteine measurement, CKT/MRI were carried out. Neuropsychological tests (the MMSE, a battery of frontal dysfunction tests (BFDT), the Clock drawing test, the test of speech activity, the five words test, semantic and categorical associations, the Tailor Manifest Anxiety Scale) were administered: Patients were stratified into 3 groups: group 1 included 34 patients with confirmed cognitive disorders and mild hyperhomocysteinemia (> 15 mcmol/l); group 2 consisted of 51 patients with cognitive disorders and normal levels of homocysteine (< 15 mcmol/l) and group 3 consisted of 36 controls without cognitive disorders and with normal levels of homocysteine. In group 1, the performance of neuropsychological tests was significantly lower and neurological deficit was the most severe. We found reverse correlations between homocysteine levels and severity of cognitive disorders, which were most strong for the results of BFDT, the clock drawing test and the test of speech activity. Hyperhomocysteinemia was positively correlated with the worse values of neurological status and severity of chronic cerebral ischemia.

A role of the free-radical processes and disturbances of oxidative-restorative blood homeostasis and nervous tissue in the pathogenesis of brain ischemic pathology and other diseases are reviewed. Attention is focused on the search for optimal ways of pharmacological correction of oxidative stress in the schemes of complex treatment of chronic blood circulation insufficiency and on the necessity of combined application of several antioxidants with different mechanisms of action which reciprocally potentiate each other. Experimental and clinical suppositions of the use of a-lipoic acid as one of the most studied antioxidant in the treatment of brain ischemia as well as the results of own studies on the preparation berlition which contains a-lipoic acid used in the neuroprotective therapy of chronic brain ischemia for correction of free-radical processes are discussed.