RESUMEN
Typical situations in the work of a primary care doctor are considered, viz. the purpose of visits familiarizing the doctor with the patient and his (her) family, drafting the patient's medical chart and the family's medical file folder, frequency and purpose of the patient's visits to the doctor's office in acute clinical condition, logical structure of primary care for planning active case detection.
Asunto(s)
Competencia Clínica , Médicos de Familia/normas , Atención Primaria de Salud/organización & administración , Humanos , Relaciones Médico-Paciente , Federación de RusiaRESUMEN
Using modern grouping of general pathological processes, human diseases have been divided into three categories according to the initial postulate i.e. the ability of the doctor to control the general pathological processes: syndromes and diseases underlied by fully reversible general pathological processes; syndromes and diseases in which general pathological processes are partially reversible; syndromes and diseases which are not controlled by the doctor in principle due to the fact that they are underlied by general pathological processes which cannot be reversed by a modern doctor.
Asunto(s)
Técnicas y Procedimientos Diagnósticos , Educación Médica/normas , Diagnóstico Diferencial , Progresión de la Enfermedad , Humanos , Federación de RusiaRESUMEN
AIM: To develop and implement intervention programmes for patients with mitral prolapse (MP) under real conditions of general medical practices of Russia in the transition period. MATERIAL AND METHODS: The MP register covered 208 patients among the adult population (n = 3346) of 2 districts served by general practitioners. According to the formalized protocols, clinical, instrumental, and psychological studies were conducted, which included examination of complaints and physical status, electrocardiography, echocardiography, paired echocardiography before and after bicycle ergometry exercise tests, psychological testing, study of the social status and life quality of patients. RESULTS: According to clinical and instrumental findings, the patients were divided into 4 groups, where differential individually based intervention programmes were implemented; the latter included modules of family upbringing, family prophylaxis, drug and nondrug treatment. Psychotherapeutical potentiation was performed in patients with the low cooperation index on an individual basis in accordance with revealed personality traits. Clinical symptoms diminished in severity, scores on pathological disease attitude scales lowered, life quality increased, persons with the low cooperation index reduced in number. CONCLUSION: The developed and tested intervention programmes in patients with MP are effective and may be successfully implemented in general medical practice facilities.
Asunto(s)
Medicina Familiar y Comunitaria , Prolapso de la Válvula Mitral/terapia , Antagonistas Adrenérgicos beta/uso terapéutico , Adulto , Ecocardiografía , Electrocardiografía , Prueba de Esfuerzo , Femenino , Humanos , Hipnóticos y Sedantes/uso terapéutico , Masculino , Prolapso de la Válvula Mitral/clasificación , Prolapso de la Válvula Mitral/diagnóstico , Prolapso de la Válvula Mitral/tratamiento farmacológico , Prolapso de la Válvula Mitral/psicología , Pruebas Psicológicas , Psicoterapia , Calidad de Vida , Sistema de Registros , Tranquilizantes/uso terapéuticoRESUMEN
A study of 20 patients with protracted myocardial infarction and 142 patients with transmural myocardial infarction showing a routine course revealed that the clinico-biochemical equivalent of prolonged course of reparative processes in protracted myocardial infarction are up to 2 months registered values of chlorine-soluble mucoprotein, serum hexoses and hexose glycoaminoglycane fractions as well as late (on the 6-7 decade of the disease) oxyprolin peaks in biological substrates.
Asunto(s)
Infarto del Miocardio/diagnóstico , Anciano , Enfermedad Coronaria/metabolismo , Electrocardiografía , Femenino , Hexosas/sangre , Humanos , Hidroxiprolina/análisis , Masculino , Persona de Mediana Edad , Mucoproteínas/sangre , Infarto del Miocardio/metabolismo , Factores de TiempoAsunto(s)
Infarto del Miocardio/patología , Cicatriz , Creatina Quinasa/metabolismo , Electrocardiografía , Glicosaminoglicanos/metabolismo , Humanos , Inflamación , Isoenzimas , Mucoproteínas/metabolismo , Infarto del Miocardio/metabolismo , Infarto del Miocardio/fisiopatología , Necrosis , PeriodicidadRESUMEN
A total of 136 patients with trans- and 200 with non-transmural myocardial infarction (MI) were examined over time for chlorine-soluble mucoprotein (MP), serum hexoses (SH), their fraction-hexoses of glycosaminoglycans (H-GAG), and hexoses of glycoproteins (H-GP), serum, plasma and urine hydroxyproline (SHP, PHP, UHP). The computation of regressions made it possible to prove multidirectional changes in chlorine-soluble MP, SH, H-GAG, SHP, PHP, and in UHP. Approximation of the curves enabled MI patients to be distributed into subgroups marked by rapid and moderate repair tempo. The factors that prolong MI repair according to the X-square test are as follows: age over 60 years, heart aneurysms, recurrent MI, chronic grade 2A heart failure, diabetes mellitus, chronic bronchitis combined with lung emphysema and stage 2 respiratory failure. That whether MI is transmural or non-transmural is not per se the sole factor determining MI repair.
Asunto(s)
Mucoproteínas/metabolismo , Infarto del Miocardio/metabolismo , Regeneración , Glicoproteínas/metabolismo , Hexosas/sangre , Humanos , Hidroxiprolina/sangre , Hidroxiprolina/orina , Infarto del Miocardio/fisiopatología , Análisis de RegresiónAsunto(s)
Infarto del Miocardio/diagnóstico , Miocardio/patología , Adulto , Anciano , Sedimentación Sanguínea , Femenino , Fibrinógeno/análisis , Glicosaminoglicanos/análisis , Humanos , Hidroxiprolina/análisis , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/metabolismo , Infarto del Miocardio/patología , Miocardio/análisisRESUMEN
Comparison of the clinical and laboratory tests with the findings of post-mortem examination of 82 hearts of patients who had died in different periods after the onset of the disease allowed the authors to distinguish three periods in the clinical course of myocardial infarction: necrotic, inflammatory and adaptational. Fever, leukocytosis, the time course of MB CPK activity, and the results of polyelectrode ECG are reliable indicators of the duration of the necrotic period. The content of the protein-carbohydrate complexes in the blood adequately reflect the exudative-proliferative phase, while the content of collagen metabolites in blood and urine reflect the collagenization phase of the inflammatory period. These tests allow the physical activity of each patient to be individualized under objective control over the rate of healing of the myocardial infarct. Most patients become fully adapted to life with a reduced mass of contractile myocardium three months after the onset of the disease.
Asunto(s)
Infarto del Miocardio/clasificación , Electrocardiografía , Humanos , Infarto del Miocardio/fisiopatología , Infarto del Miocardio/rehabilitación , Miocardio/patología , Necrosis , Factores de TiempoRESUMEN
Serial tests for the activity of creatine phosphokinase (CPK), specific cardiac isoenzyme MB CPK, lactic dehydrogenase (LDH) and its fractions LDH1 and LDH2 were conducted in 55 patients with myocardial infarction. The control group consisted of 15 healthy persons. It was found that an increase in total CPK activity allows the diagnosis of myocardial infarction to be confirmed in the first hours after the onset of the disease, while simultaneous increase in the activity of MB CPK makes the diagnosis authentic, which is particularly valuable in cases with an atypical course of the disease. A recurrent course of myocardial infarction is attended with parallel changes in the activity of total CPK and its MV fraction. Increased total CPK activity may be due both to myocardial infarction and to extracardiac causes.
Asunto(s)
Pruebas Enzimáticas Clínicas , Creatina Quinasa/sangre , Isoenzimas/sangre , L-Lactato Deshidrogenasa/sangre , Infarto del Miocardio/diagnóstico , Adulto , Anciano , Estudios de Evaluación como Asunto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/enzimologíaRESUMEN
Individual glyco- and mucoproteins and collagen metabolites were determined in dynamics in 297 patients with transmural, macrofocal nontransmural, and microfocal myocardial infarction. It is shown that these laboratory findings enable one to appraise the course of myocardial infarction healing. This may serve as one of the criteria for the elaboration of individualized rehabilitation programs.
Asunto(s)
Infarto del Miocardio/rehabilitación , Miocardio/metabolismo , Adulto , Anciano , Recuento de Eritrocitos , Femenino , Glicoproteínas/sangre , Humanos , Hidroxiprolina/sangre , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/metabolismo , alfa-Macroglobulinas/análisisRESUMEN
To develop intravital criteria of the reperative processes following myocardial infarction, clinical, biochemical and morphological parallels were traced in 62 patients dying of myocardial infarction after different periods following the onset of the disease. It was demonstrated that a set of laboratory techniques (examinations of haptoglobin, chloridesoluble mucoprotein, of heterogeneity of mucoprotein, v2-macroglobulin) helps in the evaluation of the severity of the inflammatory and macrophagel reactions in the paranecrotic zone. A useful intravital sign of the formation of a postinfarction scar is provided by the examination of collagen metabolites--oxyproline bound with collagen-like plasma protein and free serum oxyproline and urine excretion of total oxyproline. The obtained data can be used for the development of a rehabilitation programme, differentiated therapy in various groups of patients.
Asunto(s)
Infarto del Miocardio/rehabilitación , Adulto , Anciano , Asparagina , Creatina Quinasa/sangre , Recuento de Eritrocitos , Femenino , Fibrinógeno/análisis , Haptoglobinas/análisis , Humanos , Hidroxiprolina/metabolismo , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Mucoproteínas/sangre , Infarto del Miocardio/metabolismo , Infarto del Miocardio/patología , Miocardio/patología , Transaminasas/sangre , Cicatrización de Heridas , alfa-Macroglobulinas/análisisRESUMEN
In 328 patients with myocardial infarction, changes were followed occurring in the levels of haptoglobin (Hp) and chloride-soluble mucoprotein (CMP), heterogeneity of mucoprotein, and titres of anticardial antibodies. From the 2nd-3rd days after infarction, the levels of Hp, CMP, and 3rd and 4th mucoprotein fractions increased and remained elevated for 4 weeks; then the levels gradually sank, and normalized in the 7th-8th weeks after infarction. The anticardial antibody titres remained high from the 3rd to the 6th weeks. In 37 patients who died, the clinico-biochemical, immunobiological, and morphological findings were compared. It was found that assessments of the Hp and CMP levels as well as of mucoprotein heterogeneity make it possible to appraise the intensity of inflammatory reaction in myocardial necroses and thus facilitate the choice of differentiated antiinflammatory treatment of patients with myocardial infarction.