Surgical treatment of atrial fibrillation: technique of thoracoscopic radiofrequency fragmentation of the left atrium. / Khirurgicheskoe lechenie fibrilliatsii predserdii: tekhnologiia vypolneniia torakoskopicheskoi radiochastotnoi fragmentatsii levogo predserdiia.

Presented in the article is a detailed description of a modified technique of minimally invasive surgical treatment of patients with atrial fibrillation - thoracoscopic radiofrequency fragmentation of the left atrium. This modification differs from the prototype GALAXY procedure by a significant increase of the 'quantitative' rather than 'qualitative' parameter of surgical aggression in relation to the left atrium. This technique results in creation of multiple transmural continuous closed lines of lesion to the left atrium and, consequently, a reduced risk of inadequate surgical treatment for atrial fibrillation. Besides the radiofrequency action on the wall of the left atrium, the protocol of the operation included destruction of the ligament of Marshall and resection of the left atrial appendage. An indication for performing this operation is the presence of various forms of atrial fibrillation.

[Intravitreal aflibercept in high retinal pigment epithelial detachments]. / B L.N., Kh Iu.Iu., Z A.S., B A.S., K N.V. Intravitreal'noe vvedenie Aflibertsepta pri vysokikh otsloikakh retinal'nogo pigmentnogo épiteliia.

PURPOSE: To study the effectiveness of intravitreal aflibercept in high pigment epithelium detachment (PED) in eyes with age-related macular degeneration (AMD). MATERIAL AND METHODS: This study included 16 eyes of 16 patients (10 female and 6 male) aged 52 to 82 years (mean age 68.56±2.31 years). Examination of patients included determination of best-corrected visual acuity (BCVA), biomicroscopy with Goldmann lens, photographic recording of the ocular fundus, optical coherence tomography (OCT) and OCT-angiography. Results of the treatment were evaluated 1 month after the third injection of aflibercept. Among the analyzed parameters were: BCVA, maximum PED height, resorption of perifocal neuroepithelium detachment (NED), expressiveness of hyperreflective content of PED. RESULTS: One months into the treatment, after the third injection, mean BCVA improved by 0.09 to 0.36±0.04, height of PED decreased in average by 225.3±44.6 µm to 326.88±25.13 µm. Complete resolution of PED was not achieved in any of the cases. Resulting mean height of perifocal PED was 61.25±12.87 µm. Full resorption of PED was achieved in 4 eyes. Expressiveness of hyperreflective content of PED higher than 50% was observed in 13 eyes (81.25%). CONCLUSION: The results of intravitreal aflibercept in AMD patients with high PED have proved its effectiveness in reducing maximum PED height, improving resorption of perifocal NED and BCVA. Optically 'empty' PEDs had higher sensitivity to intravitreal aflibercept than hyperreflective PEDs. Statistically significant dependence of BCVA on the height and content of PED was absent.

Serum interleukin-6: Association with circulating cytokine serum levels in patients with sinus arrhythmia and patients with coronary artery disease.

In this study, we were focused on the differences between certain circulating cytokine levels in patients with or without sinus arrhythmia, according to the median IL-6 level. All patients were stable with regards to symptoms and therapy for at least one month prior to the measurements conducted within this study.Exclusion criteria were: patients with sleep apnea, asthma, respiratory insufficiency of any genesis, active infection, allergy, inflammatory diseases, cancer, diabetes of any type and treatment with anti-inflammatory drugs. The study was approved by the Institutional Review Board. All recruited patients gave their verbal and written consent for participation in the study. The study group consisted of 74 patients divided into two groups: with (38) and without sinus arrhythmia but with diagnosed coronary artery disease (36). Sinus arrhythmia was confirmed by 24h Holter monitoring. From all test parameters only cytokines IL-2, IL-8, IL-10, IL-17 and IL-18, showed statistically significant increasing in patients with statistically higher IL-6 levels. It is possible that IL-6 may not be a marker for the selection of patients with sinus arrhythmia or coronary artery disease. The findings indicate that IL-6 represents a reliable indicator for increased expression of IL-2, IL-8, IL-10, IL-17 and IL-18 in patients with sinus arrhythmia or coronary artery disease. Further studies in a large number of patients would be necessary to confirm our observations.

Risk Factors of the Invasive Breast Cancer Locoregional Recurrence.

BACKGROUND: The aim of the research was to estimate the frequency of the locoregional breast cancer recurrence appearance, the recurrence-free period continuance, and the 3- and 5-year survival depending on the scope of the surgical intervention, menstrual profile, and histological and molecular-biologic characteristics of the primary tumor. PATIENTS AND METHODS: Among 218 patients with a breast cancer, 99 patients had breast-conserving surgery (BCS) and 119 underwent radical mastectomy (RME); all patients had regional lymphatic nodes dissection. The size and the primary tumor differentiation degree, metastasis presence in the regional lymph nodes, ER expression, PR, and Her/2neu were assessed as the prognostics factors. RESULTS: It was defined that the locoregional recurrence appearance frequency in patients with BCS turned out to be 13%, and in patients after RME it turned out to be 9%; the recurrence-free period continuance was 53 ± 8 months and 56 ± 10 months, respectively. CONCLUSIONS: The locoregional cancer recurrence frequency is higher in women with the menstrual function being preserved at the moment of the primary tumor detection than in postmenopausal patients and also in patients having the hyperexpression of the Her/2neu. The ipsilateral cancer recurrence decreases the 3-year survival by 7,1% and the 5-year one by 20,3%, respectively.

Method for studies of behavior and physiology of sea mammals.

The potentialities of an original programmed complex for long-term monitoring of oxygen supply and behavior of sea mammals under conditions of free behavior were evaluated. Results of pilot studies of behavioral activity and body systems of seals are presented.

[Application of multiple-branch prostheses in reconstruction of the aortic arch in DeBakey Type I aortic dissection].

Over the period from January 2002 to March 2005, a total of 78 patients were operated on for DeBakey type I aortic dissection. Of these, five patients underwent prosthetic reconstruction of the aortic arch and brachiocephalic arteries (BCA), performed with the help of the Dacron prosthesis Gelweave four-branch plexus Vascutek. The major indication for using this prosthesis was the extending of the dissection into the BC As, with various degree of obstruction thereof. The overwhelming majority of the patients were men (80 %). The patients' average age amounted to 44.3+/-5.6 years (ranging from 36 to 57 years). In three cases, the aortic dissection was of chronic course, with acute and subacute dissection being diagnosed in the remaining two cases. The median-sternotomy access, and additional approaches to the left and right common carotid arteries were used in order to carry out prosthetic reconstruction of the ascending branch, aortic arch, right subclavian artery, right common carotid artery (CCA) and left CCA with the help of the multiple-branch prosthesis. Protection of the brain consisted of craniocerebral hypothermia, hypothermal circulatory arrest in a combination with retrograde cerebral perfusions through the vena cava superior. The duration of the circulatory arrest averagely amounted to 59.2+/-4 min, with the mean time of artificial circulation equalling 230.6+/-19.7 min, and the time of aortic occlusion was 193.1+/-11 minutes. None of the patients developed either neurological or haemorrhagic complications postoperatively. Hence, the surgical technique using multiple-branch prostheses for prosthetic reconstruction of the aortic arch in type I aortic dissection with BCA obstruction proved to be effective and safe.

[Polineoplasia: thyroid cancer and breast cancer: incidence, causes, mechanisms of development].

The dramatic situation with the incidence and mortality from breast cancer that has developed in the last decades of the past century in the industrialized countries of the world has given this disease the status of not only a medical, but also a social problem. The society reacted to this adequately: a number of measures taken for anti-cancer propaganda, early diagnosis, development and widespread use of effective methods of treatment allowed us to reverse the unfavorable trend in mortality while recognizing the limited possibilities of modern medicine in preventing breast cancer. World trends in increasing life expectancy after curing breast cancer have led to an increase in the number of patients subsequently ill with a second malignant tumor. The attention of researchers is attracted by the combination of breast cancer and thyroid cancer.

[Clinical effectiveness of nadroparin calcium in the surgical treatment of breast cancer]. / Otsenka klinicheskoi éffektivnosti primeneniia nadroparina kal'tsiia pri khirurgicheskom lechenii raka molochnoi zhelezy.

The report deals with an assessment of frequency of fatal thromboembolic complications after surgery for breast cancer, in particular, frequency and severity of the side-effects of calcium nadroparin treatment as a component of surgical preparation. Considering the low incidence of thromboembolic complications in such patients and the side-effects of anti-coagulant therapy, it is suggested that decisions be made on a strictly individual basis under stringent clinical control.