Quality of life in patients with primary hyperparathyroidism before and after parathyroidectomy: long term single center experience.

BACKGROUND: Primary hyperparathyroidism (PHPT) is a common endocrine disorder caused by a parathyroid tumor or hyperplasia, which is often accompanied with quality of life (QoL) impairment. A parathyroidectomy (PTX) is the preferred standard treatment for PHPT patients. In this single center study we aimed to evaluate the impact of PHPT on patient's QoL and identify QoL changes at early and long-term follow-up after surgery. METHODS: All the patients underwent routine PTX with the removal of the suspected hyperparathyroid gland(s). Patients filled out generic QoL questionnaire RAND SF-36, specific questionnaire PHPQoL and specific symptom assessment questionnaire PAS upon admission to the hospital before surgery, at 3 months, 12 months and 24 months after surgery. RESULTS: A total of 92 patients with PHPT (median age was 56 years, 95.7% females) were included in the study. Before PTX patient's QoL by SF-36 scores was significantly lower as compared to healthy controls (p < 0.01). Almost 40% of patients had poor or very poor QoL. The most frequent symptoms by PAS before surgery were as follows: tiredness (97.8% of patients), weakness (94.6%), forgetfulness (94.6%), mood changes (90%), feeling "blue"/depression (88%), joint pains (83.3%), headaches (80.2%), constant irritability (77.2%), bone pains (75%), thirst (70.7%) and trouble getting out of a chair (67.4%). The half of the patients had moderate-to-severe (≥ 40 scores) tiredness, weakness, joint pains, forgetfulness, as well as mood changes. Post-operative QoL changes were analysed in the group of 72 patients. After surgery there was significant improvement in QoL by all scales of SF-36 questionnaire, excluding bodily pain, and the PHPQoL total score (GEE, p < 0.01) as compared with their values before surgery. Also severity of tiredness, mood changes, weakness and forgetfulness significantly decreased after surgery as compared to their baseline values (GEE, p < 0.05). Decreased mental component of QoL by PHPQoL (OR = 0.927, 95%CI = 0.874-0.984, p = 0.013) predicted improved QoL after surgery. CONCLUSIONS: Patients with PHPT demonstrated significantly impaired QoL in physical, psychological and social functioning as well experienced a wide profile of common PHPT symptoms. Successful PTX was accompanied with remarkable QoL improvement and decrease in subjective symptoms for at least 24 months after surgery.

[Influence of remote ischemic preconditioning on brain injury markers dynamics during cardiopulmonary bypass].

INTRODUCTION: Remote ischemic preconditioning has gained clinicians' attention as a technique to protect the heart in patients undergoing cardiac surgery under cardiopulmonary bypass. While experimental data report neuroprotective properties of remote ischemic preconditioning, we failed to find any clinical studies investigating its effects on neurologic outcome in cardiac surgery. PURPOSE OF THE STUDY: This prospective randomized placebo-controlled study was undertaken with the aim of elucidating the role of remote ischemic preconditioning for neuroprotection in cardiac surgery. PATIENTS AND METHODS: 88 patients with coronary heart disease scheduled for on-pump coronary bypass grafting surgery were randomized to receive either remote ischemic preconditioning or control. We studied S100B peptide and neuron-specific enolase to assess neurological damage. Psychophysiological tests were employed to investigate cognitive function after surgery. RESULTS: The perioperative dynamics of S100B and neuron-specific enolase followed similar patterns in both groups throughout the observation period. At the end of surgery, level of S100B was significantly higher in the preconditioning group as compared to controls--0.58 (0.33-0.65) vs. 0.34 (0.23-0.42) mcg/l, p

[Analysis of genetic structure and differentiation of the bog and dry land populations of Pinus sibirica du tour based on nuclear microsatellite loci].

We evaluated the population structure of the bog and dry land populations of the Siberian pine Pinus sibirica (P. sibrica) in Western Siberia using nuclear genome markers. Six pairs of nuclear microsatellite loci were used for this analysis. We detected 30 allelic variants in 120 individuals of four populations of P. Sibirica. We established that the studied populations differ by genetic structure. The most essential differences were identified between the Siberian pine population from oligotrophic bog and the group of populations from dry land within eutrophic bogs and near settlements P. sibirica forest (F(ST) = 0.019; D(N) = 0.053). We estimated that diversification of the West Siberian populations of P. sibirica exceeded 2.4% (F(ST) = 0.024), based on an analysis of SSR markers.

[Spatial structure of acid properties of litter in the succession row of swamp birch woods ].

The general potential, exchange, and actual (pH) acidities were investigated in the litter of the succession row of swamp birch woods. Their variabilities constitute, respectively, 75.9-174.4, 3.7-25.8 mmol (+)/100 g of the sampling, 3.7-5.5. For the first time, using the methods ofgeostatistics, their spatial variability was analyzed and the contributions of the trend, autocorrelation component, and the radius of the spatial correlation were estimated. It was established that in combination with the tree waste, which is uniformly distributed along the ecological profile, the specific composition of the grass-moss tier, which corresponds to the humidity of edaphon, forms the picture of the spatial structure of acid properties of the litter. It was noted that the prime cause of variability consists in the particularities of the water regime of the habitats of swamp birch woods.

[Cardioprotective effects of glutamine in patients with ischemic heart disease operated under conditions of extracorporeal blood circulation].

It was conducted a study of glutamine cardioptotective effects during perioperative use in patients with ischemic heart disease, operated under CB. Exclusion criteria were: left ventricular ejection fraction less than 50%, diabetes melitus, myocardial infarction less than 3 months ago, Patients of the study group (n=25) had glutamine (20% solution N(2)-L-alanine-L-glutamine ("Dipeptiven" Fresenius Kabi, Germany); 0.4 g/kg/day. Patients of control group (n=25) received placebo (0.9% NaCl solution). The main indicators were the dynamics of troponin I, as well as central hemodynamics parameters. On the 1-st day after operation the concentration of troponin I was significantly lower in the glutamine-group compared placebo-group (1.280 (0.840-2.230) 2.410 (1.060-6.600) ng/ml; p=0.035). 4 hours after CB in a glutamine-group also had significantly large indicators of cardiac index (2.58 (2.34-2.91) l/min/m2 vs 2.03 (1.76-2.32)) l/min/m2; p=0,002) and stroke index (32.8 (27.8-36.0.) ml/m2 vs 26.1 (22.6-31.8) ml/m2; p=0.023). Systemic vascular resistance index was significantly lower in glutamine-group (1942 (1828-2209) dyn x s/cm(-5)/m2 vs 2456 (2400-3265) dyn x s/cm(-5)/m2; p=0.001). Conclusion. Perioperative use of N(2)-L-alanine-L-glutamine during the first 24 hours ofperioperative period gives cardioprotective effect in patients with ischemic heart disease operated under CB.

Carbon dioxide embolism during posterior retroperitoneal adrenalectomy.

We report a case of massive carbon dioxide embolism associated with injury to the inferior vena cava, during posterior retroperitoneoscopic adrenalectomy. The presenting clinical features were tachycardia, rapid oxygen desaturation and severe respiratory acidosis, without evidence of bleeding. The patient was resuscitated by increasing the fraction of inspired oxygen, administering intravenous fluid and converting to an open procedure to suture the vein. This case demonstrates that gas embolism due to vessel injury during posterior retroperitoneal adrenalectomy may arise without evidence of bleeding, severe hypotension or an abrupt increase in end-tidal carbon dioxide. Using a high carbon dioxide insufflation pressure in the retroperitoneal space enhances visualisation of the surgical field by decreasing small-calibre vessel bleeding. However, it can contribute to, and delay recognition of, carbon dioxide embolism. Knowledge of the clinical features of carbon dioxide embolism, careful monitoring and vigilance for intra-operative surgical challenges can assist with the detection of this rare but potentially fatal complication.

[Quality of life in patients with primary hyperparathyroidism after surgery].

BACKGROUND: For a comprehensive assessment of the effect of surgery in patients with primary hyperparathyroidism (PHPT), as well as for monitoring the condition of patients after treatment, it sounds reasonable to evaluate quality of life (QoL) and symptoms in PHPT patients before and after surgery. AIM: The aim of this study was to assess changes in the QoL and symptoms in patients with PHPT after surgery. MATERIALS AND METHODS: During prospective observational study, patients filled out QoL questionnaires and evaluated the presence and severity of their symptoms prior to parathyroidectomy (PTE) and 3, 12 months after surgery. Statistical analysis included the following methods: Student's t-test or Wilcoxon's non-parametric test, the generalized estimating equations (GEE), correlation analysis, χ2 and McNemar tests. RESULTS: The study included 72 patients (mean age 52 years, 97.2% female) with symptomatic (68.1%) and asymptomatic (31.9%) PHPT. Before surgery patients with PHPT exhibited significantly decreased role functioning, physical and social well-being, and vitality. Half of PHPT patients experienced moderate-to-severe symptoms such as weakness, fatigue, loss of concentration, mood changes, as well as joint and bone pain; the association between symptoms experienced and the extent of QoL impairment before surgery was shown. Three months after PTE improvement in both physical and psychological components of QoL was shown. Positive QoL changes were demonstrated in patients with both symptomatic and asymptomatic PHPT and they preserved for 12 months after surgery. Also within 12 months after PTE significant decrease in PHPT-associated symptoms such as weakness, fatigue, loss of concentration and mood changes was found. CONCLUSION: The results obtained demonstrate efficacy of PTE from the patient's perspective and confirm the value of QoL assessment in PHPT patients in management of this patients' population both for decision making and for evaluation of benefits of surgery and the degree of recovery of patients at long term follow-up.

[Validation and testing of the Russian version of PHPQoL questionnaire for quality of life assessment in patients with primary hyperparathyroidism (PHPT)].

BACKGROUND: Quality of life (QoL) assessment before and after surgical treatment in patients with primary hyperparathyroidism (PHTP) may be useful for comprehensive evaluation of the treatment effect, as well as for monitoring of the patient' condition after surgery, including in real clinical practice. AIM: The aim of the study was to validate and test the Russian version of the PHPQoL questionnaire for assessment of the quality of life (QoL) in patients with primary hyperparathyroidism (PHPT) for further application in clinical practice and research in Russia. MATERIALS AND METHODS: The linguistic and cultural adaptation of the PHPQoL questionnaire was carried out in accordance with international guidelines. Psychometric properties of the tool, namely, its reliability, validity and sensitivity were tested in the focus group of patients with PHPTResults: In the whole, 65 patients with PHPT were involved into the study (mean age - 52.3 ± 10.5 years, 97% - -women): 67.7% patients were symptomatic, 35.4% patients had moderate or severe hypercalcemia. All the patients filled out the Russian version of PHPQoL before parathyroidectomy. One third of patients filled out the Russian version of PHPQoL twice - before surgery and 3 months after surgery. Satisfactory external and content validity of the Russian version of PHPQoL was demonstrated. Its stable structure confirmed satisfactory construct validity of the questionnaire. The ability of the tool to determine differences in severity of symptoms/problems due to PHPT before and after treatment was revealed. The positive effect of the surgery on QoL in PHPT patients was shown. CONCLUSION: The results obtained during the study confirm that the Russian version of PHPQoL is a reliable, valid and sensitive tool. Feasibility and applicability of its use in research and clinical practice in Russian endocrinology settings has been demonstrated.

[Efficiency of using gelofusine and voluven in acute normovolemic hemodilution during cardiosurgical interventions].

The aim of the study was to assess the use of gelofusine and voluven for acute normovolemic hemodilution at cardiac surgery under extracorporeal circulation (EC). Sixty-seven patients with coronary heart disease were examined. Heart rate, total peripheral vascular resistance, pulmonary pressure, pulmonary artery wedge pressure, oxygen delivery and consumption, central venous pressure, arteriovenous oxygen difference, oncotic pressure, and postoperative clinical course were studied. No significant group differences were found in indices, other than arteriovenous oxygen difference, after acute normovolemic hemodilution and in central venous pressure following 6 hours of EC termination. The administration of gelofusine caused a more steady-state oxygen-transport function of the circulatory system. The use of the agent for acute normovolemic hemodilution at cardiac surgery under EC is more economically justified than that of volumen.

[Partial arthrodeses of the wrist: experimental studies]. / Arthrodèses partielles du poignet: études expérimentales.

The partial arthrodeses of the wrist joint are well known as a method of treatment of several articular pathologies. Although there exists controversies about the final range of motions. In the goal to compare the state of the ligaments to the final range of motions we realised some of the most popular intracarpal arthrodeses in an anatomical laboratory. For our study we used 10 fresh cadaver specimens with the mean age of 88 years (84-95). The arthrodeses were realised with Kirschner wires. Biggest range of motion (more than 70%) was obtained after scapho-lunatum, scapho-capitatum and luno-triquetrum arthrodeses, while after luno-capitatum, scapho-luno-capitatum and triquetro-hamato-luno-caitatum it was the poorest--less than 50% of the initial state. We found a correlation between the state of the ligaments and the final results--in specimens with tears of the ligaments the results were closer to the perfect-ones from the clinical series. In our opinion the measurement of radial and ulnar deviation in clinical practice is not exact and should not be considered in the elaboration of scientific databases.

[The functional activity of mononuclear phagocytes and nonspecific antiviral cellular resistance in acute bronchitis and pneumonia]. / Funktsional'naia aktivnost' mononuklearnykh fagotsitov i nespetsificheskaia protivovirusnaia kletochnaia rezistentnost' pri ostrom bronkhite i pnevmonii.

Functional activity of mononuclear phagocytes and antiviral cellular resistance have been examined in 75 patients with acute bronchitis, 159 pneumonia patients and 46 healthy males as shown by intracellular viremia in monocytes and lymphocytes. Progression of acute bronchitis and pneumonia conformed to inhibition of phagocytosis in mononuclear phagocytes, growing percentage of virus-affected monocytes and lymphocytes.

[Characteristics of arrhythmia and late ventricular potentials in patients with cardiological syndrome X]. / Kharakteristika narushenii serdechnogo ritma i pozdnie potentsialy zheludochkov u bol'nykh s kardiologicheskim sindromom X.

AIM: A comparative study of late ventricular potentials (LVP) in patients with cardiological syndrome X (SX) and stenotic atherosclerosis of coronary arteries (ACA) as well as their relations with arrhythmia, cardiac contractility, lipid metabolism and morphological characteristics of the myocardium. MATERIAL AND METHODS: The examination of 52 SX and 77 ACA patients as well as 17 healthy subjects included coronaroventriculography, bicycle exercise, 24-h ECG monitoring, echocardiography, signal-averaged high-resolution (SAHR) ECG, investigation of blood lipoproteins. Endomyocardial biopsy was made in 5 ACA and 5 SX patients. RESULTS: No differences were registered between SX and ACA patients by frequency and severity of arrhythmic episodes, percentage of patients with registered LVP, quantitative parameters of SAHR ECG. Frequency of high-gradation ventricular arrhythmia episodes was significantly higher in SX and ACA patients with LVP than such patients free of LVP. SX patients had correlation between parameters of SAHR ECG, myocardial contractility and lipid metabolism. Foci of diffuse cardiosclerosis are most probable anatomic substrate of LVP. CONCLUSION: The risk of prognostically unfavourable high-gradation ventricular arrhythmia episodes in SX and ACA patients is the same. LVP may predict severe ventricular arrhythmia episodes both in SX and ACA patients.

[Tissue reactions to biodegradable suture materials from polyoxyalkanoates]. / Reaktsiia tkanei na biodegradiruemye shovnye niti iz polioksialkanoatov.

The paper presents data on the materials, methods, and results of a study of tissue responses in the postoperative period to implanted suture threads made of the polymer fatty acid derivatives (polyoxyalkanoates). These suture threads have been shown to have the required strength and meet a number of other requirements for currently available materials.

[The spread of the principal socially important parasitic disease on the territory of the Chukot Autonomous Okrug (ChAO)]. / O rasprostranenii osnovnykh sotsial'no znachimykh parazitarnykh boleznei na territorii Chukotskogo Avtonomnogo Okruga (ChAO).

The paper provides the examination findings of helminthiases in the population of the town of Anadyr, the settlements of Kanchalan, Krasneno, and in the reindeer-breeding teams of the Anadyr District, CAD. The children infected with enterobiasis were shown to amount to 15.1 to 22.9%, diphyllobothriasis was detected in 12.9 - 33.7% of the examinees. Single cases of ascariasis were revealed. Analysis of 232 cases with echinococcosis demonstrates that the infection is prevalent over the whole Chukotka territory. Infection with Echinococcus multilocularis is more common in the indigenous population in the north-east of the District and that with Echinococcus granulosus in the central and northern regions. High extensive and intensive parasitic contamination rates of environmental objects, such as soil, sewage, household appliances, fish, etc., were noted, indicating a constant risk for Chukotka population's infection with parasites.

Tissue response to the implantation of biodegradable polyhydroxyalkanoate sutures.

Polyhydroxyalkanoate (PHA) sutures were implanted to test animals intramuscularly, and tissue reaction was investigated and compared with the reaction to silk and catgut. Tested monofilament sutures made of PHAs of two types--polyhydroxybutyrate (PHB) and a copolymer of hydroxybutyrate and hydroxyvalerate (PHV)--featured the strength necessary for the healing of muscle-fascial wounds. The reaction of tissues to polymeric implants was similar to their reaction to silk and was less pronounced than the reaction to catgut; it was expressed in a transient post-traumatic inflammation (up to four weeks) and the formation of a fibrous capsule less than 200 microm thick, which became as thin as 40-60 microm after 16 weeks, in the course of reverse development. Macrophages and foreign-body giant cells with a high activity of acid phosphatase were actively involved in this process. PHB and PHB/PHV sutures implanted intramuscularly for an extended period (up to one year) did not cause any acute vascular reaction at the site of implantation or any adverse events, such as suppurative inflammation, necrosis, calcification of the fibrous capsule or malignant tumor formation. No statistically significant differences were revealed in the tissue response to polymer sutures of the two types. Capsules around silk and catgut sutures did not become significantly thinner.