Cerebral toxoplasmosis in HIV-infected patients over 2015-2018 (a case study of Russia).

Cerebral toxoplasmosis is a leading cause of the central nervous system disorders in acquired immune deficiency syndrome. This study aimed to investigate the clinical course of cerebral toxoplasmosis in human immunodeficiency virus (HIV)-infected individuals. The study included 90 HIV-infected patients with cerebral toxoplasmosis, who underwent inpatient treatment. In case of positive enzyme immunoassay, HIV infection was confirmed with the immunoblot test. The HIV-1 ribonucleic acid level was determined using the polymerase chain reaction method. The flow cytometry was used for counting CD4 (cluster of differentiation 4 cells). Pathomorphological examination included the autopsy, gross and microscopic examination of internal organs, histological and other methods. The incidence of cerebral toxoplasmosis significantly increases at the CD4 count below 100 cells/µl, P < 0.001, and at the HIV viral load above 50 copies/ml, P < 0.05. The clinical picture of cerebral toxoplasmosis included focal symptoms, cognitive impairment, toxic syndrome, mild cerebral symptoms and a meningeal symptom. Given the absence of a specific clinical picture and the absence of abnormal laboratory and instrumental findings, the cerebral toxoplasmosis needs to be diagnosed with a number diagnostic methods combined: clinical examination, laboratory testing, immunological examination, molecular genetic testing and neuroradiological imaging.

[Mechanisms of cerebral damage in patients with HIV-infection].

Mechanisms of HIV transportation through blood-brain barrier, vascular plexus and interaction with cerebral cells having CD-4-receptors, CCR-5- and CXCR-4-coreceptors were studied. Cerebral damage developed through latent and acute periods also known as HIV-encephalopathy, HIV-associated neurocognitive dysfunction etc. Cerebral lesions are caused by a variety of chemical agents from pro-inflammatory cytokines to toxic HIV-proteins resulting in development of HIV-dementia through several years. Even early stage of this process revealed significant disturbances of glucose metabolism and evoked potentials EEG alterations which can serve as a marker of HIV-infection. Genetic differences of HIV in blood and spinal liquor with different drug resistance were revealed implying a new approach to therapy development.

[Possibilities of a computer tomography and 3D-reconstruction in estimation of temporomandibulare joint in patients with the secondary lowered bite].

In considerable decrease of bite height the interposition of firm and soft tissues of temporomandibulare joint (TMJ) varied, its function was broken. By means of a computer tomography we estimated width of departments of the articulate crack. The increase in back articulate space was regarded at bite correction as optimum result of treatment. Measurements were made at use of multiplanar 2D-reconstruction in sagittal projections. At performance of volume (3D) reconstruction it was noticed that in patients with atypical change of interposition of TMJ elements prospective rotation of position of a head at performance of functional tests (research performance in position of the closed mouth and at bite restoration on silicone forms) was not caught. However, in these patients clinical improvement was noted in all cases. Use of 3D-reconstruction facilitate understanding of an arrangement of heads of lower jaw in cavities of joints, including with the use of functional tests. However, to estimate the minimum degrees of rotation of position of heads of articulate shoots was not obviously possible. Also measurements of width of an articulate crack weew not absolutely representative in comparison with interpretation of multiplanar 2D-reconstruction.

[Use of the multislice spiral computed tomography in planning the treatment of patients with tumors of the biliopancreatoduodenal zone].

The authors elucidate an experience with using multislice spiral computed tomography with the method of multiphase scanning (CT-angiography) in patients with suspected tumors of organs of the biliopancreatoduodenal zone. The proposed method allows getting information on the character of the pathological process, dissemination of the tumor lesion. It helps to decide on the strategy of treatment of the patient, to plan the operative intervention and assess the results of operative treatment.

[Use of postmortem brain magnetic resonance imaging at autopsy].

The study was undertaken to define the possibilities of using postmortem MRI for examining the brain. A complex study was made to explore 21 neutral formalin-fixed gross brain specimens from patients with neurosurgical pathology. Macroscopic and target histological studies of the changed signal areas detected by MRI were performed using histochemical stains. The significance of the results obtained by MRI in vitro has been defined, which furnish considerable opportunities to use the technique for the postmortem diagnosis of various diseases, to detect macroscopically undetectable changes (perifocal changes, metastases), to make a complex of intractable diagnostic problems, and to study the histological substrate of changed MR signal areas.

[Current methods of noninvasive imaging of coronary arteries in the diagnosis of coronary atherosclerosis].

The lecture contains: presentation of possibilities of ultrasound and tomographic methods of investigation in visualization of major coronary arteries; consideration in a comparative aspect of main advantages, disadvantages and limitations of these methods in diagnostics of coronary atherosclerosis; analysis of indications for application and perspectives of their use in everyday clinical practice in patients with a diagnosis of possible or verified ischemic heart disease.

[Potentials of computed-tomography colonography with added investigations of the abdominal cavity and small pelvis in the diagnosis of diseases of the colon, assessment of dissemination of the pathological process].

The aim of the investigation was an assessment of potentials of computed-tomography colonography (CTC) in diagnosis of diseases of the colon. CTC was made in 125 patients. The investigation was performed after special preparation of the patients for purgation of the colon. The patient was in the supine and prone position. After introduction of room air in the colon the axial sections were laid from the diaphragm cupola to the pelvic floor. The obtained data were estimated and the reconstructions were fulfilled using special software. Pathological alterations or anatomical specific features of the colon were detected in 86 out of 125 cases (68.8%), in 26 of the cases (28.6%) a conclusion was made of malignant tumors in the colon according to the data of CTC. The data obtained by CTC were compared with the data of fibrocolonoscopy, rectomanoscopy, irrigoscopy and histological investigation. In most cases the coincidence of the findings was noted.

[Regional metabolic changes of supraventricular tissue in patients with relapsing-remitting and secondary-progressive multiple sclerosis]. / Regionarnye osobennosti metabolizma strukturno neizmenennogo veshchestva supraventrikuliarnykh prostranstv golovnogo mozga pri remittiruiushchem i vtorichno-progressiruiushchem tipakh techeniia rasseiannogo skleroza.

AIM: To evaluate and compare the intensity of changes in a regional meta-analysis in relapsing-remitting and secondary-progressive multiple sclerosis (RRS and SPMS). MATERIAL AND METHODS: The results of longitudinal studies of multiple sclerosis (MS) using positron emission tomography, magnetic resonance spectroscopy and diffusion tensor imaging are presented. RESULTS: In MS, metabolic changes precede the structural ones. The markers of neuronal and axonal dysfunction (a decrease in NAA/Cr ratios in the white and grey matters, without the structural changes) are recorded in the early stages. The metabolic changes in the grey matter were recorded mostly in the middle frontal gyrus and posterior cingulate cortex. With the increase of duration and severity of MS, the metabolic changes spread to the other regions of supraventricular areas. The distribution of degeneration zones is related to MS course. CONCLUSION: There is substantial evidence on the irreversible damage of neurons in the medial prefrontal cortex in SPMS that confirms the vulnerability of the frontal cingulate gyrus in MS.

[Role of cytologic and histologic examination in the diagnosis of thyroid diseases in patients exposed to radiation]. / Rol' tsitologicheskogo i gistologicheskogo issledovanii v diagnostike zabolevanii shchitovidnoi zhelezy u lits, podvergshikhsia vozdeistviiu radiatsii.

Complex cytological and ultrasound study was conducted in 300 patients with thyroid pathology exposed to 5-250 cSv. Benign goiter changes and autoimmune thyroiditis were detected in 66.2% while malignant thyroidal nodules--in 3.7%. Benign and autoimmune changes alone were in 38%. Pathomorphological features of nodular changes and autoimmune thyroiditis patterns as well as their ultrasound representations were identified.

[Functional stereotaxy with magnetic resonance tomographic guidance]. / Funktsional'naia stereotaksiia s magnitno-rezonansno-tomograficheskim navedeniem.

The paper summarizes experience with stereotactic operations by magnetic resonance imaging data by using a Russian OREOL stereotactic manipulator. It describes methods of preoperative preparation of patients by employing diagnostic magnetic resonance tomographs. A number of points of the procedure for identification and localization of deep target structures from magnetic resonance images in parkinsonism, temporal epilepsy and some mental disorders.

[Radiologic features of respiratory distress syndrome]. / Rentgenosemiotika respiratornogo distress-sindroma.

An analysis of roentgenograms of 50 patients with a respiratory distress-syndrome has shown that roentgenosemiotics of this complication discloses alterations of permeability of pulmonary and bronchial capillaries, drainage of liquid from the interstice and alveoli, hemodynamics in the microcirculation link of the lesser circulation circle. A classification of the respiratory distress-syndrome is proposed which includes 3 stages and a period of involution of the process.

[Cortical atrophy in multiple sclerosis]. / Atrofiia kory golovnogo mozga pri rasseiannom skleroze.

Objective. To identify clear patterns of the cerebral cortex atrophy in multiple sclerosis that may provide valuable information for the development of additional paraclinical methods of stages and variants of MS objectification and verification and used for assessing treatment efficacy. Material and methods. The results of morphometric data analysis of 117 patients with different variants of MS and 25 healthy volunteers are presented. The original algorithm for postprocessing MRI images was used. Age, disease duration, type of disease, FS and EDSS scores, morphometric results were the source parameters for the statistical analysis. Results. The correlation analysis showed that the total cortex volume was in inverse correlation with EDSS score, pyramidal and cerebellar dysfunction, but not with disease duration. An analysis of regional changes in 43 bilateral regions of interest (ROI) demonstrated similar results in 7 ROIs in the left (dominant) hemisphere and in 4 ROIs in the right hemisphere. ANOVA revealed atrophic changes in 20 ROIs bilaterally. Deficit of certain functional systems was accompanied by the atrophy of various functional cortex regions. ANOVA of the regional cortical atrophy in groups with varying disease severity showed the presence of significant changes in patients with moderate to severe disability. Duration and type of MS were not predictive for development of atrophy, with the exception of the precuneus bilaterally, the right paracentral lobule and right posterior cingulate gyrus. Conclusion. Regional cortical atrophy is detected in the earliest stages of the disease and increases as the disease progresses. Inconsistency of data across studies can be explained by the lack of generally accepted morphometric standards and pathogenetic heterogeneity of MS. Regional cortical atrophy may be considered as a sensitive neuroradiological biomarker for MS.

[Current possibilities of the comprehensive diagnostic assessment in the differential diagnosis of inflammation and tumors of the spine cord].

The article discusses the differential diagnosis of transverse myelitis. An algorithm for the assessment of patients was given. The authors present two clinical examples demonstrating the role of the integrated neuroradiological approach in the differential diagnosis of difficult cases.