[Disability due to arterial hypertension and alimentary factors, determining cardiovascular risk].

The problem of disability is associated with the problem of socially significant diseases, the main feature and at the same time the key characteristic of which is mass character. The epidemic nature of the spread and the medical and social burden of arterial hypertension (AH) leads to the assignment of this pathology to the number of socially significant diseases. The aim of the study was to analyze primary disability due to AH in Moscow and clinical and pathogenetic parallels between the level of arterial pressure and alimentary factors determining cardiovascular risk (CVR). Material and methods. The object of study was the data on the primary disability of the population of Moscow during the period 2011-2017 according to the form of state statistical observation #7-sobes and data of the Ministry of Health of Russia. The study was retrospective. The subject of a selective study was an analysis of the nosological spectrum of causes of disability, the nature of functional impairment and the degree of disability of elderly people who underwent inpatient treatment at the hospital for war veterans of the Rostov region in 2018-2019. The analysis of the spectrum of factors that determine the CVR. Results and discussion. The total number of newly recognized disabled (NRD) due to hypertension amounted to 11,069 people. The growth of the share of NRD of young age (6.8-11.7%), a decrease in the proportion of NRD of middle age (45.3-41.7%) and elderly in 2015-2016 (39.1-39.9%), but the growth of this indicator in this contingent in 2017 to 46.6% were noted. The proportion of NRD group III increased (to 69.1%), NRD group II decreased (to 20.3%) with a negative trend of growth in the proportion of VPI of the most severe group I. Selective survey data among people with disabilities undergoing inpatient treatment at the hospital for war veterans of the Rostov Region (2018-2019) indicated that they had a wide range of factors determining the CVR. Conclusion. The persistence of patients with hypertension triggers, supporting its further progression, is the cause of the low effectiveness of therapy and exacerbates the prognosis. It is advisable to have a unified approach to improving the efficiency of dietary use at the stages of complex treatment, prophylactic and rehabilitation programs with the goal of primary and secondary prevention of hypertension and disability due to this socially significant pathology.

Landmarks of the normal adult human trochlea based on axial MRI measurements: a cross-sectional study.

PURPOSE: For deepening trochleoplasty, a procedure used worldwide to correct trochlear dysplasia, only few surgical steps are described precisely. Important surgical landmarks, such as optimal cartilaginous trochlear depth and percentages of the new lateral and medial facet, remain unanswered. METHODS: A cross-sectional study (January 2011-August 2012) was carried out in adult patients (16-35 years) without trochlear dysplasia, who underwent magnetic resonance imaging (MRI). The main outcome was trochlear depth. The secondary outcome was the lateral/medial facet ratio. Measurements were made on the first axial cut from proximal with complete cartilage coverage of the trochlea. Differences between men and women were assessed. RESULTS: Fifty-three patients (70% men) were included. Mean age was 24.6 years (SD±5.5). Overall mean trochlear depth was found to be as 4.0 mm (95% CI 3.6-4.3). Values differed significantly by gender (p=0.0271) with a mean of 3.4 mm (95% CI 3.0-3.8) for women and a mean of 4.2 mm (95% CI 3.8-4.7) for men. The mean ratio between the lateral and medial facet was 1.71 (95% CI 1.62-1.80), the lateral facet contributing 62.6% (95% CI 61.3-63.8) and the medial facet contributing 37.4% (95% CI 36.2-38.7) to the total cartilage length. For the facet ratio, there was no statistically significant gender difference (n.s.). CONCLUSIONS: This study provides data on important landmarks for deepening trochleoplasty based on average MRI measurements in the general population. The difference between the MRI measurement and actual cartilage surface measurement is likely to be minimal, but is yet to be evaluated. Further evaluation of these landmarks by prospectively performing deepening trochleoplasty will determine the value of the clinical implication. LEVEL OF EVIDENCE: II.

[Neurosyphilis in clinical practice].

Presented is the description of the 41-year-old patient who was delivered to the emergency department of the clinical hospital. The patient has clinical manifestations of the stroke. Intracerebral hematoma of the right cerebral hemisphere was diagnosed on clinical examination. Serosurrey was positive for syphilis. Due to the suspected neurosyphilis, the central laboratory performed additional examination.

Tibial implant mineralization in rats is inversely related to serum osteogenic capacity.

In this study, the correlation between the mineralization of healing bone defects and the osteogenic capacity of the serum was tested in rats. The purpose of the study was to test the hypothesis that during callus formation, some serum factors are consumed. The bone defects in the tibia contained two different implant types, and all sustained juxta-implant fractures. One implant type was the coral Porites and the other was its recrystallized version (Interpore-200), which exhibit different mineralization rates during fracture healing. Use of these two implant types permitted generation of an expanded mineralization spectrum suitable for regression analysis. Mineralization was assessed by measuring the mineral content change (MCC) using dual-energy X-ray absorptiometry. Osteogenic capacity of sera of the implanted rats was assessed by its ability to increase specific alkaline phosphatase (ALP) activity in stromal cell cultures. The MCC was followed for 5 weeks in the Porites and Interpore-200 implants, and it was found that the MCC in Interpore-200 implants exceeded that of the Porites implants. Thus, the two implant types generated a wide mineralization spectrum. Induction of ALP in stromal cell culture was lower for sera derived from rats implanted with Interpore-200 than for sera derived from rats implanted with Porites. Two weeks after implantation, the change in serum ALP induction correlated inversely with the MCC of bone defects. This indicates that during callus formation, the mineralization rate is reciprocally related to the serum osteogenic capacity. The decreased serum osteogenic capacity may be interpreted by the hypothesis that callus formation consumes certain serum osteogenic factors.

Protease-elicited TUNEL positivity of non-apoptotic fixed cells.

The appearance of free DNA ends in the chromatin is usually considered an indication of advanced apoptosis. Unexpectedly, the nuclei of non-apoptotic cells derived from mouse thymuses could be specifically labeled by terminal transferase after proteinase K treatment of the fixed, cytocentrifuged samples. Artifactual mechanical or contaminating nucleolytic factors have been ruled out as players in the generation of free DNA ends. The phenomenon was detected in both formaldehyde- and ethanol-fixed specimens, in agarose-embedded fixed cells, and in chromatin spreads. By urea-agarose gel electrophoresis, the average single-strand size of the DNA molecules carrying the free ends was found between 50 and 250 kb. We suggest that ss discontinuities preexisting in the fixed normal cells are unmasked by protease treatment eliciting TUNEL (terminal transferase-mediated nick end-labeling) positivity.

Comparison of the anti-Ro/SSA autoantibody profile between patients with primary and secondary Sjögren's syndrome.

OBJECTIVE: To measure serum levels of anti-Ro52-kD/SSA, anti-Ro60-kD/SSA and anti-La/SSB autoantibodies in patients with primary and secondary Sjögren's syndrome. To examine if there is any connection between the disease and the subtype-spectrum of these antibodies. METHODS: We measured serum levels of anti-Ro52-kD/SSA, anti-Ro60-kD/SSA and anti-La/SSB autoantibodies by ELISA, in the sera of patients with primary Sjögren's syndrome with or without extraglandular manifestations and with or without anti-La/SSB positivity and of patients with systemic lupus erythematosus/Sjögren's syndrome overlapping disease with or without anti-La/SSB positivity. RESULTS: Differences of the distribution of the anti-Ro52-kD/SSA and the anti-Ro60-kD/SSA were found between the primary and secondary Sjögren's syndrome patients' groups; when Sjögren's syndrome is accompanied by systemic lupus erythematosus, the occurrence of anti-Ro60-kD/SSA autoantibodies is significantly higher than in primary Sjögren'syndrome. CONCLUSION: Our results suggest that there is a possible connection between the distribution of the subtypes of the anti-Ro/SSA autoantibodies and the disease type in primary/secondary Sjögren's syndrome.

Myelofibrosis in systemic lupus erythematosus.

In this study we present a case of coexisting systemic lupus erythematosus (SLE) and myelofibrosis. Literature review supports the fact that the two diseases rarely occur together in the same patient. The young female patient studied was admitted with pancytopenia and a clinical picture which met the criteria of SLE. Histological examination of the bone marrow biopsy revealed severe myelofibrosis with hypocellularity of the myeloid cell lines. Treatment with immunosuppressive and colony stimulating factor led to slow but complete regeneration of the bone marrow and subsequently to an improved haematological status, and the patient was spared bone marrow transplantation.

Anti-endothelial cell antibodies in mixed connective tissue disease: frequency and association with clinical symptoms.

OBJECTIVE: Anti-endothelial cell antibodies (AECA) have been described in a number of systemic autoimmune-inflammatory diseases. However, little is known about the relationship of AECA with mixed connective tissue disease (MCTD). METHODS: Using an ELISA, the presence of AECA was evaluated in the sera of 33 patients with MCTD and of 30 healthy subjects as controls. Serum levels of AECA were correlated with clinical activity, as well as the existence of various organ manifestations. RESULTS: Significantly increased AECA production was observed in MCTD patients (OD = 0.337+/-0.193) compared to controls (OD = 0.136+/-0.065). In addition, patients with active MCTD exerted significantly elevated serum AECA levels (OD = 0.487+/-0.090) than did patients with inactive MCTD (OD = 0.135+/-0.040) or controls. MCTD patients with pulmonary hypertension had a tendency of increased serum AECA levels (OD = 0.452+/-0.080) compared to patients without this manifestation (OD = 0.307+/-0.039). Sera of MCTD patients with AECA concentrations higher or lower than the mean serum AECA level in controls+2SD (OD = 0.266) were considered as AECAhigh (n = 19/33) and AECAlow (n = 14/33), respectively. Interestingly, all patients with active disease had AECAhigh, while all inactive MCTD patients had AECAlow sera. IgG purified from ten MCTD sera (OD = 0.415+/-0.290) showed a tendency to up-regulate E-selectin expression on cultured human umbilical vein endothelial cells (HUVEC) compared to IgG from control sera. In addition, AECAhigh MCTD sera exerted significantly increased stimulatory effect on endothelial E-selectin expression (OD = 0.651+/-0.190) compared to AECAlow (OD = 0.178+/-0.110) or control sera (OD = 0. 131+/-0.080). CONCLUSION: AECA may activate endothelial cells by the up-regulation of E-selectin expression and thus may be implicated in the pathogenesis of MCTD. Furthermore, serum AECA may be a useful marker of endothelial activation and clinical activity in this disease.

Retrospective evaluation of 5-fluorouracil-interferon-a aTreatment of advanced colorectal cancer patients.

The authors describe the retrospective analysis of treatment by 5-fluorouracil and interferon-a aof 34 patients with advanced colorectal cancer. An average of 4.6 treatment cycles (3 12) was applied. Complete remission was not observed; partial remission was observed in 8 patients; in 13 patients no change occurred and progression was detected in 14 cases. Remission rate was 22.8%, mean response time was 5.2 (3 12) months, mean progress-free survival 5.6 (0 22) months. Mean survival from the start of treatment was 11.9 (1 42) months and from the establishment of the diagnosis 26.1 (3 60) months. Severe life-threatening side-effects did not occur; other side-effects such as fever, nausea, diarrhea, leucopenia, and anemia responded to drugs. Treatment by 5-FU and interferon, in accordance with other authors findings, improved survival and well-being of patients but no breakthrough has been achieved.

Fatal mediastinitis after routine laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is now considered a routine operation with a low complication rate. In this case study, the authors present a laparoscopic cholecystectomy patient who died of masked mediastinitis and concomitant septicemia caused by an unrecognized esophageal perforation after difficult intubation. The authors call attention to the need for early detection of perforating mediastinitis to prevent a lethal outcome from this infrequent but life-threatening condition.

Natural history of individuals with asymptomatic disc abnormalities in magnetic resonance imaging: predictors of low back pain-related medical consultation and work incapacity.

STUDY DESIGN: Prospective study on individuals with asymptomatic lumbar disc abnormalities detected in magnetic resonance imaging. OBJECTIVES: To determine the natural history of asymptomatic disc abnormalities in magnetic resonance imaging and to identify predictors of future low back pain-related medical consultation and work incapacity. SUMMARY OF BACKGROUND DATA: The natural history of individuals with asymptomatic disc herniations has not been well established, but the high rate of lumbar disc alterations recently detected in asymptomatic individuals by magnetic resonance imaging demands reconsideration of a pathomorphology-based explanation of low back pain and sciatica. METHODS: Forty-six asymptomatic individuals who had a high rate of disc herniations (73%) were observed for an average of 5 years (range, 54-72 months). Four classes of variables (medical data including magnetic resonance imaging-identified disc abnormalities, general psychological factors, physical job characteristics, and psychosocial aspects of work) were assessed at baseline and follow-up. RESULTS: Disc herniations and neural compromise did not significantly worsen at follow-up, whereas disc degeneration progressed in 17 individuals (41.5%). Minor episodes of low back pain occurred in 19 individuals (41.3%), 6 of whom had to seek medical treatment and 5 of whom had to stop work temporarily. The requirement for low back pain-related medical consultation was predicted with high accuracy by listlessness, job satisfaction, and working in shifts (P < 0.001). Work incapacity was best predicted by physical job characteristics, job disaffection, and working in shifts (P < 0.01). CONCLUSION: Physical job characteristics and psychological aspects of work were more powerful than magnetic resonance imaging-identified disc abnormalities in predicting the need for low back pain-related medical consultation and the resultant work incapacity. However,the conclusions are still preliminary, and replication of the findings in larger and more representative study samples is needed.

Diagnostic value of AgNOR method in thyroid cytopathology: correlation with morphometric measurements.

A silver staining technique was applied to 51 thyroid smears. The numbers of silver-stained nucleolar organizer regions (AgNORs) were counted, and the mean AgNOR and nuclear area per cell were determined with an image analyzer. The mean AgNOR count per cell was significantly higher in malignant than in benign lesions, but there was a considerable overlap. The mean AgNOR area and the mean SD of the AgNOR area per cell were significantly higher in carcinomas than in benign lesions (P = 10-9 and P = 5 x 10-10, respectively) and there were only two and one benign cases, respectively, of overlap. A strong correlation was observed between the mean AgNOR area and the mean nuclear area (r = 0.88), the former being a better discriminator between benign and malignant lesions. The AgNOR technique may contribute to routine thyroid cytopathology.

The response of growing turkeys to dietary nutrient density.

The response to diets of different nutrient densities was evaluated in male turkeys. In 2-week experiments with 1-week-old and 14-week-old turkeys the growth response to nutrient density appeared to be biphasic with an accelerated response at the lower and a much smaller response at the upper range of nutrient density. Results suggest that the upper limit of nutrient density for obtaining the accelerated growth response was higher for older (14-week-old) than for younger (1-week-old) birds. In two additional experiments, the growth response at the upper energy range was estimated at 1 to 2% per 100 kcal. In 14-week-old turkeys, abdominal fat did not change with nutrient density.

Differential responses to dietary carbohydrates and fat of turkeys kept at various environmental temperatures.

Interactions between environmental temperature and dietary energy sources were evaluated in 6 to 9-wk and 9 to 12-wk-old turkeys using weight gain, feed efficiency, and carcass fat as response criteria. The dietary variables (soybean oil or glucose) were added in five or six increments at the expense of each other or of the fiber supplements, keeping the minima for protein and amino acid/energy constant. The resulting diets were fed to birds kept at 10 and 27 C. Duplicate experiments were conducted for each mode of dietary variable addition. Parallel increases in body weight gain and feed efficiency were obtained at the two temperatures when fat replaced carbohydrates or fiber, thereby raising dietary energy density. Some responses of weight gain and feed efficiency at the two temperatures were obtained also with a graded isocaloric addition of fat but the response was significant only at 27 C and not at 10 C. A greater response of gain and feed efficiency to energy supplied by dietary glucose was obtained at 10 C as compared with 27 C. Dietary fat supplementation resulted in increased deposition of carcass fat when given together with energy or isocalorically regardless of environmental temperature. Carcass fat was increased by glucose-energy at the low temperature only.

Laparoscopic removal of a mesenteric cyst together with the calculous gallbladder: a case report.

The incidence of mesenteric cysts is relatively uncommon. Sprague" examined its frequency and noted that five large hospitals located in the LosnAngeles area averaged one documented case of mesenteric cyst per 100,000 hospital admissions. The most common location appears to be the mesentery of the small bowel, especially that of the ileum. Cysts of the mesentery of the large bowel are somewhat less fre- quent, accounting for approximately 38% of the total incidence. Those involving the large bowel most commonly involve the mesentery of the sigmoid colon.

Laparoscopic resection of a bleeding meckel s diverticulum: a case report and review of the literature.

The preoperative diagnosis of Meckel's diverticulum in adults is uncommon, and even more infrequent is the presentation of a bleeding Meckel's diverticulum after childhood. The case of a 22-year old, otherwise healthy male is presented here. The diagnosis was made by barium examination of small bowel and confirmed by diagnostic laparoscopy, followed by complete laparoscopic resection using an Endo-GIA Stapler (United States Surgical Corp., Norwalk, Conn.]. Histopathological examination of the specimen showed inflammed ileal mucosa with hemorrhages in several foci. The literature of Meckel's diverticula and its complications are reviewed here. Based on data from the reviewed literature and our own experience, we suggest that laparoscopic resection is the treatment of choice for Meckel's diverticulum, if it is diagnosed preoperatively or during diagnostic laparoscopy. The procedure allows for a smooth postoperative course, early discharge from the hospital, and arapid return to normal activity.

A new operating room concept for minimal invasive surgery.

Since 1990 new developments have found their way into almost every area of minimally invasive surgery (MIS), and nowadays, 90% of all gynecological operations and 80% of all abdominal operations can be performed by this approach. In contrast to surgical development, operating room (OR) design has not progressed much over the past half century. While a number of surgical suites have been designed for specific specialties, more commonplace is the flexible OR concept.

[Important cause for reoperations of the common bile duct: papillary stenosis]. / Eine wichtige Ursache der Reinterventionen an den Gallenwegen: Die Papillenstenose.

The authors have surveyed 94 cases of stenosis of Vater's papilla diagnosed in 270 late reoperations. In their opinion in more than one third of the cases stenosis of Vater's papilla persisted even at the time of the first surgical interference, only it was not diagnosed and adequately solved. They are convinced that by the routine use of radiomanometry, in addition to intraoperative close circuit TV monitoring, by the correct interpretation of the data and adequate surgery, the number of late reoperations after surgery of the biliary tract can be considerably decreased. The procedure has been in use at the author's clinic since 1961.

[Sjögren's syndrome and multiple myeloma]. / Sjögren-szindróma és myeloma multiplex.

In our recent work we present two cases of coexisting Sjögren's syndrome and myeloma multiplex. Our results obtained studying a high number of patients suggest that the occurrence of myeloma in Sjögren's syndrome is much higher than in normal population. This can possibly be explained by the common pathogenetical factors of the two diseases. The survival of one of our two patients in 4 years, and her disease is still in complete remission. The possible explanation of the therapeutical success can be the rather aggressive chemotherapeutical approach in her case. Perhaps the prognosis of myeloma coexisting with Sjögren's syndrome is different that of pure myeloma, it is suggested that the earliest possible aggressive therapy of myeloma accompanied by Sjögren's syndrome can be useful and recommendable.

[Anaplastic transformation of papillary carcinoma of the thyroid]. / Papillaris pajzsmirigyrák anaplasticus transformatiója.

Anaplastic transformation of well-differentiated carcinomas of the thyroid is not common. The authors present a case of a 61-year-old woman, on whom, 17 years earlier, a near-total thyroidectomy was performed with a unilateral selective lymphatic dissection of the neck because of a papillary carcinoma of the thyroid. The operations were followed by a course of external irradiation. For 17 years the patient had no complaints, then she was treated again for recurrence of tumor in the residual thyroid tissue. By biopsy next to papillary carcinoma the authors diagnosed an anaplastic tumor with giant cells, which led to the patient's death 6 months after the operation. Surveying the data in literature they draw attention to the role of external irradiation in anaplastic transformations after the first operation.