[Comparative efficacy of various thrombolytic agents in treatment of pulmonary embolism]. / Sravnitel'naia éffektivnost' razlichnykh tromboliticheskikh preparatov v lechenii tromboémbolii legochnoi arterii.

The authors carried out a retrospective analysis of clinical efficacy of streptokinase and alteplase (actilyse®) in patients presenting with high- and intermediate-to-high risk pulmonary artery thromboembolism (PATE) who were discharged from hospital after appropriate treatment performed. Of the total number of the treated patients, we formed 2 groups comprising 20 patients each, receiving alteplase (group 1) and streptokinase (group 2). The patients were comparable by the main clinical characteristics, predisposing factors, severity of pulmonary artery thromboembolism (PATE) and duration of treatment. Efficacy of thrombolytic therapy assessed clinically and instrumentally did not differ. However, by the stratified risk and frequency of PATE relapses, the condition of patients receiving alteplase turned out to be more severe. Based on the obtained results, a conclusion was made that actilyse is a drug of choice for treatment of patients with PATE.

[Temporary tamponing of the canal while removing the great saphenous vein in elderly patients]. / Vremennoe tamponirovanie kanala pri udalenii bol'shoi podkozhnoi veny u bol'nykh pozhilogo vozrasta.

The purpose of the study was to optimize the technique of removing the trunk of the great saphenous vein (GSV) in patients over 60 years. The study included a total of eighty-five patients aged over 60 years and presenting with primary varicose veins of the lower limbs and undergoing operations performed on the superficial venous system, including all stages of classical phlebectomy - crossectomy, stripping of the GSV, removal of tributaries and ligation of incompetent perforant veins. The patients were divided into two groups: the Study Group (n=44) patients endured removal of the GSV with the use of the technique of temporal tamponing of the canal, while in Group Two patients, composing a comparison group (n=41), the GSV was removed without the use of a tampon. The groups of the patients were comparable by the main characteristics, as well as by the CEAP class and the types of the operations performed. The results of treatment were studied clinically with the use of the Venous Clinical Severity Score (VCSS). In the Study Group patients, the average VCSS score decreased from 1.52±0.11 to 0.47±0.05 (p=0.007) and in the Comparison Group from 1.21±0.11 to 0.85±0.06 (p=0.028). In the remote terms after the operation, in the Study Group patients the average VCSS score appeared to be 2 times lower than in the control group, amounting to 0.47±0.05 and 0.85±0.06, respectively (p=0.007). A conclusion was drawn that in surgical treatment of varicose veins in elderly and aged patients while removing the grate saphenous vein, it is appropriate to use the technique of temporary tamponing of the canal, which is associated with better results in the remote period as compared to the traditional stripping.

[Structural alterations of a biological prosthesis]. / Strukturnye izmeneniya biologicheskogo proteza.

The authors studied dilatation of a biological prosthesis (a specially treated xenograft made of bovine arteries) used as a femoropopliteal bypass in patients presenting with diseases of peripheral arteries. Structural alterations (ectasia) were examined in a total of 15 patients within the terms varying from 1 year to 7 years after the operation, resulting in working out a methodology of calculating structural changes of the conduit with characteristics of the composite index of dilatation of the conduit. The presence of aneurysmatically dilated portions whose dimension exceeded the initial size of the xenograft 3-4-fold did not influence the long-term patency of the shunt with preserved blood flow approximated to the major one. This made it possible to avoid a repeat surgical intervention.

The long-term survival of plasma cells.

Plasma cells sustain antibody production and hence are an essential part of immune protection. In the mucosa-associated lymphoid tissues plasma cells secrete IgA antibodies which protect the organism from invasion by pathogenic bacteria while in the bone marrow they produce the antibodies which guarantee long-term humoral immune protection. The various lymphoid organs provide specific microenvironments which support plasma cell survival. In particular, in the bone marrow, highly specialized survival niches are established by the underlying stromal reticular cells which permit plasma cells to survive for years. In some situations, however, the antibody may be detrimental to the organism. In those auto immune diseases, where plasma cells play a pathological role by producing the auto antibodies, new strategies are needed to interfere with the lifespan of plasma cells and thus to diminish their numbers. The recent finding that eosinophils are essential for the long-term survival of plasma cells in the bone marrow provides a new therapeutic target to modulate the plasma cell survival niche.

[Changes in the TNM classification of gynecological tumors]. / Anderungen der TNM-Klassifikation gynäkologischer Tumoren.

Based on the results of clinical and histomorphological studies in recent years, a revision of the TNM classification of malignant tumours of the female genital organs became necessary. Vulvar cancer saw the most significant changes. In the T1 category the new system recognises tumour size and its relation to the infiltration of adjacent structures by the tumour. The number of positive regional lymph nodes has also been included in the new staging system. For cervical cancer, there is a new subdivision of the category T2a depending on tumour size with a breakpoint of ≤ 4 cm versus > 4 cm and a subdivision into T2a1 und T2a2. In endometrial cancer, the previous pT1a and pT1b were merged to pT1a. The former category T1c has changed into T1b. The category pT1c is no longer used. For the first time, there is a TNM classification system for uterine sarcomas.

Dynamics of clinical semiotics in children with pathological tortuosity of internal carotid arteries in remote period after surgical management.

The present study enrolling a total of eighty-eight 4-to-16-year-old children and adolescents was aimed at detailed elaboration and formalization of clinical signs of the internal carotid artery pathological kinking syndrome. To achieve these objectives, the authors carried out a comparative analysis of clinical manifestations of the disease in the surgically treated subjects (constituting the Surgery Group comprising 43 children and adolescents) and non-operated patients (making up the Comparison Group consisting of 45 age- and gender-matched subjects). There were no baseline differences in the incidence rate of clinical syndromes and symptoms between the groups of the would-be operated and conservatively treated patients. Also studied were the remote outcomes (1-to-12-year follow up) of surgical correction for pathological tortuosity of the internal carotid artery. The incidence rate of regression of neurological symptomatology along different clinical signs after surgery was shown to vary within a wide range from 11.6% to 96.3%. Resection of the proximal portion of the internal carotid artery with re-implantation into the old ostium turned out to be clinically effective in 90.0% of cases, with the haemodynamic efficacy amounting to 83.3%. Arteriolysis of the internal carotid artery rendered a clinical effect in 75% of cases, with a haemodynamical effect thereof equalling 25.0%. The decision as to the type of a surgical intervention to perform was primarily made based on the findings of angiography of the internal carotid artery. The operation of arteriolysis did not lead to deterioration of the child's condition.

Increasing F2-isoprostanes in the first month after birth predicts poor respiratory and neurodevelopmental outcomes in very preterm infants.

OBJECTIVE: This study examined the association between increased early oxidative stress, measured by F2-isoprostanes (IsoPs), and respiratory morbidity at term equivalent age and neurological impairment at 12 months of corrected age (CA). STUDY DESIGN: Plasma samples were collected from 136 premature infants on days 14 and 28 after birth. All participants were infants born at ⩽28 weeks of gestational age enrolled into the Prematurity and Respiratory Outcomes Program (PROP) study. Respiratory morbidity was determined at 40 weeks of postmenstrual age (PMA) by the Respiratory Severity Index (RSI), a composite measure of oxygen and pressure support. Neurodevelopmental assessment was performed using the Developmental Assessment of Young Children (DAYC) at 12 months of CA. Multivariable logistic regression models estimated associations between IsoP change, RSI and DAYC scores. Mediation analysis was performed to determine the relationship between IsoPs and later outcomes. RESULTS: Developmental data were available for 121 patients (90% of enrolled) at 12 months. For each 50-unit increase in IsoPs, regression modeling predicted decreases in cognitive, communication and motor scores of -1.9, -1.2 and -2.4 points, respectively (P<0.001). IsoP increase was also associated with increased RSI at 40 weeks of PMA (odds ratio=1.23; P=0.01). RSI mediated 25% of the IsoP effect on DAYC motor scores (P=0.02) and had no significant impact on cognitive or communication scores. CONCLUSIONS: In the first month after birth, increases in plasma IsoPs identify preterm infants at risk for respiratory morbidity at term equivalent age and worse developmental outcomes at 12 months of CA. Poor neurodevelopment is largely independent of respiratory morbidity.

Anthropometric evaluation of the body composition of black, white, and Puerto Rican newborns.

One hundred ninety-four white, black, and Puerto Rican infants 1 to 5 days old were measured in the ward nurseries of two Philadelphia city hospitals. In addition to birth weight and length, triceps and subscapular skinfolds and upper arm circumference were obtained. Upper arm muscle circumference was calculated. Females had greater skinfold thicknesses than males but significant differences were found only for the triceps. Whites and blacks did not differ in skinfold thickness, but the Puerto Rican infants had significantly smaller triceps skinfolds. Differences in nutritional status are attributed to environmental factors.

Somatosensory evoked potential to peroneal nerve stimulation in patients with herniated lumbar discs.

The somatosensory evoked potential (SEP) to peroneal nerve stimulation was recorded from 76 patients with myelographically proven herniated lumbar disc and was compared with normative data obtained from 65 healthy subjects. All patients with disc herniation had an abnormal SEP even when examination failed to disclose sensory deficits. In the patients with distortion of a root sleeve, the SEP abnormality was confined to the involved side. When myelography demonstrated large defects in the dural sac, there was electrophysiological evidence of disturbed conduction from the asymptomatic leg also. SEP changes in postoperative examinations correlated well with improvement or worsening of the patient's condition and enabled objective evaluation of the dynamics of sensory conduction along the involved structures.

Intracranial meningiomas following low-dose irradiation to the head.

Earlier reports have suggested that low-dose ionizing irradiation might be involved in induction of intracranial meningiomas. One of the problems in evaluating irradiation-induced neoplasms is the belief that these tumors have no distinguishing features to indicate their etiology. In an attempt to identify such features in meningiomas following irradiation, a group of 42 post-irradiation meningiomas (PIM's) has been compared with a group of 84 non-PIM control meningiomas. These 42 PIM's included all the intracranial meningiomas diagnosed at the Hadassah University Hospital during the years 1952 to 1981 in individuals treated in childhood with low-dose x-ray therapy for tinea capitis. Although the individual PIM does not seem to differ from a "spontaneous" meningioma, this study indicates that PIM's as a group have distinct characteristics, namely, their location at the site of maximal irradiation, and features suggesting rapid growth and aggressive biological behavior. There was a significantly higher number of calvarial tumors (p less than 0.001), a high proportion of multiple meningiomas, a higher recurrence rate following apparent complete excision (p less than 0.02), and an increased number of histologically malignant meningiomas (p less than 0.01). The demonstration of features that distinguish PIM's from meningiomas of other etiology supports the suggestion that low-dose ionizing irradiation was involved in the pathogenesis of these tumors.

Choroid plexus papilloma: hydrocephalus and cerebrospinal fluid dynamics.

Dynamics of the cerebrospinal fluid were measured pre- and postoperatively in a patient with a choroid plexus papilloma associated with hydrocephalus. The production rate was 0.35 ml/min, absorption 0.0057 ml/min H2O, and the critical opening pressure 196 mm H2O. Following removal of the tumor, these values were 0.32 ml/min, 0.0053 ml/min/mm H2O, and 105 mm H2O, respectively. It was concluded that no over-production of cerebrospinal fluid was present in this case. The hydrocephalus was due solely to obstruction of the fourth ventricle.

Continuous lumbar drainage of cerebrospinal fluid in neurosurgical patients.

Continuous spinal drainage of cerebrospinal fluid was used in 50 patients with CSF fistulas both traumatic and postoperative. The method seemed to be helpful in the healing of leaks, thereby rendering surgery unnecessary. It also helped the surgical sealing of long standing tears.