[Sarcoidosis--granulomatosis: the modern view of the etiology and pathogenesis with clinical cases review].

Diagnostic criteria of sarcoidosis were offered in the 60-ies of XX century, however today the problem of sarcoidosis is difficult for understanding the different specialists and early detection. The development of laboratory diagnostic of viral infections and introduction of polymerase chain reaction (PCR) has greatly improved the level of diagnosis of herpes infections, reveal the previously unknown etiology of many diseases: sarcoidosis (granulomatosis), migraine, multiple sclerosis, cystic prenatal brain damage, convulsions, Hodgkin's disease and others. Sarcoidosis is the set of clinical symptoms (fatigue, shortness of breath, coughing, heaviness in the chest), laboratory, radiological and histopathological data that allow the doctor to diagnose, predict prognosis and treatment policy. Most often, sarcoidosis affects the lungs and thoracic lymph nodes. In the last period for 2011-2013 in 2930 immunologically tested patients the sarcoidosis was confirmed in 146. Primarily these patients were exposed to different diagnosis--COPD, pneumonia, tuberculosis, lung cancer. Among patients with sarcoidosis on the first place in frequency of detection were EBV and HHV-6. We were the first in 2000, described the Epstein-Barr virus as the causative factor of sarcoidosis, and has been hypothesized the immunopathology of sarcoidosis and principles of individual immunotherapy with a resolution of the granulomatous process in 92 % of cases. Subsequently, this association has been and illustrates the relationship to other viruses (HHV-6, HHV-8) demonstrated by other authors.

THE PLACE OF CARDIAC COMPUTED TOMOGRAPHY IN PREOPERATIVE PLANNING OF EXTENDED SEPTAL MYECTOMY IN PATIENTS WITH OBSTRUCTIVE FORM OF HYPERTROPHIC CARDIOMYOMATHY. / MISTsE SERTsEVOÏ KOMP'IuTERNOÏ TOMOGRAFIÏ V PEREDOPERATsIINOMU PLANUVANNI ROZShYRENOÏ SEPTAL'NOÏ MIEKTOMIÏ U PATsIIeNTIV Z OBSTRUKTYVNOIu FORMOIu GIPERTROFIChNOÏ KARDIOMIOPATIÏ.

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiomyopathy. Extended septalmyectomy (ESM) is one of the priority methods of treatment of drug-refractory obstructive HCM. In recent years,hospital mortality during surgical correction of obstructive HCM in expert centers does not exceed 1-2 %. However,typical threatening complications of septal myectomy, such as iatrogenic ventricular septal defect (VSD) and rupture of the anterior or posterior walls of the left ventricle (LV), remain a topical issue in surgery of HCM. OBJECTIVE: to show the role of preoperative CT-planning to predict and reduce possible technical problems associated with ESM, including iatrogenic VSD. METHODS AND MATERIALS: This study includes 217 symptomatic patients with obstructive HCM, who from April 2016to October 2019 as one of the steps of preoperative planning underwent cardiac CT prior to ESM. Cardiac CT was performed to delineate the left ventricular myocardium, assess the distribution of hypertrophy and the presence ofcrypts. Special attention was also paid to the anatomy of the mitral valve (MV) and subvalvular apparatus. Coronaryartery patency was assessed by CAD-RADS, a standardized method for reporting the results of coronary CT angiography to determine tactics for further management of the patient. RESULTS AND DISCUSSION: In the study group, the average age of patients was (49 ± 15) years, 48 % - men. All patientshad a symptomatic, drug-refractory obstructive form of HCM. The mean maximum wall thickness of the interventricular septum (IVS) was (20 ± 5) mm (range 16-33). The average LV mass was (118 ± 23) g/m2. 195 patients (89.9 %)had systolic anterior motion ( SAM) of the MV. MV and subvalvular apparatus anomalies were detected in 62 patients(28.6 %). A zone of scarring and regression of IVS after alcohol septal ablation (ASA) was detected in 7 patients(0.3 %) with residual LV outflow gradient. Coronary arteries atherosclerosis was detected in 32 patients (14.7 %). CONCLUSIONS: Preoperative CT-planning of septal myectomy allows to obtain information on morphology of the LV,IVS, MV and subvalvular apparatus, and gives the surgeon the advantage to form a more accurate plan for the location and volume of septal resection, and avoid complications when correcting obstructive HCM. No iatrogenic VSDwas detected in any of the patient in the study group.

The Central European GNSS Research Network (CEGRN) dataset.

The Central European GNSS Research Network (CEGRN) collects GNSS data since 1994 from contributors which today include 42 Institutions in 33 Countries. CEGRN returns a dataset of coordinates and velocities computed according to international standards and the most recent processing procedures and recommendations. We provide a dataset of 1229 positions and velocities resulting from 3 or more repetitions of coordinate measurements of each site over 4 or more years. The velocity data result from a combination of eight multiyear, partially overlapping networks, using 234 stations of class A of the European Permanent Network (EPN) for alignment to the 'European Fixed' ETRF2000 Reference Frame. The rms (root mean square) of the 8 individual contributions to the combined solution, after a 7 - parameter Helmert transformation, is less than 5 mm in the observation period 1996-2017. This combined CEGRN network maintains the origin coincident with that of the ETRF2000 reference frame to within 1.8 mm rms for the entire period of analysis. The mean positions and velocities of common EPN Class A and CEGRN stations differ by 0.0 ± 1.1, 0.5 ± 1.0 and 0.1 ± 2.7 mm for the coordinates and 0.06 ± 0.13, -0.07 ± 0.12, 0.38 ± 0.28 mm/yr for the velocities respectively for the North, East and Up components at epoch 2010.0.

[Clinical picture and several histochemical changes in the brain in cerebral rheumovasculitis]. / Klinika i nekotorye gistokhimicheskie izmeneniia v golovnom mozge pri tserebral'nykh revmovaskulitakh.

A clinical study of 70 patients with cerebral rheumovasculitis permitted the author to distinguish 3 forms of the disease: with a diffuse, mild focal and crude focal neorological symptomatology. Their dependence upon the somatical signs is demonstrated, a successional development of nervous system lesions, treatment and its effectiveness. The histochemical studies in different brain areas in patients with crude focal neorological symptomatology demonstrated allergic, metabolic and inflammatory changes in the vascular walls, accompanied by hemodynamical changes and deep dystrophy of the neurons and nervous fibres, as well as productive reaction of the astrocytes, oligodendrocytes and microglial elements.

[Effect of complamin on the systemic and cerebral hemodynamics of atherosclerosis patients with chronic cerebral vascular disorders]. / Vliianie komplamina na sistemnuiu i tserebral'nuiu gemodinamiku u bol'nykh aterosklerozom s khronicheskim narusheniem mozgovogo krovoobrashcheniia.

Thirty-eight atherosclerotic patients with chronic disorders of the cerebral circulation (CDCC) received 300 mg of complamin by intravenous drip. The clinical signs of vasodilation were noted at 5-15 min after the initiation of infusion whereas following it the findings observed included a significant reduction in the kinetic parameters of the myocardium and globular blood volume, an elevation in the peripheral vascular resistance and tone of the cerebral hemisphere vessels, a decrease in the pulse vascular resistance and tone of the cerebral hemisphere vessels, a decrease in the pulse blood-filling of the left carotid bed and deterioration of intracerebral venous congestion. Complamin is recommended for use to improve the rheological properties of the blood and microcirculation in patients with CDCC with elevated or normal myocardial contractility. Its application should be avoided in patients with low cardiac output and heart failure, in cases of labile arterial pressure and vascular dystonia with marked pulse variations in the cerebral vessels and also when the blood return to the cerebral veins is impeded.

[Effect of cavinton on systemic and cerebral hemodynamics of patients with chronic cerebral circulatory insufficiency]. / Vliianie kavintona na sistemnuiu i tserebral'nuiu gemodinamiku u bol'nykh s khronicheskoi nedostatochnost'iu mozgovogo krovoobrashcheniia.

The effect of cavinton on the systemic (by the method of diluting Evans blue according to Stewart-Hamilton) and cerebral (by the method of rheoencephalography) hemodynamics was examined in 38 patients with chronic insufficiency of the cerebral circulation (CICC) in the presence of either atherosclerosis alone (n = 22) and its combination with arterial hypertension (n = 16). Cavinton decreased the peripheral vascular resistance and the tone of the small and median vessels of the brain, increased the cardiac output and improved the rheological properties of the blood (it lowered the globular volume, viscosity and hematocrit). The best results were attained with the parenteral administration of the drug. Indications for and contraindications to cavinton in patients with CICC are discussed.

[State of general and cerebral hemodynamics in patients with ischemic strokes]. / Sostoianie obshchei i tserebral'noi gemodinamiki u bol'nykh s ishemicheskim insul'tom.

In 64 patients with ischemic strokes that occurred on the background of atherosclerosis (33) and a combination of atherosclerosis with arterial hypertension (31) using the dilution method of Evans's blue the authors studied indices of general hemodynamics compared to rheoencephalographic data. Twenty similar patients without signs of brain circulation disturbances and 20 healthy persons were taken as control groups. In 69% of the patients with ischemic strokes deep disturbances of general hemodynamics were observed. An increase of tonus, a decrease of elasticity of cerebral vessels and deficit of pulse blood repletion were determined rheoencephalographically. Insufficiency of general hemodynamics in conditions of changed autoregulation of brain circulation promotes development of ischemic disorders of brain circulation and unfavourably influences the course and outcome of the stroke.

[Effect of calcium antagonists on cerebral and systemic hemodynamics in patients with ischemic disorders of cerebrovascular circulation]. / Vliianie antagonistov ka'ltsiia na tserebra'lnuiu i sistemnuiu gemodinamiku u bo'lnykh s ishemicheskimi narusheniiami mozgovogo krovoobrashcheniia.

Doppler ultrasound and Evans blue dilution techniques were applied to investigate the corinfar and finoptin effects on cerebral circulation in 97 patients, and on regional circulation in 40 patients with cerebral ischemia. In patients with severe ischemic brain damage, the vasodilating effect without intracerebral stealing was most pronounced. Cardiodepressant effects were negligible. The authors discuss indications and contraindications to finoptin and corinfar treatment in ischemic brain disorders.

[General hemodynamic features in the cerebral circulatory disorders of patients with atherosclerosis and atherosclerosis combined with arterial hypertension accompanied by heart rhythm disorders]. / Osobennosti obshchei gemodinamiki pri rasstroistvakh mozgovogo krovoobrashcheniia u bol'nykh aterosklerozom i aterosklerozom v sochetanii s arterial'noi gipertenziei, soprovozhdaiushchimisia narusheniem sercechnogo ritma.

Parameters of the general and cerebral hemodynamics were examined in 45 patients with cerebral circulation disturbances developed in the presence of atherosclerosis (30 patients) and atherosclerosis plus arterial hypertension with cardiac arrhythmias (15 patients) and without the latter (72 patients). The examinations were carried out with the use of the Evans blue dilution method (T-1824) and rheoencephalography. Shifts in the general and the cerebral hemodynamics were revealed in the patients with and without cardiac arrhythmias, these shifts being more pronounced in patients with atherosclerosis complicated with the heart ischemic disease and cardiac arrhythmia. In the course of complex treatment which included cardiotonics and beta-adrenoblocking agents the parameters of the general hemodynamics got better along with the clinical improvement.

[Pseudoneurotic states in patients with transient cerebral circulatory disorders]. / O nevrozopodobnykh sostoianiiakh u bol'nykh s prekhodiaschimi narusheniiami mozgovogo krovoobrashcheniia

The authors describe clinical manifestations of pseudoneurotic states and vegetative paroxysms in 78 patients with transient disturbances of brain circulation which appeared due to hypertensive disease and atherosclerosis. The special studies (EEG, REG, determination of catecholamine excretion) showed that pseudoneurotic states and paroxysmal vegetative disturbances depend on the state of brain circulation and functional activity of the sympathetico-adrenal system. The authors attempt to differentiate pseudoneurotic and paroxysmal vegetative disorders in transient disturbances of brain circulation from neuroses and initial dysfunction of the vegetative structures.

[The functional state of the sympathetic-adrenal system and blood coagulation in transitory cerebral circulatory disorders]. / Funktsional'noe sostoianie simpatiko-adrenalovoi sistemy i gemokoaguliatsii pri tranzitornykh narusheniiakh mozgovogo krovoobrashcheniia

The authors studied adrenalin and noradrenalin excretion with the diurnal urine and the state of hemocoagulation in 63 patients with transient disturbances of the brain circulation. A reliable increase of adrenalin excretion, a decrease of noradrenalin and an expressed activation of hemocoagulation were established. The extent of the functional state changes of the sympathetico-adrenal system varied according to etiology of brain circulation disturbances. A close relationship between indices of the sympathetico-adrenal system and the hemocoagulation process was found.

[State of systemic and cerebral hemodynamics in patients with transient cerebral circulatory disorders]. / Sostoianie obshchei i tserebral'noi gemodinamiki u bol'nykh s prekhodiashchimi narusheniiami mozgovogo krovoobrashcheniia.

In 50 patients with transient disorders of cerebral circulation due to hypertensive disease (27 cases), and combinations of hypertensive disease with atherosclerosis (23 cases) the authors by means of diluting Ewans blue stain (T-1824) studied the indices of general hemodynamics compared to that of REG data . For control purposes 10 patients with hypertensive disease in concomitance with atherosclerosis without transient disorders of cerebral circulation and 20 normals were studied. The study permitted to detect signs of disturbed general and cerebral hemodynamics which were most expressed in patients with severe cerebro-vascular crises, accompanied by a drop in the cardiac and pulse index, an increase of the general and specific peripheral resistance, a slowing of the blood flow rate on the segment hand-ear, an increase of the tone and drop of elasticity in the cerebral vessels, a decrease of cerebral blood repletion. Insufficiency of general hemodynamics leads to disorders of cerebral hemodynamics and unfavourably influences the development of the disease and the outcome of cerebrovascular crises.

[Effect of cavinton and sulfocamphocain on systemic and cerebral hemodynamics in patients with early forms of cerebrovascular diseases]. / Vliianie kavintona i sul'fokamfokaina na sistemnuiu i tserebral'nuiu gemodinamiku bol'nykh s rannimi formami sosudistykh zabolevanii golovnogo mozga.

In a study involving 33 patients with initial manifestations of inadequate cerebral blood supply and in 22 patients with transient disorders of the cerebral circulation in the presence of atherosclerosis (n = 45) and atherosclerosis with arterial hypertension (n = 8) the authors studied the effect of intravenous administration of cavinton in combination with sulfocamphocain on the clinical manifestations and on the systemic (using the method of Evans' dilution) and cerebral (using Doppler ultrasonography) hemodynamics. It has been demonstrated that both a single intravenous administration of cavinton in conjunction with sulfocamphocain and a course of treatment with these drugs reduce the volume of the circulating blood, lower the stroke and cardiac indices, increase the linear velocity of blood flow along the carotid and vertebral arteries, and decrease neurological symptomatology. The authors discuss the questions related to indications for the administration of cavinton in combination with sulfocamphocain to patients with inadequate cerebral blood supply and transient disorders of the cerebral circulation.

[Changes in systemic and cerebral hemodynamics in patients with chronic cerebral circulatory insufficiency of atherosclerotic origin]. / Izmeneniia sistemnoi i tserebral'noi gemodinamiki u bol'nykh s khronicheskoi nedostatochnost'iu mozgovogo krovoobrashcheniia ateroskleroticheskogo proiskhozhdeniia.

Fifty atherosclerotic patients with chronic disorders of the cerebral blood circulation (CDCBC) were involved in this study of both systemic hemodynamics (by diluting Evans blue) and rheoencephalographic parameters of the cerebral circulation with regard to the stage of the CDCBC. Compensated vascular-cerebral insufficiency was associated with a significant rise in the arterial pressure, acceleration of the blood flow in the hand-ear region and with an increase in the heart rate. Visual and amplitude-frequency characteristics of REGs in a compensatory stage of the CDCBC deepened only slightly; in a remitting stage they deepened significantly in the left carotid and vertebral-basal basins; in a subcompensated stage, in both basins bilaterally; and in a decompensated stage, predominantly in the carotid basin.

[Vasoactive and cardiotonic drugs in the treatment of initial manifestations of cerebrovascular insufficiency in occlusive diseases of major blood vessels of the head]. / Lechenie vazoaktivnymi i kardiotonicheskimi sredstvami bol'nykh s nachal'nymi proiavleniiami nepolnotsennosti krovosnabzheniia mozga pri okkliuziruiushchikh porazheniiakh magistral'nykh sosudov golovy.

Patients (n = 118) with initial manifestations of brain blood supply failure induced by stenoses and occlusions of the main vessels of the head were treated by cardio- and vasoactive drugs (corglycon, strophanthin, sulfocamphocaine, euphylline, cavinton, verapamil) under control of the systemic (by Evans blue dilution according to Stewart-Hamilton) and cerebral (by rheoencephalography and ultrasound dopplerography) hemodynamics. As a result of such treatment policy, the number of cases with a complete reverse development of the symptomatology was 16.8% greater than in analogous situations where no therapy with the method proposed was carried out.

[Clinico-hemodynamic evaluation of the efficacy of vasoactive and cardiotonic agents in the combined treatment of arteriosclerosis patients with chronic cerebral circulatory insufficiency]. / Kliniko-gemodinamicheskaia otsenka éffektivnosti nekotorykh vazoaktivnykh i kardiotonicheskikh sredstv v kompleksnom lechenii bol'nykh aterosklerozom s khronicheskoi nedostatochnost'iu mozgovogo krovoobrashcheniia.

In 370 atherosclerotic patients with chronic cerebrovascular insufficiency (CCVI) the authors have investigated the cerebral (by rheoencephalography) and the systemic (by diluting Evans blue) haemodynamics before and after correcting it with papaverine, euphylline, complamin, cavinton, corglycon, strophanthin, and sulfocamphocaine. They have also specified the characteristics of the action of the drugs studied, as well as indications and contraindications for their use in chronic CCVI treatment. The given therapy optimizes the current methods of rehabilitation of patients with chronic cerebrovascular insufficiency, ensures clinical improvement in 89.5% of cases (by 18.5% more than in the control group) and reduces the period of hospitalization by an average of 3.6 days.

[Effect of finoptin on systemic and cerebral hemodynamics in patients with early cerebrovascular disorders in arteriosclerotic stenosis of major arteries of the head]. / Vliianie finoptina na sistemnuiu i tserebral'nuiu gemodinamiku u bol'nykh s rannimi tserebrovaskuliarnymi zabolevaniiami na fone ateroskleroticheskogo stenoza magistral'nykh arterii golovy.

Blood Evans Blue dilution and ultrasound Doppler cardiography were used to examine systemic and cerebral hemodynamic changes after a single intravenous administration of finoptin (5 mg) and its course treatment (a daily dose of 120-240 mg) in 30 patients with initial signs of cerebrovascular insufficiency and 30 patients with transient cerebrovascular disorders in the presence of atherosclerotic stenoses of the cephalic great arteries. Finoptin was found to increase the linear velocity of blood flow mainly in stenotic arteries, without causing intracerebral steal. The agent also exerted a clear-cut cardiodepressive action which was levelled off by its vasodilating effect by the end of its course therapy.

[Treatment of patients with transient disorders of cerebral circulation in occlusive diseases of major blood vessels of the head using vasoactive and cardiotonic drugs]. / Lechenie vazoaktivnymi i kardiotonicheskimi sredstvami bol'nykh s prekhodiashchimi narusheniiami mozgovogo krovoobrashcheniia pri okkliuziruiushchikh porazheniiakh magistral'nykh sosudov golovy.

Transient circulatory disorders of the brain arising in response to stenosis and occlusion of the major head arteries in 111 patients were treated with cardiotonic and vasoactive drugs (corglycon, strophanthin, sulfocamphocain, euphylline++, cavinton, finoptin). The treatment was controlled by monitoring systemic and cerebral hemodynamic parameters. An appreciable clinical response was achieved in more patients (by 16.3%) than it was usually the case in thus untreated patients.

[The effect of nicergoline on the systemic and cerebral hemodynamics of patients with circulatory encephalopathy and an atherosclerotic lesion of the major cerebral arteries]. / Vliianie nitsergolina na sistemnuiu i tserebral'nuiu gemodinamiku u bol'nykh s distsirkuliatornoi éntsefalopatiei na fone ateroskleroticheskogo porazheniia magistral'nykh arterii golovy

The Evans blue dilution method and ultrasound dopplerography were used to study the effect of nicergolin on the systemic and cerebral hemodynamics in 31 patients with dyscirculatory encephalopathy against the background of atherosclerotic lesions of the major head arteries. It was established that nicergolin reduces the arterial pressure, diminishes the minute blood volume, cardiac and stroke indices, increases the specific peripheral vascular resistance, the linear blood flow velocity prevailingly in the stenosed major head arteries, results in a regression of the subjective and objective neurological symptomatology. Considering the cardiodepressive effect of nicergolin, this agent is indicated in patients with the hyperkinetic type of the systemic hemodynamics.

[The effect of diltiazem on systemic and cerebral hemodynamics and on the blood rheological properties in patients with ischemic stroke and atherosclerotic involvement of the major cerebral arteries]. / Vplyv dyltiazemu na systemno-tserebral'nu hemodynamiku ta reolohichni vlastyvosti krovi u khvorykh na ishemichnyi insul't na foni aterosklerotychnoho urazhennia mahistral'nykh arterii holovy.

Overall thirty-five patients with ischemic insult against the background of occlusive lesions of major arteries of the head were evaluated for effects of cardil on systemic and cerebral hemodynamics and rheologic properties of blood. It has been shown that cardil increases significantly cerebral bloodflow predominantly on the side of the stenosis, does not cause intracerebral "stealing" in the acute phase of insult, improves bloodflow to the brain and collateral blood supply in the residual phase due to selectivity of its influence on cerebral vessels, lowers arterial pressure, decreases frequency of contractions, as well as cardial and stroke indices, and volume of circulating blood. The drug suppresses aggregatory properties of thrombocytes and erythrocytes during different stages of ischemic insult, and makes blood viscosity somewhat less.