Primary Data on ATTR-Amyloidosis Prevalence Among Elderly Patients With Left Ventricular Hypertrophy in Russia.

AIM: To estimate the prevalence of amyloid cardiomyopathy (CM) caused by transthyretin amyloidosis (ATTR) and immunoglobulin light chain (AL) amyloidosis among patients aged >65 years with interventricular septal (IVS) hypertrophy of ≥14 mm. MATERIAL AND METHODS: From January through August 2023, 60 patients (mean age 7.2±7.3 years, 34 (56.67%) men) were enrolled. Patients meeting the inclusion criteria underwent an echocardiographic study with determining the myocardial longitudinal strain, myocardial scintigraphy with 99mTc-pyrfotech, myocardial single-photon emission computed tomography, measurement of N-terminal fragment of brain natriuretic peptide and troponin I, and the immunochemical study of serum and urine proteins with measurement of free light chains. In the presence of grades 2 and 3 radiopharmaceutical uptake according to scintigraphy, a molecular genetic study was performed for differential diagnosis of wild-type transthyretin amyloidosis (wtATTR) and hereditary/variant (hATTR) ATTR-CM. RESULTS: According to data of myocardial scintigraphy with 99mTc-pyrfotech, grade 3 uptake in the absence of monoclonal secretion was detected in 5 (8.3%) cases and grade 2 radiotracer uptake in the absence of monoclonal secretion was detected in 6 (10%) patients. Myeloma complicated by AL amyloidosis and primary AL amyloidosis were found in 5 (8.3%) patients. CONCLUSION: Among patients aged ≥65 years with IVS hypertrophy ≥14 mm, amyloid CM was detected in 20% of cases (12 patients), including 5 cases (8.3%) of AL amyloidosis and 7 cases (11.7%) of ATTR amyloidosis.

[State of the venous outflow from the small pelvis after surgical correction of pelvioperineal reflux]. / Sostoianie venoznogo ottoka iz malogo taza posle khirurgicheskoi korrektsii pel'vio-perineal'nogo refliuksa.

OBJECTIVE: The study was aimed at assessing the venous outflow from the small pelvis after surgical correction of pelvioperineal reflux with the use of reference methods of examination. PATIENTS AND METHODS: We examines a total of 43 female patients (aged 41.5±5.2 years) presenting with pelvic varicose veins and subjected to phlebectomy on the external genitalia, perineum and lower limbs. All women had no evidence of pelvic venous plethora. All women underwent the following examinations: ultrasonographic angioscanning of pelvic and lower-limb veins, emission computed tomography of pelvic veins prior to operation, as well as 1, 6 and 12 months after surgical interventions. We evaluated efficacy of phlebectomy in elimination of pelvioperineal reflux and varicose syndrome, the frequency of detecting valvular insufficiency of pelvic and lower-limb veins, dynamics of the coefficient of pelvic congestion syndrome in the immediate and remote postoperative periods. RESULTS AND DISCUSSION: No cases of relapses of valvular, perineal varicosity, repeat appearance of varicose veins on the lower extremities, occurrence of signs of pelvic venous congestion were revealed. The frequency of detecting valvular insufficiency of the parametrial, uterine, gonadal and iliac veins remained unchanged. The coefficient of pelvic congestion syndrome did not alter either (Cpcs=0.8±0.11 at baseline versus Cpcs=0.78±0.1 after 12 months). CONCLUSION: The obtained results are indicative of a steady state of the venous outflow from the small pelvis in women with pelvic varicose veins and pelvioperineal reflux after surgical removal of vulvar, perineal and superficial femoral veins.

[The efficacy of pharmacological preconditioning in carotid endarterectomy].

OBJECTIVE: To assess the efficacy of pharmacological preconditioning with actovegin in carotid endarterectomy. MATERIAL AND METHODS: The study was based on the results of surgical treatment of 80 patients with hemodynamically significant uni- and bilateral lesions of carotid arteries. Half of the patients was operated immediately and others after pharmacological preconditioning with actovegin in dose of 1200 mg/daily during 1,5 months. RESULTS: Pharmacological preconditioning with actovegin increased the cerebral perfusion determined with one-photon emission computed tomography that improved significantly results of the surgery. There were significant changes in patient's state 7 days and 6 months after surgery. The improvement was correlated with the less number of asymptotic post-surgery ischemic strokes in different brain areas. CONCLUSION: A positive role of pharmacological preconditioning with actovegin in surgical treatment of carotid artery stenosis has been demonstrated.

[Pharmacological preconditioning in carotid endarterectomy].

The study was aimed at examining efficacy of preoperative preparation (pharmacological preconditioning) for carotid endarterectomy in patients with chronic cerebrovascular insufficiency. For this purpose, we analysed the outcomes of surgical treatment in a total of 80 patients presenting with haemodynamically significant unilateral and bilateral lesions of carotid arteries. Of these, 40 patients were operated on immediately and a further 40 patients underwent surgery after pharmacological preconditioning with Actovegin taken at a daily dose of 1,200 mg for 1.5 months. It was demonstrated that preoperative preparation prior to surgery increases cerebral perfusion which is determined by means of single-photon emission computed tomography, thus substantially improving the outcomes of surgical treatment. Statistically significant differences in cognitive function of these groups of patients were revealed 7 days and 6 months after the operation. Improvement of cognitive functions was associated with fewer symptom-free postoperative cerebral ischaemic foci in various regions of the brain. A conclusion was made on a positive role of pharmacological preconditioning with Actovegin in surgical management of cerebrovascular insufficiency, first of all in relation to more complete restoration of cognitive functions.

[Assessment of the diagnostic value of perfusion scintigraphy in diagnosis of pulmonary artery thromboembolism].

The present work was aimed at specifying the place of perfusion scintigraphy of the lungs in the diagnostic algorithm of pulmonary artery thromboembolism (PATE) and at determining sensitivity, specificity, and accuracy of the method concerned. The authors analysed the data regarding a total of 211 patients divided into two groups (Group One with an arbitrary algorithm of investigation, comprising 108 patients and Group Two with the suggested algorithm of «pulmonary roentgenography Doppler ultrasonography perfusion scintigraphy of the lungs¼) in clinically suspected pulmonary artery thromboembolism and scintigraphy-revealed defects of perfusion. The diagnostic complex included ECG, Doppler ultrasonography of the veins, roentgenography, perfusion scintigraphy of the lungs, and in a series of doubtful cases Echo-CG and CT angiography of the lungs. We revealed reliable signs of pulmonary artery thromboembolism (PATE) by the findings of instrumental diagnostic methods, having demonstrated a considerable increase in specificity and accuracy of perfusion scintigraphy in diagnosing PATE using the proposed diagnostic algorithm, when scintigraphy stands on the third position (specificity increased by 78% and accuracy by 22%). The following recommendations were made: the findings of scintigraphy should be interpreted with due regard for the data of roentgenography and Doppler ultrasonography of the veins; if the patient s condition is severe, the examination may be limited to roentgenography alone prior to performing perfusion scintigraphy of the lungs.

[Micronized purified flavonoid fraction in treatment of pelvic varicose veins].

Presented herein are the results of studying efficacy of micronized purified flavonoid fraction (MPFF) in treatment of pelvic varicose veins (PVV) using reference ray-tracing methods of study. We examined a total of 85 patients with PVV. Of these, 65 subjects were found to have isolated dilatation of pelvic venous plexuses (study group), and 20 were diagnosed as having combined dilation of gonadal veins and venous plexuses of the pelvis (control group). Besides clinical examination, the patients were subjected to ultrasonographic angioscanning (USAS) and emission computed tomography (ECT) of pelvic veins before treatment and 2, 6, 12, 24, 36 and 60 months after the beginning of phlebotrophic therapy. Based on the findings of the clinical and instrumental studies, it was determined that MPFF was most efficient in patients with isolated dilatation of uterine and parametrial veins. In this group of patients, pelvic pain and other symptoms of the disease disappeared completely and the clinical effect persisted for a long time (up to 6-9 months). In the control group, venotonic therapy had a positive effect which was less pronounced as compared to the control group, and pelvic pain reappeared in the nearest time (up to 3 weeks) after withdrawal of MPFF.

[Possibilities of radionuclide study of lower-limb muscles perfusion in diagnosis of chronic arterial insufficiency].

The authors have hereby proposed a method to diagnose lower-limb muscular ischaemia by means of scintigraphy, used in 35 patients suffering from atherosclerosis obliterans with stage IIB and III A chronic arterial insufficiency of limbs. To do so, administration of the radioactive agent "Myoview" (99m)Tc-tetrophosmine) manufactured by the "Nycomed" Company into a patient's peripheral vein was followed by assessing its accumulation in lower-limb muscles at rest and after standard physical load. Alterations in the parameters studied relative to the norm made it possible to judge on the presence of lower-limb circulatory impairments. The method proved highly efficient, thus making it possible to use it for both therapeutic decision-making and probably in future for dynamic control after the treatment performed. Minimally invasive nature and simplicity in use of the methodology open wide possibilities for its use.

[Regional venous hypertension as a factor of compensation for microcirculatory impairments in chronic obliterating diseases of lower-limb arteries (state of the art)].

A thorough analysis of the literature and own data confirmed a lively interest of vascularsurgeons in alterations in venous haemodynamics in patients presenting with chronic obliterating diseases oflower-limb arteries. The presence of close relationships between impaired arterial and venous blood flow and a compensatory pattern of the development of venous hypertension in the ischaemia zone was proved. This should be taken into consideration during conservative therapy of patients sufferingfrom chronic obliterating diseases of lower-limb arteries, and while working out novel types of surgical interventions, as well as for more adequate interpretation of pathophysiological peculiarities of the existing disease.

[Peculiarities of peripheral haemodynamics in patients with varicose disease of lower-limb veins complicated by trophic ulcers].

The work was dedicated to studying local, regional and systemic circulatory disorders in patients suffering from varicose disease of the lower extremities veins with accompanying trophic ulcers. The possibility of performing this work was determined by a diagnostic complex possessing high informative value (especially it concerns studying microcirculation). Based on the obtained findings we managed not only to evaluate severity of microcirculatory disorders but also to characterize them qualitatively, in particular to reveal the so-called blood microshunting phenomenon. Pathophysiologically important is the development of inflammatory hyperaemia in the area of trophic ulcers, which is prognostically favourable for their healing. Proceeding from the above-mentioned, utterly true turned out the conclusion concerning the necessity to include microcirculation-improving pharmaceutical substances into the program of treatment of patients suffering from varicose disease of the lower-limb veins, especially those presenting with concomitant trophic ulcers, along with surgical intervention.

[Effectiveness of compressive hosiery <> for therapy of chronic venous insufficiency].

Total 40 patients with III grade chronic venous insufficiency underwent conservative treatment with compressive hosiery <>. Patients were divided into 2 groups: the first group used compressive stockings, the second--tights. To objectivize the assessment, all patients underwent volumetry, radionuclide phlebography and regional blood volume measurements. It was shown that in the first group pain syndrome was coped in 73% of patients, edematous--in 60%. According to volumetry data, mean calf volume has reduced by 183+/-41 ml, phlebography has revealed an improvement of muscular-venous pump capacity in 11 patients; in 9 patients it remained unchanged. Blood filling in the affected limb decreased in 16 patients from 10.7% to 8.2% and from 7.5% to 5.3% for thigh and calf, respectively. In the second group an improvement of venous return parameters was more pronounced. Compressive tights relieved pain in lower extremities in 95%, decreased led edema--in 90% of patients. There was significant reduction in calf volume--by 259+/-31 ml to the end of treatment course. Radionuclide phlebography has shown significant improvement of muscular-venous pump evacuatory function and reduction of blood filling in all patients of the second group. In conclusion, results of the study evidenced the effectiveness of compressive hosiery for treatment of chronic venous insufficiency.

[Preoperative care of microcirculatory vessels in patients with lower limb arteriosclerosis obliterans].

The paper analyses diagnosis and treatment outcomes for 20 men aged from 55 to 76 with lower limb arteriosclerosis obliterans. Based on exhaustive laboratory and instrumental diagnostic data the authors conclude that 10-days course of Vazaprostan (20 mkg per day) for patients with IIb stage of chronic lower limb arterial insufficiency yields not only improvement in tissue metabolism, but a reduction of peripheral vascular resistance as well. Thus such therapy can be used for preoperative care before reconstructive vascular interventions in order to reduce the risk of implant thrombosis in early postoperative period.

Radionuclide assessment of the treatment by compression of patients with chronic venous insufficiency.

A study was made of the efficacy of the compression medical tricot in the treatment of chronic venous insufficiency (CVI). To evaluate the treatment by compression, the authors, in addition to the clinical examination, used radionuclide techniques such as examination of the regional blood volumes and phleboscintigraphy. The results of the given work have shown that the compression products under test are effective agents for the treatment of CVI by compression which improves venous return and the patients' quality of life. The data obtained point out that in addition to the lowering of blood filling, the medical tricot influences the interstitial element of the edematous syndrome, leading to the elimination of the latter one. The use of elastic bandages creates the known difficulties (the necessity of the patient training in bandaging, complexity of creating an adequate bandage, quick depreciation). In view of this fact the use of the compression tricot which possesses the fixed grade of compression for a concrete form and stage of CVI is preferable in the therapy of chronic venous diseases.

[Radionuclide hepatobiliscintigraphy in prediction of the Buchwald's operation effect]. / Radionuklidnaia hepatobilistsintigrafiia v prognozirovanii éffekta operatsii Bukhval'da.

The authors have proposed a method for predicting the effect of Buchwald's operation (partial iliac bypass surgery) and successfully tested it in 32 patients with hyperlipidemia. The method is based on pharmacological simulation of major pathophysiological intervention points verified by radionuclide hepatobiliscintigraphy. Evaluating lipid metabolic changes before and after simulation serves as a basis for predicting the effect of the operation.

[A present-day approach to surgery for the formation of crossed femoro-femoral shunts in unilateral occlusions of the ilio-femoral venous segment (indications, principles of the surgical technique)]. / Sovremennyi podkhod k operatsiiam perekrestnogo bedrenno-bedrennogo shuntirovaniia pri odnostoronnykh okkliuziiakh podvzdoshno-bedrennogo venoznogo segmenta (pokazaniia, printsipy khirurgicheskoi tekhniki).

As distinct from the classical Palme-D'Esperon operation in which the anastomosis is established with the common femoral vein, the authors prefer to form the anastomosis in the region of the saphenofemoral communication in inadequate drainage in the iliofemoral segment in patients with the postthrombotic disease. Seven variants of crossed femorofemoral shunting (CFFS) were carried out. The anastomoses were formed by means of precision techniques; an operating microscope was used when the anastomosis measured less than 5 mm in diameter. The CFFS was found to be patent in follow-up periods of up to 2.5 years in all cases. From analysis of the late-term results of CFFS, the authors claim that functional block of venous drainage from the femoro-iliac segment, rather than anatomical occlusion, is the indication for this operation.

[Changes in peripheral hemodynamics in patients with chronic circulatory insufficiency in the extremities after the treatment by reinfusion of UV-irradiated blood]. / Izmenenie perifericheskoi gemodinamiki u bol'nykh s khronicheskoi nedostatochnost'iu krovosnabzheniia konechnostei pri lechenii reinfuziei obluchennoi ul'trafioletovymi luchami krovi.

Reinfusion of the blood irradiated with the ultra-violet rays in patients with chronic insufficiency of the blood supply of the extremities leads to significant increase in the linear and volumetric blood flow rate in the damaged extremities, improvement in the microcirculation, reduction in the blood viscosity. The effect doesn't depend on the genesis of occlusion and degree of the impairement of circulation.

[Local radiometry in the diagnosis of postoperative pulmonary complications]. / Lokal'naia radiometriia v diagnostike posleoperatsionnykh legochnykh oslozhnenii.

34 patients in the first 5 days after surgery have been examined by local radiometry technique, using 125I-fibrinogen. Significant differences in the accumulation of marked fibrinogen have been revealed in patients with and without postoperative lung complications. The analysis of the data obtained made it possible to reveal signs characteristic of patients at high risk of pulmonary complications already on the second day postoperatively. Local pulmonary radiometry is recommended as an informative diagnostic technique for early identification of postoperative pulmonary complications of thrombotic genesis.

[Hemodynamic aspects of the treatment of patients with "critical ischemia" of the lower extremities]. / Gemodinamicheskie aspekty lecheniia bo'lnykh s "kriticheskoi ishemiei" nizhnikh konechnostei.

A complex examination of 60 patients with different stages of disturbances of blood circulation (by the Fontain classification) with chronic arterial insufficiency was performed. Specific features of regional hemodynamics were revealed in patient with "critical ischemia" (3rd and 4th stages of the disease). Threshold values of the "critical ischemia" were determined, most informative of them being the malleolus index and oxygen pressure on the foot. An analysis of results of the investigation in the dynamics of the treatment performed has shown possible effectiveness of restorative operations in treatment of patients with severe stages of chronic arterial insufficiency.