[Comparative 3-year results of phlebectomy and thermal ablation for lower limb varicose veins]. / Sravnitel'nye trekhletnie rezul'taty flebéktomii i termoablatsii pri varikoznoi bolezni nizhnikh konechnostei.

OBJECTIVE: The study was aimed at comparing clinical and ultrasonographic results during 3 years of postoperative follow up of patients presenting with lower limb varicose veins (LLVV) and subjected to either surgical or thermal-ablation procedures for removal of pathological reflux along the great saphenous vein (GSV) within the femur The study included a total of 185 patients with clinical class C2-3 LLVV in the system of the GSV. The patients were divided into three groups: Group One consisted of 63 patients subjected to short stripping of the GSV trunk + treatment of the perforant veins (66.7%); Group Two comprised 61 patients undergoing endovenous laser coagulation (EVLC) of the GSV trunk + EVLC of the perforant veins (73.7%); Group Three was composed of 61 patients undergoing radiofrequency ablation of the GSV trunk + ELVC of the perforant veins (70.4%). Complaints were dynamically assessed by the VCSS scale with ultrasonographic duplex scanning. It was revealed that pathological reflux along the GSV trunk on the crus at 1, 2 and 3 years of follow up was registered: in Group One in 33.3, 36.3 and 39.1% of cases, respectively; in Group Two in 15, 14.2 and 25% of cases, respectively; and in Group Three - in 11, 18.1 and 23.8% of cases, respectively. Group One patients at 1 year were found to have developed vertical refluxes emerging on the femur along the GSV tributaries (22.1% of cases), the presence of horizontal refluxes along newly-formed perforant veins (44.4% of cases). The diameter of the GSV trunk on the crus statistically significantly increased with years in all groups. The average diameter of the perforant veins increased at the same time periods of follow up. Alterations of venous haemodynamics revealed on ultrasonographic examination were accompanied by varicose syndrome but exerted no significant effect on subjective symptomatology in patients during 3 years of follow up. The obtained findings are indicative of progression of LLVV in part of surgically treated patients, which requires dynamic follow up and carrying out systemic pharmacotherapy.

[EFFECT OF VOLUNTARY BREATH-HOLDING AND COGNITIVE LOADS ON REGIONAL CEREBRAL BLOOD FLOW AND BIOELECTRIC ACTIVITY OF THE BRAIN].

Cerebral blood flow and bioelectric activity were studied in 10 normal volunteers in order to assess cerebrovascular reactivity during different types of functional testing. The transcranial Doppler was used to measure linear blood velocity (LBV) in the middle cerebral artery (MCA) during maximal voluntary breath-holding (apnea), controlled verbal association test and tactile memory test. Simultaneous electroencephalography (EEG) registered the bioelectric activity of the brain cortex. Both investigations were performed continuously in the course of each test. Breath-holding induced a smooth symmetric increase of CMA blood velocity; LBV rose to maximum values in the majority of the volunteered subjects. Two subjects with small focal changes in the brain's white matter displayed an asymmetric blood flow reaction to apnea. Gain in LBV was materially less during the cognitive tests; the verbal test decreased LBV in one half of the subjects and increased LBV in the other. The tactile memory test increased LBV which was particularly high in the left CMA of all subjects. LBV dynamics during the cognitive tests was essentially different from what was observed in apnea. Blood flow variations in the course of equally the verbal and tactile tests had a regular undulatory character. Concurrent LBV and EEG monitoring made it possible to compare and contrast dynamics of the cerebral blood velocity and bioelectric activity directly during testing and thus to reveal peculiar reactions of the cerebral blood flow to cognitive and physiological testing.

[Anemia during inflammatory processes: pathogenesis and clinical and morphological manifestations].

The review sums up the results of the current stage of studying the so-called anemia of inflammation (AI). The key mediator of AI is the polypeptide hepatic hormone hepcidin, the hepatocytic secretion of which is initiated by proinflammatory macrophageal cytokines (IL-6, IL-lalpha, and tumor necrosis factor-alpha) and T-lymphocyte gamma-interferon. Hepcidin has bactericidal properties and promotes iron retention in the enterocytes, macrophages, and hepatocytes through the internalization and degradation of ferroportin (a cell iron exporter into the plasma). The limited iron availability to microorganisms in AI is aimed at enhancing the body's natural resistance to infection. Therefore, AI serves as an example of fundamental reactions of innate immunity. The latent and manifest phases of AI can be identified. The major clinical and morphological manifestations of AI are a decreased functional iron stores and hepatic and splenic hemosiderosis.

[Hypersiderosis and dissiderosis in the context of data on hemochromatosis microelementosis].

The review summarizes the results of the state-of-the-art studies of hemochromatosis (HC): iron-regulatory genes (HFE, HJV, HAMP, TFR2, SLC40A1) have been discovered; the HC types caused by mutations in these genes (types 1, 2, 3, and 4 in the OMIM register) have been identified; the inflammation anemia (IA) mediator - the polypeptide hepatic hormone hepcidin that is an important constituent of the natural immunity system - has been found. This gives an idea of hypersiderosis and dissiderosis as types of iron microelementosis. Types 1, 2, and 3 HC in which iron absorption and its total reserves are increased in the body serve as examples of hypersiderosis. Dissiderosis is characterized by the redistribution of iron between the functional and spare funds inherent in type 4 HC and IA. By taking into account their findings, the authors briefly discuss the leading clinical and morphological manifestations of HC and IA, difficulties in differential diagnosis, and treatment ways and prospects.

[Liver pathology in patients with primary hemochromatosis--homozygous carriers of C282Y mutation ]. / Patologiia pecheni u bol'nykh pervichnym gemokhromatozom--gomozigotnykh nositelei C282y-mutatsii.

Liver pathology was studied in 3 patients with primary chemochromatosis. In two cases so-called iron free foci with signs of hepatocytes with feature of dysplasia were found. Many siderosomes were found ultrastructurally in the cytoplasma of hepatocytes. Histological markers of virus infection were absent in a patient with positive serum HbsAg and HCV-Ab. Alcohol did not produce typical histological changes. In this case grave liver reticuloendothelial hemosiderosis typical for secondary hemochromatosis and overloading with iron of spleen pulp according to MR imaging were observed.

[Liver hemosiderosis in chronic hepatitis]. / Gemosideroz pecheni pri khronicheskom gepatite.

Liver hemosiderosis (LH) was studied in chronic hepatitis (CH) B and C and CH of other and alcoholic (AL) etiology. LH was present in 122 patients (a study group) and was absent in 188 patients (a comparison group). LH is considered to be a marker of organ iron overload. The total incidence of LH was 39.4 +/- 2.7%, including 33.3 +/- 5.6% in LH-B, 49.3 +/- 5.8% in LH-C, and 48.7 +/- 8.0% in AL. The association with LH was characterized by a longer duration of the disease, by a higher activity and degree of hepatic cirrhosis. The efficiency of reaferon therapy was lower in hepatitis B and C in the presence of LH. These forms of the disease are considered to be secondary hemosiderosis.

[Longitudinal studies of cosmonauts' health]. / Rezul'taty dlitel'nogo nabliudeniia za sostoianiem zdorov'ia kosmonavtov.

Presented are data of the follow-up (about 30 years maximum) of cosmonauts (n = 36, main group) and candidates to cosmonauts (n = 65, control) who were also subjected to the systematic medical certification over the whole period in the corps of cosmonauts. Analysis of the data on morbidity, body mass, physiological and biochemical parameters (BP, lipid and carbohydrate metabolism, hemoglobin etc.) revealed that for the most part, dynamics of the health parameters and morbidity in remote periods after space flight was age-specific.

[Possibilities of complex etiological diagnosis of chronic viral hepatitides B and C]. / O vozmozhnostiakh kompleksnoi étiologicheskoi diagnostiki khronicheskogo virusnogo gepatita B i C.

Etiological markers for HBV and HBC were studied in 26 cases of chronic hepatitis. In 21 cases coincidence of serological and immunohistochemical results was found, in 9 cases markers of other viruses were registered. Immunohistochemical markers were identified in 3 of 5 liver biopsies in patients with negative serological tests. Histological signs of HBV and HBC corresponded to those of serological and immunohistochemical ones in 17 cases.

Male reproductive system in conditions of bed-rest in a head-down tilt.

Study of reproductive function in simulating experiments is important as for expansion of our theoretical knowledge in the field of gravitational physiology and space biology and for the decision of applied problems in space and clinical medicine. Long-term bed rest in a head-down tilt--6 degrees (BRHDT)--antiorthostatic hypokinesia is a wide spread method for ground-based simulation of space flight's conditions (mainly of hemodynamical effects of microgravity and restriction of locomotor activity). The aim of the present research was to study a reproductive function in males during 60-120 day BRHDT.

[Brunner's gland adenoma of the duodenal bulb]. / Adenoma Brunnerovykh zhelez lukovitsy dvenadtsatiperstnoi kishki.

This rare tumor was found at surgery in a 35-year-old male operated for chronic ulcer of the duodenum complicated by gastrointestinal bleeding. The tumor looked like a pedunalated polyp 6 x 3 x 2 cm in size with an ulcer 0.5 cm in diameter. Histologically, the tumor was formed of large lobules of Brunner's glands, and its surface was lined with intestinal villi. Pascual's argyrophilic test discovered focal hyperplasia of endocrine cells in the intestinal lining. The majority of these cells, according to PAP reactions with antisera to polypeptides, were serotonin-positive. Among tumor cells somatostatine-positive cells were most numerous.

[Clinico-morphologic characteristics of primary hemochromatosis]. / Kliniko-morfologicheskaia kharakteristika pervichnogo gemokhromatoza.

12 autopsy cases of primary hemochromatosis were studied: 11 males (aged between 29 and 69 years, mean age 51 years) and 1 57-year-old female. Clinical course in 6 patients ran with predominant liver damage to the small nodule or was of biliary cirrhosis type, in 3 cases main manifestation was diabetes mellitus and in 3 cases cardiomyopathy. Generalized pattern of hemosiderine deposits with involvement of the liver, pancreas, heart, adrenals, pituitary, epiphysis, thyroid and other organs was established by the Pearl's test. Apart from pigment degeneration, atrophy and fibrosis, compensatory and regenerative changes were found. These changes should be taken into account when the disease is analyzed clinically and morphologically.

[Apud cells in endometrial cancer]. / Apudotsity v rake éndometriia.

55 endometrial carcinomas containing apud cells are studied. Correlation between the endocrine-metabolic disturbances and mitotic index, on the one hand, and number of apud cells and their product on the other, is revealed. If the percentage of apud cells is above 20 of all parenchymal cells, low mitotic index in the tumour, marked production of serotonin, calcitonin and other hormones and high incidence of endocrine disturbances together with a relatively favourable prognosis are observed. Low number of apud cells associated with high mitotic index and high incidence of unfavourable outcomes while the hormone production and endocrine disturbances were rare or absent.

[A poorly differentiated apudoma of the gallbladder]. / Nizkodifferntsirovannaia apudoma zhelchnogo puzyria.

Apudoma was found in the gall bladder removed in a 76-year-old woman because of the chronic calculous cholecystitis exacerbation. Carcinoid syndrome was absent clinically. Histologically, the tumour was a poorly differentiated carcinoid with areas of small cell and polymorphic carcinoma. Argyrophilic Pasquale reaction in the tumour cells was negative, electron microscopically small neurosecretory granules were found. Numerous ACTH-reactive cells and single serotonin-reactive cells were revealed in the tumour parenchyma by means of immunohistochemical PAP-method using antibodies against ACTH, serotonin, calcitonin, somatostatin, insulin, glucagon, P-substance. Focal hyperplasia and intestinal metaplasia of epithelium with the increase of the number of argyrophilic, ACTH-reactive cells were observed outside the tumour.