[Bilateral vestibulopathy and sensorineural hearing loss in necrobiotic xanthogranuloma, multiple myeloma and amiloidosis]. / Dvustoronnyaya vestibulopatiya i sensonevral'naya tugoukhost' u patsienta s nekroticheskoi ksantogranulemoi, mnozhestvennoi mielomoi i amiloidozom.

This article describes a rare case of necrotic xanthogranuloma in a 46-year-old patient who presented with the development of periorbital xanthelasms, progressive bilateral sensorineural hearing loss and bilateral vestibulopathy, followed by multiple myeloma and amyloidosis. For several years, the patient underwent standard rehabilitation for chronic sensorineural hearing loss and was fitted with a hearing aid. During hospitalisation for exacerbation of chronic bronchitis, monoclonal gammopathy was identified, and later, after careful examination and repeated biopsies, necrotic xanthogranuloma, multiple myeloma and AL-amyloidosis were confirmed. Targeted immunochemotherapy resulted in improvement of hearing and significant recovery of the vestibuloocular reflex bilaterally.

[Chest pain and chronic heart failure as a manifestation of tertiary syphilis: clinical case].

In cardiological practice, there may be patients with chest pain and heart failure of a specific etiology, including an association with cardiovascular syphilis. This article describes a 49-year patient with chest pain, heart failure, and neurological symptoms associated with ongoing tertiary syphilis. The history included an antisyphilitic treatment 30 years before the current hospitalization. Further evaluation confirmed neuro- and cardiovascular syphilis with severe aortic regurgitation and syphilitic myocarditis. Tertiary syphilis is a rare but relevant challenge for various medical specialists, including cardiologists. This pathology requires increased medical alertness and interdisciplinary interaction for early diagnosis, effective and safe treatment, and improved prognosis.

[A medicinal liver injury with an immunomodulatory drug of natural origin. Case report].

As practice shows, there are many alternative drugs that cause drug damage to the liver. A case of medicinal damage to the liver with an immunomodulatory herbal preparation Immunostimulating collection, which included St. John's wort, Elecampane, Kopeichnik, Echinacea, Licorice, Rosehip, is presented. A 39-year-old patient came to the clinic with complaints of yellowing of the skin, whites of the eyes, heaviness in the epigastrium after eating, lightening of feces, dark urine, sour taste in the mouth, bloating, pruritus, decreased appetite, pronounced general weakness, drowsiness 10 days after you start taking herbal immunostimulant. The diagnosis of drug damage to the liver was made taking into account the history and laboratory parameters, since the patient had negative markers of viral hepatitis and increasing of biochemical blood tests: alanine transferase up to 2800 U/l (norm up to 32 U/L), aspartate transferase up to 1776 U/l (norm up to 31 U/l), total bilirubin up to 577 U/l (norm up to 21 U/l), direct bilirubin up to 116 U/l (norm up to 4.3 U/l), alkaline phosphatase up to 112 U/l (norm up to 98 U/l). After the withdrawal of the immunomodulator and the appointment of therapy, including diet, enzyme replacement therapy, drugs clinical and laboratory manifestations of liver drug damage completely disappeared. This confirms the leading role of the immunoactive drug, which the patient took in the toxic effect on the liver.

[Galactin-3: diagnostic and prognostic value in patients with chronic heart failure].

Now there is a relevant development of the new biomarkers capable to serve as the instrument of early diagnostics of a disease for the purpose of selection of a pharmacotherapy and further monitoring of its efficiency. Galektin-3 is the atypical representative of the family of galektin. Its participation in fibrosis, remodeling of heart, the immunologic answer and inflammatory reactions are shown. Prognostic value is discussed and diagnostic opportunities of Galektin-3 at CHF are widely studied and take root into clinical practice. Now a great deal of research devoted to the studying of Galektin-3, possibilities of its use as a biomarker at diagnostics, forecasting of outcomes and the choice of therapeutic strategy at other cardiovascular diseases has been conducted.

[Mineral and bone disorders in chronic heart failure].

In many patients, chronic heart failure (CHF) is associated with chronic kidney disease (CKD). Virtually all patients with terminal CKD and many patients with early CKD display various disorders of mineral and bone metabolism (MBM) related with all-cause mortality and high risk of cardiovascular complications. This review addressed disorders of mineral and bone metabolism in patients with CHF, including hypocalcemia, hyperphosphatemia, vitamin D insufficiency/deficiency, secondary hyperparathyroidism, changed levels of FGF23 and Klotho, osteoporosis, osteopenia, their clinical and prognostic significance, and possibilities of their correction.

Case of thrombosis of the portal vein and its branches in a patient seropositive for Borrelia antigens.

Borreliosis after sucking ticks is an acute problem in the world. People do not go to doctors after that often, which leads to the development of various complications. Thrombosis of veins of various localization can be one of them. Thrombosis of the portal vein represents a significant problem too with high morbidity and mortality. The risk factors for splanchnic vein thrombosis include infections, but its relationship with borreliosis has not been studied. А 34-year-old man with chronic helicobacter-associated gastritis and gallstones was hospitalized due to development during the last 11 days of epigastric pain and fever to 38.7 °C after a picnic at the forest without a registered tick bite. The blood leukocytes were increased to 11.2*109/l, lymphocytes 70%, C-reactive protein 34.6 mg/l, procalcitonin 0.195 ng/ml. The multispiral computed tomography of the abdominal cavity revealed thrombosis of portal, lienalis and superior mesenteric veins. D-dimer was 1.98 mcg/ml, antithrombin III 75%. JACK2V617F, oncological, rheumatic, thrombophilia markers, blood and urine cultures were negative. A high concentration of anti-Borrelia burgdorferi IgM 62.2 U/ml and its increasing to 190 U/ml in dynamics was revealed at the immunofluorescence assay. Anti-Borrelia IgM to OspA, p31 and OspC, p25 were detected at the immunoblotting assay. Anticoagulation, doxycycline, detoxification therapy reduced pain and normalized temperature and inflammation markers. Vein thrombosis was not detected at the control tomography after 2 weeks. Despite that the combination of thrombosis and borreliosis is rare, it is necessary to screen for Borrelia antigens in patients with splanchnic vein thrombosis and fever.

Hypothermic machine preservation facilitates successful transplantation of "orphan" extended criteria donor livers.

Hypothermic machine preservation (HMP) remains investigational in clinical liver transplantation. It is widely used to preserve kidneys for transplantation with improved results over static cold storage (SCS). At our center, we have used HMP in 31 adults receiving extended criteria donor (ECD) livers declined by the originating United Network for Organ Sharing region ("orphan livers"). These cases were compared to ECD SCS cases in a matched cohort study design. Livers were matched for donor age, recipient age, cold ischemic time, donor risk index and Model for End-Stage Liver Disease (MELD) score. HMP was performed for 3-7 h at 4-8 °C using our previously published protocol. Early allograft dysfunction rates were 19% in the HMP group versus 30% in the control group (p = 0.384). One-year patient survival was 84% in the HMP group versus 80% in the SCS group (p = NS). Post hoc analysis revealed significantly less biliary complications in the HMP group versus the SCS group (4 vs. 13, p = 0.016). Mean hospital stay was significantly shorter in the HMP group (13.64 ± 10.9 vs. 20.14 ± 11.12 days in the SCS group, p = 0.001). HMP provided safe and reliable preservation in orphan livers transplanted at our center.

[Clinical characteristics and metabolic therapy of fatigue in the acute and early recovery periods of ischemic stroke]. / Klinicheskie proyavleniya i metabolicheskaya terapiya astenicheskogo sindroma v ostrom i rannem vosstanovitel'nom periodakh ishemicheskogo insul'ta.

OBJECTIVE: To reveal clinical characteristics of asthenic syndrome with subsequent estimation of Meldonium therapy efficacy in patients in acute and early recovery periods of ischemic stroke. MATERIAL AND METHODS: The study included 94 patients diagnosed with ischemic stroke, mean age being 65.6±9.5 years. Psychoemotional status was assessed on the 10th day of hospitalization with the use of the Asthenic Disorders Inventory (MFI-20), Hospital Anxiety and Depression Scale (HADS), Apathy Evaluation Scale (AES). Patients with verified asthenic syndrome were added Mildronate in a daily dose of 1000 mg (500 mg 2 times a day) for one month to baseline therapy in a real outpatient setting, followed by an assessment of treatment efficacy. RESULTS: The presence of asthenic syndrome in patients in the acute period of ischemic stroke was detected on all subscales of MFI-20. A high level of general and physical asthenia was found in patients with subcortical localization stroke, with decreased motivation corresponding to lesions in the frontotemporal and decreased activity in the parieto-occipital lobes. Close correlations between the MFI-20 parameters and the level of depression, anxiety, apathy, and the degree of neurological deficit were found. The dynamic evaluation of the severity of main manifestations of psychoemotional dysfunction during treatment with Mildronate showed a decrease in the level of depression, general and mental asthenia, and decreased activity during the period of observation. CONCLUSION: The high prevalence and multifactorial character of asthenia in early ischemic stroke make it urgent to optimize the early treatment of asthenic syndrome. The results of assessment of Mildronate application in a daily dose of 1000mg for a month have shown therapy efficacy concerning affective and asthenic disorders, which allows recommending its inclusion in the complex therapy of ischemic stroke.

[Vectors of the filaria Thamugadia ivaschkini (Splendidofilariidae) in the southern Turkmen SSR]. / Perenoschiki filiarii Thamugadia ivaschkini (Splendidofilariidae) na iuge Turkmenskoi SSR.

1903 specimens of sandflies and mosquitoes were examined for their spontaneous infection with larvae of Thamugadia ivaschkini. The experimental infection of sandflies and mosquitoes was conducted on infected lizards. It has been established that the vectors of this filaria in the south of Turkmenia are sandflies of the genus Phlebotomus and Sergentomyia arpaclensis. The development of the helminth carries out in thoracic muscles of sandflies, the first infective larvae appear in 7 to 17 days after the infection of vectors.

[Emergence of Thamugadia ivaschkini microfilaria from the stomach into the hemocoel of Sergentomyia arpaklensis sandflies]. / Vykhod mikrofiliarii Thamugadia ivaschkini iz zheludka v gemotsel' moskitov Sergentomyia arpaklensis.

Regularities of migration of microfilarians from the stomach to haemocoel in connection with blood digestion and peritrophic membrane formation were studied in sandflies of S. arpaklensis experimentally infected with larvae of Th. ivaschkini. Whatever the number of swallowed parasites, the average number of larvae reaching the haemocoel does not exceed 5. Factors limiting the invasion are the thick layer of prosecretion of the peritrophic membrane and a peculiar way of clot formation during the feeding of S. arpaklensis sandflies with blood of reptiles. The results obtained are compared with data on members of the genus Phlebotomus and other bloodsucking Diptera.

[Passage of the microfilaria, Thamugadia ivaschkini, from the intestine into the hemocele of the sand flies of the genus Phlebotomus]. / Vykhod mikrofiliarii Thamugadia ivaschkini is kishechnika v gemotsel' moskitov roda Phlebotomus.

Sand flies of Ph. papatasii and Ph. caucasicus were experimentally infected with Th. ivaschkini. At daily fluctuations of air temperature from 27 to 32 degrees C and relative air humidity from 30 to 60% viable microfilarians migrate into haemocoel within the first 5-6 hours after the blood-sucking of vectors, before the peripheral membrane is completely formed. Most parasites leave the intestine before the formation of a blood clot, within the first 1.5 hour after feeding. The number of larvae overcoming the intestinal barrier (at studied levels of infection) does not depend on the number of devoured microfilarians and is close to 100%. Sand flies of the genus Phlebotomus lack physiological mechanisms limiting the migration of microfilarians from the intestine that causes a high mortality of these vectors at intensive infection.

[Experience with the laboratory cultivation of the mosquito, Aedes togoi (Culicidae)]. / Opyt laboratornogo kul'tivirovaniia komara Aedes togoi (Culicidae).

For cultivation of Aedes togoi the aquatic infusion of fallen leaves, peat and dry sphagnum (0.15%S) was used and a larval diet (children's haematogen with an addition of polyvitamin "Undevit" and glutamic acid) was offered. Such cultural medium provides a rapid development of larvae and their survival, high stable weight of pupae, high fecundity and viability of imago. 7 generations were obtained without reducing the quality of culture.

[An experimental quantitative assessment of the efficiency of Borrelia persica transmission by Ornithodoros papillipes ticks. 1. 2 forms of borreliemia in guinea pigs]. / Kolichestvennaia otsenka éffektivnosti peredachi Borrelia persica kleshchami Ornithodoros papillipes v éksperimente. Soobshchenie 1. Dve formy borreliemii u morskikh svinok.

Experimental borreliosis in guinea pigs caused by ticks' bites assumed two forms--typical and mild, the latter being encountered in 40% of cases. Mild form significantly differs from the typical one in some indices of borreliemia: intensity, duration, time of onset and cessation, absence of fluctuations in the number of borrelia. The form is not easily diagnosed by the analysis of animal blood preparations, which should be taken into consideration in experimental and clinical practice. In mild form of borreliemia the agent should be searched for in the blood of guinea pigs daily from days 6 to 12 after the infection, with the following control till day 20.