[Surgical treatment of a patient with liver endometriosis]. / K voprosu ob endometrioze pecheni.

Endometriosis is a functioning endometrial tissue outside the inner layer of the uterine wall. Liver endometriosis is one of the rarest forms of atypical endometriosis. In this article, we report a patient with this disease. A 59-year-old patient complained of heaviness and periodic pain in the right hypochondrium for more than a year. Previous contrast-enhanced CT revealed signs of cystic-solid hypovascular mass lesion in the right liver lobe. Histological examination revealed no reliable signs of tumor growth. According to control CT after 8 months, no significant changes were observed. Surgical treatment was indicated and atypical liver resection was performed. Histological examination revealed cystic endometrioid lesion. Liver endometrioma is a rare disease with unclear pathogenesis. Diagnosis is difficult due to uncharacteristic clinical manifestations and no specific markers. Liver endometriosis should be considered in differential diagnosis of liver lesion. Surgical treatment is preferable due to the risk of malignant transformation.

[Predictors of Left Atrial Severe Fibrosis in Patients with Nonvalvular Atrial Fibrillation].

Objective The search for predictors of severe (>35 %) left atrial (LA) fibrosis in patients (pts) with nonvalvular atrial fibrillation (AF) directed for catheter ablation (CA).Materials and Methods 69 pts with nonvalvular AF (57 paroxismal and 12 persistent) aged from 32 to 69 years (mean age 57.1±8.4, 28 females) were included in the study, among them 59 pts (86 %) with arterial hypertension (AH), 24 (34.8 %) - with AH and CAD. Complete physical study, laboratory tests (including NT-proBNP level), comprehensive echocardiography were performed. As a surrogate substrate of LA fibrosis, the area of low-voltage (<0.5 mV) zones in LA was estimated in the process of voltage electroanatomic mapping, as the first stage of CA. The total square of LA fibrosis in absolute values (Sf, cm2) and in percent of total LA square (Sf%), as well as the degree of fibrosis: degree I - <5 %, II - 5-19 %, III - 20-35 %, IV - >35 % were calculated. Degree IV of fibrosis was considered as severe fibrosis.Results Extent of fibrosis didn't depend on sex, age, body weight, presence of diabetes, CHA2DS2VASc scores, duration of AF history. There was a tendency to smaller Sf in pts with spontaneous termination of AF compared to those who required cardioversion: 7.2 cm2 (4.4; 17.1) and 12.6 cm2 (4.2; 30.5), respectively (p=0.069). Although NT-proBNP level was normal in 62 % of pts (<125 pg / ml), it was higher in Sf% ≥20 % than in Sf% <5 %: 146.0 (48.0; 276.0) and 42.8 (24.2; 91.0) pg / ml, respectively (p=0.0216). The distribution of pts by left ventricular (LV) geometry types was as follows: normal geometry (t.1) - 34, concentric remodeling (t.2) - 16, concentric LV hypertrophy (t.3) - 8, eccentric LV hypertrophy (t.4) - 11. Compared to pts with t. 1 (reference level), pts with t.3 and t.4 had higher LA volume and LV myocardial mass index, and pts with t.4 had larger end-diastolic LV volume and lower LV ejection fraction. Pts with t.4 tended to have higher Sf% than t.1: 31.1 (10.2; 46.2) and 11.2 (5.1; 28.0), respectively (p=0.053). Using logistic regression 3 independent predictors of LA severe fibrosis were detected: type 4 geometry of LV - OR=8.893 (95 % CI 1.150; 68.78), NT-proBNP >128 pg / ml - OR=6.184 (1.01; 37.99), LA volume index >34 ml / m2 - OR=5.92 (1.05; 33.38). According to ROC analysis, the area of the curve AUC = 0.839 (p<0.001), model specificity - 85.1 %, sensitivity - 70.0 %, predictive accuracy - 82.5 %.Conclusion In pts with nonvalvular AF predictors of severe (>35 %) LA fibrosis were LV geometry type in the form of eccentric LV hypertrophy, LA volume index >34 ml / m2 and NT-proBNP >128 pg / ml.

[Surgical technique in patients with chronic pancreatitis]. / Optimizatsiia tekhniki operatsii u bol'nykh khronicheskim pankreatitom.

AIM: To justify ligation of vascular branches of anterior pancreateroduodenal arterial arch or gastroduodenal artery prior to bifurcation. MATERIAL AND METHODS: This method was tested on sufficient clinical material: 147 patients with recurrent chronic pancreatitis. The interventions are presented by Frey, Beger procedures and its Berne variant. RESULTS: Comparative analysis showed reliable advantages of vascular ligation during pancreatectomy.

[Pulmonary fibrosis as the first manifestation of scleroderma systematica overlap syndrome].

The paper describes a clinical case of a female patient with signs of visceral scleroderma systematica and rheumatoid arthritis (RA). Interstitial pulmonary fibrosis was the first manifestation of overlap syndrome. The articular and cutaneous of the syndrome were moderate and cast doubts upon whether the systemic rheumatic disease was present. Postmortem examination confirmed the presence of pulmonary fibrosis, scleroderma, and RA. The case is of interest from the point of view of the atypical onset of the disease.

[Chiari network and pulmonary embolism].

We present the case of a patient with acute pulmonary embolism, Chiari network thrombus, and deep vein thrombosis in lower extremities. Chiari networks are present in the right atrium in a minority of population and are usually of no clinical significance. On the other hand it may be associated with such pathological changes as patent foramen ovale, intraatrial thrombus, or atrial arrhythmias. In our case thrombus was trapped by a Chiari's network.

[Morphometric and cytogenetic studies of the follicular epithelium thyroid of small mammals under chronic exposure to small doses].

We have detected the genotoxic effect (increase of micronuclei) after chronic exposure to low-level ionizing radiation of the thyroid follicular epithelium of the voles living for many generations in the radioactive territory. At the same time, we also discovered the stimulating effect of chronic low-level ionizing radiation on the activity of morphogenetic processes in the thyroid parenchyma of the animals from natural populations (increased micro-follicles). These data were confirmed by the experiments; chronic irradiation of the thyroid gland of rats at the doses of 5 and 50 cGy revealed an increased induction of micronuclei and the increase in the number of small follicles. An increased proliferative potential of thyroid may be regarded as a non-specific adaptive response to chronicbody exposure to ionizing radiation.

[Eosinophilic enterocolitis: a clinical case].

The paper describes a clinical case of primary eosinophilic enterocolitis in a 41-year-old female patent. It presents a brief review of the literature on the problem of primary eosinophil-associated gastrointestinal diseases.

[Chiari Network and Pulmonary Embolism].

We present the case of a patient with acute pulmonary embolism, Chiari network thrombus, and deep vein thrombosis in lower extremities. Chiari networks are present in the right atrium in a minority of population and are usually of no clinical significance. On the other hand it may be associated with such pathological changes as patent foramen ovale, intraatrial thrombus, or atrial arrhythmias. In our case thrombus was trapped by a Chiaris network.

[The adaptive structures of the fetal and placental arterial bed in chronic fetoplacental insufficiency].

OBJECTIVE: To reveal the adaptive structures of arteries in the fetal organs and placenta in hypoxia of the latter, by establishing their structure, location, origin, and significance for blood circulation. SUBJECTS AND METHODS: Thirty-four antenatal deaths of fetuses at 28-29 weeks' gestation due to chronic fetoplacental insufficiency and 10 control cases were analyzed. The tissue pieces from different organs of the fetus and its placenta, which underwent histological, histochemical, and morphometric examinations, were explored. RESULTS: The organ blood bed of the fetus and its placenta in hypoplasia of the latter shows the increased development of adaptive arterial formations, the basis for which is smooth muscle fascicles. They have different origin and sites and vary in their structure, specific features of performance, and hemodynamic effects. CONCLUSION: The described formations contribute to the rational distribution of blood flows and in the organ beds and in the area of an undeveloped placenta, by providing the maximally possible reduction in the state of fetal trophic and oxygen deprivation.

[Natural nucleotide polymorphism of the Srlk gene that determines salt stress tolerance in alfalfa (Medicago sativa L)].

Based on legume genome syntheny, the nucleotide sequence of Srlk gene, key role of which in response to salt stress was demonstrated for the model species Medicago truncatula, was identified in the major forage and siderate crop alfalfa (Medicago sativa). In twelve alfalfa samples originating from regions with contrasting growing conditions, 19 SNPs were revealed in the Srlk gene. For two nonsynonymous SNPs, molecular markers were designed that could be further used to analyze the association between Srlk gene nucleotide polymorphism and the variability in salt stress tolerance among alfalfa cultivars.

[Features of surgical treatment of moderate ischemic mitral regurgitation in high risk patients].

The experience of surgical treatment of high risk group patients with ischemic mitral regurgitation of different degree of manifestations was analyzed. The basic approaches to the management and the choice of treatment strategy are reported in this article. The authors suggested the priority strategy on the background of completed investigation: 1) the performance of the annuloplasty on pressure ring in combination with coronary bypass surgery in surgical treatment of ischemic mitral regurgitation of Ill degree, as most effective kind of intervention; 2) the performance of operation of isolated coronary bypass surgery on working heart for high risk patients with the presence of moderate ischemic mitral regurgitation, that allows the significant improvement of indices of postoperative period and the decrease of evidence of mitral regurgitation at the expense of a salvage of myocardial contractility.

Estimation of mutagenic effect and modifications of mitosis by silver nanoparticles.

We analyzed mutagenic and mitosis-modifying effects of silver nanoparticles (Allium test). Chromosome aberrations and laggings and micronuclei were simultaneously registered in the same sample. Mitotic and phase indexes were calculated. No mutagenic effects were detected after treatment with silver nanoparticles in doses of 1.0, 2.5, 5.0, and 50 mg/liter. Silver nanoparticles in a concentration of 50 mg/liter significantly increased the mitotic index. Nanoparticles in a dose of 5 mg/liter induced slight, but significant increase in mitotic index, but did not affect the ratio of phase indexes. Exposure to silver nanoparticles in concentrations of 1.0 and 2.5 mg/liter was not followed by modification of mitosis.

[Morphometric analysis of follicular structure of the thyroid gland after chronic low-dose gamma-irradiation].

A quantitative study of follicle average cross-sectional diameter distribution was conducted in the thyroid gland (TG) of mouse like rodents (25 tundra voles, 24 CBA mice, 16 Wistar rats) after chronic exposure to low-level external y-radiation both in the environment and under the experimental condition (absorbed dose range 0.05-0.5 Gy). Spectrum analysis of TG follicle cross-sectional diameter distribution in the irradiated animals has demonstrated a universal regularity: in comparison with the unirradiated animals there was a significant (1.3-1.7-fold) increase in content of small follicles (with a cross-sectional diameter lower than 36-41 microm in the studied animal species). A similar phenomenon was reproduced in the model experiments (TG regeneration in rats after hemithyroidectomy). The observed activation of the folliculogenesis processes after chronic low-dose irradiation in small doses may be interpreted as a nonspecific adaptive reaction of TG to radiation induced damage of its parenchyma.

[Bacteriological substantiation of the antituberculosis effect of immunotropic drug tubosan].

The antituberculosis effect of tubosan registered in the Russian Federation as an immunostimulant drug has been studied on a series of 53 clinical strains of Mycobacterium tuberculosis (MBT). It is established that tubosan produces a bactericidal effect on drug-sensitive MBT strains and a bacteriostatic effect on resistant MBT strains. Use of tubosan for the treatment of 102 patients with drug-resistant destructive tuberculosis showed evident clinical-radiological involution process, with prospects of clinical recovery for 75% of patients. Results of this study show that tubosan possesses both antituberculosis and immunostimulant properties. It is recommended to use tubosan for complex treatment of patients with drug-resistant tuberculosis.

[Results of plasty of postinfarction left ventricular aneurysm performed on the working heart].

The results of plasty (124 patients) of postinfarction left ventricular aneurysm performed on the working heart are presented in this article. It is shown, that the upgrade of existing surgical techniques, which are directed to the creation of the optimal left ventricle shape, could improve the clinical results after plasty of postinfarction left ventricular aneurysm. It's important to arrange the conditions, which allow avoiding a negative influence on contractility function of the myocardium. The desired conditions could be obtained, if the plasty is performed on the working or fibrillating heart provided that the patient has a consistent aortic valve.

[A case of multifocal fibrosis].

We report a case of multifocal fibrosis extending retroperitoneally (Ormond's syndrome) with urinary tract obstruction and bilateral ureterohydronephrosis that resulted in chronic renal insufficiency. The development of mediastinal and pericardial fibrosis was accompanied by clinical symptoms of exudative and constrictive pericarditis. Fibrosis of cardiac conducting system was associated with compromised sinus node and intraventricular blockade. Paraaortic, paraorbital, and periportal extension of fibrosis was documented. Diagnosis was made based on clinical observations and results of MSCT. Duration of the disease was 20 years. Immunosuppressive therapy failed to improve the patient's condition because of irreversible structural and functional changes in the organs.

[Impact of cardiac resynchronization therapy on survival in patients with ischemic and nonischemic cardiomyopathy in clinical practice].

AIM: To compare the impact of cardiac resynchronization therapy (CRT) on survival in patients with ischemic and non-ischemic cardiomyopathy (CMP) in clinical practice. SUBJECTS AND METHODS: The study enrolled 206 patients with NYHA Functional Class II-IV chronic heart failure (CHF) and a left ventricular ejection fraction of < or = 35, including 107 patients implanted with CRT devices in combination with continuous drug therapy (DT). Among the 107 patients, 48 were diagnosed as having non-ischemic CMP (NCMP), 59 as coronary heart disease (CHD). The other 99 patients (12 with NCMP and 87 with CHD) were on DT only. Later on the patients from both groups were divided into subgroups according to the treatment policy of CHF: CRT + DT or DT only. The mean follow-up period was 24 +/- 18.1 months. RESULTS: The Kaplan-Meier survival analysis revealed that overall survival in the patients on CRT + DT was significantly higher than in those on DT (70 and 49%, respectively; p = 0.004). Analysis of the chosen treatment policy in the NCMP subgroup showed no significant differences in survival rates in the patients receiving CRT + DT or DT (74 versus 78%, respectively; p = 0.5). At the same time, the survival rates in the CHD patients on CRT + DT were significantly higher than those in the DT subgroup (68 versus 44%; p = 0.04). CONCLUSION: CRT significantly reduces overall mortality in patients with CHF in clinical practice. Our findings indicated that this effect was achieved mainly in patients with CHD, rather than in those with NCMP.

[Cryoballoon ablation for pulmonary vein isolation to treat atrial fibrillation: first experience in Russian Federation].

Cryoballon ablation (CBA) for pulmonary vein (PV) isolation is a new method for catheter-based treatment of patients with atrial fibrillation (AF). The purpose of our work is to describe the CBA technique and to report its short-term results. Methods. CBA was performed in 12 patients (8 men; age 53.1+/-5.7 years) with highly symptomatic drug-refractory AF. Paroxysmal AF was present in 11 and persistent AF - in 1 patient. CBA procedure was carried out under general anesthesia with intubation in 6 and under light sedation in 6 patients. After transseptal access and direct PV angiography, 28 mm-cryoballoon was introduced into the left atrium, and more or equal 2 cryoapplications were delivered to each PV, once good PV occlusion was obtained. PV isolation was verified utilizing a circular mapping catheter. Arrhythmia recurrences were monitored every 3 months after ablation using 24-hour Holter, and additional ECG registrations. Holter monitoring was also performed in a case of symptoms. Results. Complete electrical PV isolation was achieved by only cryoballoon ablation in 11 patients, and additional cryocatheter touch-up ablation was required in left PVs in 1 patient. Total procedure time was 203.1+/-34.2 min, fluoroscopy time - 50.5+/-14.0 min. There were no complications. During a mean follow-up period of 136.8+/-59.8 days 9 (75%) patients were free from arrhythmia recurrence after a single procedure. Redo ablation was required in 1 patient, in whom electrical reconnection to all PVs was documented. Conclusion. CBA is a novel promising technique for treatment of patients with AF, and now is available in Russian Federation. The method standardizes and facilitates interventional AF treatment with acute isolation of 96% PVs. The short-term follow-up shows freedom from atrial tachyarrhythmias in 75% of patients.