[Phospholipase A2, group IIa, as an earlier unknown immunohistological marker of cardiac myxoma].

Phospholipase A2, group IIA, gene expression has been analyzed in primary heart tumors. High expression has been demonstrated through several ways: reverse-transcriptase chain polymerase chain, Northern blotting hybridization at the RNA level and immunoblotting, immunohistochemical assay at the protein level. Human cardiac myxoma exhibits highly positive phospholipase A2, group IIA, immunophenotype (100% positive cases). The immunophenotype is unique among human primary cardiac tumors. Phospholipase A2, group IIA, can be proposed as a tissue marker for pathological examination after heart tumor resection.

[Identification of cytochromes P450 in the human liver microsomes by mass spectrometry].

Proteomic approaches have been used for detection and identification of cytochromes P450 from highly-purified membrane preparations of human liver. These included the protein separation by 2D- and/or 1D-electrophoresis and molecular scanning of a SDS-PAGE gel fragment in the range of 45-66 kD (this area corresponds molecular weights of cytochromes P450). The analysis of protein content was statistically evaluated by means of original 1D-ZOOMER software package which allowed to carry out processing of mass spectra mixture instead of individual mass spectra used by standard techniques. In the range of 45-66 kDa we identified 13 microsomal membrane proteins including 11 cytochromes P450, namely CYPs 1A2, 1B1, 2A6, 2E1, 2C8, 2C9, 2C10, 2D6, 3A4, 4A11, 4F2. The microsomal samples were characterized by the enzymatic assays using the marker substrates for CYP1A, 2B, 3A4, 2C and 2E1. The 7-methoxy- and 7-ethoxyresorufin-O-dealkylase activities (i.e. the marker activities for cytochromes P450 1A1/1A2, respectively) and the erythromycin-N-demethylase activity (i.e. the marker activity for cytochrome P450 3A4) are lowered in pathology compared to these activities in norm. At the same time the benzyloxyresorufin-O-debenzylase activity (which characterizes the total activity of CYP2B and CYP2C), the activities of CYP2E1 (methanol), 7-pentoxyresorufin-O-dealkylation (CYP2B), 7-ethoxy- and 7-methoxycoumarin-O-dealkylases (CYP2B1) did not change. On the basis of the results obtained efficiency of a combination proteomic and biochemical analyses for inventory cytochromes P450 and revealing of their level expression is shown, and opportunities of mass spectrometry for a quantitative estimation of proteins are discussed.

[Clinical, diagnostic and surgical aspects of heart space-occupying lesions at children and youths].

Clinical, diagnostic and surgical aspects of primary heart tumors, pseudotumor and morphologically unidentified heart space-occupying lesions were analyzed at 52 childhood and adolescence patients. Difficulty of early diagnosis, more aggressive clinical course in majority cases, and individual approach to the choice of surgical approach has been demonstrated. Principle of oncological determinant has been ensured the success in surgical treatment of patients with non-malignant intracavitary and intramuscular neoplasms, and also with pseudotumor space-occupying lesions. Postoperative lethality was low (2.2%), and there were no true recurrences of disease in long-term period after surgery.

[Study of the revascularizing properties of the greater omentum for creating prefabricated complex autografts under experimantal conditions].

The revascularizing properties of the greater omentum used as a vascular pedicle for the prefabrication of skin, skin/cartilage or skin/ bone autografts, and their viability after rotation and recipient zone infection were studied in rat experiments. The experiment showed that complexity factor did not have a significant effect on the revascularizing properties of the greater omentum, and required only an insignificant prolongation of prefabrication period. Skin/omental, skin/cartilageous, and skin/bony autografts based on the greater omentum formed by day 7, 14, and 21, respectively. After these periods prefabricated autografts remained viable upon rotation. In case of infection, the survival rate of prefabricated skin/bone autografts, revascularized with two-layer greater omentum, is lower than that of skin/cartilage ones. The technique of prefabrication of autografts including skin, cartilage, and bone, is a promising method for closure of vast multicomponent defects in complicated clinical situations.

[Immunomorphological study of coronary grafts].

Most patients subjected to coronary artery bypass grafting develop graft occlusions in some time after successful coronary surgery. Causes of graft occlusions comprise hyperplasia of intima occurring as a response to release of cytokines and angiotensin II. Angiotensin II is formed in human body with participation of angiotensin converting enzyme (ACE) or chymase. We found high concentrations of ACE in some smooth muscle cells in hyperplasia zone. Proliferation of smooth muscle cells, their hypertrophy and increased synthesis of intercellular space proteins facilitate graft occlusion. Moreover ACE was found in cytoplasm of macrophages infiltrating graft's intima. Thus ACE can be an important contributor to the process of coronary artery bypass graft obstruction.

[The CELO-ANG recombinant avian adenovirus with human angiogenine gene inducing neovascularization in the anterior tibial muscle of rat]. / Recombinantnyi adenovirus ptits CELO-ANG, nesushchii gen angiogenina cheloveka, indutsiruet neovaskuliarizatsiiu v perednei bol'shebertsovoi myshtse krysy.

The CELO recombinant avian adenovirus carrying the gene coding the human angiogenine (ANG) synthesis was obtained. Expression of the angiogenine gene was shown in the LMH cell culture after infection with the CELO-ANG virus. The ability of CELO recombinant adenoviruses to carry out the delivery and expression of alien genes in muscle cells was demonstrated in experiments with laboratory animals (Wistar line rats). The induced neovascularization in rat muscles after the animals were administered the CELO-ANG viruses was shown.

[Family myxoma of the heart with metachronic multiple growth]. / Semeinaia miksoma serdtsa s metakhronnym mnozhestvennym rostom.

A case of familial heart myxoma in 4 members of one family combined with myxomic (hamartomatous) syndrome is reported. The tumor in a proband was characterized with a multiple growth in various heart chambers. Five operations were made in the proband for 16 years and seven myxomas of different locations were removed. Myxomas originating from the endocardium of the interatrial septum oval hole were removed in 3 members of his family. The case confirms the conception of heart myxoma origin from endothelial hamartia of the endocardium.

A comparative study of the aortic wall in patients with Marfan's syndrome and Erdheim's disease.

The materiel of intraoperative biopsies (378) and autopsies was used to study the morphology of the aortic wall in patients with Marfan's syndrome (62) and Erdheim's disease (133). Histological, histochemical and electron microscopy research methods were employed with an assay of the results obtained. It has been demonstrated that in connective tissue dysplasia in the aorta, the histological structure of the intima undergoes substantial changes alongside the pathology of the tunica media. It is marked by the formation of a focal and diffuse thickening with the predominance of the interstitial substance, rich in glycosaminoglycans, and of a small amount of fibrous structures. The morphological signs of the impairment of endothelial permeability (vacuolisation of cytoplasm, thinning of its peripheral portions and basal membrane, expansion of intercellular fissures) are identifiabe, which leads to the disorder of aortic wall metabolism and early development of atherosclerosis. The changes in the intima together with the pathology of the tunica media ere predisposing factors of aneurysm formation, dissection and rupture of the aorta.

[Genetic engineering potential and perspectives in the management of critical ischemia]. / Vozmozhnosti i perspektivy lecheniia kriticheskoi ishemii s ispol'zovaniem genno-inzhenernykh tekhnologii.

The paper presents a new approach to management of lower limb critical ischemia which implements recent advances in molecular biology and genetic engineering technologies. A new original compound incorporating angiogenin gene was developed to activate neoangiogenesis processes after injection into living tissues. Experimental data evidence a potential efficacy of new method for complex management of critical ischemia.

[PRKAR1A gene mutations in two patients with myxoma syndrome (Carney complex)]. / Mutatsii v gene reguliatornoi sub"edinitsy 1-alpha tsiklo-AMF-zavisimoi proteinkinazy A (PRKAR1A) u dvukh bol'nykh s miksomnym sindromom (kompleksom Carney).

Carney complex is an autosomic dominant disorder initially described as the association of cardiac myxomas, spotty skin pigmentation and endocrine overactivity and considered as a multiple neoplasia and lentiginosis syndrome. Mutations in the tumor suppressor gene PRKAR1A, coding for the type 1-alpha regulatory subunit of cAMP-depended protein kinase A have been previously identified in about half of the Carney complex kindreds. In this paper we report identification of the molecular defect in PRKARIA gene in two Carney complex patients. A new mutation (403delAC) located in a 3rd exon of PRKARIA gene has been observed in one case, and a previously described mutation in exon 7 (847delTC) in the second case.

[Heart myxoma histogenesis in the light of its histological and ultrastructural features]. / Predstavleniia o gistogeneze miksomy serdtsa v svete ee gistologicheskikh i ul'trastrukturnykh osobennostei.

In 168 cases of heart myxoma histological and electron-microscopic examination have revealed signs of embryonal endothelium capable of vasoformation and glycoprotein and glycosaminoglycanes synthesis in myxoma cells. Neither differentiation of myxomas cells up to mature endotheliocytes no signs of malignant transformation was found. According to the authors, heart myxoma is a true benign dysontogenetic tumor originating from embryonal endothelium. The term myxoma does not reflect morphological entity of the tumor and the authors suggest to call it embryonal endocardial endothelioma.

[Short and long-term results of surgical correction of the aortal valve dysplasia]. / Blizhaishie i otdalennye rezul'taty khirurgicheskoi korrektsii displazii aortal'nogo klapana.

Nearest and long-term results of surgical treatment of 108 patients with dysplasia of aortal valve were analyzed. Necessity of individual approach to choice of method of surgical correction (prosthesis or valvuloplasty of aortal valve) depending on degree of dysplasia and/or secondary valvular pathology, it anatomic variants, presence of concomitant infectious endocarditis and age of patients is noted. This permitted to reduce hospital lethality from 8.8 to 3.9%. Survival in 1, 5 and 10 years after prosthesis and valvuloplasty of aortal valve was 92.3 +/- 3.3, 86.8 +/- 4.8 and 85.7 +/- 5.7% versus 100, 94.1 +/- 4.1, 94.1 +/- 4.1% respectively. Quality life in remote period was evaluated as good in 80.3% operated patients, as satisfactory--in 11.1% and unsatisfactory--in 8.6%.

[Reparative regeneration of the human liver grafted from a cadaver and a relative donor]. / Reparativnaia regeneratsiia pecheni cheloveka, transplantirovannoi ot trupa i rodstvennogo donora.

The morphological features and dynamics of regeneration of the grafted human liver were studied by using data on 609 needle biopsies obtained for morphological monitoring in 38 recipients during transplantation of the liver from cadavers and relative donors. The biopsy specimens of donor organs taken prior to grafting served as a control. Irrespective of the type of grafting, regenerative processes in the grafted liver were shown to have common regularities and to run by using the mechanisms of both intracellular regeneration and proliferation. Their maximum rate was seen within a month after grafting of a cadaverous organ and within 3 months after grafting a part of the liver from a relative donor. In cadaverous transplantation, regenerative processes depended mainly on the degree of ischemic lesions; in relative donor organ transplantation, that depended on the fitness of graft mass (the index K being close to 0.5), proliferative processes and the time of higher hepatocytic ploidity increased. An adequate evaluation of the status of a cadaverous organ, estimation of the optimum mass of a grafted hepatic part from a relative donor, and effective immunosuppressive therapy ensure required reparation rates and a complete recovery of the structure of a graft.

[Differential diagnosis of hepatocellular carcinoma using laser DNA-cytofluorometry]. / Differentsial'no-diagnosticheskie kriterii gepatotselliuliarnogo raka, opredelennye metodom lazernoi DNK-protochnoi tsitofliuorometrii.

Because of insufficient amount of material obtained in many cases of puncture biopsy, Differential diagnosis of hepatocellular carcinoma (HCC) with benign tumors and focal cirrhotic lesions of the liver is difficult. The study was aimed at development of additional criteria for HCC differential diagnosis of the basis of a comparison of morphological data (histological and cytological) with DNA content in the cells of focal lesion of the liver and is based on the research of biopsy material from 111 patients with focal liver lesions. Laser DNA flow cytometry (DNA-FCM) was carried out in 59 samples using laser flowing cytometer FACScan (Becton Dickinson, USA). The complex of three HCC histological criteria was established (trabecular histoarchitecture, increased nuclear-cytoplasmatic rate and nuclear crowding) for comparison with puncture biopsy of the liver (diagnostic efficiency 93.7%). Optimal quantitative parameters for HCC diagnosis were the following: reduction of the number of cells in a GO/1 phase of the cell cycle (< 77.5%), appearance of aneuploid clone of cell DNA index > 1.0 and decreased percent of binucleated cells (< 10%). Very high diagnostic specificity of the research was found (98.3%). Usage of quantitative parameters in the complex with histological criteria of HCC increased efficiency of the diagnosis up to 98%.

[Vitaflon vascular graft for portocaval shunt: experimental and clinical study]. / Eksperimental'no-klinicheskoe issledovanie sosudistykh protezov "Vitaflon" pri portokaval'nom shuntirovanii.

Native "Vitaflon" vascular graft made of spongeous polytetrafluoroethylene for portocaval shunt was evaluated in patients with portal hypertension. Experimental series in grey rabbits proved high biological inertness of the graft. It was used for portocaval shunt in 13 patients. The follow-up from 1 to 32 months demonstrated successful results in 12 cases.

[Perioperative myocardial infarct during the surgical treatment of IHD]. / Perioperatsionnyi infarkt miokarda pri khirurgicheskom lechenii IBS.

Perioperative myocardial infarction is one of the most frequent causes of death in patients subjected to surgery for coronary disease. Study of the pathogenesis of this complication may become an approach to decreasing the postoperative mortality. Forty-seven case histories and autopsy protocols of patients who died after surgery on the coronary arteries and 241 intraoperative biopsy specimens of autovenous shunts are analyzed. The mechanisms underlying the cardiomyocyte necrosis in surgical treatment of coronary disease are based on various pathological processes, the leading of which is thrombosis of the shunts and coronary arteries. The principal factors were intraoperative ischemia of autovein endothelium and shunting of coronary artery with a narrow distal bed.

[Primary tumors of heart]. / Pervichnye opukholi serdtsa.

The analysis of 36 years' experience in surgical treatment of 162 patients with benign and malignant primary tumors of the heart, verified by morphological examination, is presented. The possibility of their timely and intra vital revealing is noted in cases of clinical alertness which makes possible to suspect this disease and purposefully examine these patients using preferably echocardiography and computed tomography. The scope of the operations and their success depend on morphological characteristics of the tumors and the extent of neoplastic process. However, by now short- and long-term results of surgical treatment evidence, that predominant part of this category of patients is potentially curable, provided that these neoplasms of the heart were revealed at an initial stage.

[Diagnostic and prognostic aspects of myxoma syndrome]. / Diagnosticheskie i prognosticheskie aspekty miksomnogo sindroma.

The analysis is presented of clinicomorphological and laboratory characteristics of myxoma syndrome which are of prognostic value. Early diagnosis of the syndrome is essential in making decision on the intraoperative and long-term postoperative treatment policy.

[Orthotopic liver transplantation]. / Ortotopicheskaia transplantatsiia pecheni.

Orthotopic liver transplantation is the only method of choice for many severe liver diseases with poor prognosis. The development of liver transplantation programmes is based on medical science achievements and high technology in surgery, anesthesiology and perfusiology. The experience of the Surgery Research Center, Russian Academy of Medical Sciences, made it possible to obtain positive results of liver transplantation and posttransplantation management. This in turn provided longer survival for 80% of recipients. At the same time the mortality of potential recipients was 60.4%, which is due to the greater shortage of donor organs and which is the main problem in the development of organ grafting in Russia. The fact that there is a high proportion of children who are recipients for the donor's liver requires that liver transplantation from living related donors should be developed.