[Possibility of complex medicamental and endovascular treatment of pulmonary hypertension in Takayasu arteritis with predominant pulmonary arteries' lesion].

Takayasu arteritis (TA) is a systemic vasculitis with predominatly lesions of aorta and its large branches. In some cases pulmonary arteries (PA) are involved in the pathological inflammatory process and lead to the formation of pulmonary hypertension and significantly worse the prognosis. Timely development of lesion of PA, appointment of adequate therapy and surgical treatment can prevent irreversible damage of blood vessels and improve the prognosis. Perioperative administration of interleukin-6 inhibitor inhibitor (tocilizumab) in at patients with indications for vascular surgery, including angioplasty PA, should be considered as a promising approach to control the inflammatory activity of TA, reduce the dose of glucocorticoids and the risk of postoperative complications. We present the clinical experience of significant improvement in the patients condition was achieved by using two-stage balloon angioplasty on the background of control of the disease activity with interleukin-6 tocilizumab intravenously and specific therapy with riociguat and iloprost.

[A case of primary diagnosis of patent ductus arteriosus at the age of 75 years]. / Sluchai pervichnoi diagnostiki otkrytogo arterial'nogo protoka u patsientov v vozraste 75 let.

The paper describes a case of primary diagnosis of functioning patent ductus arteriosus in a 75-year-old female patient.

[Radiographic assessment of pulmonary hypertension: Methodical aspects].

Pulmonary hypertension is a menacing complication of a number of diseases, which is responsible for high mortality rates and considerably poorer quality of life in a patient. The timely detection for pulmonary hypertension allows timely initiation of treatment, thus improvement in prognosis in the patient. Chest X-ray is the most commonly used radiographic technique for various causes. Physicians' awareness about the radiographic manifestations of pulmonary hypertension may contribute to the earlier detection of this severe disease. Owing to the natural contrast of reflected structures, a chest X-ray film gives a unique opportunity to assess pulmonary circulation vessels, to reveal the signs of pulmonary hypertension, and to estimate trends in the course of the disease. The paper details a procedure for analysis and the normal radiographic anatomy of pulmonary circulation vessels, gives the present classification of pulmonary hypertension, and sets forth its X-ray semiotics.

[New tasks of professional education in preparing the accreditation of radiologists].

The paper sets forth the basic provisions of the accreditation of healthcare workers, the principles of a new approach to continuing postgraduate education, by introducing the storage system of credit units, and the tasks of educational establishments to form self-education motivation and to master novel competences.

[Age-related diagnostic features of congenital atrial septal defect in adults according to the data of radiodiagnostic studies].

OBJECTIVE: To reveal diagnostic features in atrial septal defect (ASD) in different age groups; to define a role of X-ray study in the diagnosis of ASD. MATERIAL AND METHODS: Forty-eight patients (16 men and 32 women) aged 15 to 71 years with ASD at different sites were examined. All the patients underwent chest X-ray, echocardiography, and cardiac phase-contrast magnetic resonance imaging (MRI). The examinees were divided into 2 age groups: 1) less than 40 years (n = 18) and 2) more than 40 years (n = 30). The groups were compared using quantitative and alternative signs and they did not significantly differ in the volume of intracardiac shunt and in the size of the defect. The X-ray and MRI indicators reflecting the calibers of pulmonary arteries were also compared in patient groups with different pulmonary artery systolic pressures (PASP) (< 35, 36-60, and > 60 mm Hg). RESULTS: The older age group more frequently showed signs of heart failure, valvular regurgitation, and an atypical X-ray pattern. The sizes of atria, pulmonary artery and its branches, and PASP were also increased in the older age group. The patient group with high PASP (> 60 mm Hg) significantly differed from the others in all the indicators analyzed. Normal PASP and moderate pulmonary hypertension groups greatly differed only in the Moore index. CONCLUSION: Chest X-ray reflects rather precisely the hemodynamic type of the defect. High pulmonary hypertension has clear X-ray and MRI manifestations. The specificity of X-ray in the diagnosis of PASP is lower in the older age group due to the higher rate of an atypical X-ray pattern. Radiology is important in detecting pulmonary venous hypertension in patients with PASP. Pulmonary venous hypertension is indicative of elevated pressure in the left atrium and pulmonary veins and arises from different causes: shunt inversion, restrictive defect, mitral valve comorbidity, and left ventricular systolic and diastolic dysfunction.

[Prevention of contrast-induced nephropathy in the context of evidence-based medicine].

The paper considers the mechanisms of development of contrast-induced nephropathy in the use of iodinated radiopaque contrast agents (RCAs), as well as the criteria of their assessment. It gives different existing recommendations for prevention of the nephrotoxic effects of RCAs.

[Risk-group patients due to the administration of iodine and gadolinium preparations for diagnostic clinical study].

The paper discusses the concept of risk-group patients who have an increased probability of immediate systemic adverse reactions to contrast agents used clinically in various radiodiagnostic techniques. It analyzes the pathogenesis of allergoid reactions to X-ray and magnetic resonance, contrast media. On this basis, the authors describe the abnormalities and nosological entities the patients had in their medical history before diagnostic studies will be indicative of the increased risk of these complications to the administration of a contrast agent.

Aneurysm of aortocoronary bypass graft: two clinical case reports.

The article deals with the description of two clinical case reports of a rare complication following operations of aortocoronary bypass grafting, i. e., aneurysms of aortocoronary bypass grafts. The diagnosis of an aneurysm of the bypass graft was in both cases made by means of modern methods of radiodiagnosis, namely, electron-beam tomography and multislice helical computed tomography.

[Pulmonary venous occlusive disease].

The present study deals with the radiation diagnosis of the rare disease--pulmonary venous occlusive disease. The follow-up covered three cases that ended with death. The clinical picture of the disease did not differ from the manifestations of primary pulmonary hypertension. All the patients underwent chest X-ray study in four standard projections. The morphological verification of its diagnosis was made on the basis of autopsy data. X-rat study promoted identification of such signs as peculiar changes in the lung pattern in form of its looping, reticulation, fine-focality along with reticular changes, the presence of Kerley lines, the diameter of root branches, enlargements of the pulmonary trunk without any symptoms of the enlarged left atrium.

[Examining the effect of amiodarone on the lung: data of prospective study]. / Izuchenie vliianiia amiodarona na legkie po dannym prospektivnogo nabliudeniia.

Amiodarone (A) that belongs to Class III antiarrhythmics is a highly antiarrhythmic agents not only in treating, but in preventing various cardiac arrhythmias. However, its prolonged treatment may have an adverse life-threatening effect on the lung in 1-10% of patients. The purpose of our study was to verify the safe effect of A on the lung. Forty-one patients receiving A were examined in the period of its saturation and for the following 6 months. A hundred and forty-nine patients treated with its maintaining doses long (for 11 years) were also studied. Lung X-ray films and spirograms were repeated every 1-3 months at the beginning of therapy and then every 6 months. Side pulmonary effects were not observed. The findings may lead to the conclusion that comparatively small maintaining doses of A are safe for the patient.

[Examining the effect of amiodarone on the lung: prospective follow-up data]. / Izuchenie vliianiia amiodarona na legkie po dannym prospektivnogo nabliudeniia.

Amiodarone (A) that belongs to Class III antiarrhythmics is a highly antiarrhythmic agents not only in treating, but in preventing various cardiac arrhythmias. However, its prolonged treatment may have an adverse life-threatening effect on the lung in 1-10% of patients. The purpose of our study was to verify the safe effect of A on the lung. Forty-one patients receiving A were examined in the period of its saturation and for the following 6 months. A hundred and forty-nine patients treated with its maintaining doses long (for 11 years) were also studied. Lung X-ray films and spirograms were repeated every 1-3 months at the beginning of therapy and then every 6 months. Side pulmonary effects were not observed. The findings may lead to the conclusion that comparatively small maintaining doses of A are safe for the patient.

[Diagnosis of endocardial electrode microdislocation at endocardial pacing]. / K voprosu diagnostiki mikrodislokatsii éndokardial'noí élektricheskoí stimuliatsii serdtsa.

Signs of microdislocation of an endocardial electrode (EE) were observed in 56 (14.4%) of 390 patients with an implantable pacemaker in the postoperative period. The microdislocation was diagnosed from electrocardiographic evidence for no response of a pacing pulse and from fluctuations in the pacing threshold, and from X-ray findings of the thickened and ill-defined outlines of a distal EE with preserving cardiac stimulation. The microdislocation preserves high parameters, as evidenced by a PM-20 M digital analyzer.