[A Case of Apical Hypertrophic Cardiomyopathy With Rare Anomaly of Coronary Arteries Origin].

A clinical case of apical hypertrophic cardiomyopathy (HCM) in 44­years old man is presented. In this patient exercise ECG testing and 24­hour ECG monitoring revealed exercise-induced ST depression in the angiographically confirmed absence of coronary atherosclerosis. The uncommonness of this observation was the combination of HCM with a rare anomaly of coronary arteries origin.

[Abdominal radiology in oncology: The new trends in computed tomography and magnetic resonance imaging].

Paper gives a review of recent technical innovations in computed tomography (CT) and magnetic resonance imaging (MRI) that could be applied in abdominal oncology. Perfusion and dualenergy CT gives new opportunities for tissue characterization. Interactive reconstruction algorythms decrease radiation exposure to patients. Abdominal MRI has some important advantages over CT in detection and staging of abdominal malignancies. Nowadays standard MR protocols include DWI and dynamic 3D sequences with extracellular or liver-specific contrast media. Latest developments in MRI technology could expand its diag- nostic value in abdominal oncology even further.

[Challenges and opportunities for endoscopic ultrasound in the preoperative diagnosis of topical insulin the pancreas].

Insulinoma in most cases is monohormonal orthoendocrine tumor. This fact limits its searching area by a pancreas. However the insulinoma's clinical picture can be caused by other pathology. Therefore the main task of visual the tumor but also to use all the possibilities of each method for defining type of surgery and avoiding such errors and complications, as pancreatorrhage, damage of bile or pancreatic duct, necrosis of duodenal wall, etc. On the basis of our own experience of endoscopic ultrasound for 61 patients with 66 insulinomas, we have allocated the basic variants of insulinoma ultrasound pictures: hypoechoic, heteroechoic, isoechoic tumor, and also foci without a trustworthy contour. On the basis of the analysis of our own errors we have essentially added the technique, having used multiplane pancreas scanning and biplane tumor scanning. Important points in EUS algorithm are also the following items: detecting tumor relationship to pancreatic surface, distance from the tumor to the ducts, gastrointestinal wall and vessels--for definition of possibility of the tumor enucleation; careful scanning of pancreas even after detecting one tumor--for an exception of multiple tumors, especially at MEN-I; careful scanning of a contour of the gland for an exception of parapancreatic insulinomas; estimation of vascularization not only of the detected tumor and suspicious foci, but also of all the gland--for detection of hypervascularized isoechoic tumors; revealing and the description of focal changes, especially more homoechogeneous in comparison with surrounding parenchyma-- for selection patients for examination by other methods; scanning of zones of possible metastasis. Examination of patients with organic hyperinsulinism demands combined application of two or more techniques. Use of all modern possibilities of endosonography can put this technique on one of the first places in the diagnosis of insulinomas.

[Venous system of the heart in chronic heart failure].

The intravital and posthumous changes of the venous system of the heart were studied in patients with chronic heart failure (CHF). Using the method of computer spiral tomography, the increase of the diameter of subepicardial and anterior cardiac veins, as well as of the coronary sinus, was detected that correlated with the stages of heart failure development. The increase of a total thickness of the veins wall at the expense of tunica media was recorded at the initial stages of CHF, which was later followed by the decrease of wall thickness due to the development of connective tissue.

[Capacities of computed tomographic angiography in the diagnosis and estimation of the site, pattern, and degree of vascular bed lesion in nonspecific aortoarteritis].

Nonspecific aortoarteritis (NAA) is a chronic inflammatory disease that affects the aorta and its branches. The clinical manifestations of this disease are of a great variety and depend on the site of a lesion and the stage of the disease. A wide range of highly informative noninvasive imaging techniques, such as duplex scanning (DS), magnetic resonance imaging (MRI), and computed tomography (CT) of the aorta and its branches, are used to make a more accurate diagnosis and to determine the site and extent of a vascular bed lesion. The given clinical example suggests that CT angiography of the aorta and its branches is a high-precision technique in determining the site of vascular bed lesion in patients with NAA and the pattern and extent of arterial involvement and that it may be used for both the diagnosis of the disease at its developmental stages and the monitoring of the vessels during pathogenetic therapy.

[Extent and location of lesions in aorta and its main branches in patients with nonspecific aortoarteritis with various genotypes in the region of major histocompatibility complex].

AIM: To elucidate associations between location and extent of lesions of arterial vascular bed in patients with nonspecific aortoarteritis and presence of various alleles of DRB1 gene of HLA class II in patients of Russian ethnicity. MATERIAL AND METHODS: Ultrasonography, magnetic resonance imaging and computed tomography were used for examination of arteries in 25 patients aged 22-69 years. Genotyping of HLA-DRB1 locus was carried out in all patients and in a group of practically healthy subjects of the same ethnic group (controls). RESULTS AND CONCLUSION: Patients compared with controls had significantly higher frequency of class II alleles of HLA-DRB1 gene which corresponded to serological specificity DR1. Subgroup of patients carriers of DR1 allele had significantly less extensive involvement of arterial vasculature compared with subgroup of carriers of other alleles. The revealed clinical-genetic relationship reflects special features of aortoarteritis in Russian population and evidence for genetic heterogeneity of this disease.

[Therapy of patients with arterial hypertension with fixed dose combination of losartan and hydrochlorothiazide. Effect on 24 hour blood pressure and left-ventricular hypertrophy]. / Vliianie dlitel'noi terapii kombinatsiei lozartana i gidrokhlorotiazida na sutochnyi profil' arterial'nogo davleniia i gipertrofiiu levogo zheludochka u bol'nykh s miagkoi i umerennoi arterial'noi gipertoniei.

Twenty four hour blood pressure (BP) monitoring was carried out and structural state of left ventricular myocardium assessed in 20 patients with mild and moderate hypertension before and after 24 weeks of therapy with Hyzaar - fixed dose combination of losartan (50 mg) and hydrochlorothiazide (12.5 mg). According to data of 24-hour BP monitoring the use of Hyzaar was associated with lowering of diurnal (by 26.9/17.2+/-3/2 mm Hg, p<0.001), nocturnal (by 32.6/18.9+/-3/2 mm Hg, p<0.001), pulse (p<0.001) BP, and rate of morning systolic BP rise (p<0.05), decrease of nocturnal systolic and diastolic BP variability, and improvement of 24-hour BP rhythm. Trough/peak coefficients for systolic and diastolic BP (70 and 76%, respectively) reflected sufficient and steady hypotensive effect throughout 24 hours after single dose of Hyzaar. Target BP level was achieved in 70% of patients. At the background of 24-week treatment with Hyzaar left ventricular myocardial mass index significantly decreased (from 120.1+/-3.5 to 108.6+/-3.1 g/m2, D=11.5+/-1.0, p<0.001) and became normal in 60% of patients. Correlation analysis revealed independence of cardioprotective action of therapy from its hypotensive activity. Thus therapy with Hyzaar produced hypotensive and cardioprotective effects which were independent from each other.

Potential of phosphorus nuclear magnetic resonance spectroscopy in studies of the energy metabolism of skeletal muscles.

The aim of the present study was to investigate the possibility of phosphorus magnetic resonance spectroscopy (MR spectroscopy) in the diagnosis of metabolic lesions of skeletal musculature in patients with intermittent claudication syndrome, chronic cardiac failure, and varicose diseases of the lower limbs. Studies included 50 males: 20 patients with intermittent claudication, 10 patients with chronic cardiac failure, and 10 patients with varicose veins. The control group consisted of 10 healthy volunteers. The following measures were determined: the phosphocreatinine index, the intracellular pH in the gastrocnemius muscle, and the half-recovery time for the phosphocreatinine index. The phosphocreatinine index and the pH at rest did not differ between study groups. Isotonic exercise produced no change in the phosphocreatinine index in the control group; patients with intermittent claudication showed a 26.1% decrease, patients with chronic cardiac failure showed an 8% decrease, and patients with varicose veins showed a 25.6% decrease. The only group showing a significant decrease in pH during exercise was the group of patients with intermittent claudication. This group also showed an inverse correlation between the pressure index and the extent of the decrease in the phosphocreatinine index. Thus, MR spectroscopy provides a non-invasive diagnostic method for lesions of energy metabolism in skeletal musculature in patients with deranged peripheral hemodynamics.

[Characteristics of intracardiac hemodynamics in healthy volunteers studied by cine-MRI]. / Osobennosti vnutriserdechnoi gemodinamiki u zdorovykh dobrovol'tsev pri vypolnenii kino-MRT.

15 healthy volunteers were investigated by MR to study normal intracardiac hemodynamic. Cine-MRI was performed on 1.5T "Magnetom SP" System. Regions of low signal intensity in at least cardiac chamber were found in 93%. The most frequent finding was a linear area of signal loss along the anterior mitral leaflet during diastole (86%). The distinction of normal areas of signal loss from pathologic is based on the extent and duration of the flow disturbance.

[Potential possibilities of using adrenergic beta blockers in chronic heart failure]. / Potentsial'nye vozmozhnosti primeneniia beta-adrenoblokatorov pri khronicheskoi serdechnoi nedostatochnosti.

The study was undertaken to examine the efficacy of beta-adrenoblockers used in 26 patients with chronic heart failure which had been caused by coronary heart disease in 12 patients, by rheumatic heart disease in 8 patients, by dilated cardiomyopathy in 5 patients, and by chronic myocarditis in 1 patient. beta-Blockers such as oxprenolol, propranolol, and metoprolol were supplemented to the therapy of the patients with chronic heart failure who were resistant to cardiac glycosides, diuretics, and vasodilators. This resulted in functional class improvement by the New York Heart Association from 3.67 +/- 0.1 to 2.29 +/- 0.1. The authors defined the following predictors of the efficacy of beta-blockers in chronic heart failure: duration of the disease, diastolic pressure, cardiac rhythm, and left ventricular ejection fraction and discussed the mechanisms responsible for their positive effect in chronic heart failure.

[Surgical tactics in dissecting aneurysms of the ascending aorta]. / Khirurgicheskaia taktika pri rasslaivaiushchikh anevrizmakh voskhodiashchei aorty.

The aspects of surgical tactics in management of dissecting aneurysms of the ascending aorta are analysed in relation to the disease etiology, the anatomical pattern of the aortic root, presence of attending aortic insufficiency, and dissection extension. Based on the experience of 32 operations (March 1979--February 1988), it is concluded that the abnormal type must be the best criterion for choosing the surgical technique. In dissecting aneurysms due to aortic wall degeneration, Bentall-De Bono and Cabrol's modifications are preferable. In dissecting aneurysms of atherosclerotic origin, the boundary of the proximal extension of dissection should be taken into account. When the dissection extends into the aortic root, the operation using a valve-containing conduit with reimplantation of the ostia of the coronary arteries is feasible. If the aortic root is not involved, isolated prosthesis of the ascending aorta or separate prosthesis of the aortic valve and ascending aorta may be performed depending on the presence of aortic failure.

[Thrombocyte function during the performance of plasmapheresis and immunosorption in patients with familial hypercholesterolemia]. / Sostoianie trombotsitov pri provedenii plazmafereza i immunosorbtsii u bol'nykh s semeinoi giperkholesterinemiei.

The impact of plasmapheresis (PA) and immunosorption (IS) of low density lipoproteins (LDLP) on platelets was examined in patients with familial hypercholesterolemia. PA and IS sessions resulted in a decrease of platelet counts, aggregation activity in relation to TXA2 analogue, U46619, and capacity for adhesion and spreading over type-4 collagen-coated surface. All effects were of similar markedness in both procedures, i.e. they were unrelated to PA or IS specificity, but rather were due to platelet interaction with extracorporeal circulation circuit. Platelet changes seen immediately after the procedure were transitory. Platelet counts and capacity for aggregation and adhesion were recovered by the time of the next procedure (1 or 2 weeks later). Long-term (more than 6 months') use of PA or IS did not essentially affect platelet counts, aggregation and adhesion, but rather undermined platelet spreading capacity.