[PET/CT with 18F-fluorodeoxyglucose and 11C-methionine after autologous stem cell transplantation in multiple myeloma patients].

AIM: to compare the results of tumor visualization when using 18F-FDG and 11C-methionine PET/CT after auto-HSCT in MM patients. MATERIALS AND METHODS: A prospective study included 27 MM patients subjected to 18F-FDG and 11C-methionine PET/CT on day 100 after auto-HSCT. Obtained images were visually and semi - quantitatively analyzed. Focal areas of increased uptake for every radiopharmaceutical agent (hypermetabolic foci) not associated with its physiological distribution were registered. Maximum Standardized Uptake Values (SUVmax) in pathological foci were automatically calculated for every radiopharmaceutical agent separately. PET/CT findings were compared to antitumor response achieved after auto-HSCT according to International MM Working Group criteria. RESULTS: After auto-HSCT, the majority of patients (16/60%) achieved a complete response. Abnormal 18F-FDG uptake was registered in 37% (n=10) of patients, negative PET findings were obtained in 63% (n=17) of patients. 11C-methionine PET/CT revealed hypermetabolic foci in 67% (n=18) of patients, and there was no 11C-methionine uptake in 33% (n=9). Pathological foci of radiopharmaceutical agent uptake were 1.8 times more frequently revealed using PET/CT with 11C-methionine (p.

[Subcutaneous panniculitis-like T-cell lymphoma: The authors' experience of diagnosis and treatment]. / Podkozhnaya pannikulitopodobnaya T-kletochnaya limfoma. Sobstvennyi opyt v diagnostike i lechenii.

The paper gives the data of clinical, histological, immunohistochemical, and molecular studies and the results of positron emission tomography in 3 cases of subcutaneous panniculitis-like T-cell lymphoma (SPTCL). It shows the high efficiency of a GEM-P regimen in the treatment of patients with SPTCL.

[Differential diagnosis of rheumatic diseases and blood cancers involving the nasal cavity and accessory sinuses].

AIM: To provide the clinical, laboratory, radiological, morphological, and immunomorphological signs that permit the differential diagnosis to be made in patients with involvement of the nasal cavity and accessory sinuses (NCAS). SUBJECTS AND METHODS: In the period 2009 to 2013, the Laboratory for Intensive Therapy for Rheumatic Diseases, V.A. Nasonova Research Institute of Rheumatology, Russian Academy of Medical Sciences, associated the disease onset with NCAS involvement in 39 (7.6%) of 512 examinees. NCAS involvement was present at disease onset in 100% of the patients with natural killer (NK) cell lymphoma (NK/T lymphoma), in 84.5% of those with Wegener granulomatosis (WG), in 29.5% of those with IgG4-related disease (IgG4-RD), and in 17.5% of those with sarcoidosis. Such an onset could be extremely rarely observed in histiocytosis. RESULTS: Despite the similar clinical manifestations, NCAS involvements in NK/T lymphoma of nasal type and WG at disease onset show clear differences in the laboratory and systemic manifestations of these diseases. The patients with lymphoma have no characteristic laboratory abnormalities at disease onset, except the 100% presence of Epstein-Barr virus (EBV) DNA in blood and, only as a tumor grows, fever appears and there are elevated C-reactive protein and lactate dehydrogenase levels and pronounced destructive changes in the facial bones with mandatory hard palate destruction; at the same time the signs of systemic involvement are virtually absent. The patients with WG at disease onset have fever, high erythrocyte sedimentation rate, elevated C-reactive level, significant anemia, leukocytosis and 90% are found to have anti-neutrophil cytoplasmic antibodies with the rapid development of systemic manifestations: involvements of the lung, kidney, and peripheral nervous system. Destructive changes in the facial bones are minimal and hard palate destructions are absent. The patients with IgG4-RD, sarcoidosis, and juvenile xanthogranuloma have similar clinical and laboratory manifestations in the absence of hemorrhagic nasal discharge, nasal septal perforation, and facial bone destruction, with the practically involvement of the salivary/lacrimal glands and orbital regions. A third of the patients are observed to have different allergic manifestations, moderate eosinophilia, and signs of autoimmune disorders (the presence of rheumatoid and antinuclear factors, hypergammaglobulinemia). Elevated serum IgG4 levels are characteristic of IgG4-RD. CONCLUSION: Blood anti-neutrophil cytoplasmic antibodies, EBV DNA, and IgG4 levels should be determined in all patients with NCAS involvement. Mini-invasive incision biopsies of the nasal mucosa, orbital regions, and major salivary glands should be done, by morphologically verifying the diagnosis of sarcoidosis, histiocytosis, and WG and by making an immunomorphological examination to diagnose NK/T lymphoma and IgG4-RD.

[On the state and prospects of development of remote neutron therapy].

The state and prospects of remote neutron therapy were analyzed in this review. Years of experience with fast neutrons, both positive and negative, allow evaluating the most promising ways of further development of this area of radiation therapy. These include conducting targeted research for those tumors which received some encouraging results, a use of the combination of fast neutron therapy and conformal photon therapy as well as the creation of specialized medical facilities for neutron therapy based on optimization of both parameters of spatial distribution of the dose and radiobiological characteristics.

[Takayasu syndrome in Horton's disease].

Problems of diagnosis (including early diagnoses) and treatment of giant cell arteritis the commonest form of vasculitis in subjects above 50 years. An aged woman presenting with rheumatic polymyalgia is described in whom cell arteritis was diagnosed by positron emission tomography. Etiology of this disease and it medicamentous treatment are discussed with reference to the patients' age and concomitant pathologies.

Use of human VEGF(165) gene for therapeutic angiogenesis in coronary patients: first results.

The paper presents the first results of therapeutic angiogenesis in clinical cardiosurgery: human VEGF(165) gene transplantation to coronary patients. The use of this therapeutic method is particularly effective in patients with inoperable cardiovascular injuries, i.e. patients with the most severe condition, in whom treatment remains little effective at the modern level of cardiosurgery development.

[ECG-gated single-photon emission computed tomography with 99mTC-tetraphosmin in diagnostics of short-term myocardium stunning under the condition of stress-induced ischemia in CHD patients with multivascular lesions of coronary vessels].

The authors analyzed the efficiency of ECG-gated single-photon emission computed tomography (SPECT) with 99mTc-tetraphosmin in diagnostics of short-term myocardium stunning in CAD patients with transient ischemia. The technique was applied to 16 CAD patients. Combined evaluation of perfusion was based on the analysis of radiotracer uptake level in left ventricle (LV) myocardium. In order to evaluate myocardium function the authors measured LV systolic thickening index, using 20-segment pattern. 8 out of 16 patients (50%) displayed the phenomenon of stress-induced stunning. The volume of stunned myocardium in individual patients was 2 to 7 LV segments. In general, up to 37% (29/78) of reversible perfusion defects are subjected to short-term stunning under the condition of transient ischemia. After surgical treatment, 84% of segments with signs of stunning normalized their functioning both under stress and at rest.

[New approaches to the treatment of ischemic heart disease: therapeutic angiogenesis in combination with surgical revascularization of the myocardium]. / Novye podkhody k lecheniiu ishemicheskoi bolezni serdtsa: terapevticheskii angiogenez v sochetanii s khirurgicheskoi revaskuliarizatsiei miokarda.

AIM: To evaluate the results of surgical treatment of patients with ischemic heart disease in combination with intraoperative intramyocardial introduction of the human gene VEGF165 (angiostimulin). MATERIAL AND METHODS: Twenty four patients enrolled in the study were examined using 12-lead ECG, echocardiography, treadmill exercise test, single-photon emission computed tomography of the myocardium with Tc-99m-tetrophosmine, fluorodesoxyglucose (FDG) positron-emission tomography of the myocardium, selective coronarography. Out of 24 patients, 10 patients have been reexamined so far. The effect of the treatment was assessed by the data obtained at the treadmill test, transthoracic echocardiography, myocardial scintigraphy and FDG. RESULTS: All the patients demonstrated a clinical response. The class of effort angina improved, the dose of the prescribed nitric drugs was decreased, exercise tolerance and total stress time rose, quality of life improved. Myocardial scintigraphy registered reduction of the total area and better accumulation of the radiopharmaceutical under load and at rest 3 and 6 months after the operation including myocardial areas which had not been revacularised at coronary artery bypass grafting but had been treated with the preparation of the human gene VEGF165. CONCLUSION: The results of the study suggest that therapeutic angiogenesis may be an alternative impact on those myocardial areas which are supplied by the affected but ineligible for bypass grafting coronary arteries.

[Load tests in silent myocardial ischemia and latent heart failure in patients with IHD and intermittent claudication]. / Nagruzochnye proby pri bezbolevoi ishemii miokarda i skrytoi serdechnoi nedostatochnosti u bol'nykh IBS i peremezhaiushcheisia khromotoi.

244 patients with ischemia of the lower limbs were treated surgically in the specialized cardiovascular center. No lethal outcomes were reported because previously derived algorithm of detecting silent myocardial ischemia in patients with intermittent claudication and load tests (bicycle ergometry and drug stress tests) had allowed the surgeons to ascertain the extent of coronary damage and detect subclinical cardiac failure. Valid assessment of cardiac factors enabled the right choice between surgical and therapeutic methods and staging of the procedures.

Surgical treatment of the Wolff-Parkinson-White syndrome by epicardial electrical ablation.

A new operation to eliminate accessory pathways--epicardial electrical ablation--is described. In a group of 201 patients without concomitant disease, the mortality rate was 0.5% and the overall efficacy of the operation for free wall accessory pathways, 98%. A retrospective clinical study of 44 unselected patients was performed to examine how safe epicardial electrical ablation is. The criteria for intraoperative effectiveness were disappearance of both the delta wave and retrograde conduction and inability to induce tachycardia. In the postoperative and follow-up periods, the following were reviewed: electrocardiograms; Holter monitor recordings (24 to 26 hours); release of the myocardial-specific isoenzyme of creatine kinase; intracardiac hemodynamics and myocardial contractility (radionuclide methods); selective coronary arteriograms and ventriculograms; mean work capacity (bicycle ergometer); diagnostic transesophageal electrical stimulation; and histology of the area of ablation. The main conclusion of this study is that epicardial electrical ablation is a highly efficient and safe operation for surgical elimination of parietal accessory pathways in patients with Wolff-Parkinson-White syndrome. Its advantages are its technical simplicity and the opportunity to review results immediately during the operation.

[Epicardial destruction of the bundle of Kent by pulsating electric current and the criteria of its effectiveness in Wolff-Parkinson- White syndrome]. / Operatsiia épikardial'noi élektroimpul'snoi destruktsii i kriterii ee éffektivnosti pri sindrome Vol'fa-Parkinsona-Uaita.

The article deals with a new method of treatment of the Wolff-Parkinson-White syndrome. The operation for epicardial destruction of Kent's bundle by pulsating current was developed by the authors. It is distinguished by its simplicity and the possibility to determine the efficacy of the procedures during the operation itself. The results of examination of 44 patients in the early postoperative period and in late-term periods after this operation are discussed. It was found that the electric factor does not cause structural changes of the underlying structures and does not affect the pumping function of the myocardium. The revealed changes were recorded by means of angiocardiography, coronarography, radionuclide ventriculography, and the enzyme spectrum.