[Adenocarcinoma of the lung against the background of usual interstitial pneumonia]. / Adenokartsinoma legkogo na fone obychnoi interstitsial'noi pnevmonii.

Lung adenocarcinoma against the background of idiopathic pulmonary fibrosis according to the world literature ranges from 2.7% to 48%, the incidence increases every year after the diagnosis of idiopathic pulmonary fibrosis. We present a clinical and morphological analysis of an autopsy observation of lung adenocarcinoma that developed against the background of corticosteroid-treated usual interstitial pneumonia in a 78-year-old woman. According to the results of histological and immunohistochemical studies, the diagnosis was formulated as: multicentric non-mucinous invasive adenocarcinoma of the right and left lungs with a lepidic growth pattern with background of usual interstitial pneumonia.

Undifferentiated sarcoma of the pericardium after radiation therapy for Hodgkin's lymphoma.

Primary sarcomas of the pericardium are extremely rare malignant tumors of the heart. The incidence of sarcoma increases after radiation therapy in the field of breast. The specific features of this case report are the difficulties in diagnostics of undifferentiated spindle-cell sarcoma of the pericardium and the connection between the disease and the radiation therapy for Hodgkin's lymphoma.

[Neuroendocrine tumors of a pancreas: 30 year's experience of clinic of faculty surgery of N.N. Burdenko].

N.N. Burdenko surgery clinic have an experience of treatment of 342 patients with gastroenteropancreatic neuroendocrine tumors. Original algorithms of diagnosis, complex treatment and postoperative management were applied. We achieved 100% five-year survival rate after radical surgery and reduced postoperative complications 1.6 times.

[Conductive hearing loss caused by eustachian tube dysfunction according to the data of functional computed tomography].

The paper deals with computed tomography (CT) diagnosis of Eustachian tube dysfunction. A functional multislice spiral (MS) CT protocol has been first elaborated for the Eustachian tube. Twenty-three patients with unilateral conductive hearing loss and Eustachian tube dysfunction were examined. The normal functional anatomy of the Eustachian tube was evaluated on the side without evidence of pathology in 23 patients. Functional MSCT showed that the cartilaginous portion of the Eustachian tube opened partially and closed completely in 9 patients. Ten patients were found to have steady changes in the cartilaginous portion of the Eustachian tube. The developed method could confirm the cause of conductive hearing loss and optimally define a treatment policy.

[Capacities of diagnostic volumetric multislice spiral computed tomography in the diagnosis of gastric cancer].

In the period 2009 to 2010, diagnostic multislice spiral computed tomography (MSCT) was carried out in 49 patients with gastric cancer. The efficiency of dynamic MSCT in detecting a tumor and determining its locoregional extent was evaluated. The results of dynamic MSCT were compared with those of postoperative histological examination. The possibility of detecting gastric cancer by dynamic MSCT was ascertained to depend on the depth of tumor invasion and to average 29, 71, 72, and 77% for T1, T2, T3, and T4, respectively. Dynamic MSCT showed a correlation between the frequency of metastatic lesion and the sizes of lymph nodes (r = 0.54; p = 0.0001) and their number (r = 0.82; p < 0.0001).

[Lesions in lungs in patients with rheumatoid arthritis].

The aim of this work was to study the prevalence and clinical features of affection of lungs and lower respiratory tract (LRT) in patients with rheumatoid arthritis (RA). A total of 104 non-smoking patients with RA and 100 ones without RA or chronic pulmonary diseases were examined. RA was associated with affection of all parts of the respiratory tract including proximal and distal bronchi, lung interstitium, and pleura. Bronchopulmonary disorders in RA patients had multilevel character suggesting continuous inflammation and sclerotization of anatomic respiratory structures. Lesions in lungs and LRT are shown to be of prognostic value (bronchiectasis, bronchiolitis, interstitial pneumonia), they frequently produce only weak clinical symptoms, and therefore need to be actively detected. Combination of functional tests and imaging techniques is of primary importance for diagnosis of respiratory problems in patients with RA.

[Comparative analysis of modern combined methods in diagnosis of renal cell carcinoma].

To ascertain the role of multispiral computed tomography (MSCT) in diagnosis of renal cell carcinoma (RCC) and to propose optimal diagnostic policy in RCC patients, we examined 63 patients with suspected renal tumor: 37 (59%) males and 26 (41%) females, age 47-77 ages, mean age 54.2+/-1.5 years, duration of the disease from 1 month to 7 years. The following diagnostic methods were imployed: ultrasonography of the kidneys, plain and excretory urography, spiral computed tomography, angiography, MSCT, MRT, thin-needle aspiration biopsy. By the results of a combined examination and operation on the kidney lesion, the diagnosis of RCC was made in 45 (80.3%) patients including stage I in 21 (46.7%), stage II in 9 (20%), stage III in 13 (28.9%), stage IV in 2 (4.5%) patients. Benign renal tumors were detected in 8 (14.2%) patients, giant cysts of the kidneys--in 5 cases, benign renal tumors--in 3 cases, adenoma--in 2 cases, angiomyolipoma--in 1 case. Detected were also renal malformations in 3 cases, a distant retroperitoneal metastasis of RCC in 1 case, adrenal tumors in 6 (9.5%) cases. We suppose that MSCT enables multiplanar and 3-dimentional reconstruction of the images, staging of RCC, planning of surgical treatment. MSCT should be conducted after standard ultrasound examination.

[Multispiral computed tomography in diagnosis of remote complications following surgical interventions in obliterating diseases of lower limb arteries].

Multispiral computed tomography opened new horizons in diagnosis of vascular pathology. The study was aimed at evaluating the significance of MSCT in diagnosis of complications following major and minor surgical interventions for obliterating diseases of the lower-limb arteries, using the findings of the intraoperative revision as a reference method. Each of the 68 examined patients underwent MSCT (4-spiral unit) and duplex scanning. The obtained findings suggest a high informative value of MSCT, hence making it possible to recommend it for use as an alternative means of the routinely used roentgen-contrast angiography.

[Characteristics of the pathogenesis, manifestations and clinical course of psychogenically induced myocardial infarctions].

With the purpose of investigating peculiarities of psychogenically induced myocardial infarction (PIMI) 82 patients with primary myocardial infarction (MI) were chosen as the subjects of the given controlled study and divided into two groups. The main group consisted of 33 patients, the rest 49 formed the control group. The study showed that coronary atherosclerosis was more pronounced in the patients of the main group, among whom cases of exertional angina in past history were more frequent, and who had more pronounced coronary calcinosis compared to the patients of the control group. At the same time, the clinical course of MI in such patients is relatively benign, but it is more often complicated by early postinfarction angina. All this suggests that the pathogenesis of PIMI differs from that of "classic" MI. In particular, PIMI may be associated with the involvement of more distant parts of coronary vessels. Patients with PIMI seem to need to be regarded as having high risk of repeated coronary disasters.

[Anginal States provoked by psychogenic stimuli. To the problem of psychosomatic reactions in patients with ischemic heart disease]. / Psikhogenno provotsirovannye anginoznye sostoianiia (k probleme psikhosomaticheskikh reaktsii u bol'nykh ishemicheskoi bolezn'iu serdtsa).

Two types of vulnerability of coronary vessels damaged by atherosclerosis were proposed basing on results of a study of 94 patients with psychosomatic reactions accompanied with ischemia or myocardial infarction. First variant (35 patients) was characterized by stable course of the disease (high effort angina without coronary catastrophes, episodes of unstable angina, etc.) and selective sensitivity to definite key affect of high personal value. Second variant (49 patients) was distinguished by pronounced clinical manifestations (effort angina with progressive lowering of exercise tolerance). Cardiovascular system displays universal susceptibility to negative emotions of various intensity.

[Potential of tomographic methods of diagnosis and three-dimensional analysis of abdominal aortic aneurysm images]. / Vozmozhnosti tomograficheskikh metodov diagnostiki i trekhmernogo analiza izobrazhenii anevrizm briushnoi aorty.

Between 1998 and 2002, 256 tomographic investigations of the abdominal aorta were performed. Aortic aneurysms were identified in 29 (11.3%) patients. Computed tomographic angiography (CTA) was provided to 16 patients 4 patients were examined by an electron-radiation tomograph, 6 by a spiral tomograph, 6 by a multispiral tomograph, and 13 patients underwent magnetic resonance angiography (MRA), with contrast enforcement. Two- and three-dimensional reconstructions of CT- and MR-angiograms were accomplished using special computerized working stations. Good quality MR- or CT- angiograms were obtained in all the patients examined. Interpretation of the angiograms did not cause noticeable difficulties. None of the patients required conventional contrast angiography. The investigations have demonstrated the benefits of multispiral CTA recognized as the method of choice for the diagnosis of aortic aneurysms. Of the 29 patients with the verified diagnosis of aneurysm of the abdominal aorta, aneurysms in 26 subjects were located in the infrarenal aorta. Of these, 5 patients were identified to have an aneurysm extending to the iliac arteries. In two patients, aneurysms extended to the renal arteries or to the suprarenal segment. A thoracoabdominal aneurysm (type III) was revealed in one patient. Associated aneurysm and occlusive lesions of lower extremity arteries (iliac, femoral) were present in 15 (51.7%) cases. In the majority of cases (89.7%), aneurysms ran an uncomplicated course. The complications encountered by us consisted in incomplete (intramural) rupture (2 patients) and dissection (one patient). 22 patients were operated on. Comparison of the intraoperative revision data with the results of preoperative CT and MR angiography has established that the sensitivity of the tomographic methods for the diagnosis of aneurysms was 95.7% and specificity 99%. With an accuracy of up to 2-3 mm there were determined the size of aneurysms, the distance to the renal arteries, the diameter of the proximal and distal "neck", the extension of aneurysms to the iliac arteries, the presence of occlusive lesions of lower extremity arteries. CT and MR angiography with bolus contrast enforcement are safe and noninvasive methods for the diagnosis of aortic aneurysms. They have the high information content and thus allow to plan surgical (and possibly endovascular) interventions without the use of conventional contrast angiography.

[The place of multispiral computed tomography in diagnostics of ischemic heart disease.]. / Mesto mul'tispiral'noi komp'iuternoi tomografii v diagnostike ishemicheskoi bolezni serdtsa.

Multispiral computed tomography (CT) of the heart with detection of coronary artery calcification as well as clinical examination, stress tests, single photon emission computer tomography at rest and during stress, and/or stress echocardiography were used in the study of 56 patients with and 26 without ischemic heart disease (mean age 58+/-1 and 55+/-1.5 years, respectively). In 44 patients multispiral CT was performed with intravenous contrast injection and 27 patients were subjected to coronary angiography. Specificity, sensitivity of multispiral CT for detection of hemodynamically significant (>50%) stenoses compared with angiography and for diagnosis of structural changes of the myocardium were 92, 90%, and 89, 91%, respectively. Calcium index was significantly higher in patients with than without ischemic heart disease (253+/-28 and 3+/-1.5 U, respectively) and could be a significant diagnostic criterion of ischemic heart disease.

[Calculation of the radiation-induced delay in cell division during a study of the induction of chromosome aberrations (the theoretical and experimental bases of the approach)]. / Uchet radiatsionno-indutsirovannoi zaderzhki deleniia kletok pri issledovanii induktsii khromosomnykh aberratsii (teoreticheskie i éksperimental'nye osnovy podkhoda).

The possible influence of a radiation-induced delay of cell division on the yield of chromosome aberrations has been analyzed theoretically. The analysis is based on the assumption that the delay is caused by the damages that are realized in the mitosis as chromosome aberrations. It has been shown that the distributions of cells, that are registered by the number of chromosome aberrations, are a function of time of cell fixation and may substantially differ from actual disturbance. There is a correlation between the registered and actual disturbances which is determined by the kinetics of the first mitosis of nonirradiated cells and the degree of the radiation-induced division delay. Some qualitative sequels of the proposed model are in agreement with the experimental data.