[The use of multi-spiral computer tomography for early diagnosis of coronary artery stenoses in patients with high risk of development ischemic heart disease].

Results of the study of clinico-diagnostic value of multispiral computed tomography in patients with suspected ischemic heart disease (IHD) are described in this paper. We have used 64-slice spiral computer tomography in examination of 49 patients with high IHD risk referred to the cardiological hospital for IHD exclusion. We have demonstrated high capacity of this method in diagnosis of early stages of atherosclerotic coronary artery involvement. This will allow timely detection of such patients and to intervene on modifiable IHD risk factors with the aim of lowering risk of development of unfavorable clinical manifestations of IHD, such as acute coronary syndrome and sudden death.

[Significance of stress echocardiography in patients with angiographically intact coronary arteries].

With the aim of assessment of the significance of stress echocardiography in patients with unchanged coronary arteries we analyzed data from 75 patients in whom coronary angiography (CAG) detected no hemodynamically significant narrowing of coronary arteries. In 38 patients coronary syndrome X (CSX) was revealed. In the group of patients with CSX transient disturbances of local contractility were significantly more frequently observed compared with patients without CSX (52% compared with 21%, respectively). Number of patients with discrepancy between ECG and EchoCG results of a test concerning achievement of criteria of transient myocardial ischemia was also greater in the group of patients with CSX. At CAG cases of retention of contrast medium in the coronary bed were 2 times more frequently observed in the group of patients with CSX (29%) compared with those without CSX (13%) while hemodynamically insignificant stenoses of coronary arteries in this group were found to be less frequent (2.6% compared with 24%, respectively). Thus persons without hemodynamically significant stenoses in the coronary bed appear to be highly heterogeneous group comprising patients with CSX and vasospastic angina as well as patients with peculiarities of structure of coronary bed and with hemodynamically insignificant stenoses in coronary arteries. Among patients with angiographically unchanged coronary arteries without CSX in 69% of cases peculiarities of structure of coronary bed or hemodynamically insignificant stenoses of coronary arteries has been found. Low sensitivity of transient disturbances of local contractility in patients with CSX (52%) does not allow to consider stress-echoCG as a method of effective diagnosis of CSX.

[The efficacy of alteplase in pulmonary embolism treatment].

The results of pulmonary embolism treatment with streptase in 76 patients are discussed. All patients had submassive or massive pulmonary embolism. 66 (86%) of patients recovered. Thrombolysis with the use of heparin was performed in 9 patients, death occurred in 5 of them. Of 20 patients treated with "Actilize", death was reported in three cases. Authors consider alteplase to be highly effective in the treatment of massive pulmonary embolism. In case of late diagnostics of pulmonary embolism, especially recurrent, thrombolytic therapy remains to be effective up to 2 weeks after primary embolization.

[3-D X-ray contrast rotational angiography in vascular pathology diagnostics].

The experience of 3-D X-ray contrast rotational angiography use is analysed. The case examples of virtual applications use on various anatomic areas are described. Informational value of routine and 3-D angiography is comparatively evaluated. The preferences of modern technology is showed.

[Efficacy and safety of enoxaparin use during drug-eluting stents implantation].

We assessed possibility of the use of low molecular heparin enoxaparin during percutaneous coronary interventions (PCI) with implantation of drug eluting stents. Enoxaparin was administered to 225 (0.3 mg/kg intraarterially via catheter) and 215 (0.5 mg/kg intravenously) patients. In comparison group (n=207) we used unfractionated heparin (UFG) intravenously according to standard scheme under control of activated clotting time. Stents implanted (n=797) were Cypher, Taxus, and Endeavor. Immediate angiographic success was 100%. During 48 hours after PCI pronounced bleeding (4.3%) and blood transfusions predominated in UFG treated patients. Number of bleedings was minimal after the intra-arterial use of enoxaparin (0.3 mg/kg). However total rate of all adverse events after PCI turned out to be minimal (7.0%) in the group of patients receiving enoxaparin intravenously (0.5 mg/kg). Thus the use of low molecular heparin enoxaparin is justified during implantation of drug eluting stents. Its optimal dose according to data obtained is 0.5 mg/kg intravenously.

[The use of intraaortic balloon counterpulsation in patients with acute myocardial infarction]. / Primenenie vnutriaortal'noi ballonnoi kontrpul'satsii u bol'nykh ostrym infarktom miokarda.

Intraaortic balloon counterpulsation was implemented in 11 patients with acute myocardial infarction and 1 patient with unstable angina. All patients had severe multivessel coronary artery disease. In 9 patients counterpulsation was used in conjunction with percutaneous transluminal coronary angioplasty, in 3 - with thrombolytic therapy. During hospitalization 2 patients died of progressing heart failure, while significant improvement of hemodynamic parameters occurred in other patients. Thus intraaortic balloon counterpulsation used in combination with angioplasty and thrombolytic therapy is an easily accessible highly effective method of treatment of cardiogenic shock in patients with acute myocardial infarction

[Treadmill stress-echocardiography in diagnosis of coronary artery involvement in patients with various probability of ischemic heart disease]. / Stress-ékhokardiografiia s tredmilom v diagnostike stenoziruiushchego porazheniia koronarnykh arterii u patsientov s raznoi veroiatnost'iu ishemicheskoi bolezni serdtsa.

Results of treadmill stress-echocardiography were compared with those of coronary angiography in 153 patients (133 men, 20 women, mean age 55.7-/+8.5 years) with various initial probability of ischemic heart disease (IHD) which was determined for each patient basing on sex, age and status of angina. Probabilities of IHD > or = 75% and >10% but <7 5% were considered high and intermediate, respectively. According to coronary angiography 40 patients had no significant coronary artery stenoses while 32, 36 and 45 patients had hemodynamically significant single, double and triple vessel stenoses, respectively. The use of echocardiographic criteria of myocardial ischemia allowed to increase sensitivity of treadmill test in patients with high IHD probability from 74 to 91% (p<0.01) and its specificity in patients with intermediate IHD probability from 45 to 83% (p<0.001). Value of stress-echocardiography for diagnosis of the presence of stenotic lesions in coronary arteries depended on initial probability of IHD.

[Left ventricular hypertrophy does not affect diagnostic accuracy of treadmill stress echocardiography in patients with normal left ventricular contractility at rest]. / Gipertrofiia levogo zheludochka ne vliiaet na diagnosticheskuiu tochnost' stress-ékhokardiografii s tredmilom u bol'nykh s normal'noi sokratimost'iu levogo zheludochka v pokoe.

Results of exercise echocardiography (treadmill) and of coronary angiography were compared in 119 subjects (mean age 54.9-/+7.9 years) with normal left ventricular contractility at rest. Forty two patients had no pronounced lesions in coronary arteries, while 77 had >50% stenoses in main coronary arteries. Sensitivity and specificity of stress echocardiography were similar in patients with (n=48) and without (n=71) left ventricular hypertrophy (76 and 78%, 75 and 74%, respectively). Specificity and diagnostic accuracy of stress echocardiography were substantially higher than those of ECG during treadmill test especially in patients with left ventricular hypertrophy.

[Ultrasound angiography: new perspectives in diagnosis of renal mass lesions]. / Ul'trazvukovaia angiografiia: novye vozmozhnosti diagnostiki ob"emnykh obrazovanii pochek.

AIM: To evaluate diagnostic efficacy of advanced ultrasound (US) techniques in early and differential diagnosis of malignant tumors of the kidneys. MATERIAL AND METHODS: A total of 394 patients with renal mass lesions were studied. They had: renal cell carcinoma (n = 96), renal parenchyma pseudotumors (n = 22), lipoma (n = 48), angiomyolipoma (n = 19), renal abscess (n = 2), renal sinus lipomatosis (n = 1), parenchymal cysts (n = 205), retroperitoneal leiomyosarcoma with invasion in the kidney (n = 1). The following examinations were made: gray scale study with tissue harmonic imaging, panoramic scanning, US-angiography (color doppler imaging--CDI, power doppler imaging--PDI, 3D-reconstruction of the kidney vessels, 3D dynamic contrast enhanced angiography (DCEA) in the second harmonic mode with an echo-contrast agent levovist. Pulse Doppler with qualitative and quantitative evaluation of the doppler spectrum was used as an additional method. Verification of the diagnosis was made by conventional angiography, computer tomography, MR-tomography, histomorphological analysis after surgery in 91, 310, 6 and 88 patients, respectively. RESULTS: New US techniques allow differentiation of malignant tumors with renal lipomas and angiomyolipomas, focuses of inflammation, pseudotumors of the renal parenchyma and atypical renal cysts. CDI has revealed big pathologic vessels with arterio-venous and arterio-arterial shunts in renal cancer in 63.5% of the cases. PDI visualized a net of pathologically changed vessels in 74.8% of the cases. 3D-reconstruction in PDI was highly sensitive (90%) in visualization of neoplastic vessels. US-angiography was used for pre- and postoperative monitoring in 18 patients subjected to conservative renal surgery. In 23 patients DCEA with levovist allowed monitoring of all phases of contrast enhancement of renal vessels. Injection of contrast agent revealed tumor microvasculature in an early arterial phase (20-30 seconds). CONCLUSION: US-angiographic techniques in diagnosis of renal cancer increases sensitivity and specificity of the US method compared to conventional B-mode US from 55 and 60% to 98 and 95%, positive and negative predictive value from 58 and 57% to 95 and 98%, respectively.

[Radiodiagnosis of liver hemangiomas]. / Luchevaia diagnostika gemangiom pecheni.

A combined use of radiation methods in the diagnosis of liver hemangiomas is considered. Twenty-two hemangiomas were detected in 18 patients using ultrasound investigation (USI), computerized tomography (CT) and angiography. The most characteristic signs of hemangiomas were identified. USI and CT were shown quite reliable in the detection of hemangiomas. They can be used for solving diagnostic problems depending on a situation. A diagnostic algorithm envisaging the most optimum use of USI, CT and angiography in liver hemangiomas, was developed.