[Results of radiation therapy for optic nerve sheath meningioma]. / Rezul'taty luchevogo lecheniya meningiomy obolochki zritel'nogo nerva.

Optic nerve sheath meningioma (ONSM) is a slow-growing benign tumor that tends to extend intracranially. The tumor is characterized by vision disturbance, optic nerve atrophy and edema. At present, radiotherapy is recommended as the treatment of choice for ONSM. PURPOSE: To assess the neuro-ophthalmic symptomatology of ONSM and how it changes in response to radiotherapy. MATERIAL AND METHODS: In the period from 2004 to 2018, 112 patients with ONSM aged 17 to 76 years underwent stereotactic radiotherapy. In 91 patients, visual functions varied from light perception to 1.0; in 21 patients the affected eye was blind. The prospective follow-up of 103 patients lasted 6 months to 10 years (mean follow-up duration was 57 months). Studied patients underwent either conventional fractionated radiotherapy with Novalis (n=88) or hypofractionation radiotherapy with CyberKnife (n=24). RESULTS: According to ophthalmological examination, in 60.5% of cases an improvement of visual functions was observed, 39.5% of patients had visual functions remain stable at the initial level. No vision impairment during irradiation was detected. Vision deterioration in the long-term follow-up was observed in 2 patients: extended tumor growth in one case and radio-induced retinopathy in the other. CONCLUSION: The study showed that this method of treatment for ONSM is effective and safe, allowing preservation of visual functions and in some cases - its improvement, while tumor growth remains under control.

[Effect of angioprotective therapy with bioflavonoids on endothelial dysfunction in patients with acute venous thromboses]. / Vliyanie angioprotektivnoi terapii bioflavonoidami na disfunktsiyu endoteliya u bol'nykh s ostrymi venoznymi trombozami.

The study was aimed at evaluating a possibility of correcting endothelial dysfunction by means of angioprotective therapy with natural-origin bioflavonoids in patients presenting with acute venous thromboses. Ours was an open comparative prospective study including a total of thirty 34-to-60-year-old patients suffering from lower limb deep vein thrombosis. The patients were subdivided into two groups. The Study Group was composed of 15 patients receiving on the background of anticoagulant therapy with direct thrombin inhibitors (dabigatran etexilate at a daily dose of 300 mg) natural-origin angioprotectors (red grape leaf extract). The Control Group also consisted of 15 patients undergoing anticoagulant therapy with direct thrombin inhibitors alone. Blood sampling for laboratory monitoring [the quantitative level of von Willebrand factor (vWF) in blood plasma, integral assessment of the links of blood coagulation and fibrinolysis by means of thromboelastography] and ultrasonographic angioscanning of lower extremities were carried out in both Group twice: at the beginning of the study and 3 months after the beginning of therapy. The absolute majority of patients demonstrated a quantitative increase in vWF (the median in the Study Group amounted to 208.3%, being 190.0% in the Control Group, with the cut-off level equaling 140.8%). Assessing dynamics of the vWF level after 3 months on the background of using natural-origin flavonoids (the Study Group) showed a more pronounced decrease in the vWF level in the Study Group patients as compared with the Control Group patients (98.4%). Comparing the dynamic composite indices of the thromboelastogram revealed that with similar parameters in patients from the Study and Control Groups at admission, in dynamics there was observed greater growth of the level of indices of the process of dissolution of the fibrin clot (lysis) in the Study Group as compared to the Control Group. Also noted was more pronounced recanalization of the venous bed in patients taking the natural-origin bioflavonoid. A conclusion was drawn that including angioprotectors (red vine leaf extract) into the comprehensive therapy in order to correct endothelial dysfunction may improve the immediate results and terms of treatment of patients with acute venous thrombosis.

[On possible role of endothelial dysfunction in development of acute venous thrombosis].

The study included a total of 18 patients (12 women and 6 men, aged from 22 to 51 years, mean age 34 years) with newly onset unilateral acute thrombosis of deep veins in the system of inferior vena cava, confirmed by the findings of ultrasound duplex scanning. The patients had no apparent risk factors for venous thromboembolic complications, they had not used antiplatelet drugs during the last month and were characterized by a low level of risk for cardiovascular complications. Along with general clinical examination the patients were subjected to measuring the quantitative level of the von Willebrand factor (vWF), resistance to activated C-protein conditioned by V factor mutation, D-dimer, qualitative assessment of the level of C-reactive protein by a highly sensitive method, as well as integral assessment of the links of blood coagulation and fibrinolysis by means of thromboelastography. Eighteen (100%) patients had the vWF level above the norm, four (22.2%) patients were found to have resistance to activated C protein conditioned by factor V mutation, these patients had non-O (I) blood group. In twelve (66.7%) patients the quantitative level of D-dimer remained within the normal limits, and in 6 patients the D-dimer level was above the norm. The findings of thromboelastography demonstrated decreased activity of blood platelets. Fibrinolysis (LY30 and LY60) in the absolute majority of the examined patients was lowered. Six (33.3%) patients when comparing the LY30 and LY60 levels had no significant elevation of the index (<1%), four (22.2%) patients when comparing LY30 and LY60 showed an elevation of the index (>3.8%). The mean level of C-reactive protein (4.93 mg/l) exceeded the median of the reference values (2.5 mg/l) and in five (27.8%) out of 18 patients the value was two times higher than the reference ones. The obtained experimental data suggest that acute venous thrombosis is accompanied by alterations in the work of the coagulation and fibrinolytic systems, associated with endothelial dysfunction.

[Comparative assessment of antiaggregant efficacy of acetylsalicylic acid and clopidogrel in peripheral atherosclerosis].

Presented in the article are the results of studying antiaggregate activity of acetylsalicylic acid and clopidogrel in a total of 36 patients suffering from various-severity chronic arterial insufficiency of lower limbs on the background of atherosclerosis obliterans. The study was conducted prior to treatment for correct selection of a particular antiplatelet agent. The obtained results showed that clopidogrel was not always more efficient than acetylsalicylic acid, since there is individual sensitivity of each patients to a particular antiplatelet agent. Therefore, an individual approach is necessary to conservative therapy of arterial insufficiency of lower limbs. For some patients it is preferable to administer clopidogrel, for others - acetylsalicylic acid. In a series of cases combined treatment is justified, while some patients having low sensitivity to both acetylsalicylic acid and clopidogrel require careful selection of alternative agents influencing other thrombocyte receptors.

[Participation of leucocytes in pathogenesis of primary forms of lower limb chronic venous disease].

AIM: The purpose of the study was to test the hypothesis on participation of WBCs in damaging the venous wall in patients presenting with primary forms of lower limb chronic venous diseases LLCVD . MATERIAL AND METHODS: The study included a total of fifteen consecutively selected patients (13 women and 2 men) diagnosed as having grade C2-C-4 LLCVD according to the CEAP classification. Static loading (30 minutes in the sitting position) was followed by simultaneous sampling of blood from the varicose vein of the cms and ulnar vein. The total blood count including determination of both the absolute values and percentage of blood formed elements was performed using the automated haematological counter «Advia 7¼ («Bayer¼, USA). The obtained findings were statistically processed using the Microsoft Office Excel software by means of the pared two-sample τ-test for the average values. RESULTS: The number of leukocytes and their subpopulations in blood samples obtained from the crural varicose veins turned out to be significantly less as compared with that in blood sampled from the ulnar vein. Thus, blood sampled from the crural varicose veins demonstrated a decrease in the counts of WBC by 9.6% in fourteen (93.3%) patients, that of neutrophils by 4.9% in twelve (80%) patients, that of lymphocytes by 16,8% in fifteen (100%) patients, and that oi monocytes by 24% in twelve (80%) patients. The mentioned differences were statistically significant at a = 0.05. The eosinophilic counts in blood sampled from the upper and lower extremities appeared similar in 66.7% of the examined subjects. In 33.3% of cases the eosinophilic count in blood samples from crural varicose vein was by 16.7% lower than that for blood samples form the ulnar vein. No differences for the rest parameters of the clinical blood count were revealed. CONCLUSION: The absolute lymphocytic count in the blood samples taken after the 30-minute static loading from the crural varicose veins was significantly lower as compared with that in blood sampled form the cubital vein. The counts for RBCs and blood platelets, as well as other qualitative haematological indices (haemoglobin, haematocrit, average volume of the RBC, erythrocytic diameter, etc.) in blood sampled form crural and ulnar veins in the same patient were identical, thus strongly suggesting the lack of either haemodynamic or haemorheological phenomena capable of leading to redistribution of the blood formed elements in varicose veins. Hence a decrease in the counts of leukocytes and their subpopulations in blood sampled from crural varicose veins might be associated with the «leukocytic trap¼ phenomenon.

[Lactate as a marker of ischaemia in patients with atherosclerosis obliterans of the lower limb arteries on the background of dosed physical load].

The work was aimed at determining the concentration of lactate as a marker of ischaemia in patients with lower-limb atherosclerosis obliterans (hereinafter referred to as LLASO) on the background of dosed physical load (terrain cure and general physical exercises). We examined a total of 157 patients subdivided into 4 groups, i.e., 2 study groups and 2 control groups. All the patients were found to have grade 2a-2b ischaemia. The first study group consisted of the patients who had previously been receiving standard conservative therapy for several years. They were recommended to continue this type of therapy to be only supplemented with dosed physical loading. The 1st control group enrolled a total of 20 patients commissioned to receive conventional therapy alone. Patients from the 2nd study group had received no previous therapy. They were offered monotherapy in the form of dosed physical loads. Patients of the 2nd control group, also previously untreated, were given standard conservative therapy combined with physical loads. All the patients examined were initially found to have had high values of the blood lactate level. We then determined the possibility of walking and the dynamics of the blood lactate level on the background of the therapy offered, thus allowing us to confirm high efficacy of terrain cure eventually leading to increased distance of pain-free walk, both as a constituent part of the combined modality therapy and in the form of monotherapy in patients presenting with LLASO. We also revealed a correlation between the blood lactate level and the increase in the distance walked. The obtained findings suggest that the blood lactate level may be a marker of the presence of ischaemia in LLASO patients and the degree of its severity.

[Comparative value of molecular forms of prostate-specific antigen in diagnosis of prostatic cancer].

The aim of the study was to compare diagnostic significance of free PSA (fPSA)/total PSA (tPSA) versus PSA complex with alpha1-antichymotrypsin (cPSA) in tPSA level within 4-10 ng/ml in differential diagnosis of prostatic cancer (PC). A complete urological examination (digital rectal test, transrectal ultrasound investigation, serum assay for fPSA and tPSA, multifocal transperineal prostatic biopsy) was made in 108 patients with tPSA blood level 4-10 ng/ ml. Prostatic adenoma (PA) was histologically verified in 61 of 108 patients, fPSA/tPSA was normal. In the other 39 of 108 patients fPSA/tPSA was under 15% while cPSA was in the range 3.8-9.6 ng/ml. A course of etiotropic therapy of chronic prostatic inflammation produced no significant changes in fPSA/tPSA and cPSA in 28 out of 39 patients. Histologically, these 28 patients had PC. In the rest 11 of 39 patients chronic prostatitis treatment fPSA/tPSA significantly rose to 18.2%, on the average. CPSA decreased to 2.4 ng/ml. These 11 patients were found histologically to have PA and signs of chronic inflammation. In 8 of 108 patients fPSA/tPSA was not indicative of PC being 18,2% on the average while cPSA indicated the presence of PC and was 4.2 ng.ml, on the average. PC was verified histologically in these 8 patients. Thus, cPSA in PC suspects is more informative than fPSA/tPSA in PC diagnosis. CPSA in the serum depends on prostatic inflammation making difficult differential diagnosis of PC in interpretation of tPSA, fPSA/tPSA and cPSA. Therefore, estimation of PSA variants and molecular forms in PC suspects and prostatic inflammation should be made after etiotropic therapy.

[Preoperative care of microcirculatory vessels in patients with lower limb arteriosclerosis obliterans].

The paper analyses diagnosis and treatment outcomes for 20 men aged from 55 to 76 with lower limb arteriosclerosis obliterans. Based on exhaustive laboratory and instrumental diagnostic data the authors conclude that 10-days course of Vazaprostan (20 mkg per day) for patients with IIb stage of chronic lower limb arterial insufficiency yields not only improvement in tissue metabolism, but a reduction of peripheral vascular resistance as well. Thus such therapy can be used for preoperative care before reconstructive vascular interventions in order to reduce the risk of implant thrombosis in early postoperative period.

Structural and metabolic characteristics of liver acini in dogs with acute cholecystitis.

Structural and metabolic changes in liver tissue in dogs with acute cholecystitis were studied by histological, histoenzymatic, and biochemical methods. It was found that the development of destructive inflammatory processes in the gallbladder wall induces morphological damage to the liver tissue, which correlates with metabolic disorders in this organ and leads to liver dysfunction.

[Clinical significance of the procalcitonin test in differential diagnosis of systemic inflammatory reaction in pancreatonecrosis]. / Klinicheskaia znachimost' prokal'tsitoninovogo testa v differentsial'noi diagnostike sistemnoi vospalitel'noi reaktsii pri pankreatonekroze.

The significance of procalcitonin test (PCT) in the differential diagnosis of sterile and infectious pancreonecrosis was evaluated. Twenty-four patients with destructive pancreatitis were examined. Plasma procalcitonin concentrations were increased in the patients with infectious pancreonecrosis and correlated with the clinical status of patients evaluated by APACHE II and SOFA scores. The sensitivity and specificity of this test in the diagnosis of infectious pancreonecrosis were 84.4 and 83.3%, respectively, its prognostic significance being as high as 93.1%. Plasma concentrations of procalcitonin in sterile pancreonecrosis were normal or slightly increased. These results indicate that measurement of procalcitonin concentrations is an optimal laboratory test for differential diagnosis of sterile and infectious pancreonecrosis. PCT helps determine the treatment strategy in patients with various forms of destructive pancreatitis.

[Serological study of hepatitis C virus NS5 protein epitopes and their clinical and diagnostic significance]. / Serologicheskoe issledovanie épitopov belka NS5 virusa gepatita C i ikh znachenie dlia kliniki i diagnostiki.

Three peptides corresponding to the 2295-2317 aa NS5 HCV region and individual parts of this region were synthesized. Antigenic properties of these peptides were investigated. The 2295-2317 aa region contains at least two epitopes of different nature. The full-sized peptide is more promising for the diagnostic studies. Optimal conditions for ELISA with this peptide were defined, allowing the maximum complete utilization of the potentialities of both epitopes.

[Comparative morphofunctional study of the liver in peritonitis and leg gangrene]. / Sravnitel'noe morfofunktsional'noe issledovanie pecheni pri peritonite i gangrene nizhnei konechnosti.

Profound hepatic tissue morphofunctional changes with progressive hepatic failure occur in endotoxicosis caused by peritonitis and lower extremity gangrene. Comparative quantitative histoenzymatic and biochemical studies have revealed hepatic metabolic disturbances in peritonitis and leg gangrene.

[The vaccinal prophylaxis of hepatitis B among children born to mothers with persistent HBs-antigenemia]. / Vaktsinoprofilaktika gepatita B sredi detei, rodivshikhsia ot materei s persistiruiushchei HBs-antigenemiei.

In Uzbekistan and Moldova 542 children born of HBsAg carriers were immunized against hepatitis B (with vaccine Engerix B according to the immunization schedule of 4 injections). Anti-HBs antibodies in protective titers were detected by EIA and RIA techniques in 76.7% of children aged 4-5 months after the 3rd injection, in 95.7% of children aged 15-16 months and in 90.0% of children aged 2-2.5 years after the 4th (booster) injection. In the control group (117 nonimmunized children born of HBs carriers) observed during the same period anti-HBs antibodies were detected significantly less frequently (in 7.3%, 11.6% and 12.9% of these children respectively). 1-2 months after the course of immunization was completed 74.1% of the immunized children had high anti-HBs antibody titers (exceeding 1000 IU/ml) with their subsequent decrease by 2-2.5 years of age. In the control group these figures were 27.1% and 29.0% respectively. The index of immunization effectiveness obtained by the comparison of the hepatitis B morbidity rates in both groups was 7.8. No postvaccinal complications were registered.

[The significance of morphologic changes in acute occlusive cholecystitis for determining the surgical approach]. / Znachenie morfologicheskikh izmenenii pecheni pri ostrom obturatsionnom kholetsistite v opredelenii khirurgicheskoim taktiki.

Specific morphological and functional changes in the liver in acute obturative cholecystitis have been experimentally studied in 30 dogs and clinically examined in 21 patients. No morphological substrate of liver insufficiency were found in early period of acute obturative cholecystitis. Early changes in the liver are of reactive nature and have the features of active nonspecific hepatitis. The reactions of compensation and decompensation are changing each other periodically. The intensive reactions of compensation take place in the first 2 or 3 days of disease. The reactions of compensation weaken gradually. There is no correlation between changes in the liver and in blood serum. The early surgery and laparoscopic procedures in acute obturative cholecystitis are advocated.

Complete spectrum of PAH mutations in Tataria: presence of Slavic, Turkic and Scandinavian mutations.

Phenylketonuria (PKU) is an autosomal recessive disorder associated with a deficiency of hepatic phenylalanine hydroxylase (PAH). Although the molecular lesions present in the PAH genes of PKU patients have previously been determined in several Slavic populations, little is known regarding the molecular basis of PKU in the non-Slavic populations of the former Soviet Union. Guthrie card samples from twenty-one classical PKU patients residing in the Tatarian Republic were examined by a combination of denaturing gradient gel electrophoresis and direct sequence analysis. Twelve patients were of Tatarian ancestry, five were of Russian ancestry, and four were of mixed Tatarian and Russian ancestry. Two of the Tatarian patients were related, sharing one mutant allele. The single major allele identified in this study was R408W/RFLP haplotype 2/VNTR 3, which was present on 11/14 or 78.6% of all mutant chromosomes of Slavic origin, but on only 10/27 or 37.0% of mutant chromosomes of Tatarian origin. This result suggests that this allele was introduced into central Asian populations during the eastward expansion of Slavs across the Eurasian landmass. A significant influence of Turkic peoples on Tatars can be inferred from the presence of R261Q. IVS10nt546g --> a, L48S, IVS2nt5g --> c and P281L, all of which are relatively common among Turks or have been observed in Mediterranean populations. Together, these alleles are present on 11/27 or 40.7% of all mutant chromosomes in ethnic Tatars. Surprisingly, the common Scandinavian mutation IVS12ntlg --> a was also present in Tataria, as was the delta agE221D222fs mutation found previously only in Denmark. Thus, some direct or indirect gene flow from Scandinavian into Tataria seems evident. Finally, the complete absence of PAH mutations previously observed in Oriental populations suggests that there was little gene flow into Tataria from Eastern Asia.

[Dyslipoproteinemia in pancreonecrosis: cause-effect interrelationships]. / Dislipoproteidemiia pri pankreonekroze: prichinno-sledstvennye vzaimosviazi.

The work analyzes the results of study of lipid metabolism in 53 patients who underwent operation for pancreatogenic peritonitis. The blood for the test was collected from the portal vein, the hepatic vein, and the aorta which made it possible to appraise metabolism in the liver according to the "entry-exit" blood flow system. It is shown that due to pancreatogenic toxemia, toxemic hepatocytic dyslipoproteinemia develops in patients with pancreonecrosis and persists in the late period. As a consequence of such a condition of lipid metabolism, early atherosclerotic damages to the arteries of the heart and brain and the peripheral arteries occur in patients after pancreonecrosis. The fate of patients was studied 8-10 years after the operation. The nature of atherosclerotic manifestations of toxemic hepatocytic dyslipoproteinemia in the late period after recovery from destructive pancreatitis was determined on the basis of study of central and peripheral hemodynamics.