[Pattern electroretinogram and macular perfusion in glaucoma]. / Pattern-élektroretinogramma i makuliarnaia gemoperfuziia pri glaukome.

PURPOSE: To study microcirculatory and functional changes in macula in patients with Primary Open-Angle Glaucoma (POAG). MATERIAL AND METHODS: The study included 95 POAG patients and 42 healthy control subjects. Whole en face image vessel density (wiVDRetina) was measured both in fovea and in parafovea using OCT-angiography (OCT-A) by means of SD-OCT AngioVue on Avanti RtVue xR (Optovue Inc., U.S.A.). Macular thickness and parameters of macular ganglion cell complex (GCC) were measured on the same day. Blood flow in the retrobulbar vessels was evaluated by means of Color Doppler Imaging (CDI). Pattern electroretinogram (PERG) was also taken from the study eyes. Correlations between PERG, SD-OCT GCC, macular thickness, and the parameters of OCT-A and CDI were studied. RESULTS: The amplitude of t-PERG P50 decreased from 6.1±1.3 µV in normal eyes to 2.8±1.6 µV (p<0.0001) in early glaucoma and to 2.3±1.5 µV (p=0.93) in advanced stages. Relative vessel density of the capillary bed decreased from 51.3±3.0% in normal eyes to 45.9±5.0% (p<0.001) and to 41.8±5.0% (p=0.023) in early and advanced glaucoma respectively. The parameters of OCT-A and CDI correlated with morphological and functional parameters in normal and early glaucomatous eyes. CONCLUSION: The study revealed reduction of macular microcirculation and decrease of PERG in early glaucoma. Correlations between the circulatory parameters and functional changes were found in early stages of the disease.

[Pattern visual evoked potentials and their relation to the peripapillary and retrobulbar blood flow in glaucoma]. / Patternzritel'nye vyzvannye potentsialy i ikh sviaz' s peripapilliarnym i retrobul'barnym krovotokom pri glaukome.

PURPOSE: To examine the relationship between the development of bioelectric response of retinal cell elements to pattern stimulus and the ocular blood flow. MATERIAL AND METHODS: Electrophysiological studies, including pattern-reversal visual evoked potentials (VEP) with large 1 degree (1°) and small 0.25° checks, Color Doppler imaging (CDI) of the retrobulbar vessels, and OCT Angiography in the area of the optic disc and peripapillary retina were performed in 48 patients with initial primary open-angle glaucoma (POAG), 47 patients with advanced POAG, and 42 control subjects. Authors also studied the correlations between VEP values and the parameters used in CDI and OCT-A examination. RESULTS: The most noticeable differences between the study groups were the amplitudes of P100 pattern VEP values for small and large patterns and the OCT-A parameters: Whole-image Disc Vessel Density (widVD), Peripapillary Vessel Density (pVD), Peripapillary Vessel Density Inferior Temporalis (pVD IT). In initial glaucoma, a strong correlation was observed between the amplitude of P100 pattern VEP 1° and pVD IT (r=0.75; p<0.0001); the blood flow rates in ophthalmic artery, central retinal artery, central retinal vein and short posterior ciliary arteries were below normal, while the blood flow in these vessels had statistically reliable correlation with the amplitude of P100 pattern VEP (p<0.05). No correlation was found in patients with advanced stages of glaucoma. CONCLUSION: Pattern VEP is an informative method of glaucoma diagnostics which accuracy can be enhanced by combining it with OCT-A blood flow examination.

[GENDER DIFFERENCES OF THE HEMOSTASIS POSTAGRESSIVE EARLY RESPONSE IN ACUTE NECROTIZING PANCREATITIS].

The study was performed in a group of 25 patients with acute necrotizing pancreatitis (mean age 46.2 ± 6.74 years). Gender differences of the hemostasis postagressive early response in the early stages of the disease were identified by comparing the procoagulant , anticoagulant and fibrinolytic blood activity of men and women suffering from pancreatitis. Compared to men, women showed higher concentrations of fibrinogen, D-dimer and VWF and smaller values marked trombokrit , antithrombin III, inhibitor of plasmin and protein C (p < 0.05). These results suggest a greater tendency to thrombi formation in women with acute pancreatitis; We believe that gender differences should be the subject of further research.

[The algorith of preoperative cardiovascular therapy in high risk elderly oncology patients].

The study was based on 478 oncology patients (72.1 +/- 3.6 years old) with cardiovascular comorbidities operated from 1991 to 2008 in regards of abdominal and pelvic mainly 3rd stage tumors with multimodal general anesthesia (4.2 +/- 1.6 hours). In prospective group (n = 302) all patients received cardiovascular treatment, while in retrospective group (n = 176) only 48.9% received it. The evaluation of the cardiovascular therapy effect was based on the peri-operative and postoperative HR and BP dynamics. The occurrance of noticeable bradycardia and drop of BP lower than 90/60 mm Hg was considered as a deviation. It is revealed that the cardiovascular therapy with beta adrenoblockers and calcium antagonists leads to an intraoperative bradycardia in 59.8% and 73.7% of cases, while in patients without the aforementioned therapy in 26.6% and 46.4% of cases respectively (p < 0.05). Antiarrhythmics don't have a noticeable impact on the development of bradycardia (p = 0.204). Intraoperative hypotension on the basis of ATP inhibitor treatment developed in 92.2% of patients statistically significant (p < 0.01). Monotherapy with calcium antagonists or nitrates leads to the development of hypotension in 55.2% and 41.4% of cases respectively, though in patients without the given therapy a lot more often (p < 0.05). In the case of combined calcium antagonist/nitrate therapy hypotension develops in 55.5% of cases, and in 72.3% without the therapy (p < 0.05). For the means of prevention of cardiovascular complications during the surgical treatment it is appropriate to keep the therapy with nitrates, though vasodilatives should be canceled 12 hours before the surgery.

[Diagnosis and risk assessment of perioperative cardiovascular complications in geriatric patients in oncological surgery].

Cardiovascular events (CVE) developing at the stages of surgical treatment in 449 geriatric (aged 72 +/- 5.8 years) cancer patients with concomitant cardiovascular diseases (CVD) were quantitatively and qualitatively analyzed. Statistical analysis was used to compare and establish a discrepancy between the results of a predictable risk by the standard scale of the international perioperative CV risk index (ICVRI) and the actually developed complications. The logistic regression method was employed to analyze the risk factors included into the ICVRI scale. The risk factors that were best in predicting the development of CVE were determined. A mathematical formula was derived to estimate the adjusted prognosis of an individual cardiovascular risk. Based on their perioperative CV risk classification, the authors constructed an algorithm of a diagnostic search and surgical preparation tactics in seriously ill cancer patients with concomitant CVD. The algorithm has been put into the routine practice of the P. A. Herzen Moscow Research Institute of Oncology, which makes it possible to improve the results of surgical treatment in geriatric patients and to expand its indications. Examples of clinically applying the algorithm are given.