[Endoscopic endonasal removal of the invaginated odontoid process of the C2 vertebra].

UNLABELLED: Pathological processes in the craniovertebral region (clivus, C1 anterior arch, odontoid process and body of the C2 vertebra, i.e. C0-C1-C2 segments) are very difficult to diagnose and treat. The craniovertebral junction instability may develop in the case of a significant lesion of C1-C2 segments. Among diseases causing destruction of the clivus structures and C1-C2 vertebrae and compression of the spinal cord, the following ones are most common: chordoma, giant cell tumor, osteoblastoma, rheumatoid lesion, metastases, platybasia, and basilar impression. These diseases can cause the initial instability of the craniovertebral junction and be accompanied by gross neurological disorders, which complicates the diagnosis and surgical treatment of these patients. MATERIAL AND METHODS: We operated on two patients diagnosed with invagination of the odontoid process of the C2 vertebra. In both cases, one-stage operation was performed that included occipitospondylodesis and endoscopic endonasal removal of the C2 odontoid process. RESULTS: In the postoperative period, partial regression of the neurological symptoms was observed that included an increase in the strength and range of motions in the arms and distal legs, regressed spasticity in the arms and significantly reduced spasticity in the legs, and a significant improvement in all kinds of sensitivity in the arms, legs, and torso. Postoperative liquorrhea was observed in 1 case (patient 2); re-operation to close a CSF fistula was conducted. Later, no signs of liquorrhea were noted. In both cases, control MRI and spiral CT revealed a postoperative bone defect of the C2 odontoid process and clivus, complete decompression of the medulla oblongata and upper cervical spine segments, and no evidence of spinal canal stenosis; the stabilizing system was competent and properly placed. CONCLUSION: The endoscopic endonasal approach, compared to the standard transoral approach, has significant advantages in that the soft palate remains intact, the oropharynx area is less damaged, and the hospitalization and rehabilitation duration is reduced. Also, there are no problems and complications such as possible failure of sutures in the oral cavity and a large wound surface in the oropharynx area. The patient can eat on his own immediately after the operation without the use of a stomach tube (it does not cause any inflammatory complications of the oral cavity). However, the surgical technique of the endoscopic endonasal approach to the C1-C2 segment is more complex than that of transoral surgery and requires the surgeon to be skilled and experienced.

[31P Magnetic Resonance Spectroscopy in Patients With Various Genesis of Left Ventricular Hypertrophy].

PURPOSE: to assess status of myocardial energy metabolism in patients with different etiology of left ventricular hypertrophy by phosphorus magnetic resonance spectroscopy (MRS) compared with healthy individuals. METHODS: The study included 94 people: 30 healthy volunteers (group 1), 35 patients with arterial hypertension and left ventricular hypertrophy (group II), 29 patients with hypertrophic cardiomyopathy (group III). All persons underwent cardiac magnetic resonance imaging (MRI) and MRS on high field MR scanner. Energy metabolism index (ratio of phosphocreatine and adenosine triphosphate concentrations [Pcr/ATP]) was used for evaluation of myocardial energy metabolism. RESULTS: Values of Pcr/ATP were 2.11 ± 0.29, 1.65 ± 0.12, and 1.32 ± 0.16 in groups I, II, and III, respectively (p < 0.05). CONCLUSION: 31P MRS is an effective tool of detection of disordered energy metabolism in hypertrophic myocardium. Combined use of MRI and MRS can become an effective method of comprehensive study of the heart.

[31P magnetic-resonance spectroscopy in cardiac diseases].

Magnetic Resonant spectroscopy (MRS) in the nuclei of phosphorus is the only noninvasive method of studying the state of myocardial energy metabolism does not require the introduction of radiopharmaceuticals. This method uses the signals from the nuclei of 31P contained in such mattered phosphates like phosphocreatine and adenosine triphosphate. MRS can provide an answer to a variety of theoretical and clinical issues in the study of various cardiac diseases. The first is ischemic heart disease, as well as heart failure, hypertrophy of various origins, etc. In addition, the method can be used to control the various treatments, including therapeutic, interventional or surgical. Combined with magnetic resonance imaging of the heart gives information on the anatomy, size, function, perfusion defects, structural changes of the myocardium, as well as about the state of energy metabolism of myocardium.

[Evaluation of myocardial energy metabolism by 31 P-magnetic resonance spectroscopy in patients with hypertrophic cardiomyopathy versus healthy individuals].

OBJECTIVE: To estimate the left ventricular (LV) energy index from the data of 31P-magnetic resonance spectroscopy (31P-MRS) in patients with hypertrophic cardiomyopathy (HCM) versus healthy individuals. SUBJECT AND METHODS: The investigation included 46 persons, including 30 healthy volunteers (Group 1) without cardiovascular diseases and 16 patients with HCM (Group 2). All the persons underwent cardiac magnetic resonance imaging (MRI) and 31P-MRS using a high-field Achieva 3T TX MRI scanner (Philips, Netherlands). ISIS location and adiabatic pulse with iterative shimming were used to collect data. RESULTS: The PC/ATP energy index (a phosphocreatine to adenosine triphosphate ratio) was employed to evaluate myocardial energy metabolism in the patients with HCM. The PC/ATP index was 2.08 +/- 0.35 in Group 1 and 1.32 +/- 3.3 in Group 2 (p < 0.05). CONCLUSION: 31P-MRS may be used to determine the myocardial energy metabolism in patients with HCM.

[Stability of bituminous-salt mass-washing sarin, soman, and Russian VX destruction products in the aquatic environment and their effects of the sanitary conditions of water supplies].

The water environmental stability of O-isopropylmethyl phosphonate, O-pinacolylmethyl phosphonate, and O-isobutylmethyl phosphonate was studied. The very high hydrolytic stability of these products was established. The threshold and non-effective concentrations of O-isopropylmethyl phosphonate, O-pinacolylmethyl phosphonate, and O-isobutylmethyl phosphonate were determined, which affected the sanitary conditions of water bodies.

[Correlation of lipemia level after fat loading with manifestation of atherosclerosis in coronary arteries]. / Sviaz' urovnia lipemii posle zhirovoi nagruzki s vyrazhennost'iu ateroskleroza koronarnykh arterii.

AIM: To examine relationships between lipemia, atherogenicity of blood lipoproteins spectrum after fat loading (FL) and severity of angiographic manifestations of coronary atherosclerosis. MATERIAL AND METHODS: The study enrolled 72 males free of ischemic heart disease (IHD)--group 1; 60 IHD patients with moderate affection of the coronary arteries (CA), i.e. maximal narrowing of one CA 50%--group 2; 107 IHD patients with severe CA affection, i.e. CA narrowing > 50%--group 3. FL was given by J. R. Patsch technique, blood sampling was made before meal, 3 and 6 hours after FL. RESULTS: It was shown that intake of food fats in IHD and IHD-free patients stimulated development of postprandial lipemia of different severity and duration. It appeared due to increased fraction of lipoproteins rich in triglycerides. In group 2 and 3 there was a definite and up to 6 hours in duration postprandial hypertriglyceridemia associated with proatherogenic deviations in lipid and protein components (LDL and HDL) by FL hour 6: growing of LDL cholesterol, apoB, apoB/apoAI and lowering of HDL cholesterol and apoAI. Patients with severe CA atherosclerosis (> 50% narrowing of three CA) had the most severe atherogenic affections in the postprandial lipoprotein spectrum. CONCLUSION: Postprandial lipemia/hypertriglyceridemia and atherogenic changes in the spectrum of lipoproteins after FL correlate directly with angiographic manifestations of coronary atherosclerosis.

[Contribution of Communal Hygiene Department to creation and development of norm-setting basis of water sanitary legislation]. / Vklad kafedry kommunal'noi gigieny v sozdanie i razvitie normativnoi bazy vodno-sanitarnogo zakonodatel'stva.

Legal regulation of problems related to drinking water supply to the population is a pressing social problem, particularly during the transitional period of Russian economic development. Communal Hygiene Department participated in the formation and development of norm-setting base of drinking water supply to the population since the thirties. During recent 5 years the Department contributed to development of the "Law on Drinking Water and Drinking Water Supply" (the first in Russia), basic normative legislative acts regulating hygienic requirements to drinking water quality, choice and exploitation of sources of drinking water supply, zones of their sanitary protection, and many methodological documents. The paper sums up the principal basis of new generation documents of sanitary legislation concerning water.

Omega-3 fatty acids in adipose tissue and risk of myocardial infarction: the EURAMIC study.

Omega-3 fatty acids have potential antiatherogenic, antithrombotic, and antiarrhythmic properties, but their role in coronary heart disease remains controversial. To evaluate the association of omega-3 fatty acids in adipose tissue with the risk of myocardial infarction in men, a case-control study was conducted in eight European countries and Israel. Cases (n=639) included patients with a first myocardial infarction admitted to coronary care units within 24 hours from the onset of symptoms. Controls (n=700) were selected to represent the populations originating the cases. Adipose tissue levels of fatty acids were determined by capillary gas chromatography. The mean (+/-SD) proportion of alpha-linolenic acid was 0.77% (+/-0.19) of fatty acids in cases and 0.80% (+/-0.19) of fatty acids in controls (P=0.01). The relative risk for the highest quintile of alpha-linolenic acid compared with the lowest was 0.42 (95% confidence interval [CI] 0.22 to 0.81, P-trend=0.02). After adjusting for classical risk factors, the relative risk for the highest quintile was 0.68 (95% CI 0.31 to 1.49, P-trend=0.38). The mean proportion of docosahexaenoic acid was 0.24% (+/-0.13) of fatty acids in cases and 0.25% (+/-0.13) of fatty acids in controls (P=0. 14), with no evidence of association with risk of myocardial infarction. In this large case-control study we could not detect a protective effect of docosahexaenoic acid on the risk of myocardial infarction. The protective effect of alpha-linolenic acid was attenuated after adjusting for classical risk factors (mainly smoking), but it deserves further research.

[Symptomless myocardial ischemia: feasibility of diagnostic mistakes]. / Bessimptomnaia ishemiia miokarda: vozmozhnost' oshibochnoi diagnostiki.

AIM: To examine feasibility of ST segment depression on ECG in treadmill exercise test and 24-h ECG monitoring in subjects with coronarographically intact coronary arteries. MATERIALS AND METHODS: 9 males aged 41 to 52 years with chest pains unrelated to muscular load. They had neither stenosis of coronary arteries, nor arterial hypertension, valvular defects, disturbance of electrolyte metabolism. All of them have undergone treadmill exercise test and 24-h ECG monitoring. RESULTS: The exercise test provoked chest pain in none of the examinees. ST segment was depressed in one patient. 24-h monitoring registered depression of ST segment in one more patient. The rest 7 patients showed no changes in ST segment either in exercise test or 24-h ECG monitoring. CONCLUSION: It is confirmed that typical ischemic ECG changes (horizontal depression of ST segment) in healthy persons can occur and may be mistaken for silent myocardial ischemia.

[Primary malignant B-cell lymphoma of the cerebellum in an elderly female patient]. / Pervichnaia zlokachestvennaia B-kletochnaia limfoma mozzhechka u pozhiloi bol'noi.

A 72-year-old woman with malignant B-cell cerebellar lymphoma was operated on. Postoperative combined chemotherapy was performed. Immunohistological investigations of specimen are demonstrated.

Association between toenail selenium and risk of acute myocardial infarction in European men. The EURAMIC Study. European Antioxidant Myocardial Infarction and Breast Cancer.

The association between selenium status and risk of acute myocardial infarction was examined in a multicenter case-control study in 10 centers from Europe and Israel in 1991-1992. Selenium in toenails was assessed for 683 nonfatal male cases with first acute myocardial infarction and 729 controls less than 70 years of age. Median toenail selenium content was 0.553 microgram/g for cases and 0.590 microgram/g for controls. After adjustment for age, center, and smoking, the odds ratio for myocardial infarction in the highest quintile of selenium as compared with the lowest was 0.63 (95 percent confidence interval 0.37-1.07, p for trend = 0.08). The observed inverse trend was somewhat stronger when the authors adjusted for vitamin E status (p = 0.05). Analysis stratified for smoking habits showed an inverse association in former smokers (odds ratio for the 75th-25th percentile contrast = 0.63 (95 percent confidence interval 0.43-0.94)), but not in current smokers (odds ratio = 0.97 (0.71-1.32)) or in those who had never smoked (odds ratio = 1.55 (0.87-2.76)). Analysis stratified by center showed a significant inverse association between selenium levels and risk of myocardial infarction for Germany (Berlin) only (75th to 25th percentile odds ratio = 0.62 (95 percent confidence interval 0.42-0.91)), which was the center with the lowest selenium levels. It appears that the increased risk of acute myocardial infarction at low levels of selenium intake is largely explained by cigarette smoking; selenium status does not appear to be an important determinant of risk of myocardial infarction at the levels observed in a large part of Europe.

Association between beta-carotene and acute myocardial infarction depends on polyunsaturated fatty acid status. The EURAMIC Study. European Study on Antioxidants, Myocardial Infarction, and Cancer of the Breast.

Because antioxidants may play a role in the prevention of coronary heart disease by inhibiting the peroxidation of polyunsaturated fatty acids (PUFAs), the combined association of diet-derived antioxidants and PUFAs with acute myocardial infarction (MI) was investigated. This multicenter case-control study included 674 patients and 725 control subjects in eight European countries and Israel. Fatty acid composition and alpha-tocopherol and beta-carotene levels were determined in adipose tissue; selenium level was determined in toenails. For alpha-tocopherol no association with MI was observed at any PUFA level. The overall multivariate odds ratio (OR) for low (10th percentile) versus high (90th percentile) beta-carotene was 1.98 (95% confidence interval [CI], 1.39 to 2.82). The strength of this inverse association with MI was dependent on PUFA levels (in tertiles): for low PUFA, the OR for low versus high beta-carotene was 1.79 (95% CI, 0.98 to 3.25), for medium PUFA the OR was 1.76 (95% CI, 1.00 to 3.11), and for high PUFA 3.47 (95% CI, 1.93 to 6.24). For selenium increased risk was observed only at the lowest PUFA tertile (OR, 2.49; 95% CI, 1.22 to 5.09). This interaction between selenium and PUFAs was not significant and may at least partly be explained by a higher proportion of smokers at the low PUFA level. These findings support the hypothesis that beta-carotene plays a role in the protection of PUFAs against oxidation and subsequently in the protection against MI. No evidence was found that alpha-tocopherol or selenium may protect against MI at any level of PUFA intake.

Antioxidants in adipose tissue and risk of myocardial infarction: the EURAMIC Study.

Laboratory and epidemiological studies suggest that the antioxidants, vitamin E and beta-carotene, protect against coronary heart disease. In a European multicentre case-control study alpha-tocopherol and beta-carotene concentrations were measured in adipose-tissue samples collected in 1991-92 from 683 people with acute myocardial infarction and 727 controls. Mean adipose-tissue beta-carotene concentration was 0.35 microgram/g in cases and 0.42 in controls, with age-adjusted and centre-adjusted mean difference 0.07 microgram/g (95% confidence interval [CI] 0.04-0.10). Mean alpha-tocopherol concentrations were 193 micrograms/g and 192 micrograms/g for cases and controls, respectively. The age-adjusted and centre-adjusted odds ratio for risk of myocardial infarction in the lowest quintile of beta-carotene as compared with the highest was 2.62 (95% CI 1.79-3.83). Additional control for body-mass index and smoking reduced the odds ratio to 1.78 (95% CI 1.17-2.71); other established risk factors did not substantially alter this ratio. The increased risk was mainly confined to current smokers: the multivariate odds ratio in the lowest beta-carotene quintile in smokers was 2.39 (95% CI 1.35-4.25), whereas it was 1.07 for people who had never smoked. A low alpha-tocopherol concentration was not associated with risk of myocardial infarction. Our results support the hypothesis that high beta-carotene concentrations within the normal range reduce the risk of a first myocardial infarction. The findings for alpha-tocopherol are compatible with previous observations of reduced risk among vitamin E supplement users only. The consumption of beta-carotene-rich foods such as carrots and green-leaf vegetables may reduce the risk of myocardial infarction.

[The effect of maximal and submaximal physical loads on alimentary dyslipidemia]. / Vliianie maksimal'noi i submaksimal'noi fizicheskikh nagruzok na alimentarnuiu dislipidemiiu.

Short-term maximal and long-term submaximal regimens of physical exercise had been assessed for effect on serum lipoproteins in healthy subjects, in preclinical coronary heart disease (CHD) sufferers and in manifest CHD patients having food fat-induced lipemia. Fat loading caused hypertriglyceridemia in all the examinees. In healthy subjects it was associated with a rise in apo AI, while in CHD patients with relevant fall. Maximal exercise in preexisting alimentary hyperlipidemia provoked elevation of total cholesterol, triglycerides, LDL cholesterol, being atherogenic. Apo AI grew with a decrease in apo B/apo AI ratio in healthy subjects, in coronary patients apolipoprotein changes were of atherogenic origin. Prolonged submaximal exercise at the height of food lipemia resulted in lowering of total cholesterol, triglycerides and LDL cholesterol along with elevation of HDL cholesterol and apo AI both in healthy and coronary subjects evidencing anti-atherogenicity. It is noted that the response of lipids and apolipoproteins to fat and physical exercise loads was similar in subclinical and manifest CHD patients.