[Navigational bronchoscopy with tranbronchial cryobiopsy in differential diagnosis of peripheral pulmonary lesions]. / Navigatsionnaya bronkhoskopiya s transbronkhial'noi kriobiopsiei v differentsial'noi diagnostike perifericheskikh obrazovanii legkikh.

OBJECTIVE: To evaluate the efficacy and safety of tranbronchial cryobiopsy (TBCB) with 1.9-mm and 1.1-mm cryoprobes in patients with peripheral pulmonary lesions (PPLs). MATERIAL AND METHODS: We analyzed 34 patients (mean age 60 years) with PPLs who underwent bronchoscopy with TBCB. Mean lesion size was 31.5 mm, upper lobe localization was predominant (47% of cases). CT signs of appropriate bronchus were identified in 79% (27/34) of cases. Manual branch tracking and virtual bronchoscopy (VB) were performed pre-procedurally, and radial endobronchial ultrasonography (rEBUS) was performed during bronchoscopy for accurate positioning of PPLs. TBCB was performed using 1.9-mm (n=19) or 1.1-mm (n=15) cryoprobes without fluoroscopic guidance. Incidence and severity of bleeding and pneumothorax were evaluated in all patients. RESULTS: Total efficacy of TBCB was 76.5% (26/34): 78.9% (15/19) for 1.9-mm cryoprobe and 73.3% (11/15) for 1.1-mm cryoprobe (p=0.702). Efficacy depended on the presence of CT signs of bronchus (presence - 94%, absence 14.3%, p<0.001) and PPL size (94% for PPL >30 mm and 58.8% for PPL <30 mm, p=0.016). Central probe position during rEBUS was associated with 94.7% diagnostic efficacy (18/19), adjacent probe position - 72.7% (8/11) (p=0.088). Bleeding grade 3 (Nasville) occurred in 5.8% (2/34) of cases, and no pneumothorax was observed. CONCLUSION: TBCB is an effective and safe diagnostic method for PPLs.

[Difficult case of differential diagnosis of partial lung atelectasis. Case report].

In December 2018 the patient over 60 years old sought medical help with complaints of persistent cough. Based on computed tomography data there were identified the sings (symptoms) of right lung lower lobe atelectasis. To run this patient diagnostics there were performed 6 bronchoscopies narrowed down by bronchi checks up only and described the right lung central cancer picture. At the same time the biopsy taken during one of the bronchoscopies appeared non informative. Fine needle biopsy of mediastinal lymph nodes and bronchial wall was performed twice: at Tomsk Cancer Research Institute (it was suspected B-cell lymphoma based on biopsy examination) and at The Loginov Moscow Clinical Scientific Center (signs of inflammation based on biopsy examination). The video-assisted thoracoscopy with lymph node dissection of the right lung root was performed in January 2020. As a surgical material analysis result reactive adenopathy was determined. Therefore, during more than 1 year of diagnostic research the genesis of right lung lower lobe atelectasis was not established. The patient was directed to Central Tuberculosis Research Institute for diagnosis verification. Based on clinical and radiological picture Central Tuberculosis Research Institute colleagues suspected a foreign body in the intermediate bronchus. During an endoscopic examination it was revealed stenosis, biopsies were performed, but the foreign body could not be identified. In the pathomorphological laboratory of Central Tuberculosis Research Institute there were conducted histological examination of the material after endobronchial cryobiopsy and rigid needle biopsy. Both gave an unexpected result: invasive mycosis of the bronchial wall. As a conclusion the decision was taken to apply antimycotic therapy on an outpatient basis. As a result, clear clinical and radiological positive dynamics was obtained. In these favorable conditions for endoscopic examination, it was performed vitally essential cryoextraction of foreign body. The foreign body turned out to be a fragment of a spongy bone of a centimeter size. These actions have let to unlock the right lung lower lobe.

[Radial endobronchial ultrasound combined with transbronchial lung cryobiopsy in differential diagnosis of pulmonary infiltrate]. / Radial'naya endobronkhial'naya ul'trasonografiya v kombinatsii s endoskopicheskoi transbronkhial'noi kriobiopsiei v differentsial'noi diagnostike infil'trata v legkom.

Differential diagnosis of pulmonary infiltrates is difficult due to the absence of specific clinical and radiological manifestations. Differential diagnosis of pulmonary infiltrates usually includes the following «triad¼: pneumonia, tuberculosis, lung cancer. Diagnosis of pulmonary tuberculosis is based on microbiological examination of sputum and bronchoscopic respiratory samples - bronchial washing and bronchoalveolar lavage. Efficiency of molecular genetic methods (including express tests) in detecting M. tuberculosis DNA can reach 91-98%. Therefore, treatment may be started without data of microbiological examination. Nevertheless, there are rare cases of false-positive results of PCR in patients with non-tuberculous lung lesions. This aspect often results false diagnosis and delayed verification of true cause of lung lesion. Another adverse effect is associated with anti-tuberculosis therapy. Endoscopic transbronchial lung biopsy and its modern version (transbronchial cryobiopsy) as a minimally invasive diagnostic procedure are performed in such patients. These methods require a sufficiently high experience and qualification of specialist and following such aspects as navigation techniques and balloon bronchial blocking. We present this clinical case as a demonstration of modern possibilities of multimodal navigational bronchoscopic diagnosis with transbronchial cryobiopsy for local pulmonary infiltrate.

[Lymphocytic myocarditis in patients with COVID-19 (4 autopsy cases)]. / Limfotsitarnyi miokardit u patsientov s COVID-19 (4 autopsiinykh nablyudeniya).

The paper describes 4 autopsy cases of myocarditis in elderly patients with confirmed coronavirus infection. It gives the data of a morphological study of heart specimens and a detailed characterization of a myocardial infiltrate. An immunohistochemical study with cellular infiltrate typing was performed. The fact that lymphocytic viral myocarditis can develop in COVID-19 was morphologically and immunohistochemically confirmed. The features of myocarditis in COVID-19 are the development of the former in the presence of coronaritis and the possibility of its concurrence with lymphocytic endo- and pericarditis.

Mitigating Effect of Nitrates (Monizol) on Pharmacodynamic Shifts in the Cardiovascular System Caused by Radioprotector Indralin.

We studied the effect of radioprotector indralin (B-190) alone or in combination with monizol on BP and HR in rabbits, reduction of blood supply and spleen weight in rats and (CBA×C57Bl/6)F1 hybrids mice, and on blood loss from a wound on tip of the tail in mice. Being an α1-adrenomimetic, indralin caused hypertensive reaction with the development of bradycardia, reduced blood supply and spleen weight, and sharply reduced blood loss from the wound. Monizol as nitrate reduced BP without affecting HR and reduced blood loss from the wound. Monizol administered prior to indralin eliminated radioprotector-induced hypertensive reaction, reduced bradycardia by more than 2 times, and attenuated the effect of indralin on spleen weight and blood loss from the wound by 1.6-1.8 times. Monizol administered after indralin had no effect on shifts in peripheral blood supply caused by the radioprotector.

Pharmacological Analysis of the Therapeutic Effect of Radioprotectors Cystamine and Indralin in the Capacity of Radiomitigators.

The therapeutic radiomitigating effect of cystamine and indralin was studied in experiments on mice and rats and pharmacological analysis of these drugs was carried out. The animals were subjected to whole-body 60Co γ-irradiation. The mice were exposed to single (9-10 Gy) or double (8 Gy) irradiation with an interval of 1 month. The rats were exposed to 10 Gy with partial shielding of the upper quarter of the abdomen. In experiments on mice, pretreatment with reserpine abolished the therapeutic effect of cystamine administered repeatedly every 15 min over 1 h after irradiation. Moreover, summation of the radioprotective and therapeutic effects of the radioprotector was revealed under these conditions. In mice and rats, α1-adrenoreceptor blocker terazosin did not abolish the therapeutic effect of indralin administrated after irradiation, but blocked the radioprotective effect of indralin applied prior to irradiation. At the same time, 5-HT2 serotonin receptor blocker tropoxin abolished the therapeutic effect of indralin without affecting its radioprotective activity.

[Necrotizing sarcoid granulomatosis]. / Nekrotiziruyushchii sarkoidnyi granulematoz.

Necrotizing sarcoid granulomatosis (NSG) belongs to productive small-vessel vasculitis with the formation of sarcoid-like granulomas, which is accompanied by ischemic necrosis of varying degrees and duration. The disease involves the lung only. The clinical symptoms of the disease are nonspecific so the latter is detected rather rarely. The main diagnostic technique is morphological examination. Immune complex inflammation develops in the vessel walls with the formation of macrophage-histiocytic granulomas that do not contain epithelioid cells. The etiology and pathogenesis of NSG remain little studied. Its differential diagnosis is mainly presented with tuberculosis, sarcoidosis, and granulomatosis with polyangiitis.

Gonarthritis photodynamic therapy with chlorin e6 derivatives.

BACKGROUND: The new methods of osteoarthritis treatment are in constant demand due to the complexity of the early diagnosis and therapy. Specific features of Сhlorin e6 derivative (Ce6) accumulation in knee joint tissues and the efficiency of photodynamic therapy (PDT) of gonarthritis were studied. METHODS: The experimental research was conducted on the model of posttraumatic gonarthritis on rabbits. The analysis of dynamics of change of Ce6 concentration in tissues of a knee joint was carried out by the method of fluorescent diagnostics. The intra-joint PDT was carried out using 662nm laser with energy density of 120-150J/cm(2) and a sapphire diffuser. An analysis of slices was conducted to confirm the anti-inflammatory effect through apoptosis. RESULTS: The method of fluorescent spectroscopy revealed that the highest amount of Ce6 was accumulated in the synovial membrane of a damaged knee joint 2.5h after its intravenous introduction. On 14th day after gonarthritis modeling but before PDT the synovial membrane showed signs of synovitis. On 21st day after PDT the synovial membrane possessed noticeable villous structure, and no cells of inflammatory nature were observed. CONCLUSION: Fluorescent diagnostics in knee joint tissues can be used in clinical practice of gonarthritis before, during and after PDT for monitoring the Ce6 accumulation and for treatment control. Optimal radiation energy density was determined to be 150J/cm(2). In the studied time intervals (5-25min) no dependency of PDT effect on irradiation time at the same energy density was observed. The analysis of results of clinical and morphological research shows that PDT is a low-invasive method of gonarthritis treatment with a high degree of efficiency and selectivity.

[Surgical treatment of clival and axis bone cysts].

OBJECTIVE: The study objective is to present the tactics of surgical treatment of simple (solitary) bone cysts of the clival region and CII body. MATERIAL AND METHODS: Two patients were operated on for simple clival and axis cysts. RESULTS: The first patient with a simple clival cyst underwent transoral clivectomy and bone cyst evacuation. Postoperative control SCT scans revealed that the cyst cavity was lined with a hemostatic material and biological glue. Restoration of bone structures of the clivus occurred after 8 months. The second patient with a simple cyst of the second cervical vertebra (axis) underwent a two-stage surgical treatment: occipitospondylodesis was carried out first, and transoral removal of the pathological process of the CII body was performed at the second stage. Control scans a year after the surgery revealed the formation of bone tissue in the axis body region, an increased cystic cavity in the odontoid process of the axis, and posterior migration of the odontoid process, which caused compression of the brainstem structures. In connection with this, we performed transoral re-intervention with removal of the cystic separated odontoid process. Postoperative control scans revealed complete removal of the cystic odontoid process and decompression of the dural sac. The article provides a detailed analysis of the modern literature that has not reported any cases of a simple bone cyst located in the clivus or upper cervical vertebrae region and, thus, has not described the tactics for surgical treatment of these complex diseases. The article presents illustrative pre-, intra-, and postoperative images and histological specimens. CONCLUSION: The described cases present successful recurrence-free surgical treatment of simple (solitary) bone cysts located both in the clivus region (1 case) and in the body and odontoid process of the axis (1 case). A feature of the second case was that the patient had an extremely rare combination of a bone cyst of the C2 body and the cystic separated odontoid process of the axis (cystic os odontoideum).

Radioprotective Properties of Indralin in Combination with Monizol in the Treatment of Local Acute and Delayed Radiation Injuries Caused by Local Skin γ-Irradiation.

Female rats were exposed to local γ-irradiation of the right hindpaw in doses of 30-50 Gy at 131-154 sGy/min dose rate. Radioprotector indralin was administered per os 15 min prior to irradiation, monizol was injected intraperitoneally 5 min after irradiation. Indralin showed marked radioprotective properties both for acute and delayed symptoms of local radiation injuries. In combination with monizol, radioprotective effect of indralin was potentiated to dose reduction factor of 1.4-1.5 both for radiation burn severity reduction and for restriction of postradiational contracture development and amputation of the irradiated limb.

[Synovial lipoma arborescens].

The paper describes a case of synovial lipoma arborescens (tree-forming lipoma) of the knee joint. This tumor is a variety of lipomas--a benign tumor composed of mature adipose tissue without signs of atypia. Most investigators regard lipoma as a reactive rather than neoplastic process. X-ray and histological studies should be performed for its differential diagnosis with pigmented villonodular synovitis, synovial chondromatosis, synovial hemangioma, xanthoma, a group of chronic synovitis in rheumatic diseases (rheumatoid arthritis, amyloid arthropathy, psoriatic arthritis). Its final diagnosis is possible only after morphological study.

Therapeutic effect of long-term melatonin treatment on the course and fatal outcome of modeled acute radiation sickness.

We studied the effect of long-term administration of melatonin to male C57Bl/6 mice starting from day 3 after whole-body γ-irradiation (9.5-10.0 Gy, 7.7-17.1 cGy/min). It was found that replacement of drinking water with melatonin solution (5 mg/liter) did not reduce the amount of fluid intake throughout the period of acute radiation injury. The daily dose of melatonin was 0.9-1.2 mg/kg body weight (this parameter was lower at the peak of the disease and increased during the recovery stage). Melatonin by more than 20% (p<0.05) improved survival of mice exposed to γ-irradiation in a dose of LD97/30, reduced leukopenia during the stage of acute manifestations of the disease and maximum mortality, and increased blood leukocyte count by 40% (p<0.05) by day 12 after irradiation.

[Combined effect of quercetin and indralin (B-190) in alleviating carboplatin hematologic toxicity].

In experiment conducted on male mice of C57B1/6 line quercetin (80-100 mg/kg injected 60 minutes before carboplatin) or an emergency radioprotector indralin B-190 (50-100 mg/kg injected 5 minutes after carboplatin) decreased the mortality of animals from toxic carboplatin dose of 100 mg/kg from 40% to 10-11% (p < 0.05). In mice receiving both quercetin and B-190 the reduction of carboplatin toxicity evaluated by blood WBC level was even more prominent (p < 0.05). The results were confirmed in rat experiment. In animals receiving both quercetin and B-190 with 50 mg/kg of carboplatin the WBC level was higher (p < 0.05). Quercetin alone had no effect on hematologic toxicity in those settings. Besides, quercetin and B-190 didn't have any effect on RBC level changes.

[Radioprotective properties of indralin combined with cystamine and mexamine].

The study of indralin radioprotective properties at its joint application with cystamine and mexamine was carried out in the experiments on inbred mice and rats. The mice and rats were exposed to whole-body y-irradiation at a dose of 9.0 and 9.5 Gy, correspondingly. A combined parenteral administration ofindralin and cystamine at a dose of 25 mg/kg showed ponentiaton of indralin radioprotective properties up to a level of the ED50 effect versus the absence of or a weak radioprotective effect in the case of their separate application. In the experiments on rats, indralin (50 mg/kg) and mexamine (12 mg/kg) injected intraperitoneally almost completely eliminated the animal mortality from the intestinal syndrome of acute radiation sickness amounting in the control radiation group to 60% on the 7th day after exposure to radiation at a dose of 9.5 Gy. However, at the above conditions, radioprotectors at these doses had a low-level radioprotective action at the onset of the bone marrow syndrome of acute radiation sickness. Combined application of indralin and mexamine at the same doses and at the same conditions led to a radiation protection 50% as high as in the case when radioprotectors were applied separately at a double dose.

[The influence of combined application of quercetin and indralin on post-irradiation repair of hematopoiesis in acute radiation injury].

Experiments on mice-hybrids F1(CBA x C57B1/6) have detected a favorable effect of the associated application of quercetin (30-60 minutes before y-exposure of an animal) and a radioprotectant of urgent action indralin (in the case of its application after y-exposure) on a post-irradiation repair of the hematopoietic tissue in acute radiation sickness after y-exposure at a non-lethal dose of 6.7 Gy, which manifested itself in the accelerated formation of endogenous spleen colonies and spleen mass recovery, as well as in the lesser degree of leukopenia on the 12th and the 16th day after acute radiation injury. Quercetin per se did not have a radio-protective effect.

[Aneurysmal bone cyst in children].

Aneurysmal bone cyst (ABC), a tumor-like destructive lesion, is characterized by the presence of cavities of different sizes, which are filled with blood, connective tissue-septated with fibroblasts, histiocytes, osteoclast multinucleated giant cells, osteoids, bone trabecules, and accompanied by high intraosseous pressure. ABC most frequently occurs in the second decade of life. ABC is located in the metaphyseal area in children, by displacing to the diaphysis during their growth. Surgery is a basic treatment for ABC. Its relapses frequently occur, which depends on the method of a surgical intervention, methodic activity, and the belonging to a risk group (including a combination of age, cyst size, process phase, and location).

[The morphological characteristics of osteoarthrosis].

Osteoarthrosis (OA) is a group of overlapping diseases that have various etiologies, but equal biological, morphological, and clinical outcomes. OA is characterized by degenerative and destructive changes in the articular hyaline cartilage, subchondral bone, spongiosis, synovium, capsule, and articular ligamentous apparatus. The clinical symptoms of OA are closely associated with morphological changes in articular tissue elements, primarily in the articular hyaline cartilage. Six stages that reflect the magnitude of changes in the hyaline cartilage and 4 degrees of the extent of the process along the articular surface are identified.

[Pigmented villonodular synovitis].

Pigmented villonodular synovitis (PVNS) is a destructive proliferative tumoroid disease of the synovial sheath of the joints, bursae, and tendon. The microscopic pattern of PVNS is characterized by mosaicism: compact cell zones alternate with loose few-celled fields. The synovial sheath is hyperplastic; its stroma exhibits hemosiderin and siderophages, as well as histiocytes, lymphocytes, multinucleated giant osteoclasts, foamy and synoviocyte-like cells. Proliferation with destructive growth was noted in PVNS. A distinction is made between focal and diffuse, intraarticular and extraarticular forms of the disease. Early diagnosis of the disease favors effective treatment and prevention of soft tissue and bone destruction and reduces the risk of recurrences.

[Radioprotective properties of a radioprotector of emergency action indraline at its adminisration after irradiation in conditions of local shielding of a rat abdomen].

In experiences on white rats at a gamma-irradiation in a lethal dose LD97/30 in conditions of local schielding of an abdomen (in the field of a liver) and application of a radioprotector indraline after irradiation the expressed efficiency of combined protection up to 87.5% is scored at 31.3% of a survival in local schielding of an abdomen group and absence of effect from a drug.