[Balo's concentric sclerosis]. / Kontsentricheskii skleroz Balo.

Balo's concentric sclerosis (BCS) is a rare demyelinating disease, first described by Hungarian neurologist Josef Balo in 1928. BCS occurs predominantly in young adults, the average age of onset of the disease - 34 years (range from 3 to 62 years). Our case report describes a 27-year woman with acute onset progressive right-side pyramidal weakness, MRI results showed a variant of demyelination as Balo's concentric sclerosis.

[A study of the efficacy of infibeta in patients with multiple sclerosis based on NEDA-3]. / Izuchenie éffektivnosti lekarstvennogo preparata infibeta u patsientov c rasseiannym sklerozom na osnovanii kriteriev NEDA-3.

AIM: The two-year study of the efficacy of Ifnb-1B (infibeta) in patients with relapsing-remitting (RRS) and secondary progressive multiple sclerosis (SPMS) in the Moscow region with the criteria NEDA-3. MATERIAL AND METHODS: Three hundred patients, 81 men and 219 women, aged from 18 to 67 years, including 227 with RRS and 73 with SPMS, were studied. The duration of disease was from 0.5 to 39 years, the level of neurological deficit on EDSS scale was from 1 to 6.5 points. All patients received infibeta. RESULTS AND CONCLUSION: During the treatment with infibeta, the chance of exacerbation decreased by an average of 39.4 times (OR 39.4 95% CI; 16.6-122.7) during the first year, by 35.3 times (OR 35.3; 95% CI 13.5-131,2) during the second year. A statistically significant decrease in the probability of exacerbation is also confirmed in the conditional logistic regression model (p<0.001). MRI revealed the signs of exacerbation and progression of the disease only in 11.5% of patients; 54.9% of the patients met the criteria NEDA-3. The highest efficacy of infibeta is noted in patients with RRS, more than 3/4 of them responded to therapy with the absence of both clinical and MRI signs of exacerbation and increase in neurodegeneration. Thus, a good clinical result is achieved in patients with RRS and SPMS treated with infibeta. When using the NEDA-3 criteria, a positive result is achieved in more than half of patients.

[Cognitive dysfunction and the progression of neurodegenerative process in patients with multiple sclerosis]. / Kognitivnaia disfunktsiia i techenie neirodegenerativnogo protsessa u bol'nykh rasseiannym sklerozom.

INTRODUCTION: Neurodegeneration (ND) is the basis of the gradual increase in neurological deficit and cognitive impairment in patients with multiple sclerosis (MS). Morphometry of the brain is the method for monitoring of ND. The possibility of using neuropsychological tests for this purpose is being actively discussed. AIM: To examine the effect of treatment with interferon beta-1b (IFNb-1b) on the development of the neurodegenerative process according to morphometry and cognitive testing. MATERIAL AND METHODS: Twenty-three patients with relapsing-remitting MS were examined. The control group included 10 healthy people. All patients received IFNb-1b in a dose of 9.6 million IU. EDSS, MSFC, depression and anxiety Beck test, Wechsler test, magnetic resonance imaging (MRI) of the brain, voxel morphometry with FreeSurfer 5.3 were used. The EDSS score was 4.0 before treatment. RESULTS: In MS patients, MSFC and Wechsler scores were worse in comparison with similar indicators of the control group. Deterioration of neurological status, motor function test and PASAT during exacerbation was identified in 7 patients. Morphometry revealed the increase in hypointense white matter lesions (HWML) (p<0.05) in patients with MS. There was a downward trend in the cortical and subcortical gray matter volume and the increase in ventricular volume. A direct correlation between the amount of HWML and the degree of disability on EDSS scale (p=0.018), the inverse correlation between HWML and Wechsler test, PASAT (p<0.05) were identified. After a year of therapy, there were no statistically significant changes in motor and cognitive functions and no signs of 'pseudoatrophy'. CONCLUSION: Morphometric data in MS were changed compared to healthy controls. There were correlations between morphometry results, disability and cognitive dysfunction. After a year of IFNb-1b therapy, there were no significant changes in cognitive function and EDSS.

[Clinical and functional characteristics of giant pituitary adenomas in the population of patients in the Moscow region]. / Klinicheskie i funktsional'nye kharakteristiki gigantskikh adenom gipofiza v populiatsii patsientov Moskovskoi oblasti.

Benign pituitary tumors are the most common sellar neoplasms. Lesions larger than 39 mm in the maximum dimension are called giant. They are rare, and, therefore, there are few data on the clinical and morphological features of giant pituitary tumors with different hormonal activity. AIM: The aim of this study was to identify the clinical and functional features of giant pituitary tumors with different hormonal activity. MATERIAL AND METHODS: We analyzed data of clinical, laboratory, and instrumental examinations of 351 patients diagnosed with pituitary macroadenomas at the Moscow Regional Research Clinical Institute in the period between 2008 and 2017: there were 144 hormonally inactive pituitary adenomas and 207 hormonally active pituitary adenomas (65 prolactinomas and 142 somatotropinomas). RESULTS AND DISCUSSION: Among 351 patients with pituitary macroadenomas, there were 32 (9.1%) giant adenoma cases: 18 (12.5%) 144 patients with hormonally inactive pituitary adenomas and 14 (6.8%) 207 patients with hormonally active pituitary adenomas 6 (3.9%) 65 prolactinomas and 6 (2.9%) 142 somatotropinomas. The volume of giant adenomas was somewhat larger among somatotropinomas 48 926 [35 067; 97 650] mm3 and prolactinomas 36 872 [15 281; 75 102] mm3 compared to that of hormonally inactive pituitary adenomas 26 933 [21 910; 42 895] mm3. Tumors had predominant suprasellar and posterosellar growth (31 (97.8%) and 29 (90.6%) cases, respectively). The most common first patient complaints were visual impairments (59.4%) and headache and/or dizziness (43.8%). Correspondingly, due to these complaints, 16 (50%) patients first consulted an ophthalmologist. Hypopituitarism detected before any treatment was present in 16 (50%) patients. CONCLUSION: In most cases, visual impairments and headaches/dizziness were the first manifestations of giant pituitary adenomas; therefore, ophthalmologists and neurologists should always refer patients with these complaints to MRI. Patients with identified giant pituitary tumors should be referred to an endocrinologist for exclusion of hypopituitarism and, if necessary, timely prescription of hormonal therapy.

[Diabetic asymmetric proximal neuropathy]. / Diabeticheskaia asimmetrichnaia proksimal'naia neiropatiia.

AIM: To study the prevalence, clinical features and treatment of diabetic asymmetric proximal neuropathy (DAPN). MATERIAL AND METHODS: Four hundred and forty-five patients with diabetes mellitus (DM), 257 women and 188 men, mean age 47.6±0.5 years, including 163 patients with DM type I and 282 with DM type II, were examined. RESULTS AND CONCLUSION: Distal symmetric sensory motor polyneuropathy was found in 62% of the patients, autonomic neuropathy in 25.6%, somatic mononeuropathy in 28.5%, DAPN in 7.9%. DAPN was more frequent in patients with DM type II (9.6), with poor control of glycemia and DM duration more than 5 years. Pain and paresthesia in a zone of innervation of several roots and nerves, amyotrophy that spread beyond the definite myotome were key symptoms of DAPN. The efficacy of double therapy of neuropathic pain (pregabalin and duloxetine) and vitamin B complex was shown. A role of glucocorticoids and normal human immunoglobulin in treatment of DAPN is discussed.

[Wernicke-Korsakoff syndrome]. / Sindrom Vernike-Korsakova.

AIM: To study the diagnosis and treatment of non-alcoholic Wernicke-Korsakoff syndrome (WKS). MATERIAL AND METHODS: Eight patients (5 men and 3 women), mean age 38,9±1,4 years, with WKS developed due to acute gastrointestinal tract (GIT) disease (3 patients), the exacerbation of chronic GIT disease with malabsorption (2 patients) and after surgery on the upper GIT (3 patients) were included in the study. RESULTS: The disease manifested with consciousness disturbance, symptoms of ataxia, eye movement disorders and bulbar syndrome that developed after 24-48 h. Treatment resistant tonic-clonic seizures were developed in 1 patient. MRI revealed hyper intensive signals on T2-weighted images in the hypothalamus, mamillar bodies, brain stem, hippocampus as well as contrast accumulation in the mamillar bodies. Treatment with vitamin B complex (neurobion) and thiamine exerted a positive effect. CONCLUSION: Patients with GIT disease with malabsorption are at risk of WKS. Consciousness disturbance, symptoms of ataxia, eye movement disorders indicate the necessity of treatment with thiamine that allows to prevent the development of stable cognitive deficit.

[Cystic duplication of the jejunum].

The paper presents a clinical case of jejunal duplication, a rare anomaly of the gastrointestinal tract. It describes an algorithm for hospital diagnostic and therapeutic measures. The capacities of radiodiagnostic studies, such as ultrasonography and magnetic resonance imaging, applied to this clinical case, are analyzed. The paper is supplemented by a concise review of the literature. An update suggests that there are diagnostic difficulties in this anomaly, even when a complete set of radiation techniques is applied and trained specialists participate.

[Cases of atypical pulmonary diseases under influence of industrial aerosols].

The article includes discharge epicrises of patients working in contact with quartz-containing dust, welding aerosol, cotton dust, irritant gases emitted in wood burning. Description covers cases of lung fibrosis, idiopathic interstitial pneumonia, systemic vasculitis with lungs involvement, sarcoidosis. The authors suggest that further accumulation of materials, further investigations of lung tissue state, epidemiologic studies will help to widen the list of occupational pulmonary diseases.

[Interpretation of a computed tomographic pattern in pulmonary sarcoidosis].

Five main types of lung involvement were identified in pulmonary sarcoidosis: 1) focal changes; 2) ground-glass lung induration; 3) lung consolidation; 4) interstitial thickening; 5) honeycomb lung. Lung computed tomographic changes were quantitatively evaluated by three independent specialists.

[Roentgenological semiotics of sarcoidosis].

The aim of this review was to summarize semiotics of X-ray and CT-observable manifestations of intrathoracic sarcoidosis and clarify the role of conventional X-ray examination and CT (including high resolution CT) in the diagnosis of this disease and its complications. Also analysed are changes in pulmonary parenchyma compared with those detected in morphological studies.

[Differential diagnosis of intrathoracic lymph node lesions in lymphomas].

UNLABELLED: Thoracic lymphomas most commonly afflict the lymph nodes of the mediastinum and lung roots. A diagnostic difficulty is due to selectivity of the lesion in different groups of lymph nodes, which may be accompanied by no x-ray changes in the early stages of the process and by a disseminated lesion and polymorphism of its manifestations in the extensive stages of the disease. SUBJECTS AND METHODS: Two hundred and thirty-three patients with intrathoracic lymph node lesion were examined in 2003 to 2008. Conventional x-ray was a primary study. Later on multispiral computed tomography (MSCT) was performed, which was, if needed, supplemented by bolus contrast media injection and, in some cases, by magnetic resonance imaging. RESULTS: Lymph nodes were involved by lymphoma in 154 patients, among which lymphogranulomatosis was in 74 cases, malignant non-Hodgkin's lymphoma in 59, and chronic lympholeukemia in 21. Seventy-nine patients had a similar x-ray pattern that required a differential diagnosis with lymphomas (central cancer in 29 cases, sarcoidosis in 16, metastatic lesion in 12, pneumoconiosis in 10, tuberculosis in 7, Castleman's disease in 2, and lymphangioleiomatosis in 1. CONCLUSION: the application of state-of-the-art radio technologies, primary MSCT, provides the maximal accurate differential diagnosis of intrathoracic lymph node lesion in lymphoma, which is the basis of timely treatment.

[To the mechanism of edema around malignant brain glioma].

Based on the results of a comparative study (magnetic resonance imaging and/or computed tomography with a morphological study) in 11 patients with malignant brain glioma, the authors have ascertained that the extent of perifocal edema cannot fully reflect the degree of impairment of the blood-brain barrier (BBB) in the tumor vessels: the signs of BBB impairment were found in 47.1% of the tumor vessels in patients with insignificant edema and in only 15% of the vessels in those with significant edema.

[Conventional X-ray study in the diagnosis of esophageal achalasia and at its treatment stages].

The paper deals with one of rather common and clinically urgent diseases of the esophagus--esophageal achalasia (EA). By using 173 cases as an example, the authors show a diversity of clinical symptoms and basic X-ray diagnostic criteria for this abnormality. Analysis of the results of clinical and instrumental studies has enabled the authors to differentiate the complicated and uncomplicated forms of the disease, identification of which determines the choice of an algorithm of complex treatment. The paper provides strong evidence that the classical techniques of a conventional X-ray study ensure a valid differential diagnosis of EA and cardioesophageal cancer and evaluates the efficiency of treatments.

[Radiation studies in the detection of early signs of lung tissue lesion in sarcoidosis].

The capacities of various radiation techniques in the study of patients with pulmonary sarcoidosis are analyzed. The sequence of their use, which ensures a high informative value, is proposed. By analyzing the X-ray semiotics in 45 patients with pulmonary sarcoidosis, the authors give the diagnostic signs of early lung parenchymal damage in this disease. Particular emphasis is placed on the procedure of lung X-ray computed tomography.

[Potentialities of magnetic resonance imaging in the study of renal morphofunctional state in girls with internal genital malformations and space-occupying lesions].

The diagnosis of the anatomic and functional state of urinary organs in girls with internal genital malformations and space-occupying lesions involves magnetic resonance imaging by administering the optimized dose of a magnetic resonance contrast agent (MRCA). The technology makes it possible to evaluate the anatomic features of the urinary tract (magnetic resonance urography), to perform abdominal vascular magnetic resonance angiography, and to draw a conclusion on renal functional status in the use of dynamic magnetic resonance renography. Within a study using one injected MRCA dose, both the anatomic and functional state of the kidney status can be examined, by evaluating MRCA passage singly in the cortical and medullary substances and pelvises, which increases diagnostic accuracy by 46% and promotes the optimization of management tactics in this category of patients.

[Methodological features of magnetic resonance imaging mammography].

By studying 211 females by currently available radiation techniques, such as X-ray study, ultrasonography, and magnetic resonance imaging mammography (MRIM), the authors consider that the specificity of contrast-enhanced MRIM (CE MRIM) is greater than that of MRIM without administering magnetic resonance contrast agents (MRCA). CE MRIM reveals clinically suspicious early-stage breast lesions and defines the stage of a tumorous process, the patients being unexposed to ionizing irradiation. CE MRIM as an auxiliary technique becomes one of the most informative ones, particularly in girls, early reproductive-age females with developed glandular tissue, and pregnant females. In the authors' opinion, the total algorithm of a breast study in this group of patients in specialized medical centers where trained physicians work should differ from the generally accepted algorithm: instead of applying X-ray mammography (XRM) as a basic method of primary diagnosis, ultrasound mammography using Doppler color mapping, followed by MRIM or XRM should be employed.

[The comparison of glioblastoma and its surrounding edema by MRI of brain].

In the article authors consider reasons, leading to the formation of edema around the glioblastoma by analysis of perifocal edema size, glioblastoma size and necrosis zone correlation. According their data, the size of glioblastoma edema, revealed by MRI, varies widely. Practically, in third of patients the size of edema is less than the glioblastoma size, in third--their sizes are equal, in 40% the size of edema exceeds the size of glioblastoma. Relying on received data it is found out that the formation of edema around the glioblastoma is not the consequence of tumor compression on adjoining brain tissue and is determined by transmissivity of blood-brain barrier disturbance as the result of vasoactive substances secretion by blastoma.

[Magnetic resonance imaging in the differential diagnosis of chronic endometritis: capacities and methodic features].

By examining 83 females aged 17-48 years by magnetic resonance imaging (MRI), the authors conclude that the specificity and sensitivity of the technique without MR contrast agents in detecting chronic endometritis (CE) and chronic metroendometritis (CME) are 75.3 and 95.9%, respectively. On the MRI scans, hypertrophic and atrophic forms of CE have rather specific MR signs and appear as changes not only in the functional layer of the endometrium and transitional area, but also in the proper myometrium in CME. This all permits evaluating the degree of uterine wall involvement in the pathological process. Overall, the MRI criteria proposed by the authors can identify the signs of a chronic inflammatory process and its sequels and make a differential diagnosis this condition with female genital diseases to a high accuracy.