Contribution of brain imaging to the diagnosis of intracranial tuberculoma and other brain lesions in patients presenting with miliary tuberculosis.

BACKGROUND: Miliary tuberculosis (miliary TB) is characterized by a hematogenous spread of Mycobacterium tuberculosis. Cerebral lesions associated with miliary TB have been reported with diverse frequencies. METHODS: We retrospectively analyzed brain imaging in 34 patients presenting with proven miliary TB hospitalized in our teaching hospital between 2008 and 2014. RESULTS: Neurological symptoms were present at admission in 15 patients, emerged during treatment in six, and were never reported in 13. Twenty-one of 34 patients had cerebral involvement, of which five patients did not present with any neurological symptoms. The most common brain lesions on MRI were tuberculomas. Cerebrospinal fluid (CSF) analysis showed elevated cell count in eight patients who all had abnormal MRI results. Nine patients with normal CSF had abnormal MRI results. CSF cultures were positive in only eight patients. Paradoxical clinical worsening during TB and corticosteroid treatment was observed in six patients. CONCLUSION: Among patients presenting with miliary TB who underwent brain imaging, more than 60% demonstrated cerebral involvement. Abnormal imaging could occur without any clinical nor CSF impairment. Systematically performing brain imaging in miliary TB patients could therefore be informative.

Adherence to treatment guidelines for cancer-associated thrombosis: a French hospital-based cohort study.

PURPOSE: French 2008 treatment guidelines recommend low-molecular-weight heparins (LMWH) for the treatment of cancer-associated thrombosis (CAT) with treatment duration of at least 3 months and up to 6 months and beyond if cancer remains active. Our aim was to assess adherence to guidelines in hospital clinical practice. METHODS: The French hospital database (PMSI) was used to identify patients with CAT admitted to three hospitals of the Paris region to be included in a retrospective cohort study. Adherence to guidelines was assessed in patients included from different treatment periods following the venous thromboembolism (VTE) episode i.e. first 10 days (T1), day 10 to 3 months (T2), months 3 to 6 (T3) and beyond 6 months (T4) when applicable. RESULTS: A total of 240 patients with CAT were included from January 2012 to December 2012 of whom 204 were analyzable. Treatment was adherent to guidelines in 55, 31 and 34 % of patients in T1, T2 and T3 treatment periods, respectively, while overall treatment adherence was found in 52 % of patients. Adherence rates were the highest among patients with pulmonary embolism (PE, 60.5 %), catheter-related thrombosis (62.5 %), class III/IV extended cancer (58.0 %) and metastatic malignancy (60.3 %) while only 40 % with deep vein thrombosis (DVT) received a treatment consistent with guidelines. CONCLUSION: Adherence to guidelines appears insufficient since only half of patients received an appropriate treatment. Adherence dropped significantly across treatment periods T2 and T3. VTE diagnosis and cancer characteristics influenced the anticoagulant prescription. Management of patients with CAT requires further education and information of health care professionals.

[Effect of alpha-conotoxin MII and its N-terminal derivatives on Ca2+ and Na+ signals induced by nicotine in neuroblastoma cell line SH-SY5Y].

Nicotinic acetylcholine receptors (nAChRs) are implicated in the regulation ofintracellular Ca2+-dependent processes in cells both in normal and pathological states, alpha-Conotoxins isolated from Conus snails venom are a valuable tool for the study of pharmacological properties and functional role of nAChRs. In the present study the alpha-conotoxin MII analogue with the additional tyrosine attached to the N terminus (Y0-MII) was prepared. Also we synthesized analogs with the N-terminal glycine residue labeled with the Bolton- Hunter reagent (BH-MII) or fluorestsein isothiocyanate (FITC-MII). Fluorescence microscopy studies of the neuroblastoma SH-SY5Y cells loaded with Ca2+ indicator Fura-2 or with Ca2+ and Na+ indicators Fluo-4 and SBFI were performed to examine effect of MII modification on its ability to inhibit nicotin-induced increases in intracellular free Ca2+ and Na+ concentrations ([Ca2+] and [Na+]i respectively). Monitoring of individual cell [Ca2+]i and [Na+]i signals revealed different kinetics of [Ca2+]i and [Na+]i rise and decay in responses to brief nicotine (Nic) applications (10-30 microM, 3-5 min), which indicates to different mechanisms of Ca2+ and Na+ homeostasis control in SH-SY5Y cells. MII inhibited in concentration-dependent manner the both [Ca2+]i and [Na+]i increase induced by Nic. Additional tyrosine in the Y0-MII or, especially, more sizeable label in FITC-MII significantly reduced the inhibitory effect of MII. Whereas the efficiency of the Ca2+ response inhibition by BH-MII was found to be close to the efficiency of its inhibition by natural alpha-conotoxin MII, radioiodinated derivatives BH-MII can be used in radioligand assay.

[Transvaginal echography in the diagnosis of endometrioid cysts of the ovaries]. / Transvaginal'naia ékhografiia v diagnostike éndometroidnykh kist iachnikov.

Research into the value of transvaginal echography in the diagnosis of endometrioid ovarian cysts has shown that this pathology is characterized by the presence of a round or oblong formation, filled with small-dotted suspension of mean or high echogeneity, by a dense hyperechogenic component of small sizes and wall thickening up to 0.2-0.3 cm. The accuracy of diagnosis of endometrioid ovarian cysts was 92.3%.

[Echographic characteristics of uterine sarcomas]. / Ekhograficheskaia kharakteristika sarkom matki.

Sonographic potentials in the diagnosis of uterine sarcomas have been evaluated. Sarcomas were identified in 9 patients. Their populational incidence was 0.67:100,000. Specific sonographic signs of this disease were absent. The most characteristic presentation of uterine sarcomas were an anecho enic area in the myomatous node in the absence of acoustic effects of dorsal accentuation, appearance of cystic degeneration of the tumor, and a marked uterine enlargement during a follow up. It is suggested that these criteria may provide a diagnosis accuracy in a number of cases.

[Possibilities of echography in the diagnosis of polycystic ovary syndrome]. / Vozmozhnosti ékhografii v diagnostike sindroma polikistoznykh iaichnikov.

An examination was made to define the significance of echography in the diagnosis of the polycystic ovary syndrome. A total of 276 patients with the morphologically verified disease and 70 healthy females of reproductive age were studied. It was found that the reliable results in detecting the disease might be obtained when the ovarian-uterine index (OUI) proposed by the authors was calculated. The OUI is the quotient obtained when the mean ovary volume was divided by the uterine thickness. It was ascertained that the OUI greater than 3.5 was indicative of the polycystic ovary syndrome in 91%. The index lower than the threshold value was suggestive of normal ovaries in 85%. In general, the accuracy of the presence or absence of the polycystic ovary syndrome was 87% when the OUI was estimated.

[Effect of acupuncture on respiratory mechanisms in patients with bronchial asthma]. / Vliianie iglorefleksoterapii na mekhaniku dykhaniia u bol'nykh bronkhial'noi astmoi.

Simultaneous recording of the spirogram, pneumotachogram and transpulmonary pressure as well as total plethysmography were applied in 30 patients with bronchial asthma to study the respiratory ventilation and mechanism before and after single procedures of acupuncture. The bronchodilatory action of acupuncture has been proved, related, in particular, with a significant decrease of non-elastic resistance of the lungs. At the same time pronounced changes in the elastic resistance were noted. However, they appeared to be of different directions. The improvement of ventilatory function was determined not only by a decrease in the intrapulmonary resistance but also by shifts in respiratory regulation and in the activity of the respiratory musculature, confirmed by an analysis of the curves of the respiratory work obtained before and after acupuncture. The curative action of acupuncture in bronchial asthma cannot be adequately explained by the placebo effect.

[Morphologic and molecular aspects of the interaction of platelets with elements of the vascular wall]. / Morfologicheskie i molekuliarnye aspekty vzaimodeistviia trombotsitov s élementami sosudistoi stenki.

The review presents and analyzes the data available on the structure and functions of adhesive proteins, Willebrand's factor, fibrinogen, thrombospondin, and fibronectin, their secretion and interaction with blood cells and subendothelial matrix in the focus of endothelial desquamation. A structural similarity of these modular glycoproteins, their domain structure-related functions, distinctive features of cellular reception are shown. The authors also consider structural changes in platelets in their activation, rearrangement of glycoprotein complexes IIb/IIIa on the membrane for binding adhesive proteins, role of these proteins in the organization of reversible and stabilized cellular aggregates and their location in the area of the damaged endothelium. The evidence is given for one of the most important mechanisms of limiting the platelet formation-activation system of C protein, which is mediated through thrombin binding to endothelial thrombomodulin. Hemostatic abnormalities occur with congenital defects in the structure of adhesive factors or their receptors while protein deficiency in the C protein system results in formation of thromboses.

[Methodological problems of the diagnosis of pathomorphological processes]. / Metodologicheskie voprosy diagnostiki patomorfologicheskikh protsessov.

The authors hold that clinical, intravital clinicomorphological and postmortem morphological diagnosis should be based on methodological approaches of dialectical materialism providing clear-cut understanding of logical analysis and synthesis of pathological processes operable in the human body. Such understanding will promote recognition of qualitatively new clinical and morphological signs differentiating the conceptions of illness from health. Noteworthy also is algorithmization of biopsy processing which, as an objective method, is strongly recommended for introduction into the research and clinical practice of the clinical pathologists.

[Fibronectin and its role in granuloma formation]. / Fibronektin i ego rol' v granulemoobrazovanii.

Fibronectin (F) is a high-molecular-weight glycoprotein widely presented on the cell surface of fibroblasts, monocytes, endothelial cells and several types of other cells. It is also available in the extracellular matrix of connective tissue and in plasma. Active biologically, F is involved in cell-to-cell and cell-to-substrate adhesion, migration and differentiation of cells, maintenance of cellular structure, wound healing, blood coagulation and opsonic function. In addition, F has a special affinity to collagen, heparin, fibrin and fibrinogen. The above properties suggest F relevance to evolution of productive inflammation and granuloma development. The studies of F presentation, distribution, localization, concentration, function and influence on cell transformation throughout different stages of granuloma evolution can be helpful in elucidation of so far obscure traits of granuloma histogenesis.

[60 years in pathologic anatomy]. / 60 let v patologicheskoi anatomii.

A. I. Strukov--Hero of Socialist Labour, Lenin prize winner, Honoured Scientist, Academician of the USSR Academy of Medical Sciences has been involved in a pathological anatomy for 60 years. He started studying this discipline when a student, and his first teacher was Professor V. A. Afanasyev. After a short period of work as an assistant of a Chair of Pathological Anatomy in Voronezh A. I. Strukov became a chief of a department of pathology in N. A. Semashko City Hospital in Tula. Simultaneously he attended, by correspondence, a postgraduate course in a Chair of Pathological Anatomy headed by Prof. A. I. Abrikosov at the First Moscow University. Later A. I. Strukov moved to Moscow where he started working in a laboratory of pathology of the Central Institute of Tuberculosis of the USSR Ministry of Health, headed by Prof. V. G. Stefko. He inherited from his chiefs the interest to the problem of tuberculosis and, for many years, he has been studying, together with his students, the details of morpho- and pathogenesis and pathomorphosis of this disease. The results of these studies were published in a number of monographs and journals and were included into candidate and doctor theses. A. I. Strukov developed a clinico-morphological classification of tuberculosis recognised by pathologists and clinicians of the USSR. Since 1933 A. I. Strukov worked as an assistant of A. I. Abrikosov's chair and was elected a chief of the Pathological Anatomy Chair of the First Kharkov Medical Institute. He spent the Great Patriotic War (1941-1945) in Orenburg where the Kharkov Medical Institute was evacuated. Here on the basis of local civil and military hospitals, teaching, clinical and scientific work of the institute chairs, including that of pathological anatomy, was developed. A. I. Strukov returned to Moscow in 1944, worked in Prof. V. G. Shtefko's laboratory, then was elected a Professor of a Chair of Pathological Anatomy in the First Moscow Medical Institute. In 1953, after A. I. Abrikosov has retired, A. I. Strukov became the chief of this most prominent chair of pathological anatomy in the country. Continuing the traditions of A. I. Abrikosov's school, A. I. Strukov investigates with his students various problems of pathology (tuberculosis, rheumatic diseases), develops a concept of systemic and progressing disorganisation of connective tissue in rheumatic diseases, continues studying the pathology of broncho-pulmonary lesions, cardio-vascular diseases.(ABSTRACT TRUNCATED AT 400 WORDS)

[Acquired immunodeficiency syndrome]. / Sindrom priobretennogo immunnogo defitsita.

Literature data on etiology, immune disorders, pathological anatomy of the acquired immunodeficiency syndrome (AIDS) was analysed. AIDS is a low-contagious disease, is most likely caused by retrovirus HTLV-III affecting a subpopulation of T-lymphocytes helpers. The disease develops in a small number of persons with antibodies to the mentioned virus, first of all, in homosexuals, drug addicts using parenteral administration of drugs; in patients with hemophilia. The progress of the disease is relatively slow, but at present the outcome of most AIDS cases is fatal. The main cause of mortality is association of intercurrent infectious diseases (viral, parasitic, fungal, bacterial) on the background of the impaired immunity. The autopsy picture is non-specific. The authors pay attention to the high frequency of Kaposi sarcoma among the patients with AIDS. Besides such diagnostic features as presence of antibodies to HTLV-III retrovirus and the clinical picture one should take into account changes in the lymph nodes, presence of viral particles in their bioptates, a high level of alpha-thymosin, a drastic reduction of T-lymphocytes in blood and especially of T-lymphocytes helpers.

[Transbronchial biopsy in the diagnosis of sarcoidosis and certain other interstitial lung diseases]. / Transbronkhial'naia biopsiia v diagnostike sarkoidoza i nekotorykh drugikh interstitsial'nykh zabolevanii legkikh.

Results of transbronchial pulmonary biopsy studies of patients of different sex and age suffering from interstitial pulmonary lesion are presented. Different diagnostic value of transbronchial pulmonary biopsy (TBBP) is shown in relation to different lesions. In case of sarcoidosis its informative value, for example, is high, while in the diffuse processes such as cryptogenic fibrosing alveolitis, the data allow only suggestive diagnosis and recommendation of an open lung biopsy. In chronic nonspecific pulmonary diseases TBBP helps to clarify the character and the activity of the process involved. In some cases it is possible to reveal a latent cancer. It is suggested to use the term "allergic alveolitis" (indicating the mechanism of development of changes mentioned) when such changes as alveolitis, small granulemas and intraalveolar outgrowths are found in the biopsy specimens.

[Microcirculation in rheumatic mitral stenosis (clinico-morphological research by lung biopsies)]. / Mikrotsirkuliatsiia pri revmaticheskom mitral'nom stenoze (kliniko-morfologicheskoe issledovanie po bioptatam legkikh).

The study of the microcirculation in lung and visceral pleura biopsies from patients with rheumatic mitral stenosis showed the involvement of all parts of the microcirculatory system including intra- and extravascular alterations and changes of the vascular wall as well as its lymphatic part. As the pressure in the small circulation circle increased and arterial hypertension established enhancement of the vascular reconstruction, rheological disturbances and dyscoagulation in the pulmonary microvessels took place. All this resulted in hemodynamic and metabolic homeostasis disturbances in the pulmonary artery system and, consequently, in the establishment of lung hypertension.