Intravascular ultrasound-guided internal carotid artery stenting. / Stentirovanie vnutrennikh sonnykh arterii pod kontrolem vnutrisosudistogo ul'trazvukovogo issledovaniia.

AIM: The study was aimed at demonstrating efficacy and feasibility of intravascular ultrasound during internal carotid artery stenting for assessment of atheromatous plaque protrusion through a stent. PATIENTS AND METHODS: Over the period from October to December 2018, the specialists of our Centre performed a total of 90 internal carotid artery stenting procedures in 83 patients (of these, 7 patients underwent bilateral staged stenting of both internal carotid arteries) using intravascular ultrasound in order to assess intraoperative protrusion of an atherosclerotic plaque through the implanted stent. The patients' age varied from 42 to 87 (mean 68.6±6.9) years. Symptomatic lesions of internal carotid arteries were revealed in 14 (16.9%) operated patients and asymptomatic lesions in 69 (83.1%). The degree of stenosis varied from 60% to 90% according to the findings of preliminary duplex ultrasonography and was subsequently confirmed by the results of multislice computed tomography or selective angiography. The assessment of the patients' neurological status, as well as duplex ultrasonography of brachiocephalic arteries were performed at a scheduled follow-up visit on day 30 after discharge from hospital. RESULTS: The technical success of stenting was achieved in 100% of patients. According to the findings of intravascular ultrasound, plaque protrusion was observed in eight (8.8%) stented patients. Among them, six (6.6%) were free from angiographic signs of protrusion and only two (2.2%) had apparent angiographic signs of protrusion. During the early postoperative period, transient ischaemic attack was identified in four (4.4%) cases. One (1.1%) patient was found to develop ST-segment elevation acute myocardial infarction 24 hours after internal carotid artery stenting, followed by large hemispheric stroke on the side of stenting revealed on postoperative day 3. Nine (10%) patients according to the findings of intravascular ultrasound were diagnosed as having incomplete stent apposition after postdilatation, with the absence of such signs on angiography. CONCLUSION: Intravascular ultrasound during carotid stenting provides a more accurate assessment of such an event as atherosclerotic plaque protrusion through a stent's cells. At the same time, IVUS-guided assessment of the intraoperative outcome may prevent the risk for the development of stroke in the early postoperative period. Besides, intravascular ultrasound allows a more detailed assessment of stent apposition and the degree of stent expansion in order to optimize and improve the remote results of the operation.

[Chronic Heart Failure With Preserved Systolic Function and Reversible Dilatation of Cardiac Chambers].

Diagnosis of dilation (D) cardiomyopathy (CMP) requires exclusion not only of inflammatory and genetically determined forms but also of some rare diseases. This 51 year old patient with history of moderate arterial hypertension approached a cardiologist because of new onset atrial fibrillation and dyspnea. Echocardiography detected dilation of all cardiac chambers with relatively preserved ejection fraction, causing suspicion of DCMP. Among conditions excluded were coronary atherosclerosis, congenital heart defect with left to right shunt, primary pulmonary hypertension, pulmonary embolism, hypertensive heart, tachycardia induced CMP, arrhythmogenic right ventricular dysplasia, noncompaction myocardium. Further examination revealed massive pelvic arteriovenous malformation with branches of right internal iliac artery and inferior mesenteric artery as feeding vessels. This malformation was considered the leading cause of DCMP. Successful multistage embolization of feeding arteries was associated with reduction of cardiac chambers, alleviation of valvular regurgitation and pulmonary hypertension, restoration of sinus rhythm. Presentation of this case is followed by discussion of possible mechanisms of heart failure with high cardiac output and preserved systolic function in patients with arteriovenous malformations with left to right shunt. Approaches to interventional treatment of these malformations are also discussed.

[Interventional radiology in vascular surgery: congress "Cirse 2014" in Glasgow].

The world's largest Congress of the Cardiovascular and Interventional Radiological Society of Europe (CIRSE)was held in Glasgow (Scotland) on September 13-17, 2014. During four days the participants discussed the most important problems concerning cardiovascular interventional radiology. Separate sections were dedicated to treatment of stroke, aneurysms of the thoracic and abdominal aortic portions, lower-limb ischaemia, as well as interventional methods of treatment in oncology. Special attention was paid to the report delivered by Lars Lenne from Denmark entitled "Bifurcated iliac stent graft for treatment of aortoiliac aneurysms", attaching particular significance to the technique aimed at preserving the internal iliac artery. Also worthy of notice is the report of Gerard Goh (Melbourne, Australia) dedicated to treatment of patients with acute lower-limb ischaemia,presenting the results of studying time intervals of rendering care for patients with critical ischaemia and comparing various methods of treatment. Of interest was the section on visualization of vessels, where special attention was deserved by the lecture delivered by Professor Marco Das from the Medical University of Maastricht (The Netherlands) and dedicated to contrast-free interventions, also reporting the use of carbon dioxide (CO:;) used as an al~emative to iodine-containing contrast media routinely used in our practice.

[Clinical case of the sharp cholecystitis process under mask of a sharp myocardial infarction].

Presented case report of an.elderl patient having polymorbidity pathology. Clinical "mask" of the destructive cholecystitisis an acut emyocardial infarction complicated bycardia casthma. The diagnosis of myocardial infarction has not been confirmed. Onemergency indications was performed cholecystectomy.

[Clinical and ultrasound features of gallbladder pathology in patients with a weight deficit].

We undertook analysis of clinical and instrumental features of gallbladder pathology in patients with a weight deficit for the elucidation of peculiarities of eating behavior, blood leptin level, and cytokine content of gastric biopsies. Underweight patients with inflammatory and dysfunctional diseases of gallbladder more frequently than others presented with abdominal pain syndrome. All patients enrolled in the study showed every type of eating disorders with the predominance of the limiting behavior. Weight deficit in patients with chronic cholecystitis was associated with hyperleptinemia and increased production of proinflammatory cytokines.

[Experience of percutaneous transhepatic rheolytic thrombectomy using in treatment of postresection portal vein thrombosis].

Vessels resection in case of pancreatic head cancer may be associated with portal vein thrombosis. System AngioJet 9000 (Possis Medical Inc.) for rheolytic thrombectomy is one of endovascular device for treatment of patients with venous thrombosis. Descriptions of 3 cases with rheolytic thrombectomy using are presented in the article. Percutaneous transhepatic approach under ultrasound control was used for visualization of portal vein branches. Stent-grafts were implanted in 2 of 3 cases after thrombectomy in zone of portal vein thrombosis. Bleeding from liver puncture site was observed in 1 case in early postoperative period. There was not recurrent thrombosis in long-term postoperative period (31 months after surgery maximally). The authors consider that use of several endovascular techniques such as rheolytic thrombectomy with stenting or without it provides satisfactory clinical results in treatment of patients with postoperative portal vein thrombosis.

[Optimization of enuresis therapy in children using transcranial magnetotherapy].

A total of 58 children (age from 6 to 14 years) suffering from nocturnal enuresis (NE) were divided into two groups. The study group received basic therapy (driptan dose was reduced to 2.5 mg twice a day) in combination with transcranial bitemporal magnetotherapy (TcMT). The control group received placebo TcMT and basic therapy. It is shown that addition of TcMT to reduced basic therapy lowered the score of imperative voiding symptoms 1.3-fold, number of enuresis patients 1.7-fold, volume of the bladder 6.8 months after the treatment 1.9-fold, corrected vegetative status and activity of the subcortical nervous center in 24% children according to cardiointervalography versus the controls. Thus, TcMT improves clinical effect in NE patients in 2-fold reduction of pharmacological burden.

[Possibility of an emission computer tomography for an estimation cerebral perfusion at patients with carotid stenoses before and after stenting].

THE PURPOSE: To estimate possibilities for studies of cerebral perfusion with brain scintigraphy for revealing and an estimation of features of change brain perfusion at patients with a cardio-cerebral vascular pathology before and after carotid stenting (CAS). MATERIAL AND METHODS: 11 patients with established (after carotid angiography) stenosis of internal carotid artery and coronary artery disease have been studied with SPECT with analogue HMPAO teoxim--Tc99M after intravenous introduction 700 MBk up to and in 5 days and in the remote period after stenting. For analysis of results the program "Neurogam" have been used. Standartized perfusion maps have been created. RESULTS: Before performing CAS various variants of the image cerebral perfusion maps have been obtained: from diffuse insignificant reduction in both hemispheres of a brain up to the regions hypoperfusion, characteristic for ischemic changes. Regions of hypoperfusion on the side opposite to a stenosis or occasion were revealed. SPECT, performed after cas on 5th day or after 2-3 months found increase of general brain perfusion, disappearance of symmetric both asymmetric regions hypoperfusion and reduction of a degree local hypoperfusion on the side of stenting. CONCLUSIONS: Maps of brain perfusion before and after CAS adequately reflect microcirculation of a brain with local changes of perfusion. Use of perfusion parameters gives possibility to estimate changes of brain perfusion before and after CAS in patients with combined carotid and coronary pathology.

[Clinical significance of the functional and structural changes in the intestines in chronic cholecystitis].

The aim of the study was to determine the clinical significance of intestinal functional and structural alterations in biliary pathology. Clinical, endoscopic, morphological, and morphometric methods were used. The subjects of the study were 62 patients with functional gall bladder disorder, 90 patients with chronic calculous cholecystitis, and 90 patients who had undergone cholecystectomy for cholelithiasis. The study found that biliary lithogenesis was associated with intestinal dysbiosis, changes in the qualitative density of erythrocytes immunopositive to motilin and substance P, and inflammatory changes in the intestines. After cholecystectomy, changes in intestinal microecology progressed, inflammatory and atrophic changes in the intestinal mucosa appeared or deepened, the qualitative density of erythrocytes immunopositive to motilin and substance P decreased, and colon polyps appeared more frequently.

[Clinical and laboratory criteria for assessing the efficacy of Essliver Forte for patients with combined liver and gall bladder pathologies].

As many as 60 patients with combined pathologies (chronic hepatitis (CH) and chronic non-calculous cholecystitis (CNCC)) were examined, and 20 healthy subjects were included in the control group. The efficacy of Essliver Forte for patients with chronic non-calculous cholecystitis combined with chronic hepatitises (both viral hepatitis and steatohepatitis) was assessed on the basis of clinical, biochemical and bacteriological criteria. Essliver Forte was found to improve the clinical and biochemical parameters of the functional liver condition, bile biochemical characteristics and intestinal microbiocenosis in patients with combined pathologies. The positive clinical effect is most evident for patients with chronic non-calculous cholecystitis and chronic steatohepatitis (both alcohol and non-alcohol). Essliver Forte can be recommended for treatment of patients with combined pathologies.

[Possibilities of fiber bronchoscopy in complex diagnosis and treatment of inhalation injuries of the tracheobronchial tree]. / Vozmozhnosti fibrobronkhoskopii v kompleksnoi diagnostike i lechenii ingaliatsionnoi travmy verkhnikh dykhatel'nykh putei.

The treatment of patients with burn injuries of the tracheobronchial tree is a pressing problem today, because of rather high prevalence of this injury and high mortality (90%). Clinical signs during the first 24 h do not allow evaluating the severity of the injury. Based on analysis of case histories of 24 patients, the authors sum up results of complex examinations including fibrobronchoscopy, microbiological, and histological studies. Fibrobronchoscopy precisely showed the degree and extension of airway involvement in burn injuries, while accessory microbiological and histological studies help timely predict the development of pyoseptic complications. Endoscopic methods of therapy promote a more rapid reduction of inflammation and healing of erosive ulcerative involvement of the tracheobronchial mucosa.

[Endoscopic methods in multimodal treatment of patients with chemical burns of the stomach]. / Endoskopicheskie metody v kompleksnom lechenii bol'nykh s khimicheskimi ozhogami zheludka.

Endoscopic methods were used for accelerating detachment of necrotic tissues in patients with chemical burns of the stomach. The methods consist in application of drugs on necrotic surface, which alter the physicochemical status of necrotic tissues and their interactions with the underlying tissues. In 76% patients a single application was sufficient to accelerate the detachment of necrotic tissue. Endoscopic methods accelerating detachment of necrotic tissues in chemical burns of the stomach prevent the uneven detachment of tissues, decrease the probability of their spontaneous rupture, and ameliorate the course of inflammatory reparative process.

[Endoscopic diagnosis of chemical burns of the esophagus]. / Endoskopicheskaia diagnostika khimicheskikh ozhogov pishchevoda.

Analysis of endoscopic diagnosis of chemical burns of the esophagus permitted the authors to define the direct and indirect signs of esophageal involvement in chemical burns and to assess the severity of involvement. The accuracy of diagnosing the degree of chemical burn from direct signs is rather low during the first three days after caustic injury. Deep necrotic and necrobiotic changes in the esophageal wall can be assessed from indirect signs of chemical injury to the esophagus.

[Lesions of the gastroesophageal mucosa in patients with acute oral poisoning by non-caustic chemicals]. / Porazheniia slizistoi obolochki pishchevoda i zheludka u bol'nykh s ostrymi peroral'nymi otravleniiami khimicheskimi veshchestvami neprizhigaiushchego deistviia.

Pathological changes in the gastroesophageal mucosa are described, causing gastrointestinal hemorrhages in patients with acute oral poisonings with non-caustic chemicals: the Mallory-Weiss syndrome, traumatic and erosive involvement of the gastroesophageal mucosa. Analysis of esophagogastroduodenoscopy findings showed the Mallory-Weiss syndrome to be the most incident (46.9%).

[Gastrointestinal bleeding in acute intoxications with non-cauterizing chemicals]. / Zheludochno-kishechnye krovotecheniia pri ostrykh otravleniiakh khimicheskimi veshchestvami neprizhigaiushchego deístviia.

The results of esophagogastroscopy in patients with gastro-intestinal bleeding caused by acute intoxication with noncauterizing chemicals are available. Gastro-intestinal bleeding was detected in 96 of 142 patients. Mallory-Weiss syndrome was detected in 45 patients (46.9%), erosions of mucosa of esophagus and stomach--in 27 (28.1%), traumatic lesions of mucosa--24 (25.0%). The curative endoscopic intervention aimed to stop the bleeding and prevent its recurrence was performed in 31 patients.

[Evaluation of various methods of treatment in chemical burns of the stomach using fiber endoscopy]. / Otsenka razlichnykh metodov lecheniia khimicheskikh ozhogov zheludka s ispol'zovaniem éndofibroskopii.

Results of conservative measures alone and in combination with local exposure of the burn to laser radiation or clue applications have been compared for 95 patients with chemical burns in the stomach. The combined therapy proved more beneficial as it provided more active healing of the wound, less frequent stenotic complications, shorter hospital stay. Earlier start of local treatment using fiber endoscopy is recommended.