[Pathophysiological and therapeutic aspects of bone lesions in patients with multiple myelomas].

Multiple myeloma (MM) is an uncontrolled malignant proliferation of plasma cells. Today, it is the best studied form of hemoblastomas, but many pathophysiological and therapeutic aspects of this condition await a deeper insight. The medico-social significance of the disease is emphasized by its continuous growth, variable clinical manifestations, low quality of the patients" life, mean life expectancy of 3-5 years, and numerous complications. One clinical feature of MM is bone lesions that occur in all patients as osteolysis (OL), osteoporosis (OP), hypercalcemia, and combination of these disorders. Progressive degeneration of bone tissue even in patients responding to chemotherapy results in severe pain, pathological fractures, and neurologic problems. Molecular mechanisms of OL and OP in MM have recently attracted much attention. This review summarizes data on the role of cytokines, growth factors, osteopontin, OPG-RANK-RANK system, macrophage inflammatory proteins, and matrix metalloproteinases in MM-related osteodestruction. Iatrogenic origin of bone lesions is considered. Treatment of MM using thalidomide (lenlalidomide), proteasome inhibitors (bortesamide), and biphosphonates (pamidronate, zoledronic acid) is discussed as the most promising therapeutic strategy promoting plasma cell apoptosis, inhibition of bone resorption, stabilization of osteoblast function, and pain alleviation.

[Post-thyrotoxic arterial hypertension]. / Posttireotoksicheskaia arterial'naia gipertenziia.

The paper is concerned with the results of a study of the state of central hemodynamics, sympathetic-adrenal and renin-angiotensin systems to reveal their role in the development of postthyrotoxic arterial hypertension. Altogether 147 patients with diffuse toxic goiter before therapy and 114 patients after surgery (subtotal subfascial thyroidectomy after O. V. Nikolaev or its modification) were investigated. In 35 (30.7%) of 114 operated on patients BP values in the long-term postoperative period were above 160/95 mm Hg. Hemodynamic indices and the state of the vasoactive system were correlated. In the authors' opinion, raised activity of the sympathetic-adrenal and renin-angiotensin systems observed during decompensation of diffuse toxic goiter and progressing after surgery, led to the transformation of central hemodynamics of the hyperkinetic type into the hypokinetic one, causing the development of postthyrotoxic arterial hypertension.

[Clinico-morphological characteristics of surgically removed thyroid gland of the residents of Primorskii territory]. / K kliniko-morfologicheskoi kharakteristike operativno udalennykh shchitovidnykh zhelez u zhitelei Primoskogo Kraia

The authors carried out a histological study of 150 thyroid glands removed for various forms of goiter. Nodular and mixed goiter with frequent signs of degeneration prevailed in residents of the Primorsk region. Histological structure of the majority of them corresponded to the colloidal, mostly to the macrofollicular goiter. A lower percentage of morphological signs of the goiter activity in comparison with the clinical data revealed in the hospitalized patients can be attributed to the efficacy of antithyroidal therapy causing involution of the hyperactive glands. Various types of adenomas chronic thyroiditis and the initial stages of the node malignization were determined only by histological examination.