Репозиторий Университета

© 2018 Media Sphera Publishing Group. All rights reserved. The review considers modern ideas about the clinic and pathogenesis of minimal hepatic encephalopathy (MHE). It is discussed the present of cognitive impairment in this category of patients. The data of functional MRI are analyzed, and these results allow taking a fresh look at the origin of clinical disorders in this condition. The importance of cerebral connections disruption is emphasized. It is focused on the fact that in the functioning of the central nervous system the spontaneous activity of the brain has a significant importance. Separately is analyzed "the resting state". It is concluded that MHE, despite its minimal manifestations, is a clinically significant condition requiring attention of a specialists. With that, it is often not diagnosed on time in clinical practice, which could lead to more severe damage of the cerebral functions. As evidenced by the data obtained at the present time, quite extensive changes in the neuronal activity are underlid of the cognitive deficit.

© 2018, SPb RAACI. Ability of mesenchymal multipotent stromal cells (MSCs) to differentiate into several types of mesenchymal tissues allows to consider these cells the main candidates for creating tissue engineering constructions for regenerative medicine. MSCs promote integration of bio-implants into the native bone and stimulate osteogenesis. MSCs are characterized by immunomodulatory properties, due to inflammation control and modification of immune cells. MSCs affect not only the in vivo immune response by preventing immunological rejection of implanted tissue engineering designs, but it can also influence the bone tissue immunity. MSCs play an important role in bone regeneration, by regulating the osteoblastic generation, and suppressing activity of inflammation effectors and osteoclastogenesis. Some pre-clinical and first clinical trials of bone bio-implants colonized with MSC, demonstrate promising outlooks for this strategy in order to obtain tissue engineering constructions for bone regeneration.

© 2018 Media Sphera Publishing Group. All rights reserved. The review demonstrated results and prospects of non-pharmacological and drug therapy patients with liver disease, not associated with a viral infection. The presented data emphasize the relevance of studying the problem of effective therapy of diseases of the liver and its role in improving the course and outcomes of liver disease.

© Russian Journal of Cardiology.  Aim. Evaluation of clinical specifics, predictors of repeat hospitalizations and mortality in chronic obstructive pulmonary disease (COPD) patients according to pulmonary hypertension (PH) severity grade. Material and methods. To the study, 288 COPD patients included (II-IV severity grade, GOLD 2016; males 276, females 12; mean age 59,5±9,27 y. o., smoking 23,1±11,42 pack/years; 2,4±0,89 exacerbations annually, body mass index (BMI) 27,2±12,06 kg/m 2 ). According to the presence and grade of systolic pressure increase in pulmonary artery (SPPA) the patients were selected to three groups: 1st — with no PH (SPPA <40 mmHg, n=168), 2nd — with moderate PH (SPPA 40-55 mmHg, n=101), 3rd — with severe PH (SPPA >55 mmHg, n=19). Results. Increase of SPPA was found in 120 (41,7%) patients: moderate PA — in 101 (35,1%), severe PH — 19 (6,6%). It was shown that the presence and severity of PH do increase the severity of clinical signs of COPD, hemodynamic disorders, increase the rate of repeat hospitalizations and mortality rate. The predictors of repeat hospitalizations in COPD patients are increased SPPA and C-reactive protein concentration (CRP); mortality predictors are severity of symptoms by CAT, Borg dyspnea, number of exacerbations during one year, size of the right atrium, grade of SPPA increase, CRP concentration, fibrinogen, N-terminal precursors of C-natriuretic peptide (NT-proCNP) and brain peptide (NT-proBNP) in the blood. Conclusion. PH in COPD patients in most cases is moderate, and it worsens the clinical picture, hemodynamic disorders, shows only moderate correlation with breathing disorders, increases the rate of rehospitalizations and mortality risk. The survival rate of COPD and PH patients depends on the severity.

© 2018 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved. Aim. Assessment of the dynamics of arterial hypertension (AH), coronary heart disease (CHD), postinfarction cardiosclerosis (PICS), stroke, cardiovascular risk factors prevalence by visit, during 6 years in the inhabitants of rural areas. Assessment of the impact of prevention events on the revealing rate of cardiovascular diseases. Material and methods. In the years 2015-17, a retrospective analysis was done, of the database on 2202 adults (≥18 y.o.) in Mokshinskaya rural outpatient facility. Of those 970 (44,1%) males and 1232 (55,9%) females. Study object - the reports for 2011-2016. For statistics, the IBM SPSS 21.0 was used, together with WinPEPI 10.49. Precise Fisher test applied and chi-square by Pearson. Statistics borderline set to 5%. Results. In 2016г the prevalence of AH - 9,54% (of all adult population), CHD - 2,00%, PICS - 0,59%, stroke - 0,27%. Prevalence increase by: AH - 32,5%, diabetes - 30,6%, obesity - 52,4%. There was tendency to decline of all CHD cases number: from 3039,8 by 100 thousand persons to 1998,2 by 100 thsd. PICS values did not change significantly. Cardiovascular mortality in the studied population was slightly higher - 7,3 promille in 2016, than cardiovascular mortality by Rosstat data - 6,2 promille and correlates strongly negatively with prevention events that have been performed. Conclusion. During a 6 year period there is significant increase of AH, diabetes, obesity prevalence that correlates significantly with prevention events. Nevertheless, the data on 2016 remains below mean statistics for entire country, except on obesity. Increase of the number of obesity persons by 52,4% is a serious medical and social problem of the studied population. It is a risk factor sreiously influencing cardiovascular morbidity and mortality.

© 2018 Medical Education. All rights reserved. The aim of this study was to assess long-term effects of pneumococcal vaccination with 23-valent polysaccharide vaccine (PPV23) and 13-valent conjugate vaccine (PCV13) in patients with bronchial asthma. Methods. One hundred and three patients with mild to severe asthma were involved. They were randomly assigned to vaccination with PCV13, or PPV23, or PPV23 followed by PCV13, or vice versa. Clinical efficacy of vaccination was evaluated using number of asthma exacerbation a year before and 1 and 4 years after the vaccination; need in antibiotics a year before and 1 and 4 years after the vaccination; and number of hospitalizations due to asthma exacerbation a year before and 1 and 4 years after the vaccination. Results. In a year after vaccination, number of patients who had not experienced asthma exacerbation increased significantly in PPV23, PPV23/PCV13, and PCV13/PPV23 groups (p < 0.01 to p < 0.001). In 4 years after vaccination, number of patients without exacerbations increased significantly in PCV13/PPV23 group only (48.1%; p < 0.01). Number of patients who did not require hospitalization due to asthma exacerbation increased significantly in PCV13 group only (81.8%; p < 0.05). Conclusion. The authors proposed a hypothesis of impact of pneumococcal vaccines on immunopathogenesis of bronchial asthma. The authors consider vaccination against pneumococcus using PCV13 followed by PPV23 should be a part of the basic therapy of asthma.

© 2018 Medical Education. All rights reserved. The aim of the study was to investigate an efficacy of short-term treatment with acetazolamide (ACET) in patients with acute exacerbation of COPD (AECOPD) and noninvasive ventilation (NIV). Methods. This was a prospective case-control study. The study involved 20 patients. Inclusion criteria were as follows: AECOPD; pH > 7.33; PaCO2 > 48 mmHg; HCO3 - > 26 mmol/L; and treatment with NIV. Clinical characteristics, Charlson comorbidity index, APACHE II score, arterial blood gases, and serum electrolytes were recorded before inclusion. Patients were defined as cases when they had received ACET (500 mg per day) for 3 days; they were compared to a matched control group who did not receive ACET. Clinical parameters, arterial blood gases, serum electrolytes, potential adverse effects, and length of hospital stay were monitored daily. Results. No significant differences in baseline characteristics, comorbidities, or concomitant drugs used were found between the groups. Mean duration of hospital stay was significantly shorter in the ACET group (16.2 ± 8.4 days vs 19.1 ± 2.8 days; p = 0.023). An iIntra-group analysis showed a significant improvement in clinical and arterial blood gas parameters in both groups already in the first day of the treatment. In the ACET group, systolic blood pressure (SBP), respiratory rate (RR), and SpO2 significantly improved at day 4 (112.5 ± 4.9 mmHg vs 125 ± 7.1 mmHg (p = 0.001); 15.2 ± 1.1 min-1 vs 17.1 ± 0.9 min-1 (p = 0.001) and 94.7 ± 1.1% vs 92.3 ± 0.8% (p = 0.0001), respectively). There was a significant decrease in PaCO2, pH and HCO3- at day 3 (48 ± 3.8 mmHg vs 52.4 ± 5.3 mmHg (p = 0.0288); 7.374 ± 0.4 vs 7.502 ± 0.17 (p = 0.0015) and 26.4 ± 2.8 mmol/L vs 36.9 ± 4.1 mmol/L (p = 0.00001), respectively) and day 4 (44 ± 2.4 mmHg vs 48.4 ± 4.6 mmHg (p = 0.0115); 7.387 ± 0.02 vs 7.480 ± 0.02 (p = 0.00001) and 24.2 ± 2.1 mmol/L vs 35.6 ± 3.0 mmol/L (p = 0.00001), respectively) in the ACET group. No adverse events were recorded in both groups. Conclusions. ACET adjuvant to NIV appears to be effective and could prevent post-NIV alkalosis occurrence and could reduce the length of hospital stay in patients with AECOPD and mixed metabolic disorders (respiratory acidosis and metabolic alkalosis).

© 2018 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved. Aim. To evaluate the role of N-terminal procollagen type III propeptide (P3NP) as a proposed marker of myocardial fibrosis in type 2 diabetes (DM2) patients. Material and methods. In the study, 2 groups of patients participated: with DM2 and non-DM2 (both n=32). All patients underwent clinical and laboratory assessment, including P3NP, electrocardiography, echocardiography. Statistics was done with Mann-Whitney criteria and Spearman correlation. Results. The level P3NP is significantly higher in DM2 patients (р<0,00001). In DM2 patients, the level of P3NP significantly correlates with increased myocardial mass of the left ventricle (р=0,00026) and myocardial mass index of the left ventricle (р=0,03685). Conclusion. Echo- and electrocardiographic signs characteristic for myocardial fibrosis (mass increase, voltage decline) in DM2 patients are concomitant with the increase of P3NP. Significant correlation of P3NP and the size of myocardium makes it to propose P3NP as one of possible markers of myocardial fibrosis in DM2 persons.

© 2018 Meditsina Publishers. All rights reserved. A method for producing recombinant peptidoglycan-associated lipoprotein (PAL) L. pneumophila in a heterologous expression system consisting of chimerical protein His-SUMO-PAL with hexa-histidine tag (for chromatographic purification of the precursor protein) and the protein PAL, which separated by SUMO protease peptide was developed. The method allows to obtain recombinant PAL with a high degree of purity and a yield of 0.3 g per liter of bacterial culture without fermentation. The obtained recombinant PAL retains the native structure, immunogenic properties and it can be used for vaccine development and production of monoclonal antibodies as a diagnostic tool at Legionella infection.

© 2018 Stolichnaya Izdatelskaya Kompaniya. The choice of anticoagulant therapy in patients with atrial fibrillation (AF) and concomitant diseases - coronary heart disease (CHD), including acute coronary syndrome (ACS) in history, peripheral arterial disease (PAD), is discussed in the article. The overall mortality and incidence of myocardial infarction in patients with CHD and AF is higher than in patients with AF without CHD. Patients with AF and PAD compared to patients with AF without PAD have higher risks both stroke and systemic embolism. The prescription of triple antithrombotic therapy is necessary for patients with a combination of AF and CHD who underwent percutaneous coronary interventions (in ACS or elective surgery). The possibility of prescription and duration, the choice of specific drugs and their doses should be determined individually, based on the risks of ischemic events associated with stenting, the risk of ischemic stroke and bleeding. Use of new oral anticoagulants (NOAC) instead of vitamin K antagonists (eg, warfarin), low doses of NOAC, studied in trials and proven efficacy in the prevention of stroke/systemic embolism, the use of clopidogrel as a drug of choice from the P2Y12 inhibitor group, the use of low doses of acetylsalicylic acid (ASA), the routine administration of drugs from the proton pump inhibitor group is recommended to minimize the risk of bleeding. The data of subanalysis of the ARISTOTEL randomized clinical trial, indicating a high profile of efficacy and safety of apixaban in patients with AF, depending on the presence of CHD, PAD, concomitant use of ASA, are also presented in the article. The benefits of apixaban over warfarin for reducing the risk of stroke/systemic embolism, total mortality and the risk of bleeding in a subgroup of CHD patients are just as obvious as in the general population of the ARISTOTLE study, and in the subgroup of patients without CHD. Treatment with apixaban, both in the subgroup of patients taking ASA, and a subgroup of patients without ASA, is accompanied by a lower risk of strokes and systemic embolism and a lower incidence of major bleeding. The risk of stroke or systemic embolism was similar in patients with AF and PAD randomized to the apixaban group or to the warfarin group, as well as in patients with AF without PAD. Patients with AF and PAD who received apixaban or warfarin had a similar incidence of major bleeding or clinically significant minor bleeding..

© 2018 Stolichnaya Izdatelskaya Kompaniya. The review focuses on the impairment of the carotid, coronary arteries and lower-extremity arterial disease. Systemic involvement of various vascular beds in atherogenesis is emphasized. Epidemiological characteristics of morbidity and mortality from the main clinical manifestations of atherosclerosis - ischemic stroke, ischemic heart disease and lower-extremity arterial disease are given. The current principles of drug therapy are considered from the point of view of improving the prognosis and eliminating ischemia. The basic positions of International and Russian clinical recommendations on the management of patients with the presence of certain clinical manifestations of atherosclerosis are discussed. Detailed administration schemes and the preferred doses of statins and antiplatelet agents depending on the localization of atherosclerotic lesion and the severity of stenosis are described. The target blood lipids levels in the treatment with statins are given. The advantages of statins as drugs that reduce the risk of cardiovascular complications are presented. Current data on the pattern of antiplatelet use, including acetylsalicylic acid, in individuals with clinical manifestations of atherosclerosis are given. The principal tactic of dual antiplatelet therapy and schemes of its use in patients undergoing percutaneous coronary intervention, coronary artery bypass surgery and in individuals with a history of acute coronary disorders are considered..

© 2018 Dynasty Publishing House. All rights reserved. The article presents a clinical case of a patient with genetically confirmed Alagille syndrome (ALGS) with marked delay of physical development that did not correspond to the severity of liver damage. Alagille syndrome (ALGS) is a rare hereditary disease with underlying hypoplasia of the intrahepatic bile ducts manifested by cholestasis syndrome in the first weeks of life. Developmental delay is characteristic for cholestatic diseases of the liver, including ALGS, which is conditioned by impaired absorption of fats and fat-soluble vitamins in the intestines. But growth delay and underweight in this syndrome often do not correlate with the severity of cholestatis syndrome, and causes of their development remain unstudied. Cholestatis syndrome was moderate, and clinical signs of liver cirrhosis were absent. Intense skin itching, greatly disturbing not only the baby's wake period but also sleep, along with marked height and weight deficit were indications for liver transplantation at the age of 4 years, after which a fast normalisation of the parameters of physical development was noted. This clinical case study permits to hypothesize that developmental delay in children with ALGS is conditioned by chronic cholestatic liver damage, irrespective of the severity of its clinical presentation.

© Olga V. Tereshkina, Elena N. Bobkova. The late 19th and the early 20th century showed the development of new scientific views and approaches to the understanding and treatment of mental illnesses. The need arose to create and introduce new medical institutions for the provision of assistance to the mental health patients. On the one hand, it was necessary to isolate the mental health patients who could pose a danger to themselves and others, and on the other hand, the institutions needed for this not only had to provide conditions generally approaching a regular life for the most of the patients, be effective for treatment and economically justified, but also had to follow a human mental health patients principle in their attitude towards the mental health patients. The therapeutic-labor (agricultural) psychiatric colony took up this role. One of the largest of them – the Spas-Petelinsky Psychiatric Colony – was opened in 1911 at the Tula provincial zemstvo district. Through the efforts of Kamenev, and under his leadership, a three-tier system for helping the mental health patients was created and successfully functioned in Tula and the Tula province. Several projects were developed by him. These projects – not big but still important – unfortunately were not carried out. The article focuses on Tula psychiatric establishments for medical and out-of-hospital care. In all Kamenev’s projects, in order to accelerate the implementation process and ensure maximum efficiency, there was a tendency to use various local resources, including sociocultural ones. Also, little-known information is provided on Kamenev’s Moscow activities after his departure from Tula. This article is a continuation of the authors’ research work devoted to the study of regional factors in Tula health care in the context of the reforms of the turn of the 19th and the 20th century.

© 2018 Media Sphera Publishing Group. All rights reserved. Objective - to evaluate the possible epidemiological and economic efficiency of pneumococcal vaccination in men with different chronic diseases. Material and methods. A prognostic (Markov) model was constructed based on the data available in the literature. The estimated efficiency of pneumococcal vaccination in reducing mortality, preventable diseases, and economic damage over a 5-year period was evaluated in able-bodied men. According to official statistics, the group at high risk for pneumonia in the Russian Federation includes 21,575,887 able-bodied men. The sources of data on the cost of the disease were governmental tariffs in the compulsory health insurance system in 2016 and those of vaccination cost were the results of competitive bidding for the procurement of 13-valent pneumococcal conjugate vaccine (PCV13). Results. The results of extrapolation of data from Russian and foreign studies in patients with chronic respiratory diseases, circulatory diseases, or diabetes mellitus showed a significant reduction in the risk of complications due to the underlying disease (RR=0.58; p<0.05), the number of hospitalizations (RR=0.02; p<0.05), and expected postvaccination mortality. The cost of vaccination in the assessed patient group was 25,869.5 million rubles. The use of PCV13 significantly reduces the number of exacerbations and, accordingly, hospitalizations, which saves about 14,359.9 million rubles in each subsequent year after vaccination. Thus, the total budget savings can reach 2,850.3 million rubles just during 2 years. A single dose of PCV13 will save at least 61,702 lives over 5 years. Conclusion. The results of this investigation suggest that pneumococcal vaccination has high epidemiological and clinical efficiency in able-bodied men with chronic diseases. This intervention reduces morbidity rates, the number of exacerbations and hospitalizations, as well as deaths in the vaccinated group, and it is a cost-effective investment in public health service.

© 2018 SPIE. The conductivity of layers (thickness ∼ 0.5-20 μm) of composite nanomaterials consisting of bovine serum albumin (BSA) with single-walled carbon nanotubes (SWCNTs) has been studied. The BSA/SWCNT composite nanomaterial was prepared according to a route map, some steps of which are: the preparation of an aqueous dispersion based on BSA and SWCNT; preparation of substrates; deposition of BSA/SWCNT dispersion on substrates; application of water paste from SWCNT on substrates; irradiation of layers by lasers when they were in a liquid state; drying of samples; carrying out electrical and temperature measurements. Half of the layer was covered with a light-tight hollow box and the other half of the layer was laser irradiated. The laser irradiation of the layer was carried out for about 20 sec, at which time the layers completely became dry, while the other half of the layer remained in liquid. Conductivity was increased (70 ÷ 650) % by laser irradiation of the layers when they were in the liquid state. Maximum values of specific conductivity for BSA/SWCNT-1 S/m layers, and for layers SWCNT - 70 kS/m. The investigated electrically conductive layers of 99 wt.% BSA/0.3 wt.% SWCNT are promising for medical practice.

© 2018 Human Stem Cell Institute. All rights reserved. Cell therapy is one of the most promising directions in the treatment of critical limb ischemia (CLI). In spite of certain advances achieved in this field in the last decades, which are related to application of bone marrow stem cells (BMSC), a large number of problems still remain unsolved. In this review, we discuss the BMSC biology, mechanisms of their therapeutic effect in the CLI treatment and results of the most notable BMSC-based clinical studies in detail.

© 2018 Russian Transplant Society. All rights reserved. Donor organs shortage leads to extending criteria for deceased liver donation in the whole world. Aim: To compare results of deceased donor liver transplantation (DDLT) depending of donor age over 60 years old. Materials and methods: The study includes 390 DDLT from January 2010 to November 2017. All liver donors separated by age for two groups: I - 60 years and older (n = 26); II - younger than 60 years (n = 364). All donors were standardized by demographic, laboratory fi ndings and inotropic drug requirement. Results: no difference between both groups in severity of ischemia-reperfusion injury, ICU or in-hospital staying (median 2 and 7,5 days respectively) was found. There is also no difference between biliary or vascular complication rate. 5-year actuarial survival rate found no difference between both groups (I: 70%: II: 76%, p = 0,54). Conclusion. Using grafts from donors older than 60 years don't worsen early and late results of DDLT. Care should be taken to avoid other risk factors (cold ischemia time, warm ischemia time).

© 2018 Russian Transplant Society. All rights reserved. Aim: To evaluate clinical efficiency of percutaneous coronary interventions (PCI) at potential recipients of heart with the chronic ischemic heart failure (CHF). Materials and methods. In this retrospective study results of treatment at 76 patients with CHF NYHA III and 36 patients with CHF NYHA IV by scheduled PCI are presented. Duration of observation was from 6 to 160 months. The age of patients at the time of intervention was 61,7 ± 0,62 years (from 33 to 76). 108 male and 4 female. Defined life expectancy and echocardiography parameters of the left ventricle (LV) of heart. Results. 20 patients were died, 16 of them from cardiovascular events. 18 patients during this period undergo orthotopic heart transplantation (HT). The endovascular revascularization leads to LV volumes reduction, increase of ejection fraction and decrease of pulmonary artery pressure. Progress CHF is followed by negative dynamics of these characteristics and need of HT performance. In 74% of cases the effect of myocardial revascularization allows to provide increase in life expectancy of potential recipients of heart with the chronic ischemic heart failure. Conclusion. Performance of PCI at patients with the chronic ischemic heart failure can delay heart transplantation or become its alternative.

© 2018 Russian Transplant Society. All rights reserved. The method of mechanical circulation support using non-pulsating flow pumps, built on the principle of rotary (centrifugal and axial) pumps, took the leading direction (94%) in the world clinical practice for the treatment of the patients with terminal heart failure. Despite this, the clinic application of these pumps in a number of cases faced with the numbers of negative problems associated with this technology. This is stimulated of a new direction of principles for a control of the rotary pumps, based on the modulation of the speed pumps. The article analyzes the negative factors of the clinical application of non-pulsating flow pumps and gives an overview of the methods the optimization of the control pump based on the modulation of the output flow.

© 2018 Russian Electronic Journal of Radiology. All rights reserved. Lymphangioleiomyomatosis (LAM) is an orphan disease, which patterns have not been fully studied. The use various methods of diagnosing (computed tomography, HRCT, CT angiography, SPECT, PET-CT) allows to identify and to evaluate the spec-trum of thoracic and extra- thoracic changes in this disease. Purpose. To evaluate the clinical and radiation characteristics of thoracic and extra- thoracic changes in patients with LAM. Materials and methods. The study included 83 patients with morphologically con-firmed LAM. The average age of patients was 42.2 ± 6.3 years (w / m - 83/0). Clinical and X-ray were used in the complex examination of patients: radiography in two projections, com-puted tomography (CT), high-resolution CT (HRCT), and single-photon emission computed tomography (SPECT). If necessary: CT angiography - in 43 patients, PET-CT in 7 patients. Also, patients underwent a complex lung function examination (CLFE) and echocardiog-raphy. All patients were observed in dynamics (observation was 6.1 ± 4.2 years). Results. Analysis of the results of clinical and radiological investigation revealed the following variants of pulmonary manifestations of LAM: the nodular form was verified in 14 patients, diffuse in 65 patients and mixed in 4 patients. The diffuse form was divided ac-cording to the CT scan into 3 groups. The first group - with sporadic small cysts (14 pa-tients). During SPECT in patients of this group, no significant perfusion disorders were de-tected, while performing CLFE in patients of this group revealed manifestations of bronchial obstruction. The second group - with multiple large cysts (13 patients), during SPECT for the patients of this group was characterized by the presence, mainly in the central parts of lungs focuses of aperfusion, corresponding with anatomical localization of cysts. CLFE re-vealed pronounced manifestations of bronchial obstruction in combination with diffusion disorders. The third group - with multiple small cysts (38 patients) was characterized by the most unfavorable course: during SPECT in patients of this group, pronounced perfusion disorders were noted: extended hypoperfusion zones in both lungs, aperfusion areas in sub-pleural sections from both sides, according to the results of CLFE in this group of patients obstructive violations of breathing mechanics with a sharp deterioration of gas exchange conditions in the lungs (decrease in FEV1, diffusive capacity of the lungs) were revealed. Complications of the disease were determined in the majority of patients (54 patients - 63%): pneumothorax in 52 patients, chylothorax in 16 patients, pulmonary hypertension in 18 patients, pulmonary hemorrhage in 2 patients, lymphostasis in 9 patients. Extrathoracic changes were detected in 52 patients: kidney leiomyoma in 14 patients, uterine fibroids and uterine fibroids in 27 patients, liver in 3 patients, and extraorganic leiomyomas in 16 pa-tients. Conclusions. The use of a comprehensive clinical and radiation survey allows us to identify the signs of LAM in the early stages of the disease, in some cases avoid the use of surgical biopsy associated with a high risk of complications. The selection of various vari- ants of the flow of the diffuse form of LAM on the basis of the CT features of the picture, which correlate with functional disorders, allows the development of differentiated ap-proaches to therapeutic tactics and determining the prognosis of the disease.