Репозиторий Университета

© 2018 Dynasty Publishing House. All rights reserved. Objective: Development and justification of a differentiated approach to diagnosis and treatment of ectopic extratubal pregnancies. Patients and methods: 37 patients with histologically verified diagnosis «Ectopic pregnancy» were examined, in whom the ovum was located outside the uterine tubes. In 26 cases it was cervical pregnancy, in 8 - ovarian pregnancy, and 3 pregnancies within a caesarean scar. Diagnostic and treatment methods: 2D- and 3D-transvaginal echography, including power Doppler sonography; hCG testing in blood and urine, laparoscopy, hysteroresectoscopy. Results: A system of examining and treating patients with rare ectopic pregnancies has been developed, in which step-by-step measures for optimization of diagnostic and therapeutic processes are presented. The main attention is paid to organ-sparing technologies, including metroplasty and intrauterine surgery in caesarean scar ectopic pregnancy, and also intrauterine surgery in cervical pregnancy. Conclusion: The presented system permits to optimize diagnosis and treatment of patients with ectopic extratubal pregnancies with preservation of the reproductive function.

© 2018 Russian Electronic Journal of Radiology. All Rights Reserved. Purpose. Post-mortem MRI characteristics of the distribution and severity of nonimmune fetal hydrops (NFH). Materials and methods. The analysis of autopsy material of 2 stillborn and 22 newborns, divided into three groups was carried out. Group I consisted of the bodies of the dead due to NFH, group II - the bodies of newborns who died with the presence of general edema syndrome in the absence of NFH, group III (control) - the bodies of deceased newborns in the absence of NFH and general edema syndrome. Before autopsy, MRI was performed. On T1- and T2-weighted images was determined by the thickness and signal intensity of the skin with subcuta-neous tissue and the subsequent calculation of the tissue hydration index. The volume of fluid in the pericardial cavity, pleural and abdominal cavities determined when using three-dimensional processing of the obtained tomograms and calculated their specific volume in the corresponding cavities. Results. The values of the specific volume of free fluid in the pleural cavities and abdominal cavity less than 8% should be considered a natural postmortem sign, rather than the life-time accumulation of transudate, when examining the bodies of deceased newborns on the first day after death. The mean values of absolute and specific volumes of pleural fluid had the maxi-mum values in the NFH observations, exceeding the values of the control group by 6.3 and 5.1 times, respectively. The highest values of the absolute amount of ascites were observed in the group with general edema syndrome. In the NFH group, all cases had hydrothorax, 85.7% of cases had ascites, and 42.9% had hydropericardium. In the group of newborns with general ede-ma syndrome, hydrothorax was detected in 57.1%, ascites - in 85.7%, and hydropericardium - in 42.9% of cases. The thickness of the skin with subcutaneous tissue depended on the localization and group of research. The most pronounced deviations from the control level were recorded for the average values of the skin thickness of the anterior chest wall in group I and the scalp of the fronto-parietal region in group II. The mean values of the tissue hydration index were higher in the group with NFH, and the lowest in the control group. Conclusion. Postmortem MRI performing, allows an objective assessment of the nature and severity of anasarca and pathological fluid accumulations in the serous cavities of dead fe-tuses and newborns. In this regard, postmortem MRI is recommended as a mandatory component of the autopsy of the bodies of fetuses and newborns that died as a result of nonimmune fetal hydrops.

© 2018 Russian Electronic Journal of Radiology. All Rights Reserved. Purpose. To present abilities and limitations of Whole body MRI and FDG-PET/CT in the setting of sarcoid reaction and to stress the importance of use of broader differential diagnosis during interpreting its results. Materials and methods. The observation is introduced from clinical practice, examination was performed on 1.5 Tesla MRI scanner with the acquisition of four regions of interest: head and neck, thorax, abdomen, pelvis and upper thigh. Scanning protocol included diffusion-weighted imaging sequence. Results. The examination has let us exclude the presence of the active tumor tissue in breast cancer patient after systemic neoadjuvant treatment and drew our attention to false positive PET/CT result, which in turn led to change of further treatment strategy. Conclusions. Interpretation of FDG-PET/CT should be done in a complex manner with clinical, laboratory and radiological data correlation.

© 2018, Dynasty Publishing House. All rights reserved. The objective. To improve methods of surgical management of post-caesarean uterine scar defect and to justify the choice of an operative procedure depending on the clinical situation and condition of the deficient scar. Patients and methods. We examined 44 patients aged 24 to 42 years, diagnosed with «Defect of the uterine scar after caesarean section». A comparative analysis of two methods of metroplasty – abdominal and vaginal – was performed. For diagnosing the state of the scar we used: transvaginal ultrasound imaging in the 2D, 3D and high-sensitivity power Doppler modes, magnetic resonance imaging, hysteroscopy. Results. The advantage of the vaginal method was recorded by several characteristics (duration of surgery, volume of intraoperative blood loss, restoration of physical activity within the first 24 hours). But its application required a number of important conditions, among which a history of not more than two caesarean sections. Pregnancy occurred in 24 (54.5%) patients 9–26 months after surgery and ended with caesarean deliveries at term. Conclusion. Management of isthnocele per vaginalis is the least traumatic method among all known techniques. But at the slightest risk of complications associated with damage of the urinary tract, laparotomy should be used. Each patient with post-caesarean uterine scar defect needs an individual approach.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. In this article we have described clinical pharmacology and data of clinical studies of an innovational drug valsartan + sacubitril in patients with chronic heart failure (CHF). The use of supramolecular complex valsartan + sacubitril allows to elevate quality of life and improve prognosis of patients with CHF. High efficacy of valsartan+sacubitril relative to impact on composite primary end-point (cardiovascular death + hospitalization due to CHF) was demonstrated in the clinical trial PARADIGM-HF in which it was compared with angiotensin converting enzyme inhibitor enalapril. Advantages of the use of valsartan + sacubitril for the budget were demonstrated in pharmacoeconomic studies. These advantages are maximally realized at long-term administration. Cost-efficacy of the use of valsartan+sacubitril in pharmacotherapy of CHF is comparable with that of statins in the treatment of ischemic heart disease or implantation of a cardioverter-defibrillator in prevention of sudden cardiac death. Thus, introduction of the drug into practice can be expected to reduce budget expenditures.

© 2018 Media Sphera Publishing Group. All rights reserved. The results of a clinical study showing the importance of surfactant proteins A and D in assessing the activity and progression of idiopathic pulmonary fibrosis and chronic lung sarcoidosis are presented. Aim. To study the clinical significance of SP-A, SP-D in assessing the activity of idiopathic pulmonary fibrosis and sarcoidosis. We examined 81 patients with morphologically confirmed diagnoses of idiopathic pulmonary fibrosis (ILF) and sarcoidosis, a control group of 20 healthy individuals. The MSCT of the thoracic organs of the chest was performed, the diffusivity of the lungs was examined, oxygen saturation was determined. In the serum, the surfactant proteins SP-A and SP-D were determined by the enzyme-linked immunosorbent assay. Results. A significant increase in SP-A and SP-D (p<0.05) was observed in patients compared with patients in the control group, a direct correlation was found with signs of activity: SP-A with alveolitis (p<0.05), SP- D with progressive fibrosis (p<0.05), inverse correlation of surfactant proteins with respiratory function indices (p<0.05). Conclusion. Serological parameters of SP-A and SP-D reflect the activity of alveolitis and the progression of pulmonary fibrosis in patients with ILF and sarcoidosis.

© 2018 Media Sphera Publishing Group. All rights reserved. Systemic vasculitis is a heterogeneous group of inflammatory diseases, which are classified according to the diameter of the affected vessels. The treatment of systemic vasculitis is no longer empirical, because of increasing number of randomized clinical trials in this field. In recent years, there was a trend to limit the cumulative dose of glucocorticosteroids and immunosuppressive drugs, partially through biological drugs usage. However, biologic therapy is not always superior to combination of glucocorticosteroids and cytotoxic drugs. The efficacy of different biologic drugs varies in patients with different forms of systemic vasculitis, which creates the ground for personalized therapy of these diseases. Another serious problem is the absence of strict criteria to immunosuppressive therapy intensification, especially in vasculitis, affecting large vessels, due to the lack of reliable laboratory markers of disease activity. The article reviews modern approaches to the treatment of some types of systemic vasculitis, including ANCA-associated vasculitides, giant cell arteritis, Takayasu`s arteritis and cryoglobulinemic vasculitis.

© 2018 Media Sphera Publishing Group. All rights reserved. The article presents a clinical observation of two patients with generalized sarcoidosis. The woman typical granulomatous changes in the lungs and lymph nodes combined with atrial fibrillation, kidney failure and hereditary thrombophilia, men with atherosclerotic coronary arteries, re-myocardial infarction, cholestasis, tubulointerstitial nephritis. The accession of systemic manifestations was accompanied by increase of level of angiotensin-converting enzyme in the blood serum, morphological examination of lung tissue in both cases there were high histological activity of vasculitis and granulomatous inflammation. Extrapulmonary symptoms regressed when conducting immuno-suppressive therapy. Discusses modern aspects of diagnosis of sarcoidosis in clinical practice.

© Russian Journal of Cardiology. Arterial hypertension (AH) remains one of the most prevalent cardiovascular disorder in the world, as one of the main risk factors of myocardial infarction and stroke development. Monotherapy of AH is effective in no more than one half of patients even with moderate increase of blood pressure. Combinational antihypertension treatment does influence pathogenetic mechanisms of AH being an optimal solution. It is worthful to apply a fixed combination of telmisartan and hydrochlorothiazide. Such combination provides additional antihypertensive effect with more significant decrease of blood pressure than for the components separately. Also it is protective for organs and tissues that makes it to prescribe such combination to a broad range of patients.

© 2018 Publishing House of the Union of Pediatricians. All rights reserved. Background. Solid tumors in children are one of the most common childhood malignancy, second only to hemoblastosis. Among solid tumours, about 5% are bone sarcomas: osteosarcoma (3%) and Ewing's sarcoma (2%). Atypicality of the these diseases course makes an early diagnosis a real challenge. Case Reports. The article presents six clinical observations of patients with bone sarcomas. We demonstrate the difficulties in diagnosing of this disease group which is associated with the absence of both specific symptoms and distinct clinical picture. Conclusion. Pediatricians and pediatric surgeons should take into account the possibility of atypical course of bone sarcomas in children. Low cancer alertness is the reason for a significant delay in establishing the correct diagnosis which contributes to the tumour process generalization and reduces the chances of achieving remission while increasing the cost of treating such patients.

© Bionika Media Ltd. Objective. To systematize the current medical knowledge and experience in the management of pregnancy and delivery in patients with mesenchymal dysplasias (Marfan syndrome, Ehlers-Danlos syndrome, Rendu-Osler syndrome). Material and methods. The paper includes the data of foreign investigations and medical guidelines for this problem, which have been published in the past 5 years. Results. The paper describes the molecular bases of each syndrome, diagnostic criteria, and their clinical manifestations in various organs and systems: musculoskeletal and cardiovascular systems, the organ of vision, etc. Such patients during pregnancy are at extremely high risk for life-threatening complications. Conclusion. A successful outcome of pregnancy requires early diagnosis and a multidisciplinary approach throughout during pregnancy and delivery.

PURPOSE: To analyze the condition of the lacrimal gland in patients confirmed to have sarcoidosis. MATERIAL AND METHODS: The study included 46 patients (92 orbits) with verified diagnosis of systemic sarcoidosis that were examined during the period of 2009 to 2014. The age of patients ranged from 23 to 65 years and the average was 45.1 years. Among the examined patients, 66% were female and 34% male. In all patients, the diagnosis was verified according to modern criteria. RESULTS: Acoustic structure of 46 lacrimal glands of patients with systemic sarcoidosis (92 orbit), and lacrimal glands of 30 healthy individuals (60 orbits) were examined. In-depth in vivo examination of morphological changes was done using 'advanced' analysis of three-dimensional images. CONCLUSION: The analysis of a large number of studies devoted to changes in the lacrimal glands caused by sarcoidosis revealed a difficult problem: are there any differences between isolated involvement of the lacrimal gland tissue and the defeat of various organs and tissues? For now, the question remains unanswered.

© 2018 National Academy of Pediatric Science and Innovation. All rights reserved. Solid tumors in children occupy the second place in the structure of morbidity, yielding to hemoblastosis. Among solid tumors, approximately 5% are bone sarcomas: osteosarcoma (3%) and Ewing's sarcoma (2%). Atypicality of the course of these diseases makes it difficult to diagnose them early. The article describes a series of clinical observations of patients with bone sarcomas, which illustrate the complexity of diagnosing diseases of this group.

© 2018 Media Sphera Publishing Group. All rights reserved. Primary sarcomas of the pericardium are extremely rare malignant tumors of the heart. The incidence of sarcoma increases after radiation therapy in the field of breast. The specific features of this case report are the difficulties in diagnostics of undifferentiated spindle-cell sarcoma of the pericardium and the connection between the disease and the radiation therapy for Hodgkin's lymphoma.

© Bionika Media Ltd. Different factors caused by both equipment and the course of surgery (conditions under which the operation is performed, the location of incision, the characteristics of suture material, the type of surgical suture, and the amount of blood loss), by the course of the postoperative period, and the peculiarities of repair of damaged tissues influence wound healing of the uterus during cesarean section. Objective. To establish the value of premature amniorrhea and uterine inertia as predictors of impaired myometrial repair after cesarean section, by using clinical and morphological analyses. Subjects and methods. The investigation enrolled 129 patients who had given birth via cesarean section. Of them, 44 patients had delivery before birth activity, 85 during the first stage of labor. 49 and 80 women delivered before and after amniorrhea, respectively. During cesarean section, uterine tissue was taken from the upper edge of the wound after uterine incision. The myometrial biopsy specimens obtained during cesarean section were morphologically and immunohistochemically examined. The patients were divided into 4 groups according to the level of birth activity and the preservation of amniotic fluid at the time of cesarean section. Group 1 included patients with regular labor activity and amniorrhea at the time of caesarean section; Group 2 consisted of those with labor activity in the presence of whole amniotic fluid; Group 3 comprised those without birth activity in the presence of whole amniotic fluid; Group 4 included patients with premature amniorrhea without uterine contractions. 36 cases (9 in each group) were selected by random sampling for morphological and immunohistochemical examinations. The biopsy specimens were fixed in 10% neutral formalin and embedded in paraffin. The serial paraffin-embedded sections underwent histological examination and immunohistochemical tests for the following markers: TGF-β, VEGF, MMP2, TIMP1, types I and III collagen, TNF, and PDGF. Results. The morphological and immunohistochemical analyses revealed the most pronounced signs of myometrial damage during cesarean section in Group 4 patients having premature amniorrhea without uterine contractions. There were decreased VEGF, PDGF, MMP2, and TIMP levels and simultaneously increased TNF-α expression in leiomyocytes, vascular endothelium, and myometrial stromal cells. The findings may indicate the relatively lower reparative potential of the myometrium and the increased readiness for an inflammatory response in the group of women undergoing cesarean section in the presence of premature amniorrhea without uterine contractions. Conclusion. Clinical, morphological, and immunohistochemical analyses have revealed differences in the myometrial status in relation to typical clinical factors, such as amniorrhea and birth activity. Wound healing occurs under the influence of growth factors and the ratio of expression levels for growth factors can vary in different pathological conditions. The reduced expression of VEGF, MMP2, TIMP, and PDGF and the increased expression of TNF in the group having amniorrhea without uterine contractions (P-B+) suggest that there are pronounced inflammatory processes and impaired myometrial repair with the longer latency period in the absence of labor activity, which may refer these women to a group at risk for incompetent scar formation.

© 2018 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved. The article is focused on the issues of clinical efficacy of telmisartan - angiotensin II type 1 receptor blocker from the perspective of its influence on cardiovascular risk in systemic hypertension patients. The results presented, of a variety of studies, witnessing potent antihypertensive and protective properties of telmisartan. The opportunities described, for usage of the drug in high risk patients, its efficacy in cardio- and nephroprotection. Special attention is paid for an exclusive property of telmisartan to be an agonist of PPAR γ-receptors, hence to correct glucose and lipid metabolism in patients with metabolic syndrome and diabetes.

© 2018 ABV-Press Publishing House. All rights reserved. Early childhood autism, or autism spectrum disorders, is an extremely heterogeneous group of conditions that share similar symptoms of dysontogenesis. Epilepsy is the most significant comorbidity in autism. The present article covers various aspects of comorbidity between epilepsy and autism, described in the literature over the last 50 years. This review aims to analyze the development of epilepsy and autism during ontogenesis and to identify causal relationships between these diseases, considering the information on the two age peaks for epilepsy onset in patients with autism.

© 2018 Media Sphera Publishing Group. All rights reserved. Heart sarcoidosis diagnosis presents great difficulties due to the absence of specific clinical manifestations. Most often, the diagnosis is established during autopsy. Magnetic resonance imaging (MRI) of the heart with contrast enhancement is one of the most informative methods of intravital diagnosis of cardiac sarcoidosis. In this article, two clinical cases, shows the role of MRI of the heart with contrast enhancement in the diagnosis of cardiac sarcoidosis.

© 2018 Stolichnaya Izdatelskaya Kompaniya. In the article, with regard to current clinical recommendations, the place of combined antihypertensive therapy, especially triple drugs regimens, is considered in the treatment of patients with arterial hypertension. Special focus is given to the body of evidence for the efficacy of valsartan and amlodipine, as the reference drug of angiotensin II receptor blockers and calcium channel blockers, respectively. Not only their high antihypertensive properties are demonstrated, but also a favorable effect on target-organ protection and prognosis is described. In particular, the possibilities of valsartan in reducing the severity of left ventricular hypertrophy and microalbuminuria are described, and its unique properties in the class of sartans that allow the use of this drug in patients with ischemic heart disease and chronic heart failure are emphasized. Data on the antiatherosclerotic effects of amlodipine and its proven ability to reduce cardiovascular risk are presented. Current data are presented about their use in a fixed-dose combination with hydrochlorothiazide, including real clinical practice settings. The evidence base of high clinical efficacy, safety and metabolic neutrality of the triple combination of antihypertensive drugs valsartan, amlodipine and hydrochorothiazide is presented. The issues of increasing adherence of patients to treatment when prescribing fixed-dose combinations are considered. An algorithm for the selection of antihypertensive drugs in the form of monotherapy and combination therapy of two or three drugs depending on the clinical situation (the presence of certain target-organs damages and associated clinical conditions, primarily ischemic heart disease, atherosclerosis of carotid arteries and chronic heart failure) and the severity of the additional risk of cardiovascular complications..

© 2018 Bentham Science Publishers. Introduction: One promising target for novel psychotropic drugs is the 5-HT6 receptor, G-Protein-Coupled Receptor (GPCR) family, displaying seven transmembrane domains. There is considerable interest in how both 5-HT6 receptor agonist and antagonist compounds can have marked procognitive effects. Methods: An exact structure of the 5-HT6 receptor is not available, so application of powerful methods of (Q)SAR and molecular modelling, which play an essential role in modern drug design, are currently limited to structure-based homology models. The present study is devoted to a detailed QSAR analysis of 61 drugs (26 agonists and 35 antagonists) acting on the 5-HT6 receptor (rattus norvegicus and homo sapiens). Five classification methods were used: k-Nearest Neighbors (k-NN), Logistic Regression (LG), Linear Discriminant Analysis (LDA), Random Forest (RF), and Support Vector Machine (SVM). Multiple Regression Analysis (MRA) was involved also for regression analysis. Spectra of Inter Atomic Interactions (SIAI) were applied in the search for ligand centres interacting with the 5-HT6 receptor. Results & Conclusion: SAR and QSAR models based on the use of HYBOT, MOLTRA, VolSurf+, and SYBYL programs, and having cross-validated coefficients of determination of at least 0.80, show a predominant influence of H-bond acceptor ability and hydrophobicity on the type of ligand activity and degree of inhibition.