The review describes a rarely occurring state of commotio cordis (CC) — ventricular fibrillation (VF), associated with unintentional blunt impact on the anterior thoracic wall in the absence of structural damage to the heart. The development of VF is based on the coincidence of the time of a closed breast trauma with a vulnerable period during early repolarization (the so-called "vulnerability window"). More often, death occurs instantly or in the coming minutes of a post-traumatic period. CC is more common in male adolescents and seems to be the second leading cause of sudden death in young athletes. It is possible to save the victim with cardiorespiratory resuscitation or defibrillation only in 25–28 % of cases. High mortality is explained by the fact that victims often do not have time to receive immediate medical care. It is necessary to inform the population, medical community and athletes about importance to avoid hitting the heart. As a preventive measure in some sports, chest protectors are used. Information about the potential danger of blows to the heart area should be provided to the attention of athletes involved, since even an unintentional mild blow can provoke a life-threatening arrhythmia. Having access to defibrillators at sporting events, teaching people to use them and to realize the cardio-pulmonary resuscitation measures can improve the survival of the CC victims.

Background. Aspirin resistance can lead to thrombosis. Platelets interact with neutrophils in the focus of atherosclerotic damage. The levels of synthesis of reactive oxygen species (ROS) characterize their functional potential. Platelet resistance to acetylsalicylic acid (ASA) can affect the synthesis of ROS.

Objective. To reveal the features of ROS synthesis by platelets and neutrophils in patients with coronary heart disease (CHD) after coronary artery bypass grafting (CABG) depending on sensitivity to ASA and antiplatelet therapy.

Design and methods. There were 104 patients with CHD and 36 healthy donors. Patients stopped receiving antiplatelet agents 5 days before CABG, ASA was prescribed after surgery, patients on dual antiplatelet therapy (DAT) clopidogrel were added to ASA for 2–3 days. Resistance to ASA was determined at a level of platelet aggregation with arachidonic acid ≥ 20 %. The ROS synthesis levels were examined by the chemiluminescent method (CL).

Results. 31.7 % of patients were resistant to ASA (rASA). In ASA-sensitive patients (sASA), CL values were increased. In rASA on DAT, CL parameters were increased, but did not differ from sASA. In the sASA and rASA groups on ASA therapy, correlations between neutrophil and platelet CL parameters were revealed.

Conclusion. The presence or absence of interaction between platelets and neutrophils at the level of receptors and/or microvesicles can lead to platelet resistance to ASA in patients with coronary artery disease. Sometimes, this effect could be compensated by DAT.

Background. Quantitative calculation of tissue blood flow by means of radionuclide emission tomography is of great importance in studies of myocardial blood supply. Quantifying blood flow with PET requires a medical cyclotron. ^99mTc-Technetrile is a unique radiopharmaceutical (rfp) with a high and approximately the same extraction fraction by the myocardium and other tissues — chemical microspheres.

Objective. Development of a technique for calculating tissue blood flow for a quantitative assessment of the blood supply to the heart muscle, according to the determination of tissue absorption of ^99mTc-Technetrile during CardioSPECT.

Design and methods. The distribution of rfp — chemical microspheres ^99mTc-Technetrile in the body is proportional to blood flow. Determining the amount of accumulation of rfp in different regions can be performed using SPECT. We
used data of 14 patients with myocardial infarction, who underwent SPECT with ^99mTc-Technetrile, with the calculation of tissue blood flow.

Results. Evaluation of rMBF at rest in the area of unaffected myocardium revealed rMBF = 65±7 ml/min/100 g, in segments with the presence of viable myocardium according to the ultrasound test with dipyridamole rMBF = 53±7 ml/min/100 g, in postinfarction regions of the transmural damage to the left ventricular wall without viable myocardium rMBF = 27±8 ml/min/100 g.

Conclusion. The calculation of tissue blood flow via CardioSPECT is useful for pathophysiological assessment of the blood supply to the heart muscle.

Background. Weaning from mechanical ventilation (MV) became one of the main problems of intensive care unit (ICU) physicians. Choosing the optimal mode of MV, which make possible to accelerate the process of weaning the patient, remain unresolved. A promising direction is the use of new adaptive ventilation modes.

Objective. To compare the clinical efficacy of the iSV regimen with the traditional CPAP + PS (PSV) regimen in patients of a mixed ICU.

Design and methods. 45 patients (age 31–81) were examined. Patients were on prolonged MV from 5 to 28 days. In group 1 pressure support (PSV) mode was used to adapt to spontaneous breathing. Group 2 consisted of patients in whom adaptive ventilation (iSV) mode was used.

Results. Both modes of assisted ventilation provided effective respiratory support. In the PSV mode, on the 3rd and 5th days of weaning from MV, hypocapnia and a higher support by the pressure of spontaneous inspirations (PS) were noted. A higher daily energy requirement was revealed in PSV mode on day 3. The length of stay in ICU in iSV group was moderately decreased.

Conclusion. Assisted ventilation modes PSV and iSV are effective in adapting patients to spontaneous breathing after prolonged MV. The iSV mode appears to cause less respiratory stress compared to the PSV mode. Assisted ventilation in iSV versus PSV can possibly reduce ICU length of stay.

Background. Currently, the frequency of occurrence of neoplasms is emerging in the world. Under conditions of a general tumor, brain tumors are rare (0.7–1.5 %). However, high mortality, disability, limited life expectancy of patients, high economic and social inferiority, raise concerns about the medical organization of care, development and social adaptation. Of particular importance among the causes of primary brain tumors is the congenital or acquired growth of immunodeficiency. The growth in the number of drug addicts led to the elimination of the annual epidemic at the end of the 70s and the increase in the number of patients with immunodeficiency syndrome (AIDS), due to which the growth of a brain tumor began to develop in this population group. The number of Russian patients with lymphoma is also steadily increasing.

Objective. Consider an illustrative clinical case that reflects the expected continuity in patients with ordinary CNS lymphoma.

Design and methods. A 50-year-old patient with moderate memory loss was examined using various methods: MRI, PET-CT and etc.

Results. Based on histological and immunohistochemical studies, diffuse large B-cell lymphoma of the CNS was diagnosed. There was a positive trend in the reduction of tumor size after radiation therapy.

Conclusion. Primary CNS lymphoma is becoming an active epidemiological problem of society, requiring comprehensive multidisciplinary monitoring. Only high vigilance in terms of lymphoma and well-coordinated work of multidisciplinary specialists can help to perform the correct diagnostics and patient management.

Background. Craniopharyngiomas are benign epithelial tumors. According to embryogenetic theory, these neoplasms develop from the remains of the cells of Rathke’s pouch, which connects the cavities of the primary oral tube with the pituitary gland in the embryonic period. The metaplastic theory assumes the occurrence of craniopharyngiomas as a result of metaplasia of epithelial cells in the chiasmal-sellar region.

Objective. To present a clinical case of ectopic adamantium-like craniopharyngioma of the right cerebellopontine angle associated with Gardner’s syndrome.

Design and methods. The analysis of SCT, MRI, histological, histochemical and other special studies, as well as data from four other similar observations published in the literature, was carried out.

Results. We describe a case of a rare case of ectopic adamantium-like craniopharyngioma of the right cerebellopontine angle associated with Gardner’s syndrome (familial adenomatous polyposis, multiple skull osteomas and soft tissue tumors) diagnosed in a 27-year-old patient. It is noted, while inexplicable, the correlation of craniopharyngiomas in patients with Gardner’s syndrome in the region of the cerebellopontine angle.

Conclusions. In the case of patients with adamantine-like craniopharyngiomas, the including of collection of a family history and special studies to exclude adenomatous intestinal polyposis and Gardner syndrome in the complex of treatment and diagnostics id highly recommended.