Though inferior petrosal sinus sampling (IPSS) is considered the gold standard test for the differential diagnosis of ACTH-dependent Cushing’s syndrome, false-negative results have been reported in 1-10 % cases. Cavernous sinus sampling (CSS) was suggested as a diagnostic tool in a complex ACTH-dependent Cushing’s syndrome cases. Objective. To study the role of cavernous and inferior petrosal sinus sampling in differential diagnosis of ACTH-dependent Cushing’s syndrome. Materials and methods. Five patients with ACTH-dependent Cushing’s syndrome were included. All patients underwent transsphenoidal endoscopic surgery. During the surgery pituitary microadenomas were found in all patients, ACTH secretion was approved by immunohistochemistry in four patients, the fifth patient became eucortisolemic after the operation. In all patients CSS and IPSS were performed before operation and ACTH and prolactin levels were measured in plasma samples. Results. ACTH CS/P ratio was more than 2 suggesting the pituitary source in 100 %. As for the IPSS, in three cases ACTH IPS/P ratio was more than 2, supporting the data of CS. But in two cases ACTH IPS/P ratio was less than 2, indicating the ectopic ACTH syndrome, these data contradicted CSS results. Conclusion. According to our experience, catheterization of CS may improve results and increase the accuracy of the method.

The purpose of the study. To assess of iodine status and iodine intake of women of reproductive age living in Saint-Petersburg. Materials and methods. We surveyed 143 women of reproductive age from 18 up to 44 years old living in Saint-Petersburg more than 3 years. All the participants filled out a questionnaire on diet, were examined by the endocrinologist, the thyroid palpation was performed, once daily urine was taken in order to determine urinary iodine concentration (UIC) and to calculate of median UIC. Results. The median UIC was 81,0 mg/l (25,8-110,0). Above requirements of iodine intake had 11,9 % of participants, 27,3 % - iodine sufficiency, mild iodine deficiency (ID) - 39,9 %, moderate ID -18,9 %, severe ID - 2,1 %. Only 44,1 % of women use iodized salt (IS). Goiter by palpation was found in 8,4 % of participants. Conclusion. Most of the examined women of reproductive age have mild ID. Probably use IS as the main method of the prevention of IDD is not effective enough.

Objective: Within the project of the development of the algorithm for human heart rate variability (HRV) analysis we assessed the HRV parameters in an epidemiologic sample of healthy subjects in order to compose the database of short-term electrocardiograms (ECG) for further mathematical analysis. Design and methods: Altogether 101 subjects underwent short-term ECG registration by a portable 12-channel monitor “Kardiotekhnika-04-3R (M)" (“Inkart", Russia) and portable cardiorespiratory polysomnographic system “Embletta Gold" (Embla, Natus, USA). A modified active orthostatic test was used and ECG was registered for 7 minutes in the sitting position (phase 1), 7 minutes - upright (phase 2) and 10 minutes - again in the sitting position (phase 3). Results. Correlation analysis showed a negative relation between age and frequency HRV indices: HF (rs = -0,239, р = 0,034), LF (rs = -0,385, р < 0,001) and VLF (rs = -0,242, р = 0,033). Subgroup analysis (in the group of students) demonstrated a positive correlation between mean sleep duration and HRV parameters: LF from the full ECG recording (rs = 0,46; p = 0,037), during phase 1 (rs = 0,52; p = 0,015) and phase 2 (rs = 0,50; p = 0,021); VLF during phase 1 (rs = 0,46; p = 0,039) and phase 2 (rs = 0,55; p = 0,012) and HF during phase 2 (rs = 0,48; p = 0,027). Conclusions. While analyzing HRV additional parameters, such as sleep duration and quality before the study, should be considered along with the standard clinical and demographical indices. A modified active orthostatic test is characterized by the decrease of high-frequency spectrum and increased LF/HF ratio reflecting the elevated sympathetic activity. Increasing age is associated with the decrease of high frequency HTV indices.

Peroxisome proliferator activated receptors-α и γ (PPAR) are nuclear receptors which regulate different mechanisms of immune inflammation, lipid and glucose homeostasis. One of the most important pathophysiological pathways of PPAR activation is inhibition of tissue factor expression. Tissue factor is initial link of coagulation and directly related to thrombogenesis. The main common pathogenetic mechanism of PPAR and tissue factor is signaling pathway of nuclear factor κВ (NF-κB). NF-kB is a universal transcription factor which regulate expression of genes of immune inflammation, cytokine production, cell cycle and apoptosis. The disruptions of the functioning PPAR-α and PPAR-γ lead to activation of NF-κB transcription factor which binds tissue factor gene promoter and increases its expression.

A widespread introduction of cardiac transplantation methods into cardiological practice and increase in a number of cardiopulmonary bypass surgical interferences determine the necessity of improvement of myocardial protection methods from ischemic and reperfusion injuries. Myocardial contractile function and injury degree were studied on a model of isolated rat heart subjected to four-hour pharmaco-hypothermic cardioplegia and reperfusion under conditions of cardioprotection by levosimendan. The presence of cardioprotective effect of postconditioning by levosimendan in regard to an isolated heart in reperfusion period of four-hour cardioplegic ischemia was found out. The given effect was manifested in reducing of reperfusion ejection of myocardial injury enzymatic markers and a complete restoration of contractive activity parameters of isolated hearts in reperfusion period.

The high incidence of congenital heart disease among family members indicates a significant contribution of the genetic component in the development of this group of diseases. An important role of NOTCH1 in cardio-and vasculogenesis as well as a link between mutations in NOTCH1 and congenital heart disease and blood vessels has been suggested recently. It has been proved that Notch signaling plays an important role in the regulation of endothelial-to-mesenchymal transition, which is a critical event in the initial steps forming left ventricle and heart valves. Development of prenatal diagnosis by detecting defects in NOTCH1 gene will increase the probability of fetal congenital heart defects recognition, thereby contributing to the timely provision of skilled care and increasing survival of these patients

Hematopoietic stem cell transplantation (HSCT) is a necessary and sometimes the only available treatment for the many of the patients with hematological neoplasms. Development of the technologies and protocols for allows broadening of the spectrum of patients that could be treated with allogenic HSCT. One of the main complications in allogenic HSCT is immune conflict of the donor cells with patient’s tissues, named graft versus host disease (GVHD). Key studies of the mechanisms of GVHD are made in experimental models of transplantation in transgenic mice. This paper review current models of acute GVHD that helps to study mechanisms of GVHD and develop new therapeutic schemes to improve efficiency, decrease adverse effects and improving overall survival rate.

The clinical case of a patient with hereditary osteodystrophy Albright type 1 A, characterized by peripheral resistance to different groups of hormones, is presented in this article. Some clinical implications, features of a course of a disease in this patient as well as the complexity of differential diagnostic search and the algorithm of differential diagnosis of endocrine pathology are described.

The objective of this study was to examine cardiac innervation and myocardial perfusion in patients with atrial fibrillation (AF). Methods. The study included 40 patients with coronary artery disease (CAD), hypertension 3 class. There were 3 groups of patients: 15 with paroxysmal AF (PAF), 15 with long-standing persistent AF (LSPAF) and 10 patients with sinus rhythm (SR). All patients underwent scintigraphy with¹²³I-MIBG to evaluate of cardiac sympathetic activity. Heart-to-mediastinum (H/M) ratios and the washout rate (WR) were calculated from planar imaging. From SPECT images, the¹²³I-MIBG SPECT defect score was calculated by assessment of patient’s segmental¹²³I-MIBG tracer uptake score using the 17-segment model. Also all patients underwent SPECT with^99mTc-MIBI to evaluate of myocardial perfusion. Results. In patients with PAF and LSPAF the early H/M ratio and delayed H/M ratio was significantly lower compared to control subjects (early planar images: 1,57 ± 0,15 vs. 1,54 ± 0,18 vs. 1,82 ± 0,12, respectively; P < 0,05; delayed planar images: 1,47 ± 0,15 vs. 1,46 ± 0,16 vs. 1,83 ± 0,13, respectively; P < 0,05). The washout rate of¹²³I-MIBG in both the patients with PAF and LSPAF was greater compared to patients with SR (31,2 % ± 11,5 % vs. 29,4 % ± 10,5 % vs. 17,5 % ± 10,3 %, respectively; P < 0,05). However, both early and delayed SPECT images showed that the sympathetic activity defect was significantly larger in patients with LSPAF compared to patients with PAF and patients with SR (P < 0.05). No statistically significant differences were found between groups in perfusion defect score. Conclusion. Our study showed that more sympathetic innervation abnormality was observed in patients with AF in relation to the group of patients with SR. The AF has no significant effect on myocardial perfusion, and the most significant violation of the regional sympathetic activity observed in patients with LSPAF.

The aim is to reveal the most effective type of catheter ablation of persistent atrial fibrillation with consideration for complications. The data of 24 studies are presented in the article with a total number of 3115 patients. All the catheter procedures were divided according to the technique of ablation. All the complications were divided into two groups: first one included life-threatening complications, second one included complications that are serious but not life-threatening. For this study a special statistical formula was invented. The formula allows to show the most effective catheter ablation technique with the consideration for complications. Conclusion: The most effective and safe type of catheter ablation of atrial fibrillation is wide ablation circumfiration area with additional ablation line

The main goal of our research was to assess results of the suture annuloplasty for treatment of ischemic mitral regurgitation (IMR). We have analized the medical records of 37 patients with ischemic heart disease complicated by mitral regurgitation with impaired systolic function of left ventricle (ejection fraction 40 % or less). We have made combined open heart surgery in all patients: coronary bypass graphting with suture mitral valve annuloplasty. We have analyzed all cases of returning of mitral regurgitation and have found some causes. We have seen real improving in clinical status of patients in follow-up. The suture mitral annuloplasty is effective method of surgical correction of ischemic mitral regurgitation. It improves reverse LV remodeling. Clinically relevant mitral stenosis was not detected. It tends to better clinical prognosis of chronic heart failure.

Congenital small bowel obstruction is common causes of neonatal intestinal obstruction ((frequency 1:3000). Some authors prefer closed types of anastomoses. Others recommend T-shaped anastomosis or double enterostomy. Improve the results of surgical treatment of infants with small bowel obstruction, using different types of anastomoses in choosing ways to create an intestinal anastomosis. Analysis of 80 infants with small bowel obstruction, for the period from 2000 to 2014. Results: Primary anastomosis created in 47, deferred anastomosis in 33 cases. On patients with jejunum obstruction the end to end anastomosis is created in 4, Complications were found in all. T-shaped anastomosis was created in 11. Complications were found in three patients. On patients with obstruction of the ileum end to end anastomisis was created in 9, the stenosis of anastomosis was in 1 patient. T-shaped anastomosis was created in 9. No complications. In patients with T-shaped anastomosis parenteral nutrition was shorter. In patients with obstruction at the level of the jejunum the best method is T-shaped anastomosis. With obstruction at the level of the ileum we prefer - the closed types of anastomosis.

It was analyzed the results of the continuous sutural annuloplasty operations done in 340 patients with significant mitral regurgitation of non-ischemic etiology. Immediate and long-term results demonstrate the safety of the method and its effectiveness in preventing annulodilatation and ensuring stability during long-term annuloplasty. Predictors of residual failure in the early postoperative period and the reasons leading to a recurrence of mitral regurgitation in the long term are identified.

Object: the aim ofthis study is to analyse a clinical presentations of Failed Back Surgery Syndrome (FBSS). The main reasons of FBSS and clinical findings corresponding to it have been studied. Materials and methods: outcomes of 40 patients with back pain, who were underwent earlier the surgery, and pain recurrence following the operation from 3 months to 4 years were analyzed by us retrospectively. Results: the main clinical presentation of FBSS were: a facet-joint syndrome in 70 %, reflex myotonic and myofascial syndromes in 61,6 %, instability in the same level or the adjacent segment in 33,3 %. Resurgery was performed apropos lumbar disc herniation recurrence, adjacent segment disease, epidural post-operative fibrosis, instability in the same level and/or the adjacent segment etc. Conclusion: revelation of the morphological reason of the pain syndrome and orthopedic and neurologic disturbances is a ground of correct treatment tactics. It may be conservative treatment of postoperative pain syndrome after microdiscectomy or a second surgery.

Background. Glial tumors are the most common tumors of the brain, with their malignant form - anaplastic astrocytoma and glioblastoma exceed 50 % and accounting for only 2 % of all tumors in adults, take fourth place in the structure of cancer mortality. Objective: To determine the effectiveness of new technologies of treatment of malignant glial tumors (photodynamic therapy and specific antitumor immunotherapy based on autologous dendritic cells). Design and Methods: We consider the results of treatment 356 patients with malignant glial tumors. Depending on the treatment, 5 groups were formed, 3 of which, in addition to standard procedures (surgery, radiotherapy, chemotherapy) photodynamic and/or immunotherapy were used. Results: when used in addition to standard methods, photodynamic therapy in patients with anaplastic astrocytoma average life expectancy and the median survival were 50.8 months and 35 months, glioblastomas - 47.9 months and 30 months, giant cell glioblastomas - 34 months and 34 months, that is higher than in the groups of patients with only standard methods of treatment. Application of 3 or more courses of immunotherapy also improves life expectancy and median survival of these patients 50.22 months and 32 months in patients with anaplastic astrocytomas, and 23.72, and 24 months in patients with glioblastomas. Conclusions: The highest average life expectancy and the median survival among patients with anaplastic astrocytomas, glioblastomas and giantcell glioblastomas in our study were achieved in patients in which treatment in addition to standard therapies (surgery, radiotherapy, chemotherapy) was added by photodynamic therapy. When managed with immunotherapy additionally to standard methods, life expectancy increased only if more than 3 courses were used.

Objective: The article deals with the data from a study of haemodinamic parameters, indicators of the inflammatory response in the perioperative period of neurosurgical patients operated on because of tumors of the posterior cranial fossa. Design and methods: 363 patients were subject to the study. The operations were performed under the conditions of the neuro-vegetative stabilization with the use of fentanyl, clonidine and propofol. Results: There was a significant increase in the level of interleukin 10 at the stage of hemostasis, the next day after the surgery interleukin 6 significantly increased. At the stage of hemostasis a transient increase in the levels of ACTH, cortisol, prolactin was noticed, the rate of which returned to baseline the next day after surgery. Conclusion: In the context of neuro-vegetative stabilization a sufficient humoral response of the organism to surgical trauma was noticed.

In our study 106 patients with colorectal tumors were examined using combined positron-emission and computer tomography before surgical treatment and after complex therapy. Malignancies of the colon were characterized by the wall thickening or infiltration with inhomogeneous uptake of the contract media and increased uptake of¹⁸F-deoxyglucose. In metastatic lymph nodes the typical features were size growth and increased metabolism. In patients with hepatic metastases there were increase of¹⁸F-deoxyglucose uptake and focal decrease in density. If recurrences were found, an additional tissue with increased inhomogeneous¹⁸F-deoxyglucose uptake could be seen. Use of combined positron-emission and computed tomography can provide more accuracy in staging colorectal malignancies. After complex treatment recurrences and distant metastases can also be found more precisely.

The purpose of this study was to evaluate the differential CT features of bronchioloalveolar carcinoma mimicking pneumonia and pneumonia at the lung periphery. CT images of 36 patients with focal areas of parenchymal opacification at the lung periphery were retrospectively reviewed. We evaluated the presence of «groundglass attenuation», «CT-angiogram sign», «air-bronchogram sign», a bubblelike low-attenuation area within the lesion, presence of bronchial wall thickening proximal to the lesion, and air-trapping in the normal lung near the lesion, presence of pleural thickening and retraction associated with the lesion.