Vol 4, No 2 (2013)

Articles
SYSTOLIC FUNCTION AND DYSSYNCHRONY IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION
Yaroschuk N.A., Kochmasheva V.V., Dityatev V.P., Kerbikov O.B.
Abstract
Echographic evaluation of systolic function plays an important role in examination of the patients with acute myocardial infarction (AMI). Recent developments in real-time 3D echocardiography (RT3DE) allow us to evaluate additional parameters such as the dyssynchrony.The aim of this study was to evaluate the relationship between myocardium dyssynchrony and systolic function and to assess the prognostic value of dyssynchrony and its influence on the development of arrhythmias and fatal event in post AMI period.Methods: Study population consisted of 82 (mean age 52±21) patients with AMI and 65 age and gender matched persons with similar cardiovascular risk factors, but without AMI (control group). Standard deviation of the time to the regional LV minimum systolic volume for all 16 segments Tmsv4 16-SD index was used for the assessment of dyssynchrony. The follow-up period was 6 months afterAMI.Results: Tmsv 16-SD values were significantly higher in patients with MI compared control group (6.8 ± 2.7% vs 2.9 ± 1.6 % respectively, р<0,001). Moderate negative correlation was observed between Tmsv 16-SD and Cardiac Index (CI) (r =-0.58, p<0.008). No significant correlations were found between Tmsv 16-SD and mean arterial pressure and herat rate. Tmsv 16-SD was significantly lower in patients with pulmonary hypertension (maximum systolic pressure in lung artery (SPLA) – 55.0±5.58 mm Hg) as compared to patients without pulmonary hypertension (maximum SPLA – 33.0±5.76 mmHg); 4.9±0.75 vs 6.1±1.88 respectively, р=0.03. Significant positive correlation was observed between Tmsv 16-SD and end-diastolic volume (EDV) (r=0.63; р<0.05) and negative with ejection fraction (EF) (r=-0.73; p<0.05).28 patients (34%) of the MI group had the increase Tmsv 16-SD and normal values of EDV and EF. According to ROC analysis ROC Tmsv 16-SD>6.1 was associated with arrhythmic complications in post IM period (sensitivity 83.3%, specificity 87.5%, AUC=0.865, p<0.0001). Tmsv 16SD>6.1 correlates with increasing likelihood of fatal event (sensitivity 87.5%, specificity 71.6%, AUC=0.81, p<0.0001)Conclusions: Tmsv 16-SD is increased in patients with MI. In 34% of MI patients the increase of Tmsv 16-SD was observed in combination normal values of EF and EDV which allow us to consider Tmsv 16-SD as an additional indicator describing pathological changes in myocardium. Tmsv16-SD is correlated with hemodynamic indicators such as CI and SPLA. High Tmsv 16-SD is associated with increased level of arrhythmic complications and fatal events.
Journal of Clinical Practice. 2013;4(2):4-11
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CONGENITAL DIAPHRAGMATIC HERNIAS IN ADULTS
Zvezdkina E.A., Lesnyak V.N., Belov M.A., Briginevich T.A.
Abstract
Congenital diaphragmatic hernias are generally appearing in childhood, but are also occasionally detected in asymptomatic adult patients. Computed tomography is used for the correct diagnosis the hernia type and for its localization, facilitating its management and the choice of treatment. We report the case of parasternal diaphragmatic hernia of Morgagni-Larrey and two cases of posteriolateral Bochdalek diaphragmatic hernia. The patients showed no symptoms and were not surgically treated.
Journal of Clinical Practice. 2013;4(2):12-19
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RARE CASE OF FRONTAL BONE HEMATOGENIC OSTEOMYELITIS, COMPLICATED BY FOREHEAD PART BRAIN ABSCESS
Il`inykh A.S., Larin A.I., Bocharov A.A., Bobrovskaya A.N., Durov O.V., Safin A.V.
Abstract
Osteomyelitis of skull belongs to the rare necrotic infections of bones. Its distribution is about1.5% from osteomyelitis of the flat bones. During last 10 years in Russian neuro-surgical literature are no data covering this issue. Foreign publications review observations about single cases. This work describes clinical case of successful surgical treatment of frontal bone osteomyelitis, complicated by abscess in forehead part of brain.
Journal of Clinical Practice. 2013;4(2):20-25
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STAGE TREATMENT OF CELIAC TRUNK COMPRESSION SYNDROME (Case report and literature review)
Chupin A.V., Orehov P.Y., Lebedev D.P., Parshin P.Y., Lesnyak V.N., Kemezh Y.V., Bakulina I.F.
Abstract
Report and literature review of the rare disease – celiac trunk compression syndrome are presented. We discuss as typical manifestations of disease, and the most controversial aspects of the pathogenesis, diagnosis and treatment. We propose a diagnostic algorithm for early detection of the disease, and show that to achieve a good effect, may be required several stages of intervention. With the accumulation and codifying of experience it is possible to develop a more detailed indications to different types of surgery.
Journal of Clinical Practice. 2013;4(2):26-34
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HEPATOCELLULAR CARCINOMA TODAY
Semendyaeva M.I., Merculov I.A., Pastukhov A.I., Gaydascheva E.V., Lesnyak V.N., Schutova O.V.
Abstract
Hepatocellular carcinoma ( HCC ) is one of the most frequent disease among other cancer and one of the reason of mortality. There are serious opinions about increasing of HCC in the near future in connection of viral hepatitis. The diagnosis of HCC is mostly late and that is why surgical methods of treatment are inferior to others. In this article three patients with chronic liver diseases and HCC are discussed. The diagnostic algorithm is recommended and possibility of modern methods of treatment are considered.
Journal of Clinical Practice. 2013;4(2):35-49
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THYROID MALIGNANCY IN THE PRACTICE:THE RELEVANCE AND COMPLEXITY OF THE PROBLEM
Smirnov V.V., Zamyatina O.V.
Abstract
The review considers the problem of diagnosis and differential diagnosis of nodular thyroid neoplasms. It is given current classification, discussed the clinical and technological approaches to verify the diagnosis.
Journal of Clinical Practice. 2013;4(2):50-55
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OBTAINING AND APPLICATION PERSPECTIVESOF GENETICALLY MODIFIED PLURIPOTENT STEM CELLS
Kazachenko K.Y.
Abstract
This review considers genetic modelling of pluripotent stem cells, the problems of experimental studies and prospects of practical application.
Journal of Clinical Practice. 2013;4(2):56-67
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