No 43 (2015)

ИСТОРИЯ МОНИКИ

ON THE OCCASION OF THE 85TH ANNIVERSARY OF RADIOLOGICAL DIAGNOSIS IN MONIKI (1931–2016)

Vishnyakova M.V., Paleev F.N.

Abstract

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Almanac of Clinical Medicine. 2015;(43):6-10
pages 6-10 views

ARTICLES

MULTIDETECTOR COMPUTED TOMOGRAPHY IN POSTOPERATIVE ASSESSMENT OF CAROTID ARTERIES

Vishnyakova M.V., Lar'kov R.N., Vishnyakova M.V.

Abstract

Rationale: Carotid endarteractomy is a surgical intervention that is performed for prevention of cerebrovascular accidents, up to 80% of them being of ischemic origin, in the presence of a marked stenosis and occlusion of carotid arteries. A detailed description of specifics of postoperative changes in carotid arteries depending on the type of surgical intervention has not been published.

Aim: To evaluate internal carotid arteries in the early postoperative period by means of multidetector computed tomography (MDCT) and to match the changes detected with the type of surgical intervention.

Materials and methods: In 2014, 23 patients with atherosclerotic stenoses of internal carotid arteries were assessed in the Department of Roentgenology of MONIKI. As a part of preoperative work-up, the patients underwent ultrasound examination (USE) of the neck vasculature and MDCT with bolus contrast enhancement. Postoperative monitoring also included USE and MDCT. The data obtained were matched against the type of surgical intervention.

Results: After the eversion procedure (15 patients), there were 14 cases of expected (normal) postoperative changes and 1 case of changes that required a follow-up. After an open (classic) carotid endarterectomy (3 patients) there was 1 case of expected postoperative changes and 2 cases requiring a follow-up. Among 5 patients who underwent a resection of internal carotid artery and its prosthetic replacement, 2 patients had expected changes, 2 patients had changes that required a follow-up and 1 patient had a complication after surgery.

Conclusion: The postoperative use of MDCT for assessment of reconstructed arteries allows for identification of various types of postoperative changes, for detection of symptoms of severe complications and borderline conditions that require subsequent targeted diagnostics and monitoring. 

Almanac of Clinical Medicine. 2015;(43):11-18
pages 11-18 views

MAGNETIC RESONANCE IMAGING IN THE DIAGNOSIS OF THE HEART LESIONS IN PATIENTS WITH ACROMEGALY

Abramenko A.S., Vishnyakova M.V., Vishnyakova M.V., Dreval' A.V., Kovaleva Y.A.

Abstract

Background: Acromegaly is a disease caused by pathologic hypersecretion of growth hormone and insulin-like growth factors. Independent of other cardiovascular disorders, acromegalic cardiomyopathy develops in patients with acromegaly. According to the published data, it manifests by a triad of symptoms, such as hypertrophy, edema and fibrosis of the myocardium. Myocardial fibrosis (diffuse interstitial) develops due to persistent excess of growth hormone and a gradual loss of the heart muscle architectonics. It is difficult to define the rate of cardiac fibrosis in acromegalic cardiomyopathy, because studies in this area are scarce and include small patient numbers.

Aim: To develop an algorithm for cardiac magnetic resonance imaging (CMR) for identification of the key variants of myocardial abnormalities in patients with acromegaly.

Materials and methods: From 2013 to 2015, the CMR was performed in 27 patients aged from 23 to 69 years with a clinical diagnosis of acromegaly. The disease duration ranged from 4 to 38 years. The MRI investigations were performed on a MR scanner General Electric 1.5 T Optima MR450w GEM using cardiac surface coils, with contrast agents with the active substance content of 0.5 mmol / mL, at a dose of 0.3 mL / kg. Synchronization with the heart rhythm was conducted under standard VCG leads. The assessment was done in the standard planes (2- and 4-chamber, short-axis) using sequences of film loops. To identify structural myocardial abnormalities typical for acromegalic cardiomyopathy (hypertrophy, edema and interstitial fibrosis), we used a specialized protocol that in addition to the well known diagnostic sequences included new diagnostic target assessments, such as T1-mapping with a set of 30 indicators of the time inversion).

Results: The semiotics of heart abnormalities in acromegalic cardiomyopathy manifested as myocardial hypertrophy, detected in 20 (74%) patients aged 59–62 years, with disease duration from 5 to 14 years (mild, in 9, moderate, in 9, severe, in 2 cases ) and signs of interstitial fibrosis in 100% of cases. No signs of myocardial edema were found. Calculation of the difference in T1 time values obtained from the mapping of all acromegaly patients showed a change in the relaxation time of various degrees, suggesting the presence of interstitial fibrosis. Initial statistical analysis of the data revealed a significant negative correlation between T1 relaxation time of the left ventricular myocardium and growth hormone levels (r = -0.3929, p < 0.05), as well as a significant negative correlation between the difference in the left ventricular T1 relaxation time before and after administration of the contrast and growth hormone levels (r = -0.4388, p < 0.05).

Conclusion: CMR algorithm including a cine sequence seems to be the most informative in determination of the main types of myocardial abnormalities in patients with acromegaly. It allows an assessment of the functional status and myocardial hypertrophy, black blood sequence and fat saturation that help to identify myocardial edema; T1-mapping technique for the search for diffuse interstitial myocardial fibrosis.

Almanac of Clinical Medicine. 2015;(43):19-26
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LEFT ATRIAL FIBROSIS IN PATIENTS WITH ATRIAL FIBRILLATION ACCORDING TO MAGNETIC RESONANCE IMAGING WITH LATE GADOLINIUM ENHANCEMENT

Stukalova O.V., Aparina O.P., Mironova N.A., Golitsy S.P.

Abstract

Rationale: Atrial fibrillation (AF) is the most common type of arrhythmia. Left atrial abnormalities in AF require further investigation.

Aim: To evaluate characteristics of myocardial structure of the left atrium by magnetic resonance imaging (MRI) with delayed contrast enhancement in patients with AF associated with essential hypertension (EH), in those without any cardiovascular disorders, and in patients with AF after cryoablation of the pulmonary artery orifice.

Materials and methods: The study enrolled 53 patients with AF (mean age 56 years). Twenty eight of them had AF without any associated cardiovascular disorders (lone AF, or LAF group), 25 patients had AF related to EH (AF + EH group). Three patients had undergone anti-arrhythmic intervention. Cardiac MRI was performed in all patients with high resolution late gadolinium enhancement (LGE) at 15–20 min after i.v. gadoversetamide (0.15 mmol/kg). For LGE MRI, we used a novel high resolution inversion recovery (inversion times 290–340 ms) magnetic resonance pulse sequence with isotropic voxel (size 1.25 . 1.25 .2.5 mm) and fat saturation. Left atrium walls were segmented semi-automatically on the LGE images. Left atrium fibrosis quantification was performed with the original software LGE Heart Analyzer, developed in Russian Cardiology Research and Production Complex (Moscow).

Results: Left atrium fibrosis (mean, 9 [1.7; 18] %) was found both in patients with AF + EH and with lone AF. There was a trend towards more significant left atrial fibrosis in the group of AF + EH, compared to that in the lone AF group (10.972 [6.98; 19.366] % vs 4.37 [0.893; 18.575] %, respectively, p = 0.1). The extent of left atrium fibrosis correlated with left atrium dilatation (r = 0.37, p < 0.001) and with the decreased ejection fraction (r = -0.4, р < 0.001). The patients who had undergone an antiarrhythmic intervention, demonstrated formation of intensive LGE zones in the ablation areas.

Conclusion: Quantification of atrial myocardial fibrosis by high resolution LGE MRI in AF patients is feasible with the use of the original software LGE Heart Analyzer. 

Almanac of Clinical Medicine. 2015;(43):29-37
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ASSESSMENT OF CLINICO-ECONOMIC EFFICACY OF MEDICAL TREATMENT OF STABLE ISCHEMIC HEART DISEASE PATIENTS WHO UNDERWENT MYOCARDIAL REVASCULARIZATION

Sveshnikova N.D., Paleev F.N.

Abstract

Background: Impractical use of pharmaceuticals is a serious problem of the Russian healthcare system. Implementation of pharmacoeconomic analysis into the logistic technologies of medical organizations may promote the solution of this problem.

Aim: To analyze real-practice data on medical therapy of patients with stable ischemic heart disease (IHD) during their hospital stay for transcutaneous coronary stent placement and coronary artery bypass grafting.

Materials and methods: With the help of a structured form on medical treatment we extracted and analyzed data from 131 clinical records of patients with stable IHD who were hospitalized in 2014 to the Department of Internal Diseases and Department of Cardiovascular Surgery; 60 were patients after stent placement and 71, after coronary artery bypass grafting. We performed an ABC/VEN analysis of their treatment. Groups of pharmaceuticals for VEN analysis were formed according to the Recommendations of Russian National Atherosclerosis Society on Diagnosis and treatment of chronic IHD (Recommendations of Russian National Atherosclerosis Society, 2013) based on European Society of Cardiology guidelines on the management of stable coronary artery disease (ESC guidelines, 2013). We assessed if the treatment administered corresponded to the current Standard of care to patients with stable IHD – SMP No 2.01.216.0 (Russian Federal Standard, 2007).

Results: A mismatch between medical treatment that was performed in the Departments of Internal Diseases and of Cardiovascular Surgery, and that recommended by the Russian Federal Standard (2007), was found. The regimens used include the majority of agents recommended by the Russian National Atherosclerosis Society (2013) and the ESC guidelines (2013). In the Department of Internal Diseases, the mean cost of medical treatment during the whole period of stay in the hospital was 79.6 rubles. The group A agents (those with cumulative cost percentage = 80%) were represented by 9 items from the total of 54. There was a low percentage of medicines that were not indicated for this disease (13 agents, or 9.5% of the total medical costs), and all of them were administered for the treatment of concomitant disorders. In general, medical treatment performed in the Department of Internal Diseases corresponded to the ESC guidelines (2013). The costs of medical treatment during the whole period of stay in the Department of Cardiovascular Surgery was 10 741.9 rubles. The group A included 9 agents from the total of 78 used. Sixty eight per cent of costs were related to pharmaceuticals not having compelling indications (solutions, detoxification agents, agents for prevention of gastrointestinal adverse effects), whereas the costs of vitally important drugs were only 12.3% of the total and those of necessary drugs (including antibacterials), 19.7%.

Conclusion: It is obviously necessary to update the current Russian Federal Standard (2007), with inclusion of data corresponding to the worldwide trends and guidelines of the Russian National Atherosclerosis Society (2013), at least for two patient groups: those after coronary stent placement and after coronary artery bypass grafting. The elaboration of criteria for administration of medical treatment and strict compliance with them in the real practice would allow for controlling of medical treatment costs, to prevent polypragmasia and adverse drug reactions. 

Almanac of Clinical Medicine. 2015;(43):38-45
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VALIDATION OF THE MECG-DP-NS-01 MONITOR IN OSCILLOMETRY AND AUSCULTATION MODES IN CHILDREN AND ADOLESCENTS, ACCORDING TO ESH-IP2, BHS AND AAMI PROTOCOLS

Fedorova S.I., Kulakov N.V., Pronina V.P., Tyurina T.K., Kotova Y.V.

Abstract

Background: High blood pressure in childhood and adolescence is associated with a 2 to 3-fold increase of the risk of arterial hypertension. According to the Russian guidelines, only devices that have been tested by international protocols can be used for the main diagnostic method of arterial hypertension in children and adolescents, i.e. ambulatory 24-hour blood pressure monitoring.

Aim: To validate the MECG-DP-NS-01 upper arm BP monitor in oscillometry and auscultation modes within the “Soyuz” complex, in children and adolescents aged from 5 to 15 years according to the international protocol of the European Society of Hypertension (ESH) from 2010 (ESH-IP2), the protocol of the British Hypertension Society (BHS) from 1993 and the standard of the Association for the Advancement of Medical Instrumentation (AAMI).

Materials and methods: We recruited 99 children and adolescents (49 male, 50 female) aged from 5 to 15 years (33 children, from 5 to 7 years, 33, from 8 to 11 years, 33, from 12 to 15 years). Expert and device blood pressure measurements were performed in each patient according to the protocols.

Results: The MECG-DP-NS-01 upper arm blood pressure monitor was validated and its accuracy in blood pressure measurement in children and adolescents according to ESH-IP2, BHS and AAMI protocols confirmed. According to BHS 1993 protocol, its accuracy corresponded to A/A both in the oscillometry and auscultation modes.

Conclusion: According to ESH-IP2, BHS and AAMI protocols, MEGC-DP-NS-01 within the “Soyuz” complex could be recommended for 24-hour ambulatory blood pressure monitoring in children and adolescents aged from 5 to 15 years, both in the oscillometry and auscultation modes. According to the Declaration of blood pressure Measuring Device Equivalence signed by the manufacturer for the devices MDP-NS-02s “Voshod” and MEGCDPNS-01, and to the equivalence criteria for blood pressure measuring devices, the results of testing and its conclusion could be extrapolated to the device MDP-NS-02s “Voshod” produced by the “DMS Advanced Technologies”. 

Almanac of Clinical Medicine. 2015;(43):46-51
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A TECHNIQUE OF MULTIDETECTOR COMPUTED TOMOGRAPHY FOR OPTIC CEREBRAL OXYMETRY

Tarasov A.P., Vishnyakova M.V., Ivlieva A.L., Davydov D.V., Podrez D.V., Rogatkin D.A., Vishnyakova M.V.

Abstract

Aim: To assess geometric parameters of the human head based on X-ray computed tomography for construction of the first Russian optical cerebral oxymeter.

Materials and methods: Based on the data obtained by multidetector computed tomography, we retrospectively assessed thickness of the frontal bone squame, adjacent soft tissues and calculated their sum in 100 patients above 50 years of age (50 male and 50 female, mean age 64 ± 8 years). The supraorbital edge of the orbit and the middle line were chosen as the reference points.

Results: The mean frontal squame thickness was6.28 mm (± 1.58) on the right side and6.38 mm (± 1.62) on the left side. The mean thickness of the soft tissues covering the bone at this level was4.39 mm (± 1.21) on the right side and4.41 mm (± 1.22) on the left side. The mean total thickness of the frontal squame bone and soft tissue was11.76 mm (± 2.25) on the right side and11.89 mm (± 2.31) on the left side.

Conclusion: For reliable reproducibility of cerebral oxymetry, geometric characteristics of the area where the sensor will be placed, taking the supraorbital edge and the middle line as reference points. Minimal sums of the mean values and their standard deviations for the frontal bone thickness and soft tissues were measured at the intersection points of3 cm lines perpendicular to these reference points.

Almanac of Clinical Medicine. 2015;(43):52-57
pages 52-57 views

THE INFLUENCE OF PHOTOHAEMOTHERAPY ON BLOOD RHEOLOGY IN BRONCHIAL ASTHMA

Paleev F.N., Ostrovskiy E.I., Karandashov V.I., Shatokhina S.N., Sanina N.P., Ryzhkova O.Y., Gorbunova E.M., Paleev N.R.

Abstract

Background: Blood rheology abnormalities are recognized as one of the main pathophysiological components of bronchial asthma. Standard medical treatment of bronchial asthma does not exert any substantial effect on blood fluidity.

 Aim: To assess efficacy of quantum haemotherapy and its influence on blood rheology in the combination treatment of bronchial asthma.

Materials and methods: Four hundred and eighty patients admitted to our in-patient department with mild (44.5%) and severe (55.5%) exacerbations of persistent moderate asthma, were randomized into two groups: the main group (n = 250), which, along with conventional treatment, received photohaemotherapy with blue (PHB, n = 220) or red (PHR, n = 30) light, and the control group (n = 230), which received conventional treatment for two weeks. PHB (light-emitting diode devise “Solaris”) and PHR (helium neon laser) was performed according to the following regimen: duration of a session 30 minutes, number of sessions, from 5 to 7 with in-between intervals of 2 to 3 days. The degree of erythrocyte deformation, relative membrane charge and relative gradient membrane potential of erythrocytes, total erythrocyte counts, hemoglobin levels, hematocrit, and blood viscosity were assessed at days 1 and 14, as well as after 3 months.

Results: At day 14, the relative gradient membrane potential of erythrocytes decreased to 0.118 ± 0.01 r.u. in the PHB group, to 0.167 ± 0.01 r.u. in the PHR group, and to 0.153 ± 0.01 r.u. in the conventional treatment group. The relative charge of erythrocyte membranes increased to 0.202 ± 0.07, 0.19 ± 0.07 and 0.14 ± 0.07 r.u., the degree of erythrocyte deformation decreased to 1.4 ± 0.1, 1.6 ± 0.1 and 1.9 ± 0.1 scores, the degree of hypoxic anisotropy of the serum decreased to 0.8, 0.9 and 1.2 scores, respectively (in all cases, p < 0.05 for comparison with baseline values). However, a significant difference of all parameters from the normal range persisted (p < 0.001). No significant changes of hemoglobin and total erythrocyte counts were observed during the whole follow up period. At the end of the photohaemotherapy course, blood viscosity in the PHB group decreased to 4.55 ± 0.11 mPa·s (from the baseline value of 5.04 ± 0.13 mPa·s, p < 0.05), and was close to normal range (4.5 ± 0.3 mPa·s). In the conventionally treated group, blood viscosity was not changed (5.41 ± 0.11 mPa·s before treatment and 5.39 ± 0.12 mPa·s thereafter, p > 0.05). At month 3, all patients, despite their clinical well-being, demonstrated a deterioration of the parameters studies. However, only in the conventionally treated group the degree of this deterioration was compatible with parameters registered during an asthma exacerbation.

Conclusion: Blood rheology parameters demonstrated a more rapid and advanced improvement in patients with exacerbations of bronchial asthma, who were treated with the use of photohaemotherapy, compared to those who received conventional treatment only.

Almanac of Clinical Medicine. 2015;(43):58-65
pages 58-65 views

COMPARISON OF THE RESULTS OF BLOOD GLUCOSE SELFMONITORING AND CONTINUOUS GLUCOSE MONITORING IN PREGNANT WOMEN WITH PREVIOUS DIABETES MELLITUS

Dreval' A.V., Shestakova T.P., Turkay M., Dreval' O.A., Kulikov D.A., Medvedev O.S.

Abstract

Background: Pregnancy is one of the indications for continuous glucose monitoring (CGM). The data on its efficiency in pregnant women are contradictory.

Aim: To compare the results of blood glucose self-monitoring (SMBG) and CGM in pregnant women with previous diabetes mellitus.

Materials and methods: We performed a cross-sectional comparative study of glycemia in 18 pregnant women with previous type 1 (87.8% of patients) and type 2 diabetes (22.2% of patients) with various degrees of glycemic control. Their age was 27.7 ± 4.9 year. At study entry, the patients were at 17.2 ± 6.1 weeks of gestation. CGM and SMBG were performed in and by all patients for the duration of 5.4 ± 1.5 days. Depending on their HbA1c levels, all patients were divided into two groups: group 1 – 12 women with the HbA1c above the target (8.5 ± 1%), and group 2 – 6 women with the HbA1c levels within the target (5.6 ± 0.3%).

Results: According to SMBG results, women from group 2 had above-the-target glycemia levels before breakfast, at 1 hour after breakfast and at bedtime: 6.2 ± 1.6, 8.7 ± 2.1, and 5.7 ± 1.9 mmol/L, respectively. According to CGM, patients from group 1 had higher postprandial glycemia than those from group 2 (8.0 ± 2.1 and 6.9 ± 1.8 mmol/L, respectively, p = 0.03). The analysis of glycemia during the day time revealed significant difference between the groups only at 1 hour after dinner (7.1 ± 1.4 mmol/L in group 1 and 5.8 ± 0.9 mmol/L in group 2, р = 0.041) and the difference was close to significant before lunch (6.0 ± 2.2 mmol/L in group 1 and 4.8 ± 1.0 mmol/L in group 2, р = 0.053). Comparison of SMBG and CGM results demonstrated significant difference only at one timepoint (at 1 hour after lunch) and only in group 1: median glycemia was 7.4 [6.9; 8.1] mmol/L by SMBG and 6 [5.4; 6.6] mmol/L by CGM measurement (р = 0.001). Lower median values by CGM measurement could be explained by averaging of three successive measurements carried out in the period of rapid changes of glycemia.

Conclusion: The achievement of control of diabetes by HbA1c doesn't necessarily reflect current achievement of the target glycemic levels. As long as there was no significant difference in glycemia measured by SMBG and CGM, we conclude that CGM doesn't have any advantage over routine frequent SMBG in pregnant women.

Almanac of Clinical Medicine. 2015;(43):66-71
pages 66-71 views

REVIEW ARTICLE

СONGENITAL ABNORMALITIES OF THE INFERIOR VENA CAVA AND ITS TRIBUTARIES: THEIR RADIOLOGICAL DIAGNOSIS AND CLINICAL SIGNIFICANCE

Mel'nichenko Z.S., Vishnyakova M.V., Vishnyakova M.V., Volkova Y.N., Goryachev S.V.

Abstract

Abnormalities of the inferior vena cava (IVC) and its tributaries are a very rare congenital defect with an incidence of 0.6 to 3% and a wide variety of anatomical variants. In most cases, it is an accidental diagnostic finding in patients undergoing examination for other pathologies. Not infrequently, the anatomic IVC variants are ignored at the stage of exploratory diagnostic assessment due to their rarity, difficulties of identification and perhaps insufficient awareness of a radiologist in this field. It is known that some IVC abnormalities are associated with certain symptoms, and others could be a predictor of deep vein thrombosis. The information on characteristics of the IVC anatomical structure is necessary during interventional manipulation on the retroperitoneal organs and vasculature, because the presence of an atypically located vessel can lead to significant variations in the surgery protocol and potential intraoperative complications. The problems of embryogenesis, classification, variant anatomy, clinical significance and diagnostics of various abnormalities of IVC and its tributaries are discussed in this review.

Almanac of Clinical Medicine. 2015;(43):72-81
pages 72-81 views

ENDOVASCULAR TREATMENT FOR DISORDERS OF THE VENOUS SYSTEM

Osiev A.G., Vishnyakova M.V., Gegenava B.B.

Abstract

The annual rate of deep vein thrombosis in general population is from 5 to 9 cases per 10 000, whereas for venous thromboembolism (deep vein thrombosis and pulmonary embolism taken together) amounts to 14 cases per 10 000. To improve longterm results of therapy for thrombosis of deep veins of the lower extremities, it is important to restore venous function and outflow. Anticoagulant therapy with low weight or non-fractionated heparin preparations remains the most widely used method of management. However, total or partial thrombosis resolution under anticoagulant treatment is achieved only in 4 and 14% of cases, respectively. Thrombolysis allows for early resorption of the thrombus by means of a minimally invasive procedure with lower risk of complication. After the venous flow is restored, the aim of treatment is to prevent damage to the venous valves, venous hypertension and repeated thrombosis with development of the post-thrombotic syndrome. Compared to anticoagulation, systemic thrombolysis has the benefit of more rapid clot resorption and less damage to the venous valve. One of its serious limitations is a high bleeding risk related to higher doses of the drug administered through a peripheral vein catheter. Therefore, selective intra-clot administration of thombolytics (direct catheter thrombolysis) has been suggested as an alternative. For more effective therapy with the use of lower doses of thrombolytics, the so called pharmaco-mechanical thrombectomy has been developed. Venous stenosis hindering the venous outflow is frequently seen after direct catheter or pharmaco-mechanical thrombolysis. Angioplasty with stent placement is recommended in the cases with residual venous abnormality after successful thrombolysis and thrombectomy. 

Almanac of Clinical Medicine. 2015;(43):82-89
pages 82-89 views

SYSTEMIC SCLEROSIS AND OSTEOPOROSIS

Alekperov R.T., Toroptsova N.V.

Abstract

Systemic sclerosis is an autoimmune inflammatory disease of connective tissue with multi-syndrome clinical manifestations. Skeletal damage is considered to be one of significant contributors to the quality of life of these patients. The purpose of this review was to assess the prevalence of osteoporosis and associated fractures in systemic sclerosis. We performed a search in Medline database by the following key words: “systemic sclerosis”, “bone mineral density” and “osteoporosis”. From 118 publications we selected for further analysis 18 papers which contained comparisons of bone mineral density in patients with systemic sclerosis and in control groups of healthy subjects or in patients with other rheumatic disorders. These trials showed various proportions of systemic sclerosis patients with decreased bone mineral density in the range of 32 to 77%. Osteoporosis was found in 22 to 60% women with systemic sclerosis which was significantly more frequent that in healthy age-matched women (from 8 to 23%). The rates of osteoporotic fractures in patients with systemic sclerosis, according to data given by various authors, were in the range of 2 to 38%, being higher than in healthy controls (from 2 to 10%). In the majority of publications, there was an association of osteoporosis with conventional risk factors, and in some studies there was an association of osteoporosis with clinical characteristics of systemic sclerosis. The studies were performed in relatively small patient groups and their results vary widely. Further studies are necessary to elucidate the mechanisms of osteoporosis and improve its treatment and prevention in patients with systemic sclerosis.

Almanac of Clinical Medicine. 2015;(43):90-99
pages 90-99 views

CLINICAL CASES

RARE NON-TUMOR DISEASES OF THE PHARYNX AND LARYNX

Stepanova E.A., Vishnyakova M.V., Mustafaev D.M., Akhtyamov D.V., Gaganov L.E.

Abstract

A number of inflammatory systemic and non-systemic pharyngel and laryngeal diseases may clinically imitate a tumor. In these cases, computed tomography provides rapid assessment and significant additional information to that obtained from endoscopy. We present 4 clinical observations with certain common features. These are a suspicion of a neoplasm and absence of typical computed tomography symptoms characteristic of tumor lesions. IgG4-related systemic disease, rheumatoid arthritis, amyloidosis, and actinomycosis are rare disorders, however, they should be considered in the differential diagnosis. In this context, the knowledge of the radiation diagnostic characteristics of these rare nosologies will be useful for a practitioner.

Almanac of Clinical Medicine. 2015;(43):100-108
pages 100-108 views

COMPLEX RADIOLOGICAL DIAGNOSIS OF COMPLICATED WILMS' TUMOR

Vishnyakova M.V., Stepanova E.A., Denisova L.B., Vishnyakova M.V., Sobolevskiy A.B.

Abstract

Wilms' tumor is the most common primary malignant renal tumor. It is paradigm for comprehensive treatment of malignant solid tumors in children. Typically, children with this disorder are initially seen with abdominal distention, palpable masses or due to fever of unknown origin. Atypical tumor symptoms can be caused by complications, making it difficult to diagnose the disease. We present three clinical cases of Wilms' tumor in young children. Emergency multidetector computed tomography and magnetic resonance imaging provided the surgeon with sufficient information to perform an urgent radical resection.

Almanac of Clinical Medicine. 2015;(43):109-114
pages 109-114 views

A CASE OF RADIOLOGICAL DIAGNOSIS OF EPITHELIOID HEMANGIOENDOTHELIOMA OF THE RIGHT ATRIUM

Vishnyakova M.V., Chermenskiy G.V., Pronina V.P., Vishnyakova M.V., Martakov M.A., Gaganov L.E.

Abstract

We present a case of a very rare heart tumor, a primary epithelioid hemangioendothelioma with secondary pulmonary metastases. Despite of the expanded diagnostic possibilities of current radiological diagnosis procedures, the final diagnosis in such patients is made only after histological examination and immunohistochemistry.

Almanac of Clinical Medicine. 2015;(43):115-119
pages 115-119 views

A RARE LUNG MALIGNANCY IN A 3-YEAR-OLD CHILD

Stashuk G.A., Pykhteev D.A., Kazantseva I.A., Khromova A.S., Shpak O.S.

Abstract

Pleuropulmonary blastoma is a rare primary malignant tumor originating from lungs and/or pleura. It is more frequent in young children and differs from other lung neoplasms by a number of histopathological particulars. We present a clinical case of such tumor in a 3-year-old child. Initially, the disease was diagnosed as pleuropneumonia, however, computed tomography revealed a tumor originating from mediastinum. Current data indicates that diagnostics of pleuropulmonary blastoms is difficult even with the use of a full range of radiation assessment methods and participation of qualified specialists.

Almanac of Clinical Medicine. 2015;(43):120-126
pages 120-126 views

CONGENITAL ADENOMATOID LUNG TYPE 1 MALFORMATION IN A NEWBORN

Stashuk G.A., Vishnyakova M.V., Shcherbina V.I., Zakharova M.O.

Abstract

We present a case of cystic adenomatoid lung malformation in a newborn. Radiation diagnostics methods and surgical intervention of this congenital lung abnormalities are described, including prenatal ultrasound examination of the fetus and antenatal X-ray diagnostics and computed tomography.

Almanac of Clinical Medicine. 2015;(43):127-130
pages 127-130 views

PATHOLOGICAL FRACTURE OF THE SPINE IN A PATIENT WITH ANKYLOSING SPONDYLITIS: DIFFICULTIES OF RADIOLOGICAL DIAGNOSIS

Sherman L.A., Bunak M.S., Biktimirov R.G.

Abstract

We present a clinical observation of a pathological fracture of the spine in a patient with ankylosing spondylitis (Bechterew's disease). The results of a comprehensive radiological assessment (X-ray, multidetector computed tomography, magnetic resonance imaging), which enabled the differential diagnosis with a tumor and inflammatory processes and to determine a management strategy.

Almanac of Clinical Medicine. 2015;(43):131-135
pages 131-135 views

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