Methods of the endoscopic endonasal transsphenoidal adenomectomy

This paper provides the practical part of a procedure for endoscopic endonasal transsphenoidal resection of pituitary tumors. The authors have presently gained experience with about 400 endoscopic endonasal transsphenoidal operations. The advantages of endoscopic surgery include the wide vision field of an operative site under good illumination. The endoscopic intervention provides a possibility of extracting not only endo-, but also paracellular portions of a tumor under direct visual control, which can be rarely done during a standard microscopic transnasal operation. The paper gives recommendations on the equipment of an operating suite and anesthetic maintenance. It also describes surgical stages and postoperative management of patients.     

The leptomeningeal form of primary neuroectodermal tumor

Brain neoplasms as primary leptomeningeal forms are rare, particularly if the case in point is primary neuroectodermal tumors (PNET). In the literature, there are only few reports on this topic. The authors describe one of such rare cases. A 21-years-old man was admitted to a hospital for complaints about headache. Brain computed tomography and magnetic resonance imaging (MRI) revealed internal hydrocephalus and slightly uniform meningeal thickening without the signs of space-occupying lesions. Ten months after ventriculoperitoneostomy, the patient suddenly developed tetraparesis and respiratory disorders. MRI showed a pronounced diffuse non-uniform leptomeningeal dissemination of a tumor. Open biopsy of the lesion in the projection of the right fissure detected PNET. The patient underwent a course of chemotherapy (CCNU, vincristine) and radiotherapy (total focal dose 45 Gy). Control MRI could not identify a pathological leptomeningeal signal.     

The role of genetic factors in development of atrial fibrillation

The review is devoted to problems of pathogenesis of atrial fibrillation and role of genetic factors in its development. Significance of genetic factors for origination of atrial fibrillation has been proved by aggregation of the disease in families. This review contains consideration of main candidate genes possibly related to development of the disease and detailed contemplation of value of polymorphisms of potassium and other ion channels. Data on candidate genes common for arterial hypertension and atrial fibrillation which encode components of renin-angiotensin system, NO-synthase, beta-adrenoreceptors are also presented. Probable role of genes encoding components of synthesis and transport of lipids, markers and mediators of inflammation is considered as well.     

About dyslipidemic states characteristic for various forms of ischemic heart disease and cerebrovascular damages

We examined 4 groups of patients younger than 70 years with atherosclerosis of coronary and/or cerebral arteries. In 98 patients the disease began as acute myocardial infarction, 65 patient from the very beginning suffered from angina of effort, 33 had ischemic cerebral stroke, and in 26 dyscirculatory encephalopathy was diagnosed. Among patients with ischemic heart disease (IHD) and cerebrovascular damages (CVD) 87 and 89%, respectively, had dyslipidemia (DLP). Disorders of lipid composition of the blood with pronounced hypercholesterolemia prevailed in patients with IHD and elevated level of triglycerides or selective decrease of antiatherogenic fraction of lipoproteides - in patients with CVD (especially in patients with stroke). When treatment is prescribed to patients with IHD and CVD at the background of DLP it is necessary to take into consideration DLP variants in order to obtain most effective action of statins and fibrates.     

Autotransplantation of the heart as the method of treatment of congestive heart failure

Congestive heart failure with preserved or moderately lowered left ventricular pump function in some patients is caused by mitral regurgitation. Its consequences are left atrial dilation, pulmonary hypertension, tricuspid regurgitation, thromboembolic complications, disturbances of rhythm with elevated risk of sudden death. As efficacy of drug treatment and electroimpulse therapy is small surgery is the method of choice and one of alternatives - autotransplantation of the heart. Here we present a successful experience of application of this technique in a patient with moderately lowered left ventricular function, extreme degree of mitral and tricuspid regurgitation, atriomegaly, atrial fibrillation, and pronounced manifestations of congestive heart failure.     

Effect of atorvastatin therapy on the level of secretory phospholipase A2 group IIA and on the modification of low density lipoproteins in patients with ischemic heart disease

We studied effect of atorvastatin on secretory phospholipase A2 group IIA (sPLA2-IIA) in blood serum of patients with ischemic heart disease (IHD), lipid composition of low density lipoproteins (LDL) and process of modification of LDL induced by sPLA2-IIA in 20 patients taking 20 mg/day of atorvastatin for 3 months. In patients with initially high level of sPLA2-IIA ( > 8 mcg/l) its concentration significantly decreased. Amount of total cholesterol, triglyceride, lecithin, and lysolecithin remained unchanged, however in equimolar relations there occurred decrease of amount of total cholesterol and increase of cholesterol esters. At incubation of LDL, extracted from patient s plasma before initiation of the study, with human sPLA2-IIA from cardiac myxoma, 3.5 nmol of lysolecithin per 1 mg of LDL protein was formed while at incubation of LDL of same patients, extracted after 3 months of atorvastatin administration, amount of lysolecithin was 1.54 nmol/mg LDL protein. Thus atorvastatin therapy causes lowering of sPLA2-IIA in patients with initially high blood level of the enzyme and to a great extent precludes sPLA2-IIA induced LDL modification.     

Pulmonary hypertension and right ventricular failure. Part XI. Endothelin receptor blockers in the treatment of primary pulmonary arterial hypertension

In a series of articles the authors discuss literature data concerning epidemiology of pulmonary arterial hypertension (PAH), its current classification; peculiarities of its pathogenesis and treatment in various diseases and conditions. In the eleventh communication the authors discuss literature data related to the role of endothelin system in pathogenesis of primary (idiopathic) PAH, as well as PAH associated with diffuse diseases of connective tissue and congenital heart disease. This communication also contains presentation of clinical pharmacology of three available endothelin receptor blockers - bosentan, sitaxsentan, ambrisentan, and analysis of results of randomized controlled trials of efficacy and safety of these agents in patients with idiopathic PAH and PAH associated with diffuse diseases of connective tissue and congenital heart disease.     

Current methods of noninvasive imaging of coronary arteries in the diagnosis of coronary atherosclerosis

The lecture contains: presentation of possibilities of ultrasound and tomographic methods of investigation in visualization of major coronary arteries; consideration in a comparative aspect of main advantages, disadvantages and limitations of these methods in diagnostics of coronary atherosclerosis; analysis of indications for application and perspectives of their use in everyday clinical practice in patients with a diagnosis of possible or verified ischemic heart disease.     

Dynamics of parameters of heart rate variability after radiofrequency ablation in patients with paroxysmal supraventricular tachycardia: holter ECG monitoring data

Changes of parameters of heart rate variability (HRV) in patients with supraventricular tachycardia (SVT) immediately after radiofrequency ablation (RFA) have been demonstrated earlier. However dynamics of HRV parameters after RFA has not been sufficiently studied. For elucidation of dynamics of HRV parameters in patients with SVT after RFA we conducted analysis of HRV basing on data of 24 hour Holter ECG monitoring before RFA, on day 2, in 1 week and 1 month after intervention in 27 patients with paroxysmal SVT. Statistically significant lowering of temporal (SDNNi, RMSSD, NN50, pNN50) and spectral (VLF, LF, HF) HRV parameters were found on day 2 and in 1 week after RFA compared with data obtained before intervention. In 1 month after RFA the studied parameters of HRV did not differ from baseline values. Reversible changes of HRV parameters evidencing for transitory autonomic dysfunction are observed after RFA.