Umbilical blood is a source of hemopoietic stem cells for transplantation

AIM: To develop and introduce into practice scientifically validated methods of collection, testing and storage of hemopoietic stem cells of umbilical blood (UB) for non-relative transplantations. MATERIAL AND METHODS: UB and UB concentrate of 1004 mature newborns were studied with morphological, immunocytometric and cultural methods. RESULTS: The established reference values of the number of leukocytes and hemopoietic stem cells (HSC) are essential for examination whether UB is useable for production of the transplantation material. Obtained with the procedure of UB concentration based on sedimentation of erythrocytes due to hydroxyethylstarch, transplantation material has volume 20.0 ml, contains 39.0 +/- 0.48 x 10(6)/ml leucocytes and 1.37 +/- 0.029% CD34+cells and does not differ from umbilical blood by percentage of basic subpopulations of leucocytes and HSC. Assessment of efficacy of leucoconcentration procedure in different pregnancy courses, delivery and technological stages of UB collection gives grounds to consider the methods optimal for use in UB bank, while testing is thought adequate for examination of the material for transplantation fitness. CONCLUSION: Introduction of the study results into practice optimizes the work of stem cell banks and allows production of effective transplantation material.     

Acute porphyrias: problem of primary diagnosis in Russia and CIS countries

AIM: To analyse manifestations and experience in primary screening diagnosis of acute porphyrias which are rarely encountered and little known by general practitioners. MATERIAL AND METHODS: The data on 100 patients with the diagnosis acute porphyria have been analysed. Porphyrin metabolism in differential diagnosis was estimated according to standard techniques. RESULTS: Analysis of primary diagnosis of acute porphyria hepatica in Russia (region-related prevalence, duration of diagnosis, complications because of late pathogenetic treatment) demonstrates the importance of screening diagnosis of acute porphyria at the level of municipal clinics. CONCLUSION: Early diagnosis prevents severe complications of acute porphyria and reduces cost of examinations in search of accurate diagnosis.     

Informative value of orthogonal electrocardiogram in the diagnosis of the left ventricular hypertrophy

AIM: To estimate the informative value of orthogonal ECG parameters for the diagnosis of left ventricular hypertrophy (LVH). MATERIALS AND METHODS: The study comprised 142 apparently healthy individuals and 125 patients with arterial hypertension (AH) and LVH (left ventricular mass index more than 125 g/m2 for males and more than 110 g/m2 for females). Characteristic curves (ROC curves) were used to describe and compare the informative value of vectorcardiographic, demapping criteria for L VH with the informavalue of the Sokolov-Lyons criterion, the Cornelian index, and the Cornelian product. RESULTS: The informative indices of orthogonal ECG were Rx + Sz and IADIM: the area under the ROC curve was 0.89 +/- 0.02 and 0.88 +/- 0.02, respectively, which was significantly higher than with the Sokolov-Lyons criterion (0.64 +/- 0.04; p < 0.05) and similar to the Cornelian product (0.84 +/- 0.03). Of great informative value is the angle phi (area under the ROC curve was 0.88 +/- 0.04) in males and the area of QRS loop in the horizontal plane (area under the ROC curve was 0.89 +/- 0.03) in females. With 96% specificity, the male sensitivity of IADIM was 80%, Rx + Sz--73%, which was significantly higher than that of the Cornelian index (56%; p < 0.05) and the Sokolov-Lyons criterion (27%; p < 0.05). With 96% specificity, the female sensitivity of IADIM was 73%, Rx + Sz--84%, SQRSxz--70%, which was significantly higher than that of the Cornelian index (49%; p < 0.05), the Cornelian product (55%; p < 0.05), and the Sokolov-Lyons criterion (30%; p < 0.05). CONCLUSION: The threshold values of the most informative indices of orthogonal ECG are presented, which could provide the optimum sensitivity-specificity ratios. These values allow cardiac lesions to be detected in hypertensive patients with normal 12-lead ECG.     

Routine and new risk factors for cardiovascular diseases in patients with ankylosing spondylitis (Bechterev's disease)

AIM: Analysis of standard and new risk factors (RF) to develop cardiovascular diseases (CVD) in patients with ankylosing spondylitis (AS). MATERIAL AND METHODS: Examination of 96 patients with a documented diagnosis of AS has detected symptoms of CVD (arterial hypertension--AH, ischemic heart disease -IHD) and conventional CVD RF (smoking, hyper- and dyslipidemia, overweight, hereditary predisposition, diabetes mellitus). The SCORE scale assessed the risk of CVD complications within 10 years of ischemic heart disease. The following RF were also studied: the levels of C-reactive protein, fibrinogen, platelets, von Willebrand factor activity, total fibrinolytic plasma activity, left ventricular hypertrophy (LVH) according to echocardiography, intima-media complex thickness of the common carotid artery by USI. RESULTS: Prevalence of AH in the examinees (34.4%), IHD (4.2%) was within population values. Total risk for IHD calculated with consideration of conventional RF in AS patients (6.3 +/- 5.0%) did not differ much from mean populational (6.8 +/- 4.4%) while in the absence of hypertension it was lower (4.1 +/- 2.5 and 5.4 +/- 3.5%, respectively, p < 0.05). The risk for lethal CVD complications proved not high (1.46 +/- 1.34%). However, AS patients have high risk for thrombosis due to elevated levels of prothrombogenic factors (fibrinogen, von Willebrand factor, platelets) and subnormal fibrinolytic blood activity. AS patients also demonstrate frequent LVH (overall 51% and 42.9% in normotensive AS patients). CONCLUSION: Higher risk of CVD death in AS patients than in general population may be caused by additional RF missed at conventional stratification.     

Assessment of a hypnotic component on the basis of BIS monitoring during balanced anesthesia in children

The hypnotic components of balanced anesthesia under regional anesthesia were estimated in 60 children during operations on the limbs and urogenital area. BIS monitoring was to assess the grade of sedation. Analysis of the findings showed that balanced anesthesia could ensure an adequate and stable anesthesia throughout the surgical intervention. The optimal BIS index for moderate sedation was 40-60 units. Among all the types of balanced anesthesia, sevoflurane-based anesthesia was most effective.     

Stress echocardiography with the use of impulse wave tissue Doppler technology in diagnosis and quantitative evaluation of concealed myocardial ischemia

AIM: To elucidate the role of the use of impulse-wave tissue doppler technology during stress echocardiography with transesophageal atrial pacing for diagnosis and evaluation of concealed myocardial ischemia. MATERIAL: Patients (n=82, 72 men, 10 women, mean age 43+/-10 years) with syndrome of cardiac pain of obscure etiology. METHODS: Regional contractility of left ventricular wall was studied through apical approach with the use of 12-segment model. Peak systolic velocity of myocardial segments (S, cm/s), its acceleration (Asl, cm/s(2)), duration of period of preejection (PEP, ms) and isovolumic relaxation time (IVRT, ms) of each segment were calculated at rest, and during subthreshold and threshold pacing. RESULTS: Concealed myocardial ischemia was revealed by stress echo in 44 patients. Total number of analyzed segments was 984 and parameters of impulse-wave tissue doppler could be measured in 959 (97%) segments. At peak pacing rate during stress test 789 (82%) segments were normokinetic, 142 (15%) - hypokinetic, 20 (2%) - akinetic, and 8 (1%) - dyskinetic. Absence of increase or decrease of S and prolongation of PEP by 10% or more from baseline during stress test were found to be predictors of myocardial ischemia (sensitivity 35 and 75%, respectively, specificity 37 and 81%, respectively), and criteria of objectification of zones of left ventricular wall with impaired contractility (sensitivity 51 and 75%, respectively, specificity 52 and 76%, respectively). During stress echocardiography only dynamics of myocardial IVRT reflected the state of regional left ventricular diastolic function. CONCLUSION: Stress echocardiography with transesophageal atrial pacing combined with impulse-wave tissue doppler imaging is a highly informative method of diagnosis and quantitative assessment of concealed myocardial ischemia.