Abstract:

Aim: was to estimate the diagnostic performance of inferior petrosal sinus blood sampling with Desmopressin stimulation in patients with ACTH-dependent Cushing's syndrome.

Materials and Methods: all enrolled patients had clinically evident and biochemically proven ACTH-dependent Cushing's syndrome. The inclusion criteria was as follows: the absence of pituitary adenoma on MRI, pituitary adenoma less than 6 mm and/or negative high dose (8mg) dexamethasone suppression test or unsuccessful neurosurgery when the histological material was not informative. A petrosal sinus to peripheral ACTH gradient of at least 2,0 at baseline or at least 3 after Desmopressin administration suggested a pituitary source of ACTH. Plasma ACTH was measured by automated electrochemiluminescence immunoassay (F. Hoffmann-La Roche Ltd (Cobas e601).

Results: 117 patients were included in the present study (86 females (73,5%) and 31 (26,5%) males with a median age of 34 years (Q25-Q75 26-49 years). The youngest patient was 17 years old and the oldest 66 years old. The median of 24h urinary free cortisol was 2148 (1268-4129) nmol/24 hours; the morning plasma ACTH level -105,8 (67,7-150,8) ng/ml; late-night ACTH - 83,6 (51,8-126,2) ng/ml. A final histological diagnosis was available only in 110 patients (94 patients with Cushing's disease and 16 cases of ACTH-ectopic Cushing's syndrome). Only the data of patients with histological proven diagnosis was included in the final analysis. The sensitivity of bilateral inferior petrosal sinus blood sampling with Desmopressin stimulation was found to be 90,4% (95% DI 82,8-94,9), and the specificity- 93,7% (95% DI 71,7 - 98,9). The area under the curve (when the ratios before and after Desmopressin administration were analyzed) was 0,940 (95% DI 0, 893-0,988). The median duration of the procedure was 60 minutes and the median X-Ray dose was 4,7 mSv In general, the manipulation was well tolerated.

Conclusion: bilateral inferior petrosal sinus blood sampling with Desmopressin administration demonstrated the high values of sensitivity and specificity.

Article exists only in Russian.

Article exists only in Russian.

Abstract:

Aim: was to evaluate morphological features of lesions in lower limb arteries before percutaneous transluminal angioplasty (PTA) and its arterial complications in patients with critical lower limb ischemia (CLI) combined with diabetes mellitus(DM).

Materials and methods: for the period from September 2010 to June 2013, a prospective single-center study was conducted involving 171 patients with CLI and DM (80(47%) men, mean age 64,1[54-68] years, mean HbA1c 8,3[7,4-9,6]%, mean duration of diabetes 16,5[8-23] years, diabetes type 1/2-18/153) who underwent PTA in 193 lower limbs. Myocardial infarction and brain stroke in anamnesis had 53(31%) and 19(11%) patients, respectively Chronic kidney disease (CKD) 3-4 stages had 40 patients(24%), end-stage renal disease - 16 cases (10%). Diagnosis of CLI was based on recommendation of TASC II. Patency of arteries of lower limbs was evaluated by duplex ultrasound (DU) before PTA and during early follow-up period (30 days). PTA in all patients was considered technically successful in restoring continuous arterial flow to the foot of at least one crural artery without residual stenosis >50%.

Results: stenosis>50% and occlusions of tibial arteries were found in all patients. Peripheral arterial disease 4-6 classes according Graziani L. classification was marked in 180(93%) cases. Extensive tibial arterial calcification was found in 123(64%) cases, in patients with residual stenosis (> 50% remaining diameter) -113 (89%). The mean value of transcutaneous oxygen pressure (tcpO2) before PTA was 14,7(8-25) mmHg, after PTA - 35,2 (31-38) mmHg. After PTA , residual stenosis (>50%) in treated arteries was in 125(79,1%) cases, thrombosis in treated arteries - 9(5,7%), intimal dissection - 18(11,4%), incomplete stent disclosure - 3(1,9%), incomplete capture stent area stenosis - 2(1,3%), dislocation of the stent - 1(0,6%). Repeat PTA in the early follow-up period was performed in 15 patients with clinically significant complications (6%).

Conclusion: CLI in diabetic patients is characterized by having severe morphological lesions of lower limb arteries, infrapopliteal arterial calcification. DU plays important role in evaluation of arterial patency and PTA complications in early follow-up period. The high level of residual stenosis of tibial arteries after PTA is associated with chronic complications of diabetes mellitus, including renal insufficiency Timely reintervention in diabetic patients with clinical significant PTA complications promotes optimal arterial patency and permission of CLI in theese cases. 

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