Abstract

Aim: was to evaluate possibilities of puncture biopsy under ultrasound guidance of parasternal lymph nodes in patients with breast cancer.

Material and methods: study included 34 patients with breast cancer. Criteria for inclusion in the study were: primary breast cancer with a central or medial tumor localization, and patients under observation after previously undergoing surgical treatment. All patients underwent an ultrasound examination of the breast and regional zones, including the parasternal lymphatic collector. All patients underwent biopsy.

Results: in total, 39 parasternal lymph nodes suspicious on secondary lesion were detected, of which 17 (43,5%) lymph nodes had a specific lesion, 22 (56,5%) lymph nodes showed cystological signs of hyperplasia according to results of cytological examination. Parasternal lymph nodes metastases were detected in 16 (47,1%) of 34 patients included in our study. In all cases of specific lesion, lymph nodes were rounded, there was a violation of differentiation of anatomical structures, the absence of a central echo complex, a violation of differentiation and thickening of the cortical layer. In the group of primary patients, 3 (27,3%) patients with metastases in parasternal lymph nodes had distant metastases, remaining 8 (72,7%) patients, due to the lesion of the parasternal lymphatic collector, the stage of the disease were adjusted upwards (stage IIIA).

Conclusion: fine-needle aspiration biopsy under ultrasound-guidance in case of suspected secondary lesion of parasternal lymph nodes, can be successfully used to obtain morphological material with minimal traumatic impact, without the use of anesthesia, which will more adequately assess the state of parasternal lymph nodes at the preoperative stage, correctly set the stage of the disease and prescribe the appropriate treatment.

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Abstract:

According to newest clinical studies, 20%-30% of acute coronary syndrome patients without БТ elevation have nonsignificant coronary artery stenosis

Aim: was to estimate the effectiveness of percutaneous intermittent coronary sinus occlusior (ICSO) in acute coronary syndrome patients without БТ elevation and nonsignificant coronary arteries stenosis.

Materials and methods: results of endovascular treatment of patients with acute coronary syndrome patients without БТ elevation, for the period 09.10.2014-02.02.2015 were analyzed. All patients underwent ICSO for 10-13 minutes until intravenous wedge pressure plateau was achieved.

Results: in the beginning of the intervention all patients had nonsignificant coronary arteries stenosis, peripheral coronary angiospasm and slow flow in left anterior descending arteries (LAD): Т1М1 frame count in LAD (TFCLAD) was 85,9±17,6 frm; distal diameter of LAD (DLAD) was 2,1±0,5 mm; quantitative blush evaluation score in LAD (QuBELAD) was 11,8±1,4. After the ICSO procedure coronary hemodynamic was improved: TFCLAD=59,5±9,8 frm; DLAD=2,5±0,4 mm; QuBELAD= 27,4±2,2; p=0,01).

Conclusion: ICSO procedure led to the both improvement of the antegrade blood flow in LAD anc myocardial blush flow and reduction of the peripheral coronary angiospasm. ICSO procedure significantly improved the electrocardiography and clinical conditions. 

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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.

Abstract:

Aim. To compare safety and efficiency of drug-eluting stents (DES) and bare metal stents (BMS) implantation for coronary artery disease (CAD).

Materials and methods. 230 patients with CAD were divided in 2 groups: patients in group 1 received DES; in group 2 we performed BMS implantation.

Results. Long-term results (over 12 months follow-up) of DES primary implantation reduces risk of the angiographic restenosis by 15% compared to BMS (р < 0,001).

Conclusions. Notwithstanding low basic risk of restenosis, DES demonstrate no statistically significant advantages in MACE rate. It is also shown that DES implantation is associated with higher mortality and greater risk of non-cardiac complications, related to prolonged antiplatelet therapy. Thus, decision of DES implantation should be made in consideration of the patients' tolerance for double antiplatelet therapy, risk of bleeding, possible elective surgery, as well as any pre-procedure immune system disturbances. 

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2.    Van der Giessen W.J., Lincoff A.M., Schwartz R.S.  et al.  Marked inflammatory sequel to implantation of biodegradable and nonbiode-gradable polymers in porcine coronary arteries. Circulation. 1996; 94: 1690-1697.

3.    Бокерия Л.А., Алекян Б.Г., Голухова Е.З. и др. Применение стентов с лекарственным антипролиферативным покрытием в лечении больных ишемической болезнью сердца. Креативная кардиология. 2007; 1:193-198.

4.    Befeyter PJ. Percutaneous coronary intervention for unstable coronary artery disease. Text-book of interventional cardiology, 4th ed. by Topol E. Philadelphia. W.B. Saunders Company. 2003: 183-199.

5.    Bauters C., Lablanche J.M., McFadden E.P. et al. Clinical characteristics and angiographic follow-up of patients undergoing early or late repeat dilation for a first restenosis. J. Am. Coll. Cardiol. 1992; 20: 845-848.

6.    Бабунашвили А.М., Юдин И.Е., Дундуа Д.П. и др. Стенты с лекарственным покрытием при лечении диффузных атеросклеротиче-ских поражений коронарных артерий. Актуальные вопросы болезней сердца и сосудов. 2007; 4: 57-63.

7.    Waters R.E. 3 cases following DES for in-stent-restenosis (at 16, 20, 43 mo) - shortly after interruption of antiplatelet Tx. Catheter. Car-diovasc. Interv. 2005; 4: 107-115.

8.    PeterJ., Fitzgerald S. etal. Is angiographic late loss still a worthwhile surrogate endpoint in DES trials? Circulation. 2006; 54: 237-291.

Multivessel stenting in primary percutaneous coronary intervention and staged revascularization for st-elevation myocardial infarction patients with second generation drug eluting stents resolute integrity