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Lipnitsky E.M.,Nv Sklifossovsky Institute Of Emergency Medical Aid | Galperin E.I.,Nv Sklifossovsky Institute Of Emergency Medical Aid | Kotovsky A.E.,Nv Sklifossovsky Institute Of Emergency Medical Aid | Chzhao A.V.,Moscow Medical Academy | And 2 more authors.
Vestnik Rossiiskoi Akademii Meditsinskikh Nauk

The article providing in-depth analysis of pathogenesis of obstructive jaundice shows that this disease is manifest not only as changes at the hepatic level (cholestasis, cholehemia, cholangitis, cholangio- and lymphovenous shunts, hepatic encephalopathy) but also as marked dysbiotic disturbances due to anacholia and toxic metabolites that cause bacterial translocation and endotoxemia complicating liver insufficiency. Based on the literary data and original observations, a new scheme for the treatment of obstructive jaundice is proposed including simultaneous correction of both components of hepatoenteric turnover; also, it permits to improve the outcome of the postoperative period. Source

Vinokurova L.V.,Central Research Institute of Gastroenterology | Dubtsova E.A.,Central Research Institute of Gastroenterology | Yashina N.I.,Av Vishnevsky Institute Of Surgery | Shulyatyev I.S.,Central Research Institute of Gastroenterology | Osipenko Yu.V.,Central Research Institute of Gastroenterology
Terapevticheskii Arkhiv

Shwachman-Diamond syndrome is an inherited autosomal recessive disease that appears as exocrine pancreatic insufficiency, neutropenia, impaired neutrophil Chemotaxis, aplastic anemia, thrombocytopenia, metaphyseal dysplasia, and physical retardation. Its worldwide prevalence is 1:10,000 to 1:20,000 live births depending on the region. The SBDS gene and a few mutations, which lead to this syndrome, have been found in the past decade. The paper describes a case of this rare disease in a 28-year-old male patient who has all characteristic manifestations as lipomatosis and severe exocrine pancreatic insufficiency, neutropenia with bone marrow hypoplasia, physical retardation, glucose intolerance, secondary osteopenia, and minor cardiac anomalies. Its clinical diagnosis was verified by molecular genetic testing. Source

Trunecka P.,Institute for Clinical and Experimental Medicine | Klempnauer J.,Hannover Medical School | Bechstein W.O.,Goethe University Frankfurt | Pirenne J.,University Hospitals Leuven | And 9 more authors.
American Journal of Transplantation

DIAMOND: multicenter, 24-week, randomized trial investigating the effect of different once-daily, prolonged-release tacrolimus dosing regimens on renal function after de novo liver transplantation. Arm 1: prolonged-release tacrolimus (initial dose 0.2mg/kg/day); Arm 2: prolonged-release tacrolimus (0.15-0.175mg/kg/day) plus basiliximab; Arm 3: prolonged-release tacrolimus (0.2mg/kg/day delayed until Day 5) plus basiliximab. All patients received MMF plus a bolus of corticosteroid (no maintenance steroids). Primary endpoint: eGFR (MDRD4) at Week 24. Secondary endpoints: composite efficacy failure, BCAR and AEs. Baseline characteristics were comparable. Tacrolimus trough levels were readily achieved posttransplant; initially lower in Arm 2 versus 1 with delayed initiation in Arm 3. eGFR (MDRD4) was higher in Arms 2 and 3 versus 1 (p-=-0.001, p-=-0.047). Kaplan-Meier estimates of composite efficacy failure-free survival were 72.0%, 77.6%, 73.9% in Arms 1-3. BCAR incidence was significantly lower in Arm 2 versus 1 and 3 (p-=-0.016, p-=-0.039). AEs were comparable. Prolonged-release tacrolimus (0.15-0.175mg/kg/day) immediately posttransplant plus basiliximab and MMF (without maintenance corticosteroids) was associated with lower tacrolimus exposure, and significantly reduced renal function impairment and BCAR incidence versus prolonged-release tacrolimus (0.2mg/kg/day) administered immediately posttransplant. Delayed higher-dose prolonged-release tacrolimus initiation significantly reduced renal function impairment compared with immediate posttransplant administration, but BCAR incidence was comparable. The DIAMOND study demonstrates that an initial lower dose or a delayed higher dose of prolonged-release tacrolimus significantly reduces renal function impairment versus a higher initial dose of prolonged-release tacrolimus administered immediately posttransplant, over 24 weeks of treatment in de novo liver transplant recipients. © 2015 The Authors. American Journal of Transplantation published by Wiley Periodicals Inc. Source

Efremova Yu.E.,Russian Cardiology Research and Production Complex | Andreyeva E.R.,Russian Cardiology Research and Production Complex | Soboleva G.N.,Russian Cardiology Research and Production Complex | Radyukhina N.V.,Russian Cardiology Research and Production Complex | And 3 more authors.
Arkhiv Patologii

The investigation was undertaken to study the accumulation of the photosensitizer Photosens in arterial atherosclerotic plaques and to immunohistochemically identify cellular elements in them. Specimens were obtained during carotid endarterectomy. The preferential accumulation of Photosens occurred in the plaque areas containing the largest number of cells, such as macrophages and lymphocytes. The photosensitizer accumulated to a greater extent in the unstable plaques than in the stable ones, which seems to be associated with the more marked infiltration of unstable plaques by the cells involved in the inflammatory reaction. Source

Pokrovskii A.V.,Av Vishnevsky Institute Of Surgery
Angiologii{combining double inverted breve}a i sosudistai{combining double inverted breve}a khirurgii{combining double inverted breve}a = Angiology and vascular surgery

to study remote results of surgical treatment of patients presenting with a pathological deformity of the internal carotid artery. the study was based on retrospectively analysing the findings of examination and the outcomes of surgical treatment of 142 patients presenting with an isolated pathological deformity of the internal carotid artery (ICA), who underwent a total of 166 reconstructive operations. 7% of patients were operated on at the asymptomatic stage, more than half (56%) of the patients were found to have transient (21%) or persistent neurological deficit (35%), 37% of patients had stage III cerebrovascular insufficiency. Twenty-five (15%) operations were performed for C- and S-shape tortuosity, ninety-seven (58%) procedures for kinking of the internal carotid artery, and forty-four (27%) interventions for coiling. The operation of choice was resection with redressation of the internal carotid artery and reimplantation into the old ostium (74%). Analysing the results of surgical treatment showed its high neurological efficiency in prevention of cerebral circulation impairments (93% of patients at terms up to 25 years had no such complications), as well as clinical efficacy (relief of cerebrovascular insufficiency symptoms in 91.1% of patients). The effect obtained appeared to preserve during 2 and 5 years in 96% and 92% of patients, respectively, and at terms up to 25 years in 83%. The 3-, 5- and up- to-25-year survival amounted to 95%, 92% and 75%, respectively. Restenosis of the internal carotid artery was significantly more often observed after prosthetic repair of the artery (p <0.05) as compared with other methods of reconstruction employed. Thromboses of the internal carotid artery were encountered with similar frequency (8%) only after prosthetic repair and resection of the internal carotid artery with an «end-to-end» anastomosis, which was significantly more often than in resection with redressation (p <0.05). Stroke incidence in the remote postoperative period amounted to 0.8% and the «stroke + stroke-related mortality» parameter equalled 1.6%. the remote results of surgical treatment for pathological deformity of the internal carotid artery are strongly suggestive of high efficacy of this method of prevention of impairments of cerebral circulation and treatment of cerebrovascular insufficiency in patients with the pathology concerned. The operation of choice in pathological deformity of the internal carotid artery is resection with redressation of the internal carotid artery and reimplantation into the original ostium. Source

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