Редкое наблюдение разрыва аневризмы брюшной аорты с формированием тромбированной аортокавальной фистулы, тромбоза нижней полой и подвздошных вен

This article considers a rare case of rupture of abdominal aortic aneurysm with thrombosed aorto-caval fistula formation, with thrombosis of the inferior vena cava and iliac veins. During the multiphase computed tomography, early enhancement of inferior vena cava was not obtained, but non-contrasting aorto-caval fistula was revealed in the venous contrast phase, as well as the absence of the contrast in the adjacent parts of the inferior vena cava and iliac veins. The patient was successfully operated and the diagnosis was confirmed intraoperatively.Представлено редкое клиническое наблюдение диагностики разрыва аневризмы брюшной аорты с образованием тромбированной аортокавальной фистулы в сочетании с тромбозом нижней полой вены (НПВ) и подвздошных вен. В ходе выполнения мультифазной компьютерной томо­графии раннего сброса контрастного препарата из аорты в НПВ получено не было, но в венозную фазу контрастирования выявлено неконтрастирующее аортокавальное соустье, а также отсут­ствие контрастирования прилежащих отделов НПВ и подвздошных вен. Пациент был успешно прооперирован, диагноз был подтвержден интраоперационно

УСПЕШНОЕ УДАЛЕНИЕ В-КЛЕТОЧНОЙ ЛИМФОМЫ ПРАВЫХ ОТДЕЛОВ СЕРДЦА И ПРОТЕЗИРОВАНИЕ ТРИКУСПИДАЛЬНОГО КЛАПАНА У ВИЧ-ИНФИЦИРОВАННОГО ПАЦИЕНТА

ABSTRACT. Primary B-cell lymphoma of the heart is an extremely rare disease. We report a case of successful removal of the right heart B-cell lymphoma and the tricuspid valve replacement in a hIV-infected patient. The use of modern diagnostic procedures and aggressive surgical management allow clinical effect in this category of patients to be achieved. РЕЗЮМЕ. Первичная В-клеточная лимфома сердца относится к редким опухолям. В статье представлен клинический случай успешного хирургического удаления первичной лимфомы правых отделов сердца у ВИЧ-инфицированного пациента. Использование современных диагностических методов исследования и агрессивной хирургической тактики позволяют достичь клинического эффекта у указанной категории пациентов.

УСПЕШНОЕ УДАЛЕНИЕ В-КЛЕТОЧНОЙ ЛИМФОМЫ ПРАВЫХ ОТДЕЛОВ СЕРДЦА И ПРОТЕЗИРОВАНИЕ ТРИКУСПИДАЛЬНОГО КЛАПАНА У ВИЧ-ИНФИЦИРОВАННОГО ПАЦИЕНТА

ABSTRACT. Primary B-cell lymphoma of the heart is an extremely rare disease. We report a case of successful removal of the right heart B-cell lymphoma and the tricuspid valve replacement in a hIV-infected patient. The use of modern diagnostic procedures and aggressive surgical management allow clinical effect in this category of patients to be achieved. РЕЗЮМЕ. Первичная В-клеточная лимфома сердца относится к редким опухолям. В статье представлен клинический случай успешного хирургического удаления первичной лимфомы правых отделов сердца у ВИЧ-инфицированного пациента. Использование современных диагностических методов исследования и агрессивной хирургической тактики позволяют достичь клинического эффекта у указанной категории пациентов.

Geographical gradient of the <em>eIF4E</em> alleles conferring resistance to potyviruses in pea (<em>Pisum</em>) germplasm

<div><p>Background</p><p>The eukaryotic translation initiation factor 4E was shown to be involved in resistance against several potyviruses in plants, including pea. We combined our knowledge of pea germplasm diversity with that of the <i>eIF4E</i> gene to identify novel genetic diversity.</p><p>Methodology/Principal findings</p><p>Germplasm of 2803 pea accessions was screened for <i>eIF4E</i> intron 3 length polymorphism, resulting in the detection of four <i>eIF4E^A-B-C-S</i> variants, whose distribution was geographically structured. The <i>eIF4E^A</i> variant conferring resistance to the P1 PSbMV pathotype was found in 53 accessions (1.9%), of which 15 were landraces from India, Afghanistan, Nepal, and 7 were from Ethiopia. A newly discovered variant, <i>eIF4E^B</i>, was present in 328 accessions (11.7%) from Ethiopia (29%), Afghanistan (23%), India (20%), Israel (25%) and China (39%). The <i>eIF4E^C</i> variant was detected in 91 accessions (3.2% of total) from India (20%), Afghanistan (33%), the Iberian Peninsula (22%) and the Balkans (9.3%). The <i>eIF4E^S</i> variant for susceptibility predominated as the wild type. Sequencing of 73 samples, identified 34 alleles at the whole gene, 26 at cDNA and 19 protein variants, respectively. Fifteen alleles were virologically tested and 9 alleles (<i>eIF4E^{A-1-2-3-4-5-6-7}</i>, <i>eIF4E^B-1</i>, <i>eIF4E^C-2</i>) conferred resistance to the P1 PSbMV pathotype.</p><p>Conclusions/Significance</p><p>This work identified novel <i>eIF4E</i> alleles within geographically structured pea germplasm and indicated their independent evolution from the susceptible <i>eIF4E^S1</i> allele. Despite high variation present in wild <i>Pisum</i> accessions, none of them possessed resistance alleles, supporting a hypothesis of distinct mode of evolution of resistance in wild as opposed to crop species. The Highlands of Central Asia, the northern regions of the Indian subcontinent, Eastern Africa and China were identified as important centers of pea diversity that correspond with the diversity of the pathogen. The series of alleles identified in this study provides the basis to study the co-evolution of potyviruses and the pea host.</p></div

Computed Tomography Angiography in the Evaluation of Carotid Paragangliomas

Objective: to investigate the informative value of computed tomography (CT) angiography for the evaluation of carotid paragangliomas.Material and methods. Twelve patients with carotid paragangliomas were examined in the Department of X-ray Computed Tomography and Magnetic Resonance Imaging, Vladimirskiy Moscow Regional Research and Clinical Institute, in 2014-2019. Before surgery, we performed ultrasound imaging and CT angiography (Philips iCT 256 slices): non-contrast study, subsequent contrast enhancement (arterial and venous phases) using the intravenous bolus injection of 60 ml of non-ionic iso- or low-osmolar contrast media. The Shamblin criteria were used to evaluate paragangliomas. The extent of changes and the spread of mass tissue were estimated along the carotid artery walls. Surgery was performed in 11 out of 12 patients.Results. Unilateral and bilateral masses were identified in 10 and 2 cases, respectively. Two neoplasms that were characterized by small sizes and minimal involvement of carotid artery walls in the process were assigned to type I in accordance with the Shamblin classification. Type II masses (n = 5) were represented by a partial encasement of the internal and external carotid arteries by paraganglioma. Type III tumors (n = 7) were characterized by large sizes and encasement of all walls of the common, internal and external carotid arteries over a considerable length. No calcifications or necrotic areas were found in the structure of the neoplasms. Multiple small tortuous arterial vessels around the tumor were determined in 12 out of 14 cases. These changes did not match the overall length of the tumor and the degree of carotid artery encasement by the latter. Histological examination confirmed the diagnosis of paragangliomas in all cases. A pathologically altered lymph node was found in 1 case during the subsequent 5-month follow-up.Conclusion. CT angiography can assume the diagnosis of carotid paraganglioma based on its characteristic features and determine the type of tumor according to the Shamblin classification, which allows to plan the optimal surgical intervention

Multidetector computed tomography in the assessment of neurologic complications after carotid endarterectomy

Rationale: Carotid endarterectomy is a surgical procedure to prevent acute ischemic cerebrovascular accidents. Neurologic complications can occur after surgery. Multidetector computed tomography (MDCT) is used for their diagnosis in severely ill patients.Aim: To evaluate the potential of MDCT in the diagnosis of neurologic complications after carotid endarterectomy.Materials and methods: We analyzed the results of radiologic assessments in 15 patients with early postoperative neurologic complications which occurred after surgery for internal carotid artery occlusion (595 patients underwent surgery). In stable patients, brain magnetic resonance imaging (MRI) was performed (T1, T2, FLAIR, DWI modes) with non-contrast MR angiography. In critically ill patients, brain computed tomography, computed tomographic angiography and perfusion computed tomography were performed.Results: Ischemic neurologic complications were found in 11 patients. One patient had no clinical manifestation of an ischemic stroke, and acute stage signs were found in his routine brain MDCT. In 9 patients with acute brain ischemia, MDCT (n = 6) and MRI (n = 3) results were specific for this diagnosis, with no diagnostic problems. There were problems with the diagnosis of the hyperacute ischemia in 1 patient. In this patient, the complication occurred against a background of abnormal carotid blood flow before surgery, therefore, differential diagnosis between the hyperperfusion syndrome on the intervention side and the hyperacute phase of ischemic insult on the opposite side was performed. Hyperperfusion syndrome and hemorrhagic strokes were observed in 4 patients.Conclusion: The most difficult for diagnosis by MDCT is the hyperacute phase of brain ischemia. Further studies are necessary in the area of diagnosis of postoperative complications, with the search for potential specific diagnostic criteria

MULTIDETECTOR COMPUTED TOMOGRAPHY IN POSTOPERATIVE ASSESSMENT OF CAROTID ARTERIES

Rationale: Carotid endarteractomy is a surgical intervention that is performed for prevention of cerebrovascular accidents, up to 80% of them being of ischemic origin, in the presence of a marked stenosis and occlusion of carotid arteries. A detailed description of specifics of postoperative changes in carotid arteries depending on the type of surgical intervention has not been published.Aim: To evaluate internal carotid arteries in the early postoperative period by means of multidetector computed tomography (MDCT) and to match the changes detected with the type of surgical intervention.Materials and methods: In 2014, 23 patients with atherosclerotic stenoses of internal carotid arteries were assessed in the Department of Roentgenology of MONIKI. As a part of preoperative work-up, the patients underwent ultrasound examination (USE) of the neck vasculature and MDCT with bolus contrast enhancement. Postoperative monitoring also included USE and MDCT. The data obtained were matched against the type of surgical intervention.Results: After the eversion procedure (15 patients), there were 14 cases of expected (normal) postoperative changes and 1 case of changes that required a follow-up. After an open (classic) carotid endarterectomy (3 patients) there was 1 case of expected postoperative changes and 2 cases requiring a follow-up. Among 5 patients who underwent a resection of internal carotid artery and its prosthetic replacement, 2 patients had expected changes, 2 patients had changes that required a follow-up and 1 patient had a complication after surgery.Conclusion: The postoperative use of MDCT for assessment of reconstructed arteries allows for identification of various types of postoperative changes, for detection of symptoms of severe complications and borderline conditions that require subsequent targeted diagnostics and monitoring

COMPUTED ANGIOGRAPHY IN DEDICATED ASSESSMENT OF OCCLUSIVE CAROTID DISEASE FOR RECONSTRUCTIVE SURGERY PLANNING

Objective – to optimize dedicated assessment of carotid arteries in case of occlusive disease with computed angiography (CTA).Material and methods. During 2015–2016 years 65 patients underwent ultrasound examination and computed tomography examined before carotid surgery.Results. Aortic arc branching variants were observed in 26% cases. In 51% combined steno-occlusive process in common, internal carotid arteries and subclavian arteries was confirmed. In 29% of cases atherosclerotic plagues were detected in upper parts of common carotid arteries and such data changed surgical strategy. Patients included in study has internal carotid artery (ICA) stenosis more than 50% NASCET. Detailed assessment was used for cervical ICA distal to stenosis. In 62% of patients with carotid subocclusion narrowing in upper segments were detected. In 3 cases ascending pharyngeal artery arose from affected carotid artery and these findings change surgical approach. All patients underwent carotid surgery. Degree of ICA stenosis detected with CTA was conformed. CTA data for carotid plague extension were less informative – intraoperative plague length exceeded CTA results.Conclusion. CTA is high informative study that allows detailed assessment of occlusive carotid disease for carotid surgery

REMOVAL OF RIGHT HEART CHAMBER B-CELL LYMPHOMA AND TRICUSPIDAL VALVE PROSTHETICS IN A HIV-INFECTED PATIENT

Primary B-cell lymphoma of the heart is a rare tumor. The authors presented a clinical case of a successful surgical treatment of primary right heart lymphoma in a HIV-infected patient. The use of modern diagnostic assessment methods and aggressive surgical strategies help to achieve clinical effect in this patients’ category

MULTIDETECTOR COMPUTED TOMOGRAPHY FOR IDENTIFICATION OF INSTABILITY OF AORTIC ANEURYSM WALL

Background: Aortic aneurysm is characterized by high incidence, polymorphic clinical features and sudden onset of severe complications.Aim: To develop a standard multidetector computed tomography (MDCT) protocol for aortic aneurysm examination and image analysis for detection the signs of aortic wall instability.Materials and methods: The data of 279 patients with aortic aneurysm who underwent MDCT examination during 2009–2014 was analyzed to identify aortic wall instability signs.Results: Complicated course of aortic aneurysm was observed in 100 cases (36%). The most common sign of aortic wall instability was aortic dissection. According to our results, a new definition of aortic aneurysm complications was elaborated. It included signs of aortic wall instability with incomplete and/or complete disruption of aortic wall layers. A scheme of the most common patterns of aortic wall abnormalities was proposed, allowing a radiologist to reach high accuracy in characterizing this pathology.Conclusion: A dedicated MDCT protocol for aortic aneurysm detection and image analysis can increase quality of radiologic assessment of aneurysm wall allowing to approach to the level of histological accuracy