Successful Combined Treatment of a Patient with Borderline Resectable Liver Metastasis of Colorectal Cancer

Aim: to present the value of interventional radiology techniques in the treatment of a patient with liver metastasis of colorectal cancer.Key points. In 2013, a 60-year-old patient with stage IIIB sigmoid colon cancer, pT3N2M0 underwent resection of the sigmoid colon with the formation of hardware rectosigmoanastomosis, 6 courses of adjuvant chemotherapy were performed. In 2015, a control examination revealed metastatic liver damage. Liver resection could not be performed due to the small future residual volume, and systemic chemotherapy was not effective. The patient underwent 3 cycles of regional chemotherapy. Taking into account the pronounced positive dynamics, in the form of a decrease in tumor size and a decrease in cancer markers, the patient managed to perform an extended right-sided hemihepatectomy. No progression of the tumor process was detected during the follow-up.Conclusion. Modern possibilities of X-ray endovascular methods allow to achieve results in the treatment of patients with colorectal cancer metastases in the liver such as a decrease in metastases in size, that make liver resection possible

Глубокий кистозный колит: обзор литературы и клинический случай

Colitis cystica profunda is a rare nonmalignant disease, characterized by an inflammation of mucous coat of intestine and formation of submucous cysts. The clinical picture of this pathology and oncological diseases of colon and rectum is similar. It is very difficult and important to differentiate this disease from colorectal cancer to protect the patient from unjustified mutilating surgery. Nowadays either in Russian and foreign scientific literature there are single reports dedicated to this disease. In our opinion the publication of this clinical case and analysis of scientific literature devoted to this subject is currently important.In this article there is a short review of modern state of problem of diagnostics and treatment of colitis cystica profunda. Also there is an own rare clinical observation of a patient who was diagnosed with colitis cystica profunda.Глубокий кистозный колит — редкое доброкачественное заболевание, характеризующееся воспалением слизистой оболочки кишки и образованием подслизистых кист. Клиническая картина данной нозологии и онкологических заболеваний толстой и прямой кишки схожа. На практике крайне сложно и важно отличить данное заболевание от колоректального рака, чтобы уберечь пациента от неоправданной калечащей операции. На сегодняшний день как в отечественной, так и в зарубежной научной литературе встречаются единичные сообщения, посвященные данному заболеванию. На наш взгляд, публикация данного клинического случая и анализа научной литературы по данной теме является актуальной.В статье приводится краткий обзор современного состояния проблемы диагностики и лечения глубокого кистозного колита. Также представлено собственное редкое клиническое наблюдение пациента с диагнозом глубокого кистозного колита

Особенности характеристик миокарда пациентов с острым инфарктом миокарда с подъемом сегмента ST и сахарным диабетом по данным магнитно-резонансной томографии сердца с контрастированием

Introduction. The presence of diabetes mellitus in patients with acute infarction significantly worsens short- and long-term prognosis, but the features of the course of the infarction in this category of patients have not been fully studied.Objective. To compare clinical, functional and structural myocardial characteristics of patients with acute ST-segment elevation myocardial infarction with and without diabetes mellitus.Materials and methods. The study included 91 patients with revascularized ST-segment elevation myocardial infarction (41 patients with diabetes mellitus). All patients underwent cardiac MRI with contrast, including myocardial T1 mapping, tissue analysis of left ventricular myocardium with determination of infarct zone, heterogeneous zone, edema zone, pre- and post-contrast T1 values, extracellular volume values of healthy myocardium and infarct zone.Results. The presence of diabetes in patients with AMI was associated with increased EDV LV: 153 ± 38 and 181 ± 58 ml (p = 0.007), increased ESV LV: 76 ml [54–93] and 87 ml [71–122] (p = 0.035). Infarct size was significantly larger in patients with diabetes than in those without diabetes: 37 ± 15 g (95% CI: 33–41) and 47 ± 21 g (95% CI: 40–53), p = 0.017. Patients with acute infarction and diabetes mellitus had higher extracellular volume values in both healthy myocardium: 24% [22–27] and 28% [24–30], p = 0.002, and in the infarct zone: 48% [40–58] and 58% [50–61], p = 0.016.Conclusions. In patients with ST-segment elevation myocardial infarction with diabetes mellitus, the infarct size, the edema area, and the value of the extracellular volume fraction both in the infarct area and in the preserved myocardium were larger than in patients without diabetes, which may underlie the development of myocardial dysfunction and further progression of heart failure.Введение. Наличие сахарного диабета (СД) у пациентов с острым инфарктом миокарда (ОИМ) существенно ухудшает краткосрочный и долгосрочный прогноз, однако особенности течения инфаркта у данной категории пациентов до конца не изучены.Цель. Сравнить клинические, функциональные и структурные характеристики миокарда пациентов с ОИМ с подъемом сегмента ST с СД и без СД.Материалы и методы. В исследование включен 91 пациент с реваскуляризированным острым инфарктом миокарда с подъемом сегмента ST (41 пациент с СД, 50 пациентов без СД). Всем пациентам выполнена МРТ сердца с контрастированием, в том числе Т1-картирование миокарда, проведен тканевой анализ миокарда левого желудочка с определением зоны инфаркта, гетерогенной зоны, зоны отека, значений до- и постконтрастного Т1, фракции внеклеточного объема здорового миокарда и инфарктной зоны.Результаты. Наличие СД у пациентов с ОИМ ассоциировалось с увеличенным конечным диастолическим объемом левого желудочка: 153 ± 38 и 181 ± 58 мл (р = 0,007), увеличенным конечным систолическим объемом левого желудочка: 76 мл [54–93] и 87 мл [71– 122] (р = 0,035). Размер инфаркта у пациентов с СД был достоверно больше, чем у пациентов без СД: 37 ± 15 г (95% ДИ 33–41) и 47 ± 21 г (95% ДИ 40–53), р = 0,017. У пациентов с ОИМ и СД фракция внеклеточного объема была выше и в здоровом миокарде: 24% [22–27] и 28% [24–30], р = 0,002, и в инфарктной зоне: 48% [40–58] и 58% [50–61], р = 0,016.Заключение. У пациентов с инфарктом миокарда с подъемом сегмента ST и СД размер инфаркта, зона отека, а также значение фракции внеклеточного объема как в зоне инфаркта, так и в сохранном миокарде были больше, чем у пациентов без СД, что может лежать в основе развития дисфункции миокарда и дальнейшего прогрессирования сердечной недостаточности

2020 Clinical practice guidelines for Hypertrophic cardiomyopathy

Russian Society of Cardiology (RSC)With the participation: Russian Association of Cardiovascular SurgeonsEndorsed by: Research and Practical Council of the Ministry of Health of the Russian Federation Task Force: Gabrusenko S.A. (Chairman), Gudkova A.Ya.* (Chairman), Koziolova N.A. (Chairman), Alexandrova S.A., Berseneva M.I., Gordeev M.L., Dzemeshkevich S.L., Zaklyazminskaya E.V., Irtyuga O.B., Kaplunova V.Yu., Kostareva A.A., Krutikov A.N., Malenkov D.A., Novikova T.N., Saidova M.A., Sanakoev M.K., Stukalova O.V

2020 Clinical practice guidelines for Myocarditis in adults

Russian Society of Cardiology (RSC)With the participation: Eurasian Association of Therapists (EUAT), Society of Specialists in Heart Failure (OSSN), Russian Scientific Medical Society of Therapists (RNMOT), Russian Society of Pathologists, Russian Society of Radiologists and Radiologists (RSR)Endorsed by: Research and Practical Council of the Ministry of Health of the Russian Federatio

Transarterial Chemoembolization of Metastatic Liver Lesions in Patients with Colorectal Cancer

Aim. To evaluate the efficacy of transarterial chemoembolization in patients with metastases of colorectal cancer in the liver.Materials and methods. A study aimed at investigating the effect of selective transarterial chemoembolization (TACE) of the hepatic artery on liver metastases in colorectal cancer was conducted at the Oncology Centre of the RZhD Central Clinical Hospital No. 2 named after N.A. Semashko, Moscow. The research basis included data for 10 patients, who had undergone chemoembolization of the hepatic arteries using Biosphere microspheres 50– 100 µm — 25 mg and doxorubicin 50 mg.Results. Both immediate and long-term results of up to 12 months were evaluated using the RECIST 1.1 scale. A partial response was achieved after 4 TACE treatments in 22.2 % of cases. The stabilization of the oncological process in the liver was observed after 9 TACE treatments in 50 % of cases. Disease progression was noted after 5 procedures in 27.8 % of cases.Conclusions. Transarterial chemoembolization of metastatic liver lesions in patients with colorectal cancer can be used according to certain indications in specialized centres providing endovascular treatment services

Colitis cystica profunda: literature review and case report

Colitis cystica profunda is a rare nonmalignant disease, characterized by an inflammation of mucous coat of intestine and formation of submucous cysts. The clinical picture of this pathology and oncological diseases of colon and rectum is similar. It is very difficult and important to differentiate this disease from colorectal cancer to protect the patient from unjustified mutilating surgery. Nowadays either in Russian and foreign scientific literature there are single reports dedicated to this disease. In our opinion the publication of this clinical case and analysis of scientific literature devoted to this subject is currently important.In this article there is a short review of modern state of problem of diagnostics and treatment of colitis cystica profunda. Also there is an own rare clinical observation of a patient who was diagnosed with colitis cystica profunda

ВОЗМОЖНОСТИ МАГНИТНО-РЕЗОНАНСНОЙ ТОМОГРАФИИ СЕРДЦА ПРИ ОТБОРЕ КАНДИДАТОВ НА СЕРДЕЧНУЮ РЕСИНХРОНИЗИРУЮЩУЮ ТЕРАПИЮ

Cardiac resynchronization therapy (CRT) is a contemporary and established treatment for patients with symptomatic heart failure, severely impaired left ventricular (LV) systolic dysfunction and a wide (>150 ms) complex. As with any other treatment, the response to CRT is variable. The degree of preimplant scar burden and scar localization to the vicinity of the LV pacing stimulus are known to influence response and outcome. As well as providing measurements of global and segmental cardiac function, coronary venograghy, CMR also permits localization and quantification of myocardial perfusion and scars. This review explores on the role of CMR in the assessment of patients undergoing CRT, with emphasis on risk stratification and RV and LV leads deployment.Сердечная ресинхронизирующая терапия (СРТ) – современный и признанный метод лечения пациентов с симптомной хронической сердечной недостаточностью с тяжелой систолической дисфункцией левого желудочка (ЛЖ) и расширенным комплексом QRS (> 150 мс). Эффективность СРТ, так же как любого метода лечения, вариабельна. Известно, что выраженность и локализация рубцовых изменений, их расположение по отношению к стимулируемой области ЛЖ могут вносить вклад в успех СРТ. Помимо оценки глобальной и локальной сократимости сердца, изучения коронарной анатомии, с помощью МРТ сердца возможны изучение локализации и количественная оценка рубцовых изменений. В данном обзоре освещены возможности МРТ сердца в обследовании кандидатов на СРТ с акцентом на стратификацию риска и расположение право- и левожелудочковых электродов

The effectiveness of cardiac resynchronization therapy in patients with chronic heart failure of various origin depending on the structural myocardial injury in cardiac magnetic resonance imaging

Aim. To assess the effect of the size and pattern of myocardial structural injury, determined by magnetic resonance imaging (MRI), on response to cardiac resynchronization therapy (CRT) in patients with ischemic and non-ischemic heart failure (HF).Material and methods. Forty seven patients with ischemic and non-ischemic HF (age 62,3±8,9 years (mean±SD), 44,6% females and 55,4% males), left ventricle (LV) ejection fraction <35%, QRS complex >130 ms, and sinus rhythm were included in the study. Late-gadolinium enhancement-cardiovascular magnetic resonance (LGE-CMR) was undertaken to evaluate myocardial scar prior to CRT devices implantation. All CMR analysis was performed on CVI42 software. According to signal intensity, fibrosis zone and “grey zone” were defined for quantitative analysis (proportion and mass) of injury. Scar zone included fibrosis zone and “grey zone”. Scar location was assessed using a 16-segmentLV model. Response was defined as a reduction inLV end systolic volume of >15% at 6 months follow-up and HF functional class amelioration.Results. In nonresponse group there was significantly higher proportion and mass of total scar (median 4% [2,5; 19] vs 24% [7; 44], p=0,012,6 g [3,5; 32,5] vs41 g [8; 86], p=0,013)), fibrosis zone (median 0% [0; 3,5] vs 8% [0; 19], p=0,01,0 g [0; 6] vs14 g [0; 34], p=0,014) and “grey zone” (4% [2,5; 15] vs 15% [7; 23], p=0,018,6 g [3,5; 27,5] vs23 g [8; 39], p=0,25). Response proportion in non-ischemic HF patients was higher than in ischemic HF patients (78,5% vs 28,5%, p<0,01). Response to CRT was less in patients with posterolateral scar, more specifically in segments 4,5,6,11,12,15,16 (p<0,05). CRT response in ischemic HF did not depend on size of myocardial structural injury, but depend on scar localization. Lateral scar was associated with poor response. In non-ischemic HF, proportion and mass of fibrosis zone was less in responder group (median 0% [0; 1] vs 8,5% [0; 11], p<0,05,0 g [0; 1] vs14,5 g [0; 22], p<0,05.Conclusion. Response to CRT is significantly higher in non-ischemic than in ischemic HF patients. Nonresponse to CRT is associated with posterolateral scar, regardless of the HF origin. In patients with non-ischemic HF, size of fibrosis zone is lower in the responder group. In patients with ischemic HF, size ofLV structural injury does not affect the CRT efficiency, but lateral scar is associated with CRT nonresponse