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The purpose of the study was to determine the criteria for instability of atherosclerotic plaques in carotid arteries with the use of improved and new diagnostic techniques. The study enrolled a total of 92 patients examined with the help of instrumental methods of diagnosis, including ultrasound triplex scanning, magnetic resonance imaging and multislice computed tomography. All patients were subjected to the operation of carotid endarterectomy in various standard modifications. The specimens of atherosclerotic plaques taken intraoperatively were examined with the help of morphological, immunofluorescent methods, electron paramagnetic resonance, electron microscopy. A multivariate logistic regression analysis demonstrated that the plaques with an area over 90 mm2 (OR 4.05; 95% CI 1.32-13.2; p=0.006), a volume of more than 0.6 cm3 (OR 2.72; 95% CI 1.05-9.58; p=0.04), and the JBA value of not less than 8 mm2 (OR 2.82; 95% CI 1.22-6.23; p=0.02) were statistically significant independent predictors of histologically verified unstable plaques. The results were compared to the findings of histological methods. In patients with the above mentioned ultrasonographic parameters, unstable plaques were encountered in 94% of cases. Immunofluorescent assay demonstrated a significant increase in the number of inflammatory markers (CD68+, CD36+ cells), as well as CD31+ cells as markers of neovasculogenesis in unstable plaques. According to the findings of electron paramagnetic resonance, bivalent manganese is a marker of plaque instability. Further studies will help reveal the mechanisms of plaque calcification. A decrease in the content of manganese correlated with an increase in the degree of plaque calcification (r =-0.69, p<0.01). This serves as indirect evidence of a destabilizing effect of calcification on plaque stability. It was demonstrated that ultrasound elastography makes it possible to significantly extend the capabilities of standard ultrasound examination in detecting instability of atherosclerotic plaques in carotid arteries.

Presented herein is a review of the literature concerning mechanisms of calcification of atherosclerotic plaques (ASP), showing molecular mechanisms of interaction of processes of calcification with the factors inducing instability of ASPs (anti-inflammatory cytokines, neoangiogenesis, increased level of matrix metalloproteinases, etc.), also describing the effect of the value of volume of scope of calcification on stability of ASPs, followed by discussing the problems related to the role of biominerals (hydroxyapatite calcium phosphate) and Mn2+ in calcification of ASPs and their impact upon stability of the plaque.

The authors share herein their experience in diagnosis and treatment of deep vein thrombosis in neonates and nurselings. We examined a total of 132 infants undergoing treatment in an intensive care unit. Of these, 15 infants were diagnosed with various-localization thromboses. Ultrasonographic study was the main method of diagnosis. Management consisted in anticoagulant therapy. Timely administration of anticoagulant therapy made it possible to achieve complete recanalization of venous lumens in 80% of cases. Only 20% of infants were found to have vein occlusion preserved, thus requiring further follow up and treatment. Neither complications nor relapsing thromboses were observed. A conclusion was drawn that characteristic of neonates and infants under 12 months of life is a specific profile of etiopathogenesis of deep vein thrombosis. In the majority of cases thrombosis appears to be catheter-related, and only in sporadic cases it forms spontaneously. Treatment of thromboses is typically associated with high successfulness of medicamentous therapy.

Presented herein is experience in diagnosis and treatment of chronic diseases of lower-limb veins in a total of 242 children and adolescents. The authors used CEAP classification; C1 class was more often encountered in children. Treatment included surgical interventions, sclerotherapy, laser coagulation of pathological veins of lower extremities. Therapeutic outcomes were satisfactory in all patients, with no complications observed. It was determined that in paediatric phlebological practice prevailing are class C1 chronic venous diseases; characteristic is high concern of both the patient and parents. A timely commenced conservative program of treatment for children makes it possible to improve quality of life in class C1 and C2 chronic venous diseases. Laser coagulation of varicose saphenous veins of lower limbs in children makes it possible to remove pathological vessels, significantly improving quality of life of patients and shortening the terms of hospitalization twofold. Application of transcutaneous laser coagulation (Nd:YAG, 1064 nm) and microfoam sclerotherapy in children makes it possible to completely remove class C1 varicose veins, improving quality of life.