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Objective: To study the relationship of the structure of the white matter of the brain, neurovascularization and cognitive functions in obese children and adolescents., Material and Methods: The study included 64 obese patients, aged 12-17 years, and 54 children without excess body weight. A general clinical examination, neuropsychological testing (the Raven's test with the calculation of IQ, MoCA, the Rey 15-Item Memory Test (RMT), 1 and 2), magnetic resonance imaging (MR) tractography and contrast-free perfusion of the brain were conducted., Results: Obese children and adolescents had both a decrease in scores on MoCA and the Raven's test, and in terms of IQ, while according to RMT-1, there were significant differences in the two groups, and in RMT-2 the results were comparable. Perfusion analysis showed a decrease in vascularization in the white matter area of the occipital lobe on the left and its increase in the temporal lobe area also on the left. When assessing the white matter according to MR tractography, a decrease in fractional anisotropy was noted in the area of the hook-shaped beam on the right and left, anterior and posterior commissural tracts. These changes were correlated with neuropsychological results., Conclusion: In obese children and adolescents, there was a destruction of the integrity of the white matter and neurovascularization of the brain associated with a deficit of cognitive functions.

Aim: To study the effect of type 2 diabetes mellitus on changes of intracardiac haemodynamics and myocardial morphology in patients with ischaemic heart disease and a postinfarction aneurysm of the left ventricle before and after corrective operations on the heart., Patients and Methods: The study included 79 patients with ischaemic heart disease and a chronic aneurysm of the left ventricle (Group I - patients with type 2 diabetes mellitus (n=27), mean age 57.5±3.9 years, average number of shunts 2.9±0.6; Group II - patients without diabetes mellitus (n=52), mean age 55,3 ±7.1 years, average number of shunts - 2.7±0.3). In the preoperative period all patients were examined taking into account the functional class of angina pectoris, with the assessment of the left ventricular ejection fraction, end-diastolic index, end-systolic index, sphericity index. All patients underwent coronary artery bypass grafting and surgical restoration of the normal geometry of the left ventricle according to the Menicanty technique with the target end-systolic index of 60 ml/m2, during which 39 patients from both groups were subjected to intraoperative biopsy of the left ventricular myocardium and right atrial auricle., Results: The intergroup analysis revealed no statistically significant differences in age, angina pectoris class, level of arterial pressure between the groups. Neither were there statistically significant differences in the echocardiographic parameters at the preoperative stage. In the postoperative period, we detected a significant decrease in the end-systolic and end-diastolic volumes of the left ventricle in both groups, with a statistically significant increase of the left ventricular ejection fraction observed only in non-diabetic patients. One year after the operation, such patients still continued to demonstrate more favourable parameters of the systolic and diastolic functions of the left ventricle. A detailed analysis with determining the delta of the alterations in the parameters revealed more significant positive dynamics in the postoperative period in patients with ischaemic heart disease not associated with type 2 diabetes mellitus., Conclusion: The obtained findings are indicative of negative dynamics of the course of chronic ischaemic heart disease aggravated by type 2 diabetes mellitus after reconstruction of the left ventricle. Macro- and microangiopathy in type 2 diabetes mellitus significantly deteriorated the myocardial trophism. Subsequent bleedings draw phagocytic cells into the myocardial stroma, thus adversely affecting the further prognosis and course of the disease, since we demonstrated that the presence of inflammatory infiltrate in the myocardial stroma is a key factor of unfavourable outcomes of surgical treatment of patients with ischaemic cardiomyopathy.

The authors studied the parameters of arterial and venous blood flow in patients presenting with haemodynamically significant atherosclerosis of the carotid arteries before and after carotid endarterectomy, as well as while carrying out functional tests. Comparing the indices of arterial blood flow in the Study Group consisting of 52 patients and the Control Group comprising 15 apparently healthy volunteers at rest prior to the operation revealed statistically significant differences of volumetric parameters of blood flow in the internal carotid artery. The obtained results showed that the breath-holding test was accompanied and followed by increased velocity of blood flow in the middle cerebral artery (MCA) on the side contralateral to stenosis, with the reactivity index (RI) amounting to 0.98±0.20, which statistically significantly differed from the RI in the Control Group patients (1.28±0.13). The forced respiration test demonstrated a decrease in the volumetric indices of blood flow in the MCA on the side of stenosis, as well as an increase of the maximum end-diastolic velocity of blood flow on the side contralateral to stenosis. The test with sublingual administration of nitroglycerin appeared to result in reduced blood flow in the MCA. The supratrochlear test demonstrated decreased velocity of blood flow in the supratrochlear artery. Studying the venous link of cerebral vessels after the operation showed that statistically significant differences were revealed only on the side contralateral to stenosis as compared with the values prior to revascularization. An increase of blood flow in the internal jugular veins after the operation on the side contralateral to the operation was apparently suggestive of an adequate distribution of blood flow through the main vessels of the brain.

Veins of lower extremities are classic sources of pulmonary artery thromboembolism (PATE). But one should not underestimate presence of thrombi in other potential sources - veins of small pelvis, superior vena cava, and chambers of the heart. We analyzed 652 case histories and autopsy data of patients in whom PATE had been revealed at pathological anatomical investigation and selected 157 cases in which right heart chambers were sources of emboli (right atrium in 83.5% and right ventricle - in 13.7% of cases). According to autopsy data average mass of the heart was 512.5+/-36.1 g. In most patients it exceeded norm. Thrombi in both right and left cardiac chambers were found in 52.3% of cases. Eighty three patients had history of myocardial infarction or were treated for MI during last hospitalization; 52.3% of patients had atrial fibrillation. After detailed study of all anamnestic, clinical, instrumental, and pathologic-anatomic data we selected 69 factors which according to contemporary views could facilitate formation of thrombus in the right cardiac chambers. Using these factors and method of logistic regression we created a mathematical model for assessment of probability of the presence of thrombi in right cardiac chambers.

The aim of this work was to study dynamics of new cases of hospital thromboembolism of pulmonary artery branches (TEPA) based on the registry data of Tomsk hospitals for 2003-2010 and to estimate applicability of recommendations of European Society of Cardiologists (2008) on diagnostics and treatment of TEPA. Case records and autopsy protocols were available for analysis. The data were treated using Statistica for Windows 6.0 package. 5.04% of the deceased patients had TEPA according to autopsy data. The discrepancy between clinical and pathoanatomical findings averaged 57.6%. In 2010, TEPA was not diagnosed in 35.6% patients. The number of new cases of submassive TEPA and TEPA of small branches with the fatal outcome decreased to 40.7 and 48% since 2007 while the incidence of lethal massive thromboembolism amounted to 68%. Its increase was especially notable among men after 2008. In 2003, 73.3% of the patients who died from TEPA were women while it was the cause of death in 54.8% of men in 2010. The duration of hospital stay was 0-16 (mean 8/1 +- 7.8) bed-days. Most patients (60.3%) had 3 or more risk factors. The frequency of TRPA relapses correlated with the presence of pericardial fluid (p = 0.039) and acute myocardial infarction (p = 0.023). In 24.2% of the cases. TEPA originated in heart chambers.

Aim: To reveal possible predictors of thrombosis in the right cardiac chambers and to build a mathematical model to estimate the probability of thrombi in them in patients with thromboembolism of the pulmonary artery branches., Materials and Methods: The data of autopsy protocols and case histories were analyzed in'157 patients in whom the source of thromboembolism had been right cardiac chambers according to postmortem evidence. A logistic regression method was used to create a probability model., Results: The findings were used to select 69 indicators--possible provokers of thrombosis and accordingly predictors of thrombi in the right cardiac chambers. A mathematical model--a formula to estimate the probability of thrombi in the right cardiac chambers--was made. It comprised 8 indicators: weight, height, pericardial fluid, right atrial dilatation, right ventricular wall thickness, a left or right ventricular apical scar, a concomitant inflammatory process, and concurrent diabetes mellitus. CONCLUSION; The application of the developed formula may assist in identifying a group of patients who have the highest probability of thrombi in the right cardiac chambers and accordingly must undergo a more in-depth examination.

Aim: To study the frequency and structure of new cases of thromboembolism of the pulmonary artery branches among those who died at Tomsk hospitals in 2003 to 2007., Materials and Methods: The autopsy protocols and case histories of all patients (n = 442) with the lifetime and/or postmortem diagnosis of pulmonary thromboembolism (PTE) who had died at Tomsk hospitals on January 1, 2003 to December 31, 2007 were analyzed. A systemic postmortem study applied the complete organ evacuation method (complete evisceration after Shore). The variance analysis was employed to calculate variability in all values; the correlation analysis was used to estimate statistical correlations., Results: Out of the 442 patients, 217 (50.9%) patients had thromboembolism as being a direct cause of death and it worsened the course of the underlying disease in 225 (49.1%) patients. According to the number of dead patients with PTE, therapeutic (60.6%), surgical (26.6%), and cancer (9.1%) ones ranked first, second, and third, respectively. In addition to the most common inferior vena cava thrombosis (65.1%), right cardiac thrombosis was the main source of PTE in 25.6% of cases., Conclusion: The detected specific features of the occurrence of new cases of PTE at Tomsk hospitals in 2003-2007 may become the basis for planning measures by health administrators to improve the diagnosis of PTE and to improve medical and preventive care to patients with this condition in therapeutic-and-prophylactic institutions.

Aim: To study blood flow along the internal jugular veins (IJV) in the initial state and under the action of nitroglycerin in patients with essential arterial hypertension (EAH) with reference to characteristics of a 24-h profile of blood pressure., Material and Methods: A 24-h monitoring of blood pressure (MBP), duplex scanning of IJV, venous IJV outflow were studied in 26 patients with EAH stage 2 (mean age 39 +/- 5.0) before and after sublingual intake of nitroglycerin (0.5 mg)., Results: By 24-h MBP findings, two groups of patients were identified: with unaffected blood pressure profile (group 1) and affected profile (group 2). Nitroglycerin produced a unidirectional reaction of IJV (increased outflow) in group 1 and multidirectional changes of venous outflow along the IJV in patients of group 2., Conclusion: Nitroglycerin test showed different venous cerebral hemodynamics in EAH patients with different variants of 24-h MBP.

Aim: To compare echomorphostructure of atherosclerotic plaques and vascular stenosis degree with structural changes of the brain according to MR image in patients with combined atherosclerotic affection of coronary and carotid arteries in an asymptomatic course of carotid atherosclerosis., Material and Methods: MR imaging was made in 53 men aged 44 to 78 years with stenosing atherosclerotic affection of the internal carotid arteries. Vascular obstruction reached 30-80%. Neurological examination detected no signs of focal brain lesions. Hypertension, myocardial infarction, permanent atrial fibrillation were diagnosed in 19 (36%), 20 (38%) and 12 (23%) patients, respectively., Results: Ultrasound investigation has established that carotid arteries contain more frequently spongy and heterogenic plaques than dense and calcinated. MRI registered structural alterations of cerebral tissue of various degree in 96% cases., Conclusion: Significant correlations were established between ischemic affection of the brain with myocardial infarction, arterial hypertension, cardiac fibrillation, type of atherosclerotic plaque.

Aim: To assess influence of 2-week course therapy with atenolol, nebivolol, and verapamil on systolic and diastolic left ventricular function and mammary coronary blood flow in early period after revascularization., Material: Patients (n=113) after mammary coronary bypass grafting., Methods: Echocardiographic characteristics of systolic and diastolic left ventricular function, and blood flow through mammary coronary grafts were measured before and after treatment with study drugs., Results: In placebo treated patients isovolumic relaxation time (IVRT) and late diastolic filling phase (A) increased, while velocity characteristics of mammary-coronary blood flow decreased. Administration of atenolol, nebivolol, and verapamil was associated with significant increases of left ventricular ejection fraction, stroke volume, cardiac output, IVRT, peak diastolic velocity, flow through mammary coronary grafts and their lumen diameter, and decrease of E/A ratio., Conclusion: Administration of atenolol, nebivolol, and verapamil in early postoperative period after mammary coronary bypass grafting improved systolic and diastolic function of the left ventricle, and blood flow through mammary coronary grafts. None of the studied drugs had significant advantage over others.