Vol 10, No 4 (2025)

Myocardial bridges (MB) are a congenital anomaly in which the coronary artery is partially immersed in the myocardium. The prevalence of MB varies from 0.5% to 87%, depending on the diagnostic method: selective angiography detects 0.5-18% of cases, whereas CT angiography, up to 73%.

An analysis of 22 peer-reviewed papers (1986-2023) showed that in 98% of the cases MB is associated with proximal atherosclerosis due to hemodynamic disorders (turbulent blood flow, high pressure gradient). However, some studies deny a direct link or point to the potential protective effect of MB. Systolic compression of the artery causes myocardial ischemia, especially in cases of left ventricular hypertrophy or microvascular dysfunction. Clinical manifestations range from asymptomatic to angina pectoris, ACS, and sudden death. Treatment includes beta-blockers, stenting, and myotomy, but the lack of randomized trials limits universal recommendations. The contradictions in the data emphasize the need to integrate morphological and functional imaging, as well as to personalize therapy. Long-term cohort studies, risk stratification algorithms using AI, study of the angular anatomy of coronary arteries may be prospective lines of further research.

Aim – to determine the specific features of the use of the semi-quantitative Nt-proBNP immunochromatographic assessment technique for the diagnosis of chronic heart failure (CHF) in comorbid elderly patients with type 2 diabetes mellitus (DM2) in relation to indicators of clinical and metabolic status.

Material and methods. The study was performed using a cross-sectional design; 97 clinical and laboratory-instrumental indicators were studied, including the determination of Nt-proBNP by a semi-quantitative method, in a sample of 50 comorbid elderly patients with T2DM; groups were identified according to the threshold value of Nt-proBNP 450 pg/ml; the interrelationships and significance of differences in variables in the groups were analyzed, including the number of average values of biomarkers for achieving the goals of DM2 treatment and the structure of drug therapy.

Results. A high prevalence of comorbid pathology (arterial hypertension: 90%, obesity: 74%, dyslipidemia: 72%) and a high proportion of participants’ failure to achieve therapeutic goals, comparable in the Nt-proBNP groups, were revealed; a significant association between the Nt-proBNP group and the previously established stage of CHF (χ2 = 6.4; p = 0.041), a positive correlation with the ratio of transmittal blood flow rates in early and late diastole E/A (r = 0.309; p = 0.003); Indirect evidence has been obtained for the high sensitivity of the semi-quantitative assessment of Nt-proBNP for the diagnosis of early-stage CHF.

Conclusion. The majority of comorbid elderly patients with DM2 (72%) have Nt-proBNP levels above the general population threshold of 125 pg/ml and need to verify the diagnosis of CHF. The assessment of the Nt-proBNP test result in T2DM has its own specifics due to polymorbid pathology (obesity and CKD) and the presence of multidirectional “disturbing” factors. When planning a follow-up program for elderly patients with DM2 and hypertension, the indications for Nt-proBNP screening should be taken into account, and if the result is positive, for an in-depth Echocardiography examination.

Aim – to study the distribution of allele frequencies of the polymorphic marker 4G(-675)5G of the PAI-1 gene among patients with coronary heart disease and individuals with risk factors for the development of coronary heart disease.

Material and methods. The study included 63 patients with diagnosed coronary heart disease, especially with stable angina (48 men and 15 women) hospitalized in the 1st Cardiology Department of the Multidisciplinary Clinic of the Tashkent Medical Academy. The average age of patients was 56.8 ± 6.40 years (42-66 years old). The state of hypercoagulability was assessed by measures of polymorphism gene of PAI-1 and plasma level of PAI-1.

Results. The assessment of the frequency of various variants of the 4G(-675)5G polymorphic marker of the PAI-1 gene showed that differences in the distribution of the 5G/5G, 4G/5G, 4G/4G genotypes depending on the functional class of coronary artery disease are not statistically significant, since the chi-square test value was χ² = 1.85 (p > 0.05). Based on the obtained results, it can be assumed that the presence of hetero- and homozygous variants of the 4G allele of the PAI-1 gene does not affect the severity of the disease, in particular, the functional class of stable angina.

Conclusion. The 4G/5G polymorphism of the PAI-1 gene was significantly associated with the risk of coronary heart disease in the Uzbek population. When stratified by angina functional class, the results showed that the 4G/5G polymorphism is associated with an increased risk of coronary heart disease and higher plasma PAI-1 levels.

Aim – to identify the features of the formation of upper limb arthropathy in patients with ischemic stroke with 4-6 points on the rehabilitation routing scale (RRS) depending on the type of treatment and rehabilitation procedures.

Material and methods. Ninety-eight patients with ischemic stroke were examined in two periods: Period 1, 13.2 ± 0.8 days and Period 2, 189.2 ± 2.1 days. Ultrasound and X-ray examinations were performed to determine the nature of damage to the joint complex of the upper limb. The severity of the neurosomatic status was assessed using the NIHSS, MRS, MMSE, VAS, and RRS scales.

Results. Post-stroke hemiparesis in the acute period of ischemic stroke was registered in 86 patients (88%), and upper limb arthropathy in 36 (37%) of the examined patients. In 12 (32%) patients with ischemic stroke the arthropathy of the shoulder joint combined with damage to other joints. In the majority of patients with ischemic stroke with arthropathy, according to the ultrasound data of the joints, synovitis was detected in 27 (76%), and tendon tendinitis in 17 (47%) that form the structure of the shoulder joint. In dynamics, contracture of the upper limb was revealed in 12 (26%) of the examined and was combined with a more pronounced cognitive defect, which required development of preventive and corrective methods.

Conclusion. It is proposed to introduce into the diagnostic standard of patients with ischemic stroke with paresis of 0-3 points ultrasound of the affected joint to identify early markers of arthropathy in order to promptly prevent contracture of the upper limb.

Aim – to demonstrate the feasibility and relative safety of resection of the portal and/or superior mesenteric veins invaded by tumor during surgical treatment of the neuroendocrine neoplasm of the pancreatic head, as well as the feasibility of simultaneous resection of the liver for resectable metastases in patients with stage IV disease during primary surgery and at disease progression of any stage following surgical treatment.

Material and methods. Surgical treatment of 16 patients with neuroendocrine neoplasm of the pancreatic head with invasion of the superior mesenteric and/or portal veins of stages III-IV of high and moderate differentiation (G1 and G2) included a standard gastropancreoduodenal resection in 87.5% cases, extended gastropancreoduodenal resection with aortocaval lymph node dissection in 6.25% cases, and pancreatectomy in 6.25% cases. During the standard operation, in one female patient (6.25%) segmental resection of the liver was performed to remove the metastasis. The rate of portal vein resection was 6.25%, superior mesenteric vein, 50%, both major veins, 43.8%. Neoadjuvant treatment was not administered, while adjuvant XELOX treatment was administered to 3 (18.8%) patients. The statistic processing of the study results was performed in Statistica for Windows v.10 and SPSS v21. The obtained differences were deemed statistically significant at р≤0.05 (≥95% accuracy). In order to calculate the survival rate, the Kaplan-Meier method was used with log-rank test evaluation of significance of differences.

Results. The rate of R0 surgical treatment was 93.8%, the rate of complications of surgical treatment of Clavien-Dindo class III and above was 43.8% with the total rate of all complications of 75%. The main complications included gastric stasis (50.1%), arrosive hemorrhage (18.8%), acute gastrointestinal ulcer hemorrhage (18.8%), pneumonia (18.8%). The rate of postoperative thrombosis of the portal and/or superior mesenteric vein was 12.5%, leakage of the pancreato-digestive anastomosis was 12.5%, leakage of the bilio-digestive anastomosis, 6.3%, pancreatic fistula, 12.5%. Relaparotomy was performed in 2 (12.5%) patients who later died due to complications of surgical treatment (leakage of the pancreato-digestive anastomosis with arrosive hemorrhage). Disease progression was seen in 10 (62.5%) of the patients within 3 to 69.3 months, the median time before identification of progression being 39.7 [7.1; 52.8] months, and mortality from progression being 50%. Local recurrence developed in 12.5% patients, metastases in the retroperitoneal lymph nodes in 6.25%, metastases in the liver in 43.75%, in two cases, liver resection due to metastases was performed. In cases of progression, all patients received antineoplastic therapy with analogs of prolonged somatostatin. The median overall survival was 70.1 months, progression-free survival, 49.2 months, one-year survival was 81.2% and 78.6%, respectively, three-year survival, 68.2% and 63.5%, five-year, 68.2% and 36.3%, ten-year, 20.55% and 18.1%.

Conclusion. The outcomes of surgical treatment of patients with neuroendocrine neoplasm of the pancreatic head with invasion of the portal and/or superior mesenteric vein show the feasibility, relative safety and efficiency of resection of these major veins. In the majority of patients, surgical treatment may be performed in the radical volume and extended by liver resection in the event of resectable metastases. Considering the relatively favorable prognosis of the disease, liver resection for resectable metastases and disease progression may be performed: it is safe, it improves quality of life of patients, and extends the period without tumor manifestations.

Aim – to evaluate the efficacy and safety an original transmesenteric approach for laparoscopic nephrectomy with thrombectomy in patients with left kidney cancer and venous tumor thrombus (levels 0–I according to the Mayo classification).

Material and methods. The study included 19 patients with histologically verified left kidney cancer who underwent laparoscopic nephrectomy with thrombectomy using a transmesenteric approach. Eleven patients had renal vein thrombus (Mayo level 0), and eight patients had thrombus extending into the inferior vena cava up to 2 cm from the renal vein orifice (Mayo level I). The following parameters were assessed: age, body mass index, operative time, intraoperative blood loss, hospital stay, and postoperative complications.

Results. All procedures were completed laparoscopically without conversion. The mean operative time was 125.8 ± 11.4 min, and the mean blood loss was 152.6 ± 62.9 ml. The mean hospital stay was 7.4 ± 0.6 days. No early or late complications were recorded. Operative time and blood loss were significantly lower compared to previously published series of laparoscopic and open procedures. Conclusion. The transmesenteric approach minimizes surgical trauma, reduces operative time and blood loss, and lowers the risk of complications while maintaining oncological radicality. The method can be recommended for widespread use in onco-urological practice.

Cochlear implantation is a highly technological method of rehabilitation for patients with profound sensorineural hearing loss. In most cases, cochlear implantation follows a standard technique, but there are cases that require meticulous attention in the selection of tactics. Recently, chronic otitis media was considered as a contraindication for cochlear implantation due to the risk of developing a number of complications. Despite these potential problems, cochlear implantation is the only solution to help patients with chronic otitis media and stage IV sensorineural hearing loss. There are various methods for managing the above-mentioned group of patients. Some authors describe performance of cochlear implantation with middle ear surgery in one stage, while other authors, in several stages. The issue of cochlear implantation in patients suffering from chronic suppurative otitis media has always aroused discussions among otosurgeons.

In this article, we analyzed a series of clinical cases (10 patients) with chronic otitis media who underwent middle ear sanation surgery and cochlear implantation. In our opinion, a single-stage cochlear implantation together with a sanation intervention on the middle ear can be considered as a technique that allows to accelerate the auditory-speech rehabilitation of patients with stage IV sensorineural hearing loss and epitympanitis. This is especially important for patients with acquired pathology of the inner ear and the risk of ossification of the cochlea spiral canal.

Rhizarthrosis is an osteoarthritis of the trapezium-metacarpal joint, a common condition mainly affecting postmenopausal women, which has a significant impact on the quality of life and functionality of the hand. The thumb is critical for grasping and strength of the entire hand, and functional impairment of the thumb mobility in rhizarthrosis reduces hand function significantly. Despite its high prevalence and risk of disability, therapeutic options for rhizarthrosis remain limited. Treatment usually requires a multidisciplinary approach using a combination of non-pharmacological, pharmacological and surgical strategies. The literature review observes various surgical treatment options for rhizarthrosis, such as ligament reconstruction, tendon interposition, resection arthroplasty and joint replacement or arthrodesis.