Objective: to investigate the impact of smoking on radiological outcomes in patients after one- and two-level total arthroplasty (ТА) of the cervical intervertebral discs.

Material and methods. A single-center retrospective observational cohort study was performed. The study included 127 medical records of patients who had undergone one- or two-level TA of the cervical intervertebral discs for their degenerative disease. The medical records were divided into two groups: 32 smokers and 95 nonsmokers.

Results. No statistically significant differences were found in the values of cervical lordosis and the movement amplitude of the operated segments in the postoperative period. Comparing the values of the movement amplitude of the operated segments in the group of smoking patients demonstrated significant pre- and postoperative differences in the values of the above radiological parameter (p = 0.017). Comparing the rates of loss of segmental motion of the operated segments and the incidence of heterotopic ossification did not reveal any significant differences. Analysis of Kaplan-Meier curves showed no statistically significant differences between the types of implants used in smoking patients.

Conclusion. Smoking has no statistically significant impact on radiological outcomes in patients after one- or two-level ТА of the cervical intervertebral discs.

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.

Objective: to study the results of treatment in patients with direct high-flow carotid-cavernous fistulas with their transarterial occlusion using detachable balloons and microcoils.

Material and methods. Thirty-five patients underwent surgery using detachable balloons and microcoils. The clinical picture in all patients was represented by pulsating exophthalmos, ptosis on the side of the lesion, ophthalmoplegia, and conjunctival chemosis.

Results. In all patients closure of carotid-cavernous fistulas and reversal of symptoms were achieved after primary surgery. Internal carotid artery reconstruction with microcoils could be achieved significantly more often than that with balloons. An anastomotic recurrence was significantly more common in patients undergoing surgery with balloons.

Conclusion. The use of microcoils allows to perform reconstructive surgery significantly more frequently, while the recurrence rate is significantly lower than after using the balloons.

Objective. Submaximal myocardial hyperemia is known not to be achieved in 16-18% of cases during cardiac stress tests and monotonic intracubital administration of adenosine triphosphate (ATP) at a dose of 140-160 pg/kg/min. The authors set a task to elaborate a new algorithm for stress echocardiography (SEchoCG) with ATP, providing for the possibility of a stepwise increase in the dosage of the drug, as well as to test it in healthy individuals and patients with coronary heart disease (CHD).

Material and methods. The authors elaborated a new algorithm for SEchoCG on the basis of an analysis of the main science databases and their first own experience in using ATP during SEchoCG. The key provisions of the new algorithm were: (a) the exercise test consisted of 3 stages (EchoCG data should be recorded before, during, and 5 minutes after ATP infusion); (b) the criterion for achieving submaximal myocardial hyperemia during ATP administration is a systolic blood pressure (SBP) reduction of 5 and more mm Hg; (c) EchoCG was usually recorded at Stage 2 of the test 3 minutes after the start of ATP administration and with a decline in SBP; (d) the initial dose of ATP administration was 140 pg/kg/min; if SBP did not decrease at 3 minutes of the drug administration, the dosage should be first increased up to 175 pg/kg/ min at 1 minute; if there was no effect, the dosage should be increased up to 210 pg/kg/min at another 2-3 minutes. The algorithm was tested in 9 healthy volunteers, and in 26 patients with CHD.

Results. Testing the new algorithm showed that all cases achieved submaximal myocardial hyperemia. SBP decreased below 90 mm Hg in 2 patients; 1 patient developed second-degree atrioventricular block; however, a simple decrease in the ATP infusion rate within 30 sec leveled this symptomatology. The SEchoCG data acceptable for the subsequent analysis of myocardial contractility and deformation could be recorded in all the examinees.

Conclusion. The new algorithm for SEchoCG with ATP is effective in recording EchoCG findings. To have a final decision on the safety and information value of a new stress test protocol, it may be recommended to further test those in larger groups of patients during SEchoCG and in the use of other imaging procedures to assess myocardial contractility and perfusion.

Objective. Instability of the vertebral motion segments is a very urgent problem of medicine, since it has very serious consequences. Today, search for optimal diagnostic methods continues. The authors propose a new diagnostic technique - functional multislice computed tomography (fMSCT). The objective of the study was to investigate the efficiency of the technique versus radiography.

Material and methods. The new technique was used to examine 35 patients with a referral diagnosis of cervical spinal instability, who had previously undergone cervical spine radiography in the frontal and lateral projections.

Results. Instability of the spinal motion joints in its clinical manifestations is similar to the hypermobility of the cervical spine. According to the results of fMSCT, the occurrence of signs of instability and hypermobility was assessed. When performing fMSCT, compression of the spinal canal was detected in 48.6% of patients, compression of the spinal roots was revealed in 85.7%. Violation of the integrity of the anterior and posterior support complexes was registered in 11.4% and 97.1% of patients, respectively.

Conclusion. The developed fMSCT technique allows to accurately assess both the statics and dynamics of the spine and, unlike radiography, to diagnose ventral and dorsal vertebral displacements. The technique is recommended for widespread use in clinical practice.

Objective: to conduct a comparative assessment of the pharmacoeconomic advantages of using gadobutrol in comparison with half-molar (0.5 M) gadolinium chelates for the diagnosis of multiple sclerosis (MS).

Material and methods. A calculator was developed in Microsoft Excel, in which the number of exacerbations of multiple sclerosis was obtained when using one-molar (1.0 M) gadolinium-based contrast agents (GBCAs) and 0.5 M gadolinium chelates, and pharmacoeconomical results were analyzed by conducting a cost analysis and a budget impact analysis. The analysis took into account only direct medical costs (research costs (administering of GBCAs) and hospitalization costs due to exacerbations) funded under the mandatory health insurance system. The results have been calculated for a cohort of 1.000 patients.

Results. The analysis of pharmacoeconomic effectiveness showed that magnetic resonance studies of the central nervous system using gadobutrol were characterized by a reduction in the number of MS exacerbations by 70 cases. In the cost analysis the use of gadobutrol in both patients less than 75 kg (7.5 ml administered volume) and more than 75 kg (15 ml administered volume) demonstrated a reduction in total costs compared to 0.5 M gadolinium chelates (gadodiamide, gadoteric acid, and gadoteridol). Budget impact analysis showed that the transfer of 1.000 patients with studies using 0.5 M GBCAs on the gadobutrol due to the reduction in the incidence of MS exacerbations leads to budgetary savings in the group of patients under 75 kg from 4.264.610 to 6.565.827 RUB, and in patients more than 75 kg from 2.267.767 to 6.870.201 RUB.

Conclusion. As a result of pharmacoeconomical modeling, it was found that the use of gadobutrol for central nervous system studies for the diagnosis of MS in comparison with using 0.5 GBCAs can reduce the number of MS exacerbations and lead to money savings.

Carotid-cavernous fistulas (CCFs) are spontaneous or acquired communications between the internal carotid artery (ICA) and the cavernous sinus, which can be classified as direct or indirect. Direct fistulas between the ICA and the cavernous sinus can arise from injury, rupture of intracavernous carotid aneurysm, collagen deficiency syndrome, artery dissection, fibromuscular dysplasia, and direct surgical trauma. The symptoms caused by CCF are related to their size, duration, location, the direction of venous outflow, and the presence of arterial and venous collaterals. The goal of treatment for direct CCFs is to close the defect between the ICA and the cavernous sinus while maintaining the patency of the ICA. This goal can be achieved either by transarterial fistula occlusion using a removable balloon, transarterial or transvenous occlusion of the ipsilateral cavernous sinus with coils or other embolic material, or by implanting a covered stent in the fistula area. The choice of a method for CCF treatment remains relevant. The paper describes a clinical case of successful endovascular treatment for post-traumatic recanalized CCF in a patient with obvious ophthalmic manifestations as pulsating exophthalmos, conjunctival chemosis, and ischemic optic neuropathy of the right eye. Previously, the patient had undergone endovascular CCF embolization with coils and ICA reconstruction with flow diverting stents. Fistula embolization was performed with coils via transvenous access. In the opinion of the authors, the use of venous access in this case allowed them to perform total occlusion of the recanalized fistula and to achieve good angiographic and clinical results in the long-term period.