ACUTE DECOMPENSATION OF HYPERTENSIVE HEART DISEASE IN PATIENT WITH MALIGNANT URINARY BLADDER PARAGANGLIOMA: STAGES OF DIAGNOSTICS AND TREATMENT

Hypertensive heart disease with biventricular cardiac failure is not common in clinical practice. This diagnosis requires an extensive diagnostic search. We present the clinical case of the male patient of 38 aged. He was admitted to the clinic with heart failure 3-4 NYHA class. EchoCG revealed symmetric hypertrophy of the left ventricle up to 18 mm without its dilatation, a decrease in ejection fraction up to 42%, restrictive hemodynamics, overload of the right chambers, severe pulmonary hypertension (60 mm Hg). The clinical status included persistent arterial hypertension (180-220 and 120-150 mm Hg), effusion in both pleural cavities and pericardium, ascites, renal failure. During examination (multispiral computed tomography, magnetic resonance imaging, scintigraphy with 131I-MIBG), bladder paraganglioma was diagnosed (normatenafrin 1468 μg/day). The resection of the tumor was performed, according to immunohistochemical research – neuroendocrine carcinoma, G1. After 3 months a partial regression of hypertension and cardiac failure was observed with the preservation of a high level of creatinine. The criteria and differential diagnosis of the hypertensive heart disease and the syndrome of primary myocardial hypertrophy, diagnostics of the urinary bladder paraganglioma, complex mechanisms of myocardial damage within the pheochromocytoma and its prognosis are discussed.

[The possibilities for the restoration of the laryngeal function: the current state-of-the-art]

The restoration of the functional competence of the larynx following bilateral laryngeal nerve damage and vocal fold paralysis is a serious challenge for the surgeon that has thus far no satisfactory solution. Physiological re-innervation that occurs naturally with time is non-selective and, in the majority of the cases, leads to synkinesis. Laryngeal pacing achieved with the application of the implantable microchips appears to be a promising approach. The animal experiments have demonstrated the possibility of successful restoration of all the functions of the larynx by means of laryngeal pacing but simultaneously revealed a number of technical issues that have to be addressed if the further progress in this field is to be achieved including the choice of the proper materials for implantation, solution of problems pertaining to the neuromuscular mapping during pacer implantation, etc.). The results of the first prospective clinical trial involving the human patients gave evidence suggesting that the laryngeal electrostimulation technology is both safe and efficient. Nevertheless, further investigations and modification of the method are needed before it can be recommended for the wider application in the routine clinical practice.

[Diagnosis and surgical treatment of adrenocortical cancer with invasion into great veins]

AIM

To estimate immediate and remote resaults of treatment of adrenocortical cancer with invasion into great veins.

MATERIAL AND METHODS

It was analyzed survey and treatment results in 3 patients with adrenocortical cancer and invasion into renal veins and inferior vena cava.

RESULTS

Radical surgery with tumoral thrombi removal from great vessels was performed in all cases. There were no complications and deaths in early postoperative period. Life expectancy after surgery was 6, 13 and over 58 months.

CONCLUSION

At present time surgical intervention for adrenocortical cancer with invasion into great veins is single method to prolong patients' life.

[Primary hyperaldosteronism: To the 50th anniversary of Conn's syndrome description]

In 2005, 50 years passed since Jerome Conn described arterial hypertension caused by hyperproduction of aldosterone by a tumor of the adrenal cortex.

[Moot and unsolved problems in diagnosis and surgical treatment of primary hyperaldosteronism (50 years since Conn's syndrome description)]

Personal and fifty-year world experience in diagnosis and treatment of primary hyperaldosteronism (PHA) is analyzed. The following problems are discussed: 1) possibility to use simplified diagnostic algorithm for diagnosis of PHA; 2) possibility to exclude march test from diagnostic algorithm; 3) role of selective venous blood sampling in PHA; 4) Indications for surgical treatment in PHA; 5) validity of surgical procedures for "portalization" of adrenal blood flow.

[Current aspects of diagnosis and treatment of symptomatic arterial hypertension of adrenal genesis]

AIM

To analyse the experience in diagnosis and treatment of arterial hypertension (AH) of adrenal genesis.

MATERIAL AND METHODS

A total of 243 patients with adrenal AH (mean age 46.3 +/- 3.2 years) were examined. 134 of them had endogenic adrenohypercorticism (EAH), 62--primary hyperaldosteronism (PHA), 47--chromaffin tissue tumors (CTT). Diurnal urinary excretion of adrenal hormones (epinephrine, norepinephrine, aldosteron, hydrocortisone) and peripheral blood hormones (aldosteron, renin, hydrocortisone, ACTH) were measured. Topic diagnosis was made with ultrasound, computed tomography, MR-imaging, angiography, adrenal venous sampling and 123I-MIBG scintigraphy.

RESULTS

Adrenalectomy was made in 224 patients (predominantly with tumor lesions). 19 patients (idiopathic hyperaldosteronism, advanced adrenocortical carcinoma) were treated conservatively (calcium antagonists, ACE inhibitors, AT1-receptor blockers, spironolacton). Good results of the surgical treatment were achieved in 60% patients with aldosterone-producing adenoma and adrenal Cushing's syndrome as well as in 80.5% patients with pheochromocytoma. Long-term outcomes depend on hypertension duration, histologic type of the tumor, age and family hypertension history (risk of essential hypertension).

CONCLUSION

Hypertension of adrenal origin occurs more frequently than it was supposed previously. Its late diagnosis may be due to lack of typical signs and symptoms, insufficient application of novel diagnostic techniques and poor alertness of physicians. It is recommended to include tests for adrenal hormones in urine and blood and ultrasound investigation of the adrenals in a complex of primary examination of patients with severe refractory hypertension.

[Diagnosis and surgical treatment of arterial hypertension of adrenal origin]

230 patients with arterial hypertension of adrenal origin were treated. 205 of them underwent adrenalectomy with surrounding paranephral fat. There were no lethal outcomes. Endogenic adrenocorticism was diagnosed in 134 patients. Cushing's syndrom was in 96 patients, Cushing's disease--in 34, ACTH-ectopic syndrome--in 2, adrenocortical cancer--in 2. Primary hyperaldosteronism was diagnosed in 42 cases: idiopathic hyperaldosteronism in 23 patients, aldosteronproducing adenoma (Conn's syndrome)--in 19. Tumors of chromaffine tissue were defected in 30 patients. All the patients underwent complex examination (hormonal profile, US, CT, MRT, angiography if it was necessary). Symptomatic arterial hypertension of adrenal origin was diagnosed during one year in 10% patients only because of absence of typical clinical picture. Use of complex examination has permitted to make a correct topical diagnosis and to choose optimum treatment policy in all the cases.