AIM To determine the influence of the time gap between acute myocardial infarction with ST-segment elevation and intracoronary intervention performed later than 2.5 hours on myocardium, we studied indicators of perfusion over time with an aid of SPECT, including intraventricular asynchrony (2-4 days and 6-8 months after stent installation). MATERIALS AND METhOD We observed 22 patients with multivessel coronary lesion. The Russian program with the analysis of perfusion, function and the phase images was used in SPECT synchronized with ECG. RESuLTS Showed that the time gap prior to coronary intervention in the acute phase of myocardial infarction may be directly connected with the increase in impaired perfusion during the end-systole and the severity of pathological intraventricular asynchrony without ECG signs. All patients had significantly decreased wall mobility and intraventricular asynchrony together with increased R-R interval in the late period (after 6-8 months) independently from the coronary intervention time. In patients of group 1 (coronary intervention within 6 hours), focal transmural lesions of myocardium significantly decreased. CONCLuSION Late revascularization help decrease intraventricular asynchrony reducing the risk of heart failure in future.

Relevance The problem of diagnosing and treating patients with acute ischemia of the extremities against the background of thrombosis and atherosclerotic lesions of the main arteries remains very complex task and requires the use of various diagnostic methods, and the leading one is radiation diagnostics.The aim of the study . The development of radionuclide patterns of acute lower limb ischemia and assessment of the treatment efficacy in angiosurgical patients using three-phase scintigraphy. Material and methods The radionuclide method was performed to examine 264 patients with acute thrombosis of the main arteries against the background of atherosclerotic lesions of the lower extremities arteries and clinical signs of acute ischemia of the lower extremities of I-III degree according to the classification of I.I. Zatevakhin.Results We defined quantitative and visual signs of acute ischemia, designed radionuclide semiotics, which allowed to detail the damaged tissue of lower extremities and evaluate the efficacy of the conservative or surgical treatment. The study contains clinical examples of patients with varying degrees of acute limb ischemia.Conclusion The developed radionuclide patterns of acute ischemia in thrombosis of main arteries of the lower extremities allowed to determine the level of arterial occlusion and the degree of acute ischemia, identify the areas of lack of blood supply and necrosis with no clinical signs at an early stage of formation and optimize the treatment strategy.

Objective. The study objective was to assess the scintigraphy potential in the evaluation of portal hypertension and the severity of liver damage in diffuse diseases and after liver transplantation.Material and methods. The study enrolled 325 patients suffering from hepatitis and liver cirrhosis of various etiology and severity, including those after liver transplantation, namely, the patients with hepatitis (n=96), patients with liver cirrhosis of Child–Pugh class A (n=24), class B (n=87), and class C (n=118); 11 more healthy volunteers without clinical and laboratory signs of diffuse liver disease were enrolled as controls. The assessment of liver reticuloendothelial system was performed by scintigraphy with (99m)Tc-phytate colloid in a static planar mode and "whole body" mode by SPECT (Infinia II, GE).Results. In contrast to the control group, significant radionuclide signs of hepatosplenomegaly were revealed with the predominant functional activity of the left lobe; the liver function was found impaired that correlated with the cirrhosis severity evaluated according to the Child–Pugh Сlassification. The analysis of scintigraphy quantitative parameters showed that the most informative of them were the intensity of radiopharmaceutical accumulation in the spleen (S%) and in bone marrow (Вm%), and the radiopharmaceutical uptake by the reticuloendothelial cells of the liver and spleen in percentage from the administered activity (Lwb%, Swb%). Depending on the cirrhosis severity assessed by the Child–Pugh Score, the changes in quantitative parameters were accompanied by a progressive enlargement of the spleen, liver left lobe, the increase of (99m)Tc-phytate uptake by the bone marrow with a decreased radiopharmaceutical uptake by the liver. The study results showed that among the Child–Pugh class C patients, the impairment of liver reticuloendothelial function was more pronounced in the patients with cirrhosis of viral and mixed etiology, when compared to those with alcoholic cirrhosis.Conclusion. The paper has identified the most informative parameters characterizing portal hypertension and the reticuloendothelial function for all Child–Pugh defined classes of cirrhosis. These parameters include the increase of (99m) Tc-phytate accumulation in the spleen (S%) and bone marrow (Bm%); the liver and spleen uptake of the radiopharmaceutical in percentage from the administered activity (Lwb%, Swb%). The calculation of the remaining parameters is necessary for a detailed description of the organ function and for the assessment of the portal hypertension severity in repeated studies.Summary. Criteria for the objective assessment of reticuloendothelial function and portal hypertension in diffuse liver diseases, including after liver transplantation, have been developed. Contrary to the control group, in patients with diffuse liver diseases, the radionuclide signs of hepatosplenomegaly (or a decreased liver size) with a predominant functional activity of the left lobe were identified, as were the changes in the quantitative parameters of the radiopharmaceutical uptake by the liver (Lwb%), including the radiopharmaceutical accumulation in the liver left lobe (Ll%), spleen (Swb%), bone marrow (Bm%), and the liver-to-spleen area ratio (Lar/Sar). The informative and reliable (p<0.05) parameters of the function Lwb%, S%, Swb% and Bm% correlating with the cirrhosis classes assessed by Child–Pugh were identified. The radionuclide method, being highly reproducible one, can be recommended for an objective assessment of liver function and the detection of portal hypertension in hepatitis and cirrhosis, as well as for post-transplant monitoring of the liver function to prevent complications in the early and late postoperative periods.

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