Abstract: Introduction: all over the world, the number of patients with peripheral arterial lesions is growing, the progression of the disease leads to the chronic limb-threatening ischemia (CLTI) with an increasement in mortality. To carry out revascularization, it is required to accurately determine the degree and length of lesions of arteries of limbs, with the creation of a «road map» of lesions and the choice of the least affected artery ? the target arterial pathway. Aim: was to determine the effectiveness of CT angiography in diagnosing lesions of shin arteries in patients with critical lower limb ischemia (CLI) by calculating its sensitivity and specificity in comparison with digital subtraction angiography. Materials and methods: the study included 26 patients (15 men and 11 women, average age of patients 69,3 ± 10,8 years) with critical lower limb ischemia, against the background of lesions of the femoro-popliteal segment of arteries, class D TASC II. All patients underwent CT angiography on a 64-spiral computed tomography scanner. Obtained data was compared with results of catheter angiography (digital subtraction angiography), used as a reference method. Results: the sensitivity of CT angiography in determining the degree of lesion (stenosis or occlusion) of leg arteries was 100% and 94%, the specificity was 83% and 96%, respectively. The overall accuracy of CT angiography in the tibial segment was 87% for stenoses and 94% for occlusions. According to results of CTA, massive calcification was detected in 13% of cases from the total number of analyzed arteries. When evaluating these arteries according to DSA data, most of arteries (11 of 12) were occluded, and the length of occlusions in 8 cases was maximum according to the GLASS classification (the length was more than 1/3 of the artery length). The presence of strong correlations between CT angiography and digital angiography on the presence of occlusions, stenoses> 50% and their length was determined. Conclusions: CT angiography is a highly informative method for diagnosing the degree and length of lesions of shin arteries in patients with critical lower limb ischemia. References 1. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators (2018). Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018; 392(10159): 1789-1858. https://doi.org/10.1016/S0140-6736(18)32279-7 2. Reinecke H, Unrath, M, Freisinger E, et al. Peripheral arterial disease and critical limb ischaemia: still poor outcomes and lack of guideline adherence. European heart journal. 2015; 36(15), 932-938. https://doi.org/10.1093/eurheartj/ehv006 3. National guidelines for the diagnosis and treatment of lower limb arterial diseases. Expert group for the preparation of recommendations: chairmen of the expert group Academician of the Russian Academy of Sciences Bokeria LA, Academician of the Russian Academy of Sciences Pokrovsky AV. Moscow, 2019 [In Russ]. http://www.angiolsurgery.org/library/recommendations/2019/recommendations_LLA_2019.pdf 4. Aboyans V, Ricco JB, Bartelink M, et al. ESC Scientific Document Group (2018). 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries Endorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). European heart journal. 2018; 39(9): 763-816. https://doi.org/10.1093/eurheartj/ehx095 5. Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg. 2007; 33 (1): 1-75. https://doi.org/doi:10.1016/j.ejvs.2006.09.024 6. Conte MS, Bradbury AW, Kolh P, et al. Global vascular guidelines on the management of chronic limb-threatening ischemia. J Vasc Surg. 2019; 69(6S): 3-125. https://doi.org/doi:10.1016/j.jvs.2019.02.016 7. Pokrovsky AV, Yakhontov DI. The value of assessing the outflow tract in femoral-tibial reconstructions. Rossijskij Mediko-biologicheskij vestnik im. akademika I.P. Pavlova. 2013; 4: 104-112 [In Russ]. 8. Hamburg NM, Creager MA. Pathophysiology of Intermittent Claudication in Peripheral Artery Disease. Circulation journal: official journal of the Japanese Circulation Society. 2017; 81(3): 281-289. https://doi.org/10.1253/circj.CJ-16-1286 9. Bollinger A, Breddin K, Hess H, et al. Semiquantitative assessment of lower limb atherosclerosis from routine angiographic images. Atherosclerosis. 1981; 38(3-4): 339-346. https://doi.org/doi:10.1016/0021-9150(81)90050-2 10. Rutherford RB, Baker JD, Ernst C, et al. Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg. 1997; 26(3): 517-538. https://doi.org/doi:10.1016/s0741-5214(97)70045-4 11. Graziani L, Silvestro A, Bertone V, et al. Vascular involvement in diabetic subjects with ischemic foot ulcer: a new morphologic categorization of disease severity. Eur J Vasc Endovasc Surg. 2007; 33(4): 453-460. https://doi.org/doi:10.1016/j.ejvs.2006.11.022 12. Radiation diagnostics of diseases of the heart and blood vessels. National leadership. (Ed. by LS Kokov; SK Ternovoj.) Moscow, GEOTAR-Media, 2011; 688 [In Russ]. 13. ?urovi? Sarajli? V, Toti? D, Bi?o Osmanagi? A, et al. Is 64-Row Multi-Detector Computed Tomography Angiography Equal to Digital Subtraction Angiography in Treatment Planning in Critical Limb Ischemia? Psychiatr Danub. 2019; 31(5): 814-820. 14. Al-Rudaini HEA, Han P, Liang H. Comparison Between Computed Tomography Angiography and Digital Subtraction Angiography in Critical Lower Limb Ischemia. Curr Med Imaging Rev. 2019; 15(5): 496-503. https://doi.org/doi:10.2174/1573405614666181026112532 15. Lim JC, Ranatunga D, Owen A, et al. Multidetector (64+) Computed Tomography Angiography of the Lower Limb in Symptomatic Peripheral Arterial Disease: Assessment of Image Quality and Accuracy in a Tertiary Care Setting. J Comput Assist Tomogr. 2017; 41(2): 327-333. https://doi.org/doi:10.1097/RCT.0000000000000494 16. Mohler ER, Jaff MR Peripheral Artery Disease 2nd Edition. Wiley-Blackwell. 2017; 208. 17. Ayubova NL, Bondarenko ON, Galstyan GR, et al. Peculiarities of lesions of the arteries of the lower extremities and clinical outcomes of endovascular interventions in patients with diabetes mellitus with critical ischemia of the lower extremities and chronic kidney disease. Saharnyj diabet. 2013; (4): 85-94 [In Russ]. 18. Molitvoslovova NA, Manchenko OV, Jaroslavceva MV, et al. The relationship of calcification of the arteries of the lower extremities with the severity of distal neuropathy in patients with diabetes mellitus. Problemy jendokrinologii. 2013; 59(2): 7-11 [In Russ]. https://doi.org/10.14341/probl20135927-11 19. Konijn LCD, Takx RAP, de Jong PA, et al. Arterial calcification and long-term outcome in chronic limb-threatening ischemia patients. Eur J Radiol. 2020; 132: 109305.
Abstract: Introduction: congenital portosystemic venous shunts (CPVS) are rare vascular abnormalities that occur secondary to abnormal development or involution of fetal vasculature. They allow intestinal blood to enter the systemic circulation, bypassing the liver, which in the long term leads to various symptoms and complications. Today, thanks to advanced imaging techniques, the number of reported cases of CPVS is increasing, although for the most part these are single clinical cases or reports summarizing small series of cases. The overall incidence of CPVS is estimated at 1:30 000 births and 1:50 000 for those persisting beyond early childhood. Material and methods: article consists of 44 foreign literature sources, that highlight pathogenesis, classification, clinical picture, diagnosis and treatment of CPVS. Conclusion: early diagnosis and correction of this anomaly using any (endovascular or surgical) occlusion regresses symptoms and prevents long-term complications. At present, given the rarity of this pathology, there is no large statistical analysis and no standards, developed for the management of this category of patients. However, further collection of material, an emphasis on the pathophysiology and anatomy of these lesions, will help to provide more effective care for patients with congenital portosystemic venous shunts. References 1. Kim MJ, Ko JS, Seo JK, et al. Clinical features of congenital portosystemic shunt in children. Eur J Pediatr. 2012; 171(2): 395-400. 2. Florio F, Nardella M, Balzano S, et al. Congenital intrahepatic portosystemic shunt. Cardiovasc Intervent Radiol. 1998; 21(5): 421-424. 3. Baiges A, Turon F, Simуn-Talero M, et al. Congenital Extrahepatic Portosystemic Shunts (Abernethy Malformation): An International Observational Study. Hepatology. 2020; 71(2): 658-669. https://doi.org/10.1002/hep.30817 4. Ольхова Е.Б., Туманян Г.T., Венгерская Г.В. и др. Мальформация Абернети у новорожденных. Эхографическая диагностика. Радиология-практика. 2015; 5(54): 46-58. Olkhova EB, Tumanyan GT, Hungarian GV, et al. Abernathy malformation in newborns. Echographic diagnostics. Radiology-practice. 2015; 5 (54): 46-58 [In Russ]. 5. Малышева Е.Б., Захарова Е.М., Рыхтик П.И., Жулина Н.И. Мальформация Абернетти - редкая причина гемодинамического цирроза печени. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. Приложение. 2017; 27(1) S49; 48. Malysheva EB, Zakharova EM, Rykhtik PI, Zhulina NI. Abernetty's malformation is a rare cause of hemodynamic cirrhosis of the liver. Russian journal of gastroenterology, hepatology, coloproctology. Application. 2017; 27(1) S49; 48 [In Russ]. 6. Abernethy J. Account of two instances of uncommon formation in the viscera of the human body. Philos Trans R Soc Lond B Biol Sci. 1793; 83: 59-66. 7. Sokollik C, Bandsma RH, Gana JC, et al. Congenital portosystemic shunt: characterization of a multisystem disease. J. Pediatr. Gastroenterol. Nutr. 2013; 56(6): 675-681. 8. Gu?rin F, Blanc T, Gauthier F, et al. Congenital portosystemic vascular malformations. Semin. Pediatr. Surg. 2012; 21(3): 233-244. 9. Bernard O, Franchi-Abella S, Branchereau S, et al. Congenital portosystemic shunts in children: recognition, evaluation, and management. Semin Liver Dis. 2012; 32(4): 273-287. 10. Lin ZY, Chen SC, Hsieh MY, et al. Incidence and clinical significance of spontaneous intrahepatic portosystemic venous shunts detected by sonography in adults without potential cause. J Clin Ultrasound. 2006; 34(1): 22-26. 11. Gitzelmann R, Forster I, Willi UV. Hypergalactosaemia in a newborn: self-limiting intrahepatic portosystemic venous shunt. Eur J Pediatr. 1997; 156: 719-722. 12. Ponziani FR, Faccia M, Zocco MA, et al. Congenital extrahepatic portosystemic shunt: description of four cases and review of the literature. J Ultrasound. 2019; 22(3): 349-358. https://doi.org/10.1007/s40477-018-0329-y 13. De Paula Oliveira GJ, Ferreira S, Barbosa A. Abernethy Malformation – Congenital Extra-hepatic Portosystemic Shunt Associated with Multiple Liver Adenomatosis: Case Report. Universal Journal of Public Health. 2019; 7(3): 129-137. 14. Nagata H, Yamamura K, Ikeda K. Balloon-occluded retrograde transvenous obliteration for congenital portosystemic venous shunt: report of two cases. Pediatr Int. 2012; 54(3): 419-421. https://doi.org/10.1111/j.1442-200X.2011.03459.x 15. Passalacqua M, Lie KT, Yarmohammadi H. Congenital extrahepatic portosystemic shunt (Abernethy malformation) treated endovascularly with vascular plug shunt closure. Pediatr Surg Int. 2012; 28(1): 79-83. https://doi.org/10.1007/s00383-011-2944-y 16. Raghuram KA, Bijulal S, Krishnamoorthy KM, Tharakan JA. Regression of pulmonary vascular disease after therapy of Abernethy malformation in visceral heterotaxy. Pediatr Cardiol. 2013; 34(8):1882-5. https://doi.org/10.1007/s00246-012-0428-z 17. DiPaola F, Trout AT, Walther AE, et al. Congenital Portosystemic Shunts in Children: Associations, Complications, and Outcomes. Dig Dis Sci. 2020; 65(4): 1239-1251. https://doi.org/10.1007/s10620-019-05834-w 18. Ogul H, Bayraktutan U, Yalcin A, et al. Congenital absence of the portal vein in a patient with multiple vascular anomalies. Surg Radiol Anat. 2013; 35(6): 529-534. https://doi.org/10.1007/s00276-012-1059-z 19. Morgan G, Superina R. Congenital absence of the portal vein: two cases and a proposed classification system forportasystemic vascular anomalies. J Pediatr Surg. 1994; 29(9):1239-1241. 20. Glonnegger H, Schulze M, Kathemann S, et al. Case Report: Hepatic Adenoma in a Child With a Congenital Extrahepatic Portosystemic Shunt. Front Pediatr. 2020; 8: 501. https://doi.org/10.3389/fped.2020.00501 21. Raskin NH, Price JB, Fishman RA. Portal-systemic encephalopathy due to congenital intrahepatic shunts. The New England Journal of Medicine. 1964; 270: 225-229. 22. Park JH, Cha SH, Han JK, Han MC. Intrahepatic portosystemic venous shunt. Am J Roentgenol. 1990; 155: 527-528. 23. Senocak E, O?uz B, Edgьer T, Cila A. Congenital intrahepatic portosystemic shunt with variant inferior right hepatic vein. Diagn Interv Radiol. 2008; 14: 97-99. 24. Niwa T, Aida N, Tachibana K, et al. Congenital absence of the portal vein: clinical and radiologic findings. J Comput Assist Tomogr. 2002; 26(5): 681-6. https://doi.org/10.1097/00004728-200209000-00003 25. Kobayashi N, Niwa T, Kirikoshi H, et al. Clinical classification of congenital extrahepatic portosystemic shunts. Hepatol Res. 2010; 40(6): 585-93. https://doi.org/10.1111/j.1872-034X.2010.00667.x 26. Benedict M, Rodriguez-Davalos M, Emre S, et al. Congenital Extrahepatic Portosystemic Shunt (Abernethy Malformation Type Ib) With Associated Hepatocellular Carcinoma: Case Report and Literature Review. Pediatr Dev Pathol. 2017; 20(4): 354-362. https://doi.org/10.1177/1093526616686458 27. Kroencke T, Murnauer M, Jordan FA, et al. Radioembolization for Hepatocellular Carcinoma Arising in the Setting of a Congenital Extrahepatic Portosystemic Shunt (Abernethy Malformation). Cardiovasc Intervent Radiol. 2018; 41(8): 1285-1290. https://doi.org/10.1007/s00270-018-1965-5 28. Alonso-Gamarra E, Parr?n M, P?rez A, et al. Clinical and radiologic manifestations of congenital extrahepatic portosystemic shunts: a comprehensive review. Radiographics. 2011; 31(3): 707-722. https://doi.org/10.1148/rg.313105070 29. Brasoveanu V, Ionescu MI, Grigorie R, et al. Living Donor Liver Transplantation for Unresectable Liver Adenomatosis Associated with Congenital Absence of Portal Vein: A Case Report and Literature Review. Am J Case Rep. 2015; 16: 637-644. https://doi.org/10.12659/AJCR.895235 30. Duprey J, Gouin B, Benazet MF, le Gal J. Glucose intolerance and post-stimulative hypoglycaemia secondary to congenital intra-hepatic porto-caval anastomosis. Annales de Medecine Interne. 1985; 136(8): 655-658. 31. Watanabe A. Portal-systemic encephalopathy in non-chirrotic patients: classification of clinical types, diagnosis and treatment. Journal of Gastroenterology and Hepatology. 2000; 15(9): 969-979. 32. Murray CP, Yoo SJ, Babyn PS. Congenital extrahepatic portosystemic shunts. Pediatric Radiology. 2003; 33(9): 614-620. 33. Nishimura Y, Tajima G, Dwi Bahagia A, et al. Differential diagnosis of neonatal mild hypergalactosaemia detected by mass screening: clinical significance of portal vein imaging. Journal of Inherited Metabolic Disease. 2004; 27(1): 11-18. 34. Eroglu Y, Donaldson J, Sorensen LG, et al. Improved neurocognitive function after radiologic closure of congenital portosystemic shunts. Journal of Pediatric Gastroenterology and Nutrition. 2004; 39(4): 410-417. 35. Emre S, Amon R, Cohen E, et al. Resolution of hepatopulmonary syndrome after auxiliary partial orthotopic liver transplantation in Abernethy malformation. A case report. Liver Transplantation. 2007; 13(12): 1662-1668. 36. Kim MJ, Ko JS, Seo JK, et al. Clinical features of congenital portosystemic shunt in children. European Journal of Pediatrics. 2012; 171(2): 395-400. 37. Timpanaro T, Passanisi S, Sauna A, et al. Congenital portosystemic shunt: our experience. Case Rep Pediatr. 2015; 691618. https://doi.org/10.1155/2015/691618 38. Chocarro G, Amesty MV, Encinas JL, et al. Congenital Portosystemic Shunts: Clinic Heterogeneity Requires an Individual Management of the Patient. Eur J Pediatr Surg. 2016; 26(1): 74-80. https://doi.org/10.1055/s-0035-1566097 39. Achiron R, Kivilevitch Z. Fetal umbilical-portal-systemic venous shunt: in utero classification and clinical significance. Ultrasound Obstet Gynecol. 2016; 47: 739-747. https://doi.org/10.1002/uog.14906 40. Franchi-Abella S, Gonzales E, Ackermann O, et al. Congenital portosystemic shunts: diagnosis and treatment. Abdom Radiol (NY). 2018; 43(8): 2023-2036. https://doi.org/10.1007/s00261-018-1619-8 41. Musa J, Madani K, Saliaj K, et al. Asymptomatic presentation of a congenital malformation of the portal vein with portosystemic shunt. Radiol Case Rep. 2020; 15(10): 2009-2014. https://doi.org/10.1016/j.radcr.2020.07.076 42. Back SJ, Maya CL, Khwaja A. Ultrasound of congenital and inherited disorders of the pediatric hepatobiliary system, pancreas and spleen. Pediatr Radiol. 2017; 47: 1069-1078. https://doi.org/10.1007/s00247-017-3869-y 43. Nam HD. Living-donor liver transplantation for Abernethy malformation - case report and review of literature. Ann Hepatobiliary Pancreat Surg. 2020; 24(2): 203-208. https://doi.org/10.14701/ahbps.2020.24.2.203 44. Papamichail M, Pizanias M, Heaton N. Congenital portosystemic venous shunt. Eur J Pediatr. 2018; 177(3): 285-294.
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Abstract: According to American Cancer Society lung cancer is the main "killer" among all types of cancer, five year survival rate of these patients in less than 15%. Thorough staging is necessary to make prognosis of disease and choose the way of treatment. In 2009 International Association for the Study of Lung Cancer ( IASLC) published the 7th system of lung cancer staging based on TNM classification data. Defining of lung cancer and its staging is an interdisciplinary process. Moreover clinical, endoscopic and radiological data are used for this purpose. Among them, the multislice computed tomography is a leading method for lung cancer staging. References 1. Sobin L.H., Gospodarovich M.K., Vittekind K. TNM-classification of malignant tumors. [TNM-classification of malignant tumors.]. Logosfera, M., 2011; 122-134 [In Russ]. 2. Robert D.Su, Nanett A.Le, Kjetlin Braun i Majil S.Krishnam. Continous medical education: basic staging of lung cancer.. Novaja TNM-klassifikacija [Continous medical education: basic staging of lung cancer.]. Radiographics 2010; 30(5):1163-1181 [In Russ]. 3. Lung Cancer Staging Essentials: The New TNM Staging System and Potential Imaging Pitfalls. RadioGraphics Sep 2010; 30(5):1163-1181. 4. Vershchakelen J.A., Bogaert J., De Wever W. Computed tomography in staging for lung cancer. Eur. Respir. J. 2002;40-48. 5. Edward W. Bouchard, Steven Falen, MD, Paul L. Molina. Lung cancer: A radiologic overview. Аpplied radiology. 2008; [Edward W. Bouchard, Steven Falen, Paul L. Molina. Radiology plays a critical role in the detection, diagnosis, and staging of thoracic malignancies. This article reviews the use of chest radiography (CXR), computed http://www.applied-radiology.com/ Issues/2002/08/Articles/Lung-Cancer-A-radiologic-overview.aspx www.appliedradiology.com 6. Matias Prokop, Mihajel' Galanski. Spiral and multislice computed tomography. Kompjuternaja tomografija [Spiral and multislice computed tomography]. «MEDpress-inform» M., 2007; 2: 92-104 [In Russ]. 7. Richard Webb W., Charles B. Higgins. Thoracic imaging. Pulmonary and Cardiovasular Radiology. Lippincott Williams and Wilkins 2005; 66-111. 8. Valerie W. Rusch, Hisao Asamura, Hirokazu Watanabe, Dorothy J. Giroux, Ramon Rami-Porta, Peter Goldstraw, on Behalf of the members of the IASLC Staging Committee. The IASLC Lung Cancer Staging Project/ A Proposal for a New International Lymph Node Map in The Forthcoming Seven Edition of the TNM Classification for Lung Cancer. Journal of Thoracic Oncology. 2009; 4(5):568-577. 9. Tjurin I.E. «Computed tomography of thoracic organs . SPb.:JeLBI-SPb [Computed tomography of thoracic organs]. 2003; 235-265 [In Russ].
Abstract: Aim: was to evaluate possibilities of using of ultrasound classification of subcutaneous rupture of the Achilles tendon (AT) for hospital clinical practice. Materials and methods: we examined 11 patients (9 men and 2 women). Clinical and X-ray examinations were done. Ultrasound examination was done by the standard method; modern sonographic classification of the rupture of AT was done with functional probe Results: clinical signs of subcutaneous rupture of AT were obtained in each patient. According to sonographic classification, complete AT rupture was found in 27,2% patients (3 of 11), incomplete rupture was found in 72,8% (8 of 11). Tendinosis signs were found in 37,5% patients (3 of 8) with incomplete rupture. Conclusions: obtained data prove the effectiveness of ultrasound method of diagnosis of subcutaneous rupture of AT, in detection various variants of its trauma. It is important for optimization of treatment strategy. References 1. Hess G.W. Achilles tendon rupture: a review of etiology, population, anatomy, risk factors, and injury prevention. Foot Ankle Spec. 2010; 3(1): 29-32. 2. Jarvinen T.A., Kannus P, Paavola M. et al. Achilles tendon injuries. Curr. Opin. Rheumatol. 2001;13(2): 150-155. 3. Schepsis A.A., Jones H., Haas A.L. Achilles tendon disorders in athletes. Am. J. Sports Med. 2002; 30(2): 287-305. 4. Miller T.T. Common tendon and muscle injuries: lower extremity. Ultrasound Clin. 2007; 2(4):595-615. 5. Es'kin N.A. Ul'trazvukovaja diagnostika v travmatologii i ortopedii [Ultrasound diagnostics in traumatology and orthopedics]. M.: Social'no-politicheskaja mysl'. 2009; 440 s [In Russ]. 6. Robinson P Sonography of common tendon injuries. Am. J. Roentgenol. 2009;193(3): 607-618. 7. Hartgerink P, Fessell D.P, Jacobson J.A., van Holsbeeck M.T. Full versus partial-thickness Achilles tendon tears: sonographic accuracy and characterization in 26 cases with surgical correlation. Radiology. 2001; 220(2):406-412. 8. 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Function after Achilles tendon rupture in the elderly: 25 patients older than 65 years followed for 3 years. Acta Orthop. Scand. 2000; 71: 64-68. 15. Wijesekera N.T., Calder J.D., Lee J.C. Imaging in the Assessment and Management of Achilles Tendinopathy and Paratendinitis. Seminar in musculoskeletal Radiology. 2011; 15(1): 89-100. 16. Koryshkov S.M., Platonov S.V. i dr. Lechenie zastarelyh povrezhdenij pjatochnogo (ahillova) suhozhilija [ Treatment of old lesions of Achilles tendon]. Travmatologija i ortopedija Rossii. 2012; 2 (64): 34-40 [In Russ]. 17. Amlang M.H., Zwipp H., Friedrich A. et al. Clinical Study. Ultrasonographic Classification of Achilles Tendon Ruptures as a Rationale for Individual Treatment Selection. International Scholarly Research Network ISRN Orthopedics Volume, 2011, Article ID 869703, 10 pages doi:10.5402/2011/869703. 18. Bertolotto M., Perrone R., Martinoli C. et al. High resolution ultrasound anatomy of normal Achilles tendon. Br. J. 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Abstract: Aim: was to develop a classification of osteonecrosis of the midface, based on clinical and radiological examinations. Such classification can allow to make detailed planning of surgical intervention tactics and develop criteria for surgical intervention basing on the bone division of the facial skeleton, as well as to assess dynamics of changes in bones of the facial skull. Materials and methods: the study included 87 drug-addicted patients with a diagnosis of «toxic phosphate osteonecrosis». All patients underwent clinical and radiological examination. Basing on MSCT data, tactics of surgical treatment was determined. Results: basing on results of clinical and radiological methods of examination in 29 cases (33%) we observed toxic phosphate osteonecrosis of the upper and lower jaw. In 18 patients (21%) the disease occurred only in the upper jaw. Lesion of the upper jaw within the I and II parts below the infraorbital foramen was observed in 39 cases (45%). Lesion of the maxilla above the infraorbital foramen was determined in 8 cases (9%). In case of diffuse lesions of the maxilla in 23 cases (26%), different patterns of midface were involved in pathologic process. Conclusion: creation and application in clinical practice of this classification of osteonecrosis of the midface bone in patients with drug-addiction on desomorphine and pervitin, based on the data of MSCT, allowed to pinpoint boundaries and the nature of the defeat of facial bones and choose the best tactics of surgical treatment in all patients. References 1. Malanchuk V.O., Kopchak A.V., Brodec'kyj I.S. Klinichni osoblyvosti osteomijelitu shhelep u hvoryh z narkotychnoju zalezhnistju [Clinical features of osteomyelitis of the skull in patients with drug addiction]. Ukr. med. chasopys. 2007; 4 (60): 111-117 [In Ukr]. 2. Barannik N.G., 3. Malanchuk V.O., Brodec'kyj I.S., Zabuds'ka L.R. Osoblyvosti rentgenologichnoi' kartyny osteomijelitu shhelep u hvoryh na foni narkotychnoi' zalezhnosti [Radiographic features of osteomyelitis of the skull in patients on the background of drug addiction]. Ukr. med. chasopys. 2009; 2 (70): 122-125 [In Ukr]. 4. 5. Ivashhenko A.L., Matros-Taranec I.N., Priluckij A.S. Sovremennye aspekty jetiopatogeneza, klinicheskoj kartiny i lechenija ostemielitov cheljustej u pacientov s narkoticheskoj zavisimost'ju i VICh-infekciej [Modern aspects of the etiopathogenesis, clinicals and treatment of osteomyelites of jaws in patients with drug-addiction and a hiv-infection]. Zbirnikstatej. 2009: 1 (13): 213-219 [In Russ]. 6. Malanchuk V. A., Brodeckij I.S. Kompleksnoe lechenie bol'nyh osteomielitom cheljustej na fone narkoticheskoj zavisimosti [Complex treatment of patients with osteomyelitis of jaws on background of drug-addiction]. Vestnik VGMU. 2014; 2 (13): 115-123 [In Russ]. 7. 8. Medvedev Ju.A, Basin E.M., Sokolina I.A. Kliniko-rentgenologicheskaja klassifikacija osteonekroza nizhnej cheljusti [Clinical and X-ray classification of osteonecrosis of the lower jaw]. Vestnik rentgenologii i radiologii. 2013; 5: 21-25 [In Russ]. 9. Lesovaja I.G., Himenko V.M., Himenko V.V. Clinical experience in providing specialized aid to patients with atypical course of odontogenic osteomyelitis suffering from drug addiction and acquired immunodeficiency syndrome. Materialy Vseukrainskoj nauchno-prakticheskoj konferencii «Novye tehnologii v stomatologii i cheljustno-licevoj hirurgii» [Materials of Ukrainian scientific-practical conference «New technologies in stomatology and maxillofacial surgery»]. Har'kov. 2006; 77-82 [In Russ]. 10. Timofeev A.A., Dakal A.V. Klinicheskoe techenie gnojno- vospalitel'nyh zabolevanij cheljustej i mjagkih tkanej cheljustno-licevoj oblasti u bol'nyh, upotrebljajushhih narkotik «vint» [Clinical course of purulent inflammatory diseases of jaws and soft tissues of the maxillofacial area in patients using «vint»-drug]. Sovremennaja Stomatologija. 2010; 1: 96-102 [In Russ]. 11. Pogosjan Ju.M., Akopjan K.A., Gasparjan L.L.. Rentgenodiagnostika osteonekroza cheljustej u bol'nyh, upotrebljajushhih narkoticheskoe sredstvo «krokodil» [Radiographic diagnosis of jaw osteonecrosis at patients who use the drug «krokodil»]. Voprosy teoreticheskoj i klinicheskoj mediciny. 2013; 2 (78): 44-49 [In Russ]. 12. Ruzin G.P., Tkachenko O.V. Klinicheskie projavlenija toksicheskogo ostemielita v zavisimosti ot davnosti upotreblenija narkotika [Clinical symptoms of toxic osteomyelitis in connection on the time of drug use]. Ukrai'ns'kyj stomatologichnyj al'manah. 2015; 1: 47-52 [In Russ].
