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Abstract:

Background: pulmonary embolism (PE), is one of the most common cardiopulmonary pathologies in the world, has a high risk of developing after major operations on the osteoarticular system. Mortality from PE remains high, ranking third after myocardial infarction and stroke.

Aim: was to identify tomographic signs of PE in patients with osteoarticular pathology in the postoperative period.

Materials and methods: we analyzed results of computed angiopulmonography of 11 patients with suspicion on pulmonary embolism who were operated on osteoarticular pathology at the Federal Center for Traumatology, Orthopedics and Endoprosthetics of the Ministry of Health of the Russian Federation (Cheboksary). Patients showed such indirect signs of PE as discshaped atelectasis of lung tissues, expansion of diameter of pulmonary trunk and right pulmonary artery, signs of congestion in pulmonary circulation and pulmonary hypertension. Direct radiological signs included occlusion of a branch of pulmonary artery by thrombus.

Results: in 91% of examined patients, occlusion of branch of pulmonary artery by thrombus was detected, in 82% of cases - the defeat of branches of right pulmonary artery. Embolism at the level of lobar arteries was detected in 30%, segmental branches - in 60% of patients; signs of pulmonary embolism of one of subsegmental branches of right pulmonary artery - in one patient (10%). Bilateral thrombosis was observed in two patients, including massive bilateral PE in one case. One patient had discoid atelectasis of lung tissues. Expansion of diameter of pulmonary trunk and right pulmonary artery was observed in 78% of patients with PE, signs of congestion in pulmonary circulation - in 27% of cases, pulmonary hypertension - in 73% of cases.

Conclusion: visualization of direct and indirect signs of pulmonary embolism during computed pulmonary angiography confirmed the diagnosis in all examined patients. The detection of blood clots in pulmonary arteries themselves is the main criterion in making the final diagnosis.

 

 

References

 

1.     Nikolaev NS, Trofimov NA, Kachaeva ZA, et al. Prevention and treatment of pulmonary thromboembolism in traumatology and orthopedics. Tutorial. Cheboksary: Publishing house of the Chuvash University, 2020; 108 [In Russ].

2.     Krivosheeva EN, Komarov AL, Shakhnovich RM, et al. Clinical analysis of a patient with antiphospholipid syndrome and submassive pulmonary embolism. Aterotromboz. 2018; (1): 76-87 [In Russ].

https://doi.org/10.21518/2307-1109-2018-1-76-87

3.     Hepburn-Brown M, Darvall J, Hammerschlag G. Acute pulmonary embolism: a concise review of diagnosis and management. Internal Medicine Journal. 2019; 49(1): 15-27.

https://doi.org/10.1111/imj.14145

4.     Ostapenko EN, Novikova NP. Pulmonary embolism: modern approaches to diagnosis and treatment. Ekstrennaya meditsina. 2013; 1(5): 84-110 [In Russ].

5.     Sinyukova AS, Kiseleva LP, Kupaeva VA. A clinical case of recurrent pulmonary embolism and the complexity of the diagnostic search. Sovremennaya meditsina: aktual'nye voprosy. 2015; (42-43): 24-31 [In Russ].

6.     Bagrova IV, Kukharchik GA, Serebryakova VI, et al. Modern approaches to the diagnosis of pulmonary embolism. Flebologiya. 2012; 6(4): 35-42 [In Russ].

7.     Kuznetsov AB, Boyarinov GA. Early diagnosis of pulmonary embolism (review). Sovremennye tekhnologii v meditsine. 2016; 8(4): 330-336 [In Russ].

8.     Bershteyn LL. Pulmonary embolism: clinical manifestations and diagnosis in the light of the new recommendations of the European Society of Cardiology. Kardiologiya. 2015; 55(4): 111-119 [In Russ].

https://doi.org/10.18565/cardio.2015.4.111-119

9.     Sakharyuk AP, Shimko VV, Tarasyuk ES, et al. Pulmonary embolism in clinical practice. Byulleten' fiziologii i patologii dykhaniya. 2015; (55): 48-53 [In Russ].

10.   M Al-hinnawi A-R. Computer-Aided Detection, Pulmonary Embolism, Computerized Tomography Pulmonary Angiography: Current Status. Intech Open. 2019; 19.

http://doi.org/10.5772/intechopen.79339

11.   Gilyarov MYu, Konstantinova EV. How do new approaches to the treatment of pulmonary embolism affect disease outcome? Meditsinskiy sovet. 2017; (7): 48-55 [In Russ].

https://doi.org/10.21518/2079-701X-2017-7-48-55

12.   Konstantinides S. Guidelines on the diagnosis and management of acute pulmonary embolism. The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC). Eur. Heart J. 2014; (35): 3033-3080.

13.   Tagalakis V, Patenaude V, Kahn SR, Suissa S. Incidence of and mortality from venous thromboembolism in a real-world population: the Q-VTE Study Cohort. Am J Med. 2013; 126(832): 13-21.

https://doi.org/10.1016/j.amjmed.2013.02.024

 

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

 

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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].

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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

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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.

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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, Oğuz 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, Parrón M, Pérez 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

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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

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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.

https://doi.org/10.1007/s00431-017-3058-x

 

ABSTRACT:

Article presents a literature review on the role of magnetic resonance imaging (MRI) of sacroiliac joints in the diagnosis of ankylosing spondylitis.

Aim: was to analyze domestic and foreign literature sources that reflect the state of the problem and aspects of radiodiagnostics of sacroiliac joints in patients with ankylosing spondylitis.

Materials and methods: article contains analysis of 29 literature sources of leading domestic and foreign scientific journals.

Results: for a reliable diagnosis of ankylosing spondylitis, the presence of x-ray confirmed sacroiliitis is a prerequisite. However, difficulties in confirming or absence of sings of sacroiliitis on radiography at the beginning of the disease leads to a delay in the diagnosis of ankylosing spondylitis, which is established for 5-10 years after first clinical signs of the disease. Magnetic resonance imaging allows us to evaluate changes in sacroiliac joints in early stages of the disease and prevent the development of significant structural changes that lead to early disability of patients. MR-symptoms of active inflammation of sacroiliac joints in ankylosing spondylitis include: edema of the bone marrow (ostitis) in subchondral parts of iliac bones and sacrum, edema of the capsule (capsulitis) and periarticular ligaments (enteritis) joint, as well as synovitis, accompanied by synovial effusion into the joint cavity. MR-symptoms of structural changes in sacroiliac joints in ankylosing spondylitis include: bone erosion, sclerosis, fat deposits of the bone marrow, bone bridges, ankyloses.

Conclusion: magnetic resonance imaging currently occupies a leading position in the early diagnosis of ankylosing spondylitis, which allows us to identify active inflammatory and structural changes in sacroiliac joints.

  

References

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2.     Russian clinical guidelines. Rheumatology. (Ed. E.L. Nasonov.) Moscow: GEOTAR-Media, 2019; 464 [In Russ].

3.     Cherencova IA, Otteva EN, Ostrovskij AB. A new look at ankylosing spondylitis. Zdravoohranenie Dal'nego Vostoka. 2016; 2: 93–101 [In Russ].

4.     Van der Linden S, Valkenburg H, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis: a proposal for modification of the New York criteria. Arthritis Rheum. 1984; 27: 361–368.

5.     Kellgren JH, Jeffrey MR. Spondylitis ankylopoetica: een Famile en Bevolkingsonderzoek en toetsing van diagnostische Criteria (thesis). Leiden University (The Netherlands). 1982; 16–70.

6.     Bennett P, Burch T. Population studies of the rheumatic diseases. Amsterdam: The Netherland. Excerpta Medica Foundation. 1968; 456–7.

7.     Smirnov AV, Erdes ShF. Optimization of radiodiagnostics of ankylosing spondylitis in clinical practice – the importance of a survey radiography of the pelvis. Nauchno-prakticheskaya revmatologiya. 2015; 53(2): 175–181 [In Russ].

8.     Rudwaleit M, Khan MA, Sieper J. The challenge of diagnosis and classification in early ankylosing spondylitis: do we need new criteria? Arthritis Rheum. 2005; 52 (4): 1000–1008.

9.     Rudwaleit M, van der Heijde D, Khan MA et al. How to diagnose axial spondyloarthritis early. Ann Rheum Dis. 2004; 63: 535–43.

10.   Mau W, Zeidler H, Mau R et al. Outcome of possible ankylosing spondylitis in a 10 years' follow-up study. Clin Rheumatol. 1987; 6 (Suppl. 2): 60–6.

11.   Bashkova IB, Madyanov IV. Ankylosing spondylitis: diagnostic aspects and the importance of non-steroidal anti-inflammatory drugs in its treatment (to help a general practitioner). Russkij medicinskij zhurnal. 2016; 24 (2): 101–108 [In Russ].

12.   Rudwaleit M, Landewe R, van der Heijde D et al. SpondyloArthritis international Society (ASAS) classification criteria for axial spondyloarthritis (Part I): Classification of paper patients by expert opinion including uncertainty appraisal. Ann Rheum Dis. 2009; 68: 770–776.

13.   Rudwaleit M, Jurik AG, Hermann KG et al. Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS / OMERACT MRI group. Ann. Rheum. Dis. 2009; 10: 1520–1527.

14.   Levshakova AV. Differential diagnosis of sacroiliitis. Radiologiya – praktika. 2012; 2: 39–44 [In Russ].

15.   Erdes ShF, Bochkova AG, Dubinina TV et al. Early diagnosis of ankylosing spondylitis. Nauchno-prakticheskaya revmatologiya. 2013; 51 (4): 365–367 [In Russ].

16.   Rumyanceva DG, Dubinina TV, Demina AB et al. Ankylosing spondylitis and radiologically non-confirmed axial spondylitis: two stages of the same disease? Terapevticheskij arhiv. 2017; 5: 33–37 [In Russ].

17.   Bochkova AG, Levshakova AV. Criteria for a reliable diagnosis of sacroiliitis according to magnetic resonance imaging (ASAS / OMERACT recommendations and own data). Sovremennaya revmatologiya. 2010; 1: 12–17 [In Russ].

18.   Sieper J, van der Heijde D, Landewe R et al. New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis International Society (ASAS). Ann. Rheum. Dis. 2009; 68: 784–788.

19.   Dubinina TV, Erdes Sh. Inflammatory pain in the lower back in the early diagnosis of spondyloartritis. Nauchno-prakticheskaya revmatologiya. 2014; 4: 55–73 [In Russ].

20.   Levshakova AV. Radiodiagnostics of sacroiliitis. Radiologiya – praktika. 2011; 3: 33–41 [In Russ].

21.   Sudoł-Szopińska I, Jurik AG, Eshed I et al. Recommendations of the ESSR Arthritis Subcommittee for the Use of Magnetic Resonance Imaging in Musculoskeletal Rheumatic Diseases. Semin Musculoskelet Radiol. 2015; 19 (4): 396–411.

22.   Oostveen J, Prevo R, den Boer J et al. Early detection of sacroiliitis on magnetic resonance imaging and subsequent development of sacroiliitis on plain radiography: a prospective, longitudinal study. J Rheumatol. 1999; 26: 1953–1958.

23.   Smirnov AV, Erdes ShF. Diagnosis of inflammatory changes in the axial skeleton in ankylosing spondylitis according to data of magnetic resonance imaging. Nauchno-prakticheskaya revmatologiya. 2016; 54 (1): 53–59[In Russ].

24.   Tyuhova EYu. Magnetic resonance imaging of the spine and sacroiliac joints in patients with spondyloartritis.Nauchno-prakticheskaya revmatologiya. 2012; 51 (2): 106–111 [In Russ].

25.   Levshakova AV, Bochkova AG, Bunchuk NV. Magnetic resonance imaging in the diagnosis of sacroiliitis in patients with ankylosing spondylitis. Medicinskaya vizualizaciya. 2008; 2: 97–103 [In Russ].

26.   Rudwaleit M, Jurik AG, Hermann KG et al. Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI group. Ann Rheum Dis. 2009; 68 (10):1520–1527.

27.   Rudwaleit M, Landewe R, van der Heijde D et al. SpondyloArthritis international Society (ASAS) classification criteria for axial spondyloarthritis (Part II): Validation and final selection. Ann Rheum Dis. 2009; 68: 777–83.

28.   Sieper J, Rudwaleit M, Baraliakos X. The Assessment of Spondyloarthritis International Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis. 2009; 68 (2): 1–44.

29.   Levshakova AV, Bunchuk NV, Bochkova AG. Structural changes in sacroiliac joints in patients with ankylosing spondylitis according to magnetic resonance imaging. Kubanskij nauchnyj medicinskij vestnik. 2010; 6 (120): 70–74 [In Russ].

 

Abstract:

Background: article describes possibilities of computed tomography (CT) in diagnosis of wide specter of acute surgical diseases.

Materials and methods: basing on CT data of 645 patients (period jan.2015-feb.2016, S.P Botkin Clinical Hospital) an analysis was made: analyzed frequency of different nosologies in practice of doctors in CT department of emergency hospital, discussed results of method.

Results: most frequent diseases: acute intestinal obstruction - 238 cases (37%), acute pancreatitis and pancreonecrosis - 168 cases (26%), urolithiasis - 84 cases (13%), traumatic injuries of abdominal organs - 51 cases (8%), other diseases - 104 cases (16%).

Conclusion: taking into consideration non-specific clinical features of acute abdomen that doesn't need urgent operation, CT appeared to be an indespensable diagnostic method in planing of treatment in group of such patients. Complex approach in diagnosis can decrease a level of unreasonable operations and increase level of medical care quality.

 

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8.      Vlasov A.P., Kukosh M.V., Saraev V.V. Diagnostika ostryh zabolevanij zhivota [Diagnostics of acute abdominal diseases ]. rukovodstvo. M., 2012: 448 [In Russ].

9.      Charyshkin A.L., Jakovlev S.A. Problemy diagnostiki i lechenija ostrogo appendicita [Problems in diagnostics and treatment of acute appendicitis ]. Ul'janovskij mediko-biologicheskij zhrnnal. 2015; 92-100 [In Russ].

10.    Jagin M.V. Diagnostika i lechenie neoslozhnennyh destruktivnyh form ostrogo appendicita [Diagnostics and treatment of uncomplicated destructive forms of acute appendicitis]. ZhurnalEducatio. 2015; 9-3(2): 135 [In Russ].

11.    Ramalingam V., Bates D.D., Buch K., Uyeda J., et. al. Diagnosing acute appendicitis using a nonoral contrast CT protocol in patients with a BMI of less than 25. Emerg Radiol. 2016 Oct;23(5):455-62. doi: 10.1007/s10140- 016-1421-2. Epub 2016 Jul 8.

 

Abstract:

The article presents analysis of 1500 cases of varicocele endovascular occlusion (EO) in children and adolescents, giving the exhaustive account of varicocele diagnostics and treatment. Standardization of the endovascular procedure was performed, and algorithm proposed for choosing the occlusion technique and embolization agent depending on the lesion anatomy.

The authors specify 5 anatomical varieties of left testicular vein (LTV), each having some particularities in occlusion procedure. For the first time in pediatric practice the Foam-form was used for LTV occlusion against the background of prominent veno-venous reflux, which considered to be one EO contraindications. The causes were specified for false and true varicocele recurrence: the former is shown to occur due to technical imperfections, and the causes of the latter can be LTV lumen recanalization or formation of the bridging collaterals.

EO of LTV is proved to be the effective for recurrent varicocele after conventional surgery in children and adolescents.   

 

Reference 

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2.     Тарусин Д.И. Факторы риска репродуктивных расстройств у мальчиков и юношей-подростков. Автореф. д-ра мед. наук. М. 2005.

3.     Кондаков В.Т., Пыков М.И., Годлевский Д.Н. Андрологические аспекты хирургического лечения варикоцеле у подростков. Медицина и здравоохранение. 2004;     10.9: 35-39.

4.     Годлевский Д.Н. Сперматогенная функцияяичек и органный кровоток при варикоцеле у детей и подростков. Автореф. канд. мед. наук. М. 2003.

5.     Корзникова И.И. Эндоваскулярная склеротерапия в лечении варикоцеле у детей.Автореф. канд. мед. наук. М. 1988.      12.

6.     Страхов С.Н. Варикозное расширение венгроздевидного сплетения и семенногоканотика. М. 2001.

7.     Лопаткин Н.А., Морозов А.В., Дзеранов Н.К. Трансфеморальная эндоваскулярная облитерация яичковой вены в лечении варикоцеле. Урол. нефрол. 1983; 6: 1-53.

8.     Tauber R., Johnsen N. Antegrade scrotal sclerotherapy for the treatment of varicocele. Technique and late results. J. Urol. 1994; 51 (2): 386-390.

9.     Palomo A., Bernard C.A. A practical resource in the surgical treatment of the scrotalrgans. Rev. Col. Med. Guatem. 1959; 10: 246-247.

10.   Esposito C, VallaJ.S., Najmaldin A. et al. Incidence and management of hydrocele following varicocele surgery in children. J. Urol. 2004; 171 (3): 1271-1273.

11.   Tessari L., Cavezzi A., Frullini A. Preliminary. Еxperience with a new sclerosing foam in the treatment of varicose veins. Dermatol. Surg. 2001; 27 (1): 58-60.

12.   Mali W.P., Oei H.Y., Arndt J.W. et al. Hemodynamics of the varicocele. II. Correlation among the results of renocaval pressure measurements, varicocele scintigraphy and phlebography. Urol. 1986; 135 (3): 489-493.

authors: 

Abstract:

Timely diagnosis of iatrogenic injury of kidneys remains a challenge. Article is devoted to the study of diagnostic possibilities of radiological methods in the evaluation of patients with iatrogenic injuries of kidneys and postoperative complications in urology.

Materials and methods: study included 38 patients with kidney injury and postoperative complications, which were treated at the urological departments, were studied diagnostic capabilities of intravenous urography, ultrasound, CT Defined indicators of efficiency of MSCT in the diagnosis of these pathological conditions relative to data obtained intraoperatively (n = 16; 42,1%) and during follow-up (n= 22; 57,9%). According to research MSCT has the best indicators of the diagnostic value (sensitivity - 97%, specificity - 98%).

Results: defined indicators of efficiency of MSCT in the diagnosis of these pathological conditions relative to data obtained intraoperatively (n = 16; 42,1%) and during follow-up (n= 22; 57,9%). According to research MSCT has the best indicators of the diagnostic value (sensitivity - 97%, specificity - 98%). 

 

References 

1.    Russian Electronic Journal of Radiology. 2013; 3(4):88-93. Nechiporenko A.S., Nechiporenko A.N., Varec I.G. Komp'juternaja tomografija v diagnostike zakrytoj travmy pochek. [CT in diagnostics of renal blunt trauma]. Russian Electronic Journal of Radiology. 2013; 3(4):88-93 [In Russ].

2.    Komjakov B. K., Soroka I. V., Savello V. E. i dr. Osobennosti kliniko-luchevoj diagnostiki oslozhnenij sochetannyh povrezhdenij pochek v raznye periody travmaticheskoj bolezni. [Features of clinical and beam diagnostics of complications of combined renal trauma in different terms of traumatic disease]. Biomedicinskij zhurnal www.medline.ru. 2011; 12:1450-1466 [In Russ].

3.    Merinov D.S., Pavlov D.A., Fatihov R.R. i dr. Miniinvazivnaja perkutannaja nefrolitotripsija: delikatnyj i jeffektivnyj instrument v lechenii krupnyh kamnej pochek. [Miniinvasive percutaneous nephrolitotripsia: delicate and effective way to treat large renal stones]. Jeksperimental'naja i klinicheskaja urologija. 2013; 3:94-98 [In Russ].

4.    Mudraja I.S., Gurbanov Sh.Sh., Merinov D.S. Peristal'tika mochetochnika u pacientov s kamnjami pochki i urodinamika verhnih mochevyvodjashhih putej posle perkutannoj nefrolitolapaksii. [Peristalsis of the ureter in patients with renal stones and urodynamics of the upper urinary tract after percutaneous nephrolitholapaxy]. Jeksperimental'naja i klinicheskaja urologija. 2014; 1:67-71 [In Russ].

5.    Rossolovskij A.N., Chehonackaja M.L., Zaharova N.B. i dr. Dinamicheskaja ocenka sostojanija pochechnoj parenhimy u bol'nyh posle distancionnoj udarno-volnovoj litotripsii kamnej pochek. [Dynamic assessment of renal parenchyma in patients after extracorporeal shock wave lithotripsy of kidney stones]. Vestnik urologii. 2014; 2:3-14 [In Russ].

6.    Janenko Je.K., Katibov M.I., Merinov D.S. i dr. Prognosticheskie faktory dlja jeffektivnosti i bezopasnosti perkutannoj nefrolitotripsii krupnyh i korallovidnyh kamnej edinstvennoj pochki. [Prognostic factors for the efficacy and safety of percutaneous nephrolithotripsy of large and coral stones of a single kidney]. Jeksperimental'naja i klinicheskaja urologija. 2015; 3:42-47 [In Russ].

Abstract:

Aim: was to identify features of echographic imaging in patients with suspicion on nonocclusive mesenteric blood-flow disorders.

Materials and methods: we analyzed ultrasound data of 50 patients with dynamic ileus (DI). Patients with severe bulging of the transverse colon and the presence of free gas in the abdominal cavity were not included into the research.

All patients underwent ultrasound examination. We evaluated the functional and morphological state of small intestine and colon, celiac trunk and the superior mesenteric artery (SMA). We also examined intraorganic blood flow in walls of small intestine and colon with the determination of the resistance index (RI) and the linear velocity of blood flow.

The ultrasonic data was verified in 34 cases intraoperatively and morphologically, in 12 cases - only morphologically.

Colonoscopy was performed in 4 patients whose ultrasound differential diagnosis between nonocclusive blood-flow disorders in colon walls and pseudomembranous colitis.

Results: in 3 cases nonocclusive blood-flow disorder was not confirmed. Based on endoscopic and bacteriological data we revealed pseudomembranous colitis (PMC). In 1 patient with ultrasound signs of inflammatory changes in walls of the descending colon at colonoscopy revealed necrotizing ulcerative colitis and suspected circulatory problems in the intestinal wall.

It was morphologically identified that 24 patients had nonocclusive blood-flow disorders in walls of the small intestine,10 patients had nonocclusive segmental infarction of small intestine and colon, in 12 patients had nonocclusive segmental infarction of colon.

Conclusion: ultrasound study, conducted in dynamics, in patients with DI, reveals inflammatory and ischemic changes in walls of the small intestine and colon, which provides an abillity to choose the optimal method of treatment of these patients, in some cases predicted for the pathological process.

Absolute symptoms of nonocclusion ischemia of intestine during ultrasound mode in colour doppler imaging (CDI) are: violation of diameter, lack or absence of blood flow in intraorganic walls of the affected intestine while maintaining its mesentery tissue, in a number of patients - bubbles of gas in the intestinal wall.

An indirect sign of circulatory disorders of the small intestine is a complex of ultrasonic signs as an extension of its diameter with liquid contents, wall thickening by submucosal edema, mucosal folds flattening and lack of peristalsis.

An indirect sign of circulatory disorders of the colon during US is identification of a fragment of the colon with thick walls layered structure haustrum smoothness, lack of blood flow in the structure of the wall in the presence of it in the mesentery

When comparing ultrasound, endoscopic and morphological data, in some cases it is possible to make differential diagnosis between nonocclusive intestinal blood-flow disorder and pseudomembranous colitis.

 

 

 

Abstract:

Acute severe pancreatitis remains one of the actual issue in urgent surgery Forecast of the disease is dependant on spread of purulent necrotic process in pancreas and retroperitoneal tissues. Therefore diagnosis of purulent complications becomes extremely important.

The aim of the study was to demonstrate and evaluate features of ultrasonography in diagnosis and treatment strategy definition of purulent necrotic complications of acute severe pancreatitis.

Materials and methods. The study included 115 patients with acute destructive pancreatitis aged of 21-81 years The major part of them (50%) were persons at most able-bodied (working) aged 32-59 years. All patients underwent ultrasound diagnostics for determination the spread of pathology and detection of complications of the disease.

Ultrasound scanning was carried out as follows:

1. inspection of pancreatic parenchyma;

2. inspection of cellular tissues;

3. detection of free liquid in the abdominal cavity;

4. evaluation of the abdomen and kidneys;

5. inspection of the pleural cavity

Results. Examination of the parenchyma revealed that the pancreas was often inlarged, had a fuzzy, uneven contours and heterogeneous structure. However, it should be noted that in some cases, the pancreas was normal size and structure. Infected necrosis, acute liquid accumulation and/or free liquid in the abdominal cavity had occurred in 100% of cases in various combinations during examination of cellular tissues. Regarding the abdominal organs following complications were revealed: obstructive jaundice - in 5(4.3%) cases; portal vein thrombosis - in 1 (0.9%) case; splenic abscess - in 1 (0.9%) case. The presence of liquid in the pleural cavity was determined by leaves dissociation of the parietal and visceral pleura. The volume of the liquid was determined according standard classification.

Conclusion. Ultrasound scanning allows to determine the presence and extent of local complications arising at the stage of purulent necrotic complications of acute severe pancreatitis and general complications as a result of systemic pathological effect on the body of the disease.

 

References

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4.     Scaglione M., Casciani E., Pinto A. et al. Imaging Assessment of Acute Pancreatitis. Semin Ultrasound CT MRI. 2008; 29:322-340.

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15.   Бенсман В.М. Облегченные способы статистического анализа в клинической медицине. Краснодар: Издательство КГМА. 2002; 30 с.

16.   Кармазановский ГГ, Степанова Ю.А. Классификация острого панкреатита - современное состояние проблемы и нерешенные вопросы. Медицинская визуализация. 2011; 4: 133-137.

17.   Сидорова Ю.В., Шабунин А.В., Араблинский А.В., Шиков Д.В., Бедин В.В., Лукин А.Ю. Острый панкреатит: некоторые вопросы диагностики и лечения. Диагностическая и интервенционная радиология. 2011; 5(2): 15-26. 

 

 

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. 

 

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