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Abstract: Article presents a review of the scientific literature containing data on the role of ultrasound examination of joints in the diagnosis of rheumatoid arthritis, ultrasound signs of damage of main elements of joints and periarticular tissues, modern semi-quantitative scales for assessing the severity of main pathological changes detected by ultrasound examination of joints and tendons in patients with rheumatoid arthritis. Aim: was to analyze scientific publications in domestic and world literature on ultrasound examination of joints in rheumatoid arthritis. Materials and methods: 38 scientific sources of leading domestic and foreign journals were analyzed. Results: currently, radiography is the gold standard in the diagnosis of rheumatoid arthritis and is widely used to monitor the progression of rheumatoid arthritis. However, it is not sensitive enough to detect changes at early stage of rheumatoid arthritis, since it only allows assessing bone structures that are involved in the pathological process 6-12 months after the onset of first signs of the disease. Ultrasound examination provides new possibilities for early detection of rheumatoid arthritis, since it allows to detect changes at early pre-radiological stage and to prevent the development of significant structural changes leading to early disability of patients. Conclusion: the use of ultrasound examination of joints in the diagnosis of rheumatoid arthritis accelerates the diagnosis, is used to dynamically assess the course of the disease, evaluate the effectiveness of therapy, and also to predict outcomes. The diagnostic effectiveness of ultrasound examination of joints in rheumatoid arthritis involves the identification of synovitis, tenosynovitis, structural changes in the articular cartilage and bone (erosion), and an assessment of the severity of the inflammatory reaction.
Abstract: Introduction: article provides a literature review on the role of various imaging methods used in the diagnosis and control of effectiveness of therapy for rheumatoid arthritis. Aim: to analyze domestic and foreign literature sources reflecting the state of the problem and aspects of radiological diagnosis of rheumatoid arthritis. Materials and methods: 52 scientific sources of leading domestic and foreign journals were analyzed. Results: conventional radiography today is the most widely used imaging technique for diagnosing and monitoring of progression of rheumatoid arthritis. However, it is not sensitive enough to detect changes in the early stage of rheumatoid arthritis, since it only allows assessment of bone structures. Establishing the diagnosis of rheumatoid arthritis at the stage of detecting structural abnormalities in joints indicates the presence of functional impairment and disability of patients. At the same time, early diagnosis of rheumatoid arthritis, at the stage of pre-radiological changes, leads to an improved prognosis of the disease and contributes to preservation of working capacity. In this regard, it becomes necessary to introduce into clinical practice sensitive advanced imaging methods aimed at identifying changes that precede the development of structural changes in bone. Conclusion: the diagnostic effectiveness of radiation research methods in rheumatoid arthritis implies the identification of synovitis, tenosynovitis, early inflammatory changes in the bone, structural changes in the articular cartilage and bone (erosion), assessment of the severity of the inflammatory response. References 1. Muravyev YuV. Extraarticular manifestations of rheumatoid arthritis. Nauchno-prakticheskaya revmatologiya. 2018; 56(3): 356-362 [In Russ]. https://doi.org/10.14412/1995-4484-2018-356-362 2. Nasonov EL, Olyunin YuA, Lila AM. Rheumatoid arthritis: the problems of remission and therapy resistance. Nauchno-prakticheskaya revmatologiya. 2018; 56(3): 263-271 [In Russ]. https://doi.org/10.14412/1995-4484-2018-263-271 3. Turan A, ?eltik?i P, Tufan A, ?zt?rk MA. Basic radiological assessment of synovial diseases: a pictorial essay. Eur J Rheumatol. 2017; 4(2): 166-174. https://doi.org/10.5152/eurjrheum.2015.0032 4. Galushko EA, Nasonov EL. Prevalence of rheumatic diseases in Russia. Al'manah klinicheskoj mediciny. 2018; 46(1): 32-39 [In Russ]. https://doi.org/10.18786/2072-0505-2018-46-1-32-39 5. Nasonov EL, Lila AM. The efficacy and safety of sarilumab, fully human monoclonal antibodies against interleukin 6 receptor, in rheumatoid arthritis: new evidence. Nauchno-prakticheskaya revmatologiya. 2019; 57(5): 564-577 [In Russ]. https://doi.org/10.14412/1995-4484-2019-564-57 6. Lila AM, Dreval RО, Shipitsyn VV. 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Conventional radiography of the hands and wrists in rheumatoid arthritis. What a rheumatologist should know and how to interpret the radiological fndings. Rheumatology International. 2019; 39: 1331-1341. https://doi.org/10.1007/s00296-019-04326-4 22. Salaffi F, Carotti M, Beci G, et al. Radiographic scoring methods in rheumatoid arthritis and psoriatic arthritis. Radiol Med. 2019; 124(11): 1071-1086. https://doi.org/10.1007/s11547-019-01001-3 23. Vyas S, Bhalla AS, Ranjan P, et al. Rheumatoid Arthritis Revisited – Advanced Imaging Review. Pol J Radiol. 2016; 81: 629-635. https://doi.org/10.12659/PJR.899317 24. Llopis E, Kroon HM, Acosta J, Bloem JL. Conventional Radiology in Rheumatoid Arthritis. Radiol Clin N Am. 2017; 55: 917-941. http://doi.org/10.1016/j.rcl.2017.04.002 25. Forslind K, Eberhardt K, Svensson B. Repair of Erosions in Patients with Rheumatoid Arthritis. The Journal of Rheumatology. 2019; 46 (7) 670-675. https://doi.org/10.3899/jrheum.180557 26. Smirnov AV. Atlas of X-ray diagnostics of rheumatoid arthritis. M.: IMA-PRESS, 2009 [In Russ]. 27. Van der Heijde DM. How to read radiographs according to the Sharp/van der Heijde method. J Rheumatol. 1999; 26 (3): 743-5. 28. Van der Heijde DM, Dankert T, Nieman F, et al. Reliability and sensitivity to change of a simplification of the Sharp/van der Heijde radiological assessment in rheumatoid arthritis. Rheumatology (Oxford). 1999; 38(10): 941-7. https://doi.org/10.1093/rheumatology/38.10.941 29. Mathew AJ, Danda D, Conaghan PG. MRI and ultrasound in rheumatoid arthritis. Curr Opin Rheumatol. 2016; 28(3): 323-9. https://doi.org/10.1097/BOR.0000000000000282 30. Wang MY, Wang XB, Sun XH, et al. Diagnostic value of high-frequency ultrasound and magnetic resonance imaging in early rheumatoid arthritis. Exp Ther Med. 2016; 12(5): 3035-3040. https://doi.org/10.3892/etm.2016.3695 31. Waleed MH, Sherin MSh, Gehan AG. Role of magnetic resonance imaging and ultrasonography in diagnosis and followup rheumatoid arthritis in hand and wrist joints. The Egyptian Journal of Radiology and Nuclear Medicine. 2018; 49(4): 1043. https://doi.org/10.1016/j.ejrnm.2018.05.013 32. Sapundzhieva T, Karalilova R, Batalov A. Musculoskeletal ultrasound as a biomarker of remission - results from a one-year prospective study in patients with rheumatoid arthritis. Med Ultrason. 2018; 20(4): 453-460. https://doi.org/10.11152/mu-1609 33. Tan YK, Li H, Allen JC Jr, Thumboo J. Ultrasound power Doppler and gray scale joint inflammation: What they reveal in rheumatoid arthritis. Int J Rheum Dis. 2019; 22(9): 1719-1723. https://doi.org/10.1111/1756-185X.13653 34. Sun X, Deng X, Xie W, et al. The agreement between ultrasound-determined joint inflammation and clinical signs in patients with rheumatoid arthritis. Arthritis Res Ther. 2019; 21(1): 100. https://doi.org/10.1186/s13075-019-1892-0 35. Lee KA, Min SH, Kim TH, et al. 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J Rheumatol. 2016; 43(1): 12-21. https://doi.org/10.3899/jrheum.141416 44. Hassan R, Hussain S, Bacha R, et al. Reliability of Ultrasound for the Detection of Rheumatoid Arthritis. J Med Ultrasound. 2019; 27(1): 3-12. https://doi.org/10.4103/JMU.JMU_112_18 45. Xu H, Zhang Y, Zhang H, et al. Comparison of the clinical effectiveness of US grading scoring system vs MRI in the diagnosis of early rheumatoid arthritis (RA). J Orthop Surg Res. 2017; 12(1): 152. https://doi.org/10.1186/s13018-017-0653-5 46. El-Gohary RM, Mahmoud AAMA., Khalil A, et al. Validity of 7-Joint Versus Simplified 12-Joint Ultrasonography Scoring Systems in Assessment of Rheumatoid Arthritis Activity. J Clin Rheumatol. 2019; 25(6): 264-271. https://doi.org/10.1097/RHU.0000000000000847 47. Zou X, Zou J, Guo D, et al. Role of 7-Joint Ultrasonic Score in Predicting the Prognosis of Rheumatoid Arthritis. Iran J Radiol. 2020; 17(4): e102875. https://doi.org/10.5812/iranjradiol.102875 48. M?ller I, Loza E, Uson J, et al. Recommendations for the use of ultrasound and magnetic resonance in patients with rheumatoid arthritis. Reumatol Clin. 2018; 14(1): 9-19. https://doi.org/10.1016/j.reuma.2016.08.010 49. Rubin DA. MRI and ultrasound of the hands and wrists in rheumatoid arthritis. I. Imaging findings. Skeletal Radiol. 2019; 48(5): 677-695. https://doi.org/10.1007/s00256-019-03179-z 50. Cikutovic P, Contreras O, Burdiles ?, et al. Magnetic resonance of the hands for the diagnosis and follow-up of rheumatoid arthritis. Rev Med Chil. 2020; 148(9): 1315-1327. https://doi.org/10.4067/S0034-98872020000901315 51. ?stergaard M, Peterfy C, Conaghan P, et al. OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Core set of MRI acquisitions, joint pathology definitions, and the OMERACT RA-MRI scoring system. J Rheumatol. 2003; 30(6): 1385-6. 52. Smirnov A.V. Golimumab therapy-induced indicators of X-ray inflammation progression and magnitude according to magnetic resonance imaging evidence in patients with rheumatoid arthritis, ankylosing spondylitis, or psoriatic arthritis. Sovremennaya revmatologiya. 2013; 7(2): 75-82 [In Russ].
Abstract: Diagnostic criteria for extranodal lymphoma (non-Hodgkin's lymphoma) are well known and described in the literature. However, primary extranodal lymphomas are rare and pose problems for differential diagnosis with primary or secondary lesions. In the presented clinical case of a woman, 58 years old, with primary extranodal lymphoma of the stomach and spleen, an incorrect preoperative diagnosis was made: a tumor of the stomach and spleen abscess. It was mainly due to the presence of pain in the epigastric region and hospitalization for "severe acute biliary pancreatitis" in anamnesisd. Similar complaints and a "blurry" picture of manifestations of lymphoma did not allow her to be suspected preoperatively. The tumor nature of the focal lesion of the stomach was not in doubt, while the underestimation of MRI data, combined with the anamnesis, led to the erroneous diagnosis o f" spleen abscess". Patient underwent surgical operation: extended combined gastrectomy, distal resection of pancreas, splenectomy “en-bloc”, lymphadenectomy, cholecystectomy, “Roux-Y" reconstruction. The clinical picture of extranodal lymphoma depends on its primary localization and the degree of its spread. Clinical manifestations of primary lymphoma of the stomach and spleen are often nonspecific, therefore, against the background of previously transferred diseases of the hepatopancreatobiliary zone and their residual manifestations, an erroneous assessment of the situation is possible. In the presence of focal lesions, it is advisable to be more attentive to results of radiology examination, which can provide comprehensive information about their nature.
References 1. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Swerdlow S.H., Campo E., Harris N.L., Jaffe E.S., Pileri S.A., Stein H., Thiele J. (Eds). Revised 4th edition. Lyon: IARC Press, 2017; 585. 2. Manzella A, Borba-Filho P, D'Ippolito G, Farias M. Abdominal manifestations of lymphoma: spectrum of imaging features. ISRN Radiol. 2013; 2013: 483069. http://doi.org/10.5402/2013/483069 3. Lee W-K, Lau EWF, Duddalwar VA, et al. Abdominal manifestations of extranodal lymphoma: spectrum of imaging findings. American Journal of Roentgenology. 2008; 191(1): 198-206. http://doi.org/10.2214/AJR.07.3146 4. FSBI «National Medical Research Center of Oncology named after N.N. Blokhin »of the Ministry of Health of Russia Diagnostics and treatment. Types of diseases. Lymphomas, (date of access 08.07.20) [In Russ.]. https://www.ronc.ru/grown/treatment/diseases/limfomy/ 5. Psyrri A, Papageorgiou S, Economopoulos T. Primary extranodal lymphomas of stomach: clinical presentation, diagnostic pitfalls and management. Annals of Oncology. 2008; 19(12): 1992-1999. http://doi.org/10.1093/annonc/mdn525 6. Ghai S, Pattison J, Ghai S et al. Primary gastrointestinal lymphoma: spectrum of imaging findings with pathologic correlation. Radiographics. 2007; 27(5): 1371-1388. http://doi.org/10.1148/rg.275065151 7. Juarez-Salcedo LM, Sokol L, Chavez JC, Dalia S. Primary Gastric Lymphoma, Epidemiology, Clinical Diagnosis, and Treatment. Cancer Control. 2018; 25(1): 1073274818778256. http://doi.org/10.1177/1073274818778256 8. NORD: National Organization for Rare Disorders. Rare Disease Database. Primary Gastric Lymphoma. Luh JY Nabavizadeh N, Thomas CR. Jr., (date of access 20.07.2020). https://rarediseases.org/rare-diseases/primary-qastric-lymphoma 9. De Jong PA, Van Ufford HMQ, Baarslag H-J et al. CT and 18F-FDG PET for noninvasive detection of splenic involvement in patients with malignant lymphoma. American Journal of Roentgenology. 2009; 192(3): 745-753. http://doi.org/10.2214/AJR.08.1160 10. Ingle SB, Hinge CR. Primary splenic lymphoma: Current diagnostic trends. World J Clin Cases. 2016 December 16; 4(12): 385-389. http://doi.org/10.12998/wjcc.v4.i12.385 11. Dobrovolskiene L, Balukeviciute J, Maksimaitiene J. Virskinimo trakto limfomu radiologine diagnostika [Radiographic diagnosis of gastrointestinal lymphoma]. Medicina(Kaunas). 2002; 38(2):165-171. 12. Chien SH, Liu CJ, Hu YW, et al. Frequency of surveillance computed tomography in non-Hodgkin lymphoma and the risk of secondary primary malignancies: A nationwide population-based study. Int J Cancer. 2015 Aug 1; 137(3): 658-665. http://doi.org/10.1002/ijc.29433 13. Chernobai TN, Golovko TS. Radiation diagnosis of extranodal lymphomas. Clinical oncology. 2017; 4(28): 73-76 (date of access 8.07.2020) [In Ukr.]. https://www.clinicaloncology.com.ua/article/19925/luchevaya-diagnostika-ekstranodalnyx-limfom 14. Frampas E. Lymphomas: Basic points that radiologists should know. Diagnostic and Interventional Imaging. February 2013; 94(2): 131-144.
Abstract The clinical case that is presented, demonstrates the need to sub-specialize radiologists in the field of mammology for a qualitative examination of the breast and timely diagnosis, including breast cancer. During last 8 years, the patient regularly (once every two years) underwent mammography in general-specialization medical facilities. According to findings of surveys conducted, nodal pathology of the breast was not identified. During the physical examination in the upper inner quadrant of the left mammary gland, a movable mass that was soldered to the skin up to 2.0 cm. When conducting a survey mammography in two standard projections in the lower inner quadrant of the left mammary gland, the nodal formation of the BIRADS 5 category was visualized. In a retrospective analysis of past mammograms, described above, nodal formation was noted on all presented mammographic images, the growth and changes in semiotic signs of the pathological focus were also observed. After additional diagnostic manipulations, a highly differentiated breast cancer with low mitotic activity was verified. References 1. Kaprin A.D., Rozhkova N.I. National guidelines. Mammalogy. 2nd ed. M.: GEOTAR-Media. 2016; 496 [In Russ]. 2. Frantsuzova I.S. Analysis of risk factors for breast cancer. Mezhdunarodnyy nauchno-issledovatel'skiy zhurnal. 2019. -3 (81): 68-74 [In Russ]. 3. Chernaya A.V. Comparative analysis of informative value of digital mammography and mammoscintigraphy in breast cancer diagnostics. Dis. kand. med. nauk. SPb. 2018; 112. [In Russ]. 4. Vasil’ev A.Yu., Мanuylova О.О. Stereoscopic mammography. An alternative method for the breast cancer early diagnosis. Radiologiya-praktika. 2017.- 1(61): 6-14 [In Russ]. 5. Pavlova T.V., Vasil'ev A.Yu., Manuylova O.O. Method of сone-beam breast computed tomography (literature review). Radiologiya-praktika. 2019.-1(73): 21-27 [In Russ]. 6. Rozhkova N.I., Burdina I.I., Zapirova S.B., Kaprin A.D., Labazanova P.G., Mazo M.L., Mikushin S.Yu., Prokopenko S.P., Yakobs O.E. Areas of preventive work with the female population against breast cancer. Akademicheskiy zhurnal Zapadnoy Sibiri. 2019. Vol. 15.-2(79): 6-8 [In Russ]. 7. Visscher D.W. Sclerosingadenosis and risk of breast cancer / D. W. Visscher, A. Nassar, A. C. Degnim. Breast Cancer Res Treat. 2014. 144: 205-212. 8. Pavlova T.V., Vasil'ev A.Yu., Manuylova O.O., Volobueva E.A. The impact of compliance with the rules of mammography laying on the timely diagnosis of breast cancer (the clinical example). Diagnosticheskaya i interventsionnaya radiologiya. 2019. -2 (13): 60-65 [In Russ]. 9. Shumakova T.A., Solntseva I.A., Safronova O.B., Savello V.E., Serebryakova S.V. The practical application of the international classification of Bi-RADS in mammology practice. Rukovodstvo dlya vrachey - SPb NII skoroy pomoshchi im. I.I. Dzhanelidze. SPb. 2018; 217 [In Russ].
Abstract Aim: was to evaluate possibilities of puncture biopsy under ultrasound guidance of parasternal lymph nodes in patients with breast cancer. Material and methods: study included 34 patients with breast cancer. Criteria for inclusion in the study were: primary breast cancer with a central or medial tumor localization, and patients under observation after previously undergoing surgical treatment. All patients underwent an ultrasound examination of the breast and regional zones, including the parasternal lymphatic collector. All patients underwent biopsy. Results: in total, 39 parasternal lymph nodes suspicious on secondary lesion were detected, of which 17 (43,5%) lymph nodes had a specific lesion, 22 (56,5%) lymph nodes showed cystological signs of hyperplasia according to results of cytological examination. Parasternal lymph nodes metastases were detected in 16 (47,1%) of 34 patients included in our study. In all cases of specific lesion, lymph nodes were rounded, there was a violation of differentiation of anatomical structures, the absence of a central echo complex, a violation of differentiation and thickening of the cortical layer. In the group of primary patients, 3 (27,3%) patients with metastases in parasternal lymph nodes had distant metastases, remaining 8 (72,7%) patients, due to the lesion of the parasternal lymphatic collector, the stage of the disease were adjusted upwards (stage IIIA). Conclusion: fine-needle aspiration biopsy under ultrasound-guidance in case of suspected secondary lesion of parasternal lymph nodes, can be successfully used to obtain morphological material with minimal traumatic impact, without the use of anesthesia, which will more adequately assess the state of parasternal lymph nodes at the preoperative stage, correctly set the stage of the disease and prescribe the appropriate treatment. References 1. Хоперия В.Г. Тонкоигольная аспирационная пункционная биопсия узлов щитовидной железы: показания, техника, клиническое применение. Украинский научно-практический центр эндокринной хирургии и трансплантации эндокринных органов и тканей МЗ Украины. Номер: 1 (35), 2011 г. С. 57-67. 2. Федотов Ю.Н., Воробьев С.Л., Черников РА. Тонкоигольная аспирационная биопсия в диагностике заболеваний щитовидной железы. Корреляция между заключением цитолога и гистолога, технические аспекты. Клиническая и экспериментальная тиреоидология. 2009. Т. 5. № 4. С. 28-32. 3. Бурдюков М.С., Нечипай А.М. Тонкоигольная пункция под контролем эндоскопической ультрасонографии: осложнения и альтернативы. Российский электронный журнал лучевой диагностики. 2013. Т. 3. № 2. С. 26-37. 4. Марченко М.Г., Трофимов Е.И., Виноградов В.В. Современные методы выявления метастазов рака гортани и гортаноглотки в лимфатические узлы шеи. Российская оториноларингология. 2011. № 1 (50). С. 114-117. 5. TNM Classification of Malignant Tumours, 7th ed. Sobin L.H., Gospodarowicz M.K., Wittekind Ch., eds. New York: Wiley-Blackwell; 2009. 6. V. L. Kovalenko, M. F. Musafirov, R. V. Experience of video-assisted thoracoscopic parasternal lymph node dissection in breast cancer. Dal'nevostochnyj medicinskij zhural 2014 g. [In Russ.] 7. Ujmanov V.A., Nechushkin M.I., Trigolosov A.V.. Petrovskij A.V., Vishnevskaya YA.V., Zajceva A.A. Surgical techniques for morphological assessment of the state of the parasternal lymphatic collector as part of organ-preserving treatment in patients with breast cancer. Vestnik RONTS im. N.N. Blochina RAMN. Tom 23: 3(89), 2012: 29 34. [In Russ.] 8. McDonald E, Haagensen C.D. In: Diseases of the breast. 2nd ed. Philadelphia: W. B. Saunders; 1971. 9. Letyagin V.P., Laktionov K.P, Vysockaya I.V., Kotov V.A. Breast cancer. - M., 1996. - 150 s. [In Russ.] 10. Sinyakov A.G. Videothoracoscopic parasternal lymphadenectomy in the treatment of breast cancer. Mezhdunarodnyj zhurnal prikladnyh i fundamental’nyh issledovanij. №10, 2014. [In Russ.]
Abstract: Background: expansion of tourism business in countries of South and Southeast Asia, Africa, and South America led to the appearance of rare parasitic diseases in Russia, Europe, and the United Kingdom. In our country, more than 1.3 million patients with various parasitosis are officially registered annually, among which there is an increase in the incidence of intestinal protozoa. Aim: was to show features of the diagnosis of acute manifestations of necrotic amebic colitis, which simulated severe intoxication with manifestation of clinics of acute surgical disease and intestinal bleeding Material and methods: using the example of case report of a 70-year-old woman, the possibility of complex diagnostics using abdominal ultrasound, abdominal computed tomography, colonoscopy with biopsy of intestinal ulcers and parasitological research methods is shown. Results: detoxification, anti-inflammatory therapy in a surgical hospital and instrumental examination allowed us to objectively evaluate and conduct targeted therapy avoiding serious complications. Discussion: primary lesions with acutely occurring both local and general body reactions lead to severe intoxication, which does not allow to exclude acute surgical pathology, and in some cases dictate the need for urgent surgical intervention. Differential diagnosis of an amoeba with a colon cancer only on the basis of x-ray symptoms is almost impossible. Specific anti-ameba therapy leads to the disappearance of amoeba. Conclusion: only on the basis of a complex of clinical and epidemiological data, ultrasound, CT, colonoscopy, histological analysis and parasitological methods of research, pathology can be correctly identified. References 1. Bronshtejn A.M., Malyshev N.A., Luchshev V.I. Amebiasis: clinical features, diagnosis, treatment. Klinicheskaya mikrobiologiya i antimikrobnaya himioterapiya. 2001; 3(3): 215-222 [In Russ.]. 2. Gostishchev V.K., Khrupkin V.I., Afanas'ev A.N., Gorbacheva I.V. The complicated intestinal amebiasis in emergency surgery. Xirurgiya. 2009; (5): 4-9 [In Russ.]. 3. Lisicyn K.M., Revskoj A.K. Urgent abdominal surgery for infectious and parasitic diseases. M: Medicina, 1988: 237-271 [In Russ.]. 4. Petridou C, Al-Badri A, Dua A, et al. Learning points from a case of severe amoebic colitis. Infez Med. 2017; 25(3): 281-284. PMID: 28956549 5. Cook G.C. Parasitic infections of gastrointestinal tract: a worldwide clinical problem. Curr Opin Gastroenterol.1989; 2(Is1): 126-139. 6. Ozereczkovskaya N.N. Organ pathology in the acute stage of tissue helminthiases: the role of blood and tissue eosinophilia, immunoglobulinemia E, G4 and factors that induce an immune response. Medicinskaya parazitologiya iparazitarny'e bolezni. 2000; (3): 3-8 [In Russ.]. 7. Romanenko N.A. Modern tasks of sanitary parasitology. Medicinskaya parazitologiya i parazitarny'e bolezni. 2001; (4): 25-29 [In Russ.]. 8. Sergiev V.P, Filatov N.N. Infectious diseases at the turn of the century: an awareness of the biological threat. Moskva: Nauka, 2006; 572 s [In Russ.]. 9. Kry'lov M.V. The determinant of parasitic protozoa (human, domestic animals and agricultural plants). Sankt-Peterburg: ZIN, 1996; 602 s [In Russ.]. 10. Eryuxin I.A., Xrupkij V.I. (red.) Experience of medical support of troops in Afghanistan 1979-1989 V. 2: Organization and scope of surgical care for the wounded. Moskva, 2002: 379-386 [In Russ.]. 11. Scherbakov I.T., Leonteva N.I., Chebyshev N.V., i dr. Pathomorphology of colonic mucosa in patients with chronic post-parasitic colitis. Aktual'ny'e voprosy' infekcionnojpatologii. 2014; 95(6): 934- 938 [In Russ.]. 12. Ellyson J.K, Bezmalinovic Z., Parks S.N, Lewis F.R. Necrotizing amebic colitis: a frequently fatal complication. Am J Surg. 1986; 152(1): 21-26. PMID: 3728812. 13. Shirley DA, Moonah S. Fulminant amebic colitis after corticosteroid therapy: a systematic review. PLoS Negl Trop Dis. 2016; 10(7): e0004879. 14. Guzeeva T.M. Status the incidence of parasitic diseases in the Russian Federation and tasks in terms of the reorganization of the service. Medicinskaya parazitologiya i parazitarny'e bolezni. 2008; (1): 3-11 [In Russ.]. 15. Weitzel T, Carbera J, Rosas R, et al. Enteric multiplex PCR panels: A new diagnostic tool for amoebic liver abscess? New Microbes New Infect. 2017; 18: 50-53. PMID: 28626584 DOI:10.1016/j.nmni.2017.05.002. 16. Abbas М.А., Mulligan D.C., Ramzan N.N., et al. Colonic perforation in unsuspected amebic colitis. Dig Dis Sci. 2000; 45(9): 1836-1841. PMID: 11052328. 17. Sinharay R., Atkin G.K., Mohamid W., Reay-Jones N. Caecal amoebic colitis mimicking a colorectal cance. J Surg Case Rep. 2011; (11): 1. PMID: 24972391 DOI:10.1093/jscr/2011.11.1. 18. Delabroussea E., Ferreirab F., Badeta N., et al. Coping with the problems of diagnosis of acute colitis. Diagn Intervent Imaging. 2013; 94(7-8): 793—804. PMID: 23751227 DOI:10.1016/j.diii.2013.03.012.
Abstract: According to current recommendations and orders of the Russian Ministry of Health, in the department of ultrasound diagnostics of the oncological center, it is necessary and lawfully to perform invasive manipulations to obtain a morphological verification of the oncological process. Nevertheless, there are significant gaps in the existing normative acts concerning organizational aspects. Aim: to conduct an analysis of the organization and results of morphological testing of malignant neoplasms in conditions of separation of ultrasonic diagnostics of the Kursk Regional Clinical Oncology Center. Materials and methods: 5,114 results of histological and immunohistochemical studies of material obtained with biopsies under ultrasound in the period 2012 - 2016 were analyzed. For the first time we included into department - 2 manipulation rooms, corresponding to sanitary requirements for conducting sterile manipulations. We first install Sonoscape S40 scanners in the manipulation rooms. All invasive examinations were performed by ambulatory and resident patients by ultrasound specialists who have a primary specialization in surgery, gynecology or urology Core biopsy was performed under local anesthesia with semi-automatic needles 14G or 16G; a gun-needle system biopsy was performed using a Bard-Magnum biopsy gun, Results. During the research, high efficiency of the proposed organizational model is revealed. A statistical relationship is revealed between the informativeness of the material and the physiciar who manipulates and organ-object. Ways of development are offered. References 1. Kaprin A.D., Starinskij V.V., Petrova G.V. The state of oncological care for the population of Russia in 2. Order of the Ministry of Health of the Russian Federation of 04.07.2017 No. 379n «On Amending the Procedure for the provision of medical care to the population in the field of oncology, approved by Order of the Ministry of Health of the Russian Federation of November15, 2012No.915n»].URL.:http://www.consultant.ru/document/cons_doc_LAW_220809/f891655c8c9f6864b656ef 38dba5a212e7e2b0e6/ (Data obrashhenija 23.10.2017) [In Russ]. 3. Chissov V.I., Dar'jalova S.L. [Oncology]. M.: «GJeOTAR-Media». 2007; 560 s [In Russ]. 4. Ponedel'nikova N.V., Korzhenkova G.P, Letjagin VP, Vishnevskaja Ja.V. Choice of the method of verifying the volume of newgrowth of the mammary gland at the preoperative stage. Opuholi zhenskoj reproduktivnoj sistemy. 2011; 1: 41-45 [In Russ]. 5. Nazarenko G.I., Hitrova A.N. Ultrasonic diagnostics of the prostate in modern oncological practice. M.: Izdatel'skij dom Vidar-M. 2012; 288s [In Russ]. 6. About the improvement of the service of radiation diagnosis: the order of the Ministry of Health of the RSFSR of August 2, 1991 № 132. URL.:http:// www.rasudm.org /information/docs.htm (Data obrashhenija 23.10.2017) [In Russ]. 7. Order of the Ministry of Health of the Russian Federation of December 27, 2011 N 1664n "ОП the approval of nomenclature of medical services". URL.:http://www.consultant.ru/cons/cgi/online.cgi?req=doc&base=LAW&n=27 8063&fld=134&dst=1,0&rnd=0.05494875175266367#0 (Data obrashhenija 04.11.2017) [In Russ]. 8. Decree of the Chief State Sanitary Doctor of the 10, 2016. URL.: http://base.garant.ru/12177989/ #ixzz4xU73XzAB (Data obrashhenija 04.11.2017) [In Russ]. 9. Attachment №2 to the order of the Ministry of Health of the 10. SPSS: the art of information processing. Analysis of statistical data and restoration of hidden regularities. Ahim Bjujul', Peter Cefel'.- DiaSoft, 2005; 608 s [In Russ].
Abstract: Accurate and timely diagnosis of benign renal tumors is often complicated, mainly because of the large variety of manifestations. 102 patients with various renal tumors were included in the study; in 9 of them (8.8%) tumors were verified as benign. Specimen were obtained by surgical tumor excision (8 cases), and ultrasound guided needle biopsy (1 case). The importance of pre-operative CT and MRI is shown for accurate diagnosis of benign renal tumors, in particular, angiomolipoma and multilocular cystous nephroma. Authors also discussed complicacies in radiodiagnostics of benign renal tumors. Reference 1. BenningtonJ.L., BeckwithJ.B. Tumors of thekidney, renal pelvis, and ureter. In: Atlas of 9.tumor pathology. Washington. Armed ForcesInstitute of Pathology. 1975; 12: 215. 2. Xippel W.D. The incidence of benign renalnodules (a clinicopathological study).J. Urol. 10.1971; 106: 503. 3. Harmon W.J., King B.F., Lieber M.M.Renal oncocytoma: magnetic resonance 11.imaging characteristics. J Urol. 1996; 155 (3):863-867. 4. Kettritz U., Semelka R.C., Siegelman E.S.,Shoenut J.P., Mitchell D.G. Multilocular cysts 12.nephroma MR imaging appearance with current techniques including gadolini. J. Magn.Reson. Imaging. 1996; 6 (1): 145-148. 5. Semelka R.C. Abdominal - Pelvis MRI. New- 13.York. Wiley-Liss. 2002; 379-469. 6. Wegener O.H. Whole Body ComputedTomography. Boston. Blackwell ScientificPublication. 1994; 369-400. 7. Michalko T., Zelenak P., Valansky L. et al.Renal oncocytoma and its morphology, diagnosis and therapy. Bratisl. Lek. Listy. 1994; 95 (6): 267-269. 8. Muramoto M., Uchida T., Kyuuno H., IshidaH., Utsunomiya T., Egawa S., Mashimo S.,Koshiba K. et al. A case of renal oncocytoma. Hinyokika Kiyo. 1994; 40 (1): 47-50. 9. Perez-Ordonez В., Hamed G., Campbell S. Renal oncocytoma: a clinicopathologic study of 70 cases. Am. J. Surg. Pathol. 1997; 21 (8): 871-883. 10. Saucher-Chapado M., Angulocuesta J. et al. Sunhronous bilateral renal oncocytoma. Arch. Esp. Urol. 1995; 48 (9): 909-913. 11. Davidson A.J., Hayews W.S., Hartman D.S. et al. Renal oncocytoma and carcinoma. Failure of differentiation with CT. Radiology. 1993; 186, 693-696. 12. Ball D.S., Friedman A.C., Hartman D.S. et al. Scar sign of renal oncocytoma. Magnetic resonance imaging appearance and lack of specificity. Urol. Radiol. 1986; 8: 46-48. 13. Sakai Y., Gotoh S., Suzuki S., Ozawa T. A case of unilateral and synchronous occurrence of oncocytoma and renal cell carcinoma. Hinyokika Kiyo. 1997, 43 (9): 651-653. 14. Sasakis Т., Hayashi T., Tsugaya M., Okamura T, Sakakura T, Kohri K. Radiological diagnosis of renal oncocytoma. Hinyokakiyo. 1995; 41 (9): 731-735. 15. Wang Y.T., Liu K.L., Chuch S.C., Tsang Y.M. Giant renal oncocytoma: differential diagnosis.J. Formos. Med. Assoc. 2003; 102 (1): 46-48.
Abstract: The aim of the study is to evaluate the potentialities of MRI in prenatal differential diagnosis of congenital abnormalities (CA). Results of 65 MR I-studies were analyzed. Ultrasound findings of CA were the indications for MRI. MR-images were obtained on GESigna Execute II (1,5T). The final diagnoses were made by postnatal autopsy, which served as a «golden standard» of neonatal CA diagnostics. Sensitivity of the MRI for fetal CA detection was 96,7%, specificity - 100%, diagnostic accuracy - 96,9%. Predicting reliability of the method for positive results was 100%, for negative results- 71,4%. In 46,2% of cases MRI and echo results agreed, in 23,1% MRI findings changed the diagnosis, and in 16,2% MRI provided additional information, which in 10,8% changed the pregnancy management strategy. Thus, MRI is shown to be highly informative in diagnosis of the fetal CA, and be able to refine the ultrasound findings. Using the MRI improves substantially the results of prenatal testing for CA, decreases the need for invasive procedures, and allows adequate planning of antenatal and postnatal management.
Reference 1. Демикова В.П., Лапина А.С. Система мониторинга врожденных пороков развития в Российской Федерации. Лекция на II Российском конгрессе «Современные технологии в педиатрии и детской хирургии». М. 2003. 2. Панов В.О. Методические особенности ивозможности магнитно-резонансной томографии в антенатальной диагностике нарушений внутриутробного плода. Радиология-практика. 2006; 2: 12-23. 3. Levine D. Ultrasound versus magnetic resonance imaging in fetal evaluation. Top. Magn. Reson. Imaging. 2001; 12: 25-38. 4. Юсупов К.Ф., Ибатуллин М.М., МихайловИ.М., Панов В.О. МРТ в диагностике аномалий развития внутриутробного плода. Радиология-практика. 2006; 2: 24-42. 5. Munoz H., Ortega X., Soto G. et al. OC19:Ultrasound versus magnetic resonance imaging in prenatal diagnosis of fetal malformations. Ultrasound. Obstet. Gynecol. 2007; .30: 373. 6. Whitby E.H., Paley M.N., Sprigg A. et al. Comparison of ultrasound and magnetic resonance imaging in 100 singleton pregnancies with suspected brain abnormalities. Bjog. 2004;111:784-792. 7. Терновой С.К., Волобуев А.И., Куринов С.Б., Панов В.О., Шария М.А.Магнитно-резонансная пельвиометрия. Медицинская визуализация. 2001; 4: 6-12. 8. Breysem L., Bosmans H., Dymarkowski S. et al. The value of fast MR imaging as an adjunct to ultrasound in prenatal diagnosis. Eur. Radiol. 2003; 13: 1538-1548. 9. Huisman ТА, Martin E., Kubik-Huch R., Marincek B. Fetal magnetic resonance imaging of the brain: technical considerations and normal brain development. Eur. J. Radiol. 2002;12: 1941-1951. 10. Brugger PC, Prayer D. Fetal abdominal magnetic resonance imaging. Eur. J. Radiol. 2006; 57: 278-293. 11. Prayer D., Kasprian G., Krampl E. et al. MRI of normal fetal brain development. Eur. J. Radiol. 2006; 57: 199-216. 12. Wang G.B., Shan R.Q., Ma Y.X. et al. Fetal central nervous system anomalies: comparison of magnetic resonance imaging and ultrasonography for diagnosis. Engl. Chin. Med.J. 2006; 119:1272-1277. 13. Kasprian G., Balassy C., Brugger P.C., Prayer D. MRI of normal and pathological fetal lung development. Eur. J. Radiol. 2006; 57: 261-270. 14. Brugger P.C., Stuhr F., Lindner C., Prayer D. Methods of fetal MR: beyond T2-weighted imaging. Eur.J. Radiol. 2006; 57: 172-181. 15. Hormann M., Brugger PC, Balassy C, Witzani L., Prayer D. Fetal MRI of the urinary system. Eur.J. Radiol. 2006; 57: 303-311.
Abstract: On the base of a case report article shows the role of interventional and diagnostic radiology in treatment of patients with multifocal atherosclerosis. Application of modern interventional cardiology methods expands the possibilities in treatment of patients with multifocal atherosclerosis, often in severe condition, and in senile group. Article provides literary data on the prevalence of multifocal atherosclerosis. References 1. Bjerrum I.S., Sand N.P., Poulsen M.K., et al. Non-invasive assessments reveal that more than half of randomly selected middle-aged individuals have evidence of subclinical atherosclerosis: a DanRisk substudy. Int. J. Cardiovasc. Imaging. 2012. [Epub ahead of print]. 2. Sumin A.N., Gaifulin R.A., Bezdenezhnykh A.V., Mos'kin M.G., Korok E.V., Karpovich A.V., Ivanov S.V., Barbarash O.L., Barbarash L.S. Rasprostranennost multifokalnogo ateroskleroza v razlichnyh vozrastnyh gruppah. [Prevalence of multifocal atherosclerosis in different age groups] Кардиология. Kardiologiia. 2010; 52(6): 28-34 [In Russ]. 3. Belov U.V., Carchan E.R., Krasnikov M.P. Odnomomentnoe hirurgicheskoe lechenie porazhenia voshodiaschej dugi aorty, koronarnyh i sonnyh artetij u bolnogo s multifokalnym aterosklerozom) [Single-step surgical management of lesions of the ascending aorta and aortic arch, coronary and carotid arteries in a male patient with multifocal atherosclerosis]. Angiol. Sosud. Khir. 2012;18(1): 131-135[In Russ]. 4. Helgadottir A., Gretarsdottir S., Thorleifsson G., et al. Apolipoprotein(a) Genetic Sequence Variants Associated With Systemic Atherosclerosis and Coronary Atherosclerotic Burden But Not With Venous Thromboembolism. Am. Coll. Cardiol. 2012; 60(8): 722-729. 5. Lammeren G.W., Catanzariti L.M., Peelen L.M., et al. Clinical prediction rule to estimate the absolute 3-year risk of major cardiovascular events after carotid endarterectomy. Stroke. 2012; 43(5): 1273-1278. 6. Giugliano G., Di Serafino L., Perrino C., et al. Effects of successful percutaneous lower extremity revascularization on cardiovascular outcome in patients with peripheral arterial disease. Int. J. Cardiol. 2012. [Epub ahead of print]. 7. Matsuo Y, Takumi T, Mathew V, et al. Plaque characteristics and arterial remodeling in coronary and peripheral arterial systems. Atherosclerosis. 2012; 223(2): 365-371. 8. Karimov Sh.I., Sunnatov R.D., Ganiev A.M., Keldierov B.K., Irnazarov A.A., Asrarov U.A., Iulbarisov A.A., Alidzhanov Kh. Diagnostika i taktika hirurgicheskogo lechenia bolnyh s multifokalnym aterosklerozom) [Diagnostics and strategy of surgical treatment of multifocal atherosclerosis]. Vestn. Ross. Akad. Med. Nauk. 2011; 1:14-18 [In Russ].
Abstract: Methods of beam diagnostics play an important role in examination of patients with dental anomalies. Reliably establish dental anomaly is possible due to radiological examination. However, according to orthopantomography not always possible to identify the true cause of the anomaly, correct localization of abnormal tooth, preservation of periodontal ligament. All this leads to an incorrect treatment planning and the occurance of complications; in this regard all of our patients underwent addition cone-beam computed tomography Under our observation were 60 patients aged 15-30 years with a complex form anomaly of the position and the eruption of teeth. Half of patients had an anomaly of upper canines, remaining patients, the anomaly of upper premolars, canines and premolars in the mandible. The main cause of anomalies of teeth was due to lack of space in the dentition, less abnormalities were associated with the presence of obstacles in the way of the eruption, with congenital abnormalities of the maxillofacial region. Possibilities of orthodontic and surgical interventions are limited and therefore it is very important accurate and reliable diagnosis of abnormalities. Cone-beam computed tomography allows to obtain all necessary information about the position of the tooth in the bone, its structure, shape, spatial relationship with roots of adjacent teeth and important anatomic structures, which makes it possible to properly plan for the further treatment strategy and reduce the risk of possible complications. References 1. Persii L.S. Vidy zubocheljustnyh anomalij i ih klassificirovanie. [Types of dentoalveolar anomalies and their classification]. M.: MGMSU. 2002: 32 [In Russ]. 2. Uiljam R. Profit. Sovremennaja ortodontija. Per. s angl. jaz.: (Pod red. Persina L.S.) [Contemporary orthodontics] M.: MEDpress-inform, 2006; 95-123 [In Russ]. 3. Horoshilkina FJa. Ortodontija. Defekty zubov, zubnyh rjadov, anomalii prikusa, morfofunkcional'nye narushenija v cheljustno-licevoj oblasti i ih kompleksnoe lechenie [The defects of teeth, dentition, abnormal bite, morpho-functional disorders in the maxillofacial region, and their combined treatment]. M.: Medicinskoe informacionnoe agentstvo. 2006: 544 [In Russ]. 4. Shuk Mazen. Kliniko-rentgenologicheskaja diagnostika i apparaturno-hirurgicheskoe lechenie retencii klykov [Clinical and radiographic diagnosis and surgical treatment for hardware-retention canines]:Avtoref. Dis. kand. med. Nauk [thesis PhD] Tver'. 2004: 102 [In Russ]. 5. 6. Vasil'ev AJu., Vorob'ev Ju.I., Serova N.S. Luchevaja diagnostika v stomatologii [Radiodiagnostics in dentistry.] M.: GJeOTAR-Media. 2008: 201-220 [In Russ]. 7. Minjaeva V.A. Posledstvija rannej utraty zubov u detej bez zamewenija defektov ortopedicheskimi apparatami [The consequences of early loss of teeth in children without defects in replacement orthopedic devices]. Stomatologija detskogo vozrasta i profilaktika. 2003; 1(2): 61-64 [In Russ]. 8. Sergeeva L.B. Peremewenie treh retinirovannyh klykov v zubnoj rjad s pomowju nesemnoj ortodon gicheskoj tehnikoj [Moving the three impacted canine tooth in the series with non-removable orthodontic appliances]. Ortodontija. 2001; 3: 40-41. [In Russ]. 9. Fridrih A. Pasler, Hajko Vissler. Rentgenodiagnostika v praktike stomaloga. Per. s nem. jaz. (Pod red. Rabuhinoj N.A.) [X-ray diagnostics in the practice of stomaloga. (Translated from German. lang. (Eds. Rabuhinoy NA)] M.: MED- press-inform. 2007: 118-131 [In Russ]. 10. Chaushu S. The use of panoramic radiographs to localize displaced maxillary canines. Oral Surg.Oral Med. Oral Pathol. Oral Radiol. Endod. 1999; 88(4): 511-516. 11. Garcia M.A.S., Wolf U., Heinicke F. Cone-beam computed tomography for routine orthodontic treatment planning: A radiation dose evaluation. American Journal ofOrthodontics and Dentofacial (Orthopedics. 2008; 133(5): 640.e1-640.e5. 12. Haney E., Gansky 13. Volchek D.A. Sovremennye metody obsledovanija pacientov s retenciej klykov verhnej cheljusti [Modern methods of examination of patients with retentions canines of the upper jaw.] Ortodontija. 2006; 1: 24-26 [In Russ]. 14. Chibisova M.A. Algoritmy obsledovanija pacientov pri primenenie dental'noj ob#emnoj tomografii v ambulatornoj stomatologicheskoj praktike [Algorithms for evaluation of patients with the use of dental volumetric imaging in ambulatory dental practice]. Dental Market. 2010; 76-78 [In Russ]. 15. Danforth R.A. Cone beam volume tomography: an imaging option for diagnosis of complex mandibular third molar anatomical relationships. J. Calif. Dent Assoc. 2003; 31(11): 847- 852. 16. Dodson T.B. Role of computerized tomography in management of impacted mandibular third molars. NY State Dent. J. 2005; 71(6): 32-35. 17. Mah J.K., Alexandroni S. Cone-Beam Computed Tomography in the Management of Impacted Canines. Seminars in Orthodontics. 2010; 16(3): 199-204.
Abstract: A standard X-ray is still the most affordable method of evaluation of patients, including those with spinal diseases since 1895 when X-rays were found and were introduced into general practice. In the standard X-ray examination of the spine and all the anatomical structures located at different depths and different distances, projected onto x-ray film or a screen in the form of planar image. In order to neutralize these drawbacks and to improve visualization, various tomographic techniques have been developed. The most modern and promising diagnostic method is a multisection linear imaging (tomosynthesis), in which a single pass X-ray tube is a series of slices. Digital X-ray tomography with multislice linear are used as a rule, in the world, for examination of breast and lungs. The article presents data on the different types of X-ray tomography in evaluation of patients with tuberculous spondylitis.
Abstract: Procedure of pre-operative ultrasonic imaging was conducted for nine patients with verified diagnosis of cervical adenocarcinoma. All the diagnosis were morphologically confirmed. A complex ultrasonic examination consisted of transabdominal and transvaginal echography of true pelvis organs as well as transabdominal examination of abdomen cavity and retroperitoneal space. All patients underwent true pelvis ultrasonic scanning including CDM mode, ED and Doppler pulse - wave mode. Based on the analyzed data, it was defined that echography makes it possible to determine the behavior of tumor local growth and to reveal metastases. We have traced a clear relationship of a disease stage on a ultrasonically fixed tumor size. An attempt is made to reveal specific echographic signs of adenocarcinoma of the cervix.
Abstract: Acute severe pancreatitis is the most severe disease in urgent abdominal surgery In these conditions - diagnosis and treatment of this group of patients remains a high priority issue of urgent surgery and intensive care therapy It is extremely important to estimate severity of local changes and general conditions of patient in order to draw up efficient disease management and forecast the outcome of the disease. It can be done by the use of different scoring systems of severity: J.H.C. Ranson, Glasgow (Imrie), SOFA, APACHE I or II, SAPS, MODS and others. Instrumental methods of investigation are used to examine scale and type of disease of pancreas, retroperitoneum and abdominal: laparoscopy, ultrasonography, computed tomography (CT), magnetic resonance imaging. It is generally recognized that the most informative methods of diagnosis of acute severe pancreatitis and its complications are ultrasound diagnostics and computed tomography In 2008 in Mumbai the Acute Pancreatitis Classification Working Group identified two types of classification - clinical and morphological, the last is based on beam diagnostics. Clinical classification is used during the early stage of disease (within the first week of acute pancreatitis manifestation), morphological classification is applicable to the subsequent stage (usually after the first week of illness). This allows radiologists to describe the «morphology» while clinicians include the results of the examination into the overall clinical picture and draw up the plan of appropriate treatment.
Abstract: Aim: was to study features of ultrasonic imaging of local and septic forms of acute hematogenic osteomyelitis (AHO) in children. Materials and methods: 59 patients with AHO, treated in Children's hospital No. 4 of Tomsk, for the period from 2000 to 2010 - were examined. All patients with suspicion on osteomyelitis (n = 59; 100%) underwent x-ray of defeated area and ultrasonic diagnostics on the Ultrasonix 2,6 with the use of linear sensor of 9-12 MHz. All patients with AHO underwent surgical operation (n=59; 100%). Results: 47 patients had local form of disease. Each patient had one phase of osteomyelitis. Extramedullary phase, the development of which was due to the disease duration - was prevalencing^^,^. Prevalence of quantity of AHO phases (n=19) over total number of patients with a septic forms of disease (n=12), reflected existence of multiple osteomyelitis in four patients. In each patient with septic form of the AHO we found defeat of several bones in identical or different phases of an inflammation. Conclusion: obtained results will help the earlier identification of AHO signs and determination of disease phase in patients with local and generalized forms of disease. All that will help to proceed modern sanation of osteomyelitic defeat. Reference 1. Abaev Ju.K., Adarchenko A.A., Zafranskaja M.M. Gnojnaja hirurgija detskogo vozrasta. Menjajushhiesja perspektivy [Contaminated surgery of childhood. Changing perspectives.]. Detskaja hirurgija. 2004; 6: 4-7 [In Russ]. 2. Beljaev M.K., Prokopenko Ju.D., Fedorov K.K. K voprosu o vybore lechebnoj taktiki pri metafizarnom osteomielite u detej [The issue of choice of therapeutic tactics in the metaphyseal osteomyelitis in children.]. Detskaja hirurgija. 2007;4:27-29 [In Russ]. 3. Lobanov Ju.A., Cap N.A., Nagornyj E.A. Osnovnye principy diagnostiki i lechenija ostrogo gematogennogo osteomielita u detej [The basic principles of diagnosis and treatment of acute osteomyelitis in children.]. Konsilium 2007 g. Ural'skaja gosudarstvennaja medicinskaja akademija: 56-59 [In Russ]. 4. Zavadovskaja V.D., Polkovnikova S.A., Perova T.B. Vozmozhnosti ul'trazvukovogo issledovanija v diagnostike ostrogo gematogennogo osteomielita u detej [Possibility of ultrasonography in the diagnosis of acute osteomyelitis in children.]. Ul'trazvukovaja i funkcional'naja diagnostika. 2006;4:67-75 [In Russ]. 5. Brjuhanov A.V. MR-tomograficheskaja semiotika zabolevanij kostno-sustavnogo apparata [MR tomographic semiotics of diseases of bone and articular apparatus.]. Materialy Ill regional'noj konferencii 28--30 ijunja 2004 goda. Tomsk. 2004;248-250 [In Russ]. 6. Kotljarov P.M., Sencha A.N., Beljaev D.V. Ul'tra-zvukovaja diagnostika osteomielita [Ultrasound diagnosis of osteomyelitis.]. Ul'trazvukovaja i funkcional'naja diagnostika. 2008;5:110-120 [In Russ]. 7. Tas F., Oguz S., Bulut O. et al. Comparison of the diagnosis of plain radiography ultrasonography and magnetic resonance imaging in early diagnosis of acute osteomyelitis experimentally formed on rabbits. Eur. J. Radiol. 2005; 56 (1): 107-112. 8. Fitoussi F., Litzelmann E., Ilharreborde B. et al. Hematogenous osteomyelitis of the wrist in children. J. Pediatr. (Orthop. 2007; 27(7): 810-813. 9. Marochko N.V., Pykov M.I., Zhila N.G. Ul'trazvukovaja semiotika ostrogo gematogennogo osteomielita u detej [Ultrasonic semiotics of acute hematogenic osteomyelitis in children.]. Ul'trazvukovaja i funkcional'naja diagnostika. 2006;4:55-66 [In Russ].
Abstract: The main part of the research is given to radiodiagnostics of tubercolisis lesion of backbone (traditional x-ray, ultrasound diagnostics, computed tomography, magnetic resonance imaging). We have exmined 452 patients: 40 patients (8,8%) had cervical spine lesions, 185 patients (41%) - thoracic spine lesions, thoracic-lumbar spine - 75 patients (16,8%), lumbar spine - 141 patients (31,1%), lumbar-sacral spine - 11 patients (2,5%). It is especially marked that combination of lungs tuberculosis and spondylitis is higher not only in patients with antibiotic resistant infection but n patients with tuberculosis combined with AIDS. References 1. Митусова Г.М. Лучевая диагностика туберкулезного спондилита у взрослых, осложненного неврологическими расстройствами. Дис. на соиск. к.м.н. С.-Пб. 2002. 2. Советова Н.А., Савин И.Б., Мальченко О.В. и др. Лучевая диагностика внелегочного туберкулеза. Проблемы туберкулеза. 2006; 11: 7-9. 3. Руководство по легочному и внелегочному туберкулезу. Под ред. Ю.Н. Левашева и Ю.М. Репина. ЭЛБИ-С.-Пб. 2008; 273-283. 4. Васильев А.В. Современные проблемы туберкулеза в регионе Северо-Запада России. Проблемы туберкулеза. 1999; 3: 5-7. 5. Лавров В.Н. Диагностика и лечение больных туберкулезным спондилитом. Проблемы туберкулеза. 2001; 4: 30-32. 6. Гусева Н.И., Иванов В.М., Потапенко Е.И. и др. Иммунный статус больных активным туберкулезным спондилитом. Проблемы туберкулеза и болезней легких. 2003; 6: 25-28. 7. Селюкова Н.В. Зонография в диагностике туберкулеза позвоночника на поликлиническом этапе. Проблемы туберкулеза и болезней легких. 2008; 11, 21-23. 8. Мердина Е.В., Митусова Г.М., Советова Н.А. Ультразвуковая диагностика забрюшинных абсцессов при туберкулезе позвоночника. Проблемы туберкулеза. 2001; 4: 19-21. 9. Лукьяненок П.И. Магнитно-резонансная томография в диагностике туберкулезного спондилита. Руководство для врачей. 2008. 10. Щ Советова Н.А., Джанкаева О.Б., Кравцова О.С. и др. Туберкулезный спондилит взрослых в условиях генерализации инфекции и лекарственной резистентности возбудителя. Невский радиологический форум 2-5 апреля 2011 г. С.-Пб.: Научные материалы. 2011; 223-224. 11. Шилова М.В. Туберкулез в России в 2009 г. М. 2009; 159-161.
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Abstract: Modern radiodiagnostics of carotid arteries (CA) defeat has very important value in such patients' treatment tactics. CA reconstruction operations are based on 3 general factors - clinic and arterial blood flow lack in dynamics, special methods of extra- and intracrania brachial arteries diagnostics, risk of arterial blood flow lack. We have pointed indications for surgical prophylactics and necessary patients diagnostic methods. References 1. Alsheikh-Ali A.A. et al. The vulnerable atherosclerotic plaque. Scope of the literature. Ann. Intern. Med. 2010; 153 (6): 7. 387-395. 2. Cohen J.E., Itshayek E. Asymptomatic carotid stenosis. Natural history versus therapy. Isr. Med. Assoc. J. 2010; 12 (4): 237-242. 3. Delgado Almandoz J.E. et al. Computed tomography angiography of the carotid and cerebral circulation. Radiol. Clin. North. Am. 2010; 48 (2): 265-281. 4. Hebb M.O. et al. Perioperative ischemic complications of the brain after carotid endarterectomy. Neurosurgery. 2010; 67 (2): 286-293. 5. Kar S. et al. Safety and efficacy of carotid stenting in individuals with concomitant severe carotid and aortic stenosis. Eurolntervention. 2010; 6 (4): 492-497. 6. Naylor A.R. Managing patients with symptomatic coronary and carotid artery disease. Perspect. Vasc. Surg. Endovasc.Ther. 2010; 22 (2): 70-76. 7. Pokrovsky A.V., Bogatov Yu.P. Vascular surgery in Russia. Pages of history. Eur. J. Vasc. Endovasc. Surg. 1997; 13 (2): 93-95. 8. Rockman C., Riles T. Carotid artery disease: selecting the appropriate asymptomatic patient for intervention. Perspect. Vasc. Surg. Endovasc. Ther. 2010; 22 (1): 30-37. 9. Spence J.D. Secondary stroke prevention. Nat. Rev. Neurol. 2010; 6 (9): 477-486. 10. Tallarita T., Lanzino G., Rabinstein A.A. Carotid intervention in acute stroke. Perspect. Vasc. Surg. Endovasc. Ther. 2010;22 (1): 49-57. 11. Tholen A.T. et al. Suspected carotid artery stenosis. Cost-effectiveness of CT angiography in work-up of patients with recent TIA or minor ischemic stroke. Radiology. 2010; 256 (2): 585-597. 12. Walkup M.H., Faries P.L. Update on surgical management for asymptomatic carotid stenosis. Curr. Cardiol. Rep. 2010; 5.
Abstract: Despite the comparatively low morbidity rate, skin melanoma is known for its high mortality rate. High metastatic potential of the tumor, urges the necessity of improving methods of diagnostics, which can identify metastasis and assess the degree of dissemination at the early stage of disease. We have analyzed results of ultrasound imaging of one of the earliest and frequent types of progression of melanoma - metastasis in regional lymphatic nodes. The article presents results of examination of 182 patients with skin melanoma with early metastasis in lymphatic nodes, also - characteristics of the image of tumor changes are described. The high informativeness of ultrasound research for timely identification of metastatic changes and, respectively, the increase of the rate of survival of patients with skin melanoma are demonstrated. References 1. American Cancer Society.: Cancer Facts and Figures 2012. [Электронный ресурс]//Atlanta, Ga: American Cancer Society, 2012. URL: http://www.cancer.org/Research/ CancerFactsFigures/CancerFactsFigures/cancer-facts-figures-2012 (дата обращения: 21.12.2012) 2. Balch C.M., Gershenwald J.E., Soong S.J., Thompson J.F., Atkins M.B., Byrd D.R., et al. Final version of 2009 AJCC melanoma staging and classification. J. Clin. Oncol. 2009; 27(36): 6199-6206. 3. College of American Pathologists (CAP). Protocol for the Examination of Specimens from Patients with Melanoma of the Skin [Электронный ресурс]//Version 3.2.0.0. June 2011. URL: http://www.cap.org/apps/ docs/committees/cancer/cancer_protocols/2012/ SkinMelanoma_12protocol.pdf (дата обращения: 2012.12.21) 4. Thompson J.F, Shaw H.M. Sentinel node mapping for melanoma: results of trials and current applications. Surg. Oncol Clin. N. Am. 2007;16(1): 35-54. 5. Ferrone C.R., Panageas K.S., Busam K. et al. Multivariate prognostic model for patients with thick cutaneous melanoma: importance of sentinel lymph node status. Ann. Surg. Oncol. 2002; 9(7): 637-645. 6. Gershenwald J.E., Mansfield P.F., Lee J.E. et al. Role for lymphatic mapping and sentinel lymph node biopsy in patients with thick (> or = 7. O’Brien CJ., Uren R.F, Thompson J.F. et al. Prediction of potential metastatic sites in cutaneous head and neck melanoma using lymphoscintigraphy. Am. J. Surg. 1995; 170(5): 461-466. 8. Uren R.F. Lymphatic drainage of the skin. Ann. Surg. Oncol. 2004; 11(3 Suppl): 179-185. 9. Blum A., Schlagenhauff B., Stroebel W. et al. Ultrasound examination of regional lymph nodes significantly improves early detection of locoregional metastases during the follow-up of patients with cutaneous melanoma. Cancer. 2000; 88 (11): 2534-2539. 10. Voit C.A., Van Akkooi A.C.J., Sc^fer-Hesterberg G. et al. Ultrasound Morphology Criteria Predict Metastatic Disease of the Sentinel Nodes in Patients With Melanoma. J. Clin. Oncology. 2010; 28 (5): 847-852. 11. Voit C.A., van Akkooi A.C.J., Schaefer-Hesterberg G. et al. Rotterdam criteria for sentinel node (SN) tumor burden and the accuracy of ultrasound (US)-guided fine-needle aspiration (FNAC) cytology: Can US-guided FNAC replace SN staging in patients with melanoma? J. Clin. Oncol. 2009; 27: 4994-5000. 12. Струков А.И., Серов В.В. Патологическая анатомия. 4-е изд. М.: Медицина, 1995. 688.
Abstract: Aim: was to determine possibilities of ultrasound in estimation of the status of parathyroid glands (PTG) in patients with secondary hyperparathyroidism (SHPT) treated with percutaneous ethanol injections. Materials and methods: we examined 200 patients with end-stage of renal disease on dialysis. Enlargement and structural alteration of PTG were noted in 125 patients (62,5 %). Higher level of intact parathyroid hormone (iPTH) over 300 pg/ml was noted in the majority of patients with diagnosed parathyroic hyperplasia (81,6 %). Percutaneous ethanol injection therapy under ultrasound guidance was performed in 13 patients with SHPT resistant to medical therapy Average number of injections was 2,8 (from 1 to 6). Treatment effect was assessed based on iPTH level, calcium-phosphorus product level, as well as ultrasound evaluation. Results: statistically significant decrease of iPTH after injections was noted averaging by 57,3% (p=0,0007), calcium-phosphorus product - by 12,2% (p=0,003). The biggest effect was noted in case of single hyperplastic PTG. During the follow-up, tendency to continued decreasing in levels of iPTH remained in 61,5 %. Decrease of the largest dimension of PTG after ethanol injections was noted on average by 15,1%, decrease of volume by 31,6%. Significant decrease in systolic velocity as well as resistive index of the feeding artery of PTG were observed (p=0,001 and 0,03 respectively). An important sign of diminished functional activity in the injected gland was statistically significant decrease in the vascularization index as assessed by the color Doppler during the process of injections (p=0,002). Conclusion: ultrasound method provides information necessary for patients' selection for conduction of percutaneous ethanol injection therapy It assists at the time of the manipulation as well as during the follow-up assessing the condition of PTG and effectiveness of treatment. References 1. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int. 2009; 113: 1-130. 2. Cunningham J., Locatelli F., Rodriguez M. Secondary Hyperparathyroidism: Pathogenesis, Disease Progression, and Therapeutic Options. Clin. J. Am. Soc. Nephrol. 2011;6: 913-921. 3. Fukagawa M., Nakanishi S., Kazama J.J. Basic and clinical aspects of parathyroid hyperplasia in chronic kidney diseases. Kidney Int. 2006; 70 (102): 3-7. 4. Tominaga Y, Matsuoka S., Sato T. et al. Clinical features and hyperplastic pattern of parathyroid glands in hemodialysis patients with advanced secondary hyperparathyroidism refractory to maxacalcitol treatment and required parathyroidectomy. Ther. Dial. Apher. 2007; 11: 266-273. 5. Latus J., Renate Lehmann R., Roesel M. et al. Analysis of -Klotho, Fibroblast Growth Factor, Vitamin-D and Calcium-Sensing Receptor in 70 Patients with Secondary Hyperparathyroidism. Kidney Blood Press Res. 2013; 37: 84-94. 6. Tokumoto M., Taniguchi M. The mechanisms of parathyroid hyperplasia and its regression. Clin. Calcium. 2007; 17 (5): 665-676. 7. Onoda N., Fukagawa M., Tominaga Y et al. New clinical guidelines for selective direct injection therapy of the parathyroid glands in chronic dialysis patients. Nephrol. Dial. Transplant. Plus. 2008; 1 (3): 26-28. 8. Solbiati L., Giangrande A., Pra L.D. et al. Percutaneous ethanol injection of parathyroid tumor under US guidance: treatment for secondary HPT. Radiology. 1985; 155: 607-610. 9. Gerasimchuk R., Zemchenkov A., Kondakov S. Maloinvazivnyj metod korrekcii vtorichnogo giperparatireoza pri hronicheskoj bolezni pochek. [Miniinvasive technique in the correction of secondary hyperparathyroidism in cronic renal disease]. Vrach. 2009; 11: 15-22 [in Russ]. 10. Fukagawa M., Kitaoka M., Tominaga Y et al. Guidelines for percutaneous ethanol injection therapy of the parathyroid glands in chronic dialysis patients. Nephrol Dial Transplant. 2003; 18 (3): 31-33. 11. Koiwa F., Kakuta T., Tanaka R. et al. Efficacy of percutaneous ethanol injection therapy (PEIT) is related to the number of parathyroid glands in hemodialysis patients with secondary HPT. Nephrol. Dial. Transplant. 2007; 22: 522-528. 12. Yumita S. Intervention for recurrent secondary hyperparathyroidism from a residual parathyroid gland. Nephrol. Dial. Transplant. 2003; 18 (3): 62-64. 13. Polukhina E.V., Glazun L.O. Ul'trazvukovaja diagnostika patologii parashhitovidnyh zhelez u bol'nyh hronicheskoj pochechnoj nedostatochnost'ju, nahodjashhihsja na zamestitel'noj pochechnoj terapii. [Ultrasound diagnosis of the parathyroid glands pathology in patients being on replacement therapy in case of chronic renal insufficiency]. Ul'trazvukovaja i funkcional'naja diagnostika. 2008; 1: 35-42 [in Russ]. 14. Anari H., Bashardoust B., Pourissa M. The Diagnostic Accuracy of High Resolution Ultrasound Imaging for Detection of Secondary Hyperparathyroidism in Patients with Chronic Renal Failure. Acta Medica Iranica. 2011; 49 (8): 527-530. 15. Meola M., Petrucci I., Cup-isti A. Ultrasound in clinical setting of secondary hyperparathyroidism. J. Nephrol. 2013; 26 (5): 848-855. 16. National Kidney Foundation. K/DOQI clinical practice guidelines for Bone Metabolism and Disease in Chronic Kidney Disease // Am. J. Kidney Dis. 2003; 42: 1-202. 17. Kakuta T., Tanaka R., Kanai G. et al. Can cinacalcet replace parathyroid intervention in severe secondary hyperparathyroidism? Ther. Apher. Dial. 2009; 13 (1): 20-27. 18. Kalinin A.P., Pavlov A.V., Aleksandrov Ju.K. et al. Metody vizualizacii okoloshhitovidnyh zhelez i paratireoidnaja hirurgija: rukovodstvo dlja vrachej; Pod. red. A.P. Kalinina. [Parathyroid imaging techniques and parathyroid surgery: The management for doctors. Ed. A.P. Kalinin]. M.: Vidar M, 2010; 311 [in Russ]. 19. Chen H.H., Lu K.C., Lin C.J. et al. Role of the Parathyroid Gland Vascularization Index in Predicting Percutaneous Ethanol Injection Efficacy in Refractory Uremic Hyperparathyroidism. Nephron Clin. Pract. 2010; 117 (2): 120-126.
Abstract: Development of multilayer digital tomosynthesis technology allows you to get a more accurate imaging of internal organs and tissues in comparison with other traditional radiological methods of investigation, and that is achieved by the possibility of layered imaging of selected anatomical region. Aim: was to analyze possibilities of digital tomosynthesis in the assessment of lung structure in normal anatomy of organs of chest cavity Materials and methods: study include patients without lesions of the chest cavity, who underwent digital tomosynthesis in frontal and lateral projections. Results: basing on analyzed data, we identified features of normal radiological anatomy of the chest cavity using a technique of digital tomosynthesis. Schematically clarified lobar and segmental structure of lungs, as well as airways according to layered imaging. Advantages and disadvantages of the method in imaging of lungs and mediastinal structures are shown. Conclusion: the use of digital tomosynthesis in the evaluation of chest organs allows to determine main anatomical structures of lungs in more detail, through layered imaging and a high spatial resolution. References 1. Galea A. et al. Practical applications of digital tomosynthesis of the chest. Clinical radiology. 2014; 69(4): 424-430. 2. de Koste J. R. S. et al. Digital tomosynthesis (DTS) for verification of target position in early stage lung cancer patients. Medical physics. 2013; 40(9): 091904. 3. Dobbins III J. T. et al. Digital tomosynthesis of the chest for lung nodule detection: interim sensitivity results from an ongoing NIH-sponsored trial. Medical physics. 2008; 35(6): 2554-2557. 4. Vikgren J. et al. Comparison of Chest Tomosynthesis and Chest Radiography for Detection of Pulmonary Nodules: Human Observer Study of Clinical Cases 1. Radiology. 2008; 249(3): 1034-1041. 5. Quaia E. et al. Digital tomosynthesis as a problemsolving imaging technique to confirm or exclude potential thoracic lesions based on chest X-ray radiography. Academic radiology. 2013; 20(5): 546-553. 6. Jung H. N. et al. Digital tomosynthesis of the chest: utility for detection of lung metastasis in patients with colorectal cancer. Clinical radiology. 2012; 67(3): 232-238. 7. Nikitin M. M. Possibilities of digital tomosynthesis in the diagnosis of various forms of pulmonary tuberculosis. REJR. 2016; 6 (1): 35-47. [In Russ]. 8. F.Kovach F., Zhebek Z. X-ray anatomical basics of lungs’ examinations. Budapest, 1958; 364 p. [In Russ]. 9. Trofimova T. N. ed. Human X-ray anatomy. SPb.: Publishing house SPbMAPO. 2005; 496 p. [In Russ]. 10. Sapin M. R. ed. Human Anatomy. Moscow, M.: Medicine. 2001; 640 p. [In Russ]. 11. Sinelnikov R. D., Sinelnikov Ya. R. Atlas of human anatomy. M.: Medicine. 1996; 344 p. [In Russ]. 12. Kokov L. S., ed. X-ray Atlas of comparative anatomy. M.: Radiology-Press., 2012; 388 p. [In Russ].
Abstract: In patients with severe multiple trauma, posttraumatic period is often complicated by the development of polyorgan insufficiency, development of which is connected with morpho-functional changes of the liver parenchyma. Aim: was to identify dynamics of ultrasound signs of morphological and functional changes of liver in patients with multiple trauma. Materials and methods: performed analysis of ultrasound data obtained in dynamics, in 28 patients with severe multiple trauma. From the analysis, we excluded patients with blunt abdominal trauma with injury of liver. In first 2 days, 21 patients underwent surgical operations in treatment of craniocerebral trauma and trauma of musculoskeletal system. All patients underwent ultrasound examination of the abdominal cavity and retroperitoneal space to exclude possibility of appearance of free liquid; also estimated condition of liver, spleen, functional and morphological condition of the gastrointestinal tract. In first days after trauma, ultrasound examination was performed 2-3 times. Color duplex scanning of vessels of liver and spleen was performed once a day or every other day for 2-3 weeks of a traumatic period. Evaluated arterial and venous blood flow of liver by measuring the linear blood flow velocity (LBFV) and resistance index (RI), portal blood flow by measurement of linear and volumetric flow rate. Results: in all patients on admission to hospital, liver and spleen sizes had normal size. On the 3rd day after the injury, was revealed an increase in the cranio-caudal liver size by 2-4 cm and increased length of spleen by 5-8 cm, which lasts for 10-20 days. During dynamical ultrasound, 8 patients with 10-20 days against a background of increasing level of bilirubin and transaminases, in addition to increasing size of liver and spleen, we marked infiltration of tissues along hepatic veins with their narrowing and along branches of the portal vein with thickness from 0,25 to 0,7 cm. We marked LBFV decreasement by portal vein to 10-13 cm/sec and a volume flow to 250-400 ml / min, increased RI by hepatic artery In 3 patients in the liver parenchyma, we revealed avascular tissue regions with decreased echogenicity, indicating the formation of ischemic regions. Conclusion: during dynamical ultrasound in patients with severe multiple trauma, on day 3 after injury, were diagnosed morphological changes in liver parenchyma with violation of its hemodynamics. Further progression of the process observed for 10-20 days from the date of trauma: the growth of intrahepatic portal hypertension, increased peripheral resistance in arteries of liver parenchyma, the appearance of ischemic areas of liver parenchyma. The totality of above ultrasonic signs of hemodynamic disorders of liver, characterize organic hepatocellular insufficiency, which is a poor prognostic sign in the development of polyorgan insufficiency. References 1. Marushhak E.A. Povrezhdenija pecheni i selezenki u bol'nyh s zakrytoj abdominal'noj travmoj [Injury of liver and spleen in patients with blunt abdominal traums]. Avtoreferat Diss. kand. med. nauk. M. 2009; 31 [In Russ]. 2. Abdominal'naja travma: rukovodstvo dlja vrachej (Pod red. A.S. Ermolov M.Sh. Hubutija, M.M. Abakumov) [Abdominal trauma: manual for physicians]M.: Vidar, 2010; 504 [In Russ]. 3. Travmaticheskaja bolezn' i ee oslozhnenija ( Pod red. 4. Gajduk S.V. Kliniko-patofiziologicheskoe obosnovanie rannej diagnostiki sindroma poliorgannoj nedostatochnosti i visceral'nyh oslozhnenij u postradavshih s politravmoj [Clinical-pathophysiological rationale of early diagnostics of polyorgan insufficiency and visceral complications in patients with polytrauma]. Avtoreferat Diss. kand. med. nauk. SPb., 2009; 47 [In Russ]. 5. Gajduk S.V., Sosjukin A.E., Bojarincev V.V. Travmaticheskaja bolezn' i sindrom poliorgannoj disfunkcii - aktual'nye problemy mediciny kriticheskih sostojanij [Traumatic disease and syndrome of polyorgan dysfunction - actual problems of medicine of critical conditions]. Vestnik Rossijskoj Voenno-medicinskoj akademii. 2008; 1(21): 66-70 [In Russ]. 6. Zolotokrylina E. S. Voprosy patogeneza i lechenija poliorgannoj nedostatochnosti u bol'nyh s tjazheloj sochetannoj travmoj, massivnoj krovopoterej v rannem post- reanimacionnom periode [Questions of pathogenesis and treatment of polyorgan insufficiency in patients with severe multiple trauma, massive bloodloss in early postreanimation period]. Anesteziologija i reanimatologija. 1996; 1: 9-13 [In Russ]. 7. Cibuljak G.N. Obshhaja hirurgija povrezhdenij: rukovodstvo [General surgery of trauma: manual]. SPb.: Gippokrat. 2005; 646 [In Russ]. 8. Chastnaja hirurgija mehanicheskih povrezhdenij (Pod redakciej G.N.Cibuljak) [Particularistic surgery of mechanical injury.].SPB.: Gippokrat. 2011; 570 [In Russ]. 9. Saenko V.F. Desjaterik V.I., Perceva T.A., Shapovaljuk V.V. Sepsis i poliorgannaja nedostatochnost [Sepsis and polyorgan insufficiency]'. Krivoj Rog: Mineral. 2005; 441[In Russ]. 10. Tokmakova T.O.,Kameneva E.A., Grigor'ev E.V. Narushenie mikrocirkuljacii kak prichina poliorgannoj nedostatochnosti u postradavshih s tjazheloj cherepno-mozgovoj travmoj[Microcirculatory disorders as a reason of polyorgan insufficiency in patients with severe craniocerebral trauma]. Politravma. 2011; 4: 47-50 [In Russ]. 11. Gel'fand E. B., Gologorskij V.A., Gel'fand B.R. Abdominal'nyj sepsis: integral'naja ocenka tjazhesti sostojanija bol'nyh i poliorgannoj disfunkci [Abdominal sepsis: estimation of severity of condition of patients and polyorgan disfunction]. Anesteziologija i reanimatologija. 2000;3:29-34 [In Russ]. 12. Chappell D., Jacob M., Hofmann-Kiefer K. et al. A rational approach to perioperative fluid management. Anesthesiology. 2008; 109(4): 723-740. 13. Brealey D., SingerM. Multiorgan dysfunction in the critically ill: epidemiology, pathophysiology and management. J. Royal Coll. Physic. Lond. 2000; 34(5): 424-427. 14. Baker S.P, O'Neill B., Haddon W. Jr., Long W.B. The Injury Severity Score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974; 14(3): 187-196. 15. Trusov O.A. Patologicheskaja anatomija i patogenez poliorgannoj nedostatochnosti pri ostroj arterial'noj neprohodimosti konechnostej i peritonita (na materiale rannih autopsij)[Pathological anatomy and pathogenesis of polyorgan insufficiency in case of acute arterial failure of limb and peritonitis (based on early autopsy)]. Avtoreferat Diss. dokt. med. nauk. M., 2002; 41[In Russ].
Abstract: Aim: was to increase the level of differential diagnosis of thyroid nodules by evaluating their rigidity according to two ultrasound techniques - compressive elastography and shear wave elastography. Materials and methods: study is based on the result of analysis of complex clinical anc ultrasound diagnostics, performed for the period from 2010 to 2015 , on the base of ultrasound department of «Central Clinical Hospital of Ministry of Internal Affairs» of the RF in Moscow, and Medical Radiological Research Center named after AF Tsyba - FGBU branch of «National Medical Research Radiological Center» MoH Obninsk. Results: performed shear wave elastography, obtained quantitative data of rigidity of benign nodules and papillary carcinoma. Used methods of nonparametric statistics and ROC-analysis. Statistical processing was performed in SPSS 13.0 program. For benign nodes median of regidity was 15.6; 2,5-97,5 percentiles - 3,6-81,3; for papillary cancer: median 112.92; 2,5-97,5 percentiles - 13,5-196,4. Then followed an orange and yellow-red: blue color was not more than 20%, but mostly he was absent. In case of papillary cancer we observed two-color, three-color, four-color and six-color color, with prevailing of two colors - purple and blue. Conclusions: both types of elastography - compressive and shear wave elastography - help to improve the differential diagnosis of thyroid cancer. Informativeness of shear wave elastography is higher, in comparison with compressive elastography. References 1. Kotljarov P.M., Harchenko V.P., Aleksandrov Ju.K., Mogunov M.S., Sencha A.N., Patrunov Ju.N., Beljaev D.V. Ul'trazvukovaja diagnostika zabolevanij shhitovidnoj zhelezy [Ultrasonic diagnosis of thyroid diseases.]. M.: VIDAR. 2009: 239S [In Russ]. 2. Mit'kov V.V., Huako S.A., Cyganov S.E., Kirillova T.A., Mit'kova M.D. Sravnitel'nyj analiz dannyh jelastografii sdvigovoj volnoj i rezul'tatov morfologicheskogo issledovanija tela matki (predvaritel'nye rezul'taty) [Comparative analysis of data of shear wave elastography and results of uterine body morphological study (preliminary results)]. Ul'trazvukovaja i funkcional'naja diagnostika. 2013; 5: 99-114 [In Russ]. 3. Sencha A.N., Mogutov M.S., Patrunov U.N. et al. Kolichestvennie i kachastvennie pokazateli ul’trazvukovoi jelastografii v diagnostike raka shhitovidnoj zhelezy [Quantitative and qualitative indicators of ultrasound elastography in the diagnosis of thyroid cancer.]. Ul'trazvukovaja ifunkcional'naja diagnostika. 2013; 5: 85-98 [In Russ]. 4. Osipov L.V. Tehnologii jelastografii v ul’trazvukovoi diagnostike. Obzor. [ Elastography technologies in ultrasound diagnostics. Overview.] Diagnosticheskaya radiologiya i onkoterapiya. 2013; 3,4: 5-23 [In Russ]. 5. Parshin V.S., Yamasita C, Cib A.F. Zob. Ul'trazvukovaja diagnostika. Klinicheskii atlas [Ultrasound diagnostics. Clinical atlas]. Nagasaki-Obninsk. Universitet Nagasaki, 2000; S 106 [In Russ]. 6. Parshin V.S., Cib A.F., Yamasita C. Rak shhitovidnoj zhelezy. Ul'trazvukovaja diagnostika. Klinicheskii atlas [Thyroid cancer. Ultrasound diagnostics. A clinical atlas. In Chernobyl materials.]. Po materialam Cyernobilya. Obninsk. MRNC RAMN. 2002; S 230 [In Russ]. 7. Parshin V.S.,Yamashita S., Tsyb A.F. Ultrasound Diagnosis of Thyroid Diseases in Russia. Obninsk-Nagasaki. 2013; S147. 8. Cib A.F., Parshin V.S., Yamasita C. Ul'trazvukovaja diagnostika zabolevanij shhitovidnoj zhelezy [Ultrasonic diagnosis of thyroid diseases.]. M.: Medicina. 1997; S 329 [In Russ]. 9. Asteria C., Giovanardi A., Pizzocaro A., Cozzaglio L., Morabito A., Somalvico F., Zoppo A. US-elastography in the differential diagnosis of benign and malignant thyroid nodules. Thyroid. 2008; 18: 523-531. 10. Cantisani V., D'Andrea V., Biancari F., Medvedyeva O., Di Segni M., Olive M., Patrizi G., Redler A., De Antoni E.E., Masciangelo R., Frezzotti F., Ricci P Prospective evaluation of multiparametric ultrasound and quantitative elastosonography in the differential diagnosis of benign and malignant thyroid nodules: preliminary experience. Eur. J. Radiol. 2012; 81: 2678-2683. 11. Vorlander C., Wolff J., Saalabian S., Lienenluke R.H., Wahl R.A. Real-time ultrasound elastographya non-invasive diagnostic procedure for evaluating dominant thyroid nodules Langenbecks Arch. Surg. 2010; 395: 865-871. 12. Bojunga J., Herrmann E., Meyer G., Weber S., Zeuzem S., Friedrich-Rust M. Real-time elastography for the differentiation of benign and malignant thyroid nodules: a metaanalysis Thyroid. 2010; 20: 1145-1150. 13. Gharib H., Papini E., Paschke R., Duick D.S., Valcavi R., Hegedus L., Vitti P American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi and European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules. Endocr. Pract. 2010;16: 1-43. 14. Moon H.J., Kim E.K., Yoon J.H., Kwak J.Y Clinical implication of elastography as a prognostic factor of papillary thyroid microcarcinoma. Ann. Surg. Oncol. 2012; 19: 2279-2287.
