UJR 2002, vol X, # 4
THE CONTENTS
2002, vol 10, № 4, page 350
V.O. Rohozhyn, Z.Z. Rozhkova, L.H. Kyryllova
In vivo H-1 magnetic resonance spectroscopy in investigation of fetus brain metabolism
Annotation
Objective: To study the capabilities of in vivo H-1 magnetic resonance spectroscopy in investigation of the fetal brain metabolism.
Material and Methods: In vivo H-1 magnetic resonance spectroscopy was used to investigate 36 women with single pregnancy, of them 15 healthy subjects with normal pregnancy and 21 with complicated pregnancy (7 with high antibody titer to cytomega-lovirus and herpes virus, 14 with the history of complications during previous pregnancies). Water signal was used as an inner standard for determining absolute values and concentrations of main metabolites in the fetal brain.
Results: The following amounts of four main metabolites were determined from H-1 spectra (mmol/l): NAA (5.034 ± 1.3), Cr (4.24 ± 1.1), Cho (3.6 ± 0.7), Ino (8.14 ± 1.3). It was not always possible to determine NAA amount with high accuracy as they were covered by lipid signals from the adjacent fat tissue of the abdominal cavity of the mother and NAA signals from the fetal brain tissue.
Conclusion: In vivo H-1 magnetic resonance spectroscopy is a highly effective noninvasive technique for the fetus state monitoring. The obtained data about the amount of the four main metabolites in the fetal brain tissue correspond to those observed in the newborns at 36—41 weeks of gestation.
Key words: magnetic resonance spectroscopy, fetus brain, metabolite, hypoxia, encephalopathy.
2002, vol 10, № 4, page 355
L.A. Myronyak
Differential diagnosis of pathological processes in the chiasmosellar region with CT, MRI and MR angiography
Annotation
Objective: To study the capabilities of helical computed tomography (HCT), magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) in differential diagnosis of pathological conditions in the chiasmosellar region.
Material and Methods: The study involved 72 patients with clinical signs of chiasmosellar lesions. The patients were examined using CT scanner SOMATOM Plus 4 and MR scanner MAGNETOM Vision Plus (1.5 T). The data were processes using the algorithm for maximal intensity MIP and three-dimensional reconstructions. To obtain MRA images, 3D TOF technique was used.
Results: Complex HCT, MRI, MRA study allowed to reveal various pathological processes in 72 patients. Eleven nosological forms were differentiated: meningiomas (n = 15; 20.83%), neurofibromatosis I (n = 4; 5.55%), glioma of the optic chiasm (n = 5; 6.94%), germinoma metastases (n = 2; 2.78%), hypophyseal tumors (n = 9; 12.49%), craniopharyngioma (n = 7; 9.75%); hypothalamus hamartoma (n = 2; 2.78%), aneurysm (n = 15; 20.83%), carotidocavernous anastomosis (n = 3; 4.17%), optic chiasm arachnoiditis (n = 5; 6.94%), multiple sclerosis (n = 5; 6.94%). In 35% of cases the diagnosis was verified at surgery. When vascular pathology was demonstrated, digital x-ray angio-graphy was done.
Conclusion: HCT, MRI and MRA are highly informative techniques for differential diagnosis of chiasmosellar pathology, they are of primary importance for determining correct therapeutic tactics. HCT has some advantages when it is necessary to visualize the changes in the osseous structures as well as in the processes with the elements of calcification. When hypophysis microade-noma, hypothalamus hamartoma, multiple sclerosis and arachnoiditis are suspected, MRI with gadolinium contrast substances is a "golden standard". MRA is an essential part of the diagnostic algorithm revealing vascular pathology as well as the relation of voluminous formations and the brain vessels.
Key words: chiasmosellar region, helical computed tomography, magnetic resonance imaging, magnetic resonance angiography, meningioma, hypophyseal adenoma, glioma, carotidocavernous anastomosis.
2002, vol 10, № 4, page 362
I.M. Zazirniy, V.O. Rohozhyn, M.K. Ternovyy
Comparison of arthroscopy and magnetic resonance imaging in investigation of the knee joint
Annotation
Objective: To compare the findings of MRI and arthroscopy in investigation of the knee joint.
Material and Methods: MRI was done in 41 patients aged 18-56 who were treated for stage 1 and 2 osteoarthrosis of the knee joint. Arthroscopy was performed due to the signs of internal disorders in the joint. The findings of MRI and arthroscopy were compared in all 41 patients using the following MRI parameters: sensitivity, accuracy, specificity, positive preliminary value (PPV), negative preliminary value (NPV), true positive data (TPD), true negative data (TND), false positive data (FPD), false negative data (FND).
Results: In our study, PPV for the cartilage was 89.28 %, NPV - 84.61 %, sensitivity - 92.5 %, specificity - 84.61 %, accuracy 87.8%. For the medial menisci MRI findings were 95.56 %, 83.3 %, 88 %, 93.75 %, 90.2 %, respectively.
Conclusion: The analysis of accuracy, sensitivity, specificity suggests that MRI facilitates assessment of the state of the knee cartilage and menisci.
High negative preliminary data of MRI allow to avoid unnecessary arthroscopy of the knee joint.
Key words: knee joint, magnetic resonance imaging, arthro-scopy.
2002, vol 10, № 4, page 366
R.YA. Abdullayev
EchoCG parameters of left ventricle myocardium contraction and relaxation geometry in post-infarction aneurysm and chronic heart failure
Annotation
Objective: To study the relation between the development of chronic heart failure (CHF) and the contraction and relaxation geometry in the left ventricle (LV) in patients with chronic postinfarction aneurysm (CPA) with the consideration to its localization.
Material and Methods: The parameters of LV relaxation and contraction geometry were studied in 115 patients with CPA using EchoCG. Grade I-IV CHF (NYHA) was noted in 54 (46.9%) patients, of them grade I in 19 (16.6%), grade II - in 17 (14.68%), grade III in 11 (9.6%) and grade IV in 7 (6.1%).
Results: The fraction of contraction area (FCA) in patients with CPA was significantly increased in all localizations of the aneurysm when compared with the controls. The smallest FCA (39.4%) was observed when the aneurysm was localized in the postero-basal segment. The worst indices, which characterize spherical shape of the LV, were noted in antero-septal localization of the aneurysm: D/K of LV - 1.41±0.06; sphere index -0.69±0.05; 2h/D index - 0.24±0.03, Keren's index 2.26±0.51.
In antero-apical and postero-apical localization of the aneurysm, relaxation of the LV was of hypertrophic type, medio-basal aneurysms were characterized by pseudo-normal type of diastolic filling. LV filling velocity did not differ from the controls.
In patients with CHF the indices of LF contraction and relaxation got worse with the functional class of CHF. The most prominent FCA changes were present in basal and medial level of the LV. While all indices of geometry of global myocardium contraction in patients with grade I and IV CHF differed significantly, comparison of grade II and IV demonstrated significant differences only in Keren's index and FCA. All LV relaxation parameters in these groups differed significantly.
Conclusion: The lowest FCA was observed at localization in the medio-basal region of the LV and ranges within 39-41%. High degree of spherical character is observed in antero-septal localization of the aneurysm. The changes in the geometry of LV contraction at CPA are characterized by the changes of both global and regional contractility. The disturbances in LV myocardium relaxation in patients with apical aneurysm are of hypertrophic character, in medio-basal - of pseudo-normal character. With the increase in the grade of CHF, the indices of contraction and relaxation become worse. Comparison of grate II and IV CHF demonstrates significant differences only in Keren's index, basal FCA and medial FCA, %> of systolic thickening and all parameters of diastolic filling. In patients with grade IV CHF the contribution of the left atrium to diastolic filling is significantly decreased.
Key words: geometry of contraction and relaxation of the left ventricle, chronic post-infarction aneurysm, chronic heart failure.
2002, vol 10, № 4, page 371
YU.A. Ivaniv
Doppler ultrasound parameters of coronary blood flow in patients with mitral stenosis
Annotation
Objective: To study the characteristics of coronary blood flow in mitral stenosis (MS) and to compare them with the changes occurring in aortic stenosis (AS), a different in its pathophysiological mechanism defect.
Material and Methods: The study involved 38 patients who undergone transthoracic and transesophageal echocardiography with ACUSON 128XP unit. Twenty-four patients aged 18—58 (mean age 40.2±5.4) had mitral stenosis, of them 5 men and 19 women. Aortic stenosis was diagnosed in 14 patients aged 48—63 (mean age 52.4±4.6), 9 men and 5 women. The controls were 8 healthy subjects aged 24—50 (mean age 38.3±5.7). The profile of mitral and aortic flow was obtained with a constant Doppler probe. The left coronary artery was visualized at transesophageal examination with a 5 MHz probe. The control volume was placed distal to the bifurcation in the initial portion of the anterior descending artery, the curve of the flow was registered.
Results: The velocity of the diastolic flow was higher in MS vs the controls, 0.57±0.124 and 0.38±0.101 m per second respectively (p<0.05). When compared with AS, both peak systolic and peak diastolic velocity of the blood flow in MS were considerably lower. Time-velocity integral of diastolic blood flow was higher in AS than in MS, 0.169±0.039 vs 0.115±0.052 (p<0.05). Some indices of MS severity correlated with coronary flow parameters: the higher the pressure in the right ventricle, the weaker systolic coronary flow; the less the area of the mitral orifice, the higher diastolic time-velocity integral of the flow. Coronary blood flow parameters did not differ between the subgroups of the patients with MS both with and without cardiac fibrillation.
Conclusion: hemodynamic disorders caused by valve defects (mitral stenosis and aortic stenosis) cause considerable changes in the phase coronary blood flow and its velocity.
Key words: mitral stenosis, coronary blood flow, transesophageal echocardiography, Doppler echocardiography.
2002, vol 10, № 4, page 375
T.P. Yabluchanska, I.P. Vakulenko
Heart rate and ultrasound parameters of the left heart chambers in atrial fibrillation
Objective- To study the association of ultrasound parameters of the іeft heart chambers in atrial fibrillation (AF) vs sinus rhythm (SR) and the class of the heart rate (HR).
Material and Methods- The patients were divided into two groups- those with AF (the study group) and with SR (the controls). The study group consisted of 41 patients with AF (19 women and 22 men, mean age 62±15 years), the duration of AF ranged from several months to 25 years (mean 4±5 years). The cause of AF was coronary artery disease (CAD) and arterial hypertension (AH). The controls consisted of 29 patients with CAD and AH having SR (14 women and 15 men, mean age 65±11 years). Echocardiography was performed with calculation of the parameters of geometry and biomechanics of the і eft ventricle (LV), left atrium (LA) and aorta (A) in 10 consequent heart cycles. For each of them, the size and volume of the LV as well as the respective end systolic and end diastolic parameters, end systolic and end diastolic thickness of the interventricular septum and posterior wall of the LV, stroke volume and ejection fraction, l iner size of the LA and A diameter were determined. The patients from the both groups were divided into subgroups- those with HR < 80 per min (22 patients with AF and 17 with SR) and those with HR > 80 per min (19 patients with AF and 12 with SR). Statistical evaluation was done with Excel.
Results- In patients with SR distinct differences in the statistical parameters of the size of the LV, its walls, LP and A were revealed. The higher was the class of HR, the lower were diastolic and the higher were systolic parameters. In AF these correlations were less pronounced, the parameters of the left heart chambers in the both subgroups of the patients were frequently similar.
Conclusion- Small differences in the geometry and biomechanical parameters of the left heart chambers in patients with AF in different classes of HR should be evaluated as more tense conditions of the heart biomechanics in this disease. Ultrasound changes of the left heat chambers i n AF can be assessed using SR protocol.
Key words- radiodiagnosis, atrial fibrillation.
2002, vol 10, № 4, page 379
I.O. Kramnoy, I.O. Voronzhev, I.S. Loboda
X-ray diagnosis of shock lungs in early age children with intranatal lesions of the CNS
Annotation
Objective: To study x-ray signs of shock lungs in early age children with intranatal lesions of the central nervous system.
Material and Methods: Chest x-ray films of 73 children died before 1 year of age (40 boys and 33 girls) were studied. In all cases the diagnosis was hypoxic ischemic lesions of the central nervous system, acute period, severe course, severe asphyxia. To verify the diagnosis ultrasound study of the heart and brain, x-ray of the skull and cervical spine as well as complete clinical laboratory study were done. Dynamic study was performed in 28 children (38.4%).
Results: The most frequent x-ray signs of shock lungs were the changes in the lung picture (39.7%) due to development of interstitial edema and hemodynamic disturbances, i.e. stage I shock lungs. With the process progressing small focal merging shadows (0.2—0.4 mm) were noted (19.2% — stage II shock lungs). Development of stage III was observed in 23.3% of patients, it manifested by reduction in the lung tissue transparency, appearance of larger focal merging shadows (0.6—0.8 mm) with indistinct outlines, the lung picture was poorly differentiated. In 32% of the patients the x-ray films demonstrated the signs of stage II and III shock lungs. In 11% of cases there was diffuse reduction in the lung transparency, the lung picture and the roots were not differentiated. Free bands of the bronchi against a background of the dark lung fields were observed, which was characteristic for hyaline membranes (stage IV shock lungs). Bronchopulmonary dysplasia, as a sign of stage V shock lungs was revealed in 6.8% of the patients. Accompanied pneumonia was determined in 30.1% of cases. Segment and subsegment atelectases were noted in 47.9% of the patients.
Conclusion: X-ray is the primary technique for shock lungs diagnosis in early age children with intranatal lesions of the central nervous system. This category of patients is characterized by absence of distinct sings of stages and accompanying pneumonia and atelectases.
Key words: shock lungs, central nervous system, asphyxia, changes in the lungs.
2002, vol 10, № 4, page 383
V.M. Slavnov, O.A. Savych, V.V. Markov
Radionuclide study of the hepatobiliary system function in patients with diabetes mefiitus
Objective. To study the functional state of the liver parenchyma, concentration and motor functions of the gallbladder i n patients with diabetes mellitus (DM). To analyze hepatobiliary system disorders depending on the type of DM, presence of complications, duration of the disease and the age of the patients.
Material and Methods. The study involved 33 patients with type 1 and 2 severe DM at decompensation stage. In 18 of them DM was complicated with polyneuropathy, in 10 with ketoacidosis. Dynamic hepatocholecystoscintigraphy was performed using ГКС 301 T gamma camera after Tc-99m mesida administration and bile-expelling meal.
Results. In patients with DM, marked disturbances of liver secretory function as well as concentration and motor functions of the gallbladder, hypotension of Oddi'd sphincter, hypomotor and hypermotor dyskinesia were revealed. In DM complicated with polyneuropathy, disorders of the hepatobiliary system were similar to those noted in patients with ketoacidosis. In patients with compensated DM, which was not complicated with polyneuropathy or ketoacidosis, disturbances of secretory liver function were absent, in 80% of the patients dyskinesia was not observed.
Conclusion. The obtained findings suggest the necessity of radionuclide study of the hepatobiliary system in patients with DM in order to reveal pre-clinical disturbances and to treat them timely.
Key words. hepatocholecystoscientigraphy, diabetes mellitus, hepatobiliary system, polyneuropathy, ketoacidosis, dyskinesia.
2002, vol 10, № 4, page 389
V.M. Slavnov, O.A. Savych, V.V. Markov
Radionuclide study of the liver macrophage system in diabetes mellitus
Annotation
Objective: To study the functional state of the liver macrophage system (MS) in diabetes mellitus (DM) and to analyze the functional disturbances depending of the type of DM, presence of complications, duration of the disease and the age of the patients.
Material and Methods: The study involved 42 patients with type I and II (severe decompensated form) DM. In 23 DM was complicated by polyneuropathy, in 8 - ketoacidosis. Dynamic liver scanning was done using scintillation gamma-camera ГКС 301 T after intravenous Tc-99m technefit administration.
Results: In patients with type I DM, considerable disturbances in the liver MS were observed. In type II DM the changers in the liver MS were more compensated. In patients with DM complicated with polyneuropathy, the changes in the liver MS were more pronounced than in patients with ketoacidosis and the patients without complications. Decompensated character of the liver MS disturbances was revealed in patients with 10 and more year history of the disease and in those over 40 with insulin-dependent DM.
Conclusion: The obtained data suggest the necessity of radio-nuclide study of the liver MS with the purpose to reveal pre-clinical disturbances and administer timely treatment.
Key words: liver scan, diabetes mellitus, liver macrophage system, polyneuropathy, ketoacidosis.
2002, vol 10, № 4, page 394
H.I. Zvir, S.V. Novak, Z.V. Tsyhanyk, L.H. Doroshenko, M.V. Kokoruz
The influence of plasmophotopheresis on functional properties of leucocytes in patients with T-cell skin lymphoma
Annotation
Objective: To study the changes in the functional properties of the peripheral blood leucocytes in patients with different stages of T-cell skin lymphoma (TCSL) under the influence of plasmophotopheresis (PPP).
Material and Methods: The technique was used in 37 patients with I-III stage TCSL. Functional characteristics of the peripheral blood leucocytes were studied before and after PPP. Morphological and functional indices of the peripheral blood were evaluated using the findings of blood count, prolipherative activity of lymphocytes under the influence of mitogens, phagocyte activity of peripheral leucocytes.
Results: The immune changes in the patients with TCSL included reduction of lymphocyte, basophil and hemoglobin levels, elevation of leucocyte, monocyte, segmented and stab cells, ESR. Decrease in prolipherative activity and phagocyte activity of neutrophils was noted.
After PPP, morphological indices of the blood was observed. The number of leucocytes, lymphocytes, lymphoid cells decreased. Positive influence of the treatment on leucocyte and lymphocyte function was noted. Normalizing of the parameters depended on the stage of the disease.
Conclusion: The changes in the leucocyte count in patients with TCSL (eosinophilia, elevation of leucocyte, monocyte, segmented and stab cells, ESR level), reduction in prolipherative activity of lymphocytes under the influence of mitogens and phagocyte activity of neutrophils are heterogeneous and depend on the stage of the disease.
The use of PPP causes positive changes in morphological parameters of the peripheral blood (reduction of ESR, leucocyte count, including lymphocytes, eosinophils, basophils, lymphoid cells due to reduction in the pathological clone of the cells).
This method activizes prolipherative and phagocyte activity of mononuclear cells and provides better immune state of the patients with TCSL.
Key words: T-cell skin lymphoma, plasmophotopheresis, leucocyte index of intoxication, blast transformation of lymphocytes, phagocytosis.
2002, vol 10, № 4, page 399
O.O. Bondarenko, P.B. Aryasov, D.V. Melnychuk, S.YU. Medvedyev, M.A. Frizyuk
The problem of limiting and individualizing internal irradiation when radiological parameters are not sufficiently established (on the example of the object "Shelter"). Part I
Annotation
Objective: To study the approaches to simultaneous observance of the principle of limiting individual dose and the necessity of individual control of the dose load at the object "Shelter" when the controlled parameter of the working medium are not sufficiently established.
Material and Methods: Mathematical and computed methods of simulation of internal irradiation formation and interpretation of factual data according to the results of simulation. Statistical methods of generalization of the obtained findings.
Results: Reserve coefficients and their use were substantiated to provide guaranteed limitation of individual dose. A new value, "preliminary dose evaluation" was introduced into the procedure of operative dosimetric control of internal irradiation. Basing on the suggested approach special regulations were introduced to the practice of radiation safety of the object "Shelter". The developed approach was tested under the conditions of the object "Shelter".
Conclusion: The problem of accuracy of dosimetric approach is out of the studied subject of metrology and is one of the key tasks of radiation safety provision.
Key words: internal irradiation, individual dosimetric control, transuranium elements, preliminary dose evaluation.
2002, vol 10, № 4, page 404
O.O. Bondarenko, D.V. Melnychuk, P.B. Aryasov, S.YU. Medvedyev, M.A. Frizyuk
The problem of limiting and individualizing internal irradiation when radiological parameters are not sufficiently established (on the example of the object "Shelter"). Part II
Annotation
Objective: To study uncertainty and characteristics of the methods of indirect dosimetry for individual control of the dose load in the personnel from the object "Shelter".
Material and Methods: Mathematical and computed methods of simulation of internal irradiation dose formation as well as interpreting the factual data using the results of simulation. Statistical methods for the obtained results generalization. Instrumental methods of measuring the true amount of transuranium elements in the environment objects, in the products of vital activity and in the human organism.
Results: To solve the problem of insufficient sensitivity of instrumental methods of dosimetric control of transuranium radionuclides, alpha-radiation spectrometry was suggested, which allowed to achieve minimum detected activity at 0.03 mBq. ICRP publications are the basis of the developed computed methods which allow to make calculations for aerodynamic diameter instead of AMAD as well as to load directly the parameters of systemic entering of aerosols to the lungs and to calculate radioactive chains with the account of metabolism of separate nuclides.
Conclusion: To overcome the difficulties connected with inability of biophysical methods and great uncertainties of indirect dosimetry, a new approach to organization of the current individual dosimetric control and biophysical measurements is suggested.
Key words: internal irradiation, inhalation entering, individual dosimetric control, object "Shelter".
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