UJR 2003, vol XI, # 3
THE CONTENTS
2003, vol 11, № 3, page 258
H.B. Momot, Y.V. Rochin, E.М. Solovyova, D.B. Reznikov
The role of computed tomography and densitometry in pre-operative investigation of urinary calculi
Annotation
Objective: To study the capabilities of computed tomogarphy in pre-operative evaluation of the properties and chemical composition of urinary calculi as well as to predict the degree and character of destruction at extracorporal shock-wave lithotripsy.
Material and Methods: The study involved 96 patients with urolithiasis (44 men and 52 women) aged 28-54. Of them, renal calculi were studied in 57 (59.3 %), ureteral calculi — in 39 (40.7 %). The patients were performed computed tomography with densitometry of the stone using CT-9000 (General Electric, USA ) unit, which was followed by shock-wave lithotripsy (MPL-9000, Dornier , Germany ).
Results: Considerable variations in the density (120-1800 HU) were observed. Interrelation of the stone density determined by CT-densitometry, their chemical composition, degree and character of the stone destruction were revealed.
Conclusion: Computed tomography is an informative technique which can define more exactly the size and localization of the stone as well as to assess the properties of urinary calculi, which allows to predict the degree and character of stone destruction before the surgery.
Key words: computed tomography, lithotripsy, renal calculi, ureteral calculi, prognosis of stone destruction.
2003, vol 11, № 3, page 263
V.I. Grichenko, O.V. Мercalova, V.V. Lazurenko, І.V. Мatvienko
The character of central hemodynamic disturbances and their interaction with hemodynamic conditions in the "mother-placenta-fetus" system in pregnant women with insulin-dependent diabetes mellitus
Annotation
Objective: To investigate the character of central hemodynamic impairments and their interactions with hemodynamic conditions in the "mother-placenta-fetus" system in pregnant women with insulin-dependent diabetes mellitus.
Material and Methods: Complex examination of central and uterine-placental-f etal hemodynamics was carried out in 50 pregnant women with insulin-dependent diabetes mellitus. The controls were 50 pregnant women with a physiological course of pregnancy. Central hemodynamics was investigated with tetrapolar rheography. Uterine-placental-fetal hemodynamics was investigated with Dopplerography. A 3.5 MHz device working in a pulsed mode was used. The investigations were carried out in the I, II, and III trimesters of pregnancy.
Results: In pregnant women with insulin-dependent diabetes mellitus significant impairment of central hemodynamics both in vascular and cardiac links were found out. These changes began from early terms of pregnancy and enhanced with increase of the pregnancy term. Correlation between the level of central hemo dynamic disturbances and expression of hemodynamic disorders in the "mother-placenta-fetus" system, main pathogenetic link of pregnancy complications and pathological conditions of the fetus was established.
Conclusion: In women with insulin dependent diabetes mellitus hemodynamic adaptation to pregnancy is broken from early terms of the pregnancy. The level of central hemodynamic disturbances depends on severity of diabetic vascular complications. Central hemodynamic disorders promote a decline of intensity of hemo dynamics in the "mother-placenta-fetus" functional system, that leads to failure to maintain an adequate circulation of the system and thus to appearance of pregnancy complications and pathological conditions of fetus. The data obtained are evidence of necessity to carry out a complex therapy of hemodynamic disorders in women with insulin dependent diabetes mellitus during preg nancy.
Key words: pregnancy, hemodynamics, insulin-dependent diabetes mellitus, conditions of fetus.
2003, vol 11, № 3, page 267
T.O. Kvyatkovskay, E.A. Kvyatkovskiy, T.L. Kucyak, P.V. Korobka
Age-related characteristics of renal blood flow and urodynamics in mature, elderly and old age (US Doppler study)
Annotation
Objective: To establish age-related characteristics of structurally functional changes in the kidneys, renal hemodynamics and urodynamics at mature, elderly and senile age using color Doppler ultrasonography.
Material and Methods: Seventy healthy men and women aged 20—89 were examined. They were divided according to decades in age groups of 10 persons (20 kidneys). The research was carried out using ultrasonic devices HDI 1500 and Logiq-400 MD and 3.5 MHz convex transducers. The linear sizes and volume of the kidneys, length of the renal sinus, structural index, thickness of kidney parenchyma in its median portion were determined. Maxi mum arterial systolic velocity (Vmax), minimum diastolic velocity (Vmin), resistance index (RI), pulsatile index (PI), (S/D) ratio were defined in the renal, segmental and interlobar arteries. Minute volume of renal blood supply, maximum venous velocity (Vvmax), Vmin to Vvmax (D/V) ratio, S/D to D/V (RDV) ratio as well as the parameters describing the urodynamics: (frequency of the ureter-bladder discharge, maximum and average velosity of urine flow, duration of discharge) were determined.
Results: A significant reduction of the linear sizes, volume of the kidney, thickness of the kidney parenchyma, velocity para meters of hemodynamics in the renal arteries and their branches, minute volume of kidney blood supply were observed at elderly and senile age. RI, PI and S/D are significantly increased on the 7th decade. IR reaches 0.70±0.01, on the 9th decade — 0.76±0.02. These parameters decrease from renal arteries to interlobar ones in the process of branching renal arteries. There is a change of parameters (Vvmax, D/V, RDV), indicating juxtamedullar dump of the blood with age decrease of kidney cortical hemodynamics. The frequency of the ureter-bladder discharge on the 7th decade descreased by 30 % , after 70 years — almost by 50 % in com parison with a mature age. Velocity parameters of urine flow were considerably reduced.
Conclusion: It is necessary to take into account the received age norms of sonographic parameters including Doppler study of the renal hemodinamycs and urodinamics at interpretation of the patients' examination.
Key words: ultrasonography, Doppler, renal hemodynamycs, ureter-bladder discharge, age-related features.
2003, vol 11, № 3, page 273
T.P. Yabluchanskay, І.P. Vakulenko
The class of standard deviation of left ventricle ejection fraction and ultrasound parameters of left heart chambers in sinus rhythm and atrial fibrillation
Annotation
Objective: To study the dependence of ultrasound parameters of the left heart chambers and the class of heart rate (HR) in atrial fibrillation (AF) vs. sinus rhythm (SR).
Material and Methods: Two similar groups of patients with constant atrial fibrillation (study group) and sinus rhythm (cont rols) were studied. The study group consisted of 41 patients with AF (19 women and 22 men aged 65 ± 15). The duration of AF ranges from several months to 25 years (4-5 years), originating from arterial hypertension and coronary artery disease. Echocardio- graphy was performed using "Radmir" unit with calculation of geometry and biomechanics of the left ventricle and atrium as well as aorta in 10 sequential heart cycles.
Results: Statistical processing of the findings was performed using Excel software. The patients from the both groups were divided into 3 subgroups according to equal classes of s values. For AF and SR these s classes were as follows: AF < 0.63, 0.63-0.91 and > 0.91, SR < 0.57, 0.57-0.73, S > 0.73. Significance of difference in the values for the both groups was determined with Student's test.
Conclusion: The study demonstrated that irregular character of cyclic changes in AF influenced its biomechanics. The character of the changes being more significant than their degree. AF is characterized by higher dispersion of cyclic changes of LV geometry when compared to SR. The properties of the heart rhythm (AF, SR) are better reflected by ultrasound values of the left heart than the class of standard deviation of LV ejection fraction. The principles of ultrasound examination used in AF can be used in SR.
Key words: radiation diagnosis, atrial fibrillation, sinus rhythm.
2003, vol 11, № 3, page 278
V.М. Slavnov, V.V. Мarkov, S.V. Bolgarskay
Bone scan in diagnosis of inflammatory processes of the foot bones in diabetes mellitus
Annotation
Objective: To work out the radionuclide technique which can be used for diagnosis of inflammatory processes of the foot bones in patients with diabetes mellitus (DM).
Material and Methods: The worked out technique was used to examine 59 patients with type 1 and 2 DM having micro- and macroangiopathy of the lower extremities (stage II), neuropathic and neuroischemic foot ulcers. Radionuclide scanning was done after intravenous injection of 600 MBq 99mTc-methylen diphosphonate using tomography gamma-camera ГКС 301 Т. The area (in conventional units), total activity (pulses/sec) of the lesion focus as well as percentage of area asymmetry and total activity belween the focus of the lesion and healthy foot were used as criteria for evaluation of bone scan findings.
Results: Depending on asymmetry percentage in total activity between the focus of the lesion and symmetrical healthy zone, DM patients were divided into three groups: those with normal RP accumulation, in whom asymmetry did not exceed 150 % , with weak increase in RP accumulation and asymmetry percentage ranging within 150—200 % and with considerable increase of RP accumulation and asymmetry exceeding 200 % . In DM patients with normal accumulation of RP mean asymmetry percentage was 115 ± 1.6. In weak increase of RP accumulation mean percentage of the area asymmetry and total foot activity was significantly higher when compared with the patients having normal RP accumulation values. In patients with considerable accumulation of RP, area asymmetry and total activity percentage increased considerably.
Conclusion: The radionuclide technique for early diagnosis of inflammatory process in the bones of the foot was developed for DM patients. Normal RP accumulation was observed in 40.7 % of DM patients, it was slighly increased in 28.8 % , considerably increased in 30.5 % . The most important diagnostic criterion of the bone lesion in patients with DM is area asymmetty and total activity percentage between the lesion focus and symmetrical zone.
Key words: bone scan, 99mTc-methylen diphosphonate, bones, foot, inflammatory processes, diabetes mellitus.
2003, vol 11, № 3, page 282
K.М. Іgrunova, D.S. Мechev, O.І. Korchinskay, O. A. Epanchinceva, Y.P. Severin
Radionuclide evaluation of structural functional state of the heart in patients with ventricular disturbances of the rhythm
Annotation
Objective: To study the condition of the left ventricule myocardium in patients with coronary artery disease complicated by ventricular extrasystolia using radionuclide ventriculorgraphy (RV).
Material and Metods: Fortytwo patiens with coronary artery disease aged 40—60 were examined. RV was done with 99mTc- pirophotech using gamma-camera LFOV-IV (Nuclear Chicago).
Results: Hypokinetic ventricular segments, pump and contraction function were disturbed in patients with coronary artery disease, ventricular rhythm disorders without heart failure charteristic for the main disease were determined. Among the examined patients with normal ejection fraction the group of patients with contraction function disorder was singled out.
Conclusion: The complex of radionuclide ventriculography parameters allowed to evaluate objectively the left ventricular myocardium condition and discover early signs of contraction disorders in patients with heart rhythm disorders.
Key words: coronary artery disease, radionuclide ventriculography, ventricular extrasystolia.
2003, vol 11, № 3, page 285
B.A. Berdov, Y.S. Мardinskiy, V.Y. Skoropad, L.N. Titova
Intraoperative radiation therapy in multi-modality treatment of stomach cancer: methodological and technical aspects, clinical outcomes
Annotation
Objective: To study the outcomes of treatment for resectable stomach cancer (SC) using a new protocol, which includes pre- and intraoperative radiation therapy (IRT) and radical surgery.
Material and Methods: Within the period of 1993-1998, 112 patients with SC were administered a method of treatment which includes pre-operative radiation therapy (RT) (dynamic fractionation of the dose of 21 Gy per 11 days with division of the daily fractions into 2 treatments with 4-5-hour interval), surgery 1—2 days after the irradiation with IRT (12 MeV electron beam at a single dose of 20 Gy). The method was worked out at the hospital of Medical Radiation Scientific Center of Russia Academy of Medical Sciences. The applicators for collimating devices of the accelerator and the device for the transportation of the patient from the operation room to the canyon of the accelerator were specially designed and manufactured. Their characteristics are described in detail.
The controls were the patients treated only surgically.
Results: In the main group total survival was 67%, in the controls — 58% . When the tumor was localized in the walls of the stomach and the metastases to the regional nodes were absent (Tl-2 N0) the values of mean life expectancy did not differ depending on the method of treatment. The combined method had several advantages when the tumor penetrated the wall of the stomach (T3-4), mean life expectancy 33.5 vs. 22.3 months in case of metastases to regional lymph nodes (N1-2) - 26 and 13 months, respectively. The number of intra- and post-operative complications in combined treatment did not increase when compared with surgery, the incidence of post-operative pancreatitis decreased significantly from 19 to 2 % .
Conclusion: Combined treatment of operable stomach cancer with the use of pre- and intraoperative radiotherapy increases significantly mean life expectancy when the tumor involves the wall of the stomach and in metastases to regional lymph nodes (T3-4 N1-2); the number of intra- and post-operative complications does not increase.
Key words: stomach cancer, post-operative radiation therapy, intraoperative radiation therapy.
2003, vol 11, № 3, page 290
І.O.Dacyuk, R.V. Senyutovich, A.O. Gonca, V.P. Unguryan
Clinical regression and long-term results at different variants of neoadjuvant chemoradiation therapy for locally advanced breast cancer
Annotation
Objective: To study the regression of tumors and long-term results after 5 types of neoadjuvant chemoradiation therapy with different intensivity of adjuvant chemotherapy.
Material and Methods: The level of regression of the breast tumors was measured in two proj ections after neoadj uvant radition therapy (40-45 Gy) — 339 patients, neoadjuvant chemotherapy (200 patientes), neoadjuvant seqentional chemoradiation therapy (40 patients), seqentional radiation and chemotherapy (37 patients) and at combined use of radiation and chemotherapy (12 patients).
Resultes: The highest degree of local regression of the tumors was achieved at sequential neoadjuvant and radiation therapy — 12.5 % of the complete regression and 57 % of the partial regression. The results of sequential radiation and neoadjuvant therapy were similar to results of radiation and neoadjuvant chemotherapy alone (scheme CMF, 8-9,1-8% complete remission). Neoadjuvant chemotherapy in complex treatment for breast cancer with intensive adjuvant therapy (4 weeks intervals, 5-6 courses of chemotherapy) augmentation resulted in 17 % of 5-year servival of the patients.
Conclusion: In locally advanced breast cancer sequential neoadjuvant chemotherapy and neoadjuvant radiation therapy are indicated.
Key words: cancer, breast, neoadjuvant chemotherapy, radiation therapy.
2003, vol 11, № 3, page 293
Y.A. Tolkachov, L.Y. Vasilev, A.V. Svinarenko
Orcadian monitoring of ECG findings and central hemodynamics in cancer patients at radiotherapy planning
Annotation
Objective: To find the criteria for assessment of circadian changes in the cardiovascular system in patients with different malignant tumors for planning chemoradiotherapy in the most tolerable periods.
Material and Methods: Fifty-seven patients aged 34-67 (28 breast cancer, 12 — cervical cancer, 17 — rectal cancer) were examined before the specific treatment. Arterial pressure and heart rate measurement as well as ECG out tetrapolar integral rheography were performed every 4 hours, they were followed by computed processing of the findings.
Results: Circadian fluctuations of AP, HR and central hemo dynamics (stroke volume, heart index, total peripheral resistance) were irregular and varied from patient to patient. In different diseases at a definite time they were in opposite phases but, in general, they were within the limits of mean physical values. Significant rhythmic fluctuations in ECG parameters were not observed though a tendency to aggravation of repolarization processes within the period from 18 to 22 o'clock was noticed in rectal cancer.
Conclusion: Considerable circadian fluctuations of main hemodynamic and ECG parameters, which can suggest disorders of circadian rhythms or limit chemoradiotherapy were not noticed in different cancers. Functional criteria of biorhythm state require further investigation.
Key words: radiotherapy, chemotherapy, cancer patients, circadian biorhythms, cardiovascular system.
2003, vol 11, № 3, page 298
S.V. Hignyak, A.V. Klepko, O.O. Kisil, L.V. Babich, D.O. Мichuk, V.М. Voycickiy, М.E. Kucherenko
Biological effects of chronic ionizing radiation and cadmium ions
Annotation
Objective: To evaluate chronic exposure to low-dose ionizing radiation and cadmium according to a number of biochemical parameters.
Material and Methods: The experimental animals (male rats weighing 160-200 g ) were exposed to separate or combined chronic action of y-radiation of 60 Co (dose rate 0.72 cGy/day) of «Etalon» unit (Institute for Nuclear Studies, National Academy of Science of Ukraine ) and were given cadmium chloride (0.01 mg per liter of drinking water) for 5 months. The liver, mucous membrane of small intestine, brain, blood serum were studied. Lipid amount, enzyme activity, lipid peroxidation and antioxidant system parameters were studied.
The finding were evaluated using t-Student's criterion.
Results: The changes in redox homeostasis in various tissues at separate and combined action of ionizing radiation and cadmium were observed. The changes in the lipid amount were different. The changes in enzyme activity in different organs suggest disturbances in cellular membrane permeability at exposure to cadmium and ionizing radiation. The obtained data suggest a distinct reaction of the cellular systems in response to the action of ionizing radiation and cadmium.
Conclusion: The obtained data suggest that separate or combined action of y-radiation and cadmium differ in the degree of the response in various systems of the organism. Chronic combined action of the investigated factors is characterized by increased effect with the increase in the dose. The revealed changes in the cellular systems are stable, progressing thus suggesting pre- disease.
Key words: ionizing radiation, cadmium, low doses, chronic action, biochemical parameters.
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