UJR 2004, vol XII, # 3
THE CONTENTS
2004, vol 12, № 3, page 239
М. І. Spuzyak, І.O. Kramniy, І.O. Vorongev, V. V. Shapovalova
X-ray picture of syndrome of free air escape in the chest in children of early age when artificial ventilation is applied
Annotation
Objective: To study characteristics of x-ray picture of syndrome of free air escape in the chest in early-age children when artificial ventilation (AV) is applied.
Material and Methods: X-ray pictures of the chest of 73 children under the age of 1 year (45 boys and 28 girls) treated for severe respiratory distress syndrome were studied. AV was done for 1 day — 3 weeks. To evaluate the efficacy of the therapy the majority of the patients were done chest x-ray. To specify the diagnosis all the patients were done ultrasound study of the brain and heart as well as complete laboratory examination. In 19.2 % of the dead children the diagnosis was verified pathomorphologically.
Results: It was established that the presence of free air in the chest occured in 26 % of cases in this group. One of the frequent manifestations of this syndrome was interstitial lung emphysema (21.9 % of cases). This complication manifested by widening of intercostal spaces, horizontal ribs, increased pneumatization of the lung tissue, increased and rich lung picture, its network deformity, mainly in medial and lower portions. In 13.7 % of cases the process was unilateral, as a rule, on the right, in 8.2 % it was bilateral. In 6.8 % of cases bronchopulmonary displasia developed, which was suggested by inerease and deformity of the lung picture due to vascular disturbances, perivascular pneumofibrosis against a background of reduceed transparency of the lung tissue and indistinct outlines of the mediastinum. Pneumothorax was present in 12.3 % of patients (right lung 8.2 % , left lung 4.1 %), more f requenly total, which manifested by free air in the pleural cavity and collaps by 1/3 of its volume and more. In 2.7 % of cases the signs of pneumomediastinum were present. They were characterized by presence of an air band under the mediastinal pleura and a sail-like appearance of the thymus. Pneumopericardium was diagnosed in 1 dead patient (1.3 %), it manifested by oreola sign and a pericardial line.
Conclusion: X-ray study is one of the main methods of diagnosis of syndrome of free air escape in the chest in early-age children when AV is used. It allows to determine the character of the process, its degree as well as dynamics and the efficacy of the treatment. The most frequent manifestations of this syndrome are interstitial emphysema, pneumothorax, pneumomediastinum.
Key words: syndrome of free air escape in the chest, AV, early-age children, chest x-ray.
2004, vol 12, № 3, page 243
R. Y. Churilin
The structure and pecularities of lung involvement in children and teen-agers with lupus erythematosus according to radiological studies
Annotation
Objective: To define the state of the lungs, pleura, diaphragm and heart in children with lupus erythematosus using radiological studies.
Material and Methods: Radiography, tomography (3 patients) and CT findings of the chest (1 person) were performed in 36 patients aged 10-18 of them 20 before 14 years 11 month (55.6 %), 16 over the age of 15 (44.4 %), 5 boys (13.9 %) and 31 girls (86.1 %). The diagnosis was verified using a complete clinical-labo ratory-instrumental study of the patients. All of them were done ultrasound examination of the cardiovascular system.
Results: X-ray changes of the lungs, pleura and diaphragm were diagnosed in 100 % of the patients. The most frequent signs were suggestive of vascitis of various character and localization. In 16.7 % of the patients the signs of venous congestion were present, in 19.4 % pulmonitis was diagnosed, in 22.2 % - lupus diaphramitis. Different pleura pathologies were observed in a half of the patients. The most frequent complications were pneumonia(16.7 %), peri- vascular and peribronchial fibrosis (8.3 %), pulmonary edema (5.5 %). Heart pathology was noted in 69.4 % of the patients.
Conclusion: The findings of the investigations suggest frequent involvement of the vessels, lung parenchyma, pleura, diaphragm, heart. Radiodiagnosis is most objective and informative and allows to determine the changes in the lungs caused by both the disease and its complications. The study allowed to work out the scheme of main morphofunctional, x-ray, and ultrasound changes in the respiratory and cardiovascular systems.
Key words: changes in the lungs and heart, lupus erythematosus, children and teen-agers, x-ray diagnosis.
2004, vol 12, № 3, page 249
А. P. Krys-Pugach, S.M. Маrcynyak
Clinical x-ray diagnosis of solitary bone eosinophilic granuloma in children
Annotation
Objective: Retrospective analysis of clinical x-ray diagnosis of eosinophilic bone granuloma in children with the purpose of improvement of diagnosis of this pathology.
Material and Methods: Ninety cases of clinical x-ray picture of bone eosinophilic granuloma (EG) treated at Institute for Trau- matology and Orthopedics and Institute of Oncology (Academy of Medical Sciences of Ukraine) in 1957-2003 were analyzed. Solitary EG was diagnosed in 88 patients, multiple in 2. EG of the bones was chiefly observed in the childhood, more frequently in a pre-school age. The patients ages 1-35 years. Among children, only 6 were over 16. There were 48 boys (53.4 %) and 42 girls (46.6 %). To evaluate the dynamics and the character of the disease, clinical and x-ray studies were made. The foci of involvement in EG were localized in the femur 29 (32.2 %), spine 12 (13 %), pellvis 10 (11.1 %), skull 9 (10 %), f ibia 7(7.7 %). The pathological foci were localized mainly in the metaphysis and diaphysts of the long bones and in the bodies of the vertebral bodies.
Results: Peculiarities of clinical manifestations of EG depended on the localization of the foci and the stage of the process. The following stages were distinguished: osteolysis, reparation, completion. The following stages were distinguished in EG of the spine: osteolysis, pathological fracture and vertebra plana formation, completion. The correct diagnosis is possible only with the consideration on the entity of signs and clinical picture with perfect knowledge of x-ray signs of similar diseases. In some cases clinical x-ray signs were not characteristic, the diagnosis was made only after incision biopsy followed by histological study.
Conclusion: The character of clinical x-ray signs of EG depends on localization of the foci and the stage of the process. The correct diagnosis is possible only with the consideration of the entity of signs and clinical picture followed by morphologycal study of the bioptates, which, in turn, provides timely diagnosis and can improve the treatment results.
Key words: bone eosinophilic granuloma, children, x-ray diagnosis.
2004, vol 12, № 3, page 255
V. Y. Kundі
Diagnostic significance of scintigraphy investigations of the Kidneys in children using 99mTc-phosphates
Annotation
Objective: To define the diagnostic significance of investi gations with 99mTc-phosphates of nephropathies in children depending on the nosologic form of the disease, activity of the inflammatory process, efficiency of the treatment.
Material and Methods: Dynamic and static renoscintigraphy investigations with radiopharmaceutical (RP) 99mTc-pyropho-sphate (99mTc-PP) in different kidneys diseases (glomerulonephritis, pyelonephritis, hydronephrosis, anomaly of kindey deve lopment vesicoureteral reflux, and dismetabolic nephropathies) were done in 163 children aged 5-16 years. The obtained results were compared with similar researches using 99mTc-DTPA.
Results: The respective values of glomerulotropism of 99mTc-PP and 99m Tc-DTPA exhibited similarity of filtration and transport parameters of these RP. The results of static renography allowed to establish a high percent of 99m Tc-PP inclusion in glomeru-lonephritis and pyelonephritis. The reduction in the percentage of RP fixation during the treatment from 6-7 % to 4-5 % is a favorable prognostic sign of positive effect of the treatment, and stable fixation at the levels 7-8 % and testified more about the progress of the disease. The RP inclusion the in kidneys at the level 10-12 % and more testified about torpid course of the inflammatory process. The disadvantages of the investigations with 99mTc-PP in hydronephrosis, vesicoureteral ref luxs and anomaly of kidneys development were revealed.
Conclusion: 99mTc-phosphates allow to evaluate significantly filtration excretions characteristics of the kidneys and indicate the grade of the inflammation process (in contrast to 99mTc-DTPA). High informativity of scintigraphy with 99mTc-PP is noted in glomerulonephritis and pyelonephritis, and low informativity — in anomalies of kidneys and vesicoureteral reflux. The high percent of 99mTc-PP inclusion in the renal tissue is an unfavorable prognostic sign of progressing of the disease.
Key words: dynamic renoscintigraphy, static renoscintigraphy, nephropathies in children, 99mTc-phosphates, 99mTc-DTPA.
2004, vol 12, № 3, page 260
D. А. Lаzаr
Spatiotemporal optimization of gamma-therapy of primary brain tumors
Annotation
Objective: To impove the efficacy of treatment of patients with primary malignant brain tumors ( МВТ ) with development of rational techniques of radiotherapy (RT). To determine optimum spatiotemporal distribution of the dose, anatomical topographic characteristics of the irradiation depending on the tumor histology and localization.
Material and Methods: Radiotherapy with spatiotemporal optimization was done in 196 patients with primary brain tumors. The control were 121 patients who received traditional radiotherapy. The patients were divided into three groups: group 1 — those with highly malignant tumors (glioblastoma, grade III— IV astrocytoma, meningosarcoma, unverified tumors); group 2 — low malignant tumors (grade I— II astrocytoma, oligodendroglioma, medulloblastoma, ependymoma, germinoma); group 3 — tumors involving subarachnoid space (medulloblastoma, pineoblastoma, grade III-IV ependymoma, anaplastic meningeoma). Raditherapy was done using AGAT-R1, Rokus-M units with 2-3-4 fields in static mode.
Results: Higher efficacy of hyperfractionated RT when com pared with the traditional one was shown. Most effective single and total focal doses were determined in the groups of patients. In group 1 optimum single focal dose was 1.5 Gy twice a day with a 4-hour interval up to total focal dose 70.4—70.6 Gy, in group 2 and 3 — single focal of 1.2 Gy to total dose of 63.8-68.2 Gy. The use of more rational techniques allowed to prolong 5-year survival in group 1 from 14-18 month to 40.5-45.1 months, and in group 2 from 42-69.2 months to 90-95 months.
Conclusion: Hyperf ractionated RT with spatiotemporal localization of the dose increases 5-year survival by 26-34 %.
Key words: primary malignant brain tumors, spatiotemporal distribution of the dose, hyperf ractionated radiotherapy.
2004, vol 12, № 3, page 266
N.O. Маznyk, V.А. Vіnnіkov, O.А. Міhаnovskiy, O.М. Suhіnа, А.V. Shеgolkov, V.O. Теplа, O. E. Іrha, V.S. Mаznyk, V.О. Pаvlеnko, L.D. Skrypnyk
In vitro dynamics of cytogenetic damage, in peripheral blood lymphocytes of patients with uterine cancer after radiation therapy
Annotation
Objective: To investigate an in vitro dynamics of cytogenetic effects, induced by therapeutic irradiation in blood lymphocytes of patients with uterine cancer.
Material and Methods: Conventional cytogenetic analysis was carried out in 50-, 76- and 100-hrs cultures of peripheral blood lymphocytes sampled from 20 patients with uterine cancer (stages I-II) before and after external beam or combined radiation therapy. The replicative index was estimated from the ratio of different mitosis in FPG-stained preparations.
Results: The enlarging of lymphocyte culture time from 50 to 100 hours led to elimination of 83 % chromosome type aberrations, including 92 % dicentrics and centric rings accompanied with fragments, which were induced in patients' lymphocytes by therapeutic irradiation. However, in 76- and 100-hrs cultures both indices sufficiently exceeded the respective spontaneous levels. The aberrant cell disappearance rate was strictly depended on the number of chromosome rearrangements in cell, but for the most damaged cells (contained > 7 aberrations) the elimination slowed between 76 and 100 hours of cultivation. This caused the stabilization of percentage of highly damaged metaphases within aberrant cell fraction. The lymphocyte replicative index in patients after irradiation was statistically decreased in 50-h cultures and restored in 76- and 100-h cultures. At any culture time a proportion of the 2-nd mitosis cells was lower in lymphocyte cultures from patients after radiation therapy, than that of before ir radiation.
Conclusion: The in vitro dynamics of radiation-induced chromosome aberrations in patients' lymphocytes reflects a complex combination of processes, which take place in non-unif ormly irradiated population of dividing cells and include an elimination and replication of aberrations transmitted to daughter cells, an induction and releasing of the radiation-induced mitotic delay in cells accumulated several therapeutic dose fractions. The perspective application of long-term lymphocyte culture as a test-system will allow to carry out the differential modeling these factors activity in human lymphocyte-producing pool after radiation therapy.
Key words: chromosome aberrations, replicative index, lym phocytes, long-term cultivation, radiation therapy, uterine cancer.
2004, vol 12, № 3, page 277
О.V. Kuzmеnko
Circadian fluctuations of cyclophosphane myelotoxicity
Annotation
Objective: To substantiate experimentally most tolerant regiments of cyclophosphane administration with consideration of circadian rhythms of peripheral blood nuclear cells.
Material and Methods: Two series of experiments were performed on 40 white mongrel rats. In the first series (the study of chronotoxic effect of cyclophosphane on leukopoiesis on the model of prolonged myelodepression depending on the time of its administration), cyclophosphane was administered for 4 days at a dose of 4 mg per 100 g of the body mass at 12, 18, 24, and 6 o'clock. In the second series (30-day study) the degree of myelodepression and the rate of leukopoiesis restoration at a single cyclophosphane administration at a dose of 16 mg per 100 g of the body mass in the periods of minimum and maximum proliferative activity of the bone marrow were studied.
Results: Chronotoxic effect of cyclophosphane on leukopoiesis in rats depending on the time of administration was shown. Leu-kopenia observed after cyclophosphane administration was less marked on the 3 rd day after the administration at 18 o'clock, that is in the period of minimum proliferative activity of the bone marrow at standard lightening. At 4-fold increase of cyclophosphane dose, leukopoiesis tolerance is preserved at optimum time of its administration.
Conclusion: The influence of cyclophosphane toxicity on leukopoiesis in rats changes depending on the time of the day. Administration of cyclophosphane at night produces less marked effect on myelopoiesis in the animals. The choice of optimum time of cyclophosphane administration allows to increase its single dose without increase of the myelotoxic activity.
Key words: cyclophosphane, circadian rhythm, myelotoxicity.
2004, vol 12, № 3, page 282
C.M. Kаrtаshov, G.G. Udеrbаevа, О.О. Beloded, М.Y. Shаlkovа
Apoptosis investigation in patients with cervical cancer depending of the process dissemination and the type of treatment
Annotation
Objective: To study spontaneous and induced apoptosis in the primary tumor in cervical cancer (CC) depending on the process dissemination and therapeutic measures.
Material and Methods: The study involves 110 patients with stage 0-III CC (Tis-T3) and the disease relapses. Spontaneous apoptosis was studied. In 84 patients induced apoptosis was investigated depending on the type of treatment (radiation and chemoradiation therapy). The number of cells with characteristic morphology was calculated using a fluorescent microscope.
Results: Spontaneous apoptosis index (AI) in CC increased with the stage of the disease, beginning from T3 stage and in patients with relapses this parameter decreased significantly but remained higher than the reference values. Application of therapeutic measures induced apoptosis in the primary tumor in CC, induction coefficient depending on the treatment modality. Thus, the use of chemoradiation therapy (20 Gy + chemotherapy - cysplatin 75 mg/m 2 ; 5-fluoruracil 1000 mg/m 2 ) allowed to induce higher degree of apoptosis when compared with radiation therapy (20 Gy) only. In relapses, radiation therapy at a dose of 20 Gy did not increase the parameters of spontaneous apoptosis and only chemoradiation therapy provided inconsiderable AI induction.
Conclusion: Apoptosis induction coefficient in the primary tumor of CC patients as well as spontaneous AI depend on the process dissemination. In contrast to AI, induction coefficient decreased with the stage of the disease.
Key words: cervical cancer, apoptosis, stage of the disease, therapy.
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