UJR 2006, vol XIV, # 2
THE CONTENTS
2006, vol 14, # 2, page 138
R.Y. Abdullaev, S.O. Starostenko
The influence of abnormal chord location on the character of the blood flow in the outflow tract of the left heart ventricle
Annotation
Objective: To study the influence of the thickness and place of attachment of abnormally located chords (ALC) ion the character of the blood flow in the left ventricle outflow tract (LVOT).
Material and Methods: The character of the blood flow in the LVOT was investigated in 106 patients with longitudinal and diagonal location of ALC of various thicknesses and place of attachment. The study was done using color Doppler mapping from parasternal and apical approaches. The patients with the signs of aortosclerosis, myxoma degeneration of the mitral valve and organic heart pathology were excluded from the study.
Results: The highest blood flow turbulence in the LVOT was observed in the patients with ALC thickness > 4 mm, attached deeply in the subarterial segment of the interventricular septum as well as with gagging into the LVOT >8 mm. Consequently, the lowest turbulence was observed in patients with the same location of the ALC, with ALC thickness <0.2 cm attached in the proximal portion of the LVOT and sagging into the LVOT < 5 mm. The place of ALC attachment and degree of sagging to the LVOT influenced the character of the blood flow in the LVOT more significantly than ALC thickness.
Conclusion: In patients with longitudinal location of ALC the character of blood flow significantly changes in the direction of its turbulence with the increase of the chord thickness, proximity of the place of attachment to the ring of the aortic valve, increase in ALC sagging into the LVOT.
Key words: abnormal chord, left ventricle outflow tract.
2006, vol 14, # 2, page 142
O.E. Barysh, Y.A. Doluda
Peculiarities of x-ray study of the posterior supportive complex of the cervical spine
Annotation
Objective: To work out a technique for adequate visualization of the bony elements of the posterior supportive complex of the cervical spine and its vertebral motor segments (VMS) using a special device.
Material and Methods: The study involved 12 patients who were examined and treated for cervical spine (CS) diseases and injuries in Institute for Spine and Joint Pathology. All the patients were performed x-ray study in two standard orthogonal projections and in special oblique (45°) and semi-oblique (20°) projections using both traditional and original techniques. An original device consisting of an immovable goniometric platform and a seat on a telescopic support in the centre of the platform was worked out and used in the study. The seat of the device is moved along the telescopic support in horizontal and sagittal planes and is supplied with pelotas for the patient's thigh fixation. The seat is equipped with a perpendicular bar with fixators for the body and head. The x-ray findings were assessed using a traditional technique.
Results: The assessment of the peculiarities of the health of the CS posterior supportive complex using x-ray study in oblique projections distinctly visualized intervertebral foramen of the opposite side and the bony elements forming VMS. The plates of the vertebral arches, their roots, articular processes, spinous process and joint spaces are well seen in this projection. To visualize the articular mass of the opposite side and apical portion of the upper articular process, posterior semi-oblique (20°) projection is more suitable. The developed device allows eliminating visualization errors when determining angular interrelations of the sagittal plane of the investigated spine and the x-ray film cassette plane.
Conclusion: The developed technique of CS study using a special device allows to perform investigations in special projections with strict observation of angular interrelations of the sagittal plane of the patient's body and the x-ray film cassette and adequate evaluation of the state of bony elements of the posterior VMS of the CS both in standard orthogonal and special (oblique and semi-oblique) projections.
Key words: cervical spine, arcoprocessual joints, x-ray diagnosis, special projections.
2006, vol 14, # 2, page 146
I.O. Vorongev
X-ray findings in determining interstitial pulmonary emphysema severity in neonates with CNS impairments at artificial ventilation
Annotation
Objective: To make more objective determining the degree of interstitial pulmonary emphysema severity in neonates with CNS impairments at artificial ventilation using x-ray findings.
Material and Methods: Chest x-ray films of 58 children (29 boys and 29 girls) with the signs of interstitial emphysema treated for hypoxic-ischemic impairment of the CNS, syndrome of respiratory disorders and respiratory insufficiency were studied. All patients were performed artificial ventilation of the lungs. To verify the diagnosis all patients were performed ultrasonography of the brain and heart, x-ray study of the skull and cervical spine as well as complete clinical laboratory investigation. 13.8% of the patients were performed brain and spine MRI.
Results: The study allowed to establish light degree (1) interstitial emphysema in 48.3% of the patients, which manifested on the chest x-ray films by enlargement of the vertical size of the lung filed up to 6-6.5 cm, location of the right diaphragm cupola at the level of the 6-7 th ribs without displacement of the mediastinum shadow. Medium degree (2) interstitial emphysema diagnosed in 36.2% of the neonates manifested on the chest x-ray films by enlargement of the vertical lung size up to 6.5-7 cm, displacement of the right diaphragm cupola to the 7-8 th rib and mediastinum displacement (K coefficient <-50%). Severe degree (3) interstitial emphysema was less frequent (15.5%); this was characterized by enlargement of the vertical size of the lung filed up to 7 cm and more, location of the right diaphragm cupola at the level of the 8 th rib and lower, marked displacement of the mediastinum shadow (K>-51%). In 6.9% of the patients, interstitial emphysema was complicated by pneumothorax, mainly right total one.
Conclusion: X-ray is a leading method for diagnosis of interstitial emphysema in neonates with hypoxic-ischemic and traumatic lesions of the CNS at artificial ventilation application. The suggested method of determining the degree of interstitial emphysema severity in neonates is an objective and informative, does not require additional radiation load on the organism of the child. This technique can aid in controlling the efficacy of the administered treatment and prognosis of complication development.
Key words: interstitial emphysema, artificial ventilation of the lungs, neonates, chest x-ray.
2006, vol 14, # 2, page 150
A.O. Gricay
X-ray picture of the chest organs in children with acute lymphoblast leukemia
Annotation
Objective: To define more exactly the character of changes in the heart and lungs in children and teen-agers with lymphoblast leukemia.
Material and Methods: The findings of chest x-ray study of 62 patients aged 1-18 were studied. Tomography was used in 8 cases, 15 patients underwent dynamic investigation.
Results: Pathological changes in the lungs, mediastinum and heart were revealed in 90.32% of the patients. Tumor involvement of the mediastinum was present in 38.71% and was accompanied by enlargement of the paratracheal, tracheobronchial and bronchopulmonary lymph nodes with parenchyma involvement in a number of patients.
Focal infiltration was noted against a background of the interstitial tissue changes. The diagnosis of pericarditis was made in 8.06% of patients, that of pleurisy in 2, pneumonia - 5. The scheme of x-ray changes development was worked out based on the performed investigation.
Conclusion: X-ray changes in the heart and lungs are polymorphic and caused by leukemia itself and its complications.
Key words: acute lymphoblast leukemia, x-ray diagnosis of the heart and lungs, children.
2006, vol 14, # 2, page 154
M.O. Kopitin, L.O. Shkondin
Peculiarities of complex diagnosis of lung cancer in ecologically unfavorable regions of Donbas
Annotation
Objective: To study the capabilities and significance of various radiation techniques in complex diagnosis of lung cancer (LC) in persons residing in an ecologically unfavorable region of Donbas .
Material and Methods: Complex radiodiagnosis including preventive film and digital x-ray study, plain radiography in 2 projections, helical computed tomography (16 with contrast enhancement, 36 - virtual bronchoscopy with comparison of the findings with a traditional optical bronchoscopy), convection tomography (42 patients) were performed in 128 patients. All the patients were done ultrasound tomography of the abdominal organs and the retroperitoneal space, pleural cavities and lungs. MRI was done in 7 cases.
Results: The findings of the research showed that LC was present in two forms: central (67%) and peripheral (33%). Convection x-ray study and tomography did not always allowed to suggest the character of the process in the lungs. Helical computed tomography, including that of high resolution with contrast enhancement is the most accurate method of LC diagnosis and determining its stage. Virtual bronchoscopy is indicated for diagnosis of central LC. Preventive x-ray study, especially digital one, is valuable for determining peripheral LC. Ultrasound and MRI are additional methods of studying the disease dissemination.
Conclusion: Helical computed tomography is the most optimal method of LC radiodiagnosis.
Key words: lung cancer, radiodiagnosis.
2006, vol 14, # 2, page 162
O.M. Suhina, O.A. Mihanovskiy, V.Z. Gertman, V.S. Suhin, I.M. Krugova
Application of a new marker SCCA to prognosis of lymph node metastases in operable cervical cancer
Annotation
Objective: To evaluate informativity of determining primary SCCA expression level in operable cervical cancer (CC) for prognosis of possible lymph node metastases.
Material and Methods: SCCA expression level was determined in the blood serum of 24 primary patients with stage IB - IIA squamous cell cervical cancer (рT1b-2aN0-1M0) before combination therapy (Vertheim surgery and radiation therapy) followed by polychemo-therapy when indicated.
Serum SCCA expression level was determined with immuno-enzyme technique using test kits manufactured by Abbot (USA). 1.5 ng/ml were taken as the discrimination level.
Results: The obtained findings demonstrated direct correlation between SCCA expression level and metastases to regional lymph nodes at early CC stages.
Determining the level of the tumor-associated marker, SCCA, is helpful already at primary CC diagnosis for determining the stage of the disease. A high level of SCCA expression in the primary patients may suggest underevaluation of the disease stage.
Conclusion: Tumor-associated marker SCCA is a stage-dependent marker, enlargement of the tumor is associated both with the increased level of the marker and with the number of SCCA-positive cases.
High initial values of SCCA expression (> 8.6 ng/ml) suggest the presence of a high risk of pelvic nodes involvement in operable CC.
Investigation of primary SCCA expression level allows to allocate a risk group requiring additional diagnostic measures for determining the tumor stage, which is especially important at early CC stages for planning more aggressive therapy.
Key words: cervical cancer, tumor-associated marker SCCA.
2006, vol 14, # 2, page 166
S.V. Antonuk
Annotation
Objective: Complex investigation of the pulmonary surfactant system and its relationship with morphological changes of respiratory portions of the lungs in rats after chronic low-dose irradiation.
Material and Methods: Wistar male rats were exposed to total x-ray irradiation at a dose of 0.25 Gy (0,01 Gy per day at dose rate of 1.67 mGy/min) for 25 days. After that the rat lungs were examined physico-chemically and biochemically on the 1 st day.
Results: Chronic low-dose irradiation caused activation of the adaptive mechanism of respiratory portions of the lungs which manifested by high functional activity of synthesis, secretion, and catabolism mechanisms of surfactant. Surfactant system activation led to accumulation of surface-active compounds in the alveolar lumen, decreasing of intraalveolar tension, and retractive features of lungs, and development of chronic panacinar emphysema. High level of surfactant catabolism was accompanied by increase of phospholipid hydrolysis products - fatty acids and lysophospha-tidylcholin. Lysocompounds accumulation promoted development of degenerative-destructive and inflammatory changes in the air-blood barrier and diffuse sclerosis.
Conclusion: Long action of law-dose radiation leads to nonspecific activation of respiratory portion adaptive mechanisms, accumulation of surfactant and catabolism products with development of chronic panacinar emphysema, degenerative-destructive and inflammatory changes the lung parenchyma.
Key words: chronic irradiation, low doses, pulmonary surfactant system, pulmonary emphysema.
2006, vol 14, # 2, page 171
R.I. Kratenko
Influence of ionizing radiation and 12-crown-4 on coagulation system components of rat blood
Annotation
Objective: To investigate the influence of 12-crown-4 and ionizing radiation on some components of blood coagulation system: Са2+ contents and prostaglandin concentrations in the blood serum, and erythrocyte contents in the blood plasma.
Material and Methods: Са2+ content was determined using atom-absorbtion method. Prostaglandin concentrations were investigated using radioimmunologic method: PgF2a - with the aid of diagnostic isotope kit АН ВНР (PgF2a-3 H for radioimmunologic analysis of PgF2a); PgE1 and E2 - with the use of reagent kit of Advanced Magnetics Inc. ( USA ). The erythrocyte quantity determination was performed by the generally accepted methods.
Results: 12-crown-4 as well as ionizing radiation increased PgE2 contents by more than 100 %, but diminished PgE1 and PgE2 a concentration (on an average by 27 %). 12-crown-4 action resulted in reliable increase in Са2+ concentration of rat blood plasma which is probably explained by the crown-ether capacity of binding metal ions intracellular ly and its lipophylic properties, owing to which this c omplexon freely passes the plasmatic membranes and reaches the blood plasma. 12-crown-4 did not influence the blood plasma e-rythrocyte content. In the organism of rats exposed to ionizing radiation the plasma Са2+ concentration remained without alterations, however, the erythrocyte contents somewhat increased due to the emergence of inmature forms. 12-crown-4 and ionizing radiation induced coagulational properties of erythrocytes and altered the profile of prostaglandin contents in direction of thrombocyte agregation facilitation.
Conclusions: The influence of 12-crown-4 and ionizing radiation increases the coagulational properties of erythrocytes, however, one must accept the occurence of different mechanisms which result in the appearence of identical effects. The synergiom of ionizing irradiation and 12-crown-4 influence blood coagulation process points out at the occurence of radiomimetic properties of the latter.
Key words: crown-ethers, ionizing radiation, prostaglandins, erythrocytes, calcium ions.
2006, vol 14, # 2, page 175
N.E. Uzlenkova, E.M. Mamotuk
The efficacy of Lipochromin application in experimental acute radiation lesions of the skin
Annotation
Objective: To evaluate experimentally the efficacy of application of a plant drug Lipochromin in acute radiation lesions of the skin.
Material and Methods: The study was done on 95 mongrel mature male rats weighing 180-200 g. The experimental model was single local x-ray exposure of the thigh at a dose of 70.0 Gy using ТУР -60 unit (air dose rate - 80.8 Gy/min, effective energy - 18 keV, U=50 kV, J=10mA without a tube using Al filter =0.6 mm). The degree of the skin lesion in the exposed areas was evaluated according to the incidence and terms of radiation reaction development using a special scoring scale. Depending on the scheme of Lipochromin application the animals were divided into four groups: group 1 - exposed controls (20 animals), group 2 - application of the ointment with Lipochromin on the irradiated area of the skin for 30 days; group 3 - preventive daily oral administration of Lipochromin oil solution (0.2 ml) for 2 weeks before the exposure, group 4 - complex administration of oil Lipochromin solution (0.2 ml) 7 days before the exposure and after the exposure for 30 days with simultaneous applications of the ointment on the irradiated surface. Each experimental group consisted of 25 rats. The animals were under observation for 60 days.
Results: At local irradiation of the rat thigh at a dose of 70.0 Gy, acute radiation lesion of the skin (wet desquamation) was observed in all animals (100%) for 22.8 ± 0.5 days, which later transformed to erosions (25%) and radiation lesions (10%). Lipochromin efficacy in acute radiation lesion of the skin depended on the mode of administration. Preventive effect of the drug (group 3) manifested by absence of purulent-necrotic changes and radiation ulcers in the exposed skin of the rats which were administered oil Lipochromin solution. Therapeutic effect of Lipochromin manifested by 1.7-fold reduction in the frequency of acute radiation reactions of the skin. The scheme of complex administration of the drug (oral administration with simultaneous ointment application to the exposed surface) was most effective. Reduction in the incidence of dry desquamation (2.1 times), wet desquamation (1.9 times) as well as shorter healing period (by 3-7 days) absence of erosions and radiation ulcers were observed at complex administration of the drug.
Conclusion: Lipochromin is an effective therapeutic and preventive drug in acute radiation lesions of the skin.
Key words: acute radiation lesion of the skin, x-ray exposure, Lipochromin.
2006, vol 14, # 2, page 180
R.Y. Abdullaev, V.V. Gaphenko, S.O. Ponomarenko
Ultrasonography of the cervical spine methodological aspects and normal anatomy
Annotation
Objective: To systematize ultrasonography findings and to investigate ultrasonographic anatomy of the cervical spine.
Material and Methods: The study involved 34 healthy subjects aged 19-38, of them 21 men and 13 women.
Ultrasonography was performed using 5.0-9.0 MHz linear and microconvex probes. The study was performed without any preliminary preparation in supine position from anterolateral approach in a longitudinal and transverse planes. Visualization of the arcoprocessual joints and the spinal canal at C1-C2 was achieved from the posterior approach in prone position.
Results: Optimal approaches for visualization of the cervical spine structures (anterior transverse ligament, vertebral bodies, intervertebral disks, arms of the nerve radices, spinal canal) were determined. The qualitative parameters of the studied structures are presented. Bifurcation of the common carotid artery is a landmark for C3-C4 disk visualization. Turning the head to the opposite side facilitates C2-C3 disk visualization. The notch of the presternum and sternum is a landmark for C6-C7 disk visualization.
A vertebral body looks like a rectangle with rounded angles and moderately increased echogenicity. In the transverse section, an intervertebral disk is seen like an hypoechoic band between the bodies of oval-rounded shape in the transverse section. In the longitudinal section the anterior transverse ligament is seen like a hyperechoic linear structure in front of the disk. The pulpal nucleus is seen as an area of medium echogenicity without distinct borders in the center and closer to the posterior disk outline.
In the transverse section, the height an sagittal size of the vertebral bodies are determined, Doppler study of the spinal arteries on the both sides is done with calculation of the clinically significant parameters (systolic and diastolic blood flow velocity, index of peripheral resistance).
In the transverse section, frontal (transverse) size of the intervertebral disk and vertebral bodies, spinal canal, diameter of the arms of nerve radices are measured. A dural sac is seen like n anechoic oval structure surrounded by a thin hyperechoic (circular) ring in the center of the vertebral canal. This approach allows evaluating the structure of the pulpal nucleus, to reveal the thinned areas, fibers, and ruptures of the fibrous ring, to determine the size of the protrusion and hernial protrusions of the disk, areas of edema accompanying the lesions.
Lushko's joints are visualized when the probe is placed in the anterolateral area of the neck at 40-60° in craniocaudal direction.
At artificial lordosis (functional load), the study was done to reveal unstable cervical vertebrae.
Frontal and sagittal size of the vertebral canal obtained using ultrasound study were smaller than at x-ray examination, possibly because the measurement was done at the level of the intervertebral disk vs at the level of the vertebral bodies at x-ray study.
Conclusion: Ultrasonography can be successfully used to study and reveal the diseases of the cervical spine as an objective and significant diagnostic technique.
Key words: cervical spine, intervertebral disks, ultrasonography, methodological aspects.
2006, vol 14, # 2, page 185
O.V. Tepla, O.M. Kovalenko
Analysis of the influence of external irradiation component on the patients with thyroid cancer affected by the Chornobyl nuclear power plant accident
Annotation
Objective: To estimate the correspondence of external irradiation component to the range of doses that increase risk of thyroid cancer in patients with thyroid cancer affected by the Chornobyl nuclear power plant accident; to define possible relationship between the latent period and doses of external irradiation component on the thyroid gland in these patients.
Material and Methods: Dose reconstruction from external irradiation component on the thyroid gland was applied in 99 patients with thyroid cancer affected by the Chornobyl accident. The method of reconstruction was worked out at department of dosimetry and radiation hygiene of Institute for Radiation Hygiene and Epidemiology of Research Center for Radiation Medicine. Average age of patients was 31.8 ± 1.4 years. Average period from the irradiation to the development of thyroid cancer was 9.9 ± 0.39 years. The results of measurements are presented as mean ± SD of mean. Statistical analysis of differences between means was done using two-tailed unpaired Student's t-test and values of < 0.05 were regarded as significant. Pirson's correlation coefficient between the latency period and doses of the external irradiation component on thyroid was calculated.
Results: Average thyroid dose was 5.1 ± 0.5 cGy in patients with thyroid cancer that occurred within the first 5-years after the Chornobyl accident. As it was below 10 cGy it could point out that promotion effect of irradiation took place. The patients with thyroid cancer that developed after a 5 year period had average dose on thyroid 20.5 ± 1.8 cGy (p=0.00017). In 50 of these patients (61 %) average dose was above 10 cGy and cancerogeneic effect of irradiation was probable. In 32 patients with more than 5 years the latent period and rather low dose on the thyroid gland no definite conclusion could be made. These cases could be both the part of spontaneous morbidity and radiation induced. No linear relation between the latent period duration and external radiation dose component on the thyroid gland was revealed .
Conclusion: External irradiation component irrespective of internal irradiation can promote development of thyroid cancer in people affected by the Chornobyl accident because of its promotion and induced effects. External irradiation component does not always correspond to the range of the doses that increase risk of thyroid cancer. No linear relation between the latent period duration and the dose of the external irradiation component on thyroid was revealed .
Key words: thyroid cancer, external irradiation, latent period, Chornobyl accident.
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