UJR 2015, vol XXIII, # 4
THE CONTENTS
2015, VOL. XXIII, PUB. 4, PAGE 5
A. P. REVURA1, T H. FETSYCH1, YU. P. MYLIAN2
1 Danylo Halytsky Lviv National Medical University
2 Lviv State Regional Oncological Center
ROLE OF SPIRAL COMPUTED TOMOGRAPHY IN THE DIAGNOSIS AND TREATMENT PLANNING OF PATIENTS WITH COLORECTAL CANCER AND PERITONEAL CARCINOMATOSIS
Objectives. Study of the capability of spiral computed tomography with contrast enhancement for the diagnosis of peritoneal carcinomatosis in patients with colorectal cancer and surgical treatment planning.
Materials and methods. The results of CT of the abdomen and pelvis in 21 patients with colorectal cancer with peritoneal carcinomatosis were analysed. The study was conducted with single slice spiral CT scanner «Somatom Emotion» with contrast enhancement. CT findings were compared with data obtained at surgical exploration. Location and size of peritoneal implants were evaluated according to peritoneal cancer index.
Results. The diagnosis of peritoneal carcinomatosis was made using preoperative CT in 42.9 % of patients. Size was estimated accurately in 77.8 % of peritoneal implants, underestimated in 16,7 % and overestimated in 5.5 %. CT sensitivity was proved to be dependant on the size of implants and was the lowest (8.7 %) for < 0.5 cm metastases. The overall CT sensitivity for implants imaging was 26.5 %, which had statistically significant impact on underestimation of radiological peritoneal cancer index. This was the reason for the change of surgical treatment in 43.8 % of patients after surgical exploration.
Conclusions. The study shows a lack of sensitivity of single slice spiral CT for peritoneal carcinomatosis detection in patients with colorectal cancer and limited value of the method in planning of surgical treatment.
Keywords: computed tomography, sensitivity, colorectal cancer, peritoneal carcinomatosis, surgical treatment.
2015, VOL. XXIII, PUB. 4, PAGE 11
УДК: 546.172.6:616.33-006-018.2
I. M. VASYLYEVA1, N. V. KRASNOSELSKEY2, YU. A. VYNNIK3, V. I. ZHUKOV1, A. V. POLIKARPOVA1
1 Kharkiv National Medical University
2 SI «Institute of Medical Radiology named after S. P Grigoriev of Academy of the Medical Sciences of Ukraine», Kharkiv
3 Kharkiv Medical Academy of Postgraduate Еducation
STATE OF OXIDIZING NO SYNTHASE SYSTEM AND CONNECTIVE TISSUE IN PATIENTS WITH GASTROCANCEROGENESIS
Purpose. A study of the NO synthase oxidative system and structural metabolic connective tissue state in patients with gastrocancerogenesis.
Materials and methods. 44 patients with gastric adenocarcinoma aged 43 to 68 years are subjected to clinical examination in the paper. The research program includes the investigation of the state of NO synthase oxidizing system and connective tissue in patients with gastric cancer. In the serum of patients as well as healthy subjects the content of the oxidation products of nitric oxide — nitrites, nitrates, S-nitrosothiols and activity of endothelial and inducible NO synthase were determined. To assess the state of the connective tissue in blood plasma was measured the glycosaminoglycans, enzymes elastase activity content and collagenolytic activity of serum.
Results. The study of NO synthase oxidative system activity revealed elevated levels of serum nitrite, nitrate, S-nitrosothiols and activity of endothelial and inducible NO synthase. The examination of connective tissue state in patients with gastrocancerogenesis showed the increased activity of serum elastase and its collagenolytic activity, to indicate the structural and metabolic abnormalities in the connective tissue.
Conclusions. Analysis of the results indicates that cancerogenesis is accompanied with increased amounts of reactive oxygen species (ROS), th be able to transform the NO protective effects into cytotoxic within the cell. The findings suggest that gastrocancerogenesis I connected with profound metabolic disorders of connective tissue metabolism associated with the activation of proteases and accumulation of glycosaminoglycans in the serum.
Keywords: gastrocancerogenesis, NO-synthase, elastase, glycosaminoglycans.
2015, VOL. XXIII, PUB. 4, PAGE 16
УДК 618.146-073.432.19
R. Y. ABDULLAYEV, A. H. SIBIHANKULOV, O. V. GRISHCHENKO, R. R. ABDULLAYEV
Kharkiv Medical Academy of Postgraduate Education
SONOGRAPHIC INDICATORS OF A STRUCTURALLY FUNCTIONAL CONDITION OF CERVIX OF HEALTHY WOMEN DEPENDING ON AGE AND THE PERIOD OF A MENSTRUAL PERIOD
Purpose. To study ultrasound semiotics of the normal cervix in women of different age and menstrual cycle period by means of calculating of qualitative and quantitative parameters of the macrostructure using transvaginal ultrasonography.
Materials and methods. Transvaginal ultrasonography has been carried out for 162 healthy women aged from 19 to 68 on the 4-6th, 8-12th, 12-14th and 21-23rd days of the menstrual cycle. One hundred and six women had a history of pregnancy, where there were 14 abortions only and 92 cases of delivery, 56 did not experience pregnancy. Twenty-four women were in the period of menopause.
Results. The quantitative and qualitative parameters of the endocervix and the whole cervix have been estimated. In parous women of reproductive age the volume of the cervix was the highest and reached 23,7 ± 2,1 sm3 that was significantly (p < 0,001) higher than the one in nonparous women (13,1 ± 1,3 sm3). The thickness of the endocervix of nonparous women was 8,9 ± 1,0 mm, which was significantly (p < 0,05) higher than the one in parous women and women in the period of menopause.
Reduced echogenicity of the endocervix on the 8-10th days of the menstrual cycle was observed in 73,2 ± 5,9 % of nonparous women and in 66,2 ± 5,7 % of women with delivery history. The average echogenicity was more frequently observed on the 12-14th days in 69,6 ± 6,1 % and 72,1 ± 5,4 % of women, isoechogenicity on the 21-23rd days in 76,8 ± 5,6 % and in 67,3 ± 5,7 % respectively.
Conclusions. The greatest thickness and volume of the cervix are peculiar to parous women of reproductive age. The maximum thickness of the endocervix is observed on the 12-14th days of the menstrual cycle. On the 8-10th days of the menstrual cycle echogenicity of the endocervix tended to be decreased in most cases, on the 12-14th days it was medium, on 21-23rd days it was isoechoic.
Keywords: transvaginal ultrasonography, the cervix.
2015, VOL. XXIII, PUB. 4, PAGE 24
УДК 616.711.1-073.432.19-053.5
R.Yy. ABDULLAYEV, K. N. IBRAGIMOVA, R. R. ABDULLAYEV
Kharkiv Medical Academy of Postgraduate Education
METHODICAL ASPECTS OF ULTRASONIC RESEARCH OF CERVICAL INTERVERTEBRAL DISK AND SPINAL CANAL AT CHILDREN OF THE ADVANCED SCHOOL AGE
To study the normal ultrasound anatomy of the cervical spinal motion segment in healthy children under school age.
Materials and methods. Held ultrasound intervertebral discs (MPD), the spinal canal (PC) with the level of C2-C3 to C7-Th3 67 healthy children in the age groups 13-15 and 16-18 years. In the sagittal and axial projections defined sizes MTD PC dural spaces, radicular channels. Studied ehostruktura nucleus pulposus (AEs), the contours of the fibrous ring (FC).
Results. The highest sagittal size MTD and PC in the age groups 13-15 (15,6 ± 0,8 mm and 16,4 ± 0,9 mm) and 16-18 years (16,9 ± 0,7 mm and 17,3 ± 0,8 mm) was recorded at the level of C2-C3. Only in the age group 16-18 years were no significant differences (p < 0,05) compared with the level of C7-Th3 (17,3 ± 0,8 mm in front of 15,2 ± 0,7 mm). In both age groups, the height of the MTD was also the highest at C2-C3 (4,2 ± 0,23 mm and 4,5 ± 0,37 mm), but no significant differences compared with the levels of C2-C3 and C7-Th3 has not been revealed. PC area was calculated from the linear dimensions and on the perimeter. At the level of C2-C3 in 13-15 years, these figures were 188 ± 11 mm2 and 287 ± 14 mm2, aged 16-18 years — and 195 ± 12 mm2 312 ± 14 mm2. At the level of C7-Thj these figures were 152 ± 8 mm2 (p < 0,05), 158 ± 7 mm2 (p < 0,01), 236 ± 12 mm2 (p < 0,001), 248 ± 9 mm2 (p < 0,001).
The thickness of the yellow ligament (TAR) increases from top to bottom, it was the highest level of C6-C7 in the age group 16-18 years and was 2,8 ± 0,24 mm significantly (p < 0,05) higher than at the level of C2-C3 (2,1 ± 0,15 mm).
Sagittal size front dural space (PDP) in all children at all levels of MTD profit lower than the rear DP index RAP/ CAH was lowest at C4-C5 and was 0,82 ± 0,03.
Conclusions. In both age groups of children sagittal size of the MTD and the PC, the height of the MTD wheel size, the area of the PC, the width of the radicular canals, dural space have the highest value at the level of C2-C3, the lowest — at the level of C,-C, or C-Th,. Smallest index MTD/PC celebrated at C-C. Maximum thickness of the yellow ligament is registered at the level of C6-C7.
Keywords: ultrasound semiotics, cervical intervertebral discs, older children.
2015, VOL. XXIII, PUB. 4, PAGE 31
УДК: 616-066.441-07:611.018.4-076
I. ZHULKEVICH, Y. YAVORSKA, I. Ya. Horbachevsky
Ternopil State Medical University diagnostic and clinical approval of virtual bone tissue biopsy technique in HODGKIN LYMPHOMA PATIENTS
Aim of study. The implement into clinical practice a non-invasive method of histomorphometric and densitomet-ric trabecular bone status evaluation in Hodgkin lymphoma (HL) patients at the presentation and after completion of chemotherapy.
Materials and methods. Virtual biopsy in 40 (mean age 35,38 ± 2,22) patients with Hodgkin lymphoma was performed at thoracic midvertebral CT slices. Densitometric and histomorphometric parameters of vertebral trabecular bone were obtained by using ClearCanvas Workstation and ImageJ with BoneJ application software. The robust Brown-Forsythe Levene test was used as a main criterion for statistical analysis.
Results. Comparative analysis of bone denstity changes showed a significant decrease (up to 12,6 %) in all vertebrae (except I and V Th) in males and up to 14,15 % in females (only in VI, VIII) compared to the initial values at the presentation of the disease. Chemotherapy had an impact on mineralization status, structure model index in females, significant decrease of fractal and texture values in both groups, the decrease of bone surface parameter in males. Another significant factor for trabecular bone changes was the stage of HL and the occurrence of B symptoms. Conclusion. Clinical and diagnostic implementation of a non-invasive method for trabecular bone status analysis revealed gender differences and predisposing factors for trabecular structural rearrangement in HL patients after the completion of chemotherapy compared to the initial values of quantitative and qualitative parameters.
Keywords: Hodgkin lymphoma, trabecular bone status, histomorphometry, chemotherapy.
2015, VOL. XXIII, PUB. 4, PAGE 35
УДК 616.131-005.6-073.43
D. S. MECHEV1, YU. V GRABOVSKY2
1 P L. Shupyk National Medical Academy of Postgraduate Education
2 Mechnikov Dnipropetrovsk Regional Clinical Hospital pulmonary EMBOLISM: Importance OF Modern RADIOLOGY
Summary. The goal was to define the role and value of modern diagnostic radiology in the diagnosis of pulmonary embolism. It was established that pulmostsintigrafiya as emission study allows a functional characterization of the pathological process, to identify the minimum metabolic disorders at an early stage of their occurrence. While CT angiography can detect minimal structural changes in the pulmonary artery, and provide exceptionally accurate information on the localization of the identified anatomical changes. CT-AG as a minimally invasive method that allows you to identify the level of arrangement of a blood clot in the blood vessels, their scope and prevalence. Through objectivity, high resolution, speed, modern diagnostic radiology allows early diagnosis of pulmonary embolism.
Keywords: pulmonary embolism, lung scintigraphy, computed tomography, pulmonoangiografiya.
2015, VOL. XXIII, PUB. 4, PAGE 38
УДК 616.006-06[615.849.19+616-089]
L. Y. VASYLIEV1, Y. B. RADZISHEVSKA1 2, V. G. KNIGAVKO2
1 SI «Grigoriev Institute for Medical Radiology of National Academy of Medical Science of Ukraine», Kharkiv
2 Kharkiv National Мedical University
IMPACT OF SPECIAL CANCER TREATMENT ON THE FURTHER FORMATION of second TUMORS
The aim of paper is to analyze ionizing radiation and chemotherapy influenced the secondary tumors growth.
Materials and methods. Electronical database containing 570 medical records was enalyzed. There were 204 cases of the cancer patients with second tumor after 3 or more years after the treatment, 183 cases of the patients with metastatic tumors (not second tumor) and 183 cases — patients without adverse effects for more than 5 years. All patients were treated in the clinic of IMR since1993. Patients treated with different combinations of chemotherapy, radiation therapy and surgical. Long-term outcomes for these patients were studied.
Calculations were made in the statistical environment Statistica 6.1. using methods of nonparametric statistics and search technology hidden knowledge of Data Mining.
Results. The long-term outcomes of the cancer patients treated with different combinations of chemotherapy, radiation therapy and surgical treatment were studied. It was shown that patients with second tumors after the treatment of the first tumor with chemo- and radiotherapy without surgery received the total absorbed dose 2.6 times less than the patients without adverse outcomes in the future.
Conclusions: Our study did not reveal carcinogenic effects of radiotherapy and chemotherapy, as well as statistically significant positive impact on the long-term effects of treatment of first tumors using maximum value of both methods was demonstrated
Keywords: second tumor chemotherapy, radiation therapy, carcinogenic effect.
2015, VOL. XXIII, PUB. 4, PAGE 43
УДК 618.29-073.4-036
I. N. SAFONOVA
Kharkiv Medical Academy of Postgraduate Education
ULTRASONOGRAPHY VALUE AFTER 22 WEEKS OF GESTATION FOR DIAGNOSIS OF FETAL PATHOLOGY AND PREDICTION OF PERINATAL OUTCOME IN THE LOW-RISK PREGNANCY
To determine importance of ultrasonography after 22 weeks of pregnancy in a low-risk subpopulation for diagnosis of fetal pathology and prediction of perinatal outcome.
Materials and methods. At various stages of second and third pregnancy trimesters after normal findings obtained due to US screening, ultrasonography was carried out for 4580 pregnant women with initially low risk of obstetric and perinatal complications. US fetometry and calculation of the fetal weight, visual assessment of fetal anatomy, estimation of the degree of placental calcification, amniotic fluid index were performed along with Doppler velo-cimetry of the fetoplacental system as well as perinatal outcomes were studied.
Results. The total number of women with US signs of fetal abnormalities and/or placental disturbance identified after 22 gestational week in a low-risk pregnancy population was 449/4580 (9.8 %).
After 22 weeks cardiac malformations and arrhythmia, central nervous system anomalies associated with the influence of infection, abnormalities of fetal abdomen, fetal deformation sequences as well as US signs of the intrauterine infection implementation (IUI) were mostly detected. US examinations in the period of 26-34 weeks have a value mainly for detection of fetal anomalies, in the period of 26-30 weeks — for diagnosis of placental disorders and in the period of 34-37 weeks — for US detection of the implementation of IUI signs. After 37 weeks the US and Doppler symptoms of primary placental disorders were not detected and the value of US exams consisted in diagnosis of fetal perinatally significant arrhythmias, abnormal fetal position, macrosomia and multiple cord entanglement. The frequency of changes that had ambiguous perinatal prognosis and required further US monitoring was the highest at the stage of 26-30 gestational weeks (fetal abnormalities, placental noncritical violations, uterine artery hemodynamic disorders).
In 24/53 cases the detected fetal abnormalities were associated with poor or ambiguous perinatal prognosis, demanded delivery in the highest level maternity hospital, review of obstetric and perinatal approach, resuscitation and/or intensive care, consultations, neonatal transport as well as surgical interventions and / or drug therapy in the neonatal period.
Conclusions. The frequency of detection of fetal anomalies in the normal results of routine scans in pregnant women of low risk subpopulation in our study was not more than 1.15 % (OR 0.52; CI 95 % 0/44-0.56, RR 0.56; CI 95 % 0.51-0.61). At the same time, the pathological changes revealed after 22 weeks were crucial for predicting the outcome of pregnancy as well as for obstetric and perinatal approach development. On the basis of the analysis which has been carried out, inclusion of US scan of pregnancy in the third trimester into the antenatal care protocols can be considered valid.
Keywords: low risk pregnancy, foetus, ultrasound examination, perinatal result.
2015, VOL. XXIII, PUB. 4, PAGE 52
УДК 615.849:351.77(477.65)
D. S. MECHEV1, M. V. KRASNOLESKY2, N. M. SEREGINA3, K. V. GUMENYUK3, M. B. GUMENYUK3
1 P. L. Shupyk National Medical Academy of Postgraduate Education, Kiev
2 SI «Grigoriev Institute for Medical Radiology of National Academy of Medical Sciences of Ukraine», Kharkiv
3 Ukrainian Center of Tomotherapy, Kirovohrad
TOMOTHERAPY AS AN ADVANCED TECHNOLOGY OF EXTERNAL-BEAM RADIOTHERAPY
Summary. The aim of the paper was to describe the first Ukrainian Center of TomoTherapy in Kirovograd: Key parameters, structure, equipment for diagnostic (CT, MRI, ultrasound) and radiotherapy (linear accelerator Elekta Synergy and TomoTherapy system) purposes.
The TomoTherapy platform provides a highly conformal way of delivering stereotactic body radiation therapy (SBRT) to all tumors with limited exposure to the surrounding organs.
SBRT personnel, clinical parameters, treatment planning, Quality Assurance, first results and daily treatment, follow up of patients are described in this first for Ukraine publication.
Keywords: conformal stereotactic tomotherapy, SBRT, clinical parameters, QA, first clinical Results.
2015, VOL. XXIII, PUB. 4, PAGE 59
УДК 616.348-006.6-06-073
I. A. VORONZEV, I. E. KRAMNOY, D. V SERGEEV
Kharkiv Medical Academy of Postgraduate Education
CLINICAL AND RADIOLOGICAL DESCRIPTION OF LEFT SIDE COLON CANCER AND ITS COMPLICATIONS
This article containing analytical review of literature, devoted to radiological diagnostics of left side colon cancer and its complications. Clinical peculiarities of left side colon cancer. The problems of radiological diagnosis of intestinal obstruction, paracollar abscesses and ulcerations as complications of cancer of this localization. The possibilities of irrigoscopy, computed tomography and ultrasound in the diagnostics of these complications.
Keywords: left side colon cancer, its complications, irrigoscopy, computed tomography, ultrasound.
2015, VOL. XXIII, PUB. 4, PAGE 65
УДК 616.728-073.7-053.2(045)
S. A. KHMYZOV1, E. P. SHARMAZANOVA2, N. S. LYSENKO2, D. V ERSHOV1
1 SI Sytenko Institute of Spine and Joint Pathology of the Ukrainian National Academy of Medical Science, Kharkiv
2 Kharkiv Medical Academy of Postgraduate Education
DIFFERENTIAL X-RAY DIAGNOSIS OF GENU VARUM IN CHILDREN
Genu varum is a common pediatric orthopedic pathology. The author analyzed modern methods of clinical and radiological evaluation of the knee deformity in children. The characteristic of diseases associated with genu varum in children is discussed. The principles of differential diagnosis based on clinical examination and radiological data.
Keywords: pediatric knee deformity, genu varum, diagnostics.
2015, VOL. XXIII, PUB. 4, PAGE 87
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