Chest Organs Research Articles

Optimization of treatment for patients with combined unstable pelvic and thoracic injuries

Background. In patients with polytrauma, damage to the pelvis and chest organs occurs in 21.2–45.7 % of cases. Thoracic trauma, one of the most frequent localizations in multiple injuries, is found in 50–80 % of patients and is of significant importance for the prognosis of the victim’s life. Clinical studies indicate that an average of 20 % of all fatal outcomes in polytrauma are due to chest trauma. Isolated chest and pelvic injuries are serious injuries themselves, and their combination, taking into account the mutual aggravation symptom, is an urgent issue of modern orthopedics and traumatology. Its solution requires a multidisciplinary approach, and further study will allow to refine treatment strategies and improve outcomes. The purpose was to improve treatment outcomes in patients with combined injuries of the pelvis and chest by optimizing treatment algorithm. Materials and methods. The clinical study is based on the examination and treatment of 36 patients with combined chest and pelvic injuries from 2014 to 2023. The average age of the patients was 41.4 ± 16.3 years. Results. Combined injuries of the pelvis and chest lead to a severe condition of patients according to the Injury Severity Score and Trauma Score. Stable fixation in type B pelvic fractures is provided by an external fixation device, while in type C fractures, stabilization of the posterior pelvic ring is mandatory. Rib osteosynthesis performed by certain indications is a more effective approach compared to non-surgical treatment, which allows to reduce the frequency of acute respiratory distress syndrome and pneumonia, the length of stay in the intensive care unit and the period of inpatient treatment. The overall mortality in the experimental group was 11.1 %. For patients who did not survive, the average Injury Severity Score was 40.3, the average Trauma Score was 5.4 ± 1.5 points. Conclusions. 1. For type B pelvic injuries, which are characterized by anterior, rotational and partially posterior instability, stabilization of the anterior part is sufficient. Type C injuries, which are characterized by anterior and posterior instability, require stabilization of the anterior and posterior pelvic rings. 2. Rib osteosynthesis performed by indications provides a lower incidence of acute respiratory distress syndrome and pneumonia, as well as a lower need for artificial lung ventilation and a shorter stay in the intensive care unit.

CURRENT STATUS AND PERSPECTIVES OF THE USE OF SPECIES OF THE GENUS MELAMPYRUM IN MEDICINE AND PHARMACY

The dynamics of development in the world market of medicinal products based on raw materials of plant origin demonstrates the increased demand for medicinal raw materials, which are a component of pharmaceutical production products. A huge number of scientific works are devoted to the issue of the study of medicinal plants, and in particular the biologically active substances they contain. Medicinal plant raw materials, which contain various classes of active substances, attract the special attention of modern scientists. Due to the content of biologically active substances, plants of the genus Melampyrum show a wide range of pharmacological effects. Information about such effects is reflected in the works of foreign researchers.The purpose of our work: to conduct an analysis of scientific primary sources regarding the chemical composition and use of species of the genus Melampyrum, to establish the possibility of creating medicines based on biologically active substances of medicinal raw materials.In research, we used such methods as retrospective, historical, bibliographic.We have analyzed the use of plants of the genus Melampyrum in official medicine and we can draw conclusions that today they are not used in official medicine, but are widespread in the territory of Ukraine and contain various groups of biologically active substances such as carbohydrates (dulcite (melampyrite), glucose, maltose, sucrose, starch, hemicellulose, pectin, mucilage), iridoids (aucubin, catalpol, isocatalpol, aukuboside, agnuside, 8-epiloganin, melampiroside, musainoside, monomelitoside, globularifolin), flavonoids (rutin, luteolin, luteolin glycosides, apigenin and quercetin), carotenoids (α-carotene, β-carotene, violaxanthin, lutein, eloxanthin, flaoxanthin), anthocyanins, coumarins (umbelliferone), cardenolides, steroid saponins, alkaloids (cinnaroside, seneciphyllin I, senecionin II), oxycinnamic acids (caffeic, chlorogenic, ferulic), fatty acids (palmitic, oleic, linoleic and linolenic), ascorbic acid, nitrogen-containing compounds (indican, choline), free amino acids (L-glutamic acid, L-proline and tyrosine), tannins, phenolic compounds (lunularin), which accounts for a wide range of their medicinal properties.Melampyrum arvense L., Melampyrum nemorosum L., Melampyrum cristatum L. and Melampyrum pratense L. exhibit wound-healing, anti-inflammatory, sedative, anticonvulsant, hypotensive effects. Their decoctions are used for hypertension, dizziness, heart disease, neuralgia, epilepsy, diseases of the stomach and gastrointestinal tract. Externally, it is used in the form of baths, washes, poultices for such diseases as skin tuberculosis, scrofulosis, diathesis, eczema, itching, rash, rheumatism, diseases of the chest organs, as a wound-healing agent. Aqueous extracts have an anticonvulsant and sedative effect, promote blood clotting. Teas and infusions from plant leaves are used both internally and externally.Species of the Melampyrum genus have long been used in folk medicine for various diseases. They are also studied by scientists from many countries around the world. In Ukraine, the plants of the genus Melampyrum have practically not been researched, so the data on their use in medicine indicate the prospects for further pharmacognostic research of various types of Melampyrum with the aim of creating and introducing into practical medicine and pharmacy new medicinal products of domestic production.

Hematologic indices as an available tool in the diagnosis of adverse course of COVID-19

To study the prognostic significance of hematologic indices: neutrophils/lymphocytes (N/L), platelets/lymphocytes (P/L) and lymphocytes/C-reactive protein (L/CRP) in relation to the complicated course of new coronavirus infection (COVID-19), as well as their correlation with COVID-19 course severity indices and endothelial dysfunction marker sVCAM-1. 103 patients with new coronavirus infection (COVID-19) were included in the study. Based on the data of multispiral computed tomography (CT) of the chest organs, all patients were divided into 3 groups: CT group 1 - 30 patients, CT group 2 - 62 patients and CT group 3 - 11 patients. The values of N/L and P/L were significantly higher in patients of CT group 3 compared to patients of CT group 1 and CT group 2. L/CRP index, on the contrary, significantly decreased with increasing CT-degree of lung lesion. The concentration of endothelial dysfunction marker sVCAM-1 was significantly higher in patients of CT-3 and 2 groups compared to patients of CT-1 group - 272.7 [267.4; 342.6] ng/mL and 212.5 [90.3; 335.6] ng/mL vs 120.0 [75.3; 189.2] ng/mL. Significant correlations of the studied hematologic indices with clinical, laboratory and instrumental characteristics of COVID-19 severity were found. P/L and L/CRP indices were associated with sVCAM-1 concentration in blood (r=0.28 and -0.33 respectively; p<0.05). The values of N/L>2.53 and L/CRP≤0.043 are predictors of the development of cytokine storm in the examined patients. Hematologic indices N/L, P/L and L/CRP are correlated with clinical, laboratory and instrumental characteristics of COVID-19 severity, presence of endothelial dysfunction (P/L and L/CRP) and allow predicting the development of cytokine storm (N/L and L/CRP).

A RARE CASE OF COMBINATION OF DIAPHRAGMATIC HERNIA WITH EXTRALOBAR PULMONARY SEQUESTRATION: A CASE REPORT.

ABSTRACTBackground. According to the literature, the combination of extralobar sequestration withdiaphragmatic hernia is observed in 12-16% of patients with pulmonary sequestration. A clinicalcase of a combination of these anomalies is presented. None of the congenital defects werediagnosed in the prenatal period. The presence of a pulmonary sequester with an atypical bloodvessel was an intraoperative diagnosis.Clinical case description. The diagnosis of a diaphragmatic hernia was performed in the first hoursafter the birth of the baby because the newborn suffered of respiratory failure and neededresuscitation measures.The X-ray image of the chest organs revealed the presence of a left-sidedfalse diaphragmatic hernia. Thethoracoscopy took place on the 2-nd day of newborn’s life. Duringsurgeryadditional malformation was revealed. The pulmonary sequestration was detected after theorgans were immersed in the abdominal cavity. The result of the surgery (removal of pulmonarysequestration and plastic defect of the diaphragm) was successful.Conclusion. It is very important to increase the professional attention of pediatricspecialists – neonatologists, pediatricians, intensive care specialists, pediatricsurgeons, functional specialists of antenatal ultrasound diagnostics - not only tothe problem of pulmonary sequestration, but also congenital malformations ofthe chest organs in general.

Epithelioid Hemangioendothelioma of the Azygos Vein

Background. Epithelioid hemangioendothelioma (EHE) is a malignant vascular tumor of mesenchymal origin. In the mediastinum, EHE originates from the large venous vessels of the superior vena cava.The purpose of the study was to describe a rare clinical case of EHE of the unpaired vein and analyze literature data to improve diagnosis and treatment of this disease.Case presentation. We present a rare case of EHE of the unpaired vein in a 23-year-old male patient who admitted to the Herzen Moscow Oncology Research Institute with a posterior mediastinal tumor detected in August 2022. It was known from the medical history that the patient had undergone diagnostic right-sided thoracotomy and tumor biopsy at the place of residence. Morphologically, the tumor was an epithelioid hemangioendothelioma. The histological re-assessment of biopsy specimens at the Herzen Moscow Oncology Research Institute confrmed the diagnosis of EHE. Computed tomography of the chest organs revealed a mass in the posterior mediastinum (in the projection of the lumen of the unpaired vein), measuring 16×14×41 mm, with relatively clear even contours, close to the posterior wall of the trachea at the bifurcation level, the posterior wall of the right main bronchus, the left semicircle of the esophagus (without signs of invasion). Based on the data on the presence of a vascular tumor in the posterior mediastinum on the right, a multidisciplinary medical consilium recommended surgical treatment: right thoracotomy, removal of a posterior mediastinal tumor with resection of the azygos vein, marginal resection of the superior vena cava, and thrombectomy from its lumen. The duration of surgery was 180 minutes, blood loss was 200 ml. Morphological examination confrmed EHE of the unpaired vein. No complications were observed in the postoperative period. The patient was discharged from the hospital on the 8th day after surgery in a satisfactory condition.Conclusion. EHE of the unpaired vein is an extremely rare vascular tumor. The clinical feature of EHE of the unpaired vein is the absence of any pathognomonic signs, which complicates differential diagnosis of mediastinal tumors. Surgery is currently the optimal treatment approach.

Experience with the use of janus kinase inhibitors in the treatment of COVID-19 in patients in Volgograd

The new coronavirus infection (COVID-19) is characterized by high morbidity and mortality. The main approach to COVID-19 therapy should be the proactive administration of treatment before the development of a complete symptom complex of life-threatening conditions, including acute respiratory distress syndrome. The use of a selective and reversible inhibitor of janus kinase 1 and 2 prevents viral endocytosis, reduces excessive inflammatory response. The purpose of the study - to evaluate the effectiveness of the use of the Janus kinase inhibitor of the drug Baricitinib (Olumiant, manufacturer Lilly del Caribe Inc., Spain) in the treatment of patients with moderate COVID-19 in a hospital setting. During the clinical use of Baricitinib, significant positive changes were obtained compared with the initial level of vital signs and laboratory data. Significant positive changes in the following indicators were obtained: oxygen saturation increased (from 95.3 ± 4.0 to 97.5 ± 3.2 %, p = 0.011), body temperature decreased (from 37.3 ± 0.7 to 36.7 ± 0.5 °C, p = 0.000), C-reactive protein decreased (from 47.1 ± 46.0 to 32.5 ± 41.7 g/l, p = 0.010), the number of platelets increased (from 178.0 ± 59.5 to 249.5 ± 84.5; p = 0.000), when assessing the condition of patients in points on the NEWS-2 scale positive dynamics (from 1.6 ± 1.2 to 1.1 ± 1.3, p = 0.001). The level of C-reactive protein increased simultaneously with an increase in interleukin-6, an increase to 200.0 ± 6.2 pg/ml was recorded. The positive dynamics is an increase in the number of lymphocytes to 2.0 • 109/l. By the end of inpatient treatment, ferritin levels had normalized to reference values of 27.7±2.1 mmol/l and D-dimer to the upper limit of normal. Positive dynamics of changes on the CT scan of the chest organs in the form of a decrease in infiltration. According to the combination of changes in clinical, laboratory signs and CT scan results, the therapy of patients was effective.

Criteria for predicting early neonatal adaptation of newborns in women who had COVID-19 infection during pregnancy

Objective of the study: to investigate the possibility of predicting the early neonatal adaptation of newborns based on clinical and instrumental data that assesses the status of pregnant woman with COVID-19 infection and the fetus.Materials and methods. The participants of the study were 58 pregnant women with a diagnosis of COVID-19 (group A) and 40 women with a physiological course of pregnancy (group B), as well as their newborns. In addition to the analysis of standard examinations results, perinatal consequences for the mother and the fetus/newborn, the association between the saturation level (SрO2) in the pregnant woman, the short-term heart rate variability (STV) according to cardiotocography data of the fetus and the assessment of the newborn according to the Apgar scale was studied.Results. The SрO2 level was 95% or more in 87.9% of infected pregnant women, in 12.06% it was 90–94% (critical for pregnant women). 10.3% of pregnant women needed intensive therapy and respiratory support, 69% of women had inflammatory changes in the chest organs (pneumonia, etc.). Cardiotocography showed a significant difference in the type of basal heart rate between the groups (χ2 = 14.9055, p = 0,00058) and STV (7.78 ± 2.56 vs 8.39 ± 2.03 ms) in groups A and B, respectively (U = 687, p = 0.00022). The Apgar scale index in groups A and B was 6.48 ± 2.39 and 8.05 ± 0.54 points, respectively (χ2 = 21.933, df = 4). 20% of newborns in group B had 7 points in the first minute, 80% had 8 points or more. 51.85% of newborns in group A had scored 7 points or less (F = 0.00246, p &lt; 0.05, odds ratio 4.308, 95% CI 1.681 – 11.037). 10.34% of newborns required intensive care, 5.17% – administration of surfactant, 1.72% – artificial lung ventilation. Regression analysis showed that the Apgar scale indicator at the first minute of life in newborns in group A depends on the SрO2 level of the pregnant woman (Y = 0.89X1 – 79.19), as well as on the STV (Y = 0.89X1 + 0.028X2 – 79.53), where Y is the score on the Apgar scale, X1 is the SрO2 in a pregnant woman, X2 is the STV.Conclusions. Assessment of the hypoxemia degree in pregnant women with COVID-19 infection and the cardiotocographic assessment of the fetus state require special attention: there is a direct association between these indicators and the assessment of the newborn according to the Apgar scale, which allows predicting the course of the period of early neonatal adaptation. It is recommended that these newborns be classified as a risk group with a violation of the adaptation period and possible long-term consequences.

Primary ciliary dyskinesia in children: clinical, laboratory-instrumental and genetic characteristics

Background. Primary ciliary dyskinesia (PCD) is an orphan disease, and diagnosis is difficult because there is no gold standard for diagnosis. Aim. Clinical, laboratory-instrumental, genetic characteristics of PCD in children. Materials and methods. From 2009 to 2024, 31 patients with a genetically confirmed diagnosis of PCD were observed as part of a multicenter, open-ended, descriptive pilot longitudinal study. Examination methods: clinical and anamnestic method; X-ray examination and computed tomography of the chest organs and paranasal sinuses, tracheobronchoscopy; sputum/aspirate cultures of the tracheobroncheal tree with determination of sensitivity to antibiotics; transmission electron microscopy, high-speed video microscopy of the ciliated epithelium, cytological examination of bronchoalveolar lavage; monitoring computer pulse oximetry, echocardiography, audiometry, spirometry with bronchodilator test. Results. Respiratory symptoms in the neonatal period have 80% of children with PCD, lateralization defects – 35%, congenital heart defects – 13%, bronchiectasis – 68%, purulent endobronchitis – 62%, year-round rhinitis – 84%, hearing loss, otitis – 65%. The average age of onset of symptoms was 1 [1; 1] weeks, and the verification of diagnosis was 6 [2,5; 8] years. The main pathogens of chronic respiratory infection with PCD are Haemophilus influenzae, Pseudomonas aeruginosa, Staphylococcus aureus. The most common cause of PCD was biallelic variants of the DNAH5 gene. Conclusion. The diagnosis of PCD should be based on the application of the maximum number of diagnostic tests.

Swyer – James – McLeod syndrome in an adult male

Swyer – James syndrome, also called Swyer – James – MacLeod syndrome (SJMS), is a rare acquired disorder characterized by pulmonary artery hypoplasia, unilateral hyperlucent lungs, and usually also bronchiectasis. Adults with SJMS are often diagnosed with and treated for chronic obstructive pulmonary disease (COPD), bronchial asthma, pneumothorax, or pulmonary embolism due to the similar clinical manifestations. Underestimation of an important radiological sign – unilateral “impoverishment” of the pulmonary pattern and hyperlucent lung – leads to erroneous diagnosis and inadequate treatment. Diagnosis of SJMS involves a computed tomography scan of the chest.The aim of this work was to familiarize readers with aspects of diagnosis and detail the clinical, radiological, and other characteristics of a patient with McLeod syndrome. The described adult man was diagnosed with SJMS at the age of 32. Some typical mistakes in examinations of such patients and the lack of vigilance of radiologists in case of unilateral hyperlucent lung are presented.Conclusion. Using the example of a rare clinical case of SJMS, we demonstrated the need to consider this syndrome when diagnosing adults with unjustified shortness of breath and a history of frequently recurrent pulmonary infections, with radiological signs of unilateral pulmonary emphysema and hyperlucent lung. According to the literature and our observations, computed tomography of the chest organs is a fast and reliable method for establishing the diagnosis of SJMS.

Rapid patient-specific organ dose estimation in computed tomography scans via integration of radiomics features and neural networks.

Computed tomography (CT) offers detailed cross-sectional images of internal anatomy for disease detection but carries a risk of solid cancer or blood malignancies due to exposure to X-ray radiation. This study aimed to develop a new method to quickly predict patient-specific organ doses from CT examinations by training neural networks (NNs) based on radiomics features. CT Digital Imaging and Communications in Medicine (DICOM) image data were exported to DeepViewer, a clinical autosegmentation software, to segment the regions of interest (ROIs) for patient organs. Radiomics feature extraction was performed based on the selected CT data and ROIs. Reference organ doses were computed using Monte Carlo (MC) simulations. Patient-specific organ doses were predicted by training a NN model based on radiomics features and reference doses. For the dose prediction performance, the relative root mean squared error (RRMSE), mean absolute percentage error (MAPE), and coefficient of determination (R2) were evaluated on the test sets. The robustness of the NN model was evaluated via the random rearrangement of patient samples in the training and test sets. The maximal difference between the reference and predicted doses was less than 1 mGy for all investigated organs. The range of MAPE was 1.68% to 5.2% for head organs, 11.42% to 15.2% for chest organs, and 5.0% to 8.0% for abdominal organs; the maximal R2 values were 0.93, 0.86, and 0.89 for the head, chest, and abdominal organs, respectively. The radiomics feature-based NN model can achieve accurate prediction of patient-specific organ doses at a high speed of less than 1 second using a single central processing unit, which supports its use as a user-friendly online clinical application.

The significance of preventive treatment for tuberculosis infection in children

Objective: to evaluate the value of tuberculosis preventive treatment (PTT) in children with tuberculosis infection. Material and methods. As part of a continuous study, a cohort of 200 children from 1 to 17 years old taken for clinical observation in group VI A (positive test result with the recombinant tuberculosis allergen [ATR]) was analyzed. All children underwent additional examination methods to exclude the local form of tuberculosis: physical examination, laboratory clinical and biochemical tests of blood and urine, multislice computed tomography of the chest organs and, according to clinical recommendations, PTT was proposed, which the parents of 65 children refused. Study groups: 1 — those with no family contact with a patient with tuberculosis (ТВ) (n=70): 2 — those with contact with a patient with ТВ (n=65), in group 3 included children whose parents refused PTT, despite the presence of indications (n=65), incl. 14 children were from Tl lesions. Children group 1 and 2 received PTT. Control over the PTT was carried out on the "Yandex.Teleconference". Results. As a result of comparison of the three groups, reliable data were obtained on the effectiveness of PTT according to the criteria of preventing the disease and reducing the results of the ATR test. A significantly high percentage of sick children in group 3 was established, compared with children from group 1 (p=0.008; x2=18.6). When assessing the dynamics of the results of immunodiagnostic tests in children of the group 1 who received PTT, a decrease in the test with ATR was significantly more often observed compared to children without PTT(p=0.001; x2=17.2). It is worth noting that children had satisfactory tolerability of the drugs; no adverse events were observed in patients with daily video recording. Conclusion. A conclusion was made about the need for preventive work with parents of children who refused preventive treatment to increase their level of adherence, the need to evaluate the effectiveness of PTT courses using primary and additional criteria, including the importance of controlled PTT.

Mural infectious endocarditis in a patient with tetralogy of Fallot: a clinical case

The article presents a clinical case of development of mural infective endocarditis (IE) with formation of vegetations in the region of the upper third of the interventricular septum in patient A., 51 years old, with uncorrected tetralogy of Fallot. The patient was admitted with complaints of increased heart rate, interruptions in the heart work, feet swelling, shins up to the upper third, dyspnea at rest, general weakness, fever up to 39 оC, sweating, headache. During transthoracic echocardiography on the upper third of the interventricular septum (IVS) from the side of the RV, an additional echo-positive linear mobile formation 0.9 cm long is visualized, similar to the chords of the tricuspid valve. Thus, based on the identification of 1 major Duke criterion (imaging criterion — the presence of parietal vegetation) and 3 minor criteria (predisposing factors — congenital heart disease of the blue type; fever &gt;38 оC; positive blood culture not meeting the requirements for the major criterion), laboratory and instrumental diagnostic data and anamnesis, the following diagnosis was established: "Secondary infective endocarditis with damage to the upper third of the interventricular septum". Taking into account the sensitivity of the identified microflora, polymyxin and moxifloxacin were prescribed. During therapy, a dry cough and dry wheezing in the projection of the middle lobe on the right appeared. To exclude septic embologenic pneumonia, computed tomography of the chest organs was performed, on which no focal/infiltrative changes were detected. However, a shunt connecting the brachiocephalic trunk with the right pulmonary artery was visualized, which may explain the cause of compensation of hypoxemia that arose due to pathological hemodynamics as a result of high pulmonary stenosis. Given the incomplete effectiveness of therapy, as well as the sensitivity of the infectious agents isolated, a decision was made to change antibacterial therapy to vancomycin in combination with imipenem. Conservative treatment methods allowed not only to compensate for the existing clinical symptoms, but also to achieve reference values of laboratory parameters, despite the impossibility of surgical intervention.

Cross‐Institutional Prediction System for Estimating Patient‐Specific Organ Dose from Chest CT Scans without Segmenting Internal Organs

This study aims to establish and validate a cross‐institutional prediction system for estimating patient‐specific organ doses from chest CT scans. By collaborating across multiple institutions, the study seeks to develop models that allow rapid online estimation of organ doses, eliminating the need for complex organ segmentation. Researchers delineate skin outlines from chest CT images obtained from two different institutions. Radiomics features are extracted from the chest CT data and skin contours. Organ doses are computed using Monte Carlo simulations as reference organ doses. Single‐ and cross‐institutional support vector regression (SVR) models are trained with radiomics features to predict organ doses from chest CT scans. Model performance is assessed using metrics like maean absolute percentage error (MAPE) and R‐squared (R2). For chest organs (lungs, heart, spinal cord, trachea, and esophagus), single‐institutional SVR models achieve MAPE values ranging from 4.72% to 15.31% and R2 values from 0.73 to 0.93. Cross‐institutional models have MAPE values in the range of 2.16–7.49% and R2 values from 0.84 to 0.99. SVR models trained with radiomics features from skin outlines can reliably estimate organ doses from chest CT scans. The proposed method is applicable across different institutions, and cross‐institutional models enhance predictive accuracy, generality, and robustness.

A lung biopsy path planning algorithm based on the double spherical constraint Pareto and indicators’ importance-correlation degree

Lung cancer has the highest mortality rate among cancers. The commonly used clinical method for diagnosing lung cancer is the CT-guided percutaneous transthoracic lung biopsy (CT-PTLB), but this method requires a high level of clinical experience from doctors. In this work, an automatic path planning method for CT-PTLB is proposed to provide doctors with auxiliary advice on puncture paths. The proposed method comprises three steps: preprocessing, initial path selection, and path evaluation. During preprocessing, the chest organs required for subsequent path planning are segmented. During the initial path selection, a target point selection method for selecting biopsy samples according to biopsy sampling requirements is proposed, which includes a down-sampling algorithm suitable for different nodule shapes. Entry points are selected according to the selected target points and clinical constraints. During the path evaluation, the clinical needs of lung biopsy surgery are first quantified as path evaluation indicators and then divided according to their evaluation perspective into risk and execution indicators. Then, considering the impact of the correlation between indicators, a path scoring system based on the double spherical constraint Pareto and the importance-correlation degree of the indicators is proposed to evaluate the comprehensive performance of the planned paths. The proposed method is retrospectively tested on 6 CT images and prospectively tested on 25 CT images. The experimental results indicate that the method proposed in this work can be used to plan feasible puncture paths for different cases and can serve as an auxiliary tool for lung biopsy surgery.

Surgical treatment of diaphragmatic hernia in a 3-year-old child

BACKGROUND: Congenital diaphragmatic hernia (CDH) is a serious condition associated with abnormal development of the diaphragm. Its occurrence among newborns ranges from 1 per 2000 to 1 per 4000. Depending on location, CDH can be divided into four types: diaphragmatic-pleural, parasternal, diaphragmatic-pericardial, and hernias at the esophageal opening of the diaphragm. Hernias can be classified as true or false depending on the presence or absence of the hernia sac. In case of diaphragmatic-pleural hernias, when the intestine, spleen, and stomach almost completely protrude into the pleural cavity, symptoms manifest early in the form of severe cardiorespiratory and gastrointestinal disorders. CLINICAL CASE DESCRIPTION: The article discusses a case of a three-year-old child with a congenital diaphragmatic pleural hernia. From birth, the child experienced difficulty breathing at feeding, coughing; he also had recurrent pneumonia. X-ray examination and computed tomography of the chest revealed a left-sided hernia. Surgery was done via a left-sided thoracotomy, no complications. In four months after the surgery, X-ray examination showed straightened lungs and normal mediastinum; left diaphragm cupula was also normal. The child is considered to be completely healthy due to the absence of symptoms and normal chest X-ray findings. The authors' main goal was to raise awareness among doctors about rare congenital diseases such as CDH. Also, they would like to draw attention to the fact that congenital malformations of the lungs, intestines, and other organs can be unexpectedly manifested at any age. Children with frequent respiratory problems or cardiorespiratory conditions have to be X-rayed as soon as possible to detect congenital malformations of the diaphragm or other chest organs for timely surgical intervention. CONCLUSION: As the authors have noted, in recent years X-ray examination of children often reveals undiagnosed at an early age "findings" related to diaphragm pathology, such as false and true diaphragmatic hernias and dome relaxation. CDH is rare in children older than 3 years and has no specific symptoms. It often leads to delayed diagnostics, often visits to pediatricians because of respiratory infections, retardation in physical development and, as a result, to late surgical treatment.

Difficulties of the stage-by-stage surgical treatment of a teenager with bilateral advanced fibrotic-cavernous tuberculosis. Сlinical case

BACKGROUND: To achieve success in the management of adolescents with tuberculosis, a comprehensive approach including surgical intervention is needed so as to eliminate disease clinical manifestations, to achieve persistent healing of tuberculous changes with restoration of bodily functions and complete social rehabilitation CLINICAL CASE DESCRIPTION: In patient U., 17 y.o., sudden and acute onset of the disease broke out after her contacts with her aunt who had tuberculosis. The initial form was infiltrative pulmonary tuberculosis in the decay phase. A course of anti-tuberculosis therapy was prescribed considering the bacteria sensitivity to antibiotics. After the course, fibrous lesions and cavities were detected in both lungs at computed tomography examination of the chest organs. A personalized therapy was developed for the patient with consideration of her body weight and sensitivity to bacteria. In 7 months, an endobronchial valve was inserted at the bronchus mouth in the right superior lobe because of the large cavity in the right upper lung lobe and lack of changes in the cavity size. In six more months, the blocker was removed due to the lack of dynamics, and a video-assisted thoracoscopic combined resection of the right lung (upper lobectomy with resection of part SV, anatomical resection SVI with part SVIII) was performed. On analyzing surgical material, it was found out that the patient was resistant to Isoniazid, Rifampicin and fluoroquinolones, so therapy was corrected. In six months, a video–assisted thoracoscopy combined resection of the left lung (SI–III anatomical resection and marginal resection of SVI part) was made. CONCLUSION: After the performed treatment, patient's oxygenation improved, persistent abacillation was achieved, due to which the patient could return to normal lifestyle.

Situs inversus partialis (levocardia): an incidental discovery of an extremely rare case during the autopsy of a female with suicidal poisoning

BackgroundSitus inversus is a rare congenital anomaly. In this condition, the abdominal and chest organs are positioned in reverse, a mirror image of the normal anatomical position. It is divided into two categories. 1. Situs inversus totalis, in which the apex of the heart points toward the right side. 2. Situs inversus partialis or incompletus, in which the apex of the heart points toward the left side. Situs inversus totalis is present in 1 per 10,000 to 50,000 individuals of the general population, whereas situs inversus partialis is a much rarer condition and is present in 1 per 2,000,000 individuals of the general population. The term situs ambiguous is also used for the arrangement of organs and vessels in an unordered manner.Case presentationIn this paper, we present an extraordinary case of situs inversus partialis discovered incidentally during the autopsy of a female body with a documented history of suicidal poisoning. This unique finding sheds light on the diagnostic challenges and implications of situs inversus partialis, especially in patients with underlying medical conditions.ConclusionsThis report underscores the importance of thorough and systematic investigations during autopsy examinations to identify and comprehend rare anatomical anomalies that may otherwise remain unnoticed. Increased awareness of such rare congenital anomalies may contribute to a better understanding of their prevalence and potential clinical implications for healthcare professionals and researchers.

A clinical case of a floating thrombus in the right atrial cavity against the background of massive bilateral pulmonary embolism

ABSTRACT. The article presents a clinical case of massive bilateral pulmonary embolism (PE), which was promptly suspected and diagnosed using echocardiography. During the echocardiography, a floating thrombus about 5 cm long and pulmonary hypertension were found in the right chambers of the heart. The patient was urgently referred for a computed tomography scan of the chest organs, where signs of massive PE were detected and he was referred to the intensive care unit for thrombolytic therapy. Due to the correct diagnosis and adequate therapy, the patient managed to save his life. The purpose of our work is to draw the attention of practical doctors to the nonspecific symptoms of PE and the importance of timely diagnosis in the case of an emergency patient.

Pulmonary hemorrhage in oncologic patients – a diagnostic algorithm

The OBJECTIVE was to develop a diagnostic algorithm in oncologic patients with pulmonary hemorrhage.METHODS AND MATERIAL. A retrospective single-center study of the medical records of 258 patients who met the inclusion criteria was conducted. Inclusion criteria: age over 18 years, oncologic disease of the chest organs complicated by pulmonary hemorrhage. Inclusion criteria: age over 18 years, oncologic disease of the chest organs complicated by pulmonary hemorrhage. Exclusion criteria: age under 18 years, pulmonary hemorrhage of non-oncologic etiology. Pulmonary hemorrhage was considered to be the discharge of any volume of fresh blood or clots from the tracheobronchial tree, which was determined on the basis of anamnesis, clinical manifestations in the hospital, endoscopic examination. Routine diagnostic methods of investigation, such as chest radiography, chest computed tomography (including with contrast enhancement), fibrotracheobronchoscopy, bronchial arteriography were evaluated.RESULTS. The sensitivity for diagnosing the oncologic process in chest radiography, computed tomography, and fibrotracheobronchoscopy, was 84.7 %, 98.4 %, and 94.4 %, respectively. The sensitivity of fibrotracheobronchoscopy to detect the bleeding itself in oncologic patients reached 31.3 %, and the sensitivity of bronchial arteriography to diagnose the source of bleeding was 87.7 %.CONCLUSION. In pulmonary hemorrhage of oncologic genesis, the combination of fibrotracheobronchoscopy with computed tomography has sensitivity in 100 % of cases in determining the source and localization of the pathological process. Bronchial arteriography allows to perform endovascular hemostasis. It is necessary to conduct multicenter studies in order to develop and implement a unified algorithm assessing all etiopathogenetic features of pulmonary hemorrhage in oncologic patients.

Pulmonary Embolism of the Small Branches of the Pulmonary Artery as a Result of Combat Trauma: Review of the Literature and Analysis of a Clinical Case

Pulmonary embolism (PE) is recognized by WHO as one of the most common cardiovascular diseases. Even in peacetime, PE is the third leading cause of sudden death after coronary heart disease and stroke. Today, as a result of the war, there have been significant corrections in the understanding of etiology, pathogenesis, features of the clinical course and treatment of internal pathology in the wounded persons. It was established that an important feature of modern combat activity is a constant increase in the frequency of multiple and combined wounds, while combat injuries of the chest make up to 15% of the structure of sanitary losses, and closed chest injuries under combat conditions can make up to 5%. Diseases of the cardiovascular and respiratory system are observed both early and late after closed chest trauma. The early ones are represented by functional disorders of the blood circulation and breathing system and are the consequences of damage to the chest organs, and the late ones occur in the case of joining a wound infection and are characterized by inflammatory processes in the lungs, pleura, heart and blood vessels, include pneumonia, pleurisy, acute purulent-destructive diseases lungs, thromboembolic complications. The article analyzes the course and possibilities of diagnosis and treatment of PE using the example of a wounded military man. A clinical case is presented which describes the successful diagnosis and treatment of a wounded person with PE of small branches of the pulmonary artery with the development of infarct-pneumonia S8, S9 of the right lung, nosocomial pneumonia in the right lung, which was complicated by the destruction of lung tissue, with the formation of an abscess-hematoma, acute interstitial nephritis, complicated by acute kidney damage of the III degree. This therapeutic pathology arose after a gunshot shrapnel penetrating wound of the chest on the right side with damage to the right subclavian vein, migration and embolization by a metal fragment of the right pulmonary artery, a gunshot shrapnel blind wound of the upper third of the right forearm with a gunshot fracture of the ulna and the presence of a foreign body (debris) in the muscle what tissues of the forearm. During the operation a complication arose in the form of migration of a foreign body from the branches of the right pulmonary artery to the branches of the left pulmonary artery. The result of the patient’s treatment was positive dynamics of the pathological process. The serviceman was discharged from the hospital in satisfactory condition and returned to the Armed Forces of Ukraine after a medical treatment. PE of small branches of the pulmonary artery is a severe complication after gunshot shrapnel injury to the chest organs, which can occur without concomitant deep vein thrombosis of the lower extremities, most likely as a result of the development of shock and the migration of fragments along the branches of the pulmonary artery. Complex treatment with the use of surgical methods and adequate antibacterial therapy is the main method of treatment of chronic destruction of lung tissue with abscessation. Each patient needs a complex of imaging methods for dynamic examination and monitoring of the state of other organs and systems, in particular, kidney function.