Chest Organs Research Articles

A neuro-heuristic approach for recognition of lung diseases from X-ray images

Background and objectiveThe X-ray screening is one of the most popular methodologies in detection of respiratory system diseases. Chest organs are screened on the film or digital file which go to the doctor for evaluation. However, the analysis of x-ray images requires much experience and time. Clinical decision support is very important for medical examinations. The use of Computational Intelligence can simulate the evaluation and decision processes of a medical expert. We propose a method to provide a decision support for the doctor in order to help to consult each case faster and more precisely. MethodsWe use image descriptors based on the spatial distribution of Hue, Saturation and Brightness values in x-ray images, and a neural network co-working with heuristic algorithms (Moth-Flame, Ant Lion) to detect degenerated lung tissues in x-ray image. The neural network evaluates the image and if the possibility of a respiratory disease is detected, the heuristic method identifies the degenerated tissues in the x-ray image in detail based on the use of the proposed fitness function. ResultsThe average accuracy is 79.06% in pre-detection stage, similarly the sensitivity and the specificity averaged for three pre-classified diseases are 84.22% and 66.7%, respectively. The misclassification errors are 3.23% for false positives and 3.76% for false negatives. ConclusionsThe proposed neuro-heuristic approach addresses small changes in the structure of lung tissues, which appear in pneumonia, sarcoidosis or cancer and some consequences that may appear after the treatment. The results show high potential of the newly proposed method. Additionally, the method is flexible and has low computational burden.

Pulmonary Complications and Related Consequences in Patients with Traumatic Injuries

Background and Purpose: Trauma is considered to be one of the main causes of death in the world and the number of deaths caused by traumatic incidents has experienced an annual increase of 15%. Despite this fact that comprehensive information on the incidence of pulmonary complications in traumatic patients, the patients’ fate in the country and factors affecting it is not available, the present study was conducted to determine the incidence of these complications and the main factors causing them in patients with traumatic injuries visiting the emergency room of the largest medical, educational, and research center in the province, which is considered to be the most important transfer center for traumatic patients from other medical centers in the region. Methods: This is a cross-sectional prospective study conducted on the injured people who visited the emergency room of Imam Reza Hospital in Tabriz in 2015. The incidence of pulmonary complications and factors affecting them were recorded in a valid and reliable researcher-developed checklist that included demographic information and information related to the incident. The significance level was set at p < 0.05. Results: Of all the 482 traumatic patients, 63.5% were men with a mean age of 41.6±15.4, with pulmonary complications reported in 48.1% of them. Pneumonia was the most common complication among these patients which was reported in 161 (33.4%) patients, and pneumothorax and ARDS were the second and third most common complications with the frequencies 41 (8.5%) and 39 (8.1%), respectively. The main causes of the incidence of pulmonary complications were reported to be an age of above 45 (p < 0.001), reduced consciousness level based on GCS criterion (p = 0.01), single trauma to the chest (p < 0.001), synchronous trauma to the chest and other organs (p < 0.001), hospitalizations of longer than one week (p < 0.001), intubation (p < 0.001) and finally transfer of the patient to the operation room (p < 0.001). It should be noted that a pulse rate of more than 100 beats in a minute was accompanied by a decrease in the incidence of pulmonary complications (p = 0.01). In the evaluation of the patients’ fate, it was found out that only 15 (3.1%) patients were discharged from the emergency room. Finally, 34 patients (7.05%) died during the study, with the age group 15-29 years accounting for one third of the patients investigated. Pneumonia (33.4%) was the most common pulmonary complication. For 152 patients (34.8%) the duration of hospitalization was longer than seven days. Conclusion: The fact that the incidence of pulmonary complications in traumatic patients visiting the Location of research was 48.1% highlights the need for further attention to and proper management of complications in these patients. Delayed pulmonary complications are more common among traumatic patients, since the most common complication in this study was reported to be delayed pneumonia. Therefore, given the significance of such a high incidence, further studies and taking effective preventive and medical measures are strongly suggested.

Метод эндоэкстраларингеальной латерофиксации голосовых складок в лечении хронических паралитических стенозов гортани

The treatment of patients with chronic paralytic laryngeal stenoses has been one of the most relevant problems of the present-day otorhinolaryngology. The main cause of paralytic stenosis is the surgery of thyroid gland, neck and chest organs. Etiological factor of the disease is the damage of the recurrent laryngeal nerve and the outer branch of the upper laryngeal nerve. The other possible causes of bilateral paralytic stenosis are: malignant neoplasms, endotracheal intubation, neurological diseases. The diagnostics is based on anamnestic data of previous surgical intervention or concomitant somatical pathology, laryngeal endoscopy, laryngeal videostroboscopy. The treatment of paralytic stenosis at the period of 6 months onwards from the onset of the disease is the laryngeal surgery. According to the literature data, despite the various methods of surgical treatment, the recurrence of the disease in the form of laryngeal restenosis ranges from 6 to 78%. The article describes a new method of surgical treatment of chronic laryngeal stenoses, combining endoscopic laryngeal surgery with bilateral endo-extralaryngeal laterofixation of vocal folds using suture techniques. The article presents the results of 46 patients with this pathology, treated by the following method.

СОВРЕМЕННЫЕ АСПЕКТЫ ДИАГНОСТИКИ И ТАКТИКИ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ОСЛОЖНЕННОЙ ТРАВМЫ ГРУДНОЙ КЛЕТКИ

Background. Closed chest trauma is one of the most dangerous and life-threatening critical conditions. Medicosocial topicality of the problem is associated with its high frequency, large number of complications (45.6% - 75%) and high mortality rate (2% - 6.2%). The choice of the optimal tactics of diagnostics and treatment of patients with chest trauma currently continues to be a topical problem in emergency surgery. Purpose. To detail the pattern of occurrence of complications in chest trauma for increasing the effectiveness of investigation and providing adequate qualified medical help in patients with chest trauma. Material and methods. Medical documentation of 259 patients with various complicated chest injuries over the period from 2007 to 2017 was analyzed. Patients in the dynamics underwent a standard x-ray examination of the chest, ultrasound (US) investigation of the pleural cavities, ultrasound investigation of the chest with examination of ribs and sternum, computed tomography of the chest. The developed algorithm of diagnostics and treatment was applied to all patients with closed chest trauma. Results. There were no discrepancies in diagnostics of localization and the number of damaged ribs and intrapleural complications in patients who underwent simultaneous plain chest radiography and chest ultrasound investigation. Surgical interventions were performed in 231 (89.2%) patients. Urgent surgical operations were carried out in 28 (10.8%) cases. All the patients were discharged in satisfactory condition. Conclusions. Rib fractures are the most frequent damage to the chest that causes complications. An intrapleural complication can occur with any number of damaged ribs and at any time of fracture consolidation. Ultrasound examination of the chest organs should be included in the investigation complex. Computed multislice tomography should be performed as a clarifying study. Active diagnostic and treating surgical tactics enable to obtain good results in treatment of complicated chest trauma.

EXPERIENCE WITH THE USE OF NONINVASIVE VENTILATION IN CANCER PATIENTS AFTER LOBECTOMY

With the appearance of the modern devices for noninvasive ventilation (NIAVL) in our country, the interest to this issue has increased even more, because the use of a simple, atraumatic method of ventilation allows to avoid intubation and of invasive mechanical ventilation through an endotracheal tube with their complications for some patients. The purpose of the study was to investigate the effectiveness and indications for the use of noninvasive ventilation in cancer patients which underwent surgical operations on the thoracic organs. Since 2013, 34 patients who underwent surgical treatment on the thoracic organs have been examined. Patients were divided into two groups. The first group included patients (n = 24), which received noninvasive lung ventilation (NIAVL) in the early postoperative period. The second group consisted of patients (n = 10) that were treated according to the local protocol. The use of NIAVL in patients that were operated on the chest organs proved to be effective as it improved hemodynamics and blood gases balance and it can prevent the development of respiratory failure.

Prevention and treatment of infectious complications of penetrating thoracic injuries

Results of treatment of 325 wounded are analyzed with penetrating wounds of the chest and identify risk factors for the development of infectious complications. Found that infectious complications of the chest organs developed in 49 (15,1%) cases. It has been established that the most frequent infectious complications of penetrating wounds of the chest are post-traumatic pneumonia (67,3% of cases) and acute empyema of the pleura (26,5% of cases). The most prognostic significant risk factors for the development of infectious complications were identified: the type of injury (odds ratio - 2,48;95% confidence interval - 1,34-3,76), the severity of injuries (odds ratio - 7,88; 95% confidence interval - 3,9-15,92), blood loss (odds ratio - 3,09; 95% confidence interval - 1,6-5,94), duration of stay in the intensive care unit (odds ratio - 9,25;95% confidence interval - 4,57-18, 74), the intersection of chest wall structures (odds ratio - 2,84; 95% confidence interval- 1,24-6,47). Measures aimed at the prevention of infectious complications should be started from the moment the woundedperson enters the hospital. The priority tasks are to maintain the patency of the tracheobronchial tree, expanding the lung,adequate drainage and debridement of the pleural cavity. A high risk of developing infectious complications in penetratingwounds of the chest is expected in the wounded in a severe and extremely serious condition (according to the scale of fieldsurgery - condition at admission more than 31 points). The duration of stay in the intensive care unit for more than 4 daysincreases the probability of infectious complications 9 times.

The place and role of videothoracoscopic surgical interventions in war wounds and injuries of the chest organs

Thoracic injuries are considered to be one of the most severe injuries of human systems and organs, which are characterized by a large number of complications and high mortality. According to the ATO data in eastern Ukraine, the frequency of chest injuries in the general structure of combat surgical injuries is 11.7%, the overwhelming majority of which were non-penetrating injuries (83.6%). The overall mortality rate for penetrating wounds of the breast is 5–10%. Surgical tactics for injuries and injuries of the chest is diverse and depends on the type of traumatic injury, the time of first medical and specialized care, the severity of the condition of the victims, the presence of complications, the technical capabilities of the hospital. Objective: optimization of surgical tactics for wounds and injuries of the chest through the use of video-assisted thoracoscopic techniques. A retrospective analysis of the surgical treatment of 103 thoracic wounded and injured, which were located in the Military Medical Clinical Center of the Southern Region in Odessa and the area of responsibility (level II–IV medical care) from June 2014 to July 2017, was carried out. At the stages of medical evacuation of all 103 thoracic wounded and injured in most cases (41 people (39.8%)), drainage of the pleural cavity was sufficient to eliminate hemo- and pneumothorax — 25 (24.3%) underwent various surgical interventions from thoracotomic approaches, 16 (15.5%) had various video-assisted thoracoscopic surgeries, 16 (15.5%) had only surgical treatments for gunshot wounds, and 5 (4.9%) wounded and injured had only conservative therapy. Conclusions: Promising, in our opinion, can be the widespread introduction of video-assisted thoracoscopic interventions into the practice of surgeons who are involved in the ATO, followed by a multicenter assessment of the results.

The optimization of an accomodation in the thoracic cavity child the axial pump don-3 (the mathematical model research)

We have developed and tested a technique for constructing 3D models of the chest and thoracic cavity organs. Due to the obtained results, the mathematical model was successfully used in the development of classification of variants of placement of implantable auxiliary circulation systems, and also for building 3D models for other purposes. In particular, the patients were graded according to the variants of placing the children’s axial pump DON-3 inside the patient’s chest cavity. Based on the data, the first fitting of the DON-3 pump was performed on a patient aged 7 years.

Imaging in Diagnostic Nuclear Medicine

Single-photon emission computed tomography (SPECT) and positron emission tomography (PET) are modern methods for visualization in diagnostic nuclear medicine. SPECT is known as a workhorse in cardiology, and PET is the gold standard in oncology. The development of nuclear medicine is provided by cooperation of physicists, mathematicians, biologists, medical doctors, and radio-chemists. In spite of extensive clinical applications, several problems may lead to false diagnoses. In particular, the correction of attenuation of gamma radiation in human organs must be taken into account. For interpretation and evaluation of such an effect on the clinical results, we perform physico-mathematical simulation of the SPECT diagnostics in cardiology in the absence and presence of the correction of attenuation. A brief review of the state-of-the art is presented. The simulation employs the first Russian anthropomorphic mathematical phantom that describes the distribution of radio-pharmacological agent (99m Tc-methoxyisobutylisonitrile) in chest organs of a typical male patient. A model for calculation of raw images is developed with allowance for attenuation of radiation in biological tissues and the effect of collimator and detector. The results of the proposed models and calculated images are compared with clinical images obtained at the Meshalkin Institute of Circulation Pathology (Novosibirsk) and Myasnikov Institute of Clinical Cardiology (Moscow). Statistical algorithms are developed for the solution of the inverse problem of image reconstruction based on the entropy principle. The clinical and physico-mathematical approaches are compared in the evaluation of the effect of correction on the quality of reconstructed images of the left ventricle of myocardium.

Estimation of conversion coefficients for absorbed and effective doses for pediatric CT examinations in two different PET/CT scanners

Normally, during medical procedures, special attention must be given to pediatric patients when compared to adults. This is specially relevant during procedures involving ionizing radiation, as CT scans, given that children are considerably more sensitive to radiation induced stochastic effects than adults. In order to investigate the radiation doses on radiosensitive organs of pediatric patients, undergoing head, chest and abdomen CT procedures, numerical dosimetry was employed in this work. The novelty is the use of a new set of pediatric virtual anthropomorphic phantoms, coupled with Monte Carlo simulation, to determine the conversion coefficients for absorbed and effective doses. Two CT equipment were simulated, taking into account the main characteristics of those commercially available. The results were converted to conversion coefficients (mGy/100 mA) for several organs and tissues, and the highest values were obtained for the newborn phantom. This numerical approach employed a new and reliable technique for pediatric CT dosimetry.

DIAGNOSTIC SURGERY IN HIVINFECTED PATIENTS WITH DAMAGE OF CHEST ORGANS

The current epidemiological situation in the world, characterized by a constant increase in the number of HIV-infected. The steady progression of HIV infection, even in the presence of antiretroviral therapy (ART), is accompanied by the development of opportunistic diseases. Tubercolosis most often affects patients with HIV infection, as the risk of their illness is 20–37 times higher. Basically, radiation tests and immunological tests are used for the diagnostic of tuberculosis. The main diagnostic criterion for establishing the diagnosis of tuberculosis is detection of the causative agent (Mycobacterium tuberculosis by bacteriological or molecular genetic method. Other diseases with respiratory organs, pleura, and hilar lymph nodes may also occur In patients with HIV infection, which requires differential diagnostic, including surgical methods. It is often necessary to resort to a biopsy of pulmonary tissue, pleura, and hilar lymph nodes to establish a diagnosis. Among surgical methods, the use of minimally invasive operations using endoscopic techniques is most justified. Purpose of the study. Study of safety and effectiveness of the use of surgical methods in the diagnostic of chest diseases in patients with HIV infection. Materials and methods. The results of 105 diagnostic thoracic surgeries in patients with HIV infection which were performed in Moscow Research andClinicalCenterfor Tuberculosis Control of Moscow city Department in period between 2014–2017 were studied. All patients underwent diagnostic surgical interventions. Minimally invasive methods were predominantly used. The obtained diagnostic material was subjected to morphological, molecular-genetic and bacteriological analysis. Results of the research. After surgical interventions in patients with HIV infection with pathological changes in chest organs, unclear etiology, diagnosis of tuberculosis was established in 74 (70,5%) patients, nontuberculous etiology of the disease was detected in 31 (29,5%). Differential diagnosis of chest diseases in patients with HIV infection is an integral part of the work of phthisiatrician, pulmonologist and infectiologist. Surgical interventions in HIV-infected patients do not create a significant risk of changes in the immune status, respectively, their performance is independent of the level of lymphocytes and produced even with severe immunodeficiency. The use of surgical methods in diagnostic of chest diseases is safe, effective and does not lead to a significant number of complications and mortality in patients with HIV infection, regardless of the initial immune status. In addition, in number of patients, the operation is not only diagnostic, but also therapeutic, allowing significantly shortening the duration of treatment, avoiding the appointment of trial therapy. The conclusion. In case of tuberculosis, morphological verification of pathological changes in combination with bacteriological and molecular genetic research of the operation material makes it possible to assign an adequate regime of antituberculous chemotherapy in accordance with the sensitivity of the pathogen. The establishment of non-tuberculous etiology of the identified changes, changes the routing of an HIV-infected patient from an anti-tuberculosis institution to a specialized medical organization of the appropriate profile.

Small lung nodules detection based on local variance analysis and probabilistic neural network

Background and objectiveIn medical examinations doctors use various techniques in order to provide to the patients an accurate analysis of their actual state of health. One of the commonly used methodologies is the x-ray screening. This examination very often help to diagnose some diseases of chest organs. The most frequent cause of wrong diagnosis lie in the radiologist’s difficulty in interpreting the presence of lungs carcinoma in chest X-ray. In such circumstances, an automated approach could be highly advantageous as it provides important help in medical diagnosis. MethodsIn this paper we propose a new classification method of the lung carcinomas. This method start with the localization and extraction of the lung nodules by computing, for each pixel of the original image, the local variance obtaining an output image (variance image) with the same size of the original image. In the variance image we find the local maxima and then by using the locations of these maxima in the original image we found the contours of the possible nodules in lung tissues. However after this segmentation stage we find many false nodules. Therefore to discriminate the true ones we use a probabilistic neural network as classifier. ResultsThe performance of our approach is 92% of correct classifications, while the sensitivity is 95% and the specificity is 89.7%. The misclassification errors are due to the fact that network confuses false nodules with the true ones (6%) and true nodules with the false ones (2%). ConclusionsSeveral researchers have proposed automated algorithms to detect and classify pulmonary nodules but these methods fail to detect low-contrast nodules and have a high computational complexity, in contrast our method is relatively simple but at the same time provides good results and can detect low-contrast nodules. Furthermore, in this paper is presented a new algorithm for training the PNN neural networks that allows to obtain PNNs with many fewer neurons compared to the neural networks obtained by using the training algorithms present in the literature. So considerably lowering the computational burden of the trained network and at same time keeping the same performances.

INFLUENCE OF CONCOMITANT ARTERIAL HYPERTENSION ON ACTIVITY OF INFLAMMATORY PROCESS IN PATIENTS WITH COMMUNITY-ACQUIRED PNEUMONIA

The aim of the work was to determine the diagnostic value of the markers of surfactant protein D (SP-D) and C-reactive protein (C-RP) in patients with community-acquired pneumonia (CAP) with concomitant arterial hypertension (AH) and its effects on the activity of the inflammatory process. The study included 79 people. Among them, 63 patients with CAP and 16 healthy individuals who were a control group. Depending on the presence of hypertension, the patients were divided into two groups. The first group included 26 patients with CAP with AH, the second – 37 patients with CAP without AH. All patients were given general-clinical methods of examination, radiography of the chest organs in two projections. Plasma levels of SP-D and C-RP were determined. Reliable connection (p<0.05) was determined between the presence of AH and the probability of occurrence of CAP (OR - odds ratio 2.27 [95 % CI 1.05–4.94]). The level of SP-D and C-RP in patients with AH on the first day was significantly higher than in healthy subjects (p<0.05). In patients in the first group, SP-D levels were significantly higher (p<0.05) for the first, third and ninth day relative to the second group. The existence of a direct tie of average strength between the presence of AH and SP-D (R=0.41, p<0.05) has been determined. The presence of a direct correlation link of mean strength (R=0.38; p<0.05) between the AH and the level of C-RP indicates that arterial hypertension in patients with CAP increases the activity of the systemic inflammatory response.

ЛИМФОМЫ СРЕДОСТЕНИЯ: ПОСТПРОЦЕССИНГОВАЯ ОБРАБОТКА ТОМОГРАФИЧЕСКИХ ИЗОБРАЖЕНИЙ

The syndrome of lymphadenopathy (lymph-node hyperplasia) takes place in many diseases that are different by etiology, clinical course, methods of treatment and prediction. While identifying the cause of lymphadenopathy the diagnostic search should be based on the clinical situation (the character of lymphadenopathy, the presence of other symptoms, anamnestic data, the character of changes in the peripheral blood and others). The choice of the most informative method of diagnosis is defined by the diagnostic hypothesis with the consideration of the data of the primary examination of the patient, the parameters of the peripheral blood as well as the values of sensitivity and specificity of the corresponding method of study for verification of the disease supposed. The basis of this research was the material of computed-tomography examination of chest organs in 491 patients with different forms of mediastinum lymphomas in the consultative policlinic of the Far-Eastern Scientific Center of Physiology and Pathology of Respiration from 2011 till 2017. Among them there were sarcoidosis of intrathoracic lymph glands of the first, second and partially third stage (n=432); Hodgkin's lymphoma (n=17); metastases in lymph glands of mediastinum (n=25); lymphosarcoma (n=12), tuberculosis of lymph glands in adults (n=5). Beside prevailing digital radiologic studies, multispiral computed tomography was done to all of them and 78% went through fiberbronchoscopy. The verification was in 82% of patients: transbronchial biopsy under ultrasound visualization (72%) and transthoracic open biopsy (28%).

Drug-induced interstitial lung lesions

Drug-induced interstitial lung lesions (DIILL) are one of the most common forms of drug pneumopathy. DIILL account is about 3% in the structure of the entire interstitial lung pathology. Drugs induce various types of lesions of the lung parenchyma, often combining several histopathological patterns. Diagnostics of DIILL deals with many problems, since there are no specific clinical, morphological changes and specific markers. The diagnosis depends on the chronological dependence between taking the drug and the development of symptoms, and is confirmed by an improvement in the general condition of the patients after discontinuation of treatment. The aim of the work was to study the effect of various drugs on the development of DIILL, clinical diagnostic criteria, characteristic CT (computed tomography) and X-ray features, as well as the prognosis of the future course of the disease. We observed 12 patients with DIILL, which were divided into 2 groups: 1st group consisted of 4 patients with amiodarone lung, 2nd group of 8 patients, in which CT of the chest organs revealed an interstitial lesion of the lung tissue in the form of “frosted glass”. This gave us a reason to diagnose DIILL in patients who had CT scan in connection with suspected bronchocarcinoma in 3 patients, prolonged pneumonia in 3 patients and chronic obstructive pulmonary disease in 3 patients with fever. All patients took antibiotics of different groups a long time, ACE inhibitors, beta-blockers. The diagnosis of DIILL was made on the basis of the anamnesis of the patients, the CT data, as well as the positive dynamics of the general condition of the patients after the cancellation of the above medication. Diagnostic difficulties are often caused by late clinical and radiological manifestations or the lack of improvement after stopping the potentially “guilty” drug. However, timely diagnosis of DIILL is extremely important, since in many cases, the cancellation of the medication contributes to the resolution of the pathological process.

Assessment of Transcapillary Water Exchange in the Lungs by Active Radiometry

The possibility of noninvasive assessment of transcapillary water exchange in the lungs using stimulated microwave emission of the chest organs is discussed. The results of the study showed that the distribution of 1 GHz microwave emission of tissues probed using low-intensity electromagnetic waves at 65 GHz corresponded to the distribution of pulmonary blood flow. Calculations showed that the intensity of transcapillary water exchange in the lungs was distributed exponentially from the apices to the basal parts of the lungs. The distribution of the transcapillary water exchange was shown to vary according to the pulmonary perfusion gradient, which is indicative of a correlation between the parameters of pulmonary perfusion and the intensity of stimulated microwave emission of tissues at the frequency of 1 GHz. This correlation can be used for noninvasive assessment of pulmonary perfusion by active radiometry.

Analysis of X-Ray Research in Wards

Introduction.X-ray is a common diagnostic procedure in a multi-disciplinary hospitals. In the available scientific litera ture, there are some studies of the radiography in nonspecialized conditions. However, there are few aggregate data of these studies to date.Objectives.Analysis of the results of radiography in wards and resuscitation rooms, performed in multi-purpose hospitals, with the aim of forming requirements to the class of equipment for radiography in the conditions of the ward.Materials and methods.4081 X-ray studies were studied from 2015 to 2016.Results.During the analysis it was determined that in unspecialized conditions 75.0% of the shots fell to chest organs, studies of the musculoskeletal system were revealed in 22.0% of cases and abdominal organs were observed in 3%. Pathological changes were not detected for 2221 patients, which amounted to 54.4%. It was found that the most frequent disease of the chest were pneumonia of various genesis, complicated by the presence of hydro thorax.Conclusions.Based on the analysis of X-ray researches, the indications for the studies were refined and supplemented, medical requirements for X-ray machines for shooting under these conditions were formulated.

Cutting-edge technologies of medical radiography: tomosynthesis and double energy

The tomosynthesis technology is on the fringe of linear and computer tomography, combining high information capacity and low exposure. Diagnosing pathology of chest organs at early stages is complicated due to overlapping views of the lung and bone tissues. By using different X-ray energy ranges tissues with different absorption factors are separated and their separate images are received. This technology ensures that pathology is revealed at the early stage during routine screening.

Primary Mediastinal (Thymic) Large B-Cell Lymphoma

Primary mediastinal (thymic) large B-cell lymphoma (PMB-CL) is one of the primary extranodal tumors and originates from thymic medulla B cells. The disease is more common in young women and declares itself by mainly locally advanced growth within the anterior upper mediastinum with frequent involvement of chest organs. PMBCL has specific morphological, immunological, and genetic characteristics that permit to differentiate it from other similar diseases: diffuse large В-cell lymphoma, nodular sclerosis Hodgkin’s lymphoma, and mediastinal gray zone lymphoma. Immunochemotherapy with subsequent irradiation of the residual mediastinal tumor is the standard treatment of PMBCL. No benefits of one drug therapy over another have been demonstrated to date in controlled studies. Application of new imaging techniques (PET/CT) may result in withdrawal of the radiotherapy in some PMBCL patients without impairment of delayed survival rates.

Primary repair of tetralogy of Fallot combined with unilateral left lung agenesis with crossed-ectopic right lower lobe

Unilateral lung agenesis is a rare congenital anomaly often combined with congenital malformations of different systems. A case of tetralogy of Fallot repair with unilateral left lung agenesis via median sternotomy is described for the first time. In this case, the choice of surgical approach to the heart could be affected by the fears of not getting optimal surgical exposition via median sternotomy due to severe displacement of the chest organs. The case demonstrates the median sternotomy as an optimal surgical approach even in high degrees of organ displacement caused by a combination of left pulmonary agenesis and cardiac lesions.