Color Doppler Mapping Research Articles

113 Echocardiographic assessment of right ventricular outflow tract obstruction in hypertrophic cardiomyopathy - efficacy of dual chamber pacing in reducing of gradient

Abstract Hypertrophy of the right ventricle (RV) in the course of hypertrophic cardiomyopathy (HCM) is found in 30-60% of cases, with the possibility of a right ventricular outflow tract obstruction (RVOTO), obstruction in the apex or the middle part of the right ventricle. A patient, aged 41, admitted due to limitation of exercise tolerance, effort dyspnea, presyncope. In an echocardiogram, interventricular septum (IVS) hypertrophy was observed up to 2.0 cm; normal size of the heart cavities; normal left ventricular systolic function (EF-70%). A color doppler mapping detected the zone of flow acceleraction and turbulent flow in right ventricular outflow tract (RVOT), next a spectral doppler examination showed the RVOT obstruction with a maximal gradient of 64 mmHg. Because of the suboptimal echocardiographic imaging, a heart CT scan was performed, revealing the features of left ventricular hypertrophy, most severe at the base and the medium part of IVS (up to 25 mm). Asymmetric hypertrophy of the middle portion of the right ventricle and right ventricular outflow tract obstruction was also observed. A hemodynamic study confirmed the presence of gradient in RVOT, up to 40 mmHg. Holter electrocardiogram recorded an episode of non-sustained ventricular tachycardia. Taking into account the clinical picture, the family history of the disease, and calculated HCM Risk SCD (7.55%), the decision was made to implant a dual chamber cardioverter defibrillator. The defibrillator electrode was fixed at the apex of the right ventricle. A short AV delay was programmed for prevalent right ventricular stimulation (AV delay 100 ms), resulting in 99.6% ventricular stimulation. The control echocardiogram showed a reduction in the maximum gradient in RVOT to 24 mmHg. In addition, the patient was treated with a beta-blocker. To sum up, in the case of HCM we should always examine the RV with color and spectral doppler to exclude potential narrowing in RV. Constant AV sequential stimulation with a short AV delay is a recognized method that can be considered in symptomatic adult HCM patients with a left ventricular outflow tract obstruction. In the case described here, the above mentioned method proved effective in the significant reduction of the gradient in the right ventricular outflow tract. Abstract 113 Figure. gradient in RVOT

Клиническая оценка ультразвуковых маркеров внетубарных форм эктопической беременности: выбор метода оперативного пособия и принципы восстановительного лечения

Aspects of ultrasound diagnostics of extratubal forms of ectopic pregnancy are presented from the standpoint of choosing the optimal treatment tactics for patients, aimed primarily at minimiz-ing surgical procedures. The issues of diagnostics of cervical pregnancy, caesarean scar preg-nancy, ovarian pregnancy, as well as a rare indication of tubal pregnancy – interstitial pregnancy are detailed. In most cases, echography is not only decisive, but, in fact, the only method of pre-operative diagnosis. In this case, color Doppler mapping of blood flow in the vessels of the ec-topic trophoblast is of great importance, which makes it possible to assess the degree of its inva-sion and, thereby, to make adjustments to the surgical tactics. The emphasis is made on the role of rehabilitation treatment. Key words: ectopic pregnancy, extratubar forms, ultrasound diagnostics, treatment tactics, re-habilitation therapy

The role of retinal microcirculation disorders in the progression of glaucomatous optic neuropathy

To assess the progression of primary open-angle glaucoma (POAG) and to study the role of retinal microcirculation in its progression. In this 2-year prospective study, the rate of POAG progression was determined using perimetry (ROP1) and spectral domain optical coherence tomography (SD-OCT) by thinning of retinal nerve fiber layer (RNFL) (ROP2) and ganglion cell complex (GCC) (ROP3). The vessel density of parafoveal superficial plexus (VD parafovea) and peripapillary retina (VD ppr) was assessed using OCT angiography, peripheral resistance index (RI), and blood flow velocity in the posterior short ciliary arteries (PSCA) and central retinal artery (CRA) with the use of color Doppler mapping. The predictive properties of each parameter were calculated using the area under receiver operating curve (AUC). Progression was detected in 9.8% cases by perimetry and in 19.7% cases by OCT. The combination of these two methods increased the detection up to 32.8%. Circulatory parameters - VD parafovea (AUC 0.70±0.07), VD ppr (0.715±0.07), PSCA RI (0.801±0.12), CRA RI (0.798±0.11) - had similar high predictive properties as IOP max (0.79±0.05), corneal hysteresis (0.755±0.07), thickness of inner parafoveal layers (0.728±0.07) and RNFL (0.692±0.06). The study revealed the following correlations: ROP1 with maximum IOP (p=0.01), ROP2 with blood flow velocity in PSCA (p=0.01), VD parafovea with corneal hysteresis (p=0.01), and GCC thickness with ocular perfusion pressure (p=0.01). The obtained data demonstrates the importance of combining perimetry with OCT for detecting the progression of glaucoma and indicates its relationship with reduced ocular hemoperfusion.

THE INFLUENCE OF THE HYDRAULIC EFFECT OF THE BLOOD DYNAMICS AT THE EXTRASYSTOLY ON THE MORPHOLOGY OF MAINSTREAM ARTERIES

The influence of various types of extrasystole on the change in arterial hemodynamics and the morphology of changes in the wall of the mainstream arterial vessels is not well understood. The purpose of the study was to determine the effects of water hammer on the hemodynamics of the main arteries in various types of extrasystoly. The study was conducted on 228 patients (122 men and 106 women) aged 43 to 76 years, the average age was 62 ± 4.3 years. For the analysis, the data apex-cardiography, daily monitoring by Holter, echocardiography, electrocardiography, sphygmography, color Doppler mapping of the vessels of the head and neck and extremities were compared. Water hammer of extrasystoles leads to mechanical damage to the endothelium of the arterial wall and serves as a trigger for inflammation and activation of the process of neolipogenesis, the formation of the atheroma. Additional hydraulic waves contribute to trauma to the vascular wall, growth and increase in area of atheromas. The described morphological changes in the vascular wall, the authors describe as «water hammer syndrome» and analyze its role and pathophysiological mechanisms of the development of vascular complications at extrasystoles and reconstructive operations on arterial vessels.

Ultrasonic diagnosis of soft tissue sarcomas using functional vascular test

The purpose of the research is to find additional diagnostic tools that allow you to specify the nature of soft tissue lesions, differentiate between benign and malignant processes this localization.Materials and methods. Using multiparametric echography surveyed 514 patients with malignant (243 or 55.7%) and benign (193 or 44.3%) tumor, as well as non-tumor (78 or 15.2%) diseases. In all cases, used while rendering, color Doppler mapping, power Doppler blood flow spectral characteristics of the studied zone changes. In 87 (16.9%) observations applied functional vascular test.The results. Calculation of indicators diagnostic informative at diagnostics of sarcomas in relation to complex high without the use of vascular test and when you post data showed an increase in using it specificity and diagnostic accuracy stability in the total sensitivity of the entire complex. Sensitivity respectively amounted to 92.7% and 92.7%, specificity – 87.1% and 98.9%, accuracy-84.8% and 91.1% (inclusion in consideration of inflammatory processes led to the authenticity of the results obtained).Conclusion. Vascular test improves diagnostic high informativeness of the complex, but it can be usefully applied to exclude non-tumorous changes and accounting possible differences in differentiation of different constituent parts neoplasm.

Impaired Choroidal Blood Flow in Adolescents with Essential Arterial Hypertension

Arterial hypertension is a problem not only for adults, but also for children, but there are very few data on changes in the organ of vision under the influence of an elevated level of blood pressure in children.The aim of the work is to identify disturbances of the choroidal blood flow in children and adolescents with essential arterial hypertension.Methods. Fifty patients with essential arterial hypertension were examined. The age of patients ranged from 10 to 17 years, the duration of the disease ranged from 2 months to 8 years. All patients underwent color Doppler mapping of the orbital vessels, registration of the oscillatory potentials of the ERG.Results. It was revealed that increased arterial pressure causes retinal and choroidal ischemia, which is accompanied primarily by impaired blood flow in the orbital vessels and is reflected in a decrease in the amplitude and deformation of the peaks of the ERG oscillatory potentials.Conclusion. Hypertension causes and supports retinal and choroidal ischemia, which is accompanied primarily by impaired blood flow in the orbital vessels, functional depression of photoreceptors, ganglion cells and neuroglia of the retina, aggravating the identified changes as the experience of essential hypertension increases. A marker of chorioretinal ischemia is amplitude depression, a change in the shape of the teeth of the oscillatory potentials of the ERG, which indicates a decrease in the functional activity of the retinal ganglion complex.That is, these changes can be considered as a predictor of hypertensive angioretinopathy in children and adolescents with essential arterial hypertension.

LASER PHOTO-DESTRUCTION OF PYOGENIC GRANULOMAS OF THE SKIN IN CHILDREN

Introduction. Pyogenic granuloma (PG), a benign vascular tumor of the skin of inflammatory etiology, is often met in children. Complications of this pathology (ulceration and bleeding) are seen in 7.5% of cases. Material and methods. 67 patients were operated on for pyogenic granulomas. 22 patients had bleedings. Before surgery, all patients had sonography with color Doppler mapping of this vascular formation. 57 children had a planned surgery and were operated under topical anesthesia in the outpatient unit. 10 patients on admission had bleedings from pyogenic granulomas. After conservative arresting the bleeding, 7 patients out of these 10 had urgent surgery; in other three children with severe bleeding hemostasis was not achieved conservatively, and they were immediately operated on. All urgent surgical interventions were made under local anesthesia in an outpatient operating room. Patients with emergency cases, were younger than 3 y.o. They were operated in the operation room in the hospital under general anesthesia. Pyogenic granulomas in all 67 patients were removed by the technique of interstitial selective laser photodestruction, the prototype of which was “Method for treating cavernous forms of hemangiomas in children” developed and patented in CRIEPST. For this surgical intervention, two-wave laser surgical device “IRE-Polyus” (Russia), with wavelength of 0.97 mkm and 1.56 mkm was used. Results. Postoperative period in all patients was uneventful, with complete healing of wound defect in 10-12 days; no recurrences of vascular formation or its residual elements were observed in any case. All 67 patients had good clinical and aesthetic results after the applied surgical technique. Conclusion. To prevent complications in children with pyogenic granulomas, surgical treatment with the technique of interstitial selective laser photodestruction adapted for this pathology is recommended. The described interstitial selective laser photodestruction radically removes pathological tissues of pyogenic granulomas and ensures reliable hemostasis, what leads to good clinical and aesthetic results in treating the discussed group of patients both in inpatient and outpatient settings.

Ultrasonography and fine-needle aspiration biopsy in the diagnosis of a cystic type of thyroid papillary cancer

Background: Cystic type of thyroid papillary carcinoma is a rare independent disease of this organ. Its prevalence among papillary carcinomas is from 2.5 to 6%.Aim: To identify ultrasonographic features of the cystic form of papillary carcinoma for the differential diagnosis of solitary liquid neoplasms of the thyroid and to elaborate an optimal technique for its fine-needle aspiration biopsy.Materials and methods: We retrospectively analyzed the data on the diagnosis and treatment of 29 patients with the cystic type of thyroid papillary carcinoma (26 women, 3 men, mean age 52 years). The instrumental diagnosis was based on a comprehensive ultrasonography and fine-needle aspiration biopsy.Results: We identified the following ultrasonographic characteristics of “potentially malignant” cystic nodules of the thyroid: the wall thickness of 2 to 3 mm with marginal tissue components of various size (from 10 mm to 3 cm in diameter) and microcalcinates; presence of focal blood supply by color Doppler mapping; homogeneity and low echogenicity of the liquid component. Conclusion: The right interpretation of the ultrasonographic results and adequately performed fine-needle aspiration biopsy help to verify the diagnosis of thyroid carcinoma and to avoid mistake in the treatment of this patient category.

Особливості патогенезу дисплазії грудних залоз без та на тлі генітальної патології у жінок перименопаузального віку

The objective: studying of aspects of pathogenesis of dysplasia of mammary glands without and a background of genital pathology at women of perimenopause age. Materials and methods. Еxamination of 100 patients of perimenopause age about the diagnosis of dysplasia of mammary glands was conducted. The group of comparison was made by 50 women. Along with the standard methods, physical and ultrasonic researches of mammary glands, dopplerografiya with color Doppler mapping of a blood flow in parenchyma arteries, hormonal research, on displays – an intraoperative biopsy and morphological techniques. Results. Research of levels of molecular and biological markers showed that for detection of proliferative activity in mammary glands at patients with dysplasia of mammary glands it is expedient to carry out dynamic quantitative definition and when rising more than for 20% of several markers, for example IL-6, sFas, IL-1 β, is the direct indication for carrying out biopsy with the subsequent cytologic research of the received material for diagnostics of proliferative phenotype. Conclusion. highlights of pathogenesis of dysplasia of mammary glands are clinical-anamnestic data, and also changes of a zytokines exchange and the main molecular and biological markers. The received results need to be used when developing complex of diagnostic and prognostic actions. Key words: dysplasia of mammary glands, pathogenesis, genital pathology, perimenopause age.

The Role of Diffusion-weighted MRI and Follow-up Contrast-enhanced MRI in Correlation with the Adnexa MR Scoring System in the Diagnosis of Uterine Appendage Tumors

The paper analyzes the data available in the foreign and Russian literature over the past 10 years on main radiodiagnostic techniques and approaches in case of ovarian space-occupying lesions, by using both ultrasonic color Doppler mapping and complex MRI approaches in combination with routine MRI, diffusion-weighted MRI studies, and follow-up contrast-enhanced MRI. It shows that only the comprehensive introduction of the above radiodiagnostic techniques can achieve the necessary sensitivity and specificity of diagnosis of ovarian tumors. The system for assessing the risk index for ovarian tumor malignancy is discussed, by taking into account the menopausal status, the tumor marker CA-125, and ultrasonographic findings. The paper presents the Adnexa MR scoring system based on the breast imaging-reporting and data system (BI-RADS) that gives schemes for calculating and analyzing the risk of ovarian tumor malignancy in terms of certain MR criteria.

Diagnostic facilities of methods of ultrasound diagnostics in urolithiasis in children

There are presented data of the integrated ultrasound (US) examination of 85 children with urolithiasis (IBC) at the age of from 3 months up to 17 years. In traditional ultrasound study (in gray scale mode), the main criterion for the presence of stone - distal acoustic «shadow» was evaluated in dependence on its intensity from 0 to 4 scores. When using color Doppler mapping (CDM) there was established the existence of flaring artifact (FA), which occurred in the reflection of the ultrasonic wave from the reflective stone structure. According to the density index (DI) the presence and density of calculus were detected with the use of Acoustic Structure Quantification (ASQ) methodology for quantifying the structure. The obtained data were compared with data of computed tomography (CT). It has been established that in case of the presence of the «shadow» accounted of 4 scores, FA has been clearly defined, DI ranged from 5,5 to 6,8, CT indices exceed 1100-1500 Hu. When the severity of the «shadow» was of 3 scores, FA remained to be intensive, DI was in the range of 3,5-5,5 and CT density ranged from 800 to 1100 Hu. «Shadow» at 2 scores came from the central department of calculus, FA spectrum corresponded to its width, DI ranged from 3,5 to 2,0 and CT radiodensity - 250 to 800 Hu. Weak «shadow» at 1 score corresponds to a low density stone, FA was narrow, DI ranged from 2,0 to 1,5. At 0 score DI was less than 0,9 and easily permitted ultrasound through. Established patterns indicate to the feasibility of the integrated use of ultrasonic methods in the evaluation of the density of the stone in preparing the patient for performing remote lithotripsy.

Prenatal ultrasound diagnosis of esophageal diverticulum in the III trimester of gestation

The article presents a clinical case of prenatal diagnosis of esophageal diverticulum. In the study of ultrasound anatomy of the fetus at 32 weeks of gestation in the posterior mediastinum the anechogenic formation of a round shape with smooth clear contours, size 9.6 7.2 9.0 mm, avascular in colour Doppler mapping was detected. Ultrasound examination of the fetus at 36 weeks of gestation revealed a connection between the esophageal and cystic formation. This connection appeared during the filling of the esophageal amniotic fluid, which allowed the diagnosis of esophageal diverticulum. At 39 weeks of gestation occurred a spontaneous birth. The boy was born in full-term with weigh 3480 g. The prenatal diagnosis was confirmed during postnatal examination. The child is under the supervision of a surgeon. Surgical treatment is planned at the age of 6 months. The article discusses issues related to differential prenatal diagnosis of cystic masses of the mediastinum, prognosis and potential complications of the diverticulum of esophagus.

ASSOCIATIONS OF IRS-1 POLYMORPHISM WITH VARIOUS COMPONENTS OF THE METABOLIC SYNDROME IN HYPERTENSIVE PATIENTS

The metabolic syndrome is one of the most discussed cross-disciplinary problems of modern medicine. Now there are various definitions and criteria of diagnostics of metabolic syndrome. The abdominal obesity is considered the main component of the metabolic syndrome, as a reflection of visceral obesity which degree is offered to be estimated on an indirect indicator – a waist circumference. Alongside with abdominal obesity, a number of classifications distinguish insulin resistance (IR) as a diagnostic criterion of metabolic syndrome. It is proved that IR is one of the pathophysiological mechanisms influencing the development and the course of arterial hypertension (AH), type 2 DM and obesity. There are two components in the development of IR: genetic (hereditary) and acquired. In spite of the fact that IR has the accurate genetic predisposition, exact genetic disorders of its appearance have not been identified yet, thus demonstrating its polygenic nature. To establish possible associations of the insulin receptor substrate-1 (IRS-1) gene polymorphism with the severity of the metabolic syndrome components in patients with arterial hypertension (AH). 187 patients with AH aged 45-55 years and 30 healthy individuals. Methods: anthropometry, reactive hyperemia, color Doppler mapping, biochemical blood analysis, HOMA-insulin resistance (IR), glucose tolerance test, enzyme immunoassay, molecular genetic method. Among hypertensive patients, 103 had abdominal obesity, 43 - type 2 diabetes, 131 - increased blood triglycerides, 19 - decreased high density lipoproteins, 59 - prediabetes (33 - fasting hyperglycemia and 26 - impaired glucose tolerance), 126 had IR. At the same time, hypertensive patients had the following distribution of IRS-1 genotypes: Gly/Gly - 47.9%, Gly/Arg - 42.2% and Arg/Arg - 10.7%, whereas in healthy individuals the distribution of genotypes was significantly different: Gly/Gly - 86.8% (p <0.01), Gly/ Arg - 9.9% (p <0.01) and Arg/Arg - 3.3% (p <0.05). Hypertensive patients with Arg/Arg and Gly/Arg genotypes had significantly higher HOMA-IR (p <0.01), glucose, insulin and triglycerides levels (p <0.05), than in Gly/Gly genotype. At the same time, body mass index, waist circumference, blood pressure, adiponectin, HDL, interleukin-6, C-reactive protein, degree of endothelium-dependent vasodilation, as well as the frequency of occurrence of impaired glucose tolerance did not significantly differ in IRS-1 genotypes. In hypertensive patients, the genetic polymorphism of IRS-1 gene is associated with such components of the metabolic syndrome as hypertriglyceridemia and fasting hyperglycemia; it is not associated with proinflammatory state, endothelial dysfunction, dysglycemia, an increase in waist circumference and decrease in HDL.

Age Features of Hemodynamic Parameters of Blood Flow Velocity of the Main Neck Arteries in Patients with Non-alcoholic Fatty Liver Disease and Overweight

The objective: the purpose is to determine the peculiarities of the influence of non-alcoholic fatty liver disease (NAFLD) / steatosis combined with overweight (OW) on the parameters of the blood flow velocity of the main neck arteries among different age groups.Materials and methods. A total number of 290 patients were examined. Blood velocity data were compared in 150 patients with NAFLD and overweight and blood flow rates of 140 patients with normal body weight (NBW) without liver disease. The patients were divided into four age groups (according to WHO criteria): 1st age group from 25 to 34 years old, 2nd age group – 35–44 years old, 3rd age group – 45 to 59 years old, 4th age group – 60 to 75 years old. The data of the blood flow velocity of the main neck arteries, obtained with a complex duplex examination (color Doppler mapping / CDM mode and Doppler examination), were analyzed.Results. The decrease of the rate of blood flow of the main neck arteries in the patients of all age groups was found compared to the control groups and the age difference between the groups was determined. A reliable correlation between OW and blood flow velocity (p&lt;0,05), TCIM and blood flow velocity (p &lt;0,05) was found in patients of the examined groups.Conclusions. Changes in the rate of blood flow to the main neck arteries, revealed during a complex duplex examination, are the result of the effect of NAFLD (steatosis) and OW with significant (p&lt;0,05) differences in all age groups.

Torsion of morgagni hydatid in «acute scrotum» syndrome

The results of operative treatment of 252 patients aged from 3 months to 20 years (mean age 9,9±2,9 years) hospitalized with acute pain in the scrotum were demonstrated. The structure of the causes of the «acute scrotum» syndrome: the torsion of Morgagni hydatid – 86,5%, acute orcho-epididymitis – 8,7%, testicular torsion – 4,4% and traumatic injuries of the testicle – 0,4%. Although the most informative diagnostic method in the syndrome of the «acute scrotum» is ultrasonography with color Doppler mapping, often the cause of acute pain in the scrotum can be established definitely only during the operation. Active surgical tactics can prevent trophic changes, testicular atrophy and, consequently, copulatory and reproductive disorders. In the long-term period – from 3 months to 1 year after the operation, 186 patients were examined. None of the patients showed atrophic changes in the testicle.

Эффективность комплексного подхода к лечению хронического простатита, в том числе у пациентов с доброкачественной гиперплазией предстательной железы

Concurrent chronic prostatitis (CP) plays an important role in the pathogenesis and progression of benign prostatic hyperplasia (BPH), increasing the severity of lower urinary tract symptoms (LUTS), lowering the quality of life, and increasing the risk of acute urinary retention. However, in the management of patients with BPH, the role of CP is not always taken into account. To evaluate the effectiveness of integrated management of patients with CP and patients with co-occurring BPH and CP using a physiotherapeutic device Mavit for the treatment of inflammatory diseases of the prostate. Clinical effectiveness of integrated therapy using the Mavit device was studied in 45 patients with CP. The first group (BPH + CP) comprised 25 patients, who were diagnosed with stage I-II BPH co-occurring with CP. The group of CP included 20 patients with an established diagnosis of CP. Clinical outcomes were followed for 12 months after treatment. In 10 CP patients, the tissue effect of the Mavit device on the prostate blood circulation was assessed before and after the physiotherapy session using transrectal ultrasound in the color Doppler mapping mode. We studied the linear peak blood flow velocity, index of peripheral vascular resistance, and vascular density pattern. Clinical outcomes were followed for 3 to 12 months. All patients reported an improvement in dysuria and voiding, a reduction in pain in the genital area. Voiding function improvements were confirmed by IPSS, uroflowmetry, and postvoid residual urine volume. Transrectal color Doppler ultrasound mapping showed positive changes in the prostate microcirculation. In 7 patients, the treatment results were followed for 4 to 9 years. During the entire period of observation, the level of prostate-specific antigen remained below 1.75 ng/ml, which indicates the safety of this method in patients with BPH. In patients with symptomatic BPH with concomitant CP in the conservative stage of the disease, integrated treatment of CP using physiotherapeutic modalities has pathogenetic significance. It significantly reduces the LUTS secondary to BPH, improves IPSS, QoL, urinary flow rate, postvoid residual urine volume. The findings allow us to recommend the Mavit device for the treatment of CP, including in patients with I-II stage BPH.

Choroidal melanoma, simulating an optic nerve tumor: a clinical case

Choroidal melanoma is a primary malignant intraocular tumor with unfavorable vital prognosis. Factors predisposing to invasion of choroidal melanoma into the optic nerve include its juxtapapillary localization, the large tumor size, its diffuse growth, the presence of necrosis in the tumor, increased intraocular pressure and the epithelioid cell type of the tumor. The authors describe the clinical case of a 31-year-old patient with a primary diagnosis of an optic nerve neoplasm. Peripapillary edema and indistinct optic disc margins were found by ophthalmoscopy. There was a slightly protruding gray-slate lesion with indistinct boundaries near the optic nerve disc. The retina was edematous with multiple merging hemorrhages. The data obtained by echography (the focus protruding both inside the eye and along the optic nerve trunk), color Doppler mapping (single own vessels in the projection of the orbital part of the mass) and computed tomography allowed for the suspicion of the primary choroidal melanoma. To clarify the nature of the process, a trans-conjunctival orbitotomy with a revision of the orbit and the optic nerve was performed. The expansion of the proximal part of the optic nerve with partial breakthrough of the optic nerve shells was revealed intraoperatively. The patient underwent enucleation with morphological and molecular genetic verification of the primary choroidal melanoma with invasion of the optic nerve. The data obtained (absence of chromosome 3 monosomy, deletion of the short arm of chromosome 1, methylation of promoter regions of the RASSF1A gene, mutations in the 4 and 5 exons of the GNAQ gene, CT genotype of the polymorphic marker C3435T of the ABCB1 gene) indicate a relatively favorable vital prognosis, despite the extrascleral growth of the tumor and its mixed cell type. The patient underwent a course of anti-relapse proton irradiation of the orbit with a total dose of 58.8 Gy at 80–90% isodose. Currently, 7 years after the treatment, the patient continues to be followed up by ophthalmologists and oncologists, without any signs of local recurrence and distant metastases. This clinical example demonstrates the possibility of extraocular extension of a small intraocular choroidal melanoma simulating an optic nerve tumor, and confirms the need for a thorough clinical and instrumental examination for a correct diagnosis and adequate management of the patient.

Normal variants of ductus venosus spectral Doppler flow patterns in normal pregnancies

Objectives: Ductus venosus (DV) Doppler examinations in pregnancy have a widespread use for several important indications and play a crucial role in order to determine the fetal well-being. DV is usually visualized by the color Doppler mapping. We observed the instantaneous spectral flow type changes in pulsed Doppler examinations in spite of performing with the correct technique published by several authors. The variability of the pattern makes the sonographer/physician to be unsure for the correct placements of the sample gate despite fulfilling the all the criteria required for the vessel sampling. It is aimed in the study to define variations of the normal DV spectral flow types in the duration of the pulsed Doppler examinations instead of in a single cardiac cycle in normal pregnancies.Methods: This prospective study was conducted between January 2016 and February 2017. Wide-band Doppler technique was used for color mapping of the DV. Normal spectral Doppler waveforms in pregnancies are classified as types. When DV spectral flow pattern was not in the standard type, the spectral flow patterns were obtained from not only the umbilical artery and/or middle cerebral artery. Maximum and minimum blood flow velocities in the umbilical vein are measured. All Doppler examinations are performed by a single experienced specialist (CG), who had been certificated for DV flow and Doppler examinations by the Fetal Medicine Foundation.Results: A total of seven types of flow patterns were recorded during the study period and DV flow patterns were divided into two main categories as classic flow pattern and the other patterns. The classic pattern was observed in 160 (99.4%) cases in the first trimester, 495 (94.1%) cases in the second trimester and 206 (60.8%) cases in the third trimester.Conclusions: We think that the fetal circulation is complicated more than estimated. There might be some endocrine agents released in the instantaneous physiologic reactions and changing the venous return abruptly or due to decreasing of the cardiac output directed to the placenta after 34 weeks influence the volume of the circulating blood in the fetus and so thereby the flow velocities instantaneously. The spectral waveform recognition approach is not reliable to identify if the DV spectral Doppler pattern is not the classic (standard) type and the DV should be visualized by wide-band color Doppler techniques particularly in the third trimester for the pulsed Doppler examinations. Studies are needed to evaluate the normal spectral variants of the flows correlated with the physiological compensatory mechanisms.

Анатомо-функціональний стан органів малого таза у жінок зі зниженою відповіддю на стимуляцію яєчників

The objective: study of the anatomical and functional status of the uterus and ovaries in poor responders in ART programs. Materials and methods. Determination of the anatomical features and functional status of the uterus and ovaries in «poor responders» to exclude a clinically significant pathology that would affect the success of the ART program was performed by ultrasound scanning with the study of topografts, sizes, contours, echostructure of the uterus and ovary and determination of the volume of the ovaries and the number of antral follicles. Blood flow in the vessels of the stroma of the ovaries, as one of the important criteria for assessing the possible ovarian response, was assessed using color Doppler mapping. Results. «Poor responders» patients have a smaller sise of ovaries and a reduced number of antral folicles, which can be explained by the surgical interventions carried out according to the type of ovarian resection and the cysts removal. In addition, during the transition from the follicular to luteal phase, there is no decrease in the vascular resistance of the dominant follicle, which slows the process of ovulation and reduces the likelihood of fertilization in conditions of increased vascular resistance. Conclusion. Ultrasound examination of the uterus and ovaries and doplerometric investigation of peryfollicular blood flow allows us to thoroughly approach both the evaluation of the ovarian response and the endometric readiness for implantation, which dictates the need for an individual selection of preconceptional preparation and treatment programs for ART. Key words: anatomical and functional state, pelvic organs, ovarian reserve, peryfollicular blood flow, poor responders.

MODERN CAPABILITIES OF ULTRASOUND VISUALIZATION OF ABDOMINAL WALL HERNIAS

Abdominal wall hernias are the common pathology in modern clinical practice. Clinical data sometimes make the correct diagnosis not possible what requires the timely specific and targeted ultrasound examination. Aims of research. Revealing the capabilities of ultrasound examination at the assumption of abdominal wall hernias. Materials and methods. Within four years the ultrasound examination of 88 patients was carried out who suffered from different abdominal wall hernia, with the use of standard procedure of ultrasound examination and specific tests for evaluation of the condition of hernia’s content. The ultrasound scanning procedure was performed using B-mode and Color Doppler mapping mode. The majority of patients hereafter underwent the planned or emergency surgical treatment and subsequent ultrasound dynamic control. Results. The ultrasound examination gave the opportunity to reveal hernias in all the patients examined. Standards of morphometry, conditions of successful diagnosis and criterions of differential diagnosis signs of abdominal wall hernias have been detected. Criterions of differentiation of non-complicated and complicated hernias were concretized Conclusions. Ultrasound examination is a highly informative method for search, diagnosis and differential diagnosis of abdominal wall hernias. The targeted search of specific ultrasound signs allows making a correct diagnosis what has a great value for the timing of beginning of the adequate treatment.