Diagnostic Specialist Research Articles

Diagnosis and features of the treatment algorithm of non-lactational chronic mastitis on the example of a clinical case

Inflammatory processes in the mammary gland (MG) do not lose their relevance, the frequency of occurrence reaches 16% among all diseases of the MG. Non-lactational mastitis (NM) – inflammation in the MG outside the period of pregnancy and lactation – stands out among them [1]. With untimely and non-radical treatment of acute forms, there is a transition to chronic, with the formation of bacterial biofilm in the focus of inflammation and thick scar capsule after repeated surgical interventions, which is due to a vicious circle. The clinical picture of non-lactational chronic mastitis in most cases resembles a diffuse (mastitis-like, edematous-infiltrative) form of breast cancer (BC), which determines the differential-diagnostic difficulties in referring to a doctor both at initial treatment and at recurrence. This problem is faced by doctors of different specialties: oncologists, surgeons, gynecologists, therapists, specialists in radiation and radiological diagnostics [2, 3]. Radiation diagnostics is always the «gold standard» in the diagnosis of breast diseases, but has a number of disadvantages in the inflammatory process in the breast, and, in some cases, it is worth prioritizing the ultrasound method of investigation [4]. Through the combined interpretation of clinical data and ultrasound (USG) findings, the following parameters should be evaluated: skin thickness, pre-mammary fatty tissue, structure of glandular parenchyma of the MJ, presence and boundaries of inflammatory infiltrate/infiltrates in the MJ tissue; formation of «rarefaction» zones, microabscesses and/or already formed «draining» abscess cavities, assess the content of fluid cavities (homogeneity/homogeneity), the presence of pyogenic capsule, as well as the boundaries of inflammation/abscessing with unchanged breast tissue, taking into account possible «microfoci» outside the main mass of changes (like «satellites», «fluid spurs»). It is important to analyze the state of the ductal system of the breast (ductal diameter dilation, intraluminal content) and possible connection of ducts with abscessed areas, which may be a predictor of further spread of the process, recurrence or chronicization of the disease. Inflammation on the background of subacute and chronic process can lead to the development of fistulas [5]. However, there is not always the classic ultrasound picture of a purulent focus in the breast [6–9].

Training and Sustaining: Training and Learning Collaborative Outcomes Across a Statewide Network for Early Autism Diagnosis.

The objective of this study was to describe the development of a primary care professional (PCP) autism diagnosis training model and to report on outcomes related to PCP training and sustained engagement in a longitudinal learning collaborative. We developed Accelerating the Diagnosis of Autism with Primary care Training (ADAPT), a training program to prepare PCPs to develop independent competency in evaluation of autism in children aged 14 to 48 months. ADAPT includes didactic and case-based modules and practice-based coaching delivered by an expert diagnostic specialist; after training, PCPs participate in a longitudinal learning collaborative. Aligned with competency-based medical education standards, measures of autism evaluation knowledge and diagnostic competency are collected. From 2021 to 2023, 13 PCPs completed ADAPT didactic and practicum training to reach competency in independent autism evaluation. Clinicians demonstrated significant improvement in total autism knowledge after didactic training (p = 0.02). Scoring agreement on an autism observational assessment tool between clinicians and expert diagnosticians improved over case observations and practicum evaluations. Similarly, PCPs demonstrated improved evaluation competence, moving on average from Advanced Beginner to Competent Performer as rated by expert diagnosticians. After training, PCPs attended 57% of monthly learning collaborative sessions. Training PCPs to deliver autism evaluations for young children as part of tiered community-based models of care is a promising solution to address access and waitlist challenges. ADAPT is an intensive, standardized PCP training model that results in achievement of independent competency and sustained engagement in autism evaluation. Effectiveness-implementation studies are needed to ensure scalability and sustainability of training models.

MICROWAVE AIDED SYNTHESIS OF ZINC OXIDE NANOCERAMICS: A POTENT BIOACTIVE AGENTS WITH THERAPEUTIC CHARACTERS

Nanoparticles have been inexhaustibly utilized in Nanochemistry cohere with Bio-Technology to upgrade the immobilization and movement of catalysts in pharmaceutical nanoengineering for conveyance of helpful specialists in incessant illness diagnostics and in sensors.Herein communication we report microwave irradiation technique implemented for the preparation of novel Zinc oxide nanoparticles with beneficial bio-efficacy wherein the method employed has the advantages of producing small particle size metal oxide with high purity owing to short reaction time. We successfully synthesized and characterized two Zinc oxide based Cs2 doped ZnO2 and Li2 doped ZnO2 nanoparticles and were subjected to in vitro free radical scavenging assay wherein all the particles could scavenge DPPH and Nitric oxide radicals with less IC50 value over the positive control. Microbicidal properties of nanoparticles were proved by its effectiveness against both Gram positive and Gram negative bacteria tested besides its action against Candida albicans. Both nanoparticles synthesized showed a prominent inhibition of erythrocyte lysis by PhospholipaseA2 in a concentration dependent manner indicating better anti-inflammatory agent with possibility of preventing cancer. In this study we demonstrate by shell less CAM assay that synthesized nanoparticles could inhibit in vivo angiogenesis which would otherwise under abnormal conditions causes the acceleration of several inflammatory diseases in spite of its role in normal growth and wound healing process. Inhibition of such process is the promising methodology to hinder the progression of diseases. Present characteristic features make use of ZnO2 based doped nanoparticles to be a possible approach as a therapeutic molecule with favourable biological performance.

Comprehensive Assessment of Health Impacts from Exposure to Nonionizing Radiation for Healthcare Practitioners Working with MRI and Ultrasound

Background. It is necessary to monitor the health disorders of healthcare practitioners exposed to a complex of occupational hazards to optimize their activities and substantiation of preventive health measures. The purpose of the study was the hygienic assessment of occupational hazards, analysis of data on self-assessment of the state of health (SASH questionnaire) among healthcare practitioners (MRI diagnostics specialists, ultrasound diagnostics specialists, and ophthalmologists, as a control group) exposed to nonionizing radiation, ultrasound, and noise. Materials and Methods. An analysis of hygienic parameters of the working environment (workplace) and questionnaire data of healthcare practitioners were carried out. The number of illnesses and absences from work, the level of quality of life, the level of depression, and the self-assessment of the state of health were evaluated according to the questionnaire. Results. An analysis of workloads made it possible to rank the severity and intensity of labor. Health disorders (according to the self-assessment of the state of health), the number of absences from work due to illness, an increase in complaints and level of depression, and a decrease in the level of quality of life were corresponded to the severity of labor. It was revealed that healthcare practitioners were exposed to a number of hazards during their work (above the threshold limit value (TLV)), which caused an increase in health disorders. Conclusions. During the organization of workplace ergonomics and implementation of preventive measures directed to maintaining health and early diagnosis of diseases, one should take into account the hygienic indicators of the working environment that exceed TLV, the results of self-assessment of the state of health (complaints) and morbidity of healthcare practitioners, the level of quality of life and the level of depression.

143 Training & Sustaining: Training and learning collaborative outcomes across a statewide network for early diagnosis of children with autism

OBJECTIVES/GOALS: Community-based primary care autism diagnostic models are one promising solution to delays in autism diagnosis. Our objective is to describe the development and report on outcomes related to primary care professional (PCP) training and sustained engagement in a longitudinal learning collaborative across a statewide network for autism diagnosis. METHODS/STUDY POPULATION: We developed ADAPT (i.e., Accelerating the Diagnosis of Autism with Primary care Training), a training program to prepare PCPs to develop independent competency in evaluation of autism in children ages 14-48 months. ADAPT includes didactic and case-based modules and expert practice-based coaching delivered by a diagnostic specialist; following training PCPs participate in a longitudinal learning collaborative. Aligned with competency-based medical education standards, measures of autism evaluation knowledge and diagnostic competency are collected. RESULTS/ANTICIPATED RESULTS: To date, 13 PCPs have completed ADAPT didactic and practicum training reaching competency in independent autism evaluation. Clinicians demonstrated significant improvement in total autism knowledge following didactic training (p=.02). There was an overall trend toward increased scoring agreement on an autism observational assessment over case observations and practicum evaluations. Similarly, PCPs demonstrated improved evaluation competence, moving on average from Advanced Beginner to Competent Performer as rated by expert trainers. Following training, PCPs attended 57% of monthly learning collaborative sessions. DISCUSSION/SIGNIFICANCE: Training PCPs to deliver autism evaluations as part of community-based models of care is a promising solution to address access and waitlist challenges. ADAPT is an intensive, standard PCP training model which results in achievement of independent competency and sustained engagement in in autism evaluation.

Electrical Instability of the Myocardium in Children and Adolescents

Currently, there is no doubt that the problem of electrical instability of the myocardium in pediatric cardiology is relevant. The determination of various indicators of electrical instability of the myocardium, which are predictors of life-threatening rhythm disorders and sudden cardiac death, presents an underdeveloped task not only for functional diagnostics specialists, but also for pediatricians, neonatologists, pediatric cardiologists and doctors of other specialties. Non-invasive research methods such as electrocardiography (ECG), Holter ECG monitoring (HM ECG), available in almost all pediatric treatment and prevention institutions, are quite informative in terms of detecting electrophysiological heterogeneity of the myocardium as a predictor of sudden cardiac death, which is especially important in children at risk, as well as young athletes. Thus, the determination of indicators of electrical instability of the myocardium is of great interest, it is a promising direction in modern clinical practice, allowing to predict the risk of developing fatal arrhythmias in children and adolescents.

MEDICAL AND PSYCHOLOGICAL PORTRAIT OF PATIENTS DISSATISFIED WITH THE LEVEL OF DIAGNOSTIC RADIOLOGICAL CARE DURING THE COVID-19 PANDEMIC

The study aims to form a medical and psychological portrait of patients who are dissatisfied with the level of diagnostic radiological care during the COVID-19 pandemic, based on the study of their opinion on the quality of work of radiological diagnostics services in medical institutions of Lviv city and region.
 Material and Methods. The study involved a sociological survey using the questionnaire method of 409 patients who applied for medical radiological diagnostics to medical institutions of Lviv city and region in 2023. According to the results of the survey, 2 focus groups were distinguished: group 1, "Dissatisfied" - 26 patients (6.36%), who expressed a certain level of dissatisfaction with the services received during the COVID-19 pandemic, group 2, "Satisfied" - 383 patients (93, 64%), who were generally satisfied with the services provided in the same period.
 Results and Discussion. Based on the obtained data, certain psychological and medical features characteristic of individuals who were dissatisfied with the quality of medical diagnosis during the COVID-19 pandemic were identified, and their medical and psychological portrait was formed. Specifically, it is an individual who has already had an unsuccessful experience of visiting state health care facilities in the past, applies for a medical examination for work/study, mainly for the diagnosis of respiratory system organs, and is dissatisfied with the long waiting period until the appointed day of the examination and the long live queue for the examination, considers the attitude of the physician or another employee as unkind, is dissatisfied with the work of the diagnostic specialist and the opportunity to freely ask the physician the necessary questions, is dissatisfied with the low quality of medical equipment and cleanliness and comfort in the physician's office or the department.
 Conclusions. The obtained data on the characteristic features of individuals who were not satisfied with the medical care provided during the COVID-19 pandemic will be important in improving the work of the radiation diagnostics service.

Traditional medicine of three regions of Russia and the use of information technologies to investigate it

The paper presents experience of investigating the traditional medicine for the three regions of Russia – Buryatia, Kalmykia and Tuva — that has been kind of folk tradition here for centuries. This is Tibetan medicine that is the cultural and historical heir of the Indian medical tradition using some elements of the Chinese medicine. The paper gives information on the problem of objectifying and automating the Tibetan diagnostic methods (inspection, palpation, questioning) using information technologies. This research has been carried out in two directions: objectification and automation of pulse diagnostics by the development of the Computer Pulse Diagnostic System and the development of the Expert Diagnostic System for questioning and inspection of a patient. On the basis of the assessments of the experts (specialists in pulse diagnostics) and mathematically detected diagnostic signs of pulse waves, statistical models of normal and pathological pulses (pulses of «hot» and «cold» diseases) have been developed. A catalogue of pulses is being compiled. This catalogue consists of classes of computer recorded pulse signals that correspond to Tibetan nosology. The expanded and differentiated catalog of pulses and the pulse wave pattern recognition program designed to compare measured pulses and reference pulses will make the basis for combining the diagnostic results by three diagnostic methods, which will lead to the creation of an Integral Computer Diagnostic System designed for diagnosing diseases and providing recommendations for health correction in accordance with the traditions of Tibetan medicine.

Возможности лучевых методов диагностики связочно-суставного аппарата коленного сустава в современных условиях

Relevance. This article is devoted to a review of current radiation methods for visualizing pathologies of the structures of the knee joint, which represent a topical problem in modern clinical practice and require close attention and in-depth study. The range of medical treatment depends entirely on the rational and necessary use of radiation imaging methods and the competence of diagnostic specialists. Objective of the review. Based on an analysis of the literature, to assess the current state of the problem and the effectiveness of the used radiation methods for diagnosing damage to the ligamentous-articular structure of the knee. Material and methods. The search was conducted in the open electronic scientific databases PubMed of the US National Electronic Medical Library and the databases of the Russian scientific electronic library e-library using keywords and phrases: radiodiagnosis, knee joint injury, standard radiography, computed tomography, magnetic resonance imaging, arthrography . Review results. In order to make an early diagnosis through radiation methods and provide the necessary assistance, standard radiography, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound are used. Contrast x-ray arthrography, computed tomographic arthrography (CT arthrography) and magnetic resonance arthrography (MR arthrography) are also relevant methods for detecting knee joint injuries. One of the most commonly used primary methods of radiological imaging of pathologies of large joints is standard radiography in two projections. However, it is not possible to assess damage within the anatomical structures of the soft tissues and ligaments of the knee joint due to the low sensitivity of this method. The use of computed tomography in most cases is an additional way to clarify the correctness of the intended diagnosis and is of a secondary nature. Magnetic resonance imaging is the method of choice for pathologies of both intra-articular and extra-articular structures of the knee. The advantages of magnetic resonance imaging include the safety and non-invasiveness of the study, the absence of ionizing radiation and high diagnostic value. The most promising and informative invasive radiation techniques for diagnosing knee joint pathologies using paramagnetic contrast agents in clinical practice are CT arthrography and MR arthrography. Conclusion. Each radiation imaging method has its own advantages and it is important to individually determine the need for the use of diagnostic tools for certain clinical cases. Also, in order to early identify pathological conditions of the knee joint structures and carry out the necessary surgical or therapeutic manipulations, it is necessary to use an integrated approach to diagnostic measures

Stiffness, elasticity, resilience, density as clinical interpretation of physical properties of liver tissue

Objective. Evaluation of a single vector of ultrasound assessment of changes in the liver parenchyma, taking into account the correct use of such physical concepts as stiffness, elasticity, elasticity, density.Material and methods. On the basis of the Problem Research Laboratory ‘Diagnostic Research and Minimally Invasive Technologies’ a study was conducted with the participation of 112 patients of a multidisciplinary hospital. Multiparametric ultrasound examination (B-mode, quantitative liver steatometry, 2D shear wave elastography, complex format ‘liver protocol’) was performed by ultrasound doctors (n = 24) of the following groups: half-a-year residents in the specialty ‘ultrasound diagnostics’ (n = 9; 37.6%), doctors working in a multidisciplinary hospital of a medical organization of the regional center with work experience up to 5 years (n = 4; 16.6%), 6–10 years (n = 4; 16.6%), 11–20 years old (n = 3; 12.6%), 21 years or more (n = 4; 16.6%), of which 1 (4.2%) professor, 1 (4.2%) doctor of medical sciences, 3 (12.5%) candidates of medical sciences. An analysis of the protocols of ultrasound examination was carried out.Results. The correct description of changes in the liver according to B-mode data, quantitative steatometry, 2D shear wave elastography and ‘liver protocol’ correct formulations were given by 9 (37.5%) specialists. In all cases, most of the correct protocols were provided by doctors from groups of 6–10 years of experience and 21 years of experience or more.Conclusions. In the community of specialists in ultrasound diagnostics there is no agreement on a correct and unified approach to the description of diffuse liver changes using multiparametric ultrasound. To increase the level of knowledge, complex multidisciplinary interaction is necessary in the format of scientific and educational programs organized jointly with specialists in the field of medical physics.

Updated national guidelines for spirometry. Part 1. Test rules and quality criterias

Improved approaches to quality assurance have led to the need to update the technical standards of spirometry taking into account modern technical capabilities. The aim of the study is to present updated recommendations on spirometry with explanations and additions that are important for everyday work in practical healthcare. Analysis of documents on technical standards of spirometry developed by an joint task force of specialists with expertise in conducting and analyzing lung function tests and ensuring laboratory quality, appointed by the Russian Respiratory Society, the Russian Association of Functional Diagnostics Specialists, the Russian Scientific Medical Society of Therapists, as well as a joint group of the American Thoracic Society and the European Respiratory Society. The 1st part presents sections on indications and contraindications to spirometry; technical conditions of the procedure, including infection control; methods of spirometry; describes the main indicators and criteria for the quality of the study. The implementation of the presented standards and consensus recommendations for clinicians, operators and researchers is necessary for improving the accuracy of spirometric measurements and the patient experience.

Atrial septal defect. Clinical guidelines 2023

Association of Cardiovascular Surgeons of Russia Russian Society of Cardiology (RSC)Association of Pediatric Cardiologists of RussiaRussian Scientific Society of Specialists in X-Ray Endovascular Diagnostics and TreatmentAll-Russian Public Organization for the Promotion of Radiation Diagnostics and Therapy "Russian Society of Radiologists and Radiologists".Task Force members declared no financial support/conflicts of interest. If conflicts of interest were reported, the member(s) of the working group was (were) excluded from the discussion of the sections related to the area of conflict of interest.

Diagnostic challenges of heart failure with preserved ejection fraction: focus on echocardiography

Aim. To assess the features of diagnosing heart failure with preserved ejection fraction (HFpEF) using echocardiographic markers and diastolic stress test (DST) according to a survey of ultrasound and functional diagnostics specialists in the Russian Federation.Materials and methods. As part of the study, an anonymous survey of 155 ultrasound and functional diagnostic specialists from various Russian regions was conducted. We proposed to answer whether they routinely assess certain echocardiographic parameters necessary for diagnosing HFpEF. The specialists also indicated whether they conduct DST and whether they have the opportunity to refer the patient to this study.Results. A frequency analysis of the responses received was carried out. In routine practice, 83,2% of specialists measure the left ventricular (LV) ejection fraction by Simpson method, 76,1% — by Teichholz method. In addition, 80% of responders analyses LV mass index, 76,1% — relative LV wall thickness, 60% — tricuspid annular plane systolic excursion, 56,8% — left atrial volume index, 51.6% — E/e´ ratio, 94,8% — pulmonary artery systolic pressure, left ventricular global longitudinal strain — 16,1%, 7,7% — left atrial longitudinal strain. Also, 9,7% of specialists conduct DST on their own, while 41,3% have the opportunity to refer patients.Conclusion. The low assessment rate of some ultrasonic HFpEF mar­kers and DST among functional diagnostics specialists in the Russian Federation reduces the detection rate of HFpEF. It is necessary to develop diagnostic algorithms based mainly on clinical and anam­nestic data and available for use by doctors of any specialty.

Morphology of the bifid xiphoid process or foramen: is there a difference in cadaver or imaging?

Context: Anatomical variations of the sternum are frequent, in particular, the occurrence of foramina and divisions of the xiphoid process. The authors have used means of investigation ranging from dissection to imaging tests to detect these variations. Objective: To report a case of bifid xiphoid process in a male human fetus and/or xiphoid foramen through macroscopic analysis, complemented by the use of X-ray image. Case report: Anatomical variations were found at the level of the xiphoid appendix of the sternum such as a bifid formation of the appendix and a foramen found on X-ray imaging, located in the middle of a fibrous tissue that separated the two divisions of the xiphoid process. Conclusion: The present findings point to the need for greater collaboration in the use of other methods for studying the anatomical variations of the sternum. For example, Multidetector Computed Tomography (MDCT). This will be of great value to anatomists and specialists in imaging diagnostics.

CLINICAL CASE OF THROMBOCYTOPATHY DIAGNOSIS WITH THROMBOCYTOPENIA

The article is devoted to the description of a clinical case of thrombocytopathy with thrombocytopenia in patient K., who was admitted to the N. N. Burdenko State Medical Hospital to find out the cause of spontaneous multiple hematomas. Due to the complexity of the diagnosis of this condition, we used a wide range of different hematological, biochemical, immunological, and genetic studies. We present this case as an illustration of the difficulties of finding and algorithmizing diagnostics for thrombocytopathies, in accordance with modern classification and the need for the participation of a large number of specialists in clinical laboratory diagnostics. The article provides various laboratory diagnostic methods and their interpretation, as well as focuses on those laboratory tests that allow us to understand the presence of functional disorders and answer questions about where these manifestations of this pathology could be suspected at the initial stages. For diagnosis, methods of hematological, biochemical studies, morphology studies, aggregatogram and flow cytometry data were consistently used to assess the functional properties of platelets, attempts were made to use molecular genetic studies. The absence of molecular genetic markers for this form of thrombocytopathy complicates the final diagnosis, however, it allows us to focus on other methods for diagnosing the functional properties of platelets. The functional properties of platelets in this patient were reduced, which is reflected in a decrease in platelet function when activated with collagen and adrenaline, while the presence of disaggregation is noted when using thrombin and ADP as agents. Flow cytometry of the blood sample of this patient revealed reduced levels of antibodies to activated integrin aIIbß3, P-Selectin alpha granules (CD62p), the amount and volume of secretion of dense granules according to mepacrin, the proportion of procoagulant platelets according to annexin V, which undoubtedly allows us to characterize the functional properties of platelets. This work shows the importance of using modern hematological techniques, which makes it possible to suspect this pathology in mid-level laboratory units and promptly direct the thoughts of clinicians to search for and analyze thrombocytopenia, and in joint consultation with a hematologist, suggest discussing thrombocytopenia together with thrombocytopathy.

Educational video for training specialists in clinical laboratory diagnostics.

The adaptation of educational programs under restrictions during the SARS-CoV-2 coronavirus pandemic and after it is based not only on the widespread use of video lectures, but also on the introduction of a number of new educational technologies. Hybrid learning will become the cornerstone of future educational technologies in clinical laboratory diagnostics and will contribute to the creation of virtual practical classes with examples of analysis of laboratory testing results based on case histories (Case Technologies). The key aspect in the implementation of video cases into the educational process is the development of video materials. The use of educational video cases developed by Vector-Best in the process of training specialists in clinical laboratory diagnostics during the cycles «Retraining» and «General Improvement» at the Department of Clinical Laboratory Diagnostics of the Saratov State Medical University named after V. I. Razumovsky of the Ministry of Health of Russia was a convenient format and received positive assessment of cadets. Currently, the «IVD gallery» section has appeared on the FLM website and the placement of an additional educational resource - a library of educational video cases.

Опухоль Вильмса у ребенка раннего возраста: патогенетические аспек-ты, вопросы своевременной диагностики

The article deals with the issues of childhood oncopathology. Based on the literature data, the structure of oncological diseases in children in the Russian Federation and in the Novgorod region has been analyzed. It is shown that due to the rarity of oncological diseases in childhood, their detectability in outpatients in clinics requires active study with pediatricians by increasing staff awareness of this group of diseases and developing doctors’ oncological alertness skill in routine work. The article highlights the mechanisms of pathogenesis of a rare malignant embryonic neoplasm of the kidney — nephroblastoma(Wilms tumor), describes the clinical symptoms. The authors' own observation of an infant with a diagnosis of Wilms tumor is given. Conclusions were obtained about the course of the disease, the timing of the manifestation of the clinical picture. The observation demonstrates the relevance of timely screening ultrasound examination of the abdominal cavity and kidneys for children of the first year of life, the need to increase the level of knowledge in pediatric oncology of pediatricians of outpatient clinics, ultrasound diagnostics specialists, since timely diagnosis and early treatment significantly increase the likelihood of achieving remission of malignant diseases in children.

Doppler twinkling artifact: physical mechanisms and place in diagnostic practice. State of the art

The twinkling artifact has been known to specialists in ultrasound diagnostics since 1996. However, until now there is no understanding of the reasons for its appearance, and the place of its application in diagnostics.Material and methods. Electronic databases (PubMed, E-library, Web of Science) were searched studies using the keyword – “twinkling artifact”. The scientific publications on the Doppler twinkling artifact from the moment of the first reports about its existence is systematized and analyzed. The authors' own developments on this topic are presented. Modern views on this phenomenon and its place in ultrasound diagnostics are described. An explanation of the physical mechanisms of this phenomenon is given.Results. Recommendations are formulated for practitioners on changing the settings of an ultrasound scanner in order to increase twinkling artifact detectability. The directions of using the artifact to obtain additional diagnostic signs of pathological changes, which currently include the diagnosis of nephro-, uretero- and choledocholithiasis, are determined.Conclusions. The high efficiency of the use of the twinkling artifact for the diagnosis of small kidney stones, comparable with the capabilities of computed tomography, has been shown.

Розрив рудиментарного рогу матки під час вагітності: опис клінічного випадку

в статті описано клінічний випадок розриву рудиментарного рогу матки під час вагітності. Труднощі своєчасної діагностики вагітності в рудиментарному розі матки можуть обумовлювати ургентне оперативне втручання з приводу розриву рогу матки та антенатальної загибелі плода, збільшення частоти акушерських кровотеч, геморагічного шоку та збільшення частоти гемотрансфузій. Метою даного дослідження було продемонструвати варіант розвитку повторної вагітності при однорогій матці з контралатеральним рудиментарним рогом. Матеріалами дослідження слугували дані медичної карти стаціонарної хворої, що включали анамнестичні дані, результати лабораторних та інструментальних досліджень, протокол операцій та епікриз. Вагітна в терміні 16 тижні поступила до приймального відділення міського пологового будинку у 2020 році у вкрай важкому стані з ознаками гострої внутрішньочеревної кровотечі. Враховуючи тяжкий стан пацієнтки, була виконана ургентна нижньосерединна лапаротомія з ревізією черевної порожнини. Під час операції була виявлена аномалія розвитку матки - однорога матка з контралатеральним рудиментарним рогом, не з’єднаним з порожниною матки та з ознаками перерваної вагітності внаслідок розриву рогу. Тактика оперативного лікування включала відсічення рудиментарного рогу, повний гемостаз, санацією та дренування черевної порожнини. Паралельно проводилась інтенсивна терапія: трансфузія свіжозамороженої плазми та еритроцитарної маси. Аналіз літературних джерел щодо питань вроджених аномалій матки показав наявність високого ризику розвитку вагітності саме у рудиментарному розі матки та велику частоту ускладнень даної вагітності у вигляді розриву рогу переважно в ІІ триместрі. Систематизація підходів до вирішення проблеми розриву рудиментарного рогу під час вагітності свідчить про надання вищого пріоритету тактиці збереження нормально розвиненого рогу з паралельною інфузійною терапією у веденні пацієнток з розривом рудиментарного рогу матки та відносно нестабільною гемодинамікою. Разом з тим демонструється обговорення успішних випадків планового видалення рудиментарного рогу з плодом та нормальної повторної вагітності за своєчасного виявлення вродженої аномалії матки. Результати опису даного клінічного випадку можуть бути корисними для акушер-гінекологів, загальних хірургів та лікарів ультразвукової діагностики для удосконалення виявлення рідкісних аномалій розвитку жіночої репродуктивної системи в контексті диференційної діагностики причин "гострого живота" у жінок та оптимізації хірургічної тактики лікування ускладнень вагітності у рудиментарному розі матки.

Технические аспекты ультразвуковой диагностики варикоцеле и анализ европейских клинических рекомендаций.

Introduction. Varicocele is detected in 15% of healthy men, in 35% of men with primary infertility and in 80% of men with secondary infertility. The main non-invasive method to identify this pathology is ultrasound (US) with Doppler. Мaterials and methods. In this article, we reviewed and discussed the technical aspects of performing US diagnostics of varicocele, based on the clinical guidelines of the European Society for Urogenital Radiology. Results. The algorithm of US examination for the diagnosis of varicocele was analysed. It consists of 24 recommendations, which allows to increase the diagnostic value of US examination, as well as to reduce the frequency of diagnostic mistakes. Conclusions. US examination remains the most widely used imaging method of varicocele diagnostics. The described algorithm of this study may be useful for US diagnostics specialists.