Multispiral Computed Tomography Research Articles

Quantitative Determination of a Contrast Agent by Multispiral Computed Tomography and Targeted Absorption Spectroscopy in the K-Jump Region of X-Ray Photoabsorption

Quantitative Determination of a Contrast Agent by Multispiral Computed Tomography and Targeted Absorption Spectroscopy in the K-Jump Region of X-Ray Photoabsorption

Multimodal approach in radiation diagnostics to determining the intramedullary phase of strictly hematogenic osteomyelitis in children: a prospective study

INTRODUCTION: Despite the fact that acute hematogenous osteomyelitis is classified as a sufficiently studied disease, the percentage of diagnostic errors is still quite high. Timely diagnosis is crucial for the successful outcome of the disease, therefore, visualization should be aimed at early diagnosis and, as a result, successful treatment of the disease.OBJECTIVE: To identify early patterns in the intramedullary phase of the course of acute hematogenous osteomyelitis (CSO) with a multimodal approach of radiation research methods.MATERIALS AND METHODS: Twenty patients underwent a comprehensive examination, including multispiral computed tomography (MSCT) using color mapping techniques.RESULTS: In the intramedullary phase of the course of CSF, no pathological changes were detected during X-ray examination of the affected limb. Ultrasound in 75% of observations revealed a thickening of the periosteum of more than 1 millimeter (mm) in the affected bone. When using MRI in 93% of cases, and with MSCT in 95% of patients, signs of bone marrow edema were detected.DISCUSSION: The role of computed tomography in the diagnosis of acute hematogenous osteomyelitis in children has received significant recognition in pediatric surgical practice in recent years, and the use of MSCT in the diagnosis of CSO has found application in domestic healthcare. At the same time, a fairly large number of researchers reported on the high informativeness of MSCT in the diagnosis of CSOs.CONCLUSION: MSCT using the color mapping technique has a higher specificity compared to MRI and can be used as an integral method of the first level in the diagnosis of the intramedullary phase of the CSF course.

Chronic thromboembolic pulmonary hypertension: clinical case and problem review

In this article there was presented a clinical case of the chronic thromboembolic pulmonary hypertension (CTEPH) in the patient with small arteries damage. The thromb visualization was done by the lung perfusion multispiral computer tomography. The general positions of the definition, the diagnosis and treatment of the CTEPH were elucidated too. It was stated the CTEPH is a potential curable disease in case of the surgery in time. But there are some situations when it is not possible to provide the surgery and, in this case, the CTEPH treatment by specific pulmonary hypertension drugs could be used

Comparative analysis of the results of multispiral computed tomography using color mapping and magnetic resonance imaging in the diagnosis of acute hematogenous osteomyelitis in children

BACKGROUND: Although acute hematogenous osteomyelitis is considered a fairly well-studied disease, several articles emphasize that the frequency of diagnostic errors remains quite high. The clinical presentation of acute hematogenous osteomyelitis largely depends on its reactivity and localization. The latter has features of the clinical course in children of different age groups. Osteomyelitis can be difficult to detect because of the variability and nonspecificity of symptoms and physical and laboratory parameters. Rapid diagnosis is crucial for successful disease outcomes because untimely treatment increases the number of complications. Therefore, visualization should be aimed at early diagnosis and, ultimately, successful treatment.
 AIM: This study aimed to evaluate the informative value of magnetic resonance imaging and multispiral computed tomography (MSCT) in the diagnosis of the intramedullary phase of acute hematogenous osteomyelitis as its earliest stage.
 MATERIALS AND METHODS: Thirty patients suspected with acute hematogenous osteomyelitis underwent magnetic resonance imaging and MSCT using color mapping techniques and X-ray density assessment. At the final stage of the diagnostic algorithm, osteotonometry was performed. The contents of the bone marrow canal were taken for microbiological and bacteriological studies.
 RESULTS: In the intramedullary phase of acute hematogenous osteomyelitis, magnetic resonance imaging and MSCT revealed signs of bone marrow edema in 96% of the cases. The sensitivity of magnetic resonance imaging was 96%, the same as that of MSCT; however, the specificity was significantly lower than that of MSCT using the color mapping method and X-ray density assessment, which was 67% and 83%, respectively (p 0.05).
 DISCUSSION: In recent years, the role of computed tomography in the diagnosis of acute hematogenous osteomyelitis has received considerable recognition in pediatric surgical practice, and MSCT with color mapping and X-ray density assessment in the diagnosis of acute hematogenous osteomyelitis in children has been used relatively recently. Simultaneously, many researchers have reported the high informativeness of MSCT in the diagnosis of acute hematogenous osteomyelitis.
 CONCLUSIONS: The intramedullary phase of acute hematogenous osteomyelitis according to magnetic resonance imaging and MSCT indicates bone marrow edema as its earliest stage. According to the data of the present study, MSCT using color mapping and X-ray density assessment has high specificity and can be used with MRI as the main method for diagnosing the intramedullary phase of acute hematogenous osteomyelitis.

Features of radiological manifestations in the diagnosis of nontuberculous mycobacteriosis. Literature review Сlinical observation

Purpose of the study. The purpose of this literature review is to determine the radiographic features in the diagnosis of non-tuberculous mycobacteriosis (NTMB) and to assess the possibility of radiological diagnosis of a combination of tuberculosis and non-tuberculous mycobacteriosis of the lungs in a patient with HIV infection.Materials and methods. A review of the literature on the bases of scientific articles PubMed, ELibrary and Google Scholar. Attention was focused on full-text articles. The article presents a clinical observation of a patient being treated at the Clinical TB Dispensary in Omsk from 2019 to 2022 with a diagnosis of disseminated pulmonary tuberculosis, bilateral, in the infiltration phase, tuberculous spondylitis ThVII–IX, complicated by a paravertebral abscess.Results. The radiological changes characteristic of NTMB are: lesion of the right middle and lingual lobes of the lungs with the presence of diffuse bronchiectasis, changes in the type of “tree in the kidneys”, compaction of lung tissue by the type of “frosted glass” with the presence of centrilobular nodules, asymmetric small dense foci with peribronchial location, apical location of thin-walled cavities with thickening of the costal pleura, as well as foci of inflammatory infiltration. The absence of specific symptoms for this pathology requires further research in this area. The identification of characteristic radiological features will speed up the diagnosis of infection and determine the correct management tactics for patients.Conclusion. The radiosemiotics of NTMB is characterized by a large variability of manifestations. The most informative method of radiation diagnosis of NTMB is multispiral computed tomography (MSCT). Thanks to MSCT, a radiologist has the opportunity to accurately assess the localization and nature of foci, as well as assess the dynamics and prevalence of the process. The most characteristic radiological symptoms are the defeat of the right middle and lingual lobes of the lungs with the presence of diffuse bronchiectasis, changes in the type of “tree in the kidneys”, compaction of lung tissue by the type of “frosted glass” and the presence of centrilobular nodules, asymmetric small dense foci with peribronchial arrangement, apical arrangement of thin-walled cavities with thickening of the costal pleura, as well as foci inflammatory infiltration. The absence of specific symptoms for this pathology requires further research in this area. The identification of characteristic radiological features will speed up the diagnosis of infection and determine the correct management tactics for patients.

Diagnostic value of radiological examination methods in the detection of odontogenic sinusitis

It is emphasized that odontogenic sinusitis frequency for at least 9–11% of the total number of inflammatory diseases of the maxillofacial area, and the frequency of their complications ranges from 30% to 50%. Emphasis is placed on the fact that a frequent cause of the development of odontogenic sinusitis is errors in the endodontic treatment of teeth and errors in dental implantation, which is accompanied by the use of tools for processing root canals (root needles, drills, canal fillers, pulp extractors), as well as filling material and an implant behind the apex tooth root into the sinus cavity.
 Radiological research methods play a leading role in the diagnosis of odontogenic sinusitis. Traditionally, for the evaluation of paranasal sinuses, radiography in the nasolabial projection, inspection radiographs of the skull in direct and lateral projections are used. The advantages and disadvantages of multispiral computed tomography (MCT), magnetic resonance imaging (MRI) and cone beam computed tomography (CBCT) are given separately. For a group of 130 patients, the results of the diagnostic informativeness of radiological examination methods in the detection of odontogenic sinusitis are given.
 The obtained results allow to conclude that in all cases computer tomography (MCT or CBCT) made it possible to accurately diagnose the form of the disease, determine the extent of sinus damage, assess the condition of the lower bone wall of the sinus (reveal a violation of its integrity and report a tooth socket with a sinus), to determine the center of inflammation in the periodontium, as well as to detect the presence of foreign bodies in the maxillary sinus. At the same time, MCT and CBCT data were fully compared with each other, surpassed traditional radiological methods in terms of diagnostic informativeness and had such advantages as the absence of superposition, high contrast resolution, and the possibility of obtaining higher-quality image reconstructions in different planes.
 The aim of study. To analyze the diagnostic value of radiological examination methods in the detection of odontogenic sinusitis.Material and methods: We examined 130 patients in the period from 2022 to 2023. X-ray examinations were performed on a Planmeca ProMax 3D cone beam computed tomography scanner and MCT.Results: Regarding the data of СBCT, it is possible to specify the localization of the foreign body and its connection with the odontogenic factor with high probability. It is worth noting that these sinusitis belong to the iatrogenic group of diseases.Conclusions: CT methods (MCT or CBCT) are a necessary component of the complex diagnosis of odontogenic sinusitis.

Clinical and immunological predictors of Graves' orbitopathy after radioiodine therapy of Graves' disease

Data on the effect of 131I on the course of Graves' orbitopathy (GO) are contradictory. A number of studies indicate a deterioration in the course of GO against the background of RAIT, in other studies such a connection has not been established. Cytokines that regulate inflammation could potentially be biomarkers for assessing GO activity and predicting the course of GO after RAIT. The purpose of this study was to evaluate the dynamics of eye symptoms and analyze immunological parameters: cytokine TGF-β1 and cytokine receptors: sTNFα-R1, sTNFα-R2, sIL-2R, sIL-6R over time after RAIT, as possible predictors of GO activation. The study included 59 patients (118 orbits) with GD in the state of euthyroidism and subclinical hyperthyroidism and low active and inactive GO, aimed at conducting RAIT. Concentrations of cytokine TGF-β1, sTNFα-RI and sTNFα-R2, sIL-2R, sIL-6R, TSH receptor antibodies (rTSH-Ab), free thyroxine (FT4) and free triiodothyronine (FT3), -thyroid-stimulating hormone (TSH) in the blood serum were determined. Ultrasound examination of the thyroid gland, multispiral computed tomography (MSCT)/magnetic resonance imaging (MRI) of the orbits was performed. The examination was carried out 3, 6, 12 months after the RAIT. The deterioration of the course of the GO (1-2 points according to CAS) was noted after 3 months. (32.5%) and to a lesser degree after 6 and 12 months (13.2% and 8.45%, respectively). Dynamics were not noted, approximately, in the same number of patients (40.5%, 41.5%, 45.8%, respectively). An improvement in the course of the GO was noted after 6 and 12 months (45.3, 45.8, respectively). After 3 and 6 months, the achievement of hypothyroidism and a significant increase in the level of rTSH-Ab were noted. In the analysis of cytokines and their receptors a significant decrease in the level of TGF-β1 was noted after 3, 6 and 12 months. There was also a significant decrease in sTNF-R1 and sIL-2R at 3 and 6 months. The level of sTNFα-R2 significantly decreased 3 months after RAIT. The level of sIL-6R has not changed significantly. After 3 months in patients with positive dynamics of image intensification, the level of TGF-β1 did not significantly change compared with the level before RAIT, in patients with worsening of the course of GO or without dynamics, the level of TGF-β1 significantly decreased. After 6 months, there was the same trend, not reaching statistical significance. The IgG4 level and the IgG4/IgG ratio increased to 6 and 12 months, which corresponded to an increase in diplopia index. The main limiting factor in the conduct of RAIT is the activity of the autoimmune process in the orbits. Since patients with inactive (CAS 0-2) or low activity (CAS 3-4) GO were referred for RAIT, there was no pronounced activation of GO after RAIT. There was a slight deterioration in the course of GO by only 1-2 points according to CAS after 3 months. (32.5%) and to a lesser degree after 6 months (13.2%). In the study, it was found that the main predictors of the deterioration of the course of GO after RAIT are uncompensated hypothyroidism, a high level of rTSH-Ab and a decrease in the level of cytokine TGF-β1.

Changing the geometry of polymer spherical orbital implants

BACKGROUND: Over the past decades, various polymer implants have been actively used in the rehabilitation of patients with anophthalmos to form a volumetric support stump and improve the results of cosmetic prosthetics.
 AIM: To assess clinical symptoms and features of the X-ray picture in patients with anophthalmos after implantation of polymeric spherical endoprostheses with a modified geometry.
 MATERIALS AND METHODS: The study is based on the analysis of 30 patients with anophthalmos after enucleations (23) and eviscerations (7) performed using various methods of procedure and insertion into tissues of an implant made of domestic polytetrafluoroethylene. All patients underwent a multispiral computed tomography (MSCT) of the eye sockets according to the same algorithm.
 RESULTS: On the basis of the performed studies, the fact of making a change in the geometry of the implanted spherical implants was revealed, while the parameters of the modified part of the spheres were different and ranged from 14 to 18 mm of final diameters with the initial diameters of the spheres ranging from 18 to 20 mm. A decrease in the volume of spheres with modified geometry from 0.114 to 0.651 cm3 was revealed with initial diameters ranging from 18 to 20 mm.
 CONCLUSIONS: Changes in the geometry of the orbital spheres do not improve the results of cosmetic prosthetics in patients, increase the percentage of implant exposure at different times after surgery, and increase the manifestations of anophthalmic syndrome.

The potential role of radiochemical analysis of CT images of epicardial adipose tissue in the prognosis of acute myocardial infarction

Introduction. Multispiral computed tomography (MSCT) coronary angiography (CAG) is a highly informative method of visualizing atherosclerotic plaques in the coronary arteries and assessing their structure. At the same time, this method has a few significant drawbacks associated with the intravenous administration of iodine-containing radiopaque agents as well as high radiation exposure. The radiomic analysis of contrast-free MSCT images allows calculating many additional quantitative parameters, which can potentially be associated with atherosclerotic plaque instability and the degree of coronary artery stenosis. At the same time, the prognostic and diagnostic value of radiomic characteristics has not been investigated.Aim: To assess whether there is an association between radiomic indexes of EAT on non-contrast MSCT cardiac images with the degree of atherosclerotic coronary artery stenosis in patients with stable CAD, as well as the incidence of acute coronary syndrome (ACS) within 5 years in this category of patients.Material and Methods. We retrospectively reviewed 100 MSCT-CAG studies performed to diagnose coronary heart disease in patients. 39 patients with signs of coronary stenosis up to 50% and registered in Tomsk medical information systems (MIS) for at least 5 years were selected, as well as 15 people without signs of coronary arteries (CA) atherosclerosis as a control group. Epicardial adipose tissue (EAT) volume was assessed and 837 radiomic characteristics were calculated on non-contrasted MSCT cardiac images of all patients (54 people). The presence or absence of ACS within 5 years after MSCT-CAG in each patient was monitored according to Tomsk MIS data. Statistical analysis and comparison of indices were performed in control group (group 2) and study group (group 1), as well as in subgroups of patients who had suffered AMI (group 1a) and those who had not (group 1b).Results. When comparing group 1 with the control group, significant differences (p < 0.05) were found for all radiomic parameters, density, and volume of EAT. Correlation analysis did not reveal any relationship between the radiomic characteristics of EAT and the degree of coronary artery stenosis, as well as the calcium index. According to the results of the MIS of Tomsk analysis, group 1 was divided into 2 subgroups: without ACS (group 1a; n = 27 (50%)) and with ACS (group 1b; n = 12 (22%)). When comparing subgroups 1a and 1b, there were no significant differences in the volume and density of EAT (p > 0.05), however, 8 out of 837 radiomic parameters differed significantly. Multiple regression analysis has shown that the Size Zone Nonuniformity gray level zone matrix (SZN-GLSZM) and Gray Level Variance (GLCM) gray co-occurrence matrix are independent predictors of the development of ACS within 5 years. According to the results of the ROC analysis, the logistic model with the inclusion of radiomic data showed high sensitivity and specificity in predicting the development of ACS (cut-off point <8025.7; specificity 96%, sensitivity 75%, AUC = 0.806, p < 0.001 for SZN; cut-off point <4.08; specificity 93%, sensitivity 83%, AUC = 0.861 for GLV; p < 0.001).Conclusion. SZN GLSZM and GLV GLCM radiomic features on non-contrast MSCT images of EAT are associated with the incidence of ASC in patients with coronary artery atherosclerosis. Radiomic analysis of EAT could potentially be used for personalized assessment of the ACS risk.

The role of coronary artery calcium estimation in the primary prevention strategy for cardiovascular diseases

Calcification is one of the stages of complicated and uncomplicated atherosclerotic plaque development. Determination of calcium deposits in the composition of plaques by the method of multispiral computer tomography allows to assess the coronary atherosclerotic lesion severity. The advantages of the test include a relatively wide availability, low cost and dose of ionizing radiation, as well as no need to inject a contrast agent. Calculation of the coronary artery calcium (CAC) according to the Agatston method is the “gold standard” for quantitative assessment of the coronary atherosclerosis severity. The review highlights modern ideas about the role of the test in primary prevention in people without diagnosed cardiovascular disease. Methodological principles of determining coronary calcium are explained. The principles of test result interpretation and presentation based on the international СAC-RADS scale are described. Data from population studies on the prevalence of coronary calcification in people without cardiovascular disease in different age categories are provided. The results of the prognostic value of CAC based on the analysis of large population studies are presented. The prognostic value of a negative test (CAC = 0) for coronary calcium is discussed. Data are presented on the recommended frequency of repeated examinations in patients with CAC = 0 depending on an individual cardiovascular risk. The data of randomized clinical trials on the expediency of determining coronary calcium in certain age categories are given. The place of the test in international clinical recommendations for the primary prevention of cardiovascular diseases is analyzed. Research findings on a personalized approach to prescribing statins and aspirin based on coronary calcium test results are discussed. Data are provided on improved adherence in patients with coronary calcium screening compared with the standard approach. The limitations and shortcomings of the test are analyzed separately, among which the impossibility of controlling the effectiveness of hypolipidemic therapy with statins in dynamics can be identified. An integrated approach to the role of the coronary calcium test based on the analysis of current international clinical recommendations is provided.

Retrospective analysis of cases of transient global amnesia admitted to the hospital

Introduction. Transient global amnesia (TGA) is a clinical syndrome, the main clinical manifestation of which is sudden development of anterograde and retrograde amnesia, lasting not more than 24 hours, without other general cerebral or focal neurological symptoms.The aim of the work was to reveal the peculiarities of clinical manifestations and data of additional methods of examination of patients with TGA syndrome referred to the primary vascular department with suspected acute cerebral circulation disorder (ACCD).Materials and methods. The study included 16 patients with transient global amnesia diagnosed according to the diagnostic criteria of Hodges and Warlow (1990). All patients underwent a detailed neurological and general medical examination. Electrocardiography, multispiral computer tomography of the head, echocardiography, ultrasound duplex scanning of the main arteries of the head and neck, laboratory examination (lipid spectrum) were performed. The Brief Mental Status Rating Scale was used to assess cognitive impairment.Results. The majority of patients had elevated blood pressure (BP). The leading trigger factor of transient global amnesia was stress. The duration of amnesia ranged from 1.5 to 5 hours. There was a significant impairment of short-term memory. On the first and second days of hospitalization, 50% of patients had normal cognitive functions on a brief mental status assessment scale, but by the 5th−7th day only 12.5 % of patients had abnormalities. Ultrasound markers of atherosclerosis in the form of intima-media complex thickening and dyslipidemia were found in 6 patients. Signs of left ventricular hypertrophy were found in the majority of patients. Discussion TGA is a relatively rare condition and an understudied syndrome. Due to its suddenness of clinical manifestation, TGA requires differential diagnostics with acute cerebral circulatory disorders, epilepsy, acute hypertensive encephalopathy and psychogenic amnesia.Conclusion. The clinical features of TGA identified in the patients were a history of arterial hypertension, elevated BP during an episode of TGA. The leading provoking factor was stress. TGA episode occurred predominantly in the first half of the day. The majority of patients had complaints of headache on admission. Cognitive disorders detected in patients on the first and second days of the disease quickly regressed to normal. Left ventricular hypertrophy was detected in most patients.

Intelligent Decision Support System for Differential Diagnosis of Chronic Odontogenic Rhinosinusitis Based on U-Net Segmentation

The share of chronic odontogenic rhinosinusitis is 40% among all chronic rhinosinusitis. Using automated information systems for differential diagnosis will improve the efficiency of decision-making by doctors in diagnosing chronic odontogenic rhinosinusitis. Therefore, this study aimed to develop an intelligent decision support system for the differential diagnosis of chronic odontogenic rhinosinusitis based on computer vision methods. A dataset was collected and processed, including 162 MSCT images. A deep learning model for image segmentation was developed. A 23 convolutional layer U-Net network architecture has been used for the segmentation of multi-spiral computed tomography (MSCT) data with odontogenic maxillary sinusitis. The proposed model is implemented in such a way that each pair of repeated 3 × 3 convolutions layers is followed by an Exponential Linear Unit instead of a Rectified Linear Unit as an activation function. The model showed an accuracy of 90.09%. To develop a decision support system, an intelligent chatbot allows the user to conduct an automated patient survey and collect patient examination data from several doctors of various profiles. The intelligent information system proposed in this study made it possible to combine an image processing model with a patient interview and examination data, improving physician decision-making efficiency in the differential diagnosis of Chronic Odontogenic Rhinosinusitis. The proposed solution is the first comprehensive solution in this area.

Early electrophysiological predictors of progression of hydrocephalus in children with epilepsy

Hydrocephalus is a severe disease in children of all age groups. Failure to treat hydrocephalus in a timely manner can lead to progressive neurological deficits and death. Instead, early diagnosis and treatment of progressive hydrocephalus can completely recover the child. The term «early diagnosis» of hydrocephalus is the most difficult task for a pediatric neurologist. There are no pathognomonic clinical signs of this disease. Detection of electrophysiological signs of hydrocephalus progression in the early stages of the disease could significantly affect on treatment outcomes. The aim of our work is to establish early electrophysiological predictors of the progression of hydrocephalus in children with epilepsy. Materials and methods. 28 children with epilepsy were examined at the Transcarpathian Regional Children’s Hospital and the Medical Center «Diamed» in Uzhhorod from 2018 to 2022. All children were examined prospectively using video-EEG monitoring with sleep fixation, magnetic resonance imaging (MRI), multispiral computer tomography (MSCT). Results. The electrical status epilepticus during slow-wave sleep (ESES) was registered in 35 % of examined patients (8 children). The average duration from detection of the electrical status of sleep to the establishment of shunt system in the brain is 37 days (from 15 to 60 days). The ESES disappeared in 6 children during the first month after the implantation of the shunt system in the brain, in 2 children during the next 3 and 6 months of observation. We have developed our own algorithm for examining children with hydrocephalus and epilepsy up to 1 year and older than 1 year. Conclusion. An intense increase of epileptiform activity and appearance of electrical status of slow-wave sleep may be one of the predictors of the progression and decompensation of hydrocephalus and requires dynamic control. Further randomized trials are needed to assess the significance of these changes. The developed algorithm will increase the effectiveness of the use of additional examination methods for early detection of the progression of hydrocephalus in children with epilepsy.

Age assessment using CT of knee joint and neural network technologies

Age assessment of living persons plays an important role in clinical and sports medicine, as well as in law practice. Traditional methods have a number of problems: age restrictions, technical difficulties of visualization, low reproducibility and subjectivity of estimation. The proposed approach, which implies the use of multispiral computed tomography (MSCT) and database mining, will eliminate these drawbacks and improve the estimation of age. The aim of the study was to investigate the use of deep learning algorithms to classify the age groups (with a threshold level of 18 years) for CT images of knee joint. The study included 455 MSCT images of the knee joint of male and female subjects aged from 13 to 24. The method included score assessment of the distal femur's epiphyseal synostosis stages, tibia and fibula proximal epiphyses and a preliminary statistical analysis of correlations between age and stages of synostosis. The challenge of binary classification of target age groups with the use of convolutional neural networks was implemented at the second phase of the trial. Various architectures of convolutional neural networks and their ensembles were tested. The result of the study showed that the total score of epiphyseal synostosis has the highest correlation with the age (r=0.88). The proposed method of chronological age assessment on the basis of the knee area CT images research using deep learning algorithms demonstrated a good result. The classification accuracy (threshold level of 18 years) was 0.86.

Assessment of the structural features of the hard palate in endonasal surgery

To study the anatomical structure of the hard palate from the point of view of rhinosurgery, using vector analysis of multispiral computed tomography (MSCT), and to establish anatomical features that should be taken into account when performing surgical interventions on the nasal septum. 107 patients (30 men, 77 women) were examined without congenital cleft palate and surgical interventions on the structures of the nasal cavity and hard palate. All patients underwent MSCT of the nose and paranasal sinuses (PNS) followed by multiplanar image reconstruction. The key point relative to which the measurements were carried out was the posterior wall of the incisor canal from the side of the nasal cavity. The line corresponding to the bottom of the nasal cavity was chosen as the main vector. In the work, measurements of the thickness of the hard palate (THP) at the level of the palatal suture and the width of the palatal suture (WPS) were carried out. Statistical analysis of the obtained results showed that the THP is 1.74 mm [min 0.28; max 6.46], the WPS is 0.9 mm [min 0.2; max 2.51] (conditional norm). In 19 patients (17.8%), the THP was 0.82 mm, in 2 patients (1.9%) - 0.2 mm. In 3 patients (2.8%), the WPS was equal to 2.5 mm. Thus, the data obtained by us indicate that the surgical anatomy of the hard palate is characterized by significant variability, while in some patients the THP can be reduced by 8.8 times, and the WPS increased by 2.7 times compared to normal values. Such anatomical features of the structure of the hard palate should be taken into account when planning septoplasty, since this contingent of patients has an increased risk of developing iatrogenic perforation of the nasal floor during surgical intervention on the lower floor of the nasal septum.

Electrocardiogram QRS Complex Duration as a Predictor of Hospital Prognosis in Patients With COVID-19

Aim To determine the effect of major electrocardiographic (ECG) parameters on the prognosis of patients with COVID-19.Material and methods One of systemic manifestations of COVID-19 is heart injury. ECG is the most simple and available method for diagnosing the heart injury, which influences the therapeutic approach. This study included 174 hospitalized patients with COVID-19. Major ECG parameters recorded on admission and their changes before the discharge from the hospital or death of the patient, were analyzed, and the effect of each parameter on the in-hospital prognosis was determined. Results were compared with the left ventricular ejection fraction (LV EF), laboratory data, and results of multispiral computed tomography (MSCT) of the lungs.Results ECG data differed on admission and their changes differed for deceased and discharged patients. Of special interest was the effect of the QRS complex duration at baseline and at the end of treatment on the in-hospital survival and mortality rate. The Cox regression analysis showed that the QRS complex duration (relative risk (RR) 2.07, 95% confidence interval (CI): 1.17-3.66; р=0.01), MSCT data (RR, 1.54; 95 % CI: 1.14-2.092; р=0.005), and glomerular filtration rate (GFR) (RR, 0.98; 95 % CI: 0.96-0.99; р=0.001) had the highest predictive significance. In further comparison of these three indexes, the QRS duration and GFR retained their predictive significance, and a ROC analysis showed that the cut-off QRS complex duration was 125 ms (р=0.001). Patients who developed left bundle branch block (LBBB) in the course of disease also had an unfavorable prognosis compared to other intraventricular conduction disorders (р=0.038). The presence of LBBB was associated with reduced LV EF (р=0.0078). The presence of atrial fibrillation (AF) significantly predetermines a worse outcome both at the start (р=0.011) and at the end of observation (р=0.034). A higher mortality was observed for the group of deceased patients with ST segment deviations, ST elevation (р=0.0059) and ST depression (р=0.028).Conclusion Thus, the QTc interval elongation, LBBB that developed during the treatment, AF, and increased QRS complex duration are the indicators that determine the in-hospital prognosis of patients with COVID-19. The strongest electrocardiographic predictor for an unfavorable prognosis was the QRS complex duration that allowed stratification of patients to groups of risk.

Использование биометрических параметров верхних мочевых путей для планирования оперативных методов лечения нефролитиаза.

Introduction. The prevalence of urolithiasis (ICD) reaches 5-20% with an annual increase. Endoscopic methods play a leading role in the surgical treatment of urolithiasis. The aim of the surgery is the achievement of stone free status without complications. The technological progress has led to the development of computer programs for visualization before the surgery, which have been used to assess the topography, skeletotopy, anatomy of the renal cavity system, structural features and angioarchitectonics. Aim of the study. Improving the effectiveness and safety of percutaneous interventions using the biometric planning method. Materials and methods. We analyzed the treatment results of 120 patients who were underwent percutaneous interventions for nephrolithiasis in the period from 2019 to 2021. The main method of preoperative examination was multispiral computer tomography (MSCT) with 3D reconstruction and biometric assessment of anatomical parameters. Results. Single kidney stones were detected in 45 patients, multiple – in 24, coral-shaped – in 51 patients. The growth of microflora in urine culture was noted in 64 cases. The average time of X-ray screening was 20.5 minutes (7-34 minutes). The average duration of surgery is 110 minutes (65-240 minutes). Complete purification of the calyx-pelvic system from concretions was achieved in 78% of patients. Complications were detected in 21 (17.5%) patients, 52% of them – grade I-II on the Clavien-Dindo scale. The optimal parameters for percutaneous nephrolithotripsy in monotherapy mode were determined: lower polar anatomy – neck length < 2 cm, width > 0,5 cm, lower cervical-pelvic angle > 70°, lower cervical-frontal angle >135°; upper polar anatomy – single calyx, calyx neck length < 2 cm, width calyx necks > 1,0 cm, upper cervical-cervical angle > 135°, upper cervical-frontal angle >135°; anatomy of the central segment – A1. Discussion. The creation of a morphometric model makes it possible to define the stages of surgery, reduce the risks of complications, increase the efficiency and safety of the procedure. Conclusion. Currently the use of biometric parameters before percutaneous and endoscopic intrarenal interventions is the most effective method of virtual planning, which allows to free the urinary tract from the maximum volume of stone and return the patient to a full life in the shortest possible time.

Structural characteristics of chronic subdural hematomas in elderly and senile patients and their prognostic significance

o account morphological characteristicsMaterials and methods. Retrospective analysis of the results of diagnosis and treatment of patients with CSDH treated in the neurotrauma department of the Romodanov Institute of Neurosurgery NAMS of Ukraine and the City Hospital for Emergency and Emergency Medicine of Zaporizhzhya in 2010‒2019. Among the patients were 80 elderly people, 32 senile and 6 long-lived people. Multispiral computed tomography (MSCT) was performed in 86.7 % of patients, magnetic resonance imaging (MRI) in 13.3 %. In 118 cases, surgical intervention was performed (various types and volume), in 67 % ‒ a morphological study of the fragments of the capsule of the CSDH was performed.Results. The indication for surgery in elderly and senile persons with CSDH is the presence of hematomas with a volume of ≥100 cm3, regardless of the severity of the dislocation syndrome. In 95 % of observations, accompanying somatic diseases were detected. Control of treatment effectiveness was carried out with the help of MRI (in 73.5 % of cases) and CT (in 26.5 %). According to the results of histological studies, three variants of the structure of the capsule of CSDH have been established (according to the density of the location of vessels (the level of expression of the vascular endothelial growth factor (VEGF)) and the ratio of mesenchymal cells), which, together with clinical data, makes it possible to determine the genesis of CSDH. Also, several variants of the structure of the capsule of CSDH were identified, depending on the timing of the diagnosis and morphological examination. Analysis of the relative number and ratio of different cell pools (lymphocytes, fibroblasts, fibrocytes), quantification of immunopositive cells with a reaction to VEGF antibodies, as well as determination of the number of newly formed vessels per unit area makes it possible to predict the course and risk of recurrence of CSDH. Conclusions. The clinical and diagnostic characteristic of CSDH, characteristic of the elderly and senile, is the presence of hematomas with a volume of ≥100 cm3 and the discrepancy between the severity of the condition, clinical and neurological manifestations, and the degree of expressiveness of dislocation-compression changes according to MSCT/MRI data. It is effective to remove CSDH through 1 – 2 milling holes. Microcraniotomy is considered appropriate for a hematoma with complex neuroimaging architecture (multiple septa, layers, trabeculae), in some cases of hematoma recurrence. If the inner surface of the capsule is turned to the blood clot and is represented by a layer of spindle-shaped cells, this indicates a non-traumatic origin of the hematoma. A staged complex clinical and diagnostic examination for CSDH has both clinical and purely practical significance (especially expert), justifying the costs of treatment and insurance payments, ensures the social adaptation of the patient and brings the solution of these issues closer to international standards. Indications, criteria for choosing tactics and the sequence of performing procedures taking into account risks, prognostic clinical-radiological and structural signs are based mainly on recommendations and consensuses and require further detailed study.

Non-Removable Individual Retainers Made of 12Kh18N1OT Medical Steel: Multispiral Computed Tomography Data

Non-Removable Individual Retainers Made of 12Kh18N1OT Medical Steel: Multispiral Computed Tomography Data

Associations of bone mass and polygenic risk of osteoporosis with indicators of arterial wall condition

Background: The identification of genetic factors that are simultaneously responsible for the predisposition to the development of cardiovascular diseases (CVD) and osteoporosis (OP) is important for the prevention of both conditions.Aim: The aim of this study is to evaluate three genetic risk scales (GRS) that previously showed an association with bone mineral density (BMD) and fracture risk, as well as to study the associations of these GRS with vascular wall pathology.Materials and methods: 250 female outpatients (aged 45 to 69) were enrolled into a cross-sectional study. The intima-media thickness (IMT), the presence and number of atherosclerotic plaques (AP) were studied using duplex scanning. Pulse wave velocity (PWV), augmentation index (AI) were measured by applanation tonometry. Coronary vessels calcium deposits were registered by multispiral computed tomography (MSCT) using the Agatston calcium index (CI). The BMD of the spine, hip neck (HN) and proximal hip (PH) was measured using double energy x-ray absorptiometry. Bone resorption marker type-1 collagen C-terminal telopeptide (CTx) was assessed solid-phase enzyme immunoassay. The genetic study included DNA extraction from whole blood samples. Targeted sequencing was performed on the Nextseq550 sequencer (Illumina, USA). Statistical analysis was carried out using the SAS software package for Windows, version 9.0 (SAS Institute Inc., USA).Results: The chance of detecting low bone mass increased more than 4 times at values of IMT ≥0.9 mm (OR=4.17; 95%CI [1.2–14.4], p<0.02), 2.4 times in the presence of AP in the carotid arteries (OR=2.45; 95%CI [1.12–4.88], p><0.05), by 6.7 times with an Agatstone CI ≥ 100 units (OR=6.68; 95%CI [1.56–28.7], p><0.001), 1.4 times (OR=1.43; 95%CI [0.56–3.68], p><0.438) with a PWV ≥10 m/s, 1.2 times (OR=1.2; 95%CI [0.601–2.43], p><0.60) with increased AI ≥ 27%. According to multivariate linear regression analysis (adjusted for age, duration of postmenopause, marker of bone resorption CTx), a significant association of all GRS with BMD in all parts of the skeleton was revealed. Both univariate and multivariate regression models adjusted for several covariants (age, total cholesterol, systolic blood pressure) showed a reliable association of GRS62 with the presence of plaques and GRS63 — with coronary artery CI. Conclusion: The results of the study demonstrated the association of polygenic genetic risk of GRS-based OP with BMD and vascular wall status indicators in women in the peri and postmenopausal periods.>< 0.02), 2.4 times in the presence of AP in the carotid arteries (OR=2.45; 95%CI [1.12–4.88], p< 0.05), by 6.7 times with an Agatstone CI ≥ 100 units (OR=6.68; 95%CI [1.56–28.7], p< 0.001), 1.4 times (OR=1.43; 95%CI [0.56–3.68], p< 0.438) with a PWV ≥10 m/s, 1.2 times (OR=1.2; 95%CI [0.601–2.43], p<0.60) with increased AI ≥ 27%. According to multivariate linear regression analysis (adjusted for age, duration of postmenopause, marker of bone resorption CTx), a significant association of all GRS with BMD in all parts of the skeleton was revealed. Both univariate and multivariate regression models adjusted for several covariants (age, total cholesterol, systolic blood pressure) showed a reliable association of GRS62 with the presence of plaques and GRS63 — with coronary artery CI.>< 0.60) with increased AI ≥ 27%. According to multivariate linear regression analysis (adjusted for age, duration of postmenopause, marker of bone resorption CTx), a significant association of all GRS with BMD in all parts of the skeleton was revealed. Both univariate and multivariate regression models adjusted for several covariants (age, total cholesterol, systolic blood pressure) showed a reliable association of GRS62 with the presence of plaques and GRS63 — with coronary artery CI.Conclusion: The results of the study demonstrated the association of polygenic genetic risk of GRS-based OP with BMD and vascular wall status indicators in women in the peri and postmenopausal periods.