Multispiral Computed Tomography Research Articles

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.

COMPUTED TOMOGRAPHY IN THE DIAGNOSIS OF CONGENITAL HEART DISEASE

Aim of the study – Evaluate the value of multispiral computed tomography (MSCT) with intravenous contrast in the diagnosis of congenital heart disease (CHD) at the stage of preoperative preparation and choice of surgical tactics. Methods. Between January 2021 and June 2022, 30 CT cardiographies were performed in our center, of different age and mediastinal pathology. A 64-slice Somaton Siemens sensation 64 CT scanner complete with digital processing systems was used. The main vessels of the heart were examined with intravenous bolus injection of contrast agent. Image analysis included study of anatomy of the defect by three-plane tomograms and construction of multiplanar 3-D reconstructions. Results. Modern approaches to the imaging diagnosis of CHD in all age groups are presented. The role of CT-angiography with intravenous contrast in the diagnosis of congenital, acquired cardiovascular and thoracic pathology is shown. Qualitative assessment of CT-angiographic picture of CHD was performed. Conclusion. Our experience with CT cardiography in the examination of patients with CHD, in contrast to traditional ultrasound and invasive techniques, in most cases allows to obtain more valuable diagnostic information, especially extracardiac structures, which determines its significance in the examination of CHD. It details anatomy of malformations in reliable morphometric indices, diagnosis of aortic, pulmonary artery, right ventricular pathology, including pathology of its outflow tract, to assess ventricular-artery connections and atrialventricular connections.

Assessing the density of the vitreous body in young people with type I diabetes using multispiral computer tomography

Diabetic retinopathy (DR) is one of the severe complications of diabetes mellitus (DM). Despite the multiyear research of DR pathogenesis, the role of the vitreous body in DR development has not been sufficiently studied. Purpose: to demonstrate the potentials of multispiral computer tomography for assessing the density of the vitreous body in patients with type I diabetes.Material and methods. 97 practically healthy individuals (the control group) and 137 patients with type I diabetes (the main group), aged 10 to 35, were tested by multispiral computer tomography to assess their vitreous density.Results. DM type I patients showed a higher vitreous body density in the central and preretinal areas than healthy individuals. The two observation groups showed a statistically significant difference in the level of glycemia only, whilst no reliable difference in lipid metabolism was revealed.Conclusion. Multispiral computer tomography is a sufficiently sensitive testing method which allows registering even minor differences in the density of the main components of the vitreous body between healthy people and patients with type I diabetes. The higher density of the vitreous body in type I DM patients is probably associated with a higher level of glycosylation.

Ultrasound diagnosis of arteriogenic erectile dysfunction

Objective . To evaluate the effectiveness of a comprehensive study of the entire arterial tract of erectile function (EF) in patients with arteriogenic erectile dysfunction (ED) to determine the tactics of correction. Material and methods . 83 patient with newly diagnosed organic ED (N48.4 ICD-10) were examined. Ultrasound examination of the arteries of the aorto-iliac segments, transperineal examination of the internal pudendal arteries (IPA), arteries of the penis in a state of de-and tumescence, transrectal examination of the prostatectomy gland (TRUS), multispiral computed tomography (MSCT), angiography of the pelvic arteries in men. Results . A transperineal ultrasound examination of the VPA has been developed, which makes it possible to evaluate important morphometric and hemodynamic features of the artery on the perineum, effectively determine the stenoocclusive lesions of the VPA, while the accuracy of the method is 92.4%, sensitivity is 95.38%, specificity is 89.36%, which is comparable to MSCT angiography. Conclusion . The obtained information about arterial blood flow in the IPA basin using transperineal ultrasound is the advantage of this non-invasive diagnostic method. For the full diagnosis of arteriogenic ED, traditional ultrasound of the IF should be supplemented with ultrasound assessment of the arteries of the aorto-iliac segments, IPA for the study of the entire arterial tract with the subsequent choice of the proper correction tactics.

The role of multispiral computed tomography in detecting and the assessment of the degree of damage of esophago-gastric junction cancer

Purpose of the study. To find out the abilities of multispiral computed tomography (MSCT) using intravenous bolus injection in detecting and preoperative esophago-gastric junction cancer staging in order to improve preoperative diagnosis of this pathological condition.Materials and methods. The patients, diagnosed esophago-gastric junction cancer (n1 = 76), esophagus (n2 = 27) and medically fit people’s (n3 = 30) findings of investigating have been analyzed. All patients went through computed tomography on Light Speed VEX Plus and Light Speed RT 16 ("GE", The USA). The findings of MSCT have been compared with anatomical data, which were got after histomorphologic study of post-operation and endoscopic recruitment material.Results. Characteristic MSCT signs of the wall of the esophageal-gastric junction (EGJ) were revealed in healthy individuals, with esophagitis and cancer. The thickness of esophagus paries in normal conditions and in case of esophagitis and EGJ cancer is: 5.4 ± 1.01 mm, 10.36 ± 1.85 mm, 22.53 ± 8.19 mm (p < 0.001). The external diameter of the abdominal part of esophagus in the normal condition is 14.2 ± 1.68 mm, in case of esophagitis is 17.96 ± 3.7 mm, EGJ cancer is 27.9 ± 9.48 mm (p < 0.001). The main statistically significant (p < 0.001) qualitative character of esophago-gastric junction canser were: non-visualization of mucic in afflicted areas (96.8 %), bosselated upper and lower contours of narrowing (75.2 %), dissymmetric parries pachymenia (70.4 %), blunt-edged outer contours (58.4 %), cotyloid suprastenotic esophageal distensibility (45.6 %). The delicacy depended on the degree of damage delicacy and was at the stage Т1 – 66.7 %, Т2 – 76.5 %, Т3 – 77.8 %, Т4а – 86.2 %, Т4b –100.0 %, in general, diagnostic accuracy of the method in EGJ cancer Т-staging was 81.6 %.Conclusion. The results of the work showed that the inclusion of MSCT with intravenous bolus contrast in the algorithm of the study of patients with suspected tumor pathology of the EGJ will improve the diagnosis of cancer of the EGJ.

Assessment of the respiratory system in children with congenital scoliosis by impulse oscillometry and computed tomography (preliminary results)

BACKGROUND: Segmentation disorder of the vertebral body lateral surfaces and rib synostosis are severe variants of congenital pathology of the spine and thorax. They lead to the development of thoracic insufficiency syndrome and are manifested by the inability of the thorax to provide normal respiratory mechanics.
 AIM: This study presents the preliminary results of functional and radiological (CT-morphometric) methods of lung examinations in patients with congenital thoracic spine scoliosis with impaired segmentation of the lateral surfaces of the vertebral bodies and unilateral rib synostosis.
 MATERIALS AND METHODS: This design is represented by a small clinical series. This study is a prospective study of 10 patients aged 3 to 7 years with congenital spinal deformity, with impaired segmentation of the lateral surfaces of vertebral bodies and unilateral rib synostosis. This paper presents the preliminary results of the pulmonary function assessment by pulse oscillometry and CT morphometry in a 3D reconstruction of multispiral computer tomography (MSCT) of the thorax.
 RESULTS: The study of respiratory function using pulse oscillometry revealed no respiratory impairment in seven observations, also reflected in the CT morphometry results. According to the Institute of Medicine (IOM), three children with detected ventilatory abnormalities showed the following parameters with the most significant changes: total respiratory impedance, resonance frequency, and frequency dependence of the resistive component. In all patients, the morphometric indexes of the lung scoring revealed during 3D modeling of the lung were completely consistent with the results of the lung function study by the IOM method.
 CONCLUSIONS: Further study of the problem of respiratory function assessment in children with congenital scoliosis seems promising in diagnostic terms and for evaluating effective surgical treatment.

БАЗИСНЫЕ ПРОТИВОВОСПАЛИТЕЛЬНЫЕ ЛЕКАРСТВЕННЫЕ СРЕДСТВА И ИХ ВОЗДЕЙСТВИЕ НА ДЫХАТЕЛЬНУЮ СИСТЕМУ У ПАЦИЕНТОВ СО СПОНДИЛОАРТРИТАМИ И РЕВМАТОИДНЫМ АРТРИТОМ

At present interaction peculiarities of disease-modifying anti-rheumatic drugs and respiratory system in patients with spondyloarthritеs and rheumatoid arthritis are subject to thorough investigation and reassessment. Objective. To assess the impact of disease-modifying anti-rheumatic drugs (methotrexate) on the respiratory system in patients with spondyloarthritеs and rheumatoid arthritis. Material and methods. The research involved 172 patients with spondyloarthritеs and rheumatoid arthritis. The patients were interviewed and examined. The multispiral computer tomography of thorax was performed in order to determine the volume and nature of lung affection. Lung function was tested by means of spirometry and body plethysmography. In order to process the data Statistica 10 software package was used. Results. Lung disorders were found in 77,1% of patients with rheumatoid arthritis who were taking methotrexate while the percentage of patients with lung affection who were not taking disease-modifying anti-rheumatic drugs reached 100%. The patients with spondyloarthritеs or rheumatoid arthritis who were taking methotrexate showed significantly higher parameters of vital capacity and forced vital capacity than the patients with spondyloarthritеs or rheumatoid arthritis who were not taking disease-modifying anti-rheumatic drugs. Conclusion. Lung disorders were found more rarely in patients with rheumatoid arthritis who were taking methotrexate as compared to patients with rheumatoid arthritis who were not taking disease-modifying anti-rheumatic drugs. Taking into account the assessment of the lung function, we can talk of absence of the negative impact of methotrexate on the respiratory system in patients with spondyloarthritеs and rheumatoid arthritis.

ПАЦИЕНТЫ С ТЯЖЁЛЫМИ ПОРАЖЕНИЯМИ ЛЁГКИХ НА ФОНЕ СПОНДИЛОАРТРИТА ИЛИ РЕВМАТОИДНОГО АРТРИТА: ФУНКЦИЯ ВНЕШНЕГО ДЫХАНИЯ, ВЛИЯНИЕ БАЗИСНЫХ ПРОТИВОВОСПАЛИТЕЛЬНЫХ ЛЕКАРСТВЕННЫХ СРЕДСТВ

The presence of lung involvement in patients with spondyloarthritеs or rheumatoid arthritis always causes concern with regard to the choice of disease­modifying anti­rheumatic drugs. Objective. To determine clinical and instrumental peculiarities of severe lung disorders and to assess the disease­modifying anti­rheumatic drugs (methotrexate) impact on the respiratory system in patients with spondyloarthritеs and rheumatoid arthritis in the presence of severe lung disorders. Material and methods. The research involved 172 patients with spondyloarthritеs and rheumatoid arthritis. The patients were interviewed and examined. The nature of the current medication was specified. The multispiral computer tomography of thorax was performed in order to determine the presence of lung affection. Lung function was tested by means of spirometry and body plethysmography. In order to process the data Statistica 10 software package was used. Results. Lung disorders were found in 77,5 % of patients with spondyloarthritеs and 90,0 % of patients with rheumatoid arthritis. Out of all disorders severe lung disorders were found in 48,4 % of patients with spondyloarthritеs and 70,0 % of patients with rheumatoid arthritis. The patients with severe lung disorders had dyspnea, they also showed a decrease in lung function parameters. The patients with severe lung disorders who were taking methotrexate showed higher parameters of forced vital capacity and vital capacity than the patients with similar lung disorders who were not taking methotrexate. Conclusion. Severe lung disorders in patients with spondyloarthritеs and rheumatoid arthritis can be manifested by respiratory complaints and a decrease in lung function parameters. Methotrexate shows a beneficial effect on the lung function in patients with spondyloarthritеs and rheumatoid arthritis who have severe lung disorders.

Assessment of the effectiveness of medical rehabilitation after COVID-19 based on the functional capacity of the cardiovascular and respiratory systems

Aim. To assess the effectiveness of medical rehabilitation after pneumonia associated with the novel coronavirus infection (COVID-19), based on the study of functional capacity of the cardiovascular system and the external respiratory system.Methods. The study included 70 patients who had COVID-19 pneumonia and underwent a medical rehabilitation program from September to December 2020. Before being included in the rehabilitation program, all patients underwent pulmonary function tests (PFT), including an assessment of the lungs diffusion capacity, cardiopulmonary exercise testing, multispiral computed tomography (MSCT) of the chest, echocardiography, an evaluation of the quality of life according to the SF-36 questionnaire and the severity of shortness of breath on the mMRC scale. The effectiveness of rehabilitation was evaluated against the changes in PFT parameters, exercise tolerance, and quality of life.Results. At the enrollment, 46% of patients retained lung tissue lesions shown by MSCT and accompanied by a decrease in the lung diffusion capacity (67 (55 - 79%) of predicted value), dyspnea of 1.6 (1.0 - 3.0) points according to mMRC scale, moderate level of exercise tolerance and quality of life. Complex cardiopulmonary rehabilitation for 12 - 14 days in a specialized hospital led to a significant improvement in the parameters of pulmonary gas exchange and ventilation, peak oxygen consumption, and an increase in the reserve capacity of the cardiorespiratory system. The factors limiting the improvement of pulmonary gas exchange were the older age of the patients and the increased pressure in the pulmonary artery system. The positive influence of rehabilitation on both the physical and psycho-emotional components of the quality of life was noted.Conclusion. Complex cardiopulmonary rehabilitation with the assessment of changes in the oxygen metabolism parameters and functional capacity of the cardiovascular and respiratory systems has shown to be safe and highly effective in the studied group of patients who have had COVID-19 pneumonia.

Brain Perfusion and Hemodynamic Changes in Moyamoya Disease

Moyamoya disease (MMD) – is a chronic progressive disorder of the unknown etiology with the development of the critical stenoses in internal carotid arteries and abnormal vascular net formation at the basal cerebrum to compensate the hemodynamic insufficiency and further development of the ischemic attacks, strokes, hematomas. The objective: to study the cerebral hemodynamic parameters and brain perfusion in patients with moyamoya disease. Materials and methods. We performed retrospective analysis of the cerebral angiography and cerebral perfusion investigations results of 6 patients with moyamoya desease, who were hospitalized in the State Institution «Romodanov Neurosurgery Institute of NAMS of Ukraine» in 2016–2020. All patients underwent a comprehensive examination, which included neuropsychological testing, the head and neck vessels duplex scanning, multispiral computed tomography (MSCT), selective cerebral angiography (SCA), and MSCT-angiography. The assessment of myamoya vessels was done by the Suzuki angiographic scale. Cerebral hemodynamics was studied by perfusion MSCT (PMSCT). Results. The diagnosis of moyamoya desease was confirmed in all patients by SCA and MSCT angiography. The clinical manifestation of the disease was represented by ischemic (n=5; 83.3%) and hemorrhagic (n=1; 16.7%) strokes. Stage 3, Stage 4 and Stage 6 has been diagnosed by Suzuki angiographic scale. Changes of the cerebral perfusion were more significant at Stage 4 / Stage 6: CBV was increased up to 20%, CBF was decreased > 30% with MTT time > 6 sec. The most significant changes were founed ipsilaterally in the territories of the MCA, moderate – in the territories of the ACA and PCA. Conclusion. In patients with moyamoya disease we have found the restructuring of the cerebral angioarchitectonics which has been matching the decrease of cerebral perfusion. Perfusion MSCT allows to get identification of the areas with an increased risk of ischemia and provides a decisive quantitative assessment of cerebral hemodynamics changes to establish indications for surgical treatment.

Application value between dynamic electrocardiogram and MSCT myocardial perfusion imaging in the diagnosis of myocardial ischemia in coronary heart disease.

Dynamic electrocardiogram and multi-spiral computed tomography (MSCT) myocardial perfusion imaging are commonly used in clinical examination methods, which can provide important reference for the diagnosis of myocardial ischemia in coronary heart disease. To analyze and compare the application value of dynamic electrocardiogram and MSCT myocardial perfusion imaging in the diagnosis of myocardial ischemia in coronary heart disease. The clinical data of 79 patients diagnosed with coronary heart disease admitted in our hospital from October 2017 to October 2019 were retrospectively collected. Exercise load/rest myocardial perfusion imaging (MPI) confirmed the presence of myocardial ischemia, and the patients were all examined by dynamic electrocardiogram and MSCT. The diagnosis of exercise load/resting MPI was used as a benchmark to compare the sensitivity, specificity, and accuracy of the different tests in the diagnosis of myocardial ischemia in coronary heart disease. As confirmed by the exercise load/rest MPI, the 79 included patients had myocardial ischemia. Fifty-five cases of myocardial ischemia were detected by dynamic electrocardiogram, of which 33 cases showed horizontal depression of the ST segment. Also, 15 cases exhibited downward oblique depression, and seven cases showed upward oblique depression. MSCT examination showed that 78 patients had myocardial ischemia, of which 74 showed abnormal myocardial perfusion when contracted. Of these patients, 47 showed reversible perfusion filling, 20 exhibited partially reversible perfusion filling, and seven showed fixed perfusion defects. The sensitivity, specificity, and accuracy of dynamic electrocardiogram in the diagnosis of myocardial ischemia in coronary heart disease were 60.76%, 72.15%, 69.62%, respectively, while those of MSCT were 91.14%, 75.94%, and 86.07%, respectively. The sensitivity and accuracy of MSCT examination were significantly higher than those of dynamic electrocardiogram examination (P<0.05), and the specificity was slightly higher than that of dynamic electrocardiogram examination, but this difference was not statistically significant (P>0.05). Compared to dynamic electrocardiogram examination, MSCT myocardial perfusion imaging has superior sensitivity and accuracy in the diagnosis of myocardial ischemia in coronary heart disease, and can provide a reference for clinical diagnosis and treatment.

Specificity of Multispiral Computed Tomography in the Diagnosis of Avascular Necrosis of the Femoral Head

In the span of 6 years 350 patients that were clinically and radiologically diagnosed with avascular necrosis of the femoral head, at different stages, were examined. Patients were examined using comprehensive radiation examination including radiography and multispiral computed tomography (MSCT) of the hip joints, with the aim to diagnosis avascular necrosis of the femoral head at an earlier stage. According to the results of the examination, 121 patients were diagnosed with an earlier stage of avascular necrosis of the femoral head, on 99 patients was performed core decompression via drilling, 22 patients underwent a joint preservation procedure with the removal of the necrosis tissue following with a bone-graft using bonesubstituting bioresorbable material.

Case of primary diagnosis of pronounced aortic coarctation in an adult patient

In the natural course of postductal aortic coarction, the average life expectancy of the patient is 30 years. The quality of life depends largely on the severity of narrowing, the presence of an open arterial duct and the development of collaterals providing blood flow in the descending aortic basin. Adult patients are characterized by hypertension syndrome symptomatic angina pectoris arrhythmias and heart failure. Pathology is diagnosed by means of two-dimensional echocardiography with color dopplerography and three-dimensional and four-dimensional ultrasonic reconstruction. The obtained data are significantly refined and supplemented by magnetic resonance or contrast multispiral computer tomography. Timely and correct diagnosis can save a patient’s life or significantly improve its quality, preventing the consequences of persistent hypertension and the development of heart failure. The present paper considers a clinical case of pronounced aortic coarctation, first diagnosed in a man aged 30 years, previously observed with a diagnosis of hypertension, despite the signs of hypoxemia of the lower half of the trunk. The algorithm of examination is discussed, which provides timely diagnosis of this defect in order to prevent its complications.

Comparative Results of Emergency Carotid Endarterectomy and Emergency Carotid Angioplasty With Stenting in the Acute Period of Ischemic Stroke. Multicenter Study Results

AIM OF STUDY Study of hospital results of emergency carotid endarterectomy (CEE) and carotid angioplasty with stenting (CAS) in the acute period of acute cerebrovascular accident (ACVA). MATERIAL AND METHODS From January 2008 to August 2020, the study included 615 patients with hemodynamically significant stenosis of the internal carotid arteries (ICA), operated on in the acute period of ischemic stroke (within 3 days from the onset of stroke). Depending on the type of revascularization implemented, all patients were divided into 2 groups: group 1 — CAS (n=312); 2nd group — CEE (n=357). Inclusion criteria were as follows: 1. Mild neurological disorders: NIHSS score 3–8; Modified Rankin Scale score 2 of less; Barthel Scale &gt; 61; 2. Indications for CEE / CAS according to the current national recommendations; 3. Ischemic focus in the brain not more than 2.5 cm in diameter. Exclusion criteria: 1. Presence of con-traindications to CEE / CAS. Carotid angioplasty with stenting was performed according to the standard technique; in all cases, distal embolism protection systems were used. Carot-id endarterectomy was performed according to the classical and eversion techniques. When the retrograde pressure in the ICA was less than 60% of the systemic pressure, a temporary shunt (TS) was installed. In the postoperative period, all patients underwent multispiral computed tomography (MSCT) of the brain. In the absence of negative dynam-ics in the neurological status, MSCT was performed on the 7th day after the operation, if available, it was performed urgently. The checkpoints were the development of such unfa-vorable cardiovascular events as death, myocardial infarction (MI), stroke / transient is-chemic attack (TIA), “mute” stroke, “mute” hemorrhagic transformations, combined end-point (death + all strokes / TIA + MI). Strokes were mute if diagnosed according to MSCT, without symptoms. RESULTS In 69% of diabetic patients with anterior myocardial infarction and in 63% of patients with posterolateral MI 12 months after PCI, signs of LV inferiority were revealed in the form of an increase in the indices of end-diastolic and systolic volumes of the LV and low ejection fraction (≤45%). In patients without diabetes, these figures were 18% and 31%, respectively. High concentrations of NT-proBNP on the first day of myocardial infarction after PCI were of the greatest value in the diagnosis and prognosis of LV UR after 12 months. RESULTS When analyzing hospital complications, significant differences in the frequency of lethal outcome were not obtained (group 1: n=6 (1.92%); group 2: n=8 (2.24%); p=0.98; OR=0.85; 95% CI 0.29–2.49); MI (group 1: n=5 (1.6%); group 2: n=5 (1.4%); p=0.91; OR=1.14; 95% CI 0.32–3.99 ); ACVA (ischemic type) / TIA (group 1: n=5 (1.6%); group 2: n=6 (1.7%); p=0.82; OR=0.95; 95% CI 0.28–3.15), as well as “mute” ACVA (group 1: n=7 (2.2%); group 2: n=15 (4.2%); p=0.23; OR=0.52; 95% CI 0.21–1.3). However, the vast majority of hemorrhagic transformations (group 1: n=2 (0.64%); group 2: n=13 (3.6%); p=0.018; OR=0.17; 95% CI 0.03–0.76) and all “mute” hemorrhagic transformations (group 1: n=0; group 2: n=26 (7.3%); p=0.001; OR=0.02; 95% CI 0.001–0.33) were observed only in the CEE group, which was reflected in the maximum values of the combined end point: group 1: n=22 (7.05%); group 2: n=73 (20.4%); p&lt;0.0001; OR=0.29; 95% CI 0.17–0.48). Thus, in the CEE group, every 5th patient had a complication. CONCLUSION Carotid angioplasty with stenting is the safest method of revascularization for patients in the acute period of ACVA. This is largely due to the reduction in the risk of reperfusion syndrome and the prevention of embolism due to the use of modern protection systems. Carotid endarterectomy can be performed with comparable efficiency only when a tempo-rary shunt is placed in the internal carotid arteries in the absence of unstable atheroscle-rotic plaque.

ALGORITHM FOR EXAMINING PATIENTS WITH PATHOLOGY OF THE UPPER GASTROINTESTINAL TRACT USING MULTISPIRAL COMPUTED TOMOGRAPHY

The aim of the study was to develop a technique for conducting multispiral computed tomography (MSCT) when examining the upper parts of the gastrointestinal tract. A prospective analysis of MSCT images was performed in 85 people who were examined at the AI "Republican Clinical Oncology Dispensary" under the Ministry of Public Health of the Chuvash Republic in 2015-2019. All patients underwent computed tomography using Light Speed VEX Plus and Light Speed RT 16 devices ("GE", USA) using our modified esophageal and gastric MSCT technique with an emphasis on the esophageal-gastric junction (EGJ). The characteristic quantitative MSCT-signs of the esophageal wall, the stomach, and the EGJ area in the norm, as well as the ones in an abnormal esophageal wall in esophagitis and gastritis are presented. The esophageal wall thickness in the normal condition and esophagitis was 3.12±0.69 mm and 8.16±1.65 mm (p = 0.000, R=0.909), and the maximum external diameter of the abdominal part of esophagus was 14.2±1.68 mm and 17.96±3.7 mm (p = 0.000, R = 0.579), respectively. The ROC analysis revealed a threshold value equal to 5.5 mm for distinguishing the wall thickness values characteristic for the unchanged esophagus and the esophagus with inflammatory pathology (sensitivity-96%, specificity-100%, p = 0.000). The threshold value for the external diameter of the abdominal esophageal segment was 17.5 mm (sensitivity – 64%, specificity – 100%, p = 0.000). The thickness of the stomach wall in the normal condition and in gastritis made 4.6±0.48 mm and 7.52±2.71 mm (p = 0.000, R = 0.673), respectively. At this, the threshold value of this characteristic was equal to 5.5 mm (sensitivity – 87.1%, specificity – 100%). The wall thickness in the area of the cardia in the normal condition was 5.4±1.01 mm, in presence of inflammation – 10.36±1.85 mm (p = 0.000, R = 0.858), the threshold value – 7.5 mm (sensitivity – 95.83%, specificity – 98.04%, p = 0.000). The thickness of individual layers in the unchanged stomach walls did not exceed 2 mm, the thickness of the mucosa was 1.01±0.11 mm.