National Academy Of Medical Sciences Research Articles

Features of using CT and MRI in planning radiation therapy in patients with squamous cell carcinoma of the head and neck

Background. Squamous cell carcinoma of the head and neck (SCCHN) holds a significant position in global oncology. The quality of radiotherapy greatly depends on the accuracy of diagnostic procedures and radiation dosing, as even a minor increase in radiation volume can significantly raise the risk of radiation toxicity. Modern visualization methods and dose calculation algorithms are key in ensuring treatment effectiveness and reducing side effects, thereby improving patients’ quality of life. Purpose. To enhance the effectiveness of radiotherapy for SCCHN through the optimization of topometric preparation using modern visualization methods. Materials and Methods. The study was conducted at the State of Organization «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine», from January 2020 to October 2022. The study group comprised 41 cases where radiotherapy planning was performed using both CT and MRI. The comparison group included 64 cases using only CT. Radiation planning was carried out on TPS Eclipse, and irradiation was performed on a Clinac 600C linear accelerator in a classical fractionation mode with a daily dose of 2 Gy to a total dose of 66–70 Gy. Results. The clinical effectiveness of radiotherapy was not dependent on the method of planning, and a reduction in radiation volume by 11% using MRI did not affect the outcomes. It was noted that the development of grade III radiation dermatitis in patients with stage III–IV SCCHN was 2.4 times higher when using only CT compared to using both CT and MRI, which is thought to be due to a larger radiation volume. Grade III radiation mucositis was observed 2.25 times more frequently in the comparison group than in the study group. In patients with stage I–II SCCHN, there was no significant difference in effectiveness and toxicity, hence the use of MRI at these stages is not justified. Conclusions. It is necessary to use MRI with CT for planning radiotherapy in patients with stage III–IV SCCHN. This reduces the risk of grade III radiation dermatitis and mucositis compared to using only CT. For planning radiotherapy in patients with stage I–II disease, the use of CT alone is sufficient.

Factors affecting the survival of patients with glioblastoma treated with standard and hypofractionated radiation regimens

Background. Glioblastoma has the worst prognosis and is the most common primary tumor of the central nervous system (CNS) among adults. Since it is multimodal treatment that increases survival chances of patients with glioblastoma, the analysis of factors that affect survival is a necessary precondition for developing more effective therapeutic approaches for this cohort. Such analysis makes it possible to determine the subgroups of patients which demonstrate the biggest therapeutic benefit from certain types of multimodal treatment, thus leading to implementation of personalized neuro-oncological treatment. Purpose. To analyze factors affecting cancer-specific survival (CSS) of patients with glioblastoma in stratification of the cohort according to the regimen of adjuvant radiation therapy into groups of standard and hypofractionated treatment regimens. Materials and methods. The single-center non-randomized study is based on the analysis of the results of the cohort of 159 patients with primarily diagnosed glioblastoma that were treated over the period from 2014 to 2020 at the State Institution «Romodanov Neurosurgery Institute of the National Academy of Medical Sciences of Ukraine». According to the regimen of radiation therapy, the patients of the cohort (n=159) were stratified into two groups: standard regimen group – 49 (30.8%) patients (30 fractions, total radiation dose of 60.0 Gy) and hypofractionated regimen group – 110 (69.2%) patients (15 fractions, total radiation dose of 52.5 Gy). The survival of the patients was analyzed by the Kaplan–Meier method. The log-rank test was used for comparing Kaplan–Meier survival curves for different studied groups. For the purpose of studying impact of independent variables on the survival, we used regression analysis according to semiparametric proportional hazards model. Hazard ratio was calculated with 95% confidence intervals (CI). Results and discussion. The median CSS in the total cohort was 16.6 (95% CI 14.1–17.8 months) months in median follow-up time of 23.8 (95% CI 21.9–27.3) months. In standard regimen group, the median CSS was 15.7 (95% CI 14.1–17.8) months in median follow-up time of 24.4 (95% CI 23.1–25.3) months. In hypofractionated regimen group, the median CSS was 17.5 (95% CI 14.6–19.7) months in median follow-up time of 22.3 (95% CI 21.3 – 27.2) months. According to the logrank test (taking into consideration cautions about its use), no statistically significant difference in CSS of patients of both groups was determined р=0.07>0.05. For analysis of the impact of clinical factors (age, sex, radicality of the surgical treatment, chemotherapeutic treatment, functional status according to the Karnofsky scale) on the CSS of both groups, they were considered as the ones that may have different base hazard. Statistically significant impact of all studied covariates on the CSS was registered (p70 points, ceteris paribus. For male patients, the hazard of death is 1.7 times higher (р=0.016267; HR 1.7; 95% CI 1.1–2.5) than for female patients, ceteris paribus. Absence of chemotherapy in adjuvant treatment increases hazard of death by 2.37 times (HR 2.37; 95% CI 1.6–3.2), ceteris paribus. The hazard of death decreases, ceteris paribus, by 82% in chemotherapy with temozolomide and by 47% when the patient is younger than 60 years old (HR 0.53; 95% CI 0.4–0.8). Conclusions. This analysis is a stage of the study of differentiated treatment effect in groups of standard and hypofractionated regimens of radiation therapy in patients with glioblastoma. These data can be used for an in-depth subgroup analysis and serve as the basis for development of personalized approaches in treatment of neuro-oncological patients.

Можливості еластографії зсувної хвилі в діагностиці фіброзу печінки та моніторингу автоімунних захворювань печінки в дітей

Autoimmune liver disease (ALD) in children, when not diagnosed and treated timely, are characterised by a progressive course leading to liver cirrhosis. Monitoring the progression of the disease is crucial for evaluating the effectiveness of treatment in ALD patients. We believe that the use of ultrasound elastography is not only valuable for diagnosing liver fibrosis but also for monitoring the course of ALD in children, representing a promising research method. Purpose - to assess the feasibility of using shear wave elastography for diagnosing liver fibrosis and monitoring the course of ALD in children. Materials and methods. In 108 children with ALD aged 3-18 years, examined at the Department of Pediatric Hepatology of the SI «Institute of Pediatrics, Obstetrics and Gynecology named after academician O. Lukyanova of the National Academy of Medical Sciences of Ukraine», from 2019 to 2023, ultrasound shear wave elastography (2D-SWE) parameters were evaluated before treatment (baseline) and at 6, 12, 24, and 36 months of therapy, depending on the stage of liver fibrosis determined by histological method using the Metavir scoring system (F0-F4) in all children. Statistical analysis was performed using GraphPad Prism 9 version 10.0.0. Results. The mean age of the children was 11 years (range 8-13.8 years), with 91% (n=98) having liver fibrosis stage ≥F2 according to Metavir. There was a significant correlation between complete biochemical remission and median 2D-SWE at 12, 24, and 36 months of treatment (p=0.0002; p=0.002; p=0.0004, respectively). The area under the ROC curve (AUC) for diagnosing liver fibrosis stage ≥F3 and F4 at 0, 6, 12, 24 and 36 months of treatment was 0.81; 0.78; 0.67; 0.81; 0.75 and 0.80; 0.91; 0.84; 0.89; 0.92, respectively. The optimal cutoff value for median 2D-SWE was 10.1 kPa; 8.9 kPa; 9.1 kPa; 8.9 kPa; 7.0 kPa and 14.0 kPa; 10.5 kPa; 10.2 kPa; 9.7 kPa; 8.1 kPa, respectively. Conclusions. Shear wave elastography is an effective method for diagnosing fibrosis ≥F3 and cirrhosis in children with ALD. Reduction in 2D-SWE values in children with ALD during treatment is a predictor of its effectiveness. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Evaluation of Changes in the Quality of Life Using the U22 Questionnaire after Cavotricuspid Isthmus Ablation

Abstract. Atrial tachyarrhythmias are the most common forms of heart rhythm disorders. According to literature sources, isolated atrial flutter (AFL) is observed in 88 people per 100,000 population. Most quality-of-life assessment methods have been developed and used primarily to assess atrial fibrillation. In this context, the U22 questionnaire becomes a significant protocol aimed at quantifying paroxysmal symptoms associated with tachyarrhythmias.
 The aim. To evaluate changes in the quality of life in patients with typical AFL after radiofrequency ablation (RFA) and bidirectional conduction block through the cavotricuspid isthmus.
 Materials and methods. The study is based on the analysis of the results of the treatment of a group of 135 patients at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine in the period from 2014 to 2021. The patients had three follow-up examinations, which were subject to analysis and static processing: before RFA (n=135), after 1 month (n=122) and after 1 year (n=81). All the patients were interviewed concerning their arrhythmia-related symptoms, which were assessed according to the U22 protocol.
 Results. Before the procedure, the patients noted a low level of well-being (4.3±1.0 points). During the follow-up visit 1 month after RFA, the patients rated their general condition during this period at 8.9±0.7 points. The registered changes were statistically significant compared to the initial state (p<0.0001). Thus, the radical elimination of AFL led to rapid improvement in the psycho-emotional and physical condition of the patients as early as within 1 month. Similar changes were observed during the assessment after 1 year, when the patients assessed their condition at 9.3±0.7 points (p<0.0001); there was statistically significant difference compared to the initial condition and the results at the first follow-up examination. These results confirm the stability of the positive trend during the medium-term follow-up.
 Conclusions. The U22 questionnaire found symptomatic improvement in patients undergoing RFA of cavotricuspid isthmus. The U22 questionnaire can be considered as another, additional control tool for patients who underwent RFA. The peculiarity of its application is the specificity of the assessment of paroxysmal symptoms and complaints, which are specifically related to rhythm disturbances, and the possibility of a simple analysis of the dynamics for a long time after the intervention.

Catheter Ablation of Paroxysmal and Persistent Atrial Fibrillation in Patients with Secondary Atrial Septal Defect. Evaluation of the Results and Impact on the Quality of Life

Introduction. The presence of atrial fibrillation (AF) in patients with secondary atrial septal defect (ASD) has significant impact on their quality of life (QoL) and reduces life expectancy. Current guidelines recommend catheter ablation (CA) for patients with AF in case of medical treatment failure, however, its use in patients with AF and ASD is still poorly studied.
 The aim. To study the efficacy and safety of CA and its impact on the QoL in patients with AF and secondary ASD.
 Materials and methods. In 2003-2023, 1408 patients with secondary ASD were treated at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. Of these, 54 patients who had AF and underwent the CA procedure were included in group 1 of our study. There were 36 (66.7%) men and 18 (33.3%) women aged 24-76 years (mean age 61.4 ± 9.8 years). Four (9.3%) patients had persistent AF and 50 (90.7%) patients had paroxysmal AF. Fifty-six patients with paroxysmal or persistent AF and with the comparable age, duration of symptoms and associated pathology but without ASD were examined as group 2. The type and results of surgical interventions were analyzed according to surgical reports. The results of the treatment and QoL were assessed using the Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaire during the follow-up period 1, 2 and 3 months after the procedure.
 Results. Pulmonary vein isolation was performed in all 54 (100%) patients of the group 1, as well as cavotricuspid isthmus ablation in 26 (48.2%) cases, cavotricuspid isthmus ablation and left atrial linear ablation in 2 (3.6%) cases. Type, length and complication of the procedure were comparable to those in the group 2. Fourty-four (81.5%) patients with ASD were free from AF 3 months after procedure, and their results did not differ from those obtained in the group 2 (p > 0.05). Average QoL indicators according to AFEQT significantly improved in both groups of patients who underwent CA. The differences in post-treatment QoL between patients of both groups were insignificant (p > 0.05).
 Conclusions. CA was found to be safe and beneficial in patients with AF and secondary ASD. The rate of procedural complications and cure rate in patients with AF and secondary ASD (81.5%) were compatible to those in patients without ASD (80.5%). AF has negative effect on the main indicators of the patient’s life. In patients with secondary AF with ASD who underwent CA, a significant improvement in AF symptoms and QoL according to the AFEQT questionnaire (total score 56.1 ± 2.7 before the procedure vs. 78.7 ± 4.0 at follow-up) was noted.

The Influence of Carbohydrate Metabolism Disorders on the Course of Perioperative Period in Cardiac Surgery Patients with Post-Infarction Left Ventricular Aneurysms

The aim. To study the impact of carbohydrate metabolism disorders on perioperative period in cardiac surgery pa-tients with post-infarction left ventricular (LV) aneurysms.
 Materials and methods. Retrospective analysis of perioperative period in random 132 patients with post-infarction LV aneurysms of various locations, who were operated on and discharged from the department of surgical treatment of ischemic heart disease of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. Disorders of carbohydrate metabolism (DCM) were detected in 98 (74.2%) patients, among whom type 2 diabetes mellitus (DM) was diagnosed in 34 (25.7%) patients, impaired glucose tolerance (IGT) in 64 (48.5%). All the patients underwent general clinical examination, electrocardiography, echocardiography, coronary angiography and surgical treatment.
 Results. When analyzing the clinical picture in patients with post-infarction LV aneurysms, painless myocardial isch-emia was diagnosed in 41 (31.06%) patients, among whom type 2 DM in 11 (26.8%) cases and IGT in 18 (43.9%). No statistically significant difference was found in patients with and without DCM in the LV contractile function, presence of LV thrombosis, atrial fibrillation, chronic kidney disease, stenosis of brachiocephalic arteries and arteries of the lower extremities, gouty arthritis, and body weight. Intraoperatively, diameter of the coronary arteries in patients with type 2 DM was slightly smaller compared to patients without DCM. Its increase in cases of calcification of coronary arteries and aorta among patients of the study group with DCM was statistically insignificant. A careful analysis of the postoperative period in patients with and without DCM showed a statistically significant occurrence of paroxysms of atrial fibrillation in 30 (90.9%) and 3 (9.1%) cases, respectively (p=0.0115). The patients with DCM had longer stay in the intensive care unit: 4.03 ± 2.3 vs. 3.2 ± 1.3 days (p=0.0483). Acute kidney injury in the early postoperative period occurred in 8 (6.06%) patients, including 5 (62.5%) with type 2 DM (p=0.0142). Sternal wound infection occurred in 2 (1.5%) patients with type 2 DM (p=0.0156).
 Conclusions. Among cardiac surgical patients with postinfarction LV aneurysms, the major part is formed by patients with DCM (74.2%), the presence of which complicates the course of the postoperative period with the development of paroxysms of atrial fibrillation (p=0.0115), acute kidney injury (p=0.0142), sternal wound infection (p=0.0156), a long stay in the intensive care unit (p=0.0483).

The relationship between morphological manifestations, clinical and hematological indicators and lymphocyte indices in ulcerative colitis

Background. The purpose of the study was to identify correlational parallels between morphological manifestations, clinical and hematological indicators and lymphocyte indices in patients with ulcerative colitis (UC). Materials and methods. Ninety patients with UC were examined. Morphologically, the degree of damage to the intestinal mucosa, the presence of crypt abscesses, atrophic changes, and changes in crypt architectonics were determined. The number of cells of the inflammatory infiltrate, linear measurements of the mucosa were assessed by morphometric method. Clinical blood parameters were evaluated in the inpatients of the department of intestinal diseases at the Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine. The severity of the disease was assessed according to the Mayo score. Statistical processing of the results was carried out using the Statistica 6.1 program. Results. In patients with UC, histological changes in the intestinal mucosa were found. The activity of the disease was evaluated by the presence of an increased number of inflammatory cells in the infiltrate of the mucosa: neutrophils (212.20 ± 20.93), lymphocytes (2922.80 ± 76.63), eosinophils (332.50 ± 17.24), macrophages (369.70 ± 16.21). Multiple crypt abscesses, deformation of the musocal epithelium in the form of erosions and ulcers were also noted. Clinical indicators of peripheral blood also confirmed the exacerbation of the disease (anemic state, increased inflammatory markers). An increased depth of the crypts correlated with such a morphometric indicator as mucosal thickness (r = 0.46; p < 0.01). At the same time, correlations were found between mucosal thickness and the height of the surface epithelium (r = 0.35; p < 0.01). There was a relationship between the morphological and clinical and hematological indicators of UC: mucosal thickness and erythrocyte sedimentation rate (r = 0.38; р < 0.01), band cells (r = 0.37; р < 0.01) and blood neutrophils (r = 0.21; p < 0.05). The Mayo core, as an indicator of the severity of the disease, correlated with the height of the epithelium (r = 0.37; p < 0.05); neutrophils (r = 0.49; p < 0.01) and basophils (r = 0.28; p < 0.05) of the intestinal mucosa; N/L tissue index (r = 0.50; p < 0.01). Conclusions. Correlative parallels were found, which confirm our assumption regarding the connection between morphological manifestations and clinical and hematological indicators of UC. The use of T/L and N/L indices in both tissue and peripheral blood can be used as a marker of the activity of inflammatory processes in UC.

Endoscopic ultrasonography in diagnosis of digestive diseases. Review of clinical cases

Endoscopic ultrasound (EUS) is a high-tech ultrasound examination that simultaneously combines the options of endoscopic and ultrasound diagnosis of diseases of the gastrointestinal tract, pancreas, bile ducts and liver. The advantages of endoscopic ultrasound over traditional transabdominal ultrasound are that the ultrasound transducer can be guided directly through the lumen of the gastrointestinal tract to the object under visual control. The EUS is the method of choice for the study of submucosal lesions in the upper gastrointestinal tract. It is the most accurate method for the detection and diagnosis of submucosal formations due to its high sensitivity, specificity, is used as the next research method after endoscopy and can provide information about the origin, size, borders, homogeneity, as well as the choice of treatment method: endoscopic or surgical one. A more important application of EUS is the determination of the stage of malignant neoplasms of the gastrointestinal tract, as it determines the treatment and predicts the disease. And the real-time strain elastography, which allows analyzing the stiffness of tissues, helps in this. The high accuracy of this study allows for the differential diagnosis of benign and malignant neoplasms. The article presents cases of examination of patients with submucosal neoplasms of the stomach who were treated in the SI “Institute of Gastroentero­logy of the National Academy of Medical Sciences of Ukraine”.

Outcomes of Treatment of Pectoralis Major Muscle Injury

Background. The incidence of injuries to the pectoralis major muscle (PMM) is steadily increasing, necessitating an assessment of outcomes of surgical treatment.
 Objective: to analyze the outcomes of surgical treatment for PMM injuries.
 Material and Methods. The study is based on the analysis of surgical treatment outcomes of 84 patients with PMM injuries who were hospitalized in the Department of Microsurgery and Reconstructive Surgery of the Upper Extremity at the State Institution "Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine" from 2003 to 2023. The patients underwent a rehabilitation program and staged observation for up to 12 months after surgical intervention. The age of the patients ranged from 16 to 62 years; they were divided by age into three groups: up to 25 years, 25-40 years, and 41 years and older. Functional assessment of the PMM was performed using the Quick Disabilities of the Arm, Shoulder and Hand (Quick DASH), The Score and Subjective Evaluation by Patients with a Pectoral Major Tear (SEPPMT), and the American Shoulder and Elbow Surgeons (ASES) scales at the time of admission, at 6 months, and at 12 months after the surgery.
 Results. When comparing baseline functional parameters for acute and chronic PMM injuries using the Quick DASH, SEPPMT and ASES scales preoperatively, patients with acute injuries had worse results than those with chronic injuries (p < 0.001). At 6 months after surgical treatment, the group of patients with acute injuries showed significantly lower scores compared to the group with chronic injuries. At 12 months after surgical treatment, the group with acute injuries had significantly higher scores compared to the group with chronic injuries (p < 0.001), though still corresponding to excellent and good results.
 Conclusions. When comparing baseline functional parameters for acute and chronic PMM injuries using the Quick DASH, SEPPMT, and ASES scales preoperatively and at 6 and 12 months after surgical treatment, patients who underwent surgery within two weeks after the trauma demonstrated better results. In cases of chronic injuries, the results were slightly worse, but still were close to good results.

Contusion Spinе Injury in the Thoracolumbar Junction Region

Summary – Contusion spine injuries resulting from direct traumatic mechanisms that lead to spinal cord lesion are relatively rare during peacetime. The specific characteristics of such injuries are not extensively covered in contemporary literature. The need to optimize treatment methods for military personnel engaged in active combat operations on the territory of Ukraine necessitates an examination of this specific type of injury.
 Objective: To describe the clinical presentation and explore possible therapeutic approaches for closed contusion spinal cord injuries in the thoracolumbar junction.
 Materials and Methods: We conducted an analysis of patient data from those admitted for inpatient treatment at the Romodanov Neurosurgery Neurosurgery of National Academy of Medical Sciences of Ukraine, as well as patients referred to other healthcare institutions in Kyiv, from February 2022 to May 2023.
 Results: We analyzed the treatment outcomes of 5 patients, aged 27 to 53 years (mean age: 37.6 years), presenting with initial neurological deficits classified as ASIA A. Surgery was performed in 3 patients. All cases underwent wide laminectomy with facetectomy at the level of injury. Large arachnoid cysts were drained, and in one case, a subdural hematoma was removed. Posterior spinal fusion using an 8-screw transpedicular system was performed in all patients, utilizing a minimally invasive percutaneous approach. At the 2-month follow- up positive dynamics were observed in all patients. Neurological status improved to ASIA B in 2 cases and ASIA C in 1. Recovery of proprioceptive sensitivity was noted, as well as an increase in the intensity of neuropathic pain (up to 5-7 points at 2 months). In 2 patients undergoing conservative therapy, the neurological impairment level remained ASIA A, with pain intensity not exceeding 2 points.
 Conclusions: The findings emphasize the need for more comprehensive instrumental assessment in patients with suspected contusion spinal cord injuries. Active use of surgical treatment methods in this type of injury contributes to achieving better clinical outcomes.

Application of virtual navigation in the treatment of macro-re-entrant atrial tachyarrhythmias

Macro-re-entrant atrial tachyarrhythmias occupy the leading positions in the structure of tachyarrhythmias, and one of the most common in this group is atrial flutter. These abnormal rhythms lead to a significant decrease in the quality of patients’ life, and sometimes, indirectly due to complications, can lead to disability and fatal consequences. Medical treatment for this group of arrhythmias has limited effectiveness, and the surgical method of treatment – catheter ablation – comes to the first place. Ablation of atrial flutter is traditionally performed under the guidance of fluoroscopy without the use of a navigation system, but this is associated with increased radiation exposure to patients and staff. Advances in modern arrhythmology make it possible to create anatomical models of heart chambers and activation models of the excitation spreading along anatomical models, reducing the radiation load, but requiring additional equipment and skills. Aim: to compare the procedure duration and radiation load during radiofrequency catheter ablation of the cavo-tricuspid isthmus using 3D navigation with traditional methods. Materials and methods. The work was based on the analysis of treatment results in 84 patients at National M. Amosov Institute of Cardiovascular Surgery affiliated to National Academy of Medical Sciences of Ukraine in the period from 2014 to 2021. Depending on the imaging method, patients were divided into 2 groups. Group I included 31 patients who underwent radiofrequency cavo-tricuspid isthmus (CTI) ablation according to the traditional method under fluoroscopic control without using a navigation system. Group II comprised 27 patients in whom an anatomical model of the right atrium was created. Results. Success criteria were achieved in all groups, bidirectional block line was created at the level of the CTI. In group I, the average time from the first application to the restoration of sinus rhythm was 325 ± 25 s with an average number of applications of 7.4 ± 0.6 (from 5 to 10). The average procedure time was 43.0 ± 3.3 min, with an average X-ray time of 572 ± 44 s and an average dose area product (DAP) was 62.0 ± 5.0 Gy.cm2. In group II, the total duration of the first stage of the intervention was 312 ± 26 s. The average time to stopping tachycardia and restoring sinus rhythm was 230 ± 19 s. The average time from sinus rhythm restoration to confirmation of bidirectional CTI block was 71 ± 6 s with an average number of applications of 3.2 ± 3.0 per the procedure. The average procedure time was 41.5 ± 3.5 min, the average X-ray time was 120 ± 10 s, the average DAP was 15.0 ± 1.3 Gy.cm2. Conclusions. The usage of the anatomical model of the right atrium reduces X-ray exposure by 75.8 %, in comparison to the traditional technique, during radiofrequency catheter ablation of the cavo-tricuspid isthmus with similar procedure time. The anatomical model can be recommended for ablation of the cavo-tricuspid isthmus.

INVESTIGATION INTO THE ORGANIZATION OF MEDICAL CARE PROVISION IN CARDIOVASCULAR SURGERY DURING MARTIAL LAW

The aim of this study is to examine the organization of cardio-surgical medical care during martial law for offering qualified medical assistance to servicemen classified as temporary casualties, through bed allocation planning and bed-day calculation. Materials and methods: This research encompassed military personnel actively engaged in combat operations (n=473), with an average age of 44.1±2.2. The primary data source for analysis was the foundational medical records, including medical histories and initial medical records. Results. The article presents the results of the analysis of the needs aimed at providing a cardiac surgery hospital with an adequate number of inpatient beds and substantiates the duration of treatment - inpatient stay (bed days). Determining these factors holds exceptional importance as it facilitates the delivery of high-quality specialized treatment to the ill and/or injured, ensuring their timely rehabilitation and return to active duty within the Armed Forces of Ukraine. It was observed that the study groups exhibited no significant distinctions in terms of nosological categories of circulatory system diseases, average age, and the number of bed-days, with no statistical significance identified. The analysis revealed that during the full-scale invasion of the Russian Federation into Ukraine's territory in 2022, the demand for cardiac surgery hospital beds surged by 266.3% when compared to the 2014 bed capacity. Notably, the number of bed-days saw only a modest 6.3% increase during inpatient treatment for servicemen. Conclusions. The study has shown that the number of bed days did not increase significantly in the inpatient treatment of military personnel, only by 6.3%. Due to the increase in the number of patients/wounded, the State Institution "Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine" opened a Military Cardiac and Major Vessel Surgery Department. This department specializes in providing highly specialized medical care to servicemen with combat-related heart injuries, major vessel wounds, and chest trauma.

Dedicated to the Memory of Academician Grigory Vasilievich Bondar and the 80th Anniversary of the Oncological Service of Donbass

The oncological service of Donbass has a rich history. The path of its formation began in 1943, when on September 9, 1943, Professor M.K. Afanasiev signed an order to restore the activities of the Stalin X-ray station and the oncological hospital.The first organizer of the radiological service in the Donbass is considered to be Ekaterina Vladimirovna Stelling, who was appointed in 1946 to the post of head of the oncological hospital in Stalino. The radiological service appeared in 1947, when the Regional Oncological Dispensary was organized. Soon the institution was renamed the Donetsk Regional Oncological Dispensary (DROD). Soon the institution was renamed the Donetsk Regional Oncological Dispensary. In 1955, DROD, in order to increase the number of beds, was transferred to the base of the Regional Clinical Hospital. M.I. Kalinin.Under the leadership of Grigory Vasilyevich Bondar, in September 1968, an oncology course was organized, the clinical base of which was DROD. August 19, 1975 Grigory Vasilyevich headed the Department of Oncology, established at the Donetsk State Medical Institute. M. Gorky. October 12, 1992 Donetsk Regional Oncology Center received the status of an antitumor center. Academician of the National Academy of Medical Sciences of Ukraine, Doctor of Medical Sciences, Professor Grigory Vasilyevich Bondar has been appointed its General Director.The center, which subsequently became the leading one in Ukraine, had the greatest experience in surgical and combined treatment of tumors of various localizations using the methods proposed in the clinic. In 2006, the first radiotherapy complex in Ukraine was installed in the Donetsk Regional Cancer Center.At the beginning of 2014, our teacher passed away. Students with dignity continue the work of Bondar Grigory Vasilyevich. At the end of 2014, on the basis of the Donetsk Regional Antitumor Center, the Republican Cancer Center of the Ministry of Health of the Donetsk People’s Republic was created, which was named after Professor Grigory Vasilyevich Bondar. The Center proudly bears the name of the great Teacher Grigory Vasilyevich Bondar! And in our present life, he is still a mentor and assistant!We are sure that the symbiosis of science and practice of a team of professionals who selflessly give their knowledge, experience and skills for the benefit of patients will give a powerful impetus to the further development of the oncological service of Donbass.

Adenocarcinoma of the Gartner’s duct. A case from practice

Background. A malignant tumour of the Gartner’s duct is one of the rarely encountered tumours in gynaecological oncology. Only in rare cases does the epithelium of the Gartner’s duct become a source of vaginal and cervical adenocarcinoma, as the Gartner’s duct is present in 25% of women, and mesonephric cysts occur in 1% of cases.
 Purpose. To familiarise the medical community with the peculiarities of the clinical course of malignant tumours of the Gartner’s duct and methods of their treatment.
 Materials and methods. Patient L., born in 1974, who underwent special treatment at the State Organization «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine» with a diagnosis of grade II adenocarcinoma of the Gartner’s duct (T2NxM0), clinical group 3.
 Results and discussion. After examination, the patient underwent two cycles of neoadjuvant polychemotherapy and a preoperative course of external beam radiation therapy (EBRT) on the vulvar area with a total radiation dose of 30 Gy. Two weeks later, surgery was performed to remove the tumour of the Gartner’s duct from the surrounding tissues. Three weeks after the surgery, the patient’s course of EBRT was extended to the total dose of 50 Gy, and 3 cycles of adjuvant polychemotherapy were performed. The follow-up period was 3 years, with no evidence of disease recurrence.
 Conclusions. The dissemination of information about this rare but serious disease will allow doctors to be informed, as well as to predict and diagnose it in a timely manner. As a result, they can plan adequate special treatment and determine the prognosis of this disease.

X-ray diagnostics of fire damage vessels of the abdominal cavity of the retroperitoneal space

This article deals with the analysis of damage to the main vessels of the abdominal cavity. In particular, the article is devoted to the radiological diagnosis of damage to the vessels of the abdominal cavity caused by gunshot wounds. The article examines various methods and technologies of using X-ray and computer tomographic imaging for accurate localization and characterization of damage to the vascular bed. The author of the article emphasizes the importance of the clinical significance of such a diagnosis, its advantages, and possible limitations in its use for effective treatment of victims. A detailed review of foreign research was conducted to adapt and study the existing world experience in the direction of research for the opportunity to provide timely and high-quality assistance to victims.
 The aim. The aim of the work is the theoretical substantiation of gunshot injuries to the main vessels of the abdominal cavity of the retroperitoneal space.
 Scientific novelty. For the first time, a detailed analysis of damage to the main vessels of the abdominal cavity of the retroperitoneal space was carried out.
 Materials and methods. Analysis of theoretical sources, comparison, induction of isolated analytical data. The research was conducted on the basis of the repository of scientific texts of the State Institution "Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine".
 Results. It was determined that with the help of MSCT-angiography, signs of damage to the main vessels of the abdominal cavity can be accurately diagnosed, additional information about damage to bone structures, neighbouring organs and tissues is obtained.
 Conclusions. It was determined that MSCT-angiography has become the main method of assessing gunshot injuries to the vessels of the abdominal cavity. Using this method allows you to accurately determine the location and nature of injuries, which helps doctors in choosing the optimal treatment plan for affected patients. However, it is important to consider the possible limitations of this method and to develop additional diagnostic strategies for a complete and comprehensive assessment of vascular injuries

Regarding the relevance of the issue of registering diseases of the circulatory system, combat injuries of the heart and major vessels in military personnel

Objective. To develop organisational measures to improve the provision of medical care to servicemen with the most common diseases of the circulatory system, combat injuries of the heart and major vessels by creating a clinical registry of this pathology.
 Materials and methods. The study concerned servicemen, exclusively men, who participated in the Anti–Terrorist Operation/Joint Forces Operation from June 2014 to January 2022, and servicemen of the Defence Forces of Ukraine who fought against Russian aggression from February 2022 to July 2023 (n=501). The age of the study participants ranged from 21 to 58 years, with an average age of (41.5 ± 2.2) years. The most common diseases of the circulatory system, combat injuries of the heart and major vessels were analysed.
 Results. A clinical registry of circulatory system diseases, combat injuries of the heart and major vessels in military personnel was created at the Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine as a leading scientific institution of cardiac surgery with sufficient material and technical resources, highly qualified medical staff and a developed network of regional support centres in Ukraine.
 Conclusions. The creation of clinical registries in the context of active hostilities is an extremely relevant organisational measure, since the information reflected in the clinical registry makes it possible to develop organisational measures to determine the need for cardiac surgery, improve the efficiency and quality of its provision in a short time.

Survival of elderly patients with glioblastoma after hypofractionated radiation therapy

Background. Glioblastoma (GB) is the most common primary brain tumor that is malignant, and its incidence increases with age. The prognosis for elderly patients with GB (GBe) is significantly worse than that of younger patients. Due to the global trend of aging population and age-related features of the GB cohort, the number of GBe patients is expected to increase. Although there is no full consensus regarding the clinical management of GBe, hypofractionated radiation therapy (RT) has become a common therapeutic option for elderly and/or poor prognosis GB patients.
 Purpose. To analyze the survival of patients with glioblastoma in the age group ≥60 years old after standard and hypofractionated regimens of adjuvant radiation therapy.
 Materials and methods. A retrospective single-center non-randomized study based on a total cohort of 53 patients (≥60 years old) with histogically verified diagnosis of GB was performed at the State Institution «Romodanov Neurosurgery Institute of the National Academy of Medical Sciences of Ukraine» over the period of 6 years, from 2014 to 2020. According to the RT regimen, patients were stratified into 2 groups: standard RT (SRT group) – 16 (30.2%) patients (30 fractions, 2.0 Gy per fraction, total radiation dose – 60.0 Gy) and hypofractionated RT (HRT group) – 37 (69.8%) patients (15 fractions, 3.5 Gy per fraction, total dose – 52.5 Gy). Cancer-specific survival (CSS) and progression-free survival (PFS) were analyzed in the total cohort and both groups separately.
 Results. With a median follow-up of 21.9 months (95% CI (confidence interval) 20.7 – 32.3), the median CSS in the total cohort was 15.0 (95% CI 13.3 – 17.3) months; the median PFS – 9.0 (95% CI 8.0 – 10.6) months. In the HRT group, the median CSS was 14.7 (95% CI 10.5 – 18.5) months; in the SRT group – 15.0 (95% CI 12.4 – 19.3) months. In the HRT group, the median PFS was 9.0 (95% CI 7.0 – 11.9) months; in the SRT group – 9.0 (95% CI 8.0 – 11.0) months. Before and after the stratification point of 15 months, the HRT and SRT groups did not differ significantly in CSS (Log-rank test p = 0.0588 and p = 0.2009, respectively). There was no significant difference in PFS between the HRT and SRT groups before and after the stratification point of 9 months (Log-rank test p = 0.0653 and p = 0.0722, respectively). Conclusions. Improving survival of GBe pts is an urgent issue, especially taking into account global trends in population aging and age-specific features of GB. The proposed hypofractionated RT regime can be considered as an optional approach in the complex treatment of GBe pts.

Features of radiofrequency catheter ablation in patients with atrial fibrillation and secondary atrial septal defect

Objective. To study the peculiarities of radiofrequency catheter ablation in patients with atrial fibrillation and secondary atrial septal defect. 
 Materials and methods. During 2008­2022, 54 (4.8%) patients underwent catheter ablation for atrial fibrillation at the Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine. The type, early and long­term results of surgical interventions were analyzed.
 Results. Pulmonary vein isolation was performed in all 54 (100%) patients; linear ablation of the left atrium ­ in 2 (3.7%), ablation of the cavotricuspid isthmus ­ in 28 (52.0%). The average duration of the procedure was (204.3 ± 60.5) minutes. Complications occurred in 9 (16.7%) patients. Atrial fibrillation was not detected in 44 (81.5%) patients with a secondary atrial septal defect 3 months after the procedure.
 Conclusions. Radiofrequency catheter ablation in patients with atrial fibrillation and secondary atrial septal defect is an effective and safe procedure with minimal complications. However, patients should be carefully selected for this procedure in the presence of an occluder and appropriate preoperative preparation should be performed.

Risk Factors for Acute Heart Failure in Patients with Infective Endocarditis

Background. Acute heart failure (AHF) in patients with infective endocarditis (IE) is an independent indication for urgent cardiac surgery according to international guidelines. Preoperative risk factors for AHF in patients with IE empower to build the route of a patient rationally according to clinical status.
 The aim. To analyze clinically significant risk factors for AHF in patients with IE.
 Materials and methods. A retrospective single-center study was conducted which included clinical data of 311 patients with IE who were treated at the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine for the period from January 1, 2019 to October 22, 2021. The mean age of the patients was 47.9 ± 3.83 (19 to 77) years. The proportion of men in the study was 81.7% (254 patients). The mean duration of IE was 2.6 ± 0.1 (1 to 11) months. Global database for IE patients was divided into separate cohorts with different problems associated with this pathology. Diagnosis of IE was established according to the Duke criteria. The causative agent was identified and results of antibioticogram were evaluated. All the patients were divided into classes according to the New York Heart Association (NYHA) functional scale. Patients with signs of AHF were assigned to NYHA class IV. There were 2 groups of patients: 252 (81.1%) patients without signs of AHF before surgery, 59 (18.9%) patients with preoperative AHF. The risk factors for the occurrence of AHF were analyzed. Statistical significance was set at p < 0.05. The intensive care unit length of stay and hospital length of stay were evaluated.
 Results. Risk factors for preoperative AHF in patients with IE: IE of the aortic valve (odds ratio (OR), 2.97 [1.57-6.91]) (p=0.003); concomitant inflammatory pathology of the lungs (OR 3.37 [1.55-7.11]) (р=0.003); linezolid resistance of the pathogen (OR 2.34 [1.07-4.26]) (р=0.026); vancomycin resistance of the pathogen (OR 2.25 [1.13-4.74]) (p=0.032); IE of the prosthetic heart valve (OR 1.155 [1.01-1.1]) (p=0.036); nosocomial nature of the disease (OR 2.14 [0.83-4.37]) (р=0.049). The intensive care unit length of stay was significantly longer in the group of patients with AHF (8.8 ± 0.7 days) than in the group of patients without AHF (4.8 ± 0.2 days) (р˂0.001). For 311 surgical interventions, the number of deaths was 7 (2.3%). The analysis of deaths according to the type of complications revealed that 4 (1.5%) patients died due to cardiac causes (263 cardiac complications). Among them, the largest share was made up of patients with AHF: 3 (1.4%).
 Conclusions. In clinical work, it is important to identify preoperative factors that are associated with the tactics of treatment of patients with IE in order to improve the results of cardiac surgery.

Surgical Correction of Dissecting Aortic Aneurysms Combined with Coronary Bypass Surgery in Marfan Syndrome

Introduction. The cohort of patients with aortic dissection and coronary heart disease is very complex, and their surgical treatment remains a relevant and debatable topic to this day. The presence of Marfan syndrome (MS) makes this difficult group of patients even more challenging. In this work, we present our own seven-year experience with the analysis of the impact of MS on the results of surgical treatment of patients with dissecting aortic aneurysm and coronary heart disease.
 Materials and methods. Nineteen consecutive cases of dissection of the aorta combined with lesions of the coronary arteries were analyzed. All the patients were operated at the premises of the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine from 2013 to 2022. Among them, 15 operations (78.9%) were performed for type A acute dissection of the aorta, 4 (21.1%) for type A chronic dissection of the aorta. Of the 19 operated patients, 5 (26.3%) had a diagnosed MS, 14 (73.7%) were the control group of patients with aortic dissection correction and aortocoronary bypass without MS.
 Results. A comparative analysis of two groups of patients showed more profound structural changes of the aortic wall especially with MS, which may affect the technical features of surgical intervention in this cohort of patients. Analysis of the mean time of perfusion, aortic clamping and intraoperative blood loss showed that the above indicators were not significantly different in both groups (p > 0.05). Indicators such as length of stay in the intensive care unit, length of stay on a ventilator, and the postoperative level of creatine phosphokinase-MB also were not significantly different in the observed groups.
 Discussion. In our study, we evaluated the effect of the presence of MS on the results of surgical correction of aortic dissection and coronary artery bypass grafting. According to the results of our study, it can be stated that MS does not significantly affect the results of surgical treatment, provided that careful approach to planning the operation is employed, and all available intraoperative methods that reduce the risk of postoperative complications are used.
 Conclusions. MS significantly accelerates the formation of aortic aneurysm, and also makes it more dangerous in the occurrence of acute dissection. In the group of patients with MS, damage to coronary arteries in most cases was associated with their involvement in the process of dissection, and only in some cases with atherosclerotic lesions. The use of all methods of bleeding prevention, as well as myocardial protection, allows to perform surgery in patients with MS with minimal risk.