Organs In Abdomen Research Articles

Age peculiarities of skin perfusion in different parts of anterior abdominal wall based on laser doppler flowmetry data

Introduction. Operations on the abdominal cavity organs and the anterior abdominal wall account for about 23.5–25.5 % of all surgical interventions. The incidence of infectious inflammatory complications after them varies widely and reaches 67 %. The role of adequate functioning of the microcirculation system in wound healing has been repeatedly confirmed by the literature. To interpret the pathology, it is necessary to determine the features of the physiological functional status of the anterior abdominal wall microcirculation. Purpose of the study. Study the features of local blood microcirculation in various areas of the anterior abdominal wall and their age-related changes.Materials and methods. Two groups of volunteers were examined: 30 young conditionally healthy persons (average age 21±0.7 years) and 30 patients of the Surgical Department of the Semashko Clinical Hospital without pathology of abdominal organs and abdominal wall (average age 62±5,9 years). Laser Doppler flowmetry (LDF) technique was used on the LAZMA PF device (OOO NPP LAZMA, Russia). Measurements were performed on the skin of the anterior surface of the middle third of the left forearm and in 9 regions of the anterior abdominal wall.Results. In the first group, the maximum microcirculation index was determined in the suprapubic region – 7.24±1.99 perfusion units (p. u.). A statistically significant difference occurred between the indices of basal blood flow of the upper and lower floors of the abdominal wall with the average (p<0.05). Among elderly patients, the forearm microcirculation index (5.19±0.78 p. u.) was comparable to the values in all areas of the anterior abdominal wall. The values of microcirculation index in nine regions of the anterior abdominal wall did not differ from each other, being in range of 4.25–4.94 p. u.Conclusion. When planning studies of blood microcirculation in the abdominal wall tissues, the specific anatomical region and age of patients should be taken into account.

Intraoperative evaluation of the intestinal wall viability

An analysis of data from national and foreign literature was carried out in terms of intraoperative determination of the intestinal viability in cases of developing the diseases in the abdominal cavity organs, associated with impaired intestinal blood supply. The basis of this work is the analysis of the modern literature on the methods of intraoperative evaluation of mesenteric ischemia. Impaired mesenteric blood supply is often the consequence of a number of reasons of developing critical conditions (mesenteric thrombosis, acute adhesive intestinal obstruction, incarcerated hernia etc.), also representing a high risk factor for lethal outcomes. Special attention is paid to the occlusion-related pathogenetic mechanism of developing mesenteric ischemia, which is accompanied by rapid development of irreversible morphological changes in the tissues and by significant disorders in the homeostasis systems of the organism. The generally available method for visual evaluation of the intestine viability is not always valid in terms of determining the degree of intensity of the ischemic changes in the intestinal wall. The algorithm of determining the intestine viability includes the determination of the intestine color, the peristaltic motions, the pulsation and the blood filling of mesenteric vessels with dynamic evaluation of these signs after the injecting the local anesthetic drug solution into the mesenterium and after “warming” the intestine with towels soaked in warm sodium chloride solution. In the current surgical conditions, a more precise method is required for intraoperative determination of the tissue viability. For the purpose of the objective evaluation of the intestinal blood supply, the recommendations include using intraoperative ultrasonic and laser Doppler flowmetry, as well as the regional transillumination angiotensometry of the intramural vessels in the small intestine. At the same time, a number of optical spectroscopy and visualization methods show high sensitivity to changes in blood microcirculation without using exogenous contrasting, which can also be successfully used when evaluating the intestinal circulation. According to data from modern literature, there is still controversy on the efficiency of various methods for intraoperative evaluation of disorders of the regional blood microcirculation and the intestine viability, which justifies the conduct of further research works.

Active constrained motion control for a robot-assisted endoscope manipulator in pediatric minimal access surgery.

Robot-assisted laparoscopic surgery has three main system requirements: safety, simplicity, and intuitiveness. However, accidental movement of the endoscope due to body fatigue and misunderstanding of the verbal orders between the surgeon and assistant will contribute to highly unexpected tool-tissue interactions, particularly in pediatric minimal access surgery with restricted working space. This study introduces a compact, lightweight endoscope manipulator with a mechanical remote-center-motion function. Using a custom-designed human-machine interface, the surgeon can intuitively control the movement of the endoscope manipulator over their view. In addition, an active constrained motion control algorithm is proposed to generate a forbidden-region constraint for avoiding collisions between the endoscope tip and surrounding organs in a pediatric abdominal cavity with restricted space. Simulations and experiments demonstrate the performance of the proposed compact endoscope manipulator and the active constrained surface tracking control scheme.

Phytobezoar as a Cause of Recurrent Obturation Intestinal Obstruction. A Clinical Case in Surgical Practice

Introduction. Phytobezoar refers to a foreign body accumulated in the stomach when swallowing substances of natural or synthetic origin. Phytobezoar is formed in the stomach and small intestine, its etiopathogenesis is yet to be investigated. It causes obturation intestinal obstruction, which requires emergency surgical intervention. The paper presents a clinical case in surgical practice of phytobezoar in the small intestine which was complicated by a recurrent obturation intestinal obstruction. Aim: to present a clinical case of phytobezoar in the form of recurrent obturation intestinal obstruction. Materials and methods. 66­years old female patient Kh. underwent surgical treatment for obturation intestinal obstruction caused by phytobezoar twice within a short period of time. The gastric resection and consumption of bezoar-dangerous products due to a dried­fruit diet were considered to be the prerequisite for the formation of phytobezoar. According to the pathomorphologic examination, the intervention included laparotomy, enterotomy and phytobezoar extraction. Results and discussion. A complete revision of the abdominal cavity organs was performed during the first laparotomy with no other fragments of phytobezoar found. Following the first surgery and before discharge, the patient underwent ultrasound, CT scan of abdominal cavity organs, fibrogastroscopy — no volumetric pathologic formations in the abdominal cavity were detected. Therefore, the phybobezoar was assumably formed again in a relatively short period of time and led to the development of reobstruction. The patient was discharged with recovery.Conclusion. The clinical case shows that in surgical practice phytobezoar can get formed repeatedly in a short period of time and lead to the development of recurrent intestinal obstruction.

Structural tensor and frequency guided semi-supervised segmentation for medical images.

The method of semi-supervised semantic segmentation entails training with a limited number of labeled samples alongside many unlabeled samples, aiming to reduce dependence on pixel-level annotations. Most semi-supervised semantic segmentation methods primarily focus on sample augmentation in spatial dimensions to reduce the shortage of labeled samples. These methods tend to ignore the structural information of objects. In addition, frequency-domain information also supplies another perspective to evaluate information from images, which includes different properties compared to the spatialdomain. In this study, we attempt to answer these two questions: (1) is it helpful to provide structural information of objects in semi-supervised semantic segmentation tasks for medical images? (2) is it more effective to evaluate the segmentation performance in the frequency domain compared to the spatial domain for semi-supervised medical image segmentation? Therefore, we seek to introduce structural and frequency information to improve the performance of semi-supervised semantic segmentation for medicalimages. We present a novel structural tensor loss (STL) to guide feature learning on the spatial domain for semi-supervised semantic segmentation. Specifically, STL utilizes the structural information encoded in the tensors to enforce the consistency of objects across spatial regions, thereby promoting more robust and accurate feature extraction. Additionally, we proposed a frequency-domain alignment loss (FAL) to enable the neural networks to learn frequency-domain information across different augmented samples. It leverages the inherent patterns present in frequency-domain representations to guide the network in capturing and aligning features across diverse augmentation variations, thereby enhancing the model's robustness for the inputting variations. We conduct our experiments on three benchmark datasets, which include MRI (ACDC) for cardiac, CT (Synapse) for abdomen organs, and ultrasound image (BUSI) for breast lesion segmentation. The experimental results demonstrate that our method outperforms state-of-the-art semi-supervised approaches regarding the Dice similaritycoefficient. We find the proposed approach could improve the final performance of the semi-supervised medical image segmentation task. It will help reduce the need for medical image labels. Our code will are available at https://github.com/apple1986/STLFAL.

Free radical fragmentation and oxidation in the polar part of lysophospholipids: Results of the study of blood serum of healthy donors and patients with acute surgical pathology

The interaction of reactive oxygen species with cell membrane lipids is usually considered in the context of lipid peroxidation in the nonpolar component of the membrane. In this work, for the first time, data were obtained indicating that damage to human cell membranes can occur in the polar part of lysophospholipids at the interface with the aqueous environment due to free radical fragmentation (FRF) processes. FRF products, namely 1-hexadecanoyloxyacetone (PAc) and 1-octadecanoyloxyacetone (SAc), were identified in human serum, and a GC-MS method was developed to quantify PAc and SAc.The content of FRF products in serum samples of 52 healthy donors was found to be in the range of 1.98–4.75 μmol/L. A linear regression equation, CPAc&SAc (μmol/L) = 0.51 + 0.064 × years, was derived to describe the relationship between age and content of FRF products. In 70 patients with acute surgical pathology in comparison with the control group of healthy donors, two distinct clusters with different concentration levels of FRF products were revealed. The first cluster: groups of 43 patients with various localized inflammatory-destructive lesions of hollow organ walls and bacterial translocation (septic inflammation) of abdominal cavity organs. These patients showed a 1.5–1.9-fold (p = 0.012) decrease in the total concentration of PAc and SAc in serum. In the second cluster: groups of 27 patients with ischemia-reperfusion tissue damage (aseptic inflammation), – a statistically significant increase in the concentration of FRF products was observed: in 2.2–4.0 times (p = 0.0001).The obtained data allow us to further understand the role of free-radical processes in the damage of lipid molecules. FRF products can potentially be used as markers of the degree of free-radical damage of hydroxyl containing phospholipids.

Pathophysiology of the gastrointestinal tract in burn disease

The review of foreign publications resulted in a generalisation of medical reports on the pathological changes of the gastrointestinal tract in burn disease. Burn disease produces an immediate reaction in all organs and systems, which are not always able to maintain homeostasis and frequently suffer pathophysiological and morphological damage. One of those target systems is the gastrointestinal tract. Only in very rare cases do severe (mainly electrical) burns cause direct injury to the abdominal cavity organs, thus resulting in a very severe clinical course and high mortality. Patients of all ages who have experienced a burn injury have an increased overall risk of developing gastrointestinal diseases, which include pathology of the esophagus, stomach, and intestines, as well as lesions of the gallbladder, biliary tract, and pancreas. With a burn area of 40—95%, 5.7% of the victims were diagnosed with pathology of the abdominal organs. Among them, 26.0% had an abdominal catastrophe (infarction or perforation), 37.0% had bleeding from the upper parts of the gastrointestinal tract, 32.0% had paralytic intestinal obstruction, and 5.0% developed pancreatitis and acute necrotizing cholecystitis. Large burns are usually associated with a significant decrease in splanchnic perfusion. After severe burns, intestinal ischemia and hypoxia disrupt the intestinal epithelial barrier and enteric bacterial translocation, leading to serious complications such as systemic inflammatory response syndrome, sepsis, and multiple organ failure. Peritonitis or gastrointestinal bleeding accounted for 88.2% of deaths among patients with gastrointestinal dysfunction. In general, gastrointestinal dysfunction was more common in patients with inhalation injuries, burn shock, large burn areas, and high analgesic requirements.

INTERPLAY OF METABOLIC DYSREGULATIONS, OBESITY, PATHOLOGIES OF ABDOMINAL ORGANS, RESPIRATORY ORGANS, CARDIOVASCULAR SYSTEM, AND CHRONIC KIDNEY DISORDERS AS POTENTIAL RISK FACTORS FOR MALIGNANT NEOPLASMS IN THE CONTEXT OF PALLIATIVE MEDICAL PRACTICE

Metabolic changes, obesity, diseases of the abdominal cavity organs, respiratory organs, cardiovascular system, and chronic kidney diseases are risk factors for the development of malignant neoplasms. This poses new challenges in palliative practice: the use of integrated methods, the study of new biomarkers, and the application of modern technologies, the formation of professional readiness of medical personnel for activities in the field of palliative and hospice care. Objective. The study aims to conduct an epidemiological analysis of the prevalence and comorbidity of malignant neoplasms among patients in northern Bukovyna and to analyze the relationship between metabolic changes, obesity, diseases of the abdominal cavity organs and respiratory organs, cardiovascular system, and chronic kidney diseases as risk factors for the development of malignant neoplasms in the context of palliative medical practice. Material and methods. Clinical data of patients, data on metabolic status and obesity, information on the condition of abdominal cavity organs, respiratory organs, cardiovascular system, and kidneys, results of diagnostic tests, as well as applied statistical methods for assessing the relationships between different factors and the risk of malignant neoplasms were utilized.Results. The obtained results indicate a significant impact of metabolic changes, obesity, and diseases of various organs on the increased risk of malignant neoplasms in patients undergoing palliative care. The identified correlations underscore the necessity of an integrated approach to treatment, focused on managing metabolic status and systemic diseases. The discussion complements this by highlighting potential interaction mechanisms and pointing out opportunities for improving palliative care through emphasis on prevention and management of these risk factors.Conclusion. The research highlights the importance of understanding and managing metabolic, organic, and systemic risk factors, as they are interdependent in palliative practice, pointing to potential opportunities for improving treatment outcomes and the quality of life for patients with malignant diseases.

Possibilities of using the virtual simulator "Vimedix 3.2" in the process of training in the specialty "ultrasound and diagnostics"

Background. In recent years, it is important to change the methods and programs of teaching many disciplines, including ultrasound diagnostics, with the inclusion of various virtual and simula-tion devices. The practical experience of using such technologies in the teaching process is rather short, therefore, there are few original works devoted to this topic in Russian and foreign literature.Aims. To determine the possibilities and algorithm of using virtual simulator of ultrasound re-search in the process of teaching the discipline of "ultrasound diagnostics" on the basis of the results of work with it. To evaluate the advantages and disadvantages of using simulator in comparison with traditional teaching methods.Material and methods. The results of using the virtual simulator "Vimedix 3.2" in the educa-tional process were analyzed. Simulations of transabdominal ultrasound examination of abdominal cavity organs, transthoracic echocardiography, triplex scanning of main vessels were performed on it. The study involved 26 residents in the specialty "ultrasound diagnostics", as well as 47 physicians who were trained at professional retraining courses.Results. The use of a virtual simulator at the initial stage in the training process can eliminate many of the problems that residents and trainees encounter in clinical sites. The use of a simulator in the testing process seems to be less favorable than a practical examination using ultrasound scanners and real patients.Conclusions. It is advisable to use the simulator at the initial stage to practice the research methodology. It is recommended to develop and use additional teaching materials and programs in training. The advantages of the virtual simulator are comfort of work at the initial stage of training, short time of its mastering, availability of an extensive database of pathological cases. The identified non-critical deficiencies require correction during further training in the clinic.

Assessment of the diagnostic significance of endoscopic ultrasonography in the differential diagnosis of formations of the hepatopancreatoduodenal zone

Purpose of the work. To study the structure of the hepatopancreaticoduodenal zone (HPD) masses according to the endosonographic picture and to estimate the diagnostic informativeness of endoscopic ultrasonography (EUS) in diagnostics of these masses in comparison with ultrasound examination of HPD (ultrasound of HPD) and computer tomography of abdominal cavity organs (CT of OBP) with contrasting. Materials and Methods. A retrospective analysis of medical records of 71 patients with GDZ masses who underwent inpatient treatment in the department of abdominal surgery and applied for diagnostic purposes to the endoscopic centre of Karaganda Multidisciplinary Hospital No.3 for EUS for the period from January 2021 to December 2022 was carried out. Results and discussion. Sensitivity of EUS in differential diagnostics of PG tumours, hepaticocholedochal dilatation, vascular invasion and metastasis to regional lymph nodes was 85%, 94,12%, 64,71% and 100% respectively, specificity - 95,93%, 100%, 80% and 92% respectively. Conclusion. Correct assessment of all manifestations of a tumour influences the choice of treatment tactics and consequently its immediate and long-term results. EUS is an effective method of differential diagnostics of pseudocysts and cystic tumours of PG, tumours of large duodenal papilla (LDP), as well as biliary tract neoplasms.

Comparative Characterisation of Proliferation and Apoptosis of Colonic Epithelium after Electron Irradiation with 2 GY and 25 GY.

Development of new techniques for multimodal treatment and diagnostics of various neoplasms and the improvement of current techniques can significantly increase the life expectancy of patients with carcinomas of the colon and abdominal-cavity organs, since prevention of various side effects of radiation therapy is one of the main problems of oncological care. Electron irradiation is one of the most promising types of radiation therapy. There are no data on proliferation and apoptosis of the colon epithelium after irradiation with electrons, especially in different modes (single and summary). Morphological evaluation of apoptosis and proliferation of colonic epithelium after local irradiation with electrons were conducted at doses of 2 Gy (Gray) and 25 Gy. Colon fragments from sexually mature Wistar rats (n = 50, body weight 200 ± 10 g) were divided into three groups: I-control (n = 10); II-experimental group (n = 20; local single electron irradiation at a dose of 2 Gy); III-experimental group (n = 30) with local fractional irradiation with electrons at a total dose of 25 Gy. They were studied using light microscopy using hematoxylin and eosin staining and immunohistochemical reactions with antibodies to Ki-67 and caspase-3 (Cas3). Morphological disorders were accompanied by increased expression of pro-apoptotic molecules (caspase-3), and the period of regeneration by proliferative marker (Ki-67). Colon electron irradiation led to disturbances in the histoarchitecture of varying severity, and an increase in cell apoptosis was observed (increased expression of caspase-3 and decrease in Ki-67). In addition, modulation of the PI3K/AKT and MAPK/ERK signalling pathways was detected. The most pronounced destructive changes were observed in the group of 25 Gy fractionated electron irradiation.

The association of TLR4 gene polymorphisms with the severity of peritonitis in acute inflammatory diseases of the abdominal cavity organs.

Aim: To determine the role of TLR4 gene polymorphisms as risk factors for peritonitis severity in patients undergoing surgery for acute inflammatory diseases of the abdominal cavity. Materials and Methods: The study included 139 patients who were operated on for acute abdominal diseases (acute appendicitis and cholecystitis, perforated gastric or duodenal ulcer, etc.). Depending on the number of points on the modified APACHE II scale, patients were divided into two groups: Group 1 - 1-3 points (63 patients, 45.3%) and Group 2 - 4 or more points (76 patients, 54.7%). Polymorphisms rs1927911, rs2149356 and rs4986790 were determined by polymerase chain reaction. Results: The rs1927911 polymorphism of the TLR4 gene was protective for the development of peritonitis (according to the allelic model, OR 0.48; 95% CI 0.27-0.84; p=0.015). Regression analysis revealed a reduced (p=0.015) risk of severe peritonitis in rs1927911 A/A or G/A genotype carriers (OR 0.42; 95% CI 0.21-0.84) compared with G/G genotype carriers. There was no effect on the severity of peritonitis of TLR4 polymorphisms rs2149356 and rs4986790. There was a tendency to increase the frequency of the mutant G rs4986790 allele in patients with severe peritonitis (χ2=2.17; p<0.001). The analysis of the association of TLR4 gene polymorphisms with the phenotype of patients showed that carriers of mutant homozygotes and heterozygotes in the presence of severe peritonitis were older, had a tendency to coagulopathy, higher leukocytosis and leukocyte clotting rate. Conclusions: Thus, the importance of TLR in the development of severe peritonitis was confirmed and the protective role of the rs1927911 promoter polymorphism was established.

Causes of digestive symptoms in patients with COVID-19

This literature review discusses the problem of the causes of digestive symptoms in COVID-19 patients, examining papers in which SARS-CoV-2 gastrointestinal infection was the underlying cause of symptoms and papers in which the occurrence of such symptoms was associated with exacerbation of pre-existing, including previously undiagnosed GI diseases.&#x0D; Objective: to identify the most likely underlying cause of digestive symptoms in COVID-19 patients. Materials and Methods. We searched 59 literature sources from eLibrary, PubMed, Scopus, and Google scholar databases. All papers were published in the last 4 years.&#x0D; Results. The resulting digestive symptoms in coronavirus lesions are caused by direct disruption of the intestinal barrier; also, these symptoms may be a manifestation of exacerbation or debut of chronic digestive diseases on the background of COVID-19, and exacerbate the course of infection; or a result of COVID-19 therapy. A differential diagnosis of COVID-19 with inflammatory bowel diseases, chronic liver diseases, chronic and acute biliary pancreatitis is required in patients with diarrhea, abdominal pain, elevated blood liver and pancreatic enzymes. The correlation of gastroenterological symptoms with the direct COVID-19 lesion can be established by comparing the clinical picture with the detection of RNA virus in stool, histologic specimens, but sometimes there may be no unambiguous answer. Specific changes on computed tomography with angiography of the abdominal cavity organs (peri-intestinal fatty tissue strands against the background of intestinal wall thickening) are described only in the initial stage of COVID-19, at later stages the changes are nonspecific. Data from endoscopic studies in patients with COVID-19 are limited to single clinical cases or case series describing nonspecific findings and suggesting that the virus directly damages GI mucosal surfaces. This calls into question the results of the studies that have been conducted, most of which were retrospective and did not evaluate the baseline presence of gastrointestinal symptoms prior to COVID-19. Due to the peculiarities of the virus interaction with body cells and the diversity of clinical manifestations of the disease, a combined approach in the diagnosis of GI diseases in COVID-19 is necessary.

Flexion–distraction injuries of the spine: Features of diagnostics, clinical picture, and results of surgical treatment of children

BACKGROUND: Flexiondistraction injuries of the spine result from high-energy trauma (traffic accidents and falls from a height). This type of injury is commonly found in the thoracolumbar junction. Among combined injuries in the presence of flexiondistraction fractures of the vertebral column, injuries of the chest or abdominal organs are often observed, which are crucial for patient survival, and their diagnostic measure is complex because of the severe and unstable conditions of the patients.&#x0D; AIM: To analyze a cohort of pediatric patients who underwent surgery for flexiondistraction injury of the spine.&#x0D; MATERIALS AND METHODS: We analyzed the data of clinical and instrumental studies and surgical outcomes of 28 pediatric patients (aged 217 years) with flexiondistraction injuries of the spine. The standard preoperative examination included clinical and laboratory studies, spondylography, multislice spiral computed tomography and magnetic resonance imaging of the damaged area, electrocardiography, and ultrasonography of the abdominal organs and kidneys. All patients underwent surgery for the correction and stabilization of traumatic spinal deformity with a multisupport metal structure and posterior local fusion. The analysis included an assessment of the mechanism of injury, concomitant injuries, time elapsed after the injury before admission to the hospital, level of the damaged segment, and treatment. Data were processed statistically using an online calculator. The nonparametric MannWhitney method was used.&#x0D; RESULTS: Catatrauma was the leading cause of injury in 50% of the patients, compared with traffic accidents in 36%. In 80% of the patients, spinal injury was localized at the thoracolumbar junction and lumbar spine. Moreover, 71% of the patients were transferred to the National Research Center for Childrens Orthopedics and Trauma Surgery for surgical treatment on the spine in the early stages after injury (up to 7 days), and 8 children (19%) were admitted within 1045 days (average 16 days). In 19 (68%) patients, in addition to spinal injury, concomitant injuries occurred, with skeletal trauma and injuries of the abdominal cavity organs as the most frequent. All patients achieved complete correction of the deformity at the level of the damaged segment.&#x0D; CONCLUSIONS: Flexiondistraction fractures of the spine in children are characterized by a high incidence of concomitant injuries, which dictates the need for a full examination to identify them and correctly interpret the data. The elimination of mechanical instability in the early stages in this type of injury can reduce the extent of fixation and contribute to the restoration of the physiological profile and disk apparatus of the spinal column.

A primary multiple pleomorphic rhabdomyosarcoma of the heart in an adult dog

BackgroundHeart tumors are rare in dogs. They can be benign or malignant. Clinical signs depend primarily on the location of the tumor and its effect on blood flow.Case presentationAn eleven-year-old crossbreed male dog lethargic and anorectic for previous 3 days was presented to the veterinary clinic. The focused ultrasound assessment with sonograms in trauma (FAST) revealed multiple tumors in the heart which were then confirmed in echocardiographic examination performed by a veterinary cardiologist. Due to the poor general condition and grave prognosis, the dog was humanely euthanized. The autopsy revealed numerous intracardiac tumors in all four heart chambers. No proliferative changes were found in other organs either in thoracic or abdominal cavity. Immunohistochemical examination was performed using formalin-fixed, paraffin-embedded tissue from heart masses. The antibodies against myoglobin, desmin, smooth muscle actin, vimentin, CD34, S100, and pan-cytokeratin (AE1/AE3) were used. Microscopically, the tumor was composed of fascicles of spindle-shaped cells with pale eosinophilic cytoplasm with round, oval, and focally elongated nuclei and one or two prominent nucleoli. The tumor cells showed strong diffuse cytoplasmic immunopositivity for myoglobin and vimentin and focal staining for desmin. Immunostainings for smooth muscle actin-SMA, CD34, pan-cytokeratin, S-100 protein were negative. The immunohistochemical staining pattern confirmed rhabdomyosarcoma.ConclusionsThis is the first description of the primary multiple heart rhabdomyosarcoma in a dog.

Deep learning auto-segmentation on multi-sequence magnetic resonance images for upper abdominal organs.

Multi-sequence multi-parameter MRIs are often used to define targets and/or organs at risk (OAR) in radiation therapy (RT) planning. Deep learning has so far focused on developing auto-segmentation models based on a single MRI sequence. The purpose of this work is to develop a multi-sequence deep learning based auto-segmentation (mS-DLAS) based on multi-sequence abdominal MRIs. Using a previously developed 3DResUnet network, a mS-DLAS model using 4 T1 and T2 weighted MRI acquired during routine RT simulation for 71 cases with abdominal tumors was trained and tested. Strategies including data pre-processing, Z-normalization approach, and data augmentation were employed. Additional 2 sequence specific T1 weighted (T1-M) and T2 weighted (T2-M) models were trained to evaluate performance of sequence-specific DLAS. Performance of all models was quantitatively evaluated using 6 surface and volumetric accuracy metrics. The developed DLAS models were able to generate reasonable contours of 12 upper abdomen organs within 21 seconds for each testing case. The 3D average values of dice similarity coefficient (DSC), mean distance to agreement (MDA mm), 95 percentile Hausdorff distance (HD95% mm), percent volume difference (PVD), surface DSC (sDSC), and relative added path length (rAPL mm/cc) over all organs were 0.87, 1.79, 7.43, -8.95, 0.82, and 12.25, respectively, for mS-DLAS model. Collectively, 71% of the auto-segmented contours by the three models had relatively high quality. Additionally, the obtained mS-DLAS successfully segmented 9 out of 16 MRI sequences that were not used in the model training. We have developed an MRI-based mS-DLAS model for auto-segmenting of upper abdominal organs on MRI. Multi-sequence segmentation is desirable in routine clinical practice of RT for accurate organ and target delineation, particularly for abdominal tumors. Our work will act as a stepping stone for acquiring fast and accurate segmentation on multi-contrast MRI and make way for MR only guided radiation therapy.

Differential approach to the diagnosis and treatment of appendicular peritonitis in children

The incidence of appendicular peritonitis (AP) is 3-4 % among all acute surgical diseases in children, and the structure of acute appendicitis in recent decades fluctuates within 10-15 %. Timeliness and informativeness of acute abdomen diagnostics remain important tasks of clinical practice. The use of laparoscopy with its possibility of diapeutic approach allows to diagnose and eliminate the cause of the disease. On the basis of the surgical department of the Children's City Clinical Hospital No. 1 in Nizhny Novgorod. In the period from 2018 to 2022, 126 (11.2%) patients with various types of AP were treated in Nizhny Novgorod. All children were examined with assessment of general and local status, laboratory tests were performed using unified methods developed for practical healthcare. In complicated or doubtful cases, ultrasound of the abdominal cavity organs was performed (Vivid-7 of expert class using high-frequency transducers: convex (frequency up to 5 MHz) and linear (frequency up to 10 MHz). Local forms of AP prevailed – 90 %, of which appendicular abscess was found in 35 % of observations. Data of anamnesis, examination of patients, assessment of purulent-inflammatory markers in complicated and controversial situations were resolved by ultrasound of abdominal cavity organs. Instrumental diagnostics allowed them to detect anechogenic contents (effusion), delimited areas of absceding between the intestinal loops, perforation defect of the appendix wall, periappendicular abscess forming. Within the framework of surgical correction the priority was given to laparoscopy (59.5 %), a modern therapeutic and diagnostic method with a diapeutic approach. Open interventions were used in 51 (49.5%) patients, of which: Sprengel's access was performed in 31 (61%) patients, Volkovich-Dyakonov was used in 19 (37%) cases, midline laparotomy was performed in 1 child. Analysis of the results of bacteriological studies allowed us to identify the leading pathological pathogens belonging to Gram-negative or Gram-positive flora. In the postoperative period, therapy corresponding to the treatment of patients with peritonitis was prescribed. Evaluation of bacteriological examination revealed that Enterobacteriaceae (87%), non-fermenting bacteria (72%) were susceptible to all antibiotics. However, the highest susceptibility (73 %) was noted to cephalosporins. All children were discharged home in satisfactory condition, with an average bed-day of 12.32 ± 2.4.

Chronic viral hepatitis B and C in pediatric patients: possibilities of ultrasound techniques for patients’ management

Chronic viral hepatitis B and C have already become one of the medical and social problems of modern hepatology and paediatrics due to their high prevalence and ability to transform liver parenchyma and form additional complications. Nowadays, it is important to assess and examine patients by ultrasound techniques to estimate changes in morphometric, hemodynamic, and echoacoustic characteristics of the liver in patients with viral hepatitis B and C.&#x0D; The aim: to estimate ultrasound morphometric parameters and hemodynamic indexes, morphological deviations of the liver and spleen in pediatric patients with chronic viral hepatitis B and C by implementing of the system as Y. Davoudi diagnostic scale (2015) and analysis of echo-acoustic patterns.&#x0D; Materials and methods. 34 children were examined. 19 children with chronic viral hepatitis B and C formed group I, while 15 almost healthy children formed group II. All examined patients underwent collecting of anamnesis, general clinical examination, determination of the degree of liver fibrosis by non-invasive method (Fibrotest or fibroelastometry) and ultrasound examination of the abdominal cavity organs with the possibility of Doppler scanning. Differences at p&lt;0.05 were considered statistically significant.&#x0D; Results. Obtained data showed that in patients of group, I index of Y. Davoudi grayscale was higher (2,6±0,26 U) compared with patients of group II (1,4±0,32 U) (p&lt;0,01). Systolic blood flow velocities in the portal vein and the splenic vein were decreased in patients of group I (15,59±0,4 cm/s; 15,7±0,8 cm/s) compared with group II (17,68±0,8 cm/s; 17,54±0,42 cm/s) (p&lt;0,05), resistance index in the hepatic artery was increased in patients of group I (0,78±0,02 IU) compared with patients of II group (0,68±0,04 IU) (p&lt;0,05). Histogram indexes of the liver and liver-kidney region were higher in patients of group I (p&lt;0,001).&#x0D; Сonclusions. Y.Davoudi diagnostic scale, hemodynamics parameters of the portal, splenic and hepatic vessels, echoacoustic patterns and other indexes could be prognostic factors which will indicate liver fibrosis progression in patients with chronic viral hepatitis B and C. The analysis of the obtained data showed that deviations in morphometric, echoacoustic and Doppler indexes of liver and spleen in paediatric patients with chronic viral hepatitis B and C were more clinically significant compared with almost healthy children and could be taken into account as liver fibrosis predictors

Association between intra-abdominal injured organs and abdominal compartment syndrome in patients with severe blunt trauma: A propensity score matched study using nationwide trauma registry in Japan.

Abdominal compartment syndrome (ACS) after blunt abdominal trauma is a rare complication that requires early recognition and subsequent surgical intervention for optimal outcome. We aimed to investigate how differences in injured abdominal organs affect ACS development in patients with severe blunt abdominal trauma. This nested case-control study used a nationwide registry of trauma patients, namely, the Japan Trauma Data Bank (JTDB), and only included patients aged ≥ 18 years with blunt severe abdominal trauma, defined as an AIS score of abdomen ≥ 3, sustained between 2004 and 2017. Patients without ACS were used as control subjects and identified using propensity score (PS) matching. Characteristics and outcomes between patients with and without ACS were compared and logistic regression was used to identify specific risk factors for ACS. Among 294,274 patients in the JTDB, 11,220 were eligible for inclusion before PS matching, and 150 (1.3%) developed ACS after trauma. PS matching led to the inclusion of 131 and 655 patients with and without ACS, respectively. Compared to controls, patients with ACS had higher number of injured organs in the abdomen and displayed a greater frequency of vascular and pancreatic injuries, need for blood transfusion, and disseminated intravascular coagulopathy, a complication of ACS. In-hospital mortality was higher in patients with ACS than those without ACS (51.1% vs. 26.0%, p < 0.01). Logistic regression analysis revealed that a higher number of injured organs in the abdomen [odds ratio (OR) (95% confidence interval [CI]): 1.76 (1.23-2.53)] and pancreatic injury [OR (95% CI): 1.53 (1.03-2.27)] were independently associated with ACS. Greater number of injured organs in abdomen and pancreatic injury are independent risk factors for the development of ACS.

From the history of the evolution of laparoscopic surgery in the Northern Scientific Medical School of Obstetricians and Gynecologists

This article provides information on the history of the evolution of laparoscopy in the Northern Scientific Medical School of Obstetricians and Gynecologists. D.O. Ott discovered a way of visualising the organs of abdominal cavity (ventroscopy) and became the first surgeon in the world who performed the endoscopic interventions of the organs in abdomial cavity. Foreign and Russian scientists, including those from Arkhangelsk, as well as practitioners, who are presented in this article, have contributed a lot to the development of laparoscopy in gynecology. Laparoscopy in gynecology of today is an endovideosurgery, which has become a part of the routine practice of gynecologists. Laparoscopic surgery has become one of the most promising areas in gynecology for residents of the European North of Russia, focused on minimizing surgical trauma and improving the quality of patient care.