[Extraosseous abnormalities and artifacts in skeletal scintigraphy].

OBJECTIVE: to specify frequency, patterns and diagnostic significance of extraosseous soft tissue findings in 99mTc-pyrophosphate skeletal scintigraphy. MATERIAL AND METHODS: Results of skeletal scintigraphy from 1060 patients (447 men, 613 women) were analyzed. Scanning in "whole body" mode started in 3-4 hours after 740 MBq of radiotracer activity intravenous administration, and performed in anterior and posterior projections in continuous table motion mode at rate of 6-8 cm per minute. Single photon emission computed tomography/computed tomography (SPECT/CT) was additionally performed when necessary. RESULTS: Extraosseous scintigraphic findings were discovered in 161 (15.2%) patients, they can be divided into three categories: nephrourological (7.7%), soft tissue (5.4%) and artifacts (2.1%). First category included anatomical and functional changes in the urinary system (kidney location anomalies and nonobstructive uropathies). SPECT/CT was performed to differentiate calycostasis in the projection of the upper group of calyces and focal changes of the ribs. Soft tissue extrarenal findings included diffuse or focal RP hyperfixation within breasts (29 patients), thyroid glands (15), myocardium (5), scrotum (4) and abdominal cavity (4). Symmetrical increased RP accumulation in breast or thyroid lobes was accepted as normal. Pathologic soft tissue findings in 11 patients were verified by history or instrumental data: breast cancer (2), testicular cancer (1), nodular goiter (2), uterine fibroids (2), primary cancer with liver metastases (1), association of "hot kidney" phenomenon with chemotherapy (2), and "superscan" phenomenon with myelofibrosis (1). Causes of radiotracer artifacts in the liver and spleen (14) were of radiopharmaceutical factors, in axillary lymph node (7)--partially infiltrative radiopharmaceuticals administration, in the colon (1)--previous myocardial perfusion scintigraphy. CONCLUSION: Analysis and interpretation of abnormal extraosseous findings in skeletal scintigraphy is an essential component of additional diagnostic information, that can influence subsequent diagnostic and therapeutic tactics.

[Unusual 99(m) Tc-pyrophosphate accumulation in aortic aneurysm detected by bone scintigraphy].

A clinical observation of focal accumulation of 99(m)Tc-pyrophosphate in aortic aneurysm, simulating skeletal pathology of the lumbar vertebra in planar scintigraphy mode, is presented. Additional single-photon emission computed tomography combined with computed tomography-something view allowed to confirm that the radiotracer uptake focus was localized in the distal part of the aneurysm, in the zone of lumen subocclusion by a calcified thrombus. It is suggested that the local tracer accumulation is not only due to calcification but also due to inflammatory, a factor that plays a role in the genesis of aortic aneurysm.

[Phantom kidney at angionephroscintigraphy].

Based on the analysis of the data available in the literature and own clinical observations, the authors consider the diagnostic value of the little known scintigraphic phantom kidney phenomenon, a vascular pool that is detected at the angiographic stage of 99mTc-DTPA dynamic renal scintigraphy and that mimics a removed or absent kidney. The paper describes two cases of the phantom kidney. In one case, the phantom kidney detected on the side of nephrectomy manifested a kidney cancer recurrence in the bed of the removed organ; in the other, the kidney-like vascular pool in the patient with left-sided pelvic dystopic kidney was due to the recording of the intestinal vasculature at the site of the expected kidney location. Adherence to a number of methodical conditions for conducting a study, as well as combined single-photon emission computed tomography/computed tomography examination will be able to avoid interpretation errors and to ensure an adequate further diagnostic algorithm.

[X-ray endovascular surgery in the trauma and orthopedic unit].

The review of X-ray endovascular surgical methods applied in the practice of FSF CITO named after N.N. Priorov since 1970 is presented. The complex evaluation of the altered conditions of performing angiographic examinations for the time present was carried out. The main regulations of anesthesiological provisions for angiographic studies in conditions of an in-patient trauma department are described. The methods of interventional X-ray surgery became use in patients with vertebral column and spinal medulla injuries, traumas with the threat of pulmonary thromboembolism and in patients with bone pathology. More than 200 patients with a traumatic disease of the spinal medulla and scoliotic deformities were investigated. In all patients spinal angiography with the evaluation of the spinal cord blood supply was performed. The results of more than 450 angiographic examinations the patients with bone pathology are presented. In 83 cases X-ray endovascular embolizations of the regional blood flow were done. 63 Cava Filters were implanted in patients with floating pelvic and leg vein thrombosis. Own expertise of the use of tentative Cava Filters is described. These and other data testify of X-ray endovascular methods prove to be in demand in traumatological and orthopedic practice. Their application will open new possibilities for traumatologists and orthopedists in the process of preventive measures, diagnostics and treatment the patients

[Lumbosacral pain syndrome in sportsmen and ballet-dancer (diagnostic algorithm)].

There is presented an experience of the examination of 517 cases including sportsmen and ballet dancers, 15-45 olds, suffering from low back pain syndrome. 265 patients were diagnosed with osteochondrosis, 105 cases--with spondylolis, 92--with facet syndrome, and 55 cases--with pelvic ligaments ligamentopathia. Based upon the analysis of the results of examination diagnostic algorithm and differential diagnostics of these diseases were developed. The use of the proposed algorithm in patients with dissimilar variants of low back pain syndrome showed its informational content. It permits to make a right diagnosis and apply an adequate therapeutic approach.

[Posttraumatic posterior knee instability].

At the department of the sport and ballet trauma new methods of arthroscopic management of posterior posttraumatic knee instability (posterior static stabilization of knee joint with using of single-banded and double-banded transplants) in dependence on the kind, degree and form of instability, were worked out and implemented into clinical practice. Such methods permit to attain a compensated or subcompensated form of knee joint stability. Ad hoc methods of management were used in 23 patients (20 males and 3 females). A total of 62 patients (51 males and 11 females) got operative treatment at the department, that permitted us to estimate fairly different methods of operative treatment of posttraumatic posterior knee joint instability. An operational intervention was performed in average 6 month after trauma. We received data in patients which had been treated with use of new methods of operative treatment as follows: good results were drawn in 93.3% (22 patients), satisfactory results--in 6.7% of cases (1 patient).

[The formation of self-care in patients suffered from tetraplegia by dint of maxillofacial muscles and a tongue with use of electronic mechanical vehicle].

Method for the restoration of self-service ability in patients with tetraplegia was proposed. The use of the elaborated computer controlled device in creases the efficacy of rehabilitation. A basic realization of technical facilities and software can be further developed. In particular, the plan is drawn to expand the software functional for the possibility of prompt input of the required word from the dictionary. Application of this technology has shown to give a possibility toa great number of handicapped people with limitations in using a computer and thus realizing their intellectual potential in education, work and leisure to restore their self-service ability. A significantsocial and economic effect from the introduction of this technology into practice is expected.

[The application of modern module hip and knee endoprostheses "mati-cito" in patients with tumors and postresectional femur and shin bone defects].

In the paper data concerning the use of new module hip and knee endoprostheses "MATI-CITO" in the course of conservative surgery in patients with large defects of femur and proximal shin-bone, arising during removal of tumors or developing as a result of side effects of preceding management, are presented. In given category of patients the causes of high-risk of complications diminishing an efficiency of operations are discussed. It was shown that sophistication of fabrication technologies and practical application of new endoprostheses gives an opportunity to significantly improve the functional results of treatment and to decrease of number of complications. The development such new medical technologies, as X-ray endovascular surgery, intraoperational reinfusion of own blood allows to decrease operational lethality, improve the performance status of patients and accelerate their rehabilitation

[New conceptions in complex management of spine trauma patients including reconstructive microsurgery and succeeding rehabilitation].

This work is been based upon the experience of performing 100 reconstructive microsurgical operations with transplantation of combined vascular-neural autografts, in 24 cases--with introduction cellular material into zone of transplantation. The complex approach aimed to creating optimal conditions for the functional regeneration of the spinal cord (SC), including neurosurgical methods restoring anatomical integrity of the organ and also multicomponent and staging rehabilitation of patients has been developed. On the base of complex approach during a postoperative period there has been put synchronous multifactorial action, consisting of functional multichannel electrical pacing of muscles simultaneously participating in tumble. The patient concentrates all his attention on the trial to tumble with paralized extremities by himself. At that the series and the site of application of these electrical impulses forms the algorithm of this tumble. Synchronism of produced afferent and efferent impulses creates new possibilities in activating of regenerating processes in the damaged area of the spinal cord. As a result of treatment within the bounds of the developed program the authors get clinically and electrophysiologically proved certain improvement that they can not only predict but guarantee patients of this group. Presented here results of the complex treatment of patients with trauma of the spinal cord within the framework of research international program confidently testify advantages of the new approach to solving of this problem. For the first time in history of medicine there is created close cooperation and regular continuity between molecular biology, neurosurgery and rehabilitation. This scientific alliance permits in proper time to keep a close watch, quickly correct and improve every stage of treatment. The effect of implement of innovations is been summarized at the each next stage of proposed complex treatment and eventually significantly elevates an ultimate result of medical rehabilitation of invalids with trauma of the spinal cord.

[The use of myolastan in athletes with myoenthetic injuries]. / Primeneie miolastana u sportsmenov s povrezhdeniiami mioéntezicheskogo apparata.

Myolastan was given to 9 sportsmen with acute muscular injury and 5 with chronic one in addition to the standard treatment. Control subjects with similar acute and chronic injuries (7 and 3 patients, respectively) were not given the drug. The patients with acute injuries on myolastan resumed muscular exercise 4.5 weeks after the trauma, while similar controls were able to do that only 6 weeks after it. Chronic injury patients returned to their routine loads 1 week earlier than controls. Myolastan proved effective in combined treatment of acute and chronic myoenthetic damage.

[Functional condition of the liver after surgical treatment of cirrhosis in children as revealed by hepatoscintigraphy]. / Funktsional'noe sostoianie pecheni posle khirurgicheskogo lechenia tsirroza pecheni u detei po dannym stsintigepatografii.

Scintigraphy with colloid 99mTc (56 cases) and the radiopharmaceutical preparation 99mTc--HIDA (43 cases) was performed in children with early and developed cirrhosis of the liver to study the functional condition of the hepatic Kupffer's and parenchymal cells in the long-term periods after surgical treatment. Increased activity of the parenchymal cells and inactivation of Kupffer's cells were revealed after splenectomy. The formation of a portocaval shunt and denervation of the hepatic artery promoted activation of hepatocyte functioning in these patients.

[A 99mTc-colloid study of the intrahepatic blood flow in liver cirrhosis in children]. / Issledovanie vnutripechenochnogo krovotoka s 99mTc-kolloidom pri tsirroze pecheni u detei.

Hepatoscintigraphic investigations were conducted in 63 patients aged 3 to 15 to study the features of intrahepatic blood flow and degrees of its compensation in children with liver cirrhosis of different stages. 99mTc-colloid was employed as a radiopharmaceutical. Disproportions of scintigraphic liver images showed close correlation with clinico-biochemical and morphological signs of the severity of disease. Subcompensation and decompensation of the organ blood flow and reticuloendothelial system in children with developed and terminal stages of liver cirrhosis are characterized by prolonged blood RP inhibition, a decrease in the total clearance of radioactive colloid, a progressively reduced index of liver clearance, and an increase in a colloid uptake by the spleen.

[Determination of the functioning volume of the liver by multipositional scintigraphy and emission-computed tomography]. / Opredelenie funktsioniruiushchego ob''ema pecheni s pomoshch'iu polipozitsionnoi stsintigrafii i émissionnoi komp'iuternoi tomografii.

The paper is concerned with methods for the determination of the liver volume using polypositional scintigraphy (PS) and computed emission tomography (SPECT). The accuracy of both methods was assessed using a liver phantom. The methods were tested in clinical practice on patients with diffuse liver lesions. A liver volume value compared with values in normometric tables as well as differences between a geometrical volume calculated by PS and a volume calculated by SPECT were of diagnostic importance.

[Stress fractures of the metatarsal bone in sportsmen (Jones' fracture)]. / Stressovyi perelom V pliusnevoi kosti u sportsmenov (perelom Dzhonsa).

The authors examine the peculiarities of the diagnosis, the clinical course and the roentgenologic manifestations of the fracture of the 5th metatarsal bone, the so-called Jones' fracture, in sportsmen. In this type of injury a good treatment result, i.e. the consolidation of the bone and the recovery of the foot at the early posttraumatic period is achieved by surgical treatment which provides for a necessary compression at the fracture site.

[Radionuclide and sonographic diagnosis of lesions of the hepatobiliary system in opisthorchiasis]. / Radionuklidnaia i sonograficheskaia diagnostika porazhenii gepatobiliarnoi sistemy pri opistorkhoze.

Radionuclide and sonographic studies of liver and biliary tract of 37 patients infested with O. felineus, including 7 patients with an early and 30 with late chronic disease were performed. Alterations in radionuclide and sonographic characteristics were revealed, pointing to dyskinetic disturbances in the gallbladder and to the cholestatic syndrome (reduced secretory function of the liver, dilated bile ducts, late visualization and reduced concentration function of the gallbladder). The most profound abnormalities in the indices were seen in patients early in the disease. Prasiquantel treatment contributed to rapid restoration of gallbladder motor function.

[Evaluation of the activity of liver and spleen macrophages in children with hepatitis A and B]. / Otsenka aktivnosti organnykh makrofagov pecheni i selezenki pri virusnykh gepatitakh A i B.

To form a judgement about function of liver and spleen macrophages (MP) in vivo, use was made of dynamic scintigraphy with Tc-colloid. Sixty-seven children aged 5 to 14 years were examined. Of these, 45 children were afflicted with virus hepatitis B (VHB), 16 with virus hepatitis A (VHA), and 6 children had VHA associated with asymptomatic HBsAg carriership. There was an appreciable decrease of the activity of liver MP attended by consistent compensatory activation of spleen MP in all the etiological types of virus hepatitis. The changes seen in patients with VHA and VHB turned out similar, differing in the rate of the recovery of normal correlations, which was more rapid in VHA. The characteristic feature of liver and spleen MP function in patients with VHA associated with HBsAg carriership consisted in the lack of the compensatory reaction on the part of spleen MP, which was likely to be connected with overstrain of long standing and depletion of the MP system due to permanent antigenic stimulation of HBsAg. The relationship was disclosed between the activity of organ MP and the phase of the infectious process, its gravity and course as well as the character of the patient's premorbid status and intercurrent infection.