ULTRASOUND DIAGNOSTICS OF CERVICAL CHANGES WITH DIFFERENT LOCALIZATION OF THE CERVICITIS IN WOMEN WITH THE ECTOPY OF THE VAGINAL PORTION OF THE CERVIX.

The aim of the study was to improve the diagnosis of structural changes in all parts of the cervix depending on the preferential localization of the inflammatory process - in the ectocervix, endocervix, and also in the stroma in women with ectopia (pseudoerosis) of the vaginal part of the cervix. The study included women of predominantly early and middle reproductive age, as these women have inflammatory processes more often than in menopause. To perform the work, a transvaginal imaging method was used, which allowed us to see the smallest structures (up to 0.5-1.0 mm) of the cervix. We have previously developed a technique for visualizing the external part of the cervix and obtained a patent of Ukraine. The results of the ultrasound were compared with laboratory data, colposcopy and cervicoscopy. Traditionally, the diagnosis of cervicitis was made on the basis of clinical symptoms, smear results to determine the presence and type of pathogen. Endoscopic methods allowed visualization of only the mucous membrane of the cervical canal and external part of the cervix. The deep layers of the ectocervix, endocervix and cervical stroma can only be visualized using high-frequency ultrasound in a transvaginal way. According to the results of the study, it was possible to determine the preferential localization of the inflammatory process, to determine the nature of changes in different layers of the cervix. These changes were expressed in the presence of calcifications and cystic cavities of various sizes (1-6 mm), an increase or decrease in echogenicity, the degree of heterogeneity of the structure of the ecto-, endocervix and stroma.

IMPROVEMENT OF THE DERMATENSION METHOD IN THE RECONSTRUCTIVE-RECOVERY SURGERY OF DEFECTS OF SOFT TISSUES OF VARIOUS ETIOLOGY.

The problem of treating patients with loss of the skin and with a complicated course of the wound process remains topical. The problem is that, despite the relative technical simplicity of the dermatension method, the most significant complication is the decubitus of the stretchable flap, which is associated with a relatively high incidence of acute blood circulatory disturbances in the stretch tissues due to vascular compression with an excessive amount of injected fluid. The aim of the work is to improve the method of dermatension in reconstructive and recovery surgery of soft tissue defects of various genesis by planning and implementing dermatension at all its steps with instrumental control of the process using ultrasound and ICT in a complex. The results of surgical treatment of patients with a wound defect of different etiology of the scalp with which dermatension was performed in order to obtain additional plastic material in the burn center of the Kharkov City Clinical Hospital of Emergency and Urgent Care. prof. A.I. Meshchaninov for the period 2016-2018. There were only men aged 30 to 60 years among the patients. The average age of the operated patients was 45 years. In the first stage of dermatension, after filling the implanted expander with NaCl 0.9% physiological solution to achieve hemostasis, ultrasound was performed on the first day to measure the thickness of the cutaneous flap above the balloon and ICT (using the FLIR ONE Gen3 Pro thermal imager), to determine the state of the blood circulation above its dome. 10 days after the implantation of the expander, the second stage of dermatension was started (filling the tissue expander with 0.9% NaCl solution), taking into account the blood circulation parameters of the stretched flap with the help of a thermal imager and with constant monitoring of the thickness of the cutaneous flap over the balloon by ultrasound. There were stopped injecting fluid to the expander when the temperature in the center of the flap was reduced by more than 10C. With a further decrease in temperature, some of the liquid from the expander was evacuated. The results of ultrasound and ICT in the course of the operation planning (step I of dermatension), when filling the expander (step II of dermatension) and at the completion of dermatension (step III), according to the change in the thickness of the stretch flap and the formed connective tissue capsule, the dynamics of thermoreaction in the dermatitis flap allow to assess the state of blood circulation (perfusion) with a high probability, which is undoubtedly important for the prevention of such serious complications as ischemia, decubitus, necrosis of the flap, which carries stretches.

[Comparative study of performance of lower extremities blocks under ultrasonography and nerve stimulator guidance].

The aim of the study was to conduct a comparative analysis of regional anesthesia under neurostimulator, ultrasound guidance, and under combined guidance of the neurostimulator and ultrasound to ensure the safe and effective control of regional anesthesia with minimal discomfort for the patient. Ultrasound allows to gain significantly higher quality scores of local anesthesia than nerve stimulator control, to significantly reduce the number of needle extra insertions, needling cases, transposition, addition of general anesthesia, the number of unsuccessful blocks, reduce needle manipulation, significantly increase the occurrence of cases of complete blockade (sensitive and motor) on 30 min., causes less discomfort for patients. The use of ultrasound does not exclude the use of nerve stimulator as an additional means of verification of correct needle placement, particularly in the early stages of mastering the technique. The research combined use of ultrasound and nerve stimulator significantly decrease unsuccessful blockade and transposition need for a needle during manipulation. However, the difference between some indicators of quality of regional anesthesia is statistically unreliable; it requires further randomized and double blind studies on large patient groups, for different blockages.

[Main sonographic parameters of regional anesthesia conduction in the lower extremities under ultrasound guidance].

The purpose of this research is to study the main sonographic parameters of nerve and needles, as well as some methodological aspects of regional anesthesia under ultrasound control, comparing the results of different methods, approaches to the performance of lower limbs regional anesthesia under ultrasound guidance, the formulation of general principles for optimization of visual identification of the needle, catheter during anesthesia with the definition of localization, structure and distribution of entered anesthetic. The ultrasound is an effective method of control of the lower extremities regional anesthesia. The further study and improvement of methodological aspects is required. With the proposed method is possible to conduct qualitative sonographic navigation with high efficiency in all patients.