[Method of preventive ultrasound diagnosis of venous thrombosis]. / Metod preventivnoi ul'trazvukovoi diagnostiki venoznykh trombozov.

AIM: The purpose of the study was to work out a method of preventive diagnosis of venous thromboses by means of ultrasonographic duplex scanning (USDS). PATIENTS AND METHODS: A total of 306 people were examined. Of these, 146 patients presented with acute venous thrombosis, 108 subjects suffered from varicose veins, and 52 were apparently healthy people composing the control group. All those enrolled into the study were examined by means of USDS, with the D-dimer level determined. RESULTS: The obtained findings made it possible to discover and duly describe an ultrasonographic phenomenon of the presence of echo-positive inclusions in the zone of valvular sinuses, which was called the phenomenon of spontaneous echo contrast (SEC). This was followed by working out a classification of this phenomenon, describing two degrees thereof. Degree 1 SEC reflects the fact that the area of valvular sinuses is the most thrombogenic zone. Degree 2 SEC is characterised as a pathological, being simultaneously pre-thrombotic, condition and may serve as one of the earliest predictors of the development of venous thrombosis. A close correlation was established between the degree 2 SEC phenomenon, the presence of venous thrombosis and the values of the D-dimer level (r=0.89, p<0.01). CONCLUSION: Ultrasonographic examination of valvular sinuses is a simple, readily available and reproducible method of screening and may thus be used for preventive diagnosis of acute venous thromboses. The findings of this study make it possible to form risk groups by the development of deep vein thrombosis, as well as to initiate timely measures on prevention of the pathology concerned.

[Difficulties in the diagnosis of stroke in pregnant women]. / Slozhnosti diagnostiki mozgovogo insul'ta u beremennykh.

AIM: To study the features of the clinical picture of stroke and results of laboratory/instrumental study in pregnant women. MATERIAL AND METHODS: A study included 44 women at different periods of gestation (mean age 33.4±9.7 years) with clinical symptoms of stroke hospitalized within 4-11h after stroke. Neuroimaging, clinical/instrumental and laboratory examinations were carried out in the first 40 min after admission. RESULTS: A routine screening examination during the management of pregnancy in women's consultation clinics does not always reduce the risk of life threatening events. The operative delivery can decrease the severity of the focal neurological deficit. Intensive treatment and dynamic management of patients with intracranial pathology in intensive care stroke unit improves outcome of stroke. CONCLUSION: A timely differential diagnosis of pathological conditions with different symptoms of stroke at the different stages of medical care of pregnant women helps to choose an optimal treatment plan and improve the outcome.

[Ultrasound elastography in assessing efficacy of treatment for lower limb varicose veins with a phlebotrophic drug containing a micronized purified flavonoid fraction].

UNLABELLED: Venous hypertension combined with other pathogenetic links of the development of chronic venous insufficiency creates conditions for activation of an inflammatory process. Chronization of inflammation leads to alterations in the histological structure of the vascular wall and perivasal tissues, which is reflected by changes in their physical properties (elasticity or compressibility), which may be studied by means of ultrasound elastography (USEG). OBJECTIVE: The study was aimed at exploring the possibility of using ultrasound elastography for monitoring efficacy of conservative treatment of varicose disease of lower extremities with an agent containing a micronized purified flavonoid fraction (MPFF). MATERIAL AND METHODS: we examined a total of 19 patients (38 limbs) presenting with varicose disease of clinical class C2 according to the CEAP classification. The standard ultrasound examination and USEG were carried out using the unit of expert-class "Toshiba" (Japan) with a multi-frequency linear transducer 5-12 Hz. We examined the great saphenous vein in the area of the femur and crus, its tributaries, and the small saphenous vein. All examinations were performed with the patient in the supine, prone and standing positions from the standard approaches in the second half of the day prior to treatment with a phlebotrophic agent containing MPFF (Detralex) and three months after taking the drug at a dose of 1,000 mg/day. RESULTS: at baseline, according to the findings of USEG the intact veins of the lower limbs had a homogeneous pattern of the elastogram in the perivasal area. The presence of varicose transformation was associated with an inhomogeneous elastographic picture. On the background of treatment with MPFF, all patients showed a positive clinical effect in the form of decreased intensity of manifestations of complaints or complete disappearance thereof. According to the findings of ultrasound examination, there was a tendency towards a decrease in the wall thickness and diameter of the examined veins. USEG demonstrated an increase in the perivasal zones of elastographic homogeneity of tissues. The USEG-revealed alterations were more pronounced in large-diameter vessels. On the background of treatment with Detralex there was a trend towards normalization of the elastographic pattern of the vessel as a whole. CONCLUSION: the obtained findings confirm feasibility of using the technique of ultrasound elastography for identification of objective markers of treatment response to MPFF in varicose disease.

[The organ-preserving surgical treatment of the splenic rupture after the blunt abdominal trauma].

The outcomes of 383 cases of heavy combined traumas (n=273) and isolated (n=110) closed injuries of the abdomen with spleen damage were analyzed. The overall mortality was 11.74% (n=45), whereas the mortality rate during the first day after admission was 7.83% (n=30). Removal of a spleen was executed at 228 patients. The spleen-preserving operation with ligation of splenic artery, was performed in 155 patients. The optimal level of the splenic artery ligation proved to be in its proximal and median parts. The postoperative CT-angiogarphy and Doppler US scanning together with the three-dimensional reconstruction confirmed that blood supply of the body and tail of the pancreas was satisfactory thanks to the natural collateral blood circulation. The dramatic decrease in lethality and of postoperative complication rates allows to consider spleen-preserving resections to be a good alternative to spleenectomy.

Increased throughput of proteomics analysis by multiplexing high-resolution tandem mass spectra.

High-resolution and high-accuracy Fourier transform mass spectrometry (FTMS) is becoming increasingly attractive due to its specificity. However, the speed of tandem FTMS analysis severely limits the competitive advantage of this approach relative to faster low-resolution quadrupole ion trap MS/MS instruments. Here we demonstrate an entirely FTMS-based analysis method with a 2.5-3.0-fold greater throughput than a conventional FT MS/MS approach. The method consists of accumulating together the MS/MS fragments ions from multiple precursors, with subsequent high-resolution analysis of the mixture. Following acquisition, the multiplexed spectrum is deconvoluted into individual MS/MS spectra which are then combined into a single concatenated file and submitted for peptide identification to a search engine. The method is tested both in silico using a database of MS/MS spectra as well as in situ using a modified LTQ Orbitrap mass spectrometer. The performance of the method in the experiment was consistent with theoretical expectations.

[Chronic venous insufficiency. Pathogenesis and modern diagnostic possibilities].

Ultrasound angioscanning is one of modern highly effective diagnostic techniques in trophic lesion stage of varicose disease. This technique allows for reliable determination of the levels and character of pathological venous refluxes, having significant impact on the course of the disease and leading to chronic venous insufficiency (CVI). The authors revealed the leading role of profound venous valvular insufficiency in the progress of CVI, stressing the necessity for its correction. They point out to the causes of low horizontal venous-venous refluxes and valvular insufficiency of gastrocnemius muscle-venous sinuses leading to isolated insufficiency in the distal segments of posterior tibial veins, which intensifies CVI progress at the account of disturbances in the functioning of tibial muscular-venous pump.

[Application of medical-purpose knitted fabric STRUVA 23 in office surgery for varicosity].

The article proffered herein discusses a possibility of using groin-high stockings STRUVA 23 in women operated on for uncomplicated varicosity of the lower limbs in outpatient conditions by means of modern minimally invasive techniques. Analyzing the postoperative-period course in a total of 15 women making use of conventionally employed elastic bandages, as compared with 20 women wearing the woven medical-purpose stoking pulled on the postoperative leg clearly showed apparent advantages of the latter type of compression, thus enabling the authors to safely recommend the stockings STRUVA 23 for application in office surgery.

[Ultrasonic methods and semiotics in patients with vasculogenic erectile dysfunction]. / Ul'trazvukovaia metodika i semiotika u bol'nykh s vaskulogennoi érektil'noi disfunktsiei.

The authors have developed criteria for ultrasonic assessment of cavernous bodies, arterial and venous circulation in normal penile vessels and in erectile dysfunction in 125 patients; describe modern ultrasound modalities in differential diagnosis of various forms of vasculogenic erectile dysfunction basing on the experience with 92 patients; validate hydrodynamic role of the tunica albuginea in pathogenesis of venocorporal dysfunction and pathological venous drainage. Early ischemic signs of arterial insufficiency were revealed.

[Treatment of erectile dysfunction in cases of venous and corporovenous insufficiency of phallus]. / Lechenie érektil'noi disfunktsii pri venoznoi i korporovenoznoi nedostatochnosti polovogo chlena.

A total of 230 patients of different age with impaired venous drainage of penis cavernous bodies were examined. Test with intracavernous injection of papaverin, dopplerography of the vessels and cavernosometry were employed. To treat venous and corporovenous insufficiency, it is suggested to make a resection of the deep dorsal vein, ligation of the superficial and circular veins with suturing tunica albuginea. In negative result of the surgery viagra in a done 50 (100) mg is recommended or penile implants.

[The ultrasonic diagnosis of acute thrombophlebitis of the vena saphena magna]. / Ul'trazvukovaia diagnostika ostrogo tromboflebita bol'shoi podkozhnoi veny bedra.

A total of 321 patients with suspected acute thrombophlebitis were examined. There were 92 men (30%) and 229 women (70%). For control 15 patients without lower limb vein abnormalities and 19 ones with uncomplicated varicose disease were examined. Ultrasonic examinations using Ultramark-8 (Medata, Sweden) device were carried out in all the patients. Of the 313 cases (in 8 patients the diagnosis of acute thrombophlebitis was not confirmed by ultrasonic examination) ultrasonography results were erroneous in only 6 cases when assessing the proximal borderline of the great subcutaneous femoral vein thrombosis. Hence, the accuracy of duplex scanning in assessment of the proximal border of thrombosis in acute thrombophlebitis was 98.6% in our study. Ultrasonic angio-scanning in patients with superficial thrombophlebitis give reliable and valuable information about the presence, type, and extension of the pathologic process. This helps to optimally solve the therapeutic policy problems and adequately plan surgical intervention.

[The current diagnostic procedure in chronic pathology of the veins of the lower extremities]. / Sovremennaia diagnosticheskaia taktika pri khronicheskoi patologii ven nizhnikh konechnostei.

Stepwise (out- and inpatient) examination forms the basis of diagnostic examination tactics in chronic abnormalities of the veins. Noninvasive ultrasonic methods of studying the venous system are preferred. With the gradual formation of groups of patients with an affection of the veins, invasive isotope and angiographic methods are supplemented. The authors emphasize that such examination of patients in stages raises the efficacy and the quality of diagnosis in individuals with chronic venous abnormalities.

[Ultrasonic examination in the diagnosis of chronic diseases of the veins of the lower extremities]. / Ul'trazvukovoe issledovanie v diagnostike khronicheskikh zabolevanii ven nizhnikh konechnostei.

Noninvasive diagnosis of chronic diseases of the lower limb venous system is an urgent problem of modern phlebology. Ultrasonic examination (USE) makes it possible to judge adequately the condition of the deep and surface veins and, consequently, to improve significantly the management of varicose and post-thrombophlebitic diseases. The authors elaborated an original method for the diagnosis and appraisal of the condition of the lower limb venous system by means of ultrasonic scanning and various functional tests for determining the character of affection of the venous valvular apparatus. Examination of more than 200 patients with primary varicosities and post-thrombophlebitic disease, the use of highly-resolving ultrasonic equipment, and comparison of the results of USE with the findings of radiocontrast phlebography (agreement in 99.8% of cases) allow the conclusion that noninvasive ultrasonic methods must be used widely in appraising the venous status in patients with chronic diseases of the venous system of the lower limbs.

[The informativeness of ultrasonic scanning methods in obliterating diseases of the arteries of the lower extremities]. / Ob informativnosti metodov ul'trazvukovogo skanirovaniia pri obliteriruiushchikh zabolevaniiakh arterii nizhnikh konechnostei.

The authors studied the diagnostic possibilities of ultrasonic angiography and doppler sonography as compared to digital subtraction angiography. A total of 506 arterial segments was examined in 116 males suffering from various degree of atherosclerosis obliterans of the lower limb vessels. The coincidence of and disparity in the diagnosis were analysed on the aortoiliac and femoropopliteal levels according to three criteria: normal vessel, stenosis, occlusion. The diagnostic efficacy was appraised with the use of the Kapp index (K), the percentage of absolute coincidence of the diagnoses, sensitivity, and specificity. The precision of doppler sonography was found to be comparable with that of digital subtraction angiography. On the aortoiliac level K-0.68 +/- 0.06, on the femoropopliteal level K = 0.78 +/- 0.05. The diagnostic possibilities of ultrasonic angio-scanning were significantly lower. Thus, on the aortoiliac level K = 0.28 +/- 0.07, on the femoropopliteal level K = 0.4 +/- 0.05. Doppler sonography is therefore a reliable noninvasive method in the diagnosis of obliterating diseases of arteries of the lower limbs.

[The potentialities of Doppler sonography in evaluating the distal vascular channel in chronic obliterating diseases of the arteries of the lower extremities]. / Vozmozhnosti doplerovskoi sonografii v otsenke distal'nogo sosudistogorusla pri khronicheskikh obliteriruiushchikh zabolevaniiakh arterii nizhnikh konechnostei.

The work deals with the techniques of examination of the leg arteries in patients with atherosclerosis obliterans of the lower limb vessels by the method of doppler sonography (DS) and dopplerography. The authors examined 111 arterial segments in 43 patients. The results of these methods were compared with the findings of radiocontrast angiography. The absolute percentage of the coincidence of diagnosis (AP), sensitivity (Se), and specificity (Sp) of these methods were calculated according to two criteria--"normal" vessel and "occlusion". In DS, AP was 93 +/- 2%, Se-95 +/- 4%, Sp-93 +/- 2%, the respective values in dopplerography were 81 +/- 3%, 84 +/- +/- 11%, and 79 +/- 4%. The difference between these methods according to AP and Sp was statistically significant (p less than 0.001). The authors believe that the higher percentage of coincidences of diagnosis in DS is linked with the possibility of purposeful study of the blood flow in the vessel, being guided by its image.

[Extracorporeal lithotripsy in cholelithiasis]. / Ekstrakorporal'naia litotripsiia pri zhelchnokamennoi bolezni.

The authors describe their first experience with treatment of 46 patients with extracorporeal lithotripsy. Its high effectiveness has been shown. The method is atraumatic and harmless, there is no risk of lethal outcome. These properties allow using the method both in patients having contraindications to operation because of their critical general state and in patients who refused to be operated upon.

[Ultrasonographic examination in the differential diagnosis of jaundice]. / Ul'trazvukovoe issledovanie v differentsial'noi diagnostike zheltukh.

The results of complex examination of 352 patients with various forms of jaundice are discussed. All patients underwent ultrasonic examination (USE). Comparison of the results of USE with those of other methods of examination showed it to possess diagnostic value in patients with various forms of jaundice. The highest accuracy of the diagnosis was in patients with parenchymatous jaundice. In patients with benign jaundice as well as in those with jaundice of a neoplastic origin USE is a valuable method in determining the sequence of manipulations in the diagnostic program, but it cannot be a means of making the final diagnosis.