Using of contrast media (CM) during traditional x-ray examination, CT, MRI plays an important role in obtain information. This information can be crucial for the final diagnosis or making choice of treatment in different areas of medicine, like surgery, pediatrics, oncology, etc. Principles regarding contrast media utilization and associated adverse events are generally similar between children and adults, but of course have some important differences. The main peculiarities of introducing contrast in children are: using small volume of contrast media (1,5-2 ml/kg); small gauge angiocatheters (for example, 24-gauge) located in tiny peripheral vessels. It makes performing this method more hard in newborns and small children. Dose of CM is calculated according body weight and concentration of the stuff. It is important not to forget about optimal temperature mode during introducing CM. As any invasive method introducing of CM can be associated with some complications. The most frequent complications in pediatric patients are contract-induced allergy and contract-induced nephrotoxicity. The assessment of renal function in children is determined by the special formula (Schwartz Equation). General guidelines for the prevention of allergic-like reactions in children are similar to those used for adult patients and include premedication regimen, using a combination of corticosteroid and antihistamine. It is necessary to apply modern multi-layer spiral CT and special programs for reducing radiation exposure.
Background:Despite of the development the criteria for the diagnosis of axial spondyloarthritis (axSpA) the problem of late axSpA diagnostics is not resolved. The difficulties in the assessment of MRI sacroiliitis (SI) could be of the reasons of axSpA diagnostic delay.Objectives:to evaluate the inconsistency in the assessment of sacroiliac joints MRI that was performed by a blinded and unblinded rheumatologists and a radiologists.Methods:The assessment of 80 magnetic-resonance tomograms of sacroiliac joints (SIJ) was performed by 4 independent readers, one which was blinded to clinical data radiologist (BR), another radiologist was informed that the study was performed for axSpA (unblinded radiologist - UR), another 2 readers were blinded to diagnosis rheumatologists. One of the rheumatologists was trained in SIJ MRI (BTRh), another rheumatologist was not trained specially in MRI of SIJ (BURh). The study was carried out on the magnetic resonance tomography (GE Discovery MR750W 3.0T) in T1 and STIR regimens. 65 MRI were performed in pts that fulfilled the ASAS criteria for the axSpA and history of active SII (bone marrow edema) on previous SIJ MRI. According CT of SIJ 25 (38.5%) of these pts had nr-axSpA, 22 (33.8%) had SI grade II / III, in 18 (27.7%) of the pts SI grade IV was detected. 15 MRI scans were performed in healthy volunteers who did not meet the ASAS 2009 criteria at the time of the study and had no CT changes in SIJ.The number of detected by each reader cases of active SII as defined by ASAS were analyzed with the calculation of the inter-reader reliability.Results:There was found that there was inter-reader reliability between results of blinded and unblinded radiologists (73.8%) with statistical differences in the number of detected and undetected signs of SII (p <0.05).The inter-reader reliability scores between the unblinded rheumatologist and the radiologist were 97.5% and did not have statistically significant statistical differences (p≥ 0.05).And for a trained rheumatologist and a blinded untrained rheumatologist it was 53.5% and had significant statistical differences (p<0.05).The results of 4 readers SIJ MRI assessments are presented at Table 1.Table 1.The results of MRI sacroiliitis assessments performed by blinded and unblinded radiologists and rheumatologistsBRUbRBtRhBURhRevealed SII in axSpA (n = 65), n(%)44 (67.7)*64 (98.5)#62(95.4)26 (40)*Undetected SII in axSpA (n = 65), n(15)21(32.3)*1(1,5)3(4.6)39(60)*Revealed SII in controls (n = 15), n(%)2 (13.3)*3 (20) #3(20)1(6.7)*Undetected SII in controls (n=15), n(%)13(86.7)*12(80) #12(80)14(93.3)**inter-reader reliability with the results of all another reader with p<0.05. # inter-reader reliability between unblinded radiologist (UR) and blinded treated rheumatologist (BtRh) with p<0.05. BURh – blinded untreated rheumatologist. BR – blinded radiologist.Conclusion:The better agreement in inter-reader reliability in MRI of SIJ assessment was detected between unblinded radiologist and trained blinded rheumatologist. Blinded radiologist had shown lower inter-reader agreement with another specialists. The lowest of all inter-reader agreement had shown untrained blinded rheumatologist. Special MRI of SII assessment trainings for rheumatologists and radiologists are unmet need for the improvement of in-time axSpA diagnostics.Disclosure of Interests:None declared.
Boyko V., Buchneva O. Shafer Ya., Pisklova Yu., Krylova O.To date, vascular disease rank first (more than 50%) among the causes of mortality in Ukraine. Atherosclerotic vascular involvement, being the most frequent etiological factor of abdominal aortic aneurysm, in the absence of timely diagnosis and treatment, causes severe complications, early disability and death. Clinical and functional diversity of abdominal aortic aneurysm causes difficulties in diagnosing, defining different therapeutic approaches, methods of operation and protection of visceral organs and spinal cord. The article analyzes various clinical manifestations of abdominal aortic aneurysms in 264 patients who underwent surgical treatment at the State Facility V.T Zaytsev Institute of General and Urgent Surgery from 2010 to 2018.Key words:a bdominal aortic aneurysm, rupture of abdominal aortic aneurysm РезюмеАНАЛІЗ КЛІНІЧНОГО ПЕРЕБІГУ АНЕВРИЗМ ЧЕРЕВНОГО ВІДДІЛУ АОРТИБойко В., Бучнєва О., Шафер Я., Пісклова Ю., Крилова О.На сьогоднішній деньзахворювання судин займають перше місце (більше 50%) серед причин смертності в Україні. Атеросклеротичнеураженнясудин, будучи найбільш частим етіологічним фактороманевризм черевного відділу аорти, за відсутності своєчасної діагностики і лікування викликає важкі ускладнення, ранню інвалідизацію і смерть. Клінічне і функціональне різноманіття аневризм черевної аорти викликає труднощі в діагностиці, визначає різну тактику лікування, способи операції тазахисту внутрішніх органів і спинного мозку. У статті проаналізовані різноманітні клінічні презентації аневризм черевного відділу аорти у 264 пацієнтів, яким було проведено хірургічне лікування на базі ДУ "ІЗНХ ім.В. Т.Зайцева" з 2010 по 2018 рік. Ключові слова: аневризма черевної аорти, розрив аневризми черевної аорти РезюмеАНАЛИЗ КЛИНИЧЕСКОГО ТЕЧЕНИЯ АНЕВРИЗМ БРЮШНОГО ОТДЕЛА АОРТЫБойко В., Бучнева О., Шафер Я., Писклова Ю., Крылова А.На сегодняшний день заболевания сосудов занимают первое место (более 50%) среди причин смертности в Украине. Атеросклеротическом поражении сосудов, являясь наиболее частым этиологическим фактором аневризм брюшного отдела аорты, при отсутствии своевременной диагностики и лечения вызывает тяжелые осложнения, раннюю инвалидизацию и смерть. Клиническое и функциональное многообразие аневризм брюшной аорты вызывает трудности в диагностике, определяет разную тактику лечения, способы операции и защиты внутренних органов и спинного мозга. В статье проанализированы разнообразные клинические презентации аневризм брюшного отдела аорты у 264 пациентов, которым было проведено хирургическое лечение на базе ДУ "ІЗНХ ім.В. Т.Зайцева" с 2010 по 2018 год.Ключевые слова: аневризма брюшной аорты, разрыв аневризмы брюшной аорты
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