Objective. To evaluate the effectiveness of the ultrasound steatometry technique in patients with non-alcoholic fatty liver disease. Materials and methods. 68 patients aged 19–62 years (median age 40.5 years) were examined, 30 men (44.1%) and 38 women (55.9%), who underwent a single diagnostic algorithm of 7 (8) stages: questioning, clinical examination, noninvasive bioimpedance, biochemical blood test, liver ultrasound in B-mode, determination of hepatorenal index, ultrasound steatometry, liver biopsy. Results. In 4 patients (5.88%), a remote clinical picture of the metabolic syndrome, fatty liver infiltration was diagnosed. Signs of steatohepatitis were present in 19 (27.9%) patients, signs of cirrhosis — in 2 (2.9%). The sensitivity and specificity were 60.3% and 72.6%, respectively, for the B-mode, 44.3% and 51.9%, respectively, for the ultrasound measurement of the hepatorenal index, 90.6% and 92.2%, respectively, for ultrasonic steatometry. Conclusion. Ultrasound steatometry is an informative method for screening of patients with non-alcoholic fatty liver disease. Correlation (r) of the ultrasound diagnosis of steatosis with biopsy at the stage S0 corresponds to 0.81, at the stage S1 — to 0.68, at the stage S2 — to 0.74, at the stage S3 — to 0.88, that indicates a high information value of this method.
One of the main diagnostic methods used in diseases of the thyroid gland is ultrasound examination of the thyroid gland. Due to its availability and noninvasiveness, high information content, ultrasound is an extremely effective method of differential diagnosis of thyroid pathology. Despite the sufficient Arsenal of diagnostic methods that allows us to suspect nodal changes in the thyroid gland, a cytological biopsy is the “golden standard” in diagnostic algorithms. The use of ultrasound control methods for performing minimally invasive interventions significantly facilitates manipulation and reduces the risk of possible complications, but does not exclude the possibility of their occurrence. In connection with all the above, there is an idea to create a device that helps to facilitate the performance of a fine-needle aspiration biopsy to a specialist, reduce the risk of possible complications and increase the information content. In the Problem scientific research laboratory «Diagnostic studies and minimally invasive technologies” of the Smolensk state medical University developed a device to increase the efficiency and informational content of fine-needle aspiration biopsy under the control of ultrasound navigation in patients with nodular formations of the thyroid gland. 26 (9.5%) patients were performed fine-needle vacuum aspiration biopsy using the created device, thanks to which 18 (6.6%) patients were found to have adenomatous formation, changes in the type of subacute thyroiditis were found in 5 (1.8%) patients, and 3 (1.09%) cases of follicular neoplasia. In cases where a higher discharge is necessary for the collection of cytological material, and the developed device allows you to create conditions that increase the information content and facilitate the procedure, in addition, it is possible to perform the procedure by one specialist, which reduces the workload of several specialists in the Department dealing with minimally invasive interventions.
Thyroid diseases rank the second among endocrine pathology, at this, thyroid cancer is the most common among endocrine tumors. Ultrasound examination has contributed to more frequent detection of thyroid pathology and remains an effective method for the differential diagnosis of focal thyroid pathology, and the use of multiparametric ultrasound makes it possible to identify a malignant process at its early stage of development. Despite the introduction of multiparametric ultrasound, fine needle aspiration biopsy remains the "gold" standard in the differential diagnosis of benign and malignant changes in the thyroid gland. However, a large range of informative value, sensitivity and obtaining a false negative result when using this method promoted the search of solutions for modifying biopsy performing with an increase in the amount of cytological material and reducing the risks of complications. the purpose of the study is to determine the effectiveness of using v-FNAB compared to the FNAB performed with a LUER syringe. on the basis of diagnostic and minimally invasive technologies department at Clinical Hospital No. 1 of the town of Smolensk in the period from April to December 2021, 48 vacuum fine needle aspiration biopsies were performed without using modifications, and from January to April 2022, 51 vacuum fine needle aspiration biopsies were performed using a modified technique. All the results obtained were correlated with the results of 273 fine needle aspiration biopsies using a 20 ml 3LUER syringe performed in the period from 2019 to 2021. Sampling of cytological material when performing vacuum fine needle aspiration biopsy is much easier, since when using a vacuum, a negative pressure vacuum in the syringe is formed with the help of the apparatus and is maintained at a constant level. in addition, when performing a vacuum fine needle aspiration biopsy with a modified syringe, there was a decrease in the amount of cytological material lost, which in the original version was absorbed into the tissue membrane. This is especially important in hypervascular focal formations, as a result, the number of Bethesda 3 conclusions decreases from 16.6% to 5.9%. Thus, v-FNAB facilitates performing the manipulation due to no need to perform aspiration using a syringe piston, thereby reducing the number of uncontrolled needle movements during sampling the cytological material, which affects the diagnostic value of the examination. Due to the high level of negative pressure when performing v-FNAB, the amount of cytological material obtained increases, which also affects obtaining an informative conclusion. the ability to select the level of negative pressure in the syringe depending on the data of multiparametric ultrasound examination makes it possible to individualize the procedure.
Background: Due to its availability, high information content and harmlessness, ultrasound is an extremely effective method of differential diagnosis of thyroid pathology. Despite the sufficient arsenal of diagnostic methods, thyroid biopsy with cytological examination is the «gold» standard in diagnostic algorithms. Most often, fine — needle aspiration biopsy is carried out using disposable syringes of different capacities (5, 10, 20 ml3). The procedure is performed in most cases according to the «Free hand» method, this leads to several problems associated with the peculiarity of the study, primarily with the low vacuum created in the syringe and insufficient collection of cytological material, as well as insufficient practical experience for a novice specialist.Aim: Determination of the range of the possibility of using vacuum aspiration fine needle biopsy under the control of ultrasound navigation in patients with focal thyroid pathology.Materials and methods: On the basis of the Problem Research Laboratory «Diagnostic studies and minimally invasive technologies» of the Smolensk State Medical University, a device for vacuum fine — needle aspiration biopsy was developed. In the period 2019–2020, 780 vacuum fine — needle aspiration biopsy was performed under the control of ultrasound navigation in patients with thyroid nodules. The level of vacuum in the syringe during sampling of the material was — 0,5 bar (- 50 kPa).Results: A comparative analysis of the cytological results obtained with the help of vacuum fine — needle aspiration biopsy and the «Free hand» method shows a decrease in obtaining the category of Bethesda 1 by 3.3% and Bethesda 3 by 10.2%.Conclusion: This indicates the effectiveness and in formativeness of the use of vacuum fine — needle aspiration biopsy in patients with focal thyroid pathology in comparison with the standard «Free hand» method, as well as with vacuum fine — needle aspiration biopsy due to constant visual monitoring and the lack of movement of the syringe piston to create a discharge when taking cytological material, the probability of needle deviation from the biopsy zone is reduced, which increases the effectiveness of the study and facilitates the work of a novice specialist.
Objective. To demonstrate the capabilities of a comprehensive instrumental multimodal differential diagnosis of viral pneumonia in the context of the COVID-19 pandemic.Material and methods. A clinical case of a patient with complicated viral pneumonia and a detailed description of the clinical picture, laboratory information, instrumental research data using minimally invasive interventions, followed by cytological and bacteriological examination, is presented.Results. While the patient was in the hospital, a comprehensive study was performed with a targeted assessment of the state of the chest organs and using minimally invasive diagnostic methods. The signs of bilateral pneumonia (probably of viral etiology, possibly corresponding to COVID-19 infection) revealed by ultrasound and MDCT of the chest organs were the basis for patient’s hospitalization.Conclusion. The multimodal instrumental approach allows to obtain a more complete picture of the pathological process in patients with viral pneumonia in a short time and minimizing radiation and determine the further tactical position in the treatment of this category of patients.
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