Aim. To study the vascularity and malignancy degrees of hepatocellular carcinoma using spiral computed tomography angiography considering its morphological differentiation and tumor size. Methods. A comprehensive clinical and radiological examination of 300 patients (males - 170 (56.6%), females - 130 (43.4%), mean age 52.0±3.2 years) with hepatocellular carcinoma, who were picked out from 2550 patients with malignancies treated in 2005-2013, was performed. Liver cirrhosis was diagnosed in 70 (23.33%) out of 300 patients with hepatocellular carcinoma. The features of tumor bloodflow were assessed using color Doppler ultrasonography and spiral computed tomography angiography (by 4 phases of examination) considering tumor size and tumor morphological differentiation. Results. According to the morphological study results of samples from 123 patients, high-grade differentiated hepatocellular carcinoma was diagnosed in 40 patients, moderately differentiated - in 53, poorly differentiated - in 30 patients. A correlation of tumor vascularity with histological differentiation degree and tumor size was revealed. The difference in high-grade differentiated hepatocellular carcinoma maximal computed tomography density increment gradients at arterial phase compared to liver parenchyma maximal computed tomography density increment was 17 Hounsfield units in tumors sized up to 5 cm and 12 Hounsfield units in 32 (80%) of 40 patients with tumors sized over 5 cm. Thus, high-grade differentiated hepatocellular carcinoma was associated with increased vascularity in 80.0%, normal vascularity - in 8.0%, low vascularity - in 12.0% of cases. The difference in moderately differentiated hepatocellular carcinoma computed tomography density increment gradients compared to liver parenchyma was assessed as 20 and 25 Hounsfield units in tumors with the corresponding size in 45 (89.4%) out of 53 patients. Moderately differentiated hepatocellular carcinoma was associated with increased vascularity in 89.4%, normal vascularity - in 4.0%, low vascularity - in 6.6% of cases. Poorly differentiated hepatocellular carcinoma was associated with increased vascularity only in 7 out of 30 patients. Conclusion. The correlation of tumor vascularity with histological differentiation degree and tumor size was revealed. Increased vascularity was observed in high-grade differentiated and moderately differentiated hepatocellular carcinoma, low vascularity - mainly in poorly differentiated hepatocellular carcinoma.
Aim. To study the capabilities of radioechocardigraphy in the evaluation of pulmonary hypertension of various causes, early non-invasive detection of pressure increase in the pulmonary artery.Methods. The study included 800 patients with congenital (269) and acquired (217) mitral valve diseases, pulmonary embolism (140), primary pulmonary hypertension (57), coronary heart disease with acute myocardial infarction (117) of different age and gender. Digital radiography, linear tomography of chest, ECG, echocardiography, multidetector computed tomography angiography, and ultrasound of inferior vena cava were performed.Results. Radiocardiography combined with linear tomography and measurement of Moore index, right atrium index, transpulmonary distance, and width of right descending pulmonary artery at the level of intermediate bronchus, allows determining the degree, type (arterial, venous, capillary, and mixed) and cause of pulmonary hypertension. Digital radiography and linear tomography in 80% cases reveal signs of pulmonary embolism. Echocardiography makes it possible to study hemodynamics in pulmonary hypertension, to detect the dilation of the right heart, inferior vena cava, and renal veins, and to calculate the systolic pressure in the right ventricle, pulmonary artery, and right atrium. Radioechocardigraphy allows determining the cause and degree of pulmonary hypertension, and hemodynamic disorders. Sensitivity of the method for diagnosis of pulmonary hypertension is 89%, specificity is 90%, and precision is 92%.Conclusion. Radioechocardigraphy is a highly effective method for diagnosis of pulmonary hypertension; ultrasound of inferior vena cava, iliac veins, and veins of the lower limbs allows to determine the source of pulmonary embolism, to diagnose embologenicity of thromboses and to evaluate the need for vena cava filters.
1 Казанская государственная медицинская академия, г. Казань, Россия; 2 Городская клиническая больница №7, г. Казань, Россия РефератЦель. Определить возможности комплексного дооперационного обследования больных острой спаечной тон-кокишечной непроходимостью в выборе метода хирургического лечения. Методы. Изучали диагностическую значимость клинических и лучевых методов исследования в оценке распро-странённости спаечного процесса в брюшной полости у 354 больных острой спаечной тонкокишечной непро-ходимостью. Пациентов разделили на две группы: (1) группу сравнения -204 обследованных по стандартно-му протоколу без использования компьютерной томографии и ультразвукового исследования без картирования спаечных сращений, оперированных открытым методом, и (2) основную -150 пациентов, в отношении кото-рых применяли усовершенствованный нами диагностический алгоритм и лапароскопический адгезиолизис. Для более наглядного представления о распространённости спаечного процесса при ультразвуковом исследо-вании разделяли переднюю брюшную стенку на четыре сектора. Тяжесть патологического процесса оценива-ли значениями энтерального индекса и внутрибрюшного давления, отражающими степень морфофункциональ-ных нарушений. Результаты. Наибольшая чувствительность (92%) диагностических методов отмечена при проведении рентге-новской компьютерной томографии с контрастированием. Объективными критериями тяжести состояния па-циентов с острой спаечной тонкокишечной непроходимостью служат значения энтерального индекса, внутри-брюшного давления, признаки распространённого перитонита. Разработанная комплексная диагностическая программа, представленная в виде алгоритма, имела решающее значение в выборе метода хирургического вме-шательства (лапаротомия или лапароскопия). Выводы. Оптимальным вариантом лечения больных острой спаечной тонкокишечной непроходимостью можно считать лапароскопический адгезиолизис, выполнение которого следует регламентировать тяжестью состояния пациентов и распространённостью спаечного процесса; для определения распространённости спаек необходи-мо использовать комплексную диагностическую программу, в которой ведущее место принадлежит лучевым методам исследования. Ключевые слова: острая спаечная тонкокишечная непроходимость, ультразвуковое исследование, рентгенов-ская компьютерная томография, внутрибрюшная гипертензия, лапароскопический адгезиолизис. Aim. To determine the capabilities of complex preoperative examination of patients with acute adhesive small-bowel obstruction for the choice of the method of surgical treatment. Methods. The diagnostic significance was studied for clinical and radiological methods in assessment of the prevalence of adhesive process in the abdominal cavity in 354 patients with acute adhesive small-bowel obstruction. Patients were divided into two groups: (1) a comparison group of 204 subjects examined by the standard protocol without the use of computed tomography and ultrasound without mapping of adhesions operated by an open procedure, and (2) the study group of 150 patients who underwent the m...
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