DIAGNOSTIC ROLE OF DIFFUSION-WEIGHTED IMAGE OF THE LIVER WITH MAGNETIC RESONANCE IMAGING IN PREDICTING ABSTINENCE DISORDERS IN PATIENTS WITH ALCOHOLIC LIVER DISEASE

Objective. To assess the diagnostic role of diffusion-weighted images of the liver with magnetic resonance imaging in predicting abstinence disorders in patients with alcoholic liver disease. Methods. A total of 122 patients with ALD aged 48±5.4 years were examined. The survey algorithm we used included: performing liver DWI with MRI (n=122) with b-value values of 100/600/1000, ultrasound of abdominal organs with clinical elastography – 97 (80%) patients. Trepan liver biopsy was chosen as a reference method (n=64). Results. The patients were monitored for 2.5 years. The terms of follow-up were selected individually, depending on the results of clinical and laboratory research methods. A high correlation was established (r=0.879), when comparing clinical elastography and quantitative indicators of DWI of the liver, at admission and during dynamic observation of patients, also at the middle level, the data obtained correlated with the results of trephine biopsy of the liver (r=0.721). After 3 months, 6 (15%) of 40 patients showed normalization of biochemical blood test parameters with no diffusion restriction according to the results of DWI of the liver. Based on the results obtained, a high correlation was noted between changes in the biochemical blood test and MRI data in the DWI mode. After 9 months of follow-up, according to DWI data, 34 patients showed persistence of cytolysis syndrome and limited diffusion on DWI of the liver. After collecting an additional history and clarifying the details of the lifestyle of the patients' relatives, it was found that these patients continued to consume alcoholic beverages against the background of the received treatment, which was manifested by the presence of diffusion restriction on MRI in the DWI mode, which was a magnetic resonance sign of the presence of inflammatory processes in the structure of the parenchyma liver. After 12 months, positive dynamics – the absence of diffusion restriction according to the results of DWI of the liver was noted in 34 patients, which indicates the effectiveness of using the qualitative characteristics of DWI of the liver to assess the violation of the abstinence regimen (AUROC=0.906 (95% CI 0.872-0.916)). But in 16 (13%) patients from this group, changes in the biochemical blood test were noted, but no diffusion limitation was noted according to the DWI of the liver. Patients (n=16) underwent a correction of the received treatment – after 1 month there was a positive trend. There was a correlation of quantitative parameters of DWI of the liver with clinical forms of ALD, regardless of the presence or absence of diffusion restriction (r=0.936). Next, we assessed the prognostic and diagnostic significance of the developed criteria for DWI of the liver for patients with ALD on admission. The results of the study indicated the effectiveness of using the diagnostic and prognostic model of MRI in the DWI mode for patients with ALD on admission and in dynamic observation. Conclusions. 1. A high correlation was found between the quantitative parameters of DWI of the liver and clinical elastography (r=0.879) at admission and follow-up. Average correlation relationship of DWI of the liver with the results of trephine biopsy of the liver in patients with ALD on admission and follow-up (r=0.721). There was a high correlation between the results of DWI of the liver on MRI with the data of clinical and laboratory parameters in dynamic observation of patients with ALD: no diffusion limitation – positive (r=0.887); yes – negative (r=0.887). The high prognostic and diagnostic value of DWI of the liver in assessing the violation of the abstinence regimen in patients with ALD was established (AUROC=0.906 (95% CI 0.872-0.916)). Prognostic and diagnostic criteria for liver DWI on MRI in patients with ALD at admission: qualitative characteristic – AUROC=0.846 (95% CI 0.811-0.862), quantitative characteristic – AUROC=0.909 (95% CI 0.879-0.912); with dynamic observation: qualitative characteristic – AUROC=0.949 (95% CI 0.907-0.965), quantitative characteristic – AUROC=0.917 (95% CI 0.876-0.932).

A rare case of solitary fibrous tumor of the liver and highly differentiated rectal adenocarcinoma

Solitary fibrous tumors (SFT) are rare spindle cell mesenchymal neoplasms of presumably fibroblastic origin with undefined malignancy potential and rare metastasis. Their most frequent localization is in the pleura, where they have been first described. The incidence of solitary fibrous tumors localized in liver is extremely low. The clinical picture of SFT is nonspecific and is not due to the anatomical location of the tumor and it's size.In the majority of cases these tumors are benign. However, a number of them still may have signs of malignancy: an aggressive course with possible local recurrence and distant metastasis. The main method of treatment of hepatic solitary fibrous tumor (as well as SFT of other localization) with it's resectability is surgery. Radical removal of the tumor in the majority of cases leads to recovery. Subsequently, the operated patients should be subjected to strict dynamic observation with regularity as in malignant neoplasms (MN).The importance for chemotherapy and radiation therapy in the treatment of hepatic solitary fibrous tumor has not been determined in clinical guidelines to date.There are isolated reports of the use of chemotherapy or radiation therapy for the treatment of cases when tumor resection is not radical or there are signs of malignant neoplasm.In literature, there are numerous reports of a combination of a solitary fibrous tumor of any localization with malignant neoplasms of other organs in the same patients.In this report, we represent a clinical case of a 64-year-old woman, who had a solitary fibrous tumor of the liver and highly differentiated rectal adenocarcinoma. The patient underwent resection of the first segment of the left lobe of the liver. After a month and a half, transanal excision of the villous tumor of the rectum. The pathologic and immunohistochemical examination of the liver tumor revealed a malignant solitary fibrous tumor. After researching villous tumor of the rectum - a highly differentiated adenocarcinoma with a depth of invasion of the submucous layer of the intestinal wall up to 1/3 (T1sm1 according to Kikuchi). During dynamic observation for twenty-five months after the operation, the patient has no signs of tumor recurrence and metastasis.

Analysis of microtraumas of medical personnel in the workplace in a surgical hospital

The article presents an analysis of microtraumas at the workplace of medical workers of an ophthalmic surgical hospital based on the results of dynamic observation for 10 years. The structure and dynamics of microtraumas, the categories of medical workers most at risk of emergencies at the workplace are given. The structure of non-infectious diseases of patients has been determined

Development of Rhabdomyolysis in the Long-term Period of Previous New Coronavirus Infection COVID-19 (Clinical Case Report)

Relevance. Rhabdomyolysis is one of the complications of the new coronavirus infection COVID-19, which may cause acute kidney injury (AKI). The reason for the development of rhabdomyolysis in our observation in a patient after suffering COVID-19 in the long-term period was an increased muscle load.Aim of study. Presentation of a case of rhabdomyolysis with AKI in a patient after COVID-19 in the long-term period.Material and methods. In clinical observation, a 25-year-old patient L. is presented, who was being treated in the Department for the Treatment of Acute Endotoxicosis of the N.V. Sklifosovsky Research Institute for Emergency Medicine. In 2020, he developed COVID-19, complicated by rhabdomyolysis and AKI in the long term period.Results. Examination revealed an increase in creatinine phosphokinase (CPK) — 106,000.0 U/L, alanine aminotransferase (ALT) — 553.0 U/L, aspartate aminotransferase (AST) — 1582.0 U/L, lactate dehydrogenase (LDH) — 2809.0 U/L, levels of serum creatinine 164 μmol/L and myoglobin — 201 ng/ml. Virological research: IgM — 0.27 units per ml; IgG — 7.28 units per ml. 3 Three-phase scintigraphy with 99mTc-pyrfotech revealed signs of necrotic changes in the muscles of the upper half of the back, muscles of the chest (mainly on the right), muscles of the shoulder and upper half of the forearm on both sides. Kidneys: decreased perfusion of the right kidney (relative to the left), moderate slowdown of urodynamics at the level of the calyx-pelvis complex on both sides.Conclusions. The reason for the development of rhabdomyolysis in the long-term period in the patient after suffering from COVID-19 was an increased muscle load. Targeted research and medical history can help identify signs of rhabdomyolysis. The use of the radionuclide diagnostic method makes it possible to identify areas of soft tissue damage with a one-step assessment of renal function in rhabdomyolysis in the acute period of the disease, as well as to evaluate the effectiveness of treatment with dynamic observation. When rhabdomyolysis is confirmed, it is necessary to carry out detoxification and infusion therapy, to monitor renal function in order to detect acute kidney injury, and in case of deterioration of renal function and intoxication, renal replacement therapy is indicated.

Radiology Imaging of Bronchiectasis in Children and Adolescents (Literature Review with Own Observations)

Timely detection of bronchiectasis in children is of great prognostic value. The importance of modern bronchiectasis in children is due to their possible reversibility over time with effective treatment, as well as a number of significant differences between bronchiectasis in childhood and onset in children, which may reflect different phenotypes of bronchiectasis. In adult patients with bronchiectasis that began in childhood, the pathological process has a more severe and worse prognosis compared to bronchiectasis that began in adulthood. In 2020, the European Respiratory Society proposed a new formulation of the terminal «bronchiectasis» for children and adolescents, now this term refers to an abnormal expansion of the bronchi by computed tomography (CT) of the chest, which, if detected early, can be reversible. CT is the true «gold standard» for confirming bronchiectasis in children and adolescents. This method is included in the minimum set of tests for children and adolescents with suspected bronchiectasis according to the recommendations of the European Respiratory Society. When conducting CT, it is recommended to perform a continuous spiral scan with a collimation of 1 mm, the study is carried out without intravenous use using low-dose protocols. To assess the state of the bronchi in children and adolescents, it is necessary to use the pediatric norms of the broncho-arterial ratio (> 0.8). At the same time, radiation methods are not decisive in establishing the causes of bronchiectasis and only in rare cases can help in establishing bronchiectasis. Dynamic observation of bronchiectasis for children and adolescents is determined individually. Consideration should be given to repeat chest computed tomography scans to answer the question that will change treatment.

The course of bullous pemphigoid against the background of vaccination against a new coronavirus infection (COVID-19)

The article describes a clinical case of vaccination with the drug "Kovivac" of a patient of an older age group with an established diagnosis of bullous pemphigoid. Scientific data on the prevalence of bullous dermatoses in the Russian Federation (true pemphigus, Lever's bullous pemphigoid, Dhring's herpetiformis dermatitis) are presented. There is a good tolerance of the Kovivac vaccine in a patient suffering from bullous pemphigoid, which allows vaccination, in fact, without interrupting patients from their daily activities and without diverting the resources of the healthcare system to unreasonable inpatient care. The decision to vaccinate should be made on the basis of data on the available indications / contraindications for drugs, taking into account the individual anamnestic data of patients. In addition, it should be borne in mind that until now, all links of the infectious process caused by SARS-CoV-2 have not been fully studied. In this regard, before vaccination, patients must be informed of the need to comply with the anti-epidemic measures recommended for the prevention of coronavirus infection (COVID-19), even after full vaccination, as well as dynamic observation by specialist doctors.

Study of peculiarities of intra- and postoperative state of the interface «intraocular lens - posterior capsule» in phacoemulsification of senile cataract

Presence of full contact of interface «intraocular lens (IOL) – posterior capsule (PC)» ensures the transparency of the latter in the early period after phacoemulsification (PE) of senile cataract (SC). The main reasons for absence of full contact of IOL with PC are: the presence of residuals of viscoelastic (VE) in the capsular bag, uneven tension of the capsule by the haptic elements of the IOL, and the incommensurability of the size of the IOL with the capsule. Purpose. To study the features of the intra- and postoperative state of interface «IOL – PC» during PE SC. Material and methods. Dynamic observation of 42 patients (42 eyes), who operated on immature senile cataracts, was carried out. All operations were performed using OPMI LUMERA 700 surgical microscope (Carl Zeiss Meditec AG, Jena, Germany) with integrated intra-operative OCT, state of interface «IOL – PC» was examined. 2 hours after and on the 1st day after the operation state of interface «IOL – PC» was studied in all eyes by OCT on Optovue RTVue-100 (Optovue, Inc., US) with module for anterior segment examining to protocols «Cornea Line» and «Cornea Cross Line». Results. During the operation, the presence of contact between IOL and PC was observed only in 9 eyes (21.4%). 2 hours after surgery, 40 eyes (95.2%) had absence of contact between lens and capsule. On the 1st day after surgery, the optimal interface between IOL and PC was observed in 32 eyes (76.2%). Conclusion. Studies have shown that state of interface «IOL – PC» on the 1st day does not depend on its characteristics revealed intraoperative and 2 hours after the operation. The main reason for absence of contact between IOL and PC is residues of VE, and the using «impulse-irrigation» technique allows completely removing VE from the central zone of the capsule in all cases. Key words: cataract, phacoemulsification, intraocular lens, lens capsule, viscoelastic, interface «IOL – PC».

The role of ultrasonic diagnostics in kidney injury

In case of kidney damage, ultrasound is the primary, and often the main instrumental diagnostic method, which makes it possible to diagnose the main traumatic lesions: kidney contusion, hematomas of various localization, kidney rupture, and a number of vascular injuries. To clarify the prevalence of the process in high-severity injuries and damage to large vessels, it is recommended to use contrast-enhanced computed tomography, which in these cases has an advantage over the capabilities of ultrasound. Ultrasound examination is indispensable in the dynamic observation of the state of the kidney after injury

Intravitreal Ranibizumab for Treatment of Posttraumatic Choroidal Neovascularization: a Case Report

An analysis of the case of applying a course of fibrinolytic therapy and one intravitreal injection of an angiogenesis inhibitor in a patient with traumatic rupture of the choroid complicated by choroidal neovascularization (CNV) is presented. Patient B., 20 years old, complained of a lack of objective vision after a blunt injury to his right eye in March 2018. Visual acuity decreased to 0.01 (ETDRS 0 characters). During the examination revealed: partial hemophthalmus, rupture of the choroid, Berlin retinal opacification. Local fibrinolytic conservative therapy with positive dynamics was carried out in the form of increasing visual acuity to 0.3 (ETDRS 21 characters) and partial resolution of hemophthalmus. According to optical coherence tomography angiography (OCTA), minimally active CNV was detected. Due to the weak activity of the pathological process, a decision was made on dynamic observation. A follow-up examination in August 2018 revealed an increase in CNV activity according to OCTA and fluorescence angiography (FAG), in connection with which intravitreal administration of ranibizumab (lucentis) was performed. Subsequently, the patient was under dynamic observation for one year. Positive dynamics was revealed in the form of an increase in visual acuity, first to 0.7 (ETDRS 48 characters) 3 months after intravitreal injection, and after a year — to 0.9 (ETDRS 55 characters). After treatment according to OCTA and FAG, the activity of CNV was not determined. Despite the favorable result of treatment, further monitoring of the patient is necessary, since the long-term prospects for maintaining the achieved high visual functions remain unclear due to the insufficient experience in treating patients with this pathology according to the literature.