Clinical case: pregnancy-associated breast cancer

This article presents a clinical case of pregnancy-associated breast cancer. We have analyzed the features of the diagnostic algorithm, considered the radiological manifestations and presented the main literature sources about this pathology.Pregnancy-associated breast cancer is breast cancer that occurs during pregnancy or within the first year after a baby birth. It is most often diagnosed only after first clinical symptoms, the most characteristic of which is a feeling of compaction in the breast, less often bloody discharge from the nipple, pain, breast deformation and baby's refusal to breastfeed.Radiological signs of pregnancy-associated breast cancer are not pathognomonic and may mimic benign changes associated with pregnancy and lactation at early stage: lactation adenoma, mastitis, abscess, galactocele, fibroadenoma. Uncertainty of physicians about the harm of radiological methods of examination for pregnant women and the fetus and, consequently, incorrect diagnostic algorithms can delay the early detection of pathology, establish an accurate diagnosis and worsen the prognosis for the patient.Compliance with a sequential diagnostic algorithm using sonographic diagnostics, X-ray mammography with digital breast tomosynthesis, magnetic resonance imaging in accordance with the diagnostic categories of the BI-RADS scale allows you to verify breast tumors. Diagnosis should be consistent with American College Radiology guidelines.In case of detection of suspicious breast pathology in a pregnant woman or woman in labor, a doctor of any specialty should refer the patient to specialized specialists in the diagnosis and treatment of breast diseases. Adherence to the correct algorithms for the appointment, conduct and interpretation of radiological studies, taking into account changes in the breast structure, will allow timely diagnosis, proper treatment and save the lives and health of childbearing aged women.

The Comparison of the Results of Ultrasound, CT and MRI in the Diagnosis of Angiomyolipoma Kidneys, Including Complicated by Development of the Syndrome Wunderlich

Purpose: Analysis the effectiveness of various methods of radiation studies for the detection of renal angiomyolipomas (RAMLs), including the diagnosis of Wunderlich syndrome. Material and methods: The analysis of the results of a comprehensive radiation study of the kidneys of 115 patients who were diagnosed with focal formation in primary renal ultrasound was carried out. Further, of those 115 people, 47 patients underwent MRI of the kidneys, 60 patients – CT and 8 patients complex MRI+CT, including contrast-enhanced vasculature. Results and discussion: Angiomyolipoma was detected by ultrasound in 38 (33.0 %) of 115 patients, and according to MRI and CT in total in 27 (23.5 %) patients. Coincidence of ultrasound findings and MRI and CT results was in 18 patients. Consequently, the sensitivity of ultrasound in the diagnosis of RAML was compared with MRI – 45 %; when compared with CT – 42.8 %, and specificity – 55 % and 57.1 %, respectively. Reliable signs of RAML in ultrasound were hyperechogenic homogeneous structure, clear smooth contours of the formation. The rounded form of education is statistically unreliable. Statistically significant characteristics of RAML in magnetic resonance imaging are heterogeneous structure, heterogeneous hyperintense MR-signal on T1 and heterogeneously hypointensity on T2-weighted images, always uniformly hypo-Fs for T1 / T2 Fs, with hypo clear boundary between education and renal parenchyma on T1 in the opp phase. Reliable signs of RAML with CT are non-uniform structure of education, with non-uniform x-ray density. Conclusion: Ultrasound diagnosis is necessary for screening kidney disease, while CT and MRI have greater sensitivity and specificity to determine the nature of focal formation. With the development of Wunderlich’s syndrome, a complex of radiological methods, including ultrasound, MRI and CT, allows to diagnose the cause of hemorrhage, as well as to obtain complete diagnostic information necessary for the surgeon to plan treatment.

Role of liver biopsy versus non-invasive biomarkers for diagnosis of significant fibrosis and cirrhosis: a web-based survey

Background Liver biopsy is the standard reference for staging hepatic fibrosis. Non-invasive methods for assessment of hepatic fibrosis and cirrhosis are becoming increasingly popular. Objective We aimed at exploring the change in practice regarding the use of liver biopsy and non-invasive methods for staging hepatic fibrosis and cirrhosis among hepatologists. Methods We performed a survey-based study that recruited hepatologists from various Egyptian institutions. Physicians were deemed eligible if they had a degree in internal medicine with hepatology as a subspecialty. We utilized an online-based survey that assessed the acceptability and reliability of liver biopsy, serum biomarkers, and radiological tools for evaluating liver fibrosis and cirrhosis. Results A total of 573 responses were retrieved (response rate = 80.3%). Out of them, 58% were having more than 15 years of experience as a hepatologist. Liver biopsy is still considered the gold standard for assessment of hepatic fibrosis and cirrhosis by 61% of participants. Liver biopsy was accepted by 44% of their patients. 84% reported the need for a more practical alternative to liver biopsy to assess disease progression or response to treatment. 78.34% of participants know serum biomarkers, 84.08% reported that they were acceptable by their patients, 37.79% thought they are reliable. 95.4% were familiar with radiological methods of non-invasive assessment of hepatic fibrosis, 89.1% reported that radiological methods were acceptable by their patients, 62% think that they are reliable and 78% reported they were applicable in clinical practice. Sixty-five percent think that combining non-invasive methods is better than using a single method. Forty percent of participants thought that radiological methods are easier to use for assessment of hepatic fibrosis followed by a combination of non-invasive methods, serum biomarkers, and liver biopsy respectively. Conclusion In conclusion, liver biopsy is still considered the most reliable method for evaluation and staging of liver cirrhosis by hepatologists in Egyptian institutions, despite the modest acceptance by the patients. Nonetheless, non-invasive methods are gaining acceptance by Egyptian physicians and patients, and most of them consider these methods as reliable and applicable tools for predicting the course of liver cirrhosis.

Polyphenols effect on cerebrovascular health

: Polyphenols are a wide group of plant components that include a high number of individual compounds and are present in foods, dietary supplements and drugs. Many of them have shown pharmacological effects, are used in cardiovascular disease prevention, and not as many have been assayed in cancer treatment or co-treatment. In the last few years, however, the research on polyphenols implications in a healthy aging and especially in neurodegeneration and cognition improvement has increased dramatically. Most of the results found in this sense are again related with the capacity of some specific polyphenols to regulate the blood flow, but this time at the cerebral level, and to protect the endothelium at this same level. In this thorough review, we want to concentrate precisely on the effect of polyphenols on the cerebrovascular homeostasis, reviewing the mechanisms that underline this effect and the radiological methods and endogenous biomarkers that are used in human trials aimed at showing the beneficial effect of polyphenols or polyphenols rich foods on neuroprotection and cognition function.

The role of multiparametric magnetic resonance in bladder cancer management

Multiparametric magnetic resonance imaging with VI-RADS is a newly discussed method of diagnosing bladder cancer. There are more studies suggesting implementation of mpMRI with VI-RADS to the modern scheme of treating bladder cancer. It requires much more observation and trials to give a final recommendations. The aim of the summary is to present VI-RADS scale and possibilities that appear with the method. Many studies, that were made by departments of urology or radiology, showed promising results. Background: estimation of bladder cancer depends on proper tumor staging, grading and assessment of its biological potential. It is provided by a multimodal approach using clinical, histopathological and radiological methods. Development of MRI provides the best imaging technique for locoregional staging in several other tumors. Lately it was adjusted in BCa preoperative evaluation leading to significant improvement in differentiating patients with NMIBCs and MIBCs. Objective: this article aims to approximate the fundamentals of MRI in BCa and to provide an overview of the available data on the role of VI-RADS score in the diagnostic pathway of bladder cancer.

Modern aspects of diagnosis of the abdominal gun-shot woundings. Experience of a hybrid war in the East of Ukraine

Objective. To raise the efficacy of radiological diagnosis of the gun-shot abdominal woundings, using modern highly informative methods of medical visualization with determination of their sensitivity and specificity. Materials and methods. Retrospective analysis was done of the results of radiological diagnosis, endovideosurgical and invasive interventions under the radiological methods guidance in 70 injured persons with the gun-shot abdominal woundings, to whom a qualified surgical aid with some elements of specialized help was delivered in 2014-2020 yrs. Average age of the injured persons have constituted 30 complete years old. There were 68 (97.1%) men and 2 (2.9%) women. The results of digital roentgenography, ultrasonographic diagnosis, laparoscopy/laparocentesis, thoracoscopy/thoracocentesis, the puncture-draining interventions under the radiological methods guidance in the injured persons with the gun-shot abdominal woundings were compared to results of the multidetector computed tomography with dynamical contrasted enhancement as a “gold standard” of diagnosis of the gun-shot abdominal woundings and criterion of the foreign bodies visualization (metallic shrapnel, bullets, fragments of bone, drains etc.). Results. The main mechanism of damage in the affected persons with the gun-shot abdominal woundings were shrapnel, created as a result of application of various kinds of the gun-shot and explosive weapons. The part of the gun-shot shrapnel woundings statistically significantly prevailed over part of the bullet and explosive woundings. In accordance to the wound channel kind, the part of blind woundings have had prevailed over parts of the through and multiple woundings statistically significantly (p < 0,05). On a mobile tactical level the rate of application of ultrasonic diagnosis and digital roentgenography for primary selection and diagnostic monitoring was statistically significantly (p < 0.05) higher, than of other methods of medical visualization, what may be explained by improvement and optimization of the treatment and diagnosis tactics, application of urgent sonography in trauma and other modified protocols. Optimal diagnostic system was determined in accordance to indices of sensitivity and specificity of the medical visualization methods, endovideosurgical and puncture-draining interventions under the radiological methods of control - the multidetector computed tomography with dynamical contrasted enhancement. Conclusion. High sensitivity (99%) and specificity (98%) of the multidetector computed tomography with dynamical contrasted enhancement permits to apply it as a method of medical visualization of the gun-shot abdominal woundings for diagnostic selection of wounded persons and the diagnosis establishment.

Diagnostic Metods Ankle Joint

103 patients with ankle injuries were examined. 81.3% of patients complained of pain. In 78.0% of patients, joint function was impaired, in 58.8% — joint deformation, in 72.9% — swelling in the joint area, in 79.6% — soreness in the projection of interbercular syndesmosis, in 87.7% — different severity of joint movement restriction. When analyzing radiographs, fractures of one or two ankles, foot subvisions both outside and behind, fractures of the posterior edge of the tibia were detected. The Foot and Ankle Disease Assessment Scale of the American Foot and Ankle Orthopedic Association (AOFAS) was used to objectively assess the functional state of the ankle joint. Known clinical and radiological methods of examination of the ankle joint make it possible for a person skilled in the art to detect damage to both the bone structure and the ligament apparatus. However, for objective assessment of the functional state of the ankle joint and foot, it is recommended to use scales of clinical assessment of the ankle joint state.

INTEROBSERVER VARIABILITY IN LIMB LENGTH DISCREPANCY IN THR ON RADIOGRAPH - A MULTICENTRIC STUDY.

Introduction: Restoration of limb length is one of the most important aims after total hip replacement . The measurement is often done by various radiological methods ,but its measurement is often difcult and variable. We studied to check if measurements of limb length discrepancy has interobserver variability using standard anteroposterior radiograph. Material and methods: Forty patients (40 hips) underwent measurement of limb length discrepancy on standard AP radiographs. The measurement was done by two observers from two different institutions (On digital X-ray AP view of hip, a line is drawn at the level of & parallel to inter teardrop area and intersecting the lesser trochanter on each side. Compare 2 points of intersection & measure difference to determine the amount of limb discrepancy). Results:There was excellent inter-observer agreement for radiological measurments kappa=0.867 (good aggrement) for pre-operative radiographic measurements and kappa=0.811(good aggrement) for post-operative radiographic measurements. Conclusions: Our data show use of radiological measurement of Limb Length Discrepancy (using intertear drop as pelvic reference and lesser trochanter as femoral reference) has excellent interobserver agreement and hence is more reliable than manual measurement of Limb Length Discrepancy

Closed kidney injuries in children

MATERIALS AND METHODS: Within 20 yrs, 76 children aged 28 yrs with kidney trauma were under observation, and 35 of them had associated trauma. Clinical, instrumental, and radiological methods were used in the diagnosis. RESULTS: Of the 76 children with closed kidney trauma, 23 were diagnosed with kidney contusion, 14 with kidney injury with subcapsular hematoma, 16 with kidney injury with rupture of the capsule and perirenal urohematoma, 21 with kidney rupture and damage to the calyxpelvic system, and 2 with traumatic hydronephrotic kidney. Conservative treatment was carried out in 49 (64.4%) children and surgical treatment in 28 (25.6%). In the long term, 28 children with kidney injuries and treated conservatively were examined. Complications were found in nine children: pyeloectasia, deformation of the calyxpelvic system, pyelonephritis, and renal hypertension. Organ-preserving surgery was performed in 22 (28.9%) children and nephrectomy in 5 (6.6%) children. As long-term results: the function of the operated kidneys was satisfactory, some changes occurred in the calyxpelvic systems, and no data for pyelonephritis was found. CONCLUSION: Renal injuries with subcapsular rupture and perirenal urohematoma should be surgically treated to prevent severe long-term complications. In unclear cases, the choice can be a two-stage organ-preserving operation for the so-called crushing of the kidney.