Комплексное использование современных мининвазивных вмешательств под лучевым наведением в хирургическом лечении кист поджелудочной железы

Purpose. To evaluate the capabilities of modern minimally invasive interventions under the beam guidance in the surgical treatment of pancreatic cysts. Materials and Methods. The results of the examination and surgical treatment of 82 patients with pancreatic cysts. Percutaneous puncture drainage under ultrasonographic guidance holds 56 (68.3 %) patients, endoscopic transpapillary intervention in 19 (23.2%) patients, endoscopic transmural drainage of cysts by ultrasonography - in 7 (8.5%). Results. After performing percutaneous drainage of cysts positive results were observed in 51 (91.1%) patients. In 14 (25.0%) patients in the control studies showed preservation of the residual cystic cavity is not more than 3 cm in diameter, without clinical manifestations, that is not regarded as a relapse. Relapses cystic formations were observed in 5 (8.9%) patients. Positive results transpapillary stenting of the main pancreatic duct was observed in 16 patients. In 3 cases, endoscopic stenting GLP was not effective. Subsequently, the patients underwent percutaneous drainage of puncture with a positive result. Endoscopic transmural drainage under ultrasonography noted one intraoperative complication - perforation of the stomach wall. 6 patients had a good result. Term follow up of patients ranged from 10 months to 3 years. Conclusion. Integrated use of modern percutaneous endoscopic and minimally invasive interventions under the beam guidance in 82 patients with pancreatic cysts, yielded positive results in 79 (96.3%) cases, which confirms the efficiency and the prospects for further study and application of these minimally invasive procedures

Мультиспиральная компьютерная томография в диагностике, оценке тяжести и прогнозе острого панкреатита и его осложнений

Objective. To evaluate the value of multislice computed tomography in the diagnosis, assessment of severity and prognosis of acute pancreatitis and its complications, and the choice of an appropriate method of treatment. Materials and Methods. A computer tomography (CT) study of 75 patients with acute pancreatitis. Computer-tomographic study was performed on devices Siemens Somatom Sensation, Siemens Emotion Duo, slice thickness 5 mm, followed by reconstruction of 1 mm with an oral contrast intestine (Urografin) and contrast enhancement (Ultravist, Omnipaque). Results. Diagnostic efficacy of computed tomography in acute pancreatitis was determined. The association of CT severity index with clinical severity and complications were found. Using of the results of multislice computed tomography (MSCT) as a prognostic criterion of the severity of acute pancreatitis was proposed. Conclusion. Complex assessment of pathological changes identified during the initial computer-tomographic study predicts the nature of the subsequent course of the disease in most patients.Цель исследования: оценить значение МСКТ в диагностике, оценке тяжести и прогнозировании течения острого панкреатита. Материал и методы. Проведено КТ-исследование у 75 больных острым панкреатитом. КТ-исследование выполняли на аппаратах Siemens Somatom Sensation, Siemens Emotion Duo с пероральным контрастированием кишечника (Урографин) и внутривенным контрастным усилением (Ультравист, Омнипак). Результаты. Определена диагностическая эффективность КТ при остром панкреатите, выявлена связь КТ-индекса тяжести с клинической тяжестью, осложнениями. Предложено использование результатов МСКТ в качестве прогностического критерия тяжести течения острого панкреатита. Выводы. Комплексная оценка патологических изменений, выявленных при первичном КТ-исследовании, позволяет прогнозировать характер последующего течения заболевания у большинства больных

Сопоставление информативности МР-перфузии и ПЭТ с [11С]метионином в дифференциации продолженного роста церебральных опухолей и лучевых поражений головного мозга после комбинированного лечения

The aim of the study was to compare T2*-weighted MR-perfusion (pMRI) and positron emission tomography using [11C]methionine (PET-Met) in differentiating recurrent brain tumor (RT) from posttreatment radiation effect (PTRE). Material and methods. PET-Met and pMRIwere performed in 45 patients with previously treated brain tumor A total 57 lesions were analyzed. The rCBV index and [11C] methionine uptake index (UI-Met) were calculated as the ratios of the highest lesion value to the that in the reference region. The diagnostic accuracy of UI-Met and rCBV for correct identification of recurrent tumor (RT) versus PTRE was evaluated by ROC-analysis using subsequent histologic analysis or clinical and radiological follow-up. Results. According to the final diagnosis patientsexhibitedthetwo typesofabnormalities: recurrent tumor (n = 33) and non-progressive lesions (n = 24). The inter-individual agreement between the both techniques was observed in 93% of cases. In 4 patients results were discordant. High [11C]methionine uptake and low rCBV were detected in 2 cases of radiation necrosis. In 2 patients PET-Met was able to distinguish foci of radionecrosis and the viable tumor tissue. Conclusion. T2*-weighted MR-perfusion and PET-Met could be efficiently used for differentiation RT from PTRE. Inter-individual comparison of the both methods showed that PET-Met was more sensitive in imaging recurrent tumor, but perfusion MRI had higher specificity

МРТ в диагностике рассеянного склероза

Magnetic resonance imaging (MRI) nowadays is the main diagnostic tool in multiple sclerosis (MS). The article is aimed at reviewing basic signal changes, location and morphology of pathologic lesions in the brain in multiple sclerosis, the role of contrast agents in its diagnostics and monitoring. Among conventional MRI techniques T2-weighted and T2FLAIR-weighted images are the most sensitive for focal damage detection, contrast-enhanced T1-weighted images are still irreplaceable for "active" lesions visualization. Dissemination in space and time is necessary for confirming the diagnosis and forms the basis of McDonald criteria revision of 2005 and 2010. New or enlarged MS lesions on T2 and T2FLAIR images are important for disease activity evaluation together with contrast enhancing T1 lesions. MS lesions detection in the spinal cord is of great importance as it's seen in the majority of patients. MRI also let us identify atypical MS forms like Shilder's diffuse periaxial encephalitis, Balo's concentric sclerosis, Marburg disease and pseudotumorous MS, which are characterized by special neuroimaging signs and thus could be differentiated from classic multiple sclerosis and other central nervous system pathology