17 research outputs found
The role of CT and MRI in the diagnosis and management of pilomyxoid astrocytoma with spontaneous intratumoral hemorrhage - a case report
ΠΡΠ²Π΅Π΄Π΅Π½ΠΈΠ΅: ΠΠΊΠΎΠ»ΠΎ ΠΏΠΎΠ»ΠΎΠ²ΠΈΠ½Π°ΡΠ° ΠΎΡ ΠΌΠΎΠ·ΡΡΠ½ΠΈΡΠ΅ ΡΡΠΌΠΎΡΠΈ Π² Π΄Π΅ΡΡΠΊΠ° Π²ΡΠ·ΡΠ°ΡΡ ΡΠ° Π°ΡΡΡΠΎΡΠΈΡΠΎΠΌΠΈ. ΠΠΈΠ»ΠΎΠΌΠΈΠΊΡΠΎΠΈΠ΄Π½ΠΈΡΡ Π°ΡΡΡΠΎΡΠΈΡΠΎΠΌ Π΅ Π°Π³ΡΠ΅ΡΠΈΠ²Π΅Π½ Π²Π°ΡΠΈΠ°Π½Ρ Π½Π° ΠΏΠΈΠ»ΠΎΡΠΈΡΠ½ΠΈΡ Π°ΡΡΡΠΎΡΠΈΡΠΎΠΌ. ΠΠ°ΠΉ-ΡΠ΅ΡΡΠΎ ΡΠ΅Π·ΠΈ ΡΡΠΌΠΎΡΠΈ ΡΠ° Π΄ΠΎΠ±ΡΠ΅ ΠΎΡΠ³ΡΠ°Π½ΠΈΡΠ΅Π½ΠΈ, Π½Π΅ΠΈΠ½ΡΠΈΠ»ΡΡΠΈΡΠ°ΡΠΈ ΠΎΠΊΠΎΠ»Π½Π°ΡΠ° ΡΡΠΊΠ°Π½. ΠΠ°ΡΠ΅ΡΠΈΠ°Π»ΠΈ ΠΈ ΠΌΠ΅ΡΠΎΠ΄ΠΈ: ΠΡΠ΅Π΄ΡΡΠ°Π²ΡΠΌΠ΅ ΡΠ»ΡΡΠ°ΠΉ Π½Π° ΠΏΠΈΠ»ΠΎΠΌΠΈΠΊΡΠΎΠΈΠ΄Π΅Π½ Π°ΡΡΡΠΎΡΠΈΡΠΎΠΌ Π² Π΄Π΅ΡΡΠΊΠ° Π²ΡΠ·ΡΠ°ΡΡ, ΠΏΡΠΈΠ΄ΡΡΠΆΠ΅Π½ ΡΡΡ ΡΠΏΠΎΠ½ΡΠ°Π½Π½ΠΎ ΠΈΠ½ΡΡΠ°ΡΡΠΌΠΎΡΠ½ΠΎ ΠΊΡΡΠ²Π΅Π½Π΅. ΠΠ΅ΡΠ΅ Π½Π° 3-Π³ΠΎΠ΄ΠΈΡΠ½Π° Π²ΡΠ·ΡΠ°ΡΡ Π±Π΅ΡΠ΅ ΠΏΡΠΈΠ΅ΡΠΎ Π² ΡΠΏΠ΅ΡΠ½ΠΎΡΠΎ ΠΎΡΠ΄Π΅Π»Π΅Π½ΠΈΠ΅ Π½Π° Π£ΠΠΠΠ βΠ‘Π². ΠΠ°ΡΠΈΠ½Π°` Π² Π³Ρ. ΠΠ°ΡΠ½Π° ΠΏΠΎ ΠΏΠΎΠ²ΠΎΠ΄ Π½Π΅ΡΡΠ°Π±ΠΈΠ»Π½Π° Ρ
Π΅ΠΌΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΠΊΠ°, ΠΏΠΎΠ²ΠΈΡΠ΅Π½Π° ΡΠ΅Π»Π΅ΡΠ½Π° ΡΠ΅ΠΌΠΏΠ΅ΡΠ°ΡΡΡΠ°, ΠΏΠΎΠ²ΡΡΡΠ°Π½Π΅ ΠΈ Π·Π°Π³ΡΠ±Π° Π½Π° ΡΡΠ·Π½Π°Π½ΠΈΠ΅. ΠΡΠΈ Π½Π΅Π²ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ½ΠΈΡ ΠΏΡΠ΅Π³Π»Π΅Π΄ ΡΠ΅ ΡΡΡΠ°Π½ΠΎΠ²ΠΈ, ΡΠ΅ Π·Π΅Π½ΠΈΡΠΈΡΠ΅ ΡΠ° Π΄Π²ΡΡΡΡΠ°Π½Π½ΠΎ Π½Π΅ΡΠ΅Π°Π³ΠΈ-ΡΠ°ΡΠΈ Π½Π° ΡΠ²Π΅ΡΠ»ΠΈΠ½Π°. ΠΠΎ ΠΠ»Π°Π·Π³ΠΎΡ ΠΊΠΎΠΌΠ° ΡΠΊΠ°Π»Π°ΡΠ° ΠΏΠ°ΡΠΈΠ΅Π½ΡΡΡ ΠΏΠΎΠ»ΡΡΠΈ 6 ΡΠΎΡΠΊΠΈ. ΠΡ ΠΈΠ·Π²ΡΡΡΠ΅Π½ΠΎΡΠΎ ΠΏΡΠ΅Π΄ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠ²Π½ΠΎΡΠΎ ΠΊΠΎΠΌΠΏΡΡΡΡΠ½ΠΎ ΡΠΎΠΌΠΎΠ³ΡΠ°ΡΡΠΊΠΎ (ΠΠ’) ΠΈΠ·ΡΠ»Π΅Π΄Π²Π°Π½Π΅ ΡΠ΅ ΡΡΡΠ°Π½ΠΎΠ²ΠΈ Π½Π°Π»ΠΈΡΠΈΠ΅ Π½Π° ΠΈΠ½ΡΡΠ°ΡΠ΅ΡΠ΅Π±ΡΠ°Π»Π΅Π½ Ρ
Π΅ΠΌΠ°ΡΠΎΠΌ, ΠΏΡΠΈΡΠΈΠ½ΡΠ²Π°Ρ Π²ΡΡΡΠ΅ΡΠ½Π° Ρ
ΠΈΠ΄ΡΠΎΡΠ΅ΡΠ°Π»ΠΈΡ ΠΈ Π΄ΠΈΠ»Π°ΡΠ°ΡΠΈΡ Π½Π° Π»Π°ΡΠ΅ΡΠ°Π»Π½ΠΈΡΠ΅ Π²Π΅Π½ΡΡΠΈΠΊΡΠ»ΠΈ. ΠΠ΅ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎ ΡΠΏΠ΅ΡΠ½ΠΎ ΠΎΠΏΠ΅ΡΠ°ΡΠΈΠ²Π½ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΠ΅ Ρ ΠΏΠΎΡΡΠ°Π²ΡΠ½Π΅ Π½Π° ΠΈΠ½ΡΡΠ°Π²Π΅Π½ΡΡΠΈΠΊΡΠ»Π°ΡΠ΅Π½ Π΄ΡΠ΅Π½, ΠΏΠΎΡΠ»Π΅Π΄Π²Π°Π½ΠΎ ΠΎΡ ΠΏΡΠΎΠ²Π΅ΠΆΠ΄Π°Π½Π΅ Π½Π° ΠΌΠ°Π³Π½ΠΈΡΠ½ΠΎΡΠ΅Π·ΠΎΠ½Π°Π½ΡΠ½Π° ΡΠΎΠΌΠΎΠ³ΡΠ°ΡΠΈΡ (ΠΠ Π’) Π½Π° Π³Π»Π°Π²Π°. ΠΠ Π’ Π΄ΠΎΠΊΠ°Π·Π° Π½Π°Π»ΠΈΡΠΈΠ΅ΡΠΎ Π½Π° Π³ΠΎΠ»ΡΠΌΠ° ΡΡ-ΠΌΠΎΡΠ½Π° ΡΠΎΡΠΌΠ°ΡΠΈΡ Ρ ΡΠ°Π·ΠΌΠ΅ΡΠΈ 49Ρ
55 ΠΌΠΌ, ΡΠ°Π·ΠΏΠΎΠ»ΠΎΠΆΠ΅Π½Π° ΠΈΠ½ΡΡΠ°- ΠΈ ΡΡΠΏΡΠ°ΡΠ΅Π»Π°ΡΠ½ΠΎ. ΠΠ΅ ΠΈΠ·Π²ΡΡΡΠ΅Π½Π° ΠΊΡΠ°Π½ΠΈΠΎ ΡΠΎΠΌΠΈΡ ΠΈ ΠΏΠ°ΡΡΠΈΠ°Π»Π½Π° Π΅ΠΊΡΡΠΈΡΠΏΠ°ΡΠΈΡ Π½Π° ΡΡΠΌΠΎΡΠ° ΡΡΠ΅Π· ΠΈΠ·ΠΏΠΎΠ»Π·Π²Π°Π½Π΅ Π½Π° ΠΌΠΈΠΊΡΠΎΡ
ΠΈΡΡΡΠ³ΠΈΡΠ½Π° ΡΠ΅Ρ
Π½ΠΈΠΊΠ°. Π Π΅Π·ΡΠ»ΡΠ°ΡΡΡ ΠΎΡ Ρ
ΠΈΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ½ΠΎΡΠΎ ΠΈΠ·ΡΠ»Π΅Π΄Π²Π°Π½Π΅ Π΄ΠΎΠΊΠ°Π·Π° ΠΌΠΎΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ½Π°ΡΠ° ΠΊΠ°ΡΡΠΈΠ½Π° Π½Π° ΠΏΠΈΠ»ΠΎΠΌΠΈΠΊΡΠΎΠΈΠ΄Π΅Π½ Π°ΡΡΡΠΎΡΠΈΡΠΎΠΌ WHO grade II. Π Π΅Π·ΡΠ»ΡΠ°ΡΠΈ ΠΈ ΠΎΠ±ΡΡΠΆΠ΄Π°Π½Π΅: Π ΡΠ°Π½Π½ΠΈΡ ΠΏΠΎΡΡΠΎΠΏΠ΅ΡΠ°ΡΠΈΠ²Π΅Π½ ΠΏΠ΅ΡΠΈΠΎΠ΄ ΠΏΠ°ΡΠΈΠ΅Π½ΡΡΡ Π±Π΅ΡΠ΅ Ρ
Π΅ΠΌΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΡΠ½ΠΎ ΡΡΠ°Π±ΠΈΠ»Π΅Π½. ΠΡ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎΡΠΎ ΠΏΠΎΡΡΠΎΠΏΠ΅ΡΠ°ΡΠΈΠ²Π½ΠΎ ΠΠ’ ΠΈΠ·ΡΠ»Π΅Π΄Π²Π°Π½Π΅ ΡΠ΅ ΡΡΡΠ°Π½ΠΎΠ²ΠΈ ΠΏΠ΅ΡΡΠΈΡΡΠΈΡΠ°ΡΠ° ΠΈΠ½ΡΡΠ°Π²Π΅Π½ΡΡΠΈΠΊΡΠ»Π°ΡΠ½Π° Ρ
Π΅ΠΌΠΎΡΠ°Π³ΠΈΡ, Π²ΡΠΏΡΠ΅ΠΊΠΈ Π½Π°Π»ΠΈΡΠΈΠ΅ΡΠΎ Π½Π° ΠΈΠ½ΡΡΠ°Π²Π΅Π½ΡΡΠΈΠΊΡΠ»Π°ΡΠ½ΠΈ Π΄ΡΠ΅Π½ΠΎΠ²Π΅. ΠΡΠ² ΡΡΠΎΠ½ΡΠ°Π»Π½ΠΈΡΠ΅ Π΄ΡΠ»ΠΎΠ²Π΅ Π±Π΅ Π·Π°Π±Π΅Π»ΡΠ·Π°Π½Π° Ρ
ΠΈΠΏΠΎΠ΄Π΅Π½ΡΠ½Π° Π»Π΅Π·ΠΈΡ Ρ Π²ΠΈΠ΄ Π½Π° ΠΈΡΡ
Π΅ΠΌΠΈΡΠ½Π°. ΠΠΎΡΠ°Π΄ΠΈ Π»ΠΈΠΏΡΠ°ΡΠ° Π½Π° ΠΏΠΎΠ΄ΠΎΠ±ΡΠ΅Π½ΠΈΠ΅ Π² Π½Π΅Π²ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ½ΠΈΡ ΡΡΠ°ΡΡΡ, ΠΊΠ°ΠΊΡΠΎ ΠΈ Π½Π°Π»ΠΈΡΠΈΠ΅ΡΠΎ Π½Π° ΡΠ΅Π·ΠΈΠ΄ΡΠ°Π»Π½Π° ΡΡΠΌΠΎΡΠ½Π° ΠΌΠ°ΡΠ°, Π±Π΅ ΠΏΡΠ΅Π΄Π»ΠΎΠΆΠ΅Π½ΠΎ ΠΏΡΠΎΠ΄ΡΠ»ΠΆΠ°Π²Π°Π½Π΅ Π½Π° Π»Π΅ΡΠ΅Π½ΠΈΠ΅ΡΠΎ. ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅: Π’ΡΠΉ ΠΊΠ°ΡΠΎ Π»ΠΈΠΏΡΠ²Π°Ρ ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ½Π° Π·Π° ΡΠΎΠ·ΠΈ Π²ΠΈΠ΄ ΡΡΠΌΠΎΡ ΠΊΠ»ΠΈΠ½ΠΈΡΠ½Π° ΠΈΠ·ΡΠ²Π°, Π½Π°ΠΉ-ΡΠ΅ΡΡΠΎ ΠΏΡΡΠ²ΠΈΡΠ΅ ΡΠΈΠΌΠΏΡΠΎΠΌΠΈ ΡΠ° ΡΠ²ΡΡΠ·Π°Π½ΠΈ Ρ ΠΏΠΎΠ²ΠΈΡΠ°Π²Π°Π½Π΅ Π½Π° ΠΈΠ½ΡΡΠ°ΠΊΡΠ°Π½ΠΈΠ°Π»Π½ΠΎΡΠΎ Π½Π°Π»ΡΠ³Π°Π½Π΅ ΠΈ ΠΊΠΎΠΌΠΏΡΠ΅ΡΠΈΡΡΠ° Π½Π° ΠΏΠ°ΡΠ΅Π½Ρ
ΠΈΠΌΠ°, ΠΊΠΎΠΈΡΠΎ ΡΠ΅ ΠΏΡΠ΅Π΄ΠΈΠ·Π²ΠΈΠΊΠ²Π°Ρ ΠΎΡ ΠΌΠ°Ρ-Π΅ΡΠ΅ΠΊΡΠ° ΠΈ Π»ΠΎΠΊΠ°Π»ΠΈΠ·Π°ΡΠΈΡΡΠ° Π½Π° ΡΡΠΌΠΎΡΠ°.Introduction: About half of childhood brain tumors are astrocytomas. Pilomyxoid astrocytomas are an aggressive variant of pilocytic astrocytoma. Generally, these tumors are well circumscribed without infiltration. Materials and Methods: We report a case of pilomyxoid astrocytoma associated with tumoral bleeding in a pediatric patient. A 3-year-old girl presented in the Emergency Department of St.Marina University Hospital in Varna with unstable haemodinamics, fever, vomiting and loss of consciousness. The neurological examination revealed non-reactive to light pupils. The patient was assessed to have a Glasgow Coma Scale (GCS) score of 6. The preoperative CT scan showed an intracerebral haematoma, causing hydrocephalus and dilatation of the lateral ventricles. After an insertion of an external ventricular drain, a MRI scan was performed. It revealed a giant intra- and suprasellar tumor with dimentions of 49x55 mm. The patient underwent craniotomy and microsurgical partial extirpation of the tumor. After a histological examination was performed, the tumor was considered pilomyxoid astrocytoma WHO grade II. Results and Discussion: In the early postoperative period, the patient was haemodinamically stable. The postoperative CT scan demonstrated a persisting intraventricular haemorrhage, despite the inserted external ventricular drains. A hypodense lesion in the right frontal lobe consistent with subacute infarction was noticed. Due to the lack of neurological improvement and the presence of a residual tumor (confirmed by the CT scan), a subsequent surgery was necessary. Conclusion: There is no characteristic clinical presentation and the symptoms will be related to the mass effect and the tumor location, usually symptoms of raised intracranial pressure or parenchymal compression
A fatal case of non-Hodgkin lymphoma - a case report
ΠΡΠ²Π΅Π΄Π΅Π½ΠΈΠ΅: ΠΠ΅Ρ
ΠΎΠ΄ΠΆΠΊΠΈΠ½ΠΎΠ²ΠΈΡΡ Π»ΠΈΠΌΡΠΎΠΌ (ΠΠ₯Π) Π΅ Ρ
Π΅ΡΠ΅ΡΠΎΠ³Π΅Π½Π½ΠΎ Π·Π°Π±ΠΎΠ»ΡΠ²Π°Π½Π΅, ΠΏΡΠΎΠΈΠ·Ρ
ΠΎΠΆΠ΄Π°ΡΠΎ ΠΎΡ ΠΌΠ°Π»ΠΈΠ³Π½Π΅Π½Π°ΡΠ° ΡΡΠ°Π½ΡΡΠΎΡΠΌΠ°ΡΠΈΡ Π½Π° Π»ΠΈΠΌΡΠΎΡΠΈΡΠΈ ΠΈ Π²ΠΊΠ»ΡΡΠ²Π°ΡΠΎ ΠΌΠ½ΠΎΠΆΠ΅ΡΡΠ²ΠΎ ΠΏΠΎΠ΄ΡΠΈΠΏΠΎΠ²Π΅, Π²ΡΠ΅ΠΊΠΈ ΡΡΡ ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ½ΠΈ ΠΌΠΎΠ»Π΅ΠΊΡΠ»ΡΡΠ½ΠΈ ΠΈ ΠΊΠ»ΠΈΠ½ΠΈΡΠ½ΠΈ Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΡΡΠΈΠΊΠΈ. ΠΠ»ΠΈΠ½ΠΈΡΠ½Π°ΡΠ° ΠΌΠ°Π½ΠΈΡΠ΅ΡΡΠ°ΡΠΈΡ Π²Π°ΡΠΈΡΠ° ΠΎΡ Π²ΡΠ»ΠΎ ΠΏΡΠΎΡΠΈΡΠ°Π½Π΅ Π΄ΠΎ Π°Π³ΡΠ΅ΡΠΈΠ²Π΅Π½ Ρ
ΠΎΠ΄. Π Π΅ΡΠ΅Π½ΠΈΡΡΠ° Π·Π° Π»Π΅ΡΠ΅Π½ΠΈΠ΅ Π·Π° ΠΏΡΠ΅Π΄ΠΏΠΎΡΠΈΡΠ°Π½Π΅ ΡΠ΅ ΠΏΡΠ°Π²ΡΡ Π² ΠΌΡΠ»ΡΠΈΠ΄ΠΈΡΡΠΈΠΏΠ»ΠΈΠ½Π°ΡΠ½Π° ΡΡΠ΅Π΄Π°. ΠΡΠ΅Π· ΠΏΠΎΡΠ»Π΅Π΄Π½ΠΈΡΠ΅ Π΄Π΅ΡΠ΅ΡΠΈΠ»Π΅ΡΠΈΡ ΡΠ΅ Π½Π°Π±Π»ΡΠ΄Π°Π²Π° Π½Π°ΡΠ°ΡΡΠ²Π°Π½Π΅ Π½Π° ΡΠ»ΡΡΠ°ΠΈΡΠ΅, Π΄ΡΠ»ΠΆΠ°ΡΠΎ ΡΠ΅ Π½Π° ΡΠ²Π΅Π»ΠΈΡΠ°Π²Π°Π½Π΅ Π½Π° ΡΡΠ΅Π΄Π½Π°ΡΠ° Π²ΡΠ·ΡΠ°ΡΡ Π½Π° Π½Π°ΡΠ΅Π»Π΅Π½ΠΈΠ΅ΡΠΎ, ΠΏΠΎΠ΄ΠΎΠ±ΡΡΠ²Π°Π½Π΅ Π½Π° Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ°ΡΠ°, ΠΏΠ°Π½Π΄Π΅ΠΌΠΈΡΡΠ° ΠΎΡ Π₯ΠΠ ΠΈ ΠΈΠΌΡΠ½ΠΎΡΡΠΏΡΠ΅ΡΠΈΠ²Π½Π°ΡΠ° ΡΠ΅ΡΠ°ΠΏΠΈΡ. ΠΠ°ΡΠ΅ΡΠΈΠ°Π»ΠΈ ΠΈ ΠΌΠ΅ΡΠΎΠ΄ΠΈ: ΠΠΈΡΠΊΡΡΠΈΡΠ° ΡΠ΅ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅Π½ ΡΠ»ΡΡΠ°ΠΉ Π½Π° 65-Π³ΠΎΠ΄ΠΈΡΠ½Π° ΠΏΠΎΡΠΈΠ½Π°Π»Π° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΊΠ° Ρ ΠΠ΅Ρ
ΠΎΠ΄ΠΆΠΊΠΈΠ½ΠΎΠ² Π»ΠΈΠΌΡΠΎΠΌ. Π’Ρ Π΅ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠΈΡΠ°Π½Π° ΠΏΡΠ΅Π· Π°ΠΏΡΠΈΠ» 2017 Π³. Ρ ΠΊΠ»ΠΈΠ½ΠΈΡΠ½ΠΎ ΠΏΡΠΎΡΠ²Π΅Π½ΠΈ Π΄Π²ΡΡΡΡΠ°Π½Π½ΠΎ ΡΠ²Π΅Π»ΠΈΡΠ΅Π½ΠΈ ΡΠ΅ΡΠ²ΠΈΠΊΠ°Π»Π½ΠΈ Π»ΠΈΠΌΡΠ½ΠΈ Π²ΡΠ·Π»ΠΈ, Π°ΡΡΠ΅Π½ΠΎ-Π°Π΄ΠΈΠ½Π°ΠΌΠΈΡΠ΅Π½ ΡΠΈΠ½Π΄ΡΠΎΠΌ, Π·Π°ΠΌΠ°ΠΉΠ²Π°Π½Π΅ ΠΈ Π°Π±Π΄ΠΎΠΌΠΈΠ½Π°Π»Π½Π° Π±ΠΎΠ»ΠΊΠ°. ΠΡΡΠ²ΠΎΠ½Π°ΡΠ°Π»Π½ΠΎ ΡΡ Π΅ ΠΏΡΠΈΠ΅ΡΠ° Π² ΠΠΠΠ-Π‘ΠΈΠ»ΠΈΡΡΡΠ°, ΠΊΡΠ΄Π΅ΡΠΎ Π΅ ΠΎΡΠΊΡΠΈΡΠ° Π±ΠΈΡΠΈΡΠΎΠΏΠ΅Π½ΠΈΡ (Π°Π½Π΅ΠΌΠΈΡ ΠΈ ΡΡΠΎΠΌΠ±ΠΎΡΠΈΡΠΎΠΏΠ΅Π½ΠΈΡ), ΠΏΠΎΡΠ°Π΄ΠΈ ΠΊΠΎΠ΅ΡΠΎ Π΅ ΠΏΡΠ΅ΠΏΡΠ°ΡΠ΅Π½Π° ΠΊΡΠΌ Π£ΠΠΠΠ βΠ‘Π². ΠΠ°ΡΠΈΠ½Π°` Π²ΡΠ² ΠΠ°ΡΠ½Π°. Π€Π»ΠΎΡΡΠΈΡΠΎΠΌΠ΅ΡΡΠΈΡΠ½ΠΎΡΠΎ ΠΈΠ·ΡΠ»Π΅Π΄Π²Π°Π½Π΅ Π½Π° ΠΏΠ΅ΡΠΈΡΠ΅ΡΠ½Π° ΠΊΡΡΠ² Π΄Π΅-ΠΌΠΎΠ½ΡΡΡΠΈΡΠ° ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΡΠ½Π° B-ΠΊΠ»Π΅ΡΡΡΠ½Π° ΠΏΠΎΠΏΡΠ»Π°ΡΠΈΡ. Π Π΅Π·ΡΠ»ΡΠ°ΡΠΈ ΠΈ ΠΎΠ±ΡΡΠΆΠ΄Π°Π½Π΅: CT ΡΠΊΠ°Π½ΠΈΡΠ°Π½Π΅ΡΠΎ Π½Π° Π³ΡΡΠ΄Π½ΠΈΡ ΠΊΠΎΡ, ΠΊΠΎΡΠ΅ΠΌΠ° ΠΈ ΡΠ°Π·Π° ΠΏΠΎΠΊΠ°Π·Π° Π³Π΅Π½Π΅ΡΠ°Π»ΠΈΠ·ΠΈΡΠ°Π½Π° Π»ΠΈΠΌΡΠ°Π΄Π΅Π½ΠΎΠΏΠ°ΡΠΈΡ, ΡΠΈΠ½Π΄ΡΠΎΠΌ Π½Π° Π³ΠΎΡΠ½Π° ΠΏΡΠ°Π·Π½Π° Π²Π΅Π½Π° ΠΈ Π·Π½Π°ΡΠΈΡΠ΅Π»Π½ΠΎ ΡΠ³ΠΎΠ»Π΅ΠΌΠ΅Π½Π° ΡΠ»Π΅Π·ΠΊΠ° Ρ Π»Π°ΡΠ΅ΡΠ°ΡΠΈΡ, ΠΏΠ΅Π½Π΅ΡΡΠ°ΡΠΈΡ Π½Π° Ρ
Π΅ΠΌΠ°ΡΠΎΠΌΠ° ΠΏΡΠ΅Π· ΠΊΠ°ΠΏΡΡΠ»Π°ΡΠ° ΠΈ ΠΌΠ°Π»ΠΊΠ° ΠΊΠΎΠ»Π΅ΠΊΡΠΈΡ ΠΊΡΡΠ² Π² ΠΌΠ°Π»ΠΊΠΈΡ ΡΠ°Π·. ΠΠΎΡΠ°Π΄ΠΈ Π½ΠΈΡΠΊΠΈΡ Π±ΡΠΎΠΉ Π½Π° ΡΡΠΎΠΌΠ±ΠΎΡΠΈΡΠΈΡΠ΅ ΡΡ Π΅ ΠΎΡΠ΅Π½Π΅Π½Π° ΠΊΠ°ΡΠΎ Π²ΠΈΡΠΎΠΊΠΎΡΠΈΡΠΊΠΎΠ² Ρ
ΠΈΡΡΡΠ³ΠΈΡΠ΅Π½ ΠΏΠ°ΡΠΈΠ΅Π½Ρ. ΠΠΎ ΡΠ°Π·ΠΈ ΠΏΡΠΈΡΠΈΠ½Π° ΡΡΠΏΠ΅ΡΠ½ΠΎ Π΅ ΠΈΠ·Π²ΡΡΡΠ΅Π½Π° Π΅ΠΌΠ±ΠΎΠ»ΠΈΠ·Π°ΡΠΈΡ Π½Π° Π»ΠΈΠ΅Π½Π°Π»Π½Π°ΡΠ° Π°ΡΡΠ΅ΡΠΈΡ. ΠΡΠ΅Π· Π°Π²Π³ΡΡΡ 2017 Π³. ΡΠ΅ ΠΏΠΎΡΠ²ΡΠ²Π° Π·Π°Π³ΡΠ±Π° Π½Π° Π°ΠΏΠ΅ΡΠΈΡ, ΠΊΠΎΡΠ΅ΠΌΠ½Π° Π±ΠΎΠ»ΠΊΠ°, ΠΏΠΎΠ²ΡΡΡΠ°Π½Π΅, Π·Π°ΠΏΠ΅ΠΊ ΠΈ Π°Π½ΡΡΠΈΡ, ΠΊΠΎΠ΅ΡΠΎ Π΄ΠΎΠ²Π΅ΠΆΠ΄Π° Π΄ΠΎ ΠΏΡΠΈΠ΅ΠΌΠ°Π½Π΅ ΠΏΠΎ ΡΠΏΠ΅ΡΠ½ΠΎΡΡ Π² Π±ΠΎΠ»Π½ΠΈΡΠ°. ΠΠ°ΡΠΈΠ΅Π½ΡΠΊΠ°ΡΠ° ΠΎΡΡΠ°Π²Π° Π°Π½ΡΡΠΈΡΠ½Π° Π²ΡΠΏΡΠ΅ΠΊΠΈ ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½Π°ΡΠ° Ρ
ΠΈΠ΄ΡΠ°ΡΠ°ΡΠΈΡ ΠΈ Π»Π΅ΡΠ΅Π½ΠΈΠ΅, ΠΈΠ·ΠΏΠ°Π΄Π° Π² ΠΊΠΎΠΌΠ° ΠΈ Π½Π°ΡΡΡΠΏΠ²Π° Π΅ΠΊΠ·ΠΈΡΡΡ Π»Π΅ΡΠ°Π»ΠΈΡ. ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅: ΠΡΠΎΠ³Π½ΠΎΠ·Π°ΡΠ° Π½Π° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈΡΠ΅ Ρ ΠΠ₯Π Π·Π°Π²ΠΈΡΠΈ Π³Π»Π°Π²Π½ΠΎ ΠΎΡ Ρ
ΠΈΡΡΠΎΠ»ΠΎΠ³ΠΈΡΠ½ΠΈΡ ΠΊΠ»Π°Ρ, ΡΠ°Π·ΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½ΠΈΠ΅ΡΠΎ, Π²ΡΠ·ΡΠ°ΡΡΡΠ° Π½Π° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° ΠΈ ΠΎΡ ΡΠΎΠ²Π° Π΄Π°Π»ΠΈ Π±ΠΎΠ»Π΅ΡΡΡΠ° Π΅ ΡΠ°Π·ΠΏΡΠΎΡΡΡΠ°Π½Π΅Π½Π° Π² Π΅ΠΊΡΡΡΠ°Π½ΠΎΠ΄Π°Π»Π½ΠΈ ΠΎΡΠ³Π°Π½ΠΈ. ΠΠ°Π»ΠΈΡΠΈΠ΅ΡΠΎ Π½Π° ΡΠ΅Π·ΠΈ ΠΏΡΠΎΠ³Π½ΠΎΡΡΠΈΡΠ½ΠΈ ΡΠ°ΠΊΡΠΎΡΠΈ Π² Π΄ΠΈΡΠΊΡΡΠΈΡΠ°Π½ΠΈΡ ΡΠ»ΡΡΠ°ΠΉ ΠΌΠΎΠΆΠ΅ Π΄Π° ΠΎΠ±ΡΡΠ½ΠΈ ΠΈΠ·Ρ
ΠΎΠ΄Π° Π½Π° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°.Introduction: Non-Hodgkin lymphoma (NHL) is a heterogeneous disease resulting from the malignant transformation of lymphocytes and includes multiple subtypes, each with specific molecular and clinical characteristics. The clinical presentation ranges from an indolent to an aggressive nature. Treatment decisions are preferably made in a multidisciplinary setting. The last decades have seen a growth due to increased mean age of the population, improvements in diagnosis, the HIV pandemic, and immunosuppressive therapy. Materials and Methods: A case report of a 65-year-old deceased female patient with a non-Hodgkin lymphoma is discussed. She was diagnosed in April 2017 with clinical manifestation of bilaterally enlarged cervical lymph nodes, astheno-adynamic syndrome, dizziness and abdominal pain. She was initially admitted at MHAT-Silistra, where they discovered bicytopenia (anemia and thrombocytopenia) due to which she was referred to Sv. Marina University Hospital in Varna. The flow cytometric analysis of peripheral blood demonstrated a pathological B-cell population. Results and Discussion: CT scan of chest, abdomen and pelvis showed generalized lymphadenopathy, superior vena cava syndrome and significantly enlarged spleen with laceration, penetration of the haematoma through the capsule and a small collection of blood in the lower abdomen. Due to low platelet count she was evaluated as a high-risk surgical patient. A splenic arterial embolization was successfully per formed. In August 2017, she developed loss of appetite, abdominal pain, vomiting, constipation and anuria, which required urgent hospital admission. The patient remained anuric despite proper hydration and treatment, became comatose and died. Conclusion: The prognosis of NHL patients depends mainly on the histological grade, dissemination, patient`s age and whether the disease spreads in extranodal organs. The presence of these prognostic factors in the discussed case may explain the outcome for this patient
The capabilities of ultrasound - from standard echocardiography to Transcranial Doppler in the diagnostics of atrial septal defects
ΠΡΠ²Π΅Π΄Π΅Π½ΠΈΠ΅: Π£Π»ΡΡΠ°Π·Π²ΡΠΊΡΡ Π΅ ΡΠ°ΡΡ ΠΎΡ Π°ΡΡΠ΅Π½Π°Π»Π° Π½Π° Π»Π΅ΠΊΠ°ΡΠΈ ΠΈ ΡΠ°Π΄ΠΈΠΎΠ»ΠΎΠ·ΠΈ ΠΏΠΎΠ²Π΅ΡΠ΅ ΠΎΡ 50 Π³ΠΎΠ΄ΠΈΠ½ΠΈ, Π½ΠΎ Π½Π΅Π³ΠΎΠ²ΠΈΡΠ΅ Π²ΡΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΠΈ ΠΈ Π΄Π½Π΅Ρ ΠΏΡΠΎΠ΄ΡΠ»ΠΆΠ°Π²Π°Ρ Π΄Π° Π½Π°ΡΠ°ΡΡΠ²Π°Ρ ΡΡΠ΅Π· Π²ΡΠ²Π΅ΠΆΠ΄Π°Π½Π΅ΡΠΎ Π½Π° Π²ΡΠ΅ ΠΏΠΎ-Π½ΠΎΠ²ΠΈ ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊΠΈ Π² Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ°ΡΠ° Π½Π° ΡΠ΅Π΄ΠΈΡΠ° ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ. ΠΠ΄Π½Π° ΠΎΡ ΡΡΡ
ΡΠ° ΠΌΠ΅ΠΆΠ΄ΡΠΏΡΠ΅Π΄ΡΡΡΠ΄Π½ΠΈΡΠ΅ ΡΠ΅ΠΏΡΠ°Π»Π½ΠΈ Π΄Π΅ΡΠ΅ΠΊΡΠΈ (ASD) ΠΈ ΠΌΠ°ΠΊΠ°Ρ ΡΡΠ°Π½Π΄Π°ΡΡΠ½Π°ΡΠ° ΡΡΠ°Π½ΡΡΠΎΡΠ°ΠΊΠ°Π»Π½Π° Π΅Ρ
ΠΎΠΊΠ°ΡΠ΄ΠΈΠΎΠ³ΡΠ°ΡΠΈΡ (Π’Π’Π) Π΄Π° Π΅ Π΄ΠΎΠΊΠ°Π·Π°Π»Π° Π΅ΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎΡΡΡΠ° ΠΈ ΠΏΠΎΠ»Π·Π°ΡΠ° ΡΠΈ Π²ΡΠ² Π²ΡΠ΅ΠΌΠ΅ΡΠΎ, Π΄Π½Π΅Ρ Π½Π° ΡΠ°Π·ΠΏΠΎΠ»ΠΎΠΆΠ΅Π½ΠΈΠ΅ Π½Π° ΡΠΏΠ΅ΡΠΈΠ°Π»ΠΈΡΡΠΈΡΠ΅ ΡΡΡΠ΅ΡΡΠ²ΡΠ²Π° Π½ΠΎΠ² ΠΈ ΡΡΡΠΎ ΡΠΎΠ»ΠΊΠΎΠ²Π° Π½Π°Π΄Π΅ΠΆΠ΄Π΅Π½ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ΅Π½ ΠΌΠ΅ΡΠΎΠ΄ - ΡΡΠ°Π½ΡΠΊΡΠ°Π½ΠΈΠ°Π»Π½Π°ΡΠ° Π΄ΠΎΠΏΠ»Π΅Ρ Π΅Ρ
ΠΎΠ³ΡΠ°ΡΠΈΡ (cTCD). ΠΠ°ΡΠ΅ΡΠΈΠ°Π»ΠΈ ΠΈ ΠΌΠ΅ΡΠΎΠ΄ΠΈ: ΠΠΎΠΊΠ»Π°Π΄ΡΡ ΡΠ°Π·Π³Π»Π΅ΠΆΠ΄Π° Π½Π°ΡΠ°ΡΡΠ²Π°ΡΠΈΡΠ΅ Π²ΡΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΠΈ Π½Π° Π΅Ρ
ΠΎΠ³ΡΠ°ΡΠΈΡΡΠ° Π² Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ°ΡΠ° Π½Π° ΠSD. Π£ΡΡΠ°Π½ΠΎΠ²Π΅Π½ΠΎ Π΅, ΡΠ΅ ΠΎΠΊΠΎΠ»ΠΎ 25% ΠΎΡ ΡΠ²Π΅ΡΠΎΠ²Π½ΠΎΡΠΎ Π½Π°ΡΠ΅Π»Π΅Π½ΠΈΠ΅ ΠΈΠΌΠ° ΠΏΠ΅ΡΡΠΈΡΡΠΈΡΠ°Ρ ΡΠΎΡΠ°ΠΌΠ΅Π½ ΠΎΠ²Π°Π»Π΅ (ΠΠ€Π). ΠΠ½ΠΎΠ·ΠΈΠ½ΡΡΠ²ΠΎΡΠΎ ΠΎΡ ΡΠ΅Π·ΠΈ Ρ
ΠΎΡΠ° Π½ΡΠΌΠ°Ρ ΡΠΈΠΌΠΏΡΠΎΠΌΠΈ, ΡΠ²ΡΡΠ·Π°Π½ΠΈ Ρ ΡΠΎΠ²Π° ΡΡΡΡΠΎΡΠ½ΠΈΠ΅. ΠΡΠΏΡΠ΅ΠΊΠΈ ΡΠΎΠ²Π° Π² ΠΏΠΎΡΠ»Π΅Π΄Π½ΠΈΡΠ΅ Π³ΠΎΠ΄ΠΈΠ½ΠΈ ΡΠ΅ ΠΏΡΠ΅Π΄Π»Π°Π³Π° ΡΡΠ°Π½ΠΎΠ²ΠΈΡΠ΅ΡΠΎ, ΡΠ΅ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈΡΠ΅, ΠΏΡΠ΅ΠΆΠΈΠ²Π΅Π»ΠΈ ΠΊΡΠΈΠΏΡΠΎΠ³Π΅Π½Π½ΠΈ ΠΈΠ½ΡΡΠ»ΡΠΈ ΠΈΠ»ΠΈ ΡΡΠ°Π½Π·ΠΈΡΠΎΡΠ½ΠΈ ΠΈΡΡ
Π΅ΠΌΠΈΡΠ½ΠΈ Π°ΡΠ°ΠΊΠΈ (TΠΠ), ΠΈΠΌΠ°Ρ ΠΏΠΎ-Π²ΠΈΡΠΎΠΊΠ° ΡΠ΅ΡΡΠΎΡΠ° Π½Π° ΠΠ€Π. cTCD Π΅ ΠΌΠ½ΠΎΠ³ΠΎ ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»Π½Π° ΠΌΠ΅ΡΠΎΠ΄ΠΈΠΊΠ°, ΠΊΠΎΡΡΠΎ ΠΌΠΎΠΆΠ΅ Π΄Π° Π±ΡΠ΄Π΅ ΠΈΠ·ΠΏΠΎΠ»Π·Π²Π°Π½Π° Π·Π° ΠΎΡΠ΅Π½ΠΊΠ°ΡΠ° Π½Π° Π΄ΡΡΠ½ΠΎ-Π»Π΅Π²ΠΈ ΡΡΠ½ΡΠΎΠ²Π΅ (RLS) ΠΏΡΠ΅Π· ΠΠ€Π. ΠΠ° Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ°ΡΠ° Π½Π° ASD ΡΠ΅ ΠΈΠ·ΠΏΠΎΠ»Π·Π²Π° ΡΡΠ°Π½ΡΡΠ΅ΠΌΠΏΠΎΡΠ°Π»Π΅Π½ ΠΈΠ·Π³Π»Π΅Π΄, ΠΏΡΠΈ ΠΊΠΎΠ΅ΡΠΎ ΡΠ΅ ΠΈΠ·ΠΎΠ±ΡΠ°Π·ΡΠ²Π° ΡΡΠ΅Π΄Π½Π°ΡΠ° ΠΌΠΎΠ·ΡΡΠ½Π° Π°ΡΡΠ΅ΡΠΈΡ (Π‘ΠΠ). ΠΠ΅ΡΠΎΠ΄ΠΈΠΊΠ°ΡΠ° ΡΠ΅ ΡΡΡΡΠΎΠΈ Π² ΠΈΠ½ΡΡΠ°Π²Π΅Π½ΠΎΠ·Π½Π° Π°ΠΏΠ»ΠΈΠΊΠ°ΡΠΈΡ Π½Π° ΠΏΡΠ΅Π΄Π²Π°ΡΠΈΡΠ΅Π»Π½ΠΎ ΠΏΡΠΈΠ³ΠΎΡΠ²Π΅Π½ ΡΠΈΠ·ΠΈΠΎΠ»ΠΎΠ³ΠΈΡΠ΅Π½ ΡΠ°Π·ΡΠ²ΠΎΡ, ΠΊΠ°ΡΠΎ ΠΏΡΠΈ ΠΏΠΎΡΠ²Π° Π½Π° ΠΌΠΈΠΊΡΠΎΠΌΠ΅Ρ
ΡΡΡΠ΅ΡΠ° Π² Π·ΠΎΠ½Π°ΡΠ° Π½Π° Π‘ΠΠ ΠΏΠΎΡΡΠ°Π²Ρ Ρ Π³ΠΎΠ»ΡΠΌΠ° ΡΠΈΠ³ΡΡΠ½ΠΎΡΡ Π΄ΠΈΠ°Π³Π½ΠΎΠ·Π°ΡΠ° ASD. Π Π΅Π·ΡΠ»ΡΠ°ΡΠΈ ΠΈ ΠΎΠ±ΡΡΠΆΠ΄Π°Π½Π΅: Π Π΅Π΄ΠΈΡΠ° ΠΏΡΠΎΡΡΠ²Π°Π½ΠΈΡ Π΄ΠΎΠΊΠ°Π·Π°Ρ
Π°, ΡΠ΅ ΠΏΡΠΈ Π³ΠΎΠ»ΡΠΌ ΠΏΡΠΎΡΠ΅Π½Ρ ΠΎΡ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈΡΠ΅, ΠΏΡΠ΅ΠΆΠΈΠ²Π΅Π»ΠΈ ΠΈΠ½ΡΡΠ»ΡΠΈ ΠΈΠ»ΠΈ Π’ΠΠ, Π΅ Π½Π°Π»ΠΈΡΠ΅ ΡΠ°ΠΊΡΠ² Π΄Π΅ΡΠ΅ΠΊΡ, a ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ½ΠΎΡΡΡΠ° ΠΈ ΡΠΎΡΠ½ΠΎΡΡΡΠ° Π½Π° ΠΌΠ΅ΡΠΎΠ΄Π° ΡΠ° ΡΡΠΈΠ·ΠΌΠ΅ΡΠΈΠΌΠΈ Ρ ΡΠ΅Π·ΠΈ Π½Π° Π’Π’Π ΠΈ ΡΡΠ°Π½ΡΠ΅Π·ΠΎΡΠ°Π³Π΅Π°Π»Π½Π°ΡΠ° Π΅Ρ
ΠΎΠΊΠ°ΡΠ΄ΠΈΠΎΠ³ΡΠ°ΡΠΈΡ (Π’ΠΠ), ΠΊΠΎΡΡΠΎ ΡΠ΅ ΠΏΡΠΈΠ΅ΠΌΠ° Π·Π° Π·Π»Π°ΡΠ΅Π½ ΡΡΠ°Π½Π΄Π°ΡΡ. ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅: cTCD ΠΈΠΌΠ° ΡΡ
ΠΎΠ΄Π½Π° ΡΡΠ²ΡΡΠ²ΠΈΡΠ΅Π»Π½ΠΎΡΡ ΠΈ ΡΠΏΠ΅ΡΠΈΡΠΈΡΠ½ΠΎΡΡ Ρ ΡΠ°Π·ΠΈ Π½Π° cTEE ΠΏΡΠΈ ΠΎΡΠΊΡΠΈΠ²Π°Π½Π΅ΡΠΎ Π½Π° ASD, Π½ΠΎ ΠΈΠΌΠ° ΠΏΡΠ΅Π΄ΠΈΠΌΡΡΠ²ΠΎΡΠΎ Π΄Π° Π΅ Π½Π΅ΠΈΠ½Π²Π°Π·ΠΈΠ²Π΅Π½ ΠΈ Π΄ΠΎΠΊΠ°Π·Π°Π½ΠΎ Π±Π΅Π·ΠΎΠΏΠ°ΡΠ΅Π½ ΠΏΡΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ Ρ Π΅ΠΌΠ±ΠΎΠ»ΠΈΡΠ΅Π½ ΠΈΠ½ΡΡΠ»Ρ ΠΎΡ Π½Π΅ΠΈΠ·ΡΡΠ½Π΅Π½ ΠΏΡΠΎΠΈΠ·Ρ
ΠΎΠ΄. Π ΠΎΠ±ΠΎΠ±ΡΠ΅Π½ΠΈΠ΅, Π΄ΠΎΡΡΡΠΏΠ½ΠΎΡΡΡΠ° Π΄ΠΎ Π²ΠΈΡΠΎΠΊΠΎΡΠ΅Π½ΡΠΈΡΠΈΠ²Π½ΠΈ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ½ΠΈ ΡΠ΅Ρ
Π½ΠΈΠΊΠΈ, ΠΊΠ°ΠΊΠ²Π°ΡΠΎ Π΅ TCD, ΠΎΡΠΈΠ³ΡΡΡΠ²Π° Π²ΡΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡ Π·Π° Π΅ΡΠ΅ΠΊΡΠΈΠ²Π΅Π½ ΠΈ Π½Π°Π΄Π΅ΠΆΠ΄Π΅Π½ ΡΠΊΡΠΈΠ½ΠΈΠ½Π³ Π½Π° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ ΡΡΡ ΡΡΠΎΡΠ²Π΅ΡΠ½ΠΈΡΠ΅ ΠΏΠΎΠΊΠ°Π·Π°Π½ΠΈΡ.Introduction: Ultrasound has been a part of the arsenal of medical specialists for more than 50 years but its uses keep growing with the invention of newer methods in diagnostics of different pathologies. One of them are the atrial septal defects (ASD) and even though the standard transthoracic echocardiography (TTE) has proven its efficacy, there is nowadays, available to professionals, a new and equally reliable diagnostic method - transcranial Doppler ultrasonog-raphy (cTCD). Materials and Methods: This report reviews the growing capabilities of ultrasound in ASD diagnostics. It is estimated that approximately 25% of the world`s population have patent foramen ovale (PFO). The majority of these people have no symptoms associated with this condition. However, in recent years, it has been suggested that patients with cryptogenic strokes or transient ischaemic attacks (TIA) have higher prevalence of PFO. cTCD is a very sensitive technique which can be used for evaluation of right-to-left shunts (RLS) via PFO. In the diagnostics of ASD transtemporal view is used and the middle cerebral artery (MCA) is visualized. The method is performed by intravenous application of saline and the appearance of microbubbles in the MCA determines with high certainty the diagnosis of ASD. Results and Discussion: Numerous studies have shown that in large percentage of the patients with strokes or TIA such defect is present and the specificity and accuracy of the method are comparable to those of TTE and transesophageal echocardiography (TEE), which is considered a standard method for detecting RLS. Conclusion: cTCD has similar sensitivity and specificity to cTEE in detecting ASD but has the advantage of being noninvasive and reportedly safe in patients with embolic stroke of undetermined source. In summary, the availability of high sensitive diagnostic techniques such as TCD provides the opportunity of effective and reliable screening of patients with appropriate indications
Radiotherapy. stages of planning of the radiotherapy process. TNM classification
Π Π»ΡΡΠ΅Π»Π΅ΡΠ΅Π½ΠΈΠ΅ΡΠΎ Π΄Π½Π΅Ρ ΡΠ΅ ΠΈΠ·ΠΏΠΎΠ»Π·Π²Π°Ρ Π΄Π²Π΅ ΠΎΡΠ½ΠΎΠ²Π½ΠΈ Π³ΡΡΠΏΠΈ ΠΉΠΎΠ½ΠΈΠ·ΠΈΡΠ°ΡΠΈ Π»ΡΡΠ΅Π½ΠΈΡ - ΡΠΎΡΠΎΠ½ΠΈ ΠΈ Π·Π°ΡΠ΅Π΄Π΅Π½ΠΈ ΡΠ°ΡΡΠΈΡΠΈ. Π€ΠΎΡΠΎΠ½ΠΈ ΡΠ° ΡΠ΅Π½ΡΠ³Π΅Π½ΠΎΠ²ΠΈΡΠ΅, Π³Π°ΠΌΠ° ΠΈ Π²ΠΈΡΠΎΠΊΠΎΠ΅Π½Π΅ΡΠ³ΠΈΠΉΠ½ΠΎΡΠΎ ΡΠΏΠΈΡΠ°ΡΠ½ΠΎ Π»ΡΡΠ΅Π½ΠΈΠ΅ (Π₯-Π»ΡΡΠΈΡΠ΅), a ΡΠ°ΡΡΠΈΡΠΈ - Π±Π΅ΡΠ°-Π»ΡΡΠΈΡΠ΅, ΡΡΠΊΠΎΡΠ΅Π½ΠΈΡΠ΅ Π΅Π»Π΅ΠΊΡΡΠΎΠ½ΠΈ, ΠΏΡΠΎΡΠΎΠ½ΠΈΡΠ΅, ΠΏΠΈ-ΠΌΠ΅Π·ΠΎΠ½ΠΈΡΠ΅ ΠΈ ΡΠ΅ΠΆΠΊΠΈΡΠ΅ ΠΉΠΎΠ½ΠΈ. ΠΠΎ ΡΠΊΠΎΡΠΎ ΡΠ΅Π½ΡΠ³Π΅Π½ΠΎΠ²Π°ΡΠ° ΠΈ ΡΠ΅Π»Π΅Π³Π°ΠΌΠ°ΡΠ΅ΡΠ°ΠΏΠΈΡΡΠ° Π±ΡΡ
Π° Π²ΠΎΠ΄Π΅ΡΠΈ Π² ΠΡΠ»Π³Π°ΡΠΈΡ. Π‘ Π²ΡΠ²Π΅ΠΆΠ΄Π°Π½Π΅ Π½Π° Π»ΠΈΠ½Π΅ΠΉΠ½ΠΈΡΠ΅ ΡΡΠΊΠΎΡΠΈΡΠ΅Π»ΠΈ Π½Π°ΠΉ-ΡΠΈΡΠΎΠΊΠΎ Π΅ ΠΏΡΠΈΠ»ΠΎΠΆΠ΅Π½ΠΈΠ΅ΡΠΎ Π½Π° Π₯-Π»ΡΡΠΈΡΠ΅ ΠΈ ΡΡΠΊΠΎΡΠ΅Π½ΠΈΡΠ΅ Π΅Π»Π΅ΠΊΡΡΠΎΠ½ΠΈ. Π Π΅Π½ΡΠ³Π΅Π½ΠΎΠ²Π°ΡΠ° ΡΠ΅ΡΠ°ΠΏΠΈΡ ΡΠ΅ ΠΏΡΠΈΠ»Π°Π³Π° ΠΏΡΠΈ ΠΊΠΎΠΆΠ½ΠΈ Π»Π΅Π·ΠΈΠΈ Ρ ΠΌΠ°Π»ΠΊΠΈ ΡΠ°Π·ΠΌΠ΅ΡΠΈ.ΠΡΠΎΡΠ΅ΡΡΡ Π½Π° ΠΏΠ»Π°Π½ΠΈΡΠ°Π½Π΅ Π½Π° Π»ΡΡΠ΅Π»Π΅ΡΠ΅Π½ΠΈΠ΅ΡΠΎ Π΅ ΡΡΡΠ΄Π΅Π½, ΡΡΠ΄ΡΡΠΆΠ° ΠΌΠ½ΠΎΠ³ΠΎ ΡΡΡΠΏΠΊΠΈ ΠΈ Π²ΠΈΡΠΎΠΊΠΎΡΠΈΡΠΊΠΎΠ²ΠΈ Π΄Π΅ΠΉΠ½ΠΎΡΡΠΈ, ΡΡΠΉ ΠΊΠ°ΡΠΎ Π²ΠΊΠ»ΡΡΠ²Π° ΠΈΠ·ΠΏΠΎΠ»Π·Π²Π°Π½Π΅ΡΠΎ Π½Π° ΠΌΠ½ΠΎΠ³ΠΎ ΠΈΠ·ΡΠΎΡΠ½ΠΈΡΠΈ Π½Π° ΠΈΠ½ΡΠΎΡΠΌΠ°ΡΠΈΡ ΠΈ Π²Π·Π°ΠΈΠΌΠΎΠ΄Π΅ΠΉΡΡΠ²ΠΈΠ΅ΡΠΎ Π½Π° ΡΠ°Π·Π»ΠΈΡΠ½ΠΈ ΡΠΏΠ΅ΡΠΈΠ°Π»ΠΈΡΡΠΈ, ΡΡΠ°ΡΡΠ²Π°ΡΠΈ Π² Π»ΡΡΠ΅Π»Π΅ΡΠ΅Π±Π½ΠΈΡ ΠΏΡΠΎΡΠ΅Ρ. TNM ΠΊΠ»Π°ΡΠΈΡΠΈΠΊΠ°ΡΠΈΡΡΠ° ΡΠ΅ ΠΈΠ·ΠΏΠΎΠ»Π·Π²Π° Π·Π° ΠΎΠΏΡΠ΅Π΄Π΅Π»ΡΠ½Π΅ ΠΈΠ½Π΄ΠΈΠΊΠ°ΡΠΈΠΈΡΠ΅ Π·Π° Π»ΡΡΠ΅Π»Π΅ΡΠ΅Π½ΠΈΠ΅.ΠΡΠΈ Π²ΡΠΈΡΠΊΠΈ Π±ΠΎΠ»Π½ΠΈ, ΠΊΠΎΠΈΡΠΎ ΡΠ΅ ΠΎΠ±Π»ΡΡΠ²Π°Ρ Ρ Π»ΠΈΠ½Π΅ΠΉΠ½ΠΈ ΡΡΠΊΠΎΡΠΈΡΠ΅Π»ΠΈ, ΡΠ΅ ΠΏΡΠΈΠ»Π°Π³Π° ΡΡΠΈΠΈΠ·ΠΌΠ΅ΡΠ½ΠΎ ΠΏΠ»Π°Π½ΠΈΡΠ°Π½Π΅. ΠΡΠ½ΠΎΠ²Π½ΠΎΡΠΎ Π΅, ΡΠ΅ ΠΎΠ±Π»ΡΡΠ²Π°Π½ΠΈΡΡ ΠΎΠ±Π΅ΠΌ ΠΈ ΠΊΡΠΈΡΠΈΡΠ½ΠΈΡΠ΅ ΠΎΡΠ³Π°Π½ΠΈ ΡΠ΅ Π·Π°Π΄Π°Π²Π°Ρ Π² ΠΏΠΎΡΠ΅Π΄ΠΈΡΠ° ΠΎΡ ΡΡΠ΅Π·ΠΎΠ²Π΅ Ρ Π΄Π΅Π±Π΅Π»ΠΈΠ½Π°, ΠΏΠΎ-Π³ΠΎΠ»ΡΠΌΠ° ΠΎΡ 0,5 ΡΠΌ. ΠΠΎ ΡΠΎΠ·ΠΈ Π½Π°ΡΠΈΠ½ Π·Π½Π°ΡΠΈΡΠ΅Π»Π½ΠΎ ΡΠ΅ ΠΏΠΎΠ²ΠΈΡΠ°Π²Π° ΡΠΎΡΠ½ΠΎΡΡΡΠ° ΠΈ ΠΊΠ°ΡΠ΅ΡΡΠ²ΠΎΡΠΎ Π½Π° ΠΏΠ»Π°Π½ΠΈΡΠ°Π½ΠΎΡΠΎ Π»ΡΡΠ΅Π»Π΅ΡΠ΅Π½ΠΈΠ΅. Π’Π΅Ρ
Π½ΠΈΠΊΠΈΡΠ΅ Π½Π° ΠΎΠ±Π»ΡΡΠ²Π°Π½Π΅, ΠΏΡΠΈΠ»Π°Π³Π°Π½ΠΈ Ρ Π»ΠΈΠ½Π΅Π΅Π½ ΡΡΠΊΠΎΡΠΈΡΠ΅Π», ΡΠ° ΠΈΠ·ΠΎΡΠ΅Π½ΡΡΠΈΡΠ½ΠΈ ΠΈ Π½Π°Π»Π°Π³Π°Ρ ΠΌΠ°ΡΠΊΠΈΡΠ°Π½Π΅ Π½Π° ΠΈΠ·ΠΎΠ΅Π½ΡΡΡΠ° Π½Π° ΠΊΠΎΠΆΠ°ΡΠ° Π½Π° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ° ΠΈΠ»ΠΈ Π½Π° ΠΈΠΌΠΎΠ±ΠΈΠ»ΠΈΠ·ΠΈΡΠ°ΡΠΈΡΠ΅ ΡΡΡΡΠΎΠΉΡΡΠ²Π°. ΠΠ·ΠΎΡΠ΅Π½ΡΡΡΡΡ ΡΠ΅ ΠΏΠΎΡΡΠ°Π²Ρ ΠΏΡΠΈ ΠΏΡΡΠ²ΠΎΡΠΎ ΠΎΠ±Π»ΡΡΠ²Π°Π½Π΅ Π½Π° ΡΠ΅ΡΠ°ΠΏΠ΅Π²ΡΠΈΡΠ½ΠΈΡ Π°ΠΏΠ°ΡΠ°Ρ Π² ΠΏΡΠΈΡΡΡΡΠ²ΠΈΠ΅ΡΠΎ Π½Π° Π»Π΅ΠΊΠ°Ρ ΠΈ ΡΠΈΠ·ΠΈΠΊ-Π΄ΠΎΠ·ΠΈΠΌΠ΅ΡΡΠΈΡΡ, ΠΈΠ·Π³ΠΎΡΠ²ΠΈΠ» ΠΈΠ½Π΄ΠΈΠ²ΠΈΠ΄ΡΠ°Π»Π½ΠΈΡ ΠΏΠ»Π°Π½.ΠΠΊΠΎ Π²ΡΠ΅ΠΊΠΈ Π»ΡΡΠ΅ΡΠ΅ΡΠ°ΠΏΠ΅Π²ΡΠΈΡΠ΅Π½ ΡΠ΅Π½ΡΡΡ ΡΠ°Π·ΠΏΠΎΠ»Π°Π³Π° Ρ ΠΏΡΠ»Π΅Π½ Π½Π°Π±ΠΎΡ ΠΎΡ Π»ΡΡΠ΅ΡΠ΅ΡΠ°ΠΏΠ΅Π²ΡΠΈΡΠ½Π° Π°ΠΏΠ°ΡΠ°ΡΡΡΠ°, ΡΠΎΠ²Π° Π΄Π°Π²Π° Π²ΡΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡ Π·Π° Π°Π΄Π΅ΠΊΠ²Π°ΡΠ½ΠΎ ΠΈ ΡΡΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΠΎ ΠΎΠ±Π»ΡΡΠ²Π°Π½Π΅ Π½Π° Π²ΡΠΈΡΠΊΠΈ Π»ΠΎΠΊΠ°Π»ΠΈΠ·Π°ΡΠΈΠΈ Π½Π° Π·Π»ΠΎΠΊΠ°ΡΠ΅ΡΡΠ²Π΅Π½ΠΈ ΠΈ Π΄ΠΎΠ±ΡΠΎΠΊΠ°ΡΠ΅ΡΡΠ²Π΅Π½ΠΈ Π½ΠΎΠ²ΠΎΠΎΠ±ΡΠ°Π·ΡΠ²Π°Π½ΠΈΡ, Ρ ΠΈΠ½Π΄ΠΈΠΊΠ°ΡΠΈΠΈ Π·Π° Π»ΡΡΠ΅Π»Π΅ΡΠ΅Π½ΠΈΠ΅. Π ΠΎΠ½ΠΊΠΎΠ»ΠΎΠ³ΠΈΡΠ½Π°ΡΠ° ΠΈΠ½ΡΠΎΡΠΌΠ°ΡΠΈΠΎΠ½Π½Π° ΡΠΈΡΡΠ΅ΠΌΠ° ΡΠ΅ ΡΡΡ
ΡΠ°Π½ΡΠ²Π°Ρ: Π»ΠΈΡΠ½ΠΈΡΠ΅ Π΄Π°Π½Π½ΠΈ Π½Π° ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°, ΠΊΠ»ΠΈΠ½ΠΈΡΠ½Π°ΡΠ° ΠΈΠ½ΡΠΎΡΠΌΠ°ΡΠΈΡ ΠΎΡΠ½ΠΎΡΠ½ΠΎ Π·Π°Π±ΠΎΠ»ΡΠ²Π°Π½Π΅ΡΠΎ ΠΈ Π²ΠΈΠ΄Π° Π»Π΅ΡΠ΅Π½ΠΈΠ΅, Π΄ΠΎΠ·ΠΈΠΌΠ΅ΡΡΠΈΡΠ½ΠΈΡΡ ΠΏΠ»Π°Π½ Π½Π° ΠΎΠ±Π»ΡΡΠ²Π°Π½Π΅ΡΠΎ, ΠΊΠ°ΠΊΡΠΎ ΠΈ ΠΏΠΎΠ΄ΡΠΎΠ±Π½Π° ΠΈΠ½ΡΠΎΡΠΌΠ°ΡΠΈΡ Π·Π° ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΎΡΠΎ Π»ΡΡΠ΅Π»Π΅ΡΠ΅Π½ΠΈΠ΅. ΠΠ½ΡΠΎΡΠΌΠ°ΡΠΈΡΡΠ° ΡΠ΅ Π°ΡΡ
ΠΈΠ²ΠΈΡΠ° Ρ Π²ΡΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡ Π·Π° ΡΠΏΡΠ°Π²ΠΊΠ° Π½Π° Π±ΡΠΎΡ Π½Π° ΠΈΠ·Π²ΡΡΡΠ΅Π½ΠΈΡΠ΅ ΡΠ΅Π°Π½ΡΠΈ ΠΈ ΠΎΠ±Π»ΡΡΠ²Π°Π½ΠΈ ΠΎΠ±Π΅ΠΌΠΈ, ΠΊΠ°ΠΊΡΠΎ ΠΈ ΡΡΠ°ΡΠΈΡΡΠΈΡΠ΅ΡΠΊΠΈ Π°Π½Π°Π»ΠΈΠ· Π½Π° ΠΌΠ½ΠΎΠΆΠ΅ΡΡΠ²ΠΎ Π΄Π°Π½Π½ΠΈ, ΠΎΡΠ½Π°ΡΡΡΠΈ ΡΠ΅ Π΄ΠΎ ΡΡΠ»ΠΎΡΡΠ½ΠΈΡ Π»ΡΡΠ΅ΡΠ΅ΡΠ°ΠΏΠ΅Π²ΡΠΈΡΠ΅Π½ ΠΏΡΠΎΡΠ΅Ρ.In modern radiotherapy two main groups of ionizing radiation are used - photons and charged particles. The photons consist of orthovoltage x-rays, gamma rays and high-energy x-rays, and the particles are beta-rays, accelerated electrons, protons, pi mesons and heavy ions. Until recently orthovoltage and telegamatherapy have been the main types of radiotherapy in Bulgaria. Now with the installation of linear accelerators, x-rays, and accelerated electrons are most commonly used. Orthovoltage radiotherapy is used for small skin lesions.The planning process of radiotherapy is difficult and contains many steps and high-risk activities as it includes the use of many sources of information and the collaboration of different specialists participating in the radiotherapy process. TNM classification is used to define the indication for radiotherapy. Three-dimensional planning is applied to all patients that are treated at a linear accelerator. The main issue here is that the target volume and the critical organs are defined as a series of consecutive CT scans with thickness of less than 0.5 cm. Thus, the accuracy and the quality of the planned radiotherapy are significantly improved. Isocenter irradiation techniqes are used with linear accelerators and this requires marking the isocenter on the patient`s skin or on the immobilization devices.The isocenter is marked during the first irradiation at the treatment machine in the presence of a physician and a physicist-dosimetrist who has developed the individual plan.If a single radiotherapy department is equiped with the full set of radiotherapy machines, this will provide adequate and modern irradiation of all malignant tumors and benign conditions requiring radiotherapy. The oncology information system stores the demographic data of the patient, the clinical information about the disease and treatment methods, the treatment as well as detailed information about the radiotherapy course . The information is archived and allows the checking of the number of performed fractions, the irradiated volumes as well as the performing of a statistical analysis of multiple data related to the entire radiotherapy process
Kidney stone disease (Nephrolithiasis) - Pathogenesis, types of imaging diagnostic methods in contemporary medicine
Π ΠΈΡΠΊΡΡ ΠΎΡ ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ Π½Π° Π½Π΅ΡΡΠΎΠ»ΠΈΡΠΈΠ°Π·Π° Π² ΡΠ°Π·Π²ΠΈΡΠΈΡΠ΅ ΡΡΡΠ°Π½ΠΈ Π΅ ΠΎΠΊΠΎΠ»ΠΎ 12% ΠΏΡΠΈ ΠΌΡΠΆΠ΅ΡΠ΅ ΠΈ 6% ΠΏΡΠΈ ΠΆΠ΅Π½ΠΈΡΠ΅. ΠΡΠ»Π°ΡΠ° ΡΠ°ΡΠ° Π΅ ΠΏΠΎ-Π·Π°ΡΠ΅Π³Π½Π°ΡΠ° ΠΎΡ ΡΠ΅ΡΠ½Π°ΡΠ°. Π§Π΅ΡΡΠΎΡΠ°ΡΠ° Π½Π° Π·Π°Π±ΠΎΠ»ΡΠ²Π°Π½Π΅ΡΠΎ ΡΠ΅ ΡΠ²Π΅Π»ΠΈΡΠ°Π²Π° ΠΏΡΠ°Π²ΠΎΠΏΡΠΎΠΏΠΎΡΡΠΈΠΎΠ½Π°Π»Π½ΠΎ Π½Π° ΡΠ²Π΅Π»ΠΈΡΠ΅Π½Π°ΡΠ° ΡΠ΅ΡΡΠΎΡΠ° Π½Π° Π·Π°Ρ
Π°ΡΠ΅Π½ Π΄ΠΈΠ°Π±Π΅Ρ ΡΠΈΠΏ ΠΠ ΠΈ Π½Π°Π΄Π½ΠΎΡΠΌΠ΅Π½ΠΎΡΠΎ ΡΠ΅Π³Π»ΠΎ. Π‘ΡΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΠ΅ΡΠΎ ΠΌΡΠΆΠ΅ / ΠΆΠ΅Π½ΠΈ Π΅ 1,3:1. Π§Π΅ΡΡΠΎΡΠ°ΡΠ° ΡΠ΅ ΡΠ²Π΅Π»ΠΈΡΠ°Π²Π° Π²ΡΠ² Π²ΡΠ·ΡΠ°ΡΡΡΠ° Π½Π°Π΄ 20 Π³ΠΎΠ΄ΠΈΠ½ΠΈ, a ΠΏΠΈΠΊΡΡ Π½Π° ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΡΡΠ° Π΅ Π²ΡΠ² Π²ΡΠ·ΡΠ°ΡΡΠΎΠ²Π°ΡΠ° Π³ΡΡΠΏΠ° ΠΌΠ΅ΠΆΠ΄Ρ 40-60 Π³ΠΎΠ΄ΠΈΠ½ΠΈ, ΡΠ»Π΅Π΄ ΠΊΠΎΠ΅ΡΠΎ Π½Π°ΠΌΠ°Π»ΡΠ²Π° ΠΈ ΠΎΡΡΠ°Π²Π° ΠΊΠΎΠ½ΡΡΠ°Π½ΡΠ°. ΠΠ΅ΡΡΠΎΠ»ΠΈΡΠΈΠ°Π·Π°ΡΠ° Π΅ ΠΈΠ·Π²Π΅ΡΡΠ½Π° ΠΎΡΠ΅ ΠΊΠ°ΡΠΎ Π±ΡΠ±ΡΠ΅ΡΠ½ΠΎ-ΠΊΠ°ΠΌΠ΅Π½Π½Π° Π±ΠΎΠ»Π΅ΡΡ ΠΈ ΡΠ΅ ΡΠ°Π·Π²ΠΈΠ²Π° ΠΏΡΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ Ρ Π³Π΅Π½Π΅ΡΠΈΡΠ½Π° ΠΏΡΠ΅Π΄ΠΈΡΠΏΠΎΠ·ΠΈΡΠΈΡ, ΠΏΡΠΈ ΡΠΈΡΠΎΠΊ ΡΠΏΠ΅ΠΊΡΡΡ ΠΎΡ ΠΌΠ΅ΡΠ°Π±ΠΎΠ»ΠΈΡΠ½ΠΈ Π·Π°Π±ΠΎΠ»ΡΠ²Π°Π½ΠΈΡ, a ΡΡΡΠΎ ΠΈ ΠΏΡΠΈ ΠΌΠ½ΠΎΠΆΠ΅ΡΡΠ²ΠΎ ΠΊΠΎΠΌΠΎΡΠ±ΠΈΠ΄Π½ΠΈ ΡΡΡΡΠΎΡΠ½ΠΈΡ. ΠΠΎΠ²Π΅ΡΠ΅ΡΠΎ ΠΊΠ°ΠΌΡΠ½ΠΈ ΡΠ° ΠΈΠ·Π³ΡΠ°Π΄Π΅Π½ΠΈ ΠΎΡ ΠΊΠ°Π»ΡΠΈΠ΅Π² ΠΎΠΊΡΠ°Π»Π°Ρ ΠΈ ΠΏΠΈΠΊΠΎΡΠ½Π° ΠΊΠΈΡΠ΅Π»ΠΈΠ½Π°, ΡΡΡΡΠ²ΠΈΡ (Π°ΠΌΠΎΠ½ΠΈΠ΅Π²ΠΎ-ΠΌΠ°Π³Π½Π΅Π·ΠΈΠ΅Π² ΡΡΠ»ΡΠ°Ρ), ΡΠΈΡΡΠΈΠ½, Π°ΠΌΠΎΠ½ΠΈΠ΅Π² ΡΡΠ°Ρ. ΠΠ°ΠΏΠΎΡΠ»Π΅Π΄ΡΠΊ ΡΠ΅ ΠΏΠΎΠ²ΠΈΡΠ°Π²Π° ΡΠ΅ΡΡΠΎΡΠ°ΡΠ° Π½Π° Π»Π΅ΠΊΠ°ΡΡΡΠ²Π΅Π½ΠΎ ΠΈΠ½Π΄ΡΡΠΈΡΠ°Π½Π°ΡΠ° Π½Π΅ΡΡΠΎΠ»ΠΈΡΠΈΠ°Π·Π°, ΠΊΠΎΡΡΠΎ ΡΠ΅ Π½Π°Π±Π»ΡΠ΄Π°Π²Π° ΠΏΡΠΈ ΠΈΠΌΠΎΠ±ΠΈΠ»ΠΈΠ·ΠΈΡΠ°Π½ΠΈ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΈ.ΠΠ±ΡΠ°Π·Π½ΠΎΠ΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ½ΠΈΡΠ΅ ΠΌΠ΅ΡΠΎΠ΄ΠΈ Π·Π°ΠΏΠΎΡΠ²Π°Ρ Ρ ΡΠ»ΡΡΠ°Π·Π²ΡΠΊΠΎΠ²ΠΎΡΠΎ ΠΈΠ·ΡΠ»Π΅Π΄Π²Π°Π½Π΅ Π½Π° ΠΏΠΈΠΊΠΎΡΠΎ-ΠΎΡΠ΄Π΅Π»ΠΈΡΠ΅Π»Π½Π°ΡΠ° ΡΠΈΡΡΠ΅ΠΌΠ°. Π’ΠΎ ΠΎΡΠΊΡΠΈΠ²Π° Π³ΠΎΠ»ΡΠΌ ΠΏΡΠΎΡΠ΅Π½Ρ ΠΎΡ Π²ΡΠΈΡΠΊΠΈ ΠΊΠΎΠ½ΠΊΡΠ΅ΠΌΠ΅Π½ΡΠΈ, ΠΊΠ°ΠΊΡΠΎ ΠΈ ΠΏΠ°ΡΠ΅Π½Ρ
ΠΈΠΌΠ½ΠΈ ΠΏΡΠΎΡΠ΅ΡΠΈ, ΠΊΠΎΠΈΡΠΎ Π±ΠΈΡ
Π° ΠΌΠΎΠ³Π»ΠΈ Π΄Π° ΠΈΠΌΠΈΡΠΈΡΠ°Ρ ΡΠ΅Π½Π°Π»Π½Π° ΠΊΠΎΠ»ΠΈΠΊΠ°. ΠΠ±Π·ΠΎΡΠ½Π°ΡΠ° ΡΠ΅Π½ΡΠ³Π΅Π½ΠΎΠ³ΡΠ°ΡΠΈΡ Π½Π° Π±ΡΠ±ΡΠ΅ΡΠΈ, ΡΡΠ΅ΡΠ΅ΡΠΈ, ΠΏΠΈΠΊΠΎΡΠ΅Π½ ΠΌΠ΅Ρ
ΡΡ (ΠΠ£Π) ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»ΡΠ²Π° ΡΠ΅Π½ΡΠ³Π΅Π½ΠΎΠ²ΠΎ ΠΈΠ·ΡΠ»Π΅Π΄Π²Π°Π½Π΅ Π½Π° ΠΎΡΠ΄Π΅Π»ΠΈΡΠ΅Π»Π½Π°ΡΠ° ΡΠΈΡΡΠ΅ΠΌΠ°, ΠΊΠΎΠ΅ΡΠΎ Π΄Π΅ΠΌΠΎΠ½ΡΡΡΠΈΡΠ° ΠΊΠΎΠ½ΠΊΡΠ΅ΠΌΠ΅Π½ΡΠΈ Ρ ΠΊΠ°Π»ΡΠΈΠ΅Π²ΠΎ ΡΡΠ΄ΡΡΠΆΠΈΠΌΠΎ; ΠΎΠ±ΠΈΠΊΠ½ΠΎΠ²Π΅Π½ΠΎ ΠΏΡΠ΅Π΄ΡΠ΅ΡΡΠ²Π° Π²Π΅Π½ΠΎΠ·Π½Π°ΡΠ° ΡΡΠΎΠ³ΡΠ°ΡΠΈΡ ΠΈ Π΄ΡΡΠ³ΠΈ ΡΠ΅Π½ΡΠ³Π΅Π½ΠΎΠ²ΠΈ ΠΈΠ·ΡΠ»Π΅Π΄Π²Π°Π½ΠΈΡ. ΠΠ΅Π½ΠΎΠ·Π½Π° ΡΡΠΎΠ³ΡΠ°ΡΠΈΡ - ΠΌΠ΅ΡΠΎΠ΄ΡΡ Π΄Π°Π²Π° ΠΈΠ½ΡΠΎΡΠΌΠ°ΡΠΈΡ ΠΊΠ°ΠΊΡΠΎ Π·Π° ΠΏΠΎΠ·ΠΈΡΠΈΡΡΠ° ΠΈ ΡΠ°Π·ΠΌΠ΅ΡΠ° Π½Π° ΠΊΠΎΠ½ΠΊΡΠ΅ΠΌΠ΅Π½ΡΠ°, ΡΠ°ΠΊΠ° ΠΈ Π·Π° ΡΡΡΡΠΎΡΠ½ΠΈΠ΅ΡΠΎ Π½Π° Π±ΡΠ±ΡΠ΅ΡΠ½Π°ΡΠ° ΡΡΠ½ΠΊΡΠΈΡ. ΠΠ΅ΡΠΎΠ΄ΡΡ ΠΎΠ±Π°ΡΠ΅ ΠΈΠΌΠ° ΡΠΈΡΠΊ ΠΎΡ ΠΈΠ·Π²Π΅ΡΡΠ½Π° Π½Π΅ΡΡΠΎΡΠΎΠΊΡΠΈΡΠ½ΠΎΡΡ. ΠΠΎΠΌΠΏΡΡΡΡΠ½Π° ΡΠΎΠΌΠΎΠ³ΡΠ°ΡΠΈΡ Π±Π΅Π· ΠΈΠ·ΠΏΠΎΠ»Π·Π²Π°Π½Π΅ Π½Π° ΠΊΠΎΠ½ΡΡΠ°ΡΡΠ½Π° ΠΌΠ°ΡΠ΅ΡΠΈΡ Π΄Π΅ΠΌΠΎΠ½ΡΡΡΠΈΡΠ° ΠΊΠΎΠ½ΠΊΡΠ΅ΠΌΠ΅Π½ΡΠΈ Π²ΡΠ² Π²ΡΡΠΊΠ° Π΅Π΄Π½Π° ΡΠ°ΡΡ ΠΎΡ ΠΎΡΠ΄Π΅Π»ΠΈΡΠ΅Π»Π½Π°ΡΠ° ΡΠΈΡΡΠ΅ΠΌΠ°.ΠΠΌΠ° ΡΠ΅Π΄ΠΈΡΠ° Π·Π°Π±ΠΎΠ»ΡΠ²Π°Π½ΠΈΡ, ΠΊΠΎΠΈΡΠΎ ΠΌΠΎΠ³Π°Ρ Π΄Π° ΠΈΠΌΠΈΡΠΈΡΠ°Ρ ΡΠΈΠΌΠΏΡΠΎΠΌΠΈΡΠ΅ Π½Π° ΠΠΠ ΠΈ ΠΏΠΎΡΠ°Π΄ΠΈ ΡΠ°Π·ΠΈ ΠΏΡΠΈΡΠΈΠ½Π° Π΅ Π½Π΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΠΎ ΡΠ΅ Π΄Π° Π±ΡΠ΄Π°Ρ ΠΈΠ·ΠΊΠ»ΡΡΠ΅Π½ΠΈ Π² Ρ
ΠΎΠ΄Π° Π½Π° Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠ½ΠΈΡ ΠΏΡΠΎΡΠ΅Ρ. ΠΠ½Π΅Ρ ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ΡΠΎ Π½Π° Π½Π°ΡΠΊΠ°ΡΠ° Π΄ΠΎΠΏΡΠΈΠ½Π΅ΡΠ΅ Π·Π° ΠΏΠΎ-Π·Π°Π΄ΡΠ»Π±ΠΎΡΠ΅Π½ΠΎ ΡΠ°Π·Π±ΠΈΡΠ°Π½Π΅ Π½Π° ΠΏΡΠΈΡΠΈΠ½ΠΈΡΠ΅ ΠΈ ΠΌΠ΅Ρ
Π°Π½ΠΈΠ·ΠΌΠΈΡΠ΅ Π·Π° ΠΎΠ±ΡΠ°Π·ΡΠ²Π°Π½Π΅ Π½Π° ΠΊΠ°ΠΌΡΠ½ΠΈ ΠΈ ΡΡΠΎΡΠ²Π΅ΡΠ½ΠΎ - Π·Π° ΠΌΠ½ΠΎΠ³ΠΎ ΠΏΠΎ-Π΅ΡΠ΅ΠΊΡΠΈΠ²Π½ΠΎ ΠΊΠ»ΠΈΠ½ΠΈΡΠ½ΠΎ Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠΈΡΠ°Π½Π΅ ΠΈ Π»Π΅ΡΠ΅Π½ΠΈΠ΅. ΠΠ΅ΠΎΠ±Ρ
ΠΎΠ΄ΠΈΠΌΠΎ Π΅ ΠΏΠ΅ΡΠΈΠΎΠ΄ΠΈΡΠ½ΠΎ Π΄Π° ΡΠ΅ ΡΠ»Π΅Π΄ΠΈ Π·Π΄ΡΠ°Π²ΠΎΡΠ»ΠΎΠ²Π½ΠΎΡΠΎ ΡΡΡΡΠΎΡΠ½ΠΈΠ΅ ΡΡΠ΅Π· ΡΠ΅Π΄ΠΎΠ²Π½ΠΈ ΠΊΠΎΠ½ΡΡΠ»ΡΠ°ΡΠΈΠΈ Ρ Π½Π΅ΡΡΠΎΠ»ΠΎΠ³ ΠΈΠ»ΠΈ ΡΡΠΎΠ»ΠΎΠ³, ΠΊΠΎΠΉΡΠΎ Π΄Π° ΠΈΠ·Π²ΡΡΡΠ²Π° Π΅Ρ
ΠΎΠ³ΡΠ°ΡΡΠΊΠΎ ΠΈΠ·ΡΠ»Π΅Π΄Π²Π°Π½Π΅.The risk of nephrolithiasis in developed countries is roughly 12% in men and 6% in women. Caucasians are more likely to form kidney stones than black people. The frequency of this pathology increases proportionally to the rising frequency of type II diabetes mellitus and obesity. The ratio of male to female sufferers is 1.3:1. The disease is mostly observed in individuals over the age of 20, while the pique is between 40 and 60 years. Nephrolithiasis is more commonly known as kidney stone disease and develops primarily in genetically predisposed patients, patients with metabolic disorders, and multiple comorbidities. Most stones are made up of calcium oxalate and uric acid, struvite (magnesium ammonium phosphate), cystine, ammonium urate. Recently there has been an increase in medicamentation-induced nephrolithiasis, observed in immobilized patients.The imaging diagnostics begins with abdominal ultrasonography - it can find a large percentage of all calculi, as well as parenchymal processes which could simulate a renal colic. Plain abdominal radiographs can demonstrate calcium-containing stones, and usually precedes venous urograms and other exams. Venous urograms provide insight into a calculus position, as well as regarding renal function. It is, however, associated with potential nephrotoxicity. Computed tomography can natively (without contrast material) demonstrate virtually all stones in every part of the excretory system.There are several conditions which mimic the symptoms of kidney stone disease, and must therefore be exlcuded along the diagnostic pathway. Currently, advanced understanding of the reasons and mechanisms of calculus formation have contributed to more effective diagnostic and treatment methods. Periodic consultations and ultrasonographies with a nephrologist or urologist are advisable
Imaging diagnostic methods for colorectal cancer in contemporary medicine. Types and prevention
INTRODUCTION: Colon cancer (colorectal carcinoma) is a malignant tumor, stemming from the wall of the colon. It is the second most common carcinoma in men (after pulmonary and before stomach cancers) and the third most common in women (after breast and uterine carcinomas). Its frequency has been increasing steadily in the last years. It most often affects people past 50 years of age, but about 20% of cases occur before that point. Histologically, 80% of cases are of adenocarcinoma and about 20% - mucinous. Carcinomas generally develop on the basis of adenomas.AIM: To examine the types, the prevention and the imaging diagnostic methods for the cancer of the large intestine and of the colon of modern medicine.MATERIALS AND METHODS: This research applies statistical methods. The data was processed through statistical and graphical analyses.RESULTS: Screening methods applied with success are as follows: rectoromanoscopy, fibrocolonoscopy, irigography, computed tomographic colonography, magnetic resonance tomography. The most frequently used two are irigography with a barium enema and fibrocolonoscopy. The former allows for a thorough radiological topographical analysis of the whole colon, while the latter allows for direct mucosal visualization and biopsy (both cytological and histological) without radiation by means of a flexible metallic tube inserted retrogradely. Fibrocolonoscopy enables minor minimally invasive surgery such as polyp and small tumor removal. Rectoromanoscopy is a dated method, solely with historical significance. The latest imaging diagnostic methods are the tomographic ones - computed tomography, computed tomography virtual colonoscopy, and magnetic resonance tomography. They are highly informative for all diseases of the colon, contributing considerably to tumor staging, and to preoperative assessment.CONCLUSIONS: Screening programs, timely consultations with specialists and the increasing availability of imaging diagnostic equipment lead to a marked tendency of decreasing colorectal carcinoma mortality in Bulgaria
Gallstone disease (Cholelithiasis) - pathogenesis, prevention and contemporary methods of imaging diagnostics
INTRODUCTION: Cholelithiasis is a metabolic disorder, leading to stone formation in the bile ducts and gallΒbladder. The stones are classified by their composition as cholesterol, pigment, and mixed. The condition is more frequent in overweight individuals, with a stationary way of life, diabetics, and women on oral contracepΒtives. There is a female predilection with a 3.5:1 ratio. The disease has several forms. The latent one is devoid of complaints - stones are an incidental finding. The acute form manifests with right upper quadrant pain. BiliΒary colic is typical - it comes in fits of right subcostal pain, nausea, and frequently - vomiting. Complications are frequent - gallbladder and bile duct inflammation, biliary obstruction, gallbladder perforation, and biliΒary peritonitis.AIM: To analyze the pathogenesis, the prevention and the modern medical imaging methods related to the gallstones disease.MATERIALS AND METHODS: This research applied statistical methods. The data was processed through staΒtistical and graphical analysis.RESULTS: Accurate diagnosis requires a compound approach. Anamnesis of biliary colic initiates it. AbdomiΒnal ultrasonography is the fastest and most accessible imaging method for finding gallstones. It can also presΒent the gallbladder itself - whether it is enlarged, inflamed, or folded. Additional methods include magnetic resonance imaging (MRI), computed tomography (CT), and some hybrid techniques. If the data of cholelithiΒasis is ambiguous, the latter can be confirmed by endoscopic retrograde cholangiopancreatography (ERCP) - an endoscope is introduced to the level of the papilla of Vater, and contrast is injected into it. The biliary pathΒways also used to be imaged by percutaneous transhepatic cholangiography, which now is a dated technique.CONCLUSIONS: Prophylaxis includes avoiding risk factors of alimentary nature and undergoing periodic conΒtrol ultrasonographies, especially in individuals with a family history of gallstones. This is crucial, as chroni
The effect of X-ray radiation on the human body - pros and cons. Radiation protection in medical imaging and radiotherapy
INTRODUCTION: The discovery of X-rays in November 1895 by Roentgen opened a new chapter in the scientifΒic development and pretty soon it became clear that these rays can be useful for diagnostics and treatment. The most frequent use of X-rays is related to their ability to pass through matter. The main fields of application of the rays are medicine, industry, checks of goods and packages and scientific studies. Modern medicine constiΒtutes approximately 80% of the overexposure. The contribution of diagnostic radiology is approximately 22% of the total exposure of Bulgarian population. The quality of the medical services depends to a great extent on the accurate and timely diagnoses set through different methods using also ionizing radiation. The exposure of the patient should be reasonably justified and optimized but cannot be limited. The risk of exposure to high doses of radiation is justified only if this is appropriate for the diagnosis or the treatment. Each overexposure, including medical irradiation, is related to certain radiation risk. Radiation protection is a means to apply the measures intended to protect the health from ionizing radiation-related risks. It is essential to know the beneΒfits and risks of the medical procedures.AIM: To investigate radiation protection means, and the benefits and risks of medical procedures.MATERIALS AND METHODS: An analysis of literature sources was conducted.RESULTS: The medical control of the radiation protection divides exposure into three categories: professional exposure, medical exposure and exposure of the population. Irradiation by any source should be conducted by optimizing the protection and the safety, maintaining the size of the individual dose, the number of exposed persons and the exposure at levels as low as reasonably achievable considering the social and economic factors. This is the so-called optimization of the protection
Verkehrskonzept Innenstadt - Sliven/Bulgarien
Zusammenfassung in englischer SpracheIn der vorliegenden Diplomarbeit wurde ein Verkehrskonzept fΓΌr die Verbesserung des Verkehrs in der Innenstadt - Sliven auf Grund der Analyse des Ist - Zustandes dem StraΓennetz und der Verkehrsorganisation dargestellt. Im Einleitungsteil der Diplomarbeit wird stΓ€dtebauliche Beurteilungen und Kommunikationsproblemen entsprechend dem Masterplan der Stadt gezeigt. FΓΌr die Zusammenstellung des Verkehrskonzeptes werden genaue Ziele entsprechend ihrer Bedeutung definiert. Die Ziele beinhalten im Wesentlichen eine Γnderung des Modal - Splits. Im Verkehrskonzept werden ausfΓΌhrliche Untersuchungen der Ist-Zustand und Entwicklungstendenzen in Bezug auf die geografische Lage, BevΓΆlkerungsentwicklung, Verkehrsinfrastruktur und auch des Untersuchungsanteils jeder Verkehrsart. Methodisch baut das Verkehrskonzept fΓΌr die Innenstadt auf einer Haushaltbefragung auf. Diese Methode wird verwendet, um der MobilitΓ€tsverhaltens fΓΌr Haushaltmitglieder fΓΌr einen Stichtag sowie bei einer Reihe von zusΓ€tzlichen Fragestellungen bezΓΌglich Probleme und resultierenden MaΓnahmenvorschlΓ€gen zu ermitteln. Die Planung und Analyse im bestimmten Stadtteil aus der Innenstadt umfassen die HauptmobilitΓ€tsarten als FuΓverkehr, Radfahrverkehr, ΓPNV, Autoverkehr und auch die Parkraumbewirtschaftung. Die Planungen fΓΌr die verschiedenen MobilitΓ€tsformen werden auf Grund der ΓΆsterreichischen Richtlinien.12
Identification of the Reference Genes for Relative qRT-PCR Assay in Two Experimental Models of Rabbit and Horse Subcutaneous ASCs
Obtaining accurate and reliable gene expression results in real-time RT-PCR (qRT-PCR) data analysis requires appropriate normalization by carefully selected reference genes, either a single or a combination of multiple housekeeping genes (HKGs). The optimal reference gene/s for normalization should demonstrate stable expression across varying conditions to diminish potential influences on the results. Despite the extensive database available, research data are lacking regarding the most appropriate HKGs for qRT-PCR data analysis in rabbit and horse adipose-derived stem cells (ASCs). Therefore, in our study, we comprehensively assessed and compared the suitability of some widely used HKGs, employing RefFinder and NormFinder, two extensively acknowledged algorithms for robust data interpretation. The rabbit and horse ASCs were obtained from subcutaneous stromal vascular fraction. ASCs were induced into tri-lineage differentiation, followed by the eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) treatment of the adipose-differentiated rabbit ASCs, while horse experimental groups were formed based on adipogenic, osteogenic, and chondrogenic differentiation. At the end of the experiment, the total mRNA was obtained and used for the gene expression evaluation of the observed factors. According to our findings, glyceraldehyde 3-phosphate dehydrogenase was identified as the most appropriate endogenous control gene for rabbit ASCs, while hypoxanthine phosphoribosyltransferase was deemed most suitable for horse ASCs. The obtained results underscore that these housekeeping genes exhibit robust stability across diverse experimental conditions, remaining unaltered by the treatments. In conclusion, the current research can serve as a valuable baseline reference for experiments evaluating gene expression in rabbit and horse ASCs. It highlights the critical consideration of housekeeping gene abundance and stability in qPCR experiments, emphasizing the need for an individualized approach tailored to the specific requirements of the study