Background There are scanty data of right ventricular dysfunction markers after major pulmonary resection.

Objective To study the changes of plasma level of N-terminal pro-brain natriuretic peptide (NT-proBNP) and its association with pulmonary artery pressure (PAP) as markers of right ventricular dysfunction in patients who underwent bronchoplastic lobectomy or pneumonectomy.

Material and Methods The study population consisted of 36 patients aged 40–65 who underwent major  pulmonary resection for lung cancer in 2016–2018. Patients were stratified into two groups according to the type of surgical procedure: bronchoplastic lobectomy, the main group (n = 19), and pneumonectomy, control group (n = 17). They were then analyzed for plasma NT-proBNP concentration, operative time, blood loss, intraoperative fluid administration, intraoperative urine output, and mean PAP level before and after an operation.

Results The mean PAP level correlated positively with the plasma NT-proBNP concentration in the pneumonectomy group (Pearson r = 0.916754; p < 0.001). This correlation was no evident in the subset of patients undergoing bronchoplastic lobectomy at the same determination point (Pearson r = 0.234741; p = 0.330).

Conclusion The mean PAP increased significantly after pneumonectomy and is closely correlated with plasma  NTproBNP concentration. These findings support the conclusion that bronchoplasty is preferable over pneumonectomy for lung cancer patients.

Objective To study the radiologic characteristics of facet joints at different stages of the degenerative process in the lumbar spine to determine the indications for various methods of fixing the affected segment and to evaluate the results of treatment.

Material and Methods To determine the radiologic aspects of facet joints in the affected area and in  adjacent segments of the lumbar spine, two groups were formed, including 136 patients who underwent multispiral computed tomography in two-energy mode before surgery and 12 months after surgery. Group I included patients who underwent rigid fixation of the spine (360°), and group II included patients who underwent dynamic fixation using nitinol rods (180°).

Results Based on a comprehensive instrumental study, it was found that the degeneration of the intervertebral disc according to Pfirrmann II and III revealed an increase in the density of the cartilaginous plate in facet joints (HU). These digital indicators confirm the preservation of joint functionality, both in the affected area and in adjacent segments. With severe degrees of disk degeneration in Pfirrmann IV and V and facet joints, deep pathological changes occurred, directed towards the loss of facet joints functionality.

Conclusion The obtained digital indicators of dual-energy computed tomography for the state of facet joints  in combination with the results of magnetic resonance imaging can be used as criteria in a complex of patient studies to assess the degree of degeneration of the vertebral motion segment in the affected area and adjacent segments. We recommend using these criteria as a diagnostic component for finding optimal methods of surgical treatment. 

Background Early recognition of right ventricular (RV) failure in patients with chronic lung diseases is still challenging. In this regard, the study of RV diastolic function as an early marker of subclinical RV dysfunction is of significant practical interest.

Objective We sought to evaluate the influence of chronic lung pathology and age on the RV relaxation properties and to identify the criteria for differential diagnosis of age-related changes in RV diastolic function and increased myocardial stiffness in case of chronic lung disease.

Material and Methods This was a study of 80 patients aged 31 to 68 (40 patients with chronic lung  pathology and 40 healthy controls) being treated at the Research Institute – Ochapovsky Regional Hospital no. 1. All subjects underwent echocardiography with transtricuspidal and transmitral blood flow assessment and spectral tissue Doppler of the mitral and tricuspid annuli.

Results 32 (80%) patients with lung disease demonstrated RV diastolic dysfunction. Of them, 18 (81%) patients are older than 60 years, and 14 (78%) patients are younger than 60 years. The indicators of RV filling were significantly lower compared to the control group not only in older patients but also in patients < 60.

Conclusion The majority of patients with chronic lung pathology exhibited impaired RV diastolic function.The RV diastolic function was detected more often in older patients, but it also occurred in patients of the middle age group. Thus, we arrive at the conclusion that the RV myocardial stiffness is being increased in the  case of chronic lung diseases.

Objective To optimize the process of diagnostics of cosmetic threads using the high-resolution ultrasound.

Material and Methods 80 women were examined with high-resolution ultrasound after implantation of cosmetic threads made of absorbable and non-absorbable materials into the soft tissues of the face and neck. Threads based on the L-lactide-co-ԑ-caprolactone were implanted in 36 cases (45%), threads produced from silicone-sheathed polyester fiber were used for 7 (8.8%) patients, from polydioxanone for 17 (21.2%) patients, from L-lactic acid for 14 (17.5%) patients, polypropylene threads were implanted in 5 (6.3%) patients, gold threads were applied only in one case (1.2%). Patients complained of overcorrection in 10 cases, inflammatory complications in 10 cases as well, and inquired about the presence of the threads in soft tissues in 60 cases.

Results Ultrasound feature of non-absorbable threads made of silicone-sheathed polyester fiber is a heterogeneous structure with a hypoechoic center and hyperechoic margins. Inflammation around the threads is accompanied by perifocal edema in the form of a zone of reduced echogenicity. The presence of an acoustic shadow is a differential feature that distinguishes threads from the ligamentous apparatus of the skin. Effect of reverberation is a specific feature for metal threads.

Conclusion If threads are found in the implantation area, it is necessary to carry out differential diagnostics of the ligamentous apparatus, septa, and superficial fascia of the face. The methodological features lied in the fact that ultrasound diagnostics should be performed in multiple views with necessary visualization in the transverse and longitudinal sections of the studied object using the high-frequency sensors in B-mode, as
well as the Doppler technology and compression elastography.  

Background Intracranial hemorrhage is the most serious manifestation of a ruptured cerebral aneurysm, and subarachnoid hemorrhage (SAH) is the most common clinical and anatomical form. The treatment strategy for SAH varies from conservative to emergency surgical treatment and depends on the source of the hemorrhage. Currently, the search for sources is carried out using various methods of diagnostic radiology.

Objective To compare the images of intracranial arteries obtained by computed tomography (CT)  angiography with the data of cerebral angiography in the acute period of hemorrhage in the subarachnoid space.

Material and Methods We retrospectively analyzed the medical records of 242 patients with acute SAHs from September 2017 to September 2019, examined in the emergency room of the Research Institute – Ochapovsky Regional Hospital no. 1.

Results According to CT angiography, the initially occult vascular lesion was verified in 212 patients (87%), of which in 84.0% of cases (205 patients) the cause of SAH was ruptured cerebral aneurysms. In 3 patients, ruptures of arteriovenous malformations were detected (1.2%). In 4 patients, the “cerebral aneurysms” diagnosis was excluded due to the establishment of a hypertensive nature of intracranial hemorrhage (1.7%). In 30 patients, CT angiography revealed no vascular pathology. According to the results of CT angiography only, 225 patients (93%) were microsurgically operated on, and 12 patients (5%) were operated on using intravascular access. Among 30 patients whose vascular pathology was not detected by CT angiography, 6 patients were found to have single aneurysms according to cerebral angiography: the internal carotid artery – in 3 patients, the middle cerebral artery – in 2, and the pericallous artery – in 1 patient.

Conclusion CT angiography is a key tool of non-invasive diagnosis of the source of SAH in emergency  departments. The absence of vascular pathology on CT angiography in the presence of massive basal SAH, the detection of multiple and “complex” aneurysms, as well as cerebral arteriovenous malformations of the brain during CT angiography remain indications for cerebral angiography.

Objective To evaluate the results of extracorporeal shockwave lithotripsy (ESWL) versus retrograde intrarenal surgery (RIRS) for the treatment of calcium oxalate nephrolithiasis, as well as the damaging effects on renal function, taking into account the dynamics of blood cystatin C and urine beta2-microglobulin.

Material and Methods Of 94 patients with calcium oxalate nephrolithiasis aged 23–78 included in the study,  42 patients were classified as having undergone ESWL (group I) and 52 patients as having undergone RIRS (group II). Group II patients were then stratified into subset 2A (n = 32) as having undergone RIRS through rigid ureteroscope and subset 2B (n = 20) as having undergone RIRS through flexible ureteroscope. We performed plain urography and nephrosonography at 24–48 hours postoperatively and unenhanced computed tomography 4–6 weeks after surgery. We measured concentrations of serum cystatin C and urinary beta2-microglobulin as a marker for kidney damage. In group I, samples of peripheral blood and
urine were taken before and after the first, third sessions and 30 days after the last ESWL session. In group  II, samples were analyzed before surgery, on the first and 30th postoperative days.

Results The average size of calculi in the group with RIRS was 16.91 ± 2.79 mm, in the group with ESWL  12.31 ± 2.27 mm. The need for reoperation after RIRS was 19.2%, which was lower than after ESWL. Stone-free effect (no stones, or residual stones less than 3 mm) was observed in 95% of cases in patients with RIRS, and in 78% with ESWL. Group I patients demonstrated an increase in the blood leukocytes total number more often than subsets 2A (rigid RIRS) and 2B (flexible RIRS) patients. Leukocyturia was also a more common complication in group I. In the RIRS group, there was no statistically significant change in the level of blood cystatin C and urine beta2-microglobulin, on the contrary, a moderate increase in the endogenous marker of cystatin C was noted after one ESWL session. The increase in urine beta2-microglobulin levels in patients after the first and third ESWL sessions was significantly higher than after RIRS.

Conclusion Flexible RIRS may be suggested as the preferred procedure for patients requiring additional protection of renal function in the treatment of renal stones less than 20 mm. ESWL of stones less than 20 mm can be used as an alternative treatment, since it is characterized by a rather long period of stone eradication from the urinary tract, a high frequency of residual calculi after the procedure, and also has a damaging effect on the renal tissue.

In this review, we discuss the advantages and disadvantages of the existing bone defect animal models and tissue engineering techniques applied in studying novel bone defect regenerative approaches. The paper suggests the requirements for an optimal animal model, as well as analyzes in vivo bone injury models widely used in testing. The authors briefly review the methods of experimentally produced lesions of long bones, calvarial bones, mandibular bones in different animals. This review also describes the standardization techniques allowing one to evaluate the process of osteogenesis and bone-implant interactions. That will help researchers thoroughly plan and conduct experiments according to the bioethical principles.

This report presents a clinical case of emergency endovascular treatment of acute rupture of the abdominal aortic aneurysm in complex anatomically difficult conditions. Although this pathology is rare, it has a high mortality rate. Moreover, according to different authors endovascular repair is safer as compared with open surgery. We demonstrate the decision-making algorithm, show the technical nuances during the intervention which allowed us to achieve an acceptable clinical and angiographic result. Our experience will be interesting and useful for specialists who treat patients with vascular diseases.

We present the clinical observation of 55-year-old female patient with diabetic osteoarthropathy (Wagner 3; Brodsky 2; 3a) complicated with chronic osteomyelitis treated in the purulent osteology clinic. Long-term conservative treatment in the hospital at place of residence was not successful, so the patient was found requiring limb amputation. On admission to the purulent osteology clinic, the patient complained of vast purulent wound of the right foot, numbness of the fingers of both feet and disturbed support ability of the limb. The patient underwent complex restorative treatment with the Ilizarov method. Primary treatment outcomes were obvious healing of the osteomyelitis and restoration of the limb function persisting already for three years after treatment. The clinical case presented illustrates the possibility of the Ilizarov method in complex regenerative treatment of patients with diabetic osteoarthropathy, which allows to suppress the necrotic process, eliminate the existing deformation to fill the bone defect and thus restore function of the limb.

The paper presents a clinical case of coronary artery spasm after implantation of bare metal stents. The 60-year-old man was admitted to the hospital with the progression of the coronary heart disease and high angina pectoris functional class for coronary angiography. The patient had the main predisposing factor for the development of coronary artery spasm, which is 20-year smoking history. Based on the results of the coronary angiography, the decision was made to conduct endovascular treatment. The patient was discharged on the 2nd day after angioplasty with implantation of two stents in the right coronary artery. On the evening of discharge, the man developed a severe pain attack in the epigastric region and turned to the hospital. The electrocardiogram revealed ST-segment elevation in leads II, III, aVF, T-waves were negative in leads I, aVL and V3-6. Repeat coronary angiography showed the stent implantation sites were passable, there was a pronounced diffuse coronary artery spasm, which could not be eliminated by intracoronary administration of nitroglycerin.
Coronary artery spasm induced by coronary angioplasty with stent placement is a rare complication that can develop at different time intervals after endovascular intervention. Based on the presented clinical case, it appears  likely that even after bare metal stents implantation, the development of endovascular dysfunction leading to coronary spasm is possible.

Liver neoplasms represent a group of tumors of benign and malignant nature, and their differential diagnosis is rather challenging. At present, it becomes necessary to select a non-invasive, highly informative and sufficient research method for solving diagnostic problems, staging and treating focal liver lesions. Ultrasound examination using modern technologies has advantages in the diagnosis of focal liver disease. The review highlights ultrasound differential and diagnostic signs of focal liver tumors when using various methods of ultrasound diagnostics.