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Background@#In 1904, Monkeberg was first described about the coronary calcification which is the degenerative change that occurs with aging process, but the last decades many studies have been confirmed that coronary calcification was an active process same as the signaling pathways with bone mineralization. Coronary calcification increases the risk of myocardial infarction during bypass graft surgery and PCI (СМ СN. Shanahan, 1999).@*Goal@#To evaluate Agatston Coronary Artery Calcium score using contrast enhanced CT-Coronary angiography. @*Objectives@#</br>1. To assess Agatston Coronary Artery Calcium score </br>2. Age and gender relationship of coronary calcification @*Materials and Methods@#We evaluated total 215 patients who were admitted to the Reference center of Diagnostic Imaging named after R.Purev State Laureate, People’s physician and Honorary Professor of the Third State Central Hospital awarded with the Red banner of the Labor diagnosed with the coronary calcification by contrast enhanced 64 slice CT (Philips Ingenuity CT 64) between 2020 to 2022. Patient’s age was considered into 6 groups and coronary calcification was assessed by Agatston’s score. The result of our study determined by common statistical averages and errors and probabilities of the indicators were determined by Student’s criteria.@*Result@#When evaluating Agatston coronary artery calcium scoring by CT-coronary angiography, 11-400 Agatston score was predominantly in our study with p value of (P<0.001). Considering relationship of age and gender, coronary calcification occurs 42.3% of patients aged 50-69, male and female ratio was 1.7:1. @*Conclusions@#</br>1. We established Agatston coronary calcification 11-400 was occurred in 66.96% of the patients. </br>2. Coronary calcification predominantly occurred in 65% patients aged 50-69 years.
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Background@#Lower extremity arterial diseases are chronic stenosis of the artery and occlusive arterial diseases, which are commonly caused by atherosclerosis. Prevalence of lower extremity arterial diseases has positive proportional relationship with age of the patients. Furthermore, prevalence of lower extremity arterial disease is 16% among the males over the age of 60, whereas prevalence among same aged woman is 13%. Among the age group of 38 to 59 age, 60 to 69 age and 70-82 age group, prevalence of lower extremity arterial disease was 5.6%, 15.9%, and 33.8%, respectively.@*Goal@#Identifying lower extremity arterial occlusive disease and chronic stenosis of arteries by CTA-TASC classification of aorta-iliac and femoral popliteal lesions.@*Obiective@#</br> 1. To identify age and sex of the patients with lower extremity arterial occlusive disease and chronic stenosis of arteries.</br> 2. To identify lower extremity arterial occlusive disease and chronic stenosis of arteries by CTA-TASC classification of aorta-iliac and femoral popliteal lesions.@*Material and methods@#Study sample consisted of 237 patients, who were diagnosed with lower extremity arterial occlusive disease and chronic stenosis of arteries from 2019 to 2020 at reference centre on Diagnostic Imaging na after R.Purev State Laureate, People’s physician and Honorary professor of the State Third Central Hospital. Computed angiogram images of lower extremity arteries were examined. Contrast agent “Ultravist” was pumped by automatic syringe. Lower extremity arterial occlusive disease and chronic stenosis of arteries are categorized by CTA-TASC classification of аorta-iliac and femoral popliteal lesions. The youngest participant was 20 years old and the oldest participant was 76 years old. Common statistical measurements such as means and standard errors were calculated. Probability of results were checked using Student’s test.@*Results@#We have found following results: 185(78.1%±3.0) cases out of 237 diagnosed patients with lower extremity arterial occlusive disease and chronic stenosis of arteries are males and 52(21.9%±3.0) cases are female. Distribution of lower extremity arterial occlusive disease and chronic stenosis of arteries by the age group of patients are: up to 20 years of age is 3 (1.3%±0.7), 21 to 40 years of age is 14(5.9%±1.5), 41 to 60 years of age is 86(36.3%±3.1) and over the age of 61 is 134(56.5%±3.2). It is statistically highly significant that experiencing lower extremity arterial occlusive disease and chronic stenosis of arteries among the age group of over 61(P<0.001). </br> The result of lower extremity arterial occlusive disease and chronic stenosis of arteries by the CTA-TASC classification of aorta-iliac and femoral popliteal lesions are: CTA-TASS аorta-iliac lesions A-16(6.8%±1.8), B-8(3.4%±1.2), C-12(5.1%±1.4), D-41(17.3%±2.5), CTA-TASS femoral popliteal A-41(17.29%±2.5), B-53(22.36%±3.6), C-47(19.83%±2.6), D-96(40.5%±3.2), respectively.@*Conclusions@#</br> 1. Lower extremity arterial occlusive disease and chronic stenosis of arteries occurs 46.5% over the age of 60 and 78.1% of the patients are males.</br> 2. Following two categories have identified more than the rest, 17.3% CTA-TASC classification of аorta-iliac lesions, type D and 23.3% CTA-TASC classification of femoral popliteal lesions, type D.
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Background@#The American Heart Association estimates that more than 1 million people die each year from acute coronary heart disease and half a million from acute coronary syndrome, and that $ 115 billion a year is spent on diagnosing and treating coronary heart disease [Word Health Organization, 2013].@*Goal@#In this study we aimed to using coronary computed tomography angiography (CCTA) to diagnose unstable plaques in coronary artery disease.@*Material and methods@#From 2018 to 2021, we performed a coronary computed tomography angiography (CCTA) scan with a Philips Ingenuity 64-slice computed tomography (64 MD-CT) device and examined 47 patients diagnosed with unstable coronary artery disease at the Reference centre on Diagnostic Imaging named after R.Purev State Laureate, People’s physician and Honorary professor of the State Third Central Hospital.</br> Common statistical measurements such as means and standard errors were calculated. Probability of results were checked using Student’s test. @*Result@#In studying signs of coronary computed tomography angiography (CCTA) to diagnose unstable plaques in coronary artery disease that coronary artery diameters more widening to compared healthy artery 16(34.0%±6.9), low density sites clarify in plaque (lower than +30HU)- 14(29.8%±6.7), small calcification detect in plaque 36 (74.5%±6.4), ring liked additional density (lower than +130 HU) sees in edge of plaque (Halo sign)-9(19.2%±5.8), plaque edge roughness, erosion liked changes- 18 (38.3%±7.1), rupture of intima (dissection)- 8(17.0%±5.5).@*Conclusion@#We detect that computed tomography angiography (CCTA)’s specific signs of unstable plaque of coronary artery disease are coronary artery diameters widening, low density sites clarify in plaque (lower than +30HU), small calcification detect in plaque, ring liked additional density (lower than +130 HU) sees in edge of plaque (Halo sign), plaque edge roughness, erosion liked changes and rupture of intima.
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Introduction@#Cardiovascular Disease (CVD) is a major cause of morbidity and a leading contributor to mortality in both developed and developing countries. With rapid socioeconomic development, CVD has reached epidemic proportions in developing countries in recent decades. Dyslipidemia, elevated level of plasma cholesterol, together with arterial hipertension, is the main modifiable risk factor atherosclerosis and cardiovascular diseases (CVD) development. Surveys to monitor and measure dyslipidemia burden in a Mongolian population has not been conducted in recent years and the available data on the prevalence, types, and associated factors of dyslipidemia in the general population is relatively insufficient and outdated. Monitoring of lipid profile at populational level is an important instrument of prevention medicine, applied for CVD populational risk assessment.@*Goal@#Evaluate comparisons of adult blood lipid levels in age, gender and location.@*Material and Methods@#In this study, 500 people aged 25-65 were classified into age groups (47.1% for males and 52.9% for females). Blood plasma in total cholesterol (TC), triglyceride (TG), high density (HDL-C) and low density (LDL-C) lipoprotein-cholesterol, apolipoprotein - ApoA1, Apo B and ratio of ApoB / ApoA1 were estimated. Statistical analysis was performed using SPSS 22.0@*Results@#Mean age of the participants was 48.8±14.2 years old. Mean values for male TC-4.85±0.92 mmol/l, TG-1.58±1.19 mmol/l, LDL-C-3.24±0.98 mmol/l, HLD-C-1.62±0.21, for women- 4.47±0.96 mmol/l, 1.22±0.47 mmol/l, 2.95±1.01 mmol/l, 1.77±0.23 mmol/l respectively. The mean blood TC,TG levels tended to increase with age group in male compared to women. The prevalence of an increased blood LDL-C levels or risks for an increased blood LDL-C was statistically significantly high in male.@*Conclusion@#The prevalence of lipid was shown as high, that demands respective prevention and management.
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Introduction@#Studies demonstrated that the apolipoprotein B/apolipoprotein A-I (Apo B/apo A-I) ratio predicts cardiovascular risk better than any of the cholesterol indexes. Apo B and Apo A-1 are assumed to be superiormarkers for lipoprotein abnormalities [1,2]. The concentrations of Apo B and Apo A-1 are associated with cardiovascular disease more strongly than the corresponding lipoprotein cholesterol fractions, the discriminant value of these apoproteins in absolute terms appears to be less important than of their ratio (the Apo B/Apo A-1 ratio) [3, 5-7]. The Apo B/Apo A-1 ratio reflects the balance of atherogenic and antiatherogenic lipoproteins in plasma [4]. Multiple clinical and epidemiological studies have confirmed that the Apo B/Apo A-1 ratio is a superior marker for cardiovascular disease compared with lipids and lipoproteins or their ratios [8, 9].@*Goal@#We determined the variation limits of the Apo B/Apo A-1 ratio in healthy participants with normolipidemia and the relationship of this ratio with other lipid parameters.@*Material and Methods@#A total of 146 normolipidemic healthy participants aged 25–60 years were included in the study. Anthropometric measurements (height and weight) and other personal information were obtained during the clinical examination and the interview. Participants were included in the study using the following criteria: </br>1. body mass index < 30 kg/m2; </br> </br>2. TC < 5.2mmol/L; </br>3. triglycerides (TG) ≤1.7 mmol/L; </br>4. HDL-C ≥1.03 mmol/L ( woman), ≥ 1.29 mmol/L (male) . </br>The plasma levels of total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), apo A-I, Apo B and Apo B/Apo A-1 were determined after a 12 h fasting period. The non-HDL-C was calculated as the difference between the TC and HDL-C. Most research data emphasized that the values for the Apo B/Apo A-1 ratio that define a high cardiovascular risk were proposed to be 0.9 for men and 0.8 for women. Statistical Analysis. The statistical analysis was performed using SPSS 21.0 (USA). Differences between the groups were analyzed using the Mann-Whitney test and the chi-squared test. Correlations between the indices were assessed using the Spearman’s rank correlation. A value of < 0.05 was accepted as statistically significant.@*Results@#The relationship of ratio of apolipoprotein (Apo) B/Apo A-1 with other indicators of lipid metabolism in healthy people with normal lipidemia was analyzed. The Apo B/Apo A-1 ratio in the studied normolipidemic subjects was 0.69 ± 0.17. The percentage of subjects with the Apo B/Apo A-1 ratio exceeding 0.9 (the accepted risk value of cardiovascular disease) was 36.3 %.The subjects with Apo B/Apo A-1>0.9 were characterized by higher HDL-C levels and atherogenic Aпo B, Apo B/Apo A-1 but lower values Apo A-1.@*Conclusion@#The subjects with normolipidemia the unfavorable Apo B/Apo A-I ratio> 0.9 had more atherogenic lipid profile.
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@#The anatomy and diseases of the coronary artery, and number or death toll in relation to the coronary artery disease in Mongolia, CT and HRCT the pathologic physiology and risk factors of atherosclerotic calcifications of the coronary artery, the comparison between CT, HRCT and Coronary angiography of coronary arteries of the heart, the selection of a patiant, the preparation of a patient, and the steps of examination that how the patient going through ,the advantages and the disadvantages of CT coronary angiography, the limitation of use of HRCT, the indications and the contraindications to HRCT, the method and devices to reveal a calcification of the coronary artery, the AGATSTON score of calcification and its radiologic imaging, the index of calcification of the coronary artery, a guideline devoted to the patients who have coronary artery calcifications, an amount of 50 references in relation to unstable atherosclerotic plaques radiologic signs on the HRCT were used .
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Introduction@#Coronary atherosclerosis is the leading cause of morbidity and mortality in the world. Hypogonadism is not considered a traditional risk factor for coronary artery disease (CAD). Higher CVD mortality may be partially attributed to behavioral and physical characteristics of males, including increased smoking, drinking, endocrine and metabolic factor like fat distribution, and low male engagement in preventive care. In the last decades, many studies have suggested that low testosterone levels are associated with increased prevalence of risk factors for CVD, including dyslipidemia and diabetes. For the reason, this research focused on identifying any association between testosterone deficiency and risk factors of coronary heart disease.@*Goal@#This study aimed to identify any association between testosterone deficiency and risk factors of coronary heart disease in Mongolian men.@*Material and methods@#In this case control study, we determined plasma total testosterone, total cholesterol, triglyceride, high density lipoprotein-cholesterol, apolipoprotein – ApoA1, Apo B and glucose in 287 subjects, among them 125 patients with ACS and 162 healthy subjects. Statistical analysis was performed using SPSS 22.0 of IBM. @*Results@#Mean age of the participants was 55.19±6.99 years old. It was found that, mean plasma TT levels in patients with ACS (4.17 ng/ml) was significantly lower than in the healthy subjects (4.70 ng/ml). There was a negative association between plasma TT level and glucose level (r=-0.185; p=0.002) and ApoB/ApoA1 (r=-0.132, p=0.026).@*Conclusion@#The results in the present study suggest that low plasma TT level may be a risk factor for CHD in men, which may relate to the influence of plasma lipoprotein and glucose metabolism by endogenous testosterone.
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Background @#The frequency of tetralogy of Fallot among newborns and infants is 5.6-14.0% of all congenital heart defects [5, 14, 17] The most frequent complication of the early postoperative period is right ventricular failure, which is formed when the anatomy of the right ventricle and the progressive pulmonary regurgitation are disturbed [1, 3, 12]. With the development of new minimally invasive methods of examination and their introduction into clinical practice, the understanding of hemodynamic parameters after surgical correction, pathophysiological mechanisms of development of right ventricular dysfunction has improved. </br> One of these methods is transpulmonary thermodilution and pulse waveform analysis, which allows in the early hours after operation to determine preload, heart function and postload parameters [9, 20]. </br> In the long-term period, many patients after radical correction have right ventricular dysfunction due to many years of massive pulmonary regurgitation. With the introduction of MRI improved understanding of the pathophysiological mechanisms of development of right ventricular dysfunction.. Recent reports indicate that the global functional assessment of the right ventricle after surgical correction does not reflect its present function [7, 10].@*Aim@#The aim of the study was to estimate the early postoperative indices of hemodynamics in different types of the right ventricular output plastics after radical correction of Fallot’s tetralogy and to access the functional state of the right ventricle in the long- term postoperative period.@*Materials and Methods@#On the basis of cardiovascular surgery department of the Shastin P.N. hospital, a prospective cohort study of 52 patients (28 boys, 24 girls), underwent radical correction of Fallot’s tetralogy, was conducted. </br> Patients were divided into 2 groups by the type of reconstruction of the right ventricular outlow tructs: group I included patients with transannular plasty of the output part (group I, 26 patients), group II-patients with preserved fibrous ring of the pulmonary artery (group II, 26 patients). The postoperative hemodynamic status was assessed with transpulmonary thermodilution. The right ventricular function in the long-term period was estimated by means of US and MRI.@*Results@#During the first postoperative hours, hemodynamic indices according transpulmonary thermodilution technique were significantly lower in group I and reliable differed from group II. However, later (12.24,48 hour after), restoration of hemodynamic indices in group I, which did not significantly differ from group II, was observed. In the long-term period, ejection of the right ventricle was reliable higher in group II, while terminal diastolic volume of the right ventricle was significantly higher in group I. Pulmonary regurgitation was also significantly higher in group I-36.7 (32,44) versus 13,2 (3;14) (p<0,01).@*Conclusions@#Preservation of pulmonary artery fibrous ring provides better parameters of hemodynamics in the early postoperative period including systolic and diastolic functions. In the long-term period, this group of patients is less subjected to the right ventricular function.
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@#Article deals with age-related hypogonadism in men as an interdisciplinary problem. Current definition, prevalence, analyzes the relationship between age and the incidents of hypogonadism were shown. The detailed overview of clinical studies, meta analysis of causal link of androgen deficiency and erectile dysfunction, ischemic heart disease, arterial hypertension, dyslipidemia, and diabetes mellitus was presented. To date was found the relationship between metabolic syndrome and androgen deficiency. Low level of testosterone is closely connected with low libido as well as insulin resistance, abdominal obesity, dyslipidemia. Insulin resistance and hyperinsulinemia are noticed in patients with hypogonadism in comparison with obese and normal-weight patients. Therefore, metabolic risk factors are the connecting link of cardiovascular diseases and androgen deficiency. Meta-analysis of clinical trials of the effects of testosterone replacement therapy and safety of long term use was presented in the article. The article discusses the importance of a unified approach to the diagnosis and treatment of androgen-deficient conditions and cardiovascular disease.
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Middle aortic coarctation (MAC), a variantof middle aortic syndrome, is a rare entity withonly ~200 cases described in the literature.It classically presents with early onset andrefractory hypertension, abdominal angina,and lower extremity claudication(1).A 30 years-old woman, Her systolic bloodpressure measures 180-200mm Hg and diastolicpressures measure 70mm Hg in both arms,lower extremity pressures are approximately70mm Hg. Her bilateral femoral pulses andpedal pulses are nonpalpable, but present onDoppler exam and CT-Angiography.We prepared diagnostic of CT-Angiographyand Aortography before operation. Wesuccessful operated abdominal aorticcoarctation by “Silver graft” Aortoaortic bypasson the middle aortic, left nephrectomy.She was discharged home on postoperativeday 7. Post operation is good. We werecontrolled CT-Angiography.
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Background Abdominal ultrasonography assesses the size, echotexture, shape, contour and adjacent structures of pancreas. Goal The goal of our study is to determining ultrasonography criteria of acute and chronic pancreatitis and developing algorithm of differential diagnosis. Objectives 1. To determine ultrasonography criteria of acute and chronic pancreatitis 2. To develop algorithms of differential diagnosis of acute and chronic pancreatitis Material and Method During the study period, 81 patients with acute pancreatitis, 66 patients with chronic pancreatitis has examined byultrasonography in Reference centre on Diagnostic Imaging named after R. Purev state laureate, people’s physician,hoporary professor of the State III nd Central Hospital,AchtanClinicalHospi tal,Central Clinic of Ulaanbaatar railway and Hepatological clinic centre of traditional medicine Result 48 (59.3%±5.5) patients with acute pancreatitis had reported pancreatic swelling /Exudative pancreatitis/, 18 (22.2%±466) had acute hemorrhagic pancreatitis, 15 (18.5%±463) had necrotizing pancreatitis. Conclusions 1. Determined ultrasonographic criteria of acute and chronic pancreatitis 2. Acute and chronic pancreatitis has diagnosed by ultrasonographic criteria and developed differential diagnosis algorithm.
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BACKGROUNDS: Abdominal X-ray findings of destructive acute pancreatitis are usually similar with intestinal obstruction x-ray sign. GOAL: The main goal of this study is detecting X-ray findings of pancreatitis depend on type of pancreatitis and location of the pathological abnormality. OBJECTIVES: 1. Determining pancreatitis x-ray findings depend on types of pancreatitis and pathologic abnormalities location. 2. Determining radiologic features of chronic pancreatitis MATERIALS AND METHODS: From2012 to 2014, 45 patients’ x-ray finding of pancreatitis have been analysed (31 patients with acute pancreatitis and 14 patients with chronic pancreatitis). All patients have diagnosis by clinical symptom, laboratory tests, ultrasound, celiacography, CT, MRI, ERCP, MRCP,citology and biopsy. RESULTS: X-ray findings of pancreatitis are associated with type of acute pancreatitis and location of pathologic abnormalities in the pancreas. CONCLUSION: 1. Patients with pancreatic tail swelling and deformity (acute pancreatitis), whose chest radiograph shows elevation of left hemi-diaphragm. Arka signs are seen level of L2 ,right side of the L2-L3, and stomach and upper part of the small intestine filled with gas, these recognized radiographic signs are associated with head of the pancreas destruction, which is caused by acute pancreatitis. 2. In our study, commonly recognized radiographic signs associated with chronic pancreatitis include with ascending colon and hepatic flexure are filled with gas, right part of transverse colon spasms, stomach and upper part of the small intestine filled with gas and small calcification in the pancreas
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BACKGROUND:Congenital heart defects (CHD) turn out to be the leading cause of infant mortality in their first yearafter infectious diseases. Per 1,000 infants, born with CHD, about 19-75 failed to survive. It revealsthe fact that CHD is a major cause of childhood mortality in worldwide. Beyond the progress ofmedicine and surgery, the cause of CHD is not fully defined. The majority of studies reveal that CHDis triggered by many factors, such as the genetic and environmental factors.Based on the evidences of the sequence of the human genome and advances in moleculartechnology, genetic factors play a major role. Per 100 newborninfants, they’re found one child, bornwith a CHD is concerned as a highly frequent incident for birth anomaly. Only 0.5% of these congenitaldefects enable to be inherited in accordance with Mendel’s genetic laws, which is associated withthe change and mutation of a single gene. Many found that most congenital anomalies dependupon mutation or change in multiple genes and other relevant factors. As a result of the progressivedevelopment of molecular biology in the past 20 years discovered a range of genes involved in fetusformation, development, growth and control of processes. In our country case, corrective surgeryfor CHD dominates among all cardiovascular surgery in Mongolia. Particularly, for all incidents donesome corrective surgery of congenital heart defects, atrial septal defect operation occupies 42.44%,in other word it is a substantial part of the CHDoperation (D.Tsegeenjav, 2009). Molecular geneticsstudy of infant born with heart defects and simultaneous anomaly of other organ system researchstill has not been done for Mongolian population. In many cases the diagnosis of CHD is delayeduntil their adulthood, which is a research gap to address without further delay and the finding mustbe applied in practice in the near future.GOAL:The aim of the research is to conduct a molecular genetic study of children, born with CHD andcombined abnormalities of other organs and systems, identify gene lesion, location and characteristicsof mutations, pathogenetic mechanism of congenital defects and anomalies among the Mongolianpopulation.RESULT:For this study, there are 118 patients, with congenital heart disease, received surgical treatmentin the cardiovascular department of III central state hospital named P.N. Shastin, involved afterconfirmed diagnosis through objective and instrumental investigations (ECG, Fluoroscopy, EchoKG).The 118 healthy family members of patients sampled as a control group. According to the diagnosisof patients with congenital heart defect, such as atrial septal defects-95 (81.2% ± 3.6), ventricularseptal defects-17 (14.5% ± 3.3), patent ductusarteriosus- 2 (1.7± 0 .0%) have combined severedefects - 4 (3.3% ± 1.0). Out of 118 patients with congenital heart defects, 32.2% (38 patients)was male, whereas women accounted for 67.8% (80 patients) with average age of 22, 3 ± 12.9(minimum 1.0 year, maximum 51 year). These comprised 42.4% in 1-17 years old (average age10 ± 5.27) and 57.6% in 18-51 years old (average age 31 ± 9.54). The 33.9% ± 4.4 (40 patients) of operated patients responded the questionnaire that they have a hereditary heart defect. Shortnessof breath, heart pain, and recurrent pneumonia were the main complaints of patients with CHDthat significantly authentic to statistical probability. From the taken 118 blood samples, 95 werediagnosed ASD, in 7 diagnosed VSD, in 2 diagnosed PDA, in 4 diagnosed combined defects. Forthe 95 samples, we decided to examine the ASD associated GATA4, TBX5gene. It draws attentionto the fact that 81.2% of all congenital heart defects found only ASD. To examine the ASD genes inthe sample, the following changes have occurred. The study found 8 variants of mutations formingASD. It includes on exon 1 Gly 93 Ala (c.278G> C), on exon 1 P163S (c.487C>T).CONCLUSIONS:1. Patients with ASD alone occupy 81,2% of all heart defects in our study.2. For the samples of ASD, the study found 8 different mutations of GATA4.3. In the sample of blood not found TBX5 gene mutation.4. In the samples, one patient with dextrocardiasitusinvertus was combined with congenital heartdefects found E359Xfs (c.1075delG) deletion variation on exon3.
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Transthoracic ultrasound (US) has become an important diagnostic tool in modern chest medicine. The range of thoracic lesions for which transthoracic US may yield useful diagnostic information has expanded to include not only chest wall and pleural lesions, but also peripheral lung nodules, pulmonary consolidations, necrotizing pneumonias and lung abscesses, tumors with obstructive pneumonitis, mediastinal masses, and peridiaphragmatic lesions. A variety of ultrasound features and signs of chest diseases have been well characterized and widely applied in clinical practice. US guidance increases the diagnostic success rate and decreases the complications associated with interventional procedures such as thoracentesis, closed tube drainage for pleural effusion, and needle biopsy of the pleura. Transthoracic needle aspiration or biopsy, under real-time US guidance, is a relatively safe and easy procedure, and may provide adequate tissue sampling of lesions for cytologic, histologic or microbiologic analysis. This article presents the general techniques and wide applications of transthoracic US and US-guided invasive procedures in the diagnosis and management of various chest diseases.
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Introduction: Thyroid gland behind the sternum near the base of the neck, and it is one of the gland behind the sternum at cartilage southern centre of middle mediastinum and at back of superior middle mediastinum rarely [ R.E Gabunia.,E.K.Kolesnicova.,L.B.Tumanov.,1983; J.O.Shepard.,1991; S.K.Wernecke 1991; N. B.Litvakovskaya.,1994;V.P.Harchenko.,P.M.Kotlyarov.,R.V.Kertanov.,Z.S Tsallagova., 2002]. Goal: The research thesis aims to make diagnosing and identifying the nature and symptoms of thyroid gland behind the sternum by roentgen, US and computer tomography and developing the criterion characteristics of diagnostics. The following objectives will be resolved in order to implement the goal of research thesis: 1. To identify the symptoms of thyroid gland behind the sternum which is obtained by the roentgen? 2. To identify the symptoms of thyroid gland behind the sternum by diagnostics of US and computer tomography 3. Developing the criterion characteristics of thyroid gland behind the sternum by diagnostics of US, computer tomography and the roentgen Materials and Methods: Made conclusion at symptoms identified by diagnostics of US, computer tomography and the roentgen at 12 patients who were diagnosed with thyroid gland behind the sternum through 2005-2011. The diagnostics of thyroid gland behind the sternum was approved by the surgical operation and biopsy analysis which is a medical test involving the removal of tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease under a microscope by a pathologist. Results: The symptoms of 12 patients who were diagnosed with thyroid gland behind the sternum were identified by diagnostics of US, computer tomography and the roentgen. From the symptoms defined by roentgen images of thyroid gland behind the sternum, located in western upper south part of middle mediastinum (P<0.001), oval shaped thyroid (P<0.05), calcification osteoporosis (P<0.01), bronchus was pushed to healthy side (P<0.05), changes of middle mediastinumwas moved upward when cough, drink and make Valsalve’s test /a method for testing the patency of the Eustachian tubes. With mouth and nose kept tightly closed, the patient makes a forced expiratory effort (P<0.01) therefore there is true statistical probability. Conclusions: 1. During the thyroid gland behind the sternum, the additional changes are identified at thyroid gland behind the sternum, located in western upper south part of middle mediastinumat 75.0%, the mentioned changes are moved upward when made cough, drink and make Valsalve’s test by roentgen, lost similarity of structure and pushed the bronchus to healthy side at 66.7%, there is dominant symptoms by roentgen that gullet defined by barium substance was pushed to healthy side at 58.3%. 2. By the ultrasound analysis, during the thyroid gland behind the sternum, the changes are relevant to thyroid and vascularization at 100% , to capsule at 75% and osteoporosis at 66.7%. 3. Changes are relevant to thyroid and vascularization at 100% or oval shape more compactness was identified by the contrast substance , pushed the bronchus to healthy side at 66.7%, there is dominant symptoms by roentgen that bronchus was pushed to healthy side, 4. We established that there is thyroid gland behind the sternum. status of the additional changes of middle mediastinum , compactness, structure, capsule, size, shape of the thyroid gland behind the sternum, additional changes of middle mediastinum changes the location of the nearest organs due to thyroid, so identified the main criterions to diagnose and to identify the thyroid gland behind the sternum by roentgen, US and computer tomography.
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Introduction: Pancreatic cancer in young patients is usually correlated with chronic alcohol consumption and hereditary factor. Chronic pancreatitis, pancreatic trauma, pancreatic cyst, alcoholism, and diabetes mellitus are the most clearly established etiological factors (T.Y Flanders., W.S Foulkes., 1996). The cancer was located to the pancreatic head in 75% to the body in 15-20% and to the tail in 5-10% of cases (A.E Richard., 2005). Goal: Determination of the US signs in pancreatic cancer and establishment standard (control) US diagnostic criteria. Objectives: 1. To reveal direct and indirect US signs of pancreatic cancer. 2. To establish standardized US diagnostic criteria. Materials and Methods: A prospective study was carried out in 35 patients with pancreatic cancer in a 4 years period between 2006-2010 (Shastin Central Hospital, Achtan Clinical Hospital). To each patient has being filled special investigation chart. Diagnosis was confirmed on the result of physical examination, laboratory investigation, abdominal conventional radiography, upper gastrointestinal contrast radiography, CT, MRI, ERCP and biopsy. The results of the measurements were compared with the standardized control evaluation of Mongolian people (Ts.Badamsed.B.Tserendash). Results: Our sample represents US signs in 35 patients with pancreatic cancer. On the basis of our study US sign were divided into two categories: direct and indirect signs. Direct signs: a) irregular shape, b) irregular tumour edge, c) hypodensity, d) tumour size more than 2.1cm, e) different location. Indirect signs: a) CBD distends, b) gallbladder distends, c) intra hepatic bile duct distend, d) pancreatic pseudo cyst, e) near-aortic limp node enlargement, f) splenomegaly. We consider that the upper mentioned US abnormality can be as control standard criteria for the US diagnosis of the pancreatic tumour. According to the study of V.N.Demidov and G.P.Sidorov (1987), the pancreatic cancer is located to head in 50-80%. In our series it was about 45.7%± 8.4. Irregular tumour shape in 60.0%±8.3, tumour hypodensity 80.0%±7.2, irregular tumour edge 68.6%±7.8, tumour clear definition 71.4%±7.6 which are the same with N.M. Mukharllyamov (1987). Conclusions: 1. Were described direct and indirect US diagnostic signs in pancreatic cancer 2. The tumor location, shape, size, edge, consistency, intra and extra hepatic bile duct distend, gallbladder distend, near-aortic limp node enlargement are the basic control criteria for the diagnosis of pancreatic cancer.
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Introduction: There have been limited research studies done in Mongolia on clinical, laboratorial and computer tomographical diagnosis of pancreatic cancer. Goal: Our study aims to examine clinical, laboratorial and CT symptoms diagnosis of cancer pancreatitis, to diagnose the differential types of cancer pancreatitis, and to develop diagnostic criteria based on CT for differentiating among those types. Objective: 1. To study clinical symptoms of pancreatic cancer 2. To conclude the correlation between CA 19-9, CEA and sizes of the tumor during pancreatic cancer 3. To determine CT symptoms of pancreatic cancer 4. To develor diagnostic criteria based on CT for differentiating among those types Material and method: Over the years of 2006 to 2010, we have studied the CT symptoms of 35 patients diagnosed as having pancreatic cancer, and the clinical and laboratorial symptoms of 35 patients with the same disease, with the help of health facilities at Diagnostic Imaging Department of the “Achtan” clinical hospital and “Friendship-Naran” diagnostic center. The scanners such as CT-W-4 type scanner of Japanese Toshiba Corporation, MSCT Presto (made in 2007 by Hitachi, Japan) and CT Max 640 type scanner of USA Gereral Electric Corporation have been used for the diagnostics. When we made the result of survey, we used average descriptions of statistics, determined the fault of descriptions and examined probability descriptions the criterion by Stiyudent. Result: The pancreatic cancer happened to exist in the head and skull for 71.6%±8.7 (P<0.001), was non-standart shaped for 62.5%±8.6 (P<0.01), had size being bigger than 2.1 cm for 96.9%±8.4 (P<0.001), had density decline for 46.9%±8.8 (P<0.05), had tumor contour not clearly visible for 65.6%±8.4 (P<0.01), had fat tissue around cancer not seen for 75.0%±7.7 (P<0.001), had an enlarged common bile duct 65.6%±8.4 (P<0.05), had an enlarged gallbladder for 59.4%±8.3 (P<0.05), and experienced a density increase after contrast injection for 65.6%±8.4 (P<0.001). Conclusion: 1. Pancreatic cancer caused shooting abdominal pain and stomach cramps in 74.2%±8.2, diarrhea in 62.9%±8.2, flatulency in 71.4%±7.6, xerostomia and xerosis in 65.7%±8.0, neurasthenia symptoms in 85.7%±5.9, jaundice in 60.0%±8.3, and abdominal hemorrhage and bleeding symptoms in 54.3%±8.4. 2. CA-19-9 tumor marker has been found to be very sensitive for pancreatic cancer, making it an effective and easy way to diagnose, prove the diagnosis, and monitor a patient’s response to pancreatic cancer treatment. CEA marker can be used as a supporting tool for pancreatic cancer. 3. CT scanning revealed that the cancer was irregularly shaped in 62.5%±8,6, was larger than 2.1 cm in 96.9%±3.1,had non-smooth borderlines in 65.6%±8.4 and clear and visible borderlines in 62.5%±8.6. Density decreased in 46.9%±8.8, fatty tissues around the cancer were not distinguishable in 75.0%±7.7, and density increase after contrast injection in 65.6%±8.4. 4. Size, shape, structure, density, borderlines, interaction of pancreatic cancer with neighboring organs, location of the cancer in pancreas, cancer’s shape, size, numbers, border, structure, density and density after contrast injection, calcification, and shadow have been proven to be the determining factors of pancreatic cancer. 5. CT diagnostics of pancreatic cancer types and differentiating among them are very crucial to select appropriate treatment for pancreatic cancer on time
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Introduction: The normal pancreas CT density is between +30HU to +40 HU and after contrast injection it will be increased till +60HU to +80 HU. We will determine the pancreas shape, size, structure, density, borders, calcification, and cysts by CT during the chronic pancreatitis. Goal: Our research goal is to determine the clinical, laboratorial and computer tomographical diagnosis of acute pancreatitis, and to diagnose acute pancreatitis and differentiate from other diseases. Оbjectives: 1. Study clinical symptoms of acute pancreatitis 2. Determine Alpha-amylase, АSАТ, АLАТ and glucose. 3.To determine the CT signs of chronic pancreatitis. 4. To modify the diagnostic criteria for differential diagnosis Materials and Methods: We made the study chart for this study and used the 46 patient’s data were collected from Department of Imaginary Diagnosis Achtan Elite Clinical hospital and Diagnostic center -“Friendship Naran” of Naran group. We used CT scan –W-4 made by Toshiba, Japan, MSCT PRESTO by Hitachi, Japan and CT Max -640 by General Electronic, USA for our study. Additionally, we used the other diagnostic analyses such are biochemistry, X-Ray of abdominal cavity, contrast X-Ray of gastrointestinal tract, abdominal ultrasound, celiacography, cytology, biopsy and surgical procedure. The average and errors of the study data has been evaluated by the common statistic methods and the Student’s t-test is applied to data probability. Results and Discussion: The 46 patients with chronic pancreatitis were enrolled in our study in CT scan of pancreas. Size of pancreas was normal in 2(6.7%±3.0), totally enlarged pancreas were in 14(30.7%±6.7), totally got smaller in 21(45.7%±7.3), partly enlarged in 9(19.6%±5.6), very bright from next organs in 31(67.4%±5.9), not bright from next organs in 15(32.6%±6.9), pancreas structure were same homogeneity in 17(36.9%±7.1), pancreas structure homogeneity were lost in 14(30.7%±6.7), some retention liquid were collected in back of stomach space in 8(17.4%±5.6), no liquid collected in back of stomach space in 38(82.6%±5.6), low density pancreas were in 11(23.9%±6.3), low density was not same in whole pancreas in 23(50% ±6.1), high density was same in whole pancreas in 7(15.2%±5.3), high density was not same in whole pancreas in 5(10.5%±4.6), density was increased after contrast injection in 12(26.1%±6.5), density was increased not same contribution after contrast injection in 34(73.9%±6.5), calcification of pancreas not detected in 30(65.2%±7.0), calcification of pancreas detected in 16(34.8.%±7.0), calcification in parenchyma were 11(23.9%±6.3), in tube 5(10.5%±4.6). The most common CT signs were that pancreas was very bright from neighbor organs in 67.4%, pancreas homogeneity was lost in 63.1%, high density was not same in whole pancreas in 73.9% during chronic pancreatitis (P<0.001). CT signs of pancreas which totally enlarged pancreas were in 30.4±6.7 and totally got smaller in 45.7%±7.3 are higher prevalence in our study than A.B.Jakobenko (2000). But pancreas was very bright from next organs in 67.4%±5.9, pancreas structure homogeneity were lost in 50.0%±6.1 and low density was not same in whole pancreas in 34.8%±7,1 calcification of pancreas calcification in parenchyma were 23.9%±6.3, in tube 10.5%±4.6 sign were close as A.B.Jakobenko (2000). Conclusions: 1. Patients showing signs of acute pancreatitis suffered from abdominal cramps for 53.0%±6.1, pain moving to left part of the abdomen for 62.1%±5.9, diarrhea, xerostomia, xeroderma, and fever. 2. During acute pancreatitis, alpha amylase, glucose, ASAT, and ALAT in blood plasma increased 1.7 times, 2.4 times, 1.9 times and 1.5 times respectively. 3. The most common CT signs were that pancreas was very bright from neighbor organs in 67.4%, pancreas homogeneity was lost in 63.1%, high density was not same in whole pancreas in 73.9% during chronic pancreatitis. 4. Diagnostic criteria of chronic panreatitis are could be the CT signs such as pancreas size, density, borders brightness of neighbor organs, the change of density after contrast injection and calcifications.
ABSTRACT
INTRODUCTION: There have been limited research studies done in Mongolia on clinical, laboratorial and computer tomographical diagnosis of acute pancreatitis. GOAL: Our study aims to examine clinical, laboratorial and CT symptoms diagnosis of acute pancreatitis, to diagnose the different types of acute pancreatitis, and to develop diagnostic criteria based on CT for differentiating among those types. OBJECTIVES: 1. To study clinical symptoms of acute pancreatitis 2. To determine alpha amylase, ALAT, ASAT, and the amount of glucose. 3. To determine CT symptoms for the types of acute pancreatitis. 4. To develop diagnostic criteria based on CT for differentiating among those types MATERIALS AND METHODS: Over the years of 2006 to 2010, we have studied the CT symptoms of 59 patients diagnosed as having acute pancreatitis, and the clinical and laboratorial symptoms of 81 patients with the same disease, with the help of health facilities at Diagnostic Imaging Department of the “Achtan-elite” general hospital and “Friendship-Naran” diagnostics center. The scanners such as CT-W-4 type scanner of Japanese Toshiba Corporation, MSCT Presto (made in 2007 by Hitachi, Japan) and CT Max 640 type scanner of USA General Electric Corporation have been used for the diagnostics. We successfully calculated the amount of alpha amylase, ALAT, and ASAT with colorimetric analysis. For this calculation, we used amylase detector manufactured by German Human Firm. Sugar amount was measure by fermentive oxidization with dioxide-glucose. The acute pancreatitis inflammation, hemorrhage, necrosis and its various forms, and diagnosis have been proved by the brief x-ray imaging of the abdomen, x-ray with contrast injections for stomach and upper intestine, Ultrasonic, Celliacography, MRI, Cytology, Biopsy analysis and surgery. All the results were presented in commonly used statistical ways, taking into account possible calculation errors, and probabilities were checked with Student’s t-distribution. CONCLUSION: 1. During acute pancreatitis, 56.8%±5.5 suffered from abdominal shooting pain, 28.3%±5.0 from stomach cramps, 79.0%±4.5 from diarrhea, 91.4%±3.1 from fever, and 56.8%±5.5 from abdominal hemorrhage. 2. The amount of alpha amylase in blood serum increased 6 times the amount of ASAT/ALAT 3 to 5 times. 3. By CT scanning, we have found more common CT symptoms such as sharp border edges of pancreas in swollen acute pancreatitis (in 69.2%±9.2 of the patients), entire and partial enlargement of the pancreas (in 73.1%±8.9 of the patients), fluid collection in the stomach rear room (in 61.1%±11.8 of the patients), in hemorrhage acute pancreatitis and uneven density reduction (in 66.7%±12.6 of the patients) and fluid collection in the stomach rear room (in 86.7%±9.1 of the patients), in necrosis type of acute pancreatitis respectively. 4. Shape, size, structure, density, borders, interaction with surrounding body organs, change in pancreas density after contrast injection and accumulated fluid in the rear stomach are identified as the main criteria to diagnose acute pancreatitis types and differentiate among them. 5. CT diagnostics of the acute pancreatitis types and differentiating among them are very crucial to select appropriate acute pancreatitis treatment on time.