[Acute severe oral poisoning with 1,4-butandiol and ethanol with the development of coma]. / Ostroe tyazheloe peroral'noe otravlenie 1,4-butandiolom i etanolom s razvitiem komatoznogo sostoyaniya.

A case of acute oral poisoning by 1.4-butanediol, complicated by the development of severe hypoxia in a 34-year-old patient actively engaged in bodybuilding, is presented. The psychoactive substance was used by the patient to increase sexual activity and physical stamina. The duration of systematic daily intake was 4 months. The toxicogenic stage of acute poisoning was caused by a single dose of 50 ml of undiluted 13% 1.4-butanediol together with ethanol, manifested by convulsive syndrome, depression of consciousness to the level of coma II, acute respiratory failure with aspiration syndrome, respiratory acidosis (pH 7.22; partial pressure carbon dioxide 61.2 mm Hg), lactic acidosis up to 7 mmol / L, hyperammonemia up to 240 µmol / L, cerebral edema (decrease in white matter density to 21.6 ± 1.7 HU units), loss of vascular tone resistance (pareso arterioles) and a significant increase in cerebral blood flow rate to 115 ± 20.1 ml / 100 g per minute, increasing the volume of extracellular fluid (+ 130% of the proper volumes). Intensive therapy was complex, including infusion and detoxification therapy, correction of acid-base disorders, hypoxic disorders by using a substrate antihypoxant (Cytoflavin) in a daily dosage of 0.57 ml / kg body weight daily, for 9 days. The article discusses the toxicokinetics and toxicodynamics of 1.4-butanediol, radiation diagnostics and the clinical picture of acute poisoning, the features of its course, and pathogenetic approaches to therapy.

[Clinical case of thromboembolism of small branches of the pulmonary artery on the background of the single ventricle id type with the opening of the сava-caval collaterals].

A three-compartment heart - a severe congenital defect, can develop after genetic mutation or teratogenic influence on fetus at early stages of embryogenesis. According to the literary data, the survival of such patients without surgery is 6-7 %. This publication demonstrates clinical case of the patient who has single ventricle of the heart and lived up to 56 without surgery.

[Assessment of functional state of microcirculatory bed of the foot in patients with lower limb critical ischaemia]. / Otsenka funktsional'nogo sostoianiia mikrotsirkuliatornogo rusla stopy u bol'nykh s kriticheskoi ishemiei nizhnikh konechnostei.

The authors assessed perfusion of the foot in patients presenting with lower limb critical ischaemia before and after endovascular revascularization, as well as analysed the interrelationship between the change of perfusion and the clinical result of treatment. The study includes a total of 15 patients presenting with ulcerative-necrotic defects of the foot. All patients underwent study of 2D-perfusion of the foot before and after the endovascular intervention. The '2D-perfusion' package was used within the framework of an angiographic examination, and required neither increase in the volume of the contrast medium nor radiation load. Four parameters of perfusion were evaluated: the time of ingress, the time of reaching the peak value, the peak value and the area under the curve. After the intervention, as compared with the baseline values there were statistically significant differences by the time of ingress (a 2.4-fold decrease; p<0.0001), the peak value (a 1.8-fold increase; p<0.0001) and the area under the curve (a 2.4-fold increase; p<0.0001). No statistically significant differences were revealed while comparing the time of reaching the peak value before and after the intervention (p=0.767). Trophic defects healed in 11 (73.3%) patients, and in 4 (26.7%) patients the process of healing continued with positive dynamics at the check-up examination. Hence, our first experience of using the assessment of 2D-perfusion demonstrates simplicity of the method with no increase of the radiation load and the dose of the contrast medium. The method makes it possible to obtain important data about the state of microcirculation of the foot in patients with lower limb critical ischaemia, to evaluate alterations after the endovascular intervention. Improvement of the parameters of perfusion is associated with a good clinical outcome.

[CLASSIFICATION OF ACUTE PANCREATITIS: CURRENT STATE OF THE ISSUE].

The article analyzed disadvantages of "Atlanta-92" classification of acute pancreatitis and its two modifications: APCWG-2012 and IAP-2011. The school of Saint-Petersburg pancreatologists suggested the classification AP of Russian Surgical Society (2014), which represented the concept of disease staging.

[Application of exchangeable transhepatic frame stents in patients with posttraumatic strictures of the hepatic and common bile duct].

For the period from 2000 through 2007 there were 27 patients treated for lesions of extrahepatic bile ducts of different genesis. Since all the lesions were high, we have formed biliodigestive anastomoses on the exchangeable transhepatic drains by the method of Groetz-Saypol-Kurian. In a month after the operation and a standard management of the exchangeable transhepatic drains we departed from the classical technique and applied nonperforated drains. Using the nonperforated exchangeable transhepatic drains in patients after reconstructive operations on the extrahepatioc bile ducts gave good immediate results of operations and substantially improved quality of life of the patients in the postoperative period.

[The role of positron emission tomography with C18-Fluorodeoxyglucose in clinical oncology]. / Primenenie pozitronnoi émissionnoi tomografii C18-F-ftordezokcilgliukozoi v klinicheskoi onkologii.

The study was concerned with evaluation of the diagnostic potential of positron emission tomography (PET) with 18-FDG in clinical oncology and elucidation of its role in assessing therapy effectiveness. The Ecat Exact 47 and Ecat Exat HR+ (Siemens) insatllations were used to examine 674 patients, with Whole Body protocol used in 585. PET with 18-FDG proved highly effective in diagnosing malignancies of the breast, lung, liver, pancreas, testis, brain and lymphoma as well as evaluating the efficacy of therapy.

[Assessment of 18FDG PET for diagnosis of pancreatic tumors]. / Vozmozhnosti PET s 18F-FDG dlia diagnostiki opukholei podzheludochnoi zhelezy.

The paper examines the informational value of positron emission tomography (PET) using 18FDG in the diagnosis of malignant of neoplasms of the pancreas and in the estimation of the extent of a metastatic involvement. Forty-four patients (26 males and 18 females whose age ranged from 28 to 60 years) with histologically verified cancer of the pancreas were examined. The study was conducted in the whole body mode on an Ecat Exact 47 positron emission tomograph following 70-90 minutes of administration of 18FDG, 370-420 MBk. To assess the findings, the differential accumulation ratio (DAR) of formation/liver was calculated. The mean DAR in patients with benign and malignant pancreatic tumors was 1.17 +/- 0.064 and 4.90 +/- 0.3 (p < 0.05). There was a false positive case in a patient with an exacerbation of chronic pancreatitis in the study. A relationship was observed between the level of tumor tissue 18FDG capture and the degree of malignancy. PET scanning in the whole body mode estimates the extent of a tumorous process. The authors' data show that the liver was most commonly involved in a metastatic process (96.6%). Hence, 18FDG PET is a highly informative technique in the diagnosis of malignant pancreatic tumors and in the estimation of the extent of a metastatic process and permits a differential diagnosis between benign and malignant tumors.

[Comparative assessment of the diagnostic capacities of PET with 18FDG and 1-[11C] sodium butyrate in the examination of patients with tumors of the brain and cerebral circulatory disorders: results of semiquantitative assessment]. / Sravnitel'naya otsenka diagnosticheskikh vozmozhnostei PET s 18F-FDG i 1-[11C]-butiratom natriia pri obsledovanii bol'nykh s ob"emnymi obrazovaniiami golovnogo mozga i narusheniiami mozgovogo krovoobrashcheniia (rezul'taty polukolichestvennoi otsenki dannykh).

The purpose of the present study was to determine the capacities of differential diagnosis of the bulky masses of the brain by positron emission tomography (PET) with 11C-butyrate by the direct indication--the tumor RFP level measured by means of the semiquantitative indicator--the differential accumulation coefficient (DAC). For comparison, 18FDG PET widely used to detect malignant tumors was preliminarily made. Brain PET was performed in 86 patients (45 males and 41 females whose age ranged from 18 to 69 years to identify bulky masses or to rule out continuous tumor growth. In all cases, the data were histologically and morphologically verified. Of the 86 patients, 21 were found to have malignant tumors, 41 had benign tumors, arteriovenous malformations, cerebral circulatory disorders, and cysts were detected in 3, 7, and 14 cases, respectively. The level of 18FDG accumulation was ascertained to be directly related to the grade of malignancy. In 20 of the 21 patients with malignant tumors, DAC for 18FDG was greater than 1. However, it was impossible to differentiate benign tumors and non-tumoral masses by using only 18FDG. Comparing the data obtained by means of 18FDG and 11C-butyrate revealed their comparability in detecting neoplasms. Patients with vascular tumors (benign meningioma and adenoma of the pituitary were an exception. Their DAC for 11C-butyrate was greater than 1. In follow-up CT scanning, just a single injection of 11C-butyrate may allow one to estimate the vascular and tissue components of masses, which facilitates the identification of vascular non-tumoral processes and tumors. The additional criterion that allows a neoplasm to be differentiated from nontumoral processes permits a rapid tumor release of a radioactive label.

[Experience on clinical application of positron emission tomography with a new radiopharmaceutical preparation sodium 11C-butyrate in differential diagnosis of pathological volume in brain formation]. / Opyt klinicheskogo primeneniia pozitronnoi émissionnoi tomografii s novym radiofarmatsevticheskim preparatov 11C-butiratom natriia v differentsial'noi diagnostike ob"emnykh obrazovanii golovnogo mozga.

The study was aimed to investigate the possibilities of the application of a new radiopharmaceutical--"Sodium butyrate, [1-(11)C]" (11C-Butyrate) for differential diagnosis of pathological volume brain formations. Positron emission tomography (PET) ("Ecat Exact 47", Siemens) of the brain was performed in 24 patients (14 male & 10 female, aged 19-56). The scanning was carried out as static scan 4-5 min after intravenous administration of 250-350 Mbq 11C-Butyrate and proceeded within 15-20 min. In addition PET with 18F-FDG was performed in all patients. The data had been verified histologically and morphologically. In 15 out of 24 patients the brain malignant tumor has been discovered, in 4 patients--benign tumors, in 5--postoperative cysts. Results of the studies showed that the ratio tumor/normal tissue in case of 11C-Butyrate and 18F-FDG application proved to be comparable for all studied hystological types of tumors. Malignant tumors in these cases had been visualized as a hot sports-fokci of increased uptake 11C-Butyrate (ratio > 1). The obtained data testify to the possibility of 11C-Butyrate application for differential diagnosis of the pathological volumic brain formation.

[Application of new radiopharmaceutical "Sodium 11c-butyrate" and positron emission tomography in patients with coronary artery disease]. / Primenenie pozitronnoi émissionnoi tomografii s novym diofarmatsevticheskim preparatom 11C-butirat natriia dlia otsenki sostoianiia miokarda u patsientom s IBS.

UNLABELLED: The aim of this study was to examine the diagnostic value of Sodium 11C-Butyrate (11C-Butyrate) in assessing perfusion and oxydative metabolism in patients with coronary artery disease (CAD). 41 patients (39 male and 9 female, mean age 48 +/- 11) with CAD were investigated. PET-scans were performed twice: at 2-7 min and 25-31 min after i.v. injection of 250-400 MBq 11C-Butyrate. Regional perfusion was evaluated by the uptake of radioactivity in the myocardium at the first scan, intensity of beta-oxidation--by decreasing the uptake level at the second scan. RESULTS: Myocardium of the left ventricle was good visualized at the first scan. It was demonstrated fast elimination of radioactivity in segments with normal oxidative metabolism of 11C-Butyrate at the second scan. Fixed defects were seen in the scar segments both at first and second scans. Decreased uptake of 11C-Butyrate at the first scan and diminished rate of agent elimination caused by depressed beta-oxidation at the second scan were revealed in ischemic segments. CONCLUSION: Application of PET with 11C-Butyrate in patients with CAD allows estimate hypoperfused segments, evaluate heart oxidative metabolism and provides differential diagnosis of scar and ischemia.

[Computed tomographic angiography of the thoracic vessels: the method, initial experience and outlook for its use]. / Komp'iuterno-tomograficheskaia angiografiia sosudov grudi: metodika, pervyi opyt i perspektivy isol'zovaniia.

The paper presents the data available in the literature on computed tomographic angiography and the first experience with it to study thoracic vessels. It details the principles of spiral computed tomography and CT angiography. Practical aspects of their implementation, as well as basic concepts are outlined. It is concluded that CT angiography is promising in studying thoracic vessels in various abnormalities.

[The potentials of spiral computed tomography in the diagnosis of lesions of the extracranial carotid arteries]. / Vozmozhnosi spiral'noi komp'iuternoi tomografii v diagnostike porazhenii ékstrakranial'nogo otdela sonnykh arterii.

The paper summarizes the results of examination of 30 individuals aged 27 to 66 years who had extracranial carotid lesions by using computed tomographic angiography (CTA), computed tomography, Doppler ultrasonography, power Doppler imaging, digital subtraction angiography. A procedure for CTA and analysis of data and for determination of the degree of stenosis has been developed. The potentialities of CTA in visualization of extracranial carotid diseases are shown.

[Computerized tomography diagnosis of lymphadenopathies in malignant non-Hodgkin's lymphomas]. / Komp'iuterno-tomograficheskaia diagnostika limfadenopatii pri zlokachestvennykh nekhodzhkinskikh limfomakh.

The potentialities of computer-aided tomography (CAT) in the diagnosis of lymphomas were studied. A total of 223 patients with disseminated lymphadenopathy were examined (78 with malignant non-Hodgkin's lymphomas, 48 with Hodgkin's disease, 54 with metastatic involvement of the lymph nodes, 18 with HIV infection, and 25 with reactive and inflammatory lymphadenopathy). CAT helped precisely assess the dissemination of the pathological process and disease stage in patients with malignant lymphomas, permitted follow up the time course of the disease, and facilitated differentiation of the condition from other diseases manifesting by disseminated lymphadenopathies.

[The computed tomographic characteristics of adrenal tumors]. / Komp'iuterno-tomograficheskaia kharakteristika opukholei nadpochechnikov.

The clinical materials of 121 patients with volumetric abnormal adrenal formations exposed to surgical therapy were retrospectively analysed. The data of preoperative CT studies were compared with the results of postoperative histological analyses of resected adrenal tumors. The specific features of the CT images of adrenal tumors were studied according to their morphological structure and hormonal activity. The syndromes of radiation signs which are the most characteristic of tumors of various histological structure, which may make a differential diagnosis of adrenal tumors from their CT image by taking into account clinical and laboratory findings.

[Computed tomography diagnosis of extranodal manifestations in malignant non-Hodgkin's lymphoma]. / Komp'iuternaia tomograficheskaia diagnostika ékstranodal'nykh proiavlenii zlokachestvennykh nekhodzhkinskikh limfom.

The data of computed tomography (CT) were used to study the semiotics of extranodal manifestations in 78 patients with varying malignancy non-Hodgkin's lymphomas. The most common lesions were found in the viscera: liver, spleen, peritoneum, omentum, pancreas, adrenals, mesentery. The CT pattern of these lesions is diverse, each site has its own specific features. Combining the clinical manifestations and CT signs of lesions to individual organs, recording the extent of lymphadenopathy will aid in establishing the diagnosis of non-Hodgkin's lymphoma. A lesion detected in some organs located both above and below the diaphragm is a typical feature of high-grade malignancy.

[Possibilities of polyposture methods in x-ray diagnosis of renal and ureteral calculi and associated complications]. / Vozmozhnosti polipozitsionnykh metodik v rentgenodiagnostike kamnei pochek, mochetochnikov i soputstvuiushchikh oslozhnenii.

A comprehensive radiation examination of 47 apparently healthy patients has ascertained that one of the angles formed by the renal lateral axis and the body's frontal plane (BFP) is 35-45 degrees and medially open, the second made by the long axis of the kidney and BFT is 28-32 degrees and caudally open. The densitometric findings from the X-ray films of 17 patients with ureteral calculi (UC) significantly suggest that a contrast medium rapidly moves to the dilated lower urinary tract due to changes in the relative position of the renal cavities against BFP. Twelve patients underwent separate studies of diuresis, glomerular filtration and tubular reabsorption in the supine position and in the position of the lower body dropped at an angle of 45 degrees (for 20-min periods). Excretory urography followed by measurements of the mean ureteral diameter was performed in 36 patients with dilated ureters and in 31 control subjects. There was a close correlation between the size of ureteral lumen and diuretic values and there was an inverse relationship to the magnitude of tubular reabsorption.

[Computerized tomography diagnosis of splenic and hepatic lesions in malignant non-Hodgkin's lymphomas]. / Kompiuternaia tomograficheskaia diagnostika porazhenii selezenki i pecheni pri zlokachestvennykh nekhodzhkinskikh limfomakh.

Seventy eight patients with varying malignancy non-Hodgkin's lymphomas were examined. Signs of extranodal damage of the spleen and liver were studied. Spleno- and hepatomegaly were signs of the commonest diffuse visceral involvements. In terms of the malignancy (low- or high-grade), splenomegaly was seen in 71.4 and 82.5% of patients and hepatomegaly was observed in 43.9 and 28.6%, respectively. In addition, irregular visceral outlines, tuberosity, changed density of the parenchyma and its homogeneity. A high correlation was found between the enlargement of the viscera and their decreased parenchymal density. Focal visceral involvements are less difficult to be diagnosed than diffuse ones, but they are much rarer. Computerized tomographic findings indicate the malignancy of a process.

[The computed tomographic diagnosis of acute pancreatitis]. / Komp'iuterno-tomograficheskaia diagnostika ostrogo pankreatita.

Results of the clinical and computed tomography examinations of 152 patients having injuries of the pancreas were analyzed. High degree of the exact diagnosing of acute pancreatitis and complications is confirmed. The information obtained by computed tomography gives grounds for prognosing the development of the pathologic process, timely application of different curative measures.

[Effectiveness of radiologic evaluation in the diagnosis of acute traumatic pancreatitis]. / Vozmozhnosti luchevogo issledovaniia v raspoznavanii ostrogo travmaticheskogo pankreatita.

Comprehensive radiologic examinations, including panoramic roentgenography, echography, computer-aided tomography, of 29 patients with acute traumatic pancreatitis that resulted from a combined closed injury of the abdomen, have demonstrated a high efficacy of computer-aided tomography in the detection of the type of changes in the pancreas and the retroperitoneal fat. Echography is advisable for cases when pancreas imaging seems to be possible. Radiologic findings completely coincided with the intraoperative ones.

[The diagnosis and treatment of kidney ruptures]. / O diagnostike i lechenii razryvov pochki.

An experience with diagnostics and treatment of 21 patients with injuries of the kidney is presented. Possible ways to determine the kind and localization of the rupture of the kidney with the help of computed tomography are described.