EFFECTS OF DIFFERENT TREATMENT OPTIONS ON THE LEVEL OF SERUM CYTOKINES IN PATIENTS WITH LIVER CANCER.

Liver cancer is a highly lethal cancer, in which local tumor microenvironment and systemic immune suppression allow tumor to escape immune surveillance. Intervening in tumor microenvironment by locoregional treatment options can be beneficial for patients. We aimed to study changes in serum cytokines levels due to local disturbance of tumor microenvironment after radiofrequency thermal ablation procedure compare to liver resection in patients with primary and metastatic liver cancer. A total of 17 patients with primary (HCC and Cholangiocarcinoma) and secondary (metastatic) liver cancer were enrolled in this prospective study. Out of 17 patients, 7 were referred to RFA procedure and another 10 underwent surgical liver resection using non-RF based devices. Blood samples were collected from each patient before and after 1 and 3 months of treatment. The following serum cytokines: IL-10, IL-17, INF-γ, TGF-ß were assayed by ELISA (ebiosciences, USA). RFA procedure unlike liver resection decreased serum level of IL-10 in patients with liver cancer. No significant changes in the level of the studied cytokines were revealed.

INFLAMMATORY BIOMARKERS IN PATIENTS WITH UNRESECTABLE PANCREATIC CANCER: A RETROSPECTIVE STUDY.

Different types of cancers may arise from the inflamed regions of the body. It has been widely accepted that inflammation is a key mediator of pancreatic cancer development. Best indicators of systemic immunity include inflammation-associated cell enumeration easily accessible from a complete blood cell (CBC) count. In this study, we investigated changes in potential diagnostic and prognostic biomarkers for cancer: neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte-lymphocyte-ratio (MLR), derived neutrophil-lymphocyte-ratio (dNLR) and systemic immune-inflammation index (SII) in unresectable pancreatic cancer patients and their correlation with erythrocyte sedimentation rate (ERS). Patients with inoperable pancreatic cancer were retrospectively enrolled in our study. NLR, PLR, MLR, dNLR, SII and ESR were conveyed and analyzed. Statistical analysis was performed using SPSS v.26. Correlations between the variables were determined by Spearman's correlation coefficient. The area under the curve (AUC), sensitivity, specificity, and cut-off values were compared using the receiver operating characteristic (ROC) curve. In patients with inoperable pancreatic cancer, the ESR, NLR, PLR, MLR, dNLR and SII were significantly higher compared with age-matched controls. Data showed no correlation between NLR, PLR, MLR, dNLR, SII and ESR levels. MLR and NLR had the highest AUC scores. For diagnosing unresectable pancreatic cancer the AUC of the ROC curve for NLR was 0.837 with a 95% CI of 0.728-0.946 and for MLR - 0.850 with a 95% CI of 0.746-0.953. However, combining these six markers reached the best specificity and sensitivity (AUC=0.955) in case of unresectable pancreatic cancer.

[OPPORTUNITIES OF ULTRASOUND IMAGING FOR VISUALIZATION OF THE SHOULDER JOINT PATHOLOGICAL CHANGES].

Aim of investigation - the assessment of opportunities of ultrasound (US) imaging for visualization of the shoulder joint pathological changes. 100 patients with the pathologies of shoulder joint have been investigated, they included traumatic, degenerative -dystrophic and inflammatory pathologies (tendinitis, tendinosis, tendinopathy, subacromial-subdelatoid bursitis).Ultrasound study performed on ultrasound TOSHIBA xario XG by high linear probe (7,5-12.0 MHz) with dopplerography(color, energetic), transverse and sagittal planes. It has been evaluated the thickness(diffuse, local), echostructure, continuity of contours of main shoulder joint tendons in above mentioned pathologies, in order to study their diagnostic values. 23 patients have been investigated by MRI which was used as "gold standard". The thickness, structure and continuity of contours of tendons have been evaluated by MRI in following regimes: T1, T2 and PDFs. In the study group the comparative results of ultrasound and MRI research were compared to determine the high diagnostic reliability of US, which is important for timely and effective treatment. The evaluation of US diagnostic accuracy for tendon thickness showed that the sensitivity was 95.00%, specificity - 66.67%, and diagnostic accuracy - 91.30%. It should be noted that negative likelihood ratio (NLR) is significant and equals to 0.08 (95% CI - 0.01÷0.60). The assessment of US diagnostic accuracy for tendon echostructure showed that the sensitivity was 94.74%, specificity - 50.00%, and diagnostic accuracy - 86.96%. It should be noted that negative likelihood ratio (NLR) is significant and equals to 0.11 (95% CI - 0.01÷0.60). The sensitivity of the evaluation of continuity of contours by US was 95.00%, specificity - 66.67%, diagnostic accuracy - 91.30%. It should be noted that negative likelihood ratio (NLR) is significant and equals to 0.08 (95% CI - 0.01÷0.60). On the basis of obtained results we can conclude that US may be characterized by high sensitivity, moderate specificity and high diagnostic accuracy for diagnostics of shoulder joint pathologies. It should be noted that mainly NLR is significant features for this imaging technique. US can be used in primary outpatient diagnostics, MRI and MR-arthrography should be performed in the hospital, to reveal the accompanying anomalies when planning surgical and/or other interventions.

Interventional radiofrequency ablation: A promising therapeutic modality in the management of malignant biliary and pancreatic duct obstruction.

Background: Malignant biliary and/or pancreatic obstruction has often encountered in the advanced stages of periampullary and cholangicarcinomas. HabibTM Radiofrequency (RF) ablation has been successfully used in the management of various cancers of liver and pancreas. Percutaneous HPB probe (EMcision Ltd, London, UK) is a new addition to this class of tools. It is an endoluminal Radiofrequency (RF) catheter which works on the principle of ablation and induces coagulative necrosis to recanalize the obstructed duct. The aim of this study is to address the technical details of canalization, feasibilities and outcomes of percutaneous endo-luminal Radiofrequency (RF) catheter in patients with unresectable malignancy with obstructed bile and pancreatic duct (PD). Material and Method: A total of 134 patients with inoperable malignant obstruction of biliary and PD underwent RF based percutaneous endoluminal RF ablation in a tertiary referral centre between December 15th, 2010 to August 7th, 2015. This device was used in a sequential manner with an intent to recanalize the obstructed. Following the initial catheter drainage of the duct, subsequent percutaneous endobiliary RF ablation, the metallic stent was placed to recanalize the obstructed bile and PD secondary to unresectable malignancy under real-time fluoroscopic guidance. Results: The percutaneous RF based ablation of obstructed bile duct and PD with metallic stent placement was successfully achieved in 130 (97.01%) cases. The three failures were noted in cases of biliary obstruction whilst, one with PD obstruction. The patency restored in 124 and patients, where the procedure was successfully completed and revealed clinical improvement reported. Conclusion: The percutaneous endoluminal RF based ablation of obstructed duct with metallic stent placement appeared to be a safe, effective procedure and may improve survival in patients with advanced stage cancer presenting with biliary and PD obstruction. Considering the above mentioned evidence, this modality may stand ahead of stenting alone. This could be considered as viable modality in management of such patients where very limited treatment options are available.

USING OF NOVEL DOUBLE INVAGINATED PANCREATOJEJUNOSTOMY TECHNIQUE WITH TRANSANASTOMOTIC STENTING AND EXTERNAL PANCREATIC DUCT DRAINAGE: PRELIMINARY REPORT.

Following the pancreatoduodenectomy the pancreatic anastomosis, which is still "Achilles" heel of pancreatic surgery, carries the highest risk of leak and cause of morbidity and mortality. More than 80 different methods of reconstruction have been proposed, illustrating the complexity of surgical techniques as well as the absence of the "ideal" pancreatic anastomosis and gold standard up to date. Here, we describe the novel method of double invaginated pancreatojejunostomy with transanastomotic stent and external pancreatic duct drainage. The preliminary results obtained with the described method are very encouraging and indicate that this technique is less complicated and time consuming,very safe, simple, easy to perform and also applicable almost to all situations.

Percutaneous Image-Guided Pancreatic Duct Drainage: Technique, Results and Expected Benefits.

PURPOSE: The aim of this study is to provide a technical detail and feasibility of percutaneous image-guided pancreatic duct (PD) drainage and to discuss its subtleties in a series of patients with obstructed PD. MATERIALS AND METHODS: Thirty patients presenting with PD obstruction from pancreatic head tumour or pancreatitis were subjected to percutaneous image-guided PD drainage under a guidance of ultrasound or computed tomography. Following the successful puncture of PD, a locking loop drainage catheter was placed using conventional guidewire techniques under real-time fluoroscopy guidance. RESULTS: The percutaneous drainage of obstructed PD was completed in 29 (96.7%) patients as an independent therapeutic intent or as a bridge to further percutaneous procedures. Clinical improvement following drainage was documented by the gradual reduction in clinical symptoms, including pain, nausea and fever and improved blood test results, showing the significant decrease of amylase concentration. The amount of pancreatic fluid drained post procedure was between 300 and 900 mL/day. No major procedure-related complications were observed. Subsequently, 14 of 29 patients underwent further procedures, including endoluminal placement of metal stent with or without radiofrequency ablation, balloon assisted percutaneous descending litholapaxy (BAPDL), endoluminal biopsy and balloon dilatation using the same drainage tract. CONCLUSION: The percutaneous PD drainage appears to be a safe and effective procedure. It should be considered in patients with obstructed PD secondary to malignancy, pancreatitis etc., where endoscopic retrograde cannulation has been failed or impracticable. The procedure can also be contemplated either as an independent treatment option or as an initial step for the subsequent therapeutic endoluminal procedures.

CURATIVE TREATMENT OF COLORECTAL CANCER SOLITARY METASTASIS TO LIVER SUBCAPSULE BY PERCUTANEOUS US GUIDED RADIOFREQUENCY ABLATION USING HYDRODISSECTION (CASE REPORT).

Case report presents the successful treatment of solitary liver metastasis in a patient with resected colon cancer. A 39-year-old male underwent left hemicolectomy with colostomy formation followed by chemotherapy for a moderately differentiated adenocarcinoma of the colon. Two years later, a liver metastatic lesion was detected. Patient received chemotherapy; the mass remained stable in size, measuring up to 3 cm in diameter. Low-invasive percutaneous curative treatment by Radiofrequency ablation was conducted using hydrodissection by dielectric fluid intraperitoneal introduction for hydrodissection. The follow-up imaging showed the complete response to treatment. The ablation technique including peritoneal hydrodissection, described in paper avoids capsular breach and appears safe and technically effective in subcapsular lesions treatment.

ULTRASOUND AND CT GUIDED THORACIC BIOPSY APPROACHES - EFFECTIVENESS AND COMPLICATIONS.

Percutaneous needle biopsy of thoracic pathology has gained popularity showing a good accuracy with a less invasive procedure. The purpose of the paper is to present our experience of ultrasound and CT guided thoracic biopsy approaches regarding procedure effectiveness and complications. 398 Image guided percutaneal core biopsy procedures of thoracic pathology (mediastinum, lung, pleura, bone and soft tissue) has been performed to 380 (95.5%) patients. In 18 (4.5%) cases the repeated biopsy procedure has been performed as the obtained specimen appeared to be non-informative. All repeated procedures were needed when the target size was above 2-5 or >5 cm using CT guided biopsy and it was due to tumor necrosis. No complications were detected after US guided procedures; No repeated procedures were needed as the first one enable to obtain the informative biopsy specimen. Procedure related complication were detected in 48 (12.1% of all procedures) CT guided cases in total; among them in 35 (8.8%) cases pneumothorax, in 5 (1.3%) hemothorax and in 7(1.8%) hemophtisis was detected. Slight bleeding along the needle pass with the hematoma formation was detected in 1 (0.2%) case for soft tissue lesion. 47 (11.9%) complications were detected on transpulmonary approach cases and only 1 (hematoma formation - 0.2%) - on extrapulmonary approach. Percutaneous image-guided core biopsy of thoracic lesions is an accurate and safe procedure, which enables to get the tissue material from all thoracic compartments. The vast majority of complications should be expected on transpulmonary approach cases.

IMAGING GUIDED PERCUTANEAL CORE BIOPSY OF THORACIC BONE AND SOFT TISSUE LESIONS - TECHNIQUE AND COMPLICATIONS.

The purpose of the paper is to present our experience of Imaging Guided Percutaneal Core Biopsy (IGPCB) of thoracic bone and soft tissue lesions in terms of procedure planning, biopsy technique, procedure complications and their management. The results of investigation of 81 patients are presented. According to imaging guidance type the patients were subdivided in two main groups - US guided biopsy (26 patients, 26 procedures) and CT guided biopsy (55 patients, 59 procedures). 85 procedures were performed. In 4 cases the repeated biopsy procedure has been performed as the obtained specimen appeared to be non-informative. Adequate tissue material was obtained at the first attempt in 77 (95.1 %) cases; in 4 (4.9%) cases the repeated procedure was needed (when the target size was above 2-5 or >5 cm using CT guided biopsy and it was due to tumor necrosis. Procedure related complications were detected in 1 (%) case (CT guided biopsy). In 1 case the significant pain, requiring administration of additional analgetics in postprocedure period was mentioned. Percutaneous US and CT guided bone and soft tissue lesions biopsy is an effective, highly accurate, and safe method of tissue obtaining for the diagnosis of indeterminate lesions. US is fast, cheap, avoids ionizing radiation, and allows the needle tip to be monitored throughout the procedure. CT has the ability to visualize both bone and soft tissue with the advantage of making easier needle localization into lesions too deep to see on US. CT also allows for better visualization lesions with a large amount of overlying cortex, and deep-seated lesions with extensive overlying soft tissue. CT-guided percutaneous biopsy is a safe and accurate method. US is the preferable tool for biopsy procedure guidance if the target is adequately imaged by US. CT should be used in cases when US imaging is not possible due to visualization problem.

IMAGING GUIDED PERCUTANEAL CORE BIOPSY OF PULMONARY AND PLEURAL MASSES - TECHNIQUE AND COMPLICATIONS.

Paper presents the ultrasound (US) and computed tomography (CT) guided percutaneous lung core biopsy technique and procedure associated complications. 148 percutaneous biopsies of lung and peural lesions were performed in 143 patients ( in 5 (3.4%) cases the repeated procedure was needed). Procedure was guided by US in 42 cases, by CT - in 106 cases. Post-biopsy CT scan was performed and patients observed for any complications. No complications were detected after US guided procedures; No major complications were detected after CT guided biopsy procedures; minor complications (pneumothorax, hemothorax and hemophtysis) were detected in 24 (22.6%) cases. In 18 (17.0%) cases pneumothorax, in 1 (0/9%) cases - hemothorax and in 5 (4.7%) cases hemophtisis was detected on CT guided procedures. All hemothorax and hemophtisis and 13(12.3%) pneumothorax cases happened to be self-limited; in 3(2.8%) pneumothorax cases aspiration and in 2(1.9%) cases - pleural drainage was needed. Ultrasound is the most efficient for biopsy guidance if the "target" can be adequately imaged by this technique. If US guidance is impossible biopsy should be performed under CT guidance. Pneumothorax and hemothoraxs was associated with multiple needle passes, lesion diameter <2 cm and larger diameter needle use. Hemoptysis was not associated with multiple needle passes, lesioan size and larger diameter needle. No air embolism was detected on our study. The safety and biopsy procedure success high rate proves the use of imaging guided percutaneal core biopsy of pulmonary and pleural masses as a first choice procedure when the lung or pleural mass morphology is needed.

HEPATIC ARTERIAL ANATOMY VARIATIONS IN PATIENTS WITH HEPATOCELLULAR CARCINOMA EVALUATED BY COMPUTED TOMOGRAPHY ANGIOGRAPHY.

Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and one of the major reasons for performing percutaneous endovascular procedures or liver surgery. Hepatic arterial anatomy is of major importance in performing these procedures on the liver. The aim of our study was to estimate the prevalence of various hepatic arterial variants in HCC patients. 78 patients were included in the study. Abdominal multiphase Computed Tomography scans of all patients have been assessed for presence of the hepatic arterial supply anatomical variations. Prevalent variant of arterial anatomy in each group and subgroup has been determined. Standard anatomy was seen in 38 patients. The rest 40 patients had anatomical variations. Among those 7 patients had left hepatic artery (LHA) replaced to the left gastric artery (LGA). 14 patients were found to have replaced right hepatic artery (RHA) from the superior mesenteric artery (SMA). Replaced LHA and RHA were found in 1 patient. Accessory LHA originating from the left gastric artery was found in 5 patients. Accessory RHA arising from the SMA was seen in 5 patients. Simultaneous existence of the replaced RHA and accessory LHA was encountered in 6 cases. Preoperative knowledge of the range of hepatic arterial anomalies and their specific frequencies is of great importance in planning and performance of endovascular interventional procedures. High prevalence of the hepatic arterial anatomy variations favors performing pre-embolization and pre-surgical CTA for the mapping of the hepatic arteries and is in consensus with other authors.

HEPATOCELLULAR CARCINOMA: CURRENT AND PROSPECTIVE IMMUNOTHERAPEUTIC STRATEGIES.

Hepatocellular carcinoma (HCC) is a highly lethal and the most common primary liver cancer with increasing worldwide incidence. Pathogenesis of HCC is immune mediated, however, not completely understood. Chronic low-grade inflammation alters both innate and adaptive immune responses. As a result tolerogenic environment is established in damaged organ. Up to date, incomplete understanding of HCC pathogenesis and the extend of biomarker variability among patients represent the major obstacle for early diagnosis and for the choice of effective treatment. Among current treatment options for HCC, thermal ablation strategy, which in addition to cancer eradication provides adjuvant/"danger"signal to the patient's immune cells, has demonstrated its active immunotherapeutic effect. In ongoing phase I/II clinical trials, tumor antigen loaded dendritic cell (DC)-based vaccines as well as tumor-specific cytotoxic T cells are being tested. Genetically redirected T cell therapy and more refined autologous vaccines are still awaiting approaches in HCC. The topic of this review focuses on current and bench-to-bedside immunotherapeutic strategies for HCC and discusses their advantages and limitations in clinic. We also weight up several prospective immunotherapeutic approaches which in theory have the potential for further implication in HCC. Combination of the induction of effective antitumor immunity with the inhibition of the mechanisms of tumor-induced immunosuppression ought to be a key objective in these future developments.

Imaging guided mediastinal percutaneal core biopsy--technique and complications.

165 percutaneous biopsies of anterior, middle and posterior mediastinum lesions were performed to 156 patients. Procedure was guided by US in 40 cases, by CT - in 125 cases. Hydrodissection was used in 5 cases, artificial pneumothorax - in 3 cases in order to avoid transpulmonary needle pass. Post-biopsy CT scan was performed and patients observed for any complications. Adequate tissue for histological diagnosis was obtained in 156 (94.5%) cases at the first attempt; in 9 (5.5%) cases the repeated procedure was needed. No major complications were detected after biopsy procedures; minor complications (pneumothorax, hemothorax and hemophtysis) were detected in 23 (13.9%) cases. No complications were detected after US guided procedures; In 17 (10.3% of all complications) cases pneumothorax, in 4 (2.4%) cases - hemothorax and in 2 (1.2%) cases hemophtisis was detected on CT guided procedures. All hemothorax and hemophtisis and 10 pneumothorax cases happened to be self-limited; in 3 pneumothorax cases aspiration and in 4 cases - pleural drainage was needed. Percutaneous image-guided core biopsy of mediastinal lesions is an accurate and safe procedure, which enables to get the tissue material from all mediastinum compartments. Ultrasound is the most efficient for biopsy guidance, if the target is adequately imaged by it; the advantages of US guidance are: a) possibility of real-time needle movement control b) possibility of real-time blood flow imaging b) noninvasiveness c) cost-effectiveness d) possibility to perform the biopsy at the bedside, in a semiupright position; so, ultrasound is a "Gold Standard" for procedure guidance if the 'target" can be adequately imaged by this technique. If US guidance is impossible biopsy should be performed under CT guidance. Hydrodissection and artificial pneumothorax enables to avoid the lung tissue penetration related complications. Pneumothorax was associated with multiple Needle passes and larger diameter needle use. The safety and biopsy procedure success high rate proves the use of IGMPCB as a first choice procedure when the mediastinal mass morphology is needed.

[Role of proapoptotic p-53 factor in pathogenesis of nonalcoholic hepatosteatosis].

The aim of the study was to establish the role of pro-apoptotic P-53 factor in the pathogenesis of nonalcoholic hepatosteatosis in postmenopausal women. Study was performed on menopausal women (12 month amenorea) with sings of metabolic syndrome and high level of ALT in blood (2 fold higher as maximal normal level). Verification of steatosis diagnosis was made on the basis of ultrasonography and histological study of bioptats obtained by method of percutal biopsy. The study of anamnesis, lipid profile, the concentration of ALT level in blood, histological analysis of bioptats and immunohistological study of P-53 were conducted. The control group consisted of postmenopausal women with metabolic syndrome, with normal level of ALT in blood. Histological analysis of liver bioptats revealed a micro-and macro-droplet steatosis of hepatocytes. Inflammation and fibrosis were present in all patients liver. Small necrotic focuses of hepatocytes without necrosis and single lymphocyte clusters were noted in samples of patients with high level of ALT. As a result imunohystochemical studies enhanced expression of the proapoptotic protein P-53 was found in that patients with hepatosteatosis; any dependence was not revealed between the intensity of protein P-53 expression and the degree of steatohepatitis (ALT content). It is concluded that the enhanced protein expression of P-53 which indicates on the intensification of apoptosis in hepatocytes can be induced by activation of inflammatory stimuli and oxidative stress. Considering the fact that it was not found correlation between the intensity of the protein P-53 expression and severity of disease, we can assume that its participation is just one element of multiple factors involved in pathogenesis of steatohepatosis. The timely correction of lipid metabolism and redox balance in the body is usfull for the prevention of hepatosteatosis.

Some aspects of pathogenesis of nonalcoholic fatty liver disease in postmenopausal women.

In view of the reversibility of steatosis and steatohepatitis, their early diagnosis is one of the most significant problems of modern medicine. The aim of the study was the establishment futures of the pathogenesis of NAFLD in postmenopausal women. The study was conducted on postmenopausal women (n=5), with metabolic syndrome and rate of ALT in the blood at least 4 times greater than its normal maximal value. Patients had to fulfill the following inclusion criteria: at least 12 month of amenorrhea. Verification of the diagnosis of NAFLD was based on abdominal ultrosonografic examination. In addition to collecting history, study of blood lipid profile and ALT, AST, estrogen content in patients enrolled in the study free nitric oxide content in the blood and liver bioptants was determined by Electron Paramagnetic Resonance (EPR) method. The study protocol approved by the Ethics Committee of the Tbilisi State Medical University. Patients by written form confirmed their agreement to participate in the study. In patients with NAFLD levels of total cholesterol, LDL-cholesterol and triglycerides were generally increased in the blood serum, direct correlation revealed between level of NO EPR signal intensity in liver bioptat and triglycerides content in blood (r=0,96; p=0,009). It was concluded that estrogen-dependent factors, such as impaired lipid metabolism and increase expression of iNOS induce accumulation of triglycerides and free fatty acids in the liver, generation excess amounts of NO, which in oxidative stress reveal their cytotoxity and promote progression of NAFLD in postmenopausal women.

[Ultrasound in complex of radiological studies in diagnosis of ankle joint medial aspect pathologies].

The aim of the research is to study sonosemiotics of ankle joint pathology by means of ultrasound in order to optimize the diagnostic process and improve the treatment. 130 patients (age ranges from 5 to 70 years) underwent the radiological study of ankle joint medial aspect. Pathology types: degenerative-dystrophic diseases - 39 (30%), inflammatory pathology - 21 (16.2%), traumatic injuries - 20 (15.2%), vascular pathologies - 26 (20%), neurogenic problems -7 (5.4%), soft tissue neoplasms - 5 (3.8%), congenital anomalies - 7 (5.4%) and vertebral pathology - 5 (4.0%). The diagnostic studies include: a) Ultrasound, performed on digital ultrasound system using high frequency (7.5-12.0 MHz) linear probe with Doppler capability (all patients); b) X-Ray filming in antero-posterior and lateral projections (6 patients- 4.5%); c) MRI - T1 and T2 weighted images in saggital and transverse planes 10 patients (10.0%) and d) CT - 2 patients (1.5%); To 2 (1.5%) patient biopsy has been performed. This study showed that ultrasound was successful in ankle joint medial aspect pathology diagnosis in 108 cases (84.0%); It was ineffective in osseous pathology definition. In final diagnosis of impingment syndrom MRI was required in 4 (3.6%) cases. It is concluded that ultrasound should be used as a Gold Standard in diagnosis of localized pain and swelling in the ankle joint.

[Ultrasound in diagnosis of foot lateral aspect pathologies].

The aim of the research was to outline the normal sonoanatomy and possibilities of ultrasound in complex radiological diagnosis of foot pathologies. 200 patients (age ranges from 10 to 70 years) underwent the radiological study of foot lateral aspect structures. PATHOLOGY TYPES: inflammatory pathology--40 (20%) patients, traumatic injuries--76 (38%), degenerative-dystrophic diseases--28 (14%); soft-tissue masses--16 (8%). Unilateral pathology was diagnosed in 80%, bilateral--in 20% of cases. The diagnostic studies include: a)Ultrasound, performed on digital ultrasound system using high frequency (7.5-12.0 MHz) linear probe with Doppler capability (all patients); b) X-Ray filming in lateral projections--28 (14%) patients; c) MRI--T1 and T2 weighted images in saggital and transverse planes--22 (11%) patients and d) CT--in 4 (2%) cases. Ultrasound was successful in foot lateral aspect pathology final diagnosis in 146 cases (73%); It was ineffective in osseous pathology definition. Ultrasound failed defining vertebral pathology (diagnosis for verified by X-Ray and MR studies) in 16% of cases; CT was used to diagnose peroneal tendons problems on calcaneal fracture in 2% and MR helped to diagnose anterio-lateral impingement in 1% of cases. Radiological complex was needed to reach the final diagnosis in 8% of cases. Ultrasound should be used as a Gold Standard for diagnosis of foot lateral aspect pathologies due to its high detail resolution, possibility of real time imaging and Doppler study. The decision of other radiological modalities application should be made on the basis of Ultrasound study data.

[Normal sonoanatomy and ultrasound diagnosis of achilles tendon pathology].

The aim of the research was to outline the normal sonoanatomy and improve achilles tendon pathology ultrasound diagnosis (Refinement of sonosemiotics) in order to optimize the diagnostic process and improve the treatment, to avoid the possible complications. 135 patients (age ranges from 15 to 70 years) underwent the radiological study of ankle joint posterior aspect. Pathology types: traumatic injuries--45%, inflammatory pathology--30% and degenerative-dystrophic diseases--25%. Unilateral pathology was diagnosed in 85%, bilateral--in 15% of cases. The diagnostic studies include: a) ultrasound, performed on digital ultrasound system using high frequency (7.5-12.0 MHz) linear probe with Doppler capability (all patients) b) X-Ray filming in antero-posterior and lateral projections (32 patients) and c) MRI - T1 and T2 weighted images in sagittal and transverse planes (5 patients). Ultrasound was successful in ankle joint posterior compartment pathology diagnosis in 132 cases (97.8%). It was ineffective in osseous pathology definition. Ultrasound failed defining pathology (posterior impingement-syndrome, due to the presence of triangular bone) in 3 cases (2.2%). In this cases MRI was helpful; it was also critical in differential diagnosis of massive partial tear and complete tear of the tendon. Ultrasound should be used as a Gold Standard when the patient presents with localized clinical symptoms (pain and swelling). Critical is the possibility of dynamic and Doppler studies in real-time. X-Ray should be used when the bony pathology is suspected and MRI should be considered if the pain is not localized exactly.

Effectiveness of percutaneous ethanol injection therapy in benign nodular and cystic thyroid diseases: 12-month follow-up experience.

This study was designed to clarify the long-term efficacy of percutaneous ethanol injection (PEI) therapy in benign nodular and cystic thyroid diseases. Solid nodule and complex cyst were classified into three groups in accordance with volume reduction. In solid nodule (n = 38) and complex cyst (n=8), initial volume was significantly reduced to final volumes, and volume reduction persisted during follow-up period. Complete response, partial response and no response were as follows: 21 %, 63 %, 15 % in solid nodule; 37,5 %, 50 %, 12,5 % in complex cyst, respectively. Differences of volume reduction according to initial volume (>10 mL vs <10 mL) were significant. Correlation between initial and final volumes, and between initial volume and volume reduction were also significant. Complications were developed in 10,5 % of patients but there were not permanent complications. In conclusion, our data suggest that PEI therapy could be an effective and safe therapeutic modality for benign nodular and cystic thyroid diseases especially when initial volume is more than 10 mL.