Relevance of the problem. The difficulties of diagnostics of orbital diseases are well known. Especially difficult is intraspecies differentiation among the multitude of tumour, pseudotumour, inflammatory, vascular, endocrine and other diseases occurring here, manifested by the symptom complex of unilateral exophthalmos [Beradze I.N., 1978; Brovkina A.F., 1993].
Malignant intraocular neoplasms are the main cause of death of patients with diseases of the organ of vision, with 45-48% of patients dying from metastases in the first 5 years after enucleation [Alekseeva I.B., 1990, Barkhash S.A.1978, Brovkina A.F..1991, 1997; Keizer R.W.. Viclvoyc G.L.,1986],
Retinoblastoma is the most frequent malignant neoplasm in children. According to different authors, the frequency of its occurrence is 1 case per 14000 - 35000 newborns. [Bobrova N.F. and Vit V.V., 1993; Brovkina A.F., 1997; Provenzale J.M., et al., 1995; Skulski M., et al., 1997; Weber A.L., Mafee M.F, 1992; Wilms G., et al., 1989]. The frequency of patients with the most malignant intraocular tumour in adults - uveal melanoma has recently reached 7-9 people per 1 million population [Brovkina A.F., 1997; Kotslyansky E.O., 1989; Yushko N.A., Peskova L.I., Kalenich L.A., 1989; Peyster R.G., Augsburger J..I., Shields J.A., 1988; Romani A.. Baldeschi L., ct al 1998; Scott I.U., 1998].
The fundamental difference in treatment tactics, depending on the stage of development, size and topography of the tumour, as well as the seriousness of the prognosis in retinoblastomas and melanomas sharply increase the requirements for the accuracy of their differential diagnosis. At the same time, the number of diagnostic errors in ocular tumours continues to be 10-30% even when complex clinical and instrumental examination is applied in specialised ophthalmological centres [Ternovoy S.K., Panfilova G.V., Rogozhin V.A., 1979; Friedman F.E., Malyuta G.D., Kodzov M.V., 1995; Song G.X., 1991].
Widely used in ophthalmological practice traditional diagnostic methods (ophthalmoscopy, gonioscopy, diaphanoscopy, fluorescence angiography, laboratory tests) are insufficient to obtain comprehensive information about the localisation, nature of growth and prevalence of volumetric pathological formations of the eye and orbit. This circumstance and not quite satisfactory results of surgical treatment are the causes of high mortality of patients [Muratova T.T., Nigmanova N.H., Kozlovskaya G.M.. 1989, Naches A.I., 1980; Cheremisin V.M., Trufanov G.E., Kholin A.V., 1991]. Untimely or erroneous recognition of pathological processes of the orbit leads to a sharp deterioration of visual functions, up to blindness, and in some cases to the death of the patient [Yuzhakov A.M., Travkin A.G., Kiseleva O.A., 1991]. All this determines the importance of timely and accurate diagnosis of diseases of the orbit, on the one hand, and the difficulty of such diagnosis - on the other [Gabunia R.I., Kolesnikova E.K., Tumanov L.B., 1982].
The fact that the orbit is closed from direct inspection and palpation by bone walls and the eyeball, indicates the advantage of radial diagnostics in comparison with other methods of examination. In the arsenal of clinicians there is a great variety of methods of clinical-radial diagnostics of orbital pathology, however, at present the information in the literature about their resolving capabilities and significance in comparative aspect is incomplete and not fully studied. The priority of using one or another instrumental investigation, their sequence and expedient combination have not been determined yet. This makes it difficult to choose the optimal standardised approach for diagnosis and adequate treatment [Cheremisin V.M., Trufanov G.E., 1993, Weber A.L., Sabates N.R., 1996; Wenig V.M., Mafee M.F., 1998].
Thus, the study of these and other questions, contributing to the improvement of diagnostics and treatment of patients with neoplasms of the eye and ocular cavity, should be recognised as urgent urgent.
Purpose of the study. Comparative evaluation of magnetic resonance tomography capabilities and development of algorithms for complex radial diagnostics of volumetric formations of the visual organ. To solve this goal we set the following tasks.
1. To study the normal picture of the magnetic resonance image of the visual organ in comparison with other methods of visualisation.
2. To find out the possibilities of magnetic resonance tomography, ultrasound and computed tomography in detection and evaluation of intraocular neoplasms.
3. To determine the role and place of magnetic resonance tomography in differential diagnostics of volumetric pathological formations of the eye cavity in comparison with other radial methods of research.
4. To determine the indications and to develop an algorithm for the complex application of radiography, ultrasound, computer and magnetic resonance tomography for diagnostics of volumetric formations of the eye organ.
Scientific novelty.
The present work is the first to give a detailed and detailed description of the complex clinical and radiation examination, with generalisation and standardisation of magnetic resonance, computer and ultrasound semiotics of volumetric pathological formations of the eye and eye cavity. The conducted clinical and instrumental investigations allowed to determine the diagnostic value and resolving capabilities of each of the applied methods. The ultrasound, CT and MRI signs of volumetric formations of the eye organ were studied, clarified and supplemented taking into account the use of low-field magnetic field and general-purpose ultrasound apparatus. The developed standardised diagnostic algorithm of examination of patients with this pathology is new, thanks to which the pre-oppositional diagnosis of tumour and other diseases of the visual organ is improved and the total radiation load on the patient is reduced.
Conclusions
1. MPT will provide an opportunity to study the weight of the soft tissue and anatomical components of the ocular cavity, up to the optic nerve sheath and perineural liquor space, the orbital apex and chiasmal-sellar region, as well as to assess the condition of adjacent structures of the brain and facial skull. The method is limited in the evaluation of changes in the bony walls of the orbital cavity.
2. MRI is inferior in detecting characteristic signs of retinoblastoma (presence of calcification). The sensitivity of MRI was 66.6%, while for ultrasound and CT these values were 96.1 and 100%, respectively. But when the tumour spreads rstrobulbarly outside the eyeball (at 3-4 stages) the informativeness of MRI increases significantly. In uveal melanoma the sensitivity and specificity of MRI reaches 100%.
3. Both MRI and CT have a high detection rate (98.1% and 95.8% respectively) of benign orbital tumours of both primary and secondary origin. However, MRI is the preferred method of investigation. MRI is especially informative when a cranioorbital tumour and pseudotumour are suspected. The sensitivity of the method is 90.9% and 91.6%, respectively
4. In some cases ultrasound can be used to differentiate between encapsulated and diffuse neoplasms, which facilitates the diagnosis. However, when the pathological process is localised near the orbital apex, the diagnostic value of ultrasound decreases. In such cases it is advisable to use MRI.
5. In detection of primary and secondary malignant tumours of the orbital cavity both MRI and CT are quite informative (sensitivity 97,2% and 95,4% respectively), but the most comprehensive information about the state of bone walls will be provided by CT. When the process spreads intracranially, the value of MRI increases significantly, especially with the use of contrast enhancement.
6. The developed algorithm of complex clinical and radiation examination of patients with the use of ultrasound, CT and MRI is the most effective in the diagnosis of volumetric pathological formations of the eye and eye cavity, allowing to reduce to an adequate minimum the total radiation load on the patient and diagnostic period, excluding duplication of research techniques and choosing the most informative in each case, which in turn allows to develop appropriate treatment tactics and reduce the level of disability of the patient.
The research paper presents the results of diagnosis and treatment of 82 patients with focal thyroid masses. Based on a complex study of patients, main specific diagnostic criteria were determined, the use of which allows to detect thyroid cancer in their early stages. It was educed, that multiself-reactance ultrasonic research, including В-mode, EDC, DDC, spectral Doppler and elastography assist upgrading of research in the early exposure of chasse of thyroid.
The article studies the features of higher educational institutions as an object of economic diagnostics. The place of economic diagnostics in ensuring the effective operation of higher educational institutions and the importance of the principles of diagnostics in management are highlighted. The approaches to assessing the quality of higher education from the point of view of expected results in accordance with the interests of the participants in the educational process are substantiated. There are scientific conclusions and practical recommendations on the economic assessment of the quality of higher education.
Subjects of research: 815 patients with the various forms acute pancreatitis, 235 patients with primary erronous diagnosis of acute pancreatitis.
The purpose of research: improve the treatment results of the patients with acute pancreatitis by upgrading existing and developing new diagnostic methods in the treatment complex.
Methods of research: clinical, biochemical investigation.
The results achieved and their novelty. On the basis of the analysis of occurance frequency of various clinical symptoms, diagnostics system of the acute pancreatitis is offered, the criteria of the laboratory and ultrasonic diagnostics for given disease arc advanced, for a quantitative estimation of severity of a condition of the patients the ball scale is offered; the complex conservative therapy is advanced, the technique of realization of long intraarterial catheter therapy is optimized, the optimum indications to realization of retrograd and pcrcutanc endobiliar interventions in treatment of acute biliar pancreatitis arc determined, drainage and sanation of omental bag for open operative interventons is offered, the technique of treatment of the patients in postoperative period is advanced and the algorithm of medical measures is offered at acute pancreatitis.
The developed diagnostic and treatment complex has allowed to reduce frequency of diagnostic errors from 28,4% to 16,8%, to increase efficiency of conservative therapy from 89,8% up to 95,3%, long intraarterial catheter therapy -from 72,0% up to 82,8%, to reduce mortality from 7,4% to 3,4%.
The practical importance. The offered clinical system for diagnostics and the advanced criteria of laboratory diagnostics promote to increase reliability of diagnostics, the systematized ultrasonic criteria allows verify the form of acute pancreatitis. The offered scale of definition of severity of the acute pancreatitis allows quantitatively characterize a condition of the patients, dynamical changes of pathological process and efficiency of used of a complex of medical measures. The advanced complex conservative therapy, technique of realization long intraarterial catheter therapy, definition of the indications to performance retrograd and pcrcutanc endobiliar interventions, advanced draining method and sanation of omentum bag at pancrcanccrosis, combined treatment in postoperative period allow to improve results of treatment of the given category of the patients.
Degree of introduction and economic efficiency: the received results arc introduced into practical activity of surgical branches of second clinics TMA.
Area of application: emergency and abdominal surgery.
Optimization of diagnostics and schemes of pathogenetic intensive therapy of surgical sepsis in children based on clinical and laboratory criteria and bacteriological monitoring.Materials and methods: The research period is 2018-2020. The object of the study (n=73) – children with surgical pathology (widespread peritonitis, bacterial destruction of the lungs, post-traumatic brain hematomas, abdominal trauma, etc.). Research methods: microbiological monitoring to determine the sensitivity of the micro-organism to antibiotics was carried out before and at the stages of treatment (sputum, urine, wound, bron-choalveolar lavage, tracheal aspirate, blood, contents from drainages, wound surface). Determination of the sensitivity of the isolated strains to antibiotics was carried out by the disk-diffusion method. To determine predictors of sepsis in surgical patients, clinical (mean arterial pressure (mAP), heart rate (HR), respiratory rate (RR), SpO 2 , etc. and laboratory parameters on days 1–2 (up to 48 hours) of sepsis identification, days 4 and 8 of intensive therapy. Procalcitonin was determined by immuno-fluorescence on a Triage® MeterPro analyzer (Biosite Diagnostics, USA). Blood gases and electrolytes were analyzed using a Stat Profile CCX analyzer (Nova Biomedical, USA). Results: studies have shown the effectiveness of complex intensive care in 86.3 % of cases. Mortality was found in 13.7 % of cases. Patients with severe surgical pathology died: widespread peritonitis, severe TBI + coma with irreversible neurological disorders, urosepsis against the background of chronic renal failure, after repeated surgical interventions, due to the development of refractory septic shock (SS).
Conclusions. Early diagnosis of sepsis, rational early ABT under the control of microbiological monitoring, non-aggressive infusion therapy with early prescription of vasopressors (SS) with constant monitoring of the child's main life support organs contribute to an improvement in sepsis outcomes and a decrease in mortality
The article studies the features of higher educational institutions as an object of economic diagnostics. The place of economic diagnostics in ensuring the effective operation of higher educational institutions and the importance of the principles of diagnostics in management are highlighted. The approaches to assessing the quality of higher education from the point of view of expected results in accordance with the interests of the participants in the educational process are substantiated. There are scientific conclusions and practical recommendations on the economic assessment of the quality of higher education.
Subjects of the research: The diagnostics of data transmission systems’ (DTS) elements under operation terms, methods of the control of DTA (data transmission apparatus) and diagnostics of digital devises on the base of signature analysis.
Purpose of work: Investigation and development of effective control methods and diagnostic of data transmission systems’ elements.
.Method of research: On solving of given problems analytical and program methods of investigation have been used, including elaborated models and methodic with following processing and analyses of the received results. Analytical methods were based on probability theory, flow - chart theory, reliability theory, algebra logic theory, machine modeling theory.
The results obtained and their novelty: The cascade model of error source of discreet channel and the strategy of diagnostics and restoring the efficiency of DTS elements. The mathematic model of embedded control over DTS elements with and without self control and evaluation of volumes value and efficiency. Evaluation methodic of sample signatures reliability and calculation. The algorithms of despairs detection at signature analysis application, minimizing the time of search. An imitation model for evaluating the methods of compact testing and sample signatures shaping.
Practical value: The elaborated methodic, algorithms and programs are recommended for practical use at designing of control - diagnostic provision at the stage of operation of data transmission systems.
Degree of embed and economic cffcctivitv: The results of dissertation work have been adopted in AK «Uzbektelecom». The theoretical and practical results have been used at TU1T on «Telecommunications» specialty and 5A522205 - «Communication networks and control systems» specialty.
Field of application: The proposed methodic, algorithms and programs could be widely used at operation of data transmission systems, development of control - diagnostic supply of digital systems and devices of telecommunication equipment.
Torsion and necrosis of the omentum strand is a casuistic disease and occurs in 0.06% – 0.14% of all urgent surgical pathologies in the abdominal organs. Taking into account the rare occurrence and the absence of a characteristic symptoms complex in the torsion of the omentum strand the preoperative diagnosis is correctly established in single cases. The etiology of the development of this pathology remains amystery in modern medicine and attracts more interest in itself due to the difficulty in diagnosis namely in the preoperative period. There are predisposing factors (adhesions in the abdominal cavity, ventral hernia, obesity, chronic inflammation of the abdominal organs) and producing factors (physical activity, eating a large amount of food, a sharp increase in intra-abdominal pressure or sudden contraction of the muscles of the anterior abdominal wall). Most often, the clinic of torsion of the omentum strand simulates such abdominal pathologies as acute appendicitis, acute intestinal obstruction of adhesive etiology, acute cholecystitis. Over the past decade, minimally
invasive surgery has become widespread, in particular laparoscopic surgery, as a
multi-port and single-port. The article highlights the difficulties of preoperative
diagnostics, the role of laparoscopy in differential diagnostics and the features of the
clinical course of torsion and necrosis of the fatty structures of the abdominal cavity
Caries is a process of destruction of hard tooth tissues, which occurs with the participation of cariogenic bacteria in the oral cavity (in the composition of dental plaque), as well as food residues processed by them. The organic acids produced by the bacteria gradually destroy first the enamel of the tooth and then the underlying dentin. As a result, a carious cavity is formed in the tooth, the walls of which are filled with soft decay of decaying dental tissues and a large number of cariogenic bacteria. The following article looks into the reasons leading to dental problems, its diagnostics and treatment methods.
Кәсіби қызметтің кез-келген саласында өндірістік өнімнің сапасы мен жағдайының диагностикасының рольі айрықша. Мұғалімнің кәсіби педагогикалық қызметі, педагогикалық ұжымның қызметі, осы сияқты.
The article presents the features of the clinical course of chronic brucellosis at the present stage, the issues of diagnostics and treatment, taking into account the results of our own observations of patients with damage of the nervous system and musculoskeletal system. There is characteristic of clinical and epidemiological, laboratory and instrumental diagnostics of chronic brucellosis, the issues of etiopathogenetic therapy are considered.
Relevance of the problem.Despite the great successes of angiosurgery, the problem of surgical treatment of abdominal aortic aneurysms does not lose its relevance. World health statistics records a steady increase in the incidence of abdominal aortic aneurysm (ABA). According to L.J. Melton et al. (1984) and L.K. Bickerstaff et al. (1984) in the USA the number of patients with abdominal aortic aneurysm has increased 7 times in 30 years since 1951. In England and Wales, according to F.G. Fowkers et al. (1989) for the same period revealed a 20-fold increase in abdominal aortic aneurysms in men and 11-fold in women. According to the results of multicentre screening studies ABA was detected in 8% of the examined (E.S. Vourvouri, 2001), and in the age group of 64-69 years ABA was detected in 5.7% of the examined, and in the age group of 75-81 years - in 8.9% (R.A.P. Skott et al., 2001). A similar trend is observed in other countries. Accordingly, mortality from ABA is also increasing - aneurysm rupture in a number of countries is one of the ten most frequent causes of death among elderly and senile people (F.A. Lederle et al., 1990)
Currently, planned aneurysm resection has become a recognised standard of radical treatment of ABA patients and the number of these operations is steadily increasing. For example, about 40,000 ABA resections are performed annually in the USA (J.J. Grange et al., 1997). In Sweden during the period from 1987-89 to 1993-95 the number of ABA operations increased 5 times and currently 10 operations per 100,000 population are performed (A.Hallin et al., 2001), although this is 1.5 - 2 times less than the required number. However, postoperative lethality is still quite high and makes 5-7% (A.V.Pokrovskiy et al., 1992; Y.V.Belov et al., 1992; V.V.Vakhidov et al., 1992; A.W. Bradbury et al. Bradbury et al., 1997; A.Hallin et al., 2001).
E.W. Steyeberg et al. (1995) summarised the data of literature on 17238 ABA resection operations and gave an average mortality of 6.8%.
Multicentre studies in five major hospitals in the Netherlands found that only 74% of patients underwent ABA resection without complications; 26% had some complications, 9% of which were severe and 4.1% of which were fatal (G.J. Akkersdijk et al., 1998). Similar results were obtained in the Canadian Cooperative Study (K.W. Johnston et al., 1990). It was established that the peculiarity of complications in the majority of patients was their systemic character (L.L. Lau et al, 2001) The course of the postoperative period is most often complicated by cardiac, respiratory, renal, cerebrovascular, as well as complications associated with thrombosis and bleeding (W.E. Lloyd et al., 1996; R.D. Sayers et al., 1997; J.D. Blankenstein et al., 1998; R. Ayari et al., 1998). Ayari et al., 2001)
The undisputed leadership, without doubt, belongs to cardiac complications, the incidence of which varies from 10% to 20%. Moreover, cardiac complications account for 50-70% of total mortality. Cerebrovascular complications, although not uncommon, account for no more than 1-1.5%, but their mortality reaches 40%. Complications associated with thromboses and haemorrhages in the perioperative period reach 2-5% (M.M.Reigel et al., 1987; K.W.Johnson et al., 1990; N.Franklin et al., 1993; A.A.Milne et al., 1994).
Certainly, a large number of complications after resection of abdominal aortic aneurysms is caused by the initial severity of patients' condition, however, many unresolved tactical and technical issues of patients' preparation for the operation, stage of performance in case of combined lesions of several vascular basins play a practically significant role. Adequate management of the operation itself and the immediate postoperative period is no less important, taking into account the possibility of such dreadful complications as thrombosis and embolism, cerebral and cardiac death. Until now there is no unified complex analysis of the results of treatment of uncomplicated abdominal aortic aneurysms and, accordingly, recommendations for the prevention of possible complications.
All this determined our aim and objectives of the study.
The aim of the study is to improve the results of surgical treatment of ABA by developing an effective system for determining the main risk factors of surgical treatment and optimal surgical tactics to prevent possible complications.
Scientific novelty.For the first time a complex analysis of indications and contraindications to surgical treatment of abdominal aortic aneurysms was carried out
The most significant concomitant pathology capable to lead to formidable complications and lethality during the intervention and in the nearest postoperative period was revealed. Adequate measures of their prevention and treatment were proposed.
The algorithm of surgical treatment tactics for patients with combined pathology of coronary arteries and aortic arch branch lesions was developed
The state of haemostasis system at all stages of reconstructive surgery on abdominal aorta, starting from skin incision to wound closure, was studied for the first time.
Conclusions:
1. The proposed original classification of ABA, based on mutual dependence on the etiology of the disease, localisation, concomitant diseases, clinic and its course, allows to determine the strategy of early diagnosis, to estimate the most significant risk factors, the stage of intervention in combined lesions of adjacent and distant vascular basins and, ultimately, to determine the ways to reduce complications and mortality in patients with ABA.
2. The most informative methods of ABA diagnostics are duplex scanning and computed tomography. Non-invasive diagnostics capabilities are enough to determine the aneurysm size, its relation to the renal arteries, as well as to find out the state of visceral branches and aortic bifurcation. Abdominal aortography is indicated in patients with concomitant arterial hypertension to identify the state of the renal arteries.
3. Significant risk factors in these patients are ischaemic heart disease (44.1%), arterial hypertension (49%), haemostasis disorders (almost 100%).
4. The leading concomitant disease in the development of postoperative complications is ischaemic heart disease. Its share in abdominal aortic aneurysms is 40%. Postoperative cardiac complications reach 14.9%. Diagnostics of ischaemic heart disease should be based on the stage-by-stage detection of coronary lesions and its functional-compensatory abilities.
5. The main complications of the postoperative period after ABA resections are acute heart failure (14,9%), cerebral circulatory disorders (1,5%), acute renal failure (3,33%).
6. When significant coronary vascular channel lesions are detected in patients with ABA, it is fundamental to solve the issue of intervention staging. At 3-4 functional classes of circulatory insufficiency, appearance of new zones of hypo- or akinesia, decrease of ejection fraction below 40%, the first stage should be myocardial revascularisation surgery
7. In patients with combined lesions of brachiocephalic vessels in patients with ABA it is reasonable to assess the cerebral blood flow. In the presence of 70% or more stenosis of VCA, presence of embologenic plaque, bilateral haemodynamically significant stenosis it is necessary to perform carotid artery intervention as the first stage.
8. One of the most difficult problems of reconstructive operations in ABA is the contiguous lesion of renal and visceral branches of the abdominal aorta. The principle is their one-stage reconstruction. The types of reconstruction of these branches should be variable depending on the volume and extent of the pathological process.
9. Patients with aneurysmal lesion of abdominal aorta initially always have significant disorders of haemostasis system. In 30% of patients with occlusive diseases of aorta and its branches in the preoperative period the activity of thrombocytic-vascular link of hemostasis is increased, antithrombotic ability of vascular wall endothelium is decreased and blood rheological properties are disturbed. Activation of fibrinolysis was noted in patients with aneurysmal lesion of abdominal aorta.
10. During the operation for abdominal aortic aneurysmal lesion, after starting the blood flow the level of plasminogen increases additionally by 30%, which is a risk factor for haemorrhagic complications in the perioperative period. On the 1-3 day after the operation there is a significant decrease of blood anticoagulant potential - antithrombin-Sh by 25-27%, protein C by 23-25%. This period is the most dangerous in terms of thrombohemorrhagic complications development.
11. When using standard heparin during the operation there is a consumption of antithrombin-Sh by 30-45% and increase of platelet aggregation by 10%, which is a threatening condition for the occurrence of thrombosis of deep veins of the lower extremities with subsequent TELA. When using fraxiparin during reconstructive vascular surgeries the consumption of antithrombin-Sh and increase in platelet aggregation do not occur, prothrombin time, activated partial thromboplastin time, thrombin time are lengthened insignificantly that testifies to expediency of its use for prevention of thrombohemorrhagic complications.
12. Application of the diagnostic methods proposed by us to detect the main risk factors during the operation and in the nearest postoperative period, use of the algorithm of stage and volume of intervention allowed to reduce significantly the number of threatening complications, thus the lethality decreased 4 times, and the number of non-fatal complications - 4 times non-fatal complications - 1.5 times.
The article reveals the importance of economic diagnostics in the organization of preparation of management decisions and control over their implementation. The main methods of economic diagnostics of the economic potential and various components of the organization are proposed. Scientific conclusions and practical recommendations concerning the evaluation criteria in the diagnostic aspect are given.