Diagnostic role of uterine artery dopplerometry in the first trimester of pregnancy

A Doppler sonographic examination of blood flow in the left and right uterine arteries was carried out in women in the first trimester of pregnancy. Systolic- diastolic ratio (S/D) andpulsative index (PI) were assessed in 71 women with physiological course of pregnancy and in 49 women with threatened abortion. The investigation revealed clear connection of the uterine blood flow lateralization and corpus luteum localization. These interrelations are characterized differently in case of physiological pregnancy and threatened abortion. The new approach to the evaluation of uterine blood flow gives an ability ofpreclinical diagnostics of threatened abortion.

Changes in the filtration function of the spleen after surgery following traumatic organ injuries

The incidence of splenic injuries among all closed injuries of the abdominal cavity is from 15.5 to 30.0 %, and a mortality rate is between 7 % and 26 %. The tactics in the treatment of splenic injuries is determined by the degree of traumatic injury, the patient's condition during the operation, and a concomitant pathology. Studies of tissue regeneration of the operated spleen allow identifying two main options for its regeneration, associated with the nature of blood circulation in the preserved part. Objective — to study the regeneration and filtration function of the spleen after various types of surgery for the management of traumatic spleen injuries. Materials and methods. The results of treatment of 85 patients in the period 2015 — 2020 were analyzed. To investigate the changes in the filtration function of the spleen, a study of the peripheral blood (general blood test) was performed to assess the shape of erythrocytes. In order to determine the size of the residual splenic parenchyma, its structure and regenerative processes were evaluated and sonographic examination was carried out. Results. The average increase in the size of the residual splenic tissue after subtotal resection of the organ with the formation of couplings of the parenchyma averages 40.2 ± 3.4 % one year after surgery, and in patients who underwent subtotal resection of the spleen with covering the cut plane with adhesive hemostatic plate 70 % — 49.14 ± 6.77 %. The study of changes in the filtration function of the spleen in patients, who underwent subtotal resection of the spleen, showed the appearance of target cells, acanthocytes and halocytes in the peripheral blood, but their number was insignificant and did not exceed normal (not more than 3 %). Any destroyed and pathologically altered erythrocytes were not visualized in patients, who underwent atypical resection of the spleen (mass deficit less than 30 %). Conclusions. Spleen regeneration is determined both by the nature of blood supply to the residual splenic tissue and its size, and does not depend on the nature of the pathological process. Organ‑preserving surgical interventions on the spleen allow maintaining the filtration function of the spleen.

Decidualized Endometrioma: Its Sonography and Optimal Clinical Management

Endometriosis is a condition which affects many reproductive age women. During pregnancy, an ovarian endometrioma may undergo decidualization, which may take on the sonographic appearance suggestive of malignancy. In this instance, a surgical approach for treatment may be deemed necessary. Three cases are presented with different outcomes, worthy of viewing the contrasting management. In case 1, a patient was diagnosed with a left ovarian cyst at her routine 20-week gestation sonogram. This sonographic examination was suggestive of an ovarian malignancy. The patient underwent laparoscopy with left salpingo-oophorectomy at 23 weeks gestational age, without complications. The pathologic diagnosis of the removed mass was a decidualized endometrioma. In case 2, a female patient presented with bilateral ovarian decidualized endometriomas that were demonstrated sonographically and had the appearance of malignancy. This patient was treated conservatively with serial follow-up sonograms during her pregnancy. At the 2-month post-partum follow-up sonogram demonstrated persistent bilateral endometriomas, without decidualization. However, in case 3, possible decidualization of an endometrioma was seen, and a follow-up sonogram revealed the presence of ovarian carcinoma. There is previously published support for watchful waiting when similar sonographic findings, in pregnancy, are seen.

Evaluation of Diagnostic Strategies for Fetal Skeletal Dysplasia Using Ultrasound Scan and Gene Testing: A Preliminary Study in Wu Han, China

Objective: The aim of this study was to deliver prenatal diagnosis through sonographic examination and gene variation testing, and to evaluate the outcome of applied strategies in prenatal diagnosisMethods: From September 2015 to April 2021, the study investigated 24 cases with suspected short long bones, which were obtained from the prenatal diagnosis center of Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology. The likely pathogenic gene variants were analyzed by multiple approaches (including karyotype analysis, copy number variations and whole exome sequencing) and further determined with the accuracy of the prenatal diagnosis for fetal skeletal dysplasia through one year follow-up survey. Results: ① We found fetal skeletal dysplasia or malformation in 8 cases (account for 33.3%) before 24 weeks of gestation and in the rest cases after 30 weeks of gestation. ② Out of 24 cases, likely pathogenic gene variants in FGFR3, FBN2, COL1A2, CUL7 and DYNC2H1 were detected for 6 cases; genetic variants in FGFR3, IMPAD1 and GORAB as possibly lethal mutations were identified in other 6 cases; and gene variants in WNT1, FBN1, OBSL1, COL1A1, DYNC2H1 and NEK1, known as Variant of Undetermined Significance (VUS), were found in 4 cases. The rest 8 cases showed undetectable mutation in the whole exome sequencing (WES) analysis.③ A genetic diagnosis determined 12 different skeletal dysplasia genotypes in 14/24 (58.3%) cases. The other 10 cases with wild type gene (41.7%) were normal and well developed in one-year follow-up survey after study.Conclusion: Features of fatal skeletal dysplasia can be identified in utero using fetal ultrasound and gene testing. Sonographic examination combining with genetic diagnosis showed advance in prenatal diagnosis in the preliminary study and the applied strategy could be used to help with improving the accuracy of prenatal diagnosis for fetal skeletal dysplasia.

Care pathway for fetal joint contractures, Fetal Akinesia Deformation Sequence and Arthrogryposis Multiplex Congenita.

Introduction The majority of arthrogryposis multiplex congenita (AMC) and lethal forms of AMC such as fetal akinesia deformation sequence (FADS) cases are missed prenatally. We have demonstrated the additional value of fetal motor assessment and evaluation in a multidisciplinary team for the period 2007-2016. An applied care pathway for fetuses presenting with joint contracture(s) in one anatomic region (e.g. talipes equinovares), more than one body part with non-progressive contractures and motility (AMC) and with deterioration over time (FADS). Methods The multidisciplinary team of Amsterdam University Medical Centre Expertise Centre FADS and AMC developed the care pathway. Additional tools are provided including a motor assessment by ultrasound examination and postmortem assessment form. Results An eight-step care pathway is presented with a proposed timing for prenatal sonographic examination, genetic examinations, multidisciplinary meetings, prenatal and postnatal counselling of the parents by specialist also treating after birth, follow-up of prenatal and postnatal findings with counselling for future pregnancies. Discussion/conclusion The scheduled serial structural and motor sonograpahic assessment together with follow-up examinations and genetic analysis, should be tailored per prenatal centre per available resources. The multidisciplinary care pathway may pave the way to increase detection rate and diagnosis of isolated contracture(s), talipes equinovares with underlying genetic causes and the rare phenotypes AMC/FADS and prompt treatment after birth within expertise teams.

P126 LAPAROSCOPIC TREATMENT OF HYDROCELE IN FEMORAL CANAL: A CASE REPORT

Aim The hydrocele of the femoral canal (Femorocele) is one of the rarest entities of femoral hernia (1). All of the reported cases were an intraoperative diagnosis and were treated with an open approach. We are reporting, the probably first femorocele diagnosed and treated laparoscopically. Material and Methods A 57-years-old female patient was presented in our outpatient clinic with pain and an unclear lump in the groin area for 6 months. The sonographic examination revealed a cystic structure in the groin area resampling Nuck’s cyst. An elective laparoscopic exploration and transabdominal preperitoneal (TAPP) repair was planned. Results A laparoscopic exploration was carried out. Intraoperatively, the cystic structure was not found in the Nuck’s Canal, but in the femoral canal as a content of a femoral hernia with some pre-peritoneal fat. By the extraction of the cyst, a gush of clear fluid was noted. After the usual preparation of the preperitoneal area, a mesh was placed in TAPP technique. Conclusions This rare variety of femoral hernias, femorocele, is commonly misdiagnosed as a strangulated hernia or Nuck’s cyst (as in this case) among other differential diagnoses (2). All published femorocele cases were treated with an open approach. As demonstrated here, such unclear cases can be laparoscopically explored and treated accordingly.

B-SCAN: A SIGNIFICANT TOOL IN EVALUATION OF VARIOUS OCULAR LESIONS AND ITS MERITS OVER CONVENTIONAL OPHTHALMOSCOPIC EXAMINATION

INTRODUCTION: USG study of 118 patients in the present study highlights the advantages of ocular ultra sonography (B-mode) in the evaluation of retinal disorders. AIMS & OBJECTIVES: To evaluate the role of USG in cases with opaque light conducting media where direct vision by ophthalmoscopy is impossible, trauma where direct ophthalmoscopy is challenging even for experienced clinicians and in orbital diseases and in localization of intraocular foreign body. CONCLUSION: Ultrasonographic ndings were well correlated with clinical and operative observations. Sonographic examination unambiguously deserves foremost position in the algorithm for imaging pathological states of the eyeball.

LEWIS-SUMNER SYNDROME: ANALYSIS OF ATYPICAL ONSET WITH PRIMARY ASYMMETRIC LESIONS OF LOWER LIMB NERVES

Lewis-Sumner syndrome is the most common atypical form of chronic inflammatory demyelinating polyneuropathy (CIDP). In most patients, the disease is slowly progressive, which slows down the correct diagnosis. Timely diagnosis in some cases is also complicated by an abnormal primary lesion of the lower limb nerves in patients with Lewis-Sumner syndrome, for whom the typical clinical picture is upper flaccid distal paraparesis. The objective of the study is to determine the frequency of Lewis-Sumner syndrome (LSS), with the lower limb nerve onset; to characterize clinical and paraclinical characteristics of patients with the syndrome. Materials and Methods. The authors analyzed clinical data, results of stimulation electroneuromyography and ultrasound examination of peripheral nerves of 36 LSS patients. Results. The authors observed a high percentage (44 %) of LSS patients with lower limb nerve onset. However, changes in the neurophysiological and sonographic examination of the lower limb nerves, specific for CIDP, were not revealed. Changes typical of dysimmune neuropathy were verified only in the study of clinically intact long upper limb nerves. Conclusion. In asymmetric neuropathy of the lower limbs of idiopathic genesis, one should remember about LSS and, even despite the presence of symptoms only in the lower limbs, examine the peripheral nerves of the upper limbs. Key words: chronic inflammatory demyelinating polyneuropathy, Lewis-Sumner syndrome, atypical form. Синдром Льюиса – Самнера является наиболее частой атипичной формой хронической воспалительной демиелинизирующей полинейропатии (ХВДП). У большинства больных заболевание носит медленно прогрессирующий характер, что является одним из факторов увеличения сроков постановки верного диагноза. Своевременную диагностику в ряде случаев затрудняет и нехарактерное первичное поражение нервов ног у пациентов с синдромом Льюиса – Самнера, для которых типичной клинической картиной является верхний вялый дистальный парапарез. Цель исследования: определить частоту встречаемости синдрома Льюиса – Самнера (СЛС), дебютирующего с поражения нервов ног; охарактеризовать клинические и параклинические особенности больных с данным синдромом. Материалы и методы. Проанализированы клинические данные, результаты стимуляционной электронейромиографии и ультразвукового исследования периферических нервов 36 пациентов с СЛС. Результаты. Установлен высокий процент (44 %) встречаемости пациентов с СЛС с дебютом с поражения нервов ног. Однако специфические, характерные для ХВДП, изменения при нейрофизиологическом и сонографическом исследовании нервов ног не выявлены. Изменения, типичные для дизиммунной нейропатии, верифицированы только при исследовании клинически интактных длинных нервов рук. Выводы. В случаях асимметричной нейропатии нижних конечностей идиопатического генеза следует иметь настороженность в отношении СЛС и, даже несмотря на наличие симптоматики только в нижних конечностях, обследовать периферические нервы рук. Ключевые слова: хроническая воспалительная демиелинизирующая полинейропатия, синдром Льюиса – Самнера, атипичная форма.

Limited scleroderma: sonographic pattern in the stage of erythema/edema

Objective. To describe the sonopattern of limited scleroderma (LS) in the early stages after the onset of erythema.Materials and methods. The work describes a clinical case of limited plaque scleroderma. The sonographic examination was carried out on an ultrasound scanner using a transducer with operating frequencies of 10–16–18 MHz. Material sampling for the histologic examination of the skin was performed from the area with the most pronounced inflammatory changes under sonographic control.Results. It has been found that increased echogenicity of the dermis, “blurring” of the dermis/hypodermis boundary, increased echogenicity and the “stalactite-like” pattern of subcutaneous fat occur in the frst week of the disease; normalization or a signifcant improvement of the sonopattern is noted by the end of the second week or by the beginning of the third week after the onset of erythema.Conclusion. There is a certain parallelism between the histologic and sonographic patterns, which makes it possible to adequately assess both the activity and the stage of the LS process.

The results of ultrasound examination of the thyroid gland in children with hypothyroidism

Diseases of thyroid gland (TG) rank first among all endocrine pathologies and remain one of the most difficult problems. According to the statistics of Ministry of Health of Ukraine, the prevalence of hypothyroidism in children does not exceed 0.035%. However, the relatively low rate can be explained by the low level of detection and diagnosis of this pathological condition due to the variability and low specificity of its symptoms. More acceptable for practice are methods of ultrasound diagnosis of the thyroid gland and laboratory examination of the content of thyroid-stimulating hormone in the serum. Aim. To evaluate the results of ultrasound examination of the thyroid gland in children with hypothyroidism. Methods. The results are based on a survey of 94 children with hypothyroidism living in the Chernivtsi region aged 2 to 10 years. An ultrasound examination of the thyroid gland, determination of the level of thyroid hormones (thyroid stimulating hormone (TSH), free thyroxine (fT4) was performed. Statistical analysis was performed using standard methods using the StatSoft software package © Statistica® 6.0 for Microsoft® Windows XP. Results. Analysis of the results of the study showed that in 59.6% of cases (56 out of 94) the diagnosis was made by screening for congenital hypothyroidism, and in 40.4% of cases (38 out of 94) the disease was diagnosed outside the screening. According to the results of our ultrasound, it was found that in 29 patients the thyroid tissue was not visualized in a typical place or its total volume was much less than normal. Of these, in 12 individuals, thyroid tissue was not reliably visualized at the site of TG projection, and in 17 cases was hypoplasia. In 65 patients, the TG was in a typical place, and its volume corresponded to the norm on the surface area of the body. In 85 people, regardless of the state of functional activity of the TG had a heterogeneous echostructure of the thyroid parenchyma), in 9 people the echostructure of the thyroid parenchyma was homogeneous. In thyroid hypoplasia, the level of TSH was at lower values (p <0.05) compared with thyroid dystopia. Conclusion. Sonographic examination of the thyroid gland has a high level of information. In cases of malformations of the thyroid gland there is a more pronounced degree of thyroid insufficiency.