bluuebunny/crossref_metadata_2025 huggingface dataset:
Proposal and Simulation of Dynamic Financial Strategy Model
Authors: Svatošová Veronika
Published: February 2019

The financial strategy and managing the finance is understood as a fundamental part of successful business. Nevertheless, the studying theory and practice shows that this part is marginalized. Therefore, this paper deals with financial strategy and its importance in current business field. The objective of this paper is to propose the dynamic financial strategy model that could enable to simplify the financial decision-making process and solve the dilemma in setting a concrete financial strategy. The basic research method to fulfil this objective is modelling in Vensim program and further simulation the possible changes. The main purpose of this model is to find theoretical and practical comprehensive insight on setting up a concrete financial strategy and impact of possible financial changes on overall financial strategy. Afterwards, the method of simulation is used, which is a process of creating a real system implementation and experiment with this model in order to achieve a better understanding of the behaviour of the system and to assess various options of its activities. The other research methods are financial analysis of selected variables and studying of documents and relevant resources for building up the dynamic financial strategy model. The main benefits of this model are based on simulation of possible financial decision-makings and changes of the selected variables and new theoretical approach to financial strategy. Finally, the various situations in model are simulated and observed their final results. The paper shows the proposed model could be used in business practice.
A cien años de la Reforma Universitaria: Entrevista a Raúl A. Pessacq, un reformista para construir la Universidad de la democracia
Authors: Quinteros Guillermo Oscar
Published: February 2019

Esta entrevista se realizó como una actividad paralela a una investigación mayor que llevamos adelante con el Dr. Guillermo Banzato y con el propio entrevistado. La publicamos en las vísperas del aniversario número 100 de La Reforma Universitaria, comenzada en Córdoba con una proclama estudiantil (el denominado “Manifiesto Liminar”) escrita y leída por Deodoro Roca el 21 de junio de 1918.(1) Al margen de los avatares sufridos por la sociedad argentina en general y por la Universidad en particular, resulta de importancia recordar que en el año 1983 se puso fin al peor de los períodos de dictadura vividos por toda la población. Muchos varones y mujeres se comprometieron en una nueva etapa para desarmar los nefastos entramados autoritarios de la Dictadura militar. Uno de ellos fue el Ingeniero Raúl Adolfo Pessacq. Comprometido con la construcción de la democracia asumió el desafío de generar un marco legal para poner en funcionamiento una nueva Universidad Pública y al mismo tiempo, llevarlo a la práctica en la Universidad Nacional de La Plata, en la que fue su Rector Normalizador (1983-1986).
Crimen autorizado. Una revisión
Authors: Schmidt Samuel , Spector Carlos
Published: February 2019

El Crimen Autorizado es una forma de asociación entre segmentos del Estado y criminales que desvía funciones básicas del Estado que son manejadas por criminales, y la gobernación para satisfacer intereses criminales.En este artículo se hace un análisis detallado de las formas que reviste el Crimen Autorizado y se revisa el impacto de este fenómeno sobre el consenso y la legitimidad.En esta revisión abordamos distintas formas de violencia y revisamos críticamente la existencia de una violencia legítima, porque al mezclarse con el crimen se distorsiona la legitimidad.
Negocios, parentesco y Cabildo en Santiago del Estero 1726-1760
Authors: Arias María Angélica
Published: February 2019

Este trabajo se ocupa estudiar la familia santiagueña López de Velasco Sánchez Zambrano y tiene por objetivo desentrañar la relación familia-cabildo como posibilitadora de la realización de negocios y un marcado fortalecimiento patrimonial, que terminó por ubicar a sus integrantes en la escala socio-económica más alta de la sociedad criolla local. En este sentido se propone una lectura dialéctica que aglutine en una misma estructura narrativa los desempeños y cargos ocupados en el cabildo por tres de los hermanos y algunos cuñados entre 1726 y 1760 y su correspondencia con el desarrollo de actividades económico productivas y comerciales que, cuanto menos, encontraban en el cabildo un punto de apoyo para su materialización.
Actividades económicas locales y regionales desarrolladas por las elites en Santiago del Estero. El caso de Alfaro y sus descendientes durante 1700-1750
Authors: Peralta Puy Héctor
Published: February 2019

El presente trabajo de investigación posee sus inicios a partir de lecturas que fueron incrementando una inquietud que posee nombre y apellido: Alonso de Alfaro. Entre las bibliografías escritas por diversos autores santiagueños, existen referencias acerca de la importancia política, militar y religiosa que tuvo Alfaro en relación a sus actuaciones desarrolladas en el cabildo durante las primeras décadas del siglo XVIII. Sin embargo, las fuentes consultadas no poseen investigaciones relacionadas a las actividades económicas desempeñadas por Alfaro, algo que evidentemente fue una constante en la región debido a que un personaje destacado en la política y en las armas también era un comerciante fletador o un inversionista inmobiliario. Por estas cuestiones, trataremos de responder al siguiente interrogante: ¿cuál fue la importancia económica que tuvo Alfaro en Santiago del Estero y en el resto de las ciudades integrantes de la región del Tucumán?Una vez que estuvieron agotados los libros con referencias políticas al teniente de gobernador y mientras avanzábamos búsqueda de la información en el Archivo Histórico y en la Dirección General de Catastro (ambos organismos situados en Santiago del Estero), las reseñas hacia Alfaro se fueron direccionando desde las mencionadas actividades hacia el comercio local y regional y a las inversiones inmobiliarias rurales y urbanas efectuadas por él mismo o por la red familiar que fue confeccionada de acuerdo a los casamientos estratégicos de sus hijas y su nieta.
Ideas y conceptos sobre la familia en El Censor y El Argos de Buenos Ayres
Authors: Mengual de Gracia Darío Daniel
Published: February 2019

El trabajo se encuentra inserto en un proyecto de investigación de mayor alcance, denominado “Estudios en Historia Cultural de la Política y de la Violencia en Argentina. Siglos XIX- XXI”, en el que se aborda el estudio de numerosos periódicos argentinos de los siglos XIX y XX. El tema que se trata, está vinculado al intricado y dinámico cúmulo de ideas y representaciones, difundidas por la prensa gráfica en el período comprendido entre 1815 y 1825, para lo cual se realiza un muestreo de los periódicos El Censor (1815-1819) y El Argos de Buenos Ayres (1821-1825). Se tiene en cuenta sus vinculaciones con los cuerpos de gobierno y al hecho que intentaron —pese a las complicaciones coyunturales— promover la inclusión de nuevos sujetos y actores, dentro de una dinámica institucionalizante en construcción.Dicha cuestión se explora en las diversas “secciones” tanto de El Censor como de El Argos de Buenos Ayres, para ver cómo se imbricaban entre sí, una serie de ideas y temáticas de heterogéneo origen que conllevaban conceptos respecto al rol de la familia y su relación con las instituciones.
Support Teacher as Key Factor of Integration Children with Special Education Needs in Mainstream School
Authors: Voinea Mihaela , Topală Ioana Roxana
Published: February 2019

The issue of integrating children with special educational needs in mainstream school depends on several factors. The most important is the support teacher, who is the link between school, family and community, between children and teachers and other specialists. (Avramidis & all 2000, Ainscow 2016, etc.). Teachers need to change their own mind set and system of values according to the new social responsibilities in order to become promoters of human diversity, acceptance and tolerance. Therefore, teacher training must respond diligently to the new teacher’s roles and responsibilities. The main purpose of this research was to identify the training needs for support teachers based on the analysis of their own socio-educational experience (their own role and their particular training needs as support teachers), as well as (mainstream school) teachers’, pupils’ and parents’ perceptions regarding integration. This study was conducted in a mixt methods structure, which employed both quantitative and qualitative methods for data collection. A questionnaire-based survey was conducted, with mainstream teachers, on one hand, and parents, on the other hand. We addressed the issues of attitudes towards the integration of children with SEN (special education needs) and the collaboration with the support teacher. Also, focus-group interviews were conducted with support teachers. A number of 112 participants were included in the study (57 teachers from mainstream schools, 20 support teachers, and 35 parents ) Conclusion: Teachers’ and parents’ cognitive schemas regarding what a support teacher can and should do in order to facilitate the integration of children with SEN are different from his/her actual educational role and responsibilities. This gap between the social representations and the actual job description can be bridged by building a more complex and accurate understanding of how every actor involved in the integration process must become aware of one’s personal beliefs and expectations, assume and thoroughly play his/her part in a collaborative manner. Teacher training through transformative learning based on sharing experiences and group projects is a learning experience suitable for developing competences for teachers for special education.
Ear Training Made Easy: Using IOS Based Applications to Assist Ear Training in Children
Authors: Serdaroglu Emine
Published: February 2019

It is an inevitable reality that in all developed countries and in most developing countries, smart phones and tablets are an indispensable part of most children’s lives. There are many discussions and heated arguments on the negative and positive effects of digital technology on the development of children. In this paper, accepting the fact that this technology is a part of most children’s daily lives, it will be questioned whether this technology may be used to reinforce certain components of music education in general classroom and especially in private music studios. In conservatories and music schools, a considerable amount of time is dedicated to aural training of younger students. However, during music lessons in the classroom and during the instrumental lessons in private studios, lesson time is mostly dedicated to other components such as improvement of technique, musicality and sight reading. Thus, a crucial part of music education “ear training” is neglected to some extent. In this paper, several IOS based ear training applications will be evaluated considering the target group, children between ages 6-11. The possible effects and incorporation of these applications into the classroom and private studios will be discussed. Each application will be evaluated on several components; the ear training modules, user-friendliness, possibility of the evaluation of students’ progress by the teacher and probable reaction of the children to these applications.
Multiple Primary Synchronous Renal Cancer and Thyroid Gland Cancer at Patient with Doubling Inferior Vena Cava and Renal Veins on Both Sides (Clinical Case)
Authors: Stepanova Yu. A. , Teplov A. A. , Morozova M. V. , Gritskevich A. A. , Pyanikin S. S. , Chekhoeva O. A. , Karelskaya N. A. , Glotov A. V.
Published: February 2019

Renal cell carcinoma – the third on occurrence frequency tumor of urinogenital system and the most widespread renal tumor which makes about 2–3% of malignancies at adults. Doubling of inferior vena cava (IVC) is anomaly in case of which two inphrarenal segments of IVC are defined. Left IVC after lockin in it the left renal vein crosses an aorta in front, connects to the right renal vein and the right IVC. Combination of renal cell carcinoma and doubling IVC is rather seldom. The presented clinical case of a combination of renal cell carcinoma and doubling of IVC has the feature existence at the patient of metachronous multiple primary neoplasms that does necessary more careful inspection of the patient. Also a doubling of renal veins on both sides and a doubling of the left renal artery have been revealed. Possibilities of presurgical non-invasive diagnostics (ultrasonography and computer tomography) of retroperitoneal space vessels anomaly at the patient with transmural localization of kidney tumor allowing to plan and execute difficult surgery – an ex vivo resection of a left kidney in the conditions of pharmacological cold ischemia was shown. Performance of an ex vivo nephrectomy in the conditions of pharmacological cold ischemia allows to dilate indications to organ-preserving treatment of patients with the localized kidney cancer. However long cold ischemia and the subsequent vascular reconstruction demand dynamic observation over kidney’s functional conditions.
Radiological Diagnosis of Spontaneous Intercostal Pulmonary Hernia (Clinical Observation)
Authors: Sheikh Zh. V. , Arablinsky A. V. , Borzunova N. N. , Ulyanov S. A.
Published: February 2019

Pulmonary or intercostal hernia appears as a bulge lung tissue result in the subcutaneous fat through a natural orifice or pathologically caused defects of the chest wall. Difficulties of diagnosis of the true pulmonary hernia owing to extremely infrequent occurrence of this pathology are, as a rule, bound to poor knowledge of doctors and quite often lead to inaccurate medical tactics. In the diagnosis of lung hernia along with clinical and laboratory data are used such research methods as x-ray, ultrasound, CT, among which, CT is a highly informative investigation method that allows to evaluate the status of lung tissue in the hernia sac and in other parts of the lungs, just to visualize the structures of the mediastinum, as well as the condition of the pleural cavity and chest wall, determining its proper treatment.
The Use of Magnetic Resonance Imaging in Patients with Chronic Paraproctitis (Preliminary Results)
Authors: Shelygin Y. A. , Eligulashvili R. R. , Zarodnyuk I. V. , Kostarev I. V. , Chernozhukova M. O.
Published: February 2019

Aim.Investigation of possibilities of magnetic resonance imaging as a whole, as well as different modes of MR scanning (without intravenous contrast, with intravenous contrast, with the use of diffusion-weighted imaging) in the diagnosis of cryptogenic fistulas of the rectum.

Materials and methods. In the study were included 50 patients with cryptogenic fistulas of the rectum (21 women and 29 men). All patients underwent magnetic resonance imaging of the pelvic organs.

Results.The sensitivity of MRI in the diagnosis of the primary fistulas was 100%. With regard to secondary fistulas MRI sensitivity was 91.7%, specificity was 94.3%. The sensitivity of MRI in the diagnosis of chronic abscesses paraproctitis was 82.6%, specificity was 95.2%. The sensitivity of the method in the visualization of internal opening was 95.5%, specificity was 80.0%. The sensitivity of the method in the diagnosis of external openings was 91.7% and specificity was 100%. In the analysis of separates MR scanning mode we didn’t find statistically significant differences between them (p < 0.05).

 

Conclusions.Magnetic resonance imaging has a high diagnostic efficacy in the diagnosis of cryptogenic perianal fistulas. We didn’t find statistically significant differences between MR scanning modes.
The Diagnosis of Breast Cancer after Augmentation Mammoplasty (Case Report)
Authors: Vasilev A. Yu. , Pavlova T. V. , Kasatkina L. I. , Manuylova O. O. , Rotin D. L.
Published: February 2019

The number of women resorting to endoprosthesis replacement of breast is growing from year to year. To date, the most popular and safe method of correcting the shape and size of the breast is augmentation mammoplasty with silicone gel prostheses. Unfortunately, the diagnosis of breast cancer in patients who have had recourse to the augmentation mammoplasty at preclinical stages, is difficult. Most often this is due to the fact that the patient does not undergo preventive examinations. This research exemplifies a comprehensive procedure facilitating diagnostication of a breast cancer in a patient previously subjected to augmentation mammoplasty. A physical examination, a digital and an ultrasound mammography reveals a BI-RADS 5 nodal formation in the patient’s right breast. An ultrasound-guided biopsy of the newly formed tissue over the breast implant is morphologically cross-checked. The diagnosis of breast cancer is thus confirmed histologically.
Low-Dose Hepatopancreatic MDCT: Practical Experience of Applicability
Authors: Aznaurov V. G. , Kondratiev E. V. , Oganesyan N. K. , Karmazanovsky G. G.
Published: February 2019

Aims: to evaluate the possibilities of low-dose MDCT protocols in visualization of liver and pancreatic tumors.Materials and methods. 40 patients were enrolled in study and divided into 2 groups. Two scanning protocols were used, differing by the voltage on the X-ray tube-standard 120 kV, and the modified 100 kV. All studies were performed with intravenous administration of a contrast agent. The data – noise, a circumference of abdominal cavity, a relation “contrast-noise”, data of contrast strengthening of organs were evaluated. The tomograms were reconstructed using standard and iterative reconstruction algorithms. A qualitative assessment of the images was carried out according to 2 parameters – the evaluation of the whole image and the visualization of tumor on a 3-point scale.Results. Radiation exposure decreased by 31.5% using the modified protocol. The noise level did not differ with the use of standard reconstruction, but it decreased markedly using iterative reconstruction. The contrast-to-noise ratio turned out to be higher in the “100 kV” group and consistently increased with increasing levels of iterative reconstruction. Evaluations of the visualization of tumors were significantly higher in the “100 kV” group.Conclusion. The use of low-dose protocols is justified, it allows to seriously reduce the radiation exposure, improving visualization of the liver and pancreas tumors (primarily hypervascular). Application of iterative reconstruction algorithms allows achieving significant improvement in image quality and noise reduction.
A Score of Run-Off (Outflow) Resistance in Lesions Femoropopliteal Arteries Using MSCT Angiography
Authors: Maslov A. L. , Zotikov A. E.
Published: February 2019

Despite the ongoing treatment, in 10–20% of patients with obliterating diseases of the arteries of the lower limbs, the progression of the disease leads to amputation, with mortality rates being up to 50%.

The aim: to determine the effectiveness of MSCT angiography in patients with type-D femoral-popliteal arteries according to TASC II with critical ischemia of the lower extremities and poor condition of outflow tracts for performing arterialization of venous blood flow and / or superimposition of arteriovenous fistula.

Material and methods. 145 MSCT angiographic studies were performed for patients with arterial diseases of the lower extremities performed in “RAMSAY Diagnostics Rus”Moscow. For the analysis, 53 (37% of the total) of the patient with lesions of the femoropopliteal segment of Type D according to TASC II were selected. The analysis of the state of the arterial outflow pathways was carried out according to the modified Rutherford classification, where each artery of the shin was maximally assigned 3 points depending on the degree of stenosis, the blood flow resistance was estimated as 0 points – the absence of stenosis or stenosis less than 20%, 1 point stenosis 20–49% 2 points stenosis 50–99%, 3 points – occlusion.

Results. The degree of resistance of arteries of outflow tracts of 39 limbs (16 right and 23 left) was calculated in 53 patients: 10 points in 23.7% of cases; 9 points in 5.1%; 8 points – 2.5%; 7 points 18%, 6 points in 5%; 5 points 2.5%; 4 points 15.4%; 3 points 7.7%; 2 points 0; 1 point 20.5%. In patients with poor arterial outflow, with a score greater than 7, there is a high risk of early thrombosis of the prosthesis, so such patients undergo an operation with the formation of an unloading arteriovenous fistula.

Conclusion. MSCT angiography of the arteries of the lower extremities is an effective method for determining the severity of arterial damage with an accurate definition of the level, extent, prevalence with the possibility of using different classifications, including TASC II and theRutherford classification. It can be used as a screening, expert method in patients with arterial diseases of the lower extremities, may be an alternative to direct angiography, used to assess patients in the postoperative period.

Key words: peripheral arterial disease, outflow score, ball classification of outflow tracts, runoff score, computed tomography, angiography.
Effectiveness of Multimodality Imaging in Differential Diagnostics of Nonpalpable Breast Architectural Distortion
Authors: Jakobs O. E. , Rozhkova N. I. , Kaprin A. D.
Published: February 2019

Objective:the aim of the study was to estimate the informative value of  multimodality imaging in differential diagnostics of nonpalpable breast architectural distortion of different  origin.

Matherials and methods.We analyzed the results of multimodality examination of 307 women with nonpalpable breast architectural distortion of different origin. They underwent mammography, handheld sonography (B-mode), compressive elastosonography, Doppler angiography, automated breast volume US-scanning, US-guided core needle biopsy (n = 115; 38%) and stereotactic core needle  biopsy (n = 192; 62%), pathomorphologic analysis.  

Results.Breast cancer were diagnosed in 221 (72%) women, benign lesions – in 86 (28%) women. Surgical treatment was performed In 254 (83%) cases and 31 (10%) breast lesions were removed with vacuum-assisted aspiration biopsy.

Conclusion.Multimodality imaging with the invasive procedures gave 92.5% sensitivity, 100% specificity,  100% showed positive prognosis, 72.5% negative prognosis, 93.1% accuracy index.
The Role of Cone-Beam Computed Tomography in Diagnostics of Cystic Masses of the Jaw
Authors: Batova M. A.
Published: February 2019

Research objective. The study aimed to evaluate cone-beam computed tomography (CBCT) capabilities in diagnostics of cystic masses of the jaw.

Methods. Over a period of 2015–2016 32 patients age 6 to 67 underwent both panoramic tomography and CBCT (using panoramic tomographic scanner STRATO 2000 and cone-beam computed tomographic scanner i-Cat respectively). 47% (n = 15) of the participants were women, 53% (n = 17) – men. Radiation exposure for a single procedure amounts to 0,05 mSv for panoramic tomography, 0,07 mSv for CBCT (FOV =13 cm), 0,06 mSv for CBCT (FOV =8 cm).

Results. Comparative analysis of obtained results demonstrates that CBCT showed 54% (n = 27) more cystic masses of the jaws than panoramic radiography could. CBCT additionally showed the following pathologies: granulomas smaller than4 mm diameter – 85% (n = 23), 83% (n = 23) of said granulomas were found on maxilla, radicular cysts of maxilla – 11% (n = 3), incisive canal cyst – 4% (n = 1). Additionally panoramic tomography analysis misdiagnosed 5 granulomas (80% (n = 4) on mandibular premolar and molar areas) that were not found during CBCT analysis.

Conclusion. The low effective dose and high informativity of CBCT enables the method to be used instead of intraoral radiography, panoramic tomography and MSCT as a screening procedure in diagnostics of dento-facial system pathologies, including cystic masses of the jaw.
MDCT in Imaging of Hyperperfusion Syndrome after Carotid Surgery
Authors: Vishnyakova M. V.
Published: February 2019

Aim: to assess MDCT abilities in imaging hyperperfusion syndrome (HPS) after carotid surgery.

Materials and methods. Cases of hyperperfusion syndrome after carotid revascularization were analyzed at 595 patients underwent surgery during 2012–2016. Preoperatively complex visualization: ultrasound imaging of brachiocephalic arteries and cerebral vessels, computer tomography of the brain, computed angiography (CTA) brachiocephalic arteries and cerebral vessels, perfusion computer tomography (PCT). Computer tomography was held with Philips iCT 256 slices. During CTA 50 ml on nonionic contrast media was injected (4–4.5 ml/sec flow) with further arterial and venous phases. PCT covered 6 sm (basal ganglia and cerebral hemispheres), 35 cycles with 2 sec interval. If HPS was considered all patients underwent CT: non-contrast brain imaging, CTA and PCT (in stable patient condition). Further dynamic imaging was made at MRI 3 Tl with standard sequences (T1, T2, FLAIR, DWI).

Results. HPS was detected in 7 cases, all patients had characteristic clinical presentation. According to imaging data all patients could be divided in three groups. Diffuse hemispheric edema on the operation side – 3 cases, at follow up imaging – regression of changes. Hemorrhagic component – 2 patients, one – with small hemorrhagic focus, another – with massive intracerebral hematoma. In 2 cases there were no new cerebral lesions detected. At CTA and PCT – increase of cerebral flow after operation. Mortality in patients with HPS was 28% (2 patients). In other cases there was regress of clinical symptoms.

Conclusion. In all cases in our study the one was able to either to diagnose either to suggest HPS on the CT data. Detailed analyses of acquired data and comparison with clinical status were necessary, sometimes – follow up studies were essential.
Hepatic Alveolar Echinococcosis: the Possibilities of Ultrasonographyin the Planning of Surgical Operation
Authors: Ashivkina O. I.
Published: February 2019

Alveolar echinococcosis (AE) is a rare anthropozoonotic parasitic disease, which can affects the liver, lungs and other organs. R0-radical liver resection is the sole curative therapy for the patients with AE. Size of the parasitic foci, distant dissemination, and involvement of main liver vessels – all this information allows the surgeon to make the right decision about practicability and volume of operation. Formerly, ultrasonography (US) was not method of choice for the qualitative pre-operative diagnostic of AE. Nevertheless nowadays development of new technologies allows US to be an equal to CT and MRI.

The aim:to estimate the possibilities of US in the planning of surgery in patients with AE.Materials and methods.The data of 64 patients who were undergone complete liver resection or reduction surgery in A.V. Vishnevsky Surgery Institute in period from January 2008 to December 2016 we respectively analyzed. Specificity and sensitivity of US, CT and MRI were analyzed and ROC-curves were constructed. Statistical significance was calculated using Chi-square.

Results.The efficiency of US was significantly comparable to CT and MRI when we analyzed the involved of porta hepatis, vena cava, hepatic veins. Assessment of involvement of liver arteries and vena porta was not statistical significant.

Conclusion.Accumulated experience of A.V. Vishnevsky Surgery Institute shows the possibility of qualitative preoperationUS evaluation of AE-lesion, which has to include assessment of distant dissemination and involvement of the liver main vessels. In a big surgical hospitals, which has an experience of AE treatment, pre-operative US can become the method of choice in planning of surgical operation.
Possibilities of Ultrasound in Diagnosis of Kidney Cancer at the Stage of Surgery
Authors: Chekhoeva O. A.
Published: February 2019

Despite the availability of a large number of state programs for the re-equipment of state medical institutions, ultrasonic research, due to the relative simplicity of the organization of the research process and the decisiveness, still remains relevant for the examination of patients and, in particular, kidney cancer. In recent years, a number of new ultrasound techniques have emerged – three-dimensional reconstruction of ultrasound imaging, tissue harmonic technology and echocontrast with intravenous contrast agents. Due to the continuous improvement of the capabilities of ultrasound scanners and ultrasound imaging techniques, a review of the significance of ultrasound in the diagnosis and differential diagnosis of renal cell carcinoma (RCC).

The purpose:to evaluate the diagnostic possibilities of ultrasound in patients with kidney tumors at the preoperative stage.

Materials and methods.136 patients with kidney tumors aged 21 to 73 years were examined and treated in A.V. Vishnevsky Institute of Surgery in the period from 2012 to 2017. The study slightly dominated by men – 65.4%. All patients underwent a complex clinical and laboratory examination, which included the analysis of complaints, data of anamnesis, clinical examination, laboratory data, as well as a wide range of instrumental studies (ultrasound, MSCT and MRI). Each of the study methods was evaluated according to three criteria (localization, prevalence, presence of vein thrombosis), which are key to assessing the feasibility of surgical intervention and subsequent tactics of surgery. Evaluation of the informative value of each of the radiation methods of the study (ultrasound, MSCT, MRI) was carried out on the basis of the following criteria: sensitivity, specificity and overall accuracy of the method. All patients underwent surgical operations in various volumes, the formations were morphologically verified as RCC. As a “control” for each of the parameters used the protocol of subsequent surgery. The effectiveness of ultrasound is significantly comparable with CT and MRI in assessing such preoperative parameters as tumor localization in the kidney, the prevalence of the pathological process and thrombosis of the inferior vena cava and the main trunk of the renal vein. In the evaluation of thrombosis of segmental renal veins, ultrasound is also comparable to other methods of investigation, but these data can not be considered statistically reliable (due to the small number of observations) and their confirmation requires further study.

 Conclusion.In the conditions of a specialized surgical hospital focused on the diagnosis and treatment of kidney cancer, ultrasound can be comparable to CT and MRI in its effectiveness, providing the surgeon with pre-operative information sufficient for planning surgical intervention.
Quantitative Perfusion Analysis and Time Intensity Curve Analysis in Differential Diagnosis of Solid Pancreatic Tumors by Contrast-Enhanced Ultrasound. A Pilot Study
Authors: Askerova N. N. , Stepanova Yu. A. , Timina I. E.
Published: February 2019

Contrast-enhanced ultrasound began to develop rapidly  in recent years inRussia. Due to the physical properties of contrast agents it is possible to differentiate malignant and benign lesions. However, this method only involves a subjective evaluation of the obtained results. For the objectification of ultrasound with contrast enhancement implemented the function “TIC-analysis” (time intensity curve analysis).  

The aim: to assess the clinical value of the TIC-analysis in the differential diagnosis of adenocarcinoma of the pancreas and chronic pseudotumoral pancreatitis by contrast – enhanced ultrasound.

Materials and methods. In A.V. Vishnevsky Institute of surgery contrast – enhanced ultrasound and TIC-analysis was performed on 23 patients with focal lesions of the pancreas. All patients were operated on, tumors were verified morphologically: adenocarcinoma of the pancreas  in 18 (78%) patients, chronic pseudotumoral pancreatitis – in 5 (22%) patients.

Results. The results about intensity of the tumors obtained by the TIC analysis do not allow to differentiate these pathological processes statistically significant (p > 0.05), which, in all probability, due to the fact that pancreatic  adenocarcinoma and chronic pseudotumoral pancreatitis have similar morphological characteristics in the form of pronounced desmoplastic stromal response and fibrosis-hyalinosis, respectively. The “Time to peak| parameter allowed us to determine statistically significant that pancreatic adenocarcinoma had an early accumulation of contrast agent (average 16 sec) and early washout (from an average of 17 sec); the chronic pseudotumoral pancreatitis had the slow accumulation of contrast agent (average  85 sec) and slow washout (from an average of 86 seconds) (p < 0.05).

Conclusion. The “Time to peak” parameter at ultrasound examination with echocontrast allows statistically significantly differentiate adenocarcinoma of the pancreas  and chronic pseudotumoral pancreatitis.
Analysis of X-Ray Research in Wards
Authors: Alekseeva O. M.
Published: February 2019

Introduction.X-ray is a common diagnostic procedure in a multi-disciplinary hospitals. In the available scientific litera ture, there are some studies of the radiography in nonspecialized conditions. However, there are few aggregate data of these studies to date.

Objectives.Analysis of the results of radiography in wards and resuscitation rooms, performed in multi-purpose hospitals, with the aim of forming requirements to the class of equipment for radiography in the conditions of the ward.

Materials and methods.4081 X-ray studies were studied from 2015 to 2016.

Results.During the analysis it was determined that in unspecialized conditions 75.0% of the shots fell to chest organs, studies of the musculoskeletal system were revealed in 22.0% of cases and abdominal organs were observed in 3%. Pathological changes were not detected for 2221 patients, which amounted to 54.4%. It was found that the most frequent disease of the chest were pneumonia of various genesis, complicated by the presence of hydro thorax.

Conclusions.Based on the analysis of X-ray researches, the indications for the studies were refined and supplemented, medical requirements for X-ray machines for shooting under these conditions were formulated.
Oscillations of Bone Mineral Density in Peri-Prosthetic Zone after Total Hip Arthroplasty (Case Report)
Authors: Avrunin A. S. , Pavlychev A. A. , Doctorov A. A. , Kornilov N. N. , Karagodina M. P.
Published: February 2019

The hundreds thousands total hip arthroplasties (THA) annually  performed around the world with the number of revision procedures  estimated around 10%. Dual-energy X-ray absorptiometry (DEXA)  allows to control projectional bone mineral density (BMD) around hip stem dynamically with minor radiation exposure and in a cost-effective way. In routine practice there is a monthly interval between investigations that does not allow to evaluate activity and trends in  short weekly oscillations of bone metabolism in peri-prothetic areas.  Projectional BMD oscillations in peri-prosthetic zone after total hip  arthroplasty in chrono-biological manner evalua ted for the first  time. Therefore chronobiologic approach opens new opportunities for prognosis of tendencies in structural and functional skeleton  reorganization in peri-prothetic zone after THA but there is need in  further research that could give more insight.
Diagnostic Effectiveness of whole Body Diffusion- Weighted Magnetic Resonance Imaging in Focal and Diffuse Bone Marrow Involvement in Patients with Lymphoma
Authors: Kharuzhyk S. A. , Zhavrid E. A. , Sachivko N. U.
Published: February 2019

Objective:to compare diagnostic effectiveness of whole body  diffusion-weighted imaging (DWI), other magnetic resonance  imaging (MRI) pulse sequences and iliac wing trephine biopsy in the  diagnosis of focal and diffuse bone marrow (BM) involvement in patients with lymphoma.

Materials and methods.Prospective study included 130 patients  with lymphoma who underwent whole-body MRI-DWI and iliac wing  trephine biopsy before treatment (64 (49,2%) men, 66 (50,8%)  women, middle age 43,3 ± 16,3 years, interval of 18–79 years).  Hodgkin's lymphoma (HL) was at 57 (44%) patients, non-Hodgkin  lymphomas (NHL) – at 73 (56%). Diagnostic effectiveness of T1- weighted images (T1-WI), STIR, DWI and FIESTA was analyzed. BM  apparent diffusion coefficient (ADC) values were measured.

Results.BM involvement was found in 42 patients, including 9 with  HL and 33 with NHL. In HL, BM involvement was only focal. Diffuse  involvement occurred more often (64%) in the NHL as compared to  focal one. In focal involvement, all pulse sequences showed high  diagnostic sensitivity (90–100%), BM biopsy sensitivity was 33%  only. The proposed new criterion for the diagnosis of diffuse BM involvement in NHL – diffuse signal increase of the spine on DWI  above renal parenchyma – has the highest sensitivity (90%) compared to T1-WI and STIR (67%) and FIESTA (71%) (p < 0.05).  In NHL, the ADC value ≤0.575 • 10−3 mm2/s discrimi nates cases  of diffuse involvement and absence of BM involvement with a  sensitivity of 86% and a specificity of 68% (p < 0.0001). In HL, the  diffuse BM signal increase on DWI is not indicative of involvement.

Conclusion.All pulse sequences showed high effectiveness in the  diagnosis of focal BM involvement in patients with lymphoma, iliac  wing biopsy effectiveness was low. The proposed new DWI criterion  for diagnosing diffuse BM involvement in NHL is the most sensitive  one. A new algorithm based on whole body MRI-DWI for the  diagnosis of BM involvement allows to reduce the need for BM biopsy without reducing the diagnostic effectiveness.
Contrast-Enhanced MRI with Magnetization Transfer Effect in the Imaging of Brain Metastatic Lesions
Authors: Ermakova A. A. , Borodin O. Yu. , Sannikov M. Yu. , Koval S. D. , Usov V. Yu.
Published: February 2019

Purpose: to investigate the diagnostic opportunities of contrast  magnetic resonance imaging with the effect of magnetization transfer effect in the diagnosis of focal metastatic lesions in the brain.

Materials and methods.Images of contrast MRI of the brain of 16  patients (mean age 49 ± 18.5 years) were analysed. Diagnosis of  the direction is focal brain lesion. All MRI studies were carried out  using the Toshiba Titan Octave with magnetic field of 1.5 T. The  contrast agent is “Magnevist” at concentration of 0.2 ml/kg was  used. After contrasting process two T1-weighted studies were  performed: without T1-SE magnetization transfer with parameters of pulse: TR = 540 ms, TE = 12 ms, DFOV = 24 sm, MX = 320 × 224  and with magnetization transfer – T1-SE-MTC with parameters of pulse: ΔF = −210 Hz, FA(МТС) = 600°, TR = 700 ms, TE = 10 ms,  DFOV = 23.9 sm, MX = 320 x 224. For each detected metastatic  lesion, a contrast-to-brain ratio (CBR) was calculated. Comparative  analysis of CBR values was carried out using a non-parametric  Wilcoxon test at a significance level p < 0.05. To evaluate the  sensitivity and specificity of the techniques in the detection of  metastatic foci (T1-SE and T1-SE-MTC), ROC analysis was used. The sample is divided into groups: 1 group is foci ≤5 mm in size, 2  group is foci from 6 to 10 mm, and 3 group is foci >10 mm. 

Results.Comparative analysis of CBR using non-parametric Wilcoxon test showed that the values of the CBR on T1-weighted  images with magnetization transfer are significantly higher (p  <0.001) that on T1-weighted images without magnetization transfer. According to the results of the ROC analysis, sensitivity in detecting  metastases (n = 90) in the brain on T1-SE-MTC and T1-SE was  91.7% and 81.6%, specificity was 100% and 97.6%, respectively.  The accuracy of the T1-SE-MTC is 10% higher in comparison with  the technique without magnetization transfer. Significant differences (p < 0.01) between the size of the foci detected in post-contrast T1- weighted images with magnetization transfer and in post-contrast  T1-weighted images without magnetization transfer, in particular for  foci ≤5 mm in size, were found.

 

Conclusions1. Comparative analysis of CBR showed significant (p < 0.001)  increase of contrast between metastatic lesion and white matter on  T1-SE-MTC in comparison with T1-SE.2. The sensitivity, specificity and accuracy of the magnetization transfer program (T1-SE-MTC) in detecting foci of  metastatic lesions in the brain is significantly higher (p < 0.01), relative to T1-SE.3. The T1-SE-MTC program allows detecting more foci in comparison with T1-SE, in particular foci of ≤5 mm (96% and 86%, respectively, with p < 0.05).
Acoustic Radiation Force Impulse Elastometry (ARFI Elastometry) in Chronic Viral Hepatitis
Authors: Megroyan A. A. , Kamalov Ju. R. , Filin A. V. , Semenkov A. V. , Morozova M. M. , Nekrasova T. P.
Published: February 2019

Purpose:the aim of this study was to evaluate the reliabilityof ARFI elastometry for diagnosis of fibrosis severity stages in patients with chronic viral hepatitis.

Material and methods.ARFI elastometry measurements were  done in 103 patients. Mean age of patients was 39.2 ± 10.8 years.  The study included 11 patients with HBV chronic hepatitis, 87  patients with HCV chronic hepatitis and 5 patients with В+D chronic  hepatitis. Liver stiffness was measured using ARFI elastometry with  following liver biopsy which was made 1–2 after US study and  assessed according to the METAVIR score. Control group included 32  patients (20 (62.5%) volunteers and 12 (37.5%) potential liver  fragment donors). Mean age of patients was 26.9 ± 5.3 years. None  of the healthy subjects had a history of gastrointestinal, pancreatic or hepatic disease; all patients had a normal results of laboratory tests.

Results.Significant correlation (r = 0.74, р < 0.001) was found  between ARFI measurements and liver fibrosis stages. The values of  ARFI elastometry for various stages of fibrosis were: F ≥ 2 – cut-off  > 1.36 m/s (AUROC – 77%, sensitivity – 65.9%, specificity – 79%),  F ≥ 3 – cut-off > 1.36 m/s (AUROC = 95%, sensitivity – 95,5%,  specificity – 81.5%), F = 4 – cut-off > 1.66 m/s (AUROC – 97%, sensitivity – 93.3%, specificity – 100%). Liver stiffness  measurements in stages F0–F2 reliably differ from stages F3–F4 (1.25 ± 0.18 m/s vs 2.0 ± 0.52 m/s, р < 0.05).

Conclusion. ARFI elastometry is reliable diagnostic method for liver  fibrosis detection in stages F ≥ 2. The best performance of this  method was shown for the prediction of severe fibrosis and cirrhosis.
Treatment Response Evaluation in Hepatic Tumors using CT and MRI: Road Map for Radiologist
Authors: Fedash A. V. , Lomovtseva K. H. , Kondrat'ev E. V. , Blohin I. A. , Galchina Yu. S.
Published: February 2019

The number of available methods for hepatic tumor treatment is steadily increasing. Except traditional surgical resection and systemic chemotherapy there are a lot of effective and increasingly used local methods such as Radiofrequency ablation, cryodestruction, transarterial chemoembolization. Radiologist should be able to assess treatment response and evaluate prognosis. We present review of literature on various systems for hepatic tumor treatment response evaluation. WHO, RECIST 1.0, RECIST 1.1, mRECIST and Choi criteria are thoroughly explained in terms of benefits and drawbacks. Also, texture analysis and diffusion-weighted imaging are discussed.
Disseminated Liver Alveococcosis with Involving the Lower Villa of Vienna (Clinical Case)
Authors: Ashivkina O. I. , Stepanova Yu. A. , Zhavoronkova O. I. , Gavrilov Ya. Ya. , Yashina N. I. , Ionkin D. A. , Andreytseva O. I. , Ikramov R. Z. , Zhurenkova Т. V.
Published: February 2019

Among parasitic diseases, liver alveococcosis is a particular complication. It is often compared with parasitic liver cancer, due to infiltrative growth, the possibility of metastasis, as well as the high frequency of relapse after surgical treatment. However, the main difference between the course of alveococcosis liver damage is a slow infiltrative growth, which, in combination with large compensatory capacities of the hepatic tissue, often leads to the fact that the clinical manifestations of the disease occur late, even with a significant spread of the pathological process, at the stage of complications. At the same time, complete operative re moval of the tumor remains the only radical treatment for such patients. We present the clinical case of the diagnosis and multistage treatment of the patient E., 57 years old, with the widespread liver alveococcosis involving the inferior vena cava.
THE EVALUATION OF DELAYED ENHANCEMENT METHOD AS A TOOL FOR MAGNETIC RESONANCE DIFFERENTIATION BETWEEN THE METASTASES AND NEUROTOXOPLASMOSIS
Authors: Simeshchenko P. I. , Drozdov A. A. , Cheremisin V. M. , Kamishanskaya I. G. , Yakovlev A. A. , Musatov V. B. , Fedunyak I. P. , Danilov V. V.
Published: February 2019

The aimof this study was to evaluate delayed enhancement as the tool for differentiation between metastatic brain lesions and neurotoxoplasmosis.

Materials and methods.38 patients with multiple brain lesions with mass-effect and ring-type of contrast enhancement based on CT/MRI have been enrolled in the study. All cases were associated with metastatic brain lesions or toxoplasmosis. For every patient we performed contrast enhanced brain MRI and achieved axial T1WI immediately after contrast injection, in 15, 30 and 45 min. Acquired images were evaluated for the presence of contrast accumulation at delayed images in the central part of the lesions. Overall, we analyzed data for 153 lesions with 64 toxoplasmosis lesions and 89 metastatic.

Results.Among 153 lesions with ring-type contrast enhancement central contrast enhancement at delayed images was determined for 83 lesions. Among 89 metastatic lesions 81 demonstrated delayed central enhancement. Among 64 neurotoxoplasmosis lesions only 2 demonstrated delayed central enhancement. The sensitivity of the sign was 88%, specificity 95%.

Conclusions.The presence of central contrast enhancement at delayed images significantly increases the probability of metastatic nature of the lesions (specificity 95%). Consequently that sign might be effectively used for the differential between the metastases and neurotoxoplasmosis.
METHODOLOGICAL ASPECTS OF VISUALIZATION OF CORONARY ARTERIES WITH TRANSTHORACIC ECHOCARDIOGRAPHY
Authors: Agaeva Z. A. , Baghdasaryan K. B.
Published: February 2019

The transthoracic echocardiography made by multifrequency probes with support of the mode of the second harmonic imaging, is a competitive method for visualization of the main coronary arteries and allows to estimate coronary blood flow with high quality. Of course, the method has considerable restrictions, most important of which is the low spatial resolution of a method, due to small acoustic window. Because of this the transthoracic visualization of coronary arteries perhaps will not become the leading method of anatomic reconstruction of separately taken coronary artery and especially all coronary arteries system. However uniqueness and indisputable advantage of this method is an opportunity to noninvasively estimate a coronary blood flow both once, and in dynamics.
PET/CT IN THE DIAGNOSIS OF PANCREATIC CANCER: LITERATURE REVIEW
Authors: Tulin P. E. , Dolgushin M. B. , Nevzorov D. I. , Kochergin P. V. , Patyutko Yu. I.
Published: February 2019

Pancreatic cancer has a poor prognosis, often because most pancreatic neoplasms are found to be unresectable at diagnosis. Early staging of the tumor process can change the tactics of treatment and affect the survival of patients. The purpose of this review is to provide an overview of pancreatic cancer and the role of modern imaging in its diagnosis with an emphasis on PET/CT with a various radiopharmaceuticals.