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This narrative review describes the current status of imaging in the evaluation of bladder cancer, considering conventional technologies such as ultrasonography, computed tomography urography, and magnetic resonance imaging, as well as novel technologies such as contrast-enhanced ultrasonography and dual-energy computed tomography. The article is organized by first presenting an introduction on both the anatomy of the bladder (to understand its normal appearance on imaging) and the main features of bladder cancer with reference to epidemiology, clinical picture, classification, and treatment. Subsequently, the role of imaging is discussed, with an explanation of the technique and applications in bladder cancer assessment for each modality. Imaging plays a critical role in the detection and staging of bladder cancer. In particular, the role of magnetic resonance imaging is expanding because it enables differentiating muscle-invasive bladder cancer from non-muscle-invasive bladder cancer using the Vesical Imaging-Reporting and Data System (VI-RADS), along with conventional technologies, such as computed tomography urography and ultrasonography. Contrast-enhanced ultrasound and dual-energy computed tomography are new imaging modalities that offer special advantages and provide the right approach to patients with oncological conditions. This review ends with the presentation of integrated imaging modalities such as positron emission tomography combined with computed tomography or magnetic resonance imaging, which are promising methods for bladder cancer staging.

Aim. To evaluate the capabilities of ultrasound using various approaches in determining the depth of invasion of squamous cell carcinoma of the oral cavity and to compare the results obtained with data obtained by the use of other diagnostic methods. Materials and methods. In our reserch, ultrasonography was performed on 193 patients with primary malignant tumors of the mobile part of the tongue, floor of the oral cavity and tumors of rare locations (mucous membranes of the lip, cheek, alveolar processes). The age of the patients ranged from 15 to 85 years. In all patients, tumors were squamous cell carcinoma. ultrasound was performed using submandibular, intraoral and transbuccal approaches. ultrasonic data were compared with the results of pathomorphological examination, as well as of X-ray computed tomography and of magnetic resonance imaging with contrast. Results. A statistically significantly high correlation was obtained for all ultrasound approaches (submandibular, intraoral and transbuccal) with the depth of invasion of the oral tumor determined pathomorphologically (r = 0.78; r = 0.89; r = 0.93; p

Background. Mucous cysts of hand represent tumor-like masses. This pathology is associated with a large number of diagnostic and treatment mistakes with inappropriate procedures and incomplete surgical interventions, which result in recurrences and complications. Aim of the study — to analyze diagnostics and treatment mistakes in patients with mucous cysts of fingers in order to improve the quality of medical care for patients with this pathology. Methods. The study enrolled 62 patients. Diagnostics included medical history analysis, clinical and X-ray examination, and ultrasonography. According to the patients’ history, they were divided into two groups: group 1 consisted of patients who had come to the clinic for the first time, group 2 — of patients who had referred to the clinic with recurrences of mucous cysts. All patients underwent surgical interventions with osteophyte excision of the phalanx and skin defect grafting after cyst excision. Treatment results were evaluated 2, 6, 12 months after the operation using X-ray data, VAS, QuickDash questionnaire, and measurements of the range of motion in the distal interphalangeal joint. Results. Initial referrals of group 2 patients (with disease recurrence) were analyzed in terms of the profile of specialists and the type of care provided. It was found that patients with recurrence had undergone procedures (cyst puncture, cauterization, removal of thin skin over the cyst) or surgeries without osteophyte excision of the phalanx and skin defect grafting after cyst excision. The use of a diagnostic algorithm at the referral stage made it possible to confirm the diagnosis and detect an osteophyte of the affected phalanx in all patients. Patients were followed up for a year. Conclusion. At the diagnostic stage, X-ray and ultrasonography are conclusive methods of examination. The only correct method of mucous cysts treatment is radical surgery including skin defect grafting with local tissues after cyst excision and osteophyte removal.

Аim: to study the role of serum and ultrasonometric markers in the early diagnosis of malignant transformation of periductal fibrosis of the liver during the formation of cholangiocarcinoma against the background of chronic invasion of Opisthorchis felineus, in the population of endemic regions.Methods. A comprehensive one-stage comparative study was conducted in a case-control design, using the assessment of biochemical parameters (lactate, alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transpeptidase, alkaline phosphatase, glucose, direct and indirect bilirubin, high-density lipoproteins and low-density lipoproteins, triglycerides, urea and total protein), immunological parameters (transforming growth factor beta) and tumor markers (CA 19-9, СYFRA 21-1) in blood serum samples obtained from patients with O. felineus infection, with and without periductal fibrosis, O. felineus-infected patients with cholangiocarcinoma and representatives of control groups. During the analytical stage, the relationship between the structural features of the liver ac- cording to the results of ultrasound examination (presence of opisthorchiasis-associated periductal fibrosis), clinical parameters, parasitological study data (infection intensity), and changes in biochemical, immunological parameters and tumor markers in patients against the background of O. felineus infection was assessed. Statistical analysis was performed using the R programming language (version 3.6.1).Results. Evaluation of the relationship between the presence of ultrasound signs of stage 1–2 opisthorchiasis-associated periductal fibrosis and changes in serum levels of the biochemical, immunologic parameters and oncomarkers in patients with O. felineus infection demonstrated that the levels of alkaline phosphatase, conjugated bilirubin, AST, glucose and CA 19-9 oncomarker were significantly higher in the serum of patients in the group with cholangio-carcinoma and opisthorchiasis (p < 0.01).Conclusion. The first pilot data on the relationship between ultrasonometric signs of periductal liver fibrosis and the increase of CA 19-9 oncomarker as well as biochemical parameters (alkaline phosphatase, direct bilirubin, aspartate aminotransferase, glucose), which can be used for early diagnosis of malignant transformation of periductal liver fibrosis with the formation of cholangiocarcinoma in O. felineus-infected population in endemic regions, were obtained.

Aim of the study was to carry out a comparative analysis of the linear size of the right and left ovaries, determined using sonography in women in adolescence, the elderly, and old age.Material and methods. The study was based on the results of ultrasound examination of 84 women with normal pelvic dimensions who were examined at the gynecology department of the Perm Krai Clinical Hospital during the period 2021–2022 in order to exclude probable pathology of the reproductive system. Measurement of longitudinal (length), transverse (width), and anteroposterior (thickness) dimensions of the ovary was performed using transvaginal access. Women were divided into three groups: the first consisted of 28 adolescents (16 to 20 years old), the second – 29 elderly persons (56 to 74 years old), the third – 27 seniors (75 to 85 years old).Results. When comparing the indicators of ovarian size, their statistically significant decrease by old age was revealed. Right ovary length from adolescence to the old age decreased by 20.56 % (p < 0.01), left – by 28.62 % (p < 0.01). Right ovarian width becomes smaller by 20.87 % (p < 0.01) in elderly age and by 26 % (p < 0.01) in senile age, left – by 20.8 % (p < 0.01) and by 28.32 % (p < 0.01), respectively, the anteroposterior dimension of the right ovary – by 23.2 % (p < 0.01) and by 38.8 % (p < 0.01), of the left ovary – by 31.19 % (p < 0.01) and by 39 % (p < 0.01), respectively.Conclusions. The results obtained allow us to expand our understanding of the features of the age-related structure of the ovaries and further continue their detailed study, since new knowledge is needed to develop modern methods for the prevention of pathology of the female reproductive system and the timely provision of quality medical care.

Introduction and purpose Contrast enhanced ultrasound (CEUS) is a modern diagnostic method that uses ultrasound waves in combination with intravenous administration of a contrast agent. It enables obtaining high resolution and assessing microcirculation in real time, thanks to which the researcher is able to analyze the enhancement and its features, which may help in diagnosing a specific pathology. Contrast agents, similar to CT and MRI, show specific phases of enhancement after administration - arterial, venous, delayed. Their additional advantage is safety, especially for patients with impaired kidney and thyroid function, and causing fewer allergic reactions. The aim of this review is to present the CEUS examination technique and the latest reports in the field of diagnosis of renal lesions. Material and methods This review was prepared based on the literature available from recent years in the PubMed and Google Scholar scientific databases using the keywords: ultrasonography, contrast enhanced ultrasonography, kidney, renal masses. Results Studies show that CEUS can be an effective method for imaging both cystic and solid lesions in the kidney. When using a contrast agent, the lesions show characteristic features that can guide the investigator to the diagnosis. Moreover, in comparative analyses, CEUS achieved comparable or better results than other diagnostic imaging methods. Conclusions CEUS is a modern and promising diagnostic method that can successfully compete with CT and MRI. Moreover, the metabolism and pharmacokinetics of contrast agents and their safety mean that CEUS can be used for the diagnosis of unclear pathologies in elderly patients, as well as for the control and supervision of changes that require frequent imaging. Keywords: ultrasonography, contrast enhanced ultrasonography, kidneys, renal masses

This publication is the Russian translation of the Plain Language Summary (PLS) of the Cochrane Systematic Review: Glechner A, Wagner G, Mitus JW, Teufer B, Klerings I, Böck N, Grillich L, Berzaczy D, Helbich TH, Gartlehner G. Mammography in combination with breast ultrasonography versus mammography for breast cancer screening in women at average risk. Cochrane Database Syst Rev. 2023;3(3):CD009632. DOI: 10.1002/14651858.CD009632.pub3

All premature babies lack the intrauterine phase of active mineralization of the bones, osteogenesis changes, speed of ultrasound propagation in bone tissue changes. Aim. The purpose of the article was to determine osteopenia in premature babies (PB) based on ultrasound densitometry at birth and during the period of intensive care. Materials and methods. 70 premature babies and 20 full-term newborns were studied. The authors determined the bone ultrasound speed (SOS, m/s) and its comparative evaluation (Z-score) with the representative base of the ultrasound sonometer “Sunlight Omnisense 9000” (Israel). SOS was defined as average at Z ≥-1.0 SD, as low – at Z from -1.1 to -2.0 SD, and as significantly low – Z ≤- 2.0 SD. Results. 54.3 % of PB had osteopenia at birth: low indicators in 28.6 %, significantly low in 25.7 %. Postnatally, an increase in bone tissue deficiency of PB was observed – osteopenia with a low Z was diagnosed in 41.1 %, with a significantly low – in 37.5 % of PB. Conclusions. The number of PB with osteopenia increased 1.4 times, during the first 4 weeks of life. An increase in bone tissue deficiency was most often (p < 0.05) observed among children (52.0 %) with normal / average Z-score SOS indicators. Z-score SOS indicators in children with osteopenia were stable during the first month of life. The odds ratio of having osteopenia were 3.37 times higher for those born in GA of 33 weeks or less (OR = 3.37; CI 95 % [1.25, 9.09], p < 0.05), and 7.50 times higher odds of having significantly low Z-scores (OR = 7.50; CI 95 % [1.60, 34.59], p < 0.05), ), and 8.15 times higher odds of having significantly low Z-scores after 1 month of life (OR = 8.15; CI 95 % [2.23; 29.70], р < 0.05), than in children with greater GA. Indicators of physical development of premature newborns do not allow assessing the state of bone mineral velocity and require dynamic ultrasonic densitometry, despite the presence of correlations of SOS with indicators of the mass or length of infants depending on the gestational timing of birth.

Pelvic congestion syndrome is a form of varicose disease, which is considered to be one of the main causes of chronic pelvic pain in women, which is associated with a violation of pelvic veins hemodynamics. Pelvic venous disorders are invisible to clinicians due to the lack of pathognomonic symptoms and manual disease criteria, but it has significant consequences. Today, one of the main diagnostic methods of pelvic venous disorders is a transvaginal US of pelvic veins, including gonadal veins (ovarian veins in women). Thanks to this non-invasive and simple diagnostic method that does not require specific preparation and has no contraindications, we have significant opportunities in diagnosis, as well as in the further evaluation of the postoperative results of surgical correction of pelvic congestion syndrome. The aim of the study was to analyze changes of pelvic veins in patients with pelvic congestion syndrome before and after surgical intervention using the transvaginal US method. Materials and methods. The study included 35 patients which underwent surgical treatment using open surgery and endovascular procedure between April 2019 and February 2022 with pelvic congestion syndrome. All patients underwent transvaginal ultrasound of the pelvic veins before surgery. A control examination was performed after surgical treatment in 4–6 months. The examination was performed on an expert-class ultrasound system “Toshiba Aplio 500” using all international standards for transvaginal examination of pelvic veins to evaluate the changes of illiac, paraovarian, parametrial and ovarian veins from the left side and from the right side in patients with pelvic venous disorders. Conclusions. Transvaginal ultrasound of the pelvic veins can be considered one of the key diagnostic methods, with the help of which it is possible to investigate and evaluate hemodynamic disorders in the veins of the pelvis and pelvic organs in real time. Also, this method can be considered optimal for the control examination of patients who underwent surgical correction of pelvic congestion syndrome.

Introduction and purpose: A peritonsillar abscess is one of the most common complications of tonsillitis, especially among adolescents and young adults. Its diagnosis can pose a challenge, and overlooking it may pose a life-threatening risk. Various diagnostic methods have their advantages and disadvantages. The aim of this publication is to compare and identify the best diagnostic approach currently described in the literature, contributing to improved clinical decision-making and patient outcomes with particular attention to the significance of transcutaneous ultrasound as a diagnostic method. A brief description of state of knowledge: Beyond clinical symptoms imaging options include transcutaneous and oral ultrasound, computed tomography, and magnetic resonance imaging. Ultrasound has been gaining importance in the diagnosis of PTA for an extended period due to its easy accessibility, cost-effectiveness, non-invasiveness and a relatively high anticipated specificity and sensitivity.Simultaneously, the use of CT as a tool in primary diagnosis is being called into question and new proposals for the use of MRI are emerging. Summary: Currently, the use of both intraoral and transcutaneous ultrasound represents the optimal first-line solution in diagnosing peritonsillar abscess. In cases of uncertainty, a more specific diagnostic tool would be MRI, although for various reasons, CT is more commonly chosen.

Background: Salivary gland tumors account for up to 5% of all head and neck neoplasms. Ultrasonography is one of the main diagnostic modalities for the salivary gland pathology; however, its diagnostic potential is under scrutiny. Fine needle aspiration cytology is considered the main diagnostic method, although its role in the differential diagnosis is disputable.Objective: To identify, based on morphology results, the effectiveness of the main ultrasonographic signs indicating major salivary gland neoplasms in the differential diagnosis and study these signs, to evaluate the effectiveness of fine needle aspiration in the diagnosis of benign and malignant major salivary gland neoplasms.Materials and methods: This retrospective study evaluated a group of 220 patients. We calculated sensitivity, specificity, and accuracy of qualitative ultrasonographic signs of salivary gland neoplasms, analyzed the fine needle aspiration effectiveness, and compared results accuracy by calculating Pearson’s empirical χ-square.Results: Common ultrasonographic signs of benign salivary gland neoplasms included a clear contour (97.5%) and decreased echogenicity (72.7%). Malignant tumors frequently presented with a clear contour (76.7%), uneven contour (72.1%), and decreased echogenicity (69.8%). Fine needle aspiration sensitivity and specificity in the diagnosis of benign neoplasms were 75.5% and 53.6%, respectively. Fine needle aspiration sensitivity and specificity in respect of malignant tumors were 50% and 94%, respectively. Pearson’s χ-square value for the clear contour had significant differences in favor of benign neoplasms.Discussion: Benign and malignant salivary gland neoplasms often have a similar ultrasonographic pattern. A significant diagnostic sign of malignant tumors is the uneven contour. We compared the effectiveness of cytological differentiation between benign and malignant neoplasms and found high rates of specificity and accuracy for malignant tumor diagnosis.Conclusions: Clear contour and decreased echogenicity are significant ultrasonographic signs in the differentiation of benign neoplasms. Uneven contour is a significant differentiating factor for malignant neoplasms. Cytology can be used for initial morphology in diagnosing major salivary gland neoplasms, but in half of the cases it fails to identify the nature and type of the tumor.

Objectives: 1) to determine the elasticity of normal breast tissue (parenchyma and premammary adipose tissue) in healthy women using ultrasound two-dimensional shear wave elastography (2D-SWE); 2) to reveal a possible correlation between increased stiffness of the breast parenchyma and hyperprolactinemia in patients with mastodynia and mastopathy; 3) to evaluate the ability of the Vitex agnus-castus drug to reduce the stiffness of the breast glandular tissue; 4) to objectify the ability of the Vitex agnus-castus drug to affect the thickness of the breast parenchyma, the condition of the milk ducts and cystic changes. Materials and methods. Breast tissue stiffness was investigated using 2D shear wave elastography (2D-SWE) in 32 women aged 18–52 with cyclic mastalgia/mastopathy before and after treatment with Vitex agnus-castus drug. A correlation was made with laboratory parameters (prolactin level), the general condition of the breast according to the results of ultrasonography in gray scale mode. The control group consisted of 78 women without complaints, without signs of diffuse and focal pathology of the mammary glands. Results. The 2D-SWE elastography showed normal values of breast tissue stiffness in women without pathology. 2D-SWE in symptomatic women made it possible to detect increased stiffness of the breast parenchyma, thereby screening for its diffuse changes. At the same time, dynamic changes in the softbreast tissue as a result of the treatment (parenchyma thickness, dilatation of the milk ducts, the presence of simple cystic foci (BI-RADS 2)) were diagnosed, analyzed and compared in grayscale mode ultrasonography (2D). The majority of patients (90,6%) noted a decrease in the level of prolactin after treatment. Statistical evidence of the positive effect of the Vitex agnus-castus drug in the treatment of mastodynia/mastopathy has been proven. Conclusions. Assessment of the basic breast tissue stiffness using 2D-SWE makes it possible to screen patients with its elevated values. This fact makes it possible to assign these women to the risk group of developing breast cancer. Evaluation of changes in the mechanical stiffness properties of the breast soft tissues makes it possible to evaluate and objectify the effectiveness of the treatment.

Introduction: Testicular torsion is the most urgent case in pediatric andrology that requires emergency care due to the high sensitivity of testicular tissue to hypoxia.Objective: To determine statistically significant parameters indicating diagnostic significance of some ultrasonographic testicular torsion symptoms in children.Materials and methods: Ultrasonography was performed in 202 children with testicular torsion (main group) and 449 patients (control group) aged from 2 months to 17 years 11 months and 28 days. During statistical processing we determined the mean values, their standard deviation, sampling errors, significance of differences in the mean values, correlation coefficient and did ROC analysis. For an objective ultrasonographic assessment of testicular shape, we implemented the coefficient of rounding – ko = (testicular length – testicular thickness) / testicular length – and the parameter Δko calculated as the difference between ko for the affected side and the contralateral one.Results and discussion: Testicular torsion was more common in children above 12 years of age (84.7%). The ko was 0.160 ± 0.007 in the group of children with testicular torsion and 0.037±0.003 in the control group (t = 16.92, p >> .001). The ROC analysis proved the Δko to be highly informative: AUC was 0.886. The Δko was 0.130 ± 0.008 for patients with favorable treatment outcomes and 0.19 ± 0.01 (p < 0.001) for those with unfavorable outcomes. In most cases (71), the whirlpool sign was visualized with preserved blood flow. In such a case, the probability of the favorable treatment outcome was 74.6%. The whirlpool sign visualization was significantly less common (31 cases) without Doppler ultrasonography; favorable treatment outcomes were achieved in 54.8%. Of 22 patients with the undetected whirlpool sign, favorable treatment outcomes were possible only in 40.9%.Conclusions: The coefficient of rounding ko can be used as an auxiliary criterion for the early diagnosis of testicular torsion. With Δko = 0.08, the sensitivity of the parameter in respect of testicular torsion is 79.2%, and specificity is 85.7%. With Δko = 0.16, the specificity of the parameter is almost 100% with a 45.0% decrease of the sensitivity. Whirlpool sign detection using color Doppler ultrasonography is a positive prognostic factor.

BACKGROUND: A variety of ultrasound equipment and a lack of generally accepted classifications lead to inefficient equipment of medical organizations, incorrectly selected types of device, sets and probes characteristics, as well as a level of study quality. A systematic approach to equipping similar medical organizations with ultrasound devices will ensure the availability and improve the quality of primary medical care in outpatient centers. AIM: To develop a calculation algorithm and recommendations for the minimum standard for equipping regional outpatient medical facilities of the state healthcare system based on the Moscow example. MATERIALS AND METHODS: In conducting the study, we used software for statistical and comparative analysis based on the data of the Material Support Management System of the Unified Medical Information and Analytical System (MSMS UMIAS), Form No.30 of Federal Statistical Observation, as well as a number of assigned population to the outpatient center (hereinafter referred to as the OC), technical data, and reviews of modern ultrasound diagnostic devices. RESULTS: The developed minimum standard for equipment considers the following factors: 1) need to provide medical care to children and adult populations separately; 2) compliance with modern diagnostic technologies; 3) ensuring the territorial availability of diagnostics under the condition of efficient equipment operation. CONCLUSIONS: Standardization of equipment of outpatient medical facilities with ultrasound diagnostic devices contributes to improving the quality of diagnostics and the availability of providing required examinations to the assigned population, reducing the waiting time for examinations, reducing the shortage of necessary equipment, expanding the range of medical services provided to the city population, and minimizing duplicate studies at subsequent stages of medical care.

Abdominal adhesions at the stage of surgical treatment limit the possibility of safe manipulation both at the stage of access and during the surgery. The number of complications associated with adhesions can be reduced by obtaining data on their localization.The variety of methods for preoperative detection of abdominal adhesions is very limited. Ultrasonography, magnetic resonance imaging and computed tomography are used for this purpose. The article is the first part of a review devoted to the study of diagnostic methods and reveals the possibilities of ultrasonography.

Precancerous conditions increase the risk of gastric cancer by 2–3 % every 10 years. Among comorbid pathology, 46 % of all endocrinopathies are diseases of the thyroid gland. An urgent issue today is the definition of non-invasive criteria for the formation of a risk group for the detection of precancerous changes in the gastric mucosa in patients with comorbid pathology. The aim of the study was to evaluate the structure of the thyroid gland as ultrasound criterion for predicting precancerous lesions in the stomach in patients with atrophic gastritis under conditions of comorbidity. Materials and methods. The study was conducted among 81 patients with gastric precancerous conditions. The upper endoscopy was performed using EVIS EXERA III systems with an Olympus 190 gastroscope (Japan). All the patients in this study underwent a sonological examination of the thyroid gland on an ultrasound scanner Toshiba Xario (Japan). Results. In patients with atrophic gastritis, a high frequency of structural changes in the thyroid gland (77 %) was observed. Focal changes were determined in 33 % of atrophic gastritis patients with a predominance of their diagnostic frequency in patients with gastric mucosal dysplasia (χ2 = 5.32, P < 0.05 as compared to the patients with gastric mucosal atrophy and χ2 = 4.25, P < 0.05 as compared to the patients from the intestinal metaplasia group). Patients with gastric mucosal dysplasia were characterized by coarse-grained thyroid parenchyma, which was more common by 2.2 times as compared to the group of patients with atrophy (P > 0.05) and by 1.8 times as compared to the patients with intestinal metaplasia (χ2 = 4.09, P < 0.05). Conclusions. Diagnostic criteria for the formation of a risk group for the detection of gastric mucosal dysplasia are focal changes in the thyroid parenchyma (sensitivity 63.6 %, specificity 71.4 %), coarse granularity of the thyroid parenchyma (sensitivity 72.7 %, specificity 61.4 %) and an increased vascularization of parenchyma at the sonological examination of the thyroid gland (sensitivity 63.6 %, specificity 70.0 %).

Sonographic assessment of gallbladder structure and function in patients with gallstone disease needs further improvement not only to clarify the indications for organ-sparing operations such as laparoscopic cholecystolithotomy, but also to improve the results of surgical treatment of asymptomatic cholecystolithiasis by predicting probable restoration of motor-evacuatory function of the gallbladder and reduction of the number of recurrences of cholecystolithiasis. The aim of the study was to investigate changes in gallbladder structure and function in patients with asymptomatic cholecystolithiasis before and after laparoscopic cholecystolithotomy. Materials and methods. The study involved 33 patients with asymptomatic cholecystolithiasis. The majority of patients are women 82 % (n = 27), aged 23 to 54 years, mean age 48.0 ± 11.9 years. And there were 18 % of men (n = 6), aged 25 to 58 years, mean age 46.2 ± 12.4 years. Ultrasound examination of the abdominal organs was performed in all patients using Philips No. MA2540R and LOGIQ General Electric Ser No. 52993WX3 before and after laparoscopic cholecystolithotomy. During the examination, a sonographic assessment of the shape, size, contours, thickness of the gallbladder wall, as well as its relation with surrounding organs and vascular structures was performed. The size of the common bile duct, the number and size of stones in the gallbladder cavity, as well as its motor-evacuatory function were purposefully determined. Statistical processing of the material was performed using the Statistica for Windows 13 (StatSoft Inc., No. JPZ804I382130ARCN10-J). Results. Indicators of gallbladder reservoir function before and after laparoscopic cholecystolithotomy did not differ significantly. There was a significant increase in the ejection fraction of the gallbladder from 54.5 ± 2.1 % to 64.4 ± 2.9 % (P = 0.0001) and a reduction in the “latency period” from 15.6 ± 2.5 min to 8.3 ± 1.7 min (P = 0.001). Conclusion. Adherence to sonographic indications (single gallstones, less than 3 mm wall thickness and ejection fraction over 50 %) in the selection of patients with asymptomatic cholecystolithiasis for laparoscopic cholecystolithotomy allows not only to preserve the reservoir and also improve the motor-evacuatory function of it, which reduces the risk of possible recurrent stone formation in close and long-term periods of observation.

Introduction. In recent years, ultrasound and endovisual guidance have been introduced into clinical practice when performing percutaneous nephrolitholapaxy.Objective. To identify the most significant factors that influence the frequency of complete elimination of stones and the development of complications in percutaneous nephrolitholapaxy performed under ultrasound and endovisual guidance.Materials and methods. We analyzed the results of the treatment of 515 kidney stone patients who underwent percutaneous nephrolitholapaxy under ultrasound navigation and endovideoscopic guidance using a new method developed by us.Results. The average duration of the operation was 77.2 ± 1.9 min. Most of the operations were performed through one puncture access (95.1%) and in one stage (91.8%) with complete stone elimination in 80.6% of the cases. The degree of decrease in hemoglobin in the postoperative period was only 12.18 ± 0.6 g/l. The frequency of postoperative complications was 29.3%, in most cases there were 1 - 2 severity grades according to Clavien-Dindo. As a result of multivariate regression analysis, independent predictors influencing the frequency of complete stone eradication were the number of stones (p = 0.012), the fact of the presence of staghorn stone (p = 0.016), the number of stages of surgical intervention (p = 0.001). Correlation analysis revealed a statistically significant negative correlation between body mass index and the occurrence of complications (p = 0.005), a positive correlation between the presence of urinary tract infection and the occurrence of complications (p = 0.048), a positive correlation between the grade of blood loss and the occurrence of expectation (р < 0.001).Conclusions. Percutaneous nephrolitholapaxy under ultrasound and endovisual guidance without the use of X-rays is an effective intervention for most patients with kidney stones. Complete stone eradication depends on the number of stones, the presence of staghorn stone, and the number of stages of surgery. The incidence of complications is significantly affected by the body mass index, the presence of urinary infection and the degree of decrease in hemoglobin during surgery.

Aim. The pooled efficacy data of two similar randomized placebo-controlled clinical trials were analyzed. Safety was evaluated on the basis of the individual trials. Materials and methods. The efficacy analysis was based on 589 patients. Treatment was performed orally with either 3160 mg BNO 1016 (n=294) or 31 tablet placebo (n=295) for 15 days. In both trials patients underwent five visits to the investigational sites. Symptoms were evaluated according to the EPOS 2012 guideline. Ultrasonography was used to confirm the diagnosis at onset of treatment and the remission of symptoms at the last visit. Efficacy was evaluated by the investigator as the mean major symptom score (MSS) at the end of treatment (visit 5, day 14). Patients reported symptoms and social/emotional consequences of rhinosinusitis using a quality of life questionnaire (SNOT-20 GAV). Results. MSS improved during the treatment period by a mean of 10.021.61 score points to 2.472.55 for BNO 1016 and of 9.871.52 to 3.633.63 for placebo. Differences between treatment groups at end of therapy (1.163.14 score points; p0.0001) and patient-assessed quality of life (p=0.0015) were statistically significant in favor of BNO 1016. Conclusion. Daily intake of 480 mg of BNO 1016 for 15 days is an effective treatment in acute viral rhinosinusitis.

Objective. Assessment of clinical manifestations and ultrasonographic signs of enthesitis (En) in patients with psoriasis (PsO) and psoriatic arthritis (PsA).Subjects and methods. The study is based on the analysis of survey data from 106 patients with PsO for the period 2018–2021, which were firstly sent by dermatologists for a consultation with a rheumatologist due to musculoskeletal pain. The duration of the period of musculoskeletal pain in the observed patients did not exceed 12 months. In addition to general clinical and laboratory examination, all patients underwent ultrasonography of painful and/or swollen joints, tendons and ligaments using a linear sensor (frequency – 12–18 MHz) of MyLab 50 (Esaote, Italy) apparatus and supplemented by Doppler energy study with a pulse frequency of 6.6 MHz. The OMERACT definitions were used to identify En, synovitis and tenosynovitis.Results and discussion. The diagnosis of PsA was established in 73.6%, osteoarthritis – in 13.2%, gout – in 8.4%, fibromyalgia – in 17.9%. Ultrasonographic signs of En were found in 67.9% of patients: signs of an active inflammatory process in enthesises (decreased echogenicity, thickening and appearance of Doppler signals) were observed in 48.7%, signs of structural damage to enthesial zones (calcifications, enthesophytes and bone erosions) in 25,6% of patients. Isolated En was found in 24.4% of patients, a combination of En and synovitis – in 32.1% of patients, a combination of En and tenosynovitis – in 20.5% of patients. The correlation between the inflammatory domain values of the ultrasoundographic enthesial index MASEI (Madrid Sonographic Enthesitis Index) and the clinical enthesial index LEI (Leeds Enthesitis Index) was 0.71 [0.58; 0.77]. There were less pronounced clinical indicators of enthesial inflammation (lower LEI index values), functional disorders of the joints (lower values of the HAQ-DI index) and laboratory signs of systemic inflammation (lower CRP values) in patients with isolated En in comparison with combination of En and synovitis. Ultrasonographic signs of structural damage of enthesises were observed in 15.4% of patients without clinical and ultrasonographic signs of active En, which may indicate the possibility of a subclinical course of enthesial inflammation in patients with PsO.Conclusion. It was demonstrated that ultrasonography has diagnostic capabilities to identify the site of the inflammatory process in patients with PsA and differentiate patients with isolated En and a combination of En and synovitis in order to select a method of differentiated anti-inflammatory therapy.

Background: The fundamental principle of ayurveda is the tridosha theory (three doshas). These dosha are the causative and governing bio-energies responsible for the formation of body constitution. The vata dosha dominant personality have classical features like a small body frame when compared to kapha with large body built and broad anatomical structures. Pittaja body constitution has medium body built with reddish colouration and sharp features. Aim: This study aimed to correlate the radial artery intima-media thickness (IMT) and luminal diameter (LD) and further study its association with different body constitution (prakriti) and check the difference between the groups of prakriti. Methods: This observational cross-sectional study was done between May 2021 and June 2021 in the Department of Radiology, KLE Prabhakar Kore Charitable Hospital, Belagavi. Non-randomly selected volunteers ≥23 ±5years (n = 35) were divided into body constitution (prakriti) groups and evaluated for the IMT, LD (luminal diameter) of the radial artery using B-mode ultrasonography. Pearson’s co-relation was used to test the corelation between the luminal diameter and intimae media thickness of distal radial artery. Chi-square test of independence was used to check the association between luminal diameter and intimae media thickness of distal radial artery with body constitution. One-way ANOVA was used to study the difference between the groups of prakriti. Results: The mean luminal diameter (LD) in vataja body constitution (5%) was 1.450 ± 0.495 mm, pittaja body constitution (11%) was 1.750±0.10 mm, kaphaja constitution (11%) was 1.70± 0.30 mm, vatapittaja body constitution (11%) was 4.15±0.47 mm, vatakaphaja body constitution (26%) was 1.64±0.83 mm, pittakaphaja constitution (23%) as 2.3±0.15 mm and samadhatuja constitution (11%) had 1.8±0.189 mm. The mean intima media thickness (IMT) in vataja body constitution (5%) was 0.05± 0 mm, pittaja body constitution (11%) was 0.03±0 mm, kaphaja constitution (11%) was 0.05± 0.014 mm, vatapittaja body constitution (11%) was 0.107±0.09 mm, vatakaphaja body constitution (26%) was 0.83±0.07 mm, pittakaphaja constitution (23%) was 0.313±0.006 mm and samadhatuja constitution (11%) had 0.350 ± 0.012 mm. As per the analysis a low positive Pearson’s correlation was found between IMT and LD (r = 0.254) between the luminal diameter (LD) and intima medial thickness (IMT) of distal radial artery. Chi square test of independence has shown significant association between DRA dimensions (IMT, LD) and body constitution (prakriti), palpatory blood vessel consistency. Among the observed values the vatakaphaja body constitution (0.83±0.07 mm) had increased intima media thickness (IMT). Among all the observed values the vatapittaja body constitution had broadest DRA luminal diameter (LD) of 4.15±0.47mm. One way ANOVA showed no significant difference between the groups of prakiti and IMT, LD of distal radial artery. Conclusion: As per the observations of the present study different body constitution (prakriti) did not show any significant impact on distal radial artery dimensions (IMT and LD) as there are various factors like hormones, neural, blood volume regulators involved in vascular constriction and dilation. The prakriti assessment is a strong marker for prediction and the early diagnosis of diseases. This body constitution (prakriti) of an individual is the basic constituent on which the pulse wave variability of distal radial artery (DRA) acts.

Background. Facial nerve injury, filler-induced compression or soft tissue infiltrations are among the neuropathic complications of aesthetic injection procedures. The prospects of ultrasound imaging in neuropathy diagnosis are understudied. National and foreign literature does not describe facial soft tissues ultrasound in patients with cosmetic injectable-induced clinical neuropathy.Clinical Cases Description. Two clinical cases are presented of high resolution ultrasound (HRU)-empowered verification of injectable cosmetic procedures-induced neuropathy. Ultrasound imaging was proved necessary for differential neuropathic causes diagnosis via the clinical assessment of facial soft tissues, filler and thread depth, as well as topography relative to blood vessels and nerves. In the first case, threads were visualised at a 4.6 and 5.8 mm depth from epidermis, which can coincide in location with large facial nerve branches usually running along vessels in deeper subcutaneous fat. Vessels were not detected in immediate proximity to threads along the entire trajectory from implantation to fixation sites by colour Doppler imaging (CDI). The ultrasound pattern corresponded to dermal and soft tissue infiltration. In the second case, ultrasound was applied to differentially diagnose a iatrogenic cause of neuropathy, considering a 3-year-past history of filler injection at temporal muscle projection. A filler bolus was revealed adjacent to a vessel in subaponeurotic fat of right temporal region, with infiltrative signs of perifocal oedema around a piece of hyaluronic acid. Temporal soft tissue of the opposite facial half remained unchanged. According to HRU evidence, neuropathy developed due to nerve compression by facial soft tissue infiltrative distortions after thread implantation in the first case and by filler directly in the second. The HRU examination facilitated a correct diagnosis and choice of patient management.Conclusion. Ultrasonography is indicated in patients with cosmetic procedures-induced neuropathy for differential diagnosis of complication causes and current therapy monitoring.

The article presents the analysis of published data (Scopus, Web of Science, PubMed/MedLine, The Cochrane Library, and eLIBRARY databases) devoted to the study of existing criteria for assessment of pyeloplasty effectiveness. Published sources most often refer to the dynamics of reduction of the renal collecting system (RCS) and postoperative renal functional status as the assessment criteria. However, there are no consistent values, which could be employed as assessment criteria indicating success as soon as they are registered. The tools used to estimate RCS reduction are not standardized in terms of research techniques, projection of RCS dilatation measurement, and the locations between which renal and pelvic anatomic structures are measured. A variety of approaches to measuring the anteroposterior renal pelvis dimension in children with hydronephrosis tends to blur the analysis of actual pyeloplasty results. This review of published sources demonstrates the lack of agreement as regards the criteria for assessment of pyeloplasty effectiveness. There is a pressing need for appropriate steps to harmonize ultrasonography methods, to standardize the anatomic landmarks for measurement, and to define the criteria to be used to assess the effectiveness of pyeloplasty.

Background. Aesthetic medicine and plastic surgery accrue with new methods for aging correction by year. Research is aimed at reducing the acute complications risk of aesthetic surgeries and finding effective routes of their diagnosis and treatment. Vascular and non-vascular contouring complications imaging, thread implantation, atrophic postacne scars, postpartum striae, posttraumatic and postoperative scars remain the topical issues.Objectives. A review of current imaging techniques in aesthetic medicine to outline promising avenues in the diagnostics of atrophia cicatrix using high-resolution ultrasound methods.Methods. Bibliography was mined and analysed in the PubMed, eLibrary, Web of Science, Cyberleninka and Cochrane Library databases for the period of 2017–2021. Content analysis was used with the keyword queries: facial ultrasound [ультразвуковая диагностика кожи], ultrasound in dermatology [диагностика в косметологии], contouring complications [осложнения контурной пластики], complications in cosmetology, complications of hardware rejuvenation [осложнения аппаратного омоложения], atrophic scar diagnostics [диагностика рубцовых атрофий].Results. Among 351 studied, 57 sources were included in the review. An analysis of past-decade national and foreign literature revealed prevalence of surface linear array 12 and 14 MHz transducers in ultrasonic (US) cosmetology. High-frequency transducers in dermatology and aesthetic medicine have actively developed in recent years. Evidence is published on vascular and non-vascular facial contouring complications diagnosis, aesthetic thread implantation, aging dynamics, psoriasis and onychomycosis control. Scar imaging studies are sparse and not uncovering the full US potential to control their various-stage treatment.Conclusion. A dynamic advancement of high-resolution US in aesthetic medicine paves the promising ways of research into the US capacities for various-origin atrophic scar diagnosis, informative diagnostic criteria elaboration and the development of prognostic and treatment efficacy control techniques.

The paper considers an algorithm for the diagnostic study of patients with cancer of different localization, the possibility and feasibility of involving imaging techniques in radiation therapy and brachytherapy (BT) planning. The most widely used ultrasound in BT planning does not exclude a subjective assessment of the boundaries of the tumor and organs at risk, as well as the inaccuracies caused by endostatic devices. Magnetic resonance imaging (MRI) provides a high level of achievement of the criteria necessary for BT planning, but it has financial constraints and the need for individual selection of research conditions. Computed tomography (CT) is the most effective technique for visualizing the tumor, endostatic devices, and organs at risk for BT 3D planning. The involvement of MRI and positron emission tomography with CT in BT planning is a promising area that requires equipping with a mathematical tool for double and triple contouring of the tumor and organs at risk and for defining protection priorities. The prescribed and used focal dose should be controlled by direct dosimetry methods to ensure quality assurance.

Background. At present, intraocular drops of silicone oil, which is a lubricant for disposable syringes used for intravitreal injections, are being actively studied. Among the undesirable effects of their presence are patient’s complaints of visual discomfort associated with floating opacities, as well as a potential connection with episodes of intraocular inflammation and increased intraocular pressure.The aim: to assess the prevalence of silicone oil droplets in the vitreous in patients treated with multiple intravitreal injections.Materials and methods. A single-center retrospective cohort study was carried out. Inclusion criterion: treatment with multiple (at least 5) intravitreal injections of drug solutions performed according to registered indications. The study group consisted of 86 eyes of 85 patients (56 women, 29 men; age – from 36 to 89 y.o., average – 71.7 y.o.), who received an average of 13.2 injections of solutions of various drugs.Results. Drops of silicone oil were detected by biomicroscopy in 57 eyes (66.28 %) and by ultrasonography in 76 (88.37 %). The coincidence of the results of applying the methods was recorded in 73.26 % of observations. Seven (8.1 %) patients had characteristic complaints. Four patients (4.7 %) had a history of aseptic vitreitis. The hypothesis was confirmed that the possibility of silicone oil droplets getting into the vitreous increases with the number of intravitreal injections. A similar relationship was established in relation to the possibility of the appearance of characteristic complaints in patients due to the presence of drops and episodes of aseptic vitreitis.Conclusion. The release of drops of silicone oil from syringes during intravitreal injections is an urgent problem that requires further study. In the Russian Federation, the situation is aggravated by the lack of prefilled syringes with drugs approved for administration into the eye cavity, as well as the lack of syringe models designed for use in ophthalmology.

BACKGROUND: Doppler twinkling artifact is a rapid change of colors seen in CFI-mode in the presence of kidney stones and calculi. Therefore, numerous researchers use the twinkling artifact as a diagnostic sign. However, this phenomenon is under-researched, because most assumptions concerning its causes are made based on pure visual observations of the scanners screen leaving the important steps of signal transformation hidden behind the black box curtains of ultrasound machines. MATERIALS AND METHODS: Raw radiofrequency ultrasound signals were recorded in the phantom studies. The recorded echoes were received from objects that create the Doppler twinkling artifact and artificial blood vessels and soft tissues imitators. The data were collected between June 2016 and March 2021. Sonomed-500 with the 7.5 L38 and 3.4 C60 probes served as the research machine for the signal capture. Data records: We present the database containing raw radiofrequency ultrasound signals from the beam former output of the research ultrasound machine. The dataset consists of CFI and B-mode echoes recorded from twinkling objects. Therefore, this database can be useful for those who test, develop and study ultrasound signal processing algorithms. Furthermore, the database is freely available online. The 10.5 GB database consists of echoes received from five phantoms. Raw radiofrequency signals were stored in the binary files; scanning parameters were stored in text files. The database is available at: https://mosmed.ai/datasets/ultrasound_doppler_twinkling_artifact. Code availability: The public can visualize the database content with the specially written program TwinklingDatasetDisplay available at: https://github.com/Center-of-Diagnostics-and-Telemedicine/TwinklingDatasetDisplay.git. Usage notes: The database can be used to test and develop signal-processing algorithms, such as wall filtration, velocity estimation, feature extraction, speckle reduction, etc. Furthermore, the public is free to share (copy, distribute, and transmit) and remix (adapt and do derivative works) the dataset considering appropriate credit is given.

Background and introduction Primary sclerosing cholangitis (PSC) is a chronic liver disease with features of cholestasis as a result of inflammation and damage to the bile ducts, which can eventually lead to liver fibrosis and parenchymal failure at an advanced stage. Case Report A 22-year-old man was admitted urgently to the Department of Gastroenterology for complaints of abdominal pain, weakness and tarry stools. A panel of detailed examinations was performed to establish the diagnosis. An abdominal ultrasound scan showed significant enlargement of the liver and spleen. Gastroscopy revealed variceal columns of II degree in the lower esophagus, which were cauterized. Laboratory tests confirmed anemia, reduced platelet and white blood cell counts, increased activity of ALT, ASP, GTP, ALP and slight elevation of total bilirubin in the blood. Based on the clinical disease manifestation and the results of diagnostic tests, cirrhosis of unknown origin was suspected. Subsequent magnetic resonance cholangiopancreatography (MRCP) revealed the presence of multiple strictures in the intra- and extrahepatic bile ducts and gave rise to the diagnosis of PSC. Pharmacological treatment was administered. Currently, the patient remains under the close care of the Transplant Clinic, where he undergoes regular checks of liver function, and endoscopic variceal ligation (EVL) as required. Discussion with conclusions The case presented here shows that the course of PSC can be insidious and asymptomatic. Despite the absence of clinical symptoms, the disease can lead to the development of advanced cirrhosis even in patients of young age and be diagnosed as late as at the decompensated stage, when the only treatment option remains organ transplantation.

Background Height increase and improvement of body proportions for achondroplasia patients normally require two or more stages of reconstructive treatment to be followed by rehabilitation between lengthening periods, and growth correction can take a significant part of life in the cohort of patients. What is the best age to start growth correction is an important question. The purpose of this paper was to present an argument for arranging the first stage of growth correction in achondroplasia patients aged 6–9 years based on the structural and functional muscle evaluation of tibiae to be lengthened. Material and methods Achondroplasia patients aged 6–9 years (n = 30) were examined preoperatively, during distraction, fixation and at 1.5 to 2 years of frame removal. Tibial lengthening was produced monofocally and bifocally. Contractile force of the dorsal and plantar flexion muscles of the foot was measured with dynamometer. Ultrasonography of tibial muscles was performed with HITACHI ultrasound imaging device (Japan). Results Achondroplasia patients aged 6–9 year who underwent tibial lengthening of at least 50% of the initial length developed neuropathy in 2.6 % of cases and soft tissue inflammation in 5.6 % of cases. Characteristic muscle striation of m. tibialis anterior and m. extensor digitorum longus appeared to restore at 1.5 to 2 years of tibial lengthening with clear contouring of the intermuscular septa and retained contractile force of the muscles. The contractile force restored to 96.15 % of preoperative level in the anterior tibial muscles, and to 101.92 % in the posterior muscles. Conclusion The comprehensive clinical, ultrasonographic and dynamometric evaluation of tibial muscles presented a good argument for tibial lengthening in achondroplasia patients aged 6–9 years. Regained muscle striation and spare capacity of m. tibialis anterior and extensor digitorum longus, the restored force of the anterior tibial muscles to 96.15 % of the preoperative level suggested the possibility for the next stage of growth correction.

Purpose To explore the value of ultrasound in the treatment of bone union at the docking site by accordion technique. Methods Sixteen patients were recruited. The accordion operation was performed at the docking site after bone transport. The specific operation process was compression, suspension of adjustment, distraction, retraction. Ultrasound was used to monitor the hematoma, blood flow and callus in and around the docking site at each stage. Results (1) At the compression, there were 14 cases with hematoma and 2 cases without hematoma. (2) The size of hematoma was negatively correlated with the bone healing time of the docking site and the blood flow resistance index. (3) The Adler grading of blood flow gradually increased before the retraction, and then gradually decreased. But the degree of callus mineralization continued to rise. Conclusion (1) Ultrasound can dynamically monitor the change trend of hematoma, blood flow and new callus at the docking site during accordion operation, so as to predict the tendency of bone healing at the docking site. (2) This study can preliminarily demonstrate that the compression stress applied in accordion technique can promote the bone healing at the docking site.

Free-floating thrombus or a fragment of atherosclerotic plaque (mobile plaque) in the lumen of the carotid artery is extremely rare. Atherosclerosis is the most common cause underlying their occurrence. The optimal treatment strategy has not been developed, at least in part due to the rarity of observations, as well as the lack of comparative studies between conservative and surgical treatment (carotid artery stenting, endovascular thrombectomy, endarterectomy). We present two cases that demonstrate the treatment tactics of these rather rare pathologies. Patient Yu., 62 years old, was hospitalized with focal neurological symptoms, National Institutes of Health Stroke Scale of 12. According to the CT of the brain, signs of an ischemic stroke in the right middle cerebral artery circulation were detected. Selective cerebral angiography diagnosed thrombosis of the arteries of the precentral and central sulcus of the right middle cerebral artery, critical stenosis of the mouth of the right internal carotid artery, and a free-floating thrombus in its lumen with a fixation point at the level of atherosclerotic plaque, which blocked the lumen of the artery by more than 60 %. Endovascular aspiration of a free-floating thrombus was performed, followed by angioplasty and stenting of critical stenosis with a favorable clinical outcome. Patient L., 73 years old, applied for carotid ultrasonography, during which a mobile atherosclerotic plaque was diagnosed at the level of the bifurcation of the right common carotid artery. Digital selective cerebral angiography confirmed a plaque fragment floating in the lumen of the artery. After applying a loading dose of ticagrelor without complications, an emergency implantation of a carotid stent was performed at the level of the bifurcation of the right common carotid artery. Taking into account the modern possibilities of interventional radiology and a wide range of tools, the endovascular approach to the treatment of complicated atherosclerotic plaque with a floating component or a formed blood clot is the best treatment option with a good safety profile.

Background. A dynamic cross-layer visualisation of skin, its vascular structure in various anatomical facets during treatment in different age cohorts holds both scientific and practical value.Objectives. A semiotic study of skin, facial, neck and hand soft tissues using high-resolution ultrasound in women of different age cohorts.Methods. A total of 63 women aged between 22 and 59 years were enrolled. The study was designed with two comparison cohorts. The inclusion criteria were: women aged 22-59 years with no evident somatic or acute dermatological pathology not having aesthetic procedures for at least one month prior to the ultrasound examination of skin, facial, neck and hand soft tissues. The cohorts separated by age. Cohort 1 included 32 women aged 22-44 years (young), and cohort 2 — 31 women aged 45-59 years (middle-aged). High-resolution ultrasound (US) was performed in B-mode, colour Doppler and microV imaging.Results. A maximal dermal thickness was facial middle-third in both cohorts, averaging to 1.87 ± 0.35 mm in the young and 1.57 ± 0.23 — in middle-aged cohort (p

Introduction and purpose Ultrasonography (US) is a safe, non-invasive and widespread diagnostic tool. Point-of-care ultrasound (POCUS) is more and more often used in a general practitioner’s (GP) office as an element complementing the medical and physical examination. The aim of the study is to present ultrasonography as a useful diagnostic tool in the practice of a general practitioner (GP). Description of the state of knowledge Abdominal pain and gastrointestinal infections are among the most common reasons for patients visiting their GPs. A point-of-care ultrasound examination enable the shortening of the time necessary to make a diagnosis as well as the fastest possible implementation of appropriate treatment. This is especially important in acute conditions such as cholecystitis, cholelithiasis, appendicitis or renal colic.Patients who underwent ultrasound examination during their GP visit gave them a better understanding of their health problem, increased their sense of securityand confidence in the diagnosis made by the doctor. Summary Point-of-care ultrasound is an examination that is increasingly used by doctors working in primary care as a diagnostic tool ensuring earlier and more precise diagnosis. GP familiarization with ultrasound could reduce the number of incorrect referrals as well as improve the interpretation of the results. Performing the POCUS examination during a visit to the primary care physician allows GP to make a quick diagnosis and make a decision about conservative treatment, referral to the appropriate specialist or hospitalization.

Introduction: Preterm infants are at high risk for various neurological complications and mortality caused by hypoxemia, haemorrhage or inflammation concerning preterm delivery. Resulting brain lesions are mostly asymptomatic - they cannot be diagnosed clinically as such neuroimaging of preterm infants has become part of routine clinical care. In this article, newest studies about intraventricular haemorrhage, its complications and treatment methods were reviewed. The PubMed database was searched using keywords “intraventricular haemorrhage”, “preterm infant”, “intraventricular haemorrhage treatment”, “intraventricular haemorrhage outcome”. State of knowledge: Early diagnosis, appropriate nursing care and treatment can minimise morbidity. Prognosis is mainly determined by the severity of bleeding, occurred complications and neurological irreversible changes. Intraventricular haemorrhage can cause posthemorrhagic hydrocephalus, cerebral palsy, disability and mental retardation in further life. Even mild grades of haemorrhage can result in developmental disorders. Long-term issues such as neurodevelopmental disorders and cerebral palsy are as important as short-term problems. Detection of injuries affecting preterm infants is used to identify complications that might necessitate an intervention. While head ultrasound is the standard of care for routine neuroimaging screening, the use of brain magnetic resonance imaging has expanded recently. Conclusions: Considerable advances in neonatal care have resulted in improved survival and prognosis of development of preterm infants with intraventricular haemorrhage. Although there is a wide range of treatment methods, further studies are needed to assess their safety, effectiveness and impact on short- and long-term outcome.

Introduction Progressive multiplanar static deformity of the forefoot can result in hallux valgus, metatarsus primus varus, transverse flat foot and associated overload of the metatarsophalangeal joints (MTPJ) with plantar plate degeneration and rupture of MPT joints of the lesser toes leading to hammertoe deformity. Diagnostic ultrasound in the identification of plantar plate tears is easy to use at any medical center of the Russian Federation with orthopaedic services and provide a relatively inexpensive option compared with other advanced imaging modalities. The goal was to present ultrasound technology for accurate evaluation of the severity of plantar plate injury which may provide guidance for surgical treatment of hammertoe deformity of the lesser toes in patients with multiplanar static forefoot deformity. Material and methods The study recruited 88 participants with multiplanar static deformity of the forefoot, who underwent ultrasound evaluation according to the original method (RF Patent No. 2699383 "Method for determining the type of degenerative rupture of the plantar plate of the metatarsophalangeal joint due to overload metatarsalgia”) to objectify the results of a physical examination with the Hamilton-Thompson test performed for identifying the degree of instability of the MTPJ, and nonparametric analysis was produced with Pearson's Chisquare test. Results Evaluation of the severity of plantar plate injury in the study group of patients (n = 88) with the Hamilton-Thompson test and ultrasound imaging showed diagnostic error in 22.8 % of cases with the use of clinical methods that allowed reasonable reduction of surgical intervention in 2.3 % and substantial correction of the treatment approaches in 20.5 % preventing a complete plantar plate tear. Discussion The ultrasound scanning introduced in the algorithm for diagnosing the degree of plantar plate rupture facilitated an objective approach to the choice of the most appropriate treatment strategy for complicated multiplanar forefoot deformities accompanied by a non-rigid hammertoe deformity of lesser toes. Conclusion Preoperative ultrasound imaging of the plantar surface of the foot for detecting the severity of plantar plate injury should be included in the diagnostic algorithm for patients with complicated multiplanar forefoot deformities accompanied by a non-rigid hammertoe deformity of lesser toes.

The research was performed at the Loginov Moscow Clinical Scientific Center. It is based on Russian obstructive jaundice (OJ) consensus results, considered at the 45th annual Central Research Institute of Gastroenterology Scientific session Oncological issues in the gastroenterologist practice (1 March 2019). The article objective is to note the diagnostic and conservative treatment current issues in patients with OJ. The increase in the number of patients with OJ of different etiology provides problem actuality. In a large number of cases, medical treatment is delayed due to inadequate diagnostic and management, while correct patients routing today can be provided regardless of medical institution level. In this article the examination steps and conservative treatment role in patients with biliary obstruction management are presented.

Enthesitis is a common clinical feature of spondyloarthritis (SpA), characterized by inflammation of the tendon or ligament attachment site to a bone or joint capsule. The importance of detecting enthesitis for the diagnosis of SpA is confirmed by its inclusion in the classification criteria for psoriatic arthritis (PsA) – CASPAR – and in the classification criteria for SpA of the international group for the study of spondyloarthritis – ASAS. Enthesitis may be the first clinical sign of SpA, as well as the leading symptom that significantly influences the therapeutic choice. Enthesitis occurs in 30–50% of patients with SpA and is associated with high disease activity, more severe pain and worse quality of life. The frequency of enthesitis detected by ultrasound in patients with PsA is approximately 4 times higher than in patients with ankylosing spondylitis and is associated with the severity of the disease. The review presents current data on the pathophysiology, diagnosis and treatment of enthesitis. Recent studies emphasize the role of imaging methods for the diagnosis of enthesitis due to their higher sensitivity and specificity compared to clinical examination. There is very limited information on the effect of synthetic disease-modifying antirheumatic drugs on enthesitis, while targeted drugs and biologic therapy have shown high efficacy in its treatment compared to placebo. Preliminary evidence suggests that targeting interleukin (IL) 17 or IL12/23 may be more effective in enthesises inflammation suppression than tumor necrosis factor α inhibition.

Background. The use of injectables is becoming ever more popular in aesthetic medicine. However, no clear guidelines are provided for the diagnosis and treatment of their early and late complications.Objectives. Assessment of ultrasonic diagnosis capacity for facial skin and soft tissue evaluation in post-contouring facial oedema.Methods. A case-control cohort study of post-procedural oedema was conducted. Two cohorts were selected: women having oedema after facial contouring with hyaluronic acid fillers and those without evident somatic displays. The cohorts differed by the filler’s presence (infiltration surrounding geleomas) or absence (soft tissue infiltration) in the swelling as diagnosed with ultrasound. Subsequent high-resolution ultrasonography (HRUS, B-mode and Doppler imaging).Results. HRUS was used to examine 67 women with oedema after facial contouring. The patients aged 22 to 65 years had filler injections in soft facial tissues 2 weeks to 3 years prior to the visit. The fillers contained hyaluronic acid in 67 cases. Swelling was acute, with a wavelike recurrent course. According to HRUS, 30 patients had the filler in the oedema projection, 30 — in adjacent zones, 6 had no filler in oedema and 1 had fibrosis-associated oedema. The main HRUS traits of filler-induced oedemas were facial contour distortions and a uniformly amplified echogenicity of surrounding tissues.Conclusion. Patients with oedema after aesthetic contouring should have an ultrasound examination of facial skin and soft tissues for differential diagnosis, evaluation of the swelling degree and filler presence in soft tissues. Oedema typically develops in 3-4 months after the injection procedure. Hyaluronidase injections in the swelling zone are less effective without ultrasonic control.

Objective of the study: improvement of diagnostic methods for pregnant women with tumor-like formations and ovarian tumors. Materials and methods. 60 pregnant women were examined and divided into 3 groups: group I – 28 pregnant women with ovarian tumors who underwent surgical treatment during pregnancy; group II – 21 women with ovarian tumors who underwent surgical treatment at various times after spontaneous delivery; group III (control) – 11 women with a normal course of pregnancy without ovarian tumors. Doppler ultrasound was performed on a mandatory basis at the screening time, and as well as needed. MRI was performed in 8 diagnostically difficult cases. In the II trimester of pregnancy at 12–24 weeks in 49 women with ovarian tumors tumor markers were determined: CA-125, HE-4, β2-microglobulin, transthyretin, transferrin and apolipoprotein A-I, and combined ROMA and RMI indices. Results. The analysis showed the characteristic echographic signs of most ovarian tumors in pregnant women. The overall accuracy of ultrasound in determining the ovarian tumor structure at the outpatient level was extremely low and amounted to 21.8%, in a specialized medical institution it was 79.2%. In the diagnosis of mature teratomas were found MRI sensitivity and specificity of 100%, less diagnostic value (sensitivity 91.7%, specificity 96.9%) was typical for endometrioid ovarian cysts. MRI efficiency in detecting malignant potential (borderline and malignant tumors) was quite high (sensitivity 80.0%, specificity 97.4%). The presence of any ovarian tumor, except for mature teratomas, was accompanied by a significant increase in CA-125 level. The strongest correlation was found for RMI index and CA-125 and HE-4 tumor markers. Conclusions. Doppler ultrasound and MRI are complementary highly informative methods for diagnosing ovarian tumors in pregnant women. Tumor markers used for the differential diagnosis of benign and malignant tumors outside pregnancy (CA-125, HE-4, apolipoprotein A-I, transferrin, transthyretin, β2-microglobulin) do not have a high enough diagnostic value in ovarian tumors in pregnant women, therefore their tests should be supportive.

Primary hepatitis (PH) is one of the most frequently diagnosed hepatic diseases in dogs. Its popular forms are acute hepatitis (AH) and chronic active hepatitis (CAH) which can progress to hepatic fibrosis and cirrhosis. This investigation aimed to evaluate the use of hepatocyte released Canine familiaris miRNAs(cfamiR)-122 and -21 as serum biological markers for the early and reliable diagnosis of PH and to reveal the onset of hepatic fibrosis. After the ultrasonographic and histological examination, fifteen healthy dogs were involved in the study as control group to compare with other thirty dogs confirmed to have AH or CAH (n = 15). Activity of liver enzymes as well as serum level of globulin and total bilirubin were significantly elevated in AH (P 0.001) and CAH (P 0.01) groups whereas, serum level of total protein, albumin, BUN and A/G ratio were significantly lowered in both PH groups (P 0.01) compared to control. Cfa-miR-122 significantly expressed in AH (P 0.001) and CAH (P 0.01) and exhibited a potential significance in distinguishing these groups from control with an area under the curve (AUC) of 0.98 and 0.96, respectively. Additionally, cfa-miR-122 displayed a potential role in distinguishing AH (P 0.05) from CAH group with an AUC of 0.85. Cfa-miR-21 was only expressed in dogs of CAH group and displayed a potential role in distinguishing this group (P 0.001) from AH and healthy groups with an AUC of 0.99 and 0.88, respectively. Therefore, cfa-miR-122 can be significantly expressed in dogs with two forms of PH whereas, cfa-miR-21 could be potentially enhanced only in chronic form of PH and may act as new non-invasive biomarker for distinguishing AH from CAH.

This publication is the Russian translation of the Plain Language Summary (PLS) of the Cochrane Systematic Review: Colli A, Nadarevic T, Miletic D, Giljaca V, Fraquelli M, timac D, Casazza G. Abdominal ultrasound and alpha-foetoprotein for the diagnosis of hepatocellular carcinoma in adults with chronic liver disease. Cochrane Database Syst Rev. 2021;4(4):CD013346. DOI: 10.1002/14651858.CD013346.pub2

Almost half of the patients with axial spondyloarthritis (axSpA) in Russia have hip joint lesions (HJD), but the causes and rates of its progression have not been studied.Aim. To assess the relationship of X-ray progression with MRI data of hip joint examination in patients with axial spondyloarthritis during a two-year follow-up.Material and methods. We analyzed 77 patients (23 women and 54 men) with axSpA (ASAS criteria, 2009), followed for at least 2 years with clinical and/or instrumental signs of coxitis. After 2 years, the patients underwent a complete clinical, laboratory and instrumental examination (MRI and radiography of the hip joint) again. Their average age was 30.8±7.7 years, with an average disease duration of 74.0±90.3 months. 72 (94%) patients were HLA-B27 positive. In all patients, the BASRI-Hip index was assessed for each hip joint. The median values of laboratory parameters of inflammation – erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level – were initially high (20.0 mm/h and 14.5 mg/l respectively), but after 2 years the indicators decreased: ESR – down to 8.0 mm/h, and CRP – down to 5.0 mg/L (p0.005), and the number of chronic changes increased up to 29 (38%). In 25 (32%) MRI patients, signs of active inflammation were arrested, while only two (13.3%) of them showed the development of chronic changes. To assess the relationship between X-ray progression and MRI signs of inflammation of the disease, patients were divided into two groups according to the total stage of radiographic coxitis (ΔtsrC=0 and ΔtsrC>0). The group with ΔtsrC=0 included 33 patients (22 men and 11 women), and the group with ΔtsrC>0 included 44 patients (32 men and 12 women) (p>0.05). The groups did not differ in clinical parameters such as disease duration, patient age, BASDAI, ASDAS-CRP, BASFI, ESR and CRP (p>0.05). According to MRI, the signs of inflammation (osteitis, synovitis) of the groups also did not differ.Conclusion. The progression of coxitis did not depend on the activity of the disease, on the gender of the patients, and on MRI signs of inflammation in the hip joint.

Objective: To evaluate foot disability both ultrasonographically and by using the Foot Function Index (FFI) in patients with axial spondyloarthritis (SpA) and to investigate its effects on patients' quality of life and functional capacity by determining the factors that may affect the level of disability.Patients and methods. A total of 100 patients were included in the study. Enthesis sites in the feet were assessed for tenderness and swelling. Ultrasonographic examination of the Achilles tendon and plantar fascia was made and the findings were scored according to Glasgow Ultrasound Enthesitis Scoring System (GUESS). The Foot Function Index (FFI) was used to investigate the effects of foot disorders on disability and activity limitation. The correlation between GUESS and FFI scores, and relationship of GUESS and FFI scores with age, disease duration, body mass index (BMI), smoking and disease activity parameters were investigated.Results and discussion. Physical examination revealed signs of enthesitis in 13 (13%) patients, while ultrasonographic (USG) evaluation – in 36 (36%) patients. A statistically significant correlation was found between all FFI and GUESS scores except between FFI for the right foot and GUESS for right Achilles tendon enthesitis. A positive correlation was found between age and BMI and FFI (p

Objective. The purpose of the work is to improve the methods of controlling the act of swallowing normal, with the output of objective indicators with mathematical justification. To study the anatomical features of the dynamics of contraction of the muscles of the mouth and pharynx when swallowing and to give signs of their conformity to the ultrasonographic image.Object and methods. The study involved 57 volunteers without signs of dysphagia aged 25-65 years. Scans were performed in the sagittal and frontal planes with a 7.5 MHz sensor in two modes B and M at rest and during the act of swallowing. Results. New methods of ultrasonographic research are introduced in the work, where the muscles of the chin-lingual, chin-sublingual, maxillo-sublingual and biceps muscles are visualized, the amplitude of contraction of these muscles is determined from right and left, and if the amplitude of movement is less than 30%, this indicates a swallowing act. They then scanned the hyoid bone, thyroid cartilage, and mandible and measured the orifice between them at rest and during the act of swallowing. In addition, a brief overview of the methods and use of ultrasonography in assessing swallowing function in patients was described. Conclusions. In the normal act of swallowing in a healthy person, the range of motion of the hyoid bone with a reference measurement to the edge of the chin of the mandible is a maximum of 8 mm to 12 mm. During the normal act of swallowing and contraction of the sublingual muscle group, the vertical size of this complex increases by 30.8 ± 1.3% in the B-mode and about 40% in the M-mode. The range of contractions of the anterior abdomen of the biceps horizontally during swallowing decreased by 33.12 ± 1.6%

Objective. Improvement of quality of the patients’ treatment, who suffer chronic hemorrhoids Stages III-IV, applying ultrasound energy intraoperatively. Materials and metods. The results of treatment are presented of 129 patients, suffering chronic hemorrhoids Stages III-IV: in 58 of them ultrasound energy was applied (Group I - the main), and in 71 - a standard procedure was performed (Group II - a control one). Results. Average duration of the operation have constituted in patients of Group I - (15.8 ± 1.7) min, and in Group II - (38.6 ± 1.5) min (p < 0.05). Postoperatively the patients of Group I have complained of pain during (3.4 ± 0.2) days, while in the Group II - during (7.5 ± 0.5) days (p < 0.05). In the patients of Group I only nonnarcotic analgetics during (3.4 ± 0.2) days; while in the Group II narcotic preparations were needed (2.1 ± 0.2) days, and nonnarcotic - (5.4 ± 0.3) days. Postoperatively in the Group II patients the pain syndrome level on the first day have constituted (9.1 ± 0.4) points, what is in 2.4 times higher, than in Group I (p < 0.05). Average stationary stay have constituted in the operated patients of Group I (2.8 ± 0.2) days, and in the Group II - (4.3 ± 0.4) days (p < 0.05). Conclusion. Application of the ultrasound energy permits to shorten the operation duration, average duration of stationary stay of the patients, and to reduce the pain syndrome level. Also, while application of ultrasound, the necessity to use narcotic analgetics postoperatively is eliminated. The quality of life indices during 6 mo postoperatively were better in the patients, who were operated, using ultrasound, than in those, to whom classic hemorrhoidectomy was performed.

Introduction. Liver lesion in congenital syphilis in infants in the first months of life is clinically observed in 74–86% of children in the form of enlargement and thickening during palpation. Pathological and anatomical studies reveal in 100% of cases typical changes in the liver, which are mainly due to diffuse round-cell infiltration, expansion of connective tissue and formation of gummas. Purpose of research. To analyze the indicators of ultrasound examination of the liver and spleen with the assessment of organ blood flow in children born to women with syphilitic infection and to identify the most significant signs associated with early congenital syphilis in the neonatal period.Materials and methods. The paper analyzes the data of a comprehensive survey of 397 newborns who were under observation from birth to 1 month of life, included in the study with the indication of the fact, born to women with a history of documented confirmed syphilitic infection.On the basis of the total sample, three groups of children from birth to 28 days of life were formed, taking into account the Federal clinical guidelines for the management of patients with syphilis (Moscow, 2015).The results of the study and their discussion. In 1 and 2 study groups found a significant increase in the oblique vertical size of the right lobe was 74.3 ± 0.7 mm (p < 0.05) and 73.9 ± 0.4 mm (p < 0.05), vs. 68.8 ± 0.3 mm in the control, as well as the thickness of the left lobe of the liver is 35.3 ± 0.4 mm (p < 0.05) and 34.8 ± 0.6 mm (p < 0.05), compared to 31.4 ± 0.7 mm in the control group. Along with this, in these groups, a higher index of the maximum blood flow velocity in the portal vein was noted, which in these 1 and 2 groups was 0.26 ± 0.02 m/s (p < 0.05) and 0.25 ± 0.02 m/s (p < 0.05), respectively, against 0.20 ± 0.02 m/s in the control. Along with sonographic signs, there was a significant prevalence of hyperbilirubinemia in groups 1 and 2 of newborns – 24.1% (p < 0.001) and 19.9%, respectively, against 9.0% in the control group (neonatal hepatitis was diagnosed in 11.4% of newborns with early congenital syphilis).Conclusion. The ultrasound features of the liver and early congenital syphilis include an increase in size, structural changes in the liver (only in PBC with symptoms) and hemodynamic features, characterized by increased blood flow by increasing the absolute value of linear velocities (maximum systolic and minimum diastolic) with a reduced resistance index.

Aim: to improve efficacy of predicting preterm labor in the first trimester of pregnancy by combining diverse parameters of cervical ultrasound examination.Materials and methods. A prospective cohort study of 1517 women with uncomplicated pregnancy was performed. Inclusion criteria were: females underwent cervicometry at 11–14 weeks of gestation, singleton pregnancy, revealing no complaints at the onset of examination. All women were subdivided into four groups: Group 1 – 27 pregnant women with shortened cervix (less than 30 mm); Group 2 – 24 pregnant women without cervical gland area (СGA); Group 3 – 30 pregnant women with two risk factors (shortened cervix less than 30 mm and lacked СGA); Group 4 (control) consisted of 1436 pregnant women with cervix length exceeding 30 mm and presence of СGA.Results. Average delivery term in Group 1 was 35.7 weeks (95 % CI = 34.7–36.8), in Group 2 – 34.7 weeks (95 % CI = 33.59–35.0), in Group 3 – 33.23 weeks (95 % CI = 31.6–34.8), in Group 4 (control) – 38.11 weeks (95 % CI = 38.06–38.17). A significant moderate correlation (Rxy = 0.534) between shortened cervix, absence of СGA and delivery term was found (p < 0.001). A regression model consisting of cervical length and presence of СGA was simulated based upon 50.8 % factors underlying probability of preterm birth, revealing 42.6 % sensitivity, 99.1 % specificity, and 96.6 % overall diagnostic value. The area under the ROC curve was 0.902 ± 0.022 (95 % CI = 0.860–0.945). The data obtained reflect diverse biochemical changes such as collagen decomposition, altered glucosamine level and fluid amount within cervical tissues. Such processes result in shortened, softened and expanded (matured) cervix. Uncovering markers for preterm cervical maturation underlies a logical strategy to predict miscarriage.Conclusion. Untrasound cervical measurement in the first trimester of pregnancy allows for revealing valuable miscarriage predictors (shortened cervix and absence of GI). Risk assessment by combining diverse ultrasound cervix parameters would allow to improve overall predictive efficacy.

Lipodystrophy at the injection sites is most common local complication of insulin therapy. The history of its study started in 1926, when first cases of lipoatrophy at the sites of insulin injections were described. As we moved to human insulin and insulin analogues, immune mediated atrophic form of lipodystrophy has been replaced by hypertrophic one, which reflects anabolic and mitogenic effect of insulin. Lipohypertrophy at the injection sites is detected by physical examination in 40-70% of insulin-treated subjects. The detection efficiency depends on health care provider`s skills. Therefore, training of medical doctors and nurses in physical examination of injection sites seems to be reasonable. In recent years, ultrasound was introduced for diagnostics of insulin-induced lipohypertrophy. The method is more sensitive compared to palpation; ultrasound-verified lipohypertropthy was detected in more than 80% of cases. In patients with wide-spread lipohypertrophy ultrasound can be used to find suitable sites for injections (“ultrasound injection map”). Strain sonoelastography and 3D-power Doppler ultrasound can be used for quantitative estimation of rigidity and vascularization of lipohypertrophy. Both MRI and infrared images are considered as promising diagnostic tools. In a number of studies, it has been shown that the presence of lipohypertrophy is associated with high HbA1c levels, enhanced glycemic variability, «unexplained» hypoglycemia, and increased insulin doses. Thereby, lipohypertrophy aggravates the diabetes-related costs. The main risk factor for lipohypertrophy is inappropriate injection technique, including the lack of the site rotation, injections into lipodystrophic lesions, small injection area, reuse or excessive length of the needles. Accordingly, training patients in the injection technique is the basis for prevention of complication. The cessation of injections in lipohypertrophy areas and regular site rotation is essential for adequate titration of insulin dose and achievement of glycemic targets.

The paper presents Consensus Guidelines of Russian Society of Radiology (RSR) and Russian Association of Specialists in Ultrasound Diagnostics in Medicine (RASUDM) «Role of imaging (X-ray, CT and US) in diagnosis of COVID-19 pneumonia» (version 2) of the Russian Society of Radiology and the Russian Association of Specialists in Ultrasound Diagnostics in Medicine.The guidelines list radiological techniques for lung diseases, which are used in coronavirus COVID-19 infection (chest X-ray, lung computed tomography (CT), and lung ultrasound (US), diagnostic algorithm, and follow-up study. The guidelines propose the models of the work of radiological rooms/departments of a healthcare facility, the procedure for conducting an examination, and recommendations for providing a description and assessing changes in the lung and chest in existing/suspected COVID-19-related pneumonia and present the schemes of X-ray and CT protocols at the initial examination and assessment of the changes.Chest X-ray has a low sensitivity for detecting initial changes in the first days of the disease and is not recommended for early diagnosis. Mobile radiography is an important tool for diagnosis of lung pathology in the intensive care units.CT is the most sensitive technique in detecting lung changes characteristic of COVID-19-related pneumonia. It is advisable to use CT for the initial evaluation of thoracic organs in patients with severe and progressive forms of the disease, as well as for the differential diagnosis and follow up.Lung US in patients with suspected/known COVID-19-related pneumonia is an additional imaging method that does not replace or exclude X-ray and CT. If the correct procedure is followed, correct indications are selected, and trained medical personnel is available, this study is highly sensitive in detecting interstitial changes and consolidations in lung tissue, but only in their subpleural location. The US data do not always allow definite determination of the reasons for the occurrence and/or actual extent of lung tissue changes.Standard reporting guidelines (CT, X-ray) about the possibility of COVID-19 pneumonia and its severity should be used.The follow up using CT, X-ray, or US depends on the clinical indications that necessitate dynamic assessment. The recommended frequency of repeat CT and X-ray in patients having no substantial changes in their clinical condition outside the intensive care units is not more than once every 5-7 days. An objective assessment of the time course of changes is possible only when comparing the data of the same type of study.

Diagnosis of intestinal obstruction in children, one of the commonest surgical emergencies, may still test the acumen of the attending clinician. Any delay in diagnosis may lead to complications which carry high morbidity or may even be fatal. Besides clinical judgment, radiography plays an important role in the diagnosis. Ultrasonography, although not the investigation of choice but it does give an initial suggestion of the diagnosis in the child without any harmful effects of radiation. The authors declare they have no conflict of interest