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A clinical observation of focal accumulation of ⁹⁹(m)Tc-pyrophosphate in aortic aneurysm, simulating skeletal pathology of the lumbar vertebra in planar scintigraphy mode, is presented. Additional single-photon emission computed tomography combined with computed tomography-something view allowed to confirm that the radiotracer uptake focus was localized in the distal part of the aneurysm, in the zone of lumen subocclusion by a calcified thrombus. It is suggested that the local tracer accumulation is not only due to calcification but also due to inflammatory, a factor that plays a role in the genesis of aortic aneurysm.

Objective: to specify frequency, patterns and diagnostic significance of extraosseous soft tissue findings in 99mTc-pyrophosphate skeletal scintigraphy., Material and Methods: Results of skeletal scintigraphy from 1060 patients (447 men, 613 women) were analyzed. Scanning in "whole body" mode started in 3-4 hours after 740 MBq of radiotracer activity intravenous administration, and performed in anterior and posterior projections in continuous table motion mode at rate of 6-8 cm per minute. Single photon emission computed tomography/computed tomography (SPECT/CT) was additionally performed when necessary., Results: Extraosseous scintigraphic findings were discovered in 161 (15.2%) patients, they can be divided into three categories: nephrourological (7.7%), soft tissue (5.4%) and artifacts (2.1%). First category included anatomical and functional changes in the urinary system (kidney location anomalies and nonobstructive uropathies). SPECT/CT was performed to differentiate calycostasis in the projection of the upper group of calyces and focal changes of the ribs. Soft tissue extrarenal findings included diffuse or focal RP hyperfixation within breasts (29 patients), thyroid glands (15), myocardium (5), scrotum (4) and abdominal cavity (4). Symmetrical increased RP accumulation in breast or thyroid lobes was accepted as normal. Pathologic soft tissue findings in 11 patients were verified by history or instrumental data: breast cancer (2), testicular cancer (1), nodular goiter (2), uterine fibroids (2), primary cancer with liver metastases (1), association of "hot kidney" phenomenon with chemotherapy (2), and "superscan" phenomenon with myelofibrosis (1). Causes of radiotracer artifacts in the liver and spleen (14) were of radiopharmaceutical factors, in axillary lymph node (7)--partially infiltrative radiopharmaceuticals administration, in the colon (1)--previous myocardial perfusion scintigraphy., Conclusion: Analysis and interpretation of abnormal extraosseous findings in skeletal scintigraphy is an essential component of additional diagnostic information, that can influence subsequent diagnostic and therapeutic tactics.

Based on the analysis of the data available in the literature and own clinical observations, the authors consider the diagnostic value of the little known scintigraphic phantom kidney phenomenon, a vascular pool that is detected at the angiographic stage of 99mTc-DTPA dynamic renal scintigraphy and that mimics a removed or absent kidney. The paper describes two cases of the phantom kidney. In one case, the phantom kidney detected on the side of nephrectomy manifested a kidney cancer recurrence in the bed of the removed organ; in the other, the kidney-like vascular pool in the patient with left-sided pelvic dystopic kidney was due to the recording of the intestinal vasculature at the site of the expected kidney location. Adherence to a number of methodical conditions for conducting a study, as well as combined single-photon emission computed tomography/computed tomography examination will be able to avoid interpretation errors and to ensure an adequate further diagnostic algorithm.

There is presented an experience of the examination of 517 cases including sportsmen and ballet dancers, 15-45 olds, suffering from low back pain syndrome. 265 patients were diagnosed with osteochondrosis, 105 cases--with spondylolis, 92--with facet syndrome, and 55 cases--with pelvic ligaments ligamentopathia. Based upon the analysis of the results of examination diagnostic algorithm and differential diagnostics of these diseases were developed. The use of the proposed algorithm in patients with dissimilar variants of low back pain syndrome showed its informational content. It permits to make a right diagnosis and apply an adequate therapeutic approach.

The review of X-ray endovascular surgical methods applied in the practice of FSF CITO named after N.N. Priorov since 1970 is presented. The complex evaluation of the altered conditions of performing angiographic examinations for the time present was carried out. The main regulations of anesthesiological provisions for angiographic studies in conditions of an in-patient trauma department are described. The methods of interventional X-ray surgery became use in patients with vertebral column and spinal medulla injuries, traumas with the threat of pulmonary thromboembolism and in patients with bone pathology. More than 200 patients with a traumatic disease of the spinal medulla and scoliotic deformities were investigated. In all patients spinal angiography with the evaluation of the spinal cord blood supply was performed. The results of more than 450 angiographic examinations the patients with bone pathology are presented. In 83 cases X-ray endovascular embolizations of the regional blood flow were done. 63 Cava Filters were implanted in patients with floating pelvic and leg vein thrombosis. Own expertise of the use of tentative Cava Filters is described. These and other data testify of X-ray endovascular methods prove to be in demand in traumatological and orthopedic practice. Their application will open new possibilities for traumatologists and orthopedists in the process of preventive measures, diagnostics and treatment the patients

Method for the restoration of self-service ability in patients with tetraplegia was proposed. The use of the elaborated computer controlled device in creases the efficacy of rehabilitation. A basic realization of technical facilities and software can be further developed. In particular, the plan is drawn to expand the software functional for the possibility of prompt input of the required word from the dictionary. Application of this technology has shown to give a possibility toa great number of handicapped people with limitations in using a computer and thus realizing their intellectual potential in education, work and leisure to restore their self-service ability. A significantsocial and economic effect from the introduction of this technology into practice is expected.

In the paper data concerning the use of new module hip and knee endoprostheses "MATI-CITO" in the course of conservative surgery in patients with large defects of femur and proximal shin-bone, arising during removal of tumors or developing as a result of side effects of preceding management, are presented. In given category of patients the causes of high-risk of complications diminishing an efficiency of operations are discussed. It was shown that sophistication of fabrication technologies and practical application of new endoprostheses gives an opportunity to significantly improve the functional results of treatment and to decrease of number of complications. The development such new medical technologies, as X-ray endovascular surgery, intraoperational reinfusion of own blood allows to decrease operational lethality, improve the performance status of patients and accelerate their rehabilitation

At the department of the sport and ballet trauma new methods of arthroscopic management of posterior posttraumatic knee instability (posterior static stabilization of knee joint with using of single-banded and double-banded transplants) in dependence on the kind, degree and form of instability, were worked out and implemented into clinical practice. Such methods permit to attain a compensated or subcompensated form of knee joint stability. Ad hoc methods of management were used in 23 patients (20 males and 3 females). A total of 62 patients (51 males and 11 females) got operative treatment at the department, that permitted us to estimate fairly different methods of operative treatment of posttraumatic posterior knee joint instability. An operational intervention was performed in average 6 month after trauma. We received data in patients which had been treated with use of new methods of operative treatment as follows: good results were drawn in 93.3% (22 patients), satisfactory results--in 6.7% of cases (1 patient).

This work is been based upon the experience of performing 100 reconstructive microsurgical operations with transplantation of combined vascular-neural autografts, in 24 cases--with introduction cellular material into zone of transplantation. The complex approach aimed to creating optimal conditions for the functional regeneration of the spinal cord (SC), including neurosurgical methods restoring anatomical integrity of the organ and also multicomponent and staging rehabilitation of patients has been developed. On the base of complex approach during a postoperative period there has been put synchronous multifactorial action, consisting of functional multichannel electrical pacing of muscles simultaneously participating in tumble. The patient concentrates all his attention on the trial to tumble with paralized extremities by himself. At that the series and the site of application of these electrical impulses forms the algorithm of this tumble. Synchronism of produced afferent and efferent impulses creates new possibilities in activating of regenerating processes in the damaged area of the spinal cord. As a result of treatment within the bounds of the developed program the authors get clinically and electrophysiologically proved certain improvement that they can not only predict but guarantee patients of this group. Presented here results of the complex treatment of patients with trauma of the spinal cord within the framework of research international program confidently testify advantages of the new approach to solving of this problem. For the first time in history of medicine there is created close cooperation and regular continuity between molecular biology, neurosurgery and rehabilitation. This scientific alliance permits in proper time to keep a close watch, quickly correct and improve every stage of treatment. The effect of implement of innovations is been summarized at the each next stage of proposed complex treatment and eventually significantly elevates an ultimate result of medical rehabilitation of invalids with trauma of the spinal cord.

Myolastan was given to 9 sportsmen with acute muscular injury and 5 with chronic one in addition to the standard treatment. Control subjects with similar acute and chronic injuries (7 and 3 patients, respectively) were not given the drug. The patients with acute injuries on myolastan resumed muscular exercise 4.5 weeks after the trauma, while similar controls were able to do that only 6 weeks after it. Chronic injury patients returned to their routine loads 1 week earlier than controls. Myolastan proved effective in combined treatment of acute and chronic myoenthetic damage.

Scintigraphy with colloid 99mTc (56 cases) and the radiopharmaceutical preparation 99mTc--HIDA (43 cases) was performed in children with early and developed cirrhosis of the liver to study the functional condition of the hepatic Kupffer's and parenchymal cells in the long-term periods after surgical treatment. Increased activity of the parenchymal cells and inactivation of Kupffer's cells were revealed after splenectomy. The formation of a portocaval shunt and denervation of the hepatic artery promoted activation of hepatocyte functioning in these patients.

Hepatoscintigraphic investigations were conducted in 63 patients aged 3 to 15 to study the features of intrahepatic blood flow and degrees of its compensation in children with liver cirrhosis of different stages. 99mTc-colloid was employed as a radiopharmaceutical. Disproportions of scintigraphic liver images showed close correlation with clinico-biochemical and morphological signs of the severity of disease. Subcompensation and decompensation of the organ blood flow and reticuloendothelial system in children with developed and terminal stages of liver cirrhosis are characterized by prolonged blood RP inhibition, a decrease in the total clearance of radioactive colloid, a progressively reduced index of liver clearance, and an increase in a colloid uptake by the spleen.

The authors studied long-term (from 2 to 9 years) results of treatment of 178 children with intra- and periarticular localization of fractures of the upper extremities. The age of the children was from 4 to 15. It has been established that the further development of the injured joint is dependent on the character of the primary displacement, exact arrangement of fragments and correct terms of immobilization being of certain significance for the consolidation and further restoration of the anatomical integrity of the bone and for the joint functioning.

The significance of the anomalous development and acute inflammation of the bile cyst for the appearance of chronic acalculous cholecystitis in children is shown on the basis of results of complex investigations. Restoration of the bile cyst functions is shown to be possible in case of an isolated injury of the neck-duct zone by dissection of the injured tissues and cholecystocholedochostomy. The surgical treatment of chronic acalculous cholecystitis with a deformity of excretory portions of the bile cyst in children is stressed to be necessary.

Examinations and operations were performed in 32 children aged from 2 months to 15 years with common bile duct cysts. The extirpation of the cyst, hepaticojejunostomy were performed in 13 patients, cystoduodenostomy in 13, cystojejunostomy --in 4, external drainage--in 3 patients. The follow-up observations lasted for 1-10 years. Good results were obtained in most of the patients.

A cyst of the common bile duct, the most frequent variant of cystic dilatation of the extrahepatic biliary tract, presents a serious diagnostic problem. Using serial scintigraphy with 99mTc-HIDA 13 children with cysts of the common bile duct confirmed by the results of operative cholangiography, were examined. In 8 of them a radionuclide study was performed at varying times after operation (cyst extirpation with the establishing of hepatoenteroanastomosis--4 patients, and variants of internal drainage operations--4 patients). Typical scintigraphic signs were the following: sacculated or spheroidal dilatation of the common bile duct in combination with dilatation of the left (7), right (1) or both lobular bile ducts, absence of the gall bladder visualization. In the first 15 min of examination in large size cysts zones of the lowered accumulation of the radiopharmaceutical agent were revealed in the area of the portal fissure. Indicators of absorptive-excretory hepatic function changed mainly in children with spheroid-shaped cysts demonstrating alongside with the time of intestinal visualization the degree of disorder of permeability of the choledoch distal parts. The recovery of the anatomic-functional state of the biliferous system occurred earlier (up to 1.5 year) in children after cyst extirpation than after internal drainage operations. It manifested itself in returning the diameter of the bile ducts to normal and in the improvement of absorptive-excretory hepatic function.

Radionuclide and sonographic studies of liver and biliary tract of 37 patients infested with O. felineus, including 7 patients with an early and 30 with late chronic disease were performed. Alterations in radionuclide and sonographic characteristics were revealed, pointing to dyskinetic disturbances in the gallbladder and to the cholestatic syndrome (reduced secretory function of the liver, dilated bile ducts, late visualization and reduced concentration function of the gallbladder). The most profound abnormalities in the indices were seen in patients early in the disease. Prasiquantel treatment contributed to rapid restoration of gallbladder motor function.

Altogether 103 children with different variants of gallbladder abnormalities (deformities, bends, contractions, septa, diverticula) were examined using radionuclide cholescintigraphy with 99mTc-HIDA. Scintigraphic signs of organic lesion were characterized by symptoms associated with the unevenness of the filling of the gallbladder, its shape and contours. Their frequency depended on anatomical defect site. Changes in the cervical part (70%) and in the body area (60%) were better diagnosed. Changes in the gallbladder fundus (12.5%) were practically undetectable. The calculation of quantitative indices of gallbladder filling and motor function made it possible to objectify the gravity of organic change of the organ, the nature and degree of its functional compensation.

The authors examine the peculiarities of the diagnosis, the clinical course and the roentgenologic manifestations of the fracture of the 5th metatarsal bone, the so-called Jones' fracture, in sportsmen. In this type of injury a good treatment result, i.e. the consolidation of the bone and the recovery of the foot at the early posttraumatic period is achieved by surgical treatment which provides for a necessary compression at the fracture site.

The results of cholescintigraphy with 99mTc-HIDA in 245 children were analysed. The relationship of a latent time period with the state of the stomach-duodenum system was revealed. The specificity of this index was 82%, sensitivity 70%, accuracy 75% and pathology predictability 85%. The scintigraphic picture of a duodenobulbar reflux in the form of a RP "depot" in the ascending and upper horizontal part of the duodenum manifested itself with the specificity of 90% and predictability of pathology in 75%. Duodenogastric refluxes were revealed with the specificity of 94%, accuracy of 88% and pathology predictability of 90%. A low specificity of 34 and 43% was associated with a possibility of reflux detection in the lower horizontal part of the duodenum only.

Scintihepatographic investigations with colloid 99mTc before and after operations in 4 groups of children were performed: with cavo- or ileomesenterial anastomosis, with splenorenal anastomosis with splenectomy and cavo- or ileomesenterial anastomoses in children with previously performed splenectomy and in a group of comparison. Perfusion of the liver was found to decrease: in the least degree after splenorenal anastomosis and in the greater degere after cavo- and ileomesenterial one. It was established that all kinds of shunts ensured function of hepatocytes.