Introduction. Chronic obstructive disease (COPD) and thromboembolism of the branches of the pulmonary artery or pulmonary embolism (PE) remain the most common and socially significant lung diseases. Circulatory disorders in these pathologies play a critical role in the development of the disease. Radiation techniques, such as computed tomography/angiography and single-photon emission computed tomography (SPECT), are the leading ones in recognizing changes in the lung parenchyma and vessels. Many questions can be successfully solved experimentally. The main radiation techniques used to study the vascular bed when modeling lung diseases in experimental animals are microangiography and perfusion scintigraphy. Purpose. To show the capabilities of radiation diagnostic methods for identifying vascular disorders in COPD and PE in experiments and clinical manifestations. Material and methods. A clinical and experimental comparison of pulmonary circulation changes during COPD and PE was carried out based on the results of perfusion scintigraphy/SPECT in 55 rats with simulated COPD- like condition and 622 patients with COPD of varying severity, as well as 58 rats with simulated PE and 180 patients with PE. Results. When modelling lung diseases (PE and COPD), the results similar to blood circulation and structural changes in the lung parenchyma in patients with these nosologies were obtained. In COPD, changes in the lung parenchyma correlated with disturbances in functional indicators (microcirculation, PaO2, PaCO2, DSLzd, DLco/VA, SDPA) and increased levels of endothelin-1 (r=0.72) and endothelial growth factor (VEGF-A) (r=0.79). Analysis of experimental and clinical data on PE showed the importance of identifying minor forms of thromboembolism. Conclusion. 1. Persistent microcirculatory dysfunctions in the pulmonary circulation play an important role in the pathogenesis of chronic broncho-obstructive pathology. After just 7 days, initial signs of emphysema can be detected in the ischemic area of the lung tissue, and by the 60th day typical bullous cavities can be detected. 2. In the chronic course of minor forms of thromboembolism of small branches of the pulmonary artery, local emphysema is formed. 3. At the early stages of COPD formation, regional zones of emphysematous restructuring of the lung tissue with a predominance of ventilation dysfunctions and zones of «compressive ischemia» with prevailing vascular disorders are formed. As the pathological process progresses, the ischemia factor acquires independent significance in the pathogenesis of the disease.

Introduction. The problem of predicting the course of fibrosing interstitial lung diseases (FILD) is extremely relevant for the timely initiation of the treatment. Aim. To build a prognostic model based on data from a comprehensive study of the cardiorespiratory system in patients with FILD. Material and methods. The study included a group of 40 patients: 18 men and 22 women (M±S 60±9.7 years old), with verified FILD, who completed a full range of clinical and instrumental studies of the cardiorespiratory system at the time of inclusion in the study and after 12 months of observation. Then the initial group was divided into 2 groups: group A (20 patients), which did not reach the combined point, and group B (20 patients), which reached the combined point after 12 months. The combined point consisted of several outcomes: an increase in the degree of dyspnea on the m-MRC scale to 4 points, a deterioration in the results of the 6-minute walk test ≥50 m, a decrease in FVC or TLC ≥10 %, a decrease in the diffusing capacity of the lung for carbon monoxide (DLСO) ≥15 %, the lung transplantation, a death due to the lung disease. Results. Groups A and B did not have any differences in gender, age (А group (M±S) 57±11.8 y. o.; B group (M±S) 63±7.6 y. o., (p=0.06)), structure of the FILD nosology, the therapy and the frequency of the antifibrotic drug prescription. The hard endpoint at 12 months was achieved in 20 of 40 patients (50 %). Patients who reached the combined point were characterized by initially lower lung volumes (VC(M±S) 2.09±0.56 (p=0.016)); FVC (M±S) 1.99±0.55 (p=0.029)), FEV1 (M±S) 1.67±0.37 (p=0.036)), according to the results of a comprehensive study of the pulmonary function; a higher oxygen desaturation index (ODI (M±S) 5.76±4.48 (p=0.022)) and a more pronounced decrease in nocturnal saturation according to the computer pulse oximetry and the cardiorespiratory monitoring (SpO2 (M±S) 81.01±6.74 (p<0.029)). We developed a prognostic model that included such indicators as: post-bronchodilator MOC 75, TAPSE, VE/VCO2 (VO2 peak), desaturation index and minimum SPO2 % (AUC=0.949). Conclusion. The developed prognostic model for the course of FILD, based on the data from the comprehensive study of the cardiorespiratory system, demonstrated high sensitivity (93.8 %) and specificity (87.5 %).

Objective. To assess the density of the calcified substrate of atherosclerotic plaques of the carotid arteries using data from the computed tomography of patients with multifocal atherosclerosis. Material and methods. In 251 patients with verified atherosclerosis of the coronary and carotid arteries, with a high prevalence of angina pectoris, a history of myocardial infarction and modifiable cardiovascular risk factors, multislice computed tomography (MSCT) of the carotid arteries was performed to assess the calcium index and determine the equivalent density of calcium deposits (EDCD). A morphological sub-study of the material from the removed atherosclerotic plaques was carried out using scanning electron microscopy (SEM) in 12 patients. Results. According to the MSCT data, we identified 5 main types of calcium deposit location in the thickness of the atherosclerotic plaque. We noted that totally calcified plaques were associated with carotid artery stenosis by more than 30 %. According to the SEM data, we identified 2 leading patterns: diffuse and compact types of microcalcification. There was a statistically significant association of a low level of EDCD with a diffuse type of calcification both in vivo (p=0.010) and ex vivo (p=0.008). Patients, having carotid artery EDCD less than 0.21 mg/mm3, reported a significantly higher incidence of type 2 diabetes mellitus (p=0.0001) and a history of stroke (p=0.021). When comparing the MSCT data on the calcium deposit density and their localization in the atherosclerotic plaque, we noted a statistically significant predominance of low EDCD with superficial calcification of the plaque (p=0.002). Conclusion. The use of a calculated indicator of the equivalent density of calcium deposits of the atherosclerotic substrate allows us to non-invasively obtain new data on the structure of plaques. The observed association of the superficial distribution of calcification with low calcification density according to the MSCT data may indicate potential plaque instability.

Introduction. Obliterating atherosclerosis of the lower extremity vessels is a chronic, steadily progressive disease of the leg arteries, with a high risk of limb amputation and death. Timely diagnosis and adequate treatment will help slow the disease progression, maintain the patient’s good health for a long time and avoid complications. Purpose. To study arterial blood flow in the microvasculature of the lower extremities, to qualitatively and quantitatively assess perfusion disturbances in functionally significant muscles of the lower extremities. Material and methods. Radionuclide examination of the main vessels and microvasculature of the lower extremities was performed in 36 patients, five of them with a diagnosis of lower extremity obliterating atherosclerosis in dynamics. Radiopharmaceuticals was administered through a catheter installed endovascularly above the aortic bifurcation when patients underwent arteriography of the lower extremity vessels, which also involves intra-arterial administration of a radiopaque contrast agent. Results. When processing the radiological study results, we visually assessed the distribution of radiopharmaceuticals in the vascular bed of the lower extremities, identified the asymmetry in the accumulation of radiopharmaceuticals as a percentage, quantified the accumulation of radiopharmaceutical pulses in the projection of the pelvic, thigh, leg and foot muscles, determining the level of accumulation in each of the areas of interest as a percentage. The radiological study results and direct aortic arteriography of the lower extremities with determination of the level of arterial stenosis confirmed the ischemic nature of the pain syndrome; and in the control study, the effectiveness of treatment with an improvement in perfusion parameters. Conclusions. Intra-arterial administration of radiopharmaceuticals makes it possible to assess the condition of the peripheral arterial bed, which has a significant role in the prognosis of lower extremity atherosclerosis and the results of reconstructive interventions. The method makes possible a hybrid topometric comparison of arterio-perfusion maps for diagnosis, planned treatment and monitoring of its results in dynamics.

Objective. To identify the correlation between magnetic resonance (MR) semiotics and the intensity of pelvic pain syndrome in female patients with deep infiltrating endometriosis of the posterior pelvic compartment. Material and methods. We performed a retro- and prospective analysis of MR studies of pelvic organs in 77 female patients with pelvic pain syndrome, aged from 24 to 39 years. We assessed the intensity of the pain syndrome using a visual analog scale (VAS). The patients were divided into 2 groups: 1st-patients with external genital endometriosis (EGE) without involving the posterior pelvic compartment, 2nd-patients with EGE of the posterior pelvic compartment. The patients of the second group were divided into subgroups: 1 – endometriosis of the posterior pelvic compartment without MR signs of intestinal wall invasion, 2 – posterior compartment endometriosis with MR signs of intestinal wall invasion. The study was conducted on a GE Signa 1.5 Tesla MRI scanner. Results. In the second group of patients with endometriosis of the posterior pelvic compartment, the pain syndrome (8.00 (7.00–9.00) was more intense than in the first group of patients without endometriosis of the posterior pelvic compartment 7.00 (5.00–7.00), p<0.001 and we evaluated a retrovaginal, retrocervical and posterior uterine localization. In the second subgroup of patients with signs of the intestinal wall invasion, the pelvic pain syndrome on the VAS was statistically significantly more intense 8.00 (8.00-10.00) than in the first subgroup of patients without signs of the intestinal wall invasion 7.00 (6.00–7.00) (P<0.001). Conclusion. Patients with identified deep infiltrating endometriosis of the posterior pelvic compartment have more pronounced manifestations of the pelvic pain syndrome then patients with endometriosis of other localizations.

Aim. To evaluate the possibility of using nitroglycerin sublingually in combination with 99mTc-Technetril cardiac perfusion single-photon emission computed tomography (SPECT) as a test for detecting viable myocardium. Material and methods. 28 male patients with coronary heart disease (CHD) and postinfarction cardiosclerosis were examined. Group 1 included 10 patients with CHD without signs of acute myocardial infarction (AMI). Group 2 comprised 18 patients with CHD, postinfarction cardiosclerosis (PICS). The control group consisted of patients who were subsequently rejected a diagnosis of CHD. Patients took 2 tablets (1 mg) of nitroglycerin sublingually, and then, at the peak of the drug’s action (after 3–5 minutes), they were intravenously administered 370 MBq of 99mTc-Technetril (by Diamed, Russia). Myocardial SPECT with 99mTc-Technetril was performed 1 hour after RFP injection. The next day, myocardial SPECT with 99mTc-Technetril was repeated at rest. Results. When taking tableted nitroglycerin at a dose of 1 mg sublingually, its maximum plasma concentration is on average 0.26 ± 0.04 microcgram/l. It is reached by 110–150 s, then maintained within 10 % of the maximum for 7-9 minutes. Nitroglycerin leads to improvement in global and local contractility and increased LV pumping function in CHD patients. This is most pronounced in individuals with a higher class of angina pectoris after AMI and major changes in intracardiac hemodynamics initially. The nitroglycerin test in combination with 99mTc-Technetril SPECT-CT allowed to identify myocardial areas with improved blood flow and increased EFLV after CABG. Conclusion. The nitroglycerin test in combination with 99mTc-Technetril SPECT-CT is effective for detecting viable myocardium in patients with coronary atherosclerosis and CHD, safe and relatively simple due to the sublingual route of nitroglycerin intake.

Introduction. The low regenerative potential of the heart prevents replacing dead cardiomyocytes with new cells. It has been shown that cell-free allogeneic biodegradable material (ABM) can increase the efficiency of reparative processes in myocardium and improve its structural and functional state. However, how the physical training capabilities change against this background has not been practically studied. Aim. To evaluate exercise tolerance in rats after the use of ABM. Material and methods. The work was performed on Wistar rats. Myocardial damage was caused by coronary occlusion (CO) and cryodestruction (CD) of the left ventricle apex of the heart. ABM was injected into the CO zone and along the perimeter of the myocardium affected area during CD. Animals with myocardial damage were included in control groups. Rats with myocardial damage and ABM injection constituted the experimental groups. Rats were taken into the experiment 45 days after ABM injection. The physical tolerance of rats was measured using the forced swimming test. Results. It has been shown that the swimming time of rats with СO by 62.5 % and with CD by 37.5 % (p<0.05) is less compared to similar indicators for these animals in the initial (intact) state, which indicates a significant decrease in their exercise tolerance in myocardial damage. Animals with CO or CD on the background of intramyocardial injection of ABM showed 33 % and 48 % longer swimming during the test, respectively. The increase in exercise tolerance of rats against the background of the ABM administration was accompanied by the improvement in the morphometric parameters of the heart. Conclusion. The effect of ABM intramyocardial injection on the endogenous mechanisms of cardiac muscle regeneration is effective and functionally significant.

Papillary fibroelastomas are the most common tumors of the heart valves. Among all primary heart tumors, the incidence of papillary fibroelastoma is about 15 %. The clinical picture is often asymptomatic, however, it can be complicated by a transient ischemic attack, acute cerebrovascular accident, acute myocardial infarction, heart failure, pulmonary embolism, and etc. The article presents a clinical case of a 55-year-old female patient with papillary fibroelastoma of the aortic valve, which caused angina attacks and was a probable cause of several myocardial infarctions. Complex radiation diagnostics using aortic computed tomography with ECG synchronization, transthoracic and transesophageal echocardiography made it possible to visualize a formation in the commissure area between the right coronary and non-coronary aortic valve flaps as the cause of the patient’s clinical manifestations. Comprehensive diagnostics made it possible to successfully perform emergency surgical treatment.

Congenital diaphragmatic hernia (CDH) is a severe congenital malformation that occurs as a result of delayed closure of the pleuroperitoneal canal or the diaphragm failure, which leads to the displacement of abdominal organs into the thoracic cavity. Timely diagnosis of recurrent diaphragmatic hernia in the long-term period causes great difficulties. The article presents a clinical observation of a 1-year-and-8-months old female patient operated on for false congenital diaphragmatic hernia and congenital heart defect during the newborn period. Chest X-ray at the outpatient stage allowed diagnosing a relapse of CDH and determining the urgency of hospitalization. In the hospital, the diagnosis was confirmed by computed tomography, surgical treatment was performed.

Common pulmonary vein atresia is a rare congenital heart disease, in which the venous return from the lungs flows through the four pulmonary veins into the cavity behind them without connection to the heart chambers. The article presents a clinical case of a newborn child with this malformation. Computed tomography showed a lack of pulmonary vein drainage in a typical location as well as the presence of a common venous collector. On the basis of the data obtained we made a correct diagnosis.

The diagnosis of interstitial lung disease in infants (chILD) is challenging due to the fact that the differential range encompasses more than 200 variants of nosologies with an overall estimated prevalence of 1.6–46 per 100,000 according to several studies. Thus, chILDs are 10 times less common than in adults. The chILD disease spectrum differs significantly from that seen in older children and adults. Interest in the topic of chILD has increased over the past 20 years, as evidenced by the published results of numerous studies and reviews. Also, multidisciplinary groups and respiratory societies have been established, such as the American Thoracic Society (ATS), the European Research Collaboration for Children’s Interstitial Lung Disease (ERS CRC chILD-EU), the French National Reference Center for Rare Respiratory Diseases in Children (RESPIRARE), etc. This article discusses recent advances in the study and diagnosis of chILD, with a special focus on rare and ultra-rare types of chILD. In addition, the stages of the diagnostic search and the increasing role of computed tomography are discussed.