Publication of the results of scientific research: the choice of the journal and what should be the manuscript to satisfy the reviewers and the editor-in-chief.

The editorial discusses the original article of E.F. Abbasov et al. “Epidemiology anomalies of coronary artery origin and course”. Editorial stresses high incidence of congenital coronary anomalies. It discusses types of such anomalies, their classifications and clinical significance. Myocardial “bridges” are the most frequent anomaly of coronary artery course. This anomaly is benign but in rare cases when obstruction of the coronary blood flow through the tunneled segment of the artery is suspected, use of additional functional tests (studies of myocardial perfusion or coronary blood flow) is recommended. It is important to note that coronary CT-angiography has advantages over traditional catheter angiography in detection of coronary anomalies.

This article presents a clinical case demonsratinga high metastatic potential of clear cell renal cell carcinoma combined with atypical metastases to breast and paranasal sinuses. The prevalence of metastatic lesions to the breast and paranasal sinuses in various malignant tumors depending on their morphological forms is analyzed. The authors present an analysis of data published for the last 30 years. The optimal diagnostic algorithms to detect the progression of renal cell carcinoma and to evaluate the effectiveness of the treatment are considered.

Septic lesions of various organs currently remain an important topic for doctors. Frequent occurrence is associated with the high prevalence of such diseases as hepatitis, HIV, intravenous drug abuse, diabetes mellitus, different immunosuppression conditions and increasing cases of medical manipulations and interventions (catheters, endoprostheses, pacemakers). Often the injury of the “target organs” from the primary source is a clinical debut of the disease, so early diagnosis and correct interpretation of the radiologic data help in planning of the treatment and reduce the number of lethal complications and chronic course of disease. This article is dedicated to the main CT-signs of septic pulmonary embolism, as well as its possible complications.

Adrenocortical cancer (ACC) – a neoplasm of the adrenal cortex, which is rare, in 0.02–0.06% of cases. It is characterized by various clinical manifestations in the form of hypercorticism of varying severity and unfavorable prognosis. Typically, a tumor in the form of a node, often with signs of infiltration growth. Some tumors are formed by light and dark cells, there is often significant cellular polymorphism. Malignant tumors of the adrenal cortex have a pronounced tendency to hematogenous metastasis, usually in the lungs, bones and other organs. The article presents a rare clinical case of metastatic lung injury, identified 22 years after the removal of the adrenal malignant tumor (AKP).

Purpose. Until the mid-20th century they could be discovered only during autopsy, it means after death. With the introduction of coronary angiography it become possible to find them in a living person. Later on, new modalities such as computed tomography (CT) and magnetic resonance imaging (MRI) enhanced futher our abilities. It is very important to discover coronary anomalies in a living person, because some of them could lead to sudden cardiac death (SCD). In fact, coronary artery anomalies are the second main cause of the SCD in young athletes. Another importance is driven by the fact, that some of them could lead to lifethreatening complications during cardiac surgery when unknown before the operation.

Methods. We prospectively reviewed all coronary angiography films from 2011 to 2016 in our center. Coronary anomalies were reviewed and classified by two independent experienced operators. Patients with congenital heart disease and coronary fistulas were excluded.

Results. Out of 5055 patients 148 (2.9%) had coronary artery anomalies of origin and distribution. Those were 120 men (81.1%) and 28 women (18.9%) with an age range between 29 to 88 years. The three most common anomalies were myocardial bridge (48.7%), separate origin of the conus branch (13.5%) and separate origin of the LAD and LCX (8.1%).

Conclusion. In our study we found more or less the same types and incidence rates of coronary artery anomalies as in the world literature. We had apparently higher rates of myocardial bridges, compared to average number on angiography studies, but very close to authopsy study rates.

Background. Transthoracic echocardiography (TTE) is carried out according to expanded protocol. Besides that, focused echocardiography (FOCUS) used is an addition to the physical assessment of cardiac activity in searching for signs or confirming potential diagnosis in specific clinical context. Portable and hand-held imaging devices are used frequently for this aim. FOCUS has not been studied enough in the conditions of domestic health care. Therefore, an objective analysis of the world experience of this method is relevant.

Aim: to study the efficiency of FOCUS application using hand-held imaging devices in cardiological practice.

Materials and methods. Forty six scientific Englishlanguage publications were analyzed. Text and bibliography are available in the PubMed search system for 2010–2018 years. The use of FOCUS was subjected to critical analysis accordingly to various application fields.

Results. A lot of left ventricle structures and functions can be assessed by FOCUS without resorting to TTE or use it for verification later. The method has high diagnostic efficacy in myocardial contractility assessing in patients with acute coronary syndrome. Timely definition of right ventricle size and function might be crucial for clinical suspicion of pulmonary embolism. FOCUS should be used as screening diagnostic method for early detection of valve lesions in rheumatic heart disease.

Introduction. Acute abdomen is a complex condition that demands urgent diagnostics and treatment.

The propose of the study based on data we got in the Radiology Department of S.P. Botkin Municipal Clinical Hospital is to evaluate the role of computed tomography in acute abdomen diagnostics.

Materials and methods. 637 acute abdomen patient`s data were retrospectively analyzed, provided in the term from January 2017 to January 2018. The average age was 53 years old, from 18 to 98 y.o. Male to female ratio was 1:1,51, male – 383, female – 254. Inclusion criteria was acute abdomen clinical presentation.

Results. The most frequently seen conditions were ileus – 226 cases (35.5%), acute pancreatitis/pancreonecrosis – 185 cases (29%), ureteral occlusion with stones – 83 cases (13%), blunt abdominal trauma – 57 cases (9%), renal abscesses and inflammation diseases – 56 cases (9%). Liver abscesses – 13 cases (2%), mesenteric ischemia – 10 cases (1.5%), acute appendicitis – 4 (0,5%), aortic dissection – 2 cases (0,3%), hollow viscus perforation – 1 case (0.2%).

Conclusion. CT with high accuracy and in a short time identify the reason of acute abdomen in all shown cases that highly improve the quality of medical management.

Objective: to develop the basics of ultrasound elastography for diffuse and focal liver diseases.

Material and methods. 180 patients were examined, including 102 (56.7%) men and 78 (43.3%) women. Patients were hospitalized in the gastroenterological and surgical departments: 100 (55.6%) patients with diffuse liver disease (DLD), 80 (44.4%) with focal liver pathology (FLP). All elastographic techniques were used; The liver biopsy served as the reference method (n = 169 (93.8%)).

Results. If a patient has steatohepatitis, it is recommended to begin research with transient elastography (TE), in hepatitis – with compression elastography (CE), according to the study, it is determined that shear wave elastography (SWE) is informative in all clinical forms of DLD. The terms of elastographic monitoring have been developed: upon admission, after 6, 9, 12 months. With dynamic observation of patients, elastographic techniques have a high diagnostic and prognostic value with stable and positive clinical laboratory and instrumental dynamics (liver biopsy – AUROC 0,882, DI 0.741–0.699, elastography – AUROC 0,991, DI 0.779–0.997). At FLP the results of SWE help in determining the “zone of interest” for the subsequent conduct of a morphological study, with the aim of establishing a diagnosis.

Conclusions. 1. In the presence of a patient with steatohepatitis, it is recommended to begin research with TE, in hepatitis with CE, according to the results of the study, it is determined that SWE is informative in all clinical forms of DLD. 2. Dynamic elastographic monitoring in case of DLD should be performed at admission, after 6, 9 and 12 months, and then individually for each patient. 3. With dynamic observation of patients with DLD, elastographic techniques have a high diagnostic and prognostic value with stable and positive clinical laboratory and instrumental dynamics (liver biopsy – AUROC 0.882, DI 0.741–0.66, elastography – AUROC 0.991, DI 0.779–0.997). 4. It has been established that the results of all elastographic techniques can not be used as differential diagnostic tools, SWE helps in choosing a “zone of interest” for biopsy with subsequent verification of the diagnosis (AUROC 0.907 (95% DI 0.889–0.933)).

Common hepatic artery aneurism is a rare pathology. Today there are only isolated instances in the world medical literature. The risk of common hepatic artery and celiac arteries aneurism rupture is very high, and it reaches 50%. Mortality as a result of common hepatic artery aneurism rupture is 75%. Most visceral branches of aorta aneurisms occur asymptomatically unless there is a rupture. Diagnostics of common hepatic artery aneurism includes duplex ultrasound, X-ray computed tomography, magnetic resonance tomography with intravenous contrast and angiography. Differential diagnosis of common hepatic artery aneurism is between pancreas space-occupying lesion (pseudocysts) and paragangliomas. The article describes the clinic-diagnostic case of common hepatic artery aneurism.

Objective. To determine the characteristics of hemodynamics of the uterus with endometritis.

Material and methods. A retrospective analysis of 420 patients of reproductive age (19–53 years old) diagnosed with endometritis. The comparison group consisted of 323 women aged 17–52 without gynecological pathology.

Blood flow indicators in the uterine arteries, such as maximum systolic, end-diastolic, and average blood flow velocity (Vmax, Vmin, Vmean), were estimated, and an arterial perfusion index (API) was calculated. With 3D reconstruction of the uterus in angioregime, a vascularization index (VI), a flow index (FI) and a vascular flow index (VFI) of the uterus and endometrium were obtained.

Result. An increase in Vmax, Vmin, Vmean, as well as VI, VFI of the uterus and VI, FI and VFI of the endometrium in the early and middle proliferative phase of the cycle. API had monotonous values, but it should be taken into account in conjunction with VI.

Conclusions. Echography combined with color mapping, spectral Doppler graphics and vascularization index determination using 3D in angio mode is a highly effective method for the diagnosis of endometritis. Characteristic changes in hemodynamics in endometritis manifest as a violation of the venous outflow in the uterus and, especially, in the endometrium, in the presence of hypervascu larization according to data VI in the aggregate of regulatory or reduced indicators of API.

Data of MRI have the great diagnostic value for the estimation of the character of uterine leiomyoma growth, but do not allow make the unambiguous conclusions about the tumor proliferative activity.

Aim: to elucidate the relationship between MRI of uterine leiomyoma and level of tumor proliferation and assess the possibility of the using of MRI data for pre-operative diagnostic of proliferative tumor growth.

Materials and methods. Observation of 29 women with uterine leiomyoma was carried out. Before surgical treatment of the patients the MRI investigation with the general pelvic examination and estimation of the quantity of leiomyomas, their position, size and structure was conducted. In leiomyoma tissue and normal myometrium the Ki-67, transforming growth factor β3 (TGF β3) collagen 1A1 (COL1A1) and β-actin (housekeeper gene) mRNAs expressions were estimated by real-time reverse-transcription polymerasechain reaction.

Results. According MRI data the most significant differences between studied leiomyomas were connected with T2-weighted signal in comparison with unchanged myometrium: the low T2-weighted signal and preferentially homogenous tissue structure were observed in 58,5% cases, and the increased T2-weighted signal with some heterogeneous structure of tumor were found in 41.1% samples. MRI data were correlated with results of molecular-genetic investigation: the low T2-weighted signal was associated with high levels of TGFβ3, COL1A1 mRNAs expression and minimal level of Ki-67 mRNA expression, whereas in leiomyomas with high T2-weighted signal the high Ki-67 mRNA expression was noted.

Conclusion. Leiomyomas with heterogeneous structure and high T2 W signal are characterized by the high level of proliferative activity and this observation must be taken into account during leiomyoma estimation and choice of patient’s treatment tactic.

Aim. To evaluate the role of magnetic resonance imaging (MRI) as a diagnostic method in children with acute trauma of the cervical spine and spinal cord, to compare the correspondence of MRI results with neurologic symptoms in accordance with the ASIA scale.

Materials and methods. 156 children with acute trauma of spine and spinal cord at the age from 6 months up to 18 years were studied. MRI was performed on a Phillips Achieva 3T scanner. The standard protocol included MYUR (myelography) in coronal and sagittal projections, STIR and T2VI FS SE in sagittal projection, T2VI SE or T2 * VI FSGE (axial projection), 3D T1VI FSGE before and after contrast enhancement. Contrast substance was injected intravenously in the form of a bolus at the rate of 0.1 mmol/kg (equivalent to 0.1 ml/kg) at a rate of 3 to 4 ml.

Results. The causes of cervical spine blunt trauma were: road accidents (55), catatrauma (60), “diver” trauma (21), blunt trauma (20). Intramedullary lesions of the spinal cord were detected: concussion (49), bruising / crushing (27), hematomia (34), disruption with divergence of segments (21), accompanied by edema (141); extramedullary lesions: epi- and subdural, intralesive and sub-connective and soft tissues hematomas (68), ruptures of bundles (48), fractures (108), dislocation and subluxation of the vertebrae (35), traumatic disc herniation (37), spinal cord compression and/or rootlets (63), statics violation (134), instability (156).

Conclusion. MRI is the optimal method for spinal cord injury diagnostics. In the acute period of injury this technique has limited application, but it can however serve as a primary diagnostic method in these patients. MRI should be performed no later than the first 72 hours after injury. The most optimal for visualization of cervical spine trauma and spinal cord are T2VI SE and STIR in sagittal projection with suppression of signal from fat. MRI results correlate with neurologic symptoms at the time of performance according to the ASIA scale, and therefore MRI should be performed in all patients with acute cervical spine trauma, whenever possible.

Objective. Conduct a comparative analysis of clinical and neurosonographic indicators of intracranial hemorrhage in infants.

Materials and methods. In the clinical part of the study, 68 patients took part in the acute / acute periods of intracranial hemorrhage, which we took for the study on the basis of the Tashkent City Children's Clinical Hospital No1. Gender ratios of which were 69.1% boys (47 children) and 30.9% girls (21 children), from birth to 2 months of life (average age at the time of hemorrhage is 36.28 ± 9.85 days). Diagnostic examination included neurosonography (NSG) of all children in the first 24 hours of the implementation of intracranial hemorrhages on admission to the clinic.

Results. According to our study of 68 children with intracranial hemorrhage, it turned out that the average age of morbidity was 36.28 ± 9.85 days (p < 0.001) Neurosonographic indicators stated the presence of parenchymal hemorrhage (right and left hemisphere), SAH (subarachnoid hemorrhage), hemorrhage into the trunk, IVH (intraventricular hemorrhage) II, IVH III. According to neurosonography, parenchymal hemorrhage (right-16 or left hemisphere-21) was observed in 37 patients, SAH and IVH-II 21 (30.9%) patients, IVH III – in 17 (25%) patients, hemorrhage in 3 (4.4%) brain stem of patients

Conclusion. Analysis of the implementation of hemorrhage showed that not always small gestational age is the risk of hemorrhage. Cases of less severe changes (27%) on NSG with a coarser clinical picture and vice versa (15%), necessitate (taking into account the severity of the neurological state), a more detailed examination, including visualization (CT, MRI).