POSSIBILITY OF COLOR AND ENERGY DOPPLER MAPPING IN THE DIAGNOSIS OF NODULAR NEOPLASMS OF THE THYROID GLAND

T.G. AKHVERDIYEVA., A.R. AGAYEVA, G.G. ABDULLAEV

Scientific Surgical Center named after acad. M.A. Topchubashov, Baku, AZERBAIJAN

One of the most common abnormalities of TG arenodular formations. The high risk of developing of cancer in such conditions makes urgent such issues of early and differential diagnosis of space-occupying thyroidallesions. In this connection, searches of new informative diagnostic techniquesare quite justified. We were given a task to assess the capabilitiesof color duplex (CDM) and energy (EDM) mapping during the selection of a risk group (patients with suspected malignancy from the point of view of malignization). 75 patients were examined. CDM and EDM with ultrasound dopplerographywas conducted on the Sonoace-Pico device. In our previous investigations we found that subject to the morphological form of nodular formation, there occur various degrees of quantitative and qualitative changes in the regional blood flow. Thus, in case of nodulareuthyroidgoiter reduced blood flow is found both in the node itself, and on its periphery. However, in some patients there was observed a mixed type of vascularization. In case toxic adenoma there was observed an increase in the volume velocity of blood flow along thyroid arteries, presence of intensive blood flood in node and less intensive blood flood in perinodulararea, increase of the number of small and medium-calibervessels, increase in the diameter of the arteries. In patients with cystic lesions there was observed avascular type of vascular pattern, and in thyroid cancer - intensive peri- and intranodularbloodstream. Thus, the CDMallows to evaluate the speed and direction of blood flow, the state of the vessel wall and its lumen, the length and diameter of arteries and veins, the number of capillaries and arterio-venous anastomoses, visualization of slow flows, tortuosity of vessels. Connecting to CDMEDM significantly increases the information value of the results and optimizes the process of differential diagnosis of nodular thyroid formations. Advantages of EHD are connected with the absence ellysing effect, independence of mapping on the direction of blood flow and angle ofscanning, high sensitivity to visualization of slow flows and vessel walls. Thus, the EHD is an important stage in the development of the CDM, which gives quite important information about the state of flow.

WARM ISCHEMIA TIME AND ANTI-ISCHEMIC TREATMENT DURING ANATROPHIC SURGERY ON KIDNEY

AKIF MEMMEDOGLU

Azerbaijan Medical University, Baku, AZERBAIJAN

It is usually necessary to interrupt renal blood flow during partial nephrectomy or nephrolitotomy related staghorn and multiple renal stones. Clamping of the renal artery or renal pedicle reduces intraoperative bleeding to a minimum and allows to operate in a bloodless operative field. When interruption renal blood flow more than 30 minutes is usually used hypothermic protection of the kidney, but during ischemia to 30 minutes anti-ischemic protection is performed using various hyperosmolar solutions, antagonista calcium, drugs inhibiting the reabsorbtion or antioxidants.We performed a partial nephrectomy in 19 and nephrolithotomy in 10 patients by clamping kidney vessels during 2000-2011 years. Partial nephrectomy was performed in patients with the coral- and multiple renal stones complicated calicectasis and cystic destruction of the kidney pole in 9 patients, with doubling pyelocaliceal system and hydronephrosis transformation of one of the poles of the kidney in a 7- patients, with presence of triple kidney and uretero trifid, terminal hydronephrosis of the upper pole in one case, with adenocarcinoma of the middle segment of the kidney (T1b) in one case. Ischemia of the kidney performed with compression of the renal artery during partial nephrectomy in 17, during nephrolithotomy in 6 patients, clamping of the renal pedicle used for partial nephrectomy in 2 patients, for nephrolithotomy in 4 patients. Warm ischemic time were ≥20 minutes in 9 patients, 20-30 minutes in 20 patients. When partial nephrectomy or nephrolitotomy with clamping of the renal vessels hemorrhage is usually much smaller than in same procedures without compression of the renal vessels. In our observations of blood loss estimated to be 30-260 ml (average 156 ml), blood transfusion is performed in a planned manner in the presence of initial anemia in 6 patients. In terms of blood loss was a substantial difference between the groups with clamping of the renal artery and with clamping of renal pedicles, such as in first group introperative blood loss were in average 204 ml, in second only 55 ml. At the same time determined differense between groups for warm ischemic time, which is main factor influensing to functional outcome of nephron sparing surgery. In group with clamping renal artery warm ischemic time were in average 26.9 minutes, in group with clamping renal pedicles anatrophic period were 17.3 minutes. Anti-ischemic protection of the kidneys performed in 10 patients with pre-infusion hyperosmolar solution - 10% mannitol 250 ml, in 6 patients mannitol combined with the intravenous use of antogonista calcium (verapamil), in 7 - patients used a combination of mannitol and furosemide and in 4 patients to this combination added preoperative 3-day oral application of vitamin E. Complications related surgical intervention or renal ischemia were not observed. We can not make general conclusions about the version of ischemic protection of the kidney, because we have insufficient numbers of patients subjected to partial nephrectomy or nephrolithotomy with warm ischemia, especially with solitary functioning kidney. Therefore, we allowed ourselves only to share our modest experience in this field.

Date: 2014-12-28; view: 787