D TRANSVAGINAL ECHOGRAPHY IN THE MODE OF COLOR AND POWER DOPPLER IN THE FORECASTING OF OVARIAN TUMORS

A.I. DAVYDOV, V.E. MEHDIYEV

I.M. Sechenov First Moscow State Medical University, Moscow, RUSSIA

The problem of ovarian tumors play a significant role in modern gynecology, taking into consideration the fact that the frequency of occurrence of these tumors are second among oncologic diseases of female genital organs.

The aim of the study is to explore the possibilities of three-dimensional transvaginal echography in the mode of color and power Doppler in the differential diagnosis of tumors and tumour-like ovaries neoplasms, as well as to compare the information value of the Doppler method in two-and three-dimensional mode in the differential diagnosis of ovarian tumors.

Materials and methods: The study included 159 women aged between 18-73 years with tumors and tumor-like ovarian neoplasms. The complex of diagnostic and therapeutic measures include: 1) a detailed clinical study with the study of ananesis, characteristics of menstrual and reproductive function, 2) transvaginal ultrasound scanning with 2D and 3D techniques, 3) two-dimensional and three-dimensional echography in color and power Doppler mode, 4) magnetic resonance tomography, and 5) study of tumor serum markers, and 6) histological macrodrugs, removed during the operation. Average age of the examined constituted 38.7+1.47 years. The overwhelming majority were women (57.7%) at reproductive age (18-35 years), 17.3% at late reproductive age, 13.5% were women at premenopausal age and 11.5% - at postmenopausal age. By the moment of the investigation duration of postmenopause ranged between 1.5 to 14 years (average age 5.33 + 1.85 years). During transvaginal ultrasound scanning in 2D mode, the voluminous pathologic ovarian neoplasms were diagnosed in all 159 observations (100%). In the course of histological analysis of the tissue of remote macrodrug, follicular cysts were found in 15 women, cysts of yellow body - in 18, cysts supraovarian appendage - a 12. In 9 patients there were revealed polycystic ovaries, in 29 - endometrioid cysts (bilateral - in 5 observation). Serous cystic adenomas were diagnosed in 20 patients, mucinous – in 13, mature teratomas – in 21 (in 2 observations - bilateral), papillary cystic adenomas - in 10, ovarian cancer – in 12 of the examined. Additional differentially diagnostic data were obtained during the evaluation of the ratio of arterial and venous vessels of intratumoral blood flow. In our study, in 97.66% of observations, in malignant tumors were predominated by a venous link. Quantitative indicators of blood velocity curves are not of fundamental importance during differential diagnosis of benign ovarian tumors. They should be guided by during suspicions of malignancy, and should alert a researcher during the detection IR <4, PI <0.6, Vs> 25 cm/sec.

Conclusions: Thus, the conducted studies have shown information value of transvaginal echography both in 2D and 3D mode of scanning. However, three-dimensional reconstruction of the image in color and power Doppler allows more careful study of internal structure of ovarian neoplasm, the nature of distribution of vessels and the degree of vascularization of the pathologic meoplasm, and thus, extends the capabilities of traditional ultrasound investigation. This facilitates the choice of the optimal treatment strategy of patients with ovarian neoplasms. It should be noted that it is not possible to make linear measurements in a three-dimensional reconstruction, and there are restrictions as to the size of neoplasms - not more than 80-90 mm in diameter (ovarian neoplasm of larger diameter cannot be referred to the same “area of ​​interest”).

KRASOVITOV’S DERMATOPLASTY OF THE FOREARM SKIN DEFECT IN A CHILD. CLINICAL CASE

D. V. DEREVIANKO¹, D. A. BUGAEV²

Municipal Budget Institution “City Hospital №1” ¹, Novorossiysk,

Stavropol State Medical Academy², Stavropol, RUSSIA

Introduction: Treatment of open injuries of the extremities with soft tissue defects remains one of the most difficult questions in plastic surgery. If it is in some cases not possible to perform microsurgery plastic operations, classical methods of dermatoplasty become the methods of choice.

Aim of work is to present a clinical case of Krasovitov’s dermatoplasty in a child, 5 y o, injured by fall down a tree.

Materials and methods: a child was taken to a hospital 30 minutes after accident. Status localis: a wound of a palmar surface of a forearm with two pointed skin flaps. Basement of the flaps directed distally. Dimensions of the wound: length – 15 cm breadth - ½ of forearm circle. Bottom of the wound are non-damaged fascia and fat. Skin flaps are pale, partially cyanotic with bloodless edges and positive pale spot symptom. Forearm X-ray revealed no any bone pathology. A child was taken to an OR after preoperative preparation. Wound revision was performed. There were no any signs of muscles, nerves and tendons injury. Skin insections were made in the flaps with a scalpel in order to determine border of their survivability. Taking into account the signs of flaps blood supply decompensation Krasovitov’s dermatoplasty was decided to be done. The both flaps were cut at the basement, fat was removed and they also were perforated. Debridement of the wound and hemostasis were performed carefully. The wound were covered with previously prepared flaps. During postoperative period a limited area of a secondary necrosis of the flap and small hematoma under one of the flaps were noticed. Stitches were taken out by the 14 – th day. 98 – 99 % of engraftment as a result was noticed. Rehabilitation was finished in an outpatient clinic. Hypertrophic scar was formed in a limited area (2*0.5 cm) during healing. Function of an extremity is unlimited. Parents of a child are satisfied with cosmetic result.

Conclusion: Krasovitov’s dermatoplasty remains clinically actual in spite of objective risk of postoperative complications. Careful abidance by rules of the method allows getting good results of extremity injuries treatment in children.

Date: 2014-12-28; view: 929