Natalia S. Nosenko

Introduction . Nerve conduction study (NCS) is the main component of instrumental diagnostics of ulnar neuropathy at the elbow (UNE). In recent years, ultrasound (US) examination has become increasingly important, allowing the identification of the site of compression, dynamic examination, and assessment of the structures surrounding the nerve. Aim. To compare the results of NCS and US in patients with clinical signs of UNE. Materials and methods . The NCS and US data were analyzed in 93 patients with clinical signs of mild (86 patients) and moderate (7 patients) UNE. Standard NCS studies and US of the ulnar nerve were analyzed. Results. Electrophysiological changes corresponding to UNE were detected in 48 (51.5%) examined patients, ultrasound changes in 50 (54%). The groups with positive and negative NCS and US results did not differ in the main anthropometric characteristics and disease duration. When the left ulnar nerve is involved, nerve conduction study and ultrasoun are often positive; the presence of m. anconeus epitrochlearis in the retroepicondylar groove is often accompanied by negative nerve conduction study results. The ulnar nerve CSA is characterized by an inverse correlation with the amplitude of the ulnar nerve sensory response, motor nerve conduction velocity at the elbow and compound muscle action potential amplitude recorded from abductor digiti minimi muscle. The maximum ulnar nerve CSA at the elbow differs in patients with different UNE severity (p = 0.0001). Conclusions . In the group of patients, which was characterized by a predominance of patients with mild cubital tunnel syndrome, NCS and ultrasound results are highly consistent. The identified factorial interactions indicate the need for a comprehensive approach to diagnosing ulnar nerve lesions, taking into account the lateralization of the process and the specific anatomical features.

Background . Thrombosis in the inferior vena cava (IVC) system complicates the course of various pathological processes and is one of the most common vascular diseases. The most dangerous complication of venous thrombosis is pulmonary embolism (PE). An analysis of a late complication of cava filter implantation (CF) (thrombosis and inferior vena cava syndrome), which poses a threat to the patient’s life, was carried out using the patient’s example. In the long term, the disadvantages of CF implantation may dominate their therapeutic role. Clinical case description . A variant of clinical and laboratory-instrumental diagnostics, therapeutic tactics in the development of CF thrombosis and their results are described. Conclusion . Cava filters are in demand medical devices for the prevention of pulmonary embolism. However, a large number of complications after the installation of CF are understood as dynamic monitoring of the CF condition. Ultrasound is the preferred imaging method as a non-invasive and the most accessible method for assessing the degree of CF patency.

Background: Atherosclerotic stenosis of the carotid arteries is one of the main reasons of stroke, of transient ischemic attacks, of developing cognitive disorders and of incapacitating the population. The key indication to invasive treatment for this disease is the degree of stenosis in the carotid artery, due to which the most important problem in the diagnostics is the maximally precise evaluation of the stenosis degree. The duplex scanning of the carotid arteries is a safe, non-invasive and relatively inexpensive visualization method, which is the first line of diagnostics. The precision of measuring the stenosis and the occlusion of the carotid artery, according to the ultrasound examination data, varies from 70% to 90%. At the same time, the degree of stenosis, measured using various methods, does not always match. AIM: to compare the data obtained by duplex scanning of the brachiocephalic arteries and by other instrumental diagnostics methods in terms of the precision of measuring the percentage of stenosis in the carotid arteries, as well as to analyze the reasons of discrepancies between the obtained data. METHODS: The research is based on the retrospective analysis of case history data from the patients hospitalized to the Vascular Surgery Department of the Federal State Budgetary Institution «Federal Scientific and Clinical Center» under the Russian Federal Medical-Biological Agency during the period from 01.05.2023 until 20.05.2024. The obligatory inclusion criteria for the analysis were the presence of the main disease of the I65 group according to the ICD-10 and undergoing at least one of the examination types within the settings of the FSBI «Federal Scientific and Clinical Center» under the Russian Federal Medical-Biological Agency (duplex scanning, computed tomographic angiography, transcatheter X-ray contrast angiography). The statistical processing was done using the Statistica software pack version 10.0 (StatSoft). RESULTS: The conducted research has shown that there is no complete matching between the data from the transcatheter X-ray contrast angiography, the computed tomographic angiography and the duplex scanning. The analysis of the reasons of discrepancies when measuring the degree of stenosis in the orifices of the internal carotid arteries from the results of duplex scanning and computed tomographic angiography has allowed for isolating three main groups: the human factor (operator-dependent, 30.4%), the anatomic factor (23.2%) and the differences in descriptions (46.4%). CONCLUSION: Upon examining the patients, it is necessary to strictly follow the algorithm of diagnosing the stenoses of the carotid arteries, beginning from the duplex scanning of the extracranial segments of brachiocephalic arteries as the most accessible and highly informative method. Computed tomographic angiography of this vascular segment is required for selecting the patients for surgical treatment, for it is necessary to keep in mind the potential risk of developing the contrasted nephropathy and the risks of radiation exposure. A properly done ultrasound examination allows for not only decreasing the number of discrepancies between these two diagnostic methods, but also to avoid the necessity of conducting such an invasive radio-contrasting method as angiography.

   Relevance. This work presents the diagnostic capabilities of the capnometry and spirometry methods in individuals with a mild form of COVID-19 infection.   Objective. To assess changes in external respiration parameters in patients with a mild form of COVID-19 infection.   Materials and methods. The results of examination of 2 groups of patients were analyzed. Group 1 included 30 subjects after a mild form of COVID-19 infection, 10 men and 20 women, average age 56.3 ± 4.2 years. The group was also divided into 10 people depending on the period after the infection: 3 months, 6 months and 9–10 months. Group 2 included 30 healthy volunteers: 16 men and 14 women, average age 45.6 ± 2.4 years.   Results. Two groups of patients were examined: Group I — subjects who had COVID-19, Group II — 30 healthy volunteers. Capnometry revealed a statistically significant increase in the alveolar phase slope in subjects who had COVID-19 infection compared with the control group during quiet breathing and deep exhalation, and statistical differences in the Toulu index were also revealed. According to the spirometry data, no statistical difference was found in the FEV1, FVC, and FEV1/FVC ratio.   Conclusion. The capnometry method revealed ventilation-perfusion disturbances for 10 months after mild COVID-19 infection. No changes in spirometric parameters were noted after mild COVID-19 infection. The capnometry method can be recommended to identify persistent disturbances in subjects who have had mild COVID-19.

Objectives: To identify typical patterns of abdominal wall muscle activation in patients with diastasis recti and inguinal hernias compared to controls during the Valsalva maneuver, voluntary coughing, and physical activity. Methods: The study included 15 subjects: 5 with diastasis recti, 4 with inguinal hernias, and 6 healthy controls. The functions of rectus abdominis (RA) and external oblique (OE) muscles were measured by surface electromyography (sEMG). Using ultrasound, the thicknesses of the RA, OE, internal oblique (IO), and transversus abdominis (TA) muscles were assessed as well as the echo intensity (EI) of RA and OE. Results: We found a significant effect of the type of abdominal wall pathology on the maximum sEMG amplitude (p = 0.005). There was a reliable trend in maximum sEMG amplitude, with the highest one in diastasis recti and a significantly lower one in inguinal hernias. Duncan’s test showed a significant difference in muscle thickness, both on the right and left sides, between patients with diastasis and controls, but only on the left side between patients with diastasis and those with inguinal hernia (p < 0.05). Conclusions: The abdominal wall pathology results in a change in the function and structure of the abdominal muscles, which can be detected using electromyography and ultrasound examination. The presence of diastasis recti is accompanied by an increase in bioelectrical activity and a decrease in thickness.

Relevance. This article discusses the use of nitrogen depletion and lung diffusivity measurements to assess functional lung capacity (FLC) in patients with bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD).Relevance. This article discusses the use of nitrogen depletion and lung diffusivity measurements to assess functional lung capacity (FLC) in patients with bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD).The purpose. Comparative assessment of FRC values measured using diffusion tests and nitrogen-leaching methods during multiple respirations.Material and methods. An observational cross-sectional study was conducted. The examination results of the two groups were compared. Group 1: included 30 patients with BA of 3–4 severity — 13 men (43.4 %) and 17 women (56.6 %); the average age was 50.6±4.3 years at the stage of subsiding exacerbation. Group 2: included 30 patients with moderate COPD — 13 men (43.4 %) and 17 women (56.6 %), average age was 50.6±4.3 years. The functional residual capacity of the lungs was determined using the multiple-breath nitrogen washout method, whereas the diffusion capacity of the lungs. The statistical analysis and visualization of the obtained data were performed using the statistical computing environment R 4.3.0 (R Foundation for Statistical Computing, Vienna, Austria). Differences were considered statistically significant at a pResults. Two groups of patients were examined: first group — 30 patients with BA of 3–4 severity; second group — 30 patients with COPD. When statistically analyzed between the two methods, no significant differences were observed in the FRC values using the nitrogen washout method and lung diffusivity. The Bland-Altman method produced similar statistical results.Conclusion. Measurement of FRC in patients with asthma and COPD can be performed using both lung diffusivity and multibreath nitrogen washout methods.

The article discusses the use of methods for assessing lung respiratory function in patients with chronic obstructive pulmonary disease (COPD) and smokers.The aim of the study is a comparative evaluation of the informative value of capnometry, spirometry, multiple breath nitrogen washout method, and diffusion test in patients with COPD, as well as an early detection of respiratory function impairment in smokers.Results. Three groups of patients were examined: 1st — 30 patients with moderately severe COPD, average age 50.6 ± 4.3 years, 2nd — 30 smokers, average age 45.6 ± 2.4 years, 3rd (control group) — 30 practically healthy non-smokers, average age 45.6 ± 2.4 years. Capnometry showed a statistically significant increase in the slope of the alveolar phase in patients with COPD compared to the control group and smokers at rest, both before and after bronchodilator use. Significant differences between smokers and control groups were detected during forced exhalation. According to spirometry data, the FEV1/FVC ratio in patients with COPD was statistically significantly lower compared to the control group and smokers, both before and after bronchodilator use. Diffusion capacity was significantly lower in patients with COPD and smokers compared to the control group. The lung clearance index was significantly higher in the COPD group compared to the other two groups.Conclusions. All the mentioned methods were informative in patients with COPD, but capnometry and lung diffusion capacity assessment were sensitive methods in smokers, revealing uneven distribution of ventilation-perfusion ratios in the lungs and impaired gas exchange function.

The article discusses the possibilities of functional assessment of the state of the respiratory function of the lungs in patients with bronchial asthma.The purpose of the study: a comparative assessment of the information content of capnometry, spirometry, the method of multiple breath nitrogen washout and the diffusion test in patients with asthma.Results and conclusions: 2 groups of patients were examined: I — 30 patients with asthma of 3–4 degrees of severity, II — 30 healthy volunteers. Capnometry showed a statistically significant increase in the slope of the alveolar phase in patients with asthma compared to the control group with quiet breathing, both before and after the use of a bronchodilator. According to spirometry data, in patients, the FEV1 /FVC ratio was statistically significantly lower compared to the control group, both before and after bronchodilator use. In a comparative analysis of the diffusion capacity of the lungs, there was a trend towards lower DLCO values in patients with asthma. A statistically significant difference was obtained in relation to the lung clearance index between the group of patients with asthma and the control group, in which the index was significantly lower. There were no statistically significant differences between the FRC (%) estimates obtained using the diffusion test and the method of the multiple breath nitrogen washout in patients with asthma. Thus, the informative methods in patients with asthma were not only the method of spirometry, but also the method of capnometry and the method of multiple breath nitrogen washout, which revealed uneven ventilation and distribution of ventilation-perfusion ratios in the lungs.

It is important for a doctor of ultrasound specialty to understand the methodology and the course of endovascular closure of the atrial septal defect for proper ultrasound support. If the occluder is placed correctly, the heart defect is completely eliminated. The surgeon performs implantation as accurately as possible under the control of radiography and transesophageal echocardiography.