Current problems in the diagnosis of gastric cancer

Based on their own long-term experience in diagnosing gastric cancer and by taking into account the fact that clinicians and diagnosticians analyze this problem insufficiently objectively, the authors of the paper try to convince the reader that it is necessary to revert to the problems of its diagnosis again. They proceed from recent new reports on gastric cancer pertaining to both its morphological forms and diagnostic capacities wherein current radiation diagnosis requires its active return to the problem of its detection. This standpoint of the authors is based on the date of over 6000 comprehensive studies of the stomach, of them 2800 cases have been diagnosed as having tumor lesions. In addition to the assessment of current radiation diagnosis of gastric cancer, which involves both routine X-ray study and ultrasonography, X-ray computed tomography, and magnetic resonance imaging of the stomach, the authors express their opinion on some organizational issues without which the diagnosis of this disease cannot be improved.     

Contributions of the history,physical examination,and laboratory investigation in making medical diagnoses.

We report an attempt to quantitate the relative contributions of the history, physical examination, and laboratory investigation in making medical diagnoses. In this prospective study of 80 medical outpatients with new or previously undiagnosed conditions, internists were asked to list their differential diagnoses and to estimate their confidence in each diagnostic possibility after the history, after the physical examination, and after the laboratory investigation. In 61 patients (76%), the history led to the final diagnosis. The physical examination led to the diagnosis in 10 patients (12%), and the laboratory investigation led to the diagnosis in 9 patients (11%). The internists'' confidence in the correct diagnosis increased from 7.1 on a scale of 1 to 10 after the history to 8.2 after the physical examination and 9.3 after the laboratory investigation. These data support the concept that most diagnoses are made from the medical history. The results of physical examination and the laboratory investigation led to fewer diagnoses, but they were instrumental in excluding certain diagnostic possibilities and in increasing the physicians'' confidence in their diagnoses.     

Magnetic resonance tomography of temporomandibular joint

The paper shows the place of magnetic resonance imaging among other radiation diagnostic techniques in detecting abnormal changes in the temporomandibular joint. The authors' own data were based on the results of 315 examinations. The paper describes the technical features of examination of the joint and shows it possible to visualize different anatomic structures on T1-, T2- and Pd-weighted images. It also indicates the diagnostic potentialities of magnetic resonance imaging in identifying abnormal changes in the joint in its diseases and lesions. This has allowed the authors to show what is indicated for magnetic resonance imaging of the temporomandibular joint and that it is necessary to develop an algorithm of radiation diagnosis for patients with different clinical forms of joint diseases.     

Advancing the Field: Evidence for New Management Strategies in Invasive Fungal Infections

Invasive fungal infections (IFI) are a significant cause of morbidity and mortality in the immunocompromised. The traditional diagnostic methods of culture and histological examination lack sensitivity and often only make a diagnosis late when the fungal burden is high, reducing the chances of cure even with the availability of new more potent and less toxic antifungal agents. New non-culture-based serological and PCR assays have been developed. These appear more sensitive and are able to make an earlier diagnosis as compared with traditional diagnostic methods. Early diagnosis is central to reducing IFI-related morbidity and mortality. This review describes the diagnostic potential of the new serological and PCR assays and outlines how these assays have been incorporated into algorithms to improve the management of IFI.     

Radiation diagnosis of tumors at four sites (the lung, breast, stomach, and large bowel) in the organizational and methodological standpoints of practical public health of the Russian Federation

The basic idea of the paper is to put forth today's vision of detecting tumors at four sites (cancer of the lung, breast, stomach, and large bowel) at the level of municipal and regional public health systems. Based on their many years' experience in "contacting" this pathology, the authors characterize the role and significance of basic radiation techniques applied to each of these four tumors, which should be used in their diagnosis. The authors also underline the need for reasonably certifying radiation diagnostic apparatuses for municipal and regional public health systems, which would efficiently combine their diagnostic and economic profitability, which will be able to avoid materializing the potential of expensive radiation equipment by just 15-20% of its built-in efficiency. By taking into account the present epidemiological situation with each of the tumors in question and scientific-and-technological achievements of current diagnostic equipment, the authors underline the need for correcting diagnostic approaches applied in their detection. The paper also presents the opinion of the authors as to selective screening. They are sure that it is impossible without its use to gain even some moderate improvement of the results of diagnosis and hence those of treatment of tumors at four sites, which are all responsible for 50% of all malignancy. The idea that it is necessary to actively return radiation studies to the diagnosis of cancer of the lung, breast, stomach, and large bowel runs throughout the paper. As applied to tumors at each of these sites, the authors express their opinion as to their radiation diagnosis. Naturally, they could not ignore the fact that the authorities of medical industry in our country should take an active part in the solution of organizational problems touched upon in the paper.     

Counter-flow gas contrast in the differential diagnosis of formation of the cardiodiaphragmatic angle

X-ray examination using counter-flow gas contrast study was performed in 30 patients for differential diagnosis of cardiodiaphragmatic angular formations. Approximately 700 ml of gas was administered in to the mediastinum, 1500 ml into the abdominal cavity, followed by x-ray examination (roentgenoscopy, roentgenography and tomography) in 30 min. It made it possible to determine an accurate site of the formation and to make correct diagnosis in 28 cases. This method is highly informative and considerably reduces the diagnostic period, decreasing radiation exposure of a patient.     

Gastric and intestinal scintigraphy in the complex diagnosis of small bowel obstruction

An algorithm has been developed for radiation diagnosis of small bowel obstruction, which involves abdominal X-ray and ultrasound studies at the first stage and radionuclide evaluation of gastrointestinal transit, by using 100-150 ml of aqueous 99mTc-technefite or 99mTc-bromeside solution in a dose of 50-100 MBq (radiation load 0.7-1.4 MeV) per os. The sensitivity, specificity, and diagnostic efficiency of the whole radiation diagnostic complex and each procedure separately were determined by the results of examination in 180 patients with suspected small bowel obstruction, of whom 104 patients were operated on, but obstruction ceased during medical treatment. Inclusion of the radionuclide technique into the diagnostic complex involving plain radiography and ultrasonography was shown to enhance diagnostic efficiency up to 97-98%.     

Radiographic diagnosis of injuries of the pelvic ring in acute trauma

Data on 58 victims with multifocal damages to the pelvic ring were used to examine the diagnostic potentialities of different radiation diagnostic techniques and to compare their resolving power. The latter was 65.1, 83.3, and 94.7% in plain and multidimensional X-ray studies, and computed tomography, respectively. The paper describes the complex of signs of closed sacral fractures on plain X-ray films and oblique pelvic inlet (cauda), proposed by the authors, which could improve the diagnosis of fractures by 8.8 times, and an original orthopedic gauze-plate for the detection and estimation of invisible pelvic bone displacement, and an original procedure for pelvic X-ray study with targeted load in acute injury. This all can improve the quality of examination of the injured substantially and define indications for different treatments more correctly.     

Magnetic resonance cholangiopancreatography and a problem in diagnosis of hepatopancreatoduodenal diseases

Based on the findings of 54 magnetic resonance studies, the authors used 19 of them authors to study the types of normalcy. A role of the new noninvasive technique magnetic resonance cholangiopancreatography (MRCPG) in the diagnosis of hepatopancreatoduodenal diseases is assessed. The potentialities of MRCPG in the detection of most common diseases and malformations of the biliary system are demonstrated. Comparative studies of MRCPG and endoscopic retrograde cholangiopancreatography (ERCPG) were conducted in 18 cases. The paper shows a methodological approach to MRCPG and analyzes the studies by describing the MR semiotics of major diseases. Emphasis is laid on how it is important to combine routine MRI and MRCPG in certain diagnostic situations. The authors consider that MRCPG is able to replace X-ray endoscopic studies and primarily ERCPG in diagnostic terms, by reserving their therapeutical functions for itself. MRCPG has great potentialities that, require further investigations and analysis.     

Magnetic resonance imaging in the diagnosis of gastric cancer: X-ray versus MRI anatomic findings

The paper assesses the present-day role of MRI in the diagnosis of gastric cancer. The authors consider the major prerequisites for the main aim of their study to be: 1) a dramatic incidence of diffuse (endophytic) gastric carcinoma, which requires significant correction of today's approaches to its diagnosis and 2) a rather biased and, in the authors' opinion, present-day mainly negative attitude towards MRI of the stomach as a diagnostic method for its tumor lesions. By applying the X-ray-MRI anatomic principle to the comparative study of MRI findings in 50 patients with predominantly gastric intramural carcinoma and in 25 patients without gastric tumors (controls), the authors present their methods for gastric MRI, the MRI semiotics of gastric cancer by concurrently touching upon a variety of problems that characterize the potentialities of MRI of the stomach in the diagnosis of its tumor lesions, including their differential diagnosis. As a result, the authors highly appreciate gastric MRI and consider this method to be included into the diagnostic algorithm of radiation techniques used in the diagnosis of gastric cancer, which should occupy its definite diagnostic place.     

Current comprehensive diagnosis of pancreatobiliary cancer complicated by jaundice syndrome

The study was undertaken to enhance the efficiency of diagnosis of pancreatobiliary cancer complicated by jaundice by using the potentialities of currently available instrumental studies at most. The data of examination of 256 patients with this disease are presented. Based on diagnostic findings, the authors have constructed a diagnostic model of precision recognition of cancer of the extrahepatic bile ducts, pancreatic head, Vater's papilla.     

Role of digital X-ray study in the current diagnosis of gastric cancer

The authors attempted to assess and provide evidence for the expedience of using a digital radiography CR system in clinical gastroenterology. The prerequisite for this was the results of large-scale diagnostic studies of different organ and systemic diseases. The authors underline the specific features of application of this digital system: the latter allows several analogue X-ray apparatuses to be transformed to digital ones, provides economic efficiency as compared with apparatuses with the direct digitization of an image, shows telemedical prospects, and has low radiation loads as evidenced by research and experimental studies even in comparison with green systems, which makes the use of these digital systems in X-ray gastroenterology highly tempting. Based on a great body of data from 126 studies, the authors could show the effectiveness of the digital radiography CR system in the diagnosis of gastric cancer, demonstrate a modernized approach to formatting an obtained digital image, the possibility of postprocessor treatment that can enhance the validity of existing X-ray symptoms. This all permitted the authors to recommend using the CR systems in the diagnosis of gastric cancer, by taking into account the current obvious predominance of its morphological diffuse and mixed forms and corresponding difficulties of their endoscopic diagnosis.     

Role of computed tomography in every day practice of municipal health care of the Russian Federation

The basic idea of the paper is due to its authors' wish to provide a comprehensive objective assessment of the role and place of currently available technologies of radiation diagnosis in municipal health care of the Russian Federation on the basis of the computed tomography (CT) room of the Stupino Central Town Clinical Hospital that performs the function of the leading medical institution of the whole Stupino District, Moscow Region. The paper presents a detailed characterization of the basic lines of CT studies and an analysis of their scope in a great variety of clinical subunits of the multidisciplinary Stupino hospital offering 795 beds. The paper lays a great emphasis on the particularly organizational aspects associated with the CT diagnosis of different diseases at the level of municipal heart care. Moreover, the authors express the idea that the findings may be applied not only to CT, but also to the whole group of new radiation diagnostic technologies. By assessing CT at the level of municipal health care, the authors fix their attention on the technological aspects of this technique. Recommendations are given on the most suitable type of CT units for municipal health care depending on the size of the population under service and on the capacity of health care structures. One of the authors' main conclusions suggests that, in addition to the radiation diagnosis service, the administrators of both regional and municipal organizational entities of practical public health care of the Russian Federation should obligatorily participate in order to obtain the high efficiency of radiation techniques.     

Radiation diagnosis of interstitial lung diseases

The authors analyzed the results of complex radiation study of 1192 patients with various interstitial lung diseases (ILD). An algorithm of differential diagnosis of diffuse and disseminated lesions of the lung was derived by using the findings. The X-ray morphological principle underlies the algorithm. The level of structural lesions of the lung and tissue reactions and the presence of granuloma shadows are the governing criteria for evaluating the gross structure in the differential diagnostic complex. Great emphasis is laid on the significance of computed tomography (CT), high performance CT in particular, which is becoming the priority radiation diagnostic technique in pulmonology. Morphofunctional studies, 99mTc AMA and 67Ga citrate pulmonary scintigraphy in particular, specify the magnitude of changes in the microcirculatory bed and the activity of intrathoracic lymph nodes.     

64层螺旋CT不同剂量扫描对活动性继发性肺结核患者诊断价值、图像质量和辐射剂量的影响

目的:研究64层螺旋CT不同剂量扫描对活动性继发性肺结核患者诊断价值、图像质量和辐射剂量的影响,旨在为临床活动性继发性肺结核患者提供更为安全有效的检查方案。方法:将我院从2018年1月2020年1月收治的100例活动性继发性肺结核患者纳入研究。对所有患者分别进行低剂量(40 m A)以及常规剂量(120 m A)扫描和薄层重建。比较不同剂量扫描的诊断准确率、影像学表现、图像质量以及辐射参数、患者满意度。结果:64层螺旋CT低剂量扫描与常规剂量扫描诊断活动性继发性肺结核的准确率分别为92.00%、93.00%,两者比较差异无统计学意义(P>0.05)。低剂量扫描及常规剂量扫描在空洞、钙化灶、实变、磨玻璃密度影及树芽征发生率方面对比差异均无统计学意义(P>0.05)。低剂量扫描及常规剂量扫描在扫描图像质量、薄层重建图像质量方面对比差异均无统计学意义(P>0.05)。低剂量扫描各项扫描辐射参数均低于常规剂量扫描,差异有统计学意义(P<0.05)。低剂量扫描的患者满意度高于常规剂量扫描的患者(P<0.05)。结论:64层螺旋CT不同剂量扫描对活动性继发性肺结核患者的诊断价值及生成的图像质量相近,但低剂量扫描可有效降低辐射剂量,从而在一定程度上增加扫描的安全性,使患者满意度提升。     

Complex radiation diagnosis of nephroptosis in children

This paper analyzes a comprehensive study of 45 children treated at the Unit of Urology, Children's Republican Clinical Hospital One, Ministry of Health of the Russian Federation. Twenty children operated on for second- and third-degree nephroptosis made up an individual group. Clinical, laboratory, and radiation studies were performed 8-25 years after surgical treatment, by using radiation diagnostic techniques, such as excretory urography, ultrasonography, dynamic scintigraphy, aortography, Doppler color mapping ultrasonography. The authors have analyzed the capacities of complex radiation diagnosis of orthostatic renal dysfunctions in children with nephroptosis and the long-term results of nephropexy.     

Role of magnetic resonance imaging in the complex radiation diagnosis of hormonally active adrenal tumors

Based on the results of examination of 30 patients with hormonally active adrenal tumors, the authors consider the MRI sympatomatology of their different types and the potentialities of the technique in the complex radiation diagnosis of this pathology. The authors present their assessments of the relative intensity of a signal and the structure of each type of hormone-producing tumors of the glands by using different MRI pulse sequences that may be useful in establishing a presumptive morphological diagnosis. They identify MRI sequences that are of the greatest informative value for the diagnosis of each type of hormonally active adrenal tumors. There is evidence for that MRI is highly effective in detecting all types of hormonally active adrenal tumors and, in the context of their topographic and anatomic diagnosis, has an unquestionable advantage over ultrasonography and X-ray computed tomography in some cases.     

Place of digital X-ray fluorography in improving the diagnosis of pulmonary tuberculosis,lung cancer and mediastinal pathology

The prime objective of this paper is an effort to make a comprehensive assessment of a place of current digital X-ray fluorography in the diagnosis of various diseases of the lung, primarily its tuberculosis and cancer, and abnormalities of the mediastinum. The investigation used a principle of obligatory examination of the diagnostic potentialities of film X-ray study and digital X-ray fluorographic findings. Assessment of digital X-ray fluorography showed its potentialities of identifying an abnormality just on the monitor screen and through printer (paper) image reproduction. A total of 2,500 cases from different patient groups (those registered at a dispensary or identified at screening, those with a previously verified pathology). In addition to a particularly diagnostic section, the authors state their ideas on a multiplicity of organizational and methodological problems in the introduction of digital X-ray fluorography into practical public health of Russia. By defining "a diagnostic field" of application of the method, the authors restrict it only to the diagnosis of lung and mediastinal diseases.     

FRACTURES AND DISLOCATIONS OF THE CARPUS

Although one-eighth to one-tenth of all fractures of the wrist are carpal fractures, they may be overlooked, unless attention is directed particularly to them in diagnostic examination. Symptoms may be slight or lacking, but diagnosis is important because such injuries may give rise to pain or disability later. There are certain guides and procedures in physical and roentgenographic examination which make diagnosis easier and more certain. Treatment depends upon the nature of the lesion. It must be based on all the knowledge obtainable by examination, mental review of the anatomy and pathologic changes, inquiry into the cause of injury, and the interpretation of roentgenologic findings.