Computed tomography is one of the leading methods of neurovisualization. A number of issues remain unclear, especially regarding the use of computed tomography results in forensic practice, despite the long existence of this method. The formation age of traumatic intracranial subdural hematomas (TISDHs) is one of such issues. The article presents the results of own study on the possibilities of age determination of acute TISDHs using the data of a head computed tomography. The authors concluded that the investigation of this issue is promising, identified certain parameters of TISDHs that should be considered when determining the age of TISHDs in acute period.

The constant increase in the number of neurotraumas in the country leads to an increase in forensic examinations of a persons. In Russia, about 600 thousand people receive craniocerebral injuries annually, of which 50 thousand die, others are potentially will be in forensic examination during or after treatment. With an increase in the total number of such examinations, the number of erroneous conclusions is expected to increase. If it is impossible for the radiologist included in the commission to review the results of computed tomography of the head performed in the hospital, the experts are forced to use the data that are recorded in the medical documents. The present study revealed the percentage of erroneous interpretations in such descriptions, systematized typical errors, calculated the sensitivity, specificity and accuracy of computed tomography in craniocerebral injury.

OBJECTIVE Improvement and evaluation of effectiveness of the arthroscopic surgery based on individual anatomical sizes in the treatment of patients with the temporomandibular disorders (TMD). MATERIAL AND METHODS The article presents the results of complex treatment of patient with TMJ internal derangements and osteoarthritis using arthroscopic surgery. In the pre- and postoperative period, the patient was examined clinically, as well as by computed tomography (CT) and magnetic resonance imaging (MRI). In the preoperative period, the individual sizes of anatomical structures and their localization were determined according to MRI data. That made it possible to carry out surgical intervention with minimal risk. During the operation, fibrous adhesions inside the joint were eliminated with a cold plasma coblator, the disc was mechanically moved to its normal position. At the end of the operation, blood plasma and hyaluronic acid were injected into the joint. RESULTS As a result of the treatment, an increase in mouth opening by 80% of the initial state, disappearance of crepitus sounds, and complete relief of pain syndrome were documented. According to objective examination methods (MRI, CT), the elimination of internal disorders, restructuring and regeneration of intra-articular elements were recorded. CONCLUSION No complications were revealed during the surgery. Arthroscopic TMJ surgery performed according to the described protocol is an effective and safe procedure that allows quickly restore the mobility of intra-articular elements, eliminate pain and improve the patient's quality of life.

Computed tomography (CT) of chest organs is one of the most accurate diagnostic methods allowing the physician to assess the condition of lung parenchyma. Correct interpretation of CT results requires the clinician to recognize normal appearance of lung parenchyma on X-ray and know changes visualized in various bronchopulmonary diseases. It is important that the physician knows and understands underlying cause of a particular radiological pattern in order to discuss with the radiologist lung tissue changes that have been identified considering clinical symptoms. Descriptions of radiological patterns and discussion of corresponding typical clinical observations are presented in the article devoted to air cyst syndrome and cystoid changes in the lung tissue.

AIM:To study the prevalence of cognitive disorders (CD) and clinical/pathogenetic correlations of CD in patients with Behçet's Disease (BD).MATERIAL AND METHODS:One hundred and six BD patients were enrolled in the study. The majority of patients were natives of the North Caucasus (51.9%). Mean age was 33.3±0.98 years, mean illness duration 148.5±10.4 months. All the patients met the criteria of the International Study Group for BD (1990) classification. The disease activity was assessed by scoring system BDCAF. A diagnosis of a mental disorder (MD) was established by the psychiatrist in accordance with the ICD-10 using a semi-structured interview. The Montgomery-Asberg Depression Rating Scale (MADRS), the Hamilton Anxiety Rating Scale (HAM-A), a pathopsychological method 'Pictograms', clinical/psychological methods for assessment of cognitive functions (memory, attention concentration, logic thinking) were administered. Brain MRI was done in 44 (41.5%) BD patients. The study was conducted in the frames of the interdisciplinary program 'Stress factors and mental disorders in immune-mediated inflammatory rheumatic diseases'.RESULTS:CD of mild to moderate severity were diagnosed in 82 (77.4%) and anxiety-depressive disorders in 81 (76.4%) of BD patients. The patients with CD were older compared to patients without cognitive disorders (34.3±1.07 vs 29.0±2.14, p=0.006). Patients with CD were most often (84.1% vs 50.0%, p=0.001) diagnosed with anxiety-depressive disorder (anxiety, chronic/recurrent depression). MADRS scores were higher (16.1±0.74 vs 12.2±1.06, p=0.005) though did not exceed the moderate level. The impact of chronic psychosocial stressors was detected more often in CD patients. MRI results showed that the frequency of chronic multifocal, predominantly subcortical, changes in the white matter was higher in CD patients.CONCLUSION:CD are characteristic of most patients with BD. They are associated with the age, anxiety-depressive disorders, chronic stressors and minor brain multifocal subcortical parenchymal MRI lesions.

The article describes the clinical case of Langerhans cell histiocytosis with lesions in lungs and flat bones in a 40-year-old smoker. During 4 years, all stages of the disease were followed. The diagnosis was made basing on the results of thoracoscopic lung biopsy. Treatment with a cytostatic drug and smoking cessation resulted in positive X-ray changes.

Страница 24 ОПРЕДЕЛЕНИЕ УЛЬТРАЗВУКОВЫХ ПОКАЗАТЕЛЕЙ СТРОЕНИЯ И ФУНКЦИИ ЗДОРОВОГО ВИСОЧНО-НИЖНЕЧЕЛЮСТНОГО СУСТАВА Бекреев В.В. 1 , Иванов С.Ю. 2 , Буренчев Д.В. 3 , Груздева Т.А. 1 , Юркевич Р

Aim. Hemodynamic shifts in the brain, developing due to carotid surgery (carotid endarterectomy or stenting) might be the cause of perioperation strokes. Assessment for hemodynamic shifts is important. The aim of current study was to develop methodics of cerebral hemodynamics assessment at pre-operation and post-operation periods of carotid endarterectomy.Material and methods. The authors propose a mathematical model for preoperation analysis of hemodynamics changes in extracranial regions of brachiocephalic arteries after carotid endarterctomy. The development of mathematical model was based upon the data from pre- and postsurgery duplex scan and CT-angiography.Results. The results showed good prediction capacity for the shifts in cerebral hemodynamics, using the developed mathematical model.Conclusion. Study results make it to assess cerebral hemodynamis without supplementary investigations. The model includes and represents real anatomy and quantitative hemodynamics parameters by the CT-angiography and duplex scan of the vessels.

The data of the literature on epidemiology, clinical manifestations, diagnosis and treatment of Behcet's disease are presented. Particular attention is paid to international recommendations (2014) on the classification, diagnostic criteria and treatment of neurological symptoms of Behҫet disease.

The new pulse sequence (PS) has been obtained on MRI tomography Ellipse, B=0,15 and Biospec 70/30, B=7 T. The new pulse images of the brain combine features of FLAIR and its sensitivity to magnetic field heterogeneity. We named its PS as the T2 Fluid Attenuation Gradient Echo (T2 FLAGE). The T2 FLAGE characteristics of tissue contrast as well as its efficacy in detection of ICH have been assessed in 57 patients with acute stroke and in 16 experimental rats. The analysis of tissue contrast of lesions and normal brain structure has revealed the greater visibility of T2 FLAGE images compared to FLAIR. At the same time, the images sensitivity of magnetic field heterogeneity is retained. The ROC-analysis has shown that T2 FLAGE images are more effective in differential diagnosis of stroke type compared to FLAIR.

Antifosfolipidnyy sindrom (AFS) - zabolevanie, kharakterizuyushcheesya retsidiviruyushchimi arterial'nymi i/ili venoznymi trombozami, trombotsitopeniey i akusherskoy patologiey pri nalichii antifosfolipidnykh antitel. Klinicheskie proyavleniya AFS ochen' raznoobrazny i napryamuyu zavisyat ot lokalizatsii tromboza. V stat'e obsuzhdaetsya neobkhodimost' provedeniya kompleksnoy patogeneticheskoy i simptomaticheskoy terapii AFS, privoditsya teoreticheskoe obosnovanie primeneniya preparata Aktovegin. Avtory predstavlyayut sobstvennyy klinicheskiy opyt terapii sosudistykh narusheniy pri AFS

The purpose of this randomized, double-blind, placebo-controlled study was to assess safety and efficacy of cerebrolysin used in dosage 50 ml in acute ischemic stroke. Forty-seven patients with ischemic stroke, aged 45-85 years, who were admitted to a clinical unit within the first 12 h after stroke onset were included in the study. A quantitative time-related MRI analysis of the dynamics of neurological deficit revealed the more rapid decrease of stroke volume to the 28th day in the group treated with cerebrolysin (45.4% versus 43.6% in the placebo-group (p < 0.05)). No side-effects of treatment with cerebrolysin was found. The results of this prospective, randomized, placebo-controlled study suggest the positive effect of cerebrolysin on the dynamics of volume lesion in patients with ischemic stroke.

The aim of this study was to examine Taftsin derivates--macrophage inhibitory factor (MIF, Thr-Lys-Pro) and heptapeptide selank (Thr-Lys-Pro-Arg-Pro-Gly-Pro) in the model of experimental intracerebral hemorrhage in rats. The double autologous blood injection in the basal nucleus was used as a model of intracerebral hemorrhage. Animals ware randomly divided into three groups--the control group (n = 5) was treated with saline, the second group (n = 5) was injected with MIF in dose 150 mkg/ kg/day, the third group (n = 5) received Selank in dose 300 mkg/kg/day. Intraperitoneal injection of peptides was used. Body weight assessment, neurological examination and brain MRI were performed in 24, 72 hours and 10 days after the hematoma formation. The effect of neuropeptides on the functional restoration in animals, in the absence of the effect on hematoma volume and perifocal edema, was found. The significant reduction of perifocal edema and hematoma volume was observed in the 10th day after the hematoma formation in all experimental groups (p < 0.05). Only the control group of animals showed the significant (p < 0.05) weight loss in the 3rd day after the operation. The rate of neurological deficit was different: the significant improvement assessed with Menzes and limb placing test scales was seen only in the groups treated with neuropeptides in the 10th day.

An objective of the study was to compare sensitivity of low- and extra high-field frequency magnetic resonance (MR) tomography of acutest intracerebral hematomas (ICH) and to assess differences between symptoms in obtained images. A study was conducted using experimental ICH in rats (n=6). Hematomas were formed by two injections of autologic blood into the brain. MR-devices "Bio Spec 70/30" with magnetic field strength of 7 T and "Ellipse-150" with magnetic field strength of 0,15 T were used in the study. MR-tomography was carried out 3-5 h after the injections. Both MR-devices revealed the presence of pathological lesion in all animals. Extra highfield frequency MR-tomography showed the specific signs of ICH caused by the paramagnetic effect of deoxyhemoglobin in T2 and T2*-weighted images (WI) and low frequency MR-tomography - in T2*-WI only. The comparable sensitivity of low- and extra high-field frequency MR-devices in acutest ICH was established.

The aim of this study was to assess the possibility of revealing intracerebral hematomas (ICH), using MRI, within the first hours after onset and to determine their MRI semiotics features. Thirty animals with experimental ICH were studied. A method of two-stage introduction of autologous blood was used to develop ICH as human spontaneous intracranial hematomas. Within 3-5h after blood introduction to the rat brain. The control MRI was performed in the 3rd and 7th days after blood injections. ICH were definitely identified in the first MRI scans. The MRI semiotics features of acute ICH and their transformations were assessed. The high sensitivity of MRI to ICH as well as the uniform manifestations in all animals were shown. In conclusion, the method has high specificity for acute ICH detection.

A study aimed at developing the pulse consequence, the double inversion recovery (DIR), using low field magnetic tomography, and assessing its effectiveness in the detection of intracerebral hematoma. The research has been conducted at "Ellipse" MR tomograph. The new pulse sequence has been created by the modification of the regular FLAIR, its technical parameters were as follows: the first TI - 90 ms, the second TI - 1300 ms, TR - 4665 ms, echo - 3. Twenty-seven patients have been enrolled in the study. The tissue contrast coefficients on FLAIR and DIR images have been compared. it has been shown that the contrast coefficient of normal brain structures and brain lesions on the DIR images in regard to the white matter are significantly higher than on the FLAIR images. Results of the study revealed that the dynamics of MR symptoms of intracerebral hematoma is faster on the DIR images compared to the FLAIR ones. This finding can be used for detection of intracerebral hematoma in difficult clinical cases.

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