Objective: To study the diagnostic efficiency (DE) of sonographic signs in differentiation of inflammatory bowel disease (IBD) and functional bowel disorder (FBD) in children and to develop an optimal mathematical model for differential diagnosis of IBD and FBD using comprehensive assessment of sonographic signs.Material and methods: We examined 79 children with and without clinical signs of large-bowel disease. All the children underwent bowel ultrasonography with strain elastography. We also determined the level of fecal calprotectin (FC). The FC level > 120 μg/g was a cutoff value to differentiate IBD from FBD.Results: We determined the DE of sonographic signs in verification of IBD and FBD: large-bowel wall thickening (DE, 87%; P < .0001), large-bowel wall stratification (DE, 93.1%; P < .0001), enlarged mesenteric lymph nodes (DE, 53.4%; P=.591), interloop ascites (DE, 98.3%; P < .0001), Color Doppler findings in the large-bowel wall (DE, 98.3%; P < .0001), strain elastography findings in the large-bowel wall (DE, 96.5%; P < .0001). We developed an optimal model for differentiation of FBD and IBD using the analysis of sonographic signs (DE, 98.7%).Conclusions: The sonographic signs (large-bowel wall thickening, large-bowel wall stratification, interloop ascites, color Doppler findings in the large-bowel wall, stiffness found on strain elastography) can be effectively used for differential diagnosis of FBD and IBD in children. The developed mathematical model enables to reliably differentiate children with FBD and IBD.

Aim 1) To develop normative values of global and regional left ventricular longitudinal deformation (LVLD) during real time three-dimensional stress echocardiography with adenosine triphosphate (ATP) and utilization of automated function imaging technology (4D Stress-Echo + LVLD with ATP); 2) to compare the effectiveness of detection of symptom-related coronary arteries during 4D Stress-Echo with ATP using: a) traditional visual assessment of regional myocardial contractility and b) step-by-step analysis of segmental LVLD.Material and Methods 15 healthy subjects and 32 patients with coronary artery disease (CAD) were examined after coronary angiography. All individuals underwent 4D Stress-Echo + LVLD with ATP (Vivid E95, General Electric).Results The normative values of global LVLD at three stages of the pharmacological stress-test (before, during and after ATP infusion) were –19.5 (95% CI: -20.4 – -19.0), –21.6 (95% CI: -22.8 – -20.4) and –19.5 (95% CI: -20.3 – -18.6), respectively; the values of LVLD in each of the 17 segments of left ventricular myocardium in healthy subjects were also determined. In patients with CAD visual control of contractility during stress test revealed dynamic decrease in local thickening of the myocardium, appearance of new zones of contractility disorders and expansion of previously noted in 31.2% of cases, while analysis of deformation detected the appearance of new zones of deformation disturbances and expansion of previously found – in 68.7% (р = 0.0055). Stress-induced worsening of myocardial deformation during ATP infusion in the zones of blood supply of left anterior descending coronary artery, circumflex artery and right coronary artery (with presence of hemodynamically significant stenoses and occlusions detected during coronary angiography) were found in 28.0, 77.7 and 65.2% respectively (р1-3 = 0.0194; р1-2 = 0.0019; р2-3 = 0.2864).Conclusion The normal values of global and segmental LVLD for each stage of 4D Stress-Echo + LVLD with ATP were determined. 4D Stress-Echo + LVLD with ATP can significantly increase the effectiveness of symptom-related coronary arteries identification in patients with CAD in comparison with traditional Stress-Echo with visual assessment of local myocardial contractility.

Objective. Submaximal myocardial hyperemia is known not to be achieved in 16–18% of cases during cardiac stress tests and monotonic intracubital administration of adenosine triphosphate (ATP) at a dose of 140–160 μg/kg/min. The authors set a task to elaborate a new algorithm for stress echocardiography (SEchoCG) with ATP, providing for the possibility of a stepwise increase in the dosage of the drug, as well as to test it in healthy individuals and patients with coronary heart disease (CHD). Material and methods. The authors elaborated a new algorithm for SEchoCG on the basis of an analysis of the main science databases and their first own experience in using ATP during SEchoCG. The key provisions of the new algorithm were: (a) the exercise test consisted of 3 stages (EchoCG data should be recorded before, during, and 5 minutes after ATP infusion); (b) the criterion for achieving submaximal myocardial hyperemia during ATP administration is a systolic blood pressure (SBP) reduction of 5 and more mm Hg; (c) EchoCG was usually recorded at Stage 2 of the test 3 minutes after the start of ATP administration and with a decline in SBP; (d) the initial dose of ATP administration was 140 μg/kg/min; if SBP did not decrease at 3 minutes of the drug administration, the dosage should be first increased up to 175 μg/kg/ min at 1 minute; if there was no effect, the dosage should be increased up to 210 μg/kg/min at another 2–3 minutes. The algorithm was tested in 9 healthy volunteers, and in 26 patients with CHD. Results. Testing the new algorithm showed that all cases achieved submaximal myocardial hyperemia. SBP decreased below 90 mm Hg in 2 patients; 1 patient developed second-degree atrioventricular block; however, a simple decrease in the ATP infusion rate within 30 sec leveled this symptomatology. The SEchoCG data acceptable for the subsequent analysis of myocardial contractility and deformation could be recorded in all the examinees. Conclusion. The new algorithm for SEchoCG with ATP is effective in recording EchoCG findings. To have a final decision on the safety and information value of a new stress test protocol, it may be recommended to further test those in larger groups of patients during SEchoCG and in the use of other imaging procedures to assess myocardial contractility and perfusion.

PURPOSETo: 1) optimize algorithm of stress echocardiography (s-Echo) with intravenous adenosine triphosphate (ATP) infusion taking into account pharmacokinetics and pharmacodynamics of ATP in human body, 2) test new algorithm in patients with coronary and other heart diseases.MATERIALS AND METHODSIn order to determine spectrum of factors influencing the results of stress test with ATP we inspected main scientific data bases and found 48 publications on ATP application for diagnostic purposes. Analysis of these publications allowed us to optimize algorithm of ATP s-Echo. Optimized algorithm was tested on 26 subjects, who underwent ATP 4D strain-stress-echocardiography of the left ventricle.RESULTS AND DISCUSSIONOptimized algorithm has three stages: registration of Echo data sets before, at the time of ATP infusion, and after 5 min of ATP infusion termination. Registration of Echo parameters at the second stage must begin not earlier than 3 min after the onset of ATP infusion and only in the presence of signs of coronary vasodilation. We think that the main indirect criterion of submaximal coronary vasodilation is 5 mm Hg or more decrease in systolic blood pressure (SBP), but not below SBP level of 90 mm Hg. Initial dose of ATP is 140 µg/kg/min. If after 2 min of infusion SBP do not diminish we increase the infusion rate at first to 175 and then to 210 µg/kg/min. While testing new algorithm in all cases we have achieved criteria of effective vasodilation. Mean SBP decrease was 16.4±13.7 mm Hg, heart rate increase - 12.7±8.1 bpm. In all patients we obtained interpretable 4D LV Echo data sets for visual analysis of local contractility and automatic strain analysis.CONCLUSIONOptimization of ATP s-Echo algorithm was performed. Safety and efficacy of optimized algorythm for registration of echo data was demonstrated. New ATP infusion algorithm can also be recommended for testing with other cardiac imaging modalities in evaluation of myocardial perfusion and contractility (SPECT, CT, MRI, PET).

Purpose: Today easy, quick and effective examination of shape and structure of peripheral nerves in posttraumatic period is a difficult task for traumatologists and neurosurgeons. The progressive refinement of broadband transducers with frequencies higher than 10MHz and improved near-field resolution has enhanced the potential of sonography to depict changes in the nerve's shape and echotexture. This investigation was designed to analyze if high-resolution ultrasonography can be helpful in evaluation of brachial plexus nerves posttraumatic changes and in assessment of results of performed plastic surgery. Up to date a few data on this topic can be found in the literature.

AIM To assess effect of trimetazidine on global and regional systolic and diastolic left ventricular function in patients with combined postinfarction ischemic syndrome. MATERIAL Patients (n=32) with healed myocardial infarction and signs of global systolic (ejection fraction 38,5+/-2,7%) and diastolic (EIA=0,88+/-0,03) left ventricular dysfunction confirmed by Doppler echocardiography. METHODS Regional systolic and diastolic function was assessed by dobutamine stress echocardiography with Doppler tissue imaging before and after 3 months during which the patients received 60 mg/day of trimetazidine. RESULTS The segments with hibernating myocardium were found in every patient. These segments along with segments with scars displayed greatest degree of local systolic and diastolic dysfunction and because of their prevalence made significant contribution to the setting of global diastolic dysfunction. Improvement of global diastolic function at rest after trimetazidine was associated with decrease of total number of ischemic segments (from 80 to 67%) especially of those with hibernation (from 61 to 46%). CONCLUSION The hibernating myocardium was most sensitive to metabolic intervention and its presence after myocardial infarction predicted improvement after drug treatment of not only systolic but also diastolic left ventricle dysfunction. Restoration of function of hibernating myocardium turned out to be possible not only after myocardial revascularization but also after medical therapy.