URJ 3/2017

2017, vol XXV, # 3, page 173

V. KARVARSARSKAYA, N. MITRYAEVA, L. GREBENIK, V. STARENKYI, N. BELOZOR

SI «Grigoriev Institute for Medical Radiology of National Academy of Medical Sciences of Ukraine», Kharkiv

VASCULAR ENDOTHELIAL GROWTH FACTOR AND ENDOSTATIN IN BLOOD SERUM OF PATIENTS NON-SMALL-CELL LUNG CANCER IN RADIATION THERAPY

The purpose of the research is to study serum levels of VEGF and endostatin and VEGF/endostatin ratio in patients with NSCLC in radiation therapy (RT) over time.

Materials and methods. The study enrolled 16 patients with NSCLC of stage III. The patients underwent treatment at SI Grigoriev Institute for Medical Radiology of National Academy of Medical Science of Ukraine and completed a course of RT on the linear accelerator Clinac 600C. The patients with NSCLC were represented by 3 women and 13 men. The control group included 10 apparently healthy people. The general clinical, morphological and x-ray examination of all patients was carried out. The content of VEGF and endostatin in blood serum was determined by means of the method of enzyme multiplied immunoassay with the use of the standard Vektor-Best sets (Russia) before and after radiation therapy.

Outcomes. The study of serum levels of VEGF and endostatin and VEGF/endostatin ratio in patients with NSCLC in PT was conducted over time. It has been proved that in the course of radiation therapy the content of VEGF, endostatin and the ratio of VEGF/endostatin changes. It has been found that before treatment, in patients with NSCLC the angiogenic factor is produced more than antiangiogenic one. In other words, endostatin level increase is not proportional to the VEGF level increase; the balance is impaired. It leads to angiogenic cancer progression. After RT in patients with NSCLC, a non-uniform change in levels of VEGF, endostatin and VEGF/endostatin ratio depending on effectiveness of treatment is observed.

Conclusions. The level of VEGF, endostation and VEGF/endostatin ratio in patients were assessed in radiation therapy over time. It has been proved that the content of VEGF, endostatin and VEGF/endostatin ratio in blood serum in 94% of patients with NSCLC prior to RT is significantly higher than in the control group. The changes in the balance of angiogenic and antiangiogenic factors (VEGF/endostatin) in RT over time in patients with NSCLC associated with the objective response to treatment have established. It can a be predictive marker for evaluating the effectiveness of RT.

Keywords: radiotherapy, vascular endothelial growth factor (VEGF), endostatin, angiogenesis, non-small-cell lung cancer.

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2017, vol XXV, # 3, page 179

A. SUPRUNENKO, O. SOLODYANNIKOVA, I. SMOLANKA, I. DOSENKO, A. LYASHENKO, A. LOBODA, O. IVANKOVA

National Cancer Institute, Kiev

METHOD OF ENDOVASCULAR INHIBITION OF LOCALLY ADVANCED BREAST CANCER NEOVASCULARIZATION

Summary. Locally advanced breast cancer (LA BC) is one of the most hypervascular cancers of high angiogenic potential. It is identifiable by angiographic examination, which allows choosing the optimal ways of delivering cytostatics for targeted intraarterial chemotherapy.

Materials and methods. In order to maximize the locoregional effect on the neovascular network of LA BC targeted intra-arterial chemotherapy has been performed in 100 patients with cancer of II B stage diagnosed in 35, III B in 39 and IV stage in 26. In order to carry out targeted intra-arterial chemotherapy, the vessels of the tumor were catheterized from the basins of the internal thoracic, lateral thoracic, subscapular arteries. Carboplatin 300 mg/m2 or cisplatin 100 mg/m2, cyclophosphamide 600 mg/m2 have been infused. Infusion of cytostatics was carried out at a rate of 100 ml/h2. Doxorubicine was infused intravenously at a dose of 90 mg/m2.

Outcomes. Intensive extraction of cytostatic agents at the time of the first passage through the native vascular bed initiates an acute local disorder of vascular stability. Three sessions of selective intra-arterial chemotherapy is sufficient to overcome the resistance barrier of endothelial and tumor cells to chemical agents and to induce a state of oppression of tumor blood flow and tissue destruction. Anti-neovascular therapy of LS BC is aimed at the already formed tumor vessels and has the potential to destroy the already existing tumor mass.

Conclusions. A combined method of endovasular inhibition of neovascularization of the tumor has been developed to increase the loco-regional effect on the tumor vascular bed and the tumor tissue itself.

Keywords: locally advanced breast cancer, selective chemotherapy, inhibition of neovascularization, target chemotherapy, selective catheterization of tumor vessels.

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2017, vol XXV, # 3, page 186

L. BABIY, N. STROHANOVA, YU. KHOMENKO

SI National Scientific Center M. D. Strazhesko Institute of Cardiology of NAMS of Ukraine, Kyiv

LEFT VENTRICULAR DIASTOLIC FUNCTION IN PATIENTS WITH CORONARY HEART DISEASE (RADIONUCLIDE VENTRICULOGRAPHY FINDING)

The study involved 129 patients suffering from coronary heart disease (CHD). Equillibrium radionuclide ventriculography was carried out. A complex of qualitative indices of the left ventricular (LV) diastolic function included peac filling rate (PFR), time to PFR (T-PFR), filling fraction (FF1) and volume (V1) in fast filling phase, filling fraction (FF2) and volume (V2) in slow filling phase, fraction (F3) and volume (V3) in left ventricular auricle systole period. PFR decrease and hemodynamics patten changes were revealed in patients with CHD and normal systolic (EF > 50.0%) and pumping (SV > 6.0%) functions of the LV (Group 1). Diastolic indices changes in patients with CHD and myocardial infarction and normal systolic and pumping functions were more pronounced. In patients with CHD and signs of II-A stage heart failure (EF < 45.0%), diastolic indices changes were expressed to an even greater degree along with impaired hemodynamic filling structure: V1 decrease, V2 increase and V3 moderate decrease. The data provided are indicative of disturbance of active and passive regulatory mechanisms of the LV diastolic function in patientss with CHD.

Кeywords: coronary heart disease, left ventricle of the heart, diastolic function, radionuclide diagnosis.

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2017, vol XXV, # 3, page 190

A. ZELINSKAYA, YU. ВOZHOK, A. KVACHENUK, G. KULINICHENKO, A. USTIMENKO, E. SHELKOVOY, T. KUCHMENKO, E. MOTORNYI

SI V. P. Komisarenko Institute of Endocrinology and Metabolism of Academy of Medical Sciences of Ukraine, Kyiv

PHENOTYPIC FEATURES OF THYROCYTES OF RECURRENT PAPILLARY THYROID CARCINOMAS WITH REPEATED METASTASIS

Purpose. Complex cytomorphological and imunocytochemical studies of fine-needle aspiration biopsy of 28 metastases of reccurent papillary carcinomas with repeated metastasis, appearing after thyroidectomy and radioactive iodine therapy, were conducted for the first time.

Materials and methods. A comparative analysis of phenotypic features of the thyrocytes was carried out as well as the changes in phenotypic characteristics of thyrocytes between primary and secondary metastases of papillary thyroid cancer were revealed.

Results. The phenotypic features of metastases thyrocytes reflected the tendency to cell differentiation loss (loss of expression of thyroid peroxidase and thyroglobulin and cytomorphological manifestations of high thyrocites differentiation resulting in inability to accumulate radioactiave iodine by repeated metastases in comparison with the primary ones).

Keywords: thyroid, papillary carcinoma, fine needle aspiration biopsy, recurrence of papillary cancer, radioiodinerefractory metastases.

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2017, vol XXV, # 3, page 194

P. KOROL

Kyiv City Clinical Hospital No 12

METHODS OF NUCLEAR MEDICINE IN THE DIAGNOSIS OF PARA-ENDOPROSTHETIC COMPLICATIONS IN PATIENTS WITH DISEASE OF HIP AND KNEE JOINT OF VARIOUS GENESIS

Purpose. To study the role of nuclear medicine diagnostic methods in predicting implant-associated complications of patients with hip and knee joint damage of various genesis.

Materials and methods. Bone scintigraphy was carried out on a single-detector gamma camera Tamara 301-T in a static mode according to the standard protocol after intravenous administration of 99mTc-MDP activity of 600-800 MBq.

Outcomes. Significant increase in arterial inflow rates (p < 0.05) and integral perfusion with bone scintigraphy (p < 0.05) occurs in the area of hyperfixation of the radiopharmaceutical in infectious inflammatory processes due to intensification of osteoblastic activity and angiogenesis in them in comparison with the degenerative-dystrophic area of fixation of radiopharmaceutical.

In the differential diagnosis of pathological processes of the hip and knee joints, the bone scintigraphy has a greater sensitivity and accuracy (93.4 % and 88.6 %) than the method of X-ray (62,5 % and 65,8 %), ultrasound (80,7 % and 85,2 %), thermography (83,2 % and 74,3 %), respectively; However, CT and MRI methods have a high specificity (89,3 % and 92,1 %), with respect to the bone scintigrahy 83,3%), respectively.

Conclusions. Three-phase bone scintigraphy is an objective method of differential diagnosis of the pathological process in arthroplasty of hip and knee joints. This method can be used in diagnostic screening of patients during arthroplasty. Bone scintigraphy can be used to determine the stage of prevalence of the pathological process in the joints, and in combination with CT and MRI — to monitor the dynamics of the pathological process after arthroplasty.

Keywords: three-phase osteoscintigraphy, arthroplasty, hip and knee joints.

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2017, vol XXV, # 3, page 198

O. KOPYLOVA, O. STEPANENKO, L. MYSCHENKO, V. TALKO

SI National Research Center for Radiation Medicine of National Academy of Medical Sciences of Ukraine, Kyiv

ROLE OF INSULIN RESISTANCE AND HYPOTHYROIDISM IN PATHOGENESIS OF OBESITY IN ADOLESCENTS BORN OF PARENTS EXPOSED TO IONIZING RADIATION AFTER THE CHNPP ACCIDENT

The survey findings have shown that examination of 186 children aged from 12 to 17 who were born of parents evacuated out of 30km exclusion zone, citizens of the administered area, makes it possible to reveal increased risk of benign endocrine pathology (thyroid, impaired carbohydrates metabolism, obesity, hypothalamic syndrome) in adolescence with the signs of latent hormone dysfunction.

In every other adolescent there is an interaction between impaired function of the thyroid gland (hypothyroidism) and present insulinemia and insulin resistance resulting in disturbance of fat metabolism. Progressing of overweight in adolescence is accompanied by significant metabolic disorders which can be a trigger in development of MSX. Resistance to insulin as well as peripheral resistance to thyroid hormones lead to metabolic disorders, one of which is obesity. Hormone disfunction, which result in impaired of carbohydrate and fat metabolism, can be a predictive criterion of development of diabetes mellitus of type II in future.

Keywords: adolescents, ChNPP accident, insulin resistance, hypothyroidism, obesity.

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2017, vol XXV, # 3, page 202

А. MАZUR, E. МIRONOVA, М. ТKАCHENКО

Bogomolets National Medical University, Kyiv

GASTROSCINTIGRAPHIC SIGNS OF MOTOR-EVACUATION DISORDERS OF THE STOMACH

Summary. The article deals with evaluation findings of diagnostic possibilities of gastroscintigraphy in assessment of motoric evacuatory function of the stomach in case of pathology of various origin.

Materials and methods. Gastroscintigraphy was conducted for 122 patients (56 men and 66 women) aged from 18 to 72 with different gastroduodenal pathology (functional dyspepsia, chronic gastritis, chronic cholecystitis, ulcer of the stomach and duodenum. Radiopharmaceutical agent 99mTc-pertechnetate with activity of 1 MBq/kg was applied.

Results. Impaired motoric evacuatory function of the stomach was observed in 63 patients: regarding hypotonic type in most patients with functional dyspepsia (13.3%) and with chronic gastritis (19.8%); according to hypertonic type — 32 patients, mainly wih functional dyspepsia (9.8%) and gastric ulcer (6.6%). Increased motoric evacuatory function of the stomach was revealed in 40 patients: with functional dyspepsia (14.8%) and in gastric ulcer (16.4%). The gastroesophageal reflux was observed in 59 patients and duodenogastric one — in 36 patients.

Conclusions. Therefore, gastroscintigraphy in assessment of motoric evacuatory function of the stomach can completely replace X-ray examination.

Keywords: stomach, gastroscintigraphy, motor and evacuation disturbance.

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2017, vol XXV, # 3, page 206

M. TKACHENKO, A. ROMANENKO, A. MAKARENKO

Bogomolets National Medical University, Kyiv Kyiv City Clinical Hospital No 14

OSTEOSCINTIGRAPHY APPLICATION IN DIAGNOSIS OF OSTEOSARCOMAS

Purpose. The malignancy of the skeletal system is still considered to be a topical issue of current clinical diagnosis in oncology.

Materials and methods. The standard diagnosis methods include: x-ray, computed tomography (CT), magnetic resonance imaging (MRI), radionuclide examination methods. At Department of Radiology and Radiation Medicine of Bogomolets National Medical University, the examination was provided for 5 patients aged from 15 to 26, where osteosarcoma was diagnosed in 4 patients and Ewing’s sarcoma was suspected in 1 patient, as well as for 2 patients of the control group.

Results. Due to the outcomes of the study the following was established: osteoscintigraphy is rather reliable method for detection of the primary malignancy of the skeletal system. It can be applied as a method of initial screening when bone malignancy is suspected. The method makes it possible to reveal damage in the bones 3–12 months earlier than other radiological methods and to make a qualitative assessment of the degree of damaged osseous tissue.

Conclusions. Osteoscintigraphy can be applied as a method of differential diagnosis for patients with involvement of the skeletal system.

Keywords: osteosarcoma, radiation diagnosis, osteoscintigraphy.

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2017, vol XXV, # 3, page 210

A. MIHANOVSKIY1, I. YACOVTSOVA2, S. DANILUK2, O. SLOBODYANUK1, U. KHARCHENKO1, I. KRUGOVA1, N. SCHIT1, N. FEDORENKO1, M. TEPLOVA1

1 SI Grigoriev Institute for Medical Radiology of Medical Sciences of Ukraine, Kharkiv

2 Kharkiv Medical Academy of Postgraduate Education

THERAPEUTIC PATHOMORPHOSIS OF OVARIAN CANCER DEPENDING ON TECHNOLOGY OF NEOADJUVANT CHEMOTHERAPY

Purpose. Comparative assessment of pathomorphosis of ovarian cancer (OC) depending on the number of cycles of neoadjuvant chemotherapy (NCT) conducted.

Materials and methods. Therapeutic pathomorphosis of OC depending on the technology of NCT was studied in 40 patients with OC III–IV (T3a-cNxM0-1). Group 1 consisted of 5 (12.5%) patients with OC, who were treated with a combined method (surgery and postoperative chemotherapy). Group 2 consisted of 8 (20.0%) patients treated with a combined method with 1–2 NCT cycles, 27 (67.5%) patients treated with a combined method with 3 to 4 cycles of NCT.

Outcomes. The study has made it posibble to establish that 3–4 cycles of NCT are more effective than 1–2 cycles. Conclusions. In patients with OC of III–IV stage, who underwent 3–4 cycles, in 11.1% of the observations regression was complete and in 88.9% significant regression of the tumor was observed, which corresponds to III–IV degree of therapeutic pathomorphosis, significant inhibition of proliferative tumor activity and activation of apoptosis, increase of the volume of the damaged tumor.

Keywords: ovarian cancer, therapeutic pathomorphosis, neoadjuvant chemotherapy, pathological mitoses, apoptosis.

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2017, vol XXV, # 3, page 219

V. VINNIKOV1, G. KULINICH1, I. CHERNYAVSKY2

1 SI «Grigoriev Institute for Medical Radiology of National Academy of Medical Sciences of Ukraine», Kharkiv

2 National Technical University «Kharkiv Polytechnic Institute»

RADIOLOGICAL CONSEQUENCES OF POSSIBLE IRRADIATION SCENARIOS IN MILITARY PRACTICE IN UKRAINE

Objectives. To classify the main radiological consequences (health effects) of radiation exposure that lead to the loss of the work efficiency of the personnel of the Armed Forces of Ukraine in various scenarios of radiation exposure, which are expected in modern military practice.

Materials and Methods. The information search was carried out in the normative documents of the military radiation safety system and military radiology manuals. Possible scenarios of radiation exposure of military units during war time were modeled according to the modern paradigm of the usage of nuclear weapons. The genuine information was analysed and synthesized regarding early radiobiological effects of radiation exposure in humans in those conditions, which correspond to the military exposure scenarios.

Results. For the first time the logical and handy classification of possible radiation exposure scenarios in military practice is presented. It combines the causal situation, the type of battle task and early clinical effects, which lead to the reduction of the work efficiency of the personnel. Five causal situations are distinguished; each containing from one to three variants of the contact with ionizing radiation; and for each particular scenario the specific syptoms of early biomedical effects of the external and/or internal irradiation are presented. The assessment of the work efficacy of military units has to be based of the criteria of the grade and frequency distribution of the general primary reaction on the irradiation. The consequences of radiation exposure are listed in the ascending order of their health danger: from the radiophobia up to the toxemic or cerebral forms of acute radiation syndrome, early transitive disability syndrome and combined radiation-traumatic or radiation-termal injuries.

Conclusions. The clinical consequences of radiation exposure, which determine the loss of work efficiency of military subdivisions, vary essentially depending on the scenario of irradiation. The underestimation of the full possible spectrum of radiological effects beyond the acute radiation syndrome may lead to the mistakes in the evaluation of the personnel losses during the war time. Further optimization of the military radiation safety system requires the establishing of clear quantitative coeffecients linking various clinical radiation symptoms and the losses of work efficiency in exposed military units.

Keywords: military scenarios of radiation exposure, acute radiation syndrome, local radiation injuries, oropharingeal syndrome, radiophobia, loss of work efficiency of military personnel.

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2017, vol XXV, # 3, page 229

M. KHVOROSTENKO1, V. TKACHENKO2, I. KIKHTENKO1, Y. KHVOROSTENKO1

1 State establishment «Dnipropetrovsk Medical Academy of Health Ministry of Ukraine»

2 Makarov National Center for Aerospace Education of the Youth, Dnipro

PRODUCTION OF THIN-FILM RADIATION-PROTECTIVE MATERIALS

Abstract. The technology of creation of thin-film protective materials as well as applying them in manufacturing and operation of various protection flames from a penetrating radiation has been suggested. The technology is based on opening of abnormal discrete permeability for a number of the disperse environments including specially developed powder basis with particles of metal.


Keywords: thin-film protective materials, radiation, disperse environment.

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2017, vol XXV, # 3, page 235

M. TKACHENKO, G. ROMANENKO, N. MOROZOVA, O. MIRONOVА

Bogomolets National Medical University, Kyiv, Ukraine

EXPERIENCE IN TEACHING OF RADIONUCLIDE DIAGNOSIS IN RADIOLOGY COURSE AT BOGOMOLETS NATIONAL MEDICAL UNIVERSITY

The article highlights aspects of teaching radionuclide diagnosis (RND) in the study of complex radiation diagnosis and radiotherapy. Teaching of radiation at undergraduate stage is based on the results of new scientific achievements in radiology and guiding principles of evidence-based medicine. At present studying RND is intended to support the aspiration of European medical community to create a unified science-based approaches to diagnosis and it shows promise of new forms of learning that promote active creative work of a student.

Keywords: nuclear medicine, radiation diagnostics, teaching of radionuclide diagnostics.

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2017, vol XXV, # 3, page 238

G. GRUSHKA1, 3, N. LUKHOVITSKA1, 3, G. TKACHENKO1, O. ASTAPYEVA1, 2

А. SAVCHENKO1, 3, N. PIDCHENKO1, V. BOBROVA1

1 SI «Grigoriev Institute for Medical Radiology of National Academy of Medical Sciences of Ukraine», Kharkiv

2 Kharkiv National University V. N. Karazin

3 Kharkiv National Medical University

RADIONUCLIDE THERAPY OF BONE METASTASES IN COMBINATION WITH SURGICAL TREATMENT, CHEMOTHERAPY AND BISPHOSPHONATES

The review is devoted to the palliative treatment of metastatic lesions of the bone system of cancer patients using radionuclide therapy (RNT) in combination with the methods of surgical and chemotherapeutic treatment, as well as the using of bisphosphonates. The article show a broad approach to this problem. The authors analyze the advantages and disadvantages of combining these therapies based on the literature data. It is shown that the surgical treatment, administration of chemotherapy and bisphosphonates can potentially improve the effect of subsequent RNT, however, the possibility of postoperative complications and the toxic effect of chemotherapy should be taken into account. In view of the foregoing, it is necessary to conduct individual planning of combined therapy depending on the condition of internal organs and the hemopoiesis system.

Keywords: Bone marrow damage, radionuclide therapy, surgical treatment, chemotherapy, bisphosphonates.

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2017, vol XXV, # 3, page 242

T. NOVIKOVA1, N. NIKOLOV2, S. MAKEYEV1, S. KOVAL1

1 SI Romodanov Neurosurgery Institute, National Academy of Medical Sciences of Ukraine

2 National Technical University of Ukraine «Kyiv Polytechnic Institute»

STANDARDIZED PROTOCOL DESCRIBING THE OUTCOMES OF BRAIN SCINTIGRAPHY WITH PERFUSION RADIOPHARMACEUTICALS

Purpose. Development of the standardized protocol for description and analysis of clinical outcomes of scintigraphic studies of the brain with perfusion radiopharmaceuticals (RP).

Material and Methods. A retrospective analysis of scintigraphic data was provided for 86 patients with moderate diffuse changes in cerebral perfusion. As a perfusion agent, RP99mТс-НМPAO was used. The scintigraphy study consisted of recording of indirect angiography of the head and heart and single photon emission tomography of the brain.

Outcomes. The developed protocol of the outcomes of brain perfusion consists of: the patient’s passport section and the conditions of obtaining the data, the graphic part, the narrative part, indicating the quantitative and qualitative indices of accumulation of RFP in the brain, and the conclusion.

Conclusion. The protocol can be applied in practical and scientific work at radionuclide diagnosis departments and is the basis for creating electronic database of the examined patients.

Keywords: brain, perfusion, cerebralbloodflow (СBF), SPECT, 99mTc-HMPAO.

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2017, vol XXV, # 3, page 247

I. DEYNEKO1, E. ZHMURENKO2, S. MERENKOVA1, I. BARYNOV1

1 MI I.I. Mechnikov Dnipropetrovsk Regional Clinical Hospital

2 SI Dnipropetrovsk Medical Academy of Ministry of Health of Ukraine

COMBINED OPERATIONS IN LOCALLY ADVANCED THYROID CARCINOMA

The outcomes of different kinds of research do not provide full answers to the questions about indications for therapy, surgical techniques and long-term results of operations in case of locally advanced thyroid carcinoma (LA TC).

Purpose. To evaluate the results of surgical treatment of patients with LA TC.

Materials and methods. 1471 patients with LA TC were operated on within in the period from 2004 to 2016, including locally advanced form in 71 cases (4,8%).

Outcomes. All patients were operated applying extended thyroidectomy with neck lymph node dissection. As a result of tumour invasion into the tracheae, its dissection was executed in 41 cases, also including defect substitution using adipodermal flap, or using one-time «end-to-end» plastics in addition to nodal stitching. Conclusions. Among all patients with locally advanced thyroid cancer, the papillary form is most common (60.6%) with upper respiratory tract infection in 72% cases. When the tumor is invaded in the upper respiratory tract, various types of resection are effective.

Keywords: thyroid carcinoma, combined operations, trachea excision.

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2017, vol XXV, # 3, page 251

S. TKACH1, G. KULINICH2, I. BOROVIK1, M. MOSKALENKO2, V. BAGMUT1

1 Kharkiv Medical Academy of Postgraduate Education

2 SI «Grigoriev Institute for Medical Radiology of National Academy of Medical Sciences of Ukraine», Kharkiv

PRINCIPLES OF ESTABLISHMENT OF WORKING CONDITIONS INTERACTION IN EMPLOYERS DEALING WITH IONIZATION RADIATION SOURCES

The paper concerns principles of establishment of working conditions interaction in employers dealing with ionization radiation sources. A clear understanding of principles of establishment of working conditions interaction in employers dealing with ionization radiation sources will enable physicians to detect and to refer these patients to special care institutions and to improve the quality of medical examinations of employers exposed to harmful working conditions, ionization radiation sources in particular.

Keywords: ionization radiation, occupational disease, medical examinations.

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