The aim of this study was to compare three semi-quantification scales for prospective assessment of scleroderma-associated interstitial lung disease (SS-ILD) severity. Methods. From 110 prospectively followed patients with SS-ILD, we selected 12 patients (mean age, 42 ± 13 years, 11 females) with obvious improvement (n = 6) or worsening (n = 6) of lung lesions on high resolution computed tomography (HRCT) during a year. The patients had diffuse (n = 7) or limited (n = 7) SS with mean length of the disease of 8.5 ± 6.7 years (range, 1 to 23 years). HRCT was done at baseline (inclusion in the study) and in a year. CT scans were quantitatively assessed by four radiologists including one experienced radiologist. A blinded analysis of HRCT scans was done using three scales: J.H.Warrick et al. (1991), A.U.Wells et al. (1997), and E.A.Kazerooni et al. (1997). The intraclass correlation coefficient (ICC) was calculated to evaluate the assessment reliability. T-test for independent samples was used to evaluate reproducibility of the assessments. Agreement between independent experts' opinions was evaluated using Kendall's rank correlation coefficient. Results. The measurements were significantly divergent between the radiologists, both for the baseline and the follow-up HRCT scans. ICCs for investigated radiological parameters were 0.56 to 0.76. The highest ICC (0.76) was obtained for A.U.Wells' scale. All scales used to assess HRCT scans had lower interoperator reproducibility. Conclusion. Combined use of currently available semi-quantification methods for follow-up assessment of HRCT in SS-ILD patients allowed thorough qualitative evaluation of lung lesions, but the reliability of the radiological parameters in detecting 1-year fibrosis progression in SS patients was low. The risk of significant interoperator bias limited the use of the radiological parameters in clinical trials of SS-ILD patients.

Diaphragmatic injuries are quite uncommon and often result from either blunt or penetrating trauma. Acute traumatic rupture of diaphragm may be unrecognized and there is often a delay between the injury and the diagnosis. This article reviews the case reports of three patients. The first patient had a penetrating trauma of left diaphragm. The diagnosis was made 5 days later. The second patient had herniation with kidney, colon and intestine through the left diaphragmatic rupture. The third patient had right diaphragmatic rupture and herniation with hepar, сolon and stomach. Both cases were presented as early undiagnosed injuries.

No abstract

Arterial chemoembolization is an X-ray surgical method that is used for recurrent pelvic tumors complicated by bleeding. It combines occlusion of tumor vessels and local chemotherapy, for which a cytostatic and drug-saturated microspheres are used. To obtain a result, two conditions must be met: carefully close all tumor afferents, treat the maximum tumor volume with saturated microspheres.The aim of the work: to define the key points of preoperative planning for recurrent pelvic tumors in women in order to achieve reliable hemostasis and cytoreduction.An analysis of 17 women with recurrent tumors complicated by tumor bleeding is presented. The first group consisted of 7 patients in whom the uterus was not removed, the second group consisted of 10 patients with removed uterus. For preoperative planning, magnetic resonance imaging of pelvis and selective angiography of the branches of the anterior and posterior trunk of the internal iliac artery were used. The sources of blood supply to the tumor were different and depended on the localization of the process in the upper, middle, and lower levels of pelvis. Multidisciplinary planning made it possible to achieve reliable hemostasis in all cases, to prevent complications from the pelvic organs.

ÔÃÁÓ Ôåäåðàëüíûé íàó÷íî-êëèíè÷åñêèé öåíòð ñïåöèàëèçèðîâàííûõ âèäîâ ìåäèöèíñêîé ïîìîùè è ìåäèöèíñêèõ òåõíîëîãèé ÔÌÁÀ Ðîññèè, ÌîñêâàВрожденные диафрагмальные грыжи в основном проявляются в детском возрасте, но иногда являются случайными находками у взрослых пациентов, проходящих медицинское обследование по различным причинам. Компьютерная томография позволяет точно поставить диагноз, установить тип грыжи и её локализацию, определяя тактику ведения пациента и подход к лечению. Мы демонстрируем одно наблюдение парастернальной диафрагмальной грыжи Ларрея Морганьи и два наблюдения задне латеральных грыж Богдалека. Все случаи были асимптоматичными и не потребовали хирургического лечения.Ключевые слова: врожденная диафрагмальная грыжа, диафрагма, грыжа Богдалека, грыжа Ларрея Морганьи, компьютерная томография. CONGENITAL DIAPHRAGMATIC HERNIAS IN ADULTSZvezdkina E.A., Lesnyak V.N., Belov M.A., Briginevich T.A.Congenital diaphragmatic hernias are generally appearing in childhood, but are also occasional ly detected in asymptomatic adult patients. Computed tomography is used for the correct diagno sis the hernia type and for its localization, facilitating its management and the choice of treatment. We report the case of parasternal diaphragmatic hernia of Morgagni Larrey and two cases of poste riolateral Bochdalek diaphragmatic hernia. The patients showed no symptoms and were not surgi cally treated.