2020 Issue №2

The article reviews the influence of various factors on the accuracy and reproducibility of liver stiffness measurements using shear wave elastography (SWE), as well as on the reliability of judgments about the norm and patholo­gy. The tasks included analyzing the factors affecting the accuracy of meas­urements of liver stiffness depending on the equipment; testing various SWE techniques for their advantages and disadvantages; identifying the factors de­pending on the patient (body mass index, gender, respiration, etc.); finding out the reproducibility of liver stiffness measurements in SWE, depending on the skills of the operator, the minimal measurements, the use of contrast-enhanced ultrasound. The most important factors affecting the results of liver stiffness measurements include using SWE method, the diagnostic equipment and the sensors, the measurement depth and acoustic access; the reliability of various SWE methods is approximately equivalent. Among modern ultrasonic SWE technologies, the most efficient to visualize the measurement area are ARFI technologies — point shear wave elastography (pSWE) and two-di­men­sional shear wave elastography (2D-SWE). Two-dimensional SWE (2D-SWE) provides maximum color visual information about the state of liver tis­sue elasticity.

Spleen, as a lymphoid organ, can activate itself in certain diseases, which is macroscopically manifested by splenomegaly. At certain stages of a disease development, splenomegaly may be an only symptom. There are different ways to detect splenomegaly with physical diagnostic methods and instru­mental studies, but their results can be rather contradictory. The aim of the research is to provide a critical analysis of a varity of instruments. The article offers a good review of a varity of papers and methodologies on this topic in the RSCI and PubMed databases. There are different methods for determining splenomegaly in children and adults. Most researchers note relationship be­tween the size and volume of the spleen with the height of patients and the lack of connection with the patient’s weight and body mass index. Historical­ly, there is a transition from strict criteria for splenomegaly (a certain value of the length, volume of an organ, the area of its transverse section) to formulas that take into account the anthropometric characteristics of patients (gender, height).

The authors try to characterize changes in viscosities of blood and throm­boresistance of vascular endothelium after stab wounds of heart. To achieve the goal, the indicators of microblood circulation were studied in 34 patients. All patients were divided into two groups: the first group of 17 people has been operated for the wounds of heart with the thoracotomy, suturing heart wounds and the pleural cavity drainage. The second group of 17 patients had stab wounds of the chest, they underwent primary surgical treatment of wounds, drainage of the pleural cavity. A study of the patient’s blood coagula­tion capacity, the examination of markers of intravascular coagulation of the blood, the level of D-dimer, and the viscosity of the blood were made. The study established that the heart wounds are characterized by disturbances of the microcirculatory bed in the nearest post-surgery term. At the same time the maximum changes are revealed for 5—7 post-surgery days when all stud­ied indicators showed some changes of, in particular a coagulative hemostasis system got more activated which was manifested by shortening of blood plas­ma recalcification time, thrombin time, at the same time, the final process of blood coagulation was activated, which resulted in an increase in the level of fibrin in the blood. In addition, this period was characterized by a decrease in the activity of antithrombin III and an increase in HAEM-kallikrein-dependent fibrinolysis as well as the increased level of D-dimer in the blood, the increase of the viscosity of blood at all shear rates, in addition, in this peri­od there was a decline in anticoagulant and fibrinolytic activity of the endo­thelium, which can be regarded as a manifestation of DIC. The complete re­covery of the studied indicators occurred on 17—19 postoperative days. Heart wounds lead to a change in the microcirculation, the maximum of which falls on 5—7 post-surgery days. Patients with heart wounds can be referred to as thrombotic for 5—7 post-surgery days.