Наукові роботи молодих вчених. Кафедра пропедевтики внутрішньої медицини № 1, основ біоетики та біобезпеки

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24 hour ambulatory ECG (Holter) monitoring: a brief history, common uses, and advantages
(2013-11-21) Ibeh God’spower, Chinenyeze
24 hour blood pressure monitoring (ambulatory blood pressure monitoring)
(2013-11-21) Aina, Funke Grace; Ashcheulova, Tetyana; Gerasimchuk, Nina
8-изопростан как главный биологический маркер оксидативного стресса у больных бронхолегочной патологии
(2014-11-25) Герасимчук, Ульяна Сергеевна; Корнилова, Наталья Юрьевна; Герасимчук, Нина Николаевна
Экспериментальными и клиническими исследованиями установлено, что в основе ведущих метаболических процессов человека лежат окислительно-восстановительные реакции. Среди них особую роль играют свободнорадикальные реакции, ведущие к образованию перекисных соединений. 8-изопростан - это продукт метаболизма в реакциях перекисного окисления арахидоновой кислоты, изомерный простагландину F2 и его количество прямо пропорционально уровню образованных свободных радикалов.
A new era of innovations in cardiology
(2013-11-21) Jorayev, Ahmet; Ashcheulova, Tetyana
Abdominal ultrasonography
(KhNMU, 2014-04) Rastogi, Suyash; Kochubiei, Oksana
Abdominal ultrasonography (also called abdominal ultrasound imaging or abdominal sonography) is a form of medical ultrasonography(medical application of ultrasound technology) to visualise abdominal anatomical structures. It uses transmission and reflection of ultrasound waves to visualise internal organs through the abdominal wall (with the help of gel which helps transmission of the sound waves). For this reason, the procedure is also called a transabdominal ultrasound, in contrast with endoscopic ultrasound, the latter combining ultrasound with endoscopy through visualize internal structures from within hollow organs. Abdominal ultrasound examinations are performed by gastroenterologists or certain other specialists in internal medicine, radiologists or sonographerstrained for this procedure. Ultrasound testing helps in the diagnosis of a wide range of diseases and conditions, including stomach problems, gallbladder or pancreas problems, and abdominal pain. During an ultrasound test, high-frequency sound waves, inaudible to the human ear, are transmitted through body tissues using an instrument called a transducer, which transmits the information to a computer that displays the information on a monitor. Ultrasound is used to create images of soft tissue structures, such as the gallbladder, liver, kidneys, pancreas, bladder, and other organs and parts of the body. Ultrasound can also measure the flow of blood in the arteries to detect blockages. Ultrasound testing is safe and easy to perform. Abdominal ultrasound can be used to diagnose abnormalities in various internal organs, such as the kidneys, liver, gallbladder, pancreas, spleen andabdominal aorta. If Doppler imaging is added, the blood flow inside blood vessels can be evaluated as well (for example, to look for renal artery stenosis). Through the abdominal wall, organs inside the pelvis can be seen, such as the as urinary bladder or the ovaries and uterus in women. Because water is an excellent conductor for ultrasound waves, visualizing these structures often requires a well-filled urinary bladder (this means the patients has to drink plenty of water before the examination). Abdominal ultrasound is commonly used in the setting of abdominal pain or an acute abdomen (sudden and/or severe abdominal pain syndrome in which surgical intervention might be necessary), in which it can diagnose appendicitis or cholecystitis. In patients with deranged liver function tests, ultrasound may show increased liver size (hepatomegaly), increased reflectiveness (which might, for example, indicate cholestasis), gallbladder or bile duct diseases, or a tumor in the liver. The same is true for patients with an abnormal kidney functionor pancreatic enzymes (pancreatic amylase and pancreatic lipase), in which ultrasound can be used for additional anatomical information. Ultrasound can also be used if there is suspicion of enlargement of one or more organs, such as used in screening for abdominal aortic aneurysm, investigation for splenomegaly or urinary retention. Ultrasound imaging is useful for detecting stones, for example kidney stones or gallstones, because they create a clearly visible ultrasound shadow behind the stone. Ultrasonography can be used to guide procedures such as treatment for kidney stones with Extracorporeal shock wave lithotripsy, needle biopsies orparacentesis (needle drainage of free fluid inside the abdominal cavity). Ultrasound may be used to detect the following digestive problems: • Cysts or abnormal growths in the liver, spleen, or pancreas • Abnormal enlargement of the spleen • Cancer of the liver or fatty liver • Gallstones or sludge in the gallbladder Generally, no special preparation is needed for an ultrasound. Depending on the type of test, you may need to drink fluid before the ultrasound or you may be asked to fast for several hours before the procedure. During the Ultrasound: you will lie on a padded examination table; a specially trained technologist will perform the test; A small amount of water-soluble gel is applied to the skin over the area to be examined. The gel does not harm your skin and will be wiped off after the test; a wand-like device called a transducer is gently applied against the skin, you may be asked to hold your breath briefly several times; the ultrasound test takes several minutes to complete, a radiologist will interpret the test results. Studies have shown that ultrasound is not hazardous. There are no harmful side effects and there is virtually no discomfort during the test. In addition, ultrasound does not use radiation, as X-ray tests do.
Additional pericardial leads to detect myocardial infarction
(KhNMU, 2015-03) Kochubiei, Oksana; Кочубєй, Оксана Анатоліївна; Кочубей, Оксана Анатольевна; Soyombo Oluwabunmi, Emmanuel
A lead of an electrocardiograph that has one electrode placed in any of six standard positions on the chest and another electrodeplaced on a limb. A record obtained from such a lead. Also is called chest lead. Those in which the exploring electrode is on the chest overlying the heart or its vicinity. For the diagnosis of posterior-basal and myocardial infarction using abduction V 7 - V 9; V 7 - the active electrode is located 5 intercostal space on the posterior axillary area; V 8 - active electrode is located in the same intercostal space at the shoulder line; V 9 - the active electrode is located in the same intercostals space on the paravertebral line. Epigastric abduction. Epigastria exhaust applicable in those cases when it is necessary to clarify the features characteristic of the anterior wall myocardial infarction, and anterior-septal area of posterior wall of the left ventricle. Leads denoted by the letter E. Active (red) electrode is applied to the epigastric region, indifferent (yellow) on the left hand, the ECG is removed at around 1 pericardial ECG mapping. The method consists of registering 35 precordial leads from various points of the chest 5 horizontal rows and 7 vertical. The method is used to assess the severity of myocardial infarction front or anterior-lateral wall of the left ventricle. This is determined by the sum of the amplitudes of the Q wave and R, square teeth R, and S, the total ST elevation and average values. The greater the total value of ST elevation and Q, the extensive myocardial infarction, the closest and adverse long-term prognosis of disease. With precordial mapaing can evaluate the effectiveness of treatment and rehabilitation measures. Additional designated by Slopak. It is used for the diagnosis of posterior-basal myocardial infarction. Yellow (indifferent) electrode is applied to the left arm, red (active) electrode is installed in II intercostal space at the left sternal border, then on middle claviclar line, anterior and middle axillary lines. When basal posterolateral myocardial infarction sometimes detected tooth V 1 - V 3. Additional electrodes may rarely be placed to generate other leads for specific diagnostic purposes. Right sided precordial leads may be used to better study pathology of the right ventricle. Posterior leads may be used to demonstrate the presence of a posterior myocardial infraction. A Lewis lead (requiring an electrode at the right sternal border in the second intercostal space) can be used to study pathological rhythms arising in the right atrium. An esophogeal lead may be used in certain advanced electrophysiology procedures; the esophageal lead uses an electrode placed inside the esophagus, which allows for high quality measurements of the electrical activity of the left atrium.
Advantages and disadvantages of using holter monitoring in the practice of cardiologist
(2013) Alam Shahariar Sajib; Pytetska, Natalia
Age peculiarities of circadian hearth rhythm in holter monitoring administration in patients with hypertension associated with obesity
(2014-04) Ivanchenko, Svitlana; Honchar, Oleksii; Bezugla, Katerina
Age features circadian rhythm heart during Holter monitoring patients with hypertension associated with obesty were described.
Aldosteronism and hypertension: Conn’s syndrome
(KhNMU, 2015-05) Кочубєй, Оксана Анатоліївна; Кочубей, Оксана Анатольевна; Kochubiei, Oksana; Shirgba Sonter, Jacob
Most hypertension is Essential Hypertension Proportion of Essential/Secondary depends on definition of “secondary” (eg if elevated BMI was a “secondary cause” 75% of patients would have it). Conn syndrome is an aldolsterone -producing adenoma. Conn's syndrome is named after Jerome W. Conn(1907–1994), the American endocrinologist who first described the condition at the University of Michigan in 1955. Aldosterone is a steroid hormone (mineralocorticoid family) produced by the outer section (zona glomerulosa) of the adrenal cortex in the adrenal glands It plays a central role in the regulation of blood pressure mainly by acting on the distal tubules and collecting of the nephrons, increasing reabsorption of ions and water in the kid, to cause the conservation of sodium, secretion of potassium, increase in water retention, and increase in blood pressure and blood volume. When dysregulated, aldosterone is pathogenic and contributes to the development and progression of cardiovascular and renal disease. Aldosterone has exactly the opposite function of atrial nutriuretic hormone secreted by the heart. Causes: Primary hyperaldosteronism has many causes, including adrenal hyperplasia and adrenal carcinoma. The syndrome is due to: 1. Solitary adrenal (conn) adenoma, 35% 2. Bilateral (micronodular) adrenal hyperplasia, 60% 3. Glucocorticoid remediable aldosteronism (dexamethansone-suppressible hyperaldosteronism) 1% 4. Rare forms, including disorders of the renin-angiotensin system 1% Complications list for Conn's syndrome: The list of complications that have been mentioned in various sources for Conn's syndrome includes:  Enlarged heart (Heart symptoms)  Loss of deep tendon reflexes  Heart disease - due to high blood pressure  Stroke- due to high blood pressure  Congestive heart failure - due to high blood pressure  Coronary artery disease - due to high blood pressure  Abnormal heart rhythm - due to low blood potassium levels  Death - due to low blood potassium levels Diagnosis measuring aldosterone alone is not considered adequate to diagnose primary hyperaldosteronism. The screening test of choice for diagnosis is the plasma aldosterone:plasma renin activity ratio. Renin activity, not simply plasma renin level, is assayed. Both aldosterone and renin are measured, and a ratio greater than 30 is indicative of primary hyperaldosteronism. Treatment - spironoloctone. Treatment of Conn's syndrome is usually successful. Many patients with a single adrenal adenoma will be able to stop drug treatment and will have normal blood pressures. Nevertheless, many specialist centres will follow a patient with Conn's syndrome for life. This is to monitor the rare possibility of growth of a second adenoma. Patients with bilateral hyperplasia should have life-long monitoring of effectiveness and side-effects of drug treatment. Again, quality of life is generally good, although some patients may not be able to tolerate spironolactone treatment.
Allergic urticaria in internal hospital
(KhNMU, 2015-03) Кочубєй, Оксана Анатоліївна; Кочубей, Оксана Анатольевна; Kochubiei, Oksana; Ashcheulova, Tetyana; Ащеулова, Тетяна Вадимівна; Ащеулова, Татьяна Вадимовна; Weyulu, Selma
Allergic Urticarial also known as Haves, affects about 20 percent of people at some time during their lives. It can be triggered by many substances or situations and usually starts as an itchy patch of skin that turns into swollen red welts. Its signs are an outbreak of swollen, pale red bumps, patches, or welts on the skin that appear suddenly either as a result of allergies, or for other reasons. Urticaria (Hives) usually causes itching, but may also burn or sting. They can appear anywhere on the body, including the face, lips, tongue, throat, or ears. Hives vary in size (from a pencil eraser to a dinner plate), and may join together to form larger areas known as plaques. They can last for hours, or up to several days before fading. Urticaria causes angioedema too, but the swelling occurs beneath the skin instead of on the surface. Angioedema is characterized by deep swelling around the eyes and lips and sometimes of the genitals, hands, and feet. It generally lasts longer than normal hives, but the swelling usually goes away in less than 24 hours. Acute urticaria is a common disorder that often prompts patients to seek treatment in the emergency department. In fact, acute urticaria is the most common cutaneous disease treated in the emergency department. Determining whether urticaria is part of an anaphylactic reaction is important. If an anaphylactic reaction occurs. Allergic urticarial can be admitted in Internal Hospital due to the severity of the attack . It may occur with the following symptoms and medical attention from the doctor is needed right away: dizziness; wheezing; difficulty breathing; tightness in the chest; swelling of the tongue, lips, or face. If associated angioedema is present, especially if laryngeal angioedema is suspected, prehospital administration of 0.3-0.5 mg of intramuscular epinephrine may be warranted. If associated bronchospasm is present, prehospital nebulized albuterol may be warranted. Other measures may be appropriate, such as continuous electrocardiography (ECG); blood pressure and pulse oximetry monitoring; administering IV crystalloids if the patient is hypotensive; and administering oxygen. If the patient has angioedema that is treated successfully in the ED, the patient should be sent home with an EpiPen prescription. The patient should be instructed to keep the EpiPen with him or her at all times and to use it if swelling of the lips, tongue, or face develops or if his or her voice becomes acutely hoarse. Care: Identify the etiology of the acute urticaria if possible. If an inciting agent can be identified, instruct the patient to avoid it. The major goal is to control the severity of acute urticaria lesions until the process resolves over 4-6 weeks. Inpatient therapy may be required if the urticaria is severe and does not respond to antihistamine therapy, or if the patient's condition progresses to laryngeal angioedema and/or anaphylactic shock. Special care may be needed by a patient with urticarial but most important is one to stay away from the agents that causing it, if identified and to make sure patient follow all medical advises.
Ambulatory ECG recording. Its reminiscence, merits and demerits
(KhNMU, 2013-11-21) Isaac, Precious Adaora; Demydenko, Ganna
Ambulatory ECG recording. Its reminiscence, merits and demerits
An egophony test
(KhNMU, 2014-11) Aminath, Shausha; Kochubiei, Oksana; Кочубєй, Оксана Анатоліївна; Кочубей, Оксана Анатольевна
Egophony is a condition characterized by a shift in vowel sound that is heard through a patient's lungs. A positive egophony test indicates that fluid has accumulated in or around the lungs or that scar tissue has formed inside the lungs. This test is one of a number of voice transmission tests that require the patient to speak softly while the doctor listens to the lungs with a stethoscope. In patients with egophony, the sound of the letter E will take on the qualities of the letter A when heard through the lungs. The term egophony, which may also be spelled aegophony, comes from two Greek terms that mean "goat" and "sound." This name was given to the disorder because the shift in sound from E to A makes a patient's voice sound vaguely goat-like when heard through a stethoscope. This condition is only noticeable when listening directly to a patient's lungs as the vowels will not sound distorted when a patient is heard through the air. A non-invasive diagnostic tool, an egophony test is conducted in a doctor's office or hospital. The patient will be asked to speak, often repeating a word with a strong E sound, while the doctor listens to the lungs in a number of different places. It is possible for some parts of the lungs to indicate egophony while other parts sound normal. The shift in vowel sound when heard through the lungs is usually caused by the presence of additional fluid in or around the lungs. This fluid transmits high frequency sounds more easily than it does low frequency sounds. In patients with healthy lungs, listening to the lungs while a patient speaks will sound the same as listening to a patient speak through the air. Conclusion. An egophony test may be used by doctors as a preliminary diagnostic tool and can indicate pneumonia, pleural effusion, or idiopathic pulmonary fibrosis. In pneumonia, fluid builds up in a patient's lungs, making some areas of the lungs unsuitable for oxygen-carbon dioxide exchange with red blood cells. Patients with pleural effusion may have a build-up of fluid around the lungs, a condition that makes it harder for the lungs to expand to their full capacity. Idiopathic pulmonary fibrosis is a build-up of scar tissue or a swelling of lung tissue that can also make the lungs less efficient. If egophony is found in a patient, further tests to determine whether one of these conditions is the cause need to be performed.
An overview of ethical issues involved in surrogacy
(ХНМУ, 2015-03-31) Abubakar Hauwa, Kaka; Akoto, Sesime; Vizir, Marina; Візір, Марина Олександрівна
Surrogacy is the process in which a woman, the surrogate, gives birth to a child but relinquishes parental rights to intended parents. Surrogacy can be defined as traditional or gestational. Traditional surrogacy involves naturally or artificially inseminating the surrogate mother with the intended father’s sperm. The surrogate mother provides the egg, meaning that the resulting child is biologically related to her. In gestational surrogacy, the egg and sperm are provided by the intended parents or donors other than the surrogate. In this case, the surrogate is not related to the child and is merely a carrier. Surrogacy can also be classified in terms of compensation. Commercial surrogacy involves financial compensation of the surrogate while altruistic surrogacy does not. Commercial surrogacy is legal in India, Ukraine, Georgia and California. Many states in the United States, Canada, England and Australia, recognize only altruistic surrogacy. Germany, France, and Italy, consider both commercial and altruistic surrogacy to be illegal or do not recognize any surrogacy agreements. Greece, Israel and South Africa make surrogacy legally available to people based on factors such as religion, sexual orientation, or nationality. As stated above, certain countries allow surrogacy based on factors such as age of the intended mother, the sexual orientation of the intended parents or the religion of the intended parents. Do governments have the right to essentially regulate people’s reproductive lives? Moreover, who decides or has the right to decide who can become a parent? In the case of commercial surrogacy, the financial compensation of the surrogate mother lead some to regard the child as a purchasable commodity. This is perhaps the most contentious feature of surrogacy. Some governments have perhaps addressed this issue by only recognize altruistic surrogacy. There is a lack of studies on the harms and benefits of surrogacy. The stricter definition of surrogacy and higher costs in western countries will continue to force hopeful parents to seek a surrogate in surrogate friendly countries. The safe guarding of ethics may then fall to these countries willing to allow surrogacy. In India, ‘the surrogate capital of the world’, the disparity in how well compensated surrogate mothers are or the care they receive from the ART clinics while pregnant can be alleviated by regulating ART clinics in India in regards to ethics, rights and counseling offered to surrogate mothers. However, the ethics of the definition of who can be parents and who can define parenthood remains unclear.
Angiography in small intestine diseases
(KhNMU, 2014-04) Joseph, Moyosore Sandra; Kochubiei, Oksana
An angiogram is an x-ray test that uses a special dye and camera (fluoroscopy) to take pictures of the blood flow in a vessel while Angiography is the method of the procedure. This procedure is to provide detailed images of blood flow in your small intestine and to look for blocked arteries. During an angiogram, a thin tube called a catheter is placed into a blood vessel. The catheter is guided to the area under study. Then an iodine dye (contrast material) is injected into the vessel to make the area show clearly on the X-ray pictures. This method is known as conventional or catheter angiogram. The angiogram pictures can be made into regular X-ray films or stored as digital pictures in a computer. An angiogram can find a bulge in a blood vessel (aneurysm). It can also show narrowing or a blockage in a blood vessel that affects blood flow. An angiogram can show if coronary artery disease is present and how chronic it is. Certain treatments can be done during this procedure. These items are passed through the catheter to the area in the artery that needs treatment. These include: • Dissolving a blood clot with medicine • Opening a partially blocked artery with a balloon • Placing a small tube called a stent into an artery to help hold it open After the x-rays or treatments are finished, the catheter is removed. Pressure is immediately applied to the puncture site for 20-45 minutes to stop the bleeding. After that time the area is checked and a tight bandage is applied. The leg is usually kept straight for another 6 hours after the procedure. This test is done when someone has symptoms of a narrowed or blocked blood vessel in the intestines, to find the source of bleeding in the gastrointestinal tract, to find the cause of ongoing abdominal pain and weight loss when no cause can be identified, when other studies do not provide enough information about abnormal growths along the intestinal tract, to look at blood vessel damage after an abdominal injury. Results are considered normal if the arteries being examined are normal in appearance. A common abnormal finding is narrowing and hardening of the arteries that supply the large and small intestine. This is called mesenteric ischemia. The problem occurs when fatty material (plaque) builds up on the walls of your arteries. Abnormal results may also be due to bleeding in the small and large intestine. This may be caused by: Angiodysplasia of the colon, blood vessel rupture from injury, blood clots, cirrhosis, tumors.
Application of chest X-ray in pulmonology
(2014) Praharaj, Pooja; Pytetska, Natalya
A chest x-ray is an x-ray of the chest, lungs, heart, large arteries to detect diffrerent pulmonary diseases. Patient has to stand in front of the x-ray machine. You will be told to hold your breath when the x-ray is taken. Two images are usually taken. You will need to stand against the machine, and then sideways. How to prepare for the test. Tell the health care provider if you are pregnant. Chest x-rays are generally not done during the first 6 months of pregnancy. How the test will feel. There is no discomfort. The film plate may feel cold. The doctor may order a chest x-ray if you have any of the following symptoms: • a persistent cough; • chest injury; • chest pain; • coughing up blood; • difficulty breathing. It may also be done if you have signs of tuberculisis, lung cancer, or other chest or lung diseases. A serial chest x-ray is one that is repeated. It may be done to look at or monitor changes found on a previous chest x-ray. Abnormal results may be due to many things, including: In the lungs: collapsed lung, collection of fluid around the lung, lung cancer, lung tumor, malformation of the blood vessels, pneumonia, scarring of lung tissue, tuberculosis. Abnormal results may also be due to: achalasia, acute bronchitis, alpha-1 antitrypsin deficiency, aortic dissection, atelectasis, atrial myxoma, blastomycosis, breast cancer, bronchial adenoma, bronchial asthma, bronchiectasis, bronchiolitis, bronchopulmonary dysplasia, byssinosis (cotton dust lung disease), caplan syndrome, idiopathic diffuse interstitial pulmonary fibrosis, industrial bronchitis, Legionnaire’s disease, malignant hypertension, myocarditis, necrotizing vasculitis, neuroblastoma, occupational asthma, pulmonary tuberculosis, pulmonary veno-occlusive disease, Q fever, rheumatoid lung disease, sarcoidosis, senile cardiac amyloid, systemic sclerosis (scleroderma), viral pneumonia, Wilms tumor. Risks. There is low radiation exposure. X-rays are monitored and regulated to provide the minimum amount of radiation exposure needed to produce the image. Most experts feel that the risk is very low compared with the benefits. Pregnant women and children are more sensitive to the risks of x-rays.
Application of polysomnography in diagnosis of the sleep disorders
(2014) Mbabazi, Solomon; Pytetska, Natalya
Polysomnography is derived from Greek and Latin roots: the Greek, polus for "many, much", indicating many channels), the Latin somnus ("sleep"), and the Greek graphein, "to write"). Polysomnography, (PSG) also called a sleep study, is a test used to diagnose sleep disorders. Polysomnography records your brain waves, the oxygen level in your blood, heart rate and breathing, as well as eye and leg movements during the study. Physiologic sensor leads are placed on the patient in order to record: Brain electrical activity, Eye and jaw muscle movement, Leg muscle movement, Airflow, Respiratory effort (chest and abdominal excursion), EKG, Oxygen saturation. Information is gathered from all leads and fed into a computer and outputted as a series of waveform tracings which enable the technician to visualize the various waveforms, assign a score for the test, and assist in the diagnostic process. Relevance in medicine today. Polysomnography is proven method of diagnosis of sleep apnea, a condition where, for a variety of reasons, a person ceases to breathe during sleep. It can be categorized into the following types. • Central sleep apnea: the failure of the brain to signal the diaphragm and other muscles of ventilation to contract. • Obstructive sleep apnea: a decrease in airflow although there are continuing respiratory efforts. • Mixed sleep apnea: a combination of both central and obstructive sleep apneas.
Application of pulmonary plethysmography to estimate of total lung capacity
(2014) Ezepue, Sandra A.; Pytetska, Natalya
Pulmonary plethysmography is a test used to measure how much air you can hold in your lungs. Pulmonary plethysmography helps healthcare providers assess patients with lung diseases, which are often associated with a decrease in total lung capacity (TLC). Pulmonary plethysmography has been found to be more reliable than Spirometry, It can measure a person’s TLC, which is the total volume of air in the chest after they have inhaled as deeply as possible. Plethysmographic measurements are based on Boyle’s Law, a principle that describes the relationship between the pressure and volume of a gas. Technique of this method. Patient will sit in a small, airtight room known as a body box and will breathe or pant against a mouthpiece. Clips will be put on his nose to shut off his nostrils. Depending on the information doctor is looking for, the mouthpiece may be open at first, and then closed. Patient will breathe against the mouthpiece in both the open and closed positions. The positions give different information to the doctors. As patient’s chest moves while you breathe or pant, it changes the pressure and amount of air in the room and against the mouthpiece. From these changes, the doctor can get an accurate measure of the amount of air in patient’s lungs. The main risks: • anxiety from being in the closed box; • dizziness; • light-headedness; • shortness of breath.
Application of scintigraphy in pulmonology
(2014) Elhaj, Abeer; Pytetska, Natalya
Pulmonology – is a medical specialty that deals with diseases involving the respiratory tract. It is known as chest medicine and respiratory medicine in some countries and areas , considered a branch of internal medicine, and is related to intensive care medicine. Pulmonology often involves managing patients who need life support and mechanical ventilation. Pulmonologists are specially trained in diseases and conditions of the chest, particularly pneumonia, asthma, tuberculosis, emphysema, and complicated chest infections. Methods: • Laboratory investigation of blood (blood tests). Sometimes arterial blood gas measurements are also required. • Spirometry (the determination of lung volumes in time by breathing into a dedicated machine; response to bronchodilatators and diffusion of carbon monoxide). • Bronchoscopy with bronchoalveolar lavage (BAL), endobronchial and transbronchial biopsy and epithelial brushing. • Chest X-rays. • CT scanning (MRI scanning is rarely used). • Scintigraphy and other methods of nuclear medicine. • Positron emission tomography (especially in lung cancer). • Polysomnography (sleep studies) commonly used for the diagnosis of Sleep apnea. Surgical method. Major surgical procedures on the heart and lungs are performed by a thoracic surgeon. Pulmonologists often perform specialized procedures to get samples from the inside of the chest or inside of the lung. They use radiographic techniques to view vasculature of the lungs and heart to assist with diagnose. Scintigraphy ("scint," Latin scintilla, spark) is a form of diagnostic test used in nuclear medicine, wherein radioisotopes (here called radiopharmaceuticals) are taken internally, and the emitted radiation is captured by external detectors (gamma cameras) to form two-dimensional images. In contrast, SPECT and positron emission tomography (PET) form 3-dimensional images, and are therefore classified as separate techniques to scintigraphy, although they also use gamma cameras to detect internal radiation. Scintigraphy is unlike a diagnostic X-ray where external radiation is passed through the body to form an image. Lung scintigraphy. The most common indication for lung scintigraphy is to diagnose pulmonary embolism, e.g. with a ventilation/perfusion scan. Less common indications include evaluation of lung transplantation, preoperative evaluation, evaluation of right-to-left shunts. In the ventilation phase of a ventilation/perfusion scan, a gaseous radionuclide xenon or technetium DTPA in an aerosol form is inhaled by the patient through a mouthpiece or mask that covers the nose and mouth. The perfusion phase of the test involves the intravenous injection of radioactive technetium macro aggregated albumin (Tc99m-MAA). A gamma camera acquires the images for both phases of the study. Indications and contraindications. Clinical indications for pulmonary scintigraphy include, but are not limited to, the following: 1. Assessment of the probability of acute or chronic pulmonary thromboembolic disease, including the evaluation of unexplained pulmonary arterial hypertension. 2. Quantification of differential or regional pulmonary function (eg, in predicting postoperative function). 3. Evaluation of transplanted lungs. 4. Evaluation of pulmonary or cardiac right-to-left shunts. 5. Evaluation of the effects of structural abnormalities of the chest, such as pectus excavatum and congenital diaphragmatic hernia. 6. Confirmation of the presence of bronchopleural fistulae. 7. Evaluation of chronic pulmonary parenchymal disorders such as cystic fibrosis. Relative contraindications. There are no absolute contraindications for pulmonary scintigraphy. Potential benefits must outweigh the minor risks of the procedure. There might be radiation risks to the fetus. When possible, the administered activity of each radiopharmaceutical should be decreased. One of the complication of this method can be aspiration of different substances into the airway, which can lead to other different diseases.
Application of spirometry for early diagnosis of bronchopulmonary diseases
(2014) Azode, Christine O.; Pytetska, Natalya
Spirometry (meaning the measuring of breath) is the most common of the pulmonory function tests (PFTs), measuring lung function, specifically the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled. Spirometry is used for generating pneumotachographs, which are helpful in assessing conditions such as pulmonory fibrosis, asma, cystic fibrosis and COPD. Procedure. The basic forced volume vital capacity (FVC) test varies slightly depending on the equipment used. Generally, the patient is asked to take the deepest breath they can, and then exhale into the sensor as hard as possible, for as long as possible, preferably at least 6 seconds. It is sometimes directly followed by a rapid inhalation (inspiration), in particular when assessing possible upper airway obstruction. Sometimes, the test will be preceded by a period of quiet breathing in and out from the sensor (tidal volume), or the rapid breath in (forced inspiratory part) will come before the forced exhalation. During the test, soft nose clips may be used to prevent air escaping through the nose. Filter mouthpieces may be used to prevent the spread of microorganisms. The more common lung function values measured with spirometry are: • Forced vital capacity (FVC). This measures the amount of air you can exhale with force after you inhale as deeply as possible. • Forced expiratory volume (FEV). This measures the amount of air you can exhale with force in one breath. The amount of air you exhale may be measured at 1 second (FEV1), 2 seconds (FEV2), or 3 seconds (FEV3). FEV1 divided by FVC can also be determined. • Forced expiratory flow 25% to 75%.This measures the air flow halfway through an exhale. • Peak expiratory flow (PEF). This measures how much air you can exhale when you try your hardest. It is usually measured at the same time as your forced vital capacity (FVC). • Maximum voluntary ventilation (MVV). This measures the greatest amount of air you can breathe in and out during 1 minute. • Slow vital capacity (SVC). This measures the amount of air you can slowly exhale after you inhale as deeply as possible. • Total lung capacity (TLC). This measures the amount of air in your lungs after you inhale as deeply as possible. • Functional residual capacity (FRC). This measures the amount of air in your lungs at the end of a normal exhaled breath. • Residual volume (RV). This measures the amount of air in your lungs after you have exhaled completely. It can be done by breathing in helium or nitrogen gas and seeing how much is exhaled. • Expiratory reserve volume (ERV). This measures the difference between the amount of air in your lungs after a normal exhale (FRC) and the amount after you exhale with force (RV) Thus, it is necessary to use spirometry for early diagnosis of bronchopulmonary tract obstruction and appointment of adequate therapy.
Application of spirometry in pulmonilogy and its diagnostic value
(2014) Adeleke, Ayanfeoluwa; Pytetska, Natalya
Pulmonology is a medical specialty that deals with diseases involving the respiratory tract. Spirometry – the determination of lung volumes in time by breathing into a dedicated machine; response to bronchodilatators and diffusion of carbon monoxide. Spirometry (meaning the measuring of breath) is the most common of the pulmonary function tests (PFTs), measuring lung function, specifically the amount (volume) and/or speed (flow) of air that can be inhaled and exhaled. Spirometry is a common office test used to assess how well your lungs work by measuring how much air you inhale, how much you exhale and how quickly you exhale. Spirometry is used to diagnose asthma, chronic obstructive pulmonary disease (COPD) and other conditions that affect breathing. Spirometry may also be used periodically to check whether a treatment for a chronic lung condition is helping you breathe better. Why it's done? The doctor may suggest a spirometry test if he or she suspects your signs or symptoms may be caused by a chronic lung condition such as: asthma, COPD, chronic bronchitis, emphysema, pulmonary fibrosis. If you've already been diagnosed with a chronic lung disorder, spirometry may be used periodically to check how well your medications are working and whether breathing problems are under control. Spirometry is generally a safe test. You may feel short of breath or dizzy for a moment after you perform the test. Because the test requires some exertion, it isn't performed if you've had a recent heart attack or some other heart conditions. Rarely, the test triggers severe breathing problems. Key spirometry measurements include the following: • Forced vital capacity (FVC). This is the largest amount of air that you can forcefully exhale after breathing in as deeply as you can. A lower than normal FVC reading indicates restricted breathing. • Forced expiratory volume (FEV-1). This is how much air you can force from your lungs in one second. This reading helps your doctor assess the severity of your breathing problems. Lower FEV-1 readings indicate more significant obstruction.