Vol 97, No 4 (2016)

The article considers one of the causes of maternal mortality - uterine postpartum bleeding developing as a result of the placental growth into the uterus and surrounding organs. It is highlighted that the processes of trophoblast invasion during pregnancy and tumor progression have much in common. The article describes a significant role of Kiss1-gene and its receptor GPR54 in the placenta accreta development. The causes of placental abnormalities and conventional methods of treatment and surgical management in placenta accreta (controlled uterine balloon tamponade, uterine vessels ligation, uterine compression sutures, uterine artery embolization, internal iliac arteries ligation, temporary clamping or major uterine vessels ligation, hysterectomy, «Triple-P» method) are analyzed, the possible complications of these methods of treatment are listed. The developed at the Department of Obstetrics and Gynecology №1 of Kazan State Medical University examination algorithm when planning pregnancy, gestation management and organ-preserving method of delivery in pregnant women with abnormal placental attachment is presented. Used by authors methods of uterine scar examination after organ-preserving surgery or caesarean section in women in the non-pregnant state (hysterography, hysteroscopy, ultrasound scan, double-contrast study) and sonographic signs of scar failure (myometrial thinning in the scar area, irregular contour of the scar, discontinuous contours of the scar, significant number of hyperechoic inclusions, presence of non-vascular liquid formations in the scar area, triangle in the scar area) are listed. Interesting illustrative material is also presented.

Aim. To compare patency of aortocoronary bypass grafts in remote period after endoscopic and conventional (open) great saphenous vein harvesting. To analyze the patency of aortocoronary bypass grafts after endoscopic vein harvesting from calf and thigh.

Methods. The study involved 170 patients who underwent elective isolated coronary artery bypass grafting. Treatment results were evaluated in two prospectively formed groups: endoscopic (85 patients) and open (85 people) vein harvesting. Endoscopic vein harvesting was performed both from the calf and from the thigh through popliteal access using endoscopic system Vasoview 6.0. Patency of autovenous aortocoronary grafts was studied in 2.6±1.17 years after surgery using 64-slice contrast-enhanced MDCT or traditional angiography. Angiographic follow-up covered 76 patients with endoscopic vein harvesting and 79 patients with open vein harvesting.

Results. The studied groups did not differ in the frequency of detection of occluded, stenotic and fully patent autovenous aortocoronary bypass grafts (p=0.841). In endoscopic vein harvesting group frequency of autovenous aortocoronary bypass grafts occlusion was 25.7%, in the group of open vein harvesting - 25.1% (p=0.984). There was no difference in the patency of internal thoracic artery grafts to the left anterior descending artery (p=0.227), and freedom from adverse cardiac events (p=0.342). Occlusion of autovenous grafts after endoscopic harvesting from the calf developed less frequently than after endoscopic harvesting from the thigh (15.1 vs. 34.6%; p=0.013). Grafts after endoscopic harvesting in the knee region occluded most often (41.9%). Patency of aortocoronary bypass grafts after open vein harvesting was not dependent on the area of the vein harvesting (p=0.900).

Conclusion. Endoscopic vein harvesting does not compromise the patency of aortocoronary bypass graft and does not increase the risk of its occlusion; endoscopic harvesting of the veins from the calf improves indicators of aortocoronary grafts patency and reduces the risk of graft failure (odds ratio 0.3; 95% confidence interval 0.14-0.8; p = 0.013).

Aim. To specify the sequence of changes in the functional parameters of arterial hypertension in patients with chronic obstructive pulmonary disease and asthma according to the results of echocardiography, carotid arteries duplex scan and ambulatory blood pressure monitoring.

Methods. Ambulatory blood pressure monitoring, tissue Doppler echocardiography and carotid artery duplex scan were performed in 160 patients with chronic obstructive pulmonary disease, arterial hypertension, asthma, and 33 apparently healthy volunteers of both sexes aged 39-70 years.

Results. In patients with chronic obstructive pulmonary disease, an increase in hypertensive indices of time and area with the development of non-dipper or inverse-dipper 24-hour blood pressure profile disturbances is registered only at night hours. In chronic obstructive pulmonary disease, unlike asthma, carotid arteries thickening, combined hypertrophy and diastolic dysfunction of both ventricles develop. The prevalence of the thickening of «intima-media» complex and atherosclerotic plaques among patients with comorbid pathology (chronic obstructive pulmonary disease + arterial hypertension) occurs significantly more frequently than in the groups with hypertension or chronic obstructive pulmonary disease, confirming the synergistic effect of the considered nosologies on the atherosclerotic process.

Conclusion. In patients with chronic obstructive pulmonary disease changes of the ultrasonic and functional indicators of the cardiovascular system, typical for arterial hypertension are registered starting with stage I and amplified with increase in the disease severity, leading to the need of diagnostic and therapeutic management correction.

Aim. To analyze the pregnancy associated protein A and insulin-like growth factor 1 levels in blood plasma of patients with acute coronary syndrome and determination of gender- and age-related features of proteins values.

Methods. The study included 71 patients with acute coronary syndrome, including 47 men and 24 women. The control group consisted of 20 healthy people matched for age and sex, the comparison group - 40 patients with a diagnosis of «hypertension» and «chronic ischemic heart disease». Pregnancy-associated plasma protein A, and insulin-like growth factor 1 determination was performed.

Results. The concentration of a pregnancy-associated plasma protein A was higher in acute coronary syndrome compared with control and comparison groups. The content of insulin-like growth factor-1 in myocardial infarction is lower than in the comparison group. An increase in concentration of insulin-like growth factor 1 in unstable angina has no significant differences from the control and comparison groups. The highest levels of insulin-like growth factor-1 are registered in the comparison group, the lowest ones - in the subgroup with a fatal outcome. A statistically significant difference between the parameters in men and women was demonstrated in the groups with acute coronary syndrome and unstable angina for insulin-like growth factor 1, in the group with myocardial infarction - for a pregnancy-associated plasma protein A. Insulin-like growth factor 1 levels inversely correlated with age, which confirms reparative role of the protein.

Conclusion. Pregnancy-associated plasma protein A and insulin-like growth factor 1 are new highly sensitive biochemical markers of vascular inflammation and injury, their levels can be used to predict the instability of atherosclerotic plaque in acute coronary pathology and assessing the disease prognosis.

Aim. To assess the relationship between textural characteristics of the subchondral bone and standard X-ray data, to determine markers of subchondral bone remodeling in gonarthrosis.

Methods. The studied group included 92 patients aged 66.1±10.5 years with I-IV grades osteoarthritis by the Kellgren, in the comparison group - 24 volunteers aged 29.6±5.96 years without clinical or radiological signs of gonarthrosis. Standard digital X-ray of the knee joint was performed. On the image, the area of interest was chosen, including a portion of the subchondral bone of 48±2×90±4 pixels of size. According to the area texture, the gray-level histogram and 3D graph of the pixels intensity distribution in area were made.

Results. The distribution of individual pixel values relating to the average gray-level values showed an inverse correlation with the disease stage (r=-0.52, p=0.00004) and the presence of large osteophytes (r=-0.40, p=0.002). Extremum of 3D histogram minimum value directly correlated with radiographic stage of gonarthrosis (r=0.42, p=0.0009), patients’ age (r=0.33, p=0.01) and the osteophytes number (r=0.43, p=0.0007). This figure was higher in the group of patients with osteoarthritis (p=0.009) and significantly decreased with the disease progression (p=0.04).

Conclusion. For the first time the analysis of 3D surface reconstruction depending on the gray-level pixel values was used, which showed good characteristics on the distinguishing groups of patients with osteoarthritis, and comparability with standard radiographic protocol data; the best results demonstrated the minimum value at 3D histogram that had significant variation depending on the disease stage.

Aim. To improve the treatment results of patients with Barrett’s esophagus by using videoendosurgical technologies and the application of argon plasma coagulation.

Methods. Treatment results of 16 patients with Barrett’s esophagus who underwent endoscopic argon plasma coagulation of esophageal epithelium metaplasia foci are presented. Endoscopic studies protocols were based on the Prague criteria - the maximum extent of the flames (M) and the maximum extent of the circular segment of Barrett’s esophagus (C). Long segment Barrett’s esophagus prevailed in the majority of patients. Argon plasma coagulation was performed in FORCED mode (power of 30-32 watts with an argon flow of 2-2.2 L/min). For 1 session coagulation of the affected area of no more than 4 cm2 was performed.

Results. In the immediate postoperative period, complications of treatment were not observed. In 12 patients course of treatment with argon plasma coagulation was fully completed, repeated courses were administered depending on the segment length (1 patient required 1 session, 3 patients - 2 sessions, 2 - 3 sessions, 4 patients - 4 sessions, 2 patients - 5 sessions). Manipulation duration was about 5-7 minutes. In these patients, there was complete regression of metaplastic epithelium with its replacement by typical stratified squamous epithelium. 4 patients continue treatment.

Conclusion. Surgical treatment is indicated to all patients with Barrett’s esophagus, in the postoperative period - the use of endoscopic argon plasma coagulation, which should be performed in stages with 1-1.5 month intervals with obligatory endoscopic and histological control.

Aim. To study the effectiveness of a structured educational program in improving adherence to therapy with the creation of continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea/hypopnea syndrome.

Methods. The study included 40 patients with moderate to severe obstructive sleep apnea/hypopnea syndrome, who received CPAP therapy. Patients were divided into two groups: the first group (main) - 20 patients who had undergone training according to a specially designed structured educational program, the second group (control) - 20 patients who had not received training. CPAP therapy was considered as effective in case of reducing the apnea-hypopnea index to less than 5 per hour of sleep, with an average duration of the machine use for the night was to be more than 5 hours.

Results. Using a structured educational program in patients of the main (first) group showed a good adherence of patients and the effectiveness of CPAP therapy. Positive dynamics of clinical symptoms, in particular a decrease in daytime sleepiness, assessed according to Epworth sleepiness scale (17.1±4.2 vs. 3.9±1.6; p=0,0000), was registered, the number of pauses in breathing during the night significantly reduced (44.37±14.6 vs. 2.86±3.5 per hour; p=0,0000), accompanied by improvement of night saturation parameters: SpO2min (58.4±9.0 vs. 78.0±9.3; p=0,0000), SpO2mean (87.2±6.8 vs. 93.1±3.5; p=0,0018). Against this background, after 3 months of therapy a decrease in body mass index and blood pressure was registered.

Conclusion. The implementation of a structured educational program showed increase in adherence and the effectiveness of therapy with the creation of continuous positive airway pressure (CPAP therapy) in treating obstructive sleep apnea/hypopnea syndrome.

Aim. To evaluate the effectiveness of using bioresonance therapy in the treatment of patients with hypothyroidism.

Methods. Three matched groups of patients with acquired hypothyroidism consisting of 50 people aged 20 to 60 years (mean age 45.6 years) were included in a study. All patients were treated by the same conventional scheme of treatment of hypothyroidism: thyroid hormone replacement drugs. The main group, in addition to replacement therapy received bioresonance therapy. The second group (control) received only pharmacotherapy, the third group (placebo) received pharmacotherapy and simulation of bioresonance therapy procedures. Patients of the main group received 12 daily bioresonance therapy procedures using «Det Professional» device, consisting of two stages: the basic treatment stage and targeted therapy stage. 5 procedures of basic treatment and 7 procedures of targeted therapy were performed.

Results. After bioresonance therapy, free thyroxine fraction value in the main group significantly increased in comparison with the control group and the placebo group. Values of thyroid-stimulating hormone after the conducted therapy in the main group significantly decreased compared with the control group and the placebo group. The lipidogram results indicate that the content of high-density lipoproteins in the study group significantly increased compared with the control group and the placebo group. The concentrations of low-density lipoproteins, cholesterol and triglycerides in the main group became significantly lower than in the control group and the placebo group.

Conclusion. The obtained results give the evidence of the effectiveness of using bioresonance therapy in combined treatment of patients with hypothyroidism and in achieving stable remission of hypothyroidism.

Aim. The evaluate the possibility of predicting critical incidents development during elective surgery using Duke University activities of daily living questionnaire, a six-minute walk test, cardiopulmonary exercise testing.

Methods. 36 patients who had undergone elective abdominal surgery were included in the study. To determine the functional state in preoperative period patients filled in Duke University activities of daily living questionnaire, performed a 6-minute walk test, cardiopulmonary exercise testing. Critical incidents analysis was conducted by E.A. Kazakova method (2005) at two stages: induction and maintenance of anesthesia. Using statistical methods the most informative indicators for predicting critical incidents were determined.

Results. Logistic regression analysis demonstrated that only the anaerobic threshold and 6-minute walk test significantly contributed to predicting critical incidents. At the same time, ROC-analysis demonstrated the predictive value of using only the anaerobic threshold to determine the likelihood of critical incidents. It was found that this indicator threshold value is 10.85 ml/kg per minute with 100% sensitivity and 95% specificity. It is also proved that the patients’ subjective assessment leads to an overestimation of their functional state.

Conclusion. Anaerobic threshold indicator determined by a cardiopulmonary exercise testing can be used as a criterion for predicting critical incidents development; reduction in the anaerobic threshold of less than 10.85 mL/kg per minute indicates the likelihood of critical incidents development with a high level of sensitivity and specificity.

Aim. To study the content of Ca, P, F and I in enamel and dentin composition of deciduous teeth, which are formed in fluoride and iodide deficiency, and its dynamics on the background of the 3-year consumption of fluorinated and iodized salt.

Methods. The mineral composition of the deciduous teeth enamel and dentin of 6-12 years old children, born and living in conditions of biogeochemical deficiency of fluoride (0.02-0.08 ppm F in water) and iodide (0.033-0.005 ppm I in water) before and after consumption of fluorinated and iodized salt containing sodium fluoride 300±50 ppm F and potassium iodate 40±10 ppm I was studied. The first phase of the study was conducted before inclusion of fluorinated-iodized salt in the diet of schoolchildren. Using X-ray microanalysis, macro- and microelements of 47 intact deciduous teeth were studied. The contents of the four elements (Ca, P, F, and I) in three layers of enamel (the surface layer, intermediate layer, at the enamel-dentin border) and in three layers of the dentine (the layer at the enamel-dentin border, a middle layer, circumpulpal layer). The second phase of a study on the mineral composition of the enamel and dentin was conducted 3 years after the beginning of fluorinated and iodized salt consumption. 51 deciduous intact tooth were investigated.

Results. 3-year consumption of table salt with the addition of sodium fluoride and potassium iodate has led to a significant increase in calcium, phosphorus in the enamel of the all teeth groups. The highest content of fluorine was registered in the molars where the level of fluorine increased by 2.08 times from baseline. The fluorine level in canines increased by 1.76 times from baseline, in incisors - by 1.69 times. The iodine content in the enamel increased approximately 2-fold (incisors - 1.77 times, canines - 1.89 times, molars - 1.85 times), in the dentin, depending on the teeth groups, increase in the studied parameter was by 3.12-3.51 times.

Conclusion. 3-year consumption of fluorinated and iodized salt containing sodium fluoride 300±50 ppm F and potassium iodate 40±10 ppm I stimulates increasing the content of Ca, P, F and I in the enamel and the dentin of deciduous teeth formed in fluoride and iodide deficiency.

Aim. To assess the antioxidants effectiveness (ascorbic acid, methylethylpiridinol, N-acetylcysteine) in reducing the gentamicin-induced nephrotoxicity in experimental infection caused by Escherichia coli or Klebsiella pneumoniae.

Methods. The experiment was divided into two parts. In the first part, the effect of antioxidants on the sensitivity of bacteria to gentamicin in vitro according to changing the optical density of the bacterial suspension, in the second part - nephroprotective activity of antioxidants and their effects on antibiotic activity in experimental bacterial peritonitis were evaluated.

Results. All antioxidants significantly reduce the sensitivity of E. coli to gentamicin in vitro, and the level of effect is directly proportional to the antioxidant concentration. Methylethylpiridinol has the most pronounced antagonistic action against gentamicin. It is found that methylethylpiridinol at a concentration of 4 mmol/l enhances development of Escherichia coli strain by 7 times by the 6th hour of incubation. Ascorbic acid and N-acetylcysteine have a similar probacterial activity profile. In the incubation mixtures containing a strain of Klebsiella pneumoniae, a similar pattern of increase in bacterial biomass optical density was observed with maximum values in the presence of the highest concentrations of antioxidants. In experimental infection, antioxidants reduce the activity of gentamicin against Escherichia coli and Klebsiella pneumoniae, without reducing the antibiotic nephrotoxicity.

Conclusion. Ascorbic acid, methylethylpiridinol and N-acetylcysteine reduce the antibacterial activity of gentamicin against Escherichia coli and Klebsiella pneumoniae in vitro and in vivo, in a dose of 80 mg/kg they do not reduce gentamicin nephrotoxicity in bacterial peritonitis in rats; their use in the course of treatment with gentamicin is not only irrational, but also contraindicated.

Aim. To perform comparative and morphological assessment of the reparative processes in the bone and the surrounding soft tissues during intramedullary osteosynthesis using stainless steel implants and titanium nitride coated stainless steel implants.

Methods. 40 rabbits who underwent open tibial osteotomy followed by retrograde insertion of the implant into the medullary canal served as an experimental model. 2 mm diameter nails of 12X18H9T steel coated with titanium and hafnium nitrides were used. In the control group, similar nails without coating were used. Histological sections of bone fragments and postoperative wounds, which were taken for morphological study on the 10th, 30th, 60th and 180th day from the beginning of the experiment, were stained with hematoxylin and eosin and with picrofuchsin by Van-Gieson method.

Results.The percentage of leukocyte-necrotic masses on the 10th day was 3.5±0.2% in the experimental group and 6.0±0.4% in the comparison group (p

Conclusion. Osteosynthesis using nails coated with titanium and hafnium nitrides contributes to reduction of the inflammatory response in the surrounding tissues, accelerates the process of reparative regeneration, providing an earlier wound epithelialization and reducing the likelihood of complications development such as incomplete closure of bone defect.

In the present literature review modern view on the etiopathogenesis, clinical course, diagnosis, treatment and prognosis of testicular abscess, which is a rare disease, are described. Testicular abscess develops most often as a result of acute epididymo-orchitis (more than 80% of all cases), much rarer due to testicular inversion and injury. The etiological agent is often E. coli. The disease occurs at any age, especially in immunocompromised patients. Clinical and laboratory picture of testicular abscess has symptomatic nature and consists of local and general signs of purulent inflammation. There are no pathognomonic clinical symptoms. Testicular abscess may occur under the guise of acute inguinal and scrotal area diseases, in a quarter of patients it is characterized by inapparent clinical and laboratory course, simulating testicular tumor or tuberculous orchitis. Diagnostic difficulties are caused by nonspecific clinical and laboratory characteristics and radiation patterns, disease infrequency and a lack of awareness among physicians. Suspicion of testicular abscess arise in ineffectiveness of antibiotic therapy for acute epididymo-orchitis during the first 5-7 days of disease and makes physician to perform necessary X-ray studies. The method of choice for the testicular abscess diagnosis is ultrasound examination. The diagnostic capabilities of other radiation techniques have currently been studying. Ultrasound picture of testicular abscess depending on the disease stage is varying and does not differ from the ultrasound picture of abscess of other localization. The most difficult is differential diagnosis of abscess and testicular tumors. In diagnostically ambiguous cases, ultrasound-guided percutaneous testicle biopsy or exploratory surgery are performed. Choice of treatment method is determined by the disease stage. A variety of conservative and surgical treatment methods of the testicular abscess are applied, such as antibiotic therapy, percutaneous puncture and ultrasound-guided abscess aspiration, abscessotomy and orchiectomy. Prognosis for life is favorable with timely treatment of disease.

Aim. To study the state of the primary incidence and disability due to malignant neoplasms in the Republic of Bashkortostan and their structures.

Methods. The comparative analysis of the primary incidence and disability rates due to malignant neoplasms among the adult population of the Republic of Bashkortostan for the period 2010-2014 was performed. The state of the primary incidence taking into account gender and place of residence was studied. The structure of primary disability of adult population taking into account age and degree of disability was analyzed.

Results. Over the period 2010-2014 in the Republic of Bashkortostan a statistically significant reduction of primary incidence among the population and increase in the primary incidence due to malignant neoplasms by 14.6% was observed. The incidence is higher among urban residents than among rural population, in men it is higher than that in women. On average, one in four, who is recognized as disabled, suffers from malignancy. In the structure of disability of people suffering from malignant neoplasms, II degree of disability prevails. The reliable increase in the level of primary III degree disability due to malignant neoplasms is registered over time. The rate of disability caused by malignancy among people of retirement age is higher than among working-age people.

Conclusion. The given data are indicative of the need to strengthen the strategy of primary prevention of malignant neoplasms.

Aim. To study of the prevalence of the metabolic syndrome and its components among residents of the Kyrgyz Republic.

Methods. This study was conducted within the framework of the international «INTEREPID» project, in which, in addition to Kyrgyzstan, the Russian Federation and Kazakhstan participated. Study type is cross-sectional epidemiological study. A cohort was formed randomly, consisting of 1672 people, representative of sex and age structure of the population. In addition to completing the questionnaire, we performed the following examinations: estimation of height, body weight and waist size, measurement of blood pressure and heart rate, electrocardiogram, as well as the determination of a number of biochemical parameters: sugar and creatinine levels in blood and lipid profile (low density lipoproteins, high density lipoproteins and triglycerides levels).

Results.Among the residents of the Kyrgyz Republic the prevalence of metabolic syndrome was 30.9% with predominance of its occurrence among women (33.3% vs. 27.7% in men, p

Conclusion. Among the residents of the Kyrgyz Republic the high prevalence of the metabolic syndrome was registered with certain gender and ethnic features of its components occurrence.

Aim. To define characteristics of growth and development of children and adolescents of school age in the city of Samara.

Methods. Measurements of anthropometric parameters of 2617 children aged 7-17 years, of which 1397 children studied in general educational institutions of Samara, 1220 schoolchildren - in the regional centers of the Samara region, were performed. The obtained values of anthropometric parameters of physical development of schoolchildren in Samara were compared with the study results of the appropriate age and sex groups of children and adolescents living in the Samara region.

Results. Children of the regional capital and district centers come to school with virtually the same anthropometric parameters. Due to the inhomogeneous influence of conditions and nature of education, nutrition, motor activity indicators of physical development in the educative process acquire significant differences. The height of the city of Samara boys aged 7-15 years is lower than height of peers living in the Samara region (p ˂0.01). Body weight in girls to 9 years, and in boys since 7 years of age is less than in their peers who live in the district centers of the Samara region (p ˂0.05). The chest circumference of the Samara schoolchildren is significantly less than that of their peers of the Samara region in the age groups of 7-14 years in boys and 8-14 years in girls. Waist circumference of Samara boys in the age groups of 7-11 and 13 years and in girls aged 10-14 years is significantly less than that of the Samara region children. Hip circumference of the Samara schoolchildren in junior (7-10 years) and middle (11-14 years) school grades is less than in children of Samara region (p ˂0.05).

Conclusion. Revealed differences in anthropometric parameters of children of the city of Samara and Samara region demonstrate the need to develop regional standards to evaluate the physical development of children and adolescents of big cities and rural areas.

Based on the analysis of literature and their own data the authors presented modern aspects of the etiology and pathogenesis of preeclampsia from the perspective of intra-abdominal hypertension syndrome. The data are collected from a large representative sample of 647 patients at various stages of gestation. It was shown that elevated levels of intra-abdominal pressure at 20-24 weeks of pregnancy in some cases preceded the development of preeclampsia. The level of intra-abdominal pressure, preceding the development of preeclampsia in pregnant women with obesity, was significantly higher than that of normal-weight patients (p <0.001). Along with the level of intra-abdominal pressure, the rate of its increase plays an important role in the preeclampsia development, with a greater degree than the absolute value of the intra-abdominal pressure. Pregnant women with a rapid and substantial increase in intra-abdominal pressure (more than 4 mm Hg for 2 weeks of gestation) are more likely to have complications of pregnancy than patients with an increase in intra-abdominal pressure less then 2 mm Hg in a given time interval (p <0.001), while the higher the increase in intra-abdominal pressure, at the earlier stages complication develops. The article also provides information about the dynamics of intra-abdominal pressure during pregnancy, relationships of intra-abdominal hypertension with parameters of utero-placental blood flow, renal hemodynamics, intestinal perfusion and permeability, level of endotoxemia in pregnant women. Based on the results of their own investigations, the authors suggest a model of preeclampsia development as a consequence of intra-abdominal hypertension syndrome.

The modern aspects of diagnosis, preoperative planning, and indications for total hip arthroplasty in adolescents are reviewed in the article. The aim of the article is the systematization of the tactics of preoperative planning of total hip arthroplasty in the terminal stage degenerative diseases in adolescents. Preoperative planning is very challenging in total hip arthroplasty in adolescents because in all cases on hip radiographs severe anatomical hypoplasia or destruction of both the pelvic and femoral components is visualized. Before the surgery, patients undergo a complex multifactorial examination: orthopedic status specification, X-ray and radio-functional diagnostics, computed tomography and magnetic resonance imaging. Examination results allow us to determine the anatomy of the acetabulum, the path of the femoral head within it, the defect type and the diameter of brim of the acetabulum area, its depth, the integrity of the walls and roof. The authors performed total hip arthroplasty in 32 patients aged 15-18 years (11 boys and 21 girls) with terminal stages degenerative-dystrophic diseases of the hip joint with the implementation of preoperative planning in accordance with described methods. Comparison of preoperative planning results with the clinical results of total hip arthroplasty in most cases showed the agreement of calculations with the intraoperative analysis data. After total arthroplasty, evaluation of patients’ hip joint function was from 92 to 100 points. Preoperative planning is one of the most important stages of total hip arthroplasty in adolescent orthopedics. It allows to obtain reliable information about the needed model of the endoprosthesis, the optimal size of its components, the depth of the acetabulum reaming, the level of the femoral neck resection, placement and orientation of the implant cup and the stem, the possibility of correction of the lower limbs length and to achieve good results in the treatment of patients with severe congenital or acquired hip defects and progressive thigh non-weight bearing.

Aim. To study capabilities of quantitative elastographic study to assess the elasticity of the uterine cervix in women with a fetal chromosomal abnormality in the first trimester of pregnancy.

Methods. 230 pregnant women of high-risk group at 11-13.6 weeks of pregnancy (parietal-coccygeal length 45-84 mm) were included in this study. The first group consisted of 213 women without fetal pathology. The second group included 17 women, in whose fetuses different chromosomal abnormalities were detected. In ultrasound examination of pregnant women in the I trimester of pregnancy, in addition to standard methods of examination, quantitative cervical elastography was performed.

Results. According to results of quantitative elastography in 14 (82.35%) out of 17 pregnant women (second group) one or another degree of the cervical tissue softening was found, and 3 (17.64%) pregnant women with fetal chromosomal pathology had stiff cervix (all 3 cases with Down syndrome). In the control group in 10 (4.7%) of 213 pregnant women relatively soft cervix was identified, and in 203 (95.3%) women cervical density was higher than the myometrial density. A statistically significant difference between the indices of SWE-Ratio in groups was revealed. Quantitative elastography, as a diagnostic test predicting the risk of miscarriage due to chromosomal abnormalities, has a high sensitivity (84.38%) and even higher specificity (95.26%) of negative predictive value 97.57%.

Conclusion. Quantitative elastography reveals a significant decrease in the cervical elasticity (softening) in pregnant women with fetal chromosomal abnormality in the I trimester of pregnancy, which allows us to recommend this method of ultrasound examination as an additional marker for early diagnosis of miscarriage due to fetal chromosomal abnormality.