Multiparametric ultrasound evaluation of malignant testicular tumors was done in 31 patients (age ranged from 19 to 65 years (median - 33 years, 25-75^th percentiles - 27-40 years)). In all cases unilateral lesion took place. In all cases diagnosis was confirmed morphologically (seminoma - 18 (58.1%), embryonal carcinoma - 5 (16.1%), mixed germ cell tumors - 7 (22.6%), spermatocytic seminomas - 1 (3.2%)). In 13 (41.9%) cases were stages pT1, 15 (48.4%) -pT2, 3 (9.7%) -pT3. Shear wave elastography was used after preliminary gray-scale imaging of the testes (Aixplorer (Supersonic Imagine, France), linear probe 4-15 MHz). Emean median in the stiffest tumor areas (n = 31) was 109.3 kPa, 25-75^th percentiles - 77.7-145.5 kPa, 5-95^th percentiles - 18.7-192.4 kPa, minimum - maximum values - 15.3-241.4 kPa. The values of Young’s modulus (Emean) in the tumor region were significantly higher in compare to echographically intact parenchyma of the ipsilateral testis (1), contralateral testicular parenchyma (2) and normative data (3) (P < 0.0001 for all comparisons). Qualitative elastographic assessment (elastographic patterns) gives an idea of the tumor stiffness, however, depends on the chosen scale. At the moment, it is make sense to use qualitative assessment for the stiffest areas identification with following stiffness measurements. There was not found significant correlation between Young’s modulus and tumor volume, maximum linear tumor size, tumor stage, and morphological type. Direct significant correlation between the stiffness (elasticity) ratio (the ratio of Emean values in the stiffest tumor areas and echographically intact parenchyma of the ipsilateral testis) and pT stage (t_k = 0.32, P = 0.0305) was revealed. Elastometry, as a part of multiparametric testicular ultrasound, provides the new information about testicular tumors stiffness and can be used in the routine diagnosis because of low time-consuming.

Ultrasound elastography was done to 31 patients (19-65 years old) with malignant testicular tumors. In all cases lesions were unilateral, and diagnosis was confirmed morphologically (seminoma - 18 (58.1%), embryonal carcinoma - 5 (16.1%), mixed germ cell tumors - 7 (22.6%), spermatocytic seminomas - 1 (3.2%)). All patients were divided into groups depending on the morphological type of tumors: 1) seminoma (n = 18) and nonseminomatous germ cell tumors (n = 12); 2) teratoma as a component of mixed germ cell tumor (n = 6) and other germ cell tumors (n = 25). Shear wave elastography was used after testes gray scale visualization (Aplio 500 (Toshiba, Japan) and Aixplorer (Supersonic Imagine, France) with linear probes 4-15 and 5-14 MHz respectively). Technical aspects: the difference between Young’s modulus values measured in testicular tumors by using Aplio 500 (1) and Aixplorer (2) were nonsignificant (P = 0.95). Correlation between Young’s modulus measured on two ultrasound systems was high (R_s = 0.86, P = 0.0137). The values of Young’s modulus in testicular tumors were significantly higher in compare to echographically intact ipsilateral testicular parenchyma (P = 0.0017 for these comparisons on two ultrasound systems) and contralateral testicular parenchyma (P = 0.0017 for these comparisons on two ultrasound systems). There was no significant difference between Young’s modulus values in two testes (echographically intact ipsilateral testicular parenchyma and middle segment of contralateral testis) (P = 0.4057 and P = 0.8480 for ultrasound systems 1 and 2, respectively). Morphological aspects (Aixplorer ultrasound system): Emean median in the group of seminoma (n = 18) was 110.3 kPa, 25-75^th percentiles - 77.6-159.0 kPa, 5-95^th percentiles - 16.5-222.1 kPa, minimum - maximum values - 15.3-241.4 kPa; in the group of nonseminomatous germ cell tumors (n = 12) - 109.9 kPa, 83.0-129.0 kPa, 55.5-156.8 kPa, 54.2-157.8 kPa (P = 0,9325). Nonsignificant difference was also identified when comparing mixed germ cell tumors with teratoma and other tumors (P = 0.5823). Significant difference in values of stiffness (elasticity) indexes (stiffness ratio 1 - ratio of Emean values in the stiffest tumor areas and echographically intact ipsilateral testicular parenchyma, stiffness ratio 2 - ratio of Emean values in the stiffest tumor areas and contralateral testicular parenchyma, stiffness ratio 3 (intratumoral stiffness ratio) - ratio between the maximum and minimum stiffness inside the tumor) in patients with seminoma and nonseminomatous germ cell tumors was also not found.

50 patients with Alagille syndrome (first group) and 80 patients with biliary atresia (second group) were investigated in the 2000-2016 period. A retrospective analysis of hepatobiliary system, spleen, cardiovascular, and urinary systems ultrasound results was done. The age of the children at admission was 1 month of life. Ultrasound examinations of hepatobiliary system and spleen were carried out at the age of 1, 2 and 3 months of life; cardiovascular system - 1-3 months; urinary system - 1, 2, 3, 6 and 12 months. When carrying out ROC-analysis the ultrasound changes of hepatobiliary system, identified within three months of life, were taken into account. Diagnostic value of an isolated hepatobiliary system ultrasound pathologic signs in Alagille syndrome diagnosis was low. However, the sensitivity of ultrasound “triangular cord" sign in biliary atresia diagnosis was 50%, specificity - 100%, AUC - 0.750. The sensitivity of gallbladder absence or fibrous cord gallbladder form sign in biliary atresia diagnosis was 88%, specificity - 72%, AUC - 0.797. The sensitivity of diffuse periportal echogenicity sign in the biliary atresia diagnosis was 100%, specificity - 88% and AUC - 0.940. It should be noted that above mentioned signs were found on background of cholestasis, hepatomegaly and splenomegaly (100% patients with biliary atresia at the age of 3 months old). Pathologic changes of kidneys, manifested by 3 months of life, were significantly increasing in occurrence frequency by 12 months (P from 0.0295 to 0. 0001). In biliary atresia ultrasound changes in the kidneys were absent. Iincreased renal echogenicity, decreased corticomedullary differentiation on background of cholestasis have a relatively high sensitivity (70% and 64% respectively) and 100% specificity in the diagnosis of Alagille syndrome (ultrasound signs identified at 12 months of life). Ultrasound findings in hepatobiliary system organs and spleen, cardiovascular and urinary systems provide useful information for differential diagnosis and adequate treatment of infants with cholestasis.

The aim of the study was to assess cardiopulmonary exercise test value in cardiovascular risk determining in noncardiac elective surgery. The study included 136 patients with cardiac problems in anamnesis who underwent elective surgery for esophageal, gastric, and pancreatic cancer. 86 (63.2%) patients were older than 65 years. Cardiovascular complications, which were recorded during surgery and within 30 days after it, were detected in 12 (8.8%) patients (6 (4.4%) cases of non-fatal myocardial infarction, 2 (1.5%) cases of non-fatal stroke, and 4 (2.9%) cases of cardiovascular death). On the basis of presence or absence of cardiovascular complications patients were divided into two groups. In the group with cardiovascular complications (n = 12) when compared with the group without ones (n = 124) significant differences in exercise time (245.1 (188.0-310.5) vs 330.0 (258.1-411.2) sec) (here and below, median and interquartile range) (P = 0.02); maximum oxygen uptake at peak exercise (14.0 (12.2-18.2) vs 18.8 (of 15.7 and 21.9) ml/kg/min) (P = 0.04); anaerobic threshold (11.1 V (8.2-13.8) vs 14.2 (11.3 per is 16.2) ml/kg/min) (P = 0.01); heart rate increasing (in % to baseline) (35.2 (20.7-48.1) vs 20.1 (10.2-27.1) %) (P < 0,01) were revealed. Heart rate increasing (in % to baseline) m.ore than 25%c was the only independent cardiovascular complications risk factor. The standard exercise test increases the predictive ability of baseline study and should be performed before surgery in the absence of contraindications (AUC increases from 0,780 to 0,850, the sensitivity from 69 to 72%, and specificity from 73 to 76). Cardiopulmonary exercise test does not increase prognostic value of baseline study.

The diagnostic ultrasound is very useful in determining localization and morphological characterization of endocervical polyps located in the middle and upper thirds of the endocervical canal and not detectable by visual gynecological examination. Ultrasound visualization of polyps, located in the lower third of the endocervical canal, is significantly more difficult and often impossible. There is a difference in the ultrasound patterns of endocervical and endometrial polyps. There are some specific ultrasound signs of various endocervical polyps morphological types. During pregnancy, ultrasound diagnosis of decidual polyps also has important practical value, helping to differentiate the cause of bleeding in pregnant women. In this regard, we find it useful to publish the chapter “Endocervical polyps" from the M.N. Bulanov book “Ultrasound in Cervix Diseases Diagnosis. The Guide for Physicians".

Takotsubo syndrome is transient spherical expansion of left ventricle apex with dysfunction in response to intense emotional or physical stress. These signs resemble myocardial infarction. However, in takotsubo syndrome signs of coronary atherothrombosis and hemodynamically significant stenosis are absent. A clinical case of takotsubo syndrome atypical course with myocardial necrosis, left ventricular thrombosis, and scar formation is presented.

Giant cell arteritis - is a systemic vasculitis of unknown etiology, which is characterized by granulomatous giant-cell inflammation of predominantly extra- and intracranial blood vessels, occurring solely in advanced age patients. Differential diagnosis (particularly in the early stage) is rather difficult. Vertebral arteries involvement in this disease is a rare, but serious complication, which is associated with high mortality rate, despite hormonal therapy. Female patient with chronic cerebral ischemia, at whom angio imaging and laboratory examination revealed giant cell arteritis with vertebral artery involvement, is described.