INTRODUCTION: There have been limited research studies done in Mongolia on clinical, laboratorial and computer tomographical diagnosis of acute pancreatitis. GOAL: Our study aims to examine clinical, laboratorial and CT symptoms diagnosis of acute pancreatitis, to diagnose the different types of acute pancreatitis, and to develop diagnostic criteria based on CT for differentiating among those types. OBJECTIVES: 1. To study clinical symptoms of acute pancreatitis 2. To determine alpha amylase, ALAT, ASAT, and the amount of glucose. 3. To determine CT symptoms for the types of acute pancreatitis. 4. To develop diagnostic criteria based on CT for differentiating among those types MATERIALS AND METHODS: Over the years of 2006 to 2010, we have studied the CT symptoms of 59 patients diagnosed as having acute pancreatitis, and the clinical and laboratorial symptoms of 81 patients with the same disease, with the help of health facilities at Diagnostic Imaging Department of the “Achtan-elite” general hospital and “Friendship-Naran” diagnostics center. The scanners such as CT-W-4 type scanner of Japanese Toshiba Corporation, MSCT Presto (made in 2007 by Hitachi, Japan) and CT Max 640 type scanner of USA General Electric Corporation have been used for the diagnostics. We successfully calculated the amount of alpha amylase, ALAT, and ASAT with colorimetric analysis. For this calculation, we used amylase detector manufactured by German Human Firm. Sugar amount was measure by fermentive oxidization with dioxide-glucose. The acute pancreatitis inflammation, hemorrhage, necrosis and its various forms, and diagnosis have been proved by the brief x-ray imaging of the abdomen, x-ray with contrast injections for stomach and upper intestine, Ultrasonic, Celliacography, MRI, Cytology, Biopsy analysis and surgery. All the results were presented in commonly used statistical ways, taking into account possible calculation errors, and probabilities were checked with Student’s t-distribution. CONCLUSION: 1. During acute pancreatitis, 56.8%±5.5 suffered from abdominal shooting pain, 28.3%±5.0 from stomach cramps, 79.0%±4.5 from diarrhea, 91.4%±3.1 from fever, and 56.8%±5.5 from abdominal hemorrhage. 2. The amount of alpha amylase in blood serum increased 6 times the amount of ASAT/ALAT 3 to 5 times. 3. By CT scanning, we have found more common CT symptoms such as sharp border edges of pancreas in swollen acute pancreatitis (in 69.2%±9.2 of the patients), entire and partial enlargement of the pancreas (in 73.1%±8.9 of the patients), fluid collection in the stomach rear room (in 61.1%±11.8 of the patients), in hemorrhage acute pancreatitis and uneven density reduction (in 66.7%±12.6 of the patients) and fluid collection in the stomach rear room (in 86.7%±9.1 of the patients), in necrosis type of acute pancreatitis respectively. 4. Shape, size, structure, density, borders, interaction with surrounding body organs, change in pancreas density after contrast injection and accumulated fluid in the rear stomach are identified as the main criteria to diagnose acute pancreatitis types and differentiate among them. 5. CT diagnostics of the acute pancreatitis types and differentiating among them are very crucial to select appropriate acute pancreatitis treatment on time.

Introduction: The normal pancreas CT density is between +30HU to +40 HU and after contrast injection it will be increased till +60HU to +80 HU. We will determine the pancreas shape, size, structure, density, borders, calcification, and cysts by CT during the chronic pancreatitis. Goal: Our research goal is to determine the clinical, laboratorial and computer tomographical diagnosis of acute pancreatitis, and to diagnose acute pancreatitis and differentiate from other diseases. Оbjectives: 1. Study clinical symptoms of acute pancreatitis 2. Determine Alpha-amylase, АSАТ, АLАТ and glucose. 3.To determine the CT signs of chronic pancreatitis. 4. To modify the diagnostic criteria for differential diagnosis Materials and Methods: We made the study chart for this study and used the 46 patient’s data were collected from Department of Imaginary Diagnosis Achtan Elite Clinical hospital and Diagnostic center -“Friendship Naran” of Naran group. We used CT scan –W-4 made by Toshiba, Japan, MSCT PRESTO by Hitachi, Japan and CT Max -640 by General Electronic, USA for our study. Additionally, we used the other diagnostic analyses such are biochemistry, X-Ray of abdominal cavity, contrast X-Ray of gastrointestinal tract, abdominal ultrasound, celiacography, cytology, biopsy and surgical procedure. The average and errors of the study data has been evaluated by the common statistic methods and the Student’s t-test is applied to data probability. Results and Discussion: The 46 patients with chronic pancreatitis were enrolled in our study in CT scan of pancreas. Size of pancreas was normal in 2(6.7%±3.0), totally enlarged pancreas were in 14(30.7%±6.7), totally got smaller in 21(45.7%±7.3), partly enlarged in 9(19.6%±5.6), very bright from next organs in 31(67.4%±5.9), not bright from next organs in 15(32.6%±6.9), pancreas structure were same homogeneity in 17(36.9%±7.1), pancreas structure homogeneity were lost in 14(30.7%±6.7), some retention liquid were collected in back of stomach space in 8(17.4%±5.6), no liquid collected in back of stomach space in 38(82.6%±5.6), low density pancreas were in 11(23.9%±6.3), low density was not same in whole pancreas in 23(50% ±6.1), high density was same in whole pancreas in 7(15.2%±5.3), high density was not same in whole pancreas in 5(10.5%±4.6), density was increased after contrast injection in 12(26.1%±6.5), density was increased not same contribution after contrast injection in 34(73.9%±6.5), calcification of pancreas not detected in 30(65.2%±7.0), calcification of pancreas detected in 16(34.8.%±7.0), calcification in parenchyma were 11(23.9%±6.3), in tube 5(10.5%±4.6). The most common CT signs were that pancreas was very bright from neighbor organs in 67.4%, pancreas homogeneity was lost in 63.1%, high density was not same in whole pancreas in 73.9% during chronic pancreatitis (P<0.001). CT signs of pancreas which totally enlarged pancreas were in 30.4±6.7 and totally got smaller in 45.7%±7.3 are higher prevalence in our study than A.B.Jakobenko (2000). But pancreas was very bright from next organs in 67.4%±5.9, pancreas structure homogeneity were lost in 50.0%±6.1 and low density was not same in whole pancreas in 34.8%±7,1 calcification of pancreas calcification in parenchyma were 23.9%±6.3, in tube 10.5%±4.6 sign were close as A.B.Jakobenko (2000). Conclusions: 1. Patients showing signs of acute pancreatitis suffered from abdominal cramps for 53.0%±6.1, pain moving to left part of the abdomen for 62.1%±5.9, diarrhea, xerostomia, xeroderma, and fever. 2. During acute pancreatitis, alpha amylase, glucose, ASAT, and ALAT in blood plasma increased 1.7 times, 2.4 times, 1.9 times and 1.5 times respectively. 3. The most common CT signs were that pancreas was very bright from neighbor organs in 67.4%, pancreas homogeneity was lost in 63.1%, high density was not same in whole pancreas in 73.9% during chronic pancreatitis. 4. Diagnostic criteria of chronic panreatitis are could be the CT signs such as pancreas size, density, borders brightness of neighbor organs, the change of density after contrast injection and calcifications.

Introduction: There have been limited research studies done in Mongolia on clinical, laboratorial and computer tomographical diagnosis of pancreatic cancer. Goal: Our study aims to examine clinical, laboratorial and CT symptoms diagnosis of cancer pancreatitis, to diagnose the differential types of cancer pancreatitis, and to develop diagnostic criteria based on CT for differentiating among those types. Objective: 1. To study clinical symptoms of pancreatic cancer 2. To conclude the correlation between CA 19-9, CEA and sizes of the tumor during pancreatic cancer 3. To determine CT symptoms of pancreatic cancer 4. To develor diagnostic criteria based on CT for differentiating among those types Material and method: Over the years of 2006 to 2010, we have studied the CT symptoms of 35 patients diagnosed as having pancreatic cancer, and the clinical and laboratorial symptoms of 35 patients with the same disease, with the help of health facilities at Diagnostic Imaging Department of the “Achtan” clinical hospital and “Friendship-Naran” diagnostic center. The scanners such as CT-W-4 type scanner of Japanese Toshiba Corporation, MSCT Presto (made in 2007 by Hitachi, Japan) and CT Max 640 type scanner of USA Gereral Electric Corporation have been used for the diagnostics. When we made the result of survey, we used average descriptions of statistics, determined the fault of descriptions and examined probability descriptions the criterion by Stiyudent. Result: The pancreatic cancer happened to exist in the head and skull for 71.6%±8.7 (P<0.001), was non-standart shaped for 62.5%±8.6 (P<0.01), had size being bigger than 2.1 cm for 96.9%±8.4 (P<0.001), had density decline for 46.9%±8.8 (P<0.05), had tumor contour not clearly visible for 65.6%±8.4 (P<0.01), had fat tissue around cancer not seen for 75.0%±7.7 (P<0.001), had an enlarged common bile duct 65.6%±8.4 (P<0.05), had an enlarged gallbladder for 59.4%±8.3 (P<0.05), and experienced a density increase after contrast injection for 65.6%±8.4 (P<0.001). Conclusion: 1. Pancreatic cancer caused shooting abdominal pain and stomach cramps in 74.2%±8.2, diarrhea in 62.9%±8.2, flatulency in 71.4%±7.6, xerostomia and xerosis in 65.7%±8.0, neurasthenia symptoms in 85.7%±5.9, jaundice in 60.0%±8.3, and abdominal hemorrhage and bleeding symptoms in 54.3%±8.4. 2. CA-19-9 tumor marker has been found to be very sensitive for pancreatic cancer, making it an effective and easy way to diagnose, prove the diagnosis, and monitor a patient’s response to pancreatic cancer treatment. CEA marker can be used as a supporting tool for pancreatic cancer. 3. CT scanning revealed that the cancer was irregularly shaped in 62.5%±8,6, was larger than 2.1 cm in 96.9%±3.1,had non-smooth borderlines in 65.6%±8.4 and clear and visible borderlines in 62.5%±8.6. Density decreased in 46.9%±8.8, fatty tissues around the cancer were not distinguishable in 75.0%±7.7, and density increase after contrast injection in 65.6%±8.4. 4. Size, shape, structure, density, borderlines, interaction of pancreatic cancer with neighboring organs, location of the cancer in pancreas, cancer’s shape, size, numbers, border, structure, density and density after contrast injection, calcification, and shadow have been proven to be the determining factors of pancreatic cancer. 5. CT diagnostics of pancreatic cancer types and differentiating among them are very crucial to select appropriate treatment for pancreatic cancer on time

Transthoracic ultrasound (US) has become an important diagnostic tool in modern chest medicine. The range of thoracic lesions for which transthoracic US may yield useful diagnostic information has expanded to include not only chest wall and pleural lesions, but also peripheral lung nodules, pulmonary consolidations, necrotizing pneumonias and lung abscesses, tumors with obstructive pneumonitis, mediastinal masses, and peridiaphragmatic lesions. A variety of ultrasound features and signs of chest diseases have been well characterized and widely applied in clinical practice. US guidance increases the diagnostic success rate and decreases the complications associated with interventional procedures such as thoracentesis, closed tube drainage for pleural effusion, and needle biopsy of the pleura. Transthoracic needle aspiration or biopsy, under real-time US guidance, is a relatively safe and easy procedure, and may provide adequate tissue sampling of lesions for cytologic, histologic or microbiologic analysis. This article presents the general techniques and wide applications of transthoracic US and US-guided invasive procedures in the diagnosis and management of various chest diseases.

BACKGROUNDS: Abdominal X-ray findings of destructive acute pancreatitis are usually similar with intestinal obstruction x-ray sign. GOAL: The main goal of this study is detecting X-ray findings of pancreatitis depend on type of pancreatitis and location of the pathological abnormality. OBJECTIVES: 1. Determining pancreatitis x-ray findings depend on types of pancreatitis and pathologic abnormalities location. 2. Determining radiologic features of chronic pancreatitis MATERIALS AND METHODS: From2012 to 2014, 45 patients’ x-ray finding of pancreatitis have been analysed (31 patients with acute pancreatitis and 14 patients with chronic pancreatitis). All patients have diagnosis by clinical symptom, laboratory tests, ultrasound, celiacography, CT, MRI, ERCP, MRCP,citology and biopsy. RESULTS: X-ray findings of pancreatitis are associated with type of acute pancreatitis and location of pathologic abnormalities in the pancreas. CONCLUSION: 1. Patients with pancreatic tail swelling and deformity (acute pancreatitis), whose chest radiograph shows elevation of left hemi-diaphragm. Arka signs are seen level of L2 ,right side of the L2-L3, and stomach and upper part of the small intestine filled with gas, these recognized radiographic signs are associated with head of the pancreas destruction, which is caused by acute pancreatitis. 2. In our study, commonly recognized radiographic signs associated with chronic pancreatitis include with ascending colon and hepatic flexure are filled with gas, right part of transverse colon spasms, stomach and upper part of the small intestine filled with gas and small calcification in the pancreas

Background Abdominal ultrasonography assesses the size, echotexture, shape, contour and adjacent structures of pancreas. Goal The goal of our study is to determining ultrasonography criteria of acute and chronic pancreatitis and developing algorithm of differential diagnosis. Objectives 1. To determine ultrasonography criteria of acute and chronic pancreatitis 2. To develop algorithms of differential diagnosis of acute and chronic pancreatitis Material and Method During the study period, 81 patients with acute pancreatitis, 66 patients with chronic pancreatitis has examined byultrasonography in Reference centre on Diagnostic Imaging named after R. Purev state laureate, people’s physician,hoporary professor of the State III nd Central Hospital,AchtanClinicalHospi tal,Central Clinic of Ulaanbaatar railway and Hepatological clinic centre of traditional medicine Result 48 (59.3%±5.5) patients with acute pancreatitis had reported pancreatic swelling /Exudative pancreatitis/, 18 (22.2%±466) had acute hemorrhagic pancreatitis, 15 (18.5%±463) had necrotizing pancreatitis. Conclusions 1. Determined ultrasonographic criteria of acute and chronic pancreatitis 2. Acute and chronic pancreatitis has diagnosed by ultrasonographic criteria and developed differential diagnosis algorithm.

Introduction: Pancreatic cancer in young patients is usually correlated with chronic alcohol consumption and hereditary factor. Chronic pancreatitis, pancreatic trauma, pancreatic cyst, alcoholism, and diabetes mellitus are the most clearly established etiological factors (T.Y Flanders., W.S Foulkes., 1996). The cancer was located to the pancreatic head in 75% to the body in 15-20% and to the tail in 5-10% of cases (A.E Richard., 2005). Goal: Determination of the US signs in pancreatic cancer and establishment standard (control) US diagnostic criteria. Objectives: 1. To reveal direct and indirect US signs of pancreatic cancer. 2. To establish standardized US diagnostic criteria. Materials and Methods: A prospective study was carried out in 35 patients with pancreatic cancer in a 4 years period between 2006-2010 (Shastin Central Hospital, Achtan Clinical Hospital). To each patient has being filled special investigation chart. Diagnosis was confirmed on the result of physical examination, laboratory investigation, abdominal conventional radiography, upper gastrointestinal contrast radiography, CT, MRI, ERCP and biopsy. The results of the measurements were compared with the standardized control evaluation of Mongolian people (Ts.Badamsed.B.Tserendash). Results: Our sample represents US signs in 35 patients with pancreatic cancer. On the basis of our study US sign were divided into two categories: direct and indirect signs. Direct signs: a) irregular shape, b) irregular tumour edge, c) hypodensity, d) tumour size more than 2.1cm, e) different location. Indirect signs: a) CBD distends, b) gallbladder distends, c) intra hepatic bile duct distend, d) pancreatic pseudo cyst, e) near-aortic limp node enlargement, f) splenomegaly. We consider that the upper mentioned US abnormality can be as control standard criteria for the US diagnosis of the pancreatic tumour. According to the study of V.N.Demidov and G.P.Sidorov (1987), the pancreatic cancer is located to head in 50-80%. In our series it was about 45.7%± 8.4. Irregular tumour shape in 60.0%±8.3, tumour hypodensity 80.0%±7.2, irregular tumour edge 68.6%±7.8, tumour clear definition 71.4%±7.6 which are the same with N.M. Mukharllyamov (1987). Conclusions: 1. Were described direct and indirect US diagnostic signs in pancreatic cancer 2. The tumor location, shape, size, edge, consistency, intra and extra hepatic bile duct distend, gallbladder distend, near-aortic limp node enlargement are the basic control criteria for the diagnosis of pancreatic cancer.

Introduction: Thyroid gland behind the sternum near the base of the neck, and it is one of the gland behind the sternum at cartilage southern centre of middle mediastinum and at back of superior middle mediastinum rarely [ R.E Gabunia.,E.K.Kolesnicova.,L.B.Tumanov.,1983; J.O.Shepard.,1991; S.K.Wernecke 1991; N. B.Litvakovskaya.,1994;V.P.Harchenko.,P.M.Kotlyarov.,R.V.Kertanov.,Z.S Tsallagova., 2002]. Goal: The research thesis aims to make diagnosing and identifying the nature and symptoms of thyroid gland behind the sternum by roentgen, US and computer tomography and developing the criterion characteristics of diagnostics. The following objectives will be resolved in order to implement the goal of research thesis: 1. To identify the symptoms of thyroid gland behind the sternum which is obtained by the roentgen? 2. To identify the symptoms of thyroid gland behind the sternum by diagnostics of US and computer tomography 3. Developing the criterion characteristics of thyroid gland behind the sternum by diagnostics of US, computer tomography and the roentgen Materials and Methods: Made conclusion at symptoms identified by diagnostics of US, computer tomography and the roentgen at 12 patients who were diagnosed with thyroid gland behind the sternum through 2005-2011. The diagnostics of thyroid gland behind the sternum was approved by the surgical operation and biopsy analysis which is a medical test involving the removal of tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease under a microscope by a pathologist. Results: The symptoms of 12 patients who were diagnosed with thyroid gland behind the sternum were identified by diagnostics of US, computer tomography and the roentgen. From the symptoms defined by roentgen images of thyroid gland behind the sternum, located in western upper south part of middle mediastinum (P<0.001), oval shaped thyroid (P<0.05), calcification osteoporosis (P<0.01), bronchus was pushed to healthy side (P<0.05), changes of middle mediastinumwas moved upward when cough, drink and make Valsalve’s test /a method for testing the patency of the Eustachian tubes. With mouth and nose kept tightly closed, the patient makes a forced expiratory effort (P<0.01) therefore there is true statistical probability. Conclusions: 1. During the thyroid gland behind the sternum, the additional changes are identified at thyroid gland behind the sternum, located in western upper south part of middle mediastinumat 75.0%, the mentioned changes are moved upward when made cough, drink and make Valsalve’s test by roentgen, lost similarity of structure and pushed the bronchus to healthy side at 66.7%, there is dominant symptoms by roentgen that gullet defined by barium substance was pushed to healthy side at 58.3%. 2. By the ultrasound analysis, during the thyroid gland behind the sternum, the changes are relevant to thyroid and vascularization at 100% , to capsule at 75% and osteoporosis at 66.7%. 3. Changes are relevant to thyroid and vascularization at 100% or oval shape more compactness was identified by the contrast substance , pushed the bronchus to healthy side at 66.7%, there is dominant symptoms by roentgen that bronchus was pushed to healthy side, 4. We established that there is thyroid gland behind the sternum. status of the additional changes of middle mediastinum , compactness, structure, capsule, size, shape of the thyroid gland behind the sternum, additional changes of middle mediastinum changes the location of the nearest organs due to thyroid, so identified the main criterions to diagnose and to identify the thyroid gland behind the sternum by roentgen, US and computer tomography.

BACKGROUND:Congenital heart defects (CHD) turn out to be the leading cause of infant mortality in their first yearafter infectious diseases. Per 1,000 infants, born with CHD, about 19-75 failed to survive. It revealsthe fact that CHD is a major cause of childhood mortality in worldwide. Beyond the progress ofmedicine and surgery, the cause of CHD is not fully defined. The majority of studies reveal that CHDis triggered by many factors, such as the genetic and environmental factors.Based on the evidences of the sequence of the human genome and advances in moleculartechnology, genetic factors play a major role. Per 100 newborninfants, they’re found one child, bornwith a CHD is concerned as a highly frequent incident for birth anomaly. Only 0.5% of these congenitaldefects enable to be inherited in accordance with Mendel’s genetic laws, which is associated withthe change and mutation of a single gene. Many found that most congenital anomalies dependupon mutation or change in multiple genes and other relevant factors. As a result of the progressivedevelopment of molecular biology in the past 20 years discovered a range of genes involved in fetusformation, development, growth and control of processes. In our country case, corrective surgeryfor CHD dominates among all cardiovascular surgery in Mongolia. Particularly, for all incidents donesome corrective surgery of congenital heart defects, atrial septal defect operation occupies 42.44%,in other word it is a substantial part of the CHDoperation (D.Tsegeenjav, 2009). Molecular geneticsstudy of infant born with heart defects and simultaneous anomaly of other organ system researchstill has not been done for Mongolian population. In many cases the diagnosis of CHD is delayeduntil their adulthood, which is a research gap to address without further delay and the finding mustbe applied in practice in the near future.GOAL:The aim of the research is to conduct a molecular genetic study of children, born with CHD andcombined abnormalities of other organs and systems, identify gene lesion, location and characteristicsof mutations, pathogenetic mechanism of congenital defects and anomalies among the Mongolianpopulation.RESULT:For this study, there are 118 patients, with congenital heart disease, received surgical treatmentin the cardiovascular department of III central state hospital named P.N. Shastin, involved afterconfirmed diagnosis through objective and instrumental investigations (ECG, Fluoroscopy, EchoKG).The 118 healthy family members of patients sampled as a control group. According to the diagnosisof patients with congenital heart defect, such as atrial septal defects-95 (81.2% ± 3.6), ventricularseptal defects-17 (14.5% ± 3.3), patent ductusarteriosus- 2 (1.7± 0 .0%) have combined severedefects - 4 (3.3% ± 1.0). Out of 118 patients with congenital heart defects, 32.2% (38 patients)was male, whereas women accounted for 67.8% (80 patients) with average age of 22, 3 ± 12.9(minimum 1.0 year, maximum 51 year). These comprised 42.4% in 1-17 years old (average age10 ± 5.27) and 57.6% in 18-51 years old (average age 31 ± 9.54). The 33.9% ± 4.4 (40 patients) of operated patients responded the questionnaire that they have a hereditary heart defect. Shortnessof breath, heart pain, and recurrent pneumonia were the main complaints of patients with CHDthat significantly authentic to statistical probability. From the taken 118 blood samples, 95 werediagnosed ASD, in 7 diagnosed VSD, in 2 diagnosed PDA, in 4 diagnosed combined defects. Forthe 95 samples, we decided to examine the ASD associated GATA4, TBX5gene. It draws attentionto the fact that 81.2% of all congenital heart defects found only ASD. To examine the ASD genes inthe sample, the following changes have occurred. The study found 8 variants of mutations formingASD. It includes on exon 1 Gly 93 Ala (c.278G> C), on exon 1 P163S (c.487C>T).CONCLUSIONS:1. Patients with ASD alone occupy 81,2% of all heart defects in our study.2. For the samples of ASD, the study found 8 different mutations of GATA4.3. In the sample of blood not found TBX5 gene mutation.4. In the samples, one patient with dextrocardiasitusinvertus was combined with congenital heartdefects found E359Xfs (c.1075delG) deletion variation on exon3.

Middle aortic coarctation (MAC), a variantof middle aortic syndrome, is a rare entity withonly ~200 cases described in the literature.It classically presents with early onset andrefractory hypertension, abdominal angina,and lower extremity claudication(1).A 30 years-old woman, Her systolic bloodpressure measures 180-200mm Hg and diastolicpressures measure 70mm Hg in both arms,lower extremity pressures are approximately70mm Hg. Her bilateral femoral pulses andpedal pulses are nonpalpable, but present onDoppler exam and CT-Angiography.We prepared diagnostic of CT-Angiographyand Aortography before operation. Wesuccessful operated abdominal aorticcoarctation by “Silver graft” Aortoaortic bypasson the middle aortic, left nephrectomy.She was discharged home on postoperativeday 7. Post operation is good. We werecontrolled CT-Angiography.