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0:00

Вступление

0:17

Показания к УЗИ почек

4:10

Методика исследования

16:09

Фетальная дольчатость

16:51

Галетообразная почка

17:30

Подковообразная почка

20:15

Мочекаменная болезнь

25:07

Губчатая почка

25:49

Имитация камней почки

26:25

Коралловидный камень почки

27:00

Twinkle - артефакт

28:13

Камень устья мочеточника

41:53

Абсцесс почки

43:33

Поликистоз почек

Ультразвуковая анатомия молочных желез

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Channel: Профессор В.Изранов

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УЗ-диагностика перекрута яичка. УЗИ в урологии-2020 (минисерии) Станислав Феданов

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УЗИ надпочечников

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Ультразвуковая анатомия органов брюшной полости и забрюшинного пространства

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Channel: BigBiochemist

УЗИ почки

УЗИ

Урология

Феданов

#ультразвуковая

#уролог

#киста

#мочекаменная

#боткина

00:00:16

and for nikusi, in fact, I think that

00:00:18

any of us will formulate there,

00:00:20

since now this is such a

00:00:24

virtually obligatory part of the examination,

00:00:26

therefore, pain in the lower back is more airy

00:00:29

areas of

00:00:30

dysuria, there is hematuria, the presence of

00:00:32

pathological changes in other

00:00:34

organs, let’s say we can track

00:00:37

the sizes, let’s say a simple sheet and ourselves

00:00:41

did a victory when the view something about the

00:00:42

racks I will become similar again we can

00:00:44

do it we can track the dynamics of already

00:00:46

sizes ultrasound abdominal injury

00:00:50

comic people not for the identified

00:00:52

anomalies

00:00:53

observation after kidney resection

00:00:56

observation of patients with

00:00:58

urolithiasis well, actually for searching

00:01:03

ultrasound is not an ideal diagnostic method

00:01:05

easy accessibility cheap, but of

00:01:08

course, a computed tomograph is the most

00:01:10

informative, the most sensitive

00:01:12

method, this is what can affect the

00:01:14

quality of an ultrasound, this is the first with patients,

00:01:16

and how is excess weight up to when our

00:01:19

patients weigh 140 kilograms, it is very difficult

00:01:22

to discern the

00:01:24

structural features of the kidney there, and in the same way if we have

00:01:27

girl weighing 40 kilograms.

00:01:30

It turns out that it is also too close to the

00:01:31

surface of the sensor and this can also

00:01:33

be a problem, it

00:01:35

also interferes with normal visualization, I do

00:01:38

n’t know who is doing it, probably then

00:01:40

push them when we walk around with such girls

00:01:42

there and there it’s not easy to see the kidney until

00:01:46

you have to somehow invent or

00:01:48

look at the position and so on, plus

00:01:50

this is naturally due to anatomical anomalies,

00:01:52

that is, a horseshoe-shaped kidney, a

00:01:53

discounted kidney, that is, those points

00:01:55

that are not in the usual place for a

00:01:57

doctor who performs regular ultrasounds,

00:01:59

yes, they also represent

00:02:03

definitely something in the jaw from the diagnosis,

00:02:06

too, we usually, in such conditions,

00:02:07

recommend computer tomography with

00:02:10

contrast to

00:02:11

screen the intestinal gas our

00:02:14

ultrasound signal also worsens

00:02:17

the visualization earlier there in the late 80s

00:02:22

90s patients were preparing, we will open

00:02:24

old textbooks it says that it is

00:02:26

necessary to exclude

00:02:27

gas-forming foods, not even a trace of

00:02:29

gaining weight on an empty stomach, and so on, now

00:02:31

almost nowhere do ultrasound

00:02:34

machines do it better but in some

00:02:35

situations we have to

00:02:37

stop the study and

00:02:39

explain to the patients that it’s hard to see, and maybe

00:02:42

we’ll try to do it on the shore, we’ll study it

00:02:44

there a couple of days after preparation,

00:02:47

such situations happen, and the third factor is

00:02:49

this pie factor, as I called it,

00:02:53

where did it come from, it worked

00:02:56

great for us the doctor

00:02:57

himself from my lips to the Rakhmans, maybe someone

00:03:00

remembers him, and when I was still in

00:03:04

residency, I went and watched him do an

00:03:05

ultrasound, it was there in 90 for the eighth year in a row

00:03:07

already 20 years ago, he was asked why

00:03:11

we have identical-looking patients of

00:03:12

approximately the same build

00:03:14

of the same age, one can see everything is

00:03:16

great, just like in the textbook, while the

00:03:18

other is very bad and comes to

00:03:20

invent something, how then try

00:03:23

to look differently there, turn

00:03:25

on the side on the stomach, there is something else that was

00:03:27

not answered to jump, stretch the

00:03:29

patient’s brain niches like pies, in what

00:03:32

sense are they gas, they all look the same, the

00:03:34

filling is all different, and in fact

00:03:38

there is such an incomprehensible

00:03:40

indescribable factor, this is the mood of the

00:03:43

subcutaneous fatty tissue, as they write

00:03:45

in our Western textbooks, that is, this is

00:03:48

some kind of feature of the fatty

00:03:50

tissue that screens the

00:03:52

ultrasonic signal that is, it

00:03:54

extinguishes it, we have recycling later, we got

00:03:57

Austin Green, we have three more interference further,

00:04:00

accordingly, these are such inexplicable

00:04:03

things, it seems that a standard-sized

00:04:05

patient can undergo iron, I quote, they

00:04:15

even never, never lived and I think

00:04:20

that no, they have never heard this

00:04:24

maybe it’s some kind of superstition

00:04:27

and I’ve never encountered it, I’ll take a look,

00:04:30

but as for the research methodology, the

00:04:34

patient is usually not prepared now,

00:04:37

but the only thing you need to pay

00:04:39

attention to is the condition of the

00:04:42

bladder and not formally approach this

00:04:45

study, that is, if we We perform an

00:04:49

ultrasound of the kidneys, I usually always first put a

00:04:51

sensor on the bladder because

00:04:53

we are elderly people, they can’t always say

00:04:57

there they want the toilet, they don’t want a finger, it’s not

00:05:01

always easy with them, yes,

00:05:03

so it’s time to check, there may be a

00:05:04

delay in the chronic match, we all

00:05:06

know them and at the same time, the person does not experience

00:05:08

any problems and does not realize that there is not a

00:05:10

lot of residual urine, which is why,

00:05:12

before starting to look at the ultrasound of the kidneys,

00:05:15

it is advisable to place the sensor on the

00:05:16

bladder to see how much there is,

00:05:18

you need to remember that our standard

00:05:20

position of the sensor is along the posterior

00:05:22

axillary line to the hypochondrium,

00:05:25

but there is a concept of field positional

00:05:28

research if you see it poorly and in a

00:05:30

standard position yes you can

00:05:31

look died take it

00:05:33

if the point is located high and it does not

00:05:35

fall

00:05:37

when we ask here and here the animal

00:05:39

has a drink and forward to inhale

00:05:41

here you can look through the anterior

00:05:43

abdominal wall there are no

00:05:45

backs that look like yes, if you can’t

00:05:48

look and the standard position,

00:05:49

you can try from any other position, whatever is

00:05:51

convenient for you,

00:05:52

your situation, your patient, your sensor,

00:05:55

but as for cleanliness, as I

00:05:59

said already in the first lecture, the

00:06:01

higher the frequency, the less penetration,

00:06:04

so it’s standard for examining the

00:06:06

abdominal organs the

00:06:07

staff uses the crackle of a flame up to a hertz, which

00:06:09

gives a depth of about 20 centimeters,

00:06:12

even more honesty, you need to understand all the

00:06:17

limitations than we also talked about in the

00:06:20

first lecture, all the limitations of the method and

00:06:22

not to mislead either yourself or colleagues,

00:06:25

not patients, when the system does not see something

00:06:27

or we can’t analyze or

00:06:29

somehow interpret the situation, we need to

00:06:31

talk about it honestly and

00:06:34

write in the protocol that let’s say

00:06:36

visualization is impossible or difficult and the

00:06:39

patient also explains that this is your

00:06:42

situation I can’t guarantee one hundred percent that

00:06:43

this study is

00:06:46

definitive and that’s exactly what you need

00:06:49

let’s make a decanter there with a computer

00:06:50

to clarify the picture of death, there is no need to

00:06:53

take on extra responsibility; this is

00:06:54

often such a sin for ultrasound doctors because

00:06:58

they believe that Moscow is behind them and they are

00:07:00

obliged to give a final conclusion

00:07:02

and no one else is capable of doing this, so to speak,

00:07:04

it’s not like that, well and the last thing

00:07:07

is that our right kidney is located

00:07:10

lower than the left one above, and the second point is

00:07:12

that according to statistics, the left kidney is

00:07:14

a little larger in size,

00:07:17

this study was carried out, and

00:07:19

anatomists

00:07:20

associate this with the fact that the left kidney

00:07:25

is located next to the spleen, which is smaller

00:07:28

in size and development in the liver it does not

00:07:29

interfere with the development of this kidney, therefore it is

00:07:31

larger in weight and in size,

00:07:33

a little bit as for the execution of

00:07:40

the image, the same as I said, you

00:07:44

must place the organs that we are describing

00:07:46

before on our frame so that

00:07:48

there is some space on the right left from top to bottom

00:07:50

that it was clear

00:07:52

the relationship with neighboring organs when

00:07:56

describing the kidney, we indicate its length to

00:08:00

we can measure

00:08:02

the width there, but this is not necessary for

00:08:05

three hours you are a standard

00:08:07

patient with normal kidney sizes, then

00:08:10

one size is enough,

00:08:11

long enough, plus it must be taken into account that of course the

00:08:14

sizes of the kidneys are ok and all the internal ones

00:08:16

organs they depend on the build of

00:08:18

a person, we have a patient there who is about

00:08:21

ninety-five meters, his barrel can be

00:08:23

15 centimeters, but if we have a

00:08:25

patient there, she is 80 years old and 60 meters

00:08:29

tall. maybe eight years

00:08:31

is also the norm, that is, these sizes are

00:08:33

not absolute, they are on the nose, as if taking into account

00:08:36

the constitution of the patient, evaluate again

00:08:42

this is the situation when we cannot

00:08:43

remove the kidney completely,

00:08:45

I am located in such a way, we

00:08:47

can see here the shadow of the rib

00:08:49

to which the massage therapist on the image of the

00:08:51

kidney, in this case, it

00:08:54

is not necessary to do the image if there is not something there

00:08:56

that must be

00:08:57

shown and the kidney has to be assessed,

00:09:00

but in sections, that is, a separate upper

00:09:02

pole, look at the intercostal space separately, the

00:09:04

lower field separately, the middle segment,

00:09:06

that’s because it’s different it is not

00:09:09

visualized,

00:09:12

and also with regard to

00:09:15

ultrasound nomenclature, it is advisable to

00:09:18

adhere to the traditional ones: the

00:09:21

name we have an upper pole, we

00:09:23

have a lower pole, we have a division into

00:09:26

upper middle and lower segments in the

00:09:29

kidney, there is an anterior posterior surface,

00:09:31

there is an oral medial edge, yes there is a

00:09:33

gate point, this is the term and which you

00:09:36

need to use, don’t carry around, I’m inventing

00:09:39

something of my own,

00:09:41

I’ll say a few more words about

00:09:43

the protocols for ultrasound examinations in general, some are non-

00:09:46

standard, we definitely don’t have any

00:09:48

uniform requirements for this protocol,

00:09:49

so in each medical institution, in

00:09:52

fact, you will have some kind of its own

00:09:54

standard formed before which needs to be

00:09:56

adhered to and this is normal for the

00:09:58

interaction of doctors with an ultrasound doctor, you

00:10:02

are allowed in this city 16 this drive leads

00:10:04

to the fact that the ultrasound doctor already writes exactly

00:10:06

what is needed, not just what he read somewhere

00:10:10

in a textbook there or from someone who looked,

00:10:12

he drowned must be exhaustive,

00:10:15

concise and clear, and when I

00:10:18

print, I usually, again, since

00:10:20

then I read it all myself, I simply

00:10:21

put out important things in conclusion, that is,

00:10:24

they simply write a dream of goodness as a guide

00:10:26

to Asia of the prostate gland and

00:10:28

immediately drag the volume of residual urine

00:10:32

there -then if we

00:10:34

also indicate the size of the bladder in the conclusion, and

00:10:36

so on, because I thought you all

00:10:38

had to deal with this, sit and someone else’s

00:10:40

protocol for one and a half pages and say

00:10:41

there the size of the stone because at the end it

00:10:43

says ICD, it takes time and in

00:10:46

general it’s not very correct regarding the

00:10:52

anatomical position of the kidney, it is

00:10:54

located incorrectly in all

00:10:56

planes, naturally we will look at

00:10:59

the original of the body until the point is located in the

00:11:02

left picture visible at an angle of 15

00:11:05

degrees, that is, the lower pole is spaced from

00:11:07

the spine when it is

00:11:09

15 degrees relative to the upper one and the

00:11:11

kidney hilum is located relatively

00:11:13

horizontally level at an angle of 30

00:11:15

degrees to this brooder line, this

00:11:18

needs to be done as a point function here and,

00:11:21

accordingly, in the anteroposterior position

00:11:24

shown on the very left to your right

00:11:27

. it’s located as if the upper pole is

00:11:30

further than us in the lower field, it’s closer to the

00:11:33

anterior abdominal wall, also at an angle of

00:11:35

15 degrees, so when we put

00:11:37

my sensor in place, we immediately put it in this

00:11:39

position, but again, people make you like

00:11:42

this very quickly, you usually get used to

00:11:44

it already automatically happens immediately

00:11:46

the hand itself gets into

00:11:47

this position where the kidney should be there

00:11:51

no questions immediately arise no

00:11:53

dystopia no more surgery and then

00:11:55

because it is

00:11:57

oriented with the spleen of the liver it is

00:11:59

immediately clear that

00:12:00

where the kidney should be once again regarding the

00:12:06

description we describe the length of the kidney and the

00:12:09

thickness of the parenchyma yes, as it is written in

00:12:11

green steam and here is the thickness of the portico,

00:12:14

I found out in one textbook

00:12:17

that they measure separately, gave the stew, we will

00:12:19

bring it separately, the thickness of the side

00:12:20

is arranged, it seems to me that this is not needed, well,

00:12:23

just as an option, so that they understand that

00:12:25

there are such parameters, this is what

00:12:31

concerns research methods as well we

00:12:33

have to believe the size of the kidney,

00:12:36

display it on the screen in the maximum

00:12:38

size, maximum length, because

00:12:40

here it is shown that if we

00:12:42

display the kidney, the normal position on

00:12:44

you is nine and a half centimeters until

00:12:46

if we place the sensor on the right, let’s say

00:12:51

since we will have to not be very careful

00:12:53

. it turns out 7 and 7 and

00:12:56

I graze a little and make a knot.

00:12:58

Patients with

00:13:00

hypoplastic kidneys have repeatedly come to me; they bring an

00:13:03

ultrasound protocol that says 1 centimeter to the right and

00:13:05

let’s say everyone has the left one and they have to

00:13:08

redo it. absolutely the same, they are

00:13:10

God of normal large sizes, it

00:13:13

seems that this is such an

00:13:15

insignificant nuance, but the patient for whom

00:13:17

is measured incorrectly, even the size of the

00:13:19

kidney they get, so you need to

00:13:21

pay attention to this and move the sensor a little so

00:13:24

that the kidney can be brought out in the

00:13:25

optimal maximum size,

00:13:28

and then we are considering options the

00:13:32

norm

00:13:33

that occurs most often,

00:13:35

probably what you have all encountered, is

00:13:36

hypertrophy of the column of berti na or

00:13:39

hypertrophy of the renal column,

00:13:40

this is a herniation into the medulla of the

00:13:44

renal parenchyma that occurs

00:13:48

very often, it is not always possible to distinguish it from a

00:13:51

tumor, so here if you have

00:13:55

doubts, we refer patients for

00:13:58

computed tomography

00:14:00

if this is a known fact already to Ivan,

00:14:03

the patient is talking here to me, saying there is something

00:14:05

wrong there from this point, then we can

00:14:07

leave it under observation but in favor of the fact

00:14:09

that this is all hypertrophy, the patches have again become a

00:14:11

tumor plan says. the outer contour of the

00:14:14

kidney is not broken in this case, yes, there

00:14:17

are no book here, no plus edges, and the

00:14:21

second point is that the diagnostic

00:14:24

criteria are considered to be the dimensions of this one,

00:14:28

definitely more than three and a half

00:14:30

centimeters, although I have seen more

00:14:31

textbooks written to feel that this is

00:14:34

again an attempt to standardize

00:14:36

what It’s impossible to standardize, so

00:14:39

35 millimeters is not the limit, I’ve seen

00:14:41

40 out of 42 millimeters. the table is a very

00:14:46

normal version of the leg, here is another

00:14:51

option, also shown in a smaller size,

00:14:53

and you can even say that there

00:14:54

will be a doubling of the kidney, recognize his

00:14:58

creations, David, this is the presence of such a

00:15:00

prince of the mounting jumper, here in the middle,

00:15:03

the conversation is still in

00:15:04

any case, if we have doubts, we

00:15:08

understand the limitations of ultrasound

00:15:10

examination, we direct patients on

00:15:12

computer graphic tracers, the

00:15:16

next variant of normal anatomy

00:15:18

is fetal dolce, that is, that is,

00:15:21

in embryogenesis you. it looks like this

00:15:25

here in the berries of the academician describes raspberries,

00:15:27

and some adults have such a

00:15:30

bud, it lasts for the rest of their lives, the

00:15:32

person has such a wavy

00:15:34

outline, this shouldn’t confuse this is a

00:15:36

variant of the norm and the second variant of the norm is that

00:15:39

humpbacked bud, but that’s when the buds are like this

00:15:41

triangular shape as about this as about

00:15:44

always this is the left kidney, also a fairly

00:15:47

common occurrence, I did not find, unfortunately, a

00:15:53

better picture, but how can

00:15:54

it happen that such piles are just triangular,

00:15:56

just a triangle here are textbooks in

00:16:02

a foreign language, this was

00:16:04

presented as a sample of

00:16:05

this humpbacked fetal kidney lobules

00:16:10

here, it is shown especially well,

00:16:12

on the right slide we see just such an

00:16:15

uneven wavy contour of the kidney, also a

00:16:18

variant of the Pugachev norm does not follow, plus

00:16:21

here it is not shown yet now I

00:16:23

will show you on the middle picture here there is

00:16:26

also a defect hyperechoic

00:16:29

triangular shape effect on the border of

00:16:31

these

00:16:32

fused parts of the kidney is also a

00:16:36

variant of the norm, we will

00:16:37

always show it poorly, then I will add

00:16:41

better quality,

00:16:43

again, if you have doubts about the

00:16:45

fetal dolcino style, then something is wrong,

00:16:48

we send a biscuit shape on the computer

00:16:52

. I’ve never seen it in my life,

00:16:55

well, it’s described in the literature, so it

00:16:58

looks beautiful in a park with no pi

00:17:01

solutions, which sector is like two kidneys

00:17:03

completely with 1 6, but in English it’s

00:17:06

called cross fusion

00:17:10

and here it is shown with an

00:17:13

ultrasound picture

00:17:15

and an image on a computer tomography

00:17:17

and if you pay attention here, the

00:17:19

right kidney pelvis is turned to the

00:17:21

front of the left kidney pelvis turned

00:17:24

Kazan

00:17:26

came together and Tonga years back and the second

00:17:30

more frequent much more frequent

00:17:32

option and in the horseshoe kidney with

00:17:34

which you think everyone has repeatedly

00:17:36

encountered

00:17:37

what types of errors is very

00:17:42

typical situation when a horseshoe-shaped

00:17:44

kidney is detected in a person who has

00:17:46

had an ultrasound scan many times before and he

00:17:49

brings several protocols where

00:17:50

it is written that this is the right kidney

00:17:52

and this is the left one, which can allow one to

00:17:56

suspect that patients have a

00:17:58

horseshoe-shaped kidney, these are two points,

00:18:00

firstly, restriction of mobility during

00:18:02

breathing, that is, this kidney practically does not

00:18:04

move and the second moment under the

00:18:08

horseshoe-shaped kidney, we cannot

00:18:10

clearly bring out the lower pole, it seems like there is a

00:18:13

bank in the womb, but it seems to

00:18:14

end like this, you can

00:18:16

see it clearly as the upper one does not

00:18:19

work out, something is interfering with gas

00:18:22

or something Yes, and this is the reason for the

00:18:25

mistakes, that the doctors don’t think

00:18:30

about the fact that maybe it’s not just that the

00:18:31

lower pole is not visible, but maybe

00:18:33

you don’t have a lower pole until there is an isthmus

00:18:36

between the kidneys, and there were such cases,

00:18:39

here’s another one a variant of a

00:18:44

horseshoe-shaped kidney is also shown, here is

00:18:47

the upper right,

00:18:49

then the plan on the kidneys of the left half of the kidney with

00:18:52

this one on the left is even better visible that

00:18:55

instead of a clear boundary, it is approximately

00:18:57

clear that it is about to end, but

00:18:58

there are no transitions, and here on the far right

00:19:01

slide the oorta to the bottom is shown half

00:19:05

and, as a matter of fact, this isthmus and

00:19:08

smooth which lies on these vessels,

00:19:13

again, any anomaly is a reason for

00:19:16

conflicts

00:19:17

in the graph itself and because I am

00:19:18

not able to see such a native kidney fully,

00:19:21

including me, here again with a

00:19:25

horseshoe-shaped kidney, another option is the

00:19:27

similarity of sinning and I usually advise everything myself,

00:19:30

even if the game is first exposed to

00:19:32

know the mask, we will have basic

00:19:34

research for the gift of the key, someday there

00:19:36

will be problems for us, at least we will have something to

00:19:37

compare the export to before it was not there

00:19:39

because it is clear that with the return of the

00:19:42

kidney, it often happens and urolithiasis is more

00:19:43

often an infection and even nephritis, so this is a

00:19:47

biographical fact that is better

00:19:49

to record kidney dystopia, also

00:19:54

quite often the phenomenon is to

00:19:56

dissolve, in fact, only two are

00:19:58

pelvic dystopia and lumbar kidney

00:20:00

dystrophy, but in this case it

00:20:02

is shown that there is a backwater copied kidney and here is the

00:20:05

uterus above it

00:20:12

again urolithiasis, according to

00:20:18

ultrasound, have a very characteristic appearance,

00:20:20

that is, the presence of stones is the presence of hyper

00:20:23

hagen neoplasms with an acoustic

00:20:25

shadow, on this slide we can see in the

00:20:28

same patient with

00:20:31

purulent pyelonephritis, we see not only a

00:20:32

stone in the archaic segment participants,

00:20:34

we also see after all, it’s already dragging such

00:20:37

heterogeneous

00:20:38

contents from the opening of the calyx to the pelvis,

00:20:41

but these calyces, here the kidneys on the left

00:20:45

slide, are already levels of pilonephritis of the legs on a

00:20:49

computer excretory urography, we now

00:20:51

see this symptom of the index finger, familiar to us from childhood, that

00:20:54

is,

00:20:57

I did not see where the stone is located,

00:21:02

diagnosis is not difficult if

00:21:05

we see from hyper-h gene

00:21:07

formation with an acoustic shadow, these are the

00:21:09

criteria for urolithiasis,

00:21:12

here they show who I am on the map to me and

00:21:16

fermentation on a computed tomography and a

00:21:20

significant moment of 5 millimeters is the

00:21:23

limit of the possibilities and the apparatus of the Duma, you

00:21:26

also encountered this very

00:21:29

they often write as if 2-3 millimeters are multiple,

00:21:32

every two to three millimeters, everyone

00:21:34

has to explain to the patient that this is beyond the

00:21:36

limits of possibilities and how the method cannot be

00:21:44

seen, this is a very serious mistake, this is a common

00:21:45

mistake, and it’s sad that it’s

00:21:48

useless to fight people with doctors, so

00:21:51

I took five millimeters on purpose this is a

00:21:53

textbook from 2016, an American scientist of

00:21:56

ultrasound diagnostics is not old for

00:21:58

2016, I’ll even print out this page, it’s

00:22:01

lying in my hand

00:22:02

so that my hand will be in the office, but it’s printed out

00:22:07

one piece of paper, I’m just

00:22:09

showing the patients five millimeters,

00:22:13

in general, these are

00:22:17

preventive canephrons, but you can do everything like this that

00:22:22

is, writing less in less than 5

00:22:23

millimeters is wrong because

00:22:26

it could be anything, it could be a

00:22:27

seal in the vessel wall, it could be

00:22:29

some percentage in the parenchyma, or

00:22:33

anything, so here, everything that is more than

00:22:36

five millimeters, we believe everything that is less

00:22:38

I explain politely 2 theoretically they

00:22:50

are of course here the question is, in fact,

00:23:08

we are very experienced people here, already in

00:23:10

years, everyone is faced with this, I usually

00:23:13

explain to the patient that there are no specific

00:23:15

signs of beer, are they, that is,

00:23:17

is it not French, is it not Francis, is it a

00:23:20

process that you For all of us, it starts

00:23:23

from birth, but I explain that even

00:23:27

at 15 years old there is a girl and at 30 years old the

00:23:30

kidneys already look completely

00:23:31

different,

00:23:32

yes, that is, this is a manifestation of the

00:23:34

same word, so that’s why, of course, where should

00:23:38

they put it? impossible, and I

00:23:43

must also say that 5 millimeters is

00:23:45

of course good, but I had and still have

00:23:47

an exception on the other side, there was

00:23:49

a patient who described a

00:23:51

stone of 9 millimeters for three years and she

00:23:54

came to us saying that I want to get pregnant,

00:23:56

let’s remove it because who knows

00:23:58

what I sent her to a computed

00:24:01

tomograph, she comes with big eyes

00:24:03

like saucers, there are no stones, how can it

00:24:06

be that I will be treated for three years with canephron,

00:24:08

we are not there, the ultrasound is tracking to find out about it has become

00:24:11

smaller, no, it has become larger, these 9

00:24:13

millimeters of which showed that there is

00:24:14

nothing at all just there so straight he was that's why

00:24:17

even with such dimensions there

00:24:20

can be errors there are 2 more boats

00:24:24

there later I'll tell you twink artifact the so-

00:24:26

called flickering artifact

00:24:28

flickering this is considered a sign the

00:24:31

same as a stone when using a doctor that is

00:24:34

behind or the tail of a comet it's also

00:24:36

called when

00:24:37

such a multi-colored tail appears behind a stone

00:24:39

13 black red blue not multi-colored

00:24:42

red blue this effect

00:24:47

allows you to diagnose small stones,

00:24:48

but it is also such a controversial

00:24:52

thing because on many devices

00:24:53

now it is canceled out by software,

00:24:55

let’s say it will be

00:24:57

reproduced on my device there is something there, some kind of

00:25:00

lotion, which levels it all out and

00:25:03

removes these artifacts,

00:25:06

here is a spongy kidney,

00:25:09

too, this is what everyone is familiar with before,

00:25:12

this is a

00:25:14

dysplastic disease when we have a

00:25:15

lot of kidneys to expand the tubules of

00:25:18

these bellinis, as they are called, and

00:25:21

accordingly they may have

00:25:23

deposits of calcium salts and multiple

00:25:25

small stones, as a result, these

00:25:28

unfortunate patients because if

00:25:29

inflammation occurs, it is

00:25:31

almost impossible to cope with it, so

00:25:34

this picture is also called a cart wheel,

00:25:38

which is shown on the right and left, we show this one,

00:25:44

respectively, on a computer tomography,

00:25:45

we move it Calcium deposition, well, what

00:25:50

could it be for now

00:25:51

to imitate the presence of stones, this is exactly

00:25:53

what they were grieving about more, so

00:25:55

this is gas collecting on the kidney system, these are

00:25:58

calcifications in the renal arteries, this is

00:26:01

necrotizing papillitis from amputation to its

00:26:07

own weight.

00:26:08

it could be a preserved

00:26:13

tumor with qualities including, it

00:26:16

could be an inlaid wall

00:26:19

that resembles a stone, even if there are no

00:26:22

salts left, the

00:26:25

righteous stone has a very characteristic

00:26:27

picture, it occupies the entire

00:26:29

renal system, we see such a good

00:26:31

wide acoustic shadow after the collapse of the

00:26:34

gene of this signal so what happened to us is

00:26:42

incomprehensible,

00:26:48

we all returned to see me in the

00:26:54

X-ray, I think that everyone saw such an

00:26:57

extreme twink artifact

00:27:01

that he was talking about, we see on the left

00:27:03

image such a dubious date of

00:27:06

people were no longer in the cup at the border of the

00:27:09

middle and lower thirds,

00:27:11

and so on when we turn on the Doppler, we see

00:27:14

this kind of tail of the comet against after

00:27:16

these two formations, no, it’s

00:27:21

just a picture, an artifact, it allows

00:27:23

us to identify when we’re not

00:27:25

sure in the usual gray mode, we

00:27:28

’ll cut out the sulfur scale and we don’t see, that is, there’s

00:27:30

something there the tattoo with the acoustic shadow is

00:27:33

clear, yes, the lower cup seems to be

00:27:35

there, yes, the middle one, no, but when

00:27:37

the doctor turns on, we clearly see

00:27:39

this post, of course, yes, after coming to me

00:27:44

after the stone, there is a physical

00:27:47

explanation of this process, you can

00:27:49

try to use this to diagnose

00:27:51

small stones because the acoustic

00:27:56

track is clearly not here on the left

00:27:59

image and the

00:28:00

acoustic track is the main sign

00:28:02

for me, again, we have doubts,

00:28:06

we have a tomography computer that

00:28:07

shows how and not of any size,

00:28:10

unfortunately, the road costs a stone, the mouth

00:28:15

of the ureter is the same, I think that everything

00:28:17

is easy they diagnose this, it has a

00:28:21

very characteristic picture of a hyperhagen

00:28:25

formation with dilated ureters

00:28:27

above, like in the left image,

00:28:31

this is a very beneficial situation, of course,

00:28:33

for an ultrasound doctor, but because a

00:28:35

patient with renal colic comes in with

00:28:37

severe pain, otherwise frightened by this

00:28:41

story, we can here literally in two

00:28:43

seconds and this is a concern when there’s

00:28:45

your stone, I see you feel like such a

00:28:49

winner, well, somewhere I thought that inter

00:28:55

morally I was doing a little higher, but in

00:28:57

reality I think it’s probably 34

00:28:59

centimeters no more, again it all

00:29:01

depends on the patient’s build from the

00:29:04

doctor’s experience and the quality of the ultrasound machine, but

00:29:06

because when I worked here, the

00:29:08

composition in the body is a

00:29:09

very good

00:29:11

expert-class Philips device, it’s really

00:29:13

very good and she’s been working here for

00:29:15

three years, I’m

00:29:16

looking through the entire ureter, I need it

00:29:20

right from top to bottom, but this is exclusive that

00:29:23

I let’s say the device is not of such good

00:29:26

quality, I can’t do this, I

00:29:27

tried not to get it, it all depends, so it is

00:29:31

believed that we can see what is

00:29:34

below the kidneys of the urine point, is there such a life for us

00:29:36

to expand and there are disks and about

00:29:39

3-4 centimeters

00:29:41

already in the inter moral of a separate house with

00:29:43

those whose points to a very beautiful very

00:29:47

characteristic sign, yes,

00:29:51

ureteral obstruction or the absence of

00:29:52

ureteral obstruction are these ureteral

00:29:54

emissions here or rt roger

00:29:57

here you have read this is also called

00:29:59

Kendall Sayan before the symptom of a candle here is a very

00:30:04

convenient very simple method

00:30:06

again it’s also cheap when we ask

00:30:09

patients to drink, it’s half a liter, there’s 600

00:30:12

milliliters of liquid to drink and

00:30:15

after 20-30 minutes you can already start looking

00:30:18

if we have urine coming in from both the right and

00:30:21

left symmetrically in approximately equal

00:30:23

portions, which means there’s an obstruction,

00:30:25

constantly on one side

00:30:26

compromising the other, they’re not coming in or there,

00:30:29

let's say from the left side five times

00:30:31

the match has already come out until on

00:30:32

the right there is only one winner, the trouble is that it is

00:30:35

quite possible that there is an obstruction there are

00:30:38

sword cards.

00:30:39

again, this all works well for

00:30:42

relatively young patients

00:30:44

because I have repeatedly tried to

00:30:47

use it in a patient there after 70

00:30:49

years of age.

00:30:51

You know, macho, they accumulate very poorly slowly

00:30:53

and it’s difficult to trace these

00:30:56

heaps, the source of his emissions, apparently this is

00:30:59

already connected with exactly not enough

00:31:00

with some... then there are also processes, well, it’s possible

00:31:06

earlier if he already has a strong urge there,

00:31:08

but for young people it’s all very fast, yes,

00:31:12

because poppy sometimes even had our

00:31:15

employees when I sincerely want to see,

00:31:18

she seems to have sung Russia, but again

00:31:21

there is an elderly person with excess weight before

00:31:23

she’s all this liquid goes somewhere

00:31:25

with cellulose approaches accounting for bubbles does

00:31:27

not come right away and it happens very slowly

00:31:29

that there are elderly people sitting there for

00:31:31

2-3 hours already one and a half liters of river water in the

00:31:33

bladder is not filled,

00:31:35

this is unfortunately a feature of this

00:31:38

and the simplest one is in fact, if there

00:31:43

is even just an understanding and spontaneous

00:31:45

contrast when we

00:31:47

can see such gray matches even without Doppler, even in

00:32:31

fact here the question is first of all the

00:32:34

need for personalized

00:32:35

medicine, it should not come in two

00:32:37

hours when the urge for

00:32:38

advice does not always work out Taras and the

00:32:40

second point where do

00:32:42

these recommendations come from? They’re not just out of

00:32:44

thin air, but the people who get sick are mostly

00:32:46

elderly people who accumulate urine

00:32:50

slowly, this is where they appear, these

00:32:52

die in these, I don’t think so, because it

00:32:57

comes to me from experience a lot if

00:32:59

it comes at 12: 12 I work there until 2 until 2

00:33:04

this is a reason 3 somewhere I work I you

00:33:06

will find out we will now start singing it is very

00:33:08

likely that you will not be able to do an

00:33:10

ultrasound because it will come out in two hours you can

00:33:12

accumulate a hoop come in the morning at nine

00:33:14

do not go to the toilet here in the hospital

00:33:17

we’ll see if there’s enough to drink, we’ll

00:33:20

still have a whole day ahead of us, that’s how

00:33:22

it works because Zolotarev is there

00:33:25

because they’re prescribed 500 grams and the

00:33:28

patient is then 78 years old, these 500 grams beckon

00:33:31

us to the house, which coozdre doesn’t arrive

00:33:33

in an hour or so in two,

00:33:34

not in three, it’ll be there all night long and it will

00:33:38

come out before he has 400 grams during the day and the

00:33:40

tasks there are two liters of urine, so it happens so like that,

00:33:44

well, in short,

00:33:48

regarding the errors that can occur during

00:33:51

ultrasound diagnostics, this is

00:33:54

actually in fact, I didn’t write this off anywhere, I

00:33:57

brought it up before the trial,

00:33:58

these are 4 situations, firstly, this is a secret in

00:34:01

Russia which is Nuria, I think that everyone knows

00:34:04

this term,

00:34:06

or this is a resorption match that

00:34:09

occurs some time after

00:34:12

acute obstruction, that is, if we take

00:34:13

the patient to ultrasound of renal colic, which

00:34:16

happened two hours ago, we will see such a

00:34:20

vivid picture of an expanded, assemble this

00:34:22

system into an expanded scutellum, and so

00:34:23

on, if a week passes, there are two

00:34:25

weeks, we can, in the presence of

00:34:28

ureteral stones, and even in the absence of

00:34:30

kidney function, on ultrasound we can see as if normal is

00:34:33

happening this is because you can see the

00:34:35

match is touching back and the kidney

00:34:39

pause looks quite normal so

00:34:40

here

00:34:42

in the simplest version we need to

00:34:44

check the ureters for emissions, ideally

00:34:47

do a computer tomograph of course, the

00:34:48

lawyers stone and came out yes because

00:34:51

such patients who come after

00:34:53

five or after eight years with terminal

00:34:55

hydronephrosis,

00:34:56

too, everyone saw them in the West, explains here there

00:34:59

was renal colic, they took me to the hospital for

00:35:01

two days, they supported everything, everything went away, they

00:35:03

released me, I didn’t go back again, I didn’t

00:35:06

get sick, and the stone remained in place, the

00:35:09

second option d who is outside the renal

00:35:11

pelvis is

00:35:12

also a fairly common occurrence when

00:35:14

we have Normally, the pelvis can be two two and a

00:35:16

half centimeters,

00:35:18

as a rule, it looks like this on both sides,

00:35:20

and that’s also when I started working with

00:35:23

four rests, I sent such patients

00:35:27

immediately to the structural graph

00:35:30

you should do so that 10 probably

00:35:33

didn’t begin to understand what that is, we are doing and there is

00:35:35

nothing there normally, the sacred

00:35:37

function is just such large pelvis

00:35:39

on both sides, so you need to evaluate the

00:35:42

contra natural kidney accordingly,

00:35:44

you need to look at the source of its emissions,

00:35:46

and the most important thing than just a hundred lions, the

00:35:49

most said very important thoughts, you always

00:35:51

need to compare our picture when

00:35:53

examined with an ultrasound in with the collection, she pressed

00:35:57

to use this all when analyzing this

00:36:00

situation, the colic is not exact, but we

00:36:03

see that this is an expansion, most likely

00:36:05

it is either some old situation, there

00:36:08

may not be a renal ank or

00:36:10

something else, but you are based on an ank the opposite

00:36:14

situation is when we have anteroposterior

00:36:16

buttons that completely close the pelvis,

00:36:18

even with acute mail in renal

00:36:21

colic, which just

00:36:23

happened, we may not see the expansion

00:36:24

despite the fact that they will be ureters and,

00:36:27

accordingly, there will be obstruction; everything that

00:36:29

follows from this, well, and the last thing is

00:36:31

inside the service cysts which are

00:36:33

practically the norm in old age, we

00:36:35

know that after 50 years, most

00:36:38

people do not have all the peaceful crosses of different

00:36:41

sizes and they can imitate the

00:36:43

collective evaluation system of the kidney

00:36:45

expanded and in such a situation, of course, it

00:36:49

would be more correct not to interpret

00:36:52

them as training not cysts or as

00:36:55

games of nephrosis but it’s probably correct if you

00:36:58

have doubts to write that the kidney has a

00:37:01

fluid formation at the hilum of the kidney,

00:37:03

which requires further examination, a

00:37:05

parenthesis to write I’m not sure, you’re in

00:37:07

question, aggressiveness towards cysts is in

00:37:09

question, and because we all have such patients, we’ve

00:37:11

all been diagnosed with ska jump the fetus, I have an ultrasound,

00:37:12

hydronephrosis, internal ultrasound

00:37:14

Kidney cysts are scary, in fact,

00:37:18

you can’t always go and say that what in

00:37:20

fact, here are the illustrations: on the

00:37:24

left side we have hydronephrosis, and on

00:37:27

the right we have couples of fecal

00:37:29

cysts, and go prove that it’s good

00:37:31

because they look almost the

00:37:33

same terminal hydronephrosis, I

00:37:40

think that here somehow there is no longer any doubt

00:37:42

that this is happening again, I will repeat it again, it

00:37:48

seems to me that if this is how the

00:37:52

picture is here, you can write something about the

00:37:54

parking quantity before it was sold, there is no

00:37:56

hint that the ureter should be

00:37:57

dilated, the calyces, so if doubt

00:38:00

is better write a fluid inclusion in the

00:38:02

sinus cyst has expanded in question

00:38:05

this would be more correct and we always have a

00:38:10

computed tomography in case

00:38:12

these are elderly people as a rule you are elderly

00:38:14

people there is almost insufficiency we

00:38:16

have a backup option this is for the sake of the magician it is visible

00:38:21

and follows a month horse 1 photo

00:38:23

not directly on in geography which can be

00:38:24

carried out if present in Rome and

00:38:26

and which in general will show us this

00:38:29

expansion is there an obstruction or this

00:38:31

aggressive cyst underwear obstruction as they scream

00:38:35

as for the hand, but the

00:38:40

simplest classification option is a

00:38:42

simple cyst and a complicated cyst as

00:38:44

shown here with simple and a cyst with

00:38:46

homogeneous contents with clear

00:38:48

contours, delivery by the wall,

00:38:50

complicated as shown here, we see a

00:38:52

fairly large size, such a

00:38:54

solid formation inside the cyst,

00:39:00

again for the 5th stage, and in case of doubt, we have a

00:39:02

computed tomography,

00:39:08

well, the Bosniak classification, yes, I think

00:39:13

everyone knows it divides cysts into

00:39:16

4 categories 1 2 category the

00:39:20

probability for the quality of education

00:39:23

is zero percent category 2c from and

00:39:26

the follow-up yes this is an observation and everyone

00:39:29

who where you need to repeat the research

00:39:30

divorce up to the probability of my nickname

00:39:33

five percent well and accordingly 3 4

00:39:35

percent this is as shown here, 50 and

00:39:38

100 percent for the quality of education

00:39:40

from the Bosniak classification is based

00:39:42

on data from computed tomography with

00:39:45

contrast

00:39:46

and using it there with ultrasound is of course

00:39:49

not very correct because the main

00:39:52

criterion for classifying a cyst into one category or another

00:39:55

is its ability to

00:39:57

accumulate a contrast agent. I was

00:40:01

looking for a photo of the fable right here and

00:40:05

found out that the coloring still works,

00:40:07

here on the Internet there are sites for van work in

00:40:11

New York, how he receives radiation diagnostics from a radiologist, and here

00:40:16

on my website there is such a

00:40:18

cheerful, very photo of it, it’s not

00:40:20

written on the floor anymore sixty years of

00:40:22

impeccable service is

00:40:25

still working and the classification was

00:40:28

proposed back in the eight-fourth year,

00:40:31

well, here is the decoding, yes, that is, the

00:40:34

criteria for mastic and the likelihood

00:40:36

of malignancy, the figure is slightly different,

00:40:38

but in general it roughly

00:40:41

corresponds to the previous slide,

00:40:45

acute pyelonephritis

00:40:48

has such indirect signs before this

00:40:52

first the very thing that comes to this is a

00:40:55

decrease in the mobility of the kidney due to an increase in

00:40:59

size, plus what I’m saying about osago

00:41:04

Inga Vladimirovna

00:41:05

these days, that is, the sweaty kidney gave the

00:41:08

sweaty kidney this is the rarefaction

00:41:10

around the image of the perinephric

00:41:13

fiber remains more flexible, even if it’s

00:41:14

pathogenic and the apple glove

00:41:17

is finished for the account of edema

00:41:19

is adipose tissue in rare

00:41:23

cases it can be like the same or the sonata

00:41:25

that told the

00:41:26

office motor pyonephritis personal

00:41:29

gas there a little further there will be very

00:41:31

beautiful illustrations

00:41:33

in most cases it is ascending and

00:41:36

they don’t have we just heard that 85 90

00:41:39

percent of cases and is called it is

00:41:41

either Escherichia coli or a unique

00:41:44

enterococcus and without 10 15 percent hematogenous

00:41:48

immunity most often it is

00:41:50

Staphylococcus aureus here is a kidney abscess that has a

00:41:55

characteristic appearance and this is a heterogeneous

00:41:58

formation of a gate with heterogeneous

00:42:00

contents a little later there will be a slide

00:42:07

there is also such a symptom

00:42:09

called basket sein this is in Russian

00:42:13

syndrome like everyone is a symptom of a basket, yes, that

00:42:16

is, we have when a disc abscess we have no

00:42:18

blood flow you with the option the strongest

00:42:20

grass blood flow around yes and it looks like that

00:42:23

while the pictures are like this, a

00:42:25

basketball net into a basket someone throws a ball

00:42:28

well, here it is shown to interrogate and for

00:42:31

motor pyelonephritis

00:42:32

can be seen further that on our ultrasound

00:42:35

examination it looks like there are

00:42:37

three in Komi, yes, and on the left side on the

00:42:40

right side we can see gas

00:42:42

gathering in the system of such a right kidney and

00:42:47

here the left left yes, well, I decided such a

00:42:52

picture in this frosty pyelonephritis

00:42:54

when we have pause, there

00:42:55

is practically no image, you can say yes,

00:42:57

but with a computer tomography we see

00:43:00

this

00:43:01

diameter, probably more than 20 centimeters, this is the

00:43:03

formation with gas in

00:43:06

place of the right kidney, the

00:43:14

wrinkled kidney, as a rule, the

00:43:16

cortical medullary

00:43:18

differentiation is preserved here in size and reduced,

00:43:22

and plus maybe it will be

00:43:25

completely and so he is now an agent and so

00:43:27

on the left we can weld two versions of the

00:43:30

same process and polycystic kidney disease

00:43:36

is diagnosed very easily, these are

00:43:38

multiple cysts which, as a rule,

00:43:41

this kidney is more than 20 centimeters,

00:43:43

it occupies all the space here is the

00:43:45

diaphragm at home and here is the diagnosis

00:43:48

which is not difficult to place, but it is very

00:43:53

difficult to find in these fluid authorities, let’s say a

00:43:56

dilated pelvis and when

00:43:59

because it will differ little from the

00:44:01

actual cavity of the cyst such

00:44:06

patients are extremely difficult for diagnosis,

00:44:12

well, the simplest good question is a

00:44:15

difficult question because about the presence of

00:44:18

parenchyma then some of us have areas of

00:44:20

unchanged parenchyma where we can measure

00:44:22

these two centimeters there or 18

00:44:24

millimeters before, that is, we still have it

00:44:27

because the cystic field is

00:44:29

not visible to the kidneys even on the preparation, there

00:44:31

is not a single area of normal

00:44:33

parenchyma, a

00:44:35

bilateral process of the most important thing,

00:44:37

multiple cysts we will still see a

00:44:39

normal kidney and there may be

00:44:42

10 days before the hand may be there even

00:44:44

more, but we see normal

00:44:45

soil, normal with one pole,

00:44:47

lower pole here now like parenchyma

00:44:51

then that’s because it is often confused and

00:44:55

some kind of clarity here, of course,

00:44:58

it’s difficult to get it from our ultrasound doctors because they

00:45:00

often write polycystic disease when there’s just

00:45:02

more than three, you’ll also become polycystic, I

00:45:04

think everyone has also

00:45:05

encountered links to renal cell carcinoma and a

00:45:10

much more rare transition to

00:45:12

cellular carcinoma, the ratio is about

00:45:15

10, this is the presence of such a

00:45:18

formation that is, as a rule,

00:45:20

hyperechoic most often until more often it

00:45:23

disrupts the contour of the kidney, that is,

00:45:25

such a bulge appears, and it is diagnosed

00:45:29

quite poorly, which is what I was talking about, they

00:45:31

actually agreed that until the

00:45:33

moment when the palm tube

00:45:34

grows more than two centimeters, as a

00:45:36

rule, while driving and Hagen aspirin him and the

00:45:37

kidneys and we, in general,

00:45:39

cannot detect before with ultrasound on

00:45:42

computed tomography, we can because

00:45:44

it accumulates contrast in a completely different way

00:45:47

than normal straight ones him and here on the left

00:45:49

is an image of the transition to a

00:45:50

cellular tumor that oversees the

00:45:53

ureter when it leads to the development of

00:45:56

hydronephrosis here There are also options here,

00:46:02

in fact, a beam on cellular

00:46:07

kidney cancer for which occupies the entire lower

00:46:09

pole of the leg,

00:46:10

adipose tissue at the gate of the kidney, which

00:46:12

can also imitate a tumor, and on the

00:46:17

right one, that is, with a computed

00:46:19

tomography, there is no tumor there, you also

00:46:22

need to understand that

00:46:24

options and sensitivity are possible here, friends

00:46:27

far from one hundred percent, in any case,

00:46:32

in case of doubt, we have a computed

00:46:34

tomography

00:46:39

somewhere, not only now, but somewhere

00:46:41

5-6 millimeters to 5 in the community, it is correct to

00:46:45

measure something and describes, by and large,

00:46:49

here is a picture of a tumor, his blood clots in

00:46:51

the lower vena cava and but just to

00:46:53

disclose information to us, the ultrasound doctor

00:46:58

should be on the lookout, so let’s

00:47:01

see that from a sore throat anyone

00:47:05

has a very characteristic appearance, very often

00:47:07

found in women more often than in men,

00:47:10

here are the minimum dimensions of about 5-6

00:47:12

millimeters to draw or

00:47:15

he told us in detail everything about this

00:47:17

before we operate, usually if its dimensions are

00:47:20

more than four centimeters

00:47:21

or when it progresses quickly, the

00:47:24

probability of modernization is

00:47:26

one in a thousand, that is, in the general

00:47:28

majority of cases, this is such a

00:47:30

benign, non-hazardous formation

00:47:33

that, by and large, is

00:47:36

not even observed demand there for two or three

00:47:37

years we observe very much and it happens the size does

00:47:40

not change you can no longer do this so often

00:47:43

unfortunately yes very rarely but

00:48:34

well, why not also read it right away I really

00:48:36

liked medicine it’s

00:48:38

juggling possibilities and

00:48:40

probabilities so you

00:48:42

can never be one hundred percent sure about anything be sure and

00:48:46

we will also talk about the situation

00:48:50

with micro flying testicles, also the

00:48:53

latest data recommend that if the

00:48:56

patient does not have a tumor, relatives

00:48:59

do not have testicular cancer, this

00:49:01

patient does not have any provoking factors;

00:49:06

this, but

00:49:08

it is advisable to mean every year so that he

00:49:10

himself is still half and the testicle is in the center,

00:49:13

tell him that there is probably something

00:49:15

wrong here, you are either observing or an example,

00:49:17

let them go look for him, say that this one does

00:49:19

n’t need anything there, why should he himself be there

00:49:20

as wrong as possible with the probes and with

00:49:23

him, therefore, of course, it’s better

00:49:25

to play it safe here and it’s better, of course,

00:49:27

to observe them at least once a year

00:49:28

because we will never be 100%

00:49:32

sure of counting the times with our

00:49:33

feet, whether anyone has

00:49:38

metastases in the kidney are rare, but

00:49:42

they happen here, not just for the

00:49:43

lung, and bilateral in . well,

00:49:54

kidney grass here, in fact, ultrasound

00:49:58

is not the leading method, but here the

00:50:00

soup capsule arno hematoma after a

00:50:02

biopsy is shown, how much also said, agreed

00:50:05

why we don’t perform our own

00:50:07

kidney biopsy or biopsy education

00:50:09

because it is dangerous and uninformative,

00:50:13

you can classify this is the

00:50:16

American Association of

00:50:17

Surgery grass they are also already showing us and the

00:50:20

doctor is also just home to a bunch of

00:50:29

computed tomography again, if it is

00:50:31

more stable, this is the method of choice, but here’s the

00:50:34

same image, the

00:50:37

kidney cysts are also multi-chambered

00:50:40

with thick walls, we also shouldn’t

00:50:44

forget that this happens, and at least

00:50:46

take it into account when making a diagnosis here are

00:50:48

approximately 2 5 percent of all patients

00:50:51

who have and severely the halls once

00:50:56

again errors during ultrasound of the kidneys, this is the

00:50:58

necrolyte about whom they talked, that

00:51:00

is, less than five millimeters,

00:51:03

as a rule, the stones are visible and there is no need to

00:51:06

pour such a note, pay attention to the

00:51:08

patients, how to calm them down hydra if

00:51:11

goats and cysts are also a common mistake

00:51:14

because noctis you are straight chemistry is

00:51:16

common, but the syndrome was lied to with the development of

00:51:19

hydra sandpiper about for extremely rarely, often this

00:51:23

is combined with the presence of stones there, the extracted

00:51:26

calyx is dilated, so there was also

00:51:29

40 hydronephrosis, so if you are what we

00:51:31

talked about the presence of a violation of the outflow of

00:51:34

urine due to a full

00:51:35

bladder, in fact, a very important point

00:51:38

because patients with hydronephrosis also came many times

00:51:41

at the control

00:51:43

university, no hydronephrosis,

00:51:45

you ask, they did an ultrasound of the bladder,

00:51:48

no because they prescribed berries, I hoped

00:51:50

that they would do it for me, I was prepared, but the doctor

00:51:54

he told me they prescribed a top ultrasound of the kidneys,

00:51:55

so he only did an ultrasound of the kidneys, this was

00:51:58

prepared in quotation marks for the patient, the urologist,

00:52:01

having seen such a recording, is sent to the

00:52:02

Botkin hospital for an operation for

00:52:04

hydronephrosis, which is why we

00:52:05

must also remember everything,

00:52:08

we are the last ones, then the valve is not for me, that

00:52:10

is, the stones that are adjacent to With her help, the

00:52:12

q points can

00:52:14

cause such dreams, it is possible because

00:52:16

transient obstruction from such a moment

00:52:18

they interfere with the outflow of urine and cause an exact

00:52:21

field of fantasy at some point they

00:52:22

turn differently, the match passes by the

00:52:25

stones, we have

00:52:27

no obstruction hospitals. the ureters of

00:52:30

ejection work, so we also need to

00:52:33

remember this, and if patients are ready

00:52:36

financially, then perform a computed

00:52:38

tomography scan, since this is the most reliable

00:52:40

and does not affect the ureter

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