Additional Examination Methods Research Articles

Case report: segmental form of Hailey-Hailey disease

The article presents a clinical case of a rare segmental form of familial benign chronic pemphigus with a positive family history. Patient S., born in 2014, complained of unilateral eruptions in the area of the left retroauricular fold, left axilla, inguinal fold and labia majora on the left, plantar surface of the left foot. Eruptions were represented by erythematous foci, single blisters with serous contents, erosions, crusts. For the entire period, the patient was observed with the following diagnoses: microbial eczema, Sneddon-Wilkinson Disease, Inflammatory Linear Verrucose Epidermal Nevus. Due to the long-term relapsing course and ineffective therapy, additional examination methods were carried out – histological and genetic studies. Only after genetic testing, in which a heterozygous mutation of the ATP2C1 gene was revealed, and geneticist’s consultation, the final diagnosis was established – Hailey-Hailey Disease.It is known, that the segmental form is formed as a result of mosaicism, which can be of two types. The term "mosaicism" refers to the presence in an organism of two or more genetically heterogeneous cell populations formed from a genetically homogeneous zygote. The formation of type 1 mosaicism is based on a de novo postzygotic mutation at an early stage of embryogenesis. In turn, type 2 mosaicism develops as a result of a postzygotic mutation against the background of an already existing prezygotic mutation. Determining the type of mosaicism by genetic testing will make it possible to assess the prognosis of the disease and the chance of transmitting this disease to offspring.

Differential diagnosis between Gilbert’s syndrome and chronic viral hepatitis C

The article presents the analysis and differential diagnosis of Gilbert's syndrome and chronic viral hepatitis C. A retrospective analysis of 44 case histories of patients who were treated in hospital for Gilbert's syndrome and chronic viral hepatitis C. 25% of patients had Gilbert's syndrome, 75% had chronic viral hepatitis C. When analyzing the complaints, it was found that most of the patients did not notice any symptoms of the disease. Jaundice syndrome and hepatomegaly in the absence of complaints in patients make differential diagnosis and diagnosis difficult. The correct diagnosis depends on a comprehensive assessment of clinical manifestations and data from additional examination methods.

A vocal cord palsy caused by the uterine cancer metastatic tumor in the mediastinum revealed in a patient with a thyroid lesion: a case report and review of the literature

BackgroundThe main cause of vocal cord palsy (VCP) is idiopathic impairment of the recurrent laryngeal nerve (RLN). However, solid tumors along the pathway of the RLN can also impact the nerve’s function. We presented a patient with a thyroid lesion and VCP due to a bulky metastatic mass (uterine cancer) on the aortic arch field in the mediastinum. The report aims to show the significance of comorbid tumors in thyroid pathology and the importance of additional diagnostic methods in avoiding unnecessary surgeries. A patient’s lifetime and the outcome of the disease were also presented.Case presentationA 58-year-old Ukrainian woman with a hoarse voice, intermittent dry cough, and weakness was presented to an endocrine surgeon. Thyroid pathology included signs of hypothyroidism treated with Thyroxine 112.5 µg and a nodule in the left lobe. The lesion is located on the posterior aspect of the lobe, which could probably be a cause of RLN involvement. Fine needle aspiration biopsy (FNAB) was performed twice with Bethesda category 2 result. Fibrolaryngoscopy (FLS) revealed the median position of the left vocal cord. Idiopathic, laryngeal, and thyroid causes of the VCP were excluded. Additionally, the patient displayed her anamnesis of the endometrial clear cell carcinoma following hysterectomy, external beam radiation therapy, and chemotherapy. The mediastinal metastasis was revealed sixteen years later. A chest computed tomography (CT) with intravenous contrast was done. A bulky tumor was found right under the aortic arch. Subsequently, the voice complaints reduced significantly after 4 chemotherapy courses. Cancer progression had led to the appearance of lymph node metastases on the supraclavicular region. Following six months the 60-year-old patient had passed away.ConclusionA history of the disease should always be kept in mind when assessing a patient’s complaints. VCP in case of thyroid pathology and previous secondary malignancy may be caused by metastatic tumor anywhere along the RLN pathway. Such a rare case shows the importance of additional methods of examination which may avoid unnecessary thyroid surgeries.

Characteristics of infectious complications in moderate and severe forms of atopic dermatitis

Atopic dermatitis (AD) is a multifactorial, genetically determined disease with a chronic relapsing course and a predisposition to hyperimmunoglobulinemia E. Abnormal colonization of Staphylococcus aureus, Malassezia furfur, and Herpes Simplex plays a significant role in maintaining inflammation in AD. Objective — to determine the frequency of bacterial, mycotic and viral complications in a group of patients with moderate and severe AD. Materials and methods. From 2018 to 2023, 80 patients with AD (moderate and severe forms) aged from 1 year to 53 years (average age 14.6 years) were under our observation. Patients with a SCORAD index ≥ 25 were included in the study. To confirm the nature of the infectious complication, additional examination methods were used: microscopy, bacteriological culture, amplification methods of research, dermatoscopy, immunoenzyme analysis. Results and discussion. An analysis of the total number of relapses of AD during the year was carried out, depending on the age and gender of the patients. The largest number of relapses was observed in the age group from 6 to 10 years — 9.4 ± 0.6. The frequency of AD relapses had a certain correlation with the severity of the course of dermatosis — the SCORAD index increased to 31.2 ± 0.4 in the group of patients with the highest frequency of disease relapses (9.4 ± 0.6) per year and, as a result, increase in the frequency of infectious complications. The conducted analysis showed that each age group of AD patients had its own characteristic spectrum of bacterial, mycotic and viral complications. The most frequent infectious complications of AD observed in the examined patients were streptostaphyloderma (18.8 %), molluscum contagiosum (11.3 %), mycotic lesions (10.0 %), herpes infection (6.3 %), Coxsackie virus (3.8 %), EBV ­infection (2.5 %). Conclusions. As a result of the clinical study, it was established that infectious complications in AD have age, gender, and topographic features that can change the course and prognosis of dermatosis. Against the background of reduced immunoreactivity, the risk of disseminated, life­threatening forms of infections increases in patients with atopic dermatitis.

Incidence of Skin Melanoma in the Precarpathian Region. Overview of Trends of the Last Decade and Demonstration of Clinical Cases

Introduction. Melanoma is a malignant tumour that develops from melanocytes and in most cases affects the skin. Although melanomas are usually highly pigmented, they can also be amelanotic. In the structure of mortality from skin cancers, melanoma takes the leading place with a rate of 90%.
 Even small tumours can metastasise. Under such conditions, early diagnosis is of paramount importance, as its main task is to detect and eliminate the primary lesion before it becomes deeply invasive.
 However, naked eye examination is limited to a sensitivity of about 75%, and is more effective when the tumour size is more than 5 mm. Among the additional examination methods, dermoscopy has become widespread. The technique has been introduced into the world dermatological practice for a long time and is actively used in Ukraine, demonstrating high efficiency at a relatively low cost of equipment.
 Materials and methods. Statistical data on 901 cases of newly diagnosed skin melanoma in the Ivano-Frankivsk region were obtained from the bulletins of the National Cancer Registry of Ukraine for the period 2012-2022.
 Results and discussion. There has been a gradual decline in the number of undetermined melanoma cases according to the TNM classification. The indicator has changed by more than 50 percentage points, with the lowest values at the turn of 2017-2018, and a subsequent increase of 10 percentage points until 2022.
 The number of reported cases of skin melanoma where the primary tumour distribution corresponds to the TI-TII category has increased, with a peak value of 92.7% as of 2017. However, in the period 2019-2022, the trend changed dramatically. Since 2019, cases of skin melanoma diagnosed in the state of spread, which corresponds to category TIII, have prevailed – 51.1%, while cases of TI-TII accounted for 32.2%
 The global COVID pandemic that began in 2019 led to negative trends, contributed to the isolation of patients, and complicated their access to specialists. russia’s full-scale invasion of Ukraine in 2022 exacerbated this impact, which was reflected in the indicators of 2019-2022.
 The clinical cases from our practice in 2018 and 2021 were presented in the article.
 Conclusions. Melanoma is a malignant tumour with a high metastatic potential, with a better prognosis for recovery if diagnosed early. The increase in the number of registered cases of skin melanoma with primary tumour distribution in category TI-TII in 2013-2017 may indicate the effectiveness of measures aimed at promoting self-examination and timely treatment of patients for specialised care. The global COVID-19 pandemic and the full-scale russian invasion of Ukraine led to an increase in the proportion of melanomas diagnosed at the stage when the prevalence of the primary tumour corresponds to category TIII. It is necessary to resume measures that have had a positive impact on the health of residents of the Precarpathian region.

Боковой амиотрофический склероз: клинико-эпидемиологические особенности: клинический случай

ABSTRACT INTRODUCTION. Amyotrophic lateral sclerosis is a disease of the central nervous system, characterized by a steadily progressive course with selective damage to the upper and lower motor neurons. AIM. Conduct an analysis of literary sources of domestic and foreign authors describing the modern understanding of methods of diagnosis and treatment of amyotrophic lateral sclerosis. Present a clinical case of a patient with amyotrophic lateral sclerosis. MATERIAL AND METHODS. An analysis of the literature was carried out for the period from 2013–2023. Sources from the Russian scientific electronic library eLIBRARY, RSCI databases, and PubMed were used. A clinical case is presented. RESULTS AND DISCUSSION. The article presents clinical and epidemiological features, diagnostic methods, modern achievements and promising directions in the treatment of the disease. CASE PRESENTATION. Patient N., 60 years old, was admitted to the neurological department of a multidisciplinary hospital with complaints of weakness in the upper extremities, more in the distal parts, impaired fine motor skills, impaired articulation, general weakness, and fatigue. Considers himself sick for a year, when complaints of blurred speech and weakness in the hands first appeared. Needle electromyography — signs of morphofunctional reorganization of motor units associated with damage to motor neurons. Based on clinical data and the results of additional examination methods, a clinical diagnosis was established — motor neuron disease, amyotrophic lateral sclerosis, bulbospinal form, bulbar disorder syndrome, upper paraparesis with impaired selfcare. The features of the presented clinical example are the rapid rate of progression of the disease, as well as the importance of risk factors in the development of the disease. As is known from the family history, the patient served in the missile forces for a long time. The problem of environmental safety still remains relevant. Falling separated parts of launch vehicles have a detrimental effect not only on the environment, but also on the human body. CONCLUSION. Identification of risk factors is an important task necessary for the early detection of electromyography, as well as the possibility of taking preventive measures that can lead to a significant reduction in morbidity and mortality. KEYWORDS: amyotrophic lateral sclerosis, motor neuron disease, diagnosis, therapy, SOD1 gene

Specific characteristics and challenges associated with breast cancer diagnostics in women after breast augmentation and reconstructive surgeries with implants

Background. The number of plastic surgeries is constantly growing worldwide. Breast augmentation remains the most common surgical procedure in women, which demonstrated a 0.5 % increase over the past 4 years. As the number of women with breast implants increases, specialists and patients themselves face difficulties related to screening, diagnosis, and treatment of tumors, including breast cancer.Aim. To analyze specific characteristics of breast examination in patients after breast augmentation who were examined and treated in the mammological clinic of Russian Research Center of Radiology, Ministry of Health of the Russian Federation.Materials and methods. This study included 273 patients aged between 21 and 63 years (mean age 49.0 ± 7.6 years) after breast augmentation and after reconstructive surgery for breast cancer and symmetrizing surgery on the contralateral side. All women underwent clinical examination plus breast ultrasound (for patients under 40 years of age) or mammography followed by ultrasound (patients over 40 years of age). Patients who were found to have BI-RADS 3–4 tumors underwent ultrasound-guided or stereotactic breast biopsy. In case of suspicious intraductal formations according to breast nipple smears the patients were referred to breast ductography. Patients with suspected implant rupture or capsular contracture, as well as patients requiring the assessment of the disease stage underwent contrast-enhanced magnetic resonance imaging.Results. After comprehensive examination, 12 patients (5.4 %) were diagnosed with breast cancer; 38 patients (13.9 %), with implant rupture; 3 patients (1 %), with intraductal formations.Conclusion. Breast augmentation is not a contraindication to mammography in women aged over 40 years with glandular tissue. Additional examination methods include breast ultrasound, contrast-enhanced mammography, and breast magnetic resonance imaging. In case of no glandular tissue, contrast-enhanced breast magnetic resonance imaging and breast ultrasound are the methods of choice. It is important to develop new standards of screening and diagnosis of breast diseases in women after aesthetic surgery, since breast cancer incidence is likely to increase among women after breast augmentation over the next decades, considering the fact that breast cancer is the most common malignancy in women and its incidence is constantly growing.

КАЧЕСТВО ЖИЗНИ ДЕТЕЙ С НАСЛЕДСТВЕННЫМИ НАРУШЕНИЯМИ РАЗВИТИЯ СОЕДИНИТЕЛЬНОЙ ТКАНИ И ИХ РОДИТЕЛЕЙ В ПРОЦЕССЕ ДИНАМИЧЕСКОГО КОНТРОЛЯ В УСЛОВИЯХ ПОЛИКЛИНИКИ

Purpose of the study. To assess the quality of life of children with hereditary disorders of connective tissue development and their parents during dynamic monitoring in a polyclinic. Material and methods. In the period from 2020 to 2023, the patients were under dispensary observation. The main group of patients (n=30) and the comparison group (n=30) are presented. At the beginning of treatment, the average age was 4.7±0.5 years. For patients of the two groups, therapeutic measures were proposed, which included back massage (ten sessions once in 4 months), electrical stimulation of the back muscles (ten sessions once in 6 months), and a physical therapy complex. Additionally, patients from the main group were prescribed sessions at the school "Posture Correction", swimming, bracing, additional physiotherapy complexes (electrical stimulation of the back – 3 courses of 10 sessions per year), back massage (10 sessions every month), diet and vitamin therapy for 3 years. The quality of life was assessed using the PedsQL questionnaire. Results. It was statistically significantly proved that during the period of dispensary observation, the patients of the main group and their parents improved physical parameters in 65.0% of cases (in the comparison group in 20.3% of cases), p=0.016; emotional parameters improved in 59.8% of cases (in the comparison group in 21.0% of cases), p=0.014. At the same time, a satisfactory muscular corset was visualized, which was confirmed by additional examination methods (electroneuromyography, stabilometry); complications from the osteoarticular system were reduced. In patients from the comparison group and their parents, the quality of life did not change statistically significantly. The patients noted hypotonia of the back muscles in 53% of cases and pain on palpation along the spine in the thoracic region in 37.3% of cases (p<0.001). Conclusions. Over time, in the main group, the number of complications from the osteoarticular system was minimized and the quality of life in patients of the main group and their parents significantly improved.

THE SIGNIFICANCE OF BACTERIOSCOPY IN THE COMPLEX OF DIAGNOSTICS OF COMPLICATED FORMS OF DENTAL CARIES OF PATIENTS WHO PREVIOUSLY HAVE COVID-19

The issues of the complexity of diagnosing diseases of the pulpoperiodontal complex of teeth of patients who had previously recovered from COVID-19, as well as the need to select the most adapted algorithm for the treatment of pathology, depending on the clinical manifestations in the oral cavity, were studied. An increase in the activity of opportunistic microorganisms, which normally do not show activity in the oral cavity, gives rise to the development of various pathologies of hard tissues of the teeth, the pulp and periodontium. The expediency and necessity of including in this category of patients, in addition to the standard dental examination, also additional examination methods (for example, blood test, bacterioscopy, bacteriological tests, testing of the microvasculature, and others) before the start of any dental treatment. Emphasis is placed on the elimination of a certain type of microorganism, identified with the help of additional examination methods, thereby preventing the occurrence of long-term complications after endodontic treatment of the tooth.

Effective rehabilitation of children with perinatal lesions of the central nervous system

BACKGROUND: Perinatal lesions of the central nervous system (CNS) prevail among other diseases of the nervous system in children, and are an economic burden on society and public health systems. The challenge in these cases is improving the quality of life of children with perinatal hypoxic pathology, which requires long-term nursing, treatment, and rehabilitation. The level of childhood disability remains consistently high, so improving the assistance to children with disabilities is an important state task.
 OBJECTIVE: The analysis of the results of rehabilitation treatment.
 MATERIALS AND METHODS: The study utilized 150 case histories of children with perinatal lesions of the CNS, all of whom underwent commercial rehabilitation. The study of the cards was carried out post rehabilitation, which typically spanned 30 days. The study included 85 (57.0%) boys and 65 (43.0%) girls. Congenital pathologies, perinatal encephalopathy, organic lesions of the CNS, and cerebral palsy were diagnosed in 19 (13.0%), 25 (17.0%), 36 (24.0%), and 69 (46.0%) cases, respectively. The rehabilitation process included hydrokinesitherapy, Vojta therapy, exercise therapy, and massage. The assessment on the effectiveness of rehabilitation was based discharge summaries, considering the results of an objective assessment and data from additional examination methods. At the end of treatment, a survey was conducted on 95 parents of the children to assess their satisfaction level in regards to the quality and effectiveness of the rehabilitation. The survey was conducted anonymously and on a voluntary basis.
 RESULTS: Positive dynamics was observed in 115 (77.0%) cases. In 27 (18.0%) cases, there was no dynamics, and in 8 (5.0%) cases, it was negative. The survey results showed that the average satisfaction score from visiting the rehabilitation center was 9.6 (the maximum possible level was 10). The estimates and results obtained differed in families with different social statuses.
 CONCLUSION: The study proved the importance and effectiveness of comprehensive rehabilitation for children with perinatal lesions of the CNS. It also emphasized the necessity of considering the medical and social characteristics of families raising such children.

Combination of Mucocele of the Appendix and Chronic Calculous Cholecystitis: Case Report

Background: The analysis of the data presented in the foreign and national literature shows that a combination of the appendix mucocele and calculous cholecystitis is extremely rare, and the implementation of simultaneous surgical treatment in the laparoscopic version is the optimal approach. Clinical case description. Here, we present a clinical case of chronic calculous cholecystitis in combination with mucocele of the appendix in an 84-year-old patient. The main complaint was pulling pain in the right iliac region. The diagnosis was made on the basis of the main and additional methods of examination: clinical picture, ultrasound, multispiral computed tomography and magnetic resonance imaging of the abdominal organs. In a planned manner, a simultaneous surgical intervention was performed consisting of laparoscopic appendectomy and cholecystectomy. The operation duration was 1 hour 15 minutes. The morphological examination confirmed the diagnosis of calculous cholecystitis and mucocele of the appendix. The patient was discharged in a satisfactory condition on the 4th day. Conclusion. This clinical case shows that the dynamic observation of mucocele of the appendix, even in elderly patients with a comorbid pathology, is unjustified. A simultaneous surgical intervention in the form of laparoscopic appendectomy and cholecystectomy treats the two nosologies and prevents repeated hospitalization and surgery.

Limits and Possibilities of Orthodontic Treatment of Patients with Skeletal Forms of Sagittal Anomalies

The need to develop and improve methods of diagnos is and treatment of patients with deformities of the jaws is determined primarily by the frequency of it prevalence. Dental anomalies occur in 33.7 - 49% of those examined. To improve the effectiveness of orthodontic treatment of patients with skeletal forms of sagittal anomalies of occlusion of the dentition, it is necessary to conduct additional methods of examination, computer modeling of treatment results, drawing up a comprehensive treatment plan. Clinical case. Patient 33 years old. Skeletal III class, Mesial occlusion of dental arches, Narrow upper jaw, Tooth crowding, periodontal problems, gingival loss. After additional diagnostic methods, computer simulation of treatment was performed, various treatment options were considered.

КАЧЕСТВО ЖИЗНИ ДЕТЕЙ С НАСЛЕДСТВЕННЫМИ НАРУШЕНИЯМИ РАЗВИТИЯ СОЕДИНИТЕЛЬНОЙ ТКАНИ И ИХ РОДИТЕЛЕЙ В ПРОЦЕССЕ ДИНАМИЧЕСКОГО КОНТРОЛЯ В УСЛОВИЯХ ПОЛИКЛИНИКИ

In this work, the authors assessed the quality of life of patients with hereditary disorders of connective tissue development and their parents in the process of dynamic control in a polyclinic. In the period from 2014 to 2023, patients were under dispensary observation. The main group of patients (n=30) and the comparison group (n=30) are presented. At the beginning of treatment, the average age was X sr. ± 4.7±0.5 years. For patients of the two groups, therapeutic measures were proposed, which included back massage No. 10 1 time in 4 months, electrical stimulation of the back muscles No. 10 1 time in 6 months, and a physical therapy complex. Additionally, for the main group of patients, classes were prescribed at the school "Posture Correction", swimming, corseting, additional physiotherapy complexes (electrical stimulation of the back 3 courses of 10 sessions per year), back massage for 10 sessions every month, diet and vitamin therapy for 3 years. In dynamics, in the main group, the number of complications from the osteoarticular system was minimized. The quality of life in patients of the main group and their parents significantly improved according to the parameters of the PedsQL questionnaire. It was statistically significantly proved that during the period of dispensary observation, the patients of the main group and their parents improved physical parameters in 65.0% of cases (in the comparison group in 20.3% of cases), p = 0.016; emotional parameters in 59.8% of cases (in the comparison group in 21.0% of cases), p = 0.014.At the same time, a satisfactory muscular corset was visualized, which was confirmed by additional examination methods (electroneuromyographic, stabilometric), complications from the osteoarticular system were reduced. In patients in the comparison group and their parents, the quality of life did not change statistically significantly. Patients noted hypotension of the back muscles in 53% of cases, pain on palpation along the spine in the thoracic region in 37.3% of cases (p<0.001).

A clinical case of successful treatment of coronary artery dissection and left ventricular thrombosis in a young man carrier of factor V Leiden gene and transient ischemic attack

One of the causes of transient ischemic attack or ischemic stroke are mass formations in the left heart. One of the predisposing factors for thrombosis is the presence of the Leiden mutation, as the most common form of hereditary thrombophilia in the European population. At the same time, spontaneous dissection of the coronary arteries (SCA) can be one of the reasons of an acute vascular accident. Of particular difficulty is differential diagnosis, which requires additional examination methods (intravascular ultrasound, optical coherence tomography) in addition to coronary angiography. The presented clinical case describes the diagnosis and successful treatment of spontaneous anterior interventricular artery dissection, left ventricular thrombosis, detection of factor V Leiden gene mutation in a young man with a history of transient ischemic attack

Squamous cell carcinoma of the skin after cardiac transplantation: a clinical case

Background. Solid organ transplantation recipients have a high risk of non-melanoma skin tumors. Patients after heart transplantation are prone to a higher incidence of malignant skin tumors due to intensive immunosuppressive therapy. The most common histological type is squamous cell carcinoma, followed by basal cell carcinoma. These tumors have a more aggressive clinical course, including the frequency of recurrence and metastasis, and a tendency to multifocal lesions.
 Materials and methods. We present a clinical case of primary multiple squamous cell carcinoma with metastatic lesions of regional lymph nodes in a patient after heart transplantation.
 Results. A 67-year-old patient underwent an orthotopic heart transplant in September 2018 for ischemic cardiomyopathy. Subsequently, triple immunosuppressive therapy was administered, including tacrolimus combined with mycophenolate mofetil and prednisolone. In May 2022, a solid tumor with ulceration occurred on the skin of the right scapular region. After some time, similar tumors appeared on the skin of the temporal region on the left, the posterior surface of the auricle and the parietal region on the left. The patient later found a solid, painless tumor on the left jaw angle. As a part of the examination in the oncology dispensary, a biopsy of the scapular skin tumor, scrapings from tumors, and aspiration biopsy of the submandibular lymph nodes were performed. Histological and cytological studies of all neoplasms showed squamous cell keratinizing cancer with metastases to the submandibular lymph nodes. Additional examination methods showed no signs of progression. The diagnosis was made: primary multiple synchronous skin cancer: right scapular area, stage III, cT3N0M0; left parietal area, stage II, cT2N0M0; occipital area, stage I, cT1N0M0; left auricle, stage IV, cT1N2M0. Considering the localization of tumors, surgical treatment was performed, including of excision of tumors in the scapular and parietal regions. Radiation therapy was performed on lymph nodes with metastases. After 6 months, a tumor recurrence was detected in the irradiation area.
 Conclusion. After heart transplantation, squamous cell carcinoma of the skin is common. Usually, it affects the scalp and neck with metastases to the regional lymph nodes and is prone to recurrence. The primary treatment method is surgical and radiation therapy.

Retrospective analysis of cases of transient global amnesia admitted to the hospital

Introduction. Transient global amnesia (TGA) is a clinical syndrome, the main clinical manifestation of which is sudden development of anterograde and retrograde amnesia, lasting not more than 24 hours, without other general cerebral or focal neurological symptoms.The aim of the work was to reveal the peculiarities of clinical manifestations and data of additional methods of examination of patients with TGA syndrome referred to the primary vascular department with suspected acute cerebral circulation disorder (ACCD).Materials and methods. The study included 16 patients with transient global amnesia diagnosed according to the diagnostic criteria of Hodges and Warlow (1990). All patients underwent a detailed neurological and general medical examination. Electrocardiography, multispiral computer tomography of the head, echocardiography, ultrasound duplex scanning of the main arteries of the head and neck, laboratory examination (lipid spectrum) were performed. The Brief Mental Status Rating Scale was used to assess cognitive impairment.Results. The majority of patients had elevated blood pressure (BP). The leading trigger factor of transient global amnesia was stress. The duration of amnesia ranged from 1.5 to 5 hours. There was a significant impairment of short-term memory. On the first and second days of hospitalization, 50% of patients had normal cognitive functions on a brief mental status assessment scale, but by the 5th−7th day only 12.5 % of patients had abnormalities. Ultrasound markers of atherosclerosis in the form of intima-media complex thickening and dyslipidemia were found in 6 patients. Signs of left ventricular hypertrophy were found in the majority of patients. Discussion TGA is a relatively rare condition and an understudied syndrome. Due to its suddenness of clinical manifestation, TGA requires differential diagnostics with acute cerebral circulatory disorders, epilepsy, acute hypertensive encephalopathy and psychogenic amnesia.Conclusion. The clinical features of TGA identified in the patients were a history of arterial hypertension, elevated BP during an episode of TGA. The leading provoking factor was stress. TGA episode occurred predominantly in the first half of the day. The majority of patients had complaints of headache on admission. Cognitive disorders detected in patients on the first and second days of the disease quickly regressed to normal. Left ventricular hypertrophy was detected in most patients.

Bil holovy: klasyfikatsiia; diahnostyka; pryntsypy likuvannia (ohliad literatury; opys klinichnoho vypadku)

Introduction. Headache (cephalgia) is one of the most common neurological disorders and is among the 20 most disabling diseases in the world. Most cases of headaches are benign, while others require constant monitoring and treatment, and some are life-threatening. For individuals with a history of headaches, the physician should determine whether headache belongs to a well-known primary headache disorder, is an exacerbation of primary headache disorder induced by another medical condition, or a new secondary headache. The aim of the study is to conduct an analysis of a vascular events in a patient with secondary headache, who was diagnosed in the Neurology Department in 2023. Materials and methods. Systematic and comparative analysis, biblio-semantic method used for the interpretation of the obtained results were supplemented with a survey of literature including 18 articles published in the international renowned sources. Results. Secondary cephalgias are those in which the headache is a symptom of another disorder recognized as a potential underlying cause. Secondary headache occurs much less often than primary one, but it can encompass life-threatening pathology. A clinician should be able to distinguish between primary and secondary headaches, elaborating a specific diagnosis for each particular patient with a headache. For this purpose doctor should know the criteria for each type of headache and be capable to recognize "red flags" of secondary headache. The paper contains thorough analysis of the basic principles of diagnosis and diagnostic criteria of all known forms of cephalgia, as well as European principles of management of patients with the most common forms of headache disorders for general practitioners. Scaffolding of the article is consistent with International Classification of Headache Disorders, third revision (ICHD-3), developed by the International Headache Society in 2018, which currently is the main tool for diagnosing different forms headache disorders. The most important aspect in the diagnosis of different forms of cephalgia is patients history and medical examination. Primary headache is not a diagnosis of exclusion, but rather is based on clinical findings obtained during examination. The presence of atypical signs or "red flags" should raise concern about secondary headache. Conclusions. Many types of primary headaches can be diagnosed based on a thorough history and physical examination without use of additional examination methods. Neuroimaging is not necessary if the patient has migraines or other primary headaches with normal neurological status and the absence of the "red flags" or signs of secondary headache. The SNOOP mnemonic method is useful tool for ensuring that "red flags" are not missed. In case the "red flags", signs of secondary headache are detected, neuroimaging or other additional diagnostic tests should be used, out of which the preference should be given to the MRI of the brain. Keywords: primary and secondary headache, subarachnoid stroke, diagnosis, treatment.

Laparoscopic correction of combined forms of genital prolapse

BACKGROUND: The significance of pelvic organ prolapse is determined by the absence of a downward trend in its frequency and severity and by the steadily high number of recurrences in every third woman who underwent surgery. According to most authors, surgical correction is the primary treatment for genital prolapse. Therefore, the search for an effective and safe surgical treatment of this pathology is important. Currently, various minimally invasive surgical interventions have been performed via laparoscopic access, which reduces the risk of tissue or adjacent organ damage, possible intraoperative bleeding, and potential complications.
 AIM: This study aimed to assess the efficiency and safety of laparoscopic techniques for the correction of genital prolapse.
 MATERIALS AND METHODS: The study included 12 patients with pelvic organ prolapse quantification system grades IIIV who underwent surgical correction using a combined laparoscopic approach. The inclusion criterion was the presence of prolapse, including recurrent forms. At the outpatient stage, the patients medical history was collected, and complaints, and degree of pelvic organ prolapse were assessed. Genital prolapse was diagnosed based on medical history, clinical data, and additional methods of examination.
 RESULTS: With this surgical intervention technique, intraoperative bleeding was avoided, the number of possible postoperative complications was reduced, and disease recurrence was prevented. The criteria for assessing the surgical intervention included improvement of the pelvic floor anatomy, elimination of symptoms, patients satisfaction with treatment results and quality of life, and reduced risk of recurrence of complications. Mesh-associated complications were excluded by avoiding contact of the synthetic implanted material with the vaginal mucosa.
 CONCLUSIONS: Through laparoscopic access, the length of hospital stay was reduced, and compared with abdominal access, a better cosmetic effect was achieved. A comprehensive system considering the assessment of the anatomical outcome, functional status of the pelvic floor, and patients quality of life may become the most objective tool to evaluate the success of surgical treatment of genital prolapse.

Oral mucosal disease screening testing in terms of cancer alertness

Relevance. Currently, there is a steady increase in the development of oral mucosal diseases, and they are affecting younger people. If, at the beginning of the XX century, inflammatory and destructive oral mucosal diseases appeared in people over 60 y.o., who formed a senior dental patient group, now this pathology affects the working-age population. It is related to many reasons, including the consequences of COVID-19. However, diagnosis in dentistry is actively developing. There are quite many basic and additional examination methods, as well as in terms of cancer alertness. Based on the example of the study, the paper presents screening testing for oral mucosal diseases, which a dentist should perform at an appointment before starting treatment of the main pathology.Material and methods. The study examined the patients who presented for dental treatment. 16 out of 113 people were diagnosed with oral mucosal diseases.Results. The patients had poor oral hygiene, and electromyography indicated masticatory muscle spasticity in 20.3%, which may cause trauma development, including pressure ulcers.Conclusion. A dental appointment for each patient should include screening testing, which will prevent the development of a number of dental pathologies.

К ПРОБЛЕМЕ ДИАГНОСТИКИ В ПРЕВЕНТИВНОЙ ЭНДОДОНТИИ

Subject. The most significant problem of modern preventive endodontics is to determine the vitality of the pulp and, accordingly, to make a decision about the choice of treatment method. The early stages of inflammation in the pulp may not be fully detected clinically and require the inclusion of additional examination methods that assess the state of microcirculation in the neurovascular bundle, as well as the severity of the immune response. These methods include: clinical and immunological examination of the gingival fluid (GF), as well as the assessment of tissue perfusion using laser Doppler flowmetry (LDF). 
 Objectives. The purpose of the study is to optimize the diagnostics of the dental pulp condition in the context of implementing the concept of preventive endodontics.
 Methodology. 37 patients aged 19–29 years with a diagnosis of K 04.00 "Pulp hyperemia" were examined. In addition to the basic methods of examination, LDF and immunological study of GF (IL-1β, TNF-α, IL-4) were used. In each patient, 1 tooth with pulp hyperemia and 1 intact (control) tooth were examined.
 Results. In the immunological analysis of DF in the area of teeth with pulp hyperemia, higher values of cytokines were obtained compared to intact teeth (p < 0.05). At the same time, in the area of 2 teeth with pulp hyperemia (5.4%), the level of cytokines was higher than their average values in the group of carious teeth. LDF of teeth with pulpal hyperemia also revealed higher values of M and σ compared with similar parameters in control teeth (p < 0.05). At the same time, in 2 cases, the highest levels of LDF were noted, which was consistent with the previously observed high values of cytokines in the gingival fluid in these loci. Moreover, after 2 weeks, a clinic of irreversible pulpitis was observed in these 2 teeth.
 Conclusion. When diagnosing reversible forms of pulpitis and deciding on the possibility of biological treatment of pulp hyperemia, it is necessary to assess the state of microcirculatory changes that have occurred in the pulp tissue, as well as the level of local immunological reactions.