Classification Of Clinical Forms Research Articles

Register of adult patients with noncompact left ventricular myocardium: classification of clinical forms and a prospective assessment of progression

Aim. To study clinical forms of noncompact myocardium (NCM) in adults, the features of their manifestation, course and progression. Material and methods . The study included 116 adult patients with NCM of the left ventricle (LV) (67 men, mean age 46,3±15,1 years) and 42 patients with increased LV trabecularity (24 men, mean age 43,5±15,2 years). The mean LV end-diastolic diameter was 6,0±0,8 and 5,9±1,1 cm, LV ejection fraction was 38,6±14,0% and 44,6±18,3%, respectively. NCM was diagnosed using echocardiography, multispiral computed tomography (n=77) and magnetic resonance imaging (n=51), increased LV trabecularity was diagnosed according to echocardiography, multispiral computed tomography (n=11), multispiral computed tomography (n=24). DNA diagnostics was carried out according to the NGS method, followed by Sanger sequencing. The examination included the determination of anticardial antibodies, the genome of cardiotropic viruses by PCR, coronary angiography (n=29/2), scintigraphy (n=27/4). A morphological study of the myocardium was performed on 22/6 patients with NCM/increased LV trabecularity (14/6 endomyocardial biopsy, 1 intraoperative biopsy, 3 explanted heart studies, 6 autopsies). Results. Pathogenic mutations were found in 12 (10,3%) patients (MYH7, MyBPC3, LAMP2, DES, DSP, TTNgenes), variants of uncertain clinical significance (VUCS) — in other 5 (4,3%) patients; we detected VUCS in 1 patient with increased LV trabecularity. Familial cardiomyopathy may be diagnosed in 24 patients (22%). The combination of NCM with congenital heart defects was diagnosed in 11 (9,5%) patients. We identified six clinical variants of NCM: asymptomatic (2%), arrhythmic (15%), ischemic (7%), NCM in patients with dilated cardiomyopathy (42%), NCM in patients with acute/subacute myocarditis (12%) and in combination with other primary cardiomyopathies (22%) — hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, restrictive cardiomyopathy, primary myodystrophy, cardiac sarcoidosis, Danon disease. Myocarditis was diagnosed in 51,7% of patients with various forms of NCM and in 59,5% of patients with increased LV trabecularity. The frequency of the main clinical manifestations of NCM (chronic heart failure, various cardiac arrhythmias, thromboembolic complications) and outcomes varied in groups of patients with different variants of the NCM course. In patients with increased LV trabecularity, similar clinical variants were noted with a less severe myocardial dysfunction, rare arrhythmias and embolism. A significant improvement in dynamics of EF and LV end-diastolic diameter was noted only in the group of patients with acute/subacute, most of which received basic myocarditis therapy. In other groups, there was an unreliable improvement. Conclusion. NCM can be detected in a patient of any age with a previously diagnosed heart disease (coronary heart disease, arterial hypertension, congenital heart defects, cardiomyopathy, myocarditis, etc.), and in the absence of any symptoms. Stable clinical forms are characterized by stability over time with a tendency to improvement against the background of complex medical therapy.

La cromoblastomicosis en Costa Rica

A review of the four Costa Rican cases of chromoblastomycosis published to date is presented. A comparative study of other cases, confirmed from a mycological viewpoint by the presence of parasites in the lesions, is presented. A classification of the various clinical forms is suggested and the previous two classifications are reviewed. It is noted that chromoblastomycosis in Costa Rica shows no outstanding differences from that in other american countries.

MODERN VIEW ON THE PROBLEM OF RETINOPATHY OF PRETERM BABIES

The article presents a review of the data, which reflects the relevance and modern views on the problem of retinopathy of prematurity, including statistical and epidemiologic data on nosology. Various pathogenetic theories of onset and progression of this disease are discussed. A clear correlation depending on the degree of prematurity, body weight and physical condition of the newborn and the risk of disease is mentioned. The summation of etiology aspects, as well as pathogenesis, classification of clinical forms and the modern approach to the diagnostics is of a quite interest. The article also describes different treatment strategies which include various methods of conservative therapy and surgery, depending on the course and stage of disease. Rehabilitation activities for children who had come through some stage of retinopathy of prematurity and are at risk for the formation of different ophthalmopathology such as refractive errors and pathology of binocular vision in the future and require a subsequent long-term monitoring in the office catamnesis are itemized. The importance of interaction between ophthalmologists and neonatologists at all stages of neonatal screening for providing timely specialized care in order to minimize the occurrence of retinopathy and prevent progression to disabling stages, as well as to improve the quality of life of these patients is shown.

Modern view on the problem of retinopathy of preterm babies

The article presents a review of the data, which reflects the relevance and modern views on the problem of retinopathy of prematurity, including statistical and epidemiologic data on nosology. Various pathogenetic theories of onset and progression of this disease are discussed. A clear correlation depending on the degree of prematurity, body weight and physical condition of the newborn and the risk of disease is mentioned. The summation of etiology aspects, as well as pathogenesis, classification of clinical forms and the modern approach to the diagnostics is of a quite interest. The article also describes different treatment strategies which include various methods of conservative therapy and surgery, depending on the course and stage of disease. Rehabilitation activities for children who had come through some stage of retinopathy of prematurity and are at risk for the formation of different ophthalmopathology such as refractive errors and pathology of binocular vision in the future and require a subsequent long-term monitoring in the office catamnesis are itemized. The importance of interaction between ophthalmologists and neonatologists at all stages of neonatal screening for providing timely specialized care in order to minimize the occurrence of retinopathy and prevent progression to disabling stages, as well as to improve the quality of life of these patients is shown.

Dorsal scapholunate ligament injury: a classification of clinical forms

The dorsal scapholunate (SL) ligament may disrupt in variety of ways. Each form of injury requires specific fixation. To investigate the incidence of each type of ligament failure, the records of 45 patients with adequate information, good quality pictures, or videos demonstrating injury characteristics were reviewed. Four types of SL injury were found: type 1 (lateral avulsion from the scaphoid) was the most frequent, present in 19 patients (42%); type 2 (medial avulsion from the lunate) was the least frequent, with 7 cases (16%); type 3 (mid-substance rupture) was found on 9 occasions (20%); and type 4 (partial rupture plus elongation) was observed on 10 occasions (22%). Based on our observations, we submit that an arthroscopically assisted SL capsuloplasty may not be possible in all cases, particularly not when the ligament has avulsed off the bone (60% of the cases), leaving no ligament remnant on one side. Most patients will require ligament reattachment techniques using transosseous sutures, bone anchors, or ligament reconstruction.