Clinical Examples Research Articles

Human Acellular Collagen Matrices-Clinical Opportunities in Tissue Replacement.

The field of regenerative medicine is increasingly in need of effective and biocompatible materials for tissue engineering. Human acellular dermal matrix (hADM)-derived collagen matrices stand out as a particularly promising candidate. Their ability to preserve structural integrity, coupled with exceptional biocompatibility, positions them as a viable choice for tissue replacement. However, their clinical application has been largely confined to serving as scaffolds. This study aims to expand the horizon of clinical uses for collagen sheets by exploring the diverse cutting-edge clinical demands. This review illustrates the clinical utilizations of collagen sheets beyond traditional roles, such as covering skin defects or acting solely as scaffolds. In particular, the potential of Epiflex®, a commercially available and immediately clinically usable allogeneic membrane, will be evaluated. Collagen sheets have demonstrated efficacy in bone reconstruction, where they can substitute the induced Masquelet membrane in a single-stage procedure, proving to be clinically effective and safe. The application of these membranes allow the reconstruction of substantial tissue defects, without requiring extensive plastic reconstructive surgery. Additionally, they are found to be apt for addressing osteochondritis dissecans lesions and for ligament reconstruction in the carpus. The compelling clinical examples showcased in this study affirm that the applications of human ADM extend significantly beyond its initial use for skin defect treatments. hADM has proven to be highly successful and well-tolerated in managing various etiologies of bone and soft tissue defects, enhancing patient care outcomes. In particular, the application from the shelf reduces the need for additional surgery or donor site defects.

Эффективность современных методов микробиологической диагностики инфекций в офтальмологии. Клинический пример

Purpose. To demonstrate the interaction of ophthalmic and microbiological services based on the use of technologies to minimize the time of microbiological diagnosis of ocular infection on a clinical example. Methods. A clinical example of an 82-year-old patient who underwent planned cataract phacoemulsification surgery with IOL implantation is presented. On the 3rd day after surgery, the patient was diagnosed with postoperative endophthalmitis. A rapid (48 h) microbiological diagnosis of the pathogen (E. faecalis), which made possible an early etiotropic adjustment of antibacterial treatment, provided maximum therapeutic effect, minimized the toxic side effects of pharmacotherapy and gave a good anatomical and functional result. Results The clinical case demonstrated organization of a precise interaction between ophthalmic service and the laboratory, which made it possible to identify the pathogen and determine the spectrum of its sensitivity to antibiotics during the first two days after diagnosis of postoperative endophthalmitis, prescribe etiotropic treatment with a good clinical and functional outcome. Key words: mass spectrometry; infection; microbiology; endophthalmitis.

Цитологические исследования при диагностике увеита. Клинический пример

Purpose. To demonstrate on a clinical example the use of laboratory cytological methods for the differential diagnosis of masquerade syndrome and uveitis. Methods. A clinical example of а 77-year-old patient is presented. She was diagnosed with uveitis and received courses of anti-inflammatory therapy for 6 years without positive dynamics. Further, an assumption was made about the tumor cause of inflammation (primary bilateral intraocular lymphoma), a diagnostic vitrectomy with vitreous sampling for cytological examination was performed. Cytological examination confirmed the diagnosis of lymphoma. Results A patient with uveitis was suspected to have masquerade syndrome. A cytological examination of the vitreous body was performed; as a result, the diagnosis of intraocular lymphoma was unequivocally confirmed. The patient’s examination plan and further treatment were radically revised. Key words: intraocular lymphoma; uveitis; cytological examination.

Examples of surgical treatment of pulmonary echinococosis in adults and children

ABSTRACT. The article presents a modern view of the diagnosis and treatment of pulmonary echinococcosis. The etiology, pathogenesis, clinical picture, ways of diagnosis and available methods of treatment of this pathology are highlighted. The purpose of the work was to acquaint doctors of various specialties with clinical cases of pulmonary echinococcosis. Two clinical cases of pulmonary echinococcosis became the object of the work. The first clinical example concerned a 17-year-old boy who had a typical course of echinococcosis and who underwent left lower lobectomy. The second clinical example concerned a young woman in whom pulmonary echinococcosis had an atypical course and was diagnosed only intraoperatively. It was concluded that the most effective method of treatment of echinococcal lung cysts is surgical operation. The volume of surgical intervention depends on many factors and is decided individually in each specific case. In the postoperative period, preventive anthelmintic therapy is mandatory.

Aesthetic Surgery Tourism: An Opportunity or a Danger?

Medical and surgical tourism is a rapidly growing phenomenon in post-pandemic Europe. The exodus of patients abroad to perform surgery, especially cosmetic treatments, is spreading recently in industrialized countries. In the social media era, the ease of access to advertising about surgical procedures and their costs favors traveling. However, the information given is not always punctual, and there is often a lack of patient awareness about the risks related to the procedures. The objective of the manuscript is to investigate, through clinical examples, the path that a patient operated on in a non-European country must face once he returns home. From the availability and translation of clinical documentation to the problems encountered in revision surgeries. Thirteen cases of surgical tourism, patients who presented to our department with surgical complications, are investigated. Adverse events occurring during medical treatment abroad raised medico-legal and appropriateness issues, as well as concerns regarding the follow-up of patients. The current literature confirmed the high complication rate: It affects individual patients and the native country's healthcare systems. Therefore, patients must learn more about the dangers of traveling abroad for surgery. Education initiatives in the patient's home country might help achieve this. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Interpreting with a Modern Kleinian view: Clinical examples of talk therapy and what is said

Case material, disguised for confidentiality, is used to show the way interpretations are made from the Modern Kleinian therapy approach and how these interpretations evolve during the course of a session and throughout treatment. Issues of focus on defense and/or internal phantasy conflict are discussed and the centrality of projective identification and phantasy are then illustrated. In detailed clinical reports, the patient’s internal object relational struggles are highlighted, explored, and challenged with supportive interpretation. This includes a focus on transference, countertransference, and containment.

Decoding the Clavien-Dindo Classification: Artificial Intelligence (AI) as a Novel Tool to Grade Postoperative Complications.

To assess ChatGPT's capability of grading postoperative complications using the Clavien-Dindo classification (CDC) via Artificial Intelligence (AI) with Natural Language Processing (NLP). The CDC standardizes grading of postoperative complications. However, consistent, and precise application in dynamic clinical settings is challenging. AI offers a potential solution for efficient automated grading. ChatGPT's accuracy in defining the CDC, generating clinical examples, grading complications from existing scenarios, and interpreting complications from fictional clinical summaries, was tested. ChatGPT 4 precisely mirrored the CDC, outperforming version 3.5. In generating clinical examples, ChatGPT 4 showcased 99% agreement with minor errors in urinary catheterization. For single complications, it achieved 97% accuracy. ChatGPT was able to accurately extract, grade, and analyze complications from free text fictional discharge summaries. It demonstrated near perfect performance when confronted with real-world discharge summaries: comparison between the human and ChatGPT4 grading showed a κ value of 0.92 (95% CI 0.82-1) (P<0.001). ChatGPT 4 demonstrates promising proficiency and accuracy in applying the CDC. In the future, AI has the potential to become the mainstay tool to accurately capture, extract, and analyze CDC data from clinical datasets.

Acute and post-acute soft tissue reconstruction

The precise analysis of the injured structures requiring reconstruction in complex wound defects is aprerequisite for successful restoration. The fundamental reconstructive strategies for soft tissue defects of the extremities including injuries to vessels, nerves and burn wounds in the context of the acute and post-acute trauma phases are presented. The different phases of soft tissue reconstruction are described. Recommendations for action with respect to the reconstruction of the functional structures are described. Two clinical case examples illustrate the approach. The acute reconstruction phase is defined as the period 0-72 h after the traumatic event and includes surgical debridement, primary reconstruction of nerves and vessels using interpositional grafts if necessary and temporary soft tissue reconstruction. Combined thermomechanical trauma requires early debridement combined with internal fixation of open fractures. In the post-acute reconstruction phase, which is generally defined as aperiod of up to 6weeks after the traumatic event, definitive soft tissue reconstruction is performed. In the case of long reinnervation distances, nerve transfer or motor replacement plastic surgery is performed in the post-acute phase. The reconstruction of soft tissue after trauma necessitates a stage-dependent approach. In the acute phase procedures aim at the immediate preservation of the limb. In the post-acute phase, definitive soft tissue reconstruction is performed to enable maximum functional preservation. Combined thermomechanical injuries require early surgical treatment in order to prevent infections.

Modern possibilities of allergy diagnostics in real clinical practice

More than 20% of people worldwide suffer from allergic diseases. The high prevalence and wide range of provocative factors, which are increasing daily, complicate the diagnostic search. On the one hand, this leads to inadequately extensive dietary and lifestyle restrictions that reduce the quality of life for patients; on the other hand, it results in the failure to identify life-threatening allergens. The discovery of immunoglobulin E over 60 years ago initiated the search for specific biomarkers to etermine the causes of allergic diseases. Traditional methods of allergen diagnostics have several limitations that hinder the search for potential allergic disease triggers. The article discusses modern laboratory approaches to multicomponent molecular allergen diagnostics, describes its differences from traditional diagnostic methods, and analyzes the advantages, prospects, limitations, and shortcomings of this method. It also presents a comparative characterization of the test systems available today. The article presents four clinical cases that demonstrate the capabilities of the multicomponent ALEX 2 test system in diagnostics, choice of therapy tactics, and in forming further personalized recommendations for patients suffering from various allergic diseases.

Clinical experience of application Holoplant®-Tau for biliary lesions

Biliary diseases refer to the widespread in medical practice. In the absence of primary organic changes in the biliary tract, choledynamic disturbances have a functional nature. However, they usually become the starting point for the progression of pathological processes: metabolic and inflammatory changes in the wall of the gallbladder, onset of biliary sludge and gallstone disease. Holoplant®‑Tau (Propharma Plant, Ukraine) is one of the remedies that make it possible to restore and support the functions of liver, biliary tract and gall bladder. This is a unique hepatocomplex containing artichoke leaf extract 200 mg, angelica root extract 50 mg, ursodeoxycholic acid 100 mg, taurine 100 mg. Owing to the potential of each component, this composition enables achievement of greater effects than the use of large doses of individual medicinal substances. The paper considers therapeutic possibilities of the Holoplant®‑Tau hepatocomplex using clinical examples of patients’ management. The first case concerns hepatic abdominal syndrome; the second presents steatotic liver disease with accompanying chronic cholecystitis with biliary sludge and gastroduodenal pathology. The authors outlined data, that make it possible to confirm the diagnosis and to administer treatment with an assessment of its effectiveness and recommendations to the patients. For each clinical case, the causes and mechanisms of the development of these conditions have been analyzed in detail, and further prognosis was given. It has been concluded that the use of the hepatocomplex Holoplant®‑Tau in biliary disorders is expedient due to its multifaceted effects on the key pathogenetic links of the formation of the group of these diseases and high therapeutic efficiency.

Traumatizing Disorders of "Everyday Life".

Grounded in clinical examples, the text focuses on the challenges posed by working at a historical moment that, if fully taken in, presents us all-patients and analysts/therapists-with "more than mind can endure." This "too muchness" makes it particularly difficult to maintain our consulting rooms as "safe" spaces. The basic question: how to preserve a sense of safety in our clinical work while we simultaneously remain open to the disruptive and often unrepresentable dangers that surround and infiltrate us.

Clinical cases of legionelliosis in the Krasnodar region during the new coronavirus infection COVID-19 pandemic: difficulties in diagnosis

The high incidence of community-acquired pneumonia during the COVID-19 pandemic requires early differential diagnosis because of the differences in patient management techniques. Among community-acquired pneumonias, legionelliosis deserves special attention. The difficulty of clinical diagnosis of legionellosis during the COVID-19 pandemic leads to untimely prescription of specific antibacterial therapy, which worsens the prognosis. This study presents clinical examples that draw the attention of specialists to the clinical, laboratory, and radiological features of legionellosis and to the important role of epidemiological data in the differential diagnosis of legionellosis with COVID-19. A feature of the described clinical cases was as follows: late diagnosis with hospitalization on days 7–10 of illness in patients with increased body mass index, severe bilateral polysegmental pneumonia with the formation of a cavity and multirow bullae in the lungs, presence of proteinuria, increased levels of urea and/or creatinine, and lymphopenia. In all cases, the patients had history of staying in air-conditioned rooms and traveling by train. Compute tomography diagnostics described a localization that is not typical for COVID-19, manifestation from areas of consolidation with a symptom of air bronchography, presence of pleural effusion, discrepancy between the intensity of changes from the disease onset, and severity of the patient’s condition. For the specific diagnosis of legionellosis, testing for Legionella spp. To determine the legionella antigen in the urine is recommended upon hospital admission for all patients with severe community-acquired pneumonia.

A clinical example of the effect of latent infection and chronic inflammation on urination disorders in a 12-year-old child without organic pathology. Case report

A clinical example of the effect of latent infection and chronic inflammation on urination disorders in a 12-year-old child without organic pathology. Case report

Variants of uncertain significance in precision oncology: nuance or nuisance?

Variants of unknown significance cause uncertainty for patients and are a challenge for oncologists. This commentary describes 4 clinical examples illustrating these challenges.

РЕЗУЛЬТАТЫ ПОСЛЕДОВАТЕЛЬНОГО ХИРУРГИЧЕСКОГО ВМЕШАТЕЛЬСТВА И ТЕРАПИИ ИНТЕРФЕРОНАМИ МЕТАСТАЗОВ НЕЙРОЭНДОКРИННОГО РАКА ПОДЖЕЛУДОЧНОЙ ЖЕЛЕЗЫ У ПАЦИЕНТКИ С БОЛЕЗНЬЮ ФОН ГИППЕЛЯ-ЛИНДАУ

Abstract. Introduction. The article provides a literature review on the epidemiology, diagnosis, and treatment of neuroendocrine tumors. The morpho-functional classification by WHO 2022 is presented with the division of neuroendocrine tumors into three groups. Justifications are given for the choice of instrumental methods of topical diagnostics and the need for determining universal and specific biochemical markers in blood serum or plasma. The principles are indicated for choosing the advanced methods of treating neuroendocrine tumors. Aim. To review the scientific literature on neuroendocrine tumors, providing our own clinical observations. Materials and Methods. Russian- and English-language literature sources on this disease were searched for in the databases, such as PubMed, Medscape, Cochrane Library, and eLibrary. Clinical case of our female patient V., 36 years old, with von Hippel-Lindau disease (heterozygous mutation R167W of the VHL gene). Results and Discussion. As an example, we describe a clinical case of surgical treatment followed by long-term use of interferons in a female patient with neuroendocrine pancreatic cancer with metastases to the liver and retroperitoneal lymph nodes. Histological examination of the surgical material revealed highly differentiated neuroendocrine cancer with low malignant potential. A screening examination of the genetic syndrome components revealed a heterozygous mutation R167W of the VHL gene. Her survival under treatment exceeded 9.5 years, including more than 4.5 years from the start of interferon therapy. This pathology occurred in a young woman with one of the rare genetic multiorgan hereditary forms of neuroendocrine tumors, Von Hippel-Lindau disease that manifested itself as a combination of benign (retinal angiomatosis of both eyes and adenomas of both adrenal glands) and malignant diseases (pancreatic cancer). Conclusions. The given clinical example demonstrates that in a patient with highly differentiated metastatic pancreatic cancer, after distal subtotal resection of the pancreas, splenectomy, retroperitoneal lymphadenectomy, followed by treatment with interferons, life expectancy was more than 9.5 years, including more than 4.5 years from the start of therapy with interferons only. Despite the numerous side effects of interferons described in the literature, the patient tolerated the treatment well. At the same time, a connection between the hypothyroidism detected in the patient and treatment with interferons cannot be ruled out, since dysfunction of the thyroid gland is one of its side effects.

On the Logic of the Unconscious Conception of Causation Part I: The Oedipal Meta-Wish and the Sexualization of Asymmetric Time.

The direction of time is often defined by describing asymmetries between past and future events, referred to as "time-arrows." Two important time-arrows are the mutability time-arrow, which specifies that the past is unalterable, while the future is not; and the causal time-arrow, which stipulates that past events may cause future events, but not vice versa. The author argues that the unconscious conception of causation expressed in both the oedipal myth and certain oedipal wishes negates the mutability and causal time-arrows. The author suggests, therefore, distinguishing between oedipal phantasies that undermine the ordinary conceptions of causation and time (such as the wish of being one's own parent), and classical content that is in line with our time perception (such as sexual and aggressive wishes toward parents). Analyzing clinical examples suggests that some patients' oedipal phantasies are combined with unconscious sexual satisfaction from the asymmetric conception of time. When this sexual satisfaction is analyzed, they might expose the oedipal phantasies founded on the symmetric conception of time.

Seeing the Trees From the Forest: Challenges in Subgroup Analysis-Based Guidelines in Oncology

As clinical trials in oncology require substantial efforts, maximizing the insights gained from them by conducting subgroup analyses is often attempted. The goal of these analyses is to identify subgroups of patients who are likely to benefit, as well as the subgroups of patients who are unlikely to benefit from the studied intervention. International guidelines occasionally include or exclude novel medications and technologies for specific subpopulations based on such analyses of pivotal trials without requiring confirmatory trials. This Perspective discusses the importance of providing a complete dataset of clinical information when reporting subgroup analyses and explains why such transparency is key for better clinical interpretation of the results and the appropriate application to clinical care, by providing examples of transparent reporting of clinical studies and examples of incomplete reporting of clinical studies.

Diagnosis coding of neurocognitive disorders.

Objective: Diagnosis coding is a core clinical competency. A basic understanding of the structure of the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), the conventions and rules for diagnosis coding, and what constitutes accurate coding, is fundamental to the clinician's knowledge base. This commentary seeks to provide a practical framework for clinicians to perform accurate diagnosis coding of neurocognitive disorders. Method: This paper: (1) summarizes the structure of the ICD-10-CM, (2) describes the rules and conventions of diagnosis coding for diagnostic categories relevant to neurocognitive disorders, (3) presents clinical examples and pragmatic recommendations to help readers improve their day-to-day use of diagnosis codes, and (4) describes limitations and discrepancies in the diagnosis coding advice for neurocognitive disorders presented within the Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) and the DSM-5-TR Neurocognitive Disorders Supplement. Its content originates from the ICD-10-CM itself and its companion document, the ICD-10-CM Official Guidelines for Coding and Reporting. Conclusion: The ICD-10-CM classification scheme is logically organized and easy to navigate for users who understand its structure and rules. Many neuropsychologists rely on the DSM-5-TR diagnosis coding advice, however that advice is limited with respect to the range of diagnosis codes relevant to neurocognitive disorders and their underlying causes. Relying on the ICD-10-CM directly for diagnosis coding of neurocognitive disorders, rather than the DSM-5-TR or other secondary sources, is therefore preferable and aids clinicians in accurate diagnosis coding.

HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS IN PEDIATRIC PRACTICE

The article presents a review of literature sources highlighting the issues of clinical and laboratory diagnosis of hemophagocytic lymphohistiocytosis in children. The authors of various observations have repeatedly emphasized hemophagocytic lymphohistiocytosis continues to be a life-threatening disease despite modern implementations in diagnosis and treatment. At the same time, the prognosis and outcome are largely determined by the timeliness of diagnosis and the right tactic. The review is illustrated by a clinical example of a fatally ended case of an infant, he was diagnosed posthumously based on the results of a molecular genetic tests.

Decoding the Clavien-Dindo Classification: Artificial Intelligence (AI) as a Novel Tool to Grade Postoperative Complications

Abstract Background The CDC standardizes grading of postoperative complications. However, consistent, and precise application in dynamic clinical settings is challenging. AI offers a potential solution for efficient automated grading. Aims To assess ChatGPT’s capability of grading postoperative complications using the Clavien-Dindo classification (CDC) via Artificial Intelligence (AI) with Natural Language Processing (NLP). Methods ChatGPT's accuracy in defining the CDC, generating clinical examples, grading complications from existing scenarios, and interpreting complications from fictional clinical summaries, was tested. Results ChatGPT 4 precisely mirrored the CDC, outperforming version 3.5. In generating clinical examples, ChatGPT 4 showcased 99% agreement with minor errors in urinary catheterization. For single complications, it achieved 97% accuracy. ChatGPT was able to accurately extract, grade, and analyze complications from free text fictional discharge summaries. Conclusion ChatGPT 4 demonstrates promising proficiency and accuracy in applying the CDC. In the future, AI has the potential to become the mainstay tool to accurately capture, extract, and analyze CDC data from clinical datasets.