Pathology In Clinical Practice Research Articles

Utility of gastrointestinal transit scintigraphy in the evaluation of chronic constipation

AimChronic constipation is a common pathology in clinical practice. In the absence of response to treatment, assessment of gastrointestinal function is recommended. This can be performed by scintigraphy, although its use is not widespread. The aim of this paper was to assess the utility of gastrointestinal transits scintigraphy in patients with chronic constipation. Material and methodsTwenty patients (13 children) sent for scintigraphy for chronic constipation refractory to treatment, syringomyelia, rectocele or abdominal migraine were evaluated. All underwent clinical assessment, analytical determination, radiological imaging and/or rectal biopsy. A complete study protocol was performed, including gastric emptying, small bowel and colonic transits scintigraphy. For this, a dose of [111In]In-DTPA diluted in water (37MBq) was administered together with standardized food. Following international guidelines, regions of interest were defined in the stomach, terminal ileum and different regions of the large intestine to calculate the geometric center as a measure of progression. ResultsOf the 13 pediatric patients, 10 had abnormal gammagraphic patterns, with treatment being modified in 8 of them. Most of the children showed no alterations on radiological explorations. In adult patients, the results of the test changed the therapeutic management in all of them. ConclusionsScintigraphic study provided useful information in the study of chronic constipation, influencing the diagnosis and therapeutic management of the patient. The physiological and quantitative information it provides allows both global and regional of gastrointestinal transit time determination.

Utilidad de la gammagrafía de tránsito gastrointestinal en la valoración del estreñimiento crónico

AimChronic constipation is a common pathology in clinical practice. In the absence of response to treatment, assessment of gastrointestinal function is recommended. This can be performed by scintigraphy, although its use is not widespread. The aim of this paper was to assess the utility of gastrointestinal transits scintigraphy in patients with chronic constipation. Material and methodsTwenty patients (13 children) sent for scintigraphy for chronic constipation refractory to treatment, syringomyelia, rectocele or abdominal migraine were evaluated. All underwent clinical assessment, analytical determination, radiological imaging and/or rectal biopsy. A complete study protocol was performed, including gastric emptying, small bowel and colonic transits scintigraphy. For this, a dose of [111In]In-DTPA diluted in water (37MBq) was administered together with standardized food. Following international guidelines, regions of interest were defined in the stomach, terminal ileum and different regions of the large intestine to calculate the geometric center as a measure of progression. ResultsOf the 13 pediatric patients, 10 had abnormal gammagraphic patterns, with treatment being modified in 8 of them. Most of the children showed no alterations on radiological explorations. In adult patients, the results of the test changed the therapeutic management in all of them. ConclusionsScintigraphic study provided useful information in the study of chronic constipation, influencing the diagnosis and therapeutic management of the patient. The physiological and quantitative information it provides allows both global and regional of gastrointestinal transit time determination.

Cultivating Clinical Clarity through Computer Vision: A Current Perspective on Whole Slide Imaging and Artificial Intelligence.

Diagnostic devices, methodological approaches, and traditional constructs of clinical pathology practice, cultivated throughout centuries, have transformed radically in the wake of explosive technological growth and other, e.g., environmental, catalysts of change. Ushered into the fray of modern laboratory medicine are digital imaging devices and machine-learning (ML) software fashioned to mitigate challenges, e.g., practitioner shortage while preparing clinicians for emerging interconnectivity of environments and diagnostic information in the era of big data. As computer vision shapes new constructs for the modern world and intertwines with clinical medicine, cultivating clarity of our new terrain through examining the trajectory and current scope of computational pathology and its pertinence to clinical practice is vital. Through review of numerous studies, we find developmental efforts for ML migrating from research to standardized clinical frameworks while overcoming obstacles that have formerly curtailed adoption of these tools, e.g., generalizability, data availability, and user-friendly accessibility. Groundbreaking validatory efforts have facilitated the clinical deployment of ML tools demonstrating the capacity to effectively aid in distinguishing tumor subtype and grade, classify early vs. advanced cancer stages, and assist in quality control and primary diagnosis applications. Case studies have demonstrated the benefits of streamlined, digitized workflows for practitioners alleviated by decreased burdens.

Acquisition of Tok Pisin phonology in the multilingual highlands of Papua New Guinea

Purpose: Papua New Guinea (PNG) has extreme linguistic diversity reflected in its three national languages and sociolinguistic diversity comprising over 380 vernaculars or Tokples, English and the lingua francas, which include Tok Pisin (TP). This first clinical cross-sectional study of consonant acquisition in TP-speaking children sought to identify universal features and the impact of age on phonological development. Method: A local picture naming task was developed and used to elicit a speech sample from 80 children (aged 3;0–6;11). Phonetic and phonemic inventories and developmental phonological processes were analysed across the sample and also in 12-month age groups. Result: Statistically significant differences were found between the Percentage Consonants Correct (PCC) of the 3YO and other age groups. Mean PCC increased with age, but high variation within age groups meant differences were not statistically significant. Universal features observed included the early acquisition of plosives and late mastery of /r/. Language-specific features included processes such as fricatisation and earlier acquisition of /ʤ/ before /s/. Creolisation was seen in morphophonemic condensation and the influence of loanwords. Conclusion: This study demonstrates both universal and language-specific features amidst wide diversity influencing phonological acquisition in creolising TP. This first phonological study of TP consonant development will inform future clinical speech-language pathology practice in PNG.

A Comparative Study of Olopatadine Hydrochloride and Bepotastine Besilate in the Treatment of Allergic Conjunctivitis

Background -Ocular allergy is a commonly encountered pathology in clinical practice, which often is under diagnosed and consequently undertreated. These are rarely vision-threatening but can significantly decrease the quality of life for patients. Olopatadine and Bepotastine eyedrop have both antihistaminic and mast cell stabilization action. Their use can control acute symptoms and prevent relapses as well. We conducted this single blinded trial directly comparing the efficacy of the two topical anti allergic medications in mild forms of allergic conjunctivitis. Materials and Methods - A single blinded randomised control clinical trial study was conducted in patients visiting OPD of Ophthalmology at the institute for duration of 6 months. All the patients above 18 years of age having mild to moderate allergic conjunctivitis were included in the study. Patients were randomly placed in one of the two groups according to computer generated random numbers and given topical anti-allergic medication for twice daily. Group A was given Topical 0.1% Olopatadine eye drops BD and Group B was given Topical 1.5% Bepotastine eye drops BD. Ophthalmological check-up was done using slit lamp on next day, after 1 week, after 21-28 days. Results - It was seen from the study that on follow up day 1 in patients receiving Bepotastine 1.5% eyedrop, there was 50% relief of symptoms and signs seen in 80% patients while in 60% patients, only 40% relief in symptoms and sign was seen with olopatadine 0.1% eyedrop. On follow up day 7, 90% of symptoms and signs of allergic conjunctivitis were relieved in all patients receiving Bepotastine eyedrop while 80% relief was seen in those receiving olopatadine. Almost 100% relief from signs and symptoms were seen in both the groups on follow up day 21-28th. Conclusion- We conclude from our study that, Bepotastine besilate 1.5% ophthalmic solution is a preferred drug compared to Olopatadine 0.1% in the immediate relief of symptoms and signs of allergic conjunctivitis. It can be used as an initial therapy in the symptom relief and alternative to the topical steroids used in mild-moderate allergic conjunctivitis. Keywords: Allergic conjunctivitis, Ocular allergy, Olopatadine hydrochloride, Bepotastine besilate.

Novel approaches beyond standard immunofluorescence for kidney biopsies.

Immunofluorescence on frozen tissue (IF-F) utilizing antibodies against immunoglobulin (Ig) heavy and light chains (IgA, IgG and IgM, kappa and lambda) and components of classical and alternative complement pathways (C1q, C3c and C4) is the standard of renal pathology. However, conventional IF-F has limitations, particularly in nephropathies associated with organized and/or monoclonal Ig deposits. This review will discuss new applications of established methods beyond conventional IF-F and recent novel immunohistochemical methods. The combined application of paraffin immunofluorescence (IF-P) and IgG subtype staining excluded monotypic deposits in 62-66% of DNA J homolog subfamily B member 9-associated fibrillary glomerulonephritis (FGN) with apparent monotypic deposits by IF-F, whereas IF-P unmasks IgG deposits in a subset of cases of immunotactoid glomerulopathy. A novel IF technique targeting epitopes at the junction of the Ig heavy and light chains was introduced and unmasked polytypic deposits in a subset of glomerulonephritis with apparent monotypic deposits on IF-F. A recent study described the successful application of co-detection by indexing (CODEX) multiplexed IF to visualize more than a dozen target antigens within a single kidney tissue section. Finally, immunohistochemical protocols for detection of the novel antigens in membranous nephropathy have already entered the clinical practice of renal pathology. Novel ancillary techniques in renal pathology have the potential to significantly enhance our ability to evaluate renal biopsies.

Comparison of Immune Response Assessment in Colon Cancer by Immunoscore (Automated Digital Pathology) and Pathologist Visual Scoring.

Simple SummaryThe immune response to colon cancer (CC) is highly variable among patients and is clinically relevant. In this study, we compared the immune response assessment for early-stage CC, as measured by Immunoscore (IS), to pathologist visual scoring of the CD3+ and CD8+ T-cell densities at the tumor site (T-score). The objectives were to determine the inter-observer agreement between pathologists and the concordance between the two methods. Agreement between pathologists was minimal to weak. Moreover, a weak concordance between the two methods was observed, leading to misclassification of 48% of cases by pathologist scoring. Due to the high level of immune infiltrate heterogeneity resulting in disagreement of interpretation among pathologists, IS is unlikely to be reproduced via non-standardized methods.Adjunction of immune response into the TNM classification system improves the prediction of colon cancer (CC) prognosis. However, immune response measurements have not been used as robust biomarkers of pathology in clinical practice until the introduction of Immunoscore (IS), a standardized assay based on automated artificial intelligence assisted digital pathology. The strong prognostic impact of the immune response, as assessed by IS, has been widely validated and IS can help to refine treatment decision making in early CC. In this study, we compared pathologist visual scoring to IS. Four pathologists evaluated tumor specimens from 50 early-stage CC patients and classified the CD3+ and CD8+ T-cell densities at the tumor site (T-score) into 2 (High/Low) categories. Individual and overall pathologist scoring of immune response (before and after training for immune response assessment) were compared to the reference IS (High/Low). Pathologists’ disagreement with the reference IS was observed in almost half of the cases (48%) and training only slightly improved the accuracy of pathologists’ classification. Agreement among pathologists was minimal with a Kappa of 0.34 and 0.57 before and after training, respectively. The standardized IS assay outperformed expert pathologist assessment in the clinical setting.

Evaluation and Classification of Mast Cell Disorders: A Difficult to Manage Pathology in Clinical Practice.

Mast cells are granulocytic immunomodulatory cells with an important role in physiologic and pathogenic processes due to their location at the junction between the internal and external environment and to their capacity to release a broad range of active mediators. Mast cells mediators have both pro-inflammatory and anti-inflammatory activities and are implicated in various and complex pathology. Mast cells disorders (MCDs) represent a heterogeneous pathology, with frequently difficult and challenging evaluation and diagnostic workup. MCDs can be primary, secondary to other diseases, or idiopathic. Increased research interest in this field was noted during the last decade and various classification criteria, as well as diagnostic and treatment recommendations, were proposed. The aim of this paper is to review the most recent published data on the classification and evaluation of mast cells disorders and to point out the main difficulties in diagnosing and managing these complex diseases in medical practice.

Leading in a Clinical Molecular Laboratory: It Is Not Just About the Science

Although most molecular pathology professionals have a deep foundation in the science and clinical practice of pathology, many feel ill prepared for the soft skills necessary to lead a laboratory. These nonmedical skills, such as understanding the financials, productively communicating with stakeholders, and writing effective reports, are essential aspects of a laboratory leader's job. Although some of these skills are taught in trainee programs, laboratory directors and other molecular professionals frequently must learn on the job, impacting the smooth functioning of a laboratory and professional job satisfaction, which ultimately impacts patient care.

Teaching Urology to Undergraduates: A Prospective Survey of What General Practitioners Need to Know.

Background: Higher education training in Medicine has considerably evolved in recent years. One of its main goals has been to ensure the training of students as future adequately qualified general practitioners (GPs). Tools need to be developed to evaluate and improve the teaching of Urology at the undergraduate level. Our objective is to identify the knowledge and skills needed in Urology for the real clinical practice of GPs. Methods: An anonymous self-administered survey was carried out among GPs of Primary Care and Emergencies which sought to evaluate urological knowledge and necessary urological skills. The results of the survey were exported and descriptive statistics were performed using IBM SPSS Statistics version 19.0. Results and limitations: A total of 127 answers were obtained, in which ‘Urological infections’, ‘Renal colic’, ‘PSA levels and screening for prostate cancer’, ‘Benign prostatic hyperplasia’, ‘Hematuria’, ‘Scrotal pain’, ‘Prostate cancer diagnosis’, ‘Bladder cancer diagnosis’, ‘Urinary incontinence’, and ‘Erectile dysfunction’ were rated as Very high or High formative requirements (>75%). Regarding urological skills, ‘Abdominal examination’, ‘Interpretation of urinalysis’, ‘Digital rectal examination’, ‘Genital examination’, and ‘Transurethral catheterization’ were assessed as needing Very high or High training in more than 80% of the surveys. The relevance of urological pathology in clinical practice was viewed as Very high or High in more than 80% of the responses. Conclusions: This study has shown helpful results to establish a differentiated prioritization of urological knowledge and skills in Primary Care and Emergencies. Efforts should be aimed at optimizing the teaching in Urology within the Degree of Medicine which consistently ensures patients’ proper care by future GPs.

Multi-auxiliary domain transfer learning for diagnosis of MCI conversion.

In the early stage of Alzheimer's disease (AD), mild cognitive impairment (MCI) has a higher risk of progression to AD, so the prediction of whether an MCI subject will progress to AD (known as progressive MCI, PMCI) or not (known as stable MCI, SMCI) within a certain period is particularly important in practice. It is known that such a task could benefit from jointly learning-related auxiliary tasks such as differentiating AD from PMCI or PMCI from normal control (NC) in order to take full advantage of their shared commonality. However, few existing methods along this line fully consider the correlations between the target and auxiliary tasks according to the clinical practice of AD pathology for diagnosis. To deal with this problem, in this paper, treating each task domain as a different one, we borrow the idea from transfer learning and propose a novel multi-auxiliary domain transfer learning (MaDTL) method, which explicitly utilizes the correlations between the target domain (task) and multi-auxiliary domains (tasks) according to the clinical practice. Specifically, the proposed MaDTL method incorporates two key modules. The first one is a multi-auxiliary domain transfer-based feature selection (MaDTFS) model, which can select a discriminative feature subset shared by the target domain and the multi-auxiliary domains. In the MaDTFS model, to combine more training data from multi-auxiliary domains and simultaneously suppress the negative effects resulting from the irrelevant parts of multi-auxiliary domains, we proposed a sparse group correlation Lasso that includes a proposed group correlation Lasso penalty (i.e., [Formula: see text]) and a proposed correlation Lasso penalty (i.e., [Formula: see text]). The second module in MaDTL is a multi-auxiliary domain transfer-based classification (MaDTC) model that improves the voting with linear weighting-based ensemble learning. This model extends the constraints of the linear weighting method so that it can simultaneously combine training data from multi-auxiliary domains and achieve a robust classifier by minimizing negative effects from the irrelevant part of multi-auxiliary domains. Experimental results on 409 subjects from the Alzheimer's Disease Neuroimaging Initiative (ADNI) database with the baseline magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) data validate the effectiveness of the proposed method by significantly improving the classification accuracy to 80.37% for the identification of MCI-to-AD conversion, outperforming the state-of-the-art methods.

Prediction of Neoplastic Transformation of Hydatidiform Mole: Current Evidence.

Gestational trophoblastic disease is not an uncommonly encountered pathology in clinical practice. The rate of post-molar neoplastic transformation is around 5-20% with higher rates after complete versus partial molar pregnancies. Recently, a role for molecular and genetic markers in the prediction of neoplastic transformation has emerged. We read with interest the article by St. Laurent et al. published in this issue ofReproductive Sciences. The authors compared miRNA profiles between complete hydatidiform moles (CHMs) and pre-gestational trophoblastic neoplasia CHM samples at three distinct tropho-miRNA clusters, 14q32, C19MC, and miR-371-3,as well as the expression of the contiguous DLK1, DIO3, and RTL1 genes. They found significant differences in expression of the 14q32 miRNA cluster and a fivefold decrease in protein expression of DIO3 but no difference in DIO3 mRNA expression. We reviewed the literature for similar studies looking at predictive tools for neoplastic transformation. We encourage future randomized controlled trials using these 2 novel risk predictors postulated by St. Laurent et al. to validate and guide future prophylactic chemotherapy for prevention of post-molar GTN.

Analysis of lesions of liver in autopsy

Lesions of liver cause significant morbidity and mortality. Liver biopsy may not give the exact picture on lesions of liver. Autopsy study may be a better choice for this. The aims and objectives are: 1) to analyze lesions of liver in autopsy in India; 2) to establish the usefulness of autopsy pathology in clinical practice, teaching medical students and for research purposes. Retrospective analysis of histopathological findings of autopsy cases was done for the year 2017 to 2020. Inclusion criteria were cases showing positive histopathological finding in any of the following organs heart, lung, liver, spleen, kidney, and brain. Total 70 cases were taken out. The age ranged from 4 days to 77 years. Male and female were 52 and 18 respectively. Out of total 70 cases, 40 showed lesions in liver. Most common lesion was Hepatic steatosis with foci of cirrhosis 14/70 (20%). This was followed by cirrhosis (9/70)12.8%, chronic hepatitis & granuloma 4/70 (5.7%) each, Cardiac cirrhosis (2/70), Nonalcoholic hepatic steatosis in an 11 months old male baby with umbilical granuloma, hydatid cyst, metastasis from primary cancer & chronic hepatitis in 1/70 cases. Rest cases didn't show any pathology. The pattern of liver diseases is different in the different ethnic groups. In India, no such study is available. Autopsy study may have clearer picture of lesions of liver than what we see in liver biopsy, which may be used for academic & research purposes.

Clinical case of intussusception of the jejunum into gastroenteroanastomosis after gastric ­resection

Intussusception is one of the varieties of mixed (strangulation and obturation) mechanical intestinal obstruction. It arises as a result of the introduction of the adducting segment of the intestine into the abducting one. Gastroduodenal intussusception is an extremely rare type of high intestinal obstruction. It most often occurs after surgery on the stomach and much less often in non-operated patients. Intussusception of the jejunum into the stomach can occur soon after surgery, but most often, this complication occurs 515 years after the intervention. This paper describes a case of retrograde intussusception that arose 9 years after the Billroth II gastric resection with Braun anastomosis. This clinical case acquaints specialists with the possibility to encounter this pathology in clinical practice and demonstrates the appropriateness of differential diagnostics in cases with similar clinical symptoms.

Guidance on Imaging for Invasive Pulmonary Aspergillosis and Mucormycosis: From the Imaging Working Group for the Revision and Update of the Consensus Definitions of Fungal Disease from the EORTC/MSGERC.

Clinical imaging in suspected invasive fungal disease (IFD) has a significant role in early detection of disease and helps direct further testing and treatment. Revised definitions of IFD from the EORTC/MSGERC were recently published and provide clarity on the role of imaging for the definition of IFD. Here, we provide evidence to support these revised diagnostic guidelines. We reviewed data on imaging modalities and techniques used to characterize IFDs. Volumetric high-resolution computed tomography (CT) is the method of choice for lung imaging. Although no CT radiologic pattern is pathognomonic of IFD, the halo sign, in the appropriate clinical setting, is highly suggestive of invasive pulmonary aspergillosis (IPA) and associated with specific stages of the disease. The ACS is not specific for IFD and occurs in the later stages of infection. By contrast, the reversed halo sign and the hypodense sign are typical of pulmonary mucormycosis but occur less frequently. In noncancer populations, both invasive pulmonary aspergillosis and mucormycosis are associated with "atypical" nonnodular presentations, including consolidation and ground-glass opacities. A uniform definition of IFD could improve the quality of clinical studies and aid in differentiating IFD from other pathology in clinical practice. Radiologic assessment of the lung is an important component of the diagnostic work-up and management of IFD. Periodic review of imaging studies that characterize findings in patients with IFD will inform future diagnostic guidelines.

Detecting Alzheimer\u2019s disease biomarkers with a brief tablet-based cognitive battery: sensitivity to A\u03b2 and tau PET

Backgroundβ-amyloid (Aβ) and tau positron emission tomography (PET) detect the pathological changes that define Alzheimer’s disease (AD) in living people. Cognitive measures sensitive to Aβ and tau burden may help streamline identification of cases for confirmatory AD biomarker testing.MethodsWe examined the association of Brain Health Assessment (BHA) tablet-based cognitive measures with dichotomized Aβ -PET status using logistic regression models in individuals with mild cognitive impairment (MCI) or dementia (N = 140; 43 Aβ-, 97 Aβ+). We also investigated the relationship between the BHA tests and regional patterns of tau-PET signal using voxel-wise regression analyses in a subsample of 60 Aβ+ individuals with MCI or dementia.ResultsFavorites (associative memory), Match (executive functions and speed), and Everyday Cognition Scale scores were significantly associated with Aβ positivity (area under the curve [AUC] = 0.75 [95% CI 0.66–0.85]). We found significant associations with tau-PET signal in mesial temporal regions for Favorites, frontoparietal regions for Match, and occipitoparietal regions for Line Orientation (visuospatial skills) in a subsample of individuals with MCI and dementia.ConclusionThe BHA measures are significantly associated with both Aβ and regional tau in vivo imaging markers and could be used for the identification of patients with suspected AD pathology in clinical practice.

Age-related macular degeneration and diabetic eye lesion. Socio-economic aspects

Diabetic retinopathy (DR) and age-related macular degeneration (AMD) comprise a significant socio-medical problem for Russia. The article presents an analysis aimed at identifying the prerequisites for further research on the socio-economic consequences of retinal pathology. Studying the epidemiological aspects of DR and AMD, as well as the conditions for receiving medical aid helped define the main approaches to assessing the economic burden of retinal diseases in Russia. It also revealed the problems associated with completeness of registration and accounting of patients, the disparity between the volume of medical aid required and funding, and between the required and provided assistance for patients with these pathologies in clinical practice. Analysis of the disease cost will allow not only to determine the socio-economic consequences of retinal diseases, but also to find further directions for improving the quality of medical care for patients with DR and AMD in order to reduce its economic cost for the state and society. Evidently, there is a need for comprehensive assessment of the total burden of retinal diseases in Russia that would serve as a basis for subsequent assessment of the economic effectiveness of prevention and treatment measures.

Virtual Pathology Elective Provides Uninterrupted Medical Education and Impactful Pathology Education During the COVID-19 Pandemic

As students do not qualify as essential health care workers, medical education faced severe disruptions during the COVID-19 pandemic including initial suspension of all in-person lectures and on-site rotations. Our Pathology Department was among the first at Northwestern to offer a completely virtual rotation with the goals of: (1) providing a comprehensive introduction to the practice of anatomic and clinical pathology, (2) emphasizing uninterrupted and continued excellence in education, and (3) minimizing exposure risk during the pandemic. The innovative 2-week curriculum incorporated diverse teaching modalities including live and recorded lectures; live and recorded video demonstrations; interactive small group discussions; interactive virtual sign-outs; and written and multimedia assignments, quizzes, and projects. The virtual elective ran from March to July 2020 with 52 total participating medical students. On post-rotation evaluations, students rated the pathology virtual elective 4.7/5.0 compared to other virtual rotations and 4.0/5.0 compared to all rotations (including in-person and virtual). Furthermore, continual improvements were made to the established framework based on rotation feedback such that curriculum content was more abundant and more favorably rated by the last cohort when compared to the first. Finally, although students identified interest in over 10 different medical specialties, all participants expressed increased interest in choosing pathology as a specialty and better understanding of pathology’s role in patient care. We hope our detailed description of creating and evaluating a completely virtual elective rotation serves as a model for other departments to improve pathology education and visibility.

Compression of the сeliac trunk syndrome. History of the problem

The article presents the main stages of the development of ideas about a fairly rare pathology in clinical practice the syndrome of compression of the ventral trunk. Until the mid-nineteenth century, reports of the clinical picture of chronic abdominal ischemia were more descriptive. Serial pathoanatomic studies, comparison of anatomical features revealed at autopsy with clinical manifestations accompanying these changes, contributed to the isolation of chronic ischemic disease of the digestive system in a separate nosological form. The discovery of angiography contributed to the significant development of vascular surgery and the isolation of the ventral trunk compression syndrome as an independent disease, since it allowed for a lifetime comparison of the detected changes in blood vessels with the clinical manifestations of the disease. The term ventral trunk compression syndrome was first introduced by P. Harjola when describing a case of abdominal pain in a patient with compression of the ventral trunk by the neuroganglionic tissue of the ventral plexus. Later, J. Dunbar confirmed the Association of clinical manifestations of chronic abdominal pain with compression of the ventral trunk by the median arched ligament of the diaphragm. In English-language literature, the disease was named Dunbar syndrome. The effectiveness of eliminating the symptoms of this disease by surgical dissection of compression structures has been proven. Further study of this problem developed in parallel with the development of surgery in General in accordance with the emergence and introduction of new surgical technologies. The purpose of numerous studies was to study the etiopathogenetic mechanisms of the occurrence of a variety of clinical manifestations of this syndrome and improve the results of its treatment by improving known surgical techniques and introducing new ones.

Myocardial strain echocardiographic assessment: from theory to practice

Assessment of systolic and diastolic ventricular function is one of the main goals of echocardiography. Nevertheless, some patients require data beyond standard echocardiographic protocol for making more precise clinical decision and prognosis determination. The spectrum of novel parameters, including myocardial strain and strain rate, provides more comprehensive evaluation of the initial changes in myocardium in a variety of clinical conditions. New methods of quantifying the systolic function of left and right ventricles can be applied in patients with arterial hypertension, coronary heart disease, hypertrophic and dilated cardiomyopathies, also in patients with valvular heart disease such as aortic stenosis, aortic and mitral insufficiency. Besides strain analysis in patients with myocardial storage diseases, patients on cardiotoxic chemotherapy and patients with heart transplant turned out to be a specific niche for the method. Here, we provide the possibilities of strain analysis in variable heart pathologies in clinical practice.