Diagnosis Of Complicated Cases Research Articles

СОВРЕМЕННЫЙ ВЗГЛЯД НА ПРОБЛЕМУ PFAPA-СИНДРОМА (СИНДРОМ МАРШАЛЛА) У ДЕТЕЙ (клиническое наблюдение)

Background. PFAPA syndrome is the most common cause of recurrent fever in children. Despite the long history of the disease, the etiology and pathogenesis of the disease have not been definitively established. Aim. Analysis of the scientific medical literature on PFAPA syndrome (Marshall syndrome) with the presentation of personal clinical observation. Material and methods. An analysis of the medical literature devoted to the problem has been performed. A clinical case of a child with Marshall syndrome is presented. Results and discussion. The nature of the disease is associated with cytokine dysfunction and dysregulation of the inflammasome, which allows it to be classified as an autoinflammatory syndrome. The diagnosis of the disease is based on clinical and history criteria, the specificity of which has been questioned in recent years; new diagnostic criteria are now proposed. Despite the absence of double­blind randomized clinical trials, there is a wealth of experience with therapeutic approaches to PFAPA syndrome, includingВЕСТНИК СОВРЕМЕННОЙ КЛИНИЧЕСКОЙ МЕДИЦИНЫ 2021 Том 14, вып. 479ИЗ ПРАКТИЧЕСКОГО ОПЫТАthe administration of glucocorticoids, colchicine, and tonsillectomy. Our clinical example illustrates the problem of late diagnosis of PFAPA syndrome, the effectiveness of using glucocorticoids to control attacks as first­line therapy, and the need for different therapeutic approaches and differential diagnosis in complicated cases of monogenic autoinflammatory diseases. Conclusion. PFAPA syndrome is the most prevalent hereditary periodic fever syndrome. The exact epidemiology of the disease has not been studied, but it is assumed that the number of diagnosed cases is significantly lower than the actual prevalence of the disease. Attempts to revise the diagnostic criteria of PFAPA syndrome are currently underway. Despite the lack of randomized double­blind clinical trials to date, therapeutic strategies continue to improve.

Vaginal prolapse complicated with urinary bladder retroflexion and colonic herniation in a dog

A four-year-old, intact, female Anatolian Shepherd dog was presented with a three-day vaginal prolapse and anuria. She was lethargic, dehydrated, tachycardic, and blood analysis showed leukocytosis and azotemia. Ultrasonographic examination demonstrated that the urinary bladder was located in the prolapsed vaginal tissue. Ultrasound-guided cystocentesis was performed to empty the obstructed bladder and intravenous fluid therapy was instituted. When the dog was deemed cardiovascularly stable, a caudal midline celiotomy incision was made. Through gentle retraction of the uterus, the colon descendens and the bladder were placed back to their normal positions. After resolution of the cervical invagination, the cervix was pexied to the abdominal wall to prevent recurrence and ovariohysterectomy was performed. The dog made an uneventful recovery and had normal urination at the one month follow-up. Chronic vaginal prolapse can be complicated by a retroflexed urinary bladder with urethral obstruction leading to life-threatening azotemia. Ultrasonography of the prolapsed tissues contributes greatly to early diagnosis of complicated cases.

Role of Laparoscopy in Appendicular Mass among Pediatric Age Group With or Without Perforation: Early Outcome

AbstractBackground: Laparoscopic appendectomy is a safe, fea-sible and effective technique for complicated appendicitis such as mass, abscess and perforation in pediatric patients. Laparoscopic approach had several advantages over open appendectomy in that, it allow proper and wide visualization of the abdominal cavity.Aim: Our aim is to evaluate the feasibility and safety of laparoscopy in cases of appendicular mass among pediatric age group with or without perforation.Material and Methods: This study was carried out on fourty children presented by complicated appendicitis (perfo-ration, mass or abscess) with history less than 72 hours, aged between 4 and 18 years and scheduled for laparoscopic ap-pendectomy. Antibiotic regimen consisted of daily intravenous administration of (cefotiam, 80mgkg/24h) for 5 days intrave-nously and metronidazole (20mg/kg/24h) for 5 days intrave-nously, oral antibiotics (cefuroxime + metronidazole) were continued for another 1 week.Results: Intraoperative findings were 17 cases acute perforated appendicitis, 13 cases appendicular mass, two patients were converted to open appendectomy. Analysis revealed presence of gangrenous appendicitis in 75% and suppurative (Phlegmonous) appendicitis in 25% of all appen-dices. Post-operative complications were encountered in form of intraperitoneal collection in one, fever in five, umbilical port site infection in two cases.Conclusions: Laparoscopic appendectomy is a safe, fea-sible and effective technique for complicated appendicitis such as mass, abscess and perforation in pediatric patients. Laparoscopic approach had several advantages over open appendectomy in that, it allow proper and wide visualization of the abdominal cavity, moreover, it is very useful in reaching an exact diagnosis in complicated cases with experience and gentle handling.

Surgery and pleuro-pulmonary tuberculosis: a scientific literature review.

Tuberculosis (TB) is still a major public health concern, mostly affecting resource-constrained settings and marginalized populations. The fight against the disease is hindered by the growing emergence of drug-resistant forms whose management can be rather challenging. Surgery may play an important role to support diagnosis and treatment of the most complex cases and improve their therapeutic outcome. We conducted a non-systematic review of the literature based on relevant keywords through PubMed database. Papers in English and Russian were included. The search was focused on five main areas of intervention as follows: (I) diagnosis of complicated cases; (II) elimination of contagious persisting cavities, despite appropriate chemotherapy; (III) treatment of destroyed lung; (V) resection of tuberculomas; (VI) treatment of tuberculous pleural empyema. Although specific practical guidelines concerning surgical indications and approaches are currently unavailable, a summary of the evidence emerged from the scientific literature was elaborated to help the clinician in the management of severely compromised TB patients. The decision to proceed to surgery is usually individualized and a careful assessment of the patient's risk profile is always recommended before performing any procedure in addition to appropriate chemotherapy.

Imaging in pulmonary hydatid cysts.

Hydatid disease is a zoonosis that can involve almost any organ in the human body. After the liver, the lungs are the most common site for hydatid disease in adults. Imaging plays a pivotal role in the diagnosis of the disease, as clinical features are often nonspecific. Classical radiological signs of pulmonary hydatid cysts have been described in the literature, aiding in the diagnosis of the disease. However, complicated hydatid cysts can prove to be a diagnostic challenge at times due to their atypical imaging features. Radiography is the initial imaging modality. Computed tomography can provide a specific diagnosis in complicated cases. Ultrasound is particularly useful in peripheral lung lesions. The role of magnetic resonance imaging largely remains unexplored.

New Onset Visual Disturbances in a 37-Year-Old Female with Metastatic Carcinoma from Unknown Primary

Carcinoma presenting as brain metastases in a female without a known or clinically identifiable primary carcinoma has an important differential diagnosis, including lung and breast carcinoma among others. Clinical information, tumor morphology, and the use of immunohistochemistry can be used to formulate a diagnosis in complicated cases. We report a case of a young female who presented with metastatic carcinoma from an unknown primary site, which was clinically thought to represent metastatic lung cancer, who was ultimately diagnosed and treated for metastatic breast carcinoma. (The J Histotechnol 25:279, 2002)

Interictal epileptiform discharges in temporal lobe epilepsy due to hippocampal sclerosis versus medial temporal lobe tumors.

It remains controversial whether a specific pattern of interictal epileptiform activity exists that may help to differentiate temporal lobe epilepsy (TLE) due to hippocampal sclerosis (HS) from other forms of TLE. In this study, we characterized the distribution of interictal epileptiform discharges in TLE due to HS as compared with those in patients with tumors restricted to the medial temporal lobe structures. The study included 21 adult patients with unilateral HS who remained seizure free (>1 year) after anterior temporal lobectomy with amygdalohippocampectomy. Patients with "dual pathology" were excluded. The comparison group consisted of nine patients with tumors restricted to the amygdala and hippocampus. All patients underwent video-EEG monitoring preoperatively by using 39 scalp electrodes (including the 10-10 system over both temporal regions) and bilateral sphenoidal electrodes. The HS patient group showed a significantly higher percentage of ipsilateral epileptiform discharges maximal at anterior temporal electrodes (median, 97.0%; sphenoidal electrode alone, 88.1%), as compared with the tumor group (median, 72.1%; p<0.001; sphenoidal electrode alone, 24.8%; p<0.001). The HS group had significantly fewer extratemporal spikes/sharp waves (median, 0.0), as compared with the tumor group (10.0%; p<0.001). At least 90% of the interictal discharges were located in the anterior temporal region in 20 (95.2%) of 21 HS patients, but in none of the tumor patients (p<0.001). Bilateral temporal discharges were found in nine (42.9%) of 21 patients with HS and in two (22.2%) of nine tumor patients (p = 0.42). We conclude that ipsilateral interictal epileptiform discharges outside the anterior temporal region are rare (<10%) in adults with intractable TLE due to unilateral HS. Frequent posterior or extratemporal sharp waves may detract from the certainty of this diagnosis in complicated cases. These restricted epileptiform discharges suggest a smaller irritative zone in HS as compared with medial tumors, or a more organized activity associated with intrinsic hippocampal disease. Bilateral epileptiform discharges were not uncommon in both groups.