Diagnostic Examination In Patients Research Articles

Analysis of the effect of intensive therapy of premature infants on the development of neonatal retinopathy

Retinopathy of prematurity is one of the most severe diseases that lead to permanent blindness from early childhood. The frequency of retinopathy of prematurity in neonatology closely correlates with the degree of maturity of the child’s body.Goal. To conduct a analysis of the correlation of the degree of oxygenation, the number of blood transfusions with the severity of progressive retinopathy in newborns. The study included 40 premature infants diagnosed with retinopathy of newborns who were being treated in the neonatal intensive care unit. Conducted: clinical and diagnostic examination of patients; analysis of the dependence of the degree of oxygenation, the number of blood transfusions, gestational age, inotropic support and the severity of retinopathy.Materials and methods. Out of 40 patients diagnosed with neonatal retinopathy, 6 children were operated on.Results and discussion. The study showed that all the operated children were born at a gestation period of less than 29 weeks, were treated with antibacterial and inotropic drugs. There was no direct relationship between the number of blood transfusions and the risk of developing a severe form of the disease with further surgical treatment. In 40% of cases, children who developed retinopathy of stages 1 and 2 did not receive transfusion of erythrocyte suspension at all. At the treatment stage, all operated patients received a gas-air mixture with an oxygen content above 45%, as well as inotropic and vasopressor support with epinephrine and norepinephrine. Statistical analysis has shown that the number of blood transfusions is not the leading factor in the decision to refer a child for surgery. Among children with a gestation period of less than 29 weeks, retinopathy of varying severity was found in all infants; in the group of children aged 30–35 weeks, the disease developed only in 45% of patients.Conclusion. The conducted studies have shown that the parameter number of hours spent using IVL (the parameter artificial lung ventilation) is informative, and parameters such as weight and gestational age are significant.It is necessary to note the importance of additional parameters. Among the operated children, the condition of severe asphyxia was suffered by 45.5% of children in group A, in Weight groups severe asphyxia was in 28% of cases. Statistical analysis showed that children who required surgical treatment received catecholamine therapy at the initial stages. The most unfavorable percentage of oxygen supplied with the air mixture starts from 40–45%. The children who required surgical treatment received catecholamine therapy at the initial stages.

Электрофизиологические параметры органа зрения при лечении амблиопии

In amblyopia treatment, the purpose is to achieve a high maximally corrected visual acuity. Рurpose. The purpose of the study was to evaluate the electrophysiological parameters of the organ of vision in the treatment of patients with amblyopia. Material and methods. Object of study: patients with amblyopia, mean age 8.72 ± 1.43 years, who were continuously followed up for three years. Diagnostic examination of patients was carried out before and after treatment. Results. The average value of the estimated indicator in the sample population increased to 0.76 ± 0.05. The mean value of VEP amplitude in patients with mild amblyopia increased from 4.25 ± 0.4 µV to 5.35 ± 0.6 µV. In patients with moderate amblyopia, the mean VEP amplitude increased by 0.17 μV (4 % of baseline). In patients with a high degree of amblyopia, there is a significant increase in the average value of the indicator by 0.46 μV. In the group of patients with mild amblyopia, the mean latency decreased by 0.9 ms. In patients with moderate amblyopia, the mean latency significantly decreased by 2.5 % (3.1 ms). There is also a significant decrease in the index after the treatment in patients with severe amblyopia by 5.5 ms. The average threshold sensitivity in the group of patients with mild amblyopia increased by 9.2 db. In patients with moderate amblyopia, the increase in the indicator was 3.8 db (20 %), and in patients with a severe amblyopia, the average value of the indicator increased by 0.2 db. Conclusion. Thus, along with the generally accepted criteria for the effectiveness of amblyopia treatment, in particular BCVA, the values of the electrophysiological parameters of the organ of vision can be used as objective criteria for the effectiveness of the treatment of patients with different degrees of amblyopia. Keywords: amblyopia, best corrected visual acuity, electrophysiological parameters, amplitude, latency, photosensitivity.

Particularities of clinical onset and favorable evolution towards functional neurorehabilitation in a very large post-acenocoumarol overdose hematoma (C7-T10) ---a case report

Introduction: The incidence of spontaneous spinal epidural hematoma is relatively rare and it may cause a spinal cord injury possibly associated with related severe disabling conditions: sensory-motor impairments, back pain, neurogenic bladder and bowel. The MRI is the golden standard diagnostic examination in patients suspected of spinal epidural hematoma. Still, such a spontaneous condition can be, not-seldom, asymptomatic. Materials and methods: This paper presents the case of a 79-year-old male patient with permanent atrial fibrillation, treated with acenocoumarol, who was admitted, first in the General Surgery Clinic Division with rectal tenesmus and acute urinary retention and, subsequently developed a sudden onset of motor deficit, as presented in the body text. The patient was diagnosed with epidural hematoma (C7-T10) resulting in AIS/Frankel C paraplegia, with T10 neurological level. The positive and differential diagnoses concluded that the acenocoumarol overdose was the main etiopathogenic factor. Results: The patient—being promptly transferred to the Spinal Neurosurgical Clinic Division—received conservative treatment, followed by a neuro-muscular rehabilitation program achieved in our Neuro-Rehabilitation Clinic Division, with mainly favorable outcomes: at discharge he was able to walk independently on short distances. Conclusions: The clinical outcomes and quality of life of patients suffering from spinal epidural hematoma depend on the fast diagnosis and efficient acute neurosurgi-cal/conservative treatment, followed by an appropriate rehabilitation program, including with medium and long term medical follow-up. This clinical case has received the Teaching Emergency Hospital “Bagdasar-Arseni” Bioethics Committee approval No. 27/1935-25.02.2021.

Disorders of cognitive activity in patients with multiple sclerosis and hepatocerebral degeneration and its prevention

Annotation. Currently, there is an increase in dementias of various origins, which is largely due to the tendency of the aging population of the globe, with adverse environmental factors. Dementia also occurs at a young, working-aged, which makes them not only a medical but also a social problem. The incidence of Alzheimer's disease (AD) is so high that the WHO has declared the 21st century the century of the AD epidemic. The task of the work is to conduct a comprehensive clinical and laboratory examination of patients with multiple sclerosis (MS) and patients with Wilson's disease (WD) to study the problem of neurodegenerative diseases. The Mini-Mental Status Exam (MMSE) scale was used to screen for cognitive function and to study the level of intellectual performance of patients. To determine verbal memory, the method was used: “memorization of 10 words”, and to study the personality and emotional sphere, the method of Derogatis SCl-90-P was used. The sample of patients with MS was 111 people, and psycho diagnostic examination of patients with WD was performed in 33 patients. Various cognitive disorders are characteristic of MS patients. The level of general intellectual productivity is in the range from normative indicators to very pronounced systemic disorders of cognitive functions. With the age of patients and the duration of the disease, the severity of these disorders increases. A comprehensive clinical and laboratory study showed that the pathogenesis and stages of development of the dementia process in patients with WD and MS coincide with those in patients with Alzheimer’s disease and depends on three groups of factors: genetic predisposition, natural (biological) aging, and endogenous and exogenous pathogenic factors. on the brain. The study concluded that in patients with WD and MS in the pathogenetic process are always involved structures that ensure the functioning of cognitive functions of the brain, which leads to the development of their defects. For the treatment and prevention of these patients, a comprehensive, pathogenetically grounded, and personalized therapy should be prescribed.

Left Ventricular Ejection Fraction Is Associated with the Risk of Thrombus in the Left Atrial Appendage in Patients with Atrial Fibrillation.

Introduction Atrial fibrillation (AF) is associated with high risk of ischemic stroke. The most frequent thrombus location in AF is the left atrial appendage (LAA). Transthoracic echocardiography (TTE) is a basic diagnostic examination in patients (pts) with AF. Objectives To analyse the relations between basic echocardiographic features, well-established stroke risk factors, type of AF, and anticoagulation therapy with the incidence of left atrial appendage thrombus (LAAT). Patients and Methods. The study group consisted of 768 pts with AF (mean age, 63 years), admitted to three high-reference cardiology departments. Five hundred and twenty-three pts were treated with non-vitamin K antagonist oral anticoagulants (NOACs) and 227 (30%) with vitamin K antagonists (VKAs). The subjects underwent TTE and transesophageal echocardiography (TEE) before cardioversion or ablation. Results LAAT was significantly more frequent in pts with reduced left ventricular ejection fraction (LVEF): in 10.6% (7 pts) with LVEF < 40% and in 9.0% (9 pts) with LVEF 40-49%, while only in 5.5% (33 pts) with LVEF > 50%. Compared to pts without LAAT, those with LAAT presented with lower LVEF and higher left atrial diameter (LAD). Multivariate logistic regression revealed the following variables as independent predictors of LAAT: previous bleeding, treatment with VKA, and LVEF. Conclusion LAAT is related to lower LVEF and higher LAD. LVEF is one of the independent predictors of LAAT. Even in the case of adequate anticoagulant therapy, it might be prudent to consider TEE before cardioversion or ablation in patients with low LVEF and LA enlargement, especially in the coexistence of other thromboembolic risk factors.

Clinical Presentation, Imaging, and Management of Acute Cholecystitis

Acute cholecystitis (AC) is a life-threatening emergency that commonly occurs as a complication of gallstones. Severe right upper quadrant pain, abdominal guarding, fever, and a positive Murphy's sign with an elevated white blood cell count are the classical clinical manifestations of AC. Although ultrasonography is typically the initial diagnostic examination in patients with suspected AC, computed tomography and magnetic resonance imaging are commonly performed to identify complications; cholescintigraphy is recommended in patients with equivocal findings on the other imaging modalities, as this technique has the highest diagnostic accuracy in the diagnosis of AC. Imaging studies are also helpful in the timely detection of complications associated with AC. Although laparoscopic cholecystectomy is considered the gold-standard treatment for AC, percutaneous gallbladder drainage with or without cholecystostomy tube placement is a safe, effective management technique for surgically high-risk patients with multiple medical conditions. This treatment can be used as either a bridging therapy, with elective cholecystectomy performed at a later time after improvement of the patient's condition, or as definitive treatment in surgically unfit patients. Radiologists play a pivotal role in the initial diagnosis and management of patients with AC.

Self-reported colonoscopy screening in Austria

In Austria, since the early 1980s, the faecal-occult blood test is freely available within the annual health check-up system (> or =40 years of age/once a year). Since 2005 colonoscopy is recommended by the health authorities as a primary screening tool for asymptomatic persons older than 50 years (every 7-10 years). We report on the prevalence of self-reported participation and frequency of colonoscopy screening in Austrian men and women aged 40-79 years. The data analysed were extracted from a nationwide population-based cross-sectional study conducted in 2005. The study population consisted of 502 men and 553 women, which then was analysed by 10-year age groups. The questionnaire explicitly asked about a screening colonoscopy in asymptomatic persons and not for diagnostic examination in patients with symptoms. The survey revealed that of men 79.1% (n=397) knew about early detection of colorectal cancer in asymptomatic persons by screening colonoscopy and of women 82.1% (n=454). Of the 502 male respondents, 24.5% (n=123) were screened at least once and 9.8% were screened twice or more. Of the 553 female respondents, 23.7% (n=131) were screened at least once and 8.0% were screened twice or more often. The main location of colonoscopy screening was the hospital (men: 65.1%, women: 74.8%). Approximately a quarter of the respondents reported having had at least one screening colonoscopy. Compared with mammography screening (82%) and prostate cancer screening by digital rectal examination alone or combined with a prostate-specific antigen test (56%) the participation is low.

Incidental colonic fluorodeoxyglucose uptake: correlation with colonoscopic and histopathologic findings.

To evaluate the pattern and degree of incidental colonic fluorodeoxyglucose (FDG) uptake in patients without colorectal carcinoma who underwent whole-body FDG positron emission tomography (PET) for other purposes and compare them with colonoscopic and/or histopathologic findings. Cases of 27 patients without known history of colorectal carcinoma who were referred for evaluation with whole-body FDG PET and displayed incidental colonic uptake were reviewed retrospectively. Colonoscopy was performed in 10 patients; histopathologic analysis, in two; and both, in 15. The colonic FDG uptake patterns were nodular-focal, nodular-multifocal, segmental, and diffuse. The FDG uptake level was scored with a four-point scale in relation to hepatic uptake. Binomial distribution was used to calculate 95% CIs for the probability of finding an abnormality at histologic examination, as predicted by findings at FDG PET. Colonoscopic findings in eight patients with a diffuse uptake pattern were normal. Thirteen patients with nodular high FDG uptake had pathologic findings. Six (22%) of the 27 patients were not suspected of having a malignancy, and seven had benign neoplasms. With a 95% CI, nodular high FDG uptake implies at least a 79% chance that histopathologic findings may be abnormal. Colitis was seen in five of six patients with a segmental pattern of high FDG uptake. Colonoscopy is a reasonable next step for further diagnostic examination of patients who display nodular high FDG uptake in the colon. Diffuse FDG uptake often is associated with normal findings at colonoscopy, while segmental high uptake may imply inflammation.

Focal arterial injuries of the proximal extremities: helical CT arteriography as the initial method of diagnosis.

To present our experience with helical computed tomographic (CT) arteriography as the initial diagnostic examination in patients suspected to have focal arterial injuries of the proximal extremities. During 19 months, 142 arterial segments in the proximal portions of the extremities of 139 patients with trauma were evaluated with helical CT arteriography. CT arteriograms were interpreted on site by the radiologist in charge of emergency procedures and retrospectively with consensus interpretation between two radiologists. CT study quality and the presence of arterial injuries were noted. CT arteriographic findings were compared with those of surgery, conventional arteriography, and/or clinical follow-up. Five (3.6%) patients had nondiagnostic studies and underwent conventional arteriography. In the remaining 137 arterial segments in 134 patients, helical CT arteriography demonstrated arterial injuries in 61 segments and normal arteries in 76 segments. These segments were treated initially with surgery (55 segments) or endovascular intervention (four segments) or were observed (78 segments); 77 of the 78 observed segments remained stable at 3-18 months (mean follow-up, 5.2 months). There were no differences between the on-site and consensus interpretations (kappa = 1.0). The sensitivity of CT arteriography was 95.1%, and the specificity was 98.7%. Helical CT arteriography can be performed as the initial diagnostic method in most patients suspected to have focal arterial injuries of the proximal portions of the extremities.

Abdominal US for diagnosis of pancreatic tumor: prospective cohort analysis.

To elucidate the accuracy of abdominal ultrasonography (US) in the diagnosis of pancreatic tumors. In all patients referred for pancreatic US during 1988-1990, data on malignant disease and survival were analyzed by using the Swedish Death and Cancer Registries. Nine hundred nineteen patients were entered into the analysis. In 140 of them, a clinical diagnosis of tumor in the pancreatic area was confirmed within 1 year after US. These tumors were primary pancreatic tumors (n = 102), common bile duct and duodenal cancers (n = 17), and metastases in the pancreatic area (n = 21). The sensitivity of US in the detection of all tumors in the pancreatic area was 88.6% (124 of 140 patients), which was similar to that for the detection of exocrine pancreatic cancer, 90% (79 of 88 patients). There were nine false-positive US examinations, for a specificity of 98.8% (770 of 779 patients). Systematic sampling of 94 investigations confirmed an association between US accuracy and presence of clinical symptoms of pancreatic cancer. Significant differences in the sensitivity (P < .05) and accuracy (P < .01) of diagnosis were observed between three experienced investigators. Study results support the use of US as a first-line diagnostic examination in patients suspected of having pancreatic tumor. Dependency on the investigator's experience with US mandates continuous evaluation of its performance.

Excretory Urography

The problems about the value of excretory urography as a preoperative diagnostic examination in patients with benign hypertrophy of the prostate are discussed. On the basis of IVPs, renal function, and absence of hematuria and/or infection in 500 consecutive patients who were to undergo prostatic surgery, it is concluded that IVP is a superfluous examination. In patients with impaired renal function (Se-creatinine > 1.5 mg%) IVP showed abnormalities in 41.3%. In patients with normal renal function and urinary tract infection IVP revealed abnormalities in 20.6%. In patients with normal renal function and microscopic hematuria IVP showed abnormalities in 19.2%. It is thus concluded that IVP should be undertaken in patients with impaired renal function (Se-creatinine > 1.5 mg%) and may be considered in patients with normal renal function with hematuria or infection.