Diagnostic Peculiarities Research Articles

#1384 Obstructive sleep apnea and fluid management in the hemodialysis: are clinicians putting existing scientific evidence into practice?

Abstract Background and Aims Obstructive Sleep Apnea (OSA) prevalence was found to be higher in an intermittent hemodialysis (iHD) population of the French-speaking Switzerland than in the general population of the same geographical area. The high prevalence of OSA in iHD patients was linked to fluid overload. Interdialytic fluid management targeting a low dry weight showed to reduce OSA's severity, offering a novel therapeutic option in this population. The aims of this study were: 1) to assess the prevalence of confirmed OSA in an end-stage renal disease (ESRD) population undergoing iHD in the Italian-speaking area of Switzerland; 2) to assess the awareness of the treating nephrologists about the OSA's diagnosis of their patients; and 3) to evaluate whether nephrologists integrate the current knowledge in their fluid management strategy of iHD patients with OSA. Method We performed a multicenter, cross-sectional study between July 2022 and July 2023, screening all patients attending the four iHD units of the Ente Ospedaliero Cantonale (EOC), the public hospital network of Canton Ticino (Switzerland), and including those with confirmed OSA. For these patients, we collected anthropometric parameters, iHD protocol characteristics and fluid status from electronic patient dossiers. Fluid overload was measured by multifrequency bioelectrical impedance (Body Composition Monitor®, BCM®; Fresenius Medical Care). Nephrologists of the four iHD units were asked to identify patients with known OSA diagnosis, without consulting the medical dossiers, and were interviewed about their specific iHD strategy in patients with OSA. We compared the fluid management of patients identified as “OSA positive” and those with OSA diagnosis, but misclassified as “OSA negative” by the treating nephrologist. Results Out of 193 patients treated by iHD in the four HD units, 45 patients had a confirmed diagnosis of OSA and were included in this study. Mean age was 76.0 ± 7.5 y, 82.2% were men, mean BMI was 29.1 ± 4.5 kg/m2. They were treated 3 times per week, in mean for 3.76 ± 0.37 hours; 22 were treated by hemodialysis and 23 by hemodiafiltration. The 23% prevalence of diagnosed OSA observed in the study population was significantly lower than the 56% prevalence found in the French Switzerland iHD cohort (p < 0.001). Out of the 45 patients with diagnosed OSA, only 27 (60.0%) were correctly identified by the treating nephrologist. We found no difference in the dry weight target defined by the treating nephrologist between the patients correctly identified as “OSA positive” and those misclassified as “OSA negative”, both being close to the dry weight calculated with BCM® (mean difference 0.7 ± 2.3 vs 0.3 ± 1.4 kg; p = 0.564). The pre-dialysis fluid overload of the whole population was 2.4 ± 1.7 kg, being higher in the “OSA positive” group (2.9 ± 2.0 kg) than in the “OSA negative” group (1.8 ± 0.7 kg; p = 0.0172). However, we found no difference in post-dialysis achievement of dry weight between the groups (residual overweight 0.2 ± 1.0 and 0.1 ± 0.7 kg respectively; p = 0.672). In the interviews, only half of the nephrologists (4/8) were aware of the correlation between fluid overload and OSA, and two of them reported to integrate this knowledge in their fluid management strategy, even if not systematically. Conclusion Nephrologists' attention to sleep apnea in iHD patients seems to be low, despite its high prevalence in this population and scientific evidence supporting that targeting fluid overload is an effective option to improve OSA severity. However, nephrologists tried to achieve the dry weight very strictly in all patients, independently of OSA. More intensive training of nephrologists to the clinical and diagnostic peculiarities of OSA in patients with ESKD is required, in order to improve OSA diagnosis and targeted therapeutic care.

Diagnostic peculiarities of lymphomas in the cervical region in children

Thisarticle discusses various aspects of pediatric lymphadenopathy, focusing on Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). It outlines common etiologies, diagnostic techniques, and key characteristics of differ- ent lymphoma subtypes. HL is classified into classical HL (CHL) and nodular lymphocytic predominant HL (NLPHL), while NHL includes Burkitt lymphoma (BL), lymphoblastic lymphoma (LBL), diffuse large B-cell lymphoma (DLBCL), and anaplastic large cell lymphoma (ALCL). The text emphasizes the importance of accurate diagnosis through various tests, including imaging modalities such as positron emission tomography (PET) and computed tomography (CT). It also discusses the potential use of ctDNA as a prognostic marker and highlights genetic alterations contributing to lymphoma development. The relevance of these findings for pediatric patients and their impact on treatment strategies is emphasized throughout the text.

472 Right-sided diaphragmatic hernia causing gastric outlet obstruction 1 month after trauma

Abstract Diaphragmatic hernias arising from trauma are rare, and scarcely present in a delayed manner. This case report highlights a case of delayed presentation of a right-sided post-traumatic hernia in a 73-year-old woman following a fall. This report sheds light on the diagnostic peculiarities and management. The woman presented with a 3-day history of abdominal pain and coffee-ground vomiting. This followed a fall a month ago. Computed Tomography confirmed the diagnosis of a gastric outlet obstruction secondary to a right-sided diaphragmatic rupture. At surgery, the herniated abdominal contents were reduced, and the diaphragmatic defect fixed. The postoperative recovery was unremarkable and the patient discharged on day 4. This case highlights that diaphragmatic hernias should be considered as differential diagnoses following recent trauma.

Tooth root resorption: A review.

Tooth root resorption is multifactorial, leading to progressive destruction and eventual loss of tooth root dentin and cement. There are internal and external types of root resorption, each having its variety. The etiology and pathogenesis of tooth root resorption are poorly understood, and the most significant etiological factors are trauma, pulpal infection, tooth bleaching, and orthodontic treatment. Tooth root resorption is primarily asymptomatic; thus, it is revealed accidentally by radiographic examination. Progressive clinical manifestations are pain, tooth discoloration, tooth mobility, and other conditions. Awareness of the causes and risk factors allowing tooth root resorption, and regular radiographic examination, in case of necessity, make it possible to reveal resorption at an early stage and to prevent its further development. Thus, the aim of this study is to present etiopathogenesis, a clinical course, and diagnostic peculiarities of internal and external types of tooth root resorption, enabling practicing dentists to timely diagnose root resorption and take appropriate measures to avoid further complications. Within the limitation of this review, even though the etiopathogenesis of tooth root resorption is yet not fully understood, it is suggested that the etiological factors fall into two groups (endogenic and exogenic) to enhance further understanding of the possible causes and mechanisms of root resorption and allow practitioners to monitor high-risk patients and make timely diagnoses. Moreover, radiographic examination and CBCT are indispensable for the diagnosis of root resorption.

Diagnostics of chronic exercise-induced urticaria in a child (a case report)

This article shows a case report of exercise-induced urticaria diagnosis in an 8-year-old boy. The aim of this work is to show diagnostic peculiarities of chronic urticaria with known trigger. The necessity of diagnostic algorithm fully implementation is emphasized, even in presence of a clear correlation with trigger factor (in this case – physical exertion). The described case is interesting because previously healthy child without anamnesis of allergic and another chronic disease developed urticaria and symptoms of angioedema without visible cause. Objective examination did not reveal any clinically significant abnormalities except moderate nasal congestion, which was neglected by both the patient and his parents. His was without a past medical history of fever. The child underwent laboratory and instrumental examinations: clinical blood, urine and biochemical tests, immunological tests (cell-mediated and humoral immunity, phagocytosis). Acute phase response was within normal ranges. Total IgE was increased to 100.5 IU/ml, increased levels of specific IgE to cat allergen (41.13 кU/l), serum ß-lactoglobulin of cow’s milk (2.95 кU/l) and lamb meat (0.41 кU/l) were detected. Autoserum test was positive (histamine – papula of 5 mm, hyperemia of 15 mm, negative control – 0, patient’s serum – papula of 16.5 mm, hyperemia of 24 mm); thyroid autoantibodies and thyroid hormone levels were within normal ranges. Tests for physical urticarial were performed: aquagenic, cold, heat, vibratory were negative, dermographic urticaria was positive, test with physical exercise (treadmill) was positive (small-sized wheals and lower eyelid angioedema developed on the 14th minute of sweating). Detailing of anamnestic data revealed an appearance of small wheals after emotional sufferings, and a single episode of difficulty breathing with urticaria and angioedema symptoms while playing football). Conclusions. Thus, extended detailed diagnostics of this clinical case has revealed the combined influence of several factors (dermographic, physical exertion, sensitization to some allergens, autoimmune variant of urticaria/angioedema) clarifying that symptoms could be mediated by both IgE- and non-IgE-dependent mechanism in the same patient. Primary diagnosis of “chronic exercise-induced urticaria” has been changed to “anaphylaxis” requiring another approach to treatment and follow-up.

Protocolo diagnóstico de la fiebre sin foco de reciente comienzo en el paciente estable

Fever of recent onset (less than seven days) commonly has an infectious cause. The initial evaluation of a patient with fever includes an examination of alarm signs and hemodynamic instability. In a stable patient, the diagnostic evaluation will be done based on the patient's clinical conditions and current symptoms and will be oriented toward establishing the etiology in order to begin the most appropriate treatment. There are diagnostic peculiarities in the management of elderly and pluripathological patients. Fever in patients who are hospitalized or in contact with healthcare services is frequent and potentially severe. These patients are more susceptible to infection and at risk of infection by multiresistant microorganisms.

Pharmaco-chemical profiling of Desmodium gangeticum (L.) DC. with special reference to soil chemistry

BackgroundDesmodium gangeticum (L.) DC. (Fabaceae) (DG) is a perennial non-climbing herb or shrub and folklore medicine, widely shows a large number of medicinal properties, as well as contains divergent bioactive compounds. Many of the herbal formulations contain this medicinal plant, which is considered as master of medicinal plant in Ayurveda. This study is an attempt to establish this plant material based on its pharmaco-chemical profiles with special reference to soil chemistry. The pharmaco-chemical features such as organoleptic, DNA sequence, physicochemical, proximate, phytochemical, UV, and FTIR profiling were carried out using standard techniques. Moreover, the ADME-PK properties of the selected molecules were established.ResultsThe pharmaco-chemical features like organoleptic, DNA sequence, physicochemical, proximate, phytochemical, UV, and FTIR profiling, ADME-PK properties, and soil chemistry of D. gangeticum revealed its unique and diagnostic peculiarities. DNA barcoding showed that the sequence was 99.77% similar to D. gangeticum (KP094638) having 100% query coverage. The soil analysis revealed the presence of moderately high content of NPK and sufficient amount of all essential macro- and micronutrients (S, Fe, Mn, Cu, Zn, and B). The phytochemical profiling showed that the ethanolic extract of the aerial part contained glycoside, amino acid, phenols, alkaloids, flavonoids, and coumarins, while the ethanolic root extract of the plant revealed the presence of glycoside, amino acid, phenols, alkaloids, flavonoids, coumarins, and triterpenoids. FTIR results indicated that the plant extracts are mainly rich in phenolic derivatives. ADME-PK properties of pterocarpan such as gangetin (1a), gangetinin (1b), desmocarpin (1c), and desmodin (1d) were found to pass the Lipinski, Ghose, Veber, and Egan rules, supporting the drug-likeliness.ConclusionThis is the first record of pharmaco-chemical profiling of D. gangeticum along with soil chemistry, and this information helps in the proper identification and future studies on this species.Graphic abstract

Diagnostic peculiarities of benign ovarian tumors during pregnancy

Objective of the study: improvement of diagnostic methods for pregnant women with tumor-like formations and ovarian tumors.Materials and methods. 60 pregnant women were examined and divided into 3 groups: group I – 28 pregnant women with ovarian tumors who underwent surgical treatment during pregnancy; group II – 21 women with ovarian tumors who underwent surgical treatment at various times after spontaneous delivery; group III (control) – 11 women with a normal course of pregnancy without ovarian tumors.Doppler ultrasound was performed on a mandatory basis at the screening time, and as well as needed. MRI was performed in 8 diagnostically difficult cases. In the II trimester of pregnancy at 12–24 weeks in 49 women with ovarian tumors tumor markers were determined: CA-125, HE-4, β2-microglobulin, transthyretin, transferrin and apolipoprotein A-I, and combined ROMA and RMI indices.Results. The analysis showed the characteristic echographic signs of most ovarian tumors in pregnant women. The overall accuracy of ultrasound in determining the ovarian tumor structure at the outpatient level was extremely low and amounted to 21.8%, in a specialized medical institution it was 79.2%. In the diagnosis of mature teratomas were found MRI sensitivity and specificity of 100%, less diagnostic value (sensitivity 91.7%, specificity 96.9%) was typical for endometrioid ovarian cysts. MRI efficiency in detecting malignant potential (borderline and malignant tumors) was quite high (sensitivity 80.0%, specificity 97.4%).The presence of any ovarian tumor, except for mature teratomas, was accompanied by a significant increase in CA-125 level. The strongest correlation was found for RMI index and CA-125 and HE-4 tumor markers.Conclusions. Doppler ultrasound and MRI are complementary highly informative methods for diagnosing ovarian tumors in pregnant women. Tumor markers used for the differential diagnosis of benign and malignant tumors outside pregnancy (CA-125, HE-4, apolipoprotein A-I, transferrin, transthyretin, β2-microglobulin) do not have a high enough diagnostic value in ovarian tumors in pregnant women, therefore their tests should be supportive.

Superheated metastable water atomization: fine atomized water plumes diagnostics and disperse characteristics; summary of results, applications in power generation and new techniques.

Complex experimental investigation of superheated flow and dispersion characteristics of sprays in atomizing nozzles of various types is made. The comparative analysis of experimental and calculating investigations of thermo physic and hydro- gas-dynamic flow and disperse characteristics was carried out for various types of spray nozzles. It has shown that the main process, which determine peculiarities of superheated metastable water flow and phase transformation in spray nozzles, is quick (explosive) boiling up. And the optimal variant for superheated water atomization and achieving the most fine spray plumes, which contain mainly submicron droplet fraction, at initial temperature 240°C (and higher) is atomization by means of contracting-expanding nozzles. In such nozzles the explosive boiling is accomplished by quick transformation of foamed liquid into vapor-droplet flow. Diagnostic peculiarities are considered for these optically dense spray plumes; the auxiliary measurement methods were worked out for estimation superheated water high atomization level. The experimental and calculating data dimensionless treatment was made for achieving extremely fine (mainly submicron) superheated water spray. The dimensionless parameter, which determines necessary water (or some other liquids, for example – fuels) superheating level was derived. The possible technical applications of superheated water sprays are described, and up-to-date state of corresponding projects is given.

The contact ureterolithotripsy in treatment of ureterolythiasis

Objective. Аnalysis of the treatment results in patients, suffering ureteric calculi, using the contact ureterolithotripsy procedure.
 Маterials and methods. In 104 patients with ureteric calculi, in whom ureteroscopy with further laser contact ureterolithotripsy was conducted, symptoms of the disease were analyzed, as well as the diagnostic methods value, peculiarities and efficacy of surgical treatment.
 Results. In all the patients endoscopic extraction of calculi have been succeeded. Calculus does not cause significant macroscopic changes in ureter, if symptoms, characteristic for ureterolithiasis, persists up to one week. Local edema is formed, if a calculus persists in ureter longer than a week. Long-term (more than two months) local ureteric persistence of calculi enhances the risk of its intramucosal intraureteric «ingrowth» greatly.
 Conclusion. The contact ureterolithotripsy constitutes a highly effective and miniinvasive method of surgical intervention in ureterolithiasis, guaranteeing high level of postoperative “stone free rate”. Prolongation of the calculi ureteric insertion time without a process of a stone discharge causes the ureteric wall changes, complicating performance of miniinvasive interventions (the contact ureterolithotripsy and a distant shock-wave lithotripsy).

INTERACTIVE LEARNING IN THE COURSE OF INTERNAL MEDICINE: STEPS IN MAKING DIAGNOSIS

Current trends in the development of the Ukrainian education system provide a new approach to the organization of educational process. A doctor must know the algorithm of the diagnostic process and medical decision-making peculiarities underlying the making diagnosis. This requires constant improvement as the number of law cases has demonstrated that diagnostic errors are merely not due to physician’s insufficient medical qualification but often as a consequence of violation of the basic procedural laws. Studying the theory of medial diagnosis stimulates the development of clinical thinking. The purpose of this work was to systematize the main stages in making diagnosis and to outline the ways of their implementation through the interactive learning. The study involved the medical students of Zaporizhzhia State Medical University. The methodology included theoretical systematic analysis of scientific and methodological literature as well as own experience in applying interactive learning. The main motivating factor in the professional training organization should be focused on the professionally oriented use of material and fostering students’ own experience. Under these conditions, the importance of a semiotic approach to the diagnosis of diseases is increasing, i.e. the process of disease identification relies on the ability to catch and to recognise its signs. When making a diagnosis, the doctor has to rely on facts only. This is described as "clinical thinking." The interactive learning in the courses of various disciplines in the program of medical doctor training is being actively implemented at Zaporszhzhia State Medical University. It provides the opportunity for more pronounced pedagogical influence, which induces students to be more active in mastering the program, as well as to demonstrate creativity and research for solving various tasks in daily class practice. Deep understanding the theory of medical decision-making process and making diagnosis greatly contributes to clinical thinking.

ERRORS IN THE DIAGNOSTICS OF TESTICLE TORSION IN CHILDREN

Introduction. Testicular torsion is an emergency condition requiring emergency medical care. Polymorphism of symptoms in testicular torsion makes diagnostics not easy and leads to late treatment what can results in irreversible damages to the testicle. Early diagnostics is a key point to organ preservation. Material and methods. The authors describe two clinical cases of testicular torsion in adolescents with errors in diagnostics. Clinical, laboratory findings and instrumental examination (MRI, ultrasound) were used for diagnostics. Results. A diagnostic error resulted in orchectomy which was made to one patient. In the other patient - despite a diagnostic error- testiclular detorsion and urgent surgical intervention resulted in patient’s complete recovery. Discussion. These examples illustrate how important is to carefully study the patient’s case-history - onset and nature of pain, associated vegetative symptoms - nausea and vomiting - which are not characteristic for other acute testicular diseases. Conventional tactics of urgent surgical intervention for all acute testicular diseases in children does not insure against diagnostic errors in case of testicular torsion with atypical symptoms. Ultrasound examination is of irreplaceable value, but one cannot be guided only by its findings in excluding testicular torsion. Conclusion. Any of the symptoms of testicular torsion - whether it is acute onset or severe pain, or a combination with vomiting, or severe pain on palpation, or ultrasound findings - is a reason to suspect testicular torsion and, it is an absolute indication for urgent surgery. The protocol for diagnostics and treatment of acute testicular diseases developed by us includes these diagnostic peculiarities and allows to choose an effective treatment modality.

Moderne radiologische Diagnostik in der Wirbelsäulenchirurgie

Radiological imaging is important in the preoperative diagnosis of many forms of spinal pathology and plays afundamental role in the assessment of p.o. effects, which can be verified on the spinal column as well as on the surrounding soft tissues, depending on the imaging method used. The article provides an overview of the current status and possibilities of radiological diagnostic methods for the verification of possibly recommended spine surgery in the context of degenerative, inflammatory-infectious, post-traumatic or p.o. pathologies and changes in the spine: X‑rays, computed tomography (CT), magnetic resonance imaging (MRI). The supplementary nuclear medicine procedures (scintigraphy, PET[-CT], SPECT, etc.) which may be required for special questions are not discussed. The merits and limitations of the techniques used in the investigation of advanced degenerative spinal pathologies and post-traumatic conditions are discussed, with multidetector CT being the focus of attention in spinal clearance for traumatic injuries. In most cases of spinal infection, MRI images, as acentral diagnostic tool, show typical findings such as destruction of adjacent endplates, bone marrow and intervertebral disc abnormalities, and paravertebral or epidural abscesses. However, it is not always easy to diagnose aspinal infection, especially if atypical MR patterns of infectious spondylitis are present. Knowledge of them means misdiagnosis and improper treatment can be avoided. It is shown that high-quality modern radiological examinations are essential for diagnosis and p.o. management, as these provide answers to the main questions in the treatment: Is the entity/injury stable or unstable, acute or old, benign or malign; is there amyelopathy or p.o. complication? The main indications for p.o. diagnostic imaging, difficulties such as metal artefact formation, and potential pitfalls are analyzed. Entity-specific radiological image patterns, imaging algorithms and differential diagnostic peculiarities are presented and discussed based on current literature and selected case studies.

Diagnostic features of artificial pyoinflammatory diseases of soft tissues

The objectiveof the article is to discuss diagnostic peculiarities of artificial pyoinflammatory diseases of soft tissues (APIDST).Material and methods.We analyzed the clinical data of 302 military men.Results.As compared to the non-artificial pyoinflammatory diseases of soft tissues of level 2-4 (PIDST of level 2-4), APIDST are characterized by the presence of local self-induced skin injuries that are mostly located on shins, the crepitation during palpation in the projection of the abnormal focus, and the signs of anaerobic infection (86.1%) and cellular-fascia-myositis (57.6%) during the surgical intervention in the lesion.Conclusion.The revealed clinical features of pathology should be taken into account in the treatment.

Особливості вагінальної мікрофлори у жінок з безплідністю та психосоматичними порушеннями

The article presents the results of the study of clinical and diagnostic peculiarities of vaginal microflora in women with infertility on the background of psychosomatic disorders. The study included 233 patients with infertility diagnosis, which were divided into the following groups: the main – 61 patients with infertility against the background of severe psychosomatic disorders; control – 172 patients with infertility without expressed psychosomatic disorders. In both studied groups, violations of vaginal microflora in the form of bacterial vaginosis of different morphotypes by Newgent criteria were revealed. It is noted longer, with relapse of bacterial vaginosis in patients with infertility against background of psychosomatic disorders, which may be related to concomitant somatic diseases in such women, such as pathology of the gastrointestinal tract, endocrine diseases, metabolic disorders, etc., which requires additional treatment courses. Key words: vaginal microflora, bacterial vaginosis, female infertility, psychosomatic disorders.

Динамика сепсиса и септического шока в Казахстане и мире, особенности диагностики.

Динамика сепсиса и септического шока в Казахстане и мире, особенности диагностики.

Disseminated Mycobacterium Haemophilum Infection Masquerading as Erythema Nodosum and Avascular Necrosis in an Immunocompromised Host

Abstract Mycobacterium haemophilum is likely an underrecognized cause of infection among patients with deficits in their cell-mediated immunity. Despite its name, which translates to “blood loving,” it remains unclear whether hyperferritinemic patients are also at higher risk of this infection. We present a 24-year-old woman with disseminated M. haemophilum infection who has hyperferritinemia and T-cell acute lymphoblastic leukemia in remission and was initially misdiagnosed as having erythema nodosum and avascular necrosis. This report highlights the clinical and histological similarities of M. haemophilum and erythema nodosum, discusses some diagnostic peculiarities, and also reviews similar cases within the literature.

Several Dengue: About 2 Cases with Pulmonary Disease

The most widespread arbovirus in the world, dengue fever has been rampant since the 18th century. Since then, several epidemics have been documented in Asia, the Caribbean, South America and Africa. The authors report two cases of dengue fever in children aged six (6) and twelve (12) years respectively. The diagnosis of several dengue pulmonary was retained in these children, clinico-radiological and biological arguments. In addition to the hemorrhagic syndrome, the pulmonary symptomatology associated cough, dyspnea. Chest X-ray revealed bilateral and extensive alveolar interstitial radiological lesions. From a biological point of view, the positivity of dengue-specific IgM has confirmed arboviruses. From the diagnostic peculiarities of the cases observed, the authors suggest the search for factors associated with a primary dengue infection from several onsets to pulmonary manifestation in children. Indeed, this fringe of the population is no longer concerned with acute respiratory infections. In addition, the socio-cultural context of poverty, of pre-hospital therapeutic itinerary favoring traditional medicine, delays hospital care.

Abnormal Chords of Left Ventricle as Cardiac Manifestations of Connective Tissue Dysplasia Syndrome

The article highlights the major problems of diagnostics and clinical relevance of such minor structural heart abnormalities as left ventricular abnormal chords. Possible hemodynamic changes, clinical manifestations and cardio-vascular complications associated with abnormal chords are presented. Abnormal chords of the ventricles (VAC) are connective tissue and muscular formations, which have ectopic attachment unlike normal chords. Abnormal chords are the most common cardiac manifestations of non-differentiated connective tissue dysplasia syndrome (CTDS). Commonly, they are associated with mitral valve prolapse as well as with other phenotypical manifestations of connective tissue dysplasia – joint hypermobility, increased skin extensibility, scoliotic posture, duplication and ptosis of kidneys etc. Modern views concerning the prevalence of this pathology, its clinical manifestations, diagnostic peculiarities as well as prognostic value of different topical and quantitative variants of abnormal chords are given. The effect of abnormal chords on arrhythmogenesis of left ventricle, development of cardialgia and myocardial ischemia development, heart cavity remodeling, systolic and diastolic function of the left ventricle are discussed. Pathogenetic relationship between multiple abnormal chords and such serious hereditary disease as left ventricular non-compaction is emphasized. The article focuses on the statement that the patients with left ventricular abdominal chords like all patients with minor structural heart abnormalities should be placed into “the risk group” because of possible development of ventricular arrhythmias, heart remodeling and chronic heart failure.

Clinical and diagnostic peculiarities of middle ear cholesteatoma course in children

Clinical and diagnostic peculiarities of middle ear cholesteatoma course in children