Differential Diagnosis Of Pathological Conditions Research Articles

Diagnostic and therapeutic possibilities of balloon-assisted enetroscopy in clinical practice

The aim. To evaluate the effectiveness of endoscopic techniques for gastrointestinal bleeding of unknown origin in the conditions of GBUZ “KKB No. 2” and to determine the most effective therapeutic tactics. Materials and methods. The basis for our study was the analysis of the results of treatment of 47 patients with suspected small intestine bleeding in the period 2018-2023 in the State Medical Institution “KKB No. 2” of the city of Krasnodar. The study group was dominated by men -25 patients (53%) compared with women - 27 patients (47%). The age of the patients ranged from 18 to 89 years. VCE was performed in 16 patients. In controversial and unconvincing cases, BAE-14 patients were performed. A comprehensive examination of VCE + BAE was performed in 17 patients. Results: The most rational method of endoscopic hemostasis in small intestine bleeding, according to our observation, is endoscopic clipping in combination with conservative therapy. Results. According to our observation, the most rational method of endoscopic hemostasis in small intestinal bleeding is endoscopic clipping in combination with conservative therapy. Conclusion. The capabilities of clinicians in the differential diagnosis of pathological conditions of the small intestine are enhanced by the availability of modern equipment in medical and preventive institutions, as well as to perform minimally invasive treatment, reducing the rehabilitation time due to the reduction of surgical trauma.

Дифференциальная диагностика гипогликемий, развившихся на фоне врожденного гиперинсулинизма

Congenital hyperinsulinism (CHI) is a genetic disorder characterized by inappropriate insulin secretion by pancreatic b-cells. CHI may induce the development of severe hypoglycemic conditions already in the neonatal period. The causes of neonatal hypoglycemia are diverse; therefore, an accurate algorithm is needed for diagnosis and differential diagnosis of pathological conditions accompanied by hypoglycemia. One of the causes of low blood glucose levels is hyperinsulinism, both exogenous (administration of insulin or its stimulants) and endogenous (autonomous insulin secretion, disorders of the propulsive or endocrine function of the gastrointestinal tract). An increase in insulin levels in the blood due to hypoketonemia is one of the common signs of this condition. In etiopathogenesis, transient and persistent hyperinsulinism are distinguished. The latter is represented by monogenic (genetic defects in insulin secretion) and syndromic (associated with other hereditary diseases) forms. This article presents data on the characteristics of insulin metabolism, possible causes of CHI, and discusses the algorithm for differential diagnosis of neonatal hypoglycemia for timely detection of CHI. Key words: congenital hyperinsulinism, neonatal hypoglycemia, hyperinsulinism-hyperammonemia syndrome, Sotos syndrome, Beckwith–Wiedemann syndrome, Kabuki syndrome, Costello syndrome, congenital disorders of glycosylation

A clinical case of community-acquired pneumonia with severe obstructive respiratory failure syndrome caused by <i>Chlamydia pneumoniae</i> in an early-age child with a burdened premorbid background

Introduction . Violation of bronchial patency is a particularly urgent problem in pediatric practice, which is primarily due to the increase in the frequency of its development and occurrence in young children with acute respiratory infections of the lower respiratory tract, the lack of an unambiguous and unified interpretation of the causal factors of formation and pathogenetic mechanisms, as well as the difficulty of differential diagnosis of pathological conditions accompanied by obstruction. Presentation of the clinical case . The publication presents a clinical case of community-acquired bilateral lower lobe pneumonia in combination with severe obstructive type respiratory failure syndrome caused by Chlamydia pneumoniaе in an early-age child with an established diagnosis of bronchial asthma: polyvalent sensitization, who suffered COVID-19 twice during the year. The severe course of the disease with pronounced clinical manifestations of intoxication and respiratory insufficiency of the obstructive type in the patient was accompanied by laboratory changes in clinical and biochemical blood tests, the presence of a diagnostic titer of antibodies to Chlamydia pneumoniaе during serological testing and a CT picture of multiple areas of lung tissue compaction according to the ‘frosted glass’ type, predominantly rounded, of varying length in the lower parts right and left lung. In our clinical case, the differential diagnosis of obstructive syndrome in a young child caused a number of difficulties due to the influence of factors of the patient’s burdened premorbid background on its formation: the presence of a hereditary predisposition to maternal atopy (bronchial asthma) and verified diagnoses of bronchial asthma and atopic dermatitis: sensitization to birch pollen, cow’s milk protein and chicken yolk eggs; episodes of acute urticaria. Conclusion . During a comprehensive clinical and laboratory-instrumental examination conducted in a hospital, the patient was diagnosed with: ‘Community-acquired bilateral lower lobe pneumonia caused by Chlamydia pneumoniaе, severe, acute, uncomplicated, DN II–III obstructive type.’

Vascular malformation of ileum

The aim of the study is to observe a patient with vascular malformation of the ileum complicated by recurrent bleeding. Materials and methods: the article presents a clinical case of small intestine bleeding from ileum angiectasia in a 64-year-old patient. At the patient's place of residence, a video capsule endoscopy of the gastrointestinal tract was performed, angiectasia of the ileum was detected, from which fresh blood was received. Upon admission, the patient has iron deficiency anemia, and hematocheesia. In our institution, the patient underwent diagnostic egophagogastroduodenoscopy, video colonoscopy, balloon-assisted enteroscopy (BAE). According to BAE, vascular malformation with a diameter of up to 10 mm is viuzalized in the ileum Results: The patient underwent endoscopic treatment: one endoclypse was applied to the identified vascular malformation. Conclusion: The capabilities of clinicians in the differential diagnosis of pathological conditions of the small intestine are enhanced by the availability of modern equipment in medical and preventive institutions, as well as to perform minimally invasive treatment, reducing the rehabilitation time due to the reduction of surgical trauma.

Vascular malformation of ileum

The aim of the study is to observe a patient with vascular malformation of the ileum complicated by recurrent bleeding. Materials and methods: the article presents a clinical case of small intestine bleeding from ileum angiectasia in a 64-year-old patient. At the patient's place of residence, a video capsule endoscopy of the gastrointestinal tract was performed, angiectasia of the ileum was detected, from which fresh blood was received. Upon admission, the patient has iron deficiency anemia, and hematocheesia. In our institution, the patient underwent diagnostic egophagogastroduodenoscopy, video colonoscopy, balloon-assisted enteroscopy (BAE). According to BAE, vascular malformation with a diameter of up to 10 mm is viuzalized in the ileum Results: The patient underwent endoscopic treatment: one endoclypse was applied to the identified vascular malformation. Conclusion: The capabilities of clinicians in the differential diagnosis of pathological conditions of the small intestine are enhanced by the availability of modern equipment in medical and preventive institutions, as well as to perform minimally invasive treatment, reducing the rehabilitation time due to the reduction of surgical trauma.

Possibilities of diagnostic and therapeutic balloon-assisted enteroscopy in a multidisciplinary hospital

The aim of investigation: to assess the possibilities of diagnostic and therapeutic BAE in a multidisciplinary hospital.Materials and Methods: The analysis of the findings was carried out in 32 patients who underwent 40 diagnostic and 17 therapeutic procedures. Small bowel ulcers were detected in 6 patients, angioectasias in 5. One patient with subcompensated jejunal stricture in the suprastenotic section was found to have a bezoar foreign body. In 17 patients, tumors of a different nature were identified: carcinoids in 4, gastrointestinal-stromal tumors (GIST) in 6 patients, adenocarcinomas in 7 patients. One patient was diagnosed with varicose veins of the jejunum, complicated by bleeding. In 9 patients, polyps of the jejunum and ileum were identified. Reoperations were planned in 6 patients.Results: When conducting therapeutic balloon-assisted enteroscopy, the following types of endoscopic treatment were used: endoscopic clipping (angiectasia-4 and ulcers-2), argon plasma coagulation was used in 1 case, endoscopic polypectomy was performed in 9 patients, destruction of the bezoar with a diathermic loop and balloon dilatation strictures in one case. Patients who had a pathology that was not subject to endoscopic treatment were operated on.Conclusion: The availability of modern equipment significantly expands the capabilities of clinicians in the differential diagnosis of pathological conditions of the small intestine and allows for minimally invasive treatment, shortening the rehabilitation period due to the reduction of surgical trauma.

Capabilities of perfusion computed tomography in colorectal cancer detection and differential diagnosis of pathological conditions of the colon. Early results

The article presents the results of preoperative CT diagnostics of colorectal cancer using perfusion technique. It was found that CT perfusion can improve the diagnostics of local prevalence of colon cancer compared to standard computed tomography, as well as to differentiate colorectal cancer and inflammatory bowel disease.

Myocardial fibrosis — a new component of heart remodeling in athletes?

Studies on the myocardial fibrosis are a new direction in sports medicine. Much data indicate the formation of myocardial hypertrophy, as a natural myocardial response to systematic physical activity, while the fibrosis development in this category of people is not entirely explainable. Modern imaging methods, including magnetic resonance imaging, make it possible to identify different variants of subclinical myocardial fibrosis. The article discusses variants of myocardial remodeling and fibrosis formation, depending on the type of physical activity, its mechanisms, as well as early diagnosis methods applicable in pediatrics. Differential diagnosis of pathological conditions accompanied by myocardial fibrosis and possible treatment strategies are presented.

Histomorphological study on hypocellularity in mastoid processes from archaeological human skeletons

ObjectiveTo evaluate processes causing two types of mastoid hypocellularity (Type 1 and Type 3), and to provide histomorphological criteria for a differential diagnosis in archaeological human bone. Materials and methodsEight human crania from the early medieval cemetery in Dirmstein (Rhineland-Palatinate, Germany) displaying secondary obliteration of mastoid air cells were analyzed using light-microscopy and backscattered electron imaging. ResultsIn Type 1 hypocellularity, obliteration starts in the non-pneumatized portion of the mastoid process and extends into the pneumatized portion. The findings could represent a chronic, maybe recurrent condition related to a pathologically altered middle ear mucosa in early childhood. In Type 3, a sequence of resorptive and proliferative processes are present and are consistent with a healing stage of mastoiditis. ConclusionsUsing histomorphology, in vivo processes resulting in different types of mastoid hypocellularity can be assessed, even in bones that have undergone some degree of diagenesis. SignificanceThe study provides methods to evaluate the etiology of histomorphological changes of the mastoid process, which potentially provides insight into the presence of infection and inflammation in past populations. LimitationsDiagenetic modifications of archaeological bone can hinder assessment of histomorphological change, requiring careful evaluation during analysis. Suggestions for further researchIncluding histomorphology in future studies on archaeological human crania can contribute to an improved differential diagnosis of pathological conditions in the middle ear region.

Diagnosis of pathological conditions in laboratory animals by using advance nuclear medicine imaging techniques

Unlike human clinical practice, veterinary science has relied on histopathological analysis for differential diagnosis of patholog-ical conditions. However, very few attempts have been made to develop a tissue specific, non invasive, targeted imaging diagnostic tool which acts as complimentary to histopathology providing integrative outcome with much deeper insight of the pathological conditions. In present study, weat tempted to correlate PET/SPECT imaging modalities with histopathology to diagnose cancer and other pathological conditions in preclinical models in a more comprehensive way. The PET/CT imaging of spontaneous growth in rabbits (n=1) showed increased[18F] FDG and [18F]FET uptake compared to [18F]FLT, suggesting inflammatory growth. Similarly, imaging in C57Bl/6 mice (n=15) demonstrated selective accumulation of [18F] FLT in highly proliferating malignant tumor cells (n=1). Also, in salivary gland dysfunction model in rabbits (n=11), histological changes in the gland were correlated with scintigraphy. Histopathological diagnosis was used for confirmation of the type of lesion in each case. SPECT/PET-CT imaging techniques proved to be useful in the diagnosis and differentiation of inflammation and malignant tumors. However, it has limitations with inability to define the histological features of the tissue. Imaging findings and histopathological tissue analysis together increase the accuracy and specificity in detailed diagnosis or prognosis of the diseased condition.

[Difficulties in the diagnosis of stroke in pregnant women].

To study the features of the clinical picture of stroke and results of laboratory/instrumental study in pregnant women. A study included 44 women at different periods of gestation (mean age 33.4±9.7 years) with clinical symptoms of stroke hospitalized within 4-11h after stroke. Neuroimaging, clinical/instrumental and laboratory examinations were carried out in the first 40 min after admission. A routine screening examination during the management of pregnancy in women's consultation clinics does not always reduce the risk of life threatening events. The operative delivery can decrease the severity of the focal neurological deficit. Intensive treatment and dynamic management of patients with intracranial pathology in intensive care stroke unit improves outcome of stroke. A timely differential diagnosis of pathological conditions with different symptoms of stroke at the different stages of medical care of pregnant women helps to choose an optimal treatment plan and improve the outcome.

Bone Diagenesis and its Implication for Disease Diagnosis: The Relevance of Bone Microstructure Analysis for the Study of Past Human Remains

When bone is exposed to the burial environment it may experience structural changes induced by multiple agents. The study of postmortem alterations is important to differentiate decomposition phenomena from normal physiological processes or pathological lesions, as well as to assess bone tissue quality. Microscopy is of great utility to evaluate the integrity of bone microstructure and it provides significant data on long-term bone decomposition. A total of 18 human bone sections (eight archeological and ten retrieved from an identified skeletal collection) were selected for analysis under plane light and polarized light. The aim of this exploratory study was to analyze the impact of diagenesis and taphonomy on the bone microstructure, as well as on the differential diagnosis of pathological conditions. The results showed that the microscopy approach to bone tissues contributed materially as an aid in the detailed description of the main diagenetic changes observed. It showed that gross inspection does not provide a realistic assessment of bone tissue preservation, which can impact in the characterization of lesions present and subsequent disease diagnosis. Therefore, researchers should continue to consider the application of histological techniques if the aim is to comprehend tissue integrity and its association with decomposition or disease.

Palaeopathology and Differential Diagnosis—A Probable Case of Secondary Infection (Tell Masaikh, Syria)

*th , 2012; revised December 21 st , 2012; accepted January 3 rd , 2013 Palaeopathology integrates knowledge and methods from physical anthropology and medicine. It aims to obtain information concerning the type of pathological conditions, their antiquity, palaeoepidemiology and etiology in past populations. However, practice shows that despite the use of new techniques, it is often difficult or impossible to make a correct differential diagnosis of diseases based on the study of archaeological skeletal series. Here we present a case study of differential diagnosis of pathological conditions which have been observed on the bones of the skeleton of a 30 - 34 years old female from Tell Masaikh (Syria). Morphological, histological, radiological and molecular methods have been applied in order to assess the pathological lesions. The molecular analysis shows no evidence of Mycobacterium tuberculosis although this should be regarded as absence of evidence and not evidence of absence. Subsequently our diagnosis was narrowed to traumatic changes related to infection. This illustrates the complications associated with differential diagnosis of pathological conditions from ancient bones.

Transient hyperechogenicity of the renal medullary pyramids: incidence in the healthy term newborn.

A screening program was performed on 1881 clinically healthy term newborns, aimed at detecting eventual pathological conditions not diagnosed during pregnancy. Seventy-three cases of transient hyperechogenicity of the renal medullary pyramids were observed, involving one or both kidneys with either sectorial or diffuse pattern. None of the neonates examined had evidence of renal dysfunction and follow-up ultrasound scans demonstrated complete resolution of the sonographic picture. Medullary hyperechogenicity is not rare in healthy term newborns (3.9%); it presents rapid resolution and should be considered in differential diagnosis of pathological conditions.