Clinical Case Examples Research Articles

Syndromic obesity in children (using the example of clinical cases)

Obesity is a heterogeneous group of hereditary and acquired diseases associated with excessive accumulation of adipose tissue in the body. One example of syndromic obesity in children is Bardet-Biedl syndrome. This is a rare autosomal recessive disease from the group of ciliopathies, characterized by retinal dystrophy, obesity, polydactyly, mental retardation, hypogonadism, and renal dysfunction. The article presents two clinical cases of Bardet-Biedl syndrome. Diagnostic criteria for the disease are given, and the need for molecular genetic research methods in the early stages of the diagnostic search is shown. Promising directions in the treatment of the syndrome are considered.

Swyer – James – McLeod syndrome in an adult male

Swyer – James syndrome, also called Swyer – James – MacLeod syndrome (SJMS), is a rare acquired disorder characterized by pulmonary artery hypoplasia, unilateral hyperlucent lungs, and usually also bronchiectasis. Adults with SJMS are often diagnosed with and treated for chronic obstructive pulmonary disease (COPD), bronchial asthma, pneumothorax, or pulmonary embolism due to the similar clinical manifestations. Underestimation of an important radiological sign – unilateral “impoverishment” of the pulmonary pattern and hyperlucent lung – leads to erroneous diagnosis and inadequate treatment. Diagnosis of SJMS involves a computed tomography scan of the chest.The aim of this work was to familiarize readers with aspects of diagnosis and detail the clinical, radiological, and other characteristics of a patient with McLeod syndrome. The described adult man was diagnosed with SJMS at the age of 32. Some typical mistakes in examinations of such patients and the lack of vigilance of radiologists in case of unilateral hyperlucent lung are presented.Conclusion. Using the example of a rare clinical case of SJMS, we demonstrated the need to consider this syndrome when diagnosing adults with unjustified shortness of breath and a history of frequently recurrent pulmonary infections, with radiological signs of unilateral pulmonary emphysema and hyperlucent lung. According to the literature and our observations, computed tomography of the chest organs is a fast and reliable method for establishing the diagnosis of SJMS.

Injuries of the oral mucosa. Clinical cases

Background. Often with some infectious diseases, in addition to the typical manifestations, characteristic inflammatory changes are observed on the mucous membranes, which can imitate the course of other diseases. The purpose was to remind dentists and general practitioners about the importance of differential diagnosis of lesions of the oral mucosa in infectious and non-infectious pathologies on the example of clinical cases. Materials and methods. We conducted an empirical, descriptive study of 3 clinical cases of lesions of the oral mucosa in children who underwent inpatient treatment at the Kyiv City Children’s Clinical Infectious Hospital in 2023–2024. Results. In the first clinical case, the manifestation of type 1 diabetes was described, which was accompanied by oral candidiasis that was previously regarded as a suspicion of measles. The second clinical case demonstrates aphthous ulcers in HIV infection, which was previously mistaken for acute tonsillitis in a child. The third case described enteroviral vesicular stomatitis, which by the nature of the elements resembled chicken pox. Conclusions. Lesions of the oral mucosa can mimic the manifestations of common infectious and non-infectious diseases. Therefore, differential diagnosis of lesions of the oral mucosa is extremely important in various fields of medicine and dentistry.

The role of hearing and listening in hypnotic responsiveness

ABSTRACT The hypnosis literature emphasizes features of suggestion, induction, and communication that are described as evoking heightened responsiveness on the part of the subject or client. This article explores what is often overlooked: to have an effect, the subject must not only hear the suggestion but listen to it. The process of listening is described across multiple levels ranging from the acoustic signal to its transduction into a meaning-filled and motivationally enriched message that spurs action. That journey traverses challenging terrain, with numerous obstacles that serve to maintain past habits and response patterns, despite a client’s stated desire for adaptive change. The article highlights those obstacles and then provides descriptions of five language structures that can reach the client consciously or non-consciously, but always in ways that increase the odds that the therapeutic messaging is packaged in a manner that optimizes it being “heard,” absorbed, and enacted. Applications of each language structure are provided using relevant clinical case examples.

Imagery rescripting in the treatment of prolonged grief disorder: Insights, examples, and future directions

BackgroundImagery Rescripting (ImRs) has received increasing attention in the past decades. It proved to be effective in reducing symptoms associated with aversive memories in a range of mental disorders, including anxiety disorders, eating disorders, and posttraumatic stress disorder. Given its proposed working mechanisms, ImRs may also be a relevant treatment strategy for prolonged grief disorder (PGD), where negative appraisals, helplessness, and unmet needs play a key role as maintaining factors. ObjectiveWe aimed to illustrate how ImRs may be used in the treatment of PGD. MethodWe present examples of clinical cases for several central themes in PGD: (1) Unfulfilled responsibilities, self-blame, and guilt; (2) Third-party failures, other-blame, and anger; (3) Unfinished businesses, troubled minds, and regrets; (4) Unsatisfactory goodbyes; (5) Emotional loneliness; 6) Shattered self-identity and reduced self-clarity. ResultsBased on the case examples, we illustrate how ImRs may be applied for each theme. ConclusionWe hope to inspire clinicians to apply and researchers to investigate ImRs as a treatment strategy for PGD.

Acute and post-acute soft tissue reconstruction

The precise analysis of the injured structures requiring reconstruction in complex wound defects is aprerequisite for successful restoration. The fundamental reconstructive strategies for soft tissue defects of the extremities including injuries to vessels, nerves and burn wounds in the context of the acute and post-acute trauma phases are presented. The different phases of soft tissue reconstruction are described. Recommendations for action with respect to the reconstruction of the functional structures are described. Two clinical case examples illustrate the approach. The acute reconstruction phase is defined as the period 0-72 h after the traumatic event and includes surgical debridement, primary reconstruction of nerves and vessels using interpositional grafts if necessary and temporary soft tissue reconstruction. Combined thermomechanical trauma requires early debridement combined with internal fixation of open fractures. In the post-acute reconstruction phase, which is generally defined as aperiod of up to 6weeks after the traumatic event, definitive soft tissue reconstruction is performed. In the case of long reinnervation distances, nerve transfer or motor replacement plastic surgery is performed in the post-acute phase. The reconstruction of soft tissue after trauma necessitates a stage-dependent approach. In the acute phase procedures aim at the immediate preservation of the limb. In the post-acute phase, definitive soft tissue reconstruction is performed to enable maximum functional preservation. Combined thermomechanical injuries require early surgical treatment in order to prevent infections.

Rethinking Oncologic Facial Nerve Reconstruction in the Acute Phase Through Classification of the Level of Injury.

Early facial nerve reconstruction should be offered in every patient with oncological resections of the facial nerve due to the debilitating functional and psychosocial consequences of facial nerve palsy. Oncologic pathology or oncologic resection accounts for the second most common cause of facial nerve palsy. In the case of these acute injuries, selecting an adequate method for reconstruction to optimize functional and psychosocial well-being is paramount. Authors advocate consideration of the level of injury as a framework for approaching the viable options of reconstruction systematically. Authors breakdown oncologic injuries to the facial nerve in three levels in relation to their nerve reconstruction methods and strategies: Level I (intracranial to intratemporal), Level II (intratemporal to extratemporal and intraparotid), and Level III (extratemporal and extraparotid). Clinical features, common clinical scenarios, donor nerves available, recipient nerve, and reconstruction priorities will be present at each level. Additionally, examples of clinical cases will be shared to illustrate the utility of framing acute facial nerve injuries within injury levels. Selecting donor nerves is critical in successful facial nerve reconstruction in oncological patients. Usually, a combination of facial and nonfacial donor nerves (hybrid) is necessary to achieve maximal reinnervation of the mimetic muscles. Our proposed classification of three levels of facial nerve injuries provides a selection guide, which prioritizes methods for function nerve reconstruction in relation of the injury level in oncologic patients while prioritizing functional outcomes.

Medical negligence in cardiology: enter the lawyers and the experts and, then, the judge

Legal proceedings for medical negligence usually origin from painful events and their management is often complex, also at an emotional level, both for the families involved and for the physicians assumed to carry responsibility. Many of these aspects are unfamiliar and unclear to the doctors themselves who then need to interact, together with their lawyers, with judges who must take serious decisions on technical facts not easy to be fully comprehended by non-medical persons.On the basis of our different and highly specific personal experience, we have tried to clarify some of the fundamental issues concerning medico-legal cases. Accordingly, we have discussed the different types of guilt, made the distinction between civil and penal cases, with special focus on one issue which is particularly critical, namely that of the importance of guidelines. We have presented some examples of clinical cases and highlighted some glaring differences existing in the management of medico-legal cases between Italy and the United States. Despite obvious complexities, these differences might suggest some approaches toward the simplification of these proceedings and the shortening of the time involved to reach a conclusion.

Introducing the Principles of Tendon Transfer for Surgical Trainees to Improve Anatomical Knowledge

Introduction: Surgeons require procedural experience and a clear understanding of the anatomy and biomechanics of the muscles to successfully examine patients and accurately execute tendon transfer operations. Aims: The purpose of the study was to identify the principles of tendon transfer surgeries, develop a training package that focused on anatomical knowledge gaps and evaluate its effectiveness. Methods: A systematic literature review was performed to identify the principles of tendon transfers and areas of insufficient knowledge in these surgeries. 128 eligible studies were extracted through an online database search. Clinical case examples from these papers were used to develop a training package to educate trainees. The effectiveness of the training package was evaluated by a questionnaire which captured the familiarity of the trainees with the material taught. Results: The systematic review highlighted 8 main principles of successful tendon transfer procedures. The questionnaire outcome revealed 66% of attendees at the annual surgeons in training workshop recognised the need to have a firm understanding of anatomy. 70% of attendees reported a significant enhancement in their basic scientific understanding and an overwhelming 90% observed an improvement in their anatomical knowledge. 90% expressed confidence in the training provided and its prospects of improving their chances of success in their surgical examination and would therefore recommend the training to others. Conclusion: Case discussions are pivotal in improving trainee anatomical knowledge and surgical understanding. Therefore, directly refining patient assessment and achieving precise diagnosis. This coupled with applying the 8 principles will ultimately achieve more successful surgical outcomes in tendon transfer surgeries.

The Construction of the Narrative Self: Applying the Internal Multi-Actor Performance Method for Children (IMAP-C) to Help Children Cope with Emotional Distress

Currently, young people are confronted with a rapidly changing world filled with uncertainty, which often triggers negative emotions such as fear or sadness, ultimately leading to emotional distress. This article demonstrates a method that structures practitioners’ work and helps young people to cope with emotional distress. Known as the dialogical Method of Internal Multi-Actor Performance (IMAP) (Gkantona, 2023), this method was founded on the Dialogical Self Theory (DST) and has been developed for therapeutic and counseling procedures. The IMAP is a narrative method which aims to analyze the client’s multi-voicedness and its methodology follows four evolving dialogical stages (Thesis, Antithesis, Synthesis, and Meta-thesis), which facilitate the reorganization of clients’ internal narratives. Thus, the Internal Multi-Actor Performance Method for Children (IMAP-C) is presented, as modified to meet the needs of counseling and therapeutic procedures for children and adolescents experiencing emotional distress. Its adjustment to children’s needs focuses on developmental issues and the dialogical features of working with children as well as the use of art therapy techniques (i.e., role plays, drawings and therapeutic puppetry). A clinical case example illustrates the dialogical processes underlining the application of the IMAP-C in the treatment of a nine-year old boy who suffers from fears and post-traumatic stress. The child’s first attempts to form an integrated narrative identity are also highlighted.

Not Your Average Grief: Addressing the Many Layers of Dementia-Related Loss

Grief is a common and significant human emotional experience. It has known physical, emotional, and social ramifications in patients and their families. In particular, grief is central to the dementia experience for all involved – the people living with dementia (PLWD) themselves, and for all of their caregivers: family members, staff members of assisted living facility (ALF) settings, and clinicians. Grief can ultimately take a large toll on all of these different players in the dementia experience, including medically, interpersonally, and socially, and end up at times causing significant harm if not recognized and addressed.This presentation will describe the medical, psychological, and psychosocial manifestations of grief in general, and then specifically in the context of dementia. We will discuss ways in which grief can present through defense mechanisms in interactions between various caregivers of the PLWD, as well as in the PLWD themselves. We then will discuss a model of grief for caregivers of PLWD, and a newer extension of this model to apply to PLWD themselves, as well as approaches to management. Finally we will turn to a discussion of prolonged grief disorder, how this manifests in the dementia experience and beyond for the greater population, as well as appropriate treatment. Clinical case examples from the outpatient as well as ALF setting will be incorporated throughout the presentation.

Эндодонтическое лечение или экстракция: поиск компромисса

The article, using the example of clinical cases from dental practice, analyzes the causes, symptoms and tactics of dental treatment in case of periapical inflammation, an algorithm of instrumental and drug treatment. A tooth caused an apical granuloma or cysts often has to be removed. The aim of endodontic treatment is the prolonged preservation of the tooth as a functional unit of the chewing apparatus, the restoration of the health of periapic tissues and the prevention of autoinfection and sensitization of the body

Острое отравление парацетамолом у детей. Оказание неотложной помощи в реанимационном отделении многопрофильной больницы на примере клинических случаев

The article presents a three -year analysis of the structure of acute paracetamol poisoning in children. On the example of clinical cases, the tactics of treating patients with acute paracetamol poisoning are described.The effectiveness of the recommended doses and antidote therapy schemes is evaluated. The main factors contributing to the adverse outcome of the disease are indicated.

Клинический случай лечения иглоножом компрессионной радикулопатии шейного отдела позвоночника

On the example of a specific clinical case – compression radiculopathy of the spinal cord roots of the cervical spine, the causes and prevalence of this disease, the generally accepted tactics of outpatient treatment and its results, the pathophysiological substantiation of the use of new, non-traditional methods for the treatment of this pathology, such as acupotomy have been analyzed in the article.

(357) The Importance of Assessing Adult ADHD/ADD Diagnoses in Patients Presenting with Concomitant Sexual Disorders and Sexuality Related Challenges to Both Sex Therapists and Medical Providers

Abstract Introduction A 2020 literature review in The Journal of Sexual Medicine concluded that research subjects with ADHD reported more sexual desire, more masturbation frequency, less sexual satisfaction, and more sexual dysfunctions than the general population. Another study showed that all participants with self-reported ADHD showed higher rates of avoidant attachment while males with ADHD and anxious attachment reported using a greater amount of online pornography/sexually explicit media. There are unique challenges that affect singles’ and couples’ sex lives when a partner has Adult ADHD/ADD. Many patients seek out medical treatment of sex therapy for Erectile Disorder, Delayed Ejaculation, Premature/Uncontrolled Ejaculation, Genital Pelvic Penetrative Pain Disorder, and low desire and seek out sex therapists for the above diagnoses as well as infidelity, out-of-control-sexual-behavior, orgasmic disorders or sexless relationships. These patients seek to address what they regard as exclusively a medical or a relational problem. However, only through accurate assessment and treatment by both sex therapists and doctors of an intersectionality of an adult ADHD diagnosis impacting the sexual disorder will the client or couples’ challenges fully improve. Objective Many patients show up in both sex therapists’ and doctors’ offices with sexual complaints without either having been formerly diagnosed with ADHD or by sharing with the provider that they have this disorder. The ADHD/ADD diagnosis can be a treatment blind spot for both sex therapists and medical providers that can be greatly improved upon due to the integral impact it has on both a single patient's concomitant sexual disorder and a couples’ sex life. In this talk, the presenter hopes to improve participants assessment skills to treat the co-occurring symptoms that impact both sexual functioning and health. Methods In this presentation, an overview of common sexual issues occurring in single clients and couples where one partner has ADHD/ADD, will be presented along with clinical case examples. The presenter will offer some key questions to pose when assessing a patient to yield more information regarding how their sexual functioning has been impacted over the course of various stages of their adult life. This talk will also assist in educating providers on how to provide sexuality education so clients can protect their sexual health, understand the interplay of ADHD and their sexual functioning problems, and provide referrals needed to sex therapists, ADHD-specialized psychiatrists, urologists, gynecologists, and pelvic floor therapists so the patient has a holistic treatment plan. Results Clinical experience suggests assessing and treating comorbid adult ADHD in single and coupled patients may be a key to treating a common matrix of sexual comorbidities: Erectile Disorder, Anorgasmia, Out of Control Sexual Behavior, Premature Ejaculation, Anxiety and Depression. In this group these hard-to-treat problems may become more responsive to directed treatment if the disability of ADHD can be mitigated. Addressing adult ADHD provides an opportunity to reverse demoralization and open up doors to effective sexual functioning for a portion of our patients who have struggled to get a full-spectrum treatment plan. Conclusions As a sex therapist in practice for over 25 years, I have found that many adults have not been formally be diagnosed with ADHD and that their previous experiences with medical providers and general couples counselors have missed out on the impact the disorder's symptoms has on their sexual functioning. There is still scant research on ADHD and sexual functioning in the literature and I feel that our patients would improve more quickly if this disorder were taken into account by their medical and sex therapy providers. Disclosure No.

Breaking the cycle with trauma-focused mentalization-based treatment: theory and practice of a trauma-focused group intervention.

Trauma-Focused mentalization-based treatment (MBT-TF) is an adaptation of mentalization-based treatment (MBT) specifically developed for patients suffering from attachment or complex trauma, with the possibility of co-occurring borderline personality pathology. The creation of MBT-TF was driven by previous research and observations that interventions centered on mentalizing could be significantly improved by directly addressing the impact of trauma. MBT-TF aims to mitigate symptoms that arise post-trauma, such as hyperarousal, hypervigilance, intrusions, flashbacks, avoidance behaviors, dissociative experiences, negative perceptions of self and others, and ensuing relational difficulties. Implemented as a group intervention, MBT-TF typically spans 6-12 months. From a mentalizing perspective, trauma, particularly attachment trauma, leads to a failure in processing the effects of trauma through and with others. Stress and attachment behavioral systems are disrupted, which undermines the capacity for epistemic trust, and impairs mentalizing abilities. This paper offers a concise summary of the reasoning for MBT-TF's creation, its theoretical underpinnings, and its clinical strategy for addressing the adverse impacts of trauma. It further details the treatment phases, their main goals, and their interventions, supplemented by clinical case examples that underscore MBT-TF's distinctive attributes and frequent clinical hurdles.

Differential diagnostic search in dermatologic practice and its effect on quality of medical care: Clinical cases

Introduction. A differential diagnostic search is a crucial method for making a final clinical diagnosis. Lack of clinical thinking leads to tactical errors, both in making a diagnosis and in choosing a therapy algorithm. The problem of iatrogeneses especially often arises at the initial stages of patient management.Case descriptions. The paper demonstrates the difficulties of verifying the diagnosis of patients with dermatological pathology on the example of clinical cases. The stages of differential diagnostic search are covered in detail. Practicing physicians stress the importance of timely correct diagnosis and, consequently, the choice of therapy. The study involved a detailed analysis of clinical cases and mistakes causing a delay in diagnosis and wrong choice of therapeutic tactics at the outpatient stage. A clinical case with designated diagnosis is presented and analyzed as an illustrative example. Special attention was given to a complex evaluation of subjective, objective and diagnostic data, the significance of analyzing the development of dermatoses.Conclusion. Careful adherence to diagnostic algorithms will avoid iatrogenic errors and thereby improve the quality of medical care and the quality of life of dermatological patients.

Echocardiographic Assessment of Cardiomyopathy in Pediatric Oncology Associated with Increased Cardiac Output Due to the Influence of the Tumor Process: Pheochromocytoma/Paraganglioma, Neuroblastoma (Literature Review with Clinical Observations)

The condition of increased cardiac output is a state in which, in response to various pathological causes, there is a pathological activation of the renin-angiotensin-aldosterone and sympathetic-adrenal systems, which overall creates a multifaceted, increased load on the heart, ultimately leading to heart failure. The cause of this condition may be arteriovenous pathological shunts, among which arteriovenous dural fistulas in glomus tumors (intracranial paragangliomas) occupy a special place. An arteriovenous fistula is a direct connection between an artery and a vein bypassing the capillary bed, creating a massive shunt from the high-pressure system to the low-pressure system, triggering a pathophysiological chain. In addition, activation of the renin-angiotensin-aldosterone and sympathetic-adrenal systems and direct myocardial damage can be caused by elevated levels of catecholamines in the blood in cases of adrenal paraganglioma (pheochromocytoma) and neuroblastoma. The condition of increased cardiac output is more often described in the literature using examples of clinical cases in adults, with significantly less literature data available in pediatric practice.

Full mouth restorative rehabilitation of the generalized worn dentition: a step-by-step approach to treatment

In this article, full-mouth restorative rehabilitation of the generalized worn dentition is presented. In the authors' opinion, the steps to achieve a predictable functional and aesthetic outcome are proposed and illustrated using clinical case examples. The rationale for each step is outlined and the longer-term expectations, from the point of view of both the clinicians and patients are considered. CPD/Clinical Relevance: Knowledge of a step-by-step approach to the full-mouth rehabilitation of the worn dentition is valuable for clinicians.

Fundamental Electrophysiology Principles Related to Perioperative Management of Cardiovascular Implantable Electronic Devices

An increasing number of patients undergoing elective or emergency surgery in the United States have a cardiovascular implantable electronic device. Practice advisories and consensus statements have been issued by the American Society of Anesthesiologists and the Heart Rhythm Society, advocating a multidisciplinary approach. Unfortunately, anesthesia providers often find themselves in a situation in which they are left to manage these devices independently. At the University of Washington Medical Center, an anesthesiology-based service to manage these devices has existed for more than a decade. Many problems with devices have been observed, including confusing rhythms, failure of magnets to provide the desired change in device function, and actual device malfunction. With these clinical case examples taken from the authors' collective experience, this article provides an in-depth understanding of some key electrophysiology principles relevant to cardiovascular implantable electronic device function and appropriate perioperative management.