Differential Diagnostic Methods Research Articles

Diagnosis of leukemic lung infiltration mimicking fungal infection by transbronchial lung cryobiopsy: the first case report

BackgroundWe here report the first case of leukemic lung infiltration diagnosed by transbronchial lung cryobiopsy (TBLC). TBLC is likely to be a superior method to transbronchial forceps biopsy because TBLC can get larger specimens, resulting in a higher chance of containing the leukemic cells infiltrated tissues. TBLC is generally considered a superior diagnostic method compared to transbronchial lung forceps biopsy (TBLB) because it utilizes cryotechnology to obtain larger specimens, increasing the likelihood of capturing tissues infiltrated with leukemic cells.Case presentationA 69-year-old male patient with acute myeloid leukemia presented with a fever. His initial chest CT scans revealed consolidative lesions, raising suspicion of fungal infection such as angioinvasive aspergillosis or mucormycosis. TBLC and TBLB were conducted to achieve a precise diagnosis, and eventually, leukemic lung infiltration was identified exclusively in the tissues obtained from TBLC. Two cycles of chemotherapy was administrated to patient, showing improvements in symptoms and chest CT findings.ConclusionsTBLC has greater potential as a differential diagnostic method for pulmonary lesions than TBLB in leukemia patients facing therapeutic challenges due to its higher diagnostic yield.

The phenomenon of viral chromosomal integration

The literature review is devoted to the chromosomally integrating viruses, the integration property. These are revealed using modern diagnostic methods, including highthroughput sequencing. The review describes various types of viruses, such as retroviruses, adenoviruses, herpes viruses, papillomaviruses, hepatitis B, SARS-CoV-2 and others. These viruses have the ability to integrate their genomes into the host cell genomes and their prevalence. Modern information on the molecular mechanisms of viral integration and methods of differential diagnostics is presented. Each of these viruses has its own unique ways of interacting with the host cell genome to maintain a latent state, which determines the specifics of the infectious process and pathological consequences for the body due to the possibility of effective reactivation.

Raman Spectroscopy in Optical Non-Invasive Diagnostics of Skin Neoplasms

Introduction. Recent decades indicate a significant increase in the incidence of skin cancer. Aim. To upgrade the specialized device and to improve the quality of skin neoplasm diagnostics. Materials and methods. The study mainly involved the method of non-invasive differential diagnostics of skin neoplasms. The method relies upon optical research methods, including Raman spectroscopy, a spectroscopic technique. A 10-year study, conducted by the Department of Oncology, the Samara Regional Clinical Oncology Dispensary (SOKOD), included more than 500 observations. The study used samples of various skin neoplasms obtained during surgical treatment of patients. Experimental tests provided a certain spectrum of various benign and malignant human skin neoplasms, including melanoma. Results. A series of experimental tests resulted in an experimental setup that is absolutely safe to use. Discussion. The study involved comparison of individual characteristics of the Raman spectra, obtained in the examination of neoplasm and healthy skin for each patient, thereby individualizing the method. The study revealed a high accuracy rate of 92% (with sensitivity of 89%, specificity of 93%), thus minimizing risks of false negative results, which is essential for mass examination. Conclusion. Since the proposed device setup does not require consumable products and different reagents, the method is marked with lower time costs and maintenance burden. Raman spectroscopy obtains a significant potential, thus, can be widely used for skin neoplasms in various medical and preventive institutions.

Proteomic analysis of blood serum in bipolar disorder

IntroductionBipolar disorder (BD) often has symptoms similar to other mental disorders (BD), and there are no paraclinical criteria for differential diagnosis. (Geoffroy et al. Bip Dis 2017; 5 7). Published work on MD proteomics is scarce and focused on schizophrenia. (Dmitrieva et al. PeerJ. 2022; 10 e13907). Therefore, it is important to study potential biomarkers of BD using easily accessible material—blood serum (Rhee et al. Transl Psy 2023; 13 44). Identification of proteins involved in the pathogenesis of BD will help in the study of the pathogenetic mechanisms of BD, the development of differential diagnostic methods and pathogenetically based drugs.ObjectivesCarrying out a comparative proteomic analysis of blood serum from patients with BD and healthy individuals to identify potential biomarkersMethodsWe analyzed the protein spectrum of the blood serum of 14 patients with BD who were admitted during a depressive episode at the age of 32 [21;52] years with a disease duration of 8[5;11] years. The control group consisted of 10 mentally and somatically healthy individuals corresponding to the gender and age of the BD group. Blood serum was purified from 14 major proteins using affinity chromatography and separated by electrophoresis using the Laemmli method. After trypsinolysis, proteins were identified using HPLC/mass spectrometry on an Orbitrap instrument. Mass spectrometric analysis was performed on the Advanced Mass Spectrometry Core Facility of Skolkovo Institute of Science and Technology. Protein identification was carried out using the UniProtKB database using the Mascot search engine. The results were tested for significance using the nonparametric Fisher exact test with Yates correction.ResultsIn patients with BD, qualitative mass spectrometry revealed differential expression of 21 neurospecific proteins. Among them: Protein dispatched homolog 3, Ceroid-lipofuscinosis neuronal protein 6, SWI/SNF complex subunit SMARCC1, Neurogenic differentiation factor 4, Protein furry homolog-like, REST corepressor 1 – are involved in the proliferation, development and differentiation of neurons; Hemicentin-2, Dystrophin, Voltage-dependent L-type calcium channel subunit alpha-1D, Syntaxin-binding protein 5, Small conductance calcium-activated potassium channel protein 1– participate in synaptic transmission of ion transport and form receptors.ConclusionsStudying the role of these proteins in BD and their quantitative content in a larger number of patients is promising. This will help in the development of new diagnostic criteria and targets for drug therapy for BD.Support by the Russian Science Foundation grant No. 23-75-00023.Disclosure of InterestNone Declared

Comparative efficiency of differential diagnostic methods for the identification of BRAF V600E gene mutation in papillary thyroid cancer (Review).

V-Raf murine sarcoma viral oncogene homolog B1 (BRAF) encodes a serine-threonine kinase. The V600E point mutation in the BRAF gene is the most common mutation, predominantly occurring in melanoma, and colorectal, thyroid and non-small cell lung cancer. Particularly in the context of thyroid cancer research, it is routinely employed as a molecular biomarker to assist in diagnosing and predicting the prognosis of papillary thyroid cancer (PTC), and to formulate targeted therapeutic strategies. Currently, several methods are utilized in clinical settings to detect BRAF V600E mutations in patients with PTC. However, the sensitivity and specificity of various detection techniques vary significantly, resulting in diverse detection outcomes. The present review highlights the advantages and disadvantages of the methods currently employed in medical practice, with the aim of guiding clinicians and researchers in selecting the most suitable detection approach for its high sensitivity, reproducibility and potential to develop targeted therapeutic regimens for patients with BRAF gene mutation-associated PTC.

Assessment of the diagnostic significance of endoscopic ultrasonography in the differential diagnosis of formations of the hepatopancreatoduodenal zone

Purpose of the work. To study the structure of the hepatopancreaticoduodenal zone (HPD) masses according to the endosonographic picture and to estimate the diagnostic informativeness of endoscopic ultrasonography (EUS) in diagnostics of these masses in comparison with ultrasound examination of HPD (ultrasound of HPD) and computer tomography of abdominal cavity organs (CT of OBP) with contrasting. Materials and Methods. A retrospective analysis of medical records of 71 patients with GDZ masses who underwent inpatient treatment in the department of abdominal surgery and applied for diagnostic purposes to the endoscopic centre of Karaganda Multidisciplinary Hospital No.3 for EUS for the period from January 2021 to December 2022 was carried out. Results and discussion. Sensitivity of EUS in differential diagnostics of PG tumours, hepaticocholedochal dilatation, vascular invasion and metastasis to regional lymph nodes was 85%, 94,12%, 64,71% and 100% respectively, specificity - 95,93%, 100%, 80% and 92% respectively. Conclusion. Correct assessment of all manifestations of a tumour influences the choice of treatment tactics and consequently its immediate and long-term results. EUS is an effective method of differential diagnostics of pseudocysts and cystic tumours of PG, tumours of large duodenal papilla (LDP), as well as biliary tract neoplasms.

Circumscribed choroidal hemangioma and non-pigmented choroidal melanoma: clinical, instrumental and molecular genetic features

This study attempts to develop a method of non-invasive molecular genetic differential diagnostics of CCH and non-pigmented CM. Based on the results of clinical and instrumental examination methods, 60 patients (60 eyes) with CCH (n=30) and non-pigmented CM (n=30) were included in this prospective study. The control group consisted of 30 individuals without intraocular tumors. Mutations in the GNAQ/GNA11 genes were determined by real-time PCR using the analysis of genomic circulating tumor DNA isolated from peripheral blood plasma. The average follow-up period was 12.1±1.8 months. The study revealed a significant association of mutations in exons 4 and 5 of the GNAQ/GNA11 genes with the presence of non-pigmented CM (27/30; 90%). These mutations were not detected in the group of patients with CCH. Mutations in exons 4 and 5 of the GNAQ/GNA11 genes were also not detected in the control group of healthy individuals. This study proposes a method of non-invasive and low-cost differential diagnostics based on molecular genetic analysis and detection of mutations in exons 4 and 5 of the GNAQ and GNA11 genes, which are specific for CM (90%).

Stroke and peripheral vestibulopathy as a part of acute vestibular syndrome

The scope of the review is the problem of differential diagnosis between stroke and peripheral vestibulopathy in patients with acute vestibular vertigo. A vertebrobasilar stroke manifesting with the isolated vertigo has been previously recognized to be extremely rare, and the symptoms have been related to the involvement of peripheral parts of the vestibular analyzer. Recently there has been growing evidence that the isolated vertigo syndrome is commonly related to the central involvement of the vestibular analyzer. The author presents published clinical cases of acute cerebrovascular accident with a single symptom of acute vestibular vertigo. It can be also a symptom of a hemispheric stroke due to an injury of vestibular pathways connecting the vestibular nuclei with the parietal cortex. These observations extend the understanding of the common classic pathognomonic picture of central vestibular vertigo, which implies that its development is related exclusively to the brain matter lesion in vestibulobasilar stroke.
 Current clinical rating scales and tests (NIHSS, FAST) used for the diagnosis of an acute stroke, are frequently not sensitive to the vertebrobasilar stroke, and neuroimaging, including brain magnetic resonance imaging at DWI mode, may give false negative results. The most informative differential diagnostic method in acute vestibular syndrome is an otoneurological assessment including identification of nystagmus characteristics and head turn impulse test, for the assessment of vestibuloocular reflex and at bed tests (for example, tests included into the HINTS PLUS protocol). In this regard, it is important that neurology specialists in regional vascular centers and departments for acute cerebrovascular care should master the otoneurological assessment skills.

Acoustic density of the sclera of keratoconus eyes and its clinical significance

Purpose: to assess the biophysical properties of the sclera by measuring its acoustic density in keratoconus, highly myopic, and healthy eyes. Material and methods. We examined 34 patients (67 eyes) aged 15–45 with keratoconus of various stages, 15 patients (30 eyes) aged 17–28 with high myopia and 15 people (30 eyes) aged 28–37 without ophthalmic pathology. The acoustic density of the sclera (ADS) was measured on the Voluson Е8 ultrasound device (GE Healthcare, USA) in the posterior eye pole (ADS-1) and in the equatorial area (ADS-2). The axial length (AL) of the eye, corneal thickness (CT), anterior chamber depth (ACD), and lens thickness (LT) were determined using Galilei G6 (Ziemer Group, Switzerland). The vitreal chamber depth (VCD) was calculated according to the formula: VCD = AL – СT – ACD – LT. Results. In keratoconus patients, the average ADS-1 value was 242.5 ± 7.4 conventional units (CU), ADS-2 averaged 234.1 ± 12.1 CU, AL was 24.6±1.1 mm long, and VCD was 17.1 ± 0.4 mm. In high myopia group, the average value proved to be significantly lower: ADS-1 was 210.3 ± 15.7 CU, ADS-2 — 201.2 ± 11,2 CU, while AL and VCD were higher: resp. 27.0 ± 0.7 mm and 19.2 ± 0.5 mm (p < 0,05). In the control group (healthy eyes), ADS-1 was 247.5 ± 2.8 and ADS-2 was 238.1 ± 0.6 CU, which practically showed no difference to the keratoconus group (p > 0.05). AL was 23.7 ± 0.6 mm, and VCD was 16.0 ± 0.6 mm. An insignificant tendency toward ADS drop in keratoconus eyes with AL over 25.0 mm was observed. Probably, we are dealing here with a combination of keratoconus with axial myopia. Conclusion. The acoustic density of the sclera of keratoconus patients approaches the respective parameter of healthy eyes and is significantly higher than that of highly myopic eyes. The analysis of acoustic density of the sclera and vitreal chamber depth may be considered as a method of additional differential diagnostics of keratoconus and congenital myopia with high corneal refraction and astigmatism.

Connection of diagnostic parameters with the technical condition of the engine

The paper presents the results of the study experimental verification of theoretical prerequisites and methodological developments to establish the connection of diagnostic parameters with indicators of the technical condition of the engine of the Zavolzhsky Motor Plant. Experimentally, the most informative, in terms of sensitivity and stability of diagnostic signs, diagnostic modes were obtained. The method and technology of differential engine diagnostics have been developed and tested in production conditions. And also in the article the results of the analysis of the obtained data carried out in a complex of laboratory and operational tests, including experimental studies to optimize the speed mode of engine diagnostics when cranking the crankshaft; identification of the effect of valve misalignments and decompression in the engine cylinders being tested at the time of the resistance to cranking and compression resistance; study of the technical condition parameters affecting the moment of resistance to cranking of the crankshaft and compression resistance of the tested cylinders. According to the proposed method, experimental dependences of the change in the torque of the rolling resistance and compression resistance of the internal combustion engine were obtained.

Микроморфологическая характеристика твердых тканей зуба у собак различных возрастных групп

The article presents a comparative micromorphological characterization of dental hard tissues in the domestic dog depending on the generation (deciduous and permanent). The research was conducted at the veterinary clinic «Zoovetcenter», Khanty-Mansiysk Autonomous Okrug, Surgut, at the Department of «Animal Diseases and Food Safety» of Saratov State University of Genetics, Biotechnology and Engineering by N. I. Vavilov and the Department of Anatomy and Histology of Animals named after Professor A. F. Klimov of Moscow State Academy of Veterinary Medicine and Biotechnology – MVA by K. I. Skryabin. The object of the study was a domestic dog (n=30) aged from 5 months to 2 years. The material for the study were extemporized teeth (n=50) of different generation. We used a complex methodological approach, including: fabrication of tooth slides according to the generally accepted technique with subsequent staining with histological dyes, light microscopy and micromorphometry. The study of the obtained tooth slides showed differences in the structural organization of dental hard tissues at different stages of odontogenesis in the domestic dog (deciduous and permanent generation of teeth). The percentage ratio of dental hard tissues in relation to the pulp chamber was revealed. The peculiarities of the organization of the root system depending on the age features have been established. The obtained results can be used in the identification of age and dental tissues, and are basic in the improvement of old and development of new methods of differential diagnostics of dentopathologies in small domestic animals.

Expert system for the study of psychoneuro-logical diseases using the method of differential diagnostics

The article reveals the topic of developing an expert system of psychoneurological diseases using the method of differential diagnostics. The task of the system of differential medical diagnosis is to determine the diseases that the patient may suffer from, based on the observation of his symptoms. The method used in diagnosing the disease is differential. This method weeds out diseases because they do not match any facts or symptoms, which in the end must lead to the only possible disease. The developed and implemented expert system includes: a mechanism for accessing the database of symptoms for each of the correlating diseases, an algorithm for forming ES input parameters, a decision-making method based on a logical mechanism. Various decision-making mechanisms were investigated and analyzed in the work, which made it possible to avoid shortcomings and improve the work of the expert system. ES work relies on a knowledge base of symptoms. The database is a collection of differential diagnostic features, corresponding frequencies of occurrence for each of the diagnosed diseases. The application has two modes of operation: the mode of operation with the knowledge base, which provides direct work with the database and support for all necessary operations for the full functioning of the system. The mode of analysis in which the specialist receives support in making a decision when making a diagnosis. The user sets the patient's existing symptoms, after which the managed data is processed. At the end, the user receives the result of the performed analysis with the most probable diagnosis to the least probable one with a calculated conformity assessment. Such a system has high efficiency, reliability, accessibility and productivity. The use of such a system allows you to avoid redundancy of information, thereby reducing the time for primary data processing

Measuring of the heifers ovaries and probiotic defence of the mucous membranes

The results of the influence of complex probiotic defence of the mucous membranes of the reproductive system and intestines on the development of the corpus luteum of the cycle in heifers have been presented. By the method of differential palpation diagnostics in vivo, it was reliably examined that in the experimental group after carrying out procedures for the normalization of mucous membranes with the multicomponent probiotic drug “Multibacterin Veterinary Ba + La”, the number of heifers with high-quality of corpus luteum the ovaries was 48.21% more, and the number of cases of premature luteolysis was 12.50 % less (P < 0.01). The level of pregnancy in heifers in the experiment was on average 60.38 %, in the control – 46.94 %, which confirmed the positive effect of the probiotic protection of the mucous membranes on increasing the embryo survival by optimizing the conditions for embryonic nutrition on the surface of the endometrium.

Evaluation of Ultrasound Based Point Shear Wave Elastography for Diagnosis of Inflammatory Pancreatic Diseases

Introduction: A variety of imaging techniques exists for the diagnosis of pancreatic disorders. None of the broadly accepted diagnostic methods, uses elasticity as an indicator of tissue damage. A well-known fact is that pathological changes influence tissue stiffness and elasticity. US elastography in its different modalities has been widely used for evaluation and characterization of multiple abdominal structures. Point Shear Wave Elastography (pSWE) particularly has been reported to be highly effective in various clinical diagnostic applications. However, data on the role of pSWE in a deep-seated organ like pancreas is scarce. Objective: To prospectively assess the diagnostic value of abdominal US elastography in the form of point shear wave elastography (pSWE) in characterizing and differentiating between normal pancreatic parenchyma and chronic pancreatitis. To establish a cut off value for the diagnosis of chronic pancreatitis. To investigate the influence of certain independent variables and the severity of pancreatitis on the acquired results. Patients Twenty five patients diagnosed with chronic pancreatitis who visited the Department of Gastroenterology in University Hospital Kaspela, between December 2020 and August 2021, for diagnosis and/or treatment and twenty eight individuals with no evidence of pancreatic disorder, admitted at the hospital during the same period of time, were included in the study. Based on the clinical symptomatic criteria, diagnostic imaging and histological findings, patients were divided into chronic pancreatitis (CP) and healthy pancreatic parenchyma group. Methods: The ultrasound based point Shear Wave Elastography (pSWE) imaging techniques were applied. A total of five measurements was obtained in each segment of the gland. The depth of region of interest (ROI) was also recorded. Design Prospective single-center study. Results: The mean shear wave speed (SWS) values of the entire pancreatic parenchyma were 1.71m/s, 1.15m/s for the chronic pancreatitis and the normal pancreatic parenchyma respectively. With a cut off value of 1.43m/s, sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and accuracy (Ac) of 89.7%, 95.2%, 94.59%, 90.91% and 92.59% respectively were calculated for the diagnosis of chronic pancreatitis. Neither the independent variables researched, nor the severity of disease, defined according to the Cambridge score, proved to have statistically significant reflection on the SWS in patients with CP. Conclusion: pSWE established considerably higher SWS in patients with chronic pancreatitis, therefore it may be successfully adopted as a diagnostic modality in patients with chronic inflammatory pancreatic disorders. External factors have minor effect on the results obtained, suggesting that the technique is highly objective. High SWS were obtained both in patients with discrete structural abnormalities (Cambridge 2) and advanced forms of pancreatitis (Cambridge 4), which points that pSWE may be utilized as differential diagnostic method in cases in which other imaging techniques provide equivocal and inconclusive results.

Syndrom Parry–Romberg: clinical case of a rare disease

The article is devoted to ParryRomberg syndrome, one of the rare diseases. Here we declare contemporary views on predisposing factors, pathogenesis and character of clinical performance. We describe the methods of differential diagnostics, the criteria of diagnostics as well as contemporary treatment methods. We also describe a case history of the disease.

EFFECTIVENESS OF EVALUATION OF APC, GSTP1 AND RASSF1A METHYLATION LEVEL AS A PROSTATE CANCER MARKER

Prostate cancer (PC) is one of the most common oncological diseases, ranking fourth in the global mortality structure. Due to the absence of clinical manifestations in the early stages, and poor methods of differential laboratory diagnostics, the search for sensitive minimally invasive prostate cancer (PC) markers remains relevant.
 The aim of the study was to analyze APC, GSTP1 and RASSF1A methylation levels in biological material in prostate pathologies and their effectiveness in PC detection.
 Materials and Methods. For molecular genetic study of APC, GSTP1 and RASFF1A methylation levels by molecular-specific PCR test, the authors used genomic DNA isolated from samples of post-massage urine, blood plasma and biopsy material from patients with PC (n=34) and benign prostatic hyperplasia (BPH) (n=27). The control group consisted of 20 men without any identified pathology. Analysis of molecular-specific PCR products was carried out by 2 % agarose gel electrophoresis.
 Results. The average APC, GSTP1, and RASFF1A methylation level was mainly noted in all types of biological material. There were statistically significant differences between groups with pancreatic pathologies, taking into account biological material. The evaluation of the odds ratio of PC detection showed that the hypermethylated APC in post-massage urine, GSTP1 in blood plasma, and RASFF1A in biopsy material increased the probability of PC detection by 2.5, 12.1, and 4.1 times, respectively. Low sensitivity (55.3 %) and high specificity (87 %) of PC diagnostics in terms of APC methylation in post-massage urine, GSTP1 in blood plasma, and RASFF1A in biopsy material were shown. With the combined use of the methylation gene status, the sensitivity was 65.2 %, and the specificity was 82.4 %. When the total prostate-specific antigen (PSA) value was added to the panel, the indices were 79.1 % and 82.9 %, respectively.
 Conclusion. APC methylation levels in post-massage urine, GSTP1 in blood plasma, and RASSF1A in biopsy can be considered as highly specific diagnostic PC markers. The combined use of these indicators increases the specificity of diagnosis in comparison with the initial PSA level. When included in the panel, the latter also increases the panel sensitivity for PC detection.

Can malocclusion provide clinicians with information for differential diagnosis of temporomandibular joint diseases?: A review.

The aim of this literature review was to summarize the clinical characteristics and symptoms of temporomandibular joint diseases, and to discuss the associations between temporomandibular joint diseases and categorization of malocclusion. Electronic literature searches were performed using the PubMed database. The authors established a differential diagnostic method for temporomandibular joint diseases related to malocclusion. A literature search using PubMed yielded 213 texts, of which based on exclusion criteria, 28 were included in this study. Malocclusions were categorized into 5 types. The authors suggested a diagnostic tree of temporomandibular joint diseases based on the types of malocclusion and 4 variables in clinical characteristics and symptoms. Clinicians treating malocclusions must attempt to clarify the cause of the occlusal condition. If caused by temporomandibular joint disease, it is important to make a proper differential diagnosis at first, and not to overlook the causative disease. Further clinical knowledge of associations between temporomandibular joint diseases and malocclusions should be accumulated, and the diagnostic tree should be improved based on new information.

Deep learning-based fully automated differential diagnosis of eyelid basal cell and sebaceous carcinoma using whole slide images.

BackgroundThe differential diagnosis of eyelid basal cell carcinoma (BCC) and sebaceous carcinoma (SC) is highly dependent on pathologist’s experience. Herein, we proposed a fully automated differential diagnostic method, which used deep learning (DL) to accurately classify eyelid BCC and SC based on whole slide images (WSIs).MethodsWe used 116 haematoxylin and eosin (H&E)-stained sections from 116 eyelid BCC patients and 180 H&E-stained sections from 129 eyelid SC patients treated at the Shanghai Ninth People’s Hospital from 2017 to 2019. The method comprises two stages: patch prediction by the DenseNet-161 architecture-based DL model and WSI differentiation by an average-probability strategy-based integration module, and its differential performance was assessed by the carcinoma differentiation accuracy and F1 score. We compared the classification performance of the method with that of three pathologists, two junior and one senior. To validate the auxiliary value of the method, we compared the pathologists’ BCC and SC classification with and without the assistance of our proposed method.ResultsOur proposed method achieved an accuracy of 0.983, significantly higher than that of the three pathologists (0.644 and 0.729 for the two junior pathologists and 0.831 for the senior pathologist). With the method’s assistance, the pathologists’ accuracy increased significantly (P<0.05), by 28.8% and 15.2%, respectively, for the two junior pathologists and by 11.8% for the senior pathologist.ConclusionsOur proposed method accurately classifies eyelid BCC and SC and effectively improves the diagnostic accuracy of pathologists. It may therefore facilitate the development of appropriate and timely therapeutic plans.

Differential Diagnostics of Toxic Epidermal Necrolysis (Lyell’s Syndrome) in ICU: Case Reports

Toxic epidermal necrolysis (TEN) is a critical life-threating condition developing as the total detachment of epidermidis and characterized by severe pathological reactions of all body systems. The current article describes two cases of TEN with similar clinical and laboratory signs. In one case the diagnosis of TEN was subsequently refused.The objective: analysis of methods of clinical and differential diagnostics of conditions accompanied with massive epidermidis detachment in ICU patients.Results. The immunomorphological evaluation of skin specimen obtained from the patient with a torpid form of TEN showed linear IgG fixation in the intercellular space of stratum basale, stratum spinosum and stratum granulosum and C3 fixation in the intercellular space of stratum basale.Conclusion. The complex of anamnesis data and pathomorphological evaluation of skin are crucial for the diagnosis and treatment of patients with atypical TEN.

Пластичний бронхіт: клінічне спостереження

Публікація присвячена поглибленому розгляду етіології, патогенезу, діагностики та лікування рідкісного захворювання бронхів — пластичного бронхіту. Пластичний бронхіт формується частіше у дітей з уродженими вадами серця після проведення паліативної операції Фонтена (1–4 %), рідше — після оперативного втручання з приводу тетради Фалло, постопераційного хілотораксу або асциту, реконструктивних операцій; а також бронхоектатичної хвороби, бронхіальної астми, туберкульозу, муковісцидозу, хронічного бронхіту, трансплантації легень, грипу H1N1, серцевої недостатності, ревматоїдного артриту чи амілоїдозу. Ідея написання статті виникла під час клінічного спостереження дівчинки п’яти років, яка була госпіталізована в стаціонар з ознаками прогресуючої гіпоксії, задишки та нав’язливого нападоподібного кашлю; при бронхоскопії у неї виявлені пластичні зліпки. Діагностичний пошук захворювання, для якого притаманні такого роду зліпки, показав обмеженість інформації в світових літературних джерелах. Україномовних публікацій, присвячених даному захворюванню, нами не знайдено. Авторами проведений огляд сучасної світової літератури, наведені критерії діагнозу, сучасна класифікаційна система пластичного бронхіту, заснована на гістології зліпків; наведені ефективні методики діагностики та диференційної діагностики захворювань-тригерів пластичного бронхіту. Клінічне спостереження ілюстровано фотографіями зліпків бронхів, результатами рентгенографії та комп’ютерної томографії легень в спіральному режимі кроком 3 мм з мультипланарною реконструкцією, що, з нашої точки зору, може доповнити банк знань педіатрів, дитячих пульмонологів, торакальних хірургів, а також кардіохірургів і кардіологів в Україні.