Manifestations Of Obstruction Research Articles

Transatmospheric ileal stoma manometry can be applied for the early detection of stoma outlet obstruction.

Stoma outlet obstruction (SOO) is a common complication of diverting ileostomy and usually detected at the advanced stage when the intestine is obviously obstructed. The objective of this study is to explore the efficacy of transatmospheric ileal stoma manometry (TISM) in early detection of SOO before the manifestation of intestinal obstruction. A single-center prospective study was performed in patients scheduled to undergo reversal ileostomy and laparoscopic anterior rectal resection and diverting ileostomy in Second Affiliated Hospital of Zhejiang University School of Medicine from 1st July 2022 to 31st December 2022. The stoma pressure was measured by TISM at different time points. The mean stoma pressure of the 30 patients before reversal ileostomy was 5.21 cmH2O which was considered as normal standard of stoma pressure, and ranged from 1.2 to 8.56 cmH2O. After excluding two patients with anastomotic leakage, a total of 38 patients who were subjected to laparoscopic anterior rectal resection and diverting ileostomy were further included in this study. The incidence of anastomotic leakage was 5% and that of SOO was 12.5%. The mean postoperative obstruction time was 5.2 (3-7) days and the mean time from elevated stoma pressure to diagnosed as SOO was 2.8 (2-4) days in the five patients who developed SOO. The pressure measured at the third stoma manometry time point (second day after return of gut function) (10.23 vs. 6.04 cmH2O, p<0.001) and the postoperative hospital stay (10 vs. 8.49 days, p=0.028) showed significantly difference between the SOO and non-SOO groups. The pressures measured at the first time point (before return of gut function) (4 vs. 4.49 cmH2O, p=0.585), the second time point (the day of return of gut function) (6.8 vs. 5.62 cmH2O, p=0.123), and the fourth time point (discharge day) (5.88 vs. 5.9 cmH2O, p=0.933) showed no significant difference in both groups. TISM can be utilized for early detection of SOO and can be incorporated as a novel diagnostic method together with abdominal CT scan to realize the goal of ERAS.

Craniofacial anatomical Characteristics of patients with catathrenia

Objective: To analyze whether the upper airway of patients with catathrenia has obstructive manifestations using nasal resistance, craniofacial, and upper airway imaging methods, which could benefit the exploration of the etiology and treatment options. Methods: From August 2012 to September 2019, a total of 57 patients with catathrenia in the Department of Orthodontics at Peking University Hospital of Stomatology were included in the study, including 22 males and 35 females, aged (31.1±10.9) years, with a body mass index of (21.7±2.7) kg/m2. All the patients were diagnosed by full-night polysomnography at the Sleep Division, Peking University People's Hospital, of which 10 patients were combined with obstructive sleep apnea hypopnea syndrome (OSAHS). The median groaning index of patients was 4.8 (1.8, 13.0) events/h. Nasal resistance and cone-beam CT were conducted on the patients, and measurements were performed on the craniofacial structures, upper airway, and surrounding soft tissues, compared with non-snoring normal occlusion individuals' references published by the same research team (144 college students recruited at Peking University and 100 non-snoring young adults with normal occlusion recruited at six universities in Beijing). Results: The total nasal resistance of patients with catathrenia was (0.26±0.08) Pa·cm-3·s-1. The patients had overall well-developed mandibular hard tissues. However, the patients were found with increased FH/BaN (steep anterior cranial base plane), increased MP/FH (forward rotation of the mandible); increased U1/NA and L1/MP (proclined upper and lower incisors). The sagittal diameter of the velopharynx [(19.2±4.5) mm] was significantly larger than the normal reference (t=8.44, P<0.001), while the sagittal diameter at the hypopharynx [(17.4±6.4) mm] was statistically smaller than the normal reference (t=-2.79, P=0.006). Catarhrenia patients combined with OSAHS presented longer soft palate, tongue, and lower hyoid bone than those with primary catathrenia. Conclusions: In patients with catathrenia, the overall craniofacial characteristics are well-developed skeletal structures, lower nasal resistance, proclined upper and lower incisors, wide upper sagittal development of the upper airway and narrow hypopharynx. Groaning sounds might be related to the narrowing of the hypopharynx during sleep.

Патогенетические и клинико-функциональные параллели формирования когнитивных расстройств при хронических риносинуситах

Introduction. In the context of optimizing the treatment of chronic rhinosinusitis, it is important to study the pathogenetic mechanisms of the development of inflammation in the paranasal sinuses and its influence on the development or maintenance of comorbid pathology of other organs and the body as a whole. Objective. To search and systematically analyze publications on the manifestations of comorbid pathology and pathogenetic relationship with the symptoms of chronic rhinosinusitis. Materials and methods. A literature search has been carried out over the past five years in the Russian Federation and in the world using the databases Medline, PubMed, Scopus, CyberLeninka; the electronic catalog of publishing houses Elsevier, Springer Medicine, Biomed Central, Media Sphera and scientific electronic library elibrary.ru were used. An interdisciplinary approach in the analysis of literature data was based on a single symptom complex of manifestations of chronic rhinosinusitis, combined with manifestations of diseases of organs and body systems that have similar pathogenetic and functional mechanisms. Results. The results of the analysis of the presented scientific studies are systematized in accordance with the identified commonality of pathogenetic, microbiological, immunological, and clinical characteristics of chronic rhinosinusitis. A comprehensive assessment of scientific research data on the interrelated processes of the impact of nasal obstruction on cognitive impairment and lifestyle confirmed the regulatory role of the limbic and autonomic nervous systems in understanding the commonality of pathogenetic mechanisms that occur in the identified nosology. Conclusions. A systematic analysis of publications showed the presence of the impact of comorbid manifestations of nasal obstruction in chronic rhinosinusitis on the central parts of the brain with the formation of latent neuroinflammation manifested by cognitive disorders.

Multidisciplinary treatment of massive trichobezoar caused an acute gastric outlet obstruction

Introduction. Trichobezoars presents a rare form of bezoar made of swallowed hair, with clinical manifestation of gastric or intestinal obstruction, gastric ulceration, bleeding, and perforation. It is predominantly found in emotionally disturbed or mentally retarded youngsters, who eating their own hair which is clinically known as trichophagia. Patients often deny eating their own hair which makes diagnosis difficult. Case report. We present a case of acute gastric outlet obstruction caused by a giant gastric trichobezoar made of a long thin hair, in a 20-year young female. Although patient had a long history of trichophagia, she did not think her behavior was unusual and she had not been treated before. Following the initial diagnostic procedures, exploratory laparotomy was indicated. After anterior gastrotomy was performed, a massive stomach-shaped trichobezoar was removed. Postoperatively, the patient had a psychiatric consult exam. She recovered well and was discharged without complications. She was referred for further psychiatric follow-up. Conclusion. Trichobezoars are non-digestible collections that usually accumulates in stomach and can extend to small bowel, causing mechanical injury such as hollow viscus obstruction. Patients with acute gastric obstruction caused by a giant trichobezoar require urgent removal of the trichobezoar, to preserve the stomach and avoid further, catastrophic consequences.

ОСОБЕННОСТИ КЛИНИКО-АНАМНЕСТИЧЕСКИХ ДАННЫХ И РОЛЬ СЕНСИБИЛИЗАЦИИ К РЕСПИРАТОРНЫМ АЛЛЕРГЕНАМ У ДЕТЕЙ С АТОПИЧЕСКОЙ БРОНХИАЛЬНОЙ АСТМОЙ

Objective: To analyze the profile of sensitization to airborne allergens in children with atopic bronchial asthma (BA) residing in Ufa referring to the main anamnestic and clinical data. Methods: The study was carried out in two phases and included general clinical examination along with specific allergy tests. In the 1st phase, allergy screening of 121 BA patients aged from 6 years to 17 years 11 months 29 days using a panel of respiratory allergens for detection of serum specific IgE was conducted. In the 2nd phase of the study, 114 children with a verified diagnosis of atopic BA with were selected based on sensitization to the respiratory allergens, while the remaining 7 patients were excluded from the study based on the exclusion criteria. In the 2nd phase of the study, allergen sensitization was evaluated by serum specific IgE levels determined by indirect immunofluorescence on a three-dimensional porous solid phase (ImmunoCAP® 250, Phadia). The obtained data were used for subsequent assessment of respiratory allergens sensitization profiles in children with atopic BA. Results: Manifestations of atopy and concomitant pathology at an early age were revealed in 89 patients (78%). In 73 children (64%) anamnestic data analysis revealed a family history of allergic diseases and BA, which was more often on the mother’s side (46 children, 63%); among them, the most common was a family history of BA (21 children, 46%). All 114 patients had clinical manifestations of bronchial obstruction and hyperreactivity as a result of the allergen exposure, and the influence of adverse environmental triggers and ecological microenvironment. The results of the allergen screening in the 1st phase of the study showed that more commonly Class III sensitization (increased level) was determined in the patients enrolled (40 children, 35%). The data from the 2nd phase of the study revealed polyvalent sensitization in 81 patients (71%). Among the pollen allergens, most commonly children with atopic BA showed sensitization to warty birch (Betula verrucosa) (t3). Conclusion: Modern diagnostic facilities allow to search and identify allergen sensitization in children with atopic BA, effectively and timely determining causal and exogenous factors for every patient, choosing rationale and most differentiated pharmacotherapy with a response and course prediction, optimization of diagnostics, prevention, and rehabilitation. Keywords: Bronchial asthma, children, sensitization, atopic phenotype, respiratory allergens, inhaled glucocorticoids.

Hypoxic Conditioning in Rehabilitation and Secondary Prevention Programs in Cardiac Patients with Multimorbidity: a Review

INTORDUCTION. Patients with multiple chronic diseases are at higher risk of premature death, hospitalization, longer hospital stays, and reduced health-related quality of life compared to patients with a single disease. On the other hand, the presence of comorbid conditions limits the enrolment of traditional exercise-based cardiac rehabilitation programs. It is predicted that as life expectancy increases, the level of multimorbidity will increase, making it even more important to find new additional methods and technologies for the rehabilitation of cardiac patients with comorbidities. AIM. To analyze the data from the current publications or to define the validity and effectiveness of using different hypoxic conditioning regimens in cardiac patients with concomitant chronic pathology (arterial hypertension, obesity, diabetes mellitus, and chronic bronchopulmonary diseases) as well as in multimorbid elderly patients. MATERIAL AND METHODS. The search for relevant papers was carried out using the Medline, e-library, and Web of Science Core Collection databases, as well as the following keywords: “hypoxic conditioning”, “hypoxic training”, “hypoxic therapy”, “interval hypoxic therapy”, “intermittent hypoxia”, “hypoxic conditioning”, “interval hypoxia training”, and “hypoxic exposure”. The analysis included publications regarding the use of the hypoxic conditioning method in cardiac and elderly patients with multimorbid pathology, as well as publications on the use of the method in the rehabilitation of patients with certain nosologies to identify potential mechanisms in correcting bronchopulmonary violations and lipid and carbohydrate metabolism disorders. The last search date was April 05, 2022. RESULTS. Most of the analyzed studies proved that the hypoxic conditioning technology in passive interval exposure regimes is an effective method for non-pharmacological correction of cardiometabolic risks in cardiac patients with multimorbid pathology and can increase exercise tolerance, optimize hemodynamic parameters (HR, SBP and DBP), reduce the manifestations of bronchial obstruction and respiratory failure, and improve cognitive function and metabolic indicators. Personalized physical activity doses in oxygen-depleted ambient air appear to be promising, but require additional studies to establish optimal application protocols. CONCLUSION. The data presented may recommend hypoxic conditioning technologies for wider implementation in cardiac rehabilitation programs for patients with multimorbid pathologies.

Case report of pulmonary embolism in pediatric practice

An analysis of the clinical situation of a 14-year-old patient with pulmonary embolism (PE) and current information on the risk factors for the development of thrombotic events are presented. Due to the presence of gynecological pathology, the girl was prescribed hormonal drugs, in particular, dydrogesterone and estrogen + gestagen. Against the background of its use, complaints of shortness of breath appeared, which was regarded as a manifestation of bronchial obstruction and bronchodilator therapy was prescribed. Due to the lack of positive dynamics during treatment, she was hospitalized. MSCT of the chest organs was performed: signs of PE were revealed; A molecular genetic study of the DNA of buccal epithelial cells (PCR) was carried out: the carriage of prothrombogenic polymorphic variants of genes of the hemostasis system was revealed, the most significant of which is a heterozygous mutation of the prothrombin FII gene (G20210A); the study of the hemostasis system revealed thrombinemia. In therapy, thrombolysis was not performed, low molecular weight heparins were prescribed the child's condition improved. The question of the need for a comprehensive examination, including research on the carriage of prothrombogenic polymorphic variants of the genes of the hemostasis system for pediatric patients in situations requiring the administration of hormonal drugs for a long course, to prevent the ocurrence of dangerous thrombotic complications, is discussed.

DESIGN OF WHEEZING SOUND DETECTION WEARABLE DEVICE BASED ON INTERNET OF THINGS

&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Wheezing is one of the most common manifestations of airway obstruction. The use of a stethoscope in the wheezing examination has several disadvantages such as subjective results and depends on the auditor's hearing sensitivity. So an easy device is needed that helps determine the wheezing sound precisely. This study assembled a single tool to detect wheezing sounds based on the internet of things.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method&lt;/strong&gt;&lt;strong&gt;: &lt;/strong&gt;This tool is designed with a microprocessor hardware connected to an electric stethoscope so that it can be attached to the patient's chest wall. Collection of chest breathing voice data accessed on kaggle.com. The creation of algorithms with Convolutional Neural Networks (CNN) was later changed to Mel Frequency Cepstral Coefficients (MFCC). This model will be implanted in a microprocessor and use python language to be able to record the sound of chest wall vibrations. The recorded sound is converted into MFCC to make it easier to perform wheezing sound detection. MFCC image results and detection results are sent to the database via the firebase database feature which stores MFCC photos in real-time as they are detected. Designing android application software using Flutter builds communication between android applications and firebase databases that allows applications to retrieve MFCC images as the final result. &lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Result&lt;/strong&gt;&lt;strong&gt;: &lt;/strong&gt;The results of the tool trial on five volunteers, three exacerbation asthma patients and two healthy people showed the device can detect wheezing sounds at a frequency of 400Hz with 80% accuracy through CNN and MFCC algorithms Internet of things based.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion&lt;/strong&gt;&lt;strong&gt;: &lt;/strong&gt;This tool can help health workers to accurately determine wheezing sounds, enforce the diagnosis faster, the prognosis of the disease to be better, so as to reduce the number morbidity and mortality of diseases with airway abnormalities in Indonesia&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;div&gt; &lt;/div&gt;

Mesenteric misadventure: An unusual suprapubic catheter complication

Abstract Although suprapubic cystotomy for catheter insertion is commonly performed, complications can be associated with serious morbidity. This case describes delayed recognition of a transperitoneal suprapubic catheter (SPC) traversing the small bowel mesentery and causing a closed loop obstruction of the caecum 7 years after SPC insertion. There are very few cases in the literature of SPC causing mesenteric perforation and to the best of our knowledge, this is the first reported case causing subsequent obstruction of the caecum and the longest delay of 7 years between SPC insertion and manifestation of bowel obstruction.

Buerger's Disease May be a Chronic Rickettsial Infection with Superimposed Thrombosis: Literature Review and Efficacy of Doxycycline in Three Patients.

Buerger’s disease (BD) is a chronic inflammatory vasculitis of unknown etiology. The infectious etiology of BD was proposed by Buerger in 1914. Furthermore, there are scattered reports insisting that BD may be related to rickettsial infection, first asserted by Goodman since 1916, followed by Giroud and other French investigators from the 1940s through the 1960s, Nicolau in the 1960s, Bartolo (1980s), and Fazeli (2010s). However, their causal relationship has hardly been accepted because rickettsial infections are known to be acute febrile, vector-borne illnesses, whereas BD is a chronic afebrile illness. In this article we review the relevant literature on the chronic nature of Rickettsia and Orientia infections and on the rickettsial etiology of BD. Excellent initial responses to doxycycline in three patients with BD are briefly described. Based on these findings, we hypothesize that BD patients acquired a rickettsial infection far before the onset of BD. Over years, the infected area expands to become a segment of the infected vessel. Subsequently, thrombus develops on the luminal surface of the infected endothelial cells, which produces the vascular obstructive manifestations of BD. Collectively, it is postulated that BD is a chronic infection with a member of the family Rickettsiaceae with superimposed thrombosis.

Treatment of children with Pierre Robin Syndrome

Introduction. Incidence of Pierre Robin sequence (PRS) according to different studies varies from 1:8500 to 1:30000 newborns. Swallowing dysfunction may lead to aspiration of food, saliva and gastric content, resulting in severe aspirational pneumonia. Obstructive sleep apnea (OSA) may be a life threatening condition for children with PRS and may cause death by asphyxia. Average mortality rate for PRS according to different studies is approximately 16 % and varies depending on several factors: number of patients in studies, severity of the condition, diagnostic methodologies and presence of associated syndromes in maxillofacial region. Mortality rate in severe PSR (especially associated PSR) is 41,4 %. Aside from high mortality, OSA contributes to the development of cardiovascular disease including pulmonary hypertension, which progresses more rapidly than in adults. OSA exacerbates existing comorbidities; in the absence of timely treatment sleep apnea leads to learning impairment and behavioral problems, developmental delay, failure to thrive. Methods. 80 children with PSR aged between 4 days and 1 year have undergone compression-distraction osteosynthesis (CDO). 48,8 % (39) of children were diagnosed with severe degree of OSAS, 35 % (28) had moderate degree, 16,3 % (13) had mild degree. Pretreatment diagnostics included standard set of examinations and specialist consultations. Special diagnostics included CT of head and neck, fiberoptic nasopharyngoscopy, examination by ENT specialist for the assessment of the degree of upper airways obstruction and exclusion of pathologies and anomalies of nasal cavity, pharynx, larynx and trachea, which also may be the cause for reduced airflow and upper airway obstruction (intubated children haven’t undergone these examinations). Photographs were taken and videos of clinical manifestations of airway obstruction during sleep were recorded. Blood gas tests were regularly taken; blood oxygenation levels were measured with a pulse oximeter. Polysomnography was performed, which allows for accurate and comprehensive evaluation of severity of OSA based on multiple parameters. Extra-cortical and external compression-distraction devices (CONMET, KLS Martin, Synthes) were used. Results. Good outcome was achieved in 90 % (72), satisfactory in 6,3 % (5) and negative in 3,8 % (3) of cases.

Hypertension as an atypical presentation of unilateral ureteral obstruction

Ureteral obstruction (ureteropelvic or ureterovesical junction obstruction) is frequently diagnosed during the workup investigation of an asymptomatic infant or child with upper urinary tract dilatation, commonly identified in a prenatal ultrasound. In older children, recurrent lumbar pain is a red flag for ureteral obstruction. Although less frequent, hypertension may be the initial and only manifestation of ureteral obstruction. The authors present two pediatric cases of unilateral ureteral obstruction with hypertension, in which the surgical treatment of the obstruction leads to blood pressure normalisation. In all pediatric age groups, a systematic investigation for secondary causes of hyperten‑ sion is of paramount importance. In some cases, especially those of an obstructive nature, early surgical management can be curative, with normalization of blood pressure levels and prevention of renal injury.

Anti-mobbing Technology in the Conditions of an Educational Institution in Ukraine

The article reveals the essence of the concept "mobbing" and its classification in the context of pedagogical management. An empirical study has been conducted to identify the presence, frequency, causes, features of manifestations and consequences of mobbing processes in the teaching staff of general secondary education in Ukraine. Methods of randomized experiment, correlation analysis, scaling and ranking were used to process the research results. The results of the correlation analysis revealed causal relationships between some causes, manifestations, consequences of mobbing and certain statistical characteristics. The results of the empirical study prove the presence and prevalence of cases of mobbing in the teaching staff of secondary schools in Ukraine. The results of the study allow us to conclude that in general secondary education institutions, depending on the status of the persons involved, all three types of mobbing are implemented. Vertical prevails - 41.5%. Horizontal - 27.7% of respondents, mixed - 11.8%. 19% of respondents did not face mobbing. Depending on the specifics of harassment, there are different variations of mobbing processes, which sometimes overlap in their manifestations. Bosing prevails - 41.5%. 27.7% indicated bullying, social isolation - 15.8%, staffing - 14.7%, sandwich mobbing - 11.8%, gaslighting - 8.4%, outing - 7.7%, ageism - 6.8%, stalking - 5.9%, cyber mobbing - 4.7%. Also, based on the results of the survey, we can conclude that in educational institutions there are manifestations of obstruction - 3.1% of respondents. The general bases of anti-mobbing technology have been developed - a system of measures of the head and pedagogical workers to prevent, detect and combat harassment, moral pressure, psychological terror in an educational institution.

Ultrasonic Diagnosis of Intestinal Loop Obstruction After Introducing Loop Syndrome After Subtotal Gastrectomy

In this paper, a graphical diagnosis of intestinal loop obstruction input into the loop syndrome after subtotal gastrectomy based on ultrasound diagnosis is more fluid accumulating in the bridge loop. The pressure in the intestinal loop is constantly rising, causing bile and pancreatic juice excretion disorder, and dilation of intrahepatic and external bile ducts or dilation of pancreatic ducts, which is similar to the anatomical features of low biliary obstruction. For dilated bowel, the expansion of the upstream drainage pipe organ changes in physiological and pathological anatomy pathological bridge loop obstruction. The ultrasound can show good and on the ming stomach ultrasound pictures of patients with loop syndrome after major resection were analyzed. Most patients with hepatic shape changed the left hepatic duct dilatation, and the inner diameter is 4.8 cm and the length is 18.0 cm. The wall of the tube is a multi-layer structure, and fold-like echoes can be seen. The lumen does not pass through the angle between the superior mesenteric artery and the abdominal aorta. Patients with a history of pancreas Whillp or Child type surgery or a history of Roux-en-Y type biliary jejunum have clinical manifestations of bowel obstruction. The ultrasound of their bridge loop obstruction showed a long tubular anechoic dark area in the upper abdomen and dilation of the upstream drainage organ duct.

Laparoscopic biopsy and staging for locally advanced pancreatic cancer: experiences of 76 consecutive patients in a single institution.

Pathological diagnosis plays a critical role in the treatment of locally advanced pancreatic cancer (LAPC). However, the commonly used biopsy methods still have a number of shortcomings, such as a relatively low diagnostic accuracy and a high incidence of complications. A retrospective review was conducted to compare 76 patients with laparoscopic biopsy and staging and 11 patients with CT-guided pancreatic biopsy for LAPC between January 2017 and October 2020. Logistic regression with univariate and multivariate analyses was performed to identify preoperative predictors of occult metastasis. The diagnostic accuracy of laparoscopic biopsy and staging for pancreatic cancer was 100%. Sixty-two patients were confirmed to have LAPC, 59 patients by pancreatic biopsy and three patients by regional lymph node biopsy. Fourteen patients were diagnosed with distant occult metastasis, three patients by liver biopsy and 11 patients by peritoneum biopsy. Nine patients with severe obstructive manifestations underwent a simultaneous bypass procedure. No postoperative hemorrhage, pancreatic fistula, intra-abdominal infection, or trocar site metastasis was observed. Laparoscopic biopsy and staging had a higher diagnostic accuracy (100% vs. 81.8%, p=0.0147) and a shorter duration to chemotherapy (3 days vs. 9 days, p=0.035) than CT-guided biopsy. Elevated CA125 levels (≥35 U/ml) were a significant preoperative predictor of occult metastasis (OR 6.482, 95% CI 1.624-25.874, p=0.008). Laparoscopic biopsy and staging are safe and effective methods to obtain rapid pathology and precise staging for LAPC patients, especially for patients with elevated CA125 levels.

Spindle Cell Carcinoma of the Larynx with Tracheobronchial Aspergillosis: A Rare Coincidence.

We herein report a rare coincidence and a possible association between laryngotracheal fungal infection and spindle cell carcinoma of the larynx (SpCC). A 79-year-old gentleman presented to the Emergency Department with manifestations of airway obstruction. Flexible nasendoscopy showed pooling of saliva around the larynx and his neck palpation did not show cervical lymphadenopathy. Further imaging showed bilateral transglottic mass mainly in the subglottis along with right pulmonary nodularity. Percutaneous tracheostomy, panendoscopy and biopsy of the laryngeal mass confirmed a diagnosis of SpCC. A few days later, he was admitted and aspergillus fumigatus was found in a biopsy of his tracheal tissue. To the best of our knowledge, the possible correlation between laryngotracheal aspergillosis and such a rare type of cancer larynx (SpCC) has not been highlighted in the literature.

Синдром Циннера у детей

In this article, we report three cases of Zinner syndrome (renal agenesis or renal dysplasia, ipsilateral seminal vesicle cyst, and seminal duct obstruction) in children of different age and describe their diagnosis and treatment. All patients have undergone kidney and bladder ultrasonography, renal scintigraphy, and cystoscopy. Two children have also undergone contrast-enhanced computed tomography; one child has undergone magnetic resonance imaging. A 6-month-old patient with a large cyst and clinical manifestations of infravesical obstruction and chronic constipation was operated on. He has undergone diagnostic laparoscopy and cyst removal; seminal duct atresia was confirmed intraoperatively. Key words: Zinner syndrome, renal agenesis, seminal vesicle cyst

Приоритеты в тактике ведения детей с бронхиальной обструкцией на фоне острой респираторной вирусной инфекции: что нового?

Objective of the Review: To discuss aetiology, pathogenesis, clinical manifestation, and therapy of bronchial obstruction in children with acute respiratory infection. Key Points. Evaluation of bronchial obstruction in children with acute respiratory viral infection is complicated because of its genesis, differential diagnosis challenges, prevalence and rate of relapse. Issues of management of children with recurrent bronchial obstruction and rational drugs selection are discussed. Conclusion. Up-to-date approaches to the therapy of bronchial obstruction in children should be pathogenically justified and should take into account both individual haracteristics of a child and drug’s mechanism of action and pharmacokinetics. Keywords: bronchial obstruction, acute respiratory viral infection, children, bronchial asthma, sea water, salbutamol.

AGGRAVATING EFFECT OF ARTERIAL HYPERTENSION ON THE COURSE OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN PATIENTS WITH COMORBID PATHOLOGY

The aim: To study the effect of arterial hypertension on the course of chronic obstructive pulmonary disease in patients with comorbid pathology. Materials and methods: The prospective study included 61 patients with COPD: 32 stable male patients with COPD with comorbid arterial hypertension of stage II 1-3 degrees and 29 stable outpatients of men with COPD of clinical groups A-D with impaired respiratory function II-IV according to GOLD. All patients, in accordance with the goals and objectives of the study, were divided into 2 groups: group I consisted of men with isolated COPD, middle age - 56.0 (8.5) years, average duration of the disease - 16.2 (1.3) years, Group II consisted of male patients with COPD and arterial hypertension (AH), middle age - 59.5 (7.5). The patients underwent a general clinical examination, which included an assessment of complaints, anamnestic data, and a physical examination. The severity of COPD was determined on the basis of the frequency of exacerbations during the year, assessment of dyspnea using the mMRS scale, spirographic data. Statistical materials were processed using the STATISTICA 10.0 program. Results: In group I, 20 patients (69%) complained of dyspnea during exercise, in group II - 25 patients (78%) (p = 0.4), 28 patients (96.5%) complained of cough with vague sputum. group and 30 patients in group II (93.8%) (p = 0.09). When assessing the number of exacerbations over the past year, it was determined that patients with isolated COPD had an average of 1.0 (1.0; 2.0) exacerbations, and patients with COPD and AH - 2.0 (1.0; 3.0 ) (p = 0.06). According to the CAT questionnaire, the following data were obtained: in group I - 9.0 (8.0; 11.0) points, and in group II - 17.5 (10.0; 20.0) points (p = 0.02). When conducting spirographic studies, a statistically significant more expressive bronchial obstruction was found in patients with COPD and comorbid hypertension. Conclusions: The presence of comorbid arterial hypertension leads to the intermittent effect of diseases: according to the results of mMRC and SAT test, ailments for COPD were examined, they have a more severe course of underlying seizure in the presence of concomitant arterial hypertension. Clinical manifestations in patients with COPD and H are more severe compared to clinical manifestations in patients without aggravated diseases of the cardiovascular system. Concomitant arterial hypertension enhances the manifestations of bronchial obstruction, in the same way as with patients with isolated COPD.

Treatment of May–Thurner Syndrome in a Patient with an Iliac Artery Stent

May–Thurner syndrome (MTS) is caused by compression of the left iliac vein by the right iliac artery, leading to clinical manifestations of outflow obstruction in the lower limb and deep vein thrombosis. There have been increasing reports of iatrogenic MTS caused by medical implants. The authors report the case of a 60-year-old man who developed MTS after stenting of the right common iliac artery. Due to the debilitating nature of the patient’s symptoms of venous congestion in the left leg, he proceeded with endovascular venoplasty and venous stent insertion with concurrent intra-arterial balloon angioplasty of the existing right common iliac artery stent. Technical success and primary patency of arterial and venous stents were achieved. The patient remained asymptomatic at 6 weeks and 3 months follow-up and arterial and venous stents were found to be patent on duplex ultrasound. Surgical management of MTS may include thrombolysis, thrombectomy, venoplasty and stenting of the left common iliac vein. Care must be taken to preserve existing medical implants during treatment of MTS. The authors demonstrate that concurrent angioplasty of the right common iliac artery during treatment of the vein is an effective method of preventing arterial stent disruption during surgical management of MTS.