Progredient Course Research Articles

A comparative study of human endogenous retrovirus <i>HERV-E λ 4-1</i> activation in autoimmune pathology

Considering the presence of immunomodulatory properties of human endogenous retroviruses, namely (i) the ability to activate the innate immune response by HERVs nucleic acids; (ii) the antigenicity of transcriptionally competent endogenous retroviruses envelope protein molecule, which causes polyclonal activation of lymphocytes; (iii) the absence of HERVs expression and protein production in the thymus during the immune tolerance formation, which allows us to consider these proteins as autoantigens or neoantigens, it seemed relevant to investigate the association of replication-competent human endogenous retrovirus HERV-E λ 4-1 with course of some of autoimmune diseases, such as multiple sclerosis, rheumatoid arthritis and systemic lupus erythematosus. The aim of this work was a comparative study of the human endogenous retrovirus HERV-E λ 4-1 activation frequency in blood mononuclear cells in multiple sclerosis, rheumatoid arthritis, systemic lupus erythematosus, as well as in chronic nervous system non-progressive diseases and the degenerative-dystrophic disease of the musculoskeletal system. The peripheral blood mononuclear cells were isolated by the venous blood centrifugation on Ficoll density gradient of 1.078 g/cm3. Expression of the HERV-E λ 4-1 envelope gene was detected by reverse transcriptase polymerase chain reaction. It was found that the HERV-E λ 4-1 envelope gene expression frequency in the chronic non-progressive diseases of nervous system, as well as in degenerative-dystrophic joint disease, is comparable to the expression frequency in conditionally healthy individuals. However, the HERV-E λ 4-1 envelope gene expression frequency in autoimmune diseases significantly exceeded that in conditionally healthy individuals and in non-inflammatory diseases. The maximum values of expression frequency were observed in active multiple sclerosis, significantly higher than in systemic lupus erythematosus and rheumatoid arthritis in the acute stage. Moreover, the expression frequency in the remission stage of multiple sclerosis was significantly lower than in the acute stage of the relapsing-remitted course, as well as in the progredient course. Estimation of HERV-E λ 4-1 envelope gene expression frequency at different severity levels of multiple sclerosis revealed its maximum rates at III and IV-V severity levels, both in relapsing-remitting and progressive course of multiple sclerosis. Thus, activation of the human endogenous retrovirus HERV-E λ 4-1 is associated with the course of autoimmune diseases, namely multiple sclerosis, rheumatoid arthritis, and systemic lupus erythematosus; it positively correlates with the activity and severity of multiple sclerosis.

Сравнительный анализ динамики клинико-функциональных особенностей метаболического синдрома у больных ХОБЛ, перенесших новую коронавирусную инфекцию

Introduction. To date, it has been established that risk factors for the development of a novel coronavirus infection (NCI), in addition to advanced age and chronic obstructive pulmonary disease (COPD), are metabolic diseases such as obesity, diabetes mellitus, arterial hypertension (AH), non-alcoholic fatty liver disease (NAFLD), united by the notion of “metabolic syndrome” (MS). At the same time, NCI contributes to the onset and aggravation of the clinical manifestations of MS. Similar to the restoration of respiratory function in subjects who had NCI, it seems relevant to analyze the disorders of carbohydrate and lipid metabolism in the long-term period after acute NCI in COPD patients. Aim. To study in a comparative aspect the dynamics of clinical and functional characteristics of the metabolic syndrome in COPD patients who had NCI. Materials and methods. We observed for 12 months in the Therapeutic Department of the City Health Centre No. 9, Barnaul, 385 COPD patients, which were divided into 2 groups: group I – 55 patients without MS, group II – 330 patients with MS. When assessing the distribution of patients by sex, the majority were men. The mean age of patients in group I was 65.2 ± 11.1 years; in group II – 63.7 ± 9.8 years (рI–II > 0.05). Group III (comparison) consisted of 120 patients with MS without COPD, comparable in age and gender. Complaints, anamnestic data of all patients were collected. Physical examination, laboratory (assessment of carbohydrate, lipid metabolism, liver and kidney function) and clinical (electrocardiography, echocardiography) examinations were carried out. Demographic indicators, smoking habit, duration of COPD, presence of complications and comorbidities were assessed. Results. NCI was detected in 15 (27.3%) patients of group I, in 169 (51.2%) patients of group II (рI–II < 0.05). In the comparison group, NCI was diagnosed in 52 (43.3%) patients (pII–III > 0.05). Post-COVID syndrome (NICE, 2020) was diagnosed in 6.7% of patients in group I, in 34.3% of patients in group II (p < 0.05), and in 18.4% of patients in group III (p > 0.05). A direct strong correlation was found between the occurrence of post-COVID syndrome and the severity of carbohydrate metabolism disorders according to the values of the visceral adiposity index (VAI) and the insulin resistance index (HOMA-IR) (r = 0.74 and 0.72, respectively; p < 0.05). For most clinical and laboratory indicators, the negative dynamics persisted until the 6th month with improvement by the 12th month: the levels of high-density lipoprotein cholesterol and glucose decreased, the fat free mass index (FFMI) increased (p < 0.05), however, the number of patients with high normal blood pressure and AH increased statistically significantly by the 12th month after NCI, reaching 92.4% in group II (p < 0.05). Conclusion. NCI is more often diagnosed in patients with MS in combination wih COPD, in the presence of risk factors: advanced age, COPD, obesity, AH. Post-COVID syndrome was detected in every third patient with MS and COPD with the positive dynamics of carbohydrate and lipid metabolism disorders by the 12th month of the follow-up. AH with the development of complications (diastolic dysfunction, abdominal obesity, and associated NAFLD) was characterized by an unfavorable, progredient course in patients with MS in combination with COPD in the long-term period after NCI, which necessitates early initiation of therapy for comorbidities.

OPTIMIZED EXTERNAL THERAPY FOR SEVERE ZOOANTHROPONIC TRICHOPHYTOSIS

Zooanthroponic trichophytosis caused by Trichophyton verrucosum, Trichophyton mentagrofites, var.gypseum belongs to widespread dermatomycosis in the rural areas of the Uzbekistan. Suppurative mycosis forms (Celsus kerion) are often accompanied by suppurative manifestations, intoxication as well as secondary infection with bacterial microflora. Use of a combination drug mupiroban along with systemic and topical therapy promotes accelerated regression of inflammatory process that elevates therapeutic efficacy.Trichophytosis dominates in the pattern of scalp and smooth dermal layer mycosis in the Uzbekistan and poses a pressing medical and social problem. It was noted that morbidity rate was unevenly distributed in diverse regions of the Uzbekistan that depends on local environmental conditions, climate in arid zone being additionally aggravated by action of technogenic factors. In the Uzbekistan, more common is trichophytosis caused by zoophilous fungi, which role increases during mycosis epidemiologic outbreaks. Fungus culturing method detects Tr. Ectothrix megaspores (Tr. faviforme) in around 90% cases that causes acute purulent lesions on the smooth skin, scalp and face as well as sycosis; fungal spores in pathological samples preserve viability for many years in dry premises. Tr. ectothrixmicroides (Tr. mentagrophytesvar. gypseum) hold the second place among fungi seeded from patient samples. Trichophyton gypsum culture is presented as a loose sheath at the base of hair, prone to polymorphic shape causing spontaneous mycosis in various animal species, whereas in human resulting in acute purulent skin and scalp lesions. Tr. mentagrophytes most prominently exerts proteolytic and keratolytic activity. Infiltrative-suppurative form of zooanthroponic trichophytosis may be often complicated by intoxication, lymphadenitis, disturbed patient general condition and display a progredient course after applying standard therapy wioth systemic and topical antimycotic drugs. In most cases, patients are noted to have secondary infection of mycotic foci due to activated skin microflora as well as increased colonization by staphylococci and opportunistic microorganisms of the intestinal group.Over the last years, infiltrative-suppurative form of zooanthroponic trichophytosis (Celsus kerion) with atypical course and suppurative events have been recorded at higher rate. In such cases, dermal lesions are often associated with lymphadenitis, abscess formation, eczematization, potential development of allergic reactions, erythema nodosum, dermatophytic granulomas, finally resulting in cicatricial alopecia.

Sublingual allergen-specific therapy in a child with diabetes mellitus

A description of a clinical case of a pediatric patient (boy, age 12 at the start of observation) with pollen allergy (allergic rhino-conjunctivitis to grass pollen) in combination with insulin-dependent diabetes mellitus is presented. Initiation criteria of allergen-specific immunotherapy (clear seasonal peak of exacerbations, high and concordant data of allergotesting In vivo and In vitro, progredient course of pollinosis clinical signs during years before allergen-specific immunotherapy was started) discussed in case of comorbid patient. Possible risks were analyzed and absence of diabetes mellitus as contraindication for immunotherapy stated. The patient underwent 2 pre-coseasonal courses of sublingual immunotherapy with grass pollen allergens in 2020 and 2021 with a pronounced positive effect. In the second year of treatment, remission of the disease was achieved: almost complete absence of hay fever symptoms in the flowering season of 2021, no progression of the disease, a significant decrease in the need for therapy to relieve symptoms. During the course of therapy, the patient did not show any deterioration in the course of diabetes mellitus, and the daily dose of insulin did not change. The patient is being monitored, and the third course of sublingual immunotherapy with grass pollen allergens is started.

Вплив тяжкості стеатозу підшлункової залози на перебіг неалкогольної жирової хвороби підшлункової залози в дiтей

Актуальність. Неалкогольна жирова хвороба підшлункової залози — надлишкове накопичення жиру в підшлунковій залозі, асоційоване з ожирінням, при виключенні вторинної етіології стеатозу. Неалкогольна хвороба печінки може мати прогредієнтний перебіг. Чи супроводжується прогресування неалкогольної жирової хвороби підшлункової залози специфічними структурними та лабораторними змінами, залишається неясним. Мета: встановити особливості сонологічних та лабораторних змін у дітей iз неалкогольною жировою хворобою підшлункової залози залежно від ступеня стеатозу. Матеріали та методи. Ми спостерігали 93 дітей віком від 7 до 17 років, середній вік 11,87 ± 2,82 року. Ступінь стеатозу підшлункової залози оцінювали за допомогою ультрасонографії. Пацієнтам проводили зсувнохвильову еластографію і стеатометрію (кількісну оцінку ступеня загасання ультразвуку з визначенням середнього коефіцієнта загасання ультразвуку (КЗУ)) підшлункової залози за допомогою апарату Ultima PA Expert («Радмір», Україна). Фіброз та стеатоз печінки були діагностовані з використанням апарату FibroScan 502 Touch (Франція) з функцією контрольованого параметра ультразвукового загасання (КПУЗ). Діти були розділені на наступні групи: 1-ша група — 50 пацієнтів зi стеатозом підшлункової залози й ожирінням/надмірною вагою; ця група була розділена на підгрупи: S1 — 20 осіб iз 1-м ступенем стеатозу підшлункової залози; S2 — 22 пацієн­ти з 2-м ступенем стеатозу підшлункової залози, S3 — 8 хворих iз 3-м ступенем стеатозу підшлункової залози; 2-га група — 30 пацієнтів без стеатозу підшлункової залози з ожирінням/надмірною вагою, 3-тя (контрольна) група — 13 дітей iз нормальною вагою. Пацієнтам були проведенi загальноклінічний аналіз крові з визначенням швидкості осідання еритроцитів (ШОЕ), біохімічна гепатограма (аланінамінотрансфераза (AЛТ), аспартатамінотрансфераза (АСТ), гамма-глутамілтранспептидаза (ГГТП), амілаза крові). Рівень інсуліну визначали за допомогою імуноферментного аналізу з розрахунком індексу інсулінорезистентності HOMA. Статистичний аналіз проводився з використанням програмного забезпечення Statistica 7.0 за допомогою дисперсійного аналізу (ANOVA) з наступним post hoc аналізом. Результати. У дітей групи S3 порівняно з контрольною групою продемонстровано більш високий рівень ШОЕ — в 1,86 раза (р = 0,01), АЛТ — в 1,86 (р = 0,006), АСТ — в 1,96 (р = 0,00019), ГГТП — в 2,10 раза (р = 0,0001). Ми виявили, що пацієнти зi стеатозом підшлункової залози мали більш високий рівень інсуліну порівняно з контрольною групою (підгрупа S1 — 18,38 ± 5,07 мкОД/мл, S2 — 30,76 ± 3,92 мкОД/мл, S3 — 33,70 ± 5,37 мкОд/мл; 2-га група — 18,70 ± 2,98 мкОд/мл; 3-тя група — 9,480 ± 5,067 мкОд/мл (р = 0,00262)). Також у пацієнтiв зi стеатозом підшлункової залози відмічено більш високий індекс HOMA порівняно з конт­рольною групою (S1 — 4,04 ± 0,87, S2 — 7,11 ± 0,96, S3 — 7,99 ± 1,35; 2-га група — 3,81 ± 0,73; 3-тя група — 1,94 ± 0,92 (p = 0,00156)). КПУЗ був підвищеним у дітей зi стеатозом підшлункової залози порівняно з конт­рольною групою (підгрупа S1 — 234,50 ± 9,94 дБ/м, S2 — 239,05 ± 8,99 дБ/м, S3 — 245,33 ± 17,21 дБ/м; 2-га група — 197,87 ± 7,70 дБ/м; 3-тя група — 172,754 ± 12,170 дБ/м (p = 0,00156)). КЗУ сягав максимальних рівнів у дітей підгрупи S3 (S1 — 2,55 ± 0,08 дБ/см, S2 — 2,56 ± 0,09 дБ/см, S3 — 2,74 ± 0,14 дБ/см; 2-га група — 2,26 ± 0,08 дБ/см; 3-тя група — 1,72 ± 0,15 дБ/см (р = 0,00001)). Пацієнти зі стеатозом підшлункової залози мали вищий рівень жорсткості печінки та підшлункової залози, проте значущість відмінностей була недостатньою. Висновки. Дослідження показало, що неалкогольна жирова хвороба підшлункової залози в дітей супроводжується стеатозом печінки, зростанням рівня маркерів запалення та інсулінорезистентності, що збільшуються при зростанні ступеня ­стеатозу.

Clinical case of Guillain-Barré syndrome associated with COVID-19

Background: The coronavirus infection caused by SARS-Cov-2 is characterized by a damage to many organs and systems of the human body. To date, convincing information has been obtained about the involvement of various parts of the nervous system in the pathological process in patients with COVID-19. Among the most frequently described impairments, there are disorders of smell and taste, common disorders of the central nervous system, characterized by general cerebral symptoms, such as headache, asthenization, psychopathological disorders. One of the rare and severe forms of the peripheral nervous system damage in COVID-19 is Guillain-Barre syndrome (GBS), characterized by acute post-infectious inflammatory polyneuropathy with an autoimmune etiology. Clinical case description. We present a clinical case of GBS associated with COVID-19. The disease debuted as a peripheral tetraparesis with a progredient course of up to 21 days. Systemic administration of immunoglobulin stopped the disease progression. The association of GBS with COVID-19 was clarified a month after the disease onset, when bilateral polysegmental pneumonia was diagnosed, and a high level of IgG to the S-protein of SARS-CoV-2 was found, 3 times higher than the level of IgM, which indicated the duration of the disease was not less than three weeks. Conclusion: The GBS development upon infection with SARS-CoV-2 may precede the lung damage. The debut of GBS during the COVID-19 pandemic requires the exclusion of the SARS-CoV-2 etiological role in each case.

Ehlers-Danlos syndrome with damage to the digestive tract, heart, kidneys and other organs

Relevance: Hereditary connective tissue disorders (HCTDs) are a heterogeneous group of diseases caused by mutations in the genes of extracellular matrix proteins or proteins involved in connective tissue morphogenesis. Mutations of these genes lead to the development of many HCTDs. The best known monogenic variants of HCTDs are Marfan syndrome, Ehlers-Danlos syndrome, and osteogenesis imperfecta. Inheritance is mainly autosomal, dominant or recessive. Although the first signs of HCTDs develop as early as the first year of life, it takes several years for pediatricians and specialty physicians to make the diagnosis of connective tissue dysplasia because of a lack of clear methodological approach. The disease is multi-morbid and may manifest under gastroenterological, cardiological, nephrological, or respiratory masks.Aim: to present a clinical case of Ehlers-Danlos syndrome with multiorgan digestive, heart, kidneys, and other lesions.Material and methods: the case history is presented of a 15‑year-old boy with Ehlers-Danlos syndrome, classic type.Discussion: defective collagen increased the connective tissue extensibility affecting function of many body organs and systems, including gastrointestinal, biliary, and urinary tracts, musculoskeletal and cardiovascular systems. Small developmental anomalies led to functional (motor) disorders, which contributed to the chronic organic pathology (erosive reflux esophagitis, gastroduodenitis, cholelithiasis, proctosigmoiditis, chronic pyelonephritis, or chronic sinusitis). Given the multi-organ character of the lesions, the progredient course of bone and joint changes, and early development of disability, the prognosis for the health of this child is serious. A multidisciplinary approach is important to plan the follow-up (with orthopedist, gastroenterologist, cardiologist, ophthalmologist, and nephrologist). Timely rehabilitation, therapeutic physical training courses, massage, metabolic, and anti-relapse treatment are necessary to slow down the progredient course of the hereditary connective tissue disease.

THE COMPARATIVE STUDY OF HUMAN ENDOGENOUS RETROVIRUS HERV-E λ 4-1 EXPRESSION IN BLOOD IMMUNE CELLS OF MULTIPLE SCLEROSIS PATIENTS

In order to investigate the function of human endogenous retrovirus HERV-E λ 4-1 in multiple sclerosis pathogenesis, the comparative research of frequency of this retrovirus expression and mRNA level on different types of blood immune cells of progredient course multiple sclerosis patients have been conducted with using of the reverse - transcriptase polymerase chain reaction method. Peripheral blood mononuclear cells were isolated on Ficoll density gradient centrifugations. Monocytes were separated by the adhesion to plastic Petri dishes. For the estimation of the mitogen-induced HERV-E λ 4-1 expression, blood mononuclear cells were incubated with adding of phytogemagglutinin or pokeweed mitogen during 72 hours in CO2 incubator at 37 °C and 5% CO2. Results of HERV-E λ 4-1 env gene expression estimation demonstrate that both monocytes and lymphocytes express HERV-E λ 4-1. The level of the HERV-E λ 4-1 env mRNA was higher in lymphocytes than in monocytes. The main source of HERV-E λ 4-1 in progredient course MS patients between blood immune cells are lymphocytes, especially B lymphocytes.

Neurophysiological and morphological effects in the post-exposure vibration period during experimental modeling

Introduction. Vibration disease continues to occupy one of the leading places in the structure of professional pathology. In workers after the termination of contact with vibration generalization and progression of violations in an organism is noted. The pathogenetic mechanisms of the progredient course of disturbances in the nervous system in the post-contact period of vibration exposure remain insufficiently studied.The aim of the study was to test an experimental model of vibration exposure to assess the neurophysiological and morphological effects of vibration in rats in the dynamics of the post-contact period.Materials and methods. The work was performed on 168 white male outbred rats aged 3 months weighing 180–260 g. The vibration effect was carried out on a 40 Hz vibrating table for 60 days 5 times a week for 4 hours a day. Examination of animals was performed after the end of the physical factor, on the 30th, 60th and 120th day of the post-contact period. To assess the long-term neurophysiological and morphofunctional effects of vibration in rats, we used indicators of behavioral reactions, bioelectric activity of the somatosensory zone of the cerebral cortex, somatosensory and visual evoked potentials, parameters of muscle response, morphological parameters of nervous tissue.Results. In the dynamics of the post-contact period observed the preservation of violations of tentatively research, motor and emotional components of behavior. In the Central nervous system instability of activity of rhythms of an electroencephalogram, decrease in amplitude of visual evoked potentials, lengthening of latency of somatosensory evoked potentials, decrease in total number of normal neurons and astroglia is established. In the peripheral nervous system remained changes in indicators: increasing duration and latency, reducing the amplitude of the neuromuscular response.Conclusions: The experimental model allows us to study the long-term neurophysiological and morphological effects of vibration on the body. The formation and preservation of changes in behavioral activity, neurophysiological and morphological effects of vibration from the 30th to the 120th day of the post-contact period were confirmed.

Esophagectomy for End-Stage Achalasia

Treatment for achalasia of cardia is multidirectional nowadays and depends on several factors such as patient’s sex and age, type and stage of disease, co-morbidity and complications. However the treatment for end-stage achalasia is still controversial. Ones who advocate organ preservation surgery consider esophagectomy an ultima ration. These authors conceive that esophagectomy is too traumatic for benign disease with low progression. Esophagectomy as a first approach for end-stage achalasia is recommended by others authors who believe that progredient course of disease (nonreversible strongly dilated and atonic esophagus), debilitating dysphagia, regurgitation, aspiration syndrome and ineffective intervention in cardia make the extirpation of the esophagus necessary. Persistent degeneration of life quality and high possibility of such devastating symptoms as aspiration and esophageal cancer alongside with unacceptable results of myotomy raise questions on the effectiveness of the organ preservation surgery for end-stage achalasia

КЛИНИКО-БИОХИМИЧЕСКАЯ ХАРАКТЕРИСТИКА ПАЦИЕНТОВ С ПЕРВИЧНЫМ БИЛИАРНЫМ ЦИРРОЗОМ ПЕЧЕНИ

Background. Primary biliary cirrhosis (PBC) is a rare autoimmune disease characterized by a slow progredient course of the inflammatory process in the portal tracts and immune – mediated destruction of the intrahepatic bile ducts. Objective: to describe clinical and laboratory characteristics of patients with primary biliary cirrhosis in the Republic of Belarus. Materials and methods. The subjects of the study were 71 patients diagnosed with PBC. The materials of the study were patients’ blood plasma and serum, bioptic liver specimens, and data of the number connection test. Quality of life was assessed on admission using Short Form Medical Outcomes Study (SF-36). Results. All patients with PBC were female; the average age was 55 years, that coincides with menopause. The article presents clinical, laboratory characteristics and the analysis of psycho-emotional status of patients with PBC. Conclusion. The article describes patients with PBC taking into account clinical and biochemical characteristics and age. These data will contribute to earlier detection, prevention of end-stage disease and the improvement of associated symptoms thus reducing the impact of the progressive nature of the disease.

EXTRAAURAL EFFECTS IN THE OCCUPATIONAL HEARING LOSS

The article presents scientific evidence showing the role of extraaural manifestations in the course of professional sensorineural hearing loss in workers exposed to industrial noise. The leading place in the structure of concomitant pathology is occupied by circulatory diseases (44-75%), which have an average degree of professional conditionality, among which arterial hypertension dominates. A high percentage of people with high blood pressure is noted among underground miners (46.7%), mechanical engineering workers (45.5%). Diseases of the cardiovascular system potentiate the effect of noise and contribute to the earlier formation and progression of hearing loss, its progredient course, increase the risk of the occupational hearing loss. Changes in indices of central hemodynamics in the course of work can be considered as a universal adaptive response of the body to the exposure of environmental factors. Changes in the indices of the functional state of the cardiovascular system are combined with disorders of lipid metabolism, with an increase in the degree of exertion of regulatory systems and a decrease in the functional reserves of the body as the professional experience increases.

The use of trypsin-like blood activity as a marker of pulmonary fibrosis severity.

Purpose – to determine changes in the trypsin-like blood activity and its relationship with acute phase indices of inflammation in patients with pulmonary fibrosis (PF) as a marker of course severity and prognosis of the disease. Materials and Methods: The study included 18 patients: 15 (83%) women and 3 (17%) men, mean age 53±2.5 years. The control group included 15 practically healthy persons. All the examined patients (n=18) were divided into two groups: with mild or moderately severe PF – 8 (44.4%) patients (group I), severe PF – 10 (55.6%) of patients (group II). Duration of the disease - from 1 month. up to 4 years. Patients underwent clinic-laboratory and anthropometric studies, a mMRC questionnaire was used, blood saturation was measured, lung radiography in 2 projections, echocardiography, and if necessary a high-resolution computer tomography etc were performed. Results and discussion: More than half of the patients were overweight (44,4%) or had obesity of І-ІІІ st. (27.8%). The severity of dyspnea according to mMRC scale was 3.0 (3.0-4.0) points in patients of group II and 2.5 (2.0-3.0) points in patients of group I. There was a decrease in C-reactive protein (CRP) in group I and a tendency to increase in patients of group II. When analyzing the indicator of trypsin-like blood activity (TLA), it was found that the median TLA at the beginning of the observation was twice as high as in healthy individuals, direct correlation was established between the level of TLA and the severity of the disease course. After treatment the level of TLA decreased in group I patients. In the severe course of PF, the average TLA level remained high. The progredient course of LF is characterized by severe clinical symptoms, a significant increase in TLA, CRP, reduced O2 saturation, a lack of response to treatment and an unfavorable prognosis. The TLA index can be used as a biochemical marker of the severity of PF along with the CRPindex, O2 saturation and the degree of dyspnoea.

W04-02 - Differential diagnosis of catatonic psychoses

Originally considered by Kahlbaum to be an independent disease entity characterized by mental and motor abnormalities, catatonia was later viewed as a subtype of schizophrenia as it is the case in current classifications like ICD-10 and DSM-IV. Since catatonic symptoms were observable not only in schizophrenic psychoses, but also in affective, somatic or even psychogenic disorders, many researchers today consider catatonia as a nosologically unspecific syndrome. In the end, the traditional conceptions did not succeed in defining catatonia as a clinically homogeneous and valid diagnosis.An independent conception of catatonia was elaborated by the Wernicke-Kleist-Leonhard school of psychiatry. Based on a precise differentiation of diagnostically specific qualitative psychomotor disturbances, two essentially distinct forms of catatonic psychoses have been separated which differ in symptomatology, prognosis and treatment: on the one hand periodic catatonia, and on the other hand the group of systematic catatonias.Periodic catatonia usually has an acute onset, shows a bipolar and polymorphous symptomatology and runs an intermittent course. After one or more acute attacks, adynamic residual states of varying degrees of severity develop. Hyperkinetic and akinetic distortions of psychomotor activity are characteristically intermingled in attacks and residual states.In contrast, systematic catatonias begin insidiously, run a chronically progredient course without remissions and develop clear-cut and stable residual states. Six subtypes can be distinguished, each of which is characterized by a specific symptom constellation.

Cytological markers of non-progredient course of respiratory oxalosis

Respiratory oxalosis (RO), a special hereditary form of obstructive lung disease accompanied by hyperoxaluria, non-progredient course, absence of allergy and several cytology markers was studied in this comparative prospective study. We have observed 2 groups of non-smoking women (71 patients with RO and 64 patients with asthma accompanied by allergy with progredient course during 5 years). We evaluated the locomotor function of the mononuclear and polynuclear blood phagocytes using the inhibition of lymphocyte migration test as an immunological marker, and the hepatocyte function using AST / ALT ratio as a cytological marker. Their prevalence was the greatest in the 1-st group and constituted 100 % for the immunological marker and 98 % for the cytological one. We assume that function of the mononuclear phagocytes in RO probably results in the non progredient course of the disease. It relates to congenital high threshold of the immunocompetent cell sensitivity to polyclonal mitogens.

Der interessante Fall Nr. 65

Bilateral Osteomyelitis following frontal sinusitis is a rare complication in the antibiotic era. The main risk of a progredient course is mainly the formation of external subperiostal, epidural, subdural abscesses or brain abscesses with potentially life-threatening complications. This is a report on a patient who presented in our department with progredient cephalgia and swelling in the area around the glabella and frontal sinus. Macroscopical examination revealed septum deviation to the right side and nasal polyposis of the right nasal passage. A computed tomography of the paranasal sinuses showed subtotal soft tissue obstruction of all sinuses with the exception of the sphenoidal sinus. Bilateral osteolysis of the ventral osseous borders of the frontal sinus with accompanying osteosclerosis was also observed. The therapy consisted of radical frontal sinus surgery via Unterberger approach. This case demonstrates a rare case of bilateral frontal osteomyelitis together with the necessary diagnostic and therapeutic measures. The management consisted of the removal of all osteomyelitic bone and antibiotic therapy. Differential diagnostic procedures must be carried out in order to exclude orbital and intracranial complications. Regular follow-up examinations and a CT scan of the paranasal sinuses are part of the standard therapy.