Pub Date : 2023-11-08DOI: 10.17816/clinpract321381
Svetlana N. Lagutina, Olga S. Skuratova, Anna A. Zuikova, Elena Yu. Esina, Anastasia S. Kurguzova, Irina S. Dobrynina, Tatyana S. Pavlukova, Tatyana S. Klimova
Background. Infection with the SARS - CoV - 2 virus entails the development of complications that affect the prognosis of the main disease. More than 40% of the complications are related to diseases of the cardiovascular system, most of which are disorders of rhythm and conduction, to avoid this it is necessary to identify cases of infection in time at the outpatient-polyclinic stage. Clinical case description: A 40-year-old patient who was on the outpatient list for complaints received after a coronavirus infection. Period of research March 2021-January 2023. Having analyzed this clinical case, we noted that the following errors were made: lack of accurate full diagnosis, introduction of the vaccine KoviVak against the background of the disease, insufficient laboratory and instrumental diagnostics, as well as the lack of medication recommended for patients with myocarditis with stable hemodynamics. Myocarditis is one of the most common complications of SARS-CoV-2. Conclusion: Early diagnosis of this disease in patients undergoing outpatient and polyclinic treatment presents a difficulty in making a diagnosis, which later makes it difficult to prescribe timely correction, which worsens the quality of life of the patient. It is worth noting the importance of properly prescribing recommendations related to the treatment of cardiovascular complications in patients with a new coronavirus infection not only to a narrow specialist, but also to the local therapist.
{"title":"PATIENT WITH COVID - 19 COMPLICATED MYOENDOCARDITIS AND ARRHYTHMIC SYNDROME AT THE OUTPATIENT STAGE","authors":"Svetlana N. Lagutina, Olga S. Skuratova, Anna A. Zuikova, Elena Yu. Esina, Anastasia S. Kurguzova, Irina S. Dobrynina, Tatyana S. Pavlukova, Tatyana S. Klimova","doi":"10.17816/clinpract321381","DOIUrl":"https://doi.org/10.17816/clinpract321381","url":null,"abstract":"Background. Infection with the SARS - CoV - 2 virus entails the development of complications that affect the prognosis of the main disease. More than 40% of the complications are related to diseases of the cardiovascular system, most of which are disorders of rhythm and conduction, to avoid this it is necessary to identify cases of infection in time at the outpatient-polyclinic stage. Clinical case description: A 40-year-old patient who was on the outpatient list for complaints received after a coronavirus infection. Period of research March 2021-January 2023. Having analyzed this clinical case, we noted that the following errors were made: lack of accurate full diagnosis, introduction of the vaccine KoviVak against the background of the disease, insufficient laboratory and instrumental diagnostics, as well as the lack of medication recommended for patients with myocarditis with stable hemodynamics. Myocarditis is one of the most common complications of SARS-CoV-2. Conclusion: Early diagnosis of this disease in patients undergoing outpatient and polyclinic treatment presents a difficulty in making a diagnosis, which later makes it difficult to prescribe timely correction, which worsens the quality of life of the patient. It is worth noting the importance of properly prescribing recommendations related to the treatment of cardiovascular complications in patients with a new coronavirus infection not only to a narrow specialist, but also to the local therapist.","PeriodicalId":34156,"journal":{"name":"Klinicheskaia praktika","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135342708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-19DOI: 10.17816/clinpract322036
Sergey G. Sсherbak, Dmitry A. Vologzhanin, Aleksandr S. Golota, Andrey M. Sarana, Stanislav V. Makarenko
The SARS-CoV-2 coronavirus has been circulating among the world population for 3 years, infecting hundreds of millions of people. Numerous reports from all over the world indicate that the majority of infections are caused by the Omicron variant and its subvariants, which predominate over all the previously emerged variants. The genome of the Omicron strain has accumulated dozens of mutations that increase the viruss adaptability and cause the emergence of new variants and subvariants with the increased contagiousness, transmissibility, and ability to evade the immune response. This compromises the protection provided by vaccines or the humoral immunity induced by previous infections. Although the biology of SARS-CoV-2 is well understood, its ability to infect, replicate, and spread in a population depends on the specific immune context during different periods of the pandemic. It is assumed that new variants arise as a result of chronic infection in immunocompromised individuals. The intralineage recombination is an opportunity for the virus to gain phenotypic advantages from distantly related circulating variants. The last of the subvariants of the Omicron variant, named Kraken due to its unprecedentedly high transmissibility, is a descendant of the recombinant line. The virus is constantly evolving in the direction of evading immune neutralization by vaccines, therefore, a constant work is underway to develop new, more effective vaccines and other antiviral agents.
{"title":"The Omicron Strain of the SARS-CoV-2 Coronavirus and Its Variants","authors":"Sergey G. Sсherbak, Dmitry A. Vologzhanin, Aleksandr S. Golota, Andrey M. Sarana, Stanislav V. Makarenko","doi":"10.17816/clinpract322036","DOIUrl":"https://doi.org/10.17816/clinpract322036","url":null,"abstract":"The SARS-CoV-2 coronavirus has been circulating among the world population for 3 years, infecting hundreds of millions of people. Numerous reports from all over the world indicate that the majority of infections are caused by the Omicron variant and its subvariants, which predominate over all the previously emerged variants. The genome of the Omicron strain has accumulated dozens of mutations that increase the viruss adaptability and cause the emergence of new variants and subvariants with the increased contagiousness, transmissibility, and ability to evade the immune response. This compromises the protection provided by vaccines or the humoral immunity induced by previous infections. Although the biology of SARS-CoV-2 is well understood, its ability to infect, replicate, and spread in a population depends on the specific immune context during different periods of the pandemic. It is assumed that new variants arise as a result of chronic infection in immunocompromised individuals. The intralineage recombination is an opportunity for the virus to gain phenotypic advantages from distantly related circulating variants. The last of the subvariants of the Omicron variant, named Kraken due to its unprecedentedly high transmissibility, is a descendant of the recombinant line. The virus is constantly evolving in the direction of evading immune neutralization by vaccines, therefore, a constant work is underway to develop new, more effective vaccines and other antiviral agents.","PeriodicalId":34156,"journal":{"name":"Klinicheskaia praktika","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135779171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-19DOI: 10.17816/clinpract532720
Anna V. Starostina, Alla V. Sidorova, Konstantin S. Burlakov, Matgarita R. Khabazova
Background: AxenfeldRieger syndrome is a genetically heterogeneous group of morphogenesis disorders associated with abnormal development of the anterior segment of the eye, teeth, the organ of hearing, and abdominal region. Сongenital glaucoma, which is refractory to standard methods of treatment due to pronounced changes in the structures of the anterior segment of the eyeball and other comorbidities, is frequent manifestation of this syndrome. There are several methods for treating glaucoma in patients with AxenfeldRieger syndrome: sinus trabeculectomy, implantation of drainage devices and transscleral cyclocoagulation. Сlinical case description: A patient with congenital glaucoma associated with AxenfeldRieger syndrome underwent sinus trabeculectomy with posterior scleral trepanation in the right eye and valve drainage implantation in the left eye at the S. Fyodorov Eye Microsurgery Federal State Institution, Moscow due to the intraocular pressure decompensation. In the postoperative period, an encapsulated cyst around the body of the drainage was detected, and then a revision of the operation area was performed. After the anti-glaucoma operations, the intraocular pressure compensation was achieved in the follow-up period up to 9 months. Conclusion: Depending on the degree of the changes in the anterior chamber angle structures, sinus trabeculectomy or valve drainage implantation are the methods of choice for the surgical treatment aimed at the intraocular pressure compensation and visual function preservation in patients with Axenfeld-Rieger syndrome.
{"title":"Glaucoma in Axenfeld–Rieger Syndrome. A Clinical Case","authors":"Anna V. Starostina, Alla V. Sidorova, Konstantin S. Burlakov, Matgarita R. Khabazova","doi":"10.17816/clinpract532720","DOIUrl":"https://doi.org/10.17816/clinpract532720","url":null,"abstract":"Background: AxenfeldRieger syndrome is a genetically heterogeneous group of morphogenesis disorders associated with abnormal development of the anterior segment of the eye, teeth, the organ of hearing, and abdominal region. Сongenital glaucoma, which is refractory to standard methods of treatment due to pronounced changes in the structures of the anterior segment of the eyeball and other comorbidities, is frequent manifestation of this syndrome. There are several methods for treating glaucoma in patients with AxenfeldRieger syndrome: sinus trabeculectomy, implantation of drainage devices and transscleral cyclocoagulation. Сlinical case description: A patient with congenital glaucoma associated with AxenfeldRieger syndrome underwent sinus trabeculectomy with posterior scleral trepanation in the right eye and valve drainage implantation in the left eye at the S. Fyodorov Eye Microsurgery Federal State Institution, Moscow due to the intraocular pressure decompensation. In the postoperative period, an encapsulated cyst around the body of the drainage was detected, and then a revision of the operation area was performed. After the anti-glaucoma operations, the intraocular pressure compensation was achieved in the follow-up period up to 9 months. Conclusion: Depending on the degree of the changes in the anterior chamber angle structures, sinus trabeculectomy or valve drainage implantation are the methods of choice for the surgical treatment aimed at the intraocular pressure compensation and visual function preservation in patients with Axenfeld-Rieger syndrome.","PeriodicalId":34156,"journal":{"name":"Klinicheskaia praktika","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135729782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-19DOI: 10.17816/clinpract546144
Evgeny A. Epifantsev, Vladimir Yu. Gritsun, Aishe A. Keshvedinova, Alexander V. Smirnov, Yury V. Ivanov
Thymic epithelial tumors are the most common tumors of the anterior mediastinum, with an incidence of 0.18 per 100,000 population. Here, we present a review of the national and foreign literature on the surgical treatment of stage I and II thymic epithelial tumors. The Medline (PubMed) and Russian Science Citation Index (eLibrary) databases were used as search engines. The focus of the review is the problem of choosing the optimal minimally invasive surgical approach for thymectomy, and the need for lymph node dissection for thymic epithelial tumors. A number of issues remain currently unresolved in thymic epithelial tumors surgery, namely the justification of the preoperative histological verification of the tumor process, the choice of the optimal surgical access to the anterior mediastinum, the need for and prognostic effect of lymph node dissection, and the determination of the required volume of the planned operation.
胸腺上皮肿瘤是前纵隔最常见的肿瘤，发病率为0.18 / 10万人。在此，我们回顾了国内外关于I期和II期胸腺上皮肿瘤手术治疗的文献。使用Medline (PubMed)和Russian Science Citation Index (eLibrary)数据库作为搜索引擎。本文综述的重点是胸腺切除术选择最佳微创手术入路的问题，以及胸腺上皮肿瘤是否需要淋巴结清扫。胸腺上皮肿瘤手术目前仍有许多问题未得到解决，即术前肿瘤过程的组织学验证的合理性，前纵隔最佳手术通道的选择，淋巴结清扫的必要性和预后效果，以及计划手术所需体积的确定。
{"title":"Surgical Treatment of Stage I and II Thymus Epithelial Tumors","authors":"Evgeny A. Epifantsev, Vladimir Yu. Gritsun, Aishe A. Keshvedinova, Alexander V. Smirnov, Yury V. Ivanov","doi":"10.17816/clinpract546144","DOIUrl":"https://doi.org/10.17816/clinpract546144","url":null,"abstract":"Thymic epithelial tumors are the most common tumors of the anterior mediastinum, with an incidence of 0.18 per 100,000 population. Here, we present a review of the national and foreign literature on the surgical treatment of stage I and II thymic epithelial tumors. The Medline (PubMed) and Russian Science Citation Index (eLibrary) databases were used as search engines. The focus of the review is the problem of choosing the optimal minimally invasive surgical approach for thymectomy, and the need for lymph node dissection for thymic epithelial tumors. A number of issues remain currently unresolved in thymic epithelial tumors surgery, namely the justification of the preoperative histological verification of the tumor process, the choice of the optimal surgical access to the anterior mediastinum, the need for and prognostic effect of lymph node dissection, and the determination of the required volume of the planned operation.","PeriodicalId":34156,"journal":{"name":"Klinicheskaia praktika","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135778395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-19DOI: 10.17816/clinpract562713
Elena A. Zvezdkina, Anna G. Kedrova, Dmitry P. Lebedev, Sergey E. Krasilnikov, Tatevic A. Greyan, Dmitry N. Panchenkov, Yulia A. Stepanova
Background: Transarterial chemoembolization (TACE) is coming into use in the treatment of liver tumors, with drug-eluting microspheres as one of the technique variations. However, at the moment there are no systematic studies that would answer the questions: what is the role of the method in the treatment regimen for patients with primary and metastatic liver tumor and at what stage should it be used? Aim: to evaluate the effectiveness of transarterial chemoembolization with drug-eluting microspheres for the treatment of metastatic and primary malignant liver tumors at different stages of the disease. Methods: We performed а retrospective observational uncontrolled study of 65 patients with liver metastases (Group 1), and 10 patients with primary malignant liver tumors (Group 2), who underwent 102 operations of transarterial chemoembolization with drug-eluting microspheres. To plan transarterial chemoembolization and evaluate its effectiveness, computed tomography and magnetic resonance imaging were used every 89 weeks during the treatment. Results: After two transarterial chemoembolization controls, Group 1 included 51 responders (79%) and 14 non-responders (21%). Among the responders by the 16th week there was a decrease in the volume of the tumor mass in the liver from 12.4 [4.7; 24.6] to 5.2 cm3 [2; 15.5] for colorectal cancer, from 26 [18; 35] to 19 cm3 [13; 25] for neuroendocrine cancer, from 12 [4; 20] to 4 cm3 [0.6; 9] for adenocarcinomas of different localizations. There was no progression in Group 2, while, by week 16, there was a decrease in the tumor volume from 142 [51; 206] to 68 cm3 [23; 185] for hepatocellular carcinoma, from 465 [330; 600] to 187 cm3 [137;237] for intrahepatic cholangiocarcinoma. With repeated transarterial chemoembolization, a decrease in the volume of the tumor mass was also noted, while the time without progression decreased from 303 [170; 369] to 180 [105; 225] days in Group 1, from 266 [200; 367] to 120 [62; 215] days in Group 2. Conclusions: Transarterial chemoembolization with drug-eluting microspheres is an effective treatment for primary and metastatic liver tumors. It should be considered as a palliative therapy, which allows achieving a good antitumor response at different stages of cancer.
{"title":"Efficiency of Transarterial Chemoembolization with Drug-Eluting Microspheres in the Treatment of Metastatic and Primary Liver Tumors","authors":"Elena A. Zvezdkina, Anna G. Kedrova, Dmitry P. Lebedev, Sergey E. Krasilnikov, Tatevic A. Greyan, Dmitry N. Panchenkov, Yulia A. Stepanova","doi":"10.17816/clinpract562713","DOIUrl":"https://doi.org/10.17816/clinpract562713","url":null,"abstract":"Background: Transarterial chemoembolization (TACE) is coming into use in the treatment of liver tumors, with drug-eluting microspheres as one of the technique variations. However, at the moment there are no systematic studies that would answer the questions: what is the role of the method in the treatment regimen for patients with primary and metastatic liver tumor and at what stage should it be used? Aim: to evaluate the effectiveness of transarterial chemoembolization with drug-eluting microspheres for the treatment of metastatic and primary malignant liver tumors at different stages of the disease. Methods: We performed а retrospective observational uncontrolled study of 65 patients with liver metastases (Group 1), and 10 patients with primary malignant liver tumors (Group 2), who underwent 102 operations of transarterial chemoembolization with drug-eluting microspheres. To plan transarterial chemoembolization and evaluate its effectiveness, computed tomography and magnetic resonance imaging were used every 89 weeks during the treatment. Results: After two transarterial chemoembolization controls, Group 1 included 51 responders (79%) and 14 non-responders (21%). Among the responders by the 16th week there was a decrease in the volume of the tumor mass in the liver from 12.4 [4.7; 24.6] to 5.2 cm3 [2; 15.5] for colorectal cancer, from 26 [18; 35] to 19 cm3 [13; 25] for neuroendocrine cancer, from 12 [4; 20] to 4 cm3 [0.6; 9] for adenocarcinomas of different localizations. There was no progression in Group 2, while, by week 16, there was a decrease in the tumor volume from 142 [51; 206] to 68 cm3 [23; 185] for hepatocellular carcinoma, from 465 [330; 600] to 187 cm3 [137;237] for intrahepatic cholangiocarcinoma. With repeated transarterial chemoembolization, a decrease in the volume of the tumor mass was also noted, while the time without progression decreased from 303 [170; 369] to 180 [105; 225] days in Group 1, from 266 [200; 367] to 120 [62; 215] days in Group 2. Conclusions: Transarterial chemoembolization with drug-eluting microspheres is an effective treatment for primary and metastatic liver tumors. It should be considered as a palliative therapy, which allows achieving a good antitumor response at different stages of cancer.","PeriodicalId":34156,"journal":{"name":"Klinicheskaia praktika","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135728912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-19DOI: 10.17816/clinpract529678
Evgeny Akhtanin
Background: The analysis of the data presented in the foreign and national literature shows that a combination of the appendix mucocele and calculous cholecystitis is extremely rare, and the implementation of simultaneous surgical treatment in the laparoscopic version is the optimal approach. Clinical case description. Here, we present a clinical case of chronic calculous cholecystitis in combination with mucocele of the appendix in an 84-year-old patient. The main complaint was pulling pain in the right iliac region. The diagnosis was made on the basis of the main and additional methods of examination: clinical picture, ultrasound, multispiral computed tomography and magnetic resonance imaging of the abdominal organs. In a planned manner, a simultaneous surgical intervention was performed consisting of laparoscopic appendectomy and cholecystectomy. The operation duration was 1 hour 15 minutes. The morphological examination confirmed the diagnosis of calculous cholecystitis and mucocele of the appendix. The patient was discharged in a satisfactory condition on the 4th day. Conclusion. This clinical case shows that the dynamic observation of mucocele of the appendix, even in elderly patients with a comorbid pathology, is unjustified. A simultaneous surgical intervention in the form of laparoscopic appendectomy and cholecystectomy treats the two nosologies and prevents repeated hospitalization and surgery.
{"title":"The combination of mucocele of the appendix and chronic calculous cholecystitis. Case report.","authors":"Evgeny Akhtanin","doi":"10.17816/clinpract529678","DOIUrl":"https://doi.org/10.17816/clinpract529678","url":null,"abstract":"Background: The analysis of the data presented in the foreign and national literature shows that a combination of the appendix mucocele and calculous cholecystitis is extremely rare, and the implementation of simultaneous surgical treatment in the laparoscopic version is the optimal approach. Clinical case description. Here, we present a clinical case of chronic calculous cholecystitis in combination with mucocele of the appendix in an 84-year-old patient. The main complaint was pulling pain in the right iliac region. The diagnosis was made on the basis of the main and additional methods of examination: clinical picture, ultrasound, multispiral computed tomography and magnetic resonance imaging of the abdominal organs. In a planned manner, a simultaneous surgical intervention was performed consisting of laparoscopic appendectomy and cholecystectomy. The operation duration was 1 hour 15 minutes. The morphological examination confirmed the diagnosis of calculous cholecystitis and mucocele of the appendix. The patient was discharged in a satisfactory condition on the 4th day. Conclusion. This clinical case shows that the dynamic observation of mucocele of the appendix, even in elderly patients with a comorbid pathology, is unjustified. A simultaneous surgical intervention in the form of laparoscopic appendectomy and cholecystectomy treats the two nosologies and prevents repeated hospitalization and surgery.","PeriodicalId":34156,"journal":{"name":"Klinicheskaia praktika","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135667427","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-19DOI: 10.17816/clinpract400254
Igor A. Znamenskiy, Mikhail B. Dolgushin, Anastasiya A. Yurchenko, Tatiana M. Rostovtseva, Mariya A. Karalkina
The problem of diagnosis and treatment of epilepsy concerns medical society for a several thousands of years. The understanding of the causes and pathological mechanisms of this condition underwent numerous and substantial changes during this time, that allowed reaching significant advances in both the diagnosis or treatment. At the present time, there is a wide spectrum of diagnostic methods that allow localizing the epileptogenic focus, that is essential for planning the surgical treatment in patients with pharmacoresistant epilepsy. The results of the surgical treatment are strongly dependent on the diagnostic accuracy in the detection of one or several epileptogenic foci and on the prognosis of their resection. In this connection, the research on the possibilities and perfection of new diagnostic methods hold the potential to improve the results of the surgical treatment and the life quality in patients with pharmacoresistant epilepsy. This review presents a detailed description of the evolution of epilepsy diagnostics from the first implementation of electroencephalography in the 1920-s to the modern hybrid methods such as SISCOM (Subtraction Ictal SPECT Co-Registered to MRI) and PET-MRI.
{"title":"Diagnosis of Epilepsy: from the Beginning to the New Hybrid PET/MR Technique","authors":"Igor A. Znamenskiy, Mikhail B. Dolgushin, Anastasiya A. Yurchenko, Tatiana M. Rostovtseva, Mariya A. Karalkina","doi":"10.17816/clinpract400254","DOIUrl":"https://doi.org/10.17816/clinpract400254","url":null,"abstract":"The problem of diagnosis and treatment of epilepsy concerns medical society for a several thousands of years. The understanding of the causes and pathological mechanisms of this condition underwent numerous and substantial changes during this time, that allowed reaching significant advances in both the diagnosis or treatment. At the present time, there is a wide spectrum of diagnostic methods that allow localizing the epileptogenic focus, that is essential for planning the surgical treatment in patients with pharmacoresistant epilepsy. The results of the surgical treatment are strongly dependent on the diagnostic accuracy in the detection of one or several epileptogenic foci and on the prognosis of their resection. In this connection, the research on the possibilities and perfection of new diagnostic methods hold the potential to improve the results of the surgical treatment and the life quality in patients with pharmacoresistant epilepsy. This review presents a detailed description of the evolution of epilepsy diagnostics from the first implementation of electroencephalography in the 1920-s to the modern hybrid methods such as SISCOM (Subtraction Ictal SPECT Co-Registered to MRI) and PET-MRI.","PeriodicalId":34156,"journal":{"name":"Klinicheskaia praktika","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135730151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-19DOI: 10.17816/clinpract321281
Tagir I. Rakhmatullin, Mark Jain, Larisa M. Samokhodskaya, Vladimir A. Zhivotov
Thyroid cancer is the 9th most common cancer in the world. The five-year survival rate for this disease is over 98%. However, in some patients there are cases of rapidly progressive treatment-resistant cancer that cannot be differed from poor-invasive cancer by routine methods. Liquid biopsy could be one of the methods to solve this problem. This procedure consists in the analysis of tumor derivatives (in particular, circulating DNA) in body fluids. The analysis of hotspot mutations and patterns of epigenetic regulation, which are usual for neoplasms with a certain genotype, is used to identify the tumor component in the total mass of circulating DNA. The increase of circulating tumor DNA in the plasma is observed several months ahead of the characteristic signs at MR images of patients, and also surpasses conventional biomarkers such as calcitonin in medullary thyroid carcinoma. In addition, a possibility of minimally invasive determination of the tumor genotype by analyzing circulating DNA is important to select the optimal chemotherapy. This review discusses the current advances in the analysis of circulating tumor DNA in thyroid cancers such as papillary, follicular, medullary, and anaplastic carcinomas.
{"title":"Liquid Biopsy as a Method for Minimally Invasive Diagnosis of Thyroid Cancer","authors":"Tagir I. Rakhmatullin, Mark Jain, Larisa M. Samokhodskaya, Vladimir A. Zhivotov","doi":"10.17816/clinpract321281","DOIUrl":"https://doi.org/10.17816/clinpract321281","url":null,"abstract":"Thyroid cancer is the 9th most common cancer in the world. The five-year survival rate for this disease is over 98%. However, in some patients there are cases of rapidly progressive treatment-resistant cancer that cannot be differed from poor-invasive cancer by routine methods. Liquid biopsy could be one of the methods to solve this problem. This procedure consists in the analysis of tumor derivatives (in particular, circulating DNA) in body fluids. The analysis of hotspot mutations and patterns of epigenetic regulation, which are usual for neoplasms with a certain genotype, is used to identify the tumor component in the total mass of circulating DNA. The increase of circulating tumor DNA in the plasma is observed several months ahead of the characteristic signs at MR images of patients, and also surpasses conventional biomarkers such as calcitonin in medullary thyroid carcinoma. In addition, a possibility of minimally invasive determination of the tumor genotype by analyzing circulating DNA is important to select the optimal chemotherapy. This review discusses the current advances in the analysis of circulating tumor DNA in thyroid cancers such as papillary, follicular, medullary, and anaplastic carcinomas.","PeriodicalId":34156,"journal":{"name":"Klinicheskaia praktika","volume":"69 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135779016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-19DOI: 10.17816/clinpract568210
Oksana A. Zhukova, Daria A. Chudakova, Vladimir V. Belopasov, Еlena V. Shirshova, Vladimir P. Baklaushev, Gaukhar M. Yusubalieva
Ischemic stroke is a global medical problem and one of the leading causes of death or disability worldwide. The main approach of ischemic stroke therapy in the most acute period, which can prevent or minimize the development of a neurological deficit, is the restoration of the blood flow in the ischemic brain tissue using enzymatic thrombolysis or endovascular thromboextraction. When the therapeutic window is missed, the modulation of the acute inflammatory response may play an important role in determining the fate of neurons in the penumbra. The key players in this process are T-regulatory cells (Tregs) an immunosuppressive population of CD4+ T-cells with the CD4+, CD25+ CD127low, FoxP3+ phenotype. Despite the existing reports that Tregs (or certain Treg subpopulations) can exacerbate microcirculatory disorders in the ischemic tissue, many stadies convincingly suggest the positive role of Tregs in ischemic stroke. Resident CD69+ Tregs found in the normal mammalian brain have neuroprotective activity, produce IL-10 and other anti-inflammatory cytokines, control astrogliosis, and downregulate cytotoxic subpopulations of T cells and microglia. Systemic administration of Treg in stroke is accompained by a decrease in the volume of cerebral infarction and decreased levels of secondary neuronal death. Thus, the methods allowing Treg activation and expansion ex vivo open up several new avenues for the immunocorrection not only in systemic and autoimmune diseases, but, potentially, in the neuroprotective therapy for ischemic stroke. The relationship between Treg, inflammation, and cerebrovascular pathology is of particular interest in the case of ischemic stroke and COVID-19 as a comorbidity. It has been demonstrated that systemic inflammation caused by SARS-CoV-2 infection leads to a significant suppression of Treg, which is accompanied by an increased risk for the development of ischemic stroke and other neurological complications. Overall, the information summarized herein about the possible therapeutic potential of Treg in cerebrovascular pathology may be of practical interest not only for researchers, but also for clinicians.
{"title":"Treg Cells in Ischemic Stroke: A Small Key to a Great Orchestrion","authors":"Oksana A. Zhukova, Daria A. Chudakova, Vladimir V. Belopasov, Еlena V. Shirshova, Vladimir P. Baklaushev, Gaukhar M. Yusubalieva","doi":"10.17816/clinpract568210","DOIUrl":"https://doi.org/10.17816/clinpract568210","url":null,"abstract":"Ischemic stroke is a global medical problem and one of the leading causes of death or disability worldwide. The main approach of ischemic stroke therapy in the most acute period, which can prevent or minimize the development of a neurological deficit, is the restoration of the blood flow in the ischemic brain tissue using enzymatic thrombolysis or endovascular thromboextraction. When the therapeutic window is missed, the modulation of the acute inflammatory response may play an important role in determining the fate of neurons in the penumbra. The key players in this process are T-regulatory cells (Tregs) an immunosuppressive population of CD4+ T-cells with the CD4+, CD25+ CD127low, FoxP3+ phenotype. Despite the existing reports that Tregs (or certain Treg subpopulations) can exacerbate microcirculatory disorders in the ischemic tissue, many stadies convincingly suggest the positive role of Tregs in ischemic stroke. Resident CD69+ Tregs found in the normal mammalian brain have neuroprotective activity, produce IL-10 and other anti-inflammatory cytokines, control astrogliosis, and downregulate cytotoxic subpopulations of T cells and microglia. Systemic administration of Treg in stroke is accompained by a decrease in the volume of cerebral infarction and decreased levels of secondary neuronal death. Thus, the methods allowing Treg activation and expansion ex vivo open up several new avenues for the immunocorrection not only in systemic and autoimmune diseases, but, potentially, in the neuroprotective therapy for ischemic stroke. The relationship between Treg, inflammation, and cerebrovascular pathology is of particular interest in the case of ischemic stroke and COVID-19 as a comorbidity. It has been demonstrated that systemic inflammation caused by SARS-CoV-2 infection leads to a significant suppression of Treg, which is accompanied by an increased risk for the development of ischemic stroke and other neurological complications. Overall, the information summarized herein about the possible therapeutic potential of Treg in cerebrovascular pathology may be of practical interest not only for researchers, but also for clinicians.","PeriodicalId":34156,"journal":{"name":"Klinicheskaia praktika","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135779158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-13DOI: 10.17816/clinpract313396
Ekaterina S. Ostapchuk, Lyudmila I. Reihert, Oksana A. Kicherova, Tatyana E. Verbakh
Background: Chronic tick-borne encephalitis is a rare and not fully understood pathology in which the body is not able to completely get rid of the virus. The virus remains in the nervous system mainly in the motor structures, supporting the degenerative-inflammatory process in them. Clinical case description: A clinical case of a chronic form of tick-borne encephalitis, steadily progressing for 1.5 years, in a young man with a completely intact cognitive sphere is described. Damage to the motor nuclei of the trunk, motoneurons of the anterior horns of the spinal cord led to gross bulbar disorders, severe diffuse muscle atrophy with difficulty in independent movement.Conclusion: The above observation of the amyotrophic form of tick-borne encephalitis reflects the remitting-progressive nature of the course for 1.5 years.
{"title":"A CHRONIC FORM OF TICK-BORNE ENCEPHALITIS. CASE REPORT","authors":"Ekaterina S. Ostapchuk, Lyudmila I. Reihert, Oksana A. Kicherova, Tatyana E. Verbakh","doi":"10.17816/clinpract313396","DOIUrl":"https://doi.org/10.17816/clinpract313396","url":null,"abstract":"Background: Chronic tick-borne encephalitis is a rare and not fully understood pathology in which the body is not able to completely get rid of the virus. The virus remains in the nervous system mainly in the motor structures, supporting the degenerative-inflammatory process in them. Clinical case description: A clinical case of a chronic form of tick-borne encephalitis, steadily progressing for 1.5 years, in a young man with a completely intact cognitive sphere is described. Damage to the motor nuclei of the trunk, motoneurons of the anterior horns of the spinal cord led to gross bulbar disorders, severe diffuse muscle atrophy with difficulty in independent movement.Conclusion: The above observation of the amyotrophic form of tick-borne encephalitis reflects the remitting-progressive nature of the course for 1.5 years.","PeriodicalId":34156,"journal":{"name":"Klinicheskaia praktika","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135781451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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