Pub Date : 2024-05-11DOI: 10.17816/clinpract625962
Sreedevi Lekkala
INTRODUCTION: Skin tumours can be benign or malignant, resulting from proliferation of one or more skin constituents. The incidence of skin cancer has increased over last few decades, necessitating histopathological evidence to distinguish between them. OBJECTIVES: To describe epidemiology, clinical presentation, uncertain behaviour and histopathological spectrum of various skin tumours. METHODOLOGY: Present study is a prospective study conducted over a period of four years from July 2019 to July 2023 in the Out-patient Department of DVL, Government General Hospital, Anantapur. Cystic and infectious swellings and patients having multiple lesions and patients who didn’t consent for this study are excluded. All excisional biopsies of solitary cutaneous swellings are sent for Histopathological confirmation and tumours are categorised based on WHO classification. RESULTS: The study has 123 solitary cutaneous tumours, out of which, 98 cases (79.67%) were benign and 25(20.32%) are malignant. Adults aged 26-44 years are most affected (31.7%) followed by middle aged (30.08%).Males are 57(46.34%) and females are 66(53.65%).Extremities constituted the most common site with 53 cases (43.08%) followed by head and neck (29.26%). According to WHO classification of skin tumours, subcutaneous tissue tumours accounted for 42 cases (34.14%) followed by 31 cases(25.20%) of soft tissue tumours. Keratinocyte tumours are 26(21.13%), appendageal tumours are 16(13%) and least common are melanocytic and neural tumours with 4(3.25%) and 4(3.25%) respectively. Majority of benign tumours originated from subcutaneous tissues, while malignant developed from keratinocytic differentiation. CONCLUSION: In our study, most tumours had ambiguous clinical behaviour, which resulted in misdiagnosis; hence, histopathological confirmation is essential for accurate diagnosis and prompt management.
{"title":"SOLITARY CUTANEOUS NEOPLASMS: ANALYSING THE UNCERTAIN BEHAVIOUR WITH THE AID OF HISTOPATHOLOGY","authors":"Sreedevi Lekkala","doi":"10.17816/clinpract625962","DOIUrl":"https://doi.org/10.17816/clinpract625962","url":null,"abstract":"INTRODUCTION: Skin tumours can be benign or malignant, resulting from proliferation of one or more skin constituents. The incidence of skin cancer has increased over last few decades, necessitating histopathological evidence to distinguish between them. OBJECTIVES: To describe epidemiology, clinical presentation, uncertain behaviour and histopathological spectrum of various skin tumours. METHODOLOGY: Present study is a prospective study conducted over a period of four years from July 2019 to July 2023 in the Out-patient Department of DVL, Government General Hospital, Anantapur. Cystic and infectious swellings and patients having multiple lesions and patients who didn’t consent for this study are excluded. All excisional biopsies of solitary cutaneous swellings are sent for Histopathological confirmation and tumours are categorised based on WHO classification. RESULTS: The study has 123 solitary cutaneous tumours, out of which, 98 cases (79.67%) were benign and 25(20.32%) are malignant. Adults aged 26-44 years are most affected (31.7%) followed by middle aged (30.08%).Males are 57(46.34%) and females are 66(53.65%).Extremities constituted the most common site with 53 cases (43.08%) followed by head and neck (29.26%). According to WHO classification of skin tumours, subcutaneous tissue tumours accounted for 42 cases (34.14%) followed by 31 cases(25.20%) of soft tissue tumours. Keratinocyte tumours are 26(21.13%), appendageal tumours are 16(13%) and least common are melanocytic and neural tumours with 4(3.25%) and 4(3.25%) respectively. Majority of benign tumours originated from subcutaneous tissues, while malignant developed from keratinocytic differentiation. \u0000CONCLUSION: In our study, most tumours had ambiguous clinical behaviour, which resulted in misdiagnosis; hence, histopathological confirmation is essential for accurate diagnosis and prompt management.","PeriodicalId":508133,"journal":{"name":"Journal of Clinical Practice","volume":"101 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140987209","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 : 2024-03-28DOI: 10.17816/clinpract624330
Myo Tun Nay, Andrey L. Yudin, E. Yumatova, A. Vinokurov
Aim. Determination of CT signs of possible attachment of pulmonary aspergillosis in patients with COVID-19 during dynamic follow-up. Methods. The analysis of the case histories of 646 patients, in whom the results of CT monitoring of the lung condition for at least 2 months were obtained, was carried out. The total number of CT examinations is 5,279, the average number of studies per patient is 8. The main group consisted of 144 patients. The leading inclusion criterion was the presence of radiological signs atypical for COVID-19, suspected of fungal complications. Results. The analysis of the obtained images revealed the primary signs suspected of COVID–associated aspergillosis, which can be conditionally divided into typical bronchogenic and conditionally non-bronchogenic. Of the total number of patients in the main group, bronchogenic signs were noted in 56 patients (38.89%), and in 43 of them (76.79%), their transformation into signs characteristic of a fungal lesion was revealed. Relatively non-bronchogenic primary signs were identified in 88 patients (61.11%). In the process of studying the dynamics of signs suspected of COVID-associated aspergillosis, CT-signs typical of fungal lesions were obtained in 93 patients (64.58%). "Consolidations" as a primary sign and as a sign of transformation from foci were encountered in one time interval. This made it possible to collect all the signs of COVID-associated aspergillosis in a combined timing scheme. Conclusion. The features of the clinical course of the disease in patients with COVID-19 do not allow us to confidently determine the attachment of a co-infection, such as aspergillosis. There are also difficulties in isolating the culture of the pathogen. Consequently, the role of computed tomography in identifying the semiotics of "possible" aspergillosis as a complication of COVID-19 is increasing.
{"title":"Computed tomographic signs of the “possible” aspergillosis in dynamic observation of patients with COVID-19","authors":"Myo Tun Nay, Andrey L. Yudin, E. Yumatova, A. Vinokurov","doi":"10.17816/clinpract624330","DOIUrl":"https://doi.org/10.17816/clinpract624330","url":null,"abstract":"Aim. Determination of CT signs of possible attachment of pulmonary aspergillosis in patients with COVID-19 during dynamic follow-up. \u0000Methods. The analysis of the case histories of 646 patients, in whom the results of CT monitoring of the lung condition for at least 2 months were obtained, was carried out. The total number of CT examinations is 5,279, the average number of studies per patient is 8. The main group consisted of 144 patients. The leading inclusion criterion was the presence of radiological signs atypical for COVID-19, suspected of fungal complications. \u0000Results. The analysis of the obtained images revealed the primary signs suspected of COVID–associated aspergillosis, which can be conditionally divided into typical bronchogenic and conditionally non-bronchogenic. Of the total number of patients in the main group, bronchogenic signs were noted in 56 patients (38.89%), and in 43 of them (76.79%), their transformation into signs characteristic of a fungal lesion was revealed. Relatively non-bronchogenic primary signs were identified in 88 patients (61.11%). In the process of studying the dynamics of signs suspected of COVID-associated aspergillosis, CT-signs typical of fungal lesions were obtained in 93 patients (64.58%). \"Consolidations\" as a primary sign and as a sign of transformation from foci were encountered in one time interval. This made it possible to collect all the signs of COVID-associated aspergillosis in a combined timing scheme. \u0000Conclusion. The features of the clinical course of the disease in patients with COVID-19 do not allow us to confidently determine the attachment of a co-infection, such as aspergillosis. There are also difficulties in isolating the culture of the pathogen. Consequently, the role of computed tomography in identifying the semiotics of \"possible\" aspergillosis as a complication of COVID-19 is increasing.","PeriodicalId":508133,"journal":{"name":"Journal of Clinical Practice","volume":"137 48","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140369271","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}
Motor dysfunction of the upper limbs is often a consequence of a stroke. The use of traditional methods to restore upper limb motor function has limited efficacy, and the search for and development of new rehabilitation approaches is a pressing issue. In the present study, two groups of patients with upper limb dysfunction after stroke performed goal-directed arm movement training. The training consisted of 10 sessions of 10 minutes each. Patients chose one of two targets, either a close, frontal target or a more distant target to the side of the extensor arm. The groups differed in the presentation of the distant target, which was more difficult to move, whereas the near target, which was easier to move, was stationary. The results suggest that, in contrast to the effects common to both groups of reduced movement onset time, greater movement velocity in reaching the distant target, reduced rate and mean distance of the selected distant target, differences in the presentation of the distant target between the groups have an impact on the dynamics of arm movement training in patients. Presenting a target at a random distance results in a greater selection distance, a less pronounced decrease in movement onset time and an increase in hand velocity compared to the adaptive presentation algorithm. The results of the study may be useful in selecting a rehabilitation strategy for stroke patients.
{"title":"Influence of reactive and proactive motor decision strategies on hand kinematic characteristics in stroke patients","authors":"Alexey Tumyalis, Timur Ivanov, Galina Ivanova, Ekaterina Ivanova, Andrey Kirichenko, Alexey Ossadtchi","doi":"10.17816/clinpract624222","DOIUrl":"https://doi.org/10.17816/clinpract624222","url":null,"abstract":"Motor dysfunction of the upper limbs is often a consequence of a stroke. The use of traditional methods to restore upper limb motor function has limited efficacy, and the search for and development of new rehabilitation approaches is a pressing issue. In the present study, two groups of patients with upper limb dysfunction after stroke performed goal-directed arm movement training. The training consisted of 10 sessions of 10 minutes each. Patients chose one of two targets, either a close, frontal target or a more distant target to the side of the extensor arm. The groups differed in the presentation of the distant target, which was more difficult to move, whereas the near target, which was easier to move, was stationary. The results suggest that, in contrast to the effects common to both groups of reduced movement onset time, greater movement velocity in reaching the distant target, reduced rate and mean distance of the selected distant target, differences in the presentation of the distant target between the groups have an impact on the dynamics of arm movement training in patients. Presenting a target at a random distance results in a greater selection distance, a less pronounced decrease in movement onset time and an increase in hand velocity compared to the adaptive presentation algorithm. The results of the study may be useful in selecting a rehabilitation strategy for stroke patients.","PeriodicalId":508133,"journal":{"name":"Journal of Clinical Practice","volume":"103 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140370597","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 : 2024-03-27DOI: 10.17816/clinpract580663
E. G. Akramova, E. V. Vlasova, Anatolii A. Saveliev, E. B. Zakirova
Aim. to evaluate the informativeness of echocardiographic parameters in patients with acute inferior wall myocardial infarction of the left ventricle, who have undergone primary percutaneous coronary intervention, at discharge from the hospital and in the long-term period. Material and methods. Echocardiographic data was analyzed using speckle tracking technology in 144 patients with acute inferior myocardial infarction of the left ventricle before discharge and 2 years later. In the post-infarction period, 10 patients underwent magnetic resonance imaging and 15 patients underwent stress echocardiography. Results. Using the tree construction method, critical values of 7 ultrasound parameters were identified (for the left ventricle - ejection fraction, end-systolic volume index, global longitudinal and circular strains, for the right ventricle - tricuspid S', global longitudinal strain, free wall strain), which with a probability of 89.4% predict repeat revascularization. Identification of possible areas of myocardial fibrosis in the remote period by speckle-tracking echocardiography has a sensitivity of 46-57%, specificity of 68-76%, and negative predictive value of 74-87% relative to the gold standard detection of postinfarction scarring by magnetic resonance imaging. According to the results of stress-echocardiography, new zones of local contractility impairment registered after exercise were not accompanied by changes in segmental longitudinal deformation. Conclusion. The results of echocardiographic screening of patients with acute inferior myocardial infarction of the left ventricle using speckle tracking technology have high prognostic significance in assessing the likelihood of repeated revascularization at discharge and diagnostic information for verifying post-infarction fibrous changes in the long-term period.
{"title":"Informativeness of echocardiography in inferior myocardial infarction at different stages of observation","authors":"E. G. Akramova, E. V. Vlasova, Anatolii A. Saveliev, E. B. Zakirova","doi":"10.17816/clinpract580663","DOIUrl":"https://doi.org/10.17816/clinpract580663","url":null,"abstract":"Aim. to evaluate the informativeness of echocardiographic parameters in patients with acute inferior wall myocardial infarction of the left ventricle, who have undergone primary percutaneous coronary intervention, at discharge from the hospital and in the long-term period. \u0000Material and methods. Echocardiographic data was analyzed using speckle tracking technology in 144 patients with acute inferior myocardial infarction of the left ventricle before discharge and 2 years later. In the post-infarction period, 10 patients underwent magnetic resonance imaging and 15 patients underwent stress echocardiography. \u0000Results. Using the tree construction method, critical values of 7 ultrasound parameters were identified (for the left ventricle - ejection fraction, end-systolic volume index, global longitudinal and circular strains, for the right ventricle - tricuspid S', global longitudinal strain, free wall strain), which with a probability of 89.4% predict repeat revascularization. \u0000Identification of possible areas of myocardial fibrosis in the remote period by speckle-tracking echocardiography has a sensitivity of 46-57%, specificity of 68-76%, and negative predictive value of 74-87% relative to the gold standard detection of postinfarction scarring by magnetic resonance imaging. \u0000According to the results of stress-echocardiography, new zones of local contractility impairment registered after exercise were not accompanied by changes in segmental longitudinal deformation. \u0000Conclusion. The results of echocardiographic screening of patients with acute inferior myocardial infarction of the left ventricle using speckle tracking technology have high prognostic significance in assessing the likelihood of repeated revascularization at discharge and diagnostic information for verifying post-infarction fibrous changes in the long-term period.","PeriodicalId":508133,"journal":{"name":"Journal of Clinical Practice","volume":"43 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140373577","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 : 2024-03-27DOI: 10.17816/clinpract624496
EM Samoilova, Alina A Ivanova, V. Kalsin, Petr P. Laktionov, S. E. Romanov
Progressive decline in physiological functions during aging leads to various diseases that place a heavy burden on patients, their families and society as a whole. Due to the increasing average life expectancy, the problems of prevention and treatment of age-related diseases are becoming more and more relevant. As part of the research on the regulation of the aging program, considerable attention has been focused on a small family of NAD+-dependent deacetylases and deacylases called sirtuins. These proteins are involved in the regulation of numerous intracellular processes, and disruption of their functions plays an important role in the development of various diseases, such as metabolic disorders, pathologies of the cardiovascular system and other organs, musculoskeletal diseases, and neurodegeneration. It is interesting to note that the activity of sirtuins can be modulated to some extent under the influence of pharmacological agents, which makes them promising targets for age-related diseases prevention and therapy. The presented review will describe the influence of sirtuins on the development and pathogenesis of neurodegenerative diseases, as well as discuss recorded clinical trials focused on its therapy with pharmacological agents potentially affecting the activity of sirtuin proteins.
{"title":"Sirtuins in clinical trials of approaches to the treatment of neurodegenerative diseases","authors":"EM Samoilova, Alina A Ivanova, V. Kalsin, Petr P. Laktionov, S. E. Romanov","doi":"10.17816/clinpract624496","DOIUrl":"https://doi.org/10.17816/clinpract624496","url":null,"abstract":"Progressive decline in physiological functions during aging leads to various diseases that place a heavy burden on patients, their families and society as a whole. Due to the increasing average life expectancy, the problems of prevention and treatment of age-related diseases are becoming more and more relevant. As part of the research on the regulation of the aging program, considerable attention has been focused on a small family of NAD+-dependent deacetylases and deacylases called sirtuins. These proteins are involved in the regulation of numerous intracellular processes, and disruption of their functions plays an important role in the development of various diseases, such as metabolic disorders, pathologies of the cardiovascular system and other organs, musculoskeletal diseases, and neurodegeneration. It is interesting to note that the activity of sirtuins can be modulated to some extent under the influence of pharmacological agents, which makes them promising targets for age-related diseases prevention and therapy. The presented review will describe the influence of sirtuins on the development and pathogenesis of neurodegenerative diseases, as well as discuss recorded clinical trials focused on its therapy with pharmacological agents potentially affecting the activity of sirtuin proteins.","PeriodicalId":508133,"journal":{"name":"Journal of Clinical Practice","volume":"34 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140373787","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 : 2024-03-26DOI: 10.17816/clinpract624757
Valentin A. Nechaev, Aleksandr Yu. Vasiliev
Background: In radiology diagnostic errors occur in 2–5% of cases and most of them are due to perception errors, when a pathology don’t detected during the initial analysis, although its presence is very obvious during a retrospective analysis. In some cases, their appearance is associated with the presence of “blind spots” - anatomical areas that most often go unnoticed when interpreted by a radiologist. It is extremely important to know their features when analyzing the study of the head and neck area for a targeted and systematic search for pathology. Aims: determine the most common anatomical areas in which radiologists do not describe pathological changes when analyzing computed tomograms of the head and neck area. Methods: retrospectively analyzed 64 CT scans of the head and neck region in cancer patients, in which there was no description of additional clinically significant pathological changes at the initial assessment. All cases of missed pathology were identified after repeat radiological examination or retrospective analysis of the study. Results: Several anatomical zones were identified in which the most common pathological findings were not described in the initial analysis of CT studies of the head and neck area: brachiocephalic vessels (n=15; 24,2%), parotid salivary glands (n=10; 16,1% ), paranasal sinuses (n=8; 12,9%), lungs and mediastinum (n=9; 14,6%), brain and temporal bones (n=5; 8,1%), soft tissues of the neck (n =4; 6,5%), thyroid gland and cervical spine (n=3; 4,8%). Conclusions: the most common “blind spots” in the analysis of CT scans of the head and neck region have been identified. Knowledge of them can potentially lead to a reduction in the incidence of missed pathology when interpreting an CT study of this anatomical location.
{"title":"\"Blind spots\" in the analysis of computed tomography of the head and neck area","authors":"Valentin A. Nechaev, Aleksandr Yu. Vasiliev","doi":"10.17816/clinpract624757","DOIUrl":"https://doi.org/10.17816/clinpract624757","url":null,"abstract":"Background: In radiology diagnostic errors occur in 2–5% of cases and most of them are due to perception errors, when a pathology don’t detected during the initial analysis, although its presence is very obvious during a retrospective analysis. In some cases, their appearance is associated with the presence of “blind spots” - anatomical areas that most often go unnoticed when interpreted by a radiologist. It is extremely important to know their features when analyzing the study of the head and neck area for a targeted and systematic search for pathology. \u0000 \u0000 \u0000Aims: determine the most common anatomical areas in which radiologists do not describe pathological changes when analyzing computed tomograms of the head and neck area. \u0000 \u0000 \u0000Methods: retrospectively analyzed 64 CT scans of the head and neck region in cancer patients, in which there was no description of additional clinically significant pathological changes at the initial assessment. All cases of missed pathology were identified after repeat radiological examination or retrospective analysis of the study. \u0000 \u0000 \u0000Results: Several anatomical zones were identified in which the most common pathological findings were not described in the initial analysis of CT studies of the head and neck area: brachiocephalic vessels (n=15; 24,2%), parotid salivary glands (n=10; 16,1% ), paranasal sinuses (n=8; 12,9%), lungs and mediastinum (n=9; 14,6%), brain and temporal bones (n=5; 8,1%), soft tissues of the neck (n =4; 6,5%), thyroid gland and cervical spine (n=3; 4,8%). \u0000 \u0000 \u0000Conclusions: the most common “blind spots” in the analysis of CT scans of the head and neck region have been identified. Knowledge of them can potentially lead to a reduction in the incidence of missed pathology when interpreting an CT study of this anatomical location.","PeriodicalId":508133,"journal":{"name":"Journal of Clinical Practice","volume":"57 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140378160","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 : 2024-03-26DOI: 10.17816/clinpract625468
A. Belopasova, Polina Sergeevna Miglyachenko, A. Chechetkin, Mariva Vladimirovna Dreval, L. A. Dobrynina
Syndrome of transient idiopathic perivascular inflammation of the carotid artery (TIPIC syndrome) refers to a benign variant of non-atherosclerotic arteriopathy. TIPIC is characterized by regression of symptoms and pathological changes without specific therapy. The main manifestation of carotidynia is ipsilateral neck pain, which, due to low awareness of this disease, is often mistakenly regarded as dissection or atherosclerosis of the carotid artery and leads to additional unjustified diagnosis and treatment. This article presents a clinical case of a patient with idiopathic carotidynia with a discussion of the diagnostic algorithm and management of patients with unilateral neck pain and suspected TIPIC syndrome.
{"title":"Transient idiopathic perivascular inflammation of the carotid artery syndrome (TIPIC syndrome) is a rare variant of non-atherosclerotic arteriopathy","authors":"A. Belopasova, Polina Sergeevna Miglyachenko, A. Chechetkin, Mariva Vladimirovna Dreval, L. A. Dobrynina","doi":"10.17816/clinpract625468","DOIUrl":"https://doi.org/10.17816/clinpract625468","url":null,"abstract":"Syndrome of transient idiopathic perivascular inflammation of the carotid artery (TIPIC syndrome) refers to a benign variant of non-atherosclerotic arteriopathy. TIPIC is characterized by regression of symptoms and pathological changes without specific therapy. The main manifestation of carotidynia is ipsilateral neck pain, which, due to low awareness of this disease, is often mistakenly regarded as dissection or atherosclerosis of the carotid artery and leads to additional unjustified diagnosis and treatment. This article presents a clinical case of a patient with idiopathic carotidynia with a discussion of the diagnostic algorithm and management of patients with unilateral neck pain and suspected TIPIC syndrome.","PeriodicalId":508133,"journal":{"name":"Journal of Clinical Practice","volume":"118 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140379198","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 : 2024-03-25DOI: 10.17816/clinpract623690
Alexandr Smirnov
Background:. Anastomotic leak (AL) is the most serious complication in rectal surgery. Predicting and preventing AL remains an urgent task. The purpose of the study is to analyze the 17-year experience of the Federal State Budgetary Institution Federal Research Center FMBA of Russia in performing anterior resection of the rectum in patients with cancer of the rectum and rectosigmoid junction and to establish risk factors for the development of AL. Methods. The results of treatment of 492 patients who were treated in 2006-2022 were studied. anterior resection of the rectum was performed. 21 patients developed AL. A retrospective comparison of the characteristics of two groups of patients was carried out: those with a smooth course of the postoperative period and those with the development of AL. Results. Reliable risk factors for the development of AL were identified and, based on statistical analysis, a prognostic scoring model was proposed: smoking (1 point), type 2 diabetes mellitus (1 point), preoperative chemotherapy (1 point), blood loss over 50 ml (2 points), preoperative radiation therapy (3 points), and the location of the colorectal anastomosis at a distance of up to 5 cm from the anus (4 points). The sensitivity of the model on the training set with 8 points or more was 85.6%, with a specificity above 97.4%. Conclusion. The following tactics are proposed: if there are 4 points and above, we form a preventive intestinal stoma; if there are 1-3 points, we install a transanal drainage. Complete abandonment of these two preventive measures is possible only if the patient does not have any of the listed risk factors for the development of anastomotic leak.
背景吻合口漏（AL）是直肠手术中最严重的并发症。预测和预防 AL 仍是当务之急。本研究旨在分析俄罗斯联邦国家预算机构联邦研究中心 FMBA 17 年来为直肠癌和直肠乙状结肠交界处癌症患者实施直肠前切除术的经验，并确定发生 AL 的风险因素。研究方法对 2006-2022 年间接受治疗的 492 名患者的治疗结果进行了研究。21例患者发展为AL。对两组患者的特征进行了回顾性比较：术后恢复顺利的患者和出现 AL 的患者。结果显示确定了发生 AL 的可靠风险因素，并在统计分析的基础上提出了一个预后评分模型：吸烟（1 分）、2 型糖尿病（1 分）、术前化疗（1 分）、失血超过 50 毫升（2 分）、术前放疗（3 分）、结直肠吻合口位置距肛门不超过 5 厘米（4 分）。在 8 点或更多点的训练集上，模型的灵敏度为 85.6%，特异性超过 97.4%。结论。建议采取以下策略：如果有 4 个点及以上，我们就会形成预防性肠造口；如果有 1-3 个点，我们就会安装经肛门引流。只有当患者不存在上述发生吻合口漏的风险因素时，才有可能完全放弃这两种预防措施。
{"title":"Predictors of anastomotic leak after anterior rectal resections for localized malignant neoplasms","authors":"Alexandr Smirnov","doi":"10.17816/clinpract623690","DOIUrl":"https://doi.org/10.17816/clinpract623690","url":null,"abstract":"Background:. Anastomotic leak (AL) is the most serious complication in rectal surgery. Predicting and preventing AL remains an urgent task. The purpose of the study is to analyze the 17-year experience of the Federal State Budgetary Institution Federal Research Center FMBA of Russia in performing anterior resection of the rectum in patients with cancer of the rectum and rectosigmoid junction and to establish risk factors for the development of AL. Methods. The results of treatment of 492 patients who were treated in 2006-2022 were studied. anterior resection of the rectum was performed. 21 patients developed AL. A retrospective comparison of the characteristics of two groups of patients was carried out: those with a smooth course of the postoperative period and those with the development of AL. Results. Reliable risk factors for the development of AL were identified and, based on statistical analysis, a prognostic scoring model was proposed: smoking (1 point), type 2 diabetes mellitus (1 point), preoperative chemotherapy (1 point), blood loss over 50 ml (2 points), preoperative radiation therapy (3 points), and the location of the colorectal anastomosis at a distance of up to 5 cm from the anus (4 points). The sensitivity of the model on the training set with 8 points or more was 85.6%, with a specificity above 97.4%. Conclusion. The following tactics are proposed: if there are 4 points and above, we form a preventive intestinal stoma; if there are 1-3 points, we install a transanal drainage. Complete abandonment of these two preventive measures is possible only if the patient does not have any of the listed risk factors for the development of anastomotic leak.","PeriodicalId":508133,"journal":{"name":"Journal of Clinical Practice","volume":" 56","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140384819","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 : 2024-03-23DOI: 10.17816/clinpract623495
V. R. Stankevich, A. V. Smirnov, A. Zlobin, D. N. Panchenkov, Yu. V. Ivanov
Methods. We retrospectively analyzed the results of diagnostics and treatment of 14 patients who had internal bleeding in the early postoperative period after bariatric surgeries. The following parameters were studied: age and sex of the patients, average body mass index, comorbidities, volume of the performed bariatric surgery, type of internal bleeding (intraluminal/intra-abdominal), technical peculiarities of each operation, average postoperative bed-day, efficiency of instrumental diagnostic methods, types and methods of hemostasis. Results. Clinical manifestations of bleeding in all patients operated on for morbid obesity were detected on 1-2 postoperative days. The main symptoms: weakness and dizziness - in 12 cases (86%), BP decrease up to 90±60 mmHg. - in 4 (28%), tachycardia (HR 100 and more beats per minute) - in 100% of cases. Development of melena and vomiting with blood admixture was noted in 6 (42%) cases, blood flow by drainage - in 8 (58%). In 4 patients (28%) the development of bleeding was preceded by BP increase up to 180-200/100-110 mmHg. In all 14 patients hemoglobin level decreased: in 6 (42%) not lower than 100g/L (but more than 20% of the initial hemoglobin level), and in 8 (58%) - below 100g/L. Esophagogastroduodenoscopy (EGDS) was used to diagnose bleeding inside the lumen of the stomach, intestine, anastomosis, and computerized tomography (CT) of the abdominal cavity with intravenous and oral contrast for intra-abdominal bleeding. In 6 patients with intra-abdominal bleeding revision laparoscopy was performed as an emergency procedure. When the source of bleeding from the stapler line was revealed, the bleeding zone was additionally sutured with Vicryl 30 thread using separate knotted sutures. In case of bleeding from the trocar wound, hemostasis was performed with the help of Bersi needle using 1/0 capron thread.No lethal outcomes were observed. All patients were discharged in satisfactory condition. The average bed-day due to the complication increased on average by 2-3 days. Conclusion. Effective methods of diagnostics and treatment of intraluminal bleedings are endoscopic techniques with the possibility of reliable hemostasis. In case of intra-abdominal bleeding relaparoscopy with stitching or clipping of the bleeding source is shown.
{"title":"PECULIARITIES OF DIAGNOSTICS AND THERAPEUTIC TACTICS IN BLEEDING IN THE EARLY POSTOPERATIVE PERIOD AFTER BARIATRIC SURGERIES","authors":"V. R. Stankevich, A. V. Smirnov, A. Zlobin, D. N. Panchenkov, Yu. V. Ivanov","doi":"10.17816/clinpract623495","DOIUrl":"https://doi.org/10.17816/clinpract623495","url":null,"abstract":"Methods. We retrospectively analyzed the results of diagnostics and treatment of 14 patients who had internal bleeding in the early postoperative period after bariatric surgeries. The following parameters were studied: age and sex of the patients, average body mass index, comorbidities, volume of the performed bariatric surgery, type of internal bleeding (intraluminal/intra-abdominal), technical peculiarities of each operation, average postoperative bed-day, efficiency of instrumental diagnostic methods, types and methods of hemostasis. Results. Clinical manifestations of bleeding in all patients operated on for morbid obesity were detected on 1-2 postoperative days. The main symptoms: weakness and dizziness - in 12 cases (86%), BP decrease up to 90±60 mmHg. - in 4 (28%), tachycardia (HR 100 and more beats per minute) - in 100% of cases. Development of melena and vomiting with blood admixture was noted in 6 (42%) cases, blood flow by drainage - in 8 (58%). In 4 patients (28%) the development of bleeding was preceded by BP increase up to 180-200/100-110 mmHg. In all 14 patients hemoglobin level decreased: in 6 (42%) not lower than 100g/L (but more than 20% of the initial hemoglobin level), and in 8 (58%) - below 100g/L. Esophagogastroduodenoscopy (EGDS) was used to diagnose bleeding inside the lumen of the stomach, intestine, anastomosis, and computerized tomography (CT) of the abdominal cavity with intravenous and oral contrast for intra-abdominal bleeding. In 6 patients with intra-abdominal bleeding revision laparoscopy was performed as an emergency procedure. When the source of bleeding from the stapler line was revealed, the bleeding zone was additionally sutured with Vicryl 30 thread using separate knotted sutures. In case of bleeding from the trocar wound, hemostasis was performed with the help of Bersi needle using 1/0 capron thread.No lethal outcomes were observed. All patients were discharged in satisfactory condition. The average bed-day due to the complication increased on average by 2-3 days. Conclusion. Effective methods of diagnostics and treatment of intraluminal bleedings are endoscopic techniques with the possibility of reliable hemostasis. In case of intra-abdominal bleeding relaparoscopy with stitching or clipping of the bleeding source is shown.","PeriodicalId":508133,"journal":{"name":"Journal of Clinical Practice","volume":" 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140386398","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 : 2024-03-22DOI: 10.17816/clinpract623681
Dmitry V. Skvortsov, Alyna Altukhova, S. Kaurkin, Alexander A. Akhpashev
Background: Instability of the knee joint after rupture of the anterior cruciate ligament and even after its reconstruction remains a pressing problem. The use of a special functional test with fast walking can be considered as a potential tool for verifying instability. Aims: to find out whether there are biomechanical differences in joint function with and without instability, both in the period before and after anterior cruciate ligament reconstruction. Methods: A biomechanical study of the function of walking at fast speeds, including an electromyographic study, was used. 40 patients were examined, 22 underwent reconstruction of the anterior cruciate ligament. The patients were divided into two groups - with symptoms of instability - 33 people, and without them - 7 people and a control group (healthy) 20 people. Results: The time characteristics of the step cycle did not reveal significant differences between the groups and the control group. For the amplitudes of movements in the joints, there are also completely no significant differences between the parameters of one group from the other and the affected side from the intact side. Only for the intact side in the group with instability there is a significant increase in both amplitudes in the knee joint compared to the control. Electromyographic study also did not reveal significant differences. Conclusions: The use of a functional test with fast walking does not allow differentiating the state of instability. Thus, the instability of the knee joint during normal walking, even at high speed, does not manifest itself in any way. To detect it, it is necessary to develop special provocative tests.
{"title":"ARE THERE OBJECTIVE BIOMECHANICAL SYMPTOMS OF KNEE INSTABILITY AFTER ANTERIOR CRUCIATE LIGAMENT INJURY OR IT’S RECONSTRUCTION?","authors":"Dmitry V. Skvortsov, Alyna Altukhova, S. Kaurkin, Alexander A. Akhpashev","doi":"10.17816/clinpract623681","DOIUrl":"https://doi.org/10.17816/clinpract623681","url":null,"abstract":"Background: Instability of the knee joint after rupture of the anterior cruciate ligament and even after its reconstruction remains a pressing problem. The use of a special functional test with fast walking can be considered as a potential tool for verifying instability. \u0000Aims: to find out whether there are biomechanical differences in joint function with and without instability, both in the period before and after anterior cruciate ligament reconstruction. \u0000Methods: A biomechanical study of the function of walking at fast speeds, including an electromyographic study, was used. 40 patients were examined, 22 underwent reconstruction of the anterior cruciate ligament. The patients were divided into two groups - with symptoms of instability - 33 people, and without them - 7 people and a control group (healthy) 20 people. \u0000Results: The time characteristics of the step cycle did not reveal significant differences between the groups and the control group. For the amplitudes of movements in the joints, there are also completely no significant differences between the parameters of one group from the other and the affected side from the intact side. Only for the intact side in the group with instability there is a significant increase in both amplitudes in the knee joint compared to the control. Electromyographic study also did not reveal significant differences. \u0000Conclusions: The use of a functional test with fast walking does not allow differentiating the state of instability. Thus, the instability of the knee joint during normal walking, even at high speed, does not manifest itself in any way. To detect it, it is necessary to develop special provocative tests.","PeriodicalId":508133,"journal":{"name":"Journal of Clinical Practice","volume":" 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140387015","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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