Pub Date : 2022-12-28DOI: 10.18786/2072-0505-2022-50-053
I. Bakulin, E. Avalueva, E. A. Semenova, L. S. Оrеshkо, M. Serkova, Stanislav Sitkin
Food safety all over the world is largely dependent on production of grains that are cultivated in 60% of agricultural lands. Wheat is the main food for millions of people and one of the three most commonly cultivated grain cultures worldwide, along with corn and rice. Modern wheat is a product of gene engineering interventions aimed at increased productivity, yields, nutrient quota, and storage time, as well as immunogenic properties. However, the consumption of gluten, a proline and glutamine-rich wheat, rye and barley protein, triggers gluten-dependent disorders, such as celiac disease, wheat allergy, baker's asthma and wheat-dependent exercise-induced anaphylaxis. This group of disorders are curable provided the correct diagnosis has been made and strict lifelong gluten-free diet is implemented. Continuous patient's adherence to the gluten-free diet is associated with a number of medical and paramedical challenges, and the adherence level of the most compliant patients does not exceed 80%. The paper discuss other treatment strategies to improve the nutrition of people with gluten-sensitive disorders, in particular, the reduction grain gluten content, gluten sequestration in the gut before its digestion, prevention of gluten absorption and subsequent immune cell activation, and administration of tissue transglutaminase 2 inhibitors.
{"title":"Prospects for the treatment of gluten-associated diseases: on our daily bread, celiac disease, gluten proteins and more…","authors":"I. Bakulin, E. Avalueva, E. A. Semenova, L. S. Оrеshkо, M. Serkova, Stanislav Sitkin","doi":"10.18786/2072-0505-2022-50-053","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-053","url":null,"abstract":"Food safety all over the world is largely dependent on production of grains that are cultivated in 60% of agricultural lands. Wheat is the main food for millions of people and one of the three most commonly cultivated grain cultures worldwide, along with corn and rice. Modern wheat is a product of gene engineering interventions aimed at increased productivity, yields, nutrient quota, and storage time, as well as immunogenic properties. However, the consumption of gluten, a proline and glutamine-rich wheat, rye and barley protein, triggers gluten-dependent disorders, such as celiac disease, wheat allergy, baker's asthma and wheat-dependent exercise-induced anaphylaxis. This group of disorders are curable provided the correct diagnosis has been made and strict lifelong gluten-free diet is implemented. Continuous patient's adherence to the gluten-free diet is associated with a number of medical and paramedical challenges, and the adherence level of the most compliant patients does not exceed 80%. The paper discuss other treatment strategies to improve the nutrition of people with gluten-sensitive disorders, in particular, the reduction grain gluten content, gluten sequestration in the gut before its digestion, prevention of gluten absorption and subsequent immune cell activation, and administration of tissue transglutaminase 2 inhibitors.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73607563","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 : 2022-12-28DOI: 10.18786/2072-0505-2022-50-054
T. Sedova
We present a clinical case of a primary multiple synchronous highly differentiated keratinizing squamous cell skin cancer in an 84-year old patient with multiple actinic keratosis and actinic cheilitis. The clinical case is unique for the simultaneous development of primary multiple squamous cell carcinoma of the tip of the nose and the vermilion zone of the lower lip in a patient with a past occupational and solar burden, a light phenotype, and signs of chronic photo injury the skin. Clinical, dermatoscopic and sonographic signs of keratotic actinic keratosis were identified in the patient and confirmed by pathomorphological examination. The risk factors for malignant transformation of actinic keratosis were found, such as multiple efflorescences and a long disease history. The malignant transformation of the actinic areas manifested as rapidly progressive ulceration zones more than 1 cm in diameter, pronounced hyperkeratosis, inflammation and infiltration of the underlying tissues, increased bleeding and pain. It is to be underlined that definitive and differential diagnosis requires pathomorphological assessment of the skin biopsy sample. This clinical case indicates that patients with multiple foci of actinic keratosis should be under a lifelong follow-up by dermatovenereologists, with mandatory treatment and prevention measure.
{"title":"Actinic keratosis as a predictor of primary multiple synchronous squamous cell skin cancer: a clinical case","authors":"T. Sedova","doi":"10.18786/2072-0505-2022-50-054","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-054","url":null,"abstract":"We present a clinical case of a primary multiple synchronous highly differentiated keratinizing squamous cell skin cancer in an 84-year old patient with multiple actinic keratosis and actinic cheilitis. The clinical case is unique for the simultaneous development of primary multiple squamous cell carcinoma of the tip of the nose and the vermilion zone of the lower lip in a patient with a past occupational and solar burden, a light phenotype, and signs of chronic photo injury the skin. Clinical, dermatoscopic and sonographic signs of keratotic actinic keratosis were identified in the patient and confirmed by pathomorphological examination. The risk factors for malignant transformation of actinic keratosis were found, such as multiple efflorescences and a long disease history. The malignant transformation of the actinic areas manifested as rapidly progressive ulceration zones more than 1 cm in diameter, pronounced hyperkeratosis, inflammation and infiltration of the underlying tissues, increased bleeding and pain. It is to be underlined that definitive and differential diagnosis requires pathomorphological assessment of the skin biopsy sample. This clinical case indicates that patients with multiple foci of actinic keratosis should be under a lifelong follow-up by dermatovenereologists, with mandatory treatment and prevention measure.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90585392","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 : 2022-12-27DOI: 10.18786/2072-0505-2022-50-050
O. V. Karzanov, E. V. Chernyaeva, A. Kupriyanova, Y. Molochkova, E. V. Zenkevich, A. Molochkov
Pemphigus presents a group of chronic autoimmune bullous skin disorders with well-known clinical signs, which pathophysiology is mediated by antibodies to various epidermal self-antigens. For a long time, the only therapeutic option for this disease was the lifelong use of non-selective immunosuppressive agents limited by high rate of severe adverse reactions. The article presents two clinical cases of rituximab use (a targeted agent leading to B-cell depletion) in patients with pemphigus (vulgaris and foliaceous) who were previously resistant to high-dose steroid therapy. Treatment with rituximab lead to response and allowed to decrease the prednisone dose in both cases. These results confirm that rituximab can be successfully used in pemphigus as adjuvant therapy if conventional agents for this dermatosis are ineffective.
{"title":"B-cell depletion in the treatment of pemphigus: two clinical cases and literature review","authors":"O. V. Karzanov, E. V. Chernyaeva, A. Kupriyanova, Y. Molochkova, E. V. Zenkevich, A. Molochkov","doi":"10.18786/2072-0505-2022-50-050","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-050","url":null,"abstract":"Pemphigus presents a group of chronic autoimmune bullous skin disorders with well-known clinical signs, which pathophysiology is mediated by antibodies to various epidermal self-antigens. For a long time, the only therapeutic option for this disease was the lifelong use of non-selective immunosuppressive agents limited by high rate of severe adverse reactions. The article presents two clinical cases of rituximab use (a targeted agent leading to B-cell depletion) in patients with pemphigus (vulgaris and foliaceous) who were previously resistant to high-dose steroid therapy. Treatment with rituximab lead to response and allowed to decrease the prednisone dose in both cases. These results confirm that rituximab can be successfully used in pemphigus as adjuvant therapy if conventional agents for this dermatosis are ineffective.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87977093","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 : 2022-12-27DOI: 10.18786/2072-0505-2022-50-052
A. Y. Ryabchenko
Recurrent painful ophthalmoplegic neuropathy is a rare clinical syndrome, included into the International Classification of Headache Disorders, 3rd edition, and characterized by recurrent headache episodes associated with dysfunction of one or more ocular motor nerves. The diagnosis implies mandatory exclusion of other potential causes of the symptoms. The paper presents a clinical case of a 49-year old female patient with a unilateral headache paroxysms and subsequent paresis of the oculomotor nerve. A thorough clinical assessment, with neuroimaging (brain magnetic resonance imaging and magnetic resonance angiography of arteries and veins of the head) showed no morphological abnormalities that could cause clinical symptoms of oculomotor neuropathy. Her past history was remarkable for a similar episode of prolonged unilateral headache and oculomotor paresis about 10 years before, which were at that time considered as an acute cerebrovascular accident. Thus, two episodes of similar clinical signs of painful neuropathy, the absence of other possible causes of the disease, and the complete regression of symptoms after treatment (ibuprofen and gabapentin) confirmed the diagnosis of recurrent painful ophthalmoplegic neuropathy.
{"title":"A clinical observation of recurrent painful ophthalmoplegic neuropathy in a 49-year old female patient","authors":"A. Y. Ryabchenko","doi":"10.18786/2072-0505-2022-50-052","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-052","url":null,"abstract":"Recurrent painful ophthalmoplegic neuropathy is a rare clinical syndrome, included into the International Classification of Headache Disorders, 3rd edition, and characterized by recurrent headache episodes associated with dysfunction of one or more ocular motor nerves. The diagnosis implies mandatory exclusion of other potential causes of the symptoms. The paper presents a clinical case of a 49-year old female patient with a unilateral headache paroxysms and subsequent paresis of the oculomotor nerve. A thorough clinical assessment, with neuroimaging (brain magnetic resonance imaging and magnetic resonance angiography of arteries and veins of the head) showed no morphological abnormalities that could cause clinical symptoms of oculomotor neuropathy. Her past history was remarkable for a similar episode of prolonged unilateral headache and oculomotor paresis about 10 years before, which were at that time considered as an acute cerebrovascular accident. Thus, two episodes of similar clinical signs of painful neuropathy, the absence of other possible causes of the disease, and the complete regression of symptoms after treatment (ibuprofen and gabapentin) confirmed the diagnosis of recurrent painful ophthalmoplegic neuropathy.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79361339","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 : 2022-12-27DOI: 10.18786/2072-0505-2022-50-049
I. E. Khatkov, Elena Y. Tyulyaeva, K. Lesko, E. Dubtsova, D. S. Bordin, Mariia A. Kiriukova, M. Malykh, Ludmila V. Vinokurova
Chronic pancreatitis is one of the most challenging disorders from the perspective of its early diagnosis and effective treatment. Within the last decade, the diagnosis of early chronic pancreatitis has been firmly introduced into the practice of gastroenterology. The delineation of this form as an initial stage of chronic pancreatitis is based on the need in early and effective treatment that could cease the progression of the disease and reduce the possibility of its complications. The diagnostic criteria of chronic pancreatitis have been described in details in the literature; however, specifics of the diagnosis in its early stage have been scarcely highlighted. Chronic pancreatitis is commonly diagnosed with a number of imaging techniques (they can show abnormalities in morphology of the pancreas), as well as laboratory tests (showing functional organ deficit). However, morphological and imaging techniques are insufficient for the diagnosis of the early chronic pancreatitis. A new integral strategy towards early diagnosis seems necessary, that would consider not only the morphology, but also potential etiology, risk factors of the disease and its complications in patients with suspected chronic pancreatitis. The review of the literature presents the definition of the early pancreatitis and discusses the potential of imaging techniques and functional tests in its diagnosis. An adequate strategy for the diagnosis of the early pancreatitis is formulated, based on an individual patient characteristic with suspected early chronic pancreatitis, namely, risk factors, clinical manifestations, imaging results and serological biomarkers.
{"title":"Early diagnosis of chronic pancreatitis","authors":"I. E. Khatkov, Elena Y. Tyulyaeva, K. Lesko, E. Dubtsova, D. S. Bordin, Mariia A. Kiriukova, M. Malykh, Ludmila V. Vinokurova","doi":"10.18786/2072-0505-2022-50-049","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-049","url":null,"abstract":"Chronic pancreatitis is one of the most challenging disorders from the perspective of its early diagnosis and effective treatment. Within the last decade, the diagnosis of early chronic pancreatitis has been firmly introduced into the practice of gastroenterology. The delineation of this form as an initial stage of chronic pancreatitis is based on the need in early and effective treatment that could cease the progression of the disease and reduce the possibility of its complications. \u0000The diagnostic criteria of chronic pancreatitis have been described in details in the literature; however, specifics of the diagnosis in its early stage have been scarcely highlighted. Chronic pancreatitis is commonly diagnosed with a number of imaging techniques (they can show abnormalities in morphology of the pancreas), as well as laboratory tests (showing functional organ deficit). However, morphological and imaging techniques are insufficient for the diagnosis of the early chronic pancreatitis. A new integral strategy towards early diagnosis seems necessary, that would consider not only the morphology, but also potential etiology, risk factors of the disease and its complications in patients with suspected chronic pancreatitis. \u0000The review of the literature presents the definition of the early pancreatitis and discusses the potential of imaging techniques and functional tests in its diagnosis. An adequate strategy for the diagnosis of the early pancreatitis is formulated, based on an individual patient characteristic with suspected early chronic pancreatitis, namely, risk factors, clinical manifestations, imaging results and serological biomarkers.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77276148","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 : 2022-12-27DOI: 10.18786/2072-0505-2022-50-051
N. M. Khomeriki, S. Khomeriki
The review deals with the data on negative health impact of prolonged and inadequate use of proton pump inhibitors (PPI). Since their advent at the end of 1980s, their worldwide use has been continuously increasing. However, up to 70% of PPI use is not based on clear indications. Inadequate treatment with PPI not complying with clinical guidelines results in a higher risk of adverse events, especially in the elderly. Prolonged (more than 8 weeks) intake of PPI increases the risk of osteoporotic fractures, promotes Clostridioides difficile infection and gut microbiota abnormalities, community-acquired pneumonia, vitamin B12 deficiency, renal disease, dementia, risk of gastric cancer, etc. Most potential side effects of PPI are the results of hypochlorhydria and reflex hypergastrinemia. The main safety principle for PPI is adherence to short duration of treatment and minimally effective doses. Rational strategies for safe and effective PPI treatment are supported by the evidence-based deprescribing in gastroesophageal reflux disease and include dose tapering or therapy as needed after the treatment course for a specific indication has been finished, or stopping the treatment in patients with no adequate indications to PPI administration. Increased awareness of medical personnel and patients on the proper PPI use and their side effects would make it possible to optimize the use of these agents in the real world medical practice.
{"title":"Is an optimization of the use of proton pump inhibitors feasible in the real world medical practice?","authors":"N. M. Khomeriki, S. Khomeriki","doi":"10.18786/2072-0505-2022-50-051","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-051","url":null,"abstract":"The review deals with the data on negative health impact of prolonged and inadequate use of proton pump inhibitors (PPI). Since their advent at the end of 1980s, their worldwide use has been continuously increasing. However, up to 70% of PPI use is not based on clear indications. Inadequate treatment with PPI not complying with clinical guidelines results in a higher risk of adverse events, especially in the elderly. Prolonged (more than 8 weeks) intake of PPI increases the risk of osteoporotic fractures, promotes Clostridioides difficile infection and gut microbiota abnormalities, community-acquired pneumonia, vitamin B12 deficiency, renal disease, dementia, risk of gastric cancer, etc. Most potential side effects of PPI are the results of hypochlorhydria and reflex hypergastrinemia. The main safety principle for PPI is adherence to short duration of treatment and minimally effective doses. Rational strategies for safe and effective PPI treatment are supported by the evidence-based deprescribing in gastroesophageal reflux disease and include dose tapering or therapy as needed after the treatment course for a specific indication has been finished, or stopping the treatment in patients with no adequate indications to PPI administration. Increased awareness of medical personnel and patients on the proper PPI use and their side effects would make it possible to optimize the use of these agents in the real world medical practice.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79888635","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 : 2022-12-19DOI: 10.18786/2072-0505-2022-50-048
S. Zakharenko
Clostridium difficile was reclassified in 2016 under a new name of Clostridioides difficile. In 2021 to 2022, some changes were implemented into the main clinical guidelines on the diagnosis and treatment of infections caused by this pathogen. A two-step algorithm based on identification of C. difficile and then its toxins is still recommended for the diagnosis. The treatment regimens for the first episode and relapses of C. difficile-associated infection are based on metronidazole, vancomycin and fidaxomycin. Additional effectiveness of therapy has been associated with the use of microbiocenosis-oriented technologies aimed at restoration of the colon microbiota. In the Russian Federation, all widely applied diagnostic methods are available and all recommended antimicrobials, except fidaxomycin, as well as bezlotoxumab and fecal microbiota transplantation.
{"title":"Clostridioides difficile – a new name, the old problems with diagnosis and treatment","authors":"S. Zakharenko","doi":"10.18786/2072-0505-2022-50-048","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-048","url":null,"abstract":"Clostridium difficile was reclassified in 2016 under a new name of Clostridioides difficile. In 2021 to 2022, some changes were implemented into the main clinical guidelines on the diagnosis and treatment of infections caused by this pathogen. A two-step algorithm based on identification of C. difficile and then its toxins is still recommended for the diagnosis. The treatment regimens for the first episode and relapses of C. difficile-associated infection are based on metronidazole, vancomycin and fidaxomycin. Additional effectiveness of therapy has been associated with the use of microbiocenosis-oriented technologies aimed at restoration of the colon microbiota. In the Russian Federation, all widely applied diagnostic methods are available and all recommended antimicrobials, except fidaxomycin, as well as bezlotoxumab and fecal microbiota transplantation.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87566750","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 : 2022-12-16DOI: 10.18786/2072-0505-2022-50-047
A. Khlebnikova, E. Selezneva
Background: Bowen's disease (BD), or squamous cell carcinoma in situ, is an epithelium-derived tumor with high oncogenicity. Nowadays, high frequency ultrasonography is widely used for non-invasive diagnosis of skin tumors. The results of investigations into the echo signs of BD are contradictory, while they based on the use of 20 and 45 MHz converters. To make intra-epidermal lesions visible, it is necessary to use sonographic converters with at least 50 MHz resolution. Aim: To determine ultrasonographic signs of BD with the use of a high frequency 75 MHz sensor. Materials and methods: We examined 8 patients (2 women and 6 men) aged 38 to 86 years with histologically confirmed BD diagnosis. With a high resolution ultrasonographic system (75 MHz sensor) we scanned 8 solid BD lesions and 8 visually unchanged contralateral skin areas as controls, measuring the epidermal and dermal thickness, depth of hypodense areas in derma in the chosen regions of interest. Results: The ultrasonographic picture of the BD lesions was characterized by hyperdense epidermis of two types: the first one (n = 6) was of uneven thickness and wave form, with budlike sprouts into the dermal depth, while the second one (n = 2) was of similar width all through, with even external and internal contours. Mean epidermal thickness in the BD lesions was significantly different from that of the contralateral visually unchanged skin areas (192.37 75.48 vs 69.88 12.48 mcm, p = 0.011719). In BD lesion, there were intradermal hypodense areas located just under the epidermis; they included diffuse and heterogeneous band-like structures in the type 1 lesions and round structures in the type 2 lesions. The mean thickness of the hypodense BD zones in the tumor located in the open skin areas was bigger than that in those located in the closed skin areas (1288.25 450.25 vs 585.75 150.62 mcm, p = 0.025348). Conclusion: With ultrasonographic scanning with a 75 MHz sensor, we have identified the following BD characteristics: thickened epidermis with an even internal contour and hypodense intradermal areas of diffuse heterogeneous structures, which had the biggest depth in the lesions located in the open skin areas. The ultrasonographic picture of BD can be of two types depending on the combination of the main signs with different shape.
背景:鲍恩氏病(BD)，又称原位鳞状细胞癌，是一种高致癌性的上皮源性肿瘤。目前，高频超声被广泛应用于皮肤肿瘤的无创诊断。对BD回波信号的调查结果是矛盾的，而它们是基于使用20和45 MHz转换器。为了使表皮内病变可见，有必要使用分辨率至少为50 MHz的超声转换器。目的:利用高频75mhz传感器确定BD的超声征象。材料和方法:我们检查了8例患者(2女6男)，年龄38 ~ 86岁，组织学确诊为BD。我们使用高分辨率超声系统(75 MHz传感器)扫描了8个实性BD病变和8个视觉上不变的对侧皮肤区域作为对照，测量了表皮和真皮厚度，真皮低密度区域的深度。结果:BD病变超声图像表现为两种类型的高密度表皮:第一种(n = 6)厚度不均匀，波形不均匀，芽状芽深入真皮深处;第二种(n = 2)宽度一致，内外轮廓均匀。BD病变的平均表皮厚度与对侧视觉不变皮肤区有显著差异(192.37 75.48 mcm vs 69.88 12.48 mcm, p = 0.011719)。BD病变中，表皮下可见皮内低密度区;1型病变呈弥漫性和非均匀带状结构，2型病变呈圆形结构。位于开放皮肤区域的肿瘤低密度BD区平均厚度大于位于封闭皮肤区域的肿瘤(1288.25 450.25 vs 585.75 150.62 mcm, p = 0.025348)。结论:通过75 MHz超声传感器扫描，我们发现了以下BD特征:表皮增厚，内部轮廓均匀，皮内弥漫性非均匀结构的低密度区，病变深度最大，位于皮肤开放区。根据不同形态的主要征象组合，BD的超声图像可分为两种类型。
{"title":"Ultrasonographic characteristics of Bowen's disease","authors":"A. Khlebnikova, E. Selezneva","doi":"10.18786/2072-0505-2022-50-047","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-047","url":null,"abstract":"Background: Bowen's disease (BD), or squamous cell carcinoma in situ, is an epithelium-derived tumor with high oncogenicity. Nowadays, high frequency ultrasonography is widely used for non-invasive diagnosis of skin tumors. The results of investigations into the echo signs of BD are contradictory, while they based on the use of 20 and 45 MHz converters. To make intra-epidermal lesions visible, it is necessary to use sonographic converters with at least 50 MHz resolution. \u0000Aim: To determine ultrasonographic signs of BD with the use of a high frequency 75 MHz sensor. \u0000Materials and methods: We examined 8 patients (2 women and 6 men) aged 38 to 86 years with histologically confirmed BD diagnosis. With a high resolution ultrasonographic system (75 MHz sensor) we scanned 8 solid BD lesions and 8 visually unchanged contralateral skin areas as controls, measuring the epidermal and dermal thickness, depth of hypodense areas in derma in the chosen regions of interest. \u0000Results: The ultrasonographic picture of the BD lesions was characterized by hyperdense epidermis of two types: the first one (n = 6) was of uneven thickness and wave form, with budlike sprouts into the dermal depth, while the second one (n = 2) was of similar width all through, with even external and internal contours. Mean epidermal thickness in the BD lesions was significantly different from that of the contralateral visually unchanged skin areas (192.37 75.48 vs 69.88 12.48 mcm, p = 0.011719). In BD lesion, there were intradermal hypodense areas located just under the epidermis; they included diffuse and heterogeneous band-like structures in the type 1 lesions and round structures in the type 2 lesions. The mean thickness of the hypodense BD zones in the tumor located in the open skin areas was bigger than that in those located in the closed skin areas (1288.25 450.25 vs 585.75 150.62 mcm, p = 0.025348). \u0000Conclusion: With ultrasonographic scanning with a 75 MHz sensor, we have identified the following BD characteristics: thickened epidermis with an even internal contour and hypodense intradermal areas of diffuse heterogeneous structures, which had the biggest depth in the lesions located in the open skin areas. The ultrasonographic picture of BD can be of two types depending on the combination of the main signs with different shape.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78200201","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 : 2022-12-08DOI: 10.18786/2072-0505-2022-50-044
M. Andreev, E. Fedotova, Rodion N. Konovalov, S. Illarioshkin
Multiple system atrophy (MSA) is a neurodegenerative disorder characterized by autonomous insufficiency and motor abnormalities, such as akinetic rigid syndrome and cerebellar ataxia. The diagnosis of this disorder is challenging, and quite frequently the patients are seen by other specialties or with other diagnoses. The paper presents three clinical observations of patients with various phenotypic MSA subtypes. In two of them, the diagnosis of MSA was clinically proven and in the third one, clinically probable. All patients were initially followed up with other diagnoses. The authors describe specifics of complaints and past history registration, neurological examination and typical signs of MSA at neuroimaging.
{"title":"Clinical polymorphism of multiple system atrophy: a clinical case series","authors":"M. Andreev, E. Fedotova, Rodion N. Konovalov, S. Illarioshkin","doi":"10.18786/2072-0505-2022-50-044","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-044","url":null,"abstract":"Multiple system atrophy (MSA) is a neurodegenerative disorder characterized by autonomous insufficiency and motor abnormalities, such as akinetic rigid syndrome and cerebellar ataxia. The diagnosis of this disorder is challenging, and quite frequently the patients are seen by other specialties or with other diagnoses. The paper presents three clinical observations of patients with various phenotypic MSA subtypes. In two of them, the diagnosis of MSA was clinically proven and in the third one, clinically probable. All patients were initially followed up with other diagnoses. The authors describe specifics of complaints and past history registration, neurological examination and typical signs of MSA at neuroimaging.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86757419","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 : 2022-12-08DOI: 10.18786/2072-0505-2022-50-045
D. Khutorov, O. N. Startseva, O. Tikhomirova, N. Zybina
Background: Small vessel disease (SVD) is a common brain disease causing about 40% of all dementias and about 25% of ischemic strokes, which makes important the study of its pathophysiology and the search for its biomarkers. A number of studies have shown a significant role of endothelial dysfunction and nonspecific inflammation, as well as of some individual parameters of hemostasis disorders in the development of SVD. Aim: To identify the role of the laboratory markers of fibrinolytic system in the assessment of the severity of white matter lesions in patients with SVD. Materials and methods: This single center cross-sectional non-controlled observational study included 117 patients with dyscirculatory encephalopathy (chronic brain ischemia), with a mean ( SD) age of 57.7 11.5 years. Laboratory tests of the fibrinolytic system, endothelial dysfunction, markers of inflammation and for an integral assessment of plasma hemostasis were performed in all patients, including XIIa-dependent fibrinolysis, levels of plasminogen, alpha2-antiplasmin, plasminogen activator inhibitor 1 (PAI-1), fibrinogen, von Willebrand factor (vWF) and activity of blood coagulation factor VIII (FVIII), highly sensitive C-reactive protein and parameters of the thrombodynamics assay. In all the patients, brain magnetic resonance imaging was performed with the assessment of the white matter lesions by the Fazecas scale. Results: Depending on the identified neuroimaging SVD markers (assessed with the Fazecas scale), the patients were divided into the SVD group (n = 54) and no-SVD group (n = 63). Those with SVD were older than those without (65 9 vs 51 10 years; p 0.001), had higher prevalence of arterial hypertension (p 0.001), diabetes mellitus (p = 0.029) and past thrombotic events (p 0.001). The SVD patients, compared to those without SVD, had a higher time of XIIa-dependent fibrinolysis (7.6 2.9 vs 6.5 1.7 min, p = 0.032), higher alpha2-antiplasmin levels (111 [95117] vs 105 [95111]%, p = 0.016) and higher clot density (D) (22789 [2056726411] vs 20627 [1832422650] U, p 0.001), although the parameters were within the reference ranges. As far as the thrombodynamics is concerned, the SVD group had higher values for all test parameters, as well as higher levels of the inflammation and endothelial dysfunction markers. Increased time of XIIa-dependent fibrinolysis was associated with higher probability of periventricular and subcortical leukoareosis grade 2 by the Fazecas scale (odds ratio 1.31 [1.071.60], p = 0.009), including an increase in the size and number of gliosis areas. Higher plasminogen levels were associated with a lower probability of leukoareosis by the Fazecas scale (odds ratio 0.97 [0.950.98], p 0.001). Conclusion: The severity of fibrinolytic and hemostatic abnormalities correlates with the severity of brain SVD, thus forming the hypofibrinolytic and prothrombotic status of the patients with this disorder.
背景:小血管疾病(SVD)是一种常见的脑部疾病，约占所有痴呆症的40%，约占缺血性中风的25%，因此对其病理生理学的研究和生物标志物的寻找具有重要意义。多项研究表明，内皮功能障碍和非特异性炎症以及一些止血障碍的个体参数在SVD的发展中起着重要作用。目的:探讨纤维蛋白溶解系统实验室标志物在评价SVD患者白质病变严重程度中的作用。材料与方法:本研究纳入117例慢性脑缺血循环障碍脑病患者，平均(SD)年龄为57.7 ~ 11.5岁。对所有患者进行纤维蛋白溶解系统、内皮功能障碍、炎症标志物和血浆止血综合评估的实验室检测，包括xiia依赖性纤维蛋白溶解、纤溶酶原、α 2-抗纤溶酶、纤溶酶原激活物抑制剂1 (PAI-1)、纤维蛋白原、血管性血友病因子(vWF)水平、凝血因子VIII (FVIII)活性、高度敏感的c反应蛋白和血栓动力学测定参数。所有患者均行脑磁共振成像，并用Fazecas量表评估白质病变。结果:根据确定的神经影像学SVD标志物(Fazecas评分)，将患者分为SVD组(n = 54)和无SVD组(n = 63)。SVD患者比无SVD患者年龄大(65岁vs 51岁;P 0.001)，动脉高血压(P 0.001)、糖尿病(P = 0.029)和既往血栓事件(P 0.001)的患病率较高。与无SVD患者相比，SVD患者的xiia依赖性纤溶时间更长(7.6 2.9 vs 6.5 1.7 min, p = 0.032)， α 2-抗纤溶酶水平更高(111 [95117]vs 105 [95111]%， p = 0.016)，血栓密度(D)更高(22789 [2056726411]vs 20627 [1832422650] U, p = 0.001)，尽管这些参数均在参考范围内。就血栓动力学而言，SVD组所有测试参数的值都更高，炎症和内皮功能障碍标志物的水平也更高。xiia依赖性纤维蛋白溶解时间的增加与Fazecas评分2级脑室周围和皮质下白质疏松的可能性增加相关(优势比为1.31 [1.071.60]，p = 0.009)，包括胶质瘤区域的大小和数量增加。Fazecas评分显示，较高的纤溶酶原水平与较低的白斑发病率相关(优势比0.97 [0.950.98]，p 0.001)。结论:纤溶和止血异常的严重程度与脑SVD的严重程度相关，从而形成脑SVD患者的低纤溶和血栓形成前状态。
{"title":"The role of the fibrinolytic system laboratory markers in the assessment of the cerebral small vessel disease severity","authors":"D. Khutorov, O. N. Startseva, O. Tikhomirova, N. Zybina","doi":"10.18786/2072-0505-2022-50-045","DOIUrl":"https://doi.org/10.18786/2072-0505-2022-50-045","url":null,"abstract":"Background: Small vessel disease (SVD) is a common brain disease causing about 40% of all dementias and about 25% of ischemic strokes, which makes important the study of its pathophysiology and the search for its biomarkers. A number of studies have shown a significant role of endothelial dysfunction and nonspecific inflammation, as well as of some individual parameters of hemostasis disorders in the development of SVD. \u0000Aim: To identify the role of the laboratory markers of fibrinolytic system in the assessment of the severity of white matter lesions in patients with SVD. \u0000Materials and methods: This single center cross-sectional non-controlled observational study included 117 patients with dyscirculatory encephalopathy (chronic brain ischemia), with a mean ( SD) age of 57.7 11.5 years. Laboratory tests of the fibrinolytic system, endothelial dysfunction, markers of inflammation and for an integral assessment of plasma hemostasis were performed in all patients, including XIIa-dependent fibrinolysis, levels of plasminogen, alpha2-antiplasmin, plasminogen activator inhibitor 1 (PAI-1), fibrinogen, von Willebrand factor (vWF) and activity of blood coagulation factor VIII (FVIII), highly sensitive C-reactive protein and parameters of the thrombodynamics assay. In all the patients, brain magnetic resonance imaging was performed with the assessment of the white matter lesions by the Fazecas scale. \u0000Results: Depending on the identified neuroimaging SVD markers (assessed with the Fazecas scale), the patients were divided into the SVD group (n = 54) and no-SVD group (n = 63). Those with SVD were older than those without (65 9 vs 51 10 years; p 0.001), had higher prevalence of arterial hypertension (p 0.001), diabetes mellitus (p = 0.029) and past thrombotic events (p 0.001). The SVD patients, compared to those without SVD, had a higher time of XIIa-dependent fibrinolysis (7.6 2.9 vs 6.5 1.7 min, p = 0.032), higher alpha2-antiplasmin levels (111 [95117] vs 105 [95111]%, p = 0.016) and higher clot density (D) (22789 [2056726411] vs 20627 [1832422650] U, p 0.001), although the parameters were within the reference ranges. As far as the thrombodynamics is concerned, the SVD group had higher values for all test parameters, as well as higher levels of the inflammation and endothelial dysfunction markers. Increased time of XIIa-dependent fibrinolysis was associated with higher probability of periventricular and subcortical leukoareosis grade 2 by the Fazecas scale (odds ratio 1.31 [1.071.60], p = 0.009), including an increase in the size and number of gliosis areas. Higher plasminogen levels were associated with a lower probability of leukoareosis by the Fazecas scale (odds ratio 0.97 [0.950.98], p 0.001). \u0000Conclusion: The severity of fibrinolytic and hemostatic abnormalities correlates with the severity of brain SVD, thus forming the hypofibrinolytic and prothrombotic status of the patients with this disorder.","PeriodicalId":7638,"journal":{"name":"Almanac of Clinical Medicine","volume":"68 1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75943879","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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