Intermittent intestinal intussusception in patients with mesenteric lymphadenitis in the ileocecal angle

Introduction. At present, lymphadenopathy – as a cause of idiopathic intestinal intussusception in little children - comes to the fore. However, intestinal intussusception in case of destructive mesenteric lymphadenitis in combination with lymphoid hyperplasia of the ileocecal angle ( what does not exclude lymphoma intraoperatively) is extremely rare in clinical practice.Purpose. To present a therapeutic and diagnostic algorithm in intestinal intussusception which was caused by the “volumetric“ abdominal lymphadenopathy.Case Report. A 3-year-old boy was admitted by the ambulance with recurrent abdominal pain, single episode of vomiting and no stool for 4 days. The ultrasound examination revealed intermittent ileocecal intussusception. The risk factor which had triggered the disease was an acute respiratory viral infection complicated with purulent mesenteric lymphadenitis and lymphoid hyperplasia with ulcerative lesions of the mucous membrane in the ileocecal junction. Laparoscopic desinvagination with lymph node removal and colonoscopy with ladder biopsy were performed. A differential diagnostics of nonspecific lymphadenopathy, Burkitt’s lymphoma and Crohn’s disease was made. Immunohistological examination intraoperatively was made; examination of the biopsy material excluded tumor and inflammatory bowel disease (IBD). The inflammatory process regressed under conservative therapy (antibacterial, anti-inflammatory and antispasmolytic) ; there were no any recurrent intussusception episodes within one-year follow-up.Conclusion. Successive ultrasound, laparoscopic and colonoscopic examinations followed by the immunohistological analysis of intraoperative and biopsy material allowed to put a correct diagnosis and, thereby, to minimize surgical aggression in ileocecal intussusception which was accompanied by volumetric lymphadenopathy.

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Experience of Diagnosis and Treatment of Intussusception in Children

Galician Medical Journal ◽

10.21802/gmj.2016.3.13 ◽

2016 ◽

Vol 23 (3) ◽

Author(s):

O. Fofanov ◽

O. Borys ◽

R. Nykyforuk ◽

V. Fofanov ◽

I. Krasivs'kij

Keyword(s):

Medical Records ◽

Intestinal Intussusception ◽

National Medical ◽

Doppler Data ◽

Priority Method ◽

Small Intestinal ◽

Recurrent Intussusception ◽

Ileocecal Intussusception ◽

Medical University ◽

Established Treatment

The objective of the research was to establish the causes of complications of intestinal intussusception in children as well as to determine the optimal diagnostic and treatment strategy.Materials and methods. The analysis of medical records and examinations of 100 children with intestinal intussusception at the age of 1 month to 17 years who were treated at the clinic of pediatric surgery of the Ivano-Frankivsk National Medical University was made. Ileocecal intussusception was diagnosed in 77 children; 13 patients had small intestinal intussusception; there were no patients with colonic intussusception; in 10 patients the localization of intussusception was not established. Treatment of intestinal intussusception was performed urgently immediately after the diagnosis. High priority was given to conservative treatment (74 patients); it was effective in 64 (86.5%) patients. The remaining 36 patients underwent surgery, 9 (25%) of them underwent a laparoscopic disinvagination. In 27 cases open surgery – disinvagination – was used.Results and discussion. The typical age (4-12 months) was observed in 50% of patients only, however, 38% of patients were over 1 year of age, and 20% of children were older than 3 years. All children with intestinal intussusception recovered. The complications of intestinal intussusception were observed in 7 patients, most of them were admitted to the clinic 24 hours after the onset of the disease. Re-laparotomy was used in three cases; two patients underwent elective (programmed re-laparotomy) and one patient underwent urgent re-laparotomy due to the presence of signs of peritonitis. Recurrent intussusception was observed in 5 patients; 4 patients developed this condition after conservative disinvagination, one child - after surgery.Conclusions. The complications of intussusception in children are usually associated with untimely diagnosis and treatment.Diagnostic laparoscopy is a highly informative method of diagnosis in the absence of typical symptoms of intussusception being also an effective minimally invasive treatment.When selecting the method of intussusception treatment you should be guided by the duration of rectal bleeding and Doppler data being the most important criteria for determining the degree of the impairment of hemomicrocirculation in the invaginated intestine.Conservative disinvagination is the priority method of treating intussusception.

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ON SURGICAL TREATMENT OF PATIENTS WITH VERTEBROBASILAR INSUFFICIENCY ASSOCIATED WITH KIMMERLE ANOMALY

Hirurgiâ pozvonočnika ◽

10.14531/ss2005.1.69-73 ◽

2005 ◽

pp. 069-073

Author(s):

Aleksandr Kuzmich Chertkov ◽

Maksim Evgenyevich Klimov ◽

Marina Valentinovna Nesterova

Keyword(s):

Surgical Treatment ◽

Basilar Artery ◽

Intraoperative Monitoring ◽

Diagnostic Algorithm ◽

Differential Diagnostics ◽

Vertebrobasilar Insufficiency ◽

Study Objective ◽

Vertebral Arteries ◽

Clinically Significant ◽

A New Technique

Patients with vertebrobasilar insufficiency, which are frequent in neurological and neurosurgical practice, require a complex examination to reveal its ethiology and to perform a differential diagnostics. The study objective was to develop a diagnostic algorithm for detection of clinically significant forms of Kimmerle anomaly, and to introduce a new technique for surgical treatment under intraoperative monitoring of the vertebral artery decompression. When a patient with the Kimmerle anomaly shows a vertebrobasilar insufficiency, a comprehensive surgical policy includes a complex clinicalphysiological assessment of the vertebrobasilar basin (from vertebral arteries entrances up to the basilar artery and its branches). If any other pathology is excluded, the Kimmerle rings (foramen arcuale) are removed and hemodynamics in the vertebrobasilar basin is estimated by clinical and graphical Doppler methods.

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Evaluation of Gene Expression Profiles in Thyroid Nodule Biopsy Material to Diagnose Thyroid Cancer

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2007-1571 ◽

2008 ◽

Vol 93 (4) ◽

pp. 1195-1202 ◽

Cited By ~ 20

Author(s):

Stéphanie Durand ◽

Carole Ferraro-Peyret ◽

Samia Selmi-Ruby ◽

Christian Paulin ◽

Michelle El Atifi ◽

...

Keyword(s):

Gene Expression ◽

Thyroid Cancer ◽

Normal Tissue ◽

Large Scale ◽

Malignant Tumors ◽

Expression Profiles ◽

Correct Diagnosis ◽

Thyroid Tissue ◽

Biopsy Material ◽

Thyroid Carcinomas

Abstract Context: Detection of thyroid cancer among benign nodules on fine-needle aspiration biopsies (FNAB), which presently relies on cytological examination, is expected to be improved by new diagnostic tests set up from genomic data. Objective: The aim of the study was to use a set of genes discriminating benign from malignant tumors, on the basis of their expression levels, to build tumor classifiers and evaluate their capacity to predict malignancy on FNAB. Design: We analyzed the level of expression of 200 potentially informative genes in 56 thyroid tissue samples (benign or malignant tumors and paired normal tissue) using nylon macroarrays. Gene expression data were subjected to a weighted voting algorithm to generate tumor classifiers. The performances of the classifiers were evaluated on a series of 26 sham FNAB, i.e. FNAB carried out on thyroid nodules after surgical resection. Results: A series of 19 genes with a similar expression in follicular adenomas and normal tissue and discriminating follicular adenomas+normal tissue from the following: 1) follicular thyroid carcinomas (FTCs), 2) papillary thyroid carcinomas (PTCs), or 3) both FTCs and PTCs. These were used to generate four classifiers, the FTCs, PTCs, common (FTC+PTCs), and global classifiers. In 23 of the 26 sham FNAB, the four classifiers yielded a diagnosis in agreement with the diagnosis of the pathologist used as reference; in the three other cases, the correct diagnosis was given by three of four classifiers. Conclusions: We developed a procedure of molecular diagnosis of benign vs. malignant tumors applicable to the material collected by FNAB. The molecular test complied with a preclinical validation stage; it must be now evaluated on ultrasound-guided FNAB in a large-scale prospective study.

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Spine Myeloid Sarcoma: A Case Series with Review of Literature

South Asian Journal of Cancer ◽

10.1055/s-0041-1742079 ◽

2021 ◽

Vol 10 (04) ◽

pp. 251-254

Author(s):

Kajal Shah ◽

Harsha Panchal ◽

Apurva Patel

Keyword(s):

Myeloid Leukemia ◽

De Novo ◽

Correct Diagnosis ◽

Relevant Literature ◽

Bone Marrow Involvement ◽

Case Series ◽

Diagnostic Algorithm ◽

Myeloid Sarcoma ◽

Diagnostic Challenge ◽

Extramedullary Tumor

AbstractMyeloid sarcoma (MS) is a malignant extramedullary tumor consisting of immature cells of myeloid origin. It may precede, present concurrently or follow acute myeloid leukemia (AML) in de novo case or may also be present and might be the only manifestation of recurrent AML, myelodysplastic syndrome, or chronic myeloid leukemia. It frequently involves skin, orbit, bone, periosteum, lymph nodes, and gastrointestinal tract, soft tissue, central nervous system, and testis. Because of its different localization and symptoms, and the lack of diagnostic algorithm, MS is a real diagnostic challenge particularly in patients without initial bone marrow involvement. The correct diagnosis of MS is important for optimum therapy, which is often delayed because of a high misdiagnosis rate. We reported three cases of MS derived from spine presented with back pain, paraplegia, paraparesis, respectively, and reviewed the relevant literature.

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Errors in Differential Diagnosis of Burn Injury at the Prehospital Stage

Russian Sklifosovsky Journal Emergency Medical Care ◽

10.23934/2223-9022-2020-9-4-659-665 ◽

2021 ◽

Vol 9 (4) ◽

pp. 659-665

Author(s):

O. S. Pankrateva ◽

Yu. V. Yurova ◽

P. K. Krylov ◽

E. V. Zinoviev ◽

D. O. Vagner ◽

...

Keyword(s):

Differential Diagnosis ◽

Emergency Care ◽

Burn Injury ◽

Correct Diagnosis ◽

Diagnostic Errors ◽

Differential Diagnostics ◽

Diagnostic Process ◽

Medical Department ◽

Emergency Medical ◽

Inpatient Department

Relevance. An important component of the diagnostic process in combustiology is the collection of anamnesis. At the same time, verification of the very fact of a burn injury of the skin, as a rule, does not seem to be a difficult task even for a novice doctor. However, specialists from the I.I. Dzhanelidze Institute regularly encounter errors in the differential diagnosis of burn injuries at the prehospital stage on the part of both ambulance teams (EMS) and surgeons (traumatologists) of non-specialized medical institutions. Each such case attracts attention and takes up a significant part of the time resource of the entire staff of the inpatient department of the emergency medical service for the process of clarifying and verifying the correct diagnosis, as well as determining the further routing of such a patient.Aim of study. To study the structure of diagnostic errors at the prehospital stage of the EMS to optimize patient routing by improving the existing organizational and methodological standards.Material and methods. A retrospective analysis of the case histories of all victims who were admitted to the inpatient department of the Emergency Medical Department of the I.I. Dzhanelidze St. Petersburg Research Institute of Emergency Medicine during the period from January 2018 to December 2019.Results. 4,951 patients were admitted with a leading diagnosis of the referring institution, suggesting a history of burn injury. The incidence of diagnostic errors at the prehospital stage of emergency care was 410 cases (8.3%), while burn injury was completely excluded in 178 cases (3.6%).Conclusions. 1. The results of the analysis revealed a high incidence of diagnostic errors at the prehospital stage of emergency care (8.3%), the main reason for which is the lack of awareness of differential diagnostics within the narrow specialty (combustiology) of primary contact physicians. 2. Shown is the introduction of training practice for doctors and paramedics of emergency medical services, surgeons and traumatologists of primary care in combustiology cycles in specialized burn departments. 3.In order to ensure continuity in the process of providing medical care to patients with burns, it is necessary to create a unified database of convalescents to form a feedback channel with the outpatient clinic during the implementation of the rehabilitation complex.

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SPECIFIC MOMENTS IN THE DIAGNOSTICS OF UTERINE ADNEXA TORSION IN A 15-YEAR OLD GIRL

Russian Journal of Pediatric Surgery ◽

10.18821/1560-9510-2019-23-3-154-156 ◽

2019 ◽

Vol 23 (3) ◽

pp. 154-156

Author(s):

L. V. Adamyan ◽

E. V. Sibirskaya ◽

S. M. Sharkov ◽

A. K. Fayzulin ◽

Anastasia V. Vechernina

Keyword(s):

Abdominal Pain ◽

Clinical Picture ◽

Ovarian Tumor ◽

Inflammatory Process ◽

Preventive Measures ◽

Correct Diagnosis ◽

Diagnostic Errors ◽

Pain Syndrome ◽

Differential Diagnostics ◽

Adnexal Torsion

Currently, differential diagnostics and treatment of uterine adnexal torsion (UAT) in girls is not completely solved and is not an easy one because surgical and gynecological pathologies often intersect with each other. That is why, girls with abdominal pain are to be consulted by a gynecologist. The case discussed in the article demonstrates the problem with differential diagnostics in girls with “acute abdomen”. UAT differential diagnostics is not easy because this pathology has no clear clinical picture what complicates putting a correct diagnosis. UAT in girls is an acute pathology which has to be differentiated from the volume tumor-like formations in the ovaries, a frequent complication of which is an incomplete torsion of tumor leg or ovarian tumor which then leads to complete uterine adnexa torsion. Differential diagnostics should be done with other surgical pathologies such as acute appendicitis, omentum infiltration. Their clinical picture is characterized by a certain complex of symptoms which develops specific changes during the progress of the inflammatory process; this picture also depends on the anatomical peculiarities. Uterine adnexa torsion is met in 15-25% of girls with abdominal pain syndrome. The aim of this work is to demonstrate preventive measures so as to avoid possible diagnostic errors and complications associated with them in girls with abdominal pain syndrome.

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Urinary disorders and bladder-bowel dysfunction in children: approaches to diagnosis, treatment and prevention

Bulletin of Russian State Medical University ◽

10.24075/brsmu.2018.067 ◽

2018 ◽

pp. 53-59

Author(s):

AB Moiseev ◽

AA Mironov ◽

OB Kolbe ◽

EE Vartapetova ◽

VV Polunina ◽

...

Keyword(s):

Primary Healthcare ◽

Correct Diagnosis ◽

Diagnostic Algorithm ◽

Bowel Dysfunction ◽

Diagnostic Challenge ◽

Urinary Disorders ◽

Healthcare Facilities ◽

Treatment And Prevention ◽

Bladder Bowel Dysfunction ◽

Urinary Disorder

Pediatric urinary disorders manifested as urinary incontinence, compelling urges to urinate, etc. remain an important problem of contemporary healthcare. In spite of being extensively covered in the literature, urinary disorders, including enuresis, still present a diagnostic challenge to the physicians of primary healthcare facilities. Based on the findings of our retrospective study that revealed discrepancies between referral and final diagnoses of pediatric urinary disorders, we give recommendations to both physicians of primary healthcare facilities and their inpatient care colleagues that will help them to arrive at the correct diagnosis of a urinary disorder or concomitant bladder-bowel dysfunction using the proposed diagnostic algorithm.

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Diagnostic Pitfalls in Newborns and Babies with Blisters and Erosions

Dermatology Research and Practice ◽

10.1155/2009/320403 ◽

2009 ◽

Vol 2009 ◽

pp. 1-10 ◽

Cited By ~ 13

Author(s):

Elke Nischler ◽

Alfred Klausegger ◽

Clemens Hüttner ◽

Gabriele Pohla-Gubo ◽

Anja Diem ◽

...

Keyword(s):

Skin Diseases ◽

Correct Diagnosis ◽

Molecular Genetic ◽

Diagnostic Algorithm ◽

Skin Lesions ◽

Molecular Genetic Analysis ◽

Inherited Disorders ◽

Clinical Appearance ◽

Transmission Electron ◽

Disease Entities

Establishing the correct diagnosis in newborns presenting with blisters and erosions is not always a straightforward process. Many different disease entities including acquired (i.e., infectious, immunobullous, traumatic) and inherited disorders have to be taken into consideration. Similarities in clinical appearance, colonization and/or superinfections of preexisting skin lesions, as well as the absence of late changes in the neonate often pose significant diagnostic challenges. In this paper we discuss by giving examples the process of making an accurate diagnosis of blistering skin diseases in the neonatal period on the basis of a diagnostic algorithm. In addition, we provide an overview of the rational use and the limitations of laboratory procedures such as microbial testing, routine light microscopy, immunofluorescence antigen mapping, transmission electron microscopy, and molecular genetic analysis.

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Pediatric Fatty Liver and Obesity: Not Always Justa Matter of Non-Alcoholic Fatty Liver Disease

Children ◽

10.3390/children5120169 ◽

2018 ◽

Vol 5 (12) ◽

pp. 169

Author(s):

Renata Alfani ◽

Edoardo Vassallo ◽

Anna De Anseris ◽

Lucia Nazzaro ◽

Ida D'Acunzo ◽

...

Keyword(s):

Liver Disease ◽

Fatty Liver ◽

Fatty Liver Disease ◽

Large Scale ◽

Correct Diagnosis ◽

Diagnostic Algorithm ◽

Liver Imaging ◽

Dietary Counseling ◽

Alcoholic Fatty Liver ◽

Alcoholic Fatty Liver Disease

Obesity-related non-alcoholic fatty liver disease (NAFLD) represents the most common cause of pediatric liver disease due to overweight/obesity large-scale epidemics. In clinical practice, diagnosis is usually based on clinical features, blood tests, and liver imaging. Here, we underline the need to make a correct differential diagnosis for a number of genetic, metabolic, gastrointestinal, nutritional, endocrine, muscular, and systemic disorders, and for iatrogenic/viral/autoimmune hepatitis as well. This is all the more important for patients who are not in the NAFLD classical age range and for those for whom a satisfactory response of liver test abnormalities to weight loss after dietary counseling and physical activity measures cannot be obtained or verified due to poor compliance. A correct diagnosis may be life-saving, as some of these conditions which appear similar to NAFLD have a specific therapy. In this study, the characteristics of the main conditions which require consideration are summarized, and a practical diagnostic algorithm is discussed.

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