INTERDISCIPLINARY APPROACH TO THE TREATMENT OF INFANT HEMANGIOMA

2021 ◽  
Vol 100 (3) ◽  
pp. 174-182
Author(s):  
N.P. Kotlukova ◽  
◽  
T.S. Belysheva ◽  
T.T. Valiev ◽  
N.K. Konstantinova ◽  
...  
Keyword(s):  
Laser Therapy ◽  
Soft Tissues ◽  
Treatment Algorithm ◽  
Clinical Manifestations ◽  
Local Therapy ◽  
Interdisciplinary Approach ◽  
Premature Baby ◽  
Maximum Effect ◽  
Ultrasound Diagnostics ◽  
The Right

The aim of the study is to find the best approaches to the treatment of infantile hemangiomas (IH). Materials and methods of research: the experience of treatment of pediatric patients with IH of various localization is presented, which was carried out according to the protocol elaborated by the authors. Systemic therapy with propranolol, local therapy, laser therapy were used in the complex of treatment. The age of patients at the beginning of therapy ranged from 1 month up to 4,5 years. Results: in all cases, patients with propranolol treatment showed a quick and stable effect. Even at the time of the selection of the dose of the drug, IH patients began to involute, became paler, less tense. The thickness of the soft tissues in the IH area decreased by 65% compared to the baseline, the number of functioning vessels decreased by 86%. The maximum effect was achieved within the first 6 months from the start of therapy. Clinical case report – a 2,5-year-old child with extensive hemangioma of the right buttock. There was a complex treatment with propranolol, local therapy, laser therapy. The general course of treatment with propranolol was 2 years 8 months. The total number of laser interventions was 6 with the overall effect in the form of maximum regression of residual clinical manifestations of IH. A positive clinical and ultrasound picture was noted, indicating a pronounced involution of IH, and a gradual withdrawal of propranolol was started. Conclusion: the effectiveness of a comprehensive interdisciplinary approach to the treatment of extensive complicated IH was demonstrated with the participation of specialists of various disciplines: pediatricians, cardiologists, surgeons, specialists in functional and ultrasound diagnostics, specialists in laser therapy, endocrinologists in a severe premature baby with a large number of somatic problems. The clinical treatment algorithm developed and implemented for patients with IH makes it possible to avoid more aggressive methods of treatment of this pathology and to improve the quality of life of this category of patients. On the basis on the results obtained, indications for laser therapy with a selective pulsed laser were formulated.

RETROSPECTIVE ANALYSIS OF PECULIARITIES OF CLINICAL-SONOSCOPIC INDICATORS OF ACUTE APPENDICITIS IN YOUNG PERSONS

2021 ◽  
pp. 145-154
Author(s):  
Дмитрий Валериевич Судаков ◽  
Олег Валериевич Судаков ◽  
Евгений Владимирович Белов ◽  
Наталья Владимировна Якушева ◽  
Оксана Анатольевна Тюрина
Keyword(s):  
Young People ◽  
Ultrasound Examination ◽  
Clinical Manifestations ◽  
Iliac Region ◽  
Ultrasound Diagnostics ◽  
The Future ◽  
Group 2 ◽  
The Government ◽  
The Right ◽  
Group 1

Статья посвящена анализу особенностей клинико-соноскопических показателей острого аппендицита (ОА) у молодежи. Тематика является актуальной, так как в декабре 2020 года, правительством РФ были изменены возрастные рамки понятия «молодежь» - увеличены с 30 до 35 лет. Особенностью работы стало использование УЗИ - методик в комплексной диагностике ОА, которые в настоящее время не являются обязательными в стандарте обследования пациентов с подозрением на ОА. Данная работа стала результатом попытки выявить основные клинико-соноскопические симптомы ОА у молодежи, которые могли бы своевременно помочь с адекватной дифференциальной диагностикой в будущем и возможно «лечь» в основу будущего стандарта обследования. Объектами исследования послужило 150 пациентов, мужчин и женщин, в возрасте от 18 до 35 лет, мужчин (n=71) и женщин (n=59). Все больные были разделены на 3 группы по 50 человек. В 1 группу вошли больные, поступающие с жалобами на боли различного характера в области живота, которым впоследствии не был установлен диагноз ОА. 2 группу составили пациенты, которым выполняли общее УЗИ обследование органов брюшной полости и у которых впоследствии был подтвержден диагноз ОА. В 3 группу вошли пациенты, которым отдельно выполняли УЗИ правой подвздошной области и у которых впоследствии также подтверждался диагноз ОА. Основой исследования стал подробный анализ жалоб (клинических проявлений) пациентов, изучение их температуры тела и локализации боли. Так, у пациентов с ОА наиболее частой локализацией стала правая подвздошная область, а температура редко превышала 37,5 С. В дальнейшем, в работе был проведен комплексный анализ ОАК и Б/Х крови. Было установлено, что у пациентов с ОА наиболее значимо определялись изменения «маркеров» воспалительного процесса - лейкоцитоз, СОЭ, нейтрофильный сдвиг влево; изменения биохимии наоборот-были свойственны пациентам 1 группы - без ОА. Интересной особенностью стало выявление сопутствующих хронических заболеваний. Отмечалось, что с повышением возраста «молодежи» выявлялся и рост числа различных заболеваний. В завершении исследования проводилось изучение данных УЗИ-симптомов, которые были разделены на прямые и косвенные. Статья интересна практикующим врачам - хирургам и УЗИ-диагностам The article is devoted to the analysis of the features of the clinical and sonoscopic indicators of acute appenicitis (OA) in young people. The topic is relevant, since in December 2020, the government of the Russian Federation changed the age range of the concept of "youth" - increased from 30 to 35 years. A feature of the work was the use of ultrasound - techniques in the complex diagnosis of OA, which are currently not mandatory in the standard of examination of patients with suspected OA. This work was the result of an attempt to identify the main clinical and sonoscopic symptoms of OA in young people, which could promptly help with adequate differential diagnosis in the future and possibly "form" the basis of the future examination standard. The objects of the study were 150 patients, men and women, aged 18 to 35 years, men (n = 71) and women (n = 59). All patients were divided into 3 groups of 50 people each. Group 1 consisted of patients admitted with complaints of pains of various nature in the abdominal region, who were not subsequently diagnosed with OA. Group 2 consisted of patients who underwent a general ultrasound examination of the abdominal organs and in whom the diagnosis of OA was subsequently confirmed. Group 3 included patients who underwent a separate ultrasound examination of the right iliac region and who subsequently also had a diagnosis of OA. The study was based on a detailed analysis of complaints (clinical manifestations) of patients, the study of their body temperature and localization of pain. Thus, in patients with OA, the most frequent localization was the right iliac region, and the temperature rarely exceeded 37.5 C. Later, a comprehensive analysis of the OAC and B / C blood was carried out in the work. It was found that in patients with OA, the most significant changes in the "markers" of the inflammatory process were determined - leukocytosis, ESR, neutrophilic shift to the left; changes in biochemistry, on the contrary, were characteristic of patients of group 1 - without OA. An interesting feature was the identification of concomitant chronic diseases. It was noted that with an increase in the age of the "youth", an increase in the number of various diseases was also revealed. At the end of the study, we studied the data of ultrasound symptoms, which were divided into direct and indirect. The article is interesting for practicing doctors - surgeons and ultrasound diagnostics

The massive nodular cutaneous and soft tissues lesions of the right shoulder and the arm as the extramedullary manifestation of the advanced stage of multiple myeloma

Oncoreview ◽  
2017 ◽  
Vol 7 (4) ◽  
pp. 180-183
Author(s):  
Arkadiusz Drobiecki ◽  
Marcin Pasiarski ◽  
Agnieszka Stelmach-Gołdyś ◽  
Bartosz Garus
Keyword(s):  
Multiple Myeloma ◽  
Soft Tissues ◽  
Advanced Stage ◽  
The Right

Low-Level Laser Therapy as a Coadjuvant in Sodium Hypochlorite Extrusion Management

2020 ◽  
Author(s):  
Diana Ened Rodríguez Zaragoza
Keyword(s):  
Laser Therapy ◽  
Sodium Hypochlorite ◽  
Conventional Treatment ◽  
Soft Tissues ◽  
Treatment Protocol ◽  
Low Level Laser Therapy ◽  
Low Level ◽  
Low Level Laser ◽  
Level Laser ◽  
Severe Tissue

Aim: The extrusion of sodium hypochlorite through the apical foramen is an accident that can occur during the endodontic treatment although is relatively uncommon, Due to the severe tissue damage that is caused by the solution, the management becomes important to prevent serious sequalae. Low-level laser therapy might be useful to treat damaged soft tissues because of its bio modulatory effects, which may reduce edema and prevent infection. Methods: In this clinical case, the accidental leakage of 5% sodium hypochlorite during the preparation of the root canal of an upper left canine is reported. The accident caused immediate and intense pain and severe edema and ecchymosis. The conventional treatment protocol was applied along with low-level laser therapy. Results: Clinical examination revealed the healing of soft tissue in thirteen days, besides a significant pain reduction in three days after laser therapy was applied. Conclusion: The combination of low-level laser therapy with a conventional treatment protocol could be a useful tool to manage such an accident.

scholarly journals Legal and Technical Feasibility of the GDPR’s Quest for Explanation of Algorithmic Decisions: of Black Boxes, White Boxes and Fata Morganas

2020 ◽  
Vol 11 (1) ◽  
pp. 18-50 ◽  
Author(s):  
Maja BRKAN ◽  
Grégory BONNET
Keyword(s):  
Decision Making ◽  
Interdisciplinary Approach ◽  
Practical Implementation ◽  
General Data Protection Regulation ◽  
Legal Limits ◽  
Black Boxes ◽  
General Data ◽  
The Subject ◽  
The Right ◽  
Automated Decision Making

Understanding of the causes and correlations for algorithmic decisions is currently one of the major challenges of computer science, addressed under an umbrella term “explainable AI (XAI)”. Being able to explain an AI-based system may help to make algorithmic decisions more satisfying and acceptable, to better control and update AI-based systems in case of failure, to build more accurate models, and to discover new knowledge directly or indirectly. On the legal side, the question whether the General Data Protection Regulation (GDPR) provides data subjects with the right to explanation in case of automated decision-making has equally been the subject of a heated doctrinal debate. While arguing that the right to explanation in the GDPR should be a result of interpretative analysis of several GDPR provisions jointly, the authors move this debate forward by discussing the technical and legal feasibility of the explanation of algorithmic decisions. Legal limits, in particular the secrecy of algorithms, as well as technical obstacles could potentially obstruct the practical implementation of this right. By adopting an interdisciplinary approach, the authors explore not only whether it is possible to translate the EU legal requirements for an explanation into the actual machine learning decision-making, but also whether those limitations can shape the way the legal right is used in practice.

scholarly journals An autopsy-proven case of Corticobasal degeneration heralded by Pontine infarction

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dallah Yoo ◽  
Sung-Hye Park ◽  
Sungwook Yu ◽  
Tae-Beom Ahn
Keyword(s):  
Neurodegenerative Disorders ◽  
Clinical Manifestations ◽  
Neuronal Loss ◽  
Corticobasal Degeneration ◽  
Executive Dysfunction ◽  
Lacunar Infarction ◽  
Cortical Atrophy ◽  
Dystonic Posturing ◽  
Proven Case ◽  
The Right

Abstract Background Neurodegenerative disorders are characterized by insidious progression with poorly-delineated long latent period. Antecedent clinical insult could rarely unmask latent neurodegenerative disorders. Here, we report an autopsy-proven case of corticobasal degeneration which was preceded by a lacunar infarction. Case presentation A 58-year-old man presented with acute ataxia associated with a lacunar infarction in the right paramedian pons. His ataxia persisted with additional progressive gait difficulty and left arm clumsiness. Six months later, a follow-up neurological examination showed asymmetrical bradykinesia, apraxia, dystonic posturing, postural instability, and mild ataxia of the left limbs. Cognitive examination revealed frontal executive dysfunction and visuospatial difficulties. Dopamine transporter imaging scan demonstrated bilateral reduced uptakes in mid-to-posterior putamen, more prominent on the right side. Levodopa-unresponsive parkinsonism, asymmetric limb dystonia, and ideomotor apraxia became more conspicuous, while limb ataxia gradually vanished. The patient became unable to walk without assistance after 1 year, and died 4 years after the symptom onset. Autopsy findings showed frontoparietal cortical atrophy, ballooned neurons, and phosphorylated tau-positive astrocytic plaques and neuropil threads with gliosis and neuronal loss, confirming the corticobasal degeneration. Conclusions The case illustrates that precedent clinical events such as stroke might tip a patient with subclinical CBS into overt clinical manifestations.

scholarly journals Gasperini Syndrome: A Case Report and Systematic Review and Proposing a New Definition

2020 ◽  
Vol 12 (3) ◽  
pp. 433-439
Author(s):  
Riwaj Bhagat ◽  
Siddharth Narayanan ◽  
Marwa Elnazeir ◽  
Thong Diep Pham ◽  
Robert Paul Friedland ◽  
...  
Keyword(s):  
Systematic Review ◽  
Brain Mri ◽  
Cranial Nerves ◽  
Clinical Manifestations ◽  
The Other ◽  
Neurological Deficits ◽  
Brainstem Stroke ◽  
Neurological Features ◽  
The Right ◽  
Core Features

Gasperini syndrome (GS), a rare brainstem syndrome, is featured by ipsilateral cranial nerves (CN) V–VIII dysfunction with contralateral hemibody hypoesthesia. While there have been 18 reported cases, the GS definition remains ambiguous. We report a new case and reviewed the clinical features of this syndrome from all published reports to propose a new definition. A 57-year-old man with acute brainstem stroke had right CN V–VIII and XII palsies, left body hypoesthesia and ataxia. Brain MRI showed an acute stroke in the right caudal pons and bilateral cerebellum. After a systematic review, we classified the clinical manifestations into core and associate features based on the frequencies of occurring neurological deficits. We propose that a definitive GS requires the presence of ipsilateral CN VI and VII palsies, plus one or more of the other three core features (ipsilateral CN V, VIII palsies and contralateral hemibody hemihypalgesia). Additionally, GS, similar to Wallenberg’s syndrome, represents a spectrum that can have other associated neurological features. The revised definition presented in this study may enlighten physicians with the immediate recognition of the syndrome and help improve clinical localization of the lesions and its management.

scholarly journals Large papillary fibroelastoma of right atrium, an unusual case of respiratory distress in a young man

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yan Le Ho ◽  
Pui Fong Ng ◽  
Sotheenathan Krishinan ◽  
Basheer Ahamed Abdul Kareem
Keyword(s):  
Right Atrium ◽  
Clinical Manifestations ◽  
Clinical Information ◽  
Interatrial Septum ◽  
Papillary Fibroelastoma ◽  
Case Presentation ◽  
Intracardiac Masses ◽  
The Right ◽  
Embolic Risk

Abstract Background Papillary fibroelastomas are rare but benign cardiac tumour that are often found on cardiac valvular surfaces. Their clinical manifestations ranging from clinically asymptomatic to substantial complications that are usually secondary to systemic embolism. Multiple theories have been proposed to explain the pathophysiology of its formation. Case presentation We reported a rare case of large papillary fibroelastoma in the right atrium of a young gentleman which was complicated with pulmonary embolism. Transthoracic echocardiography identified a large pedunculated mass measuring 3.4cmX3.4cmX2cm in right atrium with stalk attached to interatrial septum. The intracardiac mass was resected surgically, which revealed papillary fibroelastoma in histology examination. Conclusion Differential diagnosis of intracardiac masses requires clinical information, laboratory tests and imaging modalities including echocardiography. Incidentally discovered papillary fibroelastomas are treated on the basis of their sizes, site, mobility and potential embolic complications. Due to the embolic risk inherent to intraacardiac masses, surgical resection represents an effective curative protocol in treating both symptomatic and asymptomatic right sided and left sided papillary fibroelastomas, with excellent long term postoperative prognosis.

scholarly journals Ovarian epithelioid angiosarcoma complicating pregnancy: a case report and review of the literature

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110196
Author(s):  
Xiaotong Peng ◽  
Zhi Duan ◽  
Hongling Yin ◽  
Furong Dai ◽  
Huining Liu
Keyword(s):  
Adverse Events ◽  
Soft Tissues ◽  
Malignant Tumors ◽  
Cystic Teratoma ◽  
Abdominal Distension ◽  
Epithelioid Angiosarcoma ◽  
History Of ◽  
New Ideas ◽  
The Right ◽  
Clinical Awareness

Epithelioid angiosarcoma is a rare and highly aggressive soft tissue angiosarcoma most commonly arising in the deep soft tissues. Given that abundant vascular cavities anastomose with each other, most angiosarcomas prone to metastasis recur quickly, and the overall prognosis is poor. We report a 25-year-old woman at 24 weeks’ gestation who presented with a 1-month history of abdominal distension. Ultrasonography suggested a mass in the right adnexa, and she underwent two operations owing to uncontrolled intraperitoneal bleeding with progressive anemia. The right ovarian tumor and right adnexa were removed successively. Biopsy yielded a diagnosis of primary epithelioid angiosarcoma with mature cystic teratoma. The patient died from uncontrolled progressive bleeding 1 week after the second operation. This case revealed that epithelial angiosarcoma is a highly malignant endothelial cell tumor. The results of surgery and chemoradiotherapy tend to be poor, and the recurrence rate is high. The purpose of this study is to raise clinical awareness of epithelial angiosarcoma and its adverse events and to provide new ideas for the treatment of these adverse events. Immunohistochemical staining of pathological specimens can facilitate diagnosis. Pregnancy with malignant tumors may lead to rapid disease progression, extensive lesions, and a poor prognosis.

scholarly journals Hereditary haemorrhagic telangiectasia: A case report

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110030
Author(s):  
Asfandyar Mufti ◽  
Muskaan Sachdeva ◽  
Khalad Maliyar ◽  
Marissa Joseph
Keyword(s):  
Arteriovenous Malformations ◽  
Genetic Disorder ◽  
Clinical Manifestations ◽  
Hereditary Haemorrhagic Telangiectasia ◽  
Lower Lip ◽  
Recurrent Epistaxis ◽  
Receptor Like Kinase ◽  
History Of ◽  
The Right ◽  
Symptoms And Signs

Background: Hereditary haemorrhagic telangiectasia is an autosomal dominant genetic disorder characterized by abnormalities in blood vessel formation. The clinical manifestations of patients affected with hereditary haemorrhagic telangiectasia include mucocutaneous telangiectasias and visceral arteriovenous malformations. Case Summary: We report the case of a 30-year-old female diagnosed with hereditary haemorrhagic telangiectasia presenting with the classic triad of recurrent epistaxis, mucocutaneous telangiectasias and family history of hereditary haemorrhagic telangiectasia with activin receptor-like kinase 1 mutation. Upon skin examination, she was noted to have telangiectasias under left naris, inner lower lip and surface of the tongue, and a vascular malformation on the right forearm. Conclusion: Although the skin involvement and epistaxis may be mild symptoms and signs of hereditary haemorrhagic telangiectasia, timely recognition of these can ensure vigilant monitoring of potential severe complications from cerebral and pulmonary visceral arteriovenous malformations.

scholarly journals P686 Right atrial, right ventricular and pulmonary cement embolism: a rare complication of percutaneous vertebroplasty

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Akhunova ◽  
R Khayrullin ◽  
N Stekolshchikova ◽  
M Samigullin ◽  
V Padiryakov
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricle ◽  
Right Atrium ◽  
Percutaneous Vertebroplasty ◽  
Rare Complication ◽  
Clinical Manifestations ◽  
Stable Condition ◽  
Right Atrial ◽  
Cement Embolism ◽  
The Right

Abstract A 68-year-old man was admitted to the hospital with complaints of pain in the lumbar spine. He had L5 disc herniation, Spinal stenosis of the L5 root canal - S1 on the right in the past medical history. Percutaneous vertebroplasty at the level of L3 and Th8 vertebral bodies was performed six months ago due to painful vertebral hemangioma. The man is suffering from arterial hypertension, receives antihypertensive therapy. During routine transthoracic echocardiography, a hyperechoic structure with a size of 9.5 x 0.9 cm was found in the right atrium and right ventricle. Chest computed tomography with contrast enhancement revealed signs of bone cement in the right atrium and right ventricle, in the right upper lobe artery, in the branches of the upper lobe artery, in the paravertebral venous plexuses. Considering the duration of the disease, the stable condition, the absence of clinical manifestations and disorders of intracardiac hemodynamics, it was decided to refrain from surgical treatment. Antiplatelet therapy and dynamic observation were recommended. Conclusion Percutaneous vertebroplasty is a modern minimally invasive surgical procedure for the treatment of degenerative-dystrophic diseases of the spine. However, the cement can penetrate into the paravertebral veins and migrate to the right chambers of the heart and the pulmonary artery. This clinical case demonstrates asymptomatic cement embolism of the right chambers of the heart and pulmonary artery after percutaneous vertebroplasty, detected incidentally during routine echocardiography. Abstract P686 Figure.

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