PERFORATIVE PERITONITIS IN NEWBORNS: INSTRUMENTAL AND MORPHOLOGICAL EXAMINATION FINDINGS

2021 ◽  
Vol 74 (10) ◽  
pp. 2546-2549
Author(s):  
Olga M. Gorbatyuk ◽  
Taras V. Martyniuk
Keyword(s):  
Differential Diagnosis ◽  
Clinical Symptoms ◽  
Morphological Data ◽  
Free Fluid ◽  
Bowel Loop ◽  
Morphological Examination ◽  
Hollow Viscus ◽  
Correct Treatment ◽  
Diagnostic Measures ◽  
Plain Abdominal Radiography

The aim: To study and analyze the results of instrumental diagnostic measures and morphological verification of perforations of abdominal viscera in peritonitis in newborns, their importance in timely diagnosis, as well as to present authors’ experience of examining newborns with PP, taking into account the complexity of diagnosis and treatment of these patients. Materials and methods: The study is based on the results of examining 59 newborns with PP of various etiologies. Instrumental methods that were used in the diagnosis of PP and differential diagnosis of other emergencies involved the following: radiological examination (plain abdominal radiography), abdominal and retroperitoneal ultrasound, neurosonography, echocardiography, diagnostic abdominal paracentesis. Morphological verification of hollow viscus perforations was performed by methods of histologic examination in 54 newborns who underwent surgery. Results: It is emphasized that perforations in NEC and spontaneous gastrointestinal perforations have clinical and morphological differences. The analysis of morphological data showed absence of intestinal musculature or muscular wall defect in spontaneous gastrointestinal perforations. Perforations in NEC had massive gastric or bowel wall necrosis. Morphogenesis of gastrointestinal perforations in newborns is crucial for developing correct treatment strategy and choosing surgical approach. Conclusions: Diagnosis of PP in newborns should be comprehensive and include modern instrumental studies that enable to reliably establish the cause of peritonitis and indications for surgical treatment. Differential diagnosis of PP in newborns with other diseases aims to differentiate PP from a number of similar clinical symptoms of urgent conditions in order to conduct adequate preoperative preparation and appropriate surgery. Diagnostic markers of PP involve the following: pneumoperitoneum, free fluid in the abdomen, sentinel loop (intestinal distention), fixed bowel loop, cloudy brown or greenish intra-abdominal fluid with a large number of leukocytes and bacteria.

A case report of a patient with isolated Crohn’s disease of the stomach

2021 ◽  
Vol 19 (3) ◽  
pp. 95-101
Author(s):  
E.A. Trush ◽  
◽  
A.I. Ulyanin ◽  
A.V. Korolev ◽  
L.N. Androsova ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Clinical Symptoms ◽  
Granulomatous Inflammation ◽  
Endoscopic Finding ◽  
Disease Course ◽  
Morphological Examination ◽  
Gastric Biopsies ◽  
Upper Gastrointestinal

Crohn’s disease of the esophagus, stomach or duodenum is extremely rare and characterized by an aggressive disease course with a poor prognosis. Clinical symptoms of the upper gastrointestinal tract lesion are nonspecific, therefore esophagogastroduodenoscopy with biopsy is necessary for the differential diagnosis. Crohn’s disease of the stomach is characterized by a specific endoscopic finding – bamboo-joint-like appearance of gastric folds. Granulomatous inflammation in morphological examination of gastric biopsies in patients with Crohn’s disease is rare, therefore endoscopic finding is more pathognomonic. This article presents a clinical case of a patient with isolated Crohn’s disease of stomach, differential diagnosis and treatment approaches of the disease. Key words: Crohn’s disease, Crohn’s disease with lesions of the stomach, gastroprotective agents, proton pump inhibitors, endoscopic sonography

Efficacy evaluation of the CEUS-LI-RADS-v2017 system in differential diagnosis of liver tumors

2019 ◽  
pp. 57-67
Author(s):  
A. N. Katrich ◽  
V. A. Porkhanov ◽  
N. S. Ryabin
Keyword(s):  
Risk Factors ◽  
Differential Diagnosis ◽  
Liver Tumors ◽  
Morphological Data ◽  
Malignant Neoplasms ◽  
Diagnostic Efficiency ◽  
Efficacy Evaluation ◽  
General Group ◽  
Group 2 ◽  
Group 1

Objective: efficacy evaluation of the CEUS LI RADS v2017® system for differential diagnosis of liver tumors in patients with and without cirrhosis.Materials and methods. Retrospective analysis of diagnostic results of the 165 patients with liver tumors (177 nodules) was done. All patients underwent CEUS with results interpretation in accordance to the CEUS LIRADSv2017 ® criteria. Patients were divided into 2 groups based on clinical and morphological data. Group 1 included 62 patients with cirrhosis and/or CVH. Group 2 included 110 patients without risk factors for HCC.Results. Diagnostic efficiency of CEUS LI RADS v2017® for HCC identification was: group 1 – Se – 100%, Sp – 88%, Ac – 95.5%; group 2 – Se – 100%, Sp – 68.8%, Ac – 72.7%; general group Se – 100%, Sp – 72.2%, Ac – 81.4%. In the 2nd group, 21 out of 22 neoplasms, confirmed morphologically as FNH, we classified as LR 4. By applying benign character and specific contrasting patterns of FNG, they were transferred from LR 4 to LR 3. This allowed to increase sensitivity and specificity of differential diagnosis in group 2 (Se – 100%, Sp – 90.6%, Ac – 91.8%) and in general group (Se – 100%, Sp – 90.1%, Ac – 93.2%). Diagnostic efficiency of the criteria for non hepatocellular malignant neoplasms (LR M) was: group 1 – Se – 77.8%, Sp – 100%, Ac – 97%; group 2 – Se – 90%, Sp – 96.7%, Ac – 93.6%; general group- Se – 88.1%, Sp – 98.3%, Ac – 94.9%.Conclusion. Our study confirmed high accuracy of the CEUS LI RADS v2017® system in the differential diagnosis of focal liver tumors. Modification of the system (in particular, transfer of typical FNG forms from the LR 4 category) will make it possible to increase the accuracy of diagnostics by 20%. It will allow to use the LI RADS v2017® system for interpretation CEUS not only among patients with liver cirrhosis, but also in a general group without risk factors of GCC.

scholarly journals Rare incidence of non-secretory myeloma with talaromycosis: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Haiting Qin ◽  
Ye Qiu ◽  
Yanmei Huang ◽  
Mianluan Pan ◽  
Dong Lan ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Bone Marrow ◽  
Differential Diagnosis ◽  
Lymph Nodes ◽  
Clinical Symptoms ◽  
Subcutaneous Tissue ◽  
Community Acquired Pneumonia ◽  
Pathological Examination ◽  
Subcutaneous Nodules ◽  
Lung Lymph

Abstract Background Talaromyces marneffei (TM) primarily infects patients with co-morbidities that cause immunodeficiency, but non-secretory myeloma (NSMM) is rare. TSM and NSMM are associated with fever, osteolysis, and swollen lymph nodes, thereby making it difficult for clinicians to make differential diagnosis. In this case, we describe TM infection coexisting with NSMM. Case presentation We retrospectively reviewed the case of a male (without human immunodeficiency virus infection) with fever, thoracalgia, swollen lymph nodes, and subcutaneous nodules who presented to the First Affiliated Hospital of Guangxi Medical University in February 2014. Chest computed tomography revealed patchy infiltration and positron emission tomography/computed tomography showed increased metabolic activity in the lower-right lung, lymph nodes, left ninth rib, and right ilium. Pathological examination of the lung, lymph nodes, subcutaneous nodules, and bone marrow showed no malignancy, he was diagnosed with community-acquired pneumonia. His clinical symptoms did not improve after anti-bacterial, anti-Mycobacterium tuberculosis, and anti-non-M. tuberculosis treatment. Later, etiological culture and pathological examination of the subcutaneous nodule proved TM infection, and the patient was re-diagnosed with disseminated TSM, which involved the lungs, lymph nodes, skin, bone, and subcutaneous tissue. After antifungal treatment, the patient showed significant improvement, except for the pain in his bones. Imaging showed aggravated osteolysis, and bone marrow biopsy and immunohistochemistry indicated NSMM. Thus, we conclusively diagnosed the case as NSMM with TSM (involving the lungs, lymph nodes, skin, and subcutaneous tissue). His condition improved after chemotherapy, and he was symptom-free for 7 years. Conclusion TM infection is rare in individual with NSMM. Since they have clinical manifestation in common, easily causing misdiagnosis and missed diagnosis, multiple pathological examinations and tissue cultures are essential to provide a differential diagnosis.

scholarly journals Change of differential diagnosis tactics in the process of clinical observation ofa patient

2008 ◽  
Vol 7 (2) ◽  
pp. 79-83
Author(s):  
O. V. Kalinina
Keyword(s):  
Lung Cancer ◽  
Differential Diagnosis ◽  
Clinical Observation ◽  
Clinical Symptoms

The complicated ratios of clinical symptoms of internal lesions during central lung cancer are demonstrated in the article when changes of differential diagnosis tactics were required for diagnosing that necessary keeping is priority of the clinical appraisal of the results inspection patient.

scholarly journals Endoscopic Biopsy in Differential Diagnosis of Colorectal Serrated Lesions

2020 ◽  
Vol 30 (3) ◽  
pp. 42-48
Author(s):  
K. D. Khalin ◽  
M. Yu. Agapov ◽  
L. V. Zvereva ◽  
K. V. Stegniy
Keyword(s):  
Differential Diagnosis ◽  
Endoscopic Resection ◽  
Tumour Size ◽  
Endoscopic Biopsy ◽  
Morphological Examination ◽  
Serrated Lesions ◽  
Low Sensitivity ◽  
Average Size ◽  
Sensitivity Specificity ◽  
Serrated Adenomas

Background. Preoperative biopsy is recommended for morphological verification of colorectal epithelial neoplasms prior to their endoscopic resection. However, histological reports for endoscopic biopsy and resected lesions are not reliably consistent.Aim. Assessment of sensitivity, specificity and accuracy of endoscopic biopsy in differential diagnosis of colorectal serrated adenomas and risk factors for variance between biopsy results and morphological examination of completely resected lesions.Materials and methods. The assay used data on 56 morphologically verified serrated adenomas diagnosed and resected in 50 patients (14 men, 36 women; average age 66.9 ± 10.5 years). Biopsy was taken from all tumours before endoscopic resection. Results of morphological examination of biopsy samples and resected tumours were analysed and compared. Sensitivity, specificity and accuracy of biopsy was assessed, with the tumour size and type and biopsy forceps system taken as criteria.Results. The identified cases included 22 (39.3%) right-colon, 21 (37.5%) left-colon and 13 (23.2%) rectal lesions of 28.5 ± 2.6 mm average size. Polypoid were 17 (30.3%), non-polypoid — 6 (10.7%) and spreading — 33 (59%) of the tumours. Full consistency of morphological examination was observed for 12 cases (21.4%). In 9 cases (16%), dysplasia was established as mild-graded with biopsy, whilst the eradicated tumours contained severe dysplastic foci. Foci of adenocarcinoma were detected in 10 tumours (including 2 with submucosal invasion), but only 2 cases were correctly diagnosed for malignant adenoma with biopsy. Tumour morphology was misidentified in 32 cases (57.1%).Conclusions. Preoperative forceps biopsy is shown to possess low sensitivity in differential diagnosis of serrated colorectal lesions and very low sensitivity to predict malignant serrated adenomas.

scholarly journals Difficulties of differential diagnosis of portal hypertension: case report

2021 ◽  
pp. 92-101
Author(s):  
T. V. Penkina ◽  
O. E. Berezutskaya ◽  
D. T. Dicheva ◽  
E. V. Partsvania-Vinogradova ◽  
V. S. Larina ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Portal Hypertension ◽  
Portal Vein ◽  
Portal Vein Thrombosis ◽  
Clinical Case ◽  
Clinical Symptoms ◽  
Varicose Veins ◽  
Small Diameter ◽  
Magnetic Resonance Tomography ◽  
Vein Thrombosis

In the article we analysed the difficulties of differential diagnosis of portal hypertension, considers a clinical case that illustrates the presented theoretical material. In the presented clinical observation, the patient’s disease was manifested by bleeding from the varicose veins of the esophagus. In most cases, portal hypertension syndrome in practicing clinicians is associated with liver cirrhosis, however, it is necessary to remember about the possibility of developing subhepatic portal hypertension, in particular as a result of the formation of portal vein thrombosis. If there are signs of portal hypertension, it is necessary to specify the level of obstruction to blood flow, that is, the form of portal hypertension (subhepatic, hepatic, suprahepatic). Often, portal vein thrombosis can be formed due to undiagnosed blood diseases that occur without any clinical symptoms. The provided clinical example demonstrates a case of portal hypertension in the outcome of a chronic form of myeloproliferative syndrome. Portal cavernoma is quite rare and it is formed due to multiple small-diameter venous structures that gradually replace the occluded vessel with a system of collaterals proximal and distal to the portal vein thrombosis site. In the formation of the diagnosis the main are radiation research methods, but the conclusions should be considered only in conjunction with the clinical evidence. The clinical case is interesting because a large cavernoma of the portal vein in a patient with subhepatic portal hypertension was regarded as a «solid formation» according to magnetic resonance tomography. According to the literature data, cavernous transformation has an external similarity to the tumor process, which expands the range of differential diagnosis and requires the exclusion of oncological formations. 

scholarly journals Osteomalacia in practice of endocrinologist: etiology, pathogenesis, differential diagnosis with osteoporosis

2020 ◽  
Vol 22 (2) ◽  
pp. 23-31
Author(s):  
Olga O. Golounina ◽  
Gyuzel E. Runova ◽  
Valentin V. Fadeyev
Keyword(s):  
Vitamin D ◽  
Differential Diagnosis ◽  
Vitamin D Deficiency ◽  
Clinical Symptoms ◽  
Fibroblast Growth Factor 23 ◽  
Bone Matrix ◽  
Bone Diseases ◽  
Mineral Density ◽  
Bone Formation Rate ◽  
Metabolic Bone Diseases

Osteoporosis is the most common cause of low bone mineral density (BMD) and low-traumatic fractures in adults. However, differential diagnosis should also consider other causes of decreased BMD, including osteomalacia, as treatment for these conditions vary significantly. Osteomalacia is a systemic disorder characterized by decrease in bone strength due to of excessive accumulation of non-mineralized osteoid and uncoupling between bone matrix formation and mineralization. Osteomalacia in adults mostly develops due to severe vitamin D deficiency of any etiology, less often along with kidney pathology, mesenchymal tumors secreting fibroblast growth factor 23 or hereditary metabolic bone diseases. Clinical symptoms of osteomalacia are nonspecific and mostly manifest by generalized diffuse bone pain, muscle weakness, skeletal deformities and often go unnoticed at initial stage of the disease. Histomorphometric examination is the most accurate method of the diagnosis, which allows assessment of bone formation rate and calcification. The utmost priority of the treatment of osteomalacia of any etiology is the elimination of vitamin D deficiency, hypocalcemia, hypophosphatemia and prevention of bone deformities progression and muscle hypotension.

scholarly journals Isolated free fluid on computed tomography for blunt abdominal trauma

2019 ◽  
Vol 101 (8) ◽  
pp. 552-557
Author(s):  
W Bekker ◽  
MTD Smith ◽  
VY Kong ◽  
JL Bruce ◽  
G Laing ◽  
...  
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Splenic Injury ◽  
Operative Management ◽  
Bladder Injury ◽  
Free Fluid ◽  
Abdominal Ct ◽  
Hollow Viscus ◽  
Hollow Viscus Injury ◽  
Non Operative Management

Introduction The clinical significance of isolated free fluid on abdominal computed tomography (CT) in patients with blunt abdominal trauma is unclear. This audit reviews our unit’s experience with isolated free fluid and attempts to refine our clinical algorithms for the assessment of patients with blunt abdominal trauma. Materials and methods All patients who sustained blunt abdominal trauma between December 2012 and December 2017 who were subjected to multidetector CT of the abdomen as part of their initial investigation were included in this study. Results During the five-year period under review, a total of 1066 patients underwent abdominal CT following blunt poly trauma. A total of 84 (7.9%) patients died. There were 148 (14%) patients with CT finding of isolated free fluid. Of these, 128 (67%) were selected for non-operative management, which included a period of serial abdominal examinations. In this non-operative group, five patients failed their abdominal observations and underwent laparotomy. Findings in these five cases were negative (1), non-therapeutic (1), splenic injury (1), Pancreatic and splenic injury (1) and bladder injury (1). Thirteen patients (10%) died, none of whom had surgery. The causes of death were exsanguination from a major traumatic lower limb injury (1), multiple organ failure (1), traumatic brain injury (10) and spinal cord injury (1). The remaining 20 patients underwent laparotomy. The indications were failed non-operative management (5), abdominal distension (1) and suspicion of a missed hollow viscus injury (14). In this group there were 11 therapeutic and 6 non-therapeutic surgeries and three negative laparotomies. For the 15 patients selected for operative management, the findings were as follows: hollow viscus injury (3), mesenteric bleeds (2), splenic and pancreatic injury (1), liver and bladder injury (1), splenic and bladder injury (1), non-therapeutic (4), negative (3). The finding of isolated free fluid on CT is 98% sensitive and 96% specific for true isolated free fluid (chi square 331.598; P = 0.000). This finding predicts successful non-operative management with a positive predictive value of 93% and a negative predictive value of 96%. Discussion In patients with blunt abdominal trauma, the finding of isolated free fluid on abdominal CT alone is no longer an indication for laparotomy. Other clinical factors must be taken into account when deciding on the need for laparotomy, such as haemodynamic status, clinical abdominal findings and the ability to reliably assess the abdomen. In the absence of a clinical indication for urgent laparotomy, patients with isolated free fluid may be observed.

MLL Translocation in a Multipotent Progenitor Causing Acute Lymphoblastic Leukaemia - Two-Step Model of the Disease.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2295-2295
Author(s):  
Jan Zuna ◽  
Tatiana Burjanivova ◽  
Zuzana Zemanova ◽  
Sharon Horsley ◽  
Lyndal Kearney ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukaemia ◽  
Lymphoblastic Leukaemia ◽  
Clinical Symptoms ◽  
Fusion Gene ◽  
Snp Array ◽  
Latency Period ◽  
Lymphoid Cells ◽  
Morphological Examination ◽  
Interacting Protein ◽  
Leukaemic Cells

Abstract Leukaemias with MLL gene rearrangement are usually considered prognostically unfavourable and the clinical symptoms typically follow the translocation formation rapidly. MLL rearrangement is thus thought to be a major hit in leukaemogenesis that is either sufficient to cause the disease or it is a very strong and rapid inducer of the subsequent hit(s) required for the malignant transformation. We report an unusual presentation of secondary acute lymphoblastic leukaemia (sALL) with MLL rearrangement. Our patient was diagnosed originally with acute myeloid leukaemia (AML-M3) characterised by PML/RARα fusion and an internal tandem duplication of FLT3 (FLT3/ITD). After 30 months of complete remission of AML, she developed sALL with MLL/FOXO3A fusion gene. Bone marrow (BM) samples taken during AML therapy were analysed for the presence of these aberrations. Both the PML/RARα fusion and FLT3/ITD disappeared shortly after AML onset and did not reappear. However, FISH and quantitative RT-PCR showed the presence of the MLL/FOXO3A fusion 20 months before the diagnosis of sALL, present in 10–90% of BM cells. Morphological examination showed no blast infiltration of the BM at this time. Experiments combining FISH and morphology confirmed the presence of an MLL rearrangement in myeloid as well as lymphoid cells, indicating that the fusion arose in a multipotent progenitor. In order to identify potential secondary genetic events precipitating sALL in this patient, we used Affymetrix 50K single nucleotide polymorphism (SNP) array analysis on DNA from the diagnostic sALL sample versus the "preleukaemic" (remission AML) sample taken 16 months before. This analysis revealed a 10 Mb amplification on 19q13.32 in the sALL sample, not present in the preleukaemic sample: this was confirmed by FISH with a BAC from the amplified region. A difference between the pre-leukaemic and leukaemic cells is also demonstrated by the incomplete rearrangement of IgH gene (DH1/JH) present only at the diagnosis of sALL. There are about 450 genes in the amplified region on 19q and several of them might be involved in deregulation of the preleukaemic cell if overrepresented (e.g. FLT3 ligand, interleukin 11, Ras interacting protein 1, Stem cell growth factor, Aurora C). The long latency period prior to the onset of the secondary leukaemia in our case resembles the mouse model of MLL/FOXO3A. However, in contrast to the animal model and also to the previous reports of MLL/FOXO3A patients (2 cases described so far, both secondary AMLs after Hodgkin’s disease), our child developed leukaemia from the lymphoid lineage. Taken together, these results indicate that the MLL/FOXO3A fusion alone is not sufficient to cause leukaemia and that second hit is required to the onset of the disease. A responsible gene is possibly located on the telomeric part of the 19q.

scholarly journals A diagnostic dilemma of two rare stroke mimics in a pediatric patient

2017 ◽  
Vol 4 (5) ◽  
pp. 1886
Author(s):  
Nidheesh Cheeyancheri Chencheri ◽  
Pawan Subhash Kashyape ◽  
Sonia Khamis ◽  
Maha Mohammed Elamin Agna
Keyword(s):  
Differential Diagnosis ◽  
Pediatric Patient ◽  
Male Patient ◽  
Clinical Symptoms ◽  
Diagnostic Dilemma ◽  
Cns Vasculitis ◽  
Tissue Diagnosis ◽  
Stroke Mimics

A seven and half year-old male patient presented with clinical symptoms suggestive of stroke. However, the MRI showed atypical lesions in non-vascular distribution and with varying ages. This led to extensive investigations, which suggested a differential diagnosis of CNS neurosarcoidosis and primary CNS vasculitis. Both these are exceedingly rare conditions needing tissue diagnosis and prolonged immunosuppression

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