Technical Intricacies Involved in Surgical Retrieval of a Long Standing Foreign Body in Hand- A Case Report

Foreign Bodies (F.B) are not uncommon in hand as it is involved in Day to day activities. Prompt removal during the initial examination is the norm, but sometimes foreign bodies (F.B) may be missed and they remain within the soft tissue for a long time either revealing itself at a later date as a sinus, swelling or an abscess. We present a case of retained FB in the dorsum of hand and the technique involved in retrieval of such a long standing FB.

Secure Clamping of Parts for Disassembly for Remanufacturing

Robot based remanufacturing of valuable products is commonly perceived as promising field in future in terms of an efficient and globally competitive economy. Additionally, it plays an important role with regard to resource-efficient manufacturing. The associated processes however, require a reliable non-destructive disassembly. For these disassembly processes, there is special robot periphery essential to enable the tasks physically. Unlike manufacturing, within remanufacturing there are End-of-Life (EoL) products utilized. The specifications and conditions are often uncertain and varying. Consequently the robot system and especially the periphery needs to adapt to the used product, based on an initial examination and classification of the part. State of the art approaches provide limited flexibility and adaptability to the disassembly of electric motors used in automotive industry. Especially the geometrical shape is a limiting factor for using state of the art periphery for remanufacturing. Within this contribution a new kind of flexible clamping device for the disassembly of EoL electrical motors is presented. The robot periphery is systematically developed regarding the requirements stemming from the remanufacturing approach. It consists of three clamping units with moveable pins. Utilizing two linear axes, a two dimensional working space is realized for clamping the parts depending on their conditions and shape.

Macular volume and fovea thickness as OCT-criteria for multiple sclerosis. Preliminary results

Background. The characteristic optical coherence tomography (OCT) changes in the optic nerve head in patients with multiple sclerosis are known and have been described many times, however, the state of the macular area is described in a small number of publications.The aim: to analyze the changes in the macular area of the retina in patients with multiple sclerosis, to identify the OCT signs pathognomonic for this disease and to trace their changes over time as the disease progresses.Material and methods. In addition to the standard ophthalmological examination, 28 patients (55 eyes) diagnosed with multiple sclerosis underwent OCT of the macular zone to determine the thickness of the fovea and the volume of the macula in the 6 mm zone. The follow-up period was 6–12 years. The endpoints were the primary treatment and the most recent inspection.Results. At the initial examination, the visual acuity was 0.96 ± 0.24 (95% CI: 0.9–1.03), fovea thickness – 253.0 μm (Q1–Q3: 233.0–264.0), macular volume – 5.471 mm3 (Q1–Q3: 5.281–5.625). In 37 cases (67.3 %), the macular volume was below normal. The initial fovea thickness was below normal in 9 cases (16.4 %). At the end of the study, visual acuity did not change statistically (p = 0.824) and amounted to 0.96 ± 0.25 (95% CI: 0.90–1.04). The fi nal thickness of the fovea was 247.5 μm (Q1–Q3: 233.0–260.0), changes are statistically significant (p = 0.02). Number of cases with a thickness below normal in the fi nal study was 11 (20 %), change of frequency of cases was not statistically signifi cant (p = 0.5). The fi nal macular volume was 5.393 mm3 (Q1–Q3: 5.197–5.565), the changes are statistically significant (p = 0.023). The final number of cases with a volume below the norm was 42 (76.4 %), the change in the frequency of cases is close to statistically signifi cant (p = 0.063). At all stages of the study, there was no case of an isolated decrease in the thickness of the fovea without a decrease in the volume of the macula.Conclusion. The decrease in the volume of the macula with time while maintaining the thickness of the fovea within the normal range can be attributed to the pathognomonic OCT signs of multiple sclerosis. This criterion can be used for a comprehensive assessment of the course and therapy of this disease.

Diagnostic and prognostic potential of eight whole blood microRNAs for equine sarcoid disease

MicroRNAs have been proposed as biomarkers for equine sarcoids, the most prevalent equine skin tumors globally. This study served to validate the diagnostic and prognostic potential of whole blood microRNAs identified in a previous study for long-term equine sarcoid diagnosis and outcome prediction. Based on findings of a clinical examination at the age of 3 years and a follow-up following a further 5–12 years, 32 Franches-Montagnes and 45 Swiss Warmblood horses were assigned to four groups: horses with regression (n = 19), progression (n = 9), new occurrences of sarcoid lesions (n = 19) and tumor-free control horses (n = 30). The expression levels for eight microRNAs (eca-miR-127, eca-miR-432, eca-miR-24, eca-miR-125a-5p, eca-miR-134, eca-miR-379, eca-miR-381, eca-miR-382) were analyzed through reverse transcription quantitative polymerase chain reaction in whole blood samples collected on initial examination. Associations of sex, breed, diagnosis, and prognosis with microRNA expression levels were examined using multivariable analysis of variance. Sex and breed influenced the expression level of five and two microRNAs, respectively. Eca-miR-127 allowed discrimination between sarcoid-affected and tumor-free horses. No variation in microRNA expression was found when comparing horses with sarcoid regression and progression. Expression levels of eca-miR-125a-5p and eca-miR-432 varied in male horses that developed sarcoids throughout the study period in comparison to male control horses. While none of the investigated miRNAs was validated for predicting the prognosis of sarcoid regression / progression within young horses with this condition, two miRNAs demonstrated potential to predict if young male (though not female) tumor-free horse can develop sarcoids within the following years. Sex- and breed- biased miRNAs exist within the equine species and have an impact on biomarker discovery.

Diagnosis of liver fibrosis: an emphasis on elastography

In the strategy of managing patients with chronic diffuse liver diseases, the priority areas are the determination of the diagnosis with the determination of the main risk factors, the activity of the process (steatosis, steatohepatitis), as well as the degree of fibrous transformation. The rate of progression of liver fibrosis is a decisive factor that will determine the prognosis, treatment tactics and the likelihood of severe complications. The “gold standard” for diagnosing chronic liver pathology is a puncture liver biopsy with morphological examination of the liver tissue. At the same time, potential complications, contraindications to the procedure, low patient compliance, as well as errors in the interpretation of the results obtained due to various reasons are significant limitations of this diagnostic method. These shortcomings were the reason for the search for reliable non-invasive methods for diagnosing liver fibrosis both during the initial examination and during subsequent monitoring in dynamics. Modern methods of liver elastography are widely used for non-invasive assessment of fibrosis, demonstrating good diagnostic capabilities and significantly reducing the need for liver biopsy. Various elastography methods, which have their own advantages and disadvantages, effectively complement each other, which is successfully used in clinical practice in the diagnosis of fibrous transformation. The combined use of elastographic methods and commercial predictive diagnostic panels will increase the diagnostic accuracy in the determination of liver fibrosis.

Development of renal adenocarcinoma in a ferret with renal cortical cysts (Mustela putorius furo)

CASE DESCRIPTION A 5.5-year-old 0.929-kg spayed female domestic ferret (Mustela putorius furo) underwent serial abdominal ultrasonographic and clinicopathologic examinations after multiple renal cysts were detected bilaterally during a routine examination. CLINICAL FINDINGS The ferret was apparently healthy at the start of the monitoring period and had no clinical signs for > 20 months. Four months after the initial examination, the largest cyst became increasingly mineralized; 17 months after detection, it had increased in size and become amorphous, and the ferret’s plasma BUN concentration was mildly high. Within 21 months after the first visit, a nodule was detectable, and hydronephrosis developed in the kidney with the largest cyst. Findings for fine-needle aspirates from the nodule were consistent with renal carcinoma. TREATMENT AND OUTCOME Contrast-enhanced CT revealed severe unilateral nephromegaly with no contrast uptake in the affected ureter. Following surgical removal of the affected kidney, histologic examination identified renal adenocarcinoma replacing the entire renal cortex and medulla. The ferret was euthanized postoperatively because of declining condition. On necropsy, metastasis to a mesenteric lymph node was identified; comorbidities included 2 other neoplasms and acute, severe injury of the contralateral kidney. CLINICAL RELEVANCE Neoplastic transformation of a renal cyst was suspected in the ferret of this report on the basis of observed ultrasonographic changes over time and extensive infiltration of the neoplasm throughout the affected kidney. Renal cysts are linked to renal neoplasia in other species, and the findings for this patient supported the need for periodic monitoring of renal cysts in ferrets.

Clinical Features of the Fellow Eyes of Children with Unilateral Facial Port-Wine Stains and Ipsilateral Glaucoma

Purpose: To investigate the clinical features of non-affected fellow eyes in patients with unilateral facial port-wine stain (PWS) and ipsilateral secondary glaucoma.Methods: We performed a retrospective analysis of the medical records of 35 patients with unilateral facial PWS glaucoma and those of controls (35 subjects without both facial PWS and glaucoma) between September 1996 and May 2020. We noted patients’ age at the glaucoma diagnosis (for unilateral facial PWS glaucoma patients) or at the initial examination (for controls), cup-to-disc ratio (CDR), and intraocular pressure (IOP). We compared the clinical features between the glaucoma-free eyes in patients with unilateral facial PWS glaucoma and the controls.Results: The mean age at the glaucoma diagnosis for unilateral facial PWS glaucoma patients was 0.56 ± 0.99 years (range, 0.08-4). The mean IOP of the glaucoma-free eyes was 16.68 ± 5.73 mmHg (range, 9-22.9), and the mean CDR was 0.37 ± 0.14 (range, 0.15-0.80) at glaucoma diagnosis. The mean IOP of the glaucoma-free eyes was 14.14 ± 6.29 mmHg (range, 8.1-26.7), and the mean CDR was 0.37 ± 0.12 (range, 0.26-0.82) at final examination. When comparing glaucoma-free eyes of the unilateral facial PWS glaucoma patients with the control group (mean age, 11.2 ± 7.4 years), the mean CDR was significantly greater (0.37 ± 0.12 vs. 0.30 ± 0.08; p = 0.014) but there was no significant difference in the mean IOP (14.14 ± 6.29 mmHg vs. 14.57 ± 2.49 mmHg; p = 0.712).Conclusions: The glaucoma-free eyes of unilateral facial PWS glaucoma patients showed greater CDR compared to the non-facial PWS and non-glaucoma controls. Additional longitudinal studies are needed to investigate the clinical course of those eyes, whether the risk of developing glaucoma is increased.

Assessment of spine mobility in patients with ankylosing spondylitis by ultrasound scanning (preliminary data)

Spine involvement in ankylosing spondylitis (AS) resulting in limited mobility requires a search for accurate, quantitatively methods of assessment of the decline of its function and monitoring of its dynamics. One of the promising methods for assessing movements in the spine in AS is ultrasound examination (US).Objective: to determine the relationship between the mobility of the spine measured sonographically, and the activity and functional status of patients with AS.Patients and methods. Spinal ultrasound was performed in 15 patients (10 men and 5 women, mean age 40.8±11.4 years, mean duration of the disease 5.5±3.5 years) with a confirmed diagnosis of AS, admitted to the V.A. Nasonova Research Institute of Rheumatology from April to August 2019. All patients underwent a double examination (at baseline and after 2 weeks) according to a specially developed protocol.Results and discussion. A comparative analysis of the results of sonographic measurements of the distance between the spinous processes of the vertebrae of the studied spine segment at baseline and after 2 weeks revealed a tendency towards an increase in these parameters both in the initial position and during flexion. There was no relationship between age, body mass index, duration of the disease and the distance between the spinous processes in all parts of the spine measured by sonography in initial position and during flexion. Correlation analysis data indicate the presence of a correlation between an increase in the distance between the spinous processes in the cervical and lumbar spine and a decrease in ESR, and i increase in the distance between the spinous processes in the lumbar spine and level of CRP. A weak negative relationship was found between the BASDAI index and the mobility of the spine at the LIV–V level and between sonographic measurements in all segment of the spine and the BASMI index.Conclusion. The sonographic method of determining the mobility of the spine can be recommended in patients with AS, both for initial examination and during follow-up, but it can't substitute the BASMI metrological index. Further research is needed to confirm the findings.

EFFICIENCY OF IMPLEMENTATION OF ELECTRONIC DOCUMENT CIRCULATION IN A MULTIDISCIPLINE HOSPITAL AT THE PREHOSPITAL STAGE

Статья посвящена анализу эффективности электронного документооборота в многопрофильном стационаре на догоспитальном этапе (в условиях приемного отделения). Исследование, проводимое в 2020-2021 гг в БУЗ ВО ВОКБ №1, можно считать актуальным, в виду того, что в последние годы в нашей стране в сфере здравоохранения продолжается ряд реформ, направленных на оптимизацию и модернизацию. Этот процесс был бы невозможен без повсеместно проводимой информатизации и цифрофизации. В настоящее время в Воронежской областной клинической больнице №1 происходит внедрение электронного документооборота и специализированных компьютерных программ, изучение эффективности которых и стала целью работы. Объектами исследования послужило 400 пациентов, мужчин и женщин в возрасте от 18 до 79 лет и их истории болезни. Все больные были разделены на 2 группы по 200 человек, в зависимости от того, использовались ли элементы электронного документооборота и специализированные компьютерные программы при их оформлении и при оказании им диагностических мероприятий (не использовались в 1 группе и использовались во 2). В дальнейшем пациенты каждой группы были также подразделены на 2 подгруппы, в зависимости от профиля (хирургия и терапия). В основу исследования лег анализ времени, затраченного на разные этапы догоспитальной помощи - от первичного осмотра и заполнения первичной документации врачами приемного отделения, до выполнения основного спектра лабораторных и инструментальных методов диагностики. Интересной особенностью работы стало выделение в каждой диагностической процедуре нескольких основных этапов, включающих, в том числе и этапы «доставки» пациента к врачу - диагносту, а также временные рамки ознакомления лечащих врачей (терапевта или хирурга приемного отделения или узких специалистов) с результатами исследования. Представленные в статье данные позволяют судить о существенном уменьшении времени, затрачиваемого на оформление и основные диагностические процедуры, благодаря внедрению электронного документооборота. Полученные в работе данные представляют существенный интерес как для практикующих врачей различного профиля и врачей, участвующих в разработке специализированного медицинского программного обеспечения, так и для организаторов здравоохранения The article is devoted to the analysis of the effectiveness of electronic document management in a multidisciplinary hospital at the prehospital stage (in the conditions of the admission department). The research carried out in 2020-2021 at BUZ VO VOKB № 1 can be considered relevant, in view of the fact that in recent years in our country a number of reforms aimed at optimization and modernization have been continuing in our country. This process would not have been possible without the widespread informatization and digitalization. Currently, the Voronezh Regional Clinical Hospital № 1 is introducing electronic document management and specialized computer programs, the study of the effectiveness of which has become the purpose of the work. The objects of the study were 400 patients, men and women, aged 18 to 79 years and their medical history. All patients were divided into 2 groups of 200 people, depending on whether the elements of electronic document management and specialized computer programs were used in their design and in providing them with diagnostic measures (were not used in group 1 and were used in 2). Subsequently, the patients of each group were also subdivided into 2 subgroups, depending on the profile (surgery and therapy). The study was based on the analysis of the time spent on different stages of prehospital care - from the initial examination and filling out the primary documentation by the doctors of the admission department, to the implementation of the main spectrum of laboratory and instrumental diagnostic methods. An interesting feature of the work was the identification of several main stages in each diagnostic procedure, including the stages of "delivery" of the patient to the doctor - diagnostician, as well as the time frame for familiarizing the attending physicians (therapist or surgeon of the admission department or narrow specialists) with the results of the study. The data presented in the article make it possible to judge a significant reduction in the time spent on registration and basic diagnostic procedures due to the introduction of electronic document management. The data obtained in this work are of significant interest both for practicing doctors of various profiles and doctors involved in the development of specialized medical software, and for healthcare organizers