THE ROLE OF THE INSTUMENTAL EXAMINATIONS IN DIAGNOSTICS AND STAGING OF LOCALY DISTRIBUTED STOMACH CANCER

Objective. Improvement of algorithm of diagnostics of patients with complicated stomach cancer. Materials and methods. It was shown the analysis of results of surgical treatment of 418 patients with complicated stomach cancer, which got the hospital treatment at GI “V.T. Zaycev Institute of General and Urgent Surgery of NAMS of Ukraine “ from 2010 till 2019, aged 29 till 76. Results. Patiens were examinated with using of combination of instrumental methods. Goal is total detal examination of pathologic process. SCT has precission of 95-97 % at detecting of cancer, definition of stage – 77-80 %. Endoscopy allows to define the location, spreading of process, to find a pathologic process at starting and precancer stages. There no any ideal oncomarker. Diagnostic precission of CA 72-4 is 28-80 % (40-46 % on the average). According to international guides [7], all patients were performed the diagnostic laparoscopy with researching of washout liquids of abdomen in uncertain cases. Conclusion. Only complex examination of patients with stomach cancer with using combination of SCT of abdomen, FEGDS with biopsy, laparoscopy can provide total volum of examination, staging and surgical aid.

The bright side of fibroblasts: molecular signature and regenerative cues in major organs

Fibrosis is a pathologic process characterized by the replacement of parenchymal tissue by large amounts of extracellular matrix, which may lead to organ dysfunction and even death. Fibroblasts are classically associated to fibrosis and tissue repair, and seldom to regeneration. However, accumulating evidence supports a pro-regenerative role of fibroblasts in different organs. While some organs rely on fibroblasts for maintaining stem cell niches, others depend on fibroblast activity, particularly on secreted molecules that promote cell adhesion, migration, and proliferation, to guide the regenerative process. Herein we provide an up-to-date overview of fibroblast-derived regenerative signaling across different organs and discuss how this capacity may become compromised with aging. We further introduce a new paradigm for regenerative therapies based on reverting adult fibroblasts to a fetal/neonatal-like phenotype.

Gastrointestinal Bleeding

Gastrointestinal bleeding occurs when a pathologic process such as ulceration, inflammation, or neoplasia leads to erosion of a blood vessel. Bleeding can occur in the upper gastrointestinal tract (50%) or the lower gastrointestinal tract (40%) or may be obscure (10%), meaning that no definitive source is identified. Gastrointestinal bleeding is common, with major bleeding leading to 1 million hospitalizations every year in the United States. This review details the pathophysiology of gastrointestinal bleeding and the stabilization and assessment, diagnosis, treatment, and disposition and outcomes of patients with gastrointestinal bleeding. Situations requiring special consideration are also discussed. Figures show how gastrointestinal bleeding occurs when a pathologic process causes erosion of the mucosa and exposes a submucosal blood vessel; an ulcer with a raised, red, variceal spot; a Mallory-Weiss tear; the formation of varices; vascular ectasia; treatment of esophageal varices with balloon tamponade; and a wireless capsule. Tables list the major causes of gastrointestinal bleeding, terms relating to gastrointestinal bleeding and their definitions, Blatchford score, substances that interfere with occult blood testing, clinical factors differentiating gastrointestinal bleeding placed in descending order of likelihood ratio, and a summary of American College of Radiology recommendations for angiography in nonvariceal gastrointestinal bleeding. This review contains 8 figures, 15 tables, and 107 references. Key Words: gastrointestinal bleeding, inflammation, occult blood testing, UGIB, LGIB, Blatchford score, angiography, wireless capsule endoscopy (WCE)

Small bowel intussusception in marijuana users

Intussusception occurs when one portion of bowel ‘telescopes’ into another due to a lead point created by a range of benign or pathologic process. Intussusception mostly occurs in children. Although adult intussusception (AI) is rare, accounting for <5% of intestinal obstructions, it is more concerning in adults as malignancy accounts for nearly 65% of lead points in AI. Patients present with severe abdominal pain concerning for an acute abdomen along with a degree of bowel obstruction. We have experienced a total of 11 patients within recent years presenting with symptoms of an acute abdomen due to AI. None of these patients were found to have a pathologic process creating a lead point. However, we found that all of them were marijuana users. In this report, we compare their management, hospital course and review of the literature discussing proposed mechanisms that suggest an association between cannabis and intussusception.

Erythema multiforme complicated with lichenoid mucositis: A case report

Erythema multiforme (EM) is an acute, self-limiting, mucocutaneous disease. While the histopathologic and immunopathologic feature of EM is not highly specific, the diagnosis is mainly based on the etiology and clinical manifestations. This report presented a patient whose clinical investigation indicated EM while histopathology suggested lichenoid mucositis. Considering the classic oral and skin presentation matching EM, as well as the acute onsite and spontaneous resolution of the lesions, the diagnosis highly favored EM. The immunofluorescent findings might suggest a potential common pathologic process on EM and lichenoid mucositis, which requires further investigation.

Foreign Body Retrograde Migration to the Intraglandular Duct of the Submandibular Gland with a Developing of Foreign Body-induced Sialolithiasis: Analysis of Ultrasonography, Surgery, and Literature Published during Last 124 Years

We present a unique case of a vegetal foreign body retrograde migration to the intraglandular duct of the submandibular gland with a developing of foreign body-induced sialolithiasis in a 61-year-old woman. Analysis of ultrasound examination and operation are performed. Our foreign body`s case represents an intermediate stage of complete sialolith formation around the foreign body nidus (synonym: scaffold). The paper summarizes the analysis of 28 cases with foreign body-induced sialoliths (27 cases from literature and a case of our team). Literature review which was based on the studies published during the last 124 years gave a possibility to classify the development of the ‘foreign body-induced sialolithiasis’ in 4 consecutive stages. Our case of the foreign body-induced sialolithiasis represents a second stage of this pathologic process when nidus is partially covered by calcifications.

Osteonecrosis of Bilateral Mandibular Tori After Direct Laryngoscopy

A 36-year-old man underwent direct laryngoscopy with routine general anesthesia for a knee procedure. Several days later, he experienced pain involving an ulceration along the medial aspect of the right mandible in the floor of the mouth. This evolved to a painful bony mass, and subsequently, a bony sequestrum was spontaneously shed. The initially misdiagnosed pathologic process occurred several more times on both sides of the mouth. A computed tomography scan eventually revealed large bilateral mandibular tori, a feature that likely predisposed the patient to this course of events. Pain in the floor of the mouth after airway manipulation should be carefully evaluated and the possibility of osteonecrosis considered.

Is manipulation under anaesthesia still a better option than intra articular steroid injection in primary frozen shoulder?

<p class="abstract"><strong>Background:</strong> Frozen shoulder, also known as adhesive capsulitis, is a common cause of a painful shoulder with restricted motion. The best treatment of frozen shoulder is prevention (secondary frozen shoulder), but early intervention is paramount; a good understanding of the pathologic process by the patient and the physician also is important. The aim of study is comparison between closed manipulation under anaesthesia and intra articular steroid injection in primary periarthritis shoulder.</p><p class="abstract"><strong>Methods:</strong> 30 patients each with primary frozen shoulder who were treated either with closed manipulation under anaesthesia and intra articular steroid injection. The patient is reassessed after 2 weeks, 1 month, 3 month and 6 months using shoulder pain and disability index (SPADI) and visual analogue scales (VAS) to compare the groups.<strong></strong></p><p class="abstract"><strong>Results:</strong> The SPADI index found to be better with patients under went closed manipulation under anaesthesia than intra articular steroid injection in the first 2 weeks. Follow up shows 1^st group shows better outcome than 2^nd group at 1 month, but later on 3 months and 6 months shows comparable results. VAS score shows initial period of improvement in pain with steroid injection (2^nd group). Final follow up shows better pain relief with manipulation under anaesthesia group.</p><p class="abstract"><strong>Conclusions:</strong> The immediate treatment outcome is better with patients with primary frozen shoulder underwent closed manipulation under anaesthesia although following months outcome shows almost equal effectiveness with steroid injection.</p>