Asthenia and fatigue in hyperammonemia: etiopathogenesis and methods of correction

Asthenia and fatigue are the most common syndromes in patients with liver disease, which significantly affects their quality of life. The prevalence of fatigue in chronic liver diseases is from 50% to 85%. While some progress has been made in understanding the processes that can cause fatigue in general, the underlying causes of fatigue associated with liver disease remain not well understood. In particular, many data suggest that fatigue associated with liver disease likely results from changes in neurotransmission in the brain against the background of hyperammonemia. Hyperammonemia is a metabolic state characterized by an increased level of ammonia, a nitrogen-containing compound. The present review describes hyperammonemia, which is likely important in the pathogenesis of fatigue associated with liver disease. Ammonia is a potent neurotoxin, its elevated blood levels can cause neurological signs and symptoms that can be acute or chronic, depending on the underlying pathology. Hyperammonemia should be recognized early, and immediately treated to prevent the development of life-threatening complications, such as, swelling of the brain and coma. The article gives pathophysiological mechanisms of influence of hyperammonemia on state of psychovegetative status of patients with liver diseases, also lists basic principles of treatment. A significant part of the article is devoted to L-ornithine-L-aspartate, which is effective in asthenia and fatigue to reduce the level of hyperammonemia through a variety of well-studied mechanisms in chronic liver diseases.

An Overvıew of Lower Gastroıntestınal Bleedıng ın Infants and Toddlers: A Revıew Artıcle

Lower gastrointestinal bleeding (LGIB) in infants and toddlers is commonly encountered in clinical practice. There are several factors producing LGIB in these children and are usually managed with regard to the underlying pathology that produces LGIB. Although majority of these bleeding episodes is self limited, certain infants and toddlers with LGIB may necessitate prompt management including urgent surgical intervention. In this review article it is aimed to review the etiology, epidemiology, clinical manifestations and principles of treatment of LGIB in infants and toddlers under the light of relevant literature.

Etıology and Management of Lower Gastroıntestınal Bleedıng ın Neonates: A Revıew Artıcle

Lower gastrointestinal bleeding (LGIB) in neonates is occasionally encountered in clinical practice. There are various causative factors prodicing LGIB in neonates and the babies are usually managed with regard to the underlying pathology that produces LGIB. Although majority of these bleeding episodes is self limited, certain neonates with LGIB may necessitate prompt management including urgent surgical intervention. In this review article it is aimed to review the etiology, epidemiology, clinical manifestations and principles of treatment of LGIB in neonates under the light of relevant literature.

Principles of Treatment of Patients with Diabetic Polyneuropathy in the COVID-19 Pandemic

Patients with COVID-19 may develop various neurological disorders of the central and peripheral nervous systems. It is known that diabetes mellitus (DM) type 1 or 2, cardiovascular diseases, obesity, old age and old age, male gender are risk factors for a severe course and complications of COVID-19. Currently, the COVID-19 pandemic is ongoing, and patients with the listed risk factors are recommended to follow a regime of social restriction or self-isolation. Outpatient treatment is most appropriate for this category of patients. Patients with diabetes who have undergone COVID-19 are at risk of developing or progressing diabetic polyneuropathy (DPN). It seems relevant to develop the principles of effective treatment of patients with DM and DPN in outpatient settings. Glycemic level correction, diet, weight normalization, therapy of combined cardiovascular diseases, an increase of physical activity, sleep normalization, maintenance of normal psychological state are the main principles of treatment of patients with DM and DPN in COVID-19 pandemic conditions. Pathogenetic therapy of DPN continues to be discussed, in our country the preparations of B vitamins, alpha-lipoic acid are widely used. B-group vitamin preparations can be used in the form of tablets or solutions for intramuscular injections. The effectiveness of B vitamins (B1, B6, B12) in the treatment of a severe course of COVID- 19, prevention of complications of COVID-19, especially in elderly patients and with diabetes is discussed.

A Consensus Meeting on Expert Recommendations on Operating Specifications for Laparoscopic Radical Resection of Hilar Cholangiocarcinoma

Background: With advances in techniques and technologies, laparoscopic radical resection of hilar cholangiocarcinoma (HCCA) has gradually been carried out in major medical centers in China. Its feasibility and safety have been accepted by a group of Chinese surgical experts.Methods: To standardize perioperative management of HCCA by using laparoscopic resectional approach, to ensure safety of the patient with standardized management, improve prognosis of the patient, and enable proper application and refinement of this surgical approach, the expert group on specifications for laparoscopic radical resection of HCCA in China organized a consensus meeting.Results: Laparoscopic radical resection of HCCA is difficult and associated with high risks. Appropriate patients should be carefully selected and this surgical approach should be promoted gradually. The experts met and arrived at 16 recommendations on perioperative management of HCCA by using laparoscopic surgery. There were three recommendations on preoperative diagnosis and evaluation; one recommendation on surgical principles of treatment; one recommendation on indications and contraindications; one recommendation on credentialing, staffing, and equipment; nine recommendations on laparoscopic techniques in different stages of operation; and one recommendation on indications for conversion to open surgery.Conclusion: Laparoscopic surgery for HCCA is still in the early phase of development. This consensus provides a clinical reference with the aim to promote and to facilitate its further development.

Differential diagnosis of tension headache and basic principles of treatment

Headache (cephalalgia) is one of the most common symptoms and is a manifestation of more than 50 diseases. According to the World Health Organization, at least one episode of headache during a lifetime has occurred in almost every inhabitant of the Earth, and about half of them noted periodic headaches. In its etiology, cephalalgia can be primary, not associated with organic damage to tissues and organs, and secondary, which is based on pathological changes. In particular, cephalalgia in inflammatory lesions of the paranasal sinuses, brain tumors, encephalitis and meningitis, acute cerebrovascular accident, head trauma, arterial hypertension, aneurysm of the cerebral vessels, etc., should be attributed to the secondary headache. In 95–97 % of cases, the headache is not based on organic lesion, and in this case, the headache is primary. Primary cephalalgia can be based on both vegetative-vascular and metabolic-destructive changes. Primary headache can be noted with emotional or physical overstrain, exposure to a number of light, sound or olfactory stimuli, liquorodynamic or dysmetabolic disorders, when taking certain medications. Conventionally, primary headache can be divided into three groups — tension headache, migraine and cluster headache.

Modern Methods of Treatment for Proximal Ureterolithiasis

Urolithiasis is a disease characterized by the formation of stones in the urinary tract. According to statistics, SCC causes about 30% of hospitalizations in the urology department. Treatment of SCC is divided into conservative and operative. The choice of method depends on age, clinical course of the disease, general condition of the patient, anatomical and functional condition of the kidneys and the size of the localization of the calculus. Methods of treatment of SC have changed significantly in recent years. Due to the technical achievements of the method of open ureterolithotomy, which was once the standard method of treatment of so-called «complicated» concretions of the ureter, evolved into a laparoscopic ureterolithotomy, and with the advent of ultrasonic and laser lithotriptors – began the newest era of minimally invasive urology– extracorporeal shock-wave lithotripsy and endourology: antegrade percutaneous ureterolithotripsy, retrograde ureteroscopic lithotripsy and flexible retrograde uretherolithotripsy (FURS). The purpose of the work – on the basis of scientific literature to assess the effectiveness, safety and profitability of modern methods of surgical treatment for proximal ureterolithiasis. During the scientific research, attention was paid to the following parameters: stone free rate (SFR), postoperative pain level, need for painkillers, number of postoperative bed-days, presence of postoperative fever, hemoglobin level, need for blood transfusion, and on the economic component during the implementation of a technique. The principles of treatment of patients with large proximal ureterolithiasis are described in the clinical guidelines of the European and American Associations of Urologists. However, for example, which of the 3 proposed methods of treatment of large proximal ureterolithiasis to choose – there is no consensus from the world urological community. Percutaneous antegrade ureterolithotripsy is the preferred method of choice in patients with large proximal ureteral stones that cannot be removed by contact or extracorporeal ureterolithotripsy, characterized by a high level of absence of stones and minimal complications, optimal post operative and high indicators of economic attractiveness of this technique.

Ruixia Pei’s Experience in the Treatment of Hypothyroidism

This study is to summarize Professor Pei’s experience in treating hypothyroidism. Professor Pei has been engaged in clinical endocrinology for more than 30 years and has unique insights into hypothyroidism. She believes that the disease is caused by liver depression, phlegm binding, yin deficiency, and fire effulgence. The basic principles of treatment are regulating Qi movement and harmonizing viscera. During treatment, the emphasis is on the influence of emotions on the disease. Both the liver and spleen should be given equal attention and the medication should be mild with balanced cold and heat.

Replantation fingertip without venous anastomoses in children

Objective. Traumatic complete and partial finger amputations are rare in comparison with adults. There are significant differences between mechanism of trauma, principles of treatment children with this type of injury in comparison with adults.Clinical case. A 15-years old child suffered from injury by axe, which caused the traumatic fingertip amputation of III and IV digits of his right hand. Replantation of both amputated parts was performed. Arteries and nerves were repaired with no veins anastomosed. As a result - survival of replanted parts.Discussion. A submillimeter diameter of vessels and potential venous congestion are basic problems that a surgeon deal with when perform the replantation of fingertips. Respectively, a difficulty in post-operative care of patient appears.Conclusion. Replantation of amputated part of finger is a golden standard of treatment of children with a described type of injury. The correct deliverance of amputated parts, the shortest time of ischemia as possible, a qualitive operation and post-operative care play an important role in successful survival of the replanted segments.