THE CASE OF COMBINATION OF MULTIPLE ENDOCRINE NEOPLASIA SYNDROME (MEN SYNDROME) AND ASPERGILOMA (CLINICAL OBSERVATION)

The clinical case of staged surgical treatment of multiple endocrine neoplasia and aspergilloma syndrome in a 21-year-old patient is presented. The patient was admitted to NIFP with the diagnosis: adrenocorticotropic hormone-producing tumor of the anterior mediastinum; diabetes mellitus, insulin dependent; secondary hypothyroidism; shingles; cavitary lesion of the upper lobe of the left lung, the lesion of the upper lobe of the right lung; hirsutism, edema syndrome. At the first stage, the patient underwent a sternotomy with removal of the tumor of the anterior mediastinum with adipose tissue and mediastinal lymph dissection, removal of the tumor of S3 of the right lung. At discharge, the patient was recommended to returm to NIFP in 2 months for elective surgery for aspergilloma of the upper left lung. But one month after discharge, the patient developed hemoptysis. She underwent a video-assisted typical resection of S1-S2 of the left lung. Removal of hormone-producing tumors allowed to normalize glycemia, discontinue insulin, normalize thyroid function and lead to regression of hirsutism and osteoporosis, restored muscle strength and normalized water-electrolyte balance. Key words: multiple endocrine neoplasia syndrome, aspergilloma, surgical treatment.

MODERN METHODS OF ETIOLOGICAL DIAGNOSING OF ACUTE COMMUNITY-ACQUIRED LOWER RESPIRATORY TRACT INFECTIONS

MODERN METHODS OF ETIOLOGICAL DIAGNOSING OF ACUTE COMMUNITY-ACQUIRED LOWER RESPIRATORY TRACT INFECTIONS O. L. Bororova, Y. O. Dziublyk, V.A. Iachnyk Abstract The review presents the possibilities presented by various methods of etiological diagnostics used in pulmonology. The main method of diagnosing acute community-aquired lower respiratory tract infections is the microbiological approach which includes microscopy of patient’s material with Gram staining, cultures on nutrient media, isolation of culture, identification and determination of susceptibility of a microorganism to antibiotics. But unfortunately the etiologocal factor cannot be detected in about half of patients. Recently, the popularity of molecular methods of etiological diagnosis has grown. They are characterized by greater sensitivity to microbiological methods and allow to get results faster. Molecular diagnostic tests are divided into four categories depending on the mechanism based on them: immunoassay, hybridization methods, amplification and sequencing methods. Among the tests based on the principles of immunoassay, noteworthy are rapid tests, which are most consistent with the idea of an ideal diagnostic tool in the field of laboratory medicine. They are fast, simple, cheap, highly sensitive and highly specific. However, as the appearance of specific antibodies in the body takes some time, the results of tests based on immunoassay remain positive for several weeks after the delayed episode of acute community-acquired lower respiratory tract infection, so they have diagnostic value only in the presence of clinical manifestations of the disease. The genetic approach allows the detection of infectious agents in the early stages of the disease, when serological and immunological methods are ineffective. Tests based on nucleic acid amplification, including PCR, have also become increasingly common recently. These methods should be used for the diagnosis of atypical pathogens and respiratory viruses, because their cultivation in culture is difficult. Sequencing and mass spectrometry methods are being actively developed, but there are limitations that prevent their use in everyday clinical practice. So the combination of microbiological approach with molecular diagnostic methods is the most optimal for the identification of the causative agent of acute community-acquired lower respiratory tract infections and the use of targeted etiotropic treatment. Key words: acute community-acquired lower respiratory tract infections, etiological diagnosis, microbiological, serological, immunological, molecular genetic methods, ICA, PCR, sequencing, mass spectrometry. Ukr. Pulmonol. J. 2021;29(3):58–65

SITUATION WITH THE RELAPSES OF TUBERCULOSIS IN DIFFERENT COUNTRIES OF THE WORLD

Pulmonary tuberculosis relapses (RTB) is an actual problem in the different countries of the world. As evidenced by different foreign authors the epidemic situation with tuberculosis (�B) and its relapses at the beginning of the XXI century remains tense in the world. The characteristics of RTB as a mirror reflect the weak links in realization of anti-tuberculosis measures. Doubtlessly, the cohort of RTB patients keeps TB morbidity and mortality indices high. Treatment failure in a result of low compliance is considered the main factor of high prevalence of RTB. Published results of clinical trials aimed on improvement of diagnostics and treatment indirectly demonstrate some reasons of RTB development after completion of chemotherapy and after surgical treatment of patients. Majority of authors offer separate measures for the improvement of diagnosis, detection and treatment of the patients with R�B. Until now there is neither systematized view on the reasons of nor accepted approaches to RTB prevention. Keywords: pulmonary tuberculosis, relapses, detection, treatment, anti-tuberculosis measures

ASTHMA AS A MASK OF ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS: DIAGNOSIS AND TREATMENT

ASTHMA AS A MASK OF ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS: DIAGNOSIS AND TREATMENT O. M. Rekalova Abstract Asthma is a heterogeneous diseases with multiple phenotypes, 5–10 % of which are associated with severe course of disease, resistant to standard therapy. Allergic bronchopulmonary aspergillosis (ABPA), being a separate disease (ICD-10: B44.9 — aspergillosis unspecified), may mimic asthma. A literature review of major statements regarding ABPA, focusing on definition, pathogenesis, diagnostic criteria, association of different forms of asthma with fungal sensitization and Th2-response, stage, radiological picture, diagnostic algorithm in asthma and cystic fibrosis, characteristics of major applicable lab tests, principles and algorithm of treatment of ABPA patients, and treatment prospects. Lung radiological data using computer modeling from patient with ABPA (clinical case) has been presented as an illustration. Key words: allergic bronchopulmonary aspergillosis (ABPA), asthma, diagnosis, treatment. Ukr. P

FEATURES OF RESISTANCE TO HYPOXIA IN ELDERLY PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE

FEATURES OF RESISTANCE TO HYPOXIA IN ELDERLY PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE E. O. Asanov, Yu. I. Golubova, I. A. Dyba, S. O. Asanova Abstract Aim: to study the features of resistance to hypoxia in elderly patients with COPD. Material and methods. We examined 46 elderly patients with COPD and 18 apparently healthy elderly people. Hypoxia resistance was determined by performing a hypoxic test with inhalation of 12 % O2 for 20 minutes. The state of ventilation and blood saturation were assessed. Results. Hypoxia caused the reduction of SpO2 and the development of arterial hypoxemia in elderly patients with COPD, which were more significant than in healthy elderly people. It was found that among elderly patients with COPD and healthy elderly subjects there were people with preserved and reduced resistance to hypoxia. However, reduced resistance to hypoxia was much more common in elderly patients with COPD. Decreased resistance to hypoxia in elderly patients with COPD was associated with the degree of bronchial obstruction: deterioration of bronchial passability led to reduced resistance to hypoxia. Elderly patients with COPD with reduced resistance to hypoxia had a decrease in the ΔVE/ ΔSpO2 ratio and a slow ventilation response to hypoxic exposure. Conclusions. Among healthy elderly people and elderly patients with COPD there were subjects with reduced and preserved resistance to hypoxia. Decreased resistance to hypoxia was much more common in elderly patients with COPD. Decreased resistance to hypoxia was more common in patients with moderate than mild bronchial obstruction. Elderly patients with COPD with reduced resistance to hypoxia had reduced ventilation response to hypoxia and chemoreflex sensitivity. Key words: COPD, older age, resistance to hypoxia, ventilation, saturation. Ukr. Pulmonol. J. 2021;29(3):36–40:

CASE OF THORACIC ACTINOMYCOSIS IN A CHILD

A. Rechkina, N. V. Promskaya, I. V. Liskina, O. M. Kravtsova Abstract The article presents a rare clinical case of a complex way of diagnosis and treatment of thoracic actinomycosis with lung and chest soft tissues lesions in 12 years old child. About six months passed from the time of the first complaints until the final clinical diagnosis was made. This delay led to significant destructive changes in the lungs and adjacent soft tissues. During this time, the child went through all stages of health care. Differential diagnosis with lung neoplasm was performed. The diagnosis was verified by histological and immunohistochemical studies. The biopsy material revealed separately rounded dense clusters of fungi, which morphologically most corresponded to actinomycetes. The treatment consisted of two stages (inpatient and outpatient), which lasted more than three months. Significant clinical and radiological improvement has been achieved. The child continues treatment on an outpatient basis under the regular supervision of a pulmonologist. Key words: thoracic actinomycosis, diagnosis, treatment, children. Ukr. Pulmonol. J. 2021;29(3):48–52.