Clinical profile of patients with 46 XY disorders of sex development: a single centered experience

Background: XY disorders of sex development are a complex entity that needs medical attention from childhood to adolescence and throughout life. The aim of the study was to analyze retrospectively the medical records of subjects with 46 XY disorders of sex development (DSD) and characterize their clinical profile and management course in a tertiary care centre.Methods: 32 subjects with 46 XY DSD attending Endocrinology OPD / Gynecology between 2010 to 2020 were enrolled in the study. Data collected includes age at presentation, symptoms, sex of rearing, phenotype, external masculinisation score (EMS), karyotyping, gonadal features like location and histopathology, psychosexual domain and their management and follow up. Statistical Analysis: The mean and standard deviation was calculated for normally distributed data.Results: The mean (SD) age of all study subjects (n=32) were 15.5 ± 5.32 years. 46 XY DSD included cases of complete gonadal dysgenesis (n=6), mixed gonadal dysgenesis (n=6), complete androgen biosynthetic defects (n=9), partial gonadal dysgenesis (n=2), 5-alpha-reductase type 2 deficiency (n=8) and 17 betahydroxysteroid deficiency (n=1). The most common clinical presentation was for primary amenorrhea followed by genital ambiguity and virilisation in females. Resection of testis at the earliest or a biopsy of the testis if resection is postponed in a female sex assigned 46 XY DSD is favored. Male sex assigned 46 XY DSD needs corrective surgeries and orchidopexy for undescented viable testis with periodic follow up for testicular malignancy.Conclusions: 46 XY DSD’s may shares similarities in their clinical presentation, though age of presentation may be in a wide range. Proper gender assignment, gonadectomy, reconstructive surgeries, hormone replacement and time to time follow up for testicular malignancy in cases where the testes are preserved is the ideal management

Methods for optical skin clearing in molecular optical imaging in dermatology

This short review describes recent progress in using optical clearing (OC) technique in skin studies. Optical clear-ing is an efficient tool for enhancing the probing depth and data quality in multiphoton microscopy and Raman spec-troscopy. Here, we discuss the main mechanisms of OC, its safety, advantages, and limitations. The data on the OC effect on the skin water content are presented. It was demonstrated that 70% glycerol and 100% OmnipaqueTM 300 reduce the water content in the skin. Both OC agents (OCAs) significantly affect the strongly bound and weakly bound water. However, OmnipaqueTM 300 causes considerably less skin dehydration than glycerol. In addition, the results of examination of the OC effect on autofluorescence in two-photon excitation and background fluorescence in Raman scattering at different skin depths are presented. It is shown that OmnipaqueTM 300 is a promising OCA due to its ability to reduce background fluo-rescence in the upper skin layers. The possibility of multimodal imaging combining optical methods and OC technique is discussed

assessment of blood capillaries and structural proteins localization

The papillary dermis of human skin is responsible for its biomechanical properties and for supply of epidermis with chemicals. Dermis is mainly composed of structural protein molecules, including collagen and elastin, and contains blood capillaries. Connective tissue diseases, as well as cardiovascular complications have manifestations on the molecular level in the papillary dermis (e.g. alteration of collagen I and III content) and in the capillary structure. In this paper we assessed the molecular structure of internal and external regions of skin capillaries using two-photon fluorescence lifetime imaging (FLIM) of endogenous compounds. It was shown that the capillaries are characterized by a fast fluorescence decay, which is originated from red blood cells and blood plasma. Using the second harmonic generation signal, FLIM segmentation was performed, which provided for spatial localization and fluorescence decay parameters distribution of collagen I and elastin in the dermal papillae. It was demonstrated that the lifetime distribution was different for the inner area of dermal papillae around the capillary loop that was suggested to be due to collagen III. Hence, we propose a generalized approach to two-photon imaging of the papillary dermis components, which extends the capabilities of this technique in skin diagnosis

Opisthorchosis papillitis (experimental study)

The study was performed as a part of scientific research of the opisthorchosis papillitis. The aim of the study was to investigate the condition of the biliary tract, particularly the major duodenal papilla with opisthorchosis papillitis and definition of the role of the papillitis in the development of bile hypertension. The study was conducted in 35 mature rabbits, observation lasted 12 months. Clinical, laboratory, microbiological, morphological and output-barometric data were studied in our research. To analyze the materials statistical methods of data processing were used. The obtained facts allowed determine the factors leading to a violation of the throughput of the major duodenal papilla with opisthorchosis lesions of the biliary tract on an evidence level.Работа выполнена в рамках научного исследования описторхозного папиллита. Целью исследования явилось изучение состояния желчевыводящих путей, в частности дуоденального сосочка, на фоне описторхозной инвазии и определение роли папиллита в формировании желчной гипертензии. Исследование проводилось на 35 половозрелых кроликах, наблюдения длились 12 месяцев. В динамике изучены клинические, лабораторные, микробиологические, морфологические и дебито-манометрические данные. При анализе материала применялись статистические методы обработки информации. Полученные факты на доказательном уровне позволили определить факторы, приводящие к нарушению пропускной способности дуоденального сосочка при описторхозном поражении желчных путей

Preparing the upper gastrointestinal tract for an esophagogastroduodenoscopy to identify the source of acute bleeding

Esophagogastroduodenoscopy (EGDS) is the main way to diagnose bleeding from the upper gastrointestinal tract. Diagnostic accuracy of the study depends on the preparation. Aim of the study was to evaluate the preparation of the upper parts of the digestive tract in case of esophagogastroduodenal bleeding. Material and methods. The retrospective analysis of 2570 case histories was carried out. Gastric lavage through nasogastric tube was carried out in the main group (1299 patients). Preparation for the primary EGDS was not carried out in the control group (1271 patients). A comparison of the number of EGDS performed and the detection of the bleeding source in the control and the main groups as well as the period of investigation up to the detection of the bleeding source were performed. Results. EGDS without preparation of the upper gastrointestinal tract in case of acute bleeding and determination of the diagnosis is possible in 85,6 % of patients. Preparation of the upper gastrointestinal tract for EGDS prolongs the study period by 30–60 minutes, but allows establishing the diagnosis in 93.7 % of cases that is by 8.1 % more than without preparation

Medical algorithm for patients with non-parasitic hepatic cysts

The article assesses the value of diagnostic methods for patients with non-parasitic hepatic cysts, justifies the tactics of patient management based on the results of the immediate postoperative period. Materials and methods: an analysis of the observation and treatment of 64 patients with non-parasitic liver cysts is presented, the immediate results of surgical treatment are reflected. Results: Ultasound investigation is noninvasive procedure with high value of diagnostic possibility. The use of laparoscopic operations reduces the time of treatment in the hospital, minimizing the value of complications. External drainage reduces the number of postoperative complications and the duration of treatment of the patients with infectious complications of non-parasitic hepatic cysts. Conclusions: the optimal method for diagnosing this pathology is CT. The use of external drainage of nonparasitic hepatic cysts under the control of medical imaging methods is preferable in the presence of infectious complications. Endovideosurgical treatment of non-parasitic hepatic cysts has the least number of postoperative complications. Open operations remain relevant in the presence of difficulties in the differential diagnosis.В статье проведена оценка диагностической значимости методов обследования пациентов при непаразитарных кистах печени, обоснована тактика ведения пациентов на основании оценки результатов ближайшего послеоперационного периода. Материалы и методы: представлен анализ наблюдения и лечения 64 пациентов с непаразитарными кистами печени, отражены непосредственные результаты хирургического лечения. результаты: УЗИ имеет высокие показатели диагностической значимости и является неинвазивным. Применение лапароскопических операций сокращает сроки лечения в стационаре, сводя к минимуму количество осложнений. При наличии инфекционных осложнений кист печени наружное дренирование сокращает количество послеоперационных осложнений и сроки стационарного лечения. Выводы: оптимальным методом диагностики данной патологии является КТ. Использование наружного дренирования непаразитарных кист печени под контролем методов медицинской визуализации предпочтительнее при наличии инфекционных осложнений кист. Эндовидеохирургический метод лечения непаразитарных кист печени имеет наименьшее количество послеоперационных осложнений. Открытые операции остаются актуальными при наличии сложностей в дифференциальной диагностике

Modern management of acute non-variceal upper gastrointestinal bleeding

Acute, non-varicose bleeding from the upper gastrointestinal tract remains a common clinical problem. Bleeding episodes are associated with high mortality and a significant economic burden on the health care system. Despite the continuing improvement in endoscopic treatment, recurrent bleeding and associated mortality are still a pressing issue. In addition to the well-established modalities of endoscopic hemostasis: injection, thermal, mechanical, used both as mono therapy and as part of a combination therapy, the review discusses the use of novel types of endoscopic devices. The results of the use of over-the-scope clips, coagrasper, hemostatic sprays, endoscopic angiography, radiofrequency ablation, cryotherapy and endoscopic suturing device are described. The technical aspects of their application, the issues of efficacy and safety, the advantages and limitations of methods for achieving final endoscopic hemostasis are considered. The methods of initial assessment and treatment strategies for recurrent bleeding and unsuccessful endoscopic hemostasis were also analyzed. Material and methods. Literature search was carried out using the following electronic information resources: CyberLeninka, PubMed, Nature Pathology, MEDLINE, PLoS ONE. Results. Сombined endoscopic hemostasis is a standard therapy in the treatment of gastrointestinal tract cerebral infections with an efficiency of 95-98 %, new modalities of endoscopic hemostasis are able, in some cases, to achieve final endoscopic hemostasis both in primary endoscopic treatment and in recurrent bleeding

In vivo non-invasive staining-free visualization of dermal mast cells in healthy, allergy and mastocytosis humans using two-photon fluorescence lifetime imaging

Mast cells (MCs) are multifunctional cells of the immune system and are found in skin and all major tissues of the body. They contribute to the pathology of several diseases including urticaria, psoriasis, atopic dermatitis and mastocytosis where they are increased at lesional sites. Histomorphometric analysis of skin biopsies serves as a routine method for the assessment of MC numbers and their activation status, which comes with major limitations. As of now, non-invasive techniques to study MCs in vivo are not available. Here, we describe a label-free imaging technique to visualize MCs and their activation status in the human papillary dermis in vivo. This technique uses two-photon excited fluorescence lifetime imaging (TPE-FLIM) signatures, which are different for MCs and other dermal components. TPE-FLIM allows for the visualization and quantification of dermal MCs in healthy subjects and patients with skin diseases. Moreover, TPE-FLIM can differentiate between two MC populations in the papillary dermis in vivo—resting and activated MCs with a sensitivity of 0.81 and 0.87 and a specificity of 0.85 and 0.84, respectively. Results obtained on healthy volunteers and allergy and mastocytosis patients indicate the existence of other MC subpopulations within known resting and activated MC populations. The developed method may become an important tool for non-invasive in vivo diagnostics and therapy control in dermatology and immunology, which will help to better understand pathomechanisms involving MC accumulation, activation and degranulation and to characterize the effects of therapies that target MCs

Structural features of phlegmon of the maxillofacial region from inhabitants of Khanty – Mansiysk Autonomous Okrug

Phlegmon of the maxillofacial region in the Khanty – Mansiysk Autonomous Region is one of the main pathologies of the oral and maxillofacial surgery, accounting for 4.3% of the hospitalized in the Department of oral and maxillofacial surgery (maxillofacial surgery). On the basis of a complete retrospective examination, the results of treatment of 171 patients were analyzed, it was found that the age group of 21-40 years (58.5 0%), male (67.8%) prevails. The main etiological factor is odontogenic causes (76.6%). Among the diseases that form the premorbid background, the presence of HIV infection (4.7%) and diabetes mellitus (4.1%) was noted. Surgical intervention in combination with antibacterial therapy and complex postoperative management of purulent wound allows to achieve satisfactory immediate results of treatment, to exclude lethal outcomes and to reduce the average duration of hospital treatment to 9,0 + 1,3 days.Флегмоны челюстно-лицевой области в ХМао на сегодня являются одной из основных патологий челюстно-лицевой хирургии, составляя 4,3% от госпитализированных в отделение челюстно-лицевой хирургии (ЧЛХ). На основе сплошного ретроспективного обследования проанализированы результаты лечения 171 больного, установили, что преобладает возрастная группа 21 - 40 лет (58,5 0%), мужской пол (67,8%). основным этиологическим фактором являются одонтогенные причины (76,6%). Среди заболеваний, формирующих преморбидный фон отмечено наличие ВИЧ инфекции (у 4,7%) и сахарного диабета (у 4,1%). Хирургическое вмешательство в сочетании с антибактериальной терапией и комплексным послеоперационным ведением гнойной раны позволяет добиться удовлетворительных ближайших результатов лечения, исключить летальные исходы и сократить среднюю длительность стационарного лечения до 9,0 + 1,3 койко-дня

Curative and diagnostic algorithm at non-parasitic liver cysts

There are presented the results of examination and treatment of 64 patients with non-parasitic liver cysts. Based on complete examination and treatment of patients with non-parasitic liver cysts the personalized surgical tactic was developed. The treatment of non-parasitic liver cysts is defined according to its sizes. The patients' follow up occurred when the cysts were small. Currently the main indication to a laparotomy is the bile impurity or a bleeding in a cyst cavity. The puncture under the US-control is the operation of the choice in the presence of cysts abscessing and available localization of a cyst of the average size. Laparoscopy is more preferable in patients with cysts sizes more than 10 cm in diameter and its localization in available liver segments and one of the cysts wall is located on the liver surface.Представлены результаты обследования и лечения 64 пациентов с непаразитарными кистами печени. На основании комплексного клинического обследования и лечения больных с непаразитарными кистами печени разработана индивидуализированная хирургическая тактика. При непаразитарных кистах печени лечебная тактика определяется на основании их размеров. При малых кистах проводили динамическое наблюдение. На настоящий момент основным показанием к лапаротомии служит наличие примеси желчи или кровотечение в полость кисты. Пункция под контролем УЗИ является операцией выбора при наличии абсцедирования кисты и доступной локализации кисты среднего размера. Лапароскопическая операция предпочтительнее при размерах кисты более 10 см с её расположением в доступных сегментах печени, выходящей одной из стенок на поверхность печени