Коморбидность ахалазии пищевода, смешанной тревожной и депрессивной реакции у пациентки молодого возраста: проблемы диагностики и лечения

Achalasia cardia (“cardiospasm”, “phrenospasm”, “dolichoesophagus”, “megaesophagus”, “stenosis of cardia”) represents a primary impairment of esophageal motor function associated with impaired lower esophageal sphincter relaxation and peristalsis defects of the thoracic esophagus. It is diagnosed at the age of 25 to 60 years, making up to 20% of all diseases of the esophagus, and is characterized by a triad of symptoms: dysphagia, regurgitation and chest pain when swallowing. In most cases the first manifestations of achalasia are preceded by stress situations in the anamnesis that complicates the differential diagnosis of psychogenic esophageal spasm. The presented clinical case illustrates difficulties of early diagnosis of achalasia cardia in a young femalepatient with severe anxiety and depressive symptoms which develop under conditions of chronic stressful situations in the family or at work. The issues of interdisciplinary interaction of health professionals (physician, gastroenterologist, psychiatrist, psychotherapist, and surgeon) on the course of examination and management of patients with comorbid physical and mental pathology are discussed. The efficiency of the integrative approach to treatment and rehabilitation with the use of modern reconstructive surgical interventions as well as conservative methods of therapy, psychopharmacotherapy and personality-oriented psychotherapy proves the relevance of studying psychosomatic aspects of achalasia cardia.Ахалазия кардии (кардиоспазм, френоспазм, долихоэзофагус, мегаэзофагус, кардиостеноз) представляет собой первичное нарушение двигательной функции пищевода, связанное с ухудшением расслабления нижнего пищеводного сфинктера и дефектами перистальтики его грудного отдела. Диагностируется в возрасте 25–60 лет, составляя до 20% случаев всех заболеваний пищевода, характеризуется триадой симптомов: дисфагией, регургитацией, загрудинными болями при глотании. В большинстве случаев первым проявлениям ахалазии предшествуют стрессовые ситуации в анамнезе, что затрудняет дифференциальную диагностику с психогенным эзофагоспазмом. Представленный клинический случай иллюстрирует трудности диагностики ахалазии кардиального отдела пищевода у женщины молодого возраста с выраженной тревожной и депрессивной симптоматикой, развившейся в условиях хронической стрессовой ситуации семейного и производственного плана. Обсуждаются вопросы междисциплинарного взаимодействия специалистов (терапевта, гастроэнтеролога, психиатра, психотерапевта, хирурга) по тактике обследования и ведения больной с коморбидной соматической и психической патологией. Эффективность интегративного подхода к лечению и реабилитации с использованием современных реконструктивных хирургических вмешательств, а также консервативных методов терапии, психофармакотерапии, личностно ориентированной психотерапии свидетельствует об актуальности изучения психосоматических аспектов ахалазии кардии

POSSIBILITIES FOR RADIODIAGNOSIS OF TUBERCULOUS SPONDYLITIS

The presented case illustrates the possibilities of complex radiodiagnosis in a patient with tuberculous spondylitis. The specific features of displaying a spinal tuberculous lesion during X-ray study, tomosynthesis, computed tomography, and magnetic resonance imaging are described. A rational algorithm for the examination and treatment of patients with this disease is proposed, by comparing the clinical manifestations of spinal tuberculous lesion and the results of its radiological studies

New roentgen technologies (tomosynthesis) for diagnostics and outcomes evaluation of genital tuberculosis treatment

This article describes the specific primary disorder of small pelvis organs in the female patient with no tuberculosis in her medical history. Use of this roentgen technique for genital tuberculosis detection and assessment of treatment efficacy enhances the effectiveness of diagnostic activities and allows early detection of this pathology thus reducing the risk of complications which is crucial for pregnancy planning given the young age of the patient

ВОЗМОЖНОСТИ ЛУЧЕВОЙ ДИАГНОСТИКИ ТУБЕРКУЛЕЗНОГО СПОНДИЛИТА

The presented case illustrates the possibilities of complex radiodiagnosis in a patient with tuberculous spondylitis. The specific features of displaying a spinal tuberculous lesion during X-ray study, tomosynthesis, computed tomography, and magnetic resonance imaging are described. A rational algorithm for the examination and treatment of patients with this disease is proposed, by comparing the clinical manifestations of spinal tuberculous lesion and the results of its radiological studies.Представленное наблюдение иллюстрирует возможности комплексной лучевой диагностики больного с туберкулезным спондилитом. Описаны особенности отображения туберкулезного поражения позвоночника при рентгеновском исследовании, томосинтезе, компьютерной томографии и магнитно-резонансной томографии. На основании сопоставления клинических проявлений и результатов лучевых методов исследования туберкулезного поражения позвоночника предложен рациональный алгоритм обследования и лечения пациентов с этой патологией

Comorbidity of esophageal achalasia, mixed anxiety and depressive reaction in a young female patient: problems of diagnosis and treatment

Achalasia cardia (“cardiospasm”, “phrenospasm”, “dolichoesophagus”, “megaesophagus”, “stenosis of cardia”) represents a primary impairment of esophageal motor function associated with impaired lower esophageal sphincter relaxation and peristalsis defects of the thoracic esophagus. It is diagnosed at the age of 25 to 60 years, making up to 20% of all diseases of the esophagus, and is characterized by a triad of symptoms: dysphagia, regurgitation and chest pain when swallowing. In most cases the first manifestations of achalasia are preceded by stress situations in the anamnesis that complicates the differential diagnosis of psychogenic esophageal spasm. The presented clinical case illustrates difficulties of early diagnosis of achalasia cardia in a young femalepatient with severe anxiety and depressive symptoms which develop under conditions of chronic stressful situations in the family or at work. The issues of interdisciplinary interaction of health professionals (physician, gastroenterologist, psychiatrist, psychotherapist, and surgeon) on the course of examination and management of patients with comorbid physical and mental pathology are discussed. The efficiency of the integrative approach to treatment and rehabilitation with the use of modern reconstructive surgical interventions as well as conservative methods of therapy, psychopharmacotherapy and personality-oriented psychotherapy proves the relevance of studying psychosomatic aspects of achalasia cardia