Severe Diverticulitis Associated to <i>Clostridioides difficile</i> Infection in a 91 Year Old Patient (Clinical Case)

Aim. To present a clinical case of a 91-year-old patient with a severe course of diverticulitis combined with the development of Clostridioides difficile-associated disease.Key points. On admission the patient complained of pain in the left iliac region, increased body temperature, constipation and bloating. The medical history showed that constipation increased on the background of prolonged bed rest and discontinuation of psyllium. According to the laboratory and instrumental examinations, the patient had signs of acute diverticulitis, antibacterial therapy was corrected twice, positive dynamics of the condition was noted. However, a few days later, the patient developed a clinic of C. difficile-associated disease, which required the prescription of anticlostridial therapy (vancomycin), until the laboratory confirmation of the accession of this infection was obtained. Combined therapy of exacerbation of diverticular disease and C. difficile-associated disease made it possible to achieve a steady improvement of the condition.Conclusion. The exclusion of possible development of C. difficile-associated disease on the background or prior antibiotic therapy is an important condition for correct and adequate management of a patient with exacerbation of diverticular disease. If the patient develops a clinical picture of C. difficile-associated disease, treatment may be initiated before laboratory confirmation

Asymptomatic Post-Traumatic Rupture of the Right Diaphragm Dome

Aim.  This paper is aimed at presenting the materials of clinical observations associated with diagnosing rare-occurring ruptures of the right dome of the diaphragm that have been overlooked for a long period.Results.  A 61-year-old man was admitted to hospital with a diagnosis of chronic heart failure. Chest radiograph revealed a high position of the right dome of the diaphragm. Computed tomography revealed a defect in the central parts of the diaphragm on the right, the liver was rotated outward with its visceral surface deployed anteriorly and upward. In the right thoracic cavity, anterior to the liver, were the loops of the intestine and the outlet of the stomach.More than 30 years before, the patient had experienced an explosive trauma, which might have caused a rupture in the right dome of the diaphragm. A 70-year-old man, a smoker with a ten-year history of hypertension, was hospitalized with an increase in dyspnea, a cough with the discharge of purulent sputum, the feeling of heaviness behind the sternum. Chest radiograph revealed a high standing of the right dome of the diaphragm at the level of 3rd rib with a decrease in the volume of the right lung, and an increase in cardiac silhouette (cardiothoracic index 0.64). Computed tomography revealed a high standing of the right dome of the diaphragm as well as the compression of the middle and lower lobe of the right lung with the presence of compression atelectasis. The liver was rotated, displaced into the right thoracic cavity, the deformation of the inferior vena cava to the right was visualized due to the displacement and rotation of the liver. The consolidated fractures of 10th–12th ribs on the right were visualized. The patient had had a chest injury resulting from a traffic accident about 15 years before, with no X-ray examination having been conducted at that time.Conclusion.  In the case of left-sided diaphragm ruptures, which are much more frequent than the right-sided ones, the stomach, large and small intestines as well as spleen are displaced into the thoracic cavity. In the case of rightsided diaphragm ruptures, the liver and gallbladder are displaced into the thoracic cavity. Right-sided posttraumatic diaphragmatic hernias that are not diagnosed at the time of injury or trauma and continue to be asymptomatic for a number of years are very rare. The sensitivity and specificity of computed tomography for the diagnosis of diaphragm ruptures is 61–87 % and 72–100 %, respectively. In an acute period, the treatment of diaphragm ruptures is surgical. However, in long-term asymptomatic ruptures, expectant management is possible, particularly if the risk of surgical treatment is high

Asymptomatic Post-Traumatic Rupture of the Right Diaphragm Dome

Aim.  This paper is aimed at presenting the materials of clinical observations associated with diagnosing rare-occurring ruptures of the right dome of the diaphragm that have been overlooked for a long period.Results.  A 61-year-old man was admitted to hospital with a diagnosis of chronic heart failure. Chest radiograph revealed a high position of the right dome of the diaphragm. Computed tomography revealed a defect in the central parts of the diaphragm on the right, the liver was rotated outward with its visceral surface deployed anteriorly and upward. In the right thoracic cavity, anterior to the liver, were the loops of the intestine and the outlet of the stomach.More than 30 years before, the patient had experienced an explosive trauma, which might have caused a rupture in the right dome of the diaphragm. A 70-year-old man, a smoker with a ten-year history of hypertension, was hospitalized with an increase in dyspnea, a cough with the discharge of purulent sputum, the feeling of heaviness behind the sternum. Chest radiograph revealed a high standing of the right dome of the diaphragm at the level of 3rd rib with a decrease in the volume of the right lung, and an increase in cardiac silhouette (cardiothoracic index 0.64). Computed tomography revealed a high standing of the right dome of the diaphragm as well as the compression of the middle and lower lobe of the right lung with the presence of compression atelectasis. The liver was rotated, displaced into the right thoracic cavity, the deformation of the inferior vena cava to the right was visualized due to the displacement and rotation of the liver. The consolidated fractures of 10th–12th ribs on the right were visualized. The patient had had a chest injury resulting from a traffic accident about 15 years before, with no X-ray examination having been conducted at that time.Conclusion.  In the case of left-sided diaphragm ruptures, which are much more frequent than the right-sided ones, the stomach, large and small intestines as well as spleen are displaced into the thoracic cavity. In the case of rightsided diaphragm ruptures, the liver and gallbladder are displaced into the thoracic cavity. Right-sided posttraumatic diaphragmatic hernias that are not diagnosed at the time of injury or trauma and continue to be asymptomatic for a number of years are very rare. The sensitivity and specificity of computed tomography for the diagnosis of diaphragm ruptures is 61–87 % and 72–100 %, respectively. In an acute period, the treatment of diaphragm ruptures is surgical. However, in long-term asymptomatic ruptures, expectant management is possible, particularly if the risk of surgical treatment is high

Clinical Traits of SARS-CoV-2 Infection

Aim. Analysis of clinical manifestations, laboratory and instrumental examination data in SARS-CoV-2 patients with taking into account the disease severity and outcome.Materials and methods. The study included 92 patients with confirmed coronavirus infection, including 15 lethal cases, hospitalised at the Vasilenko Clinic of Internal Disease Propaedeutics, Gastroenterology and Hepatology of the Sechenov University in April 2020. The analysis included demographic data, the presence of concomitant diseases, chest computed tomography (CT) results, laboratory tests (including SARS-CoV-2-diagnostic PCR, general and metabolic blood panels, coagulogram) and the duration of disease.Results. Patients infected with SARS-CoV-2 usually exhibit lymphopenia (p ≤ 0.001), leucocytosis, the elevated neutrophils (p ≤ 0.05), neutrophil-lymphocyte ratio (p ≤0,05), C-reactive protein (p ≤ 0.05), ferritin (p ≤ 0.05), D-dimer (p ≤ 0.05) and fibrinogen (p ≤ 0.05), altered prothrombin time (p ≤ 0.05) and INR (p ≤ 0.05). In a critical coronavirus infection, the pulmonary lesion exceeds 50% (corresponds to CT3 — CT4). The risk of critical SARS-CoV-2 infection increases with elder age (p ≤ 0.001), associates with the male gender and presence of concomitant diseases, such as obesity (p &lt; 0.01), diabetes mellitus (p &lt; 0.001), hypertension (p ≤ 0.001), CHD (p ≤ 0.001) and atrial fibrillation (p &lt;0.05).Conclusion. The risk of severe and adverse coronavirus infection is significantly higher in elder comorbid patients

Корреляция 3D-морфотопометрических характеристик опухоли почки с ее гистологическим строением

Aim. To assess the correlation between clinical characteristics (sex, age, and maximum tumor size), 3D morphometric characteristics of renal lesions obtained through processing of multispiral computed tomography data, and renal tumor histology.Materials and methods. Evaluation of kidney tumor malignancy on the basis of comparative analysis of primarily morphometric characteristics of the lesion obtained through processing of multispiral computed tomography data and histological tumor structure is presented. Data of 308 patients (175 (56.8 %) males and 133 (43.2 %) females) with unilateral renal tumors were analyzed.Results. Multivariable analysis showed that malignancy of kidney tumor is associated with sex (male), location in the middle segment, tumor size, tumor shape (spherical with conical base) (24.8 %), while mushroom-like lesion shape was more common in benign tumors (35.2 %). In univariate models, only two variables were statistically significant predictors: patient sex and tumor shape.Conclusion. The developed logistic model based on analysis of such predictors as sex and kidney tumor shape has a high percentage (87.6 %) of correct predictions of tumor histological structure.Цель исследования – оценить корреляцию общих показателей (пол, возраст, максимальный размер опухоли), 3D-морфотопометрических характеристик опухолевого узла почки, полученных при постпроцессинговой обработке данных мультиспиральной компьютерной томографии, с характером гистологического строения новообразования.Материалы и методы. Представлен опыт оценки злокачественности опухоли почки на основании сравнительного анализа преимущественно морфотопометрических характеристик новообразования почки, полученных при постпроцессинговой обработке данных мультиспиральной компьютерной томографии, и гистологического строения опухоли. Проанализированы данные 308 пациентов (175 (56,8 %) мужчин и 133 (43,2 %) женщины) с односторонней опухолью почки.Результаты. Многофакторный анализ показал, что злокачественность новообразования почки ассоциирована с полом (мужским), локализацией в среднем сегменте почки, размером опухоли, формой (шаровидной с конусовидным основанием) (24,8 %), в то время как грибовидная форма опухолевого узла наиболее часто наблюдалась при доброкачественных новообразованиях (35,2 %). В однофакторных моделях в качестве статистически значимых предикторов показали себя только 2 фактора – пол пациента и форма опухоли.Заключение. Полученная логистическая модель, основанная на анализе таких предикторов, как пол и форма новообразования почки, имеет высокий процент (87,6 %) корректных предсказаний его гистологического строения