РИСК РАЗВИТИЯ ОПУХОЛИ ГОНАД У ПАЦИЕНТОВ С ДИСГЕНЕЗИЕЙ ГОНАД И КАРИОТИПОМ 46,XY

Disorders of sex development with Y chromosome material has been associated with a high risk for developing germ cell tumors such as gonadoblastoma or dysgerminoma. The aim of the study was to investigate the risk of germ cell tumors in patients with XY gonadal dysgenesis. Material and methods. In the study included 11 patients with XY gonadal dysgenesis: 4 with complete gonadal dysgenesis and 4 with partial gonadal dysgenesis. Results. Pathologic examination revealed gonadoblastoma and dysgerminoma with gonadoblastoma in 2 of 9 (22%) patients (who had gonadectomy), including 2 of 3 patients (66 %) with complete gonadal dysgenesis. In our series of patients with gonadal dysgenesis 46,XY the risk of germ cell tumors was high, especially in patients with complete gonadal dysgenesis. Considering this results, early gonadectomy is strongly recommended in females patients. The patients with partial dysgenesis with scrotal gonads being reared as males need monitoring. Нарушение формирования пола с кариотипом 46,XY или наличием в кариотипе материала Y-хро­мосомы рассматривается в качестве фактора риска опухоли гонад из герминативных клеток: гонадобластомы и дисгерминомы. Однако характер риска при различных вариантах нарушения формирования пола окончательно не установлен.Цель исследования – определить риск развития опухоли из герминативных клеток при одном из вариантов нарушения формирования пола – дисгенезии яичек с кариотипом 46,XY.Материал и методы. В исследование включено 11 пациентов с дисгенезией яичек и кариотипом 46,XY. В 4 наблюдениях имела место тотальная, в 7 – парциальная дисгенезия яичек. В 9 случаях проведена гонадэктомия с последующим гистологическим исследованием материала.Результаты. По результатам гистологического исследования гонадобластома и дисгерминома выявлены в 2 (22%) из 9 наблюдений. При этом гонадобластома и дисгерминома имели место в 2 (66%) из 3 наблюдений при тотальной дисгенезии яичек, и не выявлены ни в одном из 6 случаев парциальной дисгенезии яичек (p = 0,1).Заключение. Таким образом, дисгенезия яичек с кариотипоп 46,XY является фактором риска развития опухоли из герминативных клеток. При тотальной форме дисгенезии яичек риск развития опухоли несколько выше. Необходимо производить гонадэктомию при тотальной дисгенезии яичек в момент выявления заболевания. При парциальной дисгенезии яичек и выборе мужского паспортного пола требуется длительное наблюдение за сохраненными гонадами

Возможности компьютерно-то쬬¬¬¬¬¬ографической ангиопульмонографии в диагностике тромбоэмболии легочной артерии

The purpose of this search is to evaluate diagnostic capability of CT pulmonary angiography (CTPAG) in patients with pulmonary embolism. Examination results of 45 patients with suspected pulmonary embolism provided. Pulmonary embolism symptoms and frequency of their occurrence in study group described. The modification of technical CTPAG protocol proposed for to improve visualization and to reduce radiation exposure.С целью оценки диагностических возможностей компьютерно-томографической ангиопульмонографии (КТАПГ) в выявлении тромбоэмболии легочных артерий (ТЭЛА) приведены результаты обследования 45 пациентов с подозрением на тромбоэмболию легочной артерии (ТЭЛА). Описаны компьютерно-томографические симптомы ТЭЛА и частота их встречаемости в обследуемой группе. Предложена модификация технического протокола КТАПГ, позволяющая повысить качество визуализации, снизить лучевую нагрузку

Treatment of autonomous intestinal neuropathy in critical care by prucalopride and multistrain probiotic

The aim of clinical case presentation. To analyze the options of autonomous intestinal neuropathy treatment in critical state patients. Key points. The clinical cases of autonomous intestinal neuropathy of various etiology are presented. Patient A., 19-year-old patient presented with constipation for up to 3 days, progressive feeling of abdominal distention and general weakness. In the past history patient underwent surgery for chronic left-side achillobursitis. In postoperative period antibacterial treatment was prescribed that included first-generation cephalosporin. At the 4thday after onset of antibiotic treatment the patient developed chronic abdominal pain that increased progressively, diarrhea up to 10 times per day and fever of 39 °C. Subsequent investigation revealed positive stool test for C. difficile toxins A and B. Urgent colonoscopy detected pseudomembranes at colonic mucosa. Histological examination of biopsy specimens from affected sites demonstrated focal cystic dilation of crypts with epithelium desquamation, severe edema of lamina propria. Pseudomembranous colitis was diagnosed and vancomycin 125 mg qid in combined to metronidazole 500 mg tid for 10 days were prescribed. At the background of treatment stool frequency gradually decreased up to 2 times per day, hematochezia stopped. However at the 7-8th days patient developed constipation, feeling of abdominal distention and progressive general weakness. The state was regarded as development of C. difficile toxin-associated autonomous intestinal neuropathy. Patient I., 54 year-old admitted to the hospital; presenting complaints included flatulence, constipation for up to three days and severe general weakness. According to the past history in 2014 patient was diagnosed to have adenocarcinoma of the right breast gland with subsequent right-sided radical mastectomy followed by radiation therapy and chemotherapy. In May 2017 patient developed boring pain in the right lumbar area, frequent small-volume urination, febrile fever and progressive general weakness. Laboratory and instrumental investigation revealed obstructive right-sided abscessing pyelohephritis with development of sepsis; antibacterial therapy included meropenem in daily dose of 3.0 g along with correction of hypoalbuminemia and detoxication therapy. At the 3rd day of treatment patient noticed improvement in the state of health: decrease in right-sided lumbar pain and general weakness, decrease in body temperature up to subfebrile level. Catheter-collected urine sample contained no admixture of pus. However in the same day patient developed constipation along with progressive abdominal distention. The most likely cause for development of ileus in this case is development of autonomous intestinal neuropathy associated to severe intoxication. Basic mechanisms for development of autonomous intestinal neuropathy are discussed: suppression of smooth muscular contractility by C. difficile toxins A and B (in the first of presented cases) and combined autoimmune neuronal damage by immune cells due to expression of proteins by neoplastic cells (in the second case). Therapeutic approaches including prescription of prokinetic drug prucalopride and multistrain probiotic containing bifido-and lactobacilli are presented (Bifidobacterium bifidum, B. longum, B. infantis, Lactobacillus rhamnosus). Prescription of prucalopride and multistrain probiotic provided resolution of neuropathy and recovery of adequate intestinal motility due to resumption neuromuscular intestinal complex activity and correction of intestinal microbiota spectrum. Conclusion. Combination of prokinetic drug (prucalopride) and multistrain probiotic medication (Bifidobacterium bifidum, B. longum, B. infantis, Lactobacillus rhamnosus) can be effective in the treatment of autonomous intestinal neuropathy in critical care

Capability of CT pulmonary angiography in pulmonary embolism diagnosis

The purpose of this search is to evaluate diagnostic capability of CT pulmonary angiography (CTPAG) in patients with pulmonary embolism. Examination results of 45 patients with suspected pulmonary embolism provided. Pulmonary embolism symptoms and frequency of their occurrence in study group described. The modification of technical CTPAG protocol proposed for to improve visualization and to reduce radiation exposure