Modern concept of differential diagnosis of colitis: from G.F. Lang to the present day. A review

The aim of the article is to improve the differential diagnosis of specific and nonspecific inflammatory bowel diseases. In Russia, this scientific direction is associated with the name of G.F. Lang, who performed in 1901–1902 the study „On ulcerative inflammation of the large intestine caused by balantidiasis“. The etiology of specific colitis is associated with infection with parasites, bacteria and viruses that cause inflammation of the intestinal wall, diarrhea, often with an admixture of mucus, pus and blood. Specific colitis (SC) may be accompanied by fever, abdominal pain, and tenesmus. Bacterial colitis is commonly caused by Salmonella, Shigella, Escherichia coli, Clostridium difficile, Campylobacter jejuni, Yersinia enterocolitica, and Mycobacterium tuberculosis. Viral colitis is caused by rotavirus, adenovirus, cytomegalovirus, and norovirus. Parasitic colitis can be caused by Entamoeba histolytica and balantidia. In gay people, SC can cause sexually transmitted infections: Neisseria gonorrhoeae, Chlamydia trachomatis, and treponema pallidum, affecting the rectum. Stool microscopy, culture, and endoscopy are used to establish the diagnosis. Stool culture helps in the diagnosis of bacterial colitis in 50% of patients, and endoscopic studies reveal only nonspecific pathological changes. Differential diagnosis of SC should be carried out with immune-inflammatory bowel diseases (ulcerative colitis, Crohn's disease, undifferentiated colitis), radiation colitis and other iatrogenic bowel lesions. The principles of diagnosis and therapy of inflammatory bowel diseases associated with various etiologica

Stable Magnetostatic Solitons in Yttrium Iron Garnet Film Waveguides for Tilted in-Plane Magnetic Fields

The possibility of nonlinear pulses generation in Yttrium Iron Garnet thin films for arbitrary direction between waveguide and applied static in-plane magnetic field is considered. Up to now only the cases of in-plane magnetic fields either perpendicular or parallel to waveguide direction have been studied both experimentally and theoretically. In the present paper it is shown that also for other angles (besides 0 or 90 degrees) between a waveguide and static in-plane magnetic field the stable bright or dark (depending on magnitude of magnetic field) solitons could be created.Comment: Phys. Rev. B (accepted, April 1, 2002

Diagnosing MALT Gastric Lymphoma in Gastroenterologist’s Practice, a Clinical Observation

Aim. A clinical case description to highlight challenges in diagnosing MALT lymphoma presented in infiltrative ulcer-ative lesions.Key points. A 60-yo patient was admitted to the Loginov Moscow Clinical Scientific Centre with epigastric pain and an 18 kg weight loss over past 4 months. A history of repeated outpatient endoscopic examinations revealing subse-quently ulcerative and infiltrative ulcerative gastric lesions of unestablished origin. A complex examination combin-ing oesophagogastroduodenoscopy (OGDS), endosonography (EUS), multislice computed tomography (MSCT), morphological and immunohistochemical (IHC) assays elicited the MALT gastric lymphoma IIE stage involving para-gastric and intraperitoneal lymph nodes. The first treatment stage included line-1 eradication therapy, rabeprazole 20 mg x 2 times a day, amoxicillin 1000 mg x 2 times a day, clarithromycin 500 mg x 2 times a day, bismuth tripotas-sium dicitrate 240 mg x 2 times a day — for 14 days. Accounting for the process prevalence and stage, six courses of R-CHOP polychemotherapy (PCT) were ordered by haematologist.Conclusion. This observation demonstrates a targeted-biopsy endoscopic examination followed by morphological, IHC, EUS (for invasion depth) and MSCT (for process advancement) assays to be decisive in differential diagnosis of ulcerative and infiltrative ulcerative gastric lesions

АТИПИЧНАЯ ЦЕЛИАКИЯ: КЛИНИЧЕСКИЙ ПРИМЕР

Celiac disease has traditionally been associated with severe malabsorption syndrome. Recent years it was shown that among children of preschool and school-age mild cases with atypical clinical picture were dominated that leads to diagnostic difficulties. Here we are citing an example of an atypical clinical/latent celiac disease course in a child aged 4.5 years.Целиакия традиционно ассоциируется с тяжелым синдромом мальабсорбции. В последние годы показано, что среди детей дошкольного и школьного возраста преобладают нетяжелые случаи с атипичной клинической картиной заболевания, что приводит к диагностическим затруднениям. Приводим клинический пример атипичного/латентного течения целиакии у ребенка в возрасте 4,5 лет.

Important problems in the diagnosis and treatment of autoimmune hepatitis (based on the Russian consensus 2017)

The analysis of publications devoted to the Russian Consensus on the Diagnostic and Treatment of Autoimmune Hepatitis (AIH), which was considered at the 43rd annual Scientific Session of the CNIIG From Traditions to Innovation (March 4, 2017) is carried out. The presence of clear algorithms and recommendations for the diagnosis and treatment of AIH significantly help the doctor in real clinical practice, but do not exclude a personified approach to the patient

Classical Simulation of Relativistic Quantum Mechanics in Periodic Optical Structures

Spatial and/or temporal propagation of light waves in periodic optical structures offers a rather unique possibility to realize in a purely classical setting the optical analogues of a wide variety of quantum phenomena rooted in relativistic wave equations. In this work a brief overview of a few optical analogues of relativistic quantum phenomena, based on either spatial light transport in engineered photonic lattices or on temporal pulse propagation in Bragg grating structures, is presented. Examples include spatial and temporal photonic analogues of the Zitterbewegung of a relativistic electron, Klein tunneling, vacuum decay and pair-production, the Dirac oscillator, the relativistic Kronig-Penney model, and optical realizations of non-Hermitian extensions of relativistic wave equations.Comment: review article (invited), 14 pages, 7 figures, 105 reference

Drugs-induced liver injury associated with non-steroidal anti-inflammatory drugs: a case report and clinical insights

Aim: To raise the awareness of general practitioners with special characteristics of the clinical manifestations of the drug-induced liver injury (DILI), which can manifest with various signs, symptoms and types of morphological injury, from asymptomatic increase in transaminases and liver steatosis to chronic hepatitis with advanced fibrosis. Key points: NSAID is one of the most commonly prescribed groups of agents worldwide. Most of them have low risk of liver toxicity. However, prolonged uncontrolled intake of NSAID by patients without proper medical follow-up and monitoring may lead to serious liver injury, illustrated by the clinical case presented. The case manifested as an extremely rare liver injury in the form of chronic hepatitis with advanced fibrosis that developed after prolonged NSAID use. Conclusion: DILI usually occur as idiosyncratic (non-predictable) reactions. This is an exclusion diagnosis requiring comprehensive medical knowledge and awareness on potential drug-induced liver toxicity, including that associated with drug interactions. To minimize potential risk of liver toxicity induced by NSAID, it is recommended to take them in the lowest effective dose and for a minimally required period. A thorough assessment of a patient's past history, monitoring of clinical chemistry parameters, and clinical judgment of the physician remain to be decisive for prevention, timely diagnosis, and treatment of DILI

Atherogenic dyslipidemia and insulin resistance associated with nonalcohol hepatic steatosis: comparison, contrast, and differentiated therapy

Aim. To study clinical, functional, morphological and pharmacological features of hepatic pathology in patients with non-alcohol hepatic steatosis (NAHS), combined with atherogenic dyslipidemia (ADL) and/or insulin resistance (IR).Material and methods. The study included 240 patients with NAHS: 100 with DL but no IR; 78 — with IR but no DL; 14 — with Type 2 diabetes mellitus (DM-2), IR and DL; 48 — without DL or IR (controls). All participants underwent standard clinical examination, blood biochemistry and hepatitis virus marker assessment, oral glucose tolerance and HOMA test, abdominal ultrasound and hepatic puncture biopsy.Results. NAHS clinical course was non-specific. Cytolysis syndrome activity was maximal in DM-2 patients. All patients had cholestasis syndrome manifestations, maximal in IR individuals. Hepatic morphology was characterized by large-drop fat dystrophy, inflammation and fibrosis. In patients with disturbed carbohydrate and lipid metabolism, hepatocyte nuclear changes and nuclear polymorphism were observed, respectively. In participants receiving a combination of statins and ezetimibe, blood lipid profile improved at the second week of the treatment. IR patients received metformin, with positive dynamics of hepatic morphology and function.Conclusion. Despite no clinical differences between NAHS patients with ADL and IR, the latter are characterized by more aggressive morphological changes. Differentiated ethiotropic therapy of NAHS should take ADL and IR presence into account

The Impact of the Angulus Biopsy on the Detection of Staging and the Grading of Chronic Gastritis

There is a generally recognized need for a morphological assessment of the individual risk of developing gastric cancer in a patient with chronic gastritis, according to the OLGA system (Operative Link for Gastritis Assessment). At the same time, the role of assessing the biopsy from the incisura angularis remains controversial. The aim of our study was to assess the value of incisura angularis biopsy in staging gastritis according to the OLGA system by examining the atrophic and inflammatory changes in the antrum, incisura angularis, and body. Materials and Methods: A total of 718 patients (576 women and 142 men) aged 20 to 84 years were examined. Most of the patients were in the age group of 50 to 70 years (54.6%). Depending on the detection of H. pylori and autoimmune gastritis markers, all patients were divided into three groups. The first group included 380 patients with H. pylori gastritis without signs of autoimmune gastritis. The second group consisted of 209 patients with autoimmune gastritis, in whom no infection was detected during the examination, and there were no indications of H. pylori eradication. The third group consisted of 129 patients with chronic gastritis of combined etiology (autoimmune and H. pylori). Endoscopy biopsies were taken according to the updated Sydney System. Histological assessments of the grade and the stage of gastritis were carried out according to the standard OLGA-based protocol. Then, the same assessments were evaluated without taking into account histological changes in the incisura angularis. Results: When assessing the severity of inflammatory changes in the gastric mucosa according to the OLGA system, grade II (72.3%) was most often detected in all groups of patients. A severe degree of activity of chronic gastritis was most often observed in the group of patients with H. pylori gastritis (6.1%). These indicators practically did not change if the assessment did not take the angulus biopsy into account. When assessing the severity of atrophy of the glands in the gastric mucosa in patients of the first group, mild stages of atrophy prevailed. Without taking into account the angulus biopsy, a decrease in the stage of atrophy was observed in 27 cases (7.11%), and in only 4 cases did stage IV change to stage III, while in 23 cases, discrepancies were noted only within groups with a mild stage of atrophy. There were no transitions from stage III to stage II. In the group of patients with autoimmune gastritis, pronounced stages of atrophy prevailed—in more than 77%. Without taking into account the angulus biopsy, a decrease in the stage of atrophy was observed in eight cases (3.83%), and in three (1.4%) patients, stage III was changed to stage II. In the group of patients with combined etiology (autoimmune + H. pylori), severe stages of atrophy also prevailed (70.5%). A decrease in the stage of atrophy without taking into account the angulus biopsy was only observed in three patients (2.32%), of which two cases concerned patients with mild stages of atrophy. Thus, in general, severe stages of atrophy of the gastric mucosa (stages III and IV according to the OLGA staging system) were detected in 313 patients (43.59%). If the assessment of the atrophy stage did not take into account changes in the angulus biopsy, then severe stages of atrophy (III and IV according to OLGA) were detected in 310 patients (43.17%). In total, changes in the assessment of the atrophy stage occurred in 38 patients (5.29%), and this was more often observed in patients with stages I and II of atrophy. Conclusions: Accounting for histological changes in the incisura angularis does not significantly affect the assessment of the grade and stage of chronic gastritis according to the OLGA system, regardless of the etiology of atrophic gastritis