Arhiv" Vnutrennej Mediciny最新文献

{"title":"Differential Diagnosis of Cardiac Amyloidosis and Hypertrophic Cardiomyopathy","authors":"M. S. Bychkova, E. V. Reznik, D. V. Ustyuzhanin, G. N. Golukhov","doi":"10.20514/2226-6704-2023-13-5-360-370","DOIUrl":"https://doi.org/10.20514/2226-6704-2023-13-5-360-370","url":null,"abstract":"Diagnosis and differential diagnosis of cardiac amyloidosis and hypertrophic cardiomyopathy is difficult in some cases, which is confirmed by the presented clinical observation. The patient A., 67 years old, from the age of 59 for 7 years suffered from arterial hypertension with a maximum blood pressure of 170/100 mmHg, received hypotensive therapy. Myocardial infarction, a history of stroke denies. Since January 2018, at the age of 65, against the background of spontaneous stabilization of blood pressure figures, shortness of breath when climbing to the 2 nd floor, lifting weights, suffocation at night, swelling of the shins, feet, in connection with which I turned to a doctor. When examined on an electrocardiogram, a low voltage of QRS complexes in the leads from the extremities was noted, there was no increase in the amplitude of the r wave in V1–3. Echocardiography revealed a thickening of the interventricular septum and the posterior wall of the left ventricle up to 1.9 cm without obstruction of the outlet of the left ventricle, restrictive type of diastolic dysfunction, dilation of the left and right atria, moderate pulmonary hypertension, moderate amount of fluid in the pericardial cavity. Magnetic resonance imaging of the heart revealed a pattern typical of cardiac amyloidosis: diffuse subendocardial contrast of the myocardium of both ventricles in the absence of local contractility disorders, increased myocardial thickness in all segments, hydropericardium. Biopsy of the skin and subcutaneous fat with Congo red staining and polarization microscopy revealed no amyloid deposits. No mutations in the transthyretin gene responsible for transthyretin amyloidosis (ATTR–amyloidosis) were detected during the genetic study. Sequencing of 10 genes encoding myocardial sarcomeric proteins in the MYBPC3 gene revealed a mutation c.3197C >G (p.Pro1066Arg) in a heterozygous state, previously described in patients with hypertrophic cardiomyopathy of Slavic origin. Cascade family screening for the mutation was not carried out due to the fact that the patient did not know the father, the mother died at the age of 75 from heart failure, the only son died from an accident six months before the patient’s treatment. On 15.02.2019, the patient suffered a circulatory arrest with successful resuscitation measures. For the purpose of secondary prevention of sudden cardiac death, a single–chamber cardioverter-defibrillator was implanted on 22.02.2019. Despite the ongoing therapy, the patient died in March 2019. from progressive heart failure. Thus, a clinical case is presented where magnetic resonance imaging suspected amyloid cardiomyopathy, which did not receive morphological confirmation in biopsies of extra–cardiac localization. Hypertrophic cardiomyopathy caused by mutation c.3197C >G (p.Pro1066Arg) in the MYBPC3 gene was confirmed on the basis of clinical and instrumental and molecular genetic methods. The pattern characteristic of cardiac amyloidosis de","PeriodicalId":31058,"journal":{"name":"Arhiv\" Vnutrennej Mediciny","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135368174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Difficulties in the Diagnosis and Management of Patients with Takayasu’s Arteritis: A Description of a 5-Year Clinical Follow-Up","authors":"A. V. Petrov, A. A. Zayaeva, J. V. Usachenko, V. A. Beloglazov, G. N. Коshukova, I. A. Yatskov, S. I. R. Younsi","doi":"10.20514/2226-6704-2023-13-5-377-384","DOIUrl":"https://doi.org/10.20514/2226-6704-2023-13-5-377-384","url":null,"abstract":"Takayasu’s disease (nonspecific aortoarteritis) is a granulomatous inflammation of the aorta and its main branches with a progressive course and development of severe ischemic disorders. The difficulty of diagnosis and the possibility of applying various methods of pathogenetic anti-inflammatory treatment of Takayasu’s arteritis make it expedient to study a clinical case. The analysis of a clinical case of a patient with Takayasu’s arteritis with manifestation of the disease in the form of general inflammatory syndrome and manifestations of severe cerebral ischemia due to bilateral stenotic carotid artery lesion was performed. The patient has been under observation since September 2017 up to the present time, various methods of pharmacotherapy and surgical correction were used in her therapy. The dynamics of clinical symptomatology of Takayasu’s arteritis and clinical results of step therapy with high doses of methylprednisolone, bolus administration of cyclophosphan followed by long-term oral cyclophosphan administration were analyzed. In the course of treatment, the patient underwent carotid angioplasty. Due to the unstable effect of the therapy, the patient was administered intravenous infusions of IL-6 blocker tocilizumab, which led to remission of the disease. The presented clinical case demonstrates the important diagnostic value of vascular imaging methods in early diagnosis and control of the disease course and the effectiveness of IL-6 inhibitors in achieving and maintaining remission of Takayasu’s arteritis.","PeriodicalId":31058,"journal":{"name":"Arhiv\" Vnutrennej Mediciny","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135412153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Zinner Syndrome: Case Series and Literature Rewiev","authors":"D. A. Kushnerova, V. S. Tikhonova, I. A. Blokhin, A. P. Gonchar","doi":"10.20514/2226-6704-2023-13-5-392-400","DOIUrl":"https://doi.org/10.20514/2226-6704-2023-13-5-392-400","url":null,"abstract":"Zinner syndrome is a rare congenital anomaly of the mesonephric duct, characterized by a triad of symptoms: seminal vesicle cysts, ipsilateral renal agenesis and ejaculatory duct obstruction. This leads to a severe complication — oligozoospermia/azospermia, which can subsequently cause infertility. The widespread use of medical imaging increases the probability of incidental detection. Namely, magnetic resonance imaging (MRI) is the imaging modality of choice for making a diagnosis. Study purpose: to optimize patient routing in Zinner syndrome, as well as to minimize the risk of misdiagnosis or missed pathology, by providing strong and weak points for each modality. Materials and methods: we present two clinical cases of Zinner syndrome. The first one is a complicated course in a 25-year-old patient, and the second one is accidentally discovered in a 27-year-old patient. The patients underwent a comprehensive diagnostic panel, including: ultrasound (US), computed tomography (CT), magnetic resonance imaging (MRI). The results obtained were analyzed in the light of available literature data. Results: in most cases, Zinner syndrome is an incidental finding during. The diagnosis based on these imaging methods and the correct patient routing allowed us to make a timely and correct diagnosis, followed by decisions on further treatment tactics. Conclusion: Zinner syndrome is a rare disease and is often diagnosed based on imaging findings only. A radiologist and clinician need to know about the diagnostic criteria for this syndrome in order to successfully diagnose and determine the optimal treatment tactics.","PeriodicalId":31058,"journal":{"name":"Arhiv\" Vnutrennej Mediciny","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135412281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Castleman’s Disease. Association with System Scleroderma","authors":"A. V. Yagoda, P. V. Koroy, D. P. Kharchenko, E. V. Bondarenko","doi":"10.20514/2226-6704-2023-13-5-385-391","DOIUrl":"https://doi.org/10.20514/2226-6704-2023-13-5-385-391","url":null,"abstract":"The article presents an observation of a rare benign lymphoproliferative disease — Castleman’s disease, with pronounced systemic symptoms. The clinical case is of interest not only for the rarity of pathology, but also for the peculiarities of clinical manifestations, including paraneoplastic pseudosclerodermic clinical and immunological syndrome, which was not previously described in the context of Castleman’s disease, Raynaud’s syndrome, severe pulmonary hypertension and a suspected (not proven morphologically) variant of extranodal lesion with its previously also notobserved localization in the sigmoid colon wall.","PeriodicalId":31058,"journal":{"name":"Arhiv\" Vnutrennej Mediciny","volume":"84 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135367941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Type 2 Myocardial Infarction on the Background of Coronary Vasospasm and Invasive Tactics of Its Diagnosis and Treatment","authors":"D. Yu. Gamayunov, A. N. Kalyagin, N. M. Balabina, A. V. Sinkov, E. S. Chujko, E. R. Kiseleva, K. B. Gajnutdinov, A. V. Sorzheev, E. O. Bykov","doi":"10.20514/2226-6704-2023-13-5-352-359","DOIUrl":"https://doi.org/10.20514/2226-6704-2023-13-5-352-359","url":null,"abstract":"Currently, type 2 myocardial infarction is a rather significant problem, both in terms of diagnosis and treatment. Myocardial infarction without obstructive coronary artery damage occurs in 5-10 % of patients with a myocardial infarction. Optimal strategies for the diagnosis and treatment of patients with myocardial damage associated with non-thrombotic mechanisms have not yet been determined. The article describes a clinical observation of type 2 myocardial infarction on the background of vasospasm, as well as diagnostic and therapeutic tactics in this clinical situation. The main provisions: the patient was 22 years old in the cardiology department due to the pain syndrome behind the sternum for the first time in his life and an increase in body temperature to 37.5 C. From anamnesis: active bodybuilding, taking testosterone in injectable form. The electrocardiogram revealed changes in the type of transmural myocardial ischemia without the dynamics characteristic of myocardial infarction. Troponin I (quantitative test) — 2.1 ng/ml at laboratory reference values of 0.010-0.023 ng/ml. A diagnostic search was conducted for myocardial infarction and acute pericarditis. For the purpose of differential diagnosis, coronary angiography was performed, during which dynamic stenosis of the posterior descending artery was revealed. The decision to stent the vessel was not made. Echocardiography revealed areas of local contractility disorders. The data of the examination showed in favor of myocardial infarction without coronary artery obstruction (type 2). Taking into account the absence of occlusive-stenotic lesions of the coronary arteries, the presence of vasospasm, 1 platelet aggregation inhibitor, medium-dose statins, isosorbide dinitrate, calcium channel blocker, angiotensin-converting enzyme inhibitor was prescribed. Conclusion. Invasive tactics made it more likely to diagnose type 2 myocardial infarction and prescribe the most optimal drug therapy.","PeriodicalId":31058,"journal":{"name":"Arhiv\" Vnutrennej Mediciny","volume":"7 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135367957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidisciplinary Approach to the Management of a Patient with Right-Sided Infective Endocarditis on Maintenance Hemodialysis","authors":"E. Yu. Ponomareva, N. A. Kosheleva, D. S. Sedov","doi":"10.20514/2226-6704-2023-13-5-371-376","DOIUrl":"https://doi.org/10.20514/2226-6704-2023-13-5-371-376","url":null,"abstract":"Infective endocarditis in patients on maintenance hemodialysis occurs more often than in the population, manifests severe complications and is characterized by high mortality. The management of such patients requires the participation of several specialists. In the presented clinical observation, both typical characteristics of infective endocarditis on maintenance hemodialysis (staphylococcal etiology, association with vascular access devices, metabolic and hemodynamic risk factors) and peculiarities of a particular case (nature of nephropathy that led to maintenance hemodialysis, mechanism of right heart damage, which is uncommon for infective endocarditis on maintenance hemodialysis) are discussed in comparison with literature data. Interdisciplinary interaction of doctors of several specialties contributed to the choice of the right tactics and a favorable outcome of the disease.","PeriodicalId":31058,"journal":{"name":"Arhiv\" Vnutrennej Mediciny","volume":"79 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135413426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathogenetic Mechanisms of the Relationship Between Osteoarthritis and Intestinal Dysbiosis","authors":"G. V. Poryadin, A. N. Zakhvatov, I. A. Zakharkin, A. Yu. Parshina, A. A. Shaev","doi":"10.20514/2226-6704-2023-13-5-325-334","DOIUrl":"https://doi.org/10.20514/2226-6704-2023-13-5-325-334","url":null,"abstract":"The potential association between dysbiosis of the gut microbiota and osteoarthritis is confirming by a growing number of studies. Given the social significance, the high prevalence of osteoarthritis, and evidences that quantitative and qualitative modification of the gut microbiota affects its progression, it seems important to clarify the underlying mechanisms of this association. Osteoarthritis is a multifactorial joint disease, which is based primarily on the progressive degeneration of articular cartilage. Impaired metabolic activity of chondrocytes, consisting in an imbalance in the extracellular matrix synthesis and degradation processes, causes the persistent release of molecular patterns associated with damage. This leads to the activation of a wide range of innate immune cells receptors and is the basis for the development of an inflammatory reaction in the joint. The involvement of macrophages in the synovial membrane and their activation leads to the production of pro-inflammatory cytokines, leading to the development of chronic low-grade inflammation in the joint, supporting the synthesis of catabolic enzymes by chondrocytes and escalating the cartilage degeneration. Microbial dysbiosis, defined as an adverse modification in the diversity, structure, or metabolic activity of the gut microbiota, is a hidden risk factor, accompanied by metabolic endotoxemia and, consequently, by increased production of pro-inflammatory cytokines, that support the systematic low-grade inflammation and pathophysiological mechanisms of osteoarthritis. It has been shown that dysbiosis of the gut microbiota intestinal takes part in the formation of other osteoarthritis risk factors for, for example, obesity and metabolic disorders. The identification of important interrelated pathophysiological mechanisms of these pathologies will contribute to the development of new pathogenetic treatment methods with their subsequent active introduction into clinical practice.","PeriodicalId":31058,"journal":{"name":"Arhiv\" Vnutrennej Mediciny","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135462970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in the Human Blood System in Patients with COVID-19","authors":"G. Sh. Safuanova, A. S. Konstantinova, N. R. Ryabchikova, D. R. Safuanova","doi":"10.20514/2226-6704-2023-13-5-335-343","DOIUrl":"https://doi.org/10.20514/2226-6704-2023-13-5-335-343","url":null,"abstract":"As is known, the SARS-CoV-2 virus affects almost all human systems, organs and tissues, causing their damage to a greater or lesser extent. Follow-up of COVID-19 patients worldwide.indicates significant changes occurring in the hematopoiesis system and morphology of blood cells. This review is devoted to the analysis of literature data on the effect of the SARS-CoV-2 virus on changes in the indicators of the human blood system, which is important in the practical work of all healthcare professionals.","PeriodicalId":31058,"journal":{"name":"Arhiv\" Vnutrennej Mediciny","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135462812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurocognitive Disorders in COVID-19 Patients: Controversed and Unresolved Issues","authors":"D. P. Kuznetsova, E. V. Efremova, V. V. Gnoevykh","doi":"10.20514/2226-6704-2023-13-5-344-351","DOIUrl":"https://doi.org/10.20514/2226-6704-2023-13-5-344-351","url":null,"abstract":"New Coronavirus Infection (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome coronavirus-2 (SARS-CoV-2). Since 2019, a large number of studies on cognitive impairment in the background of COVID-19 have emerged, and “long COVID” is among them. A non-systematic review based on 2019-2022 studies provides information on the severity of cognitive changes in patients with COVID-19, diagnostic methods that can detect these cognitive impairment and long-term neuropsychiatric and cognitive outcomes that may pose a serious public health challenge.","PeriodicalId":31058,"journal":{"name":"Arhiv\" Vnutrennej Mediciny","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135462814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medication-Overuse Headache (Review of Literature and Recommendations for Practice)","authors":"N. L. Starikova","doi":"10.20514/2226-6704-2023-13-3-175-180","DOIUrl":"https://doi.org/10.20514/2226-6704-2023-13-3-175-180","url":null,"abstract":"Medication-overuse headache (MOH) is a highly prevalent secondary headache, developing in patients with frequent and chronic cephalalgias due to excessive use of “acute” medications for headache, and significantly affecting patients’ quality of life. Treatment of MOH demands high compliance physician-patient, and the result is satisfactory not in all cases. For this reason, the prophylaxis of overuse of symptomatic medications for headaches is important. The review presents contemporary data on MOH, its treatment and prophylaxis.","PeriodicalId":31058,"journal":{"name":"Arhiv\" Vnutrennej Mediciny","volume":"465 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135449495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}