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Idiopathic hypoparathyroidism is a rare endocrine disease diagnosed when all possible causes of hypoparathyroidism are excluded.Data on the prevalence of idiopathic hypoparathyroidism is limited, there are several local studies in some countries. The variety and non-specificity of the hypoparathyroidism symptoms, similarity to other diseases (eg. epilepsy), causes the misdiagnosis and delay in pathogenetic therapy.Idiopathic hypoparathyroidism is rare. Therefore, the absence of neck surgery in the anamnesis practically excludes hypoparathyroidism from the diagnostic search. Moreover, it is necessary to rule out all known causes of decreased PTH hypoparathyroidism to determine the form of non-surgical hypoparathyroidism.We present a case series of idiopathic hypoparathyroidism, which demonstrates the difficulty in diagnosis, and the clinical features of the disease. The article covers also the problem of modern diagnostic approaches including the determination of the interferon-omega for patients with suspected autoimmune polyglandular syndrome type 1 as the most common cause of nonsurgical hypoparathyroidism.

The most common anomaly of the aortic arch and its branches is the aberrant right subclavian artery – arteria lusoria. Usually, it produces dysphagia or dyspnea and chronic coughing.Our purpose is to underline that it is necessary to exclude the anomalies of the branches of the thoracic aorta, including arteria lusoria, in the patients with cardialgia of unknown origin.Clinical case. An 18-year-old female patient without a previously diagnosed chronic pathology was admitted to a hospital with chest pain after emotional stress for about an hour. The ECG revealed a sinus rhythm with a heart rate of 50 per minute, the normal direction of the electrical axis of the heart, the incomplete right bundle branch block, the negative T wave in the lead III. After excluding ischemic heart disease, acute coronary syndrome, pulmonary embolism, contrast-enhanced chest computed tomography revealed an aortic arch anomaly – a. lusoria.Conclusion. A. lusoria may manifest by cardiac pain. In patients with chest pain of unknown origin, it is advisable to include anomalies of the aorta and its branches, including the presence of the lusoria artery, in the range of differential diagnostics.

The group of scleroderma diseases includes a number of clinical entities, the main symptom of which is skin tightening. Scleroderma is a prominent example of these diseases, characterized by excessive synthesis and deposition of collagen in organs and tissues. A patient with juvenile systemic scleroderma with induration of the skin and underlying tissues, and persistent contractures of large joints since childhood, is described. This clinical example illustrates disease course peculiarities and differential diagnosis of systemic and limited (focal) scleroderma and scleroderma-like conditions in pediatric patients. The feasibility of pathogenetic therapy aimed at improving patient's the quality of life with formed disease phenotype is shown.

The paper describes a clinical case of hypersensitivity pneumonitis in a young patient during the COVID-19 pandemic when the patient having complaints of dyspnea and interstitial lung changes as ground glass opacity was initially unambiguously diagnosed with viral COVID-related bilateral pneumonia. The chief computed tomography manifestations in the lung were infiltrative inflammatory changes as numerous areas of predominantly interstitial infiltration by the type of ground glass, with consolidation areas and reticular changes, varying in extent, peripheral localization, mainly in the lower lobes and with the 25–50% involvement of the right and left lung parenchyma. The diagnosis of hypersensitivity pneumonitis was confirmed by cytological and histological examinations of the biopsy material obtained during bronchoscopy using a set of biopsies and endobronchial cryobiopsy.This clinical case demonstrates that the chest computed tomography detection of pulmonary ground glasstype changes is a reason for further patient examinations and requires morphological verification of the diagnosis, since the cost of a diagnostic error is the life of a patient.

Несмотря на наличие клинических рекомендаций и пошаговых алгоритмов терапии биполярного аффективного расстройства (БАР) и шизофрении, в практике часто возникают трудности выбора правильной тактики лечения, связанные с проблемами дифференциальной диагностики этих заболеваний, особенно когда в структуре острых эпизодов биполярного расстройства присутствует психотическая симптоматика. Ошибочная диагностика и назначение классических антипсихотиков пациентам с БАР часто приводят к утяжелению течения заболевания и их социальной дезадаптации. В статье обсуждаются причины существующей диагностической неопределенности и возможности преодоления связанных с ней проблем терапии. В ситуации этой диагностической дилеммы терапевтический выбор упрощается благодаря внедрению в практику антипсихотиков второго поколения. Их доказанная эффективность при различных синдромальных проявлениях БАР и при шизофрении, лучшая по сравнению с классическими нейролептиками переносимость, в том числе низкий риск развития экстрапирамидных синдромов, не только расширяют возможности терапии БАР, но и нивелируют вред, возникающий вследствие ошибочной дифференциальной диагностики шизофрении и БАР. На основании анализа данных литературы в статье обсуждаются возможности дифференцированного использования антипсихотиков второго поколения при БАР в зависимости от спектра их клинической активности и с учетом особенностей соматотропного действия.

Finding a focal liver lesion during screening may not uncommonly lead to a misinterpretation of the results of radiological diagnostics. Based on the consolidation of our wide experience (more than 1000 cases) of surgical treatment of patients with various focal liver diseases, we analyzed the main causes of diagnostic pitfalls and, as a consequence, errors in the treatment of these patients. The most typical objective and subjective diagnostic pitfalls that may lead to a wrong treatment strategy are discussed with clinical cases taken as examples. The objective factors are related to the rarity of disease, absence of pathognomonic semiotics, as well as limitations in the resolution power of imaging methods. In addition, a misinterpretation of results of ultrasound examination, magnetic resonance imaging and multiaxial computed tomography may be explained by identical properties of images in different tumors related to similar physical and chemical properties of a lesion. The subjective factors are related to a wrong interpretation of clinical and instrumental assessment data, or insufficient evaluation needed in an individual patient. The number of diagnostic and treatment errors could be decreased by a multidisciplinary approach taking into account the opinions of various profile experts.

n the case of a space-occupying lesion (SOL) of the ovary, it is up to the gynecologist to diagnose a possible malignancy and then decide upon further treatment strategy. The aim of the study was to perform a comparative analysis of the existing methods for detecting the tumor markers: CA-125 – cancer antigen 125 and HE4 – human epididymis protein 4. We also compared the prognostic indices (Risk Malignancy Index – RMI and Risk of Ovarian Malignancy Algorithm – ROMA) currently used to make differential diagnoses of benign and malignant ovarian neoplasms at the preoperative stage. Materials and methods. We conducted a prospective study in 100 patients from 18 to 79 years old scheduled for surgery for an ovarian SOL. The serum levels of the CA-125 and HE4 tumor markers, pelvic sonography, the RMI and ROMA scores, as well as post-surgery histopathology results were evaluated. Results. The sensitivities of the CA-125, HE4, RMI and ROMA indices were 85.7%, 42.9%, 85.7% and 71.4%, respectively; the values of specificity were 83.6%, 97.8%, 96.7%, 97.8%, respectively. Conclusion. The most informative parameter for the differential diagnosis of benign and malignant ovarian neoplasms at the preoperative stage was the RMI, and the least informative – the HE4 tumor marker. The HE4 determination was highly informative, however, in the differential diagnosis of ovarian malignant neoplasms with endometrioid cysts in patients with elevated CA-125 levels. Notably, patients with widespread external genital endometriosis showed false-positive results of the CA-125, HE4, RMI and ROMA tests. In a patient with clear-cell ovarian carcinoma, the sensitivity and specificity of the CA-125, HE4, RMI, and ROMA tests were confirmed to be low.

The article describes present-day information on the pathogenesis, clinical picture, treatment and differential diagnostics of epidermolysis bullosa acquisita, an autoimmune skin disease caused by the production of anti-Type VII collagen autoantibodies and manifested mainly by subepidermal blisters and erosions. The authors present the results of a case study of a rare form of epidermolysis bullosa - epidermolysis bullosa acquisita in a male patient aged 53. A combined therapy with peroral prednisolone and subcutaneous injections of methotrexate had a positive effect in the form of epithelialization of most of the erosions.

Clinical presentation is given of eruption in the case of segmental vitiligo and nevus achromicus. Literary data was presented, issues of differential diagnostics were discussed.

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Acute and chronic pathology of oropharynx structures is one of the most frequent reasons to seek medical aid in pediatric practice. Taking into account the variety of the possible localization of inflammatory process in the oropharynx the inflammatory pathology of palatine tonsils – tonsillitis – is of greatest practical interest for practicing doctors. Despite the seeming simplicity of this disease currently there are a number of unresolved issues. One among them that causes hot discussion in Russia is division of recurrent and chronic forms of tonsillitis.

Objective: to establish features of a chronic pain syndrome disorders in patients with rheumatoid arthritis, to reveal correlation with psychoemotional disorders and to develop the differential approach to maintaining patients. Materials and methods. 101 patients at the age of 60.6 ± 11.8 years, 92 % of women, with reliable rheumatoid arthritis (American College of Rheumatology – ACR, 1987), were examined. The visual analog scale was used for an assessment of pain strength at the moment; the Van Korff’s questionnaire – for determination of pain strength at the moment and retrospectively for the last half a year with an assessment of disadaptation level and disability, ranging of a chronic pain syndrome on classes; the McGill Pain Questionnaire – for the characteristic of touchsensitive and emotional components of pain. Neuropathic pain was revealed by DN4 questionnaire. Anxiety and depression were determined by the Hospital Anxiety and Depression Scale (HADS). Fibromyalgia diagnosed by criteria of ACR, (1990). Results. Pain estimated by various scales and questionnaires varied from moderated to intensive. According to Van Korff’s questionnaire it was characterized by average level of disadaptation and easy disability that corresponded to the second class of chronic pain. The Rank pain index of the McGill Pain Questionnaire touch scale testified that pain was described by a smaller number of definitions on a touch scale than on emotional. This indicates a moderate impact of pain syndrome on a state of mind. Neuropathic pain is diagnosed for 37.3 % of patients with tunnel syndrome, mononeuritis and touch polyneuropathy. The secondary fibromyalgia is revealed for 2 % of patients with early rheumatoid arthritis of high activity. According to HADS anxiety and depression was revealed for 58 and 59 % of patients correspondingly. This demanded psychotherapeutic consultation and additional correction. We proposed the algorithm of diagnostic and medical tactics for rheumatoid arthritis patients with a chronic pain syndrome in therapeutic practice based on pain strength gradation, assessment of chronic pain syndrome variations, definition of anxiety and depression signs. All this allows to validate consultation of medical specialists and to differentiate treatment. Conclusions. The integrated approach to diagnostics of a chronic pain syndrome for rheumatoid arthritis allows to estimate pain strengths in dynamics of disease development, to reveal existence of pain variations, anxiety and depression. It enables usage of patient maintenance tactics and increases efficiency of treatment in therapeutic practice.

Background: High production of pro-inflammatory cytokines associated with procalcitonin synthesis and its increased blood levels play an important role in the pathophysiology of systemic inflammation in generalized bacterial infections. Aim: To assess diagnostic value of procalcitonin measurement as a marker of bacterial inflammation in cerebrospinal fluid for differential diagnostics of bacterial and viral meningitis. Materials and methods: Procalcitonin levels in blood and cerebrospinal fluid were measured by immunoenzyme analysis in 88 children aged from 3 months to 14 years who had been admitted to the hospital. Forty five percent (45.4%) of them had acute bacterial meningitis, 27.3%, viral meningitis and 27.3% had the meningitis-like syndrome (control group). Results: There was a high procalcitonin level in cerebrospinal fluid in patients with bacterial purulent meningitis (0,14 [0.0; 0.34] ng/mL (р < 0.006), with the normal range in the control group of 0.07 [0.0; 0.07] ng/mL. This parameter correlated with blood procalcitonin level (9.8 [2.05; 13.19] ng/mL) and severity of meningitis. In patients with viral meningitis, the procalcitonin levels were below the normal range (0.02 [0.01; 0.07] ng/mL). Conclusion: Measurement of procalcitonin levels in cerebrospinal fluid could be recommended for inclusion into the differential diagnostic algorithm of meningitis of various etiologies in children.

Background: Diagnosis of serious bacterial infections (SBI) in young children is a difficult task for pediatricians.Objective: Our aim was to determine regularities of the change of hemogram indicators and serum markers of inflammation for the differential diagnostics of SBI in children under the age of 5 years.Methods: The comparative retrospective study is carried out. We analyzed diagnostic characteristics of laboratory markers of SBI during the examination of 306 children with pyretic fever. We determined the number of leukocytes, neutrophils, immature granulocytes, reticulocyte hemoglobin equivalent, C-reactive protein (CRP) and procalcitonin.Results: The study of CRP content has the greatest diagnostic accuracy at differential diagnostics of SBI in children with infectious fever at the height of disease. It is established that the positive result of CRP ( 37 mg/L) increases the probability of SBI in patient from 17.6% to 70%, and the negative result (< 37 mg/L) reduces the probability of SBI to 4%.Conclusion: Cut-off values of the laboratory parameters obtained in our study can be used when assessing the post-test probability of SBI in children with infections accompanied by pyretic fever.

Usual practice of a physician quite oftenly shows difficulties in differentiation of ischemic heart disease and so called “stressor” myocardium changes, occuring in persons participating in sports.

The article gives systematicaly organized literature data and the author’s observations of different biliar tract disorder variants. The focus is on the comorbidity formation mechanisms analysis and the difficulties in differential diagnostics of various pathological conditions, associated with the gallbladder pathology and cholepatiae. Начало читайте в № 4

The article gives systematicaly organized literature data and the author’s observations of different biliar tract disorder variants. The focus is on the comorbidity formation mechanisms analysis and the difficulties in differential diagnostics of various pathological conditions, associated with the gallbladder pathology and cholepatiae.

Aim. To investigate the diagnostic potential of cardiac fatty acid binding protein (cFABP) vs. cardiac troponins at the early stages of acute coronary syndrome (ACS), by comparing specificity and sensitivity of the qualitative assessment of their blood levels. Material and methods. The independent Russian multi-centre study ISPOLIN (Clinical effectiveness of early acute myocardial infarction diagnostics, based on the assessment of cFABP levels) included 1049 patients, who were hospitalised with possible ACS diagnosis, within 1–12 hours from the clinical onset. At admission, all participants underwent a qualitative assessment of cFABP and troponin I (TrI) blood levels. For each test, sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were examined for the whole sample, as well as by gender, age, body mass index (BMI), test time, and electrocardiographic (ECG) changes. Results. The sensitivity of cFABP test was higher than that for TrI (73,8% vs. 46,7%, respectively). Specificity reached 92% and 97,2%, respectively. Respective accuracy values were 79,3% and 62,2%. PPV was 0,95 for cFABP and 0,97 for TrI, while NPV was 0,61 and 0,45, respectively. The maximal sensitivity of cFABP test was observed within 3–6 hours from the onset of acute myocardial infarction, and exceeded the sensitivity of TrI test by 18–32% at all examined time points. Regardless of the ECG change type, sensitivity of cFABP test was higher than that of TrI test by 19–73%. For both tests, sensitivity and specificity did not correlate with age, gender, or BMI. Conclusion. Within the first 12 hours from the clinical onset of possible ACS, a Russian express test, which qualitatively assesses cFABP levels, demonstrated higher sensitivity, accuracy, and NPV, compared to the TrI test. The cFABP test can, therefore, be recommended for a wider use in clinical practice.

In this article author describes the experience of J.Lacan’s psychoanalytic theory application as a basic point in the work of a school psychologist. The author insists on the necessity of interdisciplinary dialogue between psychoanalysts and teachers, psychiatrists, as well as representatives of other schools of psychotherapy. Author presents the psychoanalytic method of structural approach to differential diagnostics of neuroses and psychoses, accompanying the clinical psychoanalytic principles with examples from her own practice.

Morphological diagnostics of mesenhymal uterine neoplasms is complex due to polymorphism of benign and malignant processes. The purpose of our research was to devise the complex differential diagnostics criterions for foregoing tumors founded on expression's indexes of biological tissue's properties markers studying. We determined, that for smooth muscle tumors with unknown malignant potential diagnostics, it will be an expedient to use as main markers p53, Ki-67, ER, PGR and as auxiliary p21, bax, VEGF, TSP-1, CD34. For differential diagnosis of leiomyomas and endometrial stromal tumors it is neсessary to use СD10, desmin, α-SMA, h-caldesmon, Ki-67. For definition of atypia's level in the tumors of endometrial stroma, the most informative will be diagnostical panel from Ki-67, p53, ER, PGR, and cyclin D1. To solve the issue of histogenesis will help the complex consists of CD10, α-SMA, desmin, та h-caldesmon.

Morphological diagnostics of mammary gland neoplasm is complex due to polymorphism of tumors and tumor-like processes. The purpose of our research was to reveal the basic and additional immunohistochemical markers for differential diagnostics of some diseases. We have established that the basic markers for differential diagnostics of adenosis and invasive carcinomas were MSA, α-SMA, S100, collagen IV, р63, Кі-67 and р53, additional - 34βЕ12, СК7, СК8, СК5/6, E-cadgerin. The loss of expression of myoepithelial markers, positive reaction with Кі-67, р53, Her2/neu also matters. Mutually contrary patterns of 34βЕ12 and E-cadgerin expression allow to differentiate ductal or lobular primacy of process. СК7, СК8, 34βЕ12 play a key role in differential diagnostics of carcinosarcomas and sarcomas. myoepithelial markers and basal membrane also give the additional information. At differential diagnostics of carcinoma and malignant tumors of other nature СК7, СК8, E-cadgerin, Her2/neu, ER/PgR, myoepithelial markers were the most important, being typical only for epithelial tumors. At Paget disease the reliable diagnostic criteria are absence of S100 and expression of certain classes СК (more often luminal epithelium СК7, СК8), E-cadgerin, СЕА. Clone AE1/AE3 and revealing СК7 is valuable for diagnostics of micro-metastasises.

The results of differential express diagnostic of tick-borne encephalitis and Lyme borreliosis agents in ticks, removed from pa- tients are present in this article (1995—2004). The entire complex of serolological and genetical methods were used. The specific prophylaxis based on the results of diagnostic had shown to be very effective for both infections. The first data about human ehrli- chiosis and anaplasmosis in Irkutsk region had been obtained. The improvement of diagnostic and prophylactic procedures are pro- posed.

Tо determine principal pathogenetic factors of therapy-resistant arterial hypertension (AH), 41 patients were examined: 1 male and 40 females aged 34-65 years, who suffered from malignant arterial hypertension (MAG). Control groups included 43patients (2 males and 341 females, aged 25-66 years) with Stage I-II AH by WHO-ISH classification (1999), as well as Stage III AH patients (N=45, 2 males and 43 females, aged 34-65 years). Intracardiac and central hemodynamics was assessed by echocardiography, renal function - by renoradiography, dynamic and static renoscintigraphy, and endogenous creatinine clearance. 24-hour extraction of cyclic nucleotides (cAMP and cGMP) was assessed by radioimmune method. Renal parenchimal disorders and vasorenal factors were the leading factors of MAH development. In MAH pathogenesis, various pathogenic factors - renal, vascular, endocrine, metabolic, and neurologic - were combined. All MAH patients demonstrated resistant hemodynamic type, with severe vasospastic reactions of eye vessels, and increased cGMP excretion, a symptom of reduced vasodilatator (NO) synthesis in vascular endothelium.

The all-Russian frequency data of ulcerative colitis and Crohn’s disease are resulted in the article, the case report reflecting the difficulties of differential diagnostics of ulcerative colitis and Crohn’s disease is presented.

The authors propose a fundamentally new, theoretically grounded and empirically supported approach to psycho-pedagogical diagnostics of developmental disorders. It is shown that in Russia psychological diagnostics of developmental disorders still has no proper theoretical foundations and is carried out rather intuitively and empirically, even on the stage of differential diagnosis. The situation abroad is quite similar despite the use of standardized intelligence tests as they can only measure quantitative differences in subjects’ performance. The authors emphasize core components of cognitive activity different correlation of which determines the differences between various types of intellectual disorders that are similar in presentation. The proposed approach allows us to fully use the relevant characteristics of different types of developmental disorders. Features of the dynamics of cognitive activity, which are identified in observations and ignored in testing, significantly complement the psychological characteristics of developmental disorders.

Primary T-cell cutaneus lymphoma presents in 10-15% of children with malignant tumour. This disease is results of the neoplastic proliferation T-lymphocytes in skin. Diagnostics has based on the histology, immunology and immunohistochemistry methods. We describe a clinical case of three-month-old child with Primary T-cell cutaneus lymphoma of skin.

Objective: Identification of features of cognitive impairment at patients with alcoholic and discirculatory encephalopathy., Material and Methods: 30 patients with the alcoholic encephalopathy (AE) and 32 - with discirculatory encephalopathy (DE) participated in research. To patients conducted clinical examination, a computer electroencephalography with determination of cognitive evoked potentials, neuropsychological testing., Results: General and distinguishing characters of a clinical picture, cognitive deficiency, disturbances in the emotional and personal sphere at patients with encephalopathies alcoholic and vascular genesis are established., Conclusion: It is established that a basis of a clinical picture of encephalopathy of various genesis are the cognitive disturbances (CD) and an asthenic syndrome, of AE it is characteristic hyposthenic, and at DE - hyper - and hyposthenic syndromes. Changes of bioelectric activity of a brain at DE had primary localization in occipitoparietal departments of a brain, at AE - in temporal and occipitoparietal assignments. Disorder of categorial thinking, the long-term memory, reciprocal coordination, manual gnosis indicating dysfunction by a frontal, parietal lobe of the left hemisphere, a hippocampus, a corpus collosum are provided to CD in DE and AE patients. It is established that distinguishing characters of CD in AE and DE patients are values of indexes Δ-, β1-, β2-rhythms, the indicators characterizing the impressive speech, volume of visual figurative memory, level of severity of hypochondria.

Research objective identification of the peculiarities of indicators of audiological examination, registration of somatosensory induced potentials (SSSP), level of constant potential (LCP) and neuropsychological testing in persons of flight composition (LLS) of civil aviation exposed to intra-cabin noise, depending on the degree of expression of professional neurosensory noise (ONIHL)., Patients and Methods: Thresholds of acoustical sensitivity, levels of perception of shepotny, informal conversation, UPP, characteristic of SSVP, neuropsychological features at 45 patients with easy degree of PNST (LONIHL) and at 50 - with moderate degree of ONIHL (UONIHL) are studied., Results: LCP in the left frontal (Fs), central dark (Pz) leads increased in persons with ONIHL, and the inter-peak interval of the N13-N20 characterizing the central conduct time increased. The FAB, unlike the LONIHL, is characterized by deterioration of cognitive activity in the form of easily pronounced decrease of visual memory functions, expressive speech, FAB scale value indicating priority dysfunction of frontal, dark-occipital lobes, subcortical cerebral structures., Conclusion: Neurofunctional markers in UONIHL are the reduction of the indicators of the interfamily relations on the frontal department, conceptual thinking, visual image memory, expressive speech, MMSE and FAB tests, the increase of LCP in the left temporal, central dark, occipital right central N13-N20, inter-peak N25.

The paper focuses on the diagnostics, clinics, and treatment of functional heart diseases, which require high professionalism and interdisciplinary knowledge and skills from health professionals.