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AEROTRACTION AND ADJUSTABLE DAMPER SPINAL TRACTION
*M.K. Omarbekov
NCJSC «National medical university named after S.D. Asfendiyarov», Almaty
SUMMARY
From May 2018 to March 2020, 287 patients with a diagnosis of protrusion and hernia of the intervertebral discs of the cervical and lumbar spine were admitted to the medical center «SANA».
This article presents the results of studies to determine the effect of the Aerotraction apparatus and adjustable damper traction (Utility model patent No. 3975) on various pathological conditions of the spine (protrusion and hernia of different sizes and localizations) and a comparative analysis with previously existing methods of skeletal traction of the spine (dry and underwater) as well as determining the risk group (persons most susceptible to these diseases).
Key words: aerotraction, adjustable damper spinal traction.
UDC 614.2-616-01/-099-616.2-617 DOI: 10.24411/1995-5871-2020-10092
A MULTIPLE COMBINED COMPLICATED CHEST HYDATID CYST: MIS-DIAGNOSIS AS A CHEST MALIGNANCY
*1 B.B. Akimniyazova, 2 T.Sh. Yeshmuratov, 1 G.K. Kausova
1 Kazakhstan's medical university «Kazakhstan's school of public health», Almaty 2 Center of modern medicine «MEDITERRA», Almaty
SUMMARY
Hydatid disease, which is also known as cystic echinococcosis, is a zoonotic infection caused by the cestode tapeworm Echinococcus granulosus and rarely by Echinococcus multilocu-laris. Combined complicated multiple pulmonary echinococcosis is the most severe ^ form of pathol-ogy, the diagnosis and treatment of which presents significant difficulties in ^ connection with a long, progressive and often asymptomatic course of the disease. In this report ^ we describe a case of a 38-year-old-male patient with complaints of right side chest pain. A § computed tomography of the chest revealed a multiple masses in the left chest. Firstly, this was regarded as a chest malig-nancy. After discussion with radiology, tuberculosis specialist and oncologist, the preliminary di-agnosis was multiple echinococcosis, and thoracotomy with a echinococcectomy was performed to remove the cysts. The final pathologic diagnosis was a chest hydatid cyst. For patients from en-demic areas, hydatid cyst should be included in the differential diagnosis, moreover, clinical cases must be discussed by multidisciplinary approach
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Key words: Hydatid disease, echinococcosis, multiple, combined, complicated, chest. bekus777@mail.ru
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Introduction. Hydatid disease (HD) is and continues to be an urgent public health prob-lem in developing countries [1] with livestock production, such as the Republic of Kazakhstan. Endemic areas are located in the Asia, South America, Australia, Africa and Middle East. At that time, Kazakhstan is also endemic area of tuberculosis [2], and the increasing of oncological cases number do severity the accurate diagnosis of focal shadows on computed tomography scan.
The article presents a clinical case of combined multiple complicated chest echinococcosis, which was originally diagnosed as a malignant disease of the chest organs. A multidisciplinary ap-proach to diagnosis has successfully identified a diagnosis and treatment tactics.
Case report. A 38-year-old-male underwent annual preventive examinations
at the clinic at the place of residence where fluorography was performed, with the result that no pathology of the respiratory system was found.
At the next preventive examination on fluorography revealed shadows in the right lung. The patient was referred to a general practitioner who prescribed a chest x-ray and further consulta-tion with a tuberculosis (TB) specialist. On the chest x-ray, multiple focal shadows in the right lung were revealed, therefore the patient was sent for computed tomography of the chest (chest CT). The patient was examined by a TB specialist, so tuberculosis was excluded.
During the examination in the oncology clinic, the results of chest CT were diagnosed with pleural mesothelioma (picture 1) and a transthoracic puncture biopsy was recommended.
Picture №1. Chest CT - mesothelioma
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Having abandoned the procedure, a month later the patient independently contacted to our clinic to thoracic surgeon with the main complaint of moderate pain in the right half of the chest that occurred during breathing. In the study of chest CT, together
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with specialists in radiology, multiple focal formations of the chest and fluid formation of the lung were found, which was the criterion for the diagnosis «Combined complicated multiple echinococcosis of the right lung, pleu-ra, diaphragm, pericardium» (picture 2 ).
Picture №2. Chest CT - hydatid cyst
From the patient's anamnesis - he is an office worker, had no prior medical problems, no medical illness that run the family, no history of tobacco smoking, no consuming alcohol or chest trauma.
At presentation, he had no cough and fever. Objective status was without any pathological changes. Laboratory and instrumental methods of research were without
any pathology in his or-ganism.
During the operation process, right side thoracotomy was performed which showed an evi-dence of multiple mass in the right lung, pleura, diaphragm, pericardium, intercostal muscles, the surgical field was isolated with surgical sponges soaked with betadine to control any intraoperative spillage, and echinococcectomy was done (picture 3,4,5).
Picture №3. Surgical revision
Picture №4. Echinococcectomy
Picture №5. Parasite cavity
Microscopic description: in areas of lung tissue there are cavities where walls are represented by coarse-fibrous connective tissue, with infiltration by lymphoid cells and admixture of plas-mocytes, and necrosis on the inner surface is marked. Chitinous membranes, ribbon structures, layered, pink,
Picture №6. Fibrous capsule
with preservation of the cuticular and germ layer, are visible in the lumen.
Conclusion of the pathological study: the morphological picture corresponds to echinococcosis, chronic pleurisy with plasma cells and eosinophilic infiltration with foci of fibrosis (picture 6, 7, 8).
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Picture №7. Chitin shell
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Picture №8. Chitin shell andfibrous capsule
Postoperative chest x-ray on the first day after surgery: the lungs are
straightened, and no revealed (picture 9).
fluid or gas was
Picture №9. Postoperative X-ray
Following surgery, antibacterial, antihistamine, mucolytic, and analgesics were performed. Drainage was removed on the 3rd day after surgery. Patient was sent home after 7 days. Follow-up was done a week later, the wound looked well. The stitches were removed on the 10th postop-erative day. Albendazole (Zentel) 400 mg per day given for 28 days, with an interval of 2 weeks on the background of hepatotropic therapy (heptral 400 mg 2
times per day).
Discussion. Hydatid disease is a parasitic disease and belongs to one of the most severe types of anthropozoonosis. According to statistics, in Kazakhstan in 2017, there were 217 cases of echinococcosis per 100,000 people.
The predominant localization of the lesion is the parenchymal organs of the abdominal cavity and chest, as well as frequent
cases of multiple and combined invasion, The course of the disease requires
various infection routes even in the absence timely diagnosis and treatment to prevent
of risk factors [3], cases of rare localization morbidity, re-lapse and mortality and raise
[4], the variety of morphological changes of life quality. This case report presents the need
the parasitic cyst depending on the stage of to improve the algo-rithm for diagnosing
development, the diagnosis of the disease still and treating a population with combined
presents certain difficulties. multiple complicated echinococcosis of the
Due to the absence of pathognomonic chest organs in endemic regions, by including
symptoms, as well as the prolonged specialists in radiology, ultrasound diagnostic,
asymptomatic course, echinococcosis is pulmonology, thoracic surgeons, and
diagnosed in a number of cases by accident oncologists in the algorithm for diagnosing
during examination for other diseases [5], or focal chest le-sions.
when various complications are attached to Conclusion. A multidisciplinary
it. As in this example described, the absence approach allows not only differential diagnosis
of alertness about parasitic diseases leads to of parasit-ic diseases, but also the most rational
overdiagnosis of cancer and improper patient treatment tactics and, ultimately, improve
management tactics. treatment outcomes and patient's life quality.
REFERENCES
1. Vuitton DA. The WHO informal working group on echinococcosis. Coordinating Board of the WHO-IWGE. Parassitologia 1997; 39: 349-353.
2. Tuberculosis epidemiological review in Kazakhstan 19-09-2017 http://www.euro.who. int/en/health-topics/communicable-diseases/tuberculosis/news/news/2017/09/tuberculosis-epidemiological-review-in-kazakhstan
3. Su-Jin Kim, Jong-Han Kim, Sang-Young Han, Young-Hoon Kim, Jin-Han Cho, Jong-Yil Chai, Jin-Sook Jeong. Recurrent Hepatic Alveolar Echinococcosis: Report of The First Case in Korea with Unproven Infection Route. The Korean Journal of Parasitology 2011; 49(4): 413-418.
4. Biniam Ewnte. Hydatid cyst of the foot: a case report Journal of Medical Case Reports (2020) 14:6
5. Mustafa Calik, MD, Saniye Calik, MD, Hidir Esme, MD. Vertebral Hydatid Cyst: "White Cancer". CHEST Journal. October 2015. Volume 148, Issue 4, Supplement, Page 149A.
Bekdaulet Begdullaevna Akimniyazova https://orcid.org/0000-0002-4906-4959
Temur Sherhanovich Yeshmuratov https://orcid.org/0000-0002-4413-4196
Galina Kalievna Kausova https://orcid.org/0000-0002-4130-3337
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КвПТЕГЕН АРАЛАС КЕУДЕ ЭХИНОКОККОЗЫНЬЩ КАТЕЛ1К ДИАГНОСТИКАМ! ci
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1 «^огамды; денсаулы; сактау жогары мектебЬ» ^МУ, Алматы к-сы
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Эхинококкоз - Echinococcus granulosus жэне сирек Echinococcus multilocularis тасбегшщ цестодынан туындаган зоонозды инфекция. «Экпенщ аралас кYPделi эхино-
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НЕПРЁРЫЫНО О ОБРАЗОВАНИЕ
коккозы патологияныц ауыр TYpi болып табылады, оны аныктау жэне емдеу аурудын узак, прогрессивтi жэне жш асимптоматикалык агымына байланысты айтарлыктай киындыктар тугызады. Бул материалда оц жакта кеуде ауырсынуына шагымданган 38 жастагы наукастыц жагдайы сипатталган. Кеуде куысыныц компьютерлiк томографиясы кеуденщ сол жак жартысында бiрнеше фокальды закымдануды кeрсеттi. Бул жагдай кеуде органдарыныц катерлi iсiгi ретiнде карастырылды. Рентгенологпен, туберкулез бойынша маманмен жэне онкологпен талкылаудан кейiн алдынала диагноз койылды - кептеген эхинококкоз жэне торакотомия, эхинококкэктомия жасалды. Патоморфологиялык зерт-теу корытынды диагнозды растады - кеуде органдарыныц эхинокококкозы. Эндемиялык аймактардагы наукастар Yшiн эхинококкоз ауруы катерлi iсiктер мен туберкулездщ диф-ференциалды диагнозына енгiзу керек, сонымен катар клиникалык жагдайларды тиiстi мамандармен пэнаралык байланысты колдана отырып талкылау керек.
Клт свздер: кептеген аралас эхинококкоз, диагностика, кеуде.
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СЛУЧАЙ ОШИБОЧНОЙ ДИАГНОСТИКИ МНОЖЕСТВЕННОГО КОМБИНИРОВАННОГО ЭХИНОКОККОЗА ОРГАНОВ ГРУДНОЙ КЛЕТКИ
*1
Б.Б. Акимниязова, 2 Т.Ш. Ешмуратов, 1 Г.К. Каусова
1 КМУ «Казахстанская школа общественного здравоохранения», г. Алматы 2 Центр современной медицины «МЕДИТЕРРА», г. Алматы
АННОТАЦИЯ
Эхинококкоз, представляет собой зоонозную инфекцию, вызываемую цестодой лен-точного червя Echinococcus granulosus и редко - Echinococcus multilocularis. Комбинированный осложненный множественный эхинококкоз легких является наиболее тяжелой формой патологии, диагностика и лечение которого представляют значительные трудности, в связи с длительным, прогрессирующим, и часто бессимптомным течением заболевания. В этом материале описан случай 38-летнего пациента с жалобами на боль в груди справа. Компьютерная томография органов грудной клетки показала множественные очаговые образования в левой половине грудной клетки. Данная ситуация была расценена как злокачественная опухоль органов грудной клетки. После обсуждения с рентгенологом, фтизиатром и онкологом, был выставлен предварительный диагноз -множественный эхинококкоз, и выполнена операция торакотомия с эхинококкэктомией. Патоморфологическое исследование подтвердил окончательный диагноз - эхинокококоз органов грудной клетки. Для пациентов из эндемичных областей эхинококкоз должен быть включен в дифференциальный диагноз злокачественных опухолей и туберкулеза, rf более того, клинические случаи должны обсуждаться с помощью междисциплинарного
подхода с соответствующими специалистами. sa Ключевые слова: эхинококкоз, множественный, сочетанный, грудная клетка.
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