A description of two cases of cardiovascular syphilis is presented. The introduction discusses the relevance of visceral syphilis. The literary review is constructed in a chronological format and reflects the stages of studying the problem of cardiovascular syphilis. It emphasizes that cardiovascular syphilis is currently a rare pathology and internists are more likely to encounter it. Verification of the pathology of the cardiovascular system, including aortic aneurysm, during the early stages of syphilis (early latent) does not exclude the option of combined pathology. Early forms of syphilis in patients with diseases of the cardiovascular system should be considered a factor that complicates diagnosis. Such patients should be carefully examined to determine the cause of the disease. Rationale for the diagnosis of cardiovascular syphilis requires a comprehensive assessment of the results of clinical, laboratory and instrumental examination of the patient. A preliminary diagnosis of the specific etiology of an aortic aneurysm should be based on the following criteria: 1) relatively young age of patients with socially inappropriate sexual behavior; 2) sudden onset and rapid progression of the main signs of the disease. All patients with newly diagnosed aortic aneurysm at the outpatient stage should perform a serological examination. The diagnosis of cardiovascular syphilis, namely a syphilitic mesaortitis, can be established or confirmed by an autopsy.
A brief review of the literature on the problem of double porphyria and analysis of its own observation is presented. For more than 10 years patient B was observed for more than 10 years with a verified diagnosis of acute intermittent porphyria, which manifested with acute pain abdominal syndrome, neurological disorders in the form of peripheral polyneuropathy and hemiparesis of lower extremities, and hypertension syndrome was also noted. The observed clinical symptoms corresponded to an acute porphyrin crisis in the manifestation and / or relapse of acute intermittent porphyria. The diagnosis was confirmed by a quantitative determination of the excretory profile of porphyrin precursors (δ-aminocaproic acid, porphobilinogen) and porphyrin fractions (uroporphyrin, coproporphyrin). Their concentrations are significantly (especially porphyrin precursors) exceeding the control values, which is the cardinal diagnostic criterion of acute intermittent porphyria. Against the backdrop of persistent clinical and biochemical remission of acute intermittent porphyria, symptoms of photosensitization of the skin (blisters, erosion, pigment spots) on the dorsal surface of the hands began to appear in 4 years. Later, hypertrichosis was formed in the temporo-periorbital region. The constellation type of the excretory profile of porphyrins began to change. Against the backdrop of persistent increased excretion of porphyrin precursors (δ-aminolevulinic acid and porphobilinogen), a progressive increase in the excretion of the fraction of uroporphyrin was observed, which became dominant (up to 58% of the total content of porphyrins). Such a prolonged observation in the dynamics allowed us to state the appearance of a new variant of the porphyrin exchange disturbance, which, taking into account clinical symptoms, corresponded to another form of hepatic porphyria, namely, late cutaneous porphyria. The clinical and biochemical changes in the excretory profile of the parameters of porphyrin metabolism registered in the dynamics of observation may indicate the occurrence of a combined enzymatic defect characteristic of double porphyria. In our case, a manifestation of late cutaneous porphyria was noted against a background of compensated acute intermittent porphyria.
Purpose of research. Study of the frequency of detection of mutations in the α1 -antitrypsin SERPINA1 gene in non-alcoholic fatty liver disease (NAFLD) in comparison with individuals from the General population and assessment of features of metabolic disorders.Materials and methods. 439 people were examined, including 114 patients with NAFLD and 325 individuals in the General population. All subjects were subjected to molecular genetic testing. The frequency of mutations of the Glu342Lys (PIZ) and Glu264Val (PIS) alleles of the serpina1 α1-antitrypsin gene was evaluated. All patients with NAFLD underwent a comprehensive examination, during which standard indicators of liver function, lipid, porphyrin metabolism and cytokine spectrum were determined.Results. Mutations of the α1 -antitrypsin SERPINA1 gene are signifi cantly more common in patients with NAFLD compared to individuals in the General population. Violations of lipid, porphyrin metabolism and cytokine spectrum parameters in the presence of mutations of the α1-antitrypsin SERPINA1 gene or their absence were registered with the same frequency. Against the background of mutations of the α1 -antitrypsin SERPINA1 gene, deviations from the normal values of lipid, porphyrin metabolism and cytokine spectrum were more signifi cant. Violations of porphyrin metabolism and cytokine spectrum were found in the majority of patients (in 69.4% and 77.1% of cases, respectively). Conclusion.Conducting molecular genetic studies in NAFLD allows you to clarify the degree of metabolic disorders and assess the prognosis of the disease.
The article analyzes the problem of post-COVID syndrome, which is formed in a number of patients after an infection caused by the SARS-CoV-2 virus. The manifestations of the post-COVID syndrome are highly variable. Almost all organs and systems can be involved in the pathological process. In the presented report, two clinical cases of manifestation of post-COVID syndrome caused by dysfunction of the gastrointestinal tract are purposefully analyzed and discussed. In one case, the post-COVID syndrome manifested itself as a manifestation of dyspeptic disorders. The examination did not confrm the functional nature of the pathology. In the second case, a diarrheal syndrome was observed that arose 2 months after the infection with SARS-CoV-2. The peculiarity of the observation is that in a patient suffering from diverticular disease of the colon, a rapid growth of the polyp of the sigmoid colon was observed. The issue of the influence of infection on the progression of the tumor process is discussed.
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