Acrodystrophic axonal polyneuropathy with celiac disease: a case report.

BACKGROUND: Patients with celiac disease present with not only gastrointestinal symptoms but also extraintestinal manifestations such as anemia, osteopathy, dermatitis herpetiformis, and celiac neuropathy. Despite a fairly wide range of celiac neuropathies, we report a case of the acrodystrophic variant of celiac polyneuropathy, which has not been previously described. CASE PRESENTATION: A 41-year-old Ukrainian male suffered from symmetric, sensorimotor axonal polyneuropathy and encephalopathy associated with celiac disease, which is characterized by severe trophic disorders in the lower extremities (trophic ulcers, hyperkeratosis, and anhidrosis). Acrodystrophic changes in the lower extremities were due to both neurogenic and direct immunoinflammatory damaging effects. Clinical-electrophysiological dissociation was also noted, which was represented by a gross axonal lesion with the preservation of muscle strength. The absence of enteropathic manifestations was accompanied by the pronounced histological changes in the duodenal mucosa by IIIb stage of Marsh. A gluten-free diet in combination with membrane plasma exchange and intravenous pulse methylprednisolone was prescribed to reduce the severity of sensory disorders and regression of encephalopathy within 7 months. CONCLUSION: Celiac disease may be a potential cause of neuropathy and encephalopathy in adult patients. Further immunosuppressive treatment protocols for both intestinal and extraintestinal manifestations of celiac disease are required.

Large porous particles for respiratory drug delivery. Glycine-based formulations.

Large porous particles are becoming increasingly popular as carriers for pulmonary drug delivery with both local and systemic applications. These particles have high geometric diameters (5-30µm) but low bulk density (~0.1g/cm3 or less) such that the aerodynamic diameter remains low (1-5µm). In this study salbutamol and budesonide serve as model inhalable drugs with poor water solubility. A novel method is proposed for the production of dry powder inhaler formulations with enhanced aerosol performance (e.g. for salbutamol-glycine formulation the fine particle fraction (FPF≤4.7µm) value is 67.0±1.3%) from substances that are poorly soluble in water. To overcome the problems related to extremely poor aqueous solubility of the APIs, not individual solvents are used for spray freeze-drying of API solutions, but organic-water mixtures, which can form clathrate hydrates at low temperatures and release APIs or their complexes as fine powders, which form large porous particles after the clathrates are removed by sublimation. Zwitterionic glycine has been used as an additive to API directly in solutions prior to spray freeze-drying, in order to prevent aggregation of powders, to enhance their dispersibility and improve air-flow properties. The clathrate-forming spray freeze-drying process in the multi-component system was optimized using low-temperature powder X-ray diffraction and thermal analysis.

[A new view on the problem of nonneoplastic stenosis of the major duodenal papilla. Results of a prospective investigation].

The article contains results of a continuous prospective investigation of the normal course of the major duodenal papilla stenosis in 167 patients. It was revealed that the course of the disease was benign, pain syndrome became inconsiderable in the course of time, the degree of changes in biochemical analysis of blood was not significant. The development of complications (choledocholithiasis, acute pancreatitis, jaundice) was noted in 6-14% of the patients, depending on the presence or absence of GID. The data obtained allow suggestion of an algorithm of managing the patients.

[Adaptive immune response of people living near chemically hazardous object].

The article presents data dynamics of adaptive immune responses of people for a long time living in adverse environmental conditions caused by pollution of the environment by industrial toxic waste. It is shown that in the process of adaptation to adverse environmental factors, changes in the immune system are in the phase fluctuations of immunological parameters that are accompanied by changes in the structure of immunodependent pathology. Most sensitive to prolonged exposure to toxic compounds are the cellular mechanisms of immune protection. Violations of the structural and quantitative and functional parameters of the link of the immune system are leading to the formation of immunopathological processes.

[Analysis of efficacy of extensive systematic transperineal TRUS-guided cor biopsy of the prostate].

The paper presents the technique of extensive systemic transperineal TRUS-guided cor biopsy of the prostate. Some aspects of the patients' safety and quality of biopsy cores are considered. The analysis of TNM stages of the detected cancers (55 cases out of 142 patients who have undergone systemic biopsy) showed 65.4% of local cancer (T1-2). The quality of cores was adequate for histological examination in 92.8% cases. None serious complications was reported. Only in two of ten patients subjected to radical prostatectomy stage T2 was changed to stage T3 in the absence of metastases to regional lymph nodes and distant metastases.

[Current complex noninvasive diagnosis of parathyroid tumors]. / Sovremennaia kompleksnaia neinvazivnaia diagnostika opukholei parashchitovidnykh zhelez.

The diagnosis of bulky formations of the parathyroid glands (PTG) has become possible since current high-resolution techniques of visualization, such as ultrasound study (USS), computed tomography (CT), magnetic resonance imaging (MRI), were introduced into practice. The presence of clinical and/or laboratory signs of hyperparathyroidism (HPT) is a signal to initiate a goal-oriented search for abnormal PTG formations. The complex diagnosis of HPT involves the methods of detecting osteoporosis ranging from routine X-ray study of the hand and foot to more in-depth techniques: dichromatic X-ray absorptiometry (DXA) and quantitative CT (QCT). USS is an excellent method for screening if abnormal PTC changes are suspected; however, negative USS results in the presence of clinical and/or laboratory signs of HPT should not stop a diagnostic search. CT with intravenous contrast bolus specifies the site and structure of an formation, has some advantage in detecting retrosternal tumors. Due to its high tissue contrast, three-dimensional images, none ionizing radiation and osseous structural artefacts, MRI becomes a preferable tool for studying PTG when they are typically or atypically located. Needle biopsy is required when noninvasive methods cannot characterize the pattern of an abnormal PTG formation properly or their results are contradictory.

[The internal structure of soft and bony tissues studied by X-ray refraction introscopy]. / Issledovanie vnutrennei struktury miagkikh i kostnykh tkanei metodom rentgenovskoi refraktsionnoi introskopii.

Whether X-ray refractional introscopy can be used to examine biological objects was studied. The characteristic emission of an X-ray tube provided refractional radiograms of the rat heart and limb, which allow one to make out the details of the structure of soft tissues and bones invisible on absorption radiograms under the same conditions. High-contrast refractional images of calcified formations were seen in the real-time mode when they were registered with a two-coordinate TV detector. The potentialities of the new method and medical diagnostic means are discussed.