CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION AS A RARE INITIAL PRESENTATION OF SYSTEMIC LUPUS ERYTHEMATOSUS COMPLICATED BY ANTIPHOSPHOLIPID SYNDROME: A CASE REPORT

6a07212c65701 20260515173540 atsmu:atsmu davronov@ajoibot.tj WEB-FORM SCIENCE AND EDUCATION SE 30785022 30785030 2024 2024 1 3 Array ( [ID] => 32556 [~ID] => 32556 [NAME] => CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION AS A RARE INITIAL PRESENTATION OF SYSTEMIC LUPUS ERYTHEMATOSUS COMPLICATED BY ANTIPHOSPHOLIPID SYNDROME: A CASE REPORT [~NAME] => CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION AS A RARE INITIAL PRESENTATION OF SYSTEMIC LUPUS ERYTHEMATOSUS COMPLICATED BY ANTIPHOSPHOLIPID SYNDROME: A CASE REPORT [DETAIL_TEXT] => Pulmonary arterial hypertension (PAH) is a recognized complication of systemic lupus erythematosus (SLE), presenting with a wide spectrum of clinical manifestations ranging from asymptomatic to life-threatening. Pulmonary embolism, leading to chronic thromboembolic pulmonary hypertension (CTEPH), is a known pathogenetic mechanism of PAH in SLE patients with secondary antiphospholipid syndrome (APS). This case report describes a unique initial presentation of SLE in a 20-year-old patient manifesting as life-threatening CTEPH (WHO Functional Class IV). This case highlights the diagnostic challenges encountered in resource-limited settings. The patient presented with severe dyspnea, and CTEPH was subsequently diagnosed in the context of secondary APS. Management included transluminal balloon pulmonary angioplasty (BPA) followed by targeted medical therapy. Timely endovascular intervention and immunosuppressive therapy resulted in significant hemodynamic improvement – reducing the mean pulmonary artery pressure (mPAP) from 97 to 60 mm Hg – and an improved functional status. [~DETAIL_TEXT] => Pulmonary arterial hypertension (PAH) is a recognized complication of systemic lupus erythematosus (SLE), presenting with a wide spectrum of clinical manifestations ranging from asymptomatic to life-threatening. Pulmonary embolism, leading to chronic thromboembolic pulmonary hypertension (CTEPH), is a known pathogenetic mechanism of PAH in SLE patients with secondary antiphospholipid syndrome (APS). This case report describes a unique initial presentation of SLE in a 20-year-old patient manifesting as life-threatening CTEPH (WHO Functional Class IV). This case highlights the diagnostic challenges encountered in resource-limited settings. The patient presented with severe dyspnea, and CTEPH was subsequently diagnosed in the context of secondary APS. Management included transluminal balloon pulmonary angioplasty (BPA) followed by targeted medical therapy. Timely endovascular intervention and immunosuppressive therapy resulted in significant hemodynamic improvement – reducing the mean pulmonary artery pressure (mPAP) from 97 to 60 mm Hg – and an improved functional status. [PROPERTY_DOI_VALUE] => 10.25005/2074-0581-2026-28-1-279-287 [~PROPERTY_DOI_VALUE] => 10.25005/2074-0581-2026-28-1-279-287 [PROPERTY_DOI_VALUE_ID] => 32556:200 [~PROPERTY_DOI_VALUE_ID] => 32556:200 [PROPERTY_216_VALUE] => /upload/global/pdf/2026/1/279-287.pdf [~PROPERTY_216_VALUE] => /upload/global/pdf/2026/1/279-287.pdf [PROPERTY_216_VALUE_ID] => 32556:216 [~PROPERTY_216_VALUE_ID] => 32556:216 [DETAIL_TEXT_TYPE] => text [~DETAIL_TEXT_TYPE] => text )

CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION AS A RARE INITIAL PRESENTATION OF SYSTEMIC LUPUS ERYTHEMATOSUS COMPLICATED BY ANTIPHOSPHOLIPID SYNDROME: A CASE REPORT МЕТАСТАТИЧЕСКИЙ РАК ГОЛОВЫ И ШЕИ БЕЗ ВЫЯВЛЕННОГО ПЕРВИЧНОГО ОЧАГА: ДИАГНОСТИКА И ЛЕЧЕНИЕ Multidisciplinary Clinical Medical Center "Medical City", Tyumen, Russian Federation M.I. SOKOLOVA V.I. PAVLOVA Tyumen State Medical University, Tyumen, Russian Federation Pulmonary arterial hypertension (PAH) is a recognized complication of systemic lupus erythematosus (SLE), presenting with a wide spectrum of clinical manifestations ranging from asymptomatic to life-threatening. Pulmonary embolism, leading to chronic thromboembolic pulmonary hypertension (CTEPH), is a known pathogenetic mechanism of PAH in SLE patients with secondary antiphospholipid syndrome (APS). This case report describes a unique initial presentation of SLE in a 20-year-old patient manifesting as life-threatening CTEPH (WHO Functional Class IV). This case highlights the diagnostic challenges encountered in resource-limited settings. The patient presented with severe dyspnea, and CTEPH was subsequently diagnosed in the context of secondary APS. Management included transluminal balloon pulmonary angioplasty (BPA) followed by targeted medical therapy. Timely endovascular intervention and immunosuppressive therapy resulted in significant hemodynamic improvement – reducing the mean pulmonary artery pressure (mPAP) from 97 to 60 mm Hg – and an improved functional status. 10.25005/2074-0581-2026-28-1-279-287 Array ( [ID] => 32555 [~ID] => 32555 [NAME] => HYPERSENSITIVITY PNEUMONITIS IN AN INFANT: A CLINICAL CASE [~NAME] => HYPERSENSITIVITY PNEUMONITIS IN AN INFANT: A CLINICAL CASE [DETAIL_TEXT] => Hypersensitivity pneumonitis (HP) is a rare immunopathological disease unrelated to an IgE-mediated mechanism that affects the alveoli, interstitial tissue, and peripheral airways. It develops from repeated inhalation of organic dust and microparticles <5 μm. HP is characterized by a variable clinical course, which significantly complicates diagnosis. In recent years, the number of publications devoted to HP in children has increased, indicating growing interest in this issue. The present paper describes a clinical case of HP with pleuritis in a young child, highlighting the wide range of clinical manifestations of this pathology. Particular attention is paid to the diagnostic difficulties posed by the lack of unified diagnostic criteria and the similarity of symptoms to those of acute respiratory infections and bronchial asthma. Despite its rarity in childhood, HP requires a comprehensive diagnostic approach and careful differential analysis. The presented case emphasizes the importance of thorough assessment of medical history, clinical presentation, and laboratory and instrumental findings for timely diagnosis and selection of the optimal treatment strategy. [~DETAIL_TEXT] => Hypersensitivity pneumonitis (HP) is a rare immunopathological disease unrelated to an IgE-mediated mechanism that affects the alveoli, interstitial tissue, and peripheral airways. It develops from repeated inhalation of organic dust and microparticles <5 μm. HP is characterized by a variable clinical course, which significantly complicates diagnosis. In recent years, the number of publications devoted to HP in children has increased, indicating growing interest in this issue. The present paper describes a clinical case of HP with pleuritis in a young child, highlighting the wide range of clinical manifestations of this pathology. Particular attention is paid to the diagnostic difficulties posed by the lack of unified diagnostic criteria and the similarity of symptoms to those of acute respiratory infections and bronchial asthma. Despite its rarity in childhood, HP requires a comprehensive diagnostic approach and careful differential analysis. The presented case emphasizes the importance of thorough assessment of medical history, clinical presentation, and laboratory and instrumental findings for timely diagnosis and selection of the optimal treatment strategy. [PROPERTY_DOI_VALUE] => 10.25005/2074-0581-2026-28-1-269-278 [~PROPERTY_DOI_VALUE] => 10.25005/2074-0581-2026-28-1-269-278 [PROPERTY_DOI_VALUE_ID] => 32555:200 [~PROPERTY_DOI_VALUE_ID] => 32555:200 [PROPERTY_216_VALUE] => /upload/global/pdf/2026/1/269-278.pdf [~PROPERTY_216_VALUE] => /upload/global/pdf/2026/1/269-278.pdf [PROPERTY_216_VALUE_ID] => 32555:216 [~PROPERTY_216_VALUE_ID] => 32555:216 [DETAIL_TEXT_TYPE] => text [~DETAIL_TEXT_TYPE] => text )

HYPERSENSITIVITY PNEUMONITIS IN AN INFANT: A CLINICAL CASE МЕТАСТАТИЧЕСКИЙ РАК ГОЛОВЫ И ШЕИ БЕЗ ВЫЯВЛЕННОГО ПЕРВИЧНОГО ОЧАГА: ДИАГНОСТИКА И ЛЕЧЕНИЕ Multidisciplinary Clinical Medical Center "Medical City", Tyumen, Russian Federation M.I. SOKOLOVA V.I. PAVLOVA Tyumen State Medical University, Tyumen, Russian Federation Hypersensitivity pneumonitis (HP) is a rare immunopathological disease unrelated to an IgE-mediated mechanism that affects the alveoli, interstitial tissue, and peripheral airways. It develops from repeated inhalation of organic dust and microparticles <5 μm. HP is characterized by a variable clinical course, which significantly complicates diagnosis. In recent years, the number of publications devoted to HP in children has increased, indicating growing interest in this issue. The present paper describes a clinical case of HP with pleuritis in a young child, highlighting the wide range of clinical manifestations of this pathology. Particular attention is paid to the diagnostic difficulties posed by the lack of unified diagnostic criteria and the similarity of symptoms to those of acute respiratory infections and bronchial asthma. Despite its rarity in childhood, HP requires a comprehensive diagnostic approach and careful differential analysis. The presented case emphasizes the importance of thorough assessment of medical history, clinical presentation, and laboratory and instrumental findings for timely diagnosis and selection of the optimal treatment strategy. 10.25005/2074-0581-2026-28-1-269-278 Array ( [ID] => 32554 [~ID] => 32554 [NAME] => MINIMALLY INVASIVE ENDOSCOPIC TREATMENT OF GLOSSOPHARYNGEAL NEURALGIA USING A BURR-HOLE TECHNIQUE: CASE SERIES [~NAME] => MINIMALLY INVASIVE ENDOSCOPIC TREATMENT OF GLOSSOPHARYNGEAL NEURALGIA USING A BURR-HOLE TECHNIQUE: CASE SERIES [DETAIL_TEXT] => Glossopharyngeal neuralgia (also known as Sicard syndrome) is a rare cranial nerve compression syndrome that significantly impacts a patient's quality of life. Despite advances in conservative treatments, including pharmacotherapy, physical therapy, and nerve blocks, the optimal surgical approach remains a subject of active debate. This uncertainty stems from the rarity of the condition and the complex anatomy of the lateral skull base. Traditional surgical decompression often requires extensive resection of the occipital bone (typically exceeding 7-8 cm) to create a sufficient surgical corridor. However, endoscopic techniques are increasingly used due to their ability to provide precise visualization with minimal invasion. This approach reduces intraoperative complications, minimizes bone resection, and shortens recovery times. This article presents two clinical cases of glossopharyngeal neuralgia successfully treated using an endoscopic "burr hole" approach. We emphasize the critical role of endoscopic visualization in planning and executing surgery within this anatomically complex region. [~DETAIL_TEXT] => Glossopharyngeal neuralgia (also known as Sicard syndrome) is a rare cranial nerve compression syndrome that significantly impacts a patient's quality of life. Despite advances in conservative treatments, including pharmacotherapy, physical therapy, and nerve blocks, the optimal surgical approach remains a subject of active debate. This uncertainty stems from the rarity of the condition and the complex anatomy of the lateral skull base. Traditional surgical decompression often requires extensive resection of the occipital bone (typically exceeding 7-8 cm) to create a sufficient surgical corridor. However, endoscopic techniques are increasingly used due to their ability to provide precise visualization with minimal invasion. This approach reduces intraoperative complications, minimizes bone resection, and shortens recovery times. This article presents two clinical cases of glossopharyngeal neuralgia successfully treated using an endoscopic "burr hole" approach. We emphasize the critical role of endoscopic visualization in planning and executing surgery within this anatomically complex region. [PROPERTY_DOI_VALUE] => 10.25005/2074-0581-2026-28-1-259-268 [~PROPERTY_DOI_VALUE] => 10.25005/2074-0581-2026-28-1-259-268 [PROPERTY_DOI_VALUE_ID] => 32554:200 [~PROPERTY_DOI_VALUE_ID] => 32554:200 [PROPERTY_216_VALUE] => /upload/global/pdf/2026/1/259-268.pdf [~PROPERTY_216_VALUE] => /upload/global/pdf/2026/1/259-268.pdf [PROPERTY_216_VALUE_ID] => 32554:216 [~PROPERTY_216_VALUE_ID] => 32554:216 [DETAIL_TEXT_TYPE] => text [~DETAIL_TEXT_TYPE] => text )

MINIMALLY INVASIVE ENDOSCOPIC TREATMENT OF GLOSSOPHARYNGEAL NEURALGIA USING A BURR-HOLE TECHNIQUE: CASE SERIES МЕТАСТАТИЧЕСКИЙ РАК ГОЛОВЫ И ШЕИ БЕЗ ВЫЯВЛЕННОГО ПЕРВИЧНОГО ОЧАГА: ДИАГНОСТИКА И ЛЕЧЕНИЕ Multidisciplinary Clinical Medical Center "Medical City", Tyumen, Russian Federation M.I. SOKOLOVA V.I. PAVLOVA Tyumen State Medical University, Tyumen, Russian Federation Glossopharyngeal neuralgia (also known as Sicard syndrome) is a rare cranial nerve compression syndrome that significantly impacts a patient's quality of life. Despite advances in conservative treatments, including pharmacotherapy, physical therapy, and nerve blocks, the optimal surgical approach remains a subject of active debate. This uncertainty stems from the rarity of the condition and the complex anatomy of the lateral skull base. Traditional surgical decompression often requires extensive resection of the occipital bone (typically exceeding 7-8 cm) to create a sufficient surgical corridor. However, endoscopic techniques are increasingly used due to their ability to provide precise visualization with minimal invasion. This approach reduces intraoperative complications, minimizes bone resection, and shortens recovery times. This article presents two clinical cases of glossopharyngeal neuralgia successfully treated using an endoscopic "burr hole" approach. We emphasize the critical role of endoscopic visualization in planning and executing surgery within this anatomically complex region. 10.25005/2074-0581-2026-28-1-259-268 Array ( [ID] => 32553 [~ID] => 32553 [NAME] => ANESTHESIA DURING LAPAROSCOPIC SURGERY IN A CHILD WITH GLUCOSE-6-PHOSPHATE DEHYDROGENASE DEFICIENCY AND SITUS INVERSUS TOTALIS: A CLINICAL CASE [~NAME] => ANESTHESIA DURING LAPAROSCOPIC SURGERY IN A CHILD WITH GLUCOSE-6-PHOSPHATE DEHYDROGENASE DEFICIENCY AND SITUS INVERSUS TOTALIS: A CLINICAL CASE [DETAIL_TEXT] => This case describes the anesthetic management of a child with a complete mirror-image disposition of the internal organs (thoracic and abdominal cavities), including dextrocardia and a left-sided diaphragmatic hernia. A 4-year-old girl was admitted for a splenectomy. CT imaging revealed the spleen on the right, the liver on the left, the stomach located in the left thoracic cavity, and the heart rotated to the right.
Anesthetic challenges arose from the combination of situs inversus totalis and glucose-6-phosphate dehydrogenase (G6PD) deficiency. The plan to perform multiple surgical procedures simultaneously increased the risk of adverse anesthetic events, elevating the patient's status from ASA II to ASA III.
Upon induction and initiation of mechanical ventilation, the following modes were used: Volume Control (VC) and Assist/Control (A/C). Following the creation of pneumoperitoneum and the reduction of the abdominal organs from the chest, the ventilator was switched to VC with a Synchronized Intermittent Mandatory Ventilation (SIMV) algorithm. Anesthesia was maintained via bolus administration of anesthetics, narcotic analgesics, and muscle relaxants. Hemodynamic parameters remained stable throughout. To maintain homeostasis, 400 ml of crystalloid and colloid solutions were administered; total urine output was 230 ml. The procedure lasted 3 hours and 20 minutes with no anesthesia-related complications. [~DETAIL_TEXT] => This case describes the anesthetic management of a child with a complete mirror-image disposition of the internal organs (thoracic and abdominal cavities), including dextrocardia and a left-sided diaphragmatic hernia. A 4-year-old girl was admitted for a splenectomy. CT imaging revealed the spleen on the right, the liver on the left, the stomach located in the left thoracic cavity, and the heart rotated to the right. Anesthetic challenges arose from the combination of situs inversus totalis and glucose-6-phosphate dehydrogenase (G6PD) deficiency. The plan to perform multiple surgical procedures simultaneously increased the risk of adverse anesthetic events, elevating the patient's status from ASA II to ASA III. Upon induction and initiation of mechanical ventilation, the following modes were used: Volume Control (VC) and Assist/Control (A/C). Following the creation of pneumoperitoneum and the reduction of the abdominal organs from the chest, the ventilator was switched to VC with a Synchronized Intermittent Mandatory Ventilation (SIMV) algorithm. Anesthesia was maintained via bolus administration of anesthetics, narcotic analgesics, and muscle relaxants. Hemodynamic parameters remained stable throughout. To maintain homeostasis, 400 ml of crystalloid and colloid solutions were administered; total urine output was 230 ml. The procedure lasted 3 hours and 20 minutes with no anesthesia-related complications. [PROPERTY_DOI_VALUE] => 10.25005/2074-0581-2026-28-1-252-258 [~PROPERTY_DOI_VALUE] => 10.25005/2074-0581-2026-28-1-252-258 [PROPERTY_DOI_VALUE_ID] => 32553:200 [~PROPERTY_DOI_VALUE_ID] => 32553:200 [PROPERTY_216_VALUE] => /upload/global/pdf/2026/1/252-258.pdf [~PROPERTY_216_VALUE] => /upload/global/pdf/2026/1/252-258.pdf [PROPERTY_216_VALUE_ID] => 32553:216 [~PROPERTY_216_VALUE_ID] => 32553:216 [DETAIL_TEXT_TYPE] => text [~DETAIL_TEXT_TYPE] => text )

ANESTHESIA DURING LAPAROSCOPIC SURGERY IN A CHILD WITH GLUCOSE-6-PHOSPHATE DEHYDROGENASE DEFICIENCY AND SITUS INVERSUS TOTALIS: A CLINICAL CASE МЕТАСТАТИЧЕСКИЙ РАК ГОЛОВЫ И ШЕИ БЕЗ ВЫЯВЛЕННОГО ПЕРВИЧНОГО ОЧАГА: ДИАГНОСТИКА И ЛЕЧЕНИЕ Multidisciplinary Clinical Medical Center "Medical City", Tyumen, Russian Federation M.I. SOKOLOVA V.I. PAVLOVA Tyumen State Medical University, Tyumen, Russian Federation This case describes the anesthetic management of a child with a complete mirror-image disposition of the internal organs (thoracic and abdominal cavities), including dextrocardia and a left-sided diaphragmatic hernia. A 4-year-old girl was admitted for a splenectomy. CT imaging revealed the spleen on the right, the liver on the left, the stomach located in the left thoracic cavity, and the heart rotated to the right. Anesthetic challenges arose from the combination of situs inversus totalis and glucose-6-phosphate dehydrogenase (G6PD) deficiency. The plan to perform multiple surgical procedures simultaneously increased the risk of adverse anesthetic events, elevating the patient's status from ASA II to ASA III. Upon induction and initiation of mechanical ventilation, the following modes were used: Volume Control (VC) and Assist/Control (A/C). Following the creation of pneumoperitoneum and the reduction of the abdominal organs from the chest, the ventilator was switched to VC with a Synchronized Intermittent Mandatory Ventilation (SIMV) algorithm. Anesthesia was maintained via bolus administration of anesthetics, narcotic analgesics, and muscle relaxants. Hemodynamic parameters remained stable throughout. To maintain homeostasis, 400 ml of crystalloid and colloid solutions were administered; total urine output was 230 ml. The procedure lasted 3 hours and 20 minutes with no anesthesia-related complications. 10.25005/2074-0581-2026-28-1-252-258 Array ( [ID] => 32552 [~ID] => 32552 [NAME] => SURGICAL TREATMENT OF THORACIC OUTLET SYNDROME [~NAME] => SURGICAL TREATMENT OF THORACIC OUTLET SYNDROME [DETAIL_TEXT] => [~DETAIL_TEXT] => [PROPERTY_DOI_VALUE] => 10.25005/2074-0581-2026-28-1-238-251 [~PROPERTY_DOI_VALUE] => 10.25005/2074-0581-2026-28-1-238-251 [PROPERTY_DOI_VALUE_ID] => 32552:200 [~PROPERTY_DOI_VALUE_ID] => 32552:200 [PROPERTY_216_VALUE] => /upload/global/pdf/2026/1/238-251.pdf [~PROPERTY_216_VALUE] => /upload/global/pdf/2026/1/238-251.pdf [PROPERTY_216_VALUE_ID] => 32552:216 [~PROPERTY_216_VALUE_ID] => 32552:216 [DETAIL_TEXT_TYPE] => text [~DETAIL_TEXT_TYPE] => text )

SURGICAL TREATMENT OF THORACIC OUTLET SYNDROME МЕТАСТАТИЧЕСКИЙ РАК ГОЛОВЫ И ШЕИ БЕЗ ВЫЯВЛЕННОГО ПЕРВИЧНОГО ОЧАГА: ДИАГНОСТИКА И ЛЕЧЕНИЕ Multidisciplinary Clinical Medical Center "Medical City", Tyumen, Russian Federation M.I. SOKOLOVA V.I. PAVLOVA Tyumen State Medical University, Tyumen, Russian Federation 10.25005/2074-0581-2026-28-1-238-251