Invasive lobular carcinoma (ILC) comprises up to 15 % of all breast cancers. In contrast to ductal carcinoma, ILC frequently metastasizes into gastrointestinal organs, retroperitoneal space, and urogenital organs, as well as the eye and orbit, and metastases can be diagnosed 10–15 years after treatment of primary breast tumor. Pleomorphic, alveolar, and solid ILC subtypes are the most prone to metastases. Due to similar morphological picture between ILC and primary tumors with low cell adhesion, differential diagnosis without additional examination methods can be difficult. The article presents the key signs of distant ILC metastases into various organs and systems, as well as minimal antibody panels for differential diagnosis with primary tumors.
Primary choriocarcinoma (ChC) of the mediastinum (extragonadal) is a rather rare tumor characterized by highly aggressive clinical course and an extremely unfavorable prognosis, particularly in male patients. According to the literature, approximately 115 cases of extragonadal ChC have been reported in men between 1973 and 2017. The overall incidence rate is approximately 0.0022 cases per 1,000,000 people aged 0 to 84 years. The most common sites of ChC are the mediastinum, retroperitoneal space, and the brain. This article presents a systematic review of the literature and discusses two clinical cases: gonadal and extragonadal choriocarcinoma in men.
It has been proven and widely accepted that comprehensive cardiac rehabilitation that underlies secondary prevention reduces morbidity, disability, and mortality from cardiovascular diseases and their complications, improves quality of life, and minimizes economic losses to the healthcare system and the state as a whole. Unfortunately, despite the recognized benefits of cardiac rehabilitation, it remains underutilized or inadequately utilized. In addition to the common barriers to participation in rehabilitation that occur in most countries, the Russian Federation faces a number of limiting factors related to discrepancies between current regulations and clinical guidelines on cardiac rehabilitation, which critically impacts the rehabilitation of cardiac patients. To address this issue, it would be appropriate to separate cardiac rehabilitation from the "medical rehabilitation of patients with somatic diseases." This situation requires cardiologists to create a consensus document on cardiac rehabilitation, which should address organizational issues, routing, a description of cardiac rehabilitation programs with proven effectiveness, and criteria of the rehabilitation effectiveness specific to cardiac patients. Therefore, this should be a document aimed at reducing mortality, complications, disability, and increasing the life expectancy of cardiac patients, which is the primary goal of healthcare.
The article presents a clinical case of recovery of a patient after ischemic stroke with cognitive impairment, including aphasic disorders, and hemiparesis after systemic thrombolytic therapy and total selective endovascular mechanical thromboextraction, stent placement in the left ICA in the acute period, with a delayed start of further rehabilitation activities after nine months. The comprehensive rehabilitation program included classes with a computerized complex for training the upper limb with cognitive modules, modified mirror therapy, and classes with a speech therapist-neuropsychologist, and was aimed primarily at restoring cognitive functions, including all forms of impaired speech activity, through the cognitive load components of the program and restoring the movement function of the paretic right limb. Excellent outcomes were observed, confirmed by clinical and neuropsychological evaluations and electroencephalographic data, indicating a decrease in abnormal slow-wave activity and interhemispheric asymmetry after treatment.
Abstract Background The metabolism of aminothiols such as glutathione (GSH) and cysteine (Cys) plays an important role in the pathophysiology of stroke. We evaluate the association of cysteine and glutathione forms in blood plasma with the severity and disability of acute hemorrhagic stroke (HS). Methods The levels of reduced glutathione (rGSH), reduced cysteine (rCys) and cystine (CysS) in blood plasma were determined in patients with acute HS (n = 64; 39–59 years old), and the patients’ condition upon admission and on days 7–10 of illness was assessed using the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS), respectively. Results The median levels of plasma cystine (CysS) and reduced glutathione (rGSH) were 51.1 and 1.04 µM, respectively. Patients with high levels (≥ 50 µM) of CysS had a significantly higher frequency of mild or moderate neurological impairment (NIHSS ≤ 10) than patients with levels of CysS < 50 µM (OR = 7.73, CI95% 2.19–27.28). Patients with high levels (≥ 1.9 µM) of rGSH also had a significantly higher frequency of mild disability (mRS ≤ 2) compared to patients with rGSH < 1.9 µM (OR = 12.35, CI95% 3.43–44.5). Conclusion Thus CysS and rGSH levels are associated with reduced risk of severe neurological deficit and disability, respectively, in the acute period of hemorrhagic stroke. These indicators could be used to evaluate the severity of neurological impairment in stroke patients. Further research is needed to determine potential of circulating free thiols as biomarkers and to evaluate the usefulness of GSH-targeting therapy in acute hemorrhagic stroke.
