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CASE STUDY
Neurovegetative syndrome . Cause-effect - Case Study tic tropism , biliary stasis ). Urine biochemistry analysis , results obtained : ( urine collection by palpation , single-hand method , making light compression on the bladder ) Proteinuria - 300 mg / dl ( negative ), Hematuria - negative , Bilirubiunuria - 6 mg / dl , Urobilinogenuria - 4 mg / dl , Ketone bodies - negative , Nitrites - negative , Leukocyturia - 250 leukocytes per microliter , Urinary density - 1,020 ( 1,010 - 1,030 ), pH - 6.5 , Glucose - negative Interpretation : proteinization , impaired function of the liver by increased bilirubinemia and urobilinogenuria , leukocyte reactivity ) Dark field examination : red blood cells in the physique , excess fibrin , many polymorphonuclear cells with semi-reactive cytoplasm ; monocytes , large , reactive , without a quantitative connotation ; large , well-marked platelets , reactive , solitary ( neutrophilia , thrombocytosis , inflammatory reactive process - presence of fibrinogen ). Lack of lymphocyte modification . Ultrasound conclusion : gallbladder dilatation , bile contents with high density , liver tissue with modified morphology on an area of about 30 %. Intestinal stasis , lack of intestinal peristalsis , gastric fluid content - large amount , no foreign bodies on the intestinal area . Splenomegaly . Reduced kidneys while maintaining morphological structure . No pancreatic changes were detected . Medical conclusions from laboratory tests and imaging : 1 . quantitative / qualitative hepatobiliary dysfunction ( ammonia , transaminases , bilirubinuria , bilirubinemia ) 2 . neurovegetative deficiency on the thoracoabdominal area ( solar plexus ), pain , tenderness , local and respiratory discomfort . 3 . systemic reactivity by generalizing the sensitivity starting from the thoracosternal and hepatobiliary area . Medical conclusions from laboratory tests and imaging : 1 . quantitative / qualitative hepatobiliary dysfunction ( ammonia , transaminases , bilirubinuria , bilirubinemia ) 2 . neurovegetative deficiency on the thoracoabdominal area ( solar plexus ), pain , tenderness , local and respiratory discomfort . 3 . systemic reactivity by generalizing the sensitivity starting from the thoracosternal and hepatobiliary area . Presumptive diagnosis : Variant 1 : hepatobiliary insufficiency with the appearance of jaundice Option 2 : hepatobiliary insufficiency accompanied by reactivity of mediastinal syndrome ( chylothorax ) Option 3 : neurovegetative disorder with decreased / impaired activity at this level . Vagal indigestion ( pyloric stenosis , intestinal stasis , diarrhea , gastric dilation , stopping intestinal transit with vague interception ) Variant 4 : pseudopericardial syndrome ( compression of the heart through the mediastinal fluid , diaphragmatic paresis - phrenic nerve see cardio-respiratory dissociation ). The assessment of the general condition during the treatment revealed the following considered : a )
clinical picture in the plateau , without tendency to improve ; b ) I categorically refuse to eat or accept food ; c ) inability to swallow ; d ) maintaining urinary function ( urine changes its color depending on the amount of fluid administered parenterally ); e ) sensitivity in the gastric area , solar plexus is observed only in certain moments of wakefulness . During sleep , a state of semi-relaxation of the organism can be denoted ; f ) permanent dyspnea ( sleep - wakefulness ); g ) the assessment of the general condition requires a serious , unfavorable prognosis , incompatible with survival .
Death occurs 24 hours after stopping treatment , 4 days after the onset of the above . Presumption of pathophysiological mechanism : mediastinal syndrome associated with effects on neighboring organs ( cardiac tamponade , tachycardia , lack of swallowing , diaphragmatic hypotonia , dyspnea with atelectasis and pulmonary and tracheobronchial compression - tubal noises on the air , gastric dysphagia by compression , dysphagia by compression mediastinal lymphatics , vagal stasis in the liver , mechanical blockage of the gallbladder with bile expression in the blood and secondary enzymatic reactivity ). Missing link : undetected problem - absence of lymph nodes , possibly due to the short time of the condition and the impossibility of changing the shape and volume of the lymph nodes . Blood reactivity was detected by neutrophilia and thrombocytosis . Final conclusion : complicated mediastinal syndrome with vagal reactivity . Cause of death : neurovegetative dysautonomy ( hypotonia of both neurovegetative systems ). Disorder of visceral and enteric vegetative lymph nodes ( paravertebral , encephalic and medullary lymph nodes ). Diasautonomy clinic : digestive syndrome ( including hepatobiliary ), rarely ocular , bladder , respiratory , cardiac , locomotor , - all uncharacteristic .
FINAL CONCLUSIONS
1 . The clinical picture is based on the manifestations of the disease , otherwise on the effects of the cause of the morbid condition .
2 . The treatment of the effects does not oblige to diminish the cause of the disease state .
3 . The cause of the disease may be accompanied by irreversible clinical manifestations incompatible with survival .
4 . The application of the treatment must take into account the cause / effect principle and the quality of the reversible / irreversible , symptomatic / asymptomatic clinical manifestations .
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Vol VII - Nr . 34 ( 2 ) 2022