ARCHIVES OF THE BALKAN MEDICAL UNION

245-248

Authors: Dan Anghelescu1, Adrian Cursaru1, Diana Mihalcea2, Razvan Ene1, Catalin Cirstoiu1 1 Trauma and Orthopaedic Surgery Department, University Emergency Hospital Bucharest, Romania 2 Cardiology Department, University Emergency Hospital Bucharest, Romania

ABSTRACT Introduction. The management of patients with an acute fracture of the femoral neck who suffered an acute myocardial infarction during the previous 3 months before surgery is still a challenge. Objectives. Bystudyingtherelationshipbetweenpre- operative cardiovascular evaluation and post-operative morbidity and mortality of these patients, the time to surgery may be shortened and we can guide the op- tion of operative vs non-operative treatment by better decision making on when to operate and wheather to operate these patients. Methods. The study included 28 patients with femo- ral neck fracture that underwent surgery between 2011-2016, with a documented acute myocardial in- farction during the 3 months prior to surgery. The end-point of the follow-up was 60 day postoperatively. Main outcome measure was death after surgery, up to 60 days postoperatively. Preoperative evaluation included standard evaluation and cardiovascular eval- uation – revised cardiac risk index evaluation, elec- trocardiogram, echocardiography for left ventricular dysfunction, Duke Activity Status Index (DASI) ques- tionnaire, troponin I, NT pro BNP and high sensitivity CRP values.Results. Ten patients died at the 60 days follow-up (35.7%), five deaths being due to cardiovascular com- plications. One patient from the survivors had an acute myocardial re-infarction, 10 days after surgery, and one patient has been hospitalized for acute onset of arrhythmia. All twelve patients had troponin I lev- els greater than 0.10 μg/L, a NT-proBNP level greater than 800 pg/mL and high sensitivity CRP greater than 1.57 mg/L, showing an increased preoperative risk of cardiovascular events. The Duke activity index for the ten patients was higher than 4 but less than 6 METS. Conclusions. The femoral neck fracture in a pa- tient with recent myocardial infarction involves a dif- ficult decision and a multidisciplinary collaboration. Although rare, this combined pathology is difficult to manage and still has no consensus on when to wait, how long to wait until surgery and whether to operate or to treat functionally these particular patients. Our conclusion is that we have to make a fast preop- erative evaluation of these patients and decide for each patient individually, balancing the risks of non-opera- tive treatment and operative treatment.

254-262

Authors: Michael Ivanovich Sheremet1, Larysa Petrivna Sydorchuk2, Viktor Oleksandrovich Shidlovskyi3, Anatoly Dmitrovich Bedenyuk3, Olexander Viktorovich Shidlovskyi3, Vitaliy Vasilyovich Maksymyuk2, Volodymyr Volodymyrovich Bezruk4, Yan Viktorovich Gyrla2, Tetyana Oleksandrivna Bezruk6, Volodymyr Volodymyrovich Tarabanchuk1, Viktor Markiyanovich Batig5, Oleksandr Viktorovych Mytchenok3, Kristina Andreyvna Chympoi6, Marina Dmitryvna Gresko7 1 Surgery Department No1, Bukovinian State Medical University (BSMU), Ukraine 2 Family Medicine Department, Bukovinian State Medical University (BSMU), Ukraine 3 Surgery Department, I.Y. Horbachevsky State Medical University, Ternopol, Ukraine 4 Department of Pediatrics, neonatology and perinatology of medicine, BSMU, Ukraine 5 Department of Therapeutic Stomatology, Bukovinian State Medical University (BSMU), Ukraine 6 Department of internal medicine and infectious diseases, BSMU, Ukraine 7 Department of Obstetrics and Gynecology with the Course of Infantile and Adolescent Gynecology, BSMU, Ukraine

Introduction. In the process of their vital activity, the cells are exposed to many damaging factors of endogenous and exogenous nature. It is undoubted that various toxic influences or metabolic disorders lead to the development of oxidative stress, and in this case, the future of the cell is determined by a balance of various adaptive metabolic processes induced by a pathological factor, as well as by genetic and constitutional features of its biochemical systems.Objectives. To analyze the mechanisms of caspase-dependent apoptosis and pro- and antioxidant activity in the thyroid tissue homogenate in patients with NGAIT and TA considering the polymorphic variants of BCL-2 (rs17759659), CTLA-4 (rs231775), APO-1 / Fas (rs2234767) genes. Methods. We investigated pro- and antioxidant activity and the activity of caspases 3 and 8 in 5% of thyroid tissue homogenates. The BCL-2 (rs17759659), CTLA-4 (rs231775), Fas (rs2234767) genes polymorphism was studied by Real-Time Polymerase Chain Reaction in 95 patients with NGAIT, 30 patients with TA and 25 healthy individuals. Results. In homozygous carriers of A-allele of the BCL-2 (rs17759659) gene, the activity of effector caspase-3 is higher than in the control group. Conclusions. The imbalance between the activity of peroxidation and antioxidant defense in patients with NGAIT and TA is associated with the promoter of the CTLA-4 (rs231775) and APO-1 / Fas (rs2234767) genes and is characterized by an increasing degree of OMP in the altered thyroid tissue and also with a lower capacity of the AOP system enzymes.

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Authors: Simona Diaconu1, Simona Claudia Cambrea1,2, Lucian Cristian Petcu2, Sorin Rugină1,2 1 Clinical Hospital of Infectious Diseases, Constanta, Romania 2 Ovidius University, Constanța, Romania

Background. Gastroenteritis with rotavirus is the leading cause of severe diarrhea among infants and young children. The aim of the study was to evaluate the clinical aspects of the rotavirus gastroenteritis comparatively with the non-rotavirus disease. Material and methods. We conducted an observational, retrospective study, that included children hospitalized in the Clinical Hospital of Infectious Diseases from Constanța, Romania, between 2011-2012. We analyzed the medical records of the patients and extracted demographic data, temperature, the frequency of vomiting and diarrheic stools, the degree of dehydration, duration of parenteral rehydration and hospitalization. We compared two groups of children: 505 with rotavirus disease and 100 with non-rotavirus disease. Results. There were statistically significant differences (p=0.001) between the mean age of the two groups, the number of days of hospitalization, the maximum number of stools per day, the maximum number of vomiting per day. There were no statistically significant differences between the two groups regarding the maximum temperature value (p=0.96).Conclusions. Evolution of the rotavirus disease is more severe and prolonged comparatively with nonrotavirus gastroenteritis.

285-290

Authors: Racho Ribarov1, Tzecomir Vodenicharov2, Arkadi Ivanov3, Neda Ivanova4 1 Faculty of Public Health, Department of Preventive Medicine, Medical University of Sofia, Bulgaria 2 Faculty of Public Health, Medical University of Sofia, Bulgaria 3 4th City-Hospital, Sofia, Bulgaria 4 Sofia University, Faculty of Medicine, Sofia, Bulgaria

Introduction. Many studies have shown that patients with colorectal cancer have to be educated to self-manage their condition and improve the quality of their physical, mental and social life after cancer. Self-management support is broader than health services alone because it can include support from other cancer survivors, community, online, family, friends etc. The aim of current study was to analyze the patient’s satisfaction of medical treatment and healthcare and, on this basis, to determine the necessity of self-management support following colorectal cancer treatment. Material and methods. The current study included 315 patients with colorectal cancer. The participants were residents of seven different Bulgarian regions. The applied methods were documentary and questionnaire (anonymous), listing questions referring to the patient’s lifestyle and attitude to the disease. Results and discussion. Of the investigated patients, 37.8% esteemed the quality of medical care as good, and only 16.2% affirmed it was excellent. The level of diagnosis and treatment competency was given a good and very good estimation by 64.5% of the respondents and 64.1% gave the same esteem for physicians’ good attitude. Dissatisfaction was revealed referring to psychological counseling activities – a total of 54.6% of the respondents. A relatively small part of the investigated individuals (20%) required discretion concerning their disease state. Conclusion. The current study established a significant relationship between patient’s satisfaction and the necessity of self-management support to help for better life quality.

298-305

Authors: Olha Ivanivna Denysenko1, Sviatoslava Vasilivna Yurniuk2, Mikchajlo Petrovich Perepichka1, Maryna Yuriivna Hayevska1, Iryna Jaroslavivna Majkan3, Liliia Omelyanivna Hulei1, Oleksandra Valeriivna Shulenina1, Yuliia Pavlivna Karvatska1, Natalya Andrianivna Stepan1, Nadiia Borusivna Brodovska1, Maryna Viktorivna Storozhuk1 1 Department of Dermatoveneorology, Higher State Educational Establishment of Ukraine „Bukovinian State Medical University“ (BSMU), Chernivtsi, Ukraine 2 Department of Forensic Medicine and Medical Law, BSMU, Chernivtsi, Ukraine 3 Regional communal establishment „Chernivtsi Regional Center for the Prevention and Control of AIDS“, Chernivtsi, Ukraine

ABSTRACT Introduction. Nowadays, HIV/AIDS is one of the most urgent medical and social problems. That’s why it is important to study the regional peculiarities of dermatological manifestations of HIV/AIDS for early diagnosis and timely treatment. The objective was to study the peculiarities of clinical manifestations of dermatological diseases of HIV/ AIDS patients in the inhabitants of Chernivtsi region, Ukraine. Material and methods. The analysis of medical records of 356 HIV- infected patients and 94 AIDS-patients from Chernivtsi region. Diagnosis of HIV-infection/AIDS was based on clinical data and commonly accepted laboratory criteria. Results. The following infectious skin diseases in HIV/AIDS-patients (92.9% of patients) were registered: dermatomycoses (70.2%), viral dermatoses (51.6%), pyodermas (16.4%), combined diseases – 38.2%nonspecific dermatoses – in 26.2% of patients. Kaposi’s sarcoma was detected in 5 (1.1%) HIV/AIDS patients and hairy leukoplakia of the tongue – in 3 (0.67%) patients. The peculiarities of the structure of dermatological manifestations of HIV-infection/AIDS in patients at different stages of the clinical course of the disease were established. Conclusions. Among the HIV/AIDS patients of Chernivtsi region, the most frequent dermatological pathologies are infectious skin diseases (fungal, viral, pustular) and nonspecific skin diseases, which are characterized by severe clinical course. The frequency of their manifestations is variable, depending on the different clinical stages of the disease, and should be taken into account when examining the patients from this geographical area, as well as while teaching derma- venereology to medical students.

310-315

Authors: Daniela Popova1,2, Rayna Stoyanova1,2 1 Clinic of Metabolic Diseases, Endocrinology and Dietetics 2 University Hospital „Tsaritsa Yoanna-ISUL“, Medical University – Sofia, Bulgaria

The aim of the study was to realize a comparative analysis of nutritional risk through auditing the Nutrition Day 2016 – 23/02/2017 data in different groups of hospitalized patients in the University Hospital “Tsaritsa Yoanna – ISUL“, Sofia, Bulgaria. Materials and methods. A group of 113 patients (54 men with an average age of 60.84 ± 15.27 years and 59 women with an average age of 59.90 ± 15,07 years), hospitalized in the Clinic of Gastroenterology, the Clinic of Metabolic Diseases, Endocrinology and Dietetics, the Clinic of Oncology and Radiotherapy and the Clinic of Oto-Rhino-Laryngology of the University Hospital “Tsaritsa Yoanna-ISUL“ was included in the study. In these patients, a survey was conducted, with updated standardized questionnaire from Nutrition Day 2016, to assess the current nutritional status, food intake particularities, health status self-assessment and hospitalization length. Within the survey, patients underwent clinical examinations in order to build up the history and the current clinical data on morbidity. The anthropometric measurements and laboratory routine hematological and biochemical parameters were performed. The risk of malnutrition was evaluated in all patients through the Malnutrition Universal Screening Tool (MUST). Results. 33.33% of the patients had high Malnutrition Universal Screening Tool (MUST) risk of malnutrition, 15.38% moderate risk, and the remaining – low risk. The lowest MUST risk was attributed to patients with compensated chronic liver disease, diabetes mellitus, and metabolic syndrome, whereas the highest was to patients with inflammatory bowel disease, oncological diseases, and chronic pancreatitis. The appetite of 58.97% of the patients was estimated normal, while 41.03% reported being decreased. The dietary intake during the week prior to hospitalization corresponded to normal in 66.69% of the cases. All of the following were found to have a thorough impact on the nutritional status: age, gender, associated diseases, health status, appetite, the quantity of food intake and dietary requirements. Conclusion. The risk of malnutrition is common and significant among hospitalized patients, requiring a systematic diagnostic approach for early detection, with subsequent adequate therapeutic treatment.

323-327

Authors: Raluca Guteanu1, Ionela Belaconi1,2, Miron Alexandru Bogdan1,2, Andrei Cristian Bobocea1,2 1 National Institute of Pneumology „Marius Nasta“, Bucharest, Romania 2 University of Medicine and Pharmacy „Carol Davila“, Bucharest, Romania

Sarcoidosis is a multisystemic chronic inflammatory disease characterized by noncaseous epithelioid cell granulomas. Involvement of the lung and of bilateral hilar and mediastinal lymph nodes is most common. Atypical patterns include unilateral lymphadenopathy, that can be seen in unusual locations or may become calcified. The most frequent parenchymal pattern of sarcoidosis is a bilateral perilymphatic symmetric distribution of micronodular lesions. Miliary opacities or ill-defined irregular opacities, without air bronchograms, which develop cavitation, with satellite nodules are seen in other granulomatous diseases and neoplasms. Occasionally, parenchymal lesions coalesce, forming multiple well-defined macronodules mimicking a metastatic process. Stenosis or compression of bronchi may result from endobronchial granulomas, resulting in obstruction and atelectasis. Pleural involvement is rare including pleural effusion, pneumothorax, pleural thickening or calcifications. Thoracic sarcoidosis manifests with various patterns. Atypical manifestations of sarcoidosis may require an extensive differential diagnosis that encloses tuberculosis, silicosis, pneumoconiosis, malignancies, lymphoma, and any other causes of chronic pulmonary infiltrates.

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Authors: Cristina Maria Goanță1,2, Daniela Cîrpaciu1,2, Andreea Sorică1,3, Mihail Tușaliu1,3, Vlad Andrei Budu1,3 1 University of Medicine and Pharmacy „Carol Davila“, Bucharest, Romania 2 Clinical Emergency Hospital „Sf. Pantelimon“, Bucharest, Romania 3 Institute of Phonoaudiology and Functional ENT Surgery „Prof. Dr. D. Hociotă“, Bucharest, Romania

Ethmoid sinusitis is one of the most complicated pathologies in ear, nose, and throat (ENT) practice. Because of its anatomical particularities, ethmoid sinusitis can easily become a dangerous pathology, difficult to treat. The first method of treatment is usually proper medication, but sometimes it can be difficult to manage without surgery. Surgery may be performed, the most used being the intranasal (endoscopic) ethmoidectomy. Other types of surgical interventions are external ethmoidectomy and transantral ethmoidectomy. Each approach has advantages and disadvantages. The potential complications of endoscopic surgery are: orbital injury, blindness, orbital hematoma, epiphora, and postoperative epistaxis. Skull base injury and cerebrospinal fluid leak are very rare complications that should be discussed with patients undergoing endoscopic sinus surgery. Regardless of the approach used, the surgeon must be familiar with the anatomy and aware of all pertinent landmarks to reduce the risk of complications. Attention must be paid to avoid violating the cribriform plate or inadvertently entering the orbit.

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Authors: Dragoș Radu Marcu1, Dan Arsenie Spînu2, Cristina Nicoleta Cozma3, Laura Răducu2,3, Ioana Sorina Oprea4, Dan Liviu Dorel Mischianu1,2, Camelia Cristina Diaconu5, Ovidiu Gabriel Bratu1,2 1 Clinic of Urology, University Emergency Central Military Hospital „Dr. Carol Davila“, Bucharest, Romania 2 University of Medicine and Pharmacy „Carol Davila”, Clinical Departament 3, Bucharest, Romania 3 Plastic Surgery Department, University Emergency Clinical Hospital „Prof. Dr. Agrippa Ionescu“, Bucharest 4 Intensive Care Unit, University Emergency Central Military Hospital „Dr. Carol Davila“, Bucharest, Romania 5 University of Medicine and Pharmacy „Carol Davila”, Clinical Emergency Hospital of Bucharest, Romania

Introduction. Penile fracture is an urological emergency that implies the rupture of the tunica albuginea and of the corpus cavernosum, with or without urethral injury, secondary to a traumatic event, more often secondary to vigorous sexual intercourse. Despite the fact that clinical examination and patient history are sufficient in most cases for establishing the diagnosis, imaging investigation has an important role in confirming the presence of the tunica albuginea rupture. Case presentation. We report the case of a 44 years old male patient, who presented to the emergency department for penile swelling and hematoma, 16 hours following a traumatic sexual intercourse. The ultrasound examination revealed a discontinuity at the level of the right tunica albuginea. Surgical exploration with hematoma evacuation, hemostasis, ligation of the right injured central cavernosal artery and suture of the ruptured right corpus cavernosum and of the albuginea tunica were immediately performed. The postoperative evolution was favorable without any immediate complications, the patient being discharged 6 days after the surgery. During the periodic postop- erative follow-up the patient related that the erections were similar to those he had before the incident. No signs of penile curvature were found. Conclusions. Penile trauma with corpus cavernosum rupture is a rare pathology, in which surgical exploration is mandatory in order to prevent debilitating complications that can result secondary to the ischemic and fibrotic local changes.

353-358

Authors: Diana Belciu1, Ruxandra-Nicoleta Horodinschi1, Claudia Lucia Ionescu1, Ovidiu Gabriel Bratu2,3, Camelia Diaconu1,2

Introduction. Lung cancer is one of the most common and aggressive cancers. The most important risk factor is smoking. Case report. A 63-year-old male, with a history of smoking for 30 years, presented for dyspnea at mild effort, right upper quadrant pain and right hemiplegia installed progressively 2 weeks before admission. Clinical examination revealed: cachectic patient; decreased breath sounds, without crackles, normal blood pressure and heart rate, pain in the right hypochondrium, hepatomegaly with nodular irregularities, right quasi-complete hemiplegia. Lab tests: leukocytosis with neutrophilia, thrombocytosis, mild hepatic cytolysis, increased inflammatory markers. Tumor markers: normal alpha-fetoprotein, increased CA 125 and CA 15-3, negative Ac HCV and Ag HBs. CT scan revealed multiple brain tumors, with discrete perilesional ede- ma, some with necrosis, with thick, irregular, nodular appearance; two tumors in the left lung. Secondary pulmonary, hepatic and cerebral determinations. Right portal vein thrombosis. Polyserositis. Neurosurgical exam concluded that the patient had no surgical indication. At bronchoscopy, no lesions have been detected, therefore no biopsy could be performed. The patient was referred to the oncologist for palliative treatment. The final diagnosis was: left pulmonary tumor with hepatic and cerebral pulmonary determinations, total right portal vein thrombosis, right quasi-complete hemiplegia. Conclusions. Sometimes, the clinical onset of cancer is related to the symptoms of metastasis. A late diagnosis limits the therapeutical options only to palliative therapy. The particularity of the case consists of clinical onset with neurological signs secondary to cerebral metastasis.

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Authors: Răzvan Vasile Stoian1, Andrei Haidar2, Daniel Ion1,3, Marius Coțofană1, Amelia Voinea3, Octavian Andronic3, Dan Nicolae Păduraru1,2 1 General Surgery Department of the University Emergency Hospital, Bucharest, Romania 2 Gastroenterology Department of “ Colentina“Clinical Hospital, Bucharest, Romania 3 University of Medicine and Pharmacy “Carol Davila“, Bucharest, Romania

Introduction. Colorectal cancer and diverticular disease are conditions with high prevalence, the number of new cases diagnosed annually reaching millions. The diverticular disease progresses to diverticulitis in 4-15% of cases. Diverticular disease and colorectal cancer can have similar clinical presentations, making the differential diagnosis difficult, especially in an acute stage. Case presentation. We present the case of a 79-year-old female, who presented to the emergency room complaining of diffuse abdominal pain, diarrhea within the previous three days, a weight loss of ten kilograms in the previous month, fatigability and asthenia. During the physical examination, a palpable tumor mass in the right flank was found. From the paraclinical results, a severe anemia and leukocytosis could be noted. Conclusion On the basis of these results alone, a final diagnosis could not be established. Additional imaging tests were needed: CT scan and repeated colonoscopies. These confirmed the final diagnosis of complicated diverticular disease, the initial presumption being of an ascending colon tumor.