ARCHIVES OF THE BALKAN MEDICAL UNION

384-390

Authors: Michael I. Sheremet 1, Larysa P. Sydorchuk2, Viktor O. Shidlovskyi 3, Anatoly D. Bedenyuk3, Oleksandr V. Shidlovskyi 3, Vitaliy V. Maksymyuk1, Nina P. Tkachuk2, Volodymyr V. Bezruk4, Tetyana O. Bezruk5, Victor M. Batig6, Kristina A. Chympoi5, Marina D. Gresko7

Objectives: To analyze the influence of the CTLA-4(+49G/A)rs231775 gene polymorphism on the degree of thyroid gland enlargement in patients operated for nodular goiter secondary to autoimmune thyroiditis (NGAIT) and thyroid adenomas (TA). Also, to analyze the clinical course of the disease, depending on the genotype of this gene. Methods: The CTLA-4 (rs231775) genes’ polymorphism was studied by Real-Time Polymerase Chain Reaction in 95 patients with NGAIT, 30 patients with TA and 25 healthy individuals. Results: It has been found that, in patients with nodular goiter secondary to autoimmune thyroiditis, hyperplasia of the thyroid gland is associated with the wild A allele of the CTLA-4 gene (AA- and AG-genotypes):IB and III levels of hyperplasia are more likely to occur in carriers of the AA genotype by 30.13% and 26.35%, and the second degree of the thyroid gland enlargement- in patients with the AG-genotype by 33.52% and 34.04%, respectively. Conclusions: The incidence of hypertrophic form of autoimmune thyroiditis is associated with AA- and AG-genotypes of the CTLA-4 gene, characterized by a particular severity, with the rapid development of an “aggressive“ proliferative process in the thyroid tissue, according to sonographic findings. The carrier of the GG genotype is associated with atrophic origin of autoimmune thyroiditis; the tissue is characterized by a high content of cells in which there are atypical or follicular changes of an unclear genesis.

397-402

Authors: Necdet Özçay1, Handan Özdemir2, Hasan Besim1

Introduction: Intestinal transplantation (IT) is one of the important cause of intestinal ischemia and reperfusion injury. It is well known that anastomotic problems seen after IT are mainly related to reperfusion injury. Probiotics are non-pathogenic live microorganisms that are used for various bowel diseases due to their beneficial effects on bowel functions. Wound healing is an important bowel function and impaired healing is a series trouble after IT and ischemic bowel. In this study, we aimed to investigate the effect of probiotics on the intestinal anastomosis healing process. Methods: Forty male SD rats were divided into four groups: Group I(n:10) colonic anastomosis only; Group II (n:10) colonic anastomosis after IR injury; Group III (n:10) probiotic and colonic anastomosis; Group IV (n:10) probiotic and colonic anastomosis after IR injury. Probiotics are given 250 million/day, po. The left colon was cut and anastomosed with continuous 6/0 nylon suture after 60 minutes of reperfusion. Animals were monitored for 7 days, then sacrificed. Macroscopic findings, anastomotic bursting pressures, and histopathologic findings were evaluated. Results: Probiotics were well tolerated in the treatment groups (Groups III and IV). Macroscopically, there were no anastomotic leaks or abscess formation in either of the probiotic groups (Groups III and IV).Anastomotic bursting pressures of probiotics groups tended to be higher compared with the ischemic control group (Group II), although the difference was not statistically significant. The histologic scores of probiotic groups were very similar to the control groups. Conclusion: The probiotic groups had fewer adhesions according to the macroscopic findings; anastomotic bursting pressures tended to be high and histologically, they had equivalent healing scores compared with the control groups. We conclude that probiotics have some beneficial effect to impaired anastomotic healing processes, without any side effects on the colon in the colon. Therefore they might be considered as a supportive treatment in IT patients.

408-413

Authors: Oleksandr V. Shidlovskyi 1, Michael I. Sheremet 2, Viktor O. Shidlovskyi 1, Anatoly D. Bedenyuk1, Vitaliy V. Maksymyuk2, Nina P. Tkachuk2, Volodymyr V. Bezruk3, Tetyana O. Bezruk4, Victor M. Batig5, Kristina A. Chympoi4, Marina D. Gresko6

The objective of the study was to analyze the technology of electrophysiological identification of laryngeal nerves in goîter surgeries. Methods: The technology of electrophysiological identification of laryngeal nerves in goiter surgeries was developed. It is based on the recording of changes in the sound vibrations generated by the passage of air through the voice gap, the area of which changes in the event of a change in the tension of vocal cords from electrostimulation of the laryngeal nerves. The great- est changes in the frequency and amplitude of sound vibrations occur when electrostimulation of tissues near the nerve and the nerve itself. This phenomenon allows to determine the location of the nerve and prevent its injury. Results: The method was tested in 173 patients who had been operated for goiter. There were no cases of temporary or permanent disorders of phonation.Conclusions: The developed technology of electrophysiological identification of laryngeal nerves in goiter surgeries is reliable, easy to apply, and is not expensive. The influence of other factors on its results was not noted.

422-429

Authors: Larysa P. Sydorchuk1, Yulia I. Serdulets2, Olexandr I. Fediv2, Larysa O. Havrysh2, Yana M. Teleki2, Andrii R. Sydorchuk1, Anna I. Kshanovska1, Natalia A. Turubarova-Leunova1, Denys O. Lekhai1

Introduction. Osteoarthritis (OA) is a multifactorial disorder in which aging, genetic, hormonal and mechanical factors are major contributors to its onset and progression. Objectives. To evaluate the genotypes frequencies of Matrilin-3 (MATN3, rs77245812) and Interleukin-10 (IL-10, rs1800872) genes polymorphism in OA patients combined with arterial hypertension (AH), abdominal obesity (AO) and type 2 diabetes mellitus (DM2). Methods. The polymorphic variants of genes MATN3 (C908T) and IL-10 (C-592A) were analyzed by PCR in 74 OA patients with AO, AH, DM2 and 25 healthy individuals. Results. Distribution of MATN3 gene polymorphic variants in observed groups was as follows: CC-genotype – in 94.59% OA patients, and in 96.0% of control (p>0.05); CC-genotype – in 5.41% and 4% respectively. The C-allele prevails over T-allele by 94.95% (p<0.001) with preservation of the population equilibrium: among the OA patients – 97.30% vs 2.70% (p<0.001), among the healthy – 98.0% vs2.0% (p<0.001) accordingly. Distribution of IL-10 gene polymorphic variants in observed groups was as fol- lows: CC-genotype – in 52.7% OA patients vs 68.0% in control (p>0.05); CA-genotype – in 37.84% vs 32.0% (p>0.05) respectively; CC-genotype was found in 9.46% OA patients and none of control. C-allele of IL-10 gene dominated over the A-allele: among pa- tients – 2.52 times (p<0.001), among control group – 5.25 times (p<0.001). The wild C-allele of IL-10 gene dominated 2.96 times (p<0.001) generally in the ob- served population. Conclusions. Polymorphic variants of genes MATN3 and IL-10 are not additional risk factors of the OA occurrence in the observed population of Northern Bukovina.

434-438

Authors: Valentin Petre-Ciudin1, Cornel Petre-Ciudin2, Andreea A. Velnic1, Bianca Hanganu1, Irina Manoilescu1, Dragos Crauciuc1, Beatrice G. Ioan1

Palliative care asserts the importance of life, consider- ing that the human beings have the right to be cared and respected until the last moment of their lives. In oncologic patients, physical symptoms in general, and pain, in particular, are enhanced by psychological, social, cultural and spiritual issues. Along with progression of the disease, symptoms may become overwhelmed- ing and refractory to usual therapeutic approaches, despite the efforts, sometimes even aggressive, to identify a tolerable therapy which does not compromise the consciousness and relieves pain. One of the solutions may be palliative sedation, which means the voluntary administration of the opioids and non-opioids drugs in adequate doses and concentrations in order to lower the consciousness as much as necessary to ameliorate one or more symptoms which are refractory to other therapies. Palliative sedation, since the proposition of its practice in the healthcare of the terminal patient, with unbearable pain, generated numerous dilemmas and debates which are still ongoing. In this paper, the authors approach the issue of the palliative sedation both from medical and ethical perspectives, highlighting the importance of placing the patient in the center of the decision-making process regarding the medical treatment and its guidance according to the risks and benefits for the patient.

445-448

Authors: Cristina M. Goanță1,2, Daniela Cîrpaciu1,2, Mihail Tușaliu1,3, Vlad A. Budu1,3

Septoplasty refers to surgical manipulation and/or removal of deviated septal cartilage and/or bone to correct a nasal septal deformity. Up to 90% of people have nasal septal deviations, but the majority is asymptomatic. There are several techniques used when performing septoplasty, the endoscopic ones growing in use because of a better visibility, fewer complications and faster recovery of the patient. The article shows the different techniques for nasal disobliteration with the main steps and lists the main advantages and disadvantages of this surgery. The main indications for septoplasty are: to correct a deviated nasal septum for irreversible symptomatic nasal obstruction, for improving access for endoscopic sinus or skull base surgery or for removing septal spurs causing epistaxis.

458-461

Authors: Bogdan Socea1, Cristian A. Smaranda1, Anca A. Nica1, Alexandru C. Carâp1, Mihai Dimitriu2, Laura I. Socea3, Ovidiu G. Bratu4, Dan Dumitrescu5, Șerban V.G. Berteșteanu6, Vlad D. Constantin1

Phytobezoar is a rare cause of small bowel obstruction. This pathology represents 0.4%-4% of all mechanical bowel obstructions. Symptoms are similar to other small bowel obstructions. The most common localization of the obstruction is represented by the terminal ileum. Phytobezoars are to be considered in patients who have had gastric surgery, a high fiber intake or psychiatric disorders. Also, multiple sclerosis has shown to affect bowel motility, which is important to our case. Surgery is always indicated. A low fiber diet and prokinetics are indicated for the prevention of this pathology. We present the case of a 43-year-old female who was admitted to the ICU following a car accident. The patient presented bowel obstruction symptoms (nausea and vomiting, bloating, not passing gas and severe abdominal pain) the 5th day after admission and was transferred to the operating room for exploratory laparotomy. Intraoperatively, we discovered a phytobezoar which was confirmed by the histopathological exam.

467-470

Authors: Bogdan Socea1, Anca A. Nica1, Cristian A. Smaranda1, Alexandru C. Carâp1, Laura I. Socea2, Mihai Dimitriu3, Ovidiu G. Bratu4, Cezar E. Moculescu1, Șerban V.G. Berteșteanu5, Vlad D. Constantin1

Cecum diverticulosis is a benign, rare and generally asymptomatic disease that can manifest with acute diverticulitis or bleeding, thus complicating the diffe- rential diagnosis of the right iliac fossa pathology. The optimal management of this disease does not have a well-established treatment plan, as it may vary in some centers from conservative treatment, consisting of only antibiotics, to segmental colectomy or even right hemi- colectomy. We present the case of a 45-year-old patient, prior diagnosed with chronic pain in the right iliac fossa after appendectomy, who was diagnosed with a single cecum diverticulum.

475-479

Authors: Bianca Hanganu1, Irina Manoilescu1, Andreea A. Velnic1, Valentin Petre-Ciudin1, Dragoș Crauciuc1, Beatrice G. Ioan2

Neonaticide represents a particular issue both to so- ciety and forensic field, being admitted nowadays as a crime all over the world. Apart from common gross and microscopic examination of the newborn cadaver, thorough examination of the umbilical cord during autopsy proved many times its major utility in solving neonaticide cases. Although by its constituents, the umbilical cord is a quite resistant structure to bending and compression, mechanical properties vary along its surface, with gestational age or various pregnancy dis- orders, as well as genetic anomalies of the fetus, so that a rupture may occur. The authors present the case of a newborn found dead in a sink - about whom mother states that he accidentally fell in the feces, the moment of the birth being a surprise - and discuss on the cir- cumstances when the umbilical cord may rupture. This issue is most important when is a need to differentiate between a true accident and an intentional newborn homicide by the mother set forth as an accident.