The September issue of the journal “Archives of the Balkan Medical Union“ is ready and has lots of interesting subjects for its readers. Diffuse large B-cell lymphoma is a common form of non-Hodgkin’s malignant lymphomas, occurring at all ages. Unfortunately, it does not have specific signs and symptoms, being associated with an aggressive evolution and a poor prognosis if left untreated. The study of Birceanu Corobea et al (Bucharest, Romania), “The clinical importance of PD-L1 and PD-1 expression in diffuse large B cell lymphoma“, investigated the role of PD-1 (programmed cell death-1) and PD-L1 (programmed death-ligand 1) in diffuse large B cell lymphoma. Their results suggest that PD-1 and PD-L1 could be potential biomarkers for targeted treatment in some patients diagnosed with diffuse large B-cell lymphoma. Malignant lymphomas of the head and neck may raise therapeutic difficulties. In their minireview “Therapeutic methods used in the treatment of malignant lymphomas of the head and neck“, Tusaliu et colleagues, from the University of Medicine and Pharmacy “Carol Davila“, Bucharest, Romania, evaluated the therapeutic methods used in malignant lymphoma, such as conventional chemotherapy, radiotherapy, surgical treatment, salvage treatment, interferon treatment, monoclonal antibody treatment, medullar transplantation, and peptide treatment.

Introduction. In the last five years (from 1st of January 2013 to 31st of December 2017), we noticed 6 cases of rectal cancer, developed in patients who underwent stoma reversal more than two years before, for different pathologies. The objective of the study. That was a starting point to analyze whether the restoration of a total digestive diversion, well known to improve life quality, also increases the risk of malignancy. Material and methods. We studied all the patients with colostomy reversal hospitalized in the General Surgery Clinic of the Emergency Clinical Hospital “Sfântul Pantelimon“, Bucharest, Romania, in a ten years interval (1st of January 2008 – 31st of December 2017), no matter the primary cause of colostomy was. Results. Our study showed that stoma reversal increase the risk of developing a rectal malignancy two years from restoration. Conclusions. We recommend annual control by recto-sigmoidoscopy both in patients with terminal permanent colostomy and in those with stoma reversal, in order to early discover a subsequent rectal cancer.

Introduction. The target pathway programmed cell death-1 (PD-1)/ programmed death-ligand 1 (PD-L1) shows clinical efficacy in solid tumors, but also in Hodgkin’s and non-Hodgkin’s lymphoma. PD-L1 expression most often correlates with a poor prognosis and a PD-1 regulatory factor that mediates immunosuppression. The presence of an increased number of tumor-infiltrating lymphocytes (TILs) PD-1 + is a favorable prognostic factor in patients with diffuse large B cell lymphomas (DLBCLs) and follicular lymphomas, while the low number of TILs PD-1 + is associated with an increased risk of histological transformation. In DLBCLs, TILs PD-1 + may not reflect the depletion of T-mediated tumor cells but may be an indicator of lymphoid cell origin. Objectives. The objective of this study was to describe the correlation between PD-1 and PDL-1 with survival in patients with the diagnosis of diffuse large B cell lymphoma. Material and methods We have studied 80 patients and we have analyzed DLBCLs according to the Hans algorithm; in addition, we analyzed PD-1 and PD-L1 in tumor cells and in immune cells and we correlated this data with patient’s survival. Results. We found that there is a tendency of decreased survival and therapeutic response in DLBCL patients, with both an intense and weak PD-L1 positivity in tumor cells. PD-1 low positivity was associated in higher percentage with relapse and treatment unresponsiveness. Conclusions: Our data suggested that PD-L1 expression correlates with a poor clinical response although it is not an independent prognostic marker and PD-1 represents a favorable prediction factor for survival.

Background. Autoimmune thyroiditis (AIT) is one of the unsolved problems of modern endocrinology, the etiology and pathogenesis being still insufficiently known. Objectives. To study the effects of substitution, antioxidant and lymph-drainage ther­apy on the structure and function of the thyroid gland in patients with AIT and hypothyroidism. Methods. We have identified 2 groups of patients with AIT and subclinical hypothyroid­ism. The first group – control group – included 20 patients who received substitution therapy with thyroxine. The second group included 33 patients who received a comprehensive treatment with thyroxine, alpha lipoic acid and Lymphomyosot. Results. The use of substitution therapy with thyroxine and the proposed an­tioxidant and lymph drainage therapy in patients with AIT led to the improve­ment of the structure of the gland, reduced the activity of peroxide oxidation pro­cesses and the activity of pro-inflammatory cytokines, increased the level of anti­oxidant defense enzymes, normalized the number of aniline-positive lymphocytes, improved the lymphatic drainage function of the gland. Our results sustain the effectiveness of the proposed method of complex treatment in patients with autoimmune thy­roiditis.

Introduction. Regulation of gastrointestinal motility and eating behavior is one of the well-known ghrelin’s effects. However, its cardioprotective effect, as well as vasodilatory action and participation in arterial pressure regulation, are not sufficiently studied. Objectives. To study fasting and postprandial ghrelin levels and eating behavior in patients with comorbidities such as irritable bowel syndrome, arterial hypertension, and obesity. Materials and methods. The study included 24 patients with irritable bowel syndrome, constipation and normal body mass index, 18 patients with arterial hypertension and obesity, and 54 patients with irritable bowel syndrome, constipation, arterial hypertension, and obesity. Blood pressure monitoring was performed in all patients and fasting and postprandial ghrelin levels in blood serum were measured, as well as eating behavior type, using the Dutch Eating Behavior Questionnaire. Results. Results of 24-hour blood pressure monitoring showed a more significant rise in blood pressure, as well as a predominance of the non-dipper profile, encountered in 40.0% of patients with the association of irritable bowel syndrome-constipation, arterial hypertension and 2nd degree obesity, and in 70% of patients with 3rd degree obesity. The increased level of postprandial serum ghrelin in patients with this comorbid pathology contributes to the predominance ofexternal and emotional types of eating behavior, which were found in 37.5% and 34.2% of patients with the combination of these pathologies with obesity the 1st degree, 45.0% and 40.0% – with 2nd degree obesity and 60.0% and 40.0% – with 3rd degree obesity. Conclusions. The studied combined pathology (irritable bowel syndrome with constipation, arterial hypertension, and obesity) is accompanied by higher blood pressure, non-dipper blood pressure profile predominance, increased postprandial ghrelin level and eating disorders.

Introduction. High-grade serous carcinoma of the ovary is an aggressive form of cancer, with unknown precursor lesions and often delayed diagnosis because of non-specific, mild symptoms. Objective. We performed a clinical-pathological study of ovarian high-grade serous carcinomas, in order to evaluate morphological and new immunohistochemistry characteristics of this malignancy. Methods. This is a retrospective study of 10 cases of ovarian high-grade serous carcinoma. We evaluated patients’ age, symptoms at presentation, macroscopic aspects, bilateral involvement, microscopic features: papillary/solid areas, mitotic index, psammoma bodies, tumoral extension, lymph node metastasis, immunohistochemistry markers: CD44, ER, AR, Ki67 index. Results. Mean age was 56.9 years old. Tumors were bilateral in 50% of cases. Only 30% were limited to the ovary. Maximum tumor diameter was 16 cm. Solid component in a proportion of 50-95% was more characteristic. Most tumors had a mitotic index of 30-50 mitosis/10HPF (70% of cases). 20% of cases contained psammoma bodies. 2 cases out of 7 had lymph node metastasis. We noticed one case with pleural metastasis (M1). We observed AR<10% was characteristic of 90% of tumors. Ki67 index >80% was noticed in 30% of cases. CD44 was positive in 50% of cases and one case had diffuse positivity of CD44 in corpus luteum cells near the tumoral bed. Conclusions. The majority of patients with ovarian high-grade serous carcinomas presented with extraovarian extension and were characterized by high mitotic index, rare presence of psammoma bodies, AR expression <10%, novel marker CD44 positive in 50% of cases and curious positivity in corpus luteum cells associated with the tumor.

Introduction. Breast carcinoma represents the leading cause of oncologic mortality among women worldwide. Bilateral breast carcinoma is a distinct pathologic entity, with particular prognostic and therapeutic implications. Objective. The objective of the study was to determine the histologic and immunohistochemical characteristics of patients with bilateral breast carcinoma admitted in a university emergency hospital from Bucharest, Romania. Materials and methods. We analyzed breast carcinoma specimens registered as bilateral in the Department of Pathology of the University Emergency Hospital, Bucharest, Romania, between 2015-2017, and studied their histologic and molecular features in the clinical context obtained from our hospital database. Results. All the analyzed patients were postmenopausal women. The extent of time between the diagnosis of the first and second tumor varied in metachronous cases from 8 months to 7 years. In the majority of cases, the bilateral breast lesions shared histologic, grading and hormone expression similarities. Conclusions. Bilateral breast carcinoma is a rare entity that needs more histologic parameters to be defined as primary or metastatic.

Introduction. The purpose of the study was to determine whether the following 4 factors: age, sex, type of intervention and type of dialysis (acute or chronic), have an influence on the number of dialysis sessions associated with urological interventions. Material and methods. The study included almost 3000 patients undergoing dialysis, during a 3 year period, in 3 university hospitals in Bucharest, Romania. In the end, after applying the inclusion and exclusion criteria, the study group consisted of 89 patients. The time frame in which the number of dialysis sessions was evaluated started from the moment the patients entered urological surveillance for undergoing a urological intervention until the patients where discharged. Results. Out of the 4 factors, the following statistically significant differences were encountered: the mean number of dialysis sessions was lower in patients under 50 years than in those older than 69 years (p<0,05, p=0,02) and the mean number of dialysis sessions was lower for chronic dialysis than for acute dialysis (p<0,05, p=0.038). Conclusions. While the number of elderly patients required more dialysis sessions than the younger patients in association with urological interventions, there were no significant differences regarding the sex of the patient. Although there were no significant differences regarding the type of urological interventions, the acute onset of the renal insufficiency associated with acute dialysis required a larger number of dialysis sessions than the patients already on chronic dialysis at the time of surgery.

Introduction. Rosacea is a common chronic dermatosis characterized by lesions of open areas of the skin (face) and torpidity to treatment. The objective of our study was to determine and analyze the content of proinflammatory cytokines – interleukin-17A (IL-17A) and interleukin-18 (IL-18) in the serum of patients with rosacea, depending on the nature of the clinical course of dermatosis. Material and methods. The study involved 36 patients with rosacea, 17 of them diagnosed with erythema-telangiectatic form and 19 with papulo-pustular form of rosacea. In 18 patients, the dermatosis lasted for up to 6 months, in the remaining 18 patients for more than 6 months. In patients with rosacea, the serum content of individual cytokines, interleukin-17A and interleukin-18 was determined by the immunoassay assay. Results. It has been established that the content of proinflammatory cytokines in the serum of patients with rosacea is reliably elevated compared to that in the control group – IL-17A (4.11 times, p <0.001) and IL-18 (1.63 times, p = 0.002). A more significant increase in the level of IL-17A in the blood serum of patients with the papulo-pustular form of rosacea compared to the erythema-telangiectatic form and duration of dermatosis for more than six months has been found. At the same time, the level of IL-18 tended to increase more significantly in the early stages of dermatosis – in patients with erythema-telangiectatic stage of rosacea and duration of the disease up to 6 months, with subsequent decrease in the level of IL-18 in patients with papulo-pustular stage and duration of dermatosis more than 6 months. Conclusions. The patients with rosacea were found to have an elevated level of proinflammatory cytokines – interleukin-17A and interleukin-18. The changes in the cytokines depended on the nature of clinical course of rosacea, indicating a significant role in the regulation of inflammatory processes in the pathogenesis of dermatosis and the importance of monitoring the content of blood serum IL-17A and IL-18, as prognostic criteria for clinical course and effective treatment of rosacea.

Introduction. Lichen ruber planus (LRP) is a chronic multifactorial dermatosis characterized by skin deterioration, intensive itchiness, and resistance to therapy. It leads to long term patient disability, therefore the main objective of the management is to define the pathogenetic factors of LRP, with the purpose of treatment optimization. The objective of this study was to determine and analyze the level of individual cytokines in blood serum of patients with lichen ruber planus with different clinical symptoms of dermatosis. Material and methods. The study involved 37 patients with lichen ruber planus. In 20 patients with LRP the pathology of the skin was widespread, and in 17 patients it was limited and localized. In 19 patients the dermatosis lasted for up to 6 months, in the remaining 18 patients – for more than 6 months. In patients with LRP, blood serum concentrations of individual cytokines – tumor necrotic factor-a (TNF-a), interleukin-1ß (IL-1ß), interleukin-4 (IL-4) and interleukin-10 (IL-10) were determined by immunoassay analysis. Results. It has been found that in blood serum of patients with LRP there is a significant increase of TNF-a and IL-1ß, a mild increase of IL-4 and a tendency to decrease in IL-10 comparing to the control group. Significant changes in the content of the cytokines in the blood serum were observed for the patients with a widespread form of lichen ruber planus and the duration of the disease for more than 6 months, comparing to those with limited forms of the dermatosis and duration of the disease for up to 6 months. Conclusions. In patients with LRP, changes of the indicators of cytokine profile in the peripheral blood were observed. There was a significant increase in the level of proinflammatory cytokines (TNF-a, IL-1ß), and only a a mild increase or the tendency to decrease in the levels of anti-inflammatory cytokines IL-4 and IL-10, respectively. The magnitude of these changes of cytokines was dependent on the nature of the clinical progression of the LRP. This finding indicates the significance of the cytokines in the regulation of inflammatory processes in the pathogenesis of LRP. These findings report the importance in examining levels of pro- and anti-inflammatory cytokines, as a criteria in the clinical evaluation of LRP and the effectiveness of its treatment.

Introduction. To date, there are no early diagnostic criteria for skin changes in children with combined pathology of the gastrointestinal tract and food sensitization. Objective. To determine the ultrasound parameters of skin changes in children with Helicobacter pylori-associated chronic gastroduodenitis (CGD) combined with food allergy (FA). Methods. 168 children with H. pylori-associated CGD in combination with FA, aged between 7-15 years, were involved in a study of ultrasound parameters of skin change. Skin ultrasound was performed by ultrasound scanners with linear sensors, with variable frequency, 3.5-12.0 MHz. Average values are given in the form (M ± m), where M is the mean value of the index, m is the standard error of the mean, n – the volume of the analyzed group. Results. In the acute period, children with H. pylori-associated CGD combined with FA were characterized by pronounced thickening of the skin (epidermis, derma), unclearness of the layers of the skin, increased echogenicity of the epidermis, diffuse reduction of echogenicity of the dermis and heterogeneity of its structure, characteristic hypoechoic strip between the epidermis and dermis, stronger intra-dermal and subcutaneous arterial and venous circulation. In the subacute period, the ultrasonographic skin changes in the affected children faded and were less pronounced in remission. Conclusions. The peculiarity of the ultrasound structure of the skin in children with H-pylori-associated CGD in combination with FA is a pronounced thickening of all its layers, the presence of a hypoechoic strip in the superficial layer of the dermis and the strengthening of intradermal and subcutaneous arterial and venous blood flow.

Introduction. Focal liver lesions represent one of the main indications of ultrasound-guided liver biopsy. The purpose of the study was to evaluate the advantages and risks of liver biopsy, and to highlight the importance of a close follow-up in the prevention of postprocedural complications. Methods. We have retrospectively analyzed a number of 52 patients, who underwent liver biopsies in the Clinical Emergency Hospital of Bucharest, Romania, after being diagnosed with various types of focal liver lesions through ultrasound scanning. Results. Regarding the quality of the bioptic samples obtained: 98% of them were diagnostic, only 2% being nondiagnostic, mainly due to the tissue necrosis found within the tumor. The majority of the cases selected for the study had multiple liver lesions (70%), the rest of 30% had single lesions identified by ultrasound scanning. After histopathological analysis, in 89 % of the cases the lesion proved to be malignant (of which 70% were hepatic metastases and 30% were liver carcinomas), the rest of 11% were benign. This last category included hepatic adenomas and focal nodular hyperplasia, identified in young female population. Our study did not reveal any relation between the location of the lesion within the liver and the number of needle passes needed in order to obtain viable biopsy specimens (P = 0.16). Of all the cases that underwent liver biopsy, only 4% had complications, mainly minor bleeding and only 1% major bleeding and transitory hypotension. There was no case of death registered. Conclusions. Ultrasound guided percutaneous liver biopsy is a fast, economical and user-friendly procedure, frequently used in the diagnosis of focal liver lesions. The success rate of the biopsy in obtaining viable samples is high and it depends more on the structure of the lesion and the materials used, rather than on the anatomical localization of the lesion within the liver. Severe complications can be avoided if a close follow-up of the patients is performed.

Background. Differentiated thyroid cancer (DTC) is one of the most frequently observed neoplasms today. Recurrence of DTC has been previously reported to be dependent on tumor characteristics, the tumor size, the presence of lymph node metastasis, the presence of extra thyroid invasion, the presence of distant metastasis, oncogenes such as B-RAF proto-oncogene, advanced age and male sex. However, many studies have failed to associate many of these data with relapse. In this study, we aimed to evaluate the relationship between some histopathological and morphological findings with thyroid cancer relapse or persistent disease in a cohort of 393 DTC patients. Methods. We retrospectively analyzed 393 subjects with DTC, diagnosed in our institution between January 2000 and December 2010. Results. Histopathological analysis indicated papillary carcinoma in 362 (92.1%) subjects and follicular carcinoma in 31 (7.9%) subjects. Eighty-two (20.9%) of the subjects relapsed or had persistent disease. Male subjects had a higher trend for relapse (RR 1.739 %95 CI: 1.059-2.856) p=0.029). 18.8% of female subjects relapsed or had persistent disease, whereas the relapse rate was 30.4% in male subjects. Every 1 cm increase in tumor size increased the risk of relapse by 25% (RR=1.25, 95% CI: 1.11-1.41, p<0.001). Male sex, nodule diameter, and tumor diameter were detected to be independent parameters for relapse or persistent disease (p=0.002; p<0.0001, p<0.001 respectively). Conclusion. We demonstrated that tumor diameter and male sex were the only parameters affecting relapse or persistent disease in our cohort. A possible reason for different reports from different studies may be non-standardization of study protocols and surgical cure rates.

Objectif. L’objectif de notre étude est d’évaluer la pression artérielle et la pression différentielle chez les patients atteints du syndrome métabolique (SM), afin de déceler et de prévenir les complications cardiovasculaires qui peuvent survenir chez ces patients. Matériels et méthodes. L’analyse des cas-témoin a été faite sur un total de 1528 patients, dans un cabinet de médecine familiale, les sujets étant répartis en deux groupes: le lot avec SM et le groupe témoin (sans SM). Le groupe avec SM se composait de 388 patients diagnostiqués selon les critères harmonisés. Le groupe témoin sans SM était composé de 1140 patients n’ayant pas présenté au moins trois critères diagnostiques du syndrome métabolique. Résultats. La pression différentielle, les valeurs calculées pour les patients atteints de syndrome métabolique ont été généralement plus élevées que le taux moyen escompté à 40 mmHg, avec une valeur moyenne de 47,86 ± 12,02 mmHg. Le groupe de contrôle a une valeur moyenne (40,28 ±12.20 mmHg) du pouls, une pression significativement plus faible (p<0.0001). Conclusions. La tension différentielle est associée aux complications cardiovasculaires positives, en particulier chez les personnes âgées et surtout aux valeurs supérieure ou égale à 60 mmHg, mais cette association n’est pas indépendante de la tension artérielle.

Introduction. Polytrauma patients represent one of the most difficult pathology. Therefore, developing methods of assessing the risk of death in these patients is a continuous challenge for physicians. The aim of the study was to evaluate the levels of creatine kinase isoenzyme MB (CK-MB) and troponin, as markers of increased risk of death in the first 24 hours after admission, in polytrauma patients with associated chest trauma. Material and methods. The study included 33 polytrauma patients treated in the Emergency Department of the County Clinical Emergency Hospital Constanta, Romania, between 2014-2017. In all these patients, clinical evaluation and paraclinical investigations have been performed, including measurements of CK-MB levels. The results of the study suggest that CK-MB does not offer additional information for the risk of death in these patients, while in the case of troponin, higher values were observed in patients that didn’t survive after 24 hours. Conclusions. The results of our study suggest that troponin values may be useful in identifying the increased risk of death in polytrauma patients.

Background. Scientific and technological progress, environmental problems of society, prolonged use of broad-spectrum antibiotics, as well as the peculiarities of the immune response of the newborn’s body, which are accumulated on the disorders of the postnatal adaptation, contribute to the selection of microorganisms, with the formation of antibiotic-resistant strains. Material and methods. A retrospective analysis of medical records of newborns with neonatal sepsis, born in Chernivtsi maternity hospitals, Ukraine, during 2017 has been carried out. Results. Among infants with neonatal sepsis, premature newborns from mothers with probable risk factors for the development of generalized bacterial infection prevailed. The disease was characterized by the symptoms of multiple organ failure, with a predominant defeat of the respiratory system, hemodynamics disorders, changes in the neurological status, and a decrease in food tolerance. According to the results of bacteriological cultures of blood, the predominance of microorganisms association was established, the leading place among them belonged to Klebsiella pneumoniae. Conclusions. Prematurely born infants (84% in our study) prevailed among newborns with neonatal sepsis, from mothers with potential risk factors for systemic bacterial infection development. Fatal cases were observed among premature infants, especially with an extremely low body weight, which accounted for 60% of deaths, and with antibiotic resistant strains of Klebsiella pneumoniae cultures.

Laryngomalacia is a disease that is the most common etiology causing stridor in infants and in most cases the patient presents with inspiratory stridor that worsens during feeding, crying, supine position or agitation. In laryngomalacia the supraglottic structures collapse into the airway during inspiration causing airway obstruction. Typical symptoms are not present at birth, but appear within the first 4 months of life and disappear at maximum 24 months of age. The most common associated symptoms are swallowing dysfunctions, regurgitation, cough and sleep apnea. Laryngomalacia is a self-limiting disease with about 20% of the patients present with severe disease and they require surgical treatment.

Introduction. Neck pain (NP) is an increasingly common symptom among the general population, regardless of age, but predominantly in women. Most studies confirm the direct links between this symptom and the biomechanical changes in the cervical spine, induced by postural problems. Objectives. To identify the mechanisms of maintaining the cervical symptoms in patients with abnormal head position, as well as the benefits and limitations of manual therapy for these dysfunctions and also to suggest and develop complementary or substitutive solutions to the used therapies. Methods. 51 patients were included in the study. We used the Assessment Card for the Patient with Cranio-Cervical-Mandibular Dysfunctions, the Visual Analog Scale, the Cervical Flexion-Rotation Test, Rocabado’s, Romberg’s and Fukuda’s functional tests, Kirby’s and Root’s Biomechanical Foot Assessment Cards, Static and Dynamic Computed Baropodometry, Palmerini’s Cranio-Cervical-Mandibular Functional Assessment and the Visual Acuity Difference test developed by Giannelli. Results. The total extinction of the NP was found in 49% of the subjects, the stabilization of the upper cervical spine in 64.7% of them, while 56.8% of the patients of our study neglected to treat the primary extra vertebral cause of their cervical instability. Conclusions. Removing the extra vertebral factors that cause head position changes and implicitly NP, followed by cranio-cervical-mandibular manual therapy, results in significant improvement in the postural syndrome and the reduction of the painful symptoms.

Hepatopulmonary syndrome (HPS) is a severe complication seen in the advanced liver disease. It is characterized by the triad of abnormal arterial oxygenation caused by intrapulmonary vascular dilatations (IPVD) in the setting of advanced liver disease, portal hypertension, or congenital portosystemic shunts. Liver transplantation is the only curative option for HPS. Pulmonary vascular dilation and angiogenesis are two central pathogenic features that cause abnormal pulmonary gas exchange in experimental HPS, and thus might underlie HPS in humans. The vascular component includes diffuse or local dilation of the pulmonary capillaries, and less commonly includes pulmonary arteriovenous shunts. The mechanisms responsible for the vascular changes in HPS remain incompletely understood. Research into the underlying molecular mechanisms has mainly focused on the roles of nitric oxide (NO), carbon monoxide (CO), hydrogen sulfide (H2S), ATP-sensitive K+ channels (KATP channels), endothelin-1 (ET-1), tumor necrosis factor-alpha (TNF-a), etc. and is summarised below.

Chronic kidney disease (CKD) is a public health problem due not only to the heavy burden of renal replacement therapy, but also to the increased cardiovascular risk and higher mortality. Emerging evidence suggests that dietary patterns play a more significant role than the nutrients in CKD. Thus, several macronutrients, especially high protein intake, could be risk factors for CKD, while a vegetarian, Mediterranean or a Dietary Approaches to Stop Hypertension (DASH) diet could be at least as effective as protein restriction in reducing CKD progression. This review summarizes both the association between several macro-/micronutrients and CKD, and the existing data on the relationship between dietary patterns and renal outcome.

Gastrointestinal bleeding is a common cause of hospitalization, with a high hospital morbidity and mortality rate, but decreasing compared to previous years due to an important progress in therapeutic endoscopic techniques. It is estimated that 5-7% of gastrointestinal bleedings are of obscure origin, with a normal upper and lower gastrointestinal endoscopy. The capsule endoscopy is the state-of-the-art, non-invasive procedure, providing a fine diagnosis of intestinal lesions, especially those found in the small bowel, difficult to address by other methods. Many studies have been published during the past years regarding the sensibility and outcome of capsule endoscopy in patients with gastrointestinal bleeding, but few underline its definitive role in the diagnosis of digestive bleeding. This review looks at the role of capsule endoscopy in the evaluation of patients with gastrointestinal bleeding from the small bowel and the therapeutic options available.

The aim of this paper was to analyze the prognostic features, clinical presentation, diagnosis and treatment of primary renal sarcomas. A thorough review of the literature was made using the PubMed database. Sarcomas of the kidney are very rare malignant tumors, with a very poor prognosis compared with the other urogenital sarcomas. Several histological types have been reported, with the most common type being leiomyosarcoma. Besides complete surgical resection with wide margins, anatomical, histological, molecular and genetic factors should be taken into consideration regarding the prognosis.

Malignant lymphoma is one of the topical problem of modern medicine. Among head and neck malignancies, lymphoma is the second most common cause. Most of the extranodal lymphomas are represented by non-Hodgkin’s lymphomas. Non-Hodgkin’s lymphomas localized in the upper aerodigestive tract are classified into three categories, depending on the frequency of these types: oral cavity lymphomas, pharynx and Waldeyer’s ring lymphoma, nasal sinuses, throat, pharynx and trachea lymphomas. Main therapeutic approaches used in the therapy of malignant lymphomas are: conventional chemotherapy, radiotherapy, surgery, „salvage“ therapy, interferon therapy, monoclonal antibody therapy, bone marrow transplant, peptides treatment. Cytotoxic chemotherapy is the main treatment for medium and high grade malignant lymphomas. However, studies have shown increased toxicity and did not find a significant benefit compared to the use of CHOP cure (cyclophosphamide, doxorubicin, vincristine and prednisone), both in terms of survival at 3 years and time until therapeutic success. Using third generation of therapeutic protocols allows to achieve complete remission in approximately 50% of non-Hodgkin’s lymphoma cases. Considering the endeavor to diagnose correctly and to adopt an appropriate therapy of a malignant lymphoma suitable in head and neck area , a complex approach, with integration of clinical, morphological and cytogenetic elements, interdisciplinary collaboration between pathologist, hematologist, oncologist, radiotherapist, nutritionist, psychologist, represents the most justified method for a patient with malignant lymphoma.

The anatomist, since the beginning of human dissections, had always performed the most difficult task in medicine, the study of the structure of the human body. Religious and scientific barriers throughout the centuries made anatomists become isolated by both the scientific and civilian community. Anatomist rapt in cadavers and skeletal remains was usually depicted as an unsociable being, performing his task in secluded places.

The objective of this article is to showcase the use of opium in ancient times, as well as the beliefs surrounding it, focusing on the opinion of Diagoras of Cyprus, a physician with great knowledge of pharmacology who probably practiced ophthalmology, composing a rose-based collyrium. Opium, a drug produced from poppy, used to have several uses such as in anesthesia, pain relief and ritualistic purposes. There is evidence of its creation since before 5000BC. In Greece, the first documentation dates back to around 2600-1100 BC in Crete. Many ancient medico-philosophers used to utilize it in their practice, mentioning it in the majority of the medical texts of that time. However, there were others that disapproved of its use due to the possible side effects. Diagoras was one of them, as he categorized opium as a lethal substance that could cause severe problems to the vision. He may even have thought of the possible addiction that it can cause because of the euphoric state it puts a person in. Some practitioners mentioned Diagoras’s opinion on opium, such as Erasistratus and Pliny the Elder. Despite his contributions in opium usage and ophthalmology, Diagoras is still unappreciated as a medical figure.

One of the most frequent kidney pathologies encountered in daily practice is represented by the presence of renal cysts. Most of them are asymptomatic and are found accidentally during periodical check-ups because they don’t have clinical signs until they grow and compress the surrounding organs. We have reviewed the current data regarding this pathology, in order to underline the risk of malignant transformation and its impact on the patient’s life. It is estimated that the prevalence rate of renal cysts in the general population is approximately 10% and it increases with age.Imaging investigations, such as contrast tomography or magnetic resonance imaging, are essential for establishing the cysts characteristics, especially when ultrasonography raises the suspicion of a modified renal cyst, as well as in guiding the therapeutical protocol. The Bosniak classification is based on contrast tomography scans and has allowed the standardization of the kidney cysts, considering their characteristics. More attention should be given to Bosniak IIF and III cystic renal masses, which contain thickened walls and more septa, but no enhanced nodules/soft tissue components, because more than half of these cysts can have a malignant component.

Introduction. Amyloidosis is a rare disease associated with extracellular accumulation of abnormal protein – amyloid in various organs and systems. This disease can be either acquired or hereditary, systemic or localized. At its core, it represents a grown, tumor-like neoplastic clone of the plasma cells in the bone marrow. Gastrointestinal amyloidosis is manifested by symptoms, such as diarrhea, steatorrhea, constipation, and very rarely – hemorrhages and perforations of the colon. Case presentation. We present a case of primary intestinal amyloidosis with recurrent hematochezia and abdominal pain in a 61-year-old woman. Colonoscopy revealed polyposis of the whole colon and a total colectomy was performed, followed by morphological and paraclinical examinations. Histologically, amyloid deposition, positive for Congo red, was found in the walls of the submucosal blood vessels and in the smooth muscle cells of the muscular layers. The laboratory tests indicated anemia, high erythrocyte sedimentation rate, and Bence-Jones proteins in urine. Conclusions. Our case is a demonstration of primary amyloidosis with intestinal localization that should be taken into consideration in the presence of recurrent hematochezia.

The international guidelines for the management of type 2 diabetes mellitus have seen many changes over the last decade. They have moved from a strict glycemic control in all patients with diabetes to a more individualized approach of the diabetic patient. These changes are the result of some trials which have demonstrated, for example, that in patients with long-standing type 2 diabetes a strict glycemic control may increase the risk of complications, such as hypoglycemia and cardiovascular events1-3. While glucose lowering prevents the appearance of microvascular complications, its impact is less significant on the cardiovascular and renal complications. The most preferred oral antidiabetic drug is undoubtedly metformin. There are six antidiabetic drug classes currently recommended by the American and European international societies, in addition to metformin: sodium-glucose cotransporter 2 (SGLT2) inhibitors, glucagon-like peptide 1 receptor agonists, dipeptidyl peptidase 4 inhibitors, sulfonylureas, thiazolidinediones, and insulin. SGLT2 inhibitors are a promising new class of antidiabetic drugs, that have entered very recently in the diabetes therapeutic armamentarium. These drugs enhance the urinary glucose excretion and decrease hyperglycemia, acting independently from insulin and being effective in all diabetic patients with preserved renal function. They have a favorable efficacy-to adverse event profile in type 2 diabetes patients with moderate-to-high risk. Currently, there are four SGLT2 inhibitors approved by the US Food and Drug Administration (FDA) and the European Medicines Agency: canaglifozin, dapaglifozin, empaglifozin, and ertuglifozin3. These may be used as monotherapy or in combination with other antidiabetic agents.SGLT2 inhibitors have also pleiotropic effects, such as reducing body weight by 2-3 Kg, decreasing the blood pressure (both systolic and diastolic), decreasing plasma triglycerides, increasing HDL cholesterol, attenuating some factors associated with nonalcoholic steatohepatitis and nonalcoholic liver disease, improving the whole-body sodium balance and volume status by stimulating the natriuresis, which leads further to a better endothelial function by reducing the vascular stiffness1. Due to these effects, SGLT2 inhibitors are useful especially in obese patients with arterial hypertension. They may be indicated as single or combination therapy, with other antidiabetic agents, and are contraindicated in patients with kidney failure1 with a GFR < 45 mL/min/1.73 m2. Regarding the glucose control, in a meta-analysis, the HbA1c reduction at 24-weeks was higher in studies that included younger patients, with a shorter duration of diabetes and a higher body mass index, HbA1c and basal glucose4. The cardiovascular benefits of SGLT2 inhibitors have been demonstrated by some major trials, such as EMPA-REG OUTCOME trial (Empaglifozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients)5 and CANVAS (Canaglifozin Cardiovascular Assessment Study)6. EMPA-REG OUTCOME trial has found a reduced incidence of cardiovascular death in diabetic patients treated with Empaglifozin and also a decreased rate of hospitalization for heart failure5. CANVAS Program has showed also a decreased rate of hospitalization for heart failure in patients treated with Canaglifozin6. This is extremely important, especially for patients with type 2 diabetes and already established cardiovascular diseases, as they may benefit most from the treatment with SGLT2 inhibitors. The main side effects of SGLT2 inhibitors consist in the increased risk of genital infections (up to four-fold in clinical trials). Other side effects, more rarely, may be the risk of hypoglycemia, diabetic ketoacidosis, bone fractures (with Canaglifozin). Recently, the US Food and Drug Administration warned about the risk of necrotizing fasciitis of the perineum (Fournier’s gangrene) in patients treated with SGLT2 inhibitors7. This is an extremely rare, but life-threatening infection of the tissues around the perineal muscles, nerves, fat and blood vessels. In conclusion, SGLT2 inhibitors are the newest antidiabetic drugs class, with cardiovascular benefits in a selected population of type 2 diabetes patients. There are ongoing studies with these antidiabetic agents expected to report their data in the near future.

Introduction. Arterial variations may cause significant complications during diagnostic and interventional procedures. The objective of the study. Our study examined 73 donated cadavers in the National and Kapodistrian University of Athens, in an effort to unearth possible artery alternations. Material and methods. The major branches of the abdominal aorta, the arteries of the limps and the neck were inquired. Results. In 58.9% of the cadavers no arterial variation was found, whereas one, two and three alternations at the same cadaver were observed in 21.9%, 12.3% and 6.8% respectively. The most common anatomical variations were noted in the vascular branching of the celiac trunk found in 24.7% of the cadavers. Conclusions. There was no statistically significant difference between the two genders concerning the frequency of the observed arterial variations (p<0.05).

The objective of the study was to investigate the features of blood neutrophils’ apoptosis in case of combined trauma of the chest and both thighs in rats. Material and methods. The analysis of cell samples to determine reactive oxygen species was evaluated by the flow laser cytometry method, using 2.7-dichlorodihydrofluorescein diacetate. The percentage of neutrophils with low transmembrane mitochondrial potential and percentage of apoptotic neutrophils were evaluated by the flow laser cytometry method, using specific kits. Results. It was established the progressive, statistically significant increasing of Annexin V- positive cells percentage from the first day of the experiment, with the highest values within 7-14 days of observation. On the 28th day of experiment, the reduction of apoptotic white blood cells percentage by 7.7% than the findings on the 14th day was observed, but it remained 33.3% higher than the control. Conclusion. One of the important signaling pathways of apoptosis triggering in case of experimental combined trauma of the chest and both thighs is reactive oxygen species overproduction and disruption of the mitochondrial inner membrane, due to the decreasing transmembrane potential on 3-7 days of observation.

Introduction. It is necessary to clearly understand the norms of morphometric parameters of thorax during the fetal period of human ontogenesis, which is one of the main directions to solve the problem of modern normology. Objective. To trace the dynamics of changes of morphometric parameters of the bony thorax in human fetuses aged 7-10 months. Materials and methods. The anatomical study involved 39 human fetuses specimens of 231.0-375.0 mm of crown-rump length (CRL). The study was conducted by means of macro-microscopic preparation, morphometry and variation statistics method. Results. It was found that the length of the costal cartilage increases from rib I to VII and is the longest in the rib VII. The ribs are the highest along the midclavicular line. At the same time, the height of the ribs decreases along the posterior axillary line and becomes the shortest along the scapular line. It was revealed the greatest width of the II and III intercostal spaces along the parasternal and midclavicular lines. The width of the four superior intercostal spaces along the midclavicular line on the right and on the left is larger than the height of the corresponding ribs. The width of the II-X intercostal spaces on the right and on the left along the scapular lines exceeds the height of the corresponding ribs in 1.33-1.65 times. The greatest width of the II, IV and VII intercostal spaces was along the posterior axillary line both sided. The greatest width of the II, IV and X of the intercostal spaces was noted along the scapular lines. Conclusions. The length of the costal cartilage increases from rib I to VII and is the largest in VII ones. The smallest value of the length of the costal cartilage was found in the rib XII. During the 7th-10th months of the intrauterine development, an intensive increase in the length of costal cartilages of the ribs I-III occurs, on average, by 1.5 times, and there is a slow increase in the length of the costal cartilage of the rib VII. The ribs along the midclavicular line are the highest. At the same time, the height of the ribs decreases along the posterior axillary line and along the scapular line it is the lowest.

The aim of the study was to assess the activity of enzymes in the antioxidant system in the brain of rats subjected to intoxication with sodium fluoride in subtoxic doses. Methods. The studies were conducted on sexually mature Wistar rats weighing 180-220 g, subjected to oral exposure by means of a probe with aqueous solutions of sodium fluoride (SF) once daily for 60 days at doses of 1/10, 1/100 and 1/1000 DL50, correspondingly, equaling to 20 mg/kg, 2 mg/kg and 0.2 mg/kg of body weight. Chemoluminescent method was used to confirm the induction of free radical processes by measuring the intensity of super-weak luminescence in the homogenate of the liver and the brain in the range of 400-600 nm, which occurs as a result of chemoluminescent reactions. Statistical analysis of the results was carried out using Statistica 6.1 (StatSoft, Inc., USA). Results. Reducing the intensity of a superweak luminescence on the 60th day of oral administration of SF to rats at a dose of 1/10 DL50 indicates a depletion of the energy potential of the substrate and the inadequate admission of free radicals of biological molecules to the oxidation system. The results showed a significant (p<0.001) increase of chemoluminescence relative to the comparison group of animals in the induced by dual-valent iron ions in the brain of experimental group of rats, who were administered SF at a dose of 1/10 DL50 on the 10th day of observation, on average by 40%. Conclusion. Under conditions of long-term fluoride intoxication in the rat’s brain, the expressed disruptions of free radical oxidation occur, which is reflected as the increase in the intensity of chemoluminescence of its homogenate and decrease in the activity of the antioxidant enzymes, superoxide dismutase and catalase, in the neocortex, which is a significant factor in the depletion of the adaptive capacity of the body.

The objective of the study was to investigate the changes of the kidney functions in mature rats with rapid acetylation type, under conditions of subacute cadmium-nitrate intoxication and preventive introduction of Echinacea purpurea. Methods. Male rats, 6 months of age, with rapid acetylation type, were divided into 3 groups: ? – control; ?? – rats with of subacute cadmium-nitrate intoxication model; ??? – rats receiving intragastric alcohol tincture of fresh rhizomes with roots of Echinacea purpurea (LC “State Municipal Enterprise “Pharmaceutical Plant Vishpha””, Ukraine; 0,25 mk/rg). Results. Under the effect of preventive introduction of Echinacea purpurea in rats with rapid acetylation type and cadmium-nitrate lesion of the kidneys, diuresis and glomerular filtration rate became normal; distal transport of sodium ions increased; hyponatraemia and decreased natriuresis remained without changes; concentrations of creatinine in the blood plasma, potassium ions in the blood plasma and urine, kaliuresis decreased. Similar to the group of rats without Echinacea purpurea, proximal reabsorption of sodium ions, which is standardized by glomerular filtration, decreased. Conclusion. Under conditions of preventive introduction of Echinacea purpurea, volume regulating kidney function is maintained in mature rats with rapid acetylation type and subacute cadmium-nitrate intoxication, but it does not prevent the development of toxic nephropathy, with prevailing lesion of the nephron proximal portion, disorders of ion regulating kidney function and water-electrolytic balance.

Introduction. Throughout the centuries, plants have been used not only as a source of nutrition, but also in the fight against diseases. The most interesting are medicinal plants being well tolerated by patients regardless of age. One of these plants is Centaurium erythraea Rafn. The aim of the study was to develop an optimal technology for obtaining an alcoholic extract with the highest content of biologically active substances: hydroxycinnamic acids, phenolic compounds. Materials and methods. We have performed a study of the concentration of ethanol and multiplicity of dilution with the help of a symmetric rotary composite plan of the second order. Results and discussion. The regression equations were adequate – Fexp. < Ftab. The nature of the influence of the studied factors was determined by the magnitude and signs of the coefficients from regression. To obtain the alcohol extract with the highest content of hydroxycinnamic acids and phenolic compounds, the concentration of ethanol should be 69%, and the ratio of raw material to extractant should be 1 to 5. Conclusions. Further pharmacological studies showed the extract obtained reliability of its application for an increase in gastric acid secretion.

Introduction. Essential thrombocythemia (ET) is a clonal disorder of the hematopoietic stem cells characterized by persistent thrombocytosis in the peripheral blood, excessive proliferation of megakaryocytes and minor reticulin fibrosis in the bone marrow. It seems that oxidative stress is involved in the development and progression of ET. Objective. To evaluate oxidative stress levels in ET patients treated with risk-adapted therapy. Material and methods. 62 ET patients and 20 controls (informed consent obtained) were enrolled. ET diagnosis was based on WHO criteria (2016 revised). Reactive oxygen species (ROS) levels and the total antioxidant capacity (TAC) were evaluated at time of diagnosis and after 6 months of risk-adapted therapy. ET patients were divided into 3 groups and treated with risk–adapted therapy: a low risk group, treated with low doses of aspirin 75 mg/day or watch-and-wait; an intermediate risk group treated with low doses of aspirin 100 mg/day or low-dose aspirin + cytoreductive treatment; a high-risk group, treated with low doses of aspirin and cytoreductive treatment (hydroxyurea) or platelet-lowering agents (anagrelide). Results. ET patients had at diagnosis higher ROS levels and a lower TAC vs. controls. After 6 months of risk-adapted therapy, ROS levels decreased and TAC increased. No significant differences were seen between the effect of hydroxyurea and the effect of anagrelide on oxidative stress levels. Conclusions. ROS levels are increased and TAC is decreased in ET patients vs. controls. These values depend on the risk group assigned to the patient. Risk-adapted therapy was useful to reduce ROS levels and increase TAC.

Introduction. The study of anti-ovarian autoantibodies in patients with ovarian insufficiency against the background of normal levels of gonadotropins, prolactin and androgens shows that the incidence of autoimmune oophoritis among such women varies from 19.2% to 31.5%. The objective of the study was to study the anti-ovarian antibodies level in infertile women at the preparatory stage for in vitro fertilization. Materials and methods. We examined 30 women, who were divided into the following groups: control group – 10 reproductively healthy women, who had a birth in the history (from 1 to 3); study group – 20 women with infertility of tube origin, who were included in the in vitro fertilization program. The study was performed between 2015-2017 in the Bukovinian State Medical University and Centre of Reproductive Medicine, Ukraine. The women signed the informed consent. Results. The anti-ovarian antibodies level in infertile women was found out to be 1.7 times less than in the control group. Reduction of the level of anti-ovarian antibodies in patients from the study group was marked by the obstetric and gynecological history. Conclusions. Anti-ovarian antibodies are present in both reproductively healthy women and in patients with infertility. The level of anti-ovarian antibodies can be both increased and reduced, depending on the pathological process that caused infertility. In both cases, this fact can testify the infertility. After plasmapheresis, the increased level of anti-ovarian antibodies sharply decreases.

Introduction. The study of anti-ovarian autoantibodies in patients with ovarian insufficiency against the background of normal levels of gonadotropins, prolactin and androgens shows that the incidence of autoimmune oophoritis among such women varies from 19.2% to 31.5%. The objective of the study was to study the anti-ovarian antibodies level in infertile women at the preparatory stage for in vitro fertilization. Materials and methods. We examined 30 women, who were divided into the following groups: control group – 10 reproductively healthy women, who had a birth in the history (from 1 to 3); study group – 20 women with infertility of tube origin, who were included in the in vitro fertilization program. The study was performed between 2015-2017 in the Bukovinian State Medical University and Centre of Reproductive Medicine, Ukraine. The women signed the informed consent. Results. The anti-ovarian antibodies level in infertile women was found out to be 1.7 times less than in the control group. Reduction of the level of anti-ovarian antibodies in patients from the study group was marked by the obstetric and gynecological history. Conclusions. Anti-ovarian antibodies are present in both reproductively healthy women and in patients with infertility. The level of anti-ovarian antibodies can be both increased and reduced, depending on the pathological process that caused infertility. In both cases, this fact can testify the infertility. After plasmapheresis, the increased level of anti-ovarian antibodies sharply decreases.

Background. Rhinoplasty is considered as one of the most challenging objectives in plastic surgery and tip rhinoplasty is arguably the greatest challenge for the surgeon performing rhinoplasty. No routine tip procedure is ever used and there are many ways to reconstruct and make nasal tips more attractive. Objective. The aim of this study was to evaluate the different correction techniques, in order to improve the outcomes in tip rhinoplasty. Methods. A prospective study was performed, including all patients with nasal tip deformities who underwent closed or open rhinoplasty between December 2015-August 2016 in Bombay Hospital, India. The patients were divided into two groups: group A – treated with various types of tip sutures (12 cases), and group B – treated with combined tip sutures and grafts (18 cases). Results. The study included 30 patients, 24 (80%) females and 6 (20%) males. 12 (40%) were patients with bulbous tips, 7 (23%) were patients with droopy tips, 5 (17%) were patients with boxy (broad) tips, 3 (10%) were patients with wide tips, and 3 (10%) were patients with bifid tips. A total of 27 (90%) cases involved primary rhinoplasties, and 3 (10%) cases involved revision. Patient’s and doctor’s satisfactions were recorded by a score from 0 to 3, with 0 being the less satisfied by the result of surgery and 3 being the highest satisfied. Conclusion. Aesthetic outcome following the management of nasal tips deformities with combined suture techniques and grafts is more satisfactory than the outcome that can be achieved following suture alone, especially in certain cases.

Introduction. Primary non-Hodgkin’s lymphoma of the extrahepatic bile duct presenting as obstructive jaundice is an extremely rare disease. Case presentation. We report a case of obstructive jaundice caused by primary non-Hodgkin’s lymphoma of the common bile duct (CBD), in a 67-year-old male patient. Our patient showed clinical evidence of obstructive jaundice, and tomography revealed a dilated common bile duct with the suspicion of intra ductal lithiasis. Endoscopic retrograde cholangiopancreatography (ERCP) was performed, with efficient drainage and clinical resolution of the obstructive jaundice. One month later, the patient presented the same clinical signs of obstructive jaundice, only this time the ERCP revealed common bile duct distal stenosis. The next step was to perform an echoendoscopy (EUS), that visualized a homogeneous mass at the common bile duct distal level and cholangiocarcinoma was suspected. Fine needle aspiration (FNA) of the lesion obtained tissue fragments for histological examination. The diagnosis was diffuse B-cell type non-Hodgkin’s lymphoma in the marginal area, and the patient was evaluated in the Oncology Department for chemotherapy. Conclusions. It is very important to differentiate primary non-Hodgkin’s lymphoma of the bile ducts from other causes of obstructive jaundice, as the treatment approach and prognosis are fundamentally different. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is the definitive diagnosis technique, avoiding surgical interventions and the classic exploratory laparotomy.

Although the exact incidence of cervical cancer cases in pregnant women is not known, undoubtedly is the most common gynecological malignancy diagnosed during pregnancy. Association between the two entities does not seem to influence the oncological outcomes. However, the management of these cases remains a real challenge for the obstetrician and for the onco-gynecologist, fighting for two lives being necessary. Moreover, due to the rarity of cases, there are no standard guidelines, the therapeutic strategy being influenced only by small case series and observational studies. This is a literature review of the current therapeutic options available for the management of such cases.

The mandrake, not just a narcotic: its place in medicine and ancient greek civilization Hippocrates and his followers, as well as Pedanius Dioscorides, Pseudo-Galen and Aretaeus of Cappadocia are just a few of the many ancient Greek physicians who have used the plant mandrake. Its narcotic properties were not limited to palliate pain during surgery, but they have been also used to treat pulmonary, neurological and mental diseases. Moreover, mandrake was celebrated in ancient Greek mythology, religion and comedy.

Peritoneal carcinomatosis with breast cancer origin is an uncommon situation, which usually develops late during the evolution of the disease. The development of such lesions is commonly associated with an aggressive histology (such as lobular carcinoma) and advanced stage at diagnostic and is usually associated with a poor outcome. The positive diagnostic of peritoneal carcinomatosis with breast cancer origin can be sustained only if a biopsy from the tumoral nodules demonstrates the mammary origin of the lesions. In order to improve the outcome of these patients cytoreductive surgery alone or in association with hyperthermic intraperitoneal chemotherapy has been proposed. However, more studies are still needed in order to include the method as part of the therapeutic strategy of these patients.

?he superficial palmar arch (SPA) is usually formed by an anastomosis between the ulnar artery (UA) and the radial artery (RA) and gives off three common palmar digital arteries. Many variations of the SPA have been reported in the pertinent literature (ulnar type arch, radial type arch, complete and incomplete arch, etc). Complete SPA is reported to be formed in the 69.2 % of the right hands and 70.5 % of the left hands in the pertinent literature. We report a case of a complete ulnar type SPA, where the first and second palmar digital arteries emerge from a common stem

Vulvar cancer is a rare gynecologic malignancy usually amenable to surgery, especially in cases diagnosed in early stages of the disease. Although initially it had been considered that extended radical surgery should be routinely performed in such cases, the high rates of perioperative complications led to the modification of the therapeutic protocol, more limited surgical procedures being proposed. The extent of the surgical procedure was modified in terms of both vulvar resections and extent of lymph node dissection, sentinel lymph node dissection being widely recommended in the last decade. This is a literature review of the most consistent studies conducted on the theme of sentinel lymph node biopsy for early stage vulvar cancer patients.

Colonoscopy is a common diagnostic procedure for colon. Colonic perforation is a well-known iatrogenic complication of diagnostic colonoscopy. However, appendiceal involvement with inflammation or perforation is extremely rare and only a few cases of post-colonoscopy appendicitis have been reported so far. We describe a series of four cases operated in our clinic for acute appendicitis that developed in young age, shortly after colonoscopic examination for another pathology (irritable bowel syndrome, diverticular colonic disease, left iliac fossa and left flank pain).

Introduction: Primary cardiac tumours are very rare neoplasms, usually with a late diagnosis in clinical practice, because of nonspecific symptoms and clinical signs. Case presentation: We report the case of a 28-year-old woman, who presented for right flank and right iliac fossa pain, radiating to the right lower limb. The pain was progressive and had had its onset 3-4 days previously. The patient was known with renal calyceal microlithiasis (with renal colic in the history) and mild iron deficiency anaemia, and had a medical history of recurrent miscarriages. Physical examination revealed: sinus bradycardia (50-54 bpm), low-grade fever, and positive Giordano sign on the right side. The pain was considered as right renal colic and analgesics and antispasmodics were administered. Blood tests revealed normocytic, hypochromic anaemia and a mild inflammatory syndrome. Abdominal ultrasound revealed bilateral renal microlithiasis and also a triangular, hypoechoic area in the right kidney parenchyma, with no colour Doppler ultrasound signals. Echocardiography revealed a left atrial mass with a diameter of 1.5 cm, hyperechoic, heterogeneous, mobile, attached to the interatrial septum. Chest-abdomen-pelvis CT confirmed the presence of the cardiac mass, as well as an area of right renal infarction. Anticoagulant therapy with low molecular weight heparin was initiated. The patient was referred to the cardiovascular surgery department, where the cardiac mass was removed and sent for histological examination, which confirmed the diagnosis of left atrial myxoma. The patient had a favourable evolution. Conclusions: The presence of sinus bradycardia in a young patient, without known cardiac diseases, led to the necessity of an echocardiography, which revealed the left atrial mass. Peripheral embolization with right kidney infarction represented the clinical onset of the cardiac tumour. In this patient, who presented with abdominal and right flank pain, the previous known diagnosis of renal microlithiasis was initially misleading. Cardiac tumours have unspecific symptoms and the first manifestations could be due to the embolization of tumour fragments in the periphery, mimicking, thus, other disorders.

Sigmoid volvulus happens when the sigmoid wraps around itself and its mesentery. Sigmoid volvulus accounts for 2% to 50% of all colonic obstructions. This pathology generally affects adults, and it is more common in males. The etiology is multifactorial and controversial; the main symptoms are diffuse abdominal pain, distention and constipation, while the pregnant signs are abdominal distention and tenderness. Laboratory findings are not pathognomonic: abdominal X-ray radiographs show a dilated sigmoid colon and multiple intestinal air-fluid levels, abdominal CT and MRI demonstrate a whirled sigmoid mesentery. Flexible endoscopy reveals a spiral sphincter-like twist of the mucosa. The diagnosis of sigmoid volvulus is established by clinical, radiological, endoscopic, and sometimes operative findings. Although flexible endoscopic detorsion is advocated as the primary treatment choice, emergency surgery is required for patients who present with peritonitis, bowel gangrene, or perforation, or for patients whose non-operative treatment is unsuccessful. Although emergency surgery includes various non-definitive or definitive procedures, resection with primary anastomosis is the most commonly recommended procedure. After a successful non-operative detorsion, elective sigmoid resection and anastomosis is recommended. The overall mortality is 10% to 50%, while the overall morbidity is 6% to 24%.

Introduction. Autoimmune thyroiditis is one of the most important problems of modern endocrinology, with inadequately studied etiological and pathogenic mechanisms of development. It is characterized by the lack of objective and reliable diagnostic methods, effective treatment methods, uncertain therapy or indications for the choice of treatment methods. The aim of the study. Determination of markers for prediction of clinical course and choice of surgery’ volume in patients with nodular goiter and autoimmune thyroiditis, taking into account the oxidative, autoimmune and apoptotic processes. Material and methods. A total of 95 patients who were operated for a nodular endemic goiter on the background of autoimmune thyroiditis were examined. The status of pro- and antioxidant systems, the activity of proinflammatory cytokines, hormonal function of thyroid gland, the level of antibodies to thyroperoxidase, thyroglobulin antibodies and ultrasound structural changes in the thyroid gland have been evaluated in all patients, before and after surgery. Results. In patients with nodular endemic goiter and autoimmune thyroiditis, in the remote period after surgical treatment, there is a significant increase in the peroxide oxidation index and a decrease in the activity of antioxidant defense systems, against the suppression of apoptotic processes and the activation of pro-inflammatory cytokines. These processes lead to functional failure, hyperplasia and the progression of structural thyroid abnormalities, with progression of the functional incapacity of the thyroid gland and inadequate long-term outcome of treatment. Conclusions. The study allowed to clarify the indications and contraindications of different methods of treatment in patients with NGAIT, taking into account the parameters of severity of peroxide oxidation processes, the activity of apoptosis and functional capacity of the gland.

Introduction. Arterial variations may cause significant complications during diagnostic and interventional procedures. The objective of the study. Our study examined 73 donated cadavers in the National and Kapodistrian University of Athens, in an effort to unearth possible artery alternations. Material and methods. The major branches of the abdominal aorta, the arteries of the limps and the neck were inquired. Results. In 58.9% of the cadavers no arterial variation was found, whereas one, two and three alternations at the same cadaver were observed in 21.9%, 12.3% and 6.8% respectively. The most common anatomical variations were noted in the vascular branching of the celiac trunk found in 24.7% of the cadavers. Conclusions. There was no statistically significant difference between the two genders concerning the frequency of the observed arterial variations (p<0.05).

Introduction. It is necessary to clearly understand the norms of morphometric parameters of thorax during the fetal period of human ontogenesis, which is one of the main directions to solve the problem of modern normology. Objective. To trace the dynamics of changes of morphometric parameters of the bony thorax in human fetuses aged 7-10 months. Materials and methods. The anatomical study involved 39 human fetuses specimens of 231.0-375.0 mm of crown-rump length (CRL). The study was conducted by means of macro-microscopic preparation, morphometry and variation statistics method. Results. It was found that the length of the costal cartilage increases from rib I to VII and is the longest in the rib VII. The ribs are the highest along the midclavicular line. At the same time, the height of the ribs decreases along the posterior axillary line and becomes the shortest along the scapular line. It was revealed the greatest width of the II and III intercostal spaces along the parasternal and midclavicular lines. The width of the four superior intercostal spaces along the midclavicular line on the right and on the left is larger than the height of the corresponding ribs. The width of the II-X intercostal spaces on the right and on the left along the scapular lines exceeds the height of the corresponding ribs in 1.33-1.65 times. The greatest width of the II, IV and VII intercostal spaces was along the posterior axillary line both sided. The greatest width of the II, IV and X of the intercostal spaces was noted along the scapular lines. Conclusions. The length of the costal cartilage increases from rib I to VII and is the largest in VII ones. The smallest value of the length of the costal cartilage was found in the rib XII. During the 7th-10th months of the intrauterine development, an intensive increase in the length of costal cartilages of the ribs I-III occurs, on average, by 1.5 times, and there is a slow increase in the length of the costal cartilage of the rib VII. The ribs along the midclavicular line are the highest. At the same time, the height of the ribs decreases along the posterior axillary line and along the scapular line it is the lowest.

The aim of the study was to assess the activity of enzymes in the antioxidant system in the brain of rats subjected to intoxication with sodium fluoride in subtoxic doses. Methods. The studies were conducted on sexually mature Wistar rats weighing 180-220 g, subjected to oral exposure by means of a probe with aqueous solutions of sodium fluoride (SF) once daily for 60 days at doses of 1/10, 1/100 and 1/1000 DL50, correspondingly, equaling to 20 mg/kg, 2 mg/kg and 0.2 mg/kg of body weight. Chemoluminescent method was used to confirm the induction of free radical processes by measuring the intensity of super-weak luminescence in the homogenate of the liver and the brain in the range of 400-600 nm, which occurs as a result of chemoluminescent reactions. Statistical analysis of the results was carried out using Statistica 6.1 (StatSoft, Inc., USA). Results. Reducing the intensity of a superweak luminescence on the 60th day of oral administration of SF to rats at a dose of 1/10 DL50 indicates a depletion of the energy potential of the substrate and the inadequate admission of free radicals of biological molecules to the oxidation system. The results showed a significant (p<0.001) increase of chemoluminescence relative to the comparison group of animals in the induced by dual-valent iron ions in the brain of experimental group of rats, who were administered SF at a dose of 1/10 DL50 on the 10th day of observation, on average by 40%. Conclusion. Under conditions of long-term fluoride intoxication in the rat’s brain, the expressed disruptions of free radical oxidation occur, which is reflected as the increase in the intensity of chemoluminescence of its homogenate and decrease in the activity of the antioxidant enzymes, superoxide dismutase and catalase, in the neocortex, which is a significant factor in the depletion of the adaptive capacity of the body.

The objective of the study was to investigate the changes of the kidney functions in mature rats with rapid acetylation type, under conditions of subacute cadmium-nitrate intoxication and preventive introduction of Echinacea purpurea. Methods. Male rats, 6 months of age, with rapid acetylation type, were divided into 3 groups: ? – control; ?? – rats with of subacute cadmium-nitrate intoxication model; ??? – rats receiving intragastric alcohol tincture of fresh rhizomes with roots of Echinacea purpurea (LC “State Municipal Enterprise “Pharmaceutical Plant Vishpha””, Ukraine; 0,25 mk/rg). Results. Under the effect of preventive introduction of Echinacea purpurea in rats with rapid acetylation type and cadmium-nitrate lesion of the kidneys, diuresis and glomerular filtration rate became normal; distal transport of sodium ions increased; hyponatraemia and decreased natriuresis remained without changes; concentrations of creatinine in the blood plasma, potassium ions in the blood plasma and urine, kaliuresis decreased. Similar to the group of rats without Echinacea purpurea, proximal reabsorption of sodium ions, which is standardized by glomerular filtration, decreased. Conclusion. Under conditions of preventive introduction of Echinacea purpurea, volume regulating kidney function is maintained in mature rats with rapid acetylation type and subacute cadmium-nitrate intoxication, but it does not prevent the development of toxic nephropathy, with prevailing lesion of the nephron proximal portion, disorders of ion regulating kidney function and water-electrolytic balance.

The objective of the study was to investigate the features of blood neutrophils’ apoptosis in case of combined trauma of the chest and both thighs in rats. Material and methods. The analysis of cell samples to determine reactive oxygen species was evaluated by the flow laser cytometry method, using 2.7-dichlorodihydrofluorescein diacetate. The percentage of neutrophils with low transmembrane mitochondrial potential and percentage of apoptotic neutrophils were evaluated by the flow laser cytometry method, using specific kits. Results. It was established the progressive, statistically significant increasing of Annexin V- positive cells percentage from the first day of the experiment, with the highest values within 7-14 days of observation. On the 28th day of experiment, the reduction of apoptotic white blood cells percentage by 7.7% than the findings on the 14th day was observed, but it remained 33.3% higher than the control. Conclusion. One of the important signaling pathways of apoptosis triggering in case of experimental combined trauma of the chest and both thighs is reactive oxygen species overproduction and disruption of the mitochondrial inner membrane, due to the decreasing transmembrane potential on 3-7 days of observation.

Introduction. Throughout the centuries, plants have been used not only as a source of nutrition, but also in the fight against diseases. The most interesting are medicinal plants being well tolerated by patients regardless of age. One of these plants is Centaurium erythraea Rafn. The aim of the study was to develop an optimal technology for obtaining an alcoholic extract with the highest content of biologically active substances: hydroxycinnamic acids, phenolic compounds. Materials and methods. We have performed a study of the concentration of ethanol and multiplicity of dilution with the help of a symmetric rotary composite plan of the second order. Results and discussion. The regression equations were adequate – Fexp. < Ftab. The nature of the influence of the studied factors was determined by the magnitude and signs of the coefficients from regression. To obtain the alcohol extract with the highest content of hydroxycinnamic acids and phenolic compounds, the concentration of ethanol should be 69%, and the ratio of raw material to extractant should be 1 to 5. Conclusions. Further pharmacological studies showed the extract obtained reliability of its application for an increase in gastric acid secretion.

Introduction. Essential thrombocythemia (ET) is a clonal disorder of the hematopoietic stem cells characterized by persistent thrombocytosis in the peripheral blood, excessive proliferation of megakaryocytes and minor reticulin fibrosis in the bone marrow. It seems that oxidative stress is involved in the development and progression of ET. Objective. To evaluate oxidative stress levels in ET patients treated with risk-adapted therapy. Material and methods. 62 ET patients and 20 controls (informed consent obtained) were enrolled. ET diagnosis was based on WHO criteria (2016 revised). Reactive oxygen species (ROS) levels and the total antioxidant capacity (TAC) were evaluated at time of diagnosis and after 6 months of risk-adapted therapy. ET patients were divided into 3 groups and treated with risk–adapted therapy: a low risk group, treated with low doses of aspirin 75 mg/day or watch-and-wait; an intermediate risk group treated with low doses of aspirin 100 mg/day or low-dose aspirin + cytoreductive treatment; a high-risk group, treated with low doses of aspirin and cytoreductive treatment (hydroxyurea) or platelet-lowering agents (anagrelide). Results. ET patients had at diagnosis higher ROS levels and a lower TAC vs. controls. After 6 months of risk-adapted therapy, ROS levels decreased and TAC increased. No significant differences were seen between the effect of hydroxyurea and the effect of anagrelide on oxidative stress levels. Conclusions. ROS levels are increased and TAC is decreased in ET patients vs. controls. These values depend on the risk group assigned to the patient. Risk-adapted therapy was useful to reduce ROS levels and increase TAC.

Hereditary spherocytosis (HS) is an inherited abnormality of the red blood cell, caused by defects in structural membrane proteins. The condition is dominantly inherited in 75% of people. The severity of the disorder is related to the type and amount of membrane disruption, which is genetically determined. A patient who suffers from this disorder is commonly found in a surgical ward when the disease becomes unmanageable by a hematologist. Surgeons encounter complications such as: jaundice, splenomegaly, gallstone sand severe anemia. We present the case of a 66-year-old woman with a history of hereditary spherocytosis who presented at the emergency room for pain in the right upper quadrant, jaundice and anemia and was diagnosed with gallbladder stones and common bile duct obstruction.

Introduction. In recent years, the incidence of chronic cervical pain, as the result of degenerative processes, increased among younger people. Studies show a close relationship between cervical pain and sedentarism, as well as occupational risk factors. Throughout life, intervertebral discs are prone to a physiological wear-out process; in the degenerative discopathy, the wear is accelerated, even when it comes to young people, due to the increasingly frequent postural alterations. Objectives. To demonstrate a direct link between the postural system receptors disruption and the degenerative disc pathology, as well as the importance of postural rehabilitation strategies and specific manual therapy in the clinical-functional and therapeutic approach of degenerative cervical discopathies with a painful component. Methods. 174 patients divided into two groups undergone specific assessment tests. The study group followed a personalized therapeutic program (manual therapy, postural re-education), while the control group benefited exclusively from the standard therapeutic program, according to the medical prescription. Results. The data confirm the increased incidence of cervical algic syndromes of myofascial origin among the young population and its close relationship to postural syndromes and CCM biomechanical changes identified in the patients included in the study. This study also highlights the importance of a multidisciplinary approach of the patient with myofascial cervical pain. Conclusions. A significant and long lasting improvement in postural balance results in an obvious improvement in cervical algic syndromes and in slowing the evolution of the cervical disc degeneration process.

Introduction. Serous carcinoma is responsible for 47% of all ovarian cancers, and from these cases, only 5% are represented by low-grade serous carcinoma, the rest of them accounting for high-grade serous carcinoma. Objective. The aim of this study is an observational approach of the differences and similarities of the two types of serous carcinoma of the ovary, that must be seen as different forms of cancer and rendered with care. Methods. We performed a retrospective study using three cases of ovarian high-grade serous carcinoma and three cases of ovarian low-grade serous carcinoma, diagnosed at the University Emergency Hospital Bucharest. We analyzed patients’ age, clinical symptoms, macroscopic and microscopic features together with immunohistochemistry tests. Results. Mean age for HG carcinoma was 71.3 years old and for LG carcinoma 47.6 years old. Average tumor diameter was with 5.67 cm higher for LG carcinoma. The most encountered stage for HG tumors was pT2a and for LG tumors was pT1a. Mean value for Ki67 was with 36.33% higher for HG carcinoma. AR expressed diffuse positivity in two cases of LG and only focal positivity in two cases of HG. CD44 expressed focal positivity in all cases of LG and had different patterns in HG. Conclusions. We found considerable differences between patients’ mean age, macroscopic and microscopic features, together with immunohistochemistry expression for Ki67, AR, CD44.

Introduction. A better predictive tool to use for assessing the risk of cardiovascular complications and postoperative mortality in elderly with femoral neck fracture is still not fully developed, and new data in stratifying the cardiovascular risk are still necessary. The objective of the study was to determine the influence of preoperative variables from the cardiovascular preoperative assessment on mortality, and to try to set some standards in the preoperative management of patients with cardiac risk and hip fractures who need surgery. Material and methods. We analyzed age, metabolic equivalents according (METS) to Duke Activity Status Index (DASI), hemoglobin, N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and high sensitive C-reactive protein values, echographic measurements such as left ventricular ejection fraction (LVEF), left ventricular diastolic volume (LVDV) and diameter (LVDD), left ventricular wall hipertrophy (LVH) calculated as a mean of the posterior wall and the interventricular septum, the left ventricular contraction velocity S, pulmonary artery pressure (PAPs), the tricuspid anular plane systolic excursion (TAPSE), and time to surgery, for 72 patients aged over 60 y.o, hospitalised in the Orthopaedics Department of the University Emergency Hospital of Bucharest, Romania, between 2015-2016. Results. The deaths after 3 months from surgery were 13 (18%). The best correlation with 3 month mortality was the delay in surgery over 4 days (p<0,0001), with an area under the ROC curve of 0.943 and NT-proBNP values over 731 pg/L (p<0.0001) and an area under the ROC curve of 0.898. Good correlations were found for an echocardiographic value of s < 7.7, with an area under the curve of 0.745 and a TAPSE < 19.5, corresponding to a area under the curve of 0.807. Conclusions. The mortality was relatively high, and in our opinion, the gold standard should be speeding up the cardiovascular investigations and compensation of cardiovascular pathology, to allow surgery as early as possible, for a better survival of patients with femoral neck fractures.

The ethical medical code which was born in ancient Greece had durable grounds and survived in the medical profession until today. These ethical standards of the physicians were gradually formulated during antiquity.

Introduction. During the last decade, multiple studies tried to assess the correlation between brain hemorrhage and increased levels of Brain Natriuretic Peptide. These studies highlight the association between BNP plasma concentrations after traumatic brain injury and elevated intracranial pressure. Case presentation. We present a case of a 40-year-old male, victim of a car accident, found in prehospital with 5 pts Glasgow Coma Scale (GCS) and with severe head, thorax and lower right limb traumatic lesions. After the first evaluation, it was necessary to protect the airways and to intubate the patient. The computed tomography (CT) scan revealed multiple bone fractures of the skull with bilateral parietal epidural hematoma (30 mm thickness), pneumoencephaly, subarachnoid hemorrhage, concussion, multiple rib fractures with pulmonary contusion, double fractures of right fibula. Because the patient had severe thoracic and head trauma, we decided to complete the blood tests with N-terminal pro B-type Natriuretic Peptide (NT-proBNP) (736 pg/mL) and creatine kinase (CK) (3853 U/L). Conclusions. The association of polytrauma with increased levels of NT-proBNP present a continuous interest for researchers. An exact correlation between cerebral/cardiac trauma and this natriuretic peptide precursor has not been fully demonstrated yet, especially regarding the biological active form due to trauma. Further studies are currently performed to clarify the physiological role of this peptide, to confirm the correlation between its high levels and trauma, and to identify a specific role in the outcome of severe traumatic patients.