Introduction

Chronic limb-threatening ischemia represents the advanced stage of atherosclerosis and is often associated with significant cardiovascular morbidity, resulting in high mortality rates. The hybrid approach combines surgical and endovascular techniques, allowing for optimal revascularization of multilevel lower limb atherosclerotic lesions. Additionally, the hybrid approach offers the advantages of shorter procedure times and reduced trauma compared to the classical method. It is also expected to result in a shorter length of hospital stay for patients. Therefore, the aim of this study is to analyze the relationship between the hybrid approach and the length of hospital stay compared to the classical vascular surgical approach in patients with chronic limb-threatening ischemia, multilevel atherosclerosis, and a high anesthesiologic risk.

Material and methods

The study compares the total and postoperative lengths of stay between two groups: a prospective group (N = 48) of patients treated with hybrid revascularizations, and a control group (N = 50) treated with classical vascular revascularizations. The included patients in both groups had multilevel atherosclerotic lesions (including aorto-iliac, femuro-popliteal, and runoff) and chronic limb-threatening ischemia (Fontaine grade III and IV).

Results

The study analyzed the total and postoperative lengths of stay in both groups, including ischemia-based subgroups. The results showed that both the total and postoperative lengths of stay were significantly shorter in the hybrid approach group compared to the control group.

Conclusions

In cases where hybrid revascularizations were used, the length of hospital stay for patients with chronic limb-threatening ischemia and multilevel atherosclerosis is significantly shorter compared to the classical vascular surgical method.

Background

The unintentional leaving of gauze sponges in the abdomen after laparotomy is a rare but serious medical error. The diagnosis of a textile foreign body can be challenging due to its rarity, potential long-term asymptomatic evolution, and nonspecific imaging findings that may be unfamiliar to radiologists.

Materials and methods

The data of 13 radiologically identified and surgically confirmed cases of abdominal textilomas treated over a 15-year period were assessed retrospectively. There were 10 women (76.9%) and 3 men (23.1%); the average age was 38.5±4.7 years. The average interval between the previous procedure and the diagnosis of textiloma was 25.3±15.2 months, ranging from 1 day to 16 years.

Results

The most common imaging patterns seen on CT included masses with a typical spongiform structure with numerous small air bubbles and surrounded by a thin capsule, as well as a high-density, well-circumscribed lesion, sometimes with mottled calcification, and a dense capsule with intense contrast accumulation. Based on surgical history, physical examination, and CT scan findings, a likely diagnosis of textiloma was made before surgery in 11 (84.6%). In all patients, a repeated open surgery was necessary to remove textile foreign bodies.

Conclusions

The possibility of an abdominal textiloma should be considered in the differential diagnosis of any postoperative patient who presents with pain, infection, or a palpable mass. CT scanning is a practical and highly sensitive diagnostic tool for detecting textilomas with characteristic imaging features in both chronic encapsulated and acute inflammatory manifestations.

Introduction

Premature birth can occur at any age; however, it is important to note that the risk of preterm birth can vary based on several factors, including the mother's medical history, general health, and lifestyle. There is thought to be a relationship between maternal age and the risk of preterm birth, although the exact nature of this relationship may vary. At the same time, it is considered for ages over 35, an increased risk factor for the evolution of pregnancies with complications. Pregnant women over 35 face a higher risk of premature birth. This increased risk may be associated with age-related factors such as underlying health conditions, higher rates of multiple pregnancies (due to fertility treatments), and potential placental dysfunction.

Material and methods

In the given study, the biomarkers IL-6, IL-8, IL-10, IL-12, SDF-1α and VEGF in amniotic fluid (AF) and maternal blood were investigated, considering the above as predictive of premature birth outcome. At the same time, the oxidative stress status of maternal blood and amniotic fluid collected in the second trimester of pregnancy was identified.

Results

In the research, we obtained statistically significant increases in the biomarkers AAT-isopropyl, G-GTP, HPL-isopropyl from the amniotic fluid taken from pregnant women over 35 years of age in the second trimester of pregnancy in those pregnant women who had a preterm birth. In the serum of pregnant women with premature birth, an increase in the concentration of carnosine-histidine peptides, G-GTP, GR and SH (thiol) groups was identified, and the decrease in the values of SDF 1α, HPL – hexane and IL-12 were statistically significant in the serum pregnant women compared to that of the amniotic fluid.

Identifying the values of biochemical mediators during pregnancy can be a method of predictive diagnosis

Conclusions

Our study shows the relationship between some concentrations of oxidative stress biomarkers (AAT-isopropyl, HPL-isopropyl and G-GTP, IL-12) in amniotic fluid, and values of (Carnosine Histidine Peptide, GR and SH and SDF-1α) in the serum of pregnant women, in the second trimester of pregnancy.

Objectives

Early establishment of arthritis in PsA based on clinical data and ultrasound examination.

Material and methods

The study was conducted between 2019-2023, in the rheumatology and arthrology departments of the Timofei Moşneaga Republican Clinical Hospital, or treated in outpatient. In order to meet the requirements of the study, 100 people were examined, including 70 patients with PsA.

Results

In patients with PsA the most common changes were an increase in the amount of intra-articular fluid and the proliferation of the synovial membrane. In total, fluid was detected in 293 out of 3,232 joints (9.1%).

Conclusions

Ultrasound is a highly informative method in detecting a wide range of morphological changes in the joints of patients with PsA. The highest index of sensitivity appeared when inflammatory fluid, cartilage changes, osteophytes and tenosynovitis were detected.

Introduction

The article presents the results of studies of the effect of applying topical fluorinated glucocorticosteroids in combination with ceramides on the barrier function of the skin of experimental animals with allergic dermatoses (guinea pigs).

The purpose of the work

substantiation of the inclusion of ceramides in the base of topical fluorinated steroid preparations for the treatment of allergic dermatoses by studying the morphological changes in the skin of guinea pigs after the application of the indicated means of various compositions.

Materials and methods

Histological research was carried out on outbred guinea pigs of the same sex and condition (74 individuals). The animals were divided into separate groups depending on the applied drugs. The following combinations of drugs and, accordingly, guinea pigs were selected, which were divided as follows: IC – intact control (15 animals); O – base application (14); OC – base containing ceramides (15); FSt/kr – fluorinated steroids of strong action (betamethasone) (16); FStK/kr – fluorinated steroids of strong action (betamethasone) + ceramides (14).

Results

In order to study the traumatic effect of topical steroids on the skin and the possibility of preventing morphological (atrophic) disorders, an experimental study of the morphology of the skin of guinea pigs was carried out on a model of atrophy caused by long-term (14 days) application of topical fluorinated steroids of various compositions.

Applying the foundation to animals led to some thickening of the epidermal layer, while the morphology of the epidermis and the skin itself was not disturbed. The addition of ceramides led to the acceleration of proliferative processes and the development of proliferative acanthosis. Changes induced by betamethasone were noted mainly in the epidermis in the form of local atrophy of the epidermal layer. The addition of ceramides to a potent fluorinated steroid to some extent smoothed out the negative effects of the corticosteroid hormone. The average thickness of the epithelial layer increased by 2 times compared to the thickness of the epithelial layer of animals of the FSt/kr group and even slightly exceeded the indicators of intact animals. Vacuolar dystrophy of the cells of the spinous and granular layers occurred in all animals of the FStK/kr group. Lymphoid infiltration of the dermis, parakeratosis and acantholysis were not noted.

Conclusions. The results of an experimental study of the effect of topical fluorinated steroids of different composition on the skin of guinea pigs indicate the existence of differences between the drugs in terms of their degree of action on the intensity and development of pathological processes in experimental animals. A comparison of the effect on the skin of classic topical steroids and those additionally containing ceramides indicates the possibility of preventing the traumatic effect of hormones, which is especially important for patients with filaggrin gene mutations.

Introduction

Specialists in the field often face uncertainty in deciding whether to perform sinus lifting surgery in the presence of a mucosal cyst during the pre-implantation preparation of patients with maxillary sinus pathology. While some specialists believe that the sinus lifting operation cannot be performed in the presence of sinus pathology and should be resorted to after a long period of healing, others believe that it can be performed in the presence of sinus pathology or simultaneously with sinus sanitation. As a result, there are more controversies about the treatment tactics, stages, and timing required to achieve the rehabilitation of these patients, demonstrating the significance of the problem at hand.

Materials and methods

The study included twenty patients who were referred to the Department of OMF Surgery and Oral Implantology "Arsenie Guţan" and the dental clinic "OmniDent" between 20.06.2016 and 01.01.2019 for implant-prosthetic rehabilitation due to partial edentulism in the upper jaw in the lateral area and the presence of a mucosal cyst in the maxillary sinus. The first group comprised of seven patients in whom the mucosal cyst was completely removed while simultaneously undergoing lateral sinus lifting. The second group consisted of five patients, aged between 18 and 67 years (average 45 years), who underwent marsupialization of the mucosal cyst. The third group comprised of six patients in whom the cyst content was only aspirated, without removal or marsupialization of the cyst.

Results

All three methods were found to be effective, although total perforations of the sinus mucosa were recorded in the first two groups, preventing the performance of sinus lifting at that stage. The method of aspirating the cystic content, however, is a simple and low-risk procedure that does not carry the risk of perforating the sinus membrane and provides predictable results.

Conclusions

The mucosal cyst does not present a contraindication to sinus lifting but requires additional surgical procedures.

Introduction

Benign prostatic hyperplasia and chronic prostatitis are the most common conditions in men, the frequency of which varies with age. Chronic prostatitis (infectious or inflammatory) has a frequency of 8-35% in patients aged 20-50 years, reaching a maximum of 60-70% in those aged over 50 years.

Materials and methods

Materials for the study served the medical literature regarding benign prostatic hyperplasia and chronic inflammation, published in the local and international scientific journals. Scientific databases like Cochrane Library, Medline, Scopus, Medicus, NCBI, PubMed, Google Scholar were used to find the necessary articles. Research methods – analysis, synthesis, systematization, and description.

Results

After analyzing the available data, a review of the literature was conducted which highlighted both the strong and weak points of the historical medical approaches to addressing benign prostatic hyperplasia, as well as the ontogenetics and anatomical characteristics of the prostate gland. This included examining the incidence rates, concepts of causation and development, principles of diagnosis and classification of benign prostatic hyperplasia. The review also revealed the pros and cons of using mini-invasive treatment strategies versus traditional transvesical approaches in treating this condition, as well as the ongoing and significant socioeconomic impact in underdeveloped countries.

Conclusions

There remains the issue of reducing intra- and post-operative complications after benign prostatic hyperplasia surgery, especially a voluminous one, which imposes itself as a very critical problem in the development of an effective treatment strategy. For the first time, a problem was described by assessing the particularities of some biochemical criteria at local surgical site and in blood serum, histological - at the level of nodular prostatic hyperplasia and at the border of the surgical site. This requires a complex correlational study to assess the biochemical, histological and immunohistochemical parameters, including the evaluation of the associations or coexistence of benign prostatic hyperplasia and chronic prostatitis.

Background

The presence of prolonged sinus pauses is quite rare in children and adolescents with structural normal heart. The decision of the optimal therapeutic tactics is always challenging. 

Case report

The 16-years-old girl addressed with complains of palpitations and dizziness after the palpitations end. A Holter ECG monitoring was performed with the detection of prolonged sinus pauses after the paroxysm of atrial tachycardia. We decided to perform an electrophysiological study to diagnose the tachycardia type. The presence of atrial tachycardia originating from the ostium of the coronary sinus was demonstrated. We decided to manage the tachyarrhythmia with catheter ablation. During the application of the radiofrequency currents, the tachycardia stopped, and the sinus rhythm was restored. The ablation was preferred over medication taking into consideration the potential risk of worsening of the bradycardia by antiarrhythmic therapy. 

Conclusions

The optimal therapeutic solution in similar pediatric cases should be directed towards the supraventricular tachycardia treatment and not to the bradyarrhythmia. The majority of supraventricular tachycardias could be cured by catheter ablation. 

Introduction

Dual x-ray absorptiometry (DEXA) scan has been the gold standard for assessing bone mineral density prior to spinal instrumentation surgery. DEXA scans, on the other hand, can produce falsely elevated measurements in patients with severe degenerative changes, compression fractures, and aortic calcification, which can lead to incorrect patient selection and failed interbody fusion.

Materials and methods

Detailed anamnesis of disease development, thorough clinical examination, patient-reported outcome measures (pain VAS, ODI, SF-12), preoperative and postoperative bone-window CT of the spine (interbody fusion status assessment), vertebral bone mineral density assessment by DEXA scan, vertebral bone density measurement in Hounsfield units by computer tomography, and the review of published literature were analysed.

Results

A 67-year-old woman was diagnosed with L4-L5 degenerative spondylolisthesis. DEXA scan revealed normal bone mineral density in the lumbar vertebrae. The patient underwent midline lumbar interbody fusion (MIDLIF). The postoperative course was complicated by the occurrence of clinical and radiographic signs of pseudarthrosis. She refused revision surgery and was lost to follow-up. Three years postoperatively, she presented in good physical condition, with significant improvement in pain and functional disability. A CT scan showed delayed successful interbody fusion with complete resolution of radiolucency around implants.

Conclusions

This case report summarizes some of the possible errors in diagnosis and surgical treatment in patients with degenerative pathology associated with severe vertebral osteoporosis.

Background

Pachydermoperiostosis (or primary hypertrophic osteoarthropathy) is a rare genetic disease that usually begins in childhood or adolescence, is characterized by certain clinical signs (pachydermia, periostosis, drum sticks) that gradually progress over many years until the disease stabilizes. Currently, there are 2 genes in which mutations are associated with the development of pachydermoperiostosis - HPGD and SLCO2A1. The functions of these genes are not fully understood, but their influence on the metabolism of prostaglandin E2 is known.

Case presentation

We present a case of a 20-year-old patient mistakenly diagnosed as juvenile idiopathic arthritis. Symptoms on admission to the hospital: pain accompanied by swelling in the hands and feet, arthralgias in the talocrural joints, knees with slight swelling, paresthesia in the extremities, hyperhidrosis, fatigue. Clinical and paraclinical examinations confirmed the diagnosis of pachydermoperiostosis.

Conclusions

Pachydermoperiostosis should be considered as a differential diagnosis when a patient presents with hypertrophic osteoarthropathy and acromegalic features.