Search

Mullerian anomalies include a range of abnormalities of the lower female genital tract that can involve the uterus, cervix, the upper vagina and fallopian tubes. Women with these anomalies have a higher incidence of infertility, miscarriages, premature births, and other reproductive problems. They have a wide range of manifestations. Here, we present a patient with cervical and vaginal duplication with a normal uterus.

Introduction. The most common functional complications after the treatment of breast cancer are reduction of range of motion in the shoulder joint (incidence of 10 to 73%), lymphedema of the arm (10-30%) and nerve damage of the arm or damage of brachial plexus (1.8-4.9%). Multiple complications rarely occur and they are usually of mild to moderate forms. Case report. VV (woman), born in 1965 was exposed to quadrantectomy of the left breast with axillary dissection in 2003 (histopathology: ductal carcinoma; 4 removed lymph nodes, 1 of which with a secondary deposit). After the surgical intervention, the patient underwent chemotherapy (CMF protocol VI cycles) and radiation therapy (50 Gy/12 cycles). Four months after the therapy completion, lymphedema of the left arm was developed, and few months later brachial plexus injury as well. First visit to physiatrist was five years later, with a significant reduction of range of motion in the left arm and severe lymphedema (maximum difference to 7.5 cm). EMNG trial indicated a moderate lesion of left median nerve and ulnar nerve and mild to moderate lesion of left radial nerve injury; DASH score was 107. After repeated physical treatments (since 2009), the last control in October 2016 showed that the functional status was significantly improved: reduction of range of motion was present in flexion and abduction only, lymphedema was reduced (maximum difference of 5.5 cm); DASH score was 48, while EMNG indicated a lesion of the median nerve and ulnar nerve in lower level, with signs of recovery. Conclusion. The implementation of an early rehabilitation program for the patients who were surgically treated for breast cancer is necessary in order to prevent functional complications and to enable continuous monitoring of the patients, while in the case with already developed complications, physical therapy should be initiated regardless of the period in which the functional limitations occurred.

Introduction/Objective. About a third of the breast lesions on mammography are clinically occult. The goals of surgical treatment are to locate, remove, and verify their presence in the removed breast tissue. Standard specimen mammography (SSM) has been an official procedure for the latter, while intraoperative digital specimen radiography (IDSR) was introduced recently. The aim of this study was to evaluate the use of IDSR versus SSM and possible benefits regarding the duration of the procedures (operating room occupancy), availability of digital mammography for additional number of patients, surgeon productivity, and the quality of performed services. Methods. A retrospective chart review of 109 patients who underwent IDSR for nonpalpable breast lesions was performed between January 2014 and June 2016. We compared the difference in the duration of IDSR versus SSM procedure. We also observed the number of re-excisions and evaluated time-saving in the operating room workflow. Results. The average duration of surgery in the IDSR group of patients was 51 minutes, compared to 64 minutes in the SSM group. Every IDSR procedure saved 13 minutes over the standard SSM. That would allow another 28 procedures in the same time frame, with the same quality of service compared with SSM. In that way we increased productivity by 27.5%. Additional operation/surgery was needed for histologically involved surgical margins in three cases (2.75%). Conclusion. The use of new technology resulted in the rationalization of the operative room workflow and gave better productivity. More savings were obtained through the increase of digital mammography capacity for diagnostics, decrease of anesthesia duration, and better management of human resources. The number of ?true? re-excisions, involving additional surgery, remained similar after introducing IDSR.

The aim of the study was to compare thoracic epidural analgesia (TEA) and intravenous patient-controlled analgesia (IV-PCA) after open colorectal cancer surgery. This prospective study included sixty patients scheduled for elective open colorectal surgery and randomized to either postoperative IV-PCA with morphine (n=30) or TEA with a mixture of levobupivacaine, fentanyl and adrenaline (n=30). Th e primary outcome was return of bowel function. The secondary outcome was quality of postoperative analgesia at rest, on coughing and during mobilization. Intermediate outcomes included patient satisfaction, time out of bed, rate of side effects and postoperative complications, and time of discharge. Recovery of postoperative ileus occurred sooner (p

nema

The unprecedented characteristics of dual-gate (2G) monolithic bidirectional (MB) gallium nitride (GaN) enhancement-mode field-effect transistors (e-FETs) enable a potential performance breakthrough of current DC-link inverters, e.g. in terms of power conversion efficiency, power density, cost and complexity. In fact, a single 2G MB GaN e-FET can conveniently replace and outperform two anti-series connected conventional power semiconductors to realize the four-quadrant (AC) switch required in this circuit topology. Furthermore, a variable DC-link current control strategy can be applied to a three-phase (3-Φ) buck-boost (bB) current source inverter (CSI) system comprising a DC-link current impressing buck-type DC/DC input stage and a subsequent boost-type 3-Φ current DC-link inverter output stage to significantly reduce the occurring losses. The proposed strategy is denominated Two-Third Modulation, since by properly shaping the DC-link current with the input stage by means of a Synergetic Control structure, it allows to generate the desired 3-Φ sinusoidal load currents by switching only two out of the three phases of the output stage. Circuit simulations of the 3-Φ bB CSI system support the explanation of the analyzed concept and confirm the associated reduction of losses, for which analytical expressions are as well derived. Finally, the operation of new 2G MB GaN e-FET research samples is verified in a hardware prototype, taking the first step towards the practical realization of the described power converter.

Previous evidence suggested that lymphocytic thyroiditis (LT) was a variant of Hashimoto's thyroiditis (HT), thus the aim of the current study is to quantify structural changes in histological specimens taken from HT and LT patients. A total of 600 images containing a single lymphocyte nucleus (300 nuclei per group) were obtained from 20 patients with HT and LT. In order to quantify changes in the nuclear architecture of investigated lymphocytes, the fractal dimension (FD) and some gray-level co-occurrence matrix texture parameters (angular second moment, inverse difference moment, contrast, entropy, and correlation) were calculated for each nucleus. A statistically significant difference in the FD of the “binary-outlined” nucleus and that of the corresponding “black-and-white” nucleus was detected between HT and LT lymphocyte nuclei. In addition, there was also a statistically significant difference in contrast and correlation between HT and LT lymphocyte nuclei. In conclusion, the results of this study suggested that there was a difference in structural complexity between investigated lymphocyte nuclei; additionally, LT lymphocytes possessed probably more complex texture and larger variations as well as more asymmetrical nuclei compared with HT lymphocytes. Accordingly, these findings indicate that LT is probably not a variant of HT; however, more complex studies are necessary to estimate differences between these types of thyroiditis.

After spinal cord injury (SCI) chronic inflammation hampers regeneration. Influencing the local microenvironment after SCI may provide a strategy to modulate inflammation and the immune response. The objectives of this work were to determine whether bone or spinal cord derived ECM hydrogels can deliver human mesenchymal stem cells from the apical papilla (SCAP) to reduce local inflammation and provide a regenerative microenvironment. Bone hydrogels (8 and 10 mg/ml, B8 and B10) and spinal cord hydrogels (8 mg/ml, S8) supplemented with fibrin possessed a gelation rate and a storage modulus compatible with spinal cord implantation. S8 and B8 impact on the expression of anti and pro-inflammatory cytokines (Arg1, Nos2, Tnf) in LPS treated microglial cells were assessed using solubilised and solid hydrogel forms. S8 significantly reduced the Nos2/Arg1 ratio and solubilised B8 significantly reduced Tnf and increased Arg1 whereas solid S8 and B8 did not impact inflammation in microglial cells. SCAP incorporation within ECM hydrogels did not impact upon SCAP immunoregulatory properties, with significant downregulation of Nos2/Arg1 ratio observed for all SCAP embedded hydrogels. Tnf expression was reduced with SCAP embedded in B8, reflecting the gene expression observed with the innate hydrogel. Thus, ECM hydrogels are suitable vehicles to deliver SCAP due to their physical properties, preservation of SCAP viability and immunomodulatory capacity.

Introduction. Amniotic band syndrome is a rare congenital disorder with clinical presentation of constricting bands in different parts of extremities or whole extremities. Conservative or surgical treatment is provided depending on the type and severity of the anomaly. Case Outline. The paper presents the case of a neonate patient with constriction bands localized on the left leg. During the second week of life, a surgery was indicated, and a single-stage multiple Z-plasty was performed to correct the anomalies on the left lower leg. Postoperative edema in the distal part of the lower leg was easily managed by incisions and drainage. Two months later, the correction of the stricture of the left thigh was managed using the same procedure. The postoperative course was uneventful and the outcome was satisfactory after a two-year follow-up. Conclusion. Evaluation of a patient with amniotic band syndrome, as well as diagnosis, monitoring, treatment and postoperative care, should always be multidisciplinary. A single-stage correction approach provided satisfactory both functional and aesthetic results. Given many morphological variations of the syndrome, a decision on the strategy of treatment should be made individually for each patient.

IntroductionPapillary thyroid carcinoma (PTC) and colloid goiter (CG) represent the most common thyroid malignant and benign diseases, respectively. Oxidative stress is considered to have an important role in the pathogenesis of both diseases, but without sufficient and comprehensive data. The aim was to evaluate the redox profile, its influence on cell survival of PTC, comparing it with CG as a control and its relation with demographic, pathological and clinical parameters.Material and methodsWe evaluated for the first time the PTC and CG tissue profile of advanced oxidation protein products (AOPP) and total thiols as parameters of redox metabolism and deoxyribonuclease I (DNase I) and deoxyribonuclease II (DNase II) activity as biomarkers of cell turnover and apoptosis. Tissue levels of biochemical parameters were quantified in PTC and CG tissue using spectrophotometric methods. Study parameters were evaluated in light of different demographic, clinical and pathological features of PTC and CG.ResultsPapillary thyroid carcinoma tissue is characterized by increased antioxidant activity and a normal prooxidation level. Biochemical parameters show numerous correlations with demographic and clinical characteristics of PTC and CG patients. DNase I and II activities are dependent upon the AOPP concentration in PTC tissue. The size of CG can be predicted with combined use of AOPP, DNase I and DNase II. AOPP is the most powerful predictor of PTC capsular invasion, multicentric intrathyroid dissemination and lymph node metastasis phenotype.ConclusionsEvaluated parameters can be used for assessment of tumor redox and survival status and the clinical course of PTC and CG.

Alterations in the bone marrow niche induced by abnormal production of cytokines and other soluble factors have been associated with disease progression in classical BCR‐ABL1 negative myeloproliferative neoplasms (MPN). Variations in circulating proteins might reflect local disease processes and plasma proteome profiling could serve to identify possible diagnostic and prognostic biomarkers. We employed a human cytokine array to screen for 105 distinct analytes in pooled plasma samples obtained from untreated young MPN patients (

Introduction: Urgent demand for high-esthetic material, which at the same time has the possibility of absorption of mastication stress, has led to the technological development of hybrid nanoceramics used in CAD / CAM technology. Aim: The aim of the study was to evaluate the effects of different surface modification of hybrid nanoceramic crowns on the quality of the cement retention and the influence of the mastication stress after one year of function. Material and methods: 50 hybrid nanoceramic CAD/CAM crowns (CERASMART, GC) are cemented on titanium implant abutments with self-adhesive resin cement (G-CEM, LinkAce). The samples were divided into five main groups according to surface treatment (n=10): I (sandblasted with 50 microns Al2O3), II (treated with CERAMIC PRIMER II, GC), III (treated with 5% hydrofluoric acid), IV (treated with combination of 5% hydrofluoric acid and CERAMIC PRIMER II), V (control, non-treated group). The samples were storaged during 24 hours at 37°C, thermocycled and loaded under 10 000 mechanical cycles loads (simulation of 12 months of function). Retention forces measured in Universal testing machine. The data were represented as mean ± standard deviation, and for statistical analysis ANOVA test was used. Results: The highest initial retention force was demonstrated in the group IV (6.99±1.18), followed by group I (6.22±1.29), group III (5,97±1,25), group II (5,86±1,17) and control group samples (4.92±1.19). A statistically significant decline in retention force was recorded in all tested groups, with the lowest decrease observed in samples treated with a combination of 5% hydrofluoric acid and CERAMIC PRIMER II (6.08 ± 1.03). Conclusion: Mechanical and chemical surface modification can strongly influence the retentions between resin cement and hybrid nanoceramics. The results from this study are suggesting that the most efficient clinical outcome is the combination of 5% hidrofluoric acid and CERAMIC PRIMER II.