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BACKGROUND: The controversy of using total thyroidectomy (TT) in treatment of benign thyroid diseases still remains controversial over the rates of complication, mostly recurrence nerve palsy and hypocalcemia, compared to non-total thyroidectomies. The latest reports in this field of research showed that that the number of complications of TT is decreasing as the skills of surgeons increase. AIM: In this study, we reviewed 209 cases of total thyroidectomies for benign thyroid diseases where such surgery was indicated. The results were evaluated whether they support the previous reports that TT is save method of treatment of diffuse multinodular goiters, Graves’ disease thyroid adenomas with diffuse goiters and thyroiditis. METHODS: Two hundred and nine patients, 36 males and 173 females, medium age 47 (17–77) operated with TT between 2016 and 2018 were included in the evaluation study. We evaluated the: Diagnosis, indications for operation, pre-operative medication administration, laryngeal recurrent nerve palsy, hypocalcemia, hypoparathyroidism, and patohistology findings. The follow-up for hypocalcemia and laryngeal nerve palsy was performed 1 year postoperatively. RESULTS: The age of the patients was between 17 and 77 years, medium-range 47 years old. Of 209 patients, 173 (83%) were female and 36 (17%) male with a gender ratio of 1:4.8 males to females. Diagnoses before surgery were established as follows: Multinodular euthyroid goiter (MNEG) n = 106 (48.80%), multinodular toxic goiter n = 12 (5.74%), Graves’s disease n = 6 (2.87%), adenoma with multinodular goiter n = 73 (34.92%), and n = 16 (7.65%) patients with thyroiditis. Recurrence laryngeal nerve palsy (RLNP) occurred in 6 patients (2.87%), temporary within 3 months after the operation in 4 patients (1.92%) and permanent palsy within 6 months and more after an operation in 2 patients (0.95%). Voice hoarseness immediately and within 1 month after the operation was registered in 32 patients (15.3%). RLNP and hoarseness were registered mostly in patients with pre-operative problems, mostly with extra big MNEG. One of the permanent injuries of RLN was bilateral and all others were one sided. All patients were operated with normal pre-operative vocal cord movement findings. Post-operative hypocalcemia was registered in 35 patients (16.74%). Temporary nonsignificant hypocalcemia in 10 (4.78%), temporary significant hypocalcemia in 17 (8.13%), temporary severe hypocalcemia in 6 patients (2.87%), and permanent hypocalcemia in 2 patients (0.95%). CONCLUSION: Many studies have shown that the rate of complications is almost even for TT and NTT done for benign and malignant diseases of thyroid gland. Our data have shown that the risk of post-operative complications with TT is proportional to the number of complicated pre-operative findings of benign thyroid glands.

Introduction. Asthma is a chronic inflammatory disease of the airways in which many cells play a role with secreting a variety of mediators responsible for the clinical manifestation of asthma. It is assumed that IL-33 is one of the earliest-released mediators and can orchestrate the immune cascade of the disease. The aim of this study was to examine the role and clinical significance of IL-33 as a new and insufficiently explored mediator of inflammation in patients with uncontrolled moderate asthma. Methods. The study included 87 patients with asthma. Serum IL-33 was measured in all patients by ELISA method. The obtained data were statistically analyzedusing the Kolmogorov-Smirnov and Shapiro-Wilk's test. Qualitative data were presented in absolute and relative numbers, and quantitative data were presented with measures of descriptive statistics. Statistically significant values were considered forp Results. Majority of included patients were female (75.86%). The average age of patientswas 42.3±15.9 years. The results of IL-33 in all patients were significantly increased compared to the reference value of IL-33 which is 0pg/ml. The average values of IL-33 ranged from 6.47±29.3 and they were insignificantly higher in the group with female patients compared to males (p=0.27), and insignificantly correlated with age (p=0.26). Conclusion. Even though a limited number of studies haveexplored the IL-33, results have shown higher serum level of IL-33 in asthma patients compared to healthy people, emphasizing the factthat IL-33 is an attrac tive candidate for targeted therapy and prognosis inasthma patients.

The exposure to tobacco smoke could cause bronchoconstriction and acute asthma attack. Smoking asthmatics have an insufficient therapeutic response to the standard therapy and unsatisfactory improvement of the respiratory function. In a randomized parallel study, a therapeutic response to inhaled fluticasone propionate in a dose of 250 µg twice per day was determined in 38 asthmatics with mild asthma, smokers and nonsmokers. Short-acting ß2 agonist (salbutamol) in a dosage of 0.1 mg/per inhaled dose was used as a rescue medication when needed. In patients, asthma was detected with a positive metacholine test and/or positive bronchodilatator response of > 12% with ≥ 200 ml increase of FEV1. They were randomized in two groups according to sex, age and starting values of FEV1. Before and after 6 weeks of treatment with fluticasone propionate of the previously corticosteroid-naive patients, lung function test (spirometry) was performed. A statistically significant effect (p

Smoking in asthmatics is responsible for the worsening of asthma symptoms, more frequent asthma exacerbations and hospitalizations and lowered quality of life. In smoking asthmatics the designated doses of the inhaled corticosteroid treatment are usually insufficient to accomplish total asthma control. Out of 54 screened adult patients up to 50 years old with mild asthma, 38 were involved in the study. They were divided in two groups: smokers and non-smokers. They received a total daily dosage of 500 µg of inhaled fluticasone propionate. A rescue medication, a short-acting ß2 agonist (salbutamol) in a dosage of 0.1 mg/per inhaled dose, was used when needed. Asthma was diagnosed by a positive metacholine provocation test and/or a positive bronchodilatator response. An asthma control test i.e. the ACT-TM questionnaire was performed before the beginning of the study and 6 weeks after the treatment with fluticasone propionate of the previous corticosteroid-naive patients. A statistically positive response (p

BACKGROUND: Noninvasive mechanical ventilation (NIV) applies ventilator support through the patient’s upper airway using a mask.AIM: The aim of the study is to define factors that will point out an increased risk of NIV failure in patients with exacerbation of Chronic Obstructive Pulmonary Disease (COPD).PATIENTS AND METHODS: Patients over the age of 40, treated with NIV, were prospectively recruited. After data processing, the patients were divided into two groups: 1) successful NIV treatment group; 2) failed NIV treatment group.RESULTS: On admission arterial pH and Glasgow coma scale (GCS) levels were lower (pH: p < 0.05, GCS: p < 0.05), and Acute Physiology and Chronic Health Evaluation II (APACHE) score and PaCO2 were higher (p < 0.05) in the NIV failure group. Arterial pH was lower (p < 0.05) and PaCO2 and respiratory rate were higher (p < 0.05) after 1h, and arterial pH was lower (p < 0.05) and PaCO2 (p < 0.05), respiratory and heart rate were higher (p < 0.05) after 4h in the NIV failure group.CONCLUSION: Measurement and monitoring of certain parameters may be of value in terms of predicting the effectiveness of NIV treatment.

Introduction: In the last two decades noninvasive ventilation (NIV) has become an integral part of the protocol for the treatment of patients with acute respiratory failure. Aim: To define the factors that lead to failure of treatment with NIV, in order to avoid the delay of treatment with invasive mechanical ventilation, thus enabling better clinical management of the affected patients. Methods: Retrospectively were analyzed 120 patients with type 2 chronic respiratory failure due to COPD exacerbation, treated with NIV. The following data were analyzed: demographics, laboratory data, Acute Physiology and Chronic Health Evaluation (APACHE) II score; respiratory rate; pH; pO2; pCO2. Acid-base status was evaluated at the beginning and 1 hour after NIV treatment. Results: On admission arterial pH levels were lower (p Conclusion: Patients with higher pH and lower pCO2 and APACHE II score at admission, and by improving of these parameters after 1 hour have better outcome from treatment with NIV.

Background: Bronchiectasis are becoming a focus of the respiratory scientists in recent years. Aim of the study: To assess microbiology findings in non-cystic fibrosis bronchiectasis (non-CFB) and frequency of associated co-morbidities. Material and methods: We analyzed 172 patients with non-CFB as a primary diagnosis that were hospitalized during a period of 61 months. Results: Positive microbiology analysis was obtained in 26,74% of the patients. 14,53% of the patients had positive results on Candida albicans. The most frequent pathogen found in sputum was Pseudomonas aeruginosa (5,81%). In 3,48% Acinetobacter species was found and E. Coli and Haemophyllus influenzae were both found in 1,74 % of the patients. Other findings were Streptococcus pyogenes, Streptococcus pneumoniae, Enterobacter aerogenes, Klebsiela pneumoniae, Aspergillus niger, Aspergillus fumigatus, Stenotrophomonas maltophilia etc. In 5,23% of patients coexistence of Candida albicans with other bacterial pathogens was found. 56,66% of the non-CFB patients with positive pathogen findings had chronic respiratory insufficiency. COPD coexisted with non-CFB in 26,66% of the patients with positive pathogen microbiology findings. Co-existence of non-CFB with other co-morbid conditions were found (i.e Kartagener Syndrome, Wegener9s granulomatosis, Alcoholism, Myelodysplastic Syndrome, Esophagotracheal fistula etc). Appropriate drug treatment was carried out in all patients and one patient with esophagotracheal fistula was transferred to Surgery for consecutive treatment. Conclusion: Mayor part of fungal findings represent only colonization. Management of non-CFB should consider other co-existingdiseases and patient9s condition.

BACKGROUND: The proportion of T and B lymphocytes in pleural fluids and blood may point to the presence of local immunological phenomena in pleural disorders.AIM: Aim of study was to evaluate the lymphocyte phenotype and the ratio between helper (CD4+) and cytotoxic/suppressor (CD8+) lymphocytes in malignant and non-malignant effusions.MATERIAL AND METHODS: We studied 48 patients with pleural effusions. First group had 18 patients with tuberculosis pleural effusions; second group had 20 patients with malignant pleural fluids, third group had 10 patients with transudates and 30 healthy controls. We investigated the distribution of T and B lymphocytes, T cells with helper/inducer CD4 or suppresser/cytotoxic CD8 phenotypes and the CD16 subset.RESULTS: Results showed decreases levels of CD3, CD4, and CD16 T cells in blood of patients versus healthy controls. There were increases in the percentage of the CD3 and CD4 T cells in the pleural fluid compared with values in the blood with statistical significance in tuberculous pleurisy. The values of CD8 were similar in the pleural fluid and in blood. Levels of CD16 were non-significantly higher in pleural fluid in all groups.CONCLUSION: This study confirms the hypothesis that pleural cavity is compartment with immunological reactivity and results could be used in differential diagnosis together with other examinations.

Spinal cord hydatidosis is a rare disease, with an incidence of less than 1 %. Cysts are usually multiple and mostly extradurally located. The clinical symptoms vary depending on the part of the spinal cord that has been involved, size of the cysts, and interaction between the expanding cysts and adjacent structures. Neurological examination reveals paraparesis or paraplegia, back pain or radicular pain, numbness or sensory loss, and sphincter disturbance. Diagnosis is established based on the imaging techniques such as plain radiographs, computed tomography, and magnetic resonance imaging of the spine. Histopathological findings definitely confirm the diagnosis. The most common treatment is surgical removal of the cysts combined with medicamentous treatment (albendazole and/or mebendazole) before and after surgery to prevent metastatic infestation.

Background Specific immunotherapy (SIT) has a significant potential in the treatment of allergic rhinitis and allergic conjunctivitis. The aim of the study was to evaluate the effect of specific immunotherapy (SIT) in patients with grass-pollen induced allergic rhinitis and allergic conjunctivitis. Methods Twenty-six patients with pollen induced rhinoconjunctivitis and positive history for more than 2 years were included in our study. They had skin prick test of ≥ 5 mm, age range from 18 to 44 years and all underwent conjunctiva provocation tests before and after 1 year of SIT. Clinical severity score of nasal and conjunctiva symptoms during the season was assessed by 4-point arbitrary rating scale from 0 to 3. Conjunctiva provocations were performed out of the season until allergic symptoms occurred, achieving the allergen threshold dose (ATD). Results After 1 year of SIT, we have noticed reduction of clinical symptoms present in allergic conjunctivitis: burning, itching, lacrimation and hyperemia (P < 0,05). We have found also reduction in clinical symptoms of allergic rhinitis: secretion, irritation, itching and nasal blockade (P < 0,01). The patients tolerated significantly higher allergen doses in provocation tests after 1 year of SIT, reaching new ATD. Conclusions SIT reduces the clinical symptoms of allergic rhinoconjunctivitis and modifies the inflammatory response after specific allergen challenge.

Background To determine the frequency of patients (pts) with autoimmune diseases who developed stroke and to analyse the associated risk factors. Methods We made a retrospective analysis of 251 pts with stroke, hospitalized during 1 year period at the Department for Urgent Neurology. Of them, we selected 7 pts with a history of autoimmune diseases. Results Three patients had systemic lupus erythematosus (SLE), 2 pts had M. Behcet, one patient was diagnosed with Sneddon sy and one patient had Vascullitis allergica leucocytoclastica. All pts were females, except one male pt with M. Behcet. The average age was 49 ± 11 years. Two patients with massive ischemic stroke had a lethal outcome. Hypertension was found as an independent risk factor for stroke in all pts (P < 0.01). Other risk factors included chronic renal failure, antiphospholipid antibodies, hypercoagulable state and symptomatic seizures. Conclusions The incidence of autoimmune diseases in patients with stroke was 2.7% in our material. Hypertension was an independent risk factor for subsequent stroke.