Latest Articles from Folia Medica Latest 23 Articles from Folia Medica https://foliamedica.bg/ Thu, 28 Mar 2024 21:49:26 +0200 Pensoft FeedCreator https://foliamedica.bg/i/logo.jpg Latest Articles from Folia Medica https://foliamedica.bg/ Laparoscopic para-aortic lymphadenectomy for metastatic colon cancer in a patient with left-sided inferior vena cava: a case report https://foliamedica.bg/article/96691/ Folia Medica 65(6): 1015-1019

DOI: 10.3897/folmed.65.e96691

Authors: Efstathios Kotidis, Elissavet Anestiadou, Aikaterini Karamitsou, Georgios Gemousakakis, Orestis Ioannidis, Stefanos Bitsianis, Savvas Symeonidis, Nikolaos Ouzounidis, Odysseas Lomvardeas, Stamatios Aggelopoulos

Abstract: Transposition of inferior vena cava, or, left-sided inferior vena cava (LS-IVC) is a rare clinical entity, in which the inferior vena cava ascends along the left side of the abdominal aorta. Literature contains mainly clinical case reports. Although it is usually not associated with clinical symptomatology, this anomaly should be detected during preoperative planning to avoid iatrogenic injuries intraoperatively. We present a case of left-sided inferior vena cava encountered during laparoscopic lymphadenectomy in a 45-year-old man with previous laparoscopic hemicolectomy due to colon adenocarcinoma. Preoperative CT abdomen revealed the left-sided location of infrarenal IVC and laparoscopic trans-peritoneal aortic lymphadenectomy was decided. Intraoperatively, transposition of inferior vena cava was confirmed in accordance with the CT findings. Resection of lymph node block was conducted with no complications and with minimal blood loss. The postoperative course was uneventful, and the patient was discharged from the hospital the day following surgery. In conclusion, transposition of the inferior vena cava, although rare, constitutes an anatomical variant that should be identified preoperatively to decrease intraoperative risks. Several anatomical variants have been associated with left-sided inferior vena cava.

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Case Report Sun, 31 Dec 2023 19:00:22 +0200
Duplicated gallbladder: an incidental anatomical variation in a patient with symptomatic cholelithiasis https://foliamedica.bg/article/91397/ Folia Medica 65(5): 834-838

DOI: 10.3897/folmed.65.e91397

Authors: Ludmila Baltaga, Dimosthenis Chrysikos, Spiros Delis, Charina Triantopoulou, Dimitrios Filippou, Vasileios Protogerou, Theodore Troupis

Abstract: Congenital malformations of the biliary tract represent a relatively rare entity with which surgeons, radiologists and clinicians are not adequately familiarized. We present a rare case of gallbladder duplication in a 40-year-old female, with the accessory cystic duct entering the left hepatic duct, which depicts the fifth reported case in the international bibliography. Our case illustrates the importance of detailed knowledge of anatomical malformations of the biliary tree, serving the purpose of a preoperative diagnosis of symptomatic cholelithiasis. It is also of paramount importance to take under consideration biliary tract malformations to avoid inadvertent complications such as biliary duct injuries in case of laparoscopic cholecystectomy.

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Case Report Tue, 31 Oct 2023 22:00:18 +0200
Cell adhesion molecules in the pathogenesis of the schizophrenia https://foliamedica.bg/article/101356/ Folia Medica 65(5): 707-712

DOI: 10.3897/folmed.65.e101356

Authors: Antonino Messina, Caterina Crescimanno, Giuseppe Cuccì, Filippo Caraci, Maria Salvina Signorelli

Abstract: The causes of schizophrenia remain obscure and complex to identify. Alterations in dopaminergic and serotonergic neurotransmission are, to date, the primary pharmacological targets in treatment. Underlying abnormalities in neural networks have been identified as cell adhesion molecules (CAMs) involved in synaptic remodeling and interplay between neurons-neurons and neurons-glial cells. Among the CAMs, several families have been identified, such as integrins, selectins, cadherins, immunoglobulins, nectins, and the neuroligin-neurexin complex. In this paper, cell adhesion molecules involved in the pathogenesis of schizophrenia will be described.

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Review Tue, 31 Oct 2023 22:00:01 +0200
Anthropological study of dental indices in Bulgarian population https://foliamedica.bg/article/84820/ Folia Medica 65(4): 659-663

DOI: 10.3897/folmed.65.e84820

Authors: Zdravka Harizanova, Atanas Baltadjiev

Abstract: Introduction: A number of derived quantities (called dental indices) that characterize the shape and size of the teeth are calculated between the absolute dimensions of the teeth (mesiodistal, vestibulo-oral, and height of the dental crown). Aim: The aim of the present study was to explore the degree of sexual dimorphism in dental indices in the Bulgarian population. Materials and methods: The study included 232 Bulgarians aged 20–40. The vestibulo-oral and mesiodistal dimensions of the teeth were measured. The crown module and crown index were calculated. Results: We found that male Bulgarians had a significantly greater crown module of the upper canines, first premolars, molars, and second molars than females. The crown module of the lower molars was found to be similar in this respect. The crown module of the lower lateral incisors also revealed statistically significant differences, although in females it had higher values. Only the upper and lower canines and upper molars displayed sexual dimorphism according to the crown index, and women’s mean values were higher than men’s were. Conclusions: Our results suggest that some of the dental indices in the Bulgarian population were sexually dimorphic, which may contribute to defining sex.

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Original Article Thu, 31 Aug 2023 14:00:17 +0300
A rare variation of superior rectus muscle https://foliamedica.bg/article/79292/ Folia Medica 65(3): 514-517

DOI: 10.3897/folmed.65.e79292

Authors: Dimo Stoyanov, Meglena Angelova, Dessislava Marinova

Abstract: The extraocular muscles are responsible for all eye movements required to track and fix objects. Superior rectus muscle is located in the superior level of the orbital cavity, below musculus levator palpebrae superioris, tilted slightly to the lateral part of the orbit. In a routine dissection, we found a left, unilateral variation of the superior rectus muscle with no variation in other structures, such as nerves and vessels. The abnormal muscle presented in two parts - medial and lateral ones. The medial part bifurcated into two heads with different insertion points. It is a case of a rare variation of the extraocular muscles, which, to our knowledge, has not yet been reported.

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Case Report Fri, 30 Jun 2023 20:00:23 +0300
Absent celiac trunk and unusual arterial anatomy of the upper abdomen: into the deep https://foliamedica.bg/article/72710/ Folia Medica 65(3): 500-507

DOI: 10.3897/folmed.65.e72710

Authors: Serghei Covantsev, Rasul Uzdenov, Natalia Mazuruc, Daria Turovets, Olga Belic

Abstract: The celiac trunk is the first major branch of the abdominal aorta. It originates from the ventral aspect of the aorta at the level of T12–L1 vertebrae and was originally described as an artery that branches into the common hepatic artery, left gastric artery, and splenic artery. Absence of the celiac trunk and origin of the three arteries separately from the aorta is a rare entity that is reported in 0.38% to 2.6% of cases. It is even more uncommon that this variation can be accompanied by other vascular variations of the upper abdomen as accessory arteries to the liver, stomach, and pancreas. These cases arise during embryogenesis due to decreased arterial degeneration combined with decreased arterial fusion, which results in the anatomical variations present in the current case. Complex arterial variations are both a risk for iatrogenic injury during surgical procedures and beneficial during endovascular supply as they may provide additional access for embolization and chemotherapy.

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Case Report Fri, 30 Jun 2023 20:00:21 +0300
Application of odontometric dimensions of molars in sex assessment in Bulgarians https://foliamedica.bg/article/66861/ Folia Medica 64(5): 793-798

DOI: 10.3897/folmed.64.e66861

Authors: Zdravka Harizanova, Atanas Baltadjiev, Miroslava Yordanova, Ferihan Ahmed-Popova, Emre Boyaci

Abstract: Introduction: Sex estimation is an important step in developing a biological profile. Teeth are one of the most durable physical elements in the human body and thus can be used very successfully for this purpose. The aim of the present study was to determine sex differences in odontometric dimensions of maxillary and mandibular molars in Bulgarians. Materials and methods: The study included 232 healthy subjects (121 males, 111 females) of Bulgarian origin in the age group of 20–40 years, with fully erupted, periodontal disease free, caries free, non-worn teeth. Vestibulolingual, mesiodistal and cervicoincisal (coronal height) dimensions of maxillary and mandibular molars were measured by Dentistry Sliding Vernier Caliper, Ridge Mapping Caliper Type A and Type B and analyzed with SPSS 23.0. The level of statistical significance was set at p<0.05. Results: Cervicoincisal dimensions in both maxillary and mandibular molars, except for the maxillary left second molars, were significantly higher in males compared to females. Similar statistically significant differences were found in mesiodistal dimensions in first molars from both jaws. Vestibulolingual dimensions in both maxillary and mandibular first molars and mandibular second molars were significantly higher in males compared to females as well. Conclusions: The results of our measurements exhibited statistically significant sex differences in both maxillary and mandibular molars in people of Bulgarian origin. In accordance with similar odontometric studies, molars may successfully differentiate both sexes and thus determine the need for further investigations in this field.

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Original Article Mon, 31 Oct 2022 19:59:00 +0200
Ultrasound fusion imaging system in neurology practice https://foliamedica.bg/article/64271/ Folia Medica 64(4): 667-671

DOI: 10.3897/folmed.64.e64271

Authors: Marieta V. Peycheva, Lyubomir Chervenkov, Zdravka Harizanova, Ferihan Ahmed-Popova, Zahari I. Zahariev

Abstract: The ultrasound fusion imaging (UFI) system is a new promising imaging modality that combines live ultrasound investigations with preregistered CT, MRI, or PET images. In this study, we want to present our initial experience with the new method that combines the transcranial color-coded sonography (TCCS) in different insonation planes and the 3T-weighted MRI cerebral images. The study validates the diagnostic capabilities of the system to detect different normal cerebral structures in healthy volunteers. In the present paper, we also discuss the advantages of US fusion imaging technology and its clinical applications in Neurology.

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Short Communication Wed, 31 Aug 2022 17:30:00 +0300
Evaluation of paranasal anatomical variations with multidetector CT in Turkish population https://foliamedica.bg/article/62633/ Folia Medica 64(3): 513-520

DOI: 10.3897/folmed.64.e62633

Authors: Emrah Doğan, Mihriban Rabia Kilinç

Abstract: Abstract Aim: The aim of our study was to determine the prevalence of the paranasal sinus (PNS) variations/aspects of healthy population in Turkey with multidetector computed tomography and to evaluate the relationship of these variations/aspects with each other and difference according to gender and side. Materials and methods: Twenty-four different PNS variations/aspects of 234 healthy patients and a total of 468 bilateral sides were evaluated. Patients were compared with Pearson’s chi-squared test (χ2) according to gender and side. Also, all variations were compared with each other in the same way, and correlated variations were found (p<0.05 was considered significant). Results: The prevalence of prominent aspects of PNS are as following: tuberculum septi nasi anterior (TSNA) in 93.6%, ethmoid bulla (EB) in 72.65%, nasal deviation (ND) in 65.4%, agger nasi cell (AG) in 63.25% of the patients. There was no statistically significant difference in terms of gender and between right and left sides. P-values of correlated variations/aspects were: EB/uncinate process type (UPT) 2: 0.001; ND/concha bullosa (CB): 0.03; AG/Onodi cell (OC): 0.04; uncinate process deviation (UPD)/maxillary hypoplasia (MH): 0.04. Conclusions: The most common aspects were TSNA, EB, ND, and AG. The percentages of these anatomical structures mentioned above are far too high to be classified as a variation. They can be described as basic anatomical structures or dominant aspects. There was no difference in the incidence of variations according to gender or side, but significant correlations were found between EB and UPT 2, between ND and CB, between AG and OC, and between MH and UPD.

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Original Article Thu, 30 Jun 2022 20:00:19 +0300
Uterine angiolipoleiomyoma. A case report and systematic literature review https://foliamedica.bg/article/60937/ Folia Medica 64(2): 341-347

DOI: 10.3897/folmed.64.e60937

Authors: Victoria Psomiadou, Christos Iavazzo, Eirini Geramani, Alexandros Fotiou, Loukas Karelis, Christos Valavanis, Sofia Lekka, Kalliopi Kokkali, George Vorgias

Abstract: Uterine angiolipoleiomyomas are rare, benign mixed mesenchymal lesions. A manifestation in the gynecological region is quite uncommon, with few cases described in the literature so far. We present an interesting case of a 59-year-old woman diagnosed with uterine angiolipoleiomyoma, and the results of the conducted systematic review of the literature. The patient presented with a pelvic mass masquerading as a leiomyoma on the ultrasound and postmenopausal vaginal bleeding. At laparotomy, a large uterus was noticed and the histopathology set the diagnosis of angiolipoleiomyoma. Immunohistochemistry revealed negativity for Melan-A and HMB-45 melanoma-specific antibodies and positivity for Van Gieson and orcein histochemical stains. We systematically reviewed the literature. The eligible articles were those written in English, excluding animal studies and studies reporting angiolipoleiomyomas in other regions beside the uterus. The present case is one of the 10 cases of uterine angiolipoleiomyoma reported in the literature. In 8 out of 11 (72.7%) cases, uterine angiolipoleiomyomas arose from the corpus of the uterus, while in 2 (18.1%) cases they were located at the cervix, and in one case (9%) angiolipoleiomyoma was located in the broad ligament. Concerning symptoms, four of the patients (36.4%) presented with abdominal and pelvic pain, two (18.1%) with postmenopausal vaginal bleeding, one with menometrorrhagia (9%), and one with uterine prolapse and cystocele (9%). Immunohistochemical staining of uterine angiolipoleiomyomas was positive for SMA in 4 patients (36.4%), positive for desmin in 3 cases (27.3%), positive for anti-S-100 protein antibody in 2 patients (18.1%), while in one case (9%) immunopositivity was observed for CD31. Only our case (9%) was also tested for CD34, Van Gieson and orcein, the first of these being negative and the other two positive (at the blood vessels in a specialized pattern). Three of the patients (27.3%) were also tested for HMB-45 and all three were immunonegative. In order to establish the diagnosis of uterine angiolipoleiomyomas, ultrasonography and additional MRI may help the preoperative prediction of a benign mass. Immunohistochemistry will show strong positivity of alpha-smooth muscle actin and desmin. Complete abdominal hysterectomy is the preferable treatment.

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Case Report Sat, 30 Apr 2022 14:02:00 +0300
Pancreatic surface morphology and its classification https://foliamedica.bg/article/60567/ Folia Medica 64(2): 207-213

DOI: 10.3897/folmed.64.e60567

Authors: Serghei Covantev, Olga Belic

Abstract: Introduction: Anomalies and variants of development of the pancreas are relatively frequent. These variations can often lead to misdiagnosis and unnecessary medical procedures. Although, pancreatic diseases are a constantly researched field, fundamental research is relatively understudied and re-evaluation of the pancreatic morphology is performed rarely. Aim: The goal of the current study was to analyse pancreatic surface morphology by means of macroscopic anatomical dissection of 78 organ complex. Material and methods: The anatomy of the pancreas was studied by means of macroscopic anatomical dissection. The study was performed on 78 organ complexes (the pancreas, spleen, and duodenum with surrounding abdominal fat) donated to the department of human anatomy from patients who died of causes not related to pancreatic diseases. The organs were fixed in a 10% formalin solution separately to accurately preserve their forms. The organs were measured by a caliper. Results: The lie of the pancreas was classified according to Kreel and co-workers into 6 types: oblique shape in 11.54% of cases, sigmoid – 30.77%, transverse – 25.64%, horseshoe – 11.54%, L-shaped – 14.1%, and inverted V shape in 5.13%. Moreover, there were two possible L-shapes, the classical (8.97%) and inverted L-shape (5.13%). In one case, the pancreas had an unusual M-shape (1.28%). One specimen was a case of short pancreas (1.28%). Surface clefts were encountered in 17.95% of cases and in 5.13% of these cases, there was a branch of the splenic artery. Conclusions: The current study demonstrates variations in the lie of the pancreas as well as several new possible variants. Moreover, we propose a modified classification based on these findings. Therefore, the pancreas can have an oblique, sigmoid, transverse, horseshoe, L shape, inverted L, inverted V, and M shaped lie. Pancreatic clefts are another frequently encountered variation that should be kept in mind. The size of the pancreas alone is variable and should be analyzed together with its structure to avoid possible misinterpretation.

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Original Article Sat, 30 Apr 2022 13:02:00 +0300
Melatonin ameliorates testes against forced treadmill exercise training on spermatogenesis in rats https://foliamedica.bg/article/57544/ Folia Medica 64(1): 75-83

DOI: 10.3897/folmed.64.e57544

Authors: Seyed Ali Akbar Mahmudi, Hatef Ghasemi Hamidabadi, Ardeshir Moayeri, Maryam Nazm Bojnordi, Maria Zahiri, Zahra Madani, Mina Vardiani

Abstract: Introduction: It is well documented that some forced exercises can have bad effects on the genital system. Melatonin is a potent antioxidant that is effective in reducing the physical stress. Aim: The aim of this study was to evaluate the supportive effect of melatonin on the quality of spermatogenesis, including count, motility, morphology, viability, and apoptosis of sperm following a forced treadmill exercise. Materials and methods: A total of 40 adult male Sprague-Dawley rats were used in this experimental study. All rats were divided into five groups: control group, sham M group, melatonin (M) group, forced treadmill exercise group (Ft), and melatonin with forced treadmill exercise (MFt) group. The experimental group was trained to force treadmill stress for one hour of forced treadmill exercise daily, five days weekly for eight weeks. Then the sperm quality parameters were measured after dissection and removal of epididymis. Spermatogenesis and germ cell apoptosis were evaluated using Miller and Johnsen’s score and TUNEL staining separately. Results: Results showed the count, motility, morphology, and viability of sperm in forced treadmill-melatonin administrated group, significantly enhanced by melatonin treatment compared to the treadmill exercise group (p≤0.01). Also the number of apoptotic germ cells significantly decreased in treadmill exercised-melatonin administrated group compared to the treadmill exercised group. Conclusions: These results suggest that administration of melatonin can protect the testis against the detrimental effect of forced treadmill exercise in adult male rats.

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Original Article Mon, 28 Feb 2022 09:56:00 +0200
Bifid Pancreatic Tail: an Anatomical Case Series and their Classification https://foliamedica.bg/article/58669/ Folia Medica 63(6): 994-999

DOI: 10.3897/folmed.63.e58669

Authors: Serghei Covantev, Natalia Mazuruc, Olga Belic

Abstract: Anomalies and variants of development of the pancreas are relatively frequent. Bifid pancreatic tail is a rare anatomic variation with only a few cases reported in the literature. The present case series were encountered during dissection of 50 anatomical specimens of the pancreas, spleen, and duodenum. We observed four unusual cases (8%) of bifid pancreatic tail. One case was of a vertically oriented bifid pancreas tail (2%), in another case, the tails here horizontally oriented (2%) and in two cases the bifid tails were horizontally oriented but unequal (4%). The bifid tails had an arterial supply that penetrated the glands between the tails and two out of four were also supplied by the superior horizontal pancreatic artery of Popova. The ductal system usually bifurcated at the level of the tails, but a case of trifurcation was also encountered. The current cases should be taken into account in hepato-pancreato-biliary surgery to avoid misdiagnosis and to comprehensively assess the patient preoperatively.

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Case Report Fri, 31 Dec 2021 10:30:00 +0200
Potential role of human chorionic gonadotropin supplementation in spermatogenesis in rats subjected to forced swimming exercise https://foliamedica.bg/article/56254/ Folia Medica 63(5): 710-719

DOI: 10.3897/folmed.63.e56254

Authors: Ardeshir Moayeri, Marzieh Darvishi, Hatef Ghasemi Hamidabadi, Sina Mojaverrostami

Abstract: Aim: The aim of this study was to evaluate the supportive effect of human chorionic gonadotropin (hCG) on the quality of spermatogenesis, including count, motility, morphology, viability and apoptosis of sperm following forced swimming exercise.Materials and methods: Twenty-four adult male Sprague-Dawley rats were used in this study. All rats were divided into four groups: control group; swimming exercise group (S); hCG administration group and swimming (SG) with hCG administration group (G). The experimental group was trained to force swimming stress for 10 min for 6 days. Then the sperm quality parameters were measured after dissection and epididymis removal. Spermatogenesis and germ cell apoptosis were evaluated by using Miller & Johnsen’s score and TUNEL staining respectively.Results: Results showed the count (control: 113±3.1, S: 74±1.9, G: 111±3, and SG: 103±2.4), motility (control: 93±2, S: 67±2.8,G: 90±2.7, and SG: 78±1), morphology (control: 89±3%, S: 47±2.4%, G: 90±3.1%, and SG: 67±1.1%), and viability of sperm (control: 91±2.9, S: 50±2, G: 91±1.9, and SG: 70±1.3) in swimming exercised-hCG administered group, significantly enhanced by hCG treatment compared to the swimming exercise group (p≤0.01). Also the number of apoptotic germ cells significantly decreased in swimming exercised-hCG administered group compared to the swimming exercised group.Conclusions: These results suggest that administration of hCG can protect the testes against the detrimental effect of forced swimming exercise in adult male rats.

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Original Article Sun, 31 Oct 2021 17:00:12 +0200
A contemporary chemical entities infiltrating in the antimalarial therapy era: a comprehensive review https://foliamedica.bg/article/58995/ Folia Medica 63(5): 637-646

DOI: 10.3897/folmed.63.e58995

Authors: Sandip N. Badeliya, Pankaj P. Kapupara, Navneet F. Chauhan, Ishan I. Panchal

Abstract: Malaria, a life-threatening disease, is caused by parasitic single-celled microorganisms. It is specifically transmitted by the anopheles female mosquito of the Plasmodium family. There are a lot of drugs available in the market to treat this life-challenging disease. Chloroquine, a cheaper molecule that is available worldwide, is one of them. Drug resistance has been observed with chloroquine as well as with some other quinine derivatives and with artemisinin derivatives in the southeast region of Asia in countries like Cambodia, Thailand, Myanmar, and Vietnam country since 1957. After 1970, the drug resistance has been further increased and it has been expanded in several localities of India. Also, antimalarial agents, particularly chloroquine, have so many side effects such as nausea, vomiting, blurred vision, abdominal cramps, diarrhea, headache, appetite loss, deprivation of hearing, skin color change, baldness, reduced body weight, and seizures. Furthermore, this drug cannot be given to pregnant women. Hence, it is the right time to design and develop newer antimalarial agents so that this kind of drug resistance, as well as side effects of the drugs, can be overcome.

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Review Sun, 31 Oct 2021 17:00:02 +0200
A Case of Symptomatic Gallbladder Agenesis with Chronic Abdominal Symptoms https://foliamedica.bg/article/48291/ Folia Medica 62(3): 615-618

DOI: 10.3897/folmed.62.e48291

Authors: Christos Tsalikidis, Apostolos Gaitanidis, Christos Kavazis, Konstantinos Tepelenis, Athanasia Mitsala, Panagoula Oikonomou, Christina Nikolaou, Michail Pitiakoudis

Abstract: The anatomical area of the extrahepatic bile ducts exhibits plethora of anatomic variants. The detailed study and comprehension of anatomic variations of extrahepatic bile ducts is a prerequisite in order to avoid the intraoperative biliary or tract damages, but they are also necessary for the targeted treatment of any complications. Gallbladder agenesis is a rare congenital anomaly of the biliary tree with an estimated incidence of 0.007-0.027% in surgical series which is much lower compared to the incidence of other gallbladder anomalies. It may be asymptomatic, but sometimes is associated with symptoms such as upper quadrant abdominal pain, which may be mistaken for cholecystitis and can lead the patient to the operating room. We present a case of a 30-year-old male patient without any significant past medical history presented with a 2-year history of upper abdominal complaints, dyspepsia, epigastric abdominal pain and weight loss, normal laboratory workup and unclear radiological signs which led him to exploratory laparoscopy due to the patient’s chronic symptoms, in order to exclude the presence of another underlying pathologic process. In addition to our case presentation, a relative review of literature was conducted. As a conclusion, examinations, such as transabdominal ultrasonography, may be misleading and MCRP should be the principal method of investigation to establish a presumptive diagnosis. However, in cases with a strong suspicion for a different underlying pathology, further investigation with exploratory laparoscopy may be warranted.

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Case Report Wed, 30 Sep 2020 17:40:00 +0300
Protective Effect of Flax Seed on Brain Teratogenicity Induced by Lamotrigine in Rat Fetuses https://foliamedica.bg/article/46759/ Folia Medica 62(2): 372-377

DOI: 10.3897/folmed.62.e46759

Authors: Mahsa Kamali, Habibolah Johari, Javad Hami

Abstract: The objective of this study was to assess the effects of the hydroalcoholic extract of flax seed on the teratogenic activity of lamotrigine in the brain of fetuses of rats who had received the drug. In this experimental study, 40 female rats were assigned randomly into four groups and after mating and confirming the vaginal plug, the control animals (group 1) were kept with no intervention, and the other three experimental groups were intraperitoneally injected with respective lamotrigine (75 mg/kg), and 100 and 200 mg/kg of flax seed hydroalcoholic extract. The drug was administered during the organogenesis period. Rats were sacrificed at the 20th day of gestation (one day before term) and fetuses were macroscopically examined, weighed and crown-rump length measured. Fetal brain specimens were processed for H&E and for histological study, using the ImageJ software. Results showed that fetuses of the experimental groups that received lamotrigine had reduced body weight, prefrontal cortical and hippocampal thickness, and pyramidal neurons in the hip­pocampus; Nevertheless, these factors were improved by high-dose administration of flax seed in the experimental group 3 and 4. Our research concludes that lamotrigine negatively influences the development of brain in rats and flax seed has a protective impact on these complications.

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Original Article Tue, 30 Jun 2020 19:28:00 +0300
A New Method of Eliciting Pyramidal Tract Impairment in Adults https://foliamedica.bg/article/47768/ Folia Medica 62(1): 65-69

DOI: 10.3897/folmed.62.e47768

Authors: Ferdnand C. Osuagwu, Ronald Bradley, Usha Pasupuleti, Devakinanda Pasupuleti

Abstract: Background: To suggest a new way of eliciting pyramidal tract dysfunction in adults since the most widely utilized plantar reflex, which is the Babinski reflex, has limitations with different reliability and consistency among different examiners. Materials and methods: 168 adult subjects were examined for the new sign in addition. It consists of just an observation of the patient’s feet and toes in a conscious patient looking for the extension of the great toe along with fanning, spreading and plantar flexion of the small toes either at rest or when patient elevates one leg up at a time. Results: We were able to observe the extension of the great toe along with fanning, spreading and plantar flexion of the small toes in patients with impairment of pyramidal tract. The specificity was 94% while the sensitivity was 96%. Conclusion: Pyramidal tract lesion in adults can be elicited by this new test that observes the extension of the great toe along with fanning, spreading and plantar flexion of the small toes in patients. We suggest this sign as a complement to established signs like Babinski reflex.

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Original Article Tue, 31 Mar 2020 17:00:09 +0300
Evaluating the Effectiveness of Simulation Training in Obstetrics and Gynecology, Pediatrics and Emergency Medicine https://foliamedica.bg/article/47961/ Folia Medica 61(4): 605-611

DOI: 10.3897/folmed.61.e47961

Authors: Milena G. Sandeva, Stoilka Tufkova, Kostadin Ketev, Diana Paskaleva

Abstract: Simulation training in medicine is a powerful tool for acquiring knowledge and practical skills in an environment close to the real world. Decreasing training opportunities directly on the patient tend to introduce simulations close to the real hospital environment without compromising the patient’s safety. The aim of the study was to evaluate the effectiveness of simulation training in the Medical Simulation Training Center (MSTC) at the Medical University of Plovdiv.A prospective observational descriptive study was performed at the MSTC at Plovdiv Medical University between September 2017 and March 2019. The study included 245 respondents who participated in one or more practical simulation trainings and were surveyed.The results of the study suggest that the knowledge, skills and attitudes of the trainees improve after training sessions. By increasing the number of visits, the self-esteem and confidence in performing the manipulation also increases, knowledge and technical performance significantly improve and mistakes are reduced. A statistically significant relationship has been demonstrated between the sequence of visits and acquired competencies (p=0.0001). There are no performance mistakes in those attending three or more times, but 16.2% of them still experience uncertainty while performing. Here, however, 83.8% performed the manipulation automatically and without mistakes. Simulation training in medicine is effective and useful. It has its place in the curriculum for students and is a good tool for acquiring knowledge, skills and techniques in postgraduate education.

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Original Article Tue, 31 Dec 2019 10:00:17 +0200
Treatment Optimization of Post-pneumonectomy Pleural Empyema https://foliamedica.bg/article/47943/ Folia Medica 61(4): 500-505

DOI: 10.3897/folmed.61.e47943

Authors: Danail B. Petrov, Dragan Subotic, Georgi S. Yankov, Dinko G. Valev, Evgeni V. Mekov

Abstract: Introduction: Pleural empyema after pneumonectomy still poses a serious postoperative complication. A bronchopleural fistula is often detected. Despite various therapeutic options developed during the last five decades it remains a major surgical challenge. Results: There is no widely accepted treatment for post-pneumonectomy pleural empyema (PPE) and the management depends mostly on the presence or absence of broncho-pleural fistula (BPF) and the patient’s general condition. In the absence of BPF, the role of surgery is still not clear because of its high morbidity and impossibility to prevent recurrences. In the earlier period, the definitive treatment consisted of open window thoracostomy followed by obliteration of the pleural cavity with antibiotic solution at the time of chest wall closure. Subsequently, the proposed different methods and modifications improved the outcome. There is an association between hospital volume and operative mortality after the lung resection. Hospital volume and the surgeon’s specialty have more influence on the outcome than the individual surgeon’s volume.Conclusions: Treatment management of PPE should be individualized. Definitive treatment options comprise aggressive surgery that is not possible in quite a high proportion of impaired patients. Hospital volume, surgeon’s volume and surgeon’s specialty may influence the prognosis.

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Review Tue, 31 Dec 2019 10:00:02 +0200
Dental Fear of 6-12-year-old Children - Role of Parents, Gender and Age https://foliamedica.bg/article/39353/ Folia Medica 61(3): 444-450

DOI: 10.3897/folmed.61.e39353

Authors: Maria P. Shindova, Ani B. Blecheva, Jeny G. Raycheva

Abstract: Aim: To investigate the level of dental fear in middle childhood and the impact of various personal and social factors that contribute to developing dental fear.Materials and methods: The study included sixty-seven 6-12-year-old children and their parents, randomly selected while receiving their treatment at the Department of Pediatric Dentistry, Plovdiv. A modified version of Dental Subscale of the Children’s Fear Survey Schedule (CFSS-DS) was used to assess the dental fear of each patient. An interview was conducted with the parents to gather information about patient’s gender and age, parent’s dental anxiety (Corah’s dental anxiety scale-DAS) and pre-appointment preparation of children.Results: The results show that the mean of CFSS-DS for children is 30.28±1.17. Concerning the age and gender the comparison between groups of patients with different levels of dental fear demonstrate no significant difference (p>0.05). 60.6%±0.49 of parents prepare their children themselves for the future dental visit and 39.4%±0.49 rely on the dentists to do it. The analysis shows that parent’s dental anxiety and pre-appointment preparation are not associated with the level of dental fear of their children (p>0.05).Conclusions: In middle childhood the majority of children show no or low level of dental fear. The personal and social factors we studied are not determinant risk factors for 6-12-year-old children to develop dental fear.

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Original Article Mon, 30 Sep 2019 22:10:00 +0300
Laboratory investigation of Accuracy of Impression Materials for Border Molding https://foliamedica.bg/article/39351/ Folia Medica 61(3): 435-443

DOI: 10.3897/folmed.61.e39351

Authors: Dobromira Shopova, Diyan Slavchev

Abstract: Introduction: Border molding of the edge of the individual impression tray is an important stage of prosthetic treatment of edentulous jaws, which often depends on the final result of the treatment. Classical thermoplastic impression materials for border molding have positive qualities that make them preferable by clinicians for their hardness, unlimited manipulation time and high impression sharpness. Modern silicone impression materials for border molding have long manipulating time and appropriate viscosity to allow dentists to perform functional tests.Aim: To determine the accuracy of different impression materials for border molding of individual impression trays.Materials and methods: Four impression materials for border molding were laboratory tested: Kerr impression compound green sticks and thermoplastic GC Iso functional sticks, additive type silicone Detaseal function and condensation type silicone sta-seal f. A modified individual impression tray designed by authors was used, allowing for laboratory load and stability. Ten impressions were taken and their formed edges were measured at 10 points three times - immediately after hardening/elasification, and 24 hours and 48 hours after hardening/elasification.Results: The results were analysed using ANOVA repetition analysis, where a statistically insignificant difference in the accuracy of three of the impression materials for border molding was established, except the C-type of silicone.Conclusions: Good manipulative qualities and measured accuracy in laboratory tests define these materials as very good for border molding procedures.

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Original Article Mon, 30 Sep 2019 22:10:00 +0300
The Vertebral Artery Convergence to the Cervical Spine in Elders https://foliamedica.bg/article/39418/ Folia Medica 61(3): 377-383

DOI: 10.3897/folmed.61.e39418

Authors: Banu Alicioglu, Nadir Gulekon

Abstract: Background: In the older population, tortuosity of the vertebral artery (VA), uncovertebral joint (UVJ) osteoarthritis, and abnormal vertebral alignment may alter the normal anatomy.Aim: We aimed to determine the anatomical variations and relationships between the cervical segment of the VA and the cervical spine with regard to ageing.Materials and methods: In this retrospective cross-sectional study, the computed tomography angiography scans of 110 subjects were reviewed. Any variations in the VA, UVJ degeneration were identified. The distance between the VA and uncinate process (UP) was measured electronically. The distance between the VA and UP were compared according to the age group (group A < 45, group B = 45-65, and group C > 65 years-old).Results: With regard to the transverse foramen, 7.2% of the cases had entering abnormalities of the VA, while in one case (0.83%), the right VA had an exiting abnormality (exiting from the C2 instead of the C1). UVJ degeneration was found to be significantly higher in the older age group (p < 0.05). Furthermore, at the C4-C7 levels, the distances between the VA and UP were significantly smaller in the older age group (p < 0.01).Conclusions: The VA-UP distance has been shown to decrease due to increasing UVJ osteoarthritis in the elderly. The convergence of the VA toward the spine occurs at the most mobile segment of the cervical spine, and this anatomical alteration may predispose temporary and/or permanent vertebral artery occlusion clinically, and be dangerous during cervical spine surgery.

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Original Article Mon, 30 Sep 2019 22:10:00 +0300