Challenging clinical presentation of Zinner syndrome.

Zinner syndrome is a rare congenital malformation of the mesonephric duct comprising of seminal vesicle cyst, ipsilateral renal agenesis, and ejaculatory duct obstruction. Clinical presentation varies with perineal pain, painful ejaculation, hematospermia and infertility common presenting complaints. Here, we present a case of Zinner syndrome in a 35-year-old male with a rare clinical presentation of only abdominal discomfort. The purpose of this case report is to highlight the challenging clinical presentation of Zinner syndrome and the use of imaging modalities in diagnosing the condition.

Anatomical Variations in the Circulus Arteriosus Cerebri with Clinical Importance - Results of an Magnetic Resonance Angiography Study and Review of Literature.

OBJECTIVES: Anatomy of circulus arteriosus cerebri (CAC) shows wide variation in different individuals, and population groups and has vital clinical significance in causation and presentation of clinical disease. The literature revealed a connection between the variations of CAC and cerebrovascular disease, ischemia, stroke, aneurysms, and atherosclerosis. MATERIAL AND METHODS: In this study, 513 patients without clinical manifestation in regard to cerebrovascular diseases, who are considered healthy on CAC anatomy, are included. Patients were instructed by clinicians for head imagery with magnetic resonance angiography examination during 2016-2017 periods. RESULTS: After statistical analysis, 43.27% were male while 56.72% female, 39% were younger than 40 years old. Age interval lies from 11 to 84 years old, mean age 46. The most common variations or 9.74% is when communicant anterior artery absence and absence of both posterior communicant arteries (Type G*/E) more rarely is H*/G (0.2%), G*/D (1.75%), G*/G (0.6%), H*/D (0.4%), H*/E (3.39%), H*/H (0.4%), J*/E (0.6%), while combination J*/D, J*/G, J*/H, G*/H not found. The most often combination is absence of anterior communicant artery and absence of both posterior communicant artery (Type G*/E), more in male 10.36% than female 9.6%. CONCLUSION: The CAC is considered to play a critical role in preventing future stroke events in patients with absent of any of the arteries. Knowledge on variations in arteries forming the CAC is with clinical significance, as it is one of the components of CAC which stabilizes cerebral blood flow when principle conduits fail. Knowing the structure of arteries provide clinical knowledge to the surgeons before planning neurovascular surgeries.

The Role of Chest Computed Tomography in Asymptomatic Patients of Positive Coronavirus Disease 2019: A Case and Literature Review.

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an ongoing global health emergency. At present, patients are the primary source of infection. A randomly diagnosed confirmed case of COVID-19 highlights the importance of computerized tomography of thorax in diagnosing asymptomatic patients. In the early phase of COVID-19, routine screenings miss patients who are virus carriers, and tracking travel history is of paramount importance to early detection and isolation of SARS-CoV-2 cases.

Male Infertility and Sperm DNA Fragmentation.

BACKGROUND: One of the main factors affecting male infertility is DNA fragmentation in sperm. Male infertility is a heterogeneous group of disorders, known causes account for only 30-50%, and unknown cause (idiopathic) constitute the rest. Infertility involves nearly 15% of couples in the reproductive age, and only the male problem involves about 40% of the problems. AIM: We have studied our DNA damage to sperm cells of a group of infertile males (113 patients) with abnormal sperm parameters (oligoasthenospermia and oligospermia) and a group of male patients (80 patients) with normal semen parameters (normospermia) to document whether the Sperm Chromatin Dispersion (SCD) analysis could increase the information obtained from the sperm routine analysis to explain the causes of infertility. MATERIALS: A group of 193 patients were analysed, 113 patients in the working group and 80 patients in the control group were screened. The ejaculate samples were taken by the patient to whom the reason for the analysis was explained. All patients were from the Republic of Kosovo. Samples are collected from 2014/2018. Sperm Chromatin Dispersion (SCD) analyses in the ejaculate were analysed by the Biolab Zafi laboratory in Peja. RESULTS: Clinical data were compared between the two groups by one-way ANOVA, mean ± SD, student's t-test. A p-value of less than P < 0.05% was considered statistically significant. Outcomes: In our study, we have gained significant (P < 0.05) results in the workgroup and the control group across all hormonal parameters, sperm parameters, and fragmented DNA in the sperm. CONCLUSION: Based on our obtained results we can conclude that DNA fragmentation in spermatozoa is useful in the selection of unsuitable DNA sperm for use in ART methods. We conclude that our DNA fragmentation analysis results are encouraging and can be used for diagnostic purposes in determining male infertility.

Anatomic Variations of Pancreaticobiliary Union.

AIM: This study was designated to evaluate the frequency of anatomic variations of the pancreaticobiliary union. MATERIALS AND METHODS: Our research was observational, comparative and analytical. The investigation was conducted from January 2016-May 2017. This study included 63 patients from Clinic of Gastroenterology and Hepatology - Prishtina, assessed pancreaticobiliary union with Magnetic Resonance cholangiopancreatography. RESULTS: Union of the common bile duct and the major pancreas was biliary-pancreatic type The angle between common bile duct and the major pancreas duct had different sizes average 35.6°. We did not distinguish significant statistical significance in the size of the pancreaticobiliary angle. In men, the union angle was from the average 36.9°, while in females was average 34.3°. No correlation between the age and size of the angle between common bile duct and the major pancreas duct. CONCLUSIONS: The union of the common bile duct and the major pancreas duct was in most cases B-P Type. The common channel and angle between common bile duct and the major pancreas duct were normal in most cases.

In Vitro Action of Meconium on Bronochomotor Tonus of Newborns with Meconium Aspiration Syndrome.

AIM: Here we studied the role of meconium in the respiratory system on live and exited newborns (weight 250-3000 g). Throughout this study is followed the response of tracheal rings in acetylcholine and histamine in different molar concentrations (10-1, 10-2, 10-3, 10-4 mol/dm3). METHODS: To study the smooth tracheal musculature we used 23 tracheal preparations obtained from the newborns exited from meconium aspiration. RESULTS: Based on the functional analysis of the tracheal specimen we have concluded that the meconium aspiration did not change the smooth musculature response on acetylcholine and histamine when compared to control group, exited from lung inflammatory processes (e.g., pneumonia, bronchopneumonia, atelectasis, cerebral hemorrhage), where tracheal smooth musculature response is significant (P for other causes is not significant (P > 0.01). CONCLUSION: The conclusions suggest that meconium did not potentiate the constrictor action of acetylcholine and histamine in the tracheobronchial system and did not cause modulation of bronchomotor tonus in case of his aspiration. Meconium causes mild relaxation of smooth tracheal musculature with a mechanism which is not mediated by cyclooxygenase products, from tracheal epithelium or proteins. Also, direct activity in the smooth musculature of several tested acids seems to have no significant impact in increasing the tonus of respiratory airway of smooth tracheal musculature.

Comparison of Effect of Leukotriene Biosynthesis Blockers and Inhibitors of Phosphodiesterase Enzyme in Patients with Bronchial Hyperreactivity.

AIM: Blocking effect of leukotriene biosynthesis-zileuton and blocking the effect of phosphodiesterase enzyme-diprophylline in the treatment of patients with bronchial asthma and bronchial increased reactivity, and tiotropium bromide as an antagonist of the muscarinic receptor studied in this work. METHODS: Parameters of the lung function are determined with Body plethysmography. The resistance of the airways (Raw) was registered and measured was intrathoracic gas volume (ITGV), and specific resistance (SRaw) was also calculated. For the research, administered was zileuton (tabl. 600 mg) and diprophylline (tabl. 150 mg). RESULTS: Two days after in-house administration of leukotriene biosynthesis blocker-zileuton (4 x 600 mg orally), on the day 3 initial values of patients measured and afterwards administered 1 tablet of zileuton, and again measured was Raw and ITGV, after 60, 90 and 120 min. and calculated was SRaw; (p < 0.01). Diprophylline administered 7 days at home in a dose of (2 x 150 mg orally), on the day 8 to same patients administered 1 tablet of diprophylline, and performed measurements of Raw, ITGV, after 60, 90 and 120 min, and calculated the SRaw (p < 0.05). Treatment of the control group with tiotropium bromide - antagonist of the muscarinic receptor (2 inh. x 0.18 mcg), is effective in removal of the increased bronchomotor tonus, by also causing the significant decrease of the resistance (Raw), respectively of the specific resistance (SRaw), (p < 0.05). CONCLUSION: Effect of zileuton in blocking of leukotriene biosynthesis is not immediate after oral administration, but the effect seen on the third day of cys-LTs' inhibition, and leukotriene B4 (LTB4) and A4 (LTA4) in patients with bronchial reactivity and bronchial asthma, which is expressed with a high significance, (p < 0.01). Blockage of phosphodiesterase enzyme-diprophylline decreases the bronchial reactivity, which is expressed with a moderate significance, (p < 0.05).

Prevalence of Coxitis and its Correlation with Inflammatory Activity in Rheumatoid Arthritis.

BACKGROUND: Rheumatoid arthritis (RA) is an autoimmune inflammatory disease characterised by intra-articular and extra-articular manifestations but very rarely with coxitis. AIM: This study aimed to investigate the prevalence of coxitis, clinical changes, and its correlation with the parameters of inflammatory activity. METHODS: A cohort of 951 patients diagnosed with ACR/EULAR (American College of Rheumatology/European League against Rheumatism) 2010 criteria was enrolled in this prospective, observational and analytic research study. The CBC (Complete Blood Count), ESR (Erythrocyte sedimentation rate), CRP(C - reactive protein), Anti CCP (Antibodies to cyclic citrullinated peptides), X-ray examination of palms and pelvis, and the activity of the disease as measured by DAS - 28 (28 - joint disease activity score) were carried out in all subjects. Independent samples t-test was used to compare the group's characteristics, whereas Pearson correlation test was used to analyse the correlation between study variables. RESULTS: Of the total number of the subjects, 730 (76.8 %) were females, whereas 221 (23.2%) were males. The average age was 51.3, y/o while the most of them were between 40 - 49 y/o (32.6%). The prevalence of coxitis was 14.2%, mostly found in males (19.46%). The echosonografic prevalence of changes was 21.45%, while the radiological changes were 16.3%; in both cases, the changes were more expressed in males. The analysis showed that inflammatory parameters were significantly higher in patients with coxitis. CONCLUSION: Coxitis has high economic cost because it ends up with a mandatory need for a total hip joint prosthesis. Thus the results of this study can serve to plan and initiate early preventive measures.

Influence of Gender and Age on Average Dimensions of Arteries Forming the Circle of Willis Study by Magnetic Resonance Angiography on Kosovo's Population.

BACKGROUND: Circulus arteriosus cerebri is the main source of blood supply to the brain; it connects the left and right hemispheres with anterior and posterior parts. Located at the interpenducular fossa at the base of the brain the circle of Willis is the most important source of collateral circulation in the presence of the disease in the carotid or vertebral artery. AIM: The purpose of the research is to study the diameter and length of arteries and provide an important source of reference on Kosovo's population. METHODS: This is an observative descriptive study performed at the University Clinical Center of Kosovo. A randomised sample of 133 angiographic examinations in adult patients of both sexes who were instructed to exploration is included. RESULTS: The diameters and lengths measured in our study were comparable with other brain-cadaver studies especially those performed by MRA. All dimensions of the arteries are larger in male than female, except the diameter of PCoA that is larger in female (p < 0.05) and length of the ACoA (p < 0.05). Significant differences were found in diameters of arteries between the younger and the older age groups. CONCLUSION: Knowing the dimensions of the arteries of the circle of Willis has a great importance in interventional radiology as well as during anatomy lessons.

Importance of Alpha-adrenergic Receptor Subtypes in Regulating of Airways Tonus at Patients with Bronchial Asthma.

BACKGROUND: In this work, effect of Tamsulosin hydrochloride as antagonist of alpha1A and alpha1B- adrenergic receptor and effect of Salbutamol as agonist of beta2- adrenergic receptor in patients with bronchial asthma and increased bronchial reactibility was studied. METHODS: Parameters of the lung function are determined by Body plethysmography. Raw and ITGV were registered and specific resistance (SRaw) was also calculated. Tamsulosin was administered in per os way as a preparation in the form of the capsules with a brand name of "Prolosin", producer: Niche Generics Limited, Hitchin, Herts. RESULTS: Results gained from this research show that blockage of alpha1A and alpha1B- adrenergic receptor with Tamsulosin hydrochloride (0.4 mg and 0.8 mg in per os way) has not changed significantly (p > 0.1) the bronchomotor tonus of tracheobronchial tree in comparison to the inhalation of Salbutamol as agonist of beta2- adrenergic receptor (2 inh. x 0.2 mg), (p < 0.05). Arterial blood pressure showed no significant decrease following the administration of the dose of 0.8 mg Tamsulosin. CONCLUSION: This suggests that the activity of alpha1A and alpha1B- adrenergic receptor in the smooth musculature is not a primary mechanism which causes reaction in patients with increased bronchial reactibility, in comparison to agonists of beta2 - adrenergic receptor which emphasizes their significant action in the reduction of specific resistance of airways.

Influence of hypoxia in bronchial response to bronchoconstrictor substances at newborn with distress respiratory syndrome (DRS).

OBJECTIVE: In this work, role of hypoxia in respiratory system on live and exited newborns weight 250-3000g.) which have died due to different reasons is studied. METHODS: Response of tracheal rings in acetylcholine and histamine in different molar concentrations (10(-4), 10(-3), 10(-2), 10(-1) mol/dm3) was monitored. Study of the tracheal smooth musculature (TSM) tonus was performed in 12 tracheal preparations obtained from the newborns exited due to different reasons. RESULTS: Based on the functional analysis of the isolated tracheal preparations, we have concluded that the cases born with lung atelectasis have caused significant response ofTSM to Acetylcholine and Histamine (p > 0.01). In cases of control group, which has exited due to different reasons from lung inflammatory processes (e.g.: pneumonia, bronchopneumonia, cerebral hemorrhage), Acetylcholine and Histamine have also caused significant constriction of tracheal smooth musculature. CONCLUSION: Results suggest that exited cases with lung atelectasis (hypoxemia) and cases of lung inflammatory processes have significant constrictor action to Acetylcholine and Histamine in tracheobronchial system.

Development of receptor bronchial system in isolated preparation of piglet trachea in vitro.

In this paper we present the flow research of the development of receptor bronchial system in the first month of extra-uterine life up to the sixth month of development, performed by tracking the reactions of isolated tracheal rings in acetylcholine (Ach), propranolol (P), histamine (Hist), and prostaglandin (PGF2-alfa) in concentrations of: 10-4, 10-3, 10-2 and 10-1 mol/dm3; in piglets of ages: 1 month, 2 months, 4 months and 6 months. Results shows that Ach causes reaction of smooth muscles from the first month of extra-uterine life (p < 0.01) and that Propranolol (P) significantly emphasizes the effect of Ach (p > 0.1), while histamine and PGF2-alpha do not cause constriction (histamine up to 4 months of age, PGF2-alfa up to 6 months of extra-uterine life). This shows that cholinergic and adrenergic system in piglet airways is developed during intrauterine life and reaction can be registered in the first month of extra-uterine life, while other receptor systems are developed in later periods of extra-uterine life. This suggests that lack of reaction of tracheal smooth musculature (TSM) comes as a result of sufficient non-maturity of mast cells from which chemical mediators, with local functioning, are released.

The study of volume density of tracheal ganglions in vitro in new born babies with respiratory distress syndrome.

Volume density of respiratory organs was studied in vitro in newborn babies at different age of gestation (abort, immature, premature and mature) using stereometric method. The total of 23 cases was subject to this study. The respiratory organs (trachea, lungs) were taken from autopsies of newborn babies exited from different causes. For this purpose the tissues were fixed in formalin (10%) solution, cut serially in 7micro and 10micro slabs. Volume density of the respiratory system was assessed stereometricaly using Universal testing system Weibel M 42. We observed that volume density of epithelia, musculature and glands were proportionally present in the tracheal tissue. Cellular interstitial tissue is consistently increasing and corresponds to the developmental stages of the newborn babies. The density of tracheal ganglions is greater in premature ages of immature and premature newborns (p<0,05). Decreased number of ganglion cells is observed in mature ages (p<0,05). This is caused by intensive ramification of ganglions from serosa to deeper layers of trachea right to epithelium. Medium diameter of tracheal ganglions is greater in mature newborn babies and corresponds to developmental ages of babies.

Role of meconium in the reaction of airways smooth musculature in the newborn with meconium aspiration syndrome (MAS).

The role of meconium in the respiratory system was studied in newborns, who died from various causes (250 up to 3000 g of weight). We monitored tracheal rings response to dopamine, serotonin and ethanol in different concentrations (dopamine: 0,05 mg/ml, 0,5 mg/ml, 5 mg/ml; serotonin (5-HT): 10-4, 10-3, 10-2, 10-1 mol/dm3; ethanol: 0,02 ml, 0,5 ml, 1,0 ml; 96%). Tracheal smooth musculature tonus (TSM) was examined in 48 tracheal preparations taken after the newborn exitus due to different reasons. Based on functional researche of isolated preparations of tracheas, it may be concluded that: aspiration of meconium has not changed the response of TSM to dopamine, serotonin and ethanol (p>0,1) in comparison with the control group, which have died due to different lung inflammatory processes (e.g. pneumonia, bronchopneumonia, atelectasis, cerebral hemorrhage). The results suggest that meconium does not potentiate the constricting action of dopamine, serotonin and ethanol in tracheobronchial system. Meconium causes mild relaxation of the TSM through a mechanism that is not intermediated by the products of cyclooxygenases (prostaglandins, prostacyclins) from the tracheal epithelium or proteins. Also, as it seems, the direct activity of many tested acids in the smooth musculature has no significant impact on increase of the airways tonus in MAS syndrome.

Action of propranolol in the reaction of smooth musculature of tracheal rings induced with acetylcholine, histamine, serotonin (5-HT) and prostaglandin (PGF2-alfa) in vitro and in vivo.

Actions of acetylcholine (ACh), histamines, serotonins (5-HT) and prostaglandins (PGF2-alfa) in concentrations of 10(-4), 10(-3), 10(-2) and 10(-1) mol/dm(3) were analyzed in vitro conditions in isolated specimens of tracheas of 24 pigs, 7 guinea pigs, and dead persons for different reasons (8), in the presence and without presence of propranolol. Whilst, research regarding actions of aerosolized histamines (10 mg, 1%, 2 min), in the presence and without the presence of aerosolized propranolol (20 mg, 2%, 2 min) was done in vivo in 6 healthy persons. Study results show that propranolol does not emphasize contraction of the airways smooth musculature as induced by ACh, histamine, 5-HT and PGF2-alfa in vitro conditions (p>0,1). Also, in vivo we found a non-significance of tracheal smooth musculature constriction (p>0,1).

In vitro examination of degenerative evolution of adrenergic nerve endings in pulmonary inflammatory [corrected] processes in newborns.

Morphological aspect of tracheal preparations and pulmonary tissue was studied in vitro. The material was obtained from autopsy of newborns that died from different causes. Examinations were made in different gestational periods (immature 23-29 weeks; premature 30-37 weeks; mature >38 weeks). Material for examination was obtained up to 6 hours after death. Pulmonary and tracheal tissue was incubated for fixation in buffered formalin (10%). Special histochemical and histoenzymatic methods were used for coloring of pulmonary and tracheal tissue and the activity of ATP-ase and dopaoxidase was monitored. Cut out models were made in series of 7 micro, 10 micro and 20 micro. In peripheral axons of tracheobronchial pathways, degenerative alterations of adrenergic nerve endings in lung inflammatory processes were documented. These morphologic neuronal changes were described: Walerians degeneration, neuro-axonal degeneration and segment demyelinisation. These changes are well seen with argentafine coloring (Sevier-Munger modification for nerve endings) and with dopaoxidase reaction. In mature newborns that died from respiratory distress syndrome, we found different forms of metabolic and toxic degenerative damage in peripheral axons, such as: segment demyelinisation, neurotubular fragmentation, Schwann cell proliferation, fragmentation and bulging out of axonal neurotubules and neurofilaments. In tracheo-bronchial tissue, chromafine granules are homogeneously distributed on Lamina propria layer and through glandular structures. This gives as a contradiction, according to some authors, that adrenergic nerve fibers for muscle tissue are absent and that adrenaline and noradrenaline diffuse in muscle tissue from interstice.

In vitro examination of ontogenesis of developing neuronal cells in vagal nuclei in medulla oblongata in newborns.

The development of neuron cells in vagal nerve nuclei in medulla oblongata was studied in vitro in live newborns and stillborns from different cases. Morphological changes were studied in respiratory nuclei of dorsal motor centre (DMNV) and nucleus tractus solitarius (NTS) in medulla oblongata. The material from medulla oblongata was fixated in 10 micro buffered formalin solution. Fixated material was cut in series of 10mu thickness, with starting point from obex in +/- 4 mm thickness. Special histochemical and histoenzymatic methods for central nervous system were used: cresyl echt violet coloring, tolyidin blue, Sevier-Munger modification and Grimelius coloring. In immature newborns (abortions and immature) in dorsal motor nucleus of the vagus (DMNV) population stages S1, S2, S3 are dominant. In neuron population in vagal sensory nuclei (NTS) stages S1, S2 are dominant. In more advanced stages of development of newborns (premature), in DMNV stages S3 and S4 are seen and in NTS stages S2 and S3 are dominant. In mature phase of newborns (maturity) in vagal nucleus DMNV stages S5 and S6 are dominant, while in sensory nucleus NTS stages S4 and S5 are dominant. These data suggest that neuron population in dorsal motor nucleus of the vagus (DMNV) are more advanced in neuronal maturity in comparison with sensory neuron population of vagal sensory nucleus NTS. This occurrence shows that phylogenetic development of motor complex is more advanced than the sensory one, which is expected to take new information's from the extra uterine life after birth (extra uterine vagal phenotype).

Examination of ontogenetic-morphologic growth of adrenergic receptor system in the isolated preparation of trachea in vitro.

Morphological development of the bronchial respiratory system of the living newborns and dead newborns was studied. Tracheal smooth musculature was studied in 19 experimental preparations which were obtained from autopsy of newborns that died from different causes. Based on the morphological research of the isolated preparation of human trachea the following was stated: numerical density of the tracheal ganglions is higher in the premature. Decrease of ganglion cells number is noticed in mature newborns. This can be explained with the fact that in the phase of intensive ramification, ganglions penetrate from the serous layers in the deeper layers of the trachea--in the direction of epithelium. Main diameter of tracheal ganglions is bigger in premature; this is proportional with the developmental phase of newborns. Based on histological, histochemical and hystoenzymatic analyses, three types of synaptic-axonal neurotransmitter vesicles are visualized in our material: small granularvesicles (SGV), large granular vesicles (LGV) and aminoacid vesicles, with gamma-amino butyric acid and glycine (GABA). Vesicles give positive reaction with argentaffin, argyrophilin and dopa-oxidase. Argentaffin and argyrophile reactions are positive in synapses, hydrocyte cartilage, epithelium, smooth musculature, SGV, LGV, GABA of the tracheal-bronchial pathways. ATP is positive in hydrocyte cartilages and tracheobronchial mucus glands. On airways most of the nerve endings are vesicular (motor) type. Non-vesicular (sensory) types of nerve endings are present in perichondrial localization. These morphological data indicate interaction between adrenergic, cholinergic and third nonadrenergic-noncholinergic system in airways.