Summary Introduction In the past decade, approaches to understanding epidemiology and treating diverticular disease have changed significantly. Many of the principles used earlier have lost their relevance at the moment. In the near future, we can expect an increase in cases of the disease, given the general population aging. Moreover, the number of surgical operations performed on diverticulosis increases annually. The number of complications are worsening the prognosis for a given disease increasing the risk of death results. The aim of the study A detailed scientific review is presented on the topic “Diverticular Colon Disease”. The paper primarily uses the guidelines of World Journal of Emergency Surgery (2016), as well as Guidelines of the American Association of Gastroenterologists and Clinical guidelines for the diagnosis and treatment of adult patients with diverticular colon disease developed by the expert committee of the All–Russian Public Organization “Association of Coloproctologists of Russia”. The work gives the definition of a diverticulum, diverticulosis, and diverticulitis of the colon. The issues of prevalence and frequency of occurrence of this pathology in various age and ethnic groups in developed and developing countries are reflected. The modern views on the etiology and pathogenesis of the disease are disclosed, taking into account the views of modern scholars and international guidelines. Finally, the work analyses case report on the complicated diverticular disease. Material and Methods The search for sources was performed in the PUBMED, PUBMED Central, Google Scholar and E–Library databases by keywords: colon diverticulosis, diverticulitis, as well as their Russian counterparts. The selection of sources was mainly limited to 2000–2020. Authors declare that the research was conducted according to the principles of the World Medical Association Declaration of Helsinki “Ethical Principles for Medical Research Involving Human Subjects. Informed consent was not received due to the nature of the study. Results and Conclusion In the past decade, approaches to understanding epidemiology and treating diverticular disease has changed. Many of the principles used earlier have lost their relevance at the moment. At the same time, a careful study of the etiological factors, pathophysiological mechanisms and cause–effect relationships in the development of this pathology is required. Improving diagnostic methods, early prevention and new approaches to treatment can reduce the risk of death in this disease.
Summary Introduction Acute appendicitis (AA) – acute inflammation and infection of the appendix – is one of the most common cause for abdominal surgery in pediatrics. Appendectomy has been the gold standard since 1735, but in recent years there have been several studies that investigate antibacterial therapy for uncomplicated acute appendicitis. In 2016 new recommendations for suspected AA were implemented in emergency department setting of Children's Clinical University Hospital (CCUH). Aim of the Study To evaluate whether diagnostic criteria for patients with a suspected acute appendicitis is effective as a diagnostic tool and to evaluate whether dual antibacterial therapy is safe and effective as first line treatment for children with diagnosis of uncomplicated acute appendicitis in CCUH. Material and methods A retrospective study was made in CCUH from January 2017 to December 2017. Patients aged 7 to 18 with suspected uncomplicated acute appendicitis were identified and data were collected from an internal hospital management system and patients’ medical records. Patients were divided into two groups – A and B. In group A were patients who met the criteria of uncomplicated AA, and in group B – patients who met the criteria of complicated AA. Both groups received ampicillin and metronidazole. For statistical analysis IBM SPSS Statistics 22 program was used. Results From 98 patients majority were boys (51% (n=50)) with mean age 12.6 years. As a result of antibacterial therapy clinical condition improved in 93% (n=89) of patients who were discharged without surgery. 7 patients did not improve and underwent surgery within 48 hours after admission, another 2 had elective appendectomy. There was a significant positive moderate correlation between C–reactive protein (CRP), white blood cell count (WBC), basophil granulocytes (BASO) and appendix diameter at admisson and after 48 hours of dual antibacterial therapy (r=0.31, p=0.003 vs. r=0.37, p<0.001 vs. r=0.41, p=0.017 vs. r=0.51, p=0.013). In group A (68% (n=67)) there was a significant positive moderate correlation between CRP, WBC and appendix diameter at admission and after 48 hours of dual antibacterial therapy (r=0.31, p=0.003 vs. r=0.37, p<0.001 vs. r=0.51, p=0.013). In group B (30% (n=31)) 7 patients underwent appendectomy and 2 patients received a broad spectrum antibacterial therapy prior to elective appendectomy. There is evidence of significant association between ALVARADO score (p=0.004), rebound tenderness (p<0.001), WBC (p=0.004), CRP (p<0.001) and stage in which appendicitis has progressed to. Conclusions Antibiotic-alone treatment may be a safe and effective initial management choice in children with uncomplicated acute appendicitis. However, to fully evaluate effectiveness of antibacterial therapy and diagnostic criteria, further follow–up research is needed. A normal C–reactive protein value does not rule out uncomplicated acute appendicitis, therefore it can not act as a single marker to diagnose AA or to differentiate between complicated and uncomplicated AA. Recommendations of treatment of UCAA are acceptable for use in emergency department as they act as a unified tool that allows pediatricians and pediatric surgeons to quickly assess suspected acute appendicitis.
Summary The case report demonstrates painstaking, one step at a time multitherapy for the third most common cancer and the third cause of cancer death in western countries – colorectal cancer. Multitherapeutic approach at specialized centers for the treatment of colorectal cancer is the cornerstone for reaching favorable treatment results and prognosis.
Summary A 50-year-old female was diagnosed with significant peripapillary choroidal neovascularization (PCNV) in the left eye (LE). 12 months after a close follow-up, 4 intravitreal injections with bevacizumab and retinal laser photocoagulation were performed to limit the distribution of the lesion. A year after the primary diagnosis in the LE, a tiny PCNV also developed in the right eye (RE). Simultaneous activity was additionally observed in both peripapillary lesions at the time. At the last follow-up, after 43 months, the best corrected visual acuity in the RE was 0.8, but in the LE it was only 0.2. In total, the LE received 6 intravitreal injections with bevacizumab, while the RE received 3 injections. The case report concludes that early diagnosis and intervention helps maintain visual acuity better in the cases of a small lesion than in developed significant PCNV with intense activity characterised with oedema, hard exudates and haemorrhages.
Summary Cor triatriatum sinister is a rare congenital cardiac anomaly that has been identified in 0.1% of children with congenital heart disease. It is defined as a fibromuscular membrane that divides the left atrium into two chambers: a superior (proximal) that in most cases receives drainage from the pulmonary veins and an inferior (distal) chamber that communicates with the mitral valve and the left atrium. Cor triatriatum sinister can be an isolated lesion (approximately 25% of cases), but in many cases it is associated with other congenital cardiovascular anomalies, the most common one being – atrial septal defect(3). Symptoms in patients with cor triatriatum sinister are related to obstruction of pulmonary venous drainage, pressure loading of the right side of the heart and congestive cardiac failure. Depending on the severity of the obstruction and presence of associated cardiac anomalies it can be diagnosed at any age. Diagnosis is usually achieved by echocardiography in early infancy. Elective treatment method is surgical excision of the membrane. Here we present a pediatric patient (4 months old) presenting in cardiogenic shock with a successful correction of isolated cor triatriatum sinister. To confirm diagnosis and success of surgical repair, transthoracic and transesophageal echocardiography were used.
Summary In surgical practice, antibacterial prophylaxis (AP) is widely used to reduce the risk of possible infectious complications; it is not always administrated according to evidence-based clinical indications. Administration of AP in cases when its inefficiency for exact situation has been scientifically proven, should be considered as unwarranted. A one-year-long retrospective analysis of AP cases in the Department of Vascular Surgery of Pauls Stradins Clinical University Hospital was performed and the results were broadly analyzed within the local structural unit. It was followed by the development of the local guidelines for administration of antibiotics, as a result, a significant decrease in cases of unwarranted AP has been achieved.
Summary Introduction Aneurysmal subarachnoid haemorrhage (SAH) is associated with high mortality and morbidity. Rebleeding, cerebral vasospasm (VS) with delayed cerebral ischemia (DCI) are major complications after SAH associated with poor neurological outcome. Aim of the study To summarize the existing research data on the SAH from incidence, risk factors and clinical presentation to diagnostic, monitoring and treatment options after SAH. Materials and Methods Literature review was carried out to identify factors associated with SAH using specific keywords (aneurysmal subarachnoid haemorrhage, rebleeding, cerebral vasospasm, delayed cerebral ischemia) in the PUBMED database. In the time period from 2000 to 2019, 34 full articles were reviewed. Results According to the literature, the key risk factors for cerebral aneurysms and the SAH are hypertension, smoking, chronic alcohol abuse, family history of intracranial aneurysms in first-degree relatives and female sex. The key risk factor for early complication - rebleeding after SAH - is hypertension. The factors responsible for late complications - cerebral VS and DCI after SAH - are initially lower Glasgow coma scale and higher grades of Fisher scale, where grade IV and III predict cerebral VS in 31–37%. Furthermore, hyperglycaemic state, hyponatremia, hypotension and cerebral hypoperfusion, increased level of Troponin correlate with the incidence of cerebral VS and DCI. Although the golden standard to detect cerebral VS is digital subtraction angiography, CT angiography has become a routine examination. Transcranial doppler sonography is recommended and regional cerebral oximetry also seems to be promising. To avoid rebleeding for wide-necked, gigantic aneurysms or when SAH is combined with intraparenchymal hematoma, surgical clipping is preferred. For posterior circulation aneurisms, poor grade SAH and patients with age >70 years superior is endovascular treatment. To avoid late complications, the pharmacological method is used with Nimodipine. Conclusions SAH is still associated with poor clinical outcome due to the development of early and late complications. The highest risk patients are those with low Glasgow coma scale and high grades of Fisher scale. Timely performed obliteration methods of the ruptured aneurysm are crucial and Nimodipine is the main agent to prevent cerebral VS and DCI.
Summary Introduction The standard treatment for locally advanced rectal cancer (LARC) is neoadjuvant chemoradiotherapy (NACRT) followed by radical surgery, which allows to reduce local recurrence, downsize the tumor and facilitate its R0 resection. Aim of the study The aim of this study was to evaluate the downstaging of LARC after NACRT and to assess the impact of downstaging on progression–free survival (PFS). Materials and methods 65 patients diagnosed with LARC from 2012 to 2018, who received NACRT with subsequent radical surgery were identified in the Pauls Stradins Clinical University Hospital in Riga and included in this retrospective study. Average follow–up period was 31 months. Data were analysed with SPSS Statistics 22.0, Wilcoxon signed–rank test and Kaplan–Meier survival analysis were performed. Results Overall, 66.7% (n=40) of patients experienced a downstaging in response to NACRT, of which 37.5% (n=24, p=0.004) had a downstaging of T and 63.3% (n=38, p=0.0001) of N. 12–month PFS was 87.8%, 24–month PFS – 66.1% and 3–year PFS – 62.7%, median PFS (mPFS) was not met. 3–year PFS of those patients treated with intravenous 5FU/LV boluses was significantly higher (76.5%) than those who received oral tegafur (45.6%, mPFS 32 months), p=0.038. 3–year PFS of patients with downstaged T was 85.9%, compared to 52.1% without it; mPFS not met, p=0.04. Similarly, 3–year PFS of patients with downstaged N was 71.5%, compared to 43.3% without it (mPFS 24 months), p=0.112. Lymphatic and vascular invasion were associated with significantly lower PFS compared to the patients with absent lymphatic and vascular invasion (p=0.0001 and p=0.014, respectively), while perineural invasion did not show any impact on PFS. Age at diagnosis, tumor location, type of surgery and adjuvant chemotherapy did not have a significant impact on PFS. Conclusions Results confirm the efficacy of NACRT in LARC in the downstaging of T and N. Downstaging of LARC, intravenous chemotherapy and absence of lymphovascular invasion are associated with significantly increased PFS.
Summary Long QT syndrome is a genetically determined clinical condition that can lead to sudden cardiac death, life–threatening arrhythmias, typically ventricular tachycardia – Torsades de Pointes in young, otherwise healthy, adults and children. Congenital long QT syndrome is the most common cause of sudden death in young adults with structurally normal heart. There are several studies, which introduce us to gene mutation types, responsible for this disease. At this point 17 types of LQTS gene mutations are recognized, most patients present with the first 3 LQTS gene mutations: KCNQ1, KCNH2, and SCN5A. Secondary factors like electrolyte disbalance, dietary restrictions, and specific drugs may also cause QT interval prolongation. It is important to rule out avoidable causes, before further evaluation of congenital disease. Several treatment options are used in daily practice, which also includes a surgical approach. Although not so often used and seen, surgical technique has positive results – recognized by both doctors and patients.
Summary Diagnostic microbiology and management of sepsis have advanced, even though the complication of multiorgan dysfunction remains a significant cause of morbidity and mortality. An estimated incidence of sepsis in 2017 is about 48 million a year, including 11 million sepsis- related deaths, which represents 19.7% of all global deaths.(1,2) Acute respiratory distress syndrome (ARDS) is a devastating complication of sepsis, conventionally, a substantial number of patients require mechanical ventilation (MV) to avert hypoxemia and hypercapnia. However, MV per se can cause lung injury, accelerating the disease progression. The use of extracorporeal membrane oxygenation (ECMO) in the management of ARDS has grown considerably in the past decade. More recently, an increasing popularity of spontaneous breathing and awake patients undergoing ECMO is seen, as well as the use of various types of hemadsorbers for reducing pathologically increased inflammatory response.(3) The purpose of this case report is to review airway and multiorgan support management during ECMO.
Summary Duodenal adenocarcinoma is one of the rarest tumours of all gastrointestinal malignancies. Due to rarity and late symptoms, duodenal cancers are diagnosed in late stage, but overall survival rate is high. We present a case of locally advanced duodenal adenocarcinoma with successful surgical treatment including multiorgan resection.
Summary Introduction In the past decade, approaches to understanding epidemiology and treating diverticular disease have changed significantly. Many of the principles used earlier have lost their relevance at the moment. In the near future, we can expect an increase in cases of the disease, given the general population aging. Moreover, the number of surgical operations performed on diverticulosis increases annually. The number of complications are worsening the prognosis for a given disease increasing the risk of death results. The aim of the study A detailed scientific review is presented on the topic “Diverticular Colon Disease”. The paper primarily uses the guidelines of World Journal of Emergency Surgery (2016), as well as Guidelines of the American Association of Gastroenterologists and Clinical guidelines for the diagnosis and treatment of adult patients with diverticular colon disease developed by the expert committee of the All–Russian Public Organization “Association of Coloproctologists of Russia”. The work gives the definition of a diverticulum, diverticulosis, and diverticulitis of the colon. The issues of prevalence and frequency of occurrence of this pathology in various age and ethnic groups in developed and developing countries are reflected. The modern views on the etiology and pathogenesis of the disease are disclosed, taking into account the views of modern scholars and international guidelines. Finally, the work analyses case report on the complicated diverticular disease. Material and Methods The search for sources was performed in the PUBMED, PUBMED Central, Google Scholar and E–Library databases by keywords: colon diverticulosis, diverticulitis, as well as their Russian counterparts. The selection of sources was mainly limited to 2000–2020. Authors declare that the research was conducted according to the principles of the World Medical Association Declaration of Helsinki “Ethical Principles for Medical Research Involving Human Subjects. Informed consent was not received due to the nature of the study. Results and Conclusion In the past decade, approaches to understanding epidemiology and treating diverticular disease has changed. Many of the principles used earlier have lost their relevance at the moment. At the same time, a careful study of the etiological factors, pathophysiological mechanisms and cause–effect relationships in the development of this pathology is required. Improving diagnostic methods, early prevention and new approaches to treatment can reduce the risk of death in this disease.
Summary Acute gastric dilatation is a rare and life threatening disease. The usual symptoms of acute gastric dilatation can vary and be nonspecific, including acute abdominal pain, abdominal distension, nausea and vomiting. Many aetiologies of acute gastric dilatation are described. This article presents a case of a 13 year old girl who presented in our clinic with acute gastric dilatation after an orthopaedic operation. Clinical signs and a diagnostic pathway are presented in the report. In the early treatment of acute gastric dilatation, nasogastric tube insertion was used for gastric decompression. As a surgical approach jejunostomy insertion was used to ensure enteral feeding. Our case study shows that the optimal treatment for this pathology is mainly conservative.
Summary Occipital neuralgia is a type of chronic headache disorder in the dermatomes of the greater or lesser occipital nerve. (7) We describe here a rare case of occipital neuralgia caused by an intramuscular lipoma. A 45 year-old man presented with troublesome pain in the occipital area with 3 x 2 cm palpable mass in the right occipital region. Patient was treated by a neurologist. The X ray for cervical vertebrae and computed tomography was performed. Computed tomography revealed a mass reminding intramuscular lipoma. Surgical management was indicated. During the operation stretching of the lesser occipital nerve was detected. After resection of lipoma on postoperative follow – up, the patient reported that the pain had resolved. During the histopathological examination, lipoma was confirmed.
Summary Introduction Diabetic retinopathy (DR) is a severe complication that can lead to complete vision loss and still is one of the main blindness-causing reasons among patients with type 1 diabetes mellitus (T1DM). DR as a complication can cause vision loss to people at their working age. More than 90% of patients with type 1 diabetes will develop DR by 20 years post diagnosis (Leslie R. Dye, 2018). DR is more likely to develop in patients with T1DM (Kanski's Clinical Ophthalmology, 2016). This complication can be very serious speaking of the ability to see. Sometimes vitrectomy plays a vital role in the management of severe complications of DR at its end-stage (Myron Yanoff et al., 2020). Aim of the study To prove the development severity of DR that depends on the duration of diabetes and metabolic compensation. Additionally, to determine retinopathy's association with other micro and macrovascular diabetes mellitus complications for a better understanding of what are the contributory factors for these complications to develop and which of those may coexist. Materials and Methods A retrospective study was held at the Pauls Stradins Clinical University Hospital (Riga, Latvia). From January 2016 to March 2018, 79 (158 eyes) patient histories were analyzed who have type 1 diabetes mellitus. To obtain more precise research results, almost all patients have done check-up visits to one certain ophthalmologist. The IBM SPSS Statistics version 25.0 was used to process data. Tables were made in SPSS and Microsoft Excel 2016 programs. Statistically significant value (p) was set at < 0,05. Results No statistically significant difference is seen in the mean duration of the disease: in the group of proliferative diabetic retinopathy (PDR): 25.23 (median = 22.0) years and non-proliferative group: 24.68 (median = 23.50) years. Results show that the duration of diabetes mellitus is considerably smaller in a group without DR 11.24 (median = 8.50) years. Metabolic compensation (%) in diabetes mellitus is not statistically different between patients with diverse forms of DR; no association found either. No statistically significant difference in best corrected visual acuity (BCVA) was detected among patients with various forms of DR. Three groups were compared: both types of DR and no DR. It was detected that BCVA in patients without DR was higher in both eyes: 0.83 ± 0.27 dioptres. No statistically significant difference (pχ > 0.05) was detected between the groups of DR and therefore no association was made between the form/existence of DR and arterial hypertension. There is a strong association between DR and microvascular complications (V = 0.40) with the existence of DR and there is an even stronger association (V = 0.61) with the forms of DR. There is no statistically reliable difference (pχ > 0.05) between the groups of DR; therefore, no association with the existence of microvascular complications and also risk factors. Conclusions More than two-thirds of patients included in the research have some signs of DR. Because of the strong association of DR and other microvascular complications, patients with diabetes should be screened regularly for retinopathy, nephropathy, and neuropathy. And likewise, if a patient has at least one microvascular complication, he or she should be tested for the rest possible complications as well. According to data, most of the patients in this study have poor metabolic compensation; consequently, the metabolic compensation screening should be done certainly every three months.
Summary Introduction Anterior cruciate ligament (ACL) rupture is very common in athletes. In the general population, incidence is approximately 33 per 100 000 people. Aim of the study The aim of the study was the evaluation of morphological changes in the musculus semitendinosus tendon used for the reconstruction of ACL to understand the quality of most common for surgery used material. Material and methods The materials were obtained from four ACL autologous hamstring reconstruction surgeries. The tissue was stained with hematoxyllin and eosin and with immunohistochemical (IMH) staining of PGP9.5, VEGF, collagen I and collagen III. The material was evaluated with semiquantitative method. Results Routine staining showed practically unchanged tendon structure, with one exception when sclerotic blood vessels were observed in endotenon. Collagen III IMH demonstrated moderate to numerous positive collagen fibres in two cases, but in other two there were only few positive structures seen. Collagen I IMH showed few to moderate number of positive collagen fibres in all cases. In two cases, moderate number of PGP9.5 positive nerve fibres was observed and in two other cases occasional to few number of positive structures was detected. PGP 9.5 marked higher number of nerve fibres in peritenon than in endotenon. Numerous VEGF positive endotheliocytes were observed in two cases, but in two other cases VEGF positive endotheliocytes were occasional. Conclusions Tendon of musculus semitendinosus displays two patterns of distribution of tissue ischemia, neuropeptide containing innervation and collagen I and III. Collagen III is thought to be evaluated as a response of tendon to the ischemia and intensive innervation, while increase of collagen I probably is related to the relatively unchanged vascularity and innervation. The pattern of musculus semitendinosus tendon structural changes seems to be connected to the individual homeostasis in patients persisting before the usage of tendon for the reconstruction.
Summary Introduction Intravitreal injections have become one of the most performed surgical procedures in ophthalmology. There is a need to look for an effective alternative therapy for patients with anti-VEGF complications and systemic disease contraindications. Aim of the study To evaluate Subliminal laser effectiveness on reducing macular disease edema. Materials and methods Subliminal laser treatment was done three times with three month intervals for patients with macular edema due to retinal diseases. On 1st, 3rd, 6th and 9th month visit the best corrected visual acuity, intraocular pressure, macular thickness and macular volume were registered. Results Mean visual acuity before treatment was 0,52 (SD=0,31) that changed to 0,56 after the 9 month treatment (p>0,05). Mean central macular thickness from 326,12 μm reduced to 308,15 (p=0,76). Without significant difference, inner cycle volume changed from 1353,80 mm3 to 1297,57 mm3 (p=0,81) and outer cycle volume from 1179,4 mm3 to 1112,56 mm3 (p=0,51). Conclusions Subliminal laser controls macular edema level and could be a solution for patients who cannot afford or are emotionally distressed by monthly intravitreal injections. This treatment method can be used as additional therapy to reduce the number of intravitreal injections.
Summary Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal (GI) tract (3). A 68-year-old male patient was referred to our hospital with complaints about feeling pressure in the thorax and heavy sweating for over 2 years. Abdominal CT showed a pathological formation approximately 21 cm × 15cm × 15 cm in size. The stomach was compressed and dislocated by the tumor. The total gastrectomy Roux modification was performed. The tumor grows from the back wall of the stomach; the tumor is not grew into the mucosa. We made a final diagnosis of an extra luminal GIST of the stomach - pT4N0M0G1R0 stage II. There was no evidence of disease recurrence six months after surgery.
Abstract Introduction. In 2014, new scoring system - Kidney Donor Profile Index (KDPI) was introduced. KDPI is a numerical measure that combines ten donor factors, including clinical parameters and demographics, to summarize into a single number the quality of deceased donor kidneys. There are some publications regarding usefulness of KDPI in the first kidney transplant recipients, however there are no data focusing on repeated transplantation patients. Aim of the Study. To determine the usefulness of kidney donor profile index as a risk marker of graft failure in repeated transplantation situations. Material and methods. A single-centre retrospective study was conducted. Patients who underwent a repeated transplantation from deceased donors between 2005. and 2013. were included in the study. Data about donor’s risk factors - age, height, weight, race, history of hypertension, history of diabetes, cause of death, serum creatinine, anti-HCV and if donor is after cardiac death - were collected and KDPI was calculated for all participants. Patients were divided into groups according to determined KDPI: Group 1 - KDPI <35%; Group 2 - KDPI 36 - 69%; Group 3 - KDPI >70%. For statistical analysis, IBM Statistical Package for the Social Sciences, version 21.0 was used. Results. A total of 72 patients were enrolled in the study. There were 17 patients (23.6%) in the 1. group, 38 patients (52.8%) in the 2. group and 17 patients (23.6%) in the 3. group. The most common cause of an end stage renal disease was chronic glomerulonephritis- 59.7% (n=43). Patients with higher KDPI developed acute rejection more often. In the group with KDPI <35% it was observed in 35.3%, while in the groups with KDPI 36 - 69% and KDPI >70% in 60.5% and 64.7% of patients, p = 0.02. Graft function differed significantly both, after one (p =0.01) and three years (p=0.04) with the highest eGFR results in the group with the lowest KDPI. The difference in graft survival rates was statistically significant, p = 0.027. After three- years it was 88.2% in the first group, 86.8% in the second group and 70.6% in the third group. Patient survival rates showed trend toward significance (p = 0.076) with only two patients lost during three- year follow up. Conclusions. KDPI presents relevance with repeated transplantation outcomes. Lower KDPI indicates better transplantation outcomes - superior graft function and better graft survival. However, there is only trend towards significance in patient survival rates.
Abstract Introduction. Facial morphogenesis occurs from the fourth to the twelfth gestation week, when the cells from nerve crest migrate to the region of face, forming the primary palate. The cleft palate is an abnormality in embryogenesis period, which is characterized by the absence of fusion of palatal shelves. The incidence of cleft lip and palate is one in 700 live births. In recent years the effect of different genes and signaling molecules, including Runx2, Wnt3 and OPG have been studied in the development of cleft palate, because these substances are considered to be regulators of pathogenesis responsible for formation of bone and cartilage tissue and particularly the bone. Aim of the Study. The aim of the work was to evaluate the expression of Runx2, Wnt3 and OPG in palate bone and nasal cartilage for children with cleft palate. Material and methods.Eleven bone and cartilage samples were obtained from 21 children of the lip, soft and hard palate correction surgery. All the patients were diagnosed with clefts of the lip, alveolar process of maxilla, and palate. In the tissue sections using the immunohistochemistry method (IMH), were determined Runx2 (code: AB192256, 1: 250, Abcam GB, rabbit), Wnt3 (code: AB1992, 1: 800, Abcam GB, rabbit), and OPG (code: A0611, 1: 100, The Orbit USA, rabbit) local expression. We used a semi-quantitative census method for quantifying the positive structures. Results. Runx2 expression was observed in five patient bone tissue samples and six patient cartilage tissue samples. Of the Runx2 positive bone tissue, in one case we observed occasional, in two cases- few, in one case- moderate to numerous and in one case numerous positive osteocytes while in tissue of cartilage in two cases we observed few, in one case- few to moderate, in two casesmoderate, and in one case numerous positive chondrocytes. A significant difference in Wnt3 expiation was observed between bone and cartilage tissues. Wnt3 expressing chondrocytes were observed in all samples, where in one case- occasional, in three cases few, in one case-moderate, and in six cases-numerous positive cartilage cells were observed. The expression of the gene in the bone was observed in nine cases, which contained mostly occasional or few positive structures, except in three cases where in one Wnt3 was marked by few to moderate and in two cases numerous positive osteocytes. OPG expression was observed in all samples, but in the cartilage, the expression was more pronounced. In the cartilage in seven cases, there were numerous positive chondrocytes, in one case- few to moderate, in two cases moderate to numerous and in one case few to moderate number of chondrocytes. OPG showed variable expression. In four cases, we observed occasional to few, in one case few to moderate, in one case- moderate, in one case moderate to numerous and in four cases numerous positive bone cells. Conclusion. Cartilage tissue expresses significantly more Runx2, Wnt3 genes and OPG proteins, indicating a greater compensatory tissue capacity. In the case of palate clefts, the high expression of Wnt3 and OPG and lower expression of Runx2 could indicate a significant tissue proliferation which predominates over mineralization and ossification processes.
