Search

Worldwide breast cancer (BC) represents one of the most common type of cancer. Mortality from this disease is declining due to new therapies, but many patients face the side effects of cancer and treatment. The most common side effect is the lymphedema of the upper extremity. Although the incidence of lymphedema secondary to breast cancer is 63.4%, there are few studies on the immune mechanisms responsible for lymphedema and healing. Extensive research of the development, structure and function of the lymphatic system must be performed to identify the role of lymphatic vessels in breast cancer. All this can lead to discovery of new potential biomarkers in lymph in order to improve early detection and treatment of lymphedema and the current strategies for controlling tumor metastasis.

Graves ophtalmopathy (GO), thyroid eye disease (TED) and thyroid - associated orbitopathy (TAO) are terms referring to an autoimmune inflammatory process that affects the adipogenesis of orbital fat and periorbital tissue, associated with dysthyroidism. On imaging, such as computed tomography (CT) thyroid -associated orbitopathy (or thyroid -associated ophtalmopathy) is characterised by symmetrical and bilateral proptosis, secondary to extra-ocular muscle (EOM) enlargement and expansion of orbital fat. Imaging studies ca be useful in identifying patients risk to develop dysthyroid optic neuropathy and initiating early treatment of the condition, avoiding permanent visual loss. The purpose of this study was to reveal the prevalence of thyroid ophtalmopathy imaging considerations in Graves disease patients. A total of 19 patients were evaluated on computed tomography scanning the diameters and density of extra-ocular muscles, muscular index, proptosis, width of the optic nerve, width of superior ophthalmic vein and lacrimal gland position.

Malignant melanoma is one of the most frequent cancers diagnosed during pregnancy. Any pigmented skin lesions that change the color should be examined by an experienced dermatologist and if suspected, should be biopsied. Recent studies showed that malignant melanoma in pregnancy has not a worse outcome compared with non-pregnant state. Diagnosis of melanoma does not require an early delivery excepted pregnant patients with poor prognosis that need more aggressive treatment. Diagnosis and treatment need to be established in specialized centers with a multidisciplinary team. Pregnancy monitoring should be performed by team consisting of an obstetrician, a neonatologist and a specialist in fetal medicine.

The pathogenesis of vitiligo is still unclear. The complexity of the disease seems to be based on the intervention of environmental factors in the background of genetic predisposition which will determine the response of the immune system, the involvement of the nervous and endocrine systems, altered metabolisms and increased oxidative stress - all these elements leading to melanocytic dysfunction and their subsequent destruction. Melanocytic death has a clinical correspondent that embraces the form of white macules on the skin, associated or not with leucotrichia. A better understanding of vitiligo' s pathophysiology and mechanisms of cell death at the skin level can be a step to some appropriate treatment strategies.

Cochlear explantation is rare in surgical practice; it can be due to medical conditions or device failure. According to literature datas, there are some particularities to be expected in revision surgery. The authors describe a case of successfull explantation followed by reimplantation, with excellent results, pointing out on the surgical difficulties encountered.

Ovarian cancer represents one of the most aggressive gynecological malignancies affecting women worldwide, associated with significant rates of cancer related death within the first years after the initial diagnostic. The poor survival rates are usually explained by the presence of disseminated lesions even from the beginning. In such situations, the digestive tube is one of the most commonly involved territory, therefore necessitating extended resections in order to achieve complete cytoreduction. The aim of this paper is to report the case of a 53 year old patient who was diagnosed with peritoneal carcinomatosis from ovarian cancer, presenting multiple levels of digestive tract involvement due to the presence of disseminated tumoral masses. Therefore the patients was submitted to multiple digestive resections represented by parcelar gastrectomy, segmental ileal resection and subtotal colectomy. In order to minimize the risks of developing severe postoperative complications – due to the relatively high number of anastomoses – the continuity of the digestive tract was established by a terminal ileostomy, considering that creation of a ileorectal anastomosis would be too dangerous in the context of multiple digestive resections. The postoperative evolution was simple, the patient being further submitted to adjuvant treatment.

The pulmonary embolism (PE) represents a medical condition with increasing incidence. The various clinical forms of PE have different prognosis, related to the presence of markers of right ventricle (RV) dysfunction (biochemical or imagistic). Material and method. In this study we included 82 consecutive patients with intermediate-high risk PE, assessing the main risk factors distribution. We divided the patients in two groups, study group - receiving thrombolytic therapy (ateplase (t-Pa)) associated to anticoagulation (unfractionated heparin (UFH)) – and control group – receiving anticoagulation alone -. The inclusion in study group was indicated by the high bleeding risk, in this group being included patients without contraindications for thrombolysis, patients without severe renal dysfunction and patients with body mass index (BMI) 18.5-29.9 kg/m2. We assessed the gender distribution in the two groups, the medium age distribution and the main PE risk factors in the two groups. Also, we assessed the effect of the both therapies on the hemodynamic instability rate on 7 day from admission (defined by systolic blood pressure (SBP) < 100 mmHg or a SBP drop >40 mmHg from inclusion value). The statistical analysis was made using SPSS program, by comparing the association between risk factors and the two groups, by Chi-squared test, while the gender and age distribution was made using the Shapiro Wilk test for the evenly data distribution and Wilk test (as the data were unevenly distributed). Results. We found no correlation between the risk factors and the study groups. There was no statistical significance regarding the gender distribution, but the medium age was higher in control group (61.82 y.o vs. 71.28 y.o, p < 0.001. Regarding the hemodynamic instability rate the Chi-squared test proved a statistical significant higher incidence in the control group (p = 0.03).

Pregnancy affects women's sleep in many ways. Physical and emotional difficulties, especially towards the end of pregnancy, can lead to sleep disorders. Several studies suggest associations between sleep quality and high blood pressure, diabetes and depression. Sleep deprivation affect both mother and fetus. Sleep disorders are associated with low birth weight, intrauterine growth restriction, premature birth and cesarean births. This paper is a review based on information from the literature. The analysis was limited to articles and guidelines in English published between January 1, 2000 and May 1, 2020 on PubMed, ScienceDirect and Google Scholar using the following keywords: sleep, pregnancy, depression, anxiety, mental health, sleep disorders, pregnant women, interventions, treatment. In this review, we discuss the characteristics of prenatal maternal sleep, hormonal changes during pregnancy and their effects on sleep, the effects of changing sleep patterns on the pregnant woman, and the interventions needed to optimize sleep quality. According to the literature, sleep disorders are significant risk factors for mood disorders. Knowing sleep changes and their effects is useful for informing mothers. Consideration of non-pharmacological treatments and interventions such as cognitive-behavioral therapy, mindfulness therapy and relaxation exercises can be effective in optimizing the quality of sleep in pregnant women.

Postpartum depression remains a significant healthcare priority due to the social and family consequences. Research has shown that both mothers and fathers experience significant psychological changes during pregnancy and postnatally, including depressive disorders. Underdiagnosed in most cases, the short and long-term consequences involve infant and child development, family’s life and social disruption. Because this pathology may lead to deviation from behavioural and social norms, we want to emphasize that timely and appropriate diagnostic can improve the effectiveness of treatments and avoid complications.This may contribute to optimal social, emotional and behavioural child development that may occur consecutively to family members” emotional and psychological manifestations.

Psoriasis is a chronic skin disease with an important inflammatory compound which associates a worldwide prevalence of 0.5% to 8.5%. The involvement of the genital region can be associated with both plaque psoriasis and inverse psoriasis and survey-based studies indicate that up to 45.5% of patients present lesions of genital psoriasis. Genital psoriasis represents a frequent encounter of psoriasis which is often overlooked and which associates a significant impact on their quality of life, measured by Dermatology Life Quality Index (DLQI) scores which are twice as high as those of psoriatic patients without genital involvement. Recognising the specific clinical findings represents an important step in establishing the diagnosis and case management. Classical therapeutic options such as topical steroids or modern treatments such as ixekizumab represent important tools in fighting this affliction and regaining the patient’s quality of life. This review aims to emphasize the up-to-date clinical variants of genital psoriasis, the consequences on the quality of life of patients and to present the newest therapeutic options.

Hot flashes (HF), transitory episodes of erythema, heat sensation, anxiety followed by chills, are described in carcinoid syndrome, mastocytosis, medullary thyroid cancer, hyperthyroidism, pheochromocytoma, alcohol consumption, side effects of drugs, and infections. They are pivotal among menopause-related vasomotor symptoms beside genitourinary syndrome in addition to sleep disturbances (40-60% of females), and metabolic changes. HF affect 70% of women (20% of them have a severe impairment of life quality); they last for 4-7 years, starting 4-6 years before last menstruation. The main HF cause is ovarian-derivate estrogen deprivation which activates complex endocrine and neuroendocrine mechanisms involving noradrenaline, 5-hydroxytriptamine (5-HT), calcitonin gen-related peptide, orexin, kisspeptin, neurokinin B, and epigenetic elements like modulation of tachykinin receptor 3, accelerated epigenetic aging (as found in Women's Health Initiative Observational Study), expression of central serotonin transporters. Estrogen deficiency uncouples the negative feedback with preoptic area of hypothalamus, responsible for thermoregulation by inducing an exacerbated vasodilatory response to a small increase of body temperature. TRPV1 (transient receptor potential vanilloid 1) in preoptic hypothalamic area may play a role by NE-α2ADR (norepinephrine-activated α2-adrenergic receptors) activation. Higher expression of serotonin transporter SLC6A4 causes a lack of 5-HT at synapsis which is a trigger for presynaptic 5-HT receptor feedback, thus a release of serotonin amount prevents hot flashes. Kisspeptin and neurokinin B which are co-expressed in infundibular nucleus of hypothalamus are involved in central thermoregulation and gonadotropin releasing hormone anomalies. The NKR3 (neurokinin 3 receptor) antagonist receptor improves HF. Understanding the pivotal role of central neurotransmitters in hot flashes is the basis of new therapeutically researches because otherwise estrogen replacement has a long list of side effects, and it is contraindicated in breast cancer-related hypogonadism

Endometriosis is a benign, chronic, estrogen-dependent condition, present in 10% of women of reproductive age. The condition is associated with chronic pelvic pain and infertility that influence their quality of life, as well as married life and has important socio-economic consequences. Despite its high morbidity, its etiopathogenesis is incompletely known. A large number of studies suggest that the ability of endometrial implants to grow in ectopic locations may be correlated with the altered immune response towards the endometriotic tissue. There are enough data to show that immune system mediators, such as cytokines and chemokines, are playing key roles in the onset and olso on progression of endometriosis. There are studies that prove the association between endometriosis and autoimmune diseases. The present paper aims to investigate the implications of the immune response in the etiopathogenesis of endometriosis. The study of cellular or humoral immunity deficits, the presence of autoantibodies associated with this condition, can facilitate the understanding of the mechanisms that lead to the appearance and spread of endometriosis. We hope that this information will ultimately provide the basis for the development of new effective approaches in endometriosis management.

The increase in the incidence of ectopic pregnancy in the last 20 years, with the serious compromise of the woman's obstetric future and the life-threatening complications caused by it, makes ectopic pregnancy a very current problem, frequently encountered in Obstetrics-Gynecology clinics The aim of this study is to compare how risk factors and management can influence the incidence and the risk of recurrence of ectopic pregnancy. This paper presents a prospective case-control study for 65 patients, who have been diagnosed serologically and ultrasonically. In the present study, the most common risk factors involved were: pelvic inflammatory disease (46%), ectopic pregnancy (20%), smoking (85%), abortions (55%), and abdominal surgery (43%). In the group of patients studied, patients required surgical and medical treatment, and also a management of expectation. The risk factors that influence recurrence were smoking (100%), pelvic inflammatory disease (84.6%), abortions (53.8%), abdominal surgery (46%). By the type of surgery (laparoscopy or laparotomy), the risk of recurrence varies between 6 and 10% and does not seem to be influenced by it.

Introduction. Breast cancer is the leading cause of cancer death in Romania. In the context in which the treatments available for this pathology have increased curability, the identification of negative prognostic factors involved in the evolution of this disease seems essential to improve the overall survival as well as the time to disease progression. Aim. The aim of this study is to identify the role of prognostic factors such as ki67 proliferation index, the presence of tumour estrogen receptors, HER2 overexpression, the presence of secondary determinations at diagnosis, the association of obesity and type II diabetes. Methods. 50 patients diagnosed with breast cancer treated in the Elias University Emergency Hospital Bucharest were retrospectively followed, for which the progression was documented at the time of elaboration of this study. Thus, a database was developed in which data were entered on age, body mass index, immunohistochemical characteristics of breast tumours, the presence/absence of metastases at diagnosis and the association of type II diabetes. Statistical calculations were performed to highlight a possible correlation between obesity (quantified by measuring body mass index) and tumour aggressiveness (quantified by ki67 proliferation index) as well as statistical evaluation of potential prognostic factors that would influence time, until the disease progresses. Results. Within this group, no correlation could be established between the presence of an increased body mass index and the value of the ki67 proliferation index (p = 0.38). The mean value of the body mass index for this group of unselected patients was 28.76 ± 4.81 (DS) most patients are therefore overweight or obese. The factors involved in the evolution of breast cancer that influenced the early progression of the disease were: the proliferation index ki67 (p

Hereditary syndromes underlying neuroendocrine tumours are extremely heterogeneous and, despite the genetic background, their recognition may actually be done later in life in many cases. Our purpose is to introduce a case of neurofibromatosis type 1 – related pheocromocytoma on a patient within his six decade of life after multiple cardiovascular complications. A 53-year old male is admitted for loss of appetite with weight loss, decreased exercise tolerance, transient occipital headache, night sweats. His medical history revealed arterial hypertension, right carotid artery ischemic stroke, and a recently non-STEMI myocardial infarction diagnosed two months ago. The pathological family history illustrated mother and a brother prematurely dying of myocardial infarction (no date of skin anomalies). Clinical examination reveals café-au-lait spots, axillary freckles, skin neurofibromas and a large plexiform neurofibroma in the right thigh. Evaluation of the adrenal gland revealed highly elevated values of urinary metanephrines and normetanephrines. Computed tomography showed a left adrenal gland tumour of 31/39 mm. Thus neurofibromatosis type 1 in addition to a left pheocromocytoma was confirmed. A cardiologic examination before surgery was re-done. Given previous pathological history (cardiovascular events like stroke and nonSTEMI infarction) adrenalectomy was delayed for the moment in addition to second antiplatelet agent and the alpha blocker medication in increasing doses. The adrenal tumour removal is planned to be done as soon as cardiovascular risk is acceptable. The importance of endocrine check is seen in young patients with severe cardiovascular and neurological acute conditions that are actually caused by a hormonal excess like found in pheocromocytoma. Nevertheless, the spectrum of tumours associated with neurofibromatosis type 1 is heterogeneous and screening protocols are still a matter of debate. Delayed diagnosis worsts the overall prognosis.

Introduction. Coronavirus disease 2019 (COVID-19) has been declared as a new illness in December 2019 in Hubei Province, China and considered a pandemic by the WHO Director General`s opening remarks at the related media briefing in March 2020. This illness is caused by a virus called Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). COVID-19 involves multiple organ impairments and lung injury is one of the most common lesions of this disease. Although it has been studied for nine months, our understanding of this disease is still incomplete, including in terms of sequelae and long-term outcomes. A large number of patients are affected by the COVID-19 pandemic but only in some patients the disease has progressed rapidly to respiratory failure requiring hospitalization or treatment in intensive care units. The most common complications noticed in severe cases is acute respiratory distress syndrome with a consecutive respiratory failure. Materials and method. The detailed evaluation of the patient, the methodological and fundamental elements of the pulmonary rehabilitation adapted to the patient are interventions which have an extremely important role and application in COVID-19 treatment, in mitigating dyspnoea symptoms, anxiety relief, reducing other possible complications, minimizing disability, maintaining functionality, all in order to increase the patient quality of life. As for October 2020 and still ongoing, a number of approximately fifty patients from both the Intensive Care Unit and clinical wards of “Prof. Dr. Matei Bals” National Institute of Infectious Disease have been evaluated by the physician and underwent a physical therapy program, assisted by the physiotherapist. Results. Lung rehabilitation should be considered when possible and safe during treatment of patients with COVID-19 and may include rehabilitative nursing, specific respiratory kinesiotherapy and for increasing general effort capacity and mobility (see further for methodological details). From the physician’s point of view, it is extremely important to carefully conduct the anamnestic process and evaluation, to adjust the program to each individual, to monitor oxygen saturation, blood pressure levels, pulse and temperature throughout the exercises. Every increment or decrement of these parameters, onset of cough or fatigability, must end the rehabilitation process. Conclusions. Like for all the chronic pulmonary patients in the cases where COVID-19 resulted in respiratory sequels, specific and connected general physical and kinesiological rehabilitative interventions are necessary and useful. The methodology must be thoroughly case by case elaborated and applied considering also the epidemiologic related concerns.

Edward Hartley Angle was an eminent American scientist, dentist, great inventor, being rightly considered to be the father of modern orthodontics. The great American scientist was the author of an impressive number of patents (46) and was the coordinator of 7 editions of some impressive Orthodontic Treatises. Thus, in this material, which we structured in 2 distinct parts, we tried to present as concisely as possible the most important data from the biography of Dr. Edward Hartley Angle.

Dyke-Davidoff-Masson syndrome (DDMS) represents a severe disease that is caused by brain anomalies of different mechanisms early in life during fetal period or within first years after birth. This is a brief point of view of DDMS through an endocrine perspective. In DDMS, low TSH (thyroid stimulating hormone) hypothyroidism is part of a variable cocktail of endocrine anomalies like pituitary insufficiency that actually seem less relevant opposite to massive neurological damage which marks the clinical picture. Overall, the most spectacular anomaly and the most specific in DMMS is the imaging aspect of the brain hemiatrophy. The syndrome itself, even with a very low prevalence in general population (the level of statistical evidence is case report or series), has a heterogeneous presentation and a large area of clinical combo involving not only neurological field. On the other hand, cerebral hemiatrophy (also a rare neuroimaging finding) may have other causes, either acquired or congenital. Seizures induced by brain damage may be presented long before the imaging recognition of the syndrome is actually done. The endocrine disturbances vary and they may be subtle like central hypothyroidism or life threatening like adrenal crisis due to secondary adrenal insufficiency. Overall, DDMS represents a complex challenge from severe neurological deterioration to neuro-imagery features centered on the brain hemiatrophy to skin and bone anomalies as well as endocrine disorders which are either deficiency of pituitary hormones or diabetes mellitus and autoimmune thyroiditis. Early recognition is useful for long term prognosis, a multidisciplinary approach is essential. Underlying causes and specific clusters of classification are still running under a large shadow of unknown data.

Acute promyelocytic leukemia (APL) is a distinct subtype of acute myeloid leukemia (AML) with a generally good prognosis but characterized by potentially severe hemorrhagic complications due to coagulopathy, and thus possibly high early mortality. We present the case of a young patient with APL, with a complication which was unresponsive to conservative treatment and required surgical resection, namely herpetic lesion complicated with infection and necrosis. This case sustains the importance of teamwork in hematologic patients.

Introduction. Obtaining vascular access that allows long-term hemodialysis of children with stage 5D chronic kidney disease is a priority in the management of these patients. Complications of central venous catheters and arteriovenous fistula are directly correlated with the morbidity and quality of life of these children. The objective of the study was to assess complications of vascular access in children on long-term hemodialysis by arteriovenous fistula or central venous line. Methods. We followed 40 patients in the hemodialysis program for a period of 18 months; in 22, vascular access was by arteriovenous fistula, and 18 were dialyzed on a central venous line. Results. All 22 patients were accepted for AVF at a vein diameter of at least 3 mm, and this probably contributed to the high rate of primary maturation (86%). In the majority of these patients (64%) was brachiocephalic fistula versus radiocephalic (18%), in most cases the decision being supported by small diameters of radial artery and distal cephalic vein. Three of the arteriovenous fistulas performed had a primary failure, and one a secondary failure; 2 of the patients with arteriovenous fistula failure had to be subsequently dialyzed by central venous line and one by peritoneal dialysis, while the fourth benefited from a new arteriovenous fistula. Six patients developed fistula aneurysms, one of them evolving into a pseudoaneurysm with spontaneous rupture and hemorrhagic shock and requiring emergency ligation. Two patients developed significant vein stenosis in the proximity of the anastomosis. All 6 patients with aneurysmal fistula had hypertension, and 3 of them had thrombotic venous stenoses/occlusion in the main deep veins upstream of the fistula in the context of prolonged use of central venous lines in the jugular veins and subclavian veins. The average age of the children was 13.35 years (range 9-18 years) and the average weight was 38.6 kg (range 23-58 kg). Of the patients on dialysis on central venous lines, 76% (16 patients) had at least one episode of sepsis that required hospitalization, and all patients who were dialyzed on the catheter (from the beginning or after fistula failure) experienced at least one episode of vein thrombosis that required catheter change. In 8 (38%) of the 21 patients using central venous lines, thrombotic occlusion/stenosis of at least one persistent deep vein was observed at 3 months after the removal of the central venous line from the venous axis. Conclusions. Complications of venous access in children with hemodialysis are very common and have a major impact on the morbidity and quality of life of these patients. In this context, a multidisciplinary team (pediatric nephrologist, specialist in vascular imaging, and vascular surgeon) is needed to follow these patients in order to prevent and treat these complications.

Parvovirus B19 infection is the most common cause of non-immune hydrops in fetuses. The risk of congenital infection is highest in the 1st and 2nd trimester and there are no current recommendations regarding screening of low-risk pregnancies. Recent exposure of the mother and ultrasound findings of fetal anemia or hydrops should include parvovirus B19 infection investigation. Adequate monitoring through ultrasound and Doppler determine the fetal and perinatal outcome as interventions as intrauterine blood transfusions are the main treatment.

Hepatitis C virus infection is a systemic disorder and can have various extrahepatic manifestations like hepatitis virus C associated glomerulonephritis. KDIGO recommends that all patients with hepatitis C virus infection be tested at least annually for proteinuria, hematuria and eGFR in order to detect a possible HCV-associated kidney disease. Immunossupressive therapy must be initiated in patients who have severe complications due to hepatitis virus C infection, but the clinicians must consider two aspects: hepatotoxicity and viral reactivation due to immunosuppression. As for antivirals, DAAs are now first-line treatment for management of HCV infection, even in CKD patients with advanced renal disease. In this review, we aimed to take a look on possible therapies for HCV-induced glomerulonephritis, the interactions beteween them and the impact of different therapies on renal and hepatic diseases.

Purpose and objectives. The purpose of this paper was to compare the “outcomes” of patients with peritonitis according to the surgical method selected (laparoscopic vs. conventional/open), in the treatment of such a severe pathology, in order to obtain an efficient management of postoperative morbidities and the reduction of the mortality rate (currently estimated at 5% - 40%). Material and method. We carried out a retrospective, observational, non-randomized study on a sample of hospitalized patients, based on a descriptive and analytical epidemiological investigation, supported by the laparoscopic experience of the General Surgery Clinic in “Sf. Ioan” Emergency Clinical Hospital of Bucharest in the last decade (01.01.2009-31.12.2018). Results. We identified a sample of 378 patients with peritonitis, of which 109 were operated laparoscopically (i.e. 28.84%), and 269 patients (i.e. 71.16%) were operated traditionally. Following a rough analysis, it was observed that patients who underwent open surgery were hospitalized on an average 4.73 days longer than those operated laparoscopically (11.67 days vs. 6.94 days), the effect being statistically significant (p < 0.01). In the traditionally operated group of patients, the average duration of surgery was 46.31 minutes longer than those operated laparoscopically (113.92 vs. 67.60), the effect being also statistically significant (p < 0.01). Conclusions. The conventional surgical approach is statistically significantly associated with an increased duration of operative time and hospitalization in patients with peritonitis and can be considered a factor of severe evolutive prognosis in the therapeutic management of this pathology.

Background. Oral anti-diabetics in the treatment of gestational diabetes mellitus have had different approaches among time in medical guidelines. The interest in this pregnancy-associated disease is due to the dramatic increase of rates of gestational diabetes but also to the significantly higher short-term and longterm implications for mother and off-spring. This article aims to review the literature and guidelines on current recommendations regarding oral therapy in gestational diabetes mellitus. Methods. A systematic literature electronic search for reviews and guidelines was undertaken using Pub Med and the official websites of Diabetes and Obstetrics and Gynecology associations. Conclusions. Whereas oral anti-diabetics are an attractive alternative approach to insulin, in the last guidelines published by the societies of Obstetrics and Gynecology and Diabetes a new trend is noticeable subtracting oral anti-diabetics as the first option because of the lack in high-quality data on long-term safety, higher rate of treatment failure and pharmacokinetics.

The objective of the study is to assess the efect of thrombolitic therapy on clinical prognostic markers in patients with intermediate-high risk pulmonary embolism compared to clasic therapy, and also the assessment of the bleeding risk associated with thrombolitic therapy. Material and methods. We included 82 consecutive patients with intermediate-high risk pulmonary embolism, which were divided in two groups: study group (thrombolysed) and control group (treated with unfractioned heparine alone). Patients with lower bleeding risk were included in control group. Patients were assessed regarding the right ventricle dysfunction markers (both imagistic and biochemical) on admision and on 48 h. The early (7th day) mortality rate and hemodinamic instability rate were evaluated in the two groups, also the major bleeding rate. Outcomes. We proved a statistical significant lower mortality rate in the study group, with no difference regarding the major bleedings. Meanwhile, the hemodinamic instability was lower in the study group compared to control group. Conclusions. The proper patient selection with intermediate-high pulmonary embolism for thrombolitic therapy can bring important benefits in terms of mortality and bleeding complications

Pancreatic cancer remains one of the most aggressive neoplasms affecting people worldwide, with lower than one year rates of survival, especially if metastatic disease is encountered. In such cases palliative chemotherapy has been proposed, but the overall prognostic remains extremely poor. Meanwhile, in certain cases, spectacular response to chemotherapy has been observed, with significant reduction and even disappearance of the liver lesions. In this respect, attention was focused on establishing whether surgery might improve the outcomes in such cases. This is a literature review of the largest studies conducted on this issue.

Introduction. Atherosclerosis represents the process of stiffening of the arterial wall and includes arterial changes secondary to atherosclerosis, as well as physiological changes, reducing vascular elasticity in the elderly. However, the importance of knowing the pathology of atherosclerosis is mandatory among dentists, given the high frequency of patients with atherosclerotic lesions. Purpose. Through this study we tried to familiarize dentists on the therapeutic behavior towards patients with atherosclerosis but also the risks arising from it. Material and method. 87 practitioners from Romania helped to carry out this study between September and November 2018. Results and discussions. A clear picture emerged regarding the changes and manifestations in patients with atherosclerosis by dental practitioners as well as the attitude to be adopted in the case of treatments for such patients. Conclusions. Knowing the pathology of patients at cardiovascular risk as well as the therapy to be applied for them, is a must for dentists given the growing number of patients and the pathology with different stages of evolution.

It is unanimously accepted that patients with diabetes have a higher likelihood for infections. The metabolic imbalance associated with diabetes suppresses the immunity system of the cutaneous organ. Hyperglycemia causes an increase of the activity of the sorbitol route with consumption of NADPH. Furthermore, the sorbitol from the cells leads to increase of osmolality in cells as well as reduction of intracellular myo-inositol. These strains on the cellular metabolism expose the cells to oxidative stress. An additional factor is the reduced chemotaxis and phagocytosis impact on the bacterial activity of leukocytes which leads to further predisposition of infection for diabetes patients. Hence the poor control of glycemic levels leads to immunity changes which affects the local immune response against the aggression of pathogenic agents.

Introduction. In general, implant-prosthetic restorations, whether they are fixed or mobile, and regardless of their location (maxillary or mandibular), imply slightly different design and conceiving criteria, compared to the conventional prosthetic restorations already known. Purpose. In this material we tried to present some general and particular aspects regarding the design and manufacture of fixed implant-prosthetic restorations. Material and method. The study took place between September and December 2019 with the help of 31 dentists from Bucharest. Results and discussions. Following the application of the questionnaire, we were able to outline some aspects, frequently encountered in practice, by dentists who perform implant-prosthetic restorations related to occlusal balancing and the forces that appear at the level of implant restorations. Conclusions. The correct analysis and evaluation of the occlusal contacts and forces, leads to an increase in the life expectancy of prosthetic work as well as of their support (dental or implant).

Treating complex abdominal wall defects is challenging for the reconstructive surgeon as there are many possible complications and high reccurence rates. To date, there is no consensus on a definition of complex abdominal wall defects, as the level of complexity can be different from case to case. Thorough knowledge of the etiology of defects and relevant anatomy, adequate management during hospitalization and in postoperative period are key elements in obtaining optimal functional results. Although the etiology of abdominal wall defects is varied, reconstructive goals are well established, including recovery of structural integrity to ensure visceral coverage and maintenance of intraabdominal pressure, prevention of hernia formation, if possible with an aesthetic pleasant result; long hospitalizations increasing morbidity and costs should be avoided. Choosing the right therapeutic strategy may be very demanding, because there is no standard treating protocol to guide the management of these patients.. We present, through five clinical cases, our experience with managing abdominal wall defects having in mind the general reconstructive priciples and trying to individualize the treatment for each of them.

Objectives. Non-melanoma skin cancer (NMSC) is the most common human malignancy and is strongly related to solar ultraviolet (UV) radiation exposure. Occupational UV exposure is associated with a two-fold increased risk of developing NMSC, but still only few European countries recognize NMSC as an occupational disease. The study aims to analyze the clinical and histopathological features of NMSC with regard to personal cumulative occupational UV exposure doses. Material and methods. A retrospective, analytical, comparative study was conducted during 2017-2019 with focus on outdoor workers presenting with NMSC. Occupational solar UV exposure dose was calculated based on the Wittlich algorithm and cumulative lifetime exposure of the general population of the same age was estimated according to German Standards of 130 SED/year. Subjects were divided in two groups (OW1 and OW2) according to differences between occupational exposure and estimated cumulative lifetime exposure of the general population. High-risk clinical and histopathological characteristics were compared between groups. Outcomes. The study included 25 consecutive outdoor workers diagnosed with BCC (N=21) and SCC (N=4). Occupational solar UV exposure doses were calculated for Romanian workers and identified mean values of 17695 SED two times higher than estimative leisure cumulative lifetime solar UV exposure for a person of the same age from the general population according to German standards of 130 SED/year. Subjects were classified in two groups: group 1 (OW1) included subjects who were exposed to an additional occupational UV dose less than 50% of the cumulative lifetime exposure dose of a person of the same age from the general population according to German standards and group 2 (OW2) included subjects exposed to additional professional UV doses higher than 50%. 12 subjects were included in OW 1 and 13 subjects in OW2. Data analysis between groups identified significant statistical differences with regard to high-risk body locations and tumour size, present in 100% of OW2 and 58.3% of OW1 (χ2 (1, N=51) = 6.771, p=0.015) and to high-risk histopathological subtypes, present in 56% OW2 and 33.3% OW1 (χ2 (1, N=51) = 4.812, p=0.036). Ulceration was present on the histopathological report of all subjects in OW2. OW2 was associated with higher percentages of moderate to severe grades of actinic elastosis and of desmoplastic reaction and a more rapid evolution of lesions. Conclusions: Outdoor workers in Romania are exposed to an occupational solar UV dose two times higher than the cumulative lifetime exposure dose of the general population of the same age which may receive up to 130 SED/year according to German standards and they bear an increased risk of NMSC. Occupational NMSC induced by UV exposure should be recognized as an occupational disease if the subject received more than 50% additional UV exposure at the workplace.

ntroduction. Infectious risk in orthodontic practice is a real risk and involves problems both for the medical team of orthodontics and dental-facial orthopedics and for patients. Purpose. In this material we tried to highlight both the microbial load taken from the level of metal breaches Existing in the oral cavity but also the effect of mouthwashes with wide commercial use, on the different categories of germs isolated from these surfaces. Material and method. Microbial harvesting was carried out at different stages of the consultation and periodic examination in order to establish the effect that different substances have on reducing microbial load. Results and discussion. The results obtained for each stage and study group are graphically exemplified for a better understanding of the studied problem. Conclusions. The efficiency of the substances for removing the bacterial load is considerable but the replacement of disinfectants due to their toxicity and aggressiveness must be considered.

Telangiectasia represents a sign on the skin underlining multiple conditions, characterised by red/purple/blue thin lines caused by dilatation of capillaries/arterioles/venules. Similar lesions may be detected during a surgical procedure at the surface of a solid organ. Pathological conditions associating the lesion are: dermatomyositis, scleroderma, lupus and the syndromes of ataxia-telangiectasia, respective hereditary hemorrhagic telangiectasia. We introduce a male case with anterior and lateral cervical enlargement with local skin changes of telangiectasia type. We introduce a male case with anterior and lateral cervical enlargement with local skin changes of telangiectasia type. The twist of the case is that, despite neck tegument red thin lines, the subject actually had a severe form of thyroid cancer. This is a case presentation. This is an 82-year old non-smoker male from non-endemic area admitted for rapidly enlargement of a tumor mass at neck in addition with local skin changes like telangiectasia and erythema as well as speech, eating and breathing intermittent disturbances. Thyroid function was normal. Thyroid ultrasound showed an enlargement of right lobe, of 3.7 by 4 by 7 cm (centimeter), mostly displayed by a macronodule with mix structure, of oval shape, with extension to isthmus, which is well shaped, of 5.7 by 4 by 5.2 cm. The data are highly suggestive for a thyroid cancer, thus the patient was further referred for total thyroidectomy. The changes of neck skin like telangiectasia and redness may exceptionally be caused by an aggressive thyroid cancer.

Introduction. In the growing process of each individual, there are 4 essential stages that must be very well known by the pediatric dentist, when intervening on these changes: the stage named the age immediately after birth; pre-school age; the stage of mixed dentition and the age period after 12 years. Purpose. Starting from the existence of these 4 stages of the growing process of each individual, in this material we tried a brief presentation of some aspects, both theoretical and practical, regarding the therapeutic approach in the dental pathology of the temporary teeth. Material and method. The study was conducted through the collaboration of 35 dentists from all over the country based on a questionnaire consisting of 6 questions. Result and discussion. Following the application of the questionnaire we were able to create an image of the way in which the dental pathology of the permanent teeth is therapeutically approached by the practitioners included in the study. Conclusion. Dental lesions in the temporary dentition should be evaluated and treated with great care, to prevent the medium and long term complications of permanent dentition.

Introduction. Skin is deeply affected by aging as all the organs do, including endocrine glands and neuroendocrine circuits. The anomalies of aging are connected to the internal aspects including hormonal panel mostly vitamin D status and glucocorticoid axes integrity, melatonin networking, thyroid function, and catecholamines/serotonin release), state of health/illness, genetic background and bio-neuroendocrine/neurotransmitters pathways as well as immune defence. Moreover, external environment elements like sun exposure, radiations, pollution, physical, chemical and biological agents are consistent with internal mentioned aspects. Our purpose is to provide a mini-review regarding neuroendocrine and endocrine perspective of skin aging. Particular aspects on glucocorticoids, vitamin D and 5-hydroxytryptamine are pointed out. This is a narrative type of review. Skin is situated at the crossroad between intrinsic and extrinsic aging and the neuroendocrine approach is essential for understanding its time dependent changes.

We introduce dermatological aspects from an endocrine point of view related to pituitary tumours that display active secretor activity. This is a short literature review. 40 papers are cited including narrative reviews and original studies. Acromegaly: GH overproduction causes the thickening of the skin and swelling of the soft tissues in addition to the enlargement of extremities (like nose, hands, feet, jaw), coarsening of facial features (as front head and naso-labial folds), excessive sweating, exaggerate skin wrinkles, oily skin, and acrochordons. Cushing’s disease: cortisol overproduction has a severe protein catabolic effect at skin with collagen network disruption while immune effect of hypercortisolemia induces chronic skin infections and difficulties in wound healing. In females, consecutive androgens excess induces acne, hirsutism, and androgens-related alopecia. The classical phenotype includes: fragile skin or skin atrophy, red/purple striae, easy bruising, facial plethora. Skin changes represent the window to pituitary tumours for clinicians of different specialities, therefore contributing to final diagnosis of endocrinopathies.

Breast fibroadenoma is a benign tumour that is mostly asymptomatic thus it may be detected as an incidentaloma. Typically they are diagnosed in women of reproductive age and they reduce the dimensions during menopause because of estrogens deficiency that is why in menopause are rare. The mass is elastic, mobile and it contains an epithelial part and a stromal component (so called fibroepithelial tumours). Here is the case of a 70-year old female who had done a mammogram for the first time and she was found with such a lesion of 1.5 cm. She also is confirmed with osteopenia, most probable unrelated to the breast tumour. Menopausal fibroadenoma, even at low risk of malignancy requires a good multidisciplinary team of decision. Because of the differential diagnosis with breast cancer the positive diagnostic is based on ultrasound, mammogram and even biopsy. Menopausal fibroadenoma, even at low risk of malignancy requires a good multidisciplinary team of decision. Because of the differential diagnosis with breast cancer the positive diagnostic is based on ultrasound, mammogram and even biopsy. Due to low aggressive profile, the follow-up is, however, the most rational approach

Cardiovascular diseases (CVD) represent a major health problem in adult population worldwide. Together with conventional risk factors, gamma-glutamyl transferase (GGT) is involved in the pathogenesis of CVD. The purpose of this review is to provide informations about GGT synthesis, physiological roles and the involvement in the atherosclerotic plaque formation. The results of the most recent clinical studies performed to find an association between GGT serum activity and patients with hypertension and coronary artery disease (CAD) are presented.

Despite continuous efforts in early recognition and timely management, acute coronary syndromes (ACS) continue to be the most common cause of death worldwide. The electrocardiogram (ECG) is the fastest, repeatable and most accesible instrument with diagnostic value, prognostic significance and therapeutic implications. Based on the ECG, ACS are divided into ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation ACS (NSTEACS). Current guidelines recommend emergency reperfusion theraphy only in patients with STEMI. Conventional criteria for the diagnosis of STEMI exclude the patients with atypical ECG findings, correlated with an increased risk of transmural myocardial infarction and considered STEMI equivalents. These particular ECG phenotypes are: new or presumably new bundle branch block, ST segment elevation in aVR, isolated posterior myocardial infarction, de Winter T waves, Wellens syndrome and ischaemia induced Brugada phenocopy. Rapid risk stratification in patients with NSTEACS is crucial for adequate management. The particular ECG phenotypes discussed herein proove the need to redefine the signs of the present or iminent coronary artery occlusion, especially the left anterior descending (LAD) artery, because many patient may benefit from early invasive treatment instead of conservative pharmacological treatment.

Introduction. Reliable and rigorous, the new techniques and procedures of oral implantology have rapidly evolved, having an important place in the therapeutic plan elaboration, for the prosthetic restoration of different forms of edentation, especially single tooth edentation. Purpose. Through this study we want to implement among the dental professionals, some notions of theoretical and practical character, regarding certain therapeutic implant-prosthetic flows for restoring single tooth edentations regardless of location. Material and method. The study was carried out with the help of an 8-point questionnaire, applied to a study group composed of 45 dentists in Romania. Resultsand discussion. The results of this study create a clear picture of how physicians know and apply the concepts related to implant supported prosthetic rehabilitation. Conclusion. Implant-prosthetic rehabilitation of single tooth edentations is a safe treatment method, with few surgical complications and minimal bone loss, an aspect that also results from the answers of the doctors participating in the study.

Colorectal cancer spreads via multiple pathways, the most commonly encountered ways being represented by the peritoneal and hematogenous ones as well as by direct contiguity. At this time significant benefits in terms of survival have been reported in cases presenting locally advanced lesions and for those presenting extended peritoneal lesions of peritoneal carcinomatosis especially if radical resection is achievable. In this respect, certain authors went further and investigated whether the association of the two surgical strategies – extended pelvic resections and cytoreductive surgery of the peritoneal metastases could improve survival in cases in which both patterns of spread are present. Meanwhile, the possibility of association of hyperthermic intraperitoneal chemotherapy (HIPEC) was also investigated. The aim of the current study is to review and analyze the most relevant studies conducted on this issue.

An essential aspect of human health is sleep. Sleep, among others, interacts with the immune system, plays a role in restoring the body's energy, healing and brain function. Insomnia is often noticed in medical practice, is considered a public health problem. Acute sleep deprivation can alter cognitive performance, and chronic sleep deprivation can lead to disease development. Lack of sleep affects all major systems in the human body, and the major changes that occur in chronic insomnia have been associated with many conditions such as type 2 diabetes, cardiovascular disease, asthma, thyroid disease and gastroesophageal reflux disease.

Described for the first time in 1982, intraductal papillary mucinous neoplasms have been widely studied so far. According to the site of origin and location, it seems that these tumors have a specific risk of malignisation and therefore their type of treatment as well as the moment in which it should be applied should be carefully tailored. In this respect, multiple therapeutic strategies have been proposed, ranging from follow up and limited excision to total pancreatectomy. The current paper is a literature review of the largest studies conducted on the theme of the therapeutic strategies in intraductal papillary mucinous neoplasms.

Anatomical liver resection guided by segmental portal inflow compression proved to be an efficient tool in order to maximize the curative surgical treatment in hepatocellular carcinoma. In this respect, in the last decades, once the concept of indocyanine guided surgery gained more field, the method has been also implemented in hepatic surgery. Therefore it seems that intravenous injection followed by portal pedicle clamping and liver inspection in infrared light inspection might delimitate the segments of the liver and might successfully guide the gesture of anatomical liver resection. The current paper is a literature review of the studies which analyzed the efficacy and safety of indocyanine green guided liver surgery.

Although it represents a benign condition, endometriosis is an important and sometimes debilitating health problem affecting women worldwide, associated with a high capacity of relapse. While the correlation between different endometrial pathologies, obesity and metabolic syndrome has been clearly demonstrated lately, the relationship between endometriosis and metabolic syndrome is far to be understood. The aim of this paper is to review the most relevant studies conducted on this issue.

Hunter syndrome is the type II of mucopolysaccharidose. With impaired glycosaminoglycan catabolism, heparan and dermatan sulfate accumulate in lysosomes. Multiple organ dysfunction is a consequence of this effect. We present the case of a a 9 year-old boy was refered to our department for breathing difficulties, discussing the diagnosis and treatment challenges of the case.

Branchial anomalies are a group of malformations resulting from incomplete closure of the pharyngeal pouches and clefts. They manifest as cysts, fistulae and sinus tracts located in the neck. We present the case of a 3 years-old girl admitted to the Surgery Department of our hospital for reccurent abssceses on the left side of her neck, lateral to the sternocleidomastoid muscle. Management approach should be tailored according to the dimensions of the sinus and its relationships with the carotid artery and reccurent laryngeal nerve

Juvenile xanthogranuloma represents the most common form of non-Langerhans cell histiocytosis. It is tipically a childhood disorder, over 80% of cases developing in the first year of life. Adult onset xanthogranuloma is instead exceedingly rare; our literature research revealed a total number of only 35 cases reported to date. Cases with multiple cutaneous lesions occurring during adulthood are even rarer. The pathogenesis of the disease is incompletely understood and the possibility of extracutaneous involvement is uncertain.Although adult xanthogranulomatosis is not considered a paraneoplastic phenomenon, association with haematological malignancies is very frequent, therefore patients should be thoroughly investigated and closely monitored. We report a case of multiple xanthogranulomas developing in an otherwise healthy adult female patient and review the literature regarding this uncommon disease.

Pituitary non-functioning adenomas may be detected based on pituitary insufficiency, eye field complications or headache, etc, so called pituitary mass syndrome. We introduce a series of three cases of non-functioning pituitary macroadenoma with a different management based on local anatomy of the tumour and complications, as well as the tumour speed of growth. Non-functioning macroadenoma, even rare, require lifetime follow-up and a rigorous multidisciplinary decision of intervention.