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A successfully implemented screening program for cervical cancer is essential for detecting cervical intraepithelial lesions which offer the possibility of appropriate management and monitoring, implicitly the limitation of the progression to an invasive form of cancer. For different grades of squamous intraepithelial lesions, the use of vaginal tablets or applicators based on various natural substances as hyaluronic acid, beta-glucan and Coriolus Versicolor is possible with the purpose of expectative management or prior and post excisional intervention. We present the incidence trend of abnormal Pap smear results for the last five years in the University Emergency Hospital of Bucharest, with a summary of the literature regarding the biochemical mechanism of the main natural components from vaginal tablets used in the management of precancerous cervical lesions HPV induced and we share our personal experience with three clinical cases that benefited from this therapy. As there is a therapeutic window between the Pap-smear result, colposcopy and preparing for intervention, local treatment with natural components is a suitable choice as it is easy to use, inexpensive and efficient. The conclusion we reached is that the vaginal treatment with natural substances can be useful in terms of improving the local inflammatory process on the one hand and lubricating and regenerating tissues with the improvement of subsequent procedural performance on the other.

Objectives. The aim of this case report is to present a single patient case superimposed on the literature knowledge in regard to mophometric mandibular variations observed on dental panoramic radiography and used to identify patients with low bone mass density (BMD). Case presentation. A 62 years old female patient reported to the Blident Help Dental Clinic, for specific visits and treatments, 3 years apart. Based on the digital panoramic radiography and DXA measurement, an osteoporosis evaluation with radiomorphometric indices was performed. Values for maximum condylar height, maximum coronoid height, projective height of the mandibular ramus, minimum ramus breadth and antegonial angle are higher on both sides. the values decreased for gonial angle, gonial index, mandible cortical width (MCW), superior and inferior mental height and panoramic mandibular indices on both sides. Bigonial distance also dicreased and the mandibular cortical index (MCI) changed from C2 category in 2017 to C3 category in 2020. Discussions. This postmenopausal pacient had a decline in MCW values which were lower than 3 mm (threshold to differentiate normal) on panoramic radiographs of women with low BMD. Antegonial Index had a decreased value and could be used as a prediction index for osteoporosis. MCI index changed from C2 to C3 in correlation with the changes of bone mass density in lumbar spine. Conclusions. MCI, MCW, antegonial index and bone density played an important role in determining significance of effects of lower BMD at postmenopausal on the mandibular ramus region.

The nail apparatus serves as a protective layer over the dorsal aspect of each distal phalanx of both hands and feet. Besides protection, other functions include serving as part of defense or attack mechanisms, scratching, and dexterity. Nail development has been a subject of interest since the 19th century, from both the phylogenetic and ontogenetic points of view. Despite the early spark of interest, nail embryology has yet been analyzed by a relatively small number of scientists. In the Department of Anatomy of “Carol Davila” University of Medicine and Pharmacy, we performed a morphological analysis on 41 embryos and fetuses with gestational ages that varied between 6 and 29 weeks.

Impact of the gestational changes on cardiac contractility is not clearly defined. Our aim was to evaluate subtle changes of the right ventricular systolic function during pregnancy, assessed by new echocardiographic techniques, in a population tested for inherited thrombophilia. 87 pregnant women, with a mean age of 32 ± 4 years, genetically tested for inherited thrombophilia (22 with high-risk inherited thrombophilia and 65 control group) were included. All participants had four echocardiographic assessments, three during pregnancy (one in each trimester) and the forth at 6 months after giving birth. The right ventricular (RV) systolic function was assessed by fractional area change, ejection fraction (EF) by 3D echocardiography, tricuspid annular velocity by tissue Doppler, tricuspid annular plane systolic excursion, and strain by speckle tracking. Pulmonary artery pressure was estimated using the pressure gradient between right atrium and RV. Parameters of RV systolic function, at visits 2-4, had lower values compared with the first visit and were significantly lower in the high-risk thrombophilia group. Tricuspid regurgitation and pressure gradient between the right atrium and the RV had a significant increase during pregnancy for all subjects. At visit 1, there were no differences between groups, but at the next three visits there were higher values of the gradient in the high-risk thrombophilia group. High-risk inherited thrombophilia impacts the RV contractility, with higher pulmonary artery pressure. Further studies are needed to assess long-term impact on RV of high-risk inherited thrombophilia.

Vascular stress at the level of the uterus-placental unit, with chronic placental ischemia, results in intrauterine growth restriction. Expectation management can be used, when the situation allows, in cases of compensated intrauterine growth restriction. The aim of the present study was to evaluate the neonatal prognosis of preterm births with and without growth restriction and term births with growth restriction in order to improve decisional accuracy regarding the termination of pregnancy. The frequency of term birth infants with low birth weight for gestational age was ~2%. The male sex, predominated only in the group of premature infants with normal weight for the gestational age. The highest frequency of neonatal complications studied occurred in the group of preterm neonates small for gestational age (SGA) with statistical significance obtained for cardiovascular arrest acute respiratory failure, ulcer-necrotic enterocolitis, respiratory distress, cerebral edema, intraventricular hemorrhage, cerebral hemorrhage, pulmonary hemorrhage, neonatal infection, hypoglycemia, retinopathy, anemia, hemorrhagic disease, disseminated intravascular coagulation, disease of hyaline membranes, neonatal sepsis, need for intensive neonatal therapy and death. In conclusion, immediate neonatal adaptation of SGA preterm neonates is more deficient than for preterm neonates with appropriate weight for gestational age; the adaptation of preterm neonates, in turn, is more deficient than term newborns with intrauterine growth restriction. The term newborns with intrauterine growth restriction have a neonatal adaptation comparable to that of the term newborns with weight corresponding to the gestational age.

According to World Health Organization (WHO), fetal death is defined as the death of the fetus prior to its complete expulsion, independent of the duration of pregnancy, thus only ascribing the term stillbirth to fetal deaths in the case of pregnancies after 28 weeks of gestation. The great progress of perinatology care is reflected in a significant reduction in the rate of stillbirths, especially in well-developed countries, with approximately 98% of stillbirth cases now occurring in poor and developing countries. Stillbirth powerfully impacts both the patient and the practitioner. Because nearly half of stillbirth cases result from apparently uncomplicated pregnancies, we considered it critical to review the known predictive markers for intrauterine fetal death. In both preterm and term infants, perinatal mortality is increased in fetuses small for their gestational age, and this risk grows proportionally with the severity of the fetal growth restriction. A protracted first stage of labor has not been associated with an increased risk of perinatal mortality and morbidity, but a prolonged second stage of labor has been associated with mortality and neonatal morbidity characterized by sepsis, seizures, and hypoxic-ischemic encephalopathy. Ultrasound examination of the placenta and the umbilical cord is essential for appropriate pregnancy monitoring. Various findings from ultrasound examination have been related to variable adverse perinatal outcomes, including intrauterine fetal death. After reviewing the evidence for predictors of intrauterine fetal death, we offer a general strategy for reducing the likelihood of stillbirths.

The connection between endometriosis and pregnancy outcomes is trending among the research topics. Until recently, endometriosis and its painful symptomatology were considered to be alleviated by pregnancy. However, these beliefs have shifted, as emerging literature has demonstrated the role of this condition in affecting pregnancy evolution. The underlying pathogenesis of endometriosis is still poorly understood, all the more when pregnancy complications are involved. Debatable opinions on endometriosis associated with obstetric complications exist because of the potential bias resulting from the heterogeneity of preceding evidence. This review aims to evaluate the connection between endometriosis and adverse pregnancy outcomes and their shared pathogenic mechanisms. We searched PubMed and EMBASE and focused on the studies that include placenta praevia, premature rupture of membranes, spontaneous preterm birth, gestational hypertension, preeclampsia, obstetric hemorrhages (ante- and postpartum bleeding, abruptio placentae), miscarriage, stillbirth, neonatal death, gestational diabetes mellitus, gestational cholestasis, small for gestational age, and their association with endometriosis. Not only the risks of emergence were highlighted, but also the pathogenic connections. Epigenetic alterations of some genes were found to be mirrored both in endometriosis and obstetric complications. This review issues a warning for providing increased attention to pregnant women with endometriosis and newborns as higher risks of preeclampsia, placental issues, and preterm deliveries are associated.

Pregnancies complicated with preeclampsia associate a high incidence of intrauterine fetal death, intrauterine growth restriction, premature ruptures of membranes, abruption placentae and prematurity. Understanding the pathogenesis of preeclampsia is mandatory for a correct approach and prevention management of high risk cases. Placental hypoperfusion seems to be a key factor in developing systemic resounding. By placental necrosis and apoptosis, cell-free DNA is released in maternal circulation in early pregnancy, respectively prior 17 weeks of gestation. There is no test, useful in early pregnancy, accurate enough to predict preeclampsia. Various screening test have been proposed in order to predict the development of preeclampsia, but most of them are not sufficiently accurate for general screening. There is a continuous debate regarding the algorithm of administration, doses and timing of low dose aspirin. The initiation moment is crucial, as the administration after the development symptoms and signs of preeclampsia do not interfere with the progression and the severity of the disease. Early initiation of therapy with low dose aspirin, prior the end of the first trimester is important since the pathogenesis mechanisms of preeclampsia take place in the first trimester. The action of acetylsalicylic acid consists in inhibition of COX-1 and COX-2 (cyclooxygenase isoenzymes), necessary for prostaglandin biosynthesis. Preferential inhibition of Thromboxane A2 by low dose aspirin, counterbalance the increased production of thromboxanes characteristic to preeclampsia and modulate the inflammatory process, amplified in pregnant women with preeclampsia.

Background Inherited (hereditary) thrombophilia is a genetic disorder that affects coagulation, being responsible for more than 60% of idiopathic (spontaneous or unprovoked) thromboembolic events. Association of inherited thrombophilia with pregnancy increases the risk of thromboembolic disease, and it may be related to many complications, such as preeclampsia, recurrent miscarriage intrauterine growth restriction, early detachment of placenta, and prematurity. Areas of uncertainty Interpretation of a positive test for thrombophilia in pregnant women is difficult because they have many natural changes in the coagulation system. Genetic diagnosis of thrombophilia, after a thrombotic event or during a pregnancy complication, has a major importance, not only to define its etiology but also to determine the duration of anticoagulant treatment and risk stratification for prophylaxis treatment. Data sources Literature search was performed using electronic database (PubMed) between April 1981 and November 2018. We used different keywords and MeSH terms to generate the most relevant results related to the inherited thrombophilia and its impact on pregnancy. Results Screening for inherited thrombophilia in young women is recommended in case of personal history of venous thromboembolism, first-degree relatives with a history of high-risk thrombophilia, or personal history of second-trimester miscarriage. Decision to recommend thromboprophylaxis with anticoagulant treatment in pregnant women with inherited thrombophilia is determined by history of venous thromboembolism, type and associated risk of inherited thrombophilia, and presence of additional risk factors. Low-molecular-weight heparins are the preferred agents for prophylaxis in pregnancy, while the doses vary depending on thrombophilia type, personal history, and associated risk factors. Conclusions Association between 2 procoagulant conditions, inherited thrombophilia and pregnancy, has an important impact for the mother and fetus. This review will summarize the impact of each inherited prothrombotic factor on cardiovascular and pregnancy outcomes and will discuss the role of anticoagulation treatment for women diagnosed with inherited thrombophilia.

Placental site trophoblastic tumour (PSTT) is a very rare and unique form of gestational trophoblastic tumour, representing about 1-2% of all gestational trophoblastic tumours. Usually, the pattern is a slow growing nodule implicating the endometrium and myometrium, accompanied by abnormal uterine bleeding. Three ultrasound types of PSTT are described, but thereis no specific characteristic for diagnosis. We present the case of a patient with an atypical placental site trophoblastic tumour diagnosed two months after a caesarean scar pregnancy. In the presented case there are several particularities, such as the rapid growth and progression of the tumour, the limitation to the myometrium and the difficulty of the differential diagnosis and approach.

In adults, developmental dysplasia of the hip (DDH) represents a spectrum of disorders. It is commonly found in women in routine orthopedic practice. Hip dysplasia is a leading precursor of joint laxity; when untreated, it can contribute to chronic modifications, such as thickening of the pulvinar and ligamentum teres (which can also elongate), hypertrophy of the transverse acetabular ligament, and osteoarthritis. DDH is presumed to be associated with alterations in pelvic morphology that may affect vaginal birth by the reduction in the transverse diameter of the pelvic inlet or outlet. Here, we provide an overview of the current knowledge of pregnancy-associated DDH. We primarily focused on how a surgical DDH treatment might influence the pelvic shape and size and the effects on the mechanism of birth. We presented the female pelvis from the standpoint of bone and ligament morphology relative to a pelvic osteotomy. Then, we described whether the pregnancy was impacted by previous surgical DDH treatments, performed from infancy to adulthood. In conclusion, hip dysplasia is not associated with high-risk complications during pregnancy or with increased difficulty in vaginal delivery.

Anencephaly is a severe malformation of the central nervous system (CNS), being one of the most common types of neural tube defects. It is defined as total or partial absence of the calvarium, with absence of the brain. Anencephaly has an incidence of 1 to 5 in every 1000 births, and the mortality rate is 100% during intrauterine life or within hours or days after birth. The etiology of anencephaly remains unclear, but various maternal-related environmental and genetic risk factors have been reported, which include diabetes, obesity, exposure to different drugs or toxins, genetic polymorphisms and mutations, as well as positive family history for neural tube defects. One of the most important nutritional factors in the development of anencephaly is folate deficiency. Methylenetetrahydrofolate reductase (MTHFR) gene codes the enzyme involved in the intracellular metabolism of folic acid; the 677C-T polymorphism of this gene causes the thermolability of the enzyme and decreased enzymatic activity, which is also dependent of folate plasmatic level. Etiopathogenesis of anencephaly includes several mutations in various other genes, such as: platelet-derived growth factor receptor alpha (PDGFRA), cadherin epidermal growth factor (EGF) laminin G (LAG) seven-pass G-type receptor 1 (CELSR1), Vang-like 1 (VANGL1) and Vang-like 2 (VANGL2), the last two being involved in the process of neurulation. Screening tests include maternal serum alpha-fetoprotein level and ultrasound (US) examination. During the first trimester US screening, anencephaly is now detected in all cases, but in order to decrease the complication rate of pregnancy termination, the diagnosis should be established as soon as possible, during the pregnancy confirmation US. We conclude that given that anencephaly is a severe malformation of the CNS, morphological characterization could improve the screening by US that is mandatory in the first trimester in order to plan the best, safe and early management.

Methods to prevent the development of pathologies due to placental dysfunctions, such as gestational hypertension and preeclampsia, are the main approaches for obtaining the best maternal and fetal antepartum and postpartum prognosis. During 5 years of study (January, 2015 to December, 2019), the cases of pregnancy and puerperium complicated with pathology due to placental dysfunction were analyzed. The main objective was to determine the magnitude of the impact of thrombophilia on the development of an entity of gestational hypertension disorder. We compared the impact of thrombophilia and its associated complications in patients with gestational hypertension with moderate and severe preeclampsia. Thus, we found obesity, thrombophilia, and underlying cardiac pathology to be significant risk factors for severe preeclampsia. Regarding the comparative analysis of the risk factors and complications associated with patients with mild preeclampsia compared with those with severe preeclampsia, the presence in severe preeclampsia of thrombophilia, endocrine, liver, and cardiac pathology was higher and, a higher rate of complications was observed; complications included fetal death, intrauterine growth restriction (IUGR), prematurity, fetal arrhythmia with acute fetal distress, HELLP syndrome, and placental abruption. Thrombophilia has a significant effect on the development of severe preeclampsia, and oligohydramnios as specific complication of mild preeclampsia. Factors indicating an increased risk of progression from mild preeclampsia to severe preeclampsia are in addition to inherited thrombophilia the underlying pathologies, namely cardiac, hepatic, and endocrine factors.

COVID-19 infection has rapidly become a global issue that has brought essential changes in the daily life of patients and doctors. The pandemic outbreak represents a significant burden on humankind; yet, life still moves on with approximately 350,000 babies being born every day around the world (UNICEF-2018). Some of these mothers will have other conditions, including COVID-19 infection. As healthcare providers, it is our responsibility to treat all women equal no matter what illness they have and to offer them the best possible conditions to give birth vaginally or via Caesarian section, in a safe environment for them and their babies. The main concern is represented by the limitation of the disease transmission to pregnant patients and newborns while managing maternal or fetal emergencies. We have limited information regarding COVID-19 infection, and the data are constantly changing and evolving. New information is brought to light almost on a weekly basis. This review aims to synthesize the recommendations and current experience regarding the birth method for infected women, labor management, Caesarian section management, and breastfeeding indications in these cases.

Adolescent pregnancies are associated with a high number of risks for the newborn and mother. Hence, an increased number of emergency caesarean extractions are performed in this group of patients. The aim of this study was to analyze the pregnancy-related conditions, the way of delivery and the neonatal outcome of all the patients who delivered in the Department of Obstetrics and Gynecology of University Emergency Hospital in Bucharest, a tertiary unit in Romania in a period of 5 years. An observational, retrospective study was performed on a group of 686 patients, aged 12 to 19 years, who delivered in the Department of Obstetrics and Gynecology of University Emergency Hospital in Bucharest, between January 1, 2014 and December 31, 2018. The pregnant women were divided into two age groups. In the first group were pregnant patients aged under 18 years, and in the second group pregnant adolescents between 18 and 19 years. Whether the patients underwent prenatal screening was analyzed. Furthermore, the age of the patients, the rate of caesarean extraction and vaginal birth and the obstetrical complications were evaluated and compared. The outcome of the newborns was assessed based on Apgar score at 1 min and birth weight. Regarding the results, 464 of the 686 patients did not undergo any medical visits during pregnancy. In total, 52.76% of the patients delivered by caesarean section. The most frequent indications for caesarean extraction, in both analyzed groups, were Cephalo-pelvic disproportion, fetal distress and uterine scar after caesarean section. The lack of specific protocols regarding the ante-, peri- and post-natal management of adolescents is probably the cause of the alarmingly increasing number of patients pertaining to the group who deliver by caesarean section.

During pregnancy, maternal diet is a modifiable factor that impacts the birth outcome. Since the nutritional needs of a pregnant women vary during preconception, gestational and breastfeeding period, it is necessary to adapt the diet and lifestyle, optimally under the personalized nutrition guidance of a specialist. High quality research regarding diet during pregnancy remains challenging as nutritional concerns also vary according to religion, financial income, age and education of the pregnant woman, as well as specific traditions of each country, limited number of dietitians with special training in maternal nutrition. The obstetrician usually plays a major role in dietary counselling and the use of nutritional monitoring tools can help identify pregnant women who may be at risk due to an inappropriate diet. The age of the pregnant women can be important when it comes to dietary and lifestyle changes. In this context, we addressed a questionnaire to 100 pregnant women in third trimester of pregnancy in order to evaluate a possible correlation between the age and the dietary behavior and lifestyle of a pregnant woman. Furthermore, the maternal compliance with dietary recommendations in pregnancy and the exposure to various risks due to unhealthy nutrition were also analysed in the study.

Autoimmune thyroid pathology has been connected with several systemic autoimmune disorders, namely hereditary thrombophilia and antiphospholipid syndrome. In an iodine-replete country, these diseases need to be evaluated simultaneously. This study was conducted to assess the connection between acute and chronic thyroiditis and inherited thrombophilia and their potential implications in pregnancy. In the analysis of the cases admitted to the Department of Obstetrics Gynecology of the University Emergency Hospital Bucharest from January 2015 up to September 2019, we identified pregnancies marked by autoimmune hypothyroidism and hyperthyroidism associated with hereditary thrombophilia, by standard statistical methods. In this investigation, we determined the prevalence of immunological markers specific for thrombophilia and against thyroid antigens in pregnant women, and explored whether they associate with distinct clinical phenotypes. Besides the well-accounted impact of hereditary thrombophilia during pregnancy - which is emphasized in our study by the incidence of moderate preeclampsia - we also account for a direct and statistically significant relationship between thrombophilia and moderate intensity autoimmune diseases (including autoimmune thyroiditis). Moreover, if these two pathologies are combined there is an increased risk of the presence of another autoimmune disease.

The prevalence of pathologies due to placental dysfunction superimposed on pregnancy is constantly increasing. The prognosis of the cases complicated by gestational hypertension is usually good, significantly better compared with that of the cases associating preeclampsia. About half of the cases with gestational hypertension will progress to preeclampsia, the risk of decompensation being inversely proportional to the gestational age of the onset of gestational hypertension. The present study, analyzed the cases of pregnancy and postpartum complicated by pathologies related to placental dysfunction, during a period of 5 years. The risk factors analyzed were the presence of infections during pregnancy, diabetes, thrombophilia, pregnancy obtained by in vitro fertilization, abnormal adherence of the placenta, obesity, multiple pregnancy, the presence of an earlier hepatic, endocrine, renal, cardiac or autoimmune pathology, and the existence of an uterine malformation. Obesity appears with a significantly increased incidence in patients with gestational hypertension and middle preeclampsia. Intrauterine growth restriction appears with a significantly increased incidence in patients with mild preeclampsia. Complications such as prematurity, acute fetal distress and abruption of placentae had a significantly increased incidence in patients with severe preeclampsia. Thus, obese patients have a higher risk of moderate preeclampsia, following gestational hypertension and finally severe preeclampsia.

Thrombophilia is a group of genetical disorders that cause blood to clot abnormally. Thrombophilia is linked to recurrent pregnancy loss, foetal growth restriction, late miscarriages, stillbirth and preeclampsia. Clinicians usually apply the term thrombophilia only to patients with atypical thrombosis. A successful outcome of pregnancy requires an efficient uteroplacental circulation. Since this system may be compromised by disorders associated with a prothrombotic state, it was postulated that maternal thrombophilia might be a risk factor for preeclampsia and intrauterine growth retardation. The study included 459 pregnant women with gestational ages ranging from 14 weeks to 28 weeks and the patients in the study were tested for hereditary thrombophilia. The type of thrombophilic mutation most common found was the MTHFR mutation (25.7%), followed by the prothrombin gene mutation (20.9%) and the Leiden factor V mutation (15.7%). Also 15.03% patients had been diagnosed with preeclampsia and 6.75% of the pregnant women had IUGR fetuses.

Breast cancer kills more women annually than any other type of neoplasm. Even though he has shown a particular interest in the medical body since ancient times, the very heterogeneous nature of the tumors and their versatility have made it difficult to find a diagnostic and therapeutic consensus that fully characterizes this pathology and describes its evolution. Immunohistochemical methods manage to outline a gene-molecular profile depending on the biomarkers expressed by each tumor. Correlations between clinical aspects and molecular characteristics of tumors are of particular importance in the management of such a case. The study examined the impact of breast cancer molecular subtypes on therapeutic management for a group of 438 patients treated on the Oncology Department of the Bucharest University Emergency Hospital during 2007-2017.

The main objective of the this study is to compare the effectiveness of ovarian stimulation with recombinant gonadotrophins (FSHr) versus urinary gonadotrophins (hMG) within the number of oocytes obtained and the number of embryos in the two patient groups, according to age groups and associated pathologies. The study design was retrospective, monocentric. All patients (71) who have addressed the In Vitro Fertilization Clinic of the Prof. Dr. Panait Sirbu Clinical Obstetrics and Gynecology Hospital during 01.01.2010 and 31.12.2010 were included in this research. The total number of oocytes (8.5�3.9 vs 5.7�3.9, p=0.045), the number of fertilized oocytes (7.5�3.6 versus 3.6�2.8 p=0.004) and the number of embryos (6.6�3.5 versus 3.7�2.6, p=0.013) were higher in women under 35 years of age treated with recombinant FSHr compared to women treated with urinary gonadotrophins hMG. Ovarian stimulation with recombinant gonadotrophins provides a greater number of oocytes and a greater number of embryos in all patients, regardless of age and associated pathology. There are many variables that can influence the success rate, but the first variable that can be controlled is the choice of FSHr in daily clinical practice.

It is widely accepted that thrombophilia in pregnancy greatly increases the risk of venous thromboembolism. Pregnancy complications arise, at least partly, from placental insufficiency. Any change in the functioning of the gestational transient biological system, such as inherited or acquired thrombophilia, might lead to placental insufficiency. In this research we included 64 pregnant women with trombophilia and 70 cases non-trombophilic pregnant women, with or without PMPC, over a two-year period. The purpose of this multicenter case-control study is to analyze the maternal-fetal management options in obstetric thrombophilia, the impact of this pathology on the placental structure and possible correlations with placenta-mediated pregnancy complications. Maternal-fetal management in obstetric thrombophilia means preconceptional or early diagnosis, prevention of pregnancy morbidity, specific therapy as quickly as possible and fetal systematic surveilance to identify the possible occurrence of placenta-mediated pregnancy complications.

Introduction. High‑grade serous carcinoma of the ovary is an aggressive form of cancer, with unknown precursor lesions and often delayed diagnosis because of non‑specific, mild symptoms. Objective. We performed a clinical‑pathological study of ovarian high‑grade serous carcinomas, in order to evaluate morphological and new immunohistochemistry characteristics of this malignancy. Methods. This is a retrospective study of 10 cases of ovarian high‑grade serous carcinoma. We evaluated patients’ age, symptoms at presentation, macroscopic aspects, bilateral involvement, microscopic features: papillary/solid areas, mitotic index, psammoma bodies, tumoral extension, lymph node metastasis, immunohistochemistry markers: CD44, ER, AR, Ki67 index. Results. Mean age was 56.9 years old. Tumors were bilateral in 50% of cases. Only 30% were limited to the ovary. Maximum tumor diameter was 16 cm. Solid component in a proportion of 50‑95% was more characteristic. Most tumors had a mitotic index of 30‑50 mitosis/10HPF (70% of cases). 20% of cases contained psammoma bodies. 2 cases out of 7 had lymph node metastasis. We noticed one case with pleural metastasis (M1). We observed AR80% was noticed in 30% of cases. CD44 was positive in 50% of cases and one case had diffuse positivity of CD44 in corpus luteum cells near the tumoral bed. Conclusions. The majority of patients with ovarian high‑grade serous carcinomas presented with extraovarian extension and were characterized by high mitotic index, rare presence of psammoma bodies, AR expression

Endometriosis is an important public health issues concerning women of reproductive age due to its debilitating painful symptoms. Deep infiltrating endometriosis is the severe form, involving uterosacral ligaments, rectum, bowel and bladder. There is no optimal treatment for this disease, but there are 3 main therapeutic options: medical, surgical and a combination of both. A modern approach for the treatment of endometriosis pain uses dienogest, a progestin, as a long-term solution for women who do not wish to procreate or to whom surgery is not an option. Dienogest 2mg daily has a positive effect on the reduction of pain and endometrial lesions when used perioperatively or as a long-term postoperative treatment. This article focuses on the literature evidence on the efficacy of newly approved oral synthetic progestins in the treatment of severe endometriosis.

Diffuse large B cell lymphoma (DLBCL) is the most common form of non-Hodgkin lymphomas, which has shown an increasing incidence in the past decades. 7% of primary bone tumors consist of non-Hodgkin lymphomas. The etiology of this type of lymphoma is still unclear. Our aim was to study the latest research papers; to highlight the importance of cooperation between different medical specialty departments, in rare cases like NHL as PBT with associated HBV infection. Case report: We present the case of a 39-year-old male patient, who presented to the orthopedic department of the University Emergency Hospital of Bucharest, with moderate pain, swelling, and a palpable mass of the right lower limb. Management and Outcome: The patient underwent several investigations, whose result was DLBCL and an associated HBV infection. Due to the aggressive form of DLBCL, chemotherapeutical treatment has to be initiated as soon as possible to prevent further growth of the tumor. An antiviral therapy had to be initiated to prevent the hepatic failure, which could appear after chemotherapy and in the acute phase of viral infection. Discussion: Our case raised the question regarding what kind of relationship could be identified between the HBV infection and NHL, and how this condition influenced the outcome of the treatment.

Ankle fracture is one of the most common fractures in adults and among pregnant women. In pregnancy, the treatment must be prompt because of the risks and complications that could involve both mother and fetus. In this article, we reported the management of a patient with a bimalleolar fracture in pregnancy, its treatment, and evolution.

With the growth of the aging population worldwide, osteoporosis represents a serious health problem, which implies higher morbidity and costs, despite the continuous advances in treatment options. It involves both sexes, although menopausal women are mainly affected. This article is a brief review of literature on current osteoporosis treatment options.

This article analyses a series of 22 confirmed cases of ovarian cancer throughout a period of 14 months (January 2018 - February 2019), in which we assessed the incidence of osseous metastases, in correlation with their histological features. This retrospective study, based on medical imaging techniques, demonstrates that bone metastases are not uncommon in ovarian cancer.

Preeclampsia is and remains an actual subject of obstetrics regarding the associated immediate high risk of morbidity and mortality for both mother and future risk for cardiovascular disease. Many different strategies to prevent preeclampsia have been studied, but none of the reported results presented a widely effectiveness, until now. Possibility of predicting preeclampsia would have a significant impact in decreasing the incidence of cases with tragic outcome related to this condition. For late-onset preeclampsia there is no prediction method at this time, in this context, the suitable approach is the diagnosis as early as possible in order of a better outcome. Low-dose aspirin (LDA) administrated in the first trimester to patients who are at increased risk for pre-eclampsia is the only drug that has proven benefits for reducing the frequency of this condition and associated adverse outcomes. In terms of prophylaxis with low molecular weight heparin in combination with LDA or as a single treatment, results are controversial, additional studies being required. We intend to summarize the latest proposals regarding the measures that can be taken to prevent maternal and fetal complications that may occur as a result of the development of preeclampsia, methods of early diagnosis and characteristics of atypical forms of preeclampsia.

Congenital heart defects are one of the most interesting and important chapters regarding abnormal fetal growth pathology. The objective of this article is to present a literature review for the main cyanotic congenital heart defects. The ones presented in the article are: tetralogy of Fallot, transposition of the great vessels, double outlet right ventricle, truncus arteriosus, total anomalous pulmonary venous circulation and additional information regarding very rare malformations such as pentalogy of Cantrell and Uhl anomaly. An early and precise identification of congenital heart defects is an important step in an accurate follow-up of a potential problematic pregnancy. Knowing the sonographic aspect, associated pathology and the current available treatment procedures are vital for the fetal outcome and for the physician to adapt the right management in every situation that might appear during the pregnancy and in the neonatal period.

Pelvic floor disorders including stress urinary incontinence and pelvic organ prolapse represent a challenge for gynecologist or urogynecologist even nowadays. Conservative treatment for these conditions proves its effectiveness only in few cases selected from early forms of incontinence or prolapse the most cases being solved surgically. The introduction of the procedure imagined by Petros and Ulmsten, known as TVT (Trans Vaginal Tape) in which the medium urethra is supported by a synthetic tape produced in 1996 a revolution in the surgical treatment of stress urinary incontinence. Radical changes also appeared in pelvic organ prolapse surgery extrapolating the hernia repair procedure by using synthetic mesh. After nearly 20 years of experience the mesh surgery is today a common practice in urogynecology. Between 2011 and 2015 we operated in private practice a total number of 297 cases of which 187 cases of stress urinary incontinence and 110 cases of pelvic organ prolapse. From these 86 (78,1%) cases were represented by cystoceles, associated with early apical prolapse or rectoceles, 18 (16,3%) cases by apical prolapse (grade III-IV) and 6 (5,4%) cases by posterior compartment prolapse alone. We performed mesh surgery in 32 (29%) cases represented mainly by anterior compartment prolapse. In 6 (18,7%) cases we founded mesh extrusion which required partially resection. In two cases we performed large resection of anterior vaginal wall required grafting with acellular second generation graft. In all cases with mesh extrusion the biomechanical analysis revealed significant decrease in effective porosity of the mesh due to excessive tensioning or folding of the mesh. The use of mesh in stress urinary incontinence and pelvic organ prolapse represent a justified alternative in selected cases. The specific complications due to meshes are more frequent in prolapse surgery compared to stress urinary incontinence. In all cases altered effective porosity due to technical defects in surgery represents the leading cause.

Pelvic surgery addresses congenital malformations like Mullerian anomalies, pelvic organ prolapse or after radical intervention, while constructive surgery involves treatment of congenital/iatrogenic absence of organs: uterus or vagina. Intuitively, inert and nondegradable biomaterials appear ideal for this purpose, but surgical reality is that the persistence of a permanent foreign body in the wound has a lot of clinical postoperative disadvantages. This paper aims to discuss the properties of the biologic grafts, detailing the structure of biologic extracellular matrix, the biomechanical properties of biological grafts and the use of extracellular matrix in reconstructive pelvic surgery. A biologic graft used in pelvic surgery is a tridimensional extracellular matrix, acellular and of animal origin. It has as a low risk of transmission of viral and prionic infections and determines reduced inflammatory reaction and a low risk of rejection. The absence of crosslinking facilitates the colonization of the mesh by the host´s cells, thus avoids the foreign body reaction represented by the encapsulation of the mesh by the host. Our experience with clinical use of biological acellular grafts in reconstructive pelvic surgery includes oncoplastic surgery like in cases of vulvar cancer or neovagina reconstruction for Rokintansky syndrome, complications after prolapse surgery treated with polypropylene meshes or relapsing recto-vaginal fistulas. The biomechanical properties evaluated by tensile stress and elastic modulus revealed that biologic grafts with moderate collagen infiltration are the strongest. The degree of cross-linkage influences the rate of degradation and the degree of the inflammatory response triggered by the host organ. Cross-linked collagenous matrices induce little cell infiltration hence there is limited collagen remodeling and graft degradation. On the other hand, in non-cross- linked xenografts cell infiltration is greater with faster degradation rate and collagen production. The decrease in the mechanical strength of the graft materials is related to the lack of collagen infiltration into the material. In conclusion, taking into account the biomechanical properties of biologic grafts, these may be used in reconstructive pelvic surgery and oncoplastic surgery with little complications and good clinical results. They can be attached to large mucosal defects and on potentially septic tissue, they are mechanically resistant and they can be sutured on surrounding healthy tissue.

Ocular posterior pole modification are a pathological manifestation in complicated pregnancies, especially when pregnancy induced hypertension is present (PIH), as well as in preeclampsia (PE) or eclampsia. Nonetheless, as the pregnancy evolves, the possibility for an aggravated evolution with HELLP syndrome, disseminated intravascular coagulation, and idiopathic thrombocytopenic purpura may have an ocular manifestation that, mainly, implies a loss of visual field or acuity, that, left unattended, may constitute a permanent impairment. Pregestational conditions like pituitary adenoma or genetic pedigree for complement factor H gene (1q31.1) single nucleotide mutations could lead to central serous chorioretinopathy or retinal detachment with severe, ischemic, central cilioretinal artery or vein occlusion and optic nerve atrophy. Furthermore, although subtle in many cases, any new visual symptoms during pregnancy should constitute an alarming factor for obstetrical reevaluation and ophthalmological approach in order to preserve the mother's quality of life.

Acute dislocation of the patella is a very common injury of the knee. In more than 90% of the cases the medial patellofemoral ligament (MPFL) is injured. Reconstruction of the MPFL has become a popular soft tissue procedure, which reduces hospitalization and the rehabilitation period. Bioabsorbable materials, in form of screws and anchors are ideal for soft fixation to bones in orthopedics. We would like to present our experience and short-term results after MPFL reconstruction with semitendinous autograft and bioabsorbable fixation devices. 10 patients were involved in this study with PF joint instability, who underwent to MPFL reconstruction. In order to evaluate the functional outcome of the procedure we applied the Tegner Lysholm scoring system before and after 3 Months of surgery. MPFL reconstruction significantly improved the functionality of the PF joint. Gender distribution of the studied group was: 7 female with an average age of 25 5,03 SD and 3 male patients with an average age of 29 1 SD. The key for the success in MPFL reconstruction is the positioning of the femoral tunnel, followed by an isometric tensioning of the graft. Bioabsorbable materials reduce inflammatory, and foreign body response facilitating biointegration of the autograft.

Hallux valgus represents an acquired foot deformity characterized by lateral deviation of the hallux and medial deviation of the first metatarsal. Pain during gait is the main complain and is caused by reduction of plantar pressure under the first ray leading to insufficiency of the first ray and overload of the lesser rays. Treatment can be nonoperative or surgical with more than one hundred surgical techniques described so far. The scope of this study was to assess the short term reliability and stability of fixed loop suspension systems used for surgical treatment of this pathology using radiological evaluation of hallux valgus angle and the intermetatarsal angle. Our results show good stability of the reduction and good reliability of the suspension system, with a six months follow-up. Only one specific complication (failure of the wiring material) is highlighted by our conclusions and the need for biomechanical testing in controlled laboratory studies.

Objectives:The impact of the gestational changes on left ventricular contractility is not clearly defined. Our aim was to evaluate the subtle changes of left ventricular systolic function during pregnancy, assessed by new echocardiographic techniques, in a population tested for inherited thrombophilia. Material and methods:Eighty seven consecutive pregnant women, with a mean age of 32±4 years, genetically tested for inherited thrombophilia (22 with thrombophilic mutations and risk of thrombosis and 65 without significant mutations, considered as the control group) were included. All participants had four clinical and echocardiographyc visits: three during pregnancy (one in each trimester) and the forth six months after giving birth. Left ventricular (LV) systolic function was assessed from ejection fraction (EF) by 2D and 3D echocardiography, mitral annular velocities by tissue Doppler, and strain rate by 2D speckle tracking. Outcomes:There were no differences between groups for any of the echo parameters at each of the four visits. Comparing the third visit with the first one, all parameters of LV systolic function had significantly lower values at the end of pregnancy; EF decreased from 58% to 55% (2D echo), from 60% to 56% (3D TomTec), and from 58% to 55% (Auto4DLVQ), with p

The caesarian scar pregnancy is a rare form of ectopic pregnancy. It is a medical challenge because of the difficulties in diagnosis and treatment. We present the case of a 32 years old woman with 8 weeks amenorrhea and a pregnancy positive test, who was admitted to hospital for lower abdominal pain. Her history is unremarkable, except for a previous pregnancy finalized by caesarian-section. The diagnosis was caesarian scar pregnancy. The first treatment option was systemic Methotrexate. After 3 doses, because there was no visible effect on the pregnancy, the patient was referred to other clinic for uterine artery embolization. One week after the embolization, a suction curettage was performed with elimination of the gestational sac from the scar tissue. The follow up so far showed no defect in the uterine wall.

Gestational diabetes is a form of diabetes that starts during pregnancy and although is an affection which may regress after birth, it leaves its mark on the health of the mother and fetus in the perinatal period, but also on long-term and appropriate treatment initiated at the onset of the disease can reduce its effects. It is defined as carbohydrate intolerance of varying degrees of severity, occurring during pregnancy and that can complicate it (i.e. by increasing the risk of preeclamplsia, polyhydramnios, macrosomia, respiratory distress, hypoglycemia, hypocalcemia and hyperbilirubinemia and neonatal injury at birth). Although the diagnostic criteria varies from one guideline to another, the oral glucose tolerance test remains the gold standard method for the diagnosis of gestational diabetes. Underlying this article we have found significant studies and guidelines related to gestational diabetes published in PubMed and Cochrane databases. Gestational diabetes may be associated with repeated miscarriages, still births, pregnancy-induced hypertension, preeclampsia, premature detachment of the normally inserted placenta, trauma at birth, postpartum bleeding and infection immediately postpartum. Increased risk of maternal complications also increases the risk of premature births. The only modifiable factor in the emergence of all these complications is obesity. Gestational diabetes is a pathology that requires a multidisciplinary team and close monitoring of perinatal complications of pregnancy, in order to prevent and reduce these complications, both on short and long term.

Distal comminuted tibial fracture with or without intra-articular involvement is a very common injury of the lower limb, especially in younger patients due to high energy trauma. The anatomical and biomechanical properties of this segment of tibia, makes this pathology a major surgical challenge with a preserved clinical outcome. The aim of this study is to present different outcome of tibial fracture, treated with open reduction and internal fixation (ORIF) with titanium angle locking plates (ALP) and to underline the physiological and non-physiological bone healing effects on implants. In this study we included 48 patients with tibial pilon fracture who underwent to ORIF, applying ALP in the Orthopedics and Trauma department of the University Emergency Hospital in Bucharest. Due to preserved biomechanical properties of ALP and this anatomical region, weight bearing is not allowed till 6 to 8 weeks. Comminuted fracture of this part of tibia often have de-vascularized bony fragments which leads to delayed union or non-union. These complications often lead to implant failure, improper bone healing or non-union. Internal fixation with angle stable screws, offers a good stability of reduction in the early postoperative period. Titanium angle locking plates offers good anatomical reduction and stable fixation in the early period of healing process. Due to its rigid, fixed position of the screws in the plates, bone remodelling during healing process and early weight bearing, increases the mechanical failure of implant.Keywords: tibial pilon fractures, angle locking plates, implant failure.

Bone cement has been used for over half a century, to successfully anchor artificial joints. From its emergence there have appeared a number of types of bone cement, with the 2 major classes being bone cement with or without active substances. The one with the added antibiotics is used primarily in the treatment and revision surgery of infected total hip arthroplasty (THA), as well as a prophylactic method in primary THA in patients with high risks for this complication. The purpose of this study is to determine the mechanical properties of bone cement with added antibiotics. Over a period of 2 years, a number of 41 cases were chosen for this study: 25 with revision surgery for THA, where bone cement with antibiotics was used, and 16 with primary THA, where regular bone cement was used. A number of studies have been performed on the mechanical properties of the 2 types of cement, which determined that the cement with antibiotics presents a slightly lower compressive strength, tensile strength, elastic modulus and fatigue strength compared with regular cement. These variations, however, become more pronounced as the quantity of the antibiotic goes up. The mechanical properties of the cement with antibiotics are similar with those of the regular cement, when low doses of antibiotics are used and become more evident as the doses go up. In conclusion, the antibiotic bone cement is a trustworthy tool in the surgeon’s arsenal against infection, with minimal detriments from the mechanical view.