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To assess the frequency of multiple thrombophilia-associated mutations and polymorphisms in a selected population of high-risk pregnancies.

Breast cancer and benign neoplasm of the breast represent complex disorders with specific characteristics from a biological and clinical standpoint. Our research includes pacients diagnosed with breast tumours, admitted at the gynecology department of Emergency University Hospital Bucharest in between 2011 and 2015. We studied a sample of 434 female subjects with ages between 20 and 83, coming from all regions of the country. The objective of our research is to identify and analyze the comorbidities found in the breast tumor pathology. We went through a comparative analysis of breast tumors (both benign and malign) with frequently met disorders (overweight, diabetes mellitus, endocrine disorders, genitourinary disorders etc.). The majority of associacions between breast tumor pathology with different comorbidities are statistically significant (p<0.01). Monitoring and disease management necessitates the cooperation of varied medical expertize, ranging from the family doctor to cardiologist, oncologist and so on. The identification of comorbidities in breast tumor pathology may lead to increased life expectancy and quality of life for these patients, through personalized therapy and care. [ABSTRACT FROM AUTHOR]

Starting from the definition of evolution itself, it describes a process through which a living organism has grown and developed from earlier forms over successive generations. The phylogenetics shows us different evolutionary development and diversification for different species and this comparative anatomy study aims to highlight the similarities and the differences between human and horse bony orbit. We conducted a study of comparative anatomy of human and horse orbit in which we first observed the two orbits and then identified data about the location, the constitutive walls of the orbits and the differences and similarities between them. The evolution from the four-legged position to the bipedal position was decisive for the location and the orbital characteristics. [ABSTRACT FROM AUTHOR]

The ureter is a segment of the urinary system and its activity begins during the intrauterine life. The ureter develops from the ureteral bud. This structure appears as an extension of the mesonephros in the cloacal region, penetrating the metanephros, where it will form 1-3 million collecting tubes, the minor calyx, the major calyx, the renal pelvis and the ureter. In the Department of Anatomy of "Carol Davila" University of Medicine and Pharmacy we performed a morphological study of the ureter through dissection of fetuses between 8 and 22 weeks of gestation. We also analysed the development of the ureter and the impact of its malformations, during prenatal ultrasounds in the Department of Obstetrics and Gynecology of University Emergency Hospital Bucharest. We have been able to track the development of urinary components, focusing on aspects such as malformations that may occur both at the level of the urinary system and the kidneys and the importance of early detection by prenatal ultrasound. Genetic and epigenetic factors may be involved in the existence of ureteral malformations. The normal embryological pathway is conditioned by the integrity of the Angiotensin II receptor, but also by other parameters which constitute the biochemical environment responsible for the development of the urinary system. [ABSTRACT FROM AUTHOR]

Les recherches archéologiques de 2018 dans la fortification de Butuceni-West, au-delà des résultats prévus, a apporté une surprise. Déjà pour la deuxième année consécutive, sur le promontoire de Butuceni, les pluies torrentielles de l’été ont ramené à la surface des vestiges funéraires. En 2017, trois sépultures liées à la période médiévale ont été identifiées. L’année dernière, le temps mauvais a fait apparaître le fémur d’une inhumation qui est sorti du modèle attentes. Les recherches effectuées dans la zone située au sommet du promontoire de Butuceni, ont permis de mettre au jour le tombe avec le squelette d’une jeune femme, mal conservé, qui dans ses caractéristiques était radicalement différent des découvertes précédentes. Contrairement aux tombes médiévales sans inventaire, l’inhumation nouvellement découverte était accompagnée de 11 pièces d’ornements en bronze. Ce sont des anneaux à boucles qui ont été accouplés dans la région temporale: à droite - une paire et à gauche – autre 4 paires et une pièce singulière. Les analogies les plus proches ont été rapportées sur les sites du territoire Volhyno-podolien à partir de la période comprise entre le fin du XIIe siècle - la première moitié du XIII siècle (découvert en même temps dans les complexes funéraires, les sites d’habitat, les lieux de culte ainsi que dans les thésaurus). Le texte présente le tableau contextuel des découvertes, accompagné d’une analyse primaire des vestiges archéologiques, et la tentative de répondre, dans une phase préliminaire, à certaines des nombreuses questions que cette découverte nous a posées.

Preterm birth is the legal first global cause of neonatal death. The cervix has two roles: it has to stay closed to allow the fetus to undergo a normal development during gestation, and at term, the cervix has to dilate under the pressure of uterine contractions to allow the delivery. The purpose of this article is to establish if the ultrasound measured length of the cervix and its appearance are predictive for the spontaneous preterm birth. Cervical insufficiency can be described by painless cervical dilatation leading to pregnancy losses/ births, with no other risk factors present. During gestation, the physiological softening of the cervix is determined by the extracellular matrix components, particular decorin, and thrombospondin 2. The direction of the collagen fibers remains the same - circumferential direction, but the collagen solubility increases. Therefore, during pregnancy, the cervical tissue is more hydrated and has higher collagen extractability than non-pregnant tissue. Women with cervical incompetence have increased levels of smooth muscle cells than normal pregnant women, the number of elastic fibers is low, and also the concentration of hydroxyproline is decreased. Transvaginal ultrasound is the suitable gold standard exam that can offer essential information about the cervical length and state of the internal os in early asymptomatic stage of cervical insufficiency for predicting and preventing preterm birth. In our experience, a transvaginal ultrasound screening for the measurement of the cervix is reguired. We consider that the proper gestational age for the prediction of a preterm birth is at 18-22 weeks of gestation for the general population and earlier for patients with a history of preterm birth. Just from an observational point of view, we concluded with the fact that the cerclage of the cervix is unnecessary if the cervical length is above 2 cm and if the internal cervical os is closed. In the absence of funneling, the probability of cervical incompetence is low and the best prophylactic option is progesterone administration. [ABSTRACT FROM AUTHOR]

Taylor first described pelvic venous insufficiency in 1949. Pelvic congestion syndrome affects 15-20% of women. Chronic venous disorders affecting pelvic veins and varicose veins developed among uterus, ovaries and hypogastric plexus, including stasis results in congestion and pelvic pain. Pregnancy is a precipitating factor of occurrence, the vulnerability of vessels, based on hemodynamic factor through vascular incompetence, dilatation and retrograde flow. Secondary pelvic congestion syndrome can be caused by genital prolapse, the prolonged use of progestin agents, infections, uterine fibroids, endometriosis and uterine involution postpartum. Imaging methods that can be used for pelvic congestion syndrome diagnosis and follow-up are transvaginal ultrasonography, computer tomography, magnetic resonance, angiography and venography. Various classes of medications have been used over time, but their effect is transitory and their side effects do not allow their long-term use. Minimally invasive venous embolization remains the treatment with the best results. Areas that remain in continuous research are the optimal agencies for embolization, risk factors predictive of pelvic congestion syndrome and the significance of asymptomatic cases of ovarian venous reflux and pelvic varicosities. Without ignoring the multitude of pathologies that can lead to chronic pelvic pain, pelvic congestion must be one of the diagnostic options, considering its incidence among the population and their frequent association. We review in this article the most important studies found in the literature. [ABSTRACT FROM AUTHOR]

A velamentous umbilical cord is characterized by membranous umbilical vessels at the placental insertion site that are prone to compression and rupture, especially when they are located in the membranes covering the cervical os (vasa praevia). The velamentous insertion of the umbilical cord, with a reported incidence of 1% in singleton pregnancies and 15% in monochorionic twin gestations, has been associated with obstetric complications: fetal growth restriction, prematurity, congenital anomalies, low Apgar scores, fetal bleeding with acute fetal distress and placental retention. The pathogenesis is unknown, but the trophotropism theory is the most common and supported by the association of velamentous cord insertion and placenta praevia. The prevalence of vasa praevia is of approximately 1/2500 deliveries: the risk factors include the use of assisted reproductive technologies, low-lying placenta or placenta praevia, bilobed or succenturiate lobe placenta and multiple gestation. The diagnosis is rarely established before delivery and consequently the fetal mortality is extremely high. We report two cases of velamentous marginal umbilical cord insertion associated with vasa praevia (type 1 vasa praevia) and placenta praevia diagnosed during a routine mid-trimester fetal 2D ultrasound scan, color and power Doppler transvaginal ultrasound cervical assessment. The ultrasound examination revealed one umbilical vessel crossing the internal os of the cervix entering the placental margin and connecting to the subchorionic vasculature, remaining immobile when the uterus was shaken, the color Doppler imaging enhancing the identification of the vessel. The patients were admitted to the hospital in the third trimester and deliveries were planed and successfully performed at 38 weeks gestation, being confirmed by a macroscopic examination ultrasound diagnostic. [ABSTRACT FROM AUTHOR]

Azoospermia is found in 10-15% of infertile men. Azoospermia has been classified as obstructive (OA) (obstruction of ejaculatory and deferent ducts, or epididymis) or non-obstructive (NOA) (due to primary testicular failure or the lack of pituitary/hypothalamus stimulation). The absence of sperm from the semen probe in non-obstructive azoospermia has been associated in over half of the reviewed cases with the presence of sperm in the testes. The development of microsurgery techniques and of ICSI (Intracytoplasmatic Sperm Injection) has been successful in enhancing the possibility for these patients to have biological children using assisted human reproduction. The retrieval of sperm in non-obstructive azoospermia is usually performed using TESE (Testicular Sperm Extraction) or micro-TESE, the latter having clear advantages in the post-interventional recovery of the patient. Sperm obtained through testicular biopsy may be used for micro-injection within the ICSI procedure or can be cryogenically preserved for later use. Rarely, these procedures are used for pure diagnosis purpose. [ABSTRACT FROM AUTHOR]

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Introduction: Intrauterine fetal growth restriction (IUGR) is the the 3rd cause of perinatal death after preterm birth and congenital anomalies. IUGR correlates with hypertensive disorders during pregnancy, metabolic syndrome, fetal distress, placenta praevia. Short term and long term consequences include perinatal mortality and morbidity and an increased risk of neurological damage and neurosensory disabilities. Objectives: This review article enumerates anatomoclinical and pathophysiological aspects involved in the onset and diagnosis of IUGR according to literature findings and our experience with IUGR in the Bucharest University Emergency Hospital. Materials and methods: We have reviewed articles in the international database focused upon the diagnosis and aethiology of IUGR and compared them to our experience in the Department of Obstetrics and Gynecology. Results: Literature data and our data stand that the main cause of IUGR is placental insufficiency due to poor placental perfusion. Diagnosis of IUGR implies ultrasound evaluation, biometry, Doppler-ultrasound, cardiotocography and may involve a series of new biochemical factors (e.g. adipokines). Research in this field is in progress in all countries. Discussions: All data must be correlated with anatomical and pathophysiological changes taking place during pregnancy in a certain given population in order to correctly establish a diagnosis of IUGR. Conclusions: An accurate diagnosis of IUGR is mandatory for an appropriate management of cases. A complex team of obstetricians and neonatologists must be involved in the management of pregnancies complicated with IUGR. [ABSTRACT FROM AUTHOR]

Backgroung: Cervical cystic hygroma is a rare congenital cystic anomaly of the lymphatic vessels, which determines an excessive accumulation of liquid at this level, a cathegory of lymphangiomas. Case report: We report the case of a 14 weeks fetus with this malformation. The particularity of our case derives from the association of cystic hygroma with Down syndrome, complicated with hydrops fetalis, a situation with an extremely rare incidence and unfavourable prognosis. Conclusion: The morphological analysis of affected fetuses with cystic hygroma is important in understanding the evolution in utero of this pathology which is an essential element for a proper management of pregnant women who present fetuses with this anomaly. [ABSTRACT FROM AUTHOR]

The acardiac twin is a rare congenital abnormality that affects one percent of the monozygotic monochoryonic twins and one in 35,000 pregnancies overall. This rare condition is also known as twin reversed arterial perfusion sequence (TRAP), because the acardiac twin (recipient twin) is perfused by its co-twin or pump twin via placental arterial and venous anastomoses. Due to the suplimentary effort of the pump twin to assure a systemic circulation for the recipient acardiac twin, the first may develop cardiac failure, the perinatal mortality varying from 50 to 75%. Another common event in case of an acardiac twin is the preterm delivery. We report a case of an acardiac twin, whose peculiarities that the pregnancy was carried for 36 weeks, more than the gestational ages reported in the literature, and the pump twin was in perfect health. [ABSTRACT FROM AUTHOR]

The aim of this paper was to evaluate the types of pneumatization of anterior ethmoid cells according to their relationship to the fossa of the lacrimal sac. For this purpose, we decided to evaluate 100 computed-tomography examinations of the paranasal sinuses (200 ethmoid masses). The examinations were randomly chosen from our collection and were divided into two groups according to their gender into a male and female group. We evaluated the three types of ethmoid sinus regarding their relation to the fossa and the symmetry between the right and left ethmoid masses using transverse plane acquisitions. Also we compared our results with results from papers with similar topics. [ABSTRACT FROM AUTHOR]

Introduction: Fraser syndrome is a rare genetic multisystem malformation with an autosomal recessive pattern of inheritance that in most cases comprises 3 major defects: cryptophthalmos, syndactyly and renal anomalies. Case report: We report the case of a female fetus with a length of 39 cm and a weight of 1250 g with multiple abnormalities. The abnormal facial features were: bilateral cryptophtalmos, triangular face, low-set ears, broad nose with depressed or flat nasal bridge. The limbs are also malformed, presenting cutaneous syndactyly. We also detected laryngeal stenosis, clitoromegaly, imperforate anus and bilateral renal agenesis. Due to the fact that the specimen met the criteria necessary the diagnosis of Fraser syndrome was established. Conclusion: The case reported is a typical manifestation of Fraser syndrome, a rare plurimalformative disease. The diagnosis was established after an extensive morphological examination that revealed the most frequent anomalies associated with this condition. [ABSTRACT FROM AUTHOR]

Non-obstructive azoospermia used to be considered an untreatable cause of male infertility. By the microinjection technique, sperm that has been surgically extracted from the testis can be injected into the oocyte cytoplasm to obtain an embryo. Severe asthenozoospermia, severe oligozoospermia and azoospermia have all been success fully treated by using the ICSI technique. Sperm retrieval in combination with ICSI is the only medical procedure for an azoospermic man to father a child. Different techniques, especially testicular sperm extraction (TESE), have evolved over time and have dramatically improved the outlook for men with testicular azoospermia. However sperm retrieval rates are associated not only with the operation proposed but especially with a distinct pattern of prognostic factors that must be effectively managed for all these infertile patients for their best benefit. This report is on a case of non-obstructive azoospermia that was successfully treated by testicular biopsy (TESE) with ICSI procedure in private Hospital, MedLife Bucharest. The result is the birth of 2 baby-boys perfectly healthy. [ABSTRACT FROM AUTHOR]

Autonomic innervation of the pelvis involves sensory and motor fibers originating from the lateral horn of the spine, C12-L4 (sympathetic) or S3 to S5 (parasympathetic) and is represented by the sympathetic sacral trunk, the pelvic splanchnic nerves and the hypogastric plexus. Sacral sympathetic trunk continues the lumbar one from the upper strait of the pelvis, being in contact anterior with the rectum, posterior with the sacrum and lateral with the sacral holes. Each of the right and left trunks contain four nodes, connected by internodal fibers, that merge and form anterior to the coccyx the imparganglion. Sacral sympathetic trunk gives postnodal efferent fibers to the sacral plexus that innervate the inferior limbs and to the inferior hypogastric plexus. Superior hypogastric plexus (presacral nerve) contains sympathetic fibers from the aortic plexus anastomosed with lumbar splanchnic nerves (right and left) inferior to the bifurcation of the aorta at the level of L5. It has a short downward trajectory through the pelvis and anterior to the promontory it divides into right and left hypogastric nerves, which may have a plexiform aspect. They have a descending pathway to the anterior and lateral, reaching the lateral sides of the rectal ampulla, where they branche. Pelvic splanchnic nerves (erector) containpreganglionic parasympathetic fibers originating from the spinal segments S2-S4 and fibers from the sacral paravertebral chain. Inferior hypogastric plexus is formed by anastomosis of the hypogastric nerves with the splanhnic pelvic nerves, containing sympathetic and parasympathetic fibers. They have the aspect of a network of nerve fibers, mixed with irregular nodal masses, which can combine forming several bulky nodes. Their efferencesform periarterial plexuses (hemorrhoidal, vesical, uterine, vaginal) distributed along the internal iliac artery to all the pelvic and perineal viscera. [ABSTRACT FROM AUTHOR]

Premature rupture of fetal membranes is associated with a substantial fetal morbidity and mortality. Immediate actions that can improve the future neonatal outcome are the administration of antenatal corticosteroid therapy, infection prophylaxis, tocolytic drugs and insurance of an appropriate neonatal nursery level. One of the essential points in the management of these cases is the attempt to extend as much as possible the gestational age, especially in mid trimester premature rupture of membranes and even more considering that the duration of the latency period inversely correlates with gestational age at membrane rupture. We present the case of a patient aged 41 years admitted as obstetric emergency for suspected leakage of clear fluid in context of dichorionic, diamniotic twin pregnancy, 22 weeks of gestation, obtained by in vitro fertilization due to primary infertility. Under continuous tocolytic and antibiotic treatment, the extension of the gestational age of the first fetus with 5 weeks was successfully obtained. The second fetus was born one week later as a result of the abandonment in utero of the placenta. Complications implied by preterm rupture of membranes in twin pregnancies are significantly influenced by the presence of chorioamnionitis and by placentation. We consider that the prognosis of the second fetus, perfectly normal developed during first 5 years, was positive and significantly influenced by the prolonged gestational age with almost one week. [ABSTRACT FROM AUTHOR]

Aim: Traditional methods used in preoperative evaluation of facial vessels such as manual palpation or angiography have obvious limitations: they can not appreciate any vessel diameter or flow direction. Now, ultrasonography is widely used for the same purpose, replacing the old methods. Material and Methods: In this study, we performed measurements of the diameters of the facial veins and arteries by ultrasound method. The measurements were made at three different levels. The study group included 35 healthy patients. Results: At the inferior margin of the mandibular body, the mean value for the facial artery diameter is 2.5 mm, 1.776 mm in women and 3.416 mm in men and for the facial vein 3.307 mm, 4.38 mm and 2.502 respectively. Conclusions: There are many advantages of preoperative ultrasound exam of the recipient and donor facial vessels before a facial transplant: it is noninvasive, nontraumatic, easy and reproducible. Doppler examination gives us in the field of facial transplantation, an excellent method to evaluate the possibility of creating flaps based on facial vessels. [ABSTRACT FROM AUTHOR]

The facial artery is the major artery for the facial skin. Along with it are secondary sources: the terminal branches of the superficial temporal artery and the transverse facial artery. In their trajectory, the arteries follow several anatomical territories: bones, muscles and intermuscular septa, fascia and sometimes tendons and nerve fibers. Toward the surface, reaching a microscopic level, the vessels will follow the connective tissue to reflect regional three-dimensional disposition. The arteries branch out on the surface of the deep fascia, and afterwards their branches climb the connective network of superficial fascia, among the adipose lobules, towards the subdermal plexus. Vascular anastomoses take the form of irregular polygons. These subdermal anastomoses allow restoration of blood flow, even when there has been an extensive dissection of the skin. Depending on the form of the cutaneous vascular area of an artery, three forms of subdermal plexuses were described: radiate, parallel and circular. Every source artery which supplies a block made up of muscles, nerves and bones is usually responsible for also nourishing the skin area situated right above it. This type of composite tissue segment, with a common dependency towards a source artery, was named angiosome. A thorough knowledge of the microvascularisation of the facial region is useful for planning surgical interventions with aesthetic and reconstructive purposes, cosmetic surgery interventions and also facial transplants, as the main objective in such an intervention is the revascularisation of the transplanted tissue. [ABSTRACT FROM AUTHOR]