List of Registered Papers

*under review *invalidated *validated

Paper Authors Coauthors Status Details
THE MODULATORY EFFECTS OF SPIRONOLACTONE ON OXIDATIVE STRESS AND INFLAMMATION IN THE PERIOVARIAN ADIPOSE TISSUE OF PCOS-INDUCED RATS  Puscasu Danusia Adriana - Validated View

THE MODULATORY EFFECTS OF SPIRONOLACTONE ON OXIDATIVE STRESS AND INFLAMMATION IN THE PERIOVARIAN ADIPOSE TISSUE OF PCOS-INDUCED RATS

Fundamental Science

Author(s): Puscasu Danusia Adriana

Coordinator(s): Associate Professor Gabriela Adriana Filip

Keywords: polycystic ovary Spironolactone inflammation oxidative stress

Introduction: Polycystic ovarian syndrome (PCOS) is a heterogeneous medical condition that occurs in up to 8% of the females of reproductive age, being one of the factors that can lead to insulin resistance, type 2 diabetes mellitus, obesity and infertility. In these processes, a proinflammatory status can interfere with insulin signaling, stimulates the hyperplasia of androgen producing theca cells and promotes hyperandrogenism. Based on these data, the aim of this study is to evaluate the effect of Spironolactone on oxidative stress and inflammation in the periovarian adipose tissue (POAT) of oestradiol valerat (OV) induced PCOS.



Material and Method: 30 female Wistar rats were distributed in PCOS group (n=20; one i.m. injection of 5 mg OV/0.5 ml sesame oil) and non-PCOS group (control; n=10, 0.5 ml sesame oil). After a month, ultrasound was performed to confirm the PCOS and oral glucose tolerance test (OGTT) was performed. Afterwards, the PCOS group was divided in a treated PCOS group with vehicle (0.5 ml sesame oil) and PCOS group treated with spironolactone (2 mg/0.2 ml sesame oil). After 30 days, OGTT was assessed and the periovarian adipose tissue (POAT) was collected for oxidative stress, DNA damage and inflammatory status evaluation.


Results: Malondialdehyde (MDA) levels, expression of phosphorylated nuclear transcription (pNF)-kB and γ-H2AX increased in the POAT of PCOS group in parallel with reduced superoxide dismutase (SOD) activity and a higher fasting glycemia. Spironolactone treatment decreased MDA levels and increased glutathione peroxidase (GPx) activity in the POAT compared to vehicle (p<0.05) suggesting its antioxidant effect. In the POAT, the expression of COX-2 and γ-H2AX diminished after Spironolactone administration (p<0.05) while SOD activity and monocyte chemoattractant protein (MCP)-1 were unchanged (p>0.05).


Conclusion: Our results showed Spironolactone treatment improved antioxidant capacity and had a beneficial effect on inflammation and DNA lesions in POAT of PCOS rats. 

Bibliography: 1. Daneasa A, Cucolas C, Furcea M, Bolfa P, Dudea S, Olteanu D, et al. Spironolactone and dimethylsulfoxide effect on glucose metabolism and oxidative stress markers in polycystic ovarian syndrome rat model. Exp Clin Endocrinol Diabetes.2014:122(3):154-62. 2. Daneasa A, Cucolas C, Lenghel LM, Olteanu D, Orasan R, Filip GA. Letrozole vs estradiol valerate induced PCOS rats:glycemic,oxidative and inflammatory status assessment.Reproduction.2016;151(4):401-9. 3. Tao Zuo, Minghui Zhu,Wenming Xu. Roles of Oxidative Stress in Polycystic Ovary Syndrome and Cancers. Oxid Med Cell Longev.2016; 2016:8589318. 4.Dikmen A, Ergenoglu AM, Yeniel AO, Dilsiz OY, Ercan G, Yilmaz H. Evaluation of glycemic and oxidative/antioxidative status in the estradiol valerate-induced PCOS model of rats. Eur J Obstet Gynecol Reprod Biol.2012;160(1):55-9.5. Nteeba J, Ortinau LC, Perfield JW 2nd,Keating AF. Diet-induced obesity alters immune cell infiltration and expression of inflammatory cytokine genes in mouse ovarian and peri-ovarian adipose depot tissues. Mol Reprod Dev. 2013;80(11):948-58. 6. Baillargeon JP, Nestler JE. Polycystic Ovary Syndrome: A syndrome of ovarian hypersensitivity to insulin. J Clin Endocrin Metab. 2006; 91(1). 7. Dinger Y, Akcay T, Erdem T, Ilger Saygilli E, Gundogdu. DNA damage, DNA susceptibility to oxidation and glutathione level in women in polycystic ovary syndrome. S. Scand J Clin Lab Invest. 2005; 65(8):721-8. 8. Amengual-Cladera E. Capllonch-Amer G, Llado I, Gianotti M, Proenza AM. Proteomic study of periovarian adipose tissue in 17β-estradiol-treated and untreated ovariectomized rats. Biochem Cell Biol. 2016, 94(2):167-75.

A life without tears - Sjögren Syndrome – Clinical case report  Muntean Delia Doris , Ileana Cosmina Filipescu Covaciu Alexandra Corina, Oltean Paula Anca, Pasca Gina-Iulia Invalidated View

A life without tears - Sjögren Syndrome – Clinical case report

Case Report - Poster

Author(s): Muntean Delia Doris, Ileana Cosmina Filipescu

Coauthor(s): Covaciu Alexandra Corina, Oltean Paula Anca, Pasca Gina-Iulia

Coordinator(s): Associate Professor Ileana Cosmina Filipescu

Introduction: Sjögren’s syndrome (SS) is a chronic systemic autoimmune disorder that is best characterized by lymphocytic infiltration of the exocrine glands. The disease spectrum extends from sicca syndrome to systemic involvement and extraglandular manifestations, and SS may be associated with malignancies, especially non-Hodgkin’s lymphoma. 

Case Presentation: A 38-year-old male patient presented progressive xerophthalmia and xerostomia over the past six months and hard unilateral parotid gland enlargement (6 cm in diameter). The disease’s onset was 8 years prior to the diagnosis setting, the patient accusing recurrent alternative swelling of the parotid glands with resolution under treatment with antibiotics and non-steroid anti-inflammatory drugs. The minor salivary glands biopsy revealed focal lymphocytic sialadenitis stage 4 and the parotid gland echography documented gross inhomogeneity (grade 3), therefore Magnetic Resonance Imaging was necessary to exclude malignancy. The laboratory tests revealed: inflammatory syndrome, intense positive anti-Ro/SSA antibodies, positive anti-La/SSB, positive rheumatoid factor and antinuclear antibody titer 1:1280 with a fine speckled pattern. Treatment with Hydroxychloroquine and Prednisone was initiated. 

Conclusion: The severe involvement of the parotid gland is a prognostic factor for an adverse outcome especially in male SS patients. 

Particularities: SS represents a rare disease with a yearly incidence of four out of 100,000 in the general population, while the female-to-male ratio is 20:1. This case is particular due to the early onset of SS in man, with alternative parotid gland enlargement as the main symptom, and not the sicca syndrome. Sialolithiasis was excluded. Additionally, in male SS patients with an increased titer of Immunoglobulin G and positive cryoglobulinemia, the risk of developing lymphoma is 15–20-times higher than in people without SS, therefore regular hematologic screening is required. 

Surface Enhanced Raman Scattering-based detection of microalbuminuria  Stefancu Andrei , Moisoiu Vlad - Validated View

Surface Enhanced Raman Scattering-based detection of microalbuminuria

Fundamental Science

Author(s): Stefancu Andrei, Moisoiu Vlad

Coordinator(s): Associate Professor Nicolae Leopold , Assistant Professor Nicolae Crișan

Keywords: Surface Enhanced Raman Scattering Microalbuminuria Silver Nanoparticles

Introduction: Microalbuminuria, which is defined as the excretion of 30–300 mg of albumin per 24 hours, represents an independent risk factor for chronic renal failure and for cardiovascular morbidity and mortality. However, point of care tests used for screening in diabetic and hypertensive patients do not meet recommended sensitivity criteria for accurate identification of microalbuminuria. Therefore, the present study proposes a surface enhanced Raman spectroscopy (SERS)-based method for detecting trace amounts of urine albumin and proteins using iodine modified silver nanoparticles.

Material and Method: Iodine modified silver nanoparticles synthetized using the hydroxylamine reduction method were mixed with human urine aliquots that contained bovine serum albumin in the 30-300 mg/l range. SERS spectra were collected with a He-Ne laser emitting at 633 nm, which delivered approximately 10 mW of power at the sample. For data acquisition, the laser was focused on the sample via a 10X microscope objective (N.A. 0.25) with an exposure time of 30 s. All data processing and analysis was performed using the MATLAB software environment.   

Results: SERS spectra of urine samples presented two Raman bands at 860 cm-1 and 1003 cm-1, that were tentatively attributed to the tyrosine and phenylalanine breathing modes, respectively. The intensity of the Raman bands was proportional to the concentration of the albumin and the detection limit was approximately 30 mg/l. As opposed to enzymatic methods or immunoassays, the SERS-based detection method is insensitive to chemical modifications and could be used with other types of urine proteins as well, including degraded albumin or Bence-Jones proteins. 

Conclusion: The SERS based method can detect trace amounts of urine albumin using the Raman bands around 860 cm-1 and 1003 cm-1. Therefore, SERS is a promising method for detecting proteins in urine samples, which could be implemented in a future point of care instrumentation. 

Bibliography: W. E. Owen and W. L. Roberts, "Performance characteristics of an HPLC assay for urinary albumin," Am J Clin Pathol 124, 219-225 (2005).

NEW PSYCHOACTIVE SUBSTANCES. A CHALLENGE FOR THE FORENSIC TOXICOLOGY  Dávid Éva - Validated View

NEW PSYCHOACTIVE SUBSTANCES. A CHALLENGE FOR THE FORENSIC TOXICOLOGY

Fundamental Science

Author(s): Dávid Éva

Coordinator(s): Professor Beatrice Gabriela Ioan

Keywords: psychoactive drugs forensic toxicology

Introduction: New psychoactive substances (NPS) are drugs of abuse, in either a pure form or a preparation, that are not controlled by international drug conventions. The forensic community faces a challenge in gaining access to methods for the analysis of NPS because manufacturers produce new chemical variants to escape the legal frameworks. Chemically, novel psychoactive substances are classified as phenethylamines, amphetamines, synthetic cathinones, piperazines, pipradrols/piperidines, aminoindanes benzofurans, and tryptamines. The aim of this study was to identify the main challenges to the forensic toxicology raised by the emergence of the NPS and to underline the importance of developing of a science-based policy driven approach on NPS.
Material and Method: Currently, despite the popularity of NPS, there is a paucity of scientific data about the analytical techniques for chemical structure elucidation. Here we provide a brief review describing analyses from less selective color tests, to more selective approaches such as gas chromatography/mass spectrometry (GC/MS), liquid chromatography/mass spectrometry (LC/MS), Fourier transform infrared spectroscopy (FTIR) and nuclear magnetic resonance (NMR).
Results: Many of the drugs described did not display a peak related to its precursor ion when analyzed by GC/MS. Moreover, the gas chromatograms and mass spectra of cathinone were particularly poor. LC served a central role in the identification of NPSs. In all cases, LC/HRMS correctly identified the elemental compositions of the unknown molecules.
Conclusion: For an effective strategy against the appearance of a number of new drugs on the illicit market, cooperation among laboratories operating in this field, academia (with its more sophisticated analytical instruments and methodologies) and EWS (Early Warning System) for the sharing of knowledge on new drugs was shown to be advisable.
Bibliography: Tettey J., Crean C., New psychoactive substances: catalysing a shift in forensic science practice?, Philosophical Transactions of the Royal Society B 370 (1674) 2015 pi:20140265. Liechti M, Novel psychoactive substances (designer drugs): overview and pharmacology of modulators of monoamine signaling, Swiss Medical Weekly 145, w14043. Rossi S.S., Odoardi S., Gregori A., Peluso G., Ripani L., Ortar G., Serpelloni G., Romolo F. S., An analytical approach to the forensic identification of different classes of new psychoactive substances (NPSs) in seized materials, Rapid Communications in Mass Spectrometry 28(17) 2014, 1904–1916.

SYSTEMIC CAPILLARY LEAK SYNDROME AFTER CHEMOTHERAPY  Oltean Ioana Maria Pál Krisztina, Moldovan Diana Maria Margareta, Milotoiu Ioan Validated View

SYSTEMIC CAPILLARY LEAK SYNDROME AFTER CHEMOTHERAPY

Case Report - Poster

Author(s): Oltean Ioana Maria

Coauthor(s): Pál Krisztina, Moldovan Diana Maria Margareta, Milotoiu Ioan

Coordinator(s): Assistant Professor Andreea Rusu , MD Maria Liliana Radulescu

Introduction:

Systemic capillary leak syndrome (Clarkson’s disease) is a rare acquired disorder determined by increased capillary permeability with extravasation of plasma in the interstitial tissue leading to hypotension, dyspnea, edema, hypoalbuminemia and hemoconcentration.

The cause of this rare disorder is still unknown, but autoimmune mechanisms have been offered as an explanation.


Case Presentation:

: A 67 years old patient presents with dyspnea and edema in both lower limbs. At examination she had hypotension, tachycardia and decreased vesicular murmur on both basal areas of the lungs. Echocardiography showed dilation of the right ventricular and atrial cavities as well as severe pulmonary hypertension. The patient had a history of ovarian cancer that was treated with Paclitaxel and Carboplatin. After differential diagnosis with pulmonary embolism, chronic obstructive pulmonary disease and dysfunction of the left ventricle, treatment with diuretics and hydrocortisone was initiated. The exclusion of the differential diagnoses and the rapid improvement of the patient’s condition lead to the diagnosis of systemic capillary leak syndrome.


Conclusion:

After 7 days of treatment, echocardiography showed amelioration of the pulmonary hypertension, chest X-ray showed minimal pleural effusion and the NT-proBNP value was 600pg/ml.


Particularities:

Systemic capillary leak syndrome is a disease that does not have any diagnosis criteria and everything else must be ruled out before deciding that a patient with risk factors is suffering from this syndrome. In this patient’s case there was no other explanation for the pulmonary hypertension, pleural effusion, edema, hypotension and hypoalbuminemia except the history of treatment with Paclitaxel which is known to be a risk factor for systemic capillary leak syndrome.

Congenital cataracts, facial dysmorphism and neuropathy syndrome  Păun Maria-Loredana Trenchea Alexandru, Ciubotariu Alexandra-Evelina, Prisecariu Denisa Ioana Validated View

Congenital cataracts, facial dysmorphism and neuropathy syndrome

Case Report - Poster

Author(s): Păun Maria-Loredana

Coauthor(s): Trenchea Alexandru, Ciubotariu Alexandra-Evelina, Prisecariu Denisa Ioana

Coordinator(s): Assistant Professor Roxana Popescu

Introduction: Congenital cataracts facial dysmorphism and neuropathy syndrome (CCFDN) is a genetic disease manifested in Balkan gypsies. The pattern of inheritance is autosomal recessive and a causative mutation is in the CTDP1 gene. Affected patients display congenital cataracts, microcornea, peripheral neuropathy, mild facial dysmorphism, hypogonadism and psychomotor delay.

Case Presentation: We present the case of two siblings: a boy (11 years old) and a girl (8 years old) with CCFDN in order to illustrate a rare disorder and to discuss the management of the patients and their family.
The genetic exam was requested for congenital cataract in both eyes, facial dysmorphism and psychomotor delay. They are both children of an unrelated, young couple. The family history revealed the father and one of his brothers with ankylosing spondylitis and one father's cousin deceased at the age of 3 months with hydrocephalus.
Anamnestic data show that the boy is the first child. Pregnancy was uneventful, the child was born naturally, at term. Congenital cataract was diagnosed late and he was surgical treated at the age of 11 months. Postnatal development was delayed: he held his head at 1 year, in present he cannot stay on both legs without support and he cannot walk. The girl is the second child. Pregnancy was uneventful, she was born naturally, at term. She was diagnosed with congenital cataract, surgical treated after few months. Postnatal development was delayed (started walking at 4 years).

Additional investigations (neurological, electrophysiological, ophthalmologic) made at both children confirmed the presence of sensorimotor polyneuropathy and eye abnormalities. The sequence analysis confirm the c.863+389C>T mutation in CTDP1 gene.

Conclusion: CCFDN syndrome is a complex developmental disorder of autosomal recessive inheritance, affecting preferential the gipsy population.


Particularities: This case presents the following particularities: microcephaly, prognathism, severe kyphoscoliosis and severe motor deficiency.

SEQUESTRED THROMBUS IN FORAMEN OVALE- AN UNEXPECTED COMPLICATION AFTER A CORONARY ARTERY BYPASS GRAFTING SURGERY  Radulescu Ana-Maria , Cîntăcioiu Diana-Georgiana Necula Ovidiu, Dragoi Oana Diana, Dumitrescu Ana-Maria Validated View

SEQUESTRED THROMBUS IN FORAMEN OVALE- AN UNEXPECTED COMPLICATION AFTER A CORONARY ARTERY BYPASS GRAFTING SURGERY

Case Report - Poster

Author(s): Radulescu Ana-Maria, Cîntăcioiu Diana-Georgiana

Coauthor(s): Necula Ovidiu, Dragoi Oana Diana, Dumitrescu Ana-Maria

Coordinator(s): MD Adina Stoica , Assistant Professor Bogdan Constantin Radulescu

Introduction:

A thrombus sequestered in a patent foramen ovale(FO) is a particularly rare form of paradoxical embolism. It implicates the halting in travel of a thrombotic embolism at the point of patent defect in the interatrial septum with subsequent thrombus obtrusion into both atria. Such an emboli presents with a high risk of stroke or pulmonary embolism indicating the need for an interdisciplinary team to guide treatment. 


Case Presentation:

53 year old male presents with acute ischemia of the right arm. The patient had undergone bypass surgery 3 weeks prior. His ischemic symptomatology remits under heparin treatment but days later he experiences recurrent bouts of hemoptysis. Thoracic CT shows acute bilateral pulmonary embolism(PE). Doppler echo shows deep vein thrombosis(DVT) in the right leg, unnoticed prior to the bypass surgery. Transesophageal echocardiography shows a patent FO with a sequestered thrombus extending into both atria of significant dimensions. Emergency surgical intervention is decided upon. A spiral, adherent thrombus roughly 7x2cm lodged in the FO  extends into the right atrium, through the tricuspid valve and into the ejection tract of the right ventricle. Transseptal excision of the left atrial extension is performed and the patent septum is sealed. Lab tests indicate a thrombophilia with hyperhomocysteinemia related to a MTHFR gene mutation. 


Conclusion:

The postoperative evolution is favorable,the  patient is discharged a week later in sinus rhythm and under anticoagulation and antiaggregation therapy.Three months later,thoracic CT reveals complete remission of the bilateral PE.


Particularities:

We report  the case of a patient with previously asymptomatic trombophilia due to hyperhomocysteinemia,condition which was exarcerbated by the bypass surgery and extracorporeal circulation, and led to a fulminant protrombothic state with DVT,PE and intracardiac thrombus related to DVT,only three weeks after heparin postoperative treatment.The entrapped thrombus in FO in a surgical emergency and requires an interdisciplinary approach.

THE IMPORTANCE OF IMPLEMENTING THE CORRECT WOUND CARE PROTOCOL TO SHORTEN THE WOUND CARE HEALING TIME:  Brink Melindi Osman Aamena, Gallaby Kaisser Validated View

THE IMPORTANCE OF IMPLEMENTING THE CORRECT WOUND CARE PROTOCOL TO SHORTEN THE WOUND CARE HEALING TIME:

Medical Science

Author(s): Brink Melindi

Coauthor(s): Osman Aamena, Gallaby Kaisser

Coordinator(s): MD Kaisser Gallaby

Keywords: Chronic wounds Wound care Wound healing time Wound care protocol

Introduction:

Acute wounds are wounds that heal unremarkable within a predicted amount of time. Chronic wounds begin as acute wounds that end in lengthy recovery and it is usually accompanied by comorbidities. A UK study revealed the annual incidence of chronic wounds are 575 600, with a total annual cost of £2.3 – 3.1 billion Chronic wounds were reported to be one of the most common cause of morbidity. All of this proves that to reduce the cost of chronic wounds the treatment aim should be to reduce the time of healing. The aim is to encourage health care workers to implement a wound care protocol to reduce the healing time, which will ultimately reduce the cost of chronic wound care. 

Material and Method: Patients were divided into 2 groups: Group 1 are patients with chronic wounds and comorbidities and group 2 are patients with acute wounds. The comorbidities of the patients in group 1 were identified. Then the TIME protocol is used to make a comprehensive assessment of each wound and determine an accurate treatment plan. Patients were followed-up every 3-4 days and the treatment plan ajusted accordingly.

Results: So far 9 patients have agreed to take part in the study. Out of the 8 patients with chronic wounds. The TIME protocol was implemented correctly 3 of the 5 patients’ wounds healed in a significantly shorter time. Out of the 2 patients with hypertension only 1 had a more rapid healing process. The most significant improvement can be seen in the patient with both hypertension and diabetes. This wound persisted for 12 years, but once the protocol was implemented correctly, the wound healed within 4 months.  

Conclusion: By implementing the TIME wound care protocol correctly, the time of healing of chronic wounds can be significantly reduced. 

Bibliography: 1. N. Kalarikkal; R. Augustine; O.S. Oluwafemy; Joshy K.S; Nanomedicine and tissue engineering: State of the art and recent trends; pg 496, Chapter 14. 2. Clark RAF. Wound repair: overview and general considerations. In: The Molecular and Cellular Biology of Wound Repair. Clark RAF, editor. London: Plenum Press, 1996; 3-50. 3. Clark RAF. Mechanisms of cutaneous wound repair. Volume 1. In: Dermatology in General Medicine. Fitzpatrick TB, Eisen AZ, Wolff K et al, editors. New York: McGraw-Hill, 1993; 473-86. 4. N. Graves; H. Zheng; The prevalence and incidence of chronic wounds: a literature review; Wound practice and research; volume 22, nr 1; March 2014. 5. Frykberg RG, Banks J. Challenges in the Treatment of Chronic Wounds. Adv Wound Care (New Rochelle). 2015 Sep 1. 4 (9):560-58 6. Shubhangi Vinayak Agale; Chronic leg ulcers: Epidemiology, Aetiopathogenesis and Management; Ulcers, volume 2013, Article ID 413604, April 2013. 7. Chandan K. Sen, PhD1, Gayle M. Gordillo, MD1, Sashwati Roy, PhD1, Robert Kirsner, MD2, Lynn Lambert, CHT1,3, Thomas K. Hunt, MD4, Finn Gottrup, MD5, Geoffrey C Gurtner, MD6, and Michael T. Longaker, MD6; Human Skin Wounds: A Major and Snowballing Threat to Public Health and the Economy Wound Repair Regen. 2009 ; 17(6): 763–771. doi:10.1111/j.1524-475X.2009.00543.x. 8. P.J. Franks; The burden of chronic wounds in the UK; Nursing times, 104:3, 44-45, 2008. 9. C. Dowsett; E. Ayello; TIME principle of chronic wound bed preparation and treatment; Br J Nurs 13(Suppl 15): S16-S23.

CAN PARENTS LEVEL OF KNOWLEDGE INFLUENCE THEIR DECISION TO VACCINATE THEIR CHILDREN?  Brink Melindi Papaeleftheriou Stavroula Validated View

CAN PARENTS LEVEL OF KNOWLEDGE INFLUENCE THEIR DECISION TO VACCINATE THEIR CHILDREN?

Public Health

Author(s): Brink Melindi

Coauthor(s): Papaeleftheriou Stavroula

Coordinator(s): Professor Gabriel Demofte

Keywords: Vaccine preventable diseases Anti-vaccine movement Vaccine safety Childhood diseases.

Introduction: In recent years the anti-vaccine movements have been greatly publicized, especially on social media.  This has resulted in parents questioning the safety of vaccines, to the extent that some parents have even refused to vaccinate children.

Vaccinations don't just protect vaccinated children, but also the community from epidemics.  Although the outcomes of vaccines are widely successful, the effectiveness of it depends on the public readiness to comply.

Therefore the aim is to determine whether the parent's knowledge have an impact on their decision to vaccinate their children and if doctors can influence this for the better.

Material and Method: A survey of 23 questions were compiled.  of these 16 questions were formulated to test the knowledge of parents related to vaccine preventable diseases and vaccines itself.
The English questionnaires were posted on social media.  The Romanian questionnaires were completed by parents in Sf.Maria children's hospital, Iasi.

Results: A total of 138 questionnaires were collected.

Only 51% of parents were concerned about the possibility of their children contracting a vaccine preventable disease.  Despite anti-vaccine movements promoting severe long term side effects, only 14% of parents were concerned about it.
Majority of parents were not aware what the complications of vaccines are.  Less than 40% of parents were aware that the prevalence of 4 childhood diseases are on the rise.  

Conclusion: The study showed that parents don't have sufficient information to make the immense decision to not vaccinate their children.
The future of vaccines are in doctors hands/  therefore we are responsible to educate parents more on the importance of vaccines.

Bibliography: 1. Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases. Saad. B. Omer, M.D, B.S, Ph.D, M.P.H; Daniel. A. Salmon, Ph.D, M.P.H; Walter. A. Orenstein, M.D; M. Patricia. deHart, Sc.D, and Neal. Halsey, M.D. New England Journal of Medicine. 2009 May 7; 360:1981-1988. 2. Epidemic Pertussis in 2012 - The resurgence of a vaccine - preventable disease. James. D. Cherry, M.D. New England Journal of Medicine. 2012 August 30; 367:785-787. 3. Is the Western Cape at risk of an outbreak of preventable childhood diseases? Lessons from an evaluation of routine immunisation coverage. Joanne Corrigall, David Coetzee, Neil Cameron. South African Medical journal. 2008, 98:41-45. 4. Understanding vaccine hesitancy around vaccine and vaccination from a global perspective: a systemic review of published literature. Larson HJ. Jarrett. C, Eckersberger E, Smith DM, Patterson P. Vaccine. 2014 April 17; 32(19): 2150-9. 5. Parental hesitation in immunizing children in Utah. Luthy KE, Beckstrand RL, Callister LC. Public Health Nurs. 2010 Jan-Feb; 27(1):25-31. 6. The relationship between parent attitudes about childhood vaccines survey scores and future child immunization status: a validation study. Opel. DJ, Taylor. JA, Zhou. C, Catz. S, Myaing. M, Mangione-Smith. R. JAMA Pediatr. 2013 November; 167 (11):1065-71. 7. Anti-vaccinationists past and present. Wolfe. Robert. M, Sharp. Lisak. British Medical Journal; London, 2002 August 24; 325:430-2. 8. Understanding those who do not understand: a brief review of the anti-vaccine movement. Gregory. A. Poland, Robert. M. Jacobson; Vaccine, volume 19, Issue 17-19, 21 March 2001, Pages 2440-2445. 9. Trends affecting the future of vaccine development and delivery: The role of demographics, regulatory science, the antivaccine movement, and vaccinomics. Gregory. A. Poland, Robert. M. Jacobson, Inna. G. Ovsynnikova; Vaccine, volume 27, Issue 25-26, 26 May 2009, Pages 3240-3244. 10. Anti-vaccination movement and their interpretations. Stuart Blume. Social Science and Medicine; Volume 62; Issue 3; February 2006; Pages 628-642.

THE CONTRIBUTION OF CA 125 IN THE DIAGNOSIS OF A HEPATOCELLULAR CARCINOMA  Muñoz Groza Adriana Estefa , Croitoru Bianca Elena - Validated View

THE CONTRIBUTION OF CA 125 IN THE DIAGNOSIS OF A HEPATOCELLULAR CARCINOMA

Case Report - Poster

Author(s): Muñoz Groza Adriana Estefa, Croitoru Bianca Elena

Coordinator(s): MD Daniel Cristian Pîrvu




A first case of radical cystectomy with Bricker ileal conduit urinary diversion  Mustea Elena , Moldovan Diana Maria Margareta Mureşan Tudor-Ionuţ Validated View

A first case of radical cystectomy with Bricker ileal conduit urinary diversion

Case Report - Poster

Author(s): Mustea Elena, Moldovan Diana Maria Margareta

Coauthor(s): Mureşan Tudor-Ionuţ

Coordinator(s): MD Cristian-Doru Pop

Introduction: Radical cystectomy with ileal conduit urinary diversion is a treatment option for aggressive bladder tumors. Bricker’s technique is designed to connect the remaining ureters to the abdominal wall by interposing an ileal segment. This conduit prevents urinary reflux and therefore the deterioration of upper urinary system.

Case Presentation:

 A 55-years old man was admitted to the urology department with macroscopic haematuria. Further investigation, including CT urography and cystoscopy set the diagnosis of bladder cancer. Consecutively a transurethral resection was performed, revealing a G3pT1 tumor, followed by BCG instillation therapy. Poor short-term outcome (tumor relapse at 1 and 3 months, high risk grading, invasive aspect on follow-up MRI) imposed for a radical therapy option.
A transperitoneal approach was used. The main operative steps included dissection and isolation of the ureters followed by ligation of latero-posterior bladder pedicles, incision of the rectovesical pouch, dissection of seminal vesicles and the posterior aspect of prostate down to the urethra. The dissection continued on the anterior wall of the bladder and the prostate with ligation of the dorsal vein complex and bilateral nerve sparing and exteriorization of the specimen. Pelvic lymph node dissection was performed before the laparotomic construction of the ileal conduit as described by Bricker.Except for an episode of obstructive pyelonephritis at 2 months (successfully treated with mono-J catheter permeabilization and antibiotics), the postoperative outcomes were favorable. CT urography at 4 months showed normal functioning kidneys, ureters and urinary diversion.

Conclusion: This case sustains the idea that Bricker’s ileal conduit is a feasible urinary diversion option for patients undergoing radical cystectomy.

Particularities: The first case of Bricker ileal conduit urinary diversion in the department.

THE MARGINAL EXCISION AS A TREATMENT OF THE INGROWN TOENAIL  Pirlea Radu Cristian , Pintea Ioana Alexandra Ignat Andreea-Melania, Gîrbovan Anamaria Hermina Invalidated View

THE MARGINAL EXCISION AS A TREATMENT OF THE INGROWN TOENAIL

Case Report - Poster

Author(s): Pirlea Radu Cristian , Pintea Ioana Alexandra

Coauthor(s): Ignat Andreea-Melania, Gîrbovan Anamaria Hermina

Coordinator(s): MD Adrian Boțan

Introduction: The ingrowing toenail is a common condition, but a disabling disease, in which the side of the toenail grows into the surrounding tissue. Usually the hallux is affected and frequently the pathology is bilateral. Possible symptoms may include: pain, inflammation , an overgrowth of skin around the ingrown toenail, bleeding, infection (granuloma pyogenes).

Case Presentation: We present three cases of ingrown toenail (within the Burn Center & Plastic Surgery Department, University of Tirgu - Mures Teaching Hospital before 2010.) The procedure consisted in the marginal excision of the nail plate, the nail bed , the corresponding portion of the nail matrix and the underlying periosteum (Finogradov - Haneke procedure) , furthermore the remaining wedge - shaped defect was closed by interrupted sutures.

Conclusion: The excisions must be limited only to the affected tissue and we need to create a „ tissue trough ” in which the new nail edges can „ glide ” and grow normally in order to prevent a possible relapse. It is considered a medical mistake to remove the whole nail plate, because the future nail will grow in the same place and shape as before. Conservative treatment should be considered for both functional and cosmetic aspects. 

Particularities: These particular cases are different because the ingrowth was present on both sides of each affected toenail.

IS CAREER CHOICE INVOLVED IN THE DEVELOPMENT OF BURNOUT SYNDROME?  GĂMAN Mihnea-Alexandru , COZMA Matei Alexandru DOBRICĂ Elena-Codruța Validated View

IS CAREER CHOICE INVOLVED IN THE DEVELOPMENT OF BURNOUT SYNDROME?

Public Health

Author(s): GĂMAN Mihnea-Alexandru, COZMA Matei Alexandru

Coauthor(s): DOBRICĂ Elena-Codruța

Coordinator(s): Professor habil. Amelia Maria GĂMAN, MD, PhD , Assistant Professor Liliana NEAGU, PhD

Keywords: burnout syndrome students chronic stress career choice

Introduction: Medical profession is associated with the development of burnout syndrome, a sum of emotional exhaustion (EE), diminished professional and personal achievements (DPPA), and depersonalization (DP). However, the syndrome seems to affect students in medicine, yet it unsure whether career motivation triggers the outburst of the phenomenon and whether it is depicted in undergraduates of other faculties as well1-4. Thus, we aimed to evaluate burnout syndrome in students enrolled in medical studies and two unrelated fields.

Material and Method: Maslach Burnout Inventory (MBI) was administered via an online survey to randomly chosen students in medicine (393 respondents, mean age=21.9 years), economics (192 respondents, mean age=20.47 years) and engineering (205 respondents, mean age=21.42 years) to assess the presence of burnout. MBI comprises 25 items evaluating three dimensions: EE (9 items), DPPA (6 items) and DP (10 items). Respondents rated statements on a one (very rare) to five (very frequently) scale.

Results: 34.1% of medical students were at high risk to develop burnout, with the highest and lowest score registered in the 3rd year (121/125 and 30/125 points, respectively). 22.92% of economics students scored highly for burnout risk, with high and low values noted in 1st (110/125 points), and 2nd year of study, respectively (36/125 points). Engineering undergraduates were at high risk of burnout in 32.20% of cases, with students in the 3rd year (121/125 points) being more prone and students in the 2nd year (36/125 points) less prone to burnout.

Conclusion: Our study shows that medical students are at the most risk to develop burnout, yet comparable values were registered in non-medical fields, pointing out that career choice influences the individual response to chronic occupational stress. However, although our research was limited by the personal perception of survey respondents, raises the question whether educational policies should undergo change in our country.

Bibliography: 1. Győrffy Z, Birkás E, Sándor I. Career motivation and burnout among medical students in Hungary - could altruism be a protection factor? BMC Medical Education. 2016;16:182. doi:10.1186/s12909-016-0690-5. 2. Ştiinţele Comportamentului Uman. Aplicaţii în medicină. Ovidiu Popa-Velea. Ediţia a II-a. Editura Trei, 2013. 3. Educational and Relational Stressors Associated with Burnout in Korean Medical Students Ji-Hyun Seo, Hye Jung Kim, Bong-Jo Kim, So-Jin Lee, Hwa-ok Bae. Psychiatry Investig. 2015 Oct; 12(4): 451–458. doi: 10.4306/pi.2015.12.4.451. 4. The prevalence and consequences of burnout on a group of preclinical dental students. Cigdem Atalayin, Murat Balkis, Huseyin Tezel, Banu Onal, Gul Kayrak. Eur J Dent. 2015 Jul-Sep; 9(3): 356–363. doi: 10.4103/1305-7456.163227.

The Incidence of Occupational Diseases in Public Medical System. A 27-Year Survey.  Niță Tiberiu - Validated View

The Incidence of Occupational Diseases in Public Medical System. A 27-Year Survey.

Public Health

Author(s): Niță Tiberiu

Coordinator(s): Lecturer Mihaela Stoia

Keywords: incidence occupational hospital causative

Introduction: Often less recognized occupational risk is an issue relevant to the healthcare sector. Diseases occurring in medical personnel may cause the impaired quality of life and even mortality. Therefore, our objective was to assess the incidence of occupational illness in public hospitals.  

Material and Method: An observational study was conducted using quantitative data from the Public Health Directorate of Sibiu records covering all public hospitals from Sibiu County, Romania. The time interval was selected between 1990 and 2016. All medical departments and every occupational category were included. Selection criteria: gender, affiliation, specialization, age and seniority at diagnosis of occupational disease and causative agents. All blind-identity data were statistically analysed with SPSS. 17.0 at a significance level p < 0.01.

Results: The total number reported was 61 cases, with a peak  in 2001 at the County Hospital. Individual characteristics were reported: 76.5% women; 39.4 years mean age of the employees; 10.5 years mean seniority of the staff. Occupational hepatitis, tuberculosis and contact dermatitis were prevailing pathologies. The viral infectious etiology was 49.1% and bacillary causative agents 25.4% of all cases. 1 registered case with chronic intoxication. The incidence rate of occupational disease decreases as follows: nurses 27.8% > orderly > resident physicians > physicians 11.4%; Affiliation: Respiratory Disease Hospital > Internal Medicine Clinic > Department of Surgery. . 

Conclusion: We conclude that our highlighted risk groups should be targeted for focused guidance. Under the time pressure and the decisional stress, the risk increases significantly. Certain factors (as protective equipment, deficient training, ineffective cooperation, working overtime or night shifts) should be inspected and improved. Effective interventions should be implemented.

Bibliography: [1] "Risks to health and safety for workers in the healthcare sector. Guide to prevention and good practice", European Commission, Office for Publications, Luxembourg, 2011. [2] Professor. A. Cocârlă - "Occupational Medicine", Medical University "Iuliu Haţieganu" Publishing House, Cluj-Napoca, 2009. [3] Lecturer Mihaela Stoia - "Psyhosocial working conditions in Romania: comparasion between blue and white collars", Acta Medica Transilvanica, 2015 (and other publications of our coordinator). [4] Ntambwe Malangu - "Analysis of Occupational Infections among Health Care Workers in Limpopo Province of South Africa" , Global Journal of Health Science, 2013. [5] Shireen A. Samargandy - "Epidemiology and clinical consequences of occupational exposure to blood and other body fluids in a university hospital in Saudi Arabia", Saudi Medical Journal, 2016. [6] Diego Montano - "Chemical and biological work-related risks across occupations in Europe: a review", Montano Journal of Occupational Medicine and Toxicology, 2014.

Right Colon Tumor- Case report  Ibrahim Elsherbiny Saif - Invalidated View

Right Colon Tumor- Case report

Case Report - Poster

Author(s): Ibrahim Elsherbiny Saif

Coordinator(s): MD Mihai Gherghinoiou , MD Andrei Chelaru

Introduction: Colorectal cancers are some of the most common causes of tumor deaths worldwide. The tumors grow slowly, and a long interval elapses before they are large enough to cause symptoms. The right colon, compared to the left, has a larger caliber, thinner wall and its contents are liquid; thus, obstruction is a late event. Bleeding is usually occult.

Case Presentation:

A 59 year old gentleman, presented to the outpatients clinic of the Emergency county hospital, Constanta, with the suspicion of a colonic tumor. At the time of admission, he complained of flatulence, intestinal transit disorders with constipation-diarrhea alternation, significant weight loss, fatigue and moderate physical asthenia. The gentleman was a type-2 diabetic, under treatment, with a recent diagnosis of bilateral occlusion of the superficial femoral arteries. The history of the disease showed that the actual suffering dates back to approx. 6 months with an insidious onset of intestinal transit disorders. In the following period, the initial symptoms had evolved towards the clinical picture presented at the time of admission. Up to the time of presentation, the patient was hospitalized at the cardiovascular surgery clinic for intermittent claudication where clinical examination revealed a periumbilical palpable tumor formation, after which an abdominopelvic CT scan was performed. Eventually, further examination revealed a tumor formation at the transverse colon more towards the hepatic flexure with a complete obstruction and secondary hypochromic microcytic anemia.


Conclusion: A right hemicolectomy was performed with an extended lymphadenectomy and ligation of the vessels and the gentleman has been under chemotherapy for a year with long term supervision.

Particularities:

An unbalanced case with multiple complications; highly mobile tumor with contradictory exploratory tests; surgical indication in emergency conditions delayed; voluminous tumor without serous invasion; bulky regional adenopathy; possibility of achieving extended lymphadenectomy with ligation of vessels

IS DEPRESSION CORRELATED WITH THE MOTOR DEFICIT IN ALS?  Mudava Mihai - Validated View

IS DEPRESSION CORRELATED WITH THE MOTOR DEFICIT IN ALS?

Medical Science

Author(s): Mudava Mihai

Coordinator(s): Lecturer Anca Ioana Moţăţăianu , Lecturer Adina Stoian

Keywords: amyotrophic lateral sclerosis motor deficit depression Beck questionnaire

Introduction: Amyotrophic lateral sclerosis (ALS) is a fatal disease with a median survival of 2-3 years since the onset of symptoms. ALS is characterized by death of central and peripheral motor neuron. “Amyotrophy” refers to the atrophy of denervated muscle fibers as their corresponding anterior horn neurons degenerate and “lateral sclerosis” refers to the changes in the lateral columns of the spinal cord. Medical complications like aspiration pneumonia and respiratory insufficiency are contributing to mortality in ALS. The depression occurs as a consequence of the motor deficit because it advances in a short time and there isn`t a specific medication to stop it`s evolution. Our aim was to evaluate the presence of depression and to find a correlation of it with the motor deficit.

Material and Method: We conducted a prospective study that included 12 patients diagnosed with ALS in 2017 at the I-st Clinic of Neurology from the Emergency County Hospital of Targu Mures. We used the ALS Functional Rating Scale(ALSFRS) and ALSFRS-R (Revised) to calculate the pacients`s degree of functional impairment and asked them to complete the Beck questionnaire (BDI-II) for measuring the severity of depression. 

Results: We found out that 3 patients were presenting a medium motor deficit and borderline clinical depression according to the BDI-II, 1 of them presented extreme depression which was correlated to an extended motor impairment and 5 patients had no depression and a low or medium motor impairment. We noticed a significant Spearman correlation – RC (p=0.0202, r=0.6665), 95% CI:(0.1309-0.909) between the presence of depression and the degree of motor deficit. Seven patients needed treatment for their different levels of depression based on the BDI-II score and all of them are monitorized in evolution.

Conclusion: We found a correlation in our study between the occurrence of depression and the degree of motor impairment in the patients with ALS.

Bibliography: 1. Roos E, Mariosa D, Ingre C, Lundholm C, Wirdefeldt K, Roos PM, Fang F. Depression in amyotrophic lateral sclerosis. Neurology, 2016 Jun 14;86(24):2271-7 2. Thakore NJ, Pioro EP. Depression in ALS in a large self-reporting cohort. Neurology. 2016 Mar 15;86(11):1031-8 3. Aho-Özhan HE, Böhm S, Keller J, Dorst J, Uttner I, Ludolph AC, Lulé D. Experience matters: neurologists' perspectives on ALS patients' well-being. J Neurol. 2017 Apr;264(4):639-646.

Clinical manifestations in DiGeorge syndrome  Lie Delia - Validated View

Clinical manifestations in DiGeorge syndrome

Case Report - Poster

Author(s): Lie Delia

Coordinator(s): Lecturer Cecilia Lazea

Introduction: DiGeorge syndrome, also known as 22q11.2 deletion syndrome, is a genetic disorder resulting in medical complications, cognitive impairment, and brain morphologic changes. It is also associated with truncus arteriosus and tetralogy of Fallot. This syndrome is characterized by incomplete penetrance and therefore there is a marked variability in clinical expression between the different patients. 

Case Presentation:

We present two female patients with DiGeorge syndrome, with different clinical manifestations.
Patient 1 was diagnosed with tetralogy of Fallot, pulmonary valve atresia, aorto-pulmonary collaterals and patent ductus arteriosus, immediately after birth. At the age of one month she was hospitalized for cyanosis, failure to thrive and seizures at the right body. The level of calcium and PTH(Parathyroid hormone) were normal. She was treated with Phenobarbital for one year and she has not repeated the seizures, so treatment was ceased. The patient also presented dysmorphic features, incomplete syndactyly of the feet fingers, spleen anomaly, hiatal hernia. FISH(Fluorescence in situ hybridization) test revealed 22q11.2 deletion. Patient associated recurrent respiratory and digestive infections and moderate intellectual and neuro-motor delay.
Patient 2 was diagnosed with interrupted aortic arch in the last trimester of pregnancy. After birth, the patient presented dysmorphic features, interrupted aortic arch, ventricular septal defect. She was operated immediately after the birth, with very good evolution. FISH test revealed 22q11.2 deletion. The level of PTH was very low, so she was also diagnosed with hypoparathyroidism. At the age of 4 month, during a respiratory infection she presented hypocalcemia and seizures, despite the regular treatment with calcium. This patient also associated recurrent respiratory infections and mild intellectual and neuro-motor delay.

Conclusion: DiGeorge syndrome represents an important cause of severe cardiac malformations and hypoparathyroidism.

Particularities: The severity of hypocalcemia and hypoparathyroidism are variable in DiGeorge syndrome.

Congenital tracheoesophageal fistula : a case report  Lucia Raluca Ardelean - Invalidated View

Congenital tracheoesophageal fistula : a case report

Case Report - Poster

Author(s): Lucia Raluca Ardelean

Coordinator(s): Assistant Professor Anca Budusan

Introduction: A congenital tracheoesophageal fistula is a condition that represents an abnormal communication between trachea and esophagus. Frequency is extremely rare (0,1%) and difficult to diagnose. The aim of this presentation is to present the importance of recognition of tracheoesophageal malformation in neonate and infant period.
Case Presentation: A male pacient of 1 year and 2 months was admitted in our clinic. He was known in his medical history with recurrent pulmonary infections and frequent admitances in another hospitals. At birth, he suffered meconium aspiration syndrome and he was checked for tracheoesophageal fistula using conventional radiology, but surgical and other examinations outcomes suggested gastroesophageal reflux and he was treated for that. Due to his recurrent evolution, he was admitted in County Pediatric Emergency Hospital of Cluj Napoca- Pediatric Pneumology. Bronhoscopy was performed and revealed a communication between esophagus and trachea with the significance of  congenital tracheoesophageal fistula. CT scan was made to asses pulmonary complications- no complications were pointed out. Surgical treatment of tracheoesophageal fistula was carried out. His outcome was good and pacient was discharged with good outcome.
Conclusion: In conclusion, when recurrent respiratory infections are present in infant period, tracheoesophageal fistula must be considered, even if it's very rare.
Particularities: Congenital tracheoesophageal fistula must be considered due to it's rare frequency in reccurent pulmonary infections in infant period.

THE ONSET OF CERVICAL CANCER SCREENING IN WOMEN YOUNGER THAN AGE 25 – IS IT WORTH IT?  Mihalcea Ana-Raluca Cudalba Delia Ioana Validated View

THE ONSET OF CERVICAL CANCER SCREENING IN WOMEN YOUNGER THAN AGE 25 – IS IT WORTH IT?

Public Health

Author(s): Mihalcea Ana-Raluca

Coauthor(s): Cudalba Delia Ioana

Coordinator(s): Assistant Professor Doris Marilena Ionescu

Keywords: cervical cancer Babes-Papanicolaou screening

Introduction: In the United States, cervical cancer screening is recommended to start at age 211, whereas most European countries suggest that screening begin at age 25 (including Romania)2. Moreover, some studies suggest that women aged under 21 years should not be screened regardless of the age of sexual initiation or other risk factors. Despite current guidelines, ongoing medical practice certifies cases of young women under 25 years old who were found to have low-grade squamous intraepithelial lesions (LSIL) or even high-grade squamous intraepithelial lesions (HSIL). These diagnoses reported throughout our study and in the literature rise an issue of controversy. 

Material and Method: In this retrospective study, we analyzed, throughout 6 months, the results of Babes-Papanicolaou tests performed as a routine screening on 500 young women aged 18 to 25, sexually active. The results were confirmed by colposcopy

Database research on review articles and meta-analysis on internet searching engines and cervical cytology related books was performed. 

Results: There were 24 diagnoses of squamous intraepithelial lesions of which 22 were LSIL and 2 HSIL. Our results are in agreement with the hypothesis which states the necessity of guidelines reevaluation.
Researchers have put forward their concerns regarding the increased age at which women will start having Babes-Papanicolaou tests. It was highlighted that the results of Pap smears performed on young women aged 25 to 29 were positive for cervical cancer, when the age of onset rose from 21 to 25 in Europe.3 

Conclusion: Positive test results of women younger than the age of onset of cervical cancer screening enter into a polemic against current guidelines. 
While there are still many questions left unanswered, there is need for further research on the utility of cervical cancer screening in younger women and on other risk factors which are believed to contribute to developing cervical cancer alongside HPV infection or individually.  

Bibliography: 1. American Cancer Society, Cervical Cancer Screening Guidelines for Average-Risk Women; 2. Official Journal of Romania no. 547/2009 – decision no.881/706/2009, article 2, paragraph 2; 3. Screening and Immunisations Team, Health and Social Care Information Centre. Cervical Screening Programme, England 2012–13, HSCIC.

Schwannoma Relapse after Gamma-knife Surgery: Case Report  Reda Elsayed Abdalla - Invalidated View

Schwannoma Relapse after Gamma-knife Surgery: Case Report

Case Report - Poster

Author(s): Reda Elsayed Abdalla

Coordinator(s): Associate Professor Ligia Tataranu

Introduction: Gamma Knife surgery uses 3-D positioning tools to shoot a dose of radiation at just the right spot, killing brain tumors — or creating lesions that control other brain disorders. The gamma radiation distorts or destroys the DNA of tumor cells, causing them to be unable to reproduce and grow. The tumor will shrink in size over time. Brain conditions that may be treated with a Gamma Knife procedure include, but are not limited to brain tumors and cancers.

Case Presentation:

A 52-year old female patient was presented in 2006 in the Emergency Hospital of Bagdasar-Arseni with left facial paresis and Parkinson’s disease. The investigations showed the presence of a vestibular schwannoma that was partially resected (subtotal intracapsular resection) through a retromastoidian surgical approach, in October 2006. Later in the same year, in December, the patient presented again to the hospital as the tumor relapsed, and the patient went through a Gamma Knife radiation therapy to ablate the tumor. The tumor was removed with the statement of a favorable postsurgical evolution. In 2011, the patient came back to the hospital with the same previous symptoms along with hearing loss in the left ear and a decrease in the visual acuity of both eyes. Investigations showed a relapse of the tumor along with a peritumoral cyst. The patient was operated once more through a retromastoidian approach, as the cyst was evacuated and the tumor was found to be extra-axial, well delimitated and polynodular, being a probable relapse of the pervious schwannoma.


Conclusion: Total excision of the tumor was performed and since then the patient presents to the hospital periodically for control with a slight improvement of her symptoms.

Particularities: Even with the safety, precision and effectiveness of Gamma Knife Surgery, the relapse rates of brain tumors is mostly dependent on the nature and evolutionary course of the initial tumor

The evolution of surgical management of complicated colon cancer  Ionescu Vlad Adrian , Tuica Larisa Mihaela Olteanu Mihaela Validated View

The evolution of surgical management of complicated colon cancer

Surgical Science

Author(s): Ionescu Vlad Adrian , Tuica Larisa Mihaela

Coauthor(s): Olteanu Mihaela

Coordinator(s): Assistant Professor Marius Bica , Professor Valeriu Şurlin

Keywords: subtotal colectomy obstruction perforation anastomosis

Introduction: The goal of the study is to follow the evolution in time of the therapeutic approach in complicated colon cancer regarding single stage or multiple stage surgery.

Material and Method: We analyzed two groups of patients with colon cancer admitted to 1st Surgical Clinic of The Emergency County Clinical Hospital of Craiova. Group 1 included colon cancer patients admitted between 2001 and 2010. Group 2 included patients admitted between 2011 and 2016. We mainly followed complicated cancer cases that underwent emergency surgery and the surgical approach for those cases. Later we compared single stage and multiple stage procedures for the two groups thus attempting to show changes in surgical management between the two time periods.

Results: Group 1 included 370 colon cancer patients admitted between 2001 and 2010. 121 patients (32,7%) required emergency surgery (23 patients (19%) with right colon cancer, 98 patients (81%) with left colon cancer). Single stage procedures (colon resection with anastomosis): 23 cases (12 patients with right colon cancer (52,1% of complicated right colon cancers); 11 cases of left colon cancer representing 11,2% of complicated left colon cancers). Multiple stage procedures: 98 cases (11 cases with right colon cancer (47,9%) and 87 cases with left colon cancer - 88,8%).

 Group 2 included 265 cases. 85 cases underwent emergency surgery. 65 patients with complicated left colon cancer (22 single stage procedures and 37 multiple stage procedures) and 23 patients with complicated right colon cancer (15 single stage interventions and 8 multiple stage procedures).

Conclusion: The evolution in time of emergency surgical approach in complicated colon cancer consists in a bolder approach of cases with the increase of the number of resection with primary anastomosis procedures.

Bibliography: -Dong Baek Kang, Chang Yeol Shin, Jeong Kyun Lee, Won Cheol Park - Multivariate Analysis of the Risk Factors Associated with Complications and Mortality after and Emergency Operation for Obstructive, Perforated Colorectal Cancer; Korean Soc Coloproctol. 2009 Jun;25(3):165-171 -Min Sang Kim, Seung Woo Lim, Sung Jin Park, Geumhee Gwak, Keun Ho Yang, Byung Noe Bae, Ki Hwan Kim, Sewhan Han, Hong Joo Kim, Young Duck Kim, Hong Yong Kim - Survival Rate and Prognostic Factors in Perforated Colorectal Cancer Patients: A Case-Control Study, J Korean Soc Coloproctol. 2010 Feb;26(1):69-75 -Biondo S., Marti-Rague Joan, Kreisler Esther, Pares D., Martin A., Navarro Matilde, Pareja Laura, Jaurrieta E. - A prospective study of outcomes of emergency and elective surgeries for complicated colonic cancer; Am J Surg, April 2005, Vol. 189, Nr. 4: 377-383 -Smothers L.,Linda Hynan, Fleming J., Turnage R., Simmang C., Anthony T. - Emergency Surgery for Colon Carcinoma; Dis Col Rectum Jan 2003;Vol. 46;No. 1: 26-30 -Cuffy Madison, Abir F., Audisio R.A., Longo W.E. - Colorectal cancer presenting as surgical emergencies; Surg Onc Aug 2004; Vol. 13, No. 2: 149-157 -Hennekinne-Mucci Stéphanie , Tuech J.J., Bréhant O., Lermite Emilie, Bergamaschi R., Pessaux P., Arnaud J.P. - Emergency subtotal/total colectomy in the management of obstructed left colon carcinoma; Int J Colorectal Dis, sept 2006; Vol. 21, No 6: 538-541

PHOSPHOLAMBAN PHOSPHORYLATION ON SERINE16: CLINICAL AND MOLECULAR MANIFESTATIONS IN HYPERTROPHIC CARDIOMYOPATHY  Zah Corina Adelina - Invalidated View

PHOSPHOLAMBAN PHOSPHORYLATION ON SERINE16: CLINICAL AND MOLECULAR MANIFESTATIONS IN HYPERTROPHIC CARDIOMYOPATHY

Medical Science

Author(s): Zah Corina Adelina

Coordinator(s): Assistant Professor Diederik Kuster

Keywords: Hypertrophic Cardiomyopathy Phospholamban Serine16 phosphorylation MYBPC3

Introduction: Hypertrophic cardiomyopathy (HCM) is an inherited disease with an incidence of 1 in 500 people.More than 50 types of mutations in 13 genes encoding sarcomeric proteins cause HCM out of which mutations in cardiac myosin binding protein C (MYBPC3) are frequently encountered. A hallmark of HCM is impaired cytoplasmic Ca2+ handling of cardiomyocytes. Phospholamban(PLN), a regulator protein, plays an important role in Ca2+ reuptake in the sarcoplasmic reticulum, by regulating the SERCA2A pump. In this study we tried to identify how the level of PLN phosphorylation affects the function of the heart at a clinical and molecular level. 

Material and Method: Western blotting was used to determine PLN phosphorylated on Serine16 (Ser16). Statistical analyses were used to find correlations between PLN(Ser16), echocardiographic parameters and in vitro measurements. The clinical database consisted of left atrium dimensions, an estimation of the left ventricular filling pressure and interventricular septum (IVS) thickness. In vitro measurements consisted of calciun sensitivity (EC50) and the passive force(Fpassive) produced by the cardiomyocyte. Both were measured at the sarcomere lengths of 1.8µm and 2.2µm.

Results: Statistical significance was found between PLN and IVS (p=0.0431), showing that the septum thickness is increased at higher levels of PLN phosphorylation. Regarding the in vitro measurements, at the length of 2.2μm, the p value (0.0313) proves that the more phosphorylated Ser16 is, the higher the Fpassive produced by the cardiomyocyte. 

Conclusion: Despite the important role PLN plays in the healthy cardiomyocyte, it revealed little changes in the hypertrophic cell in patients with MYBPC3 mutation. This only led us to believe that PLN does not have a crucial role in the development of the disease as it was thought so far.  

Bibliography: 1.Ljubojevic, S., Radulovic, S., Leitinger, G., Sedej, S., Sacherer, M., Holzer, M., … Pieske, B. (2014). Early remodeling of perinuclear Ca2+ stores and nucleoplasmic Ca2+ signaling during the development of hypertrophy and heart failure. Circulation, 130(3), 244–255. 2.Sen-Chowdhry S, Jacoby D, Moon JC, McKenna WJ. Update on hypertrophic cardiomyopathy and a guide to the guidelines. Nat Rev Cardiol [Internet]. 2016 Nov;13(11):651–75. 3.Zile, M. R., & Brutsaert, D. L. (2002). New concepts in diastolic dysfunction and diastolic heart failure: Part I: Diagnosis, prognosis, and measurements of diastolic function. Circulation, 105(11). 4.Wu AZ, Xu D, Yang N, Lin S-F, Chen P-S, Cala SE, et al. Phospholamban is concentrated in the nuclear envelope of cardiomyocytes and involved in perinuclear/nuclear calcium handling. J Mol Cell Cardiol [Internet]. 2016;100:1–8. 5.Tardiff JC. The Role of Calcium/Calmodulin-Dependent Protein Kinase II Activation in Hypertrophic Cardiomyopathy. Circulation [Internet]. 2016;134(22):1749–51.

Echocardiographic assessment of cardiac function in asymptomatic for heart failure patients with type 2 diabetes mellitus  Ciocan Roxana - Invalidated View

Echocardiographic assessment of cardiac function in asymptomatic for heart failure patients with type 2 diabetes mellitus

Medical Science

Author(s): Ciocan Roxana

Coordinator(s): Assistant Professor Elena-Daniela Grigorescu

Keywords: Diabetes mellitus Cardiovascular disease Echocardiography Case series

Introduction: Diabetes mellitus (DM) is a well-established risk factor for cardiovascular disease (CVD). People with type 2 diabetes mellitus (T2DM) have a higher cardiovascular morbidity and mortality. DM is responsible for two-eight-fold improve in the risk of heart failure. Among patients with T2DM with no clinical signs of atherosclerotic cardiovascular disease, the first sign of cardiac injury is diastolic dysfunction (DD). Early diagnosis of subclinical cardiovascular impairment, followed by sustained therapeutic intervention can decrease the risk of fatal or non-fatal CV events.

Material and Method: We bring to your attention a series of 6 patients(4 women and 2 men) with uncontrolled diabetes, asymptomatic for heart failure. They associate abdominal obesity, dyslipidemia, hypertension and hepatic cytolysis syndrome. These patients were carefully evaluated through clinical and laboratory findings including echocardiography. Their current diabetologist, according to national protocols, initiated treatment with a DPP-4 inhibitor as add-on therapy to metformin and/or sulphonylurea.

Results: The mean diabetes duration of these patients is 7,5 years, all 6 cases have poor glycemic controll (baseline mean HbA1c= 7.78%). No ECG changes were found. In the clinical course of patients with T2DM was investigated the homeostasis model assessment as an index of insulin resistance(HOMA-IR), which values was above 5. The values for echocardiographic parameters evaluating diastolic function were: E/A=1.59, 1.1, 0.55, 0.52, 1.4 ,1.72 and E/Ea=3.47, 5.58,  2.85, 3, 2.77. Also one patient present the calcification of the mitral ring. Following the assessment of chronic diabetic associated complications there were not found signs of retinal and renal microangiopathy, but all patients have diabetic neuropathy.

Conclusion: We want to bring to attention the complexity of diabetes management and the necessity of the cardiac function evaluation in asymptomatic for heart failure patients. Also, the oral antidiabetic therapy with proved cardiovascular safety and benefits can prevent or/and delay deterioration of the diastolic and systolic left ventricular function.

Bibliography: 1. Type 2 diabetes and cardiovascular disease: Have all risk factors the same strength?, Iciar Martín-Timón, Cristina Sevillano-Collantes, Amparo Segura-Galindo, and Francisco Javier del Cañizo-Gómez, World J Diabetes, 2014 Aug 15; 5(4): 444–470. 2. Development and validation of risk assessment models for diabetes-related complications based on the DCCT/EDIC data, Vincenzo Lagania, Franco Chiarugia, Shona Thomsonb, Jo Furssec, Edin Lakasingc, Russell W. Jonesc, Ioannis Tsamardinosa, Journal of Diabetes and its Complications, Volume 29, Issue 4, May–June 2015, Pages 479–487 3. Assessing Cardiovascular Risk Factors and Selecting Agents to Successfully Treat Patients With Type 2 Diabetes Mellitus, Mark D. Baldwin, DO, FACOI, The Journal of the American Osteopathic Association, July 2011, Vol. 111, S2-S12. 4. Is Glucose Control Important for Prevention of Cardiovascular Disease in Diabetes?, Edoardo Mannucci, MD, Ilaria Dicembrini, MD, Angelo Lauria, MD and Paolo Pozzilli, MD, Diabetes Care 2013 Aug; 36(Supplement 2): S259-S263.

E-health tools in monitoring long-term treatment of inflammatory bowel disease – a review of recent clinical trials  Dăscălescu Vlad-Constantin - Invalidated View

E-health tools in monitoring long-term treatment of inflammatory bowel disease – a review of recent clinical trials

Fundamental Science

Author(s): Dăscălescu Vlad-Constantin

Coordinator(s): Professor Sorana-Daniela Bolboacă

Keywords: e-health inflammatory bowel disease Crohn’s disease ulcerative colitis

Introduction: Inflammatory bowel diseases (IBD) represent a therapeutic challenge mainly because of poor patient adherence to treatment and high frequency of relapses, thus decreasing quality of life (QoL) and increasing hospitalization costs. The purpose of this review was to identify whether recent clinical trials confirm that available e-health tools are useful in monitoring of IBD without a decrease in QoL score, treatment adherence and increase of disease activity.
Material and Method: PubMed database was searched on February 2017 using the keywords “e-health* AND inflammatory bowel disease*”. The search strategy was restricted to articles published in English since 2007. Only clinical trials concerning e-health systems and services were considered. 61 articles were identified and 9 were found relevant after full-text review.
Results: In total, 967 patients were enrolled in clinical trials involving various e-health monitoring systems and all trials compared collected data to a control group or to a pre-established baseline. In assessing QoL and treatment adherence, there is no study suggesting that e-health systems have a negative effect when compared to standard. All available trials found the same or slightly higher QoL and adherence score when compared to control groups or baseline. Regarding disease activity, all studies concluded that treatment-adjusting e-health services does not offer any increase in disease activity when compared to traditional monitoring systems.
Conclusion: E-health offers a safe alternative to face-to-face managing systems without the risk of impaired disease control. These systems show promise to improve medication adherence, QoL and reduce costs for patients with long-term inflammatory bowel diseases.
Bibliography: [1] Pedersen N. EHealth: self-management in inflammatory bowel disease and in irritable bowel syndrome using novel constant-care web applications. EHealth by constant-care in IBD and IBS. Dan Med J, 2015 Dec;62(12):B5168 [2] Carlsen K, Jakobsen C, Houen G, Kallemose T, Paerregaard A, Riis LB, Munkholm P, Wewer V. Self-managed eHealth Disease Monitoring in Children and Adolescents with Inflammatory Bowel Disease: A Randomized Controlled Trial. Inflamm Bowel Dis. 2017 Mar;23(3):357-365. [3] Akobeng AK, O'Leary N, Vail A, Brown N, Widiatmoko D, Fagbemi A, Thomas AG. Telephone Consultation as a Substitute for Routine Out-patient Face-to-face Consultation for Children With Inflammatory Bowel Disease: Randomised Controlled Trial and Economic Evaluation. EBioMedicine. 2015 Aug 8;2(9):1251-6. [4] Pedersen N, Thielsen P, Martinsen L, Bennedsen M, Haaber A, Langholz E, Végh Z, Duricova D, Jess T, Bell S, Burisch J, Munkholm P. eHealth: individualization of mesalazine treatment through a self-managed web-based solution in mild-to-moderate ulcerative colitis. Inflamm Bowel Dis. 2014 Dec [5] Hommel KA, Hente E, Herzer M, Ingerski LM, Denson LA. Telehealth behavioral treatment for medication nonadherence: a pilot and feasibility study. Eur J Gastroenterol Hepatol. 2013 Apr;25(4):469-73. [6] Pedersen N, Elkjaer M, Duricova D, Burisch J, Dobrzanski C, Andersen NN, Jess T, Bendtsen F, Langholz E, Leotta S, Knudsen T, Thorsgaard N, Munkholm P. eHealth: individualisation of infliximab treatment and disease course via a self-managed web-based solution in Crohn’s disease. Aliment Pharmacol Ther. 2012 Nov;36(9):840-9. [7] Elkjaer M. E-health: Web-guided therapy and disease self-management in ulcerative colitis. Impact on disease outcome, quality of life and compliance. Dan Med J. 2012 Jul;59(7):B4478. [8] Cross RK, Cheevers N, Rustgi A, Langenberg P, Finkelstein J, Randomized, controlled trial of home telemanagement in patients with ulcerative colitis (UC HAT). Inflamm Bowel Dis. 2012 Jun;18(6):1018-25 [9] Elkjaer M, Shuhaibar M, Burisch J, Bailey Y, Scherfig H, Laugesen B, Avnstrøm S, Langholz E, O'Morain C, Lynge E, Munkholm P. E-health empowers patients with ulcerative colitis: a randomised controlled trial of the web-guided 'Constant-care' approach. Gut. 2010 Dec;59(12):1652-61

Syndrome of Inappropriate Antidiuretic Hormone Secretion- Is there more to it than hyponatremia?  Tartamus Stefana Szucs Adriana Roxana Invalidated View

Syndrome of Inappropriate Antidiuretic Hormone Secretion- Is there more to it than hyponatremia?

Case Report - Poster

Author(s): Tartamus Stefana

Coauthor(s): Szucs Adriana Roxana

Coordinator(s): MD Dana Crisan

Introduction:

Syndrome of Inappropriate Antidiuretic Hormone Secretion(SIADH) is a disease defined by innapropriate secretion of vasopressin and characterized by hyponatrimia, low serum osmolarity and impaired water secretion.
SIADH is often caused by an elevated hypothalamic secretion or by an ectopic production.It can be seen in various settings such as nervous system disorders, neoplasia, pulmonary diseases and it can be drug induced. 

Case Presentation:
A 70-years-old patient presents with abdominal pain,nausea,vomiting, dizziness and inconstant blurry vision. The gastrointestinal symptoms started a week ago and worsened over time. The patient is known to have colonic diverticulosis and std.IIB hypertension (treated with Ramipril and Tertensif).
The blood tests have shown severe hyponatremia and hypochloremia,slightly lowered serum proteins, hypoosmolarity and low uric acid levels.Urinary electrolytes were tested and high natriuria and hyperosmolarity were found.
The differential diagnosis for hyponatremia took into account the plasma osmolarity and the patients volemic state. The patient showed no improvement in sodium levels after the diuretics were redrawn but kept his euvolemic status.
SIADH has been confirmed by high levels of vasopressin. The patient underwent investigations such as cerebral CT that was normal, a chest X-ray that identified a mass in the left lung. The mass was further investigated and it turned out to be Small Cell Pulmonary Carcinoma.

Conclusion:
The patient was referred to an oncologist and received treatment for the tumor :radiotherapy and chemotherapy. Shortly after, a significant reduction in the tumors size was noted.


Particularities:
The main particularity of this case is that the diagnosis algorithm was triggered only by altered sodium levels. The patient did not present any signs of lung mass nor malignancy such as weight loss or anemia.
Another particularity is the outcome. Even though hyponatremia is a sign of bad prognosis for lung cancer the patient responded well to treatment and had a good recovery.

NASAL RECONSTRUCTION WITH CHIMERIC FRONTAL AND RETROANGULAR CROSS FLAPS BASED ON SUPRAORBITAL ARTERY  Bubău Ana Marina Toma Mihai, Ciortianu Laura-Elena Validated View

NASAL RECONSTRUCTION WITH CHIMERIC FRONTAL AND RETROANGULAR CROSS FLAPS BASED ON SUPRAORBITAL ARTERY

Case Report - Poster

Author(s): Bubău Ana Marina

Coauthor(s): Toma Mihai, Ciortianu Laura-Elena

Coordinator(s): Assistant Professor Eyuphan Gencel

Introduction:

Basal-cell-carcinoma (BCC) is the most common form of malignancy1 and can be highly disfiguring as it mostly occurs on visible areas such as the neck and face2, especially rare, aggressive subtypes like basosquamous(BSC), which are prone to incomplete excision and recurrence3,4. When facing recurrent BCC, the main issues are local flap loss and the necessity to find new flap designs based on intact vessels.
Thereby, we describe the chimeric flap, a less-used but suitable form of therapy for complex craniofacial defects5,6,7.

Case Presentation:
We report the case of a 60-year-old diabetic woman with recurrent BCC of the nasal tip, dorsum and right nasolabial area, which, by the time of admission to our hospital, had ulcerated despite previous surgery.
Histopathological examination of the piece confirmed the BSC subtype. Before reconstruction, hand-held Doppler was performed to evaluate the vascular system.
Assessing the extensive tissue loss caused by the excision of the BSC and the patient’s comorbidities, we decided upon nasal reconstruction with modified chimeric flap composed of right supratrochlear artery-based frontal flap and left angular artery-based reverse-flow(retroangular) flap, a premiere in the department.
Nasal lining and external reconstruction were done without flap loss and the general outcome was favorable, without complications or recurrence two years after the surgery.

Conclusion:
Taking into consideration the patient’s background, a free flap was not an option due to high risk of flap loss. Moreover, as Georgescu8 has proved, compared to perforator flaps, when a free flap is lost, everything is lost.
But the loss of a perforator flap involves only the superficial part, whilst it has done its job covering the denuded anatomical elements while the wound granulates and heals.

Particularities: Complicated case of BSC causing extensive midface tissue loss was solved with a modified chimeric flap using the supraorbital- dorsonasal - angular-based reverse-flow artery systems.

A RARE CASE OF PHACE SYNDROME   Danciu Sabrina - Validated View

A RARE CASE OF PHACE SYNDROME

Case Report - Poster

Author(s): Danciu Sabrina

Coordinator(s): MD Maria - Corina Stanciulescu

Introduction: PHACE Syndrome is a disease represented by the presence of a large hemangioma (covering a large area of  skin on the head or neck, greater than 5 cm) associated with several other abnormalities affecting the posterior fossa (brain), eyes, heart, chest wall and greater vessels. It affects girls nine times more often than boys.  

Case Presentation: Our patient, a one month old baby girl, was brought in the Pediatric Emergency Hospital “Louis Turcanu” Timisoara with multiple red colored “tumor like” lesions on the superior lip and mandible area, soft in consistency, with no sign of inflammation, measuring 7/3 cm on the left side and 8/4.5 cm on the right side. The inferior lip was also affected by a ulcerous hemangioma, both the external and internal surfaces, making the feeding process painful for the child. Performing an echocardiography showed arteria lusoria (aberrant left subclavian artery) and also subependymal cysts. She was diagnosed with PHACE Syndrome. A feeding tube was placed to prevent starvation. She begun systemic therapy with Propanolol (2 mg/kg/body/day).  

Conclusion: After 5 days, the facial hemangiomas became noticeably paler and the patient was able to feed without the help of the feeding tube. After 6 weeks, the inferior lip ulcerations were healed and she started gaining considerable weight. After 6 months of treatment we got successful results, the hemangiomas remised and only a few telangiectasia spots were left in the facial region. The treatment was continued until the age of 1 years and 6 months.   
Particularities:  The child presented a rare disease that was difficult to identify because of its multiple abnormalities and unspecific symptoms. However, with a careful evaluation it was correctly diagnosed. The patient responded very well to the treatment with beta blocker.  

TRANSPERINEAL EVALUATION OF FETAL HEAD ENGAGEMENT IN PRIMIPAROUS AT TERM  Roy Sandra Susan John Nithiya Kadampattu, John Aksa Validated View

TRANSPERINEAL EVALUATION OF FETAL HEAD ENGAGEMENT IN PRIMIPAROUS AT TERM

Surgical Science

Author(s): Roy Sandra Susan

Coauthor(s): John Nithiya Kadampattu, John Aksa

Coordinator(s): Lecturer Dominic Iliescu , MD Zorila Lucian

Keywords: Transperineal scan Fetal head engagement primiparous prenatal diagnosis

Introduction: Clinical lack of fetal head engagement (FHE) in term primiparous has a controversial incidence and has been associated with labour arrest disorders. Our objective was to determine longitudinally the rate of FHE using transperineal ultrasound in primiparous at term. We also analysed the temporal evolution of fetal head situation at term and the correlations with the delivery mode.

Material and Method:  Unselected primiparous were invited for a series of weekly scans, starting at 37GW. We determined the occiput position, progression angle (PA), progression distance (PD), direction angle (DA) and head to perineum distance (HPD). The measurements were compared against the cut-offs for station 0 from the literature (PA >116 - 120°, PD >30mm, and HPD <36mm). Maternal and labor characteristics were noted.

Results: In 122 studied term primiparous the rates of FHE at any examination at term were between 3.3 – 5.7% (depending on the cut-off). The majority of the respective cases delivered vaginally. FHE was found in 1.58-2.94% at 37GW and the rates increased at the examinations performed within the week before delivery: 2.45% for AoP and 4.09% for HPD and PD. The primiparous that delivered by CS displayed a significant smaller PAs in the week prior to delivery (88°) and a similar trend was observed for the other linear parameters investigated. We found a good correlation between the US parameters (AoP, PD, HPD) and the majority of FHE cases achieved simultaneously multiple cut-offs (57%).

Conclusion: Objective data show that FHE is rarely present at term and primiparous women should not be alarmed because of fetal head non-engagement. Clinical FHE rate at term is reported differently and potentially overestimated in the literature due to the subjectivity of the method and the different perceptions regarding the engagement of the fetal head. 

Bibliography: 1. Dietz HP1, Lanzarone V, Simpson JM., Predicting operative delivery, Ultrasound Obstet Gynecol. 2006 Apr;27(4):409-15. 2. D. Maticot-Baptista, R. Ramanah, A. Collin, A. Martin, R. Maillet, D. Riethmuller, Ultrasound in the diagnosis of fetal head engagement. A preliminary French prospective study, Journal de Gynécologie Obstétrique et Biologie de la Reproduction, octobre 2009, Volume 38, n° 6:474-480. 3. F. Gary Cunningham, Kenneth J. Leveno, Steven L. Bloom, John C. Hauth, Dwight J. Rouse, Catherine Y. Spong, Williams Obstetrics, 23e, 2010, chapter17. 4. Diegmann EK, Chez RA, Danclair WG., Station in early labor in nulliparous women at term, J Nurse Midwifery. 1995 Jul-Aug;40(4):382-5.-Diegmann EK1, Chez RA, Danclair WG. 5. Weekes AR, Flynn MJ., Engagement of the fetal head in primigravidae and its relationship to duration of gestation and time of onset of labour, Br J Obstet Gynaecol, 1975 Jan; 82(1) :7-11. 6. Chaudhary S1, Farrukh R, Dar A, Humayun S., Outcome of labour in nullipara at term with unengaged vertex, J Ayub Med Coll Abbottabad. 2009 Jul-Sep;21(3):131-4. 7. Dayal S., Dayal A., Outcome of Labour in Nullipara at term with unengaged vertex, International Journal of Medical Research and RevieW, March- April 2014, pg 130-134. 8. Murphy K, Shah L, Cohen WR., Labor and delivery in nulliparous women who present with an unengaged fetal head, J Perinatol. 1998 Mar-Apr;18(2):122-5. 9. Debby A Rotmenseh S , Girtler O , Sadan O, Golan O,Glezerman M, Clinical significance of the floating head in nulliparous women in labour.J Reprod Med 2003; 48 (1):37-40. 10. Ansari A., Akhtar S. and Aamir M.: Causes and management of high fetal head in primigravidas at term. Pakistani Armed Forces Medical Journal, (1): P136-42, 2008. 11. Sherer D.M, Intrapartum ultrasound, Ultrasound Obstet Gynecol 2007; 30: 123–139. 12. Tutschek B, Braun T, Chantraine F, Henrich W., A study of progress of labour using intrapartum translabial ultrasound, assessing head station, direction, and angle of descent, BJOG. 2011 Jan; 118(1):62-9. 13. Tutschek B1, Torkildsen EA, Eggebø TM., Comparison between ultrasound parameters and clinical examination to assess fetal head station in labor, Ultrasound Obstet Gynecol. 2013 Apr;41(4):425-9. 14. Barbera AF, Imani F, Becker T, Lezotte DC, Hobbins JC, Anatomic relationship between the pubic symphysis and ischial spines and its clinical significance in the assessment of fetal head engagement and station during labor, Ultrasound Obstet Gynecol. 2009 Mar;33(3):320-5. 15. Henrich W1, Dudenhausen J, Fuchs I, Kämena A, Tutschek B, Intrapartum translabial ultrasound (ITU): sonographic landmarks and correlation with successful vacuum extraction, Ultrasound Obstet Gynecol. 2006 Nov;28(6):753-60. 16. Bamberg C, Scheuermann S, Slowinski T, Dückelmann AM, Vogt M, Nguyen-Dobinsky TN et. al, Relationship between fetal head station established using an open magnetic resonance imaging scanner and the angle of progression determined by transperineal ultrasound, Ultrasound Obstet Gynecol. 2011 Jun;37(6):712-6. 17. Roni Levy, Svetlana Zaks, Alon Ben-Arie, Sharon Perlman, Zion Hagay, Edi Vaisbuch, Can the "angle of progression" as measured in pregnant women before the onset of labor predict mode of delivery?, Ultrasound Obstet Gynecol. 2012 Sep;40(3):332-7. 18. Ramanathan G, Yu C, Osei E, Nicolaides KH. Ultrasound examination at 37 weeks' gestation in the prediction of pregnancy outcome: the value of cervical assessment.Ultrasound Obstet Gynecol. 2003 Dec;22(6):598-603. 19. Dimassi K, Ben Amor A, Belghith C et al. Ultrasound diagnosis of fetal head engagement. Int J Gynaecol Obstet. 2014 Oct;127(1):6-9.

Treatments of vascular anomalies in children  Danciu Sabrina , Sugu Eli- Andreea - Validated View

Treatments of vascular anomalies in children

Surgical Science

Author(s): Danciu Sabrina, Sugu Eli- Andreea

Coordinator(s): MD Maria - Corina Stanciulescu

Keywords: Vascular anomalies Infantile hemangioma ß blockers Multidisciplinary team

Introduction: Vascular anomalies are common defects present in pediatric patients. Hemangiomas and vascular malformations, the two major classes of vascular anomalies, are still being studied for a better understanding, development and treatment. In 90% of the clinical cases, a correct diagnosis can be placed simply by taking into consideration three simple aspects: the age of the patient, the debut of the lesion and its clinical signs.

Material and Method: We conducted a retrospective study from January 2014 to May 2016, analyzing 142 cases of children presenting vascular anomalies in the Pediatric Surgery and Orthopedics Clinic of Pediatric Emergency Hospital “Louis Turcanu” Timisoara. We analyzed demographic and anamnestic data, clinical evolution, management, treatment and the medical outcome. We examined vascular tumors separately from vascular malformations. The methods of diagnosis were in concordance with the newest classifications of ISSVA (2014). There were various treatments used. 

Results: The highest anomaly statistically found was the hemangioma (13.38%), specifically the infantile hemangioma, with a higher incidence in female patients (70.93%). The most applied treatment was the surgical one (59.15%), due to the fact that the retrospective study was done in a surgical clinic. The treatment with ß blockers was the second most effective, used in 38.37% cases. 

Conclusion: Although the surgical treatment had good results, we recommend ß blockers as an elective treatment for infantile hemangioma. Also, a well rounded clinical and histological classification for vascular anomalies and a multidisciplinary team are required in order to diagnose correctly and choose the best treatment option for each patient.

Bibliography: 1. Enjolras O, Wassef M, Chapot R: Color Atlas of Vascular Tumors and Vascular Malformations. Cambridge University Press 2007:3-104 2. https://s3.amazonaws.com/ClubExpressClubFiles/298433/documents/issva_classification_2014_final_trial.pdf?AWSAccessKeyId=AKIAIB6I23VLJX7E4J7Q&Expires=1465771509&response-content-disposition=inline%3B%20filename%3Dissva_classification_2014_final_trial.pdf&Signature=mwYSO9VX3Y54Q1VbCRex88JTAjk%3D / 3. Sandeep V, Daniel C, Matthew K. et al. Imaging and Percutaneous Treatment of Vascular Anomalies SEMINARS IN INTERVENTIONAL RADIOLOGY/VOLUME 25, NUMBER 3 2008 4. E. Baselga Torresa, J. Bernabéu Wittelb, D.L. van Esso Arbolave, et al. Spanish consensus on infantile haemangioma. October 2015 5. Kilcline C, Frieden IJ. Infantile hemangiomas: how common are they? A systematic review of the medical literature. Pediatr Dermatol. 2008;25:168–173. 6. Wassef M, Blei F, Adams D, et al. Vascular Anomalies Classification: Recommendations From the International Society for the Study of Vascular Anomalies. Pediatrics 2015 Jul;136(1):e203- 14. 7. Haggstrom AN, Drolet BA, Baselga E, Chamlin SL, Garzon MC, Horii KA, et al. Prospective study of infantile hemangiomas: clinical characteristics predicting complications and treatment. Pediatrics. 2006;118:882 8. Chamlin SL, Haggstrom AN, Drolet BA, et al. Multicenter prospective study of ulcerated hemangiomas. J Pediatr 2007 Dec;151(6):684-9 9. Siu Ying Angel Nip, Kam Lun Hon, Wing Kwan Alex Leung, et al. Neonatal Abdominal Hemangiomatosis: Propranolol beyond Infantile Hemangioma. Case Rep Pediatr. 2016 10. Jia Wei Zheng, Ling Zhang, Qin Zhou, et al. Review Article A practical guide to treatment of infantile hemangiomas of the head and neck. Int J Clin Exp Med 2013;6(10):851-860 11. Leaute-Labreze C, Dumas de la Roque E, Hubiche T, et al. Propranolol for severe hemangiomas of infancy. N Engl J Med 2008 Jun 12;358(24):2649-51 12. Linjun Y, Jiachuan X, Baoli S, et al. A clinical study of Timolol Maleate Eye Drops for the treatment of superficial infantile hemangiomas. Zhonghua Zheng Xing Wai Ke Za Zhi. 2015 Nov;31(6):440-5. 13. Blanchet C, Nicollas R, Bigorre M, Amedro P, Mondain M. Management of infantile subglottic hemangioma: acebutolol or propranolol? Int J Pediatr Otorhinolaryngol. 2010;74: 959 14. Abarzua-Araya A, Navarrete-Dechent CP, Heusser F, Retamal J, Zegpi-Trueba MS. Atenolol versus propranolol for the treatment of infantile hemangiomas: a randomized controlled study. J Am Acad Dermatol. 2014;70:1045 15. Pope E, Chakkittakandiyil A, Lara-Corrales I, Maki E, Weinstein M. Expanding the therapeutic repertoire of infantile haemangiomas: cohort-blinded study of oral nadolol compared with propranolol. Br J Dermatol. 2013;168:222 16. Fernandez-Pineda, R. Williams, L. Ortega-Laureano,et al. Cardiovascular drugs in the treatment of infantile hemangioma. World J Cardiol. 2016 Jan 26; 8(1): 74–80 17. Léauté-Labrèze C, Hoeger P, Mazereeuw-Hautier J, Guibaud L, Baselga E, Posiunas G, Phillips RJ, Caceres H, Lopez Gutierrez JC, Ballona R, et al. A randomized, controlled trial of oral propranolol in infantile hemangioma. N Engl J Med. 2015;372:735–746. 18. Léauté-Labrèze C, Dumas de la Roque E, Nacka F, Abouelfath A, Grenier N, Rebola M, Ezzedine K, Moore N. Double-blind randomized pilot trial evaluating the efficacy of oral propranolol on infantile haemangiomas in infants & lt; 4 months of age. Br J Dermatol. 2013;169:181–183. 19. Tawfik AA, Alsharnoubi J. Topical timolol solution versus laser in treatment of infantile hemangioma: a comparative study. Pediatr Dermatol 2015 Mar 5 20. Nasseri E, Piram M, McCuaig CC,et al. Partially involuting congenital hemangiomas: a report of 8 cases and review of the literature. J Am Acad Dermatol. 2014 Jan;70(1):75-9.

SERTRALINE INDUCED PSYCHOSIS IN A PATIENT WITH POST-TRAUMATIC STRESS DISORDER (PTSD) CAUSED BY BULLYING, OBSESSIVE COMPULSIVE DISORDER (OCD) AND ANXIETY DISORDER  Popescu Emilia-Cristina Pop Mihai Invalidated View

SERTRALINE INDUCED PSYCHOSIS IN A PATIENT WITH POST-TRAUMATIC STRESS DISORDER (PTSD) CAUSED BY BULLYING, OBSESSIVE COMPULSIVE DISORDER (OCD) AND ANXIETY DISORDER

Case Report - Poster

Author(s): Popescu Emilia-Cristina

Coauthor(s): Pop Mihai

Coordinator(s): MD Cristian Puscas

Introduction: Posttraumatic stress disorder is an illness with chronic evolution which can have an impact on interpersonal, social and occupational relationships. Bullying is commonly experienced by children and can lead to psychological distress. A review reported that childhood trauma or adversity (including bullying) increases the risk of psychosis with an odds ratio of 2.78. 
Case Presentation: A ten year old male patient was admitted for anxiety, aggressive behavior towards self and classmates, motor tics (blinking), compulsive actions (touching objects for three times),  sporadic, non-specific auditive hallucinations and multiple phobias accompanied by somatic symptoms : headache, nausea and vomiting. The patient had been under treatment with Sertraline and Alprazolam for six months and had been attending psychotherapy sessions. He had been the victim of bullying for months, reporting being hit, teased and insulted by some classmates. When looking in the mirror he saw intrusive images of his classmates and heard their voices calling him names and teasing him. He was diagnosed with PTSD, OCD and anxiety disorder. Considering the psychotic symptoms the dose of Sertraline was increased. After a short period of time the auditive hallucinations exacerbated and were followed by visual hallucinations.

Conclusion: The debut of the case was dominated by emotional symptoms. Under treatment with Sertraline the patient developed a psychotic disorder which gradually diminished after stopping Sertraline and introducing Risperidone. The association between Sertraline use and the emergence of psychotic symptoms is supported by the absence of past history, family history and fast remission of symptoms under antipsychotic treatment. On his follow-up  visit after one month he didn’t present psychotic symptoms and his anxiety symptoms improved significantly.

Particularities:

Because the patient was a hungarian native speaker the parents acted as translators during the interview making it difficult to distinguish between intrusive images, flashbacks and hallucinations, raising the suspicion of a psychotic disorder.

DEVELOPMENT AND PROGRESSION OF REFRACTIVE ERRORS IN MEDICAL STUDENTS  Bubău Ana Marina - Validated View

DEVELOPMENT AND PROGRESSION OF REFRACTIVE ERRORS IN MEDICAL STUDENTS

Public Health

Author(s): Bubău Ana Marina

Coordinator(s): Lecturer Daniela-Edith Ceană

Keywords: refractive errors medical students public health issue

Introduction: Refractive errors(RE) represent the main cause of visual impairment and blindness and a significant public health problem, affecting approximately 2 billion people worldwide[1].

In time, it was observed that students, particularly medical students are often affected due to long years of study involving extensive near-work like reading and writing[2, 3, 4, 5, 6, 7].
The purpose of this study is to assess the frequency and progression of RE during university years among students from the University of Medicine and Pharmacy Târgu-Mureș. 

Material and Method: We conducted a cross-sectional prospective study, materialized in an anonymous questionnaire, by interrogating 283 sixth-year students(66 males/217 females) with a view to quantify the progression of RE during almost six years of medical studies and identify the risk factors.
The definitions for RE were as follows: Myopia≤ -0.5D, Hyperopia≥ +0.5D, Astigmatism≥0.5D, as these are the most commonly used in literature[8]

Results: RE occurred in 173 students(61.1%), while 110(38,9%) were emmetropic. The frequency was not significantly different between females and males(64 and 51.5%, p=0.09).
Myopia was observed most frequently, 126 students(44.5%) suffering from it, while 23(8.1%) had Hyperopia and 49(17.3%) Astigmatism. Adult onset RE comprised 51.9% of all the cases, 20.8% being diagnosed 4-6years ago, 29.4% 1-3years ago and 1.73% developing them in the past months.
Family-history was strongly associated with RE, 111 out of the 173 affected had at least one family member with the same condition(p=0.0001). 

Conclusion: RE affect more than 60% of the medical students, the majority acquiring them during university years.
Their evolution is associated with family-history, but there is no significant difference between ametropic and emmetropic students with respect to amount of current close-up activity, sleeping hours or outdoor activities, as suggested by other studies[2, 5, 9] so we consider that looking further into this problem is necessary in order to develop future prevention methods.

Bibliography: [1]. Baird, Paul N., Maria Schäche, and Mohamed Dirani. "The GEnes in Myopia (GEM) study in understanding the aetiology of refractive errors." Progress in retinal and eye research 29.6 (2010): 520-542. [2]. Woo, W. W., et al. "Refractive errors in medical students in Singapore." Singapore medical journal 45 (2004): 470-474. [3]. Onal, Sumru, et al. "Refractive errors of medical students in Turkey: one year follow-up of refraction and biometry." Optometry & Vision Science 84.3 (2007): 175-180. [4]. Midelfart, A., and S. Hjertnes. "Myopia among medical students in Norway." Investigative Ophthalmology & Visual Science 46.13 (2005): 5626-5626. [5]. Kathrotia, Rajesh G., et al. "Prevalence and progression of refractive errors among medical students." (2012). [6]. Lin, Luke Lk, et al. "Changes in Ocular Refraction and Its Components among Medical Students-A 5-Year Longitudinal Study." Optometry & Vision Science 73.7 (1996): 495-498. [7]. Shulkin, David J., and Merle M. Bari. "Deteriorating vision: an occupational risk for the medical student." Archives of Ophthalmology 104.9 (1986): 1274-1274. [8]. Wolfram, Christian, et al. "Prevalence of refractive errors in the European adult population: the Gutenberg Health Study (GHS)." British Journal of Ophthalmology (2014): bjophthalmol-2013. [9]. Jacobsen, Nina, Hanne Jensen, and Ernst Goldschmidt. "Does the level of physical activity in university students influence development and progression of myopia?—a 2-year prospective cohort study." Investigative ophthalmology & visual science 49.4 (2008): 1322-1327.

MISLEADING SYMPTOMS IN A CASE OF HIATAL HERNIA  Sminchișe Oana - Invalidated View

MISLEADING SYMPTOMS IN A CASE OF HIATAL HERNIA

Case Report - Poster

Author(s): Sminchișe Oana

Coordinator(s): Assistant Professor Ștefan-Lucian Popa

Introduction: Hiatal hernia represents the prolapse of a segment of the stomach through the diaphragmatic esophageal hiatus. Most cases are asymptomatic, but some patients can present gastroesophageal reflux. It is more frequently in women and individuals over 50 years old. We present an unusual case of hiatal hernia with misleading symptoms and a particular clinical context.

Case Presentation: A 36-year-old male presented with irritating nocturnal cough, bloating and meteorism. Thoracic radiography pointed out moderate pulmonary hypertension. Due to the presenting digestive symptoms, a stool analysis was performed and revealed rectal bleeding, for which was recommended an inferior digestive endoscopy and proved the existence of  internal hemorrhoids. Furthermore, superior digestive endoscopy was performed, showing hiatal hernia with approximate 4 cm diameter, Los Angeles class B esophagitis and antral gastritis. Treatment was initiated with proton pump inhibitors. The prescribed medication was correlated with a balanced diet, excluding food that could cause gastric irritation. The symptoms remitted and the health status of the patient improved significantly.

Conclusion: The hiatal hernia caused the regurgitation of the hydrochloric acid into the esophagus, resulting in Los Angeles class B esophagitis. The treatment proved to be efficient in association with the recommended diet.

Particularities: The particularities of this case are the non-specific symptoms, which imitate a large bowel disease, the absence of risk factors: obesity, smoking, sedentary lifestyle, and the debut at an uncommonly young age.

THE MANAGEMENT OF ATYPICAL BRUGADA SYNDROME – A CHALLENGE  Sava Bianca Marcela - Validated View

THE MANAGEMENT OF ATYPICAL BRUGADA SYNDROME – A CHALLENGE

Case Report - Poster

Author(s): Sava Bianca Marcela

Coordinator(s): Assistant Professor Gabriel Guşetu

Introduction:

Brugada Syndrome is a genetic disorder, characterized by a mutation in a myocyte cell’s membrane sodium channel (SCN5A) gene, that increases an individual’s risk for ventricular arrhythmias and sudden cardiac death. It was first described by the Brugada brothers in 1992. The electrocardiogram pattern is atypical, showing ST segment elevation in the right precordial leads, unrelated to myocardial ischemia, electrolyte imbalance or structural heart disease.


Case Presentation:

A 21-year-old woman, complaining of epygastralgia, pyrosis / heartburn, chest pain and dyspnea lasting for two weeks is referred by a general physician for an upper digestive tract endoscopy. The screening ECG recorded before the procedure revealed a minor right bundle branch block and ST-segment elevation in right precordial leads (V1-V3). Because of associated personal history of syncope (at age 14 and 17) she was transferred to the cardiology ward. An electrophysiology study was performed, and even if the provocative test with iv flecainide was negative, a sustained fast ventricular tachycardia was induced and electrical cardioversion was necessary to stop it. Even if the Brugada Syndrome criteria were not fully met, an internal cardioverter defibrillator was implanted.


Conclusion:

When the high risk of sudden cardiac arrest is encountered, the implantation of an internal cardioverter defibrillator is considered to be a safe strategy, as long as the patient’s consent is given, overcoming the risks of procedure’s complications.


Particularities: Despite having history of syncope, a Brugada ECG pattern and positive programmed ventricular stimulation, the provocative test was negative.

A STUDY OF THE TNF308G POLYMORPHISM IN ROMANIAN TYPE 2 DIABETIC PATIENTS  Ilies Roxana , Aioanei Casian-Simon Catana Andreea , Popp Radu Validated View

A STUDY OF THE TNF308G POLYMORPHISM IN ROMANIAN TYPE 2 DIABETIC PATIENTS

Fundamental Science

Author(s): Ilies Roxana, Aioanei Casian-Simon

Coauthor(s): Catana Andreea , Popp Radu

Coordinator(s): MD Oana Blaga

Keywords: tnf diabetes polymorphism

Introduction: TNF is a gene encoding a multifactorial inflammatory cytokine linked to an array of biological phenomena, including cell proliferation, autoimmunity and insulin resistance. There is significant overlap between processes affected by this cytokine and the pathogenesis and manifestations of type 2 diabetes: coexistence with obesity as a comorbidity, alterations in regulation and effect of insulin,systemic inflammation. As such, our aim was to show whether alterations in the TNF-308G polymorphism bear some significance in patients diagnosed with type 2 diabetes. 

Material and Method: The design of this study was based on a case-control model, including 103 patients diagnosed with type 2 diabetes in various stages of the condition, as well as 123 healthy controls. A PCR-RFLP protocol was used for sample genotyping. The statistical analysis was carried out using SPSS 2016 Software.

Results: The heterozygous genotype(GA) was associated with an increased prevalence of type 2 diabetes( OR=1.669 (1.046—2.663 95% CI) p=0.032). The homozygous genotype association did not meet statistical significance(OR=1.027 (0.271—3.895 95% CI) p=0.969. As for gender, age and glycated hemoglobin associated genotype and allele distribution there were no statistically significant differences. (p=0.078, p=0.53, p=0.24)

Conclusion: A heterozygous genotype for TNF308G appears to be associated with the development of type 2 diabetes. A larger scale experiment would clarify the status of homozygous patients, as well as any influence of TNF308G on the progression of the disease or control of glucose levels. 

Bibliography: 1. NCBI. TNF tumor necrosis factor [ Homo sapiens (human) ]. https://www.ncbi.nlm.nih.gov/gene/7124 (accessed 5/4/2017). 2. Wellen KE, Hotamisligil GS. Inflammation, stress, and diabetes. J Clin Invest [Internet]. 2005 May 2 [cited 2017 Apr 5];115(5):1111–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15864338

TRANSNASAL ENDOSCOPIC APPROACH ON A RARE CASE OF CRANIAL JUVENILE FIBROMATOSIS - CASE REPORT  Ghita Cristina - Invalidated View

TRANSNASAL ENDOSCOPIC APPROACH ON A RARE CASE OF CRANIAL JUVENILE FIBROMATOSIS - CASE REPORT

Case Report - Poster

Author(s): Ghita Cristina

Coordinator(s): Assistant Professor Bogdan Mocanu

Introduction: Juvenile fibromatotsis is very uncommon and determins locally agressive fibroblastic proliferation. The location in the paranasal sinus is even more uncommon and only 6 more cases have been reported in the world until now, this being the first one in our country. The election treatment for this pathology is surgery with large resection margins, radio and chemiotherapy being used only for unresectable tumours or agressive reccurences.

Case Presentation: A 2 year-old pacient presented in our clinic with extensive lateral proptotsis of the right eye.  Further investigations revealed that the tumour had protuded significantly in the right orbit and had also extended to the ethmoid, sphenoid sinus and maxillary sinus. Bearing in mind the proximity of the tumour towards the optic nerve and the ethmoid, immediate surgical approach was considered. The entire surgical procedure was performed transnasally, in an endoscopic manner. We used a high performance navigation surgical device that allows us to perform resections with milimmetric precision.

Conclusion: Macroscopically, we managed to resect the entire tumour, preserving nerves and blood vassels using a minimally invasive approach. The pacient underwent a CT investigation at the end of the procedure which showed no restant tumour.  Hemostasis was performed in an efficient manner, which led to the pacient being discharged 3 days postoperatory.

Particularities: The particularity of this case resides in the extremely low rate of intracranial juvenile fibromatosis. In addition to this, the pacient was at a higher risk due to the possibility of permanent vision loss associated with neurological complications arising from the proximity of the tumour to the ethmoid.

THE PREVALENCE AND LEVEL OF STRESS AMONG CRACOW UNIVERSITY STUDENTS.  Drwila Dominika , Średniawa Anna Wojtaś Damian, Krotos Anna, Kostecka Natalia Validated View

THE PREVALENCE AND LEVEL OF STRESS AMONG CRACOW UNIVERSITY STUDENTS.

Public Health

Author(s): Drwila Dominika, Średniawa Anna

Coauthor(s): Wojtaś Damian, Krotos Anna, Kostecka Natalia

Coordinator(s): Associate Professor Tomasz Tomasik

Keywords: stress PSS-10 questionnaire students Cracow

Introduction: Stress, which can be defined as imbalance between our capabilities and the expectations of our surrounding, is an increasing problem in developed countries. Many research claim that it may cause the progression of cardio-vascular diseases and emphasize its importance. The aim of our study was to assess the prevalence and the level of stress among university students in Cracow, Poland and to find correlations between stress and some lifestyle behaviours.
Material and Method: 264 students (57% women) with a mean age of 22.2 +/- 1.5 years completed anonymously the Perceived Stress Scale-10 questionnaire. The form consists of 10 questions regarding personal thoughts and feelings during former month. Students were also asked about their sleeping habits, physical activity, smoking, livelihood, prevalence of chronic diseases and psychological/psychiatric consultations. The statistical analysis was performed using Statistica 12 software (StatSoft Inc.).
Results: According to our study 10.6% of students have high level of stress. The level of stress is statistically higher in women population (p=0.04). Students who reported the occurrence of chronic diseases are also more susceptible to stress (p=0.0088). The correlation can be also found in the group of cigarette smokers (p=0.047). No significant connections between the level of stress and physical activity or type of studies were found. There was also no significant relationship between prevalence of stress and psychological consultations.
Conclusion: Even though the younger population is considered to be easy-going and careless there are some individuals who present high level of stress. Due to the fact that stress can be a risk factor for cardio-vascular diseases, we believe that public health awareness about that problem should be risen.
Bibliography: Cohen S., Kamarck T., Mermelstein S.: A global measure of perceived stress. J Health Soc Behav. 1983;24(4):385–96. Franco G.P., de Barros A.L., Nogueira-Martins L.A., Michel J.L.: Stress influence on genesis, onset and maintenance of cardiovascular diseases: literature review. J Adv Nurs. 2003 Sep;43(6):548-54.

MALIGNANT PHEOCROMOCYTOMA ASSOCIATED WITH SECONDARY TAKOTSUBO SYNDROME  Demea Anca-Diana , Dunca Dan-Grigore - Validated View

MALIGNANT PHEOCROMOCYTOMA ASSOCIATED WITH SECONDARY TAKOTSUBO SYNDROME

Case Report - Poster

Author(s): Demea Anca-Diana, Dunca Dan-Grigore

Coordinator(s): Lecturer Lucia Agoston-Coldea

Introduction: The clinical presentation of the Takotsubo syndrome mimics an acute coronary syndrome with chest pain, ST-segment elevation, T wave inversion, and apical ballooning on echocardiography and ventriculography. Invariably, the coronary arteries are found to be normal or exhibiting minimal atherosclerotic changes. Patients are often postmenopausal women in whom symptoms are triggered by emotional or physical stress, associated with catecholamine surges. Secondary Takotsubo syndrome symptoms can be triggered, however, by an increased catecholamine release due to pheochromocytoma.

Case Presentation: A 56-year old female with type 2 diabetes mellitus presented to the emergency room with chest pain and ECG changes suggesting acute antero-lateral myocardial infarction. Coronary artery angiography was performed, ruling out coronary artery disease and apical ballooning emerged on ventriculography. Consequently, secondary Takotsubo syndrome was diagnosed and the patient was discharged from hospital within a week. Three years later, the patient was admitted to the hospital for rhabdomyolysis and acute renal failure. The abdominal ultrasound revealed an abdominal tumor, prompting further investigation by an abdominal contrast-enhanced CT scan. Subsequently, a T4NxM0 left suprarenal tumor, a T3NxM0 left renal tumor and left renal vein thrombosis were diagnosed. The patient was further referred for surgery. Left suprarenalectomy, perifascial nephrectomy and cavotomy with tumoral thrombectomy were performed. Histopathological analysis confirmed malignant pheocromocytoma and type 2 papillary renal-cell carcinoma.

Conclusion:

Catecholamine surges in patients with pheochromocytoma may trigger secondary Takotsubo syndrome. An early diagnosis of the underlying condition in patients presenting with apical ballooning syndrome could influence therapeutical decisions and improve prognosis.


Particularities:
The reported case illustrates the progression of a malignant pheochromocytoma causing rhabdomyolysis and acute renal failure in a diabetic patient with previously diagnosed secondary Takotsubo syndrome. 

VITILIGO ASSOCIATED WITH GASTRIC ADENOCARCINOMA SECONDARY TO PERNICIOUS ANEMIA  Halmagyi Salomea-Ruth Gîrbovan Anamaria Hermina Validated View

VITILIGO ASSOCIATED WITH GASTRIC ADENOCARCINOMA SECONDARY TO PERNICIOUS ANEMIA

Case Report - Poster

Author(s): Halmagyi Salomea-Ruth

Coauthor(s): Gîrbovan Anamaria Hermina

Coordinator(s): MD Daniela Porojan

Introduction: Vitiligo is a progressive depigmenting disorder of the skin, affecting 0,5-1% of the population. The etiopathogenesis of vitiligo is not fully understood, but several studies suggested that autoimmunity might play an important role. Multiple studies reported association between vitiligo and other autoimmune diseases.

Case Presentation: We present the case of a 70 years old female patient, with a history of vitiligo, diabetes mellitus type 1 and cardiovascular comorbidities. She was admitted to the hospital for warning signs and symptoms concerning for possible occult malignancy. Physical examination also found skin lesions suggestive of vitiligo. Laboratory studies showed macrocytic anemia, elevated lactate dehydrogenase, decreased vitamin B12, mild unconjugated hyperbilirubinemia and positive gastric parietal cell auto-antibodies suggestive of pernicious anemia. Upper digestive endoscopy with biopsy and histopathological examination revealed atrophic body gastritis and adenocarcinoma. Wood-lamp examination of the achromic skin lesions confirmed the diagnosis of vitiligo.

Conclusion: The patient refused the recommended surgical treatment and underwent palliative care. Vitamin B12 administration was contraindicated. She also refused local treatment of vitiligo.

Particularities: The presented case supports the role of autoimmunity in pathogenesis of vitiligo, by the association between vitiligo and other two autoimmune disorders diabetes mellitus type 1 and pernicious anemia, the latter being an important risk factor for gastric cancer.

The frequency of West Nile virus in patients with the diagnosis of acute meningitis with clear cerebrospinal fluid  Rădulescu Maria-Flavia - Invalidated View

The frequency of West Nile virus in patients with the diagnosis of acute meningitis with clear cerebrospinal fluid

Fundamental Science

Author(s): Rădulescu Maria-Flavia

Coordinator(s): Associate Professor Felicia Toma

Keywords: West Nile meningitis frequency infectious disease

Introduction: West Nile Virus (WNV) is a member of the genus Flavivirus, in the family Flaviviridae. WNV is transmitted to humans by mosquitoes, being maintained in a mosquito-bird-mosquito transmission cycle, and that’s why humans and horses are considered dead-end hosts. In humans, there are various symptoms, from unapparent infection to mild febrile illness, meningitis, encephalitis or death. Infections attributable to WNV have been reported in many countries from Europe, Asia, Africa, Australia and North, Central and South America. Migratory birds are thought to be primarily responsible for virus dispersal, including reintroduction of WNV from endemic areas into regions with sporadic outbreaks. The aim of this study is to analyze data provided by the clinical observation sheets from Infectious Disease Clinic of Braila and investigate the frequency of West Nile virus meningitis in the general population from Braila county.

Material and Method: We preformed a retrospective study using the files of patients hospitalized at the Infectious Clinic of Braila between 2013 and 2016 with the diagnosis of acute meningitis with clear cerebrospinal fluid (CSF) who were afterwards tested for anti-West Nile virus antibodies, IgG and IgM.

Results:  Of a total of 87 patients (42,53% females and 57,47% males), 40 of them were tested for anti-WNV antibodies. 30% of them were positive tested (58,33% males and 41,66% females) and 70% negative tested(53,7% males and 46, 428% females).

Conclusion: Males are more likely to suffer from acute meningitis with clear CSF than females. The highest percentage of positive tested patients was found in 2016, between August and September. This study also reveals that people from the countryside are more likely to suffer from WNV meningitis.

Bibliography: https://www.ncbi.nlm.nih.gov/pubmed

Atypical uterine rupture in the first trimester due to abnormally invasive placenta.  Jose Jeethu Ann Jose Jeeva Rose, Idiculla Chacko Ruban Invalidated View

Atypical uterine rupture in the first trimester due to abnormally invasive placenta.

Case Report - Poster

Author(s): Jose Jeethu Ann

Coauthor(s): Jose Jeeva Rose, Idiculla Chacko Ruban

Coordinator(s): MD Dominic Gabriel Iliescu

Introduction:

Abnormally invasive placenta (AIP) is a spectrum of life-threatening conditions characterised
by invasive placental villi into the depth of the myometrium. AIP leads usually to major complications, with poor obstetrical prognosis. Published studies are reporting almost
exclusive data on AIP in association with placenta praevia and history of uterine opened
surgery (UOS)

Case Presentation:
We present a case of fundal AIP without prior UOS, highly suspected on
ultrasound markers in the first trimester (FT). The pregnancy evolved with uterine rupture in
the late FT. We also review previously reported cases of uterine rupture due to AIP in early pregnancy with no previous caesarean births or UOS and evaluate the diagnosis approach, the
therapeutic options and the outcome.

Conclusion:
FT diagnosis of AIP is possible with current technology. Signs of accretion may be seen as early as in the FT. Even if the case was atypical, the US proved as an efficient tool in detecting AIP, essential in improving the management and of the outcome. Team approach is strongly advisable.

Particularities:
Invasive placentation is described in the literature using various terms: (abnormally)
invasive placenta, (morbidly) adherent placenta, placental attachment disorders. The exact
pathogenesis of the disease is unknown. In addition, variable location of the placenta together with variable number and type of risk factors make every patient unique hence the treatment plan more individualised. 

Biochemical Changes in Small Intestine during Early Stages of Experimental Acute Pancreatitis   Yakubiak Vasyl - Validated View

Biochemical Changes in Small Intestine during Early Stages of Experimental Acute Pancreatitis

Surgical Science

Author(s): Yakubiak Vasyl

Coordinator(s): Associate Professor Oleksandr Rotar

Keywords: Acute necrotizing pancreatitis Intestinal mucosae Biochemical changes

Introduction: Infection of pancreatic necrosis by gut bacteria is a major cause of morbidity and mortality in patients with acute necrotizing pancreatitis (ANP) [1]. Bacterial translocation occurs due to increase of intestinal permeability as a result of disorders of intestinal metabolism [2]. So aim of our study was to investigate the biochemical changes in small intestine during early stages of experimental AP.
Material and Method: In 70 Wistar rats ANP was induced by intraperitoneal injection of 250 mg/100 g of 20% L-arginine solution twice during 1 hour period. Changes of pro- and antioxydative status, connective tissue markers, proteolytic activity in small intestinal mucosal layer have been investigated during first 72 hours of ANP.
Results: ANP was accompanied by activation of oxidant stress. Concentration of diene conjugates, malone dialdehyde and nitric oxide metabolites increased since 12 hours after ANP initiation and reached maximum in 24 hours: levels exceeded values of intact rats on 22%, 10% and 18% accordingly (р <0,05). Their neutralization occurred after 48 hours as a result of activation of antioxidant defense: superoxide dismutase and the catalase concentrations has been raised in 1,6 and 1,7 times (р <0,05). Under influence of oxidant stress collagenolytic activity raised in 1,5 times after 12 hours and remained high until the end of experiment. Simultaneously changes in proteoglycans and glycoproteins structure appeared: concentration of hydroxiproline and hexuronic acids decreased on 15-35% (р <0,05) since 24 h.
Conclusion: In early terms of ANP oxidant stress activate collagenolytic activity and destroy structure of proteoglycans and glycoproteins in small bowel mucosal layer and represent morphological basis for development of intestinal failure.
Bibliography: 1. Alsfasser G, Schwandner F, Pertschy A, Hauenstein K, Foitzik T, Klar E. Treatment of necrotizing pancreatitis: redefining the role of surgery. World J Surg. 2012 Oct;36(5):1142-47. 2. Isenmann R, Rau B, Beger HG. Bacterial infection and extent of necrosis are determinants of organ failure in patients with acute necrotizing pancreatitis. Br J Surg. 1999 Aug;86(8):1020-4.

Chronorhythmic profile of quercetin impact on the antioxidant system under the conditions of the experimental acute kidney injury  Adamchuk Anastasiia , Horoshko Oleksandra Zeleniuk Volodymyr Validated View

Chronorhythmic profile of quercetin impact on the antioxidant system under the conditions of the experimental acute kidney injury

Fundamental Science

Author(s): Adamchuk Anastasiia, Horoshko Oleksandra

Coauthor(s): Zeleniuk Volodymyr

Coordinator(s): Professor Igor Zamorskii

Keywords: quercetin acute kidney injury circadian rhythms

Introduction: Renal function has a marked circadian periodicity. The study of renoprotective properties of drugs within their impact on the kidneys' circadian rhythms is highly relevant. Thus, the aim of our work was to investigate the influence of quercetin containing drugs on the diurinal antioxidant profile of rats under the conditions of acute renal injury (AKI).

Material and Method: In vivo studies were carried out using 28 nonlinear white laboratory rats. Glycerol-induced AKI was modeled after 50% glycerol solution injected intramuscularly (10 ml/kg). Quercetin containing drugs – lipoflavon and corvitin (8 mg/kg of quercetin equivalent) – were administrated i/p 40 min after glycerol injection 4 times a day: at 8.00, 14.00, 20.00 and 2.00.

Results: As has been found in our experiments, throughout the day malondialdehyde (MDA) content in the kidney tissues of untreated animals reached a minimum rate at 14.00 and the maximum – at 2.00 and was averagely higher by 80% than in controls. The most significant reduction of MDA content by 20% was observed at 2.00 in both corvitin and lipoflavon groups. Animals with AKI showed an increase in oxidatively modified proteins (OMP) level by 31%, with acrophase at 20.00. Meanwhile, corvitin administration caused the decline in the OMP formation intensity by 23% (acrophase at 20.00) and lipoflavon – by 16% (acrophase at 2.00). Glutathione peroxidase (GPx) activity in the kidney tissue of untreated rats with AKI decreased significantly (by 1.57 times, as compared to intact control). Meanwhile quercetin-treated rats featured improvements in the amelioration of the GPx activity averagely by 72% at 20.00 and 2.00.

Conclusion: The antioxidant protection during the AKI progression in rats via corvitin and lipoflavon intensifies mostly in the evening (20.00) and at night (2.00), respectively. Thus, the administration of quercetin containing drugs with the purpose of renoprotection should be adjusted to the renal circadian clock.

Bibliography: Stow L.R., Gumz M.L. The circadian clock in the kidney. J. Am. Soc. Nephrol 2011;22:598-604. Kahraman A., Erkasap N., Serteser M., Koken T. Protective effect of quercetin on renal ischemia/reperfusion injury in rats. J Nephrol 2003;16,2:219-224.

Arnica Montana extract effects on experimental arthritis  Schaefer Darja - Validated View

Arnica Montana extract effects on experimental arthritis

Medical Science

Author(s): Schaefer Darja

Coordinator(s): Professor Alina Parvu, MD, PHD

Keywords: Arnica Montana, Rheumatoid Arthritis, NO, MDA, TOS, TAC

Introduction: Inflammation causes an imbalance between antioxidant and pro- oxidant (including nitric oxide and oxidative stress) factors. This imbalance in turn will lead to structural and functional damage, just like in RA.1 Arnica Montana has been proven to have antioxidant capacities and was used in the treatment of chronic inflammation and rheumatoid arthritis.2 Due to this fact we tested the Arnica Montana leaf and flower extracts in different dilutions for its effect on experimental arthritis, focusing on reactive oxygen species (TOS, MDA, OSI), nitric oxide and total antioxidant capacity

Material and Method: Whistlar-Bratislava male albino rats were divided in 9 groups (n=6). Arnica Montana flower and leaf extracts solutions of 100%, 50% and 25% were administered and inflammation was induced by Freund’s Complete Adjuvant. Blood was collected via retroorbital puncture and tests were run in order to measure the total antioxidant capacity (TAC), Thiols, total oxidative status (TOS), malonyldialdehyde (MDA), Nitric Oxide (NO) and Oxidative Stress Index (OSI). 

Results: TAC was significantly decreased by arthtis (p< 0.001) and significantly increased by A. Montana leaf extracts 100%. Thiols were significantly decreased by experimental arthritis (p< 0.001) and significantly increased by A.Montana leaf extracts 100% and 50% and A. Montana flower extracts 100% (p<0.001). TOS,was significantly increased by experimental arthritis (p<0.05) and significantly decreased by leaf extract 50% and flower extract 100% (p<0.05). NO was significantly increased by experimental arthritis (p<0.001) and significantly decreased by A. Montana leaf extract 100% and 50% as well as flower extracts 100% and 50% (p<0.01). MDA was significantly increased by arthritis (p<0.001) and significantly decreased by A. Montana leaf extracts 50% and flower extracts 100%. (p<0.05). 

Conclusion: Leaf extract 50% solution of Arnica Montana and flower extract 100% solution of Arnica Montana had the best antioxidant capacity. 

Bibliography: 1) Navarro-Compán V, Melguizo-Madrid E, Hernández-Cruz B, Santos-Rey K, Leyva-Prado C, Gon-záles-Martin C, et al. Interaction between oxidative stress and smoking is associated with an in-creased risk of rheumatoid arthritis: a case-control study. Rheumatology (Oxford) [Internet] 2013 [cited 8 September 2015]; 52(3):487-93. Available from: http://rheumatology.oxfordjournals.org/content/52/3/487.full.pdf+html 2) Judzentiene A, Budiene J. Analysis of the chemical composition of flower essential oils from Arnica montana of Lithuanian origin. CHEMIJA. [Internet] 2009 [cited 22 February 2016]; Vol. 20. No.3.P.190-194. Available from: http://www.lmaleidykla.lt/publ/0235-7216/2009/3/190-194.pdf.

COLON CANCER IN MURES COUNTY DURING 2011-2016  Apostol (Popescu) Alina - Invalidated View

COLON CANCER IN MURES COUNTY DURING 2011-2016

Medical Science

Author(s): Apostol (Popescu) Alina

Coordinator(s): MD Radu Florin Demian

Keywords: colon cancer survival ratio values Avastin

Introduction: The purpose of this study is to observe the evolution of colon cancers in Mures county during the past 6 years.

Material and Method: The study is retrospective, analytical, with a set of 501 patients registered in the county’ medical office of Oncology. I have transposed the data obtained in Microsoft Excel program.

Results: The recorded data highlights the predominance of colon cancer in the countryside with a score of 54% and the predominance to male gender with 56%. Most patients were older than 70 years, where women fits with a maximum of 37.38% of 222 cases, while men with a maximum of 37.99% of 279 cases. Unfortunately, there were 30 cases between 41-50 years old, 5 cases between 31-40 years and even 1 case between 21-30 years old. Men/women ratio is 1.25 and rural/urban ratio is 1.15. It is also a progressive increase of incidence for patients aging between 61-70 years representing 110 patients from 269. Survival at six months increases from 81.48% in 2011 to 91.81% in 2014; at 1 year from 61.37% in 2011 to 85.15% in 2014; at 2 years from 43.25% in 2011 to 80% in 2014.

Conclusion: The low ratios values show a growing illness number for women and for urban environment. There are more survivals each year due to the outstretched use of Avastin.

Bibliography: www.fnoc.ro www.revista-hipocrate.ro www.medscape.com www.freemedicaljournals.com www.ascopubs.org/journal/jco

RESULTS OF THE 2 YEAR TREATMENT WITH SIROLIMUS IN A CASE OF SEVERE LYMPHANGIOLEIOMYOMATOSIS  Cotigă Diana Bițineanu Daniela Invalidated View

RESULTS OF THE 2 YEAR TREATMENT WITH SIROLIMUS IN A CASE OF SEVERE LYMPHANGIOLEIOMYOMATOSIS

Medical Science

Author(s): Cotigă Diana

Coauthor(s): Bițineanu Daniela

Coordinator(s): MD Anca Macri

Keywords: LAM Sirolimus Rapamune FEV1

Introduction: Lymphangioleiomyomatosis (LAM) is a very rare, progressive lung disease that primarily affects women. LAM is characterized by an abnormal growth of smooth muscle cells that invade lung tissues, including the airways and blood/lymph vessels that cause destruction of the lung, generally progresses to respiratory failure. Sirolimus (Rapamune) is an immunosuppressive agent first indicated for the prophylaxis of organ rejection in patients receiving kidney transplants. Recently FDA approved Sirolimus to treat LAM. Its approval was based on the results from the Multicenter International Efficacy of Sirolimus or MILES Trial, who included 89 LAM patients with moderate lung impairment and showed that those treated with Rapamune for one year experienced stabilization of lung function measured by FEV1.

Material and Method: A 28-year-old non-smoker female started to accuse an infrequent nonproductive cough and progressive dyspnea on exertion that had worsened gradually. The pulmonary function testing revealed reversible airway obstruction, so as the patient was treated empirically for asthma which showed no improvement. We performed chest HRCT that revealed an image of multiple thin wall cystic structures and bronchoscopy with BAL that backed up the diagnosis. Lately, she was diagnosed with LAM after being detected with a high level of serum concentration of VEGF-D.

Results: The author presents the results of a two year treatment with Sirolimus in a severe form of LAM. A favorable effect upon the decline of FEV1, compared to the period before the treatment. This is the first case of LAM from Romania treated with Sirolimus. Unfortunately in our country Sirolimus is compensated only for kidney transplanted patients, so the matter of cost may be a problem.

Conclusion: The efficiency of Sirolimus in LAM is indisputable. It is necessary to ascertain which is the most appropriate group of female patients and the optimal period of treatment administration that leads to a maximum effect.

Bibliography: -Urban T, Lazor R, Lacronique J, et al. Pulmonary lymphangioleiomyomatosis. A study of 69 patients. -Franz DN, Brody A, Meyer C, et al. Mutational and radiographic analysis of pulmonary disease consistent with lymphangioleiomyomatosis and micronodular pneumocyte hyperplasia in women with tuberous sclerosis. - www.nejm.org// Efficacy and Safety of Sirolimus in Lymphangioleiomyomatosis - www.thelamfoundation.org - www.fda.com

THERAPEUTIC CHALLENGES IN FISTULISING CROHN`S DISEASE – A CASE REPORT  Țoc Dan-Alexandru , Țentea Călina-Patricia Stirbu Ioana Validated View

THERAPEUTIC CHALLENGES IN FISTULISING CROHN`S DISEASE – A CASE REPORT

Case Report - Poster

Author(s): Țoc Dan-Alexandru, Țentea Călina-Patricia

Coauthor(s): Stirbu Ioana

Coordinator(s): Assistant Professor Cristian Radu Tefas

Introduction:

Crohn`s disease is an inflammatory bowel disease (IBD) that may affect any part of the gastrointestinal tract. Intestinal complications such as bowel obstruction, fistulae, abscesses and bleeding are common. The last medical treatment in Crohn`s disease is biological therapy, which poses particular challenges.

Case Presentation:
We present the case of a 38 years old male patient who was diagnosed in 2012 with fistulising Crohn`s disease A2L2pB3. The treatment, involving a “step-up” approach with  5-aminosalicylic acid, corticotherapy and Infliximab was initiated and the patient`s symptoms remitted. In March 2016 Anti-Infliximab antibodies were positive and it was decided to switch to another TNF-alpha inhibitor, Adalimumab. However, the patient had a positive Quantiferon test, needing a 6 months therapy with Izoniazide delaying the switch to Adalimumab. In October 2016 he presented multiple fistulae and an MRI showed multiple perirectal abscesses. Sigmoidostomy and fistulectomy were performed. In February 2017 the patient presented with abdominal pain and diarrhea and C. Difficile toxins A and B were positive. He underwent a 15 day treatment course with Metronidazole and Vancomycin. Finally his treatment with Adalimumab was initiated without incidents, the patient`s symptoms remitted and he was discharged. He is expected for a follow-up next month to monitor the safety and success of therapy.

Conclusion:
Infliximab is immunogenic and developing Anti-Infliximab antibodies requires a switch to a less immunogenic agent like Adalimumab. Before initiating this therapy screening for tuberculosis is needed as well as surgical drainage of any septic complications.

Particularities:
We present a case of patient with Crohn`s disease who developed severe complications under treatment with Infliximab. A switch between TNF-alpha inhibitors was necessary but multiple delays occurred, which represented a particular challenge in therapy.

Application of the Alvarado Score on children less than sixteen years of age with acute appendicitis   Kreuzer Isabel - Validated View

Application of the Alvarado Score on children less than sixteen years of age with acute appendicitis

Surgical Science

Author(s): Kreuzer Isabel

Coordinator(s): MD Anca Budusan

Keywords: Acute appendicitis Children Alvarado Score CRP, WBC, US, Clinical findings

Introduction: Acute appendicitis belongs to the most common reasons for surgical interventions in children. In 1492 Leonardo da Vinci did the first anatomical drawings describing the appendix as “an earlike structure” arising from the cecum. Appendicitis in children still remains a diagnostic challenge, especially in patients under the age of five years. Therefore this study has been performed in order to investigate whether the application of the Alvarado Scoring system on children would help the physician with either confirming or withdrawing the suspicion of acute appendicitis.
Material and Method: 261 Children under the age of sixteen admitted to the Department of Pediatric Surgery in Cluj-Napoca with the diagnosis of an acute appendicitis followed by a surgical therapy were included within the study population. Data collection took place between 01.01.2015 and 31.12.2015. Relevant patient files have been selected via the hospitals database within the above mentioned period. Furthermore specific parameters were used.
Results: The gender distribution of children admitted to the pediatric emergency department between the age of 0-16 years was 1,2:1 (male:female). The White blood cell count variations have a strong correlation to the inflammatory evolution of the appendix. 69% of the children admitted to the pediatric emergency department had a Neutrophil count of >75%. The average C-reactive protein levels were rising in correlation to the morphological stage though relatively small values were obtained lowering its significance. 49% of the ultrasound results were equivocal and only lead to a suspicion of acute appendicitis.. An increase in the Alvarado Score in correlation to the histopathological results has been noticed.
Conclusion: The Alvarado Score in combination with an ultrasound examination and C-reactive protein levels should be introduced to increase its diagnostic accuracy and significancy. All three clinical and paraclinical examinations together will enormously help the physician.
Bibliography: Petroianu A. „Acute Appendicitis – Propedeutics and Diagnosis”[Internet]. Intech Open Science; c2012 [cited 09.01.2017]. Available from: http://cdn.intechopen.com/pdfs/28061.pdf

Susceptibility of Stomach and Duperior Duodenum to Ischemic Necrosis Post-subtotal Gastrectomy  Klimko ARTSIOM , Cornea Teodor Parau Diana Validated View

Susceptibility of Stomach and Duperior Duodenum to Ischemic Necrosis Post-subtotal Gastrectomy

Surgical Science

Author(s): Klimko ARTSIOM, Cornea Teodor

Coauthor(s): Parau Diana

Coordinator(s): Assistant Professor Ursut Bogdan

Keywords: Ischemic Necrosis Subtotal Gastrectomy Vascularization

Introduction:  Subtotal gastrectomy is indicated in patients with adenocarcinomas or persistent ulcers. The procedure involves resecting up to 80% of the stomach and in rare cases, may lead to postoperative ischemic necrosis of proximal or distal remnants.This study seeks to revisit and outline the gross arterial anatomy of the stomach and proximal duodenum and apply it to explain which areas are especially susceptible to postoperative ischemic necrosis.

Material and Method: Three embalmed male cadavers were used for documenting vascular anatomy of the abdominal esophagus, stomach, and proximal duodenum. Additionally, a fourth cadaver was used to simulate a subtotal gastrectomy procedure and outline which vessels are classically resected and in what sequence. Lastly, a set of angiograms from post-op patients were used to further substantiate which areas appeared to lack robust anastomotic blood supply.

Results: All cadaver dissections showed fairly standard vascular anatomy, except the superior duodenum. All cadavers lacked a posterior gastric artery. The duodenum was supplied by the posterior superior pancreaticoduodenal artery and a supraduodenal artery; additionally, in one cadaver a few centimeters of the superior duodenum received supply from the right gastric artery.

Conclusion: Two areas are susceptible: the fundus of the stomach and the superior portion of the duodenum. The duodenum is supplied by end arteries and will depend on preservation of the posterior superior pancreaticoduodenal artery when ligating the right gastroepiploic artery off of the gastroduodenal artery. The viability of the gastric remnant will be determined by the preservation of the short gastric arteries. A portion of the gastrosplenic ligament needs to be resected to mobilize the greater curvature and may require sacrificing some branches of the short gastric. For this reason, if a splenectomy is required to assure complete nodal resection, a total gastrectomy should be chosen to avoid devascularizing the gastric remnant. 

Bibliography: Bibliography 1. Majneh, I., A. Saarinen, and J. Siivola. "Result Filters." National Center for Biotechnology Information. U.S. National Library of Medicine, Dec. 2001. Web. 19 May 2016. 2. Mondelli, M., A. Aretini, F. Ginanneschi, and L. Padua. "Result Filters."National Center for Biotechnology Information. U.S. National Library of Medicine, Oct. 2010. Web. 19 May 2016.

The onset of mixed connective tissue disease on a patient with symptoms of arthritis  Chirea Gabriela , Mangaloiu David - Invalidated View

The onset of mixed connective tissue disease on a patient with symptoms of arthritis

Case Report - Poster

Author(s): Chirea Gabriela, Mangaloiu David

Coordinator(s): Assistant Professor Isabela Maria Sarbu

Introduction:

Mixed connective tissue disease is an autoimmune disorder characterized by features of systemic lupus erythematosus, systemic sclerosis, and polymyositis. It is a rare disease and affects predominately women.


Case Presentation:

A 61-year old female patient, with a history of Mixed Connective Tissue Disease (MCTD) with arthritis and pulmonary affectation (Fibrosing Alveolitis) from 2007, in treatment with Medrol 4mg/day, with favorable evolution and tolerance comes to the hospital with mechanical cervical and low back pain, accompanied by dizziness cephalalgia, mechanical hip pain and inflammatory pain affecting the small joints of wrist and hands with morning stiffness about 30 minutes.

The symptomatology started in 2007 with mixed joint pain: bilateral shoulders and small joints of wrist and hands, hands swelling and diffuse myalgia. She was initially diagnosed with Rheumatoid Arthritis and treated with Plaquenil and Medrol for one month and her condition got better. In 2010, new symptoms appeared: arthritis of the wrist and small joints of the bilateral hands, ankles and shoulders, elevated levels of C reactive protein (CRP) and erythrocyte sedimentation rate (ESR), Fibrinogen 423mg/dl, Rheumatoid Factor 640 UI/ml. The diagnosis of MCTD was brought into consideration by the high levels of anti U1 RNP antibodies. The patient was again treated with Plaquenil and Medrol for one year with significant improvement.  


Conclusion:

The drug administered was Methotrexate (MTX) 10 mg/week one year and the patient’s condition got better. But she developed leucopenia so the MTX was stopped. In 2011 a new diagnose was added to MCTD, Fibrosing Alveolitis after persistent episodes of puffy hands and acrosclerosis. She was administered Cyclophosphamide for 6 months. In the last years the patient complains about exercise indused dyspnea and acrocianosis.


Particularities:

The particularity of this clinical case is that the symptoms of the disease didn’t appeared all at once, but over a number of years, which made the confusion with Rheumatoid Arthritis.

Autoimmune progesterone dermatitis – a case report   Dionisie Vlad Terteci - Popescu Dragoș Validated View

Autoimmune progesterone dermatitis – a case report

Case Report - Poster

Author(s): Dionisie Vlad

Coauthor(s): Terteci - Popescu Dragoș

Coordinator(s): Lecturer Simona Senila

Introduction:

Autoimmune progesterone dermatitis (APD) is a cutaneous cyclic disease induced by autoimmune response to elevated level of endogenous progesterone. APD has less than 50 documented cases and has been classified by National Institute of Health as a rare disorder. We report one case of APD with symptoms’ remission after treatment with oral contraceptives.


Case Presentation:

A 34-year-old woman presented to the Dermatology Department with a 3 months history of  pruritic eruption consisting of wide-spread erythematous papules and plaques that recurres every month, starting 5 days before menses, and disappear 1-2 days after completion of menstruation. The lesions  were localized on the cheeks, chin, V region of the neck, upper and lower limbs and are well-demarcated, symmetric, uniform in colour and with the size ranging from 5 to 20 mm. The intradermal reaction test (IDR) with progesterone read at 20 minutes was positive. Histopathological examination of the skin biopsy revealed perivascular and diffuse mononuclear cells infiltrates in the dermis and apoptosis of basal cells. These features were consistent with the diagnosis of APD. The patient received combined oral contraceptive (ethinyl estradiol, levonorgestrel) resulting in the improvement of skin lesions.


Conclusion:

The clinical presentation of APD encounters signs and symptoms ranging from unspecified dermatitis to anaphylaxis. In most of the cases, patients have been exposed to synthetic progesterone derivatives that are enough antigenic to induce sensitization to endogenous progesterone. Some cases have been determined by the rise in progesterone levels during pregnancy.


Particularities:

This case is particulary distinctive both in terms of  patient’s history - she did not followed an oral contraceptive treatment nor she was pregnant, conditions that are more frequent to determine APD and also in terms of  resources available to diagnose – the cyclic nature of the dermatitis and the IDR response differentiates this conditions from similar allergies or systemic disease. 

Effects of Artemisia absinthium in experimental inflammation  Zugravu Dalina Diana - Validated View

Effects of Artemisia absinthium in experimental inflammation

Fundamental Science

Author(s): Zugravu Dalina Diana

Coordinator(s): Professor Alina Elena Pârvu

Keywords: Artemisia absinthium acute experimental inflammation nitro-oxidative stress

Introduction: Previous studies identified the positive effect of the Arthemisia absinthium in infections, wounds healing and rheumatic pain. Therefore we tested the A. absinthium total extract for its effect in acute experimental inflammation, especially focused on the nitro-oxidative stress.

Material and Method: The anti-inflammatory activity of the tincture from A. absinthium was tested in acute inflammation induced with turpentine oil (i.m. 0.6 ml/100 g b.w.) in male Wistar rats. The animals were divided into six groups. The tinctures were tested in three dilutions (100%, 50%, 25%). The results were compared with those from a negative control group, a positive inflammation group, and a group treated with diclofenac (30 mg/100 g b.w.). The effects were evaluated by measuring the Malondialdehide (MDA) , the Nitric oxide (NO), the Total antioxidant reactivity (TAR), Total antioxidative capacity (TAC), Nitrites, total thiols, Oxidative Stress Index (OSI) and Thiols (SH).  

Results: Compared to the control inflammation caused a significant nitro-oxidative stress by increasing OSI, TOS, NO and MDA and a SH reduction. A. absinthium 100%, 50% and 25% extract dilutions reduced significantly OSI, TOS and NO. The 50% extract had a better inhibitory effect than diclofenac. Only A. Absinthium 50% reduced MDA. The A. Absinthium extract had no significant effect upon TAR. A. Absinthium increased significantly SH.

Conclusion: A. Absinthium extract had significant inhibitory effect on the nitro-oxidative stress induced by acute inflammation through OSI, TOS and NO reduction and SH increase. The antinitro-oxidative stress effect was better than that of Diclofenac for A. Absinthium 50%.

Bibliography: Miranda KM, Espey MG, Wink DA. A rapid, simple spectrophotometric method for simultaneous detection of nitrate and nitrite. Official Journal of the Nitric Oxide society. 2001; 5: 62–71. Gavrilov VB, Gavrilova AR, Mazhul LM. Methods of determining lipid peroxidation products in the serum using a thiobarbituric acid test. Vopr Med Khim 1987; 33:118–22. Erel O. A new automated colorimetric method for measuring total oxidant status. Clin. Biochem. 2005; 38: 1103–1111. Erel O. A novel automated method to measure total antioxidant response against potent free radical reactions. Clin. Biochem. 2004; 37: 112–119. Porfire AS, Lecuta SA, Kiss B, Loghin F, Parvu AE. Investigation into the role of Cu/Zn-SOD delivery system on its antioxidant and antiinflammatory activity in rat model of peritonitis. Pharmacol Rep. 2014 Aug;66(4):670-6. Mitev D. Evaluation of thiol compound and lipid peroxidative products in plasma of patients with COPD. Trakia Journal of Sciences.2010; 8(2): 306-314. Harma M, Harma M, Erel O. Increased oxidative stress in patients with hydatidiform mole. Swiss Med. Wkly. 2003; 133: 563–566.

LESS IS MORE – RETINOIC ACID STROMAL METABOLIC BYPASSING IN ACUTE MYELOID LEUKAEMIA DIFFERENTIATION THERAPY  Gafencu Grigore Aristide , - Validated View

LESS IS MORE – RETINOIC ACID STROMAL METABOLIC BYPASSING IN ACUTE MYELOID LEUKAEMIA DIFFERENTIATION THERAPY

Fundamental Science

Author(s): Gafencu Grigore Aristide,

Coordinator(s): Assistant Professor Ciprian Tomuleasa

Keywords: ATRA liposomes stroma differentiation

Introduction: All-trans retinoic acid (ATRA) is one of the first and most successful differentiation therapy developed for acute myeloid leukaemia (AML) (1). In combination with anthracyclines, and more recently by development of arsenic trioxide containing regimens, ATRA revolutionised the therapy of a type of AML, acute promyelocytic leukaemia (APL), now characterized by complete remission rates of 90% and cure rates of 80%, even higher among low-risk patients (2). In order to better understand and improve ATRA’s pharmacodynamics at the level of leukaemic bone marrow niche, we developed a liposomal form of ATRA, L-ATRA and assessed its efficacy in an in vitro model of leukaemic bone marrow niche.

Material and Method: We first generated stable <200nm liposomes containing ATRA by evaporating the solvent out of mixture DSPC:cholesterol:ATRA, then dispersing the lipid in TBS buffer followed by purification using 0.22μm cell culture media filters. Afterwards, we treated a co-culture of APL blasts and bone-marrow stromal cells with ATRA, L-ATRA, and empty liposomes at concentrations ranging from 10-10M to 10-6M, for 72h and assessed the expression of differentiation markers CD11b and CD38 via flow cytometry and the clonogenicity of the treated APL blasts via a colony forming assay.

Results: L-ATRA 10-7M may be a better differentiation agent than ATRA 10-7M in co-cultures ( CD38 fold increase 2.25 vs 1.27 – p<0.001) but L-ATRA 10-6 M is as effective as L-ATRA 10-7 M in the same conditions (CD38 rel. fold increase 2.25 vs 1.12 – p=0.061). L-ATRA 10-7M is not superior to ATRA 10-7M when it comes to lowering clonogenic activity of APL blasts.

Conclusion: L-ATRA seems to mitigate the stromal retinoid metabolism, but not in a dose dependant manner highlighting the hypothesis that higher concentrations of L-ATRA could trigger an intensified phagocytic response from the stroma cells and limit the availability of L-ATRA.

Bibliography: 1. Marchwicka A, Cebrat M, Sampath P, Snieżewski L, Marcinkowska E. Perspectives of differentiation therapies of acute myeloid leukemia: the search for the molecular basis of patients’ variable responses to 1,25-dihydroxyvitamin d and vitamin d analogs. Front Oncol [Internet]. 2014;4(May):125. Available from: http://journal.frontiersin.org/article/10.3389/fonc.2014.00125/abstract 2. Coombs CC, Tavakkoli M, Tallman MS. Acute promyelocytic leukemia: where did we start, where are we now, and the future. Blood Cancer J [Internet]. Nature Publishing Group; 2015;5(4):e304. Available from: http://www.nature.com/doifinder/10.1038/bcj.2015.25

Statins improve energy supply of the nephron cells via antioxidant effect under the conditions of the acute kidney injury  Zeleniuk Volodymyr , Shchudrova Tatiana Korovenkova Oksana, Rovinskii Oleksandr, Adamchuk Anastasiia Validated View

Statins improve energy supply of the nephron cells via antioxidant effect under the conditions of the acute kidney injury

Fundamental Science

Author(s): Zeleniuk Volodymyr, Shchudrova Tatiana

Coauthor(s): Korovenkova Oksana, Rovinskii Oleksandr, Adamchuk Anastasiia

Coordinator(s): Professor Igor Zamorskii

Keywords: statins acute kidney injury renoprotection antioxidant effects

Introduction: One of the approaches of the pharmacotherapy of acute kidney injury (AKI) is the use of drugs with antioxidant properties. Statins can prevent lipid peroxidation and disturbances of the mitochondrial energy generation. Thus, our research study was targeted at the examination of the impact of statins on the linkage between oxidative stress and impaired energy metabolism under the conditions of AKI.

Material and Method: The experiment was carried out on 40 white nonlinear male rats weighing 140-180 g. Statins (atorvastatin, simvastatin and lovastatin) at 20 mg/kg were administered intragastrically daily for 3 days before the surgery. Renal ischemia-reperfusion injury was initiated during anesthesia: median laparotomy followed by 75-minute clamping of the left renal pedicle and reperfusion for 24 h. The renal function was assessed immediately after reperfusion under the conditions of induced diuresis.

Results: Activation of the free radical oxidation led to the energy metabolism imbalance and decrease in the activity of succinate-coenzyme Q reductase (SQR) in the kidney tissue of untreated animals by 2.6 times. The latter fact was verified by an inversed correlation (r=-0.88) between the content of malondialdehyde in the kidney tissue and the SQR activity, as well as by the direct correlation (r = 0.72) between the activity of glutathione peroxidase and SQR. Concerning the antioxidant effects of statins it was managed to achieve the activation of SQR: by 2.2 times (atorvastatin), by 1.7 times (lovastatin), and by 2.3 times (simvastatin). Furthermore, the prevention of kidney damage was achieved due to antioxidant effects of statins. To illustrate: the glomerular filtration rate increased by 2.7 times, the fractional excretion of sodium reduced below 1% and proteinuria reduced by 2 times (averagely for all statins), as compared with untreated animals.

Conclusion: Statins, due to their antioxidant effect, restored disrupted energy metabolism in the nephron and ameliorated AKI.

Bibliography: Antoniades C, Bakogiannis C, Tousoulis D et al. Preoperative atorvastatin treatment in CABG patients rapidly improves vein graft redox state by inhibition of Rac1 and NADPH-oxidase activity. Circulation 2010;122,11:S66-73. Panonnummal R, Varkey J, Dinoop DR. Protective effect of atorvastatin against vancomycin induced nephrotoxicity in albino rats. Pharmacie Globale 2011;02,8:1-6. Shishehbor MH, Brennan ML, Aviles RJ et al. Statins promote potent systemic antioxidant effects through specific inflammatory pathways. Circulation 2003;108:426-431.

CLINICOPATHOLOGICAL ANALYSIS OF A CASE SERIES OF LENNERT LYMPHOMA  Selicean Sonia Emilia , Gafencu Grigore Aristide - Validated View

CLINICOPATHOLOGICAL ANALYSIS OF A CASE SERIES OF LENNERT LYMPHOMA

Medical Science

Author(s): Selicean Sonia Emilia, Gafencu Grigore Aristide

Coordinator(s): MD Ciprian Ionut Tomuleasa

Keywords: T- or NK cell lymphoma Epstein-Barr virus immunohistochemistry peripheral T cell lymphoma

Introduction: Peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS), is the most common type of mature T- or NK-cell lymphoma. According to World Health Organisation (WHO), several histologically specific lymphomas, such as Lennert lymphoma and a follicular variant of PTCL are currently classified as PTCL-NOS. However, this type of lymphomas exhibit a very heterogenous clinical behaviour and not well defined pathologic features. An accurate and effective prognostication system is still needed. The aim of our current work was a clinico-pathological description and correlation of a case series of Lennert's lymphomas from the "Ion Chiricuţă" Oncology Institute Cluj-Napoca (IOCN) [1, 2].

Material and Method: Paraffin embeded lymph node biopsies from 8 cases of Lennert lymphoma diagnosed at the IOCN between the years of 1987-2014 were used. We performed haematoxylin-eosin colouring and immunohistochemical staining for different markers, as well as Epstein-Bar virus (EBV) status determination on all samples.

Results: All of our cases showed EBV negativity, as opposed to other published cases. The 5 year survival in this case series was 87,5%, in contrast to other case reports which displayed significantly worse prognosis [3]. 

Conclusion: Considering the good overall survival of our patients and their EBV negativity, we propose EBV infection as an important factor in the survival of PTCL-NOS patients.

Bibliography: [1] Jeon YK, Kim JH, Sung JY, Han JH, Ko YH, Hematopathology Study Group of the Korean Society of Pathologists. Epstein-Barr virus–positive nodal T/NK-cell lymphoma: an analysis of 15 cases with distinct clinicopathological features. HUM PATHOL 2015;46:981-90. [2] Geissinger E, Odenwald T, Lee SS, et al. Nodal peripheral T-cell lymphomas and, in particular, their lymphoepithelioid (Lennert’s) variant are often derived from CD8(+) cytotoxic T-cells. Virchows Arch 2004;445:334-43. [3] Kitamura A, Yamashita Y, Sato Y, et al. Aggressive Lennert's lymphoma: report of three cases in comparison to non-aggressive Lennert's lymphoma. Pathol Int 2005;55:626-31.

MISLEADING DIAGNOSIS IN A CASE OF GRANULOMATOSIS WITH POLYANGIITIS IN A PATIENT WITH RIGHT NEPHRECTOMY AND CHRONIC KIDNEY DISEASE  Popescu Emilia-Cristina - Validated View

MISLEADING DIAGNOSIS IN A CASE OF GRANULOMATOSIS WITH POLYANGIITIS IN A PATIENT WITH RIGHT NEPHRECTOMY AND CHRONIC KIDNEY DISEASE

Case Report - Poster

Author(s): Popescu Emilia-Cristina

Coordinator(s): Assistant Professor Diana Sorina Feier

Introduction: Granulomatosis with polyangiitis formerly known as Wegener granulomatosis is a systemic autoimmune condition which affects 3 out of 100,000 people. It is a form of necrotizing granulomatous vasculitis characterized by damage in the respiratory tract, kidney, skin and nervous system.

Case Presentation: A female patient, age 66 known with right nephrectomy for renal carcinoma, chronic kidney disease, type 2 diabetes mellitus complicated with polyneuropathy and anemia presented with cough, haemoptysis, dyspnea and fatigue. Two months prior to the admission the patient was diagnosed with interstitial pneumonia demonstrated by chest radiography in Baia Mare County Hospital. The first unenhanced thoracic CT-scans showed diffuse parenchymal consolidation with bilateral pleural effusion. Two follow-up Ct-scans revealed crazy paving pattern with evolving bilateral focal patchy regions of ground glass opacity and signs of alveolar haemorrhages raising the suspicion of a form of pulmonary vasculitis like Wegener granulomatosis. Considering the recurrent haemoptysis and renal impairment the suspicion of granulomatosis with polyangiitis was raised and the patient was further tested for cytoplasmic antineutrophil cytoplasmic antibodies (cANCA). A high titer of cANCA was found. A pulmonary biopsy was performed and the histopathological examination of the tissue revealed pulmonary alveolar capillaritis. Treatment for Wegener granulomatosis was started with a combination of corticosteroids and cytotoxic agents. Under the treatment the evolution was favorable. 
Conclusion:

Granulomatosis with polyangiitis should be considered in the differential diagnosis of patients with anemia, cough, haemoptysis and crazy paving pattern on thoracic CT-scan, with favorable outcome under treatment.

Particularities:

Basal interstitial fibrosis is usually the first finding of the disease and in this case was interpreted as an interstitial pneumonia. Multiple nodules of variable size which are randomly distributed in the lungs are usually the most common radiological presentation but in this case the CT appearance was dominated by crazy paving changes and pulmonary haemorrhages.

The diagnostic challenge of amelanotic melanoma – a case report  Pop Mihai Popescu Emilia-Cristina Invalidated View

The diagnostic challenge of amelanotic melanoma – a case report

Case Report - Poster

Author(s): Pop Mihai

Coauthor(s): Popescu Emilia-Cristina

Coordinator(s): Lecturer Loredana Ungureanu , Lecturer Simona Șenilă

Introduction:

Amelanotic melanoma (AM) represents a very aggresive type of cancer that is considered to have one of the fastest growing incidences worldwide(2-8% of all melanomas). We report an unusual case of an AM resembling a squamos cell carcinoma(SCC), another type of malignant skin tumour that has a completely different prognosis than AM.


Case Presentation: A 75-year-old caucasian woman presented with a relatively rapidly growing solitary lesion on the right cheek. The lesion was first diagnosed by the general practitioner as a dermatitis and treated with corticosteroids for three weeks. One year after this treament, on physical examination, there was a firm, dome shaped, pink, 1.5 cm nodule with a central ulceration covered by a yellow fine crust and fine scales. Dermoscopic examination revealed white-yellow circles, white-yellow structureless areas, milky red areas, reticular white lines and a polymorphous vascular pattern. The clinical picture supported the diagnosis of squamos cell carcinoma. However, the presence of milky red areas, reticular white lines and polymorphous vascular pattern on dermoscopy later raised the suspicion of amelanotic melanoma. The lesion was excised and the histopathological evaluation confirmed the diagnosis of AM.

Conclusion: The patient was misdiagnosed as having a common case of dermatitis and then , based on the fast development in terms of clinical aspects, it was misdiagnosed a second time as SCC. The right diagnosis of AM was later possible due to the use of dermoscopy. 

Particularities: The case is particularly distinctive because it illustrates the challenge in the diagnosis of AM based on its clinical aspects. The advanced stage in the moment of diagnosis is making this disease's prognostic extremely limited, therefore underlining the importance of routinely used dermoscopy in the evaluation of non-pigmented skin tumours.

Novel detection of miR-155 based on gold nanoparticle aggregation method  Esmaeili Bandboni Aghil - Validated View

Novel detection of miR-155 based on gold nanoparticle aggregation method

Fundamental Science

Author(s): Esmaeili Bandboni Aghil

Coordinator(s): Associate Professor Sadroddiny Sadroddiny

Keywords: MicroRNAs Cancer Gold nanoparticles Limit of Detection

Introduction: MicroRNAs(miRNAs) can play important role in diagnosis of various diseases including cancers. Because of their small size, there are some challenges in regard to detect them. The gold nanoparticle aggregation is one of the techniques for detection of micro RNAs. This method have been demonstrated to have enhanced specificity and sensitivity as compared with conventional methods. Mir- 155 play a critical role in many of cancers and other diseases. In this study, we designed a cross-linking gold nanoparticles aggregation method for detection of mir-155.
Material and Method: For doing this thesis Citrate-coated AuNPs were prepared according to the procedure described by Turkevich et al. Thiolated capture probe was designed and synthesized. Probe was attached to gold nanoparticles by covalent binding. Then Nano-probes were mixed with different concentrations of synthetic miR-155 and Calibration curve was plotted.
Results: The detection was done in different concentration and the Limit of detection was defined. According to the results 10 nano molar of target miRNA concentration was determined by this method. The specificity of this method was confirmed by the comparison of detection of targeted miRNA with random synthetic miRNA.
Conclusion: Sensitivity and specificity of gold nanoparticle aggregation method is suitable for detection. Using this method, we enable the detection of specific miRNA with nanomolar sensitivity.
Bibliography: 1. Esteller M. Non-coding RNAs in human disease. Nature Reviews Genetics. 2011;12(12):861-74. 2. Mitchell PS, Parkin RK, Kroh EM, Fritz BR, Wyman SK, Pogosova-Agadjanyan EL, et al. Circulating microRNAs as stable blood-based markers for cancer detection. Proceedings of the National Academy of Sciences. 2008;105(30):10513-8. 3. Guay C, Regazzi R. Circulating microRNAs as novel biomarkers for diabetes mellitus. Nature Reviews Endocrinology. 2013;9(9):513-21. 4. Wang K, Zhang S, Marzolf B, Troisch P, Brightman A, Hu Z, et al. Circulating microRNAs, potential biomarkers for drug-induced liver injury. Proceedings of the National Academy of Sciences. 2009;106(11):4402-7. 5. Van Huyen J-PD, Tible M, Gay A, Guillemain R, Aubert O, Varnous S, et al. MicroRNAs as non-invasive biomarkers of heart transplant rejection. European heart journal. 2014;35(45):3194-202. 6. Han Z-B, Zhong L, Teng M-J, Fan J-W, Tang H-M, Wu J-Y, et al. Identification of recurrence‐related microRNAs in hepatocellular carcinoma following liver transplantation. Molecular oncology. 2012;6(4):445-57. 7. Kasinski AL, Slack FJ. MicroRNAs en route to the clinic: progress in validating and targeting microRNAs for cancer therapy. Nature reviews Cancer. 2011;11(12):849-64. 8. Chen Y, Gelfond JA, McManus LM, Shireman PK. Reproducibility of quantitative RT-PCR array in miRNA expression profiling and comparison with microarray analysis. BMC genomics. 2009;10(1):407. 9. Tian T, Wang J, Zhou X. A review: microRNA detection methods. Organic & biomolecular chemistry. 2015;13(8):2226-38. 10. Sepúlveda B, Angelomé PC, Lechuga LM, Liz-Marzán LM. LSPR-based nanobiosensors. Nano Today. 2009;4(3):244-51. 11. Mayer KM, Hafner JH. Localized surface plasmon resonance sensors. Chemical reviews. 2011;111(6):3828-57. 12. Anker JN, Hall WP, Lyandres O, Shah NC, Zhao J, Van Duyne RP. Biosensing with plasmonic nanosensors. Nature materials. 2008;7(6):442-53. 13. Chan GH, Zhao J, Hicks EM, Schatz GC, Van Duyne RP. Plasmonic properties of copper nanoparticles fabricated by nanosphere lithography. Nano Letters. 2007;7(7):1947-52. 14. Howes PD, Chandrawati R, Stevens MM. Colloidal nanoparticles as advanced biological sensors. Science. 2014;346(6205):1247390. 15. Xu X, Daniel WL, Wei W, Mirkin CA. Colorimetric Cu2+ Detection Using DNA‐Modified Gold‐Nanoparticle Aggregates as Probes and Click Chemistry. Small. 2010;6(5):623-6. 16. Xia F, Zuo X, Yang R, Xiao Y, Kang D, Vallée-Bélisle A, et al. Colorimetric detection of DNA, small molecules, proteins, and ions using unmodified gold nanoparticles and conjugated polyelectrolytes. Proceedings of the National Academy of Sciences. 2010;107(24):10837-41. 17. Lee JS, Han MS, Mirkin CA. Colorimetric detection of mercuric ion (Hg2+) in aqueous media using DNA‐functionalized gold nanoparticles. Angewandte Chemie International Edition. 2007;46(22):4093-6. 18. Tili E, Michaille J-J, Wernicke D, Alder H, Costinean S, Volinia S, et al. Mutator activity induced by microRNA-155 (miR-155) links inflammation and cancer. Proceedings of the National Academy of Sciences. 2011;108(12):4908-13. 19. Kimling J, Maier M, Okenve B, Kotaidis V, Ballot H, Plech A. Turkevich method for gold nanoparticle synthesis revisited. The Journal of Physical Chemistry B. 2006;110(32):15700-7. 20. Cordray MS, Amdahl M, Richards-Kortum RR. Gold nanoparticle aggregation for quantification of oligonucleotides: Optimization and increased dynamic range. Analytical biochemistry. 2012;431(2):99-105.

From venous ulcers to an autoimmune disease – the importance of interdisciplinary collaboration  Nastasă Răzvan Nastasă Andra Invalidated View

From venous ulcers to an autoimmune disease – the importance of interdisciplinary collaboration

Case Report - Poster

Author(s): Nastasă Răzvan

Coauthor(s): Nastasă Andra

Coordinator(s): MD Laura Florea

Introduction:

Leg ulcers are lesions of the skin and of the underlying structures in the lower extremity. Over 90% of leg ulcers are due to venous insufficiency, but there are several rare pathologies which can also be the cause of leg ulcers, in correlation with other symptoms. Here we present a case of leg ulcers which were previously associated with chronic venous insufficiency, but, upon admission to the nephrology clinic on the basis of apparently unrelated parameters, turned out to be the effect of an idiopathic cryoglobulinemia, a medical condition in which the blood contains high levels of immunoglobulins that become insoluble at reduced temperatures. 


Case Presentation:

T.M., a 41-year old woman, was admitted to the Nephrology Department with elevated urea and creatinine levels. She also presented nephrotic-range proteinuria. Medical history revealed past leg ulcers, associated with chronic venous insufficiency, and polyarthralgia. Blood analysis indicated a nephrotic syndrome, combined with an inflammatory syndrome. Both infectious and neoplastic etiologies of the nephrotic syndrome were ruled out after further blood and imaging tests, and, therefore, an autoimmune disease was considered. The presence of cryoglobulins in the blood, combined with the results of the renal biopsy (which indicated a membranoproliferative glomerulonephritis), and the absence of anti-nuclear antibodies specific to other autoimmune diseases, led to the diagnosis of idiopathic cryoglobulinemia. The treatment consisted of immunosuppressive drugs such as Prednisone and Cyclophosphamide, combined with antiproteinuric medication.


Conclusion:

The evolution of the patient with the treatment presented above is favorable. The case underlines the importance of taking into account rare etiologies in the process of correctly diagnosing and treating cutaneous ulcerations.


Particularities: The case is noteworthy because of the unexpected association the doctors had to make between leg ulcers, polyarthralgia and other signs usually connected to many common pathologies, and cryoglobulinemia, an autoimmune disease with a low prevalence among the population. 

ANATOMICAL STUDY OF THE INTERNAL THORACIC ARTERY AND IT'S COLLATERAL BRANCHES - SURGICAL IMPLICATIONS  Cornea Teodor , Soitu Mihnea Andrei Klimko ARTSIOM, Parau Diana Validated View

ANATOMICAL STUDY OF THE INTERNAL THORACIC ARTERY AND IT'S COLLATERAL BRANCHES - SURGICAL IMPLICATIONS

Surgical Science

Author(s): Cornea Teodor, Soitu Mihnea Andrei

Coauthor(s): Klimko ARTSIOM, Parau Diana

Coordinator(s): Assistant Professor Bogdan Ursut

Keywords: coronary bypass internal thoracic artery collateral branches vascularization

Introduction: The internal thoracic artery originates proximal to the subclavian artery, two centimeters superior to the clavicle. It has a descending trajectory, posterior to the first six costal cartilages. Before entering the thorax, the internal thoracic artery can be found posterior to the clavicle, internal jugular vein, and brachiocephalic veins. After it enters the thorax, the phrenic nerve crosses over it anteriorly from lateral to medial. The artery continues downwards almost vertically, and bifurcates upon reaching the seventh intercostal space into two terminal branches- the musculophrenic artery, and the superior epigastric artery. The internal thoracic artery has sternal collateral branches, which together with branches of the pericardiophrenic, posterior intercostal, and bronchial arteries participate in forming the sub pleural mediastinal plexus. The internal thoracic artery gives off branches for the first six anterior intercostal spaces, which anastomose with the posterior intercostal arteries, vascularizing the pectoral muscles, mammary glands, and skin in their respective region. Perforating branches of the internal thoracic artery penetrate into the pectoral muscles and anastomose with branches of the thoracoacromial artery. 
Material and Method: In this paper we studied four cadavers from the Human Anatomy Cathedra of UMF Carol Davila using dissection methods to study the morphology and trajectory of the internal thoracic artery and its principal collateral branches. On top of that, we collected data from open heart surgery in which the internal thoracic artery was used for coronary bypass surgery.  

Results: Dissection revealed no major variation from expected trajectory. However, during open heart surgery we were able to indentify an accessory internal thoracic artery.
Conclusion: When harvesting the internal thoracic artery, it should be kept in mind that it has many collateral branches which supply the sternum, intercostal spaces and thoracic wall, thus harvesting it should be done with caution to preserve the blood supply to these locations.

Bibliography: 1.Berdajis, Denis, Gregor Zund, Marko I. Turina, and Michelle Genoni. "Blood Supply of the Sternum and Its Importance in Internal Thoracic Artery Harvesting." Department of Cardiovascular Surgery, University Hospital Züric, Zürich, Switzerland The Society of Thoracic Surgeons, 2006. Web. 2.Cohn, Laurence H. "Use of the Internal Mammary Artery Graft and In-Hospital Mortality and Other Adverse Outcomes Associated With Coronary Artery Bypass Surgery." Circulation (2001): Circulation. American Heart Association, Jan.-Feb. 2001. 3.De Jesus, Ramon A., and Robert D. Acland. "Anatomic Study of the Collateral Blood Supply of the Sternum." Division of Plastic and Reconstructive Surgery, University of Louisville, Louisville, Kentucky, July-Aug. 1994. Web. 4.Moore, Keith L., Arthur F. Dalley, and A. M. R. Agur. Clinically Oriented Anatomy. Philadelphia: Lippincott Williams & Wilkins, 2006. N.p.: n.p., n.d. 95-96. Print. 5.Otsuka, Fumiyuki, Kazuyuki Yahagi, Kenichi Sakakura, and Renu Virmani. "Why Is the Mammary Artery so Special and What Protects It from Atherosclerosis?" Why Is the Mammary Artery so Special and What Protects It from Atherosclerosis? - Otsuka- Annals of Cardiothoracic Surgery. CVPath Institute, Inc., Gaithersburg, MD, USA, June-July 2013. Web. 03 Dec. 2016. 6.Shepherd, Rob. Grays Anatomy : Stanhope, 2014. N.p.: n.p., n.d. 942-943. Print.

ASSESSMENT OF SNAPPE II SCORE IN NEONATES WITH DUCTAL-DEPENDANT SYSTEMIC FLOW  Costea George-Claudiu Sava Marius-Constantin, Vuță Monica Validated View

ASSESSMENT OF SNAPPE II SCORE IN NEONATES WITH DUCTAL-DEPENDANT SYSTEMIC FLOW

Medical Science

Author(s): Costea George-Claudiu

Coauthor(s): Sava Marius-Constantin, Vuță Monica

Coordinator(s): Associate Professor Manuela Cucerea , Assistant Professor Laura Mihaela Suciu

Keywords: congenital heart disease neonatology prostaglandin ductal-dependant

Introduction: Congenital heart diseases with a ductal-dependent systemic flow are rare and it is often difficult to predict the outcome of these patients. The Score for Neonatal Acute Physiology with Perinatal Extension (SNAPPE-II) predicts both morbidity and mortality in neonates admitted to Neonatology Intensive Care Unit (NICU). The aim of our study was to assess the SNAPPE-II score in patients with ductal-dependent systemic flow congenital heart diseases. 

Material and Method: We retrospectively evaluated medical records of 35 neonates, admitted within the NICU of Tîrgu Mureș Emergency County Hospital between January 2014 and December 2016. Anthropometric data such as gender and weight at birth, presence of antenatal diagnosis and complications (cardiac arrest, need for mechanical ventilation and inotropic support) were collected. Also, data regarding prostaglandin treatment (day of initiation, duration of the treatment) were gathered and SNAPPE-II score was calculated for every patient.    

Results: SNAPPE-II score was statistically correlated with the sum of all complications (p<0.01, r=0.48, 95%CI 0.17-0.71). SNAPPE-II was significantly higher in patients with more than one cardiac malformation (p=0.03) and in those that were not diagnosed antepartum (p=0.01). SNAPPE-II score was significantly lower in patients that had the prostaglandin treatment initiated in the first 48 hours of life, when compared to those in which the treatment was initiated after this threshold (p=0.03, 95%CI 0.99-19.5).

Conclusion: Patients with a higher SNAPPE-II score are at a higher risk of developing cardiorespiratory complications during the admission period. SNAPPE-II score was lowered by an early initiation of prostaglandin treatment, as seen by lower score in patients with initiation within the first 48 hours of life. Also, cases in which the diagnosis of congenital heart disease was not established antepartum were associated with a higher SNAPPE-II score.

Bibliography: 1. Harsha, Shivanna Sree, and Banur Raju Archana. "SNAPPE-II (score for neonatal acute physiology with perinatal extension-II) in predicting mortality and morbidity in NICU." Journal of clinical and diagnostic research: JCDR 9.10 (2015): SC10. 2. Groenendaal, F., et al. "Improved SNAPPE-II and CRIB II scores over a 15-year period." Journal of Perinatology (2017). 3. Zupancic, John AF, et al. "Revalidation of the score for neonatal acute physiology in the Vermont Oxford Network." Pediatrics 119.1 (2007): e156-e163. 4.Keane, John F, James E. Lock, Donald C. Fyler, and Alexander S. Nadas. Nadas' Pediatric Cardiology. Philadelphia: Saunders, 2006. Print.

Major depressive episode with psychotic features in the postpartum period  Ani Cristina Miceta , Asztalos Anna Boglarka Mihai Alex, Milotoiu Ioan, Oros Adrian Invalidated View

Major depressive episode with psychotic features in the postpartum period

Case Report - Poster

Author(s): Ani Cristina Miceta, Asztalos Anna Boglarka

Coauthor(s): Mihai Alex, Milotoiu Ioan, Oros Adrian

Coordinator(s): Professor Ioana Miclutia

Introduction: Major depressive disorder is a potentially life-threatening mood disorder, most common among mature person. The etiology of this disorder has not yet been clearly identified, but a variety of factors are thought to be involved, including both genetic and environmental factors. The condition is often difficult to diagnose because it can manifest in many different ways, affecting the body, feelings, thoughts and behaviors to varying degrees. 

Case Presentation:

A 42 years old patient presented at the Emergency County Hospital Cluj-Napoca, Second Psychiatric Clinic, Department of Psychiatry in the 9th of March 2017 for emergency evaluation and was diagnosed with major depressive episode with psychotic features, in the postpartum period. The patient was first diagnosed in 2011 with major depressive episode with psychotic features and was under pharmaceutical treatment for 2 years. There have been no other admissions at the Psychiatry Clinic until the present one.

The most common symptoms of the two episodes were: diminished interest and loss of pleasure in almost all activities, decreased appetite, insomnia, feelings of worthlessness, depressed mood, delusions of guilt. The recurrent thoughts of death, suicidal ideation and the suicide attempt have been present only at the second episode.

A positive family history of depression and suicide is present. 


Conclusion: Twelve days after the admission, the evolution is favorable, with significant reduction in symptoms, with no somatic complaints, increased appetitte sleep improvement. The patient doesn’t have suicidal ideation any more. 

Particularities: We report the case of a recurrent episode of major depression, occurred in the postpartum period, as part of the mood disorders, with two important specifiers: postpartum onset and high severity (broad range of fullblown symptoms, delusions, suicidality).

Comparison Between The Effects Of Different Doses Of Vitamin C On Thermonociception  Schreiner Thomas-Gabriel , Catan Lilia - Validated View

Comparison Between The Effects Of Different Doses Of Vitamin C On Thermonociception

Fundamental Science

Author(s): Schreiner Thomas-Gabriel, Catan Lilia

Coordinator(s): Assistant Professor Andrei Luca

Keywords: Vitamin C Analgetic Thermonociception

Introduction: Vitamin C is an essential micronutrient that serves as a cofactor in a number of enzymatic and chemical pathways [1]. It acts as an antioxidant by inhibiting the formation of reactive oxygen species (ROS) which are reported to be associated with neuropathic pain [2]. The purpose of our study was to evaluate whether Vitamin C acts as an analgesic and to compare the antinociceptive effects of different doses in mice.

Material and Method: 32 BALB/c mice were divided into four groups. The mice in the first three groups received one dose of 50, 500 and 1500 mg/kg b.w. respectively of Vitamin C via intraperitoneal administration. The last group served as control group and received an equal volume of distilled water in the same manner. To evaluate the analgesic effect, Tail flick and Hot plate tests were performed before and after 15, 30, 60, 120, 180 respectively 240 minutes after administration. The results were compared using the Student’s t-test. 

Results: A single dose of 50 mg/kg b.w. of Vitamin C increased the response to thermal stimuli, reaching a maximum effect one hour post administration, however without statistical significance. The maximum nociceptive effect of the 500 mg/kg b.w. dose was noted one hour post-administration, after this period the effect seems to diminish gradually. In the Tail flick test, the 1500 mg/kg b.w. dose showed no statistical significance over four hours after administration, by comparison, in the Hot plate test it led to an increase in the response maximizing two hours post-administration.

Conclusion: Vitamin C demonstrated an analgesic effect compared with the control group (p=0.05), probably through its antioxidant capacities. Our data opens a new field of study regarding the use of ascorbic acid in acute pain and its side effects.

Bibliography: 1- Berger M. M. Vitamin C requirements in parenteral nutrition. Gastroenterology. 2009;137(5, supplement):S70–S78. doi: 10.1053/j.gastro.2009.08.012. 2- Kim H. K., Park S. K., Zhou J.-L., et al. Reactive oxygen species (ROS) play an important role in a rat model of neuropathic pain. Pain. 2004;111(1-2):116–124. doi: 10.1016/j.pain.2004.06.008.

A retrospective evaluation of cystic tumors  Beleaua Marius-Alexandru - Validated View

A retrospective evaluation of cystic tumors

Fundamental Science

Author(s): Beleaua Marius-Alexandru

Coordinator(s): Professor Ioan Jung , Professor Simona Gurzu

Keywords: cyst tumor ovary pancreas

Introduction: Cystic tumors may present a benign or malignant behaviour and histopathological differentation is sometimes difficult. The aim of this paper is to present the particular features of cystic tumors.

Material and Method: The clinicopathological aspects were examined in 628 consecutive cases of cystic lesions diagnosed during 2014-2017 at Department of Pathology of Clinical County Emergency Hospital of Tirgu-Mures, Romania. 

Results: From the 628 cases, 73 were diagnosed as cystic tumors and 555 cases were non-tumor lesions. The tumor cysts were predominantly located in the ovary (n=63), followed by pancreas (n=5) and salivary glands (n=2). Two benign tumors of the dermis and one retroperitoneal lymphangioma were also identified. Only four of the 63 ovarian tumors presented bilateral involvement of the ovaries. In all of these cases it was about serous cystadenomas/cystadenofibromas. From the other 59 ovarian tumors, 27 were dermoid cysts (mature teratomas), followed by serous cystadenomas/cystadenofibromas (n=15), cystic mucinous tumors with benign or borderline features (n=14) and mucinous adenocarcinomas (n=3). 

Conclusion: The cystic tumors presented mostly unilateral involvement of the ovary. The cystic aspect of a tumor may be an indicator of benign behaviour.

Bibliography: 1. Interventricular septum hydatid cyst presenting with acute lower limb ischemia: a case report. Libyan J Med. 2015 Jun 29;10:28634 2. Multiparasitic Infection (Hydatid Cyst of the Spleenand Ascaris Lumbricoides Infestation) Mimicking an Acute Surgical Abdomen – Case Report. Acta Medica Marisiensis 2016;62(1):138-141

THE SURGICAL MANAGEMENT OF A COMPLEX OPEN ANKLE FRACTURE  Milotoiu Ioan , Oros Adrian Mustea Elena, Mihai Alex, Oltean Ioana Maria Invalidated View

THE SURGICAL MANAGEMENT OF A COMPLEX OPEN ANKLE FRACTURE

Case Report - Poster

Author(s): Milotoiu Ioan, Oros Adrian

Coauthor(s): Mustea Elena, Mihai Alex, Oltean Ioana Maria

Coordinator(s): Assistant Professor Cristian Tudor Boescu

Introduction:

Ankle fractures are some of the most common fractures of the lower limb due to the fact that this joint is exposed to a high weight load. There is no need for strong forces applied to the ankle in order for the fracture to occur. The main mechanism consists of excessive rotation. This case expresses a pronation-external rotation pattern which accounts for 7-19% of ankle fractures leading to joint instabillity.


Case Presentation:

A 49 years old patient shows up in the emergency department with intense pain in the distal left calf and loss of motion due to an open fracture. The 10-12 cm wound has a triangular star shape with clean margins. The distal portion of the tibia is deperiostated and protrudes through the wound while the ankle is luxated postero-externally. This means that the case is a type 3b open fracture. No major vasculo-nervous damage is found. The patient is prepared for surgery. While under spinal anesthesia, the fracture is reduced and stabilized with a total of 4 screws, 1 Kirschner pin, 2 cerclages and 1 diastasis screw. After surgery the patient is put on pain relievers, anticoagulants and antibiotics.


Conclusion:

The patient’s condition improves and he is discharged 12 days after surgery with no signs of fever or any other complication.


Particularities:

This is a case of a large protrusion of the fractured bone through the skin with multiple fracture sites and an associated luxation, showing that an ankle fracture is a complex condition.

Decreased Specific Activity of Superoxide Dismutase Shows No Effect Against Specific Activity Of Catalase and Glutathione Peroxidase In Preeclamptic Placental Tissue  Marsudidjaja Stella , Aulina Rifqha Amaia Ilonka, Anabella Tracy Validated View

Decreased Specific Activity of Superoxide Dismutase Shows No Effect Against Specific Activity Of Catalase and Glutathione Peroxidase In Preeclamptic Placental Tissue

Fundamental Science

Author(s): Marsudidjaja Stella, Aulina Rifqha

Coauthor(s): Amaia Ilonka, Anabella Tracy

Coordinator(s): MD Ani Retno Prijanti

Keywords: Preeclampsia SOD Catalase GPX

Introduction: Preeclampsia is defined as the new onset of hypertension and proteinuria after 20 weeks of gestation. It happens due to incomplete pseudovasculogenesis, thus causing intraplacental hypoxia which leads to oxidative stress. Previous studies showed that decreased antioxidant levels in preeclampsia contribute to the disturbance of placental development in preeclampsia. Therefore, this research is conducted to compare the specific activity of Superoxide dismutase (SOD), catalase, and glutathione peroxidase (GPX) in early-onset and late-onset preeclampsia to find out the difference to normal placenta.

Material and Method: This research was an observational study using cross-sectional method which compares the specific activity of antioxidant enzymes, such as SOD, GPX, and catalase, in the placenta of women with normal pregnancy, early-onset and late-onset preeclampsia, admitted in Budi Kemuliaan Hospital and Cipto Mangunkusumo Hospital which is located in Jakarta, Indonesia in 2015. As a preliminary study, the minimal sample size used for each group is 10 samples and additional 2 samples for dropout. Thus, 12 samples were used for each group, except in early-onset preeclampsia because only 4 samples were found. The specific activity for the enzymes were measured using spectrophotometric assay.

Results: Statistical analysis using one-way ANOVA revealed that there were no significant differences in protein between the three groups (p=0.535), while analysis using Kruskal-Wallis revealed that there was a decrease in SOD (p=0.001), catalase (p=0.648), and GPX (p=0.399). However, only the result of SOD is significant. This elucidates the decrement of other enzymes resulted from the decreased SOD level itself, with consideration of possible productions of hydrogen peroxide other than from SOD.

Conclusion: The specific activity of SOD between normal and preeclamptic placentas showed a significant decrease while the other enzymes (Catalase and GPX) showed insignificant result. Thus, it can be concluded that preeclampsia may be caused by either a defect in SOD or an absence of ROS.

Bibliography: 1. Alvero R. Preeclampsia. In: Ferri FF, editor. Ferri's clinical advisor 2016. 1st ed. Philadelphia: Elsevier; 2016. p. 1024-1026.e1. 2. Roger S. Netter’s Obstetrics & Gynecology, 2nd ed. Philadelphia: Elsevier Saunders; 2008 : 219. 3. Sibai B. Preeclampsia and Hypertensive Disorder. In: Obstetrics: normal and problem pregnancies. Seventh edition. Philadelphia, PA: Elsevier; 2017. p. 662–7. 4. Tranquilli AL, Dekker G, Magee L, Roberts J, Sibai BM, Steyn W, et al. The classification, diagnosis and management of the hypertensive disorders of pregnancy: A revised statement from the ISSHP. Pregnancy Hypertens. 2014 Apr 1;4(2):97–104. 5. Hermanto, Adityawarman, Sulistyono, Ardian M, Dachlan EG. The characteristic of Indonesia’s pre-eclampsia: From obstetric intensive care with ventilator until epidemiologic and its molecular biology profile of pulmonary edema in severe preeclampsia. Pregnancy Hypertens. 2014 Jul;4(3):245. 6. Dennery PA. Oxidative stress in development: nature or nurture?. Free Radic Biol Med. 2010 Oct 15;49(7):1147–51. 7. D’Souza V, Rani A, Patil V, Pisal H, Randhir K, Mehendale S, et al. Increased oxidative stress from early pregnancy in women who develop preeclampsia. Clin Exp Hypertens N Y N 1993. 2016;38(2):225–32. 8. Elliot MG. Oxidative stress and the evolutionary origins of preeclampsia. J Reprod Immunol. 2016 Apr;114:75–80. 9. Gathiram P, Moodley J. Pre-eclampsia: its pathogenesis and pathophysiology. Cardiovasc J Afr. 2016 May 18;27(2):71–8. 10. Matsubara K, Higaki T, Matsubara Y, Nawa A. Nitric oxide and reactive oxygen species in the pathogenesis of preeclampsia. Int J Mol Sci. 2015 Mar 2;16(3):4600–14. 11. Hung TH, Burton GJ. Hypoxia and reoxygenation: a possible mechanism for placental oxidative stress in preeclampsia. Taiwan J Obstet Gynecol. 2006;45(3):189-200. 12. Zukra S, Prijanti AR, Purwosunu Y. Analysis of protein oxidative damage nad Pregnancy Associated Plasma Protein-A (PAPP-A) expression in preeclamptic placenta. IMERI [accepted abstract]. 2016. 13. Shu C, Litao Z, Cui L, Wei C, Wang S, Tang JJ, et al. Protein profiling of preeclampsia placental tissues. PLOS ONE. 2014;9(11):1-11. 14. Prijanti AR, Ranasasmita R, Sandra Y, Wanandi SI. Correlation between hypoxia inducible factor-1 alpha and renin expression in rat’s kidney induced by cobalt chloride. Med J Indo. 2012; 21: 128-32 15. Lin S, Leonard D, Co MAM, Mukopadhyay D, Giri B, Perger L, et al. Pre-eclampsia has an adverse impact on maternal and fetal health. Transl Res. 2015;165(4):449-63. 16. O'Tierney-Ginn PF, Lash GE. Beyond pregnancy: modulation of trophoblast invasion and its consequences for fetal growth and long-term children's health. J Reprod Immunol. 2014;104-105:37-42. 17. Borazjani F, Angali KA, Kulkarni SS. Milk and Protein intake by pregnant women affects growth of foetus. JHPN. 2013; 31(4): 435-45 18. Myatt L. Role of Placenta in Preeclampsia. Humana Press Inc. 2002; 19: 103-11 19. Stubert J, Kleber T, Bolz M, Kulz T, Dieterich M, Richter D, et al. Acute-phase proteins in prediction of preeclampsia in patients with abnormal midtrimester uterine Doppler velocimetry. Arch Gynecol. 2016;294(6):1151-60. 20. Liu W, Shen SM, Zaho XY, Chen GQ. Targeted genes and interacting proteins of hypoxia inducible factor-1. Int J Biochem Mol Biol. 2012; 3(2): 165-178 21. Ziello JE, Jovin Ion S, Huang Y. Hypoxia-Inducible Factor (HIF)-1 Regulatory Pathway and its Potential for Therapeutic Intervention in Malignancy and Ischemia. Yale J Biol Med. 2007; 80(2): 51-60 22. Li S, Yan T, Yang J-Q, Oberley TD, Oberley LW. The Role of Cellular Glutathione Peroxidase Redox Regulation in the Suppression of Tumor Cell Growth by Manganese Superoxide Dismutase. Cancer Res. 2000 Jul 15;60(14):3927–39. 23. Fukai T, Ushio-Fukai M. Superoxide dismutases: role in redox signaling, vascular function, and diseases. Antioxid Redox Signal. 2011 Sep 15;15(6):1583–606. 24. Li N, Alam J, Venkatesan MI, Eiguren-Fernandez A, Schmitz D, Stefano ED, et al. Nrf2 is a key transcription factor that regulates antioxidant defense in macrophages and epithelial cells: protecting against the proinflammatory and oxidizing effects of diesel exhaust chemicals. J Immunol. 2004 Sep 1;173(5):3467–81. 25. Poston L, Chappell L, Seed P, Shennan A. Biomarkers of oxidative stress in pre-eclampsia. Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health. 2011;1(1):22-27. 26. Weydert CJ, Cullen JJ. Measurement of superoxide dismutase, catalase and glutathione peroxidase in cultured cells and tissue. Nature protocols. 2010 Jan 1;5(1):51-66. 27. McCord JM, Keele BB, Fridovich I. An enzyme-based theory of obligate anaerobiosis: the physiological function of superoxide dismutase. Proceedings of the National Academy of Sciences. 1971 May 1;68(5):1024-7. 28. Góth L, Rass P, Páy A. Catalase enzyme mutations and their association with diseases. Molecular Diagnosis. 2004 Sep 1;8(3):141-9. 29. Funai EF, MacKenzie A, Kadner SS, Roque H, Lee MJ, Kuczynski E. Glutathione peroxidase levels throughout normal pregnancy and in pre-eclampsia. J Matern Fetal Neonatal Med. 2002 Nov;12(5):322–6. 30. Mistry HD, Wilson V, Ramsay MM, Symonds ME, Pipkin FB. Reduced selenium concentrations and glutathione peroxidase activity in preeclamptic pregnancies. Hypertension. 2008 Nov 1;52(5):881–8. 31. Swasti S, Sarvesh K, Sourabh S. Free radicals and antioxidants enzymes status in normal pregnant women. Sch J Appl Med Sci. 2015;3(4b):1703–6. 32. Mistry HD, Kurlak LO, Williams PJ, Ramsay MM, Symonds ME, Broughton Pipkin F. Differential expression and distribution of placental glutathione peroxidases 1, 3 and 4 in normal and preeclamptic pregnancy. Placenta. 2010 May;31(5):401–8. 33. Jurkovic S, Osredkar J, Marc J. Molecular impact of glutathione peroxidases in antioxidant processes. Biochem Medica. 2008;162–74. 34. Randox Laboratories. Manual Rx Monza RANSOD. United Kingdom:randox Laboratories;2009. 35. Paglia DE, Valentine WN. Studies on the quantitative and qualitative characterization of erythrocyte glutathione peroxidase. J Lab Clin Med. 1967 Jul;70(1):158–69.

MULTIPLE FINGER REPLANTIONS  Voinescu Marc Andreas , Zeca - Berbecar Cristina Elena - Validated View

MULTIPLE FINGER REPLANTIONS

Case Report - Poster

Author(s): Voinescu Marc Andreas, Zeca - Berbecar Cristina Elena

Coordinator(s): Professor Ioan Lascar , MD Marius Popescu

Introduction: Finger-replantation is challenging for micro-surgeons, due to the critical first hours of the fragment’s revascularization post-operatively leading to necrosis.
Continuous advancements in micro-surgical fields, with better, more precise instruments and lots of cases presented in the medical literature, allow a better evolution-prediction for replanted fingers.


Case Presentation: A 55-year-old factory-worker was admitted via helicopter from a territorial hospital in the Plastic Surgery Departments after accidentally amputating 8 fingers.
The operation’s purpose was restoring hand functions by gaining pinch/grasp and sensitivity.
Preoperatively he received tetanus vaccine, prophylactic antibiotics, analgesics and intravenous fluids. Radiography of hands/fragments were done for planning the intervention. Blood test revealed anemia and leukocytosis.
In the operating room, hand examination revealed a total amputation at the 2nd phalanges of the 2nd-5th finger (left), and a total amputation of the 1st phalanges of the 2nd-5th finger (right). Finger evaluation, after wound-washing/debridement, for their pedicles and neurovascular status. 
Fragments of 4th - 5th (right) and 4th (left) couldn’t be replanted, because of intense vascular damage.
Steps taken: bone-fixation by central osteosynthesis with K-wires, tendons repair, arterial, nerve and finally vein repair. The arteries, nerves and veins were done by using the microscope.

Conclusion: The intervention was initial successful for all fingers. One week post-operative, the index finger(left) developed necrosis due to the crushing mechanism.
Stumping was performed. Leeches were needed to compensate the venous drainage for the 3rd finger (right). Passive motion was started with the right fingers 7 days post-operation.
The patient was dismissed after 2 weeks and will come regularly for function/evaluation check-ups.

Particularities: Multiple finger amputation with sparing of thumbs; required two teams working parallel to replanting as many fingers as possible.
The patient was transported to the hospital via helicopter with the fragments in good preservation-conditions. Different surgical approaches were necessary due to different levels of amputation for both hands.

An interesting case of biliodigestive fistula and mechanical ileus in an elderly woman  Marginean Claudia Raluca , Mariean-Schiopu Alexandru Mărginean Oana Mirela, Robert Aurelian Tiucă Validated View

An interesting case of biliodigestive fistula and mechanical ileus in an elderly woman

Case Report - Poster

Author(s): Marginean Claudia Raluca, Mariean-Schiopu Alexandru

Coauthor(s): Mărginean Oana Mirela, Robert Aurelian Tiucă

Coordinator(s): Assistant Professor Iunius Paul Simu

Introduction: Gallstone ileus, a particular cause that leads to the mechanical obstruction of small bowel requires the passage of a gallstone from the gallbladder to the small bowel, usually through a fistula. This pathological condition is not frequent in adult population, but it's incidence increases in the elderly, especially women with chronic cholecystitis history. The passage of gallstones into the duodenal lumen leads to a mechanical small bowel obstruction.
Case Presentation: The aim of our paper is to present the case of a 79 y.o female, who developed acute surgical abdomen due to a biliodigestive fistula.

An old female, with a medical history of acute myocardial infarction, atrial fibrillation and insulin dependent diabetes mellitus, presented at admission nausea,vomiting and bowel obstruction.
In order to establish a proper medical care, the patient was investigated with maximum care. 
Biochemical parameters showed an increased level of total bilirubin and creatinine,, associated with impaired liver and kidney function.
Investigations were completed by performing abdominal and pelvic ultrasonography and native computer tomography. Two days after admission, patient's condition worsened and an emergency surgery followed. Cholecystectomy associated with surgical closure of the duodenal perforation and jejunal resection with termino-terminal anastomosis were performed. 

Conclusion: The native CT showed pneumobilia into intrahepatic and principal biliary ducts, thickened gallbladder walls and bilioduodenal fistula. The stomach, duodenum and jejunal loops were dilatated and filled with fluid and gas. Multiple radiopaque stones up to 30 mm diameter were also described. Ten days postoperative the patient presented extreme bradycardia and asistolia, with ineffective CPR. 
Unfortunately she died despite all medical efforts.

Particularities: This condition has a high mortality (12-20%), as it affects more often elderly people. In our case, the precare condition at admission, associated with patient's medical history were adverse prognostic factors, despite the appropriate medical and surgical treatment performed.

Is Antibiotic prophylaxis for open thyroidectomies necessary? A randomized trial in South Indian Population   BALASUBRMANIAN Vathul - Validated View

Is Antibiotic prophylaxis for open thyroidectomies necessary? A randomized trial in South Indian Population

Surgical Science

Author(s): BALASUBRMANIAN Vathul

Coordinator(s): Associate Professor Pari Muthukumar

Keywords: Antibiotic Prophylaxis Thyroidectomy Surgical Site Infection Clean Surgery

Introduction:  Thyroidectomies are clean surgeries,and owing to the advent of advanced sterilization and operating rooms, post op infections are uncommon. Surgical antimicrobial prophylaxis (SAP) was introduced to prevent surgical site infections (SSI). International guidelines don't routinely recommend antibiotic prophylaxis since unnecessary courses are often associated with- Resistance, superinfection with resistant pathogens, toxicity, increased cost and hospital stay Despite this antibiotics are prescribed in thyroidectomies. In India, the lack of guidelines for surgical antimicrobial prophylaxis justifies a need to generate baseline data on its usage. This study's aim is to assess the current use of perioperative antimicrobials in a tertiary care hospital. (Sri Ramachandra Medical College)
Material and Method:  120 patients with benign thyroid nodule undergoing thyroidectomies (Total or Hemi) in the General Surgery Department of Sri Ramachandra University, were included with informed consent.18 patients withdrew, due to lack of follow-up. 50 received three or more antibiotic doses, while 52 of them received none. Fine Needle Aspiration Cytology and Ultrasonography was done for all patients. Inclusion Criteria
● Benign (FNAC)
● Not Immunocompromised
● Age >18 <70
● 3 months follow up
The surgery duration was approximately 90 minutes. Post-op drain was placed. Patients were checked for SSI on days 1, 3 followed by 3 months of check-up.
Results:  3-4 doses of antibiotics were given (3rd Gen Cephalosporins) to the 50 patients in the antibiotic group. SSI evaluated on postop days 1,3 .2 cases of redness was seen, hospital stay was 4 days. The 52 patients who weren’t given antibiotics also had 2 cases of SSI (1 redness, 1 edema). The hospital stay was shorter (3 days). SSI required short course of antibiotics.

Conclusion: Rampant use of antibiotic prophylaxis for thyroidectomy is unnecessary as the SSI rates in both groups are similar. This reduces cost,antibiotic resistance,hospital stay in India,which is a front runner in antibiotic resistance.

Bibliography: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2731779/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2731779/ https://www.ncbi.nlm.nih.gov/pubmed/23149870

EVALUATION OF PATIENTS WITH LOWER EXTREMITY PERIPHERAL ARTERY DISEASE BY WALKING TESTS: A PILOT STUDY  Ciocan Andra - Validated View

EVALUATION OF PATIENTS WITH LOWER EXTREMITY PERIPHERAL ARTERY DISEASE BY WALKING TESTS: A PILOT STUDY

Medical Science

Author(s): Ciocan Andra

Coordinator(s): Associate Professor Claudia Diana Gherman , Professor Sorana Daniela Bolboaca

Keywords: Claudication Peripheral Arterial Diseases Reliable tool Walking test

Introduction: Peripheral artery disease (PAD) directly affect the quality of life, patients experimenting limiting walking ability and disability. The purpose of our study was to investigate the walking pattern of patients with lower extremity PAD in relation with several factors in a Romanian population. 

Material and Method: A cohort non-randomized design was conducted and all eligible subjects how self-referred for medical care since March 2016 to February 2017 at the Second Surgery Department, County Clinical Emergency Hospital of Cluj-Napoca were included. The eligible patients were older than 18 years, with leg pain and Rutherford grade from I to IV. Three walking tests were applied to each subject included in the study to investigate the capacity to walk as far as possible in six minute (6 minute walking test), the capacity to climb stairs (climbing stairs test) and the capacity to walk on a treadmill (treadmill test) untill the pain occurred.

Results: Twenty four patients with mean age of 65.08±8.53 years were investigated. Almost 81% of patients were with chronic pain, 46% were overweight, and 79% were smokers. The results on applied walking tests were as follows: 279.17±70.58m to 6-minutes walking test, 77.50±21.80 stairs, and 182.50±73.34 meters on treadmill test. The results of the walking tests significantly correlate with each other (ρ>0.93, p<0.0001), and all applied teste significant correlate with toe gangrene (ρ>|0.52|, p<0.01) and toe disarticulation (ρ>0.62, p<0.002). 

Conclusion: Any of the applied walking test proved reliable instruments able to identify the patients with most severe PAD.

Bibliography: [1]. Selvin E, Erlinger TP. Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999-2000. Circulation. 2004 Aug 10. 110 (6):738-43. [2]. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007 Jan. 45 Suppl S:S5-67.  [3]. Rowe VL, Lee W, Weaver FA, Etzioni D. Patterns of treatment for peripheral arterial disease in the United States: 1996-2005. J Vasc Surg. 2009 Apr. 49(4):910-7. [4]. Antoniou GA, Chalmers N, Georgiadis GS, et al. A meta-analysis of endovascular versus surgical reconstruction of femoropopliteal arterial disease. J Vasc Surg. 2013 Jan. 57(1):242-53.  [5]. Montgomery PS, Gardner AW. The clinical utility of a six-minute walk test in peripheral arterial oclusive disease patients. J Am Geriatr Soc. 1988 Jun. 46(6):706-11. [6]. Saskia P.A., et al. Extending the Range of Treadmill Testing for Patients with Intermittent Claudication. Med Sci Sports Exerc. 2010;42(4):640-645. [7]. Atul Jain, et. al.The Walking Impairment Questionnaire Stair-Climbing Score predicts mortality in men and women with peripheral arterial disease. J Vasc Surg. 2012 Jun. 55(6):1662-73.e2.

TERT GENE POLYMORPHISMS AND DNA REPAIR MECHANISM IN LUNG CANCER. A CASE CONTROL STUDY IN ROMANIAN POPULATION  Apostu Adina- Patricia , Ilies Roxana Catana Andreea , Trifa Adrian , Popp Radu Validated View

TERT GENE POLYMORPHISMS AND DNA REPAIR MECHANISM IN LUNG CANCER. A CASE CONTROL STUDY IN ROMANIAN POPULATION

Fundamental Science

Author(s): Apostu Adina- Patricia, Ilies Roxana

Coauthor(s): Catana Andreea , Trifa Adrian , Popp Radu

Coordinator(s): Assistant Professor Oana Blaga

Keywords: lung cancer TERT gene DNA repair polymorphisms Romanian population

Introduction: Lung cancer remains the most common cause of cancer- related mortality with nearly 1.6 million deaths worldwide in 2014. Telomerase plays a crucial role in cancer cell immortality and DNA repair mechanisms have a major role in genome stability. Therefore, gene variants in these genes may represent a risk factor in lung carcinogenesis. The purpose of our study was to investigate the possible association between TERT, DNA repair polymorphisms and the risk of lung cancer, in a Romanian population. 

Material and Method: For this, a group of 112 patients with lung cancer were recruited and genotyped using Real Time PCR for rs2736100 of TERT gene, Arg156Arg of XPD (ERCC2), Arg194Trp of XRCC1 gene and Arg399Gln of XRCC3 gene. 

Results: Statistical analysis revealed that rs2736100 of TERT gene is associated with Arg194Trp of XRCC1 gene and Arg399Gln of XRCC3 gene, especially in women diagnosed with lung adenocarcinoma (p=0.042).

Conclusion: In conclusion, the results of the study suggest that polymorphisms Arg194Trp of XRCC1 gene and Arg399Gln of XRCC3 gene, could be associated with TERT mutagenesis and therefore they could represent future biological markers for the development and targeted treatment of lung cancer.

Bibliography: Levy D, Neuhausen SL, Hunt SC, Kimura M, Hwang SJ, Chen W, Bis JC, Fitzpatrick AL, Smith E, Johnson AD, Gardner JP, Srinivasan SR, Schork N, Rotter JI, Herbig U, Psaty BM, Sastrasinh M, Murray SS, Vasan RS, Province MA, Glazer NL, Lu X, Cao X, Kronmal R, Mangino M, Soranzo N, Spector TD, Berenson GS, Aviv A. Genome-wide association identifies OBFC1 as a locus involved in human leukocyte telomere biology. Proc Natl Acad Sci U S A. 2010;107:9293–9298. Mangino M, Richards JB, Soranzo N, Zhai G, Aviv A, Valdes AM, Samani NJ, Deloukas P, Spector TD. A genome-wide association study identifies a novel locus on chromosome 18q12.2 influencing white cell telomere length. J Med Genet. 2009;46:451–454. de Lange T. Shelterin: the protein complex that shapes and safeguards human telomeres. Gene Dev. 2005;19:2100–2110. Hyo-Sung Jeon, Jin Eun Choi, Deuk Kju Jung, Yi Young Choi, Hyo Gyoung Kang, Won-Kee Lee, Seung Soo Yoo, Jeong-Ok Lim and Jae Yong Park. Telomerase activity and the risk of lung cancer. J Korean Med Sci. 2012 Feb; 27(2): 141–145.

Life changes after stroke: Organic personality disorder and pseudo-bulbar affect (PBA)  Mihai Alex , Ani Cristina Miceta Asztalos Anna Boglarka, Milotoiu Ioan, Moldovan Diana Maria Margareta Validated View

Life changes after stroke: Organic personality disorder and pseudo-bulbar affect (PBA)

Case Report - Poster

Author(s): Mihai Alex, Ani Cristina Miceta

Coauthor(s): Asztalos Anna Boglarka, Milotoiu Ioan, Moldovan Diana Maria Margareta

Coordinator(s): Professor Ioana Miclutia , MD Celina Niculescu

Introduction:

Strokes are a common cause of morbidity, causing significant impairments, both mental and physical. Mental impairment can arise as a direct consequence of the stroke with several cognitive impairments, and a pseudo-bulbar affect in our case. It is also possible that physical consequences, such as right hemi paresis and dysarthria may have an indirect contribution to the mental impairment.  


Case Presentation:

C.L., a 76 years old male patient, known with multiple psychiatric admissions, is brought in at the Psychiatry Clinic by his son due to following symptoms: circadian rhythm disorders, fatigue, psychomotor agitation, aggressive behavior, emotional lability and affective incontinence with involuntary outbursts of laughing and crying.

The patient is known with incipient senile cataract, organic personality disorder, and primary hypertension, mild cognitive impairment after multiple transient ischemic attacks in 2012 but also with dysarthria and pseudo-bulbar affect after a vertebro-basilar stroke in 2013.

The patient’s brother is known with paranoid schizophrenia and blood hypertension. His sister was also suffering from schizophrenia and has deceased after a stroke at the age of 55. One of his daughters was also diagnosed with paranoid schizophrenia.

The patient has 6 children of his own, of which one adopted daughter. He resides at his farm with his wife, with the daughter suffering from schizophrenia and also with the adopted daughter suffering from severe intellectual disability

The current treatment includes: Tianeptine (antidepressant), Zopliclone (hypnotic, and Pramiracetam (nootrope).


Conclusion:

Pseudo-bulbar affect is a debilitating condition predisposing to other mental impairments such as depression or changes in personality traits, violent behavior.


Particularities:

Presence of both uncontrolled crying and laughter, behavioral outbursts as post stroke symptoms.

The effectiveness of health education among post-percutaneous coronary intervention patients.   Krycinska Roza - Validated View

The effectiveness of health education among post-percutaneous coronary intervention patients.

Medical Science

Author(s): Krycinska Roza

Coordinator(s): Professor Dariusz Dudek , Associate Professor Zbigniew Siudak

Keywords: percutaneous coronary intervention coronary artery disease secondary prevention cardiovascular risk profile

Introduction: Percutaneous coronary intervention (PCI) correlates with very good short to medium-term prognosis in patients with coronary artery disease (CAD), but there is still very high readmission rate during the first five years after the procedure. PCI enables shorter hospital stay and recovery period, often provides immediate relief from the symptoms. It has been shown that undergoing PCI is a predictor of nonattendance at cardiac rehabilitation and correlates with poor adherence to lifestyle change. 

Material and Method: We performed a survey of 150 consecutive patients undergoing PCI and collected data on participants’ demographics, clinical details, CAD risk factor profile, and CAD risk knowledge as measured using our original 56-item questionnaire. Bivariate and multivariate analyses were used to analyze the influence of clinical and sociodemographic factors on the level of patients’ knowledge and risk factors control. 

Results: The study sample comprised 150 participants, 72% male, with mean age 68 ± 11 years. 59% of patients had undergone PCI prior to current hospitalization. The average knowledge score was 61.6% in the group with prior PCI and 58.4% in the group undergoing first-time PCI. The average score for risk factors control was 40% in post-PCI and 33.3% in pre-PCI group respectively. The differences between the groups were not statistically significant. There was no statistically significant correlation between the level of knowledge and the actual prevalence of CAD risk factors among the participants. We have found that 52.5% of post-PCI patients have not attended any form of rehabilitation, which correlated with poor control of CAD risk factors (p=0.02).

Conclusion: Our results indicate that current models of post-procedural education do not affect patients’ knowledge adequately and do not result in recommended lifestyle changes. It is essential to identify patients undergoing PCI as a priority group for further education and to extend the educational programs to the patients’ nearest relatives. 

Bibliography: 1. Piepoli et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016; 37: 2315–2381. 2. Kotseva et al. EUROASPIRE IV: a European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from twenty-four European countries. Eur J Prev Cardiol. 2015. 3. Serruys et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009; 360: 961–972 4. Heyde et al. Randomized trial comparing same-day discharge with overnight hospital stay after percutaneous coronary intervention: results of the Elective PCI in Outpatient Study (EPOS) Circulation. 2007;115:2299–2306. 5. Fox et al. Underestimated and under-recognized: the late consequences of acute coronary syndrome (GRACE UK–Belgian study) Eur Heart J. 2010;31:2755–64.

A rare association between thyroid ectopy with primary congenital hypothyroidism, ectopic thymus and growth hormone neurosecretory dysfunction  Jurj Iulian - Validated View

A rare association between thyroid ectopy with primary congenital hypothyroidism, ectopic thymus and growth hormone neurosecretory dysfunction

Case Report - Poster

Author(s): Jurj Iulian

Coordinator(s): Professor Carmen Georgescu

Introduction: Growth hormone (GH) neurosecretory dysfunction is a rare growth anomaly which involves a disturbance in 24-hour GH secretion pattern, causing growth delay. We report a case of growth failure in a young girl suffering from congenital hypothyroidism and GH neurosecretory dysfunction. 

Case Presentation: A 5-year old girl with short stature (-2.68 SD) presented last year in our endocrinology service for investigating its etiology. She has a history of ectopic thymus and congenital hypothyroidism caused by sublingual ectopic thyroid, being under levothyroxine replacement therapy since age of 4. The main non-endocrine causes of growth failure, such as constitutional short stature, genetic syndromes of short stature or malnutrition were ruled out. Also, Turner Syndrome and other chronic illnesses were excluded.A disharmonic dwarfism  and bilateral hip dysplasia were found, without other specific signs of hypothyroidism.The bone X-ray showed a bone delay of 3 years and 9 months. Laboratory findings suggested a proper substitution of thyroid function, excluding an inefficiently treated hypothyroidism as a potential cause of growth delay. It was also found a repeatedly decreased level of serum Insulin-like Growth Factor-1 (IGF-1) (49.8 ng/ml; 43.7 ng/ml), indicating a GH deficiency. Finally, the criteria for GH neurosecretory dysfunction were met, given the hypoplastic aspect of the pituitary, the normal response of GH after the Clonidine stimulation test (GH at 60 minutes=16 ng/dl) and the inadequate 24-hour GH secretion profile (2,94 ng/dl and a GH peak of 9,99ng/ml). In addition, the bioinactive GH deficiency was excluded after performing the therapeutic GH test.

Conclusion:

This case underlines the importance of  hormonal investigations of the hypothalamo-pituitary-somatotropic axis in hypothyroid children with persistent growth failure, despite proper substitution treatment.

Particularities:
We describe a case of complex endocrine etiology of a growth delay in a 5-year old girl with multiple congenital anomalies.

CHILDREN WITH DOWN SYNDROME AND ATRIOVENTRICULAR SEPTAL DEFECT REQUIRE SURGICAL TREATMENT IN ACCORDANCE WITH THEIR GROWTH TRAJECTORY   Bogdan Iulia Farcas Loredana Invalidated View

CHILDREN WITH DOWN SYNDROME AND ATRIOVENTRICULAR SEPTAL DEFECT REQUIRE SURGICAL TREATMENT IN ACCORDANCE WITH THEIR GROWTH TRAJECTORY

Case Report - Poster

Author(s): Bogdan Iulia

Coauthor(s): Farcas Loredana

Coordinator(s): MD Lucia Sur

Introduction: Trisomy 21 is the most frequently associated genetic abnormality with complete atrioventricular septal defect. Even though guidelines suggest that surgical treatment should be performed at 6 months of age, respiratory symptoms and failure to thrive might dictate earlier surgical repair.

Case Presentation: A one month old infant, born in poor conditions and diagnosed with Down Syndrome and complete Atrioventricular Septal Defect type Rastelli C was transfered in the 8th of December 2016 in Pediatrie I. She presented with multiple comorbidities: failure to thrive, poor feeding, polypnea, severe pulmonary hipertension and chronic respiratory failure. Taking into consideration her respiratory difficulties and poor weight gain, the surgical repair of the atrioventricular septal defect was scheduled to happen at the beginning of March. While hospitelised, she developed bronchopneumonia and afterwards, acute serous otitis, for which she needed medical treatment. Eventually, the operation was postponed for the end of April.

Conclusion: Even though medical care is necessary to alleviate symptoms of severe congenital heart disease, surgical repair remains the best option.

Particularities: Regardles her respiratory difficulties and failure to thrive, surgical repair could not be performed earlier than 6 months, because of her unstablecondition. 

CHOLEDOCOLITHIASIS COMPLICATED WITH ACUTE SUPPURATIVE CHOLANGITIS AND HEPATIC ABSCESSES – ERCP OR SURGERY?  Gordan David - Validated View

CHOLEDOCOLITHIASIS COMPLICATED WITH ACUTE SUPPURATIVE CHOLANGITIS AND HEPATIC ABSCESSES – ERCP OR SURGERY?

Case Report - Poster

Author(s): Gordan David

Coordinator(s): MD Andrei Groza

Introduction:

Acute suppurative cholangitis is characterized by the obstruction, inflammation, and pyogenic infection of the biliary tract, associated with a clinical template of fever, jaundice, pain, septic shock and central nervous system depression (Reynolds pentad). Mortality rates for severely ill patients approach 100% without appropriate antibiotic therapy and immediate decompression of the biliary tract. As emergency surgery carries formidable postoperative morbidity and mortality rates, endoscopic drainage is becoming the preferred solution for treatment.


Case Presentation:

We present the case of a 40 year old female nurse who was admitted to the hospital with right-upper quadrant pain, jaundice and fever - Charcot triad. The patient has a history of cholelithiasis for which she underwent laparoscopic cholecystectomy. The laboratory and imaging studies performed (ultrasonoghaphy, MR-cholangiography) suggest the lithiasic obstruction of the common bile duct, with large intrahepatic biliary dilatations, confirmed by the curative endoscopic retrograde cholangiopancreatography (ERCP) which followed.

After 48 hours under antibiotic treatment, high fever reappears (39°C), accompanied by tachycardia, tachypnea, BP=80/50 mmHg and alteration of the patient’s neurological status (Glasgow score 10). The antibiotic treatment is updated to Meropenem and Metronidazole. Surgical evaluation and repeated US were followed by a CT examination, revealing intrahepatic abscesses, aerobilia and peripancreatic edema.

The medical team decides to avoid surgery and successfully performs two more ERCP’s, attempting to clear the biliary system. Blood cultures turned positive for Enterococcus faecium and Pseudomonas aeruginosa, validating the septic shock and fulfilling the template of acute suppurative cholangitis. Post-ERCP treatment with Vancomycin and Ciprofloxacin resulted in complete clinical and paraclinical recovery.


Conclusion:

Appropriate antibiotic treatment and early biliary decompression are paramount in the management of acute suppurative cholangitis. Endoscopic drainage through ERCP provides a safer treatment alternative to the high morbidity and mortality rates associated with a surgical approach.


Particularities:

The severe, life threatening complications presented are uncommon for a young, immunocompetent patient.

This case highlights the importance of well-conducted clinical and imagistic workup topped by efficient endoscopic treatment of a disease which poses great risks for surgery.

THE ROAD TOWARDS DIAGNOSIS IN SNEDDON’S SYNDROME: A CASE REPORT  Taru Vlad Argintaru Cosmin, Stoleru Irina-Maria Validated View

THE ROAD TOWARDS DIAGNOSIS IN SNEDDON’S SYNDROME: A CASE REPORT

Case Report - Poster

Author(s): Taru Vlad

Coauthor(s): Argintaru Cosmin, Stoleru Irina-Maria

Coordinator(s): Lecturer Adina Stan




TINU Syndrome – A case report  Mureşan Tudor-Ionuţ , Mustea Elena Oros Adrian, Ani Cristina Miceta, Asztalos Anna Boglarka Validated View

TINU Syndrome – A case report

Case Report - Poster

Author(s): Mureşan Tudor-Ionuţ, Mustea Elena

Coauthor(s): Oros Adrian, Ani Cristina Miceta, Asztalos Anna Boglarka

Coordinator(s): Professor Ina Maria Kacso

Introduction: TINU Syndrome is a rare disease described in young adults and combines idiopatic tubular interstitial nephritis(TIN) and uveitis. Limited data suggest the pathogenesis involves mCRP(modified C-reactive protein), a self-antigen binding to  both uveea and renal tubular cells. Clinical manifestations include weight loss, abdominal pain, photophobia, bilateral ocular pain and polyuria.

Case Presentation:

A 43 years old female was admitted in the Nephrology Department with a syndrome of nitrogen retention (6,62mg/dl creatinine and 92mg/dl ureea), dehydration, left conjunctival erythema, anisocoria and cephalees. Clinical findings included diffuse abdominal pain, left eyelid oedema and eythema and conjunctival erythema.
The ophtalmic exam revealed acute anterior uveitis of the left eye. Abdominal ultrasonography showed a normal kidney appearance which sustains the diagnosis of acute renal injury. Blood tests showed  inflammation (ESR=120mm/1h), microcytic anemia, mild hypokaliemia and urine test revealed hematuria(50/µL) and proteinuria(100mg/dL). Further investigations including imunologic tests excluded a glomerular syndrome. Another diagnosic of exclusion was multiple mieloma,taking into account the unexplained anemia, value of ESR and renal injury. The electrophoresis of the urinary proteins showed no presence of monoclonal immunoglobulins. The diagnosis of TINU syndrome was set after excluding other causes of acute tubulointerstitial nephritis (NSAIDs, antibiotics, CMV and Epstein Barr infections). Treatment included intravenous rehydration, antiemetics, antibiotics (Ceftriaxon), local treatment with Dexametazone. Given the persistence of nitrogen retention syndrome, a renal puncture biopsy was perfomed. Treatment was continued with Prednison (40 mg/day,progressively lowering the doses).

Conclusion: A month later, the renal function was normal, with no other signs of disease activity. The overall prognosis is good, possibly lowered by the recurrence risk for uveitis.

Particularities:
We report a case of a middle age women presenting TINU syndrome, both the age and the frequency of the disease being uncommon. 

MEDIUM TERM ASSESSMENT OF PATIENTS WITH SCHIZOPHRENIA TREATED WITH TYPICAL VERSUS ATYPICAL ANTIPSYCHOTICS  Ilie Ana-Maria - Invalidated View

MEDIUM TERM ASSESSMENT OF PATIENTS WITH SCHIZOPHRENIA TREATED WITH TYPICAL VERSUS ATYPICAL ANTIPSYCHOTICS

Medical Science

Author(s): Ilie Ana-Maria

Coordinator(s): Professor Marieta Gabos Grecu , Lecturer Gabriela Elena Buicu

Keywords: assessment schizophrenia neuroleptics PSP and GAF scale

Introduction: Schizophrenia can lead to a psychosocial dysfunction and can influence significantly patients’ quality of life, resulting in the need for assistance in meeting basic living needs. Antipsychotic drugs are the cornerstone of the pharmacological treatment of schizophrenia. Over the past decade atypical antipsychotics have been increasingly used in the treatment of schizophrenia in preference to conventional drugs. The aim of this study is to evaluate the assessment of patients with schizophrenia using the GAF scale (according to DSM IV) and PSP scale in correlation with their atypical or typical therapeutic strategies in a routine of clinical practice.

Material and Method: We retrospectively analysed 55 patients with schizophrenia admitted in Clinical County Emergency Hospital in Targu Mures, Psychiatric Clinic, during 2015. Anthropometric data were collected and analysed such as gender (74,5% F, 25,5% M), the environment (47.2% urban area and 52.7%rural one), studies (20%higher education, 36.3%highschool and 43.7%primary school). The patients were divided in two groups according to the type of medication they were treated with: 25.5% with the typical antipsychotics (haloperidol) and 74.5% with atypical (olanzapine, risperidone and aripiprazol). Individual interviews were conducted before the discharge of the patients in order to be assessed with Global Assessment of Functioning (GAF) and Personal and Social Performance (PSP) scale.

Results: The patients under treatment with the second generation of antipsychotics showed significant improvements in the PSP score (36.5% between 51-60, 63.5% between 61-80) and GAF scale (50-60). On the other hand, patients treated with haloperidol obtained worst results in PSP score (42.8% between 21-30, 57.2% between 31-40) and GAF’s scale (35-45).

Conclusion: These data illustrate that the atypical neuroleptics show clinically meaningful improvement of functioning and treatment satisfaction. Because of EPS as an adverse reaction for the conventional antipsychotics, the PSP and GAF scales got a score that reflect varying degrees of disability.

Bibliography: 1. Grunder G., H. H. (2009). The atipicality of antipsychotics: a concept re-examined and re-defined" 2. H., M. (2012). Clozapine: balancing safety with superior antipsychotic efficacy. Clinical schizophrenia and related psychosis 3.J., C. (2002). Psychiatry. 4. https://www.ncbi.nlm.nih.gov/pubmed

An uncommon association: Diabetes mellitus- Primary open angle glaucoma- Vogt-Koyonagi-Harada Syndrome   Nicula Patricia Ariadna - Validated View

An uncommon association: Diabetes mellitus- Primary open angle glaucoma- Vogt-Koyonagi-Harada Syndrome

Case Report - Poster

Author(s): Nicula Patricia Ariadna

Coordinator(s): Lecturer Cristina Nicula

Introduction:

Vogt-Koyonagi-Harada(VKH) is an uncommon multisystemic inflammatory disorder characterized by panuveitis with serous retinal detachment and is often associated with neurologic and cutaneous manifestations including: headache, hearing loss, vitiligo and poliosis. 


Case Presentation:
We present the case of a 58 years old female with diabetes mellitus and a history of primary open angle glaucoma in both eyes, operated on the left eye two weeks prior to the presentation and under topical antiglaucomatous drops. She came into the oftalmological service with decreased visual acuity in both eyes. The slit lamp examination revealed keratic precipitates and posterior iris synechiae in both eyes and an ExPress aqueous shunt in the left eye. Inferior retinal detachment was observed during ocular fundus examination. Intraocular pressure value was in normal range under antiglaucomatose drugs. 


Conclusion:
The association of diabetes mellitus and VKH Syndrome influenced the visual prognosis of the patient because of the prolonged costicosteroid treatment. 


Particularities:
Particularities: The distinctiveness of this case was the association of the VKH Syndrome wih primary open angle glaucoma and the inability to prolong the corticosteroid treatment, necessary in this case due to the association of diabetes mellitus. 

TELOMERE LENGTH CHANGES IN ALZHEIMER DISEASE  Oekroesi Alexandra , Choubey Rahul Alushi Sultan Validated View

TELOMERE LENGTH CHANGES IN ALZHEIMER DISEASE

Fundamental Science

Author(s): Oekroesi Alexandra, Choubey Rahul

Coauthor(s): Alushi Sultan

Coordinator(s): Associate Professor Florina Bojin

Keywords: Alzheimer disease Telomere length Flowcytometric hybridization Lymphocytes

Introduction: Telomeres are regions of repetitive DNA at the end of eukaryotic chromosomes, which prevent chromosomal instability. Telomere shortening in peripheral blood mononuclear cells (PBMCs) has been associated with biological age and several chronic degenerative diseases. Telomere shortening is linked to age- related disease including Alzheimer's disease (AD) and has been reported to be reduced in leukocytes of AD patients. The aim of the present study was to measure telomere length in lymphocytes of patients with AD compared to healthy subjects.

Material and Method: We used peripheral blood mononuclear cells (PBMCs) harvested from Alzheimer disease (AD) patients (n=30) and control patients (n=30). The age of patients with Alzheimer disease ranged from 57 to 84-year old, while the control samples were harvested from elder subjects with similar age range, with no prior diagnostic of Alzheimer disease or other forms of dementia. For determination of telomere length of both study and control patients groups, we used Telomere PNA Kit/FITC which is a new flow cytometric method of hybridization, which provided data referring to relative telomere length compared to control cells. Instead of 1301 cell line (tetraploid), we used K562 as control cell line (triploid) and we adjusted the DNA index accordingly (DNA index = 1.5).

Results: Our data show significant shorter telomere length in AD patients (22.95%) compared to controls (55.49%).

Conclusion: The telomere length is age-dependent in lymphocytes and decreased in AD patients, which could mean that the AD pathology may contribute to telomere length shortening. The high variability of telomere lengths in individuals suggests that it will not be useful as a general biomarker for AD. However, it could become a biomarker in the personalized long-term monitoring of an individuals' health.

Bibliography: 1. Bodnar AG, Ouellette M, Frolkis M, Holt SE, Chiu C-P, Morin GB, et al. Extension of life-span by introduction of telomerase into normal human cells. Science 1998;279:349-52. 2. Lansdorp PM, Verwoerd NP, van de Rijke FM, Dragowska V, Little M-T, Dirks RW, et al. Heterogeneity in telomere length of human chromosomes. Hum Mol Genet 1996;5:685-91. 3. Zijlmans JMJM, Martens UM, Poon SSS, Raap AK, Tanke HJ, Ward RK, et al. Telomeres in the mouse have large inter-chromosomal variations in the number of T2AG3 repeats. Proc Natl Acad Sci USA 1997;94:7423-8. 4. Martens UM, Zijlmans JMJM, Poon SSS, Dragowska W, Yui J, Chavez EA, et al. Short telomeres on human chromosome 17p. Nat Genet 1998;18:76-80. 5. Kosciolek BA, Rowley PT. Human lymphocyte telomerase is genetically regulated. Genes Chromosomes Cancer 1998;21:124-30. 6. Hultdin M, Grönlund E, Norrback K-F, Eriksson-Lindström E, Just T, Roos G. Telomere analysis by fluorescence in situ hybridization and flow cytometry. Nucleic Acids Res 1998;26:3651-6. 7. Rufer N, Dragowska W, Thornbury G, Roosnek E, Lansdorp PM. Telomere length dynamics in human lymphocyte subpopulations measured by flow cytometry. Nat Biotechnol 1998;16:743-7. 8. Kidd M. Alzheimer’s disease- an electron microscopical study. Brain 1964; 87: 307-20. 9. Alzheimer A, Stelzmann RA, Schnitzlein HN, Murtagh FR. An English translation of Alzheimer’s 1907 paper, “U¨ ber eine eigenartige Erkankung der Hirnrinde”. Clin Anat 1995; 8: 429-31. 10. Tyas SL, Manfreda J, Strain LA, Montgomery PR. Risk factors for Alzheimer’s disease: a population-based, longitudinal study in Manitoba, Canada. Int J Epidemiol 2001; 30: 590-7. 11. d’Adda di Fagagna F, Reaper PM, Clay-Farrace L, Fiegler H, Carr P, Von Zglinicki T, et al. A DNA damage checkpoint response in telomere-initiated senescence. Nature 2003; 426: 194-8. 12. Sedelnikova OA, Horikawa I, Zimonjic DB, Popescu NC, Bonner WM, Barrett JC. Senescing human cells and ageing mice accumulate DNA lesions with unrepairable double-strand breaks. Nat Cell Biol 2004; 6: 168-70. 13. Nalapareddy K, Jiang H, Guachalla Gutierrez LM, Rudolph KL. Determining the influence of telomere dysfunction and DNA damage on stem and progenitor cell ageing: what markers can we use? Exp Gerontol 2008; 43: 998-1004. 14. von Zglinicki T, Saretzki G, Docke W, Lotze C. Mild hyperoxia shortens telomeres and inhibits proliferation of fibroblasts: a model for senescence? Exp Cell Res 1995; 220: 186-93. 15. Aikata H, Takaishi H, Kawakami Y, Takahashi S, Kitamoto M, Nakanishi T, et al. Telomere reduction in human liver tissues with age and chronic inflammation. Exp Cell Res 2000; 256: 578-82. 16. Yang L, Suwa T, Wright WE, Shay JW, Hornsby PJ. Telomere shortening and decline in replicative potential as a function of donor age in human adrenocortical cells. Mech Ageing Dev 2001; 122: 1685-94. 17. Allsopp RC, Chang E, Kashefi-Aazam M, Rogaev EI, Piatyszek MA, Shay JW, et al. Telomere shortening is associated with cell division in vitro and in vivo. Exp Cell Res 1995; 220: 194-200. 18. Panossian LA, Porter VR, Valenzuela HF, Zhu X, Reback E, Mastermann D, et al. Telomere shortening in T cells correlates with Alzheimer’s disease status. Neurobiol Aging 2003; 24: 77-84. 19. Thomas P, O’ Callaghan NJ, Fenech M. Telomere length in white blood cells, buccal cells and brain tissue and its variation with ageing and Alzheimer’s disease. Mech Ageing Dev 2008; 129: 183-90. 20. Abrous DN, Koehl M, Le Moal M. Adult neurogenesis: from precursors to network and physiology. Physiol Rev 2005; 85: 523-69. 21. Rodier F, Coppe´ JP, Patil CK, Hoeijmakers WA, Mun˜ oz DP, Raza SR, et al. Persistent DNA damage signalling triggers senescence-associated inflammatory cytokine secretion. Nat Cell Biol 2009; 11: 973-9. 22. Ju Z, Jiang H, Jaworski M, Rathinam C, Gompf A, Klein C, et al. Telomere dysfunction induces environmental alterations limiting hematopoietic stem cell function and engraftment. Nat Med 2007; 13: 742-7. 23. Blackburn EH. Structure and function of telomeres. Nature 1991; 350(6319):569-573. 24. de Lange T. Shelterin: the protein complex that shapes and safeguards human telomeres. Genes & development 2005; 19(18):2100-2110. 25. Callen E, Surralles J. Telomere dysfunction in genome instability syndromes. Mutation research, 2004, 567(1):85-104.

LYMPHOCYTES SUBSETS INVOLVED IN ALZHEIMER DISEASE-ASSOCIATED IMMUNOSENESCENCE  Choubey Rahul , Oekroesi Alexandra Vatistas Theodoros, Alushi Sultan Invalidated View

LYMPHOCYTES SUBSETS INVOLVED IN ALZHEIMER DISEASE-ASSOCIATED IMMUNOSENESCENCE

Fundamental Science

Author(s): Choubey Rahul, Oekroesi Alexandra

Coauthor(s): Vatistas Theodoros, Alushi Sultan

Coordinator(s): Associate Professor Florina Bojin

Keywords: Immunosenescence Alzheimer disease Pre-dementia Peripheral blood mono-nuclear cells

Introduction: Immunosenescence is defined as a progressive alteration of morphological and functional characteristics, at the level of the immune system, during the ageing process. The purpose of this study was to define the immunosenescence status, to characterise proliferative potential and apoptosis intensity in T lymphocyte subpopulations, as well as to define the Alzheimer disease (AD)-associated immunosenescence in clinically diagnosed dementia, as well as prodromal stages (pre-dementia). 

Material and Method: In order to establish the study groups for patients with AD in different stages, we evaluated 24 patients, age between 57-84 years old. As a result of this evaluation, correlated with other clinical symptoms, the subjects were divided into two groups: early stage dementia (10 patients) and severe dementia (14 patients). As the control group, we investigated 20 elderly patients without dementia, with a similar age range. The investigations performed on selected subjects included blood harvesting and cell processing, cell cycle analysis, annexin V/PI viability assay, and immunophenotypical analysis of peripheral blood mononuclear cells (PBMC). 

Results: Cell cycle analysis of PBMCs showed that AD and pre-Alzheimer patients present decreased proliferation rate of these cells. Statistical analysis of apoptosis propensity in different study groups showed that, compared to control subjects, the intensity of apoptotic processes in pre-Alzheimer patients and AD patients, respectively, is significantly increased compared to control group. Flowcytometric analysis of T cells subpopulations showed normal distributions of cytotoxic T cells, with a significant proportion of activated cells (CD25+), less naive T cells (CD45RA+), and increased number of memory T cells (CD45RO+). 

Conclusion: As the individuals are growing older, there is a significant change in the cellular immunity aspects, related to both the number and the function of the immune cells, which is even more important for the AD patients.  


Bibliography: 1. Hyman BT, Van Hoesen GW, Damasio AR, Barnes CL. Alzheimer's disease: cell-specific pathology isolates the hippocampal formation. Science, 1984; 225: 1168-1170. 2. Braak H, Braak E. Neuropathological staging of Alzheimer-related changes. ActaNeuropathol, 1991; 82: 239-259. 3. Premkumar DR, Cohen DL, Hedera P, Friedland RP, Kalaria RN. Apolipoprotein E-epsilon4 alleles in cerebral amyloid angiopathy and cerebrovascular pathology associated with Alzheimer's disease. Am J Pathol, 1996; 148: 2083-2095. 4. Nilsson L, Rogers J, Potter H. The essential role of inflammation and induced gene expression in the pathogenic pathway of Alzheimer's disease. Front Biosci, 1998; 3: d436-d446. 5. Marques AR, Straus SE, Fahle G, Weir S, Csako G, et al.Lack of association between HSV-1 DNA in the brain, Alzheimer's disease and apolipoprotein E4. J Neurovirol, 2001; 7: 82-83. 6. Boeckh M, Nichols WG. The impact of cytomegalovirus serostatus of donor and recipient before hematopoietic stem cell transplantation in the era of antiviral prophylaxis and preemptive therapy. Blood, 2004; 103: 2003-2008. 7. Sund F, Lidehäll AK, Claesson K, Foss A, Tötterman TH, et al. CMV-specific T-cell immunity, viral load, and clinical outcome in seropositive renal transplant recipients: a pilot study. Clin Transplant, 2010; 24: 401-409. 8. Khan N, Shariff N, Cobbold M, Bruton R, Ainsworth JA, et al. Cytomegalovirus seropositivity drives the CD8 T cell repertoire toward greater clonality in healthy elderly individuals. J Immunol, 2002; 169: 1984-1992. 9. Vescovini R, Biasini C, Fagnoni FF, Telera AR, Zanlari L, et al. Massive load of functional effector CD4+ and CD8+ T cells against cytomegalovirus in very old subjects. J Immunol, 2007; 179: 4283-4291. 10. Vescovini R, Telera A, Fagnoni FF, Biasini C, Medici MC, et al.Different contribution of EBV and CMV infections in very long-term carriers to age-related alterations of CD8+ T cells. ExpGerontol, 2004; 39: 1233-1243. 11. Derhovanessian E, Maier AB, Hähnel K, Beck R, de Craen AJ, et al. Infection with cytomegalovirus but not herpes simplex virus induces the accumulation of late-differentiated CD4+ and CD8+ T-cells in humans. J Gen Virol, 2011; 92: 2746-2756. 12. Alonso Arias R, Moro-García MA, Echeverría A, Solano-Jaurrieta JJ, Suárez-García FM, et al. Intensity of the humoral response to cytomegalovirus is associated with the phenotypic and functional status of the immune system. J Virol, 2013; 87: 4486-4495. 13. Solana R, TarazonaR, Aiello AE, Akbar AN, Appay V, et al. CMV and Immunosenescence: from basics to clinics. Immun Ageing, 2012; 9: 23. 14. Herndler-Brandstetter D, Landgraf K, Tzankov A, Jenewein B, Brunauer R, et al. The impact of ageing on memory T cell phenotype and function in the human bone marrow. J LeukocBiol, 2012; 91: 197-205. 15. Bartlett DB, Firth CM, Phillips AC, Moss P, Baylis D, et al. The age-related increase in low-grade systemic inflammation (Inflammaging) is not driven by cytomegalovirus infection. Ageing Cell, 2012; 11: 912-915. 16. Wikby A, Johansson B, Olsson J, Löfgren S, Nilsson BO, et al. Expansions of peripheral blood CD8 T-lymphocyte subpopulations and an association with cytomegalovirus seropositivity in the elderly: theSwedish NONA immune study. ExpGerontol, 2002; 37: 445-453. 17. Wikby A, Maxson P, Olsson J, Johansson B, Ferguson FG. Changes in CD8 and CD4 lymphocyte subsets, T cell proliferation responses and non-survival in the very old: the Swedish longitudinalOCTO-immune study. Mech Ageing Dev, 1998; 102: 187-198. 18. Colonna-Romano G, Akbar AN, Aquino A, Bulati M, Candore G, et al. Impact of CMV and EBV seropositivity on CD8 T lymphocytes in an old population from West-Sicily. ExpGerontol, 2007; 42: 995-1002. 19. Pellicanò M, Larbi A, Goldeck D, Colonna-Romano G, Buffa S, et al.Immune profiling of Alzheimer patients. J Neuroimmunol, 2012; 242:52-59. 20. Larbi A, Pawelec G, Witkowski JM, Schipper HM, Derhovanessian E, et al. Dramatic shifts in circulating CD4 but not CD8 T cell subsets in mild Alzheimer's disease. J Alzheimers Dis, 2009; 17: 91-103. 21. Pirttilä T, Mattinen S, Frey H. The decrease of CD8-positivelymphocytes in Alzheimer's disease.J NeurolSci, 1992; 107: 160-165. 22. Gruebeck-Loebenstein B, Wick G. The ageing of the immune system. Adv. Immunol., 2002; 80:243. 23. Gardner EM, Murasko DM. Age-related changes in type 1 and type 2 cytokine production in humans. Biogerontology, 2002; 3:271.

A rare case of a colorectal cancer and hepatic metastases in an adult with situs inversus totalis and malrotation of the intestines   Kovács Alexandra , Purtan Victoria-Teodora Năstasă Emanuela Invalidated View

A rare case of a colorectal cancer and hepatic metastases in an adult with situs inversus totalis and malrotation of the intestines

Case Report - Poster

Author(s): Kovács Alexandra, Purtan Victoria-Teodora

Coauthor(s): Năstasă Emanuela

Coordinator(s): Assistant Professor Iunius Paul Simu

Introduction:

Situs inversus totalis is a rare congenital condition characterized by complete transposition of the thoracic and abdominal viscera. The etiologic nature of this anomaly is not known. This condition is typically associated with normal life expectancy unless a gastrointestinal or cardiac anomaly is present. This anomaly is not a premalignant condition. However, many cases of malignant neoplasms and situs inversus totalis have been reported, especially gastric cancer. Association between colorectal cancer and situs inversus totalis is rare.

Case Presentation:
A 69-year old male patient was hospitalized in Surgery II Department from SCJU Tirgu-Mures on 8 November 2016 with abdominal pain, diarrhea, fatigability, significant weight loss. A colonoscopy performed on the patient revealed a mass in the rectosigmoid junction. A CT scanning highlighted situs inversus totalis and malrotation of the intestines. Also, the contrast enhanced CT revealed multiple lesions localised in the liver. Due to the association of these comorbidities, on 9 November 2016 an open surgical procedure was performed consisting of rectosigmoid resection and colo-rectal anastomosis, resection of liver metastases and drainage. 2 weeks after the procedure the pacient presents an anastomotic fistula after colorectal resection for carcinoma and postoperative adhesions, therefore, 4 days later the medical team decides on a new surgical intervention. During the surgery, the medical team proceeds with an adhesiolisis and a protective colostomy.

Conclusion:
After the surgical procedure the patient showed a favorable evolution and he was discharged on the tenth day after the second surgery. Now the pacient is under oncological and surgical supervision.

Particularities:
The particularity of the case is the  association between a rare congenital condition as  situs inversus totalis with colorectal cancer. Also, the surgical procedures are considered more difficult and the risk of occurrence of intra-operative complications is higher in comparison with the procedures of patients without situs inversus totalis.

The Development of a Polytraumatized Pacient with Lower Limb Replantation  Vîlcan Andreea , Ignat Andreea-Melania Laslo Alexandru Invalidated View

The Development of a Polytraumatized Pacient with Lower Limb Replantation

Case Report - Poster

Author(s): Vîlcan Andreea, Ignat Andreea-Melania

Coauthor(s): Laslo Alexandru

Coordinator(s): Assistant Professor Adrian Ivănescu

Introduction: Polytrauma is a severe acute condition resulted from a variety of incriminating agents ( mechanical, physical, chemical ones) with the damage to at least two anatomical regions of which at least one injury is life-threatening. The functional consequence is a systemic disorder characterized by multiple complex physiological disorders (endocrine response, metabolic, immune, coagulation disorders, shock, failure and plurivisceral dysfunction). 

Case Presentation: We present you the case of a 25 years old male patient who suffered multiple injuries after a train crash. At the time he was hospitalized, he was respiratory and hemodynamically unstable, in hemorrhagic shock, conscious but subsequently intubated because of his unstable state. The polytrauma included impaired wound extended until the 1/3 distal of the right thigh and shanck, insubstantial wound, traumatic amputation of 1/3 distal of the left thighbone, right popliteal artery injury.

The clinical investigations (CT, Inferior Members X-Ray, Orthopedic, Surgery, Plastic,  Anaesthesia and Intensive Care Medicine consult) confirmed the polytrauma. The medical decision was to replant the left pelvic limb. It required a multidisciplinary approach which implied a plastic, vascular and orthopedic surgeon. The process consisted in restoring the left vascular axis using a vein graft and using the external fixation ostheosynthesis. 

Conclusion: The post-operation evolution was not favorable. The pacient’s general condition was adulterated and shortly he developed septic shock, liver and renal failure. The dialysis was required but the results were not auspicious. Going from bad to worse, it was taken the decision to amputate both inferior limbs, one at a time. The condition was getting worse, and in about 2 months after the surgery, the pacient died of a multiple organ failure. 

Particularities: Being a very young pacient the decision was to replant the inferior left limb, and not to amputate it.

MYOCARDIAL BRIDGE - POTENTIAL SOURCE OF SOME COMPLEX HEART DISEASES – CASE REPORT  Zaharia Marius-Cristian Ghigeanu Miruna Validated View

MYOCARDIAL BRIDGE - POTENTIAL SOURCE OF SOME COMPLEX HEART DISEASES – CASE REPORT

Case Report - Poster

Author(s): Zaharia Marius-Cristian

Coauthor(s): Ghigeanu Miruna

Coordinator(s): Associate Professor Cornelia Voiculeţ

Introduction:

Myocardial bridging, a congenital coronary anomaly, is a cluster of myocardial fibers crossing over the epicardial coronary arteries. This entity is more common, with an angiographic incidence of about 15% to 60%, being present, in a third of adults, usually localized in the line of the anterior interventricular artery.
Myocardial bridges may be generally asymptomatic or associated with various clinical manifestations, some of which may be potentially fatal.


Case Presentation:
A 42-year-old female presented with recurrent retrosternal chest pain of 10 years duration, recently increased in frequency, associated with paresthesia in the left arm. The patient has a history of smoking, ischemic heart disease in the family and hypertension.
Physical examination reveals plethoric facies, bilateral basal vesicular murmur with rare subcrepitant rales and hypertension. Laboratory investigations expose a normal resting electrocardiogram. Physical efforts uncover ischemic changes in the anterior-apical territory, confirmed through myocardial scintigraphy.
Echocardiographic examination demonstrates preservation of the global systolic function, without any significant valvulopathies. The angiography unfolds the characteristic appearance of myocardial bridge, reporting both the systolic narrowing of the epicardial artery and the return to normal during diastole. 


Conclusion:
Given these findings, the patient is diagnosed with coronary muscular bridge. Treatment includes hygienic-dietary therapy associated with drug therapy to reduce heart rate, increase diastolic range and decrease systolic compression.
The evolution is favorable, three months after initiation of therapy, the patient no longer complains of chest pain at physical efforts.


Particularities: Because the systole brings only 15% of coronary flow, the clinical relevance of the myocardial bridge appears in situations such as tachycardia, myocardial infarction, arrhythmias, sudden death. Controversy exists concerning its clinical and prognostic relevance and the appropriate therapeutic approach for symptomatic patients. Therefore, clinical suspicion should be considered in all cases of chest pain in patients without cardiovascular risk factors.

Bilateral urinary stones solved by multimodal endoscopic treatment - Case Report  Kovács Alexandra , Purtan Victoria-Teodora Gîrleanu Corina Validated View

Bilateral urinary stones solved by multimodal endoscopic treatment - Case Report

Case Report - Poster

Author(s): Kovács Alexandra, Purtan Victoria-Teodora

Coauthor(s): Gîrleanu Corina

Coordinator(s): Assistant Professor Alexandru Brad

Introduction:

Urinary lithiasis represents the formation of the calculi in the urinary sistem. It may be asymptomatic, but more often the condition is extremely painful. Surgery may be necessary if the stones cannot be excreted spontaneously. It has been observed that urinary lithiasis affect hypertensive patients disproportionately compared to normotensive individuals. Also, some prospective data suggest that a history of nephrolithiasis was associated with a greater tendency to develop hypertension. Newer epidemiologic data also link obesity and diabetes, features of the metabolic syndrome, with nephrolithiasis. The aim of our paper is to present a challenging case of bilateral lithiasis intricate with various comorbidities.

Case Presentation:
A 63-year old male patient was admitted in Urology Department from Mures County Hospital on 21 February 2017 with left renal colic. The pacient is known with a medical history of lithiasis, benign prostate hyperplasia, hypertension, type 2 diabetes mellitus, obesity, hipercholesterolemia, asthma. Laboratory exam, renal ultrasound and intravenous urography showed the presence of bilateral ureteral lithiasis and left ureter hydronephrosis. On 24 February 2017 a left retrograde ureteroscopy was performed succesfully with fragmentation and extraction of 2 stones and with another one pushed back in the kidney and also a left JJ stent was placed. A month later the patient presented again to the hospital and a left  percutaneous nephrolithotomy was performed for the kidney stone and 3 days later, a right retrograde ureteroscopy which included the extraction of 3 pelvic calculi and mounting of a right JJ stent for a month.

Conclusion:
The treatment proved to be efficient. After multiple interventions, the patient is stone-free, the disease is under control  and the general state of the patient is improved. The patient was discharged home in stable condition after 3 days from surgery.

Particularities:
The particularity of the case is the multiple comorbidities associated with bilateral lithiasis.

A rare case of penile fracture healed by conservatory treatment  Ciubotariu Calina , Russu Mihai Emil Pop Tiberiu Andrei, Andrea Cora-Iulia Invalidated View

A rare case of penile fracture healed by conservatory treatment

Case Report - Poster

Author(s): Ciubotariu Calina, Russu Mihai Emil

Coauthor(s): Pop Tiberiu Andrei, Andrea Cora-Iulia

Coordinator(s): Lecturer Daniel Porav-Hodade

Introduction:

Fracture of the penis is the rupture of the tunica albuginea of the corpus cavernosa. The rupture occurs when the penis is erect because the tissue of the tunica albuginea is thinner during erection and is vulnerable to a sudden increase in the intracorporeal pressure. The urethra and corpus spongiosum may also be affected . The tear is mostly unilateral and transverse . Penile fracture is a medical emergency, and emergency surgical repair is the usual treatment. Non-surgical approaches result in 10–50% complication rates .


Case Presentation:
A 41 year old patient, without other urological backgrounds, is admitted to the emergency clinic with intense pain after penian trauma produced by a  sexual intercourse and an extended hematoma on the  foreskin of the penis. The patient refuses the surgical intervention so the conservative approach was chosen: endourethral catheter , compressive bandages and ice. Also antibiotics and antispastic with pain relievers were used to manage the pain and to prevent an infection.
The patients’ evolution is favorable with the partial remission of the penian and scrotal hematoma over the course of the 5 day admission, so the catheter was removed. During the internation the patient had clear urine and was feverless, 3 weeks after the externation the pacient come for control and the hematoma was resorbed.

Conclusion: Despite the high frequency of complications following a conservative approach this patient exhibited a good remission of the symptoms and small complications : deviation of 5 -10 % in erection.

Particularities: Even though the medical advancements have placed the surgical approach as a gold standard in penile ruptures, in exceptional circumstances the patients’ choice drives us towards conservative methods, in this case being fortunately successful.

Immunohistochemical concentration of human chorionic gonadotropin in the placenta`s trophoblast cell of the pregnant with early maturation of placental villous tree considering the iron-deficiency anemia during gestation  Petrochenkov Hennadii - Validated View

Immunohistochemical concentration of human chorionic gonadotropin in the placenta`s trophoblast cell of the pregnant with early maturation of placental villous tree considering the iron-deficiency anemia during gestation

Fundamental Science

Author(s): Petrochenkov Hennadii

Coordinator(s): Assistant Professor Oleksandra Garvasiuk

Keywords: Immunohistochemical concentration early maturation of placental villous tree IDA HCG

Introduction: Iron deficiency is the most common cause of anemia in pregnancy. It is characterized by a high frequency, which is in regions of Ukraine take place from 28.4% to 83.1%. It should be noted that the concentration of placental hormones in trophoblast's villous in cases of early maturing of placental villous tree of placenta during gestation hasn't been studied yet, particularly in the period of gestation of 29-32 and 33-36 weeks.

Material and Method: Total examined 100 placentas. Design of research: Group №1-combination of IDA of the pregnant and early maturation of placental villous tree at 29-32 week of gestation, n=18. Group №2-early maturation of placental villous tree without any anemia at 29-32 week of gestation, n=19. Group №3-combination of IDA of the pregnant and early maturation of placental villous tree at 33-36 week of gestation, n=20. Group №4-early maturation of placental villous tree without any anemia at 33-36 week of gestation, n=22. Group №5-physiological pregnancy, between 37-40 weeks of gestation. Immunohistochemical technique was performed on paraffin sections. Primary antibodies against HCG with visualization system of polymer primary antibodies (DAKO) were used. Diaminobenzidine was dyed. statistically significant differences are considered in the r ≤0,05.

Results: It is known that the peak of concentration of HCG falls on 10-11 week of pregnancy, then, every second day concentrations slowly decline. It was expected that the concentration HCG should be lower in all groups of the study. Established immunohistochemical concentration for physiological pregnancy is 0,214±0,0023 D; group №1-0,226±0,0020 D; group №2-0,249±0,0023 D; group №3-0,218±0,0019 D; group №4-0,232±0,0024 D.

Conclusion: Immunohistochemical concentration of HCG in the placenta`s trophoblast cell of the pregnant with early maturation of placental villous tree for both periods of gestation is higher than we could predict, although in case of IDA of pregnant it is lower than without anemia.

Bibliography: 1. Breymann C. Irondeficiency and anaemia in pregnancy: modern aspects of diagnosis and therapy / C.Breymann // Bld. Cel. Molecul. Dis. - 2002. - V.29, N.3. – P. 506-516. 2. Rohini M. Histological changes in the placentae from severe anaemic mothers // M. Rohini, A.S. Yogesh, M. Goyal, Praveen Kurrey // International Journal of Medical and Health Sciences. - 2013, V.2, Is.1. – P.31-35. 3. The assessment of newborn iron stores at birth: a review of the literature and standards for ferritin concentrations / A.M. Siddappa, R.Rao, J.D.Long [et al.] // Neonatology. – 2007. - N1. – P. 73-82. 4. Benirschke K. Pathology of the human placenta. / К. Benirschke, G. J. Burton., R.N. Baergen // 6th ed. – 2012. – New York: Springer. – 974 p. 5. Знаменська Т.К. Організація та перспективи розвитку перинатальної допомоги в Україні / Т.К.Знаменська, Т.М.Бойчук, Ю.Д.Годованець // Неонатологія, хірургія та перинатальна медицина. – 2013. – ТІІІ, №1(7). - С.13-18. 6. Гарвасюк О.В. Морфометричні параметри передчасного дозрівання хоріального дерева плаценти при залізодефіцитній анемії вагітних у гестаційному аспекті / О.В.Гарвасюк, І.С.Давиденко // Неонатологія, хірургія та перинатальна медицина – 2015. - Том V, №4(18). – С.90-95. 7. Давиденко І.С. Удосконалення класифікації хоріальних ворсинок плаценти, її обґрунтування методами інформаційного аналізу та практичне застосування, як досягнення науковців кафедри патоморфології Буковинського державного медичного університету / І. С. Давиденко, О. А. Тюлєнєва // Клін. анат.та операт. хірургія. – 2014. – Т.13, №2. – С.108-113. 8. Давиденко І.С. Гістологічні критерії зрілості хорального дерева для діагностики передчасного та уповільненого дозрівання плаценти людини / І.С.Давиденко, О.А. Тюлєнєва, А.В.Гошовська // Бук.мед.вісник. – 2011. – Т.15, №1(57). – С.127-130. 9. Шендерюк О.П. Концентрація плацентарних гормонів у трофобласті хоріальних ворсинок плаценти при запаленні посліду (імуногістохімічне дослідження) / О.П.Шендерюк, І.С.Давиденко // Клінічна та експериментальна патологія. – 2012. – Т.ХІ, №3(41). – 139-141.

Unusual cause of heart failure in the elderly Lutembacher syndrome  Avîrvarei Cosmin-Alexandru - Validated View

Unusual cause of heart failure in the elderly Lutembacher syndrome

Case Report - Poster

Author(s): Avîrvarei Cosmin-Alexandru

Coordinator(s): Associate Professor Catalina Lionte

Introduction:

Lutembacher syndrome is an extremely rare disease, defined by the coexistence of mitral stenosis (generally acquired) and an atrial septal defect (usually congenital, ostium primum and secundum). Pathology prevalent in women, clinically most patients are asymptomatic until the second to third decade. In general, symptoms are due ASD, depending on the size of the interatrial communication (smaller the ASD, faster the symptoms will appear). The main events include palpitations, heart failure and lung congestion.

Case Presentation:
A 75 years old patient with atrial tachycardia, for which an ablation of the ectopic focus was done, comes to the hospital for dyspnea on minimal effort and fatigue. On physical exam: BP= 105/60 mmHg; HR= 45/min, normal pulmonary sounds, breathlessness. NTproBNP's increased level orients the etiology of the dyspnea in the cardiovascular field. ECG: Wandering atrial pacemaker (P-wave with various morphologies and different PR intervals between 0.12-0.20s), average ventricular rate 45/min, intermediate QRS axis, right bundle branch block. Exploration of thyroid function (indicated by NYHA Class III heart failure and amiodarone therapy) highlights TSH de 14.7 iu/ml (n=0.4-4 iu/ml) and FT4=0.689 ng/dl (n=0.89-1.76 ng/dl) due to amiodarone-induced hypothyroidism. Echocardiography reveals moderate rheumatic mitral stenosis associated with ASD type OP with left-right shunt (Lutembacher syndrome), IAS aneurysm, severe secondary pulmonary hypertension and aortic atheromatosis.

Conclusion:
In the face of patients hospitalized with heart failure phenomena we must look for the etiology of the disease, diagnosis of this malformation so late in the patient's life being due the peculiarities of this disease.

Particularities: Although heart failure is a common disease at this age, Lutembacher syndrome as the etiology for heart failure in an elderly is unusual in daily practice. 

Recurrent meningioma with subtle clinical symptoms, Case Report  Coldea Bianca Maria - Validated View

Recurrent meningioma with subtle clinical symptoms, Case Report

Case Report - Poster

Author(s): Coldea Bianca Maria

Coordinator(s): MD Silvina Ilut , Assistant Professor Vacaras Vitalie

Introduction:

Meningiomas, the most common brain tumors in adult population, account for approximately one quarter of primary central nervous system tumors. They are thought to arise from the arachnoidal ‘cap’ cells which reside in the arachnoid layer covering the surface of the brain. This case report describes the clinical presentation, the investigations, the differential diagnosis and the current treatment options for this condition.


Case Presentation: A 53-year-old patient consulted his doctor for progressive loss of vision in his left eye, left hyposmia and frontoparietal headache. After the initial ophthalmological consult confirmed a left eye papilledema, he was further referred to a neurologist. The CT revealed an olfactory groove tumor indicating a meningioma. The management of patients with this pathology depends on patient specific factors, the location and the histopathogenesis of the tumor. Thereby, the optimal treatment was complete surgical resection resulting in complete remission of the headaches. 

Conclusion:

Brain tumors can produce a large variety of clinical symptoms from easily identifiable ones such as upper motor neuron lesion symptoms, altered consciousness to subtler signs that can be neglected such as those presented in this case report. It is of utmost importance for clinicians that in the presence of uncommon neurological signs and symptoms, cranial nerve dysfunction or failed conservative therapy not to hesitate referring the patient to a specialist.


Particularities:

The particularity of this case is that, after seventeen years, the headaches and the lowered visual acuity reappeared, accompanied by bilateral anosmia and anxiety disorder. An MRI revealed the recurrence of the olfactory groove meningioma as well as the appearance of two smaller new masses located in the prefrontal and prepontine region. The problem of meningiomatosis was raised. Clinical examination, the MRI and the ophthalmologic exam confirmed a Foster-Kennedy syndrome. Due to the patient’s cardiac decompensation, now, the best treatment is a conservative one.

GENETIC ASSOCIATION OF ADIPOQ 276G>T GENE VARIANT WITH TYPE 1 DIABETES AND TYPE 2 DIABETES. A CASE-CONTROL STUDY IN NORTHERN ROMANIAN POPULATION  Aioanei Casian-Simon , Ilies Roxana Catana Andreea , Popp Radu Validated View

GENETIC ASSOCIATION OF ADIPOQ 276G>T GENE VARIANT WITH TYPE 1 DIABETES AND TYPE 2 DIABETES. A CASE-CONTROL STUDY IN NORTHERN ROMANIAN POPULATION

Fundamental Science

Author(s): Aioanei Casian-Simon, Ilies Roxana

Coauthor(s): Catana Andreea , Popp Radu

Coordinator(s): Assistant Professor Maria-Felicia Petrisor

Keywords: Adiponectin Type 1 Diabetes Mellitus Type 2 Diabetes Mellitus Single Nucleotide Polymorphism

Introduction: Various genetic variants have been studied in relationship with type 1 diabetes (T1D) and type 2 diabetes (T2D). Gene polymorphisms of adiponectin have been demonstrated to have an important role on the plasma adiponectin level and activity, being the most abundant adipose tissue-derived cytokine. It has anti-inflammatory, anti-diabetic and anti-atherogenic properties, and low circulating levels are associated with T1D and T2D. The current project was aimed at investigating peculiarities of distribution of ADIPOQ 276G>T gene variant polymorphism with both types of diabetes and analysing possible associative links between the carrier status and the clinical onset and evolution of diabetes in a Caucasian population group.

Material and Method: A total of 155 diabetic patients were enrolled in this study and assigned to two groups: T1D group (n=55) and T2D group (n=100). In addition, 100 healthy subjects were chosen as healthy normal control. Genotypes were determined by PCR-RFLP followed by specific enzymatic digestion of the amplicons and gel electrophoresis for the resulting DNA fragments. Statistical analysis of data was performed with SPSS version 20.0 software.

Results: Statistical and comparative analyses for dominant and recessive models of ADIPOQ 276G>T polymorphism did not revealed a significant risk of T1D (χ2=1.14, P=0.06, [OR] =1.09, 95% [CI]=0.892–2.801) and a borderline risk for T2D (χ2=2.221, P=0.045, OR =1.2, 95% [CI] =1.175–4.006). Also, comparative analysis for the recessive model reveals that the variant GG genotype of ADIPOQ gene is more frequently associated with T2D then T1D (χ2=3.835, P=0.04, OR=0.447, 95% [CI] =0.197–1.015).

Conclusion: This present results suggest that the ADIPOQ gene 276G>T polymorphism may be associated with susceptibility to T1D and T2D in a Caucasian population group. However, it is still necessary to conduct larger sample studies using standardized unbiased genotyping methods and to explore the association among different ethnicities in the future.

Bibliography: 1. Ouchi N, Walsh K. Adiponectin as an anti-inflammatory factor. National Institutes of Health 2007 2. Bermúdez VJ, Rojas E, Toledo A, Rodríguez-Molina D, Vega K, Suárez L, et al. Single-Nucleotide Polymorphisms in Adiponectin, AdipoR1, and AdipoR2 Genes. American Journal Of Therapeutics 2013:414–21. 3. Cheekurhty AJP. Association of New Single Nucleotide Polymorphism with Type 2 Diabetes Mellitus. Journal Of Diabetes and Metabolism J Diabetes Metab 2015. 4. Janke A, Wilk S, Pollar W, Eriksson U. Adiponectin protects against Toll-like receptor 4-mediated cardiac inflammation and injury. Cardiovasc Res. 2013 Aug 1;99(3):422-31 5. Kacso IM, Trifa AP, Popp RA, Kacso G. Association of 276G>T adiponectin gene polymorphism to plasma adiponectin and albuminuria in type 2 diabetic patients. Int Urol Nephrol International Urology And Nephrology 2012:1771–7. 6. Kadowaki T. Adiponectin and adiponectin receptors in insulin resistance, diabetes, and the metabolic syndrome. Journal Of Clinical Investigation 2006:1784–92. 7. Li Z-P, Zhang M, Gao J, Zhou G-Y, Li S-Q, An Z-M. Relation between ADIPOQ Gene Polymorphisms and Type 2 Diabetes. Genes 2015:512–9. 8. Mohammadi S, Arefhosseini SR, Ebrahimi-Mamaeghani M, Fallah P, Bazi Z. Adiponectin as a potential biomarker of vascular disease. VHRM Vascular Health And Risk Management 2015:55. 9. Oliveira CS, Saddi-Rosa P, Crispim F, Canani LH, Gerchman F, Giuffrida FM, et al. Association of ADIPOQ variants, total and high molecular weight adiponectin levels with coronary artery disease in diabetic and non-diabetic Brazilian subjects. Journal Of Diabetes and Its Complications:94–8. 10. Peters KE, Beilby J, Cadby G, Warrington NM, Bruce DG, Davis WA, et al. A comprehensive investigation of variants in genes encoding adiponectin (ADIPOQ) and its receptors (ADIPOR1/R2), and their association with serum adiponectin, type 2 diabetes, insulin resistance and the metabolic syndrome. BMC Medical Genetics BMC Med Genet:15. 11. Shi H, Kokoeva MV, Inouye K, Tzameli I, Yin H, Flier JS. TLR4 links innate immunity and fatty acid–induced insulin resistance. Journal Of Clinical Investigation J Clin Invest 2006:3015–25. 12. Vasseur F. Single-nucleotide polymorphism haplotypes in the both proximal promoter and exon 3 of the APM1 gene modulate adipocyte-secreted adiponectin hormone levels and contribute to the genetic risk for type 2 diabetes in French Caucasians. Human Molecular Genetics 2002:2607–14

THROMBOCYTOPENIA IN CHRONIC VIRAL HEPATITIS B OR C AND END-STAGE RENAL DISEASE  Ciulei George - Validated View

THROMBOCYTOPENIA IN CHRONIC VIRAL HEPATITIS B OR C AND END-STAGE RENAL DISEASE

Medical Science

Author(s): Ciulei George

Coordinator(s): Lecturer Olga Hilda Orășan

Keywords: thrombocytopenia chronic viral hepatitis end-stage renal disease

Introduction: Thrombocytopenia (TCP) is a potential complication of chronic viral hepatitis (CVH) and of hemodialysis in patients with end-stage renal disease (ESRD). Patients with both CVH and ESRD have a slower progression of the liver disease when compared to patients with CVH only. We aimed to study the prevalence and risk factors of TCP in patients with both CVH and ESRD in comparison with patients that are affected by ESRD only.

Material and Method: A retrospective, transversal study was made to evaluate the prevalence of thrombocytopenia in a group of 50 patients with CVH and ESRD and a group of 25 patients with ESRD only. We evaluated the correlation between platelet count and age, dialysis vintage, serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin, C-reactive protein (CRP), and liver stiffness measurements (determined by transient elastography).

Results: Mean platelet count between both groups was not significantly different (168316/mm3 vs. 179068/mm3, p = 0.466), yet patients with CVH and ESRD had an increased risk of TCP (OR = 3.41, p = 0.046, CI = 1.01 to 9.7). Platelet count correlated positively with age (Spearman’s correlation coefficient ρ = 0.38, p = 0.005), CRP levels (ρ = 0.31, p = 0.026), and correlated negatively with transient elastography measurements (ρ = -0.31, p = 0.024). A CRP value above 10 mg/dL was associated with a lower prevalence of TCP in patients with CVH and ESRD (OR = 0.18, CI = 0.03 to 0.93, p = 0.044).

Conclusion: Infections with hepatitis B and C viruses are associated with a higher prevalence of TCP in patients with ESRD. Platelet counts increase with age and CRP values, but start to go lower once liver fibrosis is more advanced.

Bibliography: 1. Gauer, R. L., & Braun, M. M. (2012). Thrombocytopenia. American Family Physician, 85(6), 612–622. Retrieved from http://www.aafp.org/afp/2012/0315/p612.html 2. Shah, R., Haddad, N., Vachharajani, T. J., Asif, A., & Agarwal, A. (2014). Thrombocytopenia in ESRD patients: epidemiology, mechanisms and interventional nephrology perspective. Seminars in Dialysis, 27(6), 618–625. doi: 10.1111/sdi.12199 3. de Jesus Rodrigues de Freitas, M., Fecury, A. A., de Almeida, M. K. C., Freitas, A. S., de Souza Guimaraes, V., da Silva, A. M., … Martins, L. C. (2013). Prevalence of hepatitis C virus infection and genotypes in patient with chronic kidney disease undergoing hemodialysis. Journal of Medical Virology, 85(10), 1741–1745. doi: 10.1002/jmv.23654 4. Lin, K.-H., Hsu, P.-I., Yu, H.-C., Lin, C.-K., Tsai, W.-L., Chen, W.-C., … Lai, K.-H. (2012). Factors linked to severe thrombocytopenia during antiviral therapy in patients with chronic hepatitis c and pretreatment low platelet counts. BMC Gastroenterology, 12(1), 1–8. doi: 10.1186/1471-230X-12-7 5. Alric, L., & Bonnet, D. (2016). Grazoprevir + elbasvir for the treatment of hepatitis C virus infection. Expert Opinion on Pharmacotherapy, 17(5), 735–742. doi: 10.1517/14656566.2016.116102 6. Fan, X., Chen, L., Yang, J., & Feng, P. (2016). Entecavir-Associated Thrombocytopenia in a Decompensated Cirrhotic Patient: A Case Report and Literature Review. Medicine, 95(12), e3103. doi: 10.1097/MD.0000000000003103 7. Fabrizi, F., Messa, P., Basile, C., & Martin, P. (2010). Hepatic disorders in chronic kidney disease. Nature Reviews. Nephrology, 6(7), 395–403. doi: 10.1038/nrneph.2010.37 8. Vidales-Braz, B. M., da Silva, N. M. O., Lobato, R., Germano, F. N., da Mota, L. D., Barros, E. J. G., & de Martinez, A. M. B. (2015). Detection of hepatitis C virus in patients with terminal renal disease undergoing dialysis in southern Brazil: prevalence, risk factors, genotypes, and viral load dynamics in hemodialysis patients. Virology Journal, 12, 8. doi: 10.1186/s12985-015-0238-z 9. Bonder, A., & Afdhal, N. (2014). Utilization of FibroScan in clinical practice. Current Gastroenterology Reports, 16(2), 372. doi: 10.1007/s11894-014-0372-6 10. Orasan, O. H., Sava, M., Iancu, M., Cozma, A., Saplontai-Pop, A., Sarlea Tarmure, S., ... Dumitrascu, D. L. (2015). Serum hyaluronic acid in chronic viral hepatitis B and C: a biomarker for assessing liver fibrosis in chronic hemodialysis patients. International Urology and Nephrology, 47(7), 1209–1217. doi: 10.1007/s11255-015-1017-x 11. Sumida, K., Yamagata, K., Iseki, K., & Tsubakihara, Y. (2016). Different impact of hemodialysis vintage on cause-specific mortality in long-term hemodialysis patients. Nephrology Dialysis Transplantation, 31(2), 298–305. doi: 10.1093/ndt/gfv402 12. Nishida, C., Uto, H., Oketani, M., Tokunaga, K., Nosaki, T., Fukumoto, M., … Tsubouchi, H. (2010). Clinical significance of alanine aminotransferase levels and the effect of ursodeoxycholic acid in hemodialysis patients with chronic hepatitis C. Journal of Gastroenterology, 45(3), 326–334. doi: 10.1007/s00535-009-0149-0 13. Ando, M., Iwamoto, Y., Suda, A., Tsuchiya, K., & Nihei, H. (2001). New insights into the thrombopoietic status of patients on dialysis through the evaluation of megakaryocytopoiesis in bone marrow and of endogenous thrombopoietin levels. Blood, 97(4), 915–921. Retrieved from http://www.bloodjournal.org/content/97/4/915 14. Ahmed, S., & El-Sherif, A. (2016). Interaction between blood and dialysis membrane in hepatitis-C virus-infected patients: A comparative study. Saudi Journal of Kidney Diseases and Transplantation, 27(4), 677–684. doi: 10.4103/1319-2442.185223 15. Bat, T., Bat, B. E., El-Moghraby, A., Patel, S., Feng, X., Dunbar, C. E., & Sarac, E. (2016). Thrombopoietic status of patients on haemodialysis. British Journal of Haematology, 172(6), 954–957. doi: 10.1111/bjh.13918 16. Sette, L. H. B. C., & Almeida Lopes, E. P. de. (2014). Liver enzymes serum levels in patients with chronic kidney disease on hemodialysis: a comprehensive review. Clinics, 69(4), 271–278. doi: 10.6061/clinics/2014(04)09 17. Orasan, R. A., Patiu, I. M., Anghel, D., Bejan, C., Iosub, L., Totolici, C., ...Caprioara, M.G. (2013). Variation of clinical and laboratory features in chronic dialysis patients treated with high-flux hemodialysis after switching to online hemodiafiltration. International Urology and Nephrology, 45(5), 1415–1422. doi: 10.1007/s11255-012-0341-7 18. Kubrusly, M., Oliveira, C. M. C., de Santos, D. C. de O., Mota, R. S., & Pereira, M. L. (2012). A comparative analysis of pre- and post-dialysis albumin as indicators of nutritional and morbi-mortality risks in haemodialysis patients. Brazilian Journal of Nephrology, 34(1), 27–35. doi: 10.1590/S0101-28002012000100005 19. Osada, M., Kaneko, M., Sakamoto, M., Endoh, M., Takigawa, K., Suzuki-Inoue, K., … Ozaki, Y. (2012). Causes of thrombocytopenia in chronic hepatitis C viral infection. Clinical and Applied Thrombosis/Hemostasis, 18(3), 272–280. doi: 10.1177/1076029611429124 20. Zucker, M. L., Hagedorn, C. H., Murphy, C. A., Stanley, S., Reid, K. J., & Skikne, B. S. (2012). Mechanism of thrombocytopenia in chronic hepatitis C as evaluated by the immature platelet fraction. International Journal of Laboratory Hematology, 34(5), 525–532. doi: 10.1111/j.1751-553X.2012.01429.x 21. Molnar, M. Z., Streja, E., Kovesdy, C. P., Budoff, M. J., Nissenson, A. R., Krishnan, M., … Kalantar-Zadeh, K. (2011). High platelet count as a link between renal cachexia and cardiovascular mortality in end-stage renal disease patients. The American Journal of Clinical Nutrition, 94(3), 945–954. doi: 10.3945/ajcn.111.014639 22. Zhang, W., He, J., Zhang, F., Huang, C., Wu, Y., Han, Y., … Zhao, Y. (2013). Prognostic role of C-reactive protein and interleukin-6 in dialysis patients: a systematic review and meta-analysis. Journal of Nephrology, 26(2), 243–253. doi: 10.5301/jn.5000169 23. Valaydon, Z. S., Lee, P., Dale, G. L., Januszewski, A. S., Rowley, K. G., Nandurkar, H., … Jenkins, A. J. (2009). Increased coated-platelet levels in chronic haemodialysis patients. Nephrology, 14(2), 148–154. doi: 10.1111/j.1440-1797.2008.01026.x 24. Robitaille, R., Lafrance, J.-P., & Leblanc, M. (2006). Altered laboratory findings associated with end-stage renal disease. Seminars in Dialysis, 19(5), 373–380. doi: 10.1111/j.1525-139X.2006.00192.x 25. Ravindran, S., Hancox, S. H., & Howlett, D. C. (2016). Liver biopsy: past, present and future. British Journal of Hospital Medicine, 77(2), 90–95. doi: 10.12968/hmed.2016.77.2.90 26. Cardoso, A.-C., Carvalho-Filho, R. J., Stern, C., Dipumpo, A., Giuily, N., Ripault, M.-P., … Marcellin, P. (2012). Direct comparison of diagnostic performance of transient elastography in patients with chronic hepatitis B and chronic hepatitis C. Liver International, 32(4), 612–621. doi: 10.1111/j.1478-3231.2011.02660.x 27. Kellner, P., Anadol, E., Huneburg, R., Hundt, F., Bos, D., Klein, B., … Trebicka, J. (2013). The effect of hemodialysis on liver stiffness measurement: a single-center series. European Journal of Gastroenterology & Hepatology, 25(3), 368–372. doi: 10.1097/MEG.0b013e32835ad180

Transpedicular Percutaneus Vertebroplasty in spine hemangioma - Case report  Ignat Andreea-Melania , Elena Meloria Avram Vîlcan Andreea, Pintea Ioana Alexandra Validated View

Transpedicular Percutaneus Vertebroplasty in spine hemangioma - Case report

Case Report - Poster

Author(s): Ignat Andreea-Melania, Elena Meloria Avram

Coauthor(s): Vîlcan Andreea, Pintea Ioana Alexandra

Coordinator(s): Professor Tiberiu Bățagă , MD Dénes Márton

Introduction:

Vertebral hemangioma is a benign tumor of mesenchymal origin, resulting from an abnormal proliferation of endothelial tissue, commonly located in the toracic or lumbar vertebral body. This kind of hemangioma is frequently generalized, meaning that more than one vertebral body is affected. The majority of vertebral hemangioma are asymptomatic, thus the long period of time until the diagnosis is established, from this reason the treatment is not compulsory.


Case Presentation:

We present a case of a 50 years old female patient, known with osteoporosis and heart conditions (HBP), complaining about lumbar pain with irradiance in the inferior abdomen.Specialized investigations were performed, rulling out the gynecological and urological etiology of the current symptoms.Neurosurgical examination and MRI revealed vertebral injury described as hemangioma.The MRI highlights a vertebral hemangioma L4, solitary and macronodular with 2,85 x 3,2 x 1,7 cm diameter and another one, smaller, at L2.Surgical treatment is applied, performing left Transpedicular Percutaneus Vertebroplasty with PMMA cement. The postoperative evolution was immediately favorable.



Conclusion:

Due to vertebral hemangioma’s  slow progression rate, the symptoms occur when the tumor starts to affect the bone structures.When the bone distruction reaches a specific level, the resistance of the affected vertebral body decreases, resulting microfractures and then subsidence, which determines pain. By injection of PMMA cement, we obtain a static stabilization and also thermocoagulation of the neoformed vessels. The endocrinological treatment of osteoporosis is mandatory, especially in eccentric vertebral hemangiomas, which lead to scoliosis because of unilateral subsidence of vertebral body.



Particularities: The particularity of this case consists in the variety of investigation that were made until the diagnosis was established

A case of megaloblastic anemia with digestive manifestations  Nicoara Andreea Iulia , Bărăgan Paul-Gabriel Amza Teona Ingrid, Dițescu Bogdan Radu Invalidated View

A case of megaloblastic anemia with digestive manifestations

Case Report - Poster

Author(s): Nicoara Andreea Iulia, Bărăgan Paul-Gabriel

Coauthor(s): Amza Teona Ingrid, Dițescu Bogdan Radu

Coordinator(s): Professor Amelia-Maria Gaman

Introduction: Megaloblastic anemia appears due to lack of B12 vitamin and/or folate. It is characterized by abnormal hematopoiesis with a nucleo-cytoplasmic maturation asynchrony, induced by the lack of DNA synthesis in normal conditions of RNA and proteins synthesis.

Case Presentation:

The study is based on a pacient at the age of 75 years old, with a chronic diarrhea syndrome (3-4 times a day, for four months), recently discharged from the Department of Infectious Diseases (where it has been denied the infectious etiology of the diarrhea syndrome). She was brought in the Hematology Department of Emergency County Hospital Craiova with fatigue, left anterior epistaxis, nausea, vomiting, loss of appetite, diarrhea, weight loss, dizziness, difficulties in walking. The physical exam revealed: II grade malnutrition, pale skin and mucous membranes, scleral jaundice, diffuse abdominal pain, diminished osteotendinous reflexes. The myelogram revealed rich marrow smears in nucleated cell elements and also gigantocytes. Taking into consideration the digestive manifestations, it has been performed a superior digestive endoscopy that revealed the gastric mucosal atrophy.

Conclusion: The megaloblastic anemia due to B12 vitamin deficiency represents a complex disorder, with polymorphic manifestations. These specific manifestations arise the necessity of requiring multiple medical specialties to comprise a diagnosis, which can delay the initiation of specific therapy.

Particularities:
Differential diagnosis has been made between megaloblastic anemia due to lack of folate, myelodysplastic syndromes, hemolytic anemia and other digestive conditions that could evolve with the B12 vitamin malabsorbtion. The treatment consisted in the  parenteral administration of B12 vitamin. After 5 days from the beginning of the therapy, it has been observed the reticulocyte crisis. After a month, the complete blood count has been normalized and after two weeks the diarrhea syndrome has been resolved. The neurological syndrome has also been normalized after 3 months of treatment.

THE IN VITRO EVALUATION OF GONADOTROPIC AND SEX HORMONES INFLUENCE ON PROLIFERATION AND CELL CYCLE STATUS OF HUMAN GLIOMA CELL LINES.  Karwowska Joanna , Popławska Izabela Kretowska Anna Validated View

THE IN VITRO EVALUATION OF GONADOTROPIC AND SEX HORMONES INFLUENCE ON PROLIFERATION AND CELL CYCLE STATUS OF HUMAN GLIOMA CELL LINES.

Medical Science

Author(s): Karwowska Joanna, Popławska Izabela

Coauthor(s): Kretowska Anna

Coordinator(s): Professor Marcin Moniuszko , Assistant Professor Kamil Grubczak

Keywords: brain tumors glioma hormones

Introduction: Primary brain tumors account for 5-10% of the neoplasms, and those with the highest mortality rate are represented by tumors derived from central nervous system stem cells – gliomas. Cancer transformation is a multi-stage process initiated by the accumulation of mutations in cellular DNA, promoted by intensive divisions and ineffective remedial mechanisms. Tropic hormones, including the pituitary gonadotropins, are particularly characterized by strong modulatory properties and might contribute to uncontrolled growth and proliferation, both target tissues and other cells bearing proper receptors. Based on theoretical assumptions research tasks were aimed at the evaluation of hormonal influence on proliferation and the cell cycle status of human glioma cells.
Material and Method: Glioma cell lines (U-87; A-172) were cultured for 48h in presence of prolactin (PRL), follicle-stimulating hormone (FSH) or luteinizing hormone (LH). Cells were stained with the use of CFSE to assess proliferation. Alterations within cell cycle were determined using propidium iodide (PI) and the use of 7AAD allowed for evaluation of tumor cells viability.
Results: LH significantly inhibits glioma cell lines proliferation. PI staining showed A172 cells arrest in S-phase of cell cycle indicating reduction of cancer cells expansion. In reference to U87, LH has also cell-killing effect. Despite no changes in proliferation status of cancer cells in response to FSH, cell cycle analysis indicates its progression within A172 glioma cells.
Conclusion: Increased cell cycle progression under the FSH stimulation may explain a rise in the incidence in patients over 65 years of age, when elevated levels of this hormone are observed due to impaired gonadal hormone function. Presumably, regulation of FSH- and LH-associated pathways might be a potential target for therapeutic strategies.
Bibliography: Abdelbaset-Ismail A, Borkowska S, Janowska-Wieczorek A, et al. Novel evidence that pituitary gonadotropins directly stimulate human leukemic cells-studies of myeloid cell lines and primary patient AML and CML cells.Oncotarget. 2016;7(3):3033-3046. doi:10.18632/oncotarget.6698. Benson, V. S., Pirie, K., Green, J., Casabonne, D., & Beral, V. (2008). Lifestyle factors and primary glioma and meningioma tumours in the Million Women Study cohort. British journal of cancer, 99(1), 185-190. Deorah S., Lynch C.F., Sibenaller Z.A., & Ryken T. C. (2006). Trends in brain cancer incidence and survival in the United States: Surveillance, Epidemiology, and End Results Program, 1973 to 2001. Neurosurgical focus,20(4), E1. Dubrow R, Darefsky AS. Demographic variation in incidence of adult glioma by subtype, United States, 1992-2007. BMC Cancer. 2011;11:325. doi:10.1186/1471-2407-11-325. Galli, R., Binda, E., Orfanelli, U., Cipelletti, B., Gritti, A., De Vitis, S., ... & Vescovi, A. (2004). Isolation and characterization of tumorigenic, stem-like neural precursors from human glioblastoma. Cancer research, 64(19), 7011-7021. Krex, D., Klink, B., Hartmann, C., von Deimling, A., Pietsch, T., Simon, M., ... & Weller, M. (2007). Long-term survival with glioblastoma multiforme. Brain, 130(10), 2596-2606. Ismail, Ahmed, et al. "Novel Evidence That Pituitary Gonadotropins Directly Stimulate Human Leukemic cells—studies on Myeloid Cell Lines and Primary Patient AML and CML Cells." Blood 124.21 (2014): 2204-2204. Ohgaki, H., & Kleihues, P. (2005). Epidemiology and etiology of gliomas. Acta neuropathologica, 109(1), 93-108. Ohgaki, H., & Kleihues, P. (2005). Population-based studies on incidence, survival rates, and genetic alterations in astrocytic and oligodendroglial gliomas. Journal of Neuropathology & Experimental Neurology, 64(6), 479-489. Silvera, S. A. N., Miller, A. B., & Rohan, T. E. (2006). Hormonal and reproductive factors and risk of glioma: a prospective cohort study. International journal of cancer, 118(5), 1321-1324. Spaan M, van den Belt-Dusebout AW, Burger CW, van Leeuwen FE. Risk of Colorectal Cancer After Ovarian Stimulation for In Vitro Fertilization. Clin Gastroenterol Hepatol. 2016 May;14(5):729-37.e5. doi: 10.1016/j.cgh.2015.12.018

HEPATORENAL SYNDROME APPROACH – A LITERATURE REVIEW OF THE LATEST DISCOVERIES IN DIAGNOSIS AND EFFECTIVE TREATMENT  Achitei Razvan , Țîbîrnă-Ciolan Mălina Diaconu Anca Validated View

HEPATORENAL SYNDROME APPROACH – A LITERATURE REVIEW OF THE LATEST DISCOVERIES IN DIAGNOSIS AND EFFECTIVE TREATMENT

Medical Science

Author(s): Achitei Razvan, Țîbîrnă-Ciolan Mălina

Coauthor(s): Diaconu Anca

Coordinator(s): Lecturer Elena Albu

Keywords: Hepatorenal syndrome Acute kidney injury cirrhosis

Introduction: Hepatorenal syndrome (HRS) is a severe form of acute kidney injury (AKI) that typically occurs in patients with decompensated liver cirrhosis, but is also a frequent complication of fulminat hepatic failure and acute alcoholic hepatitis. HRS remains a diagnosis of exclusion and is associated with dismal prognosis. The purpose of this review is to present the recent advances in this field, including the recent change of the definition of HRS according to AKI criteria, the current diagnostic approach and the updated therapeutic protocols adopted in clinical practice.

Material and Method: Using PubMed database, we investigated articles related with HRS, terlipressin, cirrhosis and AKI. The inspection strategy was to exclude articles before the year of 2014 and on this wise, 6 papers were symbolic to the direction of this topic.

Results: The most important predictor for patient survival after liver transplant is the pre-transplant kidney function according to Fabrizi et al. The use of urinary levels of neutrophil gelatinase-associated lipocalin may serve to distinguish functional kidney damage from other causes of kidney injury. Furthermore, the serum cystatin C level is a good marker for predicting and survival in patient with cirrhotic ascites. Randomized studies demonstrated a much higher rate of improvement in renal function when terlipressin and albumin were used compared to other treatments. Recent data show that terlipressin is better tolerated, presenting fewer side efect when it is used in continuous infusion. The Fractionated plasma separation and absorption compared to standard medical therapy in liver failure report significant survival benefit. 

Conclusion: The medical management, surgery and instrumental therapies of HRS may play a role in the control of the syndrome and obtaining temporary remission, but the curative treatment at this moment can be achieved only by liver transplantation.

Bibliography: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4314304/ https://www.ncbi.nlm.nih.gov/pubmed/26558188 https://www.ncbi.nlm.nih.gov/pubmed/28293378 https://www.ncbi.nlm.nih.gov/pubmed/25649410 https://www.ncbi.nlm.nih.gov/pubmed/24678726

The embryological and anatomical background in Ureteropelvic Junction Obstruction  Vancea Oana Maria , Petcu Cristiana Elena - Validated View

The embryological and anatomical background in Ureteropelvic Junction Obstruction

Surgical Science

Author(s): Vancea Oana Maria, Petcu Cristiana Elena

Coordinator(s): Professor Sebastian Nicolae Ionescu

Keywords: UPJ obstruction pediatric hydronephrosis renal scintigraphy

Introduction: An ureteropelvic junction (UPJ) obstruction is defined as a total or partial obstacle of the outflow of urine from the kidney to the ureter. The etiology of UPJ obstruction consists of congenital or acquired conditions. UPJ obstruction represents the most common cause of pediatric hydronephrosis and can usually be detected by ultrasonography after the 15th to 16thweek of gestation. The question that the doctor has to answer in dealing with suspected UPJ obstruction is whether the radiologic findings correlate with the severity of the stenosis. Although drainage that has been slow for a long period of time can sometimes spontaneously improve, it is essential to define the exact anatomy of the urinary system and the underlying kidney function when evaluating and treating these patients.  

Material and Method: In this retrospective study of 139 cases of UPJ obstruction operated at the “Marie Sklodowska Curie” Emergency Hospital, the relevance of ultrasonography to the functional and anatomic evaluation of UPJ obstruction was examined. First, the urinary tract development was closely monitored using fetal ultrasonography. After birth, the degree of stenosis was fully assessed, including once again an ultrasound exam. 

Results: The urinary tract dilation was classified using the anteroposterior diameter of the renal pelvis and its surface area into mild, moderate and severe.

Conclusion: For this condition, appropriate treatment depends on a multitude of factors, including but not limited to clinical evolution, the degree of dilation, the presence or absence of urinary tract infection and renal scintigraphy.

Bibliography: Nguyen HT, Herndon CD, Cooper C, Gatti J, Kirsch A, Kokorowski P, et al. The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis. J Pediatr Urol.2010;6:212–31. [PubMed] Fernbach SK, Maizels M, Conway JJ. Ultrasound grading of hydronephrosis: Introduction to the system used by the Society for Fetal Urology. Pediatr Radiol. 1993;23:478–80. [PubMed] Ahmad G, Green P. Outcome of fetal pyelectasis diagnosed antenatally. J Obstet Gynaecol 2005;25:119e22. McDaniel BB, Jones RA, Scherz H, Kirsch AJ, Little SB, Grattan-Smith JD. Dynamic contrast-enhanced MR urography in the evaluation of pediatric hydronephrosis: part 2, anatomic and functional assessment of uteropelvic junction obstruction.AJR Am J Roentgenol 2005;185:1608. Yavascan O, Aksu N, Anil M, Kara OD, Aydin Y, Kangin M, et al.Postnatal assessment of growth, nutrition, and urinary tract infections of infants with antenatally detected hydronephrosis. Int Urol Nephrol 2009;1. Pediatric urology. John P. Gearhart, Richard C. Rink, Pierre D.E.Mouriqand -2ed The predictive value of the first postnatal ultrasound in children with antenatal hydronephrosis. Received 24 July 2010; accepted 7 September 2010 Carlo C. Passerotti a, Leslie A. Kalish b, Jeannie Chow c, Ana Maria AMS Passerotti a, Pedro Recabal a, Marc Cendron a, Richard S. Lee a, Arielle Bressler Lopez a, Alan B. Retik a, Hiep T. Nguyen a,* “Langman's medical embryology “12th ed. Sadler, T W (Thomas W); Prediction of the outcome of antenatally diagnosed hydronephrosis: A multivariable analysis Michelle Longpre a, Angela Nguana, Andrew E. MacNeily a, Kourosh Afshar a,b,*a Department of Urologic Sciences, University of British Columbia, Vancouver, Canada b School of Population and Public Health, University of British Columbia, Vancouver, Canada. Mallik M, Watson AR. Antenatally detected urinary tract abnormalities: more detection but less action. Ped Nephrol. 2008;23(6):897–904. [PubMed]

MIXED CONNECTIVE TISSUE DISEASE WITH PERIODIC FEVER SYNDROME  Nistor Mirela , Muresan Oana - Invalidated View

MIXED CONNECTIVE TISSUE DISEASE WITH PERIODIC FEVER SYNDROME

Case Report - Poster

Author(s): Nistor Mirela, Muresan Oana

Coordinator(s): Lecturer MIHAI DUMITRU POROJAN , MD TEODORA POLGAR

Introduction: Mixed connective tissue disease (MCTD) is an autoimmune disorder and is referred to as an overlap disease due to its combination of signs and symptoms of different disorders: systemic lupus erythematosus (SLE), scleroderma and myositis. The pathogenesis of MCTD is yet to be discovered, but the main cause is thought to be the presence of an antibody against U1-ribonucleoprotein (RNP). It is a rare disease that usually occurs in women under 40 years of age and its main features are: Raynaud phenomenon, swollen hands, acrosclerosis, arthritis/arthralgia, myositis, esophageal dysmotility and lung fibrosis with pulmonary hypertension. 

Case Presentation: A 59-year-old male smoker, presented with intermittent fever with vesperal exacerbations. He also complained of productive cough, chest pain, asthenia and arthralgia in the small joints of the hands. On physical examination the patient presented swollen hands with acrosclerosis and scleroderma, salt-and-pepper pigmentation of the hands, nail clubbing and Raynaud phenomenon. The laboratory tests revealed high levels of LDH, CK, rheumatoid factor, inflammatory syndrome, inflammatory anemia, and a positive result for antinuclear, anti-RNP and anti-cyclic citrullinated peptide antibodies. The tests for SLE, anti-PM/Scl and myositis-specific antibodies were negative. The hand X-ray revealed incipient osteoarthritis of the distal interphalangeal joints and nail clubbing. Soft-tissue ultrasound showed accumulation of excess synovial fluid in the metacarpophalangeal joints. A skin and muscle biopsy was performed and the results showed muscle fiber necrosis with perivascular neutrophilic infiltrate. After the spirometry test the patient was diagnosed with chronic obstructive pulmonary disease.

Conclusion: The patient was prescribed Prednisone. While on treatment the patient still presented four episodes of fever, therefore Imuran was added to his treatment plan.

Particularities: The interesting facts about this case are: the rare disease which occurred atypically in a 59-year-old male, with periodic fever syndrome and muscle fiber necrosis, in the absence of myositis-specific antibodies.

RETROGRADE APPROACH IN REVASCULARISATION OF CHRONIC TOTAL OCCLUSIONS OF RIGHT CORONARY ARTERY  Diana-Irena Stanciulescu - Validated View

RETROGRADE APPROACH IN REVASCULARISATION OF CHRONIC TOTAL OCCLUSIONS OF RIGHT CORONARY ARTERY

Case Report - Poster

Author(s): Diana-Irena Stanciulescu

Coordinator(s): MD Lucian Câlmâc

Introduction: Chronic total occlusion (CTO) is defined as atherosclerotic coronary disease that produces the complete obstruction of flow in an epicardial vessel for a period of 3 months or greater. Over the past two decades, there has been an increasing interest in retrograde techniques for successful revascularization of CTO, which is associated with improvement in symptoms, quality of life and prognosis. The complexity of these procedures presents a major challenge. 

Case Presentation: We present a case of a 65 y.o. male with cardiovascular risk factors, admitted for an anterior ST-elevation myocardial infarction. The emergency coronary angiography revealed that the culprit lesion was in the left anterior descending (LAD) artery therefore it has been treated, but also revealed an occlusion in the right coronary artery (RCA) that was not responsible for the acute event, with developed septal collaterals, and was therefore considered a CTO. The decision was to attempt revascularisation of the CTO 1 month later. Echocardiography showed 5 hypo functional segments in the inferior territory. Given that it was not possible to enter the true lumen after two antegrade approaches with different guidewires, a successful retrograde deobstruction was performed via a septal branch from the LAD, followed by antegrade angioplasty with 4 drug-eluted stents in the third, medial and proximal segments of RCA and posterior interventricular artery.

Conclusion: Successful revascularisation of chronic total occlusions of right coronary artery using retrograde approach, followed by antegrade angioplasty with implantation of 4 drug-eluted stents, reaching a final TIMI flow grade of 3.

Particularities: Retrograde approach is a procecedure that is technically complex and demanding on time and resources, however it was an option for our patient with complex CTO segments that were anatomically appropriate. There is evidence that if the territory is viable, revascularisation of the artery is beneficial and increases life expectancy. 

A rare case of subclinical esophageal squamous cell carcinoma on a patient with megaesophagus – a misleading combination  Neagu Teodora , Seulean Edina Cristina Panaitescu Paul Invalidated View

A rare case of subclinical esophageal squamous cell carcinoma on a patient with megaesophagus – a misleading combination

Case Report - Poster

Author(s): Neagu Teodora, Seulean Edina Cristina

Coauthor(s): Panaitescu Paul

Coordinator(s): MD Calin Popa , Associate Professor Nadim Al Hajjar

Introduction:

Achalasia is a rare, chronic, esophageal motility disorder with an estimated annual prevalence of 1 per 100,000 subjects in Western populations. The classic symptomatic presentation involves dysphagia to both solids and liquids. Although achalasia is a relatively rare condition, it carries high risks of complications, including megaesophagus, aspiration pneumonia and esophageal cancer.

Esophageal squamous cell carcinoma (ESCC) is known for its rapid progression and poor outcomes. Typically, when it comes to symptoms, over 90% of ESCC patients present with dysphagia, odynophagia and significant weight loss.
The reported incidence of concomitant carcinoma and achalasia ranges from 0.53% to 8.6% of patients with achalasia.


Case Presentation:
A 57 years old woman, with long-standing achalasia, that resulted in megaesophagus was committed for moderate anemia and retrosternal discomfort. She complained of mild dysphagia, which was previously attributed to the chronic motility disorder. Her comorbidities included chronic obstructive pulmonary disease (COPD), stage GOLD III. After clinical examination, imaging and endoscopic investigations, a tumoral mass was discovered in the lower thoracic esophagus. Subtotal esophagectomy – Orringer technique was performed, with good postop evolution. The patient suffered no pulmonary exacerbations, despite the risks associated with the treatment and her comorbidities. The three month evaluation revealed no complications and good pulmonary status assessment.


Conclusion:
Esophageal squamous cell carcinoma is underdiagnosed in patients with megaesophagus, due to the lack of clinical manifestations and confusion of similar symptomatology.

Particularities:
We report here a case of ESCC on a patient with end-stage achalasia and severe pulmonary obstructive dysfunction, without suggestive clinical manifestations. After transhiatal esophagectomy, without a thoracic incision, the patient reported no pulmonary exacerbations despite the risks of the procedure and associated comorbidities.

DETERMINATION OF CYTOTOXIC T-LYMPHOCYTE-ASSOCIATED PROTEIN-4 EXPRESSION IN HUMAN GLIOBLASTOMA.  Szypulska Paulina , Popławska Izabela Karwowska Joanna Validated View

DETERMINATION OF CYTOTOXIC T-LYMPHOCYTE-ASSOCIATED PROTEIN-4 EXPRESSION IN HUMAN GLIOBLASTOMA.

Medical Science

Author(s): Szypulska Paulina, Popławska Izabela

Coauthor(s): Karwowska Joanna

Coordinator(s): Associate Professor Joanna Reszeć

Keywords: Glioblastoma Brain tumor CTLA-4 Immune checkpoints

Introduction: The immune response is downregulated by protein receptors, functioning as an immune checkpoint. In recent years inhibitory checkpoint molecules have been increasingly perceived as targets for new therapeutic strategies. Gliomas are the most frequent primary brain tumors, and for highly malignant gliomas (World Health Organization grade III and IV) there is not available effective therapeutic procedure - patients survive an average of about a year even with multidirectional therapies. Although gliomas are immunogenic tumors, they are not efficiently eliminated by the immune system. That is why, in context of this study we have focused on Cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) as the crucial regulator of T cell activation and immune tolerance. This molecule has been investigated mainly in terms of the occurrence on immune cells, yet it presence was also demonstrated on the cell surface of various solid tumors. Our research was aimed at the evaluation of CTLA-4 expression within glial tumor mass, due to its presumably significant role in initiating and maintaining the neoplastic process. 

Material and Method: We have performed immnuhistochemical tests aimed at the evaluation of CTLA-4 expression within samples from 163 patients with glioblastoma, who underwent surgical biopsy. The intensity of immunostaining was evaluated in random 15 fields under 20x magnification and scored semi-quantitatively: none – 0, positive – 1, strongly positive – 2.

Results: Immunostaining revealed cytoplasmic diffuse localization in nearly 60% of analyzed cases (97 from 163 cases), where within over 20% examined slides the expression was strong.

Conclusion: The novel finding that CTLA-4 molecule is expressed on human glioblastoma cells may contribute to the further refinement of targeted therapies, for improved outcomes in patients with high-grade gliomas.

Bibliography: 1. Rolle CE, Sengupta S, Lesniak MS. Mechanisms of immune evasion by gliomas. Advances in experimental medicine and biology. 2012;746:53-76. 2. Schildberg FA, Klein SR, Freeman GJ, Sharpe AH. Coinhibitory Pathways in the B7-CD28 Ligand-Receptor Family. Immunity. 2016;44(5):955-72. 3. Pardoll DM. The blockade of immune checkpoints in cancer immunotherapy. Nature reviews Cancer. 2012;12(4):252-64. 4. Contardi E, Palmisano GL, Tazzari PL, Martelli AM, Fala F, Fabbi M, et al. CTLA-4 is constitutively expressed on tumor cells and can trigger apoptosis upon ligand interaction. International journal of cancer Journal international du cancer. 2005;117(4):538-50. 5. Hussain SF, Yang D, Suki D, Aldape K, Grimm E, Heimberger AB. The role of human glioma-infiltrating microglia/macrophages in mediating antitumor immune responses. Neuro-oncology. 2006;8(3):261-79. 6. Markovic DS, Vinnakota K, Chirasani S, Synowitz M, Raguet H, Stock K, et al. Gliomas induce and exploit microglial MT1-MMP expression for tumor expansion. Proceedings of the National Academy of Sciences of the United States of America. 2009;106(30):12530-5.

NON-INVASIVE ASSESSMENT OF LIVER STIFFNESS IN HEALTHY SUBJECTS USING SUPERSONIC SHEAR WAVE ELASTOGRAPHY  Muntean Delia Doris , Platon Lupsor Monica - Validated View

NON-INVASIVE ASSESSMENT OF LIVER STIFFNESS IN HEALTHY SUBJECTS USING SUPERSONIC SHEAR WAVE ELASTOGRAPHY

Medical Science

Author(s): Muntean Delia Doris, Platon Lupsor Monica

Coordinator(s): Associate Professor Monica Platon Lupsor

Keywords: liver stiffness Supersonic Shear Wave Elastography healthy subjects

Introduction: Real time shear wave elastography (RTSWE) is a novel, non-invasive method to assess liver fibrosis (LF) by measuring liver stiffness (LS). The aim of the current study was to define the mean value of LS measured by Supersonic shear wave elastography (SSWE) in healthy subjects and to assess its potential dependence on sex, age and body mass index (BMI).

Material and Method: The study group included a total of 48 healthy subjects, (64% female, mean age: 46±14.47 years) without clinical or biological evidence of hepatic disease, whose liver biopsies (performed in 18 subjects) excluded the presence of LF, being classified according to the Metavir score as F0. They were prospectively referred to LS quantification à jeun, using the Aixplorer US System (Supersonic-Imagine-S.A., Aix-en-Provence, France) with a convex broadband probe (SC6-1), in the right intercostal space, 4 cm in depth. The median value of five valid measurements was considered (quantified in kPa).

Results: The normal liver elasticity varied between 3.5-6.3 kPa. The mean value of LS was 4,76±0.61 kPa and did not differ significantly between the sex groups (4,73±0.62 kPa for women, n=31, respectively 4,82±0.61 kPa for men, n=17, p=0.647). Our study also confirmed no correlation between LS and age (r=0.133, p=0.373) or BMI (r=0.006, p=0.968).

Conclusion: The mean normal value of the LS assessed with Supersonic SWE in histologically proven normal livers is 4,76±0.61 kPa. The potential confounding factors that we considered (sex, age, BMI) had negligible effects on the liver stiffness values.

Bibliography: 1. Ferraioli G, Filice C, Castera L, et al. WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 3: liver. Ultrasound Med Biol 2015; 41: 1161-1179. 2. Suh CH, Kim SY, Kim KW, et al. Determination of normal hepatic elasticity by using real-time shear-wave elastography. Radiology 2014; 271: 895-900. 3. Huang Z, Zheng J, et la. Normal liver stiffness in healthy adults assessed by real-time shear wave elastography and factors that influence this method. Ultrasound Med Biol 2014; 40(11):2549-55.

Duchenne Muscular Dystrophy- what is the role of genetic testing? A case presentation and discussion on the diagnosis and therapeutic guidelines.  Belcin Ioana - Invalidated View

Duchenne Muscular Dystrophy- what is the role of genetic testing? A case presentation and discussion on the diagnosis and therapeutic guidelines.

Case Report - Poster

Author(s): Belcin Ioana

Coordinator(s): Assistant Professor Oana Blaga

Introduction: Duchenne muscular dystrophy is a rare X-linked recessive disorder caused by mutations in the dystrophin gene. Given its pattern of inheritance, DMD affects mainly males. The cardinal clinical symptom  is the muscular weakness  that is generally diagnosed in preschoolers and begins in the limbs. By their teens, the affected patients will be wheelchair bound.  Eventually, the cardiac and respiratory muscles will be affected, leading to various degrees of heart and respiratory failure. The initial diagnosis steps in the approach of the disease are the neurological exam followed by the biochemical evaluation of the muscle enzymes. Muscular biopsy tends to become less important in the diagnosis, as other non-invasive, more accurate tests become available. Genetic testing is recommended in all patients. Only symptomatic treatment is currently recommended for DMD patients, but the prospects of gene therapy in selected etiological forms of the disease, raise the interest of the medical community and emphasize the growingly important role of the genetic testing.

Case Presentation:

We present the case of a 10year old patient affected by Duchenne muscular dystrophy. The muscle weakness was observed around the age of 2 and the clinical suspicion was confirmed by elevated muscular enzymes levels. The EMG revealed a myogenic pattern. Muscular biopsy was not performed. Genetic testing, performed at the age of 11, confirmed the diagnosis.


Conclusion:

The use of diagnosis and therapeutic guidelines in the management of the patients with DMD improves the medical act with favorable impact on the quality of the patients lives. Clinical and biochemical evaluation, although mandatory for the diagnosis, do not replace the role of genetic testing. Genetic analysis is nowadays of utmost importance in the genetic counseling of the patients families and will play more and more important therapeutic parts in the gene therapy era.


Particularities: Even if the patient was clinically and biochemically diagnosed at the age of 2, genetic testing was performed at the age of 11.

THE EVOLUTION OF A DIAGNOSIS FROM A CHRONIC VILLONODULAR SYNOVITIS TO AN EPITHELIOID SARCOMA  Pintea Ioana Alexandra , Pirlea Radu Cristian Ignat Andreea-Melania Validated View

THE EVOLUTION OF A DIAGNOSIS FROM A CHRONIC VILLONODULAR SYNOVITIS TO AN EPITHELIOID SARCOMA

Case Report - Poster

Author(s): Pintea Ioana Alexandra, Pirlea Radu Cristian

Coauthor(s): Ignat Andreea-Melania

Coordinator(s): MD Carmen Friciu , MD Eugenia Moldovan




Paraneoplasic dermatomyositis in a patient with prostatic adenocarcinoma  Petcu Cristiana Elena Draganescu Cristiana Validated View

Paraneoplasic dermatomyositis in a patient with prostatic adenocarcinoma

Case Report - Poster

Author(s): Petcu Cristiana Elena

Coauthor(s): Draganescu Cristiana

Coordinator(s): Assistant Professor Alice Brinza

Introduction: Dermatomyositis is an idiopathic inflammatory myopathy with cutaneous findings. It is a systemic disorder that frequently affects the skin, muscle and, sometimes, the esophagus, the lungs or the heart. A particular form of dermatomyositis is paraneoplasic dermatomyositis. 

Case Presentation: We are presenting the case of a 64 years old male, who presented to hospital because of rash, myalgia and general systemic disturbances and was admitted to Colentina Hospital, department of dermatology. The clinical exam reveals reduced abduction movements in the scapulo-humeral joint, pain in the coxo-femoral joint, eruption along the eyelid margins, with periorbital edema and violaceous papules spread all over his nose and forehead, V-neck configuration poikiloderma, Gottron’s sign, Gottron’s papules, changes in the nailfolds of the fingers, with “splinter” hemorrhages. From the personal pathological history we mention endoscopic resection of prostate, for adenocarcinoma and high blood pressure. The lab tests showed higher levels of muscular enzymes: CK=8964 IU/L, GOT=610 IU/L, LDH=1228 IU/L and markers of inflammation: ESR=27 mm/1h, fibrinogen=515 mg/dl. The presumptive diagnosis was paraneoplasic dermatomyositis.

A muscular biopsy was made, which revealed perifascicular necrosis, with perivascular inflammatory infiltrate in the perimysium. The specific anti-bodies (anti-Jo1, anti-Mi, ANA) were negative and PSA was normal. The abdominal CT revealed an extensive tumor with malignancy characters, abdomino-pelvine lymphadenopathy and an osteosclerotic lesion on L4. It was also referred to the oncologist for reevaluation and a proper cure. The treatment consisted in corticoids, immunomodulators and antihypertensive drugs. After 10 days of medication, the muscular enzymes had approached their normal levels and the symptoms had diminished.

Conclusion:
Specific anti-bodies are frequently negative in paraneoplasic dermatomyosits. The patient should always be monitored at least 1 year after diagnosis.


Particularities: Most frequently associated tumors with this disease are ovarian and gastric tumors. Prostatic adenocarcinoma is rarely associated with dermatomyositis.

Rectosigmoidian cancer in a 37 years old male  Petcu Cristiana Elena , Vancea Oana Maria - Validated View

Rectosigmoidian cancer in a 37 years old male

Case Report - Poster

Author(s): Petcu Cristiana Elena, Vancea Oana Maria

Coordinator(s): MD Dan Cacovean

Introduction: Colorectal cancer is the most common type of gastrointestinal cancer. The etiology encompassing genetic factors, environmental exposures and inflammatory conditions. The radical treatment is represented by surgery. One of the most used procedures is Hartmann’s, which involves resection of the rectosigmoid colon with creation of a colostomy.

Case Presentation: A 37 years old male, was first admitted in August 2016 in the Gastroenterology Department of Fundeni Clinical Institute, for inferior digestive hemorrhage, diffuse abdominal pain and intermittent diarrhea for about a month. Patient’s personal history is insignificant and from his family medical history we retain his mother’s breast cancer. A colonoscopy was performed and revealed a rectal tumor, located at about 20 cm from rectal orifice. A biopsy was made. The patient was transferred to the Surgery Department of the same hospital, where was performed a colostomy, followed by 15 radiotherapy sessions.

The patient was readmitted in early February for tumor excision. Clinical exam showed pale teguments and mucosa. Blood test revealed elevated hepatic enzymes and lower albumin levels, mild anemia (Hb=9.4 mg/dl) and coagulation deficiency. A CT-scan was made to characterize the tumor and to explore the rest of the abdominal cavity. The exam showed a parietal thickening of the rectal and recto-sigmoidian junction wall and suggestive aspect of tumoral infiltration of mesorectal fascia and perirectal fat. The scan also showed a bigger liver, with multiple nodular lesions, with suggestive aspect of metastasis. During the surgery was found a polyp, with benign macroscopic aspect. It was performed a Hartmann's procedure and an atypical hepatectomy of segments VI, VII and VIII, ultrasound controlled.

Conclusion: The histopathological exam revealed hepatic metastasis and two different cancers: an invasive tumor and a polypoid adenocarcinoma. The prognostic is reserved.

Particularities: The case presented two rectal cancers in a very young patient, without family history of colorectal carcinomas.

MANAGEMENT OF A POSTTRAUMATIC VENTRICULAR SEPTAL DEFECT FOLLOWING A PENETRATING THORACOABDOMINAL STAB INJURY – CASE REPORT  Diaconu Anca , Achitei Razvan Țîbîrnă-Ciolan Mălina Validated View

MANAGEMENT OF A POSTTRAUMATIC VENTRICULAR SEPTAL DEFECT FOLLOWING A PENETRATING THORACOABDOMINAL STAB INJURY – CASE REPORT

Case Report - Poster

Author(s): Diaconu Anca, Achitei Razvan

Coauthor(s): Țîbîrnă-Ciolan Mălina

Coordinator(s): Assistant Professor Iris Băraru

Introduction:

The majority of the ventricular septal defects (VSDs) are of congenital origin, but they also may present as a complication of chest trauma. 


Case Presentation:

26 years old male was admitted for cardiovascular evaluation 2 weeks after the surgical treatment of a penetrating stab injury of the chest and abdomen, which revealed a diaphragmatic centrotendinous wound, biventricular transfixiant trauma, haemopericard and left massive haemothorax. During the intervention the patient experienced a cardio-respiratory arrest that was responsive to the resuscitation manoeuvres.

Upon arrival, the clinical exam revealed left parasternal systolic murmur with irradiation on the entire precordial area. The echocardiography exposed a posttraumatic VSD localized in the apical region of the interventricular septum, with left-right shunt, which was confirmed by the thoracic CT exam. The coronarography and ventriculography showed normal coronary arteries and moderate VSD near the apex.

Due to the presence of a febrile syndrome, that responded to empirical antibiotherapy with Vancomicine 2g/day, associated with inflammatory syndrome and negative haemocultures, the VSD correction was postponed, thus allowing an efficient postsurgery healing. Interventional approach by percutaneous implantation of an Amplatzer device was recommended for VSD correction.


Conclusion:

Considering that posttraumatic VSD are rarely found and sometimes have the tendency of enclosing by themselves, closure can often be delayed for a stable haemodynamic patient, taking into consideration the patient symptomatology and the gravity of the shunt.


Particularities:

As opposed to congenital VSD, the therapeutic algorithm of a posttraumatic VSD lacks an efficient standardization, due to few information from literature that describes the natural evolution of posttraumatic VSD. Vigilant post-interventional re-assessment and re-evaluation is vital in patients with cardiac trauma to ensure adequate closure and the absence of residual VSD.

An uncommon type of presentation of Multiple myeloma  Fitărău Maria-Antonia , Govor Larisa Maria Seleș Carmen Validated View

An uncommon type of presentation of Multiple myeloma

Case Report - Poster

Author(s): Fitărău Maria-Antonia, Govor Larisa Maria

Coauthor(s): Seleș Carmen

Coordinator(s): Assistant Professor Oana Șerban , Professor Daniela Fodor

Introduction: Multiple myeloma remains an incurable hematological malignancy, characterized by abnormal proliferation of a single clone of plasma cells in the bone marrow, resulting in large amounts of serum monoclonal immunoglobulins (M proteins). This represents the first step on the pathway to its various clinical manifestations: anemia, hypercalcemia, renal insufficiency, osteolytic lesions. Thrombocytopenia is present in 5% of patients with multiple myeloma.
Case Presentation: A 76-year-old male patient, with a history of arterial hypertension, ischemic heart disease, atrial fibrillation (anticoagulated initially with acenocumarol, substituted afterwards with dabigatran due to multiple hemorrhagic events), mitral valve prolapse with severe regurgitation, multiple episodes of pneumonia, chronic atrophic gastritis, presented with hemoptysis, fever, and asthenia. Laboratory tests revealed mild anemia, thrombocytopenia, hyposideremia, hypoproteinemia, normal erythrocyte sedimentation rate, normal serum creatinine, BUN and calcemia. Computed tomography revealed areas of pulmonary microhemorrhage in both pulmonary fields, interpreted as a major adverse event of anticoagulant treatment in conjunction with thrombocytopenia. Considering anemia and thrombocytopenia, a suspicion of myelodisplastic syndrome was raised, and a bone marrow examination was performed. It revealed 8-10% atypical plasmocytes infiltrates suggestive for multiple myeloma. This diagnosis was also sustained by decrease of serum G imunglobulin and urine and serum protein electrophoresis with immunofixation detecting overproduction of light kappa chains. No bone lesions were identified by the skeletal survey. The final diagnosis was Multiple Myeloma with light kappa chains and treatment with melphalan and methylprednisolone was initiated. The evolution was favorable with remission of asthenia and anemia, but persistence of mild thrombocytopenia.

Conclusion: Multiple myeloma is worth to be considered in patients with bicytopenia even if its typical features are lacking.

Particularities: As special features of this case, we could highlight the paucity of symptoms, negative skeletal survey, normal calcemia and normal kidney function.

Contributions to the study of the anatomy of the inner ear.  Mesina Andrei Stoicea Flavia-Mihaela, Nicolae Nitu Validated View

Contributions to the study of the anatomy of the inner ear.

Fundamental Science

Author(s): Mesina Andrei

Coauthor(s): Stoicea Flavia-Mihaela, Nicolae Nitu

Coordinator(s): Lecturer Mihaela Iustina mesina-botoran , Professor Ion M

Keywords: inner ear internal acoustic meatus nerve Membranous labyrinth endolymph

Introduction: Membranous labyrinth of arterial blood vessels originated from within the cranial cavity, being secured by labyrinthine artery, which most often is a branch of the anterior cerebral artery intero-bottom. After each labyrinthine artery divides into its branches, clinical signs vary depending on the portion obstructed artery. So modiolar spiral artery obstruction will cause hearing loss at low frequencies and vestibulocohlear artery obstruction will cause hearing loss at high frequencies and vertigo due to cochlear ischemia which stops the secretion of potassium by ATP-dependent ion pumps inducing a decrease in potential endolymph.

Material and Method: We conducted on the corpses of fetuses (4), newborns (2) and adults (2) in the discipline of Anatomy, Department of Morphological Sciences, University of Medicine and Pharmacy of Craiova. To highlight the vascular system of the inner ear have used the technique of dissection using an operating microscope images were captured using a video camera attached to the microscope operator and processed using specialized software Photoshop.

Results: After analyzing retail items available neurovascular we discovered the existence of several anatomical variants of vascularity of the inner ear, showing a labyrinthine artery anatomical variability in terms of its origin, but its path. Thus, after a laborious analysis of the provision labyrinthine artery internal acoustic meatus inside I noticed the presence uni rich plexus (2) around the facial nerve (1) and vestibulocohlear (3) in the internal acoustic meatus deep.

Conclusion: The study neurovascular elements around the internal acoustic meatus we can conclude: all cases had dissected arterial meatal loop; meatal loop pressure can be formed anterior-inferior cerebellar artery or the artery labyrinthine; in terms of relations meat loop pressure, I encountered the following types of location: intrameatal pressure loop; extrameatal pressure loop located among the items internal acoustic meatus nerve; extrameatal pressure loop located away from any internal acoustic meatus nerve;

Bibliography: 1. Anson BJ, Donaldson JA,(1981) Surgical Anatomy of the Temporal Bone, W. B. Saunders Company, Philadelphia; 3:219- 313. 2. Ataman T.,(1998) Patologia cervicofacială a nervilor cranieni, Editura Lider, Bucureşti; 5:128- 133. 3. Ataman T.(2007), Traumatismele urechii, Editura Tehnic; 10:382- 391. 4. (1983). Borg E, Nilson R, Engstrom B :Effect of the acoustic reflex on inner ear damage induced by industrial noise, Acta Otolaryngol (Stockh);95:361. 5. Calarașu R., Ataman T., Zainea V., Bogdan C.,Pascu A., și alţii(2000) Manual de patologie otorinolaringologică și cirurgie cervicofacială, Ed. Universitară, “Carol Davila”, Bu-curești . 6.(1979). Cincă D. Otoneurologie clinică, Ed. Didactică și Pedagogică, București, 7. (1972)Chouard C. H., Characon R, Morgon A., Cathala H. P., Anatomie, phatologie et chirurgie du nerf facial, Masson et Cte Editeurs, Paris, 4:75- 92. 8. (1939) Girard L. - Atlas d’anatomie et de medicine operatoire du labirinthe osseux, Paris, 3:55- 73. 9. Ionescu N., Curs de Otorinolaringologie, Ed. Medicală AMALTEA, București, 1997. 10. Jones Sherri M., Jones Timothy A. Genetics, Embriology, and Development of Auditory and Vestibular Systems Plural Publishing Inc:2001 11. Moore Persaud, The Developing Human : Clinically Oriented Embryology (8 th Edition. ) , Septembrie 2007.

A rare case of intraductal pancreatic mucinous neoplasm evolved in adenocarcinoma associated with pancreatic tail neuroendocrine tumor  Sarb Oliviu Florentiu , Zah Corina Adelina Baiu Octavian, Ceian Ciprian Validated View

A rare case of intraductal pancreatic mucinous neoplasm evolved in adenocarcinoma associated with pancreatic tail neuroendocrine tumor

Case Report - Poster

Author(s): Sarb Oliviu Florentiu, Zah Corina Adelina

Coauthor(s): Baiu Octavian, Ceian Ciprian

Coordinator(s): MD Calin Popa , Associate Professor Nadim Al Hajjar

Introduction: Intraductal Pancreatic Mucinous Neoplasm (IPMN) is a rare mucin producing cystic tumor of the pancreas, which is classified by the location as main-duct(MD), branch-duct(BD) or a mixed-type(MT). The average age of patients is 68 years. Pancreatic neuroendocrine tumors (PanNET) are neoplasms made of cells with features of normal pancreas endocrine cells. They are 1-2% of all pancreatic tumors and the association of IPMN and PanNET is completely uncommon.

Case Presentation:

A 54 years old male was admitted in our surgical department with mild abdominal pain. During clinical examination an abdominal mass was palpated in the epigastric region. Abdominal ultrasound showed a tumor within the head of the pancreas. MRI revealed a polycystic formation, measuring 8.8/6.5/10.2 cm in the cephalic pancreatic area and retrograde Wirsung dilatation. Endoscopic ultrasound established that the lesion was an IPMN cT3NxMx. 
After 8 days of preoperative preparation a pancreaticoduodenectomy was proposed. During surgery  an extemporaneous examination showed positive resection margin on pancreatic stump and total pancreatectomy was performed. Postoperative evolution was remarkable, with the patient’s glycemic levels varying from 90 to 228 mg/dl in the hospitalization period and pacient was discharged after 11 days. The three-month evaluation revealed no complications and a good glycemic control.
Final histopathology report showed MT-IPMN with severe dysplasia, pT1N0MxL0V0R0, evolved with invasive adenocarcinoma and also PanNET, pT1N0MxL0V0R0, stage IA in the pancreatic tail.

Conclusion: The patient suffered simultaneously of IPMN with severe dysplasia and invasive adenocarcinoma and PanNET, which were curatively resected and post surgery diabetes mellitus was well controlled.

Particularities: An uncommon association of MT-IPMN and PanNET, with minimal clinical symptoms. The MT-IPMN had a very large dimension,  and it featured as stage I. 

Potter Sequence or Multicystic Dysplastic Kidney? - Case Report  Călin Felicia- Alexandra Robu Mihaela Invalidated View

Potter Sequence or Multicystic Dysplastic Kidney? - Case Report

Case Report - Poster

Author(s): Călin Felicia- Alexandra

Coauthor(s): Robu Mihaela

Coordinator(s): MD Gabriela Ion

Introduction:

Multicystic dysplastic kidney (MCDK) is a congenital anomaly characterized by the presence of multiple, noncommunicating cysts of varying size separated by abnormal parenchyma.  The incidence of unilateral MCDK  is reported to be 1 in 4300 live births. MCDK can be correlated with the presence of  the oligohydramnios which is responsible for  Potter sequence (pulmonary hypoplasia, clubbed feet, cranial anomalies). The main causes of the oligohydramnios and, implicit of the Potter sequence, are the bilateral renal agenesis and the polycystic kidney disease. 


Case Presentation:

Four months old girl diagnosed with bilateral polycystic kidney (predominantly right kidney) by ultrasound in the 20th week of intrauterine life, had come to the hospital for clinical and biological evaluation. She was evaluated using ultrasound at 2 weeks and a month after birth. The echography showed multiple cysts in the renal parenchyma of the right kidney (the maximum diameter of 23 mm) and 2-3 cystic structures in the other one (sizes of 5-7 mm). At four months, the ultrasound had identified the right kidney with multiple cysts which replaced the parenchyma (the largest cyst: 2 cm; the diameter of the kidney is 5.5 cm), the left kidney with fetal lobulation, and no cystic images in the liver, spleen. After this echography, the diagnosis is MCDK. It was performed a cystography, urography and laboratory tests to evaluate the function of the contralateral kidney which was normal. 


Conclusion:

 It must be taken into consideration the psychological and economic impact upon  the family of the child because the patient should be permanently monitored due to complications which can appear: hypertension, renal insufficiency. And the renal function should periodically be evaluated. 


Particularities:

The particularity of the case was the challenge to differentiate a Potter sequence with polycystic renal disease from unilateral MCDK.

Pre-Implatation Genetic Diagnosis (PGD) in a woman affected by familial Polycystic Kidney Disease (PKD)  Gholami-Noudeh Shamin - Validated View

Pre-Implatation Genetic Diagnosis (PGD) in a woman affected by familial Polycystic Kidney Disease (PKD)

Case Report - Poster

Author(s): Gholami-Noudeh Shamin

Coordinator(s): MD Gholami-Noudeh Gholamhossein

Introduction:

Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a common nephropathy caused by a genetic fault in gene PKD1 or PKD2 that disrupts the normal development of the nephrons architecture  with transformation into clusters of noncancerous cysts.

•PKD1- accounts for 85% of the cases;

•PKD2- accounts for 15% of the cases.

•Both types have the same symptoms but they tend to be more severe in PKD1.

•The disease causes a variety of severe complications such as hypertension, hematuria, kidney stones, upper UTIs  and eventually kidney failure.

•A child has a 50% chance of developing PKD if one of the parents has a faulty gene.


Case Presentation:

A 27 years old nulligravida affected by familiar PKD1, who wishes to become pregnant, has a family history showing that her grandmother, aunt and mother were affected and that the latter died at age of 45 after 3 years of dialysis.

In order to achieve a healthy pregnancy the patient underwent IVF with egg recovery and fertilization. 10 embryos were obtained, and 6 of these reached the blastocyst stage. Trophectoderm biopsies were performed by laser on all of them. They were then vitrified and sent to the lab for further screening via karyomapping, next generation sequencing (NGS), aneuploidy screening (PGS) and diagnosis (PGD).


Conclusion:

PGD and PGS resulted in 2 normal embryos and 4 affected by PKD1.

Recently 1 of those 2 healthy embryos was thawed and transferred into the uterus (TEV) and it resulted in a singleton pregnancy. The other healthy embryo is preserved vitrified for the future. 


Particularities:

The goal of PGD is to reduce the likelihood of an affected pregnancy, however it can not negate the chances of this occurring. PGD is based on the results from testing a small number of cells from an embryo and is therefore subject to experimental error.

 A Prenatal Safe Test was performed during the 10th week of pregnancy showing the conception of a healthy male.

Pure laparoscopic fistulojejunostomy for the management of external pancreatic fistula. Case report  Petrica Ana-Maria , Cicortas Beatrice-Ana Cîmpean George-Claudiu Validated View

Pure laparoscopic fistulojejunostomy for the management of external pancreatic fistula. Case report

Case Report - Poster

Author(s): Petrica Ana-Maria, Cicortas Beatrice-Ana

Coauthor(s): Cîmpean George-Claudiu

Coordinator(s): MD Călin Popa , Associate Professor Florin Zaharie

Introduction: One of the complications after surgical treatment in the cases of severe acute pancreatitis is external pancreatic fistula (EPF). While open Roux-en-Y fistulojejunostomy is the usual surgical treatment for EPF, the laparoscopic approach is rare. However, as management of EPF we propose a pure laparoscopic fistulojejunostomy. 

Case Presentation:

We present a case of an obese 54 year-old female patient with severe acute biliary pancreatitis, Balthazar E, severity score 10/10. After one month of conservative and endoscopic management, the patient underwent a laparoscopic intervention for a complicated pseudocyst including cholecystectomy, sequestrectomy and multiple drainage. However, an EPF developed with a daily drainage fluid of 250-300 ml. A mature scar tract formed around the percutaneous drain and after a period of 6 months a laparoscopic Roux en Y fistulojejunostomy was performed. The patient’s condition improved and was discharged 14 days later. Post-operative evaluation showed no complications after one year.


Conclusion:

Pure laparoscopic fistulojejunostomy can be used as a surgical treatment for EPF.


Particularities: We put forward a case of EPF, which was managed completely laparoscopic, performing a Roux-en-Y fistulojejunostomy.

Aggressive Infective Endocarditis: A Major Challenge  Ciortea Stefana Tirpe George Razvan Validated View

Aggressive Infective Endocarditis: A Major Challenge

Case Report - Poster

Author(s): Ciortea Stefana

Coauthor(s): Tirpe George Razvan

Coordinator(s): Assistant Professor Mihaela Lupse , Assistant Professor George Dindelegan

Introduction:

Although Staphylococcus aureus is the causative agent in only 25% cases of infective endocarditis, it determines the most aggressive course of the disease with a mortality rate of 40-50%. Around 35-60% of Staphylococcus aureus bacteremias are complicated by infective endocarditis and more than half of the cases are not associated with underlying valvular disease.  


Case Presentation:

A 50-year-old patient presented to our department with the following symptoms: fatigue, arthralgia, ocular and low back pain, which had abruptly started 4 days before. Physical examination revealed temporo-spatial disorientation, fever (37,9°C), left eye subconjunctival hemorrhage, petechiae on the extremities and face, splinter hemorrhages, Janeway lesions, systolic murmur in the mitral region.

Paraclinical investigations evidenced a bacterial inflammatory syndrome, high procalcitonin levels, thrombocytopenia, hypopotassemia, elevated rheumatoid factor, hepatic cytolysis syndrome. Hemocultures from 3 blood samples were positive for Staphylococcus aureus. Transesophageal echocardiogram revealed a 4 cm² fistulised myocardial abscess, severe mitral valve insufficiency and a 60% ejection fraction.  CT scan showed multiple infarcted areas and an abscess in the spleen.

In evolution, the patient presented left eye visual impairment, episodes of dromomania and left upper quadrant abdominal pain. Under antibiotic therapy fever persisted (37-38°C) and neurological symptoms remitted. Splenectomy was performed and cardiac surgery was scheduled.


Conclusion:

The patient met 2 major and 4 minor Duke’s criteria for positive diagnosis of infective endocarditis. This demonstrates the high virulence of the staphiloccocal infection which led to important systemic manifestations.


Particularities:

This case report proved that such an acute manifestation of the disease can also be experienced by young patients with apparently no underlying valvular disease. Being previously diagnosed with gout, it was interestingly observed that the patient presented two episodes of arthritis with no hyperuricemia. In addition, after the splenectomy a new episode of fever with negative  hemocultures rises a question about its etiology. 

Placenta previa  Mangaloiu David , Raris Alexandra Lungu Adina, Rosu Mariana, Apostol Dimitri Invalidated View

Placenta previa

Case Report - Poster

Author(s): Mangaloiu David, Raris Alexandra

Coauthor(s): Lungu Adina, Rosu Mariana, Apostol Dimitri

Coordinator(s): Lecturer Antoaneta Punga

Introduction:

Placenta previa is an obstetric complication in wich the placenta implants in the lower uterine segment. It is a leading cause of antepartum hemorrhage and a life threatening condition. It affects approximately 0.5-0.7% of all labours. 


Case Presentation:

Three cases of placenta previa.

First case was a 32 year old patient, G2P1, with one previous CS. The placenta was implanted in the anterior segment of the uterus totally covering the cervical internal os, as well as involving the urinary bladder (placenta previa percreta), which was diagnosed at 19 weeks of gestation. A CS with a modified incision on the uterus was performed at 34 weeks of gestation, the placenta was not removed and conservative treatment was administred which faild and a total abdominal histerectomy was performed. The second case was a 41 year old patient, G2P1 with similar management and autcome as the first patient. The third case was a 19 year old G4P3 patient a with 3 previous CS’s. Management was the same and the patient still is on  conservative treatment and under observation for any complications. 

Conclusion: Placenta previa is a very serious complication and the future fertility of the patient must be taken in to account whithout andangering the patient’s life. The rate of placenta a has a risen due to a rise in the percentage in caesarean sections (CS) as the embryo in plants over the scar of the previous CS.

Particularities:

These cases present different outcomes using the same approach, whilst trying to recrease morbidity and mortality. Conservative management intrapartum is a option, in order to avoid the risk of massive hemorrhage at delivery however hysterectomy after delivery should always be considered, to avoid the any further complications. 

CURRENT STATUS OF ANGIOTENSIN RECEPTOR BLOCKERS AS THERAPEUTIC OPTIONS FOR ALZHEIMER’S DISEASE  GAMAN IUSTINA - Validated View

CURRENT STATUS OF ANGIOTENSIN RECEPTOR BLOCKERS AS THERAPEUTIC OPTIONS FOR ALZHEIMER’S DISEASE

Medical Science

Author(s): GAMAN IUSTINA

Coordinator(s): Lecturer CRISTINA GHICIUC

Keywords: cognition Azheimer's disease antihypertensive drugs angiotensin receptor blockers

Introduction:  Recent studies have shown that some antihypertensive medications are associated with a significant reduction in the incidence of Alzheimer’s disease.Because growing evidence suggests that angiotensin II receptors blockers (ARBs) effectively inhibit oxidative stress, amyloid beta protein (Aβ) metabolism and tau phosphorylation in animal brain, ARBs are considered to be a potential candidate for the treatment of Alzheimer’s disease. However, it remains uncertain whether antihypertensive drugs, specially ARBs may have a preventive effect on cognitive decline in patients with Alzheimer’s disease.

Material and Method:  This review summarises existing evidence regarding the plausibility of using angiontensin receptor blockers as a strategy to treat Alzheimer’s disease and highlights unresolved aspects to such approaches, namely the potential impact of altering angiotensin II-mediated processes in the central nervous system.We searched in PubMed, the latest clinical trials who evaluated the benefits of ARBs on cognitive decline and compared the results.

Results:  ARBs reduce major risck factors for Alzheimer’s disease, controlling hypertension, limiting stroke damage and ameliorating diabetes.Studies reported that ARBs have superior neuroprotective benefits, delaying disease progression and preserving executive function and cognition better than other antihypertensive drugs.

Conclusion:  In conclusion, the results of studies showes that ARBs may delay decline progression in patients with Alzheimer’s disease and a lower incidence, this antihypertensive class may offer a new therapeutic strategy of Alzheimer’s disease.

Bibliography: 1.Li W, Zhang JW, Lu F, Ma MM, Wang JQ, Suo AQ, Bai YY, Liu HQ Effects of Telmisartan on the level of Aβ1-42, Interleukin-1β, Tumor Necrosis Factor α and cognition in hypertensive patients with Alzheimer’s disease, 2012 Oct 23;92(39):2743-2746 2.Kazumasa K, Haruo H, Hirofumi S, Yusuke T, Takeshi O, Toshiniko I, Effects of Telmisartan on cognition and regional cerebral blood flow in hypertensive patients with Alzheimer’s disease, 2012 Geriatrie Gerontology Int 12:207-2014 3.Marie-Odile Guimond and Nicole Gallo-Payet How does angiotensin AT2 receptor activation help neuronal differentiation and improve neuronal pathological situations? 2012 Dec 3 article 164 4.Sonia Villapol and Juan M. Saavedra Neuroprotective effects of angiotensin receptor blockers, 2015 American Journal of Hypertension 28(3) 5.Kanarek A, Wagner A, Kuppers J et al. Crosstalk between abgiotensin and the nonamyloi-dogenic pathway of Alzheimer’s amyloid precursor protein,2017 The FEBS Journal Febs 14015 6.Hitomi Kurinami, Munehisa Shimamura,Naoyuki Sato, Hironori Nakagami, Ryuichi Morishita Do angiotensin receptor blockers protect against Alzheimer’s disease?2013 Springer International Publishing Switzerland March

PERIPROSTHETIC FRACTURE WITH CORTICAL DIAPHYSIAL PERFORATION BY THE FEMURAL STEM IN PATIENTS WITH TOTAL HIP REPLACEMENT – CASE REPORT  Oros Adrian , Milotoiu Ioan Moldovan Diana Maria Margareta, Mihai Alex, Mustea Elena Validated View

PERIPROSTHETIC FRACTURE WITH CORTICAL DIAPHYSIAL PERFORATION BY THE FEMURAL STEM IN PATIENTS WITH TOTAL HIP REPLACEMENT – CASE REPORT

Case Report - Poster

Author(s): Oros Adrian, Milotoiu Ioan

Coauthor(s): Moldovan Diana Maria Margareta, Mihai Alex, Mustea Elena

Coordinator(s): MD Daniel Oltean-Dan

Introduction: Periprosthetic femoral fractures (PFF) following total hip arthroplasty (THA) are devastating complications that are associated with functional limitations and increased overall mortality. The main risk factors for sustaining a periprosthetic fracture is osteolysis associated with implant loosening, osteoporosis and other conditions with pathologic bone. THA is a surgical procedure to correct  a hip joint damaged by degenerative disease (osteoarthritis) or fracture of the femoral neck. 

Case Presentation: A 80 years old female patient presented herself  at the Cluj-Napoca Orthopaedic Hospital, in January 2017 complaining of moderate pain started in July 2014 and gradually worsened, around the left hip and upper tigh area, and reduced function of the left foot. The patient mentions a THA was performed in 2008, followed by a local infection. After local debridement  and negative infection tests, a revision prosthesis has been performed in 2009. After initial clinical and x-ray evaluation, she was diagnosed with a PFF of the femoral diaphysis with displacement of the femural stem, and a new revision of the prosthesis was performed on 13.02.2017. During the procedure, the distal femur accidentally fractured and a cable fixation has been done.

Conclusion: Post-operative evolution was favorable, patient was discharged after 18 days. All post-operative x-ray immaging done show a good evolution with a satisfactory reduction and fixation of the femur. 

Particularities: This case represents a rare case of a THA which was complicated by an infection and revised, followed by a PFF.  The patient developed a cronic pain and three years later, the fracture and displacement of the femoral stem was diagnosed and treated successfully.  

Particular Profile of Anthracycline Toxicity Interfering with ATRA Bioavailability in an Acute Promyelocytic Leukemia Patient: Case Report  Achitei Razvan , Diaconu Anca Țîbîrnă-Ciolan Mălina Validated View

Particular Profile of Anthracycline Toxicity Interfering with ATRA Bioavailability in an Acute Promyelocytic Leukemia Patient: Case Report

Case Report - Poster

Author(s): Achitei Razvan, Diaconu Anca

Coauthor(s): Țîbîrnă-Ciolan Mălina

Coordinator(s): MD Ion Antohe

Introduction:

Acute promyelocytic leukemia (APL) is a distinct type of acute myeloid leukemia (AML) characterized by its invariable association with chromosomal translocations involving the Retinoid Acid Receptor α (RARA) gene on chromosome 17 and, more frequently, the Promyelocytic Leukemia (PML) gene on chromosome 15, leading to a chimeric PML-RARA fusion product, responsible for differentiation arrest at the promyelocyte stage. APL is unique among AML subtypes due to its quasi constant association with severe disseminated intravascular coagulation (DIC) and responsiveness to All-trans retinoic acid (ATRA), responsible for a cure rate over 90% in combination with anthracycline therapy. 


Case Presentation:

A 36 year-old female patient was admitted with hemorrhagic syndrome, pancytopenia and acute overt DIC. Bone marrow examination indicated infiltration with hypergranular promyelocytes with APL immunophenotype. Molecular tests exposed the presence of the PML-RARA fusion transcript. Thus, APL diagnosis was established and anthracycline and ATRA-based induction therapy was started, alongside DIC-directed supportive therapy. We here describe the particular toxicity profile of idarubicine, that induced severe prolonged myelosuppression (28 days) and gastrointestinal mucositis, thus altering bioavailability of oral ATRA and inducing DIC recurrence and life-threatening upper gastrointestinal bleeding.

Complete remission and negative minimal residual disease were documented by day 28 following induction. The patient remains disease-free at 24 months following diagnosis. 

Conclusion:

In the absence of the intravenous ATRA formulation, vigorous supportive therapy and future abstinence from Idarubicine therapy are needed in order to ensure patient survival. 


Particularities:

We here report the case of an APL patient in whom an uncommon profile of Idarubicine toxicity altered ATRA bioavailability and its ability to control APL-associated DIC.

Coming back from the dead. The miracle of modern oncology  Ciubotariu Alexandra-Evelina , Trenchea Alexandru Păun Maria-Loredana, Chiriac Alexandra, Nica Răzvan Invalidated View

Coming back from the dead. The miracle of modern oncology

Case Report - Poster

Author(s): Ciubotariu Alexandra-Evelina, Trenchea Alexandru

Coauthor(s): Păun Maria-Loredana, Chiriac Alexandra, Nica Răzvan

Coordinator(s): MD Teodora Alexa

Introduction:

Breast cancer is the most common cancer in women and the leading cause of cancer-related death for women aged 20 to 59 years. It is responsible for 14% of the cancer-related deaths in women.


Case Presentation:

A 47 years-old comatose patient was admitted in June 2015 to the Intensive Care Unit of the Regional Institute of Oncology Iasi. Clinical examination revealed a left breast mass; core biopsy indicated an invasive micropapillary carcinoma. Immunohistochemistry showed estrogen receptors 80-90%, progesterone receptors 50-60%, Ki67=60-70%, Her positive.  Computed tomography (CT) scan showed multiple brain metastases, which had a compressive effect on surrounding tissues.  After receiving intensive supportive care, she regained consciousness and was transferred to the Oncology Department. The multidisciplinary breast committee decided she should start treatment with Docetaxel-Herceptin. Radiotherapy was not recommended due to risk of edema and bleeding. After the first dose, her status significantly improved and her neurological symptoms disappeared. She received both drugs until she developed peripheral neuropathy (October 2015), after which she continued with Herceptin monotherapy.

The patient had a partial response to chemotherapy, as assessed by her CT scan (October 2015). At this time point, radiotherapy was considered safe and the patient received 30 Gray/10 fractions.  Following scans indicated stable disease until September 2016, when imaging studies showed progressive disease. Subsequently, Capecitabine was added to Herceptin, which induced a partial response as assessed by her CT scan in February 2017.


Conclusion:

The evolution of the patient post-chemotherapy was very good. Despite literature data indicating a poor prognosis for stage IV patients with brain metastases, her survival already exceeds 24 months.


Particularities:

We report the case of a patient diagnosed with stage IV breast cancer with a very favorable post-chemotherapy evolution (some of the brain metastasis had completely regressed, some had diminished and only one had progressed). 

The resilience of cancer can only be fought by the endurance of the patient  Trenchea Alexandru , Ciubotariu Alexandra-Evelina Nica Răzvan, Chiriac Alexandra, Păun Maria-Loredana Invalidated View

The resilience of cancer can only be fought by the endurance of the patient

Case Report - Poster

Author(s): Trenchea Alexandru, Ciubotariu Alexandra-Evelina

Coauthor(s): Nica Răzvan, Chiriac Alexandra, Păun Maria-Loredana

Coordinator(s): MD Teodora Alexa

Introduction:

Colorectal carcinoma is the most common malignancy of the gastrointestinal tract. Colorectal cancer is the third most common cancer in the world, with nearly 1.4 million new cases diagnosed in 2012.


Case Presentation:

 In 2011, she was  diagnosed with sigmoid colon tumor,  for which she underwent surgical resection with termino-terminal anastomosis. Anatomopathological examination showed poorly differentiated adenocarcinoma, which had fully invaded the intestine wall, with vascular and perineural invasion (pT4aN1b).  Afterwards, chemotherapy with FOLFOX4 every 2 weeks was initiated. She received 6 cycles of chemotherapy which she tolerated well.

During one of her follow-up evaluations, in 2013, she was diagnosed with metachronous  left colon cancer for which surgical resection was performed. Anatomopathological examination showed moderately differentiated adenocarcinoma, with 6 out of 12 lymph nodes invaded (pT4aN2a).Six cycles of FOLFIRI protocol were administered with good tolerance from May to September 2013.

In January  2016, at a periodic control, a left pararenal posterior lesion was found. The patient decided against further assessments at the time. In November 2016 imagistic testing identifies the growth of the pararenal lesion and a new hepatic lesion.

A multidisciplinary committee that assessed the patient recommended an exploratory laparotomy for removing the two lesions. The patient underwent surgery and anatomopathological exam of the tissue from the pararenal lesion  indicated  a metastatic lesion from the colon adenocarcinoma.

 


Conclusion: The patient was successfully treated for multiple types of cancer that appeared consecutively. She is currently receiving chemotherapy (FOLFOX) with good tolerance and a good response as assessed by the RECIST criteria. 

Particularities:

The incidence of 3 different types of cancer on the same patient in a relatively short time period and the successful treatment for all of them.

Na/H Exchange Inhibitor: Novel Therapeutic Approach for Perinatal Asphyxia Related Injury  Klimko ARTSIOM , Parau Diana Cornea Teodor Validated View

Na/H Exchange Inhibitor: Novel Therapeutic Approach for Perinatal Asphyxia Related Injury

Medical Science

Author(s): Klimko ARTSIOM, Parau Diana

Coauthor(s): Cornea Teodor

Coordinator(s): Professor Ana-Maria Zagrean

Keywords: Perinatal asphyxia Alkalosis MIA

Introduction: Intrapartum-related events are the third leading cause of childhood mortality worldwide. Perinatal hypoxic-ischemic encephalopathy and the following cerebral damage appears to be responsible for up to 25% of all causes of developmental disabilities in children: cerebral palsy, mental retardation, learning disturbances, and neurosensorial deficits. There are multiple etiologies, but all result from diminished supply of oxygen and blood to the CNS of the neonate, leading to brain extracellular and intracellular alkalosis resulting from an enhanced Na/H exchange dependent net extrusion of acid equivalents. These results suggest targeting BBB-mediated pH regulation as a novel therapeutic approach. 

Material and Method: Several groups of male postnatal day 6-7 rat pups were used. One of the groups was exposed for 60 minutes to 20% CO2 and 9% O2 (asphyxia). Sodium fluorescein was used to gain further information on BBB permeability. To manipulate acid transport across the BBB, a Na/H exchange blocker—MIA was used. 

Results: Seizure burden was quantified based on the number of animals with loss of righting reflex (LRR) and was compared to the control group using a two tailed Mann-Whitney U-test. Blocking the Na/H exchanger using MIA decreased the post-asphyxia alkalosis overshoot and reducing seizure burden by 88% (p=0.0002, n>8). 

Conclusion: The best current therapy for perinatal asphyxia is moderate hypothermia, which presents with limited efficacy--decreasing burden by only 11%. Thus, there is a great need for alternate therapy with greater efficacy. Na/H exchange blockers have shown to diminish seizure burden caused by asphyxia, and could be a viable and much needed future therapeutic option. 

Bibliography: Helmy MM, Ruusuvuori E, Watkins P V., Voipio J, Kanold PO, Kaila K. Acid extrusion via blood-brain barrier causes brain alkalosis and seizures after neonatal asphyxia. Brain. 2012;135:3311–9. McGuire W. Perinatal asphyxia. BMJ Clin Evid. 2007 Nov 7;2007:320. Sanches EF, Arteni NS, Spindler C, Moysés F, Siqueira IR, Perry ML, Netto CA. Effects of pre- and postnatal protein malnutrition in hypoxic-ischemic rats. Brain Res 2012;1438:85-92.

THE TRAPS OF STEMI  Cristea Alina-Elena Aștefanei Silvia Matilda Validated View

THE TRAPS OF STEMI

Medical Science

Author(s): Cristea Alina-Elena

Coauthor(s): Aștefanei Silvia Matilda

Coordinator(s): Assistant Professor Mihaela Dobranici

Keywords: Takotsubo STEMI angiography LVEF

Introduction: Frequently dubbed "stress cardiomyopathy", Takotsubo syndrome is an acute and reversible heart failure related syndrome that features different characteristic of acute coronary syndrome (ACS).
Material and Method: A 49-year-old female, with no significant medical history, presented at Targu Jiu Regional Hospital for intense constrictive retrosternal pain. The symptoms appeared 10 hours prior to admission, after experiencing a strong emotional distress regarding a member of the family. The first electrocardiogram (EKG) revealed: sinusal rhythm, pulse rate 60 bpm, normal QRS axe, ST-segment elevation in leads DII, DIII, avF, V2, V6, prolonged QT (520ms), negative T in leads V2, V6. Shortly after presentation, the patient suffered cardiopulmonary arrest due to torsades des pointes and was consequently resuscitated.
Results: The patient was transferred to Fundeni Clinical Institute in Bucharest, where coronary angiography, left ventriculography and two echocardiographies were performed. The first blood tests revealed: WBC 18530/mm, Hb 13,4 g/dl, AST 98u/l, ALT 114u/l, CK 1074u/l, CKmb 95u/l, glycaemia 122mg/dl, Mg 2,64mg/dl, K 2,5mm/l, Na 144mm/l.

Blood tests taken the following day showed increased CK and CKmb (2332u/l and CKmb 101u/l). First echocardiography: apex ballooning, including 2/3 apical of the LV, interventricular septum=12, moderate mitral regurgitation, LVEF=40%. Second echocardiography: 2/3 apical LV akinesis, altered diastolic fonction. All biological parameters were normalized in the second blood tests. Coronarography: normal, without lesions. Ventriculography: apical and mid-ventricular hypokinesia. Treatment: Sortis 20mg/day, Prestarium 5mg/day, Spirinolactone 50mg/day, Betaloc Zok 100Mg/day, Aspacardine 3cp/day, according to studies.

Conclusion: Although first appeared as a STEMI (ST-segment elevation myocardial infarction), the connection between major (mitral regurgitation) and minor (prolonged QT, ST-segment elevation, LVEF, emotional stress) risk factors together with the imagistic investigations led to the confirmation of Takotsubo syndrome in this patient.
Bibliography: http://emedicine.medscape.com www.escardio.org BRAUNWALD'S HEART DISEASE 10TH EDITION

TWO NEW CASES OF SUPERFICIAL ATRAUMATIC SIDEROSIS OF THE CNS AND REVIEW OF THE LITERATURE  Perdikaris Georgios , Kassidakis Efthymios PERDIKARIS IOANNIS Validated View

TWO NEW CASES OF SUPERFICIAL ATRAUMATIC SIDEROSIS OF THE CNS AND REVIEW OF THE LITERATURE

Case Report - Poster

Author(s): Perdikaris Georgios, Kassidakis Efthymios

Coauthor(s): PERDIKARIS IOANNIS

Coordinator(s): Professor BAZ RADU , MD COSMIN NISCOVEANU




A RARE CASE OF TCC OF THE PROSTATE – CAN IT APPEAR AS PRIMARY NEOPLASM ?  Perdikaris Georgios , Kassidakis Efthymios PERDIKARIS IOANNIS Invalidated View

A RARE CASE OF TCC OF THE PROSTATE – CAN IT APPEAR AS PRIMARY NEOPLASM ?

Case Report - Poster

Author(s): Perdikaris Georgios, Kassidakis Efthymios

Coauthor(s): PERDIKARIS IOANNIS

Coordinator(s): MD MADALINA BOSOTEANU , MD CATALIN BOSOTEANU

Introduction: Prostate cancer is a leading cause of death in men all over the world. Often co-exists with other primary cancers in synchronous or metachronous pattern. Primary Transitional Cell Carcinoma (TCC) of the prostate accounts for 1-4% of prostate cancer incidences and is usually associated with TCC of the bladder or the urethra. TCC can arise from extensions of trigonal or bladder neck tumours, proximal prostate ducts/urethra or from cell implantation from manipulation of vesical neoplasms or by the field effect.

Case Presentation: A 63 years old patient was admitted to the Urology Department with total hematuria, for specialized monitoring, investigations and treatment. Trans-Urethral Resection (TUR) of the prostate was performed and the diagnosis was prostatic tumour that proved to be a high grade TCC of the prostate, after histopathological examination completed with immunohistochemical tests.

The patient was admitted again 4 months later with macroscopic hematuria and indications for neoplasm of the Urinary Bladder of uncertain or unknown behavior. TUR of the bladder was performed where was found a 3cm tumour involving the triangle and ureteral orifices. The diagnosis was high grade G3 infiltrative TCC of the bladder.

Conclusion:
TCC of the prostate seems to be primary though it is not sure whether there is a synchronous or metachronous pattern relating it with the TCC of the bladder.
The approach of prostatic TCC must be integrated in clinical and imagistic context.

Particularities: It is extremely rare to find primary TCC of the prostate.

A CHALLENGING CASE OF MULTI-ENDOCRINE TUMOURS DISORDER IN A YOUNG PATIENT  Pascalau Sorana-Maria Nechita Irina, Pocol Roxana-Daiana, Peter Alina-Ada Validated View

A CHALLENGING CASE OF MULTI-ENDOCRINE TUMOURS DISORDER IN A YOUNG PATIENT

Case Report - Poster

Author(s): Pascalau Sorana-Maria

Coauthor(s): Nechita Irina, Pocol Roxana-Daiana, Peter Alina-Ada

Coordinator(s): Assistant Professor Oana Pinzariu , Professor Carmen-Emanuela Georgescu

Introduction: Multiple Endocrine Neoplasia (MEN) syndromes are a group of autosomal dominant disorders, which involve tumours of endocrine and non-endocrine organs. Although, MEN 1 and 2 are the “classical” forms, recently another member has joined the family, MEN 4, which encompasses several features from the first two. 

Case Presentation: We report the case of a 31-year-old female patient, who presented to the Endocrinology Department with severe headaches, glycoreglation disturbance, irregular menses and considerable weight gain. Physical examination revealed numerous neurofibromas located on the axillary, lower abdomen and inguinal regions, without “cafe au lait” spots, as well as red stretch marks, hirsutism, acanthosis nigricans and grade III obesity. The patient was known with microprolactinoma and primary hyperparathyroidism. On admission to our clinic, CT scan displayed multiple pancreatic lesions, which added to the already established diagnoses raised the suspicion of MEN 1. Endoscopic ultrasound confirmed the numerous tumorous masses with a highly suggestive aspect of neuroendocrine tumours (NET). The laboratory tests revealed the non-secretory character of the pancreatic tumors and also excluded the presence of a carcinoid syndrome. Furthermore, the patient was referred to the Surgery Department. Diagnosis of Neurofibromatosis type 1 was rejected, for skin lesions being the only sign of the disease.

Conclusion: After the surgery, the patient had a favorable evolution and histopathological diagnosis pleaded for neuroendocrine tumor G1. To strengthen the hypothesis of a MEN syndrome, genetic analysis was planned.

Particularities: Our patient presents the characteristic aspects of MEN 1 syndrome and some skin lesions, neurofibromas, specific for MEN2B syndrome. This uncommon combination made us also take into consideration the challenging diagnosis of MEN 4 syndrome, with a different type of mutation laying on the basis of this disorder.

Accidentally Ingested Foreign Body Associated with Liver Actinomycosis: the Diagnostic Value of Imaging  Prescornita Radu - Validated View

Accidentally Ingested Foreign Body Associated with Liver Actinomycosis: the Diagnostic Value of Imaging

Case Report - Poster

Author(s): Prescornita Radu

Coordinator(s): Associate Professor Monica Platon , Professor Radu Badea

Introduction:

Accidental ingestion of foreign bodies is common and usually followed by their passing through the digestive tract. Gastrointestinal perforations are rare and usually caused by fish bones. 
 

Case Presentation:
We present the case of a 54 year old patient in the emergency department with upper abdominal pain and important weight loss. Abdominal ultrasonography (US) revealed a solid, ill circumscribed liver tumor extending towards the liver hilum and the retroperitoneal space. Contrast enhanced examination ultrasound (CEUS) showed a moderate contrast uptake in the arterial phase, no wash-out during the portal venous and the delayed phases and an intense vascular signal in the surrounding liver parenchyma. The posterior gastric wall showed a 20 mm long hyperechoic image protruding from the gastric cavity towards the inferior surface of the liver. Endoscopic fine needle aspiration revealed a colony of Actynomices, surrounded by inflammatory infiltrate. Malignancy could not be excluded so the patient was transferred to a surgery department for a diagnostic laparotomy. The liver biopsy was suggestive for a chronic liver abscess. Broad spectrum antibiotics and antimycotics were administered with significant improvement, but the echoic image in the posterior wall of the stomach was still visible, suggested a foreign body or fistula. A final diagnosis of actynomicosis of the liver, stomach and pancreas secondary to antral perforation by a foreign body ingestion was established.
 

Conclusion:
Imaging techniques may be misleading because of the non-specific aspect of a liver mass, but using other techniques, such as CEUS, may help show the inflammatory substrate of the lesion. The detection of foreign bodies and fistulas using US or CT may represent the key to the etiological diagnosis.
 

Particularities:
Although abdominal actynomicosis was described more than 150 years ago, it is still one of the most misdiagnosed diseases. The presentation of the disease is more often associated with a malignancy.
 

Assessment of percutaneous closure of Gerbode defect in children  Lechowicz Patrycja , Kościelniak Joanna - Validated View

Assessment of percutaneous closure of Gerbode defect in children

Surgical Science

Author(s): Lechowicz Patrycja, Kościelniak Joanna

Coordinator(s): MD Piotr Weryński

Keywords: LV- RA shunt Gerbode defect septal defect

Introduction: Interventional VSD closing allows for avoiding surgery and is indicated when operative access is difficult and with high risk. The choice of implant type depends on VSD location, size, number and interventional team experience. One of the methods used to close of the various types of VSD is Nit-occlud Spiral Coil system. The aim of the report is presentation of our experience with this system in left ventricle – right atrium shunt (LV-RA shunt) atrioventricular septal defects in children.

Material and Method: The material consisted of 5 (3F/2M) patients aged 8-18 year, body mass 24- 56 kg, qualified after preliminary echocardiographic evaluation. All 5 pts with acquired LV-to-RA shunts were diagnosed as a complication of previous cardiac operations. The implants location, size and number were determined based on angiocardiography results. The procedure was in keeping with the manufacturer protocol.

Results: The size of LV-RA shunt was from 3 to 6 mm measured based on angiography. In all with LV-to-RA shunts the procedures were successful without complications. In one session – 2 coils size: 8x6mm and 3 coils size: 10x6mm were used. In follow-up after 16 months were no residual shunts and no rhythm disturbances were observed. The LV systolic and diastolic function was normal.

Conclusion: Pfm-Le VSD coil system is effective, especially useful in closing atypical, and surgically difficult to access VSDs. Implant plasticity ensures its effectiveness and prevents of significant interventricular septal distortion. It also provides an interventional option of treatment of specific lesions such as LV-RA shunts.

Bibliography: Gerbode F, Hultgren H, Melrose D, et al. Syndrome of left ventricular-right atrial shunt: successful surgical repair of defect in five cases with observation of bradycardia on closure. Ann Surg. 1958;148: Lorber A, Nair P, Gruberg L. Transcatheter closure of acquired Gerbode defect following mitral valve replacement using the Amplatzer duct occluder. J Invasive Cardiol. 2006 Lee SY, Song JY, Baek JS. Percutaneous closure of the acquired gerbode shunt using the amplatzer duct occluder in a 3-month old patient. Korean Circ J. 2013;43:429–31 Kelle AM, Young L, Kaushal S, et al. The Gerbode defect: the significance of a left ventricular to right atrial shunt. Cardiol Young. 2009

Easy screening of malnutrition, is it even possible? Diagnosis of malnutrition in elderly hospitalized patients and its correlation with serum albumin level.  Rozszczypała Monika , Gacek Anna - Validated View

Easy screening of malnutrition, is it even possible? Diagnosis of malnutrition in elderly hospitalized patients and its correlation with serum albumin level.

Medical Science

Author(s): Rozszczypała Monika, Gacek Anna

Coordinator(s): MD Karolina Piotrowicz , Professor Tomasz Grodzicki

Keywords: malnutrition serum albumin level Mini Nutritional Assessment- Short Form screening

Introduction: Early detection of malnutrition is of significant especially in elderly hospitalized patients since it has been linked to a wide range of risk factors, adverse outcomes and it also influences patients’ prognosis.
Material and Method: Presented study is a cross-sectional part of the prospective study on malnutrition prevalence and its determinants in the patients aged 80 and more hospitalized in the Department of the Internal Medicine and Geriatrics University Hospital in Cracow. Nutritional status was assessed with the use of the MNA - SF. Patients were classified as malnourished if they got 7 points or less. The patients’ medical records were searched for serum albumin level measured after patient’s hospital admission.
Results: Malnutrition was diagnosed in 58.6% of 99 examined patients (65.7% of women, mean age: 87.1 ±4.4 years). There was no difference in frequency of malnutrition diagnosis with regard to sex (63.1 % for women vs 50.0% for men,p=0.21). The median (Q1;Q3) serum albumin level for malnourished patients was 31.0 (27;36) for women and 31.3 (30;36) for men. For patients classified as those at risk for malnutrition or normal nutritional status the median serum albumin level was significantly higher than for those malnourished (p<0.005): 38.0 g/l (34.1;41). There was a moderate correlation between the points achieved by the patients’ in the MNA-SF scale and serum albumin levels (p<0.05, r= 0.45). The correlation was stronger in the group of the aged hospitalized men (r=0.76, p<0.05) than in the aged hospitalized women (r=0.28, p<0.05).
Conclusion: Serum albumin level might be used for the preliminary initial assessment of the aged patients’ nutritional status. However, as malnutrition is a common problem among old patients and serum albumin levels may vary due to different diseases, it is extremely important to conduct a standardized nutritional assessment in all elderly hospitalized patients.
Bibliography: Rubenstein LZ, Harker JO, Salva A, Guigoz Y, Vellas B. Screening for undernutrition in geriatric practice: Developing the short-form mini-nutritional assessment (MNA-SF). Journals of Gerontology: Series A, Biological Sciences and Medical Sciences 2001; 56: M366–M372. Dent E, Visvanathan R, Piantadosi C, Chapman I. Nutritional screening tools as predictors of mortality, functional decline, and move to higher level care in older people: A systematic review. Journal of Nutrition in Gerontology and Geriatrics 2012; 31: 97–145. http://www.mna-elderly.com/forms/mini/mna_mini_english.pdf

Total Laparoscopic Radical Hysterectomy with Pelvic Lymphadenectomy in Cervical Carcinoma: analysis of the minimally invasive surgery in gynecologic oncology  Muscă Alexandra - Validated View

Total Laparoscopic Radical Hysterectomy with Pelvic Lymphadenectomy in Cervical Carcinoma: analysis of the minimally invasive surgery in gynecologic oncology

Surgical Science

Author(s): Muscă Alexandra

Coordinator(s): Associate Professor Mihai Emil Căpîlnă

Keywords: TLRH carcinoma of the cervix IA2-IB1 FIGO feasible procedure

Introduction: In the modern oncologic era, a transition between the invasive procedures to less invasive procedures which respect the anatomy is observed and Total Laparoscopic Radical Histerectomy(TLRH) represents the perfect example. There is no doubt about the feasibility of TLRH, the procedure being associated with lower postoperative pain, less blood loss, shorter admissions, less use of analgesics, faster recoveries and a cosmetic effect. The guideline indications are IA2-IB1 FIGO and borderline indications as IB2-IIA.

Material and Method: Between November 2014 and February 2017, 7 patients with squamous cell carcinoma of the cervix underwent TLRH. The BMI was under 23.2 kg/m2 for all the patients and the mean age was 41,8 years. Stage IA2 FIGO was in one patient and stage IB1 FIGO in the other six.

Results: For 3 patients (42.85%) between 32-36 years, the ovaries were conserved, while at the patients over 50 years bilateral ovariectomy was performed. The median duration of the intervention was 249 minutes and the quantity of blood loss varied between 100 and 250 ml. No intraoperative complications were observed and the postoperative evolution was good, with the suppression of the bladder catheter in day 4 and the abdominal drain removal in the 5-6 postop. Only 2 patients (28,57%) needed the replacement of the bladder catheter for another 48 hours due to a bladder distention. All the patients were discharged in day 7 postoperative. The lymphadenectomy was performed in all patients with a mean number of lymph nodes removed of 46,2, all negative. One patient (14,28%) received postoperative adjuvant radiotherapy.

Conclusion: TLRH with pelvic lymphadenectomy can be safely performed, as a feasible procedure. Laparoscopic interventions in gynecological oncology pathology are difficult due to technical complexity, few existing centers of excellence and long learning curve. Nevertheless, for more voluminous tumors, more data of the oncological safety is needed.



Bibliography: 1.TW Kong, SJ Chang, J Lee, J Paek, HS Ryu - Comparison of Laparoscopic Versus Abdominal Radical Hysterectomy for FIGO Stage IB and IIA Cervical Cancer With Tumor Diameter of 3 cm or Greater. Int J Gynecol Cancer 2014;24: 280-288. 2.C. Reade, J. Hauspy, M. L. Schmuck, F. Moens - Characterizing the Learning Curve for Laparoscopic Radical Hysterectomy. Buddy Operating as a Technique for Accelerating Skill Acquisition. Int J Gynecol Cancer 2011;21: 930-935. 3.G. O. Chong, N. Y. Park, D. G. Hong, Y. L. Cho, I. S. Park, Y. S. Lee - Learning Curve of Laparoscopic Radical Hysterectomy With Pelvic and/or Para-Aortic Lymphadenectomy in the Early and Locally Advanced Cervical Cancer. Comparison of the First 50 and Second 50 Cases. Int J Gynecol Cancer 2009;19: 1459-1464. 4. Giorgio Bogani, MD, Antonella Cromi, PhD, Stefano Uccella, MD, Maurizio Serati, MD, Jvan Casarin, MD, Ciro Pinelli, MD, Federica Nardelli, MD, and Fabio Ghezzi, MD - Nerve-Sparing Versus Conventional Laparoscopic Radical Hysterectomy A Minimum 12 Months’ Follow-up Study. Int J Gynecol Cancer 2014;24: 787-793. 5. Athanasios Protopapas, MD,*Þ Kris Jardon, MD,* Nicola Bourdel, MD,* Revaz Botchorishvili, MD,*Benoit Rabischong, MD,* Ge´rard Mage, MD,* and Michel Canis, MD, PhD*-Total Laparoscopic Radical Hysterectomy in the Treatment of Early Cervical Cancer. Int J Gynecol Cancer 2009;19: 712-722).

Anatomical comparison of two surgical approaches at the shoulder   Raşoga Maria Gabriela , Săndoi Iulian-Adrian Popa Roberta-Silviana, Savu Ștefăniță-Andrei, Ionescu Vlad Adrian Validated View

Anatomical comparison of two surgical approaches at the shoulder

Fundamental Science

Author(s): Raşoga Maria Gabriela, Săndoi Iulian-Adrian

Coauthor(s): Popa Roberta-Silviana, Savu Ștefăniță-Andrei, Ionescu Vlad Adrian

Coordinator(s): Lecturer Ovidiu-Marcel Mărginean

Keywords: anatomy axillary approach deltopectoral approach muscles

Introduction: Fractures of the distal end of the humerus which interest the surgical neck of the humerus occur in 4,5-8,5% cases of skeleton bone fractures[1]. Alongside bone injuries there are often found vascular, nerve and muscle lesions. Because surgical approaches are based on anatomical structures through which they pass, in this paper we intend to study anatomical plane features and muscle, vascular and nerves interposed between the knife and the bone plane in the orthopedic shoulder in two manners of approache.

Material and Method: The study was conducted on ten bodies belonging to the 1st Department of Morphological Sciences, Department of Human Anatomy at the University of Medicine and Pharmacy Craiova. The method of preservation used for the embalming was a solution of alcohol and glycerol, followed by cooling in a special refrigerator for the preservation of corpses for 12 months. The methods of the study consisted in anatomical dissection[2] after cues from orthopedic surgery literature[3][4][5][6].

Results: The transverse axillary pre and retro vascular approach is very interesting, but the only advantage that it holds is that it hides the surgey scar [7]. From an anatomical point of view it represents a complicated way that does not give much room to manipulate the bone fragments. Previously addressed as the deltopectoral "Bazy" type is a classic shoulder approach that offers many advantages for the medical practitioner. Although we meet many vascular and nervous items during the dissection, the upper end of the humerus is easy to handle. Especially in need it can prolong the incision releasing the anterior bundles of the deltoid muscle[8][9].

Conclusion: The anterior deltopectoral approach is superior in comparison to the axillary approach in fractures of the surgical neck at the humerus, because it allows the implantation of bone fragments and osteosynthesis material.

Bibliography: 1. Antonescu M. Dinu, Patologia aparatului locomotor, Vol. I, Editura Medicală Bucureşti, 2006; 2. Gray's Anatomy e-dition, 39th edition The Anatomical Basis of Clinical Practice, Text with Continually Updated Online Reference via PIN By Susan Standring, PhD, DSc, Published December 2004; 3. Baciu C. Clement, Chirurgia şi Protezarea Aparatului Locomotor, EdituraMedicală, Bucureşti 1986; 4. Denischi A., Proca E., Tratat de Aptologie Chirurgicală, Ortopedia, Volumul III., editura Medicală Bucureşti, 1988; 5. Drăgoi G.S., Manualul lui Repciuc de Anatomia Omului, Reprografia Universităţii din Craiova, 1990; 6. Constantin Romulus, Manual de căi de abord chirurgicale în ortopedie şi traumatologie, Editura 3D Arte, 2008; 7. Handoll HH, Ollivere BJ, Rollins KE, Interventions for treating proximal humeral fractures in adults. Cochrane Database Syst Rev. Dec 12;12:CD000434. doi: 10.1002/14651858.CD000434.pub3. 2012; 8. Gupta AK, Harris JD, Erickson BJ, Abrams GD, Bruce B, McCormick F, Nicholson GP, Romeo AASurgical management of complex proximal humerus fractures-a systematic review of 92 studies including 4500 patients. J Orthop Trauma. Jan;29(1):54-9. doi: 10.1097/BOT. 2015; 9. Rodia F, Theodorakis E, Touloupakis G, Ventura A, Fixation of complex proximal humeral fractures in elderly patients with a locking plate: A retrospective analysis of radiographic and clinical outcome and complications. Chin J Traumatol. Jun 1;19(3):156-9. 2016.

Acute renal failure due to rare pathology - extrarenal reflex cause due to unilateral retroperitoneal compression  Savu Ștefăniță-Andrei , Popa Roberta-Silviana Berneanu Cătălina-Maria, Ionescu Vlad Adrian , Raşoga Maria Gabriela Invalidated View

Acute renal failure due to rare pathology - extrarenal reflex cause due to unilateral retroperitoneal compression

Case Report - Poster

Author(s): Savu Ștefăniță-Andrei, Popa Roberta-Silviana

Coauthor(s): Berneanu Cătălina-Maria, Ionescu Vlad Adrian , Raşoga Maria Gabriela

Coordinator(s): Lecturer Theodor Viorel Dumitrescu

Introduction: Intramural duodenal hematoma is a rare pathology which can sometimes be omitted even with a detailed exploratory laparoscopy. The symptoms usually have a slow debut causing a delay in finding the correct diagnosis.  Acute renal failure is defined as a sudden downfall of the renal function, usually occurring on otherwise normal kidneys, measured by a decreasing glomerular filtration rate which can happen over several hours or even days.

Case Presentation: A 39 year old male patient presented into the ER acusing abdominal pain, nausea, vomiting, dizziness, headache and anuria. Heredo-colateral and personal pathological antecedents are irrelevant to this particular case. The creatinin and urea blood levels registered in the first set of investigations were over three times the physiological levels. In the following days, the creatinin and urea blood levels increased up to over six times the normal ones, although the patient was subjected to emergency hemodialysis. The idea of an unusual septic syndrome was brought up and surgical intervention for diagnosis and treatment was decided. Exploratory laparotomy showed a retroperitoneal hematoma at the base of the mesentery, extended over to the bifurcation of the aorta.
Conclusion: Following the surgery, diuresis with normochromatic urine was observed. In the following days, the values of urea and creatinin dropped to physiological levels, hemodialysis not being necessary anymore.

Particularities: The particularity of this case resides in the unilateral retroperitoneal compression determined by the intramural duodenal hematoma . The acute renal failure was caused by reflex mechanisms of symphatetic stimulation that stopped glomerular filtration in both kidneys.

Systemic fibrinolysis & ultrasound-assisted catheter-directed thrombolysis in intermediate-risk pulmonary embolism: a meta-analysis  Copoeru Armin Dan - Validated View

Systemic fibrinolysis & ultrasound-assisted catheter-directed thrombolysis in intermediate-risk pulmonary embolism: a meta-analysis

Medical Science

Author(s): Copoeru Armin Dan

Coordinator(s): MD Răzvan Couţi

Keywords: pulmonary embolism intermediate-risk systemic fibrinolysis catheter-directed thrombolysis

Introduction: Intermediate-risk pulmonary embolism has a high mortality and morbidity and its treatment is still a subject of debate. Anticoagulation therapy is the mainstay, but systemic and catheter-directed fibrinolysis show promising results. In recent years, ultrasound-assisted thrombolysis (USAT) has been researched as a superior form of treatment. The purpose of this meta-analysis was to evaluate the effectiveness of USAT in intermediate-risk patients when compared to systemic fibrinolysis.

Material and Method: A PubMed and Cochrane Library search was conducted for randomized controlled trials (RCTs) and case series. Primary outcomes were all-cause mortality and bleeding (minor and major), secondary outcomes were right ventricle/left ventricle end-diastolic dimensions (RV/LV ratio) and pulmonary artery systolic pressure (PASP) up to 24h after treatment. Six USAT and 13 systemic fibrinolysis studies were selected.

Results: USAT has a lower risk of minor bleeding (OR: 0.52, 95% CI: 0.32 to 0.87, p=0.01), but no statistical difference for major bleeding (OR: 0.48, 95% CI: 0.18 to 1.22, p=0.12). There was also no improvement in all-cause mortality (OR: 0.24, 95% CI: 0.03 to 1.80, p=0.16). PASP was increased in the USAT group (SMD = 0.3, 95% CI: 0.1 to 0.5, p=0.001), while RV/LV ratio decreased (SMD = -1.1, 95% CI: -1.4 to -0.8, p<0.001).

Conclusion: Intermediate-risk pulmonary embolism continues to be a difficult pathology. USAT shows improvement in certain areas, but mortality and major bleeding remain pressing issues. Small populations and differing criteria may cause bias, so larger RCTs are needed to directly gauge the full benefits and disadvantages of USAT, compared to other therapies.

Bibliography: Swischuk JL, Smouse HB. Differentiating Pharmacologic Agents Used In Catheter-Directed Thrombolysis. Seminars in Interventional Radiology 2005, volume 22, number 2, pages 121-9 Ryan J. Pulmonary embolism: new treatments for an old problem. Open Access Emergency Medicine 2016, pages 87-95 Ain DL, Jaff MR. Treatment of Submassive Pulmonary Embolism: Knowing When to be Aggressive and When to be Conservative. Current Treatment Options in Cardiovascular Medicine 2015, pages 17-25 Mann DL, Zipes DP, Libby P, Bonow RO. Braunwald’s Heart Disease. 10th ed. Elsevier Inc.; 2015 Fuster V, Walsh RA, Harrington RA. Hurst’s The Heart, 13th ed. McGraw Hill Medical; 2011

Arrhythmogenic channelopathies patients with implantable cardioverter-defibrillator from the casuistry of an tertiary cardiology center: follow-up  Marginean Diana Roxana - Validated View

Arrhythmogenic channelopathies patients with implantable cardioverter-defibrillator from the casuistry of an tertiary cardiology center: follow-up

Medical Science

Author(s): Marginean Diana Roxana

Coordinator(s): Professor Dan Dobreanu , Assistant Professor Ioana Șuș

Keywords: Arrhythmogenic channelopathies implantable cardioverter-defibrillator arrhythmic recurrences ICD replacement

Introduction: Arrhythmogenic channelopathies can lead to malignant ventricular arrhythmias and further to suden cardiac death, therefore implantable cardioverter defibrillator (ICD) has a lifesaving role for high-risk patients. Objective: The purpose of this study was to evaluate patients diagnosed with arrhythmogenic channelopathies who underwent ICD implantation, regarding the evolution of arrhythmias, replacement and optimal programming of the device, and possible complications.

Material and Method: All patients with an ICD implanted for arrhythmogenic channelopathies were retrospectively included, using primary records of IuBCvT Targu Mures between 2009-2016.

Results: Fifteen patients met the inclusion criteria, 7 men and 8 women, aged 41+/-14 (min 19, max 68), 11 cases diagnosed with long QT syndrome and 4 cases diagnosed with Brugada syndrome. None of the Brugada syndrome patients had documented arrhythmias or symptoms related to an arrhythmia during the follow-up period of 72.8+/-19.6 months, no base treatment  was administrated, but were  recommended to avoid arrhythmic precipitating factors. Regarding LQT syndrome patients all had been treated with the maximum tolerated dose of beta blocker for the follow-up period of 56.2+/-34.6 months, in which 3 (27.3%) of them presented arrhythmic recurrences. During the follow-up period 4 patients received device therapies: appropriate-25%(torsades de pointes/polymorphic ventricular tachycardia), appropriate and inappropriate-25%(torsades de pointes followed by inadequate electric shocks for sinus tachycardia), and exclusively inappropriate-50%(post effort sinus tachycardia and the detection of interference signals due to fracture of the stimulation/detection electrode). In 60% of the cases the ICD replacement was elective (as a result of depleted battery) and in 20% of cases, the replacement was for defibrillator lead malfunction.

Conclusion: Arrhythmic recurrences had been detected only in patients diagnosed with long QT syndrome, in which both appropriate and inappropriate therapies had been found. In most cases the replacement of the device had been elected due to the need of battery replacement.

Bibliography: 1.I. Goldenberg, A.J. Moss: Long QT syndrome. J Am Coll Cardiol 2008 Jun. 2. C. Jons, A.J. Moss, I. Goldenberg, et al.: Risk of fatal arrhythmic events in long QT syndrome patients after syncope. J Am Coll Cardiol 2010 Feb 3.2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death 4.C. Antzelevitch, P. Brugada, M. Borggrefe, et al.: Brugada syndrome: report of the second consensus conference: endorsed by the Heart Rhythm Society and the European Heart Rhythm Association. Circulation 2005 Feb 5. F. Sacher, V. Probst, Y. Iesaka, et al.: Outcome after implantation of a cardioverter-defibrillator in patients with Brugada syndrome: a multicenter study. Circulation 2006 Nov 6.Proclemer, A., Ghidina, M., Facchin, D., Rebellato, L., Corrado, D., Gasparini, M., & Gregori, D. (2009). Use of implantable cardioverter-defibrillator in inherited arrhythmogenic diseases: Data from Italian ICD registry for the years 2001-6. PACE - Pacing and Clinical Electrophysiology, 434–445

A rare case of hepatocarcinoma in a young patient  Nemtanu Teona , Țiț Călin Mircea Ionuţ Negruţiu Invalidated View

A rare case of hepatocarcinoma in a young patient

Case Report - Poster

Author(s): Nemtanu Teona, Țiț Călin

Coauthor(s): Mircea Ionuţ Negruţiu

Coordinator(s): MD Nicoleta Puie , MD Daniel Rusu

Introduction: Fibrolamellar hepatocellular carcinoma (FL-HCC) is thought to be a rare variant of conventional hepatocellular carcinoma (HCC), with an incidence of 0.02 cases/100.000 individuals. However, unlike conventional HCC, it occurs in children and young adults without underlying liver disease and it does not have a gender bias.

Case Presentation: We present the case of a 18 years old patient with no previous medical history. She was refferred from another hospital in which she was diagnosticated with a hepatic mass in the third segment based on ultrasound images and dynamic contrast-enhanced MRI (DCE-MRI). The surgical approach was decided  for further investigation. Intraoperatory, the doctors performed a laparoscopic resection of the third segment and a sample was sent to the Department of Pathology. Macroscopy: Greenish-yellow unique tumoral mass, well-circumscribed, multilobulated, measuring 6.5 cm in diameter, with no signs of hemorrhage or necrosis. Microscopy: Tumoral proliferation consisting of enlarged polygonal eosinophilic hepatocytes with well defined cell borders arranged in trabeculae and small cords separated by abundant fibrous connective tissue. The stroma is organised in parallel acellular collagen fibers which are positive for Masson's Thrichrome Stain. Their cytoplasm appears eosinophilic  and granular with large vesicular nuclei and proeminent eosinophilic macronucleoli. It also contains pale bodies, hyaline globules and biliary pigments. Immunohistochemistry: The tumor cells were positive for Hep Par-1, CK 7, CD 68.

Conclusion: The  histopathological examination diagnosed the specimen lession as fibrolamellar hepatocellular carcinoma and the tumoral mass was removed.

Particularities: The particularities of this case are: the patient’s age and the lack of symptoms, the rarity of this type of cancer which was diagnosed during a routine examination. Also, the difficult differential diagnosis between fibrolamellar hepatocellular carcinoma, hepatic adenoma, focal nodular hyperplasia and scirrhous hepatocarcinoma.

Histopathological and immunohistochemical study of laterocervical lymph node metastases of unknown primary origin  Țîrcu Doina Cristina , Validated View

Histopathological and immunohistochemical study of laterocervical lymph node metastases of unknown primary origin

Medical Science

Author(s): Țîrcu Doina Cristina

Coauthor(s): ,

Coordinator(s): MD Ramona Denise Mălin

Keywords: laterocervical lymph node metastases unknown primary carcinomas histopathology immunohistochemistry

Introduction: Carcinomas of unknown primary (CUP) are histologically defined as the presence of a metastasis without detection of the primary tumor . CUP is a very heterogeneous condition, in which the type of the tumor, its extension and the treatment vary widely. In this study we examined histopathologically and immunohistochemically 24 cases of laterocervical lymph node metastases with unknown primary origin. For immunohistochemical study we used a large panel of antibodies represented by CK7, CK19, CK20, CKAE1/AE3, CK34betaE12, TTF1, HBME-1, CEA, MUC5AC and EBV.In the cases studied tumors accompanied by seemingly primitive adenopathies were located in the thyroid, lung, esophagus, stomach, rhinopharynx, hypopharynx, oropharynx and larynx. 
Material and Method: Our study comprised 24 cases with a clinical tumor adenopathy, with unknown primary tumor site. Lymph node biopsy fragments were fixed in 10% formalin, processed through the usual technique for paraffin inclusion and stained with the hematoxylin and eosin technique. 4 μm-thick serial sections were cut and subjected to immunohistochemical processing using LSAB2/HRP visualizing system (Dako, code K0690). Signal detection was performed using 3,3′-diaminobenzidine (DAB). 

Results: Study which covered a period of five years (2004-2008) included 252 cases of which 228 cases (90.48%) with secondary adenopathy and 24 cases (9.52%) with apparently primitive adenopathy, which are adenopathies of unknown primary origin. For the 24 lymph node metastases with apparently primitive origin, following clinical, laboratory, histopathological and immunohistochemical investigation, we identified the following locations of the primary tumor: thyroid-2 cases (8,33%) , lungs-2 cases(8,33%), digestive tract-2 cases(8,33%) , rhinopharynx-9 cases(37.5%), oropharynx-6 cases(25%), hypopharynx-2 cases(8.33%) , larynx-1 case(4,16%). 

Conclusion: A panel of antibodies including CK7, CK19, CK20, CKAE1/AE3, CK34betaE12, TTF1, HBME1, CEA, MUC5AC and EBV can identify the location of the primary tumor in most cases of laterocervical lymph node metastases with unknown primary origin.

Bibliography: [1] ABBRUZZESE JL, ABBRUZZESE MC, HESS KR, RABER MN, LENZI R, FROST P, Unknown primary carcinoma: natural history and prognostic factors in 657 consecutive patients, J Clin Oncol, 1994, 12(6):1272-80. [2] VARADHACHARY GR, ABBRUZZESE JL, LENZI R, Diagnostic strategies for unknown primary cancer, Cancer, 2004, 100(9):1776-85. [3] KOTHARI P, RANDHAWA PS, FARRELL R, Role of tonsillectomy in the search for a squamous cell carcinoma from an unknown primary in the head and neck, Br J Oral Maxillofac Surg, 2008, 46(4):283-7. [4] CARLSON HR, Carcinoma of unknown primary: searching for the origin of metastases, JAAPA, 2009, 22(8):18-21. [5] ISSING WJ, TALEBAN B, TAUBER S, Diagnosis and management of carcinoma of unknown primary in the head and neck, Eur Arch Otorhinolaryngol, 2003, 260(8):436-43. [6] WEBER A, SCHMOZ S, BOOTZ F, CUP (carcinoma of unknown primary) syndrome in head and neck: clinic, diagnostic, and therapy, 2001, 24(1):38-43. [7] RASPONI A, COSTA A, CLEMENTE C, MERSON M, MARCHINI S, ANDREOLI C, Lymphnodal metastases from unknown primary tumors, Neoplasma, 1982, 29(5):631-8. [8] HAAS I, HOFFMANN TK, ENGERS R, GANZER U, Diagnostic strategies in cervical carcinoma of an unknown primary (CUP), 2002, 259(6):325-33. [9] RUBIN BP, SKARIN AT, PISICK E, RIZK M, SALGIA R, Use of cytokeratins 7 and 20 in determining the origin of metastatic carcinoma of unknown primary, with special emphasis on lung cancer, Eur J Cancer Prev, 2001, 10(1):77-82. [10] ROH MS, HONG SH, Utility of thyroid transcription factor-1 and cytokeratin 20 in identifying the origin of metastatic carcinomas of cervical lymph nodes, J Korean Med Sci, 2002, 17(4):512-7. [11] CHUNG YS, KIM JY, BAE JS, SONG BJ, KIM JS, JEON HM, JEONG SS, KIM EK, PARK WC, Lateral lymph node metastasis in papillary thyroid carcinoma: results of therapeutic lymph node dissection, Thyroid. 2009,19(3):241-6. [12] EL DEMELLAWY D, NASR A, ALOWAMI S, Application of CD56, P63 and CK19 immunohistochemistry in the diagnosis of papillary carcinoma of the thyroid, Diagn Pathol, 2008, 3:5. [13] BARROETA JE, BALOCH ZW, LAL P, PASHA TL, ZHANG PJ, LIVOLSI VA, Diagnostic value of differential expression of CK19, Galectin-3, HBME-1, ERK, RET, and p16 in benign and malignant follicular-derived lesions of the thyroid: an immunohistochemical tissue microarray analysis, Endocr Pathol, 2006, 17(3):225-34. [14] SCOGNAMIGLIO T, HYJEK E, KAO J, CHEN YT, Diagnostic usefulness of HBME1, galectin-3, CK19, and CITED1 and evaluation of their expression in encapsulated lesions with questionable features of papillary thyroid carcinoma, Am J Clin Pathol, 2006, 126(5):700-8. [15] PRASAD ML, PELLEGATA NS, HUANG Y, NAGARAJA HN, DE LA CHAPELLE A, KLOOS RT, Galectin-3, fibronectin-1, CITED-1, HBME1 and cytokeratin-19 immunohistochemistry is useful for the differential diagnosis of thyroid tumors, Mod Pathol, 2005, 18(1):48-57. [16] REKHTMAN N, ANG DC, SIMA CS, TRAVIS WD, MOREIRA AL, Immunohistochemical algorithm for differentiation of lung adenocarcinoma and squamous cell carcinoma based on large series of whole-tissue sections with validation in small specimens, Mod Pathol, 2011, 24(10):1348-59. [17] FANG WT, CHEN WH, CHEN Y, JIANG Y, Selective three-field lymphadenectomy for thoracic esophageal squamous carcinoma, Dis Esophagus, 2007, 20(3):206-11. [18] LEE MJ, LEE HS, KIM WH, CHOI Y, YANG M, Expression of mucins and cytokeratins in primary carcinomas of the digestive system, Mod Pathol, 2003, 16(5):403-10. [19] FEINMESSER R, MIYAZAKI I, CHEUNG R, FREEMAN JL, NOYEK AM, DOSCH HM, Diagnosis of nasopharyngeal carcinoma by DNA amplification of tissue obtained by fine-needle aspiration, N Engl J Med, 1992, 326(1):17-21. [20] WU FY, YANG ES, WILLEY CD, ELY K, GARRETT G, CMELAK AJ, Refractory lympho-epithelial carcinoma of the nasopharynx: a case report illustrating a protracted clinical course, Head Neck Oncol, 2009, 1:18. [21] JENG YM, SUNG MT, FANG CL, HUANG HY, MAO TL, CHENG W, HSIAO CH, Sinonasal undifferentiated carcinoma and nasopharyngeal-type undifferentiated carcinoma: two clinically, biologically, and histopathologically distinct entities, Am J Surg Pathol, 2002, 26(3):371-376. [22] VOLLRATH M, ALTMANNSBERGER M, DEBUS E, OSBORN M, Differential diagnosis of tumors of the head and neck using immunohistologic and electron optic studies, Laryngol Rhinol Otol (Stuttg), 1984, 63(9):475-82. [23] THOMPSON LDR, Sinonasal Carcinomas, Current Diagnostic Pathology, 2006, 12:40-53. [24] ZONG Y, LIU K, ZHONG B, CHEN G, WU W, Epstein-Barr virus infection of sinonasal lymphoepithelial carcinoma in Guangzhou, Chin Med J (Engl), 2001, 114(2):132-136.

Alpha-1 antitrypsin gene variations and gouty inflammation  Bolunduţ Alexandru-Cristian , Andra Cristian George Hotea Ioana, Pamfil Cristina, Rednic Simona Validated View

Alpha-1 antitrypsin gene variations and gouty inflammation

Fundamental Science

Author(s): Bolunduţ Alexandru-Cristian, Andra Cristian George

Coauthor(s): Hotea Ioana, Pamfil Cristina, Rednic Simona

Coordinator(s): Associate Professor Radu Popp , Assistant Professor Tania Crişan

Keywords: gout hyperuricemia alpha-1 antitrypsin SERPINA1 polymorphisms

Introduction: Gout is caused by genetic and environmental factors that contribute to severe attacks of painful arthritis. Uric acid crystals play the main role in the pathogenesis of gout, but, most interestingly, only a small part of hyperuricemic patients develop the disease. This led us to the hypothesis that genetic factors that modulate the inflammatory reaction could be important new susceptibility candidates. Alpha-1 antitrypsin (A1AT), a protease inhibitor, is functionally proven to limit gouty inflammation. We hypothesized that polymorphisms in SERPINA1 (the A1AT gene) that lead to a decrease in activity may enhance autoinflammation and increase the risk of gout.

Material and Method: We conducted a case-control study to assess the role of SERPINA1 rs28929474 and rs17580 polymorphisms in relation to the susceptibility of developing gout in hyperuricemic patients. A total of 59 patients diagnosed with gout and 29 hyperuricemic controls were included after obtaining written informed consent. Genotyping was performed using Multiplex Polymerase Chain Reaction - Restriction Fragment Length Polymorphism. The results were analyzed using Fisher’s exact test.

Results: Our method was able to detect one heterozygote for each polymorphism per group; all the other patients tested were homozygous for the wild-type alleles. This reflects a minor allele frequency of 1.13% for both polymorphisms over the two groups combined and the presence of at least one minor allele in the genotype determines an Odds Ratio of 0.4828 (CI 0.0291 to 8.0051).

Conclusion: Our study is the first that evaluates this hypothesis in the Romanian population and has the major advantage of including hyperuricemic controls. Our pilot data showed no statistically significant difference in the distribution of the two SERPINA1 polymorphisms studied between gout patients and hyperuricemic controls. Nevertheless, A1AT remains a major research platform, because other genetic or epigenetic variations within this gene are promising candidates that can play an important role in gout susceptibility.

Bibliography: Settin A, El-Bendary M, Abo-Al-Kassem R, El Baz R. Molecular analysis of A1AT (S and Z) and HFE (C282Y and H63D) gene mutations in Egyptian cases with HCV liver cirrhosis. J Gastrointestin Liver Dis. 2006;15(2):131-5.

Mental illness related stigma among medical students  Drăgan Mona-Irina Zaharia Alexandru-Alin, Neacșa Ana-Maria Izabella Ștefania Validated View

Mental illness related stigma among medical students

Public Health

Author(s): Drăgan Mona-Irina

Coauthor(s): Zaharia Alexandru-Alin, Neacșa Ana-Maria Izabella Ștefania

Coordinator(s): Lecturer Mihail Cristian Pîrlog

Keywords: stigma mental illness social acceptance patients

Introduction: Stigma represents one of the most important barriers to mental health treatment for the individuals diagnosed with psychiatric disorders, and a significant issue for their social functioning. Moreover, data from specialized literature showed that the attitudes of medical professionals generate stigma towards this category of persons. In this respect, the present study tried to offer a review of existing research that has assessed the presence of mental illness related stigma among medical students.

Material and Method: A review of various online medical publications, indexed on Pubmed and Pubmed Central, was led to identify researches concerning the medical students attitude towards mentally ill patients. Studies that fitted the inclusion criteria were synthesized and evaluated using systematic review methods. Were searched articles published since January 1st, 1990. We used a combination of keywords such as ‘stigma’, ‘mental illness’, ‘medical students’ and the ‘titles’ and ‘abstract’ fields were searched.

Results: On Pubmed were found 56 articles published between 1990 and 2016 that met the criteria and they were analyzed individually, while on Pubmed Central, according to the same methodology were found 443 papers. When we added „Romania” as keyword, only 12 papers were found on Pubmed Central, but without any direct refference to our country in the title of the paper.

Conclusion: According to most of the researches, medical students tend to be more stigmatizing towards mental conditions than students in other non-medical study programs. This is a topic of high interest, but insufficient research has been conducted so far in our country. Based on the results from this stage of our research, in the future our aim will be to raise awareness of this phenomena in our country, since not much has been done so far, in order to overcome the stigmatic barriers and provide a more socially comfortable environment for these patients.  

Bibliography: Pubmed Pubmed Central https://www.ncbi.nlm.nih.gov/pmc/?term=%22medical%20students%22%20%22stigma%22%20%22mental%20Illness%22 https://www.ncbi.nlm.nih.gov/pubmed/?term=%22medical%20students%22%20%22stigma%22%20%22mental%20Illness%22 https://www.ncbi.nlm.nih.gov/pmc/?term=%22medical%20students%22%20%22stigma%22%20%22mental%20Illness%22%20%22Romania%22

INSIGHT INTO A RARE CASE OF INTRAMEDULLARY DIFFUSE LARGE B-CELL LYMPHOMA  Pocol Roxana-Daiana , Peter Alina-Ada Pascalau Sorana-Maria, Nechita Irina Invalidated View

INSIGHT INTO A RARE CASE OF INTRAMEDULLARY DIFFUSE LARGE B-CELL LYMPHOMA

Case Report - Poster

Author(s): Pocol Roxana-Daiana, Peter Alina-Ada

Coauthor(s): Pascalau Sorana-Maria, Nechita Irina

Coordinator(s): Associate Professor Anca Simona Bojan , MD Carmen Seleș

Introduction:

Diffuse large B-cell lymphoma(DLBCL) is the most common aggressive of the non-Hodgkin lymphoma, that typically arises in lymph nodes. For untreated patients median survival is less than a year. However, with current first-line treatment regimens, DLBCL is often curable with more than 50% of patients alive and disease free at 5 years. For chemoresponsive patients with relapsed DLBCL, autologous stem cell transplantation(ASCT) has become the preferred salvage strategy. 


Case Presentation:
A 25-years-old female was transferred in our department from the Infectious Disease Hospital, where she was admitted with multiple infections (Q fever, urinary tract infections, interstitial pneumonia), for severe anemia refractory to treatment, persistent monocytosis and trombocytopenia. Therefore, a neoplasia was suspected, yet CT scan and MRI could not establish the diagnosis.  Hence, a bone marrow biopsy was performed confirming a DLBCL with an atypical intramedullary localization.
The patient started chemotherapy and after four cycles of R-DA-EPOCH (Rituximab Dose-Adjusted, Etoposide, Prednisolone, Oncovin, Cyclophosphamide, Hydroxydaunorubicin) and one cycle of intrathecal methotrexate the lymphoma remitted, fact confirmed by a PET-CT. However, after 5 months, she presented intracranial hypertension syndrome and the MRI brought to light a tumor growth on the right cerebellar hemisphere and in both frontal lobes, that were removed by neurosurgery. The histopathological examination of the mass specimens confirmed secondary involvement of central nervous system, interpreted as a relapse. Despite the fact that the patient had indication for ASCT, she refused and started treatment with VCEP( Vincristine, Lomustine, Etoposide, Prednisolone) and intrathecal methotrexate.


Conclusion:
Due to the fact that the patient refused the ASCT, she has a poor prognosis and a chance of survival less than 10%. 


Particularities:
This case stands out by the atypical localization of a DLBCL and at the same time by the lack of findings at the clinical and paraclinical investigations, that delayed the establishment of the diagnosis and treatment.

ATG5 (c.574-12777G>C) polymorphism implication in tuberculosis   Ștefan Andreea-Nicoleta - Validated View

ATG5 (c.574-12777G>C) polymorphism implication in tuberculosis

Fundamental Science

Author(s): Ștefan Andreea-Nicoleta

Coordinator(s): MD Mihai Gabriel Cucu

Keywords: SNP Tuberculosis Genotyping Autophagy

Introduction: Pulmonary Tuberculosis (TB) is an infecto-contagious disease caused by Mycobacterium tuberculosis. According to the World Health Organization, TB is the second cause of death worldwide. Autophagy is a homeostatic process involved in nutrient regeneration and immune responses, which may be involved in intracellular killing of M. tuberculosis. Several studies linked variation in autophagy genes with susceptibility to pulmonary tuberculosis.

Material and Method: In this study, 256 patients with active or history of Pulmonary Tuberculosis were included and 332 patients without active or history of TB for the control cohort were enrolled. We genotyped single nucleotide polymorphism (SNP) in the ATG5 (c.574-12777G>C) gene using Real-Time PCR on a VIIA™ 7 Real Time PCR System. This SNP has been reported as relevant for the autophagy process and potentially for susceptibility to active pulmonary tuberculosis. DNA has been isolated and purified from whole blood collected on EDTA.

Results: For the ATG5 (c.574-12777G>C) SNP our findings show the following distribution: CC genotype was found in 123 (47.86%) subjects with TB while the same genotype was found in 152 (45.78%) subjects from the Control Group; CG genotype was found in 100(38.91%) subjects from the TB Group and 137 (41.27%) subjects from the Control Group; GG genotype was found in 34(13.23%) subjects from the TB Group and 43 (12.95%) subjects from the Control Group. The minor Allele G had a frequency of 32.68% in the TB Group and 33.58% in the Control Group.

Conclusion: In this study, no association was found between the increased risk of developing pulmonary tuberculosis and the presence of the ATG5 (c.574-12777G>C) polymorphism. This suggests that this genetic variant we focused on is not related to the risk for developing active TB in Romanian population. A possible explanation of the lack of association could be the presence of different ethnic groups in the two cohorts.

Bibliography: Watson, Robert O., Paolo S. Manzanillo, and Jeffery S. Cox. "Extracellular M. tuberculosis DNA targets bacteria for autophagy by activating the host DNA-sensing pathway." Cell 150, no. 4 (2012): 803-815. Songane, Mário, Johanneke Kleinnijenhuis, Mihai G. Netea, and Reinout van Crevel. "The role of autophagy in host defence against Mycobacterium tuberculosis infection." Tuberculosis 92, no. 5 (2012): 388-396. Yu, Xiaowen, Chunmei Li, Weiling Hong, Weihua Pan, and Jianping Xie. "Autophagy during Mycobacterium tuberculosis infection and implications for future tuberculosis medications." Cellular signalling 25, no. 5 (2013): 1272-1278. Songane, Mario, Johanneke Kleinnijenhuis, Bachti Alisjahbana, Edhyana Sahiratmadja, Ida Parwati, Marije Oosting, Theo S. Plantinga et al. "Polymorphisms in autophagy genes and susceptibility to tuberculosis." PloS one 7, no. 8 (2012): e41618. Goletti, Delia, Elisa Petruccioli, Alessandra Romagnoli, Mauro Piacentini, and Gian Maria Fimia. "Autophagy in Mycobacterium tuberculosis infection: a passepartout to flush the intruder out?." Cytokine & growth factor reviews 24, no. 4 (2013): 335-343.

The importance of Genetic Polymorphism in Pancreatic Pathology  Ciontu Cătălina Andreea , Mijea Ștefana Cătălina Croitoru Maria-Alexandra, Tolea Constantin Validated View

The importance of Genetic Polymorphism in Pancreatic Pathology

Medical Science

Author(s): Ciontu Cătălina Andreea, Mijea Ștefana Cătălina

Coauthor(s): Croitoru Maria-Alexandra, Tolea Constantin

Coordinator(s): Professor Adrian Săftoiu , Assistant Professor Vlad Pădureanu

Keywords: pancreatic disorders polymorphism genotype VEGFR-2

Introduction: Pancreatic disorders have a high prevalence worldwide. Despite the fact that screening methods became more effective and the knowledge we have nowadays about pancreatic diseases has enhanced, their incidence remains high. Our purpose was to determine whether single nucleotide polymorphism (SNP) of VEGFR-2/KDR (vascular endothelial growth factor receptor 2/kinase insert domain receptor) influences susceptibility to develop pancreatic pathology. 

Material and Method: Genomic DNA was extracted from blood samples collected from patients diagnosed with acute pancreatitis (n = 110), chronic pancreatitis (n = 25), pancreatic cancer (n = 82) and healthy controls (n = 232) from January 2013 to December 2016. VEGFR-2 (KDR) 604A>G (rs2071559) polymorphism frequency was determined with TaqMan allelic discrimination. Statistical assessment was performed by associating genetic polymorphism with clinical and pathological data.
Results: In both pancreatic disorders and healthy control groups the polymorphism we studied was in Hardy-Weinberg equilibrium. Association between increased risk for pancreatic disorders and studied polymorphism was statistically significant. KDR 604AG and AG + GG genotypes were more prevalent in acute pancreatitis and pancreatic cancer patients than in controls. These genotypes influence disease development in a low rate. No association was found between chronic pancreatitis and KDR 604AG and AG + GG genotypes. In Romanian cohort, we found an association between the KDR 604A→G polymorphism and acute pancreatitis and pancreatic cancer.

Conclusion: Carriers of the -604G variant allele were more frequent among acute pancreatitis and pancreatic cancer than among controls, suggesting that KDR 604G allele may confer an increased risk for these diseases. In the future, more extensive studies on larger groups are necessary, in order to clarify the role of VEGFR2 polymorphisms in pancreatic pathology. 

Bibliography: 1. Uzunoglu, F.G.; Kolbe, J.; Wikman, H.; Güngör, C.; Bohn, B.A.; Nentwich, M.F.; Reeh, M.; König, A.M.;Bockhorn, M.; Kutup, A.; et al. VEGFR-2, CXCR-2 and PAR-1 germline polymorphisms as predictors of survival in pancreatic carcinoma. Ann. Oncol. 2013, 24, 1282–1290. [CrossRef] [PubMed] 2. Toomey, D.P.; Murphy, J.F.; Conlon, K.C. Cox-2, VEGF and tumor angiogenesis. Surgeon 2009, 7, 174–180.[CrossRef] 3. Gille, H.; Kowalski, J.; Li, B.; LeCouter, J.; Moffat, B.; Zioncheck, T.F.; Pelletier, N.; Ferrara, N. Analysis of biological effects and signaling properties of Flt-1 (VEGFR-1) and KDR (VEGFR-2). A reassessment using novel receptor-specific vascular endothelial growth factor mutants. J. Biol. Chem. 2001, 276, 3222–3230. [CrossRef] [PubMed] 4. Millauer, B.; Wizigmann-Voos, S.; Schnurch, H.; Martinez, R.; Moller, N.P.; Risau, W.; Ullrich, A. High affinity VEGF binding and developmental expression suggest Flk-1 as a major regulator of vasculogenesis and angiogenesis. Cell 1993, 72, 835–846 [CrossRef] 5. Peters, K.G.; de Vries, C.; Williams, L.T. Vascular endothelial growth factor receptor expression during embryogenesis and tissue repair suggests a role in endothelial differentiation and blood vessel growth. Proc. Natl. Acad. Sci. USA 1993, 90, 8915–8919. [CrossRef] [PubMed] 6. Kim, M.K.; Suh, C.; Chi, H.S.; Cho, H.S.; Bae, Y.K.; Lee, K.H.; Lee, G.W.; Kim, I.S.; Eom, H.S.; Kong, S.Y.; et al. VEGFA and VEGFR2 genetic polymorphisms and survival in patients with diffuse large B cell lymphoma.Cancer Sci. 2012, 103, 497–503. [CrossRef] [PubMed] 7. Carmeliet, P. VEGF as a key mediator of angiogenesis in cancer. Oncology 2005, 69, 4–10. [CrossRef] [PubMed] 8. Sivaprasad, S.; Govardhan, B.; Harithakrishna, R.; Venkat Rao, G.; Pradeep, R.; Kunal, B.; Ramakrishna, N.;Anuradha, S.; Reddy, D.N. Association of vascular endothelial growth factor (VEGF) gene polymorphism and increased serum VEGF concentration with pancreatic adenocarcinoma. Pancreatology 2013, 13, 267–272. [CrossRef] [PubMed] Int. J. Mol. Sci. 2017, 18, 439 9 of 9 9. Kim, D.H.; Xu, W.; Kamel-Reid, S.; Liu, X.; Jung, C.W.; Kim, S.; Lipton, J.H. Clinical relevance of vascular endothelial growth factor (VEGFA) and VEGF receptor (VEGFR2) gene polymorphism on the treatment outcome following imatinib therapy. Ann. Oncol. 2010, 21, 1179–1188. [CrossRef] [PubMed] 10. Glubb, D.M.; Cerri, E.; Giese, A.; Zhang, W.; Mirza, O.; Thompson, E.E.; Chen, P.; Das, S.; Jassem, J.; Rzyman, W.; et al. Novel functional germline variants in the VEGF receptor 2 gene and their effect on gene expression and microvessel density in lung cancer. Clin. Cancer Res. 2011, 17, 5257–5267. [CrossRef] [PubMed]

T2-weighted MRI evaluation in acromegaly  Scanteie Carla-Liana - Validated View

T2-weighted MRI evaluation in acromegaly

Medical Science

Author(s): Scanteie Carla-Liana

Coordinator(s): Professor Cristina Ghervan Ghervan

Keywords: acromegaly T2-weighted MRI somatostatin analogs

Introduction: Acromegaly represents a rare condition of persisting secretion of GH (growth hormone) from a pituitary adenoma, which can be either a micro- or a macroadenoma on the MRI (magnetic resonance imaging). The aim of this study was to evaluate these adenomas according to the T2-weighted signal intensity on the MRI.

Material and Method: We conducted an observational, analytic, retrospective, cohort-type study, where we included 46 acromegalic patients with a mean age of 50.34 ± 11.61 years, 31 of which who followed surgery. The patients were divided according to the T2-weighted MRI signal intensity in hypointense, hyperintense and isointense and were evaluated after surgery and after 12 months with SSA (somatostatin analogs) therapy. The statistical analysis was performed using R version 3.2.3 (2015-12-10). A value of p<0.05 was considered to have statistical significance.

Results: Age at diagnosis, tumor volume and hormonal values were similar for both men and women. The GH values at diagnosis were higher in macroadenomas compared to microadenomas (p=0.05). In T2-weighted sequences, the most frequent adenomas were hypointense (50%). A significant statistic correlation was found between GH levels and tumor volume before and after surgery (Spearman= 0.64, r2=0.56, p<0.0001, Spearman=0.74, r2=0.79, p<0.0001, respectively). The highest percentage of optimally controlled patients with SSA treatment was in hypointense pituitary adenomas (50%). The percentage of uncontrolled patients decreased from 58.7% after surgery to 28.58% after 12 months with SSA analogs.

Conclusion: The most frequent GH-secreting pituitary adenomas on T2-weighted MRI sequences are hypointense, which present a better therapeutic response after surgery and after long-term medical treatment, than the hyper- or isointense adenomas.

Bibliography: [1] Heck A, Emblem KE, Casar-Borota O, Ringstad G, Bollerslev J. MRI T2 characteristics in somatotroph adenomas following somatostatin analog treatment in acromegaly. Endocrine 2016; 53(1): 327-30 [2] Potorac I, Petrossians P, Daly AF, Schillo F, Slama CB, Nagi S et al. Pituitary MRI characteristics in 297 acromegaly patients based on T2-weighted sequences. Endocr Relat Cancer 2015; 22(2): 169-77 [3] Freda PU, Katznelson L, van der Lely AJ, Reyes CM, Zhao S, Rabinowitz D. Long-acting somatostatin analog therapy of acromegaly: a meta-analysis. J Clin Endocrinol Metab 2005; 90: 4465-73

Utility of the omentum in the reconstruction of a complex lower limb wound: a case report  Amarinei Giorgiana - Validated View

Utility of the omentum in the reconstruction of a complex lower limb wound: a case report

Case Report - Poster

Author(s): Amarinei Giorgiana

Coordinator(s): Professor Constantin Ciuce

Introduction:

Free omental tissue transfer is a versatile reconstructive option. It’s recently observed
attributes permits new applications with superb results. The omentum was considered to be
an inert tissue without much biological significance. Since the beginning of the last 
century, studies have proven that the omentum is a unique, physiologically dynamic tissue 
with immense therapeutic potential and exceptional versatility.

Case Presentation:
A 40 year old woman presented with pain, swelling and erythema of the lower right 
limb. Ultrasonography revealed permeable veins and inguinal adenopathy. The patient 
was known and kept under surgical treatment and observation for almost a year, 
with the diagnosis of posttraumatic wound of the posterior compartment of the lower right
limb acquired in 2000 after a carbon monoxide intoxication having associated lymphedema 
and a hematoma. She went through 3 surgeries and vacuum therapy during this year,
all unsuccessful, with recurrent infections and with poor long-term prognosis regarding 
the future viability of the limb. That is because the surgeries led to a large defect, following
the extensive debridements of the necrotized tissue. Besides, the bacteriological examination
of the wound was positive for MRSA. Due to all these, we decided for an omental
free-tissue transfer. Omentum was transferred and revascularised on the right 
internal saphenous vein and the right superficial femoral artery lateralized with the left
internal saphenous vein. After a month we performed a skin grafting on the top of the 
omentum.  The surgery was successful, with expected recovery and no complications. 
A post reconstruction angiotomography was performed, showing good results. 


Conclusion:
This is a useful procedure, especially when it comes to young patients, in which case the possible amputation of the limb in the future can interfere with 
the quality of life. 

Particularities:
Our aim was to present a case of a complex lower limb wound, treated using the omental free tissue transfer technique and the advantages of this approach. 

The ERASMUS syndrome. Particularities of a short series of cases  Stoicănescu Mihaela - Validated View

The ERASMUS syndrome. Particularities of a short series of cases

Case Report - Poster

Author(s): Stoicănescu Mihaela

Coordinator(s): Professor Dan-Lucian Dumitrașcu

Introduction: Students represent a population category with vulnerability to stress. Due to the advent and spread of ERASMUS mobilities, many students live and learn abroad for longer periods. Some of these do not cope with the new conditions and develop a posttraumatic stress disorder (PTSD), called ERASMUS syndrome. We report here a series of three cases.

Case Presentation: Case 1: A male student, diligent and with good  social skills, was sent out in the Southern part of a Mediterranean country for a semester. Surprisingly, he developed there panic attacks, felt himself endangered, feared violent attacks against him, blamed the officers who intermediated his stage abroad and returned after less than 2 weeks, very unhappy for the time spent. Back home he returned to a normal life and activity.

Case 2: A male student who selected a stage in the same country became nervous before leaving, considered himself badly advised in this choice and few days before departure refused to leave because of anxiety.

Case 3: An incoming female student from a Western country became very demanding, vocal and aggressive few weeks after the arrival at the host university. Despite any effort to meet her demands, she remained until the end of her stage unhappy and vociferous.

Conclusion: This is the first report of a short series of cases with PTSD developed during the ERASMUS stage. It proves the reality of the ERASMUS syndrome.

Particularities: Case 1 was the first encountered in our area. Case 2 developed PTSD even before departure. Case 3 manifested rather an aggressive, not an anxious personality.

AN UNUSUAL CAUSE OF ANGINA PECTORIS IN A PACIENT WITH SITUS INVERSUS TOTALIS AND CONGENITALLY CORRECTED TRANSPOSITION OF THE GREAT VESSELS  Tudorache Alina-Maria , Voicu Andrei Comănescu Maria, Crăciun Roxana-Ionela, Robu Mihaela Cornelia Validated View

AN UNUSUAL CAUSE OF ANGINA PECTORIS IN A PACIENT WITH SITUS INVERSUS TOTALIS AND CONGENITALLY CORRECTED TRANSPOSITION OF THE GREAT VESSELS

Case Report - Poster

Author(s): Tudorache Alina-Maria, Voicu Andrei

Coauthor(s): Comănescu Maria, Crăciun Roxana-Ionela, Robu Mihaela Cornelia

Coordinator(s): Assistant Professor Roxana Enache




CLOSTRIDIUM DIFFICILE INFECTION OCCURRENCE IN HOSPITALIZED PATIENS   Prună Anca - Invalidated View

CLOSTRIDIUM DIFFICILE INFECTION OCCURRENCE IN HOSPITALIZED PATIENS

Medical Science

Author(s): Prună Anca

Coordinator(s): MD Ligia-Ariana Bancu

Keywords: Clostridium difficile antibiotics nosocomial infection diarrheal desease

Introduction: Clostridium difficile infection is a major cause of antibiotic-associated diarrhea and colitis. Worldwide, the incidence of infection with this organism is increasing in hospitals, consequent to the widespread use of broad-spectrum antibiotics. A large percentage of patiens die within 30 days after diagnosis. Metronidazole treatment failure in severe disease or presence of toxic megacolon lead to a poor prognosis.

Material and Method: We conducted a retrospective descriptive study on a group of 49 patiens set in the Department of Internal Medicine of Mures County Emergency Clinical Hospital. We reviewed all cases of hospitalised adult patients, who developed the symptoms of Clostridium difficile infections at least 72 hours after admission, between january 2015 and december 2016. The statistical analysis was executed with the program Microsoft Office Excel.  

Results: During these 24 months, 49 patients were admited for bacterial confirmed infections (GDH test for C. Difficile, toxin in the stool stamples, and cultures). The gender distribution was approximately equal (55,1 % females and 44,9 % males), and 91.83 of them were least 50 years old. 59,18 % of patients were treated with antibiotics in the past and 13,79 of them were also treated with proton pump inhititors. Interesting fact is that a large percentage of those who took antibiotics, to be exactly 44,82 % were treated for diffrent types of pneumonia, and the most involved class of antibiotics were cephalosporins. 20,4% of patients were immunosuppressed. From 49 patients, we had 3 with relapses (6,12%), 2 complication of the desease with pseudomembranous colitis (4,08%), 2 with toxic megacolon (4,08%), and 9 deaths (18,36%) related to comorbidities. 

Conclusion: It is uncommon for people who are not taking antibiotics to become infected with C. difficile. However, even mild to moderate C. difficile infections can quickly progress to a fatal disease if not treated promptly. 

Bibliography: 1. Riggs MM, Sethi AK, Zabarsky TF, et al. Asymptomatic carriers are a potential source for transmission of epidemic and nonepidemic Clostridium difficile strains among long-term care facility residents. Clin Infect Dis 2007; 45:992. 2. Drew RJ, Boyle B. RUWA scoring system: a novel predictive tool for the identification of patients at high risk for complications from Clostridium difficile infection, J Hosp Infect , 2009, vol. 71 3. Gorbach SL. Antibiotics and Clostridium difficile, N Engl J Med , 1999, vol. 341

Selective α7 nicotinic acetylcholine receptor partial agonist, the missing key in the Combination therapy of AD  Ognean Mihai Razvan , Oncu Vlad - Invalidated View

Selective α7 nicotinic acetylcholine receptor partial agonist, the missing key in the Combination therapy of AD

Case Report - Poster

Author(s): Ognean Mihai Razvan, Oncu Vlad

Coordinator(s): Associate Professor Alina Sovrea

Introduction: Alzheimer's disease (AD) is a neurodegenerative condition characterized by increased accumulation of Aβ, neurofibrillary tangles and degeneration of cholinergic signaling between basal forebrain and hippocampus. Also a typical marker in AD is the presence of activated microglia, reactive astrocytes and inflammatory mediators in the hippocampus. There are studies that show there is a cholinergic anti-inflammatory system within the brain that is involved in reducing or preventing the neurodegeneration. The effects of this systems are mediated by the α 7 receptor. By targeting the α7-nAChR one can observe clinical improvements in the cognitive function. The purpose of our study is to show that by combining a cholinergic agonist and an AChE inhibitor (that are currently used as a treatment for AD) results in a better cholinergic dysfunction alleviation, thus improving cognitive functions and a decrease in the neurodegenerative process.

Case Presentation: We took into consideration three cases of AD with similar symptoms (retrograde amnesia, temporo-spatial disorientation, attention deficit, etc.) and treatment (Donepezil).After a long treatment with ACh esterase inhibitor, there were only small improvements in their cognition status( MMSE 17, GAFS 56). 

Conclusion: EnVivo launched 2 trials : 49 patients with Phase1b AD and 409 with Phase 2b AD. In both trials the patients were on stable donepezil or rivastigmine therapy. After 23 weeks of  2 mg dose of EVP-6124, there was a significant improvement in cognition (p=0,00189).High selective α7-nAChR agonists such as EVP-6124  in combination with a cholinesterase inhibitor may be the key in reducing the cognitive disfunction of AD patients, tackling both the ACh deficit and the reduced activity of alfa7-nAChR (due to receptor deficit). 

Particularities: In this way, new strategies should be taken into consideration for the treatment of AD.

PANCREATIC ASCITES: A PECULIAR COMPLICATION OF CHRONIC PANCREATITIS IN A PATIENT WITH UNDERLYING LIVER DISEASE   Pirga Iulia-Alexandra , Popescu Lucian Pirvu Ramona, Ionescu Simona Mihaela, Popa Elena Georgiana Validated View

PANCREATIC ASCITES: A PECULIAR COMPLICATION OF CHRONIC PANCREATITIS IN A PATIENT WITH UNDERLYING LIVER DISEASE

Case Report - Poster

Author(s): Pirga Iulia-Alexandra, Popescu Lucian

Coauthor(s): Pirvu Ramona, Ionescu Simona Mihaela, Popa Elena Georgiana

Coordinator(s): Assistant Professor Tatiana Ivan




FOODBORNE IN THE MURES COUNTY IN TWO DIFFERENT PERIODS OF TIME AND THEIR INFLUENCE ON PEOPLE  Andrei Moșescu Köllő-Fehérvári Adrienn, Andrei-Vlad Lefter, Sas Aurel Romeo Invalidated View

FOODBORNE IN THE MURES COUNTY IN TWO DIFFERENT PERIODS OF TIME AND THEIR INFLUENCE ON PEOPLE

Fundamental Science

Author(s): Andrei Moșescu

Coauthor(s): Köllő-Fehérvári Adrienn, Andrei-Vlad Lefter, Sas Aurel Romeo

Coordinator(s): Lecturer Felicia Toma

Keywords: Foodborne Salmonella Correlations Factors

Introduction: The main goal of my study is to analyze the main factors leading to foodborne on the citizens of Mures county. The second goals are to analyze the correlations between these factors and their importance in preventing the future foodborne.

Material and Method: This study involved the data collected from 100 patients from Infectious Hospital Disease in Targu Mures. The data were collected from the hospital medical records. Statistical analysis was performed using, Fisher’s exact test and Chi-square test.

Results: We found out some of the factors that leads to foodborne such as etiology, the period of time when the foodborne took place and the site contamination. We found out a p<0,0001 for the correlation between etiology and the period of time when the foodborne took place. We’ve also found out a p=0,004 for the correlation between etiology and the site contamination. Both results are considered to be scientific significantly.

Conclusion: Foodborne with Salmonella are more frequent in ride and the foodborne with other etiologies such as Trichinella, Staphylococcus aureus are more frequent at home. The number of foodborne with Salmonella has decreased significantly in the years of 2004-2005 towards the years of 1997-1998. Also we can conclude after comparing more other factors leading to foodborne such as the age, the sex of the patients and the combination between them, that there is no relationship between foodborne and this kind of factors.

Bibliography: - https://www.ncbi.nlm.nih.gov/pubmed/28383345 - https://www.ncbi.nlm.nih.gov/pubmed/28375673 - http://reference.medscape.com/features/slideshow/food-poisoning - http://emedicine.medscape.com/article/968672-overview - http://reference.medscape.com/viewarticle/845960

Rare association of three autoimmune diseases: Diabetes Mellitus type 1, Hashimoto Thyroiditis and Gluten-Sensitive Enteropathy, accompanied by a neurological disease: Epilepsy  Horiceanu Andreea - Invalidated View

Rare association of three autoimmune diseases: Diabetes Mellitus type 1, Hashimoto Thyroiditis and Gluten-Sensitive Enteropathy, accompanied by a neurological disease: Epilepsy

Case Report - Poster

Author(s): Horiceanu Andreea

Coordinator(s): Lecturer Adriana Fodor , Assistant Professor Alina Gabriela Duțu

Introduction: The association of two autoimmune diseases in a patient is not rare; the combination of three autoimmune diseases: Hashimoto thyroiditis, type 1 diabetes mellitus and celiac disease is quite infrequent, while their occurrence together with epilepsy make a rare and interesting case. The genetic factors have a major role on the association.

Case Presentation: A 13-year-old female patient presents herself to the Diabetes, Nutrition and Metabolic Diseases Center, Cluj-Napoca for periodic control. The patient is registered in the medical records with type1 diabetes mellitus (diagnosed in December 2009 and started treatment with insulin pump in January 2010), autoimmune thyroiditis (diagnosed in 2012 for which is prescribed Euthyrox 62,5 micrograms/day) and celiac disease (diagnosed in 2015 controlled with a gluten-free diet). The patient is also known for a neurological disease, epilepsy (diagnosed in 2012). Her last blood tests: HbA1c=9,2%, fasting plasma glucose level =112 mg/dl, GGT=9 U/L, Iron=26µg/dL, TSH=6,2µU/mL, FT4=1.03pmol/L, AntiTPO=982UI/mL, Hb=11,5 g/dL certify the previous diagnostics and highlight the iron deficiency anemia for which was prescribed iron supplements. On further investigation we discovered in the family history that the mother (39 years old) is suffering of the same type of diabetes (diagnosed by the age of 9), and hypothyroidism as well (for which is also prescribed Euthyrox). 

Conclusion: The association is composed by four genetic determined diseases, 3 of them autoimmune and one neurological. The treatment is a difficult task, considering the patient's age and its influence on her growing process.

Particularities:

The combination of three autoimmune diseases is rare, especially in our case where is accompanied by a neurological one. Many studies have shown that the genetic defect which is responsible for them is located on the same chromosome, the sixth one. 

A CASE OF ANTISYNTHETASE SYNDROME  Stanciu Ilona Andreea , Sinescu Alexandra Maria Stoica Roxana-Marinela, Popescu Raluca Mihaela, Stan Danaida Carmen Validated View

A CASE OF ANTISYNTHETASE SYNDROME

Case Report - Poster

Author(s): Stanciu Ilona Andreea, Sinescu Alexandra Maria

Coauthor(s): Stoica Roxana-Marinela, Popescu Raluca Mihaela, Stan Danaida Carmen

Coordinator(s): Assistant Professor Marius Florea

Introduction: Antisynthetase syndrome is an autoimmune disorder characterized by inflammatory myopathy and interstitial lung fibrosis. Anti-JO-1 are the most frequently associated antisynthetase antibodies.

Case Presentation: A 66 year old woman, showing dyspnoea, dry cough, proximal myalgia, small joint polyarthritis, aphonia and malaise, presented to ,,CFR Hospital’’ Craiova. Laboratory evaluation showed increased ESR, LDH, RF, and Anti-JO-1 positivity. Chest radiography showed interstitial lung fibrosis. CT scan showed ”ground glass’” and ”honeycombing’’ pattern, fibrotic linear opacities and bronchiolitis. The diagnosis was antisynthetase syndrome and treatment with glucocorticoids – Medrol 16mg, q.d. and immunosuppressive agents – Azathioprine 50mg, b.i.d. – in association with PPI and Ca and Vitamin D was initiated. After 6 months, overall clinical and biological status improved but she developed Diabetes mellitus. GC taperig to 8mg q.d., AZA increase to 50mg t.i.d and addition of oral antidiabetic medication were considered and initiated, maintaining for the next 6 months the same beneficial treatment results.

Conclusion: The clinical pattern consisting in inflammatory miophaty and symptomatic interstitial lung fibrosis should always be considered  in the setting of antisynthetase syndrome. Antisynthetase antibodies, particularly anti-JO-1, are the most common immunological trait. GC in association with immunosuppressive agents are frequently used for treatment with good results. Close monitoring is the key to successful treatment and early identification of treatment adverse events.

Particularities: The particularity of this clinical case is that after 6 months of Medrol  the pacient  developed diabetes mellitus. Also the symptomatology started  with coughing and dyspnoea.

WILKIE’S SYNDROME: AN UNCOMMON CAUSE OF RECURRENT EMESIS  Voicu Andrei , Tudorache Alina-Maria Carnariu Georgiana, Dascalescu George Razvan Validated View

WILKIE’S SYNDROME: AN UNCOMMON CAUSE OF RECURRENT EMESIS

Case Report - Poster

Author(s): Voicu Andrei, Tudorache Alina-Maria

Coauthor(s): Carnariu Georgiana, Dascalescu George Razvan

Coordinator(s): Assistant Professor Vasile Daniel Balaban

Introduction: Wilkie’s syndrome or superior mesenteric artery (SMA) syndrome is a rare clinical entity comprising 1% of the cases of small intestinal obstruction. It is characterized by the entrapment and compression of the third part of the duodenum in the angle between the aorta and the SMA.

Case Presentation: A 63-year-old male, non-smoker, without significant past medical history, presented to the emergency room for unremitting vomiting, pain in the upper abdomen and significant weight loss during last few weeks. There was no history of dietary or alcohol abuse, recent trauma or surgery. The patient was extremely weak with signs of severe dehydration. Physical examination on admission revealed a distended abdomen with epigastric tenderness, hyperactive bowel sounds and a BMI of 19.5. There was no palpable organomegaly. Laboratory investigations showed mild anemia (hemoglobin 10g/dl), hypokalemia (3 mEq/L) and elevated CRP (9 mg/l); the rest of the laboratory workup was normal.  Plain abdominal radiograph showed a dilated stomach with a prominent air fluid level. Upper GI endoscopy was performed, which did not reveal any mucosal lesions. A CT was ordered which revealed distended stomach and duodenum proximal to the third part, which was compressed in the aortomesenteric angle; while, the angle between SMA and the aorta is 22 to 60 degrees, in this case, the aortomesenteric angle was 15.5. A diagnosis of Wilkie’s syndrome was set and conservative management was initiated. Because of its inefficiency the patient was transferred to surgery where a gastrojejunal anastomosis was performed. After an uneventful postoperative period, he was discharged symptom-free five days later.

Conclusion: Since its first comprehensive description by Wilkie, few cases have been reported in medical literature. Because of its rarity and non-specific symptoms, vomiting, upper abdominal pain or constipation, it can represent a real challenge for an unwary clinician.

Particularities: Considering the patient age and symptoms, a malignant pathology was suspected, whereas it was, in fact, as benign as it may be.

5 DECADES WITH A 3 CHAMBER HEART: A RARE CASE OF DOUBLE INLET SINGLE VENTRICLE   Panopoulou Georgia , Prasinos Ioannis Nasasra Mhamad , Ziadat Amjad Validated View

5 DECADES WITH A 3 CHAMBER HEART: A RARE CASE OF DOUBLE INLET SINGLE VENTRICLE

Case Report - Poster

Author(s): Panopoulou Georgia, Prasinos Ioannis

Coauthor(s): Nasasra Mhamad , Ziadat Amjad

Coordinator(s): Associate Professor Catalina Lionte

Introduction:

A double inlet single ventricle is a rare congenital heart disease, of complex anatomy, comprising 1% of all congenital heart diseases. Venous and arterial blood is inevitably mixed in the single ventricle that pumps blood to the body and lungs leading to various degrees of cyanosis.


Case Presentation: We present an unusual case of a 47 year-old female, known with a single ventricle since her hospitalization for an episode of subacute endocarditis in 2010. On inspection, she presents erythrocyanosis of the face, cyanosis of the extremities and nail clubbing. Palpable systolic thrill is felt over pulmonary area. On auscultation, systolic murmur grade VI/VI is audible over the pulmonary valve and systolic murmur IV/VI over the apex. Echocardiography reveals double inlet single hypertrophic ventricle, of left type, two atria that drain into it via a left and right AV valve, transposition of the great arteries, severe pulmonary artery stenosis and left AV valve insufficiency grade II-III, after partial correction with prosthetic ring Sorin 28 and artficial chordae tendinae. She developed heart failure NYHA III and secondary polycythemia due to chronic hypoxia. 
Conclusion: Our patient is medically treated for heart failure and polycythemia with diuretics, ARBs, antiarrhythmics, oral anticoagulants and phlebotomy when hematocrit is over 55%. A healthy lifestyle is also indicated.   

Particularities:

The single ventricle is accompanied by pulmonary stenosis, which acts as a protective barrier between the pulmonary vasculature and the high pressures of the solitary ventricle that would lead in very severe pulmonary hypertension not compatible with life. Thus, the pulmonary stenosis has a favorable effect for our patient and contributes to her astonishing long-term survival and good quality of life without surgical treatment.

Osteitis fibrosa cystica as a complication of end-stage renal disease with tertiary hyperparathyroidism  Pelea Cristina Pop Andreea Crina Validated View

Osteitis fibrosa cystica as a complication of end-stage renal disease with tertiary hyperparathyroidism

Case Report - Poster

Author(s): Pelea Cristina

Coauthor(s): Pop Andreea Crina

Coordinator(s): Lecturer Olga Hilda Orășan




Jejunal diverticulum- a rare cause of acute abdomen  Laza Yasmina , Lup Maria - Validated View

Jejunal diverticulum- a rare cause of acute abdomen

Case Report - Poster

Author(s): Laza Yasmina, Lup Maria

Coordinator(s): MD Vlad Nicolae Dudric

Introduction:

Jejunal diverticulosis are rare, incidence being less than 0.5%.  It is defined as the herniation of the mucosa and the submucosa from the inside of the muscular layer of the bowel. Often asymptomatic, it may lead acute symptoms similar to appendicitis or colonic diverticulitis. Perforated jejunal diverticulum is one of the rare causes of acute abdomen generally seen in the elderly.


Case Presentation: We report a case of a 69-year-old male patient who had presented with complaints about abdominal pain, nausea, and vomiting. He also related having diarrhoea. He had multiple comorbidities: gastritis, second type diabetes, high essential blood pressure and fatty liver disease. CT of the abdomen demonstrates the presence of extra luminal gas and fluid in the absence of pneumoperitoneum in upper left abdominal quadrant.  A laparotomy was performed, confirming the presence of localized peritonitis due to the perforation of a  jejunal diverticulum 40 cm distal to the duodeno-jejunal flexure. A segmental resection and primary anastomosis, were performed.  The patient had an uncomplicated postoperative course and was discharged after 5 days.
Conclusion:
Although jejunal diverticulum is rare and may be a disease which might
be difficult to diagnose, it must be included in the differential diagnosis of
acute abdomen. In the case of perforation and peritonitis, exploratory laparotomy, segmental
resection and primary anastomosis remains the preferred interventions. 



Particularities: We reported a rare case of acute abdomen caused by a perforated jejunal diverticulum which was diagnosed intraoperative and was  treated laparoscopically. 

COMPARATIVE DATA BETWEEN CLINICAL AND AUDIOLOGICAL INVESTIGATIONS ON PATIENTS WITH CHRONIC SUPPURATIVE OTITIS MEDIA  Cotoi Anamaria Roxana , Russu Mihai Emil Neagos Cristian, Ciubotariu Calina Validated View

COMPARATIVE DATA BETWEEN CLINICAL AND AUDIOLOGICAL INVESTIGATIONS ON PATIENTS WITH CHRONIC SUPPURATIVE OTITIS MEDIA

Surgical Science

Author(s): Cotoi Anamaria Roxana, Russu Mihai Emil

Coauthor(s): Neagos Cristian, Ciubotariu Calina

Coordinator(s): Lecturer Adriana Neagoș

Keywords: hearing loss CSOM otoscopy audiometry

Introduction: Chronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear and mastoid, which involves tympanic membrane perforation and chronic persistent drainage (more than 6 weeks).The main symptoms are painless otorrhea and hearing loss. Our objective was to find the correlation between clinical and audiological aspects in CSOM. 

Material and Method: In a retrospective observational descriptive study we included a group of 68 patients (18-75 years old) hospitalized with CSOM in the Otorhinolaryngology Clinic of Targu-Mures between 2013-2014. In order to do the paper we analyzed a number of parameters from the patients sheets such as clinical signs and symptoms, demographic data, ENT clinical examination (otoscopy), tonal audiometry and final diagnostic results. The main inclusion criteria was the final diagnosis of simple CSOM. For processing patient data we used Microsoft Excel and we worked with the GRAPHPAD software in which we used the CHI squared test to carry out the statistical analysis

Results: Statistical analysis has showed no correlation between the initial diagnosis of CSOM and the various types of hearing loss determined by tonal audiometry. Therefore, between the initial diagnosis of CSOM and conductive hearing loss we had a P value of 0.54, and by associating the diagnosis of CSOM with mixed hearing loss the results were P= 0.59, which are both statistically insignificant. Also, the results for neurosensorial hearing loss were similar. 

Conclusion: There is no correlation between the diagnosis of simple chronic suppurated otitis media and the types of hearing loss. Also, the majority of patients had conductive hearing loss which has a better outcome.

Bibliography: 1. Madell JR - Impact of otitis media on auditory function, in : R.M. Rosenfeld, C.D. Bluestone (Eds.), Evidence-based Otitis Media, B.C. Decker, Hamilton, 1999, 337-352 2. Neagos A - Notiuni de diagnostic si tratament in Otorinolaringologie, University Press, Tirgu-Mures, 2013, 292-293 3. V. Ciuchi-Patologia Inflamatorie Cronica A Urechii Medii. Sechelele Postotitice, Ed. Medicala, Bucuresti, 2004 4. A. Blitzer, J. Schwartz, P. Song, N. Young- Oxford American Handbook of Otolaryngology, Oxford University Press, 2008

FEMORAL ARTERY PSEUDOANEURYSM: AN EARLY COMPLICATION OF VENTRICULAR TACHYCARDIA ABLATION  Chibulcutean Andreea Simina , Almășan Iulia Bianca - Validated View

FEMORAL ARTERY PSEUDOANEURYSM: AN EARLY COMPLICATION OF VENTRICULAR TACHYCARDIA ABLATION

Case Report - Poster

Author(s): Chibulcutean Andreea Simina, Almășan Iulia Bianca

Coordinator(s): Assistant Professor Radu Roșu

Introduction: Monomorphic ventricular tachycardia (VT) in patients with post-infarction cardiomyopathy is caused by reentry through conducting tissue within areas of myocardial scar. Experience with catheter ablation has progressed substantially in the past years, and is now recommended as treatment for patients with structural heart disease who experience symptomatic sustained monomorphic VT. Depending of the hemodynamic tolerance of VT, a variety of mapping techniques may be used to identify sites for catheter ablation, including voltage and activation mapping.

Case Presentation: We report a case of a 62-year-old male with recurrent monomorphic ventricular tachycardia related to a post-infarction cardiomyopathy. The personal history of the patient revealed acute myocardial infarction conservatively treated in 1992, PTCA stenting of LCx and LAD in 2001, electrophysiology study with a non-inducible VT under Amiodarone and AVNRT ablation in 2002.  The ECG at rest revealed abnormal Q waves in inferior leads and in crisis monomorphic wide QRS complex greater than 200 ms on a rate of 150 beats/min. Echocardiographic, the left ventricular ejection fraction was preserved (LVEF= 69%). Due to the recurrent episodes of VT, an electrophysiology study with 3D mapping and radiofrequency ablation was performed with success. Post-procedural, the patient developed a femoral pseudoaneurysm that required the anticoagulation to be stopped immediately, which caused spontaneous partial thrombosis due to lack of recommended treatment. The pseudoaneurysm closed spontaneously without any further complications.

Conclusion: Taking into consideration the fact that VT was non-inducible post-ablation, the outcome of the patient is good, but it also depends on the underlying disease, which led to scar formation of 8.7% of the left ventricle and a LVEF greater than 55%.

Particularities: The femoral pseudoaneurysm is a rare vascular complication with an incidence of 0-8% in patients that underwent an invasive procedure and it can affect the patient outcome due to increased risk of thromboembolic events.

Limited treatment options for a 24-year-old patient with idiopathic pulmonary arterial hypertension  Andriescu Gabriela , Chiriac Andra-Mădălina Străinu Ana-Maria Invalidated View

Limited treatment options for a 24-year-old patient with idiopathic pulmonary arterial hypertension

Case Report - Poster

Author(s): Andriescu Gabriela, Chiriac Andra-Mădălina

Coauthor(s): Străinu Ana-Maria

Coordinator(s): Professor Cătălina Arsenescu Georgescu , Assistant Professor Carmen Elena Pleșoianu

Introduction: Idiopathic pulmonary arterial hypertension (IPAH) is a rare disease of unknown cause, characterized by an abnormal increase in pulmonary arterial pressure and pulmonary vascular resistance due to vasoconstriction and vascular remodeling of small pulmonary arteries. Despite improved pathophysiological understanding, IPAH remains a severe and progressive disease, associated with right heart failure, significant morbidity and early mortality.

Case Presentation:

We present the clinical case of a 24-year-old woman, known from the age of 13 with allergic asthma and diagnosed at the age of 21 with IPAH. Despite diuretic therapy and treatment with sildenafil and bosentan, she was admitted to the hospital for decompensated right heart failure in the context of corticosteroid therapy for asthma. Upon  physical examination she presented bilateral lower limb edema, hepatomegaly and sibilant rales. Cardiac auscultation revealed a III/VI systolic murmur in the tricuspid area. The echocardiography showed dilation of the right cavities with compression of the left ventricle, systolic dysfunction of the right ventricle, severe pulmonary arterial hypertension and pericardial effusion while abdominal ultrasonography revealed hepato-splenomegaly and ascitis. Intravenous diuretics and inotropic drugs were administered in order to reduce fluid overload, while maintaining optimal blood pressure levels. Heart-lung transplantation is the only curative solution in this case, therefore the patient was added to the waiting list. A major setback is the diagnosis of hepatitis C which delays the procedure.


Conclusion: The association between two pulmonary pathologies (asthma frequently requiring corticosteroid therapy and IPAH) determined progressive severe heart failure in this young patient whose last resort is a heart-lung transplantation.

Particularities: Limited therapeutical resources in a young patient due to a fatal pulmonary combination, worsens the prognosis. Also, the diagnosis of hepatitis C delays the heart-lung transplantation.

Multiple primary malignancies: Case report of synchronous appearance of prostate and rectal adenocarcinomas  Pasca Gina-Iulia Covaciu Alexandra Corina, Muntean Delia Doris, Oltean Paula Anca Validated View

Multiple primary malignancies: Case report of synchronous appearance of prostate and rectal adenocarcinomas

Case Report - Poster

Author(s): Pasca Gina-Iulia

Coauthor(s): Covaciu Alexandra Corina, Muntean Delia Doris, Oltean Paula Anca

Coordinator(s): Lecturer Liliana Dina Dina

Introduction: Multiple primary malignancies (MPMs) are defined as two or more cancers with no subordinate relationship occurring either simultaneously or not in the same patient. The incidence of MPMs is 2-6.3% of all cancers. Cases of synchronous prostate and colorectal adenocarcinomas have been sporadically reported.

Case Presentation: C.T, a 71-year-old man with intermittent history of rectal bleeding and pelvic pain was admitted to IRGH hospital. He had associated complaints such as weight loss and constipation. A digital rectal examination revealed a rigid, painful mass located 6 cm away from the anal verge. Laboratory tests were at normal level, except the serum carcinoembryonic antigen (CEA=100 U/mL3) and cancer antigen 19.9 (CA 19.9=400 U/mL3). Colonoscopy showed vegetant-ulcerative mass and the biopsy confirmed a moderately differentiated adenocarcinoma of rectum. CT scan demonstrated a semi-circumferentially, stenosed mass located on the distal rectum with multiple metastases (pulmonary, hepatic, intra-abdominal). For tumor extension, the pelvic MRI revealed rectal mass with invasion to adjacent structures, such as the prostate, and also a synchronous tumor of prostate with invasion in the bladder wall. The patient reported no urinary symptoms, but the elevated PSA (11.53 ng/ml) and biopsy confirmed the prostatic adenocarcinoma (Gleason grade=4+5).

Conclusion:

The diagnosis of synchronous prostate and colorectal cancers is an uncommon co-incidental finding. A multidisciplinary approach including rectal surgery, radiation, hormones and chemotherapy, as used in this case, is a feasible treatment option. Further follow-up is necessary to assess chronic morbidity and long term outcome.


Particularities:
Three criteria must be fulfilled in order to characterize MPMs: (I) each tumor must be distinct from each other; (II) each tumor must present definite features of malignancy; and (III) the possibility that one is a metastasis of another must be ruled out. Therefore, this case is noteworthy for the occurrence of synchronous cancers and their unusual composition and histological types.

The effects of sleep deprivation on cardiovascular parameters  Lider Burciulescu Sofia Maria - Validated View

The effects of sleep deprivation on cardiovascular parameters

Fundamental Science

Author(s): Lider Burciulescu Sofia Maria

Coordinator(s): Lecturer Raluca Papacocea , Professor Ioana Anca Badarau

Keywords: sleep deprivation heart rate on-call duty cardiovascular

Introduction: It is known that the total duration of sleep in healthy adults has an average between 7 and 8 hours per night. Sleep deprivation is becoming a problem that affects a big part of the population, and involves all social categories. Among these, one of the most affected categories by this problem is represented by physicians and medical students, especially in East European countries. The purpose of our study is to analyze the effect of sleep deprivation on cardiovascular functions on residents and medical students after continuous 24h on-call duty.

Material and Method: In our study, we have included residents, and students- aged between 22-33 years old, 12 men and 14 women. We have evaluated their cardiovascular function using electrocardiography and arterial blood pressure measurement using the manometric method, before and after one night of call duty.Each of the subjects remained awake the entire night and consumed either coffee or caffeinated drinks such as coca-cola during this period. As consequence, a caffeine unit was described. 
Results:  Surprinsingly all subjects have a decrease in their heart rate after one night of sleep deprivation - Mean: 79,77 b/min before to 71,62 b/min after(p = 0,000), also the medium arterial blood pressure is lower after the overnight call (from mean- 93,8438 mmHg before to 86,3504 mmHg after). Moreover, we have documented on EKG, an early repolarisation syndrom in 69,2% of cases.

Conclusion: Acute sleep loss for 24 hours, due to continuously, intense on-call work, modifies several cardiovascular parameters; heart rate, medium arterial blood pressure and heart repolarization, which is associated in litterature with risk of life-threatening arrhythmias. 

Bibliography: 1. Abdi Ali, Nida Butt, Azeem S.Seikh- „Early repolarization syndrome: A cause of sudden cardiac death”; World J Cardiol. 2015 Aug 26; 7(8): 466–475

Smoking habits and anti-CCP antibodies in patients with Rheumatoid Arthritis  Chirea Gabriela , Mangaloiu David - Validated View

Smoking habits and anti-CCP antibodies in patients with Rheumatoid Arthritis

Medical Science

Author(s): Chirea Gabriela, Mangaloiu David

Coordinator(s): Assistant Professor Isabela Maria Sarbu

Keywords: Rheumatoid Arthritis anti-CCP antibodies smoking

Introduction: Anti-cyclic citrullinated peptide (anti-CCP) antibodies show high specificity for rheumatoid arthritis (RA). The aim of the study was to investigate the correlation between smoking and high levels of anti-CCP antibodies in patients with RA. The secondary objectives were to evaluate the association between smoking and the disease activity and, respectively, radiological progression.

Material and Method: The retrospective study included 147 patients diagnosed with RA in the Rheumatology Department based on the American College of Rheumatology (ACR) criteria. Anti-CCP antibodies were measured by enzyme-linked immunosorbent assay (ELISA) in the serum. The smoking habits of the patients were also assessed. The other variables we evaluated were: the onset of the disease, the family history, C reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels, hand and wrist imaging. Disease activity was measured using DAS28 (Disease Activity Score based on evaluation of 28 joints). The present and past treatment of patients was reviewed. 

Results: The mean value of the anti-CCP antibodies was higher in smokers than in non-smokers (306 U/ml I vs. 289 U/ml) but the difference was not statistically significant (p>0.05). However, the study shows that smokers have a 2.33 fold higher risk of developing a form of RA with positive anti-CCP antibodies than non-smokers (p<0.05; r=0.15). Smokers were more likely to develop a severe disease. There were no significant differences between the radiological progression of disease in smokers and non-smokers. However, smokers required switching to other therapies more often than non-smokers. Smokers were also more likely to require novel therapeutic agents such as biological therapies earlier in their treatment. 

Conclusion: This research study showed that there is no statistically significant increase in the level of anti-CCP antibodies in smokers as compared to non-smokers. However, smokers were more likely to develop RA with positive anti-CCP antibodies. The disease was more severe in smokers than in non-smokers.

Bibliography: emedicine.medscape.com/

INCIDENTAL DIAGNOSIS IN A CASE OF ADULT-ONSET METACHROMATIC LEUCODISTROPHY   Beldean Ana Calina Moldovan Florina, Blaga Ioana Invalidated View

INCIDENTAL DIAGNOSIS IN A CASE OF ADULT-ONSET METACHROMATIC LEUCODISTROPHY

Case Report - Poster

Author(s): Beldean Ana Calina

Coauthor(s): Moldovan Florina, Blaga Ioana

Coordinator(s): MD Ioana Blaga

Introduction: Metachromatic Leukodystrophy (MLD) is an autosomal recessive rare degenerative disorder caused by a mutation in the arylsulfatase A (ARSA) gene. The defective structure or function of the arylsulphatase A leads to abnormal accumulation of cerebroside sulfate in the lysosomes, thus MLD being considered a sulfatide lipidosis. Depending on the time of onset of the clinical features the disease has 3 forms: late infantile, juvenile and adult. Unlike the early onset types,  in the adult-onset form, symptoms begin after 16 years of age (most common in the 3rd or 4th decade) and the patients have  a better prognosis, with increased life expectancy. Psychiatric symptoms are more frequent,  psychosis is  common, and the progressive loss of cognitive and motor functions appear later. There is no curative treatment for MLD, currently the bone marrow transplant- if performed in the presymptomatic period- has been shown to be efficient in prolonging the symptom free evolution in selected cases. 

Case Presentation: A 19 years old patient presented to the neurologist for recurrent syncopes.  While the neurological consult and  the EEG showed no abnormalities ,the cerebral MRI revealed  white matter lesions  highly suggestive for MLD.  Decreased levels of activity of the arylsulfatase A were depicted in the leukocytes. The cardiological exam and TILT table test made the diagnosis of orthostatic hypotension, that explained the syncopal episodes the patient presented.

Conclusion: Corroborating the specific MRI findings with decreased activity of arylsuphatase A, the diagnosis of MLD was made, even if, at the moment of the investigations the patient presented no signs or symptoms of MLD. Genetic counseling and genetic diagnosis is recommended.

Particularities: We report here a case of an adult-onset MLD, which is particular by the discordance between the clinical presentation that is nonspecific and the paraclinical results which  indicate a disease of great gravity.

RENAL COLIC AND PAROXYSMAL ATRIAL FIBRILLATION: TWO CONDITIONS OR ONLY ONE? - CASE REPORT  Balaceanu Beatrice , Gurau Cristian-Dorin Olteanu Diana, Staiculescu Raluca, Suta Tatiana Validated View

RENAL COLIC AND PAROXYSMAL ATRIAL FIBRILLATION: TWO CONDITIONS OR ONLY ONE? - CASE REPORT

Case Report - Poster

Author(s): Balaceanu Beatrice, Gurau Cristian-Dorin

Coauthor(s): Olteanu Diana, Staiculescu Raluca, Suta Tatiana

Coordinator(s): Lecturer Alice Balaceanu

Introduction:

Renal colic could mimic multiple pathologies as nephrolithiasis, pyelonephritis, diverticulitis, sub-occlusive intestinal syndrome, ruptured abdominal aortic aneurysm.


Case Presentation:

76 years old female presented to the emergency department for acute onset of severe back pain with radiation to the right flank. She had a history of multiple PTCA in the last years, paroxysmal atrial fibrillation, hypertension and hypercholesterolemia. Clinical examination revealed blood pressure 160/90 mmHg, 112bpm irregular pulse, dyspnea, orthopnea, right back pain worsened by deep breath, abdominal distension. Lab tests: in normal limits except leukocytosis (19.50x103/L), neutrophilia (17.90x103/L), hyperglycemia (178 mg/dl), hepatic cytolysis syndrome (AST 146 U/L, ALT 166U/L). ECG: atrial fibrillation 180bpm. Chest x-ray: cardiomegaly. Abdominal x-ray and abdominal ultrasound: in normal limits. Transthoracic echocardiography: dilated left cavities without thrombosis, left ventricular ejection fraction 45%. The initial diagnosis was: right renal colic, paroxysmal atrial fibrillation, NYHA class III heart failure, primary hypertension.

Medical history, paroxysmal atrial fibrillation, the acute onset led to suspicion of abdominal vascular embolism. Abdominal CT showed horseshoe kidney, acute ischemia of the right kidney, caused by acute thrombosis of renal artery branches. Lactic dehydrogenase (1194 U/L) and creatine phosphokinase (149,10U/L) were characteristic for renal infarction.


Conclusion:

Renal thromboembolism is a rare (0,01%), but severe condition in atrial fibrillation, that could remain underdiagnosed.


Particularities:

Common renal colic to a patient with vascular disease and atrial fibrillation hided acute renal thromboembolism.

CLINICAL AND PATHOPHYSIOLOGICAL CHARACTERISTICS IN A YOUNG STRESSED PATIENT WITH HYPERTENSION – CASE REPORT  Gurau Cristian-Dorin , Balaceanu Beatrice Olteanu Diana, Staiculescu Raluca, Suta Tatiana Invalidated View

CLINICAL AND PATHOPHYSIOLOGICAL CHARACTERISTICS IN A YOUNG STRESSED PATIENT WITH HYPERTENSION – CASE REPORT

Case Report - Poster

Author(s): Gurau Cristian-Dorin, Balaceanu Beatrice

Coauthor(s): Olteanu Diana, Staiculescu Raluca, Suta Tatiana

Coordinator(s): Lecturer Alice Balaceanu

Introduction:

Hypertension in young people is secondary, but stress could be an important risk factor.


Case Presentation:

21 years old patient presented for increased blood pressure in the last two months. He has no medical history, he is non-smoker. Physical exam: normal weight, blood pressure (BP) 160/90 mmHg, 75 bpm, regular. Laboratory tests: mild hypercholesterolemia. Abdominal ultrasound: normal right kidney, left kidney 66/48mm, thin parenchyma. Transthoracic echocardiography, thyroid ultrasonography was in normal limits. Ambulatory blood pressure monitoring showed more than 47% of diurnal values greater than 140 mmHg, with diurnal average blood pressure 137/85 mmHg and nocturnal average blood pressure 115/72 mmHg. Pulse pressure was 42.7 mmHg. Serum TSH, free T4, aldosterone, renin and urinary metanephrines, normetanephrines, 3-methoxytyramine, vanillylmandelic acid was in normal limits. Plasma cortisol was 589 nmol/L. Chest CT in normal limits. Contrast enhanced abdominal CT: normal right kidney, left kidney 70 mm, 5 mm cortical thickness, normal shape, position, secretion and excretion. Angiography showed two left renal veins, one of them over the artery, but with normal caliber of the left renal artery.


Conclusion:

Stress is responsible for a lot of physiological changes, including constant increase in blood pressure. The scale of cardiovascular risk should be reevaluated to young people through proper trials.


Particularities:

BP values occurred in conditions of a job with a lot of stress to a young patient with a left kidney malformation, but with normal renal function. 

THE INTRICATE DIAGNOSTIC AND TREATMENT OF MULTIPLE MYELOMA ASSOCIATED WITH A PLASMACYTOMA - CASE REPORT  Morariu Andrei Demirel , Barb Andreea Mihaela Gîrbovan Anamaria Hermina, Pál Krisztina, Nastase Diana Validated View

THE INTRICATE DIAGNOSTIC AND TREATMENT OF MULTIPLE MYELOMA ASSOCIATED WITH A PLASMACYTOMA - CASE REPORT

Case Report - Poster

Author(s): Morariu Andrei Demirel, Barb Andreea Mihaela

Coauthor(s): Gîrbovan Anamaria Hermina, Pál Krisztina, Nastase Diana

Coordinator(s): Assistant Professor Anca Bojan

Introduction: Multiple myeloma (MM) is a debilitating malignancy characterized by a proliferation of malignant plasma cells and a subsequent overabundance of monoclonal Immunoglobulins. The bone marrow contains an increased number of plasma cells, which usually constitute more than 30% of the cellularity. A plasmacytoma is a discrete, solitary mass of neoplastic monoclonal plasma cells in either bone or soft tissue (extramedullary). Although MM remains incurable, several drug therapies are valuable in the treatment of patients with MM, as are autologous stem cell transplantation, radiation and surgical care.

Case Presentation: A 60-year old female patient accuses sudden right eye diplopia for which a MRI is performed and an extra-axial homogeneous lesion is found in the clivus. The lesion invades the sphenoid sinus and it has a compressive effect. At this point a presumptive diagnosis of meningioma is made. The intracranial lesion is biopsied and the histopathology identifies cells with plasma cell allure. Immunohistochemistry – CD 138 is strongly positive. In the light of the last investigations the final diagnosis is Plasmacytoma. The blood count showed normochromic normocytic anemia, leucopenia and thrombocytopenia. Biochemistry showed elevated total proteins, lower levels of Ig-A and Ig-M and high levels of Ig-G. Bone marrow aspiration showed 80-95% pleomorphic plasma cells. At this point the diagnosis of Multiple Myeloma Ig-G stage 2 Salmon Durie was made. When the patient was hospitalized she presented nausea, headache, asthenia and fatigue. Under VCD treatment the marrow content of plasma cells reduced to 2%, total proteins and immunoglobulins are normal and the MRI shows the remission of the plasmacytoma.

Conclusion: The treatment proved to be efficient. After multiple relapses the disease is under control, and the general state of the patient is improved.

Particularities: We report here a case of multiple myeloma succesfully diagnosed and treated at the Hematology clinic in Cluj-Napoca. 

PERCEIVED STRESS AND WELL-BEING AMONG INTERNATIONAL FIRST YEAR MEDICAL STUDENTS IN ROMANIA   Costescu Carla , Oprea Andrea - Validated View

PERCEIVED STRESS AND WELL-BEING AMONG INTERNATIONAL FIRST YEAR MEDICAL STUDENTS IN ROMANIA

Public Health

Author(s): Costescu Carla, Oprea Andrea

Coordinator(s): Assistant Professor Dana Herța , Lecturer Bogdan Nemeș

Keywords: medical students international students stress well-being

Introduction: International medical students have an increased risk for mental health difficulties [1], through exposure to stress (high academic standards, a competitive environment [2], low peer social support [3], and language barriers [4]), in addition to some major life changes [5]: temporary migration [6], socio-cultural differences [7] and homesickness [8]. High-to-very high levels of psychological distress were found in previous studies [9]. Our aim was to assess the levels of perceived stress and reported well-being in a sample of foreign medical first year students enrolled in Romania.

Material and Method: We included 91 participants, mean age 20,9 ± 3,7 years, 52,7% females, 71,4% Europeans, enrolled in the first year at the Faculty of Medicine, English Section, at “Iuliu Hațieganu” University of Medicine and Pharmacy Cluj-Napoca. We used the Perceived Stress Scale (PSS) to measure the level of perceived stress, and the 5-item World Health Organization Well-Being Index (WHO-5) to assess the perceived well-being. 

Results: Female students reported a higher level of perceived stress than males, PSS total score 29.05 ± 6.46 vs 24,19 ± 8,19 (p < 0,01 – Mann-Whitney U), but there were no statistically significant differences concerning well-being (p > 0,05 – Mann-Whitney U). The level of perceived stress and well-being were negatively correlated both in male participants (Spearman’s r_S= -0.662, p<0.01) and female ones (Spearman’s r_S= - 0.594, p<0.01). The strongest negative correlation between perceived stress and well-being was found in non-European participants (Spearman’s r_S= -0.85, p<0.01).

Conclusion: Female participants reported a significantly higher level of perceived stress and a similar level of perceived well-being, compared with males. The negative correlation between perceived stress and well-being was stronger in male participants, compared to females, and strongest in non-Europeans. This suggests that perceived stress may be more detrimental on well-being in male students and more acculturated ones [10]. 

Bibliography: [1] Yusoff MSB, Rahim AFA, Baba AA, Ismail SB, Pa MNM, Esa AR. The impact of medical education on psychological health of students: A cohort study. Psychol Health Med. 2013;18. [2] Goebert D, Thompson D, Takeshita J, et al. Depressive symptoms in medical students and residents: a multischool study. Acad Med. 2009;84:236–241. [3] Yamada Y, Klugar M, Ivanova K, Oborna I. Psychological distress and academic self- perception among international medical students: the role of peer social support. BMC Med Educ.2014;14:256. [4] Huhn D, Huber J, Ippen FM, Eckart W, Junne F, Zipfel S, Herzog W, Nikendei C. International medical students’ expectations and worries at the beginning of their medical education: a qualitative focus group study. BMC Med Educ.2016;16:33. [5] KulsoomB, Afsar NA. Stress, anxiety, and depression among medical students in a multiethnic setting. Neuropsychiatr Dis Treat. 2015;11:1713–1722. [6] Buzoianu AD, Popescu CA, Suciu S, Armean SM. Correlates of depression, anxiety and stress among foreign medical students studying general medicine in Romania. Eur Psychiatry. 2016;33:S230. [7] Riemenschneider H, Balázs P, Balogh E, Bartels A, Bergmann A, Cseh K, Faubl N,Füzesi Z, Horváth F, et all. Do socio-cultural factors influence medical students’ health status and health-promoting behaviors? A cross-sectional multicenter study in Germany and Hungary. BMC Public Health.2016;16:576. [8] Poyrazli S, Lopez MD. An exploratory study of perceived discrimination and homesickness: a comparison of international students and American students. J Psychol. 2007;141(3):263-80. [9] Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Acad Med. 2006;81:354–373. [10] Choudhry FR,V Mani,Ming LC,KhanTM. Beliefs and perception about mental health issues: a meta-synthesis. Neuropsychiatr Dis Treat. 2016;12:2807–2818.

SELF-AMPUTATION OF TWO FINGERS DUE TO SEVERE PAIN IN A SCLERODERMA PATIENT: A CASE REPORT  Oprea Andrea , Costescu Carla - Invalidated View

SELF-AMPUTATION OF TWO FINGERS DUE TO SEVERE PAIN IN A SCLERODERMA PATIENT: A CASE REPORT

Case Report - Poster

Author(s): Oprea Andrea, Costescu Carla

Coordinator(s): Assistant Professor Maria Tămaș , Professor Simona Rednic

Introduction: Hand impairment is almost universal in systemic sclerosis (SSC), significantly affecting activities of daily living. Most patients are affected by Raynaud’s phenomenon (RP), a reversible vascular hyperreactivity, that might have the greatest impact on the quality of life in scleroderma patients. This can be a challenge of severe pain management and therapeutic approach.
Case Presentation: G.V., a 50-year-old woman, known with limited cutaneous SSC since 2010, with multiple complications, presented for exacerbated RP. The chronic treatment included Bosentanum 125mg b.i.d. and Hydroxychloroquinum 400mg/day. The rheumatological physical examination revealed scleroderma facies; slightly indured skin on face and hand (Rodnan modified score=2, SSC atrophic phase); telangiectasia on the face, palmar side of hands, chest skin and oral mucosa; ulceration on three fingers; calcinosis on two fingers; pitting scars on two fingers; two self-amputated fingers, due to severe pain; one surgically amputated finger; “salt and pepper” aspect of the skin on the anterior and posterior chest; ulceration on the ventral side of one toe. Paraclinical examinations showed nothing significant. The capillaroscopy showed low capilar density, avascular areas, a few megacapillaries - aspect of late scleroderma. Treatment of RP started with Alprostadilum 20μg IV OPD, but due pain at the site of injection, it was changed to Pentoxifyllinum 100mg IV b.i.d.. RP has improved. Discharge recommendations included: for RP, Tramadolum 100mg (as needed), a repairing, moisturising balm, and avoidance of cold; for ulceration profilaxy and for the other complications of the SSC, the continuation of the initial chronic treatment.
Conclusion: Pain due to RP in this SSC case was eventually managed with peripheral vasodilation treatment.

Particularities: Severe pain due to RP in a SSC patient, which led to digital self-amputation, makes this case particular, and draws attention to the importance of personalized treatment in this disease.

BIOLOGIC MARKERS OF CARDIAC DISFUNCTION AND RISK ASSESSMENT OF PULMONARY EMBOLISM AS PREDICTORS OF MORTALITY IN PE PATIENTS  Jiga Maria Andrada - Validated View

BIOLOGIC MARKERS OF CARDIAC DISFUNCTION AND RISK ASSESSMENT OF PULMONARY EMBOLISM AS PREDICTORS OF MORTALITY IN PE PATIENTS

Medical Science

Author(s): Jiga Maria Andrada

Coordinator(s): Lecturer Sîrbu Voichița Ileana

Keywords: pulmonary embolism mortality cardiac biomarkers risk assessment

Introduction:

Pulmonary embolism(PE) along with deep venous thrombosis(DVT) stand as surrogates for venous thromboembolism(VTE), acute PE being the most serious clinical presentation of VTE and a major cause of hospitalization, morbidity and mortality worldwide. PE represents an obstruction of the pulmonary artery and/or one of its branches by thrombus or other material that originated elsewhere in the body. Among predictors of early mortality risk, troponin and NT-proBNP values indicate RV microinfarction or RV pressure overload and a potentially ominous prognosis.Objective:The aim of this study was to identify if biologic markers of cardiac disfunction correlate with mortality in PE patients and if they have a higher predictive value in association with the clinical risk assessment. 

Material and Method: Our retrospective, observational study included 114 patients(60 women, age 68±12) diagnosed with pulmonary embolism using CT angiography, between 2012-2017. Inclusion criteria: patients diagnosed in Cardiology Department I, IUBCVT Târgu-Mureș, age>18 years, who signed the informed consent. For all patients plasma concentrations of troponin and NT-proBNP where measured and the cut-off values established at>0.009 ng/mL and>400 pg/ml, respectively. A classification of patients was made according to 2014 ESC Guidelines. 

Results: Subsequent of early mortality risk evaluation, 8,8%(n=10)of patients were classified into the HR category, 80,7%(n=92) in the IR category and 10,5%(n=12)designated as LR patients. All cause mortality was 21,9%(25 patients:3HR, 9IH risk, 13IL risk and no mortality in LR category). None correlated significantly with mortality. Using Mann Whitney test, we obtained a significant correlation between elevated NT-proBNP values and mortality(p=0,02), but not the same with elevated troponin levels(p=0,38). Multivariable analysis, including NT-proBNP and troponin levels did not show a higher predictive level. Furthermore, in association with clinical classification, NT-proBNP did not show a higher predictive value regarding mortality. 

Conclusion: NT-proBNP is an important predictor of mortality in PE patients, therefore can be routinely used in clinical practice for prognostic evaluation. 

Bibliography: Stavros V. Konstantinides, Adam Torbicki, Giancarlo Agnelli et al - 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism, Eur Heart J, 2014, 35: 3033-3080.

Massive gastrointestinal bleeding as first sign of a duodenal carcinoma  Di Nardo Nicola , Vunvulea Vlad Borz Bogdan, Pintea Ioana Alexandra, Trif Bianca Ioana Invalidated View

Massive gastrointestinal bleeding as first sign of a duodenal carcinoma

Case Report - Poster

Author(s): Di Nardo Nicola, Vunvulea Vlad

Coauthor(s): Borz Bogdan, Pintea Ioana Alexandra, Trif Bianca Ioana

Coordinator(s): Lecturer Cristian Borz

Introduction: The primary malignant tumors of the duodenum are rare diseases, representing approximately from the 0.3% to 1% of all gastro-intestinal tract tumors. Malignancies of the duodenum must be differentiated from malignant tumors of the ampulla, pancreas and common bile duct. Due to unspecific symptoms diagnosis is often delayed.

Case Presentation: We present a case of duodenal carcinoma diagnosed in emergency, for a massive gastrointestinal bleeding. Gastroduodenoscopy and biopsy revealed a hemorrhagic D2 duodenal carcinoma. After resuscitation in ICU, the patient underwent surgery: pancreatoduodenectomy (Whipple procedure). The postoperative course was uneventful. The patient was referred to Oncology for further treatment.

Conclusion: Carcinoma of the duodenum is a rare type of cancer and diagnosis is often delayed. In case of gastrointestinal bleeding we have to keep in mind the possibility of duodenal cancer. Gastroduodenoscopy with biopsy clarifies the diagnosis.

Particularities: Duodenal carcinoma is a rare malignancy and diagnosis is difficult due to unspecific signs. Massive gastrointestinal bleeding is an unusual reason for presentation in emergency as the first sign of a duodenal carcinoma. 

Hakim - Adams Syndrome. Case report of an unusual trigger.  Gavrilei Mihaela Andreea - Invalidated View

Hakim - Adams Syndrome. Case report of an unusual trigger.

Case Report - Poster

Author(s): Gavrilei Mihaela Andreea

Coordinator(s): MD Vicentiu Saceleanu

Introduction: Normal-pressure hydrocephalus is a curable neurological disease, described by Adams and Hakim in 1965, characterized by gait disturbance, urinary incontinence, dementia or cognitive disorders that occur generally in the sixth and seventh decades of life. 

 

Case Presentation:
We present the case of a male patient, M.G., aged 60 years old, without significant personal pathological antecedents, admitted to the Infectious Diseases Clinic of Alba County for a febrile episode and gait disturbance. Detailed medical history taking from the patient’s family revealed he recently suffered from gait instability, urinary incontinence, and slight cognitive impairment.These constituted the clinical triad of normal pressure hydrocephalus syndrome. The presence of normal cerebrospinal fluid (CSF) pressure and distinctive radiological findings confirmed the diagnosis of normal pressure hydrocephalus or Hakims–Adams syndrome..  The CT scan reveals an internal normal-pressure hydrocephalus. Diagnosis of viral meningoencephalitis and internal normal-pressure hydrocephalus is set and the patient is referred to a specialised centre for the management of hydrocephalus therapeutic conduct. 
After about a month of hospitalization the patient returns to the Neurosurgery Department of Sibiu, neurological symptoms being aggravated, emphasizing motor deficits. CT scan, conducted on emergency, highlights communicating panventricular hydrocephalus with signs of activity. Postoperatively, the patient’s status is favourable. 

Conclusion: Latent hydrocephalus may become manifest after an infectious episode.Worsening of neurological symptoms require ventriculoperitoneal drainage

Particularities: The patient presents the classical clinical symptomatology of normal pressure hydrocephalus, but the onset is atypical being triggered after a viral respiratory infection with secondary meningeal involvement, without a history of craniocerebral trauma.

Schizophrenia and Alcohol Dependence and the consequent health and family burden  Asztalos Anna Boglarka , Mihai Alex Ani Cristina Miceta, Milotoiu Ioan, Mustea Elena Invalidated View

Schizophrenia and Alcohol Dependence and the consequent health and family burden

Case Report - Poster

Author(s): Asztalos Anna Boglarka, Mihai Alex

Coauthor(s): Ani Cristina Miceta, Milotoiu Ioan, Mustea Elena

Coordinator(s): Professor Ioana Miclutia , MD Celina Niculescu

Introduction:

Schizophrenia is a psychiatric disorder with multifactorial etiology with a great impact on one's life by disturbances in cognition, emotion, perception, thinking and behavior. The association with Alcohol Use Disorder is quite frequent and may lead to intricate evolution.


Case Presentation:

We present the evolution of schizophrenia in a case of a 44-year-old woman, who was first diagnosed in 1994, having a positive family history for psychiatric disorders. The clinical picture intricated since 2010 with alcohol misuse and later on dependence and several alcohol withdrawals.

The patient recorded numerous admissions to the Psychiatry Clinic and the psychiatric sanatorium. The most common symptoms of the episodes were: psychomotor agitation, complex persecutory auditory hallucinations, complex visual pseudo hallucinations, paranoid, grandiose delusions, suspicious and aggressive behavior. Due to variety of symptoms the diagnosis shifted between Paranoid and Undifferentiated Schizophrenia.

During psychotic episodes, the patient psychiatric evaluation showed also erotomanic, mystical delusions, disorganized speech, loosing of associations, emotional inversion, soliloquy, disinhibited behavior and mixed insomnia. In the past years her attention and behavior were focused on alcohol consume and recovery from withdrawal states, recording several relapses and modest recoveries.

Pharmaceutical and electroconvulsive treatment was applied during the evolution.


Conclusion:

 Cognitive decline, social isolation, poor work performance, inability to adapt to new situations, non-compliance to treatment and disturbed family network are important factors for the evolution.


Particularities:

 The comorbidity of alcoholism in a schizophrenia patient influenced the worse general outcome (more frequent relapses, modest response and difficult recovery), with poor adherence and social support.

PARTIAL ANOMALOUS PULMONARY VENOUS CONNECTION WITH INTACT ATRIAL SEPTUM: A CHALLENGING DIAGNOSE  Candrea Dan Octavian - Validated View

PARTIAL ANOMALOUS PULMONARY VENOUS CONNECTION WITH INTACT ATRIAL SEPTUM: A CHALLENGING DIAGNOSE

Case Report - Poster

Author(s): Candrea Dan Octavian

Coordinator(s): MD Cerasela Goidescu

Introduction: Partial anomalous pulmonary venous connection (PAPVC)  is a congenital heart defect causing a left-right shunt due to abnormal drainage of one or more lung veins to right atrium or to systemic veins. PAPVC is a rare condition and it is often associated with other congenital heart anomalies. Our report is about a 51-year-old man who has right upper pulmonary lobe vein PAPVC draining into superior vena cava, which was found during cardiac MRI angiography. The patient was asymptomatic up to the last hospitalisation and had no accompanied congenital anomaly.

Case Presentation: The patient presented for episodically fast pace palpitations which had started in the last month, associated he presented headache and sensation of warmth in the head. He is known with erosive gastritis and benign prostatic hyperplasia since 2016. The clinical examination showed tachycardia, a normal blood pressure, no pulmonary crackles and no signs of systemic or pulmonary  stasis. Laboratory tests were normal except for hypercholesterolemia. The EKG revealed atrial flutter 2:1 ratio and major right bundle branch block. The transthoracic echocardiography showed a major dilatation of right heart and pulmonary arteries, an efficient right ventricle, mild pulmonary arterial hypertension (PAH)(35mmHg), without any visible left-right shunt. Cardiac MRI angiography was performed, which established the diagnosis of PAPVC, without any cardiac anomaly associated.

Conclusion: This case highlights the need to exclude a PAPVC and other left-right shunt in patients with unexplained, asymptomatic PAH and right-sided chamber enlargement.

Particularities:

Atypical presentation with atrial flutter but with no symptoms of PAH at admission. No atrial septal defect was present, which is a less frequent condition of PAVPC.

Assessment of postoperative recovery in patients with cartilage injury following Pridie revascularization drilling  Borz Bogdan Borz Paul-Cristian, Botan Matei Validated View

Assessment of postoperative recovery in patients with cartilage injury following Pridie revascularization drilling

Surgical Science

Author(s): Borz Bogdan

Coauthor(s): Borz Paul-Cristian, Botan Matei

Coordinator(s): Professor Tiberiu Bataga

Keywords: pridie drill chondral lesion

Introduction: Along with the advancement of investigation and imaging procedures in orthopedics, encountering articular cartilage damage during investigations of the knee has become a common occurrence, with one study placing the frequency at 63% of all knee arthroscopies in a sample of 31,516 patients. This frequency has pushed the surgical community into developing several cartilage restorative techniques, some of which include: debridement,Pridie drilling, osteochondral allograft, osteochondral autograft(mosaicplasty),  and autologous chondrocyte transplantation The aim of our study is to evaluate the postoperative recovery of patients that underwent the Pridie drilling technique.

Material and Method: We used a modified IKDC(International Knee Documentation Committee) form to evaluate the postoperative recovery of the knee and general health. We assessed the pain, mobility, swelling and social reintegration. The study consisted in a series of 27 operated patients with grade II and III cartilage injury according to the ICRS classification. There were 10 patient with grade II and 17 with grade III cartilage injury, aged between 27 and 72 years old.

Results: In our study the mean values for the knee evaluation were 7.785 for grade II lesions and 5.42 for grade III lesions, 7.23 and 5.6 for the general health evaluation. Our results showed a statistically significant difference between the scores obtained for the postoperative evolution of the knee function and general health in patients with grade II compared to patients with grade III chondral lesions (p=0.0109 for the knee evaluation and p=0.0332 for the general health evaluation). Sex and age were also factors in the recovery but did not have a statistically significant impact.

Conclusion: According to our findings the recovery is improved after surgery for grade II lesions and not influenced by sex and age. This leads us to the conclusion that it is important to diagnose and treat the disease in an earlier stage for better outcomes.

Bibliography: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3171560/

Original surgical technique for eventration in newborn- Case report  Kindriș Florinela Ana-Maria , Kindriş Aurelia Elena Teodora - Invalidated View

Original surgical technique for eventration in newborn- Case report

Case Report - Poster

Author(s): Kindriș Florinela Ana-Maria, Kindriş Aurelia Elena Teodora

Coordinator(s): MD Cristian Ștefan Berghea-Neamțu

Introduction: The inguinal hernia is a pathology resolved surgically only and it's mandatory to be operated, otherwise the risk is to become an incarcerated hernia, with a higher risk of multiple complications and mortality. The vaginal process, an outpouching of the peritoneum, is attached to the testicle. It trails the testicle as it descends retroperitoneally into the scrotum and this way is obliterated. Inguinal hernia appears when the obliteration of the vaginal process fails to occur.

Case Presentation: A 21 days old patient is brought with severe symptomatology of intestinal occlusion. The cure of the hernia consisted in placing the intestines back into the abdominal cavity after verifying they were still viable. High ligation of the hernial sac ( peritoneo-vaginal process) and the orchidopexy for the left testicle were performed. After one month the patient came back again with intestinal occlusion symptoms, which is why an exploratory laparotomy was performed and a part of the intestines had to be resected and anastomosed. Then the complications started to occur. The first eventration occurs shortly, unexpectedly, but the second and the third happened due to hyperproteinemia. The third one had to be approached differently with silicone tubes, in order to avoid this consuming pathology for the patient to recur.

Conclusion: The final intervention was a success, the abdominal wall didn't yield and the patient was clinically observed and safely discharged.

Particularities: It was beneficial for the patient that only the eventration occurred, not also the dehiscence of the intestinal anastomoses.

DERMATOMYOSITIS WITH RESPIRATORY MUSCLE WEAKNESS AND DYSPHAGIA TREATED SUCCESSFULLY WITH CYCLOPHOSPHAMIDE  Mãnãilã Roxana , Nastasiu Ioana - Invalidated View

DERMATOMYOSITIS WITH RESPIRATORY MUSCLE WEAKNESS AND DYSPHAGIA TREATED SUCCESSFULLY WITH CYCLOPHOSPHAMIDE

Case Report - Poster

Author(s): Mãnãilã Roxana, Nastasiu Ioana

Coordinator(s): Lecturer Laura Muntean

Introduction: Dermatomyositis (DM) is an autoimmune disease that involves muscles, skin and multiple organs. We report a case of 52-year old female with DM, complicated with respiratory muscle weakness and dysphagia, in order to highlight a particular clinical evolution and treatment difficulties. 

Case Presentation: A 52-year old woman presented with proximal muscle weakness, myalgias, periorbital heliotrope rash, difficulty in swallowing, weight loss, and dyspnea. She was diagnosed with DM based on clinical presentation, high levels of muscle enzymes, increased acute phase-reactants, positive antinuclear antibodies and myopathic pattern on EMG. Neoplasia screening was negative, thus treatment was initiated with high doses of corticosteroids and azathioprine, with clinical and biological improvement. The patient presented 2 months later with DM flare, worsening of dysphagia and dyspnea. In the absence of significant interstitial lung disease on high resolution computed tomography (HRCT), blood gasometry was done showing mild hypoxemia, probably due to muscle weakness. She received higher doses of corticosteroid and pulse-therapy with cyclophosphamide, with significant improvement of symptoms. However, she developed dyslipidemia due to corticosteroids and experienced an episode of paroxysmal atrial fibrillation induced by cyclophosphamide perfusion. 
Conclusion:

DM is an autoimmune myopathy with frequent extra-muscular involvement. Prognosis is variable, with frequent relapses and accumulating damage, due to disease activity and medication toxicity. 


Particularities:

In this case report we want to highlight the association of DM with rare, but potentially severe complications. As in our patient, treatment strategy is still challenging in this rare disease. 

NANAOMYCIN A – TARGETED EPIGENETIC THERAPY IN TRIPLE NEGATIVE BREAST CANCER  Temian Daiana Cosmina - Validated View

NANAOMYCIN A – TARGETED EPIGENETIC THERAPY IN TRIPLE NEGATIVE BREAST CANCER

Fundamental Science

Author(s): Temian Daiana Cosmina

Coordinator(s): Assistant Professor Laura-Ancuta Pop , Lecturer Ciprian Tomuleasa

Keywords: triple negative breast cancer epigenetics nanaomycin A DNMT3b

Introduction: Triple negative breast cancer (TNBC) defines a subtype of breast cancers that do not express estrogen receptor (ER), progesterone receptor (PR) and HER2, thus not benefiting from currently existing hormone and targeted therapies. Recent studies in the epigenetics of TNBC show that there is an overexpression of DNMT3b [1,2], a de novo DNA methyltransferase, which may be responsible for the aggressive behavior of these tumors. A specific inhibitor of DNMT3b, nanaomycin A, has shown promising results on bronhopulmonary, colon and acute myeloid leukemia cell lines [3]. Our aim is to assess the effect of nanaomycin A on TNBC cell lines.

Material and Method: We have assessed the effect of nanaomycin A and standard chemotherapeutics paclitaxel and doxorubicin on the proliferation of two TNBC cell lines – MDA-MB-231 and HS578T – and one ER positive cell line – MCF7 – using an MTT assay. IC50 were calculated at 24h, 48h and 72h. Results were analyzed using GraphPad Prism.

Results: An inhibitory effect of nanaomycin A was observed on the proliferation of MDA-MB-231 and MCF7 cell lines at concentrations comparable to those in existing literature.

Conclusion: Nanaomycin A is a newly characterized specific inhibitor of DNMT3b which inhibits the proliferation of breast cancer cell lines. DNMT3b may prove to be a new epigenetic target in TNBC.

Bibliography: 1. Roll JD, Rivenbark AG, Jones WD, Coleman WB. DNMT3b overexpression contributes to a hypermethylator phenotype in human breast cancer cell lines. Mol Cancer. 2008;7(1):15. doi:10.1186/1476-4598-7-15. 2. Sandhu R, Roll JD, Rivenbark AG, Coleman WB. Dysregulation of the epigenome in human breast cancer: contributions of gene-specific DNA hypermethylation to breast cancer pathobiology and targeting the breast cancer methylome for improved therapy. Am J Pathol. 2015;185(2):282-292. doi:10.1016/j.ajpath.2014.12.003. 3. Kuck D, Caulfield T, Lyko F, Medina-Franco JL. Nanaomycin A selectively inhibits DNMT3B and reactivates silenced tumor suppressor genes in human cancer cells. Mol Cancer Ther. 2010;9(11):3015-3023. doi:10.1158/1535-7163.MCT-10-0609.

The Importance of Scyllo-Inositol in Alzheimer’s Disease – A Literature Review  Omar Zaime Papaeleftheriou Stavroula Invalidated View

The Importance of Scyllo-Inositol in Alzheimer’s Disease – A Literature Review

Fundamental Science

Author(s): Omar Zaime

Coauthor(s): Papaeleftheriou Stavroula

Coordinator(s): Professor cristina mihaela ghiciuc

Keywords: Alzheimer's disease Scyllo-inositol Treatment

Introduction: Alzheimer’s disease (AD) is a degenerative condition in which destruction of neurons is progressively occurring by accumulation and aggregation of toxic proteins such as β-amyloid and tau; giving rise respectively to plaques and tangles formation. Until now, Mild and Moderate staged patients are receiving symptomatic relieving treatmentsuch as Cholinesterase Inhibitors (Donepezil, Rivastigmine) and NMDA receptor antagonists(Memantine). Furthermore, Inositol is a compound of six-fold alcohol of cyclohexane and it exists as nine stereoisomers. Among them, myo-inositol is the most abundant form in the nature and increased concentrations were found in Cerebrospinal Fluid (CSF) of patients diagnosedwith AD .On the contrary, Scyllo-inositol (SI) is found rarely in nature and induces a β-structure transition in Aß42 peptide that did not lead to fibril formation. 

Material and Method: Through systematic literature study, performed on 3 web search engines, articles related with SI and AD were investigated. Articles which were published before the year of 2000 were excluded from this review. Overall, 5 papers were significant for the benefits of SI as a therapeutic agent in AD.T he number of patients, dosage, length of treatment were recorded in order to compare the effects of this preventive method. 

Results: After an average of 76 weeks of treatment with SI at the doses of 1.000 and 2.000 mg,an increase of brain volume was observed with the use of MRI. But a dose of 250mg didn’t show significant imagistic changes in comparison with the placebo group. Although, according to Salloway et al, 2011 a decrease of Αβ42 in CSF was measured at this dosage. 

Conclusion: SI seems to be a promising therapeutic agent in AD, although the amyloid-targeted therapy should be started at earlier stages of this pathology to receive better benefits. Further studies should be performed in order to corroborate its efficiency.

Bibliography: https://www.ncbi.nlm.nih.gov/pubmed/28039583 https://www.ncbi.nlm.nih.gov/pubmed/27807448 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5027050/ http://www.sciencedirect.com/science/article/pii/S0168822713004208

Catamenial Pneumothorax due to Thoracic Endometriosis  Matcasu Ioana - Validated View

Catamenial Pneumothorax due to Thoracic Endometriosis

Case Report - Poster

Author(s): Matcasu Ioana

Coordinator(s): MD Olga Danaila

Introduction:

Catamenial pneumothorax describes spontaneous, recurring pneumothorax that exclusively affects women during their reproductive years.  Catamenial is derived from the Greek word meaning monthly. This pathology suggests a temporal relationship between the menses and the onset of the pneumothorax sympthoms. In the following we are going to illustrate a successfully treated case of catamenial pneumothorax


Case Presentation:

A 36 years old woman was admitted with shortness of breath and thoracic pain occuring in the first day  menses. Her medical history revealed  two in vitro fertilization and a spontaneous pneumothorax successfully treated by chest tube two months ago. Clinical examination showed  decreased vesicular murmur and hypersonority on the right thorax.

 The chest X-ray and CT scan pointed out right pneumothorax without any other lessions.

The  video-assisted thoracic surgery found white and brown spots on the parietal pleura and small ,difusely located diafragmatic holes, specially in the central tendon. No bulla or blebs were found. The patient underwent apical pleurectomy and basal parietal and diafragmatic pleural abrasion.

She was discharged two days after surgery. Imunohistochemistry confirmed pleural parietal endometriosis. MRI showed no signs of abdominal endometriosis.  She was referred to the gynecologist and received gonadotropin releasing hormone (GnRH) analogue. At a follow-up of 4 months there was no recurrence.


Conclusion:

Catamenial pneumothorax is believed to be the most frequent clinical manifestation of thoracic endometriosis. Concomitant pelvic endometriosis is found only at 61% of the diagnosed women. Although the clinical association between the development of pneumothorax and the menses are well characterized the causal mechanisms remain uncertain.


Particularities: All in all, this kind of pathologies are usually  successfully treated by associating surgical treatment to hormonal treatment 

UPPER GI BLEEDING - WHAT'S HIDDEN UNDER THE MUCOSA?  Voicu Andrei , Tudorache Alina-Maria Carnariu Georgiana, Dascalescu George Razvan Validated View

UPPER GI BLEEDING - WHAT'S HIDDEN UNDER THE MUCOSA?

Case Report - Poster

Author(s): Voicu Andrei, Tudorache Alina-Maria

Coauthor(s): Carnariu Georgiana, Dascalescu George Razvan

Coordinator(s): Assistant Professor Vasile Daniel Balaban

Introduction: GISTs-gastrointestinal stromal tumors, represent 1% of gastrointestinal tumors; they are mesenchymal neoplasms, thought to develop from  the interstitial cells of Cajal,  usually found  in the stomach or small intestine, but can occur anywhere along the GI tract. They are often characterized by over-expression of the c-KIT receptor or PDGFRA, which leads to uncontrolled proliferation.

Case Presentation: A previously healthy 46-year-old man presented in the ER with melenic stools of 48 hours duration and unremarkable medical or family history. He denied smoking, use of NSAID, antiplatelet or anticoagulants. Physical exam on admission revealed marked pallor, hypotension (systolic BP 100 mmHg), tachycardia (105 bpm), nontender abdomen without peritoneal irritation signs. Digital rectal exam confirmed melena and laboratory work-up showed  moderate normocytic anemia (Hb=7.8 g/dl), a 6g drop during the last month. Fluid resuscitation was started and an emergency upper GI endoscopy was done, which revealed a large submucosal mass on the great curvature of the stomach, with central ulcer and stigmata of recent bleeding. A CT scan was ordered to evaluate for intratumoral bleeding. The patient was admitted to the Gastroenterology Department and  was prescribed intravenous proton pump inhibitors and blood transfusions. Endoscopic ultrasound  was performed  to better characterize the mass, to evaluate the layer of origin and for the differential diagnosis of the various types of submucosal tumors. We set a preoperative diagnosis of GIST and transferred the patient to surgery. A posterior longitudinal gastrectomy  was performed, with good outcome. The histopathology report showed tumoral proliferation with round-spindle cells, with nuclear atypia and minimal mitotic activity; immunohistochemistry was positive for CD117.

Conclusion: Although rare, GISTs should be considered as a possible cause of upper GI bleeding. Surgery is the primary treatment of choice in localized GISTs.

Particularities: Although rare, GISTs should be considered as a possible cause of upper GI bleeding. Surgery is the primary treatment of choice in localized GISTs.

USE OF LINEAR STAPLERS IN DIFFICULT LAPAROSCOPIC APPENDECTOMY  PERDIKARIS IOANNIS , Perdikaris Georgios Kassidakis Efthymios Validated View

USE OF LINEAR STAPLERS IN DIFFICULT LAPAROSCOPIC APPENDECTOMY

Surgical Science

Author(s): PERDIKARIS IOANNIS, Perdikaris Georgios

Coauthor(s): Kassidakis Efthymios

Coordinator(s): MD Razvan Bosneagu , Assistant Professor Cristina Dan

Keywords: LINEAR STAPLERS LAPAROSCOPIC APPENDECTOMY ACUTE APPENDICITIS

Introduction: Laparoscopic appendectomy gained popularity in past decades, being today a feasible option to open appendectomy. Acute appendicitis – the most common surgical emergency (130.000/y in Germany); more than half performed laparoscopically . Complicated acute appendicitis – distinct entity – gangrenous appendicitis ± perforation, with various degrees of peritonitis

Material and Method: 11 cases in the past year operated by a single team (5 cases – endoloops , 5 cases – EndoGIA 30-3.5/30-4.8) . Acute gangrenous perforated appendicitis, with pericecal abscess or diffuse peritonitis (Different degrees of obesity). 1 conversion – intraperitoneal adhesions . Discharge of patients between the 2nd and 5th postoperative day. Clips (stump under 10mm) , preformed knots (Roeder or endoloop) ,10 mm – umbilical port , 10 mm – suprapubic/left flank port , 5 mm – right flank , Endo-GIA – requires a 12mm port . Retrieval of appendix after introducing in an endobag . Irrigation of peritoneal cavity . Drainage . Systemic antibiotherapy 

Results: Median operative time was 52 min. (40-75 min) .Without stump related complications or intra-abdominal abscesses . 1 case – surgical site infection . Discharge of patients between the 2nd and 5th postoperative day

Conclusion: Laparoscopic appendectomy is a safe and feasible option treatment of acute appendicitis even in complicated forms, despite higher costs

Bibliography: Bibliography A. Rickert - Appendix stump closure with titanium clips in laparoscopic appendectomy, Langenbecks Arch Surg 2012 B. Wei - Laparoscopic versus open appendectomy for acute appendicitis: a meta-analysis, Surg Endosc 2011 G. Kazemier - Securing the appendiceal stump in laparoscopic apendectomy: evidence for a routine stapling?, Surg Endosc 2006 G. Markides et. al - Laparoscopic vs. open appendectomy in adults with complicated appendicitis: systematic review and meta-analysis, World J Surg 2010

COMBINED INHERITED AND ACQUIRED FACTORS IN A PACIENT WITH BUDD-CHIARI SYNDROME  Bora Cristina Nelida , Secara Rozalia Plasoianu Ramona, Farcau Oana, Fischer Petra Validated View

COMBINED INHERITED AND ACQUIRED FACTORS IN A PACIENT WITH BUDD-CHIARI SYNDROME

Case Report - Poster

Author(s): Bora Cristina Nelida, Secara Rozalia

Coauthor(s): Plasoianu Ramona, Farcau Oana, Fischer Petra

Coordinator(s): Assistant Professor Bogdan Procopet

Introduction:

Budd-Chiari syndrome (BCS) is a rare disease, defined as the hepatic venous outflow obstruction at any level from the small hepatic veins to inferior vena cava - right atrium junction. A cause can be identified in aproximately 75% of the pacients, the most prevalent being mieloproliferative disorders followed by both inherited or aqcuired hypercoagulable states. Once BCS is diagnosed, long term anticoagulation should be started. 


Case Presentation: A 34-year-old woman was first admitted to our hospital with a 3 week history of progressive abdominal distension. The transabdominal ultrasound scan revealed ascites, inomogenous liver with left and caudate lobe hypertrophy and absent blood flow in the hepatic veins. The CT confirmed the diagnosis of BCS and anticoagulant treatment was introduced. The etiological workup revealed essential trhombocythemia (JAK2 V617F +) and the prothrombin gene mutation as etiological factors. After a good initial response to anticoagulation and diuretic treatment, the pacient presented a new ascites decompensationt, a few months after diagnosis. At that time, spontaneous bacterial peritonitis was confirmed. Later in the course of the disease, the patient presented intense abdominal pain with subocclusive syndrome and the CT scan revealed an intramural ileal hematoma secondary to the anticoagulation, that was treated with conservative treatment. Due to high risk of thrombosis, the anticoagulant treatment was not withdrawn.

Conclusion: The identification of one causal factor of BCS should not preclude the search for other associated factors. Although the anticoagulant therapy might be sufficient in controlling the disease, severe complications should be taken into consideration.

Particularities: Essential trhombocythemia is a less prevalent cause of BCS and a combination of several prothrombotic disorders is only found in one third of the pacients diagnosed with BCS. 

SURPRISING CAUSES OF ANGINA PECTORIS IN A PATIENT WITH SYSTEMIC SCLEROSIS  Crăciun Roxana-Ionela , Comănescu Maria Carnariu Georgiana, Dascalescu George Razvan Invalidated View

SURPRISING CAUSES OF ANGINA PECTORIS IN A PATIENT WITH SYSTEMIC SCLEROSIS

Case Report - Poster

Author(s): Crăciun Roxana-Ionela, Comănescu Maria

Coauthor(s): Carnariu Georgiana, Dascalescu George Razvan

Coordinator(s): Assistant Professor Roxana Enache

Introduction:

The main cause of angina pectoris in patients with systemic sclerosis (SS) is the remodeling and vasospasm of small coronary arteries (known in literature as functional myocardial Reynauld phenomenon). Recent studies show an increased prevalence of atherosclerosis in SS, distinctive mechanisms being incriminated: the presence of anti-endothelial antibodies, immunologic mediated cytotoxicity and defective angiogenesis determined by flaws in the vascular repair mechanisms.


Case Presentation:

A 57-year-old female known with SS since 2010, treated with corticosteroids and endothelin receptor antagonist (bosentan), associating severe, progressive pulmonary hypertension (PH), was admitted for fatigue, severe dyspnea and exertional angina. Laboratory tests showed dyslipidemia with LDL-cholesterol(139 mg/dl) and high BNP levels(1739 pg/ml). Resting ECG revealed right axis deviation and right atrial abnormality without ST-Tchanges. Transthoracic echocardiography showed dilation of the right chambers with moderate right ventricular systolic dysfunction, severe tricuspid regurgitation, pulmonary artery (PA) dilation of 31 mm and an estimated value of the pulmonary systolic pressure of 82 mmHg. Cardiac catheterization confirmed pre-capillary (PWP 9 mmHg) PH (PAP 72/22/45 mmHg, PVR 9.9 uW). Due to the presence of angina, a coronary angiography was performed, revealing a 30% ostial stenosis of the left coronary artery, cause by extrinsic compression by the PA trunk and a coronary-left ventricular chamber fistula. 


Conclusion:

Due to the worsening of the patient’s clinical status, (functional class III, increased BNP levels) despite the monotherapy with bosentan we added a second pulmonary specific vasodilator – a phosphodiesterase 5-inhibitor (sildenafil) along to diuretics.


Particularities: Although the patient had multiple atherosclerosis risk factors, conventional (age, family history, smoking, high blood pressure, dyslipidemia) and unconventional, SS associated (autoimmune inflammatory markers), angina pectoris is due to PH-induced changes (extrinsic compression of the ostial left coronary) and coronary-ventricular fistula, anomalous connection with a 1.2% arteriography proved prevalence. 

ADULT GRANULOSA CELL TUMOR OF THE OVARY – A RARE HISTOPATHOLOGICAL ENTITY: CASE REPORT  Ionescu Mircea , Costache Ramona Vameșu Sorin, Băltătescu Gabriela Invalidated View

ADULT GRANULOSA CELL TUMOR OF THE OVARY – A RARE HISTOPATHOLOGICAL ENTITY: CASE REPORT

Case Report - Poster

Author(s): Ionescu Mircea, Costache Ramona

Coauthor(s): Vameșu Sorin, Băltătescu Gabriela

Coordinator(s): Assistant Professor Manuela Enciu

Introduction: Adult granulosa cell tumor is a very rare low malignant potential tumor, originating form sex-cord stromal cells of the ovary. It is more common in women in the fifth decade of life and represents 1-2% of all tumors, but also 5-8% of malignant tumors of ovary. This tumor presents  a good prognosis, comparing with others epithelial tumors.  They are associated with hyperestrogenism with its consequences-endometrial hyperplasia and endometrial carcinoma, and might be associated with local recurrence. 

Case Presentation: We present the case of a 39 years old patient, hospitalized for  abdominal pain and menorrhagia. Ultrasound examination revealed a solid-cystic lesion of the left ovary. After surgery, oophorectomy specimen had a maximum diameter of 8 cm. Histopathological examination has been done in the Clinical Pathology Service of Constanta.  Inhibin alpha and Ki67 monoclonal antibodies were used. 

Conclusion: Microscopical exam revealed a malignant neoplastic proliferation with microfolicular pattern, Call-Exner bodies and trabecular pattern with nuclear grooves of the cells. The use of antibodies highlighted cytoplasmic positive immunoreaction of neoplastic cells for Inhibin alpha and Ki67 positive in less than 10% of neoplastic cells nuclei. The diagnosis was adult granulosa cell tumor-stage IA FIGO. It has been recommended the follow-up of the patient. 

Particularities: Adult granulosa cell tumor is an uncommon lesion with clinical and histopathological distinctive features. Although there are many known prognostic factors, tumor staging is the most important. Immunohistochemistry was mandatory for diagnosis of certainty. 

BASIC FIRST AID TRAINING FOR SCOUTS  Pascaru Oana-Ramona - Validated View

BASIC FIRST AID TRAINING FOR SCOUTS

Public Health

Author(s): Pascaru Oana-Ramona

Coordinator(s): Associate Professor Maria Dorina Pașca

Keywords: scouts first aid non-formal education

Introduction: Every day, the formal education helps us to be ready for predictable behavior, but the related activity, the extracurricular one, teaches us how to be ready for the unpredictable.[1] National Organisation „Romania’s Scouts” completes the education received in school and family, enhance self-knowledge, the desire of searching new passions, and helping community.[2] Nowadays, knowing and applying first aid is essential and has to be cultivated since childhood by different methods. The aim of our study is to evaluate whether the first aid training using non-formal techniques and instruments has results and efficiency.

Material and Method: We evaluated 51 scouts between the age of 12 and 17, from Tîrgu Mureș branch of National Organisation „Romania’s Scouts”. The study started in October and finished in March. The participants were tested before and after the teaching period with a questionnaire containing ten items. During this period, we organized interactive training workshops aiming ten main subjects. Among the non-formal teaching methods we used brainstorming, role-playing game, demonstration and the aquarium. 

Results: We found that in case of minor burns only 24%(12) of scouts knew the right way to approach them and after six months it increased to 94%(48). We also observed an improvement regarding first aid in case of frostbites from 20%(10) to 76%(39). In October only 25%(13) of scouts knew how to react in case of epistaxis, however in March the number increased to 82%(42).

Conclusion: Giving right away appropriate first aid can help to reduce a person’s recovery time and make the difference between the patient having a temporary or long term disability. Repeatedly learning and practicing this methods from childhood and adolescence can help future adults to cope with stress, limit situations and act by instinct when someone needs first aid.

Bibliography: 1. Moldovan, V.O. (2015), Integrating non-formal type of activities in formal educational contexts through “Școala altfel: să știi mai multe, să fii mai bun!” (The Different School: to know more, to be better!”), în Proceedings of the International Conference on Education, Reflection and Development, Cluj-Napoca, România, 2nd edition 2105, pp 43 – 51, ISSN 2457-4643. 2. Petrea, E., (2010), Ghidul liderului de temerari, Editorul manualului, Organizația Națională Cercetașii României, București.

SYNERGISTIC EFFECTS OF LOW DOSES OF CODEINE – FLURBIPROFEN ASSOCIATION IN SOMATIC NOCICEPTION IN MICE  Augustine Arlyn , Khokhar Hassan Tahir - Validated View

SYNERGISTIC EFFECTS OF LOW DOSES OF CODEINE – FLURBIPROFEN ASSOCIATION IN SOMATIC NOCICEPTION IN MICE

Fundamental Science

Author(s): Augustine Arlyn, Khokhar Hassan Tahir

Coordinator(s): Associate Professor Liliana Mititelu-Tartau

Keywords: codeine flurbiprofen tail flick writhing test

Introduction: Codeine, the second-most predominant alkaloid found in opium after morphine, is a weak analgesic and cough suppressant agent. Like morphine, it binds to opioid receptors in the brain, increasing tolerance to pain and decreasing discomfort. Flurbiprofen, a nonsteroidal anti-inflammatory drug, belonging to the group of phenyl alkanoic acid derivatives, inhibits the enzyme cyclooxygenase. It possesses an anti-inflammatory, analgesic, and anti-pyretic activity, being used to treat inflammation and pain.

Aim: Experimental researches on the effects of low doses of codeine and flurbiprofen association in somatic and visceral pain models in mice. 

Material and Method: The experiment was carried out with white Swiss mice (20-25g), distributed into 4 groups of 7 animals each, treated subcutaneous with the same volume of solution, as follows: Group I (Control): saline solution 0,1ml/10g weight; Group II (COD): codeine 15 mg/kbw; Group III (FBF): flurbiprofen 5 mg/kbw; Group IV (COD+FBF): codeine 15 mg/kbw + flurbiprofen 5 mg/kbw. To asses codeine and flurbiprofen-induced somatic antinociception was used tail flick test. The classic model of visceral pain consists of writhing test using diluted acetic acid (0,6%). Data were statistically analyzed using SPSS 13.0 variant for Windows.

Results: The administration of codeine-flurbiprofen association resulted in a prolongation of latency time response to noxious thermal tail stimulation, statistically in comparisonwith control group, the single administration of codeine and flurbiprofen in tail flick assay. In our experimental conditions, the association of codeine and flurbiprofen determined a decrease of behavioral manifestations, statistically significant compared to control, codeine, respectively flurbiprofen groups in writhing test.

Conclusion: Low doses of codeine and flurbiprofen exhibited weak antinociceptive effects in both tail flick assay and writhing test. Subcutaneously co-administration of low doses of codeine and flurbiprofen resulted in a significant enhancement of antinociceptive effect in tail flick and in writhing test, compared with the separate administration of codeine and flurbiprofen in low doses.

Bibliography: 1. Abdel-Salam O.M.E., Nofal S.M., El-Shenawy S.M., Evaluation of the anti-inflamma-tory and anti-nociceptive effects of different antidepressants in the rats, Pharmacol Res, 2003, 48, 157-165. 2. Lynch M.E., Antidepressants as analgesics: a review of randomized controlled trials, J Psychiatry Neurosci, 2001, 26(1): 30-36. 3. Micóa J.A., Ardidb D., Berrocosoa E., Antidepressants and pain, Trends in Pharmacological Sciences, 2006, 27(7): 348-354. 4. Montgomery S.A., Baldwin D.S., Blier P., Which antidepressants have demonstrated superior efficacy? A review of the evidence, Int Clin Psychopharmacol, 2007, 22(6): 323-329. 5. Ortega A., Roca A., Micó J.A., Modelos animales de dolor. Una visión crítica, Rev Soc Esp del Dolor, 2002, 9(7): 447-453. 6. Sawynok J., Esser M.J., Reid A.R., Antidepressants as analgesics: an overview of central and peripheral mechanisms of action. J Psychiatry Neurosci, 2001, 26(1): 21-29.

Pancreaticoduodenectomy with closing the pancreatic stump   Popa Roberta-Silviana , Savu Ștefăniță-Andrei Săndoi Iulian-Adrian, Raşoga Maria Gabriela, Vîrdaru Teodora-Nicoleta Validated View

Pancreaticoduodenectomy with closing the pancreatic stump

Surgical Science

Author(s): Popa Roberta-Silviana, Savu Ștefăniță-Andrei

Coauthor(s): Săndoi Iulian-Adrian, Raşoga Maria Gabriela, Vîrdaru Teodora-Nicoleta

Coordinator(s): Lecturer Theodor Viorel Dumitrescu

Keywords: pancretoduodenectomy stump anastomosis fistula

Introduction: Pancreatic fistula and anastomotic dehiscence following the pancreato-enteral anastomosis, used in the cephalic pancreatoduodenectomy (Whipple procedure), represent frequent complications of this intervention. Managing the pancreatic stump is the most important part of the pancreatoduodenectomy, in order to prevent the fistula and anastomotic dehiscence.

Material and Method: We present the 2nd surgery clinic’s experience on 13 cases of cephalic pancreatoduodenectomies (from 27 pancreatic resections); in 6 cases, pancreato-enteral anastomosis was used, while in another 7 cases, a non-anastomotic procedure was used, the pancreatic remains being sutured after the ligature of Wirsung’s duct.

Results: All 6 patients developed pancreatic fistulas that were managed differentely: in 5 cases, the flow dropped gradually to spontaneous resolution; in the 6th patient’s case, the fistula flow mantained to a 300 ml/24h and a fistulo-jejunal anastomosis was practiced.

Conclusion: The abandon of the pancreatic stump following the cephalic pancreatoduodenectomy is an alternative to anastomosis, having a higher risk, but a controlable one.

Bibliography: 1. Khosro Ayazi, Shahin Ayazi, Manouchehr Davaei - Pancreaticoduodenectomy with closing the pancreatic stump vs.standard Whipple’s procedure: a non-anastomotic technique.Hepato-gastroenterology 2005,62:617-619. 2. Sikora SS, Posner MC - Management of the pancreatic stump following pancreaticoduodenectomy. Br J Surg 1995,82:1590-1597. 3. Stuart G. Marcus, Henry Cohen, John M Ranson - Optimal management of the pancreatic remnant after pancreaticoduodenectomy. Annals of Surgery 1995,221:635-648 4. George H. Sakorafas, Helmut Friess, Bruno M. Balsiger - Problems of Reconstruction during Pancreatoduodenectomy. Digestive Surgery 2001,18 5. Piegari V, Canonico S, Napolitano V. - Closure of the residual pancreatic stump after pancreatoduodenectomy using a mechanical stapler.Pubmed 1991,12:149-51 6. Di Carlo, Chiesa V, Pontiroli R - Pancreatoduodenectomy with occlusion of the residual stump by Neoprene injection .World J Surg1989, 13:105-111

Hepatic cirrhosis and the entirety of its potentially fatal complications  Badiu Iulia , Lacau Radu - Validated View

Hepatic cirrhosis and the entirety of its potentially fatal complications

Case Report - Poster

Author(s): Badiu Iulia, Lacau Radu

Coordinator(s): MD Adriana Stoicescu

Introduction: Hepatic cirrhosis is an advanced stage of any hepatocytic affection, characterised by a fibrous orientation of the liver's architecture. Due to its complications-spontaneous bacterial peritonitis (SBP), hepatocellular carcinoma, superior digestive hemorrhage (SDH), hepatic encephalopathy (HE),  hepatorenal syndrome, its evolution can turn out to be devastating.

Case Presentation:

We present the case of a 65 years old pacient, known with chronic hepatitis with Hepatitis virus C for 18 years and with hepatic cirrhosis for 15 years, who was admitted to Elias hospital in october 2016 for enlargement of the abdomen, nausea, bilious vomiting, diffuse abdominal pain, diarrhea and oliguria. From the patient’s history: esophageal varices stage II, portal vein thrombosis, an episode of SBP 6 months ago and a hepatocellular carcinoma  diagnosed by abdominal ecography and tomography, but a normal alpha fetoprotein.
The clinical exam shows cutaneous stigmata of cirrhosis, slurred speech, tense ascitis and cachexia. Biohumoral: inflammatory syndrome with leucocitosis, hepatic depletion syndrome, hyperammonemia and azotate retention.
After performing paracentesis, the suspicion of recidivating SBP was confirmed(5600 PMN/mm3 liquid of ascitis). Multiple evacuatory and exploratory paracenteses were performed (18 L liquid of ascitis) and treatment with Ceftriaxon, human albumin 20% and fresh frozen plasma  was administered. 

Conclusion: The evolution was slowly favourable, with the resolution of the second episode of SBP, normalization of diuresis and regression of the azotate retention. Previous to the discharge, the patient suffered an episode of SDH through portal hypertensive gastropathy (a superior digestive endoscopy was performed) , followed by an aggravation of the HE manifestations. After the treatment, the clinical and biological picture ameliorates steadily.

Particularities: We report here the case of a patient with a long history of chronic infection with HVC and hepatic cirrhosis who associates multiple complications and has survived despite a recidivating SPB, a SDH and a hepatocellular carcinoma with an evolution of at least one year. 

Pancreatic pseudocyst- diagnosis and treatment problems  Ionescu Vlad Adrian , Ștefan Andreea-Nicoleta Tuica Larisa Mihaela , Savu Ștefăniță-Andrei, Săndoi Iulian-Adrian Validated View

Pancreatic pseudocyst- diagnosis and treatment problems

Surgical Science

Author(s): Ionescu Vlad Adrian , Ștefan Andreea-Nicoleta

Coauthor(s): Tuica Larisa Mihaela , Savu Ștefăniță-Andrei, Săndoi Iulian-Adrian

Coordinator(s): Assistant Professor Mircea Pîrşcoveanu

Keywords: pseudocyst pseudochistogastroanastomosis pseudochistojejunoanastomosis pancreatitis

Introduction:    Pseudocyst of the pancreas is a relatively common complication of acute pancreatitis, but also occurs in the evolution of chronic pancreatitis after pancreatic trauma. The gravity of the situation is the possibility of evolution of other types of complication such as: bleeding, rupture or infection. 

Material and Method:    Between 2010-2016, at the 3rd Surgery Clinic in Craiova, there were admitted 15 patients with pancreatic pseudocyst, 10 cases occurred after acute pancreatitis,4 cases after chronic pancreatitis and one after a concussion pancreatic, the average age of the patients was 52.3 years old. Abdominal ultrasound and CT scan were the two methods of investigation used in the diagnosis and therapeutic indication (pseudocyst size over 5 cm., pseudocyst wall maturation). External pseudocyst drainage was practiced in 2 cases and in 13 cases was practiced internal drainage: pseudochistogastroanastomosis in 9 cases and pseudochistojejunoanastomosis in 4 cases. Pancreatic psudocysts with a size below 5cm, that have undergone conservative treatment,weren’t taken into the study.  

Results:   The postoperative evolution was favorable; in 5 cases there were recorded postoperative complications: 2 cases of upper gastrointestinal hemorrhage that were stopped through medication and 3 cases of parietal suppuration.

Conclusion:    Surgery is indicated for pancreatic pseudocyst with a diameter greater than 5 cm, internal drainage representing indication of choice.

Bibliography: 1. Giovannini M., - Ultrasound-guided endoscopic surgery, Best Practice & Research in Clinical Gastroenterology, 2004, 18:183; 2. Millat B, Borie F, Guillon F - Traitement chirurgical de la necrose pancreatique et peri-pancreatique sterile ou infectee, Gastro-enterol Clin Biol 2001; 25:1S112 – 8; 3. Nemes, R., Curcã, T., Paraliov, T., Munteanu, M., Pasalega, M., Dincã, M., Mesina, C., Martin, L., Cheie, M., Talposi, L., Martin, R. - Cystic Tumors of the pancreas. Considerations upon 34 operated cases. Romanian Journal of Gastroenterology, 2002, 11:303; 4. Bailley, J. - Pancreatic pseudocysts, Part I. Gastrointestinal Endoscopy, 2004, 59:873; 5. Funariu, G. - Patologia chirurgicala a pancreasului. În “Chirurgie abdominalã“ sub redactia lui Funariu Gh. Ed. Dacia (Cluj Napoca) 2002, pag. 235-242; 6. Zhang,A.B. - Treatment of pancreatic pseudocysts in line with D'Egidio'S classification. World Journal of Gastroenterology, 2005, 11:729; 7. Saftoiu, A., Cazacu, S. - Ecoendoscopia digestivã superioarã diagnosticã si terapeuticã. În ''Gastroenterologie si Hepatologie. Actualitãti 2003'' sub redactia lui Tudorel Ciurea, Oliviu Pascu, Carol Stanciu, Ed. Medicalã (Bucuresti) 2003, pag. 519-539; 8. Andronescu P. - Pancreatita cronica. In “Tratat de patologie chirurgicala“, vol II. sub redactia Angelescu, N. Editura Medicala (Bucuresti) 2001, pag. 2021 – 2022; 9. Werner, J., Feuerbach, S., Uhl, W., & Büchler, M. W. (2005). Management of acute pancreatitis: From surgery to interventional intensive care. Gut, 54, 426–436; 10. R. Nemes, I. Georgescu, D. Mărgăritescu, A. Săftoiu, Luminita Chiutu, E. Georgescu, V. Surlin, D. Cârtu, Daniela Dumitrescu - Pseudochistul de pancreas, complicatie tardivă a pancreatitelor acute severe. Posibilităti si optiuni terapeutice, Chirurgia, 101 (3): 259-265.

A rare case of liver cystadenocarcinoma – case report  Borz Irina Maria , Bolunduţ Alexandru-Cristian - Validated View

A rare case of liver cystadenocarcinoma – case report

Case Report - Poster

Author(s): Borz Irina Maria, Bolunduţ Alexandru-Cristian

Coordinator(s): Lecturer Romeo Ioan Chira

Introduction:

Hepatic cystadenocarcinomas are rare biliary cystic neoplasms. The presence or absence of mesenchymal ovarian-like stroma differentiates the two histological types of this pathology. We present a case of liver cystadenocarcinoma with mesenchymal ovarian-like stroma, most commonly found in the sixth decade of age, in female patients. It is associated with a better prognosis than the non-mesenchymal type.


Case Presentation: A 67 years old female patient complained of vague upper abdominal pain. Physical examination revealed no other signs and symptoms apart from tenderness in right hypochondriac and epigastric regions. In the 29th of March 2016 she presented at Medicala I Hospital for investigations. She has multiple comorbidities: stage III arterial hypertension, hypertensive cardiomyopathy, Ist stage obesity, hypercholesterolemia, colecistectomy, hysterectomy and bilateral adnexectomy. The abdominal ultrasound showed a complex septaded cystic mass (14.5/13/12.5 cm) in the left liver lobe. This finding led to an abdominal computer tomography scan, that confirmed the lesion with different densities within it and the consequent compression of the main biliary duct. Blood tests also reveald cholestasis, with high levels of alkaline phosphatase and gamma-glutamyl transpeptidase. These investigations lead to the suspicion of liver cystadenoma or cystadenocarcinoma. On the 21st of June 2016 a left lateral liver sectionectomy (segments II,III, ½ IV)was performed. Histopathological analysis led to the diagnosis of liver mucinous cystadenocarcinoma.

Conclusion: The post-operation evolution is favorable with no adenopathies or secondary tumours revealed by the thoracic and abdominal CT scan performed on the 31st of October 2016. Blood tests were between normal limits (cholestasis absent).

Particularities:

We report a rare case of liver cystadenocarcinoma. The patient has shown no signs and symptoms of malignancy. Also CA19-9 and CEA blood levels were within normal limits at all times.

BREAST ULTRASOUND OF THE PREGNANT AND LACTATING PATIENT – What the radiologist needs to know  Zahari Mihaela Marioara , Stana Horatiu - Validated View

BREAST ULTRASOUND OF THE PREGNANT AND LACTATING PATIENT – What the radiologist needs to know

Medical Science

Author(s): Zahari Mihaela Marioara, Stana Horatiu

Coordinator(s): Associate Professor Angelica Chiorean , Assistant Professor Madalina Szep

Keywords: ultrasound lactation pregnancy biopsy

Introduction: Breast lesions detected during pregnancy and lactation are generally benign, but the possibility of breast cancer must also be considered to avoid any delays in diagnosis. The standard method for assessing these breast disorders is ultrasound combined, if needed, with core needle biopsy. We aim to highlight the ultrasound appearances of these disorders and intervention for evaluating this population.

Material and Method: A retrospective study was performed including all those pregnant and lactating women investigated for palpable masses during a 2-year period. Ultrasound findings, pathology results, and clinical notes were reviewed. Aspects were assessed according to BI-RADS and Tsukuba elasticity score. Means of diagnostic: percutaneous biopsies for BI-RADS 4 and 5 lesions; short term follow up BI-RADS 3 lesions and no further assessment for lesions categorized as BI-RADS 2 lesions with no suspicious clinical signs.

Results: Forty-eight lesions were included. The most frequent were fibroadenomas (twenty-five; 3 of these were growing fibroadenomas and 1 intraductal fibroadenoma), followed by galactoceles (ten), lactating adenoma (three), physiologic changes during pregnancy (two) and physiologic changes during lactation (five). Three pregnancy-associated breast cancer were identified (ductal carcinoma in situ, II grade ductal carcinoma in situ, III grade invasive ductal carcinoma). These three cases underwent surgery during pregnancy and had favorable maternal and fetal outcomes.

Conclusion: Knowledge of the entities that are specifically related to pregnancy and lactation and of their imaging appearances are essential for an accurate diagnosis. 

Bibliography: 1. Ines Beyer, Nikola Mutschler, Katrin S Blum, Svjetlana Mohrman. Breast lesions during pregnancy-a diagnostic challenge: case report. Breast Care. 2015 April 28. 10:207-210. 2. Paul Olisaemeka Ezeonu, Leonard Ogbona Ajah, Robinson Chukwudi Onoh, Lucky Osafeni Lawani, Vincet Chidi Enemuo, Uzoma MaryRose Agwu. Evaluation of clinical breast examination and breast ultrasonography among pregnant women in Abakaliki, Nigeria. OncoTargets and Therapy. 2015 May 13. 3. A. E. Ring, I. E. Smith, P. A. Ellis. Breast cancer and pregnancy. Annals of Oncology. 2005 July 19. 16:1855-1860.

UNUSUAL EVOLUTION OF RAPIDLY PROGRESSIVE CRESCENTIC GLOMERULONEPHRITIS  Moldovan Diana Maria Margareta , Oltean Ioana Maria Oros Adrian, Asztalos Anna Boglarka, Ani Cristina Miceta Validated View

UNUSUAL EVOLUTION OF RAPIDLY PROGRESSIVE CRESCENTIC GLOMERULONEPHRITIS

Case Report - Poster

Author(s): Moldovan Diana Maria Margareta, Oltean Ioana Maria

Coauthor(s): Oros Adrian, Asztalos Anna Boglarka, Ani Cristina Miceta

Coordinator(s): Assistant Professor DIANA TANIA MOLDOVAN

Introduction: The term rapidly progressive crescentic glomerulonephritis (RPGN) refers to a pathological condition characterized by extracapillary proliferation in more than 50% of glomerulus that associated with a rapid deterioration of kidney function. The most common cause of RPGN is anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis.
Case Presentation: P.S., 47-year-old male patient presented fatigue, weight loss of approximately 4-5 kg in the last 6 months and paresthesias on the anterolateral side of thigh to the dorsalis face of foot bilateral. Previous medical history shows that the patient was diagnosed with BPOC and essential hypertension stage II. Lab results from a year ago proves that the patient had normal renal function and moderate normocytic anemia. Biological parameters at hospitalization indicated: moderate normocytic normochromic anemia, significant inflammatory syndrome (ESR = 105, CRP = 4.9mg / dl) with leukocytosis, neutrophilia and eosinophilia, mild thrombocytosis, moderate nitrogen retention (creatinine = 3.66mg / dl; urea = 135mg / dl), mild hyperkalemia, hyperuricemia, moderate hypoalbuminemia,elevated levels of rheumatoid factor. Urinalysis revealed: proteinuria/24 h: nephrotic range proteinuria (2.8g), hematuria. During hospitalization the inflammatory syndrome persisted and the patient’s renal parameters have remained high. Immunological screening identified an antibody titre of ANA =1/160 and an increased p-ANCA titer (> 600) which helped establish the diagnosis of ANCA-Positive Vasculitis. Ultrasound-guided renal biopsy on the left kidney and the histopathological examination pleads for RPGN associated with a chronic interstitial severe nephritis.
Conclusion: Consequently, the patient was diagnosed with microscopic polyangiitis (p-ANCA positive vasculitis). Following a treatment with prednisone and azathioprine, the patient developed severe pancytopenia, which led to the suspension of azathioprine administration. Evolution was favorable and the patient had an overall good state at discharge.
Particularities: Some particular aspects of this case are the unexpectedly good progress of the patient and the pancytopenia caused by azathioprine administration.

Chiari Network- an incidental diagnosis  Khokhar Hassan Tahir , Augustine Arlyn Masood Syed Shah Mohammed Emmad, Zafran Mohammed Validated View

Chiari Network- an incidental diagnosis

Case Report - Poster

Author(s): Khokhar Hassan Tahir, Augustine Arlyn

Coauthor(s): Masood Syed Shah Mohammed Emmad, Zafran Mohammed

Coordinator(s): MD Oana Sirbu

Introduction:

Chairi network is a mobile net-like structure seldomly visible in the right atrium close to the opening of the inferior vena cava which is found in 2-3% of hearts during autopsy and incidentally during TTE in less than 0.6% patients.  Usually, this is of no clinical significance but it may cause diagnostic difficulties, hence a differential diagnosis with myxoma is essential.


Case Presentation:

We describe a case of a 68 year old woman who presented to the hospital with dyspnea at effort along with productive cough, sweating and epigastric pain. This presentation was preceded by a diagnosis of multiple sclerosis at the age of 16, multiple cerebral infarctions, global cerebral atrophy, meningioma and class III NYHA chronic cardiac insufficiency. The clinical picture called for further investigations which included an X-ray that raised suspicion of pneumonia. Baseline blood analysis presented with important increase in BNP, troponin and leukocytosis with neutrophilia. Transthoracic echo showed aortic atherosclerosis  and a hyperechoic image of a floating, highly mobile net like structure that suggested an atrial myxoma.  To confirm the diagnosis, TEE was performed and the previously suggested myxoma was overruled by a diagnosis of Chiari network.


Conclusion:

Treatment for myxoma involves surgery and thus a successful differential diagnosis prevented any major surgical intervention. In this case, the patient was left under observation as the Chiari network did not present with any complications. No association with Patent Foramen Ovale or Atrial Septal Aneurysm  were noted which are common associations.


Particularities:

We report this case as an incidental diagnosis of a rare condition that can cause diagnostic confusion of right atrial pathologies and thromboembolism by blocking the outflow. Furthermore, to emphasize its protective role, it may act as a filter in the inferior vena cava to protect from pulmonary embolism.

THE VALUE OF THORACOSCOPY IN CDH TREATMENT  John Aksa Roy Sandra Susan, John Nithiya Kadampattu Validated View

THE VALUE OF THORACOSCOPY IN CDH TREATMENT

Surgical Science

Author(s): John Aksa

Coauthor(s): Roy Sandra Susan, John Nithiya Kadampattu

Coordinator(s): MD Alin Stoica

Keywords: thoracoscopy minimally invasive surgery congenital diaphragmatic hernia

Introduction: Since the introduction of Minimally Invasive Surgery in the Department of Pediatric Surgery, Emergency Hospital of Craiova Romania, in 2012, thoracoscopy became “the gold standard” in surgical treatment of Congenital Diaphragmatic Hernia (CDH)

Material and Method: A number of 4 cases were operated for CDH (1 case on right diaphragm). One case was a severe premature baby (1000 grams). In all four cases different types of repair were performed. In one case recurrence occurred requiring prosthetic material. In one case rib anchorage was achieved, in two cases primary simple suture of the diaphragm was performed. 

Results:  One case in our short patient list, died postoperatively after 4 weeks. One case with recurrence, treated through thoracoscopy with prosthetic material.

Conclusion: Thoracoscopy is a fair option for CDH treatment, not very easy to do in some cases, according to the type of hernia but well tolerated by babies, even in very small patients. Positive pressure into the thoracic cavity is helpful for bowel reduction but the insufflation can be stopped almost in half of the operative period.

Bibliography: Cho SD1, Krishnaswami S, Mckee JC, Zallen G, Silen ML, Bliss DW.. Analysis of 29 consecutive thoracoscopic repairs of congenital diaphragmatic hernia in neonates compared to historical controls. J Pediatr Surg. 2009 Jan;44(1):80-6; discussion 86. doi: 10.1016/j.jpedsurg.2008.10.013 François Becmeur, MD, PhDemail, Olivier Reinberg, Corneliu Dimitriu, MD, Raphael Moog, MD, Paul Philippe, MD Thoracoscopic repair of congenital diaphragmatic hernia in children Seminars in Pediatric Surgery Volume 16, Issue 4, Pages 238–244, November 2007 Jeffrey W. Gander, Jason C. Fisher, Erica R. Gross, Ari R. Reichstein, Robert A. Cowles, Gudrun Aspelund, Charles J.H. Stolar, Keith A. Kuenzler. Early recurrence of congenital diaphragmatic hernia is higher after thoracoscopic than open repair: a single institutional study.Journal of Pediatric Surgery. Volume 46, Issue 7, Pages 1303–1308, July 2011 Lansdale N1, Alam S, Losty PD, Jesudason EC.. Neonatal endosurgical congenital diaphragmatic hernia repair: a systematic review and meta-analysis. Ann Surg. 2010 Jul;252(1):2 0-6. doi: 10.1097/SLA.0b013e3181dca0e8 Minimally invasive repair of congenital diaphragmatic hernia. Tsao K1, Lally PA, Lally KP; Congenital Diaphragmatic Hernia Study Group. J Pediatr Surg. 2011 Jun;46(6):1158-64. doi: 10.1016/j.jpedsurg.2011.03.050.

ACUTE MYELOID LEUKEMIA EVOLVING FROM CALR-POSITIVE PRIMARY MYELOFIBROSIS – CASE REPORT  Pál Krisztina , Nastase Diana Morariu Andrei Demirel, Oltean Ioana Maria, Barb Andreea Mihaela Validated View

ACUTE MYELOID LEUKEMIA EVOLVING FROM CALR-POSITIVE PRIMARY MYELOFIBROSIS – CASE REPORT

Case Report - Poster

Author(s): Pál Krisztina, Nastase Diana

Coauthor(s): Morariu Andrei Demirel, Oltean Ioana Maria, Barb Andreea Mihaela

Coordinator(s): Associate Professor Anca Simona Bojan

Introduction: Primary myelofibrosis (PMF) is the least common chronic myeloproliferative disorder (MPD) characterized by marrow fibrosis, extramedullary hematopoiesis and splenomegaly. The expression of the Janus kinase 2 (JAK2), calreticulin (CALR), or thrombopoietin receptor (MPL) genes has a major impact on the clinical course and management of PMF. PMF can evolve to an aggressive form of acute myeloid leukemia (AML) in approximately 10% of patients.

Case Presentation: T.H., a 44 year old male patient, known with non-alcoholic fatty liver disease, metabolic syndrome, gout, is referred to Hematology in March 2005 with splenomegaly where he is diagnosed with PMF. Without treatment prescribed, he is supervised periodically until 2013 when imaging shows giant splenomegaly (22/16 cm) and possible splenic infarctions. In March 2015, genetic testing reveals JAK2 negative, CALR positive, Bcr-abl negative PMF and treatment with Ruxolitinib is initiated. In February 2016 splenectomy is performed. In March 2016, laboratory tests indicate marked leukocytosis (45.000/ul), thrombocytosis (1.700.000/ul), leukemic blasts 40%. Based on bone marrow aspiration and immunophenotyping he was diagnosed with acute megakaryocytic leukemia (AML-M7).  Cytoreductive therapy using Hydroxyurea was administered with a positive response. Subsequently, “7+3” chemotherapy was initiated in May leading to complete remission followed by 3 FLAG (fludarabine+cytarabine+G-CSF) regimens. Due to thrombocytosis (1.461.000/ul) Mercaptopurine and Methotrexate treatment is necessary. The patient responded well to treatment, he is in complete remission and he is awaiting for an allogenic stem cell transplant (allo-SCT).

Conclusion: Leukemic transformation in PMF is a complication associated with a substantial life-expectancy reduction. An allo-SCT is the only potential cure for PMF.

Particularities: The complexity and severity of the case lie in the early age onset, the presence of the less common CALR mutation and the spontaneous transformation to an aggressive form of acute leukemia.

Modern Techniques of Treating Achalasia  Grama Vicentiu Alexandru , Dinu Sabina - Validated View

Modern Techniques of Treating Achalasia

Surgical Science

Author(s): Grama Vicentiu Alexandru, Dinu Sabina

Coordinator(s): Assistant Professor Radu Nițu

Keywords: Achalasia Heller cardiomyotomy anti-reflux

Introduction: The therapeutic management of achalasia has thoroughly modified through the last decades, laparoscopic Heller cardiomyotomy becoming a standard treatment. The association with an anti-reflux procedure diminishes the potential risk of post-operative pathological gastroesophageal reflux. 

Material and Method: Between January 2014 – December 2016, in the General Surgery Clinic of the County Emergency Hospital, Constantza, specific surgical procedures were performed on 6 patients presenting this disease, the diagnosis being sustained by clinical and radiological information. Laparoscopic Heller cardiomyotomy, correlated with an anterior Dor hemi-valve, was practiced in all of these cases.

Results: The cases approached in a laparoscopic manner did not require conversion to the traditional open surgery. The postsurgical evolution was bereft of complications, allowing the patient discharge 3-5 days after the intervention. The follow-up of the subjects was conducted over a period of 3-18 months and consisted of clinical examination and radiological investigations; the excellent obtained results proved a lack of dysphagic complaints during the medical surveillance period. 

Conclusion: The laparoscopic Heller cardiomyotomy, accompanied by an anti-reflux scheme, epitomizes a feasible and efficient method of treating achalasia, attaining favorable long-term outcomes, as far as the amelioration of dysphagic symptoms is targeted. Quick recovery and decreased hospitalization duration stand for the election of the presented procedure as a viable and optimal alternative to endoscopic therapies - consisting of successive dilations or Botox injections.

Bibliography: Achalasia of the Esophagus (Major Problems in Clinical Surgery, Volume IX) - by Ellis & Olsen Achalasia - Diagnosis and Treatment - by P. Marco Fisichella

GLUCOCORTICOIDS - FRIEND OR FOE?  Dumitrescu Ana-Maria Oprea Anamaria, Caragioiu Alexandra, Nicolae Maria Validated View

GLUCOCORTICOIDS - FRIEND OR FOE?

Case Report - Poster

Author(s): Dumitrescu Ana-Maria

Coauthor(s): Oprea Anamaria, Caragioiu Alexandra, Nicolae Maria

Coordinator(s): Assistant Professor Caterina Delcea , Professor Cristian Baicus

Introduction:  Dermatomyositis is an idiopathic inflammatory myopathy with specific skin involvement and possible multisystem complications. The mainstay of initial therapy are high-dose corticosteroids, which can induce multiple side effects, including an inhibitory effect on both innate and acquired immune response, thus predisposing to infection.

Case Presentation:  A 64 years old female was referred to our Dermatology department for a heliotropic rash and severe bilateral weakness of the proximal muscles. She was diagnosed with dermatomyositis and treated with 64 mg/day o.d. oral methylprednisolone. Before hospitalization, she also reported dry cough, apparently resolving, with normal chest x-ray on admission. Six days later the symptoms advanced to hemoptysis, dyspnea and fever. CT scan revealed bilateral pulmonary abscesses. Klebsiella pneumoniae infection was confirmed from cultures of bronchoalveolar lavage and broad spectrum antibiotics were administered with initial favorable outcome, but ten days later she suddenly became severely dyspneic at rest. Repeated CT scan revealed massive right pneumothorax, that was successfully drained. During hospitalization, the patient also developed drug-induced diabetes mellitus, thrombocytopenia due to linezolid, acute kidney injury because of meropenem, nausea, vomiting and diarrhea secondary to doxycycline. After a 36-day hospital stay, her numerous conditions improved and she was discharged home.

Conclusion: High-dose corticosteroid treatment has multiple repercussions, individualized to each patient, requiring close supervision and prompt interventions for any alarming sign or symptom. 

Particularities: What initially seemed a typical case of dermatomyositis turned to be a cascade of complications. Very early in the course of treatment, high dose corticosteroids unraveled a bilateral Klebsiella pneumoniae lung infection with multiple abscesses that evolved to massive pneumothorax. The patient developed several other severe complications from the therapy regimens, receiving targeted interventions for every particular one, leading to a successful recovery.

The good prognosis of early-detected oesophageal squamous cell carcinoma treated with radio-chemotherapy  Trif Bianca Ioana Di Nardo Nicola Validated View

The good prognosis of early-detected oesophageal squamous cell carcinoma treated with radio-chemotherapy

Case Report - Poster

Author(s): Trif Bianca Ioana

Coauthor(s): Di Nardo Nicola

Coordinator(s): MD Anca Negovan , MD Simona Mocan




ILEOCOLIC INTUSSUSCEPTION WITH MECKEL DIVERTICULUM AS LEAD POINT IN 10 MONTHS OLD INFANT- CASE REPORT  Cîntăcioiu Diana-Georgiana , Necula Ovidiu Radulescu Ana-Maria Invalidated View

ILEOCOLIC INTUSSUSCEPTION WITH MECKEL DIVERTICULUM AS LEAD POINT IN 10 MONTHS OLD INFANT- CASE REPORT

Case Report - Poster

Author(s): Cîntăcioiu Diana-Georgiana, Necula Ovidiu

Coauthor(s): Radulescu Ana-Maria

Coordinator(s): Assistant Professor Răzvan Constantin Datu

Introduction: Intussusception is a process in which a segment of intestine invaginates into the adjoining intestinal lumen, occurring in  2/1000 children, frequently in eutrophic infants. Even though the ethiopathogenesis is not completely established, in 2-12% of infants a surgical leading point is found such as Meckel Diverticulum, benign or malignant tumors and foreign bodies. The phisiopathologic evolution of the disease is characterised by impairment of lymphatic, venous and eventualy arterial circulation, leading to edema and intraluminal haemorrhage with a natural evolution to ischemia and necrosis with intestinal infarction. The typical clinical presentation includes vomiting, abdominal pain and "currant jelly" stool.



Case Presentation: A 10 months old, male patient is brought to the ER of the "Grigore Alexandrescu" Children Emergency Hospital, with more than 10 episodes of vomiting during the past 8 hours. The pacient had mild diahreea, with normal coloured stools, normal resultsof clinical examination of the abdomen, without palpable masses or signs of peritoneal irritation. The ultrasonography examination showed a pseudokidney sign, while the abdominal radiography sugessted an obstructive syndrome. The first therapeutic attempt was a nonsurgical reduction by a barium enema, which proved to be unsuccessful. The surgical treatment included an exploratory laparotomy, resection of the distal ileum with an end to end anastomosis and appendicectomy. Intraoperatory, after the difficult reduction of the intussusception, a Meckel diverticulum was identified as the lead point.


Conclusion:
After surgery, the evolution of the patient is favorable, the irigography reveals a correct opacification of the large bowel.


Particularities:
We report a case of ileocolic intussusception in an infant that does not present with the typical symptomatology who was succesfully diagnosed and treated. The lead point, represented by a Meckel diverticulum was identified in this patient.
Keywords: Intussusception, Meckel diverticulum, ileocolic invagination


Migration of a contraceptive subcutaneous device into the pulmonary artery-Case Report  Pasca Gina-Iulia Ciobanu Andrei Validated View

Migration of a contraceptive subcutaneous device into the pulmonary artery-Case Report

Case Report - Poster

Author(s): Pasca Gina-Iulia

Coauthor(s): Ciobanu Andrei

Coordinator(s): MD Diana Defta Defta

Introduction: Contraceptive implants with progestogens are options for women who need long-term contraception. The devices contain etonogestrel that effectively prohibits ovulation over a period of three years.

Case Presentation: R.C., a 31 year-old woman, without medical history, requested a contraceptive implant in 2013. A Nexplanon® contraceptive device was inserted into her right upper-limb without apparent complications. Nexplanon® is a radiopaque, non-biodegradable, flexible implant preloaded in a sterile, disposable applicator which contains 68mg of etonogestrel (release rate is approximately 60-70µg/day). Three years after the initial device insertion, she returned to her health-care institution requesting the removal of the contraceptive implant, as she wished to become pregnant. The device could not be located clinically or following ultrasonography. Hormone assays were positive, confirming that the implant was present in the patient's body. Imaging investigations were performed, looking for a possible migration. A chest-radiograph showed a linear-opaque structure in the pulmonary hemi-left field, whose size and shape were compatible with Nexplanon®. A thoracic CT-scan confirmed the migration and specified its location into sub-segmental branch of the left-lower-lobe pulmonary artery, without arterial stenosis/thrombosis. Retrieval of the implant was indicated, but after several discussions, it was decided to leave the original device in situ permanently rather than risk removal.

Conclusion: Cardiopulmonary complications after a contraceptive implant migration in pulmonary artery may be serious including infection and thrombosis. Exact location is crucial as endovascular-procedures are now considered as the best way to retrieve endovascular foreign bodies with high success rate and low morbidity. 

Particularities: There have been rare reports of Nexplanon® implants having reached the lung via the pulmonary artery. An implant that is not palpable or difficult to palpate at its insertion should be located as soon as possible and removed at the earliest opportunity. Patients must be fully informed about the procedure, including its complications and the risk for failure.

A RARE CASE OF RENAL CELL CARCINOMA WITH SIGNIFICANT EXTENSION INTO THE RENAL VEIN AND INFERIOR VENA CAVA  Andrea Cora-Iulia , Pop Tiberiu Andrei Stoica Andreea Bianca, Patrichi Andrei - Ionuț Invalidated View

A RARE CASE OF RENAL CELL CARCINOMA WITH SIGNIFICANT EXTENSION INTO THE RENAL VEIN AND INFERIOR VENA CAVA

Case Report - Poster

Author(s): Andrea Cora-Iulia, Pop Tiberiu Andrei

Coauthor(s): Stoica Andreea Bianca, Patrichi Andrei - Ionuț

Coordinator(s): MD Calin-Bogdan Chibelean

Introduction: Renal cell carcinoma (RCC) with renal vein and inferior vena cava (IVC) extension is discovered in 5–20% of the 54,000 newly diagnosed RCC’s each year. Because renal cell carcinoma is refractory to chemotherapy and radiation therapy, surgery in general and radical nephrectomy in particular has evolved as the primary radical treatment in patients with clinically localized and locally advanced disease. 

Case Presentation:  A 75 years old male patient known with history of stroke is hospitalized in the department of Urology for right renal colic, gross hematuria, weight loss. He has multiple comorbidities: Right Ureterohydronephrosis, Benign Prostatic Hyperplasia, anemia, hypertension stage 1. According to anamnesis, clinical and paraclinical examinations we established the following diagnostis: Right Renal Cell Carcinoma T3b N1Mx  characterized on CT scan by a solid parenchymal mass with a heterogeneous density, multiple necrosis zones, developed from posterior renal valve of superior pole. The tumor extend verticaly to mediorenal area, to renal vein and IVC thrombosis. After preoperative preparation we performed the following surgical approach : Right radical nephrectomy by a Chevron incision, cavotomy and a thrombus exctraction which expands approximately 3 cm from  the renal vein.

Conclusion:

 After surgery, the evolution is favourable, apyretic, hemodinamically and respiratory stable, clear urine, intestinal transit resumed and phases of wound healing. 

Particularities: In these cases it is important to consider an aggressive approach for vena cava involvement from malignant renal neoplasms which resulted in prevention of tumor embolus, minimization of blood loss, and maintenance of venous return to the heart.

The coronary fistulas – computed tomography evaluation  Lefter Cristina , Iacob Diana Andreea Nistor Mirela, Morariu Andrei Demirel, Buta Nicoleta-Flavia Validated View

The coronary fistulas – computed tomography evaluation

Case Report - Poster

Author(s): Lefter Cristina, Iacob Diana Andreea

Coauthor(s): Nistor Mirela, Morariu Andrei Demirel, Buta Nicoleta-Flavia

Coordinator(s): Professor Theodora Benedek , Professor Imre Benedek

Introduction:

The coronary artery fistulas(CAF) are congenital defects discovered accidentally. They represent an abnormal communication between the coronary arteries and a cardiac chamber or a vascular structure. Regularly there are not important changes, but if the symptoms persist, it needs to be treated. Non-invazive technique like Multislice Computed Tomography(MSCT) is usually used to detect the coronary anomalies. If there are sympthoms like angina or dyspnoea it is mandatory the surgical or percutaneous closure of the communications. 


Case Presentation:

We present the case of a 47-year old male patient with CAF. In his cardiovascular history, he is known with acute anterior myocardial infarction and revascularization with drug-eluting stent on left anterior descending coronary artery(LAD). The electrocardiography showed sinus rhythm with negative T waves in the precordial derivations. Echocardiogram revealed hipokinesis of the anterior wall, with an ejection fraction of 48%. The MSCT showed a persisting contrast located in the medium segment of the LAD’s stent, associated with an atheromatous plaque without significant stenosis and a coronary shunt at the emergence of the circumflex artery. The patient was asympthomatic, without chest pain, dyspnea or fatigue, thereby we chose the conservative treatment and a rigorous follow-up.


Conclusion:

This rare coronarian anomalies in most of the cases are discovered incidental. Non-invazive assessment, like magnetic resonance or multislice computer tomography-are widely available and offer safe informations of the fistulas. 


Particularities: Adults are in the most of the cases asympthomatics, but the symptomatology depends on the localization and the size of the communication. The symptoms that can occure are: chest pain, arrhythmias, dyspnoea and fatigue. At the physical examination, it was detectable a specific systolic and diastolic murmur.

A rare case of urothelial tumor  Buta Nicoleta-Flavia , Lefter Cristina Iacob Diana Andreea Validated View

A rare case of urothelial tumor

Case Report - Poster

Author(s): Buta Nicoleta-Flavia, Lefter Cristina

Coauthor(s): Iacob Diana Andreea

Coordinator(s): Assistant Professor Alexandru Brad

Introduction: Urothelial tumors develop from the transitional epithelium type which is present in the  calyces , pelvis, ureter, bladder and proximal urethra.Usually, this pathology  is more common in males around the age of 60 years old. Mainly, the risk factors involved are smoking and occupational long exposure to various toxic substances.

Case Presentation: We present the case of 72 years old male who was admitted in Urology  Clinic  of Tîrgu-Mureș Emergency County Hospital accusing: rectal bleeding, acute low back pain colic character, nausea, vomiting. From previous medical history our patient had  radical cystectomy  bypass Mainz Pouch II urinary type for muscle-invasive bladder tumor (pT2 urothelial carcinoma G2) in 2003.The patient presents chronic smoking,he worked in a toxic environment  for 30 years and urological consultation raises suspicion of high right urothelial tumor,  recommending to perform an  ultrasound abdominal  exam and abdomeno-pelvic CT. Ultrasound reveals a dilated right kidney with an inhomogeneous structure of 3x3 cm. CT scan identifies a parenchymal renal pelvis formation of 35X36 mm; without lymphadenopathy or abdominal metastases.

Conclusion: Following personal history, clinical examination and laboratory examinations ,our patient was diagnosed with high right field urothelial tumor, right secondary hydronephrosis ,anemia and chronic smoking. It  was practiced total nephroureterectomy with right uretero-sigmoid anastomosis excision.

Particularities: Our case involves risk factors as smoking, occupational exposure , in appearance of urothelial neoplasms and made occurrence also, 13 years after cystectomy for urothelial  bladder tumor, for  a new urothelial tumor which proves the importance of controlling the whole urothelial field for a long time.

AGRESSIVE EVOLUTION OF FAMILIAL MEDULLARY THYROID CANCER (FMTC)  Teodor Oana Mihaela - Validated View

AGRESSIVE EVOLUTION OF FAMILIAL MEDULLARY THYROID CANCER (FMTC)

Case Report - Poster

Author(s): Teodor Oana Mihaela

Coordinator(s): MD Ionela Florina Baciu , Professor Catalina Poiana

Introduction: Medullary thyroid cancer (MTC) arises from the neural crest-derived, calcitonin-secreting, parafollicular C cells and represents 3-10% of all thyroid cancers. Although most cases are sporadic, about 20% cases are part of an autosomal dominant inherited disorder (Multiple Endocrine Neoplasia type 2A, 2B). Mutations in the rearranged during transfection (RET) proto-oncogene are considered central to the pathogenesis, with strong genotype-phenotype correlation

Case Presentation: We report a case of a 36 years old woman diagnosed in 2009 with bilateral multifocal MTC, having highly elevated calcitonin (857 pg/ml). After total thyroidectomy, detectable calcitonin level suggested residual locoregional disease, thus an extended lateral neck dissection was performed a year later in Germany. Due to family history (mother with MTC at age 44 who died of recurrent disease seven years after apparent curative thyroidectomy), further DNA analysis was performed and the test revealed a heterozygous mutation of the 11th exon of RET gene, Cys634Tyr mutation. Current treatment includes substitution therapy addressing the postsurgical hypothyroidism and hypoparathyroidism. During the follow-up, our patient presented undetectable levels of calcitonin, until January this year, when values started to rise, now up to 7, without association of other neoplasia, physical examination revealing a good state with only mild dysphonia and positive Chvostek sign

Conclusion: The complete approach of a patient and family history combined with early genetic test of the first-degree relatives are critical to proper management. Serum calcitonin, a highly sensitive biomarker, had an essential role in post resection surveillance monitoring in this particular case suspicious of recurrence of FMTC

Particularities: The initial therapeutic strategy underestimated the preoperative calcitonin levels and familial history, missing the genetic screening before surgery. After six years of remission, calcitonin is again detectable and rising. The screening of patient’s son for the putative codon 634 RET mutation was negative, allowing exclusion for annually follow-up by calcitonin dosage

Acute diarrheal disease - Factors of pathogenicity  Dindiri Ioana Alexandra - Invalidated View

Acute diarrheal disease - Factors of pathogenicity

Medical Science

Author(s): Dindiri Ioana Alexandra

Coordinator(s): Assistant Professor Alice Gaman

Keywords: #acutediarrheal #enterotoxins #haemagglutination #Ecoli

Introduction: Infectious etiology of acute diarrheal disease is a major health problem. The term is relatively ambiguous diarrheal disease, including bacillary dysentery and enterocolitis caused by other agents, showing the same symptoms. 

Material and Method: They were taken in the study between the years 2011 - 2013 lots of children diagnosed with acute diarrheal disease hospitalized in the clinic Pediatrics of S.C.J.U Craiova and ambulatory. Highlighted factors : accession bacteria from acute diarrheal disease (a.d.d.) - hemagglutination tests, the bacteria isolated from diarrheal enterotoxins - LT enterotoxin experimental model for testing, cytotoxicity strains - Vero and HeLa cell cultures, hemolysin E. coli strains. 

Results: Bacterial adhesion and adhesion pili factors The haemagglutination method and electronic microscopy showed major role in accession of rigid filament structures. 

Conclusion: Lack of fimbrial adhesins in most EHEC strains reinforce the hypothesis that their attachment to erythrocytes is probably other ways, possibly by mannose-resistant fimbriae encoded plasmid unhemagglutination . Taking into account the fact that only in 50% of EHEC strains tested showed cytotoxin , it can be concluded that in addition to this important pathogenicity factor involved and other pathogenesis mechanisms.

Bibliography: Microbiology, Anca Ungureanu Virusology , Anca Ungureanu and Alice Gaman

Cyclopia, a severe form of holoprosencephaly - Case report  Mihu Carina - Validated View

Cyclopia, a severe form of holoprosencephaly - Case report

Case Report - Poster

Author(s): Mihu Carina

Coordinator(s): Lecturer Andrei Mihai Malutan

Introduction:

Holoprosencephaly is a major congenital malformation which can occur between the 18th and 28th day of gestation an is characterised  by the absence or incomplete cleavage of the prosencephalon into separate hemispheres. An extreme form of HPE is cyclopia, defined as the failure of the embryonic prosencephalon  to devide the orbits of the eye in two cavities. Usually cyclopia is a malformation incompatible with life, diagnosed in the first trimester. 


Case Presentation:

 A 15 year old patient delivered a 34-week living fetus with alobar holoprosencephaly, cyclopia and proboscis. The fetus was diagnosed with multiple malformations at the first obstetrical exam at 29 weeks of gestation. Despite of the patient being advised to perform further invastigations, such as genetic tests and IRM, she refused, along with her mother, any possible examination. Twenty-four hours later she delivered vaginally a living fetus weighting 1995g.The clinical examination of the new born revealed: cyclopia, proboscis, low implanted ears, polydactyly of the upper limbs. The newborn lived for 40 minutes. The pathological examination of the newborn revealed an eyeball with choroid, ciliary body and conjunctiva structures, but no retina or optic nerve. The microscopic examination of the proboscis revealed respiratory epithelium, along with mucous glands in the submucosa and cartilage fragments.


Conclusion: Cyclopia is a severe congenital malformation, incompatible with life, but due to the late obstetrical examination pregnancy termination was no longer an option.
Particularities:

Although the fetus was diagnosed with a severe congenital malformation which is normally incompatible with postnatal life, it survived for 40 minutes.

A fortunate outcome in the case of a large pleural effusion  Chiriac Andra-Mădălina , Andriescu Gabriela Străinu Ana-Maria Invalidated View

A fortunate outcome in the case of a large pleural effusion

Case Report - Poster

Author(s): Chiriac Andra-Mădălina, Andriescu Gabriela

Coauthor(s): Străinu Ana-Maria

Coordinator(s): Assistant Professor Maricel Burlacu

Introduction: Pleural effusions are excessive  fluid build-ups within the pleural  cavity, with a wide range  of underlying  potential causes:  heart  failure,  malignancy, infection, pulmonary embolism etc. Based on the  pathophysiological mechanism  of accumulation and the composition of the fluid,  there are two major types  of  pleural effusions: transudative and exsudative, each pointing towards different  ethiologies.

Case Presentation: We present the case of a 14 year old boy, previously admitted to the emergency room in Pascani with acute respiratory failure.A chest x-ray examination identified the cause to be a large pleural effusion, covering 2/3 of his left lung.He was  stabilised and further directed to Sf. Maria Hospital in Iasi for investigations. On his current admission, the patient was febrile and tachypneic,  he  had left medio-axillary thoracic pain and a productive cough.Clinical examination was consistent with the diagnosis of parapneumonic pleural effusion while common biological parameters pointed towards a bacterial infection, presumably a pneumonia: neutrophilic leukocytosis with  elevated levels  of fibrinogen and ESR.

Conclusion: The pleural fluid evacuated by thoracocentesis was rich in lymph cells, but asessment of the adenosine deaminase   and the presence of BK  were negative, so TB was ruled out. A mesothelioma was also excluded.The patient was put on a course of antibiotics, specifically Clyndamicin and Ceftriaxone, corticosteroid and mucolytic medication, with a satisfying overall evolution.

Particularities: Given the patient’s socially precarious status, the large amount of fluid and  initial findings such as very high  ESR  coupled with the predominance of lymphocites within the composition of the pleural fluid, tuberculosis  was a highly probable outcome, so in order to rule it out,  specific tests needed to be thoroughly carried out (Quantiferon and PPD ).He was also allergic to Penicillin, which rendered the use of any antibiotics in this class impossible.

ANALYSIS OF RS9939609 FTO GENE POLYMORPHISM AND ITS CORRELATION TO OBESITY AND HYPERTENSION IN A ROMANIAN ADULT GROUP  Radulescu Ana-Maria , Dragoi Oana Diana Necula Ovidiu, Cîntăcioiu Diana-Georgiana Validated View

ANALYSIS OF RS9939609 FTO GENE POLYMORPHISM AND ITS CORRELATION TO OBESITY AND HYPERTENSION IN A ROMANIAN ADULT GROUP

Fundamental Science

Author(s): Radulescu Ana-Maria, Dragoi Oana Diana

Coauthor(s): Necula Ovidiu, Cîntăcioiu Diana-Georgiana

Coordinator(s): Assistant Professor Radu Ioan Ursu

Keywords: FTO polymorphism rs9939609 obesity

Introduction: Obesity is the result of an unbalance between intake and expenditure being differently influenced by genetic and environmental factors. The FTO gene variant rs9939609 (indicator of fat mass accumulation), has been the first described in correlation with the common polygenic form of obesity in adults.

Material and Method: Our research goal was to estimate the role of FTO gene variant in obesity characteristics (biochemical and physical parameters, cofactors and comorbidities) within the selected Romanian 30 individuals divided in 2 adults groups by their in Body Mass Index (BMIs): obese(20) and normal weight(10) .The main including criteria was BMI,and the auxiliary including criteria were weight and abdominal circumference. The patients were genotyped for the rs9939609 polymorphism with the HRM-QP method. The genotypes were compared with the physical and clinical indicators of obesity (BMI,weight, abdominal circumference, age,sex,height,body fat percentage, basal metabolic rate, daily caloric needs) and also with hypertension for statistical correlations.The statistical analysis was realized with the program SPSS v 13.0 and  Microsoft Excel. 

Results: The study showed that FTO gene variant was present in 81,8%of the individuals from both groups and in 95,7% of the individuals from the obese group.Results showed that the polymorphism is an important obesity risk factor, being statistically correlated both with obesity parameters (BMI, abdominal circumference, weight,body fat percentage) and with hypertension, especially with the increase of the systolic blood pressure.The statistical correlations were stronger in the homozygote genotype.

Conclusion: This study is a first step towards the development of a new field of personalized therapeutic approach towards obesity.The possibility of detecting early in life the presence of the FTO polymorphism might help us prevent the development of obesity itself by encouraging  individuals  to have a healthy lifestyle.

Bibliography: Emilio González Jiménez.Obesity: Etiologic and pathophysiological analysis.Endocrinologia y Nutricion,2013 Hélène Choquet1 and David Meyre*,2 Molecular Basis of Obesity: Current Status and Future Prospects.Current Genomics, 2011, 12, 154-168 Pawan Gulati & Giles S. H. Yeo.The biology of FTO: from nucleic acid demethylase to aminoacid sensor.Diabetologia,2013.

AN UNUSUAL IMAGING PRESENTATION IN RENAL TUBERCULOSIS  Gliga Paula Maria , Chirilă Cristian Nicolae - Validated View

AN UNUSUAL IMAGING PRESENTATION IN RENAL TUBERCULOSIS

Case Report - Poster

Author(s): Gliga Paula Maria, Chirilă Cristian Nicolae

Coordinator(s): Lecturer Mirela Liana Gliga

Introduction:

Hematuria is a medical emergency but sometimes the patient is misdiagnosed because of lack of imaging techniques or a contraindication of the contrast agents.


Case Presentation:

FA, a 46-year-old man, was referred to the Nephrology Department of the Mureş County Hospital due to recent development of renal failure and a one year history of intermittent hematuria. He was overweight, BMI=38, in good clinical condition, complaining of continuous back-pain worsened by the upright-position. On clinical examination blood pressure was normal, Giordano sign was present bilaterally. Laboratory tests revealed an elevated serum creatinine level 1.7mg/dl, eGFR (MDRD) 46ml/min/1.73m2 and serum urea 87mg/dl. Other glomerular, liver, hematological and coagulation tests were within normal range. In case of unexplained azotemia we always perform ultrasonography, which in this case showed an unusual presentation. Both kidneys had a normal size and presented an irregular hyperechoic lining in the periphery of the cortical zone that appeared like a contour of the renal capsule, with no vascular signal on Doppler ultrasound. Bilateral grade 1 hydronephrosis was also detected. We suspected tuberculosis and the positive urine cultures confirmed the diagnosis. The patient received specific medication for 6 months. On the follow-up, the renal condition improved, urine cultures were negative and after 8 months the medication was stopped. Renal function remained normal, but the ultrasound aspect was unchanged.


Conclusion:

Clinicians should always have in mind that the association of hematuria with renal failure can also have a non-glomerular etiology. Ultrasound is a useful tool in evaluating the kidney structure and has the advantages of being noninvasive and easily repeatable.


Particularities:

Bilateral renal tuberculosis is rare, usually only one kidney being involved. The association of renal and genitourinary tuberculosis is rare, but in our case, the presence of hydronephrosis was explained by ureteral strictures. 

A suspected bone tumor turned out to be a pseudoaneurysm  Mariean-Schiopu Alexandru , Marginean Claudia Raluca Robert Aurelian Tiucă, Mărginean Oana Mirela Validated View

A suspected bone tumor turned out to be a pseudoaneurysm

Case Report - Poster

Author(s): Mariean-Schiopu Alexandru, Marginean Claudia Raluca

Coauthor(s): Robert Aurelian Tiucă, Mărginean Oana Mirela

Coordinator(s): Assistant Professor Iunius Paul Simu

Introduction: Pseudoaneurysm represents the existence of a breach into the vessel wall, so the blood remains contained by the adventitia or the surrounding tissues.It is associated with a higher risk of rupture than a true aneurysm because of the fragile vascular wall,so it requires specific treatment.
Case Presentation: We present the case of a 47 years old male who underwent a left hip replacement 3 years ago.The patient came into our clinic with a painful and throbbing swelling in left groin,so a bone tumor was at first suspected.After establishing the biological status of the patient,complex imaging tests were performed(left hip radiography,contrast computer tomography)in order to establish a final diagnosis.Contrast CT scans showed an irregular shaped image with hypervascular character,with a diameter of 48/46/37 millimeters.It had similar densitometric values to those of the femoral artery and was located next to the arterial wall, in the left inguinal region,between the adductor thigh muscles.The results were suggestive for a pseudoaneurysm and the ipothesis of a bone tumor was infirmed.Intraoperative, it was confirmed the origin of the pseudoaneurysm as being in the left internal pudental artery.Drainage of the hematoma and suture of the left internal pudental artery was performed, with a favorable postoperative evolution.
Conclusion: This case was related to surgery and considered to be a complication after the hip replacement procedure.Due to a small lession into the vascular wall,an appropriate environment for developing a pseudoaneurysm was created.
Particularities: Repeated episodes of pain and swelling located in the left inguinal region, raised the suspicion of a bone tumor, despite the throbbing nature of the swelling.Later performed imagistic investigations and intraoperative aspects infirmed the malignant ipothesis and a final diagnosis of internal pudental artery pseudaneurysm was confirmed.

    

PSORIATIC ARTHRITIS “SINE PSORIASIS” ASSOCIATED WITH HYPERURICEMIA- A CASE REPORT  Giurgiu Alina Bianca Galdean Simona-Maria, Fekete Georgiana-Camelia, Marinescu Raluca Gabriela Validated View

PSORIATIC ARTHRITIS “SINE PSORIASIS” ASSOCIATED WITH HYPERURICEMIA- A CASE REPORT

Case Report - Poster

Author(s): Giurgiu Alina Bianca

Coauthor(s): Galdean Simona-Maria, Fekete Georgiana-Camelia, Marinescu Raluca Gabriela

Coordinator(s): Assistant Professor Maria Magdalena Tămaş

Introduction: We report the case of a 46-year-old male patient who presented at the Rheumatology Department complaining of acute pain of the third finger joints of the left hand, accompanied by erythema, swelling and decreased mobility.

Case Presentation:

The disease started in 2005 with asymmetrical arthralgia affecting both small and large joints, but it was only 2014 when the patient presented at the hospital with bilateral “genu flexum”, arthritis of the wrists, squeeze sign positive and dactylitis. Biological tests revealed an important inflammatory syndrome with negative rheumatoid factor, anti-cyclic citrullinated peptide antibodies and antinuclear antibodies. Radiological imaging showed bilateral secondary osteoarthritis of the knees and advanced arthritis with ankylosis of the radiocarpal joints. Therefore, a seronegative oligoarthritis (peripheral spondyloarthritis) was suspected. Treatment with Methotrexate(MTX) was initiated with clinical and biological good response, but after one year the patient presented important side effects like chronic kidney disease KDOQI I. Laboratory tests revealed hyperuricemia of 9,4 mg/dl and ultrasounds(US) examination showed the “double-contour” sign at the hyaline cartilage of the knee, interpreted as asymptomatic hyperuricemia and a low purine diet was indicated. MTX was replaced by Sulfasalazine.

On presentation the patient had a “sausage-like-digit”. Synovitis of the metacarpophalangeal, proximal interphalangeal joints and tenosynovitis of the flexor tendon of the 3rd left finger were identified on US. Laboratory examinations revealed inflammatory syndrome and persistent hyperuricemia.


Conclusion: The episode was interpreted as dactylitis in the context of a peripheral spondyloarthritis, resolved with NSAIDs. The possibility of a gout attack was considered, therefore Colchicine was administered. 

Particularities: The particularity of the case stands in the late presentation which led to severe osteoarthritis. The clinical findings suggest a psoriatic arthritis “sine psoriasis” which appears in 10-15% of the cases of psoriatic arthritis, when rheumatological manifestations precede cutaneous lesions. Moreover, the acute onset of dactylitis may raise the possibility of a gout attack.

ANKYLOSING SPONDYLITIS WITH JUVENILE ONSET  Fekete Georgiana-Camelia , Marinescu Raluca Gabriela Giurgiu Alina Bianca, Galdean Simona-Maria Validated View

ANKYLOSING SPONDYLITIS WITH JUVENILE ONSET

Case Report - Poster

Author(s): Fekete Georgiana-Camelia, Marinescu Raluca Gabriela

Coauthor(s): Giurgiu Alina Bianca, Galdean Simona-Maria

Coordinator(s): Assistant Professor Maria Magdalena Tămaş

Introduction: Ankylosing spondylitis (AS) is an autoimmune disease which primarily affects the spine and the sacroiliac joints. The peripheral joint involvement is usually characteristic of the early onset of the disease which is considered before the age of 16.

Case Presentation: A 22-year-old male patient presented with arthritis of both knees and elbows, first right interphalangeal joint and mechanical pain of the left ankle. The first symptoms of the current disease started at the age of eight with pain, swelling and marked dysfunction of the left ankle. Treatment with nonsteroidal-anti-inflammatory drugs yielded partial response but was accompanied by gastrointestinal side effects. Subsequently, other joints were affected: left elbow, right knee, right elbow. One year ago, inflammatory low back pain, cervical pain and temporomandibular pain and dysfunction were added to the clinical manifestation. Clinical examination found a Schober Test of 3 cm. Biological markers revealed increased inflammatory parameters, while rheumatoid factor and anti-cyclic citrullinated peptide antibodies were negative. Imaging showed asymmetric bilateral sacroiliitis, absence of syndesmophytes. These findings strongly suggested the diagnosis of  AS with juvenile onset. Treatment with Sulfasalazine was indicated, but the patient had cutaneous side effects which led to the temporary interruption of the therapy. The clinical and paraclinical picture and the high disease activity score led to the indication of anti-tumor necrosis factor alfa therapy, which the patient refused motivating fear for side effects.

Conclusion: In this case the early onset of AS associated with the late diagnosis and late therapy led to the accelerated progression of the disease.

Particularities: The particularities of the case are represented by the drug therapy side effects and the refusal of biological therapy.

Surgical approaches for various types of abdominal tuberculosis  Stoian Florina - Validated View

Surgical approaches for various types of abdominal tuberculosis

Surgical Science

Author(s): Stoian Florina

Coordinator(s): MD Lucian Pripisi

Keywords: abdominal tuberculosis ascites laparoscopy tuberculostatic medication

Introduction: Abdominal tuberculosis is a Mycobacterium tuberculosis infection with a hematogenous spread from pulmonary foci, affecting extrapulmonary areas such as gastrointestinal tractum, peritoneum, mesentery and abdominal lymph nodes.

Material and Method: We performed a retrospective study on 22 pacients with abdominal tuberculosis (TB), by using „ C.F. 2” Hospital's records in Bucharest, between 1995-2006. There were a number of 16 cases with TB peritonitis, 5 with intestinal TB and 1 with mesenteric lymph nodes TB. Laboratory tests showed mild leukocytosis with lymphocytosis ( 77%), elevated ESR( 77%), anemia ( 27%), increased liver transaminases (14%). Ascitic fluid analysis în TB peritonitis cases showed an exudative nature of ascites with an amount of proteins < 3g/dl; growing Koch bacile on specific cultures concluded positive for only one pacient. CT investigation also revealed large amount of ascitic fluid, infiltration of the mesentery and transverse mesocolon, reticulomacronodular infiltrates among intraperitoneal and subperitoneal fat. For pacients with TB peritonitis, laparoscopic biopsy was performed, following the parietal peritoneum, the great omentum and the peritoneal tumor. This investigation highlighted caseating giganto-epithelioid granuloma inflammation. Diagnosis was objectified based on ascitic fluid analysis, microbiological tests, laparoscopy and peritoneal biopsy, showing caseating granulomas on histological samples.

Results: For the intestinal TB, a right hemicolectomy with ileo-transverse anastomosis on lateral side for ileo-cecal localization altogether with 4 segmental enterectomies with ileo- ileal anastomosis has been persued. Overall, 90% of the pacients had promising results. There were two post-operative complications: a low flow colon fistula, closed spontaneously after laparoscopic approach and an ascites fistula appeared after the classic surgery approach.

Conclusion: Abdominal TB comes with an insidious onset and therefore it is difficult to diagnose. An excellent method proves to be CT imaging by showing the extent of tuberculous peritonitis. Treatment for this condition requires tuberculostatic medication.

Bibliography: 1. ASTON, NO. - Abdominal Tuberculosis. World J. Surg., 1997, 21:492. 2. POP, M., POP, C., HOMORODEAN, D., ITU, C., MAN, M., GORON, M., GHERASIM, R., COROIU, G. - Abdominal miliary tuberculosis in a patient with AIDS: a case report. Rom. J. Gastroenterol., 2003, 12:231. 3. ROBADAY, S., BELIZA, C., KERLEAU, J.M. - Tuberculosis peritonitis: an always present disease. About 4 new cases. Rev. Med. Interne, 2005, 4. UZUNKOY, A., HARMA, M. - Diagnosis of abdominal tuberculosis: experience from 11 cases and review of the literature. World J. Gastroenterol., 2004, 10:3647. 5. GIARDIELLO, C., SCOTTI, L., ANGELONE, G., PROTA, C. - A case of tubercular peritonitis: diagnostic value of laparoscopy. Chir. Ital., 2003, 55:125.

Three Delirious Days in the ICU - First Transversal Study in Romanian Intensive Care Units About Delirium  Vlasie Maricela - Validated View

Three Delirious Days in the ICU - First Transversal Study in Romanian Intensive Care Units About Delirium

Medical Science

Author(s): Vlasie Maricela

Coordinator(s): Professor Sanda-Maria Copotoiu

Keywords: delirium ICU ICDSC CAM-ICU

Introduction: It is known that because delirium is an acute alteration and fluctuating disturbance of consciousness, it is a complex neuropsychiatric syndrome. From all the hospitalized patients in the intensive care unit (ICU) it is estimated to have an incidence of up to 80% and particularities that could influence mortality, especially morbidity in overlooked patients.

Material and Method: A pilot transversal study was conducted in the ICU of Tirgu Mures County Emergency Hospital to identify patients presenting clinical forms of delirium. In randomly selected 3day periods from December 2016 to April 2017, patients with a length of stay longer than 48 hours were evaluated using the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) and Intensive Care Delirium Screening Checklist (ICDSC). Those with a positive diagnosis were further monitored to assess their condition. In order to avoid misdiagnosis or misinterpretation of the manifestations, patients with dementia or other neurological severe pathology were excluded, such as stroke or craniocerebral trauma.

Results: Delirium was found in 30 patients - mainly elderly (63.33%), and mechanically ventilated patients (63.33%). Hallucinations, delusions, psychomotor agitation or retardation were some of the manifestations the eligible patients presented, the most common being inappropriate speech or mood (83.33%), followed by sleep-wake cycle disturbance (73.33%) and disorientation (70%). Evaluating the subtypes of delirium, the less encountered in our population was hyperactive (16.66%), most patients presenting the hypoactive subtype (50%) and the mixed (33.33%).  

Conclusion: Although it is a common condition in the ICU, delirium often remains underdiagnosed. A correct and complete evaluation with the proper tools can have a positive effect on both critically ill patients, by increasing their chances for a better outcome, and hospital by avoiding additional costs generated by the complications involving delirium. 

Bibliography: 1)www.icudelirium.org 2)www.qxmd.com 3)A.Katramados, P. N. Varelas - Encephalopathy 4)J. King, A. Gratix - Delirium in intensive care, Continuing Education in Anaesthesia, Critical Care & Pain vol.9, n. 5, 2009 5)N.E. Brummel, E.E. Vasilevski - Implementing Delirium Screening in the Intensive Care Unit: Secrets to Succes, Crit Care Med, 2013 6)European Delirium Association, Americam Delirium Association - The DSM-5 criteria, level of arousal and delirium diagnosis:inclusiveness is safer, BCM, 2014 7)E.W. Ely, S.K. Inouye, G. R. Bernard - The DSM-5 criteria, level of arousal and delirium diagnosis:inclusiveness is safer, JAMA, 2001 8)C. DiSabatino Smith, P. Grami - Feasibility and Efectiveness of a Delirium Prevention Bundle in Critically Ill Patients, American Journal of Critical Care, 2016 9)P. Voyer, N. Champoux, J. Desrosiers - .Recognizing acute delirium as a part of your routine[RADAR]: a validation study, BCM Nursing, 2015 10)D. Gusmo-Flores, J.I.F. Salluh, R.A. Chalhud, L. Quarantini - .The confusion assessment method for the intensive care unit (CAM-ICU) and intensive care delirium screening checklist (ICDSC) for the diagnosis of delirium: a systematic review and meta-analysis of clinical studies, Critical Care, 2012 11)T.D. Girard, P.P. Pandharipande, E.W. Ely - .The confusion assessment method for the intensive care unit (CAM-ICU) and intensive care delirium screening checklist (ICDSC) for the diagnosis of delirium: a systematic review and meta-analysis of clinical studies, Critical Care, 2008 12)D.J. Meagher, A. Morandi, S.K. Inouye, W. Ely - .Concordance between DSM-IV and DSM-5 criteria of delirium diagnosis in a pooled database of 768 prospectively evaluated patiens using the delirium scale-revised-98, BMC Medicine, 2014 13)S.M. Copotoiu, R. Copotoiu, L. Azamfirei, I. Ghitescu, J. Szederjesi - Delirium Diagnosis in an Academic ICU

Arthroscopic treatment of patellar instability  Patrichi Andrei - Ionuț , Stoica Andreea Bianca Pop Tiberiu Andrei, Di Nardo Nicola, Feier Andrei Validated View

Arthroscopic treatment of patellar instability

Case Report - Poster

Author(s): Patrichi Andrei - Ionuț, Stoica Andreea Bianca

Coauthor(s): Pop Tiberiu Andrei, Di Nardo Nicola, Feier Andrei

Coordinator(s): Professor Tiberiu Bățagă

Introduction: Patellar instabilities can be treated by classical or arthroscopic reconstruction. Both surgical treatments require a personalized rehabilitation program and a classic monitoring of the patient in the following time.
Case Presentation: A 31 years old patient presented in our outpatient clinic with complaints about chronic patellar instability in the left knee due to repeated minor trauma during amateur soccer games. A recurrent patellar instability and a positive McMurray test were highlighted at the physical examination. A magnetic resonance imaging examination was obtained, revealing multipleleft internal meniscus lesions and a partial rupture of the anterior cruciate ligament. An arthroscopic intervention was recommended under general anesthesia with the resection of the injured internal meniscus, debridement, percutaneous fixation under arthroscopic control and anatomical stabilization of the patella.The patient resumed the physiotherapy program in the 2nd day after the intervention, followed with 10 days of active physical movements, based on a personalized program. During the arthroscopy, a grade IV chondropathy was identified and the patient was directed to a platelet rich plasma treatment in three sessions. At 24 hours after surgery the knee was clinically evaluated and had no sings of inflammation, with anatomical stability and physiological patellar alignment.
Conclusion: Patellar instability combined with meniscus and chondral lesions can be surgically treated by arthroscopy leading to shorter and cheaper hospitalization expenses and also reducing the reintegration time of the patient into society.
Particularities: Before the surgery, the patient was diagnosed with urinary tract infection caused by ProteusMirabilis, responsible for the arthroscopic intervention delay. The infection was treated according to the urine culture results and antibiogram.

Pulmonary heart disease aggravated by multiple comorbidities  Corduneanu Roxana-Mihaela , Corduneanu Alina-Georgiana - Invalidated View

Pulmonary heart disease aggravated by multiple comorbidities

Case Report - Poster

Author(s): Corduneanu Roxana-Mihaela, Corduneanu Alina-Georgiana

Coordinator(s): Associate Professor Ligia Ariana Bancu , MD Simona Pogacean

Introduction: The pulmonary heart disease is defined as a hypertrophy of the right ventricle, associated with a variety of pulmonary disorders. The increased work load is due to pulmonary hypertension, which may be vasoconstrictive or obstructive. Obstructive pulmonary hypertension can follow thromboembolic disease.

Case Presentation: This is a case of a 41 years old man , who was admitted In 2nd Department of Internal Medicine with dyspnea, orthopnea, generalized edema, hypotension, productive cough, hemoptysis, ankle ulcer infected and morbid obesity. On admission, laboratory tests revealed a creatinine: 1,66 mg/dl, Urea: 91,79 mg/dl, LDH: 765 U/l, Na:131,4 mmol/L, K:3,85 mmol/l, HGB: 17, 3g/dL, the echocardiography revealed right ventricle:43 mm, tricuspid regurgitation GR II/III, sever secondary pulmonary hypertension and a hyperechoic formation in the middle of right ventricle . The thoracic computer tomography revealed a bilateral pulmonary trombembolism. He underwent treatment with diuretics, positive inotropic support, antibiotic treatment( Clindamycin, 14 days, followed by Meropenem ,10 days, and Moxifloxacin, 7 days, antifungal treatment, oxygen therapy and nebulization with bronchodilators and anticoagulant treatment with high doses of low molecular weight heparin.

Conclusion: At discharge , after therapy , the evolution was favorable with amelioration of dyspnea and orthopnea, decrease edema with a weight loss of 20 kg, echocardiography highlighted the disappearance of right ventricle hyperechoic formation.

Particularities: This was a case of a man with multiple comorbidities,  with massive edemas because of pulmonary heart disease, improved after diuretic  therapy and disappearance of right ventricle  hyperechoic formation under high doses of low molecular weight heparin.

LOW ADHERENCE IMPACT TO THE TREATMENT REGARDING THE ACUTE COMPLICATIONS IN TYPE 2 DIABETES WITH MORBID OBESITY  Stoica Andreea Bianca , Patrichi Andrei - Ionuț Tilinca Raluca-Maria, Andrea Cora-Iulia, Vinteler Andreea Bianca Invalidated View

LOW ADHERENCE IMPACT TO THE TREATMENT REGARDING THE ACUTE COMPLICATIONS IN TYPE 2 DIABETES WITH MORBID OBESITY

Case Report - Poster

Author(s): Stoica Andreea Bianca, Patrichi Andrei - Ionuț

Coauthor(s): Tilinca Raluca-Maria, Andrea Cora-Iulia, Vinteler Andreea Bianca

Coordinator(s): Associate Professor Mariana Tilinca

Introduction: Diabetes is a complex, chronic and progressive disease characterized by elevated blood sugar levels due to a decreased insulin secretion and /or insulin resistance which affects the entire metabolism. The disease is linked with the presence of many risk factors which lead to microangiopathic and macroangiopathic complications. 

Case Presentation: We present the case of a 50 years old female, smoker, obese, hypertensive, diabetic under insulin treatment, with neglected diet and treatment, which was admitted to the Diabetic Department with glycemic levels over 300 mg/dl for the following symptoms: dyspnea, fatigue, chest pain, polydipsia.The patient had 116 kg weight, 140 cm height, 170 cm AC, BMI 59 kg/m2, bilateral crepitantrales, 140/80 mmHg BP, positive bilateral Giordano sign, leg edema. The patient was investigated clinically and paraclinically being able to have specialized consults and treatments. Diagnosis: Type 2 Diabetes insulin dependent, diabetic nefropathy, chronic kidney disease stage II/III, essential artery hypertension grade II,exacerbated COPD stage II/III, morbid obesity. The treatment was based on adjusting the insulin doses in a basal bolus regime, hydroelectrolytic equilibration, high blood pressure, diuretic, antibiotic, mucolitical, bronchodilation and antiinflamatory treatment. After a nutritional counseling and pharmacological therapy and monitoring the clinical and biological data, a favorable evolution had been obtained. 

Conclusion: The multidisciplinary approach in type 2 diabetes with risk factors and complications, nutritional counseling and raising the adherence to an adequate treatmentand to a healthy lifestyle, are main elements in obtaining the optimized quality of life.

Particularities: Even the low adherence on the treatment represented the main cause of the glycemic imbalance, it’s perturbation was very accentuated by the alteration of the general state on the base of COPD exacerbation. After the treatment, especially the antibiotic one in combination with insulin therapy the remission of the acute imbalanced state had been obtained.

MULTIPLE LOCALIZED RECURRENCES OF A PATIENT WITH SPLENIC FLEXURE COLON CANCER  Pop Tiberiu Andrei , Andrea Cora-Iulia Ciubotariu Calina, Russu Mihai Emil Invalidated View

MULTIPLE LOCALIZED RECURRENCES OF A PATIENT WITH SPLENIC FLEXURE COLON CANCER

Case Report - Poster

Author(s): Pop Tiberiu Andrei, Andrea Cora-Iulia

Coauthor(s): Ciubotariu Calina, Russu Mihai Emil

Coordinator(s): Associate Professor Marius Florin Coros , MD Ghenadie Pascarenco

Introduction: Recurrence of colorectal carcinoma represents a significant challenge. As the majority of recurrences involve more than just the anastomosis, surgical resection is ordinarily a major undertaking. Curative resection may require resection of other organs and structures, resulting in complex reconstructive procedures and substantial morbidity.

Case Presentation:

A 31 years male patient underwent a subtotal colectomy one year ago due to a splenic flexure colon tumor pT4 pN0 which infiltrated the stomach, pancreas tail and the retroperitoneum. In the last three months he lost weight (13-14kg) and he complains of abdominal upper pains. Abdominal RMN showed a space-replacing process near splenic flexure of the colon which invades the great curvature of stomach and the splenic hilum; Also from the result of a colon biopsy we have the diagnosis of colon cancer recurrence.We decided to perform an exploratory laparotomy. In the supramesocolic space we found a tumoral mass that include the stomach, left lobe of liver, pancreas tail, and it extend into the retroperitoneum being closely adhered to diaphragm. We decided to excised the tumor toghether with anatomical structures affected, perform a Roux-en-Y esojejunostomy and an Entero-Enteral Anastomosis. 

Conclusion: Younger patients tend to have a higher incidence of recurrence. One explanation is that for a tumor to manifest itself at an earlier age, it has to be more aggressive and have shorter mitotic times and there must be a genetic predisposition.

Particularities: The SF colon cancers are known to be relatively rare, and these account for 5~10% of all the colorectal cancer occurrences. Some studies have reported that the incidence of obstruction for these cancers is approximately four times that of other colon cancer sites. This high frequency may reflect that the SF has an acute angle, and that the SF tumors tended to be relatively large. 

PELVIC CONGESTION SYNDROME: STILL AN UNDER-DIAGNOSED CONDITION. WHAT IS THE ROLE OF ULTRASOUND?  Chirilă Cristian Nicolae , Gliga Paula Maria - Validated View

PELVIC CONGESTION SYNDROME: STILL AN UNDER-DIAGNOSED CONDITION. WHAT IS THE ROLE OF ULTRASOUND?

Medical Science

Author(s): Chirilă Cristian Nicolae, Gliga Paula Maria

Coordinator(s): Lecturer Mirela Liana Gliga

Keywords: pelvic congestion syndrome pelvic venous insufficiency ultrasound

Introduction: Pelvic congestion syndrome (PCS) or pelvic vein incompetence is a complex medical condition consisting of constant pelvic pain which lasts more than six months, worsens at the end of the day and while sitting or standing. The intensity of the pain can vary from dull to aching with temporary flares. This syndrome is associated with pelvic venous insufficiency and varicose veins in the thigh, gluteal or vaginal region. Our aim was to describe four cases of women who presented symptoms of chronic pelvic syndrome, to assess the symptomatology related to enlargement or anatomic abnormalities of the pelvic veins (especially the left ovarian vein) and to establish a correlation between the symptoms and the ultrasound (US) findings.

Material and Method: We included in our study four female patients aged between 25 and 53 admitted to our Internal Medicine Department for chronic pelvic, lumbar pain and deep venous thrombosis. In their case, we could describe abdominal vascular malformations when performing US examination using a Philips HD11 device.

Results: In the first case of a 25-year-old woman a dilated left ovarian vein mimicked a nutcracker syndrome that caused the lumbar pain associated with pelvic pain. The second patient, a 42-year-old woman, had the left ovarian vein dilated which caused chronic pelvic pain. The third case, a woman who took oral contraceptives, was diagnosed with deep vein thrombosis and we could also detect pelvic varicosities. The last case, a 53-year-old patient, had an abnormal retro-aortic position of the left renal vein with antegrade dilatation.

Conclusion: Pelvic venous abnormalities may be associated with venous congestion, stasis and increased hydrostatic pressure in the dilated veins which can lead to painful symptoms or it can be completely asymptomatic. Consequently, the transabdominal US exploration facilitates the positive diagnosis of PCS as an easy, non-invasive, cost-effective and repetitive exploration.

Bibliography: 1. Herrera-Betancourt AL, “Sensitivity and specificity of clinical findings for the diagnosis of pelvic congestion syndrome in women with chronic pelvic pain”, Phlebology, 2017 Jan 2. Gavrilov SG, “Conservative treatment of pelvic congestion syndrome: indications and opportunities”, Curr Med Res Opin, 2017 Mar 3. Labropoulos N, “A standardized ultrasound approach to pelvic congestion syndrome”, Phlebology, 2016 Oct 4. Balica AC, “Pelvic congestion syndrome”, J Minim Invasive Gynecol, 2015 Nov-Dec 5. Jeanneret C, “Pelvic congestion syndrome and left renal compression syndrome – clinical features and therapeutic approaches”, Vasa, 2016

The prevalence of long-term oral anticoagulation therapy in a cardiology center in Bucharest, Romania  Sorescu Adelina-Mihaela Enache Tudor Validated View

The prevalence of long-term oral anticoagulation therapy in a cardiology center in Bucharest, Romania

Medical Science

Author(s): Sorescu Adelina-Mihaela

Coauthor(s): Enache Tudor

Coordinator(s): Assistant Professor Suzana Guberna

Keywords: Oral anticoagulation therapy atrial fibrillation pulmonary embolism deep vein thrombosis

Introduction: Few studies discuss the prevalence of oral anticoagulation therapy (OAT) in clinical practice, despite their increasing use worldwide1. In the USA, studies established that 20% to 80% of the patients with indication, benefit from OAT2. In Romania, there is no data regarding the utilization of oral anticoagulants. Thus, this study aims to determine the trends of OAT.

Material and Method: We designed a cross-sectional study of the patients admitted in the Cardiology Department at the “Bagdasar-Arseni” Clinical Emergency Hospital, Bucharest, from the 1st of November 2016 until the 31st of January 2017. We considered OAT indications: atrial fibrillation/flutter (AF), pulmonary embolisms (PE), deep vein thrombosis (DVT), intramural or intracavitary thrombi and left ventricle aneurysms. Statistical analysis was performed with EpiInfo.

Results: 783 patients were admitted, 253 of these having an OAT indication (mean age 73.25 years, 53.75% female). Only 167 patients (66.01%) received it, either Vitamin K Antagonists (VKA) (80 patients, 47.90%), or Novel Oral Anticoagulants (NOAC) (87 patients, 52.09%). Reasons for not indicating such therapy included the hemorrhage risk (43.27%), the lack of adherence to the treatment (18.56%), the impossibility of INR monitoring (21.84%) or the poor economic status (10.21%) and others (6.12%). 221 patients had AF (87.35%), 141 (63.8%) receiving OAT, VKA (67 patients, 47.51%), or NOAC (74 patients, 52.48%). 17 patients (6.71%) had a PE and/or DVT. 15 (88.23%) received OAT, AVK (11 patients, 73.33%), or NOAC (4 patients, 26.67%). 15 patients (5.92%) had other OAT indications (excepting AF or PE/DVT), 11 receiving OAT (73.33%), AVK (8 patients, 72.72%), or NOAC (3 patients, 27.27%).

Conclusion: We determined that 66.01% of those with indication received OAT. Similar data is reported in the USA, suggesting an underuse of anticoagulants. The risk of hemorrhage, lack of adherence, the impossibility of INR monitoring or the poor economic status were the main reasons for not recommending OAT. 

Bibliography: 1. Bartholomay E, Polli I, Borges AP, Kalil C, Arroque A, Kohler I, et al. Prevalence of oral anticoagulation in atrial fibrillation. Clinics.2014;69(9):615-620. 2. Kate Kirley, Dima M. Qato, Rachel Kornfield, Randall S. Stafford and G. Caleb Alexander. National trends in oral anticoagulant use in the United States, 2007–2011. Circ Cardiovasc Qual Outcomes. 2012 September 1; 5(5): 615–621. doi:10.1161/CIRCOUTCOMES.112.967299.

SYSTEMIC SCLEROSIS: A DIAGNOSTIC PUZZLE. A CASE REPORT  Farcas Loredana Bogdan Iulia, Ileana Cosmina Filipescu Validated View

SYSTEMIC SCLEROSIS: A DIAGNOSTIC PUZZLE. A CASE REPORT

Case Report - Poster

Author(s): Farcas Loredana

Coauthor(s): Bogdan Iulia, Ileana Cosmina Filipescu

Coordinator(s): Assistant Professor Ileana Filipescu

Introduction: Systemic sclerosis (SS) is a rare disorder, characterized by connective tissue alterations. Given the significant morbidity associated with dynamic skin fibrosis and visceral organ involvement, it is important to formulate an accurate diagnosis from the early stages of the disease. However, either as a result of the inefficiencies in the health care system or due to cognitive errors, the correct diagnosis of this condition is frequently delayed. 

Case Presentation: A 40 years old woman, with a two year history of SS, was admitted on the 9th of September 2016 in the Rheumatology Clinic (RC). She presented with multiple comorbidities: fatigue, dyspnea and important weight loss, along with the specific marks of the main condition: arthralgia of the knees, metacarpophalangeal joint stiffness of the right hand, puffy hands, Raynaud phenomenon and thickened skin on the face and forearms. Medical history revealed that she was previously treated (in a local hospital) with hydroxychloroquine and sulphasalazine, on the grounds that her symptoms (defectively evaluated) were a manifestation either of rheumatic arthritis, seronegative spondyloarthropathy or reactive arthritis. Her state worsened significantly under therapy. She was then referred to the RC where, after the physical examination of the patient (noteworthy, sclerodactyly and the skin changes were recognized only here) the suspicion of SS was raised. Capillaroscopy and high level anti-SCL-70 antibodies certified the diagnosis. Also, the computed tomography demonstrated interstitial lung fibrosis, therefore intravenous cyclophosphamide therapy was initiated.

Conclusion: One of the essential steps to improving patient care is establishing the correct diagnosis. In this case, all the necessary criteria were present upon her first addmision to the local hospital. However, due to inadequate clinical reasoning and because several investigations were not available, her diagnosis was missed. 

Particularities: The patient presented polyarticular synovitis of the metacarpophalangeal joints in a rheumatoid arthritis-like pattern, thus leading to the misdiagnosis of SS.

Puerperal complications caused by septic emboli- A case report   Stoian Florina Plesa Andreea Validated View

Puerperal complications caused by septic emboli- A case report

Case Report - Poster

Author(s): Stoian Florina

Coauthor(s): Plesa Andreea

Coordinator(s): MD Cristina Florentina Plesa , MD Carmen Adella Sirbu

Introduction:

Cerebrovascular complications may occur in the spectrum of pregnancy and puerperium due to the hypercoagulable state, intracranial hypertension and pelvic sepsis.

As a main characteristic, postpartum cerebral venous thrombosis may develop from latent pelvic or femoral thrombosis with the migration of blood clots in the cerebral area. 


Case Presentation:

A twenty three year-old woman, presented to the emergency department on postpartum day six having experienced headaches, paresthesias and acute motor deficits in the right limbs.

Laboratory tests highlighted a microcytic hypochromic anemia ( secundary to pregnancy blood loss), thrombocytosis and inflammatory syndrome- positive CRP, high ESR rate( 40 mm/h), hyperfibrinogenemia( 710 mg/dl).

The evaluation of vaginal discharge indicated positive blood cultures with Escherichia coli and Klebsiella spp.

Clinical examination revealed left lower extremity edema for which we pursued a Doppler ultrasound test and a CT scan with contrast agent, both suggesting multiple venous thrombosis.

Thus, a postpartum infection related to the genital area led to a series of complications such as venous stroke associated with cerebral hemorrhage, profound venous thrombosis and pulmonary embolism.

Cerebral MRI scan showing intracranial hematoma concludes the diagnosis of hemorrhagic parieto-occipital stroke affecting the subarachnoid area and intraparenchymal hematoma post arteriovenous malformation.

OAC using low molecular weight heparin and antimicrobial treatment subsequent to neuromodulation therapy registered positive evolution.

Thrombophilic status evaluation applies in such cases, but given the peripartum coagulation changes and the OAC treatment it has been withdrawn.


Conclusion:

Cerebral venous thrombosis is a potentially life threatening condition, with high predisposition for women presenting neurological symptoms during pregnancy and puerperium.


Particularities: Both evolution and treatment have been an outstanding challenge given the high risk of bleeding in contrast with the OAC treatment- specific for thrombotic complications.

The causes for a LVI with a fast evolution- Case Report  Ignat Andreea-Melania , Vîlcan Andreea Elena Meloria Avram Invalidated View

The causes for a LVI with a fast evolution- Case Report

Case Report - Poster

Author(s): Ignat Andreea-Melania, Vîlcan Andreea

Coauthor(s): Elena Meloria Avram

Coordinator(s): Assistant Professor Cosmin Macarie

Introduction:

A left cardiac insufficiency, or left ventricular insufficiency (LVI), is defined as the inability of the left ventricle to assure the blood necesare.
The left cardiac insufficiency is a more and more frequent pathology, met in particular in the elderly. The predominant causes are the illnesses of the heart due to an illness of the heart arteries (coronary arteries) or to a HBP (high blood pressure)or a viral cause.

Case Presentation:
We present a case of a 51 years old female patient, known with atrial fibrillation since 2015 and with oscillating blood pressure, complaining about shortness of breath at minimal effort, fatigue. The patient presents other related diseases such as hepatic steatosis and type II diabetes. 
Specialized investigations were performed, in order to find out the causes of the current symptoms. The echocardiography revealed an ejection fraction, EF= 30%, abnormaly low, especially due to the short period of time from her last echocardiography in which EF was 60% (September 2016). It also shows a global hypokinesia of the IVS ( intervetricular septum), increased left atrium (49 mm) which all are signs of LVI. Acording to the pacient’s associated disseas we needed to establish the cause that determined the LVI in such a short period of time. A coronarography was performed to see if the ischemia was responsible, but the results were normal. Also, Viral tests have been conducted, ruling out the viral cause of LVI.

Conclusion:
Investigations revealed that the main cause of LVI in this patient is oscillating blood pressure.
Thus it is mandatory to establish the cause, in order to apply the right treatment and to prevent further complications.

Particularities: The particular fact about this case, is that the evolution of this disease was very quick in a short period of time.

ACCURACY OF OPEN FIELD AND DARK-LIGHT TESTS ASSESSMENT ON MICE  Luca Rares Miclea Raluca, Vlad Ionuț-Viorel Validated View

ACCURACY OF OPEN FIELD AND DARK-LIGHT TESTS ASSESSMENT ON MICE

Fundamental Science

Author(s): Luca Rares

Coauthor(s): Miclea Raluca, Vlad Ionuț-Viorel

Coordinator(s): Assistant Professor Florin Tripon

Keywords: mice open-field test dark-light test variability

Introduction: Open field test (OFT) and dark-light test (DLT) are used to assay general locomotor activity levels and mice anxiety. These tests are most used for evaluating the anxiolytic effect of various drugs. The aim of our study was to evaluate the accuracy of these tests and the natural variability of mice tested.

Material and Method: Thirty mice were included in this study. The ethical accord was obtained from the Ethical Committee of the University of Medicine and Pharmacy in Tîrgu Mureş, Romania. For the OFT assay mice were placed in the center of the apparatus and observed for 5 min. Patterns of horizontal (distance covered and thigmotaxis) and vertical movement (rearings) were analyzed throughout the test. Initial freezing, self-grooming behaviour, the number of urine spots and defecation were also recorded. For DLT, anxiety-like behavior was measured in a dark-light box. The apparatus consists of two compartments connected by an opening. The mice were introduced into the dark compartment and observed for 5 minutes. The latency to enter the enlightened compartment, the time spent in it and the number of rearings were recorded.

Results: The mean freezing time was 1.57 seconds (SD=1.97), no significant outliers detected. The mean distance on OFT was 1105.33 cm (SD=541.32), with two significant (p<0.5) outliers detected. The mean number of squares crossed was 108.8 (SD=53.07). Two significant (p<0.5) outliers were detected. No outliers presented urine spots and defecation. The mean latency time of DLT was 62.77 seconds (SD=71.51), two significant (p<0.5) outliers were detected. The mean time spent in the enlighened compartment was 155.37 seconds (SD=77.85) and the mean number of rearings was 3.67 (SD=2.44), with no significant outliers were detected.

Conclusion: According to this data, for accurate results it is necessary to exclude a number of 6 mice (20%) for both tests as a consequence of their natural variability.

Bibliography: Perals D, Griffin A S, Bartomeus I, Sol D. Revisiting the open-field test: what does it really tell us about animal personality? Animal Behaviour 2017; 123:69–79. Wikipedia.org

LABORATORY MICE NEOPHOBIA AND SENSORIAL REFLEXES EVALUATION  Vlad Ionuț-Viorel Luca Rares, Miclea Raluca Validated View

LABORATORY MICE NEOPHOBIA AND SENSORIAL REFLEXES EVALUATION

Fundamental Science

Author(s): Vlad Ionuț-Viorel

Coauthor(s): Luca Rares, Miclea Raluca

Coordinator(s): Assistant Professor Florin Tripon

Keywords: NEOPHOBIA test sensorial reflexes tests natural variability mice

Introduction: Several studies reported the impact of domestication in mice behavioral evaluation. Moreover, the natural variability contributes with an additional effect. Even if it’s not officially written, the evaluation of mice before starting an experiment is necessary from our point of view. We started this study in order to evaluate the mice responses and their natural variability regarding neophobia and sensorial reflexes tests, and also the quality of these tests.

Material and Method: Thirty laboratory mice were included in this observational study. In order to evaluate the neophobia, we put every mice in a new box for thirty seconds. The number of vertical, horizontal and to corners moves were evaluated. Sensorial reflexes and posterior legs extension reflex were measured by holding the animal by its tail and slowly lowering it towards a black surface. The Grubbs’ test was used in order to find the outliers. This study was approved by the Ethical Committee form University of Medicine and Pharmacy from Tîrgu Mureş, Romania.

Results: For the neophobia test the mean number of vertical and horizontal moves were 11 with a standard deviation (SD) of 4, respectively 4 (SD=3) to box corners. Ten (33.3%) of the mice presented physiological needs. Two (6.66%) significant outliers (p<0.05) were found. A number of 9 mice (30%) failed to respond to sensorial reflexes test, the posterior legs extension reflex was also absent. The remaining 70 % presented a normal response from a mean distance of 5 centimeters (SD=3.53) and no outliers were detected.

Conclusion: According to our results, the described neophobia test is an accurate test with a low percentage of outliers. The described sensorial reflexes and posterior leg extension test didn’t have outliers, but its disadvantage is the big percentage of failed responses.    

Bibliography: Kelly Gouveia, Jane L. Hurst. Optimising reliability of mouse performance in behavioural testing: the major role of non-aversive handling. Sci Rep. 2017; 7: 44999.

Quality control in the pathology laboratory  Becica Mihai-Emmanuel Jeno Robert Bartha, Turdean Sabin Validated View

Quality control in the pathology laboratory

Fundamental Science

Author(s): Becica Mihai-Emmanuel

Coauthor(s): Jeno Robert Bartha, Turdean Sabin

Coordinator(s): Professor Ovidiu S. Cotoi .

Keywords: quality control pathology

Introduction: Quality control is defined as a complete set of applied procedures, which are designed to prevent, detect and correct errors occurring at different stages. These results must be constantly monitored, in order to be taken in consideration for the establishment of a correct diagnosis. 

Material and Method: The type of the study is a retrospective and prospective one, conducted in the laboratory of pathology II service within Mures County Hospital. I examined 1,000 slides derived from 300 cases. 200 of them were cytology and 800 HE stains from which 150 special stains as PAS and Van Gieson and 100 immunohistochemistry cases with approximate 300 reactions to different antibodies.

Results: In the fixation stage possible errors are inadequate containers, inadequate volume of fixative(formol) in relation to the size of the sample and too little or too much fixation time. At sampling we have to give importance to the marking with wire the surgery parts and marking with ink the surgical resection edges. At the Inclusion in paraffin, the pieces that are too big or too thick don’t fit in the inclusion tapes/boxes, and the pieces that are too small like cutaneous punch biopsy, must be included in such way that we can find the epidermal, dermal and hypodermal layers. Sectioning depends on the microtome and his lamella,the block’s quality and the included parts or individual variability of the technician. Staining must respect the laboratory protocols, the staining times, the quality of the stains and the quality of the laboratory equipment. 

Conclusion: The sources of error can be identified at any stage of performing permanent histological preparation. For quality assurance and standardization for histological tissue processing, these sources of errors must be avoided and the appointment of a person who can ensure the quality in the pathology laboratory is recommended.

Bibliography: 1. Iyengar JN. Quality control in the histopathology laboratory: An overview with stress on the need for a structured national external quality assessment scheme. Indian J Pathol Microbiol 2009;52:1-5 2. Shalinee Rao. Quality Measures in Pre-Analytical Phase of Tissue Processing: Understanding Its Value in Histopathology. Journal of Clinical and Diagnostic Research 2016;10:EC07 - EC11 3. Andrew Renshaw, MD Edwin W. Gould, MD. Quality Assurance Measures for Critical Diagnoses in Anatomic Pathology. American Journal of Clinical Pathology (2012) 137 (3): 466-469.

BEHAVIORAL DIFFERENCES BETWEEN HEALTHY MICE USING THE TAIL SUSPENSION TEST  Miclea Raluca Luca Rares, Vlad Ionuț-Viorel Validated View

BEHAVIORAL DIFFERENCES BETWEEN HEALTHY MICE USING THE TAIL SUSPENSION TEST

Medical Science

Author(s): Miclea Raluca

Coauthor(s): Luca Rares, Vlad Ionuț-Viorel

Coordinator(s): Assistant Professor Florin Tripon

Keywords: Tail Suspension Test Mice Natural Variability

Introduction: Several published case-control studies investigated some of the potential antidepressant or anti dementia drugs using the Tail Suspension Test (TST) and various mice strains. From our best knowledge, there are no studies aimed to highlight the variability of mice responses to TST. The aim of our study was to evaluate the natural variability of mice based of our test results.

Material and Method: We obtained the approval of the study from the Ethical Committee of University of Medicine and Pharmacy from Tîrgu Mureş, Romania. Thirty healthy mice were enrolled. The mice were suspended from thirty centimeters (cm) from the ground. For suspension, we used a black box made of wood with the following dimensions: 50 cm height, 50 cm length and 50 cm width. In order to detect the outliers we use the Grubbs’ test with a standard significance level of alpha value.

Results: The mean number of stationary was 8.5 with a standard deviation of +/- 4. The mean time for one stationary was 16.11 seconds with a standard deviation of +/- 12 seconds. The Grubbs’ test detected four (12%) outliers. Their physiological needs were not associated with the responses to TST. 

Conclusion: In order to have accurate results in a case-control study, according to our results, it is necessary to exclude approximately 12% of mice from the TST due to their natural variability. The omission of this step can influence the targeted outcomes.

Bibliography: Can A., Dao D.T., Terrillion C.E., Piantadosi S.C., Bhat S., Gould T.D. The Tail Suspension Test. J. Vis. Exp. 2012; 59: e3769.

Mesenteric Panniculitis – an incidental diagnosis of a rare condition  Oltean Paula Anca Covaciu Alexandra Corina, Muntean Delia Doris, Pasca Gina-Iulia Validated View

Mesenteric Panniculitis – an incidental diagnosis of a rare condition

Case Report - Poster

Author(s): Oltean Paula Anca

Coauthor(s): Covaciu Alexandra Corina, Muntean Delia Doris, Pasca Gina-Iulia

Coordinator(s): Assistant Professor Monica Platon Lupsor , Professor Radu Badea

Introduction: Mesenteric panniculitis(MP) is a chronic, benign, unspecific and idiopathic inflammation of the adipose tissue in the mesentery. It represents a phase of fatty tissue degeneration at this level, starting with lipodystrophy, continuing with inflammation and ending in retraction and fibrosis.

Case Presentation: A 70-year-old woman with documented essential arterial hypertension, liver steatosis and high triglycerides levels was admitted to the hospital after 2 months history of diffuse, unspecified abdominal-pain. She was referred for abdominal ultrasound(US) evaluation that evidenced a hypoechogenic mass in the left hypochondrium, between the intestinal loops, with vascular sign at the color Doppler investigation(CDI). Intravenous contrast agent(CEUS) was administered and showed a rapid, non-homogeneous filling of the mass during the arterial time, without a wash-out of the contrast agent during the venous time. CT scan showed the presence of hypertrophic fatty tissue at the level of the mesentery. The mesenteric vessels crossing it were surrounded by a less dense peripheral halo (fat ring sign), while the other abdominal organs were normal. The diagnosis of mesenteric panniculitis was suggested. Exploratory laparotomy was performed in order to obtain bioptic samples for the pathological examination of the lesion.

Conclusion: MP is a rare clinical entity and the diagnosis represents a challenge to physicians especially because of it’s non-specific signs and symptom.The initial diagnosis is imaging, and the final one pathological. Ultrasound examination is decisive in the primary identification of the lesion. CDI and CEUS evidence a circulatory signal, benign in nature. 

Particularities: So far, less than 300 cases have been reported in the literature.Before the “imaging era”, MP was rarely diagnosed. Nowadays, the condition is more frequent discovered, but still by chance, during examinations for other diseases. US can have a decisive role in the primary identification of the lesion. Differential diagnosis must take into account the most frequent mesenteric tumors.

Management of Major Aortopulmonary Collateral Arteries (MAPCAs) in a Patient with Double Outlet Right Ventricle  Dragoi Oana Diana Florescu Andrei Georgian, Radulescu Ana-Maria Validated View

Management of Major Aortopulmonary Collateral Arteries (MAPCAs) in a Patient with Double Outlet Right Ventricle

Case Report - Poster

Author(s): Dragoi Oana Diana

Coauthor(s): Florescu Andrei Georgian, Radulescu Ana-Maria

Coordinator(s): MD Roxana Enache

Introduction: Double outlet right ventricle (DORV) describes a heterogenous series of cardiac abnormalities involving the right ventricle outflow tract where both great arteries originate predominantly from the right ventricle being associated with the development of major aortopulmonary collateral arteries (MAPCAs). MAPCAs provide additional source of blood supply to the lungs along with the native pulmonary artery leading to hemoptysis and complications during total correction surgery.

Case Presentation: A 27 y man was admitted for hemoptysis and dyspnea upon mild exertion. He had been diagnosed in 2008 with a complex cyanotic congenital heart disease (DORV with severe infundibular pulmonary stenosis, perimembranous VSD, anterior mitral leaflet cleft with significant regurgitation) and reevaluated in 2015, when cardiac catheterization detected normal pulmonary pressures. Aortography revealed MAPCAs. Since August 2016 he experienced episodes of hemoptysis. Transcatheter embolization of a bronchial collateral artery was performed in October 2016. Two months later moderate hemoptysis recurred leading to the present hospital admission. Physical examination showed general cyanosis, 80% O2 saturation, BP 110/70 mmHg. The echocardiogram showed the mentioned abnormalities and good ventricular function. Lab results revealed polycythemia, no inflammation. Aortography showed two bronchial arteries from the upper third of the descending aorta supplying bilateral pulmonary hypervascularized areas. Embolization of the bronchial collaterals was performed via femoral artery  using 500-710 μm particles.

Conclusion: The trancatheter embolization had good results (no hypervascularization in the upper lobe of the right lung). Medium term clinical course is favorable, without recurrent hemoptysis at 3-months follow-up, allowing for referral for complete surgical correction in an expert centre (occlusion of MAPCAs reduces the risk of postoperative pulmonary edema by decreasing blood flow). 

Particularities: This case presents a complex cyanotic heart disease (DORV) associated with MAPCAs and complicated with hemoptysis impacting the decision to perform surgery. Transcatheter MAPCAs embolization is easy to perform, relatively safe and effective in potentially fatal hemoptysis. 

Orthopedic surgical management of an atypical case of chondrosarcoma  Necula Ovidiu Dragoi Oana Diana, Cîntăcioiu Diana-Georgiana, Dumitrescu Ana-Maria Validated View

Orthopedic surgical management of an atypical case of chondrosarcoma

Case Report - Poster

Author(s): Necula Ovidiu

Coauthor(s): Dragoi Oana Diana, Cîntăcioiu Diana-Georgiana, Dumitrescu Ana-Maria

Coordinator(s): MD Alexandru Ulici Alexandru , MD Maria Liana Ienulescu Maria

Introduction:

 Chondrosarcoma is a rare malignant tumor composed of cartilage-producing cells.
Unlike other bone cancers such as osteosarcoma, it is more common among older people than among children and it more  often affects the axial than the appendicular skeleton. It is resistant to chemotherapy and radiotherapy. The complete surgical removal without amputation and also the postoperative care can be challenging.

Case Presentation: A 11 year old boy is admitted for pain and edema of the upper third left calf. The pain started three months prior to the presentation, more severe in the evening  and after moderate to high phisycal effort. Radiography investigation showed a proximal metaphyseal lesion of the left tibia which suggested a diagnosis of  osteosarcoma. The histological findings based on the incisional biopsy indicated chondroblastic osteosarcoma, infirmed later by immunohistochemistry with the final diagnostic, grade 2 chondrosarcoma. The patient underwent integral arthroplasty  of 1/3 proximal left of both tibia and fibula, along with 1/3 distal left femur. The prosthesis was covered with a flap from gastrocnemian muscle. The excisional biopsy confirmed the oncological safety edges, as well as the diagnosis. . Short term post-operative development was favorable, with early introduced physiotherapy. After medium term clinical course, the plague shows a dehiscence with partial vascular necrosis of the flap. The next decision was to begin the Negative-Pressure-Wound-Therapy (NPWT). He underwent multiple  surgical procedures  for proper wound management and replacement of the NPWT dressing with favourable evolution.

Conclusion: This case presents a rare bone cancer, chondrosarcoma, occurring in an atypical young age and having an uncommon limb localizationn. The management of postoperative complications is favourable based on the Negative-Pressure-Wound-Therapy.

Particularities:
 The particularities of this case are: the rare localization of chondrosarcoma on the inferior limb, as well as the young age of the patient.

NON-CIRRHOTIC DISEASE CONTRIBUTING TO PORTAL HYPERTENSION IN A RARE CASE OF LIVER CIRRHOSIS  Lupsa Alina Ioana , Muresan Oana - Invalidated View

NON-CIRRHOTIC DISEASE CONTRIBUTING TO PORTAL HYPERTENSION IN A RARE CASE OF LIVER CIRRHOSIS

Case Report - Poster

Author(s): Lupsa Alina Ioana, Muresan Oana

Coordinator(s): Lecturer Liliana Dina

Introduction: Portal hypertension (PH) is a term used to describe an increase in portal pressure (>10 mmHg), as a result of liver cirrhosis (LC) or of non-cirrhotic disease, being known as non-cirrhotic portal hypertension (NCPH). Causes of NCPH are various, including thrombosis of the extrahepatic portal venous system, which consists in the mesenteric, splenic and portal veins.
Case Presentation: A 53-year-old male patient known with PH was admitted to our hospital with adynamia, fatigue and typical signs of PH. The medical history showed that the patient underwent splenectomy at the age of six, but no medical files for further information were found. Prior to the current admission (2010), the patient was diagnosed with liver cirrhosis of uncertain etiology: viral and autoimmune markers tested negative and the patient denied toxic consumption. Several episodes of gastrointestinal bleeding opened the way for further investigations (2014): while transjugular catheterization confirmed PH, liver biopsy was not suggestive of cirrhosis. Old mesenteric thrombosis with calcifications was identified by CT angiogram, being a possible complication of splenectomy. On current admission investigations brought new data: MRI showed involved intrahepatic biliary tree and pANCA tested positive. Therefore, a second liver biopsy was performed. In addition, echocardiography was suggestive of pulmonary hypertension confirmed by right heart catheterization. As pulmonary complications progressed rapidly, patient's death was inevitable. Liver biopsy result showed liver cirrhosis, confirmed on autopsy.
Conclusion: We report a case of PH in which the etiology was difficult to identify. Although old mesenteric thrombosis was certain, the diagnosis of LC remained unclear before the patient's death. However, the presence of one causal factor of PH did not prevent from investigating additional ones.
Particularities: Considering the two significantly different liver biopsies, LC proved to be either rapidly progressive or difficult to diagnose and evolved towards pulmonary hypertension.

Atypical presentation of pANCA vasculitis and importance of kidney biopsy in choosing the proper treatment- case report  Stoenescu Andreea Florentina , Laurentiu Tandarica Lazăr Diana-Georgiana Validated View

Atypical presentation of pANCA vasculitis and importance of kidney biopsy in choosing the proper treatment- case report

Case Report - Poster

Author(s): Stoenescu Andreea Florentina, Laurentiu Tandarica

Coauthor(s): Lazăr Diana-Georgiana

Coordinator(s): MD Andreea Andronesi

Introduction: The main abnormalityin ANCA vasculitis is the production of autoantibodies against neutrophils, with subsequenttissue injury. These are rare small vesselvasculitis, with general symptoms and multi-organ involvement mimicking many disorders, which often carries a poor prognosis in the absence of a proper treatment. 

Case Presentation:

A 75 years old female patient is hospitalized for a gradual increase in creatinine during the past 8 months. At admittance the patient was overweight, with moderate leg edema and left pleural friction rub. Biochemistry showed chronic nephritic syndrome, with creatinine 2.2 mg/dl.
The symptoms started 14 months before with myalgia, arthralgia, asthenia, inflammatory syndrome and mild anemia, so she was diagnosed in a rheumatology department with rheumaticpolymyalgia. 8 months ago she was hospitalizedin an oncological department and renal impairment. Because of pleural effusion, severe anemia and inflammatory syndrome a malignancy was suspected, but this was not confirmed. She suddenly developed left side paralysis, aphasiaand subsequently unexplained coma. Then her status gradually improved. Because of the chronic nephritic syndrome and these past symptomswe suspected a small vessel vasculitis which was further confirmed by positivity for pANCA antibodies. Kidney biopsy showed advanced glomerular and tubular sclerosis andactive glomerular lesions with necrosis and cellular crescents. Immunosuppression was started with induction therapy with steroids in small doses (because of advanced age and osteoporosis at dual X-ray absorptiometry) and 6-months cyclophosphamide pulses followed by maintenance therapy with azathioprine and alternate-days steroids.Evolution was favorable, with pANCA negativity, stable renal function, resolution  inflammatory syndrome and general symptoms, without additional neurological symptoms. 

Conclusion: Small vessel vasculitis often carries a poor prognosis, that is the main reason proper treatment should be made in time.
Particularities: Giving a personalized and a proper treatment gave a favorable prognosis while minimizing the risk of side effects in a rare disease with the potential of a severe outcome. 

The analysis of somatic mutations with prognostic value in chronic myeloproliferative neoplasms  Ghertescu Doina - Validated View

The analysis of somatic mutations with prognostic value in chronic myeloproliferative neoplasms

Fundamental Science

Author(s): Ghertescu Doina

Coordinator(s): Assistant Professor Marcela Cândea , Professor Claudia Bănescu

Keywords: myeloproliferative neoplasms JAK2 CALR thrombotic incidents

Introduction: Philadelphia-chromosome–negative myeloproliferative neoplasms(MPNs) including polycythemia vera(PV), essential thrombocytosis(ET), and primary myelofibrosis(PMF) are clonal hematopoietic stem cell disorders characterized by increased proliferation of terminally differentiated myeloid cells. Somatic mutations in the 3 driver genes, Janus-kinase-2(JAK2), calreticulin(CALR), and myeloproliferative-leukemia-virus(MPL), are involved in the pathogenesis of these rare cancers. Major causes of morbidity and mortality in MPNs are represented by arterial and venous complications. The aim of this study was to evaluate the frequency of somatic mutations in patients with MPNs as well as to assess the thrombotic phenomena.
Material and Method: This study was conducted on 57 patients with chronic MPNs found in the evidence of the Hematology Department of the Emergency Clinical County Hospital of Targu Mures. The following variables were extracted from the patients’ medical files: the status of JAK2, CALR or MPL mutations, age at the time of diagnostic and the manifestation of a major thrombotic incident(MTI).

Results: The median age was 59 years, 15.78% were young adults under 40 years-of-age, 35 were female and 22 men. The most frequent disorder was ET(45.61%), followed by PV(43.85%) and PMF(10.52%). JAK2 mutation was present in 80% of PV patients, whereas the other 20% carried no somatic mutation. From ET patients, 53.84% were JAK2-positive and 23.07% CALR-positive. Half of PMF patients had JAK2 mutation and the other half–the CALR one. There was no case of MPL mutation. Interestingly, women were 1.69 times more likely to carry the JAK2 mutation compared to men. At least one MTI happened to 40.35% of the patients(42.85% of the females and 36.36% of the males). Of all MTIs, 70.83% were arterial(acute myocardial infarction-47.05%, ischemic cerebrovascular accidents-29.41%).

Conclusion: JAK2 was the most frequent genetic mutation in MPN patients and CALR mutation was associated only with ET and PMF. There was a high incidence of MTI, a life-threatening condition for patients with MPNs.

Bibliography: [1] Elisa Rumi and Mario Cazzola, Diagnosis, risk stratification, and response evaluation in classical myeloproliferative neoplasms, Blood, 2017 129: 680-692 [2] A Tefferi and JW Vardiman, Classification and diagnosis of myeloproliferative neoplasms: The 2008 World Health Organization criteria and point-of-care diagnostic algorithms, Leukemia (2008) 22, 14–22 [3] Tiziano Barbui, Guido Finazzi and Anna Falanga, Myeloproliferative neoplasms and thrombosis, Blood 2013 122:2176-2184

EPITHELIAL MARKERS EXPRESSED BY HUMAN MESENCHYMAL STEM CELLS UPON IN VITRO INDUCTION  Alushi Sultan , Choubey Rahul Oekroesi Alexandra Validated View

EPITHELIAL MARKERS EXPRESSED BY HUMAN MESENCHYMAL STEM CELLS UPON IN VITRO INDUCTION

Fundamental Science

Author(s): Alushi Sultan, Choubey Rahul

Coauthor(s): Oekroesi Alexandra

Coordinator(s): Associate Professor Florina Bojin

Keywords: mesenchymal stem cells epithelial-like cells differentiation media

Introduction: Although the property of adult stem cells to regenerate and repair damaged tissues may be controversial, bone marrow derived cells are reported to have potential contribution to tissue repair in both physiological and pathological conditions, including various types of epithelia. In this study we verified the effect of chemical inductors to differentiate in vitro bone marrow-derived adult mesenchymal stem cells (MSCs) into epithelial-like cells. 

Material and Method: After isolation and expansion, induction of MSCs towards epithelial lineage was made using various cytokines and growth factors (epidermal growth factor – EGF, hepatocyte growth factors – HGF, fibroblast growth factor - FGF), added in culture alone or in combination. Differentiated cells were analyzed using immunofluorescence for vimentin, cytokeratin and E-cadherin markers, whereas gene expression level of cytokeratin 19 and E-cadherin was determined using RT-PCR. 

Results: In all differentiated MSCs, some modifications of cell morphology were noticed, as they become more polygonal and had a tendency to form multilayered culture. Expression of vimentin was weaker in epithelial-like cells, compared with MSCs, while expression of cytokeratin was stronger in epithelial-differentiated cells. The results of RT-PCR showed increased expression of cytokeratin 19 and E-cadherin in epithelial cells, especially in cells cultured in media without FGF, suggesting a possible role FGF in inhibition of mesenchymal to epithelial transition. 

Conclusion: The experiments showed that MSCs differentiation toward the cells expressing epithelial markers is relatively easy to obtain using a certain combination of inductors, without genetic manipulation of the cells.

Bibliography: 1. Takafumi Takebayashi, Takashi Horii, Hiromi Denno, et al. Human mesenchymal stem cells differentiate to epithelial cells when cultured on thick collagen gel. Bio-Medical Materials and Engineering, 2013; 23: 143-153 2. Paunescu V, Deak E, Herman D, Siska IR, Tanasie G, Bunu C, et al. In vitro differentiation of human mesenchymal stem cells to epithelial lineage. J Cell Mol Med, 2007; 11(3): 502-508. 3. Baksh D, Song L, Tuan RS. Adult mesenchymal stem cells: Characterization, differentiation, and application in cell and gene therapy. J Cell Mol Med, 2004; 8: 301-316. 4. Horiuchi T, Miyamoto K, Miyamoto S, et al. Image analysis of remesothelialization following chemical wounding of cultured human peritoneal mesothelial cells: The role of hyaluronan synthesis. Kidney Int, 2003; 64: 2280-90. 5. Gage HH. Mammalian neural stem cells. Science, 2000; 287: 1433-38. 6. Kuznetsov SA, Mankani MH, Gronthos S, Satomura K, Bianco P, Robey PG. Circulating skeletal stem cells. J Cell Biol. 2001; 153: 1133-39. 7. Alison MR, Poulsom R, Forbes SJ. Update on hepatic stem cells. Liver. 2001; 21: 367-73. 8. Bonner-Weir S, Sharma A. Pancreatic stem cells. J Pathol. 2002; 197: 519-26. 9. Janes SM, Lowell S, Hutter C. Epidermal stem cells. J Pathol. 2002; 197: 479-91. 10. Song L, Tuan RS. Transdifferentiation potential of human mesenchymal stem cells derived from bone marrow. FASEB J. 2005; 18: 980-982. 11. Toma C, Pittenger MF, Cahill KS, Byrne BJ, Kessler PD. Human mesenchymal stem cells differentiate to a cardiomyocyte phenotype in the adult murine heart. Circulation. 2005; 105: 93-98. 12. Kotton DN, Ma By, Cardoso WV et al. Bone marrow-derived cells as progenitors of lung alveolar epithelium. Development 2001; 128: 5181-88. 13. Rojas M, Xu J, Woods CR et al. Bone marrow-derived mesenchymal stem cells in repair of the injured lung. Am J Respir Cell Mol Biol 2005; 33: 145-152. 14. Arnhnold S, Heiduschka P, Klein H et al. Adenovirallz transduced bone marrow stromal cells differentiate into pigment epithelial cells and induce rescue effects in RCS rats. Invest Ophthalmol Vis Sci 2006; 47: 4121-29. 15. Arnhold S, Absenger Y, Klein H et al. Transplantation of bone marrow-derived mesenchymal stem cells rescue photoreceptor cells in the dystrophic retina of the rhodopsin knockout mouse. Graefes Arch Clin Exp Ophthalmol 2007; 245: 1414-22. 16. Nakagawa H, Akita S, Fukui M et al. Human mesenchymal stem cells successfully improve skin-substitute wound healing. Br J Dermatol 2005; 153: 29-36. 17. Fu X, Fang L, Li X et al. Enhanced wound-healing quality with bone marrow mesenchymal stem cells autografting after skin injury. Wound Repair Regen 2006; 14: 414-22. 18. Morigi M, Imberti B, Zoja C et al. Mesenchymal stem cells are renotropic, helping to repair the kidnez and improve function in acute renal failure. J Am Soc Nephrol 2004; 15: 1794-1804. 19. Herrera MB, Bussolati B, Bruno S et al. Mesencymal stem cells contribute to the renal repair of acute tubular epithelial injury. Int J Mol Med 2004; 14: 1035-41.

LGMD 2A: ROLE OF GENETIC ANALYSIS IN CALPAINOPATHY DIAGNOSIS  ALINA ELENA TUCANA , Tuica Larisa Mihaela Tudor Diana Maria Invalidated View

LGMD 2A: ROLE OF GENETIC ANALYSIS IN CALPAINOPATHY DIAGNOSIS

Fundamental Science

Author(s): ALINA ELENA TUCANA, Tuica Larisa Mihaela

Coauthor(s): Tudor Diana Maria

Coordinator(s): Professor Amelia Dobrescu Dobrescu

Keywords: diagnosis genetic analysis canp 3 gene gene mutations

Introduction: Calpainopathy (LGMD 2A- Limb Girdle Muscular Dystrophy 2A) is the most prevalent form of Limb Girdle Muscular Dystrophies. Calpain deficiency determined by CAPN3 gene mutations is responsible of clinical manifestations of the pathology characterized by symmetrical and selective atrophy of the pelvic, scapular and trunk muscles. Phenotypic variability of this pathology and the lack of specificity and sensibility of Western Blot analysis make the diagnostic even more difficult. Identification of CAPN3 gene mutations has become mandatory to prove their pathogenic role in the etiology of this disease.

Material and Method: Our study follows the identification of CAPN3 mutations on 9 patients with age between 8 and 31 years old. All patients represented “de novo” cases and had a clinical phenotype suggestive for LGMD 2A and a reduced amount of calpain revealed through the Western Blot analysis. The molecular study was practiced on all 9 samples collected from the patients included in our study, for 2 of them the study was focused on the analysis of cDNA, while for the rest of the patients the genetic analysis was realized on DNA extracted from peripheral blood.

Results: Mutations characterization for the patients included in this study had as a result: a. The possibility to establish with certainty the diagnosis of LGMD 2A b. Issuing different assumptions regarding the genotype-phenotype correlation c. Validation of molecular diagnostic protocol depending on the used techniques. 

Conclusion: The small number of patients of our study for establishing a connection net clinical genotype phenotype protein-phenotype can support an association between the severity of the phenotype and the presence of a genotype homozygous or heterozygous compound of mutations of fault of splincing / mutations missense / null mutations.

Bibliography: I. Richard, C. Roudaut, F. Fougerousse, N. Chiannilkulchai, J.S. Beckmann, An STS map of the limb girdle muscular dystrophy type 2A region, Mamm. Genome 6 (1995) 754–756 M Vainzof, F de Paula, A M Tsanaclis, M Zatz, The effect of calpain 3 deficiency on the pattern of muscle degeneration in the earliest stages of LGMD2A, J Clin Pathol ;56:624–626, 2003. Richard I, Broux O, Allamand V, Fougerousse F, Chiannilkulchai N, Bourg N, Brenguier L, Devaud C, Pasturaud P, Roudaut C, et al. Mutations in the proteolytic enzyme calpain 3 cause limb-girdle muscular dystrophy type 2A. Cell; 81:27–40.1995. Noguchi S, McNally EM, Ben Othmane K, Hagiwara Y, Mizuno Y, Yoshida M, Yamamoto H, Bonnemann CG, Gussoni E, Denton PH, et al. Mutations in the dystrophin-associated protein gamma-sarcoglycan in chromosome 13 muscular dystrophy. Science; 270:819–22.1995. Nigro V. Molecular bases of autosomal recessive limbgirdle muscular dystrophies. Acta Myol;22:35–42.2003. Chou FL, Angelini C, Daentl D, Garcia C, Greco C, Hausmanowa-Petrusewicz I, Fidzianska A, Wessel H, Hoffman EP. Calpain III mutation analysis of a heterogeneous limb-girdle muscular dystrophy population. Neurology. 1999;52:1015–20. ] Minami N, Nishino I, Kobayashi O, Ikezoe K, Goto Y, Nonaka I. Mutations of calpain 3 gene in patients with sporadic limb girdle muscular dystrophy in Japan. J Neurol Sci. 1999;171:31–7 [26] Luo SS, Xi JY, Lu JH, Zhao CB, Zhu WH, Lin J, Wang Y, Ren HM, Yin B, Urtizberea AJ. Clinical and pathological features in 15 Chinese patients with calpainopathy. Muscle Nerve. 2011;43:402–9

Arterial ischemic stroke caused by a cardiac tumor in child - case report  Petrescu Mihai , Ciuciulete Alexandra-Roxana PETRESCU ANA-MARIA, Singer Maria Invalidated View

Arterial ischemic stroke caused by a cardiac tumor in child - case report

Case Report - Poster

Author(s): Petrescu Mihai, Ciuciulete Alexandra-Roxana

Coauthor(s): PETRESCU ANA-MARIA, Singer Maria

Coordinator(s): Professor Ileana-Octavia Petrescu

Introduction: The cerebrovascular accident (CVA) represents a blockage or a sudden rupture of cerebral arteries or veins and causes focal cerebral lesions with clinical neurological disorders. The incidence of the arterial ischemic stroke in children has been estimated at 1.2/ 1000,000 cases per year. Heart diseases are responsible for 20-50% of the arterial thrombosis cases. Heart myxomas are very rare and represent 6% of the total heart tumors in children. The clinical picture and the risk factors of the CVA are different in children as compared to the adult. 

Case Presentation:

We present the case of 8 year-old girl, GM, without significant pathological antecedents who, while playing, had generalized, tonic-clonic seizures which did not respond to the emergency treatment. 
The seizure control was made possible only after anticonvulsant medication in a continuous drip. The CT which was rapidly performed showed a slightly hypoactive area in the left frontal-parietal side, with fewer visible vascular structures in the gyral canals. The cardiac ultrasound revealed the presence of a big (3/3.5 cm in the left atrium), mobile, non-homogenous, tumoral formation, which was attached to the interatrial septum and with a large base of implantation, a formation which entered through the mitral valve. The MRI cerebral angiography described ischemic lesions in the territory of the terminal branches of the right middle cerebral artery and an ischemic lesion which extended in the frontal-temporal-parietal area in the territory of the left middle cerebral artery.     
Dispite of the intensive treatment, the patient went into a profound coma and death occurred 14 days after. The parents refused the necropsy.  

Conclusion: The asymptomatic heart tumour was diagnosed when major complication (cerebral embolism) occurred through a stroke. Death was registered in an apparently healthy child, with no pathological antecedents.

Particularities:
The presence of asymptomatic cardiac tumor in child, followed by death caused by CVA

Abdominal Compartment Syndrome, a life-threatening complication of Acute Severe Pancreatitis  Papaeleftheriou Stavroula , Brink Melindi Amaranducai Luminita, Gallaby Kaisser Validated View

Abdominal Compartment Syndrome, a life-threatening complication of Acute Severe Pancreatitis

Surgical Science

Author(s): Papaeleftheriou Stavroula, Brink Melindi

Coauthor(s): Amaranducai Luminita, Gallaby Kaisser

Coordinator(s): MD Irina Trifescu

Keywords: Abdominal Compartment Syndrome Pancreatitis Decompression

Introduction: Abdominal compartment syndrome (ACS) is defined as sustained intraabdominal pressure above 20mmHg which can be a life-threatening complication of acute severe pancreatitis (ASP).

Material and Method: In a period of three years (2013-2016) 270 patients were admitted to Sf. Spiridon Hospital, 3rd Surgery department, Iasi. 54 patients (20%) were diagnosed with ASP of diverse origin, of which 20 (37%) presented with early ACS. These patients (median age n=43, female n=11, male=9) were included in this study. Treatment and postoperative course were assessed.

Results: To achieve abdominal decompression 15 patients underwent vacuum laparostomy while the remaining five were operated with classic laparostomy. Both approaches partly included cholecystectomy with biliary drainage, necrosectomy and drainage of pancreatic and parapancreatic pus collections. Surgical decompression was chosen two days’ post diagnosis of ACS, when medical treatment in the ICU proved to be insufficient. Peritoneal fluid cultures were positive in all cases for Klebsiella Pneumoniae and Acinetobacter, multiple resistant strains. 16 of 20 patients with ACS passed away due to septic shock and multiple organ failure (mortality rate 80%) This equals 29.6% of the 54 patients initially presenting with ASP. The surviving 4 patients were discharged after lengthy hospitalization. 

Conclusion: Acute severe pancreatitis complicated with abdominal compartment syndrome has a high mortality despite ICU support, therefore careful observation of the progress of medical therapy is paramount. Surgical treatment options (abdominal decompression) should be considered in time, and not delayed, if indicated. 

Bibliography: 1. Mentula P, Hienonen P, Kemppainen E, Puolakkainen P, Abdominal compartment syndrome in patients with severe acute pancreatitis in early stage, Surgical decompression for abdominal compartment syndrome in severe acute pancreatitis, Arch Surg. 2010 Aug;145(8):764-9. 2. Hong Chen, Fei Li, Jia-Bang Sun, and Jian-Guo Jia, Abdominal compartment syndrome in patients with severe acute pancreatitis in early stage, World J Gastroenterol. 2008 Jun 14; 14(22): 3541–3548. 3. Bhandari V, Jaipuria J, Singh M, Chawla AS. Intra-abdominal pressure in the early phase of severe acute pancreatitis: canary in a coal mine? Results from a rigorous validation protocol. Gut Liver 7:731-738, 2013. 4. De Keulenaer B, Regli A, De Laet I, Roberts D, Malbrain ML. What’s new in medical management strategies for raised intra-abdominal pressure: evacuating intra-abdominal contents, improving abdominal wall compliance, pharmacotherapy, and continuous negative extra-abdominal pressure. Anaesthesiol Intensive Ther 47(1):54-62, 2015. 5. Kirkpatrick AW, Roberts DJ, De Waele J, Jaeschke R, Malbrain ML, De Keulenaer B, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome. Intensive Care Med 39:1190-1206, 2013 6. Dejan V. Radenkovic, Colin D. Johnson, et al., Interventional Treatment of Abdominal Compartment Syndrome during Severe Acute Pancreatitis: Current Status and Historical Perspective, Gastroenterology Research and Practice, Volume 2016 (2016), Article ID 5251806

Multiple thoracic arterious-venous fistulas in a patient with non-specific cardiac symptoms  Iacob Diana Andreea , Buta Nicoleta-Flavia Lefter Cristina Validated View

Multiple thoracic arterious-venous fistulas in a patient with non-specific cardiac symptoms

Case Report - Poster

Author(s): Iacob Diana Andreea, Buta Nicoleta-Flavia

Coauthor(s): Lefter Cristina

Coordinator(s): Professor Theodora Benedek , Assistant Professor Nora Rat

Introduction:

We present a case of a  31–year–old man,  admitted in the Cardiology Clinic in Tîrgu Mureș, with non-specific symptoms associated with episodes of tachycardia-bradycardia arrhytmia.


Case Presentation:

ECG showed a heart rate of 75 bpm, flat T wave in DIII and aVF, and negative in V1 and V2. Stress testing associated with computed tomographic angiography (CTA) revelead alteration of myocardial perfusion. CTA also showed multiple arterious-venous fistulas between the aorta, superior vena cava ( SVC) , pulmonary veins and azygos system.

Cardiovascular Surgery consult indicated fistulas ligation: aorta-SVC -, aorta- left superior pulmonary vein, azygos-right superior pulmonary vein, however this intervention was rejected by the patient. In the absence of surgical intervention, the therapy consisted in metopropol 2x1/day for indefinite duration, leading to significant improvement of the symptoms.


Conclusion: Arterio-venous fistulas are very rare  malformation assciated with a large variety of signs and symptoms. CTA, the gold standard technique for detection of arterio-venous fistulas, can be used for location of this malformation, assesing their complexity and helping to choose the best therapy.

Particularities:

The particularity of the case is the discrepancy between the symptoms of the pacient and  imagistic result . Another particularity is the unknow etiology of tachycardia- bradycardia arrhythmia accompanied by chest paint wherefor  the patient was hospitalized several times.

WILSON'S DISEASE : THE DIAGNOSIS OF A LATE ONSET. A CASE REPORT  Matei Maria Miruna , - Invalidated View

WILSON'S DISEASE : THE DIAGNOSIS OF A LATE ONSET. A CASE REPORT

Case Report - Poster

Author(s): Matei Maria Miruna ,

Coordinator(s): Assistant Professor Corina Daniela Ene

Introduction: Wilson's disease or hepatolenticular degeneration is an autosomal recessive liver disease caused by mutations in the ATP7B gene, which encodes a copper-transporting ATPase. As a result of the functional shortage, copper accumulates to toxic levels that can damage tissues, particularly the liver (leading up to cirrhosis), brain (with secondary neurologic and psychiatric manifestations), cornea and kidneys.
Case Presentation: 49 years old male patient with multiple cardiovascular comorbidities, including essential hypertension, generalized ateromatosis, congestive cardiac failure and generally, a broad pathological case history, presented in April 2016 with jaundice, hyperchromic urine, steatorrhea and drowsiness. The biochimical assessment indicates nitrogen retention syndrome and cytolytic syndrome with cholestasis. Further testing shows low levels of ceruloplasmin (<20 mg/dl) and high levels of copper in both blood and urine (>40 mcg). Microscopic hematuria is detected. Tests for autoimmune hepatitis 1 and 2, acute hepatitis and systemic lupus erythematosus are negative. At this point Penicillamine  based treatment is initiated and the patient's condition is improved. Based on the elements presented below a preliminary diagnosis of Wilson’s disease is made. Neurological and psychiatric status exam concludes that the patient suffers from ataxia, aphasia, clumsiness, emotional lability and nervousness prior to an ischemic CVA which occurred in 2012. The MRI scan reveals leukoaraiosis, ventricular enlargement and demyelinated areas. Hepatic biopsy indicates cirrhosis, while special copper staining does not reveal any copper deposits. The ophthalmologic assay shows no trace of the Kayser-Fleischer rings. Genetic testing for the ATP7B mutation performed in May 2016 yields negative results. According to the Leipzig European score the diagnosis for Wilson disease is confirmed.
Conclusion: The genetic diagnosis  should not be used for definitive diagnosis because approximately 500 mutations are currently known.
Particularities: The patient is diagnosed with Wilson’s disease after the age of 40 without the Kayser-Fleischer rings.

Antibiotic sensitivity spectrum of Methicillin resistant Staphylococcus Aureus involved in respiratory tract infections  Negrila Alina - Alexandra , Ungureanu Razvan-George Oancea Dragos, Voinea Dragos Validated View

Antibiotic sensitivity spectrum of Methicillin resistant Staphylococcus Aureus involved in respiratory tract infections

Fundamental Science

Author(s): Negrila Alina - Alexandra, Ungureanu Razvan-George

Coauthor(s): Oancea Dragos, Voinea Dragos

Coordinator(s): Professor Adriana Turculeanu , Assistant Professor Alice Gaman

Keywords: MRSA sensitivity resistance antibiotics

Introduction: Staphylococcus Aureus is one of the leading causes of respiratory tract diseases and is notorious for its ability to become resistant to antibiotics, a phenomenon that is becoming more and more frequent.

Material and Method: For the purpose of this study, we have gathered 793 specimens from the upper respiratory tract: tracheobronchial secretion, sputum, nasal secretion, nasopharyngeal secretion, tonsil secretion, conjunctival secretion, auricular secretion, sinus puncture aspirate, all gathered from patients committed to “Spitalul Clinic Judetean de Urgenta Craiova”, during the time between 01.01.2015-01.01.2016. 

Microbiological diagnosis was done using both classical and automated methods (Automated bacterial identification system, as well as Phoenix antibiogram – BD). We have subjected every identified and isolated bacterial strain to the Kirby-Bauer test (disk diffusion antibiotic sensitivity test), so as to determine the sensitivity/resistance to antibiotics of said strains.

Results: Of the 793 specimens gathered, only 100 contained MRSA (Methicillin resistant Staphylococcus Aureus), 51 of which only contained Staphylococcus Aureus, and 49 of which contained, apart from MRSA, other germs as well. 
-Sensitivity: all of the 100 identified and tested MRSA strains were found to be sensitive to Linezolid, 97 to Teicoplanin, 96 to Tigeciclin, 93 to Ceftaroline, 77 to Cloramphenicol, 66 to Rifampicicn; 
-Resistance: 62 strains were resistant to Clarythromicin, 75 to Ciprofloxacin, 86 to Tetracycline, 82 to Penicillin, 87 to Amoxicillin/Clavulanic acid. MRSA in the respiratory tract had a prevalence of 49%, as sole etiological agent in 51% of the cases, and in association with other pathogens in 49% of the cases. 

Conclusion: -No difference whatsoever was found regarding the resistance of MRSA, whether as sole etiological agent, or in combination with others. 
-MRSA is resistant to other antibiotics as well: Penicillin, Tetracyclin, Clarithromycin, Rifampicin, Amoxicillin/Clavulanic acid, Ciprofloxacin (multidrug resistance)

Bibliography: Greenwood D., Slack R.C.B., Peutherer J.F. – „Medical Microbiology”, 14th edition, ELBS Churchill-Livingstone, London, 1992. Turculeanu Adriana, Bălăşoiu Maria, Avramescu Carmen – „Bacteriologie specială – Virusologie – curs pentru studenţii medicinişti”, Editura Universitaria, Craiova, 2005.

NAT2 ACETYLATOR STATUS ON A SAMPLE OF TUBERCULOSIS PATIENTS IN SOUTH-WESTERN ROMANIA  Dakhel Zeineb , Rujan Andreea Dorobantu Stefania, Ciocoiu Adela, Ciontea Marius Validated View

NAT2 ACETYLATOR STATUS ON A SAMPLE OF TUBERCULOSIS PATIENTS IN SOUTH-WESTERN ROMANIA

Fundamental Science

Author(s): Dakhel Zeineb, Rujan Andreea

Coauthor(s): Dorobantu Stefania, Ciocoiu Adela, Ciontea Marius

Coordinator(s): MD Anca Riza , Associate Professor Mihai Ioana

Keywords: tuberculosis(TB) arylamine-N-acetyltransferase-2(NAT2) acetylator status drug-induced-liver-injury(DILI)

Introduction: : Leading cause of death worldwide, tuberculosis(TB) registers a high incidence in Romania, most prominently in Oltenia. Standard regimens to treat TB consist of a combination of drugs over a prolonged period. Arylamine-N-acetyltransferase-2(NAT2) is involved in the metabolism of isoniazid(INH), major first line anti-tuberculosis drug. Polymorphisms(SNPs) in the NAT2 gene are ethnicity based and clinically relevant through modulation of N-acetylation status. Acetylator phenotypes - rapid, intermediate, and slow - impact treatment outcome and side-effects.
Material and Method: Our small-scale study was conducted on 175 pulmonary TB patients enrolled during 2011-2013 in Spitalul de Pneumoftiziologie "Tudor Vladimirescu", Gorj. TB diagnosis was assessed according to national guidelines. We genotyped three of the slow acetylator SNPs: rs1801280 (G>A,I114T) – main SNP of NAT2*5 haplotype, rs1799930 (T>C,R197Q) - NAT2*6, rs1799931 (G>A,G286E) - NAT2*7, using TaqMan probes(ThermoFisher) on a Real-Time PCR Viia7 platform(Applied Biosystems). The selected SNPs drive a slow acetylator phenotype and are frequent in Caucasians.
Results: Genotyped data shows minor allele frequencies of 37.14% for rs1801280, 34.29% for rs1799930 and 9.14% for rs1799931, comparable or higher to reported frequencies for Caucasians. Homozygosity translates into slow acetylator phenotype: 13.71% for rs1801280, 10.29% of the TB cases for rs1799930 and 8.57% for rs1799931, adding up to 32.57% of the sample group.
Conclusion: Haplotype diversity, polymorphic genetic background and functional variation would dictate acetylator status to be determined using an extensive panel of SNPs. However, similar selections of main SNPs have been used, with acceptable misclassification rates. Fast INH acetylation phenotype is at risk of not reaching drug efficacy due to low drug levels. Slow acetylation results in prolonged exposure, therefore higher drug-induced liver toxicity(DILI). Though underpowered, our findings support the potential and the need of individualized pharmacogenetic-guided INH regimen in TB patients with the aim of improved treatment outcome and decreased DILI incidence.
Bibliography: Chapter 18: Pharmacogenetics of Antituberculosis Drugs Aarnoutse NAT2 genotype guided regimen reduces isoniazid-induced liver injury and early treatment failure in the 6-month four-drug standard treatment of tuberculosis: A randomized controlled trial for pharmacogenetics-based therapy Meta-Analysis of Clinical Studies Supports the Pharmacokinetic Variability Hypothesis for Acquired Drug Resistance and Failure of Antituberculosis Therapy NAT2 variants are associated with drug-induced liver injury caused by anti-tuberculosis drugs in Indonesian patients with tuberculosis Tuberculosis Pharmacogenetics: State of The Art Arylamine N-acetyltransferases: from drug metabolism and pharmacogenetics to drug discovery

Homozygous FV Leiden and heterozygous MTHFR associated with early onset severe intrauterine growth restriction  Raris Alexandra , Mangaloiu David Apostol Dimitri, Lungu Adina, Rosu Mariana Validated View

Homozygous FV Leiden and heterozygous MTHFR associated with early onset severe intrauterine growth restriction

Case Report - Poster

Author(s): Raris Alexandra, Mangaloiu David

Coauthor(s): Apostol Dimitri, Lungu Adina, Rosu Mariana

Coordinator(s): Lecturer Antoaneta P




RARE CONGENITAL DISORDER RESURFACE IN IASI - ARTHROGRYPOSIS  Amaranducai Luminita , Papaeleftheriou Stavroula Brink Melindi, Gallaby Kaisser, Abukhalaf Basel Validated View

RARE CONGENITAL DISORDER RESURFACE IN IASI - ARTHROGRYPOSIS

Surgical Science

Author(s): Amaranducai Luminita, Papaeleftheriou Stavroula

Coauthor(s): Brink Melindi, Gallaby Kaisser, Abukhalaf Basel

Coordinator(s): MD Agnes Bacusca

Keywords: Arthrogryposis Akinesia Oligohydramnios Stenosis

Introduction: Arthrogryposis Multiplex Congenita (AMC) is a rare condition with a prevalence of 1 in 3000 in Asia and Iran. In Europe however, 1 in 12000 live births with AMC have been reported by some authors. Almost every articulation in a patient with arthrogryposis is affected, with 84% involving all limbs, 11% only the legs, 4% only the arms. The most common cause is secondary to fetal akinesia due to oligohydramnios, defects in the fetal blood supply, hyperthermia, limb immobilization or viral infections. Other causes are intrinsic factors such as molecular, muscle- and connective tissue development disorders or neurological abnormalities. Oligohydramnios and fetal akinesia are an important factor for prematurity. Hypertrophic pyloric stenosis is an important complication of prematurity found primarily in male infants in a 5 to1 ratio, resulting in multiple hospital admissions.

Material and Method: An infant was diagnosed with AMC at birth. A remarkable diagnosis for the first time in 17 years in Iasi, Romania. The pregnancy involved many complications that were monitored via ultrasound in the first and second trimester.

Results: The pregnancy involved many complications: severe oligohydramnios and possible multiple malformation syndrome from the gestational age of 20 weeks. The delivery had been made by caesarian-section at the 33 weeks of pregnancy. At 2 months old, the infant was diagnosed with Hypertrophic pyloric stenosis, however the treatment didn't require surgery. Surgical management of AMC is not the primary management plan. After therapeutic resources, such as physical therapy, some joint contractures may still persist. This is usually the time when surgical intervention is discussed in order to provide the individual with a better quality of life.

Conclusion: The diagnosis will often be made by the associated symptoms and signs, as well as genetic tests. Physical therapy started early on, is just as important as the surgery procedures.

Bibliography: 1.Taricco LD, Aoki SS. Rehabilitation of an adult patient with arthrogryposis multiplex congenita treated with an external fixator. Am J Phys Med Rehabil. 2009 May. 88(5):431-4. 2.Bamshad M, Van Heest AE, Pleasure D. Arthrogryposis: a review and update. J Bone Joint Surg Am. 2009 Jul. 91 Suppl 4:40-6. 3.Hall JG. Genetic aspects of arthrogryposis. Clin Orthop. 1985. 194:44-53. 4.Darin N, Kimber E, Kroksmark AK, Tulinius M. Multiple congenital contractures: birth prevalence, etiology, and outcome. J Pediatr. 2002 Jan. 140(1):61-7. 5.Laitinen O, Hirvensalo M. Arthrogryposis multiplex congenita. Ann Paediatr Fenn. 1966. 12:133-138 6. "The Free Dictionary: Arthrogryposis". Retrieved 11 July 2013. 7. Kalampokas, Emmanouil; Kalampokas, Theodoros; Sofoudis, Chrisostomos; Deligeoroglou, Efthymios; Botsis, Dimitrios (2012). "Diagnosing Arthrogryposis Multiplex Congenita: A Review". ISRN Obstetrics and Gynecology. 2012: 1. 8. Bevan, Wesley P.; Hall, Judith G.; Bamshad, Micheal; Staheli, Lynn T.; Jaffe, Kenneth M.; Song, Kit (2007). "Arthrogryposis Multiplex Congenita (Amyoplasia)". Journal of Pediatric Orthopaedics. 27 (5): 594–600. doi:10.1097/BPO.0b013e318070cc76. PMID 17585274. 9. Fassier, Alice; Wicart, Philippe; Dubousset, Jean; Seringe, Raphaël (2009). "Arthrogryposis multiplex congenita. Long-term follow-up from birth until skeletal maturity". Journal of Children's Orthopaedics. 3 (5): 383–90. 10. Brooks, James G; Coster, Douglas J (1994). "Arthrogryposis multiplex congenita: A report of two cases". Australian and New Zealand Journal of Ophthalmology. 22 (2): 127–32. 11.Rink, Britton D. (2011). "Arthrogryposis: A Review and Approach to Prenatal Diagnosis". Obstetrical & Gynecological Survey. 66 (6): 369–77. 12.Van Heest, Ann E.; Rodriguez, Rudy (2013). "Dorsal Carpal Wedge Osteotomy in the Arthrogrypotic Wrist". The Journal of Hand Surgery. 38 (2): 265–70. doi:10.1016/j.jhsa.2012.10.034. PMID 23267756. 13.Ezaki, Marybeth; Oishi, aScott N. (2010). "Index Rotation Flap for Palmar Thumb Release in Arthrogryposis". Techniques in Hand & Upper Extremity Surgery. 14 (1): 38–40. 14.Kawahara H, Takama Y, Yoshida H, et al. Medical treatment of infantile hypertrophic pyloric stenosis: should we always slice the "olive"?. J Pediatr Surg. 2005 Dec. 40(12):1848-51. 15.Markowitz RI. Olive without a cause: the story of infantile hypertrophic pyloric stenosis. Pediatr Radiol. 2014 Feb. 44 (2):202-11.

Difficult glycemic control under Pasireotide. Case report  Petrica Ana-Maria , Tertan Bristena Octavia - Validated View

Difficult glycemic control under Pasireotide. Case report

Case Report - Poster

Author(s): Petrica Ana-Maria, Tertan Bristena Octavia

Coordinator(s): Assistant Professor Oana Pînzariu

Introduction:

Pasireotide is a multi-receptor-targeted somatostatin analogue used for the treatment of Cushing's disease (CD). It has a safety profile similar to other somatostatin analogues with the exception of hyperglycemia. The current understanding of response to Pasireotide in CD and the management of Diabetes Mellitus during Pasireotide treatment are still controversial. 


Case Presentation:

We present the case of a 58 year-old female patient diagnosed in 2006 with pituitary microadenoma who developed bilateral adrenal hyperplasia and Cushing’s Disease.

The patient underwent radiotherapy and was placed on Ketoconazole. Due to the poor control of the disease (urinary free cortisol 263 μg/24h), hormonal therapy with Pasireotide was initiated in October 2015, which normalized the cortisol levels in only 2 months (urinary free cortisol 122,2 μg/24h in December 2015).

In June 2014, the patient was diagnosed with secondary Diabetes Mellitus, starting the treatment with Metformin. The poor glycemic control (HbA1c 7,6%) corroborated with the endocrine treatment changes led to the necessity of initiating insulin therapy with Lantus 48 I.U./day and Humalog R 30 I.U./day. After 6 months, due to the worsening of the glycemic control (HbA1c 9,48%)  the doses of Lantus were increased to 54 I.U./day.

In September 2016, HbA1c was 8.78% and the level of cortisol in normal limits.


Conclusion: We followed the evolution of the cortisol and glycemic control under Pasireotide. Diabetes is difficult to manage under this treatment, needing constant adjustments. On the other hand, Pasireotide is quick and efficient in the Cushing’s Disease. 

Particularities:

Although the decision to change to insulin therapy was made when Pasireotide treatment was initiated, Hb A1c rose with 1,82% in one year, also irrespective of the further adjustments made. 

Raman imaging for the detection of intracellular carotenoids  Moisoiu Vlad , Stefancu Andrei - Validated View

Raman imaging for the detection of intracellular carotenoids

Fundamental Science

Author(s): Moisoiu Vlad, Stefancu Andrei

Coordinator(s): Associate Professor Nicolae Leopold , Assistant Professor Ciprian Tomuleasa

Keywords: Age-related macular degeneration Carotenoids Raman imaging

Introduction: Age related macular degeneration (AMD) is the leading cause of blindness in the aging population. The only therapy in the case of non-angiogenic AMD is represented by supplementation with antioxidants, which can slow the progression of the disease in some patients. Norbixin is a water-soluble retinoid that was recently shown to protect the retinal pigment epithelium cells (RPECs) in a murine model, but further studies are needed. Raman imaging is an excellent tool for assessing the uptake and intracellular distribution of carotenoids, due to the presence of conjugated double systems that enable resonance condition with the exciting radiation. Therefore, the present work used Raman imaging to compare the uptake and accumulation of Norbixin and beta-carotene inside RPECs 

Material and Method: The RPECs (D407 cell line) were incubated with either beta-carotene or Norbixin for 24 h, at a final concentration of 100 and 200 µM and then fixed with 4% paraformaldehyde. The Raman signal was collected with a 532 nm diode laser using an exposure time of 1 s for each spectrum in 2 µm steps. Pre-processing and principal component analysis (PCA) was performed using custom built MATLAB functions

Results: By employing Raman imaging and PCA, a clear pattern of intracellular uptake was observed in the case of Norbixin, as opposed to beta-carotene, which could not be detected inside RPECs. This feature suggests that intravitreal injection should be taken into consideration in future therapies based on Norbixin. The identification of the carrotenoids was based on two characteristic Raman bands around 1005 cm-1 and 1523 cm-1. 

Conclusion: Using Raman imaging, the study showed that Norbixin accumulates inside RPECs without the need for solubilisation. This feature suggests that intravitreal injection is a viable route of administration for Norbixin, which could improve the treatment outcome in non-neovascular AMD.

Bibliography: V. Fontaine, E. Monteiro, E. Brazhnikova, L. Lesage, C. Balducci, L. Guibout, L. Feraille, P.-P. Elena, J.-A. Sahel, S. Veillet, and R. Lafont, "Norbixin Protects Retinal Pigmented Epithelium Cells and Photoreceptors against A2E-Mediated Phototoxicity In Vitro and In Vivo," PLoS ONE 11, e0167793 (2016).

A rare case of subcortical heterotopy (“Double cortex” Syndrome) in young male  Boldeanu Elena - Validated View

A rare case of subcortical heterotopy (“Double cortex” Syndrome) in young male

Case Report - Poster

Author(s): Boldeanu Elena

Coordinator(s): Assistant Professor Smaranda Niță

Introduction: Subcortical band heterotopia, also known as double cortex syndrome, is a condition of abnormal brain development that is present from birth.  This condition which primarily affects females, occurs when neurons migrate to a zone of the brain where they are not supposed to be (heterotopia), and form abnormal areas that appear as band-like clusters of white tissue underneath the gray tissue of the cerebral cortex (subcortical), creating the appearance of a double cortex.

Case Presentation: We present a 8 year old boy who was admitted for refractory epileptic seizures and delayed language development. He has a history of paroxystic manifestations that started at the age of 2 and had frequent admissions for having recurrent seizure attacks.  He was the only child of his family and was a product of uneventful term pregnancy with an Apgar Score of 8. His neuropsychomotor development was normal except dislalia and bradilalia. The physical exam was unremarkable. The lab data were all within normal, but the EEG revealed a couple of poly spike-wave discharges. A brain MRI showed generalized band heterotopia. He undergoes a multiple antiepileptic treatment scheme for keeping under control these seizures.

Conclusion: In the diagnostic evaluation of an epileptic children, a brain MRI is strongly recommended for accurate diagnosis of anomalies such as neuronal migration disorders (in this case band heterotopia) because appropriate therapeutic management are dependent on a definite diagnosis of the case.

Particularities: The “Double Cortex” syndrome is a rare congenital disease which affect mostly females, but in these rare instance a young male was diagnosed with this disease.

The difficulty of treatment in infant Acute Lymphoblastic Leukemia. Case report.  Vunvulea Vlad , Di Nardo Nicola Dinu Andreea-Adelina, Gîrbovan Anamaria Hermina Invalidated View

The difficulty of treatment in infant Acute Lymphoblastic Leukemia. Case report.

Case Report - Poster

Author(s): Vunvulea Vlad, Di Nardo Nicola

Coauthor(s): Dinu Andreea-Adelina, Gîrbovan Anamaria Hermina

Coordinator(s): Professor Maria-Despina Baghiu , MD Bogdana Dorcioman

Introduction: Leukemia is said to be responsible for about 35% of the hematologic diseases. Leukemia in infants, though, is very rare and does raise quite some interest due to the aggressive clinical presentation and the poor responses to current therapies. Out of all the forms of leukemia, Acute Lymphoblastic Leukemia (ALL) is the most common one, but ALL in infants under 1 y/o accounts for about only 4% of childhood ALL.

Case Presentation: We are reporting the case of a 1 month old baby diagnosed with ALL, treated according to the BFM Interfant-06 protocol who presented three months afterwards a combined bone marrow and central nervous system relapse. For this reason she received treatment according to the AIEOP LLA REC2003 protocol. However due to a new relapse only one month later she was prepared for an allogeneic stem cell transplantation. A TCR α/ β T-lymphocyte and CD19+ B-lymphocyte depleted PBSC transplantation from the HLA-Haploidentical father was performed. The infusion was well tolerated at first, but soon post-transplant complications appeared such as GvHD, Sepsis by ESBL Klebsiella and viral rhinitis. Due to the persistence of fever and CRP elevation empirical antibiotic treatment was started. 

After a new relapse two months later, she started treatment according o the UK ALL R3 protocol whiteout any result. 
The clinical condition worsened progressively with  and neurological impairment, the patient died at 14 months of age. 

Conclusion: In conclusion, ALL especially in infants is a very difficult pathology to manage due to the poor responses to a variety of therapies.
Particularities: The particularity of this case is the early onset of ALL, the complications and the poor results despite the large variety of treatment alternatives.

THE SURGICAL MANAGAMENT OF THE AN GIANT PITUITARY ADENOMA   Costan Claudia-Ioana Costan Ana-Maria, Florescu Adrian Gabriel, Hoza Alexandra-Maria Validated View

THE SURGICAL MANAGAMENT OF THE AN GIANT PITUITARY ADENOMA

Case Report - Poster

Author(s): Costan Claudia-Ioana

Coauthor(s): Costan Ana-Maria, Florescu Adrian Gabriel, Hoza Alexandra-Maria

Coordinator(s): Lecturer Adrian Bălaşa , MD Rareş Chinezu

Introduction: Pituitary adenomas are a common intracranial pathology with a prevalence of up to 15% all intracranial tumors. Pituitary adenomas can occur at any age but the highest incidence is between 4th and 7th decade of life. Management of pituitary adenomas is complex being influenced by tumor size, functional status of tumor, and histopathological characteristics.
Case Presentation: We present a case of a 38 years old male, smoker and known with arterial hypertension. The patient presented intense headache and sudden onset of left ophthalmoplegia. Emergency cranial CT scan showed a large homogenous, contrast enhaceing, supra/intrasellar mass measuring 5x6x6 cm, with signs of apoplexy. The patient was admitted at the Neurosurgery Department of the Targu Mures Emergency County Hospital. The clinical exam reveals a conscious patient (GCS 15p), left oculomotor nerve palsy, no motor or sensorial deficits, no meningeal signs. The lab tests showed higher levels of prolactin: > 200 ng/dl, without other pituitary deficits. MRI showed a giant pituitary adenoma, encasing both carotid arteries (right- Knosp 3 and left Knosp-4), infiltrating the sphenoid sinus, and important intradural extension (left temporal, clival and slight mesencephalic compression). The presumptive diagnosis was of giant prolactinoma. Surgery was performed, a left frontotemporal craniotomy, transsylvian approach and microsurgical resection of the tumor under surgical microscope. Aim of surgery being the decompression of the optic apparatus, and gross tumoral resection of intradural component. Postoperative course was good, with no new neurological deficits, no CSF fistula and without postoperative pituitary deficiency. Postoperative MRI showed intradural gross tumor resection with clival, intrasellar and intracavenous tumor remnant. Histopathological results were of prolactinoma. Patient was discharged 2 weeks following surgery in good neurological condition. Under dopamine receptor agonist (Cabergoline) prolactin levels have dropped to 75 ng/dl. At 3 months ophthalmoplegia was completely remitted. Ophthalmoplegia was completely remitted at 3 months. Six months’ control MRI showed important tumor control with significant reduction of residual tumor. Patient remains under constant endocrinological and imaging surveillance.
Conclusion: Management of giant pituitary adenomas is difficult and good results require coordination between neurosurgeon, pathologist and endocrinologist.
Particularities:

We presented a case of a pituitary adenoma with less obvious symptoms found in an advanced stage (Knosp score 3-4). After surgery the patient developed diabetes, epilepsy seizures and aphasia.

Esophageal Atresia with Distal Fistula  Covaciu Alexandra Corina Muntean Delia Doris, Oltean Paula Anca, Pasca Gina-Iulia Invalidated View

Esophageal Atresia with Distal Fistula

Case Report - Poster

Author(s): Covaciu Alexandra Corina

Coauthor(s): Muntean Delia Doris, Oltean Paula Anca, Pasca Gina-Iulia

Coordinator(s): Assistant Professor Rodica Muresan

Introduction: Esophageal Atresia (EA) is a congenital malformation that occurs early in devealopment of fetal life at approximately 2.55 to 10.000 births [1]. Many anomalies are asociated with EA such as vertebral, anorectal, cardiac, tracheo-esophageal, renal, limb (VACTERL), and nonrandom associations have been documented.

Case Presentation: The baby girl patient (weight=3111g , Apgar score 8/9) born spontaneously after a 40-week pregnancy, was suspected at two hours after birth of esophageal atresia. Physical examination revealed generalized jaundice, hipersalivation and abdominal distention.The esophageal continuity was tested with naso-gastric catheter which stopped about 5 cm from the nostrils.The X-ray examination of the esophageal-gastric passage confirmed the suspicion of EA type III B with eso tracheal distal fistula.The ecocardiography revealed 3 cm interatrial sept with a small cardiac shunt.

Conclusion: Right transpleural toracotomy was performed in emergency a few hours after birth.

Particularities: This case has many particularities. First of all, the gap between the esophageal ends was 3,5 cm. For such a wide gap the replacement of the esophagus it is made with colon.Secondly, it is the first time in the last 10 years in our distict when the surgery was a succes without any other interventions.The follow up are recommended because of complications which can be associated : anastomotic leaks, anastomotic stricture, recurrent tracheoesophageal fistula, tracheomalacia and gastroesophageal reflux.

Heights and Pitfalls of Mitral Valve Repair versus Replacement: Review of Literature  Bosoteanu Luana-Andreea , Boiagian Karina Popovici Catalina Gabriela Validated View

Heights and Pitfalls of Mitral Valve Repair versus Replacement: Review of Literature

Surgical Science

Author(s): Bosoteanu Luana-Andreea, Boiagian Karina

Coauthor(s): Popovici Catalina Gabriela

Coordinator(s): Assistant Professor Radu Nitu

Keywords: Mitral Regurgitation Mitral Valve Repair Mitral Valve Replacement

Introduction: Mitral regurgitation is frequently caused by degenerative changes of the valvular tissue, associated with other risk factors. Left untreated, this affection has a bad prognosis and can lead to myocardial infarction and pathological heart rhythms. The surgical treatment can be done either by Mitral Plasty or Replacement. However, choosing between the two procedures might be a challenge. Through this review, we summarized the available data regarding clinical outcomes of Mitral Valve Repair and Replacement, aiming to highlight the advantages and disadvantages of both techniques. 

Material and Method: We systemised the information from two databases of Duke Clinical Research Institute and made a retrospective analysis with reference to all the procedures of Mitral Valve Replacement and Mitral Valve Repair performed on 266 patients, over a period of 3 years. We examined the mortality rate in both types of surgery and, considering the demographics, associated comorbidities and also the past surgical interventions, we made a detailed comparison between the two surgical techniques. The data was independently extracted by the two reviewers and meta-analyzed based on the predefined criteria of study. 

Results: In comparison with patients that underwent Mitral Valve Replacement, those operated on for Mitral Valve Repair had a lower rate of operative and post- operative mortality, which demonstrates significantly reduced risks. Recurrence of at least mild mitral regurgitation was greater in Mitral Valve Repair, but the percentage of re-intervention was borderline similar. 

Conclusion: To conclude, in the current analysis, it is demonstrated that although Mitral Valve Replacement is a durable solution rarely followed by a second intervention, Mitral Valve Repair is the elective procedure due to the low morbidity. However, a thorough anamnesis is compulsory for guidance towards the correct surgical treatment. 

Bibliography: [1] Durante, James F. et al, The Mitral Valve Prolapse Syndrome/Dysautonomia Survival Guide, 2003, New Harbinger Publication [2] Dominik, Jan; Zacek, Pavel, Heart Valve Surgery-An Illustrated Guide, 2010, Springer Heidelberg Dordrecht London New York [3] Carpentier, Adams, Carpentier’s Reconstructive Valve Surgery (From Valve Analysis to Valve Reconstruction), 2010, Saunders Elsevier [4] https://www.dukehealth.org/treatments/heart/mitral-valve-disease

Arterial chemotherapy infusion for end-stage patient presenting a nasal tumour complicated with orbital invasion  Ionele Claudiu Marinel , Berneanu Cătălina-Maria Sabău Adrian-Horațiu, Ionete Mara, Popa Roberta-Silviana Validated View

Arterial chemotherapy infusion for end-stage patient presenting a nasal tumour complicated with orbital invasion

Case Report - Poster

Author(s): Ionele Claudiu Marinel, Berneanu Cătălina-Maria

Coauthor(s): Sabău Adrian-Horațiu, Ionete Mara, Popa Roberta-Silviana

Coordinator(s): MD Andrei Deaconu

Introduction:

Laterocervical and facial malignant tumours represent a significant amount of the total of patients presenting to the Interventional Radiology department. Most of them have already exhausted all other treatment options, being candidates for arterial chemotherapy infusion or chemoembolization. 


Case Presentation: The current case refers to a 75 year old female patient, diagnosed approximately 1 year ago with a nasal tumour. In the year after the diagnosis, the patient followed radiotherapy and multiple sessions of intravenous polychemotherapy, the tumour doubling in size at the 12 months imaging control for TNM staging. After multiple epistaxis episodes, the patient is referred to the Interventional Radiology department for intra-arterial treatment. Using a SIEMENS Axiom Artis dFa Angiograph placed in a hybrid OR, we proceeded to attain arterial approach via the right femoral artery with a 5F sheath. Following arterial sheath placement, we advanced a 4F VERTEBRAL catheter into the left external carotid artery. After control angiography, we infused 1000 mg of 5-fluoro-uracil intra-arterially (50 mg/ml, 20 ml), suspended in 2000 ml of saline, glucose and mannitol mixture. The infusion took 300 minutes at a constant flowrate. Just before the end of the procedure the patient had an epistaxis episode (10.000 UI of heparin administered throughout the procedure). We decided to finish the chemoinfusion and also place temporary embolizing material into the artery. 30 days follow-up CT showed tumour mass reduction.

Conclusion: Arterial chemotherapy infusion represents a viable alternative for advanced or end-stage cancers, laterocervical tumours in particular. Use of high local doses associated with relative low systemic doses makes it a go-to procedure for a wide array of tumours.

Particularities: The patient had no favorable outcome under classic therapeutic procedures, however the tumour size diminished after endovascular treatment.

Association study of ASAP1 polymorphism and pulmonary tuberculosis  Bronescu Andra Livia - Validated View

Association study of ASAP1 polymorphism and pulmonary tuberculosis

Fundamental Science

Author(s): Bronescu Andra Livia

Coordinator(s): Associate Professor Mihai Ioana , Assistant Professor Marius Florin Farcaș

Keywords: tuberculosis dendritic cells migration polymorphism

Introduction: Tuberculosis represents a major world health problem, with an incidence of its active form estimated to 8.7 million new cases and a mortality rate of 1.4 million deaths(1). One of the suspected mechanism which can lead to an increased susceptibility to Mycobacterium Tuberculosis infection is the way dendritic cells migrate to lymphatic nodes in order to activate the immune system(2). Within this pathway we looked at rs4733781 SNP(3) in the ASAP1 gene, a single nucleotide polymorphism which has been found to downregulate dendritic cell migration(4) as a genetic susceptibility variant for pulmonary tuberculosis.  

Material and Method: We performed a case-control study and by means of molecular genetics techniques, respectively Real-Time PCR TaqMan Assays we analyzed the genotype and allelic distribution of rs4733781 (A/C) in a cohort of 120 of patients with pulmonary tuberculosis and a control group consisting of 125 healthy volunteers. Statistical analysis was performed using Fisher’s exact test using both an autosomal dominant and recessive model of analysis.

Results: For the autosomal dominant model of analysis we obtained a p value of 0.700 with an odds ratio of 1.132 CI 95%(0,69 to 1,864), while for the autosomal recessive model of analysis we obtained a p value of 0.999 with an odds ratio 1.051 CI 95%(0.558 to 1.976).  

Conclusion: In our present preliminary study we found no statistically significant difference between the genotype distribution of the ASAP1 rs4733781 in our two study group, hence this polymorphism is not a genetic susceptibility variant for pulmonary tuberculosis in the romanian population.  

Bibliography: 1. Zumla A, Raviglione M, Hafner R, Fordham von Reyn C. Tuberculosis. New England Journal of Medicine. 2013;368(8):745-755. 2. Ernst J. The immunological life cycle of tuberculosis. Nat Rev Immunol. 2012;12(8):581-591. 3.. Curtis J, Luo Y, Zenner H, Cuchet-Lourenço D, Wu C, Lo K et al. Susceptibility to tuberculosis is associated with variants in the ASAP1 gene encoding a regulator of dendritic cell migration. Nature Genetics. 2015;47(5):523-527. 4. Wolf A, Linas B, Trevejo-Nunez G, Kincaid E, Tamura T, Takatsu K et al. Mycobacterium tuberculosis Infects Dendritic Cells with High Frequency and Impairs Their Function In Vivo. The Journal of Immunology. 2007;179(4):2509-2519.

OBTAINING ADEQUATE SURGICAL MARGIN STATUS IN BREAST-CONSERVATION THERAPY: INTRAOPERATIVE ULTRASOUND-GUIDED RESECTION VERSUS SPECIMEN MAMMOGRAPHY  Pop Maria Mihaela Cristian Silviu Validated View

OBTAINING ADEQUATE SURGICAL MARGIN STATUS IN BREAST-CONSERVATION THERAPY: INTRAOPERATIVE ULTRASOUND-GUIDED RESECTION VERSUS SPECIMEN MAMMOGRAPHY

Surgical Science

Author(s): Pop Maria Mihaela

Coauthor(s): Cristian Silviu

Coordinator(s): Lecturer Rares Georgescu , Assistant Professor Orsolya Hanko Bauer

Keywords: breast-conservation surgery surgical margin status intraoperative ultrasound specimen mammography

Introduction: The purpose of breast-conserving surgery (BCS) for women with cancer is to perform an oncological radical procedure with disease-free margins at the final histological assessment and with the best aesthetic result possible. Intraoperative ultrasound and postoperative specimen mammography may reduce the rates of positive margins and reexcision among patients undergoing conserving therapy.

Material and Method: A prospective study was performed on 83 patients who underwent breast conservation surgery for early breast cancer (pT1-3a pN0-1 M0) between 2014 and 2016. After excision the specimen was orientated in the operating room by the surgeon. Metallic clips and threads were placed on margins: one clip and the long thread at 12 o'clock, two clips and the short threads at 9 o'clock. Next step was intraoperative ultrasound of the specimen with selective margin shaving, afterwards mammography to identify and document the lesion and finally histopathological examination of the specimen with reporting the gross and microscopic margins. The positive margins required re-excision or boost of radiation at the posterior or anterior margins, depending on the case.

Results: We set a cut-off at 2 mm. The sensitivity and specificity of the intraoperative margin assessment via the ultrasound method were 90,91% ( 95% CI 70,84-98,88%) and 67,21% (95% CI 54-78,69%) respectively. The sensitivity and specificity of the postoperative margin assessment via the mammographic procedure were 45,45% ( 95% CI 24,39-67,79%) and 85,25% ( 95% CI 73,83-93,02%) respectively. There was positive correlation between the histopathological and intraoperative ultrasound exam (p=0,018) and negative correlation between the histopathological exam and the post-operative mammographic exam(p=0,68).

Conclusion: According to our results, the intraoperative ultrasound of the breast specimen for a cutt-of at 2 mm can decrease the rates of margin positivity compared to the mammographic proceducere and has the potential to diminish the number of subsequent undesired mastectomies.

Bibliography: 1) Brunicardi CF, Andersen DK, Billiar TR et al – Schwartz’s principles of surgery tenth edition, Ed. McGraw-Hill Education, New York, 2015, 17:497-99, 537-48 2) Moran MS, Schnitt SJ, Giuliano AE et al - SSO-ASTRO Consensus Guideline on margins for breast-conserving surgery with whole breast irradiation in stage I and II invasive breast cancer, Int J Radiat Oncol Biol Phys, 2014, 88(3): 553–564 3) McCormick JT, Keleher AJ, Tikhomirov VB et al - Analysis of the use of specimen mammography in breast conservation therapy, The American Journal of Surgery 188 (2004) 433–436 4) Lokesh B, Harris A, Davey M et al - High resolution intra-operative two-dimensional specimen mammography and its impact on second operation for re-excision of positive margins at final pathology after breast conservation surgery, The American Journal of Surgery, 2011, 202:387–394. 5) Omer RK, Sorensen KM, Neumayer LA et al - High-frequency ultrasound for evaluating margins during breast conservation surgery: Results from a 17-patient pilot study, The Journal of the Acoustical Society of America 138, 2015, 1746

Ascending aorta, aortic arch aneurysm and aortic valve regurgitation in a female pacient. Case report   Stratila Elena Diana , Coroiu Costel - Invalidated View

Ascending aorta, aortic arch aneurysm and aortic valve regurgitation in a female pacient. Case report

Case Report - Poster

Author(s): Stratila Elena Diana, Coroiu Costel

Coordinator(s): Associate Professor Horatiu Suciu , Lecturer Valentin Ionut Stroe

Introduction: An aneurysm is generally defined as a focal and persistent dilatation of the diameter of an artery of 150% or more than the diameter of adjacent uninvolved arterial segments.[1]

Case Presentation: Our case is about a female pacient 67 years old admitted in Cardiovascular Surgery Department of Targu Mures Emergency Institute of Heart Disease and Transplantation suffering of dyspnoea, fatigability and angina pectoris. We performed an Angio-CT which revealed ascending aorta and aortic arch aneurysm. Transthoracic cardiac ultrasound revealed a severe regurgitation of the aortic valve and mild left ventricular hipertrophy. 

With  femoral arterial canulation, right transauricular venous canulation and in extracorporeal circulation we performed acendind aortic replacement with “DACRON” Prosthesis 30mm diameter and aortic valve replacement with “CARBOMEDICS” prosthesis no. 23. The intervention lasted 4 hours and 45 minutes with 121 minutes of extracorporeal circulation. The pacient was in the Intensive Care Unit for 5 days.

Conclusion:
  1. The postoperative evolution was slowly favorable, without any liver and kidney disfunction, but in the 15th day after operation with an episode of diffuse abdominal pain, palor and melena. Upper gastrointestinal endoscopy revealed a superior digestive hemorrhage at the DII level of duodenum which was treated endoscopical with injection of epinephrine and application of hemoclips.

Particularities: Pacient with many risk factors such as obesity, mixt dislipidemy, history of cerebral stroke, chronic obstructive pulmonary disease stage GOLD II, histerectomy for uterine fibroma and subtotal tiroidectomy, but with good results, pacient being discharged 28 days after operation.

An Interesting Approach to Managing Foreign Object Ingestion  Masood Syed Shah Mohammed Emmad , Zafran Mohammed Hoque Shirajul, Chaudhary Usman, Khokhar Hassan Tahir Invalidated View

An Interesting Approach to Managing Foreign Object Ingestion

Case Report - Poster

Author(s): Masood Syed Shah Mohammed Emmad, Zafran Mohammed

Coauthor(s): Hoque Shirajul, Chaudhary Usman, Khokhar Hassan Tahir

Coordinator(s): MD Lucian Ambrosie

Introduction:

The case that we hope to present is that of foreign object ingestion in a 73 year old male and the unique management plan that was employed. Most examples of such cases involve pediatric cases and when they involve adults it is usually patients with neurological disorders, psychiatric disorders or due to intoxication.


Case Presentation:

The patient presented to the emergency department having accidentally ingested a square piece bovine bone. He had no previous medical history of swallowing or neurological deficits and was alert and conscious at the time of ingestion. A surgical team was called to assess the patient and it was evaluated that the bone was lodged in the junction between the superior and middle thirds of the oesophagus. Initially OGD was attempted to remove the bone however this proved unsuccessful. This therefore presented a unique dilemma that required a novel solution. It was concluded that the best course of action would be to push the bone into the oesophagus and to admit the patient until the bone passes through the GI tract and is released upon defecation. This unique approach presented a number of risks such perforation or further obstruction at multiple points along the GI tract however the strategy proved successful as the patient was able to release the bone without complication and was discharged.



Conclusion:

We feel that this is an interesting case of foreign object ingestion due to the management strategy employed. It is our intention to outline the pertinent facets related to the presentation of the patient, how and why this management plan was decided upon, the unique challenges such a case presents and ultimately how a successful outcome was obtained.


Particularities: The case involved has several particularities. Firstly the case involved a unique management plan that we intend to explore further in our presentation. Secondly the the patient demographic is not in keeping with most examples of foreign object ingestion.

Microsurgical Pial Synangiosis in a Rat Model – A Preliminary Experimental Study  Morosanu Cezar Octavian , Jurca Razvan Lucian Oradan Alex Victor Validated View

Microsurgical Pial Synangiosis in a Rat Model – A Preliminary Experimental Study

Surgical Science

Author(s): Morosanu Cezar Octavian, Jurca Razvan Lucian

Coauthor(s): Oradan Alex Victor

Coordinator(s): Associate Professor Gabriela Adriana Filip , Professor Ioan Stefan Florian

Keywords: pial synangiosis rat model moyamoya protocol

Introduction: Pial synangiosis represents a neurosurgical procedure where the superficial temporal artery is translocated from the scalp to the surface of the brain in order to augment intracranial blood flow in severe cases of neurovascular pathologies such as Moyamoya syndrome. In due course, from the repositioned artery, neovessels will arise that will supply the cortical tissue. Revascularisation surgery has a significant impact on cerebral hemodynamics, yet there are a multitude of unclear underlying factors and no animal models to reproduce these surgical conditions. The aim of the study was to elaborate a rodent model of pial synangiosis in order to establish an experimental protocol to enhance further research in this area.

Material and Method: The study was conducted on 12 adult male Wistar Rats (3-5 months, G=130±5 g). Animals were placed in a stereotaxic frame and neurosurgical steps were performed under the operating Leica microscope with the use of microsurgical instruments, suction tube and a drill. All surgical procedures, were performed under the microscope. 7 Tesla MRI and 3D reconstructions were done to evaluate the evolution of the operated segment.

Results: The dissection of the superficial temporary artery from the surrounding tissue was achieved and a 5 mm diameter craniotomy was performed, exposing the temporal cortex and underlying vessels. Due to its proper lenght and anatomical relations, the superficial temporal artery could be repositioned on the surface of the rodent pia mater and fixed there with a 10-0 thread. The craniotomy was closed with dental cement taking care not to block the vessel. Imagistic investigations revealed the integration of the artery on the surface of the brain.

Conclusion: Our experimental protocol establishes a rodent model of a pial synangiosis with the collateral hemodynamic processes. Deciphering these physiological mechanisms offers the promise of identifying new pharmacological elements that can enhance the target of this vascular neurosurgical procedure. 

Bibliography: 1. Scott RM, Smith JL, Robertson RL, Madsen JR, Soriano SG, Rockoff MA. Long-term outcome in children with moyamoya syndrome after cranial revascularization by pial synangiosis. J Neurosurg. 2004;100:142-149 2. 4. Spetzler R, Chater N. Occipital artery-middle cerebral artery anastomosis for cerebral artery occlusive disease. Surg Neurol. 1974;2:235–238. 3. Baaj AA, Agazzi S, Sayed ZA, Toledo M, Spetzler RF, van Loveren H. Surgical management of moyamoya disease: A review. Neurosurg Focus. 2009;26:E7–E12 4. 7. Smith ER, Scott RM. Surgical management of moyamoya syndrome. Skull Base. 2005;15:15–26. [PMC free article] [PubMed]

CURRENT TRENDS IN SEXUAL BEHAVIOR AMONG FEMALE POPULATION IN WESTERN ROMANIA  Ciocsirescu Cristina Ioana Daneasa Loredana Validated View

CURRENT TRENDS IN SEXUAL BEHAVIOR AMONG FEMALE POPULATION IN WESTERN ROMANIA

Public Health

Author(s): Ciocsirescu Cristina Ioana

Coauthor(s): Daneasa Loredana

Coordinator(s): Lecturer Adrian Gluhovschi

Keywords: sexual education gynecological check-up contraception female behavior

Introduction: Sexual education as an intrinsic element of preventive medicine, defines a long-lasting process of achieving knowledge and forming behaviors towards gaining a solid background for sexual health [1]. The aim of the present work was to evaluate the exposure of young women to sexual education with regards to gynecological check-ups, contraception and sexually transmitted diseases (STDs) prevention through personal experiences and based on their differences in academic studies.

Material and Method: A questionnaire-based cross-sectional study was conducted in a random sample of 406 women aged 18-25, enrolled at one of the universities of Timișoara (medical-related studies-52, 7%, non-medical related studies-47,3%). The survey took the form of a three-part self-administered questionnaire, containing 21 items about sexual behavior through self-experience.

Results: The mean age of participants was 21,81 ± 2,02. Main age group of first intercourse was 16-18 years (46,6%), with a strong association between the subjects attending medical studies and the number of their sexual partners during the past 12 months (χ2(1) = 4.98, p=.026, Chi-squared test). There was a statistically significant difference between the age of the first gynecological check-up and the time interval when it was performed (χ2(4) =146.40, p<.001, Kruskal-Wallis), with shorter check-up intervals for non-medical students (Z=2.89, p=.04, Mann-Whitney U). All subjects demonstrated a similar lack of sexual knowledge, but only 22,4% responded correctly to all questions about contraception and STDs, regardless of their undergraduate studies (p=.093). Asked whether the present-day society is in need of a sexual education program, 99,5% responses were positive, 62,3% of subjects claimed for it to start at age of 13. 

Conclusion: Among these subjects, poor sexual knowledge and occasional usage of contraception methods were indicators of a high-risk sexual activity, regardless the field of study. Different approaches to sexual education meeting the Romanian socio-cultural strata, are necessary to increase awareness from a young age.

Bibliography: 1. Salkind NJ, editor. Encyclopedia of Educational Psychology. 1st Ed. California: SAGE Publications; 2008, Vol.2, p 898.

Multiple brown tumors: manifestation of severe renal osteodystrophy  Gherghel Paula Chiriac Alexandra Validated View

Multiple brown tumors: manifestation of severe renal osteodystrophy

Case Report - Poster

Author(s): Gherghel Paula

Coauthor(s): Chiriac Alexandra

Coordinator(s): Associate Professor Crina Claudia Rusu , MD Alexandra Sfarlea

Introduction: Brown tumors (BT) are benign focal bone lesions that may appear in the context of hyperparathyroidism (HP) of various etiologies. The incidence ranges from 1.5% in primary HP to 13% in cases of secondary HP. These are most frequently situated in facial bones, ribs, pelvis and clavicle. Spine being affected is unusual, and cervical spine involvement is rare.

Case Presentation: A 26-year-old woman with end-stage renal disease, who started hemodialysis in February 2015, had seizures and cardiorespiratory arrest was successfully resuscitated during the third hemodialysis session. A neurological examination was recommended. Cerebral CT scan revealed fibrotic tumor-like mass localized in left nasal cavity. On April 2015, an MRI scan was performed, without any additional lesions being found. On the 23rd of November, following cervical trauma, a CT scan revealed the fracture of odontoid process  and of the first cervical vertebra (C1); the MRI imaging also showed multiple lesions affecting the neurocranium, the left maxillary sinus, C1 and C4. Thoracic CT also showed multiple osteolytic lesions. Serum parathormone  level was 2008pg/ml. The patient was then referred to the Nephrology department of the County Hospital of Cluj-Napoca. The Patient underwent a PET scan, which showed hypermetabolic bone lesions disseminated throughout the skeletal system, including the skull, pelvic bones, left tibia, clavicles, sternum and a large number of vertebrae. The pathologic analysis revealed a fibroblastic stroma with multinucleated osteoclast-like cells. Considering radiological, pathological and laboratory test results, the definitive diagnosis of BT secondary to HP was reached.

Conclusion:  Whenever multiple osteolytic lesions are found in a patient undergoing hemodialysis, BT due to secondary PT must be taken into account 

Particularities: We report a case of multiple BT disseminated throughout the skeletal system with the rare involvement of the cervical spine and the rapid extension of BT ( months).

THE RELATION BETWEEN WEIGHT AND TYPE 1 DIABETES MELLITUS  Țîbîrnă-Ciolan Mălina , Diaconu Anca Achitei Razvan Invalidated View

THE RELATION BETWEEN WEIGHT AND TYPE 1 DIABETES MELLITUS

Medical Science

Author(s): Țîbîrnă-Ciolan Mălina, Diaconu Anca

Coauthor(s): Achitei Razvan

Coordinator(s): Assistant Professor Otilia Niță

Keywords: overweight type 1 diabetes mellitus metformin

Introduction: Type 1 diabetes mellitus(DM) is less than 10% of DM cases, but due to multiple reasons is in fact a very important pathology. It mostly affects children, adolescents and young adults, who will have to deal with higher chances to develop chronic complications and disabilities.The purpose of this study is to investigate the relation between weight status and type 1DM.

Material and Method: We studied newly diagnosed patients between November 2011 and February 2014, in the Clinical Centre of Diabetes, Nutrition and Metabolic Diseases Iasi, using the files created when diagnosed and registering data for the initial visit and the last one recorded. A number of 119 patients had been diagnosed with type 1DM, had at least 2 clinical visits and were included in the study. The diagnosis was made according to ADA guidelines. The antropometric evaluation included weight, waist circumference(WC) and body mass index(BMI) and they were assessed according to WHO 2001 criteria.

Results: The mean age was 46 ±16,14. Regarding age, most of the patients were between 20 and 59 years old(74,8%), and only a little percentage were under 20(3,4%). 56 cases(47,1%) were women.The majority of the patients included in the study(93,7%) were receiving insulin treatment and 6,3% had combined treatment with insulin and oral medication (metformin).The latter had a BMI over 25 kg/m2. Regarding weight, the mean value at the moment of diagnostic was 73,25 ±16,18 kg, for WC was 92,84 ± 15,59 cm and for BMI a mean value of 25,41 ±5,43 kg/m2 was registered. Comparing antropometric evaluation, there was a growth of 6 ± 10,24 kg for weight, abdominal circumference increased with 5,52 ±7,99cm, and for BMI, there was a 2,07±3,64kg/m2 raise (p=0,004;p=0,005,respectively p=0,007).

Conclusion: Adding metformin to the insulin treatment-in a type 1 diabetes mellitus patient with proven overweight is not a total interdiction anymore but has physiopathological evidence.

Bibliography: 1. American Diabetes Association, Diabetes Care 2015 January, http://care.diabetesjournals.org/content/38/Supplement_1/S8 2. Obesity: Identification, Assessment and Management of Overweight and Obesity in Children, Young People and Adults: Partial Update of CG43; National Clinical Guideline Centre (UK), London: National Institute for Health and Care Excellence (UK); 2014 Nov. (NICE Clinical Guidelines, No. 189. 3. Staels F, Moyson C, Mathieu C. Metformin as add-on to intensive insulin therapy in type 1 diabetes mellitus. Diabetes Obes Metab 2017. doi: 10.1111/dom.12948. https://www.ncbi.nlm.nih.gov/pubmed/28318105 4. Șerban V. Tratat român de boli metabolice. Timișoara : Editura Brumar, 2010, Vol.1 5. Graur M. Diabetologie clinică. Iași: Litografia UMF, 1999. 6. Yki-Jarvinen H, Koivisto VA. Natural course of insulinresistence in type 1 diabetes. N Engl J Med 1986; 315: 224-230

CLINICAL MANIFESTATIONS AND EVOLUTION OF A DYSTROPHIC EPIDERMOLYSIS BULLOSA PATIENT DURING 4 YEARS OF LIFE – A CASE REPORT  Prisacariu Eduard Manuel , Romanescu Constantin - Validated View

CLINICAL MANIFESTATIONS AND EVOLUTION OF A DYSTROPHIC EPIDERMOLYSIS BULLOSA PATIENT DURING 4 YEARS OF LIFE – A CASE REPORT

Medical Science

Author(s): Prisacariu Eduard Manuel, Romanescu Constantin

Coordinator(s): Assistant Professor Ana - Simona Drochioi

Keywords: epidermolysis bullosa DEB evolution complications

Introduction: Epidermolysis bullosa (EB) is a rare and thus far incurable group of genetic disorders, affecting mainly the skin and mucosal membranes, manifesting with blisters triggered by minor mechanical trauma. Dystrophic epidermolysis bullosa (DEB) is one of the major forms of EB. The signs and symptoms of this condition vary widely among affected individuals.

Material and Method: We present the case of a 4 years and 7 months old patient, diagnosed with DEB in his first month of life. The authors traced his medical condition - from birth to present - using medical records from his numerous hospital admissions in different clinics: The Emergency Clinical Hospital For Children “Sf. Maria” Iasi, the pedeatric section of “Mavromati” Emergency Hospital Botosani, and “Ospedale Pediatrico Bambino Gesu” Rome.

Results: Throughout all ten admissions, the patient was diagnosed with various complications of the underlying disease, for example, esophageal stenosis, chronic constipation, total left hallux onycholysis, but also with some other immune or infectious overlaying pathologies: interstitial pneumonia, submandibular adenoflegmon, alergodermy etc.

Conclusion: This case represents a challenge for the medical personnel and often requires a multidisciplinary effort due to the complexity and the debilitating aspects of DEB, which strongly impacts the life of the patient and his family.

Bibliography: https://www.ncbi.nlm.nih.gov/pubmed/25201089

DIFFICULT DIAGNOSIS - NASOPHARYNGEAL CARCINOMA WITH SKULL BASE INVASION   Farcasan Roxana - Validated View

DIFFICULT DIAGNOSIS - NASOPHARYNGEAL CARCINOMA WITH SKULL BASE INVASION

Case Report - Poster

Author(s): Farcasan Roxana

Coordinator(s): MD Cristina Tiple




Using simulators such as laparoscopic Box Trainers improves the practical skills of urology residents  COZMA Matei Alexandru , DOBRICĂ Elena-Codruța GĂMAN Mihnea-Alexandru Validated View

Using simulators such as laparoscopic Box Trainers improves the practical skills of urology residents

Surgical Science

Author(s): COZMA Matei Alexandru, DOBRICĂ Elena-Codruța

Coauthor(s): GĂMAN Mihnea-Alexandru

Coordinator(s): MD Cristian TOMA TOMA

Keywords: simulation laparoscopy box trainer urology

Introduction: Minimally invasive surgery represents the actual tendency in many medical domains, including also urology. Gaining practical skills for such procedures becomes essential when preparing the resident physicians in urology. The purpose of this study is to demonstrate that using medical simulation as an education tool improves the practical skills of the urology house officers in laparoscopy by using an accessible tool such as a box trainer.

Material and Method: The study includes the objective and subjective evaluation of the practical skills of 15 residents urologists with limited experience in laparoscopy. Each participant was evaluated prior to the practical activity on the simulator simulator both in a subjective manner by filling a self-evaluation form and objective by timing the duration of doing a square knot, a surgical knot and 2 types of sutures on synthetic materials (simple interrupted, simple continuous suture) on a 10 cm wound. Residents were then re-evaluated after 5 hours of practice on the simulator by performing the same maneuvers from the beginning, subjective by completing the same self-evaluation form and objective, under the chronometer.

Results: Medical education with the help of a laparoscopic box trainer is an useful tool, observing significant differences in the group of residents during the execution of general maneuvers and the ease of their practice after the practice period.

Conclusion: We conclude that medical simulators needs to bacome a form of medical education for every health-care practitioners in order to provide better care for the patients.

Bibliography: "The Comprehensive Textbook of Healthcare Simulation". Levine, A.I., DeMaria Jr., S., Schwartz, A.D., Sim, A.J. (Eds.), 2013 "Atlas of Laparoscopic and Robotic Urologic Surgery", 3rd Edition,Jay T. Bishoff & Louis R. Kavoussi "Oxford Textbook of Medical Education, chapter Simulation-based medical education", Margaret Bearman, Debra Nestel, and Pamela Andreatta "Manual of Simulation in Healthcare", Richard H. Riley, 2008

Morphological and surgical aspects in skin tumors  Popescu Marina Naina , Popa-Ion Denisa-Ancuta Pomacu Mihnea Marian Invalidated View

Morphological and surgical aspects in skin tumors

Surgical Science

Author(s): Popescu Marina Naina , Popa-Ion Denisa-Ancuta

Coauthor(s): Pomacu Mihnea Marian

Coordinator(s): Professor Marius Eugen Ciurea

Keywords: skin tumor surgery aesthetics

Introduction:  Skin tumors are a common pathology in the population in recent years regardless of age and sex, with an increasing incidence.

Material and Method: The study was conducted on 160 patients aged between 5 and 92 years who were hospitalized between January 2012 - December 2014 to the  Plastic Surgery Department in Emergency County Hospital of  Craiova.

The study aimed to establish the incidence by age and sex, the presence of skin tumors, the presence of single or multiple tumors, their debut, the reasons for which patients presented in the medIn a study of patients it was observed that the study group had both benign and malignant tumors of various forms clinice.It was observed that skin tumors were scattered all body segments with a higher incidence of head and neckical service, such as lumps, applied surgical treatment and postoperative evolution.


Results: The patients presented mostly for aesthetic reasons, and also because of changes in tumor lately.
It were observe the increased frequency of skin tumors in elderly over 60 years but it were affected also children.

Conclusion: Surgical treatment was necessary,except that patients with pathology who didn't allow the intervention. Postoperative evolution was in the most of the cases favorable.   

Bibliography: 1. IRINEL POPESCU, Tratat de Chirurgie. Vol. 6 Chirurgie Plastica si Microchirurgie Reconstructiva. 2. ANGELESCU N. - Tratat de patologie chirurgicala. Ed. Medicala, 2001. 3. J. G. McCarthy - Plastic Surgery, Ed. W.B. Saunders.

Medical simulation in healthcare: from bench to bedside  COZMA Matei Alexandru , DOBRICĂ Elena-Codruța GĂMAN Mihnea-Alexandru Validated View

Medical simulation in healthcare: from bench to bedside

Public Health

Author(s): COZMA Matei Alexandru, DOBRICĂ Elena-Codruța

Coauthor(s): GĂMAN Mihnea-Alexandru

Coordinator(s): MD Cristian TOMA TOMA

Keywords: simulation task treiners workshop

Introduction: Medical simulation is an area that is proving to be increasingly valuable and effective in developing skills and knowledge of medical staff by understanding and putting into practice the concepts learned. We aim to show that simulation applied in medical education is beneficial to both doctors and nurses, and to patients who will benefit from the help of a better trained health practitioner.

Material and Method: We conducted the study by analysing questionnaires that assessed medical students with minimal knowledge about the medical manoeuvres involved in a six hour practical workshop which involved the use of basic clinical skills simulators (known as task trainers). The workshop consisted of eight basic manoeuvres and each student completed a self-administered form that evaluated the confidence and ability to perform each manoeuver in part on a scale of 0 to 5. The study was conducted by collecting data from a total of 18 practical workshops, attended by 394 students of all years (between 1 and 6).

Results: The practical workshop involving rectal examination, vaginal examination, palpation of the breast, urethral sounding, venous blood collection, fitting an intravenous catheter, mask ventilation and nasogastric intubation significantly improved the practical knowledge of medical students in a relatively short number of hours and prevented accidental errors that could have occurred if the procedures had been practiced on real patients with no prior practical training.

Conclusion: We conclude that the use of healthcare simulation in medical training improves medical students’ learning experience and is an useful tool to reduce errors in clinical practice. We propose a further evaluation in clinical practice of a group of 40 students regarding the manoeuvres previously listed by trained medical simulation.

Bibliography: "The Comprehensive Textbook of Healthcare Simulation". Levine, A.I., DeMaria Jr., S., Schwartz, A.D., Sim, A.J. (Eds.), 2013 "Oxford Textbook of Medical Education, chapter Simulation-based medical education", Margaret Bearman, Debra Nestel, and Pamela Andreatta "Manual of Simulation in Healthcare", Richard H. Riley, 2008

Downfalls of a Thoracic Trauma Case  Bosoteanu Luana-Andreea , Sutu Cristina Ramona Popovici Catalina Gabriela Validated View

Downfalls of a Thoracic Trauma Case

Surgical Science

Author(s): Bosoteanu Luana-Andreea, Sutu Cristina Ramona

Coauthor(s): Popovici Catalina Gabriela

Coordinator(s): MD Rodica Tudoran

Keywords: NT-pro BNP cardiac tamponade hepatic abscess

Introduction: Thoracic trauma patients usually have a severe outcome due to sequencing of events and complexity of associated lesions. The most important life-threatening lesions should be diagnosed at the pri- mary evaluation of the patient

Material and Method: A 55 year-old man presented to the Emergency Department of Emergency County Hospital Constanta on 18.12.2016. The patient was victim of a car accident, right seated passenger with seatbelt on. He was admitted in the ER with low blood pressure (blood pressure 80/55 mmHg) and dyspnea. After the car accident, nausea appeared, along with chest pain (posterior, interscapular-vertebral) and diz- ziness. No other symptoms were mentioned by the patient and no traumatic marks were identified. The mechanism of injury was by frontal impact with anoth- er vehicle. The past medical history included chronic peripheral artery disease, amputation of inferior 1/3 of right thigh, recurrent paroxysmal atrial fibrillation

Results:  Contrast chest and abdominal CT scan in A&E pro- vided the etiology of shock: hepatic abscess in 2nd and 3rd liver’s segments, size 82 mm/75 mm/61 mm, extended to subphrenic space and transdiaphragmatic, to the anterior mediastinum, where it drained in the pericardium, causing acute pericardial effusion and cardiac tamponade.

Conclusion: This case is interesting due to major discrepancy between symptoms, clinical findings and the high severity of the acute pathology. Also the case is unique from another point of view: after history, clinical examination, blood tests and imaging tests, we were able to establish the diagnosis and to provide the emergency treatment but we could not identify the primary cause of liver abscess.

Bibliography: MacKenzie E, Riyara FP, Jurkovich G, et al. A national evaluation of the effect of trauma-center care on mortality. N Engl Med. 2006; 354(4):366-78. Sauaia A, Moore FA, Moore BB, et al. Epidemiology of trauma deaths: a reassessment.) Trauma. 1995; 38(2):185-93. Scott R. Snyder, Sean M. Kivlehan, Kevin T. Collopy. Thoracic trauma: what you need to know. Pathophysiology, exam findings and management. EMS World, 2012;41(7):60a2, 646. F. Lecky M. Woodford A. Edwards 0. Bouamra T. Coats, Trauma scoring systems and databases, Br J Anaesth 2014;113(2):286’294. Joseph ]. Mistovich, William S. Krost, Daniel Limmer, Beyond the Basics: Thoracic Trauma

Problems posed by attaing hydroelecrolytical ballance in a patient with associated co-morbidities  Boiagian Karina , Bosoteanu Luana-Andreea - Invalidated View

Problems posed by attaing hydroelecrolytical ballance in a patient with associated co-morbidities

Case Report - Poster

Author(s): Boiagian Karina, Bosoteanu Luana-Andreea

Coordinator(s): Assistant Professor Irina Tica

Introduction: In Sheehan syndrome, the affected organ is the pituitary gland. Whenthe blood supply to the hypophysis is reduced, the symptoms and signs of itshypofunction affect almost any part of the body. Hyponatremia is the most frequentelectrolytic disorder of this syndrome, being present in approximately 33-69% of the patients.

Case Presentation:

We studied the case of a 78 year-old female patient,suffering from pituitary insufficiency and multiple comorbidities (type 2 Diabetes,Essential Arterial Hypertension, first-degree atrioventricular block, Heart Failure,stage 2 of Chronic Renal Disease). The medical example we present is characterized by hyponatremia, secondary to an extended diarrheic syndrome, affecting the patientfollowing a substitutive treatment with Euthyrox and Prednison. Moreover, the patientsuffered from bronchopneumonia, diagnosed with clinical, microbiological andradiological methods which imbalanced even more the electrolytic panel(hypopotassemia).


Conclusion:

Dyselectrolytemia, associated with pituitary insufficiency and with asubstantial third-age pathology, poses significant challenges for diagnosis andtreatment, often with poor prognosis.

 Keywords:


Particularities:

Due to the two-stage evolution of the medical condition (diarrheicsyndrome, hyponatremia and, successively, hypopotassemia, bronchopneumonia with bilateral pleurisy) the patient followed multiple antibiotic treatment and she wasstabilized as far as the hydro-electrolytic disorder is concerned. As soon as the

sufferer’s general state of health improved, the discharge was permitted.

Cough-associated Rectus Sheath Hematoma-Clinical Case  Poloșan Daria - Invalidated View

Cough-associated Rectus Sheath Hematoma-Clinical Case

Case Report - Poster

Author(s): Poloșan Daria

Coordinator(s): Assistant Professor Cristian Tiereanu

Introduction:

Abdominal wall hematomas are an uncommon cause of acute abdominal pain and are often misdiagnosed. They usually occur in elderly population, especially in those under antithrombotic therapy, after undergoing surgery in the abdominal region or abdominal trauma. We report a cough-associated rectus sheath hematoma  in a 37-year-old woman that did not have a recent history of trauma.


Case Presentation:

A 37-years old woman with a history of ectopic pregnancy, presented with acute pain at the Emergency Room. The pain was located in the left flank and periumbilical area with no irradiation and debuted 5 days prior to the presentation, with an intensity of 10 out of 10 and the analgesic medication had no effect. The patient accused cough due to an intercurrent respiratory pathology which perpetuated in the morning she presented to the hospital.

During the clinical exam, there were no palpable masses in the abdominal region, but there was a slight sign of muscular defense. The blood test showed a Prothrombin Time (PT%) of 49%, but after a dose of 5mg of Fitometadiona iv it has increased to 55%.

The Computer Tomography revealed a recent 4 by 5 by 11 cm hematoma inside the left rectus abdominis sheath with possible involvement of the parietal peritoneum. 


Conclusion:

The Coagulation Tests showed a PT higher than normal, but an in range Activated Partial Thromboplastic Time that suggested a hypovitaminosis or a consumption of coagulation factors. Given the lack of signs of cholestasis that would explain the hypovitaminosis, it is considered that the modifications occurred due to a higher usage of coagulation factors. 


Particularities:

1.     The particularity of this case is that the cough-associated rectus sheath hematoma occurred in a younger than usual patient with no antithrombotic medication. 

Situs Inversus Totalis Associated With Non-ischemic Dilated Cardiomyopathy and Other Comorbidities: A Case Report  BOUAZZA Imane , THONGPHETSAVONG GAUTAM Amata - Invalidated View

Situs Inversus Totalis Associated With Non-ischemic Dilated Cardiomyopathy and Other Comorbidities: A Case Report

Medical Science

Author(s): BOUAZZA Imane, THONGPHETSAVONG GAUTAM Amata

Coordinator(s): MD Ovidiu Mitu

Keywords: Situs Inversus Totalis Dilated Cardiomyopathy Heart Failure

Introduction: Situs inversus totalis is a congenital condition in which all the abdominal organs are reversed from their normal position and is found in about 0.01% of the population. We are presenting the case of a 62-year-old patient, dyslipidemic, non-smoker, who was admitted to the Cardiology Department for accusing congestive heart failure signs and symptoms. 2 years earlier, the patient presented an episode of left lower limb deep venous thrombosis, treated for a short period of time with anticoagulation. 

Material and Method:  The electrocardiogram showed atrial fibrillation (110 bpm) and 1 mm ST depression in V3-V6 leads. Echocardiography revealed situs inverted and aspects of dilative cardiomyopathy. The coronary computer tomography (CT) showed normal coronary arteries ruling out the ischemic cause. Due to thoracic pain, the diagnosis of aorta dissection was raised. Another angio-CT was performed, however, it couldn't be confirmed and eventually the investigation revealed a situs inversus totalis. 

Results: Following this diagnosis, the evolution of the patient was unfavorable, being admitted several times to the Cardiology Clinic for acute decompensation of heart failure, secondary to non-adherence to lifestyle's recommendations and maximal-limit medication. During an admission, the diagnosis of pulmonary thromboembolism was raised, but remained unconfirmed after an angio-CT. Furthermore, the patient presented other chronic comorbidities: chronic venous insufficiency with varicose ulcer, depressive affective disorder, chronic kidney disease (stage 3), and multiple small splenic infarcts. The treatment consisted of: oral anticoagulation, diuretics, beta-blockers, digitalics and small doses of angiotensin-converting enzyme inhibitors. 

Conclusion: The association between situs inversus totalis and cardiac comorbidities is very rare. Moreover, in a patient with situs inversus, common diagnosis and investigations require specific attention, with the necessity of further investigations to confirm or rule out several hypothesis of diagnosis.

Bibliography: Patient Informations taken from the Cardiology department of the hospital Sf. Spiridon

Salmonella: An unwelcomed guest in the ear.  Gallaby Kaisser , Pșenițchei Ionela-Gianina Brink Melindi Invalidated View

Salmonella: An unwelcomed guest in the ear.

Medical Science

Author(s): Gallaby Kaisser, Pșenițchei Ionela-Gianina

Coauthor(s): Brink Melindi

Coordinator(s): Associate Professor Cristina Gavrilovic

Keywords: Salmonella Otitis Media Otomastoiditis Pansinusitis.

Introduction: Otitis media is the most common reason why children visit a medical practitioner and it is an important cause of preventable hearing loss. It is a common reason for antibiotic prescription in young children.This was our encounter at Sf. Maria Hospital in iasi with a patient that had an extremely rare case of otitis media that became complicated with a otomastoiditis. Due to the rarity of this experience it prompted us to do a litrature review to see how rare this case was, for the pure fact of documenting it. That might help us reach a better diagnosis in a shorter time. 

Material and Method: A 16 years old boy presented with otorrhea and no other clinical signs. There were no abnormalities detected by routine blood test. A contrast enhanced computed tomography scan of the head revealed Otomastoiditis and Pansinusitis. A few articles we found showed particular similarities in the presentation in of the symptoms and the cause of infection.

Results:  There are extremely few cases reported in the literature in relation with Otitis with Salmonella. The first case of Otitis externa apparently caused by Salmonella Florida was published by Killinger W et al in 1954. In 1977, Lento, Milazo and Agati reported four cases of purulent otitis media, caused by Salmonella Wien. Schutzman SA reviewed the charts from 2982 patients with Otitis media, out of which 1666 patients, who had blood drawn for cultures, had bacteremia in 3% of cases. 

Conclusion:  Due to the rarity of the case, missing the diagnosis in patients is becoming a norm, and the way we can bring an end to this misdiagnosis is by implementing stricter protocols for the test of incoming patients that are generally showing no specific symptoms related to otitis media.

Bibliography: Killinger W, Wynn M, Young F., A case of otitis externa apparently caused by Salmonella florida, Laryngoscope. 1954 Aug;64(8):689-90. Lento FG, Milazzo GG, Agati G. 4 cases of purulent otitis media caused by Salmonella Wien, G Batteriol Virol Immunol. 1977 Jan-Jun;70(1-6):125-33. Schutzman SA, Petrycki S, Fleisher GR., Bacteremia with otitis media., Pediatrics. 1991 Jan;87(1):48-53 Kaplan DM, Leiberman A, Noghreyan A, Fliss DM Acute Salmonella mastoiditis in an infant., Int J Pediatr Otorhinolaryngol. 1995 Apr;32(1):87-91.

NEWCASTLE DISEASE VIRUS-INDUCED IMMUNE RESPONSE: A NEW HORIZON IN CANCER THERAPY  Blidaru Teodor Cristian , Dima Natalia Ioana - Validated View

NEWCASTLE DISEASE VIRUS-INDUCED IMMUNE RESPONSE: A NEW HORIZON IN CANCER THERAPY

Fundamental Science

Author(s): Blidaru Teodor Cristian, Dima Natalia Ioana

Coordinator(s): MD Teridah Ernala Ginting , Professor George Mathew

Keywords: Newcastle Disease Virus virotherapy interferons oncolytic virus

Introduction: Knowledge of mechanisms causing cancer have not led fully to the development of optimal treatments, therefore mortality by cancer is increasing worldwide. Newcastle Disease Virus (NDV) is an avian paramyxovirus that possesses a natural preference for replication in tumor cells compared to normal cells. The purpose of this study is to investigate the role of the immune response in NDV stained tumor cell lines.     

Material and Method: We have used NDV LaSota strain to infect three human tumor cell lines: small lung carcinoma (A549) and glioblastoma (T98G, U87). Different titrations of NDV were tested. In order to observe the difference in evolution, interferons (IFNs) Aplha, Beta, Lambda were added and combined. At 72 hours post-infection cell lysis was induced and the Bradford assay was performed to determine the concentration of proteins. Subsequently, Western Blotting was used to identify Caspase-3 as an imunohistochemical marker for cell apoptosis.  

Results: In both lung and brain cancer cell lines we have identified a dramatic increase of Caspase-3 activation and a higher number of apoptotic cells in comparison to the normal cells that have been through the same process of infection. Using interferons against neoplastic cells has proved that the most effective in moderating apoptosis is Alpha Interferon, tested by itself and merged with Beta Interferon. Also, we have observed that NDV infection predominantly induced the production of IFN-Aplha, IFN-Beta and IFN-Lambda in tumor cells, while in normal cells only an increase in IFN-Lambda was noticed.

Conclusion: The data we have gathered, together with data from a range of different studies, clearly indicate Newcastle Disease Virus as a potential efficient treatment for a wide variety of cancers. Step by step, the development of the NDV is a promising direction in order to provide the optimal oncolytic virus.     

Bibliography: 1. Ginting TE, Suryatenggara J, Christian S, Mathew G. Proinflammatory response induced by Newcastle disease virus in tumor and normal cells 2. https://www.cancer.gov/about-cancer/treatment/cam/hp/ndv-pdq 3. Tayeb S, Zakay-Rones Z, Panet A. Therapeutic potential of oncolytic Newcastle disease virus: a critical review. 4. Zamarin D, Palese P. Oncolytic Newcastle Disease Virus for cancer therapy: old challenges and new directions 5. https://en.wikipedia.org/wiki/Newcastle_disease 6. Mansour M, Palese P, Zamarin D. Oncolytic Specificity of Newcastle Disease Virus Is Mediated by Selectivity for Apoptosis-Resistant Cells

GROOVE PANCREATITIS - THE UNKNOWN ENEMY  Movileanu Ioana , Georgescu Ioana Butoi Maria-Luiza, Lazar Alexandra Maria Validated View

GROOVE PANCREATITIS - THE UNKNOWN ENEMY

Case Report - Poster

Author(s): Movileanu Ioana, Georgescu Ioana

Coauthor(s): Butoi Maria-Luiza, Lazar Alexandra Maria

Coordinator(s): Professor Mircea Diculescu

Introduction: Groove pancreatitits is a very rare and misleading type of chronic pancreatitis. It affects the anatomical area between the pancreatic head, the common bile duct and the duodenum, named “the groove area”. This localization leads to unspecific symptoms such as upper abdominal pain, postprandial vomiting and weight loss, due to the malabsorption of the important nutriments.

Case Presentation: The patient is a man, aged 65, who suffers from hypertension, dyslipidemia, anxiety disorder,  depression, known to have suffered from duodenal ulcer, having been treated with proton-pump inhibitors. He is admitted to the Gastroenterology ward accusing upper abdominal pain that radiates in the