Current issue, Nr. 4, Vol. 51 Dec 2016

A NEW EDITOR-IN-CHIEF AND THE CHALLENGES OF THE JOURNAL

CAMELIA C. DIACONU, FESC, FACC, FACP, FEFIM
University of Medicine and Pharmacy "Carol Davila", Clinical Emergency Hospital of Bucharest, Bucharest, Romania

Editorials

Camelia Diaconu It is an honour and a privilege for me to be the new Editor-in-Chief of "Archives of Balkan Medical Union" journal, since October 2016. I would first of all like to extend my sincere thanks to the leadership of the national sections of Balkan Medical Union, which has entrusted me with this important duty. On behalf of the Journal, I want also to thank Prof. Vasile Candea for his achievements as Editor-in-Chief.
The jou... [more]

BARE METAL STENTS SIZE: CORRELATIONS WITH CORONARY STENT RESTENOSIS

DANIEL NIŢĂ, IONEL DROC, LIVIU CHIRIAC, COSMIN ALEXANDRU BUZILĂ

Original papers



Introduction: The coronary stents use for the ischemic heart diseases interventional treatment, has decreased the incidence of postprocedural complications compared to the classic balloon angioplasty. Knowledge of technical factors associated with subsequent risk of angiographic recurrences can guide the strategy for selection of the patients and the type of stent to be implanted.


Methodology: The aim of this study is to identify the technical characteristics of "bare metal" stents made of cobalt chrome alloy or stainless steel which are associated with a high... [more]

A FIVE-YEAR MULTI-CENTRIC STUDY OF PHYLLODES TUMORS OF THE BREAST

RĂZVAN VALENTIN SCĂUNAŞU, TRAEAN BURCOŞ, ŞTEFAN VOICULESCU, BOGDAN POPESCU, VLAD DRĂGOI, DENISA BĂLĂLĂU, NICOLAE BACALBAŞA, CRISTIAN BĂLĂLĂU, EUGEN BRĂTUCU

Original papers

Background: Phyllodes tumors represent a heterogeneous and minority group of the breast neoplastic pathology. The malignant transformation of a Phyllodes tumor is a rare event, representing less than 1 % of breast tumors.


Methods: Our study analyzed all cases of Phyllodes breast tumors diagnosed in two medical institutions during a period of five years. We compared long term outcome results for the patients who underwent conservative treatment and mastectomy.


Results: The analysis of the histopathological results revealed a number of 39 (0,454 % of ... [more]

Original papers

Background: Previous studies have raised the possibility that uric acid might be an independent, causal risk factor for cardiovascular disease. The aim of the study was to evaluate the relationship between uric acid and endothelial function in patients with hypertension.


Methods: A total of 106 newly diagnosed never treated patients with uncomplicated essential hypertension (56 men, mean age 49, 6 +-6,8y) were studied. Classical risk factors, uric acid, creatinine and C reactive protein were determined. Endothelial function was estimated by flow-mediated dilatation of... [more]

METASTASES IN DAILY ENDOCRINE PRACTICE

MARA CARSOTE, ANA VALEA, NICOLETA DUMITRU, DANA TERZEA, EUGENIA PETROVA, SIMONA ALBU, ANDRA BURUIANA, ADINA GHEMIGIAN

Original papers

We aim at introducing a series of three cases with different types of malignancy spreading that needed an endocrine check-up. A 70-year old female has come to our attention in order to be evaluated for a prior thyroid cancer. She was previously diagnosed with a parietal lump of 2 cm. Surgery was performed and the pathological report pointed out a skin metastasis from follicular and solid variant of papillary thyroid cancer. Total thyroidectomy with local lymph nodes resection was followed by 100 mCi of 131I radioiodine treatment and suppressive therapy with L-thyroxin. After 6 years of disease... [more]

THYROID AUTOIMMUNE DISEASE: BETWEEN HYPOTHYROIDISM AND HYPERTHYROIDISM

SIMONA ELENA ALBU, MARA CARSOTE, DANA TERZEA, ADINA GHEMIGIAN, ANA VALEA, EUGENIA PETROVA, CRISTINA VASILIU

Original papers

We aim at introducing a series of cases regarding autoimmune thyroid conditions in adult non-pregnant women with a particular pattern: hypothyroidism and thyrotoxicosis in the same patient at different moments. A 61-year old non-smoking woman was diagnosed at age of 58 with Basedow's disease and treated for 3 months with thiamazole. She presented asymmetrical eye involvement and negative TRAB (TSH Receptor Antibodies). TSH (Thyroid Stimulating Hormone) rapidly increased under therapy but further on spontaneously when the drug was stopped thus levothyroxine was necessary. This aspect was unchan... [more]

Original papers

Background: Based on the results of a histological study of removed TG tissue NGAIT was found in 10, 4% of the patients (1, 2). At the same time, there are processes of both thyroid epithelium metaplasia and lymphoid tissue hyperplasia that, undoubtedly, can be considered as an optional precancerous condition (3-8). The option when cytomorphological and immunocytochemical examinations are carried out sequentially, using the same smear of a puncture material is optimal for PCE (9).


Methods: We have carried out an immunohistochemical study by means of monoclonal antibo... [more]

BLEEDING DISORDERS IN ACUTE KIDNEY INJURY PATIENTS DEPENDING ON THE CONDITION'S STAGE

ALEXANDRU ROCŞOREANU, CORNEL SZABETAY, DANIELA CERNEA, EUGEN MOŢA

Original papers

Among other complications, hemorrhagic disorders occur frequently during the evolution of acute kidney injury lesions. We analyzed two groups of patients with acute kidney injury caused by various factors (sepsis, trauma, surgery, etc.): one group of patients with RIFLE stage III acute kidney injury treated by hemodialysis and another group of patients with mild acute kidney injury (RIFLE stage I and II) that received medical treatment, without hemodialysis. We noticed the fact that most bleeding disorders (over 50% of all cases) occurred in the hemodialysis group, compared with an 8.5% rate f... [more]

MANAGEMENT OF SYMPTOMS, SPECIFIC SUPPORT NEEDS, AND ADAPTATION TO THE DISEASE IN PATIENTS WITH ADVANCED AND METASTATIC LUNG CANCER

ROXANA-ANDREEA RAHNEA-NIŢĂ, GABRIELA RAHNEA-NIŢĂ, MIHAELA POPESCU, CRISTINEL DUMITRU BADIU, ANDA-NATALIA CIUHU

Original papers

80% of lung cancer patients present with locally advanced or metastatic disease; therefore, lung cancer is a major public health problem and the management of symptoms is very important. Patients with advanced and metastatic lung cancer were evaluated, regarding the range and severity of symptoms, by using the Edmonton Symptoms Assessment Survey (ESAS) and treatment of the main 5 symptoms. They were also evaluated with concern to their specific needs and the adaptation to cancer disease by using the Needs Near the End of Life Screening Tool (NEST 13)-Item 1, 2, 3 and 4. The most important 5 sy... [more]

HEMOSTASIS IN PATIENTS WITH CIRRHOSIS: A HAZARDOUS BALANCE

DENISA BUCUR, DANIEL BERCEANU, CAMELIA C. DIACONU, MIHAELA ADELA IANCU

Reviews

Liver cirrhosis is a chronic disease with multiple causes and increased mortality. Hepatocytes are the site of synthesis of all coagulation factors and their inhibitors and that is the reason why patients with cirrhosis have a variety of hemostatic abnormalities, resulting in "rebalanced" hemostasis. The spontaneously elevated INR values in patients with cirrhosis have led to the theory of "autoanticoagulation" and to the idea that these patients may not benefit from the venous thromboembolism risk-reduction therapies. In fact, patients with severe liver disease should not be assumed to be aut... [more]

TYPE 2 DIABETES AND LIVER DISEASE: A FREQUENT AND HARMFUL CONNECTION

DANIEL BERCEANU, DENISA BUCUR, CAMELIA DIACONU

Reviews

Patients with diabetes have a high prevalence of liver disease. The entire spectrum of liver disease is seen in patients with type 2 diabetes. Non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes (T2DM) are common conditions that regularly co-exist and act synergistically to drive negative outcomes. The classical pathway consists of initial insulin resistance, increased lipolysis, lipid accumulation in the hepatocytes, oxidative stress, and cell damage followed by fibrosis. Insulin resistance is a characteristic feature of NAFLD, as a result of increased secretion of specific proinfla... [more]

TUMOR MARKERS IN ENDOMETRIAL CANCER

ALEXANDRA GIREADĂ, NICOLAE BACALBAŞA, IRINA BĂLESCU, MIHAI DIMITRIU, CRISTIAN BĂLĂLĂU

Minireviews

Endometrial cancer is the most common gynecological cancer worldwide which is usually treated by surgery. Although most cases are diagnosed in early stages when complete surgical removal of the tumor is possible, a high percentage of the patients will develop recurrences. An important test during the follow-up period of these patients remains tumor markers' serial determinations. This is a literature review of the most useful endometrial cancer tumor markers including CA 125, CA 15-3 and CA 72-4.

MALIGNANT LYMPHOMA OF THE HEAD AND NECK - THERAPEUTIC APPROACHES

MIHAIL TUŞALIU, TATIANA DECUSEARĂ, ALEXANDRU PANFILOIU, BOGDANMOCANU, CRISTINAMARIA GOANŢĂ, REMUS GABRIEL MIHALCEA, ALEXANDRA GULIGA, ANDREEA-NICOLETA COSTACHE, MARIANA VASILICĂ, VLAD ANDREI BUDU

Minireviews

Malignant lymphoma is one of the problems of modern medicine. Among head and neck malignancies, lymphoma is the second most common cause. Most of the extranodal lymphomas are represented by non-Hodgkin lymphomas. Aero-digestive upper tract non-Hodgkin lymphomas are classified into different categories, depending on the respective frequency of these types in: oral cavity lymphomas, pharynx and Waldeyer ring lymphoma and nasal sinuses, throat, pharynx and trachea lymphomas. Main therapeutic approaches of malignant lymphoma are: conventional chemotherapy, radiotherapy, surgery, "salvage" therapy ... [more]

EVALUATION OF THE DIZZY PATIENT

CRISTINAMARIA GOANŢĂ, MIHAI TUÆALIU, REMUS GABRIEL MIHALCEA, VLAD ANDREI BUDU

Minireviews

Dizziness is a symptom accused very often by patients. The patient that presents himself to the doctor for this accuse will usually say words like: I feel an illusory movement of the environment (we call this vertigo), I have a feeling of light headedness, of imbalance or I feel like I am going to faint. The ENT specialist first has to figure out if the symptoms of the patient are from a pathology to the inner ear or maybe he should sent the patient to a neurologist, neurosurgeon, orthopedic doctor. The clinical evaluation of the dizzy patient may establish the right diagnosis, only by history... [more]

DETERMINATION OF PERITONEAL LAVAGE TUMOR MARKER CONCENTRATIONS IN GASTRIC CANCER

ALEXANDRA GIREADĂ, IRINA BĂLESCU, NICOLAE BACALBAŞA, MIHAI DIMITRIU, CRISTIAN BĂLĂLĂU

Minireviews

Gastric cancer remains one of the most lethal malignancies worldwide, with a high capacity of developing peritoneal recurrences. The apparition of peritoneal seeding in the setting of a case diagnosed with gastric cancer represents the most common cause of death. Due to this aspect, researchers' attention was focused on determining which are the most efficient methods in order to provide an early diagnosis of a possible peritoneal recurrence. This is a literature review regarding the role of determination of peritoneal lavage tumor marker concentrations in patients previously diagnosed with ga... [more]

RARE CECUM DIVERTICULITIS MISLEADING TO FALSE APPENDICITIS DIAGNOSIS

CRISTIAN BĂLĂLĂU, NICOLAE BACALBAŞA, ION MOTOFEI, PETRU TONU, PETRIŞOR BANU, RĂZVAN VALENTIN SCĂUNAŞU, BOGDAN POPESCU, VLAD DENIS CONSTANTIN

Case reports



Introduction: Diverticulum of the cecum is a very rare cause of acute abdomen and can be very hard to tell apart from appendicitis prior to surgical intervention. Indication for surgery is taken on the presumptive diagnosis of appendicitis. The incidence of diverticular disease is increasing worldwide due to the aging trend of the general population.


Case report: We are presenting a case of a 47 years old adult with cecal diverticulitis, in which case acute appendicitis was the most obvious diagnostic before surgery. Appendectomy and diverticulectomy were per... [more]

CONSERVATIVE MANAGEMENT OF PHARYNX TRAUMA

BOGDAN POPESCU, ŞERBAN VIFOR GABRIEL BERTEŞTEANU, ALEXANDRA OANA PĂUN, CRISTIAN RADU POPESCU, CRISTIAN BĂLĂLĂU, ION MOTOFEI, RĂZVAN SCĂUNAŞU

Case reports

Food and beverages travel the distance between the oral orifice to the stomach through the oropharynx, hypopharynx and the esophagus following specific pathways and timing. The structure of the digestive tract is different depending on the organ. The pharynx is surrounded by soft tissue and lying on bone. Still, along the digestive tract there are areas that do not have the same mechanical support as the pharynx. These regions are so called weak regions susceptable to tears and ruptures. Blunt trauma of the pharynx may occur after diagnostic or therapy procedures such as transesophageal heart ... [more]

LAPAROSCOPIC REPAIR OF MORGAGNI HERNIA

IULIANA DOGARU, M AVRAM, M GHERGHINOIU, A CHELARU, VIOLETA TARAN, FLORIN MUŞAT, ANDREEA HANU

Case reports



Introduction: Morgagni hernia is a rare type of diaphragmatic defect, having high risk of incarceration. Case report: We present the case of a 78-years old woman arriving at the ER for upper abdominal pain, nausea, vomiting and constipation for 4 days. CT scan revealed a Morgagni hernia with stomach, transverse colon and greater omentum incarcerated. We decided to use laparoscopic approach achieving a primary tissue repair without mesh implantation.


Conclusions: Laparoscopic approach of the Morgagni hernia with a primary tissue repair without mesh is safely an... [more]

Case reports

Vanishing testes syndrome (or bilateral anorchia), as part of 46, XY differences of sex development, may be early detected during life or partial gonadal dysgenesis are discovered during adult years with mild forms of hypogonadism. Testicular regression may have a genetic background, as mutations of steroidogenic factor 1 (SF 1), but it may be potentially related to other syndromes and anomalies as mental retard, renal anomalies, etc. We aim to introduce a complex male case with a long medical history, including late diagnosis of vanishing testes syndrome. This case introduces the challenges o... [more]

CONFIRMATION OF CONGENITAL HYPOGONADOTROPIC HYPOGONADISM DURING THE THIRD DECADE OF LIFE: FRAME OF CO-MORBIDITIES AND COMPLICATIONS

ANA VALEA, NICOLETA DUMITRU, ANDRA BURUIANA, MARA CARSOTE, EUGENIA PETROVA, ADINA GHEMIGIAN

Case reports

We aim to introduce two cases with late diagnosis of congenital hypo-gonadotropic hypogonadism (HH). A 28-year female is admitted for infertility. At age of 15 she had primary amenorrhea thus she was referred for an endocrine check-up. At that moment, a pituitary computed tomography revealed empty sella; she was offered oral contraceptives with menses induction which the patient continued until present time. She had no menses if the medication was stopped. On admission, the clinical exam revealed normal female phenotype. Hormonal panel indicated HH without stimulation. Ultrasound showed hypopl... [more]

FIXATION FAILURE AFTER PROXIMAL HUMERAL FRACTURE OSTEOSYNTHESIS ON OSTEOPOROTIC BONE

MIHAELA ECATERINA RINJA, MIHNEA ANDREI DUMITRESCU, DAN BARBU

Case reports

Osteoporosis leads to low bone mass and microarchitectural deterioration of bone structure. The thinning of the cortical shell combined with less and thinner trabeculae leads to inferior mechanical properties. It is well known that untreated osteoporosis significantly increases the risk for another fracture and furthermore, aggravates fracture fixation. We present the case of a 73 year old woman with proximal humeral fracture on osteoporotic bone who underwent fracture fixation with locked intramedullary nails and later fixation failure with secondary screw migration. The patient had secondary... [more]

EXTRA PULMONARY TUBERCULOSIS IN CHILDREN

CRISTINA RAMONA ŞUŢU, RODICA OLIMPIA TUDORAN, MIHAELA I. CIOCAN, CĂTĂLINA G. POPOVICI

Case reports

Background: Tuberculosis is a highly contagious disease, produced by Mycobacterium tuberculosis (Koch bacillus). The evolution of this disease is chronic, consumptive, with a high mortality rate (in the absence of accurate treatment).As this case will be focused on extrapulmonary tuberculosis in children, it is necessary to mention that over 25% of patients (children) develop this complication and more than 10% of them do not survive.


Methods: We present the case of a 17 years old male with a history of operated pilocytic astrocytoma of the vermis, right cerebellum h... [more]

PELVIC PACKING - LIFE SAVING IN A CASE OF PLACENTA PERCRETA WITH BLADDER INVASION

M.C. T. DIMITRIU, C. A. IONESCU, IRINA PACU, ANA MARIA CIOBANU, M. BĂNACU, INA POPESCU, IULIA MARIA TÂRCOMNICU, ELENA VOICU, P. BANU, B. SOCEA, C. FURĂU, G. FURĂU, N. BACALBAŞA, F.D. CĂLIN

Case reports

Abnormal adherent placenta is a rare complication of pregnancy, associated with high maternal obstetrical complications. Placenta percreta occurs when the villi penetrate the full thickness of the myometrium and may invade different organs such as the bladder or the rectum. It may cause massive haemorrhage thereby requiring emergency hysterectomy. Although commonly discovered at the time of delivery, antenatal diagnosis of placenta percreta may be achieved with ultrasound, magnetic resonance imaging, cystoscopy and colonoscopy. Manual removal of adherent placenta is forbidden because forceful ... [more]

Ovary tumor associated to pregnancy

GLADYS CRISTINA AL JASHI, ANA NASTAS, DIANA-ELENA COMANDASU, ISAM AL JASHI

Case reports



Introduction: Presence of uterine appendages tumors is rare during pregnancy. Many tumors are luteal cysts that disappear after six weeks of pregnancy, and 1 3 of those which still persist, are mainly dermoid cysts. Pregnancy and childbed increase the risk of torsion of the ovarian masses, and if these masses are represented by dermoid cysts, then the risk that they become torsioned is much more frequent- 15% of the cases. Material and method: We present in this paper the case of a pregnant woman aged 24 years, primigravid, primipara, of Caucasian race, who was seen by the speci... [more]

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