Retinal toxicity associated with chronic exposure to hydroxychloroquine and its ocular screening. Review.

Hydroxychloroquine sulfate (HCQ, Plaquenil) is an analogue of chloroquine (CQ), an antimalarial agent, used for the treatment of systemic lupus erythematosus, rheumatoid arthritis and other autoimmune disorders. Its use has been associated with severe retinal toxicity, requiring a discontinuation of therapy. Because it presents potential secondary effects including irreversible maculopathy, knowledge of incidence, risk factors, drug toxicity and protocol screening of the patients it represents important data for the ophthalmologists. Thus, it is imperative that rheumatologists, medical internists and ophthalmologists are aware of the toxicity from hydroxychloroquine they should also be careful to minimize its occurrence and effects.

Combining tangential hydrodissection, panniculectomy, and negative pressure wound therapy in treating extensive degloving injury of the leg.

Major degloving injuries of the lower limb are daunting lesions because they are relatively rare and always produce larger soft tissue defects than direct visual inspection that could be predicted in the emergency room. Enough body of the medical literature supports the excision of the avulsed tissue and replaces it as a full-thickness skin graft. However, almost paradoxically, there is little support for the use of pristine large full-thickness skin graft in the treatment of these lesions. This article focuses on the use of tangential hydrodissection (VERSAJET Hydrosurgery System, Smith & Nephew) in preparing the avulsed wound and defatting of a large piece of full thickness skin graft taken from the abdomen by using a standard panniculectomy excision pattern and securing survival and integration of the graft with negative pressure wound therapy. The patient, a 60-year-old obese and diabetic woman, suffered a roadside accident producing a degloving injury of her leg and was treated with the presented method; the final result was excellent and the reduction of the abdominal panniculus was a bonus.

Controlled ovarian hyperstimulation and IVF pregnancy prognosis.

IVF (in vitro fertilization) often represents the ultimate step in our attempt to treat infertility. Nowadays this method is more and more used, couple's expectations are higher and higher, so that optimizing the chance that one IVF pregnancy became a healthy newborn child is becoming an important issue. In this study we analyzed the controlled ovarian hyperstimulation impact on IVF pregnancy prognosis. We studied 307 patients who had IVF fresh procedures in "Panait Sirbu" Clinical Hospital of Obstetrics and Gynecology - Department of Assisted Human Reproduction between 01.01.2008 - 31.12.2010 and obtained pregnancy; pregnancy rate according to our statistics is 34%. For statistic analysis we used the odd Student test. Our data proved better results (defined as a better birth/abortion ratio) for the patients where recombinant FSH was used towards patients where highly purified urinary gonadotropin or the combination of the two drugs was used. Our statistical data also proved that none of the variables: age, BMI (body mass index), endometrium thickness, number of oocytes, number of embryos or number of days of stimulation is a favorable variable for this better result, but the number of units of gonadotropin is a favorable variable for a better birth/abortion ratio. We consider that our data gives an interesting perspective upon the connection between controlled ovarian hyperstimulation and pregnancy outcome, especially these days when tendencies are to obtain as many oocytes in one procedure as we can, which often means to use high doses of gonadotropin.

Natural conception following total fertilization failure with intracytoplasmic sperm injection in a couple with unexplained infertility: a case report.

With the introduction of intracytoplasmic sperm injection (ICSI), couples with severe male factor infertility have been able to achieve fertilization and clinical pregnancy rates comparable to other in vitro fertilization patients. However, despite the utilization of microsurgical sperm injection techniques, failure of fertilization still occurs in a few patients. How such fertilization failure after ICSI might impact later ICSI treatments is less understood. We report a case of total fertilization failure after ICSI using sperm from a normozoospermic husband of a patient with unexplained infertility. Six months after the cancelled cycle, the couple conceived naturally. Unfortunately, it was an ectopic pregnancy, which required laparoscopy and surgical removal of the right fallopian tube. This case shows that a failed ICSI cycle, therefore, does not imply a hopeless prognosis for future ICSI treatment. Moreover, in cases with unexplained ICSI failure, natural conception can subsequently occur. The aim of this study is two-fold: to discuss a rare case of a spontaneous pregnancy after total fertilization failure with ICSI and to develop counseling material for patients and doctors who are faced with such a rare situation. To our knowledge, this is the first report of a case of spontaneous pregnancy after total fertilization failure with ICSI.

Endometriosis - clinical approach based on histological findings.

Endometriosis is a benign disease defined by the presence of endometrial glands and stroma outside of the uterus and is associated with both pelvic pain and infertility. The most common sites of endometriosis, in decreasing order of frequency, are the ovaries, anterior and posterior cul-de-sac, posterior broad ligaments, uterosacral ligaments, uterus, fallopian tubes, sigmoid colon, appendix, and round ligaments. The main treatment is surgical, but often-microscopic islands of endometrial tissue remain, which proliferate and are responsible for relapses. We tested the efficacy of two drugs (Medroxyprogesterone and Triptorelinum), administered for six months to prevent recurrence after surgery. Treatment with Medroxyprogesterone was 100% effective in terms of relapse, while Triptorelinum could not prevent recurrence of endometriosis.

Bilateral primary fallopian tube carcinoma: a case report.

Primary cancer of the fallopian tube is a very rare tumor nowadays, accounting for approximately 0.14-0.3% of all tumors of the female genital tract. From these, bilateral primary cancer is found in less than 25% of all cases. We report here a case of bilateral primary cancer of the fallopian tube in a 48-year-old woman, associating uterine fibromatosis.

[Tricophyton rubrum in a case of tinea unguium phenotypic mycological diagnostic algorithm and its limits]. / Tricophyton rubrum într-un caz de tinea unguium--algoritmul de diagnostic micologic fenotipic si limitele acestuia.

Trichophyton rubrum is the most common dermatophyte isolated from human dermatophytosis. We present the mycological diagnosis algorithm and results in an onychomycosis case--tinea unguium. Biological samples have been inoculated on both usual and special culture media and incubated at both 30 degrees C and 37 degrees C for a period of fourteen days. Based on the macroscopic and microscopic characters and on the physiological and biochemical tests results, we identified a Trichophyton rubrum granular type dermatophyte. We are discussing phenotypic mycological diagnosis limits and molecular diagnostic benefits for rapid setting up of fungal therapy in order to avoid chronic mycosis and their complications.

Giant laterocervical fibrosarcom.

Soft tissue sarcomas are rare tumors representing 1% of all malignancies and less than 10% concerning head and neck tumors. We are presenting the case of a 42-year-old patient that was admitted in our service for a giant laterocervical tumor (15/12/10 cm). We performed total excision of this tumor en bloc with the involved tegument; the resulting defect was covered with a split thick skin graft. The weight of the tumor was 500 g. Histopathological examination revealed an intermediate-grade fibrosarcoma. The postoperative evolution was good; radiotherapy was indicated.

Screening for microdeletions in human Y chromosome--AZF candidate genes and male infertility.

About 30% of couple infertilities are of male origin, some of them caused by genetic abnormalities of the Y chromosome. Deletions in AZF region can cause severe spermatogenic defects ranging from non-obstructive azoospermia to oligospermia. The intracytoplasmatic sperm injection technique (ICSI) is rapidly becoming a versatile procedure for human assisted reproduction in case of male infertility. The use of ICSI allows Y chromosome defects to be passed from father. The goal of our study is to evaluate the frequency of microdeletions in the long arm of Y chromosome, within the AZF regions, in these cases of infertilities, using molecular genetics techniques. Thirty infertile men with azoospermia or oligozoospermia, determined by spermogram, were studied after exclusion of patients with endocrine or obstructive causes of infertility. Peripheral blood DNA was extracted from each patient, then amplified by multiplex PCR with STS genomic markers from the Y chromosome AZF zones. Each case was checked by multiplex PCR through coamplification with the SRY marker. Three men with microdeletions of the long arm of the Y chromosome were diagnosed among the 30 patients, corresponding to a proportion of 10%. The relatively high proportion of microdeletions found in our population suggest the need for strict patient selection to avoid unnecessary screening for long arm Y chromosome microdeletions. The molecular diagnostics was performed according to the current European Academy of Andrology laboratory guidelines for molecular diagnosis of Y chromosomal microdeletions.

Eight years of experience in the first Romanian center of family planning and contraception.

This study describes 8 years of experience (1990-97) in the first Romanian center for family planning and contraception, which started in Bucharest at the Clinic Hospital of Obstetrics and Gynecology 'Prof. Dr. P. Sirbu' on 27 February 1990. A total of 14,258 women had attended the clinic by 1 January 1998. Trends in the use of contraceptives and the number of births and abortions at the center are described. During the 8 years, the induced abortions decreased by 65% and the uncompleted abortions (illegal abortions) by 45%. Hormonal contraception was the most commonly used contraceptive method (61.5%), followed by intrauterine devices (28.8%) and local contraception (barrier methods: condoms, diaphragms, spermicides) (9%).

Use of surfactant for prevention of respiratory distress syndrome in newborn infants in spontaneous breathing. A randomized multicentre clinical pilot-study.

OBJECTIVE: To evaluate the impact of administration of surfactant to premature infants in the delivery-room on respiratory distress syndrome (RDS) and short-term (28 days) mortality and outcome in a developing country where mechanical ventilators for infants were not available at the time of the study and neonatal mortality rate is extremely high. DESIGN: Babies with gestational age 28-33 wks were randomly assigned to receive porcine surfactant prophylaxis (200 mg/kg endotracheally) in the delivery-room or routine assistance in 4 hospitals in Romania. After randomization, supplemental oxygen and continuous airway positive pressure were allowed if available. No rescue treatment was allowed. Diagnosis of RDS was done by means of Silverman score > or = 3 within 24 hrs + requirement of supplemental oxygen > or = 40%. Other examinations were performed depending on local availability. RESULTS: 53 babies were analyzed, and 28 were given prophylaxis while 25 resulted controls. The two groups did not differ for gestational age and birth weight (mean values for prophylaxis and control infants respectively: 30.6 +/- 1.6 vs 30.2 +/- 1.7 wks and 1457 +/- 258 vs 1397 +/- 388 g.), nor for sex, type of delivery and Apgar score. Mortality 0-28 days was 42.8 vs 48% in the prophylaxis vs control group (p = ns), due prevalently to intracerebral haemorrhage in both groups. Babies given surfactant tended to die later than controls. The Silverman score resulted significantly reduced in the first 24 hours in the babies given prophylaxis vs the controls (p < 0.05) and values of PaO2/FiO2 ratio were almost constantly higher in the babies that received surfactant compared to the control infants during the first three days of life, even if the differences were not significant. CONCLUSION: Our data confirm that prophylaxis of RDS with surfactant in the delivery-room is able to improve the clinical conditions of the babies, however without the complete support of neonatal intensive care it does not resolve the problem of survival and unfavourable outcome in the babies with the lowest gestational ages. This kind of approach might anyhow facilitate the transport of the baby from a peripheral delivery-room to few equipped neonatal intensive care units to be created.

A new era begins: an official statement by Romanian Vice-Minister of Health Professor Bogdan Marinescu.

PIP: Dr. Bogdan Marinescu, Vice-Minister of Health, is responsible for mother and child care, prevention and care in schools and universities, and the newly created Family Planning Unit. The repeal, on December 25, 1989, of the law on abortion created the legal environment for the implementation of a national family planning program (FPP). The new program will be offered to all women who want it. Special attention will be given to women having an abortion. The primary objectives of the overall FPP of the Ministry of Health consists of decreasing maternal mortality and morbidity caused by abortion and facilitating the switch from using abortion techniques to modern contraceptive techniques. The 1st step will be the nomination of a head of the FP unit who could be either a gynecologist or and administrator advised by a gynecologist. The unit head will immediately create an operational task force. The Vice-Minister will chair the task force, with the unite head acting as secretary. There will be 9 officers in the task force: the head of the FPP and a senior gynecologist from one of the teaching hospitals, and the senior nursing tutor from the post-basic training college for nurses, the senior FP health statistician, the head of health education, a representative from the Romanian FP association and a consumer. The main goal of the task force is to facilitate the development of the program by advising the Vice-Minister on all issues pertaining to FP. The creation, on April 3, 1990, of a Society for Education in Contraception (SECS) will facilitate communication among, and education of, the public and specific groups at risk, such as adolescents. The family planning program will be progressively established, starting with the university teaching hospitals, and spreading to district and town hospitals, then polyclinics. Only obstetricians and gynecologists will be allowed, at least during this 1st phase, to prescribe contraceptives. The new contraceptives introduced in the country will consist mostly of combined pills, IUDs, and barrier methods. At this stage, it seems essential to disseminate written information on contraceptive technology to all health professionals involved. The counselling part of the program in FP services will rest with the nurses and midwives specifically trained under the supervision of the gynecologists in charge. The basic curriculum for nurses, midwives, and gynecology students will be modified and specific modules on FP introduced.^ieng

The improvement of fertility at women with bicervical bicornuate uterus and double vagina.

In the present work there are presented 3 clinical cases with genital malformations of the type: bicervical bicornuate uterus with double vagina, from among which one case belongs to the type of communicating uterus (uterus in H). The diagnosis is formulated through the clinical examination and the type of the malformation is determined by histerogram and endoscopy. The urogram is compulsory. The surgical indication is given by infertility (at least two obstetrical failure in antecedents), dyspareunia, dysmenorrhea, meno-metrorrhagia, primary sterility. The surgical technique is accurately described, consisting in sectioning by vaginal route the cervical and vaginal longitudinal septum and in sectioning by abdominal route the septum which separates the 2 uterine horns, according to the Bret technique.