Low-dose letrozole - an effective option for women with symptomatic adenomyosis awaiting IVF: a pilot randomized controlled trial.

RESEARCH QUESTION: Can low-dose letrozole reduce dysmenorrhoea, menorrhagia and sonographic features in symptomatic women with adenomyosis awaiting IVF? DESIGN: This was a longitudinal randomized prospective pilot study to explore the effectiveness of low-dose letrozole and compare it with a gonadotropin releasing hormone (GnRH) agonist in reducing dysmenorrhoea, menorrhagia and sonographic features in symptomatic women with adenomyosis awaiting IVF. The women were treated for 3 months, either with the GnRH agonist goserelin 3.6 mg/month (n = 77) or the aromatase inhibitor letrozole 2.5 mg three times weekly (n = 79). Dysmenorrhoea and menorrhagia were evaluated at randomization and followed up monthly using a visual analogue score (VAS) and pictorial blood loss assessment chart (PBAC), respectively. A quantitative scoring method was used to assess the improvement of sonographic features after 3 months of treatment. RESULTS: Both groups reported a marked improvement in symptoms after 3 months of treatment. In both the letrozole and GnRH agonist groups, VAS and PBAC scores decreased significantly over the 3 months (letrozole: P = 0.0001 and P = 0.0001 for VAS and PBAC, respectively; GnRH agonist: P = 0.0001 and P = 0.0001 for VAS and PBAC, respectively). Participants on letrozole had regular menstruation cycles, while most of the women who received the GnRH agonist were amenorrhoeic, with only four women reporting mild bleeding. Haemoglobin concentrations also improved after both treatments (letrozole P = 0.0001, GnRH agonist P = 0.0001). A quantitative assessment of sonographic features showed significant improvements following both treatments (diffuse adenomyosis of the myometrium: letrozole P = 0.015, GnRH agonist P = 0.039; diffuse adenomyosis of the junctional zone: letrozole P = 0.025, GnRH agonist P = 0.001). Women with adenomyoma also responded well to both therapies (letrozole P = 0.049, GnRH agonist P = 0.024), whereas the letrozole group responded comparatively better in focal adenomyosis when the outer myometrium was involved (letrozole P < 0.001, GnRH agonist P = 0.26). No noticeable side effects were observed in women receiving letrozole therapy. Additionally, letrozole therapy was found to be more cost-effective than GnRH agonist treatment. CONCLUSIONS: Low-dose letrozole treatment is a low-cost alternative to a GnRH agonist, with comparable effects in improving the symptoms and sonographic features of adenomyosis in women awaiting IVF.

Core-Level Binding Energy Reveals Hydrogen Bonding Configurations of Water Adsorbed on TiO_{2}(110) Surface.

Using x-ray photoelectron spectroscopy of the oxygen 1s core level, the ratio between intact (D_{2}O) and dissociated (OD) water in the hydrated stoichiometric TiO_{2}(110) surface is determined at varying coverage and temperature. In the submonolayer regime, both the D_{2}O∶OD ratio and the core-level binding energy of D_{2}O (ΔBE) decrease with temperature. The observed variations in ΔBE are shown with density functional theory to be governed crucially and solely by the local hydrogen bonding environment, revealing a generally applicable classification and details about adsorption motifs.

Intercalation of transition metals in aluminene bi-layers: An ab initio study.

Using first principles calculations based on density functional theory (DFT), we probe various possible stacking arrangements of bilayer aluminene and intercalate six transition metal (TM) atoms (Ti, Cr, Mn, Fe, Co, and Ni) in unique bilayer aluminene systems. Further, we calculate valence charge density and electron localization function to ascertain the nature of bonding present in both the pristine and TM-intercalated composite systems. Intercalation of Cr, Mn, and Fe is found to result in the magnetic ground state. For Ti, Co, and Ni-intercalated systems, the starting trigonal symmetry has changed to a tetragonal symmetry. Co and Ni intercalated systems exhibit much higher (negative) formation energies compared to the other composite systems. In addition, nesting of the Fermi surface has been probed for the Co and Ni intercalated systems and observations indicate the possibility of the presence of charge density wave in the systems. A dispersion-corrected DFT study suggests that the van der Waals interaction is not likely to play a crucial role in determining the properties of both the pristine and TM-intercalated systems.

Fungal Systematics and Evolution: FUSE 5.

Thirteen new species are formally described: Cortinarius brunneocarpus from Pakistan, C. lilacinoarmillatus from India, Curvularia khuzestanica on Atriplex lentiformis from Iran, Gloeocantharellus neoechinosporus from China, Laboulbenia bernaliana on species of Apenes, Apristus, and Philophuga (Coleoptera, Carabidae) from Nicaragua and Panama, L. oioveliicola on Oiovelia machadoi (Hemiptera, Veliidae) from Brazil, L. termiticola on Macrotermes subhyalinus (Blattodea, Termitidae) from the DR Congo, Pluteus cutefractus from Slovenia, Rhizoglomus variabile from Peru, Russula phloginea from China, Stagonosporopsis flacciduvarum on Vitis vinifera from Italy, Strobilomyces huangshanensis from China, Uromyces klotzschianus on Rumex dentatus subsp. klotzschianus from Pakistan. The following new records are reported: Alternaria calendulae on Calendula officinalis from India; A. tenuissima on apple and quince fruits from Iran; Candelariella oleaginescens from Turkey; Didymella americana and D. calidophila on Vitis vinifera from Italy; Lasiodiplodia theobromae causing tip blight of Dianella tasmanica 'variegata' from India; Marasmiellus subpruinosus from Madeira, Portugal, new for Macaronesia and Africa; Mycena albidolilacea, M. tenuispinosa, and M. xantholeuca from Russia; Neonectria neomacrospora on Madhuca longifolia from India; Nothophoma quercina on Vitis vinifera from Italy; Plagiosphaera immersa on Urtica dioica from Austria; Rinodina sicula from Turkey; Sphaerosporium lignatile from Wisconsin, USA; and Verrucaria murina from Turkey. Multi-locus analysis of ITS, LSU, rpb1, tef1 sequences revealed that P. immersa, commonly classified within Gnomoniaceae (Diaporthales) or as Sordariomycetes incertae sedis, belongs to Magnaporthaceae (Magnaporthales). Analysis of a six-locus Ascomycota-wide dataset including SSU and LSU sequences of S. lignatile revealed that this species, currently in Ascomycota incertae sedis, belongs to Pyronemataceae (Pezizomycetes, Pezizales).

Successful autotransplantation of a mature mesiodens to replace a traumatized maxillary central incisor.

AIM: This case describes the successful transplantation of a mature mesiodens tooth to replace a traumatized maxillary central incisor. SUMMARY: A 17-year-old male attended 1 week after a traumatic injury to his left maxillary central incisor (tooth 21). Radiographs revealed a horizontal root fracture and a poor prognosis. The tooth was atraumatically removed and replaced with a mesiodens lying in the same region. After stabilization, root canal treatment was performed and aesthetics were restored with a tooth coloured restoration. A 2-year follow-up revealed the tooth had good aesthetics and function. KEY LEARNING POINTS: A supernumerary nonfunctional tooth such as a mesiodens can be successfully used to replace a missing permanent tooth by autotransplantation. Autotransplantation has a high success rate if case selection is good, appropriate surgery is carried out and excellent hygiene is maintained. Autotransplantation should be considered as one of the most biologic techniques for replacing a missing tooth with minimal cost. Autotransplantation can be carried out even after complete root formation in the donor tooth.

The van der Waals coefficients between carbon nanostructures and small molecules: A time-dependent density functional theory study.

We employ all-electron ab initio time-dependent density functional theory based method to calculate the long-range dipole-dipole dispersion coefficient, namely, the van der Waals (vdW) coefficient (C(6)) between fullerenes and finite-length carbon nanotubes as well as between these structures and different small molecules. Our aim is to accurately estimate the strength of the long-range vdW interaction in terms of the C(6) coefficients between these systems and also compare these values as a function of shape and size. The dispersion coefficients are obtained via Casimir-Polder relation. The calculations are carried out with the asymptotically correct exchange-correlation potential-the statistical average of orbital potential. It is observed from our calculations that the C(6) coefficients of the carbon nanotubes increase nonlinearly with length, which implies a much stronger vdW interaction between the longer carbon nanostructures compared with the shorter ones. Additionally, it is found that the values of C(6) and polarizability are about 40%-50% lower for the carbon cages when compared with the results corresponding to the quasi-one-dimensional nanotubes with equivalent number of atoms. From our calculations of the vdW coefficients between the small molecules and the carbon nanostructures, it is observed that for H(2), the C(6) value is much larger compared with that of He. It is found that the rare gas atoms have very low values of vdW coefficient with the carbon nanostructures. In contrast, it is found that other gas molecules, including the ones that are environmentally important, possess much higher C(6) values. Carbon tetrachloride as well as chlorine molecule show very high C(6) values with themselves as well as with the carbon nanostructures. This is due to the presence of the weakly bound seven electrons in the valence state for the halogen atoms, which makes these compounds much more polarizable compared with the others.

Ab initio study of stoichiometric gallium phosphide clusters.

We have studied the static dipole polarizability of stoichiometric gallium phosphide clusters (Ga(n)P(n) with n=2-5) by employing various ab initio wave function based methods as well as density functional theory/time dependent density functional theory (DFT/TDDFT). The calculation of polarizability within DFT/TDDFT has been carried out by employing different exchange-correlation functionals, ranging from simple local density approximation to an asymptotically correct model potential-statistical average of orbital potential (SAOP) in order to study their influences. The values obtained by using the model potential-SAOP are lower than those obtained by local density approximation and generalized gradient approximation. A systematic analysis of our results obtained using the DFT/TDDFT with several exchange-correlation functionals shows that the values of polarizability obtained within generalized gradient approximation by using Perdew-Burke-Ernzerhof exchange with Lee-Yang-Parr correlation functional and Perdew-Burke-Ernzerhof exchange-correlation functionals are the closest to the corresponding results from Møller-Plesset perturbation theory. We have found that the value of average static dipole polarizability per atom reaches the bulk limit from the above as the size of the clusters increases.

Caregiver-Based Interventions to Optimize Medication Safety in Vulnerable Elderly Adults: A Systematic Evidence-Based Review.

OBJECTIVES: To study the effect of caregiver-focused interventions to support medication safety in older adults with chronic disease. DESIGN: Systematic review. SETTING: Studies published before January 31, 2017, searched using Ovid Medline, PubMed, EMBASE, Scopus, CINAHL, PsycINFO, and Google Scholar. PARTICIPANTS: Caregivers with or without a care recipient. MEASUREMENTS: Inclusion criteria: interventions focused on caregivers aiming to improve medication safety. Studies not focusing on older adults, not evaluating medication safety, failing to include caregivers, or without a comparison group were excluded. RESULTS: The initial search revealed 1,311 titles. Eight studies met inclusion criteria. The strategies used in randomized trials were a home-based medication review and adherence assessment by a clinical pharmacist (2 home visits 6-8 weeks apart, with pharmacist and physician meeting independently) that found no difference in nonelective hospital admissions (p=.8) but fewer medications (p=.03); a 19-minute educational DVD and an hour-long medication education and training that improved caregiver satisfaction (p<.04); a medication education and adherence intervention (2-3 home visits per care recipient and caregiver dyad over 8 weeks) that found no difference in knowledge, administration, or accessibility of medications (p=.29); and a collaborative case management program (16-month program of assessment, meeting, and monthly follow-up telephone calls) that reduced perceived caregiver burden (p=.03). Quasi-experimental trials included collaborative care transitional coaches, an outpatient collaborative care model, and education and training programs. Of these, educational interventions showed improvements in self-efficacy, confidence, and preparedness. The collaborative care intervention reduced rehospitalizations (p=.04) and improved quality-of-care outcomes. CONCLUSION: Although some interventions improved caregiver medication knowledge and self-efficacy, effects on clinical outcomes and healthcare use were insufficiently studied. Two studies implementing collaborative care models with medication management components showed potential for improvement in quality of clinical care and reductions in healthcare visits and warrant further study with respect to medication safety. J Am Geriatr Soc 66:2128-2135, 2018.

Positive and Negative Predictive Factors for Treatment Response in Patients with Chronic Viral C Hepatitis.

More than 200 million people worldwide are infected with hepatitis C virus. In the United States, suggested estimates are that more than 5 million people live with HCV. The purpose of this paper is to identify, within the Southwestern Romanian population, host factors associated with the response to Pegylated Interferon and Ribavirin treatment for Hepatitis C virus infection. We investigated several factors and their correlation to sustained virological response. The study included 267 patients diagnosed with chronic Hepatitis C between 2013 and 2016, treated with Pegylated Interferon and Ribavirin in the 2nd Medical Department of the Emergency County Hospital Craiova. From the 267 patients included in this study, 149 (55,81%) achieved sustained virological response during the 48 weeks of treatment. Several factors were taken in consideration regarding the treatment response. Positive predictive factors for achieving sustained virological response were: the female gender (35,96%), Low Viral Load at the beginning of treatment, Early Virological Response 75 (28,09%), Rapid Virologic Response133 (49,81%), and stage of fibrosis, with Stage F1 having the highest rate of Sustained Virological Response during double therapy 81 (30,34%). Although at the present time a number of more effective antiviral products have been approved for the treatment of viral hepatitis C, in our country the standard of treatment remains with PegInterferon and Ribavirin therapy. Multiple clinical and paraclinical tools can identify patients with a high chance of responding to treatment, or those who, during treatment, do not meet the criteria for prolonging therapy.

The benefits of a comprehensive rehabilitation program in patients diagnosed with spastic quadriplegia.

Spastic quadriplegia has as an etiopathogenic substrate, a non-progressive brain lesion; however, the clinical manifestations of the disease evolve over time. Children diagnosed with spastic quadriplegia show a variety of symptoms in different areas: sensorimotor, emotional, cognitive, and social. The purpose of this study was to assess the functional status in patients diagnosed with spastic quadriplegia, who followed a complex medical rehabilitation program, during a year, and highlight the importance of using physical and kinetic techniques in improving their status. A total of 10 children diagnosed with spastic quadriplegia were included in the study and the Gross Motor Function Classification System (GMFCS) and manual ability classification system (MACS) were used to evaluate the functionality status of each patient. Every patient was evaluated initially (T1), after six months of program (T2), and after they completed the study. All the children were originally monitored daily, for 5 days per week for a period of one month, then two times a week for a year. A statistically significant difference regarding the modification of the GMFCS and MACS stage was found, which occurred between the first and the third evaluation. The inverse correlation of the statistical significance between the ages of patients and the decrease in GMFCS or MACS stage was highlighted; the younger the patient, the more the scale decreased. A direct link between the gross motor function and the manual ability was noticed. Applying a complex rehabilitation program has proven efficient by improving both the gross motor functionality and the manual ability.

Correlations between risk factors and functional evolution in patients with spastic quadriplegia.

Cerebral palsy is the most common cause of developing neuro-motor disability in children, in many cases, the triggering cause remaining unknown. Quadriplegia is the most severe spastic cerebral palsy, characterized by severe mental retardation and bi-pyramidal syndrome. The purpose of this paper was to demonstrate the importance of knowing the risk factors and the psychosomatic ones, determining to what extent they influence the functional evolution in patients diagnosed with spastic quadriplegia. 23 children diagnosed with spastic quadriplegia were included in the study, being aged between 1 year and half and 12 years. Patients were assessed at baseline (T1), at one year (T2) and after two years at the end of the study (T3). Patients received a comprehensive rehabilitation program for the motor and sensory deficits throughout the study. Initially, a comprehensive evaluation (etiopathogenic, clinical and functional) that started from a thorough medical history of children (the older ones), was conducted but chose parents to identify the risk factors, and a complete physical exam. At each assessment, joint and muscle balance was conducted. To assess functionality, the gross motor function classification systems (GMFCS) and manual ability (MACS) were used. Many risk factors that were classified according to the timeline in prenatal factors, perinatal and postnatal, were identified from a thorough history. A direct correlation was noticed between the decrease of coarse functionality and manual ability, both initially and in dynamic and low APGAR scores, low gestational age, low birth weight and a higher body mass index of the mother. A direct link was observed between the gross motor function and the manual ability. A significant improvement in the MACS score was noticed in patients with a better GMFCS score.

Pegylated Interferon-Induced Sarcoidosis Presenting With Anterior Uveitis in a Patient with Chronic Hepatitis C - Case Report.

Sarcoidosis is a chronic inflammatory systemic disorder of unknown etiology. It is known to be triggered by an autoimmune process, and is currently recognized as a rare adverse event to interferon therapy for Hepatitis C Virus Infection. Clinical presentation of interferon-triggered sarcoidosis is varied, but ocular manifestation as a first symptom was only once, previously reported. We report the case of a 32 year old woman, infected with hepatitis C, for whom antiviral therapy was initiated. Prior to treatment, the patient had outstanding medical history. Three months from the initiation, patient accused pain and redness of the left eye and mild visual loss. The diagnosis of Interferon induced sarcoidosis was established. We are presenting this case because it illustrates the possibility of sudden and severe complications and we want to emphasize the importance of performing ophthalmological examination in patients treated with pegylated interferon α.

A Case of Bilateral Aseptic Necrosis of the Femoral Head.

Aseptic necrosis of the femoral head is a disease whose etiology is not completely elucidated and generally affects young adults aged between 30 and 50 years. In a significant number of patients bilateral disease occurs, which makes detection in its early stages constitute an important objective. We present the case of a male patient, aged 23 years, with the following risk factors: smoking and chronic alcohol consumption, who is diagnosed with aseptic necrosis of the left femoral head, ARCO stage IV, and in just six months after the diagnosis and hip arthroplasty, he suffers an injury which leads to the same diagnosis in the contralateral hip. We want to emphasize that for all patients with a high index of suspicion there should be an MRI examination, because the plane radiographs or CT are most often not relevant in detecting early signs of this condition. Diagnosis of aseptic necrosis of the femoral head in the early stages is a necessity in order to obtain an optimal result of conservative treatment.

Silicene beyond mono-layers--different stacking configurations and their properties.

We carry out a computational study on the geometric and electronic properties of multi-layers of silicene in different stacking configurations using state-of-the-art ab initio density functional theory based calculations. In this work we investigate the evolution of these properties with increasing number of layers (n) ranging from 1 to 10. Although a mono-layer of silicene possesses properties similar to those of graphene, our results show that the geometric and electronic properties of multi-layers of silicene are strikingly different from those of multi-layers of graphene. We observe that strong inter-layer covalent bonding exists between the layers in multi-layers of silicene as opposed to weak van der Waals bonding which exists between the graphene layers. The inter-layer bonding strongly influences the geometric and electronic structures of these multi-layers. Like bi-layers of graphene, silicene with two different stacking configurations AA and AB exhibits linear and parabolic dispersions around the Fermi level, respectively. However, unlike graphene, for bi-layers of silicene, these dispersion curves are shifted in the band diagram; this is due to the strong inter-layer bonding present in the latter. For n > 3, we study the geometric and electronic properties of multi-layers with four different stacking configurations, namely AAAA, AABB, ABAB and ABC. Our results on cohesive energy show that all the multi-layers considered are energetically stable. Furthermore, we find that the three stacking configurations (AAAA, AABB and ABC) containing tetrahedral coordination have much higher cohesive energy than the Bernal (ABAB) stacking configuration. This is in contrast to the case of multi-layers of graphene, where ABAB is reported to be the lowest energy configuration. We also observe that bands near the Fermi level in lower energy stacking configurations AAAA, AABB and ABC correspond to the surface atoms and these surface states are responsible for the semi-metallic character of these multi-layers.

Incidence of cholinesterase inhibitor therapy initiation among hospitalized patients.

BACKGROUND: Initiation of cholinesterase inhibitor (ChEI) therapy for delirium during hospitalization is ineffective and may be associated with increased morbidity and mortality. OBJECTIVE: To describe the incidence of initiating ChEI therapy during hospitalization. DESIGN: A retrospective cross-sectional study. SETTING: A tertiary-care academic medical center. PATIENTS: Inpatient admissions from September 2010 through March 2011 with ChEI administration. INTERVENTION: None. MEASUREMENTS: Incidence of ChEI exposure, initiation of ChEI therapy, initiation of antipsychotics and benzodiazepines, infection, in-hospital mortality, and hospital length of stay. RESULTS: The incidence of adult admissions with ChEI exposure and ChEI initiation was 23.2 (95% confidence interval: 21.2-25.4) and 2 (95% confidence interval 1.5-2.8) per 1000 admissions, respectively. Of 476 admissions receiving ChEI, 9% (n = 42) initiated therapy during the hospital stay and 91% (n = 434) continued on previously started therapy. Patients initiated on ChEI therapy frequently had infection (20 of 42) and were commonly initiated on antipsychotics (14 of 42) and benzodiazepines (13 of 42). Patients were hospitalized for a median of 2 days (interquartile range, 1-4) before initiation of ChEI and were exposed to therapy for a median of 3 days (interquartile range, 2-6). Of the 41 patients discharged from the hospital, 90% (n = 37) had orders to continue the ChEI postdischarge. CONCLUSIONS: Despite a lack of evidence to support the practice, 9% of patients who received ChEI therapy were initiated during the inpatient setting. These patients were not routinely screened for delirium and frequently received treatments associated with delirium.

Initiation of cholinesterase inhibitors in an inpatient setting.

We examined initiation of cholinesterase inhibitors (ChEIs) to determine whether ChEIs were being newly prescribed without sufficient evaluation for dementia and/or delirium and to explore whether there are differences in outcomes, such as mortality, hospital readmission rates, and duration of hospitalization, between patients newly started on ChEI and those who continued such medications prior to admission. Patients hospitalized in fiscal year 2008 and prescribed ChEI were identified. We reviewed electronic medical records. Of 282 patients, 15.6% (44) were new-starts and 84.4% (238) were continuations. Median length of stay was 16 days in new-starts versus 6 days in continuations (P < .05). Of new-starts, 38.6% were also treated of infection. Chart review additionally suggested possible treatment of delirium by initiation of benzodiazepines and antipsychotics in 11.4% and 22.7% of new-starts, respectively. We observed a substantive practice of initiating ChEIs in hospitalized elderly patients at risk of delirium. Although there was no difference in the 30-day mortality or readmission rates, new-starts were more likely to have a longer hospital stay than continuation patients.

P53 and Ki67 immunoexpression in mucinous malignant ovarian tumors.

Ovarian cancer is the fourth cause of death by cancer among women and the first mortality cause in gynecological neoplasia. Our goal was to evaluate p53 and Ki67 immunoexpression and also the correlations with tumor stage and type. The study included 45 primary ovarian malignant mucinous tumors, diagnosed in patients in the IV and VI decade. From the standpoint of histopathology, there were 28 cases of borderline mucinous tumors and 17 mucinous carcinomas, predominantly stage I of the disease. The immunostaining for Ki67 was positive in all the cases, the highest levels being recorded in mucinous carcinomas (22.2% medium index) compared to the borderline tumors (9.5% medium index). Opposed to Ki67, the immunoreaction for p53 was present in 37.7% of all the tumors, predominantly in mucinous carcinomas where the stain has high values (52.3% medium index) in contrast with borderline lesions (15.5% medium index). The study indicated significant differences in p53 and Ki67 immunostain in relation to the tumor stage and histological type, there being a direct correlation of the expression of both proteins, in the studied tumors. P53 and Ki67 are useful markers for evaluating aggressive tumoral behavior and differentiating between mucinous carcinomas and borderline mucinous tumors.

The implications of increasing age on erectile dysfunction.

Erectile dysfunction (ED) has long been correlated with psychological well-being. More recently, an understanding has developed of ED being, in some cases, a vascular condition of the penile artery. Given the narrowness of the penile artery, a small amount of atherosclerosis may result in ED before any other manifestations are evident, making ED a useful marker for other vascular conditions with potentially greater clinical implications. In light of this, possible underreporting of ED takes on added significance. A questionnaire regarding ED prevalence and management was distributed for self-administration to men in the waiting room of primary care clinics; the data were analyzed with a focus on the relationship between ED and age. The study had a remarkable response rate of >95%. The prevalence of ED in the ≥70-year age-group was 77%, compared with 61% in the 40- to 69-year age-group (p = .0001). ED correlated linearly with age (R(2) = .80, p < .0001). Among those who had ED, more than half had not discussed it with any provider; the likelihood of discussing ED did increase with the reported severity of symptoms (p < .0001). Older men had more severe ED than younger men (p < .0001). Furthermore, 72% of men with a history of ED were never treated. Younger men were more likely to be treated than older men (p = .004). Given the potential implications of underreporting ED, and the willingness of the men in this study to complete the questionnaire, further work may be merited on new models for ED assessment and follow-up.

Macroscopic and microscopic findings in avascular necrosis of the femoral head.

UNLABELLED: The avascular necrosis of the femoral head is an illness induced by the cutoff of blood flow to the femoral head and it affects mostly young adults between the ages of 30 and 50 years, raising therapeutic and diagnostic issues. Many risk factors are incriminated in the development of avascular necrosis of the femoral head like: trauma, chronic alcohol consumption, smoking, administration of corticosteroid drugs, most of the cases are considered to be idiopathic. The main goal of our paper is to describe the macroscopic and microscopic variations of the bone structure, which occur in patients with avascular necrosis of the femoral head. MATERIALS AND METHODS: The biological material needed for our study was obtained following hip arthroplasty surgery in 26 patients between the ages of 29 and 59 years, which previously were diagnosed with avascular necrosis of the femoral head and admitted in the Orthopedics Department of the Emergency County Hospital of Craiova (Romania) between 2010 and 2011. From a macroscopic point of view, we found well defined areas of necrosis, most of which were neatly demarcated of the adjacent viable tissue by hyperemic areas, loss of shape and contour of the femoral head and transformations of the articular cartilage above the area of necrosis. When examined under the microscope, we found vast areas of fibrosis, narrow bone trabeculae, obstructed blood vessels or blood vessels with clots inside, hypertrophic fat cells, bone sequestration but also small cells and pyknotic nuclei. The microscopic and macroscopic findings on the femoral head sections varied with the patients and the stage of the disease.