Management and Treatment of Coxarthrosis in the Orthopedic Outpatient Clinic.

Coxarthrosis, or hip osteoarthritis (OA), is one of the main causes of hip pain, which can affect patients of all ages, being one of the most common reasons for patients presenting to the specialized outpatient clinic. The objective of our research was to determine the number of patients with coxarthrosis who presented to the Department of Orthopaedics and Traumatology within the Emergency County Hospital of Drobeta Turnu Severin, between 2017-2019, the sex, age, social environment of the patients. All patients underwent a thorough clinical examination to determine the risk factors, the favouring factors and their correlation with the paraclinical data obtained through imaging investigation (pelvis X-ray, computer tomography and nuclear magnetic resonance). The study included 462 patients, aged between 23 and 89 years old, who were diagnosed with varying degrees of coxarthrosis within the specialized outpatient clinic. The main risk factors were obesity, osteoporosis, chronic smoking, rural environment, female sex, the existence of a hip injury and intense physical exertion. The main purpose of the research was to analyse a series of data, which would bring information on the incidence, distribution by age groups, sex, living environment and professional activity of the population with coxarthrosis, in order to develop a therapeutic management as effective as possible.

Benign tumors of the superficial lobe of the parotid gland.

Tumors of the parotid gland are a rare occurrence among head and neck tumors (only 3-8%), and the vast majority are benign. Most benign tumors of the parotid gland are pleomorphic adenoma (PA), followed by Warthin's tumor (WT) and they occur in the superficial lobe. The only reasonable treatment is considered to be total tumor removal, but the appropriate surgical approach remains a matter of controversy. Over time, it went from enucleation to superficial parotidectomy (SP) and then to extracapsular dissection (ECD). SP is often considered to be the "gold standard"; however, the risk of intraoperative damage to the facial nerve (FN) cannot be ignored. Lately, ECD - which does not expose the main trunk of the FN - has been regarded as a safe technique for the treatment of small benign parotid tumors. PATIENTS, MATERIALS AND METHODS: The study retrospectively reviewed all parotidectomies for benign parotid tumors of the superficial lobe performed in the Department of ENT, Municipal Emergency Clinical Hospital, Timisoara, Romania, between January 2014 and December 2018. The following patient data were collected: age; sex; follow-up duration; extension of the resection; use of FN monitoring and lesion features, including position, pathology, and size. Preoperative investigation protocol included a computed tomography (CT) scan to assess the size and location of the tumor helping the treatment planning. The same surgical team performed both standard SP and ECD for the treatment of these tumors. All cases were confirmed as benign parotid tumors. Recurrences of any kind and tumors involving the deep lobe of the gland were excluded from the study. All patients underwent a macroscopically complete resection of the tumor. The main outcome was the postoperative complications in the two groups. Data regarding these complications were recorded on follow-up visits at one, six, 12 and 24 months. RESULTS: Ninety-five patients with benign parotid tumors were operated by the same surgical team at the Department of ENT, Municipal Emergency Clinical Hospital, Timisoara, between January 2014 and December 2018 but only 89 (38 men and 51 women) met the follow-up criteria and were included in the study. Sixteen (18%) patients underwent ECD, and 73 (82%) patients underwent SP as a primary intervention. The mean lesion size for ECD group was 2.0±0.9 cm and 4.2±1.7 cm in the SP group, and it was statistically significant (p<0.05). As expected, the most common type of tumor was PA but the distribution between the groups was different: in the SP group, PA represents 83% (61∕73) of cases but only 44% (7∕16) of cases in the ECD group. Median follow-up time was comparable in the two groups - 33±8 months for the ECD group and 39±11 months for the SP group. There were also differences between the two groups regarding the postoperative complication rate. There were significantly more transient and permanent FN paralysis, transient and permanent great auricular nerve (GAN) dysfunctions and Frey's syndrome (FS) in the SP group. CONCLUSIONS: A comparison between ECD and SP as surgical procedures for the treatment of benign tumors of the parotid seems inappropriate as their indications do not overlap. ECD showed similar effectiveness and fewer side effects than SP and can be considered the treatment of choice for small, superficial and/or marginal tumors located in the lateral lobe of the parotid gland.

Hepatic injuries resulting from chronic alcohol abuse identified by forensics.

Alcohol intake is largely spread all over the world, although it is well-known that it causes important changes of the liver, from liver steatosis, hepatitis to liver cirrhosis. The study we performed on 93 patients deceased in suspicious circumstances and brought to the Institute of Forensic Medicine, Iasi, Romania, confirmed through the determination of Ethyl glucuronide, that these were alcohol consumers. The macroscopic analysis during necropsy highlighted the presence of alcoholic liver disease (ALD), while microscopy studies confirmed the macroscopic observations. The immunohistochemical studies showed the existence of a chronic liver inflammation, the transdifferentiation of stellate hepatic cells, the activation of Kupffer cells, important changes of the hepatic vascular network, hepatocyte necrosis, lipid loadings and the progression of liver fibrosis process.

Systemic and adipose tissue inflammation in NASH: correlations with histopathological aspects.

INTRODUCTION: Non-alcoholic steatohepatitis (NASH) is a progressive form of liver steatosis that involves a risk of progression towards fibrosis, cirrhosis, and end-stage liver disease. Low-grade inflammation is recognized to be involved in non-alcoholic fatty liver disease (NAFLD) pathogeny. Additionally, adipose tissue dysfunction plays an important role in the development of metabolic diseases. PATIENTS, MATERIALS AND METHODS: We conducted a study on 68 patients with liver steatosis confirmed through liver biopsy during the surgery. In all the patients, we recorded anthropometric parameters and we performed blood tests for systemic inflammation [high-sensitivity C-reactive protein (hs-CRP), fibrinogen] and serum adipokines related to adipose tissue inflammation (leptin, adiponectin). Additional to histopathological examination, we also performed the immunohistochemical study of inflammatory mononuclear cells. RESULTS: The 68 patients had a mean age of 56.57±4.94 years old, had a mean value of hs-CRP of 2.30±0.91 mg∕L, a mean value of leptin of 14.02±17.02 ng∕mL and a mean value of adiponectin of 7.54±0.38 mg∕L. In all the cases studied by liver biopsy, the steatosis exceeded 5% of hepatocytes, but the frequency of NASH was 26.47%. Cluster of differentiation (CD)45-positive, CD4-positive, and CD8-positive T-lymphocytes predominated in the studied cases. We obtained a statistically significant high association between definite NASH and the values of hs-CRP, serum adiponectin and leptin∕adiponectin ratio (p<0.0001). CONCLUSIONS: Systemic and adipose tissue inflammation was statistically significant associated with histological lesions of steatosis and NASH, suggesting that the determination of hs-CRP and serum adipokines in dynamics in patients with NAFLD is predictive for the progression of the disease.

Triglyceride and glucose index: a useful tool for non-alcoholic liver disease assessed by liver biopsy in patients with metabolic syndrome?

INTRODUCTION: Non-alcoholic fatty liver disease (NAFLD) is associated with metabolic impairments, being a component of metabolic syndrome. Considering the involvement of fat accumulation and insulin resistance in NAFLD, triglyceride and glucose (TyG) index was proposed as a marker of NAFLD progression. The "gold standard" for the evaluation of liver lesions characteristic for NAFLD remains the liver biopsy. The aim of this study was to establish the links between TyG index, assessing insulin resistance, and histopathological lesions of liver samples obtained by liver biopsy in patients with metabolic syndrome. PATIENTS, MATERIALS AND METHODS: We conducted a study over a period of three years, including 113 adult patients with metabolic syndrome in whom hepatic disorders were assessed by liver biopsy and insulin resistance was evaluated by TyG index. RESULTS AND DISCUSSIONS: In our study, steatosis had a frequency of 92.03%, being identified 26 cases with mild steatosis, 48 with moderate steatosis and 31 with severe steatosis. Regarding non-alcoholic steatohepatitis (NASH), the frequency of this disorder in our study group was 29.2% in the subjects with liver steatosis, while liver fibrosis had a frequency of 53.09%. When we analyzed the relationships between TyG index and the presence of each type of lesion necessary for NASH diagnosis, we obtained statistically significant differences for the presence of hepatocyte ballooning (p=0.01) and a high statistically significance for the NAFLD activity score (NAS) (p<0.0001). CONCLUSIONS: TyG index is a facile tool that can be used to identify patients at risk for advanced NAFLD lesions evaluated by liver biopsy.

Hypertensive cardiomyopathy - histopathological and immunohistochemical aspects.

Arterial hypertension (AH) represents the main cause of morbidity and mortality all over the world. Approximately 40% of the adults aged over 25 years old and about 90% of the persons aged over 80 years old suffer from AH. It is a multifactorial condition, in whose etiopathogeny there are involved numerous genetic, metabolic and environment factors. In its turn, AH is one of the most important risk factors for heart disease, stroke, heart failure, kidney disease and peripheral vascular diseases. In hypertensive patients, it progresses into the left ventricle hypertrophy, as a result of some major changes of the cardiomyocytes, but also of the extracellular conjunctive matrix (ECM). We evaluated some histopathological and immunohistochemical changes induced by AH on some fragments of myocardium from the left ventricle. There was observed an increase of the ECM quantity, manifested by the expansion of the intercellular spaces, fibrillar collagen synthesis and its deposit in the perivascular and interstitial spaces, a significant reduction of the number of microvessels in the myocardium, the alteration of cardiomyocyte structure, by reducing the quantity of desmin and of the intercellular connections, by reducing cluster of differentiation 56 (CD56) (neural cell adhesion molecule 1 - NCAM1) immunomarker.

The process of liver fibrosis in chronic hepatitis C - histological and immunohistochemical study.

Liver fibrosis is one of the most serious histopathological (HP) lesions that, together with the inflammatory process and the hepatocyte lesions, determine the change of the liver architecture, having as a clinical result the onset of liver failure phenomena. Hepatitis C virus represents one of the most frequent conditions leading to the onset of liver fibrosis and favors the progression of the disease towards hepatocellular carcinoma. We evaluated the HP and immunohistochemical (IHC) aspects on fragments of liver biopsies taken from 104 patients diagnosed with chronic hepatitis C and altered capacity of work. In our study, we observed a growth of the portal (Kiernan) spaces by the presence of a chronic inflammatory infiltrate, the presence of collagen fibers and conjunctive matrix. The density and dimensions of collagen fibers were correlated with the severity of the liver disease, in the severe forms being highlighted porto-portal and porto-central fibrous bridges. The IHC examinations highlighted the change of the phenotype of perisinusoidal dendritic cells, the growth of the myofibroblast cells in the portal spaces, the growth of the macrophage number in the inflammatory infiltrate and of the Kupffer cells in the liver parenchyma.

Evaluation of Helicobacter pylori infection in patients with eso-gastro-duodenal pathology.

Helicobacter pylori (HP) infection is one of the most frequent bacterial infections in humans. The studies performed in the last 30 years showed that this bacterium is the main cause of chronic gastritis and the main etiological agent of peptic ulcer and gastric cancer. We investigated the prevalence of HP infection in a group of 1525 patients who addressed a gastroenterology medical center between 2010-2014, in Craiova, Romania, for dyspeptic symptoms. The patients underwent a clinical, endoscopic and serologic investigation for highlighting a possible HP infection. The age of the patients with gastric duodenal pathology varied between 16 and 87 years old. Of the 1525 patients, a number of 971 (63.67%) were diagnosed with HP infection, while the rest of 554 (36.33%) were not infected. The study on the distribution of gastric duodenal pathology and HP infection showed that the lesions of the upper digestive tract and HP infection emerged quite early, a number of 29 patients being aged less than 20 years old; among these, 21 (72.41%) patients were HP positive and only eight (27.59%) were HP negative. In the age group of 20-29 years old there were recorded 184 patients, of which 120 (65.22%) were HP positive and only 64 (34.78%) were HP negative. There may be observed that in the age group of 20-29 years old, both the patients with gastric duodenal pathology and the ones with HP infection increased six times in comparison to the first decade. Most cases were recorded in the patients aged between 50 and 69 years old. The two decades comprised a total number of 607 (39.8%) patients, of which 375 (61.78%) were HP positive and 232 (38.22%) were HP negative. By evaluating the distribution of HP infection according to the social environment, there was observed that there were no significant differences between the patients coming from the urban area and the ones from the rural area, as far as the HP infection was concerned.

Anatomo-clinical correlations in hepatic steatosis in patients with C chronic hepatitis.

Hepatic steatosis is a progressive liver disease, frequently met in chronic virus C hepatitis, playing an important role in its evolution towards fibrosis, necroinflammation and the final stage the hepatocellular carcinoma. The present paper studies the correlation between clinico-epidemiological parameters and the pathology test outcome in patients with hepatic biopsies carried out before they began the antiviral treatment. We used the classical histological staining and the immunolabeling. The presence of steatosis is not directly associated with clinico-epidemiological parameters and with the degree of fibrosis and inflammation.