[Peripheral nerve lesions of the lower leg due to tibiofibular ganglion]. / Periphere Nervenläsion am Unterschenkel durch tibiofibulares Ganglion.

Cystic formations around the knee are a common object of orthopedic treatment. When associated with neurological or vascular deficits further diagnostic imaging is required. This case study demonstrates the appearance of an intramuscular ganglion causing drop foot, arising from the tibio-fibular joint.

[Medical and sociodemographic aspects of domestic violence. Systematic evaluation of patient data from the emergency department of a maximum care hospital]. / Medizinische und soziodemographische Aspekte häuslicher Gewalt. Systematische Auswertung von Patientendaten einer Notaufnahme eines Krankenhauses der Maximalversorgung.

BACKGROUND: Injuries due to domestic violence are a frequent occurrence in emergency departments. Although domestic violence has been well analyzed from the sociological point of view, medical data concerning patterns of injuries are rare. METHODS: Victims of domestic violence who presented at the emergency department of a maximum care hospital were included in the study. Sociodemographic data and patterns of injuries were documented. RESULTS: Of the patients who presented at the emergency room 1.4 % suffered injuries due to domestic violence and 70 % were women who had been predominantly attacked by the (ex) partner. The male victims were predominantly attacked by friends. In 88 % the head and neck were involved. Male patients were attacked with objects (as a kind of weapon) more frequently than women. A migration background was documented in 45 % of the female and 30 % of the male patients. CONCLUSION: Patterns can be easily recognized: the victims were predominantly female and were attacked by the (ex) partner. Injuries were localized to the upper part of the body. No excessive violence with life-threatening or fatal injuries was observed.

[Carpal lesions associated with dislocated fractures of the distal radius. A systematic screening of 104 fractures using preoperative CT and MRI]. / Karpale Begleitläsionen bei dislozierter distaler Radiusfraktur. Eine systematische Erfassung durch präoperative CT- und MRT-Untersuchung.

BACKGROUND: The functional outcome of surgically treated dislocated fractures of the distal radius is limited and does not correlate with radiographic results. Additional carpal lesions are assumed to be the cause. This study has evaluated which carpal lesions are associated with dislocated fractures of the distal radius. MATERIAL AND METHODS: A total of 104 consecutive patients with dislocated fractures of the distal radius were included in the study. The injured wrist was examined by radiography, computed tomography (CT) and magnetic resonance imaging (MRI) to determine additional carpal lesions. RESULTS: Radiographically 51 of the 104 fractures presented as type A according to the AO classification, 10 as type B and 39 as type C. The CT scan detected that only 5 of the 51 type A fractures were exclusively metaphyseal fractures. All type A fractures were associated with ligamental lesions in MRI. CONCLUSIONS: The results of the study confirm the hypothesis that every dislocated fracture of the distal radius is a combined carpal trauma associated with additional osseous and/or ligamental lesions.

Effective teaching modifies medical student attitudes toward pain symptoms.

INTRODUCTION: Recent studies have raised the question of whether last year medical students and first year residents show an adequate attitude toward their patient's pain as reflected by prescribed pain medication. Underuse of analgetics could be demonstrated in several studies even after a correct diagnosis of pain was made and has led to the term "oligoanalgesia." Our study was aimed at evaluating the potential of improving student attitudes toward pain by changing the curriculum during the last year of medical education. METHODS: The study was designed as a prospective, randomized controlled, blinded cohort study. A recent change by law (2002) in the official curriculum ("Approbationsordnung") made it possible to compare two groups of last year medical students who were trained in different curricula during a 1-year transitional period. One group received special training on various aspects of pain and analgesic therapy (new curriculum), while the other group followed the conventional curriculum (old curriculum) without further special training. Both students and examiners were blinded toward the study target. Measurement parameters were a clinical experiment with standardized patients (OSCE) and a key features test. RESULTS: The study shows a considerable improvement of attitude toward pain in those students undergoing the new curriculum. This group demonstrated better OSCE results and significant improvement in key features tasks, and also outperformed the old curriculum group in the choice of analgesia. DISCUSSION: Our results confirm the importance of humanistic attitudes in future doctors in addition to the traditional implementation of knowledge and skills. Changes in the medical curriculum can positively influence these attitudes.

Demo-geographical data of myelodysplastic syndrome based on a large sample of patients from a Romanian Hematological Center.

PURPOSE: To present some retrospective data on the epidemiology of myelodysplastic syndrome (MDS) in Romania, in a large but well-defined territory and over a long period of time, as reflected by a large single-hospital based Registry. METHODS: The registration forms provided by the MDS Foundation were filled in with the data of the new adult primary MDS patients admitted in the Hematological Department of Fundeni Clinical Institute, Bucharest, during 1985-2004 and classified according to French-American-British (FAB) criteria. RESULTS: The study comprised 306 patients accrued from a delimited geo-administrative zone, 137 (45%) from Bucharest and 169 (55%) from the rest of the region. The results revealed male predominance, obvious increase of the crude and ≥60 years age group specific incidence temporal trend, nonnegligible proportion of the <50 years age group, similar distribution and temporal trend of both rural/urban areas and gender in all included counties, and no geographical and familial clustering. CONCLUSIONS: The increase of the MDS incidence in Romania appears not to be related to the ageing of the population but rather to: 1) the increasing addressability to health care of the elderly; 2) the greater awareness of the physicians on MDS; 3) the expansion of the hematological laboratories network; 4) the increasing number of hematologists and oncologists. The methodology used in this work, using a comprehensive analysis of the standard population, can allow a better comparison of the different MDS Registries of an European or regional network and of the data of the same Registry from different time intervals.

Laparoscopic splenectomy can induce significant improvement in hypoplastic myelodysplastic syndrome.

A 20 years old male patient was diagnosed as hypoplastic myelodysplastic syndrome (hMDS) - refractory cytopenia with multilineage dysplasia in November 2002. He received packed blood cells, methylprednisolon and dexamethason but no persistent improvement and even worsening of the thrombocytopenia and the appearance of neutropenia were registered. Laparoscopic splenectomy has been performed in January 2003, when the platelets were approximately 15000/mm3, without intraoperative incidents. After splenectomy, no other therapy or transfusions have been applied and a slow but continuous improvement of the peripheral blood counts up to normal values has been noted. In the bone marrow, a notable increase of cellular density was registered after more than three years from splenectomy, with the persistence of the other morphological dysplastic features.

Multiple myeloma in remission complicated by bone marrow granulomas.

BACKGROUND: Granulomas are encountered in 1-2% of biopsies performed in various hematological and non-hematological diseases. Almost 50% of bone marrow granulomas are associated with infections and 25% with hematologic disorders, especially lymphoma and multiple myeloma. Toxoplasmosis is reported to induce granulomas in bone marrow inmunosuppressed patients. On the other side, long-term unexplained remissions after conventional treatment in multiple myeloma were mentioned in up to 10% of cases. CASE REPORT: A 56-years-old female patient was diagnosed with IgG(kappa) multiple myeloma in 1992. After 5 years, being still in complete remission, frequent bone marrow epithelioid non-caseating granulomas were noticed in biopsy, without clinical symptomatology or modifications of routine paraclinical examinations. The history revealed no treatments with antiarrhythmic, antihypertensive, anticonvulsivants or nonsteroid antiinflammatory drugs. The serologic tests for other infections or systemic diseases known to induce granulomas were negative, except those for toxoplasma gondii IgG. The treatment with azithromycine and pyrimethamine induced the disappearance of granulomas, simultaneously with an important decrease of anti-toxoplasma IgG antibodies titer. CONCLUSIONS: The bone marrow granulomas provide a valuable histologic clue to opportunistic infections and the bone marrow biopsy is useful for their diagnosis. In the specific case of toxoplasmosis, a recently proposed treatment with azithromycin induced the resolution of the granulomas. Due to the usual lack of specificity of the most bone marrow granulomas, a broad and long-term clinical, histopatological and serological follow-up to establish the etiology should be performed.

Hypoplastic myelodysplastic syndrome transformed in acute myeloid leukemia after androgens and cyclosporin. A treatment.

The apparent contradiction between clonal expansion and marrow failure encountered in myelodysplastic syndromes (MDS) is more evident in hypocellular forms at presentation. Hypoplastic MDS (hMDS) appears to be a distinct clinicopathologic entity, accounting for about 15% from all MDS. The pathogeny is supposed to result from immunosupressive mechanisms and some observations on successful treatment with Cyclosporine A (CsA) are reported. The case of a young female patient diagnosed by bone marrow core biopsy with hMDS - refractory anemia (FAB and WHO classification) with normal karyotype and scarce CD34(+) cells by immunohistophenotyping is presented. She was treated with androgens followed by CsA for a few months and shortly after she developed an acute myeloid leukemia (M4) which responded to low-doses of daily oral melphalan. This is one of the first few reports on such an event during the immunosuppressive therapy in MDS and the possible explanations for this unusual evolution are discussed.

Clinical and hematological aspects of chronic myelomonocytic leukemia. Study on 20 cases from a single center from Romania.

Chronic myelomonocytic leukemia (CMML) has long been recognized as a disorder with both myelodysplastic and myeloproliferative characteristics, some patients showing clinical and morphological features resembling myelodysplastic syndrome (MDS) especially refractory anemia with excess of blasts (RAEB) with monocytosis, and others leukocytosis with neutrophilia, monocytosis and splenomegaly resembling myeloproliferative syndrome (MPS). The intrinsec differences determined at first the separation of CMML in two forms, one named "dysplastic", more similar with RAEB, and the other "proliferative", closer to chronic myeloid leukemia and then included by the recent WHO classification into a separate new created group--myelodysplastic diseases (MDD)/chronic myeloproliferative diseases (CMPD). The aim of this study was the analysis of some features of 20 cases of CMML, with emphasis on the differences between the two forms. The proliferative form of CMML differed from the dysplastic one by greater white blood cells and neutrophils counts (P < 0.001), a more important monocytosis in periferal blood (P = 0.07), and by the size and frequency of splenomegaly (P = 0.03). The sex and age of the patients, the frequency of the general symptoms, the frequency of the general symptoms and signs and that of infections, the hemoglobin and hematocrit values, the platelet counts, the percentage of myeloblasts and monocytes in bone marrow, the frequency of dysplastic traits, the percentage of reticulocytes and the modified Bournemouth prognostic index were not significantly different. These findings support the concept that CMML is a heterogeneous "overlap" syndrome between MDS and CMPD.

Autoimmune hemolytic anemia with warm antibodies complicated with an intercurrent attack of hemolysis with cold agglutinins in a case of Waldenström disease.

The paper presents a case of autoimmune hemolytic anemia (AIHA) with warm IgG antibodies associated with Waldenström's disease in which in the stage of compensated hemolysis after treatment, there appeared a severe hemolytic attack induced by transitory cold agglutinins with high thermal amplitude. The case described is a novelty by the intrication of two autoantibody populations which causes autoimmune hemolysis. The difference from other similar associations is discussed.

Serologic diagnosis in the differentiation of autoimmune hemolytic anemias.

A complex serologic study was carried out in 20 patients with autoimmune hemolytic anemias (AIHA). The methods used were: the direct Coombs' test with specific sera anti IgG, IgM, IgA and complement (C), the direct and indirect test with papain treated erythrocytes (at 37 degrees C), determination of cold agglutinin titer and of warm and cold hemolysins. By these investigations using indigenous sera, the 20 cases of autoimmune hemolytic anemia could be classified: a) according to the thermal behaviour of autoantibodies, into warm antibody AIHA -- 15 cases, cold antibody AIHA -- 2 cases and both warm and cold antibody AIHA -- 3 cases; and b) according to the sensitizing globulin, into: IgG type -- 10 cases, IgG + C type -- 7 cases, IgG + IgM + C type -- 1 case, type C + cold agglutinins -- 2 cases.

[Herpetic etiology of gastric and duodenal ulcer. II. Study in humans]. / Etiologia herpetica a ulcerului gastric si duodenal. Partea a II-a Studiu la om

By inducing experimental ulcers in the rabbit with the type 1 Herpes simplex strain, isolated from the herpes vesicles from a vagotomized patient, the authors demonstrate the protective role of vagotomy, the ulcerogenic capacity of the virus, which can be considered as an etiological factor of human gastroduodenal ulceration. They also discuss the possibilities for a new medical therapy of this disturbance.