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1.
Maedica (Buchar) ; 14(3): 196-202, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31798732

RESUMO

Objectives:The impact of the gestational changes on left ventricular contractility is not clearly defined. Our aim was to evaluate the subtle changes of left ventricular systolic function during pregnancy, assessed by new echocardiographic techniques, in a population tested for inherited thrombophilia. Material and methods:Eighty seven consecutive pregnant women, with a mean age of 32±4 years, genetically tested for inherited thrombophilia (22 with thrombophilic mutations and risk of thrombosis and 65 without significant mutations, considered as the control group) were included. All participants had four clinical and echocardiographyc visits: three during pregnancy (one in each trimester) and the forth six months after giving birth. Left ventricular (LV) systolic function was assessed from ejection fraction (EF) by 2D and 3D echocardiography, mitral annular velocities by tissue Doppler, and strain rate by 2D speckle tracking. Outcomes:There were no differences between groups for any of the echo parameters at each of the four visits. Comparing the third visit with the first one, all parameters of LV systolic function had significantly lower values at the end of pregnancy; EF decreased from 58% to 55% (2D echo), from 60% to 56% (3D TomTec), and from 58% to 55% (Auto4DLVQ), with p<0.001 for all three methods. Moreover, strain assessed by speckle traking decreased during pregnancy, with no differences between groups. In addition to this, mitral annular velocities obtained by tissue Doppler assessment decreased during the gestational period, with no differences between groups. At six months after giving birth, all values were normalized. Conclusion:During pregnancy, LV contractility has a slight decrease, with no criteria of systolic dysfunction. Thrombophilic mutations, with correct anticoagulant treatment, has no impact on LV systolic function.

2.
Rom J Morphol Embryol ; 60(2): 469-478, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31658320

RESUMO

Currently, Romania ranks first in Europe with regard to cervical cancer mortality. A new solution proposed for optimizing cytology-based screening, before seeing the risk associated with minor abnormalities results, is the use of molecular markers. This study concerns atypical squamous of undetermined significance (ASC-US) results, the grey zone of cytology that hides up to 15% high-grade lesions, to see how dual immunocytochemistry (ICC) staining for p16INK4a∕Ki67 help to better identify and manage high-risk (HR) ASC-US patients. We included and reviewed 183 cases with ASC-US results and p16INK4a∕Ki67 double staining (DS) performed in MICOMI Clinic (Bucharest) during 2014-2016. All patients were referred for colposcopy and biopsy if appreciated as necessary and followed-up at six and 12 months. One DS(+)∕HR human papillomavirus (HPV) negative case was positive for HPV73 Group IIB International Agency for Research on Cancer (IARC). The mean age for ASC-US in our study group was 32 years, with a median of 31 years and 31% of patients were aged 25-29 years. The sensibility of p16INK4a∕Ki67 double immunostaining was 100%, the specificity 88%, the positive predictive value (PPV) was 82%, and the negative predictive value (NPV) was 100%. The use of p16INK4a∕Ki67 ICC test optimizes the medical approach towards screening or monitoring especially in ASC-US HR HPV(+) young patients, unnecessary colposcopies are avoided thus invasive gestures at nulliparous are limited.

3.
Rom J Morphol Embryol ; 60(1): 307-317, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31263861

RESUMO

Metastatic colorectal cancer during pregnancy and postpartum is rather rare, but it represents major diagnostic and therapeutic challenges for obstetricians and surgeons. Cancer itself rarely affects the placenta or growing baby directly. However, metastatic disease is much more common than in nonpregnant patients and detecting cancer while pregnant can be complicated for both the mother and the health care team. In this article, we report a case of moderately differentiated colon adenocarcinoma in pregnancy that was diagnosed in an advanced stage, implying a complex diagnostic and therapeutic approach. The classic histological and immunohistochemical (IHC) study on this case reveals that tumorous areas have lost goblet cells and, implicitly, mucus; also, there are absent estrogen and progesterone receptors, possible causes of neoplasm in pregnancy, the rate of tumor proliferation is increased, the IHC reaction that highlights the protein responsible for cytoplasmatic anchoring of cadherins is intense positive, and the enzyme responsible for inflammation and pain is increased in these areas.

4.
Am J Ther ; 26(3): e364-e374, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30985485

RESUMO

BACKGROUND: Inherited (hereditary) thrombophilia is a genetic disorder that affects coagulation, being responsible for more than 60% of idiopathic (spontaneous or unprovoked) thromboembolic events. Association of inherited thrombophilia with pregnancy increases the risk of thromboembolic disease, and it may be related to many complications, such as preeclampsia, recurrent miscarriage intrauterine growth restriction, early detachment of placenta, and prematurity. AREAS OF UNCERTAINTY: Interpretation of a positive test for thrombophilia in pregnant women is difficult because they have many natural changes in the coagulation system. Genetic diagnosis of thrombophilia, after a thrombotic event or during a pregnancy complication, has a major importance, not only to define its etiology but also to determine the duration of anticoagulant treatment and risk stratification for prophylaxis treatment. DATA SOURCES: Literature search was performed using electronic database (PubMed) between April 1981 and November 2018. We used different keywords and MeSH terms to generate the most relevant results related to the inherited thrombophilia and its impact on pregnancy. RESULTS: Screening for inherited thrombophilia in young women is recommended in case of personal history of venous thromboembolism, first-degree relatives with a history of high-risk thrombophilia, or personal history of second-trimester miscarriage. Decision to recommend thromboprophylaxis with anticoagulant treatment in pregnant women with inherited thrombophilia is determined by history of venous thromboembolism, type and associated risk of inherited thrombophilia, and presence of additional risk factors. Low-molecular-weight heparins are the preferred agents for prophylaxis in pregnancy, while the doses vary depending on thrombophilia type, personal history, and associated risk factors. CONCLUSIONS: Association between 2 procoagulant conditions, inherited thrombophilia and pregnancy, has an important impact for the mother and fetus. This review will summarize the impact of each inherited prothrombotic factor on cardiovascular and pregnancy outcomes and will discuss the role of anticoagulation treatment for women diagnosed with inherited thrombophilia.


Assuntos
Anticoagulantes/uso terapêutico , Complicações na Gravidez/prevenção & controle , Trombofilia/complicações , Tromboembolia Venosa/prevenção & controle , Aborto Habitual/etiologia , Aborto Habitual/prevenção & controle , Feminino , Humanos , Período Periparto/sangue , Pré-Eclâmpsia/etiologia , Pré-Eclâmpsia/prevenção & controle , Gravidez , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/etiologia , Nascimento Prematuro/etiologia , Nascimento Prematuro/prevenção & controle , Fatores de Risco , Trombofilia/sangue , Trombofilia/tratamento farmacológico , Tromboembolia Venosa/epidemiologia , Tromboembolia Venosa/etiologia
5.
Rom J Morphol Embryol ; 59(3): 927-931, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30534835

RESUMO

Chondrosarcoma (CHS) is the third most common primary bone tumor after myeloma and osteosarcoma. Histologically, it is made of pure hyaline cartilage differentiation. The tumor itself may have myxoid modification and calcification. It occurs especially after 50 years, with an equal gender distribution. Most CHS are solitary, the etiology is still unclear and most of them are discovered accidentally. Early diagnosis is crucial for a good prognosis. In this paper, we would like to present a case of a female patient with an accidentally discovered CHS of the iliopubic and ischiopubic ramus of the pelvis. The purpose of this report is to highlight the importance of multidisciplinary management of tumor pathology, especially when the site of the tumor is surgically hardly accessible and to underline possible common genetic aspects of benign and malignant tumors.


Assuntos
Condrossarcoma/diagnóstico , Pelve/anormalidades , Adulto , Condrossarcoma/patologia , Feminino , Humanos , Pelve/patologia
6.
Drugs Context ; 7: 212510, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29445408

RESUMO

Background: The availability of various oral contraceptive (OC) pill formulations with different hormone compositions suggests that there is potential to align a particular product with an individual user's needs and preferences. To explore this concept further, a survey was conducted of current users of OCs to define and confirm areas of specific needs, and to gain insight into their views and preferences for OC formulations. Methods: During November and December 2015, women users (n=615) of OCs in five Central and Eastern European countries were surveyed in face-to-face interviews conducted by experienced interviewers. The survey questionnaire comprised 34 questions about the use of and specific needs for OCs. Results: Four basic needs of women taking OCs were identified: reliable contraception, reversibility of contraception, no effect on body weight and safety. Overall, 85% of surveyed women indicated that prevention of pregnancy was the main reason for taking OCs. Weight gain was the side effect of greatest concern with OC use (46% spontaneous answer; 65% aided answer). Independent behavioural segmentation analysis identified four groups - Solved Cycle Problems (46% of participants), Low Hormone Content (22%), Lifestyle (17%) and Beauty (14%) - which characterised the women according to needs and preferences beyond the basic needs of OCs. Each group had unique features and distinct preferences for different formulations of OCs. Conclusions: Aligning product advantages with specific individual needs may enhance users' overall experience with OCs as a contraceptive option.

7.
Rom J Morphol Embryol ; 58(3): 989-995, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29250679

RESUMO

Borderline tumors have a histological aspect of atypical epithelial proliferation without stromal invasion and typically occur in fertile ages, approximately one-third of women diagnosed are younger than 40. Serous borderline tumors are the most encountered and they can present micropapillary features that are associated with a higher rate of recurrence and the possibility of peritoneal implants. We present the case of a serous borderline ovarian tumor in a young patient and the diagnosis and treatment particularities. The patient presented with no symptoms, for a specialist advice, in the context of failure obtaining spontaneous pregnancy over a period of seven months. Paraclinical, the only modified parameter was CA 125, respectively a slight increase of its value. The atypical appearance on abdominal and transvaginal ultrasound indicated a presumptive diagnosis; both ovaries with multiple irregular vegetation, moderately vascular on Doppler examination, with the starting point in epithelial capsule shell, that appeared thick and hyperechogenic. About 7 cm of pelvic fluid was also present. During exploratory laparoscopic intervention, the surrounding tissue of both ovaries was biopsied and the fragments were sent for histopathological and immunohistochemical exam. Immunohistochemical assays correlated with the histopathological analysis and anatomical clinical data confirmed the diagnosis. After informed consent, the patient underwent radical surgery with a quick and uneventful recovery. The series of investigations had the objective to establish the best management of the case and reviewing the possibility of a conservative surgery. Patient clinical aspect matched with the patterns of ovarian borderline tumors by the asymptomatic presence of the bilateral adnexal masses.


Assuntos
Neoplasias Ovarianas/diagnóstico por imagem , Neoplasias Ovarianas/terapia , Ultrassonografia/métodos , Adulto , Feminino , Humanos , Neoplasias Ovarianas/patologia , Adulto Jovem
8.
Medicine (Baltimore) ; 96(46): e8735, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29145319

RESUMO

RATIONALE: Primary myelofibrosis is encountered with the myeloproliferative diseases and is the least prevalent among women of childbearing age. The prognosis is guided by pancytopenia, leukemic transformation and thrombosis which are the dominant complications. PATIENT CONCERNS: Data regarding protocol management during pregnancy in the context of myelofibrosis are insufficient. Fewer than ten cases have been described until now and half of this cases have resulted in fetal death due to placental infarction during the second and third trimesters. DIAGNOSES: We present the case of a 34-year-old pregnant woman diagnosed with Jak 2- negative primary myelofibrosis. Personal history did not include miscarriage or stillbirth. INTERVENTIONS: The patient was previously treated with anagrelide hydrochloride, which was interrupted at 6 weeks of gestation when the pregnancy was confirmed. It was replaced with Interferon-a 3 MU/day. Because of severe thrombocytosis, administration of aspirin 150 mg/day was recommended. OUTCOMES: The pregnancy was uneventful. The patient was hospitalized at 33 weeks of gestation because of moderate vaginal bleeding and high risk of preterm birth. After a specialized hematological investigation, the treatment with aspirin was replaced with low-molecular-weight heparin 0.6 ml per day. This combined treatment assisted in the natural tendency to lower platelet counts during pregnancy and resulted in stabilization of the hematological status. At 38 weeks of gestation the patient delivered a healthy baby boy via cesarean. He weight 2850 grams and his Apgar score was 9. Anticoagulant and interferon treatments were continued post-partum under hematologist surveillance. LESSONS: This case was rare and complex. Because it was related to pregnancy it required continuos collaboration and supervision between obstetrician and hematologist.


Assuntos
Aspirina/administração & dosagem , Fibrinolíticos/administração & dosagem , Heparina de Baixo Peso Molecular/administração & dosagem , Complicações na Gravidez/tratamento farmacológico , Mielofibrose Primária/tratamento farmacológico , Adulto , Cesárea , Quimioterapia Combinada , Feminino , Humanos , Nascimento Vivo , Gravidez , Resultado do Tratamento
9.
Med Ultrason ; 19(1): 66-72, 2017 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-28180199

RESUMO

AIM: To present the systematic ultrasonographic assessment in fetal osteochondrodysplasias and to evaluate the fetal MRI intake, as a complementary exploration to US, in the prenatal diagnosis and perinatal prognosis of fetal nonlethal osteochondrodysplasias. Material and methods: In this tertiary multicentre study were included 37 cases diagnosed prenatally with various entities in the category of nonlethal fetal osteochondrodysplasias. The initial diagnosis was carried out by the routine or detailed ultrasound examination. Fetal MRI was accomplished for selected cases. RESULTS: Nonlethal skeletal dysplasia was suspected and then diagnosed after 17 gestational weeks. The suspicion of osteochondrodysplasia as a reference diagnosis element has required systematic and thorough ultrasound examination. Fetal MRI is a valuable exploration, complementary to prenatal ultrasound bringing in very useful details for the diagnosis of osteochondrodysplasias. The global diagnosis of skeletal dysplasia depends to a great extent on the genetic or biochemical abnormality that causes them. CONCLUSIONS: US is always the fundamental screening exploration for fetal assessment in nonlethal osteochondrodysplasias. The details brought by the fetal MRI are useful, and the exploration is harmless for the fetus and the mother. Certain diagnosis cannot be accurate and complete without the contribution of genetics, maternal and fetal medicine, obstetrics or radiology.


Assuntos
Imagem por Ressonância Magnética/métodos , Osteocondrodisplasias/diagnóstico por imagem , Diagnóstico Pré-Natal/métodos , Adulto , Feminino , Humanos , Gravidez , Reprodutibilidade dos Testes , Ultrassonografia Pré-Natal , Adulto Jovem
10.
Rom J Ophthalmol ; 61(2): 83-89, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29450378

RESUMO

Ocular posterior pole modification are a pathological manifestation in complicated pregnancies, especially when pregnancy induced hypertension is present (PIH), as well as in preeclampsia (PE) or eclampsia. Nonetheless, as the pregnancy evolves, the possibility for an aggravated evolution with HELLP syndrome, disseminated intravascular coagulation, and idiopathic thrombocytopenic purpura may have an ocular manifestation that, mainly, implies a loss of visual field or acuity, that, left unattended, may constitute a permanent impairment. Pregestational conditions like pituitary adenoma or genetic pedigree for complement factor H gene (1q31.1) single nucleotide mutations could lead to central serous chorioretinopathy or retinal detachment with severe, ischemic, central cilioretinal artery or vein occlusion and optic nerve atrophy. Furthermore, although subtle in many cases, any new visual symptoms during pregnancy should constitute an alarming factor for obstetrical reevaluation and ophthalmological approach in order to preserve the mother's quality of life.


Assuntos
Síndrome HELLP , Complicações na Gravidez , Descolamento Retiniano , Coriorretinopatia Serosa Central , Feminino , Humanos , Gravidez , Qualidade de Vida
11.
Rom J Morphol Embryol ; 58(4): 1453-1460, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29556640

RESUMO

Body stalk anomaly (BSA) is a rare abdominal defect, generally considered to be lethal. Reported prevalence ranges from 0.4 to 3.2 per 100 000 live births. An early prenatal diagnosis offers the possibility of parental counseling and the termination of pregnancy. Also called limb-body wall complex, the anomaly is characterized by finding the intrathoracic and abdominal organs outside the cavity comprised by amnio-peritoneal membrane attached directly to the placenta and the umbilical cord short or absent. We report a case of BSA in a monochorionic-diamniotic twin pregnancy, diagnosed antenatal by the massive midline thoraco-abdominal wall defect, severe scoliosis and absent umbilical cord, presented at fetal ultrasound first trimester examination; portions of the heart, kidney and lung were contained into the placenta. The second fetus was echographically normal. At 18 weeks of gestation, a recommended amniocentesis exam was performed, an abnormal karyotype being excluded through this method. At 33 weeks of gestation, the patient presented with spontaneous preterm rupture of membranes. Delivery occurred by emergency Caesarean section for acute fetal distress; extracted first live fetus was admitted in the neonatal intensive care; the second live fetus with a severe thoraco-abdominal wall defect, fragments of organs included into the placental mass and severe reduction defect of the inferior right limb, deceased at 30 minutes from delivery. The fetus together with the placenta has been sent for histopathological exam. Clinical examination confirmed the diagnosis suspected by ultrasound examination. There are only a few reports in the literature about BSA in multiple gestations, and fewer about twin pregnancies in which only one fetus was affected by this condition.


Assuntos
Coluna Vertebral/anormalidades , Ultrassonografia Pré-Natal/métodos , Adulto , Feminino , Humanos , Gravidez , Gravidez de Gêmeos , Diagnóstico Pré-Natal
12.
Med Ultrason ; 18(4): 469-474, 2016 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-27981280

RESUMO

AIMS: The aim of the study was to evaluate the diagnostic ability of sonovaginography (SVG) with ultrasound gel in patients with endometriosis. MATERIAL AND METHODS: We conducted a multicentre prospective study, which included 193 patients with symptoms highly suggestive for endometriosis. All patients were investigated by transvaginal sonography and SVG with gel and afterwards underwent laparoscopic surgery. For each category of endometriotic lesions investigated, we calculated and compared the sensitivity, specificity,  positive predictive value and negative predictive value of the imagisticinvestigations used. RESULTS: In the case of endometriotic lesions of the uterosacral ligaments, SVG with gel had a sensitivity of 78.5% and a specificity of 96% (p=ns). The lesions of the vagina and rectovaginal septum were diagnosed with a sensitivity of 79%, respectively 94% (p=ns), obtaining a specificity of 99%, respectively of 97% (p=0.007). The lesions of the Douglas pouch were identified with a sensitivity of 81% (p=0.015), and those of the rectosigmoid with a 94% sensitivity (p=0.010). We obtained lower sensitivity (67%) in detecting the lesions of the urinary bladder (p=ns). CONCLUSIONS: SGV with ultrasound gel represents a useful investigation tool for the evaluation of endometriotic lesions in the posterior pelvic compartment.


Assuntos
Endometriose/diagnóstico por imagem , Endometriose/epidemiologia , Endossonografia/estatística & dados numéricos , Cremes, Espumas e Géis Vaginais , Doenças Vaginais/diagnóstico por imagem , Doenças Vaginais/epidemiologia , Adulto , Endometriose/patologia , Endossonografia/métodos , Feminino , Humanos , Aumento da Imagem/métodos , Prevalência , Reprodutibilidade dos Testes , Medição de Risco , Fatores de Risco , Romênia/epidemiologia , Sensibilidade e Especificidade , Doenças Vaginais/patologia
13.
Rom J Morphol Embryol ; 57(3): 995-1002, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-28002515

RESUMO

Endometrioid endometrial adenocarcinomas (EECs) are frequent genital tumors for which the clinical, imaging and histopathological integrated analysis is the basis of differential diagnosis and therapeutic attitude. This research represents a tertiary multicenter study including 58 cases examined histopathologically and immunohistochemically, surgically treated, on a five years period. The main characteristics of the patients in the study group are represented by the average age of 66 years, associated with obesity, hypertension, diabetes, history of infertility, early menopause, nulliparity or long-time oral contraception. The most important clinical sign was the menopausal or postmenopausal vaginal bleeding. The golden standard in the diagnosis of endometrial carcinoma is the dilation and curettage of the uterine cavity, followed by histopathological assessment. The association between transvaginal ultrasonography (TVUS) and endometrial biopsy increases to 100% the diagnostic sensitivity. The use of an antibodies panel that includes CK, ER, PR, vimentin can guide the diagnosis to EEC and the analysis of Ki67, p16, p53 and CEA immunoreactions can be useful both for EEC differential diagnosis and to assess the tumor aggressiveness. The interrelation between the accurate histopathological diagnosis and the adequate surgical staging is the cornerstone of curative therapy in the EEC.


Assuntos
Carcinoma Endometrioide , Neoplasias do Endométrio , Idoso , Carcinoma Endometrioide/diagnóstico por imagem , Carcinoma Endometrioide/patologia , Carcinoma Endometrioide/cirurgia , Neoplasias do Endométrio/diagnóstico por imagem , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Imuno-Histoquímica , Imunofenotipagem , Pessoa de Meia-Idade
14.
Rom J Morphol Embryol ; 57(1): 249-52, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27151716

RESUMO

Cephalopagus is a rare variety of conjoined twins. They are fused with their heads, thoracic and upper abdominal cavities. The exact mechanism for development of conjoined twins cannot be clearly explained. It appears that there is an alteration in the normal developmental process of monozygotic twins, which fail to separate from each other. We present the morphology of a cephalothoracopagus, revealed through anatomical dissection, emphasizing the arrangement of the viscera in the thoracic and abdominal cavities. They are fused with their heads, thoracic and upper abdominal cavities. The lower abdomen and pelvic cavities are free. Each twin has two upper and lower limbs, normally shaped. Each twin has a heart and two lungs. There is a single pharynx, esophagus and stomach, but normal lower abdominal systems. The genital and urinary systems are apparently normal. Due to the fusion of the heads and abnormal arrangement of the superior central nervous system, surgery is not attempted in these cases, the prognosis being very poor.


Assuntos
Anormalidades Múltiplas/patologia , Cabeça/anormalidades , Tórax/anormalidades , Gêmeos Unidos/patologia , Abdome/anormalidades , Humanos
15.
Roum Arch Microbiol Immunol ; 75(1-2): 12-7, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-29616528

RESUMO

Clostridium difficile is the agent of many cases of antibiotic associated diarrhea. The prevalence of the toxigenic Clostridium difficile strains was assessed by real-time PCR between May 2014- January 2015, at the Emergency University Hospital, Bucharest, Romania. The incidence of the Clostridium difficile infection was 0.47%. Among the 1119 stool specimens tested, 165 (13.8%) were positive for C. difficile toxins A and B by immunochromatography test. All 165 positive samples were investigated by real time PCR and 134 (81%) samples were positive for toxin B and for the binary toxin, while the rest were positive for toxin B. A high number of samples positive for binary toxin was recorded in the General surgery department (29.85%), Neurology (13.43%), and Internal medicine (12.68%). Many of the infected patients presented as underlying pathology, cancer, diabetes mellitus and stroke. A rapid decision concerning the antibiotic therapy was made, to decrease the risk of nosocomial spread.


Assuntos
ADP Ribose Transferases/genética , Proteínas de Bactérias/genética , Toxinas Bacterianas/genética , Infecções por Clostridium/epidemiologia , Clostridium difficile/isolamento & purificação , Enterotoxinas/genética , Genes Bacterianos , Vigilância da População , Adulto , Idoso , Idoso de 80 Anos ou mais , Cromatografia de Afinidade , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/microbiologia , Infecções por Clostridium/prevenção & controle , Clostridium difficile/classificação , Clostridium difficile/genética , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/prevenção & controle , Estudos Transversais , Feminino , Departamentos Hospitalares , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Romênia/epidemiologia , Sensibilidade e Especificidade
16.
Maedica (Buchar) ; 11(3): 241-244, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28694860

RESUMO

Two main causes of arterial thrombosis are known: fi rst - atherosclerosis, extensively studied, and the second - atrial fi brillation. The lack of any risk factors and the occurrence at young age of a thrombotic event requires us to investigate possible other conditions, including inherited thrombophilia that is represented by a series of genetic disorders that increase the risk of thromboembolic disease. The role of thrombophilia in the occurrence of arterial thrombosis is inconsequential; this disorder is characterized by the tendency of developing venous thrombosis. We present a rare case of a 29 year old woman that presents an arterial thrombotic event subsequent to the caesarean section. The patient had a positive familial history for thrombotic events and a cavernous sinus thrombosis in personal history. Prophylactic treatment with unfractionated heparin throughout pregnancy was applied. At 31 weeks gestation the patient underwent cesarean surgery for nonreassuring fetal status, 2 weeks fetal intrauterine growth restriction and absent diastolic fl ow of uterine arteries. Three days post operatory arterial thrombosis is suspected. The context that led to this suspicion was paresthesia, color modifi cation of the right leg and abolished popliteal pulse. Angiographic-CT confi rmed the presumptive diagnosis. A cardiovascular, conservatory treatment was successfully applied. Considering the particularities of the presented case we discuss the occurrence of arterial thrombosis postpartum in the context of confi rmed thrombophilia by reviewing the specialized literature.

17.
Maedica (Buchar) ; 11(4): 334-340, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28828053

RESUMO

Located under the cerebral hemispheres and draining the anterior and central regions of the brain into the sinus of the posterior cerebral fossa, the vein of Galen aneurysmal malformation is considered to be a rare cause of hydrocephaly. The presence of this condition in the neonatal period typically includes intractable heart failure and a poor prognosis. We report a case of aneurysm of the vein of Galen diagnosed prenatally at 28 weeks of gestation, with the delivery at term by caesarean section of a female infant. Sonographically, the vein of Galen appeared in the mid-sagittal plane, large, supratentorial, non-pulsatile; on color Doppler, the structure filled with bright color, reflecting a turbulent venous flow. A low grade of ventriculomegaly was present during the evolution of pregnancy; regarding the cardiovascular function, an intrauterine right cardiac insufficiency overlapped a tricuspid regurgitation and right atrial dilatation. A multidisciplinary committee decided a neonatal embolization of the aneurysm as an emergency requirement due to increased pulmonary hypertension developed in the next 24 hours after birth. After the embolization of the two main drainage vessels, the cardiac dysfunction persists. Two days later the evolution became unfavorable, leading to the necessity of the second embolization, which resulted in a 48 hours' coma and death, due to a cerebral hemorrhage secondary to thrombosis and fissure of the embolized aneurysm. The prognosis for the neonate with malformation of the Galen vein depends upon the severity of the cardiovascular status. Embolization represents actually the treatment of choice with the best results of these cases, but the mortality remains as high as 50 percent even in the most specialized centers of the world. As far as we know this is the only case of Galen aneurysmal malformation in Romania which beneficiated of embolization by interventional treatment in neonatal period.

18.
Maedica (Buchar) ; 11(2): 115-121, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28461830

RESUMO

INTRODUCTION: Endometrial hyperplasia represents a diversified set of disorders which has challenged pathologists for decades. Due to its high likelihood of progression to carcinoma, endometrial intraepithelial neoplasia (EIN) demands prompt and specialized intervention. MATERIALS AND METHODS: This 15-month (September 2014 - November 2015) retrospective analysis involved 258 cases of female patients with atypical and non-atypical endometrial hyperplasia investigated and treated at the University Emergency Hospital in Bucharest, Romania. Our purpose was to evaluate the histopathological, immunohistochemical and therapeutical aspects of premalignant endometrial lesions as well as their concurrence with endometrial carcinoma. RESULTS: Our findings indicate that 23% of the women preoperatively diagnosed with atypical hyperplasia were found with endometrial carcinoma on the hysterectomy specimen. Surprisingly, we identified two cases of atypical hyperplasia with focal p53 expression. Mutation of p53 is a late genetic event seen in endometrial carcinoma which does not usually occur in EIN. Interestingly, these cases did not present endometrial carcinoma on the hysterectomy specimen. CONCLUSION: All female patients diagnosed with EIN have an increased risk of developing endometrial carcinoma, as there are no histologic subdivisions or grades of atypical hyperplasia to further stratify risk for malignancy. Therefore, we emphasize the importance of accurate detection of premalignant endometrial lesions and exclusion of a coexisting endometrial carcinoma as mandatory prerequisites for proper medical management.

19.
Maedica (Buchar) ; 11(1): 80-83, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28465758

RESUMO

Fraser syndrome is a rare autosomal recessive genetic disorder characterized by major features such as cryptophthalmos, syndactyly, malformations of the larynx and genitourinary tract, craniofacial dysmorphism, orofacial clefting, mental retardation and musculoskeletal anomalies. In total, about 150 affected patients have been described in the literature. The diagnosis of this syndrome can be established after clinical examination. We present the clinical findings of a rare case of Fraser syndrome with lethal phenotype due to bilateral renal agenesis in a female stillborn.

20.
Rom J Morphol Embryol ; 57(4): 1375-1381, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-28174807

RESUMO

Vulvar malignant melanomas are extremely rare neoplasms, representing less than 3% of all cancers in women, 9% of all external genital tract malignancies and 9% of all primary vulvar malignancies. We present the case of a 60-year-old Caucasian patient, who has been admitted in the Clinic of Obstetrics and Gynecology with polymorphic, vulvar local, pelvic-abdominal, genitourinary and general symptoms, being diagnosed with nodular and superficial spreading vulvar melanoma and multiple voluminous uterine leiomyoma with various degenerations. Our study presents the approach of this case in terms of surgical pathology, management, prognosis and outcome. Surgical treatment is the central element of therapeutic management. Vulva melanomas are in general a relatively unpredictable unfavorable prognosis. The sizes of the tumor, the thickness and micro-staging are essential factors for prognosis.


Assuntos
Abdome/patologia , Melanoma/terapia , Neoplasias Cutâneas/terapia , Neoplasias Vulvares/terapia , Feminino , Humanos , Melanoma/patologia , Melanoma/cirurgia , Pessoa de Meia-Idade , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/cirurgia , Neoplasias Vulvares/patologia , Neoplasias Vulvares/cirurgia
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