The Risk of Para-Aortic Lymph Node Metastases in Apparent Early Stage Ovarian Cancer.

Background and objectives: To identify the risk factors for para-aortic lymph node metastases in cases with presumed early stage ovarian cancer. Materials and methods: Between 2014 and 2019, 48 patients with apparent early stage ovarian cancer were submitted to surgery. In all cases, pelvic and para-aortic lymph node dissection was performed for staging purposes. Results: Among the 48 cases we identified nine cases with positive pelvic lymph nodes and 11 cases with positive para-aortic lymph nodes. The positivity of the retrieved lymph nodes was significantly correlated with the histopathological subtype represented by serous histology (p = 0.02), as well as with the degree of differentiation (p = 0.004). Conclusion: Patients with serous ovarian carcinomas in association with a poorer degree of differentiation are at risk of associated lymph node metastases even in presumed early stages of the disease. Therefore, lymph node dissection should be performed in such cases in order to provide adequate staging and tailoring of further treatment.

Primary Pleural Hydatidosis-A Rare Occurrence: A Case Report and Literature Review.

Introduction: The larvae of Echinococcus, a parasitic tapeworm, cause hydatid disease. The most commonly involved organ after the liver is the lung but there are cases of hydatid cysts in all systems and organs, such as brain, muscle tissue, adrenal glands, mediastinum and pleural cavity. Extra-pulmonary intrathoracic hydatidosis can be a diagnostic challenge and a plain chest x-ray can be misleading. It can also lead to severe complications such as anaphylactic shock or tension pneumothorax. The purpose of this paper is to present a severe case of primary pleural hydatidosis, as well as discussing the difficulties that come with it during diagnosis and treatment. Case Report: We present the case of a 43-year-old male, working as a shepherd, presenting with moderate dyspnea, chest pain and weight loss. Chest x-ray revealed an uncharacteristic massive right pleural effusion and thoracic computed tomography (CT) confirmed it, as well as revealing multiple cystic formations of various sizes and liquid density within the pleural fluid. Blood work confirmed our suspicion of pleural hydatidosis with an elevated eosinophil count, typical in parasite diseases. Surgery was performed by right lateral thoracotomy and consisted of removal of the hydatid fluid and cysts found in the pleura. Patient was discharged 13 days postoperative with Albendazole treatment. Conclusion: Cases of primary pleural hydatidosis are very rare but must be taken into consideration in patients from endemic regions with jobs that may have exposure to this parasite. Proper treatment, both surgical and antiparasitic medication, can lead to a full recovery and a low chance of recurrent disease.

Present tendencies of elective caesarean delivery in Romania: Geographic, social and economic factors.

The literature review was conducted to identify the causes of the rising incidence of caesarean section (CS) cases in Romania, and to create a database and a measurement plan to quantify the amount of CS on maternal request and the influence of geographical, social and economic factors. The review was conducted at the Department of Obstetrics and Gynaecology Clinical Emergency Hospital Sf Pantelimon, Bucharest, and comprised figures of clinical records of all patients who underwent CS between 2009 and 2014. The results showed an increase in the number of CS on maternal requests. In 2014 it reached a rate of 36.90 cases in every 100 newborn infants, which was 2.62% higher than 2013. Increasing rate of CS seemed to have resulted from a few factors, including the constant preoccupation to improve the obstetrical field in Romania; its services; the prophylactic measures in obstetrics; the trials to prevent the fear of the obstetrical malpraxis and its risks and consequences; and the fact that some obstetricians have done multiple CS deliveries on maternal requests.

Consistent Correlation between MTHFR and Vascular Thrombosis in Neonates-Case Series and Clinical Considerations.

BACKGROUND: MTHFR polymorphism has been inconsistently linked to thrombotic events-some studies have shown its contribution to venous thrombosis, arterial thrombosis, and ischemic stroke, whereas others have found no statistically significant correlation between them. METHODS: A descriptive case series study was performed in the Neonatal Intensive Care Unit of "Marie Sklodowska Curie" Emergency Clinical Hospital for Children in Bucharest, Romania. RESULTS: All patients had positive results for MTHFR variants; 14 patients were positive for compound heterozygosity, 13 patients for MTHFR C677T (seven of which were homozygous), and 13 patients for MTHFR A1298C (three of which were homozygous). Eighteen patients received anticoagulants (heparin, enoxaparin, or bivalirudin), and thrombolytics (alteplase) were administered in six cases. In one case, a thrombectomy was performed; in another, vascular plasty was undertaken. Only in six cases was complete revascularization possible. Incomplete revascularization occurred for one patient with a negative outcome. CONCLUSION: The particularity of this case series is that every patient in our unit who developed thrombi had a positive genetic result for MTHFR mutations. MTHFR mutations should be regarded as a thrombotic risk factor for critically ill patients, and screening for MTHFR mutations should be performed in every admitted patient to intensive care units, thus achieving the prevention of thrombi.

Ectopic Intrauterine Device Revealed by Ureteral Colic in a 37-Week Pregnant Woman: Case Report.

Copper T intrauterine devices (IUDs) are a popular long-acting reversible contraceptive method. The most common reasons for contraceptive failure are expulsion and extrauterine migration. We report a case of a 28-year-old female, G13P3, 37 weeks pregnant, who presented to the hospital for left abdominal flank pain. The patient was admitted for treatment of left ureteral colic. The woman went into labour, and Caesarean Section was performed due to foetal distress. During the surgery, an inspection of the peritoneal cavity revealed a copper IUD embedded in the granulous tissue located in the left lateral abdominal region, which was extracted. No uterine scar tissue could be identified macroscopically. The migration of an IUD in the abdominal cavity is a rare finding, and coexistence with third-trimester pregnancy is an infrequent but serious event due to potential visceral complications. Higher gravidity can be associated with an increased risk of IUD migration in women with a non-scarred uterus.

Synchronous arterial resection in pancreatic cancer: A case report.

Pancreatic cancer is one of the most lethal malignancies affecting people worldwide. As it is frequently diagnosed in advanced stages of the disease, the 5-year overall survival rate is <10%. Advanced stages are usually characterized by the local invasion of the superior mesenteric axis, celiac axis and portal vein and are considered a sign of unresectable cancer. The association between venous resections and survival outcomes has been widely reported. The effect of arterial invasion remains unclear as only isolated cases have been reported thus far. The present study investigated the preliminary experience in the field of arterial resection for locally advanced pancreatic cancer. Between January 2018 and January 2020 arterial resection was successfully associated with pancreatoduodenectomy in four cases. The mean age at the time of surgery was 48 years, and in all cases the indication of resection was represented by pancreatic head adenocarcinoma. Different types of venous resections were required in all cases. Postoperative reoperation was required in one case, while histopathological studies confirmed microscopic negative resection margins in all but one case. In selected cases, combined pancreatoduodenectomy with venous and arterial resection may be required to increase the chances of radical surgery.

Neonatal intensive care unit on-site surgery for congenital diaphragmatic hernia.

The present study presents the experience gained in the Newborn Intensive Care Unit (NICU) of 'Maria S. Curie' Emergency Clinical Hospital for Children in Bucharest (Romania) after performing a series of bedside surgery interventions on newborns with congenital diaphragmatic hernia (CDH). We conducted a retrospective analysis of the data for all patients operated on-site between 2011 and 2020, in terms of pre- and post-operative stability, procedures performed, complications and outcomes. An analysis of a control group was used to provide a reference to the survival rate for non-operated patients. The present study is based on data from 10 cases of newborns, surgically operated on, on average, on the fifth day of life. The main reasons for operating on-site included hemodynamical instability and the need to administer inhaled nitric oxide (iNO) and high-frequency oscillatory ventilation (HFOV). There were no unforeseen events during surgery, no immediate postoperative complications and no surgery-related mortality. One noticed drawback was the unfamiliarity of the surgery team with the new operating environment. Our experience indicates that bedside surgery improves the likelihood of survival for critically ill neonates suffering from CDH. No immediate complications were associated with this practice.

Use of platelet-rich plasma in the treatment of infertility in poor responders in assisted human reproduction procedures.

Couple infertility is a pathology with an absolute number of cases growing markedly over the last decade in connection mainly with the increased age of couples wishing to conceive. Platelet-rich plasma (PRP) is an alternative treatment used for several years for experimental purposes. Yet, this method is not yet defined as a standard therapeutic option in the infertility protocol for poor responders in assisted human reproduction procedures. Thus, the present study is a retrospective study conducted between February 2019 and February 2020 to evaluate the effect of ovarian PRP injection in patients with a poor ovarian response (POR) to ovarian stimulation. Women (n=20; age 31-44 years) diagnosed with POR based on the European Society of Human Reproduction and Embryology criteria underwent ovarian injection with autologous PRP injection. Markers of ovarian reserve before, during the following two menstrual cycles, and at six months after treatment were followed as well as stimulation and fertilisation parameters before and post-treatment. PRP treatment resulted in increased antral follicle count and serum anti-Mullerian hormone, while levels of serum follicle-stimulating hormone and luteinising hormone were decreased. These changes were more pronounced during the 2nd menstrual cycle following treatment. By six months following the injection, their values return to pre-treatment levels and any small differences were not considered statistically significant. The average dose of gonadotropin used and duration remained statistically unchanged, but a significant increase in estradiol achieved by the day of the human chorionic gonadotropin trigger day was achieved. The cancellation rate decreased following PRP treatment while the number of collected oocytes, number of oocytes in metaphase II rose. The number of embryos (of A and B quality) resulting also increased but fell short of the significance level set (α=0.073). Following the PRP injection, two singleton pregnancies were achieved, resulting in live births at term without complications during pregnancy. Another pregnancy was achieved spontaneously 45 months following the PRP and a failed assisted human reproduction procedure. Although the group included a small number of women, the results indicate the potential benefits of an ovarian autologous PRP injection in women with POR. Positive results appear to be short-term for 2-6 months after the procedure.

Investigating Caesarean Section Practice among Teenage Romanian Mothers Using Modified Robson Ten Group Classification System.

The Robson ten-group classification system is a recognized effective method of assessing caesarean rate. It is based on dividing patients into ten mutually exclusive groups, focusing on six maternal and newborn variables (parity, gestational age, plurality, foetal presentation, previous caesarean, and mode of labour onset). The aim of our analysis was twofold: first, to present the implementation of Robson classification in a pregnant teenage population; and second, to identify the indications for CS in the adolescent population. This study was designed as a one-year prospective analysis and considered all women younger than 20 years of age who delivered in a tertiary care hospital. Before discharge, women who had caesarean delivery responded to a questionnaire regarding their education, prenatal surveillance, and obstetrical history. Caesarean sections accounted for 47.01% of all births. A proportion of 24.57% of the participants had at least one previous caesarean section. Group 10 (all women with a single cephalic preterm pregnancy) was second most often identified among women in middle adolescence (14.03%); 32.20% of the participants in late adolescence were in group 5 (multiparas with a scarred uterus, single cephalic term pregnancy). Differences between the two age groups were not statistically different (p = 0.96). Abnormal cardiotocographic findings (38.23%), the arrest of descent (19.11%) and arrest of dilation (19.11%), were the most frequent indications for caesareans in Robson group 1. Neonates from mothers in Robson groups 8 (women with a multiple pregnancy) and 7 (multiparas single breech pregnancy) had the most unfavourable outcomes regarding gestational age at delivery and admission to the intensive care unit. We concluded that future focus on obstetrical management is mandatory in Robson groups 7 and 8. Adolescents in Robson group 1 (nulliparas, single cephalic term pregnancy, spontaneous labour) are the primary beneficiaries of strategies to reduce caesarean sections rates.

Review of the measles epidemic in children from Central Eastern Europe in the third millennium.

Measles is an extremely contagious viral disease. Even though a safe vaccine exists for this disease, it remains one of the leading causes of mortality and morbidity in infants and young children. We aimed to create a retrospective descriptive study in which to analyze the evolution of the measles epidemic at the European level. The documentation was carried out using European Centre for Disease Prevention and Control (ECDC) and World Health Organization (WHO) statistics. At the same time, we present the epidemic's evolution in Romania, using data provided by the Romanian National Institute of Public Health and Ministry of Health. European statistical data indicate a high number of patients diagnosed with measles both among children and adults. All European countries benefit from the measles vaccination in the form of the measles-mumps-rubella (MMR) trivaccine included in their National Vaccination Programme. The vaccination schedule varies from country to country. In the vaccination scheme, most European countries include two doses of the MMR vaccine among the pediatric population. Romania registered a limited number of cases of measles between 1980 and 2015 following the introduction of the measles vaccination in the National Vaccination Programme. Since 2005, the Romanian vaccination schedule includes two doses of MMR trivaccine, administered at 12 months and at 6-7 years. After 2015, as a result of a significant decrease in the number of vaccinated children, Romania is facing a major increase in the cases of measles. Consecutively, a measles epidemic was declared in 2016 and an additional dose of mandatory MMR trivaccine was introduced at the age of 9 months. After 4 years of this schedule of administration, starting with August 2020, the additional dose of MMR administered during infancy has been discontinued. We propose an analysis of the factors that influenced the downward evolution of the measles epidemic in Romania at the beginning of the third millennium. Issues related to the limitation of interpersonal contact in the context of the social distancing imposed by the Sars-CoV-2 virus pandemic are discussed. We consider necessary a detailed documentation of the percentage of new disease cases that will appear in the pediatric population in the near future, in the context of the resumption of daily activity after the reopening of nurseries, kindergartens and schools.

Assessment of Postpartum Depression in Adolescents Who Delivered during COVID-19 Social Restrictions: The Experience of a Tertiary Hospital from Bucharest, Romania.

In the context of the viral spread of COVID-19 in 2020, Romanian authorities declared national confinement for two months. Our country faces a public health issue regarding adolescent pregnancy. This study assessed the predisposition of teenage mothers to postpartum depression and the influence of the viral pandemic on their emotional status. This study enrolled patients 10 to 19 years old who delivered in our department between March-December 2020. Teenagers were attributed to the "lockdown group" (n = 30) and the "open group" (n = 171). All study participants agreed to take an interview based on a three-part questionnaire, including the Edinburgh Postnatal Depression Scale (EPDS). In the "lockdown group", 16.67% of patients felt stressed over the last year compared to 11.11% of individuals in the "open group", but there was no statistically significant difference between groups regarding overall EPDS scores (z value 0.51, Mann-Whitney U test). Predictable variables for postpartum depression were the use of cigarettes (OR = 1.08, 95% CI: 1.00-1.16), intended pregnancies (OR = 0.25, 95% CI: 0.09-0.68, p = 0.007) and absence of stressors in the last year (OR = 0.07, 95% CI: 0.02-0.30, p = 0.0002). More adolescents were stressed during confinement compared to those who delivered in the following time period; this aspect did not interfere with depression screening scores. A planned pregnancy, even during adolescence, can serve as a protective factor for postpartum depression.

A finite element analysis for predicting outcomes of cemented total knee arthroplasty.

The study was designed to assess the validity of a finite element analysis for predicting the behavior of cemented knee implant used in total knee arthroplasty (TKA), for different mechanical loads, and correlation with clinical outcomes of this procedure. We conducted computational simulations using finite element analysis of two situations: i) The ideal prosthetic component positioning; and ii) variable varus tibial malposition, but with a balanced knee. A total of 80 cemented TKAs performed on 70 patients were divided into two groups. Patients from one group required secondary asymmetric tibial recut for balancing the prosthetic knee and patients from the other group, did not. In regards to the results, we observed no differences upon analysis of the postoperative results of the Knee Society Score (KSS), the angle between the femur and tibia, the range of motion and frontal laxity between groups. The finite element analysis showed that in a 3˚ varus inclination of the joint interline, but with a balanced knee, the maximum contact stress, measured on the tibial plateau surface, increased by 11% compared to the value of mechanical alignment. In conclusion, analysis of the computational model using finite elements showed predictable results of cemented TKA for the different situations of mechanical loads.

Prognostic value of the location of submucosal uterine leiomyomas in infertility.

Submucosal fibroid location and size are predictive factors of impaired fertility. Submucosal fibroids cause infertility through several mechanisms including distortion of the endometrial cavity, increased uterine contractility, local inflammation and remodeling of the endometrial blood supply. This is a monocentric, retrospective, cross-sectional study, conducted in the Department of Obstetrics and Gynecology of 'Sf. Pantelimon' Clinical Emergency Hospital, analyzing patients from a 5-year period (January 2015-December 2019). In the present study, the relationship between different characteristics of the submucosal fibroids (among others, location and dimensions) and fertility (birth rates, early pregnancy loss rates) were investigated. This study identified that submucosal and intramural fibroids are risk factors for reduced birth rate compared with subserosal fibroids (P=0.02, RR=2.58, 95% CI 1.03-6.47; P=0.005, RR=1.18, 95% CI 1.02-1.35, respectively). In addition, G2 leiomyomas are risk factors for low birth rate compared with G0 and G1 fibroids (P=0.01, RR=1.95, 95% CI 1.05-3.60). Moreover, the presence of a subserosal fibroid was associated with an increased early pregnancy loss rate (P=0.01, RR=2.14, 95% CI 1.05-4.35). In conclusion, the location and degree of uterine cavity distortion are important factors that alter the normal development of a pregnancy and the birth rate.

Monaldi cavernostomy for lung aspergillosis: A case report.

Pulmonary aspergillosis in patients with respiratory failure can severely affect the pulmonary functional status and may aggravate it through pulmonary suppuration, by recruitment of new parenchyma and hemoptysis, which can sometimes be massive, with lethal risk by flooding the bronchus. The treatment consists of a combination of medical therapy, surgery and interventional radiology. In small lesions, less than 2-3 cm, medical therapy methods may be sufficient; however, in invasive forms (larger than 3 cm) surgical resection is necessary. Surgical resection is the ideal treatment; nevertheless, when lung function does not allow it, action must be taken to eliminate the favorable conditions of the infection. In such cases, whenever the lung cavity is peripheral, a cavernostomy may be performed. Four cases of lung cavernous lesions colonized with aspergillus, in which the need for a therapeutic gesture was imposed by repeated small to medium hemoptysis and by the progression of respiratory failure, were evaluated, one of which is presented in the current study. Cavernostomy closure can be realized either surgically with muscle flap or spontaneously by scarring, after closure of the bronchial fistulas by epithelization and granulation. There were no recurrences of hemoptysis or suppurative phenomena. There was one death, a patient with severe respiratory failure caused by superinfection with nonspecific germs. However, in the case presented in this study, the patient recovered following cavernostomy, which seems to be an effective and safe method for cases in which lung resection is not feasible.

Obstetrical Soft Tissue Trauma during Spontaneous Vaginal Birth in the Romanian Adolescent Population-Multicentric Comparative Study with Adult Population.

Romania is a country with high rates of adolescent births, associating scarce comprehensive obstetrical management with this specific population. This research aims to assess soft tissue trauma after vaginal birth in teenage mothers compared to their adult counterparts. A retrospective case-control study was conducted for one year in two hospitals. All vaginal deliveries were considered; the age cut-off value was considered at 20 years old for case and control groups. Lacerations were divided into three subgroups, considering the involved anatomical region; group I: labial and periurethral lacerations, group II: vaginal and perineal lacerations, and group III: cervical lacerations. There were 1498 women included in the study: 298 young mothers and 1200 adults. Teenagers were more likely to have an episiotomy during vaginal delivery compared to adult women: 56% versus 26.7% (p = 0.00, Pearson Chi-square) and a 1.89 times increased risk for developing additional group II lacerations: p = 0.01, Pearson Chi-square test with Bonferroni correction: OR = 1.89, 95% CI: 1.18-3.02. Group II lacerations were the most frequent type of birth trauma in both study groups. Fetal weight ≥4000 g was associated with a two times higher risk for vaginal and perineal lacerations when age criterion was not considered (OR = 1.98, 95% CI: 1.13-3.47, p = 0.01). The incidence of group I and II lacerations increased with age: from 0% and 9.1% between 10 and 14 years old to 6% and 26.2% between 18 and 19 years old. All groups of lacerations were more often identified in the case group, compared to the adult group. Fetal macrosomia and spontaneously ruptured membranes at admission could not be documented as risk factors for obstetrical injury in young mothers. Episiotomy performed in teenagers was not a protective procedure for group II lacerations.

Predictors of Burnout in Healthcare Workers during the COVID-19 Pandemic.

The purpose of this study was to identify the predictors of burnout in healthcare workers during the COVID-19 pandemic. Data were collected from March to June in 2020, during the COVID-19 pandemic, from employees of two Romanian hospitals. Five hundred and twenty-three healthcare workers completed a series of questionnaires that measured burnout, job demands, job resources, and personal resources. Among the respondents, 14.5% had a clinical level of exhaustion (the central component of burnout). Three job demands (work-family conflict, lack of preparedness/scope of practice, emotional demands), three job resources (training, professional development, and continuing education; supervision, recognition, and feedback; autonomy and control), and one personal resource (self-efficacy) were significant predictors of burnout, explaining together 37% of the variance in healthcare workers' burnout. Based on our results, psychological interventions during the COVID-19 pandemic for healthcare employees should focus primarily on these demands and resources.

Primary Leiomyoma of the Visceral Pleura: An Unexpected Occurrence.

BACKGROUND/AIM: Leiomyoma is a rare benign tumor originating from smooth muscle fibres. In the respiratory tract, these tumors are rare and in the pleura, cases are exceptional, with only a few reported so far. This is the main reason we decided to present this case of primary leiomyoma of the visceral pleura. CASE REPORT: We present a case of a 51-year-old asymptomatic patient who, during a routine medical examination using standard chest radiography, presented with a 3 by 2 cm homogenous mass in the right superior pulmonary area, tangent to the chest wall (same level with the 3rd rib). Further investigation using computed tomography (CT) in the chest confirmed the presence of a 31/18 mm solid mass in the right upper lobe, in contact with the parietal pleura. Surgery was performed for two reasons: i) removal of the tumoral mass and ii) establishing a histopathological diagnosis. Intraoperatively, a well-defined, homogenous, ivory white non-infiltrating mass was discovered in the right upper lobe on the visceral pleura and in close proximity to the minor fissure. The mass was removed with negative surgical margins and was left with healthy tissue. Histopathological examination and immunohistochemistry came as a surprise, establishing our diagnosis of leiomyoma. CONCLUSION: Primitive pleural leiomyoma must remain a possibility when considering the differential diagnosis of pleural tumors. The main course of treatment is complete surgical resection. In our case, long-term follow up did not present any local recurrence.

Neoadjuvant intraperitoneal chemotherapy for advanced stage gastric cancer (Review).

Gastric cancer remains one of the most lethal malignancies especially when diagnosed in advanced stages of the disease; most often patients diagnosed later during the progression of their disease will present a certain degree of peritoneal contamination such as positive peritoneal cytology or peritoneal metastatic nodules. In such cases most often they then progress to peritoneal carcinomatosis and succumb to the disease within one year. In order to increase the lifespan in such cases multiple therapeutic strategies have been proposed such as radical surgery and intraperitoneal heated chemotherapy or direct intraperitoneal chemotherapy followed by radical surgery. To date, the benefits of intraperitoneal heated chemotherapy at the time of resection have been widely investigated; however the method is still associated with increased rates of perioperative complications. Therefore, attention was focused on investigating the benefits of such procedures as neoadjuvant therapies followed by radical surgery. The aim of the present review was to examine the most efficient therapeutic strategies in advanced-stage gastric cancer such as neoadjuvant laparoscopic heated intraperitoneal chemotherapy, perioperative heated intraperitoneal chemotherapy and neoadjuvant systemic and peritoneal chemotherapy.

Pheochromocytoma as a rare hypertensive complication rarely associated with pregnancy: Diagnostic difficulties (Review).

This review provides a brief clinically relevant review of pheochromocytoma in pregnancy, to raise awareness among doctors in obstetrics and the aim is to serve as the first point of reference when confronted by their presence. Pheochromocytomas are neuroendocrine, catecholamine-secreting tumours. Despite having the highest incidence rate among other hormone-secreting adrenal tumours, they remain rare especially when associated with pregnancy. The non-specific presentation of pheochromocytomas, the difficulties in their diagnosis during pregnancy as well as the high maternal and fetal mortality rates associated with them, present a challenge. Clinical suspicion and meticulous patient history-taking remain the primary lines of defense, while biochemical proof of catecholamine excess (or their metabolites) and imaging-based localisation of the tumour are required for diagnosis. Antenatal diagnosis and complete localisation of the tumour increase the likelihood of successful outcomes for both mother and newborn. Magnetic resonance imaging (MRI) remains the method of choice during pregnancy without excluding the use of ultrasound. Treatment goals should include the avoidance of hypertensive crises while maintaining adequate uteroplacental circulation. The target blood pressure is not strictly defined but is in line with the general guideline addressing chronic hypertension during pregnancy. Antihypertensive medications remain the cornerstone in managing pheochromocytoma. As a first-line, the α-adrenergic, nonselective antagonist phenoxybenzamine is the most frequently used agent, while α1-selective adrenergic antagonists with or without the addition of ß- or ß1-blockers are also prescribed in certain cases, rendering calcium channel blockers as 'second-choice'. Blood-pressure control of the mother and the well-being of the fetus are determining factors in deciding the time of delivery, which is preferably conducted by Caesarean section. Excision of the tumour(s) remains the final treatment goal. Lifelong biochemical testing is required with or without medical treatment, to address mineralocorticoid or glucocorticoid deficits. Despite ever-improving positive outcome rates, pheochromocytoma associated with pregnancy remains a pathology with high mortality and morbidity rates.

Giant chondroid lipoma of the breast: A case report and literature review.

Chondroid lipoma is a rare benign lesion affecting the breast, in which the diagnosis of malignancy is difficult to be excluded during preoperative studies. In this respect, a correct histopathological diagnosis is mandatory in order to avoid overdiagnosis and subsequently overtreatment. In the present study, the case of a 61-year-old patient who self-referred for the development of a large tumor at the level of the left breast is reported. Biopsy raised the suspicion of a chondroid lipoma; thus, the patient was submitted to conservative surgery. The lesion was completely excised by performing a total mastectomy. The histopathological studies confirmed the presence of chondroid lipoma, with no signs of malignant transformation. At the 24-month follow-up interval no signs of recurrence were detected. In conclusion, although it may reach significant dimensions, giant chondroid lipoma of the breast is a benign lesion that may benefit from conservative treatment and does not recur.