Paragangliomas and Anemia: Literature Review and Case Report.

Paragangliomas are rare neuroendocrine tumors that arise from the extra-adrenal autonomic paraganglia, i.e., small organs consisting mainly of neuroendocrine cells that are derived from the embryonic neural crest and have the ability to secrete catecholamines. Paragangliomas can derive from either parasympathetic or sympathetic paraganglia. Most of the parasympathetic ganglia-derived paragangliomas are nonfunctional, and symptoms result from mass effect. Conversely, the sympathetic paragangliomas are functional and produce catecholamine. Although such patients could have symptoms similar to pheochromocytoma, mass effect symptoms, or non-specific symptoms, being benign tumors, they can also present with anemia, specifically iron-deficiency anemia. Considering that neoplastic pathology is chronically accompanied by moderate, normochromic, normocytic anemia, association between paragangliomas that are mostly benign but with a potential degree of malignancy and anemia is not as frequent as expected, with only 12 cases reported in the literature. We report a case of a 54-year-old female patient diagnosed with a paraganglioma of the carotid glomus accompanied by severe normochromic, normocytic anemia, which reached normal limits after excision of the paraganglioma.

High bilateral fenestration of the internal jugular vein.

Duplications and fenestrations of the internal jugular vein (IJV) are rare anatomic variations. There were previously found mostly unilateral fenestrated internal jugular veins, either empty, or traversed by the spinal accessory nerves. It was documented the computed tomography angiogram of a 65 year-old female patient and bilateral high fenestrations of the IJVs were found. On both sides, the superior ends of the fenestrations were in the jugular foramina. On the right side the fenestration had 3.8 cm length and was located in front of the transverse processes of the first two cervical vertebrae. On the opposite side the fenestration had 1.5 cm length and was antero-lateral to the transverse process of the atlas vertebra. On both sides the antero-medial arms of the fenestrations received the inferior petrosal sinuses and anterior condylar veins. Such highly placed fenestrations of the IJVs should be carefully documented either preoperatively, or prior to central venous access.

A Rare Entity-Percutaneous Lead Extraction in a Very Late Onset Pacemaker Endocarditis: Case Report and Review of Literature.

The number of infections related to cardiac implantable electronic devices (CIEDs) has increased as the number of devices implanted around the world has grown exponentially in recent years. CIED complications can sometimes be difficult to diagnose and manage, as in the case of lead-related infective endocarditis. We present the case of a 48-year-old male diagnosed with Staphylococcus aureus device-related infective endocarditis, 12 years after the implant of a single chamber pacemaker. A recent history of the patient includes two urinary catheterizations due to obstructive uropathy in the context of a prostatic adenoma, 2 months previously, both without antibiotic prophylaxis; no other possible entry sites were found and no history of other invasive procedures. After initiation of antibiotic therapy according to antibiotic susceptibility testing, we decided to remove the right ventricular passive fixation lead along with the vegetation and pacemaker generator; because of severe lead adhesions in the costoclavicular region, and especially in the right ventricle, we needed mechanical sheaths to remove the abundant fibrous tissue that encompassed the lead. After a difficult, but successful, lead extraction along with a large vegetation and 6 weeks' antibiotic therapy, the clinical and biological evolution was favorable, without reappearance of symptoms. While very late lead endocarditis is a rarity, late lead-related infective endocarditis (more than 12 months elapsed since implant) is not an exception; this is why we find that endocarditis prophylaxis should be reconsidered in certain patient categories, our patient being proof that procedures with neglectable endocarditis risk according to the guidelines can lead to bacterial endocarditis.

Implantation of a Dual-Chamber Automatic Cardioverter Defibrillator in a Patient with Persistent Left Superior Vena Cava: Case Report and Brief Literature Review.

Persistence of the left superior vena cava (PLSVC) is a congenital anomaly reported in 0.3-0.5% of patients. Due to the multiple and complex anatomical variations, transvenous lead placement can become challenging. We report the case of a 47-year-old patient diagnosed with non-ischemic dilated cardiomyopathy with reduced left ventricular ejection fraction (LVEF-27%), who was referred to our clinic for implantation of a dual-chamber cardioverter defibrillator for primary prevention of sudden cardiac death. During the procedure we encountered an abnormal guidewire trajectory and after venographic examination we established the diagnosis of persistent left superior vena cava. After difficult implantation of a 7F defibrillation lead through the coronary sinus, we managed to place the atrial lead through a narrow brachiocephalic vein into the right atrial appendage. In this paper, we aim to illustrate the medical and technical implications of implanting a cardioverter defibrillator in patients with PLSVC, highlighting the benefit of identifying and utilizing both the innominate vein, and the left superior vena cava and coronary sinus for placement of multiple leads, which would otherwise have been impossible.

Non-nutritive sucking recorded in utero via fetal magnetography.

Several studies in term and pre-term infants have investigated the rhythmic pattern of non-nutritive sucking (NNS) indicating correlations between the quantitative measures derived from sucking pressure variation and/or electromyographic (EMG) recordings and a range of factors that include age, perinatal stress and sequelae. In the human fetus, NNS has been reported from 13 weeks of gestation and has been studied using real-time Doppler ultrasonography exclusively. The present study indicates that NNS in fetus can be reliably recorded and quantified using non-invasive biomagnetic measurements that have been recently introduced as an investigational tool for the assessment of fetal neurophysiologic development. We show that source separation techniques, such as independent component analysis, applied to the high-resolution multichannel recordings allow the segregation of an explicit waveform that represents the biomagnetic equivalent of the ororhythmic sucking pressure variation or EMG signal recorded in infants. This enables the morphological study of NNS patterning over different temporal scales, from the global quantitative measures to the within burst fine structure characterization, in correlation with the fetal cardiac rhythm.

Clinical-Morphological Aspects in Spinal Tuberculosis.

Osteoarticular tuberculosis (OATB) Aim: The authors made a clinical morphological assessment of tissue samples from patients admitted in Surgical Departments of the Emergency County Hospital of Craiova, Romania, between 1990 and 2015, proved as presenting tuberculous lesions of the spine in the Department of Pathology of the same Hospital. MATERIALS AND METHODS: The studied material consisted of bone, joint and sometimes muscle tissue fragments resulted from biopsies or surgical excisions from 7 cases coming out of 54 patients investigated in the above-mentioned period of time, where the established histological diagnosis was tuberculosis (TB). For diagnostic confirmation, Ziehl-Neelsen staining has been used as a rule but, in some cases, immunohistochemistry was also used. RESULTS: TB lesions have prevailed in men and around the age of 50 years. Thoracic segment of the spine was the most involved. Epithelioid and giant Langhans cells dominated the inflammatory cellular population. Necrosis was always present, usually in its classical acidophilic form. Fibrosis was almost always absent. On the whole, the granulomatous reaction was in almost half of the cases hyporeactive and disorganized. CONCLUSIONS: The clinical morphological profile of our series is fitting with data described in the literature. Because of its life threatening potential, spinal TB should be investigated thoroughly especially in its morphological features in order to obtain as quickly as possible an etiological diagnosis.

Magnetographic assessment of fetal hiccups and their effect on fetal heart rhythm.

Fetal hiccups emerge as early as nine weeks post-conception, being the predominant diaphragmatic movement before 26 weeks of gestation. They are considered as a programmed isometric inspiratory muscle exercise of the fetus in preparation for the post-natal respiratory function, or a manifestation of a reflex circuitry underlying the development of suckling and gasping patterns. The present paper provides the first evidence of non-invasive biomagnetic measurements of the diaphragm spasmodic contractions associated with fetal hiccups. The magnetic field patterns generated by fetal hiccups exhibit well-defined morphological features, consisting of an initial high frequency transient waveform followed by a more prolonged low frequency component. This pattern is consistent across recordings obtained from two fetal subjects, and it is confirmed by signals recorded in a neonatal subject. These results demonstrate that fetal biomagnetometry can provide insights into the electrophysiological mechanisms of diaphragm motor function in the fetus. Additionally, we study the correlation between hiccup events and fetal cardiac rhythm and provide evidence that hiccups may modulate the fetal heart rate during the last trimester of pregnancy.

Cardiac vectors in the healthy human fetus: developmental changes assessed by magnetocardiography and realistic approximations of the volume conductor.

This study sought to characterize the developmental changes of three measures used to describe the morphology of the fetal cardiac vector: QRS peak-amplitude, QRS duration and QRS time-amplitude integral. To achieve this objective, we rely on a recently developed methodology for fetal cardiac vector estimation, using multichannel fetal magnetocardiographic (fMCG) recordings and realistic approximations of the volume conductors obtained from free-hand ultrasound imaging. fMCG recordings and 3D ultrasound images were obtained from 23 healthy, uncomplicated pregnancies for a total of 77 recordings performed at gestational ages between 22 and 37 weeks. We report the developmental changes of the cardiac vector parameters with respect to gestational age and estimated fetal weight, as well as their dependence on the estimated ventricular mass derived from cardiac dimensions measured with M-mode ultrasound. The normative values can be used along with the cardiac time intervals reported by previous fMCG studies to assist future clinical studies investigating conditions that affect fetal cardiac function.

Pathologic crossroads: cardio-vascular diseases, periodontal diseases and calcium antagonists.

RATIONALE: During the last decennium a more focused attention has been directed to the presence of chronic inflammation in cardiovascular diseases (CVD), but mainly to the high impact that this one has in generating and fastening the atherosclerotic process. OBJECTIVE: To highlight the causal relationship between periodontal diseases (PD) and CVD. One of the most important chronic inflammations, present in the modern societies in the vast majority of the population, is represented by the periodontal diseases (PD). Both types of diseases are characterized by a high and continuously increasing prevalence. It is now clear that they share some common risk factors, but it would be of great interest, not only for a scientific purpose, but also from a possible health benefit, as PD can be prevented and treated efficiently, to prove that there is a causal link between these two pathologies. METHODS: We will present a review of the actual data concerning their relationship. DISCUSSION: The study of this causal relationship is made more difficult due to the increased utilization, due to the guides' recommendations of the calcium antagonists (CA) in treating CVD.

[Formolization of the bladder mucosa for hemostatic purposes]. / Formolizarea în scop hemostatic a mucoasei vezicale.

The authors have used formalin solutions for the control of haematuria induced by bladder tumours. The 10 percent solution was efficient but induced severe side effects, such as peritonitis due to vesical necrosis, urethral fistulae, etc. The 1 percent solution is also efficient, and the local aggressivity is practically lacking, provided only 1--3 applications are carried out. The method should be used only in cases of haematuria that cannot be stopped by classical conservative means and in which surgery is not indicated, either temporarily or definitively.

Morphogenesis and pathogenesis of chronic lung diseases. XVIII. Influence of cyclophosphamide on the evolution toward fibrosis of experimental lung granulomas: a quantitative analysis.

The stereotyped evolution toward fibrosis of lung granulomas induced in rabbits by an intravenous injection of the complete Freund adjuvant was analysed under the influence of a prolonged treatment with cyclophosphamide. While the histopathological picture of untreated rabbits showed a progressive evolution toward fibrosis of experimental lung granulomas, cyclophosphamide administration (1.5 mg/kg body, daily for three weeks) reduced the number of granuloma cells on the surface unit and the density of reticulin fibrils up to statistically significant values.

Morphogenesis and pathogenesis of chronic lung diseases. XX. Effects of repeated hypersensitivity reactions upon experimental immuno-granulomas of the lung.

In order to analyse the effects of repeated hypersensitivity reactions upon chronic lung lesions, lung granulomas were experimentally induced in rabbits by an intravenous injection of 1 ml of the complete Freund's adjuvant added with 10 per cent human gammaglobulin. Groups of rabbits with 14- and 21-day-granulomas were intratracheally challenged with 1.000 I.U. human gammaglobulin injected two or three times at 7-9 days interval. The responses of the lung tissue were of the Arthus type with neutrophil granulocytic accumulations and proteasic action; the intensity of cell accumulations was decreasing after the 2nd and 3rd challenge. The lesional evolution after challenge showed intra- and perigranulomatous infiltrations with alkaline-phosphatase positive lymphocytes and plasma cells. The density of the intragranulomatous reticulin network developed after the hypersensitivity reactions increased progressively and was morphometrically assessed as statistically significant. Cellular and fibrillar lesions led to the restructuring of the lung tissue.

[Aetiological aspects of uveitis (author's transl)]. / Aspects étiologiques des uvéites.

An analysis of the probable aetiology of 222 cases of uveitis. In order of frequency the aetiology was: infectious focis 31%, rheumatism 28%, tuberculosis 7.6%, streptococci 4%, viral 3.6%, rickettsia 1.3%, syphilis, brucellosis in 0.5%. In 22.1% of cases the aetiology was not established. In young subjects the majority consisted of bacterial and viral infections particularly streptococcal. In adults the most frequent aetiology was rheumatic and in the elderly foci of infection.

Primary sideroblastic anemia masked by bleeding.

A patient with characteristic features of iron deficiency was unexpectedly found to have circulating siderocytes. Bone marrow iron stain at this time showed absence of both hemosiderin and ringed sideroblasts; electron microscopy revealed absence of mitochondrial iron loading but presence of cytoplasmic ferritin in normoblasts. Replenishment of iron stores led to development of typical sideroblastic anemia. These observations suggest that increased percentage of siderocytes in otherwise typical iron deficiency anemia may signify the presence of a sideroblastic process masked by iron deficiency due to bleeding.

[Volvulus of the gallbladder]. / Volvulusul de vezicula biliara.

An observation is presented concerning a volvulus of the gallbladder, a rare cause of acute abdomen. This affection is mostly encountered in aged people or in those with various background diseases, and its development is favoured by the presence of congenital malformations, visceral ptoses, or by exaggerated intestinal peristaltism. The preoperative diagnosis is only exceptional and indications for surgical intervention are made on the basis of signs suggesting peritoneal irritation, or the presence of a "tumor" in the right flank. Cholecystectomy, facial in most of the cases is followed by full recovery in all the cases when the intervention is performed at an early stage.

Bronchiolar pathology. IV. a morphometric analysis of the incidence and location of lesions induced in rabbits by intratracheally injected detergent solutions.

An experimental model of bronchiolar lesions was elaborated. It consisted of three intratracheal administrations in rabbits of 2 ml of a 3 per cent detergent solution, pH 2.5-3; the adequate development of the process was induced when the second injection was given 48 h after the first and the third on days 5-6. The induced process evolved during three phases: a) hypertrophy with hyperfunction of Clara cells, cell beheading by apo- and merocrinia and denudation of basement membranes; b) lesions of subepithelial components, mainly of capillaries, with granulative response and restructuration of the peribronchiolar tissue, and c) tardy regenerative response of epithelial cells, sometimes with neoformation of bronchioli. The morphometric analysis of this experimental process asserted the validity of the model which led to damages involving at less 70 per cent of the bronchioli (under 200 epithelial nuclei on a circumferential section) and of the small bronchi (with 200-500 epithelia nuclei); the other small and large bronchi were never involved. The morphometric analysis also showed the relations of the intervals between injections to the lesional intensity and stereotyping.

[Post-therapeutic complications in mandibular fractures: a retrospective study]. / Complicatii postterapeutice în fracturile de mandibula: studiu retrospectiv.

The analysis in based on 12,096 patients with fractures of the mandible admitted to and treated in the Clinical of Oral and Maxillofacial Surgery of Iasi in the interval 1951-1995. Posttreatment complications were found in 10.52% of the cases, 9.81% of them being of inflammatory type. Anatomo-clinically these consisted in suppurations of the soft tissues, osteitis and osteomyelitis. The prejudices caused by these complications were multiple: longer hospital stay, additional suffering for the patient, temporary work inability, higher treatment costs.

[The treatment of segmental fractures of the middle face]. / Tratamentul fracturilor etajului mijlociu al fetei.

During the past two decades new methods and techniques for the treatment of middle floor facial fractures have been developed. The orthopedic approach alone or associated with various procedures of internal suspension gradually became obsolete. Nowadays, a successful treatment implies the early surgical exploration and a careful restoration of bone skeletal structure. Osteosynthesis with mini-plates provides for the reduction and tridimensional stability of bone fragments. Moreover, in the communicative fractures and in those accompanied by substance loss, the titanium mini-plates are the best method for the immediate fixation of bone grafts.