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GAVE syndrome (gastric antral vascular ectasia) is a rare cause of gastrointestinal bleeding. It affects mainly the elderly. The syndrome was named “watermelon stomach” because of its typical endoscopic appearance of “watermelon stripes” observed at the gastric antral level. We present the case of an 80-year-old female patient, under iron substitution therapy for an iron deficiency anemia previously diagnosed. The woman was admitted to our hospital for non-specific symptoms, severe asthenia and postural instability. The clinical examination noted pallor of skin and sclera, without hematemesis or melena. Paraclinical tests revealed severe hypochromic microcytic anemia and hyposideremia, with a positive fecal occult blood test. Because the patient was refractory to the iron therapy, presenting with severe anemia, which required blood transfusions, we suspected a diagnosis of acute hemorrhagic gastritis. In order to reveal the source of the hemorrhage, an upper gastrointestinal endoscopy was performed, which described the typical appearance of prominent, tortuous, erythematous streaks traversing the antrum and converging toward the pylorus, creating the “watermelon stripes” pattern, with lesions that bleed easily during the biopsy process. In a different endoscopic session, the argon plasma coagulation treatment was applied, resulting in clinical and biological improvement. Gastric antral vascular ectasia is a rare medical condition, insufficiently recognized and poorly understood, which can be treated efficiently by endoscopic means, if it is early diagnosed. Although this condition tends to be underdiagnosed at the present time, doctors may exceed their limits by acquiring a high grade of clinical suspicion.

Hepatocellular carcinoma (HCC) is the 5th most frequently diagnosed cancer in the world, according to the World Health Organization. The incidence of HCC is between 3/100000 and 78.1/100000, with a high incidence reported in areas with viral hepatitis B and hepatitis C, thus affecting Asia and Africa predominantly. Several international clinical guidelines address HCC diagnosis and are structured according to the geographical area involved. All of these clinical guidelines, however, share a foundation of diagnosis by ultrasound surveillance and contrast imaging techniques, particularly computed tomography, magnetic resonance imaging, and sometimes contrast-enhanced ultrasound. The primary objective of this review was to systematically summarize the recent published studies on the clinical utility of serum biomarkers in the early diagnosis of HCC and for the prognosis of this disease.

Hyposplenism is associated with autoimmune diseases, inflammatory bowel disease, severe celiac disease, autoimmune thyroiditis, untreated HIV infection and chronic graft-versus-host disease. The aim of this study was to review the existing data on hyposplenism associated with celiac disease and Hashimoto's autoimmune thyroiditis. Our research was based on a clinical case concerning a 41-year-old female who presented with asthenia, fatigue, dyspepsia and chronic diarrhea. The medical history revealed autoimmune Hashimoto's thyroiditis, type 2 diabetes, fatty liver disease, chronic gastritis and thrombocytosis. Multiple investigations showed hyposplenism and complex autoimmune dysfunction with positive serum markers for celiac disease and type 1 autoimmune hepatitis along with minor symptomatology. The intestinal symptomatology of celiac disease is often hid by hypothyroidism-associated autoimmune thyroiditis. Asymptomatic or minimally symptomatic celiac disease associated with Hashimoto's autoimmune thyroiditis is diagnosed by biomarkers. Hyposplenism in celiac disease can occur regardless of the disease stage, latent or symptomatic.

In the European Liver Transplant Registry, there are 137,863 liver transplantations recorded. Forty-one percent of patients survived 20 years after liver transplantation in the European countries. From 1988, when the US database for liver transplantation was created, to 2006, there are more than 56,000 liver transplants. Almost 80% of the liver transplant recipients survived 5 years after transplantation. The incidence of deep vein thrombosis (DVT) in the European population is 70–140/100.000 person-years. Cancer, paresis, immobilization, thrombophilia, inflammatory bowel disease, replacement hormonal or contraceptive therapies are associated with an increased risk of occurrence DVT or complications. The incidence of DVT in long-term surveillance of liver transplant recipients is unknown. Immunosuppressive therapy, thrombophilia abnormalities, hepatitis C and hepatocellular carcinoma recurrence, renal insufficiency, malignant tumours, obesity and diabetes were associated with DVT in long-term post-liver transplantation. The reported maximum time between liver transplantation and DVT was 210 days. The aim of the study is to update existing data in the literature regarding the occurrence and management of deep vein thrombosis in liver transplant patients over the long-term surveillence period. There are no specific guideline recommendations regarding acute DVT treatment in long-term surveillance after liver transplantation. Low molecular weight heparin (LMWH), unfractionated heparin (UFH) and vitamin K antagonist (VKA) are the anticoagulants used in specific complications post-transplantation. The safety and the efficacy of direct anticoagulants in liver transplantation recipients need to be assessed in future trials. Given that long-term survival of liver transplantation is much improved, complications associated with transplantation and ageing require appropriate cardiovascular guidelines.

Anticoagulant therapy is very important in preventing thromboembolic complications in a broad category of patients. When a bleeding event appears in anticoagulated patients, we should take into consideration the circumstances and the moment when the anticoagulant treatment should be resumed in patients who have an indication for temporary or permanent anticoagulation. This decision is often difficult. It should be weighted very carefully, on one hand, the thromboembolic risk of the patient, on the other hand the risk of recurrence of the recent bleeding event. The decision to resume the anticoagulant therapy depends also on the severity of the bleeding event, as well as the source of bleeding.

Objective:The aim of the study was to assess the particularities and the comorbidities in hypertensive very elderly patients.Design and method:We performed a retrospective study on 119 patients admitted to a Clinical Emergency Hospital between July 2014 and December 2018.Results:Pacients in the stud

Pregnant women especially have an increased risk for arterial hypertension, which can lead to maternal and fetal complications. Preeclampsia and severe arterial hypertension are associated with the highest risk. In pregnancy, there are four major hypertensive disorders: chronic (preexisting) hypertension, preeclampsia-eclampsia, gestational hypertension and preeclampsia-eclampsia superimposed on chronic hypertension. The therapeutic approach of hypertension in pregnant women should balance the risks and benefits for both mother and fetus. The factors that should be taken into consideration are: the level of blood pressure, the etiology of the hypertension, and timing of delivery.

Deep vein thrombosis and pulmonary embolism are two clinical entities of a single disease called venous thromboembolism. Venous thromboembolism is an important cause of maternal morbidity and mortality. Diagnosis and treatment of venous thromboembolism in pregnant women are much more difficult than in non-pregnant women. Pregnant patients were excluded from all major clinical trials investigating therapeutic combinations for acute thromboembolism. Although, for many years, the standard anticoagulant during pregnancy and postpartum was unfractionated heparin, current guidelines recommend low molecular weight heparin. The advantages of low molecular weight heparin are lower risk of bleeding, predictable pharmacokinetics, lower risk of fracture because of thrombocytopenia and heparin-induced osteoporosis.

Primary cardiac tumors are very rare tumors, and cardiac sarcomas are uncommon tumors. We report the case of a 22-year-old previously healthy woman with notable medical history who presented with 4 days of light-headedness, nausea, and vomiting, 1 day of loss of awareness in orthostatism, and severe right ventricular failure. Two-dimensional transthoracic echocardiography revealed a hypoechoic homogeneous tumor measuring 50 mm on the long axis in the right ventricle and occupying the entire cavity of the right ventricle. Computed tomography (CT) confirmed the mass, with no other visible pathologic masses. Postsurgical histopathologic results showed malignant fibrous histiocytoma (MFH; undifferentiated pleomorphic sarcoma). Six follow-up monthly cardiac and abdominal sonographic examinations revealed no tumor recidivism, mild tricuspid insufficiency, normal liver aspects, no fluid in the pericardium, pleura, or peritoneum, and no images of additional tumors. To our knowledge, a case of primary MFH of the right ventricle in Romania has not been reported previously, and this is the fourth reported case in the world. Our case was especially unusual because of the primary location in the right ventricle (the usual site for metastasis), lack of symptoms until the development of severe right cardiac failure, and the young age of the patient.

Diuretics are frequently recommended as antihypertensive agents. Some of the main side effects of diuretic therapy are hypokalaemia and hyponatremia. The objective of the study was to describe the frequency of hyponatremia in a group of elderly hypertensive patients treated with diuretics.The study included 202 elderly hypertensive patients (over 65 years old), treated with diuretics at least 4 weeks before hospitalization, consecutivly admitted in the Internal Medicine Clinic of the Clinical Emergency Hospital of Bucharest during a period of 4 months.The distribution by sex: 103 (52.28%) men and 94 (47.71%) women. The mean age of the patients was 72 ± 8 years. Incidence of hyponatremia was 24.87% (49 patients) in the whole group. From the 49 hyponatremic patients, 31 (63.26%) were women and 18 (36.73%) men. The distribution by age of hypertensive hyponatremic female patients was: between 65-70 years old--4 patients (12.90%), between 70-75 years old--7 patients (22.58%), over 75 years old--20 patients (64.51%). The distribution by age of hypertensive hyponatremic male patients was: between 65-70 years old--3 patients (16.66%), between 70-75 years old--2 patients(11.11%), over 75 years old--13 patients (72.22%). Most of the patients affected (73.46%) used a thiazide-type diuretic, the other 26.54% being on loop diuretics.Elderly hypertensive patients were more likely to develop hyponatremia after age 75. Female patients had a higher frequency of hyponatremia than male patients. The main cause of hyponatremia in patients treated with diuretics was thiazide.

We report the case of a 84-year-old admitted with symptoms of congestive heart failure. Ultrasonography revealed a hyperechoic nodule in the left lobe of the liver, with a peripheral hypoechoic rim, multiple irregular hypoechoic nodules in both hepatic lobes, portal vein, inferior vena cava, and right atrium thrombosis. On ultrasonographic and alpha-fetoprotein criteria the case was interpreted as hepatocellular carcinoma with Budd-Chiari syndrome. The particularity of the case is the initial presentation of the hepatocellular carcinoma as Budd-Chiari syndrome. The inferior vena cava and right atrium thrombosis, as a cause of secondary Budd-Chiari syndrome in a patient with hepatocellular carcinoma, has been rarely reported.

Charged hadron identification in the Compressed Baryonic Matter experiment (CBM) is realized via the Time-of-Flight method [1]. For this purpose the CBM-ToF collaboration designed a Time-of-Flight wall composed of Multi-gap Resistive Plate Chambers (MRPCs). Due to the high interaction rate in CBM of 10 MHz the key challenge is the development of high rate MRPCs above 25 kHz/cm2 which become possible after the development of low resistive glass with extremely good quality. In this article we present the actual conceptual design of the ToF-wall which is subdivided in three parts namely the outer wall, the inner wall and the forward zone that are discussed in detail.