Search

Paraovarian cysts (POCs) develop within the broad ligament of the uterus. POCs are considered to be giant when the threshold of 150 mm is exceeded. Clinical signs and symptoms occur as a consequence of the pressure effect on adjacent organs or due to complications. Abdominal ultrasonography, computed tomography or magnetic resonance imaging are useful imaging tools, but most often the exact origin of such voluminous cysts is revealed only by surgical exploration. The review aims to appraise and update the diagnostic, the histological aspects and the treatment of the giant POCs in rare cases. We carried out a systematic search in Medline-PubMed, Google Scholar and ResearchGate electronic databases. Twenty-seven papers fulfilling the selection criteria were included in the review. The data extracted included information about first author, year of publication, country, patient age, size and side of the POCs, symptoms, tumoral markers, imaging methods, preoperative diagnosis, surgical management and histopathological findings. Although not very numerous, all the studies highlighted the low incidence of giant POCs, the impossibility of establishing the origin of the cystic mass by clinical and imaging methods even with advanced technical tools and the low risk of torsion (11.1%). Despite the recognized benign nature of POCs, we found an unexpected high percent (25.9%) of borderline giant POCs. Surgical excision is the only treatment option. Ovarian-sparing surgery was performed in 85.1% of the cases, and minimally invasive techniques were applied in only 42.9% of the patients, which demonstrates the need of a high-level laparoscopic expertise. Knowledge of this pathology, its recognition as a possible etiology of an abdominopelvic cyst, and a higher awareness of the possibility of a borderline histology in giant POCs are required for the proper management of these particular cases.

An individual's behavior can be defined as a set of complex reactions of the body to internal and external stimuli. Case description: We present a case of a young adult student who, under the circumstances of an anomic environment, causes a female person multiple stab wounds to the cervical region. The patient has an addiction to virtual reality, personal psychiatric history of a depressive disorder, emotional and anxious behavioral disorders, as he was a regular cannabis user. The young man was attending an event where he was consuming alcohol and banned substances (Ecstasy), whose effect combined with antidepressants creates a virtual reality in which the individual has a particular mental state, having the impression that bystanders want to hurt him. Under the impulse of this state, the individual uses a bladed weapon and causes multiple wounds to the victim. The patient is examined in the psychiatric forensic examination commission to determine the discernment at the time of the act of violence and for recommendations regarding safety measures. Conclusion: The approach of hetero-aggression behaviour is based on three categories of causal factors, in a triune concept that implies the consequence of the interaction of the existential environment, with the personality structure of the young individual and with the circumstantial factors that precipitate the act.

Ovarian cystic lesions, once considered uncommon in children, represent nowadays subject for many studies. Controversies regarding the diagnostic and treatment still exist. Unspecific symptoms and difficulties in performing an accurate ultrasound in children, sometimes led to misdiagnose this condition. Ovarian cystic lesions in premenarcheal girls may have hormonal influence, changing the biochemical balance, so an endocrinologist should be consulted. The main goal is to preserve the adnexal tissue. The purpose of this study is to analize the diagnostic and treatment of ovarian cystic lesions in premenarcheal girls, highlighting the opportunity of a multidisciplinary team and the necessity of the ovarian preservation.

Oral anticoagulants have been used for more than 50 years as antithrombotic agents, particularly in the primary and secondary prophylaxis of thromboembolic disorders. Our study�s purpose is to synthetize and analyze the toxicological methods used to determine the oral anticoagulants, described in the literature, so we can identify the optimal methods, taking into consideration the diversity of forensic medicine workload. In the electronic databases, for the period 1990-2019, there were identified 56 articles that included the searched keywords. Of these, 28 were included in our study. We excluded the articles that were not lining up with the objective of our study, the update-type articles and the case studies. After analyzing the literature, it was observed that liquid chromatography-mass spectrometry is the ideal method for detecting low-dosed drugs, such as oral anticoagulants.

The possible use of biochemical markers in the postmortem diagnosis of sudden cardiac deaths is well known in the forensic setting, though several issues have limited its widespread adoption. The aim of the present study was to describe the discovery of cardiac troponin I (cTnI), myoglobin (MYO) and creatinine kinase MB (CK-MB) in femoral whole blood (FWB), pericardial fluid (PF) and vitreous humor (VH) samples, that were collected post-mortem, in various cases of death related to ischemic heart disease, using the rapid diagnostic test 'Cardiac Markers Combo Rapid Test Device'. The authors conducted a prospective study in which they analyzed a total of 100 autopsies performed at the Legal Medicine Clinical Service of Galați County. The results of the present study showed that cardiac markers can be determined using rapid diagnostic tests for blood from the femoral vein and pericardial fluid, but not for the vitreous humor. Using postmortem biochemical markers of myocardial ischaemia requires caution and flexibility, so that the forensic pathologist has to take into consideration, when interpreting the results, both the postmortem interval, and the type of biological sample. Keywords: sudden death, cardiac, markers, troponin, forensic pathology

This article describes rehabilitation of one case, complex psychiatric treatment, facial asimetry, with mandibular and maxilla missing teeth and dental disharmony, with a fixed and also removable hybrid prosthesis.Rehabilitation with fixed or removable prosthesis is even more challenging when the edentulous span is long and the ridge is irregular deformities and unfavorable biomechanics encountered at the prosthetic field for complex rehabilitation. In such situation, a fixed-removable prosthesis allows favorable biomechanical stress distribution along with restoration of esthetics, phonetics, comfort, hygiene, and better postoperative care and maintenance.

Endometrial stromal sarcoma (ESS) is a rare tumor, predominantly occurring as a primary tumor of the uterus. Rare cases of primary extrauterine ESS (EESS) have been reported. Low-grade ESS (LG-ESS) is more common than high-grade ESS (HG-ESS). We present five cases of ESS and one case of EESS. All cases received external radiotherapy (EBRT) at the Radiotherapy Department of the Emergency Clinical Hospital ‘Sfantul Apostol Andrei’ Galati, during 2004-2020. Five cases underwent EBRT in two-dimensional (2D) technique and only one patient received EBRT with three-dimensinal conformational radiotherapy (3DCRT) technique with a linear accelerator, Elekta Synergy. Five patients were referred to postoperative radiotherapy after hysterectomy. The median age of the patients was 57.4 years. One patient was referred to radiotherapy with palliative intent. EESS localized in the retroperitoneum, in the para-aortic region, was identified in one 64-year-old patient with a personal history of hysterectomy and bilateral salpingo-oophorectomy in 1997; EESS was complicated with vertebral extension at the L1-L2 level and spinal cord compression syndrome. ESS represents a rare diagnosis and a high- or low-grade tumor profile is distinguished by immunohistochemistry (IHC) tests. Up to 30% of patients have EESS at presentation. The treatment of ESS is multimodal, its management requiring a multidisciplinary team, and it is different according to the primary tumor location and tumor staging. The role of adjuvant radiotherapy remains controversial in high-grade EESS and due to the rarity of these cases there are limited data concerning the efficacy of adjuvant EBRT available from prospective randomized control clinical trials.

Background Mortality is often used as an indicator of public health efforts. Even if mortality in psychiatric hospitals decreased since the introduction of modern treatment, the death toll is still high. The authors have analyzed the forensic autopsy data and the medical documentation regarding 115 death cases from psychiatric hospitals in south-eastern Romania during the period of 2000–2020. Results The average annual mortality rate was 5.13‰, the necropsy data corroborated with those from the medical documentary material indicates acute myocardial infarction as the dominant cause, with 65 (56.5%) cases, followed by upper respiratory tract occlusion with 23 cases (20%) and pulmonary thromboembolism in 4 cases (12.2%). Furthermore, in 6 cases (5.2%) the cause of death was traumatic: 4 cases of cranio-cerebral trauma and 2 cases of hanging. Conclusions In the mortality structure of psychiatric patients, cardiac death predominated, being influenced by the cardiotoxic effect of medication administered for the specific pathology; hence, an early involvement of cardiologists in the follow-up of patients and the finding of treatment schemes with a reduced cardiotoxic effect are required.

The pathophysiological involvement of uric acid in cardiovascular disease has been intensively addressed in the last decades by the medical community. The tendencies to elucidate its role in cardiac events have been carried out in numerous researches with controversial results. In an attempt to understand this phenomenon, the existence of a paradox is admited, according to which uric acid behaves as an antioxidant, capturing reactive oxygen species, and in the context of an existing cardiac pathology, manifests a precipitating oxidative effect of circulating lipids, there being also present. inflammatory substrate. The involvement of the target organs in hypertension, along with other factors such as hyperlipidemia, obesity, pathologies of the valvular apparatus, contributes to the appearance of hyperuricemia of excretory cause. The ability of xanthine oxidoreductase to produce reactive oxygen species that contribute to the occurrence of oxidative stress and endothelial dysfunction has redirected our visions to a more complex approach to ischemic heart disease. And the use of xanthine oxidoreductase inhibitors in cardiovascular disease in patients with hyperuricemia has allowed to appreciate real benefits in improving renal function and preventing atherosclerosis. Keywords: uric acid, cardiovascular disease, factor

Drug facilitated sexual assault (DFSA) can be defined as sexual activity occurring where consent is invalid or absent due to the effects of drugs and/or alcohol. We report a rare case of pro-active drug facilitated sexual assault involving non-oral administration of sedative-hypnotic intoxicant without primary alcoholic ingestion. For eight years, a male nurse administered sedative-hypnotic drugs to patients admitted to the hospital unit, in order to subsequently maintain sexual intercourse with them. The intravenous administration without primary alcoholic ingestion distinguishes this case of pro-active drug facilitated sexual assault from those presented in associated literature.

Drug facilitated sexual assault (DFSA) can be defined as sexual activity occurring where consent is invalid or absent due to the effects of drugs and/or alcohol. We report a rare case of pro-active drug facilitated sexual assault involving non-oral administration of sedative-hypnotic intoxicant without primary alcoholic ingestion. For eight years, a male nurse administered sedative-hypnotic drugs to patients admitted to the hospital unit, in order to subsequently maintain sexual intercourse with them. The intravenous administration without primary alcoholic ingestion distinguishes this case of pro-active drug facilitated sexual assault from those presented in associated literature. Keywords: Drug facilitated sexual assault; Benzodiazepines; Barbiturates

Primary malignant melanoma of the small bowel is extremely rare. A limited number of cases was described in the specialty literature. The small bowel is most frequently affected by metastatic tumors of other primary lesions, especially epidermal. We report the case of a 77 years old male patient with primary bowel malignant melanoma, diagnosed histologically and immunohistochemically after segmental ileal resection. It was not discovered a primary lesion atskin, eye, anus and rectum levelor with other localization, through the investigations performed after surgery.

Cutaneous metastases from endometrial cancer are rare and unusual. This is the case of a 72 years old female patient, diagnosed in 2018 with G3 endometrial serous carcinoma (ESC). At 18 months from the surgical intervention, the patient developed bilateral inguinal lymph nodes metastases and skin secondary lesions; histological and immunohistochemical tests were performed. Computed tomography scan did not indicate visceral secondary lesions, local or regional relapses. We present the treatment practiced, the case's evolution and we discuss about epidemiology, molecular biology, treatment options and management of advanced and local lesions. The appearance of skin metastases in theses cases is associated with poor prognosis and treatment options are limited to palliative chemotherapy and radiotherapy.

The article explores the challenges of ensuring voluntary and informed consent which is obtained from potential research subjects in the north-eastern part of Romania. This study is one of the first empirical papers of this nature in Romania. The study used a quantitative survey design using the adapted Quality of Informed Consent (QuIC) questionnaire. The target population consisted of 100 adult persons who voluntarily enrolled in clinical trials. The informed consent form must contain details regarding the potential risks and benefits, the aim of the clinical trial, study design, confidentiality, insurance and contact details in case of additional questions. Our study confirmed that although all required information was included in the ICF, few clinical trial participants truly understood it. We also found that the most important predictive factor for a good subjective and objective understanding of the clinical trial was the level of education. Our study suggests that researchers should consider putting more effort in order to help clinical trials participants achieve a better understanding of the informed consent. In this way they will ensure that participants' decision-making is meaningful and that their interests are protected.