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Foramen ovale is a flaplike opening between the upper chambers of the heart during fetal development, that usually closes in early-childhood. This opening allows blood to flow from the right to left atria without passing through pulmonary circulation. Patent foramen ovale (PFO ) is a congenital cardiac lesion in which the communication between the two atria persists into adulthood, permitting a right-to-left shunt, which is a common cause of cryptogenic stroke in young and middle-aged patients. Patients with stroke under the age of 55 years are more likely to have a PFO compared with older patients who have a high prevalence of atherosclerosis or other cardiac diseases, including atrial fibrillation, which could explain their vascular events. We present the case of a 45 year-old woman admitted with sustained monomorphic VT, suspected of arrhythmogenic right ventricular cardiomyopathy (ARVC), who suffered a stroke during her hospitalization. Presence of thrombi in the right ventricle as shown by CMR, along with no other identified cause of stroke, raised the suspicion of a PFO, which was confirmed by transesophageal echocardiography. [ABSTRACT FROM AUTHOR]

Background: Patients with stage 5 chronic kidney disease (CKD) begin chronic hemodialysis with variable diuresis levels correlated to a comparable low glomerular filtration rate. Residual diuresis influences long-term evolution of the hemodialyzed patient, modifying the prognosis even if optimal Kt/ V is achieved. Aim of the study: The present study emphasizes the main determining factors of diuresis in a cohort of stage 5 CKD subjects at the beginning of hemodialysis. Material and methods: 216 patients with stage 5 CKD starting chronic hemodialysis were included in the study, and were grouped according to their residual diuresis: group A (urine output ≤ 500 mL/ day); group B (urine output between 500-1200 mL/ day); group C (urine output ≥ 1200 mL/ day). Results: Glomerular etiology, cardiac systolic dysfunction, severe malnutrition, emergency dialysis initiation and lack of permanent vascular access were proved to be associated with significant low diuresis. Age, gender, estimated glomerular filtration rate (GFR) and the presence of systemic hypertension did not influence the amount of daily diuresis. Conclusions: In CKD stage 5 patients, residual diuresis presents large variations in conditions of comparable low GFR. Factors influencing residual diuresis may be distinct from those that influence residual GFR. [ABSTRACT FROM AUTHOR]

Introduction: Lately, the in vitro and in vivo studies on serotonin metabolism have been pointing its influence in bone health. Also, there are no particular recommendations in performing the serum serotonin assessment in order to evaluate the skeletal status. Aim: We aimed to correlate the bone turnover markers and lumbar bone mineral density (BMD) with serotonin. Material and methods: There is a cross-sectional study in Caucasian postmenopausal women. They were not diagnosed with carcinoid syndrome, or bone anomalies, and received no treatment (including antiresorptives). The following bone formation markers were performed: serum alkaline phosphatase (AP), serum osteocalcin (OC), and the bone resorption marker: serum CrossLaps (CL). Serum serotonin (high-pressure liquid chromatography), as well as central DXA (GE Prodigy) were assessed. Results: 191 women of 57.1 years mean age were grouped according to DXA (WHO criteria). The linear regression analysis between serum serotonin and CL were not statistically significant (SS), between serotonin and OC was SS in the newly diagnosed osteoporosis group (N=40, r=0.4, p=0.03), between serotonin and AP SS was found in osteopenia group (N=88, r=0.24, p=0.03), with no changes when adjusting for age and BMI. The partial correlation between serotonin and BMD was not SS. Discussion: The study raises the question of serotonin as a bone metabolism marker seeing that the results were not consistent. The main limit of our study was that we did not analyze the possible use of antidepressants to these women. Overall, this was a pilot study in clinical practice where few reports have been published, but still necessary, because the use of serum serotonin in current skeletal evaluation is still unclear. [ABSTRACT FROM AUTHOR]

There are three stages in the development of hydatid cysts: initial, tumoral and the stage of complications. In the initial and pseudotumoral stages, the diagnosis depends on topographic localisation. In the complications stage, diagnosis is established on the basis of the most frequent clinical manifestations of the gall bladder, of peritoneal syndromes, of complications involving the lungs and pleura, of venous compression syndromes or the presence of rash. The biofluid-based diagnosis of liver hydatid cysts includes parasite identification (parasitological diagnosis) and immunological investigations indicating host-vs-parasite conflict (immunological diagnosis). Liver hydatid cysts exhibit several particular features depending on their location, size, and relation to adjacent organs. [ABSTRACT FROM AUTHOR]

Antithyroid dwgs as thionamides are largely used in the treatment of the thyrotoxicosis. Side effects were reported in less than 10% of the cases, especially hematological, hepatic or skin allergies. One of the most severe manifestations is agranulocytosis, probably based on an immune mechanism that is exacerbated by the presence of the thyroid autoimmune disease itself. If the presence of the severe leucopenia is actually an epiphenomenon of a preexisting hematological disturbance as multiple myeloma is debated. The myeloma may also be correlated with an autoimmune predisposition. We present the case of a 56 years old female patient diagnosed with Graves' disease, who developed agranulocytosis after 8 months of therapy with thiamazole. Two months after antithyroid drug's withdrawal, the granulocytes number increased and she received therapy with radioiodine. Two years later she came back for diffuse bone pain that turned out to be caused by a multiple myeloma, confirmed by bone marrow biopsy. It might be a connection between the severe form of leucopenia that the patient developed and the medullar malignancy. [ABSTRACT FROM AUTHOR]

Introduction. Lately, the in vitro and in vivo studies on serotonin metabolism pointed their influence in bone health. In addition, there are no particular recommendations in performing the serum serotonin assessment in order to evaluate the skeletal status. Aim. We aimed to correlate the bone turnover markers and lumbar bone mineral density (BMD) with serotonin. Material and Methods. There is a cross-sectional study in Caucasian postmenopausal women. They were not diagnosed with carcinoid syndrome, or bone anomalies, and received no treatment (including antiresorptives). We performed the bone formation markers: serum alkaline phosphatase (AP), serum osteocalcin (OC), and the bone resorption marker: serum CrossLaps (CL). Serum serotonin (high-pressure liquid chromatography), as well as central DXA (GE Prodigy) were assessed. Results. 191 women of 57.1 years mean age were grouped according to DXA (WHO criteria). The linear regression analysis between serum serotonin and CL was not statistically significant (SS), between serotonin and OC was SS in the newly diagnosed osteoporosis group (N=40, r=0.4, p=0.03), between serotonin and AP we found SS in osteopenia group (N=88, r=0.24, p=0.03), with no changes when adjusting for age and BMI. The partial correlation between serotonin and BMD was not SS. Discussion. The study raises the question of serotonin as a bone metabolism marker seeing that the results were not consistent. The main limit of our study is that we did not analyze the possible use of antidepressants by these women. Overall, this is a pilot study in clinical practice in which few reports have been published yet, but still necessary because the use of serum serotonin in current skeletal evaluation is still unclear. [ABSTRACT FROM AUTHOR]

The authors present their personal experience regarding the reconstruction of the nasal pyramid on 150 cases, encompassing both children and adults during the period 2000-2011. Reconstruction of the nasal pyramid, regardless of age, was performed in cases of dysmorphias due to congenital malformations, accidents and surgical treatments with great loss of substance (benign or malignant tumors). There were used the classical methods of reconstruction meaning rhino correction and rhinoplasty. However we mainly focused on the use of heterografts (implantable silicone implants - endoprostheses), or on the reconstruction of the nasal pyramid entirely with elastomeric silicone (epitheses), fixed with adhesive, implants and titanium magnets. Silicone, as a synthetic material, is very well tolerated by the body, having been demonstrated that it is a good oxygen carrier. Moreover, both nasal silicone and titanium implants are well tolerated as well and, in addition, they have good aesthetic, functional and psychological results. Patients regain an almost normal appearance, having good family and social integration and improved quality life. [ABSTRACT FROM AUTHOR]

The paper had as an applicative objective the epidemiological analysis of the appearance of traumatic injuries in athletes during competitions and trainings. In the period the athletes have been followed (one year), 426 traumatic injuries have been registered in 87 athletes who were analyzed in the study. Most of them were mild injuries, to which recovery has been made quite rapidly. The knee was the most affected of the joints, followed by the joints of the fingers from the hand, the ankle and hip. Moreover, the distribution of the cases of traumatic injuries was followed, as it was done according to the way they happened: by direct traumatism (collision with another player, with the ball or the ground due to a fall) or by mechanic overload with indirect injuries (stress injuries, including muscular eccentric/ plyometric contractions). Most of the traumatic injuries are recurrent, this fact being explained by the raise in the vulnerability of the affected segment when exposed to traumatic agents, probably because of some insufficient processes of recovery or/ and the early resumption of physical activity. The prevention of traumatic injuries in sports is based on the following: ... a good physical preparation and an optimum adaptation of the organism to the specific physical effort in this sports field; ... avoiding excessive training (of the overtraining) ... an environment which assures the security of the athletes; ... an optimum recovery of the previous injuries; ... a specialized observation of the sports activity; ... strengthening the security rules and mastering the adequate technique; ... quality medical-sports selection and the biological preparation for the contest; ... quality management of the sports activity. [ABSTRACT FROM AUTHOR]

Background: Violent behavior is often met in patients with mental health disorders. An important area of research studied different factors that can influence aggressive behavior in psychiatric patients. Objectives: The paper's aim was to compare different characteristics between two groups of patients, who presented with psychiatric disorders and aggressive behavior. Demographic characteristics, diagnosis, use of alcohol, history of brain injury, physical and verbal aggression were analyzed in both groups. Methods: The first group was formed of 23 mentally ill patients framed into the Article 114 Criminal Code who presented aggressive behavior and committed various offences. In the second group, 45 patients admitted at psychiatry without their consent were included, after having committed different acts of aggression. Results: The patients from the first group had significantly more psychiatric admissions in their history than the patients from the second group. A higher percentage of alcohol users was registered in the first group, compared to the second one. More patients with personality disorders and concomitant use of alcohol were present in the first group, compared to the second group. In both groups, aggressive behavior was more frequent in patients having psychotic disorders, compared to other diagnosis. Even if overall aggression was more frequent in the second group, when alcohol use (with or without brain injury) was present, aggressive behavior became more frequent in the first group. Conclusions: Results of the study suggest that when certain conditions are met, they can significantly influence the behavior of psychiatric patients, with notable differences in each group. [ABSTRACT FROM AUTHOR]

Ischemic colitis occurs as a result of the decrease of arterial blood supply at the level of the colon and may have consequences which vary from completely reversible lesions to ischemic necrosis. It is a condition that affects both sexes, predominantly people over the age of 50, having multiple etiologies in which the main role is played by atherosclerosis. The symptomatology varies from mild symptoms, which are reversible, to severe ones, with a vital risk. The colonoscopy does not show pathognomonic signs, but it has high sensitivity due to the involvement of the mucosa. There are different treatments according to the clinical form. In general, it goes into remission spontaneously. Emergency surgical treatment is required in acute pancolitis, toxic megacolon, massive hemorrhages, when a subtotal colectomy is performed. [ABSTRACT FROM AUTHOR]

One of the most important causes of perinatal mortality and morbidity complicating significant percentage pregnancies is intrauterine growth restriction (IUGR). Fetal growth restriction is the main cause of intrauterine fetal death and the second leading cause of death in the neonatal period. Numerous studies in different populations reveal an association between intrauterine growth restriction and perinatal and postnatal developments, which differ according to the sex of newborns with intrauterine growth restriction. However, the mechanisms of intrauterine programming, the critical time necessary to cause injury and involvement of other factors are unclear and although several authors' opinions differ, it seems that females are more likely to develop intrauterine growth restriction. [ABSTRACT FROM AUTHOR]

The various anatomoclinical forms of hepatic echinococcosis require the choice of surgical procedures aiming to reduce or to eliminate the pericystic cavity. The presence or the absence of a biliary fistula and the surgical attitude towards the pericyst differentiate between the surgical procedures. Thus, for hydatid pericysts with a biliary fistula the following are indicated: bipolar external drainage of the residual cavity, partial pericystectomy with the suture of the fistulae, pericysto-digestive drainage, pericysto-biliary drainage, total pericystectomy or hepatectomy. For hydatid pericysts without a biliary fistula, the pericystotomy-rhaphy or partial pericystectomy are indicated. [ABSTRACT FROM AUTHOR]

The nonsurgical treatment of hepatic hydatid cyst has made significant progress lately through the use of efficient parasiticidal drugs and through the technique of fine needle puncture which enables the instillation of the parasiticidal substances directly inside the cyst. At present, the indications of the drug treatment as well as of the punctures are well defined for certain anatomoclinical hydatid cysts. [ABSTRACT FROM AUTHOR]

The various anatomoclinical forms of hepatic echinococcosis require the choice of surgical procedures aiming to reduce or to eliminate the pericystic cavity. The presence or the absence of a biliary fistula and the surgical attitude towards the pericyst differentiate between the surgical procedures. Thus, for hydatid pericysts with a biliary fistula the following are indicated: bipolar external drainage of the residual cavity, partial pericystectomy with the suture of the fistulae, pericysto-digestive drainage, pericysto-biliary drainage, total pericystectomy or hepatectomy. For hydatid pericysts without a biliary fistula, the pericystotomy-rhaphy or partial pericystectomy are indicated. [ABSTRACT FROM AUTHOR]

This study provides a comprehensive examination of the current methodologies and potential strategies for the treatment of articular fractures of the foot. In the field of orthopedic healthcare, these fractures present a significant challenge due to their complex nature and the fact that they affect the routines of patients. The motivation behind this study is based on two main concepts. The first one is represented by the use of emerging medical technologies and personalized medicine to bring a significant transformation in the management of foot fractures and give a better quality of treatment that is accepted by the patient. However, because there are inequities in the availability of the necessary medical care and equipment, as well as uneven incorporation in clinical settings, new technologies cannot be used to treat these types of fractures. Regarding the second concept behind this study, it is indicated that although current treatment methods are essential, they have a number of shortcomings when it comes to properly addressing these types of injuries. An approach is needed that takes into account the biomechanical points of view and the particularities of each patient. This approach could be applied in all hospital settings. Through this study, we want to highlight the progress made in recent years in surgical techniques such as 3D printing, minimally invasive surgery (MIS), and biological products. However, in the application of this new discovery, new obstacles have been discovered that prevent the efficient treatment of these types of injuries. This study examines the effectiveness and limitations of current treatments, as well as how differences in healthcare, such as available equipment, training of medical staff, and technological advances, affect patient outcomes in everyday life. This research wishes to emphasize that continuous innovation, interdisciplinary collaboration, and the use of an optimal approach that is appropriate for each patient, are essential. This study aims to provide new insights and useful recommendations for future research and clinical practice. The main role of this research is to improve the quality of life of patients and increase the standards of care in this complex field, which is in permanent evolution.

Glaucoma is a multifactorial degenerative optic neuropathy characterized by the irreversible loss of retinal ganglion cells. Vascular, genetic, anatomical and immune factors are present in etiopathogenic mechanisms. Being the second cause of blindness worldwide after cataract, and with an irreversible character, glaucoma has turned into a disease with a significant impact on public health. Patients with primary open-angle glaucoma (POAG) may have central neurodegenerative changes, such as sensorineural hearing loss and static changes. Aim: The aim of this study was to estimate the connections between visual and auditory functional changes in glaucoma. The subjects were grouped as follows: patients with glaucoma compared with patients without glaucoma, while trying to identify the functional defect of the optic nerve (visual field) and a hearing testing (audiogram). Materials and methods: The prospective, cross-sectional study included 32 eyes of 16 subjects with POAG in a group of study and 24 eyes of 12 healthy subjects in the other group, with a mean age of both groups between 61,64 ± 6,53 years old. Both groups were examined from ophthalmological, audiological and radioimaging perspectives with Pure-tone audiometry (PTA) and magnetic resonance imaging (MRI) for brain. All patients had ophthalmologic assessments according to a standardized protocol. Moreover, auditory functional parameters (audiometry) were recorded. Results: Female cases, over 65 years old, with residency in a city, predominated in the group of study. Compared to the control group, patients in the group of study had average levels of the PTA and modified visual field (VF) parameters. Multivariate analysis demonstrated that the correlation of PTA was indirect, reduced in intensity, both with MD (r = -0.108; p = 0.585), Cal HOV (r = -0.268; p = 0.168) and the slope profile of the right eye. Multivariate analysis demonstrated that there was a correlation of the right PTA, which was indirect, reduced in intensity, both with MD (r = -0.108; p = 0.585), Cal HOV (r = -0.268; p = 0.168) and the slope profile of the right eye. The left ear PTA correlation was indirect, moderate in intensity, statistically significant with both MD (r = -0.584; p = 0.001) and slope profile (r = -0.377; p = 0.048) and reduced as intensity with Cal HOV (r = -0.147; p = 0.456) of the left eye. Conclusions: Patients with POAG showed changes in audiometry in connection with ophthalmological parameters, a fact suggesting that the auditory system might have been affected in POAG. This study highlighted the interdisciplinarity of the medical field with the aim of ensuring the quality of life of glaucoma patients. A good collaboration between the ophthalmologist and the otolaryngologist was very important for our patients. Abbreviations: RE = Right eye, LE = Left Eye, POAG = Primitive Open Angle Glaucoma, PTA = Pure-tone audiometry, VF = visual field, MRI = magnetic resonance imaging, IOP = Intraocular pressure, BVAC = best visual acuity corrected, MD = mean defect, CNS = central nervous system, SAP = standard automated perimetry, CCT = central corneal thickness, ONH = Optic nerve head, CDR = Cup/ Disc ratio, RNFL = Retinal fiber layers., (#x00A9; The Authors.Romanian Society of Ophthalmology.)

Glaucoma is one of important causes of irreversible vision loss and remains a global health problem. The pathophysiology of glaucoma involves several etiopathogenic mechanisms that have generated the development of topical and surgical treatments with an effect in slowing the progression of the disease. In the last decade, it was concluded that glaucomatous optic neuropathy is a disease with neurodegenerative elements, the destructive neuronal lesions being located not only in the structure of the retina, but also at the central visual pathways. This review highlights the experimental and clinical data obtained so far, which underline the neurodegenerative character of the glaucomatous disease and the elements of neuroconnectivity developed during the evolution of the disease., (© The Authors.Romanian Society of Ophthalmology.)

Antithyroid drugs as thionamides are largely used in the treatment of the thyrotoxicosis. Side effects were reported in less than 10% of the cases, especially hematological, hepatic or skin allergies. One of the most severe manifestations is agranulocytosis, probably based on an immune mechanism that is exacerbated by the presence of the thyroid autoimmune disease itself. If the presence of the severe leucopenia is actually an epiphenomenon of a preexisting hematological disturbance as multiple myeloma is debated. The myeloma may also be correlated with an autoimmune predisposition. We present the case of a 56 years old female patient diagnosed with Graves' disease, who developed agranulocytosis after 8 months of therapy with thiamazole. Two months after antithyroid drug's withdrawal, the granulocytes number increased and she received therapy with radioiodine. Two years later she came back for diffuse bone pain that turned out to be caused by a multiple myeloma, confirmed by bone marrow biopsy. It might be a connection between the severe form of leucopenia that the patient developed and the medullar malignancy.

Background: The compatibility study of active substances with excipients finds an important role in the domain of pharmaceutical research, being known the fact that final formulation is the one administered to the patient. In order to evaluate the compatibility between active substance and excipients, different analytical techniques can be used, based on their accuracy, reproducibility and fastness., Results: Compatibility study of two well-known active substances, procaine and benzocaine, with four commonly used excipients, was carried out employing thermal analysis (TG/DTG/HF) and Fourier Transform Infrared Spectroscopy (UATR-FT-IR). The selected excipients were microcrystalline cellulose, lactose monohydrate, magnesium stearate and talc. Equal proportion of active substance and excipients (w/w) was utilized in the interaction study. The absolute value of the difference between the melting point peak of active substances and the one corresponding for the active substances in the analysed mixture, as well the absolute value of the difference between the enthalpy of the pure active ingredient melting peak and that of its melting peak in the different analysed mixtures were chosen as indexes of the drug-excipient interaction degree. All the results obtained through thermal analysis were also sustained by FT-IR spectroscopy., Conclusions: The corroboration of data obtained by thermal analysis with the ones from FT-IR spectroscopy indicated that no interaction occurs between procaine and benzocaine, with microcrystalline cellulose and talc, as well for the benzocaine-lactose mixture. Interactions were confirmed between procaine and benzocaine respectively and magnesium stearate, and for procaine and lactose.

In the last decade, many researches have reached to the conclusion that preservation of residual renal function (RRF) is important after initiating dialysis, as well as in the predialysis period. RRF has been proven to contribue to the quality of life of dialysis patients. Longer preservation of RRF provides a better small and middle molecule removal, improved volemic status and arterial pressure control, diminished risk of vascular and valvular calcification due to better phosphate removal. Deterioration of RRF results in worsening of anemia, inflammation and malnutrition. It is now proven a direct relationship between RRF value and survival in dialysis patient. Several therapeutical intervention have been proven to ameliorate the decline of RRF in dialysis patients. Some of them are identical with those before initiating dialysis: ACE-inhibitors and/or angiotensin-receptor blockers, limiting the use of nephrotoxic drugs, avoiding contrast media procedures, adequate control of blood pressure. Others are specific for dialysis period: adequate dialysis dose, avoiding excessive ultrafiltration, preventing arterial hypotension during dialysis sessions, using biocompatible dialysis membranes, ultrapure water for dialysis, dietary interventions.

Homocysteine is a sulfurated amino acid used for the synthesis of methionine. The last decade's researches proved that hyperhomocysteinemia is an independent risk factor for atherosclerotic vascular disease. The vascular injury induced by several mechanisms of hyperhomocysteinemia is the hallmark of homocysteine's atherogenic properties. Hyperhomocysteinemia is present in 85% of the patients with chronic renal failure (cardiovascular diseases are the main cause of mortality) and persists after initiating dialysis or after renal transplantation. Although folic therapy or folinic acid therapy reduce homocysteine levels with 20-40% in hemodialysis patients, the effects on cardiovascular morbidity have yet to be proven in future studies.

Cerebral ischemia and anoxia induce sequential changes that include ionic redistribution, alteration of enzimatic reactions governing metabolism and intracellular signaling. Despite high technology instrumentation including positron emission, tomography and magnetic resonance imaging used to unravel the intricacies of cerebral blood flow and metabolism, the electroencephalography (EEG) retains a useful place in the evaluation of processes induced by cerebral ischemia, especially in experimental conditions. We have investigated in this study EEG suppression and recovery following global cerebral ischemia, obtained by "four vessel occlusion model", reperfusion and anoxia. Both cerebral ischemia and anoxia have produced a sudden diminution of electrical brain activity and flat line was recorded after 8-10 sec. in the ischemic rats, but after 35-40 sec. in the anoxic rats. After same period of time (2 min) of ischemia and anoxia EEG recovery has been faster in the ischemic rat.