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1 pages, 194 KiB

Open AccessEditorial

Interdisciplinary Medicine

by Camelia Cristina Diaconu

Medicina 2021, 57(5), 427; https://doi.org/10.3390/medicina57050427 - 28 Apr 2021

Cited by 1 | Viewed by 1595

Abstract

Motto: [...] Full article

(This article belongs to the Special Issue Interdisciplinary Medicine)

Research

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12 pages, 546 KiB

Open AccessArticle

Determining Risk Factors Associated with Depression and Anxiety in Young Lung Cancer Patients: A Novel Optimization Algorithm

by Yu-Wei Fang and Chieh-Yu Liu

Medicina 2021, 57(4), 340; https://doi.org/10.3390/medicina57040340 - 1 Apr 2021

Cited by 4 | Viewed by 2303

Abstract

Background and Objectives: Identifying risk factors associated with psychiatrist-confirmed anxiety and depression among young lung cancer patients is very difficult because the incidence and prevalence rates are obviously lower than in middle-aged or elderly patients. Due to the nature of these rare [...] Read more.

Background and Objectives: Identifying risk factors associated with psychiatrist-confirmed anxiety and depression among young lung cancer patients is very difficult because the incidence and prevalence rates are obviously lower than in middle-aged or elderly patients. Due to the nature of these rare events, logistic regression may not successfully identify risk factors. Therefore, this study aimed to propose a novel algorithm for solving this problem. Materials and Methods: A total of 1022 young lung cancer patients (aged 20–39 years) were selected from the National Health Insurance Research Database in Taiwan. A novel algorithm that incorporated a k-means clustering method with v-fold cross-validation into multiple correspondence analyses was proposed to optimally determine the risk factors associated with the depression and anxiety of young lung cancer patients. Results: Five clusters were optimally determined by the novel algorithm proposed in this study. Conclusions: The novel Multiple Correspondence Analysis–k-means (MCA–k-means) clustering algorithm in this study successfully identified risk factors associated with anxiety and depression, which are considered rare events in young patients with lung cancer. The clinical implications of this study suggest that psychiatrists need to be involved at the early stage of initial diagnose with lung cancer for young patients and provide adequate prescriptions of antipsychotic medications for young patients with lung cancer. Full article

(This article belongs to the Special Issue Interdisciplinary Medicine)

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16 pages, 775 KiB

Open AccessArticle

Safety of Laparoscopic Cholecystectomy for Acute Cholecystitis in the Elderly: A Multivariate Analysis of Risk Factors for Intra and Postoperative Complications

by Dragos Serban, Bogdan Socea, Simona Andreea Balasescu, Cristinel Dumitru Badiu, Corneliu Tudor, Ana Maria Dascalu, Geta Vancea, Radu Iulian Spataru, Alexandru Dan Sabau, Dan Sabau and Ciprian Tanasescu

Medicina 2021, 57(3), 230; https://doi.org/10.3390/medicina57030230 - 2 Mar 2021

Cited by 37 | Viewed by 5681

Abstract

Background and Objectives: This study investigates the impact of age upon the safety and outcomes of laparoscopic cholecystectomy performed for acute cholecystitis, by a multivariate approach. Materials and Methods: A 2-year retrospective study was performed on 333 patients admitted for acute cholecystitis who [...] Read more.

Background and Objectives: This study investigates the impact of age upon the safety and outcomes of laparoscopic cholecystectomy performed for acute cholecystitis, by a multivariate approach. Materials and Methods: A 2-year retrospective study was performed on 333 patients admitted for acute cholecystitis who underwent emergency cholecystectomy. The patients included in the study group were divided into four age subgroups: A ≤49 years; B: 50–64 years; C: 65–79 years; D ≥80 years. Results: Surgery after 72 h from onset (p = 0.007), severe forms, and higher American Society of Anesthesiologists Physical Status Classification and Charlson comorbidity index scores (p < 0.001) are well correlated with older age. Both cardiovascular and surgical related complications were significantly higher in patients over 50 years (p = 0.045), which also proved to be a turning point for increasing the rate of conversion and open surgery. However, the comparative incidence did not differ significantly between patients aged from 50–64 years, 65–79 years and over 80 years (6.03%, 9.09% and 5.8%, respectively). Laparoscopic cholecystectomy (LC) was the most frequently used surgical approach in the treatment of acute cholecystitis in all age groups, with better outcomes than open cholecystectomy in terms of decreased overall and postoperative hospital stay, reduced surgery related complications, and the incidence of acute cardiovascular events in the early postoperative period (p < 0.001). Conclusions: The degree of systemic inflammation was the main factor that influenced the adverse outcome of LC in the elderly. Among comorbidities, diabetes was associated with increased surgical and systemic postoperative morbidity, while stroke and chronic renal insufficiency were correlated with a high risk of cardiovascular complications. With adequate perioperative care, the elderly has much to gain from the benefits of a minimally invasive approach, which allows a decreased rate of postoperative complications and a reduced hospital stay. Full article

(This article belongs to the Special Issue Interdisciplinary Medicine)

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6 pages, 290 KiB

Open AccessArticle

Emergency Medical Teams Interventions due to Cardiovascular Diseases in 2018: Polish Regional Observational Study

by Klaudiusz Nadolny, Magdalena Wierzbik-Strońska, Jerzy R. Ładny, Beniamin O. Grabarek, Oliwia Warmusz, Dariusz Boroń and Aleksander Ostenda

Medicina 2021, 57(2), 139; https://doi.org/10.3390/medicina57020139 - 4 Feb 2021

Viewed by 1873

Abstract

Background and objectives: The goal of this work was to assess the interventions for cardiovascular causes (ICD-10: I) and analyze the time between the request for intervention and the arrival of the Medical Emergency Team realized by the Voivodeship Rescue Service in Katowice [...] Read more.

Background and objectives: The goal of this work was to assess the interventions for cardiovascular causes (ICD-10: I) and analyze the time between the request for intervention and the arrival of the Medical Emergency Team realized by the Voivodeship Rescue Service in Katowice in the period between 1 January 2018 to 31 December 2018. Materials and Methods: Analysis of the characteristics of the interventions was completed based on the information contained on the dispatch order cards and medical emergency services. Statistical analysis was done using the Chi-square test (p < 0.05). Results: Out of 211,548 cases, 26,672 were associated with cardiovascular diseases. It can be observed that the large majority of interventions took place in urban areas (89.98%; 23,998 cases), whereas only 11.02% took place in rural areas (2674 cases). The most common cause for medical interventions being made by the Medical Emergency Team was primary hypertension—11,649 cases. The average arrival time to urban areas was 9 min and 12 s ± 3 min and 54 s, whereas for rural areas it was 11 min and 57 s ± 4 min and 32 s (p < 0.05). Conclusions: It can be observed that the Medical Emergency System in Katowice operates accordingly with the intentions of the legislator. The obtained data also indicates that there is a high societal awareness of the residents about the purpose of the Medical Emergency Team. Full article

(This article belongs to the Special Issue Interdisciplinary Medicine)

14 pages, 1171 KiB

Open AccessArticle

Real-World Data Analysis of Pregnancy-Associated Breast Cancer at a Tertiary-Level Hospital in Romania

by Anca A. Simionescu, Alexandra Horobeț, Lucian Belaşcu and Dragoş Mircea Median

Medicina 2020, 56(10), 522; https://doi.org/10.3390/medicina56100522 - 6 Oct 2020

Cited by 4 | Viewed by 2680

Abstract

Background and objectives: Breast cancer is among the most common cancer types encountered during pregnancy. Here, we aimed to describe the characteristics, management, and outcomes of women with pregnancy-associated breast cancer at a tertiary-level hospital in Romania. Material and Methods: We retrospectively and [...] Read more.

Background and objectives: Breast cancer is among the most common cancer types encountered during pregnancy. Here, we aimed to describe the characteristics, management, and outcomes of women with pregnancy-associated breast cancer at a tertiary-level hospital in Romania. Material and Methods: We retrospectively and prospectively collected demographic, oncological, and obstetrical data for women diagnosed with cancer during pregnancy, and who elected to continue their pregnancy, between June 2012 and June 2020. Complete data were obtained regarding family and personal medical history and risks factors, cancer diagnosis and staging, clinical and pathological features (including histology and immunohistochemistry), multimodal cancer treatment, pregnancy management (fetal ultrasounds, childbirth, and postpartum data), and infant development and clinical evolution up to 2020. Cancer therapy was administered following national guidelines and institutional protocols and regimens developed for non-pregnant patients, including surgery and chemotherapy, while avoiding radiotherapy during pregnancy. Results: At diagnosis, 16.67% of patients were in an advanced/metastatic stage, while 75% were in early operable stages. However, the latter patients underwent neoadjuvant chemotherapy rather than up-front surgery due to aggressive tumor biology (triple negative, multifocal, or HER2+). No patient achieved complete pathological remission, but only one patient relapsed. No recurrence was recorded within 12 months among early-stage patients. Conclusions: In this contemporary assessment of real-world treatment patterns and outcomes among patients with pregnancy-associated breast cancer, our findings were generally consistent with globally observed treatment outcomes, underscoring the need for a multidisciplinary team and reference centers. Full article

(This article belongs to the Special Issue Interdisciplinary Medicine)

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9 pages, 780 KiB

Open AccessArticle

Methotrexate and Adalimumab Decrease the Serum Levels of Cardiovascular Disease Biomarkers (VCAM-1 and E-Selectin) in Plaque Psoriasis

by Natalia Zdanowska, Agnieszka Owczarczyk-Saczonek, Joanna Czerwińska, Jacek J. Nowakowski, Anna Kozera-Żywczyk, Witold Owczarek, Wojciech Zdanowski and Waldemar Placek

Medicina 2020, 56(9), 473; https://doi.org/10.3390/medicina56090473 - 15 Sep 2020

Cited by 11 | Viewed by 2792

Abstract

Background and objectives: The shared pathogenesis of psoriasis and atherosclerosis may be determined by assaying the levels of endothelial activation molecules. This study aimed at evaluating vascular cell adhesion molecule 1 (VCAM-1) and E-selectin serum concentrations, and atherosclerosis severity in patients with plaque [...] Read more.

Background and objectives: The shared pathogenesis of psoriasis and atherosclerosis may be determined by assaying the levels of endothelial activation molecules. This study aimed at evaluating vascular cell adhesion molecule 1 (VCAM-1) and E-selectin serum concentrations, and atherosclerosis severity in patients with plaque psoriasis. It also aimed to determine the effects of methotrexate/adalimumab treatment for 12 weeks on the plasma levels of the aforementioned molecules. Materials and Methods: The study included 34 psoriasis patients (17 treated with methotrexate and 17 treated with adalimumab) and eight controls. The 10-year risk of a fatal cardiovascular disease, body mass index, Psoriasis Area and Severity Index, and body surface area were calculated for each subject. VCAM-1 and E-selectin levels were determined via an enzyme-linked immunosorbent assay at baseline and after 12 weeks. Results: Baseline E-selectin and VCAM-1 levels were higher in the adalimumab group than in the methotrexate and control groups. VCAM-1 levels decreased in the adalimumab (p = 0.02) and methotrexate groups (p = 0.008), while E-selectin levels decreased in the methotrexate group (p = 0.004). Conclusions: The results indicate a correlation between systemic psoriasis treatment and E-selectin and VCAM-1 plasma concentrations, which may be associated with the risk of cardiovascular disease development. Full article

(This article belongs to the Special Issue Interdisciplinary Medicine)

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9 pages, 1425 KiB

Open AccessArticle

Vaginal Reconstruction in Patients with Mayer–Rokitansky–Küster–Hauser Syndrome—One Centre Experience

by Adelaida Avino, Laura Răducu, Adrian Tulin, Daniela-Elena Gheoca-Mutu, Andra-Elena Balcangiu-Stroescu, Cristina-Nicoleta Marina and Cristian-Radu Jecan

Medicina 2020, 56(7), 327; https://doi.org/10.3390/medicina56070327 - 1 Jul 2020

Cited by 6 | Viewed by 7503

Abstract

Background and Objectives: The Mayer–Rokitansky–Küster–Hauser syndrome is a congenital condition in which patients are born with vaginal and uterus agenesis, affecting the ability to have a normal sexual life and to bear children. Vaginal reconstruction is a challenging procedure for plastic surgeons. The [...] Read more.

Background and Objectives: The Mayer–Rokitansky–Küster–Hauser syndrome is a congenital condition in which patients are born with vaginal and uterus agenesis, affecting the ability to have a normal sexual life and to bear children. Vaginal reconstruction is a challenging procedure for plastic surgeons. The aim of this study is to report our experience in the management of twelve patients with congenital absence of the vagina due to the MRKH syndrome. Materials and Methods: We performed a retrospective study on 12 patients admitted to the Plastic Surgery Department of the Clinical Emergency Hospital “Prof. Dr. Agrippa Ionescu”, Bucharest, Romania, for vaginal reconstruction within a period of eleven years (January 2009–December 2019). All patients were diagnosed by the gynaecologists with vaginal agenesis, as part of the Mayer–Rokitansky–Küster–Hauser syndrome. The Abbe‘–McIndoe technique with an autologous skin graft was performed in all cases. Results: The average age of our patients was 20.16 (16–28) years. All patients were 46 XX. The average surgical timing was 3.05 h (range 2.85–4h). Postoperative rectovaginal fistula was encountered in 1 patient. Postoperative average vaginal length was 10.4 cm (range 9.8–12.1 cm). Regular sexual life was achieved in 10 patients. Conclusion: Nowadays, there is no established standard method of vaginal reconstruction. In Romania, the McIndoe technique is the most applied. Unfortunately, even if the MRKH syndrome is not uncommon, less and less surgeons are willing to perform the procedure to create a neovagina. Full article

(This article belongs to the Special Issue Interdisciplinary Medicine)

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12 pages, 2043 KiB

Open AccessArticle

Patterns and Factors Associated with Self-Medication among the Pediatric Population in Romania

by Petruța Tarciuc, Ana Maria Alexandra Stanescu, Camelia Cristina Diaconu, Luminita Paduraru, Alina Duduciuc and Smaranda Diaconescu

Medicina 2020, 56(6), 312; https://doi.org/10.3390/medicina56060312 - 25 Jun 2020

Cited by 20 | Viewed by 5734

Abstract

Background and objectives: Self-medication is a global phenomenon in both developed and emerging countries. At present, data regarding the practice, patterns, and factors associated with self-medication in Romanian patient groups of various ages and health are relatively scarce. A pilot study that uses [...] Read more.

Background and objectives: Self-medication is a global phenomenon in both developed and emerging countries. At present, data regarding the practice, patterns, and factors associated with self-medication in Romanian patient groups of various ages and health are relatively scarce. A pilot study that uses a questionnaire was conducted to observe the attitudes as well as the behaviors of a group of Romanian parents related to self-medication, specifically their beliefs and perceived risks of the administration of medicine to their children without medical advice, frequency of self-medications, symptoms, and types of medications most commonly used without medical advice. Materials and Methods: The questionnaire was sent via e-mail or WhatsApp link on a mobile phone using the existing data at the general practitioner’s office together with the protection of data form and the informed consent form; some participants completed the questionnaire when they came for a regular visit at the general practitioner’s office. Of 246 applied questionnaires, we had a rate of responses of 98%. Results: We found a high percentage (70%) of parents who self-medicate their children. The data reveals a significant relation between parents’ beliefs on self-medication and their tendency to administrate drugs to their children without medical advice. A significant relation was also found between the likelihood of parental self-medication for their children and the number of illnesses experienced by their children over the six-month period prior to the survey. Even when parents have a correct understanding of self-medication risks, these are not aligned with actual behavior; therefore, parents continue to administer drugs to their children without medical advice. Conclusions: Our study helps to describe the patterns of parents’ decisions about self-medicating their children and to identify parents who are more predisposed to administering self-medication to their children. Full article

(This article belongs to the Special Issue Interdisciplinary Medicine)

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15 pages, 353 KiB

Open AccessArticle

Reasons for and Facilitating Factors of Medical Malpractice Complaints. What Can Be Done to Prevent Them?

by Bianca Hanganu, Magdalena Iorga, Iulia-Diana Muraru and Beatrice Gabriela Ioan

Medicina 2020, 56(6), 259; https://doi.org/10.3390/medicina56060259 - 27 May 2020

Cited by 15 | Viewed by 5659

Abstract

Background and objectives. Medical malpractice is an increasing phenomenon all over the world, and Romania is not spared. This matter is of concern as it has a significant impact on the physicians and the patients involved, as well as on the health care [...] Read more.

Background and objectives. Medical malpractice is an increasing phenomenon all over the world, and Romania is not spared. This matter is of concern as it has a significant impact on the physicians and the patients involved, as well as on the health care system and society in general. The purpose of our study was to perform an insight analysis on the reasons for medical malpractice complaints as well as the factors that facilitate the complaints to identify specific ways to prevent them and, implicitly, to improve the medical practice. Materials and Methods. The authors conducted a retrospective study of the medical malpractice complaints registered in the period 2006–2019 at the Commission for monitoring and professional competence for malpractice cases in the region of Moldova, Romania, collecting data on both the patients and the medical professionals involved. Results. The authors analyzed 153 complaints directed against 205 medical professionals and identified 15 categories of reasons for complaints, the most significant being related to the occurrence of complications, and to the doctor–patient interaction (e.g., communication, behavior, informed consent). The most frequently reported medical specialties were obstetrics and gynecology, emergency medicine, general surgery, and orthopedics and traumatology. Emergency medicine was often involved in complaints suggesting an over utilization of this department in our country and the need for health policies, which could divert the large number of patients accessing emergency medicine towards primary care. Conclusions. Regarding the dysfunctions in the doctor–patient relationship frequently claimed by patients, the authors concluded that doctors need special undergraduate training and periodic updating during their practice for them to be able to adequately address the challenges of interacting with their patients. Full article

(This article belongs to the Special Issue Interdisciplinary Medicine)

10 pages, 1366 KiB

Open AccessArticle

Inherited Risk Factors of Thromboembolic Events in Patients with Primary Nephrotic Syndrome

by Gener Ismail, Bogdan Obrișcă, Roxana Jurubiță, Andreea Andronesi, Bogdan Sorohan and Mihai Hârza

Medicina 2020, 56(5), 242; https://doi.org/10.3390/medicina56050242 - 19 May 2020

Cited by 9 | Viewed by 2982

Abstract

Background and objectives. Venous thromboembolic events (VTEs) are among the most important complications of nephrotic syndrome (NS). We conducted a study that aimed to determine the prevalence of inherited risk factors for VTE in NS and to identify which factors are independent predictors [...] Read more.

Background and objectives. Venous thromboembolic events (VTEs) are among the most important complications of nephrotic syndrome (NS). We conducted a study that aimed to determine the prevalence of inherited risk factors for VTE in NS and to identify which factors are independent predictors of VTE. Materials and Methods. Thirty-six consecutive patients with primary NS that underwent percutaneous kidney biopsy between January 2017 and December 2017 were enrolled in this retrospective, observational study. VTEs were the primary outcome. Baseline demographic and biochemical data were collected from medical records, and genetic testing was done for polymorphisms of Factor V, PAI, MTHFR, and prothrombin genes. Results. The incidence of VTE was 28%, and the median time to event was 3 months (IQR: 2–9). The prevalence of inherited risk factors was 14% for Factor V Leiden mutation, 5.6% for prothrombin G20210A, 44.5% for PAI, and 27.8% for each of the two polymorphisms of the MTHFR gene. On multivariate analysis, the presence of at least two mutations was independently associated with the risk of VTE (HR, 8.92; 95% confidence interval, CI: 1.001 to 79.58, p = 0,05). Conclusions. These findings suggest that genetic testing for inherited thrombophilia in NS could play an important role in detecting high-risk patients that warrant prophylactic anticoagulation. Full article

(This article belongs to the Special Issue Interdisciplinary Medicine)

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15 pages, 1180 KiB

Open AccessArticle

Use of Glycated Hemoglobin (A1c) as a Biomarker for Vascular Risk in Type 2 Diabetes: Its Relationship with Matrix Metalloproteinases-2, -9 and the Metabolism of Collagen IV and Elastin

by Krasimir Kostov and Alexander Blazhev

Medicina 2020, 56(5), 231; https://doi.org/10.3390/medicina56050231 - 11 May 2020

Cited by 16 | Viewed by 4478

Abstract

Background and objectives: HbA1c measurements may be useful not only in optimizing glycemic control but also as a tool for managing overall vascular risk in patients with diabetes. In the present study, we investigate the clinical significance of HbA1c as a biomarker [...] Read more.

Background and objectives: HbA1c measurements may be useful not only in optimizing glycemic control but also as a tool for managing overall vascular risk in patients with diabetes. In the present study, we investigate the clinical significance of HbA1c as a biomarker for hyperglycemia-induced vascular damages in type 2 diabetes (T2D) based on the levels of matrix metalloproteinases-2, -9 (MMP-2, MMP-9), anti-collagen IV (ACIV), and anti-elastin (AE) antibodies (Abs) IgM, IgG, and IgA, and CIV-derived peptides (CIV-DP) reflecting collagen and elastin turnover in the vascular wall. The aim is to show the relationship of hyperglycemia with changes in the levels of vascular markers and the dynamics of this relationship at different degrees of glycemic control reported by HbA1c levels. Materials and Methods: To monitor elastin and collagen IV metabolism, we measured serum levels of these immunological markers in 59 patients with T2D and 20 healthy control subjects with an ELISA. Results: MMP-2, MMP-9, and the AEAbs IgA levels were significantly higher in diabetic patients than in control subjects, whereas those of the AEAbs IgM, ACIVAbs IgM, and CIV-DP were significantly lower. MMP-9 levels were significantly lower at HbA1c values >7.5%. Conclusions: A set of three tested markers (MMP-2, MMP-9, and AEAbs IgA) showed that vascular damages from preceding long-term hyperglycemia begin to dominate at HbA1c values ≥7.5%, which is the likely cut-point to predict increased vascular risk. Full article

(This article belongs to the Special Issue Interdisciplinary Medicine)

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8 pages, 460 KiB

Open AccessArticle

Clinical Predictors of Preeclampsia in Pregnant Women with Chronic Kidney Disease

by Bogdan Marian Sorohan, Andreea Andronesi, Gener Ismail, Roxana Jurubita, Bogdan Obrisca, Cătălin Baston and Mihai Harza

Medicina 2020, 56(5), 213; https://doi.org/10.3390/medicina56050213 - 27 Apr 2020

Cited by 2 | Viewed by 3071

Abstract

Background and Objectives: Pregnant women with chronic kidney disease (CKD) are at high risk of adverse maternal and fetal outcomes. Preeclampsia (PE) superimposed on CKD is estimated to occur in 21%–79% of pregnancies. Both conditions share common features such as proteinuria and [...] Read more.

Background and Objectives: Pregnant women with chronic kidney disease (CKD) are at high risk of adverse maternal and fetal outcomes. Preeclampsia (PE) superimposed on CKD is estimated to occur in 21%–79% of pregnancies. Both conditions share common features such as proteinuria and hypertension, making differential diagnosis difficult. Objective: The aim of this study was to evaluate the incidence and the clinical-biological predictors of preeclampsia in pregnant women with CKD. Material and Methods: We retrospectively analyzed 34 pregnant women with pre-existing CKD admitted to our department between 2008 and 2017. Results: Among the 34 patients, 19 (55.8%) developed PE and the mean time of occurrence was 31.26 ± 2.68 weeks of gestation. The median value of 24-h proteinuria at referral was 0.87 g/day (interquartile range 0.42–1.50) and 47.1% of patients had proteinuria of ≥1 g/day. Patients with PE tended to be more hypertensive, with a more decreased renal function at referral and had significantly higher proteinuria (1.30 vs. 0.63 g/day, p = 0.02). Cox multivariate analysis revealed that proteinuria ≥1 g/day at referral and pre-existing hypertension were independently associated with PE (adjusted hazard ratio = 4.10, 95% confidence interval: 1.52–11.02, p = 0.005, adjusted hazard ratio = 2.62, 95% confidence interval: 1.01–6.77, p = 0.04, respectively). The cumulative risk of PE was significantly higher in pregnant women with proteinuria ≥1 g/day at referral (log-rank, p = 0.003). Proteinuria ≥ 1 g/day at referral and pre-exiting hypertension predicted PE development with accuracies of 73.5% and 64.7%, respectively. Conclusions: Pregnant patients with pre-existing CKD are at high risk of developing preeclampsia, while proteinuria ≥ 1 g/day at referral and pre-existing hypertension were independent predictors of superimposed preeclampsia. Full article

(This article belongs to the Special Issue Interdisciplinary Medicine)

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13 pages, 3559 KiB

Open AccessArticle

Pleural Solitary Fibrous Tumors—A Retrospective Study on 45 Patients

by Cornel Savu, Alexandru Melinte, Radu Posea, Niculae Galie, Irina Balescu, Camelia Diaconu, Dragos Cretoiu, Simona Dima, Alexandru Filipescu, Cristian Balalau and Nicolae Bacalbasa

Medicina 2020, 56(4), 185; https://doi.org/10.3390/medicina56040185 - 16 Apr 2020

Cited by 16 | Viewed by 3237

Abstract

Introduction: The purpose of this paper is to study the type, the clinical presentation, and the best diagnostic methods for pleural solitary fibrous tumors (PSFTs), as well as to evaluate which is the most appropriate treatment, especially as PSFTs represent a rare occurrence [...] Read more.

Introduction: The purpose of this paper is to study the type, the clinical presentation, and the best diagnostic methods for pleural solitary fibrous tumors (PSFTs), as well as to evaluate which is the most appropriate treatment, especially as PSFTs represent a rare occurrence in the thoracic pathology. Material and Method: A retrospective study was conducted on a group of 45 patients submitted to surgery between January 2015 and December 2019. In most cases, the diagnosis was established through imaging studies—thoracic computed tomography (CT) scan with or without contrast—but also using magnetic resonance imaging (MRI) or positron emission tomography (PET) scans when data from CT scans were scarce. All patients were submitted to surgery with curative intent. Results: Most patients included in this study were asymptomatic, with this pathology being more common in patients over 60 years of age, and more common in women. The occurrence of malignant PSFT in our study was 17.77% (8 cases). All cases were submitted to surgery with curative intent, with a single case developing further recurrence. In order to achieve complete resection en bloc resection of the tumor with the chest wall, resection was performed in two cases, while lower lobectomy, pneumectomy, and hemidiaphragm resection, respectively, were needed in each case. Postoperative mortality was null. Conclusion: Thoracic CT scan remains the most important imagistic investigation in diagnosing. MRI is superior to thoracic CT, especially in cases that involved the larger blood vessels within the thorax, spinal column, or diaphragm. Complete surgical resection is the gold standard in treatment of PSFT, and the prognosis in benign cases is very good. Full article

(This article belongs to the Special Issue Interdisciplinary Medicine)

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7 pages, 265 KiB

Open AccessArticle

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

by Nicolae Bacalbasa, Irina Balescu, Mihaela Vilcu, Simona Dima, Camelia Diaconu, Laura Iliescu, Alexandru Filipescu, Mihai Dimitriu and Iulian Brezean

Medicina 2020, 56(3), 108; https://doi.org/10.3390/medicina56030108 - 3 Mar 2020

Cited by 4 | Viewed by 2489

Abstract

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 [...] Read more.

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). Conclusions: 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. Full article

(This article belongs to the Special Issue Interdisciplinary Medicine)

9 pages, 281 KiB

Open AccessArticle

Dietary Attitude of Adults with Type 2 Diabetes Mellitus in the Kingdom of Saudi Arabia: A Cross-Sectional Study

by Waqas Sami, Khalid M Alabdulwahhab, Mohd Rashid Ab Hamid, Tariq A. Alasbali, Fahd Al Alwadani and Mohammad Shakil Ahmad

Medicina 2020, 56(2), 91; https://doi.org/10.3390/medicina56020091 - 24 Feb 2020

Cited by 5 | Viewed by 3916

Abstract

Background and Objectives: There is a paucity of literature on the dietary attitude (DA) of patients with type 2 diabetes in the Kingdom of Saudi Arabia (KSA). Although the prevalence of diabetes mellitus (DM) is high in Gulf countries, there remains a lack [...] Read more.

Background and Objectives: There is a paucity of literature on the dietary attitude (DA) of patients with type 2 diabetes in the Kingdom of Saudi Arabia (KSA). Although the prevalence of diabetes mellitus (DM) is high in Gulf countries, there remains a lack of understanding of the importance of dietary behavior in diabetes management among patients. Understanding the behavior of patients with diabetes towards the disease requires knowledge of their DA. Therefore, this study aimed to assess and evaluate the DA of type 2 diabetes patients, and it is the first of its kind in the KSA. Material and Methods: An analytical cross-sectional study was conducted among 350 patients with type 2 diabetes. A self-administered DA questionnaire was used to collect the data. Psychometric properties of the questionnaire were assessed by face validity, content validity, exploratory factor analysis, and internal consistency reliability. The data were collected using a systematic random sampling technique. Results: The overall DA of the patients was inappropriate (p = 0.014). Patients had an inappropriate DA towards food selection (p = 0.003), healthy choices (p = 0.005), food restraint (p < 0.001), health impact (p < 0.001), and food categorization (p = 0.033). A poor DA was also observed in relation to the consumption of red meat (p <0.001), rice (p < 0.001), soup and sauces (p = 0.040), dairy products (p = 0.015), and junk food (p < 0.001). Conclusions: It is highly recommended that patients with diabetes receive counseling with an empowerment approach, as this can bring about changes in their dietary behavior, which is deeply rooted in their daily routine. Healthcare providers should also be well-informed about patients’ attitudes and beliefs towards diabetes to design tailored educational and salutary programs for this specific community. Diabetes self-management educational programs should also be provided on a regular basis with a special emphasis on diet and its related components. Full article

(This article belongs to the Special Issue Interdisciplinary Medicine)

8 pages, 1384 KiB

Open AccessArticle

Timing between Breast Reconstruction and Oncologic Mastectomy—One Center Experience

by Adelaida Avino, Laura Răducu, Lăcrămioara Aurelia Brînduşe, Cristian-Radu Jecan and Ioan Lascăr

Medicina 2020, 56(2), 86; https://doi.org/10.3390/medicina56020086 - 20 Feb 2020

Cited by 9 | Viewed by 3935

Abstract

Background and objectives: Breast cancer is the most common cancer in women. The immunohistochemical profile, but also the stage of the tumor determines the therapeutic management, which varies from conservative surgery to mastectomy associated with chemotherapy, hormonal and biological therapy and/or radiotherapy. Mastectomy [...] Read more.

Background and objectives: Breast cancer is the most common cancer in women. The immunohistochemical profile, but also the stage of the tumor determines the therapeutic management, which varies from conservative surgery to mastectomy associated with chemotherapy, hormonal and biological therapy and/or radiotherapy. Mastectomy remains one of the most radical surgical intervention for women, having great consequences on quality of life, which can be improved by realizing immediate or delayed breast reconstruction. The objective of the study was to evaluate the period of time between the mastectomy and the breast reconstruction. Material and methods: We performed a retrospective study on 57 female patients admitted to the Plastic Surgery Department of the Clinical Emergency Hospital “Prof. Dr. Agrippa Ionescu”, Bucharest, Romania. All the patients underwent immediate or delayed breast reconstruction after mastectomy for confirmed breast cancer. Descriptive data analysis was realized with evaluation of type of breast reconstruction considering the staging of the tumor, the invaded lymph nodes, and the necessity of adjuvant chemoradiotherapy. Moreover, the median period between mastectomy and reconstruction was evaluated. Results: The immediate breast reconstruction was performed in patients with stage I, in patients with stage II, delayed reconstruction was performed after minimum six months, and the patients with stage III had the breast reconstructed with free flap (50%), 8–43 months post-mastectomy. Radiotherapy determines the type of breast reconstruction, in most of the cases the latissimus dorsi flap was used with implant (22.6%). Conclusions: Breast reconstruction is an important step in increasing the quality of life for women who underwent mastectomy after breast cancer. The proper timing for breast reconstruction must be settled by a team formed by the patient, the plastic surgeon, and the oncologist. Full article

(This article belongs to the Special Issue Interdisciplinary Medicine)

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7 pages, 288 KiB

Open AccessArticle

Quality of Life in Patients with Surgically Removed Skin Tumors

by Laura Răducu, Adelaida Avino, Raluca Purnichescu Purtan, Andra-Elena Balcangiu-Stroescu, Daniela Gabriela Bălan, Delia Timofte, Dorin Ionescu and Cristian-Radu Jecan

Medicina 2020, 56(2), 66; https://doi.org/10.3390/medicina56020066 - 9 Feb 2020

Cited by 12 | Viewed by 2866

Abstract

Background and Objectives: Skin cancer is one of the most frequently diagnosed malignancies. The main goal of the therapeutic management is total excision with the prevention of recurrence and metastasis. The quality of life of the patients with skin cancer is affected [...] Read more.

Background and Objectives: Skin cancer is one of the most frequently diagnosed malignancies. The main goal of the therapeutic management is total excision with the prevention of recurrence and metastasis. The quality of life of the patients with skin cancer is affected by the morbidity risk, surgery, and cosmetic or functional aspects. The aim of this study was to evaluate the quality of life of patients with skin cancer prior to and post surgical intervention. Material and methods: We performed a prospective study on 247 patients with skin tumors. Quality of life was evaluated through an initial questionnaire that was given to all consenting patients. This was used to determine patients’ mobility, selfcare, normal activities, pain, and despair, using a five-point Likert scale. The general autoperceived health state was also recorded using a 100-point scale. The study included the responses of all patients at hospital admission, after one month of surgery, and after one year of surgery. Results: In patients with squamous cell carcinoma (SCC), the general health state indicator statistically significantly decreased one month after surgery and increased at one-year follow-up. In malignant melanoma (MM) patients, mobility, selfcare, normal activities, and discomfort presented a decrease in values one year after surgery, compared to the values registered at hospital admission. In patients with basal cell carcinoma (BCC), all indicators of quality of life presented an impaired value one year after surgery, after a decreasing trend. The general health state indicator statistically significantly increased one month after surgery and after one year. Conclusions: Surgery is one of the main steps in treating skin cancer. It has a great impact on patients’ quality of life because of pain andthe effect on mobility and normal activities. Skin cancers influence the quality of life of patients both psychologicallyand physically. Full article

(This article belongs to the Special Issue Interdisciplinary Medicine)

Review

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7 pages, 505 KiB

Open AccessEditor’s ChoiceReview

Is There a Relationship between COVID-19 and Hyponatremia?

by Gina Gheorghe, Madalina Ilie, Simona Bungau, Anca Mihaela Pantea Stoian, Nicolae Bacalbasa and Camelia Cristina Diaconu

Medicina 2021, 57(1), 55; https://doi.org/10.3390/medicina57010055 - 9 Jan 2021

Cited by 44 | Viewed by 9509

Abstract

Nowadays, humanity faces one of the most serious health crises, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. The severity of coronavirus disease 2019 (COVID-19) pandemic is related to the high rate of interhuman transmission of the virus, variability of clinical presentation, [...] Read more.

Nowadays, humanity faces one of the most serious health crises, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. The severity of coronavirus disease 2019 (COVID-19) pandemic is related to the high rate of interhuman transmission of the virus, variability of clinical presentation, and the absence of specific therapeutic methods. COVID-19 can manifest with non-specific symptoms and signs, especially among the elderly. In some cases, the clinical manifestations of hyponatremia may be the first to appear. The pathophysiological mechanisms of hyponatremia among patients with COVID-19 are diverse, including syndrome of inappropriate antidiuretic hormone secretion (SIADH), digestive loss of sodium ions, reduced sodium ion intake or use of diuretic therapy. Hyponatremia may also be considered a negative prognostic factor in patients diagnosed with COVID-19. We need further studies to evaluate the etiology and therapeutic management of hyponatremia in patients with COVID-19. Full article

(This article belongs to the Special Issue Interdisciplinary Medicine)

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9 pages, 292 KiB

Open AccessReview

Caudal Duplication Syndrome Systematic Review—A Need for Better Multidisciplinary Surgical Approach and Follow-Up

by Spătaru Radu-Iulian, Avino Adelaida, Iozsa Dan-Alexandru, Ivanov Monica, Serban Dragos, Tomescu Luminiţa Florentina and Cirstoveanu Cătălin

Medicina 2020, 56(12), 650; https://doi.org/10.3390/medicina56120650 - 27 Nov 2020

Cited by 4 | Viewed by 2478

Abstract

Background and Objectives: Caudal duplication syndrome is a rare association of anatomical anomalies describing duplication of the hindgut, spine, and uro-genital structures, leading to varied clinical presentations. The current literature focuses on case reports which describe the embryological etiology and anatomical spectrum of [...] Read more.

Background and Objectives: Caudal duplication syndrome is a rare association of anatomical anomalies describing duplication of the hindgut, spine, and uro-genital structures, leading to varied clinical presentations. The current literature focuses on case reports which describe the embryological etiology and anatomical spectrum of the condition giving little attention to the surgical preparation, the need for a well-structured follow-up program, or the transition into adult healthcare of these complex patients. No reviews have been published regarding this complex pathology. Materials and Methods: A review of caudal duplication syndrome cases was done to assess the range of the clinical malformations, timing, and types of surgical interventions. Inconsistencies in multidisciplinary care, follow-up, and risk events were described. Results: Hindgut duplication always involved the anorectal region. Anorectal malformations were evenly distributed as unilateral and bilateral. Colon duplication extended from the anal region to the transverse colon or ascending colon in most of the cases and less to terminal. In females, genital duplication was present in all cases. The follow-up period varied between 3 months and 12 years. In all adult females, the motive of presentation was related to pregnancy (complications after successful delivery, fertility evaluation) or late complications (fecalith obstruction of the end-to-side colon anastomosis, repeated UTIs with renal scarring). Conclusions: Complex malformations affecting multiple caudal organs may have a strong impact in many aspects of the long-term quality of life; therefore, patients with caudal duplication syndrome need increased awareness and joined multidisciplinary treatment. Full article

(This article belongs to the Special Issue Interdisciplinary Medicine)

8 pages, 1723 KiB

Open AccessReview

Topical Corticosteroids a Viable Solution for Oral Graft versus Host Disease? A Systematic Insight on Randomized Clinical Trials

by Arin Sava, Andra Piciu, Sergiu Pasca, Alexandru Mester and Ciprian Tomuleasa

Medicina 2020, 56(7), 349; https://doi.org/10.3390/medicina56070349 - 14 Jul 2020

Cited by 3 | Viewed by 2411

Abstract

Background and Objectives: This research attempts to provide a clear view of the literature on randomized clinical trials (RCTs) concerning the efficacy of topical dexamethasone, clobetasol and budesonide in oral graft versus host disease (GVHD). Materials and Methods: An electronic search of the [...] Read more.

Background and Objectives: This research attempts to provide a clear view of the literature on randomized clinical trials (RCTs) concerning the efficacy of topical dexamethasone, clobetasol and budesonide in oral graft versus host disease (GVHD). Materials and Methods: An electronic search of the PubMed, Web of Science and Scopus databases was carried out for eligible RCTs. Studies were included if they had adult patients with oral GVHD treatment with topical corticosteroids, and if the RCT study was published in English. The Cochrane Risk of Bias tool was used to assess the quality of these studies. Overall, three RCTs were included (an Open, Randomized, Multicenter Trial; a Randomized Double-Blind Clinical Trial; and an Open-Label Phase II Randomized Trial). Results: The trials involved 76 patients, of which 44 patients received topical dexamethasone, 14 patients received topical clobetasol and 18 patients received topical budesonide. Topical agents were most frequently used when oral tissues were the sole site of involvement. It appears that the best overall response is present for budesonide with no difference between the four arms, followed by clobetasol, and then by dexamethasone. The limitation of the current study is mainly represented by the fact that overall response was derived in two of the studies from other parameters. Moreover, both budesonide and clobetasol were used in only one study each, while two assessed dexamethasone. Conclusions: Based on the clinical trials, all three agents seem to be effective in treating oral GVHD and had a satisfactory safety profile. There is still a need for assessing high quality RCTs to assess the efficacy of these therapies on a larger cohort. Full article

(This article belongs to the Special Issue Interdisciplinary Medicine)

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12 pages, 353 KiB

Open AccessReview

State of the Art in Fertility Preservation for Female Patients Prior to Oncologic Therapies

by Călin Bogdan Chibelean, Răzvan-Cosmin Petca, Dan Cristian Radu and Aida Petca

Medicina 2020, 56(2), 89; https://doi.org/10.3390/medicina56020089 - 23 Feb 2020

Cited by 4 | Viewed by 2984

Abstract

Quality of life improvement stands as one of the main goals of the medical sciences. Increasing cancer survival rates associated with better early detection and extended therapeutic options led to the specific modeling of patients’ choices, comprising aspects of reproductive life that correlated [...] Read more.

Quality of life improvement stands as one of the main goals of the medical sciences. Increasing cancer survival rates associated with better early detection and extended therapeutic options led to the specific modeling of patients’ choices, comprising aspects of reproductive life that correlated with the evolution of modern society, and requires better assessment. Of these, fertility preservation and ovarian function conservation for pre-menopause female oncologic patients pose a contemporary challenge due to procreation age advance in evolved societies and to the growing expectations regarding cancer treatment. Progress made in cell and tissue-freezing technologies brought hope and shed new light on the onco-fertility field. Additionally, crossing roads with general fertility and senescence studies proved highly beneficial due to the enlarged scope and better synergies and funding. We here strive to bring attention to this domain of care and to sensitize all medical specialties towards a more cohesive approach and to better communication among caregivers and patients. Full article

(This article belongs to the Special Issue Interdisciplinary Medicine)

Other

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8 pages, 1720 KiB

Open AccessCase Report

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

by Cornel Savu, Alexandru Melinte, Vasile Grigorie, Laura Iliescu, Camelia Diaconu, Mihai Dimitriu, Bogdan Socea, Ovidiu Stiru, Valentin Varlas, Carmen Savu, Irina Balescu and Nicolae Bacalbasa

Medicina 2020, 56(11), 567; https://doi.org/10.3390/medicina56110567 - 27 Oct 2020

Cited by 7 | Viewed by 3168

Abstract

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 [...] Read more.

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. Full article

(This article belongs to the Special Issue Interdisciplinary Medicine)

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6 pages, 2497 KiB

Open AccessCase Report

A Very Rare Case of Colosalpingeal Fistula Secondary to Diverticulitis: An Overview of Development, Clinical Features and Management

by Natalia Darii Plopa, Nicolae Gica, Marie Gerard, Marie-Cécile Nollevaux, Milenko Pavlovic and Emil Anton

Medicina 2020, 56(9), 477; https://doi.org/10.3390/medicina56090477 - 17 Sep 2020

Cited by 6 | Viewed by 3105

Abstract

Background: Colosalpingeal fistula is a rare complication secondary to diverticular disease. The pathogenesis is still not clearly understood. We present the case of a colosalpingeal fistula and a review of the management of this pathology. Case report: A 69-year-old patient with uncomplicated diverticular [...] Read more.

Background: Colosalpingeal fistula is a rare complication secondary to diverticular disease. The pathogenesis is still not clearly understood. We present the case of a colosalpingeal fistula and a review of the management of this pathology. Case report: A 69-year-old patient with uncomplicated diverticular disease was referred to our department for recurrent vaginal discharge. The clinical examination was unremarkable, hysteroscopy revealed the presence of air in the uterine cavity in the absence of a uterine fistula. A preliminary diagnosis of colosalpingeal fistula was made and was confirmed by computed tomography (CT) scan and hysterosalpingography. A one-stage surgery via laparotomy was successfully performed with remission of the symptoms. Conclusion: Colotubal fistula is a rare complication resulting from intestinal diverticular disease. The purpose of this paper was to emphasize the presence of a rare, but serious complication occurring in diverticular disease with atypical symptoms and one-stage surgery treatment. Full article

(This article belongs to the Special Issue Interdisciplinary Medicine)

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8 pages, 3679 KiB

Open AccessCase Report

Management of a Patient with Tuberous Sclerosis with Urological Clinical Manifestations

by Vlad Padureanu, Octavian Dragoescu, Victor Emanuel Stoenescu, Rodica Padureanu, Ionica Pirici, Radu Cristian Cimpeanu, Dop Dalia, Alexandru Radu Mihailovici and Paul Tomescu

Medicina 2020, 56(8), 369; https://doi.org/10.3390/medicina56080369 - 23 Jul 2020

Cited by 1 | Viewed by 2457

Abstract

The tuberous sclerosis complex (TSC) is highly variable as far as its clinical presentation is concerned. For the implementation of appropriate medical surveillance and treatment, an accurate diagnosis is compulsory. TSC may affect the heart, skin, kidneys, central nervous system (epileptic seizures and [...] Read more.

The tuberous sclerosis complex (TSC) is highly variable as far as its clinical presentation is concerned. For the implementation of appropriate medical surveillance and treatment, an accurate diagnosis is compulsory. TSC may affect the heart, skin, kidneys, central nervous system (epileptic seizures and nodular intracranial tumors—tubers), bones, eyes, lungs, blood vessels and the gastrointestinal tract. The aim of this paper is to report renal manifestations as first clinical signs suggestive of TSC diagnosis. A 20-year-old patient was initially investigated for hematuria, dysuria and colicky pain in the left lumbar region. The ultrasound examination of the kidney showed bilateral hyperechogenic kidney structures and pyelocalyceal dilatation, both suggestive of bilateral obstructive lithiasis, complicated by uretero-hydronephrosis. The computer tomography (CT) scan of the kidney showed irregular kidney margins layout, undifferentiated images between cortical and medullar structures, with non-homogenous round components, suggestive of kidney angiomyolipomas, bilateral renal cortical retention cysts, images of a calculous component in the right middle calyceal branches and a smaller one on the left side. The clinical manifestations and imaging findings (skull and abdominal and pelvis CT scans) sustained the diagnosis. Full article

(This article belongs to the Special Issue Interdisciplinary Medicine)

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11 pages, 3301 KiB

Open AccessCase Report

Krukenberg Tumor in Association with Ureteral Stenosis Due to Peritoneal Carcinomatosis from Pulmonary Adenocarcinoma: A Case Report

by Irina Balescu, Nona Bejinariu, Simona Slaniceanu, Mircea Gongu, Brandusa Masoud, Smarandita Lacau, George Tie, Maria Ciocirlan, Nicolae Bacalbasa and Catalin Copaescu

Medicina 2020, 56(4), 187; https://doi.org/10.3390/medicina56040187 - 17 Apr 2020

Cited by 1 | Viewed by 3073

Abstract

Krukenberg tumors from pulmonary adenocarcinoma represent an extremely rare situation; only a few cases have been reported. The aim of this paper is to report an unusual such case in which almost complete dysphagia and ureteral stenosis occurred. The 62-year-old patient was initially [...] Read more.

Krukenberg tumors from pulmonary adenocarcinoma represent an extremely rare situation; only a few cases have been reported. The aim of this paper is to report an unusual such case in which almost complete dysphagia and ureteral stenosis occurred. The 62-year-old patient was initially investigated for dysphagia and weight loss. Computed tomography showed the presence of a thoracic mass compressing the esophagus in association with a few suspect pulmonary and peritoneal nodules, one of them invading the right ureter. A biopsy was performed laparoscopically on the peritoneal nodules. The right adnexa presented an atypical aspect; right adnexectomy was also found. The histopathological and immunohistochemical studies confirmed that the primitive origin was pulmonary adenocarcinoma. Although both peritoneal carcinomatosis and ovarian metastases from pulmonary adenocarcinoma represent a very uncommon situation, this pathology should not be excluded, especially in cases presenting suspect pulmonary lesions. Full article

(This article belongs to the Special Issue Interdisciplinary Medicine)

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7 pages, 1080 KiB

Open AccessCase Report

Synchronous Cervical Adenocarcinoma and Ovarian Serous Adenocarcinoma—A Case Report and Literature Review

by Nicolae Bacalbasa, Irina Cecilia Balescu, Camelia Diaconu, Simona Dima, Laura Iliescu, Mihaela Vilcu, Alexandru Filipescu, Ioana Halmaciu, Dragos Cretoiu and Iulian Brezean

Medicina 2020, 56(4), 152; https://doi.org/10.3390/medicina56040152 - 29 Mar 2020

Cited by 2 | Viewed by 2606

Abstract

Background/Aim: Synchronous gynecological malignancies are rarely encountered, and most often these cases are represented by synchronous ovarian and endometrial cancer. The aim of this paper is to present the case of a 53-year-old patient who was diagnosed with synchronous cervical and ovarian cancer. [...] Read more.

Background/Aim: Synchronous gynecological malignancies are rarely encountered, and most often these cases are represented by synchronous ovarian and endometrial cancer. The aim of this paper is to present the case of a 53-year-old patient who was diagnosed with synchronous cervical and ovarian cancer. Case presentation: The patient had been initially investigated for vaginal bleeding and was submitted to a biopsy confirming the presence of a cervical adenocarcinoma. Once the diagnostic of malignancy was confirmed, the patient was submitted to a computed tomography which revealed the presence of large abdominal tumoral nodules of peritoneal carcinomatosis and was submitted to palliative chemotherapy with poor response. Eighteen months later she developed intestinal obstruction and was submitted to surgery. At that moment, synchronous ovarian and cervical tumors were diagnosed. Total radical hysterectomy with bilateral adnexectomy, pelvic and para-aortic lymph node dissection, omentectomy, and pelvic peritonectomy was performed; in the meantime, the histopathological studies confirmed the presence of two synchronous malignancies. Conclusion: Although synchronous lesions are rarely encountered, this eventuality should not be omitted. In such cases, surgery should be taken in consideration and the intent of radicality should regard both lesions. Full article

(This article belongs to the Special Issue Interdisciplinary Medicine)

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7 pages, 2669 KiB

Open AccessCase Report

Total Exenteration En Bloc with a Nephrectomy for Locally Advanced Cervical Cancer Invading a Pelvic Kidney—A Case Report and Literature Review

by Nicolae Bacalbasa, Irina Balescu, Mihaela Vilcu, Simona Dima, Camelia Diaconu, Laura Iliescu, Alexandru Filipescu and Iulian Brezean

Medicina 2020, 56(1), 33; https://doi.org/10.3390/medicina56010033 - 15 Jan 2020

Viewed by 2962

Abstract

Introduction: Extended pelvic resection might be the option of choice in patients presenting locally advanced cervical cancer. However, the possibility of a co-existence of an ectopic, pelvic kidney that is invaded by such a tumor is extremely rare. Case Presentation: A [...] Read more.

Introduction: Extended pelvic resection might be the option of choice in patients presenting locally advanced cervical cancer. However, the possibility of a co-existence of an ectopic, pelvic kidney that is invaded by such a tumor is extremely rare. Case Presentation: A 54-year-old female patient, diagnosed with locally advanced cervical cancer in the presence of a pelvic kidney, was submitted to surgery with curative intent. A large, abscessed cervical tumor invading the urinary bladder and the rectum was found, so a total exenteration was planned. Intraoperatively, tumor invasion of the left kidney, which was found in an ectopic, pelvic position was also encountered; therefore, total pelvic exenteration in association with a left nephrectomy was successfully performed. Conclusions: The presence of an ectopic, pelvic disposition of the kidney makes it susceptible to be invaded by locally advanced pelvic tumors; in such cases, a nephrectomy might also be needed. Full article

(This article belongs to the Special Issue Interdisciplinary Medicine)

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