Introduction. Even though, primary thyroid lymphoma (PTL) is a rare thyroid malignancy and extranodal non-Hodgkin lymphoma, this type of disease should not be disgraced in order to achieve an early diagnosis and multimodal treatment. Materials and method. We selected for discussions a primary thyroid lymphoma patient with absent constitutional (B-type) symptoms, who undergoes a multidisciplinary approach of the disease, chemotherapy and radiotherapy. In this clinical case report a 84 yo male patient with stage IE diffuse large B-cell histological type (Ann Arbor staging) was treated using R-CHOP chemotherapy, followed by involved field radiotherapy, with an excellent treatment response and disease control. Results and Discussion. Usually this type of extranodal non-Hodgkin lymphoma is present in the seventh decade of life, with males being affected earlier than females. One of the most common presentations of thyroid lymphoma is an enlarging neck mass and a history of Hashimoto’s thyroiditis, which is the major risk factor. The most common PTL subtypes are diffuse large B-cell lymphoma (the most aggressive histological subtype, representing 70% of all PTLs) and MALT lymphoma (30% of the PTLs). Advances in both diagnosis and treatment in the last years have improved the early diagnosis and shortened the time for treatment implementation.
Background: This topic is aimed to review the treatment approach in adult patients diagnosed with urosespsis, in order to decrease mortality and to maximize the outcome of the antibiotic stewardship efforts. Methods: We present an approach of antibiotic therapy in urosepsis from an infectious diseases physician perspective, based on the recently published data integrating the epidemiology of the urinary tract infections in a multidisciplinary hospital from Romania. Results: The principles of therapy in urosepsis should have five goals, but not limited to rapid diagnosis, specific intensive care unit treatment, obtaining urine and blood cultures, anti-infective treatment and identifying and correction of underlying risk factors. Due to the higher prognostic value, the antimicrobial therapy in urosepsis should consist in “two steps” regimen: initial antimicrobial therapy, based on “empirical” approach for the first 48 - 72 hours and directed or “definitive” antimicrobial therapy adapted to the susceptibility profile of the isolated pathogens, the penetration into the urinary tract and the patient clinical response. Clinicians should be aware of the different antibiotic susceptibility profile of the bacteria from the hospital compared to the community. Thus, the initial choice of antimicrobial agents depends on several criteria like the severity of illness and the risk factors for multidrug resistant pathogens: the immune status of the patient (age, debilitating chronic illnesses, immunosuppressive treatment or uncontrolled malignancies), broad-spectrum antimicrobial use and health care environment exposures in the previous 3 to 6 months, susceptibility of prior urinary isolates, and local community resistance prevalence of bacteria. Conclusions: Our important messages highlighted the need of a holistic approach of urosepsis, in a multidisciplinary team, with integration of risk factors for AMR, focusing on the first phase of antibiotic treatment as the main driven of the survival rate.
One of the great dreams of humanity has been the improvement of its behavioural, affective and emotional status. Depression represents the suffering of beings over their existential course, as a point of passage between the human condition and its destiny. The attempts of psychiatry to introduce efficient and increasingly performing antidepressants represent one of medicine’s great achievements. At the same time, antidepressant overdosing may lead to cardiotoxic manifestations presenting lethal risks as consequences [1]. We hereby present the case of a patient that was poisoned with tianeptine, ingested for suicidal purposes, who survived repetitive episodes of ventricular fibrillation, electrically converted to sinusal rhythm. The GC/MS analytical diagnosis played an essential part in detecting tianeptine in the biological samples. The rapid and very competent therapeutic intervention allowed for the patient’s survival, despite further complications. A review of main tianeptine information is also presented, as this type of intoxication may have deadly consequences.
The diagnosis of pigmented basal cell carcinoma can bring significant distress to patients and physicians alike. However, astute clinicians that can employ correctly the clinical and dermatoscopical clues can reach a correct preoperative diagnosis, and as such can avoid unnecessary worry for the patient, additional work-up, or overtreatment. We present a case series of pigmented basal cell carcinomas and a comparative case with pigmented cutaneous melanoma, together with a literature review, that will highlight these aspects of the management of pigmented tumours of the skin.
Acute drug-related acute intoxications or suicidal ideation following overdose with anticonvulsants may cause major morbidity, in many cases requiring intensive care and prolonged periods of hospitalization. The case of a 35-year-old patient known for a history of epilepsy with phenobarbital and carbamazepine treatment is brought to the Emergency Unit by transfer from another hospital in a comatose state with insufficient respiratory performance, bilateral active mydriasis. From the family members' claims, the patient discontinued treatment with phenobarbital two weeks ago. Following interdisciplinary examination, hospitalization in the Neurology Department with the diagnosis of epileptic status is decided. Due to the progressive aggravation of acute respiratory insufficiency, the ventilator support is constituted. Since the biological samples related to probability diagnosis and cerebral imaging were not conclusive, toxicological samples were collected. The GC/MS analytical toxicology screening in urine reveals the presence of carbamazepine and phenobarbital and their plasma levels (5.92 and 92.3 mg/l) as determined by the FPIA method indicate an overdose of phenobarbital therapy. The patient is taken over by the Department of Clinical Toxicology where specific intensive care measures are applied. Clinical evolution is favorable. The psychiatric examination highlights the depressive idea, suicidal ideas, and uselessness. The suicide attempt is confirmed. It also presents a review of the main information about acute poisoning with anticonvulsants, but also about the analytical laboratory methods that bring precious information in establishing the diagnosis of certainty.
The case of 73 years - old male patient with inferior crossed renal ectopia diagnosed upon imaging workup using a GE LightSpeed 16 Slice CT, with urothelial carcinoma, at the level of the left kidney, nephrolithiasis and thrombosed aneurysm at the level of the origin of right common iliac artery. The upper lobe of the right kidney fused with the lower lobe of the left kidney, on the left side of the midline. There were 6 renal arteries (4 on the left and 2 on the right) originating from the left side of the abdominal aorta, at the level of the termination of the abdominal aorta, the left common iliac artery and the right internal iliac artery. The patient presented with 6 renal veins (3 on the left and 3 on the right) that drained anteriorly on the left side of the inferior vena cava into the left common iliac vein and into the right internal iliac vein.
Moyamoya disease is a rare affliction, which progressively affects cerebral arteries, more frequently those in the circle of Willis and the internal carotid arteries. This condition has a genetic component, but the cause of the disease is unknown. It usually affects children but can affect adults as well, representing a health issue due to its mortality. Not in a few cases, Moyamoya disease has been difficult to recognize as a cause of ischemic or hemorrhagic strokes. In this article, we present the case of a young patient, with a medical history of cerebral hemorrhage, which was diagnosed with Moyamoya disease after clinical and cerebral angiographic corroboration in a specialized vascular center. The patient entered the Emergency Receiving Unit with a sudden comatose state. Paraclinical tests revealed massive intraparenchymal hemorrhage, with movement in the medial line and ventricular flooding.
One of the most obvious trends in current prosthetic dentistry is the introduction of digital techniques. Of these, the techniques that offer the possibility of aesthetic prefiguration of the final prosthetic result are of particular interest to the dentist. The aim of this paper was to verify the applicability of the Digital Smile Design application, which is the most commonly, used aesthetic prefiguration application, an application designed for the dentate patient, to full edentulism. Two groups of full edentulous patients were formed: the first group, complete denture carriers, dissatisfied with the aesthetic aspects, that they wanted to improve in the new denture, and, the second group, newly bimaxillary full edentulous patients with high aesthetic expectations. Thus, on the first group, the tests were performed on the existing denture, and the second one with the maxillary occlusion template. However, the view of the final result offered the patients the chance to have a realistic picture of their desires regarding the shape, color, size of the teeth, which were inadequate in relation to age and facial typology. The use of this application also improves communication with the dental laboratory. In full edentulism, the current DSD technique can be used with some limitations and the use of it in this field needs more complex studies on larger groups of patients.
The pneumatization of all nasal turbinates is an extremely rare finding. Several previous reports have presented the bilateral superior, middle, and inferior conchæbullosæ. We report the bilateral pneumatization of middle and superior nasal turbinates. The variant was documented in cone beam computed tomography (CBCT) in all three dimensions. The inferior concha bullosa was a bilaterally moderate subtype of lamellar pneumatization that presented as a conchal recess of the maxillary sinus. The concha bullosa media was bilaterally of the extensive or true type and associated unilaterally with an uncinate bulla. The concha bullosa superior was asymmetrical bilaterally, narrower on the right side, and larger on the left where it was also septated and tri-cameral. The supreme conchæ were rudimentary, as were their pneumatizations. For an accurate anatomic diagnosis of conchæbullosæ in computed tomography, sagittal, coronal, and axial cuts, as well as three-dimensional reconstructions, should be used to ensure adequate planning of functional endoscopic sinus surgery.
Clear cell acanthoma represent a benign solitary epidermal tumor of the clear glycogen containing epithelial cells, which is quite common in dermatologic practice. The etiology of this tumor formation is not known exactly at the moment. Clinically, the lesion appears as a single reddish papule or papule-nodule and the characteristic of this lesion is represented by a peripheral scaling collarette. Although solitary lesions represent the most common form of presentation of the acanthoma with clear cells, less than thirtieth cases of multiple clear cell acanthoma, from two up to four hundred lesions, have been described in the medical literature to date. The diagnosis based on clinical features frequently needs to be supported using a dermoscopy exam and, in most cases, a histopathology exam is required. The treatment consists is complete removal (standard surgical excision, cryotherapy, electrofulguration alone, carbon dioxide laser or shave removal or curettage followed by electrofulguration). For the cases with multiple lesions, cryotherapy, or topical 5- fluorouracil are preferred. We present the case of a 62-year-old male patient, presented to our Dermatology Department for multiple asymptomatic rounded papules and multiple exophytic nodular tumor formations (approximate fifteen), on the lower extremities, which had occurred approximately two years previously and gradually increased in number.
