Background: Late-delayed complications after radiotherapy (RT) results from an imbalance between cell lesions and the protective capacities of the CNS. Temozolomide (TMZ) after RT may represent a potent radiosensitizing regimen. Although radionecrosis (RN) of the anterior visual pathway has been documented, in our opinion this is the first report of reversible visual field loss associated with occipital lobe radionecrosis. Case observation: We report a patient who suffered a left lateral homonymous hemianopia one year after radiochemotherapy (RCT) for an infiltrative low grade fibrillary astrocytoma. The visual field deficit was completely reversible after one month. Visual field defects have been described after the use of conventional external beam therapy for lesions near the anterior visual pathway. The cortex is relatively spared after RT. Conclusions: Given the new scientific data, we suppose that neuroplasticity may play a role in the reversibility of visual field deficit. At this time there is no proven treatment of radionecrosis. Homonymous hemianopia caused by occipital lesions are attributable to vascular disease and tumors, but take into account radiation effects. The risk of neurogenic visual loss must be factored into the decision to irradiate the whole brain.
Benzodiazepine overdose has various clinical manifestation, mainly regarding the central nervous system (CNS), cardiac and respiratory side effects, but rarely results in significant morbidity and mortality. Acute benzodiazepine poisoning results in dizziness, ataxia, nystagmus, dysarthria, hypoxia, hypothermia, bradycardia, hypotension, apnea, pulmonary aspiration, respiratory depression, coma, cardiopulmonary arrest and death. Anyway, deep nonresponsive coma should be investigated for additional etiologies. On the other hand, human transmissible prion disease has a fatal outcome with no specific treatment.
Benzodiazepine overdose has various clinical manifestation, mainly regarding the central nervous system (CNS), cardiac and respiratory side effects, but rarely results in significant morbidity and mortality. Acute benzodiazepine poisoning results in dizziness, ataxia, nystagmus, dysarthria, hypoxia, hypothermia, bradycardia, hypotension, apnea, pulmonary aspiration, respiratory depression, coma, cardiopulmonary arrest and death. Anyway, deep nonresponsive coma should be investigated for additional etiologies. On the other hand, human transmissible prion disease has a fatal outcome with no specific treatment.
Objective: The purpose of this study is to compare the capsular structure appearing in follicular adenoma and papillary thyroid carcinoma to differentiate the benign and malignant thyroid nodules. Methods: Second Harmonic Generation (SHG) Microscopy was used to image collagen distribution in the capsules of several types of nodules. The tissue fragments were formalin-fixed, paraffin-embedded but without H&E staining, with 4-5 microns thick sections. From the same sample, two consecutive sections were made. The first was colored with H&E and capsule images were acquired with an optical microscope. The second was not colored with H&E. On the uncolored sample, type I collagen from the capsule was visualized by SHG microscopy. In addition, a parameter was used to study the orientation of collagen fibers, obtained from the Fast Fourier Transform (FFT) analysis of 2D-images. Results: SHG microscopy images were acquired to assess the collagen organization of tumoral capsular thyroid nodules previously diagnosed as benign or malignant by conventional H&E staining. Different degree of collagen fibers orientation was observed from the two kinds of capsules and quantified using FFT analysis. Conclusion: These above described microscopy method can be used to distinguish between benign and malignant thyroid nodules, based on different degree of the capsular collagen fibers orientation.
Making medical countermeasures requires documentation to assess vulnerabilities, threats and operational risks and bioterrorism through the collection and processing of specific multidisciplinary data in human medicine, veterinary, phytosanitary, the environment, defense and national security, etc. Based on retrospective data and late information (medical intelligence), we can estimate the prospective risk to public health, respectively for troops and civilian population in a given area, the area of operations. The biological military or bioterrorist attack, whether overtly or masqueraded as human or animal epidemics can cause a major biological crisis for troops and the civilian population, for domestic and wild animals, for crops or wild plants or for the environment, which remains contaminated. Therefore, it is important to constantly monitor the situation of infectious diseases in the area of responsibility (national territory, operations theaters) to assess vulnerability, threat and bioterrorist risk but also for making medical anti-bioterrorist countermeasures, which can only be effective by genuine cooperation between all specialized structures of the Ministry of Defense, other departments and the civil society.
Vasile Voiculescu (1884-1963), besides being a well-known writer, was also a prominent, much respected physician who practiced between the two world wars. He attended the courses of the Faculty of Letters and Philosophy in Bucharest for a year (1902-1903), but gave up on them in order to attend the Faculty of Medicine. The literary debut took place in 1912 in the journal Convorbiri literare. He published the first volume of lyrical poems in 1916 and in 1918 he was granted the Academy Award for lyrical volume From the Aurochs Country and other poems. In 1935 he became a member of the Academy of Sciences of Romania and in 1941 he received the National Poetry Prize. The following volumes of poems are: Ripeness (1921), Poems with Angels (1927), Destiny (1933), Ascent (1937), Gleams (1939). His work also includes a short story: The Demiurge (1943). Shakespeare's last imaginative sonnets in Vasile Voiculescu’s translation (1964), and the novel Zahei-The blind (1966), Sentimental Gymnastics (1972) are published posthumously. The present article is aimed at revealing the world of Voiculescu’s short stories.
Treatment resistant schizophrenia (TRS) is a severely disabling disorder, which decreases dramatically the quality of life and overall functionality, while it increases the rate of hospital admissions and overall healthcare costs. The main objective of this research was to evaluate the risk factors for TRS in a group of patients based on a retrospective analysis. The secondary objective was to design an algorithm for initial evaluation in patients with schizophrenia, in order to detect the candidates at risk for developing TRS. Medical charts and consultation records of all patients aged between 18 and 30, diagnosed with TRS, evaluated during 1-year in our department, were selected for analysis. The most significant risk factors for TRS found in univariate model were younger age at schizophrenia onset, male gender, living in rural areas, co-morbid drug dependence, lower therapeutic adherence, and premorbid personality disorder. Marginally significant were higher Positive and Negative Syndrome Scale (PANSS) scores at previous admissions, higher scores on PANSS negative symptoms sub-scale, and lower educational background. In the multivariate model, TRS was still significantly predicted (p<0.05) by younger age at the disease onset, addictive co-morbidity, and lower therapeutic adherence. An algorithm based on these risk factors is suggested, based on (a) structured PANSS evaluation using SCI-PANSS and Informant Questionnaire for PANSS, (b) a scale for the detection of co-morbid drug dependence (i.e. Inventory of Drug Taking Situations, IDTS), (c) an interview for detecting premorbid personality disorders (i.e. Structured Clinical Interview for DSM IV – Axis II Disorders, SCID-II), and (d) Treatment Satisfaction Questionnaire for Medication (TSQM) for therapeutic adherence monitoring. Also, the inclusion of several pharmacogenetic parameters (at least CYP450 2D6 panel for detection of poor/ultrarapid metabolizers) could be useful when establishing an adequate therapeutic management, and may help in decreasing the rate of non- response due to variations in antipsychotics plasma levels.
Breast carcinoma represents the leading cause of oncologic mortality for women. Due to therapeutic and diagnostic advances, the mortality and morbidity in the last decade declined, but breast cancer still has a great impact on quality of life and also on medical service cost. In the light of these facts, an integrated approach, considering histopathology features, molecular profiles and corroboration with clinical and imagistic data is necessary. A descriptive retrospective one-year study analyzed the breast cancer heterogeneity in 121 cases registered in the Pathology Department of the University Emergency Hospital in Bucharest, Romania. Our purpose was to evaluate histopathological, immunohistochemically, clinical and imagistic aspects of breast cancer considering the current molecular classification (Luminal A, Luminal B, HER2 enriched and triple negative/basal like). Our assay revealed that most prevalent histotype was NST (no special type) followed by invasive lobular carcinoma. Considering the molecular pattern, the most common was luminal B. Triple negative basal like and HER 2-enriched were correlated with an aggressive morphologic pattern and lymph-nodes positivity. Considering the imagistic acquisitions, mammography proved to be the most accurate technique for measuring the dimension of NST. In conclusion, breast carcinoma is a heterogeneous disease that needs an integrated approach and personalized treatment based on the histopathologic and molecular features. Considering the great number of advanced stages as diagnosis, a national screening program for breast cancer is imperiously needed.
Gingival conditions are frequently encountered in dental clinical practice and they can raise diagnosis and treatment problems. The diagnostic is variable from normal conditions to autoimmune diseases or even malignancy. Some of them cause disturbances such as pain, burning sensation and have an impact on patient’s quality of life.
The purpose of this paper is to provide information about mortality rate in patients undergoing primary angioplasty for STEMI. Cardiovascular diseases lead to one third of the deaths worldwide, surpassing the mortality rate produced by neoplasia, acute respiratory failure and diabetes mellitus all together. In the world, approximately 17 million die annually because of cardiovascular disease and every 5 seconds one is suffering from a myocardial infarction. In 2010, in our country was implemented a national program (RO-STEMI) to offer rapid interventional treatment for patients with STEMI, aligned to ESC Guidelines. At the beginning only small parts of the patients were transferred to the hospital in charge for STEMI, so, we chose to study patients from the second year of the program and from last year. We made a retrospective study, including patients with STEMI that reached our hospital for primary angioplasty in the first 12h after the debut of the symptoms, aiming to make a parallel between the in-hospital mortality rates at maximum one month after the primary PCI. In order to be included, the patients must present ST elevation and another 1 out of 3 criteria (clinical, echocardiographic and biological changes suggestive for myocardial infarction). The main target was to evaluate the evolution of early mortality rates post primary PCI after the changes in the ESC Guidelines and the progresses in the medical field. A secondary target was to correlate mortality rates with the presence of comorbidities or risk factors. INTRODUCTION Alexander Muirhead is reported to have attached wires to a feverish patient's wrist to obtain a record of the patient's heartbeat in 1872 at St Bartholomew's Hospital.[1] Another early pioneer was Augustus Waller, of St Mary's Hospital in London.[2] His electrocardiograph machine consisted of a Lippmann capillary electro- meter fixed to a projector. The trace from the heartbeat was projected onto a photographic plate that was itself fixed to a toy train. This allowed a heartbeat to be recorded in real time. in Leiden, working the Netherlands, used the string galvanometer first practical electrocardiograph) he invented in 1901.[2] (the than both This device was much more sensitive the capillary electrometer Waller used and the string Galvano- meter that had been invented in 1897 by the separately engineer Clément French Ader.[3] An initial breakthrough came when Willem Einthoven, Einthoven had previously, in 1 Carol Davila University Central Emergency Military Hospital, Bucharest 2 Titu Maiorescu University, Faculty of Medicine, Bucharest 7
