Yolk sac tumor or endodermal sinus tumor is a rare malignant ovarian germ cell tumor (is a borderline tumor) diagnosed in young females up to 25 years old. Histopathological it resembles the mesenchyme of the primitive yolk sac. Microscopically it presents the following triad: Schiller-Duval bodies, reticular aspect and PAS+ hyaline droplets (α-fetoprotein). The diagnosis of Yolk sac tumor is made by dosing serum α-fetoprotein, ultrasound and MRI – DWI imaging. It requires surgical treatment, followed by chemotherapy (new therapies – platin or carboplatin, etoposide, bleomycin) [1]. Survival prognosis at 5 years is of 80% for stage I. Differential diagnosis is with Brenner tumor, ovarian clear cell carcinoma, dysgerminoma, malignant teratomas, androblastoma, dermoid cyst.
From an anatomical perspective, the dental pulp is a connective tissue with a specific microcirculatory system with repairing abilities in order to preserve the vitality of the pulp15. Different therapeutic methods in treating the affected dental pulp can be compromised by different factors and can lead us to failure. Due to disorders emerged in the microcirculatory system, the treatment of the affected dental pulpin patients with type 2 diabetes is an additional challenge. Type 2 diabetes can impact different functions of the patients’ immune system, with a predisposion to chronic inflammation, progressive tissue degradation and reduced tissue repairing15. Regarding the endodontic therapy of the affected dental pulp in patients with diabetes mellitus (DM), an important role in the treatment of pulpal complications is played by the calcium hydroxide which is considered „the golden standard” because of its excellent properties, the very alkaline pH being one of the most important.
Introduction: The gastrointestinal stromal tumors (GIST) are dominated by KIT and PDGFRA mutation. The immunohistochemical detection of CD117, a protein express by KIT gene, is essential for the diagnosis and those that are negative always represented a diagnostic challenge Case reports: In this article we present a series of 4 cases of CD117 negative GIST tumors, diagnosed and surgically resected in Fundeni Clinical Institute and an overview of the histogenesis, diagnostic problems and management of c-kit negative GIST. All patients were males and the tumors were located in the stomach and small bowel. Conclusion: It is important for the pathologists to beware of the fact that a CD117 negative in the context of a typical morphological appearance does not exclude a GIST tumor and also the oncologist must be aware not to exclude the therapy with imatinib based on the negativity of CD117.
Radical prostatectomy is the gold standard treatment for patients with localized prostatic cancer, but often the pathological diagnosis reveals a locally advanced stage. The aim of this paper is to present the oncological follow-up after radical prostatectomy on a group of 42 patients, patients which have been diagnosed after surgery with a more aggressive stage, locally advanced PCa. Over a period of four years 136 patients have undergone radical prostatectomy. The pathological examination has established that 42 patients presented extracapsular invasion and/or lymph node invasion. 18 patients (pT3-4N0M0) have undergone radiotherapy alone and 24 patients (8 pN1 and 16 pT3-4N1M0) have received androgen deprivation therapy in association with radiotherapy. Over the next two years 15 patients presented biochemical recurrence. For these patients chemotherapy was initiated, but in two cases PSA increase has been observed during periodic evaluation. Although it is not uncommon that postoperatively the histopathological examination establishes a more aggressive disease stage than that established before surgery, radical prostatectomy remains the solution for the localized prostate cancer, solution that can be boosted by radiotherapy and/or androgen deprivation therapy.
Contemporary hybrid war is a novelty in that it is taken to populated conflict zones, with the participation of the population, under the eyes of the international community. Thus, according to many authors, the most serious threats to the United States, including to its NATO dimension and to its partnership with Europe, would come from extremist groups and their ideology, fueled by poor urban areas of the world, where youth faces great economic and social problems, and is militating for a change. These unconventional actors can operate beyond state control by circumventing international borders, norms and agreements. Some of these belong to global terrorist networks, and others co- operate with criminal elements to destabilize certain areas. The hybrid confrontation with these groups will become "a clash beyond the physical elements of the conflict, in which media manipulation, the use of the internet and the integration of information operations with strategic communication programs are as important as weapon systems on the battlefield." Crises generated in the context of a hybrid war are events characterized by low probability and important consequences that threaten an organization for its most profound purposes. Because of their low probability, these events defy any interpretation and require a sustained effort to understand and adapt the reactions. Crises affecting social groups differ in their causes and duration. Obviously, because of the multitude of types of crises, human reason can only play a limited role in their development. However, they trigger human action, which can turn small deviations into major crises. Crisis and conflict management involves very complex systems of political, diplomatic, social, economic, cultural, international, military and other actions. Such a system could be structured on political, diplomatic, social, economic, informational, military, psychological and cultural components and could include the following types of action: on the causes; on effects; on the phenomenon; on value systems; on crisis-generating strongpoints (critical areas); on vulnerable sites; on the leaders. METHODS The analysis of open sources of information and of the experience gained during the activity in the field of communication and public relations, concretized through the elaboration and implementation of both the communication management strategies and of the projects included in the field of defense and national security. In hybrid war, opponents (states, state-supported or independent movements) will exploit access to modern military capabilities and support insurgent, terro- rist and criminal movements as well as the intervention of states that can combine high- tech military capabilities with terrorist actions and cyberwar operations against financial targets. The analysis of available sour- 1 Carol Davila University of Medicine and Pharmacy, Bucharest 33
The evolution of the endoscopic skull base surgery in the last ten years had led to the development of new surgical reconstructive techniques. In the endoscopic reconstructive surgery of the CSF leaks both synthesis and natural materials. The advancement of the endoscopic reconstructive surgery was closely linked with the production of new synthesis materials. The aim of the paper is to compare the efficacy of synthesis versus natural materials in the closure of CSF leaks and to point out certain rules of when and where to use a synthesis or natural material. INTRODUCTION In the reconstructive surgery of the skull base, the surgeon can use both natural and synthesis materials. The developments of the endoscopic surgery of the skull base had led to removing bigger tumors from high-risk areas that were not suitable for endoscopic surgical approach up to now. The endoscopic surgical approaches tend to replace the external approaches even in malignant tumors of the skull base in selected cases. Because of that, the surgeon started to encounter more defects at the level of the skull base with or without CSF leaks. New surgical reconstructive techniques started to be developed in close connection with the production of new surgical reconstructive materials and adhesives. [1] The materials used in the reconstruction of the skull Corresponding author: Silviu Pițuru piturus@yahoo.com base defect can be divided in autologous tissue and synthesis reconstructive materials. Autologous tissues that are used in the reconstructive skull base surgery are: fascia, cartilage, bone, fat, free mucosal grafts, vascularize flaps and free flaps with micro anastomosis. Fat can be used to obliterate dead space or to plug a CSF leak.[1] Fascia lata or fascia temporalis can be placed in an underlay technique between the dura and the skull base or overlay technique in the sinus cavities. Multilayered fascia lata was the effective especially management of open cisterns or in cases of another type of high-pressure CSF leak.[2] in Bone or septal cartilage are placed in the underlying tech- 1 The “Carol Davila” University of Medicine and Pharmacy Bucharest, Romania 2 “Prof. Dr. Dorin Hociotă” Institute of Phonoaudiology and Functional ENT surgery, Bucharest, Romania 29
Pathologists observed the presence of tumor infiltrating lymphocytes (TILs) in solid tumors many years before the research focus shifted from cancer cells to the tumoral microenvironment. In lung adenocarcinoma TILs vary in number, phenotype and distribution. Our study investigate the type and distribution of TILs regarding the stage of disease and histological subtype in 27 cases of lung adenocarcinoma. By immunohistochemistry we evaluated semi-quantitatively CD3, CD8 and cyclin D1. We have found that CD3+CD8- lymphocytes prevail at the invasive margin and in tumoral stroma. Cyclin D1 was diffusely positive in tumoral cells in all the five cases of lepidic type of lung adenocarcinoma. In other histological types cyclin D1 was focally positive, most at the margin of the tumor irrespective of the presence or absence of TILs.
Background and aim: Obstructive coronary disease is one of the most important causes of death worldwide. Percutaneous coronary intervention is one of the most important treatments of this pathology. Using of coronary artery stents represented a major advance in interventional cardiology. While bare metal stents (BMS) set the reference point for improved safety over balloon-angioplasty, first-generation drug-eluting stents demonstrated significant improvements in efficacy, but not necessarily safety, and further technologic developments have focused on optimizing both. Methods: We studied 228 patients with STEMI in the last 6 months, divided in 2 groups – in the first group are 122 patients (53.5%) who developed in stent restenosis and the second group has 106 patients had no signs of restenosis (46.5%). The mean time of performing the angiographic reevaluation was 111 days for the first group and 154 days for the second group. The clinical signs that indicate the need of coronary reevaluation was stable angina (116, 50.87%), acute coronary syndrome (58, 25.4%) and asymptomatic patients (64, 28.9%). The cardiovascular risk factors correlate with high risk of restenosis was diabetes (24.3% in first group and 12.2% in the second one, p=0.004), active smoking (p=0.010) and metabolic syndrome (p=0.003). The stent’s length >28mm, stent’s diameter ≤ 2.5 mm and chronic occlusion correlate with high risk of in-stent restenosis in BMS. Conclusion: Understanding the importance of risk factors control, will reduce the risk of restenosis, of other cardiovascular event, even sudden death.
Introduction: Tuberculosis (TB) is still one of the most frequent infectious diseases, causing 2 million deaths a year worldwide. The prevalence of TB has increased in both immunocompetent and immunocompromised and virtually, it can affect any organ. Up to 25% of tuberculosis cases present extra-pulmonary involvement. The diagnosis of extra-pulmonary TB (EPTB) is difficult, often requiring biopsy. Material and methods: We present two cases of EPTB in immunocompetent young women. The first case is about a 15-years old female who presented with persistent high fever, ascites and an increased CA-125 serum level. Biochemical analysis of ascites fluid revealed a high value of adenosine deaminase (ADA), negative Ziehl-Neelsen stain and undetectable Mycobacterium tuberculosis at PCR assay. The peritoneal biopsy confirmed the diagnosis of peritoneal TB. The second case, a 29-years old female with a seven-month history of cervical lymph nodes swelling, with drainage and excision biopsy performed, misdiagnosed as cats-scratch disease based on the histological description as granulomatous lymphadenitis, which turned out to be tuberculous lymphadenitis at the second histopathological opinion. In conclusion, these cases highlight the need for tuberculosis consideration in the differential diagnosis of extra-pulmonary involvement, even in immunocompetent individuals, in order to decrease the misdiagnoses and complications rates.
