A unique approach to the treatment of posttraumatic stress disorder (PTSD) is difficult to support, because of the complexity and heterogeneity of this pathology. Multiple evidence-based guidelines for PTSD treatment exist, elaborated by prestigious institutions around the world, but a certain level of the inconsistency of their recommendations appears when these sources are compared with each other. Therefore, a review of current guidelines and extraction of the most supported by evidence recommendations is considered important for clinical practice, due to the need to approach such complex cases as PTSD-diagnosed patients in a stepwise manner. Structured monitoring of the clinical status during the treatment is also an important and rather neglected aspect of the case management in PTSD, and the necessity of follow-up visits for efficacy and tolerability should be taken into consideration. Psychotherapy (especially cognitive- behavioral oriented therapies and eye movement desensitization and reprocessing therapy) is supported by evidence as a first-line approach, as well as certain antidepressants, like the selective serotonin reuptake inhibitors and venlafaxine. Many second-line pharmacological agents and psychotherapies are also available, but there is an obvious need for more pragmatic trials with PTSD patients.
Leiomyosarcoma is a rare type of smooth muscle cell tumor, with an incidence of 7-10% compared to other types of sarcomas. It develops primarily in the retroperitoneal cavity, the genital tract and extremities. Leiomyosarcoma can also affect the bone, either as a primary tumor or as metastasis. Primary osseus leiomyosarcoma is a rare finding in patients with radiologically identified osteolytic lesions having an incidence of <1% of total primary bone tumors.Due to its low incidence patients with primary osseous leiomyosarcoma are never diagnosed before immunohistochemical analysis and case management is difficult because of the lack of specific indications pertaining to primary osseus leiomyosarcoma. Data on age specific incidence is scarce but there seems to be a tendency towards a higher incidence with advanced age. The purpose of this work is to discuss the complete management of primary osseus leiomyosarcomas based on interdisciplinary medical teams’ indications in a Romanian hospital setting.
