"Background: It is well known that patients with polycystic kidney disease (PKD) are at increased risk of developing cerebral aneurysms, however, this association has not been well studied for patients with polycystic liver disease (PLD). Material and methods: Cross-sectional descriptive study, which included 15 adult patients diagnosed with polycystic liver disease at the Gastroenterology and Hepatology Department of Fundeni Clinical Institute. Standard neurological exam and brain MRI were performed in all patients on a 1.5 Tesla MRI. Brain imaging protocol included T1/T2, T1SE, T2-FLAIR, DWI, SWI, 2D-TOF, 3D-TOF. Results: The majority of patients (93%) were females. The mean age was 53 ± 5 years old. Patients with AD-PKD and polycystic hepatic disease predominated (60%). Aneurysms were found in only one patient diagnosed with AD-PKD (in whom three aneurysms were described). The overall prevalence of cerebral aneurysms in our patient group was 7%. However, none of the patients with isolated PLD was found to have intracranial aneurysms. Other brain imaging abnormalities were frequent but nonspecific (mostly attributable to vascular-degenerative changes). Conclusions: Given these results, and due to the small number of patients in our study, it is hard to appreciate if polycystic liver disease is indeed associated with an increased risk of cerebral aneurysms. "
Background: Neuroendocrine tumors of the pancreas (NTP) comprise a unique and relatively rare group of tumors, of which gastrinoma and insulinoma are the most common types. Insulinomas tend to be small, solitary and benign, with surgical resection curable in most cases. Introduction: Insulinomas are localized preoperatively using conventional imaging studies as transabdominal ultrasonography (US), computed tomography (CT), and/or magnetic resonance imaging (MRI). Purpose: Endoscopic ultrasound (EUS) is a valuable tool in the diagnosis of insulinomas. Goals & methods: We performed a retrospective study on 21 patients with insulinoma (6 male and 15 female, 25 to 73 years of age), who were hospitalized and operated on between 2003 and 2012 at "Dr. Carol Davila" Central Military Emergency University Hospital, Bucharest. Results: US view was positive in 10% of patients (2 of 20), that presented proximal location. The sensitivity of CT was unsatisfactory, 21.05% (4 positive results of 19). CT failed to detect liver metastases, but identified nodal metastasis in one patient. MRI was performed in 18 patients and was diagnostic in 11 of them, recording a detection sensitivity of 61.11%, including infracentimetric tumor size. EUS has a high resolution which allows detection of lesions with very small diameter is safe and minimally invasive. EUS was performed in all patients, being able to identify formations in 17, was inconclusive in 3, showing a diagnosis sensitivity of 81%. Liver metastases were demonstrated in 3 patients, one by US and all 3 by MRI. Conclusions: - CT with intravenous iodinated contrast agent had a poor sensitivity in detecting the primary tumors, was insensitive in detecting liver metastases, but showed metastases in lymph nodes. - MRI has higher sensitivity than CT in detecting primary tumors, including insulinomas with infracentimetric size, and is the imaging test of choice for possible liver metastases. - EUS is the preoperative imaging test of choice.
Bariatric surgery represents one of the most efficient treatments addressing obesity and its associated complications with an increasing trend. Even if the medical benefits for patients are huge, due to weight loss and despite technical improvements in bariatric procedures, it is still associated with diverse types of complications. Most of the complications appear due to nutrient deficiency, as absorption is compromised after surgical anatomy modification. Neurological complications after bariatric surgery are very diverse with an occurrence within days to years after surgery, most frequently in patients with gastrointestinal or surgical complications. Any segment of the nervous system can be affected with distinct types of manifestations ranging from peripheral axonal neuropathy, nerve palsy secondary to compartment syndrome, encephalopathy, and myelopathy, to psychiatric and demyelinating central nervous system diseases. Identifying patients at risk and systematic screening for nutrient deficiency with proper supplementation is essential for preventing neurological complications and lifelong sequelae. In this paper, we present the spectrum of neurological complications reported after bariatric surgery.
Background: Although locoregional anesthesia techniques in total knee arthroplasty (TKA) have progressed steadily, the emergence of the adductor canal block representing a step forward for postoperative evolution in preservation of the quadriceps muscle strength, analgesia of the posterior territory of the knee still remains a challenge. The emergence of IPACK, in association with earlier techniques, offers promising preliminary results in terms of its contribution to a favourable evolution and to the satisfaction of TKA patients. Materials and methods: Prospective trial performed on a group of 28 patients undergoing a total knee arthroplasty intervention; analgesia control in the postoperative period was performed either with opioid and nonopioid systemic analgesics, or by associating the continuous adductor canal block with IPACK and systemic analgesics. The primary objective is pain control at rest/on mobilization, while the secondary purpose is analysis of opioid use, their side effects and recovery of joint mobility. Results: There is a significantly better pain control in the group of patients with locoregional anesthesia, both at rest and on mobilization.
The long-distance post-SARS-CoV2 infection effects were partially known. The study aims to follow the evolution of the patients with acute post-COVID 19 clinical symptoms presented in the Emergency Department. Methods: We analyzed 262 presentations more than 14 days after the initial COVID-19 diagnosis and with at least one acute COVID-19-related symptom. This study included presented between 01.01 and 31.05.2021 in the Emergency Department of Bucharsti- Emergency University Hospital. Data were obtained in real-time, at the presentation, from the patients' medical charts, and afterward from SUUB's database. Results. Out of the total of 262 presentations, 40.84% required patient hospitalization. The highest number of presentations with (18.70%) or without (22.90%) hospitalization was recorded in the first month after the COVID-19 diagnosis. Patients with less than 30 days between presentations had significantly fewer hospitalization days, compared to those with more than 30 days between presentations (8.3 vs 14.14 days, p=0.009). We found a high amount of hospitalization days (1093 days), with 29.88% deaths. Conclusions: COVID-19 complications require prolonged hospitalization, with implications on the patients' quality of life, the overcrowding of intensive care facilities, high-cost treatment, and unfavorable evolution for a great number of patients
"The recent increase in life expectancy is the main argument for a better understanding of the pathophysiological mechanisms underlying aging. These, once known, can provide possible links to therapies to prevent aging or slow down the process. Normal aging is associated with a progressive decrease in the glomerular filtration rate. Accurate estimation of GFR in the elderly is under the suspicion of multiple errors mainly due to sarcopenia and decreased protein intake. Differentiation between chronic kidney disease and the physiological decline of GFR might be a challenge in clinical practice and this has consequences on the evolution and treatment of the numerous comorbidities of the elderly. The current trend to use non-invasive diagnostic techniques explains the need to identify a serological marker to help differentiate between decreased GFR secondary to kidney aging or the development of chronic kidney disease."
This study analyzes the satisfaction of the patients with radical prostatectomy according to the signs and symptoms included in the EORTC QLQ -C30 and EORTC QLQ -PR25 questionnaires, including their relation with the health state that influences the pre and postoperative life quality. Fifty patients with prostate cancer in a localized stage were studied and analyzed in a prospective manner and for a period of 12 months, before and 6 months after the radical prostatectomy. In choosing the patients, the common denominator was the use of the same postoperative plan and the lack of postoperative complications, as well as the lack of chronic diseases. Erectile dysfunction, urine incontinence were quite frequent after radical prostatectomy, while the urinary obstruction and the weak urinary stream were less frequent. In this regard, people noticed a significant decrease of life quality. Although the study addressed a small group of patients, the results are similar to those belonging to other clinical studies. Even if the aspect of life quality is more rarely taken into account, the questionnaires regarding the life quality are specific, useful and quite cheap in evaluating different therapies.
The identification of organophosphate (OP) compounds dates back to the 1800s. OPare largely used pesticides in the agricultural field and households but prior use as a chemical weapon was considered during wars. Their toxicity on humans has been previously studied and addresses both acute intoxication and low-level chronic exposure. Symptoms of acute exposure describe a cholinergic syndrome with bradycardia, miosis, confusion, fasciculations, tearing, sialorrhea, diarrhea, bronchorrhea, and bronchospasm. The intermediate syndrome causes paralysis of the gait muscles, neck flexors, and respiratory failure. Moreover, unrestricted access to OP has increased the rate of suicide, accounting for around 30% of cases, increasing concern about OP availability. Western countries have drastically restricted access to OP by imposing regulations regarding handling these hazardous substances, but efforts have to be made to globally reduce this struggle
Retroperitoneal tumors grow quietly and are generally large in size, more than half of them being larger than 20 cm at the time of diagnosis. They usually present several therapeutic challenges because of their rarity, relative late presentation and anatomical location, often in close relationship with several important structures in the retroperitoneal space. Due to intimate relationships with vital organs in retroperitoneum, extensive surgery with en bloc resection of the involved organ is often required, most frequently the kidneys, followed by colon, pancreas and spleen. Malignant tumors have a poor prognosis, the most significant factors regarding survival rates being delayed diagnosis, high histological grade, inoperability due to invasion into vital organs, and a positive surgical border.
" We aim to introduce a 2022 update on CHD (carcinoid heart disease) considering a multidisciplinary perspective. This is a narrative mini-review. We searched English, full-length papers (PubMed). Inclusion criteria: original articles regardless of the level of statistical significance. We identified 44 papers and manually selected those with CHD, as follows: 8 original studies, 1 case series (N=9 patients), 16 case reports (N=1 patient/paper), and a total of 1,030 patients on published studies. The most remarkable results are the longest period of enrolment of 3-4 decades; CHD ratio among carcinoid syndrome of 37%; 30-day mortality post-cardiac surgery of 12%; median survival in CHD from 1.3 to 3.9 years (more than 2 years if valve intervention is provided); most useful prognostic markers: 5HIIA, NT-pro-BNP, but, potentially, chromogranin A. The specific protective role of somatostatin analogs against developing CHD is yet to be determined. CHD in the absence of carcinoid syndrome/liver metastasis may be related to ovarian NEN (neuroendocrine neoplasia) with a better outcome if prompt intervention. Remarkably, 3 guidelines are released regarding CHD on behalf of ENETS (European Neuroendocrine Tumor Society), and ESC (European Society of Cardiology). CHD still represents a most challenging entity situated at the crossroads of surgery, cardiology, oncology, endocrinology, and gastroenterology. "
Abstract: Toxoplasma Gondii is a protozoan parasite which causes multisystem affections and unusual clinical outcomes. Although primo- infection takes place frequently during childhood, there is a possibility for it to be found during pregnancy, when it could lead to congenital toxoplasmosis, with serious ocular and cerebral lesions (that can be identified during ultrasound). The positive diagnostic for the mother is made after a serologic test and for the fetus the parasite can be found in the amniotic fluid during amniocentesis. A prompt treatment can avoid the presence of cerebral lesions (hydrocephalus, ventriculomegaly, intracerebral calcifications). Keywords: protozoan, pregnancy, serology, amniocentesis, hydrocephalus, ventriculomegaly, intracerebral calcifications.
"Background: Infection and sepsis represent major complications after abdominal surgery for secondary peritonitis. Finding new tools that can help identify patients at risk for developing postoperative complications is of the utmost importance for clinicians. We tried to evaluate the use of different biomarkers in evaluating the postoperative prognosis of patients with secondary peritonitis. Methods: We searched the available literature on the usefulness of serum biomarkers in evaluating prognosis in patients with secondary peritonitis. Results: Elevated postoperative lactate levels and high procalcitonin (PCT) levels were associated with negative outcomes. C-reactive protein values increase rapidly in response to the surgical insult but have no value in assessing the overall prognosis. Conclusion: Procalcitonin (PCT) is superior to other biomarkers in predicting severe septic complications and overall mortality in patients with secondary peritonitis. "
