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Potorac A, Varlas VN, Borș RG, Baroș A, Cirstoiu M. The Management and Diagnosis of Anti-NMDA Receptor Autoimmune Encephalitis in Pregnant Women: A Case Report and Literature Review. Medicina (Kaunas) 2023; 59:2110. [PMID: 38138213 PMCID: PMC10744478 DOI: 10.3390/medicina59122110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023]
Abstract
Rationale: Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is a form of autoimmune synaptic encephalitis, often mediated by neuronal surface antibodies. Clinically, it manifests through a diverse range of neurological and psychiatric symptoms, primarily affecting young women with ovarian teratoma, which is rare in pregnant women. Patient concerns: We report a case of a 35-year-old multiparous pregnant patient at 38 weeks of gestation presented to the emergency room with seizure, psychiatric symptoms like delirious speech with mystical visual and auditory hallucinations, bradylalia, and retrograde amnesia. Diagnosis: The diagnosis of autoimmune encephalitis with anti-NMDA antibodies was concluded by considering the lumbar puncture results, brain imaging, and the patient's persistent symptoms. Outcomes: This case is noteworthy for its rarity and the symptoms' breadth. At 38 weeks of gestation, the patient underwent a cesarean section, resulting in excellent maternal recovery observed during the 6-month follow-up and good neonatal adaptation. Lessons: Our goals include raising awareness about this condition and emphasizing the significance of early diagnosis. This encephalitis is treatable and potentially reversible, underscoring the importance of prompt identification.
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Affiliation(s)
- Alina Potorac
- Doctoral School, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.P.); (R.G.B.)
| | - Valentin Nicolae Varlas
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.B.); (M.C.)
- Department of Obstetrics and Gynaecology, Filantropia Clinical Hospital, 011132 Bucharest, Romania
| | - Roxana Georgiana Borș
- Doctoral School, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.P.); (R.G.B.)
| | - Alexandru Baroș
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.B.); (M.C.)
- Department of Obstetrics and Gynecology, University Emergency Hospital, 050098 Bucharest, Romania
| | - Monica Cirstoiu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.B.); (M.C.)
- Department of Obstetrics and Gynecology, University Emergency Hospital, 050098 Bucharest, Romania
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Varlas VN, Bors RG, Cretoiu R, Carp-Veliscu A, Mehedintu C, Cirstoiu M. The Artificial Ovary: the Next Step in Fertility Preservation in Cancer Patients. Maedica (Bucur) 2023; 18:477-482. [PMID: 38023739 PMCID: PMC10674111 DOI: 10.26574/maedica.2023.18.3.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
The cryopreservation procedure of ovarian tissue is used for subsequent transplantation to preserve fertility in cancer patients. In the case of cancers with possible ovarian damage, due to the increased risk of transmission of malignant cells in the cryopreserved ovarian tissue, after remission of the disease, the transplant cannot be performed due to the high rate of recurrence. Thus, to resolve fertility preservation in these cancer patients, making an artificial ovary that could be transplanted under maximum safety conditions was necessary. This was not easy to achieve because it was essential to develop a porous and rigid matrix that could encapsulate and protect the ovarian follicles and, at the same time, create an optimal neuroendocrine environment. The present article analyzes the technological progress in creating an artificial ovary, the opportunity for transplantation, the proper counseling of these patients, and the prognosis regarding using this modern technique to preserve fertility.
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Affiliation(s)
- Valentin Nicolae Varlas
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Roxana Georgiana Bors
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, Bucharest, Romania
- Victoria Medical Center, Bucharest, Romania
| | - Rebeca Cretoiu
- Department of Pituitary and Neuroendocrine Disorders, C.I. Parhon National Institute of Endocrinology, Bucharest, Romania
| | - Andreea Carp-Veliscu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Obstetrics and Gynecology, "Prof. Dr. Panait Sârbu" Hospital, Bucharest, Romania
- Embryos Fertility Clinic, Bucharest, Romania
| | - Claudia Mehedintu
- Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Monica Cirstoiu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, Romania
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Ionescu OM, Frincu F, Mehedintu A, Plotogea M, Cirstoiu M, Petca A, Varlas V, Mehedintu C. Berberine-A Promising Therapeutic Approach to Polycystic Ovary Syndrome in Infertile/Pregnant Women. Life (Basel) 2023; 13:life13010125. [PMID: 36676074 PMCID: PMC9864590 DOI: 10.3390/life13010125] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/25/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023]
Abstract
Polycystic ovary syndrome (PCOS) is a disorder with an unknown etiology that features a wide range of endocrine and metabolic abnormalities that hamper fertility. PCOS women experience difficulties getting pregnant, and if pregnant, they are prone to miscarriage, gestational diabetes, pregnancy-induced hypertension and preeclampsia, high fetal morbidity, and perinatal mortality. Insulin, the pancreatic hormone best known for its important role in glucose metabolism, has an underrated position in reproduction. PCOS women who have associated insulin resistance (with consequent hyperinsulinemia) have fertility issues and adverse pregnancy outcomes. Lowering the endogen insulin levels and insulin resistance appears to be a target to improve fertility and pregnancy outcomes in those women. Berberine is an alkaloid with a high concentration in various medicinal herbs that exhibits a hypoglycaemic effect alongside a broad range of other therapeutic activities. Its medical benefits may stand up for treating different conditions, including diabetes mellitus. So far, a small number of pharmacological/clinical trials available in the English language draw attention towards the good results of berberine's use in PCOS women with insulin resistance for improving fertility and pregnancy outcomes. Our study aims to uncover how berberine can counteract the negative effect of insulin resistance in PCOS women and improve fertility and pregnancy outcomes.
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Affiliation(s)
- Oana-Maria Ionescu
- Faculty of Medicine “Carol Davila”, University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
| | - Francesca Frincu
- Faculty of Medicine “Carol Davila”, University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
- Correspondence:
| | - Andra Mehedintu
- Faculty of Medicine “Carol Davila”, University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
| | - Mihaela Plotogea
- Department of Obstetrics and Gynecology, “Nicolae Malaxa” Clinical Hospital, 022441 Bucharest, Romania
| | - Monica Cirstoiu
- Faculty of Medicine “Carol Davila”, University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
| | - Aida Petca
- Faculty of Medicine “Carol Davila”, University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
| | - Valentin Varlas
- Faculty of Medicine “Carol Davila”, University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
| | - Claudia Mehedintu
- Faculty of Medicine “Carol Davila”, University of Medicine and Pharmacy Bucharest, 050474 Bucharest, Romania
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Mehedintu C, Frincu F, Carp-Veliscu A, Barac R, Badiu DC, Zgura A, Cirstoiu M, Bratila E, Plotogea M. A Warning Call for Fertility Preservation Methods for Women Undergoing Gonadotoxic Cancer Treatment. Medicina (B Aires) 2021; 57:medicina57121340. [PMID: 34946285 PMCID: PMC8709408 DOI: 10.3390/medicina57121340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/25/2021] [Accepted: 12/02/2021] [Indexed: 11/30/2022] Open
Abstract
Malignant hematological conditions have recognized an increased incidence and require aggressive treatments. Targeted chemotherapy, accompanied or not by radiotherapy, raises the chance of defeating the disease, yet cancer protocols often associate long-term gonadal consequences, for instance, diminished or damaged ovarian reserve. The negative effect is directly proportional to the types, doses, time of administration of chemotherapy, and irradiation. Additionally, follicle damage depends on characteristics of the disease and patient, such as age, concomitant diseases, previous gynecological conditions, and ovarian reserve. Patients should be adequately informed when proceeding to gonadotoxic therapies; hence, fertility preservation should be eventually regarded as a first-intention procedure. This procedure is most beneficial when performed before the onset of cancer treatment, with the recommendation for embryos or oocytes’ cryopreservation. If not feasible or acceptable, several options can be available during or after the cancer treatment. Although not approved by medical practice, promising results after in vitro studies increase the chances of future patients to protect their fertility. This review aims to emphasize the mechanism of action and impact of chemotherapy, especially the one proven to be gonadotoxic, upon ovarian reserve and future fertility. Reduced fertility or infertility, as long-term consequences of chemotherapy and, particularly, following bone marrow transplantation, is often associated with a negative impact of recovery, social and personal life, as well as highly decreased quality of life.
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Affiliation(s)
- Claudia Mehedintu
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.M.); (F.F.); (A.C.-V.), (R.B.); (A.Z.); (M.C.); (E.B.)
- Department of Obstetrics and Gynecology, “Nicolae Malaxa” Clinical Hospital, 022441 Bucharest, Romania;
| | - Francesca Frincu
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.M.); (F.F.); (A.C.-V.), (R.B.); (A.Z.); (M.C.); (E.B.)
- Department of Obstetrics and Gynecology, “Nicolae Malaxa” Clinical Hospital, 022441 Bucharest, Romania;
| | - Andreea Carp-Veliscu
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.M.); (F.F.); (A.C.-V.), (R.B.); (A.Z.); (M.C.); (E.B.)
| | - Ramona Barac
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.M.); (F.F.); (A.C.-V.), (R.B.); (A.Z.); (M.C.); (E.B.)
| | - Dumitru-Cristinel Badiu
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.M.); (F.F.); (A.C.-V.), (R.B.); (A.Z.); (M.C.); (E.B.)
- Correspondence: ; Tel.: +40-723226346
| | - Anca Zgura
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.M.); (F.F.); (A.C.-V.), (R.B.); (A.Z.); (M.C.); (E.B.)
| | - Monica Cirstoiu
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.M.); (F.F.); (A.C.-V.), (R.B.); (A.Z.); (M.C.); (E.B.)
| | - Elvira Bratila
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (C.M.); (F.F.); (A.C.-V.), (R.B.); (A.Z.); (M.C.); (E.B.)
| | - Mihaela Plotogea
- Department of Obstetrics and Gynecology, “Nicolae Malaxa” Clinical Hospital, 022441 Bucharest, Romania;
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Frincu F, Carp-Veliscu A, Petca A, Badiu DC, Bratila E, Cirstoiu M, Mehedintu C. Maternal-Fetal Outcomes in Women with Endometriosis and Shared Pathogenic Mechanisms. Medicina (Kaunas) 2021; 57:1258. [PMID: 34833476 PMCID: PMC8625694 DOI: 10.3390/medicina57111258] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/13/2021] [Accepted: 11/16/2021] [Indexed: 12/20/2022]
Abstract
The connection between endometriosis and pregnancy outcomes is trending among the research topics. Until recently, endometriosis and its painful symptomatology were considered to be alleviated by pregnancy. However, these beliefs have shifted, as emerging literature has demonstrated the role of this condition in affecting pregnancy evolution. The underlying pathogenesis of endometriosis is still poorly understood, all the more when pregnancy complications are involved. Debatable opinions on endometriosis associated with obstetric complications exist because of the potential bias resulting from the heterogeneity of preceding evidence. This review aims to evaluate the connection between endometriosis and adverse pregnancy outcomes and their shared pathogenic mechanisms. We searched PubMed and EMBASE and focused on the studies that include placenta praevia, premature rupture of membranes, spontaneous preterm birth, gestational hypertension, preeclampsia, obstetric hemorrhages (ante- and postpartum bleeding, abruptio placentae), miscarriage, stillbirth, neonatal death, gestational diabetes mellitus, gestational cholestasis, small for gestational age, and their association with endometriosis. Not only the risks of emergence were highlighted, but also the pathogenic connections. Epigenetic alterations of some genes were found to be mirrored both in endometriosis and obstetric complications. This review issues a warning for providing increased attention to pregnant women with endometriosis and newborns as higher risks of preeclampsia, placental issues, and preterm deliveries are associated.
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Affiliation(s)
- Francesca Frincu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (F.F.); (A.P.); (E.B.); (M.C.); (C.M.)
| | - Andreea Carp-Veliscu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (F.F.); (A.P.); (E.B.); (M.C.); (C.M.)
| | - Aida Petca
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (F.F.); (A.P.); (E.B.); (M.C.); (C.M.)
| | - Dumitru-Cristinel Badiu
- Department of General Surgery, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Elvira Bratila
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (F.F.); (A.P.); (E.B.); (M.C.); (C.M.)
| | - Monica Cirstoiu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (F.F.); (A.P.); (E.B.); (M.C.); (C.M.)
| | - Claudia Mehedintu
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (F.F.); (A.P.); (E.B.); (M.C.); (C.M.)
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Trasca LF, Poenaru E, Patrascu N, Cirstoiu M, Vinereanu D. A comprehensive echocardiographic study of the right ventricular systolic function in pregnant women with inherited thrombophilia. Echocardiography 2020; 37:1037-1042. [PMID: 32596919 DOI: 10.1111/echo.14783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 05/04/2020] [Accepted: 06/08/2020] [Indexed: 01/10/2023] Open
Abstract
Impact of the gestational changes on cardiac contractility is not clearly defined. Our aim was to evaluate subtle changes of the right ventricular systolic function during pregnancy, assessed by new echocardiographic techniques, in a population tested for inherited thrombophilia. 87 pregnant women, with a mean age of 32 ± 4 years, genetically tested for inherited thrombophilia (22 with high-risk inherited thrombophilia and 65 control group) were included. All participants had four echocardiographic assessments, three during pregnancy (one in each trimester) and the forth at 6 months after giving birth. The right ventricular (RV) systolic function was assessed by fractional area change, ejection fraction (EF) by 3D echocardiography, tricuspid annular velocity by tissue Doppler, tricuspid annular plane systolic excursion, and strain by speckle tracking. Pulmonary artery pressure was estimated using the pressure gradient between right atrium and RV. Parameters of RV systolic function, at visits 2-4, had lower values compared with the first visit and were significantly lower in the high-risk thrombophilia group. Tricuspid regurgitation and pressure gradient between the right atrium and the RV had a significant increase during pregnancy for all subjects. At visit 1, there were no differences between groups, but at the next three visits there were higher values of the gradient in the high-risk thrombophilia group. High-risk inherited thrombophilia impacts the RV contractility, with higher pulmonary artery pressure. Further studies are needed to assess long-term impact on RV of high-risk inherited thrombophilia.
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Affiliation(s)
| | - Elena Poenaru
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Natalia Patrascu
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Monica Cirstoiu
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.,University and Emergency Hospital of Bucharest, Bucharest, Romania
| | - Dragos Vinereanu
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.,University and Emergency Hospital of Bucharest, Bucharest, Romania
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Trasca LF, Poenaru E, Patrascu N, Bruja R, Munteanu O, Cirstoiu M, Vinereanu D. Left Ventricular Systolic Function in Pregnant Women with Inherited Thrombophilia. Maedica (Bucur) 2019; 14:196-202. [PMID: 31798732 DOI: 10.26574/maedica.2019.14.3.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objectives:The impact of the gestational changes on left ventricular contractility is not clearly defined. Our aim was to evaluate the subtle changes of left ventricular systolic function during pregnancy, assessed by new echocardiographic techniques, in a population tested for inherited thrombophilia. Material and methods:Eighty seven consecutive pregnant women, with a mean age of 32±4 years, genetically tested for inherited thrombophilia (22 with thrombophilic mutations and risk of thrombosis and 65 without significant mutations, considered as the control group) were included. All participants had four clinical and echocardiographyc visits: three during pregnancy (one in each trimester) and the forth six months after giving birth. Left ventricular (LV) systolic function was assessed from ejection fraction (EF) by 2D and 3D echocardiography, mitral annular velocities by tissue Doppler, and strain rate by 2D speckle tracking. Outcomes:There were no differences between groups for any of the echo parameters at each of the four visits. Comparing the third visit with the first one, all parameters of LV systolic function had significantly lower values at the end of pregnancy; EF decreased from 58% to 55% (2D echo), from 60% to 56% (3D TomTec), and from 58% to 55% (Auto4DLVQ), with p<0.001 for all three methods. Moreover, strain assessed by speckle traking decreased during pregnancy, with no differences between groups. In addition to this, mitral annular velocities obtained by tissue Doppler assessment decreased during the gestational period, with no differences between groups. At six months after giving birth, all values were normalized. Conclusion:During pregnancy, LV contractility has a slight decrease, with no criteria of systolic dysfunction. Thrombophilic mutations, with correct anticoagulant treatment, has no impact on LV systolic function.
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Affiliation(s)
| | - Elena Poenaru
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Natalia Patrascu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Ramona Bruja
- "Victor Babes" Clinical Hospital, Bucharest, Romania
| | - Octavian Munteanu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Monica Cirstoiu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Dragos Vinereanu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Mehedintu C, Bratila E, Cirstoiu M, Petca A, Brinduse LA, Berceanu C, Barac RI, Andreescu CV, Petca RC, Sandru F, Ionescu OM. Evaluation of Effectiveness and Tolerability of Boric Acid in the Treatment of Vaginal Infection with Candida Species. Rev Chim 2019. [DOI: 10.37358/rc.19.7.7343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Vulvovaginal candidiasis is the most prevalent vaginal infection worldwide. Considering the violence of the symptoms that some patients report, the tendency to relapse or of resistance to the azole therapy, and the success reported by some studies in the treatment with boric acid of the vaginal infection with various pathogens, we conducted a prospective study in which we used vaginal boric acid for Candida species infection. The aim of our study was to evaluate the effectiveness and tolerability of boric acid in the treatment of vaginal infection with Candida species. Analysing the data from the satisfaction questionnaire completed by the patients who reached the end of the study showed that our investigational product has a good and very good effectiveness in sterilizing the infection (71%), being considered by patients to be easily administered (67.7%), the safety of the product being perceived as good and very good by 93.6% of them.
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Munteanu V, Radu G, Cirstoiu M. ARE TUMORAL MARKERS PREDICTIVE FACTORS FOR MOLECULAR SUBTYPES IN BREAST CANCER? JSS 2019. [DOI: 10.33695/jss.v5i4.249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Breast cancer kills more women annually than any other type of neoplasm. Even though he has shown a particular interest in the medical body since ancient times, the very heterogeneous nature of the tumors and their versatility have made it difficult to find a diagnostic and therapeutic consensus that fully characterizes this pathology and describes its evolution. Immunohistochemical methods manage to outline a gene-molecular profile depending on the biomarkers expressed by each tumor. Correlations between clinical aspects and molecular characteristics of tumors are of particular importance in the management of such a case. The study examined the impact of breast cancer molecular subtypes on therapeutic management for a group of 438 patients treated on the Oncology Department of the Bucharest University Emergency Hospital during 2007-2017.
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Bodean O, Bratu O, Bohiltea R, Munteanu O, Marcu D, Spinu DA, Vacaroiu IA, Socea B, Diaconu CC, Fometescu Gradinaru D, Cirstoiu M. The Efficacy of Synthetic Oral Progestin Pills in Patients with Severe Endometriosis. Rev Chim 2018. [DOI: 10.37358/rc.18.6.6335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Endometriosis is an important public health issues concerning women of reproductive age due to its debilitating painful symptoms. Deep infiltrating endometriosis is the severe form, involving uterosacral ligaments, rectum, bowel and bladder. There is no optimal treatment for this disease, but there are 3 main therapeutic options: medical, surgical and a combination of both. A modern approach for the treatment of endometriosis pain uses dienogest, a progestin, as a long-term solution for women who do not wish to procreate or to whom surgery is not an option. Dienogest 2mg daily has a positive effect on the reduction of pain and endometrial lesions when used perioperatively or as a long-term postoperative treatment. This article focuses on the literature evidence on the efficacy of newly approved oral synthetic progestins in the treatment of severe endometriosis.
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Patrascu N, Trasca L, Mihalcea D, Lungeanu Juravle L, Bruja R, Neagu M, Cirstoiu M, Vinereanu D. P3256Pregnant women with gestational hypertension or preeclampsia had lower global and regional left ventricular systolic function by comparison with normotensive pregnant women. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Turcan N, Bohiltea R, Bratila E, Mehedintu C, Munteanu O, Toader O, Comandasu DE, Cirstoiu M. The impact on self-regard of menopausal atrophic vaginitis. Maturitas 2017. [DOI: 10.1016/j.maturitas.2017.03.170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bratila E, Mehedintu C, Berceanu C, Bohiltea R, Toader O, Cirstoiu M, Comandasu DE. The impact of chronic vulvar dystrophy on sexual function at menopause. Maturitas 2017. [DOI: 10.1016/j.maturitas.2017.03.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Bratila E, Cirstoiu M, Mehedintu C, Berceanu C, Bohiltea R, Toader O, Comandasu DE. The effect of chronic vulvar dystrophy on urinary continence in patients at climacterium. Maturitas 2017. [DOI: 10.1016/j.maturitas.2017.03.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Trasca LF, Patrascu N, Mihalcea D, Lungeanu L, Mihaila S, Bruja R, Neagu M, Cirstoiu M, Albu S, Vinereanu D. GESTATIONAL HYPERTENSION AND PREECLAMPSIA ARE ASSOCIATED WITH SUBCLINICAL LEFT VENTRICULAR SYSTOLIC AND DIASTOLIC DYSFUNCTION. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34207-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ota T, Senaratne DNS, Preston NK, Ferrara F, Djikic D, Villemain O, Takahashi L, Niki K, Patrascu N, Benyounes N, Popa E, Diego Bellavia DB, Sundqvist M, Wei-Ting C, Papachristidis A, Djordjevic-Dikic A, Volpi C, Reis L, Nieto Tolosa J, Nishikawa H, D'angelo M, Testuz A, Mo YJ, Hashemi N, Toyota K, Nagamine K, Koide Y, Nomura T, Kurata J, Murakami Y, Kozuka Y, Ohshiro C, Thomas K, Townsend C, Wheeler S, Jacobson I, Elkington A, Balkhausen K, Bull S, Ring L, Gargani L, Carannante L, Russo V, D'alto M, Marra AM, Cittadini A, D'andrea A, Vriz O, Bossone E, Mujovic N, Dejanovic B, Peric V, Marinkovic M, Jankovic N, Orbovic B, Simic D, Sitefane F, Pernot M, Malekzadeh-Milani G, Baranger J, Bonnet D, Boudjemline Y, Uejima T, Nishikawa H, Semba H, Sawada H, Yamashita T, Sugawara M, Kayanuma H, Inoue K, Yagawa M, Takamisawa I, Umemura J, Yoshikawa T, Tomoike H, Mihalcea DJ, Mihaila S, Lungeanu L, Trasca LF, Bruja R, Neagu MS, Albu S, Cirstoiu M, Vinereanu D, Van Der Vynckt C, Gout O, Cohen A, Enache R, Jurcut R, Coman IM, Badea R, Platon P, Calin A, Beladan CC, Rosca M, Ginghina C, Popescu BA, Sonia Dell'oglio SD, Attilio Iacovoni AI, Calogero Falletta CF, Giuseppe Romano GR, Sergio Sciacca SS, Lissa Sugeng LS, Joseph Maalouf JM, Michele Pilato MP, Michele Senni MS, Cesare Scardulla CS, Francesco Clemenza FC, Salman K, Tornvall P, Ugander M, Chen ZC, Wang JJ, Fisch S, Liao RL, Roper D, Casar Demarco D, Papitsas M, Tsironis I, Byrne J, Alfakih K, Monaghan MJ, Boskovic N, Rakocevic I, Giga V, Tesic M, Stepanovic J, Nedeljkovic I, Aleksandric S, Kostic J, Beleslin B, Altman M, Annabi MS, Abouchakra L, Cucchini U, Muraru D, Badano LP, Ernande L, Derumeaux G, Teixeira R, Fernandes A, Almeida I, Dinis P, Madeira M, Ribeiro J, Puga L, Nascimento J, Goncalves L, Cambronero Sanchez FJ, Pinar Bermudez E, Gimeno Blanes JR, De La Morena Valenzuela G, Uejima T, Takahashi L, Semba H, Sawada H, Yamashita T, Lopez Fernandez T, Irazusta Cordoba FJ, Rosillo Rodriguez SO, Dominguez Melcon FJ, Meras Colunga P, Gemma D, Moreno Gomez R, Moreno Yanguela M, Lopez Sendon JL, Nguyen V, Mathieu T, Kerneis C, Cimadevilla C, Kubota N, Codogno I, Tubiana S, Estrellat C, Vahanian A, Messika-Zeitoun D, Ondrus T, Van Camp G, Di Gioia G, Barbato E, Bartunek J, Penicka M, Johnsson J, Gomez A, Alam M, Winter R. Poster Session 3The imaging examination and quality assessmentP626Value of mitral and tricuspid annular displacement to assess the interventricular systolic relationship in severe aortic valve stenosis : a Pilot studyP627Follow-up echocardiography in asymptomatic valve disease: assessing the potential economic impact of the European and American guidelines in a dedicated valve clinic, compared to standard care.P628The tricuspid valve: identification of optimal view for assessing for prolapseP629Right atrial volume by two-dimensional echocardiography in healthy subjectsP630Disturbance of inter and intra atrial conduction assessed by tissue doppler imaging in patients with medicaly controlled hypertension and prehypertension.P631Liver stiffness by shear wave elastography, new noninvasive and quantitative tool for acute variation estimation of central venous pressure in real-time?P632Weak atrial kick contribution is associated with a risk for heart failure decompensationP633Usefulness of wave intensity analysis in predicting the response to cardiac resynchronization therapyP634Early subclinical left ventricular systolic and diastolic dysfunction in gestational hypertension and preeclampsiaP635Clinical comparison of three different echocardiographic methods for left ventricular ejection fraction and LV end diastolic volume measurementP636Assessment of right ventricular-arterial coupling parameters by 3D echocardiography in patients with pulmonary hypertension receiving specific vasodilator therapyP637Prediction of right ventricular failure after left ventricular assist device implant: assessing usefulness of standard and strain echocardiographyP638Kinematic analysis of diastolic function using the novel freely available software Echo E-waves - feasibility and reproducibilityP639Evaluation of coronary flow velocity by Doppler echocardiography in the treatment of hypertension with the ARB: correlation to the histological cardiac fibrosisP640The clinical significance of limited apical ischaemia and the prognostic value of stress echocardiography - A contemporary study from a high volume centerP641Effects of intermediate stenosis of left anterior descending coronary artery on survival in patients with chronic total occlusion of right coronary arteryP642Left ventricular remodeling after a first myocardial infarction in patients with preserved ejection fraction at dischargeP643Left atrial size and acute coronary syndromes. Let is make simple.P644Influence of STEMI reperfusion strategy on systolic and diastolic functionP645Aortic valve resistance risk-stratifies low-gradient severe aortic stenosisP646Does permanent pacemaker implantation complicate the prognosis of patients after transcatheter aortic valve implantation?P647Influence of metabolic syndrome and diabetes on progression of calcific aortic valve stenosis - The COFRASA - GENERAC StudyP648Low referral for aortic valve replacement accounts for worse long-term outcome in low versus high gradient severe aortic stenosis with preserved ejection fractionP649The impact of right ventricular function from aortic valve replacement: A randomised study comparing minimally invasive aortic valve surgery and conventional open heart surgery. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Georgescu TA, Cirstoiu M, Costache M, Lazaroiu A, Dumitru A, Sajin M. Histopathological, Immunohistochemical and Therapeutical Assessment of Premalignant Endometrial Lesions in a Hospital Based Series of Cases. Maedica (Bucur) 2016; 11:115-121. [PMID: 28461830 PMCID: PMC5394573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Endometrial hyperplasia represents a diversified set of disorders which has challenged pathologists for decades. Due to its high likelihood of progression to carcinoma, endometrial intraepithelial neoplasia (EIN) demands prompt and specialized intervention. MATERIALS AND METHODS This 15-month (September 2014 - November 2015) retrospective analysis involved 258 cases of female patients with atypical and non-atypical endometrial hyperplasia investigated and treated at the University Emergency Hospital in Bucharest, Romania. Our purpose was to evaluate the histopathological, immunohistochemical and therapeutical aspects of premalignant endometrial lesions as well as their concurrence with endometrial carcinoma. RESULTS Our findings indicate that 23% of the women preoperatively diagnosed with atypical hyperplasia were found with endometrial carcinoma on the hysterectomy specimen. Surprisingly, we identified two cases of atypical hyperplasia with focal p53 expression. Mutation of p53 is a late genetic event seen in endometrial carcinoma which does not usually occur in EIN. Interestingly, these cases did not present endometrial carcinoma on the hysterectomy specimen. CONCLUSION All female patients diagnosed with EIN have an increased risk of developing endometrial carcinoma, as there are no histologic subdivisions or grades of atypical hyperplasia to further stratify risk for malignancy. Therefore, we emphasize the importance of accurate detection of premalignant endometrial lesions and exclusion of a coexisting endometrial carcinoma as mandatory prerequisites for proper medical management.
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Affiliation(s)
| | - Monica Cirstoiu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Mariana Costache
- Department of Pathology, Emergency University Hospital, Bucharest, Romania
| | - Anca Lazaroiu
- Department of Pathology, Emergency University Hospital, Bucharest, Romania
| | - Adrian Dumitru
- Department of Pathology, Emergency University Hospital, Bucharest, Romania
| | - Maria Sajin
- Department of Pathology, Emergency University Hospital, Bucharest, Romania
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Dumitru A, Costache M, Lazaroiu AM, Simion G, Secara D, Cirstoiu M, Emanoil A, Georgescu TA, Sajin M. Fraser Syndrome - a Case Report and Review of Literature. Maedica (Bucur) 2016; 11:80-83. [PMID: 28465758 PMCID: PMC5394498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Fraser syndrome is a rare autosomal recessive genetic disorder characterized by major features such as cryptophthalmos, syndactyly, malformations of the larynx and genitourinary tract, craniofacial dysmorphism, orofacial clefting, mental retardation and musculoskeletal anomalies. In total, about 150 affected patients have been described in the literature. The diagnosis of this syndrome can be established after clinical examination. We present the clinical findings of a rare case of Fraser syndrome with lethal phenotype due to bilateral renal agenesis in a female stillborn.
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Affiliation(s)
- Adrian Dumitru
- Department of Pathology, Emergency University Hospital, Bucharest, Romania
| | - Mariana Costache
- Department of Pathology, Emergency University Hospital, Bucharest, Romania
| | | | - George Simion
- Department of Pathology, Emergency University Hospital, Bucharest, Romania
| | - Diana Secara
- Department of Obstetrics and Gynaecology, Emergency University Hospital, Bucharest, Romania
| | - Monica Cirstoiu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Alina Emanoil
- Department of Obstetrics and Gynaecology, Emergency University Hospital, Bucharest, Romania
| | | | - Maria Sajin
- Department of Pathology, Emergency University Hospital, Bucharest, Romania
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Radoi V, Bohiltea C, Bohiltea R, Cirstoiu M. Clinical Utility of Non-Invasive Prenatal Screening from Maternal Blood. Maedica (Bucur) 2015; 10:382-385. [PMID: 28465744 PMCID: PMC5394445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Viorica Radoi
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Camil Bohiltea
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Roxana Bohiltea
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Monica Cirstoiu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Tufan C, Georgescu C, Bohiltea R, Cirstoiu M. Cornual Heterotopic Pregnancy - a Rare Cause for Haemorrhagic Shock. Maedica (Bucur) 2015; 10:357-360. [PMID: 28465739 PMCID: PMC5394441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Heterotopic pregnancy represents an intrauterine gestational sac in the presence of an ectopic pregnancy. It is a very rare occurrence in spontaneous pregnancy but its incidence has increased with the use of assisted reproductive techniques, being identified in up to 1% of these cases. There aren't any guidelines regarding the management of heterotopic pregnancies, but the general principles include: elimination of the ectopic pregnancy, conservation of the intrauterine pregnancy and haemostasis. In this article we are going to present the case of a 26 year old woman that presented with haemorrhagic shock secondary to a ruptured spontaneous cornual heterotopic pregnancy at 8 weeks gestation. She underwent emergency laparotomy, excision of the right uterine cornua and aspiration of the uterine pregnancy. The intrauterine pregnancy was removed because, during the cornual excision, the intrauterine gestational sac was ruptured. She had a non-complicated postoperative evolution and was discharged 4 days later.
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Affiliation(s)
- Cicerone Tufan
- Department of Obstetrics and Gynaecology, Emergency University Hospital, Bucharest, Romania
| | - Cristina Georgescu
- Department of Obstetrics and Gynaecology, Emergency University Hospital, Bucharest, Romania
| | - Roxana Bohiltea
- Department of Obstetrics and Gynaecology, Emergency University Hospital, Bucharest, Romania
| | - Monica Cirstoiu
- Department of Obstetrics and Gynaecology, Emergency University Hospital, Bucharest, Romania
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Patrascu OM, Cirstoiu M, Lazaroiu AM, Dumitru AV, Mihai AE, Popa M, Dimitriu A, Sajin M, Costache M, Iliesiu A. Disseminated CMV and Tuberculosis Infection with Osseous Metaplasia in a Presumable Crohn's Patient: Case Report. Maedica (Bucur) 2015; 10:131-135. [PMID: 28275405 PMCID: PMC5327804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Associations of different pathologies are not uncommon in every day practice, but association of disseminated infections like cytomegalovirus infection and tuberculosis are quite rare and hard to diagnose. Both are infections which appear frequently in immunocompromised patients and have unfavorable prognosis. We present a case of a 62 year old male with a history of Crohn's disease and tuberculosis which presented with symptoms of relapse and infection. He was treated with immunosuppressive medication and cortisol for the past 6 weeks. Cytomegalovirus (CMV) infection was serologically confirmed. In evolution, he suffered from gastrointestinal hemorrhage and died afterwards due to the hemorrhage and pulmonary infections. Histology confirmed the CMV modification in the lungs and intestines, but also highlighted active and disseminated tuberculosis (TB), bronchopneumonia, osseous metaplasia, hyaline membranes, numerous TB abscesses in the intestinal wall and specific CMV and TB modifications in the liver. The trigger for such important and serious infections remains unclear, for the cause can be represented by the Crohn's disease per se or only by the immunosuppressive treatment. Also, CMV can trigger modifications in immune system and patients with immune-mediated diseases have an increased risk for TB reactivation.
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Affiliation(s)
| | - Monica Cirstoiu
- Department of Obstetrics and Gynecology, Emergency University Hospital,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Anca Mihaela Lazaroiu
- Department of Pathology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | | | | | - Manuela Popa
- Department of Pathology, Emergency University Hospital, Bucharest, Romania
| | - Anca Dimitriu
- Department of Gastroenterology and Hepatology, Fundeni Clinical Institute, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Maria Sajin
- Department of Pathology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Mariana Costache
- Department of Pathology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Andreea Iliesiu
- Department of Pathology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Cirstoiu M, Mitrache LE, Popa M, Mehotin NC, Sajin M, Cirstoiu C. A Rare Case of Benign Xanthogranuloma Located on the Uterine Cervix - a Case Report. Maedica (Bucur) 2015; 10:127-130. [PMID: 28275404 PMCID: PMC5327807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We report the case of a 44-year-old woman who presented with vaginal bleeding. Vaginal examination and colposcopy showed a tumor on the anterior lip of the cervix. Trans-vaginal sonography revealed a thickened endometrium with accentuated vascularization. Samples from the tumor and endometrium were collected by byopsic curettage. Histopathologic examination showed atypical hyperplasia of the endometrium and benign xanthogranuloma of the cervix. Therefore, surgical intervention was performed.
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Affiliation(s)
- Monica Cirstoiu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Manuela Popa
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Maria Sajin
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Catalin Cirstoiu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Coriu L, Copaciu E, Tulbure D, Talmaci R, Secara D, Coriu D, Cirstoiu M. Inherited thrombophilia in pregnant women with intrauterine growth restriction. Maedica (Bucur) 2014; 9:351-355. [PMID: 25705304 PMCID: PMC4316879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 12/04/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Intrauterine growth restriction (IUGR) is a major cause of fetal morbidity and mortality during pregnancy. The role of mutation in the factor V gene, prothrombin gene, MTHFR gene, as risk factors for intrauterine growth restriction during pregnancy, is not very well known so far. MATERIALS AND METHODS This is a retrospective study of 151 pregnant women with a history of complicated pregnancy: intrauterine growth restriction, preeclampsia, recurrent pregnancy loss or maternal venous thromboembolism, who were admitted in Bucharest Emergency University Hospital, during the period January 2010 to July 2014. Genetic testing was performed for all the cases to detect: factor V Leiden mutation, G20210A mutation in the prothrombin gene, C677T mutation and A1298C mutation in methylenetetrahydrofolate reductase (MTHFR) gene. Blood samples were obtained as soon as the diagnosis of intrauterine growth restriction was established with ultrasonography. RESULTS The following gene mutations were associated with increased risk of IUGR: G20210A prothrombin gene mutation (OR 4.81, 95% CI 1.05 - 2.22, p= 0.043), G1691A factor V gene mutation (factor V Leiden) (OR 1.58, 95% CI 0.61 - 4.080, p= 0.347), C677T MTHFR gene mutation (OR 1.61, 95% CI 0.79 to 3.26, p= 0.186), compound heterozygous MTHFR C677T and A1298C (OR 1.66, 95% CI 0.81- 3.42, p= 0.169). Particularly, for G20210A prothrombin gene mutation we found statistically significant risk (p≤0.05) of IUGR.
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Affiliation(s)
| | | | - Dan Tulbure
- Fundeni Clinical Institute, Bucharest, Romania
| | | | - Diana Secara
- Emergency University Hospital, Bucharest, Romania
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Coriu L, Ungureanu R, Talmaci R, Uscatescu V, Cirstoiu M, Coriu D, Copaciu E. Hereditary Thrombophilia and thrombotic events in pregnancy: single-center experience. J Med Life 2014; 7:567-71. [PMID: 25713624 PMCID: PMC4316141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 10/20/2014] [Indexed: 11/18/2022] Open
Abstract
Pregnancy is a normal physiological state that predisposes to thrombosis, determined by hormonal changes in the body. These changes occur in the blood flow (venous stasis), changes in the vascular wall (hypotonia, endothelial lesion) and changes in the coagulation factors (increased levels of factor VII, factor VIII, factor X, von Willebrand factor) and decreased activity levels of natural anticoagulants (protein C, protein S). In this study, we tried to determine a possible association between thrombosis and inherited thrombophilia in pregnant women. This is a retrospective study of 151 pregnant women with a history of complicated pregnancy: maternal thrombosis and placental vascular pathology (intrauterine growth restriction, preeclampsia, recurrent pregnancy loss), who were admitted in our hospital during the period January 2010 to July 2014. We performed genetic analyses to detect the factor V Leiden mutation, the G20210A mutation in the prothrombin gene, the C677T mutation and the A1298C mutation in methylenetetrahydrofolate reductase (MTHFR) gene. The risk of thrombosis in patients with factor V Leiden is 2.66 times higher than the patients negative for this mutation (OR 2.66 95% CI 0.96-7.37 P=0.059). We did not find any statistical association with mutations in the MTHFR gene. Pregnant women with a family history of thrombosis present a 2.18-fold higher risk of thrombosis (OR 2.18 CI 0.9-5.26 P=0.085). Of 151 pregnant women, thrombotic events occurred in 24 patients: deep vein thrombosis, pulmonary embolism, cerebral venous sinus thrombosis and ischemic stroke. The occurrence of thrombotic events was identified in the last trimester of pregnancy, but especially postpartum. Thrombosis in pregnancy is a redoubtable complication requiring an excellent cooperation between the obstetrician and anesthesiologist.
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Affiliation(s)
- L Coriu
- University Emergency Hospital, Bucharest, Romania
| | - R Ungureanu
- University Emergency Hospital, Bucharest, Romania
| | | | | | - M Cirstoiu
- University Emergency Hospital, Bucharest, Romania
| | - D Coriu
- Fundeni Clinical Institute, Romania
| | - E Copaciu
- University Emergency Hospital, Bucharest, Romania
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Popovici LR, Ciulcu A, Dorobat B, Dumitraşcu M, Horhoianu VV, Cirstoiu M. Therapeutic approaches in pelvic bleeding of neoplastic origin. J Med Life 2014; 7:391-5. [PMID: 25408762 PMCID: PMC4233446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 06/10/2014] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVES The aim of this study is to present the main - surgical and non-surgical - therapeutic approaches (or methods) used in the treatment of pelvic bleeding of neoplastic origin. MATERIALS AND METHODS analysis of the materials found in the literature on this subject. RESULTS Among the surgical methods used, hypogastric artery ligation is the oldest therapeutic approach in cervical bleedings of neoplastic origin. Due to the frequent recurrence of haemorrhages, mere ligation has been proven not to be sufficient, but necessitating the concomitant ligation of the lumbo-ovarian, round and uterosacral ligaments. In the case of severe bleedings, difficult to control, direct embolization of the hypogastric artery below the level of ligation is usually practiced. As for the non-surgical methods used, we chose to present uterine artery embolization and the application of haemostatic Mohs' paste. Uterine artery embolization consists in the permanent occlusion of the uterine arteries in neoplastic abundant haemorrhages, when the intervention includes the use of permanent embolic material. Stopping the bleeding within the first 24 hours from the embolization means that the intervention has been a success, and provides the patient with the possibility to continue the therapy protocol according to her stadialization. Recent studies of the Japanese researchers have indicated the possibility to use the Mohs' paste for haemostatic purposes on patients with cervical bleedings of medium intensity, in cases of advanced cervical cancer. CONCLUSIONS With severe haemorrhages - occurring spontaneously or during surgery - the emergency haemostatic intervention consists in the bilateral hypogastric artery ligation. With long-lasting haemorrhages of medium intensity, we usually resort to uterine artery embolization, since this is a minimally invasive method and may also be performed with abundant bleeding under emergency pressure. The application of the Mohs' paste for haemostatic purposes is a new therapeutic method, whose efficiency cannot be yet estimated.
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Affiliation(s)
| | - A Ciulcu
- Dr. I. Cantacuzino Clinical Hospital
| | - B Dorobat
- University Emergency Hospital, Bucharest
| | | | | | - M Cirstoiu
- University Emergency Hospital, Bucharest
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Mitrache LE, Dumitru VA, Simion G, Cirstoiu M, Sajin M. A rare case of uterine myxoid leiomyosarcoma: a case report. Maedica (Bucur) 2014; 9:269-271. [PMID: 25705290 PMCID: PMC4305996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 09/06/2014] [Indexed: 06/04/2023]
Abstract
We present the rare case of a 61-year-old female patient who was submitted in the hospital with metrorrhagia and pelvi-abdominal pain. Echographic examination revealed an heterogeneous uterine mass measuring 190/130/110 mm. Therefore, total hysterectomy with bilateral ooforectomy was performed. Grossly, the uterus presented a tumoral mass with areas of hemorrhage, necrosis and abundant mucoid degeneration. On light microscopic examination a malignant neoplastic proliferation with features of myxoid leiomyosarcoma was noted. In this paper, we presented this rare form of leiomyosarcoma with an emphasis on its particularities that have not been mentioned in the literature.
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Affiliation(s)
- Luminita Elena Mitrache
- Department of Pathology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Vasile Adrian Dumitru
- Department of Pathology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - George Simion
- Department of Pathology, Emergency University Hospital, Bucharest, Romania
| | - Monica Cirstoiu
- Department of Pathology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Maria Sajin
- Department of Pathology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Costache M, Cirstoiu M, Contolenco A, Lazaroiu AM, George S, Sajin M, Patrascu OM. A comparison between clinical diagnosis of death and autopsy diagnosis. A retrospective study of 131 newborns, stillborns and aborted fetuses. Maedica (Bucur) 2014; 9:183-188. [PMID: 25705276 PMCID: PMC4296763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/25/2013] [Accepted: 06/23/2014] [Indexed: 06/04/2023]
Abstract
In recent years, the autopsy was considered necessary only in medico-legal cases, or when the clinician requires it to better understand the pathology and cause of death (with the deceased family's consent). Although it has been shown in numerous studies that the autopsy and the postmortem histopathological examination are the only ones that can diagnose correctly and completely, the autopsy rate is declining. The primary motive of the family in consenting to a perinatal necropsy, may be to determine the cause of death of their child and to be aware of possible complications of their future pregnancy. This study shows the rate of concordance between clinical diagnosis and autopsy diagnosis, and the rate of concordance between macroscopic diagnosis and microscopic findings, pointing out once again the importance and the utility of the autopsy in medical practice.
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Affiliation(s)
- Mariana Costache
- Department of Pathology ,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania ; Department of Pathology, Emergency University Hospital, Bucharest, Romania
| | - Monica Cirstoiu
- Department of Obstetrics-Gynecology III, Emergency University Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Andreea Contolenco
- Department of Pathology, Emergency University Hospital, Bucharest, Romania
| | - Anca Mihaela Lazaroiu
- Department of Pathology ,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania ; Department of Pathology, Emergency University Hospital, Bucharest, Romania
| | - Simion George
- Department of Pathology, Emergency University Hospital, Bucharest, Romania
| | - Maria Sajin
- Department of Pathology ,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania ; Department of Pathology, Emergency University Hospital, Bucharest, Romania
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Bodean O, Munteanu O, Cirstoiu C, Secara D, Cirstoiu M. Probiotics--a helpful additional therapy for bacterial vaginosis. J Med Life 2013; 6:434-6. [PMID: 24868256 PMCID: PMC4034315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 09/30/2013] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Bacterial vaginosis is a condition of unknown etiology, associated with an imbalance of the normal vaginal microbiota, characterized by a high recurrence rate despite of classical therapy solutions. Probiotics are microorganisms, which taken in adequate amounts, are proven to bring health benefits in human and animal bodies, by re-establishing the normal flora at different levels. OBJECTIVE The present article studies the possibility of using probiotic treatment as an adjuvant therapy for nonspecific vaginosis and reducing its recurrence rate. METHODS We have evaluated the evolution of patients with bacterial vaginosis who received the classical antibiotic therapy and a probiotic product. The study group consisted of 173 non-pregnant, sexually active patients, 20-45 years old, with no additional health problems and no contraceptive undergoing treatment, which have been admitted to the department of Obstetrics and Gynecology of the Bucharest Emergency University Hospital between 1.01.2012-31.12.2012.The bacteriological evaluation was made on cervical and vaginal cultures. RESULTS From a total of 173 patients, those who used probiotics oral capsules while taking an antibiotic had lower recurrence rates. More than a half of women who did not use any probiotic product had 3 or more relapse episodes per year. Vaginal capsules with probiotics have also proven to be useful in lowering the recurrence rate, but research is still needed. CONCLUSION Probiotic products are proven to be a helpful adjuvant therapy for bacterial vaginosis, with no adverse outcomes.
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Affiliation(s)
- O Bodean
- Department of Obstetrics and Gynecology, Bucharest University Emergency Hospital
| | - O Munteanu
- Department of Obstetrics and Gynecology, Bucharest University Emergency Hospital
| | - C Cirstoiu
- Department of Orthopedics and Traumatology, Bucharest University Emergency Hospital
| | - D Secara
- Department of Obstetrics and Gynecology, Bucharest University Emergency Hospital
| | - M Cirstoiu
- Department of Obstetrics and Gynecology, Bucharest University Emergency Hospital
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Munteanu O, Radulescu L, Bodean O, Cirstoiu C, Secara D, Cirstoiu M. Is antibiotic prophylaxis mandatory after the insertion of levonorgestrel-releasing intrauterine systemin order to decrease the risk of pelvic inflammatory disease? J Med Life 2013; 6:459-61. [PMID: 24868262 PMCID: PMC4034310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 09/30/2013] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE This study was undertaken in order to determine if antibiotic prophylaxis is mandatory, after the insertion of levonorgestrel-releasing intrauterine system in order to decrease the risk of pelvic inflammatory disease. MATERIALS AND METHODS We prospectively evaluated 44 patients, admitted in the Bucharest Emergency Hospital between the 1ⁱ of February 2012 and the 1ⁱ of October 2012, in whom the levonorgestrel-releasing intrauterine system was inserted. The patients enrolled were divided into two groups. In group A, a number of 22 patients, received, after the insertion of levonorgestrel-releasing intrauterine system, 875mg Amoxicillin Trihydrate + 125 mg Potassium Clavulanate, a dose every 12 hours for 5 days. Group B was represented by the other 22 patients who did not receive antibiotic prophylaxis. All patients were reevaluated at 4 and 12 weeks after the insertion of levonorgestrel-releasing intrauterine system. RESULTS During the first 4 weeks after the insertion of levonorgestrel-releasing intrauterine system only two patients, one from group A and one from group B were diagnosed with pelvic inflammatory disease. At a second follow up visit - 12 weeks after the insertion of levonorgestrel-releasing intrauterine system, no other patient was diagnosed with pelvic inflammatory disease. CONCLUSION Antibiotic prophylaxis is not mandatory, after the insertion of levonorgestrel-releasing intrauterine system in order to decrease the risk of pelvic inflammatory disease.
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Affiliation(s)
- O Munteanu
- Department of Obstetrics and Gynecology, Bucharest University Emergency Hospital
| | - L Radulescu
- Department of Biochemistry, “Carol Davila” University of Medicine and Pharmacy, Bucharest
| | - O Bodean
- Department of Obstetrics and Gynecology, Bucharest University Emergency Hospital
| | - C Cirstoiu
- Department of Orthopedics and Traumatology, Bucharest University Emergency Hospital
| | - D Secara
- Department of Obstetrics and Gynecology, Bucharest University Emergency Hospital
| | - M Cirstoiu
- Department of Obstetrics and Gynecology, Bucharest University Emergency Hospital
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Radulescu L, Munteanu O, Popa F, Cirstoiu M. The implications and consequences of maternal obesity on fetal intrauterine growth restriction. J Med Life 2013; 6:292-8. [PMID: 24155784 PMCID: PMC3806033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 06/29/2013] [Indexed: 11/28/2022] Open
Abstract
CONTEXT The prevalence of maternal obesity has been increasing dramatically in the recent years (body mass index ≥ 30 kg/m2). Maternal obesity is associated with an unequivocal increase in maternal and fetal complications of pregnancy and more than that, these complications also extend beyond fetal life in childhood and adulthood. Objective. The aim of this study was to evaluate maternal and neonatal complications at birth associated with maternal obesity. MATERIALS AND METHODS The study included all women who gave birth between January 1, 2012 and December 31, 2012 at Bucharest University Emergency Hospital. Collected data included information about maternal health (the degree of obesity, associated complications of birth, anemia, and type of birth) and neonatal status (birth weight, gestational age, associated diseases and Apgar score). RESULTS A higher incidence of IUGR, as well as an increased frequency of infants who needed intensive care after birth, a higher rate of cesarean surgery and a higher frequency of thromboembolic complications were observed in patients with associated obesity. CONCLUSIONS Complications grow both in number and severity with increasing obesity. Diagnosis of the fetuses with IUGR is important for the monitoring and management of the pregnancy associated with obesity and it involves a close collaboration between obstetrician, family physician and neonatologist.
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Affiliation(s)
- L Radulescu
- Biochemistry Department, “Carol Davila" University of Medicine and Pharmacy, Bucharest
| | - O Munteanu
- "Carol Davila" University of Medicine and Pharmacy, Department of Obstetrics and Gynecology of University Hospital, Bucharest
| | - F Popa
- Carol Davila" University of Medicine and Pharmacy, Department of General Surgery,
“Sf. Pantelimon" Clinical Emergency Hospital, Bucharest
| | - M Cirstoiu
- "Carol Davila" University of Medicine and Pharmacy, Department of Obstetrics and Gynecology of University Hospital, Bucharest; Project Manager of “Infrastructure development and translational research in molecular pathology and imaging – MOLIMAGEX"
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Ene R, Popescu D, Panaitescu C, Circota G, Cirstoiu M, Cirstoiu C. Low complications after minimally invasive fixation of calcaneus fracture. J Med Life 2013; 6:80-3. [PMID: 23599826 PMCID: PMC3624654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 01/16/2013] [Indexed: 11/27/2022] Open
Abstract
Calcaneus fractures are still a delicate point regarding the indication for osteosynthesis. Knowing the skin's poor vascularisation of the back foot, the purpose of this study is to present the benefits of proper surgical options between an open and invasive osteosynthesis with anatomical reduction and internal fixation or minimally invasive approach preserving the quality of the soft parts. 66 interventions that targeted reduction and internal fixation of calcaneus fractures were performed between 2009-2012, in the Orthopaedic and Traumatology Department of Bucharest Emergency University Hospital. 29 cases underwent open reduction and internal fixation with plates and screws or Kirschner wires, and 37 cases underwent a minimally invasive reduction and Essex Lopresti osteosynthesis technique. No patient who underwent a minimally invasive reduction had skin lesions, but showed pain due to osteoarthritis lesions that appeared in the subtalar joint. 4 of them, who underwent open reduction and internal fixation had postoperative wound infections and skin necrosis.
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Affiliation(s)
- R Ene
- Orthopaedics-Traumatology Department of Bucharest University Emergency Hospital
| | - D Popescu
- Orthopaedics-Traumatology Department of Bucharest University Emergency Hospital
| | - C Panaitescu
- Orthopaedics-Traumatology Department of Bucharest University Emergency Hospital
| | - G Circota
- Orthopaedics-Traumatology Department of Bucharest University Emergency Hospital
| | - M Cirstoiu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest
| | - C Cirstoiu
- Orthopaedics-Traumatology Department of Bucharest University Emergency Hospital
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Cirstoiu M, Bodean O, Secara D, Munteanu O, Cirstoiu C. Case study of a rare form of endometriosis. J Med Life 2013; 6:68-71. [PMID: 23599823 PMCID: PMC3624650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 02/14/2013] [Indexed: 11/01/2022] Open
Abstract
Endometriosis is a common, benign, chronic, estrogen-dependent disorder. The endometrial tissue implants itself outside the uterus and can be usually found in the pelvis or, in rare cases, it can be found nearly anywhere in the body. There are no pathognomonic symptoms of this disease, therefore, in some cases the tumors are incidentally discovered during surgery. Deep infiltrative endometriosis (DIE) is a rare form of this condition, which mostly affects the uterosacral ligaments, the rectovaginal space, and the upper third of the posterior vaginal wall, the bowel, and the urinary tract. We present the case of a 29-year-old pregnant female who was diagnosed with infiltrative endometriosis during the cesarean section at 38 weeks of gestation. The tumors involving the vesicouterine peritoneum had a tendency of infiltrating the urinary bladder, but the patient had been completely asymptomatic prior to this incidental discovery. As cited by literature, the discovery and management of urinary endometriosis, as well as that of other localizations of DIE, is not based on high-level evidence data, but rather on case-series reported by surgical teams working in different centers worldwide.
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Affiliation(s)
- M Cirstoiu
- Obstetrics and Gynecology Department, Bucharest University Hospital
| | - O Bodean
- Obstetrics and Gynecology Department, Bucharest University Hospital
| | - D Secara
- Obstetrics and Gynecology Department, Bucharest University Hospital
| | - O Munteanu
- Obstetrics and Gynecology Department, Bucharest University Hospital
| | - C Cirstoiu
- Orthopedics and Traumatology Department, Bucharest University Hospital
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Cirstoiu M, Munteanu O, Bodean O, Cirstoiu C. A rare case of fetal spondylocostal dysostosis - prenatal diagnosis and perinatal care in a patient with multiple large leiomyomas. J Med Life 2013; 6:93-6. [PMID: 23599829 PMCID: PMC3624657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 02/20/2013] [Indexed: 10/27/2022] Open
Abstract
The spondylocostal dysostosis (SCD) is one of the two major clinico-radiological subtypes of the Jarcho-Levin syndrome (JLS). The JLS is a rare heterogeneous entity characterized by facial dysmorphism, short-neck, short-trunk, normal sizes limbs, with multiple vertebral anomalies at all levels of the vertebral column and costal defects. The JLS has been classified into 2 major clinical phenotypes, based on the extent and distribution of skeletal anomalies, the pattern of inheritance and the prognosis. We report the case of a non-consanguineous 35-year-old female patient, with a history of multiple large leiomyomas gravida 1, para 1. A three-dimensional ultrasound at 18 weeks of gestation revealed: thoracic and lumbar hemivertebrae with abnormal alignment of the vertebral bodies and kypho-scoliosis, also the absence of two right ribs and abnormal shaped ribs. The biometric measurement was appropriate for gestational age and no other malformations were found. Although there was no previous history, based on the three-dimensional ultrasound findings a mild subtype of JLS was suspected. At term, the patient gave birth, by Cesarean section, to a male fetus, with a weight of 2700g, a length of 50cm and a calculated Apgar score of 9. The postpartum examination of the fetus confirmed the diagnose of SCD. The evolution of the newborn was good - he had no respiratory difficulty; he will benefit from an experimental surgery involving expandable titanium ribs. Our case illustrates the importance of an accurate ultrasound examination, which can be hindered by multiple large leyomiomas, in order to diagnose and to differentiate the two subtypes of JLS. The SCD can have a favorable evolution with the appropriate perinatal and postpartum care.
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Affiliation(s)
- M Cirstoiu
- Obstetrics and Gynecology Department, Bucharest Emergency University Hospital
| | - O Munteanu
- Obstetrics and Gynecology Department, Bucharest Emergency University Hospital
| | - O Bodean
- Obstetrics and Gynecology Department, Bucharest Emergency University Hospital
| | - C Cirstoiu
- Orthopedics and Trauma Department, Bucharest Emergency University Hospital
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Cirstoiu M, Munteanu O. Strategies of preventing ureteral iatrogenic injuries in obstetrics-gynecology. J Med Life 2012; 5:277-9. [PMID: 23125877 PMCID: PMC3487176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 09/09/2012] [Indexed: 11/18/2022] Open
Abstract
The incidence of ureteral lesions varies between 0.1% and 30% depending on the type of the surgical intervention. However, the surgical interventions in Obstetrics and Gynecology are responsible for 50% of the total iatrogenic ureteral lesions. Sadly, only 1/3 of the iatrogenic ureteral lesions are recognized during surgeries and 25% of the unrecognized cases of ureteral lesions lead towards the loss of the damaged kidney, while a delayed diagnostic may also lead to a progressive deterioration of the renal function. On this matter, of decreasing the rate of morbidity and the following forensic risks, the gynecologist surgeon must be able to anticipate the potential apparition of a specific ureteral lesion, based on the known risk factors of the patient, so that he can then prevent the iatrogenic ureteral lesion.
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Affiliation(s)
- M Cirstoiu
- Clinic of Obstetrics and Gynecology, University Emergency Hospital, Bucharest
| | - O Munteanu
- Clinic of Obstetrics and Gynecology, University Emergency Hospital, Bucharest
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