Volume 15 (2018): Issue 2 (May 2018)

Insulin resistance is a determinant factor for the increased prevalence of hypertension and dyslipidemia in type 2 diabetes patients. In this study we determined those modifications of clinical and biochemical parameters associated with insulin resistance in the diabetic patient, these alterations can offer us indications concerning the pathophysiological mechanisms that lead to the diabetes development in the case of most patients. Also we determined a correlation between insulin resistance and cardiovascular risk, through the combined effect of age and insulin resistance on this risk.

OSAS (obstructive sleep apnoea syndrome) is the most common type of sleep apnoea, characterised by obstruction of the upper airways during sleep, causing the absence or reduction of airflow, although there is respiratory muscular activity. It contributes to the occurrence of multiple complications such as hypertension, obesity, diabetes mellitus, cardiac and cerebral pathology, metabolic damage. The objective of this study was to evaluate the major comorbidities associated with OSAS in a group of 101 clinically diagnosed and polysomnographic patients with OSAS at “Marius Nasta” Institute in Bucharest during 2014-2015. The obtained results revealed a very high prevalence of ENT disorders, hypertension, dyslipidaemia and gastroesophageal reflux. Also, among these patients, there was an increased incidence of rhythm disorders (17.8%), such as RBB, ESSV, FiA, but also of ischaemic heart disease (16.83%).

Introduction This pathology is rare in patients younger than 40 years old (5%) and, in those older than 70 years old, almost 50% exhibit colonic diverticulosis. Most cases have mild symptoms and only 20% presents complications as: bleeding, bowel obstruction, abscess and secondary peritonitis.

Aim. The aim is to analyse different types of complications in colonic diverticulosis and compare the data from literature to those in Argeș geographical area.

Material and method. The medical records of 120 patients out of which 101 were admitted in gastroenterology department and 19 in general surgery department were analysed. Diagnosis methods: colonoscopy, computed tomography with contrast dye, simple abdominal radiograph for acute abdominal pain.

Results. 40 patients (33.33%) with asymptomatic colonic diverticulosis, 28 patients (23.33%) moderate diverticulitis, 25 patients (20.83%) with moderate anorectal bleeding, 25 patients (20.83%) with secondary peritonitis, and 2 (1.68%) cases with complications.

Conclusions. All the patients were older than 50 years old, 44 % of diverticulitis cases led to complications (almost half with bleeding and the rest with peritonitis). No bowel obstruction. In 99% of the cases, the localisation of the diverticula was at the level of sigmoid and descending colon.

Catecholamine tumoral syndrome is caused by lesions of the medulosuprarenal cromafin tissue (pheochromocytoma or pheochromocytoblastoma) or of the neural crest (paraganglioma), from the ganglionar cells (ganglioneurinoma or ganglioneuroblastoma) or from the sympathetic nervous cells (sympathogonia – sympathoblastoma and sympathoblasts – neuroblastoma), tumors that excessively secrete cathecolamines (adrenaline and noradrenaline), but also neuropeptides. Indications for testing are associated with the clinical context. Because the pheochromocytoma means a heterogeneous group of secretory tumours, there is no analysis achieving the 100% accuracy. The diagnosis can be established by hormonal dosages for basal determinations and by dynamic tests or through nonspecific tests. Imagistic explorations like computer tomography, abdominal and pelvic MRI can localise the tumour. Plasma and urinary metanephrines dosage are the first intention tests because have a higher accuracy compared to catecholamines or other metabolites. Considering the low prevalence of catecholamine secreting tumours, we considered it necessary to systematise diagnostic possibilities.

Coumarin anticoagulants era (warfarin, acenocumarol) seems to be coming to an end with the launch of the novel anticoagulants like dabigatran, rivaroxaban, apixaban and edoxaban. Dabigatran (Pradaxa) is a prothrombin (factor II) inhibitor that doesn't necessitate monitoring by coagulation tests, doesn't have food or drug interactions, except for P-gp inhibitors. Rivaroxaban (Xarelto) is a direct inhibitor of factor X and is approved for the prevention of thromboembolic events in patients with non-valvular atrial fibrillation and for the prevention of deep venous thrombosis in patients undergoing orthopaedic surgery (hip and knee prosthesis). Apixaban (Eliquis) is a direct inhibitor of factor X and is indicated for the prevention of venous thromboembolic events in patients undergoing hip or knee arthroplasty, the prevention of thromboembolic events in patients with non-valvular atrial fibrillation and treatment or prevention of recurrences in patients with deep vein thrombosis or pulmonary embolism. Edoxaban (Savaysa), recently approved is USA, is a direct inhibitor of factor X and is indicated for deep venous thrombosis, pulmonary embolism and for the prevention of thromboembolic events in patients with non-valvular atrial fibrillation. The most recent studies focus on antidotes specifically designed to bind and neutralise the anticoagulant activity of both direct thrombin inhibitors and direct factor Xa inhibitors. The drugs currently being studied are idarucizumab, a specific antidote, andexanet alfa, a class-specific antidote and ciraparantag, a universal antidote. Of these, only idarucizumab was approved by the FDA.

The congenital cardiac diseases predominately affect the children, as well as the young adults, and they are the consequence of an abnormal embryological development.

Atrial septal defect (DSA) is a congenital heart malformation, which can close in the first year of life, being shown by the presence of a communication between the left atrium and right atrium with the left-to-right shunt, and it subsequently produces some complications.

We report the case of a 31 years-old-female without previous medical history, who was diagnosed with atrial septal defect.

Cystic echinococcosis is the disease that occupies, together with trichinosis, the first place in the zoonoses in Romania. We present the case of a 75-year-old urban patient known for echinococcosis, firstly operated for bone cysts in the right coxofemoral joint at the age of 24, then in 2000 she was operated for a lung hydatid cyst and in 2011 she underwent a surgery for recurrent bone echinococcosis.

After a 7-year lull, she returns due to the appearance of tumorous masses in the abdominal right flank, the right thigh, accompanied by pain in the right coxofemoral joint, functional impotence of the right lower limb, asthenia, anorexia. Based on clinical, immunological, imagistic examinations, the diagnosis of cystic echinococcosis localised in the liver, bone and muscle was established. Since the patient in association had ischaemic heart disease in NYHA III (New York Heart Association) congestive heart failure, surgical treatment was delayed and preoperative treatment with Albendazole 10-15mg/kg/day was started. Initially we will apply a conservative treatment, laparoscopic drainage and aspiration of the contents, saline instillation and aspiration.

Erdheim-Chester syndrome, a non-Langerhans histiocytosis, is a very rare disease, in the present approximately 500 cases being reported in literature. It is characterized by the histiocytic infiltration of various organs and systems, therefore clinical signs and symptoms are miscellaneous. Despite that, there are a few patognomonic elements that help recognizing the disease: symmetrical involvement in the long bones of the lower limbs, bilateral perirenal infiltration (“hairy kidneys”) and circumferential aortic infiltration (“coated aorta”). However, in order to confirm the diagnosis, biopsy is required, histopathologic examination revealing “foamy” histiocytes. Currently, interferon alpha serves as the first line of treatment, most literature data showing that it might improve survival rate in patients diagnosed with Erdheim-Chester syndrome.