Volume 16 (2019): Issue 5 (October 2019)

Objectives. In this study we tried to determine the values of the left atrial (LA) strain in patients with atrial fibrillation (AF) and set a parameter that could be a predictor of sinus rhythm (SR) maintenance.

Study population. We included 60 patients with left ventricular ejection fraction (LVEF) ≥50% - 33 (55%) of them were known to have in their personal history AF (newly diagnosed, paroxysmal and persistent) and they were examined at SR. The second group was represented by 27 (45%) patients that were examined in AF. Using two dimensional speckle tracking echocardiography (2D STE) it was quantified the strain of the 3 functions that characterize the physiology of the LA - reservoir, conduct and pump in the apical sections, mentioning that the pump was absent in patients examined in AF.

Results. The average of the reservoir (R%) for all sections had a significantly higher value in patients with SR (20,2±6,225%) compared to patients examined in AF (6,505±2,66%): P<0.001. With the help of the logistic regression model was observed that only systolic LA strain had the highest predictive power of maintenance of SR. The cutt off value of ≥13,25% of the R% has a sensitivity (Se) and a specificity (Sp) of 90,9%, respectively 100% for maintenance of SR.

Conclusions. In the present study, after analyzing all the parameters that were associated between the 2 groups, it was found that only R %, as the only variable, has the highest predictor power for maintenance of SR.

Introduction. The objective of the present study is to assess the diagnosis and therapeutic particularities in post-cholecystectomy cholangitis at patients with type 2 diabetes mellitus. Patients suffering of diabetes frequently present other pathologies existing before cholecystectomy: cardio-vascular, neurological, renal; these conditions can negatively influence the therapeutic approach of the complex post-cholecystectomy pathology.

Material and method. The study was performed on 76 hospitalized patients. The main diagnosis of these patients was post-cholecystectomy cholangitis. 12 patients had type 2 diabetes mellitus as associated condition. A control batch was selected, 12 non-diabetes patients, having approximately the same age, mainly living in urban areas and having the same main hospitalization diagnosis.

Results.The etiology of post-cholecystectomy cholangitis in case of patients suffering of diabetes was represented by chronic pancreatitis (25%), choledochal lithiasis (33.33%), acute pancreatitis (8.33%), cholangiocarcinoma (16.66%), head pancreas tumor (8.33%).

Conclusions. As a particularity in the surgical approach in case of patients suffering of diabetes within the assessed group, a strict monitoring should be applied in regards with the metabolic status, especially in case of disbalanced diabetes mellitus with chronic complications.

Chronic kidney disease (CKD) is amajor health problem affecting 10–16% of the general adult population in Asia, Europe, Australia, and the United States^{(1,2,3,4,5,6)}. Progression to end stage renal disease (ESRD) remains a major clinical problem because the number and the cost: there are currently over a million patients worldwide on dialysis, with the number continuing to increase by ~7% annually⁽⁷⁾ and the cost of dialysis is very expensive, costing ~US$80,000 per patient per year in the United States⁽⁸⁾.

Since 1951 when was the first published report of the use of kidney biopsy in the diagnosis of medical kidney disease⁽⁹⁾, renal biopsy is an essential procedure in the diagnosis of renal disease, and it is now hard to imagine that one could practice nephrology without knowing pathology. However, there remain no consensus guidelines available to the global renal community outlining the indications for this important diagnostic and prognostic test. In this review, we shall outline the current and potential future uses of renal biopsy in diagnosis, prognosis, response to treatment, and disease progression in the setting of current day nephrology.

Optimal treatment of heart failure (HF) is a continuous challenge. Pharmacological progress, interventional or surgical procedures, kinesio-therapeutic rehabilitation have modestly improved the prognosis of HF with reduced ejection fraction (EF), and patients with HF with preserved EF, or those hospitalized for HF regardless of EF still have a high mortality risk^1,2. The association to the standard treatment of HF either of CoQ10 (CoQ10) or selenium has been evaluated over the last 30 years in many small and non-statistical powered studies. The recent publication of randomized trials Q-SYMBYO and Kisel-10 renewed interest in these supplements. The article aims to synthesize literature data on the role and mechanism of action of CoQ10 and selenium in HF as well as the results of the published trials and meta-analyses, focusing on the latest.

The gallbladder represents a vast pathological subject, vastly disputed because of the many diseases and conditions that can develop. One of the diseases of the bladder is acute cholecystitis, a pathological entity that is induced by the acute inflammation of the gallbladder. It is of particular interest to the patients that present gallstones, with a prevalence of 10 to 25% of the total surgical interventions regarding the gallbladder diseases.

The objective of this article is to analyze the diagnosis and treatment of acute cholecystitis and highlight the importance of diet in this pathology.

The incriminating factor of acute cholecystitis is the biliary stasis, along with bacterial infections that also intervene and the possible ischemia of the bladder wall. In about 90 to 95% cases the biliary stasis is a follow up to the calculous obstruction of the cystic duct, context in which patients are diagnosed with acute lithiasic cholecystitis

Under antibiotic therapy clinical improvement occurs rarely, most often a stationary phase of acute cholecystitis settles in. The unfavorable evolutions refer to patients who develop complications. Bile peritonitis which may be generalized or localized, most often a localized peritonitis occurs, which will develop a plastron in a few days that acts as an armor, is even to touch and presents a dull percussion

Conclusions. Acute cholecystitis is a common disease in clinical practice, and most often it represents a surgical emergency. The quality of life of a patient that suffers from gallbladder diseases may be affected, as they must follow a certain diet.

Background. Percutaneous lung biopsy is an essential step in the management of equivocal lung lesions. Percutaneous lung biopsy is a minimally-invasive procedure with a diagnostic accuracy of more than 90% and a major complication rate of less than 6%⁽¹⁾. Because it is an easy, rapid and safe procedure, percutaneous lung biopsy has become an attractive diagnostic tool for both radiologists and clinicians. However, before planning a percutaneous lung biopsy, the radiologist must carefully evaluate the lung lesion in order to avoid unnecessary lung biopsies.

Aim. The aim of this paper is to evaluate pulmonary pseudolesions that do not require biopsy and to point out key imaging features that help differentiate these lesions from lung cancer.

Case presentations. The authors are analyzing six cases of pulmonary pseudolesions (round pneumonia, pulmonary infarction, round atelectasis, pulmonary artery pseudoaneurysm, pulmonary sequestration and inflammatory pseudotumour) encountered in our hospital that were referred to biopsy as suspicious for malignancy.

Conclusions. There is a wide range of conditions that produce imaging features that mimic lung cancer. However, a careful evaluation of the lesion along with relevant clinical and laboratory findings help make an accurate diagnosis.

We present the case of a 34-year-old male who suddenly experienced upper right quadrant abdominal pain of medium-high intensity that radiated towards his right lumbar area and right testicle, accompanied by nausea and vomiting. His personal history was significant for having an eye prosthesis implanted when he was three years old, due to structural degradation of undetermined cause in his left eye.

He was first seen by a surgeon who recommended an abdominal CT scan and an urology consultation. In the urology clinic, renal and testicular ultrasounds were normal and he was prescribed symptomatic medication.

Due to the pain escalating, the patient underwent a contrast CT scan of the abdomen and pelvis that revealed two renal infarction lesions in the middle and inferior thirds of the right kidney.

The patient was admitted and anticoagulants and pain medication were started. A full body CT scan did not reveal any other abnormalities. Tumour markers and genetic thrombophilia markers were sent for analysis. He was referred to a nephrology clinic, where he underwent screening for multiple myeloma and vasculitic/autoimmune causes, with negative results. A contrast renal vascular ultrasound of the right kidney identified the obstructions as being in the middle and inferior interlobar veins.

Afterwards, the genetic tests revealed three thrombophilic mutations – factor V Leiden positive homozygote, MTHFR C677T and A1298C both positive heterozygote. This might have also been the cause of the childhood ocular surgery. The patient continued anticoagulation with apixaban, with no further significant medical events to this day.

We present the case of a 36-year-old patient admitted with dyspnea, subjective sensation of edema of the cervical region, and precordial pain with sudden onset. Pathological antecedents revealed a respiratory intercourse three weeks ago. Laboratory findings indicated an inflammatory syndrome accompanied by hypoproteinemia. We performed an echocardiographic examination which revealed important pericardial effusion and swinging heart aspect with diastolic collapse of the right atrium and ventricle. According to the existing guidelines pericardiocentesis was immediately required. The hemorrhagic pericardial effusion had an intense positive Rivalta reaction with frequent macrophages and malignant atypical cells. The next step was a full-body computer tomography scan, which revealed an expansive mediastinal mass, invading the upper cava vein and pericardium, with mediastinal adenopathy. A biopsy was performed and the pathology examination concluded there was a classical Hodgkin’s lymphoma nodular sclerosis type. Finally the patient was directed to oncology department.

Introduction: Going through a complete cardiac rehabilitation is essential for all cardiac patients undergoing complex surgery, including those who wear intracardiac devices. Determining the effort capacity after the surgical intervention might provide satisfactory results with the improvement of the quality of life.

Case presentation: We present the case of a male patient, 44 years old, known with aortic bicuspid valve, aortic mechanical valve evolved with prosthesis mismatch and aortocoronary bypass (right coronary artery), followed by total atrioventricular block which required cardiac pacemaker VVI, who is admitted in the Cardiovascular Rehabilitation Clinic to continue the second phase of the rehabilitation program. The ergospirometry test (which was performed in order to evaluate the impairment of the effort capacity) showed a moderate-severe decrease of effort capacity (42% of maximal oxygen consumption, class C Weber), effort hypotension and chronotropic incompetence which led to pausing cardiopulmonary test before anaerobic threshold. Stepper exercise or climbing stairs did not cause the lowering of blood pressure and heart rate, which led to the idea of controlling and adjusting the stimulation parameters. Within cardiopulmonary testing in patients with pacemaker special regards should be paid towards: parameters assessment during effort (heart rate during the test in pacemakers without adaptation to exercise, heart rate during the test in pacemakers with adaptation to exercise, evaluation of the effort response in patients undergoing resynchronization therapy) and diagnosis of exercise-induced arrhythmia (atrial fibrillation, ventricular extrasystoles, ventricular tachycardia, as well as identification of arrhythmias in patients with implantable cardioverter defibrillator).

Conclusion: The cardiopulmonary stress test in patients with cardiostimulation should respect certain conditions in conducting the test in order to obtain realistic results of functional capacity. Due to the position of the piezoelectric crystal and the immobilization of the limbs during the cycle ergometer test it is recommended testing using the treadmill.