Duodenal carcinoid tumour – a case report

Duodenal carcinoids are rare tumours of the small intestine with heterogenous clinical and pathological characteristics. The long-term prognosis is very good if discovered in the early stages. We present the case of a patient with a non-functional duodenal carcinoid tumour discovered incidentally during an upper gastrointestinal endoscopy. The diagnosis was confirmed through immunohistochemistry. Treatment consisted of the endoscopic resection of the tumour and the surveillance of the patient for the following 2 years, with no signs of recurrence. We have conducted a literature review regarding the clinical manifestations, diagnosis, treatment, and follow-up of patients with this type of tumours

Nanoparticles in the treatment of chronic lung diseases

Nanoparticles, although considered a topic of modern medicine, actually have an interesting history. Currently, advances in nanomedicine hold great promise as drug carrier systems for sustained release and targeted delivery of diverse therapeutic agents. Nanoparticles can be defined as complex drug carrier systems which incorporate and protect a certain drug or particle. Nanoparticles can be administered via different routes, such as intravenous injection, oral administration, or pulmonary inhalation. Even though the use of nano-carriers via pulmonary inhalation is heavily debated, this system represents an attractive alternative to the intravenous or oral routes, due to the unique anatomical and physiological features of the lungs and the minimal interactions between the targeted site and other organs. Some of the widely used nano-carriers for the treatment of chronic pulmonary diseases, via pulmonary route, are as follows: polymeric nanoparticles, liposomal nano-carriers, solid lipid nanoparticles, and submicron emulsions. Nano-carrier systems provide the advantage of sustained-drug release in the lung tissue resulting in reduced dosing frequency and improved patient compliance. Further studies focusing on understanding the mechanisms of action of nanoparticles and improving their chemical structure are required in order to better understand the potential long-term risk of excipient toxicity and nanoscale carriers

Imatinib-induced interstitial pneumonitis – a literature review and case report

Imatinib is generally well tolerated, with mild common side effects such as nausea and vomiting, diarrhea, muscle cramps, fatigue, skin rash and edema; however, pulmonary complications are uncommon. A 73-year-old woman undergoing one month treatment with Imatinib for chronic myeloid neoplasm associated with eosinophilia was admitted for sudden alteration of her performance status, dyspnea at rest and productive cough. On clinical examination, the patient was hypoxic (oxygen saturation on room air was 87%), and auscultation of her lungs revealed diffuse bilateral fine crackles. Computed tomography showed bilateral pulmonary interstitial syndrome. Imatinib was discontinued and the patient received systemic corticosteroid therapy and oxygen therapy. After one month, the symptoms and radiological findings were resolved. When Imatinib therapy was resumed, respiratory symptoms reappeared, which is why treatment with Imatinib was interrupted. Imatinib-induced pneumonitis should take into consideration when patients develop respiratory symptoms or abnormal pulmonary radiological features

Duodenal carcinoid tumour – a case report

Duodenal carcinoids are rare tumours of the small intestine with heterogenous clinical and pathological characteristics. The long-term prognosis is very good if discovered in the early stages. We present the case of a patient with a non-functional duodenal carcinoid tumour discovered incidentally during an upper gastrointestinal endoscopy. The diagnosis was confirmed through immunohistochemistry. Treatment consisted of the endoscopic resection of the tumour and the surveillance of the patient for the following 2 years, with no signs of recurrence. We have conducted a literature review regarding the clinical manifestations, diagnosis, treatment, and follow-up of patients with this type of tumours

The molecular mechanisms linking metabolic syndrome to endometrial and breast cancers

The metabolic syndrome represents a plethora of cardio-metabolic risk factors including obesity, arterial hypertension, atherogenic dyslipidemia, hyperglycemia, accompanied by pro-inflammatory and pro-thrombotic state. The metabolic syndrome is one of the key risk factors for certain types of cancer. Among these malignancies, breast cancer and endometrial neoplasms require special attention. Incriminated major causes for the development of breast and endometrial cancer in metabolic syndrome patients are: the pro-inflammatory status and related cytokines, adipokine imbalances, hyperestrogenism, growth factors, disturbances in cancer microenvironment, insulin resistance and hyperinsulinemia. The metabolic syndrome consists of molecular dysregulations that create a pro-oncogenic status. Our review aims at providing a better understanding of the mechanisms underlying the link between the metabolic syndrome and endometrial and breast cancer

Renal damage induced by non-steroidal anti-inflammatory drug treatment

Non-steroidal anti-inflammatory drugs (NSAIDs) are extensively used worldwide due to their analgesic, antipyretic and antiinflammatory effects. NSAIDs (both non-selective NSAIDs and selective cyclooxygenase-2 inhibitors) have nephrotoxic potential, particularly when used chronically.The principal mechanism of action of NSAIDs is cyclooxygenase inhibition, which prevents the conversion of arachidonic acid to prostaglandins, prostacyclins and thromboxanes. In the kidney, prostaglandins induce vasodilation and counter the action of the renin-angiotensin-aldosterone system and the sympathetic nervous system, ensuring optimal renal perfusion. Inhibition of this mechanism by NSAIDs can result in renal damage: acute kidney injury through hemodynamic mechanism, acute interstitial nephritis, glomerular disease, papillary necrosis, water and electrolyte imbalances, HTN. Chronic NSAID use may lead to chronic kidney disease.The nephrotoxic effect is reduced in young patients without renal disease or other comorbidities, but increases significantly in elderly patients with pre-existing kidney disease, nephrotic syndrome, diabetes mellitus, severe congestive heart failure, volume depletion, cirrhosis with ascites, HTN, atherosclerosis, or in patients under treatment with diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor inhibitors

Arterial stiffness in aortic stenosis - complex clinical and prognostic implications

Arterial stiffness and degenerative aortic stenosis (AoS) are frequently associated leading to a combined valvular and vascular load imposed on the left ventricle (LV). Vascular load consists of a pulsatile load represented by arterial stiffness and a steady load corresponding to vascular resistance. Increased vascular load in AoS has been associated with LV dysfunction and poor prognosis in pre-intervention state, as well as after aortic valve replacement (AVR), suggesting that the evaluation of arterial load in AoS may have clinical benefits. Nevertheless, studies that investigated arterial stiffness in AoS either before or after AVR used various methods of measurement and their results are conflicting. The aim of the present review was to summarize the main pathophysiological mechanisms which may explain the complex valvulo-arterial interplay in AoS and their consequences on LV structure and function on the patients' outcome. Future larger studies are needed to clarify the complex hemodynamic modifications produced by increased vascular load in AoS and its changes after AVR. Prospective evaluation is needed to confirm the prognostic value of arterial stiffness in patients with AoS. Simple, non-invasive, reliable methods which must be validated in AoS still remain to be established before implementing arterial stiffness measurement in patients with AoS in clinical practice

Adipokines and Arterial Stiffness in Obesity

Adipokines are active molecules with pleiotropic effects produced by adipose tissue and involved in obesity-related metabolic and cardiovascular diseases. Arterial stiffness, which is a consequence of arteriosclerosis, has been shown to be an independent predictor of cardiovascular morbidity and mortality. The pathogenesis of arterial stiffness is complex but incompletely understood. Adipokines dysregulation may induce, by various mechanisms, vascular inflammation, endothelial dysfunction, and vascular remodeling, leading to increased arterial stiffness. This article summarizes literature data regarding adipokine-related pathogenetic mechanisms involved in the development of arterial stiffness, particularly in obesity, as well as the results of clinical and epidemiological studies which investigated the relationship between adipokines and arterial stiffness

Diagnostic difficulties in chronic kidney disease – Is it or is it not Fabry disease?

Introduction. Renal impairment and neurological symptoms are common manifestations of Fabry disease. Although rare, Fabry disease should be taken into consideration when consulting a patient who presents with neurological and renal impairment, acroparesthesia and fatigue. The aim of this paper is to discuss the case of a female patient presenting with mild systemic symptoms and consequent renal impairment. Case report. The female patient, aged 64, presented for a painful ankle swelling, acroparesthesias, nycturia and fatigue. We diagnosed a gout attack, but found that she had biological signs of renal impairment, aggravated by the use of non-steroidian anti-inflammatory drugs. The search for an etiology of her renal failure proved difficult because she refused the kidney biopsy. The positivity of pANCA antibodies added another potential cause of kidney disease. The mild deficiency of alpha-galactosidase could not fully support the diagnosis of Fabry disease. Discussions and conclusions. In women, Fabry disease should be suspected even if the symptomatology is not typical and as severe as in men. It is difficult to diagnose the Fabry disease in a female patient with chronic kidney disease, because of its polymorphic manifestations and association with other comorbidities, in our case, pANCA vasculitis

The assessment of risk factors for brainstem injuries and supratentorial brain injuries in patients with traumatic brain injury

Traumatic brain injury (TBI) is an important cause of death with a significant worldwide percentage. In the United States, there are approximately 2.8 million TBIs yearly with 250,000 hospitalized patients and 50,000 TBI-related deaths. Every year, there are one million hospitalizations in the European Union, resulting in more than 50,000 deaths, most of which occur due to road traffic accidents. Needless to say, these estimations varied based on the different sources of data. The patient’s outcome is determined by the context of the trauma, the type of lesion, as well as other factors. The aim of the study was to assess variables associated with brainstem injury and supra-tentorial brain injury in patients with TBI. This cohort included 70 consecutive TBI-related deaths from the Institute of Legal Medicine Cluj-Napoca. There was a significant difference in brainstem contusion (haemorrhage contusion) in patients younger than 60. According to the computed tomography (CT) data, brain contusion and laceration were observed in association with brainstem contusion in a significant percentage of TBI-related deaths (p=0.016). Neither the meningo-cerebral blood collections nor the intraparenchymal hematomas had a significant occurrence with brainstem contusion. The diffuse axonal injuries were detected on a CT scan in a significant number of cases with brainstem contusion (p=0.011). The mass effect with brain herniation in the posterior fossa was associated with the occurrence of brainstem contusion, possibly as an extensive process (p=0.041). Analyzing the histopathological data, we observed the significant presence of intracranial haemorrhage in association with a hemorrhagic contusion in the brainstem (p=0.004), but not with meningeal haemorrhage. The poor neurological assessment evaluated by GCS was not an independent variable in relation to this brainstem lesion. That was probably caused by the complexity of the TBI. We did not include this variable in a multivariate analysis considering the poor outcome for all patient