Postoperative median incisional hernias occurrence and their surgical treatment with retromuscular prolene mesh and hernial sac

University of Medicine and Pharmacy of Targu Mures, Romania, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: Median incisional hernias are the most frequent postoperative complications in the surgical practice. They can occur in different forms and at different ages. Because of its high incidence rate, many surgical techniques are being used, but neither one is superior over the others. However some creative combined techniques show promising results. Aim: Analyzing occurrence rates and types of postoperative median incisional hernias at different ages and genders. Evaluation of the efficiency of different surgery techniques. Materials and Methods: We conducted a retrospective study at the 2nd Department of Surgery, Emergency County Hospital in Tirgu Mures, during January 2010 and January 2016. Results: From 763 patients 517(67.76%) were females and 246(32.24%) were males. The highest incidence rate was noticed between the age of 60 and 70, at both genders (35.13%). We found in 18(2.36%) cases giant incisional hernias and in 98(12.84%) cases multilocular hernias. There were 48(6.29%) life threatening cases, caused by incarcerated incisional hernias. Recurrences appeared in 51(6.68%) cases. In most of the cases (485=63.57%) abdominal wall reconstructions were made with prolene mesh in retromuscular position, followed by primary suture repairs (211=27.65%) and finally (67=8.78%) prolene mesh in retromuscular position and hernial sac were used together in the surgical treatment. The two most common early complications were: rectus sheath hematomas and subcutaneous seromas. Conclusion: Postoperative median incisional hernias have a high incidence and recurrence rate, especially between the age 60 and 70. Prolene mesh in retromuscular position or primary suture repairs are not always enough. Using prolene mesh in retromuscular position together with the hernial sac is a more secure and low cost proceeding, especially in cases of giant incisional hernias

Is the gender an important variable in evaluating the psoriatic arthritis activity when using stockerau activity score?

University of Medicine and Pharmacy Targu Mures, Romania, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Background: In last decade, several disease activity scores for the inflammatory diseases such as rheumatoid and psoriatic arthritis were validated. Still, the auto - evaluation in real life is less utilised in clinical practice. A new score – the Stockerau Activity Score for Psoriatic Arthritis (SASPA), aimed to be used by the patients is to be validated. Aim: to evaluate the gender as an independent variable for the SASPA score. Material and method: A prospective, cross-sectional study was started on February 2016 in the rheumatology ambulatory settings. SAPSA activity score consisting of five questions aiming the tender joints, the degree of arthritis, the stiffness, the general health and the skin disease was completed by thirty - six (17 women, 19 men) patients diagnosed with psoriatic arthritis (PsA). Mann Whitney test was applied. Results: All the patients completed the SAPSA in less than 2 minutes. No differences were observed concerning the tender joints (p: 0.6067), the arthritis overall evaluation (p: 0.6863), the general health (p: 0.5074) and the stiffness (p: 0.8951) comparing the results of women versus men. On the p scale we observed a tendency to achieve a differentiation when asked by the skin involvement (p: 0.0789), being with a delta of 0.4 more affected the women. Conclusions: The skin involvement in association with the gender is to be carefully considered when applying activity scores in PsA

Hydroxycloroquine is a foe friend in a drug induced systemic lupus erythematosus?

University of Medicine and Pharmacy, Targu Mures, Romania, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: The golden standard in the management of systemic lupus erythematosus (SLE) is the hydroxycloroquine. The main listed side effects of hydroxycloroquine are the ocular toxicity and in lupus with myositis overlaps the desquamation. Clinical case: A female patient known with a history of sterility and upper respiratory tract infection (started on June 2015 and resolved in December 2015) on treatment with Amoxicillin and symptomatics presents in January 2016 with parotid swelling and sicca symptoms. Corroborating the history (photosensibility, amoxicillin intake, parotid swelling, sicca symptoms, mother diagnosed with psoriasis) with the immunology panel (positive antibodies for SSA, SSB, RO-52, dsDNA and histone) the patient was diagnosed with secondary Sjogren Syndrome Associated with drug induced SLE. Hydroxicloroquine Associated with low doses of Prednisone was started. After the first dose, the patient complained about pruritus and extended erythematosus plaque. She was admitted in the ER. She was put on high doses of corticosteroids and the hydroxycloroquine was stopped. A skin biopsy was performed showing a pattern characteristic for toxic dermatitis. Results from a prior parotid biopsy are expected. The patient was admitted in the Department of Rheumatology to start a new drug treatment. Conclusion: Four major questions arised from the history of our patient. Did we missed something prior the onset of the treatment with hydroxycloroquine? Was the Amoxicillin to be blamed for the drug induced lupus? Are we dealing with a secondary Sjogren syndrome with complications – eg. lymphoma? What is the best treatment to be started

Is psoriatic arthritis a risk factor for diabetes mellitus?

University of Medicine and Pharmacy, Targu Mures, Romania, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: Three meta-analyses evaluated the role of psoriasis and/or psoriatic arthritis in the development of type 2 diabetes mellitus. The difference of the three studies consisted in evaluating different parameters involved alongside psoriasis (Ps) and/or psoriatic arthritis (PsA) in the onset of diabetes. The aim of our study is to find if psoriatic arthritis is an independent risk factor. Material and Method: We enrolled 330 patients diagnosed with psoriatic arthritis according with CASPAR criteria in our observational study. The following variables were monitored: the presence of diabetes pre or post onset of psoriasis or psoriatic arthritis, the onset of the disease, the gender, the treatment – classical or biological disease disease-modifying anti-rheumatic drugs (DMARDs), corticotherapy, body mass index, alcohol intake, smoking habits, dyslipidaemia, active or inactive status in society. Graph Pad Prism 6.0 software was used to assess the statistically the data. Results: Two-hundred and eighty-seven patients (pts.) with psoriatic arthritis and lack of diabetes were enrolled to the control group. Forty-three patients were associating type 2 diabetes mellitus. In the control group, we found a positive association between overweight (p: 0.008, r: 0.159), obesity (p:0.020, r: 0.138) and glucose intolerance and a protective role of methotrexate (p: 0.023, r: - 0.134). In the study group, according with the statistics, all the patients that developed diabetes were obese and the onset was correlated with the skin lesions (p: 0.038, r: 0.317). Conclusions: Obesity and skin disease seemed to play an important role in the onset of type 2 diabetes mellitus. A nutritionist should be involved in the management of the disease

Multiple organ dysfunction induced by alprostadilum in a patient diagnosed with scleroderma (systemic sclerosis)

University of Medicine and Pharmacy Targu Mures, Romania, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: Painful, slow-healing ulcers of the fingers are most common in patients with progressive systemic sclerosis. Prostaglandine E1(PGE1) is a vasodilatator that has been found to reduce the pain of the severe periphereal arterisclerotic vascular disease and to promote healing of the accompanying ulcers. Clinical case: We present the case of a 46-years old, female, allergic to Hymenoptera venom, and witch in 2010 received swine flu vaccine. In october 2010, she reach on the departament of Rheumatology, Targu Mures accusing pain and swelling in the extremities, skin changes at the same level accompanied by vasomotor disturbances at cold. Having in mind this clinical appearance of skin, typical for scleroderma, Associated with the mesenchymal nonspecific inflammatory syndrome proven by laboratory test, with increased antibody titer (antinuclear antibodies-ANA: 45.2 UI/ml and topoisomerase-I antibodies-anti Scl 70: 39.5 UI/ml) and after radiographic appearance of early resorption of the distal phalanx, IV finger, right hand is given a diagnosis of progressive systemic scleroderma and we have initiated a background treatment with methotrexate. But after two months the disease progresses rapidly with necrotizing vasculitis and pulmonary injury. So we initiated a treatment with cyclophosphamide 600 mg intravenously with favorable evolution until October 2011 when it stopped due to a suspected hemorrhagic cystitis, and when peripheral ischemia occur we decide to introduce back azathioprine in the treatment plan but with modest results resuming the treatment with Cyclophosphamide in May 2012, which was Associated with Alprostadilum and in February 2013reenter Methotrexate. In january 2014,after the treatment with Alprostadilum, the patient suddenly accuse chills, low grade fever, muscular pain, without auscultatory lung changes, arrhythmic heart sounds, with ischemic changes on electrocardiogram, rising the suspicion of an acute coronary syndrome, but which was rejected after cardiological examination. Subsequently, after two days, the patient presents coffee grounds vomiting for which was made an upper gastrointestinal endoscopy in emergency, which shows no active bleeding source. Concidering progressive hemodynamic alterations, the patient is transferred in Gastroenterology Clinic where is established the diagnosis of acute gastric ulcer with upper gastrointestinal bleeding. After 2 weeks, the patient presents in the emergency room in bad general condition with necrotic changes in the fingers and she was hospitalized to the intensive care unit with inflammatory syndrome, marked anemia, hepatic and renal failure, pleural effusion fluid with cytopathology diagnosis of atypical cells and suspected neoplastic process having a rapidly evolution to death.In conclusion even if we considered all aspects and risk factors related to the patient’s disease, when we prescribe Alprostadilum we should expect to face a tragic outcome

Spontaneous pneumothorax after a respiratory distress syndrome – a case report

University of Medicine and Pharmacy of Targu MuresBackground. Respiratory distress syndrome(RDS) of the newborn is caused by pulmonary surfactant deficiency in the lungs of neonates which leads to alveolar collapse and noncompliant lungs. It can be primary or secondary, due to meconium aspiration or Group B Streptocoocus (GBS) infection. RDS is usually diagnosed with a combination of clinical signs and/or symptoms (apnea, cyanosis, grunting, inspiratory stridor, nasal flaring, poor feeding, and tachypnea), chest radiographic findings, and arterial blood gas Results. In near term or term infants with great respiratory effort, RDS can be complicated with spontaneous pnumothorax

Partial 13 monosomy with corpus callosum agenesis and other congenital abnormalities – a case report

University of Medicine and Pharmacy of Targu Mures, RomaniaBackground. The corpus callosum comprises the largest tract of nerve fibres in the human brain. It is developed from the telencephalon starting in the 11th week of foetal life. Partial or complete agenesis of the corpus callosum is a rare developmental anomaly of unknown cause. A case of corpus callosum agenesis is described

Myeloid proliferation associated with Down syndrome: a case report

University of Medicine and Pharmacy of Targu Mures, RomaniaBackground. Atypical chronic myeloid leukemia (aCML), BCR-ABL1 negative is a rare myelodysplastic syndrome (MDS)/myeloproliferative neoplasm (MPN) for which no current standard of care exists. ACML is characterized by many clinical features (splenomegaly, myeloid predominance in the bone marrow with some dysplastic features but without a differentiation block) and laboratory abnormalities (myeloid proliferation, low leukocyte alkaline phosphate values). A review of the literature suggests that the presence of an abnormal chromosome 21 may predispose to the development of leukemia

The Intersection of Dermatological Dilemmas and Endocrinological Complexities: Understanding Necrobiosis Lipoidica—A Comprehensive Review

Background: Necrobiosis lipoidica (NL) is a rare granulomatous skin disorder with a predilection for females, often associated with diabetes mellitus (DM). This paper aims to comprehensively review the literature on NL, focusing on its association with DM, thyroid disorders, and the metabolic syndrome. Methods: A systematic search was conducted in English-language literature from inception to October 2023, utilizing PubMed. We identified 530 studies and selected 19 based on clinical significance, statistical support, and relevance to the paper’s goals. Results: The coexistence of NL and DM is prevalent, with rates ranging from 11% to 65.71%. NL may precede DM diagnosis and a correlation between NL and increased daily insulin requirements has been observed in such patients. NL is suggested as a potential prognostic marker for DM complications; however, recent studies question this association, highlighting the need for further research. Studies in the context of NL and Thyroid Disease indicate a correlation, especially with autoimmune thyroiditis. Regarding NL and Metabolic Syndrome, the prevalence of metabolic syndrome among NL patients is notably higher than in the general population. Additionally, DM patients with ulcerated NL commonly exhibit hypertension or obesity, raising questions about the potential influence of hypertension and obesity on NL ulcerations. Conclusion: Additional research is required to untangle the complex connections between NL and various comorbidities

Assessing the Impact of Organ Failure and Metastases on Quality of Life in Breast Cancer Patients: A Prospective Study Based on Utilizing EORTC QLQ-C30 and EORTC QLQ-BR45 Questionnaires in Romania

Breast cancer (BC) significantly impacts the quality of life (QoL) of affected individuals. This study, conducted at Colțea Clinical Hospital, Bucharest, aimed to assess the impact of organ failures and metastases on QoL in breast cancer patients using EORTC QLQ-C30 and EORTC QLQ-BR45 questionnaires and the survival rate to understand the clinical journey and the quality of life status in breast cancer patients. From January 2019 to October 2022, a prospective, observational study surveyed 874 patients, revealing 201 fatalities, 66 refusals, and 607 eligible participants. Results indicated statistically significant differences in various QoL aspects for patients experiencing heart failure, including physical functioning, pain, insomnia, global health status, and overall summary score. Kidney failure exhibited significance in physical functioning for QLQ-C30 and body image, sexual functioning, and endocrine sexual symptoms for QLQ-BR45. Respiratory failure demonstrated significant differences across multiple QoL domains. Patients with bone metastases reported lower physical functioning (p = 0.006) and increased pain (p = 0.002). This study has revealed an overall 5-year life expectancy of 68.8%, with survival rates of 93.8% for Stage I, 86.3% for Stage II, and 77.2% for Stage III breast cancer. Metastatic cancer patients have shown a 35.6% survival rate over 45 months, with a median survival duration of 36 months. A significant limitation of our study was the administration of the questionnaire only once, preventing us from quantifying the impact of specific treatment types on quality of life. This study emphasizes the necessity of using standardized QoL assessments in clinical practice from the initial presentation to ongoing follow-up