Case-report: a case of peritoneal tuberculosis in young women without lung lesion

Scopul lucrării. Prezentarea unui caz dificil de diagnostic diferențiat cu stabilirea afecțiunii tuberculoase extrapulmonare peritoneale. Materiale și metode. Pacientă tânără fără semne de leziuni pulmonare și alte comorbidități, cu leziuni neclare peritoneale. Rezultate. A fost aplicat algoritmul complet de examinare pentru cancer ovarian și anume: analize clinice generale, ecografie transvaginala ale organelor bazinului mic, tomografie computerizată a toracelui, abdomenului si bazinului mic cu contrastare intravenoasă, rezonanță magnetică nucleară a bazinului mic cu contrastare intravenoasă, endoscopie digestivă superioară și inferioară, markerii tumorali CA 125, HE4, indicele ROMA, examenul citologic al lichidului ascitic. Diagnosticul definitivat după biopsie peritoneala în cadrul laparoscopiei diagnostice, examenul patomorfologic și imunohistochimic fiind unul de tuberculoza peritoneală. Concluzii. Procesul de diagnostic și apreciere a tacticii de tratament pacienților cu suspiciune de carcinomatoză peritoneală necesită abordare multidisciplinară și imperative sunt dependente de rezultatele examinărilor patomorfologice și imunohistochimice ale probelor bioptice.Aim of study. To demonstrate a diagnostically hard case of peritoneal tuberculosis without pulmonary manifestations. Materials and methods. We perform diagnostically hard cases of peritoneal tuberculosis in young women without pulmonary lesions or other comorbidities. Results. We performed a full plan of investigations that are typical for ovarian cancer. Clinical signs and investigations results were mostly corresponded to ovarian cancer: routine blood analyses, transvaginal US, CT of thorax, abdomen and pelvis with contrast, MRI of pelvis with contrast, video gastroscopy, video colonoscopy, markers CA 125, HE4, ROMA index, laparocentesis with cytological investigation of peritoneal fluid. The diagnosis was made only after diagnostic laparoscopy, random peritoneal biopsy and subsequent pathology and immunohistochemistry. Conclusions. All diagnosis for peritoneal canceromatosis and choice of treatment must be based on multidisciplinary approach and results of pathology and immunohistochemistry of peritoneal biopsies

Clinical application of perfusion computed tomography in the early diagnosis of acute ischemic stroke and hemorrhagic transformation prediction

Department of Radiology and Neuroimaging, Department of Neurology Institute of Neurology and Neurosurgery, Chisinau, the Republic of Moldova, Department of Molecular Biology and Human Genetics, Nicolae Testemitsanu State University of Medicine and Pharmacy, Chisinau, the Republic of MoldovaBackground: Our study was designed to evaluate the efficacy of perfusion computed tomography (PCT) in patients with acute phase of stroke for the early diagnosis of this pathology and prediction of hemorrhagic transformation in the ischemic area. Material and methods: We studied the functional PCT maps obtained at admission from 23 patients with acute ischemic stroke, compared to follow-up computer tomography or magnetic resonance imaging. Results: Mean Transit Time(MTT) map showed that the highest sensitivity (80.3%) and parameters of relative Cerebral Blood Flow (rCBF) and Cerebral Blood Volume (rCBV) were the most specific (95.0% and 96.9%, respectively) in the early diagnosis of ischemic stroke. Automatic technique “Tissue Classification” showed the highest value of the overall accuracy (91.7%), a significant correlation with the final stroke extension and differentiation of potentially salvageable regions from the irreversibly damaged, which plays an important role in the treatment management. Evaluation of permeability function of the blood-brain barrier with a Permeability Surface area product (PS) showed high values of specificity, sensitivity and overall accuracy (89.5%, 75.0% and 87.0%) in the prediction ability of hemorrhagic transformation. Conclusions: Quantitative analysis of functional parameters of dynamic cerebral perfusion computed tomography has significant efficacy in emergency diagnosis of acute ischemic stroke and hemorrhagic transformation prediction in tissue exposed to ischemia

Hemorrhagic transformation of ischemic stroke – prediction and evaluation with different computed tomography modalities

Department of Radiology and Neuroimaging, Department of Neurology Institute of Neurology and Neurosurgery, Chisinau, the Republic of MoldovaBackground: Hemorrhagic transformation (HT) of ischemic stroke is a complex and heterogeneous phenomenon, which involves numerous parameters whose knowledge remains partial. Large HT is often associated with poorer outcome and higher mortality, especially parenchymal hematoma type 2, that’s why the search of strong HT predictors is very important and can improve management of ischemic stroke patients. Our aim was to review the literature regarding computed tomography (CT) imaging predictors of HT and possible input of different computed tomography modalities in diagnosis and evaluation of HT following acute ischemic stroke. The contribution of non-contrast computed tomography, computed tomography angiography (CTA) and dynamic Perfusion CT (PCT) investigation in the prediction of the hemorrhagic transformation risk were studied. Multiple multicentre studies revealed useful information on different CT patterns predictors of symptomatic intracerebral hemorrhage after stroke, which is the most important type of hemorrhagic transformation from a clinician’s point of view. Conclusions: Data from the multiple studies and trials revealed that different CT modalities show high potency in HT prediction and evaluation. Non-contrast CT standard investigation showed high accuracy in HT prediction by assessment of early ischemic signs, quantification of the Alberta Stroke Program Early CT Score (ASPECTS), grading of leukoaraiosis severity. CTA is useful in HT prediction by the assessment of collateral vessels; intra-arterial occlusion and ASPECTS score calculated from the CTA source images. PCT showed the best predictive values by the measurement of blood-brain barrier permeability