Romanian Journal of Military Medicine, Dec 1, 2016
The major practical advantage of the direct oral anticoagulants (DOACs), comprising the thrombin ... more The major practical advantage of the direct oral anticoagulants (DOACs), comprising the thrombin inhibitor dabigatran and the factor Xa inhibitors apixaban, edoxaban, and rivaroxaban, over vitamin K antagonists is their fixed dosing without the need for laboratory monitoring. With the recent, rapid introduction of the DOACs for the treatment of acute venous thromboembolism (VTE), clinicians are now faced with various questions regarding the efficacy and safety of these compounds overall and in specific high-risk populations. The collective evidence from 6 large clinical trials involving 27,000 patients has demonstrated that DOACs are as effective as vitamin K antagonists (VKA) in preventing recurrent VTE while being associated with a significantly lower risk of major bleeding. These findings are consistent in subgroups of patients with pulmonary embolism, the elderly, and those patients with a high body weight or moderate renal insufficiency, making these agents suitable for a broad spectrum of patients with VTE. DOACs are also an attractive treatment option in patients with VTE and concomitant cancer, thrombotic antiphospholipid syndrome, or heparin-induced thrombocytopenia, but the currently available clinical data is insufficient to make evidence-based recommendations on the use of DOACs in these settings. Several studies evaluating the efficacy and the safety of DOACs in these high-risk populations are underway.
Romanian Journal of Military Medicine, Jun 21, 2015
Introduction: We present the case of a 65 years-old woman who was admitted with a severe macrocyt... more Introduction: We present the case of a 65 years-old woman who was admitted with a severe macrocytic anemia Hb= 5.7g/dl and diffuse bone pain. Biologically she has moderate thrombocytopenia 35 000/µl, a hepatic cytolysis and cholestatic syndrome. Material and method: The patient was extensively evaluated before presentation for a mild irondeficiency anemia for which she underwent endoscopic examination of the upper and lower gastrointestinal tract-normal. The bone marrow aspiration on admission revealed a marked hyperplasia of the erythroblastic line with ~50% basophilic erythroblasts suggesting a regenerative erythroid hyperplasia. These changes along with the marked reticulocytosis on the peripheral blood smear oriented us towards a hemolytic anemia; Folic acid, vitamin B12, autoimmune tests and hemolytic tests were all normal. We continued the investigations with a thoraco-abdominopelvic computed tomography which identified diffuse demineralization, vertebral compactation and pelvic stress fractures. The breast examination revealed a right breast nodule, but the breast ultrasonography pleaded for benignity. Lacking a clear definitive diagnosis we decided to perform a bone marrow biopsy. Results: The osteo-medullary biopsy pointed towards a medullar invasion from a lobular mammary carcinoma; In these circumstances we performed an ultrasound guided biopsy of the right mammary lump thus histologically confirming a tumoral invasion of the bone marrow with subsequent anemia. The patient started chemotherapy in the Oncology ward. Conclusion: The particularity of this case consists in the pattern of anemia, which initially seemed iron deficient and afterwards macrocytic-apparently hemolytic and was actually due to the tumoral medullar invasion and also the nonspecific ultrasonographic appearance of the breast tumor.
Romanian Journal of Military Medicine, Jun 21, 2015
Introduction: We present the case of a 65 years-old woman who was admitted with a severe macrocyt... more Introduction: We present the case of a 65 years-old woman who was admitted with a severe macrocytic anemia Hb= 5.7g/dl and diffuse bone pain. Biologically she has moderate thrombocytopenia 35 000/µl, a hepatic cytolysis and cholestatic syndrome. Material and method: The patient was extensively evaluated before presentation for a mild irondeficiency anemia for which she underwent endoscopic examination of the upper and lower gastrointestinal tract-normal. The bone marrow aspiration on admission revealed a marked hyperplasia of the erythroblastic line with ~50% basophilic erythroblasts suggesting a regenerative erythroid hyperplasia. These changes along with the marked reticulocytosis on the peripheral blood smear oriented us towards a hemolytic anemia; Folic acid, vitamin B12, autoimmune tests and hemolytic tests were all normal. We continued the investigations with a thoraco-abdominopelvic computed tomography which identified diffuse demineralization, vertebral compactation and pelvic stress fractures. The breast examination revealed a right breast nodule, but the breast ultrasonography pleaded for benignity. Lacking a clear definitive diagnosis we decided to perform a bone marrow biopsy. Results: The osteo-medullary biopsy pointed towards a medullar invasion from a lobular mammary carcinoma; In these circumstances we performed an ultrasound guided biopsy of the right mammary lump thus histologically confirming a tumoral invasion of the bone marrow with subsequent anemia. The patient started chemotherapy in the Oncology ward. Conclusion: The particularity of this case consists in the pattern of anemia, which initially seemed iron deficient and afterwards macrocytic-apparently hemolytic and was actually due to the tumoral medullar invasion and also the nonspecific ultrasonographic appearance of the breast tumor.
Journal of Gastrointestinal and Liver Diseases, 2016
Background: Alveolar hemorrhage is a potentially life-threatening condition which is usually mana... more Background: Alveolar hemorrhage is a potentially life-threatening condition which is usually managed by the pulmonologist. When considering its etiology, there is a rare association that sets the disease into the hands of the gastroenterologist. Case presentation: We report the case of a 48 year-old female who was admitted to the intensive care unit for severe anemia and hemoptysis. On imaging, diffuse pulmonary infiltrates suggestive of alveolar hemorrhage were detected and a diagnosis of pulmonary hemosiderosis was made. She received cortisone therapy and hematologic correction of anemia, with slow recovery. In search of an etiology for the pulmonary hemosiderosis, an extensive workup was done, and celiac disease specific serology was found positive. After confirmation of celiac disease by biopsy, a diagnosis of Lane-Hamilton syndrome was established. The patient was recommended a gluten-free diet and at 6 months follow-up, resolution of anemia and pulmonary infiltrates were obser...
Romanian journal of internal medicine = Revue roumaine de médecine interne, 2008
Polycystic hepatic disease is a very rare hereditary disease. Most of the patients have no sympto... more Polycystic hepatic disease is a very rare hereditary disease. Most of the patients have no symptoms but sometimes they present abdominal discomfort, fever, jaundice. Almost half of the patients associate renal cysts. Rarely, the cysts may appear in other organs such as the pancreas, the spleen or the lung. We present a case of polycystic hepatic disease. In our patient the cysts replace almost the entire hepatic structure. However, the hepatic functional tests were normal.
Cystic fibrosis (CF) is one of the most common lethal inherited diseases in the caucasian populat... more Cystic fibrosis (CF) is one of the most common lethal inherited diseases in the caucasian population. The hope of understanding the physiopathology of CF appeared after identification of the gene which encodes CF. The alteration in CFTR protein breaks the hydric balance of the mucosal secretions, producing mucus with increased viscosity. Broncho-pulmonary infections are constant encountered because of the stasis of the mucus. The most common bacterial pathogens in the sputum of patients with MV are Haemophilus influenzae, Staphylococcus aureus, Pseudomonas aeruginosa, Burkholderia cepacia. MV remains a severe, incurable disease, but the evolution is getting better because of the improvements of care methods.
Ultraschall in der Medizin - European Journal of Ultrasound, 2008
Background: The rapid and accurate diagnosis of patients with abdominal pain and jaundice is alwa... more Background: The rapid and accurate diagnosis of patients with abdominal pain and jaundice is always challenging in clinical practice. The aim of the study is to evaluate the role of the ultrasound examination performed in the emergency room in these patients. Material and methods: We included in this retrospective study 256 patients who presented between 2005–2007 in the emergency room with abdominal pain and jaundice. In all patients, clinical examination, the standard biochemical workup and the standard abdominal ultrasound were performed. Results: In the emergency room, the ultrasonography offered a clear diagnosis in 188 cases (73.4%) and the distribution of these cases was: acute cholecystitis: 46 cases (27 linked to the presence of the gallstones); gallbladder cancer: 1 patient; obstruction of commune bile duct by gallstones, intraductal tumors, pancreatic tumors, lymphnodes: 34 cases; portal vein thrombosis with signs of cirrhosis or presence of digestive tumors: 27 cases; liver tumors (primitive or metastases): 23 cases; liver abscesses (after liver trauma or associated with tumoral necrosis): 15 cases; acute pancreatitis: 42 cases. In 37 cases we found only indirect signs, which correlated with clinical and biological data suggested the diagnosis: signs of portal hypertension in cirrhosis or caval and suprahaepatic vein distension in congestive heart failure. Other imaging techniques were necessary for the diagnostic in 31 cases with ultrasound abnormalities but without an evident cause: cholangio-MRI (revealing stones or tumors) or endoscopic retrograde cholangiopancreatography (revealing stenosis of the Oddi's sphincter) in patients with dilated common bile duct and computed tomography in patients with inhomogeneous liver or pancreas (revealing tumors). Conclusions: Ultrasonography, as a noninvasive and feasible method, performed in the emergency room, has a diagnostic value in almost three quarters of patients with abdominal pain and jaundice. In these patients it should be the first choice imaging method but, in some cases, other techniques are required to complete the diagnosis.
Romanian journal of internal medicine = Revue roumaine de médecine interne, 2006
Alpha-1-antitrypsin deficiency (AAT) is one of the three most common lethal genetic diseases in t... more Alpha-1-antitrypsin deficiency (AAT) is one of the three most common lethal genetic diseases in the caucasian population (together with cystic fibrosis and Down syndrome). Its primary manifestation is early-onset panacinar emphysema. Slowly progressive dyspnea is the primary symptom, although some patients initially have symptoms of cough, sputum production, or wheezing. A minority of patients develops hepatic cirrhosis. We present a case of a 40 year-old male, light smoker, with chronic obstructive lung disease with predominance of panacinar emphysema, with AAT deficiency (72 mg/dl; normal values = 200-300 mg/dl) complicated with cor pulmonale and chronic respiratory failure. The main clinical consequence of AAT deficiency is the early onset of panacinar emphysema, typically more severe at the lung bases. Smoking plays an important part in the natural history of the disease, both increasing the severity and decreasing the age at onset of emphysema.
Romanian Journal of Military Medicine, Dec 1, 2016
The major practical advantage of the direct oral anticoagulants (DOACs), comprising the thrombin ... more The major practical advantage of the direct oral anticoagulants (DOACs), comprising the thrombin inhibitor dabigatran and the factor Xa inhibitors apixaban, edoxaban, and rivaroxaban, over vitamin K antagonists is their fixed dosing without the need for laboratory monitoring. With the recent, rapid introduction of the DOACs for the treatment of acute venous thromboembolism (VTE), clinicians are now faced with various questions regarding the efficacy and safety of these compounds overall and in specific high-risk populations. The collective evidence from 6 large clinical trials involving 27,000 patients has demonstrated that DOACs are as effective as vitamin K antagonists (VKA) in preventing recurrent VTE while being associated with a significantly lower risk of major bleeding. These findings are consistent in subgroups of patients with pulmonary embolism, the elderly, and those patients with a high body weight or moderate renal insufficiency, making these agents suitable for a broad spectrum of patients with VTE. DOACs are also an attractive treatment option in patients with VTE and concomitant cancer, thrombotic antiphospholipid syndrome, or heparin-induced thrombocytopenia, but the currently available clinical data is insufficient to make evidence-based recommendations on the use of DOACs in these settings. Several studies evaluating the efficacy and the safety of DOACs in these high-risk populations are underway.
Romanian Journal of Military Medicine, Jun 21, 2015
Introduction: We present the case of a 65 years-old woman who was admitted with a severe macrocyt... more Introduction: We present the case of a 65 years-old woman who was admitted with a severe macrocytic anemia Hb= 5.7g/dl and diffuse bone pain. Biologically she has moderate thrombocytopenia 35 000/µl, a hepatic cytolysis and cholestatic syndrome. Material and method: The patient was extensively evaluated before presentation for a mild irondeficiency anemia for which she underwent endoscopic examination of the upper and lower gastrointestinal tract-normal. The bone marrow aspiration on admission revealed a marked hyperplasia of the erythroblastic line with ~50% basophilic erythroblasts suggesting a regenerative erythroid hyperplasia. These changes along with the marked reticulocytosis on the peripheral blood smear oriented us towards a hemolytic anemia; Folic acid, vitamin B12, autoimmune tests and hemolytic tests were all normal. We continued the investigations with a thoraco-abdominopelvic computed tomography which identified diffuse demineralization, vertebral compactation and pelvic stress fractures. The breast examination revealed a right breast nodule, but the breast ultrasonography pleaded for benignity. Lacking a clear definitive diagnosis we decided to perform a bone marrow biopsy. Results: The osteo-medullary biopsy pointed towards a medullar invasion from a lobular mammary carcinoma; In these circumstances we performed an ultrasound guided biopsy of the right mammary lump thus histologically confirming a tumoral invasion of the bone marrow with subsequent anemia. The patient started chemotherapy in the Oncology ward. Conclusion: The particularity of this case consists in the pattern of anemia, which initially seemed iron deficient and afterwards macrocytic-apparently hemolytic and was actually due to the tumoral medullar invasion and also the nonspecific ultrasonographic appearance of the breast tumor.
Romanian Journal of Military Medicine, Jun 21, 2015
Introduction: We present the case of a 65 years-old woman who was admitted with a severe macrocyt... more Introduction: We present the case of a 65 years-old woman who was admitted with a severe macrocytic anemia Hb= 5.7g/dl and diffuse bone pain. Biologically she has moderate thrombocytopenia 35 000/µl, a hepatic cytolysis and cholestatic syndrome. Material and method: The patient was extensively evaluated before presentation for a mild irondeficiency anemia for which she underwent endoscopic examination of the upper and lower gastrointestinal tract-normal. The bone marrow aspiration on admission revealed a marked hyperplasia of the erythroblastic line with ~50% basophilic erythroblasts suggesting a regenerative erythroid hyperplasia. These changes along with the marked reticulocytosis on the peripheral blood smear oriented us towards a hemolytic anemia; Folic acid, vitamin B12, autoimmune tests and hemolytic tests were all normal. We continued the investigations with a thoraco-abdominopelvic computed tomography which identified diffuse demineralization, vertebral compactation and pelvic stress fractures. The breast examination revealed a right breast nodule, but the breast ultrasonography pleaded for benignity. Lacking a clear definitive diagnosis we decided to perform a bone marrow biopsy. Results: The osteo-medullary biopsy pointed towards a medullar invasion from a lobular mammary carcinoma; In these circumstances we performed an ultrasound guided biopsy of the right mammary lump thus histologically confirming a tumoral invasion of the bone marrow with subsequent anemia. The patient started chemotherapy in the Oncology ward. Conclusion: The particularity of this case consists in the pattern of anemia, which initially seemed iron deficient and afterwards macrocytic-apparently hemolytic and was actually due to the tumoral medullar invasion and also the nonspecific ultrasonographic appearance of the breast tumor.
Journal of Gastrointestinal and Liver Diseases, 2016
Background: Alveolar hemorrhage is a potentially life-threatening condition which is usually mana... more Background: Alveolar hemorrhage is a potentially life-threatening condition which is usually managed by the pulmonologist. When considering its etiology, there is a rare association that sets the disease into the hands of the gastroenterologist. Case presentation: We report the case of a 48 year-old female who was admitted to the intensive care unit for severe anemia and hemoptysis. On imaging, diffuse pulmonary infiltrates suggestive of alveolar hemorrhage were detected and a diagnosis of pulmonary hemosiderosis was made. She received cortisone therapy and hematologic correction of anemia, with slow recovery. In search of an etiology for the pulmonary hemosiderosis, an extensive workup was done, and celiac disease specific serology was found positive. After confirmation of celiac disease by biopsy, a diagnosis of Lane-Hamilton syndrome was established. The patient was recommended a gluten-free diet and at 6 months follow-up, resolution of anemia and pulmonary infiltrates were obser...
Romanian journal of internal medicine = Revue roumaine de médecine interne, 2008
Polycystic hepatic disease is a very rare hereditary disease. Most of the patients have no sympto... more Polycystic hepatic disease is a very rare hereditary disease. Most of the patients have no symptoms but sometimes they present abdominal discomfort, fever, jaundice. Almost half of the patients associate renal cysts. Rarely, the cysts may appear in other organs such as the pancreas, the spleen or the lung. We present a case of polycystic hepatic disease. In our patient the cysts replace almost the entire hepatic structure. However, the hepatic functional tests were normal.
Cystic fibrosis (CF) is one of the most common lethal inherited diseases in the caucasian populat... more Cystic fibrosis (CF) is one of the most common lethal inherited diseases in the caucasian population. The hope of understanding the physiopathology of CF appeared after identification of the gene which encodes CF. The alteration in CFTR protein breaks the hydric balance of the mucosal secretions, producing mucus with increased viscosity. Broncho-pulmonary infections are constant encountered because of the stasis of the mucus. The most common bacterial pathogens in the sputum of patients with MV are Haemophilus influenzae, Staphylococcus aureus, Pseudomonas aeruginosa, Burkholderia cepacia. MV remains a severe, incurable disease, but the evolution is getting better because of the improvements of care methods.
Ultraschall in der Medizin - European Journal of Ultrasound, 2008
Background: The rapid and accurate diagnosis of patients with abdominal pain and jaundice is alwa... more Background: The rapid and accurate diagnosis of patients with abdominal pain and jaundice is always challenging in clinical practice. The aim of the study is to evaluate the role of the ultrasound examination performed in the emergency room in these patients. Material and methods: We included in this retrospective study 256 patients who presented between 2005–2007 in the emergency room with abdominal pain and jaundice. In all patients, clinical examination, the standard biochemical workup and the standard abdominal ultrasound were performed. Results: In the emergency room, the ultrasonography offered a clear diagnosis in 188 cases (73.4%) and the distribution of these cases was: acute cholecystitis: 46 cases (27 linked to the presence of the gallstones); gallbladder cancer: 1 patient; obstruction of commune bile duct by gallstones, intraductal tumors, pancreatic tumors, lymphnodes: 34 cases; portal vein thrombosis with signs of cirrhosis or presence of digestive tumors: 27 cases; liver tumors (primitive or metastases): 23 cases; liver abscesses (after liver trauma or associated with tumoral necrosis): 15 cases; acute pancreatitis: 42 cases. In 37 cases we found only indirect signs, which correlated with clinical and biological data suggested the diagnosis: signs of portal hypertension in cirrhosis or caval and suprahaepatic vein distension in congestive heart failure. Other imaging techniques were necessary for the diagnostic in 31 cases with ultrasound abnormalities but without an evident cause: cholangio-MRI (revealing stones or tumors) or endoscopic retrograde cholangiopancreatography (revealing stenosis of the Oddi's sphincter) in patients with dilated common bile duct and computed tomography in patients with inhomogeneous liver or pancreas (revealing tumors). Conclusions: Ultrasonography, as a noninvasive and feasible method, performed in the emergency room, has a diagnostic value in almost three quarters of patients with abdominal pain and jaundice. In these patients it should be the first choice imaging method but, in some cases, other techniques are required to complete the diagnosis.
Romanian journal of internal medicine = Revue roumaine de médecine interne, 2006
Alpha-1-antitrypsin deficiency (AAT) is one of the three most common lethal genetic diseases in t... more Alpha-1-antitrypsin deficiency (AAT) is one of the three most common lethal genetic diseases in the caucasian population (together with cystic fibrosis and Down syndrome). Its primary manifestation is early-onset panacinar emphysema. Slowly progressive dyspnea is the primary symptom, although some patients initially have symptoms of cough, sputum production, or wheezing. A minority of patients develops hepatic cirrhosis. We present a case of a 40 year-old male, light smoker, with chronic obstructive lung disease with predominance of panacinar emphysema, with AAT deficiency (72 mg/dl; normal values = 200-300 mg/dl) complicated with cor pulmonale and chronic respiratory failure. The main clinical consequence of AAT deficiency is the early onset of panacinar emphysema, typically more severe at the lung bases. Smoking plays an important part in the natural history of the disease, both increasing the severity and decreasing the age at onset of emphysema.
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