Giant Hydrarthrosis of The Knee The Clinical Expression of a Rare Disorder,

Pachydermoperiostosis

Author: Dan Alexandru Arhire

Scientific coordinator: Oana Arhire, MD, Smaranda Miu,MD

Introduction: Pachydermoperiostosis (PDP) or primary hypertrophic osteoarthropathy is a rare

autosomal dominant inherited disorder which develops in childhood or teen-age and progresses
slowly for 15-20 years, stabilising afterward. The common triad includes: digital clubbing,
pachydermia (thickening of the facial skin and/or scalp) and periostosis (periosteal new bone
formation).

Materials and methods: A 29-year-old male patient, with personal pathologic antecedents of
hydrarthrosis of the left knee (for which a synovectomy had been allegedly performed two
years before) presented for gigantic tumefaction of the right knee and arthralgia (bilateral knee,
wrist and hand). The clinical examination shows thickening and folding of facial and scalp
skin, clubbing of digits, induration and soft-tissue swelling of the extremities, watch glass
like shape of the nail, massive tumefaction of the right knee, pseudoankilosis of the both knees
and gait difficulties. The biological tests show no inflamatory findings, thus hands and bilateral
knee X-Rays and US are demanded.

Results: The radiological investigations show bilateral, symmetrical and circumferential

periosteal reaction in the diaphyseal-metaphyseal region of the long bones (radius, ulna, femur,
tibia and fibula) with compact multilamellar feature. The bones are deformed and thickened.
The huge distension of the right suprapatellar bursae determines a massive opacity on its
topography. The ultrasound reveals gigantic collection of the right knee joint with
innumberable synovial proliferation nodules and also soft tissue hypertrophy of the nail matrix
and bed. The pacient refused synovial fluid aspiration, synovectomy and the proposed
treatment with nonsteroidal anti-inflammatory drugs and bisphosphonates.

Conclusion: In order to make a diagnosis of pachydermoperiostosis, careful analysis and

clinical-imagistic correlation is required. Monitoring and radiological follow-up is strongly
recommended, because of the high risk of malignant transformation. The most important
differential diagnosis is the secondary hypertrophic osteoarthropathy (paraneoplastic
syndrome), which was excluded in this case by a chest X-Ray.

Keywords: Periosteal Reaction, Digital Clubbing, Pachydermia

Lemierre's Syndrome Associated with Mediastinitis: A Case Report

Author: Alexandru Trenchea

Co-author: Alexandra-Evelina Ciubotariu
Scientific coordinator: Lecturer Floria Mariana, MD

Introduction: Lemierre syndrome is a rare but serious illness that associates pharyngeal
infection and thrombosis of the internal jugular vein or one of its tributaries with subsequent
distant septic emboli. Fusobacterium necrophorum, a Gram-negative anaerobic microorganism
that normally inhabits the oropharynx, is responsible for the infection in the majority of cases.
The aim of our paper is to review the pathogenesis, clinical presentation, and treatment of this
disease.

Materials and methods: We present the case of a 60-year-old woman, without any
significantly medical history, who presented to our Emergency Department with a chief
complaint of fever, associated with pharyngeal pain, neck erythema on the left side and
generalized weakness. According to biological and biochemical exams she was noted to be in
septic shock. Chest computed tomography showed mediastinitis. Blood cultures were positive
for Fusobacterium necrophorum.

Results: One month later, after an intensive intravenous antibiotics therapy, right atrial and left
internal jugular vein thrombosis was diagnosed. She recovered after intensive supportive care, a
long course of intravenous antibiotics therapy and anticoagulation, combined with surgery.

Conclusion: Lemierre syndrome usually affects previously healthy adolescents and young
adults in a characteristic manner, often with fatal results if left untreated. There is a
significantly increasing number of reported cases of Lemierre syndrome, possibly reflecting the
trend to withhold antibiotics for initially uncomplicated oropharyngeal infections. Treatment
with broad-spectrum antibiotics is the elective choice of treatment of Lemierre syndrome.
Surgery is indicated in the case of abscess formation.

Keywords: Lemierre's Syndrome, Jugular vein thrombosis, Medistinitis

Patient Diagnosed with Tuberous Sclerosis (Bourneville Syndrome), a Rare
Genetic Disorder and with Many Complications

Author: Bulgaru Bianca-Costinelia

Co-author: Sibel Chiamil
Scientific coordinator: Damian Luminita, MD

Introduction: Tuberous sclerosis complex (TSC) is a genetic disorder caused by mutations in

the TSC1 or TSC2 genes, affecting cellular differentiation, proliferation, and migration early in
development, resulting in a variety of hamartomatous lesions that may affect virtually every
organ system of the body. This genes provide instructions for making the proteins hamartin and
tuberin which act as tumor suppressors.

Materials and methods: Data were extracted from Bucharest Emergency University
Hospitals medical records and combined with information from older paper-based records and
medical charts. Computed tomographic (CT) scans and echography were performed every 2 to
3 years as part of routine follow-up. Angiomyolipoma and subependymal giant cell
astrocytoma were identified by CT scan, epilepsy was measured by electroencephalography,
and other manifestations were determined by clinical examination and history taking. The
treating physicians observations were used to determine the presence of skin lesions and assess
cognitive function.

Results: 1978 (1,5 year old) - epileptic seizure, 1986-diagnosis of Bourneville Syndrome based
through the cutaneous manifestation. 1993- macroscopic hematuria and a left kidney colic,
echography: bilateral kidney cysts and a caudat lobe tumor, CT: subependymal giant cell
astrocytoma. 1994- left kidney nephrectomy (subcapsular renal haemorrhage, massive
hematuria not responding to conventional therapy). From 1998- episodes of right kidney
subcapsular hematoma. 2010- a resection of the hepatic tumor was perfomed at Liver Surgical
Centre Regesburg/Germany, hispotathological result: hepatocellular carcinoma well-
differentiated. 2012: hysterectomy with bilateral adnexectomy. 2016- autoimmune hemolytic
anemia, COOMBS test: positive, therapy with methylprednisolone, the immune system was
supressed and it caused a pulmonary infection wich bring the decease.

Conclusion: TSC is a lifelong condition, therefore individuals should be regularly monitored

by an experienced clinician. TSC must be included in the differentials of children presenting
with seizures, developmental delay, and mental retardation.

Keywords: Tuberous Sclerosis, Angiomyolipoma, Nephropathy

Evaluation of Low-Dose Glucocorticoid Regimen in Association with
Cyclophosphamide in Inducing and Maintaining Remission in Patients with
Glomerulonephritis: Retrospective Analysis of 140 Cases in The Real Life of a
Nephrology Department

Author: Covic Andreea

Co-authors: Hirja Anca,MD; Mihai Ruxandra
Scientific coordinator: Assistant Professor Luminita Voroneanu, MD, PhD

Introduction: Current guidelines suggest that the combination of an alkylating agent and orally
corticosteroid is associated with short- and long-term benefits in adults with different types of
glomerulopathies. Many of these patients experienced significantly side effects from systemic
corticosteroid use: weight gain, diabetes, hypertension, dyslipidaemia, and osteoporosis. In this
context, we tried to assess the efficiency of monthly pulse intravenous corticosteroids plus
cyclophosphamide instead of continuous oral steroids plus cyclophosphamide on proteinuria
and renal progression in patients with glomerulonephritis.

Materials and methods: We conducted a retrospective cohort study including all patients with
glomerulopathies and a renal biopsy between 2005 and 2015 from Moldova (N-E Romania).
Patients with obesity and/or prediabetes / diabetes and/or age > 65 received monthly i.v.
methylprednisolone 1g x 3days and cyclophosphamide without orally corticosteroids (group 1).
The rest of the patients received oral prednisone in association with i.v. cyclophosphamide
(group 2).
The following end points were assessed at 6-monthsL complete remission (proteinuria less than
0.3 g/d), partial remission (proteinuria 0.3 - 3.5 g/d or its decrease > 50% from baseline),
change in eGFR, requirement for renal replacement therapy or death.

Results: 120 patients were included in analysis (age = 47.7+ 15.4 years, 58.3% males and
10.8% diabetics). Baseline eGFR and proteinuria were 34.7 ml/min/1.73m2 and 6.3 g/24h in
group 1, respectively 33.3 ml/min/1.73m2 and 4,8 g/24h in group 2 (p = NS).
After six months, there was no difference concerning complete remission rate between groups
(22.2% versus 24.1% p = NS). The partial remission rate was: 44.4% versus 44.8%, p = NS.
eGFR was also comparable between groups: 33.3 ml/min/1.72m2 vs 42.4 ml/min/1.73m2 (p =
NS).

Conclusion: Monthly pulse intravenous corticosteroids plus i.v.cyclophosphamide has a

similar efficacy compared with continuous oral steroids plus cyclophosphamide in inducing
remission in patients with glomerulonephritis.

Keywords: glucocorticoid, glomerulonephritis, cyclophosphamide

Clinical and Cytogenetic Characteristics in Three Cases of Wolf-Hirschhorn
Syndrom

Author: Gorduza Oana - Cornelia

Co-author: Miron Mihnea, Iosep Diana
Scientific coordinator: Assistant Professor Caba Lavinia, MD, PhD

Introduction: Wolf-Hirschhorn syndrome (WHS) is a rare chromosomal disease

(1/50.000 new-borns) generated by a terminal 4p deletion.

Materials and methods: We present three cases of WHS diagnosed in Medical

Genetics Department of "Cuza-Voda" Obstetrics and Gynaecology Hospital Iasi in
last 10 years.

Results: In all cases we discovered the following features of WHS: marked prenatal
growth deficiency, microcephaly, facialdysmorphism (ocular hypertelorism, down
turned "fishlike" mouth, short upper lip and philtrum). We found cardiac anomalies in
2 cases, ocular abnormalities in all cases, cleft lip in 1 case and talipes in 2 cases.
Chromosomal analysis was performed in all 3 cases. All patients presented the 4p
deletion specific to WHS, but each case a different chromosomal formula: 46,XX,del
(4)(p15.2 ->pter), 46,XX,del (4)(p16->pter) and 46,XX,del (4)(p15.1->pter). In the
case with 46,XX,del (4)(p16->pter) chromosomal formula we applied also FISH with
specific probe for WHS and we confirmed the presence of deletion. Because in some
cases the terminal 4p deletion could be the results of a malsegregation of
chromosomes implied in a reciprocal translocation in one of the parents, we made the
karyotype in parents of all cases and the results were all normal.

Conclusion: Our data confirm the importance of both clinical examination and
chromosomal analyse in cases with plurimalformative syndromes.

Keywords: Wolf-Hirschhorn Syndrome, Clinical Features, 4p Deletion

The Therapeutic Onset of An Autoimmune Hepatic Affliction

Author: Silvia Matilda Atefanei

Co-author: Alina-Elena Cristea, Alexandra Ioni, MD
Scientific coordinator: Associate Professor Tudor Nicolaie, MD, PhD

Introduction: Autoimmune hepatic affliction takes different types of clinical and serologic
expression that appears in a particular way.

Materials and methods: A 34-year-old patient, with a history of autoimmune hepatic

affliction (2008), right adnexectomy (2013), blood transfusion for postoperative
hemoperitoneum (2013), presented at the hospital for tiredness, itching localised to both calves,
pain in the right hypochondrium. Objective examination reveals slight jaundice of the skin,
striaerubra, striaegravidarum on the lower abdomen, diffuse abdominal sensitivity.

Results: Paraclinically: hepatocytolitic syndrome (ALT~5x normal, AST~2x normal),

cholestatic syndrome (hypercholesterolemia, hyperlipidemia, hypertriglyceridemia, GGT~36x
normal, alkaline phosphatase~3x normal, total bilirubine raised because of the direct one),
antimitochondrial antibodies (AMA) 149 AU/ml, antinuclear antibodies (ANA) 1/320, liver-
kidney microsomal antibodies (anti-LKM1) and anti smooth muscle antibodies (ASMA) in
normal range, negative viral marketing. Morphology: cholangio-NMR+ CIV: chronic
hepatopathy with an NRM aspect of primary biliary cirrhosis (PBC), without pathological
dilations of intra and extrahepatic biliary passage. Positive diagnosis: overlap syndrome-
autoimmune hepatitis- AIH (cytolysis+ANA) + PBC (cholestasis, AMA, specific imagery).
Differential diagnosis: Wilson disease, alpha-1 antitrypsin deficiency, hemocromatosis,
primary sclerosing cholangitis.

Conclusion: Vital and functional prognosis, related to the ability of work, depends on the
treatment adherence and on the hygienic-dietary regimen (no alcohol, tobacco, fat-free diet).
Treatment: objective: the prevention of complications and transplant and the improvement of
lifes quality. Medication: Prednisone and Azathioprine for immunosuppression and Ursofalk
for cholestatic disease. The therapeutic onset imposed by morbid situation requires clinical-
biological supervising for the treatment monitoring depending on further results.

Keywords: AIH, PBC, overlap syndrome

NOT ACCEPTED

Synergistic Effects Of Low Doses Of Codeine Flurbiprofen Association In

Somatic Nociception In Mice

Author: Arlyn Maria Augustine

Co-author: Hassan Tahir Khokhar
Scientific coordinator: Associate PROFESSOR Liliana Mititelu-Tartau, MD, PhD

Introduction: Experimental researches on the effects of low doses of codeine and

flurbiprofen association in somatic and visceral pain models in mice

Materials and methods: Codeine, the second-most predominant alkaloid found in

opium after morphine, is a weak analgesic and cough suppressant agent. Like
morphine, it binds to opioid receptors in the brain, increasing tolerance to pain and
decreasing discomfort. Flurbiprofen, a nonsteroidal anti-inflammatory drug,
belonging to the group of phenyl alkanoic acid derivatives, inhibits the enzyme
cyclooxygenase. It possesses an anti-inflammatory, analgesic, and anti-pyretic
activity, being used to treat inflammation and pain.

Results:

Conclusion:

Keywords:codeine, flurbiprofen, pain

SHOULD BE IN FUNDAMENTAL SCIENCES

The Effects of some Dopaminergic Receptor Antagonists in Visceral Nociception

Experimental Data

Author: Hassan Tahir Khokhar

Co-author: Arlyn Maria Augustine, Shirajul Hoque
Scientific coordinator: Associate professor Liliana Mititelu-Tartau, MD, PhD

Introduction: Experimental research on the effects of some dopaminergic receptor

antagonists in a visceral pain model in mice. SCH 23390 ((R)-(+)-8-chloro-2,3,4,5-
tetrahydro-3-methyl-5-phenyl-1H-3-benzazepin-7-ol)-is a selective D-1 receptor
antagonist. Pimozide- 1- [1- [4,4- Bis(4- fluorphenyl) butyl] -4- piperidinyl] -1, 3-
dihydro-2 H- benzimidazol -2-one is a selective blocker of dopamine D2 receptors.

Materials and methods: The experiment was carried out, with white mice (20-
25g), divided into 4 groups of 7 animals each, treated intraperitoneally with the
same volume of solution, as follows: Group I (DW): distilled water 0,1 ml/10 g
body weight; Group II (coded IND): indomethacin 30 mg/kbw; Group III (coded
SCH): SCH-23390 0,3 mg/kbw; Group IV (coded PMZ): pimozide 0,7 mg/kbw.
The model of visceral pain consists of writhing test with acetic acid 0,6%. The
behavior modifications (contractions of the abdomen, writhes) were observed
scored and data were statistically analyzed using SPSS program, version 17.00 for
Windows. Experimental protocols were implemented according to the
recommendations of the Grigore T. Popa University Committee for Research and
Ethical Issues, and to the guidelines of the International Association for the Study of
Pain Committee for Research and Ethical Issues.

Results: intraperitoneal administration of both SCH-23390 0,3 mg/kbw and

pimozide 0,7mg/kbw resulted in a significant reduction of the writhes number
(p<0,05) in this experimental pain model in mice. The effects of SCH-23390 were
more accentuated than those of pimozide in all time intervals of the determinations
in the experiment.

Conclusion: These dopaminergic receptor antagonists displayed significant

antinociceptive effects, but less intense than those of the standard nonsteroidal anti-
inflammatory indomethacin, in writhing test.

Keywords: SCH-23390, nociception, writhing test

Multidetector Computer Tomography Evaluation of Coronary Artery
Revascularization Procedures

Author: Botezatu Ion Emil

Co-author: Bulgaru-Iliescu Andra Irina, Rusu Alexandra-Cristina
Scientific coordinator: Cristina Furnica, MD, PhD

Introduction: Development of electrocardiographically (ECG) gated multidetector

computed tomography (MDCT) had a significant impact in cardiovascular imaging
both in preoperative planning and postoperative evaluation of surgery.

Materials and methods: Due to its improved spatial and temporal resolution and its
ability to produce three-dimensional, dynamic and multiplanar images, MDCT
assumes an integral role in characterization of graft patency, congenital heart diseases
interventions, aortic procedures, aortic valve prostheses, and endovascular devices.
Except these specific indications, MDCT allows investigation of alternative
postoperative complications due to its excellent tissue discrimination. In addition, the
expanded capabilities of volumetric imaging may provide valuable anatomical
information in preoperative planning for redo cardiac surgery in order to avoid
potential life-threatening intraoperative incidents.

Results: All cardiovascular physicians need to maintain an understanding of

diagnostic modalities including strengths and weaknesses of each test. The aim of
this pictorial review is to illustrate normal and pathologic postoperative aspects
identified by MDCT in case of open or endovascular coronary artery
revascularization procedures with emphasis on its utility for the cardiovascular
surgeon.

Conclusion: A thorough knowledge of possible findings will allow an appropriate

identification and differentiation of normal MDCT findings from post-procedural
complications.

Keywords: coronary revascularization, electrocardiographically gated multidetector

computed tomography, post-procedural complications
Coffee: Potential Supplementary Treatment in Liver Diseases?: A Meta-Analysis

Author: Padmapriya Krishnamurthy

Co-author: Aamena Osman, Sujitan Raviranjan
Scientific coordinator: Assistant Lecturer Gheorghe Balan Jr., MD, PhD

Introduction: Chronic liver disease is a burden on global mortality with 29 million

people suffering from these conditions in the EU. The diseases mainly responsible
are: cirrhosis, hepatitis and HCC. Current treatment approaches include: lifestyle
changes, alcohol cessation, antiviral medications and liver transplantation.
Remarkably, it appears that coffee consumption can slow the progression of liver
fibrosis.
The objective is to identify the relationship between coffee consumption and liver
diseases and whether coffee consumption could be supplementary preventative
treatment.

Materials and methods: A literature search was performed. Articles other than
original research were eliminated. Cohort and control studies identifying the
relationship between liver diseases and coffee consumption were included. From
these studies the following variables were focused on: type of liver disease, daily
consumption, metabolic anomalies (BMI, diabetes, smoking, alcohol). The mortality
and survival rate along with disease risk assessment were analysed.

Results: An average relative risk (RR) of liver cirrhosis was 0.52 in those persons
that consumed 3 cups /day, compared to a RR of 0.85 in those that only drank one per
day. It was identified that consumption of 3 cups of coffee per day decreases the
likelihood of liver cirrhosis progression. In comparison, the RR of alcoholic cirrhosis
was decreased when 2 cups were consumed. The risk of hepatic fibrosis is reduced in
persons consuming coffee compared with if they didn't.
Furthermore, the relationship between drinking an average of 3 cups/day, compared
with none, shows a significant decrease in risk of HCC progression (p<0.0001).

Conclusion: There is an inverse correlation between coffee consumption and risk of

liver disease. Most remarkably, there is evidence of its effects post-transplant surgery.
The survival rate after 3 month follow up was higher when compared to non-coffee
drinkers.Furthermore, increased consumption seemed to show a positive trend in
reducing the risks of liver disease.

Keywords: Coffee, Liver disease, Treatment

Gastroesophageal Reflux Disease In Patients With Atrial Fibrillation Ablation

Author: Alexandra-Evelina Ciubotariu

Co-author: Alexandru Trenchea
Scientific coordinator: Lecturer Floria Mariana

Introduction: It seems that gastroesophageal reflux disease (GERD) could be more

frequently after radiofrequency catheter ablation (RFCA) of atrial fibrillation (AF).

Materials and methods: We aimed to assess how frequent is GERD at 3 months

after RFCA in patients with paroxysmal AF. We included prospectively patients with
paroxysmal AF with or without RFCA. GERD was diagnosed clinically (symptomatic
GERD) and all patients underwent upper gastrointestinal endoscopy. A number of 67
patients were included: 45 patients who underwent AF ablation (62.2% men, mean
age 57.767.66 years, BMI of 28.963.12 kg/m2) and 22 patients without AF
ablation (31,8% men, mean age 67.818.52 years, 26.815.19 kg/m2); p=0.001,
respectively 0.03 and 0.046.

Results: Stable sinus rhythm was present in 40 (88,9 %) with AF ablation

respectively 12 (57,1%) patients (p=0.009) without AF ablation at the time of upper
gastrointestinal endoscopy. Hypertension respectively diabetes mellitus was
diagnosed in 29 patients (64.4%) with GERD and 19 patients (90.5%) without GERD
(p=0.028), respectively 8 patients (17.7%) with GERD and 4 patients (19%) without
GERD (p=0.827). Left atrium area as a marker of structural remodeling was not
different in these groups (26.515.31 versus 26.475.33 cm2, p=0.766). On the
contrary pro-BNP was significantly different (344180 versus 760253 pg/ml,
p=0.001). GERD was detected in 19 (42,2%) respectively 13 (61,9%) patients
(p=0.22). The percentage of patients taking proton pomp inhibitors was not different
in patients with or without AF ablation (26.7% vs 28.6%, p=0.893).

Conclusion: Gastroesophageal reflux disease seems to not be more frequently in

patients which have undergone atrial fibrillation ablation comparing to those patients
who havent undergone atrial fibrillation ablation.

Keywords: Gastroesophageal Reflux, Radiofrequency Catheter Ablation, Atrial

Fibrilation
The Role Of Radiotherapy in Palliative Treatment of a Recurrent Lip Cancer in
an Elderly Patient Case

Author: Cepoi Maria-Ruxandra

Co-author: Ciocan Roxana, Maftei Octavia
Scientific coordinator: Dragos Teodor Petru Iancu MD, PhD; Camil Ciprian
Mirestean MD, PhD

Introduction: Lip cancer is the most frequent malignant neoplasm of the oral cavity.
Typically, squamous cell carcinoma originates in the red lip, whereas basal cell carcinoma
involves the white lip. The most frequent tumour related to the lips is squamous cell carcinoma,
with the lower lip more commonly involved than the upper lip

Materials and methods: We present the case of a 97 years old female with multiple
cardiovascular comorbidities diagnosed in 2010 with squamous cell carcinoma of the upper lip
treated by surgical excision. In 2013 and 2014 two surgical reintervention were practiced for
local-regional reccurences in the nasal groove with tumor-free margins < 2 mm in healthy
tissue and positive margins respectively. The pacient did not recived adjuvant treatment. In
May 2015 the pacient had a new reccurence with significant substance loss in the left nasal and
genian region complicated by local hemorrhage. She was considereded outside the therapeutic
resources of surgery, and after the initial presentation in the Radiotherapy Department, a
palliative and hemostatic radiotherapy in total dose (TD) of 30 Gy/10 fractions with photons
was initiated.

Results: Seven months after completing radiotherapy treatment the patient return with a local
bleeding. It was decided to initiate a superficial radiotherapy (orthovoltage) with hemostatic
intention and healing. The irradiation was interrupted after DT= 33 Gy/11 fractions because of
a mycosis and a grade III oral mucositis and best supportive care was recommended. The
evolution was favorable after the treatment and the patient died 4 months later due to
comorbidities.

Conclusion: Radiotherapy may be a feasible solution with good palliative hemostatic and
healing results for patients who are not candidates for curative surgical treatment. Adjuvant
radiotherapy performed within 3 months after surgery if positive or inadequate surgical margins
is indicated for reducing the risk of local relapse. Elderly patients should not be excluded from
a therapeutic option but comorbidities and performance status can be a limiting factors for a
aggressive treatment with curative intent.

Keywords: Radiotherapy, Lip Cancer, Elderly Patient

Particularities in The Treatment of a Complex Case of Osler-Weber-Rendu
Syndrome

Author: Sandu Gabriel

Co-author: Florea Cristina-Maria, Constantinescu Angela
Scientific coordinator: Professor Florin Mitu, MD, PhD

Introduction: The Osler-Weber-Rendu syndrome is a monogenic disorder with autosomal

dominant transmission whose distinctive feature is represented by arteriovenous malformation.
Known as Hereditary Hemorrhagic Telangiectasia (HHT), this syndrome affects 1/5000 people,
the principal systems affected being the respiratory, the digestive and the nervous.

Materials and methods: We present the case of a 65 year old female admitted for persistent
diffuse headache and vertigo. The patient is known to have a history of Hereditary hemorrhagic
telangiectasia (transient ischemic attacks, very high blood pressure values with a maximal
value of 220 mmHg, electrically cauterized oral mucosa hemorrhage, goiter, vestibular
syndrome) and chronic type B and C hepatitis. The family history shows that her mother and
aunt also have the same symptoms, being diagnosed with HHT. The clinical examination
highlights telangiectasia on the oral mucosa, tongue, lips and on bilateral upper limbs distal
phalanges, as well as varices on both legs and a hearth rate of 62 bpm. he electrocardiography
revealed sinusal rhythm and minor right bundle branch block. The echocardiographic
examination showed aortic atheromatosis, concentric left ventricular hypertrophy, but with
normal function and kinetics. Computed tomography was initiated for the purpose of showing
the arteriovenous malformations that could explain the cephalalgia and episodes of dizzyness,
but the result was negative. Instead, moderated difusedcerebelous and cerebral atrophy was
observed

Results: The pacient had a favorable outcome after the treatment with betahistine, flavonoid
glycosoides ,ginkgolides and bilobalides based drugs, with a decreased number of cephalalgia
and episodes of dizziness.

Conclusion: Hereditary Hemorrhagic Telangiectasia disease has an imprecise prognosis due to

the wide variety of locations of the hemorrhage. Palliative treatment is recommended, which
means therapy for cerebral and digestive bleeding, but also improving the anaemia and ablation
of hemorrhagic lesions by electrocautery.

Keywords: Telangiectasia, Autosomal dominant transmission, Transient ischemic attacks

Impact of Previous Frequent Hospitalizations on The Symptoms Burden and
Health Status in Patients with Severe COPD Exacerbations

Author: Anca-Raluca Apostol

Co-author: Alexandra Hordila MD, Resident Physician in Gastroenterology, Sf
Spiridon University Hospital Iasi, Romania; George Leahu MD, Resident Physician
in Anesthesiology &Intensive Care Sf Spiridon University Hospital Iasi, Romania;
Scientific coordinator: Sabina Antoniu MD, PhD, Lecturer Palliative Care-Nursing

Introduction: In COPD frequent hospitalizations due to severe exacerbation might be

associated with an increased symptoms burden and with a worse health status at the
next severe exacerbation.Our objective was to compare the severity of cardinal
respiratory symptoms (such as dyspnea) and general symptoms (such as fatigue and
quality of life) in patients with at least two hospitalizations for COPD exacerbations
during the previous 12 months (FHP) versus patients with less than two
hospitalisations for COPD exacerbations (non-FHP).

Materials and methods: COPD patients hospitalised over a 6 month period in an

university hospital for pulmonary disease and consenting to participate to the study
were included in this analysis. Health status (HS) was measured with the Clinical
COPD Questionnaire (CCQ), dyspnea with Dyspnea-12 and fatigue with FACIT
Fatigue Scale version 4 (FFS).

Results: A total sample of 61 patients was analysed. Mean age (SD) was 65.1 (11.98)
years, most of the patients were males 45 (73.7%) and ex-smokers 29 (47.5%) .
Compared to non-FHP patients, FHP subset had more severe dyspnea (p=0.024),
worse quality of life (p=0.003) and more severe fatigue at the beginning of the
hospitalisation (p=0.01).

Conclusion: In FHP both respiratory (dyspnea) and non-respiratory symptoms

(fatigue) are useful to characterize this sub-phenotype and represent the main
modifiable factors for a better outcome. Further studies are needed to confirm these
findings.

Keywords: COPD, symptom exacerbation, quality of life

A Difficult Case of Thrombotic Thrombocitopenic Purpura in a 24 weeks Old
Pregnancy

Author: Vreme Otilia-Flaviana

Co-author: Hutanu Andrada
Scientific coordinator: Teaching Assistant Minela Aida Maranduca,MD, PhD

Introduction: Thrombotic thrombocytopenic purpura (TTP) is a hematologic disorder which is

clinically characterized by thrombocytopenia, microangiopathic hemolytic anemia, fever,
neurologic symptoms, cardiac and renal involvement. It is well known that TTP is associated
with pregnancy and that prognosis for the mother and child is poor. An analysis of the literature
shows that plasmapheresis has dramatically improved the prognosis of the disease with a
survival rate of more than 80%. TTP is a rare disorder with a high mortality rate, if untreated or
by delayed therapy

Materials and methods: We report the case of a 24 weeks pregnant woman , who was
admitted to the Neurology department of Professor N. Oblu Emergency Hospital Iasi for
hypertension induced seizures manifested after a C section for fetal demise. Preliminary
laboratory investigations also revealed low hemoglobin values, low platelet count, high
fibrinogen levels, erythrocytic anisocytosis, important schistocytes numbers on the blood smear
and acute renal insufficiency.
After management of the high blood pressure, the patient was transferred to the Sf.Spiridon
Hospital Internal Medicine Clinic for further hematological assessment. After professional
analysis she was diagnosed with TTP and targeted treatment was initiated.

Results: The patient has undergone two sessions of plasmapheresis alongside corticosteroid
therapy, with a very good therapeutic response and a spontaneous improvement of Hemoglobin
values and platelets numbers.

Conclusion: Considering that TTP is a severe hematological condition which can be related to
pregnancy and can cause severe complications for both the fetus and the mother, it is highly
recommended to supervise the patients condition, particularly for a possible relapse, where
plasma exchange therapy should be considered immediately, or in case of future pregnancy
planning.

Keywords: Thrombotic, Plasmapheresis, Pregnancy

Metabolic Influences Of Thyroid Hormones In A Group Of Euthyroid Women

Author: Enache Laura-Madalina

Co-author: Purice Ioana-Elena
Scientific coordinator: Ioana Armasu, MD, PhD

Introduction: Thyroid hormones play critical roles in the differentiation, growth, metabolism,
and physiological function of virtually all tissues. One of their most important action is the
increase in basal energy expenditure obtained acting on protein, carbohydrate and lipid
metabolism. We performed a retrospective study evaluating the correlations between thyroid
metabolism and metabolic parameters in a group of female patients with normal thyroid
function.

Materials and methods: Seventy-two female patients were evaluated at the Endocrinology
Department, Sf. Spiridon Hospital Iasi between January-December 2016. Normal thyroid
function was defined by thyroid-stimulating hormone (TSH) levels between 0.4-4 microUI/ml
and free-thyroxine (fT4) levels between 0.89-1.76 ng/dl. Metabolic parameters evaluated were:
total protein, glucose, total cholesterol and triglycerides levels. Explorations included the
evaluation of body fat mass through DEXA (dual energy X-ray absorptiometry) method.
Statistical analysis was performed using SPSS.

Results: We studied 72 female patients with a mean age of 53.4+/-11.8 years (age between 35
and 78). Mean TSH levels were 1.5+/-0.8 microUI/ml; mean fT4 levels were 1.1+/-0.176 ng/dl.
No statistically significant correlations were noticed between TSH levels, biologic metabolic
parameters or body fat mass. Concerning fT4, a positive correlation was noticed with glucose
levels (r=0.276, p=0.019), but not with total cholesterol (r=0.118, p=0.332), triglycerides
(r=0.172, p=0.150) or total protein (r=0.188, p=0.114) levels. Body mass composition
investigation revealed that total body fat was comprised between 25.1% and 51.1% (mean of
37.8+/-5%, with a predominance of overweight patients) and fT4 was positively correlated only
with peripheral fat (r=0.404, p=0.011) rather than central fat mass.

Conclusion: Only discreet correlations were noticed between fT4 and metabolic parameters.
Thyroid hormones seem to rather modulate the activities of metabolic pathways on a medium-
or long-term basis, with multiple interactions either direct or possibly through modifying the
activity of other regulatory hormones such as insulin, glucagon or catecholamines.

Keywords: TSH, fT4, Hormones

Mishap Towards Good: (Or) When Treatment is an Adjunct Diagnostic Tool in
Disguise

Author: Cosmina Ponor

Co-author: Paula Munteanu
Scientific coordinator: Dan Iliescu, MD, PhD

Introduction: It is clearly known that atrial fibrillation increases the risk of stroke and it is
clinically demonstrated that the use of anticoagulants in such cases improves patients
outcomes. This paper presents a case in which anticoagulant treatment is both a cardiologist's
challenge and, surprisingly, a pseudo-diagnostic tool.

Materials and methods: A 64-year-old man, who suffered of acute rheumatic fever at 20 years
old and diagnosed with large mitral stenosis in 2005, presents at the cardiologist complaining
of dyspnea, chest pain and marked fatigue. He is diagnosed with mitral stenosis, atrial
fibrillation and class II NYHA heart failure, and is treated with Amiodarone, Enalapril and
Acenocumarol. After one year, the patient returns, complaining of dizziness, fatigue and
melena. The biological findings (severe anemia and thrombocytopenia) explains the urgency of
an endoscopy, which reveals a gastric ulcer Forrest IIb. After ceasing Acenocumarol and use of
the appropriate treatment of ulcer, his clinical evolution was good. After another year, the
patient presents the same symptoms (while on oral anticoagulant), the same biological findings
and, this time, the endoscopy showed and hemorrhagic gastritis. The history repeats itself four
months later and the patient once again presents melena and severe anemia. A RBC
scintigraphy shows an unusual left paramedian abdominal accumulation of isotope. A capsule
endoscopy followed by an enteroscopy confirms an ulcerated-vegetative lesion, possibly
malign, in the jejunum, with the impossibility of a biopsy.

Results: The pathological diagnosis after a laparoscopic segmentaryenterectomy was stromal

small intestine tumor. Postoperative evolution was good. After one year from the abdominal
surgery, the patient consents with a mitral valve replacement. The preoperative coronarography
shows an occlusion of the anterior descending artery with possible rechanneled thrombus with
distal emboli (but no intracardiac thrombi were found in previous TEE). Therefore, he also
receives an arterial by-pass. Although still under anticoagulants, until now (after 4 years) there
has not been any recurrence of the tumor.

Conclusion: This case demonstrates that the correct treatment of a disease can, peculiarly, help
diagnose another rare condition, such as a gastrointestinal stromal tumor (that accounts for less
than 1% of all GI tumors). It also teaches us that acting like a detective, following all the clues,
being persistent and using appropriate tests, is for the patient's best interests.

Keywords: oral anticoagulant,red blood cell scintigraph, stromal gastrointestinal tumor

Incorporating Multiple Serologic Biomarkers as a New Way to Enhance AFP-
Based Diagnosis of Hepatocellular Carcinoma: A Meta-Analysis

Author: Adam Abdulwakil Kawosha

Co-authors: Andrei Bancu, Aamina Osman
Scientific coordinator: Gheorghe Balan Jr. LL.B., M.D., PhD stud.

Introduction: Hepatocellular carcinoma, accounts for almost 90% of primary liver

cancer cases, being one of the deadliest types of malignant tumors, ranking 2nd in
cancer-related deaths in men and 6th in women. An emerging clinical interest in this
type of tumor is justified by a positive trend in the number of cases over the past 15
years despite new treatment options. This stimulated the amount of research done in
the diagnostic area, leading to the discovery of novel serological biomarkers found in
diseased patients. Consequently, the alpha-fetoprotein-based diagnosis is losing its
early diagnostic and monitoring value especially in developed countries, leaving no
alternative but to replace it or to be merged with cutting-edge biomarkers.

Materials and methods: A meta-analysis was performed in PubMed and Google

Scholar, yielding a total of 21 articles that assesed the diagnostic power of different
serological biomarkers in combination with AFP. Studies published before 2016 were
excluded, as well as those that determined prognosis, required payment or didn't
include AFP combinations at all.

Results: The study showed a significant increase in the sensitivity and specificity of
these novel biomarkers when combined with AFP. These findings are superior to the
diagnostic capacity of AFP alone with values that can reach 100% for both sensitivity
and specificity with an Area Under the Curve (AUC) as high as 1.

Conclusion: Given the tremendous performance of these new biomarkers combined

with AFP, hepatocellular carcinoma can be diagnosed more accurately not only in
first world countries but in the developing nations as well where AFP is still used
routinely for early detection of liver cancer.

Keywords: Hepatocellular Carcinoma, Liver, Meta-Analysis

Hepatitis C New Generation Antiviral Regimens

Author: Joseph Abuazza

Co-author: Mohamed Abuazza
Scientific coordinator: Irina Giurlanu, MD

Introduction: Chronic hepatitis C virus Infection and cirrhosis have a higher risk for
liver-related complications. This study assessed the efficacy and safety of
ombitasvir/paritaprevir/ritonavir and dasabuvir, without ribavirin, for 12weeks in
HCV genotype 1b infection and compensated cirrhosis patients.

Materials and methods: Peginterferon/ribavirin-treated patients prospectively

received 12weeks of ombitasvir/paritaprevir/ritonavir and dasabuvir.
Treatment Criteria: Stage 4 fibrosis evaluated by Fibromax, compensated cirrhosis
(maximum Child A6), with or without previous decompensating, no evidence of
hepatocellular carcinoma, sober >6 months, with no age limit.
Efficacy was assessed by the percentage of patients achieving Sustained Virological
Response (HCV RNA undetectable) 12weeks post-treatment.

Results: Between December 2015-February 2016, 196 patients were analyzed. 126
(64.3)% female, 54.05% treatment-experienced, Child-Pugh A5 class (76.8%), 24.3%
with esophageal varices, and 5.3 % with albumin <3.5g/dl. The overall rates EOT
were 96.4% for ITT. ITT analysis showed negative PCR at the SVR12 in 95.9% of
cases and 99.4% per protocol. Treatment discontinuation rate was 3.58 % (7 patients)-
2 depression, 2 cardiac failure, 1 cardiac arrhythmia, 1 acute kidney failure, 1 hepatic
encephalopathy, 1 acute liver failure, and 1 ascitic decompensation. Adverse events
were: anemia (33.8%), asthenia (25.2%), insomnia (15.6%), and pruritus (13.9%).
Two patients died from cardiovascular disease, and acute liver failure. During the
follow-up period, three patients developed variceal bleeding.

Conclusion: The HCV regimen of ombitasvir/paritaprevir/ritonavir and dasabuvir

with or without ribavirin for 12 weeks had a high efficacy and was well tolerated in
HCV genotype 1b-infected patient.

Keywords: HCV, Hepatitis C, Antiviral

The Role Of Neuraminidase Inhibitors In Treatment And Prophylaxis Of
Influenza Infection

Author: Victor Daniel Miron

Co-author: Andreea Onofrei, Dragos Andrei Marin
Scientific coordinator: Professor Adrian Streinu-Cercel, MD, PhD; Teaching
Assistant Oana Sandulescu, MD;

Introduction: Seasonal infection with the influenza virus is associated with a considerable rate
of mortality and morbidity.To decrease the impact of the influenza infection, two paths can be
followed: active immunization and, respectively, the treatment or prophylaxis with antiviral
drugs. Neuraminidase inhibitors are the first-line of antiviral agents recommended in terms of
targeted activity influenza A and B viruses, as well as aimed at decreasing the transmission rate
of the virus from a person to another.

Materials and methods: By using the search terms "neuraminidase inhibitors" and "influenza"
on PubMed and narrowing the search down to the publication timespan January 2015 - January
2017, we have identified 21 studies that describe the role of neuraminidase inhibitors.

Results: We have identified in the specialty literature, regarding the therapeutic administration,
clinical benefits especially in the case of early establishment of the treatment, in less than 24-48
hours from the beginning of the clinical manifestations. The information about the efficiency of
the treatment in preventing the influenza complications is limited. However, controlled studies
show a significant decrease mainly in pulmonary complications as compared to placebo.
Regarding the use of prophylactic of the neuraminidase inhibitors, the literature mentions its
effectiveness, but warns about the risk of resistance. Consecutively, the prophylaxis indications
with antivirals are restricted now, in post-exposure situations, for the patients who may develop
severe forms of the disease, and on a short period of time.

Conclusion: The treatment with antivirals in influenza virus infection can significantly reduce
the symptomatology and hospitalization period, but data about the prevention of complications
in influenza are limited in the specialty literature, which is why the prevention remains
critically important. Vaccination remains the best prophylaxis for influenza although, in certain
particular situations, the administration of neuraminidase inhibitors may be prescribed.

Keywords: influenza virus, neuraminidase inhibitor, treatment

NOT ACCEPTED

Meta-Analysis About Methods For Male Breast Cancer: Screening

Author: Piedboeuf Claire

Co-author: Bouazza Imane, Thongphetsavong Amata
Scientific coordinator: Matei Mioara, MD

Introduction: Men have breast like women but there are less developed. Male breast
cancer (MBC) accounts for less than 1% of all breast cancer. In 2015, breast canadian
society has estimated that 25000 women would be diagnosed against 220 men
only.MBC is rare and unknown but it exists. in this abstract we will introduce
different screening methods for MBC diagnosis.

Materials and methods: Using literature and official sites like the breast canadian
society or the breast french national institut, we can see severals diagnostic method
for MBC that are mostly similar for men and women.

Results: Data analysis showed different unavoidable steps. First, the medical and
family history that shows: corelation between prostatic cancer and MBC; a mutation
in the BRCA2 gene; smoking; radiation exposure or a chronic liver desease. Then,
Estrogen Receptor analysis, HER2 statut analysis; mammography; soography or
magnetic resonnance imaging of the breast. finally, testosterone, estradiol, LH and
hCG-dosage.

Conclusion: The MBC screening is similar with the female breast cancer; Doctors
and men should be informed about this risk. An international register should be
established to allow a shredder from objective bases to prospective reflection on
screening and prices in therapeutic charge of these patients

Keywords: Male Breast Cancer, Screening, Diagnosis

Does Diabetes Mellitus Have A Significant Impact On Cerebral Injury? Can It
Speed Up Cognitive Decline?

Author: Aamena Osman

Co-author: Melindi Brink, Padmapriya Krishnamurthy
Scientific coordinator: Mohammed Reza Parker, MD

Introduction: Diabetes Mellitus (DM) can cause microvascular changes in the brain,
which leads to infarction in the brain. This connection is what is most involved in
research into Cognitive Dysfunction, but is it the diabetes itself that is causing this, or
in fact the extents to which changes in the brain occur? To assess the current scientific
data on the direct effects DM has on Cognitive Decline.

Materials and methods: A literature review has been carried out whereby PubMed
and Science Direct were used to search for studies, meta-analysis and/or review
articles associating Cognitive Decline parameters due to cerebral changes as a result
of DM.

Results: The study carried out by Sonnenet al, has for the first time showed two
distinct patterns of cerebral injury in patients with dementia, linked to their diabetic
status having possible etiologic and therapeutic implications. A very significant
finding was that in patients with DM and dementia, more deep micro vascular infarcts
(MVIs) were identified. In an autopsy study it was found that the occurrence of
apolipoprotein E 4 allele carrier lesions was more common in those with diabetes
than without. Smaller brain volumes in grey matter are associated with ischaemic
lesions in diabetic patients.

Conclusion: Further research that needs to be done is to see how type II DM and its
treatment affect insulin signalling in the brain. By identifying which diabetic
treatments can trigger cerebral damage, a conclusive report can be made to identify to
what extent DM can lead to dementia and other pathologies of Cognitive
Dysfunction. There is currently an ongoing study started in 2015 which aims to
identify cellular mechanisms by which molecular pathologies lead to cell dysfunction
and consequently Cognitive Decline

Keywords: Diabetes Mellitus, Cerebral Injury, Correlations

Diagnosis Traps in Children Acute Abdomen

Author: Richter Patricia

Co-authors: Murgu Razvan Alexandru, Damian Radu
Scientific coordinator: Lecturer Alina Murgu, MD, PhD

Introduction: Acute abdomen in children represents one of the main causes of the ER cases in
the hospital. More than 75% of the cases represent a surgically acute abdomen, most frequently
caused by appendicitis/peritonitis, intestinal occlusion, Meckel diverticulitis, organ torsion.
There are other rare causes like neurofibromatosis (NF) with digestive manifestation, which
can constitute diagnosis traps and which can temporize a positive diagnosis with unfavorable
repercussions as regards the evolutional prognosis of the patient.

Materials and methods: The authors expose the issue concerning the management of a
surgically acute abdomen case of clinical and radiological aspect of sub occlusive syndrome -
intestinal invagination that needed an emergency surgical intervention. During the intervention,
a polyp in the small intestine area (ileum) was observed; from a hystopatological perspective,
we deal with an invagination enteritis on surface ulcerated plexiform neurofibroma. The
cutaneous manifestations of "cafe au lait" spots type associated with the intestinal plexiform
neurofibroma represented the essential criteria for the positive diagnosis of type 1 NF.

Results: Favorable post-surgical evolution during the dynamic monitoring but, 18 months later,
the patient complains from intermittent abdominal pain of the upper abdominal level. The
paraclinic investigations (upper digestive endoscopy, echography and MRI) indicate the
following aspects: Gallbladder polyps; 2nd degree esophagitis; purpura gastritis; purpura
duodenitis; duodenal-gastric reflux. The specific pharmacological management referred to the
gastric-duodenal pathology. The gallbladder polyps recommend an echographic monitoring of
the dimensions in evolution. In case of symptoms ingravescence or dimensions growth > 1 cm
we recommend surgery because of the high malignization risk.

Conclusion: The presence of abdominal pain in children with clinical elements suggesting NF1
needs a compulsory exploration, prompt and adequate therapy, as well as continuous
monitoring in order to decrease the risk of digestive neurofibroma and/or polypoid lesions,
which imprints the vital diagnosis either by severe acute digestive complications or by possible
malign degeneration.

Keywords: Neurofibromatosis, Acute Abdomen, Children

Courage And Responsibility in A Controversial Clinic Case: Between Protocol
and Reality

Author: Richter Patricia

Co-author: Elisei Diana
Scientific coordinator: Aurora Constantinescu, MD, PhD

Introduction: In nowadays medicine, any diagnosis and therapeutic conduct is only reported to the
characteristic protocols for different pathologies. Difficulty occurs when a patient cumulates several
conditions, becoming impossible to apply a unique protocol. We thus face the occurrence of contradictory
therapeutic solutions. The cerebrovascular accident is the most frequent neurological condition of high
prevalence for physical, mental and social-professional handicap. Associated comorbidities might generate
a high therapeutic difficulty.

Materials and methods: Patient of age 75, chronic drinker with lower myocardial infraction and lesions in
two coronary arteries treated by stent and coronary angioplasty, permanent atrial fibrillation and 2nd degree
HBP neglects his therapy for a month. The evolution towards complications in case of this patient is
reasoned by a sequence of four ischemic vascular accidents during a short period of only 4 weeks. The CT
scan shows the following affected areas: left cerebellar area, left occipital area, left sylvian area, with
aspects of different ages and total right sylvian area - acute phase. The last vascular accident on the total
territory of the right sylvian generates cephalalgia with vertigo, flabby left hemiplegia with oculocephalic
deviation towards right and severe dysarthria, leading to a complete exploration of the case.
The balance of the vascular risk factors imposes an anticoagulant therapy with Fraxiparina 0.6mgx2,
together with the neurotrophic and vascular parameters support therapy.
After 2 weeks of evolution, the clinic condition complicates by melena; the patient is subject of a complete
gastroenterological assessment. Following the assessment, we detected a hemorrhagic bulbar duodenal
ulcer and a Helicobacter pylori gastritis with an interdiction of the anticoagulant medication. The risk of
thrombosis is unavoidable in absence of anticoagulation (immobilized patient), developing a deep venous
thrombosis at the level of the left lower limb.

Results: The therapeutic decision is very controversial: the gastroenterological protocol forbids
anticoagulation, while the vascular protocol recommends it. We shall choose the half way with antiplatelet
drugs (Clopidogrel 75mg/day) for a short period of time and hypodermal anticoagulants prophylactic
therapy 0.4 mg, with very strict monitoring of any thrombotic or hemorrhagic event. We also add the
recommendation to follow a therapy to eradicate the H. pylori infection and to stop aspirin administration.

Conclusion: The prognostic is unpredictable, while the patient s evolution depends on the quality of the
multidisciplinary specialists protocols of using the adequate anticoagulant pathogenic and prophylactic
medication.

Keywords: Ischemic CVA, Anticoagulation, Duodenal Ulcer

A Review On Takayasus Arteritis - New Means Of Treatment

Author: Teodor Serban

Scientific coordinator: Assistant Professor Mihai ROCA, MD, PhD; Tatiana
ERBAN, MD

Introduction: Takayasus arteritis or the No-Pulse-Disease is a rare type of large-

vessel vasculitis that affects mostly the aorta and its branches. The disease is
diagnosed mostly in young women with ages between 15 and 18 years, but in
asimptomatic patients it can also be diagnosed later. The disease begins with a sudden
increase in ESR and other non-specific inflammatory markers, leading to an decrease
or even complete absence of pulse in the upper limbs. In this review we will try to
explain some aspects regarding the pathophisiology and the immunological
mechanism of the disease.

Materials and methods: We observed that almost every patient diagnosed with
Takayasus arteritis had a previous Mycobacterium tuberculosis or staphilococcal
infection and also had certain HLA genes. Recent studies have shown that a certain
sub-type of T lymphocytes - T - is responsabile for the perpetuation of the vessel
inflammation. These cells are special because they can act as antigen-presenting cells
(APC) and it is believed that they play a key role in the production of self antibodies.

Results: The majority of the patients suffering from this disease have a good
evolution under steroid anti -inflammatory and imunosupressive treatment. There are
some patients though that show a poor response to the classic treatment and require
other means to stop the inflammation from progressing. We tried to explain the
necessity of introducing a new drug - Tocilizumab- in the treatment of recidivist
Takayasus arteritis that showed promising results during clinical trials.

Conclusion: Understanding the pathological mechanism of the disease can play a

major role in finding a more appropriate and efficient treatment of Takayasus
arteritis.

Keywords: T Gamma Delta, Tuberculosis, Immunosupression

Correlations Between Serum Alpha-Fetoprotein and Prognostic Factors in
Hepatocellular Carcinoma

Author: Andrei Bancu

Co-author: Fizah Muratib, Adina Olaru
Scientific coordinator: Gheorghe Balan Jr. LL.B., MD, PhD student

Introduction: Alpha-fetoprotein has been the standard tumor biomarker for hepatocellular
carcinoma for many years. Nowadays, new challenges emerge that threaten the existence of
this 54 year old glycoprotein in the diagnosis and surveillance of liver cancer, by replacing it
with newer, more sensitive and specific serological biomarkers. While the data about the
prognostic usefulness is scarce and debatable, more insight about the relationship between AFP
and prognostic and predictive factors is required in order for this classic biomarker to maintain
its clinical ability.

Materials and methods: A cross-sectional analytical study was performed at the Institute of
Gastroenterology and Hepatology Iasi, from January 2014 to December 2015 yielding a total of
86 patients that were newly identified with hepatocellular carcinoma. Basic demographic
parameters, complete blood count, liver function tests, associated pathologies, ultrasonographic
and CT scan features as well as Child-Pugh and TNM stagingwereassesed. Furthermore, the
patients were divided into 3 groups according to their AFP levels: normal (<20IU/ml),slightly
elevated (21-199IU/ml) and markedly elevated (>200 IU/ml).Correlations of serum AFP levels
with the above parameters were investigated by applying Spearman's rank correlation and
ANOVA test.

Results: Analysis of the data revealed a total of 38 (44.2%) patients that were part of the first
AFP group, 22 (25.6%) in the second, and 26(30.2%) in the third one.A plethora of statistically
significant correlations were identified between AFP and Child-Pugh score (p<0.0001, r=-
0.403), vascular thrombosis (p<0.0001, r=0.399), nodular size, localization and TNM-staging
features (p<0.01, r>0.2).

Conclusion: Prospectively, AFP will still be an important prognostic tool in developing

countries, despite the fact that it`s losing interest in first world nations where superior
biomarkers are cost-accessible. Taking the results into account, AFP is nevertheless a
productive marker that shows a noteworthy correlation to aspects of hepatic tumors.

Keywords: Hepatocellular Carcinoma, AFP, Prognostic Factors

Situs Inversus Totalis Associated With Non-Ischemic Dilated Cardiomyopathy
And Other Comorbidities: A Case Report

Author: Imane Bouazza

Co-author: Amata Thongphetsavong Gautam, Claire Piedboeuf
Scientific coordinator: Teaching Assistant Ovidiu Mitu, MD, PhD; Associate
Professor Irina Costache, MD, PhD

Introduction: Situs inversustotalisis a congenital condition in which all the abdominal organs
are reversed from their normal position and is found in about 0.01% of the population. We are
presenting the case of a 62-year-old patient, dyslipidemic, non-smoker, who was admitted to
the Cardiology Department for accusing congestive heart failure signs and symptoms. 2 years
earlier, the patient presented an episode of left lower limb deep venous thrombosis, treated for a
short period of time with anticoagulation.

Materials and methods: Situs inversustotalis is a congenital condition in which all the
abdominal organs are reversed from their normal position and is found in about 0.01% of the
population. We are presenting the case of a 62-year-old patient, dyslipidemic, non-smoker, who
was admitted to the Cardiology Department for accusing congestive heart failure signs and
symptoms. 2 years earlier, the patient presented an episode of left lower limb deep venous
thrombosis, treated for a short period of time with anticoagulation.

Results: Following this diagnosis, the evolution of the patient was unfavorable, being admitted
several times to the Cardiology Clinic for acute decompensation of heart failure, secondary to
non-adherence to lifestyle's recommendations and maximal-limit medication. During an
admission, the diagnosis of pulmonary thromboembolism was raised, but remained
unconfirmed after an angio-CT. Furthermore, the patient presented other chronic comorbidities:
chronic venous insufficiency with varicose ulcer, depressive affective disorder, chronic kidney
disease (stage 3), and multiple small splenic infarcts. The treatment consisted of: oral
anticoagulation, diuretics, beta-blockers, digitalics and small doses of angiotensin-converting
enzyme inhibitors.

Conclusion: The association between situs inversustotalisand cardiac comorbidities is very

rare. Moreover, in a patient with situs inversus, common diagnosis and investigations require
specific attention, with the necessity of further investigations to confirm or rule out several
hypothesis of diagnosis.

Keywords: Situs Inversus Totalis, Dilated Cardiomyopathy, Heart Failure

Radiation Enteritis Complicated By Ileal Adenocarcinoma - 25 Years After
Exposure

Author: Ruxandra Mihai

Co-author: Alexandra Starica, Andreea Covic
Scientific coordinator: Assistant Professor Gabriela Stefanescu, MD, PhD

Introduction: Radiation therapy, effective method in genital cancer, prostate and rectal cancer
is accompanied by numerous side effects. The most severe is the radiation enteritis, which in
chronic form is progressive and irreversible. Clinical manifestations are varied, most similar to
inflammatory bowel disease. Latent period from the episode of irradiation to symptoms ranges
from 3 months to 30 years. Approximately 50% of patients with radiation enteritis require
surgery for complications: perforation, stenosis, fistulas, adenocarcinoma.

Materials and methods: The patient aged 77 years with cancer of the cervix operated and
irradiated after 25 years, shows insidious onset during the last 6 weeks of symptomatology of
upper abdominal pain, accompanied by nausea, vomiting and weight loss. Physical examination
revealed diffuse abdominal tenderness on palpation and meteorism. Biological samples were
within normal limits except inflammatory syndrome. Upper endoscopy revealed esophagitis
grade B without other changes, and the colonoscopy was normal. Both abdominal ultrasound,
and computed tomography with contrast agent drew attention to small bowel pathologies -
dilated bowel loops, thick-walled, without being able to identify the presence of an obstacle.
The video capsule revealed inflammatory changes in the small intestine.

Results: The video capsule has not been removed and the patient was sent for surgery service.
Intraoperative, the capsule has been found impacted in the terminal ileum in a tumor lesion -
histologically confirmed as adenocarcinoma of the ileum. The tumor was resected and framed
in stage II (T3N0M0). Adjuvant chemotherapy has not been chosen (tumor stage with the
absence of adverse prognostic factors, advanced age and patients choice).

Conclusion: This case consists in the diagnosis of a rare entity: radiation enteritis complicated
by intestinal adenocarcinoma after 25 years from the initial episode of irradiation for uterine
cancer.

Keywords: Radiotherapy, Adenocarcinoma, Radiation Enteritis

The Hidden Mask of Resistant Systemic Arterial Hypertension - Case
Presentation

Author: Stefania-Teodora Duca

Co-authors: Alexandru-Dan Costache, Sorana-Caterina Anton
Scientific coordinator: Associate Professor Irina-Iuliana Costache, MD, PhD;
Teaching Assistant Ovidiu Mitu, MD, PhD; Professor Florin Mitu MD, PhD

Introduction: Refractory hypertension represents about 5% of all cases of hypertension and is

defined as the impossibility to achieve the target blood pressure values corresponding to a
certain level of cardiovascular risk, in conditions of respecting the antihypertensive therapy,
which includes at least 3 classes of antihypertensives. This resistance may be due to the fact
that under the mask of apparently resistant hypertension hides a form of secondary
hypertension. Renovascular hypertension due to renal artery stenosis is one of the most
common causes of secondary hypertension. The main incriminated pathogenic mechanism is
the activation of the renin-angiotensin-aldosterone system.

Materials and methods: We are presenting the case of a 56-year-old patient with
cardiovascular risk factors and old hypertensive, who has been registering improper blood
pressure values in the last 3 months of treatment. Clinical examination objectifies a harsh,
rough systolic murmur, with the maximum intensity in the aortic area and both carotid arteries
and an abdominal and renal arteries systolic murmur. These clinical elements oriented to the
suspicion of renovascular hypertension by plaques of atheroma in one or both renal arteries.

Results: The diagnosis was confirmed biochemically (hypokalemia, metabolic alkalosis) and
imagistic (Doppler ultrasound of renal arteries, MRA and computer tomography). In addition,
thrombosis of abdominal aorta under the origin of renal arteries has been materialized, with
multiple parietal calcification. The patient was directed to Cardiovascular Surgery Service,
where was conducted aortobifemural bypass grafting and endarterectomy of the abdominal
aorta. Postoperatively, the evolution is good, with normalization of blood pressure below the
minimum antihypertensive therapy.

Conclusion: This case denotes the necessity of permanent monitoring of any hypertensive
patient, because its evolution can be unpredictable. Most often, the persistent high blood
pressure is interpreted as a lack of compliance to treatment, although it can hide or expose a
form of secondary hypertension.

Keywords: Renovascular Hypertension, Renal Artery Stenosis, Renin-Angiotensin-

Aldosterone System
Takayasus Arteritis The Pulseless Disease. Case Report

Author: Teodor Serban

Scientific coordinator: Assistant Professor Mihai Roca, MD, PhD; Tatiana erban,
MD

Introduction: Takayasu arteritis is a rare inflammatory disease which affects mostly the aorta
and its main branches, leading to the lowering and even to the complete absence of the arterial
pulse in the upper limbs. The pathology affects mostly women with ages between 15 and 18
years. In 50% of the cases the disease starts with a dramatic increase in ESR and anemia,
followed later by a chronic state with inflammatory changes in arteries, leading to marked
stenosis of the aorta and its main branches. In the other 50% of the cases, the disease is
asymptomatic until the late vascular changes occur.

Materials and methods: We present the case a 39 years old woman which accuses diffuse
myalgia, fatigability, generalized pruritus, vision problems and vertigo while moving the head
laterally. The patients history includes: 2004 Pulmonary Tuberculosis, 2008 Celiac
Disease, 2012 Colonic Polyposis, Aortic Insufficiency grade III-IV considered to be
congenital and inflammatory anemia. The hematologic examination shows lymphoproliferative
syndrome and IgM monoclonal disglobulinemia. The ECG shows left ventricular hypertrophy,
and the echocardiography shows mitral insufficiency grade I-II, aortic insufficiency grade III-
IV and ascending aorta dilatation. The carotid Color Doppler shows marked stenosis of the left
and right common carotid arteries (50 -75% stenosis). The MRI confirms the echocardiography
findings, but also reveals a marked stenosis of the ascending aorta.

Results: The patient suffers aortic valve replacement with biologic prosthesis (the patients
choice) and ascending aorta replacement with Dacron prosthesis. The histopathologic exam
confirms the diagnosis of TAKAYASUS Arteritis stage IIB. The patients treatment is
Azathioprine, Prednisone, Acetylsalicylic Acid and Pantoprazole.

Conclusion: The cases of Takayasus Arteritis are very difficult to diagnose because for now
there are no specific markers for this disease. The only efficient way of diagnosis is through
careful examination and by observing the evolution of the symptoms and biologic parameters
in time.

Keywords: Vasculitis, IgM Disglobulinemia, Tuberculosis

A Clinical Case of Erythema Multiforme

Author: Anna Maria Louka

Co-author: Christina Tsitou, Nikolaos Anthis
Scientific coordinator: Xrisostomos Mpoukas, MD

Introduction: Erythema Multiforme is characterized by acute recurrent rash with

skin lesions or iris-shaped targets. It has an incidence of 1%, mainly of ages 20- 40
years, with a mild predominance on men. Usually the disease is preceded by malaise,
anorexia, arthralgia, myalgia, low grade fever, upper respiratory system infections.
The skin lesions are accompanied by a feeling of tension, burning or itching. The
recommended therapy is with corticosteroids and antihistamines.

Materials and methods: We present a male of 82 years-old patient, that was brought
to the emergency room of the General hospital of Corfu, presenting irritating skin
rashes, erythematous and spotted, throughout the anterior and posterior torso, the
upper and lower limbs, and also the face and neck .The patient had been diagnosed
and hospitalized with urinary tract infection with Pseudomonas aeruginosa species 3
days ago, obtaining a treatment with levofloxacin .The patient was treated with triple
allergy scheme at the ER and continued his hospitalization with other lines of
antibiotics.

Results: After 4 days of antibiotic therapy, the rashes had already receded and the
prognosis of the patient was excellent. A continuation of the therapy has suggested
after he got discharged from the hospital

Conclusion: The case was hard to be diagnosed by the physicians due to its low
incidence and the difficulty to differentiate diagnose between other pathologies, as
Steve-Jonsons Syndrome, skin paraneoplastic syndrome and eventually to underline
the cause of the disease appearance.

Keywords: Erythema Multiforme, Allergy, Antibiotics

Management of Systemic Lupus Erythematosus A Therapeutic Challenge

Author: Corina Ioana Varlam

Co-author: Eugen-Mihail Teodorescu-Soare
Scientific coordinator: Lecturer Maria-Magdalena Leon-Constantin, MD, PhD

Introduction: Systemic Lupus Erythematosus (SLE), also called "the disease with a
thousand faces", is an autoimmune disorder that affects one or more systems of the human
body, whose characteristic is the evolution in spikes. It is a chronic disease that occurs
mainly in young women.

Materials and methods: We present the case of a 24 years old female, admitted in the
Cardiovascular Clinic for the treatment of secondary hypertension. The patient was
diagnosed with lupus nephritis at age 15, cortisone treatment being initiated. Because the
evolution was unfavorable, it was decided to adopt the following scheme: EuroLupus,
with 2 pulses of cyclophosphamide and corticosteroids, with a positive effect, but with
consecutive severe leucopenia, anemia and thrombocytopenia. After 5 weeks, a new
treatment with Azathioprine and Prednisone is started. Two years later, cutaneous
complications arise, requiring treatment with Imuran, unbearable for the patient, therefore
Plaquenil was added. Despite those methods, proteinuria and nitrate retention products
increase their levels, which makes us restart the Metilprednisolone pulse, followed by
Prednisone and Cyclophosphamide induction therapy, without any favorable results. The
developed resistance to the Cyclophosphamide treatment, leads to administrating
CellCept, digestively not tolerated by the patient. Afterwards, a salvation therapy with
Rituximab is initiated.

Results: As an adverse effect to drugs, a noticeable weight loss is observed, accompanied

by an increasement of the blood pressure values. The patient presents joint pain, the MRI
revealing osteonecrosis of the femoral head and tibia, after the cortisone treatment.
Because of the osteoarticular modifications, a progressive reduction of Prednison therapy
is initiated. In order to maintain the renal function, cyclosporine, pentoxifylline, silymarin
and nephro-protective treatment are added, with a favorable evolution until present.

Conclusion: The development of LES has an unpredictable evolution, which involves the
frequent changing of the therapeutic scheme, in order to keep the disease under control.

Keywords: Systemic Lupus Erythematosus, secondary hypertension, lupus nephritis

From Consumptive Syndrome to Systemic Sarcoidosis: A Case Report

Author: Ioana Florea

Co-author: Elena Diana Nfureanu, Andreea Florea
Scientific coordinator: Teaching Assistant Raluca Dumea, MD

Introduction: Sarcoidosis is a chronic multisystem inflammatory disease of unknown

etiology that manifests as noncaseating granulomas, predominantly in the lungs and
intrathoracic lymph nodes. The prevalence is around 10-20 cases per 100,000 population.

Materials and methods: We report a case of a 66-year-old Romanian woman admitted in

the hospital for breathlessness, productive cough and elevated serum creatinine and urea.
The patient reported weight loss (almost 20 kg) and asthenia over the past two years.
Blood count revealed anemia, leukocytosis and thrombocytopenia. Biochemical tests
showed inflammatory syndrome, hypercalcemia, elevated serum creatinine and urea along
with discrete proteinuria. Imaging evaluation (thoracic radiography, abdominal
ultrasonography, thoracoabdominal CT) revealed pulmonary fibrosis and generalised
lymphadenopathy, which led to a laparoscopic exploration. The lymph node biopsy
showed granulomatous inflammation with giant cell granuloma. Fibrobronchoscopy with
bronchoalveolar lavage and flux cytometry-immunophenotyping revealed 17.2 %
lymphocytes and CD4+/CD8+ over 35. The patient was diagnosed with systemic
sarcoidosis with the pulmonary, renal and ganglionic systems affected. JAK2 genotyping
and BCR-ABL quantification were performed, with negative results. Immunologically,
ANA and c-pANCA were within normal values.

Results: Corticotherapy was started and the initial outcome was favorable. The patient
was transferred to the nephrology clinic because the renal function was highly affected.
She was diagnosed with aggravated chronic kidney failure and bronchopneumonia.
Antibiotherapy and hemodialysis were started and the immunosuppression was decreased.
Despite proper treatment, the patient went into septic shock.

Conclusion: In conclusion, sarcoidosis is a rare multisystem disease. The main treatment

is corticotherapy, which presents a great amount of benefits, whilst, as any other
immunosuppressant, it predisposes to infectious complications, which could lead to death .

Keywords: sarcoidosis, bronchopneumonia, corticotherapy

Particular Clinical Aspects of Phenylketonuria Case Report

Author: Alina Georgiana Apostol

Co-author: Alexandra-Elena Florea
Scientific coordinator: Lecturer Dana-Teodora Anton Paduraru, MD,PhD Teaching
Assistant Ana-Simona Drochioi

Introduction: Phenylketonuria (PKU) is an autosomal recessive disorder and one of the most
frequent metabolic causes of mental retardation which can be diagnosed through newborn
screening. Specific features of PKU is the phenylalanine hydroxylase deficiency, the enzyme
that converts phenylalanine to tyrosine. Clinically, the baby with PKU looks normal at birth,
but in the following 3 to 4 months the signs start to show. T`he most severe symptoms are the
intellectual disabilities and the neurological problems that include generalized hypotonia or
hypertonia, spastic paraplegia, exaggerated deep tendon reflexes. The patients sweat and urine
odor is mousy or musty. The one year old child presents hyperactivity, spontaneous
movements, athetosis. Without treatment, mental retardation is imminent: only 5% of the
patients have an IQ over 68.

Materials and methods: We have two cases. The first one is a 3 years and 9 months old boy,
diagnosed through newborn screening with PKU, who follows the diet. The second one is a 12
years and 10 months old boy who was diagnosed too late (1 year and 7 months old) because at
that moment the newborn screening wasnt available in Romania.

Results: In the first case, the family is compliant and they strictly follow the diet, who has a
normal weight and waist (G = -0.67 DS; T = -1.20 DS) and also has good psychomotor skills
(IQ=80). In the second case, even though the family was informed about the disease, they
refused to follow the treatment. Therefore, the child has normal staturo-ponderal aspects (G =
+1.68 DS; T = 0.70 DS), but he presents severe mental and language deficiencies (IQ=45).

Conclusion: Newborn screening for PKU makes possible to diagnose the disease before any
sign or symptom start to show. It is possible to have complete control over the disease with the
right treatment.

Keywords: Phenylketonuria, Phenylalanine Hydroxylase, Newborn Screening

A Clinical Case of Bilateral Synchronous Male Breast Cancer

Author: Christina Karaoulani

Co-author: Hee Feong Kau, Alin-Costel Nicodin
Scientific coordinator: Lecturer Irina Daniela Florea, MD, PhD

Introduction: Male breast cancer (MBC) is a rare cancer (0.5-1% of all breast
cancers) and diagnosed usually in advanced stage. The common types are: infiltrative
ductal, papillary and lobular carcinomas. The incidence of synchronous bilateralism is
even rarer (<2% of MBC). Different hypotheses regarding the causes of MBC are
mentioned in the bibliography but none of them is currently confirmed.

Materials and methods: We present a case of 61-years old man hospitalized in IRO,
Iasi with a painless mass at the left breast and a bloody nipple discharge from the
right breast. Anamnesis showed no family history of cancer and no related risk factors
were mentioned. Physical examination revealed palpable masses in both breasts.
Taking into consideration the patients clinical picture further paraclinical procedures
were performed.

Results: Breast ultrasound showed 2 hyperechoic nodules (1/0.9cm, 0.74/0.65cm) on

the right breast and a retroareolar mass (2.6/2.1cm) together with a hyperechoic
nodule on the left breast. Diagnostic biopsy was performed; histopathological analysis
revealed invasive cribriform carcinoma with axillary lymph nodes metastases on right
breast (pT1cN1a-G1) and mixed cribriform ductal carcinoma without lymph node
metastases on left breast (pT1cN0-G1). Immunohistochemistry showed ER(+), PR(+),
HER2(-) tumors. Modified radical mastectomy was performed followed by adjuvant
chemotherapy (6C with cyclophosphamide and doroxubicin/epirubicin) and hormonal
therapy (tamoxifen). The postoperative evolution was favorable, the patient was
released in the 8th post-operatory day. He was supervised for 3 years without signs of
recurrence. After 5 years, he returned and diagnosed with gastric lymphoma.

Conclusion: Due to the low incidence rate, the absence of clinical trials and
awareness, MBC is diagnosed in late stages with poor prognosis. Raising the level of
education in the society and promoting screening programs may help in the earlier
detection, diagnosis and efficient therapy.

Keywords: Male Breast Cancer, Modified Radical Mastectomy, Infiltrative Ductal Carcinoma,
Awareness.
Primitive Neuroectodermal Tumor in a Young Female and its Evolution
over a 15 Years Period. Case Presentation

Author: Stefan Iacob

Scientific coordinator: Teodora Alexa-Stratulat, MD, PhD

Introduction: Peripheral primitive neuroectodermaltumours (pPNET) are extraosseous

forms of Ewing's Sarcoma. In the "Journal of Thoracic Oncology" its affirmed that
pPNETs are rare, rapidly progressive, small-round cell tumors with a poor prognosis
despite multimodal therapy, including surgery and chemoradiotherapy.

Materials and methods: We present the case of a 28 years old female patient which was
admitted three times from 2002 (13 years old at that time) to 2007 in the surgery unit,
initially for a right sided latero-cervical mass, about 1 cm in diameter and later for local
recidives. During this period, the histopathological examinations described the excised
masses, quite uncertain, as carcinomyxosarcoma. In 2016 she was readmitted in the
surgical unit after a MRI exam revealed two massive recurrences, one of them 72/64/92
mm located retro-cervical and the other located latero-cervical on the right side, 59/64 mm
in dimensions, which infiltrated the right Sternocleidomastoid muscle, without signs of
metastases. Excision and reconstructive surgery were performed and the histopathological
examination highlighted the real diagnosis:pPNET. After a postoperative CT scan, we
identified the tumors remains on the right cervical area, multiple latero-cervical
adenopathies and multiple pulmonary and bone metastases. Following this imagistic result
and the elevated LDH levels, we established the VAC chemotherapeutic protocol
(Cyclophosphamide, Adriamycin, Vincristine). During the chemotherapy treatment, our
patient developed severe infectious symptoms, with unknown origins, for which empiric
antibiotherapy was established.

Results: Our patients symptoms progressively diminished in intensity after the treatment
was established, but for a short period of time, after which our patient became anemic and
the chemotherapy treatment was ceased. Our patient died shortly after, due to various
infectious complications.

Conclusion: Aggressive local control measures and intensive neoadjuvant and adjuvant
chemotherapy, report durable remissions in 50-80% of patients with local-regional
disease, the percentage decreasing significantly in metastatic stages.

Keywords: Neuroectodermal, Treatment, Outcome

Diagnostic Challenges Of Left Ventricular Noncompaction
Cardiomiopathy: Case Report

Author: Diana Abdalla

Scientific coordinator: Lecturer Mihai Roca, MD, PhD, Doina Abdalla, MD

Introduction: Left ventricular noncompaction cardiomyopathy (LVNC), also known

as spongy myocardium, is a rare, unclassified type of cardiomyopathy. It could be
congenital (resulting from failure of spongy myocardium development into compact,
mature musculature during embryogenesis) or acquired (in athletes, peripartum). Its
prevalence varies between 0.05-0.24% and it is more frequent in males. The main
morphological features of LVNC are: double striation aspect of myocardium (with a
thinner layer of compacted myocardium adjacent to the epicardium and a thicker layer
of the noncompacted myocardium adjacent to the endocardium), prominent and
excessive trabeculations, deep intertrabecular recesses, specific localization of the
noncompacted regions in the lateral wall, apex and/or inferior wall of the left
ventricle. Frequently, for lack of knowledge, echocardiographers are misdiagnosing it
with dilatative cardiomyopathy, hypertrophic cardiomyopathy, apical thrombosis.

Materials and methods: A 19-year-old female, with non-pathological personal

history, came to the hospital for a general consultation because of palpitations during
moderate exercise. An electrocardiography test was performed and revealed T
negative waves in the left ventricular precordial derivations and ventricular
extrasystoles. The cardiac ultrasound showed increased end-systolic and end-diastolic
volumes and a 42% ejection fraction. A coronary computed tomography angiography
was performed and did not indicate any coronary abnormalities.

Results: As it was believed that she has dilatativecardiomyopathy, it was indicated a

cardiac magnetic resonance imaging to be performed. The result was LVNC. Beta
blockers were indicated as symptomatic treatment.

Conclusion: LVNC is a rare disease which could manifest various cardiac symptoms
at any age. Beside subjective and objective clinical examination, the diagnostic
procedures (electrocardiography, cardiac ultrasound, coronary computed tomography
angiography, cardiac magnetic resonance imaging) represent the corner stone of
LVNC diagnosis.

Keywords: Left Ventricular Noncompaction Cardiomiopathy, Cardiac Magnetic

Resonance Imaging, Beta Blockers
Ulcerative Colitis - From Diagnosis To a Relatively Uncommon
Evolution. A Case Report

Author: Elena Diana Nfureanu

Co-author: Ioana Florea, Silvia Cristina Strat
Scientific coordinator: Lecturer Irina Grleanu, MD, PhD

Introduction: Ulcerative colitis is an inflammatory bowel disease, with an unknown

exact cause, which affects the large bowel and rectum, causing long lasting
inflammation, ulcerations and extradigestive manifestations such as pyoderma
gangrenosum, colangitis and amyloidosis.

Materials and methods: We report the case of a 38 year old patient, known with
ulcerative colitis under treatment with Mesalazine and Adalimumab, who was
admitted for ulcerative skin lesions in the nasal area, pustules on the posterior thorax
and fever, after he voluntary stopped the biological treatment. The patient had normal
stools and no abdominal pain. Biological tests showed an important inflammatory
response yet the cultures taken from the lesions were negative. Investigations have
been completed by the skin biopsy that has identified neutrophilic dermatosis with
noncazeomatousgranulomas.

Results: The diagnosis of pustular pyoderma gangrenosum was based on a

multidisciplinary approach consisting of dermatology, infectious diseases and
gastroenterology sections and on the differential diagnosis between necrotizing
fasciitis, other infectious skin diseases and leukocytoclastic vasculitis. Given the
results of the skin biopsy, the biological treatment has been initiated, associated with
corticotherapy even if the ulcerative colitis was in remission.

Conclusion: The management of the case showed the mandatory treatment for
ulcerative colitis, with no cessation in time, and the need of biopsy for confirming the
pathology as an evolution of the main condition.

Keywords: Ulcerative Colitis, Pyoderma Gangrenosum, Biopsy