Publications by authors named "Adelaida Avino"

9 Publications

  • Page 1 of 1

The importance of adrenal venous sampling in ACTH-independent Cushing syndrome: A case report and literature review.

Exp Ther Med 2021 Jul 18;22(1):772. Epub 2021 May 18.

Discipline of Pediatric Surgery, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.

Independent Cushing's adrenocorticotropic hormone (ACTH) syndrome can have several causes, including adrenal carcinoma or simple adrenal hyperplasia. Although the distinction between malignant and benign can be effectively made through imaging investigations, in the situation where there are bilateral formations, their hormonal activity is impossible to appreciate via non-invasive techniques. The present study includes the presentation of a clinical case on the basis of which a literature review was made. The clinical case pertains to a 32-year-old patient with ACTH-independent Cushing's syndrome and bilateral adrenal tumor formations leading to the utility of adrenal venous sampling to avoid bilateral adrenalectomy. A literature review was subsequently conducted focusing on articles pertaining to the PICO criteria in order to describe: The diagnosis of adrenal tumor masses, the decision on the type of surgery and most importantly, the impact of adrenal venous sampling in avoiding surgical resection. These interventions severely limit the patients' quality of life.
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http://dx.doi.org/10.3892/etm.2021.10204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8145433PMC
July 2021

6 Years of Breast Reconstruction in One Center - An Objective Analysis.

Chirurgia (Bucur) 2021 Mar-Apr;116(2 Suppl):98-104

Breast cancer represents the most common type of neoplasm in women around the world. Breast reconstruction following mastectomy has become a demanding procedure in the treatment of patients suffering from breast cancer. Their major role is to improve the quality of life of women, leading to better aesthetic outcomes. Based on each type of reconstruction, the complications following surgery and the duration of hospital stay, the financial implications slightly vary. Our study included 168 female patients who underwent immediate or delayed breast reconstruction after mastectomy. We assessed the clinical management of each of these cases and we evaluated the average final cost of the treatment after the reconstruction, focusing on the reconstructive method used, the complications that occurred and the number of days of hospitalization. The total cost of care in breast reconstruction surgery depends on the type of reconstructive procedure used, which consequently affects the duration of hospitalization of the patients. The expenses also depend on the materials that are used: the type of implant/expander or the use of ADM. Costs were higher in patients who underwent breast reconstruction using a latissimus dorsi flap associated with an implant, in comparison to reconstruction using a free flap. Breast reconstruction represents a crucial process in the management of women who underwent mastectomies following cancer and presumes variable financial resources, depending on the chosen reconstructive method.
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http://dx.doi.org/10.21614/chirurgia.116.2 Suppl.S98DOI Listing
May 2021

Patient-Reported Quality of Life 3 Months after Breast Reconstruction.

Chirurgia (Bucur) 2021 Mar-Apr;116(2):232-237

Breast cancer is considered to be the second major cause of cancer death in women after lung cancer. Due to a remarkable progress, the treatments against breast cancer became more efficient and less toxic. In addition, the reconstructive procedures after mastectomy have improved significantly the quality of life especially in younger women. The aim of the study was to evaluate the quality of life of patients 3 months after breast reconstruction. We performed a prospective study on 25 female patients who underwent immediate or delayed reconstruction of the breast after mastectomy. A health-related quality of life questionnaire was distributed and the answers were evaluated. The patients from the rural area reported that their health in general was much worse than one year ago. The patients with ductal carcinoma reported a serious limitation for vigorous activities, such as running, lifting heavy objects, participating in strenuous sports. 15 patients declared that their general health is good, 8 very good and just two women considered it excellent. Breast reconstruction following mastectomy have an effect on the patient's quality of life. Therefore, there is an increased need to recognize and evaluate the quality of life after post reconstruction.
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http://dx.doi.org/10.21614/chirurgia.116.2.232DOI Listing
May 2021

Caudal Duplication Syndrome Systematic Review-A Need for Better Multidisciplinary Surgical Approach and Follow-Up.

Medicina (Kaunas) 2020 Nov 27;56(12). Epub 2020 Nov 27.

Discipline of Pediatrics, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania.

Caudal duplication syndrome is a rare association of anatomical anomalies describing duplication of the hindgut, spine, and uro-genital structures, leading to varied clinical presentations. The current literature focuses on case reports which describe the embryological etiology and anatomical spectrum of the condition giving little attention to the surgical preparation, the need for a well-structured follow-up program, or the transition into adult healthcare of these complex patients. No reviews have been published regarding this complex pathology. : A review of caudal duplication syndrome cases was done to assess the range of the clinical malformations, timing, and types of surgical interventions. Inconsistencies in multidisciplinary care, follow-up, and risk events were described. Hindgut duplication always involved the anorectal region. Anorectal malformations were evenly distributed as unilateral and bilateral. Colon duplication extended from the anal region to the transverse colon or ascending colon in most of the cases and less to terminal. In females, genital duplication was present in all cases. The follow-up period varied between 3 months and 12 years. In all adult females, the motive of presentation was related to pregnancy (complications after successful delivery, fertility evaluation) or late complications (fecalith obstruction of the end-to-side colon anastomosis, repeated UTIs with renal scarring). : Complex malformations affecting multiple caudal organs may have a strong impact in many aspects of the long-term quality of life; therefore, patients with caudal duplication syndrome need increased awareness and joined multidisciplinary treatment.
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http://dx.doi.org/10.3390/medicina56120650DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759832PMC
November 2020

Primary thyroid angiosarcoma in a non-endemic region - a rare case.

Rom J Morphol Embryol 2020 ;61(1):267-271

Department of Plastic and Reconstructive Surgery, Prof. Dr. Agrippa Ionescu Clinical Emergency Hospital, Bucharest, Romania; Discipline of Internal Medicine I and Nephrology, Department of Medical Semiology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Department of Nephrology, Emergency University Hospital, Bucharest, Romania;

Thyroid angiosarcoma (AS) is a specific type of vascular tumor that arises from the endothelial cells, being highly aggressive, with increased recurrence rates and metastasis. It is characterized by positive endothelial markers and co-positive markers for cytokeratins and epithelial membrane antigen. We are describing the case of a 76-year-old patient who presented to the hospital for dyspnea and asthenia. The clinical and paraclinical investigations confirmed the presence of a right large thyroid nodule, which turned out positive at immunostaining for AS. Even if thyroid AS is a rare type of tumor, mainly described in the Alps, one has to take into account that it can evolve in any other regions and should be considered as a differential diagnosis.
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http://dx.doi.org/10.47162/RJME.61.1.32DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7728125PMC
June 2021

Vaginal Reconstruction in Patients with Mayer-Rokitansky-Küster-Hauser Syndrome-One Centre Experience.

Medicina (Kaunas) 2020 Jul 1;56(7). Epub 2020 Jul 1.

Department of Plastic and Reconstructive Surgery, "Prof. Dr. Agrippa Ionescu" Clinical Emergency Hospital, 011356 Bucharest, Romania.

The Mayer-Rokitansky-Küster-Hauser syndrome is a congenital condition in which patients are born with vaginal and uterus agenesis, affecting the ability to have a normal sexual life and to bear children. Vaginal reconstruction is a challenging procedure for plastic surgeons. The aim of this study is to report our experience in the management of twelve patients with congenital absence of the vagina due to the MRKH syndrome. We performed a retrospective study on 12 patients admitted to the Plastic Surgery Department of the Clinical Emergency Hospital "Prof. Dr. Agrippa Ionescu", Bucharest, Romania, for vaginal reconstruction within a period of eleven years (January 2009-December 2019). All patients were diagnosed by the gynaecologists with vaginal agenesis, as part of the Mayer-Rokitansky-Küster-Hauser syndrome. The Abbe'-McIndoe technique with an autologous skin graft was performed in all cases. The average age of our patients was 20.16 (16-28) years. All patients were 46 XX. The average surgical timing was 3.05 h (range 2.85-4h). Postoperative rectovaginal fistula was encountered in 1 patient. Postoperative average vaginal length was 10.4 cm (range 9.8-12.1 cm). Regular sexual life was achieved in 10 patients. Nowadays, there is no established standard method of vaginal reconstruction. In Romania, the McIndoe technique is the most applied. Unfortunately, even if the MRKH syndrome is not uncommon, less and less surgeons are willing to perform the procedure to create a neovagina.
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http://dx.doi.org/10.3390/medicina56070327DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7404697PMC
July 2020

Infection with hepatitis C virus in hemodialysis patients: An overview of the diagnosis and prevention rules within a hemodialysis center (Review).

Exp Ther Med 2020 Jul 17;20(1):109-116. Epub 2020 Mar 17.

Discipline of Internal Medicine I and Nephrology, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.

Increase in the number of patients with chronic kidney disease (CKD) calls for improved management of these patients. In stage 5 CKD, when the initiation of renal replacement therapy (RRT) becomes necessary, there is an increase in the infection risk of the patients and immunological tests for hepatitis C virus (HCV) detection turn positive at an alarmingly higher rate compared to general population. With the introduction into clinical practice of diagnostic tests, the increased prevalence of HCV among CKD patients has been known since the 1990s. Also, the negative impacts of HCV infection on CKD evolution as well as the unfavorable evolution of grafts received by HCV infected patients are known. Chronic hemodialysis patients are a category of patients whose risk of HCV infection is substantial. Currently, in the hemodialysis centers, at the base of the transmission of HCV infection there are a multitude of factors. Infection with HCV has a different impact on patient with end-stage renal disease (ESRD). Comorbidities in this case have significant sources of mortality and morbidity. It was proven that the post transplantations problems were prevented and mortality was reduced for patients who were diagnosed with HCV and in whom the infection was treated before the kidney transplant (KT). Consequently, early detection of the infection and the application of specific treatment has a considerable impact on the outcome of the patients. Another important component of the management of HCV infection in the chronic hemodialysis patients is the prevention of the infection transmission by applying specific methods.
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http://dx.doi.org/10.3892/etm.2020.8606DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7271692PMC
July 2020

Timing between Breast Reconstruction and Oncologic Mastectomy-One Center Experience.

Medicina (Kaunas) 2020 Feb 20;56(2). Epub 2020 Feb 20.

Department of Plastic and Reconstructive Surgery, Faculty of Medicine "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania.

Breast cancer is the most common cancer in women. The immunohistochemical profile, but also the stage of the tumor determines the therapeutic management, which varies from conservative surgery to mastectomy associated with chemotherapy, hormonal and biological therapy and/or radiotherapy. Mastectomy remains one of the most radical surgical intervention for women, having great consequences on quality of life, which can be improved by realizing immediate or delayed breast reconstruction. The objective of the study was to evaluate the period of time between the mastectomy and the breast reconstruction. We performed a retrospective study on 57 female patients admitted to the Plastic Surgery Department of the Clinical Emergency Hospital "Prof. Dr. Agrippa Ionescu", Bucharest, Romania. All the patients underwent immediate or delayed breast reconstruction after mastectomy for confirmed breast cancer. Descriptive data analysis was realized with evaluation of type of breast reconstruction considering the staging of the tumor, the invaded lymph nodes, and the necessity of adjuvant chemoradiotherapy. Moreover, the median period between mastectomy and reconstruction was evaluated. The immediate breast reconstruction was performed in patients with stage I, in patients with stage II, delayed reconstruction was performed after minimum six months, and the patients with stage III had the breast reconstructed with free flap (50%), 8-43 months post-mastectomy. Radiotherapy determines the type of breast reconstruction, in most of the cases the latissimus dorsi flap was used with implant (22.6%). Breast reconstruction is an important step in increasing the quality of life for women who underwent mastectomy after breast cancer. The proper timing for breast reconstruction must be settled by a team formed by the patient, the plastic surgeon, and the oncologist.
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http://dx.doi.org/10.3390/medicina56020086DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7073902PMC
February 2020

Quality of Life in Patients with Surgically Removed Skin Tumors.

Medicina (Kaunas) 2020 Feb 9;56(2). Epub 2020 Feb 9.

Department of Plastic and Reconstructive Surgery, Clinical Emergency Hospital "Prof. Dr. Agrippa Ionescu", Bucharest, 011356, Romania.

: Skin cancer is one of the most frequently diagnosed malignancies. The main goal of the therapeutic management is total excision with the prevention of recurrence and metastasis. The quality of life of the patients with skin cancer is affected by the morbidity risk, surgery, and cosmetic or functional aspects. The aim of this study was to evaluate the quality of life of patients with skin cancer prior to and post surgical intervention We performed a prospective study on 247 patients with skin tumors. Quality of life was evaluated through an initial questionnaire that was given to all consenting patients. This was used to determine patients' mobility, selfcare, normal activities, pain, and despair, using a five-point Likert scale. The general autoperceived health state was also recorded using a 100-point scale. The study included the responses of all patients at hospital admission, after one month of surgery, and after one year of surgery. In patients with squamous cell carcinoma (SCC), the general health state indicator statistically significantly decreased one month after surgery and increased at one-year follow-up. In malignant melanoma (MM) patients, mobility, selfcare, normal activities, and discomfort presented a decrease in values one year after surgery, compared to the values registered at hospital admission. In patients with basal cell carcinoma (BCC), all indicators of quality of life presented an impaired value one year after surgery, after a decreasing trend. The general health state indicator statistically significantly increased one month after surgery and after one year. Surgery is one of the main steps in treating skin cancer. It has a great impact on patients' quality of life because of pain andthe effect on mobility and normal activities. Skin cancers influence the quality of life of patients both psychologicallyand physically.
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http://dx.doi.org/10.3390/medicina56020066DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7074335PMC
February 2020
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