Publications by authors named "Adriana Nica"

18 Publications

  • Page 1 of 1

PI3K/AKT/mTOR signalling pathway involvement in renal cell carcinoma pathogenesis (Review).

Exp Ther Med 2021 May 23;21(5):540. Epub 2021 Mar 23.

Department of Family Medicine and Clinical Base, Dr. Carol Davila Central Military Emergency University Hospital, 010825 Bucharest, Romania.

Renal cell carcinoma (RCC) accounts for over 90% of all renal malignancies, and mainly affects the male population. Obesity and smoking are involved in the pathogenesis of several systemic cancers including RCC. The phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR) signalling pathway regulates cell growth, differentiation, migration, survival, angiogenesis, and metabolism. Growth factors, hormones, cytokine and many extracellular cues activate PI3K/AKT/mTOR. Dysregulation of this molecular pathway is frequently reported in human cancers including RCC and is associated with aggressive development and poor survival rate. mTOR is the master regulator of cell metabolism and growth, and is activated in many pathological processes such as tumour formation, insulin resistance and angiogenesis. mTOR inhibitors are used at present as drug therapy for RCC to inhibit cell proliferation, growth, survival, and the cell cycle. Temsirolimus and everolimus are two mTOR inhibitors that are currently used for the treatment of RCC. Drugs targeting the PI3K/AKT/mTOR signalling pathway may be one of the best therapeutic options for RCC.
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http://dx.doi.org/10.3892/etm.2021.9972DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014975PMC
May 2021

Impact of adipose tissue in chronic kidney disease development (Review).

Exp Ther Med 2021 May 23;21(5):539. Epub 2021 Mar 23.

Department of Family Medicine and Clinical Base, Dr. Carol Davila Central Military Emergency University Hospital, 010825 Bucharest, Romania.

Obesity is a worldwide pandemic health issue. Obesity is associated with the pathogenesis of type 2 diabetes, hypertension, dyslipidemia, cardiovascular diseases, cancer, and kidney diseases. This systemic disease can affect the kidneys by two mechanisms: Indirectly through diabetes mellitus (DM) and hypertension and directly through adipokines secreted by adipose tissue. Obesity is a risk factor for chronic kidney disease (CKD), which is associated with an increased risk of morbidity and mortality among the adult population. Increased visceral adipose tissue leads to renal glomerular hyperfiltration and hyperperfusion, which may lead to glomerular hypertrophy, proteinuria, and CKD development. Adipokines are hormones produced by fat tissue. They are involved in energy homeostasis, sugar and fat metabolism, reproduction, immunity, and thermogenesis control. Hormones and cytokines secreted by adipose tissue contribute to the development and progression of CKD. Decreased serum or urinary adiponectin levels are specific in diabetic and non-diabetic CKD patients, while leptin presents increased levels, and both are associated with the development of glomerulopathy. Excessive adipose tissue is associated with inflammation, oxidative stress (OS), insulin resistance and activation of the renin angiotensin-aldosterone system (RAAS). Therefore, adipose tissue dysfunction plays an important role in the development of CKD.
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http://dx.doi.org/10.3892/etm.2021.9969DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014972PMC
May 2021

Not only appendicitis: rare appendix disorders manifesting as surgical emergencies in children.

Eur J Pediatr 2021 Feb 18;180(2):407-413. Epub 2020 Aug 18.

Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center of Israel affiliated with Sackler Faculty of Medicine, Tel Aviv University, Kaplan St 14, 4920235, Petah Tikva, Israel.

Acute appendicitis is the most common cause of acute abdominal pathology in children. However, other rare non-inflammatory non-neoplastic disorders involving the appendix may manifest as surgical emergencies. This study aimed to describe these atypical entities and present representative cases. The database of a tertiary children's medical center was reviewed for all the patients aged 0-18 years who underwent urgent appendectomy between June 2014 and December 2019, for rare disorders of the appendix unrelated to inflammatory or neoplastic processes. Of 1367 patients who underwent appendectomy, 1345 were operated urgently or emergently. Of these, six, all males, mean age 32.6 months (range 0.7-76), underwent appendectomy for rare surgical complications that involved the appendix. These included torsion of the appendix (2), a strangulated internal hernia through an appendicular ring (1) or through a mesoappendix gap (1), an incarcerated appendix in an acute hernia sac (1), and appendiceal intussusception (1). In all cases, the role of the appendix in the pathologic process was unexpected and came as a surprise to the surgeon. During a median follow-up of 4.2 months (range 1-8 months), one patient underwent relaparotomy for small bowel obstruction 4 weeks after the original procedure.Conclusion: The appendix in children can be the source of rare pathological disorders that present as surgical emergencies. Familiarity with these entities may aid in achieving accurate preoperative diagnosis and contribute to surgical team orientation on exploratory laparotomy. However, correct diagnosis is often only established during timely surgical intervention.
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http://dx.doi.org/10.1007/s00431-020-03784-4DOI Listing
February 2021

Cingulate cortex function and multi-modal connectivity mapped using intracranial stimulation.

Neuroimage 2020 10 17;220:117059. Epub 2020 Jun 17.

Epilepsy Monitoring Unit, Neurology Department, Emergency University Hospital Bucharest, 169 Splaiul Independentei Street, Bucharest, Romania; Neurology Department, Medical Faculty, Carol Davila University of Medicine and Pharmacy Bucharest, 8 Eroii Sanitari Boulevard 8, Bucharest, Romania; Brain Research Group, Romanian Academy, 125 Calea Victoriei Street, Bucharest, Romania. Electronic address:

The cingulate cortex is part of the limbic system. Its function and connectivity are organized in a rostro-caudal and ventral-dorsal manner which was addressed by various other studies using rather coarse cortical parcellations. In this study, we aim at describing its function and connectivity using invasive recordings from patients explored for focal drug-resistant epilepsy. We included patients that underwent stereo-electroencephalographic recordings using intracranial electrodes in the University Emergency Hospital Bucharest between 2012 and 2019. We reviewed all high frequency stimulations (50 ​Hz) performed for functional mapping of the cingulate cortex. We used two methods to characterize brain connectivity. Effective connectivity was inferred based on the analysis of cortico-cortical potentials (CCEPs) evoked by single pulse electrical stimulation (SPES) (15 ​s inter-pulse interval). Functional connectivity was estimated using the non-linear regression method applied to 60 ​s spontaneous electrical brain signal intervals. The effective (stimulation-evoked) and functional (non-evoked) connectivity analyses highlight brain networks in a different way. While non-evoked connectivity evidences areas having related activity, often in close proximity to each other, evoked connectivity highlights spatially extended networks. To highlight in a comprehensive way the cingulate cortex's network, we have performed a bi-modal connectivity analysis that combines the resting-state broadband h non-linear correlation with cortico-cortical evoked potentials. We co-registered the patient's anatomy with the fsaverage FreeSurfer template to perform the automatic labeling based on HCP-MMP parcellation. At a group level, connectivity was estimated by averaging responses over stimulated/recorded or recorded sites in each pair of parcels. Finally, for multiple regions that evoked a clinical response during high frequency stimulation, we combined the connectivity of individual pairs using maximum intensity projection. Connectivity was assessed by applying SPES on 2094 contact pairs and recording CCEPs on 3580 contacts out of 8582 contacts of 660 electrodes implanted in 47 patients. Clinical responses elicited by high frequency stimulations in 107 sites (pairs of contacts) located in the cingulate cortex were divided in 10 groups: affective, motor behavior, motor elementary, versive, speech, vestibular, autonomic, somatosensory, visual and changes in body perception. Anterior cingulate cortex was shown to be connected to the mesial temporal, orbitofrontal and prefrontal cortex. In the middle cingulate cortex, we located affective, motor behavior in the anterior region, and elementary motor and somatosensory in the posterior part. This region is connected to the prefrontal, premotor and primary motor network. Finally, the posterior cingulate was shown to be connected with the visual areas, mesial and lateral parietal and temporal cortex.
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http://dx.doi.org/10.1016/j.neuroimage.2020.117059DOI Listing
October 2020

Synchronous Multiple Breast Cancers-Do We Need to Reshape Staging?

Medicina (Kaunas) 2020 May 11;56(5). Epub 2020 May 11.

Faculty of General Medicine, University of Medicine and Pharmacy Carol Davila Bucharest, 050474 Bucharest, Romania.

Current recommendations and treatment regimens in breast cancer are a reflection of its heterogeneity on multiple levels including histological subtypes, grading, molecular profiling, and numerous prognostic indices. Although based on extensive research, current guidelines are not explicit in the case of surgical specimens showing various degrees of mismatch between different parts of the same tumor and even more so between multicentric lesions. Synchronous breast cancer is the ideal prototype for studying inter- and intra-tumoral heterogeneity, therefore we envisaged that a study on patients with multicentric and multifocal lesions could contribute to the reshaping of the staging, prognosis, and treatment of breast malignancies. A prospective observational study was conducted between January 2013 and May 2017 on 235 patients diagnosed with breast cancer (BC) and surgically treated at Emergency University Hospital, Bucharest. Thirty-seven patients had multiple breast tumors and were eligible for assessment of the heterogeneity of their lesions. : 6 were multicentric and 31 multifocal. The number of foci varied from 2 to 11. We encountered numerous mismatches between the index and the secondary tumors, as follows: 3 cases (8.1%) with histopathological mismatch, 13 (35.1%) with different grades of differentiation, 11 (29.8%) with ER (Estrogen Receptors) status mismatch, 12 (32.4%) with PR (Progesterone Receptors) status mismatch, 8 (21.6%) with molecular phenotype mismatch, and 17 (45.9%) cases with variable Ki-67. After careful analysis of index and secondary tumors, apart from the mismatches reported above, we discovered that the secondary tumors were actually dominant in 5 cases (13.5%), and therefore at least those cases had to be reclassified/restaged, as the supplementary data commanded changes in the therapeutic decision. For synchronous breast tumors, the current Tumor-Node-Metastasis (TNM) staging system ignores not only the histopathological and immunohistochemical characteristics of the secondary foci, but also their size. When secondary lesions are more aggressive or their cumulative mass is significantly bigger than that of the index tumor, the treatment plan should be adapted accordingly. We believe that information obtained from examining secondary foci in synchronous breast cancer and assessment of the cumulative tumoral mass should be reflected in the final staging and definitive treatment. The clinical benefit of staging the patients based on the most aggressive tumor and the cumulative tumoral burden rather than according to the biggest single tumor, will avoid under-treatment in cases with multifocal/multicentric BC displaying intertumoral mismatch.
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http://dx.doi.org/10.3390/medicina56050230DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7279247PMC
May 2020

Fatal outcome of gastric perforation due to infection with Sarcina spp. A case report.

IDCases 2020 11;19:e00711. Epub 2020 Feb 11.

Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.

is an extremely rare pathogen. These gram-positive cocci bacteria are rarely identified in gastric biopsies and usually described in the scientific literature as an incidental finding, particularly in patients with delayed gastric emptying, gastroparesis, emphysematous gastritis or gastric perforation. It occurs most commonly in adult women and can be identified easily by its distinctive morphologic features, such as basophilic staining, cuboidal shape, tetrad arrangement, red blood cell-sized packets, flattened cell walls, and refractile nature in bright field microscopy. Although the pathogenesis of the microorganism is highly debated in humans, this bacterium is a well-known pathogen in livestock. Fewer than 30 cases of human infection have been described in the scientific literature so far, but none mentioned this micro-organism as a potential cause of death. We report the case of a 76-year-old patient with gastric perforation due to massive infection with . To date, this is the first report of human infection with in Romania.
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http://dx.doi.org/10.1016/j.idcr.2020.e00711DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7031000PMC
February 2020

Splenectomy in Lymphoproliferative Disorders: A Single Eastern European Center Experience.

Medicina (Kaunas) 2019 Dec 27;56(1). Epub 2019 Dec 27.

Faculty of General Medicine, University of Medicine and Pharmacy Carol Davila Bucharest, 050474 Bucharest, Romania.

Hematological malignancies are usually systemic diseases of life-threatening impact, and frequently require prompt and energetic therapeutic intervention. Due to systemic involvement, the role of surgery is generally limited to diagnostic approaches, and it is very rarely employed as a therapeutic modality. Splenectomy represents an exception to this paradigm, being used both as a diagnostic and tumor debulking procedure, notably in splenic lymphomas. We investigated the role of splenectomy in a single center prospective study of splenectomy outcome in patients with splenic involvement in the course of lymphoproliferative disorders. In the present study, we included all patients treated in our department for lymphoid malignancies over a period of six years, who underwent splenectomy as a diagnostic or debulking procedure after referral and workup, or had been referred to our department after first being splenectomized and diagnosed with splenic lymphoma. Patient characteristics and treatment outcome were investigated. : We enrolled 54 patients, with 34 (63%) splenectomized patients: 12 splenectomies (22.2%) for diagnostic purposes and 22 (40.7%) for treatment. Special attention was given to the 28 (51.85%) patients diagnosed with splenic marginal zone lymphoma (SMZL), a subtype with a clear therapeutic indication for splenectomy. Average age of patients was 57.5 (±13.1) years with a higher prevalence of feminine gender (66.67%). Age above 60 years old ( = 0.0295), ECOG (Eastern Cooperative Oncology Group) > 2 ( = 0.0402) and B-signs ( nonsignificant (NS)) were most frequently found in SMZL patients. Anemia, and notably autoimmune anemia, was more frequent in SMZL versus other small-cell lymphomas and also in splenectomized patients, as was leukocytosis and lymphocytosis. Treatment of patients with lymphoproliferative disorders consisted of chemotherapy and/or splenectomy. Most SMZL patients received chemotherapy as first line treatment (61.5%) and had only partial response (57.7%). Second treatment line was splenectomy in 80% of patients who required treatment, followed by a 60% rate of complete response (CR). Splenectomy offered a higher complete response rate (twice as high than in non-splenectomized, regardless of histology type, = NS), followed by a survival advantage (Overall Survival (OS)~64 versus 59 months, = NS). Particularly, SMZL patients had a 4.8 times higher rate of CR than other non-Hodgkin lymphoma (NHL) patients ( = 0.04), a longer progression free survival (73 months vs. 31 months for other small-cell NHLs = NS) and a 1.5fold lower death rate ( = NS). The procedure was rather safe, with a 38.5% frequency of adverse reactions, mostly minor and manageable. Our data suggest that splenectomy is an effective and safe therapeutic option in patients with lymphoid malignancies and splenic involvement, particularly splenic marginal zone lymphoma.
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http://dx.doi.org/10.3390/medicina56010012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7022624PMC
December 2019

Correlation between Pregnancy Related Weight Gain, Postpartum Weight loss and Obesity: a Prospective Study.

J Med Life 2019 Apr-Jun;12(2):178-183

"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.

Weight gain during pregnancy can be a real risk factor for long-term obesity which has implications in all areas of medicine. This study is designed to assess pregnancy-related weight gain and postpartum weight loss, to identify a possible correlation between weight gain during pregnancy and the risk of obesity in the late postpartum period. The batch comprised 306 women, hospitalized in the Obstetrics and Gynecology Section of the "Nicolae Malaxa" Clinical Hospital between June - November 2017. During this study, we assessed the weight status using the Weight, Body Mass Index, Height, and Abdominal Circumference. These parameters were clinically assessed in three periods pre-pregnancy, early postpartum period, late postpartum period. We also collected data on the evolution of the pregnancy using the anamnesis and the personal pregnancy monitoring sheet. Pregnancy and postpartum period represent a key moment in women's lives in which the risk of obesity is real. Understanding women experiences with weight changes during pregnancy and postpartum period can improve the management of losing weight following pregnancy, avoid long-term weight gain and so reduce the risk for obesity. Also, the correct management of obesity should include the assessment of somatic disorders that may cause major dysfunction, requiring complex rehabilitation programs.
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http://dx.doi.org/10.25122/jml-2019-0015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6685304PMC
October 2019

Fractionated Irradiation in Photobiomodulation Therapy of Ankle Sprain.

Am J Phys Med Rehabil 2019 08;98(8):692-698

From the National Institute of Research and Development for Optoelectronics - INOE 2000, Magurele, Romania (MAC, DM, RS); Carol Davila University of Medicine and Pharmacy, Bucharest, Romania (AB, AH, ASN); Emergency University Hospital, Bucharest, Romania (AB); National Institute for Infectious Diseases Prof Dr Matei Bals, Bucharest, Romania (AH); and National Institute of Rehabilitation, Physical Medicine and Balneoclimatology, Bucharest, Romania (ASN).

Objective: The aim of this study was to test whether fractionated irradiation in photobiomodulation therapy enhances short-term recovery in patients with moderate severity ankle sprain.

Design: Nineteen patients were randomly assigned to one of two groups: one group receiving photobiomodulation therapy combined with the standard rest, icing, compression, and elevation treatment, or a group receiving only standard treatment. Group 1 patients were irradiated using a laser system (635 nm, 15 mW) according to a double-fractionated irradiation scheme consisting of two sessions (4.5 and 9 J/cm) separated by a 30-min time interval. Short-term outcomes (reflectance, pain, and clinical outcomes) were assessed at baseline, 10 days, and 6 wks after treatment.

Results: Reflectance data analysis showed significant changes in group 1 (P = 0.027). There was also an ankle function score improvement more in group 1 than in group 2, with a significant short-term effect (P = 0.011) but without significant long-term effects (P = 0.178). Compared with group 2, group 1 had an immediate effect on pain reduction, but no long-term effect (P = 0.074).

Conclusions: Combined with standard treatment, fractionated irradiation photobiomodulation therapy has been shown to have favorable short-term effects on the recovery of patients with ankle sprains, but its long-term effects should be improved.
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http://dx.doi.org/10.1097/PHM.0000000000001178DOI Listing
August 2019

Appendiceal Mass - Dilemmas Regarding Extension of the Resection.

Chirurgia (Bucur) 2019 Jan-Feb;114(1):126-130

Starting from a typical case, we try to highlight the main critical elements, both in the diagnostic algorithm and in the therapeutic one. We hereby present a 54-year old patient, known with hepatic steatosis and renal microlithiasis, which undergoes an ultrasonography in ambulatory, on the background of unsystematised abdominal discomfort; the ultrasound reveals the presence of a tumoral mass in the right iliac fossa.
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http://dx.doi.org/10.21614/chirurgia.114.1.126DOI Listing
June 2019

New insights in the molecular pathways linking obesity, type 2 diabetes and cancer.

Rom J Morphol Embryol 2019 ;60(4):1115-1125

Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy of Craiova, Romania;

Steadily, cancer is becoming the first cause of mortality, with over 9 million deaths estimated in 2018. Increasing evidence supports a direct association between obesity, type 2 diabetes mellitus (T2DM) and cancer, with a higher risk of cancer mortality especially for some of the most common malignancies, such as breast, colon, and rectal cancers. So far, several mechanisms underlying the cancer-diabetes relationship have been investigated revealing dysregulations of the insulin-insulin-like growth factor (IGF) system as the most important paradigm. Other molecular mechanisms that seem to play a role in the association cancer-T2DM consist of alteration of the signaling pathways activated by inflammatory cytokines, adipocytokines or adhesion molecules. The overall aim of this review is to provide an overview of the molecular mechanisms linking obesity, T2DM and cancer, as related to the receptors and signaling pathways involved in these associations.
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July 2020

Emerging concepts and latest advances regarding the etiopathogenesis, morphology and immunophenotype of basal cell carcinoma.

Rom J Morphol Embryol 2018 ;59(2):427-433

Department of Pathology, Department of Plastic Surgery, University Emergency Hospital, Bucharest, Romania;

Basal cell carcinoma (BCC) represents the most common skin malignancy, which has been linked over time to multifactorial causes. It usually occurs on sun-exposed areas in people with fair skin and with predilection for men. BCC usually affects elderly patients and has an extremely wide range of histological subtypes, which can present clinically under different variants, some with really challenging differentials. Although BCC may occur in familial settings, such as nevoid BCC syndrome, Rombo or Bazex-Dupré-Christol syndromes, nonsyndromic multiple BCCs have also been described in the scientific literature. In this review, we discuss in detail the latest scientific concepts regarding BCC, its etiology, pathogenesis, genetic bases of disease, morphology and immunophenotype, as well as the currently known genetic syndromes, which may lead to development of multiple BCCs, especially in young adults.
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December 2018

Immunohistochemical mismatch in a case of rhabdomyoblastic metastatic melanoma.

Rom J Morphol Embryol 2018 ;59(1):339-344

Department of Periodontology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania;

Melanomas can exhibit a wide range of unusual morphologies due to the neural crest origin of melanocytes. Several authors have documented variations in size and shape of cells, cytoplasmic features and inclusions, nuclear features and cell architecture. Metastatic melanoma with rhabdomyoblastic differentiation is an extremely rare condition with poor prognosis. Few studies concerning rhabdoid or rhabdomyoblastic differentiation in melanoma are currently available and the current report highlights some of the most important immunohistochemical features of this rare entity. We report on a case of a rhabdomyoblastic metastatic melanoma showing intense positivity for both melanocytic and rhabdoid markers in two cell populations dissociated within the tumor with multiple mismatches in immunomarker expression. Improved recognition of this rare morphological pattern may provide the means for developing new techniques to identify novel therapeutic targets, which would improve the prognostic outlook for these patients.
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October 2018

Cutaneous microcystic/reticular schwannoma: case report and literature review of an exceedingly rare entity with an unusual presentation.

Rom J Morphol Embryol 2018 ;59(1):303-309

Department of Anesthesiology and Intensive Care, University Emergency Hospital, Bucharest, Romania; Department of Plastic Surgery, University Emergency Hospital, Bucharest, Romania;

Conventional schwannoma represents a benign peripheral nerve sheath tumor derived from Schwann cells, which usually arises in the fourth or fifth decade of life, in the subcutaneous tissue of the distal extremities, or in the head and neck region of adult patients, with no gender predilection. In addition to the classic type, at least 11 different histopathological subtypes have been described and unawareness of these uncommon histopathological entities may lead to diagnostic pitfalls and risk of mistreatment. Recently described in the scientific literature, microcystic/reticular schwannoma is still relatively unknown to both surgeons and pathologists. The purpose of this paper is to highlight its existence by describing an additional case that occurred in the retroauricular area, and to further characterize its clinical, histopathological and immunohistochemical features. We reviewed the literature and compared the current case with others that have been documented thus far, discussing all possible differential diagnoses.
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October 2018

Appendiceal Intussusception: A Diagnostic Challenge.

Eur J Pediatr Surg 2018 Feb 25;28(1):30-33. Epub 2017 Jul 25.

Department of Pediatric Surgery, Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel Aviv University, Petah Tikva, Israel.

Introduction:  Appendiceal intussusception is a rare condition in children characterized by an invagination of the appendix into the cecum to various degrees. The treatment is appendectomy; however since symptoms are not specific, clinical diagnosis is challenging and frequently only intraoperative. We present a series of five patients with appendiceal intussusception and discuss features that may direct the pediatric surgeon to achieve early recognition and provide optimal treatment.

Materials And Methods:  The database of a tertiary medical center was retrospectively reviewed for all patients treated for appendiceal intussusception during the period from January 1995 to January 2016. Data collected by chart review included demographics, clinical characteristics, imaging studies, surgical technique, and outcome. The findings were analyzed by descriptive statistics.

Results:  This series included five patients (two females and three males) with ages ranging between 27 and 42 months (mean: 35.2). Patients presented with intermittent abdominal pain (IAP, all five patients), alternate vomiting (three of five patients), alternate diarrhea (two of five patients), fever (two of five patients), and rectal bleeding (one of five patients). The average length of symptoms was 22.6 days. Eighteen diagnostic studies were performed, including abdominal ultrasound for all patients, barium enema for three patients with secondary ileocolic intussusception, and abdominal computed tomography (CT) for one patient. The average number of studies per patient was 3.6. In surgery, the appendiceal intussusception was found to be complete in four patients, whereas it was partial in the remaining patient. In all patients, appendectomy was performed with resection of a small rim of cecal wall due to marked congestion and edema in an attempt to decrease recurrence.

Conclusion:  The mainstay of clinical presentation is intermittent abdominal pain while patients may be completely asymptomatic between attacks. Appendiceal intussusception may act as a leading point to ileocolic intussusception and is frequently concealed by it. The treatment is appendectomy. Both pediatric surgeons and radiologists should be aware of this occurrence to provide adequate management and avoid complications.
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http://dx.doi.org/10.1055/s-0037-1604400DOI Listing
February 2018

"Off-label" use of intravitreal bevacizumab in non-ischemic macular edema secondary to retinal vein obstructions.

Rom J Ophthalmol 2016 Apr-Jun;60(2):90-95

"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania Department of Ophthalmology, University Emergency Hospital Bucharest, Romania.

Objective: To evaluate the safety and efficacy of intravitreal Bevacizumab in treatment of non-ischemic macular edema secondary to retinal vein obstruction (RVO).

Materials And Methods: A 2-year-retrospective study was performed on 26 patients hospitalized for non-ischemic macular edema secondary to RVO. All the patients underwent a complete ophthalmologic exam, with best corrected visual acuity (BCVA) testing, fundus photography, fluorescein angiography (FA) and macular thickness measurement by optical coherence tomography (OCT). Reevaluation was performed monthly for VA, OCT, and ophthalmoscopy and, at every 3 months, by FA. A standard protocol of 0.05 ml intravitreal Bevacizumab injection was applied. Further administrations were performed according to clinical evolution.

Results: The medium follow-up period was of 9,7 months (6-20 months). There were no significant complications following the procedure. The number of intravitreal Bevacizumab injections varied from 2-5/ patient. All the patients experienced an improvement in VA and a significant regression of macular edema. The smallest number of intravitreal Bevacizumab injections and the best visual prognosis were observed in cases with branch retinal vein obstruction (BRVO) and early presentation (p<0.05).

Conclusions: As a pathogenic therapy, intravitreal Bevacizumab is a safe, repeatable procedure and it may be considered an effective and lasting treatment for non-ischemic macular edema secondary to RVO. Intravitreal Bevacizumab should be included in the therapeutic protocol of RVO, both for early and delayed presentations. RVO = retinal vein obstruction, BRVO = branch retinal vein obstruction, CRVO = central retinal branch obstruction, BCVA = best corrected visual acuity, FA = fluorescein angiography, OCT = optical coherence tomography.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5711371PMC
April 2018

Virtual reality as a method for evaluation and therapy after traumatic hand surgery.

Stud Health Technol Inform 2013 ;191:48-52

National Institute for Rehabilitation, Physical Medicine and Balneology Bucharest, Romania.

In the last decade, Virtual Reality has encountered a continuous development concerning medical purposes and there are a lot of devices based on the classic "cyberglove" concept that are used as new therapeutic method for upper limb pathology, especially neurologic problems [1;2;3]. One of the VR devices is Pablo (Tyromotion), with very sensitive sensors that can measure the hand grip strenght and the pinch force, also the ROM (range of motion) for all the joints of the upper limb (shoulder, elbow, wrist) and offering the possibility of interactive games based on Virtual Reality concept with application in occupational therapy programs. We used Pablo in our study on patients with hand surgery as an objective tool for assessment and as additional therapeutic method to the classic Rehabilitation program [4;5]. The results of the study proved that Pablo represents a modern option for evaluation of hand deficits and dysfunctions, with objective measurement replacement of classic goniometry and dynamometry, with computerized data base of patients with monitoring of parameters during the recovery program and with better muscular and neuro-cognitive feedback during the interactive therapeutic modules.
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May 2014

Efficacy of a comprehensive rehabilitation programme combined with pharmacological treatment in reducing pain in a group of OA patients on a waiting list for total joint replacement.

Clin Exp Rheumatol 2012 Mar-Apr;30(2):233-9. Epub 2012 Apr 13.

Department of Clinical Neurophysiology & Pain Rehabilitation Unit, Rehabilitation Institute of Montescano, Salvatore Maugeri Foundation, IRCCS, Montescano (PV), Italy.

Objectives: It has been shown that combined rehabilitation and pharmacological treatment reduce pain in subjects with osteoarthritis (OA), although the efficacy of either therapy alone may be limited. We studied the effects of a comprehensive rehabilitation programme alone and together with pharmacological treatment in relatively young OA patients awaiting total joint replacement (TJR).

Methods: Forty-four OA patients randomly divided into two groups underwent three weeks of comprehensive day hospital rehabilitation treatment alone (group A) or in combination with acetaminophen 1g three times a day. Pain intensity was measured using a visual analogue scale (VAS) before and during treatment, and for four weeks afterwards, and compared between the groups using Student's t-test for unpaired data.

Results: In group A, pain intensity was not reduced after the first week of treatment (T0 vs. T1: p=0.739), but was significantly reduced from the end of the second week to the end of the observation period (p<0.01). In group B, pain intensity was significantly reduced (p<0.01) from the first week of treatment to the end of the observation period. The differences in the VAS score variations from T0 between the two groups were statistically significant throughout the study period (T0-T1: p=0.004, T0-T2: p=0.041, T0-T3: p=0.035, T0-T4: p=0.009, T0-T5: p=0.011, T0-T6: p=0.014 T0-T7: p=0.015).

Conclusions: Rehabilitation is effective in reducing pain even in patients with severe OA on a waiting list for TJR, but its efficacy is boosted by adding appropriate pharmacological treatment.
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July 2012