The Journal of Bucharest College of Physicians and the Romanian Academy of Medical Sciences

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Atypical Evolution of Peptic Ulcer Disease in a Chronic Hemodialyzed Patient

2014-04

D. Baboi, Cristiana David, Ileana Peride, A. Niculae, B. Geavlete, I.A. Checheriță, I. Dina

Digestive manifestations due to uremia and uremic toxins are multiple in patients with chronic kidney disease (CKD) on hemodialysis (HD). As much as 79 percent of these patients report gastrointestinal symptoms manifested as nausea, vomiting, dry mouth, dysgeusia, halitosis, pyrosis, abdominal pain, bloating, diarrhea (1,2). Due to many pathogenic mechanisms, the prevalence of gastro-duodenal peptic ulcer disease is higher in HD subjects than in general population, but comparable in frequency with nondialyzed CKD patients (3-5). A recent published 10 years-study presented that the incidence of peptic ulcer disease is 4 times higher in patients with CKD and 9.4 times higher in individuals on chronic HD compared to the general population (6). Regarding localization, gastric ulcers are twice more frequent documented than duodenal ulcers (6-8). An imbalance between protective and aggressive mucosal factors in favor of the last ones is noticed in HD patients. Chronic dialysis stress, intradialysis hypotension (causing mucosal hypo-perfusion), anemia, intra-dialysis anticoagulant, metabolic acidosis, potentially ulcerogenic medication (steroids, non-steroid anti-inflammatory and antiplatelet drugs) lead to high frequencies of peptic ulcer disease (9). Since the appearance of ulcerous lesions, the risk of their complications (e.g.: hemorrhages, perforations, penetrating injuries) is much higher than in general population. One recent cohort study in Taiwan showed that the incidence of gastro-duodenal bleedings is double in CKD patients and 5 times higher in HD ones (2). Subsequently, common comorbidities such as diabetes, liver cirrhosis and ischemic heart disease participate as pathogens in digestive bleedings (10).

An adequate diagnosis and monitoring of peptic ulcer disease in dialysis patients represent a constant concern of our clinical practice, because of the high prevalence of this kind of pathology, the life-threatening potential complications and the complexity of the treatment. Therefore, further on we discuss the case of an atypical peptic ulcer disease in a chronic HD patient.

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Lentigo Maligna - A Scientometric Analysis of Mainstream Scientific Knowledge

2014-04

Alice Brīnzea, B. Geavlete, Magda Mirescu, Roxana Nedelcu, Oliviana Geavlete, Daniela Ion

Lentigo maligna (LM) is a type of melanocytic proliferation, the term being used by clinicians and pathologists for melanoma in situ on chronically sun damaged skin (1) in case that the lesion is confined to the epidermis. The pathology in question is classified as lentigo maligna melanoma (LMM) when it invades the dermis (2), over a protracted period of time (3). They both represent a subtype of malignant melanocytic proliferation according to the World Health Organization criteria (4). Once the dermis is invaded, the prognosis of the lesion is similar to that specific for other types of melanoma (5). Most LM patients display a slowly enlarging pigmented macula or patch which tends to occur in middle aged and older individuals (6), with a slight female preponderance (2).

The preferred method for diagnosing LM is excision (7), secondary to dermatoscopy (8) and biopsy (9). Distinguishing LM from a background of increased melanocytes on chronically sun damaged skin in a small biopsy specimen remains one of the most serious diagnostic challenges for dermatopathologists (10). Histology shows proliferation of atypical melanocytes at the epidermal-dermal junction in small nests or single cells (11).

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Chronic Lymphocytic Leukemia. From Diagnosis to Treatment Decision

2014-04

Ana-Maria Ivanescu, Madalina Oprea, A. Colita, A. Turbatu, Anca Roxana Lupu

Chronic lymphocytic leukemia (CLL), haematological described since the early nineteenth century, is considered a haematological indolence, but of-a-time there was found that its evolution can be extremely varied.

Most of the patients were over 60 years at the time the diagnosis was established, and this may be due to decreased immune competence with age. Males are affected 2 times more frequently than the female, the male percentage: female being 2:1. Fewer than 10% of cases occur in adults and in children below 40 years old have been few reported cases of CLL. (1.2)

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HPV Implications in Benign Prostatic Impairments - A Literature Review

2014-04

D. Spīnu, D. Mischianu, O. Bratu, A. Aungurenci, Ș. Manache, Agnes Ciucă

Benign prostatic impairments are a heterogeneous group of diseases that can coexist or be separate entities. Some of these conditions (prostatitis) are included in the pelvic pain syndrome, while the other is represented by the prostatic adenoma and its implications.

Benign prostatic hyperplasia (BPH) is histologically associated, in most cases, with the presence of inflammatory infiltrate at this level. Histopathological examination of the resected pieces and fragments of prostatic biopsy in many cases reveals stromal inflammatory infiltrate adjacent to the prostatic acini. (1, 2) In addition to the many factors involved in the prostate benign microbial pathology (E. coli, Pseudomonas aeruginosa, Serratia spp., Klebsiella spp., Enterobacter aerogenes and the great family of enterococci), there are numerous data in specialized literature, certifying the presence of viral genomes in both benign and malignant pathology of the prostate. (3, 4) Among them the following stand out: Papilloma virus (HPV), Polyoma viruses, cytomegaloviruses (CMV), Epstein-Barr virus (EBV), Herpes Virus 8 (HHV 8) and xenotropic murine leukemia virus recently (XMRV). (5)

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Innovative Techniques for the Endoscopic Diagnosis in Inflammatory Bowel Diseases

2014-04

Adriana-Corina Andrei, L.S. Andrei, Larisa-Elena Fulger

Inflammatory bowel diseases, Crohn's disease (CD) and ulcerative colitis (UC), are chronic conditions in which idiopathic inflammation of the gastrointestinal tract wall is the characteristic feature.

The etiology of these disorders is not fully elucidated, proposed causes including environmental, immunological and genetic factors. A consensus hypothesis is that in genetically susceptible individuals, both exogenous factors (eg. Intestinal flora) and factors related to the host (barrier function of epithelial cells, innate and acquired immune response function) produce a chronic immune dysfunction in the intestinal mucosa which is further modified by the action of environmental factors (eg. smoking).

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