Abstract The link between venous thromboembolism (VTE) and cancer is well known. VTE could be the initial sign of an occult malignancy. There are more diagnoses of cancer after an unprovoked VTE ...compared to a provoked VTE, with a reported prevalence between 4.5% and 5.6% over 12 months, within the first 6 months of VTE diagnosis. There are no recommended guidelines and scores yet adopted in clinical practice, but many studies support occult cancer screening in unprovoked VTE patients. We report the case of a patient with a history of unprovoked pulmonary embolism (PE) diagnosed with bronchopulmonary neoplasm in an advanced stage one year after the thromboembolic event. When the cancer was first diagnosed, the patient’s condition was already serious, being too late for the adoption of measures meant to decrease the risk of mortality and increase the duration of survival. We wanted to emphasize the importance of occult cancer screening in patients with unprovoked VTE and the fact that early cancer diagnosis reduces the risk of cancer progression, decreasing mortality and morbidity related to it.
Introduction The triangular recess (TR), also called triangular fossa or vulva cerebri, represents the anterior extension of the diencephalic ventricle, located between the anterior columns of the ...fornix and the anterior white commissure. Over time, this structure of the third cerebral ventricle generated many disputes. While some anatomists support its presence, others have opposite opinions, considering that it only becomes visible under certain conditions. The aim of the study is to demonstrate the tangible structure of the triangular recess. Secondly, the quantitative analysis allowed us to establish an anatomical morphometric standard, as well as the deviations from the standard. Materials and methods Our study is both a quantitative and a qualitative evaluation of the triangular fossa. We dissected 100 non-neurological adult brains, which were fixed in 10% formaldehyde solution for 10 weeks. The samples are part of the collection of the Institute of Anatomy, “Grigore T. Popa” University of Medicine and Pharmacy, Iasi. We highlighted the triangular fossa by performing dissections in two stages at the level of the roof of the III ventricle. Results The qualitative analysis is a re-evaluation of the classical data concerning the anatomy of the fossa triangularis. We proposed an original 3D model of the triangular recess in which we described a superficial part called vestibule and a deep part called pars profunda . We measured the sides of the communication between the two proposed segments, as well as the communication with the III ventricle. By applying the Heron’s formula, we calculated the area of the two communications. Statistical evaluations have shown that these communications are higher than they are wide. In addition, there is a statistical difference between the surfaces of the two communications: 34.07 mm 2 ± 7.01 vs. 271.43 mm 2 ± 46.36 ( p = 0.001). Conclusion The outcome of our study is both qualitative and quantitative. Firstly, we demonstrated the existence of the triangular fossa and we conceived a spatial division of this structure. Secondly, the measurements carried out establish an anatomo-morphometric norm of the triangular recess, which is useful in assessing the degree of hydrocephalus during the third endoscopic ventriculoscopy.
The ponticulus posticus (PP) is a bony bridge that emerges from the posterior aspect of the superior articular process, to connect the posterior arch of the atlas. It is often associated with ...neurological symptoms. The aim of this study was to obtain an insight into this malformation, and prevalence in the North East region of the Romanian population.
This anatomical variant was analyzed through an observational and retrospective study which was carried out in St. Spiridon Hospital Iasi. The duration of the study was 10 months and, a number of 487 patients who presented neurological symptoms without cranio-cerebral traumatisms were enrolled and a computed tomography (CT) scan was performed. We proposed a new classification of PP in five types. The prevalence of PP was calculated and Skewness test, ANOVA test with Bonferroni correction, and Student's
-test were used for statistical analysis.
: Among the sample of 487 patients, PP was found in 170 cases (34.90%) in an age group of 8-90 years (mean age = 59.52 years, SD ± 19.94 years). Type I was found in 11.29%, followed by Type II-8.21%, Type III-5.13%, Type IV-5.54%, and Type V-4.72% (
= 0.347). It was 19.5%, mirroring the incomplete type, whereas the complete type was reported in 15.40% of cases (
= 0.347), the highest prevalence, namely 41.17% was found in the "41 to 60 years" age group, followed by 36.95% in the "21 to 40 years" group (
= 0.00148). The mean age was higher in patients with PP Type III (61.16 years, SD ± 19.98), while patients with PP Type V recorded the lowest mean age (56.48 years, SD ± 22.13). The differences between the comparative average ages on types were not statistically significant (
= 0.411). The gender and age were not good predictors of PP Type V (AUC < 0.600).
according to our study, incomplete types of PP were found to be more prevalent as compared to complete types. No difference between males and females was detected. PP is more frequent in adults and young adults than in the elderly population. It is confirmed that gender and age were not good predictors of the bilateral complete type of PP.
Pulmonary veins carry oxygenated blood from lungs to the left atrium of the heart. The anatomy of the pulmonary veins is variable with some anatomic variants. In clinical practice the difference ...between the normal anatomy of pulmonary veins with its variants and abnormal anatomy is very important for clinicians. Variants of pulmonary veins may occur in number, diameter and normal venous return. We present a case report and a review of the literature with the pulmonary venous return that deviates from the usual anatomical configuration and ranges from normal variant drainage to anomalous pulmonary-systemic communication. Initially, it was considered as an anatomical variant of the pulmonary venous return associated with the persistence of the left superior vena cava. Upon detailed exploration it was established that it was an anomaly of the pulmonary venous return which led in time to the installation of its complications. Diagnosis can be difficult, sometimes missed, or only made late in adulthood when complications were installed. Knowledge of variant anatomy and anomalous pulmonary venous return play a crucial role in the diagnostically challenging patient.
Acute compartment syndrome is a major surgical emergency with complex pathophysiology and a highly unpredictable pattern of evolution. We hypothesized that the onset of acute compartment syndrome of ...the leg or forearm is associated with variations in the surface temperature of the distal segment (foot or hand) with a distinct pattern, which acts as an early warning sign.
We developed a monitoring device that consists of two thermic sensors attached to a modular limb splint, which continuously measure the temperature difference between the proximal and distal regions of the limb (i.e., arm-hand, thigh-foot). Firstly, we investigated both the arm-hand and thigh-foot temperature gradients of hospitalized patients' healthy limbs (43 patients, 56 upper limbs, 64 lower limbs) in order to establish a baseline. Secondly, we examined the correlation between the thermic gradients and intracompartmental pressure values in compartment syndrome limbs (20 patients, 6 upper limbs, 14 lower limbs).
For the control group, the mean values for the normal limb thermic gradients were -0.17 °C for the upper limbs. and 0.03 °C for the lower limbs. In the impending compartment syndrome group (defined by intracompartmental pressure values), the mean index was -0.38 °C. In the fully developed compartment syndrome group, the mean value was 4.11 °C.
Analysis was performed using the ANOVA one-way statistical method. This showed significant differences between the compartment syndrome group and the impending and control groups. A decreasing trend in the thermic gradient in patients with impending compartment syndrome compared with the control group was noted.
The thermic gradient of limbs presenting signs of impending compartment syndrome decreases as a result of the increased temperature of the distal segment. This pattern can be used as an early diagnostic method for acute compartment syndrome. This technique is non-invasive and bears no risk to the patient, allowing facile continuous monitoring during immobilization.
The aberrant origin of the right subclavian artery (ARSA), also known as the lusoria artery, is a congenital malformation with an incidence of 0.5-4.4%. Most cases are incidental due to minimal ...clinical manifestations. Computer tomography (CT) is important in diagnosing and evaluating these patients.
We conduct a computerized search in two databases, PubMed and EMBASE, for articles published between 1 January 2022 and 31 December 2023, PROSPERO code: CRD42024511791. Eligible for inclusion were case reports and case series that presented the aberrant origin of the right subclavian artery. The main outcome was the highlighting of the morphological types of ARSA. In this context, we proposed a new classification system of this anomaly. The secondary outcome was the evaluation of the demographic distribution of the lusoria artery.
Our search identified 47 articles describing 51 patients with ARSA. The typical course for ARSA is retroesophageal, being registered in 49 out of 51 patients. This malformation is frequently associated with Kommerell diverticulum (15 out of 51), troncus bicaroticus (7 out of 51), and aberrant origins of the right vertebral artery (7 out of 51). We observed a higher incidence of the condition among women (32 out of 51) compared to men (19 out of 51). From a demographic point of view, ARSA is more frequent in the "44 to 57 years" and "58 to 71 years" age ranges.
ARSA is a congenital malformation resulting from a defect in the development of the aortic arches. The imaging studies such as computer tomography play a defined diagnostic role.
We report the case of a 77-year-old patient admitted for worsening dyspnea, palpitations and dizziness. The electrocardiogram (ECG) showed atrial fibrillation (AF) and left bundle branch block ...(LBBB). Clinical examination showed hypoxemia (SaO
87% room air), jugular venous distension, pitting edema, arrhythmic heart sounds, a splitting of the second heart sound and systolic murmur (III–IV/VI) in the tricuspid area. Transthoracic echocardiography (TTE) showed right heart dilation, moderate tricuspid regurgitation, biventricular hypertrophy, and a dilated coronary sinus (CS). Agitated saline injection in the left basilar vein raised a suspicion of persistent left superior vena cava (PLSVC) to coronary sinus fistula. Transesophgaeal ecocardiography (TOE) showed a superior sinus venosus defect, with bidirectional shunt, and persistence of LSVC. CT angiography confirmed and detalied the malformation features. A low suspicion for congenital defects in older adults presents a significant diagnostic challenge. Multimodality cardiac imaging is critical in determining the etiology of right heart dilation, and knowledge of the anatomy and physiology of various shunt lesions is essential for clinicians.
Acute organophosphate (OP) poisoning can be deadlier than any other type of chemical poisoning. So far, only a few cases have been described that include extensive neurological complications. We ...present an outstanding case of severe oral OP poisoning with intermediate syndrome developed on the fourth day after hospital admission. The clinical picture involved weakness of the proximal upper and lower limb muscles and several muscles supplied by motor cranial nerves, but, what is peculiar, the distal upper and lower limb muscles were also affected (forearms, hands, legs, and feet). To our knowledge, this is a unique presentation, as lower limb muscle weakness was reported only in the context of delayed polyneuropathy. Another remarkable feature was the involvement of six of the twelve cranial nerves, which makes this case of intermediate syndrome the first with such a spread of muscle weakness and provides new insights into the polymorphic clinical manifestations of acute OP poisoning.
For decades the surgical treatment of choice for breast cancer in Romanian hospitals has been radical mastectomy. Nowadays the preferred method of treatment for many women with early breast cancer is ...conservative surgery. Fifty seven breast cancer patients were surveyed to assess the differences in quality of life and explore the importance of religious coping in their recovery. Findings show an important prevalence of religious coping among patients with breast cancer and a lower quality of life for patients who underwent conservative surgery. Further attention needs to be paid to the impact of different types of surgical treatments on patients’ quality of life.
In the actual pandemic context, cancer patients are at additional risk, and protocols are always changing. We present the case of a 62-year-old patient who develops three types of cancer over four ...years and who was admitted to the hospital in the Emergency Room for hematemesis, melena, and abdominal pain. We know from the pathological antecedents that he was operated in 2017 for a left scapular tumour (basal cell carcinoma). The current clinical examination reveals another right scapular tumour (malignant melanoma), and the hematemesis comes from a gastro-esophageal junction tumour (squamous cell carcinoma). SARS CoV2 infection changes the rules of treatment in such a case. Thus, the patient is operated for the right scapular tumour, the gastrectomy being delayed due to the lung lesions given by SARS CoV2. Finally, the patient undergoes surgery for the gastric tumour, the RT-PCR retest being negative.
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