Pub Date : 2024-03-01DOI: 10.26574/maedica.2024.19.1.195
Claudiu-Octavian Ungureanu, Floris Stanculea, Octav Ginghina, Cosmin Ene, Andrei Stoica, Bogdan Geavlete, Daniel Alin Cristian, Valentin Titus Grigorean, Petrisor Geavlete, Niculae Iordache
Inguinoscrotal hernia (ISH) is an entity for which treatment is under debate. Open surgery is the standard approach, but the laparoscopic technique has a great outcome when used by experienced surgeons. Seroma is one of the complications following laparoscopic hernia repair for these scrotal hernias, which is due to the large hernia sac, usually transected, leaving in place a remnant of the sac. Conservative measures can be applied for the treatment of seroma; however, in symptomatic cases, puncture and aspiration of fluid are recommended. Sometimes, these seromas can reach a large size and require surgery to remove the remnant sac. Herein, we report the case of a 49-year-old male with a large seroma that occurred four days after the laparoscopic approach - total extraperitoneal repair (TEP) for inguinoscrotal hernia. Conservative measures failed, and because the symptoms were not alleviated, reintervention was opted for. The distal sac was excised and the patient recovered uneventfully. The six-month follow-up did not show any recurrence of the hernia or seroma. We emphasize the importance of sac management in large ISH cases and discuss seromas after laparoscopic hernia repair in such instances.
阴茎腹股沟疝(ISH)是一种实体疝,其治疗方法尚存在争议。开腹手术是标准方法,但如果由经验丰富的外科医生使用腹腔镜技术,则会取得很好的疗效。血清肿是阴囊疝腹腔镜疝修补术后的并发症之一,其原因是疝囊较大,通常被横切,留下残余的疝囊。血清肿的治疗可采用保守疗法,但对于有症状的病例,建议进行穿刺和抽液。有时,这些血清肿会变得很大,需要手术切除残余的囊。在此,我们报告了一例 49 岁男性患者的病例,他在采用腹腔镜方法--全腹膜外修补术(TEP)治疗腹股沟疝四天后出现大血清肿。保守治疗无效,由于症状没有得到缓解,患者选择了再次手术。切除了远端囊肿,患者恢复顺利。六个月的随访未发现疝气或血清肿复发。我们强调了在大型 ISH 病例中囊处理的重要性,并讨论了在这种情况下腹腔镜疝修补术后血清肿的问题。
{"title":"Large Symptomatic Inguinoscrotal Seroma Occurred Early after Laparoscopic Total Extraperitoneal Hernia Repair (TEP): a Case Report and Literature Review.","authors":"Claudiu-Octavian Ungureanu, Floris Stanculea, Octav Ginghina, Cosmin Ene, Andrei Stoica, Bogdan Geavlete, Daniel Alin Cristian, Valentin Titus Grigorean, Petrisor Geavlete, Niculae Iordache","doi":"10.26574/maedica.2024.19.1.195","DOIUrl":"10.26574/maedica.2024.19.1.195","url":null,"abstract":"<p><p>Inguinoscrotal hernia (ISH) is an entity for which treatment is under debate. Open surgery is the standard approach, but the laparoscopic technique has a great outcome when used by experienced surgeons. Seroma is one of the complications following laparoscopic hernia repair for these scrotal hernias, which is due to the large hernia sac, usually transected, leaving in place a remnant of the sac. Conservative measures can be applied for the treatment of seroma; however, in symptomatic cases, puncture and aspiration of fluid are recommended. Sometimes, these seromas can reach a large size and require surgery to remove the remnant sac. Herein, we report the case of a 49-year-old male with a large seroma that occurred four days after the laparoscopic approach - total extraperitoneal repair (TEP) for inguinoscrotal hernia. Conservative measures failed, and because the symptoms were not alleviated, reintervention was opted for. The distal sac was excised and the patient recovered uneventfully. The six-month follow-up did not show any recurrence of the hernia or seroma. We emphasize the importance of sac management in large ISH cases and discuss seromas after laparoscopic hernia repair in such instances.</p>","PeriodicalId":74094,"journal":{"name":"Maedica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11079739/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140913049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.26574/maedica.2024.19.1.30
Sanjeev Satpathy, Aiswarya Kar, Ranjan Kumar Sen, Himel Mondal
Introduction: Altered levels of thyroid hormones can impact various body systems, including the nervous system. Hypothyroidism may disrupt nerve conduction due to pathophysiological changes associated with hormone deficiency. The tribal population, characterized by distinct lifestyles and dietary habits, may experience unique influences on their growth and development. Aim: This study aimed to compare nerve conduction in newly diagnosed and untreated tribal women affected by hypothyroidism with euthyroid tribal women. Methods:A cross-sectional study was conducted in southern Odisha, India, spanning from April 2020 to January 2021. Forty-five newly diagnosed hypothyroid tribal women were enlisted from the outpatient department of general medicine as the case group. Additionally, 45 age-matched apparently healthy euthyroid tribal women were included as the control group. The subjects' height and weight were measured by an expert clinician. Nerve conduction (motor and sensory) study on both extremities (left and right side) were conducted for all participants in the human physiology laboratory. Results:The mean age of participants was 48.13±12.12 years in the case group and 47.18±12.2 years in the control group. In hypothyroid tribal women, a significant decrease in conduction velocity was observed in the majority of motor nerves (right median [p = .03], left median [p = .02], left ulnar [p = .04], right posterior tibial [p = .001], left posterior tibial [p = .0001]) and sensory nerves (right median [p =.005], right ulnar [p = .02], right sural [p = .001], and left sural [p = .02]). Conclusion:In newly diagnosed cases of hypothyroidism in tribal women, there is a risk of neuropathy that impacts both motor and sensory neurons. Therefore, it is crucial to initiate early diagnosis and immediate treatment to prevent additional neurological damage.
{"title":"A Cross-Sectional Study on Motor and Sensory Nerve Functions in Women Newly Diagnosed and Untreated for Hypothyroidism in a Tribal Area of Odisha, India.","authors":"Sanjeev Satpathy, Aiswarya Kar, Ranjan Kumar Sen, Himel Mondal","doi":"10.26574/maedica.2024.19.1.30","DOIUrl":"10.26574/maedica.2024.19.1.30","url":null,"abstract":"<p><p><b>Introduction:</b> Altered levels of thyroid hormones can impact various body systems, including the nervous system. Hypothyroidism may disrupt nerve conduction due to pathophysiological changes associated with hormone deficiency. The tribal population, characterized by distinct lifestyles and dietary habits, may experience unique influences on their growth and development. <b>Aim:</b> This study aimed to compare nerve conduction in newly diagnosed and untreated tribal women affected by hypothyroidism with euthyroid tribal women. <b>Methods:</b>A cross-sectional study was conducted in southern Odisha, India, spanning from April 2020 to January 2021. Forty-five newly diagnosed hypothyroid tribal women were enlisted from the outpatient department of general medicine as the case group. Additionally, 45 age-matched apparently healthy euthyroid tribal women were included as the control group. The subjects' height and weight were measured by an expert clinician. Nerve conduction (motor and sensory) study on both extremities (left and right side) were conducted for all participants in the human physiology laboratory. <b>Results:</b>The mean age of participants was 48.13±12.12 years in the case group and 47.18±12.2 years in the control group. In hypothyroid tribal women, a significant decrease in conduction velocity was observed in the majority of motor nerves (right median [p = .03], left median [p = .02], left ulnar [p = .04], right posterior tibial [p = .001], left posterior tibial [p = .0001]) and sensory nerves (right median [p =.005], right ulnar [p = .02], right sural [p = .001], and left sural [p = .02]). <b>Conclusion:</b>In newly diagnosed cases of hypothyroidism in tribal women, there is a risk of neuropathy that impacts both motor and sensory neurons. Therefore, it is crucial to initiate early diagnosis and immediate treatment to prevent additional neurological damage.</p>","PeriodicalId":74094,"journal":{"name":"Maedica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11079738/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140913109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.26574/maedica.2024.19.1.147
Eleni Litsou, Victoria Tsoumani, Lentiona Basiari, Georgios V Psychogios
Laryngocele, a dilation of the laryngeal saccule, is an uncommon and benign air-filled lesion that expands upwards into the ventricle of Morgagni. A unilateral growth within the larynx that is in communication with the laryngeal lumen typically signals its presence. The exact cause of the disorder remains uncertain, although there are three main theories which suggest congenital reasons, increased pressure in the larynx, or mechanical obstruction of the ventricle of Morgagni. The classification for laryngoceles is based upon their location with respect to the thyrohyoid membrane, and they may be internal, external, or combined. A laryngocele, along with a gradually enlarging submandibular mass, was located in the region from below the hyoid bone to the anterior sternocleidomastoid muscle on the right side of the neck. The diagnosis of a laryngocele may be confirmed through clinical examination, endoscopic investigation and imaging tests. For cases of combined laryngocele, we recommend its removal using an external approach, which not only ensures safety and accuracy but also allows for a complete removal of the laryngocele. Additionally, this approach guarantees that the surgical intervention is carried out with maximum precision and effectiveness, as all procedures will be performed under direct visualization.
{"title":"Combined Laryngocele and External Approach.","authors":"Eleni Litsou, Victoria Tsoumani, Lentiona Basiari, Georgios V Psychogios","doi":"10.26574/maedica.2024.19.1.147","DOIUrl":"10.26574/maedica.2024.19.1.147","url":null,"abstract":"<p><p>Laryngocele, a dilation of the laryngeal saccule, is an uncommon and benign air-filled lesion that expands upwards into the ventricle of Morgagni. A unilateral growth within the larynx that is in communication with the laryngeal lumen typically signals its presence. The exact cause of the disorder remains uncertain, although there are three main theories which suggest congenital reasons, increased pressure in the larynx, or mechanical obstruction of the ventricle of Morgagni. The classification for laryngoceles is based upon their location with respect to the thyrohyoid membrane, and they may be internal, external, or combined. A laryngocele, along with a gradually enlarging submandibular mass, was located in the region from below the hyoid bone to the anterior sternocleidomastoid muscle on the right side of the neck. The diagnosis of a laryngocele may be confirmed through clinical examination, endoscopic investigation and imaging tests. For cases of combined laryngocele, we recommend its removal using an external approach, which not only ensures safety and accuracy but also allows for a complete removal of the laryngocele. Additionally, this approach guarantees that the surgical intervention is carried out with maximum precision and effectiveness, as all procedures will be performed under direct visualization.</p>","PeriodicalId":74094,"journal":{"name":"Maedica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11079744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140913122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Adult degenerative scoliosis (ADS) is a coronal deviation of the spine greater than 10° resulting from the progressive degeneration of the vertebral elements in middle age, which is a three-dimensional deformity. In this study, the effect of conservative treatment methods on pain, disability, and quality of life of patients with ADS was evaluated. Methods:Thirty females with ADS were included in the present study. Demographic characteristics, Cobb angles, Visual Analog Scale (VAS), Short Form-36 (SF-36), Scoliosis Research Society-22 (SRS-22) and Roland Morris Disability Questionnaires (RMDQ) were noted. Fifteen sessions of physical therapy (hotpack, TENS and ultrasound) and exercises were administered to all patients. All assessment scales were used for evaluation at baseline as well as one month and three months after treatment. Results:Visual Analog Scale scores statistically differed between the first, second and third measurements (p<0,001). There was a significantly improvement in RMDQ between periods of time (p<0,001). While the second assessment was significantly lower than the first measure (p=0,001), there was no difference between the third and second measures (p=0,496). Similarly, quality of life assessments (SRS-22, SF-36) significantly differed between the first and second assessments and continued at the third assessment. Conclusion:Given the difficulties of surgical treatment and patients' comorbidities, conservative treatment methods are becoming important for ADS. Non-surgical treatments for ADS should be taken into consideration to improve pain, disability and quality of life outcomes.
{"title":"Conservative Treatment in Adult Degenerative Scoliosis: a Prospective Cohort Study.","authors":"Fethullah Bayram, Bilinc Dogruoz Karatekin, Belgin Erhan, Ozge Pasin, Yasemin Yumusakhuylu","doi":"10.26574/maedica.2024.19.1.23","DOIUrl":"10.26574/maedica.2024.19.1.23","url":null,"abstract":"<p><p><b>Background:</b> Adult degenerative scoliosis (ADS) is a coronal deviation of the spine greater than 10° resulting from the progressive degeneration of the vertebral elements in middle age, which is a three-dimensional deformity. In this study, the effect of conservative treatment methods on pain, disability, and quality of life of patients with ADS was evaluated. <b>Methods:</b>Thirty females with ADS were included in the present study. Demographic characteristics, Cobb angles, Visual Analog Scale (VAS), Short Form-36 (SF-36), Scoliosis Research Society-22 (SRS-22) and Roland Morris Disability Questionnaires (RMDQ) were noted. Fifteen sessions of physical therapy (hotpack, TENS and ultrasound) and exercises were administered to all patients. All assessment scales were used for evaluation at baseline as well as one month and three months after treatment. <b>Results:</b>Visual Analog Scale scores statistically differed between the first, second and third measurements (p<0,001). There was a significantly improvement in RMDQ between periods of time (p<0,001). While the second assessment was significantly lower than the first measure (p=0,001), there was no difference between the third and second measures (p=0,496). Similarly, quality of life assessments (SRS-22, SF-36) significantly differed between the first and second assessments and continued at the third assessment. <b>Conclusion:</b>Given the difficulties of surgical treatment and patients' comorbidities, conservative treatment methods are becoming important for ADS. Non-surgical treatments for ADS should be taken into consideration to improve pain, disability and quality of life outcomes.</p>","PeriodicalId":74094,"journal":{"name":"Maedica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11079735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140913126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.26574/maedica.2024.19.1.80
Mandar Ramchandra Sane, Kailash U Zine, Sachin Darandale, Harshal Thube
Burned corpses are of medicolegal importance as circumstances may suggest means that are used for committing or concealing homicidal death or death occurring due to accidental causes. Postmortem burns, which may include homicidal burns (torch murder) or burns used to conceal the crime, are committed with the motive of identity destruction, transposing the cause and manner of death and destruction of evidence. The present study aimed to analyse the cases of postmortem burns in the context of the cause of death, manner of death and circumstances pertaining to death. This is a retrospective study performed in the Government Medical College δ Hospital, Aurangabad (MH), India, between 1 January 2009 - 31 December 2016. Cases involving burn injuries were examined in detail by autopsy reports, toxicological analyses, crime scene investigation and police records submitted at the Institute's office. A careful examination of vitality signs of burns, soot deposition in the lower respiratory tract and the presence of other fatal injuries was performed for each case. Cases exposed to fire before death were all excluded. Similarly, bodies being charred to such an extent to prevent distinguishing the vitality of burns were also excluded. Postmortem burns were recorded in 13 cases (0.46%) of deceased bodies to cover homicides. Females were reported to be more commonly involved and more in a household environment. Head injury was the most common cause of death, followed by death due to asphyxia due to any means. The findings of the present study reinforce the fact that burning cannot always effectively destroy the evidence, hindering the perpetrator from covering up the crime. Apart from the evidence at autopsy, a transdisciplinary approach must be initiated with detailed crime scene investigation, toxicology, ascertaining the cause of death with analyses of fatal injuries and contributory data for identification of the deceased.
{"title":"Postmortem Burns to Conceal Homicidal Deaths: an Eight-Year Study.","authors":"Mandar Ramchandra Sane, Kailash U Zine, Sachin Darandale, Harshal Thube","doi":"10.26574/maedica.2024.19.1.80","DOIUrl":"10.26574/maedica.2024.19.1.80","url":null,"abstract":"<p><p>Burned corpses are of medicolegal importance as circumstances may suggest means that are used for committing or concealing homicidal death or death occurring due to accidental causes. Postmortem burns, which may include homicidal burns (torch murder) or burns used to conceal the crime, are committed with the motive of identity destruction, transposing the cause and manner of death and destruction of evidence. The present study aimed to analyse the cases of postmortem burns in the context of the cause of death, manner of death and circumstances pertaining to death. This is a retrospective study performed in the Government Medical College δ Hospital, Aurangabad (MH), India, between 1 January 2009 - 31 December 2016. Cases involving burn injuries were examined in detail by autopsy reports, toxicological analyses, crime scene investigation and police records submitted at the Institute's office. A careful examination of vitality signs of burns, soot deposition in the lower respiratory tract and the presence of other fatal injuries was performed for each case. Cases exposed to fire before death were all excluded. Similarly, bodies being charred to such an extent to prevent distinguishing the vitality of burns were also excluded. Postmortem burns were recorded in 13 cases (0.46%) of deceased bodies to cover homicides. Females were reported to be more commonly involved and more in a household environment. Head injury was the most common cause of death, followed by death due to asphyxia due to any means. The findings of the present study reinforce the fact that burning cannot always effectively destroy the evidence, hindering the perpetrator from covering up the crime. Apart from the evidence at autopsy, a transdisciplinary approach must be initiated with detailed crime scene investigation, toxicology, ascertaining the cause of death with analyses of fatal injuries and contributory data for identification of the deceased.</p>","PeriodicalId":74094,"journal":{"name":"Maedica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11079746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140913054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01DOI: 10.26574/maedica.2023.18.4.726
Daniela Maria Nemtut Roman, Cornel Adrian Petreanu, Ruxandra Ulmeanu
We describe the case of a male patient who remarkably survived two severe cardiovascular events: ascending aortic dissection and descending aortic dissection two years later. Later, the third occurrence of aortic dissection, this time involving the abdominal aorta, became an absolute nightmare for the patient, progressively being complicated by periaortic hematoma and severe anemia - events that ultimately led to his death.
{"title":"Aortic Dissection: Spectacular Survival or Nightmare?","authors":"Daniela Maria Nemtut Roman, Cornel Adrian Petreanu, Ruxandra Ulmeanu","doi":"10.26574/maedica.2023.18.4.726","DOIUrl":"10.26574/maedica.2023.18.4.726","url":null,"abstract":"<p><p>We describe the case of a male patient who remarkably survived two severe cardiovascular events: ascending aortic dissection and descending aortic dissection two years later. Later, the third occurrence of aortic dissection, this time involving the abdominal aorta, became an absolute nightmare for the patient, progressively being complicated by periaortic hematoma and severe anemia - events that ultimately led to his death.</p>","PeriodicalId":74094,"journal":{"name":"Maedica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10859211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139725214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01DOI: 10.26574/maedica.2023.18.4.555
Andrei Tarus, Cristian-Traian Paius, Alberto-Emanuel Bacusca, Laura Benchea, Silviu-Paul Stoleriu, Adi-Petrisor Ungurianu, Mihail Enache, Grigore Tinica
Introduction: Severe aortic stenosis is often associated with left ventricular hypertrophy (LVH). Elevated left ventricular mass (LVM) is linked to higher cardiovascular morbidity and mortality. Traditionally, surgical aortic valve replacement (SAVR) has been the standard treatment, but transcatheter aortic valve implantation (TAVI) offers an alternative for high-risk surgical patients. Understanding how these interventions affect left ventricular mass regression is crucial. Materials and methods: This retrospective study analyzed 315 patients treated between December 2014 and December 2022, categorizing them into surgical and transcatheter treatment groups. Clinical and echocardiographic data were collected at baseline and six-month follow-up. Statistical analysis assessed differences between groups and predictors of LV mass reduction. Results:The overall dataset indicated an average percentage reduction in LVM of 10.86%±29.41%. Segmenting the data, the TAVI subgroup exhibited a reduction of 4.28%±30.31%, while the SAVR subgroup highlighted a pronounced decline of 17.92%±26.76%. Preoperative LVMi and mean pressure gradient positively correlated with LVM reduction, while TAVI negatively impacted it. Conclusions: Both TAVI and SAVR interventions yield benefits in reducing left ventricular mass, with SAVR showing a superior outcome. Recognizing predictors of LV mass regression is crucial for optimizing treatment strategies, and early valve replacement should be considered to prevent irreversible LV hypertrophy.
{"title":"Comparative Analysis of Left Ventricular Mass Regression Following Transcatheter Aortic Valve Implantation and Surgical Aortic Valve Replacement - a Single Center Experience from Romania.","authors":"Andrei Tarus, Cristian-Traian Paius, Alberto-Emanuel Bacusca, Laura Benchea, Silviu-Paul Stoleriu, Adi-Petrisor Ungurianu, Mihail Enache, Grigore Tinica","doi":"10.26574/maedica.2023.18.4.555","DOIUrl":"10.26574/maedica.2023.18.4.555","url":null,"abstract":"<p><p><b>Introduction:</b> Severe aortic stenosis is often associated with left ventricular hypertrophy (LVH). Elevated left ventricular mass (LVM) is linked to higher cardiovascular morbidity and mortality. Traditionally, surgical aortic valve replacement (SAVR) has been the standard treatment, but transcatheter aortic valve implantation (TAVI) offers an alternative for high-risk surgical patients. Understanding how these interventions affect left ventricular mass regression is crucial. <b>Materials and methods:</b> This retrospective study analyzed 315 patients treated between December 2014 and December 2022, categorizing them into surgical and transcatheter treatment groups. Clinical and echocardiographic data were collected at baseline and six-month follow-up. Statistical analysis assessed differences between groups and predictors of LV mass reduction. <b>Results:</b>The overall dataset indicated an average percentage reduction in LVM of 10.86%±29.41%. Segmenting the data, the TAVI subgroup exhibited a reduction of 4.28%±30.31%, while the SAVR subgroup highlighted a pronounced decline of 17.92%±26.76%. Preoperative LVMi and mean pressure gradient positively correlated with LVM reduction, while TAVI negatively impacted it. <b>Conclusions:</b> Both TAVI and SAVR interventions yield benefits in reducing left ventricular mass, with SAVR showing a superior outcome. Recognizing predictors of LV mass regression is crucial for optimizing treatment strategies, and early valve replacement should be considered to prevent irreversible LV hypertrophy.</p>","PeriodicalId":74094,"journal":{"name":"Maedica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10859189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139725242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: Infertility is a complex condition that depends on numerous mechanisms regarding its occurrence and evolution. It does not appear as a single pathology, and therefore the diagnosis and management involve both the identification of etiological causes and other possible systemic interactions. Infertility is defined as a succession of unsuccessful attempts of unprotected intercourse within a couple for 12 months, during the reproductive life. Among the many causes related to infertility, uterine pathology has an important place and hysteroscopy is outstanding in diagnosing and treating various pathologies in this category. Material and methods: This descriptive study was conducted on a retrospective analysis of a group of patients from Bucur Clinical Hospital, Bucharest, Romania. The main data were obtained from medical electronic records and included the type of infertility, associated diagnoses and symptoms, previous investigations, hysteroscopic procedure and follow-up. In order to obtain the database, the above parameters were evaluated and processed in the IBM SPSS Statistics version 28, including other few graphs processed in Microsoft Office Excel 2007. Results:The present study included 51 patients aged between 20 and 40 years, with a mean of 32.02 ± 3.7. Out of the total number of patients, 76.47% of participants to the present study were diagnosed with secondary infertility and 58.82% described menometrorrhagias as the most common symptom. Endometrial polyps were more frequently associated with menometrorrhagias (70% of patients), while synechiae and secondary amenorrhea were found together in 75% of cases. Previous ultrasound evaluation identified uterine cavity abnormalities as nonhomogeneous echo-pattern in 58.82% of cases, with some of them being suggestive of endometrial polyps (37.25%), intrauterine synechiae (3.92%) and uterine fibromas (9.8%). We noticed that 12% of cases required laparoscopy and 4% laparotomy. The outcomes of hysteroscopic management resulted in a conception rate of 39%. We found that 20% of pregnancies achieved were complicated with placenta praevia, 5% with gestational hypertension and 15% with imminence of abortion. Conclusions:Secondary infertility was more frequently encountered than primary infertility and the most common associated manifestations included menometrorrhagia, followed by secondary amenorrhea and pelvic-abdominal pain. Transvaginal ultrasound was correlated with hysteroscopic diagnosed pathology; posthysteroscopic results were favourable, regardless of the size and location of changes in the uterine cavity, thus highlighting the importance of hysteroscopic therapeutic techniques in increasing the chances of conception.
目的:不孕症是一种复杂的病症,其发生和演变取决于多种机制。它并不是一种单一的病理现象,因此在诊断和治疗时既要找出病因,又要考虑其他可能的系统性相互作用。不孕症的定义是在生育期内,一对夫妇连续 12 个月在无保护措施的情况下性交失败。在与不孕症相关的众多病因中,子宫病变占有重要地位,而宫腔镜检查在诊断和治疗这类病变方面具有突出的优势。材料和方法:这项描述性研究对罗马尼亚布加勒斯特布库尔临床医院的一组患者进行了回顾性分析。主要数据来自医疗电子记录,包括不孕症类型、相关诊断和症状、既往检查、宫腔镜手术和随访。为了获得数据库,上述参数在 IBM SPSS 统计软件 28 版中进行了评估和处理,包括在 Microsoft Office Excel 2007 中处理的其他一些图表。结果:本研究共纳入 51 名患者,年龄在 20-40 岁之间,平均年龄(32.02±3.7)岁。在所有患者中,76.47%的人被诊断为继发性不孕,58.82%的人将子宫出血描述为最常见的症状。子宫内膜息肉更常与月经失调相关(70%的患者),而75%的病例同时发现了子宫内膜息肉和继发性闭经。之前的超声评估发现,58.82%的病例宫腔异常为非均质回声形态,其中一些病例提示有子宫内膜息肉(37.25%)、子宫内膜异位症(3.92%)和子宫肌瘤(9.8%)。我们注意到,12%的病例需要进行腹腔镜检查,4%的病例需要进行开腹手术。宫腔镜手术的受孕率为 39%。我们发现,20%的妊娠并发前置胎盘,5%并发妊娠高血压,15%并发即将流产。结论:继发性不孕比原发性不孕更常见,最常见的相关表现包括月经失调,其次是继发性闭经和盆腹痛。经阴道超声与宫腔镜诊断的病理相关;无论宫腔内病变的大小和位置如何,宫腔镜检查后的结果都是好的,这突出了宫腔镜治疗技术在增加受孕机会方面的重要性。
{"title":"Hysteroscopy for Infertility in Young Women - Our Experience.","authors":"Cristina Diana Popescu, Romina-Marina Sima, Mihaela Amza, Tina Ioana Bobei, Silvia Cirstoiu, Liana Ples","doi":"10.26574/maedica.2023.18.4.631","DOIUrl":"10.26574/maedica.2023.18.4.631","url":null,"abstract":"<p><p><b>Objective:</b> Infertility is a complex condition that depends on numerous mechanisms regarding its occurrence and evolution. It does not appear as a single pathology, and therefore the diagnosis and management involve both the identification of etiological causes and other possible systemic interactions. Infertility is defined as a succession of unsuccessful attempts of unprotected intercourse within a couple for 12 months, during the reproductive life. Among the many causes related to infertility, uterine pathology has an important place and hysteroscopy is outstanding in diagnosing and treating various pathologies in this category. <b>Material and methods:</b> This descriptive study was conducted on a retrospective analysis of a group of patients from Bucur Clinical Hospital, Bucharest, Romania. The main data were obtained from medical electronic records and included the type of infertility, associated diagnoses and symptoms, previous investigations, hysteroscopic procedure and follow-up. In order to obtain the database, the above parameters were evaluated and processed in the IBM SPSS Statistics version 28, including other few graphs processed in Microsoft Office Excel 2007. <b>Results:</b>The present study included 51 patients aged between 20 and 40 years, with a mean of 32.02 ± 3.7. Out of the total number of patients, 76.47% of participants to the present study were diagnosed with secondary infertility and 58.82% described menometrorrhagias as the most common symptom. Endometrial polyps were more frequently associated with menometrorrhagias (70% of patients), while synechiae and secondary amenorrhea were found together in 75% of cases. Previous ultrasound evaluation identified uterine cavity abnormalities as nonhomogeneous echo-pattern in 58.82% of cases, with some of them being suggestive of endometrial polyps (37.25%), intrauterine synechiae (3.92%) and uterine fibromas (9.8%). We noticed that 12% of cases required laparoscopy and 4% laparotomy. The outcomes of hysteroscopic management resulted in a conception rate of 39%. We found that 20% of pregnancies achieved were complicated with placenta praevia, 5% with gestational hypertension and 15% with imminence of abortion. <b>Conclusions:</b>Secondary infertility was more frequently encountered than primary infertility and the most common associated manifestations included menometrorrhagia, followed by secondary amenorrhea and pelvic-abdominal pain. Transvaginal ultrasound was correlated with hysteroscopic diagnosed pathology; posthysteroscopic results were favourable, regardless of the size and location of changes in the uterine cavity, thus highlighting the importance of hysteroscopic therapeutic techniques in increasing the chances of conception.</p>","PeriodicalId":74094,"journal":{"name":"Maedica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10859202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139725246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-01DOI: 10.26574/maedica.2023.18.4.722
Aikaterini Lianou, George Alexiou, Athina Zarachi, Evangelos Giotakis, Vasileios Ragos
Nasal masses are a clinical entity with great diversity. They present with various symptoms such as nasal obstruction, facial pain, discomfort, epistaxis, headache, anosmia and visual disturbances. Especially unilateral nasal masses are very suspicious and must be differentiated between benign and malignant lesions. Nasal endoscopy is a weapon in the quiver of otorhinolaryngologists. It is an innovative, quick, direct and inexpensive examination that can be performed even at the otorhinolaryngologist's office. Immediate imaging of lesions within the nasal cavity allows rapid initiation of treatment. This article highlights the importance of correct differential diagnosis of a unilateral nasal mass in a 37-year-old female patient.
{"title":"Unilateral Nasal Mass Mimicking Tumor in a Young Patient: The Value of Differential Diagnosis.","authors":"Aikaterini Lianou, George Alexiou, Athina Zarachi, Evangelos Giotakis, Vasileios Ragos","doi":"10.26574/maedica.2023.18.4.722","DOIUrl":"10.26574/maedica.2023.18.4.722","url":null,"abstract":"<p><p>Nasal masses are a clinical entity with great diversity. They present with various symptoms such as nasal obstruction, facial pain, discomfort, epistaxis, headache, anosmia and visual disturbances. Especially unilateral nasal masses are very suspicious and must be differentiated between benign and malignant lesions. Nasal endoscopy is a weapon in the quiver of otorhinolaryngologists. It is an innovative, quick, direct and inexpensive examination that can be performed even at the otorhinolaryngologist's office. Immediate imaging of lesions within the nasal cavity allows rapid initiation of treatment. This article highlights the importance of correct differential diagnosis of a unilateral nasal mass in a 37-year-old female patient.</p>","PeriodicalId":74094,"journal":{"name":"Maedica","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10859205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139725255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}