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Nicoleta F. Dumitru and Daniela I. Bartos

Summary

Angiosarcoma is a rare malignant tumor of vascular endothelial cell origin, accounting for 1-2 % of all sarcomas. We present a 24-year-old female patient, initially diagnosed and treated for tuberculous pleurisy for one month. Then transthoracic echocardiography (TTE) revealed a rare cause for the pleural and pericardial effusion - a tumoral mass apparently arising from the right atrium and extending into the upper vena cava. The patient presented with worsening dyspnea, stabbing pain in the right hemithorax and persistent, irritating cough, a recent history of haemoptysis, bilateral pleurisy and hemorrhagic pericardial effusion. The ECG showed sinus rhythm with negative T-waves in leads DI, Dll, aVL, V3 to V6. The TTE showed an irregularly shaped right atrial tumoral mass, not resembling a thrombus, which extended to the upper vena cava. The transesophageal echocardiography showed an invasion of the serous (parietal and visceral) pericardium and a dilated right atrium almost completely occupied by the tumoral mass. The CT scan revealed invasion of the upper vena cava ostium and anterior mediastinum with pretracheal adenopathies, and hemorrhagic pleural and pericardial effusion suggestive of a sarcoma. The histological examination and immunohistochemistry confirmed the diagnosis of angiosarcoma. Although a rare form of malignant tumor that affects the head, neck, breast, bone, liver, spleen and heart, angiosarcoma must be considered as a possible cause of pleural and pericardial effusion, especially in previously healthy young patients.

Open access

Emma Weiss, Cristina Japie, Ana Maria Balahura, Daniela Bartos and Elisabeta Badila

Abstract

Background: The Roma population has a high prevalence of cardiovascular risk factors, higher mortality, and shorter life expectancy. It is found in largest numbers in Romania, but published data are still scarce here. We studied cardiovascular risk factors and disease along with target organ damage on a population of Roma inhabitants from Bucharest, Romania.

Methods: This cross-sectional study enrolled, in a community-based participatory research manner, 806 Roma subjects (18-83 years). Demographics included anthropometric data, a questionnaire on social status, education, medical history, and health deleterious behaviors. Medical evaluation included clinical examination, blood pressure, ankle-brachial index, pulse wave velocity measurements, blood tests (complete blood count, lipid profile, glucose, creatinine, uric acid), dip-stick microalbuminuria, dilated fundoscopy, ECG, and echocardiography.

Results: Prevalence of all cardiovascular risk factors was high, peaking in abnormal lipid metabolism (82.13%), heavy smoking (63.02% including ex-smokers) and obesity (50.99%). The first and the latter were actually similar to the general population in Romania. Almost half of subjects were at high or very high risk for fatal cardiovascular disease.

Conclusions: The study shows that the Roma population in a more affluent region in Romania shares a similarly high cardiovascular burden to their surrounding community.

Open access

Elisabeta Bădilă, Mihaela Hostiuc, Emma Weiss and Daniela Bartoş

Abstract

The use of illicit drugs has dramatically increased during the past years. Consequently, the number of presentations at the emergency departments due to the adverse effects of the illicit drugs has also increased. This review discusses the cardiovascular effects of cocaine, opiates and opioids, cannabinoids, amphetamines, methamphetamines and hallucinogens as we consider that it is essential for a clinician to be aware of them and understand their mechanisms in order to optimize the therapeutic management.

Open access

Elisabeta Bădilă, Claudia Negrea, Alina Rîpă, Emma Weiss, Daniela Bartoş and Cristina Tîrziu

Abstract

Background. Syncope is a commonly encountered problem in an emergency hospital. Global cerebral hypoperfusion is the final pathway common to all presentations of syncope, but this symptom presentation has a broad differential diagnosis. It is important to identify patients for whom syncope is a symptom of a potentially life-threatening condition.

Material and methods. We identified adult patients presenting with syncope to the Emergency Department of our hospital from January 2012 to June 2014. Of 590 patients found in the hospital database we further selected 217 patients who met our criteria, namely having a positive diagnosis of syncope (being clearly distinguished from other TLOCs) and an etiology of the disease. Thus, definite diagnosis was established retrospectively by reviewing medical records.

Results. The demographics of our group shows a slightly different distribution between men and women (49% men and 51% women) and a majority of the urban population (67%). As for the age range, most of our patients were in the age group of 70-80 years (30%), 29% were > 80 years old, and the percentage decreases significantly in the 60-70 years range (17%). The most frequent causes of syncope were cardiac (32%), vasovagal (23%) and due to orthostatic hypotension (12%), but we have also found various cases of mixt or iatrogenic causes.

Conclusions. The incidence of syncope increases sharply after 70 years of age and poses special consideration in light of multiple comorbid conditions, age-related changes, atypical presentation, and concomitant medication use. The most common causes of syncope in this population are cardiac causes, orthostatic hypotension and carotid sinus hypersensitivity. Often, root cause of syncope remains undiagnosed, despite exhaustive diagnostic testing.

Open access

Ana Maria Balahura, Andrada Guţă, Vlad Mihalcea, Emma Weiss, Maria Dorobanţu, Daniela Bartoş, Elisabeta Bădilă and Gheorghe Andrei Dan

Abstract

Introduction. Pulmonary thromboembolism (PTE) represents a medical emergency and is the third most common cause of mortality after myocardial infarction and stroke. The purpose of this study was to describe the characteristics and management of patients with PTE admitted in a referral emergency hospital in Romania.

Material and methods. We retrospectively reviewed all cases of PTE diagnosed in one of the largest emergency hospitals in Bucharest during a 2-year period (January 2014 – December 2016). Patients with acute PTE were identified by a database search of the diagnostic codes of all discharge diagnoses. Demographic, clinical and paraclinical tests data was retrieved from medical records.

Results. 221 patients (48.87% male, mean age 61.76 years (range 21-94 years)) were diagnosed with PTE in our hospital (0.31% of all hospitalizations). Dyspnea was the most frequent symptom reported (78.9%), followed by pleuritic chest pain (23.9%) and unilateral leg pain (15.8%). Upon presentation, 12.6% of patients had high-risk PTE. Up to 72.8% of patients had at least one thrombotic risk factor, while cancer (14%) was the most frequent amongst them. The mean length of hospitalization was 10.3 ± 4.6 days. Unfractioned heparin (UFH) was the preferred anticoagulant during hospital stay (73.7%, p < 0.001). Vitamin K antagonists (AVK) were the preferred anticoagulant (71.7%, p < 0.001) after discharge, whereas non-antivitamin K oral anticoagulants (NOAC) were recommended in 26.3% of patients. Thrombolysis was used in 18 (8.4%) cases. Mortality was 0.9%. Younger patients more frequently associated thrombophilia or a previous thromboembolic event and clinical signs of DVT at presentation. Older patients associated more frequently a history of hospitalization for heart failure or atrial fibrillation during the previous 3 months and a history of cancer. The clinical presentation in older patients was more severe, with higher PESI scores (103.6 ± 33.4 vs. 55.5 ± 17.9, p<0.001) and a longer hospital stay (10.7 ± 4.7 vs. 9.2 ± 3.9, p = 0.03). The type of anticoagulant treatment did not differ depending on age.

Conclusion. In our emergency hospital, PTE is a relatively rare cause of hospitalization; the rate is, however, comparable with other major hospitals. Dyspnea and pleuritic chest pain was the clinical presentation dyad. UFH was the preferred anticoagulant for in-hospital treatment while AVK was the preferred option for long term treatment and recurrence prophylaxis; however an increasing number of patients are prescribed NOAC. In older patients clinical severity was higher upon presentation, hospitalization duration was increased and cancer was more frequently associated. Younger patients associated more frequently a primary hypercoagulable state and recurrent thromboembolism. Mortality rate was low during hospitalization, comparable with that seen in other studied populations.