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M. Mară and Oana Dârlău

Abstract

The present study brings new data regarding the landforms occurring on gypsum rocks through the action of denudation processes. The landforms signaled complement the domain literature with natural dams, vertical shafts and reappearing springs, developed at the contact between the Subcarpathians and Berzunţi Mts. The presence of the gypsum dam has slowed down the intensity of erosion processes upstream, in comparison to the neighboring valleys. The analyzed area has also an educational importance, offering sufficient objectives for the knowledge of the local characteristics or for field applications. The perimeter presents sufficient objectives also to be included on the list of protected areas of national interest.

Open access

G. Popescu, A. Giovani, N. Bucur, A. Neacsu, A. Gheorghiu, S. Mara and R.M. Gorgan

Abstract

Introduction: Intracranial epidermoid and dermoid cysts are the result of an embryogenesis dysfunction leading to an abnormal migration of ectodermal cells characterised by a slow and benign rate of growth which is associated with minimal neurological symptoms in large or giant tumors.

Materials and methods: We retrospectively reviewed the case files of 17 patients with epidermoid and dermoid cysts operated using the operative microscope and neuronavigation in our department between January 2011 and December 2015.

Results: Reviewing the case files we selected fourteen patients with epidermoid cysts and 3 patients with dermoid cysts who underwent surgical resection. Most of the cysts were located infratentorial (64%) with a propensity for the CP angle (81%). Total resection was attempted in all cases but was possible in only 13 cases. All cases with subtotal resection were infratentorially located in close relation to the brainstem or cranial nerves.

Conclusion: When the tumor extension reaches beyond the limits of the surgical approach used, the tumor remnant should be addressed in a second surgery. Using the cysternal anatomy and the vessels dissection technique the risks aseptic meningitis and of injuring the cranial nerves are diminished.

Open access

Mara Carsote, Adina Ghemigian, Ana Valea, Anda Dumitrascu, Corina Chirita and Catalina Poiana

ABSTRACT

Introduction The field of Cushing syndrome is a various area; there are still subjects incompletely clarified as the subclinical pattern as well as cortisol producing bilateral adrenal tumours.

Case presentation The paper presents a 67-year old male case previously known with metabolic complications. He had an abdominal ultrasound done for unspecific complains and multiple gallbladder stones together with a right adrenal tumour were found. Later the computer tomography revealed bilateral adrenal tumours of almost 1.5 centimetres diameters (right larger than left) and a morning plasma cortisol level of 2.58 micrograms/ decilitre after low dose of dexametasone suppression test confirming the subclinical Cushing syndrome. After 6 months the endocrine and imagery profile was similar but the gallbladder patter aggravated so surgery was performed (together with right adrenalectomy) by a laparoscopic procedure. The blood pressure profile improved after surgery.

Conclusion Subclinical Cushing syndrome diagnosis is challenging especially if metabolic complications or bilateral adrenal tumours are presented. Based on our observations in this case unilateral adrenalectomy improved the metabolic pattern

Open access

Lilian A. Monteiro, Jefferson S. Novaes, Mara L. Santos and Helder M. Fernandes

Abstract

This study aimed to analyze the effects of age, family income, body mass index and dance practice on levels of body dissatisfaction and self-esteem in female students. The sample consisted of 283 female subjects attending a public school with a mean age of 11.51±1.60 years and a mean body mass index of 18.72 kg/m2 (SD=3.32). The instruments used were the Body Dissatisfaction Scale for Adolescents and the Rosenberg Self-Esteem Scale, both of which showed good internal consistency (0.77 and 0.81, respectively). The tests were applied (two-factor ANOVA) to compare the students practicing and those not practicing dance; the differences in the levels of body dissatisfaction (p=0.104) and self-esteem (p=0.09) were considered significant. The results demonstrated that age negatively correlated with body dissatisfaction (r=-0.19; p<0.01) and that higher body mass index levels were associated with greater body dissatisfaction (r=0.15, p=0.016) and lower levels of self-esteem (r=-0.17, p<0.01) only in non-practitioners. The practice of dance had a significant effect on levels of body dissatisfaction (F=4.79; p=0.030; η2=0.02), but there was no significant difference in self-esteem (F=1.88; p=0.172; η2=0.02). It can be concluded that female children and adolescents practicing dance have higher self-esteem, and are more satisfied with their body weight and their appearance. Moreover, results showed that self-esteem and body dissatisfaction were influenced by the body mass index levels only in the nonpractitioners group.

Open access

R.M. Gorgan, Angela Neacsu, Silvia Mara Baez Rodriguez, G. Popescu, Catioara Cristescu and A. Giovani

Abstract

Schwannomas arise in the cells responsible for the mielinating the neurons distal to the Obersteiner-Redlich zone. Most of the intracranian Schwannomas are in the posterior fossa, developed from the VIIIth or Vth nerve stheath. The location on other cranian nerves is quite rare, only 6% of the orbital tumors being Schwannomas. We review the case of a 52 years old male patient, presenting for right eye exophthalmia and visual field deficit, diplopia due to VIth nerve paresis, and stubbing pain in the right eye, the MRI showing a tumor, located in the orbital apex displaced the globe forward and superiorly, and the optic nerve medially and superiorly. A modified lateral orbital approach was preferred. The choice of the orbitotomy allowed us to maintain the integrity of the lateral rim of the orbit without the need of a bony reconstruction at the end of the intervention, as it faced the anterior margin of the temporal muscle, covering it and not the skin over the zigomatic bone. The technical approach for orbital schwanomas should be tailored to reach the lesion through an esthetic incision and orbitotomy, immediately under the resected bone, with no need retracting the ocular globe or the vasculonervous elements in the orbit.

Open access

Ana Valea, Alexandra Marcusan, Mara Carsote, Adina Ghemigian, Cristina Ghervan and C. Dumitrache

ABSTRACT

Introduction The Rathke cyst represents an unusual benign tumour derived from Rathke’s cleft remnants. The diagnosis is potential seen at any age. The most frequent signs are mostly mass effects as headache, visual field defects and hypopituitarism.

Case presentation 30-year old female is admitted for persistent headache that was later associated with secondary amenorrhea and visual field defects for the last two years. The clinical data are consistent with high levels of serum prolactin, gonadotropes deficiency, as well as central hypothyroidism. The magnetic resonance imagery found a pituitary tumour of 2.7 centimetres with extrapituitary extension up to the optic chiasm. Surgery was performed in order to remove the tumour. The pathologic report confirmed a Rathke’s cleft cyst. Diabetes insipidus associated with panhypopituitarism was diagnosed and treated after the procedure. Close follow-up is necessary.

Conclusion This case highlights the fact that headache sometimes embraces a severe neoplasia diagnosis and that the iatrogenic complications after surgery are lifelong care demanding

Open access

Ana Valea, Andra Morar, D.P. Dumitru, Mara Carsote, Adina Ghemigian and C. Dumitrache

ABSTRACT

Introduction Cushing’s disease is a complex endocrine disorder characterized by excessive glucocorticoid secretion caused by an ACTH-secreting pituitary adenoma. Hyperandrogenism and menstrual disorders such as amenorrhea and oligomenorrhea complete the clinical picture of Cushing’s syndrome. Infertility is relatively common, involving complex pathogenetic mechanisms, which differ depending on the cause of hypercortisolism.

Case presentation We present the case of a female patient diagnosed with Cushing’s disease during the investigations carried out to assess infertility. After transsphenoidal adenomectomy, the patient underwent treatment with pasireotide and dopamine agonists, achieving normalization of gonadotropin and estradiol levels.

Conclusion Current guidelines recommended transsphenoidal adenomectomy as first-line therapy in an attempt to correct hypercortisolism and restore fertility in patients with Cushing’s disease. In case of relapse pasireotide and dopamine agonists can be effective in normalizing the hormonal profile

Open access

Mara Carsote, Ana Valea, Anda Dumitrascu, Cristina Capatina, Diana Paun, Catalina Poiana and Adina Ghemigian

ABSTRACT

Introduction Prolactinomas without galactorhhea may be considered menopause or not diagnosed. This is a cases series.

Case1. 76-year female with menopause at age of 52 was discovered at 66 yrs with high prolactin and a pituitary micro-nodule. Bromocriptin was continued for 6 years then switched to cabergoline with constant imagery. The patient did not display at all galactorrhea. Osteoporosis was diagnosed at age of 66 with previous 2 fragility fractures.

Case2. 45-year female is known with secondary amenorrhea (without galactorrhea) for the last 7 years being considered menopause. She experienced headaches thus a MRI was performed and found a pituitary tumour of 1.5cm. Low FSH with increased prolactin was revealed. Cabergoline was started. Within 2 months the menses resumed and headache mildly improved. After 3 months prolactin normalised under weekly 2 mg of cabergoline. Periodical prolactin control is necessary as well as a pituitary scan at 6 months.

Case3. 39-year female had a 3 yrs history of secondary amenorrhea. A prolactin of 117ng/mL and a microprolactinoma of 0.77cm were found. Cabergoline was started and progressively increased up to 1.5mg per week. The prolactin quickly normalised up to 8ng/mL within 4 months. She was followed for 2 years and the imagery found a tumour reduction to 0.44cm.

Conclusion Prolactinomas associate a great variety of clinical presentations. They interfere with menopause by mimicking it in cases without galactorrhea. Also a newly diagnosed prolactinoma during menopause needs long term therapy and followed-up for especially for bone safety.