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  • Author: Marius Florin Coroș x
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Abstract

Introduction: The aim of this presentation is to highlight the usefulness of high-frequency ultrasound (18 MHz) in localized morphea for: identification of the lesion, guided skin biopsy, quantification of skin thickness, evaluating the severity by measuring total echogenicity.

Case presentation: A 62-year-old Caucasian woman was referred to the Dermatology Department for a well-circumscribed indurate plaque localized on the right side of the abdominal wall and thigh. On clinical examination, a large well-delimited, indurate plaque, silvery in the center and surrounded by a purplish-red halo (lilac ring) was noticed on the right side of the abdomen and thigh. An ultrasound-guided punch biopsy was carried out and the microscopic examination of the biopsy revealed moderate interstitial inflammatory infiltrate together with abundant collagen bundles in the dermis and subcutis and a diagnosis of localized morphea (scleroderma) was established. Ultrasonography was performed and skin thickness was measured using high-frequency US (18 MHz) and was found to be 3.1 mm to 3.9 mm.

Conclusion: high frequency ultrasound is an inexpensive, easy to perform, noninvasive method, replacing surgical biopsy and offering a valuable quantification of skin fibrosis.

Abstract

Malignant melanoma is a neoplasia that has its origin in the melanocytes, the melanin-synthesizing pigment cells present in the epidermis or sometimes in the dermis. Sentinel lymph node biopsy (SLNB) is the standard procedure used for staging patients with malignant melanoma in the majority of surgical centers in the world. With a probability of approximately 20% of finding positive lymph nodes, it spares a large number of patients of a complete lymphatic dissection. The aim of this study is to evaluate the factors that can predict the positivity of sentinel lymph nodes in malignant melanoma patients. We performed a retrospective study analyzing the histopathologic reports of patients who underwent SLNB for malignant melanoma between 2012 and 2015. There were 32 patients identified, out of which only three (9.37%) had positive SLN, so the majority of our patients were spared of regional lymphatic dissection. In our series, lymphatic invasion (p = 0.01), Breslow index >4 mm (p = 0.0064), AJCC staging (p = 0.0008), the presence of precursory lesions (p = 002), and microsatellitosis (p = 0.017) were predictive factors for the positivity of the SLN in malignant melanoma patients. Although our results are similar to those published in the literature, we consider that larger cohort studies should be performed to consolidate our results.

Abstract

Background: Clostridium difficile (CD) is the major cause of nosocomial antibiotic-associated infections, having as main manifestation diarrhea and life-threatening inflammation of the colon. Surgery may be necessary in up to 80% of patients due to the frequent complications associated with this condition. The mortality rate of this devastating disease could reach 50% even after proper treatment.

Case report: We report a case of a 24-year-old female who was admitted with clinical signs of an odontal inflammatory process. After repeated surgical treatments and antibiotic therapy, she presented acute abdominal pain on the 14th postoperative day. The explorative laparotomy was negative. Clostridium difficile was isolated from her stool, and she was transferred to the Department of Infectious Diseases. After a few days without any favorable clinical outcome, she was transferred to the intensive care unit (ICU), where she developed acute respiratory distress syndrome. Despite the immediate surgical intervention and ICU care, she died within 15 days after admission.

Conclusions: CD infection is considered a complication of antibiotic treatment, having as main cause the combination of fluoroquinolones with antisecretory drugs. In the first phase, the changes of the colon can be minimal with the manifestation of a false acute surgical abdomen, but toxic colon can develop in evolution, leading to multi-system organ failure and death.

Abstract

Objective: To evaluate and demonstrate the accuracy of fine-needle aspiration (FNA) in thyroid lesions in our department and to highlight probable causes of errors leading to unsatisfactory sampling, which may depend on the characteristics of the nodule.

Methods: This is a retrospective study conducted on 319 diagnosed cases of thyroid nodules referred to the Surgery Unit of Puls hospital, Tîrgu Mureș in the January 2014 – December 2015 period, who underwent fine-needle aspiration. Histological examination was considered to be the gold standard; therefore we compared the cytological diagnosis with the histological one.

Results: Of the 319 cases, 289 (90.6%) were female and 30 (9.4%) male patients; 210 cases (69.3%) were interpreted as benign, 46 cases (15.2%) as follicular lesion of undetermined significance, 4 cases (1.3%) as suspect for malignancy, 1 case (0.3%) as malignant sampling, and 42 cases (13.9%) as unsatisfactory. We compared the results of fine-needle aspiration cytology (FNAC) with the corresponding histopathological results (49 in total). FNAC achieved a sensitivity of 76.47%, a specificity of 83.1%, a positive predictive value of 35.1%, a negative predictive value of 96.7%, a false positive rate of 16.9%, a false negative rate of 23%, and an overall accuracy of 82.3%.

Conclusions: The results of our study demonstrate the accuracy of the FNA technique in the first-line diagnosis of thyroid nodules.