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  • Author: Zizi Niculescu x
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Essential thrombocythemia – Incidence of thrombotic complications

Abstract

Essential thrombocytemia is a classic negative chronic myeloproliferative disease BCR-ABL characterized by global myeloid proliferation but mainly on the megacariocitary series. Most symptomatic patients show manifestations due to the vascular thromboses or haemorrhages. The objective of the paper is to evaluate the incidence of thrombotic complications.

The study was carried out in the Haematology Compartment of Constanta County Clinical Hospital on a lot of 60 cases with essential thrombocytemia.

The diagnosis criteria were OMS 2008 criteria.

On the studied lot, on the diagnosis, 45 patients (75%) were symptomatic. Among the symptomatic ones 27 patients (60%) showed thromboembolic manifestations in the moment of the diagnosis or after diagnosis.

The thrombotic manifestations present at the patients with essential thrombocytemia taken for the study were: cerebral micro thromboses - 10 cases; peripheral micro thromboses - 3 cases; erythromelalgia - 6 cases; acrocyanosis - 2 cases; coronary thrombosis - 1 case; portal vein thrombosis - 2 cases; pulmonary thromboembolism - 1 case; thrombosis of placenta vessels- 2 cases.

The thrombocytosis degree is not the only important risk factor for thrombosis. The age over 60 years, arterial hypertension, dyslipidemia, smoking, atherosclerosis, are associated risk factors (independent from thrombocytosis) for the frequency and severity of the thromboses. In this framework, on the one hand the increase of accessibility to the background therapy proven efficient (interferon, anagrelide) and on the other hand the mentioning in the cardiovascular pathology guides of primary and secondary thromboses as risk factors along with hypertension, diabetes, dyslipidemias, etc is required.

Open access
Suggestive symptoms and signs of pulmonary thromboembolism in cardiac failure

Abstract

Pulmonary thrombembolism can be a complication or it can lead to the onset of heart failure. The early diagnosis of pulmonary thromboembolism may make the difference between life and death. The aim of the study was to determine pulmonary thromboembolism incidence in patients with cardiac failure and to attempt diagnosis optimization.

Study group included 150 patients admitted at Medical Clinic II, Emergency Clinical County Hospital Constanta with preexistent known or unknown heart disease, which led to cardiac failure. Patients were suspected with incipient pulmonary thromboembolism. Dyspnea was the most frequently manifested symptom leading to pulmonary thromboembolism suspicion (99%). Pulmonary thromboembolism suggestive dyspnea displayed two forms: sudden onset of dyspnea and increased dyspnea in patients suffering from dyspnea at rest. Thoracic pain was present in approximately 90% of the patients and was manifested in two forms: retrosternal pain, not increasing with respiratory movement, and acute localized thoracic pain, accompanied by hemoptysis and dyspnea; these symptoms suggest pulmonary infarction.

Pulmonary thromboembolism complicates clinically manifested heart failure or precipitates heart failure onset in patients with latent myocardial dysfunction.

Open access
From Symptoms and Signs to Diagnosis in a Rare Disease, Type I Gaucher Disease

Abstract

Gaucher disease is the most frequent lysosomal storage disease, caused by the deficiency of an enzyme called β-glucocerebrosidase. Three types of Gaucher disease are described. Type I Gaucher disease benefits from lifelong enzyme replacement therapy with imiglucerase.

Herein, we present the case of a 34-year-old female patient, a commercial worker, who was admitted to our Department of Haematology in the Emergency Clinical Hospital of Constanta in order to investigate the aetiology of a persistent splenomegaly. Clinical examination and laboratory testing evidenced the following: splenomegaly, hepatomegaly, anaemia, leukopenia and neutropenia, thrombocytopenia, and a myelogram showing Gaucher cells. In this context, the suspicion of Gaucher disease was raised and the investigations were further completed through specific enzyme testing and genetic testing. The low values of lysosomal enzymes, coupled with the detection of two specific genetic mutations confirmed the diagnosis of Gaucher disease.

In January 2017, treatment with 2400U of imiglucerase in intravenous perfusion every two weeks was begun.

Open access
Sick building syndrome, a crossroad in modern occupational medicine assessment

Abstract

Sick building syndrome (SBS) is a complex syndrome consisting of non-specific symptoms with an onset associated with subjects’ presence in some modern building and the disappearance of symptoms shortly after they leave it. The effects of SBS may be the result of a series of protective reactions of the human body triggered by various types of surrounding environment, further suggesting that the human response could be based on a three-phase biological model: sensory perception, low degree inflammatory reactions and environmental stress reactions. Besides stress created by the discomfort of people who develop symptoms, SBS is the cause of an extensive loss of productivity, sickness absenteeism, wasted time in complaints with all the legal punitive issues that arise from them. The subjects diagnosed with SBS are hard to follow-up over time due to workers often leaving their jobs and being lost from cohort databases. Achieving a reputation of a “sick building” may prove difficult to rehabilitate even after expensive repairs and upgrades. In extreme cases closure and even demolition can occur. SBS is an evolving concept and this review we will present part of this evolution and what are the major challenges for its definition.

Open access
Thank God for Lab: Systemic Lupus Erythematosus - A Difficult Diagnosis, a Difficult Disease

Abstract

Systemic Lupus Erythematosus (SLE) involves autoimmune mechanisms that affect multiple systems and has variable clinical manifestations. It affects mainly feminine gender, usually of child-bearing age. Very late onset SLE (patients older than 75 years) is rarely met and difficult to diagnose due to the unspecific symptoms. The diagnosis is frequently mistaken for drug-induced SLE or for other age-specific disorders.

We present the case of a 78 years old male patient complaining of hemoptysis in small amounts, fever, dyspnea at small efforts, weight loss, and important asthenia. Based on physical examination, severe anemia and thoracic CT aspect, several diagnosis were taken into account: anemic syndrome and pleurisy due to refractory pneumonia, pulmonary neoplasm, pulmonary tuberculosis, congestive heart failure and Wegener granulomatosis. Only when direct Coombs test came positive and all the other serological tests resulted negative, diagnosis of SLE was considered. Confirmation came along with high titers of antinuclear antibodies, anti double strained DNA antibodies and lupic anticoagulant and low levels of C3c and C4.

We conclude that the diagnosis of SLE must be taken into consideration even in elder male patients. Therapeutic options in these patients are challenging because of the associated comorbidities and side effects.

Open access