The scope of the study was to identify the associated risk factors of lower limb lymphedema development in cervical and endometrial cancer patients. We retrospectively analysed 326 patients: 186 cases (57.06%) with cervical cancer and 140 cases (42.94%) with endometrial cancer were treated in Surgery, Radiotherapy, Oncology and Gynaecology Clinics of 'St. Apostle Andrew' Emergency Clinical Hospital Galati over 9 years. Adjuvant radiotherapy was performed in 83.57% of endometrial cancer cases. Adjuvant chemotherapy was performed in 45.16% of cervical cancer cases. Over 10 lymph nodes were removed in 74.73% of cervical cancer patients. Incidence of lymphedema was 15.05% in cervical cancer patients and 10% in endometrial cancer patients, P=0.06. Analysed risk factors for lower limb lymphedema occurrence were: Age, disease stage, radiotherapy, number of invaded lymph nodes (for cervical cancer patients), number of removed lymph nodes (for cervical cancer patients) and obesity. Multivariate analysis for associated risk factors of lower limb lymphedema development in cervical cancer showed that number of removed lymph nodes, OR=2.109 (0.907-4.903), P<0.0001, number of lymph nodes with metastasis, OR=1.903 (0.253-4.332), P=0.004 and obesity, OR=1.713 (0.226-2.967), P= 0.006 were found as statistically significant risk factors for lower limb lymphedema onset. For endometrial cancer patients, obesity, OR=1.518 (0.721-2.75), P=0.0003, was the only associated risk factor with statistical significance for the lower limb lymphedema development. Lower limb lymphedema represents one of the adverse reactions of multimodal treatment in gynaecological cancers which affects patient's quality of life. Lower limb lymphedema occurrence is related with number of risk factors, the most important being removed lymph nodes, obesity and radiotherapy.

Natural killer (NK)/T-cell lymphomas represent a rare type of lymphoid malignancy with mostly extranodal involvement, having NK cell or (rare) T cell lineage, classified by the World Health Organization into several subtypes which can involve the head and neck region, with the most frequent one being the nasal type. This article presents the case of a 31-year-old patient who presented at the Emergency Unit of Saint Andrew Emergency Clinical Hospital of Galati suffering from mycosis fungoides-like cutaneous lesions, associated with partial left eyelid ptosis of unknown etiology, as well as a poor health status with fever and respiratory failure. The final diagnosis was NK/T-cell non-Hodgkin lymphoma, possibly nasal type with medium sized T cells. The complexity of the rare diagnosis, associated with the unusual rapid patient evolution towards exitus 3 months after diagnosis, the intra-orbital metastatic involvement and the absence of a standardized treatment are case peculiarities, some of which are consistent with current literature data.

The cytokine storm from the evolution of severe cases of COVID-19, requiring strong immunosuppressive therapies, has raised the issue of reactivation of hepatitis B virus (HBV) infections in these patients. An analysis of the first observational studies in patients with COVID-19 and immunosuppressive therapy and HBV infection along with special clinical cases was presented, as well as personal experience on a series of cases (a group of 958 patients with COVID-19), compared with the analysis of studies performed on patients with HBV infection that underwent biological therapies for psoriasis and personal experience (a group of 81 psoriasis patients treated with biological therapies). Clinical studies have revealed that HBV reactivation in patients undergoing biological therapies for psoriasis, can be prevented with monitoring and treatment protocols and thus, these therapies have been demonstrated to be safe and effective. In COVID-19, immunosuppressive therapies are short-lived but in high doses, and the conclusions of clinical trials are contradictory, but there are published cases of HBV reactivation, which requires a unitary attitude in the prevention of HBV reactivation in these patients. An algorithm was presented for monitoring and treatment of HBV infection for patients with psoriasis treated with biological therapy and the conditions when this protocol can be used for patients with COVID-19 and immunosuppressive therapy.

Opioids are the drugs of choice for medium and high-intensity postoperative pain. Morphine is considered to be the most effective, but it can also lead to an increased risk of allergic reactions, including anaphylactic shock. A retrospective study was conducted, where postoperative positive intradermal skin tests to morphine of 90 patients with total abdominal hysterectomy and bilateral salpingo-oophorectomy were analysed. Patients were categorized in terms of the type of anaesthesia, diet, sugar diet and the amount of alcohol consumed. It was found that the type of anaesthesia significantly influences the frequency of positive intradermal skin test to morphine, which is most common in patients with general anaesthesia and endotracheal intubation (67% vs. 40%; P D 0.01). There is a correlation between the type of anaesthesia and allergy to morphine, but not a very strong one. Diet and alcohol consumed had moderate influence on the frequency of positive intradermal skin test to morphine. There was no correlation observed between sugar consumption and allergy to morphine.

Posterior endodontically treated teeth are exposed to risk fracture due to the great masticatory forces developed in the area. Fiberglass posts are considered a practical solution for such situations, but their main disadvantage yet remains the poor adhesion to the remaining tooth structures. The purpose of the present study was to evaluate a material that could replace the use of fiberglass posts on posterior teeth. 32 premolars were selected and divided into 4 groups (n=8): the first group was considered the control group; the second group was composed of endodontically treated teeth that were filled with gutta-percha, but without any coronal restoration; the third group was composed of teeth that received the same endodontic treatment as in the second group but were restored with a fibreglass post and a light cured microfilled hybrid composite material; the fourth group was similar to the third one, except teeth were restored with a short-fibre-reinforced composite (EverX Posterior, GC Europe N.V., Leuven, Belgium) and a microfilled hybrid composite over it. The fracture resistance of all the teeth was tested using a universal testing device. One-way ANOVA and the Tukey post-hoc variation tests for multiple comparisons were used to analyze the results. The short-fibre-reinforced composite material increased the fracture resistance of endodontically treated teeth (1159.42 N), twice as much as that obtained by using fiberglass posts (522.35 N)). Within the limitations of the present study, EverX Posterior represents a better alternative compared to fiberglass posts in the crown and root reconstruction of posterior endodontically treated teeth.

No abstract

The differential diagnosis of lower limb persistent thrombophlebitis should consider the compression by abdominal aneurysm, consequent to a vascular complication from bacteremia with Salmonella spp.

Intraoperative anaphylactic reactions may range from mild, erythema-like to anaphylactic shock, with tension crash and bronchospasm. The substances considered to be most responsible for the occurrence of intraoperative allergic reactions are neuromuscular blocking agents, antibiotics and latex. Recent studies have identified a new receptor, Mas-Related G-Protein-coupled Receptor X2 (MRGPRX2), considered as a target for some neuromuscular blockers such as atracurium, rocuronium or fluoroquinolone, resulting in pseudoallergic or anaphylactoid reactions. Induction of anesthesia can use both depolarizing myorelaxants, useful especially in emergency situations, in the patient with gastric plenitude or at high risk of intubation, and non-depolarizing myorelaxants such as atracurium, cisatracurium and rocuronium. Succinylcholine has a short time of action and it is rapidly metabolized. Atracurium, although having a slightly longer time to action, has the benefit of a low risk of increased levels of potassium in blood, which is extremely important in patients with cardiac pathology or associated kidney diseases. The present study compared the side effects of systemic anesthesia with succinylcholine vs. atracurium.