Alice Balaceanu

Alice Balaceanu

Renal Artery Thromboembolism in Paroxysmal Nonvalvular Atrial Fibrillation

Renal thromboembolism is a rare, but severe condition in non-valvular paroxysmal atrial fibrillation, that could remain underdiagnosed. Due to atrial fibrillation the embolus is organized in left atrium and auricle then reach the renal artery with subsequently ischemia. Renal colic could mimic multiple pathologies as nephrolithiasis, pyelonephritis, kidney ischemia, diverticulitis, sub-occlusive intestinal syndrome, ruptured abdominal aortic aneurysm. [...]

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Another Onset Mode for Rheumatoid Arthritis: Emergency Lab, Ultrasound or Both? Case Report and Literature Review

Rheumatoid arthritis is a systemic autoimmune disease, with complex etiology and multiple genetic, immunologic, hormonal factors[1]. The onset could be insidious, like in the most patients or acute, with synovitis and extra-articular manifestations, encountered in 10% of patients[1]. We report a case of a 41 years old woman, non-smoker, without medical history, who complains about inter-mittent leg pain for 2 months, initially left calf, than bilateral, with edema in the both ankle and calf. The patient denied trauma. She is referred to emergency department for deep vein thrombosis suspicion [...]

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Diagnostic Challenges in Atypical Pulmonary Carcinoid

The spectrum of neuroendocrine tumors (NETs) of the lung is wide and heterogeneous, ranging from well-differentiated bronchial neuroendocrine tumors to highly malignant and poorly differentiated small cell lung cancer and large cell neuroendocrine carcinoma. NETs of the lung share both morphologic and immunohistochemical characteristics with neuroendocrine tumors. [...]

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Worsening Renal Function in Elderly Patients with Heart Failure and Chronic Kidney Disease: An Update

Chronic kidney disease (CKD) is defined as either kidney damage or eGFR (estimated glomerular filtration rate) < 60 mL/min/1.73 m2 for three or more months [1]. Elderly patients have often an impaired basal renal function due to intrinsic renal disease or to a physiological decrease in the number of functional nephrons [2]. Half of adults over the age of 70 years have eGFR < 60 mL/min/1.73 m2 [3]. CKD occurs in about 4.5% of the general population and 50% in patients with chronic or acute heart failure (HF) [4]. Commonly, CKD can be associated with chronic heart failure in elderly patients [2] [...]

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Peripheral Arterial Disease in Hemodialysed Patients

There is increased evidence that the prevalence of peripheral artery disease (PAD) in hemodialysed patients is higher than in general population [1,2]. According to ACC/AHA (American College of Cardiology / American Heart Association) guidelines, the following risk factors are associated with PAD [3,4]

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HYPONATREMIA IN PREDIALYSIS HOSPITALIZED PATIENTS: AN UPDATE ON CLINICAL DATA AND MANAGEMENT

Hyponatremia, with an incidence of 15 - 22%, is considered when serum sodium levels are < 135 mEq/L (in institutionalized geriatric patients, in 1 - 4% to 7 - 53% cases there have been reported values below 130 mEq/L) [1-3]. Additionally, according to expert panel recommendations the frequency of hyponatremia in hospitalized patients depends on the detected level of hyponatremia [2]. This special condition is highly important to be detected on time because it represents a recognized risk factor of morbidity and mortality, even in asymptomatic patients [1]. Furthermore, it was noticed that a swift correction can induce severe neurological disorders and even death [1]. Therefore, for an adequate treatment management (prophylaxis and therapy) is vital for understanding hyponatremia main causes and the incriminated pathophysiological mechanisms [1].

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LIVER FUNCTION TESTS ANOMALIES IN PATIENTS WITH CHRONIC HEART FAILURE

Chronic heart failure is a major public health problem, with increasing prevalence due to population aging and increased survival of cardiovascular patients. Chronic heart failure is a clinical syndrome characterized by a variety of effects on other organs and systems. Occasionally, patients with chronic heart failure may present with signs and symptoms of a noncardiac disorder, such as hepatic dysfunction. The main pathophysiologic mechanism involved in hepatic dysfunction of patients with heart failure is either passive congestion due to increased filling pressures or low cardiac output and the consequences of impaired perfusion. Passive hepatic congestion may lead to increase of liver enzymes and total bilirubin. Right ventricular dysfunction can be associated with severe hepatic congestion, which can be asymptomatic and revealed only by abnormal liver function tests. When hemodynamic abnormalities are prolonged, the hepatic function is further altered, with impaired coagulation tests and decreased albumin synthesis. Morphologically, the liver becomes fibrotic and ultimately cardiac cirrhosis appears. Decreased perfusion from low cardiac output may be associated with hepatocellular necrosis and increased serum aminotransferases. Acute cardiogenic liver injury appears in severe systemic hypotension due to exacerbation of heart failure
the level of aminotransferases increases, as well as lactic dehydrogenase and prothrombin time.
The aim of our study was to evaluate the frequency and the importance of liver function tests abnormalities in a group of patients with chronic heart failure, as well as the prognostic value of these liver tests.

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Vascular Calcifications, Major Risk Factor for Cardiovascular Events in Chronic Kidney Disease: An Update on the Pathophy...

Hypertension, diabetes mellitus, dyslipidaemia are frequently encountered in patients with chronic kidney disease (CKD) (1). They are the major risk factors for the development and progression of the endothelial dysfunction and atherosclerosis and contribute to the progression of renal failure (1). Microalbuminuria increases to two- to four-fold the cardiovascular risk (1). It is also a quantitative association between glomerular filtration rate (GFR) and cardiovascular risk (1). The risk increase to two to four-fold in stage 3 of CKD (GFR 30-59 mL/min/1.73 m²), four- to 10-fold in stage 4 (GFR 15-29 mL/min/1.73 m²) and 10- to 50-fold in stage 5 renal failure (GFR <15 mL/min/1.73 m² OR dialysis) in comparison with persons free of CKD (1). Atherosclerosis with intimal involvement and Moenckeberg’s media sclerosis are the main cardiovascular determinations in CKD. Coronary artery calcifications attain the highest levels in young adults patients with renal failure and dialysis, as has been shown in angiographic studies (2). These patients have many coronary risk factors leading to intimal calcifications and these are coexisting with medial calcification founded only in CKD (2). The degree of coronary artery calcifications seems to be related to the estimated GFR in a multivariate analysis (2). KDIGO guidelines recommend that patients with CKD stages 3-5D with known vascular/valvular calcification be considered at highest cardiovascular risk (class 2A recommendations) (3).

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