Myocarditis is an inflammatory disease of the myocardium, that can be produced by a multitude of infectious or noninfectious agents. The incidence rate of the disease is between 10 to 22 per 100,000 individuals. Among the infectious causes, viruses are considered to be the most frequent pathogens. Regarding the clinical presentation, viral myocarditis may have a wide variety of manifestations, ranging from asymptomatic disease to chest pain, myalgia, fatigue, heart failure, arrhythmias and, in some cases, sudden death. A definitive diagnosis of viral myocarditis involves histological evidence for myocarditis associated with positive viral polymerase chain reaction (PCR). Endomyocardial biopsy represents the gold standard for diagnosis; in the absence of histological, immunologic and immunohistochemical criteria, a definitive diagnosis cannot be established.

Introduction: Ankylosing spondylitis is a chronic inflammatory disorder which primarily affects the axial skeleton, the major characteristic of the disease being the early involvement of the sacroiliac joints. The condition manifests by chronic inflammatory back pain and, as the disease progresses, patients will develop extreme impairment of spinal mobility because of spinal fusion. Case presentation: A 66-year-old man, diagnosed with HLA-B27-positive ankylosing spondylitis, permanent atrial fibrillation, ischemic cardiac disease, arterial hypertension, type 2 diabetes mellitus and stage 3A chronic kidney disease, was admitted for cervicalgia radiated to both shoulders and bilateral mechanical gonalgia. His son was also diagnosed with ankylosing spondylitis at the age of 29 years. Regarding the history of ankylosing spondylitis treatment, initially, the patient was prescribed nonsteroidal antiinflammatory drugs (NSAIDs); because of the inadequate response to NSAIDs, biological therapy with an anti-TNF agent was initiated (Infliximab). Fifteen months after the initiation of Infliximab, the patient presented with worsening symptoms; anti-Infliximab antibodies were detected, therefore he was switched to another anti-TNF agent, Adalimumab. Upon current admission, the clinical examination revealed thoracic kyphosis and marked limitation of cervical and lumbar spine mobility. Blood tests revealed mild anemia, inflammatory syndrome and azotate retention. The pelvic X-ray showed grade 3-4 bilateral sacroiliitis. The continuation of treatment with Adalimumab and Sulfasalazine was decided, with close monitoring of the patient. Conclusions: Ankylosing spondylitis is a multisystem inflammatory disorder, whose natural course includes periods of flares and remission. The peculiarity of this case consists in the early development of anti-Infliximab antibodies (secondary non-responder).

Background: Hydrofluoric acid (HF) is an extremely dangerous weak inorganic acid, which can produce extensive burn lesions, depending especially on the solution concentration and exposure time, systemic toxicity occurring in patients with large burn areas, high concentration of acid or an extensive time of exposure. The subcutaneous infiltration and intravenous administration of calcium gluconate is essential for preventing dyselectrolytemia and severe pain appearance. Case summary: A 26-year-old man patient presented to our hospital after a hydrofluoric burn, secondary to an occupational accident. At the scene, the wound was irrigated with fresh water and topical calcium gluconate was applied. In the Emergency Department, we started the intravenous calcium gluconate administration, and in the Burn Unit it was injected subcutaneously and the pain was thus diminished. A prolonged QT interval was identified upon admission that has been corrected over the next few days. Particularly, the serum pseudocholinesterase levels were within normal range. The local treatment involved repeated copious lavage with sterile water and Betadine solution, the evolution being rapidly favorable with the burn lesions completely healed in the next week. Conclusion: HF burns are a very special type of chemical burn taking into account that exposure to a small quantity of solution can be life threatening and that the immediate treatment is mandatory in order to maximize the outcome. It is of vital importance that any medical facility had a chemical burn protocol.

Telemedicine ensures remote medical services through technologies that facilitate the interaction between a health professional and patients and offers the possibility of a interdiciplinary consultation between specialists, in order to obtain a diagnosis and treatment plan. It involves secure transmission of medical data and information, through text, sound, images or other forms needed for the prevention, diagnosis, treatment and follow-up of patients. With the help of telemedicine, people from rural areas, with dificult access to primary care, and those with reduced mobility can benefit from healthcare services. This paper is a review of the latest data available in the literature regarding telemedicine and the future prespectives in this field in Europe.

Breast milk is recommended as an optimal and exclusive source of early nutrition for all infants from birth to at least 6 months of age. Despite all the benefits of breastfeeding, there are situations where breastfeeding is contraindicated. There are differences of opinion regarding the contraindications of breastfeeding, the current research bringing more knowledge in this area. It is important to know the differences of opinion for the correct approach of the breastfeeding patient.

High flow nasal cannula (HFNC) oxygen therapy devices are used on a daily-basis in many intensive care units and postoperative wards. Such a device deliver a mixture of air and oxygen, warmed, humidifi ed, with gas flow between 20-60 L/min, and inspired oxygen fraction between 0.21-1. Therefore, it improves oxygenation, decreases dead space, washes out the carbon dioxide (CO2) from patients’ airways, improves thoraco-abdominal synchrony and decreases the work of breathing. Studies have shown effi cacy of HFNC oxygen therapy use for acute hypoxemic respiratory failure, for patients with exacerbations of chronic pulmonary diseases, after extubation in order reduce the need for mechanical ventilation, in perioperative period to prevent atelectasis and in palliative care, in order to reduce breathlessness. It isn`t feasible for patients with severe altered neurological status, facial trauma, basal skull fracture, complete airway obstruction or epistaxis. There are no standardized recommendation for the use or contraindication of HFCN oxygen therapy. The weaning is realised according with patients’ tolerance, oxygen saturation, respiratory and heart rates.

Over the past six decades, abdominal compartment syndrome (ACS) remained a very controversial subject, both in surgical and non-surgical specialties. Doctors failed to understand why critically ill patients died in the ICU with distended abdomens without fi nding any cause or why postoperative patients with wound defects such as dehiscence died after suturing the wound again „very tightly”. After the concept of intra-abdominal pressure (IAP) was established and methods for measuring it and diagnosing intra-abdominal hypertension (IAH) were available for clinicians to use it, it became clearer that ACS was a very serious and life threating pathology and the need for a correct treatment is essential. In this article we will try to make a literature review of the past decade and see when and how to diagnose correctly a patient with ACS and also how the diagnostic and treatments methods changed over the years.

Dyslipidemia constitutes a well-known factor that can lead to acute pancreatitis. Hypertrigliceridemia and hypercholesterolemia are part of dyslipidemia. In a prospecitve study, we analyzed the role of hypercholesterolemia in triggering episodes of acute pancreatitis and the capacity of cholesterol blood level to predict the severity and the evolution of acute pancreatitis. In our prospective study, a preexistent cholesterol blood level above 240 mg/dl proved to be a trigger for pancreatitis and an increasing cholesterol level in evolution predicts a pancreatitis with organ failure (moderately-severe or severe).

Acute hypoxemic respiratory failure may have different causes. Case presentation: We present the case of a 42-year-old woman, with history of recent thyroidectomy and a late history of sleeve gastrectomy, who presented for acute dyspnoea. The chest X-ray revealed hydropneumothorax, and, therefore, an intercostals chest tube drainage was inserted. The evolution was unfavourable, with further respiratory status deterioration. A computed tomography of the thorax and abdomen was performed, that revealed a dilated thoracic oesophagus and stenosis of the esophagogastric junction, with lack of substance in the oesophageal wall and extravasation of oesophageal content in the posterior mediastinum, due to an oesophageal pleural fi stula. An oesophageal stent was inserted under endoscopic guidance and the patient underwent minim-invasive surgical interventions for evacuation of the mediastinal and pleural collections, with a favourable evolution. Conclusions: Acute respiratory failure can be the face of multiple conditions, some of these can be life threatening and in need for rapid detection and treatment.

The combination of posterior femoral head dislocation with ipsilateral intertrochanteric fracture is an extremely rare occurrence, therefore, few reports exist. The posterior femoral head dislocation is an injury most common encountered in road traffic accident (dash-board) and may associate various types of acetabular, femoral head or femoral neck fractures[1-3] but almost never an intertrochanteric fracture. [...]

"Endometriosis is a chronic, hormone-dependent condition with a nonspecific clinical picture, including chronic pelvic pain, a disturbing symptom that causes the patient to seek specialist medical advice"[1]. It is a chronic, often progressive, condition that affects women of reproductive age in a proportion of 5-10%. Despite such high prevalence, endometriosis remains an enigmatic disease with a poorly understood pathophysiology. [...]

Alcoholism is a common condition and frequently clinicians are forced to confront its complications in general hospital settings. Within each country, there is an excellent correlation between the level of alcohol consumption and the prevalence of alcohol-related harm. In fact, the consumption in Europe is 10.9 liters of pure alcohol per person per year[1]. There are an estimated 3 million alcohol-dependent people in Romania alone, with episodes of withdrawal severe enough to require pharmacologic treatment[1]. [...]

Nowadays, doctors face a challenging medico-legal environment. This is also the case of urologists with many legal claims against them. The fact that urology is a surgical specialty is not encouraging, surgical specialties being situated on top of the chain. One of the most important problems is the lack of information from the specialized editorials. This kind of data is hard to find especially since it is often regarded as confidential information. [...]

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 [...]

Iatrogenic ureteral injuries represent an important complication of abdomino-pelvic surgery with serio-us consequences in the absence of a prompt diagnostic and adequate treatment. According to literature it has been estimated that over 75% of all ureteral injuries are iatrogenic and that the incidence of ureteral lesions during an abdomino-pelvic surgery ranges from 0.5% to 10%[1-5]. Studies concerning this pathology have shown that obstetric and gynecological surgery accounts for approximately 50-60% or even more, followed by colorectal surgery 10-25%, vascular surgery (aortoiliac and aorto-femural bypass) and urological surgery 15-30% (classic, laparoscopic and endoscopic approach)[5-11]. [...]

HPV represents without any doubt one of the biggest health problems nowadys. Since the early days of its discovery by zur Hausen[1] the importance of this pathogen has risen. It is role in cervix neoplasia has been already demonstrated and steps have been made to counter this threat (vaccine). There are proofs that link this virus to other ano-genital neoplasia (here we include the penis, vulva, ano-rectal region and later the laryngeal neoplasia). [...]

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. [...]

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] [...]

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].

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.

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).

Heart failure is a complex clinical syndrome that can be determined by any structural or functional cardiac disease that impairs the ability of the left ventricle to fill or eject blood. In developed countries, heart failure is a main cause of morbidity and mortality for adults older than 65 years, the risk of developing heart failure being increased with advancing age. Heart failure hospitalizations are associated with substantial morbidity and mortality. Understanding factors that influence clinical outcomes of patients hospitalized for heart failure, particularly the modifiable ones, may be useful for identifying strategies to improve the outcomes of these patients.
The aim of the study was to investigate the clinical characteristics, management and outcomes of patients with chronic heart failure consecutively admitted in the Internal Medicine Clinic of the Clinical Emergency Hospital of Bucharest, during a period of 8 months (1st of January - August 31, 2012).