Introduction: Endometriosis represents the aberrant implantation of endometrial tissue, respectively outside the uterus. It is one of the gynecological diseases with a great impact on the patient’s quality of life and especially on the fertility aspects. Due to the aberrant implantation, this disease can theoretically affect any organ in the abdominal and retroperitoneal cavity. Thus, cases involving the organs of the urinary tract are not a surprise.
Material and methods: The present paper focuses on the urological impairment of endometriosis, etiology according to various hypotheses and an update of existing treatment methods. The possible proposals of therapeutic guides found in the literature are also taken into account.Results: The urological condition of this disease seems to increase in frequency in recent years. If in the case of asymptomatic patients an expectant attitude can be approached in relative safety, the local invasive nature of the disease, which can lead to the loss of the function of the various organs of the urinary tract, must not be omitted. In the case of symptomatic patients, the treatment is either hormonal or surgical, lately there is a tendency to combine the two types of treatment. Being a condition with relatively rare urological involvement, the differential diagnosis often omits endometriosis. There are currently several plausible guide proposals, but it takes time and richer casuistry to be able to standardize them. From the point of view of surgical treatment, there is a tendency to introduce robotic surgery in the therapeutic arsenal of this disease, both in the case of classical endometriosis and in the case of urological involvement.

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.

Introduction: Cushing’s disease (CD) is characterized by multiple complications, particularly due to the condition itself, but also as a result of curative treatment. Nowadays, transsphenoidal surgery is considered the first-line therapy. Persistent hypercortisolism requires the initiation of medical therapy in order to limit the consequences of the disease. A common complication of pasireotide treatment is type 2 diabetes mellitus. We present a case of persistent Cushing’s disease after transsphenoidal adenomectomy and pasireotide therapy, evaluated in several medical centers. Case presentation: A 27-year-old female was referred to our clinic for weight gain, hypertension, transient headache and recurrent depression. Clinical examination revealed plethoric moon face, purple striae, hirsutism with a Ferriman-Gallwey score of 14, acanthosis nigricans. The hormonal profi le showed high ACTH (adrenocorticotropic hormone) levels (of 110.6 pg/mL, normal: 7.2-63.3 pg/mL), high urinary free cortisol (UFC) (of 846.5 μg/24h, normal: 50-190 μg/24h) and serum cortisol, accompanied by non-suppression of cortisol after the 1 mg DXM (Dexamethasone) suppression test (of 26.6 μg/dL, normal: 18 μg/dL) and adequate suppression after the overnight 8 mg DXM test. Pituitary MRI (Magnetic Resonance Imaging) revealed a microadenoma measuring 4.3/4.4/6.2 mm. Transsphenoidal adenomectomy was recommended. After surgery, the patient developed multiple pituitary hormone deficiency, without significant remission of hypercortisolism. Pasireotide therapy was initiated, followed by inadequate control of hypercortisolism and the onset of type 2 diabetes mellitus, requiring oral antidiabetic agents and insulin. Conclusion: In persistent Cushing’s disease, the challenge lies in identifying the optimal therapeutic methods in order to achieve a cure while, at the same time, limiting their side effects. Careful long-term follow-up by a multidisciplinary team is required.

In recent years, the number of medical litigations is increasing and defensive medicine becomes a widespread approach among physicians all over the world. Defensive behavior of physicians is more common in scheduled, elective, compared to emergency medical services. The immediate direct consequences of this defensive behavior are found in the increase of costs (additional investigations) and the increase of waiting time for certain procedures and interventions (repeated postponements). Difficult and uncomfortable to admit that it exists, but defensive behavior is a reality. It raises numerous and complex ethical issues, and the goal of health policies should be to reduce this phenomenon.

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.

Repairing an incisional ventral hernia represents a challenge for the surgeon. The high recurrence rates observed during hernia repair by tissue approximation leads to development of tension-free procedures by using prosthetic materials. Incisional or ventral hernia is a very common multifactorial pathology that requires surgical intervention to prevent complications, such as pain, discomfort, bowel obstruction or strangulation. To perform the wall repair it is of utmost importance to understand the pathogenesis of the hernia, the anatomy and physiology of the abdominal wall, and surgical techniques. Several repair methods are available, including open suture repair, open mesh repair, the component separation technique, and tissue expansion assisted closure. To perform the ventral hernia repair properly, a full understanding and correct selection of mesh and management of probable complications, such as seroma, bowel injury, enteric fistulae, and recurrence, is essential. There are lots of scientific debates about an ideal material for mesh parietal repair. In latest years, the tendency is that the continuous decreasing territory of polyester mesh to be slowly replaced by the increasing territory of polypropylene mesh in open procedures for abdominal incisional hernia repair. The goals of incisional hernia repair are the prevention of visceral eventration, incorporation of the abdominal wall in the repair, provision of dynamic muscular support, and restoration of abdominal wall continuity in a tension-free manner. We present the case of a 55 years old woman who had a history of multiple surgical interventions. We performed an open surgical approach, tension free technique using an intraperitoneal dual-mesh.

When a surgical team is dealing with an after-hours colorectal surgery, they are actually confronting with a chain of elements and events, some linked to the patient and severity of the surgical case, others related to the medical team ability to cooperate, from nurses to surgeon and anesthetist. There is a series of differences between elective and emergency performed surgeries, two of them and most important elements are the patient (disease type, age, preoperative condition) and the operating team (experience, technical performance after-hours, especially at night).

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.

Inflammatory bowel diseases (IBD), namely Crohn’s disease and ulcerative colitis, are relatively rare diseases in our country, known as a low prevalence geographic region. IBD are a multidisciplinary problem, that implies gastroenterologists, as well as surgeons. Surgical management in inflammatory bowel disease is often impaired by a high complication rate and a significant recurrence rate, specifi c mostly for Crohn’s disease. Indications for surgery include failure of medical therapy (including delayed puberty for young patients and drug intolerance), toxic megacolon, bowel perforation, obstruction, enteric fi stula and abdominal or perianal abscess. Advances in medical treatment options for IBD are continuously accumulating. However, a large number of patients still require surgical procedures during lifetime.

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 definined as the presence of endometrial-like tissue outside the uterine cavity and it presumably affects 10-15% of reproductive aged women. The prevalence of endometriosis appears to be higher in women in Philippines, Indian, Japanese and Korean origin[1]. Clinical manifestations depend upon the site where the ectopic endometrial tissue is located and include dysmenorrhea, dyspareunia, chronic pelvic pain, infertility, but the possibility of being asymptomatic exists. [...]

"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. [...]

Ureteral anomalies often represent a great challenge for physicians regarding their diagnostic and therapeutical management. Ureteral duplication is one of the most frequent urogenital congenital malformations, usually more frequent in female patients, with an incidence rate estimated at approximately 1%[1,2]. [...]

Renal scintigraphy is a nuclear medicine technique that uses medical radioactive isotopes for the evaluation of the renal function. Functional data complete clinical and anatomical data obtained through other imaging techniques and can assist the clinician in the diagnostic and management of various renal disorders. The most widely used radioactive isotope for me-dical imaging is Technetium-99m. In renal scintigraphy 99m-Tc is coupled to a substance that is eliminated predominantely by glomerular filtration (DTPA) or tubular excretion (MAG3) or which is attached to tubular proteins (DMSA). DTPA and MAG3 allow a dynamic study which result in the generation of a nephrographic curve for each kidney and the calculation of clearance parameters - ie glomerular filtration rate (GFR) or the effective renal plasma flow (ERPF), respectively. [...]

Testicular cancer has an increased incidence among young males (15-35 years old)[1]. The incidence in testicular cancer for this category of patients is quite high, 7.52 new cases for 100000 people. The predominant histopathological subtypes among fertile-aged young males are embryonal carci-noma and teratocarcinoma[1]. [...]

Tuberculosis represents one of the most important pro-blems in public health. It is an intense studied infectio-us disease, in the past and also in present[2,3].
The incidence of tuberculosis is decreasing in most indistrualized countries due to the improvement of prevention and therapeutic means (BCG vaccination, antituberculostatic therapy)[3]. [...]

As in cervix carcinoma the role of HPV has been proved, infact there is a rare type of PC which is directly linked to HPV[3]. As such, the prevalence of penile neoplasia is related to that of HPV in general population. Strains 16 and 18 are the most common findings in penile carcinoma[4]. [...]

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). [...]

Cystic renal masses represents a pathology that may rise diagnosis and management difficulties. The differential diagnosis of large renal cystic masses should be made with normal renal cysts, hydronephrosis, renal abscess, renal hematoma, morpho-functional demaged kidney or with a renal tumor with necrosis and abscess. [...]

Premature ejaculation (PE) is a serious health problem with an important impact on male self-confidence, in-terpersonal relationships and quality of life. [...]

Despite the constant technological advances achieved during the past decades, large size benign prostatic hyperplasia (BPH) pathology continues to raise questions concerning the most appropriate therapeutic approach. Interestingly enough, the classical open prostatectomy still represents the standard option for this type of cases despite the substantial perioperative morbidity [1]. [...]

Spontaneous rupture of the urinary collecting system is a rare urologic pathology, but due to the severity of its possible complications, it represents an urological emergency which requires adequate urgent treatment. [...]

to emphasize this statement mice are used due to human DNA similarity (According to The Jackson Laboratory over 95% of the mouse genome is similar to our own, making mouse genetic research particularly applicable to human disease), simplicity in procurement, handling and short lifespan [1-3]. The purpose of this information is to help investigators who pursue an economical and efficient research that still allows the achievement of the study goals [4-7] [...]

Genital prolapse is a frequent pathology in women associated with different urological and gynecological complications affecting women `s normal life [1]. It is defined as pelvic organ slipped from their anatomical position through vagina. The pelvic structures which might slip are uterus, bladder, rectum, small intestine or vaginal vault. Each one of these benefits of a specific surgical procedure [1].

We believe that with the apparition of the first settlements and the act of eating also appeared the first potentially urinary lithiasis patients. One of the "leading minds"[1] of the twentieth century, Margaret Mead (1901-1978) (fig. 1), renowned anthro-pologist used to say "it is easier to change a nation religion rather its eating habits".

Epstein-Barr virus (EBV) is a member of the Herpes Virus family and is also known as Human Herpes Virus 4. The virus was first isolated in 1964 by the British virologists Michael Anthony Epstein and Yvonne Barr, on a cell line derived from a Burkitt lymphoma. EBV infection is especially common in young individuals with low hygiene standards and also low social and economic status. Thereby it is considered that until the third decade of life, around 80 - 100% individuals have become carriers of infection [1,2]. Although EBV is considered to be a lymphotropic B virus, it can also infect T and NK lymphocytes or some epithelial cells, as it has beenfound in T cell lymphomas, stomach, nose, andthroat carcinomas [2]. The most common host cellfor EBV is B lymphocyte, although in some cases the virus can also be detected in epithelial cells. The role of epithelial cells is likely to permit the replication and amplification of EBV persistence than that of the latent infection [3].

The medical profession is certainly there for thousands of years, the first documented therapeutic methods being used since prehistoric times. Although to date there has been significant advance in this area, current treatments are not infallible, which means that in medical practice there are certain errors. Sometimes patients may interpret these errors as malpractice, accusing the physician with certain charges related to his work, or rather the lack of his work. In terms of ethical norms, the Medical College of Physicians in Romania’s Code of Ethics has been prepared in accordance with the Geneva Declaration issued in 1948 and has a complementary legislative role stated above, the purpose of regulating the fundamental principles of professional conduct for doctors. All these laws are meant to guide medical staff attitudes in clinical practice and are relevant in a medical malpractice case.

Benign prostatic impairments are a heterogeneous group of diseases that can coexist or be separate entities. Some of these conditions (prostatitis) are included in the pelvic pain syndrome, while the other is represented by the prostatic adenoma and its implications. Benign prostatic hyperplasia (BPH) is histologically associated, in most cases, with the presence of inflammatory infiltrate at this level. Histopathological examination of the resected pieces and fragments of prostatic biopsy in many cases reveals stromal inflammatory infiltrate adjacent to the prostatic acini. (1, 2) In addition to the many factors involved in the prostate benign microbial pathology (E. coli, Pseudomonas aeruginosa, Serratia spp., Klebsiella spp., Enterobacter aerogenes and the great family of enterococci), there are numerous data in specialized literature, certifying the presence of viral genomes in both benign and malignant pathology of the prostate. (3, 4) Among them the following stand out: Papilloma virus (HPV), Polyoma viruses, cytomegaloviruses (CMV), Epstein-Barr virus (EBV), Herpes Virus 8 (HHV 8) and xenotropic murine leukemia virus recently (XMRV). (5)