Romanian journal of internal medicine = Revue roumaine de médecine interne
-
Review Practice Guideline
A step by step approach in differential diagnosing of adrenal incidentaloma (epinephroma), (with comments on the new Clinical Practice Guidelines of the European Society of Endocrinology).
To present a step by step approach for the diagnosis of adrenal incidentaloma (AI). ⋯ Density less than 10 HU is in most cases characteristic of a lipid rich benign adenoma. More than 10 HU or/and history of malignancy raise the possibility for cancer. 1 mg dexamethasone test and plasma metanephrines should be done in all patients. If there is history of hypokalemia and/or resistant hypertension we test the plasma aldosterone to plasma renin ratio (ARR). Newer studies have shown that tumours even nonfunctioning and less than 4 cm may increase the metabolic risks so we may consider surgery at an earlier stage.
-
The present paper is aimed at briefly presenting psychological factors involved in cancer related pain and what psychosocial interventions are efficient in reducing it. Cancer related pain is a complex experience and the most integrative and recommended approach is the biopsychosocial model. ⋯ Psychological factors influencing pain experience can be intuitively grouped starting with awareness of pain (i.e., attentional factor), then with evaluation of pain (i.e., cognitive factors) which is leading to feelings (i.e., emotional factors), and behaviours (i.e., coping strategies) regarding pain. Psychosocial interventions (i.e., skill based and education based interventions) have strong evidence that is effective in reducing cancer related pain.
-
Review
Diagnostic value of calprotectin in irritable bowel syndrome and in inflammatory bowel disease.
The inflammation is an important component of the bowel wall structure. The amount of inflammation is gradually increased from normal state, to functional bowel disorders and to inflammatory bowel disease. ⋯ We also show on a sample of patients that inflammation as tested with fecal calprotectin test may also be found, in lower degree, in irritable bowel syndrome. In inflammatory bowel disease, the calprotectin fecal test shows higher intensity values.
-
Pulmonary arterial hypertension is defined as a group of diseases characterised by a progressive increase in pulmonary vascular load, leading to marked increase in pulmonary artery pressure, right ventricular failure and premature death. Given the nonspecific nature of its early symptoms and signs, pulmonary arterial hypertension (PAH) is often diagnosed in its advanced stages. Although clinical assessment is essential when initially evaluating patients with suspected PAH, echocardiography is a key screening tool in the diagnostic algorithm, because, in comparison with invasive measurements, it has the advantages of being safe, portable, and repeatable. ⋯ Several echocardiographic techniques centered on the Doppler principle (both conventional Doppler parameters and tissue Doppler imaging) used in the assessment of PAH magnitude and its cardiac effects are presented in this paper. They provide important data on the severity, possible causes and consequences of pulmonary hypertension, both initially and during follow-up, therefore having the ability to estimate disease progression, prognosis, or to monitor therapeutic response. Doppler echocardiography allows to noninvasively estimate systolic pulmonary arterial pressure (SPAP), mean and end-diastolic pulmonary arterial pressure, as well as the quantification of right ventricular (RV) function and the evaluation of pulmonary vascular resistance (PVR).
-
Recently, a novel heart syndrome, mimicking acute coronary syndrome, was described. Patients commonly present with chest pain, ST segment elevation, prolonged QT interval and slight elevation of cardiac enzymes and biomarker levels, despite the absence of significant coronary artery disease. Because of the peculiar left ventricular apical ballooning shape, given by characteristic regional wall motion abnormalities consisting in apical akinesis and basal hyperkinesis, this syndrome was named "Takotsubo" cardiomyopathy, after a round Japanese octopus fishing pot. ⋯ The management of this syndrome consists mainly in supportive and symptomatic therapy. The evolution, although mainly uneventful, can be complicated, rarely, by left ventricular rupture, making thus the takotsubo cardiomyopathy a newly recognized cause of sudden death. We present some data on the epidemiology, pathogenesis, clinical picture and management of this peculiar form of heart disease, which, although easily confounded with an acute coronary syndrome, has emerged as a unique nosologic entity.