[Takotsubo cardiomyopathy]. / Cardiomiopatia takotsubo.

Takotsubo cardiomyopathy or "heart broken syndrome" or transient apical ballooning syndrome is an increasingly reported syndrome characterized by the fact that most patients are women aged over 65 years. The most common electrocardiographic changes are ST-segment elevation and negative T waves in precordial leads. Symptoms at onset are similar to those of acute myocardial infarction; the ventricular dysfunction is shaped like a takotsubo (a Japanese pot for fishing octopus), echocardiography and ventriculography show akinesia, hipokinesia or diskinesia (ballooning) of apical segments of left ventricle and hyperkinesia of the basal; the coronary arteries are normal angiographic; the dysfunction improves rapidly within a few weeks. Its origins are unclear, there are several pathophysiological theories, most sustained is a myocardial stunning secondary catecholamine-induced excess of intense physical or mental stress. There is no clear standard of treatment. In cases evolving with hemodynamic instability the use of beta agonist agents must be avoided, aortic balloon counterpulsation is preferable. The patient prognosis is usually good, reaching maximum mortality of 8%. In rare situations were reported complications such as acute pulmonary oedema, cardiogenic shock, acute mitral regurgitation, potentially fatal arrythmias ventricular fibrillation or torsades de pointes. In Cardiology Clinic of Cardiovascular Diseases Institute "Prof. Dr. George I.M. Georgescu" Iasi were hospitalized 4 cases with Takotsubo cardiomyopathy from 2008 to 2011. Their features are presented in this paper. The difference of prognosis and treatment between Takotsubo cardiomyopathy and acute myocardial infarction require an accurate diagnosis, the clinical hypothesis result only after knowledge the clinical and paraclinical peculiarities of this pathological entity.

[Myeloid metaplasia with myelofibrosis associated with acute coronary syndrome. Case report]. / Metaplazia mieloida cu mielofibroza complicata cu sindrom coronarian acut.

A 66-year-old man with myelofibrosis and myeloid metaplasia was admitted to hospital where he was diagnosed with acute coronary syndrome. Percutaneous transluminal coronary recanalization followed by drug-eluting stenting resulted in successful revascularization. Because besides thrombus formation the myeloproliferative syndrome has a potential for bleeding, it is very important to carefully follow-up any clotting abnormality.

[A trap "fold" in a Takayasu arteritis]. / Un "fald" capcana intr-o boala Takayasu.

Sometimes, acute aortic dissection diagnosis, a significant cardiological and surgical emergency, is particularly difficult. Therefore, Takayasu arteritis associated dissection fold may be a real diagnostic "trap", in spite of all modern exploratory techniques.

Rheumatoid arthritis: travelling biological era a Romanian X-ray population.

BACKGROUND: Rheumatoid arthritis (RA) is associated with loss of overall functionality of the locomotion system and it is connected with substantial economic losses. OBJECTIVE: To describe the clinical characteristics and healthcare resource utilization characteristics and to analyze the correlations in a cross-sectional sample of 206 patients in Romania. METHOD: RA cases have been enrolled from southern and western part of the country, covering a surface of 23 counties. RESULTS: Particularly in the literature data, Romanian RA patients become work disabled at 5.65 +/- 5.99 years old after the diagnosis. At cohort level, retirement in the first year after RA diagnosis is of 22.9%. From those, 13% were treated with biologic DMARDs; those on non-biologic DMARDs were 28.6%. In oral therapy group the most prescribed drug is lefunomide (61.2%). RA has an important impact on pain, function and utility, influenced by social factors. Patients' follow up is often based on hospitalization. CONCLUSION: Currently, when the clinician may choose for one certain therapy or another, the social influence is still overwhelming at all the evaluation levels in RA patients, as well as at economic impact.

[Acute myocardial infarction--a possible complication in polycythemia vera. Case report]. / Infarctul miocardic acut--o posibila complicatie în policitemia vera. Prezentare de caz.

A 66-year-old woman with Polycythemia Vera suffered an postero-inferior acute myocardial infarction: this is a relative rare association. The association between primary coronary angioplasty with stent implantation and anti-aggregant and myelosuppressive treatment was followed by important clinical benefits for the patient. To our knowledge, there are rare reports in the literature relating the triad of Polycythemia Vera, acute myocardial infarction and primary coronary angioplasty with stent implantation.

[Hypersensitivity myocarditis, a surprising diagnosis. Case report]. / Miocardita de hipersensibilizare--o surpriza diagnostica. Caz clinic.

Hypersensitivity myocarditis is a rare morphoclinical entity that may cause sudden death through arrhythmia and cardiogenic shock. The focus of the paper is the histological evaluation of the cases to identify the death cause of a 50-year-old patient, known to have suffered of hypertrophic cardiomyopathy, infective endocarditis and severe mitral regurgitation, case in which hypersensitivity myocarditis precipitated the evolution of the disease. The basis of the study was a complete cardiac evaluation including the morphological diagnosis on necropsy specimens. The paper shows that hypersensitivity myocarditis is a cause of sudden death through acute cardiac failure, and the setting of a precise morphological diagnosis is very important for an early targeted treatment.

[Pleiotropic effects of therapy in endothelial dysfunction syndrome]. / Efectele pleiotrope ale terapiei sindromului de disfunctie endoteliala.

Endothelial dysfunction syndrome initiates and usually accompanies the atherosclerotic process. Through their antioxidative, antiinflammatory, antiproliferative and antithrombotic role, the angiotensin-converting enzyme inhibitors, statins, the third generation of calcium antagonists, aspirin and salicylate derivates slow down, stop and improve the endothelial dysfunction, being a real therapy of atherosclerosis.

A Romanian instrument to facilitate bone density measurement indication in postmenopausal women.

UNLABELLED: The aim of the study is to find and valid a clinical instrument which identifies the women that need a bone density measurement because of their high risk for osteoporosis. MATERIAL AND METHOD: A number of 356 women were enrolled in this study. They filled in a study formular and their bone density was measured by DEXA exam (dual energy X-ray absorbtiometry) in the lumbar spine and proximal femur. Statistical correlations between the dependent variable minimal T-score and the other variables (clinical risk factors) were established. The most significant osteoporosis risk factor were included in a classification tree for the dependent variable minimal T-score with 5 splits, 5 independent splitting variables and 6 terminal knots. RESULTS: The most significant osteoporosis predictors included in our classification tree are: current weight, decreasing of height, sedentary life, alcohol consumption, number of deliveries. In predicting osteoporosis, the classification tree has high values both for sensitivity and for specificity (88.2%, respectively 74.11%).The osteoporosis prevalence is very high (74.34%) within the group predicted as having osteoporosis (53.7% of all women). The osteoporosis prevalence was 11% within the group predicted as having osteopenia. CONCLUSIONS: The classification tree facilitates a bone density measurement strategy and establishes the criteria for initiation of the treatment in high risk osteoporosis cases. It allows postponing the DEXA-exam for low risk women and selective measurement of the bone density for intermediar osteoporosis risk women.