EFFECTS OF DEPRESSION, ANXIETY, OR LOW SELF-ESTEEM UPON GLYCEMIC VARIABILITY, IN DIABETIC PREGNANT VERSUS NON-PREGNANT PATIENTS.

Objective: We analyzed the correlation between glycemic variability and psychological problems such as depression, anxiety disorder, and low self-esteem in pregnant and non-pregnant (excluding gestational diabetes) patients with diabetes. Besides its originality, this study might contribute to better / earlier diagnosis of these psychological conditions, with a special interest in pregnant diabetic women. Better management and cost reduction of care could be a consequence. Methods: We compared diabetic pregnant and non-pregnant women from the perspective of the glycemic variability (for a period of 15 days prior inclusion in the study) and their results on the standardized questionnaires: Beck depression inventory, Hamilton anxiety scale - HRSA, Rosenberg self-esteem test. Results and Conclusions: A statistically significant correlation was identified in both groups between the glycemic oscillation and depression, anxiety, and low self-esteem. Diabetic pregnant women had a higher statistical significance for the correlation between the glycemic oscillation and depression, as well as between the glycemic oscillation and anxiety than non-pregnant diabetic patients. The present data justify further research. Our results could be developed into a preliminary intervention protocol, using the daily glycemic values measurements, collected by patients.

THE RELATIONSHIP BETWEEN DEPRESSION, ANXIETY DISORDER AND LOW SELF-ESTEEM IN REGARD TO GLYCEMIC VARIABILITY IN DIABETIC PATIENTS.

Objective: We analyzed the possible correlation between glycemic variability and psychological disorders such as depression, anxiety disorder, and low self-esteem, in diabetic patients. These correlations are relevant, as they consume a large number of resources. Their better understanding can increase the effectiveness of incident reduction techniques and could provide better management and cost reduction of care. Methods: We compared the relationships between the glycemic variability (for a period of 10 days prior to completing the depression questionnaire) and the results of two standardized questionnaires: Hamilton anxiety scale - HRSA (group 1: 500 patients), Rosenberg self-esteem test (group 2: 490 patients) and Beck depression inventory (both groups). Results: A statistically significant correlation was identified between the glycemic oscillation and depression as well as both anxiety and low self-esteem. The present data justify further research. Our results could be developed into a preliminary intervention protocol, using the daily glycemic values measurements, collected by patients. In conclusion, psychometric tests could be an important instrument in the management of diabetic patients.

Histiocytosis X and Pericarditis - A Rare Association and a Difficult Diagnosis.

Histiocytic disorders are a group of rare diseases with systemic involvement and with multiple clinical manifestations. We present the case of a 51 years old patient investigated for dyspnea with orthopnea, dry cough, asthenia, muscular weakness and ataxia. The association of previous symptoms with skin lesions, diabetes insipidus, partial hypophyseal insufficiency and pericarditis induced many diagnostic debates. The diagnosis is Histiocytosis X must be sustained by tissue biopsy with immunohistochemical assay or genetic testing. The particularity of our patient is the presence of pericarditis, rarely associated with histiocytosis. Collaboration between medical specialties is mandatory in order to treat this disorder.

Anencephaly: pitfalls in pregnancy outcome and relevance of the prenatal exam.

Anencephaly is an embryological malformation of the central nervous system, invariable lethal, characterized by the absence of the brain and cranial vault and by other defects of the cranial structures. It has no cure but it can be detected during the pregnancy with ultrasonography. We present a rare case of a 15-year-old primipara, with no prenatal care, who delivered at 37 weeks an anencephalous female newborn. Ultrasonography avoided the confusion with a breach presentation, which, in conjunction with the prematurity, premature rupture of membranes and the young maternal age would have favored the cesarean section. The rarity of the case is increased by the singularity of the malformation. The importance of the prenatal care and genetic workup are stressed out in this embryologic pathology.

Rare association of adrenal tumors.

Adrenal incidentalomas represent a true problem both in the clinical diagnosis and in their treatment. A great variety of pathologies may be found under the umbrella of this concept: benign adenomas - functioning or not, myelolipomas, hamartomas, or granulomatous infiltrations of the adrenal. The possibility of malignancy should be considered in each case, especially in patients with a known extra-adrenal primary. In true incidentalomas, size appears to be predictive of malignancy. We present an interesting case because of the surprising association of two adrenal tumors, with a long time lapse between them, with ascites and pleurisy and because of the difficulty of treatment in a patient refusing surgery. We did not find such an association in the medical literature. Miss MR, 61 years old, was treated surgically for pheochromocytoma 28 years ago (left adrenalectomy). She was diagnosed in the past with peritoneal carcinomatosis; paraneoplastic left pleurisy, chronic hepatitis of unknown etiology. She presented at admission cashexia, pallor, signs of left pleural effusion and of ascites, hearts beats and blood pressure within normal limits. Investigations were performed including hormonal tests, ultrasound investigation, hepatic tests, and CT scan but no specific tumour markers. A right adrenal incidentaloma of 21/15 mm - in association with ascites and pleurisy - was found at CT scan. Diagnostic problems are discussed because the patient refused surgery, so no pathological examination was available.

[Urachal cyst in an adult woman]. / Chist voluminos de uraca la o femeie adulta.

Urachal abnormalities represent a rare pathology and, in case of presence, they are more frequent in children and, among adults, in men. We report a case of urachal cyst in an adult woman in whom it was difficult to determine preoperatively the origin of the abdominal tumor. Positive diagnosis and treatment implied surgical exploration and resection. Even rare, this pathology should be considered in the differential diagnosis of an abdominal cyst. While the diagnosis may be established by clinical examination and imaging methods, surgical exploration is justified and, besides, offers the therapeutic opportunity.

[Experimental study of the use of piritramide as intrathecal analgesic]. / Cercetari experimentale privind utilizarea piritramidei ca analgezic intratecal.

Opioids proved their advantages as general and intrathecal (i.t.) analgesics. Piritramide (P), a largely used analgesic opioid today, has not been studied in i.t. administration. Our experimental research aimed in determining the efficiency, security and optimal dose of i.t. P. In 9 adult mongrel dogs equally randomized in 3 groups we injected i.t. P 1.3 mg x kg-l (group 1), P 0.8 mg x kg-l (group 2) and sodium chloride 0,9% (group 3) and we registered the motility, the pain reaction to electrical and mechanical nociceptive stimuli, the respiratory rate and amplitude, electrocardiogram, heart rate, mean arterial blood pressure electroencephalogram and, for 2 subjects from group 1, electromyogram. The P-induced analgesia was strong, dose-dependent, and segmental, with a time of onset of 5-8 min, duration of 1h 45 min-2h 30 min, and prolonged residual analgesic level for 5-6 h. The dogs from the 1st group presented moderate side effects: bradypnea, tachycardia and arterial hypotension at 5 min, reduction in the posterior limbs motility, sleep. We could conclude that i.t. piritramide 0.8 mg x kg-l provides a solid, segmental, long-lasting analgesia, without marked adverse effects.

Pre-emption dimensional study aiming to obtain significant statistical results for the variation of serum cortisol during ovarian stimulation.

UNLABELLED: Ovarian stimulation has an important place in the contemporary impressive development of infertility treatment. There are few and not concordant data concerning its influence on cortisol serum levels. AIM: The present study aimed at finding the necessary number of determinations in order to statistically assess the variation of cortisol during and caused by the ovarian stimulation. METHODS: In 25 consecutive infertile women (23-45 years old, average: 32.4 years) enrolled in an ovarian stimulation program (gonadotropin releasing hormone agonist--busereline--from the first day of the cycle, human menopausal gonadotropin beginning with the 14th day of the cycle, ovulation triggering by human chorionic gonadotropin), serum cortisol was measured one month before the study, the 1st, 14th, 16th, 19th, 22nd, 24th day, the day before the triggering of the ovulation, one, two, 19 days and one month after triggering. General methods of data analysis map into descriptive and inferential statistics were used, with BMDP, SAS 6.0 and Epilnfo 5 software. RESULTS AND CONCLUSIONS: The calculated number of determinations, in order to obtain a significant statistical variation of cortisol for the studied set of samples and stimulation protocol is between 28-35--but smaller (15 and 19) around ovulation triggering and 39 patients for a > or = 5% variation compared to control values. The suppositions considered in the present paper seem to offer a correct estimation for obtaining the size of the sample sets to be analyzed in a future study.

[Ovarian cyst and pregnancy. Conservative management and consecutive emergency cystectomy. Case report]. / Chist ovarian asociat cu sarcina. Conduita conservativa si chistectomie intempestiva ulterioara. Caz clinic.

The association of an ovarian cyst with pregnancy is relatively rare; it may result in serious maternal and fetal complications and its treatment is still controversial. We present a case in which the rarity is given by the association of an 11cm--serous right ovarian cyst (with signs of torsion) with a monofetal 6 gestation week--pregnancy, by the initial conservative management and by the subsequent laparotomy and cystectomy at 16 gestational weeks, required by the acute abdominal pain caused by the torted cyst. The approach was initially conservative followed by laparotomy and cystectomy at 16 gestation weeks, required by the acute abdominal pain caused by the torsive cyst. Pregnancy was, afterwards, uneventful and the patient delivered vaginally, at term, a 3200 g healthy girl. Management options of such a case are discussed.

Asymptomatic abdominal wall endometrioma 15 years after cesarean section.

Abdominal wall endometriosis is rare and its diagnosis is difficult. However, the consequences may be serious, like recurrences or even malignant transformation. We report a rarer case of asymptomatic abdominal wall endometrioma, accidentally found during a surgical procedure for a second cesarean section, in a 39-years old patient, without any relevant history of endometriosis. The tumor was subcutaneous, 3/3 cm in size, located in the left angle of the incision from the 15 years previously performed cesarean section and freely mobile in relation with the skin and the fascia. It was excised, with clear margins (to prevent recurrences), during the procedure. The patient was discharged after five days. The postoperative period and the follow-up at one and three months were uneventful. The pathological examination clarified the diagnosis by revealing an endometrioma with decidual reaction. Such a condition may be, therefore, evoked before an abdominal wall tumor, even without specific symptoms, even in a 39-years old woman and longtime after the possible causal surgery. Pathological examination remains the ultimate diagnostic tool. Relevant prophylactic attitude at the end of the cesarean section may be considered.

[Etiologic, clinical and prognostic correlations in abruptio placentae]. / Dezlipirea prematura de placenta normal inserata. Corelatii etiologice, clinice si prognostice.

Placental abruption implies, still, a largely unknown causality and frequent unsatisfactory results. This study was designed to explore the possible correlations between some etiologic factors, the dependent clinical decisions and outcome. In a prospective cohort, we included 95 successive pregnant women (aged 15-42, 22-42 gestational weeks) with abruptio placentae necessitating cesarean section, during 2001-2005. Maternal blood pressure, premature rupture of membranes, infants' sex ratio, hematomas' volumes were correlated with the clinical outcome. There were 25 mortality cases (2 maternal and 23 fetal) and physicians performed 9 hysterectomies (2 with bilateral adnexectomy). Premature rupture of membranes was seen in 32% of the cases. Hypertension was an etiological and aggravating factor: it was reported in 70% of cases, in all the severe ones. The volume of placental hematomas was in direct concordance with the severity of the outcome. Interestingly, the majority of the patients were young and 63% of newborns were male.

[The value of transvaginal ultrasonography in the follow-up of postmenopausal women's endometrium]. / Valoarea ecografiei transvaginale în monitorizarea endometrului pacientelor în postmenopauza.

Endometrial cancer remains, today, a serious problem, especially for postmenopausal women. The aim of our study was to evaluate the utility of the transvaginal ultrasound examination in the management of the endometrial abnormalities in postmenopausal women. We included, in a prospective cohort, 49 successive postmenopausal women: 34 with metrorrhagia (group I) and 15 with no symptoms (group II) and we compared the results obtained by ultrasound examination, Pap smear and endometrial biopsy. Patients in group I had a higher frequency of risk factors and thick and abnormal endometrium. Unlike Pap smear, ultrasound examination and biopsy had comparable values. We could conclude that transvaginal sonography is a reliable technique for the endometrium evaluation in the postmenopausal women. Ultrasound exam could select the cases (without any symptoms) for endometrial biopsy and detect associated gynecological pathology.