Monica Mihaela Cîrstoiu

An update on osteoporosis

Abstract With the growth of the aging population worldwide, osteoporosis represents a serious health problem, which implies higher morbidity and costs, despite the continuous advances in treatment options. It involves both sexes, although menopausal women are mainly affected. This article is a brief review of literature on current osteoporosis treatment options.

Non-Hodgkin lymphoma as primary bone tumor in a patient with B hepatic viral infection - case report

Abstract Diffuse large B cell lymphoma (DLBCL) is the most common form of non-Hodgkin lymphomas, which has shown an increasing incidence in the past decades. 7% of primary bone tumors consist of non-Hodgkin lymphomas. The etiology of this type of lymphoma is still unclear. Our aim was to study the latest research papers; to highlight the importance of cooperation between different medical specialty departments, in rare cases like NHL as PBT with associated HBV infection. Case report: We present the case of a 39-year-old male patient, who presented to the orthopedic department of the University Emergency Hospital of Bucharest, with moderate pain, swelling, and a palpable mass of the right lower limb. Management and Outcome: The patient underwent several investigations, whose result was DLBCL and an associated HBV infection. Due to the aggressive form of DLBCL, chemotherapeutical treatment has to be initiated as soon as possible to prevent further growth of the tumor. An antiviral therapy had to be initiated to prevent the hepatic failure, which could appear after chemotherapy and in the acute phase of viral infection. Discussion: Our case raised the question regarding what kind of relationship could be identified between the HBV infection and NHL, and how this condition influenced the outcome of the treatment.

Management of bimalleolar fracture in pregnancy

Abstract Ankle fracture is one of the most common fractures in adults and among pregnant women. In pregnancy, the treatment must be prompt because of the risks and complications that could involve both mother and fetus. In this article, we reported the management of a patient with a bimalleolar fracture in pregnancy, its treatment, and evolution.

EP31.05: Implementation of gynecological ultrasound examination report (software REGU) based on consensus of international specialised groups

lipid values. Bone density was measured by lumbar spine dual energy X-ray absorptiometry (DXA), and osteoporosis was diagnosed if bone mineral density was ≤70% of the young adult mean (YAM). Testing for significance used the t-test and Kruskal-Wallis test. The study was approved by the ethics committee of our hospital. Results: The mean age of the 70 patients was 42.8±5.0 years. Carotid ultrasonography found arteriosclerotic plaques in 13 patients, consisting of moderate arteriosclerosis in one and mild arteriosclerosis in twelve. The median plaque score was 1.5. Stratified by age, 2 of these 13 patients were in their 30s, 10 were in their 40s and one was in her 50s. Only one patient was diagnosed as having osteoporosis. Stratification on the basis of presence/absence of carotid plaques indicated no significant differences with regard to any of the lipid values or YAM. Conclusions: The present study of patients with primary ovarian insufficiency found high incidences of carotid artery lesions of more than 20% in women in both the 4th and 5th decades of life. However, it was difficult to predict carotid artery lesions based on the assayed lipid values. Additionally, the prevalence of osteoporosis was low, suggesting that hormone replacement therapy might be contributing to its prevention. The incidence of carotid artery lesions is high in women with primary ovarian insufficiency, whereas the prevalence of osteoporosis may be low.

High-grade ovarian serous carcinoma in a young woman - case report and literature review

1. Pathology Department, University Emergency Hospital Bucharest, Romania 2. Pathology Department, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 3. Obstetrics and Gynecology Department, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 4. Obstetrics and Gynecology Department, University Emergency Hospital Bucharest, Romania 5. Department of Anatomy, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

Caesarian scar ectopic pregnancy. A case report

The caesarian scar pregnancy is a rare form of ectopic pregnancy. It is a medical challenge because of the difficulties in diagnosis and treatment. We present the case of a 32 years old woman with 8 weeks amenorrhea and a pregnancy positive test, who was admitted to hospital for lower abdominal pain. Her history is unremarkable, except for a previous pregnancy finalized by caesarian-section. The diagnosis was caesarian scar pregnancy. The first treatment option was systemic Methotrexate. After 3 doses, because there was no visible effect on the pregnancy, the patient was referred to other clinic for uterine artery embolization. One week after the embolization, a suction curettage was performed with elimination of the gestational sac from the scar tissue. The follow up so far showed no defect in the uterine wall.

Colposcopic assessment and outcome in low grade cervical intraepithelial neoplasia treated with loop electrosurgical excision procedure

The aim of the research was to assess the outcome of persistent (≥two years) low-grade cervical intraepithelial neoplasia (CIN 1) medicated with loop electrosurgical excision procedure (LEEP). An analysis of 38 topics with persistent biopsy-confirmed CIN 1 diagnosed after low-grade squamous intraepithelial lesion (LSIL) or atypical squamous cells of undetermined significance (ASC-US) on Pap test and treated using LEEP was performed. Post-LEEP follow-up were scheduled in 6 months, 1 year, and yearly thereafter: cytology, colposcopy, and plasma diagnostic examinations. There were 38 LSIL patients treated with LEEP conization. About 6 patients were excluded from the study due to subsequent hysterectomy and 2 patients never attended the follow-up schedule in the rest. The remaining 30 patients were retrospective studied for the incidence of recurrent rate. The mean age of the patient was 44 years. About 50% of patients were multiparity and nearly one - third used oral contraceptive pill. The results of this study suggest that the incidence of CIN 2+ lesions during follow-up of persistent biopsy-confirmed CIN 1 after ASC-US/LSIL treated by LEEP is very low.

EP14.06: Two years' experience in diagnostic and management of abnormally invasive placenta.

Objectives: The reported incidence of AIP has risen, as well the ratio of multiple pregnancies gained by PMA techniques. These two phenomena can cause multiple pregnancies associated to AIP. We report the biggest existing case series of only one Institution, comparing it with cases in Literature. Our aim is clarifying the early age of the first diagnosis, which is the best location where cutting uterus during CS, how planning monitoring and timing delivery. Methods: This is a retrospective analysis of 7 cases of twin pregnancies with AIP. We focused on gestational age at the first diagnosis, numbers of previous Caesarean sections, eventual PMA techniques, age of deliveries, eventual complications, maternal fetal outcomes. Results: We analysed 7 pregnant women referred to Maternal Fetal Unit at ‘‘Civico’’ Hospital between 2012 and 2016. They were observed at the end of the first trimester, six had had previous Caesarean sections, one had had 7 suctions and curettage for miscarriages. Five patients had a dichorial diamniotic pregnancies, one a triplet trichorial triamniotic with one placenta accreta, and one was monochorial. Another case, still monitored, at 10th weeks of gestation is dichorial diamniotic, with a vanishing twin whose placenta is accreta. Four out of seven pregnancies came from PMA. A hysterectomy during CS needed for all, except one who had premature rupture of membranes at 20 weeks, a spontaneous labour with partial retention of placenta, undergone to a late puerperal hysterectomy. Conclusions: Reviewing the literature there are only 14 case reports of multiple pregnancies with AIP. We observed that the main problems are the early age of the first diagnosis, doing a topographic placental mapping for identifying the best location where cutting uterus during CS, planning a strict monitoring and timing delivery. These became our goals and, collecting several cases, we could standardise a protocol, called ‘‘AMaTi’’ (Age Mapping Time) to avoid early complications, to evaluate the evolution of these pregnancies and to achieve the best maternal fetal outcomes.

EP31.03: The role of ultrasonography in the evaluation of functional and anatomical disorders associated with static pelvic disorders.

E. Falò4, M. Leombroni4, D. Buca4, R. Savone4, S. Gustapane1, A. Santarelli4, F. Frondaroli4, A. Ricciardulli2, C. Di Matteo4, F. Fanfani4, M. Liberati4, F. D’Antonio3 1Department of Obstetrics and Gynecology, ”D’Annunzio” University, Chieti, Italy; 2Department of Obstetrics and Gynecology, University of Chieti, Francavilla al Mare, Italy; 3Department of Fetal Medicine, UiT, University of Northern Norway, Tromsø, Norway; 4Department of Obstetrics and Gynecology, G.d’Annunzio University, Chieti-Pescara, Chieti, Italy

Non-invasive prenatal testing - a new method in improving first trimester screening for chromosome-related abnormalities

In the last 15 years, major advances have been made in prenatal screening. Cohort studies have led to an understanding of the causes of many common diseases that are determined by the combined effects of genetic and phenotypic factors. Non-invasive prenatal testing (NIPT) is a technology used to isolate deoxyribonucleic acid (DNA) placental fragments from the mother’s blood at as early as 10 weeks of gestation, using cell free fetal DNA technology. NIPT screens for trisomy 13,18 and 21 for sex chromosome abnormalities with a high detection rate. Cohort studies have shown a high detection rate and a low false positive rate for NIPT, but it is still considered a screening test and not diagnostic. It is recommended confirmation in case of a positive test, with a diagnostic procedure as chorionic villus sampling or amniocentesis. It is essential that NIPT be used ethically and effectively. Because of its high sensitivity (true positive rate) and its specificity (true negative rate) many recommend that NIPT should be used as a diagnostic method. However, today NIPT is used as a screening method, an attractive alternative to the serum screens and invasive test currently in use. There is a continuing decline in sequencing costs and hopefully, soon, the cost will be reduced.