Archive issue

Current Health Sciences Journal

vol. 48 no. 1, 2022

1. The Influence of the Inflammatory Bowel Diseases on the Perceived Stress and Quality of Life in a Sample of the South-Western Romanian Population

D.E. Popa, M.C. Pirlog, D.O. Alexandru, D.I. Gheonea

Background: Inflammatory bowel diseases (IBD) represent a category of chronic diseases of gastrointestinal tract with a long-term evolution which includes flares and periods of remission. The aim of the study is to identify and quantify the relationship between IBD status, perceived stress, coping mechanisms, and patients QOL. Methods: Cross-sectional study on two samples consisting of 70 IBD patients monitored in the Gastroenterology Department of the Emergency Clinical County Hospital Craiova, Romania, respectively 70 healthy volunteers. Collected data include socio-demographic details, personal and familial medical history, clinical status, presumed risk factors, perceived stress (Perceived Stress Scale-PSS), coping strategies (COPE questionnaire) and Health-Related Quality of Life (HRQOL-SF-36 scale). Results: Perceived stress was considerably higher on IBD subjects (p<0.0001). The assessment of HRQOL has shown that patients had the best perception over their physical and emotional domains of SF-36 (p<0.0001), while the most often coping mechanisms used are those from the problem-focused category. Conclusions: There is a significant relationship between increased activity of IBD and higher level of stress, that led to the development of problem-focused coping strategies. We did not find a strong correlation between lower HRQOL levels and the items considered as potential risk factors.

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2. Assessment of the Biological Activity of Thyme Essential Oil in the Presence of the Classic Antibiotic Tetracycline

D.F. Pancu, R. Buzatu, R. Milutinovici, S. Iurciuc, A. Dolghi, M. Poenaru

The present study was purported to assess the activities: (i) antibacterial and synergistic against three types of both Gram-positive and Gram-negative bacteria that are susceptible to drug resistance and (ii) cytotoxic and synergistic on colorectal adenocarcinoma cells, of thyme essential oil (TEo) in combination with tetracycline (Tcyc). Chemical composition of thyme essential oil was evaluated by gas chromatography-mass spectrometry (GC-MS) method, antioxidant capacity by 2,2-diphenyl-1-picryl-hydrazyl-hydrate (DPPH) assay, antibacterial and synergistic properties were determined by disk diffusion method and cytotoxic activity by quantifying viable cells by using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay. Thyme essential oil has an elevated antioxidant activity, antibacterial potential against both Gram-positive and Gram-negative bacteria, especially on S. aureus and K. pneumoniae at the highest concentration tested (50µL/mL), also having a synergistic effect when combined with tetracycline (50µL/mL TEo with 10µg/mL Tcyc). Essential oil-treated cells showed a dose-dependent reduction in colorectal adenocarcinoma cell viability, while combination with tetracycline leads to a significantly attenuated decrease in viability.

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3. Aspects of Humoral Immunity after Vaccination with Bnt162b2: A Small Study

L.I. Giubelan, F. Dumitrescu, L. Dragonu, A.C. Stoian, C. Ilie, I. Stanciu

Starting from December 2020, vaccination against COVID-19 became available in Romania. There are a lot of uncertainties regarding the kinetics of immunity and its persistance over time. This is a small prospective study developed between January-September 2021 in the Infectious Diseases Clinic from Craiova and comprising 61 subjects immunised with BNT162b2 (Comirnaty). We have found that after two doses of vaccine there is a strong humoral response, but the immunity lowers six months later. Subjects with a diagnosis of COVID-19, previously or in between the two doses, have had the most significant immunological response, but, also, the sharpest decline in antibody titer. The immune response seems to be the same, regardless the gender of the subjects. There are a variety of responses at the individual level, but overall vaccine effectiveness is 96.72% two weeks following immunisation and 88.52% after six months; however for those who have been in contact with the virus, they all had an antibody titer well above the laboratory limit.

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4. The Clinical, Biological, Psychological and Psychiatric Impact of the Diagnosis of Breast Cancer in Women

R.A. Schenker, I. Marinescu, P.O. Stovicek, E. Lukacs, L. Pauna-Cristian, D. Nica-Badea, M.E. Ciurea

Objective. Psychosocial factors are correlated with the risk of breast cancer, by the lack of externalization of feelings and aggressive tendencies, or with a negative prognosis, by the presence of a high level of stress and reduced coping abilities. Impairment of psychological status should be assessed early to identify quantifiable psychooncological changes, such as depression, anxiety, and self-esteem. These indicators, measured in this study, may become psychometric markers for predicting the existence of the neoplastic process, prior to histopathological evaluations. Methods. 58 patients diagnosed with breast cancer and in different stages of evolution and 61 breast lumps patients were evaluated for depression, anxiety and self-esteem. Results. The correlation of depression and anxiety levels according to the evolutionary stage of the disease was as follows: in stage I cases of severe depression with significant anxiety predominate, in stage II mild depression predominates with insignificant anxiety, in stage III depression predominates moderate with significant anxiety, while in stage IV moderate depression with significant anxiety predominates. Conclusions. The presence of significant anxiety in the uncertainty phase and the anxious-depressive clinical picture can be an alarm signal for the initiation of specific psychotherapeutic strategies, to increase the adaptive potential and resilience to the disease to ensure a therapeutic collaboration of the patient by increasing adherence and compliance. the proposed therapeutic plan. Relatively sudden anxiety in a young woman, risk factors for breast cancer, and deficient cognitive impairment require intensified clinical and paraclinical investigations to confirm early oncological diagnosis.

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5. Moldova Region Population Study of Social Cases Affected by Partial Edentation

F.C. Bida, D. Agop-Forna, C.I. Creu, W.E. Al Hage, N.C. Forna

As the number of partially edentulous patients grows, so will the demand for removable partial dentures (RPDs) in clinical practice because it is a safe, conservative, and cost-effective alternative that provides good plaque control but necessitates periodic maintenance visits. The goal of this research was to look at the incidence of partial edentulism, RPD type, design, and components, as well as their frequency of use, among patients at the Dental Faculty's Department of Partial Dentures in Iasi.

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6. Study on the Application of PRP Enriched with Hyaluronic Acid to Skin Wounds-Macroscopic Result

E.A. Marinescu, O. Nica, V. Parvanescu, R. Mercut, D. Marinescu, A. Cojocaru, M. Georgescu, M.E. Ciurea

Tissue healing is a complex process of replacing damaged tissue structures, being a dynamic process with spatial and temporal involvement. In practice, there are three types of healing: primary, secondary and tertiary. Since even tertiary healing can cause different problems depending on the individual patient, the medical world has always strived for new, easier, more effective, faster, and low cost-effective methods to cover skin wounds. This experiment aims to find a method that is as efficient and fast as possible, with minimal costs, of native healing of skin wounds and the development of a protocol that is as reliable and safe as possible for the patient. The experiment was carried out within the animal facility of the University of Medicine and Pharmacy of Craiova, with the agreement of our institutional Ethics Committee. The experimental group consisted of 30 individuals (Wistar laboratory rats), clinically healthy, male and female, being divided into 3 sublots of 10 individuals each. Each sublot was sacrificed at different time intervals: 7, 14 and 21 days, respectively. The local evolution of each individual was monitored during the experimental days, as well as their general state of health. Before slaughter, the lesions were examined macroscopically, following their size, whether or not the infection was present and the presence of other self-inflicted lesions later. Macroscopically, a faster wound healing was found where PRP enriched with hyaluronic acid was applied from the 7th day, so we can say that at first glance the "free" healing period in the case of enhanced epithelialization was about 7 days shorten. This fact will be confirmed or refuted following histopathological examinations and immunohistochemistry.

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7. Air Pollution and Socio-Economic Determinants of Chronic Obstructive Pulmonary Disease in Albania

E. Shehu, H. Farruku, H.Smaili

Introduction. Chronic obstructive pulmonary disease (COPD) has become a global issue. The Global Burden of Disease Study reports a prevalence of 251 million cases of COPD in 2016, while it is estimated that 3.17 million deaths were caused by the disease during that period. In this paper we conduct an ecological study, to analyze the effects of socio-economic factors and air pollution on the COPD prevalence at the population level in Albania. Methods. Group-level data from 61 municipalities in Albania was used to assess the relationship between environmental exposures, living conditions, and socioeconomic factors with the prevalence of chronic obstructive pulmonary disease. Results. The regression analysis shows that for every percent increase in the concentration of PM2.5 in Albanian cities, a 32% increase in the prevalence of COPD was observed. Similarly, there was an increase in COPD prevalence associated with the increase of the urban population and the number of vehicles registered per city. It is worth mentioning that no statistically significant relationship was observed between the prevalence of COPD, smoking levels, and the Poverty Index. Conclusions. Within the limitations of an ecological analysis, these findings support an association between the prevalence of chronic obstructive pulmonary disease and environmental exposures, socioeconomic factors, and living conditions. However, there is a call to more individual-level analysis and more in-depth research to further investigate the extent of this association in Albania.

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8. Contributions to the Study on the Effects of Incorrect Implantation of Knee Prostheses Depending on the Degree of Varus / Valgus

M.C. enovici, D.N. Tarnia, D.L. Popa, R.C. Vaduva, M.O. Ciobanu, I.L. Petrovici

Introduction. The human knee is one of the most complex human joints, by the number of components, by the stresses to which it is subjected, by the complicated spatial geometry of the components and by the existence of multiple contacts between different components. Material and Method. A series of modern devices and equipment that were used for the three-dimensional reconstruction of the components of the analyzed systems. Results. Also, the elements of a knee prosthesis were modeled in a parameterized virtual environment and six orthopedic systems were compared. These systems have been studied using the finite element method using loads specific to normal human gait. Discussion. The results obtained consisting of maps of displacements, deformations and stresses were stored, analyzed and compared. Conclusions. Finally, important conclusions were highlighted.

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9. A Novel Inflammatory Marker in the Follow-up of Moderate-to-Severe Acne Vulgaris Administered Isotretinoin: Systemic Immune-Inflammation Index (SII)

C. Turan, N. Metin

Background: Systemic immune-inflammation index (SII) is calculated by multiplying the neutrophil-lymphocyte ratio (NLR) and the platelet count. In this study, we aimed to investigate the difference of SII and other inflammatory markers in patients with acne vulgaris compared to healthy controls and themselves after Oral isotretinoin (ISO) treatment. Materials and methods: In this study 190 patients with severe acne vulgaris who received at least 3 months of ISO treatment (0.5-1mg/kg/day) and 66 healthy individuals were evaluated. Hemoglobin, neutrophil, lymphocyte, monocyte, and platelet counts, mean platelet volume (MPV), Plateletcrit (PCT), NLR, platelet-lymphocyte ratio (PLR), monocyte-lymphocyte ratio (MLR), and SII were analyzed. Results: Before ISO treatment, patients with moderate-to-severe acne vulgaris had significantly higher neutrophil counts and SII levels than healthy controls (p=0.036, p=0.028; respectively). In the third month of ISO treatment, both neutrophil count and SII level were similar to healthy control (p=0.376, p=0.379; respectively). In the follow-up of patients using ISO, a significant decrease was observed especially in SII levels (p=0.037). Although the lymphocyte count was not significantly different from the control group before treatment, it increased significantly after ISO and was significantly higher than both the control and pretreatment period (p=0.134, P=0.026, p=0.017; respectively). Although NLR was not different from control in the pre- and post-treatment period, the change in neutrophil and lymphocyte counts after treatment caused a statistically significant decrease in NLR (p=0.682, p=0.289, p=0.043; respectively). Conclusions: We believe that SII is a more useful parameter as an indicator of the anti-inflammatory effect of isotretinoin.

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10. Combination of Pentoxifylline and Ginko Biloba Nephroprotective Effect in Animal Models with Vancomycin-Induced Nephrotoxicity

R. Popa, M. Diaconu, V. Cirlig, C. Marius Varu, D.C. Caragea, R.A. Codea, F.A. Tabaran, M. Aurori, M. Gafencu, C.C. Georgescu

Antioxidants have been commonly used in medicine for thousands of years. Clinically, pentoxifylline and Ginkgo biloba have beneficial renal effects. Our study evaluated the nephroprotective effect of Gingko biloba in combination with Pentoxifiln in an experimental model of vancomycin-induced nephrotoxicity. Male Winstar rats were used in 3 groups: CONTROL, VANCO and VANCO+GBI+PTX and each group included 6 rats. Insufficient studies in the literature on the prevention of acute kidney injury by the combination of Ginkgo biloba and pentoxifylline led to the necessity to perform the study. Acute kidney injury was demonstrated by measuring serum values of classical markers such as urea and creatinine but also by measuring the urinary N-acetyl-?-d-glucosaminidase index, a topical marker in modern medicine. The significant decrease of the biochemical parameters in group III (VANCO+GBI+PTX) compared to group II (VANCO) and values similar to group I (CONTROL), demonstrates, the nephroprotective effect of the use in combination of the two substances.

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11. Simultaneous Determination of Two Tyrosine Kinase Inhibitors in Tablets by HPLC-MS analysis

D.M. Croitoru, C.V. Manda, J. Neamu, A. Bia, O. Croitoru, S.T. Stancu, S.D. Neamu

The class of tyrosine kinase inhibitors (TKIs) is represented by a group of compounds which are currently used in the treatment of different types of cancer. These oral medicines present a narrow therapeutic index and a large inter-and intra-individual variability. Within this work, a simple, accurate and rapid reversed phase ultra-high-performance liquid chromatographic (RP-UHPLC) method with mass spectrometric (MS) detection for simultaneous analysis of two TKIs, ibrutinib and ruxolitinib, using pentoxifylline as internal standard (IS) in tablet dosage forms is presented. The separation was carried out on a Waters (Milford, Massachusetts, USA) Arc System coupled with a Waters QDa mass detector. The column used was a Waters CORTECS C18 (4.6×50mm, 2.7?m); a gradient elution was carried out using a mixture of ammonium formate 10 mM aqueous solution and acetonitrile. The flow rate of the mobile phase was set to 0.5mL/min. The column temperature was equilibrated to 40°C. The injected volume was 5?L. All samples were kept at 20°C during the entire analysis. Mass spectra were recorded in positive ionization mode in the range of m/z 100-400 for ruxolitinib and m/z 100-500 for ibrutinib. Quantification was established in single ion recording (SIR) mode for each compound, using pentoxifylline as internal standard. The method was validated according to International Guidelines in terms of stability, limit of detection, limit of quantitation, linearity, precision and accuracy. The validated method can be successfully applied for simultaneous determination of TKIs in tablet dosage forms.

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12. Comparison of the Efficacy of Balthazar Score and C-Reactive Protein-Albumin Ratio for Determination of Acute Pancreatitis Severity

M. Kiyak, A. Tanoglu

Acute pancreatitis (AP) clinic has a wide spectrum ranging from asymptomatic cases to mortality. Early diagnosis and prediction are of great importance to prevent mortality in AP patients. Many prognostic scoring systems have been developed for AP to date. At the time of the initial assessment of attendance to the emergency department (ED), it is impractical to use existing prognostic scoring systems for patients with a diagnosis of AP in most patients. The prognostic performances of radiological and clinical scoring systems of 329 patients diagnosed with acute pancreatitis were compared in terms of C-reactive protein-albumin ratio (CAR) levels, mortality and severity according to Balthazar score. It was observed that the CAR value increased as the AP severity increased. For mortality estimation, the ROC curve was used for sensitivity, specificity, and cut-off values for each scoring system for CAR. When mild pancreatitis and severe pancreatitis were compared according to Balthazar score, the differences between CAR were statistically significant and positive correlations were present. The CAR value has been shown to be a useful clinical tool that can be used with its high predictive value. CAR has the advantages of being easily accessible, inexpensive, and having moderately high diagnostic power to predict AP severity.

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13. Accuracy of Endoscopic Ultrasonography for Gastric Cancer Staging

V.M. Sacerdotianu, B.S. Ungureanu, S. Iordache, M.M. Filip, D. Pirici, I.M. Liliac, A. Saftoiu

Gastric cancer remains a health problem, with treatment indications varying with the TNM stage. We aimed in this study to highlight the role of EUS in GC patients and also to calculate the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of EUS for T and N staging in our group of patients with this disease. In this study, we included 41 GC patients, and individual values for every T stage accuracy, sensitivity, specificity, PPV, NPV, correct staging, understaging, and overstaging were calculated. EUS overall accuracy for T staging was 58.53%, with the highest sensitivity reached for the T4 stage, 95.83%. For N+vs. N-staging, EUS accuracy was 68.29%, with a sensitivity of 75% and a specificity of 44.44%. The positive and negative predicted values for the presence or absence of nodal disease were 82.75%, respectively 33.33%. In conclusion, this study confirmed the importance of EUS for the assessment of GC T and N stage and highlighted the role of this tool in the detection of liver micrometastasis unrevealed by other imaging techniques like abdominal ultrasound or MSCT.

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14. Histopathological Study of the Prostate Cancer Growth Patterns in Relation with the Grading Systems

T.C.T. Popescu, A.E. Stepan, M.M. Florescu, C.E. Simionescu

Prostate adenocarcinomas are common lesions with a high incidence and variable prognosis, which can be assessed using tumor grading systems. In this study, we analyzed 329 prostate adenocarcinomas in relation to tumor variants, growth patterns, classical and updated grading systems. The study indicated statistical associations of atrophic, pseudohyperplastic and microcystic variants with low grading scores, the associations of glomeruloid, cribriform with or without necrosis and signet ring-like cell variants with high grading scores, and also of single growth patterns with intermediate scores, which supports the accordance and usefulness of existing grading systems for the identification of aggressive prostate tumor lesions.

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15. The Role of Cognitive Coping Mechanisms in the Psychotherapeutic Approach of the Major Depressive Disorder

S. Patru, A.M. Poenaru, V. Gheorman, D. Bondari, D.O. Alexandru, M.C. Pirlog

The depressive disorder represents nowadays an important global health problem, with severe effects for the affected person and for the society as a whole. The psycho-social factors are a major risk element in the onset of depression, overlapping both on the individual vulnerabilities of the affected person, and on the coping mechanisms, especially the disadaptive one. Our study aims were the comparative evaluation of the cognitive coping mechanisms in the evolution of depression and in determining the quality of the therapeutic response in two samples of depressive patients benefiting from pharmacologic treatment, respectively pharmacologic therapy and cognitive-behavioral psychotherapy. The most frequently used cognitive coping strategies in the depressive patients from the two samples in the study were predominantly maladaptive, more precisely ruminating, catastrophizing, self-culpability, respectively putting into perspective. It was evident though that the adaptative coping mechanisms, such as accepting the current situation, positive refocus and positive re-evaluation, are protective factors contributing to reaching psycho-social rehabilitation and granting support to the combined therapeutic intervention. Consequently, the identification of coping mechanisms dominant in each individual with major depression is required in order to increase the efficiency of cognitive behavior therapy as enhancer for pharmaco-therapy.

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16. Non-Melanoma Skin Cancer: Statistical Associations between Clinical Parameters

A.R. Ciuciulete, A.E. Stepan, B.C. Andreiana, C.E. Simionescu

Non-melanoma skin cancer (NMSC) represent an important health problem in medical practice. This is the most frequent type of cancer and its incidence is constantly increasing. Basal cell carcinoma and squamous cell carcinoma constitute the majority of NMSC, respectively 70% and 25% of total cases. The present retrospective study was conducted over a one-year period and included 439 cases of NMSC, of which 336 BCC and 103 SCC. We analyzed a series of clinical parameters: gender, age, tumor size and tumor topography. The statistical analysis of the investigated parameters indicated gender-age associations for BCC, and topography-gender, as well as topography-age for SCC.

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17. A Study Regarding Nursing Leadership

R.E. Belei, A.M. Kamal, C. Cotocel, D. Radulescu, D.O. Alexandru, A. Patracu, A.M. Goganau

Purpose: The research included the analysis and processing of questionnaires applied in county hospitals in Craiova. The purpose of this article is to highlight the qualities, skills and competencies of a leader, necessary in the development of leadership and professional development skills. Material and method: We performed a descriptive and cross-sectional study involving 166 medical staff from hospitals in Craiova. Between January 2020 and January 2021, we used a questionnaire as an investigative tool containing 26 questions on complex leadership issues. The results were stored in Microsoft Excel files (Microsoft Corp., Redmond, WA, USA) and were statistically analyzed using the Microsoft Excel XLST AT (Addinsoft) software suite. SARL, Paris,). Secondary data processing: calculation of fundamental statistical parameters, mean and standard deviation of their ratio, coefficient of variation, graphical representation and calculation of regression coefficients was performed with Excel, Pivot Tables using controls, Functions, Statistics, Diagram and Data Analysis module. In conclusion, a better organization of the management of the hospital units is required, taking into account the leadership in nursing.

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18. Uterine Hemangioma Presenting as an Endometrial Polyp in a Postmenopausal Woman

A. Ullah, Y. Jin, N. Omar, B. Tareen, E. Pryor, I. Ghleilib

Uterine hemangioma (UH) is a rare benign lesion involving the myometrium and cervix. UH often presents as an endometrial polypoid mass that mimics an endometrial polyp. UH is commonly present in women of reproductive age with menorrhagia or pregnancy-associated complications. However, reported cases in postmenopausal women present with postmenopausal bleeding. The bleeding hemangiomatous polyps are treated with hysteroscopic polypectomy. We report the case of a 65-year-old postmenopausal woman with vaginal bleeding severe enough to seek emergency medical care. Transvaginal ultrasonography showed an endometrial thickness of 10.1mm but was otherwise unremarkable. Hysteroscopic examination revealed two endometrial polyps measuring 2.0cm, and 0.5cm. Surgeons had difficulty removing these polyps using usual methods, ultimately resorting to sharp excision. Microscopic examination showed scant endometrium without hyperplasia and a polypoid lesion with numerous CD31 positive capillaries entirely filling the stroma, supporting the diagnosis of capillary hemangioma. The contributing factor to UH in our case was unclear, which opens the door for future investigation of UH in post-menopausal women.

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19. Primary Gastric Malignant Melanoma in a 68-Year-Old Woman: A Case Report and Review of the Literature

G. Gabos, E.D. Burtea, S.C. Brici, F. Costea, C. Nicolau

Non-cutaneous melanoma is a very rare clinical entity. Gastric melanoma can be primary or secondary, but determining their nature is in most cases very challenging. To date, very few cases of primary gastric melanoma have been described in the literature. We report the first case of primary gastric melanoma documented in a Romanian patient, confirmed through clinical, imagistic, and pathological diagnosis. A 68-year-old female patient presented to our hospital with complaints of dyspepsia, abdominal pain, and weight loss. Esophagogastroduodenoscopy revealed two large sessile masses in the gastric fundus, which was histologically compatible with melanoma; immunohistochemistry staining was positive for vimentin, S100 protein, HMB45 antibody and Melan A/MART1, and negative for pan-CKAE1/AE3, leukocyte common antigen and DOG1. Extensive dermatological and ophthalmological examinations did not identify a primary lesion. The patient was therefore diagnosed with primary melanoma of the stomach. At the time of the diagnosis, multiple bone and pulmonary metastases were detected and considering the poor general status of the patient, surgery was not recommended. She died three months following diagnosis. A review of the literature identified only 32 other reported cases of primary gastric melanoma, all in individuals ?50 years of age and most of them in male patients. Partial or total gastrectomy was the usual treatment of choice, but prognosis was overall poor. Awareness of this rare condition must be increased among healthcare providers, as early detection can improve survival chances.

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20. Bronchogenic Cyst in Infants-Clinical and Histopathological Features

C. Singer, S. Cooveanu, I. Petrescu, R. Spataru, O. Ciobanu, G. Dumitra, M. Singer, D. Neagoe, M. Popescu

A male infant, one month old, weight 4000 g, breastfed only, no pathological history, was admitted to the 2nd Pediatric Clinic, Clinical Emergency County Hospital in Craiova with fever and cough. Clinical findings when he was admitted: fever 38.70C, perioral cyanosis, spastic cough, expiratory dyspnea, intercostal retraction, polypnea, subcrepitant rales in the right lung area. The chest x-ray revealed pneumonia aspect in the right middle perihilar region. He was administered antibiotic treatment, HHC, antithermics, with a favorable evolution. The control x-ray, when the infant was in a fair general state, with no disease symptomatology, pointed out a cystic formation at the level of the right middle lobe. The pulmonary CT revealed cavitary lesion, with a diameter of about 40mm in the right lung, and with the presence of septa to the interior and air content. The infant was urgently transferred to Marie Curie Hospital in Bucharest, where the cyst formation was removed through a surgical procedure. The anatomo-pathological examination revealed a bronchogenic cyst. The evolution was favorable after the surgical procedure.

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