Timisoara Medical Journal

The objective of the study. The main focus of the medical degree program in human medicine is the acquisition of practical skills necessary for the practice of the medical profession, its theoretical and scientific foundation and the examination of diagnostic procedures with the aid of technical and communicative means. The mediation of these medical contents should generate a broad and lasting knowledge among the students, taking into account the current scientific knowledge, coupled with a cosmopolitan, critical and patient-oriented attitude. Students will be prepared for their aspired profession with a problem-solving orientation and enabled to lifelong learning. The concept of this curriculum is based on the flexible acquisition of new forms of teaching and learning on the parallel acquisition of medical knowledge and scientific, communicative and psychosocial competences. Material and methods. For the development of the curriculum at the SFU Medical Faculty we used and consulted the reform Curricula of the Universities of Freiburg, Basel, Bern, Maastricht and the Berlin Charité and the RWTH Aachen. The medical degree program is structured according to the Bologna architecture into a bachelor's and a master's degree, each of which can be completed individually. It is a modular system that organizes the recognition and therapy of disease-related problems of the human organism in interdisciplinary topics. Results. The SFU decided to adopt in his curriculum the CanMEDS model, so the graduates should be trained optimally for their medical profession. The degree program is divided into a Bachelor and a Master's degree program shared by six semesters each. The teaching is modular interdisciplinary organ- and system-centered. The basic concept is - following the example of German and Swiss Reform curricula - the unit of preclinical and clinical teaching. The goal here to develop students with a responsible medical attitude. The former “classic” concept "first theory, then practice" is dissolved. The curriculum focuses more on individual body parts and organ systems which are taught in blocks ("modules"). Conclusions. This new way in teaching is called "organ-centered learning". The medical curriculum is designed as a learning spiral. Starting from the first semester students are confront with clinical disease pattern. Until the end of the sixth semester of the bachelor program each organ system is discussed in a preclinical and clinical unit. In the Master program the entire organ systems are taught at a higher level, including in the last year a clinical year. One of the greatest challenges teaching in a new curriculum is the teaching staff. Most of medical teacher have undergone a “classic” teaching career and therefore there must be flexibility in approaching a new teaching concepts. Anatomy is one of the classic disciplines suffering reorganization in a modular teaching curriculum. As an anatomy teacher the author describes the challenges that occur when restructuring didactical concepts. Full article

Objectives: The histological findings in normal uterine tubes have been described sporadically in the scientific literature. The major reason for the lack of investigation in this regard has been the success of in vitro fertilization techniques which enable bypassing of the uterine tubes, so these organs have become somehow neglected, since they are no longer vital for successful conception. This has resulted in the lack of interest in medical community to study tubal morphology. Material and Methods: Summary of our previously published results on histological, immunohistological and electron-microscopic analysis of human uterine tubes, with focus on tubal epithelium and intraepithelial T- lymphocytes, tubal mucosal lymphatic lacunae and tubal telocytes. Results and Conclusions: Since 1904, no one has paid any comprehensive attention to lymphatic drainage of the uterine tubes at the level of lymphatic capillaries. The habilitation thesis authored by a German physician Paul Kroemer was the first to describe the lymphatic lacunae inside the tubal folds, which he named "Lymphbahnen" ("lymphatic channels"). Despite this first description has been existing for more than 110 years, there is no mention of these lacunae in most of the current literature. This status quo is even more striking when we consider that these lymphatic lacunae may be responsible for the thickening of the fimbriae during the oocyte pick-up and the maintenance of the tubal fluid. Similarly, the histological literature also ignores the issue of nomenclature regarding the epithelial cells of the uterine tubes, even though this tubal epithelium may be the source of high-grade ovarian carcinomas. A detailed identification of intraepithelial immunologically active cells can elucidate the questions regarding the immune suppression within the uterine tubes. In our study, we identified intraepithelial regulatory T-lymphocytes. These T-lymphocytes can be involved in the process of immune tolerance of non-self cells (sperm) and partially non-self cells (those of developing embryo), preventing the activation of local immune responses. The last decade of research confirmed the presence of newly discovered population of cells within the interstitium of female genital organs, including uterine tubes. The real significance of these cells – telocytes – however is still at the level of highly hypothetical conjectures. Full article

Objectives: Primary hyperparathyroidism (PHPT) is an endocrine disorder resulting from the hyperfunction of one or more parathyroid glands, with hypersecretion of parathyroid hormone (PTH). We aimed to evaluate the clinical-pathological profile of PHPT patients. Materials and Methods: We performed a retrospective study in patients with PHTP, diagnosed on surgical resection specimens excised in the Department of Surgery of the "Pius Brinzeu" County Clinical Emergency Hospital from Timișoara, on a period of 8 years. Clinical and serological data (serum PTH), morphological aspects and immunohistochemical profile (chromogranin A and Ki67 antigen) were analyzed in these patients. Results: PHPT was diagnosed in 67 patients (55 women, 12 men, mean age 53.9 years). The causes of HPTP were: parathyroid adenomas (36 cases), atypical parathyroid neoplasms (parathyroid tumors with uncertain malignant potential – 3 cases), parathyroid hyperplasia (27 cases) and parathyroid carcinoma (1 case). Parathyroid adenomas were diagnosed more frequently in women (female:male ratio of 8:1), in the 7th decade of life. They were mainly located in the lower parathyroid glands. Parathyroid hyperplasia also predominated in females (female:male ratio of 5.75:1). Parathyroid carcinoma was diagnosed in a 45-year-old man. In 9 cases, PHPT was associated with neoplastic thyroid pathology (papillary thyroid carcinomas). Serum PTH values were recorded in 25 patients, being moderately elevated, generally higher in adenomas. 60% of the investigated patients were symptomatic. Conclusions: Primary hyperparathyroidism is usually diagnosed in women, in the 6-7th decades of life, the most common morphological substrate being the parathyroid adenoma. Frequently, hyperparathyroidism is associated with neoplastic thyroid pathology, requiring complex clinical, serological and imaging investigations before surgery, especially when opting for a minimally invasive parathyroidectomy. Full article

The objective of the study was to investigate the immunohistochemical expression of isocitrate dehydrogenase in tissue samples from patients with surgically managed gliomas. Material and methods. Biopsies from 20 patients that underwent neurosurgery for brain tumors from January to June 2024 in Timișoara County Hospital, were formalin-fixed and paraffin-embedded. In addition to the routine stain, the immunohistochemical technique with anti-IDH1 antibody (R132H) was used. Results: The routine stain showed the predominant fibrillar pattern with variable cell densities, the inconstant presence of tumor necrosis with palisading and microcirculation proliferations, orienting the diagnosis towards a high-grade glioma, in the vast majority of astrocytic origin. 17 cases were diagnosed as glioblastoma G4 (12 wild-type; 5 NOS, the latter because of progression / recurrence of a previously known high grade glioma). The gender distribution was M:F = 7:10, the most involved decade being the 7th (8 cases). The remaining cases were astrocytomas G3 and G4 respectively, IDH1 mutant and one case of oligodendroglioma G3, IDH1 mutant, pending for genetic testing for 1p/19q codeletion. The demographic parameters of these 3 cases were M:F = 1:2, each case being diagnosed in different decade: 3rd, 4th and 7th respectively. Conclusions. Patients with IDH1 mutant gliomas are much younger, respond better to chemotherapy with temozolomide and could benefit of an IDH1 R132H mutation-specific vaccine. Full article

The objective of the study is to present intraductal carcinoma of the prostate from the perspective of its definition, diagnostic criteria, significance, and therapeutic implications. Material and methods. The relevant literature from recent years regarding intraductal carcinoma of the prostate (IDC-P) has been studied. Results. IDC-P is a recently introduced entity in the WHO classification of prostate carcinomas and most often represents a late stage in the evolution of prostate tumors, and much more rarely, a precursor lesion for invasive carcinoma. IDC-P poses a challenge for pathologists in terms of diagnostic criteria and differential diagnosis with other similar lesions, is associated with negative prognostic factors, and may have therapeutic implications. Conclusions. IDC-P is an important pathological finding that should be thoroughly evaluated and documented in both needle biopsies and radical prostatectomy specimens. Its identification has critical clinical implications for the prognosis and management of prostate cancer. Full article

The objective of the study: Considering the significant effect that a melanoma diagnosis has regarding the life quality of the patients affected by this life-threatening disease, we wanted to contribute to a better understanding of the clinical and morphological characteristics of primary extracutaneous melanomas. Material and Methods: We performed a retrospective observational study with cases collected from the Pathology Department of “Pius Brînzeu” Emergency County Clinical Hospital. We identified all the cases with a melanoma diagnosis from the database, from January 2018 to December 2023 and then we extracted the primary extracutaneous melanomas. Results: From the 8 cases of extracutaneous primary melanomas identified, 5 were diagnosed as ocular melanomas (62.5%), 2 as anal mucosa melanomas (25%) and one as penile glans melanoma (12.5%). Regarding the ocular melanomas, 3 cases were diagnosed in female patients and 2 cases in male patients, median age 57.8 years (age range 50-70 years). One tumor was located in the choroid (pT3), one in the uvea and choroid (pT2a), one in the conjunctiva (pT1a) and 2 cases involved the ciliary body (pT4b and pT4e). Two of the cases (40%) presented extraocular extension. One of the patients with anal mucosa melanoma was previously diagnosed with poorly differentiated rectal adenocarcinoma and urinary bladder urothelial carcinoma (63 years, male). This patient presented to the hospital with abdominal pain. The macroscopic aspect of the anal melanoma was nodular. The other patient presented to the hospital with rectal bleeding (86 years, female). A stenosing tumour was described by endoscopy. The penile glans melanoma invaded the corpus spongiosum and extended along the urethra. The case also presented lympho-vascular invasion and an inguinal lymph node metastasis. The patient was previously diagnosed with an adenocarcinoma of the colon (78 years, male). Conclusions: The primary extracutaneous melanomas are very rarely diagnosed. The ocular melanomas were the most frequently diagnosed primary extracutaneous melanomas in our study. Full article

Introduction: Pulmonary pathologies are among the most common diseases in both children and adults, representing the leading cause of death in children under the age of 5. Over the years, the applicability of thoracic ultrasound has evolved, becoming a routine investigation, and its indications for use in evaluating both pediatric and adult populations have expanded. The classic diagnostic methods for pulmonary pathology in the general population include chest X-ray and CT scans, which expose the patient to ionizing radiation. Methods: Thoracic ultrasound is a non-invasive, painless technique that does not cause discomfort to the patient. A linear probe is preferred, and the examination begins with the transducer in a longitudinal position for a general assessment of the thorax. The examiner can then focus on an area of interest with the transducer in a transverse position. Each hemithorax is divided into anterior, lateral, and posterior zones by the anterior and posterior axillary lines. Each zone is then subdivided into upper and lower regions by an imaginary line passing through the nipple line. Results: Physiologically, A-lines can be visualized, which are horizontal, hyperechoic, equidistant lines parallel to the pleura, representing multiple reflections of the pleural line. B-lines, on the other hand, are long, well-defined vertical lines originating from the pleural line. B-lines may be considered physiological in newborns but can also appear in pathological conditions (more than 3 B-lines in one examined space). The main indications for thoracic ultrasound include: respiratory distress syndrome, transient tachypnea of the newborn, meconium aspiration syndrome, pulmonary hemorrhage, neonatal atelectasis, pneumothorax, pneumonia, viral infections, and pleural pathology (such as pleurisy). Conclusions: Pulmonary ultrasound has the significant advantage of being a non-radiative investigation, making it an extremely important diagnostic tool, especially for this patient population, as it helps reduce the risk associated with repeated radiation exposure. Full article

Aim of the study. The objective is to study cellular spaces, as compartments lined with lax connective tissue, bounded by fascia, muscle, bone and other anatomical structures. They may contain different anatomical elements such as vessels, nerves and lymph nodes. According to their anatomic-topographic localization we distinguish: subcutaneous, interfascial, sub and interserosal, subfascial, osteo-fascial, parafascial, paravasosal, paraneural, paraarticular and paravisceral. Terminal branches of peripheral nerves are also located in them, thus there is the possibility to perform loco-regional blocks by injecting AL into the respective compartments. Material and Methods. This study is based both on the bibliographic analysis of the literature in the field of topographic anatomy and loco-regional anesthesia, and on our own experience within the ITA section of the Oncological Institute of Moldova. The chosen resources included fundamental textbooks and papers from recognized scientific journals published in the last 15 years. Results. Subfascial cellular spaces are located beneath the fascia propria (deep fascia) surrounding one or groups of muscles, between which are located intermuscular fascial septa or bony surfaces. According to recent research (including imaging methods) of the cellular space (interfascial plane), it is considered to be the space between two septa of the fascia propria (deep) and is presented by adipose tissue, elastin and reticular fibers. It may contain nerves, blood vessels, bone and muscle, and has a fixating, cushioning and lubricating role. Injecting AL into the interfascial space can block both the peripheral branches of nerves within the interfascial space and the nerve endings that distribute into the fascial fascia. Localization of the interfascial space to external landmarks alone is uncertain. Hence the advent of ultrasound with live, real-time visualization of anatomy has revolutionized both medical diagnosis and the technique of loco-regional anesthesia. Elsharkawy et al. suggested that the biomechanical properties of the fascia might play an important role in the diffusion of local anesthetics, and ultrasound can detect changes in the interfascial space during monitoring of LA dispersion. Conclusions. The knowledge of the anatomic-topographic particularities of the interfascial spaces allows us to understand the mechanism of action, indications, technique and complications of fascial plane anesthesia. With the widespread introduction of ultrasonography (especially hand-held ultrasonography), it became possible to visualize the anatomy in vivo: needle-layer relationship, nerves, vessels, local anesthetic spread. In this aspect the fascial plane blocks have shifted from techniques based on anatomic landmarks to ultrasonographic guidance, and their utilization is increasing. Full article

Objectives of the study. This study aims to evaluate lung morphology in lung trauma. Material and method. Lung trauma was categorized according to the type of lesions of the contents and the contents of the lungs, i.e. 36 cases. The following examinations were used: radiography and lung CT. The increased frequency of traumatic lung pathology justifies the choice of the subject of this study. Results. Of the total of 36 traumatic injuries of the chest, 9 cases of thoracic contusion, 5 cases of hemothorax, 5 cases of pneumothorax, 14 cases of rib fractures, 2 cases of sternal fractures, 1 case of vertebral contusion and 2 cases of wounds were recorded. A significantly higher percentage: 73% were male. Thoracic trauma was more common in rural patients: 64%. Age groups 41 - 60 years and over 60 years were particularly affected. Front and profile chest radiography is the most important paraclinical examination for the correct diagnosis of the thoracic contents and contusion, indication of the correct therapeutic method, follow-up of the evolution of the disease, diagnosis of trauma to other neighboring segments of the chest. Imaging examination brings important additions to the radiographic examination of traumatic thoracic disorders. CT is extremely useful. Conclusions. The majority of patients were treated in the thoracic surgery department. The statistical study of the cases hospitalized in the thoracic surgery department emphasized once again that, the knowledge of the anatomy (morphology) of the thorax and its contents is a fundamental condition for the imaging interpretation. The complete examination, consisting of a correct clinical examination performed by a specialized physician, complemented with radiologic and imaging examination is mandatory and of maximum efficiency in the diagnosis and treatment of thoracic trauma. Full article