Vol. 63 No. 3, July-September 2022

1. Boron-containing compounds in Dentistry: a narrative review

Ioana Mitrut, Ion Romulus Scorei, Horia Octavian Manolea, Andrei Bita, Laurentiu Mogoanta, Johny Neamtu, Ludovic Everard Bejenaru, Maria Viorica Ciocilteu, Cornelia Bejenaru, Gabriela Rau, George Dan Mogosanu

Research on the use of boron (B) in the field of oral health has gained momentum in recent years, with various studies on the possibilities of using various B-containing compounds (BCCs). A multitude of applications have been discovered, from cariostatic activity to anti-inflammatory and antifungal activity, paving the way for other new research directions. B is a microelement that is commonly found in the human diet, and present throughout the body, with the highest concentration in the structure of bones, teeth, and gastrointestinal mucus gel layer. Multiple studies have demonstrated that B plays some important roles, especially in bone development and recently has been proposed to have an essential role in the healthy symbiosis. In addition, B has also attracted the interest of researchers, as various studies used BCCs in conventional or modern biomaterials. In this review, we have brought together the information we have found about B updates in the dental field and analyzing its future perspectives and potential for further studies.

Corresponding author: Ion Romulus Scorei, Professor, PhD; e-mail:

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2. Current approach to branchial remnants in the neck

Daniela Vrinceanu, Maria Sajin, Mihai Dumitru, Carmen Aurelia Mogoanta, Romica Cergan, Madalina Gabriela Georgescu

Congenital branchial fistulas and cysts are an interesting subject in cervical pathology. There are congenital malformations with late expression in young adults that require correct diagnosis and appropriate treatment. We review essential notions of cervical embryology to understand the mechanism of occurrence of these malformations and their clinical expression. The most common cases present vestiges from the second branchial arch, with the appearance of a cystic tumor or a fistulous orifice on the anterior edge of the sternocleidomastoid muscle, at the level of the hyoid bone. Performant imagery is mandatory for appropriate diagnosis, so we recommend a cervical computed tomography (CT) scan or cervical magnetic resonance imaging (MRI) to evaluate the relations with great vessels of the neck or other lesions. The treatment implies complete surgical excision because otherwise there is a high risk of recurrence of the lesion. The differential diagnosis includes cystic lymphangioma, dermoid cyst, tuberculous adenopathy, cystic hygroma, lateral cervical cystic metastases. Histological examination is mandatory for a definite diagnosis. Also, there is a small percentage of malignancy of these malformations, but it is very important to check that all the histological diagnostic criteria for a primary branchiogenic carcinoma are accomplished. Therefore, although it is a benign cystic cervical pathology, the diagnosis and treatment must be made very accurately for a complete cure, and this review aims to summarize the current approach to branchial remnants of the neck.

Corresponding author: Mihai Dumitru, Assistant Professor, MD, PhD, ENT Consultant; e-mail:; Carmen Aurelia Mogoanta, Senior Lecturer, MD, PhD; e-mail:

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3. Modern aspects of the management of pancreatic intraductal papillary mucinous neoplasms: a narrative review

Efstathios T. Pavlidis, Konstantinos G. Sapalidis, Theodoros E. Pavlidis

Intraductal papillary mucinous neoplasms (IPMNs) account for approximately 35% of all cystic tumors in the pancreas and represent the largest subgroup. They are characterized by mucin production and intraductal papillary epithelium growth. IPMNs range from benign to malignant lesions. Biomarkers combined with 18F-Fluorodeoxyglucose-positron emission tomography (18FDG-PET) is the best diagnostic tool. The risk of malignant transformation for main-duct IPMNs is between 34-68% and for low-risk branch-duct (BD)-IPMNs it is 1.1%. Monitoring is crucial for determining the optimal time of surgical excision. Novel artificial intelligence combining clinical, tumor biomarkers, imaging and molecular genomics plays a determinant role in the evaluation of such lesions. The first diagnostic tool is multidetector helical computed tomography (MDHCT) or up-to-date magnetic resonance imaging (MRI). MRI detects malignancy by enhancing mural nodules >=3 mm. Novel endosonographic interventional techniques have been added to the diagnostic armamentarium. Pancreatoscopy is feasible and effective but challenging for evaluating the diagnosis, invasiveness, and extent of IPMNs. Its findings may change the surgical approach. Pancreatic juice and duodenal fluid have been used recently for molecular biological analysis. The genes most frequently altered include Kirsten rat sarcoma viral proto-oncogene (KRAS), tumor protein p53 (TP53), cyclin-dependent kinase inhibitor 2A (CDKN2A), SMAD family member 4 (SMAD4), and guanine nucleotide-binding protein, alpha stimulating (GNAS). Despite the advances in diagnostic modalities, assessment of this premalignant lesion of pancreatic cancer, with its poor prognosis, is a challenging task. Pancreatectomy is the indicated approach for malignant or high-risk IPMNs with potent malignancy. Conservative management or enucleation for preserving the pancreas of low-risk BD-IPMNs is recommended, but long-term follow-up for recurrence is necessary. The management of IPMNs must be individualized based on preoperative high-risk stigmata and worrisome features.

Corresponding author: Efstathios T. Pavlidis, MD, MSc, PhD; e-mail:

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4. Impact of COVID-19 on fertility and assisted reproductive technology (ART): a systematic review

Maria Sidonia Sandulescu, Constantin-Cristian Vaduva, Mirela Anisoara Siminel, Anda Lorena Dijmarescu, Sidonia Catalina Vrabie, Ioana Victoria Camen, Daniela Elise Tache, Simona Daniela Neamtu, Rodica Daniela Nagy, Andreea Carp-Veliscu, Maria Magdalena Manolea

The appearance of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been a major obstacle for the performing of current medical activities throughout the world. COVID-19 has affected humanity in many ways, thus causing a great medical, social, economic, and political instability. The aim of this study was to make an analysis of the scientific data obtained by so far to highlight the impact that COVID-19 has had on fertility and assisted reproductive technology (ART). Infection with SARS-CoV-2 alters the normal immune response by local and systemic damage to tissues and organs. After the virus enters the body, the first lesions are produced in the respiratory tract. Extrapulmonary lesions specific to COVID-19 include acute renal lesions/acute kidney damage, hepatocellular lesions, neurological diseases, myocardial dysfunction and arrhythmia, gastrointestinal diseases but also genital impairment. The possible impairment of the male reproductive system is because angiotensin-converting enzyme 2 (ACE2) receptors are in an increased number in the testes, seminiferous duct cells, spermatogonia, Leydig cells and Sertoli cells. Many published studies to date have pointed out that COVID-19 could also affect female fertility and disrupt the functions of the female reproductive system. The theory that this virus can also be transmitted sexually and can cause infertility or testicular damage is supported by the fact that the virus can be isolated in the semen of COVID-19 patients but only during the disease. Choosing the best method of treating infertility during the COVID-19 pandemic is multifactorial, but the risk of infection and compliance with specific ART hygiene protocols must always be considered. Currently, there is no scientific basis regarding the fact that the COVID-19 vaccination would influence fertility.

Corresponding author: Andreea Carp-Veliscu, MD, PhD; e-mail:

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5. Clinical and morphopathological assay in vulvovaginal candidiasis

Maria Magdalena Manolea, Anca-Maria Istrate-Ofiteru, Maria Sidonia Sandulescu, Ioana Victoria Camen, Ionel Alin Piciu, Anda Lorena Dijmarescu, Sidonia Catalina Vrabie, Simona Daniela Neamtu, Cosmin Vasile Obleaga, Mirela Anisoara Siminel

Candida vulvovaginitis is characterized by the appearance of inflammatory changes in the vaginal and vulvar epithelium secondary to infection with Candida species. The purpose of this study was to analyze and compare the clinical, microbiological, and histopathological aspects of pregnant and non-pregnant patients, symptomatic or asymptomatic in the case of candida vaginitis and to correlate the microscopic aspects with the symptoms before applying the local treatment with Nystatin. The study presents a retrospective analysis of the management of vaginitis in 166 pregnant or non-pregnant patients during 2021-2022. We observed the structure of the Malpighian squamous epithelium without keratinization present on the vaginal mucosa and the structure of the subepithelial connective tissue, which shows increased numerical values of inflammatory and vascular cellularity in the case of candida vaginitis symptomatic compared to asymptomatic ones. We noticed also in the microscopic study that in cases of asymptomatic patients before treatment, the number of inflammatory cells and blood vessels situated immediately under the epithelium was significantly lower compared to their number in symptomatic patients before treatment. Analyzing the results obtained after the administration of the treatment proposed by us, we can say that local Nystatin treatment is beneficial and safe for pregnant and non-pregnant patients and is a good alternative for patients with recurrent vulvovaginal candidiasis.

Corresponding author: Anca-Maria Istrate-Ofiteru, MD, PhD; e-mail:; Maria Sidonia Sandulescu, MD, PhD; e-mail:

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6. Bcl-2 and p53 immunophenotypes in colorectal adenocarcinoma in type 2 diabetes mellitus versus non-diabetic patients

Horatiu-Cristian Popescu-Valceanu, Mihai Ciprian Stoicea, Valentin Enache, Razvan Matei Bratu, Petronel Mustatea, Ramona Maria Dragut, Emilia Rusu, Constantin Ionescu-Tirgoviste, Gabriela Radulian

We aimed to investigate immunohistochemical expression of the p53 tumor suppressor protein, and the B-cell lymphoma-2 (Bcl-2) apoptotic protein in colorectal adenocarcinoma patients with or without type 2 diabetes mellitus (T2DM). Tissue sections from 95 paraffin-embedded colorectal adenocarcinomas, originating from 52 T2DM and 43 non-diabetic patients, were immunostained for p53 [Ventana mouse monoclonal primary antibody (mAb) in vitro diagnostic (IVD) anti-p53, clone Bp53-11] and Bcl-2 (Ventana mAb IVD anti-Bcl-2, clone Bcl-2/124). Immunohistochemistry analysis did not find statistically significant differences between the two groups, but analysis on subgroups of patients in terms of presence or absence of obesity identified overexpression of p53 (>70% of cells) in the T2DM obese patients compared to non-diabetics. Overexpression of p53 was present in 80% of tumor cells coming from T2DM obese patients compared to 37.2% of tumor cells coming from non-diabetics obese and non-obese, and in 36.6% of tumor cells coming from non-diabetic non-obese patients (p=0.024). There was a single non-diabetic obese patient with p53 overexpression. Most cancer cells of T2DM obese patients presented more frequently p53 overexpression by comparison with cancer cells of the T2DM non-obese patients (80% vs 40.5%, p=0.028). Bcl-2/p53 co-expression was an infrequent event in T2DM patients group. The results of this study suggest that patients with colorectal adenocarcinoma that associate T2DM and obesity exhibit higher p53 protein expression in malignant cells. In conclusion, our research highlights that obesity is a potential key factor in the relationship between T2DM and colorectal cancer.

Corresponding author: Emilia Rusu, Associate Professor, MD, PhD; e-mail:

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7. Immunoexpression of E-cadherin, CD44 and Claudin 7 in gastric adenocarcinomas

Oana Iulia Cretu, Cristiana Eugenia Simionescu, Mirela Marinela Florescu, Mioara Desdemona Stepan, Konstantinos Sapalidis, Alex Emilian Stepan

Gastric adenocarcinomas represent frequent malignant tumors in the digestive tract, with a high and constant mortality rate in last decades. The disturbance of the adhesion molecules expression, which normally is essential in maintaining epithelial homeostasis, has a critical role in the initiation and progression of tumors. In this study, we analyzed the immunoexpression of E-cadherin, cluster of differentiation 44 (CD44), and Claudin 7 in 58 cases of gastric adenocarcinomas, in relation to the histopathological parameters of the lesions aggressiveness. Increased E-cadherin immunoexpression was observed in tubular adenocarcinomas, those of low grade and in stages I-III. CD44 presented high scores in discohesive, hepatoid, tubular, and tubulopapillary adenocarcinomas, those of high grade and in advanced stages. Claudin 7 associated increased scores for tubular, tubulopapillary and micropapillary tumors, those of low grade and mainly in stage I. The markers used in the study can be useful for assessing the aggressiveness of gastric adenocarcinomas, in the context of specific adapted therapy.

Corresponding author: Mirela Marinela Florescu, Teaching Assistant, MD, PhD; e-mail:; Mioara Desdemona Stepan, Lecturer, MD, PhD; e-mail:

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8. Ozone and microstructural morphological changes of tooth enamel

Alin Daniel Floare, David Focht, Adrian Ioan Hajdu, Ioana Cristina Niculescu Talpos, Octavia Iulia Balean, Cornelia Veronica Muntean, Dorian Sebesan, Daniela Elisabeta Jumanca, Atena Galuscan

The paper aims to study the impact of ozone (O3) treatment on the microstructural changes of the tooth enamel after the treatment at different time intervals. The ozonation was performed with gaseous O3 produced by HealOzone X4, the demineralization level was measured with the DiagnoDent Pen 2190 device, and the microstructure changes of enamel surface were observed using scanning electron microscopy (SEM) analysis. The results showed the exposure to O3 for 40-50 seconds enhanced enamel micro-hardness and ensures a rate of remineralization between 96.82-97.38%. In conclusion, in search of new minimally invasive solutions in the treatment of caries and to offer antimicrobial support of the oral cavity, the use of O3 as an alternative therapy to classical solutions may be a viable solution in dentistry.

Corresponding author: Ioana Cristina Niculescu Talpos, Assistant Professor, DMD, PhD; e-mail:; Octavia Iulia Balean, Assistant Professor, DMD, PhD; e-mail:

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9. Subgemmal neurogenous plaques of the tongue: a systematic autopsy study

Jose-Fernando Val-Bernal, Maria-Francisca Garijo, Natalia Fontanil

Subgemmal neurogenous plaque (SNP) is a subepithelial nerve plexus associated with taste buds, occasionally observed in tongue biopsies. There is no evaluation of the prevalence of this structure in the general population. We present a systematic study of samples obtained at random from the dorsal portion of the oral tongue in 205 consecutive complete autopsies. Each sample was about 15 mm long and 10 mm thick. Four hundred fifty-eight samples were routinely obtained and an average of 2.23+/-0.88 samples per case (range 1-7) was collected. The total number of SNPs observed was 556, with a mean of 2.71+/-2.68 per case (range 0-16). This means that for every 15 linear mm of the oral tongue, approximately 2.7 SNPs can be present. SNPs display several ages, and they do not show sex differences. The mean size of these structures was 2.1+/-0.94 mm (range 0.6-3.6 mm). SNP is characterized by its unique neural, zonal pattern with a superficial neurofibroma-like area and a deeper neuroma-like area. Special features of the SNPs include the presence of taste buds (49.1%), ganglion cells (26.3%), dilated thin-walled vessels (11.3%), salivary gland excretory ducts emptying on the surface of the papillae (6.1%), moderate-severe inflammatory infiltrate (6.8%), presence of lymphoid tissue in the vicinity (7.0%), and hyperplasia of the epithelial cover with pseudoepitheliomatous appearance (7.0%). The differential diagnoses include schwannoma, neurofibroma, ganglioneuroma, traumatic neuroma, mucosal neuroma, and squamous cell carcinoma. SNPs are small, normal structures that may undergo hyperplasia and are usually seen incidentally.

Corresponding author: Jose-Fernando Val-Bernal, Professor, MD, PhD; e-mail:

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10. The histopathological features and their prognostic impact in the postoperative follow-up of colorectal cancer patients

Stefan Patrascu, Liliana Cercelaru, Giorgiana Maria Graure, Maria Andreea Firut, Ionela Rotaru, Dan Cartu, Daniela Marinescu, Ana Maria Patrascu, Razvan Ilie Radu, George Mitroi, Valeriu Surlin

The validation of histological prognostic markers in colorectal cancer not only for survival parameters but also for early postoperative outcomes is of paramount importance. The aim of our study was to search for the tumor histopathological (HP) characteristics that may influence the postoperative morbidity, especially the occurrence of anastomotic leakage. Our results indicated that peritumoral inflammatory cell infiltrate appeared to correlate with both anastomotic fistula and overall postoperative complications. Likewise, high-grade and undifferentiated colorectal tumors seemed to be correlated with a higher incidence of postoperative leakage and complications. No relation could be established between the other HP features and the postoperative untoward outcomes.

Corresponding author: Maria Andreea Firut, MD, PhD Student; e-mail:; Ionela Rotaru, MD, PhD; e-mail:

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11. Benign tumors of the superficial lobe of the parotid gland

Eugen Horatiu Stefanescu, Carmen Aurelia Mogoanta, Elena Irina Caluianu, Octavian Ion Predescu, Charoula Florou, Vlad Chercota, Gheorghe Iovanescu

Tumors of the parotid gland are a rare occurrence among head and neck tumors (only 3-8%), and the vast majority are benign. Most benign tumors of the parotid gland are pleomorphic adenoma (PA), followed by Warthin s tumor (WT) and they occur in the superficial lobe. The only reasonable treatment is considered to be total tumor removal, but the appropriate surgical approach remains a matter of controversy. Over time, it went from enucleation to superficial parotidectomy (SP) and then to extracapsular dissection (ECD). SP is often considered to be the gold standard; however, the risk of intraoperative damage to the facial nerve (FN) cannot be ignored. Lately, ECD - which does not expose the main trunk of the FN - has been regarded as a safe technique for the treatment of small benign parotid tumors. Patients, Materials and Methods: The study retrospectively reviewed all parotidectomies for benign parotid tumors of the superficial lobe performed in the Department of ENT, Municipal Emergency Clinical Hospital, Timisoara, Romania, between January 2014 and December 2018. The following patient data were collected: age; sex; follow-up duration; extension of the resection; use of FN monitoring and lesion features, including position, pathology, and size. Preoperative investigation protocol included a computed tomography (CT) scan to assess the size and location of the tumor helping the treatment planning. The same surgical team performed both standard SP and ECD for the treatment of these tumors. All cases were confirmed as benign parotid tumors. Recurrences of any kind and tumors involving the deep lobe of the gland were excluded from the study. All patients underwent a macroscopically complete resection of the tumor. The main outcome was the postoperative complications in the two groups. Data regarding these complications were recorded on follow-up visits at one, six, 12 and 24 months. Results: Ninety-five patients with benign parotid tumors were operated by the same surgical team at the Department of ENT, Municipal Emergency Clinical Hospital, Timisoara, between January 2014 and December 2018 but only 89 (38 men and 51 women) met the follow-up criteria and were included in the study. Sixteen (18%) patients underwent ECD, and 73 (82%) patients underwent SP as a primary intervention. The mean lesion size for ECD group was 2.0+/-0.9 cm and 4.2+/-1.7 cm in the SP group, and it was statistically significant (p<0.05). As expected, the most common type of tumor was PA but the distribution between the groups was different: in the SP group, PA represents 83% (61/73) of cases but only 44% (7/16) of cases in the ECD group. Median follow-up time was comparable in the two groups - 33+/-8 months for the ECD group and 39+/-11 months for the SP group. There were also differences between the two groups regarding the postoperative complication rate. There were significantly more transient and permanent FN paralysis, transient and permanent great auricular nerve (GAN) dysfunctions and Frey s syndrome (FS) in the SP group. Conclusions: A comparison between ECD and SP as surgical procedures for the treatment of benign tumors of the parotid seems inappropriate as their indications do not overlap. ECD showed similar effectiveness and fewer side effects than SP and can be considered the treatment of choice for small, superficial and/or marginal tumors located in the lateral lobe of the parotid gland.

Corresponding author: Carmen Aurelia Mogoanta, Senior Lecturer, MD, PhD; e-mail:; Elena Irina Caluianu, Assistant, MD; e-mail:

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12. Primary bone leiomyosarcoma of distal femur: case report and literature review

Vlad Alexandru Georgeanu, Raluca Ioana Pletosu, Teodora Camelia Vladescu, Simona Bondari, Andrea Craciunescu, Octav Marius Russu

We present the case of a 58-year-old patient presented with a spontaneous right supracondylar fracture. The initial bone biopsy, highlighted the defining histopathological (HP) elements for a leiomyosarcoma (LMS), initially considered a metastasis. The complex imaging examinations did not reveal another tumor, so the final diagnosis was primary bone LMS. Final treatment was a wide tumor resection and reconstruction with a knee tumor prosthesis, preceded and followed by three cytostatic cycles (Doxorubicin 75 mg/sqm). The HP examination has confirmed the previous diagnosis. The key microscopic features for the diagnosis of bone LMS was: malignant mesenchymal proliferation composed of intersecting fascicles of cells with eosinophilic, fibrillary cytoplasm and pleomorphic, elongated, blunt-ended, cigar-shaped nuclei of variable sizes; variable mitotic count; presence of tumor necrosis and stroma with changes that include hyalinization, myxoid change, with absence of chondroid or osteoid matrix; diffuse positivity for smooth muscle immunohistochemical markers: smooth muscle actin, desmin, h-caldesmon. At 12 months after the tumor resection, the patient is in good condition without any sign of local recurrence or metastatic disease. LMS represents a type of soft tissue sarcoma (STS), a variant of the spindle cell sarcomas, accounting for about 7% to 10% of all STS. Bone LMS can be primary or secondary; the primary variant is very rare, representing a very small percentage (around 0.7%) of all primary malignant bone tumors, according to the literature data. Very few cases are presented in the literature; the management of this kind of tumor is controversial, especially regarding the chemo- and radiotherapy.

Corresponding author: Vlad Alexandru Georgeanu, MD; e-mail:

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13. Complete oculomotor nerve palsy - first manifestation of gastric adenocarcinoma: clinical experience and literature review

Irina Andreea Pavel, Claudia Florida Costea, Catalin Constantin Anton, Ioana Roxana Mariuta, Delia Gabriela Ciobanu Apostol, Anca Sava, Andrei Ionut Cucu, Simona Delia Nicoara, Mihaela Dana Turliuc, Speranta Schmitzer, Daniela Maria Tanase, Dragos Viorel Scripcariu, Camelia Margareta Bogdanici

The diagnosis and management of the alteration of the normal function of the oculomotor nerve (third cranial nerve) varies depending on the characteristics of the paralysis, the age of the patient, and the associated symptoms and signs. Oculomotor nerve palsy may be caused by lesions located anywhere from the oculomotor nucleus to the termination of the third nerve in the extraocular muscles. Although there have been significant advances in neuroimaging to facilitate early diagnosis, the management of a patient presenting with isolated oculomotor palsy is still challenging. This review tackles the case of a 52-year-old patient, with a history of pulmonary tuberculosis (at the age of five), referred to the Department of Ophthalmology, St. Spiridon Emergency Clinical Hospital, Iasi, Romania. The patient had diplopia accompanied by right eyelid ptosis, symptoms that began suddenly 10 days before hospitalization. The clinical examination showed right eye grade II palpebral ptosis, exotropia with limitation of eyeball movements in adduction, supra-/infraduction. Biomicroscopic examination of the anterior pole revealed the presence of anisocoria and light-near dissociation on the affected side. Numerous investigations were performed to identify the cause, starting with tumoral markers, which were within normal limits. Magnetic resonance angiography (MRA) was performed, and posterior communicating artery aneurysm was ruled out. The endocrinology examination and hormonal laboratory tests were also within normal parameters. Due to suspicions of generalized tuberculosis raised by the infectious disease doctor or presence of secondary lesions, thoraco-abdomino-pelvic computed tomography (CT) scan with contrast agent was done and its findings required gastroenterological exploration. After various explorations, the certainty diagnosis was set by histopathological examination, which revealed gastric adenocarcinoma.

Corresponding author: Claudia Florida Costea, Associate Professor, MD, PhD; e-mail:; Dragos Viorel Scripcariu, MD; e-mail:

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14. Esophageal ulcer associated with mild hemophilia A: case report

Cristian Mircea Nicolescu, Alexandru Nesiu, Amelia Uzum, Damian Cristian Laza, Laura Corina Nicolescu, Paul Freiman, Andrei Ardelean, Razvan Ene, Teodora Daniela Marti

In this paper, we present the case of a 68-year-old male with personal medical history of coagulopathy issues, who presented to our Emergency Room (Emergency County Hospital, Arad, Romania) with bleeding of the superior tract of the digestive system; the case was difficult to manage, thus warranting the intervention of the Department of Gastroenterology. Endoscopy was performed to localize the site of bleeding and to stop the hemorrhage. This procedure was not successful. The patient was transferred to our Intensive Care Unit where different medications, such as proton pump inhibitor, hemostatic agent and prokinetic drugs were administered. Unfortunately, our attempt to stop bleeding failed; this led us to expand our investigation. We focused on a possible hemophilia as the cause of bleeding, which was confirmed as hemophilia A through the coagulometry test after a period of three days. Patient medical history and coagulation test led us to believe that this is a very rare case of a mild hemophilia A. Finally, the correction of Factor VIII deficiency and repeated endoscopic hemostasis clip was able to stop patients bleeding and ensured a favorable clinical evolution of the patient.

Corresponding author: Amelia Uzum, Lecturer, MD, PhD; e-mail:; Razvan Ene, MD, PhD; e-mail:

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