Vol. 63 No. 4, October-December 2022

1. Radiographic methods for locating impacted maxillary canines

Stefania Dinu, Liana Todor, Irina Nicoleta Zetu, Mariana Pacurar, Anca Porumb, Raluca Adriana Milutinovici, Ramona Amina Popovici, Silviu Brad, Bogdan Adrian Sink, Malina Popa

Maxillary canine impaction is a fairly common phenomenon in dental practice. Most studies indicate its palatal position. For a successful orthodontic and/or surgical therapy, it is necessary to correctly identify the impacted canine in the depth of the maxillary bone, using conventional and digital radiological investigations, each with their advantages and disadvantages. Dental practitioners must indicate the most targeted radiological investigation. This paper aims to review the various radiographic techniques available for determining the location of the impacted maxillary canine.

Corresponding author: Liana Todor, Associate Professor, DMD, PhD; e-mail:; Irina Nicoleta Zetu, Habilitated Professor, DMD, PhD; e-mail:

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2. The clinicopathological challenges of symptomatic and incidental pulmonary hamartomas diagnosis

Adriana Grigoras, Cornelia Amalinei, Ciprian Sebastian Lovin, Constantin Cristian Grigoras, Diana Lavinia Pricope, Constantin Aleodor Costin, Irina Rodica Chiselita, Radu Adrian Crisan-Dabija

Pulmonary hamartomas (PHs) are the most common benign lung tumors. Usually, they are asymptomatic and incidentally discovered during assessment for other diseases or during the autopsy exam. In this context, we have performed a retrospective analysis of surgical resections in a 5-year series of patients diagnosed with PHs in the Clinic of Pulmonary Diseases, Iasi, Romania, aiming to evaluate their clinicopathological features. A total of 27 patients with PH (40.74% males and 59.26% females) were evaluated. 33.33% of patients were asymptomatic, while the others exhibited variable symptoms, such as chronic cough, dyspnea, chest pain or weight loss. In most cases, PHs presented as solitary nodules, predominantly disposed in the right upper lobe (40.74% of cases), followed by the right lower lobe (33.34%), and left lower lobe (18.51%). The microscopic examination revealed a mixture of mature mesenchymal tissue, such as hyaline cartilage, adipose tissue, fibromyxoid tissue, and smooth muscle bundles, in variable proportions, associated with clefts of entrapped benign epithelium. A dominant adipose tissue component was observed in one case. PH was associated with a history of extrapulmonary cancer diagnosis, in one patient. Although considered benign lung tumors, PHs diagnosis and therapy may be challenging. Having in mind the possibility of recurrence or their occurrence as a part of specific syndromes, PHs should be thoroughly investigated for an appropriate patients management. Their complex significance and the correlation with other types of lesions, including malignancies, may be further studied, by more extensive studies of surgical and necroptic cases.

Corresponding author: Cornelia Amalinei, Professor, MD, PhD; e-mail:; Adriana Grigoras, Associate Professor, MD, PhD; e-mail:,

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3. Meropenem antibiotic therapy in acute secondary peritonitis, therapeutic effects superior to other therapies - experimental clinical and histopathological study in the laboratory animal

Costin George Florea, Daniel Alin Cristian, Ionut Simion Coman, Cristin Coman, Teodoru Soare, Anwar Erchid, Iancu Emil Plesea, Mircea Litescu, Valentin Titus Grigorean

Aim: A perforated peptic ulcer is the most common cause of peritonitis through the perforation of the digestive tube, which occurs in a percentage between 2% and 14% of patients diagnosed with peptic ulcer and being associated with a 10% to 30% mortality rate. Materials and Methods: Considering the above, we imagined a study, using laboratory animals, in which we produced gastric perforations, then followed their evolution without antibiotic treatment and under antibiotic therapy with Cefuroxime 25 mg/kg/24 hours intravenously or Meropenem 40 mg/kg/24 hours intravenously, following the tissue changes both macroscopically and microscopically. Results: The study revealed a mortality of 36.6%, most deaths (81.82%) occurred in the first 24 hours after the perforation, all subjects belonging to the group that did not receive antibiotic treatment and the group treated with Cefuroxime. From a clinical point of view (evaluation of the general condition), macroscopically and microscopically, a better evolution of the subjects who received antibiotic therapy can be observed, compared to those who did not receive antibiotic therapy, thus in the case of subjects who received antibiotic therapy, the absence or the presence of a small amount of intraperitoneal fluid, which has a serocitrine appearance, as well as the absence of macroscopic changes at the level of unaffected intraperitoneal organs, can be observed. Microscopically, it can be seen that in the subjects treated with Meropenem, changes in the parietal peritoneum were minimal. Conclusions: Antibiotic therapy with Meropenem in acute peritonitis has a survival rate comparable to peritoneal lavage and source control.

Corresponding author: Mircea Litescu, Lecturer, MD, PhD; e-mail:; Iancu Emil Plesea, Professor, MD, PhD; e-mail:

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4. Benign cartilaginous tumors of the hand, a five-year retrospective study

Razvan Nicolae Teodoreanu, Andreea Grosu-Bularda, Flavia Francesca Lita, Florin-Vlad Hodea, Valentin Enache, Adrian Frunza, Andra-Luana Lazarescu, Dragos Muraru, Ioan Lascar, Cristian Sorin Hariga

Benign and malignant cartilaginous bone tumors of the hand are rare findings, however representing a particular pathology due to the capacity to induce significant functional impairment. Even though a large proportion of tumors of the hand and wrist are benign, these may present destructive characteristics, deforming adjacent structures until compromising function. The most appropriate surgical approach for most benign tumors is intralesional lesion resection. Malignant tumors often require wide excision, up to segment amputation to obtain tumor control. A five-year retrospective study was performed on patients admitted in our Clinic with benign cartilaginous tumors of the hand, in which 15 patients were admitted within this period, 10 presenting with enchondroma, four presenting with osteochondroma, and lastly one with chondromatosis. After clinical and imaging evaluation, all the aforementioned tumors were surgically removed. Definitive diagnosis for all bone tumors, either benign or malignant, was established by tissue biopsy and histopathological examination, dictating therapeutic strategy.

Corresponding author: Andreea Grosu-Bularda, MD, Primary Physician in Plastic Surgery, Aesthetic and Reconstructive Microsurgery; e-mail:

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5. Surgical treatment for patent ductus arteriosus in adult patients: a single center experience

Horatiu Suciu, Marius Mihai Harpa, Liviu Moraru, Andrei Dan Raicea, Victor Cornel Raicea

In contemporary practice, percutaneous closure of the patent ductus arteriosus (PDA) has become the procedure of choice. While the surgical ligation of ductus arteriosus ensures an immediate and definitive obliteration of the ductus, this therapeutic option is rarely used and reserved for situations when percutaneous solution is unsuitable. In this manuscript, we summarize the clinical and intraoperative findings of consecutive adult patients referred to our Institution in an interval of 10 years for surgical treatment of PDA. A total of five cases of surgical closure for PDA were performed in our Center. Four subjects were not suitable for percutaneous closure, and one was discovered intraoperatively, during surgery for another cardiac condition. In all patients, the closure of the PDA was carried out by means of a suture with reinforced patch threads, in a double layer. The intervention was performed in total cardiopulmonary bypass and mild or moderate hypothermia, through a transpulmonary approach. Total circulatory arrest was not required, in any of the cases. The occlusive balloon technique was applied to all patients. All patients survived the intervention and did not suffer perioperative complications. Postoperative follow-up at 36 months did not show repermeabilization of the arterial duct or aneurysmal dilation of the adjacent aorta. Moreover, all patients showed postoperative improvement in the performance of the left ventricle. In adult patients with PDA and contraindication to percutaneous closure or in those who require surgical sanction for other cardiac diseases, surgical closure of the duct is safe and associated with favorable clinical evolution.

Corresponding author: Andrei Dan Raicea, MD, Resident Physician; e-mail:

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6. Preoperative C-reactive protein is related with renal cell tumor dimension? Preliminary results

Adelina Miron, Viorel Jinga, George Daniel Radavoi, Tudor Marian Proca, Andreea Stan, Dragos Puia, Catalin Pricop

Introduction: Renal tumors do not benefit from an unanimously accepted tumor marker. We tried to evaluate the advantages of preoperative C-reactive protein (CRP) values and monitor the dynamic of CRP values from the perspective of the evolution of patients diagnosed with Grawitz tumors. Patients, Materials and Methods: We researched the medical records of patients with renal parenchymal tumors admitted to the Urological Clinic in Iasi, Romania, between 01.01.2018 and 01.08.2022. Data were collected regarding age, environment, comorbidities, paraclinical data, tumor characteristics, and treatment performed. Ninety-six patients were included. The data on the inflammatory syndrome pre- and postoperatively were evaluated comparatively. All patients were diagnosed with clear cell renal cell carcinoma (RCC). Results: We found that the renal tumor dimension correlates with an increased preoperative CRP level. For other variables, the correlations regarding age, sex, tumor, node, metastasis (TNM) stage, and size in relation to the increase or decrease of CRP had no statistical significance. Conclusions: The analysis of preoperative CRP and CRP dynamics could predict the tumor s aggressiveness and the treatment s effectiveness. A clear association between CRP levels and RCC pathogenesis is not yet defined, thus, further studies are necessary.

Corresponding author: George Daniel Radavoi, MD, PhD; e-mail:

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7. Locally advanced choroidal melanoma with favorable molecular prognosis - case report

Andrei-Theodor Balasoiu, Alin Stefan Stefanescu-Dima, Maria Balasoiu, Raluca Niculina Ciurea, Andrei Muraru, Alexandra Oltea Dan, Cristiana Eugenia Simionescu

Uveal malignant melanoma is a rare malignant tumor comprising less than 5% of melanoma cases. It is nevertheless the intraocular tumor with the highest incidence in adults, that arises from the melanocytes in the uveal tract. The authors present the case of a patient with locally advanced choroidal melanoma: from presentation to diagnosis, treatment, and prognosis. A 63-year-old female patient presented in the Ambulatory of the Emergency County Hospital, Craiova, Romania, on the February 1, 2021, accusing visual acuity drop and photophobia in her left eye for about three weeks. Pathology examination in Hematoxylin-Eosin (HE) staining reveals a dense cell proliferation, with small and medium spindle cells and pigment production. The following immunohistochemical markers were used in our study: human melanoma black 45 (HMB45), Ki67, cyclin D1, B-cell lymphoma 2 (Bcl2), S100, Wilms tumor 1 (WT1), p16, and p53. Uveal melanoma is a malignant tumor that can arise in all the uveal components: iris, ciliary body, and choroid. Out of the three components, iris melanomas have the best prognosis, while ciliary body melanomas have the worst prognosis. It is mandatory for the patient to respect the follow-up schedule, as follow-ups can provide early diagnosis of eventual metastasis.

Corresponding author: Raluca Niculina Ciurea, Professor, MD, PhD; e-mail:; Alin Stefan Stefanescu-Dima, Lecturer, MD, PhD; e-mail:

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8. Incidental finding of solitary fibrous tumor of male breast: case report and review of literature

Etienne El-Helou, Manar Zaiter, Huu Hoang, Bart Lelie, Denis Larsimont, Ahmad Awada, Florin Grosu, Isabelle Veys, Catalin Florin Pop

Solitary fibrous tumor (SFT) of the breast is a rare mesenchymal tumor composed of spindle-shaped tumor cells with collagen and large blood vessels in the shape of a staghorn. It is discovered anywhere in the human body, usually incidentally or through nonspecific symptoms. A combination of clinical, histological, and immunohistochemical features is required to establish a diagnosis. There are no proper guidelines for the treatment of SFTs because of their rarity; however, wide surgical excision remains the gold standard. A multidisciplinary team approach is recommended. They are mostly benign with a 5-year survival rate of 89%. Following a PubMed-indexed English literature review, only six publications presenting nine cases of breast SFT in a male patient were found. The following is the case of a 73-year-old man who presented with dry cough. A SFT in the right breast was discovered incidentally during the investigative work up, and the patient was referred to our Breast Clinic at the Jules Bordet Institute, Brussels, Belgium, for appropriate treatment. The patient s presentation, imaging, and histological sample all supported the diagnosis, and he underwent uneventful surgical resection. Here, we present the first case of an incidental finding of a SFT of the male breast, with its diagnosis and therapeutic challenges.

Corresponding author: Florin Grosu, MD, PhD; e-mail:; Catalin Florin Pop, MD; e-mail:

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9. Letter to the Editor: Mast cells in tumors. First evidence

Domenico Ribatti


Corresponding author: Domenico Ribatti, Professor, MD, PhD; e-mail:

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