Monica CIRSTOIU

Latest posts by Monica CIRSTOIU (see all)

Left Ventricular Systolic Function in Pregnant Women with Inherited Thrombophilia - October 17, 2019
Histopathological, Immunohistochemical and Therapeutical Assessment of Premalignant Endometrial Lesions in a Hospital Based Series of Cases - July 5, 2016
Fraser Syndrome – a Case Report and Review of Literature - March 31, 2016

Articles signed on MÆDICA, JCM:

Left Ventricular Systolic Function in Pregnant Women with Inherited Thrombophilia

MÆDICA - a Journal of Clinical Medicine | Vol. 14, No. 3, 2019

Livia Florentina TRASCA, Elena POENARU, Natalia PATRASCU, Ramona BRUJA, Octavian MUNTEANU, Monica CIRSTOIU and Dragos VINEREANU

ABSTRACT

Objectives: The impact of the gestational changes on left ventricular contractility is not clearly defined. Our aim was to evaluate the subtle changes of left ventricular systolic function during pregnancy, assessed by new echocardiographic techniques, in a population tested for inherited thrombophilia.
Material and methods: Eighty seven consecutive pregnant women, with a mean age of 32±4 years, genetically tested for inherited thrombophilia (22 with thrombophilic mutations and risk of thrombosis and 65 without significant mutations, considered as the control group) were included. All participants had four clinical and echocardiographyc visits: three during pregnancy (one in each trimester) and the forth six months after giving birth. Left ventricular (LV) systolic function was assessed from ejection fraction (EF) by 2D and 3D echocardiography, mitral annular velocities by tissue Doppler, and strain rate by 2D speckle tracking.
Outcomes: There were no differences between groups for any of the echo parameters at each of the four visits. Comparing the third visit with the first one, all parameters of LV systolic function had significantly lower values at the end of pregnancy; EF decreased from 58% to 55% (2D echo), from 60% to 56% (3D TomTec), and from 58% to 55% (Auto4DLVQ), with p<0.001 for all three methods. Moreover, strain assessed by speckle traking decreased during pregnancy, with no differences between groups. In addition to this, mitral annular velocities obtained by tissue Doppler assessment decreased during the gestational period, with no differences between groups. At six months after giving birth, all values were normalized.
Conclusion: During pregnancy, LV contractility has a slight decrease, with no criteria of systolic dysfunction. Thrombophilic mutations, with correct anticoagulant treatment, has no impact on LV systolic function.
Keywords: pregnancy, contractility, thrombophilia

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Histopathological, Immunohistochemical and Therapeutical Assessment of Premalignant Endometrial Lesions in a Hospital Based Series of Cases

MÆDICA - a Journal of Clinical Medicine | Vol. 11, nr. 2, 2016

Tiberiu Augustin GEORGESCU, Monica CIRSTOIU, Mariana COSTACHE, Anca LAZAROIU, Adrian DUMITRU and Maria SAJIN

ABSTRACT

Introduction: Endometrial hyperplasia represents a diversified set of disorders which has challenged pathologists for decades. Due to its high likelihood of progression to carcinoma, endometrial intraepithelial neoplasia (EIN) demands prompt and specialized intervention.

Materials and methods: This 15-month (September 2014 – November 2015) retrospective analysis involved 258 cases of female patients with atypical and non-atypical endometrial hyperplasia investigated and treated at the University Emergency Hospital in Bucharest, Romania. Our purpose was to evaluate the histopathological, immunohistochemical and therapeutical aspects of premalignant endometrial lesions as well as their concurrence with endometrial carcinoma.

Results: Our findings indicate that 23% of the women preoperatively diagnosed with atypical hyperplasia were found with endometrial carcinoma on the hysterectomy specimen. Surprisingly, we identified two cases of atypical hyperplasia with focal p53 expression. Mutation of p53 is a late genetic event seen in endometrial carcinoma which does not usually occur in EIN. Interestingly, these cases did not present endometrial carcinoma on the hysterectomy specimen.

Conclusions: All female patients diagnosed with EIN have an increased risk of developing endometrial carcinoma, as there are no histologic subdivisions or grades of atypical hyperplasia to further stratify risk for malignancy. Therefore, we emphasize the importance of accurate detection of premalignant endometrial lesions and exclusion of a coexisting endometrial carcinoma as mandatory prerequisites for proper medical management.

Keywords: non-atypical endometrial hyperplasia, atypical endometrial hyperplasia, EIN, endometrial carcinoma

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Fraser Syndrome – a Case Report and Review of Literature

MÆDICA - a Journal of Clinical Medicine | Vol. 11, nr. 1, 2016

Adrian DUMITRU, Mariana COSTACHE, Anca Mihaela LAZAROIU, George SIMION, Diana SECARA, Monica CIRSTOIU, Alina EMANOIL, Tiberiu Augustin GEORGESCU and Maria SAJIN

ABSTRACT

Fraser syndrome is a rare autosomal recessive genetic disorder characterized by major features such as cryptophthalmos, syndactyly, malformations of the larynx and genitourinary tract, craniofacial dysmorphism, orofacial clefting, mental retardation and musculoskeletal anomalies. In total, about 150 affected patients have been described in the literature. The diagnosis of this syndrome can be established after clinical examination. We present the clinical findings of a rare case of Fraser syndrome with lethal phenotype due to bilateral renal agenesis in a female stillborn.

Keywords: Fraser syndrome, cryptophthalmos, syndactyly, urogenital malformation

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Clinical Utility of Non-Invasive Prenatal Screening from Maternal Blood

MÆDICA - a Journal of Clinical Medicine | Vol. 10, nr. 4, 2015

Viorica RADOI, Laurentiu Camil BOHILTEA, Roxana BOHILTEA and Monica CIRSTOIU

Fetal chromosomal abnormalities, especially trisomy 21 (Down syndrome) are frequent so that their prenatal detection represents one of the main goals of maternal-fetal medicine.

Abnormalities of the number and structure of chromosomes frequently appear in humans, appearing for: about 10% of gametes, for normal and fertile persons, 3% of 10 week fetuses and 2% of those of 15-16 weeks of gestation, 50-60% of early miscarriages (15-25% of all pregnancies), 10% of all stillborns (1% of all pregnancies), 0,7-1% of all live-borns (>1:120), 2% of all pregnancies for women over 35 in the moment of the conception (1).

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Cornual Heterotopic Pregnancy – a Rare Cause for Haemorrhagic Shock

Cicerone TUFAN, Cristina GEORGESCU, Roxana BOHILTEA and Monica CIRSTOIU

ABSTRACT

Heterotopic pregnancy represents an intrauterine gestational sac in the presence of an ectopic pregnancy. It is a very rare occurrence in spontaneous pregnancy but its incidence has increased with the use of assisted reproductive techniques, being identified in up to 1% of these cases. There aren’t any guidelines regarding the management of heterotopic pregnancies, but the general principles include: elimination of the ectopic pregnancy, conservation of the intrauterine pregnancy and haemostasis. In this article we are going to present the case of a 26 year old woman that presented with haemorrhagic shock secondary to a ruptured spontaneous cornual heterotopic pregnancy at 8 weeks gestation. She underwent emergency laparotomy, excision of the right uterine cornua and aspiration of the uterine pregnancy. The intrauterine pregnancy was removed because, during the cornual excision, the intrauterine gestational sac was ruptured. She had a non-complicated postoperative evolution and was discharged 4 days later.

Keywords: heterotopic pregnancy, cornual, haemorrhagic shock

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Disseminated CMV and Tuberculosis Infection with Osseous Metaplasia in a Presumable Crohn’s Patient: Case Report

Oana Maria PATRASCU, Monica CIRSTOIU, Anca Mihaela LAZAROIU, Adrian Vasile DUMITRU, Andreea Elena MIHAI, Manuela POPA, Anca DIMITRIU, Maria SAJIN, Mariana COSTACHE and Andreea ILIESIU

ABSTRACT

Associations of different pathologies are not uncommon in every day practice, but association of disseminated infections like cytomegalovirus infection and tuberculosis are quite rare and hard to diagnose. Both are infections which appear frequently in immunocompromised patients and have unfavorable prognosis. We present a case of a 62 year old male with a history of Crohn’s disease and tuberculosis which presented with symptoms of relapse and infection. He was treated with immunosuppressive medication and cortisol for the past 6 weeks. Cytomegalovirus (CMV) infection was serologically confirmed. In evolution, he suffered from gastrointestinal hemorrhage and died afterwards due to the hemorrhage and pulmonary infections. Histology confirmed the CMV modification in the lungs and intestines, but also highlighted active and disseminated tuberculosis (TB), bronchopneumonia, osseous metaplasia, hyaline membranes, numerous TB abscesses in the intestinal wall and specific CMV and TB modifications in the liver. The trigger for such important and serious infections remains unclear, for the cause can be represented by the Crohn’s disease per se or only by the immunosuppressive treatment. Also, CMV can trigger modifications in immune system and patients with immune-mediated diseases have an increased risk for TB reactivation.

Keywords: cytomegalovirus, tuberculosis, Crohn’s disease, osseous metaplasia, gastro-intestinal hemorrhage

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A Rare Case of Benign Xanthogranuloma Located on the Uterine Cervix – a Case Report

Monica CIRSTOIU, Luminita Elena MITRACHE, Manuela POPA, Nicoleta Corina MEHOTIN, Maria SAJIN and Catalin CIRSTOIU

ABSTRACT

We report the case of a 44-year-old woman who presented with vaginal bleeding. Vaginal examination and colposcopy showed a tumor on the anterior lip of the cervix. Trans-vaginal sonography revealed a thickened endometrium with accentuated vascularization. Samples from the tumor and endometrium were collected by byopsic curettage. Histopathologic examination showed atypical hyperplasia of the endometrium and benign xanthogranuloma of the cervix. Therefore, surgical intervention was performed.

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A Comparison Between Clinical Diagnosis of Death and Autopsy Diagnosis. A Retrospective Study of 131 Newborns, Stillborns and Aborted Fetuses

Mariana COSTACHE, Monica CIRSTOIU, Andreea CONTOLENCO, Anca Mihaela LAZAROIU, Simion GEORGE, Maria SAJIN and Oana Maria PATRASCU

ABSTRACT

In recent years, the autopsy was considered necessary only in medico-legal cases, or when the clinician requires it to better understand the pathology and cause of death (with the deceased family’s consent). Although it has been shown in numerous studies that the autopsy and the postmortem histopathological examination are the only ones that can diagnose correctly and completely, the autopsy rate is declining. The primary motive of the family in consenting to a perinatal necropsy, may be to determine the cause of death of their child and to be aware of possible complications of their future pregnancy. This study shows the rate of concordance between clinical diagnosis and autopsy diagnosis, and the rate of concordance between macroscopic diagnosis and microscopic findings, pointing out once again the importance and the utility of the autopsy in medical practice.

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A Rare Case of Uterine Myxoid Leiomyosarcoma: a Case Report

Luminita Elena MITRACHE, Vasile Adrian DUMITRU, George SIMION, Monica CIRSTOIU and Maria SAJIN

ABSTRACT

We present the rare case of a 61-year-old female patient who was submitted in the hospital with metrorrhagia and pelvi-abdominal pain. Echographic examination revealed an heterogeneous uterine mass measuring 190/130/110 mm. Therefore, total hysterectomy with bilateral ooforectomy was performed. Grossly, the uterus presented a tumoral mass with areas of hemorrhage, necrosis and abundant mucoid degeneration. On light microscopic examination a malignant neoplastic proliferation with features of myxoid leiomyosarcoma was noted. In this paper, we presented this rare form of leiomyosarcoma with an emphasis on its particularities that have not been mentioned in the literature.

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Inherited Thrombophilia in Pregnant Women with Intrauterine Growth Restriction

Letitia CORIU, Elena COPACIU, Dan TULBURE, Rodica TALMACI, Diana SECARA, Daniel CORIU and Monica CIRSTOIU

ABSTRACT

Background: Intrauterine growth restriction (IUGR) is a major cause of fetal morbidity and mortality during pregnancy. The role of mutation in the factor V gene, prothrombin gene, MTHFR gene, as risk factors for intrauterine growth restriction during pregnancy, is not very well known so far.

Materials and methods: This is a retrospective study of 151 pregnant women with a history of complicated pregnancy: intrauterine growth restriction, preeclampsia, recurrent pregnancy loss or maternal venous thromboembolism, who were admitted in Bucharest Emergency University Hospital, during the period January 2010 to July 2014. Genetic testing was performed for all the cases to detect: factor V Leiden mutation, G20210A mutation in the prothrombin gene, C677T mutation and A1298C mutation in methylenetetrahydrofolate reductase (MTHFR) gene. Blood samples were obtained as soon as the diagnosis of intrauterine growth restriction was established with ultrasonography.

Results: The following gene mutations were associated with increased risk of IUGR: G20210A prothrombin gene mutation (OR 4.81, 95% CI 1.05 - 2.22, p= 0.043), G1691A factor V gene mutation (factor V Leiden) (OR 1.58, 95% CI 0.61 - 4.080, p= 0.347), C677T MTHFR gene mutation (OR 1.61, 95% CI 0.79 to 3.26, p= 0.186), compound heterozygous MTHFR C677T and A1298C (OR 1.66, 95% CI 0.81- 3.42, p= 0.169). Particularly, for G20210A prothrombin gene mutation we found statistically significant risk (p0.05) of IUGR.

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