Intracerebral hemorrhages represent the second most frequent, but the most severe form of stroke, with 1 in 3 patients passing away shortly after its debut. Considering these data, it is necessary to identify efficient ways to evacuate intracerebral hematomas and improve their morbidity and mortality, with brain imaging being truly helpful to neurosurgeons. Objectives. To identify the role of imaging for the evacuation of spontaneous intracerebral hematomas. Methods. We performed an extensive literature review, examining the latest published studies and therapeutic protocols. We performed a comprehensive evaluation of the latest imaging and surgical techniques for the diagnosis and treatment of intracerebral hemorrhages. Results. These studies suggest that surgical intervention and evacuation of the hematoma, based on imaging and clinic, can have an immediate life-saving effect on certain groups of patients, but it does not significantly influence the long-term prognosis and death rate. Conclusions. Modern imaging techniques help neurosurgeons preoperatively, as they can more accurately estimate the benefits of the surgical intervention, intraoperatively through neuronavigation, and postoperatively, modulating therapeutic management by identifying specific imagistic signs. Surgical interventions, both invasive and especially minimally invasive, have a proven positive effect on the evolution of patients, reducing acute mortality, but with uncertain results regarding improving long-term prognosis.

Vitamins are substances necessary to sustain life, with many functions. Vitamins must be obtained from food, as they are either not made in the body at all or are not made in sufficient quantities for growth, vitality and wellbeing. Lack of a particular vitamin can lead to incomplete metabolism, fatigue and other important health problems. Deficiency of a vitamin causes symptoms which can be cured by that vitamin. Large doses of vitamins may slow or ever reverse diseases such as cancer, osteoporosis, nerve degeneration and heart disease.

A 76-year-old female presents at the emergency department with dyspnea and pleuritic, sharp right laterothoracic pain that started suddenly. Her medical history includes stage 2 hypertension, diabetes mellitus type 2, chronic obstructive pulmonary disease stage IV GOLD with home oxygen therapy, chronic pulmonary heart disease, diffuse interstitial lung disease with a previous episode of alveolar hemorrhage, chronic renal disease stage 2, and paroxysmal atrial fibrillation, for which she had a Watchman device implanted, taking into consideration her anticoagulation contraindication due to the previous alveolar hemorrhage episode. The biological findings reveal hypoxemia and hypocapnia, a positive D-dimer test, an inflammatory syndrome, mild hypopotassemia, acute decompensation of chronic renal disease, and a positive urine culture with Enterococcus faecium. Emergency thoracic computed tomography reveals bilateral pulmonary thromboembolism. Immediate parenteral anticoagulation and antibiotic therapy are initiated with favorable evolution. At discharge, concerning the risk-benefit balance of anticoagulation in a senior patient with multiple comorbidities, the anticoagulant therapy is changed to a novel oral anticoagulant for at least three months, with reevaluation needed after that period.

Although it was thought that the gut microbiome affects gut physiology only locally, it becomes clearer that these trillions of organisms that reside in the gastrointestinal tract of a human being have a more complex function. Preclinical studies have shown that the microbiome has the ability to interact with the brain in various ways. There have been at least three different channels of communication that favour bidirectional interaction between the brain and the gut. The aim of this review is to summarize the connection between the gut microbiome and the brain, highlighting the process in which stress, in its various forms, can affect the homeostasis of the gastrointestinal tract. Modifications in the gut-brain-microbiome interactions have been analysed and determined in several rodent models of digestive and neurological disorders. The manner in which this information can apply to human beings, is yet to be discovered. Taking all things into account, it is clear that a better understanding of this means of communication could open the door for future therapies for gastrointestinal conditions.

Crohn s disease is a lifelong, relapsing systemic inflammatory disease of unknown etiology, mainly caused by an impaired immune response, characterized by chronic inflammation of any part of the gastrointestinal tract, with an increasing incidence worldwide. This disease is associated with multiple extraintestinal manifestations and patients frequently present persistent diarrhea, abdominal pain and weight loss. It affects people of all ages, but its onset generally occurs at a young age. Several triggers have been implicated in the etiopathology of Crohn s disease, including a dysregulated immune system, an altered intestinal microbiome, genetic susceptibility and environmental factors, but the main cause of the disease still remains an enigma. Due to its debut at a young age, in most cases, a long-term and early established treatment is undoubtedly required to prevent its progression with multiple intestinal and extraintestinal complications. Nowadays, novel biologic therapies or small-molecule drugs may deeply change the innate history of this pathology and could also decrease the rate of complications and the need for surgery. In order to establish the proper diagnosis, endoscopy with the histological evaluation of biopsy specimens represents the most reliable method, even if less invasive biomarkers are being developed. Crohn s disease is a comprehensive disease and the treatment should be adapted to each patient’s underlying pathogenetic mechanism.

Background: Adenosquamous lung carcinoma is a relatively rare subtype of non-small-cell lung cancer that contains both adenocarcinoma (ADC) and squamous cell carcinoma (SCC) components. It is difficult to reach a proper diagnosis before surgery, with the histopathological examination of the resected specimen being the method of choice. A supplementary immunohistochemistry examination of the sample is needed. In order to initiate targeted treatment, molecular testing is mandatory. Case presentation: A 47-year-old female, smoker (15 packs-year), without pathological personal history, presented for fatigue and moderate bilateral leg edema for about 3 months. The blood tests showed severe microcytic, hypochromic anemia and chronic disseminated intravascular coagulation. Computed tomography (CT) scan revealed a tumor in the right basal pleura with secondary pleural effusion, multiple lymphadenopathies, disseminated in the mediastinum, abdominal and pelvic cavity. Two other tumors were noticed, one in the right breast (7 mm) and the other in the vesicouterine pouch (7/10 mm). Prior to lung biopsy, a transthoracic and then transesophageal echocardiography were performed, highlighting the presence of a band on the aortic valve, suggesting marantic endocarditis. Tumor markers were also elevated. In evolution, the patient became bradypsychic, with head CT showing a brain metastasis in the left high-parietal region. Immunohistochemistry examination of the biopsy sample suggested a adenosquamous lung carcinoma. Conclusion: We reported the diagnostic path of a rare subtype of lung cancer in a young female without known comorbidities, with an atypical presentation - multiple extrapulmonary non-metastatic manifestations: metabolic etiology - weight loss, fatigue; vascular and hematological etiology – marantic endocarditis (a very rare complication), severe microcytic, hypochromic anemia and chronic disseminated intravascular coagulation; neurological etiology – peripheral sensorimotor neuropathy of the right arm. A tissue biopsy was performed from the most accessible region – 1/3 inferior right thorax, posterior axillary line. The particularity of the adenosquamous lung carcinoma in this case lies in multiple metastases in less common sites (breast, vesicouterine pouch and probably kidney).

Hyponatremia is a frequent electrolyte imbalance with diverse etiology that may occur secondary to chemotherapy or autoimmune pathologies. We report the case of a 76-years-old female who presented for symptoms of severe hyponatremia like digestive intolerance, nausea, vomiting, generalized muscle weakness and vertigo, with a serum sodium level of 110 mEq/L. The patient was known with multiple cardiovascular and malignant comorbidities, being diagnosed with a right breast neoplasm with right radical mastectomy and axillary lymphadenectomy. Subsequently, multiple adenopathies were detected, which is why the patient followed several series of chemotherapy with trastuzumab and capecitabinum. These drugs can cause side effects, such as xerophthalmia, xerostomia, which are also frequently encountered in autoimmune pathologies. Hyponatremia is one of the most frequent side effects of capecitabinum. All these side reactions were investigated later, thus following the immunological tests, the diagnosis of Sjogren s syndrome was established. After ruling out other causes, it was established that hyponatremia appeared secondary to the recent administration of capecitabinum or within a syndrome of inappropriate antidiuretic hormone secretion (SIADH), which can be the result of a Sjogren s syndrome.