An elevated level of total plasma homocysteine has been associated with a higher risk of atherosclerosis and coronary heart disease. The aim of our research was to study the relation between homocysteine and myocardial infarction (MI) in young patients. We conducted a case-control study in Constanţa County, Romania including 61 patients, divided in two groups. The first group, the MI group, consisted of 28 patients, male (67.9%) and female (32.1%) aged less than 45 years who were consecutively admitted to the Intensive Coronary Care Unit of the Emergency County Hospital of Constanţa from September 1, 2017 to August 31, 2018 (12 months), with an established diagnosis of first acute MI. The second group, the control group, included 33 patients, male (75.8%) and female (24.2%) aged less than 45 years, with cardiovascular risk factors and/or stable angina pectoris that were consecutively addressed for ambulatory cardiac evaluation at the Outpatient Clinic of Emergency County Hospital of Constanţa during the same period. Fasting plasma homocysteine was determined in both groups, within 24 h after MI onset, respectively after first cardiac exam in the controls. High homocysteine was statistically confirmed to be a risk factor in the study group, especially in association with smoking, chronic kidney disease (CKD), and to a lesser extent with diabetes mellitus (DM) and hypertension. Data analysis was performed using IBM SPSS Statistics 23. The procedures used included descriptive statistics, parametric statistical tests (Independent sample t-test), non-parametric statistical tests [Chi-square test of the association, with the evaluation of odds ratio (OR)]; the significance level used in the analysis (P-value) was 0.05. After adjusting for variables, our study results pointed out a strong association between plasma homocysteine and first acute MI among young patients, emphasising plasma homocysteine as a possible risk factor for myocardial infarction.

We present the case of a 31-year-old patient, without cardiovascular risk factors, without significant pathological or family history of cardiovascular disease, who was diagnosed with severe coronary artery disease, left main bifurcation localization, which required surgical coronary revascularization. The angiographic and intraoperative aspect excluded the most common causes of non-atherosclerotic causes of coronary lesions. Vasculitis was another possible etiology but was also excluded based on the normal clinical examination, negative inflammation markers, lack of diffuse vascular impairment, TPHA and negative VDRL. Prolonged mental stress can lead to accelerated progression of atherosclerosis by inducing endothelial dysfunction, our patient describing a "burnout syndrome" in the last few months. The particularity of the presented case is the severe coronary artery disease in a young patient without discovering the main etiology of the advanced atherosclerotic process.

Since 2000, the synthetic cannabinoids drug market is in a continuous expansion and development. Unfortunately, addictive trends include not only the adult population but also adolescents. The new synthetic cannabinoids compounds have similar effects as the Cannabis plant, but are more potent and present a higher risk for consumers. Globally, the fight against drug production, distribution and use involves several directions, including the development of new analytical tools able to identify these new illicit substances. The aim of this paper is to present a systematic review regarding the class of cannabinoids in terms of their physico-chemical properties and biological effects.

We present a case of severe thromboembolic pulmonary hypertension in a patient with history of recurrent deep vein thrombosis and pulmonary restrictive disease due to pulmonary and vertebral tuberculosis in young adulthood. He was considered not eligible in the National Program for Primary Pulmonary Hypertension, being referred for thoracic surgery, but he was considered unfit for thrombendarterectomy. Despite guidelines, we administered him specific medical therapy (phosphodiesterase-5 inhibitors and endothelin receptor antagonists). His clinical evolution was satisfactory, with increasing effort tolerance and decreasing need for ambulatory oxigenotherapy.Keywords. Pulmonary thromboembolic hypertension, thrombendarterectomy, phosphodiesterase-5 inhibitors, endothelin receptor antagonists. Irinel Raluca ParepaUniversity "Ovidius" of Constanţa, Faculty of Medicine, Department of Cardiology Aleea Universităţii 1, 900470, Constanța email : irinel_parepa@yahoo.com 10.1515/arsm-2017-0017 ARS Medica Tomitana -2017 2(23): 94 -98 Case ReportWe present the case of a 64 years old male patient, with history of right femuro-popliteal deep vein thrombosis and recurrent pulmonary thromboembolism. He experienced his first pulmonary embolism 3 years ago and repeated a new episode after about 6 months, when we estimated at echocardiography a value of the systolic pressure in the pulmonary artery of 70 mmHg, indicating severe pulmonary hypertension.Due to the recurrence of the pulmonary thromboembolism, at that time we performed investigations aiming to highlight some of the associated thromboembolic risk factors: the thrombophilic profile was normal, tumoral markers, abdominal and pelvic CT were negative for malignant diseases. He had no family antecedents of clinical manifestations of thromboembolic diseases.After a period of about 6 months with minimal symptoms under oral anticoagulant and diuretic treatment, the patient returns in the Cardiology Clinic with decompensated right heart failure (inferior limbs edema, hepatomegaly with turgid jugulars), respiratory insufficiency (spontaneous Sp02 = 88%) and systemic hypotension (blood pressure = 90/60mmHg, equal on both arms). Clinical examination also revealed severe decreased body mass index (16,6kg/m2) and diastolic murmur in the pulmonary area. On ultrasound we detected worsened pulmonary pressures (systolic

Colo-rectal cancer is one of the major mortality causes in the world, with an increased frequency in western countries, which are better developed economically. Romanian statistics show that the frequency of this type of cancer is increasing rapidly. In the year 2000, all over the world there were approximately 1 million new cases of colo-rectal cancer, and over 500 thousands deaths, thus affecting 1 from 20 inhabitants from the developed countries and being the second main cancer death cause, at both sexes in Europe. In Romania, incidence and mortality have doubled in the last 20 years, reaching a 17.74/ 100000 inhabitants incidence in the year 2000. Both for men and women, this disease is on the 3rd place in Romania, after bronho-pulmonary cancer and gastric (for men) and breast and uterus cancer, respectively. This paper has as purpose obtaining data about the frequency of colo-rectal cancer in recent years, and the repartition of this data on years, sex, age, environment, complications and other particularities. To reach this purpose we have done a retrospective study on patients that were admitted during 2010-2014 in the surgical clinic, medical clinic and oncology section from the Constanta Emergency County hospital, with colo-rectal neoplasm as a diagnosis.