The Journal of Bucharest College of Physicians and the Romanian Academy of Medical Sciences

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Saturday, November 17 2018 @ 05:37 EET

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A Case of Neurodegenerative Langerhans Cell Histiocytosis

2018-03

Ana-Maria Petrica, Nicolae-Ovidiu Gavrilovici, Doina Paula Pruteanu, Roxana Petean, Emilie Mihut, Rodica Cosnarovici, Elena Diana Olteanu

https://doi.org/10.31689/rmm.2018.25.3.181

Langerhans cell histiocytosis (LCH) is a myeloproliferative neoplasm of pathologic dendritic cells (DC). This is supported by the clonality of these cells, the recurrent mutations in BRAF-V600E and other MAPK pathway genes, the identification of the BRAF-V600E mutation in hematopoietic stem cells and myeloid precursors in patients with high-risk LCH[1]. An estimated 4-5 per million patients are affected each year, from the neonatal period to adulthood, although it appears to be more common in children of 0-15 years[2,3]. [...]

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Another Approach of Resistant Hypertension: What to Do When the Pharmacological Treatment Fails?

2018-03

Silvia Matilda Astefanei, Alina-Elena Cristea, Ana-Maria Zaharie, Oana-Claudia Deleanu

https://doi.org/10.31689/rmm.2018.25.3.175

Obstructive sleep apnea (OSA) is an important risk factor for elevated blood pressure (BP), especially in patients with resistant hypertension (RHT)[1]. HT physiopathology in OSA patients involves aspects such as secondary sympathetic hyper reactivity because of intermittent hypoxia, decreased barometric sensitivity, endothelial dysfunction. [...]

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X-linked Lissencephaly: a Smooth Brain and a Rough Journey for a 15-Year-Old-Patient

2018-03

Marius-Cristian Zaharia, Diana Anamaria Epure, Ioana Streata, Raluca Ioana Teleanu

https://doi.org/10.31689/rmm.2018.25.3.171

The cerebral cortex shows a precise layering of multiple neuronal types with distinct form and function, essential for the cognitive functions that define us as humans. Remarkably, cortical neurons are not formed in the cortex itself but in specialized proliferative regions deep in the brain, so that postmitotic neurons must migrate as far as 1000 cell body-lenghts to reach their final destination[1]. [...]

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Aggressive Nasal Type Extranodal Natural killer/T-cell Lymphoma Presenting as Refractory Granulomatosis with Polyangiitis...

2018-03

Aggressive Nasal Type Extranodal Natural killer/T-cell Lymphoma Presenting as Refractory Granulomatosis with Polyangiitis (Wegener’s Granulomatosis)

Andreea-Alexandra Aldea, Anca Bojan, Laura Muntean, Simona Rednic

https://doi.org/10.31689/rmm.2018.25.3.163

We present a rare case of nasal type extranodal NK/T-cell lymphoma mimicking granulomatosis with polyangiitis (GPA), in order to highlight the difficulties in the differential diagnosis of destructing nasal lesions. Extranodal NK/T-cell lymphoma, nasal type is a rare type of non-Hodgkin’s lymphoma, often associated with Epstein-Barr virus (EBV) infection, characterised by destructive lesions arising in the naso-sinusal tract and progressively invading the midfacial bones. [...]

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Unusual Combination of Posterior Femoral Head Dislocation and Ipsilateral Intertrochanteric Open Fracture: Case Report

2018-03

Ion Cocolos, Tiberiu Paul Neagu, Andrei Ursache, Ioan Cristescu, Adina Ghemigian, Andra Maria Cocolos, Camelia Cristina Diaconu, Ovidiu Gabriel Bratu, Mirela Tiglis, Olivera Lupescu

https://doi.org/10.31689/rmm.2018.25.3.159

The combination of posterior femoral head dislocation with ipsilateral intertrochanteric fracture is an extremely rare occurrence, therefore, few reports exist. The posterior femoral head dislocation is an injury most common encountered in road traffic accident (dash-board) and may associate various types of acetabular, femoral head or femoral neck fractures[1-3] but almost never an intertrochanteric fracture. [...]

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Results in Breast Reconstruction - Retrospective Study

2018-03

Iulia Gabriela Stan, Cristian Radu Jecan, Ovidiu Stefanescu, Laura Raducu, Tiberiu Paul Neagu, Ioan Lascar

https://doi.org/10.31689/rmm.2018.25.3.149

In the last century, the breast reconstruction after mastectomy has become an important element of the multicentric treatment of the patients suffering from breast cancer. Breast reconstruction was initially developed to reduce the complications of mastectomy and the deformations of the thoracic wall. Currently, it is known the fact that reconstruction can improve the psychosocial state and the quality of life of the patients with breast cancer[1]. [...]

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Symptoms of Attention Deficit, Hyperactivity and Impulsivity in a Sample of Personality Disorder Patients

2018-03

Laura Aelenei, Dan Prelipceanu

https://doi.org/10.31689/rmm.2018.25.3.137

ADHD and personality disorders are known to have clinical presentations that sometimes share different symptoms. Their characteristics are pervasive, relatively stable over the years. This study tries to determine the prevalence of attention deficit and hyperactivity/im-pulsivity symptoms in a population of individuals with a personality disorder. [...]

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Endometriosis-Associated Infertility

2018-03

Elena-Silvia Nada, Lacramioara Brinduse, Ovidiu Bratu, Dragos Marcu, Elvira Bratila

https://doi.org/10.31689/rmm.2018.25.3.131

Endometriosis is definined as the presence of endometrial-like tissue outside the uterine cavity and it presumably affects 10-15% of reproductive aged women. The prevalence of endometriosis appears to be higher in women in Philippines, Indian, Japanese and Korean origin[1]. Clinical manifestations depend upon the site where the ectopic endometrial tissue is located and include dysmenorrhea, dyspareunia, chronic pelvic pain, infertility, but the possibility of being asymptomatic exists. [...]

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Management of Hypertension in the Elderly by Modern Methods

2018-03

Sorina Maria Aurelian, Ruxandra Dascalescu, Andreea Zamfirescu, Ana Capisizu

https://doi.org/10.31689/rmm.2018.25.3.125

An increasing public health concern is the hypertensi-on in the elderly (above the age of 65 years)[1], which is under-recognized as a major contributor to premature disability and institutionalization[2]. Numerical increase in older people and consequently the consumption of drugs, associated with morpho-functional changes of the old body, bring the elderly in relationship with drugs in different position than young adults. [...]

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Update on Rehabilitation Protocol Following ACL Reconstruction

2018-03

Gavril Lucian Gheorghievici, Adriana Sarah Nica, Brindusa Mitoiu, Delia Clantau, Emil Haritinian, Cristian Ioan Stoica

https://doi.org/10.31689/rmm.2018.25.3.117

Anterior cruciate ligament lessions represent one of the most frequently met injuries of the knee, with an increasing incidence depending on the statistics, most of them occuring in athletes or young adults[1-5]. The re-construction of the anterior cruciate ligament can be obtained by using different surgical procedures and varies according to the graft material that is used. The outcomes after ACL reconstruction is depended on both surgical and rehabilitation factors[6,7]. [...]

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Methods of Transvaginal Ultrasound Examination in Endometriosis

2018-03

Alexandra Bruja, Lacramioara Brinduse, Ovidiu Bratu, Camelia Diaconu, Elvira Bratila

https://doi.org/10.31689/rmm.2018.25.3.111

"Endometriosis is a chronic, hormone-dependent condition with a nonspecific clinical picture, including chronic pelvic pain, a disturbing symptom that causes the patient to seek specialist medical advice"[1]. It is a chronic, often progressive, condition that affects women of reproductive age in a proportion of 5-10%. Despite such high prevalence, endometriosis remains an enigmatic disease with a poorly understood pathophysiology. [...]

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Renal Artery Thromboembolism in Paroxysmal Nonvalvular Atrial Fibrillation

2018-02

Alice Balaceanu, Raluca Stirban, Beatrice Balaceanu, Dorin Cristian Gurau, Adriana Stanica

https://doi.org/10.31689/rmm.2018.25.2.107

Renal thromboembolism is a rare, but severe condition in non-valvular paroxysmal atrial fibrillation, that could remain underdiagnosed. Due to atrial fibrillation the embolus is organized in left atrium and auricle then reach the renal artery with subsequently ischemia. Renal colic could mimic multiple pathologies as nephrolithiasis, pyelonephritis, kidney ischemia, diverticulitis, sub-occlusive intestinal syndrome, ruptured abdominal aortic aneurysm. [...]

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Intravascular Papillary Endothelial Hyperplasia - Case Report

2018-02

Liliana Gabriela Popa, Manuela Simtea, Irina Ahmed Salem, Mara Madalina Mihai, Cornelia Nitipir, Calin Giurcaneanu

https://doi.org/10.31689/rmm.2018.25.2.103

Intravascular papillary endothelial hyperplasia (IPEH), first described by Pierre Masson in 1923 is an uncommon benign vascular lesion that involves the skin or the soft tissue[1]. IPEH represents 2-4% of vascular tumors arising in the skin and soft tissue[2]. It usually occurs in the fourth decade of life and has a slight predilection for the female gender[3]. [...]

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Adrenal Suppression and Exogenous Cushing Syndrome After Inhaled and Topical Corticosteroids - Two Clinical Cases and Review...

2018-02

Adrenal Suppression and Exogenous Cushing Syndrome After Inhaled and Topical Corticosteroids - Two Clinical Cases and Review of the Subject

Gheorghe Serpoi, Constantin Cucu

https://doi.org/10.31689/rmm.2018.25.2.95

Corticosteroid (CS) therapy is used by 1% of world population, especially for non-endocrinological indications. Compartmental administration of CS (i.e. topical, inhaled or intraarticular) was developed to prevent undesired effects. Still even these therapies could generate major endocrine syndromes, as our two cases tend to illustrate - Table 1 and Table 2. [...]

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Negative Prognostic Factors in Severe Burns - Implication for Clinical Outcome

2018-02

Mihaela-Cristina Andrei, Andreea Grosu-Bularda, Oana Vermesan, Serban Arghir Popescu, Alexandra Chivu, Khalid Al-Falah, Luana Lazarescu, Tiberiu Paul Neagu, Ioan Lascar

https://doi.org/10.31689/rmm.2018.25.2.83

Burn injuries are a major public health problem all over the world and despite significant improvements in critical care and surgical treatment, major burns are associated with high morbidity and mortality and poor recovery outcome. Patients with severe burns need immediate intervention and rapid initiation of speci-alized treatment in a dedicated critical care burn unit in order to minimize morbidity and mortality. The complex nature of burn injuries requires an integrative approach, by a multidisciplinary team in order to obta-in an optimal care. [...]

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The Effect of Timolol on the Iris Vascular Tone in Rats

2018-02

Dragos-Constantin Lunca, Horia Paunescu, Mihnea Costescu, Laurentiu Coman, Ion Fulga

https://doi.org/10.31689/rmm.2018.25.2.77

Vascular tone is generally controlled by both the humoral component and the neuro-vegetative component. Regarding the second one, catecholaminergic sympathetic innervation of blood vessels is almost a rule in the body[1,2].

It is known that the iris is sympathetically inner-vated, both at the level of the iris dilator muscle[1,2] and at the level of iris blood vessels[3]. Cathecolamines are responsible for vasoconstriction and, in some vascular beds, vasodilation. [...]

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Alcohol Withdrawal Syndrome: a Review

2018-02

Iustin Moroi, Mihaela Adela Iancu, Alexandra Ana Maria Stanescu, Anca Pantea Stoian, Razvan Hainarosie, Bogdan Socea, Dragos Marcu, Dan Arsenie Spinu, Ovidiu Gabriel Bratu, Camelia Diaconu

https://doi.org/10.31689/rmm.2018.25.2.69

Alcoholism is a common condition and frequently clinicians are forced to confront its complications in general hospital settings. Within each country, there is an excellent correlation between the level of alcohol consumption and the prevalence of alcohol-related harm. In fact, the consumption in Europe is 10.9 liters of pure alcohol per person per year[1]. There are an estimated 3 million alcohol-dependent people in Romania alone, with episodes of withdrawal severe enough to require pharmacologic treatment[1]. [...]

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Urological Malpractice

2018-02

Dan Arsenie Spinu, Ioana Oprea, Oana Bodean, Bogdan Socea, Camelia Diaconu, Dan Mischianu, Dragos Marcu, Ovidiu Gabriel Bratu

https://doi.org/10.31689/rmm.2018.25.2.65

Nowadays, doctors face a challenging medico-legal environment. This is also the case of urologists with many legal claims against them. The fact that urology is a surgical specialty is not encouraging, surgical specialties being situated on top of the chain. One of the most important problems is the lack of information from the specialized editorials. This kind of data is hard to find especially since it is often regarded as confidential information. [...]

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Improved Knee Function after Intraarticular Administration of a New Drug Combination: a Case Series Report

2018-01

Felician Stancioiu, Dana Vlasceanu-Catanas

https://doi.org/10.31689/rmm.2018.25.1.54

Pathological modifications of the large joints (knee, hip, shoulder, ankle) due to trauma and/or inflammation are a common occurrence, which increases as the general population gets simultaneously older and more active[1]. Progress in this therapeutic area has not kept up with the increased need for more effi cient treatments, an overall consideration which includes efficacy in reducing discomfort, cost of treatments, presence of adverse reactions and the long term effects on the function and structure of the joints, which may prompt the need for repeated or different treatments. [...]

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Proximal and Distal Humerus Fractures in a Patient with Chronic Inflammatory Joint Disease Undergoing Biologic Therapy

2018-01

Razvan Turcu, Marius Moga, George Dinache, Adrian Barbilian

https://doi.org/10.31689/rmm.2018.25.1.48

Rheumatoid arthritis affects women more frequently, aged 40 to 70, three times more frequently than men. Bone changes occurring in people with rheumatoid arthritis increase the incidence of fractures in these patients [1]. In the complex fractures of the proximal 3 of the humerus, the treatment of choice is represented by open reduction and osteosynthesis. This method can also be applied minivasively, known as minimally invasive plate osteosynthesis (MIPO)[2,3]. [...]

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Posttraumatic Renal Artery Thrombosis

2018-01

Mirela Tiglis, Ioana Cristina Grintescu, Mihaela Buiuc, Cristian Cobilinschi, Angela Popa, Tiberiu-Paul Neagu, Liliana Mirea, Ioana Marina Grințescu

https://doi.org/10.31689/rmm.2018.25.1.44

Posttraumatic renal artery thrombosis is a very rare complication of abdominal trauma which occurs especially in young people, after car accidents, with an increasing incidence in the last few years. There are about 400 reported cases in the literature[1], meaning less than 0.08% of all reported abdominal traumas and being found in 1-4% of patients with renal damage[2]. [...]

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The Management of Congenital Ureteral Duplication Anomalies Complications - Case Presentation

2018-01

Dragos Marcu, Dan Spinu, Dan Mischianu, Raluca Mititelu, Ioana Oprea, Ovidiu Bratu

https://doi.org/10.31689/rmm.2018.25.1.39

Ureteral anomalies often represent a great challenge for physicians regarding their diagnostic and therapeutical management. Ureteral duplication is one of the most frequent urogenital congenital malformations, usually more frequent in female patients, with an incidence rate estimated at approximately 1%[1,2]. [...]

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Surgical Treatment in Acute Phase of Severe Burns - a Comprehensive Approach

2018-01

Mihaela-Cristina Andrei, Andreea Grosu-Bularda, Oana Vermesan, Adrian Frunza, Serban Arghir Popescu, Sabina Ionita, Razvan Teodoreanu, Khalid Al-Falah, Tiberiu-Paul Neagu, Ioan Lascar

https://doi.org/10.31689/rmm.2018.25.1.24

Major burn represents the most severe type of trauma, requiring high standard of treatment into regional specialized bun care centers[1]. According to American Burn Association(ABA), a major burn, which requires hospitalization in burn units, is represented by at least one of the following situations[2,3] [...]

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Evaluation of the Metabolic Profile During a Two Week Period in a Balneary Resort

2018-01

Gavril Lucian Gheorghievici, Adriana Sarah Nica, Gabriela Radulian

https://doi.org/10.31689/rmm.2018.25.1.18

Metabolic syndrome (MetS) is defined as a cluster of elements represented by increased levels of fasting plasma glucose, raised tryglicerides, high blood pressure and modified values of HDL cholesterol associated with the presence of abnormal abdominal waist[1,2]. Due to this elements it represents a predicting factor regarding the development of type II diabetes and cardiovascular disease. Although insulin resistance[3] and central obesity[4] represent the main causative factors, there are still many unknown variables of its components that require further research. [...]

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Non-dominant Primary Motor Cortex Repetitive Transcranial Magnetic Stimulation for Moderate to Severe Chronic Pain Caused by...

2018-01

Non-dominant Primary Motor Cortex Repetitive Transcranial Magnetic Stimulation for Moderate to Severe Chronic Pain Caused by Diabetic Neuropathy: Case Series from a Small Crossover Pilot Study

Liviu Cozma, Laura Dumitrescu, Bogdan David, Adriana Nicolau, Mirela Enache, Ruxandra Patrascu, Bogdan Ovidiu Popescu

https://doi.org/10.31689/rmm.2018.25.1.14

Repetitive transcranial magnetic stimulation (rTMS) is a relatively new therapeutic and diagnostic technique that uses non-invasive neuromodulation and has an excellent safety profile[1]. According to recent EAN guidelines on central neurostimulation in chronic pain conditions there is only week evidence for primary motor cortex rTMS in neuropathic pain[2], while other guidelines on rTMS state a defi nite analgesic effect of high frequency rTMS of the primary motor cortex contra-lateral to pain site in neuropathic pain[3]

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The Role of Histamine and Serotonin in the Control of Vascular Motricity of the Anterior Ocular Segment - Review of..

2018-01

The Role of Histamine and Serotonin in the Control of Vascular Motricity of the Anterior Ocular Segment - Review of the Literature from 1997 to 2018

Dragos-Constantin Lunca, Horia Paunescu, Laurentiu Coman, Ion Fulga

https://doi.org/10.31689/rmm.2018.25.1.6

Histamine and serotonin (5-hydroxytryptamine) are two amino acid derivatives with important biological functions [1]. Histamine, an endogenous monoamine, is synthesized from the histidine and is stored in most tissues and degraded in liver by histaminase. The most important roles of histamine are: mediation of type I allergic reactions, stimulation of stomach secretion of hydrochloric acid and pepsin (as autacoid), and functioning as a neurotransmitter (especially in the central nervous system)[2]. Regarding the vascular effects of histamine in non-ocular territories, there have not been many published literature reviews, for example, there are data reviewed for pulmonary artery[3], brain territory[4], but these data are not recent.

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The Use of Mineral Therapeutic Waters in Metabolic Disorders - a Review of the Literature

2018-01

Adriana Sarah Nica, Gavril Lucian Gheorghievici, Brindusa Ilinca Mitoiu, Delia Clantau, Gabriela Radulian

https://doi.org/10.31689/rmm.2018.25.1.1

Metabolic Syndrome (MetS) represents a group of clinical and biological criteria that when combined can become a potential threat for the development of severe pathologies -diabetes mellitus, cardiovascular disease, obesity. The International Diabetes Federation(IDF) defines the presence of MetS when 3 or more of the following criteria are detected: 1.raised triglycerides ≥150 mg/dL (1.7 mmol/L) or specific treatment for this lipid abnormality; 2.reduced HDL cholesterol <40 mg/dL (1.03 mmol/L) in males <50 mg/dL (1.29 mmol/L) in females or specific treatment for this lipid abnormality; 3.raised blood pressure systolic BP ≥130 or diastolic BP ≥85 mm Hg or treatment of previously diagnosed hypertension; 4.raised fasting plasma glucose, (FPG) ≥100 mg/dL (5.6 mmol/L), or previously diagnosed type 2 diabetes; 5.central obesity (defined as waist circumference* with ethnicity specific values) (IDF guidelines)[1-3].

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Another Onset Mode for Rheumatoid Arthritis: Emergency Lab, Ultrasound or Both? Case Report and Literature Review

2017-04

Alice Balaceanu, Adriana Diaconu, Adriana Stanica, Camelia Diaconu

https://doi.org/10.31689/rmm.2017.24.4.214

Rheumatoid arthritis is a systemic autoimmune disease, with complex etiology and multiple genetic, immunologic, hormonal factors[1]. The onset could be insidious, like in the most patients or acute, with synovitis and extra-articular manifestations, encountered in 10% of patients[1].

We report a case of a 41 years old woman, non-smoker, without medical history, who complains about inter-mittent leg pain for 2 months, initially left calf, than bilateral, with edema in the both ankle and calf. The patient denied trauma. She is referred to emergency department for deep vein thrombosis suspicion [...]

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Hypospadias - the Surgical Treatment Performed in "Grigore Alexandrescu" Emergency Clinical Hospital for Children

2017-04

Laura Niculescu, Catalin-Ion Chiriac-Babei, Andra Rusalim

https://doi.org/10.31689/rmm.2017.24.4.209

Hypospadias represents one of the most frequent con-genital anomalies, in 1 out of 300 male newborns, involving significant biological and socioeconomical implications. Furthermore, recent studies show an increase in its incidence, even after ajusting it according to race, geographic region or socioeconomical status[3]. The same pattern was recorded by the EUROCAT study group, which was monitoring the statistical and epidemiological data regarding the congenital anomalies in Europe. One prospective study, which evaluated the incidence of the hypospadias in Holland (0.7%), demonstrated that it is more frequent than congenital heart anomalies (0.5%), which are considered to be the most frequent ones by the EUROCAT study group[5]. [...]

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Essential Aspects in Ensuring the Efficient Management of Ovarian Tumors in Children in Case of an Acute or Chronic Setting

2017-04

Catalin Ion Chiriac-Babei, Andra Rusalim, Adham Charkaoui, Razvan Constantin Datu

https://doi.org/10.31689/rmm.2017.24.4.204

Considering the unspecific signs and symptoms asso-ciated to ovarian tumors, a proper diagnostic procedure must be followed in order to establish the most suitable therapeutic approach. Furthermore, there is no correlation between the clinical presentation of the patient and the type of ovarian tumor which is causing it. Consequently, the imagistic examination of the patient is crucial in the diagnostic process, but it is not infallible. This study is attempting to emphasize the main differences between the imagistic features of the ovarian tumors compared to the ones discovered intraoperatively, as well as the associated conditions which could prevent getting a proper preoperative diagnosis. [...]

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Radionuclide Imaging. An Update on the Use of Dynamic Renal Scintigraphy

2017-04

Raluca Mititelu, Ovidiu Bratu

https://doi.org/10.31689/rmm.2017.24.4.199

Renal scintigraphy is a nuclear medicine technique that uses medical radioactive isotopes for the evaluation of the renal function. Functional data complete clinical and anatomical data obtained through other imaging techniques and can assist the clinician in the diagnostic and management of various renal disorders.

The most widely used radioactive isotope for me-dical imaging is Technetium-99m. In renal scintigraphy 99m-Tc is coupled to a substance that is eliminated predominantely by glomerular filtration (DTPA) or tubular excretion (MAG3) or which is attached to tubular proteins (DMSA). DTPA and MAG3 allow a dynamic study which result in the generation of a nephrographic curve for each kidney and the calculation of clearance parameters - ie glomerular filtration rate (GFR) or the effective renal plasma flow (ERPF), respectively. [...]

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The Impact of Testicular Cancer on Fertility - Literature Review

2017-04

Vasilica Minciuna, Octavian Cretu, Dan Spinu, Dragos Marcu, Ovidiu Bratu

https://doi.org/10.31689/rmm.2017.24.4.195

Testicular cancer has an increased incidence among young males (15-35 years old)[1].

The incidence in testicular cancer for this category of patients is quite high, 7.52 new cases for 100000 people. The predominant histopathological subtypes among fertile-aged young males are embryonal carci-noma and teratocarcinoma[1]. [...]

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The Diagnosis of Urological Neoplasm in Dialysis Patients - a Brief Review

2017-04

Mircea Merticariu, Andrei Niculae, Corina-Ioana Merticariu, Ileana Adela Vacaroiu, Flavia Liliana Turcu, Viorel Jinga

https://doi.org/10.31689/rmm.2017.24.4.190

The ideea of this review arised from a small lot of patients recently evaluated by a joint team of urologists and nephrologists in one of the largest dialysis departments in Bucharest, Romania. We decided to review the existing medical literature in order to have a better grasp of the peculiarities regarding the incidence, symptoms, tumor markers and imaging studies for urological cancers in end stage renal disease (ESRD) patients undergoing dialysis. [...]

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Important Aspects to Take Into Consideration When Administering Cytotoxic Chemotherapy. A Review

2017-04

Cornelia Nitipir, Ana-Maria Popa, Pompilia Motatu, Bogdan Popescu, Cristian Iaciu, Mihaela Olaru, Anca-Mihaela Pantea Stoian, Razvan Hainarosie, Silviu Pituru, Maria Barbu

https://doi.org/10.31689/rmm.2017.24.4.185

In the last decade, huge efforts have been made to optimize and personalize oncological treatment. Many novel therapies and better combinations of older ones have been implemented. Even if novelty is always exciting, one has take into consideration that the way a drug is administered is as important as the drug itself. The present review focuses on how the administration of several cancer drugs can minimize the toxicity they induce. It stresses that if enough importance is given to this aspect, patients can tolerate effective doses of treatment with better outcomes and have better quality of life. [...]

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Relevance of Genotyping for the Clinical Management, Transmission and Control Programs of Tuberculosis

2017-04

Olimpia Nicolaescu

https://doi.org/10.31689/rmm.2017.24.4.177

More than 130 years after the discovery of its causative agent, TB still produces nearly 9 million new infections and 1.5 million deaths every year (one-quarter among them are patients co-infected with human immunodeficiency virus - HIV)[1]. Th eincidence of TB ranges from less than 10 per 100.000 in North America to 100 - 300 per 100.000 in Asia and Western Russia, to over 300 per 100.000 in Southern and Central Africa. In several regions of the world, the rise of incidence is linked to the increasing impact of HIV epidemics, drug resistant TB and deficiencies of current TB control programs. Th ese reasons determined WHO to declare TB a global emergency in 1993[2]. [...]

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The Versatility, Plasticity and Esthetic Aspect of Latissimus Dorsi Muscle-Cutaneous Flap in Breast Reconstruction - Case Report

2017-03

Iulia Gabriela Marcu, Ovidiu Stefanescu, Cristian Radu Jecan, Tiberiu Paul Neagu, Ioan Lascar

https://doi.org/10.31689/rmm.2017.24.3.167

In the last decades, the approach manner of the defects of the soft parts post-mastectomy developed significantly together with the innovative surgical techniques of oncoplastic surgery.

Among these techniques, the reconstruction of the breast with LD flap and implant continues to be a reliable and easy to perform method, both by the experi-enced surgeons and also for the beginners[1]. [...]

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Complicated Primary Spontaneous Pneumothorax - Challenges to Overcome: Case Report and Literature Review

2017-03

Catalin Ion Chiriac-Babei, Andra Rusalim, Ciprian Bolca

https://doi.org/10.31689/rmm.2017.24.3.163

The studies concerning spontaneous pneumothorax in children offer a limited amount of information about the best approach with regard to the patients who require surgical treatment of this condition. The less severe forms respond to conservative treatment which consists of oxygen therapy and pain medication. If medical treatment does not alleviate the symptoms or if the pneumothorax persists, the patient requires chest tube drainage[4,5,6]. Surgical treatment is indicated when the pneumothorax reoccurs or if effective pleural drainage does not improve the condition of the patient[5,7]. [...]

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A Rare Cause of Recurrent Syncope in the Pediatric Patient

2017-03

Ioana Adriana Ghiorghiu, Cristina Ramona Radulescu, Doina Anca Plesca

https://doi.org/10.31689/rmm.2017.24.3.157

Syncope is type of transient, complete loss of consciousness with an abrupt onset, short duration and complete, spontaneous recovery[1]. It is a frequent symptom in the general population, most patients having a first occurrence between the ages of 10 and 30[2,3]. Strictly considering the pediatric population (under 18 years of age) the reported incidence may be as high as 15%[4]. [...]

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Versatility of the Cross-Finger Flap for Reconstruction of the Thumb

2017-03

Tiberiu Paul Neagu, Sabina Ionita, Iulia Gabriela Marcu, Razvan Nicolae Teodoreanu, Cristina Iulia Filip, Cristian Radu Jecan, Ioan Lascar

https://doi.org/10.31689/rmm.2017.24.3.151

It is well known that the thumb is responsible for 40% of the hand function. Th erefore, preserving its length and mobility represents the main objective of the plastic surgeon while choosing the most appropriate reconstruction technique[1]. When resurfacing of the fingers is needed after hand injuries, cross-finger flaps have proved themselves very useful[2]. Since its premier many years ago[3], this type of flap remains an elegant method in order to cover exposed bones or tendons of the fi n-ger, in order to ensure length preservation and function recovery. [...]

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Complex Treatment of a High-Energy Proximal Femur Fracture in a Young Adult - a Case Presentation

2017-03

Fabian Klein, Florin Safta, Daniel Vilcioiu, Ioan Cristescu

https://doi.org/10.31689/rmm.2017.24.3.146

Highly comminutive proximal femur fractures in yo-ung healthy adults often occur after high energy trau-ma, such as traffic accidents[1].

The classification of fracture type poses a difficulty, as highly comminuted fractures don’t necessarily respect the anatomical regions of the proximal femur, but rather affect the area as a whole[2,3]. [...]

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How Complicated a Complicated Case Can Become?

2017-03

Mirela Tiglis, Liliana Elena Mirea, Raluca Ungureanu, Ioana Cristina Grintescu, Tiberiu Paul Neagu, Ioana Marina Grintescu

https://doi.org/10.31689/rmm.2017.24.3.142

The incidence of work related injuries is high worldwide. More than 300 million accidents happen during work and are responsible for almost 2 millions of deaths. The incidence of crush syndrome is 2-15% in all trauma patients and frequently can determine trauma-related amputations, especially if the lower limb is involved and the main mechanism is crushing. Crush syndrome is the systemic manifestation of rhabdomyolysis due to muscles reperfusion injury that happened when the compressive forces on the tissues are released, being of-ten related with occupational accidents[1]. [...]

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Tuberculosis of Testis: a Rare Disease

2017-03

Vasilica Minciuna, Ovidiu Gabriel Bratu, Octavian Cretu

https://doi.org/10.31689/rmm.2017.24.3.138

Tuberculosis represents one of the most important pro-blems in public health. It is an intense studied infectio-us disease, in the past and also in present[2,3].

The incidence of tuberculosis is decreasing in most indistrualized countries due to the improvement of prevention and therapeutic means (BCG vaccination, antituberculostatic therapy)[3]. [...]

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Optimizing the Surgical Approach in Hypertrophic Pyloric Stenosis - the Utility of Different Types of Surgical Incisions

2017-03

Costin Datu, Olivia Stanciu, Mircea Andriescu, Catalin Chiriac-Babei

https://doi.org/10.31689/rmm.2017.24.3.134

Hypertrophic pyloric stenosis (HPS) is the most common surgical indication for children during the first six months of life[1]. In infants with HPS, the pyloric canal is elongated, its muscular walls severely thickened with an edematous mucosa. As a result, the pyloric relaxation is markedly restricted, causing upper digestive ob-struction[2]. [...]

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Predictive Factors in Compressive Neuropathies Treatment Outcome

2017-03

Roxana Maria Tomek-Enescu, Andreea Grosu-Bularda, Alexandru Stoian, Ioan Lascar

https://doi.org/10.31689/rmm.2017.24.3.125

Peripheral nerve damage may lead to substantial mor-bidity, and the costs associated with these conditions can be elevated for both the individual and society.

Nerve entrapment syndromes represent a common occurrence, but sometimes are not correctly diagnosed. They appear more frequently and are better known in upper limb. Carpal tunnel syndrome has the higher prevalence, of 3.72% in USA[1]. [...]

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How Can the Number of Diseased People Be Reduced in General by Implementing One Health Concept (ONE HEALTH WHITE BOOK)

2017-03

Nicolae Manolescu, Mircea Ifrim

https://doi.org/10.31689/rmm.2017.24.3.120

From our point of view, the living environmentrefers to the sum total of events that take place around-the-clock in a living area that includes the soil alongside air, and water, including all living creatures(plants, animals and humans), plus the invisible worldthat causes di-seases in humans and animals, consisting of both biotic factors(bacteria, viruses, fungi and parasites) and abiotic factors(toxic and oncogenic chemicals). [...]

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Penile Neoplasia Forensic Approach

2017-03

Dan Spinu, Catalin Belinski, Ioana Oprea, Dragos Marcu, Dan Mischianu, Ovidiu Bratu

Penile cancer is a relatively rare neoplasia with the overall incidence of less than 1 from 100000 patients in Europe and USA[1,2]. The majority of them are common scuamous cell carcinoma 48-65% of the cases followed by basaloid carcinoma, warty carcinoma, verrucous carcinoma, papillary carcinoma which cover for more than 30% with the rest of 5% going to rare types of neoplasia or mixed types.

As in cervix carcinoma the role of HPV has been proved, infact there is a rare type of PC which is directly linked to HPV[3]. As such, the prevalence of penile neoplasia is related to that of HPV in general population. Strains 16 and 18 are the most common findings in penile carcinoma[4]. [...]

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A Curious Case of Rhinophyma in a 73-Year-Old Patient

2017-02

Tiberiu Paul Neagu, Khalid Al-Falah, Mirela Tiglis, Iulia Gabriela Marcu, Cristian Radu Jecan, Liliana Elena Mirea, Ioan Lascar

Rhinophyma is a benign tumor characterized by a pro-gressive hypertrophy of the nose soft tissues, with a re-ddish and bulky appearance, affecting most frequently elderly Caucasian males[1], which may also cause functional airway obstruction. It is believed to be the end stage of severe acne rosacea, but the real cause and the exact etiology remain unknown[1]. The male to female ratio of rhinophyma patient varies between 5 to 1 and 30 to 1 [2,3]. The diagnosis is based on the clinical features of this rare and disfiguring disease using Rhinophyma Severity Index Score (RHISI)[4]. The main differential diagnosis is the basal cell carcinoma (BCC), with an occult incidence of 3% to 10% in patients with rhinophyma[1]. [...]

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Prenatal Diagnosis and Genetic Counselling in Turner Syndrome: Case Report and Literature Review

2017-02

Viorica Tudor, Octavia Velicu, Mihai Mitran, Elvira Bratila, Emilia Severin

The first paper describing female patients with Turner syndrome (TS) was published in 1938 by Henry Turner[1]. It was later discovered that in 1930, Otto Ullrich had already reported a case report of a girl with suggestive symptoms of TS[2]. Therefore, the complete name is Ullrich-Turner syndrome.

Turner’s syndrome is a pathology found only in females, characterized by the partial or total absence of a second sex chromosome which leads to a wide range of physical findings that often includes congenital lymphedema, short stature, and gonadal dysgenesis[1]. The physical symptoms depend on the karyotype, as only 50% of Turner patients are 45,X the others displaying mosaics or abnormalities in the second sex chromosome. [...]

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Cardiotoxicity of Multimodal Treatment for Breast Cancer

2017-02

Radu Valeriu Toma, Georgia Luiza Serbanescu, Mihail Alexandru Oprea, Rodica Maricela Anghel

In the era of the optimal and the personalized oncological treatments, life expectancy increases, therewith the need of understanding and managing side effects is a challenging task.

The most notable research advances in breast cancer involve new radiation treatments techniques and targeted therapies.

Cardiac toxicity following radiotherapy (RT) is recognized as an important issue. Furthermore, with the prevalent and necessary treatment with anthracyclines and trastuzumab, which carry an independent and confirmed risk of cardiotoxicity[1-3] the additional heart disease risk following radiotherapy must be kept to a minimum. [...]

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Charcot Foot Diagnosis - Still an Issue?

2017-02

Ion Cocolos, Tiberiu Paul Neagu, Andrei Tudor Ursache, Ioan Cristescu, Mircea Vasile Ghemigian, Liliana Elena Mirea, Gheorghe Ion Popescu

The Lisfranc fracture-dislocation of the foot is uncommon and many cases are misdiagnosed. The Lisfranc lesion involves the medial cuneiform and base of the second metatarsal which are considered to be the keystone of the structural integrity of the midfoot. This joint has a stabilization effect on longitudinal and transverse arches of the foot. A neglected or untreated injury to the Lisfranc joint can lead to secondary arthritis and significant morbidity with disability. Furthermore, it is well known the correlation between pacients with periferic neuropathy and this type of lesion, also known as Charcot Foot[1]. It has been documented to occur as a consequence of various peripheral neuropathies, but diabetic neuropathy has become the most common etiology[2]. [...]

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A Retrospective on the Treatment of Trochanteric Fractures of the Femur in the Bucharest Clinical Emergency Hospital in 2015

2017-02

Fabian Klein, Ioan Cristescu, Florin Safta, Daniel Vilcioiu

Fractures of the proximal femur are some of the most commonly encountered fracture types, especially when talking about elderly patient[1,2]. Apart from the immediate impact on the patient’s health, a more problematic issue is the impact on the quality of life, especially when talking about geriatric patients[3]. Early surgical treatment, combined with early discharge from hospital and a well-tailored rehabilitation program are mandatory for assuring a quick recovery of the patient’s autonomy. It is estimated that every person over the age of 65 has a 10% chance to fall once per year, with the possibility of contracting a proximal femur fracture. [...]

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The Use of Tranexamic Acid for Preventing Bloodloss During Percutaneous Nephrolithotomy

2017-02

Raluca Barbilian, Victor Cauni, Bogdan Mihai, Ioana Buraga, Mihai Dragutescu, Dan Mischianu

Percutaneous nephrolithotomy (PCNL) is a minimally invasive method of treatment used for large kidney stones (>20 mm). It remains the standard procedure for large renal calculi according to EAU (European Association of Urology) guidelines. The stones are extracted from the kidney by a small puncture wound (about 1 cm) through the skin. Since its introduction this technique has replaced almost completely open surgery for renal lithiasis, who nowadays is used only rarely in selected cases. Although this procedure has much lower complications than open surgery, the complications following this procedure can be serious[1] (Table 1). Morbidity and complications following PCNL are dominated by fever (10.5%) and bleeding (7.8%)[2]. [...]

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The Value of Computed Tomography in Establishing the Proper Surgical Treatment of a Complex Proximal Humerus Fracture

2017-02

Razvan Turcu, Marius Moga, Mircea Ifrim

Proximal humerus fractures result from indirect trauma, are associated with osteoporosis, and are classified into: humeral head fractures, anatomical cervical fractures, trochiter, trochin, surgical neck, or proximal diaphysis. Types of fracture and displacement are determined by the position of the humerus at the time of trauma, bone quality and the direction of muscle forces on fractured fragments[1,2].

Fractures with two, three or four shifted parts require surgical treatment. The dislocation fractures, except for the simple trohiter fractures, should be analyzed by the orthopedic surgeon, the reduction of the dislocation will precede the treatment of the fracture. It should be emphasized that powerful damping maneuvers can move fractured fragments, so it will be preferable to reduce it under radiological control[14]. [...]

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The Role of Psoas Compartment Block in the Management of Pain During and After Total Hip Arthroplasty

2017-02

Bianca Basgan, Nicolae Iordache, Dragos Cocos

The "Psoas Compartment Block" technique was described for the first time in 1974 by the American doctor Alon P. Winnie, in a revolutionary article for that time[1], that was detailing both the anterior approach of the lumbar plexus (3 in 1 Block or femoral nerve block), and the posterior approach.

Subsequently, doctors Chayen D., Nathan H. and Chayen M. are making a series of additions and practical indications, in an article about the posterior approach, entitled "The Psoas Compartment Block"[2], and the technique presented in this article also constitutes the basis for this study. [...]

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One Healthand Advanced Biotechnology

2017-02

Nicolae Manolescu, Emilia Balint, Sabin Cinca, Calin Chirila

The merit of coagulating the various components of one-health concept and disseminating it in practice at largeis credited to the United States and especially to the two US structures, respectively ONE HEALTH COMMISSION coordinated by Mrs. Cheryl Stroud and ONE HEALTHINITIATIVE - with the excep-tional coordination of Dr. Bruce Kaplan, Dr. Laura Kahn, Dr. Lisa Conti and Prof. Gregory Gray from Duke University, Florida.

This concept has spread throughout the world, including Europe. The year 2014 represents the formalization of this concept in Europe under the coordination of the Federation of European Academies of Medicine (FEAM), with Prof. Dr. Bernard Charpentier, Prof. André Laurent Parodi and Prof. George Griffin as chairpersons. [...]

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The Cutaneous Adverse Events at the Site of Insulin Injections

2017-02

Rucsandra Danciulescu Miulescu, Georgeta Vacaru, Nicoleta Mindrescu

Cutaneous adverse events at the site of insulin injections include local allergic reactions to insulin (erythema, pruritus, and induration) and lipodystrophy The allergic reactions are usually short-lived, and resolve spontaneously within a few weeks [1]. Lipodystrophies are a group of diseases characterised by a morphological and/or functional impairment of the adipose tissue. Classification of lipodystrophy include genetic and acquired forms. Acquired forms can be generalized (Lawrence syndrome), partial (Barraguer-Simons syndrom, associated with sclerodermia or acquired immunodeficiency syndrome and antiretroviral therapy), or local (associated with drug: glucocorticoids, post-injection-insulin, somatostatin analogs, pegvisomant)[2]. Clinical forms of lipodystrophy include lipoatrophy and lipohypertrophy. [...]

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Single-Stage Reconstruction of Distal Third of the Dorsum Nasi Using a Nasolabial Flap after Removal of Basal Cell Carcinoma

2017-01

Tiberiu Paul Neagu, Mirela Tiglis, Ioana Cristina Grintescu, Sebastian Valcea, Serban Arghir Popescu, Ioan Lascar

The nose represents a common site for skin cancer, especially for Basal Cell Carcinoma (BCC) which is the most common malignant tumor in humans[1-3]. The removal of the tumor will lead to a defect that can involve skin, cartilage and even nasal mucosa. Therefore, reconstruction of this tridimensional structure can be a challenge even for the most experienced surgeons[4]. There are many techniques described in the literature for restoring the lining and skeletal framework[1-8], but all of these techniques should be adapted to the patient’s needs. In this paper we described our preferred surgical method to cover a medium defect of the distal third of the dorsum nasi after tumor excision using a nasolabial flap. In order to perform a single-stage reconstruction, we pushed the limits of the flap measurements and did some tricks so as the pedicle to be well fitted, leading to good aesthetic results. [...]

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Transmandibular Excision of Symptomatic Large Parapharyngeal Rhabdomyoma - Case Presentation and Literature Review

2017-01

Andreea Nae, Patrick Sheahan

Adult rhabdomyoma is a very rare slow-growing tumor arising in the head and neck region. It has a male predilection and a mean age of 60 at presentation. The most common head and neck sites for this tumor are floor of mouth, oral cavity and parapharyngeal space[1-3]. Common presenting complains of the patients are fullness around the angle of the mandible or airway obstruction if the tumor is present in the parapharyngeal space. Investigations should include FNA or biopsy and imaging of the neck. Imunohistological studies should be performed as due to its rarity, the rhabdomyoma sometimes could be difficult to diagnose on routine histology and also for confirmation of the diagnosis. Complete surgical excision is mandatory as recurrences occur in incomplete removal of the rhabdomyoma. [...]

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Iatrogenic Ureteral Injury Following Radical Hysterectomy - Case Presentation

2017-01

Dragos Radu Marcu, Ovidiu Gabriel Bratu, Dan Arsenie Spinu, Ioana Sorina Oprea, Ileana Adela Vacaroiu, Bogdan Florin Geavlete, Camelia Diaconu, Dan Mischianu

Iatrogenic ureteral injuries represent an important complication of abdomino-pelvic surgery with serio-us consequences in the absence of a prompt diagnostic and adequate treatment. According to literature it has been estimated that over 75% of all ureteral injuries are iatrogenic and that the incidence of ureteral lesions during an abdomino-pelvic surgery ranges from 0.5% to 10%[1-5]. Studies concerning this pathology have shown that obstetric and gynecological surgery accounts for approximately 50-60% or even more, followed by colorectal surgery 10-25%, vascular surgery (aortoiliac and aorto-femural bypass) and urological surgery 15-30% (classic, laparoscopic and endoscopic approach)[5-11]. [...]

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Breast Reconstruction Particularities after Radiotherapy - Case Report

2017-01

Iulia Gabriela Marcu, Ovidiu Stefanescu, Cristian Radu Jecan, Laura Raducu, Tiberiu Paul Neagu, Ioan Lascăr

Postmastectomy radiation therapy decreases the incidence of locoregional disease recurrence in patients with invasive breast cancer and has been proven to reflect a survival advantage for patients with node positive disease[1,2]. The optimal timing and technique of breast reconstruction procedures in patients requiring post-mastectomy radiation therapy are controversial[1] . Patients undergoing postmastectomy breast reconstruction, with a history of prior radiation therapy, present a particular clinical scenario. This is because of their well-documented higher complication rates, secondary to deleterious effects of irradiation on the soft tissue envelope of the remaining breast. [...]

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Multivisceral Resection for Pancreatic Adenocarcinoma. Case Report and Literature Review

2017-01

Sebastian Valcea, Octavian Enciu, Cosmin Pantu, Mihaela Vartic, Tiberiu Paul Neagu, Mircea Beuran

Pancreatic cancer (PC) remains a deadly disease with a dismal prognosis in which the mortality rate nearly equals its incidence [1,4]. Despite advances in modern chemoradiotherapy, the best and only chance of cure for patients with PC is an oncological surgical resection aimed at complete removal of all gross and microscopic disease[5]. Early disease and curative-intent surgery are the best predictors of outcome. Locally advanced cancer of the pancreatic tail involving adjacent organs is often considered unresectable. Radical distal pancreatectomy with en bloc resection of the invaded viscera with or without vascular reconstruction was introduced to treat these tumors[2,3]. Tumors of the body and tail have evidence of involvement of surrounding structures either by tumor infiltration or inflammatory adhesions. In such circumstances, it is advisable to perform en bloc resections to obtain negative surgical margins[6]. According to Shoup, multivisceral resections are technically feasible and, based on the limited data available, these resections are associated with improved survival (5-year survival rates of 16-22%) [7,8]. Given the high morbidity and mortality associated with these procedures, they should be performed only when the possibility of achieving R0 seems distinctly feasible[3,6,8]. [...]

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A Retrospective Forensic Study in Head Trauma Patients with Undiagnosed Skull Fractures at Computerised Tomography (CT) Scans

2017-01

Roxana-Maria Duncea, Relu-George Calota, Alec Cosmin Moldovan, Vladimir Belis

Computerized tomography (CT) scan is the primary screening modality of investigations in head trauma victims[1]. Since 1971 when it was invented, CT scan has advanced significantly from time-intensive single-section scanning to multi-detector row CT[2]. Nowadays, rapid and accurate assessment of injuries in emergency departments is based on CT scans. Th ere is a high degree of difficulty in terms of causal link, between the injury and the death causing mechanism in patients, with multiple affections and head trauma[3]. [...]

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The Effect of Allopurinol on Endothelial Function, Serum Uric Acid and NT-proBNP in Acute Decompensated Heart Failure

2017-01

Madalina Sorina Ababei, Alexandru Campeanu, Diana Cornelia Nistorescu, Ondin Zaharia, Gabriela Gheorghe, Ileana Peride, Andrei Niculae, Ioan Tiberiu Nanea

Acute decompensated heart failure has an increasing incidence and poor prognosis, being a major cause of death and hospital readmission and requiring urgent optimized therapy[1]. Under the influence of some decompensation risk factor, such as infections, arrhythmias, decompensation of some comorbidities, lack of adherence to the treatment, patients with a history of heart failure may suffer a progressive symptomatology worsening; therefore, more than 70% of cases of acute heart failure represent the clinical worsening of chronic heart failure - ADHF[2]. [...]

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Contrast Enhanced Ultrasonography in Diagnosis of Hypertensive Nephrosclerosis

2017-01

Liliana Albusoiu, Alexandru Campeanu, Marina Budau, Viorel Jinga, Ileana Peride, Andrei Niculae, Cristiana David, Ioan Tiberiu Nanea

The link between kidney damage and HT remains a challenge in medical research from a century when HT concept was defined, taking in consideration than HT is a major risk factor for cardiovascular disease morta-lity worldwide, due to the increasing prevalence, poor compliance to treatment and many complications[1-3]. The hypertensive nephrosclerosis is currently diagnosed in the latest stages of the disease because, for a long period of time, the injuries are compensated by kidney and therefore the clinical presentation is not specific[4]. The current diagnostic methods are non-specific, especially for early diagnosis of hypertensive nephrosclerosis, except the renal biopsy which is considered the gold standard but is rarely indicated in clinical routine due to its invasiveness and possible severe complications[5]. The pathogenic mechanism is complex and not very well understood but renal microcirculation impairment seems to be responsible for the onset and progression of this disease[6]. Therefore, any method that can accurately assess the early microvasculature changes of renal cortex, easy to use, simple and safe, with no invasiveness, could be an important diagnostic tool in hypertensive nephrosclerosis approach. [...]

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Pharmacodynamics of Serotonin. Emphasis on 5HT-3 Antagonists and SSRI Medication (II)

2017-01

Mihnea Costescu, Horia Paunescu, Sorina Vasile, Aurelian Zugravu, Oana Andreia Coman, Ion Fulga

5-HT4 receptors are a G-protein-coupled family of re-ceptors coupled with Gs protein that stimulates the pro-duction of the intracellular signaling molecule cAMP. It has two isoforms (5-HT4S and 5-HT4L), differing in the length and sequence of their C-termini[1]. 5-HT4 are present both in the central nervous system and peripheral tissues; in the brain, are found mostly in basal ganglia and the hippocampus[2]. In the periphery, 5HT4 play an important role in the functioning of gastrointestinal tract, urinary bladder, heart and adrenal gland. Gastrointestinal 5-HT4 receptors potentiate peristalsis, and electrolyte secretion. In the urinary bladder, acti-vation of 5-HT4 receptors modulates cholinergic and purinergic transmission. Stimulation of atrial 5-HT4 receptors produces tachycardia and arrhythmias. In the adrenal gland, activation of 5-HT4 receptors releases cortisol, aldosterone and corticosterone[3]. [...]

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HPV and Bladder Cancer - Is There a Connection?

2017-01

Dan Arsenie Spinu, Ovidiu Gabriel Bratu, Dragos Radu Marcu, Andrei Niculae, Bogdan Florin Geavlete, Camelia Diaconu, Dan Mischianu

HPV represents without any doubt one of the biggest health problems nowadys. Since the early days of its discovery by zur Hausen[1] the importance of this pathogen has risen. It is role in cervix neoplasia has been already demonstrated and steps have been made to counter this threat (vaccine). There are proofs that link this virus to other ano-genital neoplasia (here we include the penis, vulva, ano-rectal region and later the laryngeal neoplasia). [...]

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An Unfortunately Surprise of a Renal Cystic Mass - Case Presentation

2016-04

Ovidiu Bratu, Dragos Marcu, Dan Spinu, Ioana Oprea, Ileana Peride, Dan Liviu Dorel Mischianu

Cystic renal masses represents a pathology that may rise diagnosis and management difficulties. The differential diagnosis of large renal cystic masses should be made with normal renal cysts, hydronephrosis, renal abscess, renal hematoma, morpho-functional demaged kidney or with a renal tumor with necrosis and abscess. [...]

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Upper GI Bleeding with Hemorrhagic Shock Caused by Infectious Esophagitis

2016-04

Daniela Tabacelia, Madalina Ilie, Gabriel Constantinescu, Radu Tincu, Bogdan Popa, Raluca Stanciulescu, Valentin Enache, Dragos Ene

CMV infection in healthy hosts is generally asymptomatic, producing a latent infection with antibodies persisting for months or even years after the recovery. In the population at risk, CMV infection is one of the most frequent opportunistic infection. The most frequent GI manifestation of CMV infection is colitis followed by esophagitis although it can affect all organs. CMV esophagitis has been reported in immunocompromised hosts by conditions like organ transplantation, bone marrow transplantation, in patients with HIV infection and AIDS or other debilitating diseases. [...]

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Comparison of Osteosynthesis Using Plates and Screws Versus Kirschner Wire Fixation for Unstable Metacarpal Fractures: a...

2016-04

Comparison of Osteosynthesis Using Plates and Screws Versus Kirschner Wire Fixation for Unstable Metacarpal Fractures: a Retrospective Clinical Study

Tiberiu Paul Neagu, Ion Cocolos, Mirela Tiglis, Ioana Cristina Grintescu, Mazen Elfarra, Ioana Teona Sebe, Cristian Radu Jecan, Ioan Lascar

Hand surgery is considered to be the biggest challenge for every plastic surgeon. The social value of the hand is appreciated by any individual, butmostly by plastic surgeons which are, par excellence, hand-working persons. When a hand injury is treated you must consider the Hippocratic concept which states that "healing is a matter of time but it is sometimes also a matter of opportunity". The hand forms a functional unit with the forearm which is a high-precision machine, with multiples levers, who has tactile intelligence that ensure its auto-mechanism, being able to grab and maintain, in any spatial position, large and small tools invented by human genius. The hand is both a motor and sensory organ, and in terms of society,it is an organ of defense, an organ of creation and expression. This is why hand surgery is very important, both in medical and social terms, and any research in this domain has one purpose: improving the treatment of hand injuriesin order to obtain functional results closer to the genetic scale of the divine creation. The purpose of this study was to assess different osteosynthesis techniques in order to establish which one is better in matters of functional results. [...]

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Diagnostic Challenges in Atypical Pulmonary Carcinoid

2016-04

Alice Balaceanu, Camelia Diaconu, Florin Andrei, Mazen Elfarra, Gheorghita Aron, Ion Dina

The spectrum of neuroendocrine tumors (NETs) of the lung is wide and heterogeneous, ranging from well-differentiated bronchial neuroendocrine tumors to highly malignant and poorly differentiated small cell lung cancer and large cell neuroendocrine carcinoma. NETs of the lung share both morphologic and immunohistochemical characteristics with neuroendocrine tumors. [...]

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Intrathoracic Anastomotic Leak after Ivor Lewis Esophagectomy: Non-Surgical Management

2016-04

Dragos Ene, Claudiu Stefan Turculet, Teodor Florin Georgescu, Madalina Ilie, Radu Tincu, Mircea Beuran

Esophagectomy is the best therapy for the patients with locoregionally advanced esophageal cancer, but carries serious risks of associated morbidity and mortality. Esophageal anastomotic leak is a severe post-operative complication with a rate of mortality that can reach 60%. Clinical presentations of esophageal anastomotic leaks varies from asymptomatic to severe sepsis and death. The prognosis depends on the duration to diagnosis and the severity of contamination. An anastomotic esophageal leak has a great impact on the length of hospitalization, morbidity, stricture formation and dysphagia. The management of intrathoracic anastomotic leaks include conservative, surgical or endoscopic treatment, but the indication between these options of treatment remains controversial. [...]

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Pre and Postoperative Evaluation of Cutaneous Facial Flaps Using Infrared Thermographic Camera

2016-04

Laura Raducu, Cristina Nicoleta Cozma, Laura Oana Stroica, Tiberiu Paul Neagu, Cristian Radu Jecan

Cutaneous flaps are usually utilized in covering skin defects in different parts of the body. Facial reconstruction is an important topic for plastic and reconstructive surgeons, facial defects having a serious impact on patient’s quality of life. [...]

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Glycoproteic Pituitary Hormones in the Cerebrospinal Fluid of Patients with Pituitary Adenomas

2016-04

Cristina Capatina, Vasile Ciubotaru, Andra Caragheorgheopol, Cristina Stancu, Mihail Coculescu, Catalina Poiana

Pituitary adenomas are benign neoplasms originating in the anterior pituitary cells, that represent 15-20% of all intracranial tumors. Pituitary adenomas (PA) can be secreting (producing growth hormone-GH, prolactin-PRL, adrenocor-ticotropic hormone-ACTH or, very rarely gonadotro-pins-FSH and LH or thyrotropic hormone TSH) or non-secreting (NPA). [...]

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Predictive Factors of Mortality in Acute Pancreatitis

2016-04

Cristian Constantin Popa, Dumitru Cristinel Badiu, Octavia Cristina Rusu, Valentin Titus Grigorean, Stefan Ilie Neagu, Cristian Razvan Strugaru

Acute pancreatitis is acute inflammation of pancreatic glandular acinar cells followed by intraparenchymal enzymatic activation and pancreatic auto digestion. In most cases develop mild or moderate forms, with low morbidity and mortality. There is however a lower category of patients that develop severe forms of disease with increased morbidity and mortality. [...]

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Atypical Lipomatous Tumor/Well Differentiated Liposarcoma: a Borderline Malignancy Tumor

2016-04

Cornelia Nitipir, Florin Andrei, Dragos Zamfirescu, Florina Vasilescu, Dana Terzea, Irina Radu, Maria Alexandra Barbu, Bogdan Popescu

Adipocytic tumors represent the largest single group of mesenchymal tumors, due to the high prevalence of lipomas and angiolipomas. Liposarcomas are histologically divided into five subtypes: myxoid, pleomorphic, dedifferentiated, round cell and atypical lipomatous tumor (well-differentiated liposarcoma). Atypical li-pomatous tumor (ALT) is the most common histological subgroup, they account for 40% to 45% of all liposarcomas. Well-diff erentiated (WD) liposarco-mas are locally aggressive but incapable of metastasis. Approximately 75% develop in the deep soft tissue of the limbs, followed by 20% in the retroperitoneum and a much smaller percentage in the inguinal region and the mediastinum. They are usually diagnosed after the fifth decade of life, with a slight male predominance re-ported. Atypical lipomatous tumor is an intermediate (locally aggressive) neoplasm composed either entirely or in part of a mature adipocytic proliferation showing significant variation in cell size, atypical stromal cells and a limited number of scattered monovacuolated or multivacuolated lipoblasts. [...]

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Therapeutic Approaches in Premature Ejaculation

2016-04

Dragos Marcu, Ovidiu Bratu, Dan Spinu, Ioana Oprea, Andrei Niculae, Dan Liviu Dorel Mischianu

Premature ejaculation (PE) is a serious health problem with an important impact on male self-confidence, in-terpersonal relationships and quality of life. [...]

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Advances in Peripheral Nerve Regeneration: Materials, Methods, Techniques

2016-04

Victor Ioan Popa, Otilia Florentina Racasan, Arina Cristiana Margina, Silviu Cortan, Paul Neagu, Ioana Teona Sebe

Peripheral nerve injuries have a high incidence in limb trauma and have a devastating impact on the quality of life of the patient. Results after surgical treatment are unsatisfactory especially in cases with complete tran-section of the nerve (neurotmesis) associated with late repair. Thus, the necessity to implement into current practice new techniques, materials and methods for nerve repair. [...]

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Vertebral Synovial Sarcoma - Onset with Spinal Cord Compression Syndrome. Case Report

2016-03

Laura Rebegea, Dumitra Miron, Mihaela Dumitru, Dorel Firescu, Mary Lupu, Rodica Anghel

Synovial sarcomas (SS) are rare. Less than 5% occur in spine, mediastinum, head and neck and at the retroperitoneal level and in approximately 85% of the cases occur at the level of the soft tissues and extremities. SS metastases are not rare, they occur predominantly at the level of lungs, bones and liver. Standard treatment consists in surgery, ideal, in large excision with negative margins, R0 (when is possible). For unresectable tumors, the therapeutic options include CMT and/or RTE [2]. [...]

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Adenocarcinoma of Duodenum - Case Report

2016-03

Amelia Genunche-Dumitrescu, Daniela Badea, Mihail Badea, Paul Mitruț, Vlad Pădureanu, Aurelian Adrian Badea

Primary duodenal carcinoma represent 35-45% of all tumors in the small bowel but he has a small share in all gastro-intestinal tumors (0.35%) [1,2]. The most frequent type of tumor in the duodenum is the adenocarcinoma, but can observed other types of tumours such as lymphomas, carcinoid tumors, gastrinomas, leiomyo-sarcomas and stromal tumors [3]. The localization of the primary duodenal adenocarcinomas is in the first and second level of the duodenum, and 20% and 10% remain in the next two levels. [...]

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Serum Troponin - a Sensitive Indicator of the Cardiac Involvement in Septic States

2016-03

Andrei Seri, Adrian Madalan, Isabela Tiglea, Daciana Marta

Troponins (Tn) are protein associations located on the filaments of the movement-generating apparatus in the striate (both cardiac, and skeletal) musculature. There are three distinct proteins coded by separate genes: TnC, TnI, TnT. Th ey are important regulatory components of the myocardial contraction machine. Their nomenclature reflects the role each of them plays in contraction [1]. [...]

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Crohn’s Disease or Intestinal Tuberculosis. A Diagnostic Challenge

2016-03

Alina Constantin, Madalina Ilie, Daniela Tabacelia, Bogdan Popa, Gabriel Constantinescu, Radu Tincu, Radu Alexandru Macovei

TB usually affects the lungs but many other organs may be involved. Intestinal tuberculosis primarily involves the distal ileum and cecum, followed by the jejuno-ileum, colon and rectum. The development of strictures and fistulas mimic Crohn’s disease, and generalized colonic involvement mimics ulcerative colitis. A 42 year old patient was admitted to the Gastroenterology Department of Emergency Clinical Hospital Bucharest with a 3 months history of unintentional weight loss (15 kg), diarrhea (7-8 unformed stools per day), right iliac fossa pain, night sweats. He had a history of recent fungal esophagitis and antral gastritis. He denied prior contact with patients with tuberculosis and has no pets. [...]

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The Vasopressin System in Metabolic Syndrome and Insulin Resistance - a Mini-Review

2016-03

Madalina Vintila, Mihail Coculescu, Florin Grigorescu, Catalina Poiana

Metabolic syndrome (MetS), type 2 diabetes, and consequent cardiovascular complications are serious healthcare problems worldwide [1,2]. The prevalence of MetS or its components around the world is variable in different ethnic populations [3,4], and this can be explained by interactions between susceptibility genes specifically expressed in certain ethnic groups and environmental factors [5]. Nonetheless, the number of people aff ected by these conditions is continuously increasing at a global level [4,6] and along with it the mortality and morbidity of populations [7,8]. Cardiovascular disease (CVD) is the main cause of mortality in people suffering from MetS and/or diabetes [9]. The research in this field is ongoing, in the attempt to elucidate the pathophysiological mechanisms and pathways involved in MetS, and to find reliable biomarkers for diagnosis and disease prognosis, as well as therapeutic targets. [...]

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Review on Non-Invasive Diagnosis of Pancreatic Cancer

2016-03

Iulia Petre, Coralia Bleotu, Madalina Ilie, Radu Tincu, Bogdan Popa, Gabriel Constantinescu

The pancreatic cancer has the worst prognosis among gastrointestinal cancers with a mortality rate close to incidence. The analysis on the globe carried out by GLOBOCAN in 2012 places the pancreatic cancer on the 13th place in terms of incidence and on the 8th place in terms of mortality of all cancers and in relation with digestive cancers it occupies the 6th place for both epidemiological indices [1]. [...]

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Recent Advances in the Genetics of Pheochromocytomas and Paragangliomas

2016-03

Alexandra Mirica, Ioana Anca Badarau, Radu Mirica, Sorin Paun, Catalina Poiana, Diana Loreta Paun

Pheochromocytomas (Pheos) and paragangliomas (Pgls) are rare neuroendocrine tumors, with the same embriologic origin. Based on WHO classification, chromaffin tumors of the adrenal medulla are called Pheos, whereas tumors arising from extra-adrenal chromaffi n cells, along the autonomous nervous chains, are named Pgls [1]. Furthermore, there are two types of Pgls according to their homologous nervous chain: sympathetic and parasympathetic tumors. Sympathetic Pgls are developing from the pre- and paravertebral sympathetic ganglia (ex: Pgls of the thorax, mediastinum, abdomen) and from the connective tissue within the pelvic organs (ex:urinary bladder Pgl). They release dopamine or norepinephrine (NE) because they lack phenylethanolamine N-methyltransferase (PNMT), the enzyme in charge of transforming NE into epinephrine (E), that is specific to adrenal medulla. [...]

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Osteosarcoma in Children and Adolescents - a Single Center Review of Presentation, Therapy and Outcome

2016-03

Razvan-Cosmin Petca, Stefan Gavriliu, Gheorghe Burnei

Worldwide, cancer is the second leading cause of death, following heart disease, accounting for 23% of all deaths. Although most cancers causing death are carcinomas of lung, prostate and breast, primary malignancy of the bone is ranked as the third leading cause of death in patients with cancer who are younger than 20 years [1]. [...]

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A Long Term Clinical Comparison in Cases of High Volume Benign Prostatic Obstruction - Bipolar Plasma Enucleation Versus...

2016-03

A Long Term Clinical Comparison in Cases of High Volume Benign Prostatic Obstruction - Bipolar Plasma Enucleation Versus Standard Prostatectomy

Catalin Bulai, Petrisor Geavlete, Cosmin Ene, Ovidiu Bratu, Ileana Peride, Andrei Niculae, Bogdan Geavlete

Despite the constant technological advances achieved during the past decades, large size benign prostatic hyperplasia (BPH) pathology continues to raise questions concerning the most appropriate therapeutic approach. Interestingly enough, the classical open prostatectomy still represents the standard option for this type of cases despite the substantial perioperative morbidity [1]. [...]

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Outcome of Children with Acute Lymphoblastic Leukemia Treated with the ALL-BFM 95 Protocol during 2001-2014 at the Pediatric...

2016-03

Outcome of Children with Acute Lymphoblastic Leukemia Treated with the ALL-BFM 95 Protocol during 2001-2014 at the Pediatric Hematology Center from Tirgu-Mures

Adrienne Horvath, Zsuzsanna Erzsebet Papp, Mihaela Chincesan, Maria Despina Baghiu

Acute lymphoblastic leukemia (ALL) is responsible for 25% of all childhood cancers. The outcome has dramatically changed during the last decades, reaching an overall survival rate of approximately 80% in high-income countries and lower rates in low and middle-income countries [1-6]. Recent trials with risk stratifi cation based on biological features of leukemic cells and response to therapy report an even better survival rate of 90% [7].

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Vitamin D Levels Correlate with Wheezing and Asthma Recurrence in Children

2016-03

Marius Cornitescu, Gabriel Mircescu, Mariana Moiceanu, Eugenia Buzoianu, Vlad Plesca, Andrei Zamfirescu, Doina Anca Plesca

Vitamin D is a secosteroid with a pivotal role in the calcium and phosphate metabolism, two ions that are essential for bone mineralization, neuromuscular activity and general cell functions. Sources of vitamin D are either endogenous (production in the skin from 7-dehydrocholesterol under the influence of sunlight UV-B radiation) [1] or exogenous (dietary). The dietary forms of vitamin D are either of vegetal origin (ergocalciferol, vitamin D2) [2] or of animal origin (colecalciferol, vitamin D3) [3]. The two calciferol forms are similarly metabolized in humans, have equal bioavailability and effectiveness [4]. [...]

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Two-Dimensional Speckle Tracking Echocardiography - a Useful Non-Invasive Method in Predicting Significant Coronary Artery...

2016-03

Two-Dimensional Speckle Tracking Echocardiography - a Useful Non-Invasive Method in Predicting Significant Coronary Artery Disease in Low Risk Acute Coronary Syndrome

Roxana Onut, Monica Stoian, Sebastian Onciul, Diana Zamfir, Cristina Marinescu, Ioana Petre, Silvia Iancovici, Alexandra Paval, Alexandru Scafa, Lucian Calmac, Vlad Bataila, Maria Dorobanțu

Echocardiography is the first cardiac imaging technique used to evaluate patients presenting with acute coronary syndrome (ACS). However, in the absence of wall motion abnormalities, conventional echocardiography at rest provides little information. Patients presenting with low risk ACS usually have normal wall motion and left ventricle ejection fraction (LVEF) at rest.

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Carcinosarcoma of the Uterine Corpus - a Case Report and Brief Review of the Literature

2016-02

Tiberiu Augustin Georgescu, Monica Cirstoiu, Florin Catalin Cirstoiu, Mariana Costache, Anca Lazaroiu, Adrian Dumitru, Maria Sajin

Malignant Mixed Müllerian Tumors (MMMT) also referred to as carcinosarcomas are very rare and extremely aggressive tumors of the uterine corpus accounting for less than 1% of all gynecologic malignancies, 2-5% of all uterine malignancies and more than 15% of all uterine cancer associated deaths [1]. They occur almost exclusively in post-menopausal women, but have been reported in premenopausal women as well, including young girls [2]. Carcinosarcomas have poor prognostic outcome, regardless of stage at diagnosis. The five-year survival rate ranges between 5% and 40% for patients with tumors of all stages [2-5] and does not improve significantly even with the introduction of increasingly aggressive adjuvant therapies.

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A Rare Tumor - Primary Leiomyosarcoma of Pulmonary Artery. Case Presentation

2016-02

Laura Rebegea, Dorel Firescu, Mihaela Dumitru, Alina Mihaela Calin, Rodica Anghel

Pulmonary artery sarcomas (PA) are uncommon; the first case was documented in 1923 by Mandel Staam. Leiomyosarcoma, fibrosarcoma and rhabdomyosarcoma are the most often histologically confirmed incidences. PA tumor is frequently misinterpreted as thrombo-embolism, as its correct diagnosis is difficult. Magnetic Resonance Imaging (MRI) is superior in providing an accurate diagnosis. Surgery is the only therapeutic strategy which may extend life expectancy. The survival rate in the absence of surgical care is of 1.5 months, survival for 5 years - 6%. In most cases, death occurs by heart failure, and rarely by distant metastases. [...]

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Urinary System Spontaneous Rupture - an Urological Emergency

2016-02

Dragos Marcu, Ovidiu Bratu, Dan Spinu, Robert Popescu, Agnes Ciuca, Maria Galaman, Ioana Oprea, Dan Mischianu

Spontaneous rupture of the urinary collecting system is a rare urologic pathology, but due to the severity of its possible complications, it represents an urological emergency which requires adequate urgent treatment. [...]

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The Role of the Extraperitoneal Drainage in the Corrective Surgery of the Intraoperative-Discovered Accidental Lesions of the...

2016-02

The Role of the Extraperitoneal Drainage in the Corrective Surgery of the Intraoperative-Discovered Accidental Lesions of the Common Bile Duct

Alec Cosmin Moldovan, Florin Dan Ungureanu, Vladimir Belis

Up to date, one of the most well-known and used classification for defining bile duct lesions belongs to Bismuth [1] and was later assumed by laparoscopic surgery as well. In this classification, the author is taking into consideration the remaining intact bile duct length and does not include bile collections that may arise from a bilistasis defect in the cystic duct or the liver bed, nor the lateral solutions of continuity of the main bile duct and right hepatic duct. These kind of iatrogenic injuries were initially reported only after classic cholecystectomy, and this is why, later, with the development and rise of the laparoscopic approach, Strasberg and Soper [2] modified this classification of accidental injuries inclu-ding these as well. [...]

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Pharmacodynamics of Serotonin. Emphasis on 5HT-3 Antagonists and SSRI Medication (I)

2016-02

Mihnea Costescu, Horia Paunescu, Sorina Vasile, Aurelian Zugravu, Oana Andreia Coman, Ion Fulga

Serotonin (5-hydroxytryptamine or 5-HT)is a mo-noamine neurotransmitter involved in regulating and modulating physiological and behavioral processes [1]. Serotonin also plays an important role in the functio-ning of enteric nervous system [2]. [...]

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Genome-Wide Association Scan for Variants Associated with Early-Onset Prostate Cancer in Romania

2016-02

George Daniel Radavoi, Paul Daniel Iordache, Viorica Radoi, Radu Ioan Ursu, Stefan Rascu, Cristian Sima, Marian Vargau, Bogdan Cheorpeaca, Dan Mischianu

Prostate cancer incidence varies more than 25-fold worldwide, largely due to the widespread practice of prostate specific antigen (PSA) testing and subsequent biopsy [1]. It is the second most frequently diagnosed cancer of men (914.000 new cases per year, accounting for 13.8% of total cancer cases) and the 5th most common cancer overall worldwide. The incidence is expected to grow to 1.7 million new cases and 499.000 deaths by 2030, mainly due to the growth and aging of the global population [2]. [...]

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Blood Pressure Control and Quality of Life in Hypertensive Patients Treated with Amlodipine/Valsartan Fixed Dose Combination...

2016-02

Blood Pressure Control and Quality of Life in Hypertensive Patients Treated with Amlodipine/Valsartan Fixed Dose Combination - IMPROVE Study Results

Oana Tautu, Irina Antohi, Viorica Pantelimonescu, Violeta Macovei, Elena Cristina Popescu, A. Stoica, Daniela Selaru, Diana Matura, Daniela Pantilie, Maria Dorobantu

High blood pressure is the world’s most common cause of death, estimated to affect at 4 out of 10 Romanian adults [1-3]. Despite the availability of a wide range of antihyper-tensive drugs, about 70% of treatment hypertensive pa-tients fail to achieve the blood pressure target of less than 140/90 mmHg recommended by the current guidelines [4,5]. In Romania, less than one quarter of treated hypertensive adults have a controlled blood pressure (less than 140/90 mmHg) [1-3,6,7]. [...]

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Is Vascularized Composite Allotransplantation a Suitable Reconstructive Option for Extensive Defects in Burned Patients?...

2016-02

Is Vascularized Composite Allotransplantation a Suitable Reconstructive Option for Extensive Defects in Burned Patients? Clinical and Immunological Evaluation Protocol

Andreea Grosu-Bularda, Serban Arghir Popescu, Razvan Teodoreanu, Liviu Cojocaru, Luana Lazarescu, Ioan Lascar

Vascularized composite tissue allotransplantation (VCA) is a recent reconstructive entity that bases on the restoration of deformity by the allotransplantation of a vascularised tissue unit with more components (skin, muscle, bone, cartilage, bone marrow, tendon, nerve). Since the field emerged with the first hand transplant performed in France in 1998, VCA showed a huge potential in replacement of extensive tissue defects and disfigurements (after burns, severe high energy trauma like gunshots, congenital facial malformations), offering a viable treatment option for injuries that involve multiple layers of functional tissue, impossible to repair using conventional surgical techniques, permitting restoration of extensive defects in just one stage procedure with good functional and aesthetic results. A significant number of those procedures have been reported worldwide for various anatomic locations including upper and lower extremities, face, tongue, trachea, larynx, abdominal wall, uterus and penis. These procedures are offered for quality of life and functional indications rather than life-saving indications [1-7]. [...]

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Can Complementary Feeding Patterns Influence Rapid Weight Gain in Infancy?

2016-02

Iulia Florentina Tincu, Cristina Becheanu, Daniela Păcurar, Radu Ciprian Tincu, Laurentiu Coman, Dumitru Oraseanu

Current knowledge based on large randomized con-trolled trials documented so far that early protein intake from milk products, in the first six months of life, is associated with various changes in later outcomes regarding body weight or body composition [1,2]. Beyond the exclusive milk nutrition period, complementary fe-eding practices are less investigated in terms of obesity appearance [3]. Macronutrients supply in early life, such as carbohydrates and fats, do not seem to be implicated in later childhood obesity [4], whereas protein supply is much more studied in the present [5]. Due to rapid weight gain and body size evolution in first 3 years of life, nutritional requirements are high, but exceeding some normal ranges leads to future disturbances. [...]

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The Analgesic Effect of 5-fluorouracil in Mice

2016-02

Smaranda Stoleru, Horia Paunescu, Aurelian Zugravu, Sorina Vasile, Oana Andreia Coman, Ion Fulga

Pain is defined by IASP (International Association for the Study of Pain) as an unpleasant sensorial and emotional feeling which is produced by an actual or potential tissue injury. Chronic pain management is currently a major public health challenge throughout the world, especially for patients with oncologic disorders. Data show that up to 90 percent of cancer patients suffer from pain during the course of their illness and 50-80 percent receive an inadequate pain management. [...]

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Burden of Clostridium Difficile Infection in Inflammatory Bowel Disease

2016-02

Alina Constantin, Madalina Ilie, Daniela Tabacelia, Bogdan Popa, Gabriel Constantinescu, Radu Tincu, Radu Alexandru Macovei

Inflammatory bowel disease (IBD), including Crohn’s disease (CD) and Ulcerative Colitis (UC), is characterized by chronic inflammation of the gastrointestinal tract. There is epidemiologic evidence that in patients with IBD, Clostridium difficile infection (CDI) occurs more frequently than in the general population and that these rates have been increasing over the past several decades. [...]

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The Role of Capsule Endoscopy in Obscure GI Bleeding: Experience of a Tertiary Center in Romania

2016-02

Lucian Negreanu, Ana Filimon, Ana Stemate, Theodor Voiosu, Bogdan Mateescu

Obscure gastrointestinal bleeding OGIB represents about 5% of those patients with gastrointestinal bleeding of any type. It is defined as persistent or recurrent bleeding of unknown origin (i.e., recurrent or persistent iron-deficiency anemia, positive fecal occult blood test, or visible bleeding) with a negative upper and/or lower gastrointestinal endoscopy. [...]

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Implications of Interleukins in Liver Fibrosis and Sustained Virological Response in Patients with Viral Hepatitis C

2016-02

Alexandra Floriana Rosu, Ovidiu Mircea Zlatian, Viorel Biciusca, Lucica Rosu, Rui Tato Marinho, Tudorel Ciurea

Hepatitis C virus (HCV) is a major cause of progressive hepatic disease with a high impact on human health worldwide. Patients with chronic hepatitis C have an increased risk of complications with need of hospitali-zation for different associated pathology. Liver fibrosis is correlated with high morbidity and mortality. Liver cirrhosis is frequently associated with anemia caused by gastrointestinal hemorrhage from esophageal varices or from angiodysplasia of the antrum. [...]

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Secrets Behind a Successful Career

2016-02

Stefan Hell

"Today, now co-responsible for the new generations of scientists, I often wonder whether the way in which science is organized sufficiently encourages young re-searchers to pursue unusual research topics." [...]

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Protocol for Fat Tissue Manipulation in Regenerative Treatment for Bilateral Coxarthrosis in Dogs

2016-01Dana Jianu, Gabriel Predoi, Iuliana Ionascu, Oltjon Cobani, Stefan Jianu, Andreea Nita, Mircea Ifrim

Hip dysplasia commonly leads to osteoarthrosis of the hip joint (coxarthrosis) and these two diseases are two of the most frequently encountered problems in veterinary practice. The available treatment modalities are varied and range from drugs to alleviate pain and inflammation to surgical techniques, such as hip replacement, and various physical therapy measures.

The research regarding therapy using adipose derived stem cells (ADSC) in veterinary medicine, started in 2002. Advances in understanding of the biology of adult stem cells have attracted the attention of the biomedical research community, including those studying osteoarthritis. (1) Autologous adult stem cells are immunologically compatible, can be harvested from a variety of sources, including bone marrow and adipse tissue (1), and have no ethical issues related to their use [...]

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External Postoperative Biliary Lithiasic Fistulae Associated with Choleperitoneum

2016-01Alec Cosmin Moldovan, Laurentiu Ungurianu, Mihaela Pricop, Mirela Debretin, Toba Madalina, Florin Dan Ungureanu, Vladimir Belis

Laparoscopic cholecystectomy is regarded as a safe procedure, which could allow only with great difficulty the possibility of unpleasant progression or intraoperative surprises [2]. Both findings are now able to allow in most cases an optimal therapeutic conduct and a most simple postoperative evolution, devoid of consequences.

But, however, even with diagnosis establishment and surgical indication with maximum precision, such as a very advanced surgical technique, surgery further reserves the right to not always provide nor pleasant, nor easy to solve surprises [...]

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Metachronous Cancers

2016-01Matei Bara, Georgia-Luiza Serbanescu, Toma Radu Valeriu, Rodica Anghel

According to GLOBOCAN, cervical cancer is the fourth most common cancer worldwide touching woman, with approximately around 500000 new cases and 266000 deaths in 2012; in Romania, cervical cancer is the second malignancy diagnosed in women. Cervical cancer is responsible for 7.5% from the whole female cancer deaths and 87% of these cases are encountered in the less developed regions of the world.

The more advanced is the stage of cervical cancer, the worse the prognosis is and the treatment in these cases is mainly palliative with an average survival period of only 7 years as observed in recurrent and/or metastatic cancer [...]

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Lipoma of the Proximal Forearm with Compression of the Superficial Radial Nerve

2016-01Roxana Maria Enescu, Alexandru Ioan Tomek, Marius Popescu, Ioan Lascar

Compressive neuropathies in the upper limb represent a common and admittedly more and more frequent pathology, given how certain peripheral nerves posess an inherent risk of becoming injured due to anatomical positioning. [14] Obesity rate increase and the ageing of population altogether suggest that compressive neuropathies in the upper limb will become even more frequent in the next decade. [14] The most common sign of nervous compression is the carpal tunnel syndrome, prevailing in approximately 3% of the general population, followed by the cubital tunnel syndrome, and finally the radial tunnel syndrome, which is quite rare. [9] [...]

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Worsening Renal Function in Elderly Patients with Heart Failure and Chronic Kidney Disease: An Update

2016-01Alice Balaceanu, Carmen Bogeanu, Razvan Dragomirescu, Camelia Diaconu, Gheorghita Aron, Ion Dina

Chronic kidney disease (CKD) is defined as either kidney damage or eGFR (estimated glomerular filtration rate) < 60 mL/min/1.73 m2 for three or more months [1]. Elderly patients have often an impaired basal renal function due to intrinsic renal disease or to a physiological decrease in the number of functional nephrons [2]. Half of adults over the age of 70 years have eGFR < 60 mL/min/1.73 m2 [3]. CKD occurs in about 4.5% of the general population and 50% in patients with chronic or acute heart failure (HF) [4]. Commonly, CKD can be associated with chronic heart failure in elderly patients [2] [...]

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Metabolic Syndrome - Cardiovascular and Metabolic, Complex, Difficult to Quantify Risk Factor

2016-01Radu-Valentin Coltuc, Victor Stoica

MS is a clinical and pathological entity, characterized by a cluster of related clinical, anthropometric and biochemical features such as abdominal obesity, hyperglycemia, dyslipidemia and hypertension. (1) The importance of MS results from the fact that its component factors increase cardiovascular risk (2), are a strong predictor of occurrence of type 2 diabetes (3), generate fatty liver (4) and also increase all-cause mortality. (5) [...]

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The Role of Echocardiography in the Surgical Management of Secondary Mitral Regurgitation

2016-01Sebastian Onciul, Vlad Vintila, Maria Dorobantu

Secondary mitral regurgitation (MR) also known as functional mitral regurgitation is more common, portends a worse prognosis than primary MR and its management is more difficult and less sustained by evidence. [1]The etiology of secondary MR may be ischemic or nonischemic such as in idiopathic dilative cardiomyopathy. The prognosis of patients with secondary MR is worse with increasing severity of MR.[2]

The mechanism of secondary MR is linked to the left ventricle (LV) geometrical remodeling with secondary tethering of the mitral leaflets, while the valve morphology is normal. [3][4] [...]

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Familial Isolated Pituitary Adenomas

2016-01Ionela Baciu, Serban Radian, Catalina Poiana

Pituitary adenomas (PAs) are the most frequent cause of cranial tumors [1,2], benign by histology but with high morbidity caused by their complications – hypersecretion of pituitary hormones but also compression of surrounding structures thus affecting the visual field or causing pituitary deficiency. Their etiology, although intensely studied in the last 30 years, is still largely unknown.

The natural evolution and the response to current treatment options of PAs (surgery, medication and radiotherapy) are very variable, influenced by various factors, some identified and some still to be found. Early diagnose and treatment is associated with better prognosis thus identifications of patients at risk for developing a PA and targeted follow-up would result in a better management of the disease [...]

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Integrated Multidisciplinary Diagnostic Service Using a Telemedicine Platform

2016-01Andrei Manu-Marin

The term of telemedicine involves the use of medical information sent between two or more sites via electronic communication means, having as an ultimate goal the improvement of patients’ clinical condition. After already four decades of development and practical use of this diagnostic and treatment modality, with demonstrations in hospitals extending their remote healthcare services, the use of telemedicine extended rapidly, now being integrated in different current operations in hospitals, specialty departments, home care agencies, private practice offices, and also in different workplaces or residential sites, benefiting nowadays of a variety (constantly increasing) of applications and services using bi-directional video broadcasts, e-mail services, smart phones, wireless devices and other forms of telecommunication technology. (1,2) [...]

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Importance of Nutritional Status in Treatment Response of Patients with Nasopharyngeal Carcinoma

2016-01Cristina Sanda, Irina Radu, Bogdan Popescu, Maria Alexandra Barbu, Codrut Sarafoleanu, Cornelia Nitipir

Nasopharyngeal carcinoma (NPC) is the most frequent type of malignant tumor of nasopharynx. It represents 2% of all upper aero-digestive tract cancers (1). There is no uniform geographic spread of NPC with the highest rate in Southern China (Guangdong Region) 20-50/100.000 inhabitants, then South-Eastern Asia, Eskimos population, Northern Africa and Middle East.

The incidence is higher in male gender than in women with a ratio of 2-3:1 (2). It has been observed in both high and low incidence areas [...]

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Cytostatic Therapy on Tumor Bearing Mice: Biochemical and Hematological Aspects

2016-01Laurentiu Anghelache, Bogdan Marinescu, Gheorghita Isvoranu, Dan Cringanu, Andrei Niculae, Ovidiu Bratu

The animals used in research as experimental models are selected for genetic, anatomical and physiological similarities. Rodents are the most representative experimental model; to emphasize this statement mice are used due to human DNA similarity (According to The Jackson Laboratory over 95% of the mouse genome is similar to our own, making mouse genetic research particularly applicable to human disease), simplicity in procurement, handling and short lifespan [1-3].

The purpose of this information is to help investigators who pursue an economical and efficient research that still allows the achievement of the study goals [4-7] [...]

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Urinary Leukotriene Level in Children with Asthma

2016-01Eugenia Buzoianu, Mariana Moiceanu, Oana Virban, Varvara Toma, Felicia Cora, Aurora Craiciu, Vlad Plesca, Ioana Grapinoiu, Doina Anca Plesca

Asthma is a chronic inflammatory disease of the airways and it represents a major cause of morbidity and mortality, having a rising incidence in the entire world (1).

The physiopathological features of asthma are chronic inflammation of the bronchial mucosa and bronchial hyperreactivity which is expressed as bronchoconstriction in response to various triggers (2) [...]

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Blood Lead Levels and Oxidative Stress

2016-01Radu Ciprian Tincu, Dana Tomescu, Laurentiu Coman, Radu Alexandru Macovei

Environmental lead sources are represented by air, soil, food, water. Lead distribution in the environment continues to be a worrying public health issue considering its potential cumulative effects in the body due to various routes of exposure. Once exposed to lead, individuals have persistent elevated blood levels because of redistribution from bones sanctuaries, even years after cessation of exposure. Oxidative stress seems to play an important part regarding lead adverse effects, because the metal is responsible for reactive oxygen species (ROS) production and it also might inhibit antioxidants levels [...]

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Obesity-Related Comorbidities: One Actress, Multiple Scenes

2016-01Camelia C. Diaconu, Giorgiana Dediu

Obesity is a chronic disease, with increasing incidence and prevalence in Europe and United States, not only in adults, but in children and adolescents too. Worldwide, mean BMI is increasing, 36.9% of men and 38% of women being estimated as having a BMI ≥25 Kg/m2 (1,2).

In 1997, the World Health Organization declared obesity as a major public health problem and a global epidemic [...]

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Left Atrial Structural and Functional Remodeling in Hypertensives - An Echocardioghraphic Study

2016-01Ioana Petre, Adriana Alexandrescu, Silvia Iancovici, Sebastian Onciul, Oana Florentina Tautu, Maria Dorobantu

Arterial hypertension (HTN) is a common cardiovascular pathology that usually complicates with cardiac dysfunction. HTN alters atrial dynamics significantly, leading to left atrial (LA) morphological and functional abnormalities.

Echocardiography proved to be an adequate method of evaluation of LA remodeling, by its means of assessing with accuracy LA size, volumes and its multiple functions [...]

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Obstructive Jaundice of Malignant Origin

2015-04

Claudiu Turculeț, Bogdan Popescu

Obstruction of the billiary tree caused by a malignant tumor of the head of the pancreas, of the extrahepatic bile ducts or of the ampula of Vater it seems to become more frequent in Romania. Our country places 10th in the incidence and 9th in mortality in Europe for pancreatic cancer in male patients[1]. Unfortunately most of the patients are not suited for a curative surgical treatment at the moment of the diagnosis.

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Posterior Pelvic Exenteration for Atypical Recurrence after Surgically Treated and Irradiated Endometrial Cancer

2015-04

Nicolae Bacalbașa, Irina Bălescu

Endometrial carcinoma is the fifth most common malignancy in women worldwide and the most common gynaecologic cancer in developed countries, being associated with increased fat consumption, obesity and exposure to unopposed estrogens (1,2,3). Endometrial cancer is usually diagnosed in an early stage of the disease; up to 75% of cases are diagnosed in stage I of the disease and are associated with good long term prognosis.

Unfortunately, it is estimated that in time 13% of cases diagnosed with endometrial cancer will develop recurrence, in these cases the mortality rate being up to 25% (4,5). Once the recurrent disease is diagnosed, the main therapeutic options include chemotherapy for distant or widely metastatic recurrence, radiotherapy for small, isolated pelvic recurrences especially if the patient had not been submitted to radiation therapy previously and resection for cases presenting localized centro-pelvic recurrence (6-8). However, most patients experiencing pelvic recurrence within the first three years after the initial diagnosis are diagnosed with vaginal vault relapse, in these cases total colpectomy or even pelvic exenteration being required (7,9,10).

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Intraoperative Monitoring of the Recurrent Laryngeal Nerve During Thyroidectomy

2015-04

Răzvan Hainăroșie, Octavian Ceachir, Mura Hainăroșie, Irina Ioniță, Cătălina Pietroșanu, Carmen Drăghici, Viorel Zainea

Following thyroidectomy, the preservation of the recurrent laryngeal nerve is the gold standard. Visual identification of the recurrent laryngeal nerve is mandatory during thyroidectomy. That technique has decreased the rate of permanent palsy during thyroid or parathyroid surgery (1). However, the palsy can occur when using only the visualization of the nerve, even in experienced hands (2).

Intraoperative nerve monitoring is a common technique in ear surgery, used to permanently monitor the facial nerve. This technique can be used in the thyroid surgery as well. Intraoperative neuromonitoring of the recurrent laryngeal nerve represents an adjuvant technique, until the visual identification and functional confirmation of the nerve.

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Controversies and challenges of chronic wound infection diagnosis and treatment

2015-04

Mara Mădălina Mihai, Călin Giurcăneanu, Liliana Gabriela Popa, Cornelia Nițipir, Mircea Ioan Popa

Over the last decade, chronic wounds such as venous or arterial ulcers, diabetic foot ulcers, pressure sores, and non-healing surgical wounds were brought into the spotlight of the medical community, due to their increasing prevalence and to their significant economic burden (1). In developed countries billions of dolars are spent each year (2,3) for the repeated hospitalizations and expensive treatment of patients suffering from non-healing ulcers. The persistent pain, either spontaneous or induced by treatment (4), the malodour of the ulceration (5), the mobility restrictions (6), and the excessive exudate, significantly impair the patients` quality of life, who might also experience secondary mood disorders (50-75%) (6) or sleep disorders (69%) (7).

The persistent bacterial colonization of the wound, as well as the longterm use of antibiotics predispose to the development of nosocomial infections with resistant strains such as methicillin resistant Staphylococcus aureus (MRSA), extended spectrum beta-lactamases (ESBLs) producing micro organisms, and multiple antibiotic resistant Pseudomonas aeruginosa(8).

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Alternative Pathways of Delivering Cardiac Resynchronization Therapy: A Single Center 10 Year Experience on 400 Consecutive...

2015-04

Alternative Pathways of Delivering Cardiac Resynchronization Therapy: A Single Center 10 Year Experience on 400 Consecutive Patients

D.A. Radu*, R.G. Vătășescu*, C. Iorgulescu, Ș. Bogdan, E. Ene, A. Năstasă, M. Dorobanțu

Heart failure (HF) can be either induced or aggravated by the existence of left ventricular (LV) intraventricular dyssynchrony (IVD). Cardiac resynchronization therapy (CRT) can potentially correct LV-IVD in well-characterized populations (see current Guidelines). CRT has demonstrated clear benefits in both soft (NYHA class, 6MWT, QoL) and hard (all cause mortality, 6 months hospitalizations) randomized control trial (RCT) endpoints. The standard approach is to deliver a unipolar (UP)/bipolar (BP) dedicated LV-lead via the coronary sinus (CS) into a postero-lateral (PL) tributary vein.

Suboptimal LV-lead positioning has been long recognized as an important cause of CRT non-response. Optimal, delay targeted LV-lead placement might sometimes only be possible with non-standard techniques due to various patient particularities. We decided to retrospectively evaluate the frequencies and types of techniques we used in over a decade of CRT experience in our centre. "Alternative CRT" is not yet a coined term. We defined unexpendable variations from the straightforward technique as alternative pathways of delivering CRT.

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Peripheral Arterial Disease in Hemodialysed Patients

2015-04

Ileana Peride, Daniela Rădulescu, Andrei Niculae, Alice Bălăceanu, Ileana Adela Văcăroiu, Ruxandra Diana Sinescu, Ionel Alexandru Checheriță

There is increased evidence that the prevalence of peripheral artery disease (PAD) in hemodialysed patients is higher than in general population [1,2]. According to ACC/AHA (American College of Cardiology / American Heart Association) guidelines, the following risk factors are associated with PAD [3,4]

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The Rehabilitation of Elderly Institutionalized Patients with Osteoarthritis (Multiple Joint Involvement) Using...

2015-04

The Rehabilitation of Elderly Institutionalized Patients with Osteoarthritis (Multiple Joint Involvement) Using Alternative Methods Associated to Drug Therapy

Mircea Ovidiu Lupușoru, Claudia-Camelia Burcea, Ileana Adela Văcăroiu, Silviu Pițuru, Ileana Peride, Iulian Brezean, Lucian Negreanu, Andrei Niculae, Luminița Georgescu, Gabriela Elena Lupusoru, Teodora Ionescu, Dumitru Ferechide

Osteoarthritis, as a major cause of disability and due to the high prevalence among chronic diseases, represents one of the most important public health problems worldwide [1]. The limitation of physical function and the restriction of independence produce negative effects on the mental status of patients suffering from osteoarthritis, namely the emergence of depression and decreased self-confidence [2,3].

Developing a kinesiotherapeutic strategy based on the clinical, anatomical and functional stage of the disease and other comorbidities, as well as exploiting psychological and psychopedagogical resources will improve the physical performance and increase the independence of these patients [4,5].

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Identification of Osteoarthritis with Multiple Joint Involvement in Elderly Institutionalized Patients Concomitant with...

2015-04

Identification of Osteoarthritis with Multiple Joint Involvement in Elderly Institutionalized Patients Concomitant with Psycho-Kinesiotherapeutic Intervention Strategies - A Preliminary Study

Claudia-Camelia Burcea, Mircea Ovidiu Lupușoru, Lucian Negreanu, Ileana Adela Văcăroiu, Silviu Pițuru, Andrei Niculae, Iulian Brezean, Ileana Peride, Luminița Georgescu, Gabriela Elena Lupușoru, Dumitru Ferechide

Related to the rehabilitation of patients with osteoarthritis, kinesiotherapy addresses the methods, procedures and methodology that will be used depending on the anatomic, functional and clinical stage of the disease and its location after setting treatment goals. Furthermore, priorities of the rehabilitation program are established considering both medical issues and also paramedical and social aspects [1].

The kinesiotherapeutic opera tional strategy in rehabilitating patients with osteoarthritis is planned according to the characteristic comorbidities of elderly patients [2]. Clinical trials highlight that cardiovascular mortality is reduced when sedentary individuals become moderately active [3,4].

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Three Paediatric Cases Study with Over 80% TBSA Burn Injury - Surgical Treatment by Using Skin Allografts: A Viable Option...

2015-04

Three Paediatric Cases Study with Over 80% TBSA Burn Injury - Surgical Treatment by Using Skin Allografts: A Viable Option for Alternative Cover

Cristina A. Avram, Dan M. Enescu, Dan Ionita

Burn is the most severe type of injury that a human being may suffer which can be quantified and evaluated by surface and depth of lesions. Treatment of this kind of injuries needs complex teams, competent and devoted, consistent therapeutic principles, specific conditions of care and specific funding.

In full thickness burns, deep partial burns on important functional area (hand, foot, periarticular regions) and burns up to 40% TBSA, predominantly deep, surgical treatment consists in early excision and grafting, which improve prognosis compared to the burned area and also cosmetic and functional results.

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Telemedicine as an Alternative Model for Delivering Healthcare Services: Preliminary Results of the MultiMED Project

2015-04

Andrei Manu-Marin

According to the formal definition of the profile American association, the term of telemedicine involves the use of medical information sent between two or more sites via electronic communication means, having as an ultimate goal the improvement of patients’ clinical condition.

After already four decades of development and practical use of this diagnostic and treatment modality, with demonstrations in hospitals extending their remote healthcare services, the use of telemedicine extended rapidly, now being integrated in different current operations in hospitals, specialty departments, home care agencies, private practice offices, and also in different workplaces or residential sites, benefiting nowadays of a variety (constantly increasing) of applications and services using bi-directional video broadcasts, e-mail services, smart phones, wireless devices and other forms of telecommunication technology.

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Advanced Genital Prolapse - Mesh Surgical Treatment

2015-04

O. Bratu, I. Oprea, D. Spînu, B. Geavlete, C. Farcas, V. Calu, A. Niculae, D. Mischianu

Genital prolapse is a frequent pathology in women associated with different urological and gynecological complications affecting women `s normal life [1].

It is defined as pelvic organ slipped from their anatomical position through vagina. The pelvic structures which might slip are uterus, bladder, rectum, small intestine or vaginal vault. Each one of these benefits of a specific surgical procedure [1].

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Parathyroid Hormone-Related Bone Loss in End-Stage Renal Disease: Where to Measure?

2015-04

Dan Niculescu, Roxana Dusceac, Andra Caragheorgheopol, Gener Ismail, Catalina Poiana

Renal osteodystrophy is almost universally found in patients with end-stage renal disease (ESRD). Although bone biopsy is the gold standard for assessment of bone status it is infrequently used.

Guidelines (KDIGO, 2009) recommend the use of dual-energy X-ray absorptiometry (DXA), as a method for measuring bone quantity, in all dialysis patients who either have had fractures or have risk factors for osteoporosis but state against routine use of DXA for bone mineral density (BMD) measurement. This is because low BMD measured by DXA was consistently associated with an increased risk of low trauma fractures in general population but in patients with ESRD studies produced conflicting results (Inaba et al., 2005; Jamal et al., 2002; Kaji et al., 2002; Urena et al., 2003; Yamaguchi et al., 1996). There are many causes of this heterogeneity including secondary hyperparathyroidism, presence of low bone turnover disease, osteomalacia, site of BMD measurement or fracture assessment (clinical vs. radiological).

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Transoral Approach of the Parapharyngeal Tumors

2015-04

Andreea Sorică, V. Zainea, Octavian Ceachir, Irina-Gabriela Ioniță, Cătălina Pietroșanu, Carmen Drăghici, Cristina Zamfir, Răzvan Hainăroșie

Parapharyngeal space has the shape of a reversed pyramid with the base at the cranial surface delimited by temporal and sphenoid bone and and the top pointing to the large horn of the hyoid bone.[1] Styloid diaphragm divides the parapharyngeal space into two regions with different anatomy and constituents: prestyloid space, anterior, conta-ining the deep lobe of the parotid gland, internal maxillary artery, inferior alveolar nerve, lingual, auriculo-temporal, and retrostyloid space, posterior, neurovascular, that contains the internal carotid artery, internal jugular vein, cranial nerves glossopharyngeal, vagus, accessory, hypoglossal and cervical sympathetic chain. [2]

Tumors arising in parapharyngeal space are rare, representing less than 1% of all head and neck malignancies. Any of the structures contained in this space can be a starting point for developing a tumor masses at this level. Most of these tumors are benign, approximately 20% are malignant. [1] The most common tumors of the salivary gland tissue derived from space and are epithelial in nature. Others are likely neurogenic, vascular, lymphatic, etc. [3]

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The Benefit of Breast Reconstruction after Mastectomy

2015-04

Iulia Mihaela Iacob, Crenguța Coman, Ruxandra Mihai, Dragoș Zamfirescu, Șerban Dumitrache, Ioan Petre Florescu, Carmen Giuglea

Being diagnosed with breast cancer means that the involved patients are dealing with a new phase in their lives. We can say that their priorities change radically. A study from 2011 shows that the leading cause of cancer deaths, in women, in developing countries, is breast cancer, compared to the past decade where the main cause was the cervical cancer. (1)

Up to accepting the diagnosis and regaining the strength to move forward, women go through frustration, denial, guilt, feelings exacerbated by physical mutilation (mastectomy) which they have to deal with this disease. Breast cancer is the most commonly diagnosed cancer and the main cause of cancer death among females, representing 23% of total cancer cases and 14% of cancer deaths. (1)

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Age-Dependent Prevalence of Persistent Wheezing Phenotypes in Romanian Children

2015-04

Marius Cornitescu, Gabriel Mircescu, Mariana Moiceanu, Eugenia Buzoianu, Andrei Zamfirescu, Marcel Plesca, Doina Anca Plesca

Asthma is a heterogeneous group of disease entities with common characteristics such as intermittent respiratory symptoms (wheezing, tightness, cough, dyspnea), reversible airway obstruction and bronchial hyperresponsiveness [1]. Wheezing, caused by airflow restriction through narrowed airways, is the main clinical sign associated with asthma.

Two concepts related to asthma are currently in a process of disentanglement: the concept of asthma phenotypes (particular clinical characteristics, without reference to the underlying pathologic process) and endotypes (pathological mechanisms of disease) [2]. The disentangling of asthma phenotypes and endotypes is important for the prediction of disease evolution and for accurate therapeutic action.

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Economic Impact of Early Detection and Treatment of Skin Cancer on the Health Care System

2015-04

Laura Raducu, Diana Ruxandra Sinescu, Cristina Nicoleta Cozma, Iulia Cristina Filip, Cristian Radu Jecan

Non-melanoma skin cancer (NMSC) ranks as the fifth most costly cancer to treat in the United States even though the mortality rate is not high [1].

In Romania, the dermatologist is the one who generally detects skin cancer, but any clinician, especially the primary care physician who has a constant connection with the patient, plays an important role in skin cancer detection. In the early detection stage, a good collaboration with the plastic surgeon permits the surgical excision of the tumour with oncologic safety margins and primary suture, resulting in minimal costs [2]. Unfortunately, a great number of patients involved in our study (>84%) showed up in more advanced stages which required a reconstructive method.

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Modern Diagnostic Approach of Acute Lymphoblastic Leukemia in Children and Adolescents...

2015-04

Modern Diagnostic Approach of Acute Lymphoblastic Leukemia in Children and Adolescents - Experience of a Single Pediatric Hematology-Oncology Center

Claudia Dita, Anca Colita, Mirela Asan, Anca Gheorghe, Constantin Arion

Acute lymphoblastic leukemia (ALL) is the most frequent malignancy in children, representing 25% of all the neoplastic diseases in people younger than 15 years [1].

The peak of incidence is between ages 2 and 3 years [1]. In adolescents (15 to 19 years), ALL comprises only 7% of all cancers [2]. In the United States, it is estimated that 2500 - 3500 children are diagnosed with ALL every year [1]. The incidence appears to be increasing. In Europe it was reported a 1.4% increase in incidence from 1970 to 1999 [3].

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A History of an Old and Still New Disease: Urinary Lithiasis

2015-04

Dan Mischianu, Dan Spinu, Cătălin Pricop, Ovidiu Bratu

We believe that with the apparition of the first settlements and the act of eating also appeared the first potentially urinary lithiasis patients.

One of the "leading minds"[1] of the twentieth century, Margaret Mead (1901-1978) (fig. 1), renowned anthro-pologist used to say "it is easier to change a nation religion rather its eating habits".

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Response to Chemotherapy of Paraneoplastic Erythroderma in a Patient with Ovarian Cancer

2015-03

Cornelia Nitipir, Liliana Gabriela Popa, Maria Alexandra Barbu, Irina Radu, Mara Mihai, Calin Giurcaneanu

Erythroderma is an uncommon potentially fatal skin disorder first described by Hebra in 1868. Erythroderma is a definitive term that refers to generalized erythema and desquamation affecting 90% of the body surface. It usually occurs in individuals older than 40, except when the subjacent disease is atopic dermatitis, seborrheic dermatitis or hereditary ichthyosis [1,2]. Erythroderma represents a reaction pattern, a maximal form of skin irritation that may be secondary to certain cutaneous diseases, drug reactions, infections, solid or hematological malignancies, and other conditions. In the absence of a suggestive history, the clinical and histopatho logic distinction between the underlying causes is often problematic and determining the specific etiology is very challenging, an important proportion of cases being classified as idiopathic erythroderma.

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Enhancing the Patency Rates for Native Arteriovenous Access for Dialysis: A Classical Two-Step Superficialization of a Deep...

2015-03

Enhancing the Patency Rates for Native Arteriovenous Access for Dialysis: A Classical Two-Step Superficialization of a Deep Brachiocephalic Arteriovenous Fistula in a Normal Weight Patient

I.A. Checheriță, M. Elfarra, I. Peride, C. David, A. Niculae, M. Găvănescu, A. Ciocâlteu, R.D. Sinescu, I. Lascăr

Native arteriovenous fistulae (AVF) are the best options for chronic hemodialysis (HD) access. Unfortunately, not every patient fulfils the requirements necessary for this type of vascular access: the artery and the vein implicated in dialysis fistula creation must accomplish some criteria which makes them suitable for this procedure. If these criteria are not fully met, the chances to a successfully intervention and a quick and qualitative maturation of the fistula are dropping [1-5]. An artery that is suitable for AVF creation has an inner diameter > 2 mm, optimal initial flow and elastic walls allowing dilatation to accommodate a supplementary 10 - 20 fold blood flow increase after the AVF is performed [1,2,5-11]. The participating vein must be superficial enough (less than 5 mm from the skin surface), wide enough (a caliber bigger than 2.5 mm) and its walls must allow important dilatation (without fibrosis, injuries, and thickenings). In elderly, diabetics or patients with late initiation of HD some of these demands are frequently absent; we need to adapt surgical procedures, taking advantage of any oppor tunity to overcame shortcomings and create a native dialysis access [1,2,5,9].

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Technical Challenges of Laparoscopic Cholecystectomy in Patients with Cholestasis

2015-03

Sorin Păun, Ioan Tănase, Ionuț Negoi, Bogdan Stoica, Mircea Beuran

Although mainly asymptomatic, patients with biliary gallstones frequently associate common bile duct (CBD) stones. A percent ranging between 10-18% (1,2) from the patients that underwent cholecystectomy for gallbladder stones associate CBD lithiasis. The presence of CBD stones can be anticipated in the presence of jaundice, cholangitis, pancreatits, with altered hepatic function, or directly identified by imagistics (3). The percentage of preoperative undiagnosed CBD reaches almost 25% even for the newest imagistics (4). Acute cholecystitis is the most common infectious complication of gallstones, occuring with a frequency of 6-11% for the patients with 7-11 years of symptomatic gallstones (5). Recent studies are showing indirect signs of CBD stones in 37.7% of patients with acute cholecystitis, these signs being noticed for 72 % of patients with prooved choledocholithiasis (6).

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Arterial Hypertension and Cognitive Decline Is it More than Pure Coincidence?

2015-03

Elisabeta Bădilă, Emma Țintea, Daniela Bartoș

The life-span increase recorded during the past decades across the global population has led to an increase in the number of people suffering from dementia. Recent analyses have estimated the worldwide number of people living with Alzheimer’s disease (AD) and dementia at between 27 million and 36 million, and projections by Alzheimer’s disease International estimate that 115 million people worldwide will be living with AD/dementia by 2050, less developed countries being more affected by these rising numbers(1). Alzheimer’s disease is the most prevalent form of dementia - 60-70% cases, while vascular dementia accounts for another 25% of cases(2). Alzheimer’s disease is a neurodegenerative pathology associated with the intraneuronal accumulation of hyperphosphorylated proteins and with the extracellular aggregation of β amyloid precursors(3). These structural modifications lead to a metabolic cascade responsible for neuronal death and, subsequently, dementia.

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Experimenting on LAB Rodents - Ethical Principles

2015-03

Elena-Rodica Dragu, Bogdan Liviu Chioaru, Ioana Teona Sebe, Ioan Lascăr, Oana Andreia Coman2

People have reported themselves differently regarding different species of animals and had different reactions about the animal species. The attention paid to them depends on the role held by them in human life, either as pets or as a method of entertainment, either as research subjects.

Some species enjoy privileges as pets (dogs cats, birds, turtles), others are used to satisfy human native instincts as hunting animals.

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Epstein Barr Virus and Cytomegalovirus in Prostate - A Controversial Subject

2015-03

D. Spînu, O. Bratu, A. Aungurenci, D. Marcu, C. Ursaciuc, G. Isvoranu, I. Peride, A. Niculae, D. Mischianu

Epstein-Barr virus (EBV) is a member of the Herpes Virus family and is also known as Human Herpes Virus 4. The virus was first isolated in 1964 by the British virologists Michael Anthony Epstein and Yvonne Barr, on a cell line derived from a Burkitt lymphoma. EBV infection is especially common in young individuals with low hygiene standards and also low social and economic status. Thereby it is considered that until the third decade of life, around 80 - 100% individuals have become carriers of infection [1,2]. Although EBV is considered to be a lymphotropic B virus, it can also infect T and NK lymphocytes or some epithelial cells, as it has beenfound in T cell lymphomas, stomach, nose, andthroat carcinomas [2]. The most common host cellfor EBV is B lymphocyte, although in some cases the virus can also be detected in epithelial cells. The role of epithelial cells is likely to permit the replication and amplification of EBV persistence than that of the latent infection [3].

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An Overview of Advanced Multimodal Imaging Techniques in Low Grade Gliomas

2015-03

D. Mariș, A. Mohan, H. Moisa, Alexandru Vlad Ciurea

Diffuse infiltrative low-grade gliomas (LGG) of the cerebral hemispheres in adults are a group of tumors with distinct clinical, histological and molecular characteristics. The management of such tumors is still controversial. (1)

In LGG neuroimaging plays a crucial role. Starting of a "watch and wait" management plan has been frequently based solely on imaging. Conventional MRI is a valuable method in conducting a differential diagnosis, assisting surgery, planning radiotherapy and surveying treatment response, but it focuses on structural changes within tumours and often provides limited information only.

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The Additive Value of 2D Longitudinal Strain During Stress Echocardiography in Coronary Artery Disease Detection in Low Risk...

2015-03

The Additive Value of 2D Longitudinal Strain During Stress Echocardiography in Coronary Artery Disease Detection in Low Risk Acute Coronary Syndrome - A Pilot Study

Roxana Onuț, Sebastian Onciul, Cristina Marinescu, Diana Zamfir, Maria Dorobanțu

Approximately 20% of patients arriving in the crowded emergency departments (ED) present with acute chest pain (ACP) and 60% are admitted in order to rule out an acute coronary syndrome (ACS). In the latter category, the ACS is confirmed only in 15% of patients thus resulting in a huge number of unnecessary admissions and wasted resources. (1) Stratifying ACP as low, moderate or high risk ACS allows physicians to take immediate action, initiate treatment and transfer the patient to the appropriate location.

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Problems with the Monitoring of Patients with Colonic Polyps

2015-03

Csongor Toth, Mircea Ifrim, Ovidiu Hategan, Cris Precup, Gyori Zsolt, Ovidiu Bulzan

Colorectal neoplasm ranks third in incidence and 4th among the most common causes of cancer death worldwide. In Romania, Arad, of all digestive cancers, colorectal cancer is the No. 3, both in incidence - in both men and women - and mortality. Colorectal cancer incidence is estimated to be 10.1 / 100,000 inhabitants in men and 7.3 / 100,000 inhabitants in women.

This paper is a retrospective statistical study, carried out over a period of 5 years. This study includes the monitoring of patients recorded with colonic polyps, within the area of 4 family physician practices. This study was conducted because there was a decrease of addressability (adherence) of patients recorded with having colonic adenomatous polyps. (1)

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Particularities and Surgical Treatment of Constriction Band Syndrome Syndactyly, in Children

2015-03

Doina-Iulia Nacea, Dan Mircea Enescu, Simona Ioana Stoicescu, Raluca Teodora Tatar

Constriction band syndrom syndactyly is a sporadic condition, that may be present in association with other congenital anomalies such as musculoskeletal (including total amputation of the limb), craniofacial (like cleft lip and cleft palate) and thoraco-abdominal disorders (such as gastroschisis and extrathoracic heart), neural tube defects, scoliosis and hemangiomas (1, 2, 3, 4, 5, 6). Some of these manifestations are uncommonly noted at birth because they result in spontaneous abortion.

There are two main theories about constriction band syndrome etiology, the first of which is the intrinsic theory proposed by George Streeter, the director of embryology at Carnegie Institute, in 1930 which is called, "Streeter’s Dysplasia". Streeter suggested that an intrinsic defect in the subcutaneous germplasm resulted in focal mesenchymal hypoplasia, tissue loss, and scarring (7, 8).

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The Distally Based Superficial Sural Artery Angiosome Flap Concept: Anatomy, Indications, Surgical Technique, Results...

2015-03

The Distally Based Superficial Sural Artery Angiosome Flap Concept: Anatomy, Indications, Surgical Technique, Results, Complications and Technical Aspects to Minimize Complications

Cristian Radu Jecan, Viorel Goleanu, Laura Răducu, Luminița Tomescu, Daniel Hernic, Ioan Lascăr

Located between the popliteal fossa and the midportion of the calf, centered over de midline raphe, between the medial and lateral heads of the gastrocnemius muscle, the sural flap is the best known neurocutaneous flap of the leg. [1,2]

The sural angiosome was first introduced in practice by Ponten in 1981, when he reported the use of 23 fasciocutaneous proximally based flaps for soft tissue defects.[3] Donski and Fogdestam described the anatomy of the distally based sural flap and presented three clinical cases in 1982. [4]

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The Evolution of Electrocardiographic Changes after Revascularization Therapy in Patients with ST Segment Elevation...

2015-03

The Evolution of Electrocardiographic Changes after Revascularization Therapy in Patients with ST Segment Elevation Myocardial Infarction

Magda Ruxandra Zaharia, Oliviana Geavlete, Alice Brînzea, Oana Tăutu, Gheorghița Aron, Ioan Tiberiu Nanea

Despite the advanced technologies, the 12 leads electrocardiogram (ECG) remains an important investigation modality for providing a fast diagnostic of acute coronary syndromes (ACS). This method offers data concerning the presence, extension and severity characterizing the ischemic process (1). The ECG interpretation is still essential during the initial evaluation of patients admitted for ischemia suggestive symptoms (2).

Moreover, being a cheap, non-invasive and accessible technique, ECG continues to represent the gold-standard alternative for the differential diagnostic, for determining the appropriate treatment approach, for selecting patients susceptible of benefiting from reperfusion as well as regarding risk stratification (1).

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Predictive Factors for Native AVF Complications in Dialysis Patients - A Prospective Study in a Public Hemodialysis Center

2015-03

Mazen Elfarra, Cristiana David, Ileana Peride, Andrei Niculae, Alexandru Ciocâlteu, Ruxandra Diana Sinescu4, Ionel Alexandru Checheriță

The prevalence of end stage renal disease (ESRD) is constantly increasing in worldwide population, as is the necessity of renal replacement therapy [1-3]. The improvements in dialysis techniques determined increasing quality and lifetime of dialysis patients and the need for a reliable vascular access that sustains the procedure for long periods of time. On the other hand, the progressive aging of dialyzed population and the emerging complications, as well as the rising prevalence of diabetes as a cause for chronic kidney disease (CKD), hampers the processes of obtaining and maintaining an adequate vascular access [1,4,5].

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Mesenchymal Stem Cells - What is in the Name?

2015-03

Alt Eckhard

Since more than 40 years ago Friedenstein first described cells derived from bone marrow stroma that were plastic adherent and had the ability to differentiate into other lineages, our knowledge about stem cells has constantly been growing over the last decades.

Nearly 10 years ago a definition was given by Dominici et al describing Mesenchymal Stem Cells as being plastic adherent, expressing CD73, CD90, CD105 and having the ability to differentiate into osteoblasts, adipocytes and chondrocytes. Since this time the expression "Mesenchymal Stem Cells" has been used to describe what we believe are multipotent cells.

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Talking About Malpractice: A Possible Future Case

2015-02

Dan Mischianu, Ovidiu Bratu, Alexandru Aungurenci, Dragos Marcu, Agnes Ciucă, Robert Popescu, Dan Spînu

The medical profession is certainly there for thousands of years, the first documented therapeutic methods being used since prehistoric times. Although to date there has been significant advance in this area, current treatments are not infallible, which means that in medical practice there are certain errors. Sometimes patients may interpret these errors as malpractice, accusing the physician with certain charges related to his work, or rather the lack of his work.

In terms of ethical norms, the Medical College of Physicians in Romania’s Code of Ethics has been prepared in accordance with the Geneva Declaration issued in 1948 and has a complementary legislative role stated above, the purpose of regulating the fundamental principles of professional conduct for doctors. All these laws are meant to guide medical staff attitudes in clinical practice and are relevant in a medical malpractice case.

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An Unusual Presentation of Primary Cutaneous Aggressive Epidermotropic CD8+ T Cell Lymphoma

2015-02

Mihai Lupu, Vlad Voiculescu, Laura Papagheorghe, Cornelia Nițipir, Ana Maria Neagu, Liliana Gabriela Popa, Călin Giurcăneanu

Primary cutaneous aggressive epidermotropic CD8+ T cell lymphoma is an extremely rare type of cytotoxic lymphoma reported for the first time by Berti et al. in 1999, (1) who described the tumor as a distinct clinico-pathologic entity with an aggressive clinical course. It presents as widespread, rapidly evolving papules, plaques, and tumors, often showing central necrosis and ulceration, histologically characterized by epidermotropism of CD8+ CD4- T cells. The condition has an increased tendency of spreading to extranodal sites, usually responds poorly to conventional therapies for classic CD4+ cutaneous T cell lymphomas (CTCLs), and has an unfavorable prognosis. (1-4)

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Cytoreductive Surgery for Peritoneal Carcinomatosis from Endometrial Cancer - A Case Report and Literature Review

2015-02

N. Bacalbașa, C. Anghel, I. Barbu, I. Dudus, M.I. Ionescu, M. Pautov, M. Motthor, Irina Bălescu, V. Brașoveanu

Endometrial cancer is one of the most common malignancies of the genital tract in women, with an increasing incidence in the last few years. The reported incidence in the United States surpassed 40.00 cases/year while the death rate reached almost 7500 deaths/year (1,2). The most important prognostic factors are thought to be diabetes, estrogen secreting tumors, nulliparity and the higher number of overweight persons (2). While up to 70% of patients are diagnosed in an early stage of the disease and report an excellent outcome (5 year overall survival of 90%), patients diagnosed in an advanced stage of the disease have a poor prognosis associated with low rates of survival - 67% and 23%, respectively, for cases with regional or distant disease (3). However, in these cases it seems that an aggressive surgical approach similar to the one performed in advanced ovarian cancer is perfectly justified (2,4).

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Histopathology and Forensic Diagnostics Difficulties in a Patient with Multiple Affections and Double Cranio-Cerebral Injuries

2015-02

Cris Precup, Mircea Ifrim, Ovidiu Bulzan, Csongor Toth, Gyori Zsolt, Hategan Ovidiu

This paper is a case presentation. This case was chosen because it presented several problems with indicating, with certainty, the cause of death and therefore establishing the tanato-generating mechanism. The patient is a female from the rural environment who dies after a hospitalization (03 March 2013) in the Clinical Emergency Hospital in Arad, Department of Neurology. The patient is admitted through the emergency unit due to a cranio-cerebral trauma in the left parietal-temporal region, assisted respiratory failure and second degree coma.

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Treatment Management of Bilateral Lower Eyelids Basal Cell Carcinomas with Total Lower Eyelid Reconstruction

2015-02

L. Răducu, R. Jecan, C. Cozma, D. Hernic, I. Lascăr

Basal cell carcinoma (BCC) is known as the most common type of skin cancer with a rapidly rising incidence, 90 % of the cases occurring in the head and neck region. (1) The eyelids are involved in 10% of these cases, making it the most prominent eyelid malignancy. (2)

It predominantly affects fair-skin individuals, notably type I and II Fitzpatrick photo types, most of them presenting with a positive history of chronic sunlight exposure. Etiology may be multifactorial, but sun exposure has been involved in most of the cases. (3) Basal cell carcinomas arise from the basal layer of the epidermis, probably as a result of activating the proto-oncogenes and inactivating the suppressor genes in the keratinocytes. (4)

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Gastrointestinal Angiodysplasia in Patients with Chronic Kidney Disease and Hepatic Cirrhosis

2015-02

A. Niculae, A.-E. Balcangiu-Stroescu, Ileana Peride, I. A. Checheriță, M. Jinga

Angiodysplasia (AD), gastric antral vascular ectasia (GAVE or watermelon stomach), radiation-induced vascular ectasia and Dieulafoy's lesions are considered sporadic lesions and they can induce gastrointestinal bleeding (1). AD is the most common vascular abnormality of the gastrointestinal tract, probably the most common cause of recurrent gastrointestinal hemorrhage in patients with renal failure (2) and an important cause of erythropoiet-inresistant anaemia in dialyzed patients. Angiodysplasia injuries developed in the gastric antrum were first described in 1953 and named GAVE, being characterized as submucosal capillary dilatation and fibromuscular hyperplasia (3).

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Impedance Cardiography: The Next Technology in Obstetrics?

2015-02

R.M. Sima, I.A. Bădărău, C. Ciornei, R.I. Papacocea, C. Alexandroaia, L. Pleș

Impedance cardiography (ICG) is a noninvasive modality to assess hemodynamic parameters. It uses changes in impedance across the thorax. It can evaluate the thorax fluid capacity which includes extravascular, intravascular and chest water content and, indirectly, represents the degree of heart failure.

This technique allows the assessment of cardiac output (CO), cardiac index (CI), stroke volume (SV), stroke index (SI), systemic vascular resistance (SVR), systemic vascular resistance index (SVRI), left ventricular ejection fraction (LVEF), left ventricular ejection time (LVET). CO, CI, SV and SI can reflect the myocardial blood flow; SVR and SVRI can reflect systemic vascular resistance and cardiac afterload; PEP, LVEF, LVET and STR can reflect myocardial contraction (prolonged PEP, LVET shortening, increase of STR and decrease of LVEF represent the compromised cardiac function). (1, 2)

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Modern Management of Benign Bile Duct Strictures

2015-02

Cristian Balahura, Petre Iacob Calistru, Gabriel Constantinescu

Benign biliary strictures (BBS) are a heterogeneous group of disorders whose diagnosis and treatment may be challenging. Surgical injury of the bile duct is the most common cause in the Western world (1). Inflammatory lesions of the biliary ducts, such as chronic pancreatitis represent the second most common cause of BBS.

The appropriate evaluation and management frequently require collaboration between gastroenterologists, surgeons and radiologists. The confirmation of the stricture is preferably made by magnetic resonance cholangiopancreatography (MRCP). A mainstay of diagnosis is the differentiation of BBS from malignant obstructions which are more prevalent. Tissue sampling during ERCP or endoscopic ultrasound with fine needle aspiration can be useful.

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Laparoscopic Management of Concomitant Gallstones and Common Bile Duct Stones - Current Practice and Our Experience

2015-02

Bogdan V. Marțian, Bogdan I Diaconescu, Mircea Beuran

Despite many advances in the last decades the optimal treatment for concomitant gallstones and common bile duct (CBD) stones is still controversial. While for the asymptomatic gallbladder stones the need for surgery is still under debate, there is large consensus regarding the indication to remove the CBD stones, which appear to be associated in 3-10% of patients (1). Before the laparoscopic era the standard treatment for CBD stones was open cholecystectomy and CBD exploration. For the patients unfit for surgery, or with severe complica-tions such as acute cholangitis, jaundice and pancreatitis, ERCP with endoscopic sphincterotomy (ES) and stone extraction was a valuable, seldom stand alone, life saving, alternative. With the advent of laparoscopic cholecystectomy (LC) in 1987-1988, new techniques added to the armamentarium of CBD stones treatment. Reddick & Olsen (2,3) sustained the ERCP with endoscopic sphincterotomy (ES) and stone extraction as early as 1990; Petelin (4), introduced almost simultaneously, the laparoscopic CBD exploration (LCBDE). The current standards of practice recognise 3 options: the combined laparo-endoscopic, the totally laparoscopic and the open approach.

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Cardiac Biomarker NTproBNP in Chronic Kidney Disease - A Brief Review

2015-02

A.-M. Nechita, D. Rădulescu, I. Peride, A. Niculae, D.R. Sinescu, I. A. Checheriță, A. Ciocâlteu

Chronic kidney disease (CKD) is a worldwide health problem [1,2] affecting between 7 - 10% of young individuals (30 - 64 years old) in Europe [2] and approximately 10 - 18% of the population in the USA [3]. In 2013, in Romania, the prevalence of CKD was approximately 13.1%, meaning about 1,900,000 persons, and 13,899 patients were on chronic dialysis [4].

CKD is associated with increased cardiovascular morbidity, even from early stages [5-8]. Decreased glomerular filtration rate (GFR) is a strong predictor of cardiovascular events, even in the absence of other cardiac risk factors [9]. Risk for cardiovascular disease in CKD patients is 10 - 30 times higher than in non-CKD individuals and mortality from cardiovascular diseases (CVD) accounts for approximately 50% from all causes of death in dialysis population [6,10,11,12]. Predisposing features for developing CVD in CKD patients include both traditional and nontraditional - uremia associated - factors [11,12].

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Renal Artery Stenosis - Review Upon Current Diagnosis and Endovascular Treatment in Light of Recent Studies

2015-02

Dana-Oliviana Geavlete, Carmen Beladan, Magda-Ruxandra Zaharia, Alice Brînzea, Dan Deleanu, Ionel A. Checheriță, Bogdan A. Popescu, Carmen Ginghină

Renal artery stenosis represents the main cause of secondary hypertension and, due to its progressive profile, leads to end-stage renal disease and important cardiovascular events (1). Despite the large number of trials in this particular field of interest, RAS therapy remains a complex challenge for clinicians with regard to interventional revascularization, eventually resulting in renal function preservation, improved blood pressure control (BP) and prevention of adverse cardiovascular events in selected patients (2).

In fact, the matter of debate is represented by the proper selection of patients which would benefit the most from renal revascularization with stent implantation, while also taking into account the outcomes of the recently emerging large clinical trials that were unable to confirm the clear benefits of endovascular therapy.

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Nutritional Impact on Cardiovascular Risk in Chronic Hemodialysed Patients - A Systematic Review

2015-02

Andra E. Balcangiu-Stroescu, Ileana Peride, Ileana Adela Văcăroiu, Ionel Alexandru Checheriță, Andrei Niculae

Protein-energy malnutrition is a frequent clinical condition in chronic hemodialysis patients (1). The causes of protein-energy malnutrition are: interaction between blood and dialyzer with subsequent activation of the complement, amino acids and peptides losses when undergoing hemodialysis, metabolic acidosis, chronic inflammation and anorexia (2). There are two types of protein-energy malnutrition. Type 1 protein-energy malnutrition is characterized by patients’ poor food intake. This occurs along with slow decrease of serum albumin and loss of muscle mass, the presence of normal levels of C-reactive protein and response to nutritional interventions. The second type of protein-energy malnutrition is characterized by an increased serum level of C-reactive protein and lower serum albumin level than in type 1, even with an optimal food intake. This type of protein-caloric malnutrition is strongly associated with chronic inflammation and does not respond to nutritional intervention (3).

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Experimental Research on the Interactions between Selective COX-2 Inhibitors and Antidepressants

2015-02

Horia Păunescu

Several studies have suggested an association between depression and inflammation (reviewed in 1, 2, 3, 4). Treatment with pro-inflammatory agents (Calmette-Guerin bacillus, endotoxins) causes depressive symptoms (5, 6, 7). Non-steroidal antiinflammatory agents, NSAIDs, particularly the COX-2 selective ones (e.g., celecoxib) showed promising results in the augmentation of the antidepressant effect in clinical studies on major depression or depressive symptomatology. The antidepressant activity of celecoxib was apparent both in the assessment of the frequency of the remissions, and in the assessment of the therapeutic response (reviewed in 8). Contrary to these studies, there is evidence that NSAIDs decrease the antidepressant effects of the antidepressant drugs. Certain NSAIDs showed depressant effects in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) clinical trial (concomitant administration of NSAIDs and antidepressants was shown to decrease the responder percentage to 45% in major depression, vs. 55% responder percentage when antidepressants were given without NSAIDs) (9). There is experimental evidence of antidepressant effects of NSAIDs in laboratory animals, particularly mice and rats, but also two studies showing that certain NSAIDs have depressant activity when given alone or in association with serotonin-specific reuptake inhibitors, SSRI (9, 10, 11, 12).

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Botulinum Toxin Type A - Possible Anti-Nociceptive Effect on Mice

2015-02

Elena-Rodica Dragu, Bogdan Liviu Chioaru, Ioana Teona Sebe, Ioan Lascăr, Oana Andreia Coman

Botulinum neurotoxin has been used in the treatment of various groups of cronic neuromuscular diseases, which include neuromuscular junction signaling, non-neuromuscular transmission, cholinergic, or non-cholinergic.

Having specificity on releasing neurotransmitter vesicles with acetylcholine in the synaptic gap, the main usage of botulinum toxin was as a muscle relaxant drug in painful or painless spastic syndromes.

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Long-terme Evaluation of Primary Syndactyly Treatment in Children, Using a Flatt Modified Technique

2015-02

Doina-Iulia Nacea, D.M Enescu, Simona Stoicescu

Syndactyly is one of the two most common congenital hand abnormalities, the other being polydactyly (1, 2, 3). It occurs in about 1: 2,500 live births, more commonly in males, and is most often seen in the third web space (2, 4). The condition has a strong familial tendency and is bilateral in half of the cases (4, 2, 5). Inheritance is thought to be autosomal dominant with variable penetrance and expressivity, which may explain the male predominance (6).

Unlike secondary syndactyly, which occurs due to abnormal fusion of initially individualized fingers, primary syndactyly mainly occurs due to the failure of differentiation between adjacent digits, caused by the absence of apoptosis in the interdigital mesenchyme during the seventh and eighth weeks of gestation (7,8). Syndactyly may occur as an isolated event or it may be linked to other anomalies in the body, being known as syndromic syndactyly (7).

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Cardiovascular Autonomic Dysfunction: A Possible Prognostic Marker in Patients with Arterial Pulmonary Hypertension

2015-02

Alexandru Ioan Deaconu, Silvia Iancovici, Diana Zamfir, Tudor Constatinescu, Claudia Toma, Dragoș Zaharia, Miron Bogdan, Maria Dorobanțu

In the past two decades, the association between the cardiovascular autonomic dysfunction and the cardiovascular mortality has been well documented. This association indicates that individuals with abnormal autonomic function tests are candidates for close surveillance. In type 2 diabetes it is recommended that a baseline determination of cardiovascular autonomic function be performed upon diagnosis and within 5 years of diagnosis for those with type 1 diabetes, followed by a yearly repeat test.[1]

Out of the markers that objectify this relationship, heart rate variability (HRV) has proven to be the most reliable and the easiest to quantify. Although HRV has been the subject of numerous clinical studies whose purpose was linking heart rate changes to the gravity and the evolution of the disease, only in two clinical settings a consensus was reached. The drop in HRV can be used as a risk factor in the period following an acute myocardial infarction (AMI) and as a warning sign for cardiac autonomic neuropathy (CAN) in diabetic patients. HRV parameters and their possible prognostic significance have not been thoroughly evaluated in patients presenting pulmonary arterial hypertension.

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Malignant Peripheral Nerve Sheath Tumor Relapse Detected by Positron Emission Tomography

2015-01

Mădălina Olivia Adameșteanu, I. Lascăr, M. Vâlcu, Ioana Teona Sebe

Malignant peripheral nerve sheath tumors (MPNST) are soft tissue tumors showing neuroectodermal differentiation. They arise in connection to a major nerve trunk, a peripheral nerve or a preexisting neuroma in patients with hereditary neurofibromatosis type 1. [1, 2]

They usually develop in the deep soft tissue between anatomic compartments, the root of the limbs (inguinal region, the axilla) being one of the most common sites of occurrence.

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Spontaneous Rupture of the Spleen on a Patient with Splenic Hemangioma and Multiple Cystic Lesions in Kidney and Liver...

2015-01

Spontaneous Rupture of the Spleen on a Patient with Splenic Hemangioma and Multiple Cystic Lesions in Kidney and Liver. Case Report and Literature Review

Andreea Iliesiu, Oana Cristina Ciornenchi, M. Tampa, Clara Matei, Simona-Roxana Georgescu, C. Cirstoiu, N. Zarnescu, Maria Sajin, A. Dumitru

Splenic hemangioma is a vascular malformation which is one of the most common benign neoplasms of the spleen. They may represent small, incidental lesions that can produce significant splenomegaly and predispose to splenic rupture. These tumors are rare and resemble their counterparts in other organs. The vascular spaces are usually irregular and cavernous, containing abundant red blood cells.

Differential diagnoses include benign or malignant neoplasms, metastases, lymphoma, splenic abscess or cystic lesions. The incidence of autopsy examination of their diagnosis ranges from 0.03 to 14% [1], and most often is encountered in adults between the ages of 30 and 50 [2]. Most are small lesions, usually clinically silent, diagnosed accidentally. Sometimes, however, they may be symptomatic, manifested by splenomegaly, abdominal pain, bowel disorders, anemia and thrombocytopenia, Kasabach-Merritt syndrome (anemia, thrombocytopenia and coagulopathy) and in rare cases by spontaneous rupture of the spleen [3].

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Total Pelvic Exenteration for Locally Invasive Cervical Cancer with Vesico-Vaginal Fistula

2015-01

N. Bacalbașa, Irina Bălescu

Cervical cancer still represents an important health problem, many cases still being diagnosed in an advanced stage of disease with already existing invasion of the surrounding viscera. (1,2) The presence of a locally invasive cervical tumor with aggressive surgical behaviour can produce local tumoral invasion which sometimes is associated with continuity solutions between different organs. When it comes to cervical cancer, the viscera most frequently affected by the formation of these fistulas are rectum and urinary bladder. (3,4) We present the case of a 49 year old patient diagnosed with stage IVA cervical cancer in whom a total supralevator exenteration was performed.

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Existing Controversies in Inguinal Hernia Treatment

2015-01

S. Aldoescu, T. Pătrașcu

Inguinal hernia is one of the most frequently encountered adult pathologies requiring surgical treatment, and it represents an important problem for healthcare systems, with multiple consequences on both the social and economic plan. Although its incidence and prevalence are not exactly known, the admitted possibility for an individual to get an inguinal hernia during his lifetime ranges around 27% for men compared to only 3% for women. [1] [2]. The evolution of surgery has brought to the fore multiple technical developments which, although technically alluring, could not manage to become surgical standard procedures. The 80’s saw the development of synthetic alloplastic materials and also "tension-free" repair principles, peaking with the Lichtenstein technique, which decreased the relapse rate so much that it made this procedure the "gold standard" of this type of pathology for many surgeons. The development of minimal invasive surgery gradually overtook all abdominal "organs" and the early nineties, starting with 1993, saw the rapid development of minimal invasive techniques for the treatment of inguinal hernia, which proved to be statistically as efficient as the technique Lichtenstein initially described. From that moment on, the surgical world adopted radically different positions, each surgical school offering arguments for or against classical or laparoscopy methods, a dispute which triggered many controversies, more or less backed by statistical data.

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Therapy Principles in Ischemic Mitral Regurgitation

2015-01

V. Goleanu

Ischemic mitral regurgitation (IMG) is the mitral regurgitation that is determined by the ischemic coronary disease and must be differentiated from the mitral regurgitation, which coexists with ischemic coronary disease. It appears secondary to acute myocardial infarction with angiographic or echocardiographic signs of contraction anomaly of left ventricle in a region vascularized by a critically stenosed coronary artery (1-3).

Ischemic mitral regurgitation is determined by an excess of tethering of one or both mitral valves, as a result of displacement of one or both papillary muscles. All patients have anterior acute myocardial infarction with regional anomaly of left ventricle wall contraction. Statistically, approximately 80% display posterior infarction and 20% anterior infarction (4).

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Current Aspects of Clinical Genetic Diagnosis in Werdnig-Hoffman Spinal Muscular Atrophy

2015-01

Axinia Corches

Type I Werdnig-Hoffman spinal muscular atrophy (SMA) is a progressive neuromuscular disease with recessive autosomal transmission characterized by muscular weakness and atrophy caused by degeneration of motor neurons in the spinal cord and in the brainstem nuclei.

In the early 1980s, Werdnig and Hoffman described a disorder with childhood onset that was characterized by progressive muscle weakness. In terms of histopathology, it showed loss of neurons in the previous horns of the spinal cord. (Katirji B, 2002).

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Surgical Attitude Towards the Hepatic Hydatid Pericystic Cavity

2015-01

I. Brezean, M. Vilcu, I. Pantea, E. Catrina, D. Ferechide

There are a variety of anatomoclinical forms of hepatic echinococcosis. This has led to finding and applying a number of surgical procedures which have the same aim, namely the reduction or elimination of the pericystic cavity. Besides, solving the residual pericystic cavity after the elimination of the parasite represents the main problem of the surgical treatment. The postoperative complications of the hydatid cyst are caused by the failure to adapt the surgical procedures to the morphological characteristics of the pericystic cavity.

In the Romanian medical literature, the surgeries performed for the hepatic hydatid cyst are divided into the so-called conservative surgeries, which abandon the pericystic cavity or resect a part of the pericyst, and the so-called radical surgeries, which completely remove the pericystic cavity by sacrificing a smaller or greater area of the parenchyma of the liver.

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Biomarkers and Imagistic Methods for Early Diagnosis and Prognostic of Laryngeal Cancer

2015-01

Cristina Maria Goanta, Daniela Cirpaciu

For years, intermediate and advanced staged tumors were approached with total laryngectomy and post-operative RT until 1991, when the Veterans Administration Larynx Study and other subsequent organ preservation trials established the role of chemo radiation in the upfront treatment of intermediate laryngeal cancers (stage III and early IV a).

Surgical management of the larynx and hypo-pharyngeal malignancies have become increasingly challenging as surgical organ preservation strategies are applied. Failures of these protocols are often accompanied by post radiation sequels, which enhance post-surgical complications when a salvaging laryngectomy/laryngopharyngectomy is undertaken.

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SIRS and MODS in Acute Pancreatitis

2015-01

C.C. Popa, Octavia Cristina Rusu, Alexandra Kocsis, S.I. Neagu, C.R. Strugaru

Acute pancreatitis is the acute inflammation of the glandular pancreatic acinar cells, the consequence of parenchymal enzyme activation. Acinar local autodigestion which determines tissue destruction and ischemic necrosis sets in. Simultaneously, the local inflammatory reaction is followed by the release of pancreatic enzymes in the systemic circulation. In this situation, inflammatory cells appear, which stimulates the production of inflammatory mediators (1,2).

The loss of local control or exaggerated inflammatory reaction triggers the systemic inflammatory response syndrome (SIRS). The factors involved in determining the systemic response may be infectious (bacteria, viruses, fungi, parasites etc.), noninfectious (trauma, pancreatitis, burns etc.), or a combination of all the above (Fig. 1).

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Ultrastructural Arguments for the Extracellular Location of Amyloid Deposits

2015-01

E. Mandache, M. N. Penescu

Amyloidosis is a disease characterized by deposition and accumulation of insoluble proteins as small or large deposits of a fibrillar material. Despite the fact that these deposits are ultrastructurally identical, the basic proteins are chemically different, so far being recognized over 25 amyloidogenic precursors [1]. All these proteins can be immuno-histochemically identified, thus leading to a more and more precise diagnosis and an appropriate treatment.

Amyloid fibrils have an 8 to 12 nm diameter, are extremely strong, highly ordered and organized and can be formed, as already mentioned, by a large number of proteins and peptides [2]. They are rigid, nonbranching, hollow-cored tubules randomly arranged. Examined in X-ray diffraction they have a characteristic β-pleated sheet configuration. This macromolecular helix of 100 nm periodicity, formed by two twisted β-pleated sheet micelles is responsible for the resistance of amyloid to solubilization or proteolytic digestion. The amyloid precursor peptides may be normal serum proteins, or abnormal degradation variants, which can be repetitively incorporated into a developing amyloid fibril. The P component of amyloid fibril is a pentagonal, 8 nm diameters, doughnut like glyco-protein, similar to complement component C1t and C-reactive protein. P component is probably the cause of amyloid deposit staining with iodine. All amyloids contain a proteoglycans matrix. Pure amyloid contains amyloid fibrils, P component and proteoglycans matrix. In tissue, the deposits are contaminated with varying amounts of plasma proteins and collagen. Variations in staining and density of amyloid result from different amounts of non-amyloid components attached to the fibrilar scaffold.

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IPSS Score and IL-6 Before and During Treatment with Dutasteride in Patients with Benign Prostatic Hyperplasia

2015-01

C.V. Ene, Corina Daniela Ene, Ilinca Nicolae, B. Geavlete, Oana Andreia Coman

Benign prostatic hyperplasia (BPH) is one of the most common pathologies in aging men, associated with lower urinary tract symptoms (LUTS). This pathology has a multimodal approach depending on different factors like age, prostate size, prostate-specific antigen level, and severity of the symptoms [1].

Medical treatment is the first option in what patients with low or moderate LUTS are concerned. There are two major drug classes already established in all international treatment guidelines, 5 alpha-reductase inhibitors and alpha-blockers. 5 alpha-reductase inhibitors block the transformation of testosterone in dihydrotestosterone within the prostate, leading to the decrease of prostate volume, increased peak urinary flow rate, improvement of symptoms, decreasing the risk of acute urinary retention. Their main secondary effects are the erectile dysfunction, the decreasing of libido and of the ejaculate volume, and also gynecomastia [2]. Alpha-blockers act on alpha-adrenoceptor sites found particularly at the bladder neck, at the trigone and within the prostate. They have a fast action on the prostate gland, leading quickly to symptom relief, but without reducing the risk of acute retention or surgical treatment. As secondary effects, alpha-blockers can affect blood pressure [3-5].

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Presence of p53 in Tumor Cells - an Indicator of Disease Severity? Retrospective Study in Patients with NSCC (Partial Results)

2015-01

Antonela Dragomir, M. Alexe, Diana Leonte, Florina Vasilescu, Daciana Marta

The lung cancer is the leading cause of death determined by malignancies in the world, followed by breast, prostate and colon cancer. The malignant cells present a variety of genetic aberrations that can be grouped into six essential pathways: (1) the acquisition of self sufficient or autonomous growth signals; (2) insensitivity to growth inhibitory signals; (3) resistance to signals of apoptosis; (4) unlimited proliferation potential; (5) sustained angiogenesis; and (6) invasion and metastasis1.

The p53 protein is a protein with molecular mass of 53 kDa (from where its name derives). The gene p53 encoding the protein p53 is located on the short arm of chromosome 14. The protein p53 is involved in maintaining control cellular genome stability and its disruption can lead to the emergence of malignancies. In about 50% of human cancers, the mutant protein p53 was detected. At the cellular level it regulating the transcription of some genes involved in cell growth control and apoptosis. The gene p53 can be inactivated by punctiform mutations and protein p53 can be inactivated by the formation of complexes with the cellular proteins or by proteolysis.

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NBI Guided TURBT in NMIBC Management - "The Right Path" to Better Tumor Ablation

2015-01

B. Geavlete, C. Ene, C. Bulai, I. Al. Checheriță, P. Geavlete

Over the past few years, the conventional transurethral resection of bladder tumors (TURBT) has undergone increasing criticism among the international urological community due to its’ inability to achieve a complete tumor ablation [1].

This substantial oncologic drawback has been mainly related to the limited sensitivity of the classical white light cystoscopy (WLC) [2]. In other words, the standard endoscopic assessment of the bladder was often outlined as insufficiently capable of accurately identifying all of the existing tumor formations [3].

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Optimal Treatment for Myocardial Revascularization: Surgery or Stenting?

2014-04

S. Wan and M. J. Underwood

Since the introduction of coronary artery bypass grafting (CABG) in 1967, and percutaneous transluminal coronary angioplasty (PTCA) 10 years later, several major clinical trials have been conducted comparing the two therapeutic strategies, such as the Bypass Angioplasty Revascularization Investigation (BARI) (1) and the Coronary Angioplasty versus Bypass Revascularization Investigation (CABRI) (2) trials. The seven-year outcome data of the BARI trial (involving 1,829 patients) demonstrated that CABG carried a significant survival benefit over PTCA and this was particularly pronounced in diabetic patients (1). In addition, nearly 60% of the patients treated with PTCA had to undergo repeat revascularization procedures and half of them relied on CABG as a subsequent therapy (1).

Nevertheless, the past two decades have witnessed a rapid progression of PTCA technology, in particular the development of intra-coronary stents. Drug-eluting stents (DES) especially, appear to have impacted significantly on the current daily practice of treating patients with coronary artery disease (3). These advances and their immediate influence on clinical practice provide a good example of how technology may shift the paradigm of medicine. Consequently, the mechanism and technique of revascularization needs to be redefined in the present era.

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Hepatocyte Growth Factor: Cardiotrophic Roles and Potential Therapeutics for Cardiovascular Diseases

2014-04

S. Mizuno and T. Nakamura

Due to prolonged lifespans, cardiovascular disease is on the increase worldwide and is now the leading cause of death, especially in developed countries. Histologically, it is characterized by coronary atherosclerosis, in which the over-proliferation of vascular smooth muscle cells (VSMC) is evident, associated with endothelial injury and foamy cell-like macrophages (i.e., local inflammation) (1,2). Such a sclerotic event triggers narrowed lumens (i.e., stenosis) and a decrease in coronary blood flow leads to local hypoxia, apoptosis, and eventually the onset of myocardial infarction (MI) (2). Thus, the major approaches proposed to prevent or restore MI are: (i) prevention or restoration of coronary atherosclerosis, the primary cause of heart disease; (ii) induction of cardiac angiogenesis with cytokines/growth factors; (iii) inhibition of cardiomyocyte cell death during heart ischemia (i.e., anti-apoptotic therapy); and, (iv) possible reconstitution of cardiomyocytes via recruitment of intrinsic stem cells, or cell transplantation (i.e., regenerative therapy).

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The Use of NBI in Early Detection and Follow up of the Laryngeal Malignancies

2014-04

R. Hainăroșie, O. Ceachir, Irina Ioniță, Cătălina Pietroșanu, Carmen Drăghici, Cristina Zamfir, Viorel Zainea

Laryngeal tumors are often discovered in advanced stages because the patients do not pay attention to early symptoms. Sometimes small tumors are difficult to see even if the surgeon performs a fiber optic exam that uses conventional white light. In the last years some technologies started to be used in order to help the surgeon to perform an early detection or to follow up de patient with laryngeal malignancies (1).

Early detection of laryngeal neoplasm is one of the most important factors for the success of the treatment. Visualizing abnormal modification at the follow up exam for patient with laryngeal cancer will help the surgeon to initiate the treatment for the recurrence. Some of technologies such as autofluorescence or video contact endoscopy started to be used for early detection of laryngeal malignancies (2,3).

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The Rubens Flap - Breast Reconstruction - Anatomical Dissection on a Cadaver

2014-04

S. Cortan, I. Lascar, I.P. Florescu, M. Valcu, Ioana Teona Sebe

The concealment of cutaneous and subcutaneous defects has always been a challenge in surgery. The breast is one of the most important and defining elements of feminine beauty. Neoplastic pathology has always made it difficult to aesthetically repair the extirpated mammary tissue. Plastic and aesthetic surgery and reconstructive microsurgery, through microsurgical techniques of autologous free flap transfers, try to solve these problems.

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Atypical Evolution of Peptic Ulcer Disease in a Chronic Hemodialyzed Patient

2014-04

D. Baboi, Cristiana David, Ileana Peride, A. Niculae, B. Geavlete, I.A. Checheriță, I. Dina

Digestive manifestations due to uremia and uremic toxins are multiple in patients with chronic kidney disease (CKD) on hemodialysis (HD). As much as 79 percent of these patients report gastrointestinal symptoms manifested as nausea, vomiting, dry mouth, dysgeusia, halitosis, pyrosis, abdominal pain, bloating, diarrhea (1,2). Due to many pathogenic mechanisms, the prevalence of gastro-duodenal peptic ulcer disease is higher in HD subjects than in general population, but comparable in frequency with nondialyzed CKD patients (3-5). A recent published 10 years-study presented that the incidence of peptic ulcer disease is 4 times higher in patients with CKD and 9.4 times higher in individuals on chronic HD compared to the general population (6). Regarding localization, gastric ulcers are twice more frequent documented than duodenal ulcers (6-8). An imbalance between protective and aggressive mucosal factors in favor of the last ones is noticed in HD patients. Chronic dialysis stress, intradialysis hypotension (causing mucosal hypo-perfusion), anemia, intra-dialysis anticoagulant, metabolic acidosis, potentially ulcerogenic medication (steroids, non-steroid anti-inflammatory and antiplatelet drugs) lead to high frequencies of peptic ulcer disease (9). Since the appearance of ulcerous lesions, the risk of their complications (e.g.: hemorrhages, perforations, penetrating injuries) is much higher than in general population. One recent cohort study in Taiwan showed that the incidence of gastro-duodenal bleedings is double in CKD patients and 5 times higher in HD ones (2). Subsequently, common comorbidities such as diabetes, liver cirrhosis and ischemic heart disease participate as pathogens in digestive bleedings (10).

An adequate diagnosis and monitoring of peptic ulcer disease in dialysis patients represent a constant concern of our clinical practice, because of the high prevalence of this kind of pathology, the life-threatening potential complications and the complexity of the treatment. Therefore, further on we discuss the case of an atypical peptic ulcer disease in a chronic HD patient.

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Lentigo Maligna - A Scientometric Analysis of Mainstream Scientific Knowledge

2014-04

Alice Brînzea, B. Geavlete, Magda Mirescu, Roxana Nedelcu, Oliviana Geavlete, Daniela Ion

Lentigo maligna (LM) is a type of melanocytic proliferation, the term being used by clinicians and pathologists for melanoma in situ on chronically sun damaged skin (1) in case that the lesion is confined to the epidermis. The pathology in question is classified as lentigo maligna melanoma (LMM) when it invades the dermis (2), over a protracted period of time (3). They both represent a subtype of malignant melanocytic proliferation according to the World Health Organization criteria (4). Once the dermis is invaded, the prognosis of the lesion is similar to that specific for other types of melanoma (5). Most LM patients display a slowly enlarging pigmented macula or patch which tends to occur in middle aged and older individuals (6), with a slight female preponderance (2).

The preferred method for diagnosing LM is excision (7), secondary to dermatoscopy (8) and biopsy (9). Distinguishing LM from a background of increased melanocytes on chronically sun damaged skin in a small biopsy specimen remains one of the most serious diagnostic challenges for dermatopathologists (10). Histology shows proliferation of atypical melanocytes at the epidermal-dermal junction in small nests or single cells (11).

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Chronic Lymphocytic Leukemia. From Diagnosis to Treatment Decision

2014-04

Ana-Maria Ivanescu, Madalina Oprea, A. Colita, A. Turbatu, Anca Roxana Lupu

Chronic lymphocytic leukemia (CLL), haematological described since the early nineteenth century, is considered a haematological indolence, but of-a-time there was found that its evolution can be extremely varied.

Most of the patients were over 60 years at the time the diagnosis was established, and this may be due to decreased immune competence with age. Males are affected 2 times more frequently than the female, the male percentage: female being 2:1. Fewer than 10% of cases occur in adults and in children below 40 years old have been few reported cases of CLL. (1.2)

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HPV Implications in Benign Prostatic Impairments - A Literature Review

2014-04

D. Spînu, D. Mischianu, O. Bratu, A. Aungurenci, Ș. Manache, Agnes Ciucă

Benign prostatic impairments are a heterogeneous group of diseases that can coexist or be separate entities. Some of these conditions (prostatitis) are included in the pelvic pain syndrome, while the other is represented by the prostatic adenoma and its implications.

Benign prostatic hyperplasia (BPH) is histologically associated, in most cases, with the presence of inflammatory infiltrate at this level. Histopathological examination of the resected pieces and fragments of prostatic biopsy in many cases reveals stromal inflammatory infiltrate adjacent to the prostatic acini. (1, 2) In addition to the many factors involved in the prostate benign microbial pathology (E. coli, Pseudomonas aeruginosa, Serratia spp., Klebsiella spp., Enterobacter aerogenes and the great family of enterococci), there are numerous data in specialized literature, certifying the presence of viral genomes in both benign and malignant pathology of the prostate. (3, 4) Among them the following stand out: Papilloma virus (HPV), Polyoma viruses, cytomegaloviruses (CMV), Epstein-Barr virus (EBV), Herpes Virus 8 (HHV 8) and xenotropic murine leukemia virus recently (XMRV). (5)

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Innovative Techniques for the Endoscopic Diagnosis in Inflammatory Bowel Diseases

2014-04

Adriana-Corina Andrei, L.S. Andrei, Larisa-Elena Fulger

Inflammatory bowel diseases, Crohn's disease (CD) and ulcerative colitis (UC), are chronic conditions in which idiopathic inflammation of the gastrointestinal tract wall is the characteristic feature.

The etiology of these disorders is not fully elucidated, proposed causes including environmental, immunological and genetic factors. A consensus hypothesis is that in genetically susceptible individuals, both exogenous factors (eg. Intestinal flora) and factors related to the host (barrier function of epithelial cells, innate and acquired immune response function) produce a chronic immune dysfunction in the intestinal mucosa which is further modified by the action of environmental factors (eg. smoking).

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Psychological Aspects of Pain at Patients with Critical Limb Ischemia

2014-04

Liliana Veronica Diaconescu, I. Diaconescu

Peripheral arterial disease is one of the major conditions that affect middle and old aged persons. Its prevalence ranges from 3% (for people aged 37- 69 years old) to 20% (for people aged over 70 years old) (1). In advanced stages (III and IV Leriche) the main symptoms are ulcers and pain- at rest, intolerable, nocturnal increased, needing analgesic treatment (inclusive opiates). Critical limb ischemia (CLI) is characterized by chronic ischemic rest pain, ulcers or gangrene attributable to objectively proven arterial occlusive disease (2,3). CLI is considered like a "malignant" disease - due to generalized atherosclerosis these patients are predisposed to various cardiovascular complications (e.g. myocardial infarction, strokes) which can cause death in few years (4).

The patients affected by CLI are patients generally considered difficult cases, destined to repeated approach to the health care services. Physicians have to take in charge not the pathology but to take in charge the patient. For the control of the pain it turns out essential, near the block of the perception of the pain, to act with psychological participation, in order to interfere with the perception of the pain and the meant one of the pain, modify the feelings associated to the pain, modify the behavior induced by pain (5).

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Current Issues in Acute Diarrheal Disease

2014-04

Ruxandra Laza, A. Crișan, Luminița Bădițoiu, Emilia Nicoară, Narcisa Nicolescu, Voichița Lăzureanu, Ruxandra Jurac

The intestinal microflora consists of micro-organisms (bacteria required for normal functioning of the digestive tract), which are interacting with the human body (commensalism), the digestive tract is the habitat required for the development of these bacteria, and these, in turn, produce the constituents necessary for the organism. Disruption of this balance makes some ordinary saprophytic species to become pathogenic.

Clostridium difficile(CD), gram positive bacillus, anaerobic, sporulated, enters into the structure of normal enteric resident flora in a proportion of 60-70% in newborns, 10 to 30% in hospitalized patients, and only 3% in healthy adults (1). If this flora is iatrogenic depressed by antibiotic therapy, chemotherapy, inhibitors of gastric acidity, CD wins "vital space"; by multiplying causes damage to the intestinal mucosa and subsequently, on the background of comorbidities, gives the lead of severity to the clinical evolution.

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Correlations between Hypercalcemia and Endoscopic Findings in HD Patients - A Prospective Study

2014-04

D. Baboi, Cristiana David, Ileana Peride, A. Niculae, I.A. Checheriță, I. Dina

Patients with chronic renal disease frequently display eso-gastro-duodenal associated pathology: anorexia, heartburn, nausea, vomiting, abdominal pain, gastric motility disorder so far as gastroparesis; some of these symptoms decline once the substitution therapy of the renal function is initiated through hemodialysis, and some persist because of the interdialytic metabolic acidosis, used anticoagulant in dialysis or complementary therapies.

The most severe clinical manifestation is superior digestive hemorrhage, with multiple intricate causes (mucosal lesions induced by gastrin, angiodysplasia including GAVE - gastric antral vascular ectasia, treatments with lesion potential - NSAIDs, corticoids, oral iron drugs, mucosa inflammation under uremic toxins or oxygen radicals, gastric and intestinal wall edema due to interdialytic hypervolemia, malnutrition). The gastric hyperacidity induced injuries in renal patients are often esophagitis, gastritis, duodenitis and gastro-duodenal ulcer.

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Bacterial Pneumonia in Children - Epidemiological Study on Nine Years

2014-04

Mirela Luminița Chiru, Daniela Pacurar, D. Oraseanu

Pneumonia can be defined as an inflammation of the pulmonary parenchyma, mainly affecting the alveolar space. Inflammation can be caused by bacteria and viruses, as well as by inhalation of chemical agents or due to thoracic trauma (1,2,6).

Most authors classify bacterial pneumonias depending on the pathogenic agent, this classification including species of Pneumococcus, Hamophillus Influenzae, Klebsiella, Staphylococcus, Legionella and other gram-negative microorganisms. Some germs, especially Staphylococcus may be disseminated in a haematogenous manner.

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Total Lower Lip Reconstruction - What Techniques Should We Choose

2014-04

N. Calcaianu, S.A. Popescu, Daniela Diveica, I. Lascăr

While the incidence of lip cancers incidence in the central Europe is low 0.7% of all malignant tumors compared to the 1-2% generally considered (2-5), they are extremely important from a clinical and surgical point of view because of the morphological and functional changes involved. More than 90% of these tumours are squamous cell carcinomas (SCCs) and, in lesser numbers, basal-cell tumours (BCCs); however, some adenocarcinomas deriving from the minor salivary glands can be observed and, even more rarely, melanomas, sarcomas and lymphomas. BCCs generally occur in the upper lip and do not usually present lymph node metastases (4, 6). In contrast, SCCs develop most often in the lower lip, with a possibility of neck metastases. Lip carcinomas frequently appear on top of precancerous lesions, such as radiodermitis, chronic chelitis and xeroderma pigmentosum. The diagnosis and treatment of these pre-cancerous lesions, facilitated by a direct view of the lesions, is, therefore, crucially important in order to avoid their evolving into actual tumours. The subjects most at risk of this type of tumour are fair-skinned elderly people who work in the open air. Men are more at risk than women, (1.3% men and 0.3% women) (1) probably because the latter use lipstick or lip-salve (2, 7-9).

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Acute Myocardial Infarction in Youngs: Presentation, Treatment and Outcome

2014-04

Anna-Maria Andronescu, A. Nechita, Eugenia Panaitescu, M. Vintilă, Maria Dorobanțu

Coronary Artery Disease (CAD), the world’s leading cause of death and morbidity, it is not anymore an attribute of old age (1). The increase prevalence of atherosclerotic risk factors among the young and very young population is responsible for more premature CAD cases (2). Prior studies highlighted that AMI in young’s is associated with different clinical features and has a better short-term outcome than in older population (3,4,5). However, long-term follow-up revealed a higher mortality and morbidity in young AMI survivors than in general population (6,7). Also, the conclusion of several studies and "real-world" registries was that patients with STEMI and NSTEMI, regardless of age and despite different management, have similar inhospital outcome and longterm survival (8,9).

In our country, RO-STEMI registry is providing the most extensive information on the profile, treatment and inhospital outcome of the STEMI Romanian patients (10) but only few reports about mid and long-term follow up of young Romanian patients with AMI, especially in case of NSTEMI, are available (11,12,13).

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Intrahepatic Cholangiocarcinoma - the Impact of Pathological Characteristics on the Long-Term Outcome after Resection

2014-04

Zenaida Emilia Ionel, T. Dumitrașcu, V. Brașoveanu, I. Lupescu, R. Anghel, V. Herlea, M. Ionescu, I. Popescu

Intrahepatic cholangiocarcinoma (ICC) is the second as frequency primary liver cancer after hepatocellular carcinoma (HCC), arising from the biliary epithelium of the second branch (segmental branch) or the proximal branch of bile duct (1,2). Recent reports suggest that the incidence of ICC varies considerably according to geographical location, and accounts for about 5-30% of primary liver cancers, with an increasing incidence during the past years all over the world (3-6). Radical resection (R0) remains the only potential curative treatment, but the resectability rate is still low because of late diagnosis. In general, prognosis is poor, with a reported rate of 5-year survival, usually below 20 to 40% for patients with potentially curative resection (7).

However, the recent progress in anesthesiology and intensive care, the development of more effective surgical techniques in hepatobiliary surgery, and the advent of new devices for parenchymal trans-section made more applicable aggressive surgical approaches for ICC, improving the resectability rate in the last two decades (8,9).

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Ontogenesis - Complementarity or Opposition between Materialism and Idealism, between Science and Religion

2014-04

M. Ifrim

The "Albert Schweitzer" International Academy, founded and directed by the academician Kazimierz lmielinski, scientific personality of worldwide renoun, nominalized for the award of the Nobel prize, represents by its prestigious members an international saientific authority in the framework which are debated: medical problems of a fundamental and functional character, as well as philosophical conceptual aspects regarding the materiality and the ideality of the Universe in which we live.

In this context, I present some aspects refering to ontogenesis, which may open interesting perspectives for the medical science.

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THROMBUS FORMATION ON DISRUPTED PLAQUES

2014-03

A. Yamashita and Y. Asada

Acute cardiovascular events that usually involve thrombus formation at sites of disrupted atherosclerotic plaques are currently described as atherothrombosis. Thrombosis is a major complication of atherosclerosis and also a rare but serious complication after stent implantation. However, it does not always result in complete thrombotic occlusion with subsequent acute symptomatic events (1). Therefore, thrombus growth is critical to the onset of clinical events. Thrombus formation is probably modulated by the thrombogenicity of exposed plaque constituents, local hemorheology, systemic thrombogenicity and fibrinolytic activity. Although the mechanisms of thrombus formation have been intensively investigated, little is known about either the mechanisms involved in thrombogenesis or thrombus growth after plaque disruption and stent implantation. This article examines the pathology of atherothrombosis, including late drug-eluting stent (DES) thrombosis, and recent advances in the understanding of thrombogenetic mechanisms and thrombus growth on atherosclerotic lesions, especially coronary atherothrombosis.

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ENDOTHELIAL DYSFUNCTION AND INFLAMMATION

2014-03

M. Slevin and G. McDowell

Conventional based methods of catheter removal of arterial blockages formed during the process of atherosclerosis often result in production of a series of rapidly occurring events which follow the balloon catheter-induced tearing of the existing atherosclerotic plaques and concomitant arterial damage and luminal destruction and ending with significant lumen narrowing within a period of around 6 months (between 4-10% of cases following endarterectomy and approximately 33% of cases in coronary arteries for example; Fig. 1).

The more recent introduction of stents has helped to resolve/reduce some of the problems associated with balloon angioplasty, in that it provides a scaffold which can prevent constriction from the intima, and when coated with anti-proliferative or anti-inflammatory drugs, can significantly slow down the process of in-stent restenosis. However, angiographic restenosis (>50%) and clinical symptomatic restenosis still occurs in 20-30% and 10-15% of patients respectively in the first year after treatment (1), and evidence has shown that there is no significant difference in long-term (3-5 years) follow up regarding subsequent myocardial infarction and death (2).

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The Use of Ultrasonic Aspirator in the Surgery of the Fibrous Dysplasia Involving the Skull Base

2014-03

V. Zainea, M. Hainăroșie, O. Ceachir, Irina G Ioniță, Andreea Sorică, Cătălina Pietroșanu, R. Hainăroșie

Craniofacial fibrous dysplasia is a non-malignant disease. It appears due to the mutations of the GNAS gene that results in inhibition of the differentiation and proliferation of bone-forming stromal cells and leads to the replacement of normal bone and marrow by fibrous tissue and woven bone. Sometimes it is isolated to a single or multiple skeletal sites and / or endocrine organ (1, 2, 3, 4).

The disease commonly progress as a slow developing mass. Distortion of optic nerve, eye ball, nasal airway, facial nerve, teeth and middle year ossicles can occur. In young patients, at prepubertal age, the growth is rapid and can cause aneurismal bone cysts or mucoceles (1, 3, 5). The malignant change to osteosarcoma or other form of sarcoma can appear in less than 1% of cases (1, 2).

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The Inferior Gluteal Flap - Breast Reconstruction - Anatomic Dissection on a Cadaver

2014-03

S. Cortan, I. Lascar, I.P. Florescu, M. Valcu, Ioana Teona Sebe

The breast has been the expression of beauty and fertility since ancient times. The aesthetic reconstruction of the breast is and has been a challenge for plastic surgeons. Microsurgical techniques of dissection and free transfer are commonly used.

During the dissection of one fresh, female cadaver, age 67, a free inferior gluteal flap was taken from gluteal region, using loupe magnification. The dissection preparations were photographed with a high definition camera.

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POSTERIOR PELVIC EXENTERATION FOR ADVANCED, UNRESPONSIVE TO RADIATION THERAPY CERVICAL CANCER - A CASE REPORT

2014-03

N. Bacalbașa, Irina Bălescu

Although pelvic exenterations represent aggressive surgical procedures which might associate physical and psychological problems and a worsened body image, they are the only potential solution with curative intent in centro-pelvic tumors originating from both digestive and gynecologic tract. (1,2,3) In selected cases preoperative oncologic treatment can offer a tumor down-staging or can diminish the tumoral invasion in adjacent organs providing this way the possibility of less aggressive surgical procedures. In other cases this desiderate cannot be obtained; the tumor proves to be unresponsive to neo-adjuvant treatment and multivisceral resections being needed in order to obtain a good control of the disease. Studies have shown that clinical features of the tumor and both molecular and non-molecular biomarkers can be responsible for the poor tumoral response at irradiation. (4) In these cases surgery remains the only treatment with curative intent. We present the case of a 62 year old patient diagnosed with a large cervical tumor in which neo-adjuvant treatment failed to obtain an acceptable control of the disease. She was addressed to our service after augmentation of the tumor under neo-adjuvant treatment; we performed a total hysterectomy en bloc with bilateral adnexectomy, total colpectomy, abdomino-perineal rectal resection and pelvic lymph node dissection with good results.

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The Use of Coblation in the Surgery of the Juvenile Angiofibroma

2014-03

R. Hainăroșie, M. Hainăroșie, O. Ceachir, Irina G Ioniță, Cătălina Pietroșanu, V. Zainea

Coblation is a surgical technology which consists in delivering radiofrequency energy to soft tissue. This technology uses radiofrequency in a bipolar mode with a conductive solution, such as saline (1). It energizes the ions in the saline to form localized plasma near the tissue placed in the area of surgical interest. Plasma’s energy dissociates water molecules from saline solution thus providing the optimal chemical conditions for breaking the tissue’s molecular bonds (2).

The application of this technology has three effects: tissue ablation, localized removal and tissue volumetric reduction (2). The dissipated heat by using this type of radiosurgery is significantly lower than common radiofrequency techniques. This is due to intrinsic of the chemical process and the continuous cooling of the tissue from the surrounding saline solution at the level of the instrument’s tip (3). In this way the temperature rises to 45-85°C (1, 2). The decreased thermal effect of coblation, better than classic radiosurgery, induces a gentle but efficient surgical effect in the target area. Thus the surgeon can gently remove tumors, small organs (tonsils) and can melt some anatomical structures (turbinate, palate, base of tongue). There is a large field of surgical applications in the pathology of the upper aero digestive tract.

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Narrow Band Imaging - From Technological Progress to Superior Urothelial Cancer Diagnostic

2014-03

M. Jecu, P. Geavlete, I.A. Checheriță, C. Ene, B. Geavlete

Bladder cancer represents the most common malignancy of the urinary tract and the 7th most frequent cancer in men and 17th in women. The prevalence of this malignancy varies between regions and countries. In Europe for example, the highest age-standardized incidence rate has been reported in Spain and the lowest in Finland (1). In the United States, the incidence and mortality due to bladder cancer is also high (more than 60,000 new cases and up to 13,000 deaths annually) (2). Therefore, in the last decades, it has been noticed an increased prevalence of bladder cancer, probably caused by tobacco abuse, industrial carcinogens risk factors and overall aging process of the population (3).

75-85% of all newly diagnosed bladder tumors is represented by non-muscle-invasive bladder cancer (NMIBC), a multifocal disease, that includes stages pTa, pT1 and carcinoma in situ (CIS) (4). Furthermore, this pathology has a high recurrence rate within the first 5 years after the initial diagnosis (5), despite the recent technological advances (6).

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Multiple Benefic Effects of the Systemic Exposure to the Hydroxychloroquine Sulfate

2014-03

Aida (Pancă) Geamănu, Alina Popa-Cherecheanu, B. Marinescu, D.C. Geamănu, Liliana Voinea

In the twentieth century, the widespread use of quinacrine by the U.S. military as malaria prophylaxis was accompanied by other observations suggesting efficacy for treatment of rheumatologic diseases [1].

During the 1950s, the hydroxychloroquine (HCQ) derivative of quinacrine showed a favorable usage profile with less eye toxicity than chloroquine itself, and the use of this agent in the treatment of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) has become common. In RA, HCQ is usually a component of a drug combination, including triple drug therapy with methotrexate and sulfasalazine, a formula which was claimed as a safe alternative, well tolerated compared to expensive biological therapies [2].

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HYPONATREMIA IN PREDIALYSIS HOSPITALIZED PATIENTS: AN UPDATE ON CLINICAL DATA AND MANAGEMENT

2014-03

Alice Bălăceanu, I.A. Checheriță, A. Niculae, Ileana Peride, Camelia Diaconu, Gheorghița Aron

Hyponatremia, with an incidence of 15 - 22%, is considered when serum sodium levels are < 135 mEq/L (in institutionalized geriatric patients, in 1 - 4% to 7 - 53% cases there have been reported values below 130 mEq/L) [1-3]. Additionally, according to expert panel recommendations the frequency of hyponatremia in hospitalized patients depends on the detected level of hyponatremia [2]. This special condition is highly important to be detected on time because it represents a recognized risk factor of morbidity and mortality, even in asymptomatic patients [1]. Furthermore, it was noticed that a swift correction can induce severe neurological disorders and even death [1]. Therefore, for an adequate treatment management (prophylaxis and therapy) is vital for understanding hyponatremia main causes and the incriminated pathophysiological mechanisms [1].

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PERFORATORS OF THE CALF ARTERIES - ANATOMICAL STUDY

2014-03

Crenguța Coman, D.M. Enescu, Iulia Iacob, S. Dumitrache, C. Bejinariu, Carmen Giuglea

In reconstructive surgery, perforator flaps have a short history. Not more than 27 years ago, Nakajima et al. described the six types of perforator vessels known at present: direct cutaneous, direct septocutaneous, direct cutaneous branch of muscular vessel, perforating cutaneous branch of muscular vessel, septocutaneous perforator and musculo-cutaneous perforator [1]. (Fig. 1)

The knowledge about these perforator vessels continuously grew, by identifying the vascular networks of the entire body, formed by the perforator vessels. Therefore, it became possible to create a lot of perforator flaps based on these perforator vessels [2]. Thus, perforator flaps can be considered the latest milestone in the evolution of reconstructive flap surgery. Many methods are used for investigating the exact location of the perforators, such as imaging methods: computed tomography, magnetic resonance angiography and lately thermal imaging that became also reliable [3]. The exact knowledge of the location and caliber of perforators became a real help for plastic surgeons, especially in the calf area, where the reconstructive method has to accomplish the functional and aesthetic needs for both reconstructed and donor areas.

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Study Regarding the Distribution and Degree of Dysplasia of Colonic Polyps

2014-03

M. Ifrim, C. Toth, C. Precup

There are worldwide standardization attempts, through therapeutic guidelines of colon cancer screenings. For a screening to be effective, it must involve a more complex understanding of risk factors, finding effective methods and most importantly to applied en masse at an acceptable cost.

In this study I tried to present the situation regarding colon cancer screening in at risk patients in Arad county.

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Split-thickness Skin Grafting in the Treatment of Surgically Operated Diabetic Foot. A Retrospective 2-Year Study (2010-2011)

2014-03

Mihaela Vilcu, E. Catrina, T. Pătrașcu, Z. Filipovski, I. Brezean

Diabetes mellitus is a major health problem with significant impact on the quality of life, due to both its complications and comorbidities and due to the costs it generates. There is widespread agreement that the incidence of the disease has increased over the last years, both due to better population monitoring and improvements in diagnosing methods.

Thus, the number of cases of diabetes mellitus worldwide was 382 million in 2013 and the number is rising; there are 75 million cases of diabetes mellitus which go undiagnosed, as the majority of diabetic patients are discovered only when complications set in. (1)

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Dispersion of Ventricular Repolarization in Relation to Blood Pressure Values in Essential Hypertension

2014-03

Ana Ciobanu, Andreea Simona Hodorogea, Mădălina Ababei, Gabriela Silvia Gheorghe, Adriana Mihaela Ilieșiu, Gabriela Uscoiu, Camelia Nicolae, I.T. Nanea

Hypertension associates with sudden cardiac death, its relationship with ventricular arrhythmias being demonstrated by numerous studies (1). Multiple mechanisms were proposed in order to explain this association, involving both structural and electrophysiological myocardial changes. The electrical ventricular remodeling includes non-uniform prolongation of action potential and duration heterogeneity of refractory periods and conduction velocities of adjacent myocardial areas. All of these changes are referred to as increased dispersion of ventricular repolarization.

As cellular basis for this important mechanism of arrhythmogenesis, 3 myocardial cell types were described, with distinct electrophysiological properties: epicardial, endocardial and midmiocardial M cells (2). Differences between their repolarization periods have as an electrocardiographic correspondence changes in T wave features (2). Subsequently, several non-invasive electrocardiographic (ECG) parameters were proposed for quantification of the repolarization dispersion such as QT interval duration, QT dispersion (QTd), T wave microalternans, and more recently, T peak - T end interval (Tpe), T peak - T end/QT ratio (Tpe/QT) and T peak - T end interval dispersion (dTpe).

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LIVER FUNCTION TESTS ANOMALIES IN PATIENTS WITH CHRONIC HEART FAILURE

2014-03

Camelia C. Diaconu, Alice Bălăceanu, Daniela Bartoș

Chronic heart failure is a major public health problem, with increasing prevalence due to population aging and increased survival of cardiovascular patients. Chronic heart failure is a clinical syndrome characterized by a variety of effects on other organs and systems. Occasionally, patients with chronic heart failure may present with signs and symptoms of a noncardiac disorder, such as hepatic dysfunction. The main pathophysiologic mechanism involved in hepatic dysfunction of patients with heart failure is either passive congestion due to increased filling pressures or low cardiac output and the consequences of impaired perfusion. Passive hepatic congestion may lead to increase of liver enzymes and total bilirubin. Right ventricular dysfunction can be associated with severe hepatic congestion, which can be asymptomatic and revealed only by abnormal liver function tests. When hemodynamic abnormalities are prolonged, the hepatic function is further altered, with impaired coagulation tests and decreased albumin synthesis. Morphologically, the liver becomes fibrotic and ultimately cardiac cirrhosis appears. Decreased perfusion from low cardiac output may be associated with hepatocellular necrosis and increased serum aminotransferases. Acute cardiogenic liver injury appears in severe systemic hypotension due to exacerbation of heart failure; the level of aminotransferases increases, as well as lactic dehydrogenase and prothrombin time.

The aim of our study was to evaluate the frequency and the importance of liver function tests abnormalities in a group of patients with chronic heart failure, as well as the prognostic value of these liver tests.

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The Use of the Composite Muco-perichondrial-cartilaginous Vascularised Septal Flap in the Reconstructive Surgery of the Skull..

2014-02

The Use of the Composite Muco-perichondrial-cartilaginous Vascularised Septal Flap in the Reconstructive Surgery of the Skull Base Defects

R. Hainăroșie, O. Ceachir, M. Hainăroșie, Irina G Ioniță, Cătălina Pietroșanu, V. Zainea

The original vascularised nasoseptal mucoperichondrial flap was described and used, in the endoscopic reconstructive surgery of the skull base tumors, for the first time in 2006, by two surgeons, Hadad and Bassagasteguy [1]. This kind of vascularised flap provides the surgeons the ability to close large skull base deffects after removing sinonasal tumors. The vascularisation is provided by the posterior septal branch of the spheno-palatine artery [1]. The flap is well vascularised and the surgeon is able to harvest a large surface flap using almost all septal mucosa from one nostril. Sometimes, if the defect that had to be reconstructed was very large, some authors reported that they harvested the nasal mucosa from the nasal floor too. Some modifications were reported on patients where the flap was created by using bilateral nasal mucosa, but no advantage was gained by sub-maximal, bilateral septal flap harvesting as compared to a single, large, long, unilateral flap, taken to the vestibular skin anteriorly and to the inferior meatus laterally including the palatal floor [2,3]. Bilateral mucosal elevation leaves denuded septal cartilage and bone on both sides of the septum which prolongs the return of nasal mucosal function unless a formal posterior septectomy is also performed. The large surface area of the nasoseptal flap allows great versatility of movement [4]. It is capable of reaching any single segment of the ventral skull base, including the sella turcica, planum sphenoidale, clivus or the cribriform plate [4,5]. At its largest dimension, the nasoseptal flap is able to cover an entire anterior craniofacial defect from the frontal sinus to the planum sphenoidale and from orbit to orbit. The good vascularisation of the flap and the origin of the vascular source provide the surgeon with the ability to rotate the flap almost all directions [5].

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Para-Aortic Lymphadenectomy Associated with Excision of Liver Lesions in Advanced-Stage Cervical Cancer - A Case Report

2014-02

N. Bacalbașa, Irina Balescu

Cervical cancer represents a major health problem, ranking worldwide as the second most frequent malignancy in women (1,2). Although screening tests for cervical cancer are widely utilized, there is still a large number of patients who are diagnosed in an advanced stage of the disease (3). The main patterns of tumoral spread involve mainly parametria, upper vagina, uterus and pelvic lymph nodes (4,5). The incidence of positive lymph nodes increases proportionally with FIGO stage: pelvic lymph node metastases range between 12% in stage Ib up to 43% in stage IIb (4). Metastases to the aortic lymph nodes are secondary to the pelvic ones, the risk of positive para-aortic lymph nodes rising up to 30 %; on the other hand, skip metastases to aortic nodes represents a very rare condition (6-10). Extended para-aortic lymph node dissection provides an appropriate debulking surgery, allows an adequate histological evaluation and disease staging and offers important information in order to plan the extension of postoperative radiation field (7-15).

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Nonsurgical Treatment of Hepatic Hydatid Cyst

2014-02

I. Brezean, M. Vilcu, E. Catrina, I. Pantea, D. Ferechide

Hopes for a medical treatment of the hydatid cyst are old. However, the noninvasive treatments (vaccinotherapy, immunotherapy, chemotherapy) used so far did not lead to a cure. The latest drugs introduced as treatment are albendazole and mebendazole with a parasiticidal effect and praziquantel with a parasitostatic effect. Chemotherapy indications, established by WHO in 1996, are the adjuvant treatment administered preoperatively and postoperatively in the plurivisceral hydatid disease

when surgical treatment is contraindicated. The contraindications for chemotherapy are given by the occurrence of cysts complications or by the death of the parasite (1). The results of chemotherapy as a single treatment are 10-13% cure, 40-60% partial remission, 10-30% failure (1,2). Albendazole is a benzimidazole anthelmintic derivative for roundworms, flatworms and the larval forms of E. Granulosus. It acts at the level of the parasites’ cells, respectively of the proligerous membrane of E. Granulosus by inhibiting the poly-merization of β-tubulin from which the intracyto-plasmic tubules are formed and through which glucose is absorbed. Blocking glucose absorption causes parasite’s death through a process of vesicula-tion and fibrosis of the proligerous membrane which becomes infertile. Albendazole dosage is 10-15/mg/kgc/day, in two daily doses, over a 30-day course of treatment, which is to be repeated after a two-week pause.

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The Ethical Implications of Complementary and Alternative Medicine in Systemic Lupus Erythematosus

2014-02

Monica Costescu, Simona Roxana Georgescu, F. Draghia, M. Tampa, L. Coman, Oana Andreia Coman

Lupus erythematosus is an autoimmune disease with multiple symptoms and each patient presents a particular clinical and immunological-biological profile. The cause of the disease remains unknown. Lupus erythematosus embraces three clinical forms: chronic, subacute and systemic. Events in the three clinical forms range from skin involvement (chronic form) to serious systemic implications, affecting patient's health and life (as a systemic disease).

The systemic form - systemic lupus erythematosus - has a wide range of immunological abnormalities that cause inflammation in various organs and systems. The inflammation occurs as a result of excessive production of autoantibodies, that are directed against self structures that are no longer recognized. In systemic lupus, cutaneous manifestations are often accompanied by renal, cardiac, osteoarticular, neuropsychiatric disorders.

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Vascular Calcifications, Major Risk Factor for Cardiovascular Events in Chronic Kidney Disease: An Update on the Pathophy...

2014-02

Vascular Calcifications, Major Risk Factor for Cardiovascular Events in Chronic Kidney Disease: An Update on the Pathophysiological Process

Alice Bălăceanu, Camelia Diaconu, Cristiana David, A. Niculae, Ileana Peride, Gheorghița Aron

Hypertension, diabetes mellitus, dyslipidaemia are frequently encountered in patients with chronic kidney disease (CKD) (1). They are the major risk factors for the development and progression of the endothelial dysfunction and atherosclerosis and contribute to the progression of renal failure (1). Microalbuminuria increases to two- to four-fold the cardiovascular risk (1). It is also a quantitative association between glomerular filtration rate (GFR) and cardiovascular risk (1). The risk increase to two to four-fold in stage 3 of CKD (GFR 30-59 mL/min/1.73 m˛), four- to 10-fold in stage 4 (GFR 15-29 mL/min/1.73 m˛) and 10- to 50-fold in stage 5 renal failure (GFR <15 mL/min/1.73 m˛ OR dialysis) in comparison with persons free of CKD (1). Atherosclerosis with intimal involvement and Moenckeberg’s media sclerosis are the main cardiovascular determinations in CKD. Coronary artery calcifications attain the highest levels in young adults patients with renal failure and dialysis, as has been shown in angiographic studies (2). These patients have many coronary risk factors leading to intimal calcifications and these are coexisting with medial calcification founded only in CKD (2). The degree of coronary artery calcifications seems to be related to the estimated GFR in a multivariate analysis (2).</p>

KDIGO guidelines recommend that patients with CKD stages 3-5D with known vascular/valvular calcification be considered at highest cardiovascular risk (class 2A recommendations) (3).

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The Management of Facial Fibrous Dysplasia

2014-02

V. Zainea, O. Ceachir, Mura Hainăroșie, Irina G Ioniță, Andreea Sorică, R. Hainăroșie

Fibrous dysplasia is a benign condition consisting in replacement of normal bone with fibrous tissue and unorganized bone woven (1). The malignant change to osteosarcoma can appear in less than 1% of cases (2). Osteosarcoma is found most often, but other lesions as fibrosarcoma, chondrosarcoma, and malignant fibrohistiocytoma are reported (3,4).

Fibrous dysplasia appears due to somatic activation of mutation in the G protein encoded by the gene GNAS. GNAS gene mutations cause McCune-Albright syndrome defined by the triad of PFD, café-au-lait skin macules and endocrinopathies, including amongothers, precocious puberty (5). It is caused by a random mutation in the GNAS gene that occurs very early in development.

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Zinc and Androgen Hormones in Benign Prostatic Hyperplasia

2014-02

C. Ene, Corina Daniela Ene (Nicolae), Ilinca Nicolae, L. Coman, Oana Andreia Coman

Prostatic pathology represents one of the most common causes of dermato-urological addressability, because of the varied age interval, but also because of the symptoms that decrease rapidly and visibly the patients’ quality of life.

Benign prostatic hypertrophy (BPH) is represented by increased volume of the prostate, which generates an obstructive and irritative symptomathology in the pelvic urinary tract. The hormonal influence presents a certain contribution in the development and evolution of BPH, by the imbalance occurred between androgens and estrogens, revealed by the significant decrease of the ratio androgens/estrogens hormones and by the inflammatory factors (1,2,3,4).

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Predictors of Increased Arterial Stiffness in Hypertensive Patients

2014-02

Oana Florentina Tăutu, Roxana Darabont, S. Onciul, A. Deaconu, Ioana Petre, R.D. Andrei, B. Drăgoescu, Maria Dorobanțu

In Romania, a high cardiovascular (CV) risk East European country, where prevalence of hypertension is still high and optimal blood pressure control still represents a doubtfull challange (1-5), adopting a treatment approach strategy based on total cardiovascular risk assessment can maximize the costeffectiveness of hypertensive patinets management, ensuring the best use of the limited resources of our health-care system, to prevent cardiovascular diseses and to decrease CV morbidity and mortality.

Recent research show that increased arterial stiffness represents an independent predictor of fatal and non-fatal CV events in hypertensive patients (6-10).

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Upper Digestive Tract Lesions in Inflammatory Bowel Diseases

2014-02

Adriana-Corina Andrei, Larisa-Elena Fulger, L.S. Andrei, G. Becheanu, Mona Dumbrava, Carmen-Monica Preda, M.M. Diculescu

Inflammatory bowel diseases, Crohn's disease (CD) and ulcerative colitis (UC), are chronic, idiopathic diseases characterized by the inflamation of the wall tube (1). Ulcerative colitis was first described in the mid-1800s (2), whereas Crohn's disease was first reported later, in 1932, as "regional ileitis" (3). Because Crohn's disease can involve the colon and shares clinical manifestations with ulcerative colitis, these entities have often been conflated and diagnosed as inflammatory bowel disease, although they are clearly distinct physiopathological entities. Ulcerative colitis is the most common form of inflammatory bowel disease worldwide. In contrast to Crohn's disease that can extend in the entire intestinal wall, ulcerative colitis is a disease of the mucosa that is less prone to complications and can be cured by means of colectomy, and in many patients, its course is mild (4).

Until recently, it was considered that, unlike Crohn's disease (whose location can be at any level of the digestive tract), ulcerative colitis is strictly localized in the colon. However, in the recent years, increasingly more studies reveal the existence of a moderate, chronic, diffuse gastroduodenitis in pacient with ulcerative colitis, which normally causes no macroscopical lesions being highlighted only based on histopathologic examination (5). Most of these studies invoke the presence in the duodenum of a diffuse inflamation with neutrophilic infiltration in the glandular crypts, with redness and swelling during an acute exacerbation. In the stomach the predominant lesions are chronic focal gastritis (5,6,7).

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Left Atrial Function in Patients with Reentrant Paroxysmal Supraventricular Tachycardia with Narrow QRS Complex - The Role of..

2014-02

Left Atrial Function in Patients with Reentrant Paroxysmal Supraventricular Tachycardia with Narrow QRS Complex - The Role of Speckle Tracking Echocardiography

Adriana Alexandrescu, S. Onciul, Ioana Petre, Oana Tautu, A. Scafa, Maria Dorobanțu

The reentrant paroxysmal supraventricular tachycardias with narrow QRS complex are in a large majority represented by atrioventricular reentrant tachycardia (AVRT) and atrioventricular nodal reentrant tachycardia (AVNRT). From an electrophysiological (EP) point of view the difference between the two forms is made by the type of the reentry circuit. That means that the former requires an accessory pathway with retrograde conduction while the latter implies the existence of perinodal pathways.

The left atrium (LA) is a part of the circuit in both types of arrhythmias. In sinus rhythm the left atrium has several functions: it acts as a conduit during protodiastole, it has a contractile function raising the filling pressure during atrial systole but it also has a reservoir function during ventricular systole. (1)

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The Academy of Medical Sciences - a Short History; National Missions in an International Context

2014-02

M. Ifrim

The Romanian Academy of Medical Sciences, a forum of consecration and lucrative activity, bearing an institutional counterpart in every country on the planet, came into being in 1935 by a Royal Decree issued based on the decision of the bicameral Parliament of the country, upon the initiative of Prof. Dr. Daniel Danielopolu. The Professor held from the very beginning the position of Permanent Executive Secretary of the forum, its Presidents coming from the ranks of personalities such as the Minister of Education at the time, Ion Angelescu, and many others that followed.

By the existent law, the Academy of Medical Sciences bore the responsibility, as a subordinate to the Ministry of Health, of conducting medical research and strategizing health policies. Following the French model, which is in fact a model for most, if not all, Academies spread around the globe, it was composed of Academicians from different specialties of medical activity.

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Hypopharyngeal defect reconstruction, following extended total laryngectomy, using a myocutaneous sternocleidomastoid flap

2014-01

O. Ceachir, R. Hainăroșie, V. Zainea

Hypopharyngeal cancer represents approximately 7% of all head and neck malignancies, occurring more frequently in men (male / female ratio 3:1) with a maximum incidence in the 6th and 7th decades (1, 2).

The lack of specific symptoms causes late presentation with advanced T-stage disease (T3-T4) which restricts surgical options to total laryngectomy with partial pharyngectomy or total laryngectomy with circular pharyngectomy, associated, in most cases, with bilateral neck dissection (1, 3). Submucosal extension of the tumor is what compels the surgeon to practice an extended resection in order to meet the criteria of oncological resection (4, 5). In order to achieve a primary suture of the pharynx is imperative that the width of the remaining mucosa is at least 2.5-3 cm (2, 6). If this goal is not achieved then the resectional stage is mandatory followed by a reconstructive one, in order to prevent pharyngocutaneous fistula occurrence, pharyngeal stenosis or poor vocal rehabilitation. For lateral pharyngeal wall defects, reconstruction can be performed using regional flaps (myocutaneous pectoralis major flap, lateral island trapezius, deltopectoral flap, latissimus myocutaneous flap, submental island flap) or free flaps (radial forearm fasciocutaneous free flap, lateral arm free flap) (1,2,3,5,6). If a circumferential resection has been performed the optimal reconstruction is the one that re-creates a lumen that can allow normal deglutition so, jejunal free flaps, ileocolic free flaps, radial arm free flaps, anterolateral tigh flap, peroneal flap, gastro-omental free flap, gastric transposition and many other methods were successfully used (3, 5, 6, 7, 8, 9). The reconstructive procedure performed by us used a pediculated, myocutaneous sternocleidomastoid flap harvested from the same side as the lesion and it was addressed to a lateral hypopharyngeal wall defect.

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Revascularization - A Key Element for Obtaining Granulation Tissue in a Patient with Diabetes and Arteriopathy

2014-01

Mihaela Vîlcu, Z. Filipovski, I. Brezean, T. Pătrașcu

The morbidity of the patients with diabetes is generated - besides the renal, occular, cerebral, cardiac impairment - to a great extent by the diabetic foot infections. The infection develops due to the ulcerations whose etiology (neuropathy or arteriopathy) is particularly important for the approach of the therapeutic algorhythm, which often involves an interdisciplinary collaboration. Diabetes mellitus is the risk factor associated with the highest rate of critical ischemia of the lower limbs. [1]

The association of peripheral arterial disease with infection represents the determining binomial of major amputations in the patient with diabetes and, in 80% of the cases, the gateway is an ulceration of the foot. [1].

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A Retrospective Clinical Study of 640 Scoliosis Treated by Posterior Segmental Rachisynthesis

2014-01

M. Jianu, A. Thiery, Beatrice Frumușeanu, Raluca Damean, Violeta Oriță

Although the scoliosis has in Romania relatively the same incidence as in most of the European countries, it is usually late diagnosed, when the Cobb angle has significant values.

Since 2010, Romania has a program of screening and early treatment of spine deformities funded by The Ministry of Health.

In a 14 years period in Pediatric Orthopedic Department of Central Emergengy Hospital for Children "Grigore Alexandrescu" Bucharest and also in the private hospitals "Regina Maria" and "Sanador" were examined and diagnosed 14.853 patients with scoliosis.

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Reactive Thrombocytosis in Pediatric Pathology

2014-01

Alina Deaconu, Cătălina Bica, D. Bulucea

Thrombocytosis (over 500.000/mmc) is classified as primary (clonal) or secondary (reactive). Increasing the number of platelets as response to various stimuli (inflammatory diseases, acute and recurrent bleeding, systemic infections or various types of malignancies) are considered to be reactive thrombocytosis [1,2,3].

Clonal or primary thrombocytosis (PT) is an abnormality of platelets production caused by clonal expansion of hematopoietic progenitor cells. In primary thrombocytosis autonomous platelets production is not regulated by physiological feedback mechanisms to maintain platelets count normal.

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The Dietotherapy of Malignant Degeneration of Small Intestine and Colon, Correlated with the Anticancerous Therapy

2014-01

T. Mogoș, Andra Evelin Iacobini

The presence of primary or metastatic cancer in small intestine has as a first line treatment the segmental resection. We reach the same therapeutic conduct in case of cancerous patients exposed to abdominal radiation therapy, sometimes severily affecting the small intestine (perforations, strictures, hemorrhages, fistulae). The nutritional implications of intestinal resection are significant, given the role of small intestine in digestion and absorbtion of nutricious principles, and the maintainance of enterohepatic circulation of biliary salts [1].

When we resort to ileal resection, if it does not exceed 100 cm, then a considerable part of biliary salts can not enter the reversed hepatic circuit (the surface for intestinal absorbtion diminishes) and they enter the colon, where they induce a watery diarrhea. It can be avoided if the patient is administered cholestyramine (it binds biliary salts, making them unable to induce diarrhea). Dietary measures alone are not sufficient. We start with 4 grams of cholestyramine per day, dosage after which the diarrhea stops abruptly. Afterwards, the dosage is decreased to half or less. In the mentioned conditions, though a part of the biliary salts loose their capacity to emulsify fats, the absorbtion of fats is not considerably disturbed [2].

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The Dietary Adjustment to the Digestive System’s Alterations Induced by the Anticancer Therapy

2014-01

T. Mogoș, Andra Evelin Iacobini

The nutrition of patients in which the cancerous disease has already spread does not cure the disease [1]. This statement is radically contrary to multiple theories supported by some followers of these cancer specific diets (ex. the shark cartilage diet, the distilled water and wheat seeds diet, etc.). This situation is also encountered in the neoplasm of the digestive system [1].

The objectives of the cancerous disease’s nutrition are represented by the ability to provide the caloric and nutritional requirements which are able to improve the patient’s clinical status, to increase the effort capacity, to extend the survival duration and to amplify the capacity to tolerate chemotherapy and radiation therapy [2].

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Clinical Characteristics and Outcomes of Patients with Heart Failure Hospitalized in the Clinical Emergency Hospital ofBucharest

2014-01

Camelia C. Diaconu, Bianca Paraschiv, Daniela Bartoș

Heart failure is a complex clinical syndrome that can be determined by any structural or functional cardiac disease that impairs the ability of the left ventricle to fill or eject blood. In developed countries, heart failure is a main cause of morbidity and mortality for adults older than 65 years, the risk of developing heart failure being increased with advancing age. Heart failure hospitalizations are associated with substantial morbidity and mortality. Understanding factors that influence clinical outcomes of patients hospitalized for heart failure, particularly the modifiable ones, may be useful for identifying strategies to improve the outcomes of these patients.

The aim of the study was to investigate the clinical characteristics, management and outcomes of patients with chronic heart failure consecutively admitted in the Internal Medicine Clinic of the Clinical Emergency Hospital of Bucharest, during a period of 8 months (1st of January - August 31, 2012).

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Contributions to the Study of Psychosocial Aspects in Hematologic Malignancies

2014-01

Amelia Maria Găman, M. A. Găman

Hematological malignancies are severe diseases, fatal when untreated, with a profound psychosocial impact on the patient, family members, friends and society. Scientific discoveries from the last years about the understanding of the pathophysiological mechanisms of hematological malignancies and the innovative modern treatment options (including bone marrow transplantation) have changed in a favourable way the evolution and the prognosis of patients with these diseases, but brought along other consequences on the quality of life, psychoemotional aspects and social insertion. The psychological manifestations are variable, occuring at each transitional point of illness: establishment and communication of diagnosis of the hematological malignancy, beginning of treatment, evolution and disease progression. The factors which influence the psychosocial response are the emotional stability of the person before diagnosis and the existence of a social support (family members, friends, colleagues).

The communication of diagnosis determined an acute emotional stress of the patient, family members and friends, because they associated the hematological malignancy with a severe disease, a specific aggressive long-term treatment, frequent and unpleasant side effects (nausea, vomiting, hair loss, sexual dysfunction, neurological complications, neutropenia etc), lenghty hospitalisation, family separation, temporary or definitive loss of social insertion, financial burden. The emotional response of the patient and family to the diagnosis of the hematological malignancy is characterised by shock, disbelief, denial, anxiety, depression, sleep and appetite disturbances, difficulty in performing everyday activities (1, 2, 3).

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The Importance of Aortic Arch Plaque Characteristics in Patients with Ischemic Stroke

2014-01

Mihaela Marian, Ana Câmpeanu, C. Popa

Stroke is the fourth leading cause of death inUnites States and the leading cause of adult morbidity and disability in Europe (1). Ischemic stroke represents approximately 88% of all strokes; however, in NINDS (National Institute of Neurological Disorders and Stroke) database almost 40% of ischemic strokes are listed as cryptogenic strokes (2). In the context of secondary prevention, establishing an etiological diagnosis is essential when it comes to prescribing the optimal treatment for every patient. Routine evaluation of a stroke patient includes evaluation of cervico-cerebral vessels and also cardiological evaluation in order to rule out an atrial arrhythmia with embolic potential in cerebral circulation (3,4).

Between the heart and the carotid and vertebral arteries lies the aorta, an area difficult to explore. Latest data from the literature suggest an association between aortic arch atheromas and ischemic stroke, thus aortic atheromatosis may be the missing link, responsible for most of the cerebral infarctions of undetermined cause (5,6).

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Arterial Hypertension Epidemiology: Romania among the Balkan Countries - Data from SEPHAR Surveys

2014-01

Maria Dorobanțu, S. Onciul, Roxana Darabont, Oana Tautu, S. Ghiorghe, Maria Vasilescu, I. Manitiu, C. Pop, D. Lighezan, E. Apetrei

Cardiovascular disease prevention showed its utility and efficiency in developed countries, where it lowered the cardiovascular morbidity and mortality. Instead, in Balkan countries, the mortality due to this pathology displayed an ascendant, worrying curve [1], diagnosis and control of arterial hypertension (HT) representing efficient methods for lowering cardiovascular mortality. Though recent studies didn’t show any significant differences between hypertension prevalence in developed versus developing countries [2], stroke mortality (the best surrogate marker of hypertension effects) was much higher in developing countries. Since modifying genetics was a target impossible to reach for the moment, the only solution was represented by the evaluation and correct treatment (pharmacological and non pharmacological) of arterial hypertension.

As international scientific organisations recom-mend, cardiovascular disease prevention must be implemented in an individualized way in each geo-graphical region, being inappropriate and impossible to apply the same prevention methods globally [3,9]. In this context, the Balkan Peninsula aggregates a number of countries with common geographical and social characteristics, many of them sharing economical transition.

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Toward an European Legislation in Administrating Forensic Probation

2014-01

V. Beliș

In 1994 I began working together with Prof. Scripcaru on elaborating new regulations regarding the expertise activity in Romania and we succeeded within the year to accomplish what we called "Law for the management of forensic institutes". After presenting it in front of the Romanian Parliament, this became an effectual law that has been adjusted since by the Law 459/2001, G.O. no. 57/2001 and the Law no. 271/2004.

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"Medicina Moderna" - New Series

2014-01

I. Popescu

The Romanian Academy of Medical Sciences has been honored to join the College of Physicians of Bucharest in the new series of "Medicina Modernă". Definitely, at this moment Romania needs good medical journals, where our medical scientists could publish. The demand is big, particularly since academic promotions are so much related to the articles published in indexed journals. The offer, unfortunately, is still rather small.

As we all know, it is not easy to get a journal indexed (especially in the ISI web of knowledge) and to keep it at such a high level. That impliesa lot of effort and a very good team. Without a good and efficient team such an endeavor cannot succeed.

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"Medicina Moderna" - A New Step in Sharing Medical Experience

2014-01

I. Lascăr

Starting with the first issue, published in 1994, the aim of "Medicina Modernă" Journal has been to promote the significant achievements of the Romanian medical activity, to communicate and share medical knowledge and to be a valuable database of Romanian research.

Because the Journal is under the patronage of Bucharest College of Physicians and Romanian Academy of Medical Sciences, doctors and researchers from all Romania and also from abroad can submit their work and most significant results, assuring them of the high standards of morality and ethics of our Journal.

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