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

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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 BrÓnzea, 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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