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

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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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