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

Welcome to ModernMedicine
Wednesday, November 21 2018 @ 12:54 EET

View Printable Version

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.

View full article
View Printable Version

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].

View full article
View Printable Version

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.

View full article
View Printable Version

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.

View full article
View Printable Version

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].

View full article
View Printable Version

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].

View full article
View Printable Version

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).

View full article
View Printable Version

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).

View full article
View Printable Version

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).

View full article
View Printable Version

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.

View full article
View Printable Version

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.

View full article
View Printable Version

"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.

View full article
View Printable Version

"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.

View full article