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

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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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