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

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Tuesday, July 17 2018 @ 04:40 EEST

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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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