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

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Wednesday, November 21 2018 @ 12:22 EET

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Obstructive Jaundice of Malignant Origin

2015-04

Claudiu Turculeț, Bogdan Popescu

Obstruction of the billiary tree caused by a malignant tumor of the head of the pancreas, of the extrahepatic bile ducts or of the ampula of Vater it seems to become more frequent in Romania. Our country places 10th in the incidence and 9th in mortality in Europe for pancreatic cancer in male patients[1]. Unfortunately most of the patients are not suited for a curative surgical treatment at the moment of the diagnosis.

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Posterior Pelvic Exenteration for Atypical Recurrence after Surgically Treated and Irradiated Endometrial Cancer

2015-04

Nicolae Bacalbașa, Irina Bălescu

Endometrial carcinoma is the fifth most common malignancy in women worldwide and the most common gynaecologic cancer in developed countries, being associated with increased fat consumption, obesity and exposure to unopposed estrogens (1,2,3). Endometrial cancer is usually diagnosed in an early stage of the disease; up to 75% of cases are diagnosed in stage I of the disease and are associated with good long term prognosis.

Unfortunately, it is estimated that in time 13% of cases diagnosed with endometrial cancer will develop recurrence, in these cases the mortality rate being up to 25% (4,5). Once the recurrent disease is diagnosed, the main therapeutic options include chemotherapy for distant or widely metastatic recurrence, radiotherapy for small, isolated pelvic recurrences especially if the patient had not been submitted to radiation therapy previously and resection for cases presenting localized centro-pelvic recurrence (6-8). However, most patients experiencing pelvic recurrence within the first three years after the initial diagnosis are diagnosed with vaginal vault relapse, in these cases total colpectomy or even pelvic exenteration being required (7,9,10).

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Intraoperative Monitoring of the Recurrent Laryngeal Nerve During Thyroidectomy

2015-04

Răzvan Hainăroșie, Octavian Ceachir, Mura Hainăroșie, Irina Ioniță, Cătălina Pietroșanu, Carmen Drăghici, Viorel Zainea

Following thyroidectomy, the preservation of the recurrent laryngeal nerve is the gold standard. Visual identification of the recurrent laryngeal nerve is mandatory during thyroidectomy. That technique has decreased the rate of permanent palsy during thyroid or parathyroid surgery (1). However, the palsy can occur when using only the visualization of the nerve, even in experienced hands (2).

Intraoperative nerve monitoring is a common technique in ear surgery, used to permanently monitor the facial nerve. This technique can be used in the thyroid surgery as well. Intraoperative neuromonitoring of the recurrent laryngeal nerve represents an adjuvant technique, until the visual identification and functional confirmation of the nerve.

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Controversies and challenges of chronic wound infection diagnosis and treatment

2015-04

Mara Mădălina Mihai, Călin Giurcăneanu, Liliana Gabriela Popa, Cornelia Nițipir, Mircea Ioan Popa

Over the last decade, chronic wounds such as venous or arterial ulcers, diabetic foot ulcers, pressure sores, and non-healing surgical wounds were brought into the spotlight of the medical community, due to their increasing prevalence and to their significant economic burden (1). In developed countries billions of dolars are spent each year (2,3) for the repeated hospitalizations and expensive treatment of patients suffering from non-healing ulcers. The persistent pain, either spontaneous or induced by treatment (4), the malodour of the ulceration (5), the mobility restrictions (6), and the excessive exudate, significantly impair the patients` quality of life, who might also experience secondary mood disorders (50-75%) (6) or sleep disorders (69%) (7).

The persistent bacterial colonization of the wound, as well as the longterm use of antibiotics predispose to the development of nosocomial infections with resistant strains such as methicillin resistant Staphylococcus aureus (MRSA), extended spectrum beta-lactamases (ESBLs) producing micro organisms, and multiple antibiotic resistant Pseudomonas aeruginosa(8).

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Alternative Pathways of Delivering Cardiac Resynchronization Therapy: A Single Center 10 Year Experience on 400 Consecutive...

2015-04

Alternative Pathways of Delivering Cardiac Resynchronization Therapy: A Single Center 10 Year Experience on 400 Consecutive Patients

D.A. Radu*, R.G. Vătășescu*, C. Iorgulescu, Ș. Bogdan, E. Ene, A. Năstasă, M. Dorobanțu

Heart failure (HF) can be either induced or aggravated by the existence of left ventricular (LV) intraventricular dyssynchrony (IVD). Cardiac resynchronization therapy (CRT) can potentially correct LV-IVD in well-characterized populations (see current Guidelines). CRT has demonstrated clear benefits in both soft (NYHA class, 6MWT, QoL) and hard (all cause mortality, 6 months hospitalizations) randomized control trial (RCT) endpoints. The standard approach is to deliver a unipolar (UP)/bipolar (BP) dedicated LV-lead via the coronary sinus (CS) into a postero-lateral (PL) tributary vein.

Suboptimal LV-lead positioning has been long recognized as an important cause of CRT non-response. Optimal, delay targeted LV-lead placement might sometimes only be possible with non-standard techniques due to various patient particularities. We decided to retrospectively evaluate the frequencies and types of techniques we used in over a decade of CRT experience in our centre. "Alternative CRT" is not yet a coined term. We defined unexpendable variations from the straightforward technique as alternative pathways of delivering CRT.

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Peripheral Arterial Disease in Hemodialysed Patients

2015-04

Ileana Peride, Daniela Rădulescu, Andrei Niculae, Alice Bălăceanu, Ileana Adela Văcăroiu, Ruxandra Diana Sinescu, Ionel Alexandru Checheriță

There is increased evidence that the prevalence of peripheral artery disease (PAD) in hemodialysed patients is higher than in general population [1,2]. According to ACC/AHA (American College of Cardiology / American Heart Association) guidelines, the following risk factors are associated with PAD [3,4]

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The Rehabilitation of Elderly Institutionalized Patients with Osteoarthritis (Multiple Joint Involvement) Using...

2015-04

The Rehabilitation of Elderly Institutionalized Patients with Osteoarthritis (Multiple Joint Involvement) Using Alternative Methods Associated to Drug Therapy

Mircea Ovidiu Lupușoru, Claudia-Camelia Burcea, Ileana Adela Văcăroiu, Silviu Pițuru, Ileana Peride, Iulian Brezean, Lucian Negreanu, Andrei Niculae, Luminița Georgescu, Gabriela Elena Lupusoru, Teodora Ionescu, Dumitru Ferechide

Osteoarthritis, as a major cause of disability and due to the high prevalence among chronic diseases, represents one of the most important public health problems worldwide [1]. The limitation of physical function and the restriction of independence produce negative effects on the mental status of patients suffering from osteoarthritis, namely the emergence of depression and decreased self-confidence [2,3].

Developing a kinesiotherapeutic strategy based on the clinical, anatomical and functional stage of the disease and other comorbidities, as well as exploiting psychological and psychopedagogical resources will improve the physical performance and increase the independence of these patients [4,5].

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Identification of Osteoarthritis with Multiple Joint Involvement in Elderly Institutionalized Patients Concomitant with...

2015-04

Identification of Osteoarthritis with Multiple Joint Involvement in Elderly Institutionalized Patients Concomitant with Psycho-Kinesiotherapeutic Intervention Strategies - A Preliminary Study

Claudia-Camelia Burcea, Mircea Ovidiu Lupușoru, Lucian Negreanu, Ileana Adela Văcăroiu, Silviu Pițuru, Andrei Niculae, Iulian Brezean, Ileana Peride, Luminița Georgescu, Gabriela Elena Lupușoru, Dumitru Ferechide

Related to the rehabilitation of patients with osteoarthritis, kinesiotherapy addresses the methods, procedures and methodology that will be used depending on the anatomic, functional and clinical stage of the disease and its location after setting treatment goals. Furthermore, priorities of the rehabilitation program are established considering both medical issues and also paramedical and social aspects [1].

The kinesiotherapeutic opera tional strategy in rehabilitating patients with osteoarthritis is planned according to the characteristic comorbidities of elderly patients [2]. Clinical trials highlight that cardiovascular mortality is reduced when sedentary individuals become moderately active [3,4].

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Three Paediatric Cases Study with Over 80% TBSA Burn Injury - Surgical Treatment by Using Skin Allografts: A Viable Option...

2015-04

Three Paediatric Cases Study with Over 80% TBSA Burn Injury - Surgical Treatment by Using Skin Allografts: A Viable Option for Alternative Cover

Cristina A. Avram, Dan M. Enescu, Dan Ionita

Burn is the most severe type of injury that a human being may suffer which can be quantified and evaluated by surface and depth of lesions. Treatment of this kind of injuries needs complex teams, competent and devoted, consistent therapeutic principles, specific conditions of care and specific funding.

In full thickness burns, deep partial burns on important functional area (hand, foot, periarticular regions) and burns up to 40% TBSA, predominantly deep, surgical treatment consists in early excision and grafting, which improve prognosis compared to the burned area and also cosmetic and functional results.

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Telemedicine as an Alternative Model for Delivering Healthcare Services: Preliminary Results of the MultiMED Project

2015-04

Andrei Manu-Marin

According to the formal definition of the profile American association, the term of telemedicine involves the use of medical information sent between two or more sites via electronic communication means, having as an ultimate goal the improvement of patients’ clinical condition.

After already four decades of development and practical use of this diagnostic and treatment modality, with demonstrations in hospitals extending their remote healthcare services, the use of telemedicine extended rapidly, now being integrated in different current operations in hospitals, specialty departments, home care agencies, private practice offices, and also in different workplaces or residential sites, benefiting nowadays of a variety (constantly increasing) of applications and services using bi-directional video broadcasts, e-mail services, smart phones, wireless devices and other forms of telecommunication technology.

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Advanced Genital Prolapse - Mesh Surgical Treatment

2015-04

O. Bratu, I. Oprea, D. Spīnu, B. Geavlete, C. Farcas, V. Calu, A. Niculae, D. Mischianu

Genital prolapse is a frequent pathology in women associated with different urological and gynecological complications affecting women `s normal life [1].

It is defined as pelvic organ slipped from their anatomical position through vagina. The pelvic structures which might slip are uterus, bladder, rectum, small intestine or vaginal vault. Each one of these benefits of a specific surgical procedure [1].

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Parathyroid Hormone-Related Bone Loss in End-Stage Renal Disease: Where to Measure?

2015-04

Dan Niculescu, Roxana Dusceac, Andra Caragheorgheopol, Gener Ismail, Catalina Poiana

Renal osteodystrophy is almost universally found in patients with end-stage renal disease (ESRD). Although bone biopsy is the gold standard for assessment of bone status it is infrequently used.

Guidelines (KDIGO, 2009) recommend the use of dual-energy X-ray absorptiometry (DXA), as a method for measuring bone quantity, in all dialysis patients who either have had fractures or have risk factors for osteoporosis but state against routine use of DXA for bone mineral density (BMD) measurement. This is because low BMD measured by DXA was consistently associated with an increased risk of low trauma fractures in general population but in patients with ESRD studies produced conflicting results (Inaba et al., 2005; Jamal et al., 2002; Kaji et al., 2002; Urena et al., 2003; Yamaguchi et al., 1996). There are many causes of this heterogeneity including secondary hyperparathyroidism, presence of low bone turnover disease, osteomalacia, site of BMD measurement or fracture assessment (clinical vs. radiological).

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Transoral Approach of the Parapharyngeal Tumors

2015-04

Andreea Sorică, V. Zainea, Octavian Ceachir, Irina-Gabriela Ioniță, Cătălina Pietroșanu, Carmen Drăghici, Cristina Zamfir, Răzvan Hainăroșie

Parapharyngeal space has the shape of a reversed pyramid with the base at the cranial surface delimited by temporal and sphenoid bone and and the top pointing to the large horn of the hyoid bone.[1] Styloid diaphragm divides the parapharyngeal space into two regions with different anatomy and constituents: prestyloid space, anterior, conta-ining the deep lobe of the parotid gland, internal maxillary artery, inferior alveolar nerve, lingual, auriculo-temporal, and retrostyloid space, posterior, neurovascular, that contains the internal carotid artery, internal jugular vein, cranial nerves glossopharyngeal, vagus, accessory, hypoglossal and cervical sympathetic chain. [2]

Tumors arising in parapharyngeal space are rare, representing less than 1% of all head and neck malignancies. Any of the structures contained in this space can be a starting point for developing a tumor masses at this level. Most of these tumors are benign, approximately 20% are malignant. [1] The most common tumors of the salivary gland tissue derived from space and are epithelial in nature. Others are likely neurogenic, vascular, lymphatic, etc. [3]

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The Benefit of Breast Reconstruction after Mastectomy

2015-04

Iulia Mihaela Iacob, Crenguța Coman, Ruxandra Mihai, Dragoș Zamfirescu, Șerban Dumitrache, Ioan Petre Florescu, Carmen Giuglea

Being diagnosed with breast cancer means that the involved patients are dealing with a new phase in their lives. We can say that their priorities change radically. A study from 2011 shows that the leading cause of cancer deaths, in women, in developing countries, is breast cancer, compared to the past decade where the main cause was the cervical cancer. (1)

Up to accepting the diagnosis and regaining the strength to move forward, women go through frustration, denial, guilt, feelings exacerbated by physical mutilation (mastectomy) which they have to deal with this disease. Breast cancer is the most commonly diagnosed cancer and the main cause of cancer death among females, representing 23% of total cancer cases and 14% of cancer deaths. (1)

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Age-Dependent Prevalence of Persistent Wheezing Phenotypes in Romanian Children

2015-04

Marius Cornitescu, Gabriel Mircescu, Mariana Moiceanu, Eugenia Buzoianu, Andrei Zamfirescu, Marcel Plesca, Doina Anca Plesca

Asthma is a heterogeneous group of disease entities with common characteristics such as intermittent respiratory symptoms (wheezing, tightness, cough, dyspnea), reversible airway obstruction and bronchial hyperresponsiveness [1]. Wheezing, caused by airflow restriction through narrowed airways, is the main clinical sign associated with asthma.

Two concepts related to asthma are currently in a process of disentanglement: the concept of asthma phenotypes (particular clinical characteristics, without reference to the underlying pathologic process) and endotypes (pathological mechanisms of disease) [2]. The disentangling of asthma phenotypes and endotypes is important for the prediction of disease evolution and for accurate therapeutic action.

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Economic Impact of Early Detection and Treatment of Skin Cancer on the Health Care System

2015-04

Laura Raducu, Diana Ruxandra Sinescu, Cristina Nicoleta Cozma, Iulia Cristina Filip, Cristian Radu Jecan

Non-melanoma skin cancer (NMSC) ranks as the fifth most costly cancer to treat in the United States even though the mortality rate is not high [1].

In Romania, the dermatologist is the one who generally detects skin cancer, but any clinician, especially the primary care physician who has a constant connection with the patient, plays an important role in skin cancer detection. In the early detection stage, a good collaboration with the plastic surgeon permits the surgical excision of the tumour with oncologic safety margins and primary suture, resulting in minimal costs [2]. Unfortunately, a great number of patients involved in our study (>84%) showed up in more advanced stages which required a reconstructive method.

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Modern Diagnostic Approach of Acute Lymphoblastic Leukemia in Children and Adolescents...

2015-04

Modern Diagnostic Approach of Acute Lymphoblastic Leukemia in Children and Adolescents - Experience of a Single Pediatric Hematology-Oncology Center

Claudia Dita, Anca Colita, Mirela Asan, Anca Gheorghe, Constantin Arion

Acute lymphoblastic leukemia (ALL) is the most frequent malignancy in children, representing 25% of all the neoplastic diseases in people younger than 15 years [1].

The peak of incidence is between ages 2 and 3 years [1]. In adolescents (15 to 19 years), ALL comprises only 7% of all cancers [2]. In the United States, it is estimated that 2500 - 3500 children are diagnosed with ALL every year [1]. The incidence appears to be increasing. In Europe it was reported a 1.4% increase in incidence from 1970 to 1999 [3].

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A History of an Old and Still New Disease: Urinary Lithiasis

2015-04

Dan Mischianu, Dan Spinu, Cătălin Pricop, Ovidiu Bratu

We believe that with the apparition of the first settlements and the act of eating also appeared the first potentially urinary lithiasis patients.

One of the "leading minds"[1] of the twentieth century, Margaret Mead (1901-1978) (fig. 1), renowned anthro-pologist used to say "it is easier to change a nation religion rather its eating habits".

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