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

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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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