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

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The Use of the Composite Muco-perichondrial-cartilaginous Vascularised Septal Flap in the Reconstructive Surgery of the Skull..

2014-02

The Use of the Composite Muco-perichondrial-cartilaginous Vascularised Septal Flap in the Reconstructive Surgery of the Skull Base Defects

R. Hainăroșie, O. Ceachir, M. Hainăroșie, Irina G Ioniță, Cătălina Pietroșanu, V. Zainea

The original vascularised nasoseptal mucoperichondrial flap was described and used, in the endoscopic reconstructive surgery of the skull base tumors, for the first time in 2006, by two surgeons, Hadad and Bassagasteguy [1]. This kind of vascularised flap provides the surgeons the ability to close large skull base deffects after removing sinonasal tumors. The vascularisation is provided by the posterior septal branch of the spheno-palatine artery [1]. The flap is well vascularised and the surgeon is able to harvest a large surface flap using almost all septal mucosa from one nostril. Sometimes, if the defect that had to be reconstructed was very large, some authors reported that they harvested the nasal mucosa from the nasal floor too. Some modifications were reported on patients where the flap was created by using bilateral nasal mucosa, but no advantage was gained by sub-maximal, bilateral septal flap harvesting as compared to a single, large, long, unilateral flap, taken to the vestibular skin anteriorly and to the inferior meatus laterally including the palatal floor [2,3]. Bilateral mucosal elevation leaves denuded septal cartilage and bone on both sides of the septum which prolongs the return of nasal mucosal function unless a formal posterior septectomy is also performed. The large surface area of the nasoseptal flap allows great versatility of movement [4]. It is capable of reaching any single segment of the ventral skull base, including the sella turcica, planum sphenoidale, clivus or the cribriform plate [4,5]. At its largest dimension, the nasoseptal flap is able to cover an entire anterior craniofacial defect from the frontal sinus to the planum sphenoidale and from orbit to orbit. The good vascularisation of the flap and the origin of the vascular source provide the surgeon with the ability to rotate the flap almost all directions [5].

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Para-Aortic Lymphadenectomy Associated with Excision of Liver Lesions in Advanced-Stage Cervical Cancer - A Case Report

2014-02

N. Bacalbașa, Irina Balescu

Cervical cancer represents a major health problem, ranking worldwide as the second most frequent malignancy in women (1,2). Although screening tests for cervical cancer are widely utilized, there is still a large number of patients who are diagnosed in an advanced stage of the disease (3). The main patterns of tumoral spread involve mainly parametria, upper vagina, uterus and pelvic lymph nodes (4,5). The incidence of positive lymph nodes increases proportionally with FIGO stage: pelvic lymph node metastases range between 12% in stage Ib up to 43% in stage IIb (4). Metastases to the aortic lymph nodes are secondary to the pelvic ones, the risk of positive para-aortic lymph nodes rising up to 30 %; on the other hand, skip metastases to aortic nodes represents a very rare condition (6-10). Extended para-aortic lymph node dissection provides an appropriate debulking surgery, allows an adequate histological evaluation and disease staging and offers important information in order to plan the extension of postoperative radiation field (7-15).

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Nonsurgical Treatment of Hepatic Hydatid Cyst

2014-02

I. Brezean, M. Vilcu, E. Catrina, I. Pantea, D. Ferechide

Hopes for a medical treatment of the hydatid cyst are old. However, the noninvasive treatments (vaccinotherapy, immunotherapy, chemotherapy) used so far did not lead to a cure. The latest drugs introduced as treatment are albendazole and mebendazole with a parasiticidal effect and praziquantel with a parasitostatic effect. Chemotherapy indications, established by WHO in 1996, are the adjuvant treatment administered preoperatively and postoperatively in the plurivisceral hydatid disease

when surgical treatment is contraindicated. The contraindications for chemotherapy are given by the occurrence of cysts complications or by the death of the parasite (1). The results of chemotherapy as a single treatment are 10-13% cure, 40-60% partial remission, 10-30% failure (1,2). Albendazole is a benzimidazole anthelmintic derivative for roundworms, flatworms and the larval forms of E. Granulosus. It acts at the level of the parasites’ cells, respectively of the proligerous membrane of E. Granulosus by inhibiting the poly-merization of β-tubulin from which the intracyto-plasmic tubules are formed and through which glucose is absorbed. Blocking glucose absorption causes parasite’s death through a process of vesicula-tion and fibrosis of the proligerous membrane which becomes infertile. Albendazole dosage is 10-15/mg/kgc/day, in two daily doses, over a 30-day course of treatment, which is to be repeated after a two-week pause.

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The Ethical Implications of Complementary and Alternative Medicine in Systemic Lupus Erythematosus

2014-02

Monica Costescu, Simona Roxana Georgescu, F. Draghia, M. Tampa, L. Coman, Oana Andreia Coman

Lupus erythematosus is an autoimmune disease with multiple symptoms and each patient presents a particular clinical and immunological-biological profile. The cause of the disease remains unknown. Lupus erythematosus embraces three clinical forms: chronic, subacute and systemic. Events in the three clinical forms range from skin involvement (chronic form) to serious systemic implications, affecting patient's health and life (as a systemic disease).

The systemic form - systemic lupus erythematosus - has a wide range of immunological abnormalities that cause inflammation in various organs and systems. The inflammation occurs as a result of excessive production of autoantibodies, that are directed against self structures that are no longer recognized. In systemic lupus, cutaneous manifestations are often accompanied by renal, cardiac, osteoarticular, neuropsychiatric disorders.

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Vascular Calcifications, Major Risk Factor for Cardiovascular Events in Chronic Kidney Disease: An Update on the Pathophy...

2014-02

Vascular Calcifications, Major Risk Factor for Cardiovascular Events in Chronic Kidney Disease: An Update on the Pathophysiological Process

Alice Bălăceanu, Camelia Diaconu, Cristiana David, A. Niculae, Ileana Peride, Gheorghița Aron

Hypertension, diabetes mellitus, dyslipidaemia are frequently encountered in patients with chronic kidney disease (CKD) (1). They are the major risk factors for the development and progression of the endothelial dysfunction and atherosclerosis and contribute to the progression of renal failure (1). Microalbuminuria increases to two- to four-fold the cardiovascular risk (1). It is also a quantitative association between glomerular filtration rate (GFR) and cardiovascular risk (1). The risk increase to two to four-fold in stage 3 of CKD (GFR 30-59 mL/min/1.73 m˛), four- to 10-fold in stage 4 (GFR 15-29 mL/min/1.73 m˛) and 10- to 50-fold in stage 5 renal failure (GFR <15 mL/min/1.73 m˛ OR dialysis) in comparison with persons free of CKD (1). Atherosclerosis with intimal involvement and Moenckeberg’s media sclerosis are the main cardiovascular determinations in CKD. Coronary artery calcifications attain the highest levels in young adults patients with renal failure and dialysis, as has been shown in angiographic studies (2). These patients have many coronary risk factors leading to intimal calcifications and these are coexisting with medial calcification founded only in CKD (2). The degree of coronary artery calcifications seems to be related to the estimated GFR in a multivariate analysis (2).</p>

KDIGO guidelines recommend that patients with CKD stages 3-5D with known vascular/valvular calcification be considered at highest cardiovascular risk (class 2A recommendations) (3).

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The Management of Facial Fibrous Dysplasia

2014-02

V. Zainea, O. Ceachir, Mura Hainăroșie, Irina G Ioniță, Andreea Sorică, R. Hainăroșie

Fibrous dysplasia is a benign condition consisting in replacement of normal bone with fibrous tissue and unorganized bone woven (1). The malignant change to osteosarcoma can appear in less than 1% of cases (2). Osteosarcoma is found most often, but other lesions as fibrosarcoma, chondrosarcoma, and malignant fibrohistiocytoma are reported (3,4).

Fibrous dysplasia appears due to somatic activation of mutation in the G protein encoded by the gene GNAS. GNAS gene mutations cause McCune-Albright syndrome defined by the triad of PFD, café-au-lait skin macules and endocrinopathies, including amongothers, precocious puberty (5). It is caused by a random mutation in the GNAS gene that occurs very early in development.

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Zinc and Androgen Hormones in Benign Prostatic Hyperplasia

2014-02

C. Ene, Corina Daniela Ene (Nicolae), Ilinca Nicolae, L. Coman, Oana Andreia Coman

Prostatic pathology represents one of the most common causes of dermato-urological addressability, because of the varied age interval, but also because of the symptoms that decrease rapidly and visibly the patients’ quality of life.

Benign prostatic hypertrophy (BPH) is represented by increased volume of the prostate, which generates an obstructive and irritative symptomathology in the pelvic urinary tract. The hormonal influence presents a certain contribution in the development and evolution of BPH, by the imbalance occurred between androgens and estrogens, revealed by the significant decrease of the ratio androgens/estrogens hormones and by the inflammatory factors (1,2,3,4).

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Predictors of Increased Arterial Stiffness in Hypertensive Patients

2014-02

Oana Florentina Tăutu, Roxana Darabont, S. Onciul, A. Deaconu, Ioana Petre, R.D. Andrei, B. Drăgoescu, Maria Dorobanțu

In Romania, a high cardiovascular (CV) risk East European country, where prevalence of hypertension is still high and optimal blood pressure control still represents a doubtfull challange (1-5), adopting a treatment approach strategy based on total cardiovascular risk assessment can maximize the costeffectiveness of hypertensive patinets management, ensuring the best use of the limited resources of our health-care system, to prevent cardiovascular diseses and to decrease CV morbidity and mortality.

Recent research show that increased arterial stiffness represents an independent predictor of fatal and non-fatal CV events in hypertensive patients (6-10).

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Upper Digestive Tract Lesions in Inflammatory Bowel Diseases

2014-02

Adriana-Corina Andrei, Larisa-Elena Fulger, L.S. Andrei, G. Becheanu, Mona Dumbrava, Carmen-Monica Preda, M.M. Diculescu

Inflammatory bowel diseases, Crohn's disease (CD) and ulcerative colitis (UC), are chronic, idiopathic diseases characterized by the inflamation of the wall tube (1). Ulcerative colitis was first described in the mid-1800s (2), whereas Crohn's disease was first reported later, in 1932, as "regional ileitis" (3). Because Crohn's disease can involve the colon and shares clinical manifestations with ulcerative colitis, these entities have often been conflated and diagnosed as inflammatory bowel disease, although they are clearly distinct physiopathological entities. Ulcerative colitis is the most common form of inflammatory bowel disease worldwide. In contrast to Crohn's disease that can extend in the entire intestinal wall, ulcerative colitis is a disease of the mucosa that is less prone to complications and can be cured by means of colectomy, and in many patients, its course is mild (4).

Until recently, it was considered that, unlike Crohn's disease (whose location can be at any level of the digestive tract), ulcerative colitis is strictly localized in the colon. However, in the recent years, increasingly more studies reveal the existence of a moderate, chronic, diffuse gastroduodenitis in pacient with ulcerative colitis, which normally causes no macroscopical lesions being highlighted only based on histopathologic examination (5). Most of these studies invoke the presence in the duodenum of a diffuse inflamation with neutrophilic infiltration in the glandular crypts, with redness and swelling during an acute exacerbation. In the stomach the predominant lesions are chronic focal gastritis (5,6,7).

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Left Atrial Function in Patients with Reentrant Paroxysmal Supraventricular Tachycardia with Narrow QRS Complex - The Role of..

2014-02

Left Atrial Function in Patients with Reentrant Paroxysmal Supraventricular Tachycardia with Narrow QRS Complex - The Role of Speckle Tracking Echocardiography

Adriana Alexandrescu, S. Onciul, Ioana Petre, Oana Tautu, A. Scafa, Maria Dorobanțu

The reentrant paroxysmal supraventricular tachycardias with narrow QRS complex are in a large majority represented by atrioventricular reentrant tachycardia (AVRT) and atrioventricular nodal reentrant tachycardia (AVNRT). From an electrophysiological (EP) point of view the difference between the two forms is made by the type of the reentry circuit. That means that the former requires an accessory pathway with retrograde conduction while the latter implies the existence of perinodal pathways.

The left atrium (LA) is a part of the circuit in both types of arrhythmias. In sinus rhythm the left atrium has several functions: it acts as a conduit during protodiastole, it has a contractile function raising the filling pressure during atrial systole but it also has a reservoir function during ventricular systole. (1)

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The Academy of Medical Sciences - a Short History; National Missions in an International Context

2014-02

M. Ifrim

The Romanian Academy of Medical Sciences, a forum of consecration and lucrative activity, bearing an institutional counterpart in every country on the planet, came into being in 1935 by a Royal Decree issued based on the decision of the bicameral Parliament of the country, upon the initiative of Prof. Dr. Daniel Danielopolu. The Professor held from the very beginning the position of Permanent Executive Secretary of the forum, its Presidents coming from the ranks of personalities such as the Minister of Education at the time, Ion Angelescu, and many others that followed.

By the existent law, the Academy of Medical Sciences bore the responsibility, as a subordinate to the Ministry of Health, of conducting medical research and strategizing health policies. Following the French model, which is in fact a model for most, if not all, Academies spread around the globe, it was composed of Academicians from different specialties of medical activity.

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