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

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Wednesday, December 19 2018 @ 03:29 EET

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THROMBUS FORMATION ON DISRUPTED PLAQUES

2014-03

A. Yamashita and Y. Asada

Acute cardiovascular events that usually involve thrombus formation at sites of disrupted atherosclerotic plaques are currently described as atherothrombosis. Thrombosis is a major complication of atherosclerosis and also a rare but serious complication after stent implantation. However, it does not always result in complete thrombotic occlusion with subsequent acute symptomatic events (1). Therefore, thrombus growth is critical to the onset of clinical events. Thrombus formation is probably modulated by the thrombogenicity of exposed plaque constituents, local hemorheology, systemic thrombogenicity and fibrinolytic activity. Although the mechanisms of thrombus formation have been intensively investigated, little is known about either the mechanisms involved in thrombogenesis or thrombus growth after plaque disruption and stent implantation. This article examines the pathology of atherothrombosis, including late drug-eluting stent (DES) thrombosis, and recent advances in the understanding of thrombogenetic mechanisms and thrombus growth on atherosclerotic lesions, especially coronary atherothrombosis.

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ENDOTHELIAL DYSFUNCTION AND INFLAMMATION

2014-03

M. Slevin and G. McDowell

Conventional based methods of catheter removal of arterial blockages formed during the process of atherosclerosis often result in production of a series of rapidly occurring events which follow the balloon catheter-induced tearing of the existing atherosclerotic plaques and concomitant arterial damage and luminal destruction and ending with significant lumen narrowing within a period of around 6 months (between 4-10% of cases following endarterectomy and approximately 33% of cases in coronary arteries for example; Fig. 1).

The more recent introduction of stents has helped to resolve/reduce some of the problems associated with balloon angioplasty, in that it provides a scaffold which can prevent constriction from the intima, and when coated with anti-proliferative or anti-inflammatory drugs, can significantly slow down the process of in-stent restenosis. However, angiographic restenosis (>50%) and clinical symptomatic restenosis still occurs in 20-30% and 10-15% of patients respectively in the first year after treatment (1), and evidence has shown that there is no significant difference in long-term (3-5 years) follow up regarding subsequent myocardial infarction and death (2).

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The Use of Ultrasonic Aspirator in the Surgery of the Fibrous Dysplasia Involving the Skull Base

2014-03

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

Craniofacial fibrous dysplasia is a non-malignant disease. It appears due to the mutations of the GNAS gene that results in inhibition of the differentiation and proliferation of bone-forming stromal cells and leads to the replacement of normal bone and marrow by fibrous tissue and woven bone. Sometimes it is isolated to a single or multiple skeletal sites and / or endocrine organ (1, 2, 3, 4).

The disease commonly progress as a slow developing mass. Distortion of optic nerve, eye ball, nasal airway, facial nerve, teeth and middle year ossicles can occur. In young patients, at prepubertal age, the growth is rapid and can cause aneurismal bone cysts or mucoceles (1, 3, 5). The malignant change to osteosarcoma or other form of sarcoma can appear in less than 1% of cases (1, 2).

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The Inferior Gluteal Flap - Breast Reconstruction - Anatomic Dissection on a Cadaver

2014-03

S. Cortan, I. Lascar, I.P. Florescu, M. Valcu, Ioana Teona Sebe

The breast has been the expression of beauty and fertility since ancient times. The aesthetic reconstruction of the breast is and has been a challenge for plastic surgeons. Microsurgical techniques of dissection and free transfer are commonly used.

During the dissection of one fresh, female cadaver, age 67, a free inferior gluteal flap was taken from gluteal region, using loupe magnification. The dissection preparations were photographed with a high definition camera.

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POSTERIOR PELVIC EXENTERATION FOR ADVANCED, UNRESPONSIVE TO RADIATION THERAPY CERVICAL CANCER - A CASE REPORT

2014-03

N. Bacalbașa, Irina Bălescu

Although pelvic exenterations represent aggressive surgical procedures which might associate physical and psychological problems and a worsened body image, they are the only potential solution with curative intent in centro-pelvic tumors originating from both digestive and gynecologic tract. (1,2,3) In selected cases preoperative oncologic treatment can offer a tumor down-staging or can diminish the tumoral invasion in adjacent organs providing this way the possibility of less aggressive surgical procedures. In other cases this desiderate cannot be obtained; the tumor proves to be unresponsive to neo-adjuvant treatment and multivisceral resections being needed in order to obtain a good control of the disease. Studies have shown that clinical features of the tumor and both molecular and non-molecular biomarkers can be responsible for the poor tumoral response at irradiation. (4) In these cases surgery remains the only treatment with curative intent. We present the case of a 62 year old patient diagnosed with a large cervical tumor in which neo-adjuvant treatment failed to obtain an acceptable control of the disease. She was addressed to our service after augmentation of the tumor under neo-adjuvant treatment; we performed a total hysterectomy en bloc with bilateral adnexectomy, total colpectomy, abdomino-perineal rectal resection and pelvic lymph node dissection with good results.

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The Use of Coblation in the Surgery of the Juvenile Angiofibroma

2014-03

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

Coblation is a surgical technology which consists in delivering radiofrequency energy to soft tissue. This technology uses radiofrequency in a bipolar mode with a conductive solution, such as saline (1). It energizes the ions in the saline to form localized plasma near the tissue placed in the area of surgical interest. Plasma’s energy dissociates water molecules from saline solution thus providing the optimal chemical conditions for breaking the tissue’s molecular bonds (2).

The application of this technology has three effects: tissue ablation, localized removal and tissue volumetric reduction (2). The dissipated heat by using this type of radiosurgery is significantly lower than common radiofrequency techniques. This is due to intrinsic of the chemical process and the continuous cooling of the tissue from the surrounding saline solution at the level of the instrument’s tip (3). In this way the temperature rises to 45-85°C (1, 2). The decreased thermal effect of coblation, better than classic radiosurgery, induces a gentle but efficient surgical effect in the target area. Thus the surgeon can gently remove tumors, small organs (tonsils) and can melt some anatomical structures (turbinate, palate, base of tongue). There is a large field of surgical applications in the pathology of the upper aero digestive tract.

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Narrow Band Imaging - From Technological Progress to Superior Urothelial Cancer Diagnostic

2014-03

M. Jecu, P. Geavlete, I.A. Checheriță, C. Ene, B. Geavlete

Bladder cancer represents the most common malignancy of the urinary tract and the 7th most frequent cancer in men and 17th in women. The prevalence of this malignancy varies between regions and countries. In Europe for example, the highest age-standardized incidence rate has been reported in Spain and the lowest in Finland (1). In the United States, the incidence and mortality due to bladder cancer is also high (more than 60,000 new cases and up to 13,000 deaths annually) (2). Therefore, in the last decades, it has been noticed an increased prevalence of bladder cancer, probably caused by tobacco abuse, industrial carcinogens risk factors and overall aging process of the population (3).

75-85% of all newly diagnosed bladder tumors is represented by non-muscle-invasive bladder cancer (NMIBC), a multifocal disease, that includes stages pTa, pT1 and carcinoma in situ (CIS) (4). Furthermore, this pathology has a high recurrence rate within the first 5 years after the initial diagnosis (5), despite the recent technological advances (6).

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Multiple Benefic Effects of the Systemic Exposure to the Hydroxychloroquine Sulfate

2014-03

Aida (Pancă) Geamănu, Alina Popa-Cherecheanu, B. Marinescu, D.C. Geamănu, Liliana Voinea

In the twentieth century, the widespread use of quinacrine by the U.S. military as malaria prophylaxis was accompanied by other observations suggesting efficacy for treatment of rheumatologic diseases [1].

During the 1950s, the hydroxychloroquine (HCQ) derivative of quinacrine showed a favorable usage profile with less eye toxicity than chloroquine itself, and the use of this agent in the treatment of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) has become common. In RA, HCQ is usually a component of a drug combination, including triple drug therapy with methotrexate and sulfasalazine, a formula which was claimed as a safe alternative, well tolerated compared to expensive biological therapies [2].

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HYPONATREMIA IN PREDIALYSIS HOSPITALIZED PATIENTS: AN UPDATE ON CLINICAL DATA AND MANAGEMENT

2014-03

Alice Bălăceanu, I.A. Checheriță, A. Niculae, Ileana Peride, Camelia Diaconu, Gheorghița Aron

Hyponatremia, with an incidence of 15 - 22%, is considered when serum sodium levels are < 135 mEq/L (in institutionalized geriatric patients, in 1 - 4% to 7 - 53% cases there have been reported values below 130 mEq/L) [1-3]. Additionally, according to expert panel recommendations the frequency of hyponatremia in hospitalized patients depends on the detected level of hyponatremia [2]. This special condition is highly important to be detected on time because it represents a recognized risk factor of morbidity and mortality, even in asymptomatic patients [1]. Furthermore, it was noticed that a swift correction can induce severe neurological disorders and even death [1]. Therefore, for an adequate treatment management (prophylaxis and therapy) is vital for understanding hyponatremia main causes and the incriminated pathophysiological mechanisms [1].

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PERFORATORS OF THE CALF ARTERIES - ANATOMICAL STUDY

2014-03

Crenguța Coman, D.M. Enescu, Iulia Iacob, S. Dumitrache, C. Bejinariu, Carmen Giuglea

In reconstructive surgery, perforator flaps have a short history. Not more than 27 years ago, Nakajima et al. described the six types of perforator vessels known at present: direct cutaneous, direct septocutaneous, direct cutaneous branch of muscular vessel, perforating cutaneous branch of muscular vessel, septocutaneous perforator and musculo-cutaneous perforator [1]. (Fig. 1)

The knowledge about these perforator vessels continuously grew, by identifying the vascular networks of the entire body, formed by the perforator vessels. Therefore, it became possible to create a lot of perforator flaps based on these perforator vessels [2]. Thus, perforator flaps can be considered the latest milestone in the evolution of reconstructive flap surgery. Many methods are used for investigating the exact location of the perforators, such as imaging methods: computed tomography, magnetic resonance angiography and lately thermal imaging that became also reliable [3]. The exact knowledge of the location and caliber of perforators became a real help for plastic surgeons, especially in the calf area, where the reconstructive method has to accomplish the functional and aesthetic needs for both reconstructed and donor areas.

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Study Regarding the Distribution and Degree of Dysplasia of Colonic Polyps

2014-03

M. Ifrim, C. Toth, C. Precup

There are worldwide standardization attempts, through therapeutic guidelines of colon cancer screenings. For a screening to be effective, it must involve a more complex understanding of risk factors, finding effective methods and most importantly to applied en masse at an acceptable cost.

In this study I tried to present the situation regarding colon cancer screening in at risk patients in Arad county.

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Split-thickness Skin Grafting in the Treatment of Surgically Operated Diabetic Foot. A Retrospective 2-Year Study (2010-2011)

2014-03

Mihaela Vilcu, E. Catrina, T. Pătrașcu, Z. Filipovski, I. Brezean

Diabetes mellitus is a major health problem with significant impact on the quality of life, due to both its complications and comorbidities and due to the costs it generates. There is widespread agreement that the incidence of the disease has increased over the last years, both due to better population monitoring and improvements in diagnosing methods.

Thus, the number of cases of diabetes mellitus worldwide was 382 million in 2013 and the number is rising; there are 75 million cases of diabetes mellitus which go undiagnosed, as the majority of diabetic patients are discovered only when complications set in. (1)

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Dispersion of Ventricular Repolarization in Relation to Blood Pressure Values in Essential Hypertension

2014-03

Ana Ciobanu, Andreea Simona Hodorogea, Mădălina Ababei, Gabriela Silvia Gheorghe, Adriana Mihaela Ilieșiu, Gabriela Uscoiu, Camelia Nicolae, I.T. Nanea

Hypertension associates with sudden cardiac death, its relationship with ventricular arrhythmias being demonstrated by numerous studies (1). Multiple mechanisms were proposed in order to explain this association, involving both structural and electrophysiological myocardial changes. The electrical ventricular remodeling includes non-uniform prolongation of action potential and duration heterogeneity of refractory periods and conduction velocities of adjacent myocardial areas. All of these changes are referred to as increased dispersion of ventricular repolarization.

As cellular basis for this important mechanism of arrhythmogenesis, 3 myocardial cell types were described, with distinct electrophysiological properties: epicardial, endocardial and midmiocardial M cells (2). Differences between their repolarization periods have as an electrocardiographic correspondence changes in T wave features (2). Subsequently, several non-invasive electrocardiographic (ECG) parameters were proposed for quantification of the repolarization dispersion such as QT interval duration, QT dispersion (QTd), T wave microalternans, and more recently, T peak - T end interval (Tpe), T peak - T end/QT ratio (Tpe/QT) and T peak - T end interval dispersion (dTpe).

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LIVER FUNCTION TESTS ANOMALIES IN PATIENTS WITH CHRONIC HEART FAILURE

2014-03

Camelia C. Diaconu, Alice Bălăceanu, Daniela Bartoș

Chronic heart failure is a major public health problem, with increasing prevalence due to population aging and increased survival of cardiovascular patients. Chronic heart failure is a clinical syndrome characterized by a variety of effects on other organs and systems. Occasionally, patients with chronic heart failure may present with signs and symptoms of a noncardiac disorder, such as hepatic dysfunction. The main pathophysiologic mechanism involved in hepatic dysfunction of patients with heart failure is either passive congestion due to increased filling pressures or low cardiac output and the consequences of impaired perfusion. Passive hepatic congestion may lead to increase of liver enzymes and total bilirubin. Right ventricular dysfunction can be associated with severe hepatic congestion, which can be asymptomatic and revealed only by abnormal liver function tests. When hemodynamic abnormalities are prolonged, the hepatic function is further altered, with impaired coagulation tests and decreased albumin synthesis. Morphologically, the liver becomes fibrotic and ultimately cardiac cirrhosis appears. Decreased perfusion from low cardiac output may be associated with hepatocellular necrosis and increased serum aminotransferases. Acute cardiogenic liver injury appears in severe systemic hypotension due to exacerbation of heart failure; the level of aminotransferases increases, as well as lactic dehydrogenase and prothrombin time.

The aim of our study was to evaluate the frequency and the importance of liver function tests abnormalities in a group of patients with chronic heart failure, as well as the prognostic value of these liver tests.

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