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

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Monday, November 12 2018 @ 09:54 EET

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Optimal Treatment for Myocardial Revascularization: Surgery or Stenting?

2014-04

S. Wan and M. J. Underwood

Since the introduction of coronary artery bypass grafting (CABG) in 1967, and percutaneous transluminal coronary angioplasty (PTCA) 10 years later, several major clinical trials have been conducted comparing the two therapeutic strategies, such as the Bypass Angioplasty Revascularization Investigation (BARI) (1) and the Coronary Angioplasty versus Bypass Revascularization Investigation (CABRI) (2) trials. The seven-year outcome data of the BARI trial (involving 1,829 patients) demonstrated that CABG carried a significant survival benefit over PTCA and this was particularly pronounced in diabetic patients (1). In addition, nearly 60% of the patients treated with PTCA had to undergo repeat revascularization procedures and half of them relied on CABG as a subsequent therapy (1).

Nevertheless, the past two decades have witnessed a rapid progression of PTCA technology, in particular the development of intra-coronary stents. Drug-eluting stents (DES) especially, appear to have impacted significantly on the current daily practice of treating patients with coronary artery disease (3). These advances and their immediate influence on clinical practice provide a good example of how technology may shift the paradigm of medicine. Consequently, the mechanism and technique of revascularization needs to be redefined in the present era.

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Hepatocyte Growth Factor: Cardiotrophic Roles and Potential Therapeutics for Cardiovascular Diseases

2014-04

S. Mizuno and T. Nakamura

Due to prolonged lifespans, cardiovascular disease is on the increase worldwide and is now the leading cause of death, especially in developed countries. Histologically, it is characterized by coronary atherosclerosis, in which the over-proliferation of vascular smooth muscle cells (VSMC) is evident, associated with endothelial injury and foamy cell-like macrophages (i.e., local inflammation) (1,2). Such a sclerotic event triggers narrowed lumens (i.e., stenosis) and a decrease in coronary blood flow leads to local hypoxia, apoptosis, and eventually the onset of myocardial infarction (MI) (2). Thus, the major approaches proposed to prevent or restore MI are: (i) prevention or restoration of coronary atherosclerosis, the primary cause of heart disease; (ii) induction of cardiac angiogenesis with cytokines/growth factors; (iii) inhibition of cardiomyocyte cell death during heart ischemia (i.e., anti-apoptotic therapy); and, (iv) possible reconstitution of cardiomyocytes via recruitment of intrinsic stem cells, or cell transplantation (i.e., regenerative therapy).

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The Use of NBI in Early Detection and Follow up of the Laryngeal Malignancies

2014-04

R. Hainăroșie, O. Ceachir, Irina Ioniță, Cătălina Pietroșanu, Carmen Drăghici, Cristina Zamfir, Viorel Zainea

Laryngeal tumors are often discovered in advanced stages because the patients do not pay attention to early symptoms. Sometimes small tumors are difficult to see even if the surgeon performs a fiber optic exam that uses conventional white light. In the last years some technologies started to be used in order to help the surgeon to perform an early detection or to follow up de patient with laryngeal malignancies (1).

Early detection of laryngeal neoplasm is one of the most important factors for the success of the treatment. Visualizing abnormal modification at the follow up exam for patient with laryngeal cancer will help the surgeon to initiate the treatment for the recurrence. Some of technologies such as autofluorescence or video contact endoscopy started to be used for early detection of laryngeal malignancies (2,3).

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The Rubens Flap - Breast Reconstruction - Anatomical Dissection on a Cadaver

2014-04

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

The concealment of cutaneous and subcutaneous defects has always been a challenge in surgery. The breast is one of the most important and defining elements of feminine beauty. Neoplastic pathology has always made it difficult to aesthetically repair the extirpated mammary tissue. Plastic and aesthetic surgery and reconstructive microsurgery, through microsurgical techniques of autologous free flap transfers, try to solve these problems.

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Atypical Evolution of Peptic Ulcer Disease in a Chronic Hemodialyzed Patient

2014-04

D. Baboi, Cristiana David, Ileana Peride, A. Niculae, B. Geavlete, I.A. Checheriță, I. Dina

Digestive manifestations due to uremia and uremic toxins are multiple in patients with chronic kidney disease (CKD) on hemodialysis (HD). As much as 79 percent of these patients report gastrointestinal symptoms manifested as nausea, vomiting, dry mouth, dysgeusia, halitosis, pyrosis, abdominal pain, bloating, diarrhea (1,2). Due to many pathogenic mechanisms, the prevalence of gastro-duodenal peptic ulcer disease is higher in HD subjects than in general population, but comparable in frequency with nondialyzed CKD patients (3-5). A recent published 10 years-study presented that the incidence of peptic ulcer disease is 4 times higher in patients with CKD and 9.4 times higher in individuals on chronic HD compared to the general population (6). Regarding localization, gastric ulcers are twice more frequent documented than duodenal ulcers (6-8). An imbalance between protective and aggressive mucosal factors in favor of the last ones is noticed in HD patients. Chronic dialysis stress, intradialysis hypotension (causing mucosal hypo-perfusion), anemia, intra-dialysis anticoagulant, metabolic acidosis, potentially ulcerogenic medication (steroids, non-steroid anti-inflammatory and antiplatelet drugs) lead to high frequencies of peptic ulcer disease (9). Since the appearance of ulcerous lesions, the risk of their complications (e.g.: hemorrhages, perforations, penetrating injuries) is much higher than in general population. One recent cohort study in Taiwan showed that the incidence of gastro-duodenal bleedings is double in CKD patients and 5 times higher in HD ones (2). Subsequently, common comorbidities such as diabetes, liver cirrhosis and ischemic heart disease participate as pathogens in digestive bleedings (10).

An adequate diagnosis and monitoring of peptic ulcer disease in dialysis patients represent a constant concern of our clinical practice, because of the high prevalence of this kind of pathology, the life-threatening potential complications and the complexity of the treatment. Therefore, further on we discuss the case of an atypical peptic ulcer disease in a chronic HD patient.

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Lentigo Maligna - A Scientometric Analysis of Mainstream Scientific Knowledge

2014-04

Alice Brînzea, B. Geavlete, Magda Mirescu, Roxana Nedelcu, Oliviana Geavlete, Daniela Ion

Lentigo maligna (LM) is a type of melanocytic proliferation, the term being used by clinicians and pathologists for melanoma in situ on chronically sun damaged skin (1) in case that the lesion is confined to the epidermis. The pathology in question is classified as lentigo maligna melanoma (LMM) when it invades the dermis (2), over a protracted period of time (3). They both represent a subtype of malignant melanocytic proliferation according to the World Health Organization criteria (4). Once the dermis is invaded, the prognosis of the lesion is similar to that specific for other types of melanoma (5). Most LM patients display a slowly enlarging pigmented macula or patch which tends to occur in middle aged and older individuals (6), with a slight female preponderance (2).

The preferred method for diagnosing LM is excision (7), secondary to dermatoscopy (8) and biopsy (9). Distinguishing LM from a background of increased melanocytes on chronically sun damaged skin in a small biopsy specimen remains one of the most serious diagnostic challenges for dermatopathologists (10). Histology shows proliferation of atypical melanocytes at the epidermal-dermal junction in small nests or single cells (11).

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Chronic Lymphocytic Leukemia. From Diagnosis to Treatment Decision

2014-04

Ana-Maria Ivanescu, Madalina Oprea, A. Colita, A. Turbatu, Anca Roxana Lupu

Chronic lymphocytic leukemia (CLL), haematological described since the early nineteenth century, is considered a haematological indolence, but of-a-time there was found that its evolution can be extremely varied.

Most of the patients were over 60 years at the time the diagnosis was established, and this may be due to decreased immune competence with age. Males are affected 2 times more frequently than the female, the male percentage: female being 2:1. Fewer than 10% of cases occur in adults and in children below 40 years old have been few reported cases of CLL. (1.2)

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HPV Implications in Benign Prostatic Impairments - A Literature Review

2014-04

D. Spînu, D. Mischianu, O. Bratu, A. Aungurenci, Ș. Manache, Agnes Ciucă

Benign prostatic impairments are a heterogeneous group of diseases that can coexist or be separate entities. Some of these conditions (prostatitis) are included in the pelvic pain syndrome, while the other is represented by the prostatic adenoma and its implications.

Benign prostatic hyperplasia (BPH) is histologically associated, in most cases, with the presence of inflammatory infiltrate at this level. Histopathological examination of the resected pieces and fragments of prostatic biopsy in many cases reveals stromal inflammatory infiltrate adjacent to the prostatic acini. (1, 2) In addition to the many factors involved in the prostate benign microbial pathology (E. coli, Pseudomonas aeruginosa, Serratia spp., Klebsiella spp., Enterobacter aerogenes and the great family of enterococci), there are numerous data in specialized literature, certifying the presence of viral genomes in both benign and malignant pathology of the prostate. (3, 4) Among them the following stand out: Papilloma virus (HPV), Polyoma viruses, cytomegaloviruses (CMV), Epstein-Barr virus (EBV), Herpes Virus 8 (HHV 8) and xenotropic murine leukemia virus recently (XMRV). (5)

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Innovative Techniques for the Endoscopic Diagnosis in Inflammatory Bowel Diseases

2014-04

Adriana-Corina Andrei, L.S. Andrei, Larisa-Elena Fulger

Inflammatory bowel diseases, Crohn's disease (CD) and ulcerative colitis (UC), are chronic conditions in which idiopathic inflammation of the gastrointestinal tract wall is the characteristic feature.

The etiology of these disorders is not fully elucidated, proposed causes including environmental, immunological and genetic factors. A consensus hypothesis is that in genetically susceptible individuals, both exogenous factors (eg. Intestinal flora) and factors related to the host (barrier function of epithelial cells, innate and acquired immune response function) produce a chronic immune dysfunction in the intestinal mucosa which is further modified by the action of environmental factors (eg. smoking).

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Psychological Aspects of Pain at Patients with Critical Limb Ischemia

2014-04

Liliana Veronica Diaconescu, I. Diaconescu

Peripheral arterial disease is one of the major conditions that affect middle and old aged persons. Its prevalence ranges from 3% (for people aged 37- 69 years old) to 20% (for people aged over 70 years old) (1). In advanced stages (III and IV Leriche) the main symptoms are ulcers and pain- at rest, intolerable, nocturnal increased, needing analgesic treatment (inclusive opiates). Critical limb ischemia (CLI) is characterized by chronic ischemic rest pain, ulcers or gangrene attributable to objectively proven arterial occlusive disease (2,3). CLI is considered like a "malignant" disease - due to generalized atherosclerosis these patients are predisposed to various cardiovascular complications (e.g. myocardial infarction, strokes) which can cause death in few years (4).

The patients affected by CLI are patients generally considered difficult cases, destined to repeated approach to the health care services. Physicians have to take in charge not the pathology but to take in charge the patient. For the control of the pain it turns out essential, near the block of the perception of the pain, to act with psychological participation, in order to interfere with the perception of the pain and the meant one of the pain, modify the feelings associated to the pain, modify the behavior induced by pain (5).

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Current Issues in Acute Diarrheal Disease

2014-04

Ruxandra Laza, A. Crișan, Luminița Bădițoiu, Emilia Nicoară, Narcisa Nicolescu, Voichița Lăzureanu, Ruxandra Jurac

The intestinal microflora consists of micro-organisms (bacteria required for normal functioning of the digestive tract), which are interacting with the human body (commensalism), the digestive tract is the habitat required for the development of these bacteria, and these, in turn, produce the constituents necessary for the organism. Disruption of this balance makes some ordinary saprophytic species to become pathogenic.

Clostridium difficile(CD), gram positive bacillus, anaerobic, sporulated, enters into the structure of normal enteric resident flora in a proportion of 60-70% in newborns, 10 to 30% in hospitalized patients, and only 3% in healthy adults (1). If this flora is iatrogenic depressed by antibiotic therapy, chemotherapy, inhibitors of gastric acidity, CD wins "vital space"; by multiplying causes damage to the intestinal mucosa and subsequently, on the background of comorbidities, gives the lead of severity to the clinical evolution.

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Correlations between Hypercalcemia and Endoscopic Findings in HD Patients - A Prospective Study

2014-04

D. Baboi, Cristiana David, Ileana Peride, A. Niculae, I.A. Checheriță, I. Dina

Patients with chronic renal disease frequently display eso-gastro-duodenal associated pathology: anorexia, heartburn, nausea, vomiting, abdominal pain, gastric motility disorder so far as gastroparesis; some of these symptoms decline once the substitution therapy of the renal function is initiated through hemodialysis, and some persist because of the interdialytic metabolic acidosis, used anticoagulant in dialysis or complementary therapies.

The most severe clinical manifestation is superior digestive hemorrhage, with multiple intricate causes (mucosal lesions induced by gastrin, angiodysplasia including GAVE - gastric antral vascular ectasia, treatments with lesion potential - NSAIDs, corticoids, oral iron drugs, mucosa inflammation under uremic toxins or oxygen radicals, gastric and intestinal wall edema due to interdialytic hypervolemia, malnutrition). The gastric hyperacidity induced injuries in renal patients are often esophagitis, gastritis, duodenitis and gastro-duodenal ulcer.

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Bacterial Pneumonia in Children - Epidemiological Study on Nine Years

2014-04

Mirela Luminița Chiru, Daniela Pacurar, D. Oraseanu

Pneumonia can be defined as an inflammation of the pulmonary parenchyma, mainly affecting the alveolar space. Inflammation can be caused by bacteria and viruses, as well as by inhalation of chemical agents or due to thoracic trauma (1,2,6).

Most authors classify bacterial pneumonias depending on the pathogenic agent, this classification including species of Pneumococcus, Hamophillus Influenzae, Klebsiella, Staphylococcus, Legionella and other gram-negative microorganisms. Some germs, especially Staphylococcus may be disseminated in a haematogenous manner.

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Total Lower Lip Reconstruction - What Techniques Should We Choose

2014-04

N. Calcaianu, S.A. Popescu, Daniela Diveica, I. Lascăr

While the incidence of lip cancers incidence in the central Europe is low 0.7% of all malignant tumors compared to the 1-2% generally considered (2-5), they are extremely important from a clinical and surgical point of view because of the morphological and functional changes involved. More than 90% of these tumours are squamous cell carcinomas (SCCs) and, in lesser numbers, basal-cell tumours (BCCs); however, some adenocarcinomas deriving from the minor salivary glands can be observed and, even more rarely, melanomas, sarcomas and lymphomas. BCCs generally occur in the upper lip and do not usually present lymph node metastases (4, 6). In contrast, SCCs develop most often in the lower lip, with a possibility of neck metastases. Lip carcinomas frequently appear on top of precancerous lesions, such as radiodermitis, chronic chelitis and xeroderma pigmentosum. The diagnosis and treatment of these pre-cancerous lesions, facilitated by a direct view of the lesions, is, therefore, crucially important in order to avoid their evolving into actual tumours. The subjects most at risk of this type of tumour are fair-skinned elderly people who work in the open air. Men are more at risk than women, (1.3% men and 0.3% women) (1) probably because the latter use lipstick or lip-salve (2, 7-9).

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Acute Myocardial Infarction in Youngs: Presentation, Treatment and Outcome

2014-04

Anna-Maria Andronescu, A. Nechita, Eugenia Panaitescu, M. Vintilă, Maria Dorobanțu

Coronary Artery Disease (CAD), the world’s leading cause of death and morbidity, it is not anymore an attribute of old age (1). The increase prevalence of atherosclerotic risk factors among the young and very young population is responsible for more premature CAD cases (2). Prior studies highlighted that AMI in young’s is associated with different clinical features and has a better short-term outcome than in older population (3,4,5). However, long-term follow-up revealed a higher mortality and morbidity in young AMI survivors than in general population (6,7). Also, the conclusion of several studies and "real-world" registries was that patients with STEMI and NSTEMI, regardless of age and despite different management, have similar inhospital outcome and longterm survival (8,9).

In our country, RO-STEMI registry is providing the most extensive information on the profile, treatment and inhospital outcome of the STEMI Romanian patients (10) but only few reports about mid and long-term follow up of young Romanian patients with AMI, especially in case of NSTEMI, are available (11,12,13).

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Intrahepatic Cholangiocarcinoma - the Impact of Pathological Characteristics on the Long-Term Outcome after Resection

2014-04

Zenaida Emilia Ionel, T. Dumitrașcu, V. Brașoveanu, I. Lupescu, R. Anghel, V. Herlea, M. Ionescu, I. Popescu

Intrahepatic cholangiocarcinoma (ICC) is the second as frequency primary liver cancer after hepatocellular carcinoma (HCC), arising from the biliary epithelium of the second branch (segmental branch) or the proximal branch of bile duct (1,2). Recent reports suggest that the incidence of ICC varies considerably according to geographical location, and accounts for about 5-30% of primary liver cancers, with an increasing incidence during the past years all over the world (3-6). Radical resection (R0) remains the only potential curative treatment, but the resectability rate is still low because of late diagnosis. In general, prognosis is poor, with a reported rate of 5-year survival, usually below 20 to 40% for patients with potentially curative resection (7).

However, the recent progress in anesthesiology and intensive care, the development of more effective surgical techniques in hepatobiliary surgery, and the advent of new devices for parenchymal trans-section made more applicable aggressive surgical approaches for ICC, improving the resectability rate in the last two decades (8,9).

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Ontogenesis - Complementarity or Opposition between Materialism and Idealism, between Science and Religion

2014-04

M. Ifrim

The "Albert Schweitzer" International Academy, founded and directed by the academician Kazimierz lmielinski, scientific personality of worldwide renoun, nominalized for the award of the Nobel prize, represents by its prestigious members an international saientific authority in the framework which are debated: medical problems of a fundamental and functional character, as well as philosophical conceptual aspects regarding the materiality and the ideality of the Universe in which we live.

In this context, I present some aspects refering to ontogenesis, which may open interesting perspectives for the medical science.

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