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

Welcome to ModernMedicine
Wednesday, December 19 2018 @ 03:15 EET

View Printable Version

Talking About Malpractice: A Possible Future Case

2015-02

Dan Mischianu, Ovidiu Bratu, Alexandru Aungurenci, Dragos Marcu, Agnes Ciucă, Robert Popescu, Dan Spînu

The medical profession is certainly there for thousands of years, the first documented therapeutic methods being used since prehistoric times. Although to date there has been significant advance in this area, current treatments are not infallible, which means that in medical practice there are certain errors. Sometimes patients may interpret these errors as malpractice, accusing the physician with certain charges related to his work, or rather the lack of his work.

In terms of ethical norms, the Medical College of Physicians in Romania’s Code of Ethics has been prepared in accordance with the Geneva Declaration issued in 1948 and has a complementary legislative role stated above, the purpose of regulating the fundamental principles of professional conduct for doctors. All these laws are meant to guide medical staff attitudes in clinical practice and are relevant in a medical malpractice case.

View full article
View Printable Version

An Unusual Presentation of Primary Cutaneous Aggressive Epidermotropic CD8+ T Cell Lymphoma

2015-02

Mihai Lupu, Vlad Voiculescu, Laura Papagheorghe, Cornelia Nițipir, Ana Maria Neagu, Liliana Gabriela Popa, Călin Giurcăneanu

Primary cutaneous aggressive epidermotropic CD8+ T cell lymphoma is an extremely rare type of cytotoxic lymphoma reported for the first time by Berti et al. in 1999, (1) who described the tumor as a distinct clinico-pathologic entity with an aggressive clinical course. It presents as widespread, rapidly evolving papules, plaques, and tumors, often showing central necrosis and ulceration, histologically characterized by epidermotropism of CD8+ CD4- T cells. The condition has an increased tendency of spreading to extranodal sites, usually responds poorly to conventional therapies for classic CD4+ cutaneous T cell lymphomas (CTCLs), and has an unfavorable prognosis. (1-4)

View full article
View Printable Version

Cytoreductive Surgery for Peritoneal Carcinomatosis from Endometrial Cancer - A Case Report and Literature Review

2015-02

N. Bacalbașa, C. Anghel, I. Barbu, I. Dudus, M.I. Ionescu, M. Pautov, M. Motthor, Irina Bălescu, V. Brașoveanu

Endometrial cancer is one of the most common malignancies of the genital tract in women, with an increasing incidence in the last few years. The reported incidence in the United States surpassed 40.00 cases/year while the death rate reached almost 7500 deaths/year (1,2). The most important prognostic factors are thought to be diabetes, estrogen secreting tumors, nulliparity and the higher number of overweight persons (2). While up to 70% of patients are diagnosed in an early stage of the disease and report an excellent outcome (5 year overall survival of 90%), patients diagnosed in an advanced stage of the disease have a poor prognosis associated with low rates of survival - 67% and 23%, respectively, for cases with regional or distant disease (3). However, in these cases it seems that an aggressive surgical approach similar to the one performed in advanced ovarian cancer is perfectly justified (2,4).

View full article
View Printable Version

Histopathology and Forensic Diagnostics Difficulties in a Patient with Multiple Affections and Double Cranio-Cerebral Injuries

2015-02

Cris Precup, Mircea Ifrim, Ovidiu Bulzan, Csongor Toth, Gyori Zsolt, Hategan Ovidiu

This paper is a case presentation. This case was chosen because it presented several problems with indicating, with certainty, the cause of death and therefore establishing the tanato-generating mechanism. The patient is a female from the rural environment who dies after a hospitalization (03 March 2013) in the Clinical Emergency Hospital in Arad, Department of Neurology. The patient is admitted through the emergency unit due to a cranio-cerebral trauma in the left parietal-temporal region, assisted respiratory failure and second degree coma.

View full article
View Printable Version

Treatment Management of Bilateral Lower Eyelids Basal Cell Carcinomas with Total Lower Eyelid Reconstruction

2015-02

L. Răducu, R. Jecan, C. Cozma, D. Hernic, I. Lascăr

Basal cell carcinoma (BCC) is known as the most common type of skin cancer with a rapidly rising incidence, 90 % of the cases occurring in the head and neck region. (1) The eyelids are involved in 10% of these cases, making it the most prominent eyelid malignancy. (2)

It predominantly affects fair-skin individuals, notably type I and II Fitzpatrick photo types, most of them presenting with a positive history of chronic sunlight exposure. Etiology may be multifactorial, but sun exposure has been involved in most of the cases. (3) Basal cell carcinomas arise from the basal layer of the epidermis, probably as a result of activating the proto-oncogenes and inactivating the suppressor genes in the keratinocytes. (4)

View full article
View Printable Version

Gastrointestinal Angiodysplasia in Patients with Chronic Kidney Disease and Hepatic Cirrhosis

2015-02

A. Niculae, A.-E. Balcangiu-Stroescu, Ileana Peride, I. A. Checheriță, M. Jinga

Angiodysplasia (AD), gastric antral vascular ectasia (GAVE or watermelon stomach), radiation-induced vascular ectasia and Dieulafoy's lesions are considered sporadic lesions and they can induce gastrointestinal bleeding (1). AD is the most common vascular abnormality of the gastrointestinal tract, probably the most common cause of recurrent gastrointestinal hemorrhage in patients with renal failure (2) and an important cause of erythropoiet-inresistant anaemia in dialyzed patients. Angiodysplasia injuries developed in the gastric antrum were first described in 1953 and named GAVE, being characterized as submucosal capillary dilatation and fibromuscular hyperplasia (3).

View full article
View Printable Version

Impedance Cardiography: The Next Technology in Obstetrics?

2015-02

R.M. Sima, I.A. Bădărău, C. Ciornei, R.I. Papacocea, C. Alexandroaia, L. Pleș

Impedance cardiography (ICG) is a noninvasive modality to assess hemodynamic parameters. It uses changes in impedance across the thorax. It can evaluate the thorax fluid capacity which includes extravascular, intravascular and chest water content and, indirectly, represents the degree of heart failure.

This technique allows the assessment of cardiac output (CO), cardiac index (CI), stroke volume (SV), stroke index (SI), systemic vascular resistance (SVR), systemic vascular resistance index (SVRI), left ventricular ejection fraction (LVEF), left ventricular ejection time (LVET). CO, CI, SV and SI can reflect the myocardial blood flow; SVR and SVRI can reflect systemic vascular resistance and cardiac afterload; PEP, LVEF, LVET and STR can reflect myocardial contraction (prolonged PEP, LVET shortening, increase of STR and decrease of LVEF represent the compromised cardiac function). (1, 2)

View full article
View Printable Version

Modern Management of Benign Bile Duct Strictures

2015-02

Cristian Balahura, Petre Iacob Calistru, Gabriel Constantinescu

Benign biliary strictures (BBS) are a heterogeneous group of disorders whose diagnosis and treatment may be challenging. Surgical injury of the bile duct is the most common cause in the Western world (1). Inflammatory lesions of the biliary ducts, such as chronic pancreatitis represent the second most common cause of BBS.

The appropriate evaluation and management frequently require collaboration between gastroenterologists, surgeons and radiologists. The confirmation of the stricture is preferably made by magnetic resonance cholangiopancreatography (MRCP). A mainstay of diagnosis is the differentiation of BBS from malignant obstructions which are more prevalent. Tissue sampling during ERCP or endoscopic ultrasound with fine needle aspiration can be useful.

View full article
View Printable Version

Laparoscopic Management of Concomitant Gallstones and Common Bile Duct Stones - Current Practice and Our Experience

2015-02

Bogdan V. Marțian, Bogdan I Diaconescu, Mircea Beuran

Despite many advances in the last decades the optimal treatment for concomitant gallstones and common bile duct (CBD) stones is still controversial. While for the asymptomatic gallbladder stones the need for surgery is still under debate, there is large consensus regarding the indication to remove the CBD stones, which appear to be associated in 3-10% of patients (1). Before the laparoscopic era the standard treatment for CBD stones was open cholecystectomy and CBD exploration. For the patients unfit for surgery, or with severe complica-tions such as acute cholangitis, jaundice and pancreatitis, ERCP with endoscopic sphincterotomy (ES) and stone extraction was a valuable, seldom stand alone, life saving, alternative. With the advent of laparoscopic cholecystectomy (LC) in 1987-1988, new techniques added to the armamentarium of CBD stones treatment. Reddick & Olsen (2,3) sustained the ERCP with endoscopic sphincterotomy (ES) and stone extraction as early as 1990; Petelin (4), introduced almost simultaneously, the laparoscopic CBD exploration (LCBDE). The current standards of practice recognise 3 options: the combined laparo-endoscopic, the totally laparoscopic and the open approach.

View full article
View Printable Version

Cardiac Biomarker NTproBNP in Chronic Kidney Disease - A Brief Review

2015-02

A.-M. Nechita, D. Rădulescu, I. Peride, A. Niculae, D.R. Sinescu, I. A. Checheriță, A. Ciocâlteu

Chronic kidney disease (CKD) is a worldwide health problem [1,2] affecting between 7 - 10% of young individuals (30 - 64 years old) in Europe [2] and approximately 10 - 18% of the population in the USA [3]. In 2013, in Romania, the prevalence of CKD was approximately 13.1%, meaning about 1,900,000 persons, and 13,899 patients were on chronic dialysis [4].

CKD is associated with increased cardiovascular morbidity, even from early stages [5-8]. Decreased glomerular filtration rate (GFR) is a strong predictor of cardiovascular events, even in the absence of other cardiac risk factors [9]. Risk for cardiovascular disease in CKD patients is 10 - 30 times higher than in non-CKD individuals and mortality from cardiovascular diseases (CVD) accounts for approximately 50% from all causes of death in dialysis population [6,10,11,12]. Predisposing features for developing CVD in CKD patients include both traditional and nontraditional - uremia associated - factors [11,12].

View full article
View Printable Version

Renal Artery Stenosis - Review Upon Current Diagnosis and Endovascular Treatment in Light of Recent Studies

2015-02

Dana-Oliviana Geavlete, Carmen Beladan, Magda-Ruxandra Zaharia, Alice Brînzea, Dan Deleanu, Ionel A. Checheriță, Bogdan A. Popescu, Carmen Ginghină

Renal artery stenosis represents the main cause of secondary hypertension and, due to its progressive profile, leads to end-stage renal disease and important cardiovascular events (1). Despite the large number of trials in this particular field of interest, RAS therapy remains a complex challenge for clinicians with regard to interventional revascularization, eventually resulting in renal function preservation, improved blood pressure control (BP) and prevention of adverse cardiovascular events in selected patients (2).

In fact, the matter of debate is represented by the proper selection of patients which would benefit the most from renal revascularization with stent implantation, while also taking into account the outcomes of the recently emerging large clinical trials that were unable to confirm the clear benefits of endovascular therapy.

View full article
View Printable Version

Nutritional Impact on Cardiovascular Risk in Chronic Hemodialysed Patients - A Systematic Review

2015-02

Andra E. Balcangiu-Stroescu, Ileana Peride, Ileana Adela Văcăroiu, Ionel Alexandru Checheriță, Andrei Niculae

Protein-energy malnutrition is a frequent clinical condition in chronic hemodialysis patients (1). The causes of protein-energy malnutrition are: interaction between blood and dialyzer with subsequent activation of the complement, amino acids and peptides losses when undergoing hemodialysis, metabolic acidosis, chronic inflammation and anorexia (2). There are two types of protein-energy malnutrition. Type 1 protein-energy malnutrition is characterized by patients’ poor food intake. This occurs along with slow decrease of serum albumin and loss of muscle mass, the presence of normal levels of C-reactive protein and response to nutritional interventions. The second type of protein-energy malnutrition is characterized by an increased serum level of C-reactive protein and lower serum albumin level than in type 1, even with an optimal food intake. This type of protein-caloric malnutrition is strongly associated with chronic inflammation and does not respond to nutritional intervention (3).

View full article
View Printable Version

Experimental Research on the Interactions between Selective COX-2 Inhibitors and Antidepressants

2015-02

Horia Păunescu

Several studies have suggested an association between depression and inflammation (reviewed in 1, 2, 3, 4). Treatment with pro-inflammatory agents (Calmette-Guerin bacillus, endotoxins) causes depressive symptoms (5, 6, 7). Non-steroidal antiinflammatory agents, NSAIDs, particularly the COX-2 selective ones (e.g., celecoxib) showed promising results in the augmentation of the antidepressant effect in clinical studies on major depression or depressive symptomatology. The antidepressant activity of celecoxib was apparent both in the assessment of the frequency of the remissions, and in the assessment of the therapeutic response (reviewed in 8). Contrary to these studies, there is evidence that NSAIDs decrease the antidepressant effects of the antidepressant drugs. Certain NSAIDs showed depressant effects in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) clinical trial (concomitant administration of NSAIDs and antidepressants was shown to decrease the responder percentage to 45% in major depression, vs. 55% responder percentage when antidepressants were given without NSAIDs) (9). There is experimental evidence of antidepressant effects of NSAIDs in laboratory animals, particularly mice and rats, but also two studies showing that certain NSAIDs have depressant activity when given alone or in association with serotonin-specific reuptake inhibitors, SSRI (9, 10, 11, 12).

View full article
View Printable Version

Botulinum Toxin Type A - Possible Anti-Nociceptive Effect on Mice

2015-02

Elena-Rodica Dragu, Bogdan Liviu Chioaru, Ioana Teona Sebe, Ioan Lascăr, Oana Andreia Coman

Botulinum neurotoxin has been used in the treatment of various groups of cronic neuromuscular diseases, which include neuromuscular junction signaling, non-neuromuscular transmission, cholinergic, or non-cholinergic.

Having specificity on releasing neurotransmitter vesicles with acetylcholine in the synaptic gap, the main usage of botulinum toxin was as a muscle relaxant drug in painful or painless spastic syndromes.

View full article
View Printable Version

Long-terme Evaluation of Primary Syndactyly Treatment in Children, Using a Flatt Modified Technique

2015-02

Doina-Iulia Nacea, D.M Enescu, Simona Stoicescu

Syndactyly is one of the two most common congenital hand abnormalities, the other being polydactyly (1, 2, 3). It occurs in about 1: 2,500 live births, more commonly in males, and is most often seen in the third web space (2, 4). The condition has a strong familial tendency and is bilateral in half of the cases (4, 2, 5). Inheritance is thought to be autosomal dominant with variable penetrance and expressivity, which may explain the male predominance (6).

Unlike secondary syndactyly, which occurs due to abnormal fusion of initially individualized fingers, primary syndactyly mainly occurs due to the failure of differentiation between adjacent digits, caused by the absence of apoptosis in the interdigital mesenchyme during the seventh and eighth weeks of gestation (7,8). Syndactyly may occur as an isolated event or it may be linked to other anomalies in the body, being known as syndromic syndactyly (7).

View full article
View Printable Version

Cardiovascular Autonomic Dysfunction: A Possible Prognostic Marker in Patients with Arterial Pulmonary Hypertension

2015-02

Alexandru Ioan Deaconu, Silvia Iancovici, Diana Zamfir, Tudor Constatinescu, Claudia Toma, Dragoș Zaharia, Miron Bogdan, Maria Dorobanțu

In the past two decades, the association between the cardiovascular autonomic dysfunction and the cardiovascular mortality has been well documented. This association indicates that individuals with abnormal autonomic function tests are candidates for close surveillance. In type 2 diabetes it is recommended that a baseline determination of cardiovascular autonomic function be performed upon diagnosis and within 5 years of diagnosis for those with type 1 diabetes, followed by a yearly repeat test.[1]

Out of the markers that objectify this relationship, heart rate variability (HRV) has proven to be the most reliable and the easiest to quantify. Although HRV has been the subject of numerous clinical studies whose purpose was linking heart rate changes to the gravity and the evolution of the disease, only in two clinical settings a consensus was reached. The drop in HRV can be used as a risk factor in the period following an acute myocardial infarction (AMI) and as a warning sign for cardiac autonomic neuropathy (CAN) in diabetic patients. HRV parameters and their possible prognostic significance have not been thoroughly evaluated in patients presenting pulmonary arterial hypertension.

View full article