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

Lucian Negreanu

Lucian Negreanu

Type III Gastric Neuroendocrine Tumor - a Case Report

We present the case of a 71 year old female that was endoscopically diagnosed with type III neuroendocrine gastric tumor (NET). NETs are rare, slowly growing neoplasm originating in the neuroendocrine cells, that can occur anywhere in the body. Gastrointestinal forms account for more than a half of them. If type I and II gastric neuroendocrine tumors can be managed endoscopically, type III and IV have sugery as their main therapy. Because type III lessions have the greatest potential to generate metastasis, we did a CT scan on the patient and found distant metastasis located in the liver and also to the lymph nodes. Treatment options depend on the type of tumor, its location, signs and symptoms experienced by the patient, due to excess hormones produced by the tumor, and also if there is resectable metastatic disease or not. Altough our patient had a voluminous tumor, surgical resection was possible, followed by chemotherapy, with good evolution.

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Recent Advances in Colonic Preparation for an Accurate Colonoscopy - How to Improve Our Practice to Meet the Quality Criteria

Colorectal cancer (CRC) remains a major problem of global health. Screening colonoscopy is the gold standard in detection of CRC. A quality colonoscopy needs good indication, adequate bowel preparation, adequate examination time (30 to 45 minutes), a minimum 6 minutes time for mucosal examination during colonoscopy descent, a good centre adenoma detection rate. In 28-33% of the colonoscopies, the bowel preparation is unsatisfactory which leads to several hidden costs including the rise of preventable and treatable death rate regarding colorectal carcinoma. The ESGE (European Society of Gastrointestinal Endoscopy) recommends a maximum of 10% poor preparations, threshold that is difficult to reach in many centres. Newer low-volume laxative regimens for bowel cleansing are better in the fields of compliance and tolerability than the classic 4L PEG with 2L PEG-CS (Clensia ®) being one of the new promising low-volume formulas. The low fibre diet is now preferred due to better compliance and tolerability. Conclusions: One of the easiest ways to improve colonoscopy quality is through improved compliance. Two of the most effective measures are using newer laxative bowel cleansing formulas (like 2L PEG-CS) and a low-fibre diet.

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Quality of Care in Inflammatory Bowel Disease: the Role of Steroid Assessment Tool (SAT) - a Review

Corticosteroids have an important role in induction of remission in inflammatory bowel disease, but they are not an indicated for maintenance treatment as they are associated with many side effects. Despite new efficient therapeutic options for maintaining remission, there is an excess in prescribing steroids in inflammatory bowel disease. Corticosteroid use was evaluated in international cohorts given that steroid free remission and avoiding serious side-effects of corticosteroids is a desirable goal. We discuss the role and the evidences on a secure web-based steroid assessment tool (SAT) which can be used as an instrument of evaluation of corticosteroid use, a quality indicator in inflammatory bowel disease.

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Case Presentation: a Facial Ulceration in a Patient with Ulcerative Colitis

We present the case of a patient with severe ulcerative colitis treated with infliximab that was admitted for an extensive facial ulceration located on the left cheek. Pyoderma gangrenosum, bacterial, mycobacterial and fungal infection were taken into account. The patient was diagnosed with a Klebsiella abscess originating from a tooth infection. Infectious complications might arise more frequently in IBD patients treated with anti TNF and adequate diagnosis and therapy is required.

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An Angiographic Treatment for a Pancreatic Pseudoaneurysm

Interventional radiology has made significant progress to the care of severe acute pancreatitis complications with the introduction of percutaneous procedures. More recently, radiologic intervention has become the gold standard in treating a rare condition like pancreatic pseudoaneurysms. We report the case of an 40 years old male, heavy drinker and smoker, at the second episode of acute pancreatitis that developed an pseudoaneurysm cured through angiographic embolotherapy.

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The Bucharest College of Physicians’ Study on Burnout Amongst Healthcare Professionals in Romania’s Capital City

Since its fi rst description in 1980 by Freudenberger, the phenomenon of burnout has been studied intensively by many scholars in the past decades and stakeholders are getting more and more aware of the problematic burnout poses in the professional fi eld, as well as the healthcare threat it poses. It is well known today that when it comes to the fi eld of healthcare workers, burnout plays a signifi cant role in regards to physicians’ well-being. The Bucharest College of Physicians wanted to evaluate this phenomenon amongst doctors working in Romania’s capital city and launched a survey addressing its’ members. The study revealed a rather high number of physicians suffering from at least one kind of burnout. The numbers were highest in the fi eld of personal and professional burnout – 55% and 52% of respondents respectively. In regards to burnout caused by the nature of their work (working with patients), a still high number of 36% of respondents showed signs of burnout. Participants in the study named the increasing number of bureaucratic tasks as one of the major stressors at the job and suggested that by eliminating some bureaucracy, one could improve their level of stress on the job. The results of the study conducted by the Bucharest College of Physicians fall in line with other studies regarding healthcare workers around the globe. The alarmingly high numbers of burnout cases and increased levels of stress should signal stakeholders in the healthcare system to take action in order to improve physicians’ well-being.

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Identification of Osteoarthritis with Multiple Joint Involvement in Elderly Institutionalized Patients Concomitant with...

Related to the rehabilitation of patients with osteoarthritis, kinesiotherapy addresses the methods, procedures and methodology that will be used depending on the anatomic, functional and clinical stage of the disease and its location after setting treatment goals. Furthermore, priorities of the rehabilitation program are established considering both medical issues and also paramedical and social aspects [1].
The kinesiotherapeutic opera tional strategy in rehabilitating patients with osteoarthritis is planned according to the characteristic comorbidities of elderly patients [2]. Clinical trials highlight that cardiovascular mortality is reduced when sedentary individuals become moderately active [3,4].

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The Rehabilitation of Elderly Institutionalized Patients with Osteoarthritis (Multiple Joint Involvement) Using...

Osteoarthritis, as a major cause of disability and due to the high prevalence among chronic diseases, represents one of the most important public health problems worldwide [1]. The limitation of physical function and the restriction of independence produce negative effects on the mental status of patients suffering from osteoarthritis, namely the emergence of depression and decreased self-confidence [2,3].
Developing a kinesiotherapeutic strategy based on the clinical, anatomical and functional stage of the disease and other comorbidities, as well as exploiting psychological and psychopedagogical resources will improve the physical performance and increase the independence of these patients [4,5].

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