Publications by authors named "Bogdan Socea"

26 Publications

  • Page 1 of 1

The importance of adrenal venous sampling in ACTH-independent Cushing syndrome: A case report and literature review.

Exp Ther Med 2021 Jul 18;22(1):772. Epub 2021 May 18.

Discipline of Pediatric Surgery, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.

Independent Cushing's adrenocorticotropic hormone (ACTH) syndrome can have several causes, including adrenal carcinoma or simple adrenal hyperplasia. Although the distinction between malignant and benign can be effectively made through imaging investigations, in the situation where there are bilateral formations, their hormonal activity is impossible to appreciate via non-invasive techniques. The present study includes the presentation of a clinical case on the basis of which a literature review was made. The clinical case pertains to a 32-year-old patient with ACTH-independent Cushing's syndrome and bilateral adrenal tumor formations leading to the utility of adrenal venous sampling to avoid bilateral adrenalectomy. A literature review was subsequently conducted focusing on articles pertaining to the PICO criteria in order to describe: The diagnosis of adrenal tumor masses, the decision on the type of surgery and most importantly, the impact of adrenal venous sampling in avoiding surgical resection. These interventions severely limit the patients' quality of life.
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http://dx.doi.org/10.3892/etm.2021.10204DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8145433PMC
July 2021

Clinical and therapeutic features of acute cholecystitis in diabetic patients.

Exp Ther Med 2021 Jul 13;22(1):758. Epub 2021 May 13.

4th Surgery Department, Emergency University Hospital Bucharest, 050098 Bucharest, Romania.

The present study aimed to compare the clinical, paraclinical, intraoperative findings, and postoperative complications in acute cholecystitis in diabetic patients vs. non-diabetic patients. A 2-year retrospective study was performed on the patients who underwent emergency cholecystectomy for acute cholecystitis between 2017 and 2019 at the 4th Department of Surgery, Emergency University Hospital Bucharest. The diabetic subgroup numbered 46 eligible patients and the non-diabetic one 287 patients. Demographics, the severity of the clinical forms, biological variables (including white cell count, urea, creatinine, coagulation and liver function tests) comorbidity status, surgical approach, postoperative complications, and hospital stay were analyzed. Statistical analyses were performed to assess comparative results between the aforementioned data (SPSS V 13.0). The CCI and ASA risk classes were increased in the diabetic group, with 34.78% of patients having 3 or more associated comorbidities. No statistically significant associations were demonstrated between diabetes and the severity of the cholecystitis and risk for conversion. Postoperatively both minor complications such as surgical site infections and major cardiovascular events were more common in the diabetic subgroup (P=0.0254), well associated with the preoperative status and baseline cardiovascular comorbidities. Laparoscopic cholecystectomy is a safe procedure for diabetic patients, which can provide the best outcomes, by decreasing the risks of surgical wounds. Attentive perioperative care and good glycemic control must be provided to minimize the risk of complications.
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http://dx.doi.org/10.3892/etm.2021.10190DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8135114PMC
July 2021

Incidence of thyroid carcinomas in an extended retrospective study of 526 autopsies.

Exp Ther Med 2021 Jun 14;21(6):607. Epub 2021 Apr 14.

Department of Pathology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.

Thyroid cancer accounts for 1% of all malignancies, and is becoming increasingly common worldwide. The literature reports a prevalence of ~50% of thyroid nodules detected during autopsies in subjects with unknown thyroid pathology. An extended retrospective study of 526 autopsy cases was performed to identify the prevalence of thyroid carcinoma, among various types of thyroid nodules identified incidentally. Tissue samples were taken from thyroid nodules, for investigation of the presence of thyroid carcinoma, along with their macroscopic and microscopic features by means of histopathology and immunohistochemistry (IHC) methods. Histopathological diagnosis of malignancy was found in 51 cases of analyzed thyroid samples. Systematic detailed studies demonstrated that a thyroid gland, apparently normal on macroscopic examination, may be the site of pathological manifestations, sometimes presenting carcinomatous findings. Among thyroid carcinomas, the highest frequency was that of papillary microcarcinomas, which have a long evolution, and are incidentally detected during autopsies. Papillary microcarcinoma is an extremely common incidental finding and the vast majority of these tumors pursue a benign course. Furthermore, it is therefore necessary to create national screening programs for the early detection of thyroid carcinoma.
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http://dx.doi.org/10.3892/etm.2021.10039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8082578PMC
June 2021

Acute surgical abdomen during the COVID-19 pandemic: Clinical and therapeutic challenges.

Exp Ther Med 2021 May 22;21(5):519. Epub 2021 Mar 22.

Third Department of Surgery, Faculty of Medicine, 'Lucian Blaga' University Sibiu, 550169 Sibiu, Romania.

The present study investigated the effects of the COVID-19 pandemic on the clinical presentation and therapeutic management of acute surgical abdomen. A retrospective study of emergency hospitalizations with a diagnosis of acute surgical abdomen between April and July 2020 vs. a similar period in 2019 was performed. The observation sheets and the operating protocols were analyzed. Between April and July 2020, 50 cases of acute surgical abdomen were hospitalized and treated, compared to 43 cases in the same period last year. The main types of pathology in both groups included: Occlusions (60%, respectively 44.2% in 2019) and peritonitis (32%, respectively 41.8% in 2019). There was an increased rate of patients with colorectal cancers neglected therapeutically or uninvestigated, who presented during the pandemic period with emergencies for complications such as occlusion or tumor perforation (32 vs. 6.97%, P=0.0039). One case, with gastric perforation, was COVID-positive, with no pulmonary symptoms at admission. The number of postoperative infectious complications was lower during the pandemic (2 vs. 13.95%, P=0.0461). As the COVID-19 pandemic appears to be still far from ending, we should learn to adapt our surgical protocols to the new evidence. Oncological patients are a vulnerable group, who were neglected in the first months of the pandemic. SARS-Cov-2 infection may be a cause of abdominal pain and should be taken into account in different diagnoses of acute abdomen in surgical wards. Correct wearing of adequate personal protective equipment (PPE) and respecting strict rules of asepsis and antisepsis are required for preventing in-hospital transmission of infection.
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http://dx.doi.org/10.3892/etm.2021.9950DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014977PMC
May 2021

Predictors of Burnout in Healthcare Workers during the COVID-19 Pandemic.

Healthcare (Basel) 2021 Mar 9;9(3). Epub 2021 Mar 9.

Department of Psychology, University of Bucharest, 030018 București, Romania.

The purpose of this study was to identify the predictors of burnout in healthcare workers during the COVID-19 pandemic. Data were collected from March to June in 2020, during the COVID-19 pandemic, from employees of two Romanian hospitals. Five hundred and twenty-three healthcare workers completed a series of questionnaires that measured burnout, job demands, job resources, and personal resources. Among the respondents, 14.5% had a clinical level of exhaustion (the central component of burnout). Three job demands (work-family conflict, lack of preparedness/scope of practice, emotional demands), three job resources (training, professional development, and continuing education; supervision, recognition, and feedback; autonomy and control), and one personal resource (self-efficacy) were significant predictors of burnout, explaining together 37% of the variance in healthcare workers' burnout. Based on our results, psychological interventions during the COVID-19 pandemic for healthcare employees should focus primarily on these demands and resources.
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http://dx.doi.org/10.3390/healthcare9030304DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8001536PMC
March 2021

Safety of Laparoscopic Cholecystectomy for Acute Cholecystitis in the Elderly: A Multivariate Analysis of Risk Factors for Intra and Postoperative Complications.

Medicina (Kaunas) 2021 Mar 2;57(3). Epub 2021 Mar 2.

3rd Department Surgery, Faculty of Medicine, "Lucian Blaga" University Sibiu, 550169 Sibiu, Romania.

This study investigates the impact of age upon the safety and outcomes of laparoscopic cholecystectomy performed for acute cholecystitis, by a multivariate approach. A 2-year retrospective study was performed on 333 patients admitted for acute cholecystitis who underwent emergency cholecystectomy. The patients included in the study group were divided into four age subgroups: A ≤49 years; B: 50-64 years; C: 65-79 years; D ≥80 years. Surgery after 72 h from onset ( = 0.007), severe forms, and higher American Society of Anesthesiologists Physical Status Classification and Charlson comorbidity index scores ( < 0.001) are well correlated with older age. Both cardiovascular and surgical related complications were significantly higher in patients over 50 years ( = 0.045), which also proved to be a turning point for increasing the rate of conversion and open surgery. However, the comparative incidence did not differ significantly between patients aged from 50-64 years, 65-79 years and over 80 years (6.03%, 9.09% and 5.8%, respectively). Laparoscopic cholecystectomy (LC) was the most frequently used surgical approach in the treatment of acute cholecystitis in all age groups, with better outcomes than open cholecystectomy in terms of decreased overall and postoperative hospital stay, reduced surgery related complications, and the incidence of acute cardiovascular events in the early postoperative period ( < 0.001). The degree of systemic inflammation was the main factor that influenced the adverse outcome of LC in the elderly. Among comorbidities, diabetes was associated with increased surgical and systemic postoperative morbidity, while stroke and chronic renal insufficiency were correlated with a high risk of cardiovascular complications. With adequate perioperative care, the elderly has much to gain from the benefits of a minimally invasive approach, which allows a decreased rate of postoperative complications and a reduced hospital stay.
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http://dx.doi.org/10.3390/medicina57030230DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8002041PMC
March 2021

Association between vascular comorbidity and glaucoma progression: A four-year observational study.

Exp Ther Med 2021 Mar 26;21(3):283. Epub 2021 Jan 26.

Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.

Glaucoma, one of the significant causes of blindness worldwide, is a chronic optic neuropathy, characterized by progressive loss of retinal ganglion cells and specific perimetric defects. This study aimed to assess the association between the risk of glaucoma progression and different systemic vascular abnormalities. A 4-year prospective study was carried out on 204 patients diagnosed with open-angle glaucoma. Associated systemic vascular pathology was documented in 102 cases. Progression was encountered in 57 (55.9%) patients with vascular comorbidities and only in 10 (9.8%) patients with no associated vascular diseases (OR 13.81, P<0.01). The vascular risk factors associated with glaucoma progression in the study group were diastolic hypotension (OR 5.444, P=0.027), ischemic cardiac disease (OR 5.826; P<0.01), peripheral vasospasm (OR 3.108, P=0.042) and arterial hypertension (OR 2.593, P=0.05). Diabetes was not significantly correlated with progression in the study group, but only patients without diabetic retinopathy were included. This study highlights that systemic comorbidities associated with endothelial lesions, atherosclerosis and hypoperfusion can lead to damage to the retinal nerve fiber layer and the underlying conjunctive tissue.
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http://dx.doi.org/10.3892/etm.2021.9714DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7851678PMC
March 2021

Heterogeneity of antigenic constellation in human hepatocellular carcinoma.

Exp Ther Med 2021 Mar 25;21(3):270. Epub 2021 Jan 25.

Pathology Department, 'Sf. Pantelimon' Emergency Hospital, 021659 Bucharest, Romania.

Hepatocellular carcinoma is one of the primary liver malignancies responsible for over a million deaths per year worldwide (approximately 10% of all deaths in the adult age range). The diagnosis of HCC can be difficult and often requires the use of more than one microscopic technique. A retrospective study was performed on a study batch of 42 cases that died of HCC due to metastasis or other secondary complications. Tissue samples were taken in order to investigate the tumour antigenic constellation by means of IHC method using a large variety of antibodies. hybridization was also performed for albumin mRNA to assess the albumin expression in some selected cases. Telomerase activity was investigated using IHC method for the hTERT catalytic subunit. A cocktail of hepatic cytokeratins (CK8, 18) combined with Hep Par-1 and associated to albumin proved to be more powerful than albumin alone in differentiating HCC and increased the value of tumour diagnosis. hTERT expression was proportionally reverse to the tumour degree of differentiation, but was independent from the expression of tumour-proliferating indexes. The heterogeneity of the antigenic constellation in hepatocellular carcinoma suggests an antigenic mosaicism, which can be expressed a synchronous or metachronous manner, depending on the tumour degree of differentiation.
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http://dx.doi.org/10.3892/etm.2021.9701DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7851646PMC
March 2021

Fibroblast involvement in cardiac remodeling and repair under ischemic conditions.

Exp Ther Med 2021 Mar 25;21(3):269. Epub 2021 Jan 25.

Department of Pathology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.

Cardiac fibroblasts play a main role in the physiological turnover of the extracellular matrix, as well as its pathological remodeling. A study was performed on a batch of 23 cases who died of various cardiac complications secondary to scarring myocardial infarctions. The aim of the study was to assess the fibroblast involvement in cardiac repair under ischemic conditions after myocardial infarction. Tissue myocardial samples from the left ventricle were taken from these cases for microscopy examination, in order to investigate the type and degree of fibrosis as well as the presence of cardiac interstitial fibroblasts. Multiple series of histological sections were also performed and examined, along with immunohistochemical analysis. The fibroblasts were diffusely distributed in the interstitium among the residual cardiomyocytes, showing variable expression of vimentin and smooth muscle actin. During cardiac remodeling, there was a successive interstitial deposition, first of reticulin fibers and then of collagen fibers, leading to interstitial fibrosis and myocardial replacement. There was a correlation between vimentin and smooth muscle actin expression and collagen deposition. Fibrosis with cardiac remodeling is based on maintaining proliferation capacity of the fibroblast and its capacity of protein synthesis in the extracellular matrix. Under hypoxic ischemic conditions, followed by myocardial infarction, the fibroblast switches phenotype and transdifferentiate into myofibroblast, contributing to the healing by secreting extracellular matrix proteins and collagen deposition, with subsequent cardiac remodeling and regulation of the micro-environment metabolism.
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http://dx.doi.org/10.3892/etm.2021.9700DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7851673PMC
March 2021

A finite element analysis for predicting outcomes of cemented total knee arthroplasty.

Exp Ther Med 2021 Mar 25;21(3):267. Epub 2021 Jan 25.

Department of Orthopedics, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.

The study was designed to assess the validity of a finite element analysis for predicting the behavior of cemented knee implant used in total knee arthroplasty (TKA), for different mechanical loads, and correlation with clinical outcomes of this procedure. We conducted computational simulations using finite element analysis of two situations: i) The ideal prosthetic component positioning; and ii) variable varus tibial malposition, but with a balanced knee. A total of 80 cemented TKAs performed on 70 patients were divided into two groups. Patients from one group required secondary asymmetric tibial recut for balancing the prosthetic knee and patients from the other group, did not. In regards to the results, we observed no differences upon analysis of the postoperative results of the Knee Society Score (KSS), the angle between the femur and tibia, the range of motion and frontal laxity between groups. The finite element analysis showed that in a 3˚ varus inclination of the joint interline, but with a balanced knee, the maximum contact stress, measured on the tibial plateau surface, increased by 11% compared to the value of mechanical alignment. In conclusion, analysis of the computational model using finite elements showed predictable results of cemented TKA for the different situations of mechanical loads.
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http://dx.doi.org/10.3892/etm.2021.9698DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7851662PMC
March 2021

Pregnancy and Colorectal Cancer, from Diagnosis to Therapeutical Management - Short Review.

Chirurgia (Bucur) 2020 Sept-Oct;115(5):563-578

Colorectal cancer (CRC) is one of the most common human malignancies, affecting one of 20 persons in areas with high socio-economic standard but cases of digestive cancers during pregnancy are rare. From an etiological point of view, CRC represents an entity induced on the one hand by environmental factors and on the other hand by genetic factors or, not rarely, by their combination. The difficulty of diagnosing digestive cancers in pregnancy is the consequence of a symptomatology often masked by signs and symptoms that can be attributed to pregnancy. Essential in terms of assessing the staging of TNM in CRC, CT remains the subject of numerous debates. Over the last 40 years CT has been contraindicated in pregnant women due to teratogenic and carcinogenic effects on the fetus. Pregnancy MRI method is preferable to any other method of investigation that uses ionizing radiation. The CRC's treatment plan must take into account the interests of two people, the mother and the fetus, so that the "interest" of one does not affect the other, respecting an axiom: for the mother, treatment as soon as possible after birth, respectively, for the foetus, delaying the therapy until it is viable. Colorectal neoplasia is, in generally, a predominantly surgical pathology at the time of disease discovery, especially in conditions of a major complication that leaves no time for a therapeutic alternative (obstruction, perforation, significant bleeding). A chemotherapy-type oncology protocol option is preferred for cases with advanced, metastatic neoplasms.
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http://dx.doi.org/10.21614/chirurgia.115.5.563DOI Listing
December 2020

Primary Pleural Hydatidosis-A Rare Occurrence: A Case Report and Literature Review.

Medicina (Kaunas) 2020 Oct 27;56(11). Epub 2020 Oct 27.

Internal Medicine Department, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania.

: The larvae of Echinococcus, a parasitic tapeworm, cause hydatid disease. The most commonly involved organ after the liver is the lung but there are cases of hydatid cysts in all systems and organs, such as brain, muscle tissue, adrenal glands, mediastinum and pleural cavity. Extra-pulmonary intrathoracic hydatidosis can be a diagnostic challenge and a plain chest x-ray can be misleading. It can also lead to severe complications such as anaphylactic shock or tension pneumothorax. The purpose of this paper is to present a severe case of primary pleural hydatidosis, as well as discussing the difficulties that come with it during diagnosis and treatment. We present the case of a 43-year-old male, working as a shepherd, presenting with moderate dyspnea, chest pain and weight loss. Chest x-ray revealed an uncharacteristic massive right pleural effusion and thoracic computed tomography (CT) confirmed it, as well as revealing multiple cystic formations of various sizes and liquid density within the pleural fluid. Blood work confirmed our suspicion of pleural hydatidosis with an elevated eosinophil count, typical in parasite diseases. Surgery was performed by right lateral thoracotomy and consisted of removal of the hydatid fluid and cysts found in the pleura. Patient was discharged 13 days postoperative with Albendazole treatment. Cases of primary pleural hydatidosis are very rare but must be taken into consideration in patients from endemic regions with jobs that may have exposure to this parasite. Proper treatment, both surgical and antiparasitic medication, can lead to a full recovery and a low chance of recurrent disease.
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http://dx.doi.org/10.3390/medicina56110567DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7694107PMC
October 2020

Neutrophil/Lymphocyte Ratio as Predictor of Anastomotic Leak after Gastric Cancer Surgery.

Diagnostics (Basel) 2020 Oct 9;10(10). Epub 2020 Oct 9.

General Surgery Department, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania.

Introduction: Neutrophil/lymphocyte ratio (NLR) is known as a prognostic for the outcome of the patients with gastric cancer. As no definite risk marker for anastomotic leakage after gastric resection was identified, we investigated the possible role of NLR.

Methods: Peripheral blood count for neutrophils and lymphocytes was done at the patient's admission. We retrospectively evaluated 204 gastric cancer patients, who underwent gastric resection, comparing the values of NLR between the group of patients with anastomotic leakage and those without complications.

Results: Using the ROC curve, we found the cutoff value of NLR, which permitted the comparison of the group with low NLR, presenting increased NLR. The cutoff value for NLR was 3.54. Between the two groups, we could observe statistically significant differences in developing fistula ( < 0.01) and complications leading to death ( < 0.025). The odds ratio for patients with NLR greater than 3.54 to develop anastomotic leak was 17.62, compared to those with lower NLR.

Conclusion: Peripheral blood NLR proved to be a predictor for anastomotic leakage.
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http://dx.doi.org/10.3390/diagnostics10100799DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7601164PMC
October 2020

Reconstruction of superior mesenteric artery by prostheses placement in a case of chronic mesenteric ischemia: A case report and literature review.

Exp Ther Med 2020 Oct 12;20(4):3504-3507. Epub 2020 Aug 12.

Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.

Although superior mesenteric artery stenosis is a relatively common situation, it is rarely symptomatic due to the fact that in a significant number of cases an adequate collateral circulation exists. The aim of this study is to report a case in which arterial reconstruction was needed due to the absence of such a patent collateral circulation. The 47-year-old patient was investigated for chronic postprandial pain and was diagnosed with superior mesenteric artery stenosis. Percutaneous treatment was the initial option of choice but the patient rapidly became symptomatic again. Therefore surgery was performed, the segment of arterial stenosis was resected and the arterial continuity was re-established by using a synthetic prosthesis. The postoperative outcome was uneventful, the patient was discharged in the seventh postoperative day under anticoagulant therapy. In conclusion, superior mesenteric artery reconstruction by using a synthetic prosthesis can be useful in cases presenting chronic mesenteric ischemia and failure of percutaneous treatment.
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http://dx.doi.org/10.3892/etm.2020.9119DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7464867PMC
October 2020

Dormant cardiac stem cells: A promising tool in cardiac regeneration.

Exp Ther Med 2020 Oct 15;20(4):3452-3457. Epub 2020 Jul 15.

Pathology Department, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.

Stem cells represent an old niche with various new potential therapeutics. Besides drug treatment, reperfusion procedures and surgical revascularization, stem cell therapy could be a good option in ischemic cardiac diseases. A study was performed on a small group of cases who died of cardiac arrhythmia secondary to scarring myocardial infarctions. Tissue cardiac samples were taken from these cases (from the anterior and lateral wall of the left ventricle), for microscopy examination, in order to investigate the presence of cardiac stem cells (CSC). Multiple series of histological sections were also performed and examined, along with immunohistochemical analysis (IHC). The cells were identified in close contact with the residual ischemic cardiomyocytes, in the proximity of the myocardial collagenous scar, in old myocardial infarctions. They were activated by hypoxic ischemia and were influenced by the capillary microvascular density and the interstitial micro-environment conditions. In chronic intermittent ischemia they seem to turn themselves from dormant quiescent cells into activated progenitor committed cells.
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http://dx.doi.org/10.3892/etm.2020.9015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7465489PMC
October 2020

Acute Colonic Pseudoobstruction (Ogilvie Syndrome) - A Severe Complication in the Evolution of the Hospitalized or Institutionalized Patients.

Chirurgia (Bucur) 2020 May-Jun;115(3):357-364

Ogilvie syndrome, or acute colonic pseudo-obstruction (ACPO), represents a pathological entity, potentially with a severe outcome, due to the acute important dilation of the large bowel, in the absence of a mechanical luminal obstruction. Usually, it occurs in patients admitted in intensive care unit, that associate severe surgical or medical pathologies. The mechanism of the ACPO has not been completely explained, but it is assumed that the motor function of the colon may be affected, as a result of autonomic regulation disturbance. Early diagnosis and treatment help reduce the risk of severe outcome, such as ischemia or perforation. Material and Method: In addition to our experience, a literature search was elaborated in order to evaluate the incidence, the etiology, the clinical presentation and the diagnosis of the ACPO. Results and The present study may be of help in the process of guiding the optimal management of a critically ill patient is at high risk of developing colonic pseudo-obstruction.
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http://dx.doi.org/10.21614/chirurgia.115.3.357DOI Listing
July 2020

Burnout syndrome in Romanian medical residents in time of the COVID-19 pandemic.

Med Hypotheses 2020 Nov 7;144:109972. Epub 2020 Jun 7.

"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania; "Sf. Pantelimon" Emergency Hospital, Department of Surgery, Bucharest, Romania.

Burnout is a state of physical or mental collapse caused by overwork or stress. Burnout during residency training has gained significant attention secondary to concerns regarding job performance and patient care. The new COVID-19 pandemic has raised public health problems around the world and required a reorganization of health services. In this context, burnout syndrome and physical exhaustion have become even more pronounced. Resident doctors, and especially those in certain specialties, seem even more exposed due to the higher workload, prolonged exposure and first contact with patients. This article is a short review of the literature and a presentation of some considerations regarding the activity of the medical residents in a non-Covid emergency hospital in Romania, based on the responses obtained via a questionnaire. Burnout prevalence is not equal in different specialties. We studied its impact and imagine the potential steps that can be taken in order to reduce the increasing rate of burnout syndrome in the pandemics.
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http://dx.doi.org/10.1016/j.mehy.2020.109972DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7276114PMC
November 2020

Venous thromboembolism in cancer patients: Still looking for answers.

Exp Ther Med 2019 Dec 18;18(6):5026-5032. Epub 2019 Sep 18.

Internal Medicine Department, Clinical Emergency Hospital of Bucharest, 014461 Bucharest, Romania.

Patients with cancer-associated venous thromboembolism (VTE) represent a real challenge in clinical practice. Patients with cancer have a greater risk both of VTE and bleeding. There are only a few studies regarding the therapeutic approach of VTE in patients with cancer, especially after cancer surgery, and on thromboprophylaxis during chemotherapy. Many of the anticoagulation therapy recommendations for cancer patients are extrapolated from trials that are not conducted in cancer cohorts. It is essential to assess the efficacy and safety of VTE prophylaxis in this particular subgroup, which bears higher risks both of VTE recurrence and major hemorrhagic events. The introduction of direct oral anticoagulants in everyday practice represented a major evolution of the anticoagulant treatment. Direct anticoagulants could represent a more appealing alternative to low-molecular-weight heparin in paraneoplastic venous thrombosis, due to the patient comfort, easy administration of the drug and emerging studies that prove similar efficacy and safety as the standard treatment. However, there is limited data on the treatment with direct oral anticoagulants in patients with paraneoplastic venous thromboembolism.
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http://dx.doi.org/10.3892/etm.2019.8019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6895781PMC
December 2019

Minimally invasive biopsy in retroperitoneal tumors.

Exp Ther Med 2019 Dec 18;18(6):5016-5020. Epub 2019 Sep 18.

University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania.

Minimally invasive biopsy procedures have proven over the years to be essential for obtaining a correct diagnosis of retroperitoneal tumors, that allows proper therapeutical conduct. These procedures offer valuable tissue fragments for histopathological examination, that permits the distinction between benign and malignant tumors, identifying the tumors that can benefit from neo-adjuvant treatments, such as chemotherapy or radiotherapy and those that have a direct surgical indication. We have searched the existing data regarding minimally invasive biopsy in retroperitoneal tumors using the PubMed database, in order to evaluate the role of this procedure in establishing a correct diagnosis, as well as to find out the risks of tumor cell seeding and local recurrence after needle biopsy. The risk of tumor cell seeding is very low (<2%) and in some cases, it is considered negligible (<0.5%). Compared to open biopsy, needle biopsy seems to be associated with a significantly lower risk of tumor cell seeding. According to the existing data, the incidence of needle track tumor cell seeding also depends on the histological type of the tumors. Image-guided retroperitoneal biopsy has proven to be low cost, accessible, and a reliable procedure (in terms of diagnostic accuracy), usually associating with a low rate of complications and a low risk of tumor seeding. Several authors have underlined the importance of the retroperitoneal approach and the association with a co-axial imaging technique in order to avoid potentially deadly complications.
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http://dx.doi.org/10.3892/etm.2019.8020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6880447PMC
December 2019

The erectile dysfunction as a marker of cardiovascular disease: a review.

Acta Cardiol 2020 Aug 6;75(4):286-292. Epub 2019 Apr 6.

Department of Urology, University of Medicine and Pharmacy "Carol Davila", Emergency University Central Military Hospital, Bucharest, Romania.

Cardiovascular disease (CVD) and erectile dysfunction (ED) are two conditions that often coexist. Both diseases are consequences of the systemic vascular disease, sharing common risk factors, like diabetes mellitus, arterial hypertension, smoking, obesity, dyslipidaemia. Furthermore, they share the same pathological basis, endothelial dysfunction. Symptoms of ED precede with three to five years the clinical manifestations of CVD. This period may be a window of opportunity for the early initiation of a prompt therapeutic action for cardiovascular risk factors. This article reviews the incidence and prevalence of CVD and ED, the common risk factors, the pathophysiological link between the two diseases, and the current diagnosis and management strategies of patients with CVD and ED, in order to prevent myocardial infarction, stroke or heart failure.
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http://dx.doi.org/10.1080/00015385.2019.1590498DOI Listing
August 2020

The Current Surgical Managemnt of the Parietal Deffects in Patients with Liver Cirrhosis - Options and Limits. Our Experience and Review of Literature.

Chirurgia (Bucur) 2019 Jan-Feb;114(1):29-38

The abdominal wall hernias in patients with liver cirrhosis have a significant higher prevalence than those in non- cirrhotic patients. The best surgical treatment option and the optimal operative time still represent a subject of debate. Material and method: We have retrospectively analyzed the cases of abdominal wall hernias in patients with liver cirrhosis admitted in the Surgical Department of the Sfantul Pantelimon Clinical Emergency Hospital from Bucharest, undergoing surgical treatment between January 2012 and December 2016. Data regarding the laboratory results (the serum albumin and bilirubin levels, the Prothrombin Time) and the clinical aspects (the presence of ascites or encephalopathy) that helped establish the grade of the disease according to Child classification system, and, also, the information regarding the type of hernia, the character of the surgical indication (emergency or elective), the surgical technique and the postoperative evolution have been collected from the medical documents of the patients included in the present study. The statistical analysis has been made using the chi- square test. 32 cases out of the total 65 patients included in the study, that underwent surgical intervention for the treatment of the abdominal wall defects, had umbilical hernia (49,23%), 18 cases presented with inguinal hernia (27.69%), 11 with incisional hernia (16.92%) and 4 with epigastric hernia (6.15%). 29 patients were subjected to elective surgery (44.6%) and 36 to emergency surgery (55,4%). Regarding the Child classification system used in the present study, 24 patients presented with Child A grade of cirrhosis (36.92%), 30 with Child B (46.15%) and 11 with Child C (16.92%). The postoperative morbidity rate was 45,83% in Child A group, 56,66% in Child B group and 81,8% in Child C group. The mortality rate was 4,16% in the Child A group (one death), 13.33% in the Child B group (4 deaths) and 72.72% in Child C group (8 cases). The highest mortality rates have been registered in patients that underwent emergency surgical intervention. The parietal defects in patients with liver cirrhosis can be surgically treated with satisfactory outcomes. The best results have been registered in patients with compensated form of the cirrhosis or in cases undergoing elective surgery. The methods used for the surgical treatment of the abdominal wall defects vary from herniorrhaphy to alloplastic techniques. For patients with ascites, a good control of this complication represents an important factor for the favourable postoperative evolution. The emergency surgical interventions are associated with greater risks of morbidity and mortality.
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http://dx.doi.org/10.21614/chirurgia.114.1.29DOI Listing
June 2019

Appendiceal Diverticulitis - A Case Report.

Chirurgia (Bucur) 2017 Jan-Feb;112(1):82-85

Appendiceal diverticulitis is a very rare cause for pain in the right iliac fossa. Whether it is simptomatic or discovered randomly during an appendectomy or barium enema, understanding its clinical evolution is important for having a good management. In this report we present the case of a 50 year old female who underwent an open appendectomy during which we discovered appendiceal diverticulitis.
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http://dx.doi.org/10.21614/chirurgia.112.1.82DOI Listing
June 2017

Traumatic abdominal wall hernia associated with small bowel injury-case report.

Indian J Surg 2015 Apr 2;77(Suppl 1):174-6. Epub 2015 Feb 2.

General Surgery Department, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania ; General Surgery Department, "Sfântul Pantelimon" Emergency Clinical Hospital, Pantelimon Street, no 340-342, First Floor, District 2, Bucharest, Romania.

Traumatic abdominal wall hernias (TAWHs) are rare. Their diagnosis is mostly clinical and can be overlooked in the setting of trauma and distracting injuries or they can be misinterpreted as parietal hematomas. Associated lesions can influence decision making regarding time of operation and surgical technique. Our case highlights the management of a high-energy TAWH that associates a small bowel traumatic lesion. Surgical repair of TAWHs should follow general hernia repair principles. Further exploration of surgical options is necessary for a consensus to be reached.
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http://dx.doi.org/10.1007/s12262-015-1238-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4425802PMC
April 2015

Insulin resistance is associated with all chronic complications in type 1 diabetes.

J Diabetes 2016 Mar 28;8(2):220-8. Epub 2015 Apr 28.

2nd Clinical Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.

Background: Insulin resistance (IR) is present in type 1 diabetes mellitus (T1DM) and is suggested to be related to chronic diabetic complications. The primary aim of our study was to assess IR in T1DM patients with and without chronic complications. A secondary aim was to evaluate the possible association between IR and chronic diabetic complications.

Methods: This cross-sectional study enrolled 272 patients with T1DM. Insulin resistance was quantified using the estimated glucose disposal rate (eGDR). Associations between eGDR and each diabetes complication were first evaluated using binary logistic regression, then multiparametric logistic regression with stepwise selection of covariates. The discriminative value of eGDR was assessed by receiver operating characteristic (ROC) curve analysis.

Results: Estimated GDR was lower in patients with chronic diabetic complications (6.1 vs. 6.9 mg/kg per min [P = 0.02] for retinopathy; 6.3 vs. 7.3 mg/kg per min [P < 0.01] for nephropathy; 6.5 vs. 7.6 mg/kg per min [P < 0.01] for neuropathy; and 5.2 vs. 7.5 mg/kg per min [P < 0.01] for cardiovascular complications). In univariate analysis eGDR was associated all diabetic complications. These associations remained significant after adjustment for different variables in the final regression models. In addition, eGDR was a good discriminator for each diabetic complication, with an area under the curve between 0.609 and 0.759.

Conclusions: Patients with chronic diabetic complications are more insulin resistant than those without complications. Moreover, IR was independently associated with the presence of each chronic diabetic complication, and seems to be a good discriminator for them all.
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http://dx.doi.org/10.1111/1753-0407.12283DOI Listing
March 2016

A histopathological and immunohistochemical approach of surgical emergencies of GIST. An interdisciplinary study.

Rom J Morphol Embryol 2014 ;55(2 Suppl):619-27

Department of General Surgery, "St. Pantelimon" Emergency Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania;

The tailored approach to gastrointestinal stromal tumors (GISTs) has led to better prognosis for these types of tumors. Also, finding out GIST's pathology has led to a better understanding of oncogenesis and cancer therapy in general. The rapid expansion of molecular and pathological knowledge of GISTs has given this disease a promising future. We analyze 30 cases of GISTs operated on in our clinic with confirmed diagnosis by immunohistochemistry. Most of the cases were acute cases that required urgent surgical therapy. An extended analysis of these cases is performed in order to underline their special features. We recorded 17 GISTs of the stomach, 12 GISTs of the small bowel and one esophageal GIST. Of the 30 cases, 15 cases required urgent surgery presenting with GI bleeding or shock following intraperitoneal rupture and bleeding or intestinal obstruction. Of the 15 cases that required urgent surgery 12 cases presented with serosal involvement. Twenty-four cases presented spindle cell histology, four cases were epithelioid and two cases presented mixed cellularity. Although acute presentation of GISTs is not the rule, 15 of 30 of our cases required immediate surgery and a high proportion of them (12/15) presented with serosal involvement. Serosal involvement may warrant the need for a macroscopic classification of GISTs and correlation to therapy. While overall mortality was not high in our series, morbidity is affected by acute presentation, though not specifically pertaining to the diagnosis of GIST. Acute presentations were more frequent, in our series, for small bowel GISTs, compared to gastric GISTs. Serosal involvement was more frequent in the group with acute presentation compared with non-acute GISTs and was present at the most cases of small bowel GISTs with acute onset. The Ki-67 index showed no difference between acute and non-acute onset of GISTs.
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April 2015

Multimodal management of upper gastrointestinal bleeding caused by stress gastropathy.

J Gastrointestin Liver Dis 2009 Sep;18(3):279-84

St. Pantelimon Hospital, General Surgery Clinic, 340 Pantelimon Street, 73561 Bucharest, Romania.

Background: The 1999 ASHP (American Society of Health-System Pharmacists) recommendation regarding the prevention of stress-related mucosal disease and bleeding in critical care patients by using PPI and H2RA still holds. We tried to compare the results obtained by our group with the international data available and determine the benefits of this prophylactic therapy.

Methods: The present paper presents a retrospective single center report of 36 patients with upper gastrointestinal (GI) bleeding caused by stress gastritis. Despite prophylaxis, the patients included in this study who were admitted in the ICU during a five year period (2003-2008) with various underlying conditions, had clinical and endoscopic diagnoses of bleeding from stress-related gastric mucosal disease. The initial treatment focused on patient stabilization first by medical intervention aimed at maintaining an elevated intragastric pH, in association with haemostatic drugs and blood transfusions; complementary endoscopic or surgical haemostatic therapy was employed for patients unresponsive to the initial management.

Results: Despite prophylactic acid suppressive therapy, upper GI bleeding findings were consistently present in high risk patients, 69.4% presenting hematemesis and 55.6% presenting coffee-ground gastric content.

Conclusions: Each institution needs to have guidelines in place to establish the patients that actually have sufficient risk factors to justify stress gastritis prophylaxis.
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September 2009