Publications by authors named "Ovidiu Stiru"

38 Publications

Diabetes Mellitus as a Prognostic Factor for Locally Advanced Rectal Cancer.

In Vivo 2021 Jul-Aug;35(4):2495-2501

Department of Radiotherapy II, "Prof. Dr. Alex. Trestioreanu" Institute of Oncology, Bucharest, Romania.

Background/aim: Currently, the impact of diabetes mellitus (DM) on rectal cancer patients is complex and just partly elucidated. The purpose of this study was to investigate the impact of diabetes mellitus on rectal cancer patients focusing on tumor differentiation grade, neoadjuvant chemoradiotherapy (NACRT) response, disease-free (DFS) and overall (OS) survival.

Patients And Methods: Our study's population consisted of a group of 53 patients diagnosed with locally advanced rectal cancer, who underwent NACRT, followed by radical oncological surgery. This patient population was further divided into two groups according to diabetes presence.

Results: Downstaging rates, local control, DFS, and OS were lower in the DM subgroup compared to the non-DM locally advanced rectal cancer patients.

Conclusion: The presence of DM at the time of diagnosis of locally advanced rectal cancer patients may be a negative predictive factor for response to neoadjuvant therapy, distant metastases, and local recurrences rates.
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http://dx.doi.org/10.21873/invivo.12530DOI Listing
June 2021

Successfully superior mesenteric artery stenting in operated type A aortic dissection complicated with delayed mesenteric malperfusion.

SAGE Open Med Case Rep 2021 3;9:2050313X211021184. Epub 2021 Jun 3.

Emergency Institute for Cardiovascular Diseases "Prof. Dr. C.C. Iliescu," Bucharest, Romania.

Here, we describe a case of a 61-year-old male patient with acute type A aortic dissection involving the ascending aorta, aortic arch, descending aorta, and the abdominal aorta down to the iliac bifurcation with evidence of left common iliac artery occlusion. Computed tomography angiography revealed progressive dissection into the superior mesenteric artery and left renal artery with no clinical signs of mesenteric ischemia. Emergent ascending aortic reconstruction of the dissected aorta relieves the leg ischemia. On a postoperative day 9, the evolution was complicated by massive right hemothorax. Although the patient was hemodynamically stable after obtaining hemostasis, the patient developed paralytic ileus with a high elevated lactate level. Visceral malperfusion was not detected by exploratory laparotomy. Emergency abdominal aortic angiography revealed superior mesenteric artery intermittent occlusion, successfully treated by stenting implantation.
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http://dx.doi.org/10.1177/2050313X211021184DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8182222PMC
June 2021

Extracorporeal Membrane Oxygenation (ECMO) Rescue Therapy in Post-cardiotomy Cardiogenic Shock: A Case Report.

Rom J Anaesth Intensive Care 2020 Dec 31;27(2):77-79. Epub 2020 Dec 31.

Institutul de Urgenta pentru Boli Cardiovasculare Prof Dr C C Iliescu Bucharest, Romania.

Cardiogenic shock is a constant challenge for the intensivist when complicating a myocardial infarction, due to the high rate of associated morbidity and mortality, especially in the setting of mechanical complications such as papillary muscle rupture. We present the case of a 49-year-old woman with cardiogenic shock due to acute myocardial infarction (AMI) complicated by severe mitral valve insufficiency due to papillary muscle rupture. She was treated initially by medical optimization, followed by mitral valve replacement and complete surgical revascularization, requiring rescue mechanical circulatory support by extracorporeal membrane oxygenation (ECMO). ECMO proved to be a rescue therapy in a patient with refractory cardiogenic shock after urgent cardiac surgery.
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http://dx.doi.org/10.2478/rjaic-2020-0019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8158319PMC
December 2020

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

Catheter-related giant right atrial thrombosis mimicking a myxoma: A case report.

Exp Ther Med 2021 Jun 14;21(6):603. Epub 2021 Apr 14.

Department of Cardiovascular Surgery, 'Prof. Dr. C. C.' Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania.

Despite the development of imagistic methods, the differential diagnosis of a right atrial mass may be difficult to be established, the most common pathologies which should be taken in consideration being represented by thrombus, tumors, prominent crista terminalis, or vegetation of infectious endocarditis. In this study, we present the case of a 63-year-old man with chronic kidney disease, in hemodialysis (HD) with a silicone central venous catheter (CVC) with the incidental transthoracic echocardiography (transthoracic echocardiogram, TTE) finding of a tumoral mass of 35x26 mm in the right atrium (RA), not related with the catheter, which was diagnosed as right atrial myxoma and underwent surgical excision. After reviewing the histopathology probe, the diagnosis of right atrial thrombus was confirmed. In conclusion, differentiating intracardiac right atrial masses (RAMs) could may prove challenging. In our patient, clinical presentation and the preoperative investigations could not differentiate the right atrial thrombus from a myxoma, and only the postoperative histopathology diagnosis was able to guide correct diagnosis.
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http://dx.doi.org/10.3892/etm.2021.10035DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8082616PMC
June 2021

Endoventricular Pericardial Patch Repair of a Giant Left Posterior Ventricular Aneurysm.

In Vivo 2021 May-Jun;35(3):1901-1905

Emergency Institute for Cardiovascular Diseases "Prof. Dr. C.C. Iliescu", Bucharest, Romania.

Background/aim: Left ventricular aneurysms are complications following acute myocardial infarction. Left posterior left ventricular aneurysms occurring in a submitral position constitute a minor entity, and those leaving the mitral apparatus intact are extremely rare.

Case Report: Herein, we report the case of a 58-year-old patient with a past medical history of coronary artery disease and myocardial infarction with a giant left posterior left ventricular aneurysm with moderate mitral valve incompetence.

Results: The patient underwent myocardial revascularization and, through a transaneurysmal approach, successful endoventricular pericardial patch wall reconstruction with no impact on mitral valve competence.

Conclusion: Whenever the mitral valve is not affected, a trans aneurysmal approach with endoventricular pericardial patch in association with myocardial revascularization represents a safe and reproducible approach with good functional outcomes.
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http://dx.doi.org/10.21873/invivo.12455DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8193276PMC
June 2021

Abdominal paraaortic paraganglioma: Management of intraoperative hemodynamic emergencies during elective resection procedures (A case presentation).

Exp Ther Med 2021 May 23;21(5):543. Epub 2021 Mar 23.

Department of Cardiovascular Surgery, 'Prof. Dr. C. C. Iliescu' Institute of Emergency for Cardiovascular Diseases, 022322 Bucharest, Romania.

Paragangliomas are extremely rare neuroendocrine tumors. We report a case of a 44-year-old man with hypertension who presented a tumoral mass located retroperitoneally at the aortic bifurcation which included both the common iliac arteries and the posterior left iliac vein, who experienced an unpredictable intraoperative cardiac arrest with electromechanical dissociation at 5 min after laparotomy. After successful resuscitation and hemodynamic stability, the lesion was fully excised. In the course of tumor manipulation, the patient developed a major hypertensive crisis with peak systolic blood pressure over 280 mmHg. Pathologic examination revealed the presence of diffuse proliferation of large and medium-sized mature adipocytes consistent with paraganglioma diagnosis. The patient was discharged at home on the seventh postoperative day. He did not present evidence of recurrence at the one-year follow-up. In conclusion, paragangliomas can require particular management due to their location but also due to their capacity to discharge substances which might induce life-threatening intraoperative complications.
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http://dx.doi.org/10.3892/etm.2021.9975DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014983PMC
May 2021

PI3K/AKT/mTOR signalling pathway involvement in renal cell carcinoma pathogenesis (Review).

Exp Ther Med 2021 May 23;21(5):540. Epub 2021 Mar 23.

Department of Family Medicine and Clinical Base, Dr. Carol Davila Central Military Emergency University Hospital, 010825 Bucharest, Romania.

Renal cell carcinoma (RCC) accounts for over 90% of all renal malignancies, and mainly affects the male population. Obesity and smoking are involved in the pathogenesis of several systemic cancers including RCC. The phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (mTOR) signalling pathway regulates cell growth, differentiation, migration, survival, angiogenesis, and metabolism. Growth factors, hormones, cytokine and many extracellular cues activate PI3K/AKT/mTOR. Dysregulation of this molecular pathway is frequently reported in human cancers including RCC and is associated with aggressive development and poor survival rate. mTOR is the master regulator of cell metabolism and growth, and is activated in many pathological processes such as tumour formation, insulin resistance and angiogenesis. mTOR inhibitors are used at present as drug therapy for RCC to inhibit cell proliferation, growth, survival, and the cell cycle. Temsirolimus and everolimus are two mTOR inhibitors that are currently used for the treatment of RCC. Drugs targeting the PI3K/AKT/mTOR signalling pathway may be one of the best therapeutic options for RCC.
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http://dx.doi.org/10.3892/etm.2021.9972DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014975PMC
May 2021

Impact of adipose tissue in chronic kidney disease development (Review).

Exp Ther Med 2021 May 23;21(5):539. Epub 2021 Mar 23.

Department of Family Medicine and Clinical Base, Dr. Carol Davila Central Military Emergency University Hospital, 010825 Bucharest, Romania.

Obesity is a worldwide pandemic health issue. Obesity is associated with the pathogenesis of type 2 diabetes, hypertension, dyslipidemia, cardiovascular diseases, cancer, and kidney diseases. This systemic disease can affect the kidneys by two mechanisms: Indirectly through diabetes mellitus (DM) and hypertension and directly through adipokines secreted by adipose tissue. Obesity is a risk factor for chronic kidney disease (CKD), which is associated with an increased risk of morbidity and mortality among the adult population. Increased visceral adipose tissue leads to renal glomerular hyperfiltration and hyperperfusion, which may lead to glomerular hypertrophy, proteinuria, and CKD development. Adipokines are hormones produced by fat tissue. They are involved in energy homeostasis, sugar and fat metabolism, reproduction, immunity, and thermogenesis control. Hormones and cytokines secreted by adipose tissue contribute to the development and progression of CKD. Decreased serum or urinary adiponectin levels are specific in diabetic and non-diabetic CKD patients, while leptin presents increased levels, and both are associated with the development of glomerulopathy. Excessive adipose tissue is associated with inflammation, oxidative stress (OS), insulin resistance and activation of the renin angiotensin-aldosterone system (RAAS). Therefore, adipose tissue dysfunction plays an important role in the development of CKD.
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http://dx.doi.org/10.3892/etm.2021.9969DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014972PMC
May 2021

Hypocalcemia: A possible risk factor for anastomotic leak in digestive surgery.

Exp Ther Med 2021 May 22;21(5):523. Epub 2021 Mar 22.

Department of Diabetes, Nutrition and Metabolic Diseases, Prof. N.C. Paulescu National Institute of Diabetes, Nutrition and Metabolic Disease, 020021 Bucharest, Romania.

Anastomotic leaks (ALs) remain the most severe complication in digestive surgery, as well as the most consumptive in terms of human and financial resources. There is an abundance of international research which has focused on identifying and correcting risk factors, and on individualized surgical management as well. The most frequent risk factors are male sex, obesity, diabetes, advanced malignant disease, ASA score, perioperative blood loss or perioperative transfusion, long operation time, emergency operation and altered nutritional status. The aim of the present study was to measure the preoperative serum calcium level and to find a possible correlation between calcium levels and the risk of AL occurrence. A retrospective analysis of medical records for 122 patients who underwent surgical gut resection with anastomosis for different pathologies was carried out. Preoperative serum calcium level and the occurrence of AL was noted. The results revealed that the average value of total blood calcium was 8.78 mg/dl, without a significant difference in sex groups. Hypocalcemia was identified in 44 patients (36.1%). AL was identified in 8 patients (6.6%), with a statistically insignificant difference between male and female patients. The average value of blood calcium in the AL patient group was 8.07 mg/dl, while in patients without AL the average value was 8.83 mg/dl. Hypocalcemia, defined as a serum calcium level below 8.5 mg/dl, was observed in 7 of the 8 patients presenting with AL (87.5%) and 37 patients who did not present with AL (32.5%), a significant difference with which to consider and include hypocalcemia in the group of risk factors for AL (P=0.001). In conclusion, preoperative low serum calcium level can represent a risk factor for AL in digestive surgery.
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http://dx.doi.org/10.3892/etm.2021.9955DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014963PMC
May 2021

The Impact of COVID-19 Infection on the Postoperative Outcomes in Pancreatic Cancer Patients.

In Vivo 2021 Mar-Apr;35(2):1307-1311

Department of Surgery, "Ponderas" Academic Hospital, Bucharest, Romania.

Background/aim: The aim of this study is to report a case series of three patients who developed postoperative severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) infection, although the initial tests were negative.

Patients And Methods: Between April and September 2020, three patients submitted to pancreatoduodenectomy developed SARS-CoV-2 infection; their outcomes were compared to those of a similar group in which the postoperative outcomes were uneventful.

Results: There were no significant differences between the two groups in terms of pre- and intraoperative outcomes; however, all of the three cases who developed SARS-CoV-2 infection postoperatively required re-admission in the intensive care unit and a longer hospital in stay. The overall mortality rate was null.

Conclusion: Patients submitted to pancreatoduodenectomy for pancreatic head cancer who develop SARS-COV-2 infection postoperatively need a more appropriate supportive care; however, the overall mortality does not appear to increase, justifying, in this way, the continuation of programmed oncological of surgeries.
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http://dx.doi.org/10.21873/invivo.12383DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8045124PMC
March 2021

Management of acute intradialytic cardiovascular complications: Updated overview (Review).

Exp Ther Med 2021 Mar 26;21(3):282. Epub 2021 Jan 26.

Department of Medical Semiology, Discipline of Internal Medicine I and Nephrology, Faculty of Medicine, 'Carol Davila̓ University of Medicine and Pharmacy, 020021 Bucharest, Romania.

An increasing number of patients require renal replacement therapy through dialysis and renal transplantation. Chronic kidney disease (CKD) affects a large percentage of the world's population and has evolved into a major public health concern. Diabetes mellitus, high blood pressure and a family history of kidney failure are all major risk factors for CKD. Patients in advanced stages of CKD have varying degrees of cardiovascular damage. Comorbidities of these patients, include, on the one hand, hypertension, hyperlipidemia, hyperglycemia, hyperuricemia and, on the other hand, the presence of mineral-bone disorders associated with CKD and chronic inflammation, which contribute to cardiovascular involvement. Acute complications occur quite frequently during dialysis. Among these, the most important are cardiovascular complications, which influence the morbidity and mortality rates of this group of patients. Chronic hemodialysis patients manifest acute cardiovascular complications such as intradialytic hypotension, intradialytic hypertension, arrhythmias, acute coronary syndromes and sudden death. Thus, proper management is extremely important.
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http://dx.doi.org/10.3892/etm.2021.9713DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7851674PMC
March 2021

Kidney aging process and the management of the elderly patient with renal impairment (Review).

Exp Ther Med 2021 Mar 25;21(3):266. Epub 2021 Jan 25.

Department of Dialysis, Emergency University Hospital, 050098 Bucharest, Romania.

As life expectancy increases, a rise in the number of chronically ill patients is observed due to the aging population. Among the various diseases, chronic kidney disease is at present one of the main causes of morbidity and, due to its typical complications, it is also one of the most important causes of mortality in the general population. For these reasons, the understanding of the kidney aging process, its consequences and its adequate management are essential. The judicious use of certain types of drugs, the prevention of episodes of renal injury either by toxic mechanisms or by dehydration are important aspects and are part of the apropriate approach for elderly patients. The most effective treatment of various types of conditions with a negative impact on renal function and for which an increased incidence is known as we age should also be considered. Thus, in the case of elderly patients, in order to protect the kidneys, an integrative approach is recommended, one that includes both elements of prevention and the appropriate treatment of existing diseases.
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http://dx.doi.org/10.3892/etm.2021.9697DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7851660PMC
March 2021

Pulmonary Mucinous Cystadenoma - A Rare Pathology.

In Vivo 2021 Jan-Feb;35(1):629-634

Department of Visceral Surgery, Center of Excellence in Translational Medicine "Fundeni" Clinical Institute, Bucharest, Romania.

Background: Pulmonary cystadenoma is a very rare benign tumor of the lung with slow growth rate and most often, asymptomatic.

Case Report: We present the case of a 58-year-old patient admitted in the hospital for coughing with hemoptoic sputum. Standard thoracic radiography revealed a 4/5 cm macronodular opacity in the right inferior lobe, paracardiac. Thoracic computed tomography (CT) with contrast discovered a 3.8/4.7 cm homogenous mass in the right inferior lobe. After intraoperative assessment of the lesion a lower right lobectomy with mediastinal and local lymphadenectomy was performed.

Conclusion: Pulmonary mucinous cystadenoma is one of the primary pulmonary mucinous cystic neoplasia (PMCT) alongside PMCT of low malignancy and pulmonary mucinous cystadenocarcinoma (PMCAC). Because of this and because of the clinical and imagistic similarities between these main entities, establishing a preoperative diagnosis becomes very difficult. Therefore, histopathological and immunohistochemistry studies are mandatory in order to establish the correct diagnosis.
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http://dx.doi.org/10.21873/invivo.12301DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7880777PMC
June 2021

Pathological Examination of the Late Embryonic Heart Using the Same 4-chamber and 3-vessel Planes Used in Fetal Echocardiography.

In Vivo 2021 Jan-Feb;35(1):533-539

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

Background/aim: The incidence of early pregnancy loss widely varies according to age, being considerably higher in older women. Severe congenital malformations play an important role in pregnancy loss, having a high risk of recurrence. Congenital heart defects are the most common congenital abnormalities, thus the diagnosis of such malformations in aborted embryos is important for establishing both a possible cause for pregnancy loss and for correctly counseling the parents. Pathologic examination of the heart that is only a few millimeters in size, is very challenging.

Patients And Methods: A pathologic examination protocol using transverse microscopic sections at the level of the 4-chamber and 3-vessel planes is proposed for heart evaluation.

Results: Two 9-10 gestational weeks embryos were microscopically examined using transverse slides of the thorax. The 4-chamber and 3-vessel slides were analyzed and compared to 11-13 weeks ultrasound images of the 4-chamber and 3-vessel views from 10 cases. The pathologic examination provided a detailed view of the ventricles, atria and great vessels, sometime surpassing even the ultrasound examination that was performed at a later gestational age.

Conclusion: We consider our proposed pathologic examination protocol feasible for evaluating normal heart structures and ruling out severe congenital heart disease.
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http://dx.doi.org/10.21873/invivo.12288DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7880781PMC
June 2021

Dyselectrolytemia-management and implications in hemodialysis (Review).

Exp Ther Med 2021 Jan 26;21(1):102. Epub 2020 Nov 26.

Department of Medical Semiology, Discipline of Internal Medicine I and Nephrology, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.

Hemodialysis is a method for the renal replacement therapy followed by series of acute and chronic complications. Dyselectrolytemia appears in patients undergoing dialysis through mechanisms related to the chronic kidney disease and/or to the dialysis therapy and for this group of patients it is associated with an increase of morbidity and mortality. The dialysate has a standard composition, which can be modified according to the patient's characteristics. During hemodialysis patients are exposed to 18,000-36.000 litres of water/year, and the water purity along with the biochemical composition of the dialysate are essential. The individualization of the dialysis prescription is recommended for each patient and it has an important role in preventing the occurrence of dyselectrolyemia. The individualization of the treatment prescription according to the blood constants of each patient is the prerogative of the nephrologist and the association of the electrolyte imbalances with the patients cardiovascular mortality explains the importance of paying special attention to them.
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http://dx.doi.org/10.3892/etm.2020.9534DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7725007PMC
January 2021

Hepatic artery reconstruction after extended resection for borderline resectable pancreatic head cancer: A case report.

Exp Ther Med 2021 Jan 26;21(1):87. Epub 2020 Nov 26.

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

Pancreatic head cancer is frequently associated with invasion of the surrounding vascular structures, such cases being considered for a long period of time as unresectable. Improvement of the vascular surgery techniques allowed association of extended vascular resections and reconstructions, increasing in this way the percentage of patients benefiting from radical surgery. We present the case of a 47-year-old male patient with no significant medical history diagnosed with a large pancreatic head tumor invading the common and proper hepatic artery as well as the portal vein. The venous reconstruction was performed using a synthetic prosthesis while the left hepatic artery was sutured to the left gastric artery; meanwhile the right hepatic artery was reconstructed using the splenic artery. In conclusion, extended hepatic artery resection followed by arterial reconstruction in association with portal vein resection and prosthetic replacement might be needed in cases presenting large pancreatic head tumors with vascular invasion.
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http://dx.doi.org/10.3892/etm.2020.9518DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7725027PMC
January 2021

Iatrogenic Iliac Arteriovenous Fistula Management after Lumbar Discectomy Surgeries: A Case Report and Review of the Literature.

Heart Surg Forum 2020 Nov 23;23(6):E863-E866. Epub 2020 Nov 23.

Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania.

Iatrogenic iliac arteriovenous fistula (IAVF) is an extremely rare complication after lumbar discectomy surgery (LDS), with potentially life-threatening consequences. An IAVF results from the close anatomic relation between the iliac vessels and the last lumbar vertebrae and the corresponding discs. We report the case of a 45-year-old woman who developed a large right IAVF 3 years after L4-L5-S1 laminectomy. The arteriovenous fistula (AVF) was successfully treated with an endovascular technique using a WALLSTENT self- expanding stent. The postoperative period was uneventful, and the patient was discharged from the hospital in good general condition on the third postoperative day.
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http://dx.doi.org/10.1532/hsf.3289DOI Listing
November 2020

Transapical Left Ventricular Approach for Cardiac Papillary Fibroelastomas: A Case Report.

In Vivo 2020 Nov-Dec;34(6):3681-3685

Prof. Dr. C. C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, Romania.

Background/aim: Cardiac papillary fibroelastomas (CPF) are benign tumors, frequently asymptomatic, characterized by a mobile pedunculated mass that arises from the endocardium. When CPF is located in the left ventricle, it may protrude into the left ventricular outflow tract and affect hemodynamics. They are highly thrombogenic, and can also cause some life-threatening events such as cerebral and peripheral embolization.

Case Report: We herein report a case of a 74-year-old female admitted to our center with palpitations and dyspnea on exertion. Her past medical history revealed that she had had a transient ischemic attack 7 months before presentation. Echocardiography and cardiac magnetic resonance imaging revealed an intracardiac mass anchored in the anteroapical interventricular septum without interference with aortic or mitral valve functionality. Surgical resection of the left ventricular mass was performed through the left apical ventriculotomy approach. Histopathological examination of the tumor was suggestive of papillary fibroelastoma. The postoperative course was uneventful. The patient was discharged home on the eighth postoperative day, with no recurrence at 6 months.

Conclusion: Although left ventricular papillary fibroelastomas are benign tumors, they carry a high risk for embolic complications and therefore surgery should be proposed, the transapical approach being a safe and effective method.
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http://dx.doi.org/10.21873/invivo.12216DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7811624PMC
June 2021

Neuroendocrine syndrome in bronchial carcinoid tumors.

Exp Ther Med 2020 Dec 14;20(6):200. Epub 2020 Oct 14.

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

Pulmonary carcinoid tumors represent bronchopulmonary neuroendocrine neoplasms which might synthetize serotonin, histamine, bombesin or other types of hormones responsible for the development of a broad spectrum of signs and symptoms, known as carcinoid syndrome. Data of 98 patients submitted to surgery for bronchial carcinoid tumors in the Thoracic Surgery Clinic of the 'Marius Nasta' Institute of Pneumophtisiology between 2014 and 2018 were retrospectively reviewed. All patients were submitted to paraclinical tests, imagistic studies (computed tomography or magnetic resonance imaging), bronchoscopy and biopsy in order to have a positive diagnostic of pulmonary carcinoid. The most common clinical symptoms at the time of presentation were: Persistent cough followed by dyspnea and recurrent pulmonary infections. The main neuroendocrine syndromes found were Cushing and Carcinoid Syndrome. All patients were submitted to surgery with curative intent consisting of wedge resection (in 4 cases, 4.08%), lobectomy (in 79 cases, 80.61%), bilobectomy (in 5 cases, 5.1%) and pneumonectomy respectively (in 10 cases, 10.2%). In all cases neuroendocrine specific symptoms disappeared once the carcinoid tumor was removed. In conclusion, bronchial carcinoid tumors have a positive outcome in most cases. Specific neuroendocrine markers as well as neuroendocrine syndrome disappears once the tumor is removed.
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http://dx.doi.org/10.3892/etm.2020.9330DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588783PMC
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

Brachial Mycotic Pseudoaneurysms Due to Prosthetic Valve Infective Endocarditis: A Case Report and Review of the Literature.

Heart Surg Forum 2020 Aug 28;23(5):E617-E620. Epub 2020 Aug 28.

Department of Cardiovascular Surgery, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Prof. Dr. C. C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, Romania.

Brachial mycotic pseudoaneurysms (BMPA) are a rare complication of infective endocarditis (IE), but potentially could be a limb-threatening condition. We present the case of a 38-year-old male referred to our department, complaining of the sudden onset of a painful pulsatile mass 5 x 10 cm in the right antecubital fossa that slowly progressed over time. Two years before this, he underwent aortic and mitral valve replacement with mechanical prosthetic valves and tricuspid annuloplasty for IE with methicillin-susceptible Staphylococcus aureus after a six-week course of intravenous antibiotherapy with oxacillin. Clinical examination of the right upper limb revealed a pulsatile and compressible mass with a normal temperature and without other clinical signs of inflammation. Pulse of the axillary artery, brachial and radial arteries were palpable. He was diagnosed by Doppler ultrasonography and digital subtraction angiography with BMPA. Furthermore, transesophageal echocardiography (TEE) revealed normal function of the aortic and mitral prosthetic valve with no signs of prosthetic valve endocarditis and no feature of congestive heart failure. Considering these clinical findings, surgical treatment was planned. He underwent re-section of the brachial pseudoaneurysm and arterial reconstruction. One year after the pseudoaneurysm resection, evolution was excellent. This manuscript presents this rare, uncommon complication after IE and also reviews the available surgical management strategies for this pathology.
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http://dx.doi.org/10.1532/hsf.2951DOI Listing
August 2020

Successful concomitant open surgical repair of aortic arch pseudoaneurysm and percutaneous myocardial revascularization in a high risk patient: A case report.

Int J Surg Case Rep 2020 15;74:86-90. Epub 2020 Aug 15.

Emergency Institute for Cardiovascular Diseases Bucharest, Romania; University of Medicine and Pharmacy, Bucharest, Romania.

Introduction: We present a case of open surgical repair of an aortic arch pseudoaneurysm (AAP) without the use of hypothermic circulatory arrest in a patient with low ejection fraction and associated coronary artery disease (CAD) and discuss some issues regarding the management of this case.

Presentation Of The Case: A 69-year-old male with multiple pathologies and history of angina pectoris was transferred to our center from a local hospital with an initial diagnosis of non-ST-segment elevation myocardial infarction. Coronary angiography revealed stenotic lesions affecting all three coronary arteries. Multislice 3D contrast-enhanced computed tomography (CT-scan) revealed a 36 × 27 mm AAP. Endovascular stent-grafting was deemed to be unsuitable due to hostile landing zone. Therefore, the heart team decided for simultaneou treatment of the AAP and percutaneous therapy of CAD. The AAP was excised, and repair was performed with a Dacron patch on beating heart. After the surgical procedure, PCI with drug-eluting stents (DES) was performed on the right coronary artery (RCA) and the left circumflex artery (LCx) in the operating room. The patient's postprocedural course was uneventful and after thirteen days, he was discharged in good shape. 3D CT-scan performed after three month showed no residual AAP.

Discussion: We established this approach as being the most suitable for our case based on favorable circumstances such as: stable CAD, beating heart procedure with low impact on myocardial ischemia, the impossibility of successful placement of an endovascular stent-graft, the presence of a pseudoaneurysm neck with minimum calcification.

Conclusion: We consider the best approach for individual cases is tailoring the treatment plan and the procedure to the patient's specific anatomy and pathology.
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http://dx.doi.org/10.1016/j.ijscr.2020.07.085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7452561PMC
August 2020

Primary thyroid angiosarcoma in a non-endemic region - a rare case.

Rom J Morphol Embryol 2020 ;61(1):267-271

Department of Plastic and Reconstructive Surgery, Prof. Dr. Agrippa Ionescu Clinical Emergency Hospital, Bucharest, Romania; Discipline of Internal Medicine I and Nephrology, Department of Medical Semiology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Department of Nephrology, Emergency University Hospital, Bucharest, Romania;

Thyroid angiosarcoma (AS) is a specific type of vascular tumor that arises from the endothelial cells, being highly aggressive, with increased recurrence rates and metastasis. It is characterized by positive endothelial markers and co-positive markers for cytokeratins and epithelial membrane antigen. We are describing the case of a 76-year-old patient who presented to the hospital for dyspnea and asthenia. The clinical and paraclinical investigations confirmed the presence of a right large thyroid nodule, which turned out positive at immunostaining for AS. Even if thyroid AS is a rare type of tumor, mainly described in the Alps, one has to take into account that it can evolve in any other regions and should be considered as a differential diagnosis.
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http://dx.doi.org/10.47162/RJME.61.1.32DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7728125PMC
June 2021

Infection with hepatitis C virus in hemodialysis patients: An overview of the diagnosis and prevention rules within a hemodialysis center (Review).

Exp Ther Med 2020 Jul 17;20(1):109-116. Epub 2020 Mar 17.

Discipline of Internal Medicine I and Nephrology, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.

Increase in the number of patients with chronic kidney disease (CKD) calls for improved management of these patients. In stage 5 CKD, when the initiation of renal replacement therapy (RRT) becomes necessary, there is an increase in the infection risk of the patients and immunological tests for hepatitis C virus (HCV) detection turn positive at an alarmingly higher rate compared to general population. With the introduction into clinical practice of diagnostic tests, the increased prevalence of HCV among CKD patients has been known since the 1990s. Also, the negative impacts of HCV infection on CKD evolution as well as the unfavorable evolution of grafts received by HCV infected patients are known. Chronic hemodialysis patients are a category of patients whose risk of HCV infection is substantial. Currently, in the hemodialysis centers, at the base of the transmission of HCV infection there are a multitude of factors. Infection with HCV has a different impact on patient with end-stage renal disease (ESRD). Comorbidities in this case have significant sources of mortality and morbidity. It was proven that the post transplantations problems were prevented and mortality was reduced for patients who were diagnosed with HCV and in whom the infection was treated before the kidney transplant (KT). Consequently, early detection of the infection and the application of specific treatment has a considerable impact on the outcome of the patients. Another important component of the management of HCV infection in the chronic hemodialysis patients is the prevention of the infection transmission by applying specific methods.
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http://dx.doi.org/10.3892/etm.2020.8606DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7271692PMC
July 2020

Characteristics of patients at initiation of renal replacement therapy - experience of a hemodialysis center.

Exp Ther Med 2020 Jul 17;20(1):103-108. Epub 2020 Mar 17.

Discipline of Internal Medicine I and Nephrology, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.

The monitoring and care of patients with chronic kidney disease (CKD) before the dialysis initiation contribute to a better survival rate and an improvement in quality of life. The patients who do not benefit from a good predialysis management have a worse short and long-term prognosis. A retrospective, unicentric study was performed to evaluate the status of patients with stage 5 CKD at the time of initiation of renal replacement treatment. A total of 109 patients were included in the study. The evaluation of the patients included the clinical manifestations leading to hemodialysis initiation, the clinical and laboratory data of the patients when the hemodialysis was started. Based on the obtained data, a statistical analysis was performed using the Chi-square test, Fisher's exact test, ANOVA, and Kruskal-Wallis H test. The mean age of the patients was 64.61±13.59 years. Of the patients 51.38% were women. Vascular nephropathies and diabetes mellitus dominated the etiology of CKD. The comorbidities were high blood pressure, ischemic heart disease, history of myocardial infarction, heart failure, history of stroke, peripheral artery disease or atrial fibrillation. Only 43 (39.45%) of our patients were monitored before the hemodialysis initiation. Hemodialysis was initiated on central venous catheter (in most cases non-tunneled) in 78.90% of the patients. Most of the patients had an altered general status, fatigue/tiredness with poor exercise capacity when hemodialysis was initiated. Most of the patients (98.17%) had anemia, the average level of hemoglobin being 8.69±1.85 g/dl. In conclusion, careful monitoring of patients in the early stages of CKD would result in lower morbidity and mortality. These objectives can be achieved by implementing screening programs and early interventions.
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http://dx.doi.org/10.3892/etm.2020.8608DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7271700PMC
July 2020

Abdominal aortic calcification in predialysis patients: Contribution of traditional and uremia-related risk factors.

Exp Ther Med 2020 Jul 17;20(1):97-102. Epub 2020 Mar 17.

Department of Medical Semiology, Discipline of Internal Medicine I and Nephrology, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.

Cardiovascular disease is the main cause of morbidity and mortality in end-stage renal disease (ESRD) patients. Recent population based epidemiological studies demonstrated a correlation between reduced renal function and risk for all causes and cardiovascular mortality, 50% of patients dying before the commencement of renal replacement therapy. Vascular calcifications (VC) and arterial stiffness are major contributors to cardiovascular disease and are independent predictors of cardiovascular mortality in ESRD patients. Scarce information is available on the risk factors and prognosis of predialysis patients with VC. The aim of this study was to evaluate the contribution of traditional and uremia related risk factors to abdominal aortic calcification in predialysis patients. A single center, retrospective study was performed on 305 adult patients monitored at the Bucharest University Emergency Hospital for at least 6 months. Our study reports an increased incidence of VC in predialysis chronic kidney disease (CKD) patients, higher in those with advanced age, history of cardiovascular disease, osteoporosis, and declining renal function.
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http://dx.doi.org/10.3892/etm.2020.8607DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7271689PMC
July 2020

Unusual Location of a Posterior Lipoma Originating From the Left Atrial Roof: Case Report and Review of the Literature.

Heart Surg Forum 2020 03 16;23(2):E140-E142. Epub 2020 Mar 16.

Prof. Dr. C. C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, Romania.

Lipomas are the most common type of soft tissue tumors. They mainly are located in subcutaneous tissue in the body, including the heart. The cardiac location of lipomas is rare, mostly asymptomatic, and can cause life-threatening complications by rapid growth. The clinical symptoms, when present, occur in evolution with the growth in size, depending upon the location and degree of invasion in the endocardium. We present the case of a 63-year-old male patient with a large intrapericardial lipoma with an unusual location, originating from the left atrial roof. The initial symptoms of the patient were shortness of breath, dizziness, and mild dyspnea. Transthoracic echocardiography (TTE) was the first line diagnosis method, followed by computed tomography (CT); both showed a large posterior intrapericardial mass. Resection of a 12/8/5 cm lipomatous tumor mass was performed via median sternotomy, under cardiopulmonary bypass (CPB) on the beating heart. Histopathologic examination revealed the presence of diffuse proliferation of large- and medium-sized mature adipocytes consistent with the diagnosis of pericardial lipoma. The patient was discharged at home on the seventh postoperative day, with a marked improvement of his clinical state and effort tolerance. He did not present evidence of recurrence at his 1-year follow up.
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http://dx.doi.org/10.1532/hsf.2933DOI Listing
March 2020

Transseptal Approach for Mitral Valve Replacement in Dextrocardia with Situs Inversus Totalis: A Case Report and Review of the Literature.

Heart Surg Forum 2020 02 10;23(1):E030-E033. Epub 2020 Feb 10.

Prof. Dr. C. C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, Romania.

We consider mitral valve disease requiring surgery in a patient with dextrocardia and situs inversus totalis to be an exceptional finding. The transseptal approach for mitral valve surgery in dextrocardia represents a technical challenge owing to its anatomic particulars. We present the case of a 56-year-old female patient who had been diagnosed with situs inversus totalis in childhood and with chronic atrial fibrillation in adulthood and was under oral anticoagulant treatment. She was referred to our hospital for increasing dyspnea and palpitation. Transthoracic echocardiography detected severe mitral regurgitation associated with moderate tricuspid regurgitation, with normal left and right ventricular function. Contrast chest computed tomography (CT) and preoperative abdominal CT showed both dextrocardia and situs inversus totalis, with normal continuity of the inferior vena cava. Biatrial cannulation was performed with the surgeon standing on the right side of the patient, and mitral valve replacement using a transseptal approach was performed with the surgeon standing on the left side of the patient. In this case report, we emphasize the rarity of mitral valve disease in a patient with dextrocardia and the inherent potential difficulty that can appear in this particular anatomic condition.
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http://dx.doi.org/10.1532/hsf.2757DOI Listing
February 2020

Case Report: Aberrant Left Vertebral Artery Management in Traumatic Transection of the Aortic Isthmus.

Heart Surg Forum 2019 12 17;22(6):E481-E485. Epub 2019 Dec 17.

Prof. Dr. C. C. Iliescu Emergency Institute for Cardiovascular Diseases, Bucharest, Romania.

Association of elective debranching and endovascular thoracic aortic repair (TEVAR) with aberrant left vertebral artery (AVA) revascularization and supra-aortic left carotid-subclavian bypass in post-traumatic pseudoaneurysm of the distal aortic arch are extremely rare procedures that can minimize unnecessary neurologic complications. The patient was a 42-year-old man, stable, with a post-traumatic transection of the aortic isthmus, with origin of the AVA between the left common carotid artery (LCCA) and left subclavian artery (LSA). Preoperative planning and proper sizing of the stent-grafts were evaluated by means of computed tomography angiography (CT scan) images. The patient underwent a hybrid procedure that included TEVAR with landing zone 2, covering the origin of both the AVA and LSA and concomitant supra-aortic reimplantation of the AVA in the LCCA and left carotid-subclavian bypass combined with both ligation of the AVA and LSA proximally. Postoperative arteriography images confirmed the exclusion of the aneurysm and the patency of all arch vessels, including the AVA. No endoleak was reported.
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http://dx.doi.org/10.1532/hsf.2677DOI Listing
December 2019
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