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Open access

Monica Cirstoiu, Octavian Munteanu, Oana Bodean, Florina Paulet, Bogdan Șerban, Bogdan Cretu and Cătălin Cirstoiu


This report represents an analysis of 19 confirmed cases of breast cancer throughout a period of 14 months (January 2018 - February 2019), in which we assessed the incidence and sites of osseous metastases, in correlation with their histopathologic classification. This retrospective analysis is based on medical imaging techniques (X-ray radiography and nuclear medicine functional imaging).

Open access

Ramona Dobre, Dan Niculescu, Gheorghe Popescu, Adrian Barbilian, Cătălin Cîrstoiu and Cătălina Poiană


Introduction: Hip fracture is the most severe consequence of osteoporosis and an important cause of excess mortality in the elderly.

Objective: We aimed to evaluate the in-hospital mortality rate after osteoporotic hip fracture in patients treated surgically or functionally in specialized centers in Bucharest.

Materials and methods: We calculated the in-hospital mortality rate in 745 patients (540 women [72.48%], with a mean age of 79.1 ± 11 years), surgically or functionally treated for fragility hip fracture over a 12 months period.

Results: Average length of hospitalization was 18.12 days. In hospital mortality rate was 5.36% (n=40, women 60%). An important risk factor associated with mortality was age, p=0.001. The male sex was also a risk factor with a mortality rate of 7,8% (n=16), compared to 4.44% in women, p<0.005, with OR of 1.57. Out of the 40 patients, 57.5% had a femoral neck fracture, 35% intertrochanteric, and 5.5% atypical fracture in absence of bisphosphonates. 7.5% had previous fragility fractures. 85% of the patients had a history of one or more cardiac pathologies (34.28% with atrial fibrillation), 57.5% underwent surgical intervention (n=23) with an average day of intervention of 8.82 after admission. None of the patients had an osteoporosis treatment before the event and on average 3.73 medications with an increased risk of falling and fracture.

Conclusion: In-hospital mortality rate after hip fracture remains high; probably this being related to the high comorbidity associated with male sex and increased age as risk factors.

Open access

Alexandru Papuc, Ioan Mihai Japie, Traian Ciobanu, Octavian Nutiu, Dragos Radulescu and Radu Radulescu


The GCT is an aggressive benign tumor with metastatic potential, most often within the lungs in 2-3% of the patients. It makes about 5% of total bone tumors and about 15% of total benign bone tumors.

The maximum incidence occurs between 30 and 40 years old, most frequently affecting the long bones epiphysis (distal femur, proximal tibia, and distal radius).

We report the case of a 50-year-old female, with no previous medical history, admitted in the emergency department (ED) for significant pain and functional impairment of the left knee. Clinical examination and imaging tests established the diagnosis of distal femoral tumor.

The patient underwent surgical segmental resection of the tumor within oncological limits and subsequent arthroplasty with cemented modular tumoral prosthesis was performed.

Even if the GCT is a benign tumor, it has an aggressive behavior and malignancy potential with an important impact on quality of life. Due to localization, this type of tumor can quickly manifest clinically, which allows an early diagnosis and a less invasive surgical technique.

Open access

Teodora Serban, Iulia Satulu, Ioana Cretu, Oana Vutcanu, Mihaela Milicescu and Mihai Bojinca


Background: Osteoarthritis (OA) and rheumatoid arthritis (RA) can overlap and the presence of OA can interfere with the evaluation of patients with RA.

Objectives: The aim of this study was to evaluate the possible impact of OA on the clinical, laboratory and ultrasound parameters currently evaluated in patients with early RA (ERA).

Methods: We have evaluated the data obtained from patients with ERA referred to our Early Arthritis Research Center (EARC). Only data from patients who fulfilled EULAR/ ACR 2010 criteria for RA and had symptom duration of less than 12 months were analyzed. All patients underwent clinical examination, laboratory tests and ultrasound (US) examination.

Results: There was a clear predominance of women (62.8%). The mean age was 55.47±13.71 years. At baseline, 21 patients (48.8%) were diagnosed with OA. Hand OA did not influence the values of any of the parameters assessed (p>0.05). For patients with knee OA, significantly higher values were observed only for DAS28 at baseline (p=0.018) as well as after 12 months of observation (p=0.031).

Conclusions: Significantly higher values of DAS28 were observed in patients with ERA who associated knee OA, while the values of SDAI were not influenced, suggesting that SDAI may be superior to DAS28 in evaluating patients with ERA and knee OA. The values of patient’s VAS were not influenced by the presence of hand or knee OA suggesting that these types of OA do not influence the patients’ perception of the disease activity. Moreover, the values of ultrasound scores were not influenced by the presence of OA.

Open access

Ali Asghar Peyvandi, Mahbobeh Oroei and Shahrokh Khoshsirat


BACKGROUND. Septoplasty is routinely used to resolve the deviated nasal septum. To obviate postoperative complications, some surgeons pack both nasal cavities and some other use suturing techniques after septoplasty.

OBJECTIVE. To investigate the efficacy of septal suturing and packing in patients post-septoplasty.

MATERIAL AND METHODS. This study was conducted in the Department of Otorhinolaryngology, Loghman Hakim, Tehran, Iran. 146 patients aged 17 years and above were enrolled for septoplasty. Septal suture was performed in 73 patients (group A) and nasal packing in the other 73 patients (group B). The principal outcomes in terms of bleeding, pain, respiratory problems, septal hematoma, adhesion and perforation were measured over a post-operative follow-up period.

RESULTS. A total of 146 patients, 74% female and 26% male, were enrolled. There were statistically significant differences between the two groups with respect to respiratory problems and patient comfort (p<0.001). The patients in both groups had no septal perforation.

CONCLUSION. Septoplasty using trans-septal suturing without packing can be safe and suitable to prevent or minimize postoperative complications.

Open access

Ramiya Ramachandran Kaipuzha, Nirmal Coumare Venkataramanujam, Padmanabhan Karthikeyan and Davis Thomas Pulimoottil


OBJECTIVE. To study and compare the benefits of microdebrider-assisted endoscopic sinus surgery and conventional endoscopic sinus surgery in terms of subjective and objective improvement in symptoms of nasal polyposis.

MATERIAL AND METHODS. This study involved 60 patients with bilateral sinonasal polyposis scheduled to undergo Endoscopic Sinus Surgery. The patients were randomized into two groups: Group A -Conventional endoscopic sinus surgery and Group B -Microdebrider-assisted endoscopic sinus surgery.

RESULTS. There was a significant difference in the mean VAS at 3 months postoperatively in Group B, but no significant difference at 6 months postoperatively following either of the two methods. The mean time for surgery (p<0.01) and the mean intraoperative blood loss (p<0.01) were significantly lower in Group B.

CONCLUSION. A well-trained surgeon with proper anatomical knowledge, good instruments, hypotensive anaesthesia, minimal mucosal injury and regular proper follow-up will have similar postoperative results with both methods.

Open access

Ioan Mihai Japie, Radu Rădulescu, Adrian Bădilă, Ecaterina-Maria Japie, Alexandru Papuc, Traian Ciobanu, Adrian Dumitru and Cătălin Cîrstoiu


Introduction. Bisphosphonates (BPs) represent the main therapy in patients with osteoporosis, although a long-term treatment can lead to atypical fractures.

Material and methods. We conducted a retrospective study between 2008 and 2017 and included 23 female patients with atypical femoral fractures (AFFs). The mean period of BPs therapy administration was 5.2 years. We included 7 subtrochanteric fractures and 18 femoral shaft fractures. Two of the total patients presented bilateral femoral fractures. 18 patients presented prodromal symptoms from 2 to 18 months before the diagnosis of fractures, all of them following low energy trauma. All the patients included in our study underwent surgery with intramedullary nail or gamma nail. The postoperative mean follow-up was 2 years. Results. Of all 23 female patients with a total of 25 fractures – 10 underwent osteosynthesis with gamma nail and 15 underwent osteosynthesis with intramedullary nail. From the total number of patients: 13 patients achieved complete union, 6 presented delayed union and 3 non-union (2 intramedullary nail and one gamma nail), whereas in one patient treated previously with gamma nail we observed implant failure.

Conclusion. The treatment of AFFs after BPs therapy administration represents a challenge for orthopaedic surgeons regarding both surgical technique and postoperative follow-up.

Open access

Mircea Mureșan, Simona Mureșan, Ioan Balmoș, Daniela Sala, Bogdan Suciu and Arpad Torok



Despite recent advancements in antibiotic therapy and the progress made in critical care and modern diagnostic methods, acute mediastinitis continues to be a severe condition.

Diagnosis and treatment

Acute mediastinitis can occur in the context of cardio-thoracic surgery, oesophageal perforations and oropharyngeal infections condition. Forty-five percent of oesophageal perforations occurs during simple endoscopy. Spontaneous perforation (Boerhaave syndrome) accounts for 15% of perforations, and twelve percent are due to the ingestion of foreign bodies. Other causes include blind or penetrating trauma, and circa 9% to intraoperative lesions. CT scan is the standard investigation that reveals direct signs of mediastinitis.

The oral administration of contrast substances can underscore the level of oesophageal perforation. Conservative treatment is the first-choice treatment and surgical treatment is reserved only for specific situations.

The principles of surgical treatment consist of drainage, primary suture, oesophageal exclusion with or without the application of oesophagectomy, endoscopic vacuum wound assisted therapy of the perforation and associated paraoesophageal mediastinal drainage and endoscopic stenting associated with drainage.


The lowest mortality rate is recorded in patients with perforations diagnosed less than twenty-four hours after the onset of symptoms. Surgical treatment remains the gold standard especially in cases of thoracic and abdominal perforations while further investigations are mandatory before endoscopic stenting is carried out.