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Open access

Andrei Turbatu, Andrei Coliţă, Marilena Stoian, Ana-Maria Bordea, Mădălina Oprea, Cecilia Ghimici, Ionel Gelatu, Loredana Alina Ghimfus, Andra Georgiana Stoica, Cristina Elena Banu and Anca-Roxana Lupu

Abstract

Hodgkin lymphoma, formerly known as Hodgkin disease, has gone from an incurable disease to one with a cure rate of almost 75%. The disease is defined in terms of its microscopic appearance (histology) and the expression of cell surface markers (immunophenotype), but its biologic behavior and clinical characteristics are also important.

Treatment of Hodgkin lymphoma is tailored to disease type, disease stage, and an assessment of the risk of resistant disease. General treatment modalities include radiation therapy, induction chemotherapy, salvage chemotherapy, and hematopoietic stem cell transplantation.

Open access

Elena-Roxana Săraru, Răzvan Peagu, Ana-Maria Călin-Necula, Alexandru Moldoveanu and Carmen Fierbinţeanu-Braticevici

Abstract

Gastroesophageal reflux disease (GERD) is one of the most common chronic gastrointestinal ailments worldwide, with a high prevalence and extremely costly diagnostic and therapeutic management. A hygienic-dietary regimen, accompanied by weight loss, are important factors for improving the symptoms of reflux disease. Various ways of correct diagnosis and for therapeutic management have been attempted over the years, of which themost widely used diagnostic method is empirical therapy with proton pump inhibitors. Also, questionnaires, upper digestive endoscopy with biopsies, barium radiography, ambulatory monitoring of esophageal pH, pH-impedance and esophageal manometry are widely used. Upper gastrointestinal endoscopy has a good specificity, but a low sensitivity for GERD. Also, the GERQ questionnaire has a good sensitivity and specificity in the accuracy of GERD diagnostic. Barium swallow use belongs to the past, and is recommended mostly for the detection of anatomical anomalies and not for the diagnosis of reflux disease. 24-hour ambulatory monitoring of esophageal pH is the study of choice to confirm the diagnosis of reflux disease in patients without endoscopic modifications suggestive of GERD. The association of impedance to esophageal pH monitoring is the gold standard for diagnosing GERD, making it possible to differentiate between acid reflux, weakly acid and non-acid episodes, and is also useful for diagnosing other conditions that mimic the GERD's clinical symptoms.

Open access

Oana Irina Gavril, Lidia Iuliana Arhire, Ovidiu Mitu, Radu Sebastian Gavril, Alexandra Mastaleru, Madalina Ioana Zota, Maria-Magdalena Leon-Constantin, Teodor Vasilcu, Laura Mihalache and Florin Mitu

Abstract

Introduction. Non-alcoholic fatty liver disease (NAFLD) is regarded as the hepatic expression of the metabolic syndrome, both conditions presenting similar clinical features.

Aim. The aim of this study was to evaluate, among diabetic subjects, the relationship between fatty liver load and the presence of metabolic syndrome criteria.

Methods. An observational study was conducted on 92 subjects with type 2 diabetes. We followed anthropometric measurments, lipid profile, blood pressure and the degree of hepatic steatosis using ultrasonography.

Results. The average age of the study group was 60,38 ± 10,37 years, with an approximately equal distribution by gender (48% male and 52% female). More than half of the subjects presented hypercholesterolemia, hypertriglyceridemia, and low HDL cholesterol level. Most of the patients included in the study had varying degrees of liver fat load (only 9,89% of cases of apparently normal liver on ultrasound), and met the criteria for metabolic syndrome (81,31%). It was found that the frequency of the cases with fatty liver impairment was significantly higher in subjects with metabolic syndrome (32,43% compared to 5,88% for those without metabolic syndrome, p = 0,01) and the frequency of the cases with normal liver were significantly higher in subjects without metabolic syndrome (23,53% to 6,76%, p=0,02).

Conclusion. We can say that NAFLD is a risk factor for the presence of metabolic syndrome and it can be considered the hepatic expression of this syndrome.

Open access

Vlad Alin Pantea, Larisa Renata Pantea-Roșan, Daniela Rahotă, Carmen Radu and Teodor Maghiar

Abstract

Chronic marginal periodontal disease is caused by the damage to the mucous membrane of the gum and the profound structures of the periodontium caused by a chronic inflammatory process. Next, we will present a 46-year-old patient with no known cardiovascular antecedents, presenting to the dentist for the paroprotective solution of the upper arcade, at which the presence of atrial fibrillation and pulmonary thromboembolism.

Open access

Anca Hâncu, Florin Mihălţan and Gabriela Radulian

Abstract

High prevalence of noncommunicable diseases with their associated costs are related more and more to unhealthy behaviours such as unappropriated diets, lack of physical activity and smoking. Lifestyle medicine is now more and more scientific and with evidence-based fundament. The key in lifestyle change is negotiation and cooperation. Physicians should do more than education, should empower and motivate the patient in planning a healthy lifestyle leading to sustained change.

Open access

Mihaela Bolog, Mihaela Dumitrescu, Mârzan Luminiţa, Florentina Romanoschi, Elena Păcuraru and Alina Râpă

Abstract

The aim of the paper is to investigate the utility of left atrial longitudinal strain (LALS) in the diagnosis of heart failure with preserved ejection fraction (HFpEF) when left ventricular diastolic function is indeterminable and the assessment of natriuretic peptides is not routinely performed.

Method. The study included 180 patients with signs and symptoms suggestive of non-acute heart failure, examined clinically and echocardiographically, both conventionally and via speckle tracking method.

Results. 33 patients had a normal echocardiographic examination. Diastolic dysfunction (DD) was present in 116 patients of whom 32 patients had grade I, 66 patients grade II, 18 patients grade III DD. Diastolic function could not be determined in 31 patients. The mean value of LALS and NTproBNP in patients with normal echocardiography was significantly different from the group with DD for both variables (p<0.001). LALS was inversely correlated with the grade of DD (r=-0.83, p<0.001). The cut-off value of LALS for predicting DD was 25%. Applying this value in patients with indeterminate diastolic function we identified 21 patients with HFpEF (p<0.001).

Conclusions. LALS can help in the diagnosis of HFpEF when other echocardiographic criteria are irrelevant and NTproBNP is not routinely performed. LALS was correlated with the presence and severity ofDDwith a cut-off value of 25%.

Open access

Geanina Tudor, Roxana Călin, Nuta Petrut, Ioniţă Radu Florentina, Jinga Mariana and Bucurică Sandica

Abstract

Introduction. H. pylori infection occurs secondary to the bacterial colonisation of the stomach and the first portion of the small intestine. Patients infected with H. pylori can develop gastritis, peptic ulcer, gastric cancer, and MALT lymphoma. H. pylori infection is defined as a type I carcinogen by the WHO, and its role in gastric carcinogenesis is sustained by many studies.

Objectives. The objective of this study was the description and correlation of the endoscopic aspect of the gastric mucosa in the Helicobacter pylori infection and the incidence in a selected patient group.

Material and method. The study was conducted in the “Dr Carol Davila” Central Military University Emergency Hospital, Section of Gastroenterology, Department of digestive endoscopy, during a period of 12 months (2012--2013) on 1690 consecutive examinations on patients with ages between 18 and 92 years, with a retrospective cohort analytic study. As diagnosis method of the individuals infected with H. pylori, upper digestive endoscopy was used.During the intervention, biopsieswere taken and rapid urease tests were performed.

Results. Regarding the variation of these endoscopic aspects within the examined population, we determined the fact that we encounter in the highest percentage gastritis with all its forms according to the Sidney classification (described below) which represents 59.3%, followed by endoscopic determination with a normal aspect in 18.8% of cases, then follows ulcer with a percentage of 10.33%, followed by duodenitis with 8.67%, and finally the most severe conditions, gastric cancer and lymphoma, reaching only 2.70% and 0.18%, respectively, of the general population examined endoscopically.

Open access

Pașc Priscilla, Ioana Alexandra Coţe and Mircea Ioachim Popescu

Abstract

Cardiovascular pathology in the elderly is a topic of particular interest because it is themain cause of morbidity and mortality in this segment of the population, but also because in the last century the population over 60 years (this is the arbitrary limit from which a person is considered to be elderly) has doubled and is estimated to increase 2-3 times during the first century of this millennium. With the aging of the population, the number of associated diseases increases, but also the complexity of treatment for these diseases and the cost of hospitalization. Ischemic coronary artery disease has an increased incidence in the elderly population.

Acute myocardial infarction (AMI) with ST segment elevation is manifested relatively frequently with atypical symptoms at onset - dyspnea, diaphoresis, nausea, confusion, epigastric pain, syncope. The influence of age on diagnosis and therapeutic management. There are no electrical changes in 40% of the elderly with acute myocardial infarction. Statistics show that 50% of patients addmited for AMI are elderly and 80% of acute myocardial infarction deaths occur in the elderly, due to both greater risk of post-treatment complications (eg left ventricular rupture after fibrinolysis) and general suboptimal treatment in the eldery, either due to age, comorbidities and atypical presentation delaying the diagnosis. Generally, outcomes of patients undergoing percutaneous coronary intervention are better compared to patients treated with fibrinolysis, the invasive strategy being thus preferred in these patients.

Open access

Gabriel Ungureanu, Ioana-Dana Alexa and Maria-Christina Ungureanu

Abstract

The authors discuss an important chapter of iatrogenic pathology – unneccessary medicine, by reviewing epidemiological aspects and financial impact and identifying such elements in no less than 10 areas: surgery, interventional medicine, diagnostic investigation, substitute procedures, preventive medicine, drug therapy, aesthetic shared medical appointments, surgery, unconventional medicine, medicine on political demand. We shall review the causes, motives and mechanisms of unnecessary medicine such as one’s hyperprudence to cover oneself with diagnosis arguments or to prevent potential complications through preventive therapies (defensive medicine), weak functionality of the institutionalized inspection bodies, onerous motivation. The respect for the fundamental principles of medical ethics (the primum non-nocere principle doubled by the principle of doing good), the use of practice guidelines, the proper functioning self-control mechanisms in exercising the medical profession, a different management of error and the existence of a consistent protective legislation for both the patient and doctor would be key-elements to avoiding unnecessary medicine.

Open access

Raul Mateescu, Raluca Costache, Petru Nuţă, Mariana Jinga, Florentina Ioniţă-Radu, Mihai Pătrășescu, Bogdan Macadon, Roxana Călin and Săndica Bucurică

Abstract

Background. Colonoscopy is a common performed procedure in Gastroenterology, and it’s widely used for diagnosis, treatment and surveillance of a wide range of conditions and symptoms. Properly performed, it’s generally safe, more accurate than a virtual colonoscopy and well-tolerated by patients. The completion of a colonoscopy is defined by cecal intubation with the visualization of colonic mucosa and distal terminal ileum when it’s possible.

Patients and methods. We reviewed retrospectively all consecutive endoscopies database of the lower digestive tract, done over a period from 2014-2017 in our clinic. The recommended completion based on the latest guidelines ranges from 90-95% completion rate according to the indication.

Results. 11214 consecutive colonoscopies were done. Overall cecal intubation was successful in 9456 procedures (87.3%). If we exclude the interventional procedures (414 procedures), where cecal intubation was not necessary, the main reasons of non-intubation were due to intolerance of the patients (388 patients), followed on the second place by patients with obstructive cancer (299 patients). The presence of diverticulosis, poor preparation for colonoscopy and post-surgical adhesions were significant findings in non-successful procedures.

Conclusions. In normal daily practice, colonoscopy is completed in 88.01% of the procedures but we think that this result will stimulate the efforts to incorporate more quality measures and time in our endoscopy laboratory.