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Open access

Bogdan Cretu, Zsombor Panti, Mihai Nica, Bogdan Serban, Mihnea Popa, Răzvan Ene and Cătălin Cîrstoiu

Abstract

As the population becomes more active and life expectancy increases, gonarthrosis has proportions of epidemics. Total knee arthroplasty (TKA) is an intervention that decreases pain and gives the patients the possibility of quickly returning to the desired level of activity. It is an intervention with a patient satisfaction rate of about 90-95% with a survival of the implant over 15 years of 90%. When dealing with TKA the following elements should be taken into account: clinical examination (walking analysis), leg deformities and knee alignment (foot deformation management), posterior tibial tendon dysfunction, cavovarus foot, posttraumatic deformity, neuropathic arthropathies, ankle arthrosis, foot deformities and knee arthroplasty. Ankle or foot deformity may be causes of progression of gonarthrosis or a TKA failure. Post-operative alignment of TKA is an extremely important element in the long-term survival of the prosthesis. By improving biomechanical alignment of the complete pelvic limb, TKA survival and patient satisfaction will increase.

Open access

Bernadette Kerekes-Máthé, Csaba Dudás, Nóra Csergő and Krisztina Mártha

Abstract

Background: Measurement-based studies are prone to measurement errors, which occur at the same operator or between different operators during repeated measurements of the same sample.

Aim of the study: To assess the inter-operator reliability of morphometric measurements using a bidimensional image analysis method.

Material and methods: Eight study models have been selected, images of teeth and models were taken from vestibular and occlusal view. The following parameters were measured individually by three, previously trained operators: mesio-distal, occluso-gingival, and vestibulo-oral dimensions, vestibular and occlusal area, depth of palatal arch, arch breadth, arch circumference, and arch length. Intraclass correlation coefficients were calculated for each measurement.

Results: The reliability of the measurements showed high degrees, all values being higher than 0.8.

Conclusions: Dental morphometric measurements done by 2D image analysis can be performed by multiple operators with an excellent reliability.

Open access

Olivera Lupescu, Mihai Dan Roman, Bogdan Deleanu, Horea Benea, Horia Haragus, Radu Prejbeanu, Dorel Sandesc, Octav Marius Russu, Tiberiu Bataga, Gheorghe Ion Popescu and Cătălin Cîrstoiu

Abstract

Two types of femoral neck fractures are nowadays identified: those resulting from low energy trauma, usually by direct by falling on the hip, in patients with affected bone stock (the so-called “fragility fractures”) and those produced by high energy trauma, even in younger people, with normal bone stock. These recommendations are addressed to the first category. for which impaired mineral bone density (MBD), osteopenia, and osteoporosis represent major enabling factors. These recommendations refer to classification-based local and general treatment of femoral neck fractures (excluding the basilar neck ones). The presumptive and definitive diagnoses include the precise description of the fracture pattern, by complete imagistic evaluation. The treatment depends on the type of the patient (demanding or non-demanding), on the type of the fracture (stable or unstable), as well as on the facility of early treatment, in certain cases. The main therapeutic goal in femoral neck fractures is early social and professional reinsertion of the patient, by gaining a status as close as possible to the one before the trauma; stable stabilization allowing early mobilization has a key role in fulfilling this objective Therefore, complete evaluation and monitoring of the patient by a multidisciplinary team is mandatory in order to perform a proper evaluation of the anaesthetic and surgical risk ( as these patients usually have pre-existing health problems, sometimes severe) , a safe and adapted (form the point of view of invasivity) surgery and an appropriate post-operative local and general treatment. Therefore, these recommendations have numerous connections with those involving the intervention of physicians from other specialities with whom orthopaedic surgeons must cooperate in these cases

Open access

Flavius Mocian, Ruxandra Oancea and Marius Coroș

Abstract

We present the case of a 48-year-old patient with a recurrent rectovaginal fistula, who we treated surgically by transposing the gracilis muscle. The patient with a history of ulcerative colitis underwent colorectal resection with mechanical anastomosis and diverting ileostomy for rectal cancer. She was subsequently treated by radiation and chemotherapy. Six weeks later, the ileostomy was removed, but afterwards the patient developed a recto-vaginal fistula. A new diverting ileostomy was performed. After eight months, a transvaginal surgical procedure was performed, and the diverting ileostomy was closed after four months. Two years after the last surgery, the patient performed an MRI scan, which revealed the relapse of the rectovaginal fistula. This time the patient was reoperated using a flap of the gracilis muscle interposed between the rectum and the vagina, but the patient refused any diverting stoma. The rectovaginal fistula relapsed again after thirteen days. Fortunately, after six months of intensive systemic and local treatment with aminosalicilic-5-acid, the fistula closed by itself. Our conclusion is that with a well-managed medical treatment, the gracilis flap, because of its good vascular supply, could be successfully used to treat rectovaginal fistulas even in patients with ulcerative colitis who underwent rectal surgery and radiation therapy for cancer.

Open access

Olivera Lupescu, Mihail Nagea, Nicolae-Marian Ciurea, Alina Grosu, Alexandru Lisias Dimitriu and Gheorghe Ion Popescu

Abstract

Ankle fractures are frequent and have a significant impact upon the function of the lower limb, as this joint has a crucial role in standing and especially in walking. Several classification systems have been developed concerning these fractures, connecting the traumatic mechanism to their treatment. Due to their character of articular fractures, functional restoration of local anatomy is necessary; therefore, surgery is mandatory in displaced fractures, affecting the congruency, the stability or the mobility of the ankle joint. The purpose of this paper is to describe the factors influencing the results of surgical treatment in these fractures, as it results from the experience of a level 1 Trauma Centre.

Open access

Anca E. Chiriac, Adrian Naznean, Cristian Podoleanu, Simona Stolnicu and Anca Chiriac

Abstract

Superficial venous malformations can be clinically diagnosed since birth as localized, bluish or purple lesions, especially on the lower extremity, but deep venous malformations are difficult to diagnose only by clinical appearance. The diagnostic algorithm for superficial venous malformations in newborns includes clinical examination and Duplex ultrasonography. The latter allows differentiating tumors (hemangiomas) from vascular malformations and evaluating flow characteristics as well as localizing the site of the malformation.

Open access

Cornelia Nitipir, Ana Maria Popa and Cristina Orlov-Slavu

Abstract

Giant cell tumors of the bone are tumors whose malignant character has long been debated. Lung metastases have been reported in some cases. They usually represent osteolytic, locally aggressive bone tumors for which surgery is the standard of care. Denosumab is the most effective systemic treatment in these cases, but both the timing and the duration are a matter of debate. The aim of this short review was to describe the most important trials that treated patients with this drug and to discuss both advantages and long-term toxicity. It can be concluded from the presented data that the choice of adding denosumab in the treatment sequence of giant cell tumor of the bone has to be taken in a personalized manner for each patient.

Open access

Anca Negovan, Ioan Țilea, Septimiu Voidăzan, Simona Mocan, Andreea Szoke, Andreea Stoica and Monica Pantea

Abstract

Background: The additional benefits of certain frequently used chronic drugs such as statins or aspirin are investigated for their possible effect of influencing various types of cancer, including gastric cancer. The possible role of statins in the occurrence of pre-neoplastic gastric lesions has not been investigated.

Aim: The study aims to determine the influence of chronic statin therapy on premalignant gastric lesions (glandular atrophy, intestinal metaplasia and dysplasia), adjusted with the most important aggressive environmental factors of the gastric mucosa (Helicobacter pylori [H. pylori] infection, low-dose aspirin [acetylsalicylic acid, ASA], biliary reflux, smoking, alcohol consumption).

Method: The study included 566 patients with cardiovascular diseases who underwent an upper endoscopy: 222 patients with chronic statin therapy (atorvastatin 20–80 mg/day or rosuvastatin 5–20 mg/day for at least 6 months) and 344 patients without statin intake. A complete set of biopsies from the gastric antrum and corpus were routinely processed and examined, and demographical, clinical, and pathological variables were recorded.

Results: Active H. pylori infection in gastric biopsies (p = 0.45), biliary reflux (p = 0.74), alcohol consumption (p = 0.43), or prior ulcer disease (p = 0.07; OR: 0.59; 95% CI: 0.33–1.04) were not associated with an increased risk for premalignant lesions, neither in the statin, nor the no-statin group. Smoking was associated with premalignant lesions in both groups (p = 0.01; OR: 2.24; 95% CI: 1.12–4.47; and p = 0.04; OR: 1.72; 95% CI: 1.01–2.94, respectively), while chronic use of ASA had no influence (p = 0.24, respective p = 0.35). In multivariate regression models, chronic treatment with statins had a protective effect (p = 0.006; OR: 0.59; 95% CI: 0.4–0.8), while smoking (p = 0.01; OR: 1.99; 95% CI: 1.17–3.39) and age >50 years (p <0.01, OR: 3.09; 95% CI: 1.84–5.21) were predictors for pre-neoplastic lesions. H. pylori infection, gender, alcohol consumption, biliary reflux, or prior ulcer disease were not associated with premalignant lesions (p >0.05). Conclusions: In the studied population, chronic statin treatment seems to be associated with a decreased risk for premalignant gastric lesions, while age over 50 years and smoking, regardless of gender or ASA consumption, remain the most important risk factors for premalignant gastric lesions.