Aim: Surgical treatment is the main treatment method for esophageal cancer. The prognosis is poor due to high local recurrence and distant metastasis rates. Study aims to evaluate the most effective local treatment modality esophageal squamous cell carcinoma (SCC) according to real life data. Method: 136 patients were studied retrospectively. All patients were middle or lower esophageal cancer and had the SCC histology. Patients were divided into the surgical resection, definitive CRT (dCRT), and multimodal treatment groups according to curative local treatment they received. Result: 32.4% were in the surgical, 36% were in the dCRT, and 31.6% were in the multimodal group. Median disease-free survival was 21 months (95% CI 14-27) in the surgical group, 8 months (95% CI 4-11) in the dCRT group, and 18 months (95% CI 0-39) in the multimodal group (p=0.059). The median overall survival was found to be 40 months (95% CI 0-92) in the surgical group, 19 months (95% CI 15-22) in the dCRT group, and 54 months (95% CI 11-96) in the multimodal group (p=0.012). In multimodal group, the number of patients receiving preoperative CRT was 25, and postoperative CRT was 18. Median OS was 47 months (95% CI 0-99) in the preoperative CRT group, and 64 months (NA) in the postoperative CRT group (p=0.302). Conclusion: DFS and OS contributions of multimodal treatment in esophageal SCC have been shown in the present study. The addition of CRT to surgery in the preoperative or postoperative period has a contribution independently of the treatment sequence.
The present paper describes the morphological characteristics of 12 celiac-mesenteric trunk cases highlighted by angiography-computed tomography (CT), characteristics met only in male cases (1.82% of the cases). In relation to the vertebral column, the origin of the trunk was found in the the upper half of the L1 vertebra – intervertebral disk between L1 and L2 vertebrae. At the level of its origin from the aorta, the celiac-mesenteric trunk had an external diameter with values ranging from 8.7-13.4 mm, the aortic ostium of the celiac-mesenteric had a vertical diameter ranging from 8.8 to 13.1mm, the horizontal diameter values ranging from 8.8 to 11.2mm. At the level of its origin, the celiac-mesenteric trunk and the aortic wall had an angle with values ranging from 30.0o to 90.2o. The length of the celiac-mesenteric trunk had values ranging from 21.8 to 42.5 mm, most frequently met values were ranging from 30.7 to 33.5mm. At the level of its bifurcation, the celiac-mesenteric trunk had an angle with values ranging from 82.2 to 120,7, most frequently met values were over 90o. The celiac trunk resulted from the celiac-mesenteric bifurcation had an exterior diameter of 6.2 – 10.2 mm, values that in relation to exterior diameter the celiac-mesenteric originated, it represented 65.57 – 92.47% of its external diameter. The celiac trunk up to the end of its ramification had a length with values ranging from 6.3 to 16.8 mm. In all cases being a hepatosplenic trunk, the left gastric aorta originated in the abdominal aorta in 10 cases (83,3% of the cases) and in the other 2 cases, the left gastric aorta originated in one case under the end bifurcation of the celiac trunk whereas the other case in the celiac-mesenteric trunk, before its end bifurcation. The superior mesenteric artery resulting from the ramification of the celiac-mesenteric trunk had an external diameter with values ranging from 4.4 to 8.5 mm that represented 44.44 – 85.06% of the external diameter of the celiac-mesenteric trunk.
In the current military-political context, with the Cold War having ended, we find ourselves in full anti-terror war, in which Romania is a direct participant, as a member of N.A.T.O. and the E.U., and the issue of biological warfare and bioterrorism is again highly topical but bearing other valences. There is information that there are still laboratories and plants specializing in the research and manufacture of biological weapons. Most of the results of such research are not intended to be published; however, a number of research guidelines that testify to the trends in the improvement of biological weapons and their means of use can be deduced from the data published by researchers from several research institutes. We believe that the threats posed by bioterrorism are real and that it is mandatory to be prepared at any time to prevent, combat and liquidate the consequences of "bio-chem" attacks, respectively the management of the consequences.
The biological attack is the artificial spread by various means of pathogens that can cause serious infectious and contagious diseases as well as the spread of germ toxins that can be used by an aggressor as a means of fighting in order to reduce the troops’ fighting force, by causing serious disease outbreaks or by killing people, animals and/or plants. Biological agents are microorganisms and/or microbial, animal or plant toxins, used as specific ammunition for biological weapons or used by terrorists in "bio-chem" attacks. The risks of bioterrorism and biocrime attack in the contemporary world are real, and the history of the 20th century and the beginning of the 21st century confirms this. It is necessary for preventive measures to be implemented on the unlawful use of biological agents. Early medical and non- medical countermeasures must be prepared for the prophylaxis, treatment and cessation of the consequences of any biological attack.
Opioid use disorder is a worldwide challenge for an increasing number of patients, and still the therapeutic options presented in clinical guidelines for this condition are very few. The first line pharmacological therapies for opioid use disorder continue to be opioid agonists as substitution treatment, but the need to find new treatments without the effect of prolonging opioid dependence become more and more obvious. This systematic review presents the most supported by evidence pharmacological agents that can be used as monotherapy for opioid use disorder patients (i.e., naltrexone, extended release/implant and oral formulation), or as adjuvants to substitution therapy (e.g. olanzapine for aggressive behaviours, memantine or dextromethorphan for reducing inflammatory processes related to opioid use). More good quality data derived from larger, well designed trials are needed in order to find solid recommendations for non-opioid agonists in the treatment of opioid use disorder.
Diabetes mellitus is a serious condition, causing multiple health problems due to the disease itself, but also to the complications that these patients are predisposed to. Being a current health problem, many patients tend to disregard the doctor's recommendations concerning the necessary measures to maintain adequate and continuous control of the glycaemia levels. This, in turn, may cause complications, which include neuropathy, microangiopathy and a predisposition to infections due to weak local defence mechanisms. In otorhinolaryngology, the infectious pathology is one of the most often causes for presentation to the physician. Ranging from common otitis, acute pharyngitis or laryngitis and sinusitis, these different entities will cause significant discomfort for the patient, prompting the need for medical care. In patients with diabetes, the natural course of the disease is altered, with more severe symptoms, a more extended period of recovery and the predisposition for aggravated cases with the tendency to complications. Such complications may be life-threatening if we take into account the complications associated with acute sinusitis for example, which include orbital or cerebral abscesses. Our paper aims to present the authors experience on the complete approach of patients with infectious pathology concerning the sinuses associating diabetes mellitus. Always, we must keep in mind that patients with diabetes represent a particular class of patients that require a personalized approach. They are predisposed to a vicious circle, in which the infection causes diabetes imbalance, which in turn decreases the defense mechanism and predisposes to complications. The correct management must always include a proper control of diabetes, a complete evaluation that will determine if complications are already present and aggressive management of the infection, with regular check-ups to determine the evolution of the patient.
Renal angiomyolipomas (AML) are the most common benign renal tumors. By containing an important amount of fat tissue they are easily identifiable on CT and MRI images, thus no biopsy should be needed for a diagnosis. However there is a small percentage of AMLs that have very little fat tissue and are very difficult to differentiate from renal cell carcinoma. Along fat tissue, they also contain smooth muscle and blood vessels. Renal AMLs can occur as a sporadic finding, or more frequently in association with tuberous sclerosis complex (TSC) or pulmonary lymphangioleiomyomatosis (LAM). These tumors are usually an incidental finding on imaging tools, but sometimes a serious presentation is rupture and hemorrhage, which can easily evolve to shock. Therapeutical management vary from active surveillance to surgical removal, and it needs to be individualized for every patient and according to the clinical presentation.
The aim of this study was to compare two computerized digital esthetic design methods (DSD and Visagismile) in order to properly choose the appropriate form of the maxillary frontal teeth for complete bimaxillary edentulous patients and to validate the use of these applications in complete edentulism. An online questionnaire was submitted to a group of 100 persons (dental doctors, dental medicine students and persons activating in other fields); the respective persons were requested to choose the form of maxillary frontal teeth for a group of four complete bimaxillary edentulous patients, whose esthetic design had been performed by using the two computerized progams. Following the respondents’ analysis of the esthetic previews elaborated for the four patients 60% of the total answers were in favour of DSD while the remaining 40% were in favour of Visagismile; these percentages are identical with the ones obtained on the basis of the answers given by dental doctors and dental medicine students. In case of the respondents activating in other fields the percentages were 66% in favour of DSD and 34% in favour of Visagismile. Based on the results of the study the two computerized methods were validated also for cases of complete edentulism but further studies to confirm this validation are still required. These two methods improve the dental doctor/patient communication and certainly provide a higher predictability of the esthetic results of prosthetic restorations not only for dentate patients but also in cases of complete edentulism.
Retroperitoneal tumors grow quietly and are generally large in size, more than half of them being larger than 20 cm at the time of diagnosis. They usually present several therapeutic challenges because of their rarity, relative late presentation and anatomical location, often in close relationship with several important structures in the retroperitoneal space. Due to intimate relationships with vital organs in retroperitoneum, extensive surgery with en bloc resection of the involved organ is often required, most frequently the kidneys, followed by colon, pancreas and spleen. Malignant tumors have a poor prognosis, the most significant factors regarding survival rates being delayed diagnosis, high histological grade, inoperability due to invasion into vital organs, and a positive surgical border.
Renal disease in pregnancy is a rare pathology, but it raises several problems in terms of normal pregnancy evolution. Among pregnant women with renal injury, the rate of complications such as spontaneous abortion, preeclampsia, hypertension, intrauterine growth restriction, premature birth, fetal and neonatal mortality are much higher. For a good understanding of the pathology and a correct management of pregnant women with renal disease, it is necessary to know the normal pregnancy changes and the differentiation of chronic kidney disease from the acute injuries occurring during pregnancy. It is useful to ensure counseling prior to conception and to perform all prophylactic measures in order to prevent pregnancy complications and subsequent decline in renal function in all cases of pregnant women with chronic renal insufficiency. Treatment of acute renal failure in pregnancy involves therapy of the underlying condition that caused renal injury, prevention of irreversible kidney injury and pre-vention of maternal and fetal secondary complications. Monitoring carefully this cate-gory of pregnant women, although additional risks strike, often results in favorabl pregnancy evolution.
