Stroke has a significant prevalence in Romania. The predisposition for this multifactorial disease is partially known. The aim of this study is to investigate the predisposition for stroke in Romanian population. Material and methods. We selected cases with recent ischemic stroke (n=100) and healthy control subjects (n=100). The AGTR1 A1166C (rs5186) polymorphism was genotyped by restriction of amplicons with Dde I endonuclease. Results. Active cigarette smoking (O.R. =6.92, p=0.0001) or presence of the AT1R C variant (O.R. =6.69, p=0.0006) in overweight or obese women significantly increase the risk for ischemic stroke. The diagnosis of stroke (71.5 vs 68 years old) or T2DM (63.39 vs 60.77 years old) was recorded at an older age in women compared to men (p<0.05). Obesity considered independent (O.R. =4.22, p<0.05) or in association with T2DM (O.R. = 10.16, p=0.0002) confers the highest risk of stroke when compared to women. Conclusions. Obesity in association with T2DM confers the highest risk of stroke for men when compared to women. Active cigarette smoking or AT1R C variant significantly increase the risk for stroke in women with a high BMI compared with controls.
Intestinal anastomoses have always been a major problem in digestive surgery. With the use of mechanical suture devices, intestinal anastomosis techniques have improved, allowing standardization of methods and shorter duration of surgical procedures. In addition to shortening the operative time, reduced operating room utilization and length of stay (LOS), health financial strain is also reduced by a lower rate of postoperative complications, quicker recovery and socioprofessional reintegration of patients, and by lowering costs related to treating permanent disabilities such as permanent intestinal stoma. The aim of this study was to estimate the costs of surgical patients with colorectal anastomosis (mechanical or manual suturing) and to identify economically efficient surgical techniques. Material and method: Unicentric 10-year retrospective study in the Bucharest "Prof. Dr. D. Gerota" Emergency Hospital. The costs associated with manually constructed and stapled anastomoses in colorectal surgery were compared. Results: In the group with manual colorectal anastomoses (363 patients) the costs per patient were on average 5190 RON and the average hospital stay 14.95 days. In the group with mechanical colorectal anastomoses (97 patients) the average cost per patient was 5037 RON with an average hospital stay of 11.5 days. Conclusions: The use of mechanical colorectal suture devices resulted in a cost reduction of approximately 150 RON per case and a shortening of average hospital stay by 3.45 days. In addition to these direct benefits, we also list the increase in surgical volume (including the diversification of the range of operations) or indirect effects such as faster socioprofessional reintegration of patients.
Acute intentional poisonings represent an important part of emergency pediatric pathology, as well as a psychiatric one, with an escalation tendency over the past years. The current paper consists of a descriptive prospective study, which took place over a period of 12 months, and included 342 children within the age range 6-18 years, that presented in the Emergency Unit, being subsequently treated as in-patients of the Pediatric Poisoning Center of “Grigore Alexandrescu” Emergency Clinical Hospital for Children. The number of pediatric acute intentional poisonings hospitalized within the time frame of the study was 819 cases. Of these, 342 were intentional, which constitutes a percentage of 41.75%, and 477 were accidental, i.e. 58.24%. The etiology of the acute intentional poisonings is varied; however, medication (54.38%), ethanol (28.65%) and drugs of abuse (12.28%) were predominant. A higher frequency of acute intentional poisonings was noticed in girls (65.49%) as compared to boys (34.50%), probably due to the particularities the psychological profile of this sex shown at this age, i.e. higher emotional instability and display tendency. Out of the total number of acute intentional poisonings, we identified 20 cases of suicide attempts, which represent 5.83% of the total acute voluntary poisonings. Moreover, some of these cases constitute a repeated suicide attempt. The studied group included 30 cases of chronic substance abuse and 6 chronic alcohol abuse cases, with ages within the 13-17 years range, 12 of which were females and 24 males. Out of the 36 chronic substance/alcohol abuse patients, 4 were social cases. Pediatric acute intentional self-poisonings are an important public health issue, alarming through its consequences and through its hidden neuropsychiatric and behavioral substrate. This is due to the fact that adolescence is a period of marked emotional fragility, sensitive to all sorts of influences.
Skin cancer represents an important part of the reconstruction is the most frequently used procedure. The main objective of this paper is to report and evaluate our experience in the treatment of facial nonmelanoma skin cancer. Method. The study is based on 303 patients who were diagnosed with facial malignant tumors, between 2004 and 2015, in the Plastic and Reconstructive Surgery Clinic, Emergency University Hospital Bucharest Romania. We statistically analyzed the distribution by age, gender, facial location, the time from onset until the presentation, the type of tumor, the size of the tumor, the margin status, and the recurrence. Results were as follows: median age at 70 years, with an even gender distribution. The most affected areas were the cheek, followed by the nose, forehead, and eyelids. We calculated the dimensions of the tumors between 1.57 mm2 and 1,846 mm2, with a median value at 235 mm2, and a mean value at 421.23 mm2. Patients in whom safe margins were not obtained had a 4.15 times higher relapse rate versus the ones with safe margins at the first intervention, with a high statistical significance p=0.002 (15% recurrence rate if safe margins were not obtained, versus 4.1% if margins were safe). Conclusion. When discussing tumor excisions, one of the most controversial topics is that of safety edges. Currently, even if there are recommendations, a unified protocol is not formulated, which is why we found it useful to research this topic with extensive medical associations.
Bladder trauma is caused by a direct blow to the distended bladder, severe injury fracturing the pelvis, iatrogenic, or penetrating wounds. Early detection and diagnosis are key to successful management of cases, but omission or late reveal of bladder damage increase mortality and create long-term problems. A bladder injury may not always present with immediate obvious signs and symptoms, especially in a multi-trauma patient, who is also more difficult to investigate. Moreover, during the COVID-19 pandemic, delayed patients’ access to tertiary, multidisciplinary hospitals, increases the risk for delayed diagnosis and also increases the need for more specialists from different surgical and non-surgical areas to raise their awareness of less common manifestations of bladder trauma. We present a review of literature and cases of less common bladder damage from the perspective of a multi-disciplinary team in the University Emergency Hospital in Bucharest.
The purpose of this paper was to evaluate the existence of the anterolateral ligament of the knee in the Romanian population. Multiple studies have investigated the anterolateral structures of the knee, but there is some inconsistency regarding the existence of the anterolateral ligament. Materials and methods: A cadaver dissection study was performed on 10 knees (5 left and 5 right), 3 males and 2 females Results: The anterolateral ligament was observed in all 10 knees. The mean length was 32±6mm, the width was 5.1±2 mm, and the thickness at the articular line was 1.1±5 mm. Conclusions: A 100% presence was found, with a slight difference from the length, width, and thickness in other countries, race not being a decisional factor in differences.
Demons-Meigs syndrome is a rare benign pathology that can be confused with other benign and malignant pathologies. The clinical picture is marked by an increase in abdominal volume, pelvic-abdominal pain, but it can also be associated with breathing difficulties due to excess ascites fluid and pleurisy. Imaging paraclinical examination easily reveals the three components: ascites, pleurisy, and ovarian mass. Surgical treatment helps to relieve symptoms in a relatively short time.
The study aims at complementing the historical knowledge regarding the participation of Dr. Bucur (Hilarius) Mitrea and Dr. Ioan Arsenie within the Austrian volunteer corps in Mexico, using as sources the copies of their conduct lists preserved in the military archives of Vienna. The new data concern the battles they took part in, together with characterizations of their behavior and personality. The latter consolidate the image built by former biographers in the case of Dr. Mitrea and help to sketch a less known portrait in the case of Dr. Arsenie.
In this study, symptoms, functions, and outcomes of patients who underwent surgery with the diagnosis of Elastofibroma dorsi between 2007-2019 in our clinic were discussed retrospectively. A total of 19 patients were operated on with the diagnosis of Elastofibroma dorsi in our clinic. The demographic characteristics of patients such as age and gender, symptoms, clinical findings, diagnostic and radiological features, surgical procedures, results of surgical treatments, and postoperative follow-up results were evaluated based on the records. The mean age of patients who underwent surgery was 55.7 and there were 13 females and 6 males. The most common clinical complaint was swelling (61%). Seven of ED were located on the right side, 3 of them were located on the left side and 7 of ED were located bilaterally. The mass in all cases was over 5 cm in diameter, complete surgical excision was done via muscle-sparing technique. All patients were followed up postoperatively and there was no recurrence. ED should be considered in terms of differential diagnosis when middle-aged patients present with a mass in the scapular region and shoulder pain. Total excision is surgically sufficient in symptomatic patients.
Commentary, VARIA
The use of Laser Doppler vibrometry (Doppler principle) for middle ear research and diagnosis
Adela I. Mocanu, Iulia Alecu, Alexandru Bonciu