Oradea, Romania
Oradea, Romania

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Ober M.C.,County Emergency Clinical Hospital | Homorodean C.,County Emergency Clinical Hospital | Homorodean C.,University of Medicine and Pharmacy, Cluj-Napoca | Tataru D.A.,County Emergency Clinical Hospital | And 6 more authors.
Journal of Gastrointestinal and Liver Diseases | Year: 2017

Background: Acute mesenteric ischaemia is a condition with a grim prognosis on conservative treatment. Endovascular revascularisation is a promising approach for some of these patients. Case report: We present the case of a 44-year-old woman with a history of severe arterial hypertension, left leg claudication, and overlooked symptoms of chronic mesenteric ischaemia for one year, who was admitted for severe abdominal pain for one week. Computed tomographic angiography (CTA) showed acute mesenteric ischaemia by occlusion of the coeliac trunk and the superior mesenteric artery (SMA), without bowel perforation. In addition, CTA showed tight left renal stenosis and left external iliac stenosis. We performed angioplasty with a stent of the SMA, followed by revascularisation of the left renal artery. On control injection, the SMA appeared re-occluded, requiring a second stent implantation and a loading dose of dual antiplatelet therapy, with a good final result. Subsequently, the clinical course was uneventful, with no need of surgical exploration; a second procedure was planned, aiming at iliac revascularisation. At one month, the patient was asymptomatic, with normal Doppler flow in the SMA. Angiographic control during iliac revascularisation procedure showed a permeable SMA with a good filling of the coeliac trunk territory. Because of the suspicion of fibro-muscular dysplasia as aetiology, coronary angiography and cerebral CTA were performed, in order to exclude other potential lesions. Conclusions: Endovascular revascularisation in AMI is a promising alternative to the surgical approach in patients presenting without bowel perforation. Nevertheless, its safety and many tactical details remain to be clarified. Existing networks for revascularisation in acute myocardial infarction may be useful for the implementation of this approach. © 2017, Romanian Society of Gastroenterology. All rights reserved.


Ildiko S.,University of Medicine and Pharmacy of Targu Mures | Szabolcs S.,University of Medicine and Pharmacy of Targu Mures | Szabolcs S.,Mures County Emergency Hospital | Jurcau A.,Municipal Clinical Hospital | And 5 more authors.
Romanian Journal of Neurology/ Revista Romana de Neurologie | Year: 2012

factor for stroke incidence and determinant of outcome, the management of BP in acute stroke remains undefined. The present study assesses patients recruited into the 'Efficacy of Nitric Oxide in Stroke' (ENOS) trial from Romania, one of 19 participating countries. Methods. ENOS is an international multicentre prospective randomised controlled trial that is assessing the safety and efficacy of: (i) lowering BP with transdermal glyceryl trinitrate, and (ii) whether pre-stroke antihypertensive therapy should be continued or stopped temporarily, in acute ischaemic stroke or primary intracerebral haemorrhage (PICH). Interventions are given for 7 days and the primary outcome, modified Rankin Scale (mRS), is measured at 90 days. Results. 135 patients were recruited from 3 Romanian sites between March 2009 and August 2011; 56% of these patients were also in the continue-stop arm of the trial. In comparison with the Rest of the World (RoW), Romanian patients were recruited earlier (29 vs. 22 hr), had a higher rate of previous high BP (63 vs. 76%), had less severe stroke at baseline (Scandinavian Stroke Scale, SSS 37 vs. 43/58), were less likely to have a PICH (17 vs. 10%), and had more cases of no visible stroke lesions on baseline CT (27 vs. 49%). Impairment (SSS) at day 7 did not differ. As compared to RoW, the length of stay in hospital was shorter in Romania (14 vs. 9 days); the adjusted death rate at follow-up at 90 days was doubled (odds ratio 1.97, 95% confidence intervals 1.07-3.63) although this was not refl ected by a difference in the adjusted rate of death or dependency (mRS>2) at 90 days (OR 1.04, 95% CI 0.66-1.63). Conclusion. ENOS will continue recruiting patients until the summer of 2013. The presented data show that enrolment is feasible in Romania and the trial has been found to be easy to manage and recruit into.


Lee A.Y.Y.,University of British Columbia | Lee A.Y.Y.,British Columbia Cancer Agency | Kamphuisen P.W.,University of Groningen | Meyer G.,University of Paris Descartes | And 161 more authors.
JAMA - Journal of the American Medical Association | Year: 2015

Importance: Low-molecular-weight heparin is recommended over warfarin for the treatment of acute venous thromboembolism (VTE) in patients with active cancer largely based on results of a single, large trial. Objective: To study the efficacy and safety of tinzaparin vs warfarin for treatment of acute, symptomatic VTE in patients with active cancer. Design, Settings, and Participants: A randomized, open-label study with blinded central adjudication of study outcomes enrolled patients in 164 centers in Asia, Africa, Europe, and North, Central, and South America between August 2010and November 2013. Adult patients with active cancer (defined as histologic diagnosis of cancer and receiving anticancer therapy or diagnosed with, or received such therapy, within the previous 6 months) and objectively documented proximal deep vein thrombosis (DVT) or pulmonary embolism, with a life expectancy greater than 6 months and without contraindications for anticoagulation, were followed up for 180 days and for 30days after the last study medication dose for collection of safety data. Interventions: Tinzaparin (175 IU/kg) once daily for 6 months vs conventional therapy with tinzaparin (175 IU/kg) once daily for 5 to 10 days followed bywarfarin at a dose adjusted to maintain the international normalized ratio within the therapeutic range (2.0-3.0) for 6 months. Main Outcomes and Measures: Primary efficacy outcomewas a composite of centrally adjudicated recurrent DVT, fatal or nonfatal pulmonary embolism, and incidental VTE. Safety outcomes included major bleeding, clinically relevant nonmajor bleeding, and overall mortality. Results: Nine hundred patients were randomized and included in intention-to-treat efficacy and safety analyses. Recurrent VTE occurred in 31 of 449 patients treated with tinzaparin and 45 of 451 patients treated with warfarin (6-month cumulative incidence, 7.2% for tinzaparin vs 10.5% for warfarin; hazard ratio [HR], 0.65 [95% CI, 0.41-1.03]; P = .07). There were no differences in major bleeding (12 patients for tinzaparin vs 11 patients for warfarin; HR, 0.89 [95% CI, 0.40-1.99]; P = .77) or overall mortality (150 patients for tinzaparin vs 138 patients for warfarin; HR, 1.08 [95% CI, 0.85-1.36]; P = .54). A significant reduction in clinically relevant nonmajor bleeding was observed with tinzaparin (49 of 449 patients for tinzaparin vs 69 of 451 patients for warfarin; HR, 0.58 [95% CI, 0.40-0.84]; P = .004). Conclusions and Relevance: Among patients with active cancer and acute symptomatic VTE, the use of full-dose tinzaparin (175 IU/kg) daily compared with warfarin for 6 months did not significantly reduce the composite measure of recurrent VTE and was not associated with reductions in overall mortality or major bleeding, but was associated with a lower rate of clinically relevant nonmajor bleeding. Further studies are needed to assess whether the efficacy outcomes would be different in patients at higher risk of recurrent VTE. Copyright © 2015 American Medical Association. All rights reserved.


Axente D.D.,Vth Surgical Clinic | Axente D.D.,University of Medicine and Pharmacy, Cluj-Napoca | Major Z.Z.,University of Medicine and Pharmacy, Cluj-Napoca | Major Z.Z.,Municipal Clinical Hospital | And 4 more authors.
Chirurgia (Romania) | Year: 2013

Numerous minimally invasive techniques for thyroid surgery have been described in recent years. Technical disadvantages have led to low practicability, although these techniques proved to be safe and to deliver good results. The robotic system was developed to overcome the limits of endoscopic surgery. Recently, based on the advantages of this new technology, robot assisted endoscopic surgery was introduced for minimally invasive thyroid surgery as well. Our experience with robot-assisted transaxillary thyroid surgery begins in November 2010 when we have practiced our first unilateral total lobectomy. From November 2010 to March 2012, 50 patients underwent robotassisted endoscopic thyroid surgery using the transaxillary approach. The aim of this study is to present the technical details and particularities of this procedure, based on our experience. Copyright © Celsius.


Vacaras V.,University of Medicine and Pharmacy, Cluj-Napoca | Vacaras V.,Cluj County Emergency Hospital | Zsigmond Major Z.,University of Medicine and Pharmacy, Cluj-Napoca | Zsigmond Major Z.,Municipal Clinical Hospital | And 5 more authors.
Neuropsychopharmacologia Hungarica | Year: 2014

Introduction: By analyzing literature data regarding glatiramer acetate in the treatment of relapsing-remitting multiple sclerosis one might find controversial data but the majority of authors state that the clinical evolution under the treatment showes a positive course. Materials and methods: Our goal was to analyze groups of patients, both non-treated and treated with the drug, for relapse rate, Kurtzke's Expanded Disability Status Scale (EDSS) score, Multiple Sclerosis Functional Composite (MSFC) score - upper limb disability, lower limb disability and cognition, and for cognitive dysfunction, using the Montreal Cognitive Assessment (MoCA) test, in order to objectively quantify the clinical impact of the drug. Results/ Conclusions: Our results are in accordance with the literature for most of the investigated measures - relapse rate, EDSS, MSFC -, and furthermore suggest the possibility to use more extensively the MoCA test for evaluation of MS patients from the point of view of cognitive functions, after a much wider comparative assessment.


Axente D.D.,University of Medicine and Pharmacy, Cluj-Napoca | Axente D.D.,Municipal Clinical Hospital | Silaghi H.,University of Medicine and Pharmacy, Cluj-Napoca | Silaghi H.,Municipal Clinical Hospital | And 7 more authors.
Langenbeck's Archives of Surgery | Year: 2013

Purpose: The main benefits of robot-assisted transaxillary thyroid surgery are to overcome the technical limitations of other endoscopic procedures for this surgical pathology and to avoid any cervical skin incision. This article describes the first experience of a Romanian team with the endoscopic robot-assisted thyroid surgery. Material and methods: We used the da Vinci SI intuitive surgical system to carry out 50 thyroid operations: 33 unilateral total lobectomies with isthmectomy (TL), 8 unilateral total lobectomies, with contralateral subtotal lobectomy, and 9 total thyroidectomies. Preoperatively, the patients were diagnosed with nodular goiter in 42 cases, nodular autoimmune thyroiditis in 3 cases, Basedow disease in 2 cases, toxic thyroid adenoma in 2 cases, and diffuse goiter in 1 case. We analyzed the clinical characteristics, size and location of the nodules, surgery duration, postoperative complications, pain medication, histopathological findings and postoperative cosmetic results. Results: All surgical procedures were carried out without major incidents. One case required conversion to open approach. The mean length of surgery was 159 ± 38.2 min and the average console time was 68 ± 39.9 min; postoperatively, we recorded one case of transient brachial plexus neurapraxia, one transient vocal cord paresis, one transient hypocalcemia, and four postoperative wound complications. The final histopathological examination revealed two cases of well-differentiated carcinoma. Conclusions: This paper reports the largest series to date in Southeast Europe about robot-assisted transaxillary thyroidectomy. On a group of selected Caucasian patients, postoperative results were similar to open cervicotomy in terms of postoperative complications. The major cosmetic advantage is the absence of scar in the anterior cervical region. © 2013 Springer-Verlag Berlin Heidelberg.


Chirila D.N.,University of Medicine and Pharmacy, Cluj-Napoca | Turdeanu N.A.,University of Medicine and Pharmacy, Cluj-Napoca | Constantea N.A.,University of Medicine and Pharmacy, Cluj-Napoca | Pop T.R.,University of Medicine and Pharmacy, Cluj-Napoca | And 6 more authors.
Human and Veterinary Medicine | Year: 2012

Objective: we want to evaluate the cases with synchronous malignant tumors of the colon and rectum among the patients admitted in our hospital between 2005-2012. Material and Methods: there is a retrospective study of 20 cases diagnosed with multiple malignant tumors of the large bowel and rectum, collected from the patients observational datas. Results: 6 of these patients died in this period, but the others are still alive and in a good condition. Conclusion: in some sites the cancer has a better survival rate because of an earlier diagnosis, some of these patients develop synchronous or metachronous malignant lesions and in such cases is needed an agressive approach. There is still a small number of multiple malignant synchronous lesions, usually met with a colorectal localisation, discovered when we investigate the entire large bowel and rectum and not only a small portion of them. A synchronous malignant lesion associated with colorectal cancer can be discovered if the lesion has symptoms or when we perform CT scan, or MRI or another imagistic method which permit the diagnosis. Also, it is important not only for metachronous lesions but for synchronous lesions not diagnosed with the first tumor, an appropriate control of the patients postoperatively, giving the patient a chance of cure.


Axente D.D.,Municipal Clinical Hospital
Chirurgia (Bucharest, Romania : 1990) | Year: 2013

Numerous minimally invasive techniques for thyroid surgery have been described in recent years. Technical disadvantages have led to low practicability, although these techniques proved to be safe and to deliver good results. The robotic system was developed to overcome the limits of endoscopic surgery.Recently, based on the advantages of this new technology, robot assisted endoscopic surgery was introduced for minimally invasive thyroid surgery as well. Our experience with robot-assisted transaxillary thyroid surgery begins in November 2010 when we have practiced our first unilateral total lobectomy. From November 2010 to March 2012, 50 patients underwent robot assisted endoscopic thyroid surgery using the transaxillary approach. The aim of this study is to present the technical details and particularities of this procedure, based on our experience.


Crisan N.,Municipal Clinical Hospital | Petrut B.,Institute of Oncology | Nechita F.,Municipal Clinical Hospital | Feciche B.,Municipal Clinical Hospital | And 3 more authors.
Timisoara Medical Journal | Year: 2010

Introduction and objectives: The prostate-specific antigen (PSA) screening has brought about an increase in the diagnosis of localized forms of prostatic cancers. We set out to assess the results of the first 108 radical prostatectomies (both laparoscopic and classical) performed as a result of the CLOSER screening programme. Materials and methods: More than 10,000 men over 50 years of age cancer were evaluated in the CLOSER programme between March 2005 and March 2009. As a result of this programme, 315 patients were found to have prostatic cancer, 45% in a localized form. The latter underwent radical surgical treatment; 108 radical prostatectomies were performed (58 laparoscopic, 50 open), the rest being included in a radiotherapy programme. Results: The mean age of the patients was 63 years (range 50 to 70 years), and the mean PSA value was 8.9 ng/ml (range 1.7-33 ng/ml). A number of 28 patients were staged clinically as T1c, 69 as T2, 11 as T3. The positive margin rate was 10/58 for the laparoscopic and 9/50 for the classical interventions. From the oncological point of view, a PSA<0.2 ng/ml was obtained in 41 laparoscopic and 45 respectively classical prostatectomies. The assessment of the partial functional results showed a 63% preservation of continence in laparoscopic patients and 78% respectively, for classical surgery patients respectively. Conclusion: Laparoscopic radical prostatectomy remains the surgical technique with the least hemorrhagic complications as compared to the classical one, even when assessed on small groups of patients. The difficulties of laparoscopic anastomosis impose a longer indwelling catheter time, at the beginning of the learning curve, at least.


Chirila D.N.,University of Medicine and Pharmacy, Cluj-Napoca | Bungardean C.I.,Municipal Clinical Hospital | Pop T.R.,University of Medicine and Pharmacy, Cluj-Napoca | Constantea N.,University of Medicine and Pharmacy, Cluj-Napoca
Human and Veterinary Medicine | Year: 2012

Objective: we want to present two cases of multiple synchronous neoplasias of the colon and upper rectum admitted in our department, for which a limited excision was not enough. Case presentation: there were two cases for which we performed a total colectomy with ileo-rectostomy with "J"-reservoir, avoiding a straight ileo-rectoanastomosis. Results: the patients recovered without complications, with few bowel emissions per day. Post-surgery recovery was uneventful in both patients. One year after the surgery, the patients experienced two and three normal bowel motions daily and no episodes of incontinence. Conclusion: the method is good for patients with multiple primary neoplasias of large bowel and upper rectum and offers a good condition of life.

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