University of Medicine Iuliu Hatieganu

Cluj-Napoca, Romania

University of Medicine Iuliu Hatieganu

Cluj-Napoca, Romania
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Kereiakes D.J.,Christ Hospital | Yeh R.W.,Harvard University | Yeh R.W.,Massachusetts General Hospital | Massaro J.M.,Harvard University | And 21 more authors.
JACC: Cardiovascular Interventions | Year: 2015

Objectives This study sought to compare rates of stent thrombosis and major adverse cardiac and cerebrovascular events (MACCE) (composite of death, myocardial infarction, or stroke) after coronary stenting with drug-eluting stents (DES) versus bare-metal stents (BMS) in patients who participated in the DAPT (Dual Antiplatelet Therapy) study, an international multicenter randomized trial comparing 30 versus 12 months of dual antiplatelet therapy in subjects undergoing coronary stenting with either DES or BMS. Background Despite antirestenotic efficacy of coronary DES compared with BMS, the relative risk of stent thrombosis and adverse cardiovascular events is unclear. Many clinicians perceive BMS to be associated with fewer adverse ischemic events and to require shorter-duration dual antiplatelet therapy than DES. Methods Prospective propensity-matched analysis of subjects enrolled into a randomized trial of dual antiplatelet therapy duration was performed. DES- and BMS-treated subjects were propensity-score matched in a many-to-one fashion. The study design was observational for all subjects 0 to 12 months following stenting. A subset of eligible subjects without major ischemic or bleeding events were randomized at 12 months to continued thienopyridine versus placebo; all subjects were followed through 33 months. Results Among 10,026 propensity-matched subjects, DES-treated subjects (n = 8,308) had a lower rate of stent thrombosis through 33 months compared with BMS-treated subjects (n = 1,718, 1.7% vs. 2.6%; weighted risk difference -1.1%, p = 0.01) and a noninferior rate of MACCE (11.4% vs. 13.2%, respectively, weighted risk difference -1.8%, p = 0.053, noninferiority p < 0.001). Conclusions DES-treated subjects have long-term rates of stent thrombosis that are lower than BMS-treated subjects. (The Dual Antiplatelet Therapy Study [DAPT study]; NCT00977938) © 2015 American College of Cardiology Foundation.


PubMed | University of Medicine Iuliu Hatieganu, Monash University, University of Bern, Mercy Hospital and 14 more.
Type: Comparative Study | Journal: JACC. Cardiovascular interventions | Year: 2015

This study sought to compare rates of stent thrombosis and major adverse cardiac and cerebrovascular events (MACCE) (composite of death, myocardial infarction, or stroke) after coronary stenting with drug-eluting stents (DES) versus bare-metal stents (BMS) in patients who participated in the DAPT (Dual Antiplatelet Therapy) study, an international multicenter randomized trial comparing 30 versus 12 months of dual antiplatelet therapy in subjects undergoing coronary stenting with either DES or BMS.Despite antirestenotic efficacy of coronary DES compared with BMS, the relative risk of stent thrombosis and adverse cardiovascular events is unclear. Many clinicians perceive BMS to be associated with fewer adverse ischemic events and to require shorter-duration dual antiplatelet therapy than DES.Prospective propensity-matched analysis of subjects enrolled into a randomized trial of dual antiplatelet therapy duration was performed. DES- and BMS-treated subjects were propensity-score matched in a many-to-one fashion. The study design was observational for all subjects 0 to 12 months following stenting. A subset of eligible subjects without major ischemic or bleeding events were randomized at 12 months to continued thienopyridine versus placebo; all subjects were followed through 33 months.Among 10,026 propensity-matched subjects, DES-treated subjects (n= 8,308) had a lower rate of stent thrombosis through 33 months compared with BMS-treated subjects (n= 1,718, 1.7% vs. 2.6%; weighted risk difference-1.1%, p= 0.01) and a noninferior rate of MACCE (11.4% vs. 13.2%, respectively, weighted risk difference-1.8%, p= 0.053, noninferiority p< 0.001).DES-treated subjects have long-term rates of stent thrombosis that are lower than BMS-treated subjects. (The Dual Antiplatelet Therapy Study [DAPT study]; NCT00977938).


Yeh R.W.,Massachusetts General Hospital | Yeh R.W.,Harvard University | Kereiakes D.J.,Christ Hospital Heart and Vascular Center | Steg P.G.,University Paris Diderot | And 18 more authors.
Journal of the American College of Cardiology | Year: 2015

Background The benefits and risks of prolonged dual antiplatelet therapy may be different for patients with acute myocardial infarction (MI) compared with more stable presentations. Objectives This study sought to assess the benefits and risks of 30 versus 12 months of dual antiplatelet therapy among patients undergoing coronary stent implantation with and without MI. Methods The Dual Antiplatelet Therapy Study, a randomized double-blind, placebo-controlled trial, compared 30 versus 12 months of dual antiplatelet therapy after coronary stenting. The effect of continued thienopyridine on ischemic and bleeding events among patients initially presenting with versus without MI was assessed. The coprimary endpoints were definite or probable stent thrombosis and major adverse cardiovascular and cerebrovascular events (MACCE). The primary safety endpoint was GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Arteries) moderate or severe bleeding. Results Of 11,648 randomized patients (9,961 treated with drug-eluting stents, 1,687 with bare-metal stents), 30.7% presented with MI. Between 12 and 30 months, continued thienopyridine reduced stent thrombosis compared with placebo in patients with and without MI at presentation (MI group, 0.5% vs. 1.9%, p < 0.001; no MI group, 0.4% vs. 1.1%, p < 0.001; interaction p = 0.69). The reduction in MACCE for continued thienopyridine was greater for patients with MI (3.9% vs. 6.8%; p < 0.001) compared with those with no MI (4.4% vs. 5.3%; p = 0.08; interaction p = 0.03). In both groups, continued thienopyridine reduced MI (2.2% vs. 5.2%, p < 0.001 for MI; 2.1% vs. 3.5%, p < 0.001 for no MI; interaction p = 0.15) but increased bleeding (1.9% vs. 0.8%, p = 0.005 for MI; 2.6% vs. 1.7%, p = 0.007 for no MI; interaction p = 0.21). Conclusions Compared with 12 months of therapy, 30 months of dual antiplatelet therapy reduced the risk of stent thrombosis and MI in patients with and without MI, and increased bleeding. (The Dual Antiplatelet Therapy Study [The DAPT Study]; NCT00977938) © 2015 American College of Cardiology Foundation.


PubMed | University of Massachusetts Medical School, University of Bern, University of Medicine Iuliu Hatieganu, Massachusetts General Hospital and 9 more.
Type: Comparative Study | Journal: Journal of the American College of Cardiology | Year: 2015

The benefits and risks of prolonged dual antiplatelet therapy may be different for patients with acute myocardial infarction (MI) compared with more stable presentations.This study sought to assess the benefits and risks of 30 versus 12 months of dual antiplatelet therapy among patients undergoing coronary stent implantation with and without MI.The Dual Antiplatelet Therapy Study, a randomized double-blind, placebo-controlled trial, compared 30 versus 12 months of dual antiplatelet therapy after coronary stenting. The effect of continued thienopyridine on ischemic and bleeding events among patients initially presenting with versus without MI was assessed. The coprimary endpoints were definite or probable stent thrombosis and major adverse cardiovascular and cerebrovascular events (MACCE). The primary safety endpoint was GUSTO (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Arteries) moderate or severe bleeding.Of 11,648 randomized patients (9,961 treated with drug-eluting stents, 1,687 with bare-metal stents), 30.7% presented with MI. Between 12 and 30 months, continued thienopyridine reduced stent thrombosis compared with placebo in patients with and without MI at presentation (MI group, 0.5% vs. 1.9%, p < 0.001; no MI group, 0.4% vs. 1.1%, p < 0.001; interaction p = 0.69). The reduction in MACCE for continued thienopyridine was greater for patients with MI (3.9% vs. 6.8%; p < 0.001) compared with those with no MI (4.4% vs. 5.3%; p = 0.08; interaction p = 0.03). In both groups, continued thienopyridine reduced MI (2.2% vs. 5.2%, p < 0.001 for MI; 2.1% vs. 3.5%, p < 0.001 for no MI; interaction p = 0.15) but increased bleeding (1.9% vs. 0.8%, p = 0.005 for MI; 2.6% vs. 1.7%, p = 0.007 for no MI; interaction p = 0.21).Compared with 12 months of therapy, 30 months of dual antiplatelet therapy reduced the risk of stent thrombosis and MI in patients with and without MI, and increased bleeding. (The Dual Antiplatelet Therapy Study [The DAPT Study]; NCT00977938).


Clugru D.,Grigore T. Popa University of Medicine and Pharmacy | Clugru M.,University of Medicine Iuliu Hatieganu
Journal of Ocular Pharmacology and Therapeutics | Year: 2015

Purpose: To prospectively evaluate the effects of intravitreal bevacizumab (IVB, Avastin; Genentech, Inc., San Francisco, CA) injections in patients with acute central/hemicentral retinal vein occlusions (C/HCRVOs) (≤1 month after the occlusion was diagnosed) over the course of 3 years. Methods: The study included 57 patients with unilateral acute C/HCRVOs. Initially, the treatment for acute C/HCRVO patients consisted of 4 consecutive IVB injections administered off-label at a dose of 2.5 mg per injection, with each injection spaced ∼45 days apart. Thereafter, IVB therapy was flexible, and subsequent injections were administered during scheduled visits whenever a best corrected visual acuity (BCVA) loss of ≥5 Early Treatment Diabetic Retinopathy Study (ETDRS) letters occurred and/or iris/angle neovascularization appeared (regardless of the intraocular pressure level). Changes in the BCVA and foveal thickness (FT), number of IVB injections administered, and incidence of neovascular glaucoma (NVG) were estimated. Results: The increase in the BCVA score at month 36 was 17.15 (ETDRS letters) (P<0.0001) in cases of nonischemic and 26.81 (ETDRS letters) (P<0.01) in cases of ischemic occlusions. At the end of the follow-up, the proportion of BCVA score improvements greater than 15 ETDRS letters was similar in patients with both forms of occlusions (measured in 45.5% of nonischemic and 45.8% of ischemic patients) (P=0.977). There were significant reductions in FT from baseline values to 230±40.50 μm (P=0.0001) in patients with nonischemic occlusions and 270±40.50 μm (P=0.0001) in patients with ischemic forms. There was a significant difference (P<0.03) in the number of IVB injections administered in patients with nonischemic C/HCRVOs (8.7±1.58) compared to patients with ischemic occlusions (9.7±1.78). NVG occurred in 2 cases of ischemic occlusions. Conclusions: The 3-year IVB therapy provided sustained vision and FT gains in most phakic patients with acute C/HCRVOs, making this treatment option a rational and viable therapeutic strategy. Bevacizumab was more effective in patients with ischemic occlusions who required a significantly higher number of injections. © 2015, Mary Ann Liebert, Inc.


Georgescu A.V.,University of Medicine Iuliu Hatieganu | Ignatiadis I.,KAT Hospital | Ileana M.,University of Medicine Iuliu Hatieganu | Irina C.,University of Medicine Iuliu Hatieganu | And 2 more authors.
Microsurgery | Year: 2011

The authors present the long-term results in a series of 44 cases with post-traumatic bone defects solved with muscle-rib flaps, between March 1997 and December 2007. In these cases, we performed 21 serratus anterior-rib flaps (SA-R), 10 latissimus dorsi-rib flaps (LD-R), and 13 LD-SA-R. The flaps were used in upper limb in 18 cases and in lower limb in 26 cases. With an overall immediate success rate of 95.4% (42 of 44 cases) and a primary bone union rate of 97.7% (43 of 44 cases), and despite the few partisans of this method, we consider that this procedure still remains very usefully for small and medium bone defects accompanied by large soft tissue defects. © 2011 Wiley-Liss, Inc.


Georgescu A.V.,University of Medicine Iuliu Hatieganu
Archives of Plastic Surgery | Year: 2012

Simple or complex defects in the lower leg, and especially in its distal third, continue to be a challenging task for reconstructive surgeons. A variety of flaps were used in the attempt to achieve excellence in form and function. After a long evolution of the reconstructive methods, including random pattern flaps, axial pattern flaps, musculocutaneous flaps and fasciocutaneous flaps, the reappraisal of the works of Manchot and Salmon by Taylor and Palmer opened the era of perforator flaps. This era began in 1989, when Koshima and Soeda, and separately Kroll and Rosenfield described the first applications of such flaps. Perforator flaps, whether free or pedicled, gained a high popularity due to their main advantages: decreasing donor-site morbidity and improving aesthetic outcome. The use as local perforator flaps in lower leg was possible due to a better understanding of the cutaneous circulation, leg vascular anatomy, angiosome and perforasome concepts, as well as innovations in flaps design. This review will describe the evolution, anatomy, flap design, and technique of the main distally pedicled propeller perforator flaps used in the reconstruction of defects in the distal third of the lower leg and foot. © 2012 The Korean Society of Plastic and Reconstructive Surgeons.


Georgescu A.V.,University of Medicine Iuliu Hatieganu | Matei I.R.,University of Medicine Iuliu Hatieganu | Capota I.M.,University of Medicine Iuliu Hatieganu
Diabetic Foot and Ankle | Year: 2012

Background: Peripheral vascular disease and/or diabetic neuropathy represent one of the main etiologies for the development of lower leg and/or diabetic foot ulcerations, and especially after acute trauma or chronic mechanical stress. The reconstruction of such wounds is challenging due to the paucity of soft tissue resources in this region. Various procedures including orthobiologics, skin grafting (SG) with or without negative pressure wound therapy and local random flaps have been used with varying degrees of success to cover diabetic lower leg or foot ulcerations. Other methods include: local or regional muscle and fasciocutaneous flaps, free muscle and fasciocutaneous, or perforator flaps, which also have varying degrees of success. Patients and methods: This article reviews 25 propeller perforator flaps (PPF) which were performed in 24 diabetic patients with acute and chronic wounds involving the foot and/or lower leg. These patients were admitted beween 2008 and 2011. Fifteen PPF were based on perforators from the peroneal artery, nine from the posterior tibial artery, and one from the anterior tibial artery. Results: A primary healing rate (96%) was obtained in 18 (72%) cases. Revisional surgery and SG for skin necrosis was performed in six (24%) cases with one complete loss of the flap (4%) which led to a lower extremity amputation. Conclusions: The purpose of this article is to review the use of PPF as an effective method for soft tissue coverage of the diabetic lower extremity and/or foot. In well-controlled diabetic patients that present with at least one permeable artery in the affected lower leg, the use of PPF may provide an alternative option for soft tissue reconstruction of acute and chronic diabetic wounds. © 2012 Alexandru V.Georgescu et al.


Poanta L.I.,University of Medicine Iuliu Hatieganu | Albu A.,University of Medicine Iuliu Hatieganu | Fodor D.,University of Medicine Iuliu Hatieganu
Medical Ultrasonography | Year: 2011

Nonalcoholic fatty liver disease (NAFLD) is a clinic-pathological syndrome closely associated with obesity, dyslipidemia, diabetes and atherosclerosis. Some authors suggest that NAFLD is, in fact, another component of the metabolic syndrome. Aim: To determine the prevalence of NAFLD in diabetes mellitus (DM) patients, and to evaluate the carotid artery status in these patients. Methods: Fifty six patients with uncomplicated type 2 DM were enrolled. Hepatic steatosis (HS) and carotid atherosclerosis (intima-media thickness - IMT) were evaluated by ultrasonography. Plasma liver function tests and other biochemical blood measurements were determined. Results: HS was found in 38 patients (67.8%) with DM. Subjects with HS had higher values for body mass index, diastolic blood pressure, mean blood pressure and triglycerides, and lower HDL cholesterol concentration, but there were no differences regarding IMT between DM patients with or without HS. Behavioral variables (smoking, diet, and sedentarism), fasting plasma glucose, and LDL cholesterol levels, also, did not significantly differ between subjects with and without HS. Conclusion: DM patients with HS in our study showed a cluster of cardiovascular risk factors but non-significant carotid atherosclerosis. The detection of HS by abdominal ultrasound should alert to the existence of a higher cardiovascular risk, but in DM this is still under discussion, the results being still unconfirmed.

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