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Tarcoveanu E.,Romanian Academy of Sciences | Moldovanu R.,St. Mary Clinic | Ciobanu D.,St Spiridon University Hospital
Chirurgia (Romania) | Year: 2016

The abdominal cystic lymphangioma (CL) in adults is a rare benign tumor of the lymphatic system. Methods: We report a retrospective study from January 2002 to Decemberr 2014 concerning 18 patients who underwent surgical removal of a CL, 9 patients with laparoscopic approach included. The localization, size, and number, diagnostic, treatment and results have been reported for patients approached laparoscopically. Results: There were 8 women and 1 man with median age at diagnosis was 35,6 years (range 20-51 years). Clinically, the main symptom was an abdominal pain found in 8 patients (88.8%). Physical examination revealed an abdominal mass in 5 patients (55.5%). The CL was asymptomatic in four patients; the discovery of CL was performed preoperatively during an ultrasound for another pathology (n=3) or intraoperatively (n=1). US exam & CT scan usually allow the preoperative diagnosis. The most common site was shared equally between the mesentery (n = 3; 33%) and left retroperitoneum (n = 3;33%), followed by the right retroperitoneum and the posterior cavity of the lesser omentum and great omentum, each one case. The most common procedures performed were: laparoscopic total cystectomy of a closed cyst in two patients andevacuation of larger cysts followed by total cystectomy in seven patients. No conversion, no mortalities and no morbidity was noted. Mean hospital stay was 3.4 days. No recidive after 28 months in the average after treatment. Conclusions: The laparoscopic approach is the gold standard in the treatment of intraabdominal CL.We recommend complete surgical excision to avoid recurrence.


Makkai-Popa S.-T.,Grigore T. Popa University of Medicine and Pharmacy | Makkai-Popa S.-T.,Regional Institute of Oncology | Lunca S.,Regional Institute of Oncology | Tarcoveanu E.,St Spiridon University Hospital | And 2 more authors.
Romanian Journal of Morphology and Embryology | Year: 2014

The current literature related to colorectal cancer shows there is a great inhomogeneity in patient outcome, even between patients in the same stage, which means that the TNM staging does not seem enough anymore to make a therapeutic decision. This is why many of the recent studies focus on the study of prognostic and predictive factors that would make the therapeutic decision-making process more accurate. In the current study, we focused on the study of two lymph node based scores - the lymph node ratio and the log odds ratio and the morphological characteristics of the tumor to try to see if any of them can predict a more aggressive tumor behavior in order to approach the patient in an appropriate way. The study included 25 patients presenting over a period of two years (2009-2011) for a local relapse or a metastasis after curative surgery for colorectal cancer. From the morphological characteristics of the tumor, only the protruding character of the tumor positively correlated at a statistically significant level with the recurrence-free time. We also proved that between the two lymph node scores and the pN stage, the log odds ratio was the one that best correlated with both the number of invaded lymph nodes and the number of resected nodes. The log odds ratio also proved to correlate well with the risk of developing a distant metastasis. Our study also shows for the first time that the log odds ratio is able to stratify patients according to their risk of a fast relapse.


Chirila I.,Grigore T. Popa University of Medicine and Pharmacy | Chirila I.,National Institute of Public Health RCoPH | Petrariu F.D.,Grigore T. Popa University of Medicine and Pharmacy | Ciortescu I.,Grigore T. Popa University of Medicine and Pharmacy | And 5 more authors.
Journal of Gastrointestinal and Liver Diseases | Year: 2012

Background & Aims. Recent papers highlight the role of the diet in irritable bowel syndrome (IBS), but very few population-based studies have evaluated this. The aim of the study was to determine the prevalence of IBS in the general urban population and to evaluate the type of diet associated with IBS symptoms. Methods.A randomized sample of subjects (n=300) from a general urban population in Romania selected from family doctors' patient lists was invited for interview in the doctor's office. Selected subjects were evaluated for the diagnosis of IBS using Rome III criteria and for their eating habits and diet using a food frequency questionnaire. Socio-demographic factors and general medical history were also included in the interview together with standard weight measurements. Results from logistic regression were presented as odd ratios and 95% confidence intervals. Results. From the selected sample, 193 subjects (80 males, 113 women, mean age 50.8±16.2) agreed to participate (rate 64.3%). Prevalence of IBS was 19.1% (19.4% for females and 18.7% for males). IBS was associated with older age (1.05, 1.02-1.08, p<0.001) and past history of digestive diseases (5.0, 2.0-12.7, p<0.01). IBS subjects eat significantly more frequently canned food (23.74, 3.17-177.7, p<0.01), processed meat (4.7, 1.6-14.1, p<0.01), pulses (legumes) (4.0, 1.3-16.3, p<0.01), whole cereals (8.7, 2.0-37.8, p<0.01), confectionary (5.7, 1.8-23.2, p<0.01), fruit compotes (canned or not) (7.4, 2.5-23.1, p<0.001) and herb teas (4.0, 1.3-16.3, p<0.001). Conclusions. This study updates prevalence data and reveals a possible association between diet and irritable bowel syndrome.


Trifan A.,Grigore T. Popa University of Medicine and Pharmacy | Trifan A.,University Hospital | Tarcoveanu E.,Grigore T. Popa University of Medicine and Pharmacy | Tarcoveanu E.,St Spiridon University Hospital | And 6 more authors.
Journal of Gastrointestinal and Liver Diseases | Year: 2012

Heterotopic pancreas is a rare condition and its preoperative diagnosis is difficult. It is generally asymptomatic, but it may become clinically evident depending on the size, location and the pathological changes. Heterotopic pancreas can occur anywhere in the gastrointestinal tract, but most commonly is found in the antrum of the stomach. We report an unusual case of a 31-year-old male patient with gastric outlet obstruction and chronic pancreatitis caused by a submucosal tumor at the pre-pyloric area revealed at endoscopy. Distal gastrectomy was performed and a histological diagnosis of heterotopic pancreas was established. The patient had an uneventful postoperative course and remained symptom free in the follow-up of six months. The difficulty of making an accurate preoperative diagnosis is highlighted and a review of the literature on this pathology is hereby presented. Although heterotopic pancreas is rare, it should be considered in the differential diagnosis of pancreatitis and gastric outlet obstruction caused by a submucosal gastric tumor.


Tamas I.,Al. I. Cuza University | Tamas C.,Grigore T. Popa University of Medicine and Pharmacy | Enasoae I.,Al. I. Cuza University | Corduneanu A.,St Spiridon University Hospital
Revista Romana de Bioetica | Year: 2013

On 25 February 2012, Pope Benedict XVI was enthusiastically applauded at the National Centre for Bioethics, on the occasion of the XVIII General Assembly of the Pontifical Academy for Life. The reason was the attention that the Roman Catholic Church proposes to provide for the infertile suffering couples and, for this reason, to encourage medical research on transsexuality. The Holy Father underlined the Catholic bioethics position towards the communion of love and life, that is marriage, which is the only worthy place of calling into existence a new human being, which is always a gift. The vocation to love is the vocation to selfgiving, and this cannot be prevented by any bodily condition. So, where science cannot find an answer, the answer that fills us with creative light comes from Christ. In this paper we will follow the religious understanding of human sexuality in the light of Holy Scripture (normality condition in human sexuality, sexuality, the sacred road to holiness, desire and action and the Church's position on the issue of transsexuality and sex change surgery, and we will explain how this position based on sex and gender semiotics reflects specific ontological views of the Roman Catholic Church about the human body.


Irimia R.,Grigore T. Popa University of Medicine and Pharmacy | Stanciu C.,St Spiridon University Hospital | Cojocariu C.,Grigore T. Popa University of Medicine and Pharmacy | Cojocariu C.,St Spiridon University Hospital | And 4 more authors.
Journal of Gastrointestinal and Liver Diseases | Year: 2013

Background & Aims. Minimal hepatic encephalopathy is difficult to diagnose due to the lack of a gold standard test. Oral glutamine challenge has been found to increase blood ammonia in cirrhosis leading to secondary cognitive impairment. The aim of this study was to evaluate the value of oral glutamine challenge in improving the psychometric performance for the diagnosis of minimal hepatic encephalopathy, and the risk of this condition for overt hepatic encephalopathy in cirrhotic patients. Methods. Fifty-four cirrhotics (34 males; mean age 55.2 years) and 16 healthy controls were included. Minimal hepatic encephalopathy was assessed by the psychometric hepatic encephalopathy score. Arterial ammonia concentrations and psychometric tests were evaluated 60 minutes before and after a 20 g oral glutamine load. Follow-up lasted 12 months. Results. At baseline, 29 (53.7%) of 54 patients had minimal hepatic encephalopathy and significantly more (79.63%) post-glutamine (p<0.0001). Baseline arterial ammonia levels significantly raised post-glutamine in cirrhotics (85.2±20.8μg/dL versus 159.82±66.01μg/dL, p<0.0001), while in controls they remained unchanged (p=0.064). For the diagnosis of minimal hepatic encephalopathy, baseline arterial blood ammonia showed an area under the ROC curve of 0.54 (CI95%: 0.402-0.680, p=0.58), with no significant post-glutamine changes (0.53, CI95%: 0.389-0.667, p=0.77). Ten patients (18.51%) developed overt hepatic encephalopathy, among which 9 had minimal hepatic encephalopathy (4 at baseline, 5 post-glutamine). At multivariate analysis, MELD score (1.5187, CI95%: 1.0690-2.1574, p=0.0197) was an independent predictor of the overt hepatic encephalopathy. Conclusions. In cirrhotic patients, an oral glutamine load improves the psychometric diagnostic performance for minimal hepatic encephalopathy. MELD score has been independently related to overt hepatic encephalopathy.


Giusc S.E.,Grigore T. Popa University of Medicine and Pharmacy | Giusc S.E.,St Spiridon University Hospital | Cruntu I.D.,Grigore T. Popa University of Medicine and Pharmacy | Cimpean A.M.,Victor Babes University of Medicine and Pharmacy Timisoara | And 4 more authors.
Anticancer Research | Year: 2015

The prognostic value of mast cells (MCs) in patients with liver metastases is a relatively new topic. The present study comparatively assessed tryptase-positive (MCT+) and CD117+ MCs in liver metastases from various sites and correlated their expression with clinicopathological prognostic factors and survival. Our data pointed to differences in MCT and CD117 expression in liver metastases that seem to be related to the origin of the primary tumor. For colon cancer metastases, intratumor MCT+ MCs were significantly correlated with tumor grade and nodal status, while peritumoral MCT+ MCs and peritumoral CD117+ MCs were significantly correlated with overall survival. No significant correlations between MCT+ and CD117+ MC number and clinicopathological parameters or survival were found for gastric cancer metastases. To the best of our knowledge, this is the first report regarding MC involvement in liver metastases from different malignant tumors correlated with clinicopathological parameters and overall survival. Different mast cell phenotype together with their specific correlation with tumor grade, nodal status and survival suggest their involvement in the metastatic process in a specific manner related to tumor origin. Mast cells from liver metastases remain a questionable issue regarding their origin, pathogenic role and their ability to be potential targets for adjuvant therapy.


Vasilescu A.,St Spiridon University Hospital | Cotea E.,St Spiridon University Hospital | Palaghia M.,St Spiridon University Hospital | Vintila D.,St Spiridon University Hospital | Tarcoveanu F.E.,St Spiridon University Hospital
Chirurgia (Romania) | Year: 2013

Gallstone ileus is an uncommon complication of cholelithiasis with a high morbidity and mortality rate. We report a rare case of small bowel gallstone obstruction in an 87-year-old female patient with cholecystoduodenal fistula. We performed an enterolithotomy, repair of fistula and cholecystectomy. During the postoperative course a wound dehiscence appeared, which required suturing and prolonged hospitalisation. We review the diagnostic and therapeutic aspects, given that the diagnosis of this condition is usually difficult and often made intraoperatively. In fact, here is no standard surgical procedure for this disease. The one-stage procedure should be reserved for stabilized patients, but in cases with associated comorbidities, only enterolithotomy can represent the best option..


PubMed | St Spiridon University Hospital
Type: Case Reports | Journal: Journal of gastrointestinal and liver diseases : JGLD | Year: 2012

Heterotopic pancreas is a rare condition and its preoperative diagnosis is difficult. It is generally asymptomatic, but it may become clinically evident depending on the size, location and the pathological changes. Heterotopic pancreas can occur anywhere in the gastrointestinal tract, but most commonly is found in the antrum of the stomach. We report an unusual case of a 31-year-old male patient with gastric outlet obstruction and chronic pancreatitis caused by a submucosal tumor at the pre-pyloric area revealed at endoscopy. Distal gastrectomy was performed and a histological diagnosis of heterotopic pancreas was established. The patient had an uneventful postoperative course and remained symptom free in the follow-up of six months. The difficulty of making an accurate preoperative diagnosis is highlighted and a review of the literature on this pathology is hereby presented. Although heterotopic pancreas is rare, it should be considered in the differential diagnosis of pancreatitis and gastric outlet obstruction caused by a submucosal gastric tumor.


PubMed | St Spiridon University Hospital
Type: Journal Article | Journal: Maedica | Year: 2011

The QT interval prolongation may determine a type of polymorphic ventricular tachycardia named torsades de pointes. This ventricular arrhythmia could also appear after thrombolysis of acute myocardial infarction.Case reports. A 57 years old man was admitted 2 hours after the onset of a posterior-inferior-lateral acute myocardial infarction (reinfarction). He underwent pharmacological revascularization with reteplase. In the first 24 hours after thrombolysis a sustained polymorphic ventricular tachycardia was unregistered after the second dose of a quinolone recommended for a urological problem. Despite of the normal serum potassium and magnesium QTc suffered an augmentation from 400 ms to 480 ms. After beta-blocker augmentation dose and the antibiotic changing, ventricular arrhythmia disappeared without repetition during hospitalization. This ventricular tachycardia was considered precipitated by the quinolones therapy by increasing of QTc interval. It could also be considered a reperfusion sign or a complication of the reinfarction in the same area, which means different therapeutical solutions.

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