Journal of Mind and Medical Sciences

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Open AccessCase Report

The Effectiveness of Cardiac Resynchronization in a Patient with Ischemic Cardiomyopathy

by Diana R. Tudorașcu, Constantin Bătăiosu, Alina Paraschiv, Elena-Anca Târtea, Ionuț Donoiu and Cristina Florescu

J. Mind Med. Sci. 2018, 5(1), 145-150; https://doi.org/10.22543/7674.51.P145150 - 31 Mar 2018

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Abstract

Cardiac resynchronization therapy (CRT) in multiple and large trials has been demonstrated to improve symptoms and decrease hospitalization and mortality of patients when used in addition to optimal medical therapy. The global mechanical performance of the heart is affected in subjects with heart [...] Read more.

Cardiac resynchronization therapy (CRT) in multiple and large trials has been demonstrated to improve symptoms and decrease hospitalization and mortality of patients when used in addition to optimal medical therapy. The global mechanical performance of the heart is affected in subjects with heart failure by atrio-ventricular, interventricular, or intraventricular conduction disorders, which lead to the desynchronization of electrical activity. Cardiac resynchronization therapy can effectively improve the clinical and haemodynamic status of these patients. According to literature data, CRT is performed only on well-selected patients (who qualify for CRT based on current indications), and approximately 70% of those patients respond favorably. We present the case of a patient responsive to cardiac resynchronization therapy which led to lowering of his NYHA classification and to improvement of left ventricle hemodynamics. The benefits of cardiac resynchronization therapy were multiple in this case, including improved tolerance to physical exercise and a decreased rate of hospitalization, which overall led to improved quality of life. Full article

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Open AccessCase Report

Triple Valve Infective Endocarditis—A Late Diagnosis

by Edme R. Mustafa, Sineta C. Firulescu, Cristina D. Parvanescu, Beatrice A. Chisalau, Georgica C. Tartea, Ion C. Efrem, Andreea L. Barbulescu, Stefan C. Dinescu, Paulina L. Ciurea, Lucretiu Radu and Ananu F. Vreju

J. Mind Med. Sci. 2018, 5(1), 141-144; https://doi.org/10.22543/7674.51.P141144 - 31 Mar 2018

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Abstract

Behcet's disease is a systemic vasculitis of unknown aetiology with cardiac involvement as well as damage to other organs. Whether the sterile valvular inflammation which occurs in this autoimmune disease predisposes to bacterial adhesion and infective endocarditis is not yet established. We present [...] Read more.

Behcet's disease is a systemic vasculitis of unknown aetiology with cardiac involvement as well as damage to other organs. Whether the sterile valvular inflammation which occurs in this autoimmune disease predisposes to bacterial adhesion and infective endocarditis is not yet established. We present the case of a patient with Behcet disease in which transthoracic echocardiography showed mobile masses on the aortic, tricuspid, and mitral valves, leading to multivalvular infective endocarditis diagnosis, possibly in the context of valvular inflammation. The case presented in this article confirms observation of other studies, namely that ultrasonography plays an important role in the diagnosis and evaluation of rheumatic diseases and permits optimal management in daily practice. Full article

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Open AccessCase Report

Clinical-Evolutional Particularities of the Cryoglobulinemic Vasculitis in the Case of a Patient Diagnosed with Hepatitis C Virus in the Predialitic Phase

by Daniel C. Caragea, Larisa Săndulescu, Vlad Pădureanu, Mircea C. Forțofoiu, Costin Streba, Lidia Boldeanu, Mihail V. Boldeanu, Mircea Popescu-Drigă, Marius E. Ciurea, Maria Forțofoiu, Ion Rogoveanu, Tudorel Ciurea and Cristin C. Vere

J. Mind Med. Sci. 2018, 5(1), 135-140; https://doi.org/10.22543/7674.51.P135140 - 31 Mar 2018

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Abstract

Hepatitis C virus (HCV) represents a fundamental issue for public health, with long term evolution and the gradual appearance of several complications and associated pathologies. One of these pathologies is represented by cryoglobulinemic vasculitis, a disorder characterized by the appearance in the patient’s [...] Read more.

Hepatitis C virus (HCV) represents a fundamental issue for public health, with long term evolution and the gradual appearance of several complications and associated pathologies. One of these pathologies is represented by cryoglobulinemic vasculitis, a disorder characterized by the appearance in the patient’s serum of the cryoglobulins, which typically precipitate at temperatures below normal body temperature (37 °C) and dissolve again if the serum is heated. Here, we describe the case of a patient diagnosed with HCV that, during the evolution of the hepatic disease, developed a form of cryoglobulinemic vasculitis. The connection between the vasculitis and the hepatic disorder was revealed following treatment with interferon, with the temporary remission of both pathologies and subsequent relapse at the end of the 12 months of treatment, the patient becoming a non-responder. The particularity of the case is represented by both the severity of the vasculitic disease from its onset and the deterioration of renal function up to the predialitic phase, a situation not typical of the evolution of cryoglobulinemia. Taking into account the hepatic disorder, the inevitable evolution towards cirrhosis, and the risk of developing the hepatocellular carcinoma, close monitoring is necessary. Full article

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Open AccessCase Report

Recurrent Vulvar Carcinoma: Complex Surgical Treatment via Perineal Excision and Reconstruction with Musculocutaneous Flap

by Dragoș Popa, Cosmin V. Obleagă, Ștefan Paitici, Stelian Ș. Mogoanta, Ionică D. Vîlcea, Pouya Pourgolafshan, Cristian Gheorghe, Manuela I. Vasile, Raluca Câmpeanu and Cecil S. Mirea

J. Mind Med. Sci. 2018, 5(1), 129-134; https://doi.org/10.22543/7674.51.P129134 - 31 Mar 2018

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Abstract

Vulvar cancer is a malignant disease having a low frequency and with well-established surgical and oncological treatments based on the stage of the disease. The most important therapeutic problem encountered is represented by cases of perineal local regional recurrence, which are common in [...] Read more.

Vulvar cancer is a malignant disease having a low frequency and with well-established surgical and oncological treatments based on the stage of the disease. The most important therapeutic problem encountered is represented by cases of perineal local regional recurrence, which are common in patients with large primary tumors and can occur even if the margins of the resection had no tumoral invasion. We present a case study of a 64-year-old patient diagnosed one year ago with squamous vulvar carcinoma (G3) for which a vulvectomy was performed after neoadjuvant radiotherapy. The patient later developed local recurrence with invasion of the anal sphincter, creating a delicate problem regarding a surgical approach. The size and the extent of the recurrent tumor required a complex surgical intervention using a mixed surgical team of general surgeons and plastic surgeons. Surgical intervention with a large excision of the recurrent cancer along with amputation of the inferior rectum via perineal route, and creation of a left iliac anus was performed. The perineal defect was covered via a musculocutaneous flap using the gracilis muscle. The immediate post-operative evolution was favorable. Full article

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Open AccessArticle

Unmodifiable Variables Related to Thyroid Cancer Incidence

by Cornelia Nitipir, Lucian Alecu, Iulian Slavu, Raluca Tulin, Radu C. Jecan, Cristina Orlov, Silviu Pituru, Dana L. Stanculeanu, Razvan Hainarosie, Anca Pantea Stoian and Adrian Tulin

J. Mind Med. Sci. 2018, 5(1), 123-128; https://doi.org/10.22543/7674.51.P123128 - 31 Mar 2018

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Abstract

The incidence of thyroid cancer is significantly different between male and female patients. Thyroid cancer is also the only form of cancer where age can be considered a staging variable. Identifying biological prognostic factors such as age or sex is important as it [...] Read more.

The incidence of thyroid cancer is significantly different between male and female patients. Thyroid cancer is also the only form of cancer where age can be considered a staging variable. Identifying biological prognostic factors such as age or sex is important as it helps select an optimal personalized therapy. The present analysis is an observational, prospective study that enrolled all patients with thyroid disease who were operated upon at a single center. The study aimed to determine the most frequent age at presentation, the predominance of one sex over the other, the incidence of malignant thyroid disease, and the relative risk for each sex to develop thyroid carcinoma. The incidence of thyroid carcinoma was higher for women than for men, with a higher relative risk in the female subgroup. Incidence was also highest in the 50–60-year-old group. Given that studies show better survival for women and for younger patients, even when presenting with advanced disease, compared with older, male patients, such prognostic indicators should be a factor in the treatment decision. Full article

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Open AccessArticle

Comparative Cytotoxicity Study of Nicotine and Cotinine on MRC-5 Cell Line

by Ana-Maria Vlasceanu, Daniela L. Baconi, Bianca Galateanu, Miriana Stan and Cristian Balalau

J. Mind Med. Sci. 2018, 5(1), 117-122; https://doi.org/10.22543/7674.51.P117122 - 31 Mar 2018

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Abstract

Nicotine has several health hazards regarding carcinogenic potential. It also imparts increased risk for respiratory, cardiovascular, and gastrointestinal disorders. Several mechanisms have been proposed for the carcinogenic potential, including effects on cell proliferation, inducing oxidative stress, DNA mutation, or inhibition of apoptosis. The [...] Read more.

Nicotine has several health hazards regarding carcinogenic potential. It also imparts increased risk for respiratory, cardiovascular, and gastrointestinal disorders. Several mechanisms have been proposed for the carcinogenic potential, including effects on cell proliferation, inducing oxidative stress, DNA mutation, or inhibition of apoptosis. The cotinine metabolite is generally thought to have effects similar to nicotine in some experimental systems. The purpose of this study was to assess the nicotine and cotinine cytotoxicity on MRC-5 lung fibroblasts. The pulmonary fibroblasts were treated with various concentrations of nicotine or cotinine (in the range 1 µM – 2 mM) for 24 or 48 h and analyzed for cell viability by MTT test. The results indicated that high nicotine concentrations (2 mM) induced marked cell death (about 50%) in MRC-5 cell line. Cotinine showed lower toxicity than nicotine on the MRC-5 cells. In contrast to nicotine treatment, cells treated with cotinine continued to proliferate after the 48h incubation period. Full article

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Open AccessArticle

The Role of Reactive Astrocitose in the Chronological Evolution of Traumatic Brain Injury

by Roxana M. Duncea-Borca, Vladimir Belis, Mihnea Costescu, Relu G. Calota, Reka Kutasi and Cosmin A. Moldovan

J. Mind Med. Sci. 2018, 5(1), 109-116; https://doi.org/10.22543/7674.51.P109116 - 31 Mar 2018

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Abstract

Introduction and objectives. This study aims to investigate whether the cerebral modifications of posttraumatic reactive astrocitose can be considered an objective criterion for determining the age of traumatic cranio-cerebral lesions. Materials and methods. The present study consists of a series of 23 medico-legal [...] Read more.

Introduction and objectives. This study aims to investigate whether the cerebral modifications of posttraumatic reactive astrocitose can be considered an objective criterion for determining the age of traumatic cranio-cerebral lesions. Materials and methods. The present study consists of a series of 23 medico-legal cases that underwent autopsy inTeleormanCounty(Romania) Department of Forensic Medicine during 2007–2016, with full immune-histochemical microscopic examination using GFAP staining. The study consists of two groups, a series of 13 cases with cranio-cerebral trauma with different posttraumatic survival periods and 9 cases as a control group. Results and discussions. We discovered GFAP+ reactive astrocytes even when death occurred immediately after the trauma event and up to 4 months after the traumatic incident. We also discovered an intense positive correlation between the density of the GFAP+ cell from the perilesional area and the posttraumatic survival period. The highest cerebral density of the GFAP+ astrocytes occurred with acute death prior (1 to 24 hours) and the lowest in the chronic period (over 2 weeks). Conclusions. The gradual and differentiated appearance of the reactive astrocytes in close relation with the cerebral posttraumatic interval, with specific lesional and perilesional distribution as well as in surrounding area, clearly demonstrates that the state of the reactive astrocitose may constitute an objective index for evaluation of the elapsed time after the posttraumatic event. Full article

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Open AccessArticle

Does Sex of the Patient Play a Role in Survival for MSI Colorectal Cancer?

by Adrian Tulin, Iulian Slavu, Raluca Tulin, Lucian Alecu, Radu C. Jecan, Cristina Orlov, Cristian I. Iaciu, Dana L. Stanculeanu, Razvan Hainarosie, Silviu Pituru, Anca Pantea Stoian and Cornelia Nitipir

J. Mind Med. Sci. 2018, 5(1), 101-108; https://doi.org/10.22543/7674.51.P101108 - 31 Mar 2018

Viewed by 38

Abstract

Microsatellite instability (MSI) is a feature of colorectal tumors that develops as a result of inactivation of the DNA mismatch repair system. It is found in about 15% of all colorectal cancers and is an important prognostic molecular marker when assessing patients with [...] Read more.

Microsatellite instability (MSI) is a feature of colorectal tumors that develops as a result of inactivation of the DNA mismatch repair system. It is found in about 15% of all colorectal cancers and is an important prognostic molecular marker when assessing patients with colorectal cancer. It can influence prognosis and treatment decisions in both the advanced and early stages. Although in early stages this marker suggests a favorable prognosis and presents an important argument against adjuvant treatment in stage II disease, in metastatic stages it no longer associated with such an optimistic outcome. The present trial is a prospective, single-center study which included 122 colorectal cancer patients who were tested for MSI using immunohistochemistry. The trial included patients with stage II to IV colorectal cancer, treated in the Prof. Dr. Agrippa Ionescu Emergency Hospital, Bucharest, Romania. Follow-up data were collected during a 24-month period. The study attempted to determine whether differences exist in overall survival for MSI (microsatellite instability) vs. MSS (microsatellite stable) colorectal cancer and to ascertain whether sex of the patient influences prognosis in MSI patients, irrespective of stage or treatment. Results demonstrated no significant differences in survival for MSI vs MSS colorectal patients, and patients’ gender proved not to influence the outcome in MSI patients. Full article

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Open AccessArticle

Melatonin Attenuates Oxidative Stress and Modulates Inflammatory Response After Experimental Burn Trauma

by Minka Hristova, Ganka Bekyarova, Milena Atanasova and Maria Tzaneva

J. Mind Med. Sci. 2018, 5(1), 93-100; https://doi.org/10.22543/7674.51.P93100 - 31 Mar 2018

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Abstract

Introduction. Thermal injury activates an inflammatory response. Melatonin possesses anti-oxidant and anti-inflammatory properties. The objective of the present work was to study melatonin effects on the inflammatory response under conditions of oxidative stress during the early stage of thermal injury. Materials and methods. [...] Read more.

Introduction. Thermal injury activates an inflammatory response. Melatonin possesses anti-oxidant and anti-inflammatory properties. The objective of the present work was to study melatonin effects on the inflammatory response under conditions of oxidative stress during the early stage of thermal injury. Materials and methods. We used 24 white male rats of Wistar breed, randomly divided into three experimental groups. Group one was the control, group two was inflicted with burn trauma, and group three was inflicted with burn trauma, with melatonin application following the thermal injury. Melatonin was applied twice in doses of 10 g/kg b.m. immediately after the burn trauma and again at 12 hours. Plasma levels of tumor necrosis-factor-α (TNF-α), a pro-inflammatory mediator, and of interleukin-10 (Il-10), an anti-inflammatory mediator, were examined and their ratio was calculated. The levels of malondialdehyde (MDA), an oxidative stress marker, were also estimated. Results. Thermal trauma significantly increased plasma TNF-α levels (ð < 0.01) and TNF-α /IL-10 ratio but did not change IL-10 ones. Plasma MDA concentrations were significantly elevated as well (ð < 0.0001). Melatonin application significantly reduced TNF-α (ð < 0.05), increased IL-10 (ð < 0.05), down-regulated TNF-α/IL-10 ratio and changed MDA concentrations (ð < 0.01). In conclusion, our results show that local alteration induces oxidative stress and inflammatory response with TNF-α /IL-10 disbalance. Melatonin modulates this response and attenuates oxidative stress in experimental burn injury. Full article

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Open AccessArticle

Dietary Habits and Lifestyle in School-Aged Children from Bucharest, Romania

by Anca Pantea Stoian, Liliana F. Andronache, Razvan Hainarosie, Dan N. Paduraru, Cristinel D. Badiu, Andreea Arsene, Claudia Mehedintu, Georgiana Ditu, Silviu M. Pituru, Cristina Orlov, Mihaela Oros and Cornelia Nitipir

J. Mind Med. Sci. 2018, 5(1), 85-92; https://doi.org/10.22543/7674.51.P8592 - 31 Mar 2018

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Abstract

Background. This study evaluated the difference between boys and girls in terms of nutritional status, lifestyle, and dietary habits during school life. Materials and Methods. A descriptive and observational study was conducted in 2016, in which 251 children, aged 7–17, from 3 elementary [...] Read more.

Background. This study evaluated the difference between boys and girls in terms of nutritional status, lifestyle, and dietary habits during school life. Materials and Methods. A descriptive and observational study was conducted in 2016, in which 251 children, aged 7–17, from 3 elementary schools and a high school inBucharest,Romania, were evaluated. A questionnaire was used to assess food behavior, eating, and lifestyle habits. Results. Boys had a significantly higher waist circumference (71.18 ± 9) than girls (67.46 ± 9.91) (p = 0.004). Thus 27% of boys were overweight or obese compared with only 22% of the girls. Differences were also seen between the two groups in terms of main meals and snacks and following a rhythm of meals: a statistically significant percentage of girls (36.3%) skip breakfast, while most boys (63.8%) take a food package to school. A total of 23.8% of the boys and 24% of the girls state that they eat while sitting in front of the computer or TV. Conclusions. We found that boys are more overweight or obese than girls. Obesity in the pediatric population of Romania could be explained by the country’s emergence from communism 25 years ago, pattern typical of all Eastern European countries and which currently involve an overexposure of people to fast food, fizzy drinks and sweets, as well as to a high consumption of salt and food additives. Unbalanced and highly caloric food had been preferable to healthy food in the last period. Leisure time is rather spent in front of the TV, tablet, detrimental to rational physical exercise, recreational sports or hiking. The family environment is very important and all our actions should be focused on continuous education about the risks of unhealthy food and a sedentary lifestyle. Full article

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Open AccessArticle

Depression and Breast Cancer—Postoperative Short-Term Implications

by Răzvan V. Scăunașu, Ștefan Voiculescu, Bogdan Popescu, Roxana Popa, Denisa Bălălău, Laura Răducu, Cristina N. Cozma and Cristian R. Jecan

J. Mind Med. Sci. 2018, 5(1), 82-84; https://doi.org/10.22543/7674.51.P8284 - 31 Mar 2018

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Abstract

Introduction. Pre and postoperative psychological status is an important aspect in patients diagnosed with breast cancer, having a great impact on their quality of life. Considering the high incidence, mortality rate, and the added effect on self-image, breast cancer is considered a major [...] Read more.

Introduction. Pre and postoperative psychological status is an important aspect in patients diagnosed with breast cancer, having a great impact on their quality of life. Considering the high incidence, mortality rate, and the added effect on self-image, breast cancer is considered a major stressor for women worldwide, almost 50% of these experiencing psychological distress. Methods. Our study retrospectively analysed the relationship between preoperative diagnosed depression and the number of medical care days, on patients diagnosed with breast cancer and admitted for surgical treatment in Colțea Clinical Hospital between 2017 and 2018. Results. We had 62 patients scheduled for breast cancer surgery, who had been preoperatively evaluated using psychological tests. Of those patients, 18 had scores indicating significant symptoms of depression (moderate or severe symptoms, HDSR > 17). Patients with high HDSR scores needed an 18.4% longer hospitalization than patients without symptoms of depression. They also had 35.4% more ambulatory visits in the month following discharge, and a higher incidence of postoperative complications. Conclusions. There seem to be both physiological and somatic determinants responsible for the need of prolonged medical care, but the mechanisms responsible for these effects remain unclear. Identifying high-risk patients could not only lower the postoperative morbidity, but also increase the therapeutic outcomes. Full article

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Open AccessArticle

Histopathology Report on Colon Cancer Specimens—Measuring Surgical Quality, an Increasing Stress for Surgeons

by Stefan Morarasu, Tudor Frunza, Karina Bilavschi, Ana Maria Patrascu, Sorinel Lunca and Gabriel Dimofte

J. Mind Med. Sci. 2018, 5(1), 75-81; https://doi.org/10.22543/7674.51.P7581 - 31 Mar 2018

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Abstract

Introduction. Improving the quality of surgical resections by evaluating surgical specimens is probably the most important feedback a surgeon can receive. Moreover, prognosis of patients with colon cancer is based on achieving appropriate resection margins and assessment of lymph node status. For [...] Read more.

Introduction. Improving the quality of surgical resections by evaluating surgical specimens is probably the most important feedback a surgeon can receive. Moreover, prognosis of patients with colon cancer is based on achieving appropriate resection margins and assessment of lymph node status. For these reasons we aim to provide a retrospective analysis on colon cancer specimens operated by a single surgical team. Materials and Methods. 88 patients operated between 2013 and 2016 were included in the study. Data were gathered prospectively and assessed by multivariate analysis for the main variables (age, gender, tumor staging, specimen length, distance to closest resection margin, number of lymph nodes, and number of positive lymph nodes). Results. The mean number of lymph nodes excised was 31.9, with more after right colectomies (39.6) than after left colonic resections (29.1). The average specimen length was 29.2 cm after right colectomies, 35.6 cm after left hemicolectomies and 18 cm after segmental colectomies. There was a significant correlation between the number of lymph nodes, specimen length, and age of patients. Conclusion. Lymph node status is correlated with specimen length and age. The standard of 12 lymph nodes was achieved and surpassed, being comparable to the benchmark literature. Standards on colon resections need to be reevaluated as many surgeons are pressured by quality measurements which do not always reflect sound oncologic principles. Full article

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Open AccessArticle

The Psychosocial Impact of Vaginal Delivery and Cesarean Section in Primiparous Women

by Liana Pleș, Romina M. Sima, Delia Carp, Camelia Alexăndroaia, Denisa O. Bălălău, Anca D. Stănescu and Octavian G. Olaru

J. Mind Med. Sci. 2018, 5(1), 70-74; https://doi.org/10.22543/7674.51.P7074 - 31 Mar 2018

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Abstract

The aim of this study was to identify how the method of delivery and birth experience interfere with maternal psychological status early after puerperium. We conducted a prospective study on 148 women after puerperium from November 2017 to January 2018 in Bucur Maternity [...] Read more.

The aim of this study was to identify how the method of delivery and birth experience interfere with maternal psychological status early after puerperium. We conducted a prospective study on 148 women after puerperium from November 2017 to January 2018 in Bucur Maternity Hospital. Women that delivered vaginally mobilized in the first 6 hours in 73.7% of the cases, but for cesarean section after 12–24 hours in 43.6% of the cases. Women described good support from the obstetrician in 58.1% of the cases. 90.5% of the women reported that the method of delivery did not have an impact on infant care and 73% had no lactation problems. The majority described little trauma, in 32.4% of the cases. 70.3% of the patients reported that they wanted to have more children and 59.5% of them desired the same method of delivery. Negative feelings, lactation, and taking care of the baby were not influenced in this study by the method of delivery, but by prematurity of birth and the complications that women experienced at birth. Full article

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Open AccessReview

The Mind-Body Problem—Three Equations and One Solution Represented by Immaterial-Material Data

by Ion G. Motofei and David L. Rowland

J. Mind Med. Sci. 2018, 5(1), 59-69; https://doi.org/10.22543/7674.51.P5969 - 31 Mar 2018

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Abstract

Human life occurs within a complex bio-psycho-social milieu, a heterogeneous system that is integrated by multiple bidirectional interrelations existing between the abstract-intangible ideas and physical-chemical support of environment. The mind is thus placed between the abstract ideas/concepts and neurobiological brain that is further [...] Read more.

Human life occurs within a complex bio-psycho-social milieu, a heterogeneous system that is integrated by multiple bidirectional interrelations existing between the abstract-intangible ideas and physical-chemical support of environment. The mind is thus placed between the abstract ideas/concepts and neurobiological brain that is further connected to environment. In other words, the mind acts as an interface between the immaterial (abstractintangible) data and material (biological) support. The science is unable to conceives and explains an interaction between the immaterial and material domains (to understand nature of the mind), this question generating in literature the mind-body problem. We have published in the past a succession of articles related to the mind-body problem, in order to demonstrate the fact that this question is actually a false issue. The phenomenon of immaterial-material interaction is impossible to be explained because it never occurs, which means that there is no need to explain the immaterial-material interaction. Our mind implies only a temporal association between the immaterial data and material support, this dynamic interrelation being presented and argued here as a solution to the mind-body problem. The limited psycho-biologic approach of the mind-body problem is expanded here to a more comprehensive and feasible bio-psycho-social perspective, generating thus three distinct (bio-psychological, bio-social, and psycho-social) equations. These three equations can be solved through a solution represented by a dynamic cerebral system (two distinct and interconnected subunits of the brain) which presumably could have the capability of receiving and processing abstract data through association (with no interaction) between immaterial and material data. Full article

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Open AccessReview

Management of Deep Space Infections of the Neck

by Emil Mărginean, Sargarovschi Egor, Ciprian Venter, Alina Pantiș, Oana Vălenaș, Ildiko Sorban, Maria Domuța, Cristian Bălălău, Răzvan Scaunasu and Bogdan Popescu

J. Mind Med. Sci. 2018, 5(1), 53-58; https://doi.org/10.22543/7674.51.P5358 - 31 Mar 2018

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Abstract

Infections of the deep neck spaces often present a clinical challenge for the ENT surgeon. Management of these complex suppurations of the neck requires in fact a multidisciplinary approach due to possible complications like mediastinitis, septic shock and MSOF, life threatening bleeding and [...] Read more.

Infections of the deep neck spaces often present a clinical challenge for the ENT surgeon. Management of these complex suppurations of the neck requires in fact a multidisciplinary approach due to possible complications like mediastinitis, septic shock and MSOF, life threatening bleeding and ICU management. The spread of infection from the primary site to other regions is possible through the lymphatic, arterial and venous vessels, or directly along the fasciae. There are several classifications for the etiology, pathogenic mechanism and site of evolution, the most frequently encountered clinical forms being peritonsillar abscess, retropharyngeal abscess, lateropharyngeal abscess, and the deep cervical abscess. All of these abscesses are suppurative complications of primary neck infections. Extensive inflammation and suppuration of the neck requires in most cases multiple incisions for drainage such that patients experience significant scarring of the neck. Along with the presence of the tracheostomy and nazo-gastric feeding tube, the aesthetic aspect of the neck surgery involves a high degree of psychological stress for the patients. As a conclusion and in line with literature data, patients must be fully informed about the technique and the outcome of the surgery so that they can provide informed consent since the pathology can be both life- threatening and mutilating. Full article

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Open AccessReview

Pelvic Floor Disorders in Gynecological Malignancies. An Overlooked Problem?

by Oana M. Bodean, Radu D. Marcu, Dan A. Spinu, Bogdan Socea, Camelia C. Diaconu, Octavian Munteanu, Nicoleta Taus and Monica Cirstoiu

J. Mind Med. Sci. 2018, 5(1), 46-52; https://doi.org/10.22543/7674.51.P4652 - 31 Mar 2018

Viewed by 23

Abstract

Cervical, endometrial, ovarian, vulvar, and vaginal cancers affect women of a broad age spectrum. Many of these women are still sexually active when their cancer is diagnosed. Treatment options for gynecological malignancies, such as gynecological surgery, radiation, and chemotherapy, are proven risk factors [...] Read more.

Cervical, endometrial, ovarian, vulvar, and vaginal cancers affect women of a broad age spectrum. Many of these women are still sexually active when their cancer is diagnosed. Treatment options for gynecological malignancies, such as gynecological surgery, radiation, and chemotherapy, are proven risk factors for pelvic floor dysfunction. The prevalence of urinary incontinence, fecal incontinence, and sexual dysfunction before cancer treatment is still unclear. Hypotheses have been raised in the literature that these manifestations could represent early symptoms of pelvic cancers, but most remain overlooked even in cancer surviving patients. The primary focus of therapy is always cancer eradication, but as oncological and surgical treatment options become more successful, the number of cancer survivors increases. The quality of life of patients with gynecological cancers often remains an underrated subject. Pelvic floor disorders are not consistently reported by patients and are frequently overlooked by many clinicians. In this brief review we discuss the importance of pelvic floor dysfunction in patients with gynecological malignant tumors. Full article

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Open AccessReview

The Importance of Circulating Tumor Products as ‘Liquid Biopsies’ in Colorectal Cancer

by Alina S. Miscoci, Cristian D. Pirvu, Veronica Calborean, Costin T. Streba, Otilia C. Rogoveanu, Vlad Padureanu and Cristin C. Vere

J. Mind Med. Sci. 2018, 5(1), 39-45; https://doi.org/10.22543/7674.51.P3945 - 31 Mar 2018

Viewed by 49

Abstract

Liquid biopsies represent an array of plasma analysis tests that are studied to evaluate and identify circulating tumor products, especially circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA). Examining such biomarkers in the plasma of colorectal cancer patients has attracted attention due [...] Read more.

Liquid biopsies represent an array of plasma analysis tests that are studied to evaluate and identify circulating tumor products, especially circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA). Examining such biomarkers in the plasma of colorectal cancer patients has attracted attention due to its clinical significance in the treatment of malignant diseases. Given that tissue samples are sometimes challenging to procure or unsatisfactory for genomic profiling from patients with colorectal cancer, trustworthy biomarkers are mandatory for guiding treatment, monitoring therapeutic response, and detecting recurrence. This review considers the relevance of flowing tumor products like circulating tumor cells (CTCs), circulating tumor DNA (ctDNA), circulating messenger RNA (mRNA), circulating micro RNA (miRNA), circulating exosomes, and tumor educated platelets (TEPs) for patients with colorectal cancer. Full article

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Open AccessReview

Mandatory Multidisciplinary Approach for the Evaluation of the Lymph Node Status in Rectal Cancer

by Marian Diaconescu, Cosmin V. Obleaga, Cecil S. Mirea, Mihai C. Ciorbagiu, Emil Moraru and Ionica D. Vilcea

J. Mind Med. Sci. 2018, 5(1), 29-38; https://doi.org/10.22543/7674.51.P2938 - 31 Mar 2018

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Abstract

Colorectal cancer is the third most frequently reported malignancy and also the third leading cancer-related cause of death worldwide. Lymph node evaluation, both preoperatively and postoperatively, represents an important aspect of the diagnosis and therapeutic strategy in colorectal cancer, such that an accurate [...] Read more.

Colorectal cancer is the third most frequently reported malignancy and also the third leading cancer-related cause of death worldwide. Lymph node evaluation, both preoperatively and postoperatively, represents an important aspect of the diagnosis and therapeutic strategy in colorectal cancer, such that an accurate preoperative staging is required for a correct therapeutic strategy. Treatment of rectal cancer with positive lymph nodes, a very important predictive prognostic parameter, is currently based on neoadjuvant chemoradiotherapy followed by total/ surgical mesorectal excision and adjuvant regimen. Preoperative evaluation of the lymph node status in rectal cancer is based on endoscopic ultrasound and magnetic resonance imaging, but their accuracy, specificity, and sensitivity still require improvement. Postoperative evaluation also presents points of debate, especially related to the role of sentinel lymph node mapping and their final implication, represented by detection of micrometastases and isolated tumor cells. The pathologic interpretation of tumor deposits represents other points in discussion. From a surgical perspective, extended lateral lymph node dissection vs. abstinence and (neo)adjuvant therapeutic approach represent another unresolved issue. This review presents the major controversies existing today in the treatment and pathologic interpretation of the lymph nodes in rectal cancer, the role/ indication and value of the lateral pelvic lymph node dissection, and the postoperative interpretation of the value of the micrometastatic disease and tumor deposits. Full article

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Open AccessReview

Positive Surgical Margins in Nephron-Sparing Surgery; The Great Unknown

by Dan Spinu, Oana M. Bodean, Bogdan Socea, Dan Mischianu, Ioana Oprea and Radu D. Marcu

J. Mind Med. Sci. 2018, 5(1), 21-28; https://doi.org/10.22543/7674.51.P2128 - 31 Mar 2018

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Abstract

There is a currently a general trend towards organ-preserving surgery, and urology is no exception. Specifically, nephron-sparing surgery (NSS) has gained general acceptance for T1a renal cell carcinoma (guidelines recommendations). Moreover T1b, T2 and even T3 stage tumors have been included on the [...] Read more.

There is a currently a general trend towards organ-preserving surgery, and urology is no exception. Specifically, nephron-sparing surgery (NSS) has gained general acceptance for T1a renal cell carcinoma (guidelines recommendations). Moreover T1b, T2 and even T3 stage tumors have been included on the nephron sparing list at some centers. An unresolved issue is that of positive surgical margins (PSM), not only their detection but also the implications for follow up and treatment. This paper highlights data available on risk factors for PSM, their clinical relevance, and possible therapeutic consequences. From the surgeon’s viewpoint, NSS is a daring and risky surgical procedure. Urological guidelines stress the importance of NSS, and thus the trend is moving in that direction. Unresolved, however, is the problem of PSM. Trifecta, MIC, and pentafecta are applicable concepts which attempt to define the optimal endpoint of NSS, but further elaboration is necessary. Specifically, research needs to focus less on the concept of definitive margins and more on their identification and avoidance. Although some studies suggest that PSMs do not influence overall survival rate, the basic idea of preserving tissue that is not cancerous leads to further medical, social, and psychological considerations. Full article

304 KiB

Open AccessReview

Emergency Surgery on Mentally Impaired Patients: Standards in Consenting

by Mihai Păduraru, Ahmed Saad and Krystian Pawelec

J. Mind Med. Sci. 2018, 5(1), 16-20; https://doi.org/10.22543/7674.51.P1620 - 31 Mar 2018

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Abstract

Emergency surgery is often performed on the elderly and susceptible patients with significant comorbidities; as a consequence, the risk of death or severe complications are high. Consent for surgery is a fundamental part of medical practice, in line with legal obligations and ethical [...] Read more.

Emergency surgery is often performed on the elderly and susceptible patients with significant comorbidities; as a consequence, the risk of death or severe complications are high. Consent for surgery is a fundamental part of medical practice, in line with legal obligations and ethical principles. Obtaining consent for emergency services (for surgical patients with chronic or acute mental incapacity, due to surgical pathology) is particularly challenging, and meeting the standards requires an up-to-date understanding of legislation, professional body guidelines, and ethical or cultural aspects. The guidance related to consent requires physicians and other medical staff to work with patients according to the process of ‘supported decision-making’. Despite principles and guidelines that have been exhaustively established, the system is sometimes vulnerable in actual clinical practice. The combination of an ‘emergency’ setting and a patient without mental ‘capacity’ is a challenge between patient-centered and ‘paternalistic’ approaches, involving legislation and guidelines on ‘best interests’ of the patient. Full article

281 KiB

Open AccessReview

Vascular Neurocognitive Disorders and the Vascular Risk Factors

by Carmen V. Albu, Vlad Pădureanu, Mihail V. Boldeanu, Ana M. Bumbea, Anca Ş. Enescu, Dana M. Albulescu, Cristian A. Siloși and Aurelia Enescu

J. Mind Med. Sci. 2018, 5(1), 7-15; https://doi.org/10.22543/7674.51.P715 - 31 Mar 2018

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Abstract

Dementias are clinical neurodegenerative diseases characterized by permanent and progressive transformation of cognitive functions such as memory, learning capacity, attention, thinking, language, passing judgments, calculation or orientation. Dementias represent a relatively frequent pathology, encountered at about 10% of the population of 65-year olds [...] Read more.

Dementias are clinical neurodegenerative diseases characterized by permanent and progressive transformation of cognitive functions such as memory, learning capacity, attention, thinking, language, passing judgments, calculation or orientation. Dementias represent a relatively frequent pathology, encountered at about 10% of the population of 65-year olds and 20% of the population of 80-year olds. This review presents the main etiological forms of dementia, which include Alzheimer form of dementia, vascular dementia, dementia associated with alpha-synucleionopathies, and mixed forms. Regarding vascular dementia, the risk factors are similar to those for an ischemic or hemorrhagic cerebrovascular accident: arterial hypertension, diabetes mellitus, dyslipidemia, smoking, obesity, age, alcohol consumption, cerebral atherosclerosis/ arteriosclerosis. Several studies show that efficient management of the vascular risk factors can prevent the expression and/ or progression of dementia. Thus, lifestyle changes such as stress reduction, regular physical exercise, decreasing dietary fat, multivitamin supplementation, adequate control of blood pressure and serum cholesterol, and social integration and mental stimulation in the elderly population are important factors in preventing or limiting the symptoms of dementia, a disease with significant individual, social, and economic implications. Full article

332 KiB

Open AccessReview

Androgenic Alopecia—The Risk–Benefit Ratio of Finasteride

by David L. Rowland, Ion G. Motofei, Ioana Păunică, Petrișor Banu, Mihaela F. Nistor, Stana Păunică and Vlad D. Constantin

J. Mind Med. Sci. 2018, 5(1), 1-6; https://doi.org/10.22543/7674.51.P16 - 31 Mar 2018

Viewed by 41

Abstract

Finasteride is currently approved and largely used as a therapeutic option for androgenetic alopecia. Apparently a safe drug and effective at the onset of its application, several concerns have since appeared over the years regarding the frequency and magnitude of finasteride adverse effects, [...] Read more.

Finasteride is currently approved and largely used as a therapeutic option for androgenetic alopecia. Apparently a safe drug and effective at the onset of its application, several concerns have since appeared over the years regarding the frequency and magnitude of finasteride adverse effects, which in some cases appear irreversible even after drug termination. This paper discusses the use of finasteride for androgenic alopecia from two distinct perspectives. On the one hand, androgenic alopecia is a condition that especially affects a person’s self-image and esteem, aspects that are subjectively-constructed and thus relative and changeable. On the other hand, this condition involves a multifactorial etiology, with androgens being only partly responsible. Because androgens have important and unique physiological roles within the body, any procedure that results in androgenic suppression should be advised with caution. Furthermore, adverse effects induced by finasteride are neither fully documented nor easily treated. Finally, as alternative therapeutic approaches (such as topical finasteride) become available, the oral administration of finasteride for androgenic alopecia should, in our opinion, be reevaluated. Due to such concerns, a detailed and informed discussion should take place with patients considering therapy with finasteride for androgenic alopecia. Full article

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J. Mind Med. Sci., Volume 5, Issue 1 (March 2018) – 22 articles

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