Romanian Journal of Military Medicine

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Authors: Dan Mischianu

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Authors: A. Rădulescu, Victor Mădan, A. Aungurenci, Ovidiu Bratu, C. Farcaş, Marius Dinu, Dan Mischianu

Introduction: UTI (urinary tract infections) represent a central pathology for a urological service. Antibiotic resistance is growing at a steady and alarming rate worldwide and especially in Romania. Method and materials: We have analyzed all the patients that were admitted to our clinic for continuous hospitalization between January 2015 and October 2015. All patients undergone urine culture and all cultures positive had an antibiogram worked up. We have selected all patients that had antibiotic resistance to at least an antibiotic. Results: From 1745 patients admitted for continuous hospitalization, we had 180 positive urine cultures at admission from which 125 had at least an antibiotic resistance. Conclusions: Antibiotic resistance is a serious phenomenon, with potential lethal complications, which we encounter daily in urological practice

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Authors: Florin Săvulescu, Costin Duţu, Cristian Cârlan

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Authors: R. Popescu, Ovidiu Bratu, D. Spînu, D. Marcu, C. Farcaş, Marius Dinu, Dan Mischianu

Objectives: This review aims to provide practicing clinicians with the most recent knowledge of the biological nature of prostate cancer especially the information regarding neuroendocrine differentiation. Methods: Review of the literature using PubMed search and scientific journal publications. Results: Much progress has been made towards an understanding of the development and progression of prostate cancer. The prostate is a male accessory sex gland which produces a fraction of seminal fluid. The normal human prostate is composed of a stromal compartment (which contains: nerves, fibroblast, smooth muscle cells, macrophages) surrounding glandular acins – epithelial cells. Neuroendocrine cells are one of the epithelial populations in the normal prostate and are believed to provide trophic signals trough the secretion of neuropeptides that diffuse and influence surrounding epithelial cells. Prostate cancer is the most frequently diagnosed malignancy in men. In prostate cancer, neuroendocrine cells can stimulate growth of surrounding prostate adenocarcinoma cells (proliferation of neighboring cancer cells in a paracrine manner by secretion of neuroendocrine products). Neuroendocrine prostate cancer is an aggressive variant of prostate cancer that commonly arises in later stages of castration resistant prostate cancer. The detection of neuroendocrine prostate cancer has clinical implications. These patients are often treated with platinum chemotherapy rather than with androgen receptor targeted therapies. Conclusion: This review shows the need to improve our knowledge regarding diagnostic and treatment methods of the Prostate Cancer, especially cancer cells with neuroendocrine phenotype.

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Authors: Ovidiu Bratu, D. Marcu, D. Spînu, A. Rădulescu, I. Oprea, Dan Mischianu

Introduction: Stress urinary incontinence is a highly debilitating condition, with an important impact over the quality of life. When the conservative treatment fails, the surgical treatment is a viable solution. Minimally invasive sling procedures have become the gold standard of surgical management for stress urinary incontinence (SUI) in women. Material and methods: The study was conducted on 68 patients with stress urinary incontinence, 52 have undergone the retropubic tension-free vaginal tape and 16 patients were operated using the transobturator tape procedure. All the patients were evaluated before the operation and the indication of the surgical treatment was established on the basis of physical examination (all the patients had positive cough test), abdominal ultrasound (to determine postvoid residual urine volume), urinalysis and urine culture (the majority of the patients have had before the operation recurrent urinary tract infections). Results: The satisfaction was similar in both groups of patients, with an average satisfaction rate of 91% for TVT and 86% for the patients who have undergone TOT procedure. The patients were in a proportion of 78,9% at menopause, with an average number of natural births of 1.9 and a mean BMI of 28.2. Regarding the surgical duration, this has varied between 20 and 40 minutes, being higher in the TVT cases (up to 5-7 minutes longer than TOT), because cystoscopy was performed during the operation to verify if the bladder was perforated or not. The urethral catheter was removed immediately after the operation in the case of the TOT procedure and in the day after the operation for the patients who have undergone TVT procedures (all of these patients associated genital prolapse). The hospitalization time was 3 days. We haven’t encountered significant intraoperative and postoperative complications. Conclusions: The TOT and TVT procedures have proven to be highly effective and safe methods in the treatment of SUI. There are no significant differences regarding the efficacy of these two surgical methods, but the risk of intraoperative complications is a little higher for the TVT procedure. The mid urethral sling procedures improve significantly the quality of life for patients with stress urinary incontinence.

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Authors: D. Marcu, Ovidiu Bratu, D. Spînu, A. Rădulescu, C. Farcaş, Dan Mischianu

Introduction: Erectile dysfunction(ED) is a serious condition which can affect men of all ages, with an important impact over the quality of life. When conservative therapy fails, a viable solution is the penile prosthesis implantation (PPI). Objective: The purpose of this paper is to present data from recent literature regarding the satisfaction rates of men who have undergone penile PPI and as well as the partners satisfaction rates, ease of use, informations regarding long term survival of these prosthesis, postoperative complications and long distance complications, the effectiveness and the way that penile prosthesis have influenced the quality of life of the men who have opted for this solution. Material and methods: We have analyzed recent long term studies concerning the outcomes of the PPI, studies which were made retrospectively, over a period of time of 10 to 15 years. Results: Compared with the conservative treatment for ED, the satisfaction rates achieved after penile prosthesis implantation are higher. According to these studies, the overall patient’s satisfaction is 70-90%. The difference between patient and their partners’ satisfaction rate is negligible, this difference ranging between 2 to 8%. The satisfaction rate regarding the adequate erection for sexual intercourse is 80-90%. The overall satisfaction rates for the malleable prostheses are lower compared with inflatable devices, 30-75%, respectively 75-90% for the inflatable prosthesis. The mechanical and overall survival rates for the malleable prosthesis range between 65-80% at 10 years, and 58-75% for the inflatable devices. Overall ease of use is rated as 78%. Complications after implantation can be encountered in less than 5% of cases and infections in less than 2%. The likelihood of continued use is higher in the group of the patients with the inflatable prosthesis compared with the malleable ones 70-80%, respectively 50-60%. Up to 85- 90% of patients with inflatable prosthesis would recommend them. Conclusions: PPI is a high effective treatment for erectile dysfunction, refractory to pharmacological treatment. The inflatable penile prosthesis (IPP) provides more overall satisfaction than the malleable ones. The patients with IPP are more likely to continue using their devices than those with the malleable prosthesis. PPI improves significantly the quality of life for patients with erectile dysfunction.

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Authors: Mariana Jinga, Vasile Balaban

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Authors: Vasile D. Balaban, Alina Popp, Georgiana Robu, Bogdan Macadon, Mihaita Patrasescu, Sandica Bucurica, Raluca S. Costache, Petrut Nuta, Florentina Ionita Radu, Mariana Jinga

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5

Authors: Andrada Popescu, Andrei Gavrila, Petrut Nuta, Raluca S. Costache, Mariana Jinga, Sandica Bucurica, Bogdan Macadon, Mihaita Patrasescu, Florentina Ionita Radu

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Authors: Catalina Diaconu, Florentina Ioni?a Radu, Mariana Jinga, Petru? Nu?a, Sandica Bucurica, Bogdan Macadon, Mihai?a Patra?escu, Andrada Popescu, Vasile Balaban, Laura Voicu, Daniel O. Costache, Raluca S. Costache

Chronic liver disease is a late stage of progressive hepatic fibrosis. It consists of functional and structural disruptions in most chronic liver diseases. An accurate diagnosis allows us to establish the degree of fibrosis and the stage of the disease, the prognosis of the patient and to predict a treatment response. Despite the fact that liver biopsy is considered a gold standard, noninvasive methods for diagnosing liver fibrosis have gained more and more importance. Whether we talk about serum biomarkers or imagistic methods from transient elastography to 3-D magnetic resonance elastography, the question remains: are these useful or useless? Serum biomarkers represent blood components that can reflect liver histological changes, thus they can monitor the continuous process of fibrosis. These can be subcategorized in direct (that show extracellular matrix turnover) and indirect markers (that reflect disturbances in the hepatic function). However these markers alone are not as accurate in the staging of fibrosis, only help differentiate patients without or with low grade of fibrosis from those with significant fibrosis and cannot be considered alone in the diagnosis of liver fibrosis. Imagistic methods include: ultrasound-based transient elastography, magnetic resonance elastography (MRE), 2D-shear wave elastography, acoustic radiation impulse imaging (ARFI) and cross sectional imaging, the first being the most used. Using a combination of non-invasive tools allows us to diminish the number of patients in need of liver biopsy. However, the patient must always be informed of the advantages and disadvantages of each method and its limitations.

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Authors: Raluca S. Costache

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Authors: Cristian Bănică, Ion Ştefan

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Authors: Adina Mazilu, Mona Gheorghiu, Mădălina Mușat, Narcis Tănase, Răzvan Petrescu, Adrian Ciuche, Augustin Tudose, Florina Vasilescu

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6

Authors: Daniel O. Costache, Cosmin Dobrin, Ruxandra Dinulescu, Laura Voicu, Raluca S. Costache

As the medical sciences advances, so does the volume of information which becomes more and more consistent. The health care system is one of the most complex systems encountered in our society. Today, knowledge management practices have been adopted in many Romanian business sectors. However, Romanian health care system is slowly adopting such principles and concepts. This fact is created mainly because of the organizational culture. In the sanitary industry, this barrier is composed both from an organizational perspective and also, from an individual perspective. Through the knowledge management practices, doctors could benefit from the amount of data spread in different geographical regions.

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Authors: Ioan Sîrbu

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Authors: Carmen A. Sîrbu, OctavianM. Sîrbu, AncaM. Sandu, Cristina P. Sandu, Marian Ștefănescu

A male from rural area, S.M., aged 77 years, was admitted in our department for discontinuous headache. His medical history was irrelevant. He has been experiencing intermittent right parietal-occipital headaches during the last 3 months. Neurologic exam revealed a slight right limb ataxia. Initial laboratory findings revealed a white blood cell count of 6500/mm3 with 75% polymorphonuclear leukocytes, 15% lymphocytes and 8% monocytes. His serum glucose was 90 mg/dL. Non Gadolinium CT scan shows rounded, inhomogenous spontaneous hyperdense area (40-45 UH) between 5-12 mm diameter, localized frontal, temporal, occipital and cerebellar bilaterally. The question was whether the lesions were metastasis or parasitic infection?

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Authors: A. Popenţiu, D. Moga, C. Weber-Lauer, C. Nieman, D. S. Kauvar, D. Sabău, Adrian Popenţiu

We present a report of a unique surgical entity: acute cholecystitis caused by the gallbladder strangulation within a recurrent right upper quadrant incisional hernia. A previously healthy 39 year-old male patient presented to our Emergency Department with abdominal pain, nausea, vomiting, and a tender mass in the right upper quadrant of the abdomen, where an incisional hernia was palpable. He had a history of a gunshot wound to the right upper quadrant and multiple operations to include repairing mesh of the incisional hernia in that area. Abdominal computed tomography demonstrated an acutely inflamed gallbladder within the recurrent hernia. Open cholecystectomy and primary hernia repair were performed. Intraoperatively, the gallbladder appeared being strangled within the hernia. The patient recovered uneventfully and no cholelithiasis was observed on gross examination of the gallbladder. Though there have been a few reports of gallbladder strangulation within primary incisional hernia, ours is the first to describe this phenomenon in a recurrent hernia.

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Authors: Diana M. Popescu, Viorel Ordeanu, Lucia E. Ionescu, Gabriela V. Dumitrescu,Simona N. Bicheru, Marius Necşulescu

Decontamination after terrorist attacks or industrial accidents with biological and/or chemical agents („bio-chem“) must be fast and efficient, in order to reduce the number of victims and to eliminate the consequent damages. The decontamination of living biological agents (bacteria, viruses) or nonliving ones (toxins, regulators) and toxic chemicals could be accomplished by reactions of hydrolysis in various experimental conditions, in particular in alkaline medium, reactions with amines or ammonia, alcohols, phenols etc. and by their transformation into less toxic degradation products. “Bio-chem” intentional or unintentional contamination is a real risk, towards which an effective management must be available to prevent and control it. Decontamination is an essential measure to protect the personnel and the environment. Synthesis and testing of new „bio-chem“ decontaminants, based on quaternary ammonium salts, complete the arsenal of protection against chemical and biological agents. The most effective selected substances could be produced and used for decontamination in accordance with legal procedures.

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Authors: Lucia E. Ionescu, Gabriela V. Dumitrescu, Viorel Ordeanu

The spring of 2014 has brought a new calamity, the exotic infectious disease: Ebola Hemorrhagic Fever, which is caused by a highly contagious and pathogenic virus, transmitted directly by interpersonal contact or indirectly by common usage of objects. The epidemic which occurred in Guinea tended to expand to neighboring countries; 83 deaths have been reported on April 1st 2014. Genetic analysis have revealed that the virus that causes this epidemic is similar in a proportion of 98% to Ebolavirus Zaire (EBOV) species that were responsible for the epidemic in Democratic Republic of Congo, in 2008. The Ebola virus belongs to the Filoviridae family, Ebolavirus genus and causes Ebola Hemorrhagic Fever, with a rate of fatality of up to 90% in humans. There are five distinct species: Bundibugyo Ebolavirus (BDBV), Ebolavirus Zaire (EBOV), Reston Ebolavirus (RESTV), Sudan Ebolavirus (SUDV) and Taï Forest Ebolavirus (TAFV).

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Authors: Florentina Ioniță Radu, Mariana Jinga, Petruț Nuță, Raluca S. Costache,Sandica Bucurica, Bogdan Macadon, Vasile Balaban, Mihăiță Pătrășescu

Nonalcoholic fatty liver disease (NAFLD) is defined as the presence of fat in the liver (hepatic steatosis) either on imaging or on liver histology only after the exclusion of secondary causes of fat accumulation in the liver (e.g. high alcohol drinking, drugs and other medical ailments). Considering the fact that there are many causes of hepatic steatosis, the term NAFLD is reserved for the liver disease that is predominantly associated with obesity and metabolic syndrome. The presence of inflammation and cell injury defines steatohepatitis (NASH) which has the potential to evolve into cirrhosis and hepatocarcinoma, being, therefore, the stage of NAFLD most amenable to treatment. Among the treatments available, the most important are: weight loss, vitamin E and, last but not least, probiotics.

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Authors: Gabriela V. Dumitrescu, Viorel Ordeanu, Simona Bicheru, Lucia Ionescu,Diana Popescu, Marius Necşulescu

Clostridium difficile (C. difficile) is a Gram-positive sporogenous bacillus strictly anaerobic, which in the last decade has became the most important anaerobic bacterium in nosocomial human pathology. Cl.dificile is the etiological agent of more than 20% of diarrhea postantibiotics, over 95% of pseudomembranous colitis and the first cause of nosocomial infectious diarrhea in adults. Although this bacterium usually colonizes the intestine of vertebrates (the normal microbiota), the toxinogenic strains (tcdA and tcdB) are pathogenic in the digestive tract. Given the excessive use of antibiotics and the increased spores resistance, it is possible an environment contamination, with strains which may already be resistant to antibiotics. The main causes of this infection are decreased resistance to antibiotic-induced colonization, contamination with a pathogenic strain of Cl.difficile, secretion of A and/or B toxins and deficient immune response. Due to the increasing worldwide incidence of infections with C. difficile on one hand and to the discovery of new ways of transmitting the infection according with some studies regarding the genetic diversity of bacterium strains on the other hand, a new approach is necessary for C. difficile related topics..

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Authors: Cristian Năstase, Marian Mitrică, Cristian Popescu

Many patients, usually over 60 years old, presenting presenile dementia associated with marked gait disorders, impaired balance, urinary incontinence, have been shown to have enlarged ventricles associated with relatively small cortical atrophy. Intracranial pressure monitoring indicates normal values, or subject to only minor peaks, usually at night. Because some of these patients improve markedly after ventricular shunting procedures it has been suggested that their neurological dysfunction may be caused by a pressure effect on the brain from the increased internal surface of the ventricles. Many of these patients do benefit from surgery, and a lot of them have a history of subarachnoid hemorrhage, traumatic brain injury or meningitis which might have impaired the CSF absorption.