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Stoian M, Andone A, Boeriu A, Bândilă SR, Dobru D, Laszlo SȘ, Corău D, Arbănași EM, Russu E, Stoian A. COVID-19 and Clostridioides difficile Coinfection Analysis in the Intensive Care Unit. Antibiotics (Basel) 2024; 13:367. [PMID: 38667043 PMCID: PMC11047694 DOI: 10.3390/antibiotics13040367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/14/2024] [Accepted: 04/16/2024] [Indexed: 04/29/2024] Open
Abstract
Since the emergence of SARS-CoV-2 in late 2019, the global mortality attributable to COVID-19 has reached 6,972,152 deaths according to the World Health Organization (WHO). The association between coinfection with Clostridioides difficile (CDI) and SARS-CoV-2 has limited data in the literature. This retrospective study, conducted at Mureș County Clinical Hospital in Romania, involved 3002 ICU patients. Following stringent inclusion and exclusion criteria, 63 patients were enrolled, with a division into two subgroups-SARS-CoV-2 + CDI patients and CDI patients. Throughout their hospitalization, the patients were closely monitored. Analysis revealed no significant correlation between comorbidities and invasive mechanical ventilation (IMV) or non-invasive mechanical ventilation (NIMV). However, statistically significant associations were noted between renal and hepatic comorbidties (p = 0.009), death and CDI-SARS-CoV-2 coinfection (p = 0.09), flourochinolone treatment and CDI-SARS-CoV-2 infection (p = 0.03), and an association between diabetes mellitus and SARS-CoV-2-CDI infection (p = 0.04), as well as the need for invasive mechanical ventilation (p = 0.04). The patients with CDI treatment were significantly younger and received immuno-modulator or corticotherapy treatment, which was a risk factor for opportunistic agents. Antibiotic and PPI (proton pump inhibitor) treatment were significant risk factors for CDI coinfection, as well as for death, with PPI treatment in combination with antibiotic treatment being a more significant risk factor.
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Affiliation(s)
- Mircea Stoian
- Department of Anesthesiology and Intensive Care, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540139 Targu Mures, Romania;
| | - Adina Andone
- Gastroenterology Department, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania; (A.B.); (D.D.)
| | - Alina Boeriu
- Gastroenterology Department, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania; (A.B.); (D.D.)
| | - Sergio Rareș Bândilă
- Orthopedic Surgery and Traumatology Service, Marina Baixa Hospital, Av. Alcade En Jaume Botella Mayor, 03570 Villajoyosa, Spain;
| | - Daniela Dobru
- Gastroenterology Department, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania; (A.B.); (D.D.)
| | - Sergiu Ștefan Laszlo
- Intensive Care Unit, Mures, County Hospital, Street Gheorghe Marinescu No 1, 540136 Targu Mures, Romania; (S.Ș.L.); (D.C.)
| | - Dragoș Corău
- Intensive Care Unit, Mures, County Hospital, Street Gheorghe Marinescu No 1, 540136 Targu Mures, Romania; (S.Ș.L.); (D.C.)
| | - Emil Marian Arbănași
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania;
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania;
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Eliza Russu
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania;
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Adina Stoian
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540136 Targu Mures, Romania;
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Stoian M, Roman A, Boeriu A, Onișor D, Bandila SR, Babă DF, Cocuz I, Niculescu R, Costan A, Laszlo SȘ, Corău D, Stoian A. Long-Term Radiological Pulmonary Changes in Mechanically Ventilated Patients with Respiratory Failure due to SARS-CoV-2 Infection. Biomedicines 2023; 11:2637. [PMID: 37893011 PMCID: PMC10604756 DOI: 10.3390/biomedicines11102637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/18/2023] [Accepted: 09/24/2023] [Indexed: 10/29/2023] Open
Abstract
From the first reports of SARS-CoV-2, at the end of 2019 to the present, the global mortality associated with COVID-19 has reached 6,952,522 deaths as reported by the World Health Organization (WHO). Early intubation and mechanical ventilation can increase the survival rate of critically ill patients. This prospective study was carried out on 885 patients in the ICU of Mureș County Clinical Hospital, Romania. After applying inclusion and exclusion criteria, a total of 54 patients were included. Patients were monitored during hospitalization and at 6-month follow-up. We analyzed the relationship between invasive mechanical ventilation (IMV) and non-invasive mechanical ventilation (NIMV) and radiological changes on thoracic CT scans performed at 6-month follow-up and found no significant association. Regarding paraclinical analysis, there was a statistically significant association between patients grouped by IMV and ferritin level on day 1 of admission (p = 0.034), and between patients grouped by PaO2/FiO2 ratio with metabolic syndrome (p = 0.03) and the level of procalcitonin (p = 0.01). A significant proportion of patients with COVID-19 admitted to the ICU developed pulmonary fibrosis as observed at a 6-month evaluation. Patients with oxygen supplementation or mechanical ventilation require dynamic monitoring and radiological investigations, as there is a possibility of long-term pulmonary fibrosis that requires pharmacological interventions and finding new therapeutic alternatives.
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Affiliation(s)
- Mircea Stoian
- Department of Anesthesiology and Intensive Care, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, 540139 Targu Mures, Romania;
| | - Adina Roman
- Gastroenterology Department, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, 540142 Targu Mures, Romania; (A.B.); (D.O.)
| | - Alina Boeriu
- Gastroenterology Department, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, 540142 Targu Mures, Romania; (A.B.); (D.O.)
| | - Danusia Onișor
- Gastroenterology Department, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, 540142 Targu Mures, Romania; (A.B.); (D.O.)
| | - Sergio Rareș Bandila
- Orthopedic Surgery and Traumatology Service, Marina Baixa Hospital, Av. Alcade En Jaume Botella Mayor, 03570 Villajoyosa, Spain;
| | - Dragoș Florin Babă
- Department of Cell and Molecular Biology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, 540142 Targu Mures, Romania;
| | - Iuliu Cocuz
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, 540136 Targu Mures, Romania; (I.C.); (R.N.); (A.S.)
| | - Raluca Niculescu
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, 540136 Targu Mures, Romania; (I.C.); (R.N.); (A.S.)
| | - Anamaria Costan
- Faculty of Medicine, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, 540142 Targu Mures, Romania;
| | - Sergiu Ștefan Laszlo
- Intensive Care Unit, Mureș County Hospital, Street Gheorghe Marinescu no 1, 540136 Targu Mures, Romania;
| | - Dragoș Corău
- Intensive Care Unit, Mureș County Hospital, Street Gheorghe Marinescu no 1, 540136 Targu Mures, Romania;
| | - Adina Stoian
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, 540136 Targu Mures, Romania; (I.C.); (R.N.); (A.S.)
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Stoian A, Bajko Z, Stoian M, Cioflinc RA, Niculescu R, Arbănași EM, Russu E, Botoncea M, Bălașa R. The Occurrence of Acute Disseminated Encephalomyelitis in SARS-CoV-2 Infection/Vaccination: Our Experience and a Systematic Review of the Literature. Vaccines (Basel) 2023; 11:1225. [PMID: 37515041 PMCID: PMC10385010 DOI: 10.3390/vaccines11071225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/30/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The neurological complications of coronavirus disease 2019 (COVID-19) infection and the side effects of vaccination include immune-mediated diseases of the central nervous system (CNS) such as acute disseminated encephalomyelitis (ADEM). It is an acute-onset demyelinating disease that involves a rapid evolution and multifocal neurological deficits that develops following a viral or bacterial infection or, less frequently, following vaccination. Acute hemorrhagic leukoencephalitis (AHLE) is the hemorrhagic variant of ADEM that presents a more severe evolution which can be followed by coma and death. The objectives of this study consist in evaluating the diagnosis, clinical characteristics, imaging and laboratory features, evolution, and treatment of ADEM and AHLE following COVID-19 infection or vaccination. METHODS We performed a systematic review of the medical literature according to PRISMA guidelines that included ADEM cases published between 1 January 2020 and 30 November 2022 following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and vaccination and also included our own clinical experience regarding this pathology. RESULTS A total number of 74 patients were diagnosed with ADEM, 45 following COVID-19 infection and 29 after a SARS-CoV-2 vaccine. A total of 13 patients (17.33%) presented AHLE. The moderate form of COVID-19 presented a positive correlation with AHLE (r = 0.691, p < 0.001). The existence of coma and AHLE was correlated with poor outcomes. The following more aggressive immunomodulatory therapies applied in severe cases were correlated with poor outcomes (major sequelae and death): therapeutic plasma exchange (TPE) treatment (r = 382, p = 0.01) and combined therapy with corticosteroids and TPE (r = 0.337, p = 0.03). CONCLUSIONS Vaccinations are essential to reduce the spread of the COVID-19 pandemic, and the monitoring of adverse events is an important part of the strategic fight against SARS-CoV-2. The general benefits and the overall good evolution outweigh the risks, and prompt diagnosis is associated with a better prognosis in these patients.
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Affiliation(s)
- Adina Stoian
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Zoltan Bajko
- Department of Neurology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Mircea Stoian
- Department Anesthesiology and Critical Care Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | | | - Raluca Niculescu
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Emil Marian Arbănași
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Eliza Russu
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Marian Botoncea
- Department of General Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Rodica Bălașa
- Department of Neurology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
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Stoian M, Stoica V, Radulian G. Retraction Notice to: Stem cell and colorectal carcinogenesis. J Med Life 2023; 16:329. [PMID: 36937473 PMCID: PMC10015559 DOI: 10.25122/jml-2023-1009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 03/21/2023] Open
Abstract
[This retracts the article on p. 6 in vol. 9, PMID: 27713769.].
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Affiliation(s)
- M Stoian
- Carol Davila University of Medicine and Pharmacy, Bucharest; Internal Medicine Department, Dr. Ion Cantacuzino Clinical Hospital, Bucharest, Romania
| | - V Stoica
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Nicolae Paulescu National Institute of Diabetes, Nutrition and Metabolic Diseases, Bucharest, Romania
| | - G Radulian
- Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Nicolae Paulescu National Institute of Diabetes, Nutrition and Metabolic Diseases, Bucharest, Romania
- Corresponding Author: Gabriela Radulian, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Nicolae Paulescu National Institute of Diabetes, Nutrition and Metabolic Diseases, Bucharest, Romania. E-mail:
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Boeriu A, Roman A, Dobru D, Stoian M, Voidăzan S, Fofiu C. The Impact of Clostridioides Difficile Infection in Hospitalized Patients: What Changed during the Pandemic? Diagnostics (Basel) 2022; 12:diagnostics12123196. [PMID: 36553203 PMCID: PMC9778033 DOI: 10.3390/diagnostics12123196] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/03/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
(1) Background: Clostridioides difficile (C. difficile) and SARS-CoV-2 coronavirus represent significant health threats. Our study focused on the impact of concurrent infections on patient outcomes against the backdrop of changes imposed by the pandemic. (2) Materials and methods. We performed a retrospective analysis and included patients diagnosed with CDI who were admitted in our hospital before and during the pandemic. We compared patient exposure to risk factors for CDI in both groups and patient negative outcomes: need for ICU care, prolonged hospitalization, organ failure, toxic megacolon, and death. (3) Results. Overall, 188 patients were included, of which 100 had CDI (the pre-pandemic group), and 88 patients presented both CDI and COVID-19 (the pandemic group). Patients in the pandemic group were significantly older, with a higher Charlson Comorbidity Index (CCI) and a greater exposure to antibiotics and corticosteroids, and were more likely to develop organ dysfunction, to require ICU care and have prolonged hospitalization. The severity of COVID-19, leukocytosis and increased D-dimer levels were indicators of poor prognosis in the pandemic group. Higher CCI scores and leukocytosis increased the risk for negative outcomes in CDI alone patients. (4) Conclusions. The study highlights the negative impact of associated infections on patient outcome. The severity of COVID-19 directly influences the prognosis of patients with concurrent infections.
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Affiliation(s)
- Alina Boeriu
- Gastroenterology Department, University of Medicine Pharmacy, Sciences, and Technology “George Emil Palade” Targu Mures, 540142 Targu Mures, Romania
- Gastroenterology Department, Mureș County Clinical Hospital, 540103 Targu Mures, Romania
| | - Adina Roman
- Gastroenterology Department, University of Medicine Pharmacy, Sciences, and Technology “George Emil Palade” Targu Mures, 540142 Targu Mures, Romania
- Gastroenterology Department, Mureș County Clinical Hospital, 540103 Targu Mures, Romania
- Correspondence: (A.R.); (D.D.); Tel.: +40-(75)-2934465 (A.R.)
| | - Daniela Dobru
- Gastroenterology Department, University of Medicine Pharmacy, Sciences, and Technology “George Emil Palade” Targu Mures, 540142 Targu Mures, Romania
- Gastroenterology Department, Mureș County Clinical Hospital, 540103 Targu Mures, Romania
- Correspondence: (A.R.); (D.D.); Tel.: +40-(75)-2934465 (A.R.)
| | - Mircea Stoian
- Intensive Care Unit Department, University of Medicine Pharmacy, Sciences, and Technology “George Emil Palade” Targu Mures, 540142 Targu Mures, Romania
- Intensive Care Unit Department, Mureș County Clinical Hospital, 540103 Targu Mures, Romania
| | - Septimiu Voidăzan
- Epidemiology Department, University of Medicine Pharmacy, Sciences, and Technology “George Emil Palade” Targu Mures, 540142 Targu Mures, Romania
| | - Crina Fofiu
- Gastroenterology Department, University of Medicine Pharmacy, Sciences, and Technology “George Emil Palade” Targu Mures, 540142 Targu Mures, Romania
- Internal Medicine Department, Bistrița County Hospital, 420094 Bistrița, Romania
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Roman A, Moldovan S, Stoian M, Ţilea B, Dobru D. SARS-CoV-2 associated liver injury: a six-month follow-up analysis of liver function recovery. Med Pharm Rep 2022; 95:393-399. [PMID: 36506606 PMCID: PMC9694743 DOI: 10.15386/mpr-2347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 03/16/2022] [Accepted: 04/08/2022] [Indexed: 12/15/2022] Open
Abstract
Background and aims SARS-CoV-2 infection has raised the interest in clinical and paraclinical research worldwide, representing a public health issue since the beginning of 2020. Studies have established the variable, unpredictable character of COVID-19. Our main objective was to assess the liver function of patients without pre-existing liver disease, diagnosed with SARS-CoV-2 associated liver injury in a 6-month follow-up study after discharge from hospital. Methods We conducted a prospective paraclinical and imagingstic follow-up study between 1st September 2020 and 30th April 2021 on patients without pre-existing liver disease previously diagnosed with SARS-CoV-2 associated liver injury who had been admitted in Mures County Clinical Hospital, Targu Mures, Romania. We followed up the patients 'clinical and paraclinical datacharacteristics at index COVID-19 hospitalization and at T1 (6-month follow-up visit). Results We performed abdominal ultrasonography and laboratory examinations in 78 patients (mean age 45±10 years) hospitalized 6 months earlier for symptomatic COVID-19, with a male:female ratio of 1.3:1.Thirty patients (38.46%) were discharged at index COVID-19 hospitalization with abnormal liver function tests, while the rest presented paraclinical normalization at discharge and mean duration of liver injury of approximately 7 days. Follow-up examination revealed abnormal liver function tests in twenty-four patients, most of which presented with mild liver injury. All patients with severe COVID-19 at index hospitalization presented with abnormal liver function tests at follow-up examination. Conclusions By performing a complete clinical and paraclinical 6-month follow-up study, with a specific focus on 34.6% of patients in which we noted a persistence of liver function tests abnormality, we could analyzse a possible long-term effect of SARS-CoV-2 infection over liver function and also raise awareness of liver function tests monitoring and therapeutic management in post COVID-19 patients. Long-term follow-up studies of COVID-19 multi-organ sequelae are therefore mandatory in order to improve the practice of consultant gastroenterologists.
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Affiliation(s)
- Adina Roman
- Gastroenterology Department, Mureş County Clinical Hospital, Târgu Mureş, Romania,“George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureş, Romania,Doctoral School, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureş, Romania
| | - Septimiu Moldovan
- “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureş, Romania,Intensive Care Unit, Mures County Clinical Hospital, Târgu Mureş, Romania
| | - Mircea Stoian
- “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureş, Romania,Intensive Care Unit, Mures County Clinical Hospital, Târgu Mureş, Romania
| | - Brînduşa Ţilea
- “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureş, Romania,Infectious Diseases Department, Mures County Clinical Hospital, Târgu Mureş, Romania
| | - Daniela Dobru
- Gastroenterology Department, Mureş County Clinical Hospital, Târgu Mureş, Romania,“George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureş, Romania
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Stoian A, Bajko Z, Maier S, Cioflinc RA, Grigorescu BL, Moțățăianu A, Bărcuțean L, Balașa R, Stoian M. High-dose intravenous immunoglobulins as a therapeutic option in critical illness polyneuropathy accompanying SARS-CoV-2 infection: A case-based review of the literature (Review). Exp Ther Med 2021; 22:1182. [PMID: 34475972 PMCID: PMC8406741 DOI: 10.3892/etm.2021.10616] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 07/27/2021] [Indexed: 01/08/2023] Open
Abstract
The still ongoing COVID-19 pandemic has exposed the medical community to a number of major challenges. A significant number of patients require admission to intensive care unit (ICU) services due to severe respiratory, thrombotic and septic complications and require long-term hospitalization. Neuromuscular weakness is a common complication in critically ill patients who are treated in ICUs and are mechanically ventilated. This complication is frequently caused by critical illness myopathy (CIM) or critical illness polyneuropathy (CIP) and leads to difficulty in weaning from the ventilator. It is thought to represent an important neurologic manifestation of the systemic inflammatory response syndrome (SIRS). COVID-19 infection is known to trigger strong immune dysregulation, with an intense cytokine storm, as a result, the frequency of CIP is expected to be higher in this setting. The mainstay in the diagnosis of this entity beside the high level of clinical awareness is the electrophysiological examination that provides evidence of axonal motor and sensory polyneuropathy. The present article presents the case of a 54-year-old woman with severe COVID 19 infection who developed neuromuscular weakness, which turned out to be secondary to CIP and was treated successfully with a high dose of human intravenous immunoglobulins. Related to this case, we reviewed the relevant literature data regarding the epidemiology, pathophysiology and clinical features of this important complication and discussed also the treatment options and prognosis.
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Affiliation(s)
- Adina Stoian
- Department of Pathophysiology, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540136 Targu Mures, Romania
| | - Zoltan Bajko
- Department of Neurology, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540136 Targu Mures, Romania
| | - Smaranda Maier
- Department of Neurology, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540136 Targu Mures, Romania
| | | | - Bianca Liana Grigorescu
- Department of Pathophysiology, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540136 Targu Mures, Romania
| | - Anca Moțățăianu
- Department of Neurology, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540136 Targu Mures, Romania
| | - Laura Bărcuțean
- Department of Neurology, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540136 Targu Mures, Romania
| | - Rodica Balașa
- Department of Neurology, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540136 Targu Mures, Romania
| | - Mircea Stoian
- Department of Anesthesiology and Intensive Therapy, 'George Emil Palade' University of Medicine, Pharmacy, Sciences and Technology, 540136 Targu Mures, Romania
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Stoian A, Bălașa R, Grigorescu BL, Maier S, Andone S, Cocuz IG, Bajko Z, Filep CR, Stoian M. Guillain-Barré syndrome associated with Covid-19: A close relationship or just a coincidence? (Review). Exp Ther Med 2021; 22:916. [PMID: 34306190 PMCID: PMC8281479 DOI: 10.3892/etm.2021.10348] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 04/29/2021] [Indexed: 02/06/2023] Open
Abstract
Several neurological complications affecting the central and peripheral nervous system were described secondary to COVID-19 infection such as hyposmia, headache, nausea, impaired consciousness, psychosis, neurocognitive syndromes and even cerebrovascular accidents. The mechanism of these complications is not fully understood, but heterogenous mechanisms such as cytokine storm, secondary hypercoagulability and direct neurotropism of the virus are thought to be involved. Guillain-Barré syndrome is a heterogeneous disease that frequently follows a bacterial or viral infection. During the ongoing SARS-CoV-2 pandemic, several isolated case reports and case series have suggested an association between this viral infection and the occurrence of Guillain-Barré syndrome. The main mechanism of Guillain-Barré syndrome is probably post-viral dysregulation of the immune system generated by SARS-CoV-2. The clinical characteristics and disease evolution seem to be similar to those observed in Guillain-Barré syndrome secondary to other etiologies. The aim of the present review is to summarize the relevant literature regarding SARS-CoV-2-related Guillain-Barré syndrome.
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Affiliation(s)
- Adina Stoian
- Department of Pathophysiology, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540136 Targu Mures, Romania
| | - Rodica Bălașa
- Department of Neurology, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540136 Targu Mures, Romania
| | - Bianca Liana Grigorescu
- Department of Pathophysiology, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540136 Targu Mures, Romania
| | - Smaranda Maier
- Department of Neurology, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540136 Targu Mures, Romania
| | - Sebastian Andone
- Department of Neurology, 1st Neurology Clinic, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania
| | - Iuliu Gabriel Cocuz
- Department of Pathophysiology, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540136 Targu Mures, Romania
| | - Zoltan Bajko
- Department of Neurology, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540136 Targu Mures, Romania
| | - Cristian Rares Filep
- Department of Interventional Radiology, Mures County Clinical Emergency Hospital, 540136 Targu Mures, Romania
| | - Mircea Stoian
- Department of Anesthesiology and Intensive Therapy, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540136 Targu Mures, Romania
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Abstract
Immunotherapy in Oncology, a fundamental distinctive treatment in cancer patients, needs molecules with different mechanisms: immune checkpoint inhibitors (ICIs) who attenuate the cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) and the programmed cell death 1 (PD-1)/ligand 1 (PD-L1) pathways, depriving cancer cells of a key strategy of evasion from immunosurveillance. Although their success in improving overall patient survival, unfortunately, superior clinical response of immunotherapy is often associated with treatment toxicity. European Society of Medical Oncology (ESMO) published in 2021 a comprehensive review of qualitatively resynthesized information on endocrinopathies after cancer immunotherapy with ICIs with practical recommendations for screening and management. Endocrinopathy such as thyroid dysfunctions, hypophysitis, primary adrenal insufficiency, type 1 diabetes mellitus, central diabetes insipidus, or hypoparathyroidism were reported and called immune-related adverse effects (irAEs). Practical guidelines for monitoring, diagnosis, and treatment of ICIs related endocrine toxicities are constantly updated. Given the increasing use of ICIs, cooperation between oncologists and endocrinologists is crucial in the management of oncologic patients.
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Affiliation(s)
- S. Coniac
- “Carol Davila” University of Medicine and Pharmacy, Faculty of General Medicine, Bucharest, Romania
- Coltea Hospital, Oncology Clinic, Bucharest, Romania
| | - M. Stoian
- “Dr Ion Cantacuzino” Hospital, Bucharest, Romania
- Coltea Hospital, Oncology Clinic, Bucharest, Romania
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Scarlatescu AI, Onciul S, Pascal A, Petre I, Zamfir D, Guzu C, Iancovici S, Stoian M, Vijiiac A, Onut R, Dorobantu M. Prediction of left ventricular remodeling following ST elevation myocardial infarction: role of myocardial deformation parameters. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC -A2-0.2.2.1-2013-1 cofinanced by the ERDF - I agree that this information can be anonymised and then used for statistical purposes only
Background
Left ventricular (LV) remodeling after ST elevation myocardial infarction (STEMI) plays an important role in predicting the outcome of this patient group. It is also useful in assessing the benefit of revascularization. Its identification is also of clinical importance in order to set up preventive strategies for patients with adverse remodeling
Purpose
To find an echocardiographic predictor of LV adverse remodeling following STEMI.
Materials and methods
In this prospective study we included 52 consecutive patients, aged between 35-70, with STEMI treated by primary PCI. We performed conventional 2D transthoracic echocardiography for patients. In addition to conventional parameters we also measured LV global longitudinal strain (GLS) and LV mechanical dispersion using 2D speckle tracking imaging. For morphological and functional analysis of LV we used 3D echocardiography (volumes, LVEF). LV remodeling (LVR) was defined as an increase of over 15% of the LV end diastolic volume (LVEDV) at 6 months follow up.
Results
We found significant differences in time (baseline and 6 month follow up) between LVEF (43,08 vs 47,91, p = 0.034), LVEDV (105,95 vs 113,21, p = 0.000), LV GLS (-12.61 vs - 14,58, p = 0.01), and mechanical dispersion (61,68 vs 56,11, p = 0.00) in all patients. LV remodeling at 6 months (15% increase in LVEDV) was observed in 30 % of the included patients.
At 6 months after STEMI we observed a significant difference between the two groups (remodeling vs no remodeling) regarding 3D LVEF (42.28 %vs 50.30%,p = 0.009), LVEDV (131 ml vs 109 ml, p = 0.05), GLS (-11.15 vs -16.02, p = 0.00) and LV mechanical dispersion (69.02 vs 50.54, p = 0.00). Patients with LV remodeling at 6 months after STEMI had lower LVEF, worse LV GLS and higher LV mechanical dispersion at baseline.
Using ROC curve analysis we identified two cut off values, one of -11.55 for baseline LV GLS (Sb 78%, Sp 81%, AUC 0.852, CI 95%, p = 0.00) and another one of 63.7 for LV baseline mechanical dispersion (Sb 71,4%, Sp 66 %, AUC 0.762, p 0.005) to discriminate between patients with or without LV adverse remodeling at 6 months. Using linear regression analysis, we demonstrated that GLS (p = 0.00) and LV mechanical dispersion (p = 0.016) are able to predict LV remodeling in time.
We also found a negative correlation between peak CK-MB levels at baseline LVEF at 6 months. Regression analysis showed that CK-MB levels at baseline could predict LVEF at 6 months (p = 0.008)
Conclusion
Baseline LV mechanical dispersion and LV GLS can predict LV adverse remodeling at 6 months after STEMI. These parameters could be used at baseline in order to predict worse outcome in STEMI patients. Further larger scale studies are needed to validate these findings.
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Affiliation(s)
- AI Scarlatescu
- Clinical Emergency Hospital Bucharest, Bucharest, Romania
| | - S Onciul
- Clinical Emergency Hospital Bucharest, Bucharest, Romania
| | - A Pascal
- Clinical Emergency Hospital Bucharest, Bucharest, Romania
| | - I Petre
- Clinical Emergency Hospital Bucharest, Bucharest, Romania
| | - D Zamfir
- Clinical Emergency Hospital Bucharest, Bucharest, Romania
| | - C Guzu
- Clinical Emergency Hospital Bucharest, Bucharest, Romania
| | - S Iancovici
- Clinical Emergency Hospital Bucharest, Bucharest, Romania
| | - M Stoian
- Clinical Emergency Hospital Bucharest, Bucharest, Romania
| | - A Vijiiac
- Clinical Emergency Hospital Bucharest, Bucharest, Romania
| | - R Onut
- Clinical Emergency Hospital Bucharest, Bucharest, Romania
| | - M Dorobantu
- Clinical Emergency Hospital Bucharest, Bucharest, Romania
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11
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Roman A, Georgescu AM, Moldovan S, Stoian M, Dobru D. Liver injury in COVID-19 patients - a multidisciplinary experience and a call for national consensus. J Gastrointestin Liver Dis 2020; 29:688-690. [PMID: 33331346 DOI: 10.15403/jgld-3119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Adina Roman
- Gastroenterology Department, Mureș County Clinical Hospital; George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureș, Romania.
| | - Anca Meda Georgescu
- George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureș; Infectious Diseases Department, Mureș County Clinical Hospital, Târgu Mureș, Romania.
| | - Septimiu Moldovan
- Intensive Care Unit Department, Mureș County Clinical Hospital, Târgu Mureș, Romania.
| | - Mircea Stoian
- George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureș; 3) Infectious Diseases Department, Mureș County Clinical Hospital, Târgu Mureș; Intensive Care Unit Department, Mureș County Clinical Hospital, Târgu Mureș, Romania.
| | - Daniela Dobru
- Gastroenterology Department, Mureș County Clinical Hospital; George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureș, Romania.
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12
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Scarlatescu A, Onciul S, Pascal A, Zamfir D, Petre I, Onut R, Iancovici S, Stoian M, Guzu C, Vijiiac A, Dorobantu M. Correlations between 3D mitral valve parameters and left ventricular remodeling at 6 months after ST elevation myocardial infarction: pilot study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Mitral valve regurgitation and LV remodeling are associated with worse prognosis in acute ST elevation myocardial infarction (STEMI) patients. 3D echocardiography provides a more accurate assessment of mitral ring and leaflet remodeling thus offering a better understanding of mitral valve (MV) and LV geometrical changes in time.
Purpose
We aimed to assess the echocardiographic evidence of the mitral valve geometrical changes after STEMI.
Methods
In this prospective study we included 30 consecutive patients aged between 35 and 68 years old, with STEMI treated by primary PCI. All underwent conventional transthoracic echocardiography. In addition to conventional parameters we measured LV global longitudinal strain (GLS) and mitral valve parameters using 3D echocardiography (4D MV Assessment 2.2 software). All measuremets were performed at baseline and at 6 month follow up. LV remodeling was defined as an increase of over 15% of the LV end diastolic volume (LVEDV) at 6 months after the STEMI.
Results
We found significant differences in time between LVEF (39.22% vs 43.63%, p=0.00), VTDVS (116ml vs 120ml, p=0.00), LV GLS (−13.41 vs −15.52, p=0.10). LV remodeling at 6 months after STEMI has been observed in 17% of the patients.
Regarding the type of the infarction, in anterior STEMI, anterior leaflet surface increased in time (from 6.44cmp vs 7.42cmp, p=0.05), while there was no significant change in posterior leaflet area. In inferior STEMI, the area of posterior mitral leaflet decreased (4.8 cmp vs 4.5 cmp, p=0.52) as well as the leaflet length (1.42 cm vs 1.19 cm p=0.003), but the anterior leaflet remained the same.
At 6 months we observed significant differences between the 2 groups (with and without LV remodeling) in the following mitral valve 3D parameters: mitral annulus area (2.6 cmp vs 1.67 cmp, p=0.02), mitral circumference (2.57 cm vs 1.74 cm, p=0.021), bicomisural diameter (2.66 cm vs 2.16 cm, p=0.018), tenting area (p=0.009), anterior leaflet length (2,66 cm vs 2,015 cm p=0.018) and anterior leaflet area (3,69 cmp vs 2.49 cmp, p=0.002).
Baseline LV GLS significantly correlated with the following mitral valve 3D parameters at 6 months: anterior leaflet area, posterior leaflet area, anterior leaflet length, tenting height, tenting area, mitral ring 3D area, anteroposterior and bicommissural diameters and mitral circumference (correlation coefficient >0.5).
Using linear regression we proved that LV GLS can predict the shortening of the posterior MV (cut off −12.6, AUC 0.844, p=0.011) after 6 months follow up.
These findings were independent of the presence and severity of mitral regurgitation.
Conclusion
Using 3D echocardiography, significant changes in mitral valve geometry were detected at 6 months follow up in STEMI patients. LV remodeling is associated with increased mitral annulus dimensions.
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC -A2-0.2.2.1-2013-1 cofinanced by the ERDF.
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Affiliation(s)
| | - S Onciul
- Clinical Emergency Hospital Bucharest, Bucharest, Romania
| | - A Pascal
- Clinical Emergency Hospital Bucharest, Bucharest, Romania
| | - D Zamfir
- Clinical Emergency Hospital Bucharest, Bucharest, Romania
| | - I Petre
- Clinical Emergency Hospital Bucharest, Bucharest, Romania
| | - R Onut
- Clinical Emergency Hospital Bucharest, Bucharest, Romania
| | - S Iancovici
- Clinical Emergency Hospital Bucharest, Bucharest, Romania
| | - M Stoian
- Clinical Emergency Hospital Bucharest, Bucharest, Romania
| | - C Guzu
- Clinical Emergency Hospital Bucharest, Bucharest, Romania
| | - A Vijiiac
- Clinical Emergency Hospital Bucharest, Bucharest, Romania
| | - M Dorobantu
- Clinical Emergency Hospital Bucharest, Bucharest, Romania
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Vijiiac A, Guzu C, Scarlatescu A, Onciul S, Iancovici S, Petre I, Zamfir D, Pascal A, Onut R, Stoian M, Dorobantu M. Non-invasive assessment of right ventriculo-arterial coupling in dilated cardiomyopathy – insights from 3D echocardiography. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Right ventricular-pulmonary artery coupling (RVPAC) reflects the mechanical efficiency of the interaction between the right ventricle (RV) and the pulmonary circulation unit. Although it has been traditionally assessed with right heart catheterisation (RHC), modern imaging techniques enable the non-invasive estimation of the RVPAC, which proved to correlate well with measurements derived from RHC.
Methods
We used three-dimensional (3D) echocardiography to study 88 consecutive patients (60.4±13.4 years, 69 men) with dilated cardiomyopathy (DCM) and left ventricular ejection fraction<40% and we measured the RV volumes and RV ejection fraction (RVEF) using dedicated software. 15 healthy individuals served as controls. RVPAC was estimated non-invasively as the ratio between the RV end-systolic volume and stroke volume. Right-sided heart failure was defined as either elevated jugular venous pressure, pedal oedema or congestive hepatomegaly.
Results
Patients with DCM showed larger RV end-diastolic volume (163±60.9 ml vs. 91.3±13.2 ml; p<0.0001), as well as larger RV end-systolic volume (97.3±43.2 ml vs. 39.8±7.2 ml; p<0.0001) than healthy controls. The patients in the study group showed lower RVEF: 41.5±8.5% vs. 56.5±3.6% (p<0.0001). Non-invasive RVPAC was 1.53±0.60 in DCM patients vs. 0.78±0.11 in controls (p<0.0001). RVPAC had an excellent negative correlation with RVEF, both in DCM patients (r=−0.96, p<0.0001) and in controls (r=−0.99, p<0.0001). Patients with no signs of right-sided heart failure had lower RVPAC (1.38±0.45) than patients with at least one sign of right heart failure (1.90±0.72, p=0.03). Patients with mild symptoms of heart failure (NYHA classes 1 or 2) showed lower RVPAC (1.37±0.48) than DCM patients with severe heart failure (NYHA classes 3 or 4): 1.79±0.68 (p=0.003).
Conclusions
3D echocardiography provides useful insights in the functional assessment of the cardiopulmonary unit. Non-invasive RVPAC is impaired in patients with DCM, and it is more impaired when signs of right-sided heart failure are present. Severe symptoms are associated with more pronounced decoupling of the RV and the pulmonary circulation. The prognostic significance of non-invasive RVPAC in a disease primarily involving the left ventricle remains to be clarified.
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC -A2-0.2.2.1-2013-1 cofinanced by the ERDF
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Affiliation(s)
- A.E Vijiiac
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - C Guzu
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - A Scarlatescu
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - S Onciul
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - S Iancovici
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - I Petre
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - D Zamfir
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - A.M Pascal
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - R Onut
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - M Stoian
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - M Dorobantu
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
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14
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Scarlatescu AI, Stoian M, Popa-Fotea NM, Nicula G, Oprescu N, Mihai CA, Bataila V, Calmac L, Zamfir D, Ploscaru V, Scafa-Udriste A, Micheu MM, Dorobantu M. P933 Peak left atrial systolic strain as a marker of left ventricular diastolic dysfunction in patients with ischemic heart failure with depressed ejection fraction after STEMI: pilot study. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC -A2-0.2.2.1-2013-1 cofinanced by the ERDF
Background
Echocardiographic assessment of diastolic dysfunction and left ventricular (LV) filling pressures is a complex and challenging process, requiring a multiparameter analysis. In recent years strain imaging has been emerging as a promising method for evaluation of left atrium (LA) function, being correlated with LV systolic dysfunction.
Purpose
We sought to evaluate LA mechanics in a cohort of patients with ischemic heart failure (HF) at one month after ST elevation myocardial infarction (STEMI)
Material and methods
40 patients were enrolled in this study: 30 consecutive patients with ischemic HF after STEMI, with LVEF < 50% and 10 healthy age- and sex-matched controls. All patients had standard echocardiographic examination; also LA strain curves were obtained using speckle tracking with measurement of peak LA systolic strain. Categorization of diastolic dysfunction severity into 3 grades was realized according to 2016 guidelines.
Results
2D and 3D LVEF (33% vs 55%, p = 0.00), LV global strain (-10 vs -19, p = 0.00) and peak LA systolic strain (16 vs 33, p = 0.00) were significantly reduced in HF patients compared to controls. In both groups LA strain correlated with the following parameters: 2D EF (p = 0.024), 3D EF (p = 0.02), LV global strain (p = 0.00), E/A (p = 0.05), septal e’ (p = 0.00), lateral e’ (p = 0.00), E/septal e’ (p = 0.006), E/lateral e’ (p = 0.003), E/mean e’ (p = 0.014), LA volume (p = 0.014) and LV filling pressures (p = 0.001). Peak LA systolic strain (PALS) values progressively decreased with worsening of diastolic function showing significant differences between all diastolic dysfunction grades. Using ROC analysis we identified 3 PALS thresholds to distinguish between normal diastolic function and the 3 diastolic dysfunction grades. The optimal cut off values were as follows: between normal diastolic function and grades 1-3 with PALS cut off value of 26.5 (Sb 90%, Sp 87%), AUC 0.963, CI 95%, p = 0.00; between grades 0-1 and grades 2-3 with peak LA strain cut off value of 17.2 (Sb 75%, Sp 93%) AUC = 0.828, CI 95%, p = 0.002; between grade 0-2 and grade 3 with peak LA strain cut off value of 11 (Sb 85%, Sp 93%), AUC 0.942, CI 95%, p = 0.00.
Also, PALS value differed significantly between patients with normal vs high LV filling pressures. Using ROC analysis we determined a cut off value for LA of 15.1 to differentiate between the two subgroups with excellent discrimination power AUC 0.902, CI 95%, p = 0.00, Sb 88.9%, Sp 83% thus making LA strain an accurate surrogate estimate of LV filling pressures.
Conclusions
Global peak LA systolic strain is significantly correlated with LV systolic and diastolic function. PALS is a feasible option for detection and categorization of diastolic dysfunction in patients with HF and depressed LVEF after STEMI. Incorporating LA strain into noninvasive assessment of LV diastolic dysfunction may improve the detection of elevated LV filling pressures. Further large scale studies are needed to validate this data.
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Affiliation(s)
- A I Scarlatescu
- Emergency Clinical Hospital Floreasca, Department of Cardiology, Bucharest, Romania
| | - M Stoian
- Emergency Clinical Hospital Floreasca, Department of Cardiology, Bucharest, Romania
| | - N M Popa-Fotea
- Emergency Clinical Hospital Floreasca, Department of Cardiology, Bucharest, Romania
| | - G Nicula
- Emergency Clinical Hospital Floreasca, Department of Cardiology, Bucharest, Romania
| | - N Oprescu
- Emergency Clinical Hospital Floreasca, Department of Cardiology, Bucharest, Romania
| | - C A Mihai
- Emergency Clinical Hospital Floreasca, Department of Cardiology, Bucharest, Romania
| | - V Bataila
- Emergency Clinical Hospital Floreasca, Department of Cardiology, Bucharest, Romania
| | - L Calmac
- Emergency Clinical Hospital Floreasca, Department of Cardiology, Bucharest, Romania
| | - D Zamfir
- Emergency Clinical Hospital Floreasca, Department of Cardiology, Bucharest, Romania
| | - V Ploscaru
- Emergency Clinical Hospital Floreasca, Department of Cardiology, Bucharest, Romania
| | - A Scafa-Udriste
- Emergency Clinical Hospital Floreasca, Department of Cardiology, Bucharest, Romania
| | - M M Micheu
- Emergency Clinical Hospital Floreasca, Department of Cardiology, Bucharest, Romania
| | - M Dorobantu
- Emergency Clinical Hospital Floreasca, Department of Cardiology, Bucharest, Romania
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Vijiiac AE, Neagu C, Cherry A, Onciul S, Zamfir D, Onut R, Stoian M, Iancovici S, Dorobantu M. P907 Ventriculo-vascular interaction in patients with severe aortic stenosis: a comparison of three different clinical settings. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC -A2-0.2.2.1-2013-1 cofinanced by the ERDF
Ventriculo-arterial coupling (VAC) reflects the interaction between the ventricle and the arterial system and its prognostic role was studied in different clinical settings. VAC can be assessed with echocardiography as the ratio between the arterial elastance (Ea) and the end-systolic left ventricular elastance (EES). Data concerning the role of VAC in severe aortic stenosis (AS) are scarce.
We aimed to determine VAC in patients (pts) with severe AS and assess its relationship with symptoms.
We included 61 consecutive pts with severe AS (vave area < 1 cm2) and we divided them in 3 groups according to their symptoms: group A consisted of 28 pts (81 ± 10 yrs, 14 men) admitted for acute pulmonary edema, group B consisted of 25 pts (76 ± 12 yrs, 13 men) with either angina, syncope or dyspnea class I-III NYHA and group C consisted of 8 asymptomatic patients (71 ± 19 yrs, 3 men). We determined the VAC non-invasively and we compared the results between the 3 groups using one-way analysis of variance and a post-hoc Tukey test.
There were no significant differences in age (p = 0.08) and aortic valve area (p = 0.18) between groups. Variations of Ea and EES between groups were not significant (p = 0.08 and p = 0.94, respectively). However, VAC differed significantly between the 3 groups, being most impaired in group A (1.11 ± 0.69), followed by 0.77 ± 0.23 in group B and 0.73 ± 0.16 in group C (p = 0.03). The left ventricular ejection fraction (EF) also differed significantly between groups: 41 ± 13% in group A, 51 ± 11% in group B and 57 ± 3% in group C (p < 0.001). VAC and the EF had a moderate negative correlation in group A (r=-0.52, p = 0.004) and group B (r=-0.51, p = 0.009), but no correlation in group C (p = 0.37).
VAC is impaired in patients with severe AS and acute heart failure and it differs significantly from VAC in severe AS with chronic, stable symptoms and from VAC in asymptomatic severe AS. This suggests that the progression of symptoms in severe AS might be related to the interactions between the left ventricle and the vascular load, making thus VAC a potential therapeutic target and a parameter to be considered in the thorough evaluation of patients with severe AS.
Group A Group B Group C Ea 2.69 ± 1.31 2.09 ± 0.94 1.95 ± 0.60 p = 0.08 EES 2.93 ± 1.90 2.87 ± 1.33 2.71 ± 0.73 p = 0.94 VAC 1.11 ± 0.69 0.77 ± 0.23* 0.73 ± 0.16* p = 0.03 EF 41 ± 13% 51 ± 11%* 57 ± 3%* p < 0.001 *significant difference with group A
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Affiliation(s)
- A E Vijiiac
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - C Neagu
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - A Cherry
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - S Onciul
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - D Zamfir
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - R Onut
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - M Stoian
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - S Iancovici
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - M Dorobantu
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
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Vijiiac AE, Iancovici S, Onciul S, Petre I, Zamfir D, Onut R, Stoian M, Dorobantu M. P1385 Mechanical dispersion of the right atrium in dilated cardiomyopathy: does the etiology matter? Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC -A2-0.2.2.1-2013-1 cofinanced by the ERDF
Background
Mechanical dispersion assessed by myocardial strain reflects a susceptibility for arrhythmia development. While the contractile heterogeneity of both ventricles has been assessed in different clinical settings, the incidence and significance of right atrial (RA) dyssynchrony in dilated cardiomyopathy (DCM) are unknown.
Methods
50 consecutive patients with DCM were divided in 2 groups according to the etiology: group I had 26 patients with ischemic DCM (68 ± 10 years, 23 men), group N had 24 patients with non-ischemic DCM (52 ± 12 years, 18 men). We assessed the RA strain by 2D speckle-tracking analysis, and we calculated RA mechanical dispersion as the standard deviation of the time-to-peak contraction strain in 6 RA segments. 20 healthy individuals served as controls. Data were compared between groups with one-way analysis of variance and using a post-hoc Bonferroni correction.
Results
The RA strain was reduced in DCM patients, both in group I and in group N. All three components of the RA strain were most reduced in group I (p < 0.001 for reservoir and conduit strain, p = 0.001 for contraction strain) (Table). The RA mechanical dispersion was highest in group I (56.8 ± 21.6 ms), followed by group N (39.9 ± 15.3 ms) and controls (23.8 ± 7.7 ms)(p < 0.001). Patients with DCM and documented supraventricular arrhythmias (either atrial fibrillation, atrial flutter or premature atrial contractions) had higher RA mechanical dispersion (57.5 ± 19.7 ms) than DCM patients with no documented atrial rhythm disturbances (44.9 ± 19.9 ms, p = 0.04).
Conclusion
Mechanical dispersion of the RA is pronounced in patients with DCM and it is higher in patients with documented supraventricular arrhythmias. Patients with ischemic DCM have a more pronounced mechanical dispersion of the RA than patients with non-ischemic DCM, reflecting a more heterogenous RA contraction in ischemic heart disease when compared to other forms of DCM. The prognostic significance of RA dyssynchrony in a disease primarily involving the left heart warrants further studies.
Group I Group N Controls P value Reservoir RA strain (%) 12.9 ± 7.4§ 17.6 ± 12.9§ 30.1 ± 9.9 <0.001 Conduit RA strain (%) -6 ± 5.5§ -8 ± 8.9§ -15.2 ± 6.4 <0.001 Contraction RA strain (%) 6.9 ± 6§ 9.6 ± 8.1 14.9 ± 6.1 0.001 RA mechanical dispersion (ms) 56.8 ± 21.6§ 39.±15.3§* 23.8 ± 7.7 <0.001 § significant difference with controls; * significant difference with group I
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Affiliation(s)
- A E Vijiiac
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - S Iancovici
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - S Onciul
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - I Petre
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - D Zamfir
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - R Onut
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - M Stoian
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - M Dorobantu
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
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Guzu C, Zamfir D, Onciul S, Pascal A, Scarlatescu A, Diaconeasa A, Stoian M, Cojocaru I, Petre II, Iancovici S, Bataila V, Dorobantu M. P1517 Prognostic value of echocardiographic parameters for RV function in long term follow up of patients presenting with ST elevation myocardial infarction. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Funding Acknowledgements : This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC -A2-0.2.2.1-2013-1 cofinanced by theERDF
Background
The prognostic value of right ventricular (RV) function assessed by echocardiography in patients with acute ST elevation myocardial infarction ( STEMI ) treated by primary percutaneous coronary intervention (PCI) remains controversial, especially in terms of long term follow up .
AIMS
To evaluate the relation between RV function assessed by various echocardiographic parameters in patients presenting with STEMI and the occurrence of major cardiovascular adverse events (MACE) whithin a long period of follow-up.
Methods
We have prospectively analyzed a cohort of 37 patients (mean age: 62.49+/- 1.67 years, 28 males) presenting with a first STEMI treated successfully by PCI. Patients with history of cardiac or pulmonary diseases were excluded. All patients underwent serial conventional 2D echocardiography, tissue Doppler imaging ( TDI ), speckle tracking echocardiography (STE) and 3D echocardiography at 24 hours after the acute event, at discharge, at 6 month, 1 year and 4 years of follow up. We measured in each patient the following RV functional parameters : tricuspid annular plane systolic excursion (TAPSE) , RV free wall systolic velocity (St ) assessed by TDI , RV free wall strain (RVFWS) and RV global longitudinal strain (RVGLS), RV myocardial performance index assessed by pulsed wave Doppler (RV MPI -PW) and right ventricular ejection fraction (RVEF). The mean follow up duration was 36 +/-4 months . The combined end-point of MACE was defined as all cause mortality, recurrent myocardial infarction, need for repeat revascularization or stroke.
Results
During the follow-up period 8 patients ( 18.9 % ) reached the combined end-point . In the analyzed group we observed that of all the studied parameters that reflect RV function, only RV MPI –PW and St at discharge were predictors of worse outcomes independent of LVEF or the culprit coronary artery. RV MPI was predictive at a cut-off value greater than 0,56 with a sensitivity of 66,6% and a specificity of 85,7 % ( 95% CI 0.51 to 0.67, p = 0.017, AUC= 0.71), respectively St at a cut -off value lower than 0,13 m/s with a sensitivity of 92 % and a specificity of 41 % ( 95% CI 0.12 to 0.16 p = 0.012, AUC = 0.64 ).
Conclusions
In STEMI patients treated by primary PCI, RV global function and RV regional systolic function evaluated at discharge provide prognostic information for long term MACE, independendent of infarct size or location. Our results need to be confirmed in larger cohorts of patients.
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Affiliation(s)
- C Guzu
- Clinical Emergency Hospital, Department of Cardiology, Bucharest, Romania
| | - D Zamfir
- Clinical Emergency Hospital, Department of Cardiology, Bucharest, Romania
| | - S Onciul
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - A Pascal
- Clinical Emergency Hospital, Department of Cardiology, Bucharest, Romania
| | - A Scarlatescu
- Clinical Emergency Hospital, Department of Cardiology, Bucharest, Romania
| | | | - M Stoian
- Clinical Emergency Hospital, Department of Cardiology, Bucharest, Romania
| | - I Cojocaru
- Clinical Emergency Hospital, Department of Cardiology, Bucharest, Romania
| | - I I Petre
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - S Iancovici
- Clinical Emergency Hospital, Department of Cardiology, Bucharest, Romania
| | - V Bataila
- Clinical Emergency Hospital, Department of Cardiology, Bucharest, Romania
| | - M Dorobantu
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
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18
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Scarlatescu AI, Micheu MM, Stoian M, Zamfir D, Petre I, Dorobantu M. P1387 Correlations between left atrial strain parameters and left ventricular function in young patients presenting with acute ST elevation myocardial infarction. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC -A2-0.2.2.1-2013-1 cofinanced by the ERDF
Background
Previous studies demonstrated the role of left atrial (LA) deformation parameters in characterisation of left ventricular (LV) diastolic dysfunction. It is a marker of the severity of diastolic dysfunction; LA remodelling also proved to be a predictor of clinical outcome, therefore a prognostic marker in acute coronary syndromes.
Purpose
In this study we aimed to investigate the correlations between left atrial strain and conventional systolic and diastolic dysfunction parameters in a cohort of young patients with acute ST elevation myocardial infarction (STEMI) treated by primary PCI.
Material and methods
We included 56 consecutive patients in this study: 46 patients under 50 years of age with STEMI and 10 healthy age and sex matched controls. We performed conventional transthoracic echocardiography for all included patients. In addition to conventional echocardiographic parameters, LA strain curves were obtained for each patient using two-dimensional speckle tracking imaging with measurement LA deformation parameters.
Results
LV ejection fraction, LV global strain and peak LA systolic strain (PALS) were significantly reduced in STEMI patients compared to controls. PALS had significant correlation with 2D LVEF (p = 0.00), LV global longitudinal strain (p = 0.03), E wave (p < 0.05), E/e’ (p < 0.05), left atrial volume and the type of diastolic dysfunction (p = 0.06). PALS also had inversre correlation with the presence of an occluded coronary artery at angiography.
PALS was higher in control group than in STEMI group ( 34.6 vs 20.4, p < 0.05). PALS values progressively decreased with worsening of LV diastolic dysfunction showing significant differences between all diastolic dysfunction grades. Using ROC (Receiver operating Characteristics) analysis we identified a cut off value of 25.9 (Sensibility 88%, Specificity 74%, AUC 0.94, CI 95%, p < 0.05) to discriminate between diastolic dysfunction and normal diastolic function.
Moreover, PALS was significantly different in patients with normal vs high LV filling pressures. Using ROC analysis we determined a cut off value of 14.5 for LA peak systolic strain to discriminate between the two subgroups, with excellent discrimination power, AUC 0.935, CI 95%, p = 0.045, Sensibility 100%, Specificity 91%. Therefore LA peak systolic strain could be considered a surrogate estimate of LV filling pressures.
Conclusion
LA peak systolic strain correlated significantly with LV systolic and diastolic function in young patients with acute myocardial infarction treated with primary PCI. Peak LA strain may be helpful as a complementary method to evaluate diastolic dysfunction in this patient population and may also improve the detection of elevated LV filling pressures.
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Affiliation(s)
- A I Scarlatescu
- Emergency Clinical Hospital Floreasca, Department of Cardiology, Bucharest, Romania
| | - M M Micheu
- Emergency Clinical Hospital Floreasca, Department of Cardiology, Bucharest, Romania
| | - M Stoian
- Emergency Clinical Hospital Floreasca, Department of Cardiology, Bucharest, Romania
| | - D Zamfir
- Emergency Clinical Hospital Floreasca, Department of Cardiology, Bucharest, Romania
| | - I Petre
- Emergency Clinical Hospital Floreasca, Department of Cardiology, Bucharest, Romania
| | - M Dorobantu
- Emergency Clinical Hospital Floreasca, Department of Cardiology, Bucharest, Romania
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19
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Zamfir D, Onciul S, Scarlatescu A, Guzu C, Pascal A, Cojocaru I, Stoian M, Petre I, Iancovici S, Bataila V, Dorobantu M. P980 RV longitudinal dysfunction predicts outcomes in anterior ST elevation myocardial infarction treated by primary PCI. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC -A2-0.2.2.1-2013-1 cofinanced by the ERDF
Background
The prognostic value of LV function in the setting of an acute ST elevation myocardial infarction (STEMI) is well established, but data regarding the association between RV function and adverse events in this population of patients are still scarce, especially for the cases with anterior wall localization of necrosis. Two-dimensional speckle tracking echocardiography (STE) is able to detect subclinical changes in local or regional RV function.
AIMS
To evaluate the relation between STE parameters of RV global and regional function recorded 24 hours after admission and the occurrence of major non-fatal cardiovascular adverse events (MACE) in anterior STEMI patients treated by primary percutaneous intervention (PCI)
Methods
We have prospectively analyzed a cohort of 80 consecutive patients (mean age 61.17 years, 68.8% males) presenting with a first STEMI treated successfully by PCI. Patients with history of cardiac or pulmonary disease were excluded. All patients underwent conventional echocardiography and STE, 24 hours after the index event. RV strain was assessed as RV free wall strain (RVFWS) representing the average of peak strain values encountered in three segments of the RV free wall and RV global longitudinal strain (RVGLS) obtained by averaging peak strain values in six segments including RV free wall and interventricular septum . The mean follow-up duration was 8.2 ± 0.69 months.The combined endpoint of non fatal MACE was defined as recurrent myocardial infarction, need for repeat revascularization, hospitalization for heart failure or stroke.
Results
In the study population 45 patients (56%) had the culprit lesion on the anterior descendent artery. In this group we observed that RVGLS was predictive for non fatal MACE independent of LVEF or extension of necrosis expressed by wall motion score index with OR 0.89 95 % CI 0.7-0.9, p = 0.042, with a ROC curve with a sensitivity 73% and specificity 53%, AUC =0.7. In addition, in anterior STEMI complicated by LVEF <40 % , a RVFWS absolute value lower than -14.3 % has proved to be an additional parameter of negative prognosis with a sensitivity of 91 %, and a specificity of 40% (AUC 0.68, CI 95%: 0.3-0.7)
Conclusions
In anterior STEMI patients treated by primary PCI, global RV longitudinal dysfunction assessed by STE early after the index event is predictive for non fatal MACE independently of LV function or the infarct size. In addition, RV regional longitudinal dysfunction provides incremental prognostic information in patients with anterior STEMI with moderate or severe LV systolic dysfunction. These data highlight the importance of the assessment of subclinical RV dysfunction in this setting.
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Affiliation(s)
- D Zamfir
- Emergency Clinical Hospital Bucharest, Bucharest, Romania
| | - S Onciul
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - A Scarlatescu
- Emergency Clinical Hospital Bucharest, Bucharest, Romania
| | - C Guzu
- Emergency Clinical Hospital Bucharest, Bucharest, Romania
| | - A Pascal
- Emergency Clinical Hospital Bucharest, Bucharest, Romania
| | - I Cojocaru
- Emergency Clinical Hospital Bucharest, Bucharest, Romania
| | - M Stoian
- Emergency Clinical Hospital Bucharest, Bucharest, Romania
| | - I Petre
- Emergency Clinical Hospital Bucharest, Bucharest, Romania
| | - S Iancovici
- Emergency Clinical Hospital Bucharest, Bucharest, Romania
| | - V Bataila
- Emergency Clinical Hospital Bucharest, Bucharest, Romania
| | - M Dorobantu
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
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20
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Vijiiac AE, Neagu C, Cherry A, Onciul S, Zamfir D, Onut R, Stoian M, Iancovici S, Petre I, Dorobantu M. P6470Ventriculo-arterial coupling in severe aortic stenosis: does the flow-gradient pattern play a role? Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Ventriculo-arterial coupling (VAC) assesses the interplay between ventricular contractility and afterload and it is calculated as the ratio between arterial elastance (Ea) and end-systolic left ventricular elastance (EES). Severe aortic stenosis (AS) carries different configurations according to transvalvular flow rates and pressure gradients and each of these entities has its particularities in terms of physiology and clinical outcome. Little has been studied so far regarding the changes of VAC in severe AS.
Purpose
We sought to assess the VAC non-invasively in patients (pts) with severe AS and to characterize it according to the flow-gradient pattern.
Methods
We included 61 consecutive pts with severe AS (78±13 years, 30 men, indexed aortic valve area <0.6 cm2/m2), for whom we performed a comprehensive echocardiography. VAC was determined as the ratio between Ea and EES. Patients were divided in 4 groups, depending on stroke volume index (low-flow [LF] vs. normal-flow [NF]: 35 ml/m2) and mean transaortic pressure gradient (low-gradient [LG] vs. normal gradient [NG]: 40 mm Hg). This resulted in the following flow-gradient patterns: LFLG, LFNG, NFLG, NFNG. Data were compared between groups with one-way analysis of variance and then with a Tukey test.
Results
There were 11 pts (18%) in the LFLG group, 20 pts (32.8%) in the LFNG group, 8 pts (13.2%) in the NFLG group and 22 pts (36%) in the NGNG group. The arterial elastance was highest in the LFLG group: 3.37±1.49 vs. 2.79±0.92 in the LFNG, 2.05±0.57 in the NFLG and 1.54±0.49 in the NFNG group (p<0.001). The ventricular elastance was also highest in the LFLG group (4.03±2.46) vs. 3.16±1.33 in the LFNG, 2.21±1.22 in the NFLG and 2.29±0.78 in the NFNG group (p=0.007). VAC was most impaired in the NFLG group (1.35±1.08), followed by LFNG group (1.00±0.47), LFLG group (0.93±0.27) and NFNG group (0.70±0.14) (p=0.01). Valvulo-arterial impedance (ZVA) was highest in the LFNG group: 7.78±2.15, followed by 7.38±2.17 in the LFLG group, 4.93±1.17 in the NFLG group and 4.33±1.23 in the NFNG group (p<0.001). VAC and ZVA showed no significant correlation (p=0.27), with VAC being significantly more impaired in patients with abnormal ZVA (>4.5 mm Hg/ml/m2): 0.99±0.60 vs. 0.73±0.20 (p=0.02).
Conclusion
The ventriculo-vascular interaction in severe AS varies noticeably according to the flow-gradient pattern. Low-gradient states, particularly NFLG, have the most impaired VAC. This study supports the idea that these 4 configurations are different clinical entities and it highlights the importance of integrating the flow-gradient pattern for a comprehensive evaluation of AS severity.
Acknowledgement/Funding
This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC -A2-0.2.2.1-2013-1 cofinanced by the ERDF
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Affiliation(s)
- A E Vijiiac
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - C Neagu
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - A Cherry
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - S Onciul
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - D Zamfir
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - R Onut
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - M Stoian
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - S Iancovici
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - I Petre
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - M Dorobantu
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
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21
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Vijiiac AE, Acatrinei C, Neagu C, Onciul S, Zamfir D, Onut R, Stoian M, Iancovici S, Petre I, Dorobantu M. P2598Left atrial mechanics in patients with acute pulmonary edema and preserved ejection fraction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The left atrium (LA) is a highly dynamic chamber that has 3 mechanical functions (reservoir, conduit, booster pump), as well as additional endocrine and regulatory properties. It is a marker of both the severity and chronicity of diastolic dysfunction and its remodelling has been shown to be a reliable predictor of clinical outcome in patients with heart disease. While LA function has been extensively studied in chronic heart failure, information about LA mechanics in patients with acute heart failure and preserved left ventricular ejection fraction (EF) are scarce.
Purpose
We sought to assess LA mechanics in a cohort of patients with acute pulmonary edema and preserved EF and compare it with a normal reference group.
Methods
We included 50 consecutive patients (22 men) with acute pulmonary edema, preserved EF and sinus rhythm in our study. Patients with significant mitral or aortic valve disease were not considered eligible. The control group consisted of 30 subjects (18 men) with no previous cardiovascular disease. We performed conventional transthoracic echocardiography for all patients and we assessed various parameters of LA mechanics. To evaluate the reservoir function, we determined the total ejection volume (EV), the total EF, the LA expansion index (LAEI) and the LA function index (LAFI). To evaluate the conduit function, we determined the passive EV and passive EF. For the booster pump function, we determined the active EV, active EF, the atrial filling fraction, the ejection force and the LA kinetic energy (LAKE). We used T-test to compare the parameters between the two groups.
Results
The mean age in the study group was 72±14 years, while in the control group the mean age was 56±16 years (p=0.06). The total EV did not differ significantly between groups (p=0.44). The total LA ejection fraction was lower in the study group: 29±10% vs. 51±9% (p<0.001), as well as the LAEI (45.1±24.6 vs. 110.9±32.1, p<0.001) and the LAFI (0.17±0.12 vs. 0.58±0.20, p<0.001). Among parameters assessing LA conduit function, there were no differences in passive EV (p=0.64), but passive LA ejection fraction was significantly lower in the study group: 15±7% vs. 28±11%, p=0.003. The same trend was noted for active LA ejection fraction (16±10% vs. 31±13%, p=0.005). The ejection force was impaired in the study group: 39.1±30.6 kdynes vs. 15.2±12.3 kdynes, p<0.001. Other parameters evaluating LA booster pump function did not differ significantly between groups (p=0.12 for atrial filling fraction, p=0.74 for LAKE).
Conclusion
All three integrated phases of left atrial mechanics (reservoir, conduit, booster pump) are impaired in patients with acute pulmonary edema and preserved left ventricular EF. These findings highlight the importance of diastolic dysfunction in the pathogenesis of acute heart failure for these patients and they suggest that LA dysfunction might be a potential therapeutic target in this clinical setting.
Acknowledgement/Funding
This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC-A2-0.2.2.1-2013-1 cofinanced by the ERDF
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Affiliation(s)
- A E Vijiiac
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - C Acatrinei
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - C Neagu
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - S Onciul
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - D Zamfir
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - R Onut
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - M Stoian
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - S Iancovici
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - I Petre
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - M Dorobantu
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
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Vijiiac AE, Neagu C, Cherry A, Onciul S, Zamfir D, Onut R, Stoian M, Dorobantu M. P744Ventriculo-arterial interplay in acute pulmonary edema: relationship with the ejection fraction and the clinical outcome. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Ventriculo-arterial coupling (VAC) represents a comprehensive expression of the mechanical efficiency and performance of the ventriculo-vascular system. It is defined as the ratio between the arterial elastance (Ea) and the end-systolic ventricular elastance (EES) and it has potential clinical applicability in different settings. The interaction between the ventricle and the aorta in the setting of acute heart failure has been insufficiently investigated.
We sought to assess the VAC in patients with acute pulmonary edema (PE) and to establish its relationship with the ejection fraction (EF) and clinical outcome.
We included 120 consecutive patients (mean age 74±12 years, 61 men) admitted for acute PE, with either preserved or reduced EF. The control group consisted of 50 subjects (mean age 40±13 years, 35 men) with no previous cardiac history. All patients underwent standard echocardiography on admission and we assessed the VAC non-invasively. We followed the patients for a composite endpoint of death, recurrent PE and acute coronary syndrome (ACS) for a month after hospitalisation.
The VAC was significantly impaired in the acute PE group: 1.05±0.49 vs. 0.84±0.16 (p<0.001). In the study group, 59 patients (49%) had preserved EF (mean EF 55±8%) and 61 patients (51%) had reduced EF (mean EF 28±7%, p<0.001). Subgroup analysis in the study group showed that the VAC was more impaired in patients with low EF (1.29±0.56) vs. preserved EF (0.79±0.20, p<0.001). VAC had a moderate negative correlation with the EF in the study group, both for low EF patients (r=−0.31, p=0.01) and preserved EF patients (r=−0.30, p=0.02).
14 patients (12%) in the study group had at least one in-hospital major cardiovascular event (MACE): in the low EF subgroup, there were 7 recurrent PE (11.5%) and 1 death (1.6%), while in the preserved EF subgroup, there were 5 recurrent PE (8.5%) and 1 ACS (1.7%). There was no significant difference in VAC between patients with in-hospital MACE and MACE-free patients (p=0.55 for low EF subgroup, p=0.59 for preserved EF subgroup).
10 patients (8.3%) in the study group had at least one MACE in the first month after discharge: in the low EF subgroup, there were 4 recurrent PE (6.6%) and 1 death (1.6%), while in the preserved EF subgroup, there were 2 deaths (3.4%) and 3 recurrent PE (5.1%). VAC was more impaired in low EF patients with MACE at 1 month (2.27±0.85) vs. low EF patients MACE-free at 1 month (1.21±0.44, p=0.04). No differences in VAC were noticed for the preserved EF subgroup (p=0.97).
Ventriculo-vascular interaction is decoupled in acute PE, with VAC being more impaired when the EF is reduced. Furthermore, for patients with acute PE and low EF, VAC was worse in those who suffered a MACE at 30 days. This suggests the prognostic value of VAC in acute PE and it highlights the importance of integrating this easy-to-obtain parameter in the echocardiographic evaluation of acute heart failure patients.
Acknowledgement/Funding
This work was supported by CREDO Project - ID: 49182, financed through the SOP IEC-A2-0.2.2.1-2013-1 cofinanced by the ERDF
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Affiliation(s)
- A E Vijiiac
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - C Neagu
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - A Cherry
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - S Onciul
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - D Zamfir
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - R Onut
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - M Stoian
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
| | - M Dorobantu
- Emergency Clinical Hospital Floreasca, Cardiology Department, Bucharest, Romania
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23
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Kebed K, Moustafa TAMER, Conte R, Doering C, Van Grootel RWJ, Badacz R, Nemes A, Uejima T, Oehman J, Ceponiene I, Fabiani I, Garcia Martin A, Nishikawa H, Jurko AJR, Pasanisi E, Zagatina A, Stoian M, Monteagudo Ruiz JM, Lazaro Mendes AS, Ruiz Fernandez D, Chong A, Park YH, Mizariene V, Hlubocka Z, Ring L, Kruse E, Addetia K, Ciszek B, Thykattil M, Guile B, Lang RM, Mor-Avi V, Mahfouz RAGAB, Elzayat AHMED, Goda MOHAMD, Gad MARWA, Sansone F, Napoli F, Tonacci A, Raciti M, Landi P, Grande A, Ait-Ali L, Sveric K, Richter U, Strasser RH, Wunderlich C, Menting ME, Mcghie JS, Strachinaru M, Vletter WB, Geleijnse ML, Roos-Hesselink JW, Van Den Bosch AE, Kablak-Ziembicka A, Urbanczyk-Zawadzka M, Banys RP, Musialek P, Pieniazek P, Mleczko S, Zmudka K, Przewlocki T, Marton I, Domsik P, Kalapos A, Posfai E, Modok S, Borbenyi Z, Forster T, Takahashi L, Nishikawa H, Semba H, Sawada H, Yamashita T, Jurkevicius R, Petkeviciene J, Gustiene O, Tamuleviciute-Prasciene E, Motiejunaite J, Slapikas R, Pugliese NR, La Carrubba S, Antonini Canterin F, Colonna P, Caso P, Benedetto F, Citro R, Carerj S, Di Bello V, Moya Mur JL, Lazaro Rivera C, Rincon Diaz LM, Miguelena Hycka J, Garcia Lledo A, Jimenez Nacher JJ, Fernandez-Golfin C, Rodriguez-Roda J, Zamorano JL, Uejima T, Takahashi L, Semba H, Sawada H, Yamashita T, Jurko A, Jurko T, Mistinova-Polakova J, Sbrana F, Petersen C, Bigazzi F, Dal Pino B, Coceani M, Ripoli A, Pianelli M, Luciani R, Sampietro T, Zhuravskaya N, Vareldzhyan Y, Kamenskikh M, Shmatov D, Zamfir D, Vijiiac A, Pitic D, Tamasescu G, Onciul S, Onut R, Stefan C, Dorobantu M, Gonzalez-Gomez A, Izurieta C, Fernandez-Golfin C, Marco A, Alonso Salinas GL, Hinojar Baydes R, Garcia Martin A, Casas Rojo E, Zamorano JL, Ferreira AR, Moura Ferreira J, Leite L, Oliveira AP, Ribeiro N, Barbosa AJ, Mata Martins R, Ramos D, Pego M, Gamaza Chulian S, Diaz Retamino E, Camacho Freire S, Gutierrez Barrios A, Oneto Otero J, Bansal M, Grewal HK, Kasliwal RR, Wahi S, Lee SH, Lee DS, Hwang JM, Kim JS, Kim JH, Chun KJ, Bieseviciene M, Verseckaite R, Jonkaitiene R, Janenaite J, Jurkevicius R, Dostalova G, Hlubocky J, Novotny R, Vondracek V, Lindner J, Linhart A, Preston NK. Poster Session 1The imaging examination and quality assessmentP185Why did the normal values of the left and right atrial volumes increase in the recent chamber quantification guidelines update?P186Atrial electromechanical delay, Left Atrial mechanical functions and longitudinal left ventricular strain in pre-diabetic patientsP187A web-based platform for e-training in echocardiographyP188Righ atrial size as a marker of success in electrical cardioversion in patients with persistent atrial fibrillationP189Echocardiographic assessment of left atrial dimensions and function in a healthy populationP190Impact of carotid artery revascularization on the cognitive and functional outcome and cerebral flow on TCD and brain MRI in patients with symptomatic carotid artery stenosis: a preliminary reportP191Aortic elasticity is impaired in hypereosinophilic syndromeP192Disturbed intracardiac flow transit prognosticates early decompensation in dilated cardiomyopathyP193Ultrasound guided treatment in acute heart failureP194Determinants of impaired global longitudinal function in middle-aged subjects free of cardiovascular diseaseP195Left ventricular remodeling in asymptomatic heart failure: classification and prognostic evaluationP196Restricted displacement of lateral right ventricular wall: a physiopathological explanation of geometrical and functional cardiac changes after cardiac surgeryP197A novel method to image intracardiac flow stagnation for the risk stratification for thrombosisP198Magnetic resonance imaging of anomalous origin of the left coronary artery from the pulmonary artery in children older than 4 monthsP199Coronary flow reserve is improved by LDL apheresis in patients with familial hypercholesterolemia and chronic ischemic heart diseaseP200 High velocities in the proximal part of the coronary arteries during routine echocardiography can predict nearest prognosisP201Recovery potential of the right ventricular function in the setting of a first STEMI treated by primary PCI: an echocardiographic studyP202Severe aortic stenosis patients with preserved ejection fraction according to flow and gradient classification: prevalence and outcomesP203Is basal left ventricular ejection time able to predict the severity of aortic stenosis in patients with depressed ejection fraction?P204Acceleration time in aortic stenosis: a new echocardiographic diagnostic parameterP205Application of novel Doppler indices of stenosis severity in the assessment of rheumatic mitral stenosis beyond conventional valve area and transvalvular gradientsP206Comparison of conventional echo score in patients with symptomatic rheumatic mitral stenosis: transesophageal echocardiography versus transthoracic echocardiographyP207Speckle-tracking echocardiography in evaluation early left ventricular systolic dysfunction in asymptomatic aortic regurgitation patients with good left ventricular ejection fractionP208Expansible aortic ring annuloplasty: mid-term results of aortic valve repairP209Papillary muscle dysfunction: insights into mitral valve prolapse using speckle tracking imaging. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Botianu PH, Chirtes R, Marcu C, Kosza H, Stoian M, Brusnic O, Botianu A, Dobre A. Inferior Vena Cava Resection and Reconstruction for Tumoral Recurrence after Right Nephrectomy. Chirurgia (Bucur) 2016; 111:340-344. [PMID: 27604673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2016] [Indexed: 06/06/2023]
Abstract
We report a 60 years old patient who was admitted for a local recurrence after a right nephrectomy performed 2 years ago (papillary renal carcinoma with areas of sarcomatoid differentiation - pT3a). CT scan showed a retroperitoneal mass with invasion of the inferior vena cava. We performed a complete en-bloque excision of the tumor with the infrarenal portion of the inferior vena cava and lympha-denectomy. The vascular reconstruction was performed by the interposition of a 20 mm diameter Dacron prosthesis. The postoperative course was complicated due to an episode of digestive bleeding (duodenal ulcer) which stopped after conservative treatment (antisecretory and hemostatics, including rFVIIa), but eventually favourable. At 6 months follow-up the patient presents no sign of tumoral relapse and a functional vascular prosthesis. The case is interesting due to the rarity of the surgical procedure and the indication. The surgical approach of the retroperitoneal tumors with vascular involvement is possible in centers with adequate technical endownment and human expertise.
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Stoian M, Stoica V, Radulian G. Colorectal Chemoprevention. Rev Med Chir Soc Med Nat Iasi 2016; 120:508-514. [PMID: 30044571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
With over 1 million cases diagnosed worldwide each year - incidence which seems to rise with the progressive westernization of lifestyles in Asian and African populations - colorectal cancer is the third most commonly diagnosed cancer in both men and women. Colorectal neoplasms and/or pre-neoplasms can be prevented by interfering with the various steps of oncogenesis, which begins with uncontrolled epithelial cell replication, continues with the formation of adenomas and eventually evolves into malignancy. The knowledge described herein will help to reduce and prevent this malignancy, which is one of the most frequent neoplasms in some developed countries. Genetics, experimental and epidemiologic studies suggest that colorectal cancer results from complex interactions between inherited susceptibility and environmental factors. Primary prevention involves the identification of genetic, biologic, and environmental factors that are etiologic or pathogenic in the development of cancer, and subsequent complete or significant interference with their effects on carcinogenesis.
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Stoian M, Stoica V, Radulian G. Stem cells and colorectal carcinogenesis. J Med Life 2016; 9:6-11. [PMID: 27713769 PMCID: PMC5052488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 01/25/2016] [Indexed: 11/24/2022] Open
Abstract
Colorectal cancer represents an important cause of mortality and morbidity. Unfortunately, the physiopathology is still under study. There are theories about carcinogenesis and it is known that not only a single factor is responsible for the development of a tumor, but several conditions. Stem cells are a promising target for the treatment of colorectal cancer, along with the environment that has an important role. It has been postulated that mutations within the adult colonic stem cells may induce neoplastic changes. This theory is based on the observation that within a colon cancer, less than 1% of the neoplastic cells have the ability to regenerate the tumor and therefore they are responsible for recurrence. It is important to know that a new way of treatment needs to be found, since these cells are resistant to chemotherapy and radiotherapy.
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Affiliation(s)
- M Stoian
- "Carol Davila" University of Medicine and Pharmacy, Bucharest; Internal Medicine Department, "Dr. Ion Cantacuzino" Clinical Hospital, Bucharest, Romania
| | - V Stoica
- "Carol Davila" University of Medicine and Pharmacy, Bucharest; Internal Medicine Department, "Dr. Ion Cantacuzino" Clinical Hospital, Bucharest, Romania
| | - G Radulian
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania "Nicolae Paulescu" National Institute of Diabetes, Nutrition and Metabolic Diseases, Bucharest, Romania
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Boeriu A, Boeriu C, Drasovean S, Pascarenco O, Mocan S, Stoian M, Dobru D. Narrow-band imaging with magnifying endoscopy for the evaluation of gastrointestinal lesions. World J Gastrointest Endosc 2015; 7:110-120. [PMID: 25685267 PMCID: PMC4325307 DOI: 10.4253/wjge.v7.i2.110] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 10/29/2014] [Accepted: 12/10/2014] [Indexed: 02/05/2023] Open
Abstract
Narrow band imaging (NBI) endoscopy is an optical image enhancing technology that allows a detailed inspection of vascular and mucosal patterns, providing the ability to predict histology during real-time endoscopy. By combining NBI with magnification endoscopy (NBI-ME), the accurate assessment of lesions in the gastrointestinal tract can be achieved, as well as the early detection of neoplasia by emphasizing neovascularization. Promising results of the method in the diagnosis of premalignant and malignant lesions of gastrointestinal tract have been reported in clinical studies. The usefulness of NBI-ME as an adjunct to endoscopic therapy in clinical practice, the potential to improve diagnostic accuracy, surveillance strategies and cost-saving strategies based on this method are summarized in this review. Various classification systems of mucosal and vascular patterns used to differentiate preneoplastic and neoplastic lesions have been reviewed. We concluded that the clinical applicability of NBI-ME has increased, but standardization of endoscopic criteria and classification systems, validation in randomized multicenter trials and training programs to improve the diagnostic performance are all needed before the widespread acceptance of the method in routine practice. However, published data regarding the usefulness of NBI endoscopy are relevant in order to recommend the method as a reliable tool in diagnostic and therapy, even for less experienced endoscopists.
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Rusu E, Enache G, Jinga M, Dragut R, Nan R, Popescu H, Parpala C, Homentcovschi C, Nitescu M, Stoian M, Costache A, Posea M, Rusu F, Jinga V, Mischianu D, Radulian G. Medical nutrition therapy in non-alcoholic fatty liver disease--a review of literature. J Med Life 2015; 8:258-62. [PMID: 26351523 PMCID: PMC4556902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/29/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND AIM Non-alcoholic fatty liver disease (NAFLD) is the most common cause of liver disease worldwide, with a prevalence of 20%-40% in Western populations. The purpose of this article is to review data related to lifestyle changes in patients with NAFLD. METHOD We searched a public domain database (PubMed) with the following categories: disease (NAFLD, fatty liver, and non-alcoholic steatohepatitis [NASH]) and intervention (lifestyle intervention, diet, nutrition) with each possible combination through 25 September 2014, for relevant articles. Review of articles was restricted to those published in English. We selected the studies involving adult patients only. CONCLUSION There is no consensus as to what diet or lifestyle approach is the best for NAFLD patients. However, patients with NAFLD may benefit from a moderate- to low-carbohydrate (40%-45% of total calories) diet, coupled with increased dietary MUFA and n-3 PUFAs, reduced SFAs. More CRT are needed to clarify the specific effects of different diets and dietary components on the health of NAFLD patients. ABBREVIATIONS NAFL = Non-alcoholic fatty liver, NAFLD = non-alcoholic fatty liver disease, NASH = non-alcoholic steatohepatitis, HCC = hepatocarcinoma, BEE = basal energy expenditure, CRT = A small clinical randomized trial showed that short-term carbohydrate restriction is more efficacious in reducing intrahepatic triglyceride, IHT = intrahepatic triglyceride, VLCD = Very low calorie diets, AST = aspartate aminotransferases, SFAs = saturated fatty acids.
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Affiliation(s)
- E Rusu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - G Enache
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - M Jinga
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - R Dragut
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - R Nan
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - H Popescu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - C Parpala
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - C Homentcovschi
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - M Nitescu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - M Stoian
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - A Costache
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - M Posea
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - F Rusu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - V Jinga
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - D Mischianu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - G Radulian
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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Posea M, Dragomir A, Rusu E, Nan R, Dragut R, Popescu H, Stoicescu F, Teodoru I, Hancu A, Stoian M, Radulian G. Evaluation of dietary habits and the nutritional content of the intake food to overweight and obese patients. Atherosclerosis 2014. [DOI: 10.1016/j.atherosclerosis.2014.05.749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Stoian M, State N, Stoica V, Radulian G. Apoptosis in colorectal cancer. J Med Life 2014; 7:160-4. [PMID: 25408720 PMCID: PMC4197486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 02/04/2014] [Indexed: 11/23/2022] Open
Abstract
Apoptosis is an inborn process that has been preserved during evolution; it allows the cells to systematically inactivate, destroy and dispose of their own components thus leading to their death. This programme can be activated by both intra and extracellular mechanisms. The intracellular components involve a genetically defined development programme while the extracellular aspects regard endogenous proteins, cytokines and hormones as well as xenobiotics, radiations, oxidative stress and hypoxia. The ability of a cell to enter apoptosis as a response to a "death" signal depends on its proliferative status, the position in the cell cycle and also on the controlled expression of those genes that have the capacity of promoting and inhibiting cell death. The fine regulation of these parameters needs to be maintained in order to ensure the physiological environment required for the induction of apoptosis. Any malfunction in any of the steps of controlled cellular death can lead to dysfunctions and, as a consequence, to different pathological conditions. The importance of apoptosis lies in its active nature and in the potential of controlling biological systems.
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Affiliation(s)
- M Stoian
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Internal Medicine Department, "Dr. Ion Cantacuzino" Clinical Hospital, Bucharest
| | - N State
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Internal Medicine Department, "Dr. Ion Cantacuzino" Clinical Hospital, Bucharest
| | - V Stoica
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Internal Medicine Department, "Dr. Ion Cantacuzino" Clinical Hospital, Bucharest
| | - G Radulian
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Institute of Diabetes, Nutrition and Metabolic Diseases "N. C. Paulescu", Bucharest
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Stoian M, State N, Stoica V, Radulian G. Albuminuria--marker of progressive renal disease. J Med Life 2012; 5:420-2. [PMID: 23346243 PMCID: PMC3539836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 12/10/2012] [Indexed: 11/24/2022] Open
Abstract
The presence of albuminuria has long been recognized as an adverse prognostic feature in patients with renal disease: the patients with appreciable albuminuria are much more likely to develop tubulointerstitial scarring and fibrosis and progress to end-stage renal failure. For many years, it was thought that excess albuminuria was simply a marker of a more severe renal disease, which was more likely to progress as a result of this severity rather than as a result of the albuminuria itself. This conviction was strengthened by the general assumption that albumin was a benign or inert molecule serving primarily to exert oncotic pressure and act as a carrier within the circulation. More recently, this view has been challenged with the accumulation of evidence suggesting that albumin is able to influence the function of cells with which it makes contact in the manner of a signalling molecule.
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Affiliation(s)
- M Stoian
- “Carol Davila" University of Medicine and Pharmacy, Bucharest, Internal Medicine Department, "Dr. Ioan Cantacuzino" Clinical Hospital, Bucharest
| | - N State
- “Carol Davila" University of Medicine and Pharmacy, Bucharest, Internal Medicine Department, "Dr. Ioan Cantacuzino" Clinical Hospital, Bucharest
| | - V Stoica
- “Carol Davila" University of Medicine and Pharmacy, Bucharest, Internal Medicine Department, "Dr. Ioan Cantacuzino" Clinical Hospital, Bucharest
| | - G Radulian
- “Carol Davila" University of Medicine and Pharmacy, Bucharest, "N. C. Paulescu" Institute of Diabetes, Nutrition and Metabolic Diseases, Bucharest
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Belengeanu V, Viskari H, Tallila J, Lahtela J, Farcas S, Andreescu N, Stoian M, Bohiltea CL, Fryns JP. Lethal evolution of a newborn with consistent features of hydrolethalus syndrome--Romanian patient. Genet Couns 2011; 22:293-304. [PMID: 22029171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Hydrolethalus syndrome is a severe lethal disorder most commonly found in Finland. We present a lethal case of complex congenital malformation in a Romanian family who showed multiple signs described in hydrolethalus syndrome. Our case presented the specific characteristics: macrocephaly, midline cleft-lip, cleft palate, polydactyly of both hands and feet but without occipitoschisis, considered as the pathognomonic sign of the syndrome. Sequencing analysis of HYLS1 did not identify the point mutation present in the Finnish cases or other mutations in this gene.
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Affiliation(s)
- V Belengeanu
- Department of Medical Genetics, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania.
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Botianu AM, Botianu PV, Dobrica AC, Botianu AM, Butiurca A, Stoian M, Chiujdea D. Transthoracic Approach to the Subphrenic Abscesses. Chest 2010. [DOI: 10.1378/chest.9964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Socolov D, Anton G, Anton AC, Anton E, Socolov RV, Teleman S, Melinte A, Boiculese L, Stoian M. Electrosurgical loop excision/conisation for cervical intraepithelial neoplasia in an algorithm that excludes punch biopsy--a study of 210 cases. Chirurgia (Bucur) 2009; 104:295-301. [PMID: 19601461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
UNLABELLED This study aims to evaluate the use of LLETZ/conisation in an algorithm that excludes the colposcopically guided biopsy. MATERIAL AND METHODS The study was carried out on 210 patients with LLETZ/conisation, performed in our service in 2 years. They were selected by pap smear, colposcopy, HPV genotyping, without punch biopsy. RESULTS The pathological results on the excision specimen showed: benign lesion 10%, CIN 1/condyloma 58%, CIN 2 18%, CIN 3/CIS 11%, microinvasion 2% and invasion 1%. The Pap test showed: HGSIL 27%, LGSIL 56%, ASCUS 13%, and normal/benign in 4%. The therapeutic efficiency of the excisional treatment showed that there was a 9.5% excessive treatment, 14.8 residual lesions, 3 cases of hemorrhage, 2 cervical stenosis, and 7 cases with specimen alteration that made the pathological diagnostic difficult or impossible. In conclusion, the LLETZ/conisation are ambulatory procedures with an acceptable rate of over-treatment and residual lesions, and reduced rate of complication.
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Affiliation(s)
- D Socolov
- Department Obstetrics and Gynecology, University of Medicine and Pharmacy "Gr.T. Popa", Iasi, Romania.
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Lăzăroiu AM, Comănescu M, Moldovan V, Secară D, Cîrstoiu M, Sajin M, Stoian M, Anton G. Past experience of SUUB's Pathology Department in classic based cervico-vaginal cytology. Rom J Morphol Embryol 2009; 50:619-623. [PMID: 19942956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The importance of screening to detect early lesions that may soon turn into cervical carcinoma is well known. The Romanian contribution to the diagnosis of these lesions dates back over a century ago and is due to A. Babes (1926 and later in the standardization of the Papanikolaou 1928). The experience of the Cytology Compartment of the University Emergency Hospital in Bucharest increased permanently regarding smears made conventionally and those in liquid medium. We believe that this experience should be statistically analyzed and compared with the histological results, especially for the cases of high-grade intraepithelial neoplastic lesions. The article scholastically presents the activity of SUUB's Cytology Compartment, our cases arising mostly from Departments of Gynecology and from medical or surgical emergency cases that were considered at risk by SUUB's clinicians. Our study is based on conventional based Pap test cervico-vaginal cytology activity reports of SUUB's Pathology Department from the past 23 months - 9730 cases -, using Bethesda 2001 system, including descriptive statistics parameters by age, year period, and diagnostic categories. The authors make a detailed description of the pool, enumerating its epidemiological attributes for a future comparative analysis CBP versus LBP - the current technical procedure in SUUB's Cytology Compartment.
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Lupulescu A, Negoescu I, Petrovici A, Nicolae M, Stoian M, Balan M, Stancu H. Autoradiography and ultrastructure of the thyroid gland in endemic cretinism. Cells Tissues Organs 2008. [DOI: 10.1159/000142948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Moldovanu R, Grecu F, Târcoveanu E, Scripcariu V, Georgescu S, Burcoveanu C, Niculescu D, Dănilă N, Andriescu L, Bradea C, Bulat C, Chifan M, Dăscălescu C, Grigorovici A, Lăzescu D, Pădureanu S, Stoian M, Ferariu D, Crumpei F, Tuţuianu B, Pleşa C, Dragomir C. [Pancreaticoduodenectomy with or without pylorus preservation: a retrospective analysis of 137 patients]. Chirurgia (Bucur) 2007; 102:651-664. [PMID: 18323227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE We performed a retrospective study to assess the postoperative results, long-term survival and quality of life after pylorus preserving pancreaticoduodenectomy (PPPD) versus standard Whipple pancreaticoduodenectomy (WPD). METHODS A retrospective study was performed in a nonselected series of 137 patients who were operated in the Surgical Clinics of "St. Spiridon" University Hospital Iaşi, Romania, from January 1st, 1995 till December 31, 2005. Demographics, preoperative and intraoperative data, as well as postoperative morbidity, mortality and follow-up were analyzed. Quality of life, after to at least six months after discharge, was also studied. RESULTS There were no significant differences noted in demographics data. Jaundice was more frequent in the PPPD group as for WPD patients (p=0.047). For the most patients the digestive reconstruction after resection were performed as in Child technique: the first anastomosis was pancreaticojejunostomy (end-to-end or end-to-side), the second anastomosis was hepaticojejunostomy (end-to-side) and the last anastomosis was gastrojejunostomy end-to-side (duodenojejunostomy in PPPD group). For 31 cases a pancreatico-gastrostomy were performed. We also noted 14 cases with pancreatico-gastrostomy and duodenojejunostomy end-to-end, and a Roux jejunal loop for 3 patients with previous gastrectomy and gastrojejunostomy (Reichel-Polya). The operating time was shorter in the PPPD group as in WPD (p < 10-3), but the mean blood loss was the same. Postoperative morbidity rate was 46.8% in PPPD group vs 39.2% in WPD (p > 0.05), but the reintervention rate was significant higher in PPPD group (30.6% vs 15%; p = 0.027). We also noted no significant differences of Delayed Gastric Emptying, postoperative mortality rate (14.5% in PPPD group vs 10.1% in WPD group) and mean survival time (42.42 months (24.94 - 59.89; 95% CI) in PPPD group vs 46.78 months (28.07 - 61.50; 95% CI) in WPD group; log rank test p = 0.643). Pathological exam diagnosed a malignancy in 109 cases (54 cases with pancreatic cancer); we noted chronic pancreatitis in 22 cases. Quality of life was also the same in the two groups. CONCLUSIONS PPPD and WPD were associated with comparable results, but, there is a tendency of increase rate of postoperative morbidity and mortality for PPPD patients. We also noted that postoperative quality of life is the same for both procedures.
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Affiliation(s)
- R Moldovanu
- Clinica I Chirurgie I. Tănăsescu-Vl. Buţureanu Iaşi, Universitatea de Medicină şi Farmacie Gr. T. Popa Iaşi.
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Moldovanu R, Grecu F, Târcoveanu E, Georgescu S, Scripcariu V, Niculescu D, Burcoveanu C, Dănilă N, Andriescu L, Bradea C, Bulat C, Chifan M, Dăscălescu C, Grigorovici A, Lăzescu D, Pădureanu S, Stoian M, Ferariu D, Crumpei F, Pleşa C, Dragomir C. [Pancreaticoduodenectomy for pancreatic head cancer, 54 cases]. Rev Med Chir Soc Med Nat Iasi 2007; 111:402-415. [PMID: 17983176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
UNLABELLED Pancreatic cancer has an increase rate in western countries. From the first pancreaticoduodenectomy (PD) performed by Kausch in 1909, the value of the resection in the treatment of pancreatic head cancer was disputed. AIM To assess the PD with or without pylorus preservation as surgical treatment for pancreatic cancer. METHODS Retrospective review of the clinical records of patients undergoing PD for pancreatic cancer. RESULTS From January 1995 till December 2005, in the First and Third Surgical Units, "St. Spiridon" University Hospital Iaşi, Romania, were performed 137 PD. From these, 54 cases were histologic diagnosed with pancreatic cancer; 23 cases underwent pylorus preserving pancreatico-duodenectomy (PPPD) and 31 patients, classical Whipple procedure (PDW). Mean age was 59.07 +/- 1.42 years old (26-75 years old), and male to female ratio was 29 to 25. Jaundice was presented in 51 cases (94.4%), abdominal pain at 39 patients (72.2%) and Curvoisier-Terrier sign at 37 cases (68.7%). Fever was observe only in 4 cases (7.4%). Other biological and imaging parameters (e.g. main diameter of the biliary duct, tumor and wirsung ) were also discussed, but no significant difference was found between PPPD and PDW. Pancreatico-jejunostomy was performed in 41 cases (28 during the PDW and 13 in PPPD) and 13 pancreatico-gastrostomy (3 during PDW and 10 during PPPD). Mean operating time and mean blood loss in the PDW group were 358.22 +/- 10.53 minutes and 587.74 +/- 60.87 mL. After PPPD, these figures were 326.08 +/- 15.04 minutes and 571.74 +/- 90.50 mL, but no significant difference was noted. Delayed Gastric Emptying (DGE) was presented at 15 patients: 8 in PPPD group and 7 in PDW group (p=0.322). Postoperative morbidity rate (excluding DGE) was 33.33% (8 cases in PDW group and 10 in PPPD group). Pancreatic leak has a rate of 5.55% (3 cases--one in PPPD group vs two in PDW group), biliary leak has a rate of 12.96% (4 in PPPD group vs 3 in PDW group)and duodeno-jejunal anastomotic fistula appeared in one cases (PPPD). Acute postoperative pancreatitis is presented in one case (PPPD group) and postoperative hemorrhage appeared in 4 cases (2 in PPPD and 2 after PDW). Hospital stay was 19.91 +/- 2.28 days in PPPD group vs 18.87 +/- 2.24 days in PDW group (p = 0.751). Postoperative mortality rate was 5.5% (one case after PPD and 3 cases after PDW). Histological exam diagnosed ductal pancreatic adenocarcinoma in 51 cases (94.44%). Mean long-term survival rate was 20.98 months (10.52-31.45 months; 95 CI) and no difference was revealed between PPPD and PDW (log rank test - p = 0.796). CONCLUSION PD should be performed for any pancreatic tumor even without preoperative histologic confirmation. The results after PPPD (postoperative morbidity and mortality, long-term survival) are similar to that following conventional Whipple procedure, if the principles of viable and tumor free margins are observed.
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Affiliation(s)
- R Moldovanu
- Universitatea de Medicină si Farmacie "Gr.T. Popa" Iaşi. Facultatea de Medicină Clinica I Chirurgie "I. Tănăsescu-Vl. Buţureanu" Iaşi
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Bulat C, Bîşca L, Stoian M. [Tumors of the ampulla of Vater--local or radical resection?]. Rev Med Chir Soc Med Nat Iasi 2006; 110:609-12. [PMID: 17571553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Duodenal ampulla is a complex anatomical and histological site and a tumor may arise from one of three types of epithelium: duodenal mucosa, pancreatic duct and distal common bile duct. Neoplasia from each of these locations may exhibit different growth models and though it is difficult to establish their origin before operation, surgical treatment for all resectable tumors is essentially alike. The outcome of these tumors is vitally influenced by the type of epithelium from which they derive. Benign adenomas appear to be a frequent precursor of carcinoma of the ampulla of Vater, therefore, a local resection can lead to an under treated early cancer which would have benefited from a radical excision, with a much better long term result. We consider acceptable to perform an ampullectomy whenever is possible to safely state the benignity of the tumor or when a major procedure is hazardous.
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Affiliation(s)
- C Bulat
- Universitatea de Medicină şi Farmacie Gr. T. Popa Iaşi, Facultatea de Medicină, Clinica a III-a Chirurgicală, Centrul de Cercetare in Chirurgia Oncologică
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Dăscălescu C, Bulat C, Lefter LP, Stoian M. [Surgical treatment of esophageal strictures secondary to gastroesophageal reflux disease]. Rev Med Chir Soc Med Nat Iasi 2006; 110:598-603. [PMID: 17571551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The end point in gastro-oesophageal reflux disease (GERD) evolution is oesophageal stenosis. The aim of this study is merely to establish the absolute requisite of treating simultaneously the oesophageal stenosis and the causal disorder, GERD. This article analyses the diversity of surgical treatment in relationship with the location and length of the oesophageal stenosis using a group of 35 patients with GERD over a period of 25 years. Treatment of this condition has enriched and diversified in the last decades with more conservative and complex techniques, having the task to preserve, whenever possible, the oesophagus. The ability to decide the optimal moment for the surgical treatment, to elect the most suitable procedure, to treat simultaneously the stenosis and to prevent further reflux guarantee a successful, free of recurrence outcome.
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Affiliation(s)
- Cristina Dăscălescu
- Universitatea de Medicină şi Farmacie Gr. T. Popa Iaşi, Facultatea de Medicină
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Bulat C, Stoian M, Damian M, Pricop A. [Surgical resection in esophageal-gastric junction adenocarcinoma]. Rev Med Chir Soc Med Nat Iasi 2006; 110:122-127. [PMID: 19292090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Between January 1999 and November 2005 there have been a number of 44 cases of cancers of the esophageal-gastric junction. Only 24 of them have been surgically removed. The carcinoma of the esophageal-gastric junction was defined on topographical and histological grounds, complemented by radiological, endoscopical and tomographical aspects. The authors analyzed the location of the tumor, compared the imaging with the intra-surgical findings and chose the surgical strategy. The authors widely used the classification proposed by Siewert and Stein, which should be the reference for such tumors. The distal esophagectomy for type I and II tumors should reach much closer, at a reasonable, oncologically sufficient, distance from the upper limit of the tumor; the transhiatal approach is as good as a trans-thoracic one for an accurate mediastinal lymphadenectomy; an esophago-jejunal anastomosis should not be carried out at any costs, reducing the height of the esophageal resection (a risk of positive resection margins), for the length of the jejunal segment to fit the gap.
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Affiliation(s)
- C Bulat
- Spital "Sf. Spiridon" Iaşi, Secţia clinică IV Chirurgie
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Dăscălescu C, Bulat C, Dănilă R, Dragomir C, Stoian M. [Tailored surgical treatment for post-caustics stenosis of the upper digestive tract with complicated lesions. Clinical experience at our department in the last ten years]. Rev Med Chir Soc Med Nat Iasi 2005; 109:77-81. [PMID: 16607832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The ingestion of caustic substances generates severe lesions of superior digestive tract, leading to stenosis in 50% of patients, of which almost 50% will require surgical treatment. A number of 29 patients with caustic lesions were treated in the IIIrd Surgical Unit from 1993 to 2004. The most frequent corrosive agent was a strong alkaline solution. The location of the post caustics strictures was esophageal in 18 cases, esophagogastric in 7 cases and laryngo-pharyngo-esophageal in 4 cases. Surgical procedures consisted of 8 esophagoplasties with ascending colon and ileum, 12 with left colon, 3 with transverse colon and splenic flexure, and in 5 cases transhiatal resection with cervical esophago-gastric anastomosis. 5 patients required gastric resections of variable extent, in addition to the esophageal reconstruction: antrectomy with trunk vagotomy--1 case, subtotal gastrectomy--3 cases and total gastrectomy--1 case. In the group with pharyngeal lesions, esophageal reconstruction followed pharyngoplasty with cutaneous tube performed in the ENT department. Hospital mortality rate was 3,4 % (1 case). Postoperative morbidity of 20,6 % consisted of cervical anastomosis leakages in 2 cases and pleural effusions in 4 cases. Surgical treatment of the post caustics strictures of the upper digestive tract must be adapted to the location and severity of the lesions, requiring adequate operative experience and special pre- and postoperative care.
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Affiliation(s)
- Cristina Dăscălescu
- Universitatea de Medicină şi Farmacie Gr T Popa Iaşi, Facultatea de Medicină, Clinica a III-a Chirurgie
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Scripcariu V, Diaconu C, Stoian M, Dragomir C. [Transhiatal esophagectomy for treatment of benign and malignant esophageal diseases]. Rev Med Chir Soc Med Nat Iasi 2004; 108:390-6. [PMID: 15688820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
In 1978 the technique of transhiatal esophagectomy without thoracotomy was rediscovered and now it is widely used in certain, selected, cases. Between 1987 and 2003 we have performed transhiatal esophagectomy in 35 patients with intrathoracic esophageal disease: 13 (37.14%) for benign lesions of the esophagus and 22 (62.85%) for malignant lesions (22.72% upper, 9% middle and 68.18% lower third of the thoracic esophagus). The reconstruction was performed at the same operation in all but two patients. The esophageal substitute was stomach in all but one patient when left colon was used. Hospital mortality was 14.28% with one death due to uncontrollable intraoperative hemorrhage. Major complications included anastomotic leak, recurrent laryngeal nerve paralysis, atelectasis/pneumonia. The advantages of this approach over standard transthoracic esophagectomy are avoidance of a combined thoracoabdominal operation in a debilitated patient and fewer postoperative pulmonary complications and also avoidance of an intrathoracic esophagogastric anastomotic leak with high mortality due to mediastinitis.
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Affiliation(s)
- V Scripcariu
- Universitatea de Medicină şi Farmacie Gr.T. Popa Iaşi, Facultatea de Medicină, Clinica a III-a Chirurgicală
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Bulat C, Stoian M, Pădureanu S, Bîşcă L, Blănaru O. [Intraoperative and early postoperative intraperitoneal chemotherapy--adjuvant treatment for locally advanced digestive system cancer]. Rev Med Chir Soc Med Nat Iasi 2004; 108:403-8. [PMID: 15688822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
UNLABELLED Surgical treatment for locally advanced digestive cancers (invasion beyond the serosa, adjacent structures penetration and perforated tumors) is followed by a high rate of peritoneal recurrence and distant metastasis. Simultaneous intraperitoneal chemotherapy with surgical resection, which is continued over the early postoperative period act on the tumor cells which can be mobilized during the surgical dissection. This adjuvant treatment could lead to better control of local recurrence. Moreover, high levels of the agents are reached in the portal circulation which could be profitable for preventing hepatic metastasis. The main drawback of the method is represented by the impaired immunologic activity of the peritoneum, which can cause, at least theoretically, detrimental complications. OBJECTIVE The efficiency of the intraoperative and early postoperative intraperitoneal chemotherapy is the subject of a prospective randomized study, started 8 months ago in our department. METHOD Patients with locally advanced (penetration of the tumor beyond serosal layer, without liver metastasis) are randomized for adjuvant intraperitoneal chemotherapy or standard treatment. Intraoperative chemotherapy is commenced after surgical resection but before accomplishing any anastomosis. We use 50 mg of cisplatinum for washing the peritoneal cavity and continue to instill 20 mg/m2 of cisplatinum intraperitoneally in the first four days after surgery. (8 patients were selected to be treated according to this protocol). CONCLUSION Immediate postoperative outcome does not seem to be influenced by this treatment. The disease free interval and the overall survival rates can not be assessed at this moment of the study.
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Affiliation(s)
- Cr Bulat
- Universitatea de Medicină şi Farmacie Gr.T. Popa Iaşi, Facultatea de Medicină, Spitalul Sf. Spiridon Iaşi, Secţia Clinică IV
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Diaconu C, Dogaru C, Scripcariu V, Stoian M, Dragomir C, Russu I, Pandrea V, Zugun F, Carasievici E, Mihailovici MS. [Synchronous colonic cancers]. Chirurgia (Bucur) 2002; 97:351-5. [PMID: 12731254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
UNLABELLED The aim of this study is to present the difficulty of an accurate preoperative diagnostic for synchronous colonic cancers and to sustain the necessity of total colectomy. A retrospective study was carried out on 16 patients hospitalized in the IIIrd Surgical Unit, St. Spiridon Hospital, U.M.Ph. "Gr.T.Popa" Iasi between 1990-1999. The surgical procedures were: extensive colectomy with ileo-sigmoid anastomosis, segmentary colectomy, total colectomy with ileo-rectal anastomosis. RESULTS Perioperative mortality: zero; uneventfully recovery for all patients. A metachronous lesion 3 years after the first operation was detected in one patient; postoperatively, one patient developed occlussion 3 months after, requiring re-operation. CONCLUSIONS 1. synchronous colonic cancers are closely related with a genetic instability of the colonic mucosa; 2. total colectomy is a safe manner to prevent metachronous lesions.
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Affiliation(s)
- C Diaconu
- Clinica a IIIa Chirurgicala, Spital Sf. Spiridon, UMF Gr.T. Popa, Iasi
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Stoian M, Dolinescu C, Dăscălescu C, Stoica SC, Pădureanu S. Familial adenomatous polyposis--which operation? Rev Med Chir Soc Med Nat Iasi 1998; 102:97-104. [PMID: 10756821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Familial adenomatous polyposis (FAP) syndromes are well recognized entities that benefit from surgical treatment which should not be delayed. Screening of first degree relatives is important. The aim of removing the colorectal mucosa with significant potential of malignant transformation can be achieved by means of three distinct procedures: pan-proctocolectomy and ileostomy, subtotal colectomy with ileorectal anastomosis, restorative proctocolectomy with ileoanal anastomosis. In a series of eight patients with FAP we performed mostly subtotal colectomy with ileorectal anastomosis. Of five patients who underwent a form of subtotal colonic resection, one was lost from follow up and two developed carcinoma in the remaining rectal mucosa, which necessitated completion of the resection with proctectomy and permanent ileostomy. Nevertheless, in the increasing number of patients amenable to regular outpatient supervision, there are strong points for recommending sphincter-saving operations.
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Affiliation(s)
- M Stoian
- Clinica a III-a Chirurgie, Facultatea de Medicină, Universitatea de Medicina şi Farmacie Gr. T. Popa, Iaşi
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Stoian M, Dolinescu C, Dăscălescu C, Stoica SC, Pădureanu S. Polipoza adenomatoasă familială--care operaţie? [Familial adenomatous polyposis--which operation?]. Rev Med Chir Soc Med Nat Iasi 1997; 101:179-86. [PMID: 10756751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Familial adenomatous polyposis (FAP) syndromes are well recognized entities that benefit from surgical treatment which should not be delayed. Screening of first degree relatives is important. The aim of removing the colorectal mucosa with significant potential of malignant transformation can be achieved by means of three distinct procedures: panproctocolectomy and ileostomy, subtotal colectomy with ileorectal anastomosis, restorative proctocolectomy with ileoanal anastomosis. In a series of eight patients with FAP we performed mostly subtotal colectomy with ileorectal anastomosis. Of five patients who underwent a form of subtotal colonic resection, one was lost from follow up and two developed carcinoma in the remaining rectal mucosa, which necessitated completion of the resection with proctectomy and permanent ileostomy. Nevertheless, in the increasing number of patients amenable to regular outpatient supervision, there are strong points for recommending sphincter-saving operations.
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Affiliation(s)
- M Stoian
- Facultatea de Medicină, Universitatea de Medicina şi Farmacie Gr. T. Popa, Iaşi
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Stoian M, Repanovici R, Corniţescu F. Clinical and epidemiological correlations between the infection with HPV 16 and HPV 18 and female cervical lesions. Rom J Virol 1995; 46:161-170. [PMID: 9179967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A number of 66 specimens from female cervical lesions were examined for infection with human papillomavirus (HPV) types 6, 11, 16, and 18 by nucleic acid hybridization in dot-blot techniques and 35 sera were tested by the immunodot-blot technique, in order to detect the presence of anti E4 and E7 HPV protein antibodies. The findings were compared with the histologic diagnosis. Fifty-six per cent of specimens contained HPV DNA sequences. In 47% of specimens from cervical carcinoma, HPV 11 was detected in 4 cases, HPV 16 in 21 cases, and HPV 18 in 7 cases. Serum antibodies against HPV 16 E4 and HPV 16 E7 occurred in all the cases of uterine carcinoma, in 4 of 10 cases of CIN I-II, and in 3 of 5 sera obtained from apparently healthy women. The analysis of risk factors disclosed the early onset of sexual activity, a relatively high number of births and abortions before the age of 22 years, the use of oral oestroprogestative contraceptive agents, the presence in anamnesis of genital infections with bacterial flora--Candida albicans, Trichomonas vaginalis, Chlamydia trachomatis, Mycoplasma, etc. Our results showed that HPV typing by nucleic acid hybridization was useful for differentiating low- from high-risk cervical lesions and also tried to elucidate the risk factors associated with HPV infections and progression to malignancy.
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Affiliation(s)
- M Stoian
- Stefan S. Nicolau Institute of Virology
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