Even if βAPP remains the gold standard in identifying diffuse axonal injuries, other histological... more Even if βAPP remains the gold standard in identifying diffuse axonal injuries, other histological, ultrastructure, histochemical, or immunohistochemical markers may aid the diagnosis and may better characterize this traumatic brain pathology. Moreover, associated changes, including neuronal body changes, the presence of microglial clusters, and so on, when identified in a traumatic context, should suggest at least the need of using specific markers for identification of DAIs. The purpose of this article is to present the main microscopy techniques used in forensic practice to detect diffuse axonal injury.
Translational research tries to apply findings from basic science to enhance human health and wel... more Translational research tries to apply findings from basic science to enhance human health and well-being. Many phases of the translational research may include non-medical tasks (information technology, engineering, nanotechnology, biochemistry, animal research, economy, sociology, psychology, politics, and so on). Using common bioethics principles to these areas might sometimes be not feasible, or even impossible. However, the whole process must respect some fundamental, moral principles. The purpose of this paper is to argument the need for a different approach to the morality in translational bioethics, and to suggest some directions that might be followed when constructing such a bioethics. We will show that a new approach is needed and present a few ethical issues that are specific to the translational research.
Objective To characterize the pattern of primary small bowel cancers in a tertiary East-European ... more Objective To characterize the pattern of primary small bowel cancers in a tertiary East-European hospital. Methods A retrospective study of patients with small bowel cancers admitted to a tertiary emergency center, over the past 15 years. Results There were 57 patients with small bowel cancer, representing 0.039% of admissions and 0.059% of laparotomies. There were 37 (64.9%) men, mean age of 58 years; and 72 years for females. Out of 57 patients, 48 (84.2%) were admitted due to an emergency situation: obstruction in 21 (38.9%), perforation in 17 (31.5%), upper gastrointestinal bleeding in 8 (14.8%), and lower gastrointestinal bleeding in 2 (3.7%). There were 10 (17.5%) duodenal tumors, 21 (36.8%) jejunal tumors and 26 (45.6%) ileal tumors. The most frequent neoplasms were gastrointestinal stromal tumor in 24 patients (42.1%), adenocarcinoma in 19 (33.3%), lymphoma in 8 (14%), and carcinoids in 2 (3.5%). The prevalence of duodenal adenocarcinoma was 14.55 times greater than that of the small bowel, and the prevalence of duodenal stromal tumors was 1.818 time greater than that of the small bowel. Obstruction was the complication in adenocarcinoma in 57.9% of cases, and perforation was the major local complication (47.8%) in stromal tumors. Conclusion Primary small bowel cancers are usually diagnosed at advanced stages, and revealed by a local complication of the tumor. Their surgical management in emergency setting is associated to significant morbidity and mortality rates.
ABSTRACT Objective: To emphasize the value of emergency diagnostic angiography and angioembolizat... more ABSTRACT Objective: To emphasize the value of emergency diagnostic angiography and angioembolization in massive postoperative bleeding. Methods: A case report was presented and electronic search of U.S. National Library of Medicine National Institutes of Health PubMed/MEDLINE, EMBASE, Google Scholar, ISI Web of Knowledge, to identify original articles and reviews about the subject. Results: A 55 year-old male patient was addmited for rectal bleeding. ECOG index=2, digital rectal examination revealed the inferior pole of a middle rectal tumor. Colonoscopy exam validated the presence of a middle rectal tumor, 8 cm from the anal verge. CT scan showed rectal wall thickening up to 3 cm, that extends 9 cm proximally, whit infiltration of the perirectal fatty tissue and multiple enlarged lymph nodes up to 12 mm in dimension. There was a laparoscopic converted to open approach, with low anterior resection of the rectum and total mesorectal excision, an end to end stapled colorectal anastomosis and protective loop ileostomy. In the 5th postoperative day a massive lower gastrointestinal bleeding occured, with hypovolemic shock and a decrease in hemoglobin. Emergency angiography was performed. This revealed active bleeding from an internal iliac branch that was successfully angioembolized. Conclusions: Angiography with angioembolization is an effective tool in emergency setting, avoiding the morbidity and associated mortality of a surgical reinervention. In early postoperative hemorrhages, only a rapid clinical recognition, a personalized diagnostic workup and an agressive intervention may offer the patient the best chances for cure.
ABSTRACT Introduction: Total quality management is a systematic approach focused on satisfying cu... more ABSTRACT Introduction: Total quality management is a systematic approach focused on satisfying customers' expectations, identifying problems, analytically solving patient's problems and to implement continuous quality improvement. Method: Systematic review of the English language medical literature, using electronic search of the Pubmed, ProQuest and ScienceDirect databases with different combinations of the keywords: total quality management, healthcare, trauma, and minimally invasive surgery. Results: The assessment of outcomes in surgery represents a part of the quality assurance of patients' care. Usually, the surgeons have their own set of mental variables that can predict good and bad outcomes Surveys of complication rates and outcome are a poor substitute for quality control. For the reported complications it is impossible to know which complications are real (inherent to surgery and unavoidable) and which are a consequence of a mistake or an error in judgment. For polytrauma patients, optimal outcome requires an initial management fulfilling a high standard of quality assurance. A prerequisite is the availability of adequate resources at all times, including personnel, technical equipment, and special designed emergency room. Conclusions: Romanian hospitals need a more aggressive implementation of total quality management policy, in order to maintain their competitiveness on nowadays European Union competitive market.
Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie, 2015
The discovery of cardiac stem cells (CSCs) able to renew the pool of cardiomyocyte raised the que... more The discovery of cardiac stem cells (CSCs) able to renew the pool of cardiomyocyte raised the question of how these cells can be recognized and directed towards cardiac reconstruction after severe ischemic injury. The functional studies demonstrated that the differentiation of adult cardiac stem cells reproduce the stages observed in the embryonic development. Each stage is characterized by a complex molecular signature, which can be used for identification and molecular targeting. Three major markers have been used to isolate CSCs: c-kit, Sca-1, and Isl1 and different progenitor populations have been described: side-population (SP), cardiosphere-derived, epicardial-derived. Combinations between the main three markers and other transcription factors, cell surface proteins and regulatory RNAs may delimit even further the cardiac precursors. Accumulation of data leads to the idea that a single, yet unidentified unique cardiac stem cell is at the origin of those observed variants. In t...
Post-mortem computed tomography (PMCT) is considered to be a useful tool in assessing gunshot fat... more Post-mortem computed tomography (PMCT) is considered to be a useful tool in assessing gunshot fatalities, allowing fast location of the bullets, as well as being able to perform an accurate description in relation to the entrance and exist wounds, especially when bone lesions are involved. However, PMCT is limited when addressing soft tissue and parenchyma lesions. The authors evaluated two cases of gunshot fatalities, which underwent multi-phase postmortem CT angiography (MPMCTA) prior to forensic autopsies. The acquired images were examined through axial views as well as 2D and 3D reconstructions. MPMCTA proved to be an important asset in evaluating the wound paths and associated lesions, offering more details than the native scan. When available, MPMCTA should be used as a standard in order to enhance the forensic classic investigation of ballistic deaths.
Resumo: OBJETIVOS: Analisar o ponto de vista de médicos em treinamento a respeito do consentiment... more Resumo: OBJETIVOS: Analisar o ponto de vista de médicos em treinamento a respeito do consentimento informado como autorização autônoma em pediatria e discutir os efeitos limitantes da norma de competência nesse campo. MÉTODOS: Foi realizado um estudo multi-institucional com 158 residentes de medicina com o intuito de analisar o ponto de vista de médicos em treinamento a respeito do consentimento informado como autorização autônoma em pediatria. A participação no estudo foi voluntária, e os participantes eram ...
Introduction: Sudden death in young athletes remains an exciting chapter for the challenge of for... more Introduction: Sudden death in young athletes remains an exciting chapter for the challenge of forensic pathologists to find the medical cause of death. Cause is not always clear. There are some difficult cases requiring detailed laboratory and necroscopy explorations. Methods and Results: We present a case of the young man who died suddenly while playing professional football and whose cause of death was acute myocardial infarction associated with multiple myocardial brigdes (1.8 cm on the anterior interventricular artery, 1.3 cm on the circumflex artery, and an intramyocardial trajectory of the posterior interventricular artery). It was a triple myocardial bridging associated with atypical coronary topography. Myocardial bridging (MB) is defined as the presence of an intramural course of a coronary artery, most likely caused by a defect in resorption of the musculature that encircles the epicardial arteries during morphogenesis. Condusion: The authors discuss the causes of death and possible consequences of this pathology. Potential malpractice issues are analyzed on sports medicine psysicians who rated the health of the footballer over time. Introduction: Armanni-Ebstein lesions were traditionally described as a histological diagnostic feature in diabetic ketoacidosis. Alcoholic ketoacidosis, starvation and hypothermia were recently reported to be associated with this lesion. Though these lesions are described in diabetic and non-diabetic conditions there are subtle differences such as staining properties which may indicate that these lesions are not identical. Methods: Case Description: An adult female was found dead after an episode of binge drinking. Results: Autopsy was macroscopically normal. Histology of the kidney showed subnuclear vacuolations in proximal tubular epithelia resembling Armanni-Ebstein lesions which however did not stain positive with PAS. Toxicology of vitreous fluid confirmed the cause of death as alcoholic ketoacidosis and exduded diabetic ketoacidosis. Condusion: The differences in staining properties and location \ t •
Informed consent is nowadays one of the most important concepts guiding the physician-patient rel... more Informed consent is nowadays one of the most important concepts guiding the physician-patient relationship, based on the right of the person to autonomy. Data about the patient-physician relationship in the Romanian countries before the second half of the XIXth century are scarce, and usually come from literary sources or letters. These, even if associated with a high degree of subjectivity, can however allow us to identify a certain pattern. This article aims to summarize the available data regarding the physician-patient relationship before the second half of the XIXth century in the Romanian countries. The discussion will be divided in two time periods: before the emergence of the first legal rules and regulations specifically regarding medical practice (drafted at the end of the XVIIIth century), and between these and the foundation of modern Romanian medicine (foundation of the first medical university). In both stages the patient-physician relationship is highly paternalists, based on the Hippocratic model, with a very strong physician figure and a patient with a very weak bargaining position.
Before the last part of XIX th century one cannot speak about obstetrics as a distinct medical di... more Before the last part of XIX th century one cannot speak about obstetrics as a distinct medical discipline in Romania (nor in the most of Europe as a matter of fact). The act of birth was aided by untrained midwifes, whose empirical skills were responsible for numerous deaths. The purpose of this article is to present the way medical secret was implemented in obstetrics in Romania, its particularities and the influences guiding its development. Understanding the particularities and the evolution of the ethical ideas in medicine may aid our understanding of today's particularities of medical ethics in Romania and the way it is implemented in clinical practice. By using original and derived sources obtained from the States Archive, the old fund of books from the Romanian Academy, and the National Library of France, and also online resources of old books (DacoRomanica for Romanian documentary materials, Gallica for French documentary materials, and Google Books and archive.org for materials in English) we were able to draw a sketch of the medical secret in obstetrics, whose main conclusions are: (1) medical confidentiality in Romanian Principalities, even if it has specific elements, like the almost complete absence of regulations or etiquette regarding the medical secret, is highly influenced by French and Ottoman culture; (2) the most preeminent regulations regarding medical secret belong to Midwifery institution, being implemented 30 years before the law regulating it for all medical disciplines; knowing what are the origins of the medical confidentiality (and medical ethics in general), may lead to a better understanding of the way ethical principles are implemented in today's clinical practice.
The usefulness of evaluating aesthetic prejudice with aesthetimetric scales. Although in medical-... more The usefulness of evaluating aesthetic prejudice with aesthetimetric scales. Although in medical-legal practice the quantification of an esthetic prejudice it's often needed and there are more then one known and widely used international scales (of which best known are those made by Greff and Hodin) in Romania they are rarely used for various reasons (they are difficult to work with, they are supposedly decreasing the role of the forensic doctor by allowing anyone with access to the scales to quantify an esthetic prejudice, aren't very good for lesions from other parts of the body, etc). We compared the results obtained from forensic evaluations with the ones obtained from a slightly modified Greff aesthetimetric scale. We have analyzed some parameters used in it -color, keloid/hypertrophic scars, location, etc. We also analyzed the role played by facial fractures in determining an esthetic prejudice (not quantified by Greff scale which only takes in consideration cutaneous scars; this parameter is used in Hodin scale, a more complete and complex scale). The results obtained are showing only minor differences between the use of the modified Greff scale and the ones from the forensic evaluations regarding the diagnosis of disfigurement.
Nowadays the laparoscopic approach represents the gold standard for acute cholecystitis, but we a... more Nowadays the laparoscopic approach represents the gold standard for acute cholecystitis, but we are facing little evidence regarding the elderly patients. The purpose of this study is to define the benefits in terms of early outcome for laparoscopic cholecystectomy in patients over 70 years old and to compare them with the open cholecystectomy through a retrospective study of patients that underwent a cholecystectomy during 12 months in the Emergency Hospital of Bucharest, Romania. Out of 49 patients, 20 had a laparoscopic cholecystectomy (LC) and 29 an open approach (OC). The mean age was 74,6 ± 4,2 (LC) vs. 77,2 ± 5,4 (OC) (P>0.05). There were 7 (33,3%) (LC) vs. 2 (7,1%) (OC) catarrhal cholecystitis, 13 (62%) (LC) vs. 9 (32,1%) (OC) phlegmonous cholecystitis, and 1 (4,8%) (LC) vs. 17 (60,7%) (OC) gangrenous cholecystitis (P=0.001, Cramer's V=0,590). The median operative time was 90 (LC) vs. 60 (OC) minutes (P=0.001). There were no differences regarding the ASA risk scale (P...
Thyroid pathology is rarely involved in the pathogenesis of sudden death in young people. We repo... more Thyroid pathology is rarely involved in the pathogenesis of sudden death in young people. We report here the cases of two young patients with decreased levels of thyroid hormones whose death was caused by an increased thrombotic status, with venous thrombosis and pulmonary thromboembolism. In both cases the thyroid pathology was not considered as the underlying cause of death as the association between this condition and venous thrombosis is still debatable. However its presence may be considered a circumstantial factor, which could increase the severity of the disease and subsequently the lethality rate in pulmonary thromboembolism. An increased awareness for hypothyroidism or subclinical hypothyroidism in clinical practice may lead to a decrease in mortality secondary to thromboembolic disease. Also, increased awareness for thyroid pathology during forensic autopsy in sudden deaths may lead to potentially significant results, that could explain some of the sudden death with an unknown cause, and decrease the number of the so called blank autopsies.
Objective. In Romania medical-legal studies on the pattern of drug consumption have not yet been ... more Objective. In Romania medical-legal studies on the pattern of drug consumption have not yet been conducted nationwide; the purpose of this study was, therefore, to determine whether such a pattern could be identified. Methods. A total number of 577 analyses were performed during a three-year period on people suspected of non-lethal substance abuse, in more than two-thirds of the counties in Romania. Preliminary tests were conducted using immunoassay tests (blood or urine) and confirmatory tests were carried out using either GC-MS or HPLC. Results. 240 cases (41.6%) were negative while 327 cases (58.4%) tested positive for illegal drugs, central nervous system medication or both. Men represented 89.5% of all cases, while women accounted for only 10.5%. The pattern of substance abuse varied significantly, depending on the geographical area. In most cases, the identified drugs of abuse were cannabinoids and opiates, with a significantly different distribution of cases, depending on the...
Even if βAPP remains the gold standard in identifying diffuse axonal injuries, other histological... more Even if βAPP remains the gold standard in identifying diffuse axonal injuries, other histological, ultrastructure, histochemical, or immunohistochemical markers may aid the diagnosis and may better characterize this traumatic brain pathology. Moreover, associated changes, including neuronal body changes, the presence of microglial clusters, and so on, when identified in a traumatic context, should suggest at least the need of using specific markers for identification of DAIs. The purpose of this article is to present the main microscopy techniques used in forensic practice to detect diffuse axonal injury.
Translational research tries to apply findings from basic science to enhance human health and wel... more Translational research tries to apply findings from basic science to enhance human health and well-being. Many phases of the translational research may include non-medical tasks (information technology, engineering, nanotechnology, biochemistry, animal research, economy, sociology, psychology, politics, and so on). Using common bioethics principles to these areas might sometimes be not feasible, or even impossible. However, the whole process must respect some fundamental, moral principles. The purpose of this paper is to argument the need for a different approach to the morality in translational bioethics, and to suggest some directions that might be followed when constructing such a bioethics. We will show that a new approach is needed and present a few ethical issues that are specific to the translational research.
Objective To characterize the pattern of primary small bowel cancers in a tertiary East-European ... more Objective To characterize the pattern of primary small bowel cancers in a tertiary East-European hospital. Methods A retrospective study of patients with small bowel cancers admitted to a tertiary emergency center, over the past 15 years. Results There were 57 patients with small bowel cancer, representing 0.039% of admissions and 0.059% of laparotomies. There were 37 (64.9%) men, mean age of 58 years; and 72 years for females. Out of 57 patients, 48 (84.2%) were admitted due to an emergency situation: obstruction in 21 (38.9%), perforation in 17 (31.5%), upper gastrointestinal bleeding in 8 (14.8%), and lower gastrointestinal bleeding in 2 (3.7%). There were 10 (17.5%) duodenal tumors, 21 (36.8%) jejunal tumors and 26 (45.6%) ileal tumors. The most frequent neoplasms were gastrointestinal stromal tumor in 24 patients (42.1%), adenocarcinoma in 19 (33.3%), lymphoma in 8 (14%), and carcinoids in 2 (3.5%). The prevalence of duodenal adenocarcinoma was 14.55 times greater than that of the small bowel, and the prevalence of duodenal stromal tumors was 1.818 time greater than that of the small bowel. Obstruction was the complication in adenocarcinoma in 57.9% of cases, and perforation was the major local complication (47.8%) in stromal tumors. Conclusion Primary small bowel cancers are usually diagnosed at advanced stages, and revealed by a local complication of the tumor. Their surgical management in emergency setting is associated to significant morbidity and mortality rates.
ABSTRACT Objective: To emphasize the value of emergency diagnostic angiography and angioembolizat... more ABSTRACT Objective: To emphasize the value of emergency diagnostic angiography and angioembolization in massive postoperative bleeding. Methods: A case report was presented and electronic search of U.S. National Library of Medicine National Institutes of Health PubMed/MEDLINE, EMBASE, Google Scholar, ISI Web of Knowledge, to identify original articles and reviews about the subject. Results: A 55 year-old male patient was addmited for rectal bleeding. ECOG index=2, digital rectal examination revealed the inferior pole of a middle rectal tumor. Colonoscopy exam validated the presence of a middle rectal tumor, 8 cm from the anal verge. CT scan showed rectal wall thickening up to 3 cm, that extends 9 cm proximally, whit infiltration of the perirectal fatty tissue and multiple enlarged lymph nodes up to 12 mm in dimension. There was a laparoscopic converted to open approach, with low anterior resection of the rectum and total mesorectal excision, an end to end stapled colorectal anastomosis and protective loop ileostomy. In the 5th postoperative day a massive lower gastrointestinal bleeding occured, with hypovolemic shock and a decrease in hemoglobin. Emergency angiography was performed. This revealed active bleeding from an internal iliac branch that was successfully angioembolized. Conclusions: Angiography with angioembolization is an effective tool in emergency setting, avoiding the morbidity and associated mortality of a surgical reinervention. In early postoperative hemorrhages, only a rapid clinical recognition, a personalized diagnostic workup and an agressive intervention may offer the patient the best chances for cure.
ABSTRACT Introduction: Total quality management is a systematic approach focused on satisfying cu... more ABSTRACT Introduction: Total quality management is a systematic approach focused on satisfying customers' expectations, identifying problems, analytically solving patient's problems and to implement continuous quality improvement. Method: Systematic review of the English language medical literature, using electronic search of the Pubmed, ProQuest and ScienceDirect databases with different combinations of the keywords: total quality management, healthcare, trauma, and minimally invasive surgery. Results: The assessment of outcomes in surgery represents a part of the quality assurance of patients' care. Usually, the surgeons have their own set of mental variables that can predict good and bad outcomes Surveys of complication rates and outcome are a poor substitute for quality control. For the reported complications it is impossible to know which complications are real (inherent to surgery and unavoidable) and which are a consequence of a mistake or an error in judgment. For polytrauma patients, optimal outcome requires an initial management fulfilling a high standard of quality assurance. A prerequisite is the availability of adequate resources at all times, including personnel, technical equipment, and special designed emergency room. Conclusions: Romanian hospitals need a more aggressive implementation of total quality management policy, in order to maintain their competitiveness on nowadays European Union competitive market.
Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie, 2015
The discovery of cardiac stem cells (CSCs) able to renew the pool of cardiomyocyte raised the que... more The discovery of cardiac stem cells (CSCs) able to renew the pool of cardiomyocyte raised the question of how these cells can be recognized and directed towards cardiac reconstruction after severe ischemic injury. The functional studies demonstrated that the differentiation of adult cardiac stem cells reproduce the stages observed in the embryonic development. Each stage is characterized by a complex molecular signature, which can be used for identification and molecular targeting. Three major markers have been used to isolate CSCs: c-kit, Sca-1, and Isl1 and different progenitor populations have been described: side-population (SP), cardiosphere-derived, epicardial-derived. Combinations between the main three markers and other transcription factors, cell surface proteins and regulatory RNAs may delimit even further the cardiac precursors. Accumulation of data leads to the idea that a single, yet unidentified unique cardiac stem cell is at the origin of those observed variants. In t...
Post-mortem computed tomography (PMCT) is considered to be a useful tool in assessing gunshot fat... more Post-mortem computed tomography (PMCT) is considered to be a useful tool in assessing gunshot fatalities, allowing fast location of the bullets, as well as being able to perform an accurate description in relation to the entrance and exist wounds, especially when bone lesions are involved. However, PMCT is limited when addressing soft tissue and parenchyma lesions. The authors evaluated two cases of gunshot fatalities, which underwent multi-phase postmortem CT angiography (MPMCTA) prior to forensic autopsies. The acquired images were examined through axial views as well as 2D and 3D reconstructions. MPMCTA proved to be an important asset in evaluating the wound paths and associated lesions, offering more details than the native scan. When available, MPMCTA should be used as a standard in order to enhance the forensic classic investigation of ballistic deaths.
Resumo: OBJETIVOS: Analisar o ponto de vista de médicos em treinamento a respeito do consentiment... more Resumo: OBJETIVOS: Analisar o ponto de vista de médicos em treinamento a respeito do consentimento informado como autorização autônoma em pediatria e discutir os efeitos limitantes da norma de competência nesse campo. MÉTODOS: Foi realizado um estudo multi-institucional com 158 residentes de medicina com o intuito de analisar o ponto de vista de médicos em treinamento a respeito do consentimento informado como autorização autônoma em pediatria. A participação no estudo foi voluntária, e os participantes eram ...
Introduction: Sudden death in young athletes remains an exciting chapter for the challenge of for... more Introduction: Sudden death in young athletes remains an exciting chapter for the challenge of forensic pathologists to find the medical cause of death. Cause is not always clear. There are some difficult cases requiring detailed laboratory and necroscopy explorations. Methods and Results: We present a case of the young man who died suddenly while playing professional football and whose cause of death was acute myocardial infarction associated with multiple myocardial brigdes (1.8 cm on the anterior interventricular artery, 1.3 cm on the circumflex artery, and an intramyocardial trajectory of the posterior interventricular artery). It was a triple myocardial bridging associated with atypical coronary topography. Myocardial bridging (MB) is defined as the presence of an intramural course of a coronary artery, most likely caused by a defect in resorption of the musculature that encircles the epicardial arteries during morphogenesis. Condusion: The authors discuss the causes of death and possible consequences of this pathology. Potential malpractice issues are analyzed on sports medicine psysicians who rated the health of the footballer over time. Introduction: Armanni-Ebstein lesions were traditionally described as a histological diagnostic feature in diabetic ketoacidosis. Alcoholic ketoacidosis, starvation and hypothermia were recently reported to be associated with this lesion. Though these lesions are described in diabetic and non-diabetic conditions there are subtle differences such as staining properties which may indicate that these lesions are not identical. Methods: Case Description: An adult female was found dead after an episode of binge drinking. Results: Autopsy was macroscopically normal. Histology of the kidney showed subnuclear vacuolations in proximal tubular epithelia resembling Armanni-Ebstein lesions which however did not stain positive with PAS. Toxicology of vitreous fluid confirmed the cause of death as alcoholic ketoacidosis and exduded diabetic ketoacidosis. Condusion: The differences in staining properties and location \ t •
Informed consent is nowadays one of the most important concepts guiding the physician-patient rel... more Informed consent is nowadays one of the most important concepts guiding the physician-patient relationship, based on the right of the person to autonomy. Data about the patient-physician relationship in the Romanian countries before the second half of the XIXth century are scarce, and usually come from literary sources or letters. These, even if associated with a high degree of subjectivity, can however allow us to identify a certain pattern. This article aims to summarize the available data regarding the physician-patient relationship before the second half of the XIXth century in the Romanian countries. The discussion will be divided in two time periods: before the emergence of the first legal rules and regulations specifically regarding medical practice (drafted at the end of the XVIIIth century), and between these and the foundation of modern Romanian medicine (foundation of the first medical university). In both stages the patient-physician relationship is highly paternalists, based on the Hippocratic model, with a very strong physician figure and a patient with a very weak bargaining position.
Before the last part of XIX th century one cannot speak about obstetrics as a distinct medical di... more Before the last part of XIX th century one cannot speak about obstetrics as a distinct medical discipline in Romania (nor in the most of Europe as a matter of fact). The act of birth was aided by untrained midwifes, whose empirical skills were responsible for numerous deaths. The purpose of this article is to present the way medical secret was implemented in obstetrics in Romania, its particularities and the influences guiding its development. Understanding the particularities and the evolution of the ethical ideas in medicine may aid our understanding of today's particularities of medical ethics in Romania and the way it is implemented in clinical practice. By using original and derived sources obtained from the States Archive, the old fund of books from the Romanian Academy, and the National Library of France, and also online resources of old books (DacoRomanica for Romanian documentary materials, Gallica for French documentary materials, and Google Books and archive.org for materials in English) we were able to draw a sketch of the medical secret in obstetrics, whose main conclusions are: (1) medical confidentiality in Romanian Principalities, even if it has specific elements, like the almost complete absence of regulations or etiquette regarding the medical secret, is highly influenced by French and Ottoman culture; (2) the most preeminent regulations regarding medical secret belong to Midwifery institution, being implemented 30 years before the law regulating it for all medical disciplines; knowing what are the origins of the medical confidentiality (and medical ethics in general), may lead to a better understanding of the way ethical principles are implemented in today's clinical practice.
The usefulness of evaluating aesthetic prejudice with aesthetimetric scales. Although in medical-... more The usefulness of evaluating aesthetic prejudice with aesthetimetric scales. Although in medical-legal practice the quantification of an esthetic prejudice it's often needed and there are more then one known and widely used international scales (of which best known are those made by Greff and Hodin) in Romania they are rarely used for various reasons (they are difficult to work with, they are supposedly decreasing the role of the forensic doctor by allowing anyone with access to the scales to quantify an esthetic prejudice, aren't very good for lesions from other parts of the body, etc). We compared the results obtained from forensic evaluations with the ones obtained from a slightly modified Greff aesthetimetric scale. We have analyzed some parameters used in it -color, keloid/hypertrophic scars, location, etc. We also analyzed the role played by facial fractures in determining an esthetic prejudice (not quantified by Greff scale which only takes in consideration cutaneous scars; this parameter is used in Hodin scale, a more complete and complex scale). The results obtained are showing only minor differences between the use of the modified Greff scale and the ones from the forensic evaluations regarding the diagnosis of disfigurement.
Nowadays the laparoscopic approach represents the gold standard for acute cholecystitis, but we a... more Nowadays the laparoscopic approach represents the gold standard for acute cholecystitis, but we are facing little evidence regarding the elderly patients. The purpose of this study is to define the benefits in terms of early outcome for laparoscopic cholecystectomy in patients over 70 years old and to compare them with the open cholecystectomy through a retrospective study of patients that underwent a cholecystectomy during 12 months in the Emergency Hospital of Bucharest, Romania. Out of 49 patients, 20 had a laparoscopic cholecystectomy (LC) and 29 an open approach (OC). The mean age was 74,6 ± 4,2 (LC) vs. 77,2 ± 5,4 (OC) (P>0.05). There were 7 (33,3%) (LC) vs. 2 (7,1%) (OC) catarrhal cholecystitis, 13 (62%) (LC) vs. 9 (32,1%) (OC) phlegmonous cholecystitis, and 1 (4,8%) (LC) vs. 17 (60,7%) (OC) gangrenous cholecystitis (P=0.001, Cramer's V=0,590). The median operative time was 90 (LC) vs. 60 (OC) minutes (P=0.001). There were no differences regarding the ASA risk scale (P...
Thyroid pathology is rarely involved in the pathogenesis of sudden death in young people. We repo... more Thyroid pathology is rarely involved in the pathogenesis of sudden death in young people. We report here the cases of two young patients with decreased levels of thyroid hormones whose death was caused by an increased thrombotic status, with venous thrombosis and pulmonary thromboembolism. In both cases the thyroid pathology was not considered as the underlying cause of death as the association between this condition and venous thrombosis is still debatable. However its presence may be considered a circumstantial factor, which could increase the severity of the disease and subsequently the lethality rate in pulmonary thromboembolism. An increased awareness for hypothyroidism or subclinical hypothyroidism in clinical practice may lead to a decrease in mortality secondary to thromboembolic disease. Also, increased awareness for thyroid pathology during forensic autopsy in sudden deaths may lead to potentially significant results, that could explain some of the sudden death with an unknown cause, and decrease the number of the so called blank autopsies.
Objective. In Romania medical-legal studies on the pattern of drug consumption have not yet been ... more Objective. In Romania medical-legal studies on the pattern of drug consumption have not yet been conducted nationwide; the purpose of this study was, therefore, to determine whether such a pattern could be identified. Methods. A total number of 577 analyses were performed during a three-year period on people suspected of non-lethal substance abuse, in more than two-thirds of the counties in Romania. Preliminary tests were conducted using immunoassay tests (blood or urine) and confirmatory tests were carried out using either GC-MS or HPLC. Results. 240 cases (41.6%) were negative while 327 cases (58.4%) tested positive for illegal drugs, central nervous system medication or both. Men represented 89.5% of all cases, while women accounted for only 10.5%. The pattern of substance abuse varied significantly, depending on the geographical area. In most cases, the identified drugs of abuse were cannabinoids and opiates, with a significantly different distribution of cases, depending on the...
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