[TIVA-TCI (Total IntraVenous Anesthesia-Target Controlled Infusion) versus isoflurane anesthesia for laparoscopic cholecystectomy. Postoperative nausea and vomiting, and patient satisfaction]. / TIVA-tCI vs. anestezia inhalatorie pentru colecistectomia laparoscopica. Incidenta sindromului emetic postoperator si satisfactia pacientilor.

UNLABELLED: Numerous studies have shown that TIVA is followed by a significant reduction in the incidence of PONV in day-case surgery, including laparoscopic cholecystectomy, where the incidence of PONV can reach 70% according to some studies. TCI is the TIVA technique that maintain a constant plasma concentration due to pharmacokynetic models incorporated in TCI device that inject the anesthetic agent. Besides implementing TIVA-TCI in clinical practice in Romania, our study was designed to evaluate the impact of TIVA-TCI on postoperative outcome and our patient satisfaction after laparoscopic cholecystectomy. PATIENTS AND METHODS: After informed consent, 70 patients ASAI/II undergoing laparoscopic cholecystectomy were randomized in 2 equal study groups: group 1 (n = 35) included patients with TIVA-TCI with propofol (Cpi = 4 microg/ml) and remifentanil, and group 2 (n = 35) were patients undergoing Isoflurane anesthesia. In both groups propofol was administered during induction and remifentanil followed the same protocol: 0.5 microg/kg/min in the first minute during induction, followed by 0.25 microg/kg/min. This infusion was modified by 0.05 microg/kg/min steps according to analgesic needs. PONV (evaluated as both incidence and number of episodes), severity of pain and patient satisfaction score IOWA were compared between study groups. RESULTS: Both the incidence of PONV (p = 0.03) and the number of episodes/24 h/patients (p = 0.01) were significantly lower in TIVA-TCI group, while there was no significant difference in opioid requirements in study groups (p = 0.21). Patients IOWA satisfaction score at 24 hours postoperatively was significantly higher in TIVA-TCI groups (p = 0.0001). CONCLUSIONS: Compared with Isoflurane, TIVA-TCI was followed by significantly lower incidence of PONV and significantly greater patients satisfaction.

[Clinical aspects with prognostic value in gastric cancer--analysis of 468 cases with gastric adenocarcinoma]. / Aspecte clinice cu implicatie prognostica în cancerul gastric--analiza a 468 cazuri de adenocarcinom gastric.

The aim of this study is to assess clinico-pathological parameters and find out the correlation between them and their possible prognostic value. We made a retrospective analysis of a group of 468 patients with gastric adenocarcinoma which were operated in the 3rd Surgical Clinic--Cluj Napoca--01.01.1998-31.12.2003. The median age was 62 years. Patients in pTNM 0 stage were significantly younger than the rest of patients, with an average of 7.5 years. The male/female ratio was 1.7:1, this ratio being significantly higher in cases with proximal gastric cancers. There was not found any significant correlation between the interval : onset of symptoms and surgery, and pTNM stage. The most frequent signs and symptoms were epigastric pain, weight loss, indigestion, fatigue, pallor and loss of appetite, each of them were found in more than 40% patients. Multivariate analysis of symptoms showed that weight loss (p=0.00638) was independently correlated to advanced pTNM stages. The number of signs and symptoms was significantly correlated to advanced pTNM stages (p=0.000026). This significant group of patients studied has maintained characteristics encountered in populations with higher incidence of gastric adenocarcinoma, men being more frequently affected, distal localization and intestinal histologic type being encountered more frequently.

[Morbidity and mortality in gastric cancer surgery--analysis of 468 cases with gastric adenocarcinoma]. / Morbiditate si mortalitate în chirurgia cancerului gastric--analiza a 468 cazuri de adenocarcinom gastric.

The aim of this study is to evaluate the morbidity and mortality in the surgical treatment of gastric cancer and the factors that could influencing them. We made a retrospective analysis of a group of 468 patients with gastric adenocarcinoma which have been operated in the 3RD Surgical Clinic-Cluj Napoca--01.01.1998-31.12.2003. We analyzed parameters related to patient, pTNM stage and type of treatment. Morbidity was significantly higher in these circumstances: elder patients, cases with lower serum levels of hemoglobin and total proteins, after Billroth II procedures; we found no significant differences of morbidity depending on gender, pTNM stage, type of intervention: simple or multiorgan resection, subtotal or total gastrectomy, radical or palliative procedure or only exploratory laparotomy, presence or absence of splenectomy or caudal pancreatectomy, D1 or D2 lymphadenectomy (in radical procedures), palliative resection or gastrojejunal bypass. Elder patients and male patients have had a mortality significantly higher; we found no significant differences of mortality depending on serum levels of hemoglobin and total proteins, pTNM stage, type of intervention: simple or multiorgan resection, subtotal or total gastrectomy, radical or palliative procedure or only exploratory laparotomy, presence or absence of splenectomy or caudal pancreatectomy, D1 or D2 lymphadenectomy (in radical procedures), type of restoring of the digestive continuity after subtotal gastrectomy, palliative resection or gastrojejunal bypass.

CompAc information system for traditional Chinese medicine.

The paper presents a system developed for the assistance of diagnosis and treatment in alternative medicine, based on traditional Chinese methods. The system named CompAc, is a result of an interdisciplinary cooperation and is designed for the physician, specialist in acupuncture. The Compac system allows the determination of the type of energetic imbalance starting from the clinical picture of the patient and establishing whether an organ or any of the viscera are affected. It allows also the indication of different variants of treatment. The diagnosis proposed by the system has to be confirmed by the physician and can be modified by him. The system is also useful for medical training.

HIV-1 diversity in Romania.

OBJECTIVES: To evaluate the prevalence and the dynamics of HIV-1 subtypes in Romanian adults and children, and to investigate the origins of the nosocomial epidemic. DESIGN: A total of 1000 serum and plasma samples, from adults (n = 579) and children (n = 421) who were diagnosed as being HIV-1-infected during 1990-1997 in 39 of the 41 Romanian districts, were serotyped. Viral DNA was isolated from blood samples of 84 patients and the viruses were genotyped. METHODS: Serotyping was performed with a peptide subtype-specific enzyme immunoassay (SSEIA), based on in vitro competition for antibody binding between the representative V3 peptides of the different clades (A-F). Proviral HIV-1 DNA was genotyped by heteroduplex mobility assay or by sequence analysis of the C2-V3 env region. RESULTS: SSEIA showed that 93% of the samples from horizontally infected children were serotype F, 1% were serotype B, and the remaining 6% were uninterpretable. In vertically infected children, 74% of strains were serotype F, 10% were serotype A, 3% were serotype B, and 3% were serotype E. Serotype F was also the dominant subtype in adults (68%), but serotypes A, B, C, D and E were also detected. SSEIA gave indeterminate results in 7% of cases. A strong correlation (90%) between serotyping and genotyping for subtype F was found. Analysis of the relative incidence of the different serotypes over a 7-year period (1990-1997) showed a stable distribution. CONCLUSIONS: Subtype F largely dominates the epidemiology of HIV-1 infection in both children and adults in Romania, although other major subtypes are present. The predominance of subtype F in Romania may be a future potential source of HIV-1 variability in Europe.

Introduction to the study of adult T-cell leukemia and HTLV-I sero-positivity in Romania.

The study presents 6 cases of leukemia/lymphoma (with mature T-cells) corresponding to the diagnostic criteria of adult T-cell leukemia (ATL): adult age onset of leukemia/lymphoma, organomegaly but normal mediastinum, leukemic cells with typical morphology and phenotype hypercalcemia. The evolution of disease was severe of subacute with resistance or partial response to therapy. The virologic assays were positive according to the ELISA test in four cases of which two presented, according to the Western blot assay, HTLV-I infection. The epidemic aspect of this infection is discussed as well as the possibility of contamination and the geographic spread of the places of origin of the patients. Emphasis is laid on the young age (22-26 years) of three of the patients infected, as a peculiar feature of the disease in Romania.