A Critical Assessment of the Need for Harmonization of the Legal Framework Concerning Abusive Informal Debt Collection Practices in the European Union: Is Harmonization Possible and How Can it Best Be Attained?

The loss of jobs and the decline in real incomes caused by the 2008 financial crisis and the COVID-19 pandemic have affected consumers' ability to repay their debts. These have led to high ratios of non-performing loans (NPLs), which affect the stability of the financial industry and undermine economic recovery. The result has been a need for faster debt enforcement and a drastic increase in abusive informal debt collection practices (IDCPs). In the EU, the need to regulate and harmonize abusive IDCPs surfaced in 2018 in connection to the Proposal for a Directive on Credit Servicers, Credit Purchasers and the Recovery of Collateral (CSDP). The directive would enable banks to outsource the servicing of NPLs to a specialized debt collector, but it contained no protection rules against abusive IDCPs. In this article, the researcher critically assesses the need for harmonization of the legal framework concerning abusive IDCPs in the EU, mainly from the standpoint of the initial and current text of the CSDP. Where necessary, the researcher will refer to both historical and comparative law perspectives. The researcher focuses on the legal character of informal debt collection, its relation to financial services, and its potential sui generis character. After that, the researcher will address the arguments for and against establishing pan-EU sector-specific legislation dedicated to IDCPs. Next, the researcher discusses the constitutional authority of the EU to regulate abusive IDCPs. Finally, the researcher will examine the interaction of the CSDP with other consumer (financial) protection instruments to identify the best solution for harmonizing abusive IDCPs at the EU level. The researcher will juxtapose several dichotomies: general versus sector-specific, procedural versus substantive, minimum versus maximum harmonization, and hard versus soft regulation. In the conclusion, the researcher shall synthesize the core problems and suggest an approach.

Regulation of Abusive Debt Collection Practices in the EU Member States: An Empirical Account.

The article seeks to establish, in a comprehensive manner, if and how abusive debt collection practices are regulated in the respondent EU Member States. Using empirical data gathered from consumer and supervisory agencies as well as debt collection associations in 26 EU Member States, it provides an insight into (a) the existence of a licencing regime for debt collectors; (b) the potential transboundary dimension of debt collection and its implications for the common market; (c) the types of abusive debt-collection practices encountered in the Member States; (d) the efficacy of self-regulation via Codes of Conduct; and (e) the potential traditional remedies available to consumer-debtors. The article concludes that the existence of different national models creates potential issues and discrepancies in the legal status and defences available to consumer-debtors across the EU, which ultimately affects the proper functioning of the single credit servicing market. The advocated solution is that of a harmonized sector-specific regulation of abusive debt collection practices at EU level.

Measuring Patient Safety Culture in Romania Using the Hospital Survey on Patient Safety Culture (HSOPSC).

Purpose To explore patient safety culture among Romanian staff, using the U.S. Hospital Survey on Patient Safety Culture (HSOPSC). MATERIAL AND METHODS: A cross-sectional study was carried out in six hospitals, located in four Romanian regions (Craiova, Cluj-Napoca, Bucharest and Brasov), based on staff census in the Units/hospitals which volunteered to participate in the study (N=1,184). The response rate was 84%. The original questionnaire designed by the American Agency for Healthcare Research and Quality was translated into Romanian (with back translation), pre-tested before application and psychometrically checked. It consists of 42 questions grouped in 12categories, covering multiple aspects of patient safety culture (dimensions). Percentages of positive responses (PPRs) by question and category were analyzed overall and by staff profession. RESULTS: Most respondents were nurses (69%). The main work areas were surgery (24%) and medicine (22%). The highest PPRs were for Supervisor/Manager Expectations & Actions Promoting Safety (88%), Teamwork Within Units (86%), Handoffs and Transitions (84%), Organizational Learning-Continuous Improvement (81%), Overall Perceptions of Safety (80%), Feedback & Communication About Error (75%). The lowest PPRs were for: Staffing (39%), Frequency of Events Reported (59%) and Non-punitive Response to Errors (61%). Nurses exhibited significantly higher PPRs than doctors. CONCLUSIONS: This small-scale study of staff's attitude towards patient safety in Romanian hospitals suggests that there is room for future improvement, especially within the doctor category. Further research should assess the relationship between patient safety culture and frequency of adverse events.

The laparoscopic management of simple hepatic cysts.

The hepatic polycystic disease represents a hereditary condition with a reduced prevalence in the general population, sometimes associated with polycystic kidney disease. We present a retrospective observational study applied to 49 patients. The study aimed to observe the laparoscopic surgery of simple hepatic cysts. Laparoscopic approach is a simple and successful surgery management of these types of cysts.

Novel predictors of intrapulmonary vascular dilatations in cirrhosis: extending the role of pulse oximetry and echocardiography.

BACKGROUND AND STUDY AIMS: Intrapulmonary vascular dilatations (IPVDs) are a criterion for the diagnosis of hepatopulmonary syndrome in patients with liver cirrhosis. We aimed to show that IPVDs are more common than suspected in a heterogenous cirrhotic population and to identify new diagnostic parameters. PATIENTS AND METHODS: Forty-three consecutive patients with cirrhosis admitted to our Gastroenterology department were included in this prospective study. History, physical examination, ECG and, when warranted, pulmonary function tests and chest radiograph were used to exclude patients with significant cardiac or pulmonary disease. Contrast enhanced transthoracic echocardiography (CEE) was used to determine the presence of IPVDs. Pulse oximetry readings were taken in the supine and standing positions. RESULTS: We found 12 patients with IPVDs. Statistical analysis proved the correlation between IPVDs and systolic pulmonary artery pressure (sPAP) (p= .049), right ventricle wall width (RVW) (p = .013) and E/A ratio (p = .034) but not left atrial or ventricular diameter. Orthodeoxia was also present more frequently in patients with positive CEE. The difference between supine and standing oxygen saturation (changeSat) proved a fair diagnostic test for detecting IPVDs, with an area under the receiver operated curve (AUROC) of 0.823. CONCLUSIONS: Our study shows that RVW, sPAP, E/A and orthodeoxia determined by pulse oximetry are valuable novel predictors of IPVDs, encouraging the routine use of pulse oximetry and echocardiography in cirrhotic patients.

[Experimental left orthotopic mono-pulmonary transplantation swine model]. / Model experimental porcin de transplant mono-pulmonar stâng ortotopic.

UNLABELLED: The swine model is an orthotopic pulmonary transplantation model often uses in the transplantation experiments. The purpose of this study is to control the transplantation technique on swine model and perform the learning curve of this procedure, as much from surgical than anaesthetic point of view. METHODS: 20 orthotopic left pulmonary transplantations were performed on 20 pairs of domestic female pigs, weighting 30-35 kg. Tracheal intubation's time, monitoring time, bronchial, arterial and venous anastomosis time, warm ischemia time, were recorded. The causes of morbidity and mortality were also analyzed. RESULTS: Bronchial anastomosis was a running mattress suture. All bronchial anastomoses were airtight. Arterial anastomosis was a running mattress end-to-end anastomosis. The venous return was carried out by a left atrium-venous running mattress suture anastomosis. Satisfied blood flows in all arterial and venous anastomoses were obtained. CONCLUSIONS: We established an experimental swine model of pulmonary transplantation. The anaesthetic and surgical team performed their learning curve. Various anastomoses times and consequently, the total time of the intervention, were shortened.

Pneumoperitoneum--rare complication in end stage renal disease patient on automated peritoneal dialysis.

Peritoneal dialysis (PD) is the first option for patients in end stage renal disease (ESRD). Several complications such as peritonitis, exit-site or tunnels infections are encountered during PD. Other complications such as pain, proteic malnutrition, hyperglycemia, hypertension, cardiac failure are described in patients on continuous ambulatory peritoneal dialysis (CAPD) or APD (automated peritoneal dialysis). Rare complications are incapsulated sclerosing peritonitis, hemoperitoneum or pneumoperitoneum. We present the case of a female patient, 66 years old, on cyclic continuous peritoneal dialysis (APD-CCPD) admitted for pneumoperitoneum developed during a dialysis change from a CCPD schedule, due to an error in the Tenckhoff catheter and peritoneal dialysis manipulation. The treatment consisted in extracting the air during manual peritoneal dialysis changes, with the patient in Trendelenburg position and pressing on the abdominal wall, without any other complications.

[Thoracoscopic sympathectomy for vascular disorders of the upper limbs: preliminary results]. / Simpatectomia toracoscopica înalta pentru afectiuni vasculare ale membrelor superioare: rezultate preliminare.

Between January 2005-December 2006 we have performed 12 sympathectomies in 10 patients with ischemic hand disease Indication, surgical techniques, and early results were discussed. Thoracoscopic sympathectomy in patients with severe ischemia of upper limb extremities and unsuccessful medical therapy and local care permits optimal symptomatic control and maximum tissue salvage. Because the procedure is minimally invasive, safe, and associated with a low rate of complications, it should be considered earlier in the natural course of this disease as the best therapeutic option.

Recurrent spontaneous pneumothorax in renal transplantation.

Renal transplantation could be associated with severe complications. Pneumothorax is a rare and severe complication among renal transplant recipients. The relationship between pneumothorax and post transplantation status, pulmonary infections or immunosuppressive treatment is controversial. We report the case of a young female with normal renal graft function who developed recurrent pneumothorax after three years of kidney graft.

[Minimally invasive combined surgical treatment in a case of bilateral pulmonary hydatidosis]. / Tratament chirurgical mini-invaziv combinat într-un caz de hidatidoza pulmonara bilaterala.

The minimally invasive surgical techniques had an explosive development in the last 15 years. In thoracic surgery, these techniques were rapidly adopted, especially because of medical advantages, but also for aesthetic reasons. We present the case of a 33 years old patient, with bilateral pulmonary hydatidosis, treated in one-stage surgery, by VATS (video-assisted thoracic surgery) and thoracoscopic approach. The post-operative course was uneventful and the patient was discharged in five days. In selected cases, of patients with uncomplicated hydatid cysts, the minimally invasive surgical approach is not only possible, but probably also indicated.

[Single-stage operation in simultaneous pulmonary and liver hydatic disease]. / Tratamentul chirurgical într-o singura sedinta operatorie al maladiei hidatice hepato-pulmonare.

The most frequent association of hydatic disease lesions is hepatic and pulmonary localisations. It is generally admitted that surgical treatment is the only effectiveness treatment in hydatidosis. The classic approach is the two-stage surgical interventions of pulmonary and liver localisation or one-stage extensive thoraco-phrenic-laparotomy, exclusively reserved to right pulmonary hydatic cysts associated with hepatic dome localisations. The study presents single-stage operation by thoracotomy or mini-invasive thoracic surgery and laparotomy or laparoscopy, or single-stage thoracic approach, as alternative of classic attitude and evaluates the results in 10 patients with synchronous pulmonary and liver hydatic cysts. Overall observations are-encouraging.

[Thoracoscopic splanchnicectomy--a method of pain palliation in non-resectable pancreatic cancer and chronic pancreatitis]. / Splanhnicectomia toracoscopica--metoda de paliatie a durerii în cancerul pancreatic nerezecabil si pancreatita cronica.

Severe upper abdominal pain is a dominant and distressing feature in advanced pancreatic cancer and in chronic pancreatitis. A way of palliation needs to be practiced in the non-resectable pancreatic cancer in order to control the pain. Between the many methods of palliation the thoracoscopic splanchnicectomy seems to be the best due its simplicity, no risk to the patient and the good results. In the Center of General Surgery and Liver Transplantation from Fundeni Clinical Institute we have practiced 50 thoracoscopic splanchnicectomies in a number of 49 patients during a period of 3 years. The morbidity was 2% and the mortality 0. We noticed a significant improvement in the pain score, the quality of sleep and the overall quality of life and consecutively a quick social reintegration of these patients. The quality of life is greatly improved (with a significant reduction of the pain score in 92% of the cases) after this minimally invasive procedure, a fact the qualifies this procedure as the technique of choice in these patients.

[Renal vascular lesions and the occurrence of hypertension in patients with IgA nephropathy]. / Lésions vasculaires rénales et développement d'une HTA chez les patients atteints d'une glomérulonéphrite à dépôts mésangiaux d'IgA. Une histoire familiale d'hypertension artérielle.

Worse prognosis of IgA nephropathy (IgAN) is associated to hypertension, high proteinuria, glomerular and vascular sclerosis. A family story of hypertension (FHT) in relatives could be a strong predictor of the occurrence of hypertension (HT) in children. Renal vascular lesions (RVL) are often observed in normotensive patients with IgAN. In order to evaluate a possible association between FHT and LVR in patients with IgAN, we investigated two groups of 73 IgAN patients, sex (56 males and 17 females) and age matched, according to the presence or not of FHT. FHT was diagnosed if relatives and/or at least one child under 60 years of age had treatment for HT or systolic and diastolic BP over 140/90 mmHg at the time of the survey. Patients entering into the study were followed during an average period of 5 to 8 years. At the end of the study, all patients were explored for HT and renal function. Creatinine clearance (CrCl) was evaluated by Cockcroft and Gault formula and renal failure was defined as CrCl<60mL/min. The results were as follow: at the time of renal biopsy, RVL were observed in 73% of males with FHT vs 16% of males without FHT (p<0.0001) and 70.6% of females with FHT vs 29.4% of females without FHT (p<0.001); at the end of the study period, HT was significantly associated to FHT in 89.6% of patients group with FHT vs 22.6% of HT patients in the group without FHT (p<.0001). Renal failure was present in 45.2% of patients with FHT vs 4.1% of patients without FHT (p<0.0001). These data suggest: VRL could be dependent of genetic factors; FHT should be an early predictor of VRL in patients with IgAN; FHT might be a risk factor for renal failure in patients with this renal disease.

A difficult case of mediastinal parathyroid adenoma: theoretical and clinical considerations.

About one quarter of patients with primary hyperparathyroidism have ectopic parathyroid tissue. The majority of parathyroid glands can be reached through a cervical approach, but in about 2% of the cases the ectopic gland is in the mediastinum in a location that requires a thoracic approach. Failure to remove ectopic mediastinal parathyroid tissue results in persistent hyperparathyroidism. Reoperative exploration for persistent hyperparathyroidism is often difficult even in the hands of experienced surgeons. Recent advances in preoperative localization techniques and intraoperative parathyroid hormone measurement have improved the rates of successful resection. We present a difficult case of persistent hyperparathyroidism secondary to an ectopic middle mediastinal parathyroid adenoma, which was eventually successfully managed in a specialised unit.

[Neoadjuvant radiochemotherapy in the treatment of esophageal squamous carcinoma:Preliminary results in a series of 15 patients]. / Radiochimioterapia neoadjuvanta în tratamentul carcinomului epidermoid esofagian. Rezultate preliminare pe un lot de 15 pacienti.

The purpose of this study is to analyze the experience of the Center of General Surgery and Liver Transplantation from Fundeni Clinical Institute (Bucharest) regarding the results of neoadjuvant radiochemotherapy in the squamous carcinoma of the esophagus. During 01.01.2001-09.07.2003, 15 patients with squamous carcinoma of the esophagus were treated using neoadjuvant radiochemotherapy (RCT); 13 patients (86%) underwent esophageal resection (in 2 patients resection was not possible due to the mediastinal invasion). Complete histological response (the lack of malignant tissue on the esophagectomy specimens) was noted in 5 cases. The morbidity and mortality rates were 48%, respectively 6%. RCT increases the resectability in esophageal cancer and decreases the postoperative morbidity and mortality.

[Arterial hypertension in the hemodialysis patient. A model of salt-sensitive hypertension in man]. / L'hypertension artérielle du patient hémodialysé. Un modèle d'hypertension sensible au sel chez l'homme.

In uremic patient treated by hemodialysis (HD), a low potassium intake and a salt load due to diet and or a high sodium concentration in dialysate are often associated to refractory hypertension. Numerous reports in general population, based on epidemiologic and demographic data, have pointed to the relationship between sodium intake and hypertension. The degree of blood pressure fall in patients who have evidence of salt-sensitivity varies directly with the severity of the hypertension, being most prominent in those with higher pressures. Recent studies have suggested that a reduction of dialysate sodium can control hypertension in maintenance haemodialysis patients. In this study, five hypertensive haemodialysis patients were assigned to a regime of lowering the dialysate sodium concentration from 142 to 135 mmol/L in combination with an attempt to lower salt intake by advising the patients to eat a NaCl-restricted diet of no more than 6-8 g/day. During the period under study, dialysis time was kept constant. A significant increase of ultrafiltrate sodium concentration was observed during the first week after lowering the dialysate sodium concentration. Post dialysis systolic and diastolic pressures showed a clear trend to fall (systolic pressure 174 +/- 18 vs 118 +/- 13 mmHg, diastolic pressure 96 +/- 7 vs 75 +/- 13 mmHg) without a change of dry weight. The reduction of the mean arterial pressure on 48 h was demonstrated with ambulatory blood pressure recording. The results of this study suggest that reducing the dialysate sodium concentration lead to a decrease in peripheral resistance. A link between sympathetic overactivity as it is found in haemodialysis patients and sodium load could be a stimulating hypothesis. It is concluded that increasing dialysate sodium in short dialysis is responsible for the high prevalence of arterial hypertension often insufficiently controlled by antihypertensive medication. In hemodialysis patients with refractory hypertension, the lowering of the dialysate sodium concentration is indicated.

[Ischemic renal diseases have become the most frequent causes of end stage renal disease in the elderly]. / La néphroangiosclérose et la néphropathie ischémique athéromateuse sont devenues les causes les plus fréquentes d'insuffisance rénale terminale chez le sujet âgé de plus de 60 ans.

In the 80s it was established that atherosclerotic renal artery stenosis (ARAS) is a leading cause of renal insufficiency and that this condition ranks among the rare etiologies of chronic renal failure amenable to improvement or stabilization particularly in the white. Nephroangiosclerosis (NAS) is an increasing cause of ESRD in the western countries, especially in blacks. Epidemiological data on the vascular nephropathies leading to ESRD are still rare. In this study, we compare annual incidence of ESRD due to ARAS and NAS during two five-year periods: period A = 1982-1986, period B = 1992-1996. The region of the survey comprised 410,664 inhabitants (99.6% of Caucasians), of whom 100,230 were aged over 60 years. Diagnosis of ARAS required arteriography and that of NAS a renal biopsy. Undetermined vascular nephropathy was diagnosed when ESRD patients had had previously no arteriography or no histological examination. Major results were as follow (A vs B, incidence = n/million inhabitants): 1) Increasing incidence of ESRD due to all causes: 76 vs 95 per million, mean age at ESRD 56 vs 62 yrs, percentage of patients over 65 yrs 28 to 59% (p < 0.001). 2) Increasing incidence of ESRD due to vascular nephropathies: 5.5 vs 27.5 per million (p < 0.0001) in general population and 22 vs 110 per million (p < 0.0001) in population aged over 60 years, mean age at ESRD 68 vs 73 yrs. 3) Increasing incidence of different types of ischemic renal diseases leading to ESRD: ARAS 2.5 vs 15 per million (p < 0.0001) in general population and 10 vs 60 per million (p < 0.001) in those aged over 60 yrs, mean age 69 vs 74 yrs, NAS: 1 vs 8 and 4 vs 32 per million (p < 0.001), mean age 67 vs 72 yrs, undetermined VN 0.5 vs 2.5 and 2 vs 10 per million, 65 vs 73 yrs. Our study demonstrates that ischemic renal diseases 1) have become the most frequent causes of ESRD (27% of all patients and 43% of those aged over 6C years) in the Caucasian elderly. 2) are the only cause of increasing incidence of ESRD in this French region.

Hypertrophic cardiomyopathy in old agers. Definitions and general considerations.

Hypertrophic cardiomyopathy (HCM), a primary heart disease, in most of the cases genetically transmitted, characterized by hypertrophy, often asymmetric, of the left ventricle (LV), presents certain peculiarities in old agers. The shape of the LV in old agers, is characterized by aorto-septal angulation, by the frequent presence of a septal bulge and the calcification of the posterior mitral ring which contributes to the narrowing of the LV ejection tract by the anterior displacement of the mitral valve. Thus, HCM in old agers can also have an acquired component associated with the mild changes of aging, which in certain conditions can lead to the appearance of some peculiar forms of disease.