[Microsurgical decompression of lumbar spinal stenosis]. / Mikrochirurgische Dekompression der lumbalen Spinalkanalstenose.

Lumbar spinal stenosis in most cases is due to progressive degeneration of the spine, resulting in thickening of facet joints and flaval ligament. Thus the diameter of the lumbar spinal canal is reduced to less than 12 mm in the AP direction. Typically complaints consist in neurogenic claudication. Patients usually experience improvement of pain when bending their back or walking up a hill. Diagnosis of lumbar spinal stenosis is confirmed by MRI. CT myelography may help detect where compression is most pronounced. Surgical treatment should be based on the clinical symptoms of the mostly elderly people and should be performed as microsurgical decompression or in cases of clinical instability as TLIF.

Orthopedic approach of haemophiliacs. A single center experience in Romania.

Clinical expression of inadequately treated haemophilia is dominated by orthopedic complications, requiring invasive or non-invasive interventions. OBJECTIVE: In Romania, with under dosed and late introduced "on demand" substitution, we aimed at highlighting the experience of orthopedic treatment and its outcome. PATIENTS, METHODS: Single center retrospective analysis regarding orthopedic interventions and their outcomes was conducted on 59 hemophilia A, B, and von Willebrand disease patients, between 2002 and 2007. RESULTS: The majority of interventions, invasive (60.71%) and non-invasive (39.28%), were elective, only two being emergencies. Postoperative functional evolution after synovectomies was good in 68.28%, fair in 24.39%, satisfactory in 7.31%. Results of 33 non-invasive (extensive releases) procedures were very good in 27.27%, good in 63.63%, poor in 9.09%. DISCUSSION, CONCLUSIONS: The important number and complexity of orthopedic interventions are proving the precarious musculoskeletal state in persons with hemophilia, demonstrating the need of improving substitution, at least with discontinue prophylaxis in patients with severe forms.

The effectiveness and tolerance of betablockers in elderly patients (> or = 70 years) with heart failure.

UNLABELLED: The beta blockers (BB) being less prescribed in elderly patients (P) with heart failure (HF), the aim of this study was to assess the effectiveness and tolerance of BB (meteoprolol, bisoprolol or carvedilol) given on the top of the conventional therapy in HF due to LV systolic dysfunction in P > or = 70 year (n=57, group 1) and < 70 year (n=101, group 2). Differences in baseline clinical characteristics between the 2 groups were not significant. The BB doses given in group 1 P was lower but the difference was significant for bisoprolol only. Intolerance to BB imposing withdrawal occurred in 12% of group 1 P and in 10% group 2 P (p>0.05). Symptomatic improvement expressed as a significant decreases in NYHA class was observed in both groups. Readmission for worsening HF was needed in 42% vs. 39% while 1 year mortality rate was 11.4% vs. 10.4% in group 1 and 2 P respectively (p>0.05). CONCLUSION: BB are tolerated and seem to be effective in most elderly P with HF. Therefore, BB should be tried in all HF P without contraindication irrespective of age.

Assessment of treatment with orotate magnesium in early postoperative period of patients with cardiac insufficiency and coronary artery by-pass grafts (ATOMIC).

The benefit of the treatment with magnesium orotate (magnerot) was assessed in a randomised, single blind and placebo controlled study. Respecting the inclusion criteria were selected 32 patients with ischemia chronic failure in early postoperative period after CABG. The main improvements induced by magnesium orotate are the increase in exercise capacity (distance ambulated during 6 minutes walk test and ergospirometric parameters) and the reduction of ventricular premature beats. The treatment was well tolerated and the adverse reactions were not significant. The study strongly suggests the benefit of magnesium orotate added to classical antiischemic therapy in the complex management of coronary patients after CABG.

The value of echocardiography in the early diagnosis of myocardial impairment due to connective tissue diseases.

The study comprised 14 patients with systemic lupus erythematosus (SLE) and 12 patients with diffuse scleroderma. Echocardiography ascertained 5 cases of congestive and 1 case of restrictive cardiomyopathy among the patients with SLE, as well as 6 cases with restrictive cardiomyopathy among those with scleroderma. The authors specify two important echocardiographic variables: the E-septum distance and the septal and wall motion after amyl-nitrite test, which reveal the intrinsic contractile properties of the myocardium, allowing an early diagnosis of myocardial impairment, as well as the selection of patients for an efficient treatment with vasodilator drugs.

Importance of morpho-clinical correlations in the diagnosis of congestive cardiomyopathies.

A morphologic score was performed in 17 myocardial biopsy specimens proceeding from patients with congestive cardiomyopathies. The electron microscopic changes were estimated according to their frequency and severity. According to this score, the morphological findings were compared with the clinical data and some echographic indexes of the myocardial contractility. These correlations turned out to be of great value in estimating the prognosis of these patients and allowed to set up three different stages of evolution in the congestive cardiomyopathies.

Immunologic investigation in cardiomyopathies.

A group of 6 patients with congestive cardiomyopathy were investigated from the immunologic pint of view. Changes of serum immunoglobulins with increase of IgA and IgM were observed in all the patients. The immunofluorescence test in myocardial fragments, taken by transparietal biopsy from the six patients, confirmed the presence of IgA and IgG in two cases. A pathogenic immunologic mechanism is discussed in cardiomyopathies and especially in the alcoholic one.

[Diagnosis of primary chronic rheumatic carditis in adults]. / Contributii la diagnosticul carditei reumatice primare cronice la adult.

The authors maintain that in some cases one can note the so-called primar chronic rheumatic carditis, or apparently primary rheumatic carditis. Streptococcal infections can be held responsible for the eventuality of a sub-clinical evolution of rheumatism, and there which develops as a clinical form of latent rheumatism, and there is the possibility of ulterior development of valvular cardiopathy without a clear history of acute rheumatic fever in the antecedents. One of the groups subjects with maximal exposure to repeated streptococcic infection is represented by the teaching personnel working permanently in school or pre-school children collectivities or with teen-agers, which are both carriers and disseminators of the rheumatogenic streptococcal infection. Of a total of 50 cases of apparently primary chronic valvular cardiopathies that have been followed by the ASCAR personnel, 48 had tonsillary infections in their antecedents, 8 had arthralgia and 4 cases were detected by chance. In school collectivities at high risk prophylaxis with penicillin should be mandatory, both for the students and for the teaching personnel.