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   You are here: Home ›› Archive ›› Vol. XIV, no. 1
Stem cells & tissue engineering
Basics for regenerative medicine - a synthetic overview
Assoc. Prof. G. Onose, MD, Prof. A.V. Ciurea, MD, Prof. I.P. Florescu, MD, Prof. Crina Sinescu, MD, Prof. Fl. Purghel, MD,
Ruxandra Mihai, MD, Ingrid Marinescu, MD, A. Anghelescu , MD, Monica Haras, MD, F. Brehar, MD, St.M. Iencean, MD,
Mihaela Unguru, MD, Cristina Chendreanu, MD
Clinical emergency hospital “Bagdasar-Arseni”, Bucharest, Romania (GO, AVC, IPF, CSI FP, RM, 1M, AA, MH, FB, CC)
“Sf. Treime” Clinical Hospital, Iasi, Romania (SI)
“Sf. Ioan” Clinical Hospital, Bucharest, Romania (MU)
Keywords: stem cells, tissue engineering, regenerative medicine

This paper aims to be an introduction in stem cell therapies and tissue engineering, starting from the isolation and first description of stem cells in 1998, and emphasizing their huge importance and potential as they might lead to the long waited healing of most, yet incurable diseases and conditions. Stem cells made a real landmark between traditional and nowadays revolutionary Regenerative Medicine, by encompassing also tissue engineering, i.e. building and replacing damaged organs or part of them. We will shortly present the achievement of scientists to grow replacement tissues for people with various conditions, including pancreatic cells for people with diabetes, neurons for people with Alzheimer's disease and spinal or brain injuries, bone marrow for cancer patients, skin for burn, trauma and aesthetic surgery, cardiac muscle cells for heart diseases, bone and cartilage for orthopedic or/and rheumatologic conditions, etc.

Epidemiology of the traumatic spinal cord injury at old age
The expertise of the clinical emergency hospital “Bagdasar-Arseni”
A. Anghelescu, MD, Assoc. Prof. G. Onose, MD, PhD, Florica Georgescu, Sociologist, Anca Sanda Mihaescu, Senior therapist
The Clinical Emergency Hospital “Bagdasar-Arseni”, Bucharest, Romania
Keywords: epidemiology, spinal cord injury, old age, associated degenerative pathology

Study Design. Retrospective analysis, focused on the epidemiology of traumatic spinal cord lesions (SCI) at old persons (over 65 years), admitted in the Rehabilitation Department, during a period extended upon 10 years (1995-2005), continuation of a previous study tradition. Methods. Data - collected and analyzed from441 medical files. Setting. Rehabilitation Clinic, Emergency Hospital “Bagdasar-Arseni” Bucharest. Results.
Male's number (355) predominate over the female's (86) (r= 4.12). Most of the cases were from rural regions (74%). Tetraplegics (367 subjects, 83.2%) predominate over the subjects with paraplegia (74 cases, 16.8%). Falls from height dominated the etiology (74.3%), especially falls from the chariot and the trees (also house, ladder, hay). Traffic accidents were responsible as second cause of SCI at old age (19.5%) Associated degenerative pathology (single or multiple factors) favored the incidence of SCI: cardio-cerebral-vascular, chronic alcoholism, rheumatologic, metabolic diseases. Conclusions. Socio-economic problems and associated pathology were responsible for the incidence of SCI at this fragile category of population.

Romanian contributions to the development of the international project “ICF core sets - for spinal cord injury”
A. Anghelescu, MD, Assoc. Prof. G. Onose, MD, Prof. A.V. Ciurea, MD, Anca S. Mihaescu, MD
The Clinical Emergency Hospital “Bagdasar-Arseni”, Bucharest, Romania
Keywords: International Classification of Functioning, Disability and Health (ICF-DH), ICF Core Sets, spinal cord injury (SCI), disability, rehabilitation

The Physical & Rehabilitation Medicine (PRM) Clinic Division of the Clinical Emergency Hospital “Bagdasar-Arseni”, in Bucharest, participated to an international multidisciplinary expert research project: the developing of the International Classification of Functioning, Disability and Health (ICFDH) Core Set, for persons with SCI, undergoing the early post-acute and respectively, the chronic, rehabilitation phase. Hereby, we presented our contribution to the third point of the project, i.e. the expert survey.

Olfactory groove meningiomas clinical and therapeutically features a retrospective study
Prof. A.V. Ciurea, MD, PhD, B.O. Ene, MD, Ligia Tataranu, MD, PhD, V.G. Ciubotaru, MD, PhD, M. Lisievici, MD, PhD, A. Stefanescu, MD
Neurosurgery Clinic, "Bagdasar-Arseni" Clinical Emergency Hospital, Bucharest, Romania (AVC, BOE, LT, VGC) Pathology Laboratory "Bagdasar-Arseni" Clinical Emergency Hospital, Bucharest, Romania (ML)
Ophtalmology Clinic, Dolj County Emergency Hospital, Craiova, Romania (AS)
Keywords: olfactory groove meniongioma, behavioral disorders, visual field defects, CT, MRI, angio-MRI, surgical treatment

Objectives. Descriptive, retrospective study assessing clinical symptomatology, ancillary diagnostic tests, therapeutically options and clinical outcome in the patients admitted with this diagnostic to Bagdasar-Arseni Clinical Emergency Hospital between 2000 and 2004. Method. Cases were included based on the diagnostic codes in the hospital archives and their clinical records were studied retrospectively. Subgroups were defined according to sex and age criteria in order to provide an accurate epidemiological evaluation. Results.20 cases of olfactory groove meningioma were admitted and investigated during the period mentioned above; 14 were female and 6 male (F/M = 2.3/1), between the ages of 46 and 77; mean age was 57.35±9. Ancillary diagnostic tests were used, including imaging techniques: CT, MRI, angio-MRI, corroborated with ophthalmologic examination. 18 patients underwent surgery. Exitus occurred in 2 patients, consecutive to respiratory insufficiency due to persistent pulmonary infections associated with prolonged immobilization. Conclusions. Olfactory groove meningiomas are a relatively rare disease, more frequent in females, 4th and 5th life decade. As symptomatology may be insidious, diagnosis is only achieved when the tumor is already large; frequently over 4 cm. Diagnosis is basically imagistic, allowing assessing dural and boning involvement. Surgical management with complete tumor removal is usually curative.

Brain stem cavernous malformations
St.I. Florian, MD, PhD, Linda Antuaneta Iordache, MD, A. Oslobanu, MD, C. Matei, MD, L. Dura, MD
University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Romania (SIF, AO)
1st Department of Neurosurgery, County Emergency Hospital Cluj-Napoca, Romania (LAI, CM, LD)
Keywords: brain stem cavernoma, hemorrhage, management

This paper presents the author's experience in the field of cavernous angiomas of the brainstem, based on 6 cases operated in our department between 01.01.2002- 31.12.2006. In our pathology brainstem cavernomas represent about one third from all cavernomas operated. The age of the patients ranged between 24 and 51 years. The diagnosis was established in all cases based on clinical findings, CT scan, MRI and pathological findings. Regarding the locations it was the following: 4 in pons, 1 in the postero-lateral medulla, and 1 located in the mesencephalic region. All 6 patients presented neurological deficit as a consequence of recurrent hemorrhage, and due to this they underwent surgery with complete lesion removal. Favorable surgical results with only minor morbidity have been achieved.

Cerebral vasospasm in elderly patients with ruptured intracranial aneurysms - case series and review of the literature
Ass. Prof. M. Gorgan, MD, PhD, Angela Neacsu, MD, Narcisa Sucur, MD, PhD, V. Pruna, MD, Nicoleta Diaconu, MD, Calina Nichi, MD
First Neurosurgical Clinic Clinic Emergency Hospital "Bagdasar-Arseni", Bucharest, Romania
Keywords: cerebral vasospasm, ruptured aneurysms, elderly patients

Spontaneous subarachnoid hemorrhage (SAH) is often a devastating condition and a significant cause of worldwide morbidity and mortality. Because the percentage of senior citizens is increasing in many countries and because of the increased incidence of SAH in elderly patients, ruptured intracranial aneurysm is an increasingly frequent pathology in all countries. The number of elderly patients with cerebral aneurysms has markedly increased since 1991, and in 2000 approximately 32% of all patients with cerebral aneurysms were elderly. Twenty years ago, older people were considered to have such a poor prognosis that they were frequently excluded from active treatment on the unique basis of their advanced age. Improving results published in recent studies showed that the classic fatalistic attitude associated with age and intracranial aneurysm (IA) should be reconsidered. Therefore, because of improvements in surgical results and neuro-intensive care, and more aggressive rehabilitation programs, the management of ruptured intracranial aneurysms in the elderly is changing. This paper aims to emphasize the specific aspects of the disease in the elderly, and present the current management of SAH in an elderly population. Cerebral vasospasm in elderly patients who were operated on the acute stage after subarachnoid hemorrhage was studied under strict criteria. We analyzed a number of 180 cases admitted between January 2000- June 2006, with subarachnoid hemorrhage secondary to an aneurismal rupture, diagnosed on CT scan and DSA angiography. The 180 patients were classified into two age groups: 59 years or younger (group A: 123 cases), 60 to 79 years (group B: 57 cases). Severity of both the subarachnoid hemorrhages on computed tomography scan and the angiographic vasospasms was graded. The angiographic vasospasms were analyzed at the internal carotid artery, M1 segments of the middle cerebral artery, and A2 segments of the anterior cerebral. Clinical vasospasm was appreciated in direct relation with the neurological deficits. In all the relationships among the subarachnoid hemorrhage grades, and the operative approaches to the angiographic vasospasm grade, there was a tendency for the angiographic vasospasm grades to be lower with increasing age in both the internal carotid artery and the M1 segment of the middle cerebral artery. Despite the literature reports of the incidence rate of symptomatic cerebral vasospasm and rebleeding is the same in both groups of age, in our series elderly patients presents a lower incidence of clinical and angiographic vasospasm, because of higher atherosclerosis incidence and cerebral atrophy. The surgical morbidity and mortality rates were 26.31 % (15 cases) and 5.26 % (3 cases), respectively. These rates were non-significantly higher than those for younger patients. CONCLUSION: Prognosis of surgical treatment in aneurismal subarachnoid hemorrhage in elderly patients is not directly related to the severity of hemorrhage or vasospasm but with the associated diseases age related.

Hemi facial spasm - Medical and neurosurgical treatment
Prof. A.V. Ciurea, MD, A. Tascu, MD, F. Brehar, MD, R. Rizea, MD, R. Radulescu, MD
Clinic Hospital “Bagdasar-Arseni”, Bucharest, Romania, First Neurosurgical Department
Keywords: Hemi facial spasm (HFS), Magnetic resonance imaging (MRI), MRI-Angiography (MRIA), Botulinum toxin (BTX), Micro vascular decompression (MVD)

Hemi facial spasm (HFS) is characterized by clonic contractions of the muscles innervated by the facial nerve. The differential diagnosis is very important in order to distinguish this from other causes of facial spasms, such as blepharospasm, psychogenic facial spasm, facial tic, facial myokymia, and tardive dyskinesia. Magnetic resonance imaging (MRI), MRI-Angiography (MRIA) and 3D-angiography studies frequently demonstrate vascular compression of the facial nerve. Also the neuroimagistic data are important to exclude the patient with space-occupying lesion. Botulinum toxin (BTX) injection to the facial muscles is an effective treatment for HFS, with few disabling side effects, but the results are faire only for 3 - 6 months. Micro vascular decompression (MVD) represents the best method to cure HFS with good results in time.

Giant infra and supratentorial medulloblastoma in an under 3 years old child
Case study
St.I. Florian, MD, PhD, E. Mihut, MD, PhD, D. Cernea, MD, PhD, C. Abrudan, MD, C. Suciu, MD, Z. Andrasoni, MD
1st Department of Neurosurgery, County Emergency Hospital, Cluj-Napoca, Romania (SIF, CA, CS, ZA)
Institute of Oncology “Ioan Chiricuta”, Cluj-Napoca, Romania (EM, DC)
Keywords: medulloblastoma, multiple stage surgery, chemotherapy

We report a very unusual case of giant medulloblastoma with supratentorial extension of a 3-year-old boy, who had been treated over a two-year period. As he was considered at the eleventh month of life, as a case out of surgical resources because of poor prognostic and a short life expectancy, the child was operated eight months later in our department despite the huge dimensions of infra and supratentorial tumoral extensions. Adequate chemotherapy regimen conducted to decrease and even neuroradiological disappearance of some tumor reminiscence after subtotal surgical ablation. The purpose of this case study is to discuss certain aspects of the sequential surgical treatment and associate chemotherapy, and also to discuss where the limits are, if there are any in the multimodal treatment. We consider it a very illustrative case for what surgery along with adequate regimen of chemotherapy can obtain in patients under 3 years old with radiosensitive tumors: it prolongs survival over 3 years and makes children able to benefit from radiotherapy at appropriate age.

The clinical expertise of the emergency hospital "Bagdasar - Arseni" in the complex rehabilitation of post-traumatic brain injury patients
Assoc. Prof. Onose G. MD, PhD, Prof. Ciurea A.V. MD, PhD, Virginia Rotarescu, senior clinical psychologist, Anghelescu A. MD, Anca Mihaescu, senior therapist, Mardare D.C. senior therapist, Cristina Chendreanu MD, Monica Haras MD, Doina Georgescu senior sociologist
The Clinical Emergency Hospital "Bagdasar-Arseni", Bucharest, Romania
Keywords: TBI, neuroprotection, complex & syncrethic management, motor-sensitive / psycho-cognitive rehabilitation, family / social / professional re-integration/insertion, QOL

Objective. To systematically evaluate the outcomes we obtained in the complex rehabilitation of post-traumatic brain injury (TBI) patients compared to similar approaches. Material and methods. This study is a retrospective statistical analysis on a series of 333 post-TBI patients - 245 males and 88 females - with the mean age around 40 years, most of them married, transferred to our PRM clinic division, during 2001-2005. To assess the motor-functional/ independence status and its evolution / outcomes, at admission and at discharge, we used a simplified by us, mixture (from seven to four levels, respectively, from six to four grades), of the FIM instrument (by the State University of New York at Buffalo / UBFA, 2007) and of the modified Rankin, scales. For assessing speech disorders, at admission and at discharge, the aphasia classification we used, comprised (also) four levels: from very severe (global), to mild (moderate anomic and respectively, disarthria). The psychological aspects were recorded in two moments: the initial evaluation (45 patients-at their discharge) and the final one (30 patients-after one year), using: MMSE, Hamburg-Wechsler Intelligence Scale, Cattell Anxiety Questionnaire, SF-8TM and respectively, the "Behavior and Mood Evaluative" Scale. All the collected data were processed with the Statistical Package for Social Sciences (SPSS10.0): descriptive, correlative, differential/inferential. Results and discussions.
The main causes of TBI were: car accidents = 194 cases (58.2%), falls from height = 63 cases (18.9%), aggressions = 44 cases (13.2%), other causes = 32 patients (9.6%). Regarding the motor-functional/ independence outcome status, the statistical analysis showed that this correlated with the at admission levels: the better the initial state, the better the final one. As for speech disorders, 121 (36.3%) patients presented aphasia; at discharge, 117 (96.7% of them were ameliorated (in very large variable amounts, ranging from 25% to 8000%) and 4 (3.3%) were stationary. Concerning family re-integration, 270 (81%) of our patients were completely re-integrated in their families environment, 15% only partially and almost 4% were no longer accepted by their families. As for the professional re-insertion, farmers/peasants (65.8%) and respectively, college students & pupils (8-18 years old: 65.2%), achieved the highest levels of occupational re-integration, in contrast with graduated employees, followed by undergraduates, who showed the smallest amount of professional re-insertion: 79% and respectively, 52% of them, retired / quit high schools because of their post-TBI sequels. Towards the global perception on their quality of life (QOL), our patients displayed an improving trend during the first year after TBI, from - initially - a negative perception, to a positive one: finally, 97% appreciated they were satisfied with their (late) post-TBI lives. Conclusions. Our results - including especially the rehabilitation outcomes - are quite similar to those obtained and published by other rehabilitation centers, worldwide. As confirmed at the 4 International Conference of Academia Multidisciplinaria Neurotraumatologica (AMN - Copenhagen, 2006), the 333 patients we studied represent, to date, the largest post-TBI case series, internationally.