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Papers by mariana mihaila

Gastroenterology Insights

Foreign bodies in the digestive tract represent a frequent pathology for the emergency service. F... more Foreign bodies in the digestive tract represent a frequent pathology for the emergency service. Foreign bodies are represented by impacted food bolus or voluntarily and involuntarily swallowed objects. Involuntary swallowing of objects occurs most frequently in children, especially between six months and three years of age. Food impaction is mostly encountered among adults with different pathologies. For the removal of swallowed foreign bodies, digestive endoscopy is the gold standard method, being successful in over 95% of cases without significant complications. For the endoscopic management of foreign bodies, it is crucial to be aware of the indications, devices, techniques and patient preparation in order to achieve successful and safe removal from the digestive tract. Recommendations in this article are based on a review of the literature and extensive personal experience.

Journal of Clinical Medicine

Background: Liver failure represents a life-threatening organ dysfunction with liver transplantat... more Background: Liver failure represents a life-threatening organ dysfunction with liver transplantation as the only proven curable therapy to date. Liver assist devices have been extensively researched to either bridge such patients to transplantation or promote spontaneous recovery. The aim of our study was to compare two such devices, the Molecular Adsorbent Recirculating System (MARS) and CytoSorb, in patients with liver failure. Methods: We retrospectively included 15 patients who underwent MARS during their intensive care unit stay and matched them to 15 patients who underwent hemoadsorption using CytoSorb. Clinical and paraclinical data obtained after each individual session, after the course of treatment, as well as at the end of the intensive care unit stay were compared between the two groups. Results: Single sessions of CytoSorb and MARS were both associated with a significant decrease in bilirubin (p = 0.04 and p = 0.04, respectively) and ammonia levels (p = 0.04 and p = 0.0...

Surgery, Gastroenterology and Oncology

We present the case of a 62 year old male with no relevant medical history, who for the last two ... more We present the case of a 62 year old male with no relevant medical history, who for the last two months had been complaining of dysphagia for solids and liquids, marked physical fatigue, oliguria. Clinical examination revealed palor and dehydrated skin, as well as a tumoral mass of 10/10 cm palpable in the upper abdomen. Upper digestive endoscopy was performed, showing a vegetant lesion of 6 cm on the gastric angle, with a central ulcer of 4 cm. The oesophagus and duodenum were normal, and Helicobacter pylori test was negative. Histological exam from the gastric lesion revealed diffuse large-cell malignant lymphoid tumoral proliferation, with tumoral cells infiltrating the mucosa between the glands. Immunohistochemical analysis diagnosed B cell lymphoma. CT scan of the thorax, abdomen and pelvis was performed, revealing multiple tumors involving the gastric walls, the posterior parietal peritoneum, the intra-peritoneal fat, the pancreatic tissues and the right antero-inferior mediastinum, as well as multiple adenopathies on both sides of the diaphragm and ascites. We performed paracentesis, and malignant cells were detected in the peritoneal fluid. Bone marrow biopsy was normal. The patient was referred to the hematology department for treatment. He received chemotherapy including CHOP followed by RICE with the disappearance of the gastric tumor on upper endoscopy and the disappearance of peritoneal, mediastinal and pancreatic region tumors with the persistence of a circumferential thickening of the horizontal gastric region walls on CT reevaluation.

Surgery, Gastroenterology and Oncology

Budd-Chiari syndrome (BCS) represents a rare medical entity which has an estimated incidence of 0... more Budd-Chiari syndrome (BCS) represents a rare medical entity which has an estimated incidence of 0.1 to 10 people per million every year. It is defined by the obstruction of the flow in the inferior vena cava or the hepatic veins. Various classifications have been proposed. So, it can be acute or chronic and primary or secondary. The chronic form is more frequent and is characterized by signs of portal hypertension. Liver transplantation is the ultimate therapeutic management of Budd-Chiari syndrome. Primary BCS is mostly a result of hematological disorders and hypercoagulable conditions. Secondary BCS appears due to invasion or extrinsic pressure of the veins from various reasons, including hepatocellular carcinoma (HCC), liver abscesses and cysts. We presented a rare case of a young lady with Budd Chiari syndrome and IVC thrombosis who were transplanted with hepatic left lobe from her sister.

Diagnostics

Hereditary hemorrhagic telangiectasia (HHT) has significant morbidity due to multiorgan involveme... more Hereditary hemorrhagic telangiectasia (HHT) has significant morbidity due to multiorgan involvement and an unpredictable disease course. We analyzed the data of 14 patients diagnosed with HHT. The case series comprised 14 patients with a median age at presentation of 48 years old (41–74 years). In twelve patients (85.7%), the diagnosis was confirmed by using the Curacao Criteria. The most common reason for admission was epistaxis, with 9 patients (57%) presenting with nosebleed refractory to prolonged self-tamponade. The biochemical abnormalities identified were elevations in AP and gamma-GT; liver synthetic function was generally normal, even though 21% of patients had clinical or imaging findings for cirrhosis. Nosebleeds were the main reason for admission and significantly impacted quality of life through anemia and frequent hospital admissions. However, the visceral manifestations seemed to be more serious. The hepatic arteriovenous malformations (AVMs) appeared to remain asympt...

BMC Anesthesiology

Background Video-assisted surgery has become an increasingly used surgical technique in patients ... more Background Video-assisted surgery has become an increasingly used surgical technique in patients undergoing major thoracic and abdominal surgery and is associated with significant perioperative respiratory and cardiovascular changes. The aim of this study was to investigate the effect of intraoperative pneumoperitoneum during video-assisted surgery on respiratory physiology in patients undergoing robotic-assisted surgery compared to patients undergoing classic laparoscopy in Trendelenburg position. Methods Twenty-five patients undergoing robotic-assisted surgery (RAS) were compared with twenty patients undergoing classic laparoscopy (LAS). Intraoperative ventilatory parameters (lung compliance and plateau airway pressure) were recorded at five specific timepoints: after induction of anesthesia, after carbon dioxide (CO2) insufflation, one-hour, and two-hours into surgery and at the end of surgery. At the same time, arterial and end-tidal CO2 values were noted and arterial to end-tid...

Current Issues in Molecular Biology

Background: Neuroendocrine neoplasms are a heterogeneous group of tumors that raise challenges in... more Background: Neuroendocrine neoplasms are a heterogeneous group of tumors that raise challenges in terms of diagnosis, treatment and monitoring. Despite continuous efforts, no biomarker has showed satisfying accuracy in predicting outcome or response to treatment. Methods: We conducted a systematic review to determine relevant circulating biomarkers for angiogenesis in neuroendocrine tumors. We searched three databases (Pubmed, Embase, Web of Science) using the keywords “neuroendocrine” and “biomarkers”, plus specific biomarkers were searched by full and abbreviated name. From a total of 2448 publications, 11 articles met the eligibility criteria. Results: VEGF is the most potent and the most studied angiogenic molecule, but results were highly controversial. Placental growth factor, Angiopoietin 2 and IL-8 were the most consistent markers in predicting poor outcome and aggressive disease behavior. Conclusions: There is no robust evidence so far to sustain the use of angiogenic bioma...

Buletinul Academiei de Ştiinţe a Moldovei. Ştiinţe Medicale, 2006

Un moment crucial în dezvoltarea chirurgiei hepatice şi a transplantului românesc îl reprezintă i... more Un moment crucial în dezvoltarea chirurgiei hepatice şi a transplantului românesc îl reprezintă introducerea transplantului de fi cat în România. Primul transplant hepatic (TH) cu supravieţuire a fost realizat în România în Centrul de Chirurgie Generală şi Transplant Hepatic din Institutul Clinic Fundeni în aprilie 2000. Experienţe preliminare au constituit subiectele unor studii anterioare [1,2]. Lucrarea de faţă analizează experienţa acumulată din anul 2000 până în luna aprilie 2006 în TH ortotopic cu fi cat întreg de la donator decedat la pacienţi adulţi (THO). Material şi metode: În perioada aprilie 2000-aprilie 2006 în Centrul de Chirurgie Generală şi Transplant Hepatic din Institutul Clinic Fundeni au fost realizate 45 de TH cu fi cat întreg de la donator decedat la pacienţi adulţi. Datele generale ale seriei sunt prezentate în tab. 1. Tabelul 1 Datele generale ale pacienţilor cu THO Raport Femei/Bărbaţi 20/25 Vârsta 19-57 ani Media vârstei 45 ani

Surgery, Gastroenterology and Oncology, 2021

Background: The liver transplantation program of Fundeni Clinical Institute reached a milestone (... more Background: The liver transplantation program of Fundeni Clinical Institute reached a milestone (1000 operations performed by the same team in 20 years). It is a program for both adults and children, including cadaveric and living donor liver transplantations. We analyze the indications and results to emphasize the advantages of a combined program. Methods: Between April 2000 and March 2020, 957 patients received 1,000 LTs at a single institution (Fundeni Clinical Institute, Bucharest, Romania). The demographics of donors and recipients, indications for liver transplantations, surgical procedures and results were analyzed. Results: Deceased donor liver transplantation (DDLT): 831 DDLTs in 790 patients (83.1%): whole LT in 769 patients (80.4%), split LT in 17 patients (2%), reduced-size LT in 2 patients (0.5%), auxiliary LT in 1 patient (0.1%) and domino LT in 1 patient (0.1%). Living donor liver transplantation (LDLT): 169 LDLTs in 167 patients (17.2%) using right hemiliver in 121 patients (12.6%), left lateral section in 28 patients (2.9%), left hemiliver in 9 patients (0.9%), left hemiliver with segment 1 in 6 patients (0.6%), and dual graft LDLT in 3 patients (0.3%). Overall major morbidity rate was 42.2% (422 patients), while perioperative mortality was 8.3% (79 patients). Retransplantation rate was 4.5% (43 patients). The estimated 1-, 3-, 5and 10-year overall survival rates for LT patients were 82.3%, 77.8%, 76.3% and 71.2%, respectively. Conclusions: A combined cadaveric and living donor LT program including all surgical variant LT procedures offers the possibility to increase the volume with the well-known consequences on the postoperative results. The living donor program has a positive influence on the waiting list mortality; using both cadaveric and living donors enhance the possibilities in the case of an urgent retransplantation.

Without a doubt, the inflammation is a key process in liver pathology. At the same time, it repre... more Without a doubt, the inflammation is a key process in liver pathology. At the same time, it represents the liver response to different and constant types of aggressions such as viral infections, alcohol, and drug-toxicity. According to current evidence, the liver inflammation activates immune cells such as Kupffer cells, innate macrophages, monocytes, natural killer cells, neutrophils and other granulocytes, and dendritic cells. All of them contribute to liver inflammation. Herein, we try to underline the basic knowledge of human liver inflammation.

Romanian Journal of Neurology, 2017

We report the case of a 62-year old patient who presented a rare association of Mycosis fungoides... more We report the case of a 62-year old patient who presented a rare association of Mycosis fungoides, a subtype of cutaneous T-cell lymphoma and sensorimotor axonal neuropathy. Usually, leptomeningeal dissemination and central nervous system involvement are much more frequently encountered in cases of Mycosis fungoides with extracutaneous spread and only few case reports describe the involvement of peripheral nerves. The challenge in our case was to correlate a possible etiopathogenic factor with the polyneuropathy. Although, it was most probably a paraneoplastic manifestation, the associated neuropathy could have had other possible pathogenic mechanisms.

Revista Romana de Medicina de Laborator, 2018

Background: Severe complications of chronic hepatitis C – i.e. cirrhosis and hepatocellular carci... more Background: Severe complications of chronic hepatitis C – i.e. cirrhosis and hepatocellular carcinoma – are important causes of morbidity and mortality worldwide. Despite the overwhelming rates of sustained virologic response achieved after therapy with different combinations of direct-acting antiviral drugs (DAAs), treatment failure is still recorded, and is due to the mutations harboured by hepatitis C virus (HCV) resistance associated variants (RAVs) selected during therapy. Baseline RAVs testing was found significant for guiding treatment in the cases of treatment failure and, sometimes, in naïve patients. Methods: Romanian chronic hepatitis C patients unexposed to DAAs and infected with subtype 1b HCV were studied. Serum samples were used for Sanger population sequencing of a fragment containing NS3 viral protease, known to harbour resistance mutation against protease inhibitors (PIs). Results: Catalytic triad and zinc-binding site in the studied sequences were conserved. Low-i...

Chirurgia (Bucharest, Romania : 1990)

Journal of Translational Medicine and Research, 2015

Background: Liver transplantation (LT) has become an established treatment for end-stage liver di... more Background: Liver transplantation (LT) has become an established treatment for end-stage liver disease, with more than 20.000 procedures yearly worldwide. The aim of this study was to analyze the results of Romanian National Program of LT after 15 years of activity. Methods: Between April 2000 and April 2015, 648 pts received 678 LTs in Romania. Male/female ratio was 382/266, while adult/pediatric ratio was 588/60, with a mean age of 45 years (median 50 yrs; range 7 months-68 yrs). Main LT indications were HBV-related cirrhosis (176 pts; 27.1%), hepatocellular carcinoma (128 pts; 19.7%), and HCV-related cirrhosis (118 pts; 18.2%). Waiting time and indications for LT, patient and donor demographics, graft features, surgical procedures, and short and long-term outcomes were analyzed. Results: DDLT was performed in 532 pts (82.1%): whole LT in 512 pts (79%), split LT in 16 pts (2.5%), reduced LT in 2 pts (0.3%), and domino LT in 2 pts (0.3%). LDLT was performed in 116 pts (17.9%): right hemiliver in 78 pts (12%), left lateral section in 26 pts (4%), left hemiliver in 7 pts (1.1%), left hemiliver with segment 1 in 3 pts (0.4%), and dual graft LDLT in 2 pts (0.3%). Overall major morbidity rate was 43.8% (284 pts), while perioperative mortality was 7.9% (51 pts). Retransplantation rate was 4.6% (30 pts): 23 whole LTs, 3 reduced LTs, 3 split LTs, and 1 LDLT. Long-term overall 1-, 3-, and 5-year estimated survival rates for patients were 88.8%, 82.5%, and 79.2%, respectively, while for transplanted grafts were 77.9%, 71.6%, and 68.8%, respectively (p<0.001). Median waiting time for LT decreased significantly over time: from 107, 99, 51, and 45 months to 28, 18, 34, and 20 months in case of 0I, AII, BIII, and ABIV group pts, respectively. One-year overall mortality on waiting list also decreased significantly over time from 31.4% to 11.8%. Conclusions: The liver transplantation program in Romania addresses all causes of acute and chronic liver failure or liver tumors in adults and children, using all surgical techniques.

Romanian Journal Of Internal Medicine, 2016

We present the case of a 76 year old female patient admitted in the Department of Cardiology for ... more We present the case of a 76 year old female patient admitted in the Department of Cardiology for physical asthenia, profuse sweating and dyspnea with orthopnea for about one month. Clinical and paraclinical assessments performed at admission confirmed the diagnosis of cardiac tamponade. Surgical intervention was performed and 400 mL of clear effusion were drained. Post-operative evolution was marked by recurrence of symptoms, requiring after 3 weeks a new drainage of 600 mL of clear effusion, and biopsy of the pericardium was performed. Pathological exam described serous pericarditis with chronic inflammatory infiltrate, xanthogranulomatous reaction intricated in the pericardium and mesothelial hyperplasia. The patient was subsequently transferred to the Department of Internal Medicine for further investigations. Physical examination showed a patient with altered general status, pallor, vesicular murmur absent in both bases, presenting cutaneous hyperpigmentation at the level of the...

Romanian journal of gastroenterology, 2002

Liver transplant currently represents the therapeutic method for irreversible acute and chronic l... more Liver transplant currently represents the therapeutic method for irreversible acute and chronic liver diseases without any other available therapy. In some cases, before or after liver transplantation, it is necessary to replace the functions of the liver. We report the case of a 7 year-old female patient with type I glycogenosis who was transplanted in July 2001 using living-related donor transplantation and who developed chronic rejection two months later. In this case, we used MARS (Molecular Adsorbents Recirculating System) detoxification therapy to optimise the patient's clinical and biological status and to create a bridge that allowed the patient's survival until retransplantation was available. The therapy was well tolerated, with no major incidents. We noted favourable clinical effects and significant improvement in serum bilirubin level, urea nitrogen level and serum creatinine level. We consider that MARS treatment is a temporary solution for patients with acute a...

Liver Tumors - Epidemiology, Diagnosis, Prevention and Treatment, 2013

Transplantation, 2008

Introduction: Graft failure after liver transplantation remains an important cause of graft loss ... more Introduction: Graft failure after liver transplantation remains an important cause of graft loss and leads to patient death or retransplantation, resulting in lower survival rate. The purpose of this study was to evaluate the epidemiologic and cause of graft failure and fi nd out the risk factors infl uencing graft failure after adult living donor liver transplantation (LDLT). Method: We analyzed 286 patients among 330 patients who underwent adult LDLT from May 1999 to Jan. 2008, in which was consisted of 28 patients in graft failure group and 258 patients in control group. The patient with graft failure was divided to two groups according to period of graft failure, early failure, before discharge after transplantation and later failure, after discharge. Result: There was no signifi cant difference between two groups in preoperative and operative factors. The 11 patients were suffered from early graft failure and their causes consisted of 7 in vascular problem and 4 in graft dysfunction and the only one patient survived after retransplantation. The late graft failure occurred in 17 patients and the biliary complications including biliary leakage or strictures were the main causes of failure in 9 patients, and other causes consisted of hepatic artery or vein stenosis and TACE complication for recurrent HCC. Among them, the 4 patients survived after retransplantation, and 1 patient died of graft dysfunction in spite of retransplantation. Conclusion: The main causes of graft failure after LDLT originated from technical problem and to prevent the graft failure, meticulous surgical technique is required. After graft failure, considering retransplantation is important to increase the survival rate.

Transplantation, 2003

Domino liver transplantation is one possibility to overcome the discrepancy between the small num... more Domino liver transplantation is one possibility to overcome the discrepancy between the small number of liver donors and the long waiting lists. Homozygous familial hypercholesterolemia (FHC) is a genetic disorder of lipoprotein metabolism defined by the absence or small number of functional low-density lipoprotein receptors (LDL-Rs) and the ensuing high levels of serum cholesterol. We report a case of a patient with FHC whose liver was used for domino transplantation in a patient with cirrhosis and hepatocellular carcinoma. The patient diagnosed with FHC received the large part of a split liver. The liver of the patient with FHC was then transplanted into the patient with cirrhosis and hepatocellular carcinoma. Quantification of extrahepatic LDL-R was performed by flow cytometry on monocytes, and the gene expression of LDL-R was assayed by reverse transcriptase-polymerase chain reaction on monocyte-derived macrophages and cultured fibroblasts isolated from the patients. One year after surgery, the donor&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s serum cholesterol (without treatment) was normal, and the recipient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s serum cholesterol (with simvastatin treatment) was slightly increased. Quantification of peripheral LDL-R on monocytes isolated from the patients revealed values of 6.7% in the patient with FHC and 71% in the patient with cirrhosis and hepatocellular carcinoma. The reverse transcriptase-polymerase chain reaction assay revealed the presence of gene expression for LDL-R. Domino transplantation can be efficiently used in a patient with marginal indications for transplantation using a liver from a patient with FHC. The slightly elevated serum cholesterol level in the recipient may be explained by the normal function of extrahepatic LDL-R.

Transplantation, 2008

variation of INR, creatinine and bilirubin, MELD score variation in the last 3 months (p<0.0001 f... more variation of INR, creatinine and bilirubin, MELD score variation in the last 3 months (p<0.0001 for each), as well as INR (p<0.0001), creatinine (p=0.01) and bilirubin (p<0.0001) variation in the last 3 months. The independent predictors of death on our WL were: current MELD score (p=0.0006), refractory ascites (p=0.001), renal failure (p=0.01), hepatic encephalopathy (p=0.03). Based on a logistic regression analysis a new score has been developed including these independent predictors of death on the WL: Score= 1/(1+ exp(-(-4.59 + 1.51 x Refractory ascites + 0.18 x Current MELD), where refractory ascites is registered as 1 if the event occurs. The c-statistic for the new score for prediction of death on the WL was 0.84 compared to 0.80 for current MELD score. Conclusion: Refractory ascites should add valuable points to the current MELD in order to better prioritize for liver transplantation patients included on large WL.

Gastroenterology Insights

Journal of Clinical Medicine

Surgery, Gastroenterology and Oncology

Diagnostics

BMC Anesthesiology

Current Issues in Molecular Biology

Buletinul Academiei de Ştiinţe a Moldovei. Ştiinţe Medicale, 2006

Surgery, Gastroenterology and Oncology, 2021

Romanian Journal of Neurology, 2017

Revista Romana de Medicina de Laborator, 2018

Chirurgia (Bucharest, Romania : 1990)

Journal of Translational Medicine and Research, 2015

Romanian Journal Of Internal Medicine, 2016

Romanian journal of gastroenterology, 2002

Liver Tumors - Epidemiology, Diagnosis, Prevention and Treatment, 2013

Transplantation, 2008

Transplantation, 2003

Transplantation, 2008