L L Frâncu’s research while affiliated with Grigore T. Popa University of Medicine and Pharmacy and other places

This article revises the evolution of the concept "informed consent" in medical and stomatological practice, insisting on the legislation that supports it: intergovernmental instruments, but also the Romanian law, including the deontological code of the dentist. The discussions carried out with the purpose of obtaining the patient's consent include the nature of the procedure and reasonable alternatives of the proposed intervention, the risks and benefits of the treatment, the cost of the interventions and, finally, the acceptance or refusal of the stomatological procedure by the patient. There are three major obstacles that prevent a good communication between the dentist and the patient: the differences of language, of culture and the alteration of communication between dentist and patient during treatment. On the other hand, the adequate quality of the information depends firstly on the rational standard of the dentist, but also on the rational standard of the patient. We insist on the attributes of the informed consent and, finally, we revise the misunderstandings and disagreements that may come up between the dentist and the patient, most of them due to the dentist's misinterpretation of some facts. It is necessary to increase the standard of the informed consent by post university training for the dentists, by increasing the patients' awareness regarding the necessity of a much more explicit consent, by accepting the educational role of the dentist.

Morphological alterations of peritoneum in chronically dialyzed patients involve fibrosis and angiogenesis as pathogenic mechanisms. The aim of this retrospective study was to evaluate morphological changes of peritoneum in chronic peritoneal dialysis (PD) at 4, 8, 12, and 14 years. Peritoneal changes were investigated in 110 patients with end stage renal failure, which were included in a PD program. Intraoperative biopsies were grouped in four study Groups (A: 1-48 months, B: 49-96 months, C: 97-144 months, and D: 145-168 months), and were processed histologically and stereologically. Mesothelial denudation was found in percentage volumes of 5.49% - Group A, 16.10% - Group B, 16.68% - Group C and 19.88% - Group D. Reduplication of the basement membrane was observed in patients with over five years of PD. Interstitial stromal fibrosis recorded percentage volumes of 25.49% (Group A), 26.10% (Group B), 35.85% (Group C) and 56.63% for the patient with 14 years of PD. Subendothelial hyalinizing vasculopathy was recorded in percentage volumes of 2.22%, 6.63%, 9.16% up to 9.20%. Vascular permeability reduction was recorded as decreasing percentage volumes from 22.59% to 12.81%, 7.77% and 7.37%. Perivascular inflammation was marked in the serosa of the patients in Group A (4.55%). Calcifications recorded percentage volumes of 1.63% at eight years, 3.74% at 12 years and 4.03% at 14 years of PD. Peritoneal morphological changes appear at 3-4 years of PD and progressively aggravate with long-term PD.

Twenty-two cases with gastrointestinal stromal tumors (GISTs) have been studied, sized from 2 cm to invasive gigantic tumors and also from low to high degree of malignancy. The altering of the form and the size of the nucleus is a reference point of malignancy, being used in the histological grading of many types of tumors and also as an appreciating parameter of the tumoral prognosis, with a high degree of accuracy in the colorectal, uterine, prostatic or ovarian cancers, as it was pointed in the previous researches. The aim of this study is to evaluate the dimensional characteristic of the nuclei and the mitosis in GIST with a cholic and gastric localization, attempting a quantitative differentiation of the two tumors, by studying the following aspects: nuclear dimensions, mitotic activity index and the mitotic density. The results of the proliferative activity quantification (mitotic activity index and mitotic density) have shown that this can be a decisive criterion for the precocious appreciation of the evolution. The most important morphological criterion with a predictive role is the mitotic activity index, but is recommended to be applied correlated with the size and the localization of the tumor. Although various nuclear morphometry studies in different types of malignant tumors have been performed, the data in gastrointestinal stromal tumors is scarce and only few similar studies have been reported in the specialty literature; from this point of view, the present study is new and original and is also trying to point out that even with GIST, such analysis and prognosis is as valuable as in any other malignant diseases.

Esophageal cancer has always been subject of research for various studies. According to some authors, esophageal cancer represents the 10th leading cause of cancer in the world with a 5-year survival of 10 %. In terms of anatomopathological form of the esophageal neoplasia, the literature mainly describes two major pathological types: adenocarcinoma and esophageal squamous cell carcinoma. Lately there has been an increased incidence of esophageal adenocarcinoma. The aim of the present work was to study neoangiogenesis in esophageal adenocarcinomas. The study was conducted on 40 cases diagnosed and surgically treated. Subsequently, fragment processing was performed using various immunohistochemical staining and marking with CD34 and p53 antigen. Later, quantitative measurements were performed, and images were taken using a microscope imaging system. In the end of the procedures, the professional program PRODIT 5.2. was applied. The study of the vascular system in the esophageal epithelial tumors revealed an axis consisting of three elements which have a mutual induction process: inflammatory infiltrate—neoangiogenesis—fibrosis, with significant differences between the three degrees of differentiation. A significant increase in tumor micro vascular density was present together with the increasing of the histological grading, with an inverse correlation with the degree of differentiation and directly proportional to the risk of malignancy.

Psychiatric disorders are known to be a risk factor for the development of many problems regarding oral health status. Schizoaffective disorder is a mental disorder closely related to the other two conditions, namely schizophrenia and an affective disorder associated with depression or bipolar behavior. This study evaluated the oral health effects of schizoaffective disorder and side effects of medications used to treat this disorder. Oral health status in patients with schizoaffective disorder is more precarious, most of them presenting extensive or total edentations. Negative symptoms of mental disorder contribute to an inappropriate oral health status and impede the oral rehabilitation of these patients. Treatment plan of a patient with psychiatric disorders and medication induced xerostomia is complicated by the fact that medication can not be stopped, replaced or changed

DENTAL EROSION AND OTHER ORAL ANATOMICAL CHANGES CAUSED GASTROESOPHAGEAL REFLUX (Abstract): Gastroesophageal reflux can cause oral pathological changes. Dental erosion is the predominant oral manifestation of the disease and allows the dentist to make the initial diagnosis. Undiagnosed erosion can cause devastating damage to the dentition over time. Patients were not aware of the underlying condition. The causes of erosion are difficult to define without a detailed history. Erosive lesions were present in various degrees in the same patient, maxillary teeth showing greater erosive lesions in comparison with the lower teeth. Dentists must be familiar with typical and atypical symptoms of the disease because they could be the first to suspect the presence of the disease by observing dental erosion that cannot be explained. The consequences of intrinsic erosion are often severe and require a complex restorative treatment to restore tooth tissue loss. Key words: GASTROESOPHAGEAL REFLUX, TOOTH EROSION, ORAL EFFECTS OF GASTROESOPHAGEAL REFLUX

LINGUAL PIERCING: DENTAL ANATOMICAL CHANGES INDUCED BY TRAUMA AND ABRASION (Abstract): Rising popularity of lingual piercing among young people alarm doctors everywhere. The tongue is the most prevalent oral piercing site, typically pierced in the midline and just anterior to the lingual frenum. The purpose of this study to highlight the side effects of lingual piercing, paying particular attention to dental anatomy changes pursuant to this unusual practice. The evaluated patients in this study were not aware or informed of any consequences that could result from the piercing procedure. Long-term chronic complications arise as a result of the constant trauma exerted by the metal bar, such as broken teeth, fracture of fillings, abrasion, gingival trauma, localized gingival recession. Dentists should be aware of the sequelae that may occur as a result of this practice and to perform an active role in convincing these patients to remove these ornaments.

POST APIECETOMY RECCURRENCE: ANATOMIC CONDITIONS, ORTHOGRADE RE-TREATMENT (Abstract): Orthograde approach of chronic apical periodontitis recurrence after endodontic surgery is a huge challenge for the dentist. Success rates ranging from 25 to 90% for surgical endodontic procedures have been reported in the literature. The causes of failure can be iatrogenic, biological (infection), diagnostic errors, fractures, and adverse reaction to retrograde filling materials. A number of other factors can affect prognosis in periradicular surgery, including patient demographic and systemic condition, tooth involved (type, number and location), amount and location of bone loss, quality of previous root canal treatment or retreatment, coronal restoration, occlusal microleakage, surgical materials and techniques, and surgeon skills. In this article the authors present several cases successfully treated. After clinical and radiological examination of the patient, we discovered several areas of disease recurrence. We disinfected the endodontic system then proceeded to orthograde filling with MTA. Recall radiographs at 6 months confirmed the lesion was diminishing, that is it was healing. The use of magnification may influence outcomes simply by enhancing practitioner’s visual acuity, although there are no data to support this. The availability of a root-end filling material, such as MTA, offers advanced components that promote healing in the periradicular tissues. This report presents three cases of chronic apical periodontitis recurrence after surgical treatment treated by orthograde approach.

Gastroesophageal reflux can cause oral pathological changes. Dental erosion is the predominant oral manifestation of the disease and allows the dentist to make the initial diagnosis. Undiagnosed erosion can cause devastating damage to the dentition over time. Patients were not aware of the underlying condition. The causes of erosion are difficult to define without a detailed history. Erosive lesions were present in various degrees in the same patient, maxillary teeth showing greater erosive lesions in comparison with the lower teeth. Dentists must be familiar with typical and atypical symptoms of the disease because they could be the first to suspect the presence of the disease by observing dental erosion that cannot be explained. The consequences of intrinsic erosion are often severe and require a complex restorative treatment to restore tooth tissue loss.

Tooth luxation, abnormal dislocation of the tooth within the socket caused by traumatic injury of the dentoalveolar ligament, has a prevalence ranging between 15% and 61%. The clinical manifestations are various and differ from patient to patient depending on the type of trauma but also on previous dental status. Of the 135 patients with posttraumatic luxation we report 2 cases which had a particular course requiring a certain type of restorative approach that allowed us to pinpoint some compulsory steps in the diagnosis and treatment. The patients were monitored with respect to pulp response and occurring complications, and the restorative options are discussed. The prosthetic treatment recommended in case of frontal teeth loss as a result of dentoalveolar trauma is represented by dental implants that support fixed dentures that resemble the missing teeth.