Author Archives: administrare

Asymptomatic Myxomatous Degeneration of the Mitral Valve, in a Young Male

DOI: 10.2478/amma-2020-0018

Background: In young patients, the most common cause of mitral valve regurgitation is prolapse or flail of the valve, which is morphologically reflected by myxomatous degeneration. In rare cases, such this presented in this paper, this lesion might be incidentally identified, in young people.
Case presentation: A 43-year-old male, with familial history of hypertension, presented in our Department of Cardiology for a routine check-up. Despite of lack of symptoms, an intense murmur was detected at mitral auscultation area. The echocardiography revealed a severe mitral regurgitation caused by flail of posterior mitral valve. The patient was transferred to the Cardiac Surgery Department for surgical intervention consisting in mitral valve repair. The histopathological examination revealed severe myxomatous degeneration of the spongiosa and fibrosa layers. The recovery after surgery was very good with no postoperative complications. The patient was discharged seven days after surgery, with no significant mitral regurgitation at the three-month follow-up.
Conclusions: In young, asymptomatic patients, the proper time for mitral valve repair should be decided by an interdisciplinary team. For a better understanding of myxomatous degeneration particularities, histopathological assessment should be done in any replaced valve. Certification of such lesions, under microscope, might be an indicator for familial cardiovascular screening, in first degree relatives.

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Establishing the Diagnostic and Prognostic Value of Serum Interleukin 6 Levels in Sepsis

DOI: 10.2478/amma-2020-0014

Objective: Establishing a serological profile of interleukin 6 (IL-6) in order to evaluate its usefulness as a biological marker for the diagnosis and early prognosis in sepsis.
Materials and Methods: The study included 246 individuals, divided into 2 groups: 131 in the septic subgroup (S) and 115 in the septic shock (SS) subgroup. Inflammatory markers, bacteriological examinations and laboratory samples were determined within 24 hours of the first signs of infection. Severity scores were also calculated within the first day of the onset of sepsis.
Results: The SS subgroup (median 121.2 pg/ml, 18.59-10235 pg/ml; SD = 1920) shows significantly higher values of IL-6, compared to the S subgroup (median 43.49 pg/ml, 13, 27-6566 pg/ml; SD = 1367) (p = 0.0026). The SS subgroup has a significantly higher death rate than S subgroup (p = 0.001). The cut-off values of the mortality prediction degree were 184.74 pg/ml. The area under the curve of the cytokine IL-6 for the differentiation of sepsis from septic shock was 0.693 (95% CI 0.582-0.790, p = 0.002). The optimal value of the cut-off that allows the differentiation of the septic subgroup from the one with organ dysfunction, was 52.72 pg / ml.
Conclusion: Serum IL-6 values are significantly higher in the septic shock group. All deceased patients had higher IL-6 serum values.

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Effect of Isoflurane Anesthesia on the Heart Rate and Blood Pressure Response to Autonomic Nervous System Stimulation and Inhibition in Rats

DOI: 10.2478/amma-2020-0016

Objective: Many experimental studies aim to assess the autonomic nervous system (ANS), but this is often hampered by interactions with anesthetic drugs. We aimed to evaluate whether isoflurane anesthesia is suitable for ANS evaluation in rats.
Methods: Six Wistar rats were anesthetized with isoflurane (4 L/min, 2.5%). Systolic blood pressure (SBP) and heart rate (HR) were measured at baseline and 20 min after sympathetic inhibition (propranolol, 5 mg/kg) and stimulation (isoproterenol, 2.5 mg/kg), and parasympathetic inhibition (atropine nitrate, 2 mg/kg) and stimulation (carbamylcholine, 0.4 mg/kg; acetylcholine, 0.1 mg/kg). Six additional rats were used to assess the effects of isoproterenol, carbamylcholine, and atropine nitrate in the absence of anesthesia.
Results: Propranolol significantly decreased the HR and the SBP, whereas isoproterenol significantly increased the HR (all p≤0.01) in the isoflurane-anesthetized rats. However, the HR response to sympathetic stimulation was significantly reduced in the anesthetized compared to the non-anesthetized rats (p=0.03). Carbamylcholine and acetylcholine significantly decreased both the HR and SBP (all p<0.05) in the anesthetized rats, but the response to carbamylcholine administration was significantly more pronounced in the non-anesthetized rats (p=0.03). Atropine nitrate significantly increased the HR (p<0.001) in the non-anesthetized rats, but it had no effect on either the HR or the SBP in the presence of isoflurane anesthesia (both p>0.05).
Conclusions: Isoflurane anesthesia appears to interfere with both components of the ANS and is therefore not an optimal approach for experimental ANS evaluation. Our data indicate autonomic receptors and/or post-receptor mechanisms as the most likely site for isoflurane-ANS interactions.

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Left Ventricular Function and Morphology after Cardiac Surgery for Severe Mitral Insufficiency – A Single Center Experience

DOI: 10.2478/amma-2020-0015

Introduction: Mitral insufficiency is a common valvular disease affecting 10% of the general population. The main treatment of the severe mitral regurgitation is surgical. We have analyzed the impact of cardiac surgery on the left ventricular performance and morphology, in patients treated for severe mitral insufficiency accordingly to the type of intervention, ischemic time and type of cardioplegia.
Methods: Ninety patients diagnosed with isolated severe mitral insufficiency that benefited from mitral valvular replacement or mitral valvuloplasty were retrospectively enrolled. The left ventricle, the left atrium, the right ventricle diameters and the left ventricle ejection fraction were measured by two-dimensional (2D) echocardiography before and after surgery. The influence of the myocardial ischemia time and the type of cardioplegia administered on the ventricular systolic function were also analyzed.
Results: Regardless the surgical technique chosen, after surgery we noticed a decreased size of the left ventricle (preoperative mean 54.91mm ±8.18 vs postoperative mean 51.94mm±8.15, p=0.035), right ventricle (preoperative mean 33.49mm±5,87 vs postoperative mean 32.41mm±6.03, p=0.0001), as well as the ejection fraction (preoperative mean 51.29%±8.51 vs postoperative mean 46.57%±8.71, p=0.0001).
Conclusions: Immediately after surgery, a decrease in the size of cardiac cavities as well as a decrease of the left ventricle ejection fraction is noticed.

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Correlation Study of Serum Zinc Concentration and Retina Layer Thickness in Hypertensive Patients

DOI: 10.2478/amma-2020-0017

Objective: The aim of our study was to evaluate whether blood serum zinc concentration correlates with the thickness of human retina layers, in hypertensive patients with microvascular damage.
Methods: Retinas of elderly patients with arterial hypertension and microvascular damage were imaged using a swept-source ocular coherence tomography from Topcon. Automatic retinal segmentation was applied on a 6mm X 6mm scan protocol and average thickness for 5 examined layers was used for statistical analysis. Serum zinc concentration was measured using the Zinc Assay kit from Sentinel Diagnostics in a spectrophotometric method.
Results: The average age of the twenty-three enrolled patients was 70 years, varying between 62 and 76. The mean zinc value was 9.9 µmol/l ±1.62 (SD). All five examined layers of the retina presented inverse correlation with serum zinc concentration. The complex including the inner plexiform layer and ganglion cell layer indicated the Spearman’s (rho) correlation coefficient -0.42 and a significance level of p=0.04. Patients in high-Zn group (≥ 9.87 µmol/l) had thinner macular retina layers, most importantly in the inner-plexiform layer-ganglion cell layer complex (p=0.006).
Conclusions: Our study has found that serum zinc concentration is inversely correlated with the thickness of retina layers with statistical relevancy in the inner plexiform layer – ganglion cell layer complex. This finding emerges experimental studies in order to elucidate its clinical significance and to evaluate whether the fine architecture of the inner retina has the potential to benefit from oral zinc supplementation through modulating serum levels of zinc in patients with microvascular-damaging diseases.

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Necrobiosis Lipoidica Diabeticorum

DOI: 10.2478/amma-2020-0013

Introduction: Necrobiosis lipoidica diabeticorum is a rare complication occuring mostly in diabetic patients appearing as a skin redness that soon transforms into an extensive necrosis. The usual aspect of such lesions is a deep ulceration with irregular borders developing especially on the lower limbs.
Case presentations: This paper intends to present two cases of necrobiosis lipoidica diabeticorum focusing on the clinical aspect of this disease and the original treatment applied in the Plastic Surgery Department of the Clinical County Hospital of Targu Mures. Both patients suffered from type II insulin-requiring diabetes. The first case is a 63 year old female with different stages of necrobiosis lipoidica diabeticorum lesions developed on the anterior aspect of both legs. This patient was treated using only conservative methods. The second case is a 64 year old male who developed an extensive full-thickness necrosis on the right dorsal aspect of the hand and forearm. The lesions required conservative treatment and the surgical debridement of the extensive necrotic tissues.
Conclusions: Necrobiosis lipoidica diabeticorum is a dramatic condition requiring a well informed approach in order to save the healthy tissues as much as possible. In both cases, the wounds healed spontaneously after a long period of time.

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An Update on the Genetic Aspects in Congenital Ventricular Septal Defect

DOI: 10.2478/amma-2020-0012

Ventricular septal defects (VSDs) are the most common type of heart malformation and may occur like a part of a syndrome or as an isolated form. Clinical manifestations are related to the interventricular flow, which is determined by the size of the defect. Aiming at the identification of genetic causes is important in both syndromic and non-syndromic forms of VSD, to estimate the prognosis and choose the optimal management. Other reasons of the identification of genetic factors in the etiopathogenesis include the assessment of the neurodevelopmental delay risk, recurrence in the offspring, and association with extracardiac malformations. The diagnostic process has been improved, and currently, the use of the most suitable and accessible technique in the clinical practice represents a challenge. Additional advantages in genetic testing were brought by next-generation sequencing technique, various testing panels being available in many laboratories.

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Urinary Retention in Female after Augmentation Gluteoplasty: A Case Report

DOI: 10.2478/amma-2020-0011

Introduction: There are many well-known complications after gluteal augmentation surgery, such as: seroma, hematoma, capsular contracture, retraction, wound dehiscence etc., but there are some due to nervous damage (especially submuscular pockets with large implants) insufficiently recognized. The aim of this case report is to highlight a rare complication (urinary retention) after gluteal augmentation surgery with use of solid silicone implants in case of 41-year-old female. Woman aged 41 with a buttock augmentation with silicone implant (submuscular pocket, 300cc) performed 2 months before at plastic surgery service in Madrid, was admitted in our service, the Clinic of Urology from Tg. Mures, with permanent bladder catheter inserted for urinary retention.
Outcome: At the admission, two months after the surgery the clinical examination revealed a permeable urinary catheter with clear urine and a fistulisated wound infection localized in the superior 1/3 of the incision in the intergluteal sulcus. Neither neurological or gynecological examination identified any pathology. After the removal of the catheter, next day the abdominal ultrasonography showed a distended bladder, with a postvoid residual urine volume of 320 ml. Urodynamic investigations (uroflowmetry, pressure flow studies) revealed a reduced Qmax. 7,6 ml/sec, underactive detrusor with a reduced BCI value of 60 (bladder contractility index), requiring self-intermittent catheterization, associated with alpha-blockers.
Conclusions: Buttock implantation is a frequently used plastic surgery procedure with rather high rate of complications, some of them not well identified, unknown such as detrusor underactivity leading to urinary retention.

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A Study of Heat Generation in Orthopaedic Bone Drilling Process

DOI: 10.2478/amma-2020-0009

Reconstruction and repair of a complete bone fracture requires surgical drilling of bone in order to create holes which support easy insertion of screws. The objective of the research is to optimize kinematic parameters when drilling bone in order to avoid bone necrosis and increase the capacity of bones to retain the surgical screws. In literature there are presented attempts to measure the temperature of bones by introducing thermocouples into bone near the drill path which is not a satisfactory method. In this research it is proposed a new method for measuring temperature by means of a digital infrared thermometer oriented on bone surface where holes are made. We have drilled animal bones and represented the experimental curves of temperature for a wide range of kinematic parameters that are supposed to be used during orthopaedic operations. It is concluded speeds ranges that can be used when drilling bone holes, which ensures good cutting conditions and temperatures at a level which does not affect the quality of the assembly.

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