Category Archives: AMM 2015, Volume 61, Number 3

The Assessment of the Colo-rectal Polyps in Order to the New Diagnostic and Therapeutic Strategies

Diac Andreea Raluca*, Brusnic Olga, Gabos Gabriella, Onisor Danusia, Drasoveanu Silvia Cosmina, Boeriu Alina, Dobru Daniela Ecaterina

University of Medicine and Pharmacy Targu Mures, Romania

DOI: 10.1515/amma-2015-0060

Objective. Assessment of the histological and endoscopic features of the colo-rectal polyps is requered for the application of the new diagnostic and therapeutical strategies in the managment of the diminutive polyps.
Methods. This paper is a descriptive retrospective study on 52 pacients reffered for colonoscopy in Gastroenterology Clinic – Clinical County Hospital Targu Mures from January until September 2014. 80 polyps were assessed. Narrow band imaging examination targeted on the protrusive lezions allowed NICE (Narrow Band Imaging International Colorectal Endoscopic) classification and corroboration of the histology prediction and pathological assessment.
Results. Polyp detection rate was 48,58%, given the quality of bowel preparation in hospital fair in 84,5%.The predominant histological type was the tubular adenoma (46,25%), and 40% of the polyps were located in the sigmoid. Among the diminutive polyps, 58,33% were hyperplastic(p<0,0001), mainly in the recto-sigmoid (66,67%); the incidence of high grade displasia or cancer was 0. Real –time prediction of the histology of the colorectal polyps using NBI established: NICE 1: 19 polpyps, histology- 16 hyperplastic, (p<0,0001, sensitivity: 100%, specificity: 95%), NICE 2: 59 polyps, histology- 53 adenomatous, (p<0,0001, sensitivity: 96%, specificity: 76% ), NICE 3: 2 polyps- histology-cancer.
Conclusions. We did not observe any distribution pattern in the topography of the diminutive polyps. Histologicaly the predominant type was the hyperplastic type. NBI was accurate in real-time prediction of the histology of the colo-rectal polyps. The results are relevant for application of the new strategies in the managment of the diminutive polyps.

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Prevalence of Rubber Dam Usage Among Dental Practitioners and Final Year Students in Tirgu Mures: A Questionnaire Survey

K.-Ivácson A. Csinszka1*, Monea Monica1, Pop Mihai1, Albu-Stan Aurita2, Borda Angela3

1 Discipline of Odontology and Oral Pathology , Faculty of Dentistry, University of Medicine and Pharmacy Tirgu Mures
2 PHD student, University of Medicine and Pharmacy Tirgu Mures
3 Discipline of Histology, Faculty of Medicine, University of Medicine and Pharmacy Tirgu Mures Mures

DOI: 10.1515/amma-2015-0059

The purpose of this study was to determine the prevalence of rubber dam usage among endodontists, other specialized practitioners, general practitioners and undergraduate final year students in Tirgu-Mures, Romania.
Material and method: A questionnaire was distributed among 250 subjects. Final year students and dentists were surveyed in relation to their prevalence of rubber dam usage.
Results: Overall response rate was 72,4. While 84,07% of the subjects knew about the advantages, only 49,72% used it during their practice, mostly endodontist (90%) and other specialized practitioners (53,84%). The use of this system on pediatric patients was lower compared to adult patients. The frequency of the rubber dam usage during endodontic treatment was higher (71,11 %) compared to dental restorations (35,55%), and 84,49% of the subjects were are willing to gain further knowledge about this system.
Conclusions: The results were similar to other reports originally from Eastern-European countries. The low percentage of the rubber dam usage presents quality issues, safety and medico-legal concerns for both the patient and the dentist. Greater emphasis should be placed on the advantages of rubber dam. Perception of final year dental students needs to be improved and continuing dental education for practitioners should be necessary to update their knowledge.

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Pancreatico-gastric Anastomosis Following Cephalic Duodenopancreatectomy: New Perspectives

Tudor A1,2, Butiurca VO2*, Nicolescu C1,2, Bianca Tudor1, Simona Gurzu1, Molnar C1, Copotoiu C1

1 University of Medicine and Pharmacy Tirgu Mures, Romania
2 Surgical Clinic No. 1, Târgu-Mureș Emergency County Hospital, Mureș County, Romania

DOI: 10.1515/amma-2015-0058

Introduction. Although in recent years there have been various versions of pancreatic – digestive reconstruction after cephalic duodenopancreatectomy, this issue is still highly debated.
Purpose. This paper aims at comparing postoperative outcomes after gastric pancreatic anastomosis using transfixing threads as opposed to the purse-string suture method.
Material and methods. Our study consisted of a lot of 15 patients that underwent cephalic duodenopancreatectomy from the 1th of May 2014 to the 30th of April 2015. The pancreatico – digestive reconstruction was done by pancreatico-gastric anastomosis using three different techniques: double purse-string suture used for the patients in the first group (group 1, n = 5 patients); one purse-string suture and 2 transfixing “U-sutures” passed through the stomach and the pancreas for the patients in the second group (group 2, n = 5 patients) and ducto-mucosa anastomosis with pancreatico-gastric transfixing threads in the third group (group 3, n = 5 patients).
Results. Morbidity was 40% for the entire lot. Pancreatic fistula, occurred in two patients, one type A fistula in a patient in group 2 and one type B fistula in a patient in group 3. Biliary fistula occurred in one patient in group 2. Mortality was at 13.3%. The median time to carry out the anastomosis in group 1 was 14 minutes, for patients in group 2, 20 minutes, and for patients in group 3, 25 minutes.
Conclusions. Gastric pancreatic anastomosis using purse-string sutures is a feasible, safe and fast process which reduces complications due to transfixing pancreatic threads.

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Pain and Distress in Cancer Patients

Burger-Szabo Anna*, Gabos-Grecu Marieta, Moica Theodor, Finta Hajnal, Ferencz Melinda,
Gabos-Grecu Cristian, Gabos-Grecu Iosif

University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0057

Background: A significant number of patients with cancer suffer from anxiety and depressive disorder. Perceived emotional distress, anxiety and depressive symptoms are significantly more frequent in cancer patients with pain than in patients without pain. Despite their high prevalence cancer pain and distress are frequently undertreated.
Material and method: Thirty two oncology patients were included in the study who were receiving concurrent oncologic and pain treatment in the Oncology Clinic TgMures. Patient demographic and clinical information was obtained from medical records and patient report. Patients were screened for pain scores using the Visual Analog Scale and distress scores, using the Distress Thermometer.
Results: The gender proportion of the sample is: 38% female, 62% male. More than 75% of the sample was over 50 years of age , and more than half of the patients (59.3%) had metastatic disease. Significant decreasing trend were seen for pain score difference before and after the pain treatment was reassessed (dosage increase or conversion) (p<0.0001), and decreasing trend seen for distress score (p<0.0001) also.
Conclusions: Pain and distress occurred concomitant in this population. An adequate pain management and pain reassessment contributes to improve the cancer patient emotional distress score, anxiety and depressive symptoms. An accurate screening instrument can facilitate the recognition of patients who needs further assessment and psychiatric treatment.

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Anaesthesia and Postoperative Analgesia Performed by Insertion of a Perineural Catheter at the Brachial Plexus Site – Case Series

Lazar Alexandra, Szederjesi Janos*, Copotoiu Sanda Maria, Simon Noemi Szidonia, Badea Iudita, Azamfirei Leonard

University of Medicine and Pharmacy Tîrgu-Mures, Romania

DOI: 10.1515/amma-2015-0055

Postoperative pain management is of major importance and the existence of a device that ensures a good analgesia in the immediate postoperative period and also removes the side effects of the systemic drugs, is becoming a necessity.
Objectives: The goal was to obtain a good quality anaesthesia and also a good postoperative analgesia by inserting a perineural catheter at the brachial plexus site.
Material and method: This study included adult patients who underwent brachial plexus anaesthesia through a perineural catheter inserted at the brachial plexus site. The perineural catheter was introduced by ultrasound guidance with neurostimulation control. After insertion, a quantity of a anaesthetic admixture of 0.4mg/kg is administered. The anaesthetic admixture contained Ropivacaine and Lidocaine, equimolar concentration of 0.5% In the postoperative period, the analgesia was ensured trough the already installed catheter. The analgesic mixture contained Ropivacaine and Lidocaine, equivalent concentrations of 0, 25%. The administration rate was 5 ml every 4 hours, starting 6 hours postoperatively.
Results: The anaesthesia, obtained through the perineural catheter, was a good quality anaesthesia ensuring both, good sensory and motor block. The feedback regarding postoperative analgesia was positive, this type of pain management being efficient and without the systemic drug side effects. This approach of brachial plexus block was accepted easily by the patients and was rated as a very satisfactory method.
Conclusions: The insertion of a perineural catheter for anaesthesia and postoperative analgesia represents a safe and efficient method of achieving both analgesia and anaesthesia.

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Is There a Risk Factor More Responsible for Disaster?

Carasca Cosmin1*, Muresan Vasile Adrian2, Tilea Ioan3, Magdas Annamaria4, Carasca Emilian4, Incze Alexandru4

1 County Emergency Clinical Hospital, Tirgu Mures, Romania
2 Surgical Clinic 1, County Emergency Clinical Hospital, Tirgu Mures, Romania
3 Cardiovascular Rehabilitation Clinic, Dept. Family Medicine, Institute of Cardiovascular Diseases and Transplantation Tirgu Mures, Romania,
4 Internal Medical Clinic 4, County Clinical Hospital, Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0054

Background: Risk factors for peripheral arterial disease are generally the same as those responsible for the ischemic heart disease and in both cases are overlapping risk factors involved in the etiology of atherosclerosis, such as smoking, dyslipidemia, diabetes and hypertension.
Case report: We present a case of a 61 years old male, whose ischemic peripheral symptoms began in 2003, at the age of 49, presenting as a Leriche syndrome. The patient was subjected to first revascularization procedure consisting in aortic-bifemoral grafting in the same year. General examination revealed no risk factors except smoking. Only a year after, he returns with critical right lower limb ischemia due to bypass thrombosis, therefore two thrombectomies were performed followed by a right side femoro-popliteal bypassing with Dacron prosthesis. The patient’s condition was good until 2008 when a femoro-popliteal bypass using inverted autologus saphenous vein was imposed due to occlusion of the previous graft. In 2013 the patient was readmitted to hospital with left lower limb critical ischemia. A femoro-popliteal bypass was performed, followed by two thrombectomies and the amputation of the left thigh. Up to this date, the patient kept smoking.
Discussions: Although our patient has a low/medium risk level of atherosclerosis by Framingham score and a minimum Prevent III score, all the surgical revascularization procedures were not able to avoid the amputation.
Conclusions: There are enough reasons to believe that smoking as a single risk factor can strongly influence the unfavorable progression to amputation in patients with peripheral arterial disease.

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Study on Changes of the Urea, Serum Creatinine and Glomerular Protein Permeability, after General Anesthesia with Sevoflurane

Stoian Mircea, Stoian Adina*, Costel Dumitru, Tripon Florin, Badea Iudita, Azamfirei Leonard

University of Medicine and Pharmacy of Tirgu Mureș, România

DOI: 10.1515/amma-2015-0053

Introduction: The widespread use of sevoflurane as an induction and maintenance volatile agent of general anesthesia demostrates an increased safety profile. Sevoflurane contact with CO2 absorbents lead to the occurrence of toxic compounds such as Compund A and Compound B . Among the side efffects of Sevoflurane remember the renal toxic effect much discussed in the literature but still unresolved. In previous research we have demonstrated the glomerular protein changes as a result of exposure to Sevoflurane. In the current study we intend to monitor the changes in blood urea nitrogen and serum creatinine after exposure to Sevoflurane.
Material and method: We included in our study 90 patients who were anesthetized in the Department of Anesthesiology of the County Mure Hospital during 01.10.2009-01.10.2014. They had normal values for blood urea nitrogen and serum creatinine and had no preoperative proteinuria. Serum and urine samples were taken preoperatively and at 24 and 72 hours postanesthetic and were analyzed in the laboratory. Proteinuria was determined by spectrophotometry.
Results: After protein quantitative determination by spectrophotometry and statistical anaysis we obtained significant differences by comparing the average preoperative/24 hours total protein (p<0.0001) and 24/72 hours (p<0.0001). There are no significant statistical differences by comparing the blood urea nitrogen at the three intervals (p<0.53) and no statistical changes for mean serum creatinine (p<0.18).
Conclusions: Changes in glomerular filtered proteins following exposure to Sevoflurane demonstrate its toxic effect on glomerular tubules. Lack of perioperative significant wich is why we recommend determining perioperative urinary protein as a marker of glomerular damage.

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Knee Arthroplasty: With or Without Patellar Component?

Sólyom Árpád1, Király Ildikó2, Benedek Csaba2, Fülöp Csongor1, Nagy Örs3, Bățagă Tiberiu1

1 Ist Orthopaedic and Trauma Clinic, Mureș County Emergency Clinical Hospital, Tîrgu Mureș, Romania
2 University of Medicine and Pharmacy of Tîrgu Mureș, Faculty of General Medicine, sixth year medical student, Tîrgu Mureș, Romania
3 IInd Orthopaedic and Trauma Clinic, Mureș County Hospital, Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0052

Arthroplasty is used when there is irreversible damage to the articular cartilage of the knee. It involves implanting a bicompartimental (femoral and tibial components) or a tricompartimental (femoral, tibial and patellar components) prosthesis. It is a very invasive and costly operation, so our objective was to evaluate the necessity of the patellar component. Material and methods: We included 39 patients in the study: in 27 cases we used tricompartimental prosthesis, while the other 12 received only the bicompartimental components. Patients were evaluated preoperatively and postoperatively using the International Knee Documentation Comitee score. Results: We’ve found that there is little to no difference between the two groups regarding mobility and complication, however patients with bicompartimental arthroplasty complained of less pain. Conclusion: We’ve found that bicompartimental arthroplasty – being a less invasive procedure – is superior not only in terms of pain management, but is also associated with less bleeding and shorter intraoperative time. The revision is easier and the technique presents also financially advantages, for both the patient and the medical facility.

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Associated Behavioral Risks in a Group of Women During Pregnancy from Mures District

Ruța Florina1, Avram Călin2, Voidăzan Septimiu3, Rus Victoria1*, Georgescu Mihai4, Abram Zoltan5, Tarcea Monica1

1 University of Medicine and Pharmacy Tirgu Mures, Department of Community Nutrition and Food safety
2 University of Medicine and Pharmacy Tirgu Mures, Department of  Medical Informatics and Biostatistics
3 University of Medicine and Pharmacy Tirgu Mures, Department of Epidemiology
4 Regional Emergency Hospital of Tirgu-Mures, Gynecology ward no 1
5 University of Medicine and Pharmacy Tirgu Mures, Department of Hygiene

DOI: 10.1515/amma-2015-0051

Background. It is well-known that the exposure during pregnancy to lifestyle risk factors can affect thehealth both for the mother and the fetus. There are many risk factors for pregnancy, including: smoking, alcohol consumption, sedentary pattern, irregular daily meal serving plan, lack of knowledge regarding health prevention. The main objective of our study was to assess the practices, knowledge and attitudes towards lifestyle risk behaviors during pregnancy in a group of women from Tirgu-Mures area.
Materials and methods. We used a cross-sectional study based on a questionnaire, assessingsmoking behavior and lifestyle patterns during pregnancy, on a group of 481 women from the urban area (58.84%), as well as from the rural area (41.16%) from Mures county.
Results. In the study group, 190 women (39.5%) used to smoke before pregnancy; among which 37.36% continued to smoke even after they found out they are pregnant. In the group of pregnant women that continued to smoke during pregnancy, we have studied other behavioral factors related to lifestyle, identifying the following: 5,73% have been consuming alcohol weekly, 56.33% reduced greatly their physical activity level, 3.63% have been consuming at least 3 cups of coffee a day. During pregnancy, 12.72% did not have a regular, daily meal serving plan, and 67.26% was a little or not at all concerned about their eating habits. Only 30.9% from the smoking pregnant women group have received information from the family doctor (GP) regarding the risk factors of smoking habits, while 38.18% did not receive any information.
Conclusions. Behavioral risk factors in pregnancy have to be followed closely by the HealthCare System in order to avoid complications for the mother and the child. The best way of accomplishing that is through an efficient community intervention.

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Metabolic Effects of Two Different Doses of Venlafaxine Therapy on Rats

Imre Annamária1, Kolcsár Melinda1*, Groșan Alexandra1, Imre M2, Dogaru Maria Titica1

1 Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

DOI: 10.1515/amma-2015-0049

Objectives: Venlafaxine is an antidepressant, categorized as a serotonin-norepinephrine reuptake inhibitor (SNRI) with suspected metabolic side effects. The aim of our study was to assess these metabolic effects in rats, using two different doses of venlafaxine.
Materials: Three groups of Wistar rats have been treated with venlafaxine during seven weeks. The rats have received a daily dose of 10mg/kg (D1) and 40 mg/kg (D2) while the control group (Dc) has received no treatment. Rats were given “ad libitum” access to food and water. The rats were weighted at treatment day 0, 7, 14, 21, 28, 35, 42 and 49. After completion of venlafaxine treatment, the rats were sacrificed, blood was harvested and the following biochemical parameters have been determined from the centrifuged plasma: triglycerides, glucose and total cholesterol levels.
Results: Both the 10 mg/kg and the 40 mg/kg dose venlafaxine therapy resulted in a highly significant increase of rat’s weight. Compared with the control group the mean weight of D1 group has increased with 130.5 ±21.79 g (<0.01) while the mean weight of the second group increased with 94±24.16 g (p<0.01). In addition weight gain of D1 group was significantly higher than that of D2 group (p<0.01). Venlafaxine therapy induced significant increase in serum triglyceride levels (140.04±55.46 mg/dL p<0.01, 83.59±52.85 mg/dL p=0.05). This metabolic effect has been shown to be more evident in case of 10mg/kg dose therapy (p=0.03). Simultaneously, serum cholesterol levels have been reduced, however this decrease proved to be significant only in case of group D2 (p=0.03). Despite of increased triglyceride values, glucose levels were significantly decreased in both treated groups (133.33±36.18mg/dL p=0.05, 118.10±51.98 mg/dL p=0.02).
Conclusions: Our results suggest that venlafaxine administrated to rats has unwished dose related metabolic effects such as significant increase in weight and hypertriglyceridemia, however serum cholesterol and plasma glucose levels appears to be decreased by this medication.

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