Category Archives: AMM 2011, Volume 57, Number 1

Clinical Aspects of the Schizoaffective Disorder in Comparison with Schizophrenia After a 15-year Evolution

Bredicean Cristina1,3, Ienciu Monica1,2, Papava I.1,3, Salva Emanuela2, Mihalcea Roxana2, Popa Ica3,
Ile L.2,3

1 Department of Psychiatry, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy Timisoara
2 Psychiatric Clinic Eduard Pamfil, Timisoara
3 Mara Institute, Timisoara

Background: Schizoaffective disorder is currently one of the debated nosological categories, nowadays existing more controversial suppositions regarding its ranging.
Aim: The assumption of this study was that schizoaffective disorder is a version of schizophrenic disorder.
Methods: In pursuit of this supposition, two groups of subjects were selected, called group A, which includes subjects diagnosed with current schizoaffective disorder – according to ICD 10 – and group B, who were diagnosed with current schizophrenia. The two groups were relatively analyzed aiming at socio-demographic and clinical parameters at first admission and clinical evolution and global functioning 15 years past the first episode.
Results: The results showed that there are differences on diagnosis at first hospitalization in subjects who subsequently developed schizoaffective disorder, which could have been produced by an episode of schizophrenia, an episode of acute and transient psychosis or an affective episode. Also, the long-term outcome of the subjects showed differences between the two groups regarding the number of hospitalizations – which is much higher in subjects from schizoaffective group than in those with schizophrenia. The schizoaffective disorder group shows superior professional and family functioning in comparison with the group diagnosed with schizophrenia.
Conclusions: The conclusion of this study is that schizoaffective disorder is a nosological entity different from schizophrenia. In order to clarify its nosological status, neurophysiologic, laboratory examinations and family studies are needed.

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Comparative Study On Chiral Separation Of Pyrethroic Acids with Amino and Neutral Cyclodextrine Derivatives

Cârje Anca Gabriela1, Juvancz Z.2, Iványi R.3, Schurig V.4, Tőkés B.1

1 Departament of Physical Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy, Târgu Mureş
2 Departament of Environmental Engineering Tech Polytehnical Institution, Budapest, Hungary
3 Cyclolab cyclodextrin R&D, Budapest, Hungary
4 University of Tübingen, Institute of Organic Chemistry, Germany

Background: Pyrethroids are used as synthetic insecticides. They have more intensive effects than pyrethrum acid, or natural analogues found in the flowers of Chrysanthenum cinerariaefolium (Fam. Asteraceae). In the pyrethroic acids, both the geometric and chiral isomerisms appear as cumulated, therefore these compounds can be successfully used to study chiral separation.
The aim of the study was to separate by means of positively ionizable selector: permethyl- monoamino-b-cyclodextrin (PMMAbCD), monoamino-b-cyclodextrin (MAbCD) and other neutral b-cyclodextrin derivatives, the enatiomers and diastereomers of permethrinic, deltamethrinic and chrysanthemic pyrethroic acids.
Methods: Pyrethroic acids studied were chrysanthenum, permethrynic and deltamethrinic with pKa values 5,1±0,4. As chiral selectors, we used cyclodextrins: permethyl-monoamino-b-cyclodextrin( PMMAbCD) and monoamino-b-cyclodextrin( MAbCD) particularly the positively charged cyclodextrins. Experiments were carried out on a Hewlett Packard 3DCE system (Hewlett Packard, Waldbronn, Germany) with diode array UV detector at 25 °C. To characterise the separation of enantiomers we used resolution values Rs (calculated by half-width method).
Results: The PMMAbCD at 15 mM is an effective chiral separation agent for pyrethroic acids as it can fully separate all isomers of chrysanthemic, permethrinic and deltamethrinic acids with the exception of trans chrysanthemic acid which was only partially separated.
Conclusion: The best chiral separation agent toward pyrethroic acids studied was found to be permethyl-momoamino-b-cyclodextrin (PMMAbCD). The cis isomers show higher selectivity than trans isomers in the ionized form of acids. Our results show that dissociation alone can not fully explain the appearance of experimental curves, should take into consideration stereochemistry contributions.

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Stability Studies of Ampicillin Trihydrate in Suspensions and Acidic Aqueous Solutions

Rad I.1, Croitoru M. D.2, Pálffy Ágnes2, Gyéresi Á.3

1 “Dimitrie Cantemir” College, Tg. Mures
2 Public Health Centre, Tg. Mures
3 University of Medicine and Pharmacy of Tîrgu Mureș, Faculty of Pharmacy

Background: Ampicillin in trihydrate form is a b-lactamine antibiotic frequently used in therapy as suspensions and capsules. Because of the low stability only dry suspensions are sold, and also the low stability in acidic environment is source of unwanted side effects and bioavailability variations.
Aim: Our goal was to stabilize ampicillin so that a better stability can be obtained both in water suspensions and acidic solutions. This way misuse due to faulty preparation, side effects and bioavailability problems can be avoided.
Methods: In order to assess the changes in the ampicillin concentration high performance liquid chromatography (HPLC) and thin layer chromatography (TLC) methods have been used.
Results: None of the tried excipients improved stability of ampicillin suspensions. In contrast cyclodextrins and magnesium salts of glutamic and aspartic acid greatly improved the stability of ampicillin acidic solutions. In high amounts cyclodextrins also change the decomposition kinetic of ampicillin, which is usually a first order kinetic process.
Conclusions: Cyclodextrins and magnesium salts of glutamic and aspartic acid have the potential to be used in ampicillin containing formulations in order to increase its stability, bioavailability and to reduce adverse effects.

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Evaluation of Antimicrobial Effect of Mineral Trioxide Aggregate, Calcium Hydroxide and Calcium Hydroxide with Iodoform on Microbial Growth in Vitro

Eşian Daniela¹, Monea Al.², Man A.³

1 Department of Pedodontics-Orthodontics, Faculty of Dentistry, University of Medicine and Pharmacy, Târgu-Mureş
2 Department of Endodontics-Periodontics, Faculty of Dentistry, University of Medicine and Pharmacy, Târgu-Mureş
3 Department of Microbiology, Faculty of Medicine, University of Medicine and Pharmacy, Târgu-Mureş

Background: The success of treatment of a young permanent tooth with pulp necrosis appropriate each stage of development depends primarily on the complete sterilization of infected root canals using specific endodontics drugs capable of destroying pathogenic microorganisms, especially obligate and facultative anaerobic bacteria.
Aim: The purpose of this research is to evaluate the antimicrobial effect of the three most used intraradicular substances, respectively mineral trioxide aggregate, calcium hydroxide and calcium hydroxide with iodoform on anaerobic bacteria isolated from infected root canals and also on pure bacterial species, namely Staphylococcus Aureus , Enterococcus Faecalis and Candida Albicans, cultures coming from the collection of the microbiology laboratory.
Material and methods: Anaerobic species grown on specific culture medium were prepared in the form of bacterial suspension using standardized system of 0, 5 McFarland turbidity diluted by half. The three drugs tested were used in different concentration and to each of them was added 1 ml of bacterial suspension obtained previously. From each sample obtained were made insemination on specific anaerobic medium and interpretation of results was made by comparing the number of bacterial colonies grown.
Results: Following this study MTA has failed to demonstrate superiority over calcium hydroxide in terms of antibacterial properties results showing that each substance tested has elective action on bacterial species.
Conclusion: All endodontic materials tested have shown antimicrobial properties able to effectively sterilize infected root canals but they compared different actions on bacterial species taken to study depending on the amount of active substance tested.

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Considerations Upon a Case of Hepatocellular Carcinoma Treated with Magnetic Resonance Imaging – Guided Percutaneous Cryotherapy Guidance

Colțescu Camelia¹, Habersetzer F.¹, Oltean G.², Bățagă Simona², Georgescu D.², Garnon J.³

1 Department of Hepatology and Gastroenterology, University Hospital Strasbourg
2 Department of Internal Medicine, 1st Medical Clinic, Faculty of Medicine, the University of Medicine and Pharmacy (UMPh) Targu Mures
3 Department of Radiology, University Hospital Strasbourg

Hepatocellular carcinoma represents 5 % of the cases of death in the world. The recent epidemiological data show a major increase of its incidence in the western countries and USA, the explanation being through the growth in the incidence of viral hepatopathies, especially with hepatitis C virus. Of the patients diagnosed with hepatocarcinoma, 70 % benefit from palliative treatment only. The curative treatment in the case of hepatocarcinoma includes surgical resection, liver transplant, radiofrequency. Magnetic Resonance Imaging-guided percutaneous cryotherapy, the method in progress of evaluation, seems to give spectacular results in the case of small size, non resectable situated very close to the hepatic hylum. The evolution of a patient with viral cyrrhosis C complicated with a hepatocarcinoma and the problems related to hepatocarcinoma treatment while waiting for liver transplantation was the object of an analysis that allowed the emphasis of the lack of tumoral progress and the reduction of tumoral volume until its disappearing from an imagistic point of view.

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Is Psychiatry a Profession Associated with High Anxiety?

Roșu Codruța Maria1, Nireștean A.1,2, Toma Mirela1, Echim Iulia1

1 Acute Psychiatric Clinic II, Targu Mures, Romania
2 Psychiatric Department, University of Medicine and Pharmacy, Targu Mures, Romania

Background: Depending on intensity, anxiety can have an adapting and mobilizing role, or it can represent a serious risk.
Aim: To examine the prevalence of anxiety symptoms for those who work in a clinic of psychiatry.
Material and method: Group consists of 35 persons who work in the Acute Psychiatric Clinic II – Targu Mures. Anxiety was measured as a current emotional state and as a trait by Spielberger’s State-Trait Anxiety Inventory (STAI).
Results: Applying Spielberger’s Inventory 33.3% of the female and 28.5% of the male might be suspected of suffering from significant anxiety symptoms as a state. Also the subject’s predisposition to anxiety as a trait of the subject’s personality is important, 24% of female and 43% of men had levels of anxiety over 60% compared with standards.
Conclusions: An important number of people who work in psychiatry have high scores of anxiety. Further studies are needed to clarify to what extent this relates to a high prevalence of anxiety disorders.

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Lymph Node Harvest in Resected Colon Cancer Specimens

Kiss R.1, Kiss L.1, Chis F.1, Ilie S.3, Porr P.2, Alexe D.2, Maniu D.5, Mitachescu S.6, Zaharia I.4

1 1st Surgical Clinic, County Emergency Hospital of Sibiu
2 1st Medical Clinic, County Emergency Hospital of Sibiu
3 Intensive Care Clinic, County Emergency Hospital of Sibiu
4 Department of Pathology, County Emergency Hospital of Sibiu
5 Radiology Department, County Emergency Hospital of Sibiu
6 Gastroenterology Department, County Emergency Hospital of Sibiu

Background: The number of lymph nodes evaluated may be a measure of quality in colon cancer care and appears to be inadequate in most patients treated for colon cancer. We performed a systematic review of the evidence for the association between lymph node evaluation and oncologic outcomes in patients with colon cancer.
Aim: The adequate lymph node evaluation for cancer involvement, prognosis and adequate treatment of patients with colon cancer.
Method: It included information about diagnosis, patient age at diagnosis, the surgical procedure that was performed, anatomic location of the cancer, histology, tumor size, number of LN identified, number of LN positive for cancer, general stage (local, regional or to distance, TNM stage /A7CC). Rectal cancer was excluded. We analyzed data from the cancer registry of 1st Surgical Clinic of Sibiu including 287 patients with colon cancer. This registry includes follow-up information from 1998 to 2009. Identification of ≥12 LN (lymph nodes) in resected colon cancer specimens has been considered as a quality indicator. In patients with resected colorectal cancer, LN the involvement has particular importance for patient prognosis and adjuvant therapy.
Results: The average number of LN identified increased from 6±3 during 1998–2003, to 14±5 during 2003–2009. The proportion of patients diagnosed with positive LN increased from 31.6% during 1998–2003 to 37% during 2003–2009. No significant change in the proportion of patients diagnosed with just one positive LN (10% versus 10.6%) was observed.
Conclusion: The results suggest a relationship between the survival and identification of 12+ LN for stage I or II, considering the disease.

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Correlation Between Helicobacter pylori, Hiatal Hernia and Barrett’s Esophagus

Macarie Melania1, Bățagă Simona1, Crosnoi Daniela3, Macarie I.2, Török Imola1, Georgescu D.1,
Sârbu-Pop Silvia3

1 Clinic of Gastroenterology, Faculty of Medicine, UMPh Târgu Mureş
2 1st Medical Clinic, Faculty of Medicine, UMPh Târgu Mureş
3 Targu Mures County Clinical Emergency Hospital

Background: The incidence of adenocarcinoma of the esophagus has dramatically increased during the last 2 decades and so has the incidence of Barrett’s esophagus, one of the most important risk factors for esophageal adenocarcinoma.
Aim: The aim of this study was to determine whether infection with Helicobacter pylori is associated with a lower risk of Barrett’s esophagus development in our area, and if there is a direct correlation between hiatal hernia and Barrett’s esophagus.
Material and method: We studied a series of 4359 patients who were investigated by upper endoscopy in the Gastroenterology and Endoscopy Unit of Targu Mures County Clinical Emergency Hospital between the 1st of January 2009 and 31st of December 2009. Barrett’s esophagus was defined as the presence of specialized columnar epithelium with goblet cells in the esophagus. We compared the patients with Barrett’s esophagus with a similar serie with patients without reflux disease.
Results: In 33 patients a diagnosis of Barrett’s esophagus was established. There was a strong predominance of males. The mean age at diagnosis was 64.18 years. Helicobacter pylori was present in 17 cases (51.51%) in the control patients compared to 42.42% in patients with Barrett’s esophagus (p 0.622, Odds Ratio: 0.69 95% CI: 0.26-1.83). Hiatal hernia was present in patients with Barrett’s esophagus in 21 cases (63.63%), and in patients without reflux disease only in 5 cases (15.15%) (p<0.001, Odds Ratio: 9.8: 95% CI: 2.99-32.18).
Conclusions: A significant correlation between hiatal hernia and Barrett’s esophagus was demonstrated in our study (p<0.001).

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The Role of SCID II in Diagnosis of Cluster B – Personality Disorders Associated or Not with Affective Comorbidity – a Pilot Study

Toma Mirela1, Nireştean A.1,2, Roșu Codruța1, Echim Iulia1

1 Acute Psychiatric Clinic II, Targu Mures, Romania
2 Psychiatric Departament, University of Medicine and Pharmacy, Targu Mures, Romania

Background: Affective co-morbidities are often associated with Cluster B – personality disorders,so it is very important to pay attention when we put these diagnoses.
Aim: To investigate the applicability of SCID II to patients with personality disorders.
Material and method: We applied the SCID II – The Structured Clinical Interview for DSM IV Axis II Personality Disorders, to a group of 10 patients with cluster B personality disorders with affective disorders as depression, anxiety or both admitted to The Psychiatric Clinic II Targu Mures, Romania at admission, at the end of the hospitalization, and every 3 months for a year (2009), which we compared with a group of 5 patients without affective disorders followed also for a year.
Results: We observed the time needed to complete the test, the way of answering the questions, at both groups, from admission to discharge and every three months for a year.
Conclusion: The diagnosis of personality disorders, with or without affective comordity can be established using this psychometric instrument – SCID II.

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Primary Cutaneous Melanoma: 7-year Follow-up (2003–2009)

Chifu M. D.1, Sin Anca2, Chifu Madalina3, Milutin Doina1, Mocan Simona1

1 Department of Pathology, University of Medicine Targu Mures Romania
2 Institute of Cardiovascular Diseases Targu Mureş
3 Faculty of Medicine, University of Medicine and Pharmacy, Targu Mureş

Background: Primary cutaneous melanoma constitutes the main cause of skin cancer death in developed countries, and its incidence in recent years has been increasing in a steady, worrisome manner.
Aim: This study evaluated the histopathological aspects of this disease, and correlated them with patient prognosis.
Material and methods: The study included 138 patients with mild to severe primary cutaneous melanoma who were diagnosed in the Laboratory of Pathology Targu Mures during 2003–2009. Data were provided from hospital registers and the statistical analysis was performed by using the computer program called Excel.
Results: We found 76 malignant melanoma in females and 62 in males. The most common lesion areas were: the lower limbs (50), and the trunk (41).
Conclusions: Malignant cutaneous melanoma is still a major clinical challenge because all our patients with advanced tumors were diagnosed with poor prognosis.

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