Category Archives: AMM 2011, Volume 57, Number 3

Cervical Lymph Node Metastases in Neck Malignancy – An Ultrasonographic and Histopathological Comparative Study

Genes Ionela¹, Draşoveanu C¹, Mühlfay Ghe¹, Cătană Ramona Teodora²

1 ENT Department, ENT Clinic, Emergency County Hospital, Târgu Mureş, România
2 Endocrinology Department, Emergency County Hospital, Târgu Mureş, România

Objectives: Different approaches have been made to differentiate benign from malignant cervical lymphadenopathy by Ultrasound examination. Assessment of nodal status is essential in patients with head and neck carcinomas as it predicts prognosis and helps in the selection of treatment options. The present study was designed to evaluate the role of ultrasonography in the assessment of malignant cervical lymph nodes. Grey scale Ultrasound assesses the nodal size, shape, border, internal architecture (echogenicity and necrosis).
The vascular pattern of lymph nodes is evaluated with Color Doppler Ultrasound.
Methods: 117 cervical masses evaluated by ultrasonography in 83 patients over a period of 29 mounths (between January 2008 and June 2010) were evaluated for the presence of intranodal vascular pattern, which was considered benign when it traversed through the node without disruption.
Results: Of the 117 cervical tumors evaluated, 73 were found to be malignant on pathologic review. Malign vascular markings were present in 93/117 lymph nodes evaluated. The presence of malign vascular pattern had a sensitivity of 97.3% and a negative predictive value of 91.7%. Malignant Gray scale Ultrasound martkings had a sensitivity of 23.3% and a positive predictive value of 100%.
Conclusions: The presence of normal intranodal blood flow was associated with a benign diagnosis in 91.7% of the masses evaluated. The addition of this Color Doppler Ultrasound finding improves the ability of ultrasonography to predict the likelihood of malignant involvement.

Keywords: malignant tumors, ultrasound examination, lymph nodes, positive predictive value

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Terminological Problems and Information Missing in Descriptions of Injuries in the Hungarian Forensic Medical Discourse

Fogarasi Katalin

Department of Medical Linguisitics, Faculty of Medicine, University of Pécs, Hungary

Introduction: In Hungary, the official template of a Medical Diagnostic Report is filled in by traumatologists or GPs on the occasion of assaults and accidents. It is a vitally important document in forensic medicine, as only on the basis of this document are forensic experts able to assess injuries. However, in numerous cases forensic examiners are not able to reconstruct injuries because of important information missing or terminology not used in the appropriate way. The research aims at comparing descriptions of injuries with those given by forensic experts and showing which problems may impair understanding.
Material and method: The following corpus-based study was conducted on 343 authentic Medical Diagnostic Reports from different forensic institutions and the related expert opinions. The terminology of the descriptions was compared with that of the expert opinions and the essential pieces of information were processed by statistical analysis.
Results: The analysis showed that 84% of the MDRs did not give the exact time of medical care and 59% if the patient had consumed alcohol. The injuries were arranged according to body parts, and 27% of them neglected the side aspect of the location. Because of terminological problems 5.6% of the injuries were regarded as only partly assessable and 15% as not assessable by the forensic expert.
Discussions: The analysis showed that the sixth part of the MDRs was ambiguous due to inappropriate and missing information.
Conclusions: Terminology could be unified and the template optimised using the results of the current study.
Keywords: terminology, forensic medicine, corpus analysis, discourse community, genre analysis

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Smoking and the Risk of Colorectal Cancer and Colorectal Polyps

Crosnoi Daniela¹, Bățagă Simona², Török Imola², Macarie Melania², Sârbu-Pop Silvia¹

1 Emergency County Hospital Targu Mures
2 1st Clinic of Gastroenterology, Faculty of Medicine, University of Medicine and Pharmacy, Targu Mures

Purpose: Tobacco is one of the risk factors in colon cancer and colon polyps. We have studied the connection between smoking and the risk of developing the colorectal cancer and colorectal polyps.
Materials and methods: Our study refers to patients with mucosal modifications at the colon level, hospitalized and colonoscopy investigated in the 1st Clinic of Gastroenterology, Tg Mures between 2008–2010.
Results: There were 193 patients with colorectal cancer and colorectal polyps compared with 206 control patients investigated in the same hospital. From the study group, 53 patients (27.46%) were ‘current smokers’ compared with ‘control patients’ 27 patients (13.10%). As a result of this comparison there was a significant association with an increased risk for colorectal cancer and colorectal polyps (OR = 2.77, CI: 1.64–4.67). It was also observed a significant increased tendency of the risk for the colorectal polyps and colorectal cancer in parallel with the increase of the number of smoked cigarettes per day and years of cigarette smoking (< 10 cigarettes/day – OR = 1.03, CI: 0.45–2.33; 10-20 cigarettes/day – OR = 4.47, CI: 1.73–10.55; > 20 cigarettes/day – OR = 5.41, CI: 2.13–13.72 and < 10 years of cigarette smoking OR = 1.41, CI: 0.63–3.16; 10–20 years of cigarette smoking OR = 3.63, CI: 1.46-8.98; > 20 years of cigarette smoking OR = 4.43, CI: 1.83–10.74).
Conclusions: A high exposure to cigarette smoking is strongly associated with an increased risk of colorectal cancer and colorectal polyps.

Keywords: colorectal polyps, colonoscopy, colorectal cancer, smoking

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Particularities of Depressive Disorders Installed in Perimenopause

Crişan R, Gabos Grecu I, Buicu Gabriela, Ţăran Livia, Gaboş-Grecu Marieta, Nireştean A, Gliga Florina

University of Medicine and Pharmacy, Tg.Mures

Background: The risk of woman to present a depressive clinical picture increases in parallel with the approaching age of perimenopause.
Aim: The main purpose of the paper is to study correlations between symptoms of perimenoapuse and depressive episode occurance, taking into consideration the severity and the frequency of symptoms of perimenopause.
Material and methods: We have selected the cases by performing a screening to pacients with major depressive disorder, hospitalized in No. 1 Psychiatric Clinic, between 01.01.2007–31.12.2009.
Results: From the total patients admitted (1342) only 160 patients aged 34–55 years, voluntarily wanted to participate, representing 11.92% of all patients. Analyzing the severity of psychological symptoms we have obtained statistical significance in the age group 46–50 years: p = 0.0303. Analyzing the frequency of vasomotor symptoms by age group, we have obtained statistical significance in the age group 34–40 years: p = 0.006. Analyzing the frequency and severity of somatic symptoms by age groups, we have obtained statistical significance in the age group 34–40 years.
Conclusions: The rural environment proved to be a protective factor in the emergence of depressive disorders (P = 0.0189). Estimating the role of hormonal decline at patients aged over 40 years, helped us to understand that the emergence and evolution of clinical manifestations during perimenopause and menopause may be caused by fluctuations of central secretion of pituitary hormones and sex steroids.

Keywords: depression, perimenopause

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Issues on Malnutrition in Children with Cancer

Chinceșan Mihaela¹, Baghiu Despina¹, Mărginean Oana¹, Horváth Adrienne¹, Eșianu Andrea²

1 University of Medicine and Pharmacy of Tîrgu Mureș, Pediatric Clinic No 1
2 Emergency County Hospital Tîrgu Mureș, Pediatric Clinic No 1

Introduction: Malnutrition is present in a high percentage in children with cancer. It can be evaluated by anthropometric measurements and laboratory data.
Aims: 1. To determine the prevalence and severity of malnutrition at diagnosis in children with cancer. 2. To define the best modalities to assess nutritional status.
Material and methods: A prospective study was performed on 27 children hospitalized and diagnosed with various type of cancer in the Pediatric Clinic No.I Targu-Mures, between November 2009–January 2011. We evaluated anthropometric and biochemical parameters: weight, height, body mass index (BMI), middle-upper arm circumference (MUAC), triceps skin fold thickness (TSF), total protein, albumin, Insulin-like growth factor-1 (IGF-1). We divided patients into three categories depending on nutritional parameters: severely malnourished, risk of malnourished and adequately nourished. We correlated anthropometric parameters with biochemical parameters.
Results: Our group consisted of 20 males (74.04%) and 7 females (25.96%). Of the 27 children with cancer, 14 children were severely malnourished, 8 children were with risk of malnourished and only 5 children with normal nutritional status. At the onset of malignant disease, 16 patients (59.25%) had low serum protein values and 10 patients (37.03%) had low levels of serum albumin. IGF-1 was decreased in 18 children (66.66%). We found a good correlation, statistically significant between TSF and serum proteins (r = 0.41; p = 0.02), between TSF and IGF-1 (r = 0.44; p = 0.02), and between MUAC and IGF-1 (r = 0.39; p = 0.04).
Conclusions: 1. The prevalence of malnutrition in children with cancer is high. 2. Arm anthropometry in conjunction with serum protein and IGF-1 most accurately characterizing the nutritional status.

Keywords: malnutrition, cancer, child

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Quantifying Human Enamel Erosion Caused By Freshly Squeezed Juices

Borş Andreea¹, Fazakas Zita², Molnar-Varlam Cristina¹, Cămărăşan Alina¹, Mucenic Simona¹, Kerekes-
Máthé Bernadette¹, Székely Melinda¹

1 Department of Morphology of Teeth and Dental Arches; Technology of Dental Prosthesis and Dental Materials, Faculty of Dentistry, University of Medicine and Pharmacy, Târgu-Mureş
2 Department of Biochemistry, University of Medicine and Pharmacy, Târgu-Mureş

Aims: The present in vitro study intended to investigate minimal erosive effects of different freshly squeezed fruit juices on human enamel during short time incubation by determination of calcium and phosphate dissolution.
Material and methods: Healthy adult human molars and premolars were cut in 160 blocks (5 mm x 6 mm x 2 mm) and divided randomly in sixteen groups of 10 samples each (n = 10). Each group was assigned for immersion at 37 oC in 5 ml juice, for different spot times 3, 6, 9 and 12 minutes, respectively. The freshly squeezed juices analyzed were orange juice, apple juice, orange mixed with carrot juice (1:1) and apple mixed with carrot juice (1:1). Amount of titratable acid and pH was measured for the tested solutions. Calcium and phosphate release were determined photometrically using VIS-UV/VIS spectrophotometer. ANOVA test compared the data generated (p < 0.05).
Results: The apple juice showing the lowest pH and a high value for buffering capacity had the most pronounced erosive effect. The orange juice was less erosive (p < 0.001). The least erosive was the orange mixed with carrots (1:1) (p < 0.001), which has the highest pH. The enamel demineralization increased when prolonging the immersion time (p < 0.0001).
Conclusions: All freshly squeezed juices caused the dissolution of calcium and phosphate in human enamel. Erosive capacity is mainly determined by pH and to a lesser extent by the buffering capacity. The amount of demineralization is directly correlated with the exposure time. Absorption spectroscopy allows detection of very small mineral loss using standardised human enamel samples.

Keywords: in vitro, chemical analysis, dental erosion, human enamel, fresh juice

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Clinical Presentation and Precipitating Factors for Acute Heart Failure Hospitalization

Baricz Emőke, Szakács O, Toma L, Szabados Cs, Baricz J, Gyalai Zs, Carașca E

Cardiology Department, Internal Medicine Clinic, Faculty of Medicine,University of Medicine and Pharmacy, Târgu Mureș

Introduction: Acute heart failure syndromes are the most common cause of hospitalization in patients over 65 year. The number of hospitalizations for heart failure has tripled over the last three decades and it is expected to grow further.
Matherials and methods: We followed 390 patients, with an average age of 69.2 yrs, admitted in the Cardiology Department of Internal Medicine Clinic IV of Târgu Mureș, from January 2009 till January 2010 for treatment of the acute heart failure. The aim of this study was the analization of the clinical presentation and the precipitating factors of the heart failure at these patients.
Results and discussions: The most common clinical presentation at this category of patients is decompensated heart failure (peripherial oedema/congestion). In this particular case over two thirds of patients have history of heart failure (p < 0.0001). Hypertensive heart failure is a common finding in the novo cases (p = 0.0004). Cardiogenic shock is relatively rare form at this group but with very high hospital mortality. The most common trigger is infection, that frequently causes acute heart failure syndromes, mostly right heart failure in patients with pulmonary cardiopathy (p < 0.003). It is the most frequently identified trigger, both, in worsening chronic heart failure (p = 0.0002) and de novo heart failure group (p = 0.251).
Conclusions: The prevalence of triggers varies considerably depending on the target population, but infections, arrhythmias, elevated blood pressure and non-compliance remain frequent causes of acute heart failure syndromes.

Keywords: acute heart failure, clinical presentation, trigger, precipitating factor

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Plagiarism – a Societal Contagious Disease or Just a Means for Opportunists to Reach for a Better Position?

Sanda-Maria Copotoiu, Dan Dobreanu

The amount of medical articles retracted by editors is escalating alarmingly. Accessed on May the 3rd 2011, the Pub Med site displayed 644 articles retracted. The dimensions of the phenomenon mirrored by other data source are impressing: ”of the 9 398 715 articles published between 1950 and 2004, 596 were retracted. This wave of retraction impacts highly respected journals.” [1]. And the increase even if limited to the period comprised between 1990 and 2006 is significant with a p = 0.002 [1].
It would be insane to read them all in order to identify the reasons they were sieved, it would be unprofessional since nobody is qualified enough to assess them in a reliable way and obviously it would be impossible to fulfill such an unrealistic task. Nobody would benefit of it.
The editors always make a formal statement as to the reasons of retractions: inquires unveiling the lack of ethics committees’ approval of research, the inability to provide the documents relevant to the research published, unintentional alteration of the data, inappropriate use of statistics, any form of trespassing the ethical conduct of research, to name a few.
Sometimes, plagiarism is committed involuntarily. For instance, a prominent lecturer recently paraphrased a statement omitting to quote the author, failing to acknowledge the paraphrasing, and still pointing out on research fraud. Seated in the audience, somebody next to me showed me a book purchased at the airport bookstore. The book contained an example promoted by the lecturer. I can only imagine that taken by the wave of rhetoric, he forgot to credit the author and involuntarily committed plagiarism while vituperating against it. Is it then so easy to misbehave, or are the definitions of plagiarism too tight? [More]

Keywords: plagiarism, retracted articles

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