Category Archives: AMM 2011, Volume 57, Number 4

Results of Osteochondral Mosaic Grafting in a Sheep Model

Szántó A1, Gergely I2, Pop TS2, Russu O2, Zuh S2 Zazgyva Ancuţa2, Nagy Ö2

1 County Emergency Hospital, Miercurea Ciuc, Romania
2 University of Medicine and Pharmacy, Department of Orthopaedics and Traumatolog, Tîrgu Mureș, Romania

Objective: We present the results of an experimental study in sheep on using autogenous, cylindrical osteochondral grafts for treating cartilage defects in the knee. The aim was to produce hyaline or hyaline-like cartilage on weight-bearing surfaces through autogenous osteochondral transplantation using special instrumentation and the mosaicplasty technique.
Methods: We used a sheep model – cartilage defects were made in the knees of 16 young sheep from the Tigaia breed. At 4 and 8 weeks postoperatively macroscopic, radiologic and microscopic examinations were performed on the transplanted sites and the donor sites.
Results: We found that grafts incorporated well in the recipient sites, showing good survivorship. Joint congruency was maintained, with 75 to 80% hyaline cartilage at the transplanted site.
Conclusions: Our results lead us to conclude that mosaic-like osteochondral grafting is an excellent treatment method for repairing chondral defects in major joints.

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The Importance of Histo-pathological Factors in Setting the Long Term Prognosis for Non-small Cell Lung Cancer

Suciu B1, Bud V1, Copotoiu C1, Brânzaniuc Klara2, Copotoiu Ruxandra3, Fodor D1, Butiurcă V4

1 County Emergency Clinical Hospital Tîrgu Mureș, Surgical Clinic I
2 University of Medicine and Pharmacy of Tîrgu Mureș, Department of Anatomy and Embriology
3 County Emergency Clinical Hospital Tîrgu Mureș, Clinic of Anesthesia and Intensive Care
4 Student, University of Medicine and Pharmacy of Tîrgu Mureș

Introduction: In the last decades, the rate of pulmonary cancer has risen alarmingly. Pulmonary cancer represents the main cause of death in women and men in the United States of America, 100,000 new cases being registered annually in men and 50,000 new cases in women. The purpose of our study is to evaluate the importance of histo-pathological factors in the long term outcome of patients operated for lung cancer.
Material and methods: In order to write the present paper, we carried out a retrospective observational study on a period of 6 years. We used the casuistry of the Surgical Clinic I of the County Emergency Clinical Hospital Tîrgu Mureș. We studied all the patients’ papers who were admitted to Surgical Clinic I from the 1st of January 2005 till 31 December 2010. Further, we based our research on 197 patients that were admitted to Surgical Clinic I for bronchopulmonary tumors.
Results: We studied the importance of the T descriptor (tumor) from the TNM staging for establishing the long term prognosis. The value of p was 0.1676 so we didn’t obtain any value of statistical importance. We also took into consideration the value of N from the TNM staging as a prediction factor for long term survival in patients who underwent surgical intervention for pulmonary cancer. The p parameter was 0.0152 so we can say that we obtained a direct connection between the stages of lymph nodes metastasis and long term survival rate.
Conclusions: Long time survival rate of the patients depends on the histological type of the tumor. Long term survival prediction rate is better if the patients are over 60 years, compared with patients under 60 years. The N descriptor can be considered an important prediction factor, while the T descriptor’s value is useless. The existence of N’s descriptor in more stages of the TNM classification shows its limits and encourages for further improvements.

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Comparative and Morphological Analysis of Patellar Tendon with the Native Anterior Cruciate Ligament (ACL): an Electron, Microscopic and Morphological Study

Sólyom Á1, Zuh GyS2, Ivănescu A3, Nagy Ö2

1 University of Medicine and Pharmacy of Tîrgu Mureș, Department of Orthopaedics and Traumatology II
2 University of Medicine and Pharmacy of Tîrgu Mureș, Department of Orthopaedics and Traumatology I
3 University of Medicine and Pharmacy of Tîrgu Mureș, Department of Anatomy and Embriology

Background: Ligaments and tendons are similar in composition but differ in proportion and arrangement. Tendons are used as grafts for the ACL reconstruction. The microscopic structure of these tendons has not been sufficiently studied and compared to the native ACL.
Objective: To compare the structure of the patellar tendon graft with the structure of a normal anterior cruciate ligament.
Material and methods: A null hypothesis was declared stating that the anterior cruciate ligament should be histologically, morphologically and functionally different from the patellar tendon used for ACL reconstruction. We investigated similarities and dif-ferences of the structure of ACL and patellar tendon used as a graft tissue for ACL reconstruction. In this study, samples of patellar tendon, and the ACL were harvested from 18 patients during ACL reconstruction and analysed by light and electron microscopy, immunohistochemistry and morphometry.
Results: The thickness of the collagen fibrils, collagen organization and diameter, the fibril/interstitium ratio, density of fibroblasts and blood vessels, and distribution of the collagen type I, III and V fibrils were analyzed.
Discussions: The ACL had the highest concentration of type III and V collagen fibrils as well as elastic fibers.
Conclusion: The histological and ultrastructural appearance of the ACL differs from patellar tendon used as graft for ACL reconstruction.

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Development of a Separation Method of Four Penicillin Derivatives by Capillary Electrophoresis

Simon Brigitta1, Hancu G2, Gyéresi Á2

1 Martin Luther str. 79, Săcele, Brașov
2 University of Medicine and Pharmacy of Tîrgu Mureş, Faculty of Pharmacy, Department of Pharmaceutical Chemistry

Introduction: The objective of this paper is the development and optimization of a capillary electrophoresis method, which allows the separation of four frequently used penicillin derivatives (amoxicillin, ampicillin, benzilpenicillin and oxacillin), with possible application in the analysis of environmental samples.
Material and method: In our experiments we worked on water solutions of the studied penicillins. The analysis was performed on an Agilent Capillary Electrophoresis System with a diode array detector. The data were recorded and processed by Chemstation software.
Results: Different buffer solutions were tried out in order to reach the most efficient separation of the studied compounds. The influence of different analytical parameters was evaluated by varying the buffer concentration, buffer pH, voltage, temperature, injection time and pressure. The analytical performance of the method was verified, in order to estimate reproducibility and sensitivity.
Conclusions: A micellar electrokinetic capillary chromatography method has been developed for the separation of the four penicillins. We obtained the best results with a buffer solution containing 25 mM sodium tetraborate and 100 mM sodium dodecyl sulfate (pH = 9.3), the separation being achieved in approximately 5 minutes.

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Surgical Management of Deep Infiltrating Endometriosis and Impact on Quality of Life

Rozsnyai FF1, Szabó B1, Pușcașiu L1, Túrós J1, Bereczky Katalin1, Molnar CV1, Roman H2

1 County Emergency Clinical Hospital Tîrgu Mureș, Clinic of Obstetrics and Gynecology I, Tîrgu Mureș, Romania
2 Rouen University Hospital-Charles Nicolle, Department of Gynecology and Obstetrics, Rouen, France

Objective: The purpose of this retrospective review study was to assess the impact of surgery and quality of life for patients presenting painful deep infiltrating endometriosis (DIE).
Patients and methods: All patients with histologically proved infiltrating endometriosis who had surgery from 1.01.2006 to 31.12.2010 at the Clinic of Obstetrics and Gynecology I, Tîrgu Mureș, Romania and the Department of Gynecology and Obstetrics of the Rouen University Hospital-Charles Nicolle, Rouen, France were included in the study. Surgical exeresis of endometriosis for patients with deep infiltrating endometriosis with GnRha (Gonadotrophin-releasing hormone) analogues treatment before and after the surgery.
Results: One-hundred-fourteen subjects underwent operative laparoscopy for deep infiltrating endometriosis. Involvement of urinary tract was confirmed in thirty patients and the colorectal localization in eighty-four patients. Intra-operative finding according to American Fertility Society reviewed-classification (AFSr) score revealed stage I 6 (5.3%), stage II 9 (7.9%), stage III 18 (15.8%), and stage IV 81 (71.1%).
Conclusion: Resection for deep endometriosis appears to relieve some symptoms. However, patients should be informed that pain may persist and that there is a risk of urinary and digestive side effects.

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The Superiority of Laparoscopic Appendectomy: Myth or Reality?

Roşca Ancuţa Noela, Corhan T, Hintea A, Georgescu R, Coroş MF

County Emergency Clinical Hospital Tîrgu Mureș, Surgery Clinic I, Tîrgu Mureș, Romania

Background: Laparoscopic appendectomy is a laparoscopic intervention that could be achieved with the improvement of laparoscopic instruments and technology. It presented an upward trend in recent years despite the many controversies surrounding this type of intervention. In our clinic was a “bridge route” to acquire advanced laparoscopic surgical techniques.
Methods: Comparative analysis of laparoscopic appendectomy and classic appendectomy; establishing the superiority of laparoscopic approach. We have studied the casuistry of the Surgery Clinic I of the County Emergency Clinical Hospital Tîrgu Mureș for the 2008–2011 period (3 and half years). Several parameters were analyzed.
Results: In the analyzed period 209 appendectomies were performed: 98 (53%) by laparoscopic approach and 111 (47%) by open approach. 49.13% of all women operated received laparoscopic surgery, while only 44.08% of men have had this approach. The time of laparoscopic surgery was on average 13.10 minutes longer than the classic. Conversions were 10% of total laparoscopic interventions. Complications that required reintervention were recorded in 1 case (20%) after the laparoscopic approach, as opposed to 4 cases (80%) for the classic approach.
Conclusions: Laparoscopic appendectomy weight increased progressively from year to year. The average duration of laparoscopic appendectomy learning curve was part of any specific type of laparoscopic intervention. The benefits of this type of intervention are clear, as represented by the possibility of exploring the peritoneal cavity and differential diagnosis of “painful right iliac fossa syndrome” in women, can guide classic approach in case of conversion, rapid mobilization and early resumption of transit, decreased parietal pain, a lower rate of parietal infection, short-term hospitalization and faster reintegration in activity.

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Metabolic Markers Evolution During Antegrade and Retrograde Normothermic Blood Cardioplegia

Raicea V1, Moraru L1, Raicea I2, Șerban V1, Péter Orsolya1, Raicea Camelia3, Gusu Rodiana4

1 University of Medicine and Pharmacy, Clinic of Cardiovascular Surgery, Tîrgu Mureș, Romania
2 University of Texas Medical School of Houston, Department of Cardiothoracic and Vascular Surgery, Houston, USA
3 Institute of Public Health Tîrgu Mureș, Romania
4 University of Medicine and Pharmacy, Faculty of Medicine, Tîrgu Mureș, Romania

Background: Several studies suggested that the ventricular myocardium is suboptimally protected during retrograde blood cardioplegia.
Methods: Twenty patients (10 patients for subgrups) undergoing an elective valvular replacement mitral and aortic, with right atrial approach, mitral transeptal or tricupid procedures were randomized to receive antegrade or retrograde normothermic blood oxigenated cardioplegia. Astrup determinations (astrup values, lactate production, pH and BE) and ventricular differences in oxygen extraction from separate coronary ostium canulation were monitored during aortic cross-clamping at time at cardioplegic delevery immediately after cross clamping, at first, 20 minutes or 30 minutes of ischemia, after aortic declamping immediately and after 10 minutes. Hemodynamic recovery and postoperative complications were noted.
Results: The preoperative characteristics of the two groups were similar. Lactate production and oxygen extraction in the right ventricular myocardium were higher in the retrograde group. In this group, the right ventricle also extracted more oxygen and produced more lactate and acid than did the left ventricle. A typical cumulative ischemic pattern with progressively decreasing pH, BE values and progressively increasing lactate values could be observed similar in both groups in all patients. It was not the degree of lactate washout, but the lactate concentration at the end of each reperfusion wich increased proportional with ischemic time bettewen cardioplegic administration and after declamping — that correlated significantly with global metabolic recovery time. Nevertheless, the postoperative course was uneventful in both groups.
Conclusions: Despite of value of lactate production, acidosis and oxygen extraction, were more prominent in the right ventricular myocardium during retrograde cardioplegia after declampation, at 10 minutes this value became similar, and clinical and inotropic necesity were similar in this two groups. During antegrade cardioplegia the washout of myocardial metabolites is very efficient and the peak levels of lactate decrease rapidly at the end of cardioplegic administration and after declampation compared with retrograde administration. No diference seems to be seen between retrograde or anterograde cardioplegic administration 10 minutes after declampation. Nevertheless the postoperative course seems to be unproblematic in two series.

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Improvements of Oxacillin Stability in a pH = 1.2 Acidic Environment

Rad I1, Croitoru MD2, Gyéresi Á2

1 Dimitrie Cantemir College, Tîrgu Mureș
2 University of Medicine and Pharmacy of Tîrgu Mureș, Faculty of Pharmacy

Introduction: Oxacillin sodium is a semisynthetic penicillin used in therapy against Staphylococcus species. It is orally administered as capsules. Because of the low stability of oxacillin in stomach acid, a low bioavailability is recorded during oral administration (30%).
The aim of this study was to improve, by using some auxiliary substances, the stability of oxacillin in acidic environment.
Methods: The improvement of oxacillin stability was measured by high performance liquid chromatography in the presence of β-cyclodextrin, 2-HP-β-cyclodextrin, magnesium glutamate and magnesium aspartate.
Results: Cyclodextrins significantly improved the stability of oxacillin in acidic environment. Glutamate and aspartate showed no effect on this regard. First order decomposition kinetics of oxacillin was modified by cyclodextrins.
Conclusions: Significant improvement of oxacillin stability and possible pharmacokinetics can be achieved by using cyclodextrins.

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The Impact of Modifiable Risk Factors on the Short-term Outcome of Stroke

Orbán-Kis K1,2, Szőcs Ildikó2, Szatmári Sz2,3

1 University of Medicine and Pharmacy, Department of Physiology, Tîrgu Mureș, Romania
2 County Emergency Clinical Hospital, 2nd Department of Neurology, Tîrgu Mureș, Romania
3 University of Medicine and Pharmacy, Department of Neurology, Tîrgu Mureș, Romania

Objective: The high stroke morbidity and related mortality in Central-Eastern European countries might be related to several factors. In this study we used a large, database from Tîrgu Mureș (Romania) to investigate the impact of risk factors on the short-term outcome of stroke. We opted for this method as hospital databases usually provide more detailed information on risk factors, stroke severity and correlated outcome than population based registries.
Methods: We analyzed the data of 1478 consecutively hospitalized stroke patients during a period of one year, regardless of the ward they were admitted to. We recorded risk factors, stroke severity and correlated with the short-term outcome (i.e. in-hospital outcome, assessed by Glasgow Outcome Scale) of stroke.
Results: Significantly more men and patients with a lower age than the European average were admitted. 26% of admitted patients had a previous cerebrovascular disease in their history. The prevalence of modifiable risk factors such as hypertension, diabetes, hyperlipidaemia, smoking, etc was higher than in other European countries. Overall case fatality was 10.4% and 75% of discharged patients had some degree of disability. Outcome at discharge was worse with higher systolic and diastolic blood pressure, increased heart rate, higher serum glucose, higher white blood cell count as well as decreased consciousness and increased age.
Conclusions: In this large hospital based database we found an alarming number of untreated and frequently aggregated risk factors. Our findings emphasize the role of modifiable risk factors as well as indicate major opportunities for more efficient stroke prevention.

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The Analysis of Flavonoids from Inula helenium L. Flowers and Leaves

Nan Monica1, Vlase L2, Eşianu Sigrid1, Tămaş M3

1 University of Medicine and Pharmacy of Tîrgu Mureș, Faculty of Pharmacy, Department of Pharmacognosy, Tîrgu Mureș
2 University of Medicine and Pharmacy “Iuliu Haţieganu”, Faculty of Pharmacy, Department of Pharmaceutical Technology and Biopharmaceutics, Cluj Napoca
3 University of Medicine and Pharmacy “Iuliu Haţieganu”, Faculty of Pharmacy, Department of Pharmaceutical Botany, Cluj Napoca

Objective: In this study we investigated the flavonoids in the leaves and flowers of Inula helenium L..
Material and method: Flowers and leaves were harvested from the Medicinal Plant Garden of the University of Medicine and Pharmacy of Tîrgu Mureș. Dried vegetable product was extracted with methanol and in order to investigate aglycones we prepared hydrolised extracts. We screened the vegetable product for flavonoids using a TLC method, then we determined the total flavonoid content by a spectrophotometric method. HPLC-MS and HPLC-UV methods were used to determine polyphenols in methanolic and hydrolised extracts.
Results: Flavonoid content varies from 1.83% in leaves to 1.43% in flowers, equivalent in hyperoside. We identified the flavonols quercetin and kaempferol and the glycosides isoquercitrin, quercitrin and rutoside. Isoquercitrin is the major compound, in a concentration of 0.898 mg/g dry vegetable product.
Conclusions: Our study shows that the leaves and flowers of Inula helenium L. contain a high percentage of flavonoids with pharmacological activities.

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