Category Archives: AMM 2011, Volume 57, Number 4

The Radial Artery in Coronary Surgery – Our Initial Clinical Experience

Moraru L1, Raicea V2, Șerban V2, Ivănescu A1, Ghiga Dana3, Brânzaniuc Klara1, Deac R2

1 Department of Anatomy and Embriology, Faculty of Medicine, UMF Tg. Mures
2 Clinic of Cardio-Vascular Surgery, Faculty of Medicine, UMF Tg. Mures
3 Department of Research Methodology, faculty of Medicine,UMF Tg. Mures

Objective: We compared in our experience the radial artery harvested in the skeletonized versus pedicled manner as an additional arterial graft for coronary surgery.
Material and methods: In this study we evaluated the results obtained of 47 patients to whom we harvested the radial artery using skeletonized technique (14 cases) and pedicled technique (33 cases). In all the cases, preoperatively the radial artery was evaluated by using the modified Allen test, echo Duplex and angio CT, intraoperative the grafts were used for grafting the circumflex and right coronary system grafting and postoperative the patients were evaluated clinically and angiographically.
Results: The age was situated in between 36–77 years. The harvest time was comparable for both methods (mean 42 minutes vs 34 minutes), the length of the conduit was also comparable (mean 14.4 cm vs 13.9 cm) and without having local complication in both techniques, but the diameter of the graft and its uniformity was greater with the “pedicled” method (mean 3 mm vs 2.2 mm). The function of the grafts was good in both circumflex and right coronary systems, with corresponding values measured at the end of the operation: flow 21–67 ml/min (mean) and pulsatility index 1.3–3.9 (mean). There were no complications at the harvest site and the patients were free from angina after the operation, the angiographic control demonstrating a good function of the grafts in both groups.
Conclusions: The “pedicled” surgical harvest of the radial artery offers an arterial graft with a superior and uniform diameter associated with a corresponding length for the patients with total arterial myocardial revascularization.

Keywords: , ,
Full text: PDF

The Role of Ureteral Stents in Non-complicated Retrograde Ureteroscopies for Ureteral Calculi

Mitranovici E1, Tudor Bianca2

1 Emergency County Hospital of Deva, Department of Urology
2 University of Medicine and Pharmacy of Tîrgu Mureș, Department of Microbiology

Objective: The objective of this retrospective study is to evaluate the benefits of inserting the ureteral stent, for one week, in patients whose ureteral calculi were endoscopically fragmented without any intra-operative complications.
Material and method: The study comprised 140 patients who had ureteroscopies with the ultrasonic fragmentation of the calculi, under regional anaesthesia. The dimension of the calculi was between 5–10 mm. One-hundred-nine patients, who had intra-operative incidents, were split into two groups: group A – 54 patients – to whom a stent was inserted during the procedure, and group B – 55 patients – with no stent insertion. The following parameters were observed: the presence of lumbar pain, suprapubic pain, renal cramps, irritative urinary syndrome, urinary infection and the need for analgesic administration comparatively for the two groups.
Results: The presence of the post-operative ureteral stent diminishes the lumbar, suprapubic and colicative pains, the need of analgesic administration, and the increases of the risc of urinary infection and of the irritative urinary syndrome.
Conclusions: The ureteral stent inserted at the end of the endoscopic procedures [ureteral calculi fragmentation] has a role in a favourable evolution of the patients by increasing the post-operative comfort, but it also represent an inconvenience by the need of its postoperative removal.

Keywords: , , ,
Full text: PDF

Turn-taking Mechanisms in Dialogues Between General Physicians and Cardiac Patients

Lőrinc-Sárkány Anita, Csongor Alexandra

University of Pécs, Faculty of Medicine, Department of Languages for Specific Purposes, Pécs, Hungary

Introduction: The subject of this research is to investigate communication between general physicians and patients by focusing on the mechanism of turn-taking. The study is meant to identify some characteristics of successful doctor-patient communication and will also attempt to analyze a history taking event with regard to its turn-taking structure.
Material and method: The subject of this research is doctor patient dialogues. The transcribed versions of the recordings contain important information about the content and the process of the conversation as well as special signs for interruptions, breaks and intonation. A history taking encounter of a general physicians and a heart patient was analyzed. Doctor-patient communication was studied from the aspect of trustful relationship. The methods, number, and places of turn-taking were explored.
Results: Based on the results, the patient’s turns were allocated by self-selection 12 times and there were 10 instances of current – the doctor-selecting next speaker. Table II shows the number and different types of indicating turn allocation in the dialogue. According to the results, turn allocation was indicated by the patient’s questions and the doctor’s imperative sentences.
Conclusions: The present research is to be extended with further investigations concerning the mechanisms of problem-solving and turn-taking. For the purposes of widening the focus of the present research further doctor-patient encounters will be recorded, and analyzed using the method of conversation analysis.

Keywords: , , ,
Full text: PDF

A New Method of Mobilization of Hematopoietic Stem Cells in Autologous Stem Cell Transplantation

Kakucs Enikő1, Benedek I2, Benedek Erzsébet1, Köpeczi Judit Beáta1, Tunyogi Aliz1, Istrati Monica1

1 Clinical Hematology and Bone Marrow Transplantation Unit, Tîrgu Mureș
2 University of Medicine and Pharmacy of Tîrgu Mureș

Background: Plerixafor is a selective and reversible antagonist of CXCR4 chemokine receptor indicated in combination with G-CSF (Granulocyte colony stimulating factor) to release haematopoietic stem cells (HSC) into the peripheral blood for collection and subsequent autologous transplantation for lymphoma and myeloma patients.
Objective: We studied the efficacy of the plerixafor in association with G-CSF in poorly mobilizing patients.
Materials and methods: We performed 11 mobilization procedures using plerixafor in combination with G-CSF in 8 patients with Hodgkin’s lymphoma, 2 patients with non-Hodgkin’s lymphoma and 1 patient with multiple myeloma. The majority of patients have already been heavily pretreated with cytostatic chemotherapy two of them were also treated with radiotherapy. Patients received G-CSF (10 μg/kg/d) for 4 days. On the evening of day 4, they were given plerixafor (0.24 mg/kg) and in the morning we started the apheresis procedures.
Results and discussion: Mobilization with G-CSF and plerixafor was associated with a satisfactory release of CD34+ cells to the peripheral blood as measured 8 hours after plerixafor administration. The final stem cell product contained a median of 3.14 × 106 CD34+ cells/kg (range 1.51–12.1).
Conclusion: Stem cell mobilization with plerixafor and G-CSF provides a solution for majority of patients who were heavily pretreated.

Keywords: , ,
Full text: PDF

Transchondral Drilling and Osteochondral Autografting (Mosaicplasty) in Knee Articular Cartilage Defects

Ivănescu A1, Melinte R2, Sólyom Á2, Moraru L3, Petrișor M4, Brânzaniuc Klara1

1 University of Medicine and Pharmacy of Tîrgu Mureș, Department of Anatomy and Embriology
2 County Emergency Clinical Hospital Tîrgu Mureș, Orthopedic Clinic II
3 County Emergency Clinical Hospital Tîrgu Mureș, Clinic of Cardiovascular Surgery
4 University of Medicine and Pharmacy of Tîrgu Mureș, Department of Medical Informatics and Biostatistics

Background: The cartilage is a complex and specialized tissue. It is extremely difficult to repair or to replace it, once damaged. The management of cartilage defects remains controversial and over the last five decades various treatment options and surgical techniques have been tried to optimize the clinical outcome.
Objective: The aim of this study is to evaluate, but not to compare the results of two of the most used cartilage repair techniques: trans-chondral drilling and osteochondral autografting.
Material and methods: Between January 2009 and June 2010, we performed 55 transchondral drillings and 10 mosaicplasties on patients with articular cartilage defects of the knee. All patients were followed up at 6 months. Hughston clinical and radiological scales were used to evaluate the patients in the transchondral drilling group.
Results: The Hughston Clinic score was 2 in 2 cases (3.6%), 3 in 5 cases (9.9%) and 4 in 48 cases (86.5%), giving over 95% of good results. The Hughston radiological score was 2 in one case (2%), 3 in 4 cases (7.3%) and 4 in 50 cases (90.7%). In the mosaicplasty group,the average area of the osteochondral lesion covered with autologous osteochondral transplantation ranged from 0.8 to 6 cm2 (average: 2.13 cm2). The diameter of the grafts used ranged from 6 to 10 mm and 1 to 6 grafts were used in each case to achieve >90% covering of the lesion area.
Conclusions: Both techniques offer satisfactory functional outcome and do not compromise the patients’ future options.

Keywords: , , ,
Full text: PDF

Psychological Autopsy — An Effective Method for the Positive Diagnosis of Suicide in Schizophrenia

Hădărean V2, Sălcudean Andreea1, Gaboș-Grecu I1,2, Gaboș-Grecu Marieta1,2, Buicu Gabriela2, Sălcudean D3, Stanciu Camelia4

1 Psychiatric Clinic 1, Tîrgu Mureș
2 University of Medicine and Pharmacy of Tîrgu Mureș
3 Law firm, Tîrgu Mureș
4 ”Dimitrie Cantemir” University of Psychology, Tîrgu Mureș

Purpose: This paper aims to analyze suicide in schizophrenia in terms of application of psychological autopsy.
Material and methods: We studied 53 persons who committed suicide between 2000–2009. We carried a series of interviews with people close to the persons who committed suicide, to analyze the motivation behind the suicidal act. The method chosen for the interviews was empathic post-suicide listening in parallel with a questionnaire.
Results: Disorganized and paranoid types of schizophrenia have led to most victims. 22.6% of the persons who committed suicide had auditory hallucinations with imperative suiciding character.
Conclusions: Detecting suicidal motivations and their understanding plays an important role in shaping a socio-psychological or a psychopathological profile by interpreting sociological, familial parameters, with emphasis on the personal dynamics of selfdestructing behavior, adult characteristics and identification of the persons with an increased suicide risk.

Keywords: , ,
Full text: PDF

Experience and Results After 100 Cases of Hypospadias Operated with Tubularized Incised Plate Technique

Gozar H¹, Gliga V², Patraulea F², Bălă G¹, Turcu Anne-Mary¹, Kertész Zsuzsánna²

¹ County Emergency Clinical Hospital Tîrgu Mureș, Clinic of Pediatric Surgery
² University of Medicine and Pharmacy of Tîrgu Mureș

Aim: To report our experience with tubularized incised plate urethroplasty (TIP).
Material and methods: Tubularized incised plate urethroplasty was undertaken in 100 patients within 0 and 17 years (mean age 5.31 years), during the last two and a half years. All of them had the same procedure performed in the Clinic of Pediatric Surgery Tîrgu Mureş. The patients were followed-up at 2 weeks, 4 weeks, 3 months, 6 months and 1 year.
Results: Overall complications were encountered in 16 cases. We had 40 small patients (0–3 years) with a success rate of 95%, 46 mid age patients (4–11 years) with a success rate of 82.60% and 14 pubertal patients (12–17 years) with a success rate of 71.42%. The operation was performed for the first time in the case of 63 boys (54 had no complications) and it was a re-operation in the case of the other 37 (30 had no complications). Distal and mid shaft hypospadias had similar rate of success (89.58% and 84.61%). In proximal hypospadias, the rate of success was 61.53%.
Conclusions: The tubularized incised plate urethroplasty is a versatile single stage procedure for all types of hypospadias. We consider now that this procedure is the best in the treatment of hypospadias.

Keywords: , ,
Full text: PDF

Particularities of Helicobacter pylori Infection in Diabetic Patients

Floarea Ramona1, Georgescu ED2, Frunză-Dumitru Anca3, Mitroi-Maxim Corina1, Maxim RG1

1 ”Carol Davila” University of Medicine and Pharmacy, Faculty of Medicine, Sf. Ioan Emergency Clinical Hospital, Internal Medicine Clinic, Bucharest
2 ”Carol Davila” University of Medicine and Pharmacy, Faculty of Medicine, Sf. Ioan Emergency Clinical Hospital, Department of Internal Medicine, Bucharest
3 ”Carol Davila” University of Medicine and Pharmacy, ”Prof. Dr. N.C. Paulescu” National Institute of Diabetes, Nutrition and Metabolic Diseases, Diabetes Clinic, Bucharest

Introduction: In the last few years many studies were focused on the implications of Helicobacter pylori infection in the evolution of patients with diabetes mellitus. Most of the results are controversial. Our aim was to study the prevalence of the bacterial infection and some of its epidemiological features in diabetic versus non-diabetic patients and the particularities of the association of Helicobacter pylori with diabetes mellitus.
Material and method: We studied 70 consecutive patients with dyspeptic syndrome evaluated with The Leeds Dyspepsia Questionnaire, divided in 2 groups: 35 diabetic and 35 non-diabetic patients.
Results: The prevalence of the Helicobacter pylori infection was similar in our groups (p >0.05). Inside each group, the prevalence of bacterial infection did not differ related to the determination method – serology vs. invasive test (p >0.05). In the diabetic patients we found a positive correlation between the bacterial infection and parameters like family size (>5) (p <0.01). The metabolic control of the diabetics was not influenced by the infection. Regarding diabetes complications, there is significant association of neuropathy with Helicobacter pylori. The eradication rate of infection was similar in diabetic and non-diabetic groups.
Conclusions: The prevalence of Helicobacter pylori infection did not differ in diabetics versus non-diabetics. Both determination me-thods proved similar efficacy for bacterial diagnosis, but is recommended an association of an indirect and a direct method. The bacteria did not influence the glycemic status. Neuropathy is strongly associated with Helicobacter pylori infection.

Keywords: , , ,
Full text: PDF

Metabolic Profile and the Histological Changes in Patients with Chronic Viral Hepatitis

Crăciun P1, Oltean G2, Georgescu D3, Crăciun Lucia4

1 Chronic Haemodialysis Center, Tîrgu Mureș
2 County Emergency Clinical Hospital Tîrgu Mureș, Medical Clinic I
3 County Emergency Clinical Hospital Tîrgu Mureș, Clinic of Gastroenterology I
4 Sighișoara Municipal Hospital, Integrated Specialty Dispensary

Objective: To evaluate the incidence of steatosis and its correlation with lipidic profile changes comparing the patients with HVB to those with HVC.
Material and method: We enrolled a number of 87 patients who were diagnosed with viral hepatitits B and C between 2004–2008 in Medical Clinic I from Tîrgu Mureș, based on positive test results for HBs antigen and HCV antibody, on the presence of HCV-ARN and on histological features. To all patients it was performed hepatic biopsy and we determined cholesterol, triglyceride, glucose, ALT and AST blood levels.
Results: Steatosis had a higher incidence in patients with HCV infection. The steatosis is correlated with necroinflammation and fibrosis in patients with HVC. In the case of patients with HVB there was no correlation between the steatosis and the grade of fibrosis. The HVC group yielded lower mean values of cholesterol, triglycerides and glicemia than the HVB group. The values of the aminotransferases were increased in patients with hepatic steatosis in both groups.
Conclusions: Hepatic steatosis appears with a higher incidence in patients with HVC and it is correlated with the necroinflammatory and fibrosis scores. There is no correlation between the steatosis and fibrosis stage in HVB patients. Both in HVB and HVC the steatosis is correlated with high values of serum aminotransferases.

Keywords: , , ,
Full text: PDF

Statistical Study of Pathology Associated to Urethral Infection with Ureaplasma urealyticum and Mycoplasma hominis

Chiujdea Natalia-Simona1, Tilinca Mariana2, Chiujdea A3

1 County Emergency Clinical Hospital Tîrgu Mureş, Clinic of Gynecology II, Laboratory
2 University of Medicine and Pharmacy of Tîrgu Mureș, Department of Cell Biology
3 County Emergency Clinical Hospital Tîrgu Mureş, Clinic of Urology

Introduction: Ureaplasma urealyticum and Mycoplasma hominis are present as part of the normal flora of the urethra, but in some conditions of multiplication they can cause infections of the prostate or sterility.
Material and method: Two-hundred-fifty patients were tested in the laboratory under the proposed criteria of selection.The Stamey test was done for the differential diagnosis of chronic prostatitis. The harvesting was done with Dacron swab, which was then placed in a transport medium. We used the Mycofast Duo kit for the identification and quantification of Mycoplasmas, as well as for the testing of antibiotic susceptibility.
Results: Of the 43 positive cases, 15 presented only Ureaplasma and 28 presented both bacterias. Mycoplasmas were found in 8.57% of urethritis cases and 10.25% of prostatitis cases. 33.33% of patients with a diagnosis of infertility had a positive Mycoplasma test. 23.6% of cases were associated with Gram positive or Gram negative infections and 2 with Chlamydia trachomatis.
Discussions: The incidence of Ureaplasma urealyticum has been reported to be between 9% and 42% in the literature. It is noted this bacteria has a good sensitivity to the new macrolides, josamycine, pristamycine and roxithromycine. However, Doxycycline is still on the first place, azithromycin on the 4th place, and fluoroquinolones have the lowest sensitivity of all.
Conclusions: Our results suggest that infertility in men is significantly associated with the presence of the studied Mycoplasmas. The treatment of urogenital inflammatory disease would require the corroboration of all the results from the Stamey test, stained microscopic examination, testing for Gram positive and negative bacteria – Chlamydia trachomatis and urogenital Mycoplasmas, and an antibiotic or a combination of targeted antibiotics for each pathological strain detected.

Keywords: , , ,
Full text: PDF