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Category Archives: AMM 2011, Volume 57, Number 5
Gastric Trichobezoar
Introduction: Trichobezoars arise from the aggregation of ingested hair with other indigestible organic fibers. Trichotillomania, the practice of habitually pulling hair out, in association with habitual ingestion of hair (trichophagia) can predispose to the formation of trichobezoars.
Material and method: We present the case of a 28 year-old woman who was admitted to our clinic for abdominal pains, nausea and weight loss. The clinical examination revealed an abdominal mass in the upper part. The laboratory parameters were normal excepting a mild anemia and hipoproteinemia. A CT Scan of her abdomen showed a markedly distended stomach with a centrally located soft tissue abnormality. The patient underwent exploratory laparotomy and gastrotomy. We found an intragastric mass made up by hair. The trichobezoar was removed intact as a firm black mass and it was confirmed by the microscopic examination.
Results: The patient’s post-operative course was uneventful and she was discharged after 7 days of hospitalisation. We suggested psychiatric counseling.
Conclusions: The trichobezoar appears in young people with psychiatric disorders. Due to its dimensions, the only treatment in this case was open surgery. The after surgery course is usually favorable and needs psychiatric counseling.
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Acute Infusion Reaction to Infliximab in a Case of Crohn’s Disease with Recto-Scrotal Fistula
Crohn disease is an inflammatory bowel disease that involves any region of the alimentary tract from the mouth to the anus and it is transmural. Children with early onset are more likely to have colonic involvement. Infliximab constitutes today one of major therapeutic approaches in severe and fistulising cases of Crohn disease. We present the case of a 16 year-old boy who was admitted to our department presenting recto-scrotal fistula, fever, tenesmus, red-bloody stools, pain during and after defecation. In order to induce remission of the disease, we administrated Infliximab. The initial response to therapy was good, but he developed an acute infusion reaction during the administration of the 3rd dose, which forced us to quit this therapy.
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Chronic Vulvar Pain
Background: Chronic vulvar discomfort due to paucity of clinical signs is often associated with the term “vulvodynia”, perceived as a psychiatric problem.
Case report: A 28-year-old female patient presented for a 2-year history of vulvodynia, without any pathologic vulvar aspects. We investigated this syndrome by means of vulvar cytology, vulvoscopy, histology and ViraPap, too.
Results: Our interdisciplinary consultation indicates that vulvar vestibulitis syndrome co-exists with micropapillomatosis labialis (MPL), due to certain types of HPV. A herpes simplex episode occured 4 months after therapy and recurrent vulvovaginal candidiasis, too. During a period of 8 months, clinical examination showed smooth and well-demarcated whitish shiny plaques, that affected the clitoral hood, labia minora, the posterior fourchette and perineum. The clinical picture suggested a vulvar dystrophy.
Discussions: In this case report we intend a multidisciplinary approach to give a physical support to certain cases of vulvodynia, often associated with an expression of a psychological discomfort.
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Routine Immunophenotyping in Acute Leukemia, the Importance of Lineage Assessment
We present the case of an adult male patient, where the assessment of cell line could not be done without corroboration of the immunophenotype and cytological analysis. The correct lineage assessment is needed in order to treat the patient correctly. Morphology, cytochemistry, and immunophenotyping were used and the diagnosis we established was B acute lymphoblastic leukemia with aberrant myeloid markers (CD13, CD33). Periodic Schiff Acid stain was very useful to obtain an accurate diagnosis. Adult B acute lymphoblastic leukemia usually has an unfavorable prognosis because of certain cytogenetic abnormalities (Philadelphia chromosome) and different reactivity to treatment. This case strongly supports the continued use of immunophenotyping in the diagnosis and monitoring of acute leukemia and corroboration of different diagnostic techniques for the diagnosis.
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Survival Analysis after Cephalic Pancreatoduodenectomy for Carcinoma of the Ampulla of Vater
Background: Ampulla Vater carcinoma is a rare condition, having the best prognosis in periampullary malignant tumors. The purpose of this paper is to analyze the factors involved in long term survival after duodenopancreatectomy for carcinoma of the ampulla of Vater.
Material and method: This paper is a retrospective study across a 15-year period (1995–2009), during which 130 interventions for ampullary vaterian carcinoma were performed in Surgery Clinic I Tîrgu Mureş and Surgery Clinic III Cluj-Napoca. Cephalic pancreatoduodenectomy was performed in 86 cases, and we have obtained informations regarding late postoperative survival in 63 cases. The data was processed in Microsoft Excel, and the statistical analysis was performed with SPSS v. 17 for Windows. The threshold of significance was p <0.05.
Results: Survival at 5 years after cephalic pancreatoduodenectomy, in the group analyzed (63 cases) was 43.1%. We found a higher percentage of survival rate at 5 years for stage T1 tumors (tumor limited to the ampulla of Vater or sphincter of Oddi) – 68.3%, in the absence of regional adenopathies N0 – 68.3%, well differentiated tumors G1 – 90.5%, in tubulo-papillary adenocarcinoma histological type – 66.6%, in patients without lymphovascular invasion – 91.3% and in those without perineural invasion – 82.3%. Multivariate analysis of prognostic factors shows a high risk of death in the presence of lymphovascular invasion (p = 0.0031).
Conclusions: 1. Survival at 5 years after cephalic pancreatoduodenectomy was 43.1%, which is influenced by tumor extension, the presence of regional lymphadenopathy, the histopathological type of tumor, the degree of tumor differentiation, the lymphovascular or perineural invasion. 2. Multivariate analysis of prognostic factors shows that lymphovascular invasion is statistically significant in postoperative survival.
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Damage Control Surgery in Abdominal Trauma Associated with Pelvic Fracture
Introduction: A haemodynamically unstable patient with abdominal injury associated with pelvic fractures is a serious challenge for trauma surgeons and anesthesiologists. The purpose of this study is to evaluate the efficiency of patients’ treatment with combined abdominal-pelvic lesions using the TRISS and ASCOT predictive scores.
Patients and methods: The study included polytraumatized patients with haemodynamic instability or signs of acute abdomen witch required emergency laparotomy. Between 2008 and 2010, 124 patients were operated for abdominal trauma, 12 cases (9.6%) being associated with pelvic fracture.
Results: The mean age was 50.1 years (range 25–80 years).The lesions associated with pelvic fractures were the following: rupture of spleen (2 cases), liver rupture (2 cases), lung rupture (2 cases), diaphragm rupture and detachment (3 cases), small intestine and colon lesions (3 ca-ses), rupture of the urinary bladder (4 cases), urethra rupture (3 cases), and head trauma (3 cases). In the treatment of retroperitoneal bleeding in 6 cases it was necessary to perform packing control of the pelvic haemorrhage. Four patients died, giving an overall mortality rate of 33.3%. The mortality was not influenced by age (p = 0.31), ISS (p = 0.42) and pH (p = 0.63). The probability of survival calculated using TRISS was 62.3% and the probability of death calculated using ASCOT was 28.6%.
Conclusions: The control of haemostasis and peritoneal decontamination are priorities in the case of adominal-pelvic lesions. The packing control of haemorrhage proved to be effective in the management of bleedings caused by rupture of a retroperitoneal hematoma in the peritoneal cavity.
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Formulation and Evaluation of Valproic Acid Suppositories for Children
Introduction: Rectal suppositories of valproic acid were prepared using different lipophilic excipients: Suppocire NAI, Adeps solidus 50, Adeps solidus 3, Lipex 403, Cacao oleum. Each prepared suppository has been evaluated for various physical parameters like weight variation, disintegration and softening time and crushing (breaking) strength.
Methods: Suppositories were prepared by fusion method. The quantity of active drug (valproic acid) added to the suppositories was 200 mg, thus resulting 1.0 g suppositories. Prepared suppositories were visually inspected. Randomly selected suppositories were cut longitudinally and the surfaces were examined with naked eye. For determination of weight variation, 20 suppositories were weighed and the average weight was determined. Disintegration time, softening time and breaking strength of the prepared suppositories were determined according to the 5th European Pharmacopoeia.
Results: All the suppositories were free from pits, fissures and cracks. All formulas studied were disintegrated in less than 30 minutes. Valproic acid decreased the disintegration time of suppositories. The used excipient also influences the disintegration time, with a greater effect on the F1 formula (Suppocire NAI). After one month of preservation, the disintegration time of all formulas increased, but was less than 30 minutes. The softening time of the suppositories was the largest for the F1 formula (Suppocire NAI). The softening time decreases in the presence of valproic acid. The softening time and breaking strength increased for all formulas after one month.
Conclusions: The prepared suppositories were within the permissible range of physical parameters. The results obtained allow the selection of excipients in order to assure the optimum characteristics for prepared suppositories.
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Traditional Risk Factors in Hypertensive Women and Men with Ischemic Heart Disease
Background: Ischemic heart disease is the main cause of morbidity and mortality in Europe. It occurs often in women, and its prevalence increases with age. Hypertensive patients with coronary heart disease are at highest risk and thus are the most important target of secondary prevention strategies. The purpose of this study was the identification of traditional cardiovascular risk factors in group of patients with known cardiovascular disease.
Material and methods: One hundred seventy-six patients took part in this cross -sectional study, which included 72 women and 104 men. Statistical analysis was performed with Microsoft Excel and SPSS 17 Programs.
Results: The average age of the patients was 66 for women and 68 for men. Obesity (BMI >30) was found more among women. We haven’t found statistically significant differences between the sexes regarding lipid profile, this being a common risk factor for both men and women. New cases of diabetes have been discovered in 19%.
Conclusions: Traditonal cardiovascular risk factors are present both in women and men with hypertension and ischemic heart disease.The target levels for lipids suggested by secondary prevention guides are not achieved by a large number of patients.
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Study Regarding the Phototoxicity of Some Tricyclic Antidepressants
Objective: Our main objective was the development of a research methodology in order to assess the phototoxic potential on in vitro erythrocytes of five frequently used tricyclic antidepressants derivates.
Methods: The hemolytic effect of imipramine, clomipramine, amitryptiline, nortryptiline, doxepine hydrochloride was studied on erythrocytes after irradiation with UV light.
Results: The studied substances exhibited phototoxic effects on erythrocytes in the presence of UV light, causing their lysis to a greater extent than the one observed in a saline erythrocytes solution irradiated with UV light.
Discussions: The differences between the effects of the studied antidepressants on erythrocyte lysis in UV light are noticeable, the most pronounced effect being observed in the case of clomipramine hydrochloride and the lowest being observed in the case of doxepin hydrochloride.
Conclusions: The molecular structure influences significantly the phototoxic character of the studied substances. The molecule photosensitivity is not directly proportional with the phototoxic potential of the tricyclic antidepressants.
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