Category Archives: AMM 2011, Volume 57, Number 5

Overexpression of HER2/neu Receptor – Prognostic Factor in Endometrial Cancer

Ilyés L1, Rădulescu Carmen1, Grama O1, Gârbovan O1, Ádám A1, Jung J2, Rădulescu C1

1 Clinic of Obstetrics and Gynecology II, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Pathology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Objective: The purpose of the study is to assess the incidence of the HER2/neu transmembrane receptor in patients diagnosed with endometrial cancer, and to determine the association of HER2/neu with other negative prognostic factors.
Material and method: We followed the survival rates for 2 and 3 years depending of the presence of HER2/neu, correlated with other prognostic factors of endometrial cancer like the stage of the disease, the histological type and the grade of malignancy.
Results: Out of 42 patients treated, 72.42% were HER2/neu positive. In stage I 65%, in stage II 73.33%, in stage III 100% were positive for HER2/neu. The cases with endometrioid type were positive in 65.62%, with non-endometrioid type in 90%. In well differentiated forms 50%, in moderately differentiated forms 84.21% and in undifferentiated forms 77.77% were HER2/neu positive. The 2 year survival rate was 80% in HER2 positive cases, and 83.33% in negative cases. The 2 year survival rate was 85% in stage I, 80% in stage II, 66.66% in stage III and 92.85% in G1, 89.47% in G2 and 55.55% in G3 forms.
Conclusions: High expression of HER2/neu was present in advanced stages, in non-endometrioid types and in less differentiated forms of endometrial cancer. The stage of the disease and the degree of malignancy are the factors that can influence the long term survival. The pre-sence of HER2 transmembrane receptor seems not to influence the survival rates. More important prognostic predictors are the stage of the disease, the histological type and the grade of malignancy.

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Ultrasound and Doppler Assessment of Fetuses with Growth Restriction in the Absence of an Evident Etiological Factor

Grif Caterina1, Voidăzan S2, Rădulescu Carmen1, Gliga M1, Rădulescu C1

1 Department of Obstetrics and Gynecology 2, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Epidemiology, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Background: Differentiation between normal and pathological fetal growth may be difficult and a regular fetal biometry is required, with ultrasound examination of the placenta, amniotic fluid index assessment and Doppler velocimetry of pregnancies with fetal growth disorders, even in the absence of a clear etiologic factor.
Material and method: This is an observational study and includes two groups: one with 24 pregnancies with FGR confirmed postpartum (SGA+) and another with 42 pregnancies with normal birth weight (SGA-). The database contained personal data, several parameters of fetal biometry, amniotic fluid index, placentation and velocimetric indices, birth-related data. Statistical analysis of obtained data was carried out using Microsoft Excel and Graphpad Prisma programs. We used the Student test, Z test and Chi square test and Fisher when needed. P <0.05 was considered statistically significant. We also used Pearson correlation index.
Results: Between the two groups there were statistically significant differences regarding fetal biometry parameters, especially AC and ultrasound estimated weight and birth weight, infant length, Apgar score at 5′ and days of hospitalization. Velocimetric indices were significantly higher in placental uterine and umbilical artery in SGA+ group. There was a negative correlation between umbilical RI and AFI in SGA+ group but without statistical significance.
Conclusions: Fetal biometry, umbilical artery Doppler examination (when RI <0.6) and AFI calculation (>10) are the most used methods in the assessment of normal fetal growth and intrauterine fetal wellbeing.

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Multi-trauma Patients Management: a Cross-sectional Study

Gomotîrceanu F, Bățagă T

Clinical Emergency County Hospital, Tîrgu Mureș, Romania

 

Introduction: The aim of this study was to evaluate the multi-trauma critical patient management in the Clinical Emergency County Hospital of Tîrgu Mureş, Romania.
Material and method: We conducted a cross-sectional study, data collection was achieved by extracting records from hospital patients database. We collected the data from January 2007 until June 2011. The initial search revealed a number of 784 patients diagnosed with multi-trauma. From this sample we included in the study only a number of 312 patients diagnosed with critical multi-trauma from whom 194 underwent emergency surgery. We evaluated clinical consults distribution, the frequency of mechanisms of injury, therapeutical and diagnostic procedures, clinical transfers, lesions associations, traumatic lesions that required emergency surgery, injured organs and thoracic injuries that required emergency surgery.
Results: From the total number of patients, 214 (68.58%) were men and 98 (31.42%) were women. The incidence of multi-trauma regarding age, showed a peak in the 1st and 2nd decade. Regarding the mechanism of injury, the main cause is represented by car accidents, followed by assault and fall. It was observed that the most frequent clinical consults were the surgical ones, followed by orthopaedic and neurosurgical consults. In the Surgical Department, in the studied period of time, there was admitted a number of 272 patients diagnosed with critical multi-trauma.
Conclusions: In recent years, the incidence of critical multi-trauma patients increased especially in the first and second life decades. Critical multi-trauma patients with emergency surgery presented a low vital prognosis, with a mortality of 4.77%. Survival of this category of patients could increase due to the establishment of a complete chain of care (patient management): accidents site, transport, emergency service, hospital operating room, intensive care postoperative therapy.

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Non-Steroidal Anti-Inflammatory Drugs’ Complexes with Cyclodextrins – Molecular Modelling Study

Fülöp Ibolya1, Gyéresi Á2, Laczkó-Zöld Eszter3, Croitoru MD1

1 Department of Biopharmacy and Pharmacokinetics, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Department of Pharmacognosy, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Objectives: Association of non-steroidal anti-inflammatory drugs with cyclodextrins is a largely used method to increase their stability and water solubility. The aim of our study was to clarify the interactions between seven nonsteroidal anti-inflammatory drugs and HP-β-CD and the spatial geometry of these inclusion complexes by using molecular modelling.
Methods: From the non-steroidal anti-inflammatory class seven representatives were chosen: ibuprofen, ketoprofen, piroxicam, meloxicam, tenoxicam, mefenamic acid and flufenamic acid. Computational study on host-guest complexes was carried out using molecular mechanics in Hyperchem software, both in vacuum and water periodic box condition.
Results: The obtained results show that all NSAIDs form inclusion complex with HP-β-CD. The spatial geometry of complexes was established by molecular mechanics computation and the complex formation energies were calculated.
Conclusions: Intermolecular hydrogen bonds and hydrophobic interactions play an important role in the binding of NSAIDs to HP-β-CD. The results show good correlation with literature data.

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The Presence of Nucleated Red Cells in the Blood of Critical Care Patients is Associated with an Increased Mortality Risk

Duțu Mădălina¹, Negoiță S¹, Manolescu Rely ¹, Calu V3, Corneci D¹, Georgescu Anca5, Togănel Cornelia4, Azamfirei L²

1 Anesthesiology Clinic, Elias Emergency University Hospital, Bucharest, Romania
2 Anesthesiology Clinic I, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
3 Surgical Clinic, Elias Emergency University Hospital, Bucharest, Romania
4 Department of Oncology, County Emergency Clinical Hospital, Tîrgu Mureş, Romania
5 Clinic of Infectious Diseases, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Background: The occurrence of nucleated red blood cells (NRBCs) in critically ill patients is a consequence of either hypoxic or inflammatory injuries. Therefore erythroblasts’ detection may be used as an early indicator of high mortality risk.
Material and methods: In a prospective study the detection of NRBCs was used for daily monitoring of 90 patients for a 3-months term. The prognostic significance of the NRBCs presence was compared with two risk scores: APACHE II and SAPS II.
Results: The incidence of erythroblasts’ presence was 20% (18/90). The mortality of NRBC-positive patients was 88.8% (16/18) and was significantly higher (p <0.05) than the mortality of NRBC-negative patients: 30.5% (22/72). The incidence of the erythroblasts in peripheral blood has increased simultaneously with APACHE II and SAPS II scores. On average, NRBCs were detected for the first time 6.5 days before death. The occurrence of NRBCs was not associated with a specific cause of death; however septic patients who died had the highest incidence of NRBCs’ presence.
Conclusion: The daily screening of the presence of NRBCs seems to be a useful tool to estimate the mortality risk in critically ill patients, the parameter being of high prognostic strength regarding the mortality risk.

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The Role of Acanthosis Nigricans in Identifying Clinical and Metabolic Features of the Metabolic Syndrome in Obese Children

Duncescu Corina1, Mărăzan Monica1,2, Chirita-Emandi Adela1, Craioveanu Teodora2, Dăescu Camelia1,2, Sabău I2, Micle Ioana1,2

1 “Louis Ţurcanu” Emergency Hospital for Children, Timişoara, Romania
2 1st Pediatric Clinic, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania

Background: Acanthosis nigricans (AN) is a dermatologic marker of hyperinsulinemia and has been linked with metabolic syndrome in adults. In children, the relationship between AN and different components of the metabolic syndrome has received mixed research results. We investigated whether the clinical and metabolic profile of obese children with AN was different from those without AN.
Material and methods: We studied retrospectively the observation charts of children who were evaluated in our clinic for obesity and/or anomalies of glucose metabolism from January 1st 2005 to December 31st 2009. The study population consisted of 52 children. The analyzed data included: age, sex, body mass index (BMI), the presence or absence of AN, systolic and diastolic blood pressure, the results of the oral glucose tolerance test, triglycerides and high-density lipoprotein (HDL) cholesterol levels, baseline insulin, the homeostatic model assessment: insulin resistance (HOMA-IR), glicated hemoglobin. We divided our study population into two groups according to the presence or absence of AN. We used One-Way ANOVA to evaluate the clinical and metabolic differences between the two study groups.
Results: We found significant differences between the two groups for BMI, systolic and diastolic blood pressure, triglycerides, HDL cholesterol, baseline insulin and HOMA-IR.
Conclusions: Our study shows that AN seems to be linked with most of the features of the metabolic syndrome in children. The relationship of AN and anomalies of glucose metabolism need further testing.

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The Importance of the Mesorectal Lymph Nodes in Rectal Cancer Surgery

Diac OC1, Diac Raluca2, Copotoiu C3

1 Department of Surgery, Gheorgheni Hospital, Gheorgheni, Romania
2 Department of Internal Medicine, Gheorgheni Hospital, Gheorgheni, Romania
3 1st Surgery Clinic, County Emergency Clinical Hospital, Tîrgu Mureș, Romania

Introduction: Regarding the rate of local recurrences, improvement of survival rates and quality of life, the treatment of rectal cancer has registered a remarkable progress during the last two decades. This was possible through multidisciplinary and gradual development of rectal cancer management, where surgical resection remains the “key factor” and all surgical interventions considered radical involve mesorectal excision. The status of lymph nodes is probably the only and most important marker of global survival in patients with rectal cancer, which is associated with the risk of systemic dissemination rather than local recurrence.
Material and method: The aim of this study was to analyze the importance of mesorectal lymph nodes, in case of rectal cancer disseminated locally and in remote organs, based on treated rectal cancer cases at the 1st Surgery Clinic, Tîrgu Mureș between January 2000 and December 2009. During this period, out of the 618 recorded rectal cancer cases, in 505 cases the patients underwent surgical intervention where besides the rectal tumor, the perirectal lymphatic tissue was also excised.
Results: The performed histopathological examinations revealed in 223 cases lymph node invasion (stage III and stage IV). We also studied different surgical interventions regarding lymph node excision performed during rectal cancer surgery, analyzed the average number of excised perirectal (mesorectal) lymph nodes and the average number of lymph nodes with histopathologically confirmed tumor metastasis resulted from rectal resection.
Conclusion: In our study, we found that in surgical interventions involving resection with anastomosis the average number of lymph nodes per specimen is biger than the number recorded subsequent to abdominoperineal rectal resection.Therefore the resection with mesorectal excision is the best option for rectal cancer surgery any time is possible.

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Study on the Pre-hospital Cardiac Arrest Resuscitations Of the Mobile Intensive Care Ambulance Teams From Tîrgu Mureș, Romania, in 2009

Copotoiu Sanda-Maria1, Bratu Simona2

1 Department of Anesthesiology and Intensive Care, Clinical Emergency County Hospital, Tîrgu Mureş, Romania
2 UPU-SMURD, Clinical Emergency County Hospital, Tîrgu-Mureş, Romania

Objective: To analyze the results of the resuscitation efforts of the SMURD medical teams, in pre-hospital, in 2009.
Methods: We conducted a prospective study between 01/01/2009 – 12/31/2009. We included in the study all the cases with cardiac arrest at the arrival, those that occurred during transport and all the CPR attempts performed together with the first aid teams. For the statistical study we used SPSS program version 17, χ2 test and p values were determined to compare the data obtained.
Results: In 2009, the team had 250 cardiac arrest cases, 16.7% of the total of 1490 calls. Resuscitation was performed on 67.6% of patients.The good outcome of the resuscitation was statistically correlated with the distance to the case p = 0.01.The acute coronary syndrome was responsible for 27% of the cardiac arrest cases, severe trauma for 11%. The initial cardiac arrest rhythm was in 83.2% of cases asystole. BLS was performed, before the arrival of the team, to a number of 41 patients, bystander CPR representing only 2.36%. The SMURD team resuscitated a number of 58 patients in pre-hospital, 34.32% out of the 169 that had CPR, 41 died in the Emergency Department and 17 were hospitalized; 4 patients were discharged in good condition.
Conclusions: The early resuscitation outcome is good, comparable with the international data reported, the rate of late survival is smaller. The proportion of ventricular rhythms with a good prognosis is lower, which correlates with longer distances traveled to the scene and less involvement of the population in BLS.

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Is the Doppler Ultrasound Score More Reliable than the Grey Scale Ultrasound Score in Assessing the Rheumatoid Arthritis Patient’s Joints?

Copotoiu Monica1, Georgescu Lia1, Poór G2, Copotoiu Ruxandra3

1 Department of Rheumatology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 1st Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
3 Department of Anaesthesia and Intensive Care, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Background: Rheumatoid arthritis (RA) is a complex disease with multiple faces, one of them being its activity. At the moment, there are multiple-choice tools to assess the activity of the disease, no one gaining the complete status of “gold standard”. In the evaluation of the disease activity biological and non-biological methods are used and interposed. The methods are more or less subjective, thus the validation of measurements in RA is highly relevant.
Objective: The main objective of the study was to evaluate the reliability of the Doppler Ultrasound score versus the Grey scale ultrasound score in the assessment of the disease activity in rheumatoid arthritis patients.
Methods: A number of 66 patients diagnosed with rheumatoid arthritis were assessed with the B-mode and consequently Colour Doppler ultrasound score system. The joints examined were the second and the third metacarpal (MCP) and proximal interphalangeal joints (PIP) on the dorsal and ventral side. Two thousand twelve images were stored and evaluated on both scales. Data were analysed with GraphPad Prism 5.0. In order to assess the validity of the ultrasound methods used in the study as non-biological markers for the activity of rheumatoid arthritis Pearson correlation, Bland-Altman method and linear regression were used.
Results: A positive correlation was found when analyzed the two methods of assessment of the disease activity in rheumatoid arthritis. A single mismatch was found (Pearson correlation and linear regression) at the level of the second metacarpal on the ventral and right side when compared the Doppler ultrasound versus the Grey scale score, but we presumed that this is due to the particularity of the individual outcome. The Bland-Altman method showed that the Grey scale of quantification overrated the scores versus the Color Doppler Ultrasound scale.
Conclusions: The semi-quantitative Color Doppler method which assesses the intra-joint activity in rheumatoid arthritis patients was validated in our research to be further used. Even though none of the statistic methods used for validating the Doppler score in our study showed significant statistic differences between them, it is for the best to apply all of them for validating any intended method to be used in any study.

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Clinical Presentation of Thyroid Nodules in Patients Submitted to Surgery

Cătană Ramona1, Genes Ionela2, Sala Tatiana3, Borda Angela4

1 Department of Endocrinology, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
2 Department of Otorhinolaryngology, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
3 Department of Surgery, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
4 Department of Histology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Background: Thyroid nodules can be discovered in the most varied circumstances. There are very few published data demonstrating the way in which thyroid nodules come to medical attention. This study aims to evaluate the clinical presentation of thyroid nodular disease, and to assess whether the presence of malignancy influences the presentation.
Methods: This paper is a prospective analysis of 164 patients diagnosed with thyroid nodular disease who underwent thyroid surgery in the two Departments of Surgery of the Tîrgu Mureş Emergency County Hospital. Face-to-face interviews were conducted to obtain data on how these patients with thyroid nodules come to medical attention. The patients were classified in the following categories: no symptoms and no signs; only symptoms, no signs; no symptoms, only signs (cervical tumor); symptoms and signs. The final pathological diagnoses of the thyroid resected specimens were obtained from database registries of the Department of Pathology.
Results: Most of the patients (64.01%) with thyroid nodular disease require a medical advice when they have cervical symptomatology, in the presence or not of a clinically apparent cervical tumor. 23.18% were patients in which the thyroid nodules were found incidentally by imaging tests performed for other purposes. The higher proportion of malignancy was recorded in patients with thyroid evident growth 52.38%.
Conclusion: The presence of a cervical tumor represents a clear invitation to a medical examination. The incidental discovery of thyroid nodules should not be overlooked. The cervical symptoms might have anything to do with the presence or with the size of thyroid nodules.

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