Category Archives: AMM 2011, Volume 57, Number 6

Mineral Bone Disorder in Hemodialysis Patients – a New Face of an Old Concept

Gliga Mirela1, Caldararu Carmen1,2, Radu Pop Corina3, Gliga M2, Hosu I1, Dogaru G1

1 Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Physiology, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Department of Endocrinology, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Aim: We studied in a hemodialysis (HD) population the correlations between bone metabolism markers measured by DEXA compared with other bone markers: serum calcium, serum phosphate, serum iPTH level and the inflammatory status, known as high risk for morbidity in HD patients which has not been studied yet.
Method: Twenty-seven patients from a hemodialysis unit were included in the study. The following parameters were measured: serum calcium (Ca), serum phosphate (P), total alkaline phosphatase (AP), intact parathormon level (iPTH) as bone metabolism markers and fibrinogen and C reactive protein (CRP) as inflammatory markers. Osteodensitometry was measured with DEXA technique and T-score was recorded. Statistical data were analyzed with the program Excel 2007 and mean, SD, Pearson’s correlation coefficient r and χ2-test were calculated.
Results: Significant correlations were found between serum Ca levels and P (p=0.002), AP (p=0.002) and T-score (p=0.0003). Also there was a correlation between CRP and phosphate (p=0.029) and CRP and fibrinogen (p=0.037). Calculating the correlation coefficient r, the significant correlation threshold was relevant to Ca and AP (r=0.33, p <0.05), Ca and BMD (r=0.31, p <0.05), P and BMD (0.30, p <0.05), P and fibrinogen (r=0.6, p <0.01).
Conclusions: In HD patients, CRP is correlated with bone metabolism, in the absence of infection. Serum phosphate is the only marker correlated
with bone markers, inflammatory markers and T-score for osteodystrophy, being an important tool for the future prognostic of these patients.

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Our Short-term Experience with the Use of S53p4 (BonAlive®) Bioactive Glass as a Bone Graft Substitute

Gergely I, Nagy Ö, Zagyva Ancuţa, Zuh SGy, Russu OM, Pop TS

Department of Orthopaedics and Traumatology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Objective: To analyze the results of using S53P4 as a bone graft substitute in a series of orthopaedic procedures.
Methods: We included a number of 9 patients in our study between July 2010 and March 2011. There were 4 cases of cystic or tumoral lesions, 2 revision total hip replacements, 1 primary hip replacement, 1 calcaneus fracture and 1 case on femoral supracondylar non-union. All were treated using bioactive glass as a bone substitute alone, or in conjunction with morselized allografts and autogenous bone grafts. Patients were evaluated clinically and radiologically at 1, 3 and 6 months after surgery.
Results: We found good results on clinical evaluation and radiological evaluation showed signs of graft osteo-integration and incorporation of the synthetic bone substitute in all cases.
Conclusions: Our preliminary results have shown that bioactive glass (S53P4) can be successfully used as a bone substitute material in all of the presented pathological conditions. We believe that this type of synthetic bone substitute will become more popular in the future, due to its special properties.

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Association Between Angiotensin Converting Enzyme Gene Insertion (I)/Deletion (D) Polymorphism and Secondary Arterial Hypertension in a Romanian Children Population

Duicu Carmen1, Bănescu Claudia2, Gáll Zsuzsanna1, Grama Alina1, Gozar Horea3

1 Department of Pediatrics, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Genetics, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Department of Pediatric Surgery, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: Arterial hypertension is defined as systolic or diastolic blood pressure measurements higher than 95 age-gender-height percentile of the adopted reference values. Angiotensin-converting enzyme (ACE) is a component of renin-angiotensin system. ACE insertion/deletion (I/D) gene polymorphisms have been associated with the risk of various cardiovascular anomalies.
Aim: The purpose of our study was to assess the possible association of ACE I/D polymorphism gene and secondary hypertension in children.
Material and method: We genotyped 40 healthy and 38 hypertensive children and adolescents. The ACE I//D gene polymorphism was determined by polymerase chain reaction (PCR) and restriction fragment length polymorphism technique utilizing specific primers. We compared the distribution of ACE I/D genotypes in the two study groups.
Results: The results of the study showed that the frequency of I/D ACE genotype distribution in patients with hypertension (DD = 18.42%,
ID = 68.42%, II = 13.16%) did differ significantly from genotype distribution in controls (DD = 47.5%, ID = 42.5%, II = 10%), and the DD genotype was not associated with secondary hypertension.
Conclusion: In conclusion we demonstrate that ACE gene polymorphisms are genetic markers for secondary arterial hypertension in children.

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Incidence of Stroke and CHADS2 Score in Patients with Paroxysmal, Persistent or Permanent Atrial Fibrillation: Prognosis at 1 Year of Follow-Up

Dorgo Monica Letiţia¹, Keresztesi A2, Asofie Gabriela2, Caraşca E¹

1 Medical Clinic IV, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Clinic of Neurology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Objectives: our main endpoints were to determine the incidence of fatal or nonfatal stroke either ischemic or hemorrhagic or transient ischaemic attack, associated with paroxysmal versus persistent and permanent atrial fibrillation (AF), in patients receiving oral anticoagulation therapy (OAC) compared to antiplatelet group, and to test the accuracy of CHADS2 score for the prediction of tromboembolic and hemorrhagic complications, at one year follow up. Secondary endpoints were the hospitalization rate, case fatality at one year and rate of progression of paroxysmal to persistent/permanent AF.
Material and methods: we performed a retrospective (2007–2008) observational study on 468 patients admitted to our department with paroxysmal, persistent and permanent nonvalvular AF, on oral anticoagulation or antiplatelet therapy. We compared the incidence of thromboembolic and hemorrhagic events in patients with paroxysmal AF, persistent and permanent AF, and in patients undergoing anticoagulation versus antiplatelet therapy.
Results: we found a statistically difference between the group of patients treated with OAC and the one treated with antiplatelet therapy in favor for the OAC group of AF in what concerns one year rate of stroke. We also found a statistical difference between the CHADS2 score values and the rate of stroke after during one year.
Conclusions: permanent form of atrial fibrillation carries a higher risk of tromboembolic events than persistent and paroxysmal AF. OAC therapy is superior to platelet therapy in all forms of cardiac arrhythmia in preventing the tromboembolic events. CHADS2 score is a good predictor for stroke.

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Vascular Permeability Changes in Experimental Diabetic Retinopathy, Under the Effect of Stem Cell Stimulation, in Rats

Dóczi-Keresztesi Z1,2, Jung J3, Ember I4, Kiss I4, Mezei T3

1 Department of Pharmacology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Ophtalmology Clinic, Tîrgu Mureș, Romania
3 Department of Pathology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
4 Department of Public Health, University of Pécs, Hungary

Objective: The purpose of this experiment was to determine the long-term effect of stem cell stimulator Olimpiq® StemXCell treatment on retinal vascular permeability and breakdown of the blood-retinal barrier (BRB) in alloxan-induced diabetic rats.
Methods: Male Whistar rats were divided into three groups. Two groups received a single intraperitoneal injection of Alloxan (125 mg/kg) – a specifically pancreatic beta cell-toxic substance, and the other control group received vehicle. The Alloxan-induced diabetic rats were treated with Olimpiq® StemXCell SL for 4 weeks, whereas controls were fed with standard lab chow. Permeability of blood-retinal barrier was measured by the extravasation of fluorescein isothiocyanate labeled bovine serum albimin (FITC-BSA).
Results: Six weeks subsequently to Alloxan treatment, a significantly elevated tissue fluorescence, vascular leakage, and BRB breakdown could be demonstrated in the diabetic group, compared to the non-diabetic group. Olimpiq® StemXCell SL treatment significantly decreased the BRB breakdown, tissue fluorescence, and vascular leakage, compared with the control, non-treated group. Long-term Olimpiq ® StemXCell SL treatment significantly decreased tissue fluorescence, vascular leakage, and the BRB breakdown. The mechanism for these effects may involve retinal vascular regeneration induced by stem cell stimulation. Blood glucose values were decreasing gradually, without significant differences between groups, therefore insulin secreting beta cell regeneration could not be demonstrated.
Conclusions: The results suggest that Olimpiq® StemXCell SL would be useful for treatment of ocular diseases associated with BRB leakage, such as diabetic macular edema and retinopathy.

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Medium Term Evaluation of the Results Achieved in the Treatment of Congenital Clubfoot at Paediatric Surgery and Orthopaedic Clinic, Tîrgu Mureş

Derzsi Z¹, Gozar H², Patraulea F², Nagy Ö¹

1 Orthopaedic Clinic II, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Pediatric Surgery and Orthopedic Clinic, County Emergency Clinical Hospital, Tîrgu Mureş, Romania

Introduction: Congenital clubfoot or talipes equinovarus is the most frequent congenital deformity of the lower extremity and we can define it as the position of the foot in varus, equines and the adduction of the forefoot.
Material and method: This study is based upon a retrospective study performed at the Paediatric Orthopaedic Surgery Clinic of Tîrgu Mureş between 2001–2010. The study group comprises a number of 153 patients. Here we present the classification, surgical and orthopaedic treatment, treatment of relapses, pre- and postoperative preparations, after care and follow-up protocol.
Results: Our group comprises 153 patients out of which 113 were male (73.85%) and 40 female (26.14%). Fifty-nine (38.56%) of them presented bilateral malformation, in 25 (16.33%) of them conventional treatment had satisfactory results, but the rest of the 128 patients (83.66%) required hospitalization in order to continue the applied conventional treatment and intervention. We detected associated anomalies in 34 of the studied patients. Out of these 128 patients we had 11 (8.59%) relapses. Post-operatory we identified recurrent syndromes in 36 patients.
Conclusions: This study proves the effectiveness of the applied surgical treatment. The weak point of the treatment protocol we followed was the conventional treatment, thus we should increase effectiveness or adopt another method of treatment.

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Retrospective Analysis of Breast Cancer Patient Data for Identification of Candidates for BRCA Mutation Detection

Dénes L1, Stolnicu Simona2, Pap Zsuzsanna1, Bődi Zsuzsanna3, Fail Ágnes3, Pávai Z1

1 Department of Anatomy and Embryology, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Pathology, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Student, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Introduction: Breast cancer is the leading type of cancer affecting women, with an increasing trend of mortality, and a lifetime risk of more than 10%. There are cases of inherited predisposition, which is mostly caused by mutations of the tumor suppressor genes BRCA1 and BRCA2. The objective of this retrospective study is to identify presumptive candidates for BRCA1 mutation carriers using available clinical, histopathological and immunohistochemical data.
Material and method: We processed the available recorded data of 1334 patients diagnosed with breast cancer between the years 2005 and 2010 from the archives of the Pathology Department of the Clinical County Hospital Tg.-Mures. We considered age under 45, histopathological characterization and available immunohistochemical information.
Results: The main selection criteria (age below or equal to 45 years) excluded the majority from further analysis, while 188 cases (12.35%) remained. After performing distribution into histopathological type groups, we looked at the immunohistochemical data. We obtained 19 ER-/PR- negative cases without Her2/neu information, and only 12 cases could be proven to be triple negative, and thus to be considered as primary candidates for BRCA mutation screening.
Conclusions: We identified a very small number of presumptive BRCA mutation carrier candidates. This is due mostly to the fact that the information available comprised macroscopic and classical histopathological data. Immunohistochemical characterization is not widespread, but this shortcoming will be circumvented by prospective reprocessing of the archived biological materials, in order to characterize the BRCA mutation patterns of our population.

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The Evaluation of the Intramyocardial Coronary Microvasculature Subsequent to Heart Transplantation Using Microscopic and Immunohistochemical Methods

Cotoi OS1, Suciu H1, Sin Anca1, Margaritescu C2, Turcu M1, Stolnicu Simona1

1 University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 University of Medicine and Pharmacy, Craiova, Romania

Introduction: This paper presents some histologic and immunohistochemical aspects of the intramyocardial microvascular network performed subsequently to cardiac transplantation in Romanian patients.
Material and method: We investigated a group of 30 heart transplant patients, aged between 12 and 58 at the time of transplantation, with an average age of 39 years, 23 male and 7 female patients. We studied in these patients the affection of the intramyocardial microvascular network subsequently to cardiac transplantation, using histologic and immunohistochemical standard methods. We followed the occurrence of foam cell arteritis at the level of large epicardial coronary arteries, as a direct sign of chronic rejection, lesions detected post-mortem at necropsy.
Results: In our study the most frequently detected microvascular lesions were the endothelial cell alterations, vascular wall thickening and severe perivascular fibrosis. Ischemia and reperfusion lesions with slight microvascular impairment were present in all patients in the first post-transplant biopsies (first 3–6 weeks). Acute cellular rejection developed in 6 patients in the middle and late period, in these cases we detected vasculitis lesions at the level of endomyocardial biopsies. Chronic rejection has affected three patients, who presented lesions at the level of large epicardial coronary arteries, as well as at the level of the small intramyocardial ones, such as wall thickening or perivascular fibrosis.
Conclusion: Subsequent to heart transplantation, small intramyocardial vessels are affected by immunological (rejection) or non-immunological factors (ischemia and fibrosis). Histologic and immunohistochemical study methods applied at the level of endomyocardial biopsies or post-mortem are useful for accurate assessment of small intramyocardial vessels and their involvement in the viability of the allograft.

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Risk of Addiction and Burnout

Copotoiu Monica1, Ioniță Alexandrina2, Copotoiu Ruxandra3, Copotoiu Sanda-Maria3

1 Clinic of Rheumatology, Emergency County Hospital, Tîrgu Mureș, Romania
2 Department of Anesthesia and Intensive Care, Emergency County Hospital, Tîrgu Mureș, Romania
3 Clinic of Anesthesia and Intensive Care, Emergency County Hospital, Tîrgu Mureș, Romania

Background: A significant problem in medical practice is represented by addiction to chemical substances and frequently to alcohol. The impact of addiction to alcohol in medical professions is similar to others, although there are slightly different circumstances.
Aim: To compare the rate of dependence to different substances in several medical specialties.
Material and method: We ran a survey based on a questionnaire to assess the level of burnout in connection to the habit of using chronic medication, coffee, alcohol and tobacco. The respondents were our colleagues, 70 doctors of different backgrounds: 28 anaesthesiologists, 27 general surgeons and urologists, 15 gastroenterologists and internists, but also emergency physicians. Data were processed with Graph Pad Prism 5.0.
Results: We found a moderate risk of burnout both in anaesthesiologists and surgeons. Anaesthetists tended to use chronic medication more then their colleagues (20%). As for alcohol use, the surgeons seemed to be placed in pole position (22.22%). The internists styled themselves as no chronic users whatever the item investigated.
Conclusions: Alcohol use and chronic medication were associated frequently to burnout. It is important to clarify if the dependence is a reaction to occupational stress to certain individuals or not. Due to the limited number of respondents, our results do not entitle us to take them as a model.

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Follow-up in the Surgical Treatment of Tetralogy of Fallot

Căpîlna R1, Harpa M2, Suciu H3, Căpîlna Brîndușa4, Brînzaniuc Klara5

1 Clinic of Cardiovascular Surgery, County Emergency Clinical Hospital, Tîrgu Mureş, Romania
2 University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Clinic of Cardiovascular Surgery, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
4 Clinic of Pediatrics I, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
5 Department of Anatomy and Embriology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Objective: The purpose of this study is to evaluate the early and intermediate results after total correction of Tetralogy of Fallot in 193 consecutive patients, with a mean age of 29 months, who underwent surgical correction in Transplant and Cardiovascular Disease Institute Târgu Mureș between 2005 and 2011.
Methods: The records of these patients were reviewed. Follow-up was obtained through clinical appointments and telephone questionnaires.
Results: One-hundred forty-four (74%) patients underwent single-stage complete repairs; 49 (25%) patients underwent initial palliative operations (systemic-pulmonary shunt), whereas 40 (20%) of them underwent secondary total corrections. Early and late mortality was 2% (n=4) and 2.5% (n=5), respectively. Mean follow-up was 35 months (range: 4 months to 71 months). Respiratory infection was a risk factor for early mortality (p=0.0032). For the reconstruction of the right ventricular outflow tract we used 21 valved conduits, 68 transannular patches and for the others patients right ventricular patches + pulmonary valvuloplasty/valvulotomy. On late postoperative echocardiography, 59 patients presented moderate pulmonary regurgitation, 21 a small residual ventricular septal defect, 4 severe residual dynamic stenosis of RVOT and 5 calcifications of the transannular patch, for whom we carried out 7 replacements of the pulmonary valve and 14 reconstructions of the right ventricular outflow tract.
Conclusions: Surgical repair of patients with simple or complex forms of tetralogy of Fallot can be achieved with low early mortality. Late mortality and the need for reoperation continue to influence the quality of life for these patients.

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