Category Archives: AMM 2012, Volume 58, Number 2

New Therapeutic Perspectives in Hypertension Treatment

Makó Katalin

2nd Department of Internal Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Despite the many therapeutic options available today for the treatment of hypertension, a large number of patients remain uncontrolled. The classic antihypertensive therapies including β-blockers, diuretics, calcium channel blockers and the wide class of renin–angiotensin–aldosterone system blockers (converting enzyme inhibitors, angiotensin receptor blockers, renin inhibitors, and mineralocorticoid receptor blockers), are variably successful in achieving the target blood pressure values in hypertensive patients. Although these numerous, safe and effective pharmacologic therapies are available to treat hypertension, novel therapeutic approaches are warranted to improve the management and prognosis of patients with this condition. Several lines of research suggest promising results based on novel pharmacologic and device-based approaches that may treat effectively resistant hypertension and target organ damage in the future. A large number of the new therapeutic strategies are related to renin angiotensin aldosterone system (RAAS). Modulation of the RAAS provides the rationale for current new antihypertensive drugs already used in clinical practice, including eplerenone and aliskiren. The combined angiotensin-converting-enzyme and neutral endopeptidase blockade decreases blood pressure, aldosterone synthase inhibitors improve tolerability in aldosterone antagonism, prorenin-receptor blockers could prevent the angiotensin-independent actions of renin. In the past few years new minimally invasive surgical procedures like carotid baroreceptor activation and renal symphatetic denervation were developed and could be a therapeutic option for patients with uncontrolled hypertension.

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Immunomorphometric Study of E-caderin Expression in Malignant Skin Tumors

Varo Eniko1, Egyed-Zsigmond I2

1 PhD student, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Pathology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Objective: Cadherins are transmembrane glycoprotein molecules, which interact with the cytoskeleton and their role is in cell recognition, tissue morphogenesis and tumor suppression. Our aim is to evaluate cell adhesion behavior in the main forms of skin cancer.
Methods: Between 2003–2007, we made a retrospective study on 150 cases of skin biopsies of basal cell, squamous cell carcinomas and malignant melanomas. In the Laboratory of Pathology of the Clinical Emergency County Hospital Tîrgu Mureș, the formalin-fixed paraffin-embedded tumoral tissues were studied with immunohistochemical (for E-cadherin) and morphometrical methods using a digital technique and statistical evaluation.
Results: Average percentages of immunopositive areas (APMIS) were obtained for both basal cell and squamous cell carcinomas, as well as for malignant melanoma. We showed a rising percentage of disorganization in the cell membrane, with decreased APMIS values, with the increasing degree of tumor malignancy evidenced by immunohistochemical reaction of cadherins.
Conclusion: Cell adhesion decreases with increasing malignancy in all three studied malignant tumors, especially in malignant melanomas.

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Nutritional Status Assesment in Overweight and Obese Children

Pitea Ana Maria, Baghiu Maria Despina, Mărginean Oana, Eșianu Andreea

Pediactrics Clinic 1, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Background: Obesity represents the abnormal/excessive accumulation of fat in adipose tissue. Anthropometry takes a person’s body measurements, especially for use on a comparison or classification basis to establish his/her nutritional status. Nutritional condition also includes clinical examination and laboratory findings. Our aim was to assess the nutritional status in a group of obese children versus normal-weight children.
Material and methods: Our prospective study, conducted between October 1, 2010 and April 15, 2011, included a study group with 20 obese children and a control-group with 35 healthy children; we performed antropometric measurements, we calculated some anthropometric indices and performed laboratory tests, abdominal ultrasound and real-tyme elastography; statistical analysis involved Graph PadPrisma and Graph Pad InStat Demo programme; Student’s t test and correlation coefficient Pearson were used.
Results: Children weight and weight-for-age z-score significantly differed between the study-group and controls, at each age group, stature and height-for-age z-score was not significantly different. Medium upper-arm circumference (MUAC) had higher values than Body Mass Index, (BMI), while Tricipital Skin-fold (TSF) recorded the highest values, reflecting the fat deposits of obese children (in controls these indices were between -2SD and +2SD). The laboratory findings were generally within normal limits; total cholesterol values were higher in obese and triglycerides were incresed in a part of children in which they were determined. Liver elasticity was lower in obese than in the control-group.
Conclusion: Overweight alters the nutritional status, disturbs lipid metabolism and decreases the elasticity of the liver, highlighting the risks related to obesity and the importance of prevention and treatment of this disorder.

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Clinical Efficiency of Diffusion Weighted Imaging with Background Body Signal Suppression in Magnetic Resonance Mammography — Choosing a Qualitative or a Quantitative Approach

Nechifor-Boila IA1, Buruian M1, Frandeș-Podeanu Daniela1, Charlot Matilde2, Borda Angela3

1 Department of Radiology and Medical Imaging, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
2 Department of Radiology and Medical Imaging, Lyon Sud Hospital Center, Pierre-Bénite, France
3 Department of Histology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Objectives: Diffusion Weighted Imaging with Background Body Signal Suppression (DWIBS) is a new and promising imaging technique designed to improve diagnostic performance of Dynamic Contrast-Enhanced-Magnetic Resonance Mammography (DCE-MRM). The aim of our study was to assess the diagnostic efficiency of both qualitative and quantitative DWIBS in a retrospective cohort study.
Methods: We performed a registry-based study at the Department of Radiology, Lyon Sud Hospital. All consecutive MRM examinations from 02.2010 to 02.2011 were reviewed. DWIBS was interpreted blindly, both qualitatively (lesion characteristics and signal) and quantitatively (Apparent Diffusion Coefficient – ADC). The ADC cut-off value was determined using Receiver Operating Characteristics (ROC) curve analysis. Clinical efficiency indicators were calculated using either the pathological examination or the disease status after a minimum of 6 months follow-up as gold standard.
Results: The lot consisted of 78 women, with a mean age of 50.3±14 years and a total of 112 breast lesions. Qualitative DWIBS found 73 suspicious and 39 non-suspicious lesions, while the gold standard (pathological diagnosis/follow-up) reported 56 benign and 56 malignant ones. The sensitivity and specificity values for qualitative DWIBS were 84% and 53.37%, respectively. ROC curve analysis revealed the best performance for quantitative DWIBS at an ADC of 1.1×10-3 mm2/s, resulting in a sensitivity of 71.4% and a specificity of 76.8%.
Conclusion: DWIBS is a new and improved diffusion technique with a dual and efficient interpretation system applicable in clinical settings. Moreover, its use as a complement to DCE-MRM offers large potential for improving MRM efficiency in breast cancer diagnosis.

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An Outbreak of Achromobacter Bacteremia in Pediatric Clinic 1 Tîrgu Mureș in 2010

Man Lidia1, Baghiu Despina1,3, Székely Edit2,4, Man A2

1 Pediatric Clinic I, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
2 Microbiology Department, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Pediatric Department I, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
4 Central Clinical Laboratory, Department of Bacteriology, County Emergency Clinical Hospital, Tîrgu Mureș, Romania

Introduction: Achromobacter is a less common pathogen, with implications in patients with immune deficiency. The purpose of this paper is to evaluate the Achromobacter spp. bacteremia outbreaks in the hematology department of Pediatric Clinic I Tîrgu Mureș and to establish the involvement of this species as an etiologic agent of bacteremia/septicemia or solely as a contaminant of blood culture samples.
Material and methods: We analyzed an outbreak of Achromobacter infection from 2010’s summer-autumn season in Pediatric Clinic I. Bacteriological (blood culture, antibiotic susceptibility), laboratory (white cells count, inflammatory tests) and clinical aspects (underlying disease, body temperature, treatments, age, sex) were followed.
Results: A total of 26 blood cultures collected from nine children admitted in this period were positive for Achromobacter spp., other 28 were negative. In febrile patients with positive blood cultures, the leukocyte and neutrophil count was increased. In non-febrile patients with positive blood cultures, changes in the total number of leukocytes and granulocytes did not show significant variations. The antibiotic susceptibility test for Achromobacter strains identified a 100% resistance to ticarcillin, gentamicin, and trimethoprim-sulfamethoxazole, sensitivity to most classes of antibiotics, but an OXA-114 β-lactamase producing phenotype.
Conclusions: An association between the inflammatory syndrome and Achromobacter spp. bacteremia was established. Achromobacter spp. isolated from blood sampled through catheters is most likely a contaminant. The antibiotic susceptibility testing of Achromobacter spp. revealed sensitivity to most classes of antibiotics.

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Primary Surgical and Non-surgical Treatment of Advanced Stage Laryngeal and Hypopharyngeal Carcinomas

Koltai P1,2, Lengyel Cs1, Remenár Éva1, Boér A1, Kásler M1,2

1 Department of Head and Neck Surgery, National Institute of Oncology, Budapest, Hungary
2 School of Doctoral Studies, University of Medicine and Pharmacy, Târgu Mureș, Romania

In the past two decades, according to studies published in the early ’90s, the standard treatment of advanced laryngeal and hypopharyngeal carcinomas has been changed: instead of radical surgery, larynx-preserving methods came into view. To evaluate our results with this new approach we conducted a retrospective study summarizing the treatment data of the patients who received non-surgical (n=44) or surgical (n=207) therapy for their advanced, resectable laryngeal or hypopharyngeal cancer in the National Institute of Oncology between 2002 and 2007. Non-surgical treatment consisted of platinum base chemoradiotherapy plus salvage surgery if needed, while surgical treatment patients underwent laryngectomy with or without neck dissection followed by radiotherapy or chemoradiotherapy. With non-surgical treatment, the one-year laryngoesophageal dysfunction (LED) free survival (the patient is alive with functioning larynx without local relapse, tracheostomy or feeding tube) is 82.9% (SD=0.0592), at 24 months 79.8% (SD=0.0645). Non-surgical treatment proved to be beneficial regarding distant metastases as well (9.09% in non-surgical and 27.08% in surgical group at two years, respectively). Formation of a second primary tumor was more frequent in the non-surgical group (11.36% vs 8.33%). There was no significant difference in overall survival between treatment groups when stratified according to primary tumor site and stage. The results of larynx preserving treatments conducted in our Institute are similar to those published in the literature, confirming this method as standard therapy in this group of patients.

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Association Between Tooth Agenesis and Polymorphisms of FGFR1, IRF6, MSX1 and PAX9 Genes in Patients from Tîrgu Mureş

Kerekes-Máthé Bernadette¹, Jobbágy-Óvári Gabriella², Székely Melinda¹, Cămărăşan Alina¹, Borş Andreea¹, Mucenic Simona¹, Varga G²

1 Department of Morphology of Teeth and Dental Arches; Technology of Dental Prosthesis and Dental Materials, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Oral Biology, Semmelweis University, Budapest, Hungary

Aim: Tooth agenesis is the most prevalent congenital malformation in humans. Many studies showed the importance of genetic factors in the emergence of tooth agenesis. MSX1, PAX9, PVRL1, IRF6, FGFR1, AXIN2 are genes involved in tooth agenesis. In this study we attempted to determine genetic traits data of patients from Tîrgu Mureş regarding tooth agenesis.
Material and method: Thirtyfour patients with tooth agenesis and 51 healthy volunteers were examined. Oral mucosal scrapings were collected from all the subjects. DNA was isolated and a genotyping experiment was performed. The procedures included four single nucleotide polymorphisms (SNPs): PAX9 -912 C/T, MSX1 3755 A/G, FGFR1 T/C, and IRF6 A/G.
Results: Besides the dominant allele, we observed the presence of the rare allele as well in each investigated polymorphism. There was a statistically significant difference in the distribution of the FGFR1 T/C gene polymorphisms between the two groups (p=0.02). Differences in the distribution of the IRF6, MSX1 and PAX9 gene polymorphisms were not significant statistically (p>0.4).
Conclusions: Our study showed, that FGFR1 T/C (26190464) polymorphism is a significant risk factor for non-syndromic tooth agenesis, preferential premolar agenesis. PAX9 and MSX1 gene may be associated with syndromes that include tooth agenesis. Further investigations are needed.

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Carotid Angioplasty with Autologous Facial Vein

Jerzicska Ernő, Fărcaș Felix, Győrbíró László

Clinic of Cardiovascular Surgery, County Emergency Clinical Hospital, Tîrgu Mureș, Romania

Introduction: Carotid endarterectomy (CEA) is the „gold standard” for the treatment of carotid stenosises. In this study we evaluate the results after using an alternative patch material for arteriotomy closure.
Material and methods: This study is a retrospective, observational study, in which we have compared 2 groups of 8 patients operated on in our clinic between 2008–2012, the first group of 8 patients with CEA and facial vein patch, the second group of 8 consecutive patients with CEA and PTFE patch.
Results: In the A group there were 6 males, in the B group 5 males. Group A had a median age of 60 years, group B had a median age of 60.5 years. All patients were operated for severe carotid stenosis. We evaluated the time of surgery, which varied for group A between 70 and 85 minutes, with a median of 77 minute, for group B between 75 and 100 minutes, with a median of 88 minutes. We observed a significant difference between the 2 groups regarding the time of surgery, in favour of group A (p=0.010).
Conclusions: The advantages of a autologous venous material are represented by endothelised patch, reduction of desendothelised area, higher resitance to infections. The use of facial vein for endarterectomy patch needs the same incision, elevating the cost-efficency of the procedure, and significantly reduces the operating time compared with PTFE due to a faster achievment of haemosthasis.

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New Onset Diabetes Mellitus in Heart Transplant Recipients

Ispas Mihaela, Deac R, Maloș Mihaela, Chincișan Carmen, Bonț Alexandrina, Scripa Ernestina, Hadadi L

Emergency Institute of Cardiovascular Diseases and Transplantation, Tîrgu Mureș, Romania

Introduction: New onset diabetes mellitus in patients with heart transplant is a known complication with importance in the long term survival.
Material and methods: We have studied the incidence of new onset diabetes in a group of 38 patients with heart transplant that are included database of Emergency Institute of Cardiovascular Diseases and Transplantation, Tîrgu Mureș, between 1999–2011.
Results: The incidence of new onset diabetes was of 24.32% in the 1st month of posttransplant evolution, 22.58% at 1 year of evolution, 18.18% at 3 years of evolution and 10% at 5 years of posttransplant evolution. We have studied these posttransplant complications in relation with the risk factors and the most important complications in the evolution of these patients.
Conclusions: New onset diabetes in heart transplant recipients is a serious complication with high incidence and with serious implications in their evolution, requiring an accurate screening of the recipients in the waiting list and a periodical posttransplant evaluation, an early detection and a prompt and efficient treatment.

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Obesity and Insulin Resistance Status: The Impact of Using Different International Growth Standards in Romanian 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

Introduction: Worldwide, childhood obesity is on the rise. A lot of debate exists within the scientific community regarding the best way to define overweight and obesity in different populations. Currently, three sets of growth references are in use internationally: the 2007 World Health Organization (WHO) growth standards, the International Obesity Task Force (IOTF) reference, and the 2000 Center for Disease Control and Prevention (CDC) growth charts. We examined the impact of using these international growth references on diagnosing obesity in a group of overweight and obese Romanian children. Afterwards, we evaluated the relationship between diagnosed obesity and insulin resistance status.
Material and method: We studied retrospectively the observation charts of children who had their insulin levels tested in our hospital’s laboratory between January 1st 2008 and December 31st 2009. The study population consisted of 76 children. We analyzed: age, gender, body mass index (BMI), the homeostatic model assessment: insulin resistance (HOMA-IR). We divided the children into two categories according to their HOMA-IR values. We used each of the standards and grouped the study population into two BMI groups: overweight and obese. We used One-Way ANOVA to evaluate the differences between the three definitions.
Results: We found significant differences between the WHO and the IOTF and CDC references. The WHO standards identified the least overweight children with insulin resistance.
Conclusions: Our study shows that using WHO growth standards may be the proper method to diagnose obese children. A large populational study is needed to establish the proper growth references for our population.

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