Category Archives: AMM 2012, Volume 58, Number 3

Magnetic Resonance Mammography: Actual Trends and Perspectives

Nechifor-Boila IA1, Buruian M1, Borda Angela2

1 Department of Radiology and Medical Imaging, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
2 Department of Histology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: Magnetic Resonance Mammography (MRM) is a new radiologic examination with wide perspectives in breast cancer diagnosis. We performed a systematic review of the literature, in order to obtain a clear view on the actual role of MRM, together with an accurate evaluation of its performance in clinical settings.
Material and methods: We conducted a thorough PubMed search, both directly and through MeSH (Medical Subject Headings), using specific keywords. We then applied the following filters: articles published only between 1999 and 2011 and written in English or French. Priority was given to reviews and clinic trials according to previously set criteria.
Results: We evaluated the clinical efficiency of MRM using sensitivity, specificity and predictive values (positive and negative). Sensitivity varied between 81 and 98%, while specificity had a much wider dispersion (65–93%), thus supporting the statement that MRM is a sensitive but not a specific examination. Diffusion MRM was comparable to standard MRM, while spectroscopy showed a low sensitivity and a high specificity.
Conclusions: MRM is a complex investigation, with well documented recommendations and good sensitivity. Diagnostic specificity remains an important issue, but with improvement perspectives from new techniques like diffusion and spectroscopy.

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Multifocal Sarcomatoid Carcinoma of the Small Intestine

Fülöp Emőke1, Marcu Simona Tünde1, Loghin Andrada1, Fülöp EF2, Mocan Simona3

1 Department of Histology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Internal Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Department of Pathology, County Emergency Clinical Hospital, Tîrgu Mureş, Romania

Sarcomatoid carcinomas (SCs) or carcinosarcomas are rare, biphasic tumors, with poor prognosis, only rarely located in the small and large intestine. The first treatment option of these tumors is surgical approach, adjuvant therapy showing no important role in the treatment protocol. We present the case of a 63 years old male patient, hospitalized in the Surgical Department II of the County Emergency Clinical Hospital Tîrgu Mureş with the diagnosis of small intestine tumor with jejunal localization. Microscopically, in hematoxylin-eosin (HE) staining, the tumor was consisting of two components, an epithelial and a mesenchymal one. From immunohistochemical point of view, tumor cells were strongly positive for cytokeratin AE1/AE3 as well as for vimentin. They were negative for epithelial membrane antigen (EMA), CD117, CD34, S100, chromogranin-A and synaptophisin. Based on the macroscopic and microscopic appearance, respectively the immunohistochemical feature of the tumor, the patient was diagnosed with multifocal sarcomatoid carcinoma of the small intestine.

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Particular Clinical-Therapeutic Aspects of Rhinophyma — Atypical Case Report

Andrei Liliana1, Bordeianu I2, Iordache IV2, Bratu I3

1 Hypocrate Medical Center, Tulcea, Romania
2 Faculty of Medicine, Ovidius University, Constanța, Romania
3 Faculty of Pharmacy, Ovidius University, Constanța, Romania

The authors present a case of pseudotumoral rhinophyma with some specific and rare clinical, evolutional and therapeutic aspects. Therapeutic indication was put on functional rather than cosmetic reasons, and surgery led to good functional and cosmetic results, accompanied by a fast spontaneous-directed epithelialization.

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The Predictive Value of Mannheim Score in Patients with Colon Related Peritonitis

Teleanu G¹, Iordache F², Beuran M2

1 General Surgery Clinic I, Clinical Emergency Hospital Floreasca, Bucharest, Romania
2 Faculty of Medicine, University of Medicine and Pharmacy, Bucharest, Romania

Introduction: The aim of this study, is to confirm the predictive value of the Mannheim peritonitis index at the patients with colonic peritonitis.
Material and method: From January 2003 to October 2007 in Surgical Department of Emergency Hospital Bucharest, 98 cases were studied and the patients were divided into two groups according to the Mannheim Peritonitis Index value 24.
Results: A life table was constructed to compare patients survival rate. Patients with Mannheim Peritonitis Index less than or equal to 24 had a mortality not reach 6% and patients with Mannheim Peritonitis Index greater than 24 had a mortality rate of 45%.
Conclusions: The Mannheim Peritonitis Index is a useful method to determine study group in patients with colonic peritonitis. He has a predictive value of outcome at the patients with colonic peritonitis.

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The Usefulness of Magnifying Chromoendoscopy with Methylene Blue in the Detection of Specialized Intestinal Metaplasia and Dysplasia in Barrett’s Esophagus — a Preliminary Report

Pascarenco Ofelia¹, Dobru Daniela¹, Boeriu Alina¹, Brusnic Olga¹, Galeanu Iuliana², Onisor Danusia³, Stoian M4

1 Department of Gastroenterology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Gastroenterology, Municipal Hospital, Câmpulung Moldovenesc, Romania
3 Department of Gastroenterology, Municipal Hospital, Luduș, Romania
4 Department of Intensive Care, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Background: Barrett’s esophagus appears in relation with gastroesophageal reflux disease, which damages the normal squamous mucosa; the injury heals through a metaplastic process in which columnar cells replace squamous ones. The specialized intestinal metaplasia has a malignant potential, but the diagnosis is often difficult in conventional endoscopy.
Aim: Our purpose was to evaluate the results of magnifying chromoendoscopy using methylene blue in the diagnosis of specialized intestinal metaplasia and dysplasia in Barrett’s esophagus.
Methods: Nine patients with proven or suspected Barrett’s esophagus in conventional endoscopy underwent magnified chromoendoscopy with methylene blue for confirming and/or monitoring the intestinal metaplasia or for detecting dysplasia. Biopsies were taken from sites coloured with methylene blue and from regions with particular patterns according to Endo’s classification.
Results: Specialized intestinal metaplasia was reported in 16 out of 29 biopsies; one biopsy proved low grade dysplasia and two samples showed indefinite for dysplasia. The sensitivity and specificity of methylene blue staining in detection of specialized intestinal metaplasia were 87% and 66% respectively (p=0.005). Taking into consideration Endo’s classification, tubular and villous patterns had a significant correlation with SIM detection (p=0.0004) with a sensitivity and a specificity of 66% and 100%.
Conclusions: Magnifying chromoendoscopy with methylene blue allows targeted biopsies for SIM and dysplasia detection; it also allows the selection of the site of the biopsy according to pitpattern.

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Correlation Between Postoperative Cervical Haematoma in Carotid Surgery and Antiplatelet Treatment

Jerzicska Ernő, Fărcaș Felix, Győrbíró László

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

Introduction: Cervical haematoma is one of the local complications of carotid endarterectomy. Cervical haematoma may determine oesophageal compresion or tracheal deviation. We evaluated the correlation between cervical haematoma and preoperative antiplatelet treatment.
Material and methods: We evaluated retrospectively 100 consecutive patients operated with carotid endarterectomy between 2009 and 2011. Group A of 48 patients had monoantiaggregant preoperative treatment, group B of 52 patients had dual preoperative antiaggregant treatment.
Results: We observed cervical haematomas in 16 patients from the total of 100, 13 of them being in group B. Evaluation of age, sex, surgical technique and local drainage showed no differences between the two groups. The group with monoantiaggregant preoperative treatment had a smaller chance to develop cervical haematoma (p=0.022).
Conclusions: Preoperative antiplatelet treatment is crucial for a succesful carotid endarterectomy procedure. We sustain the use of monoantiaggregant preoperative treatment, which is associated with less cervical haematomas as a local haemorrhagic complication, instead of dual antiaggregant preoperative therapy.

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Laparoscopic Transperitoneal Adrenalectomy for Patients with Previous Abdominal Surgery

Ganescu Roxana1, Paun S1, Beuran M1, Vartic Mihaela1, Paun Diana2, Dumitrache C2

1 Emergency Hospital, Bucharest, Romania
2 ”C.I. Parhon” National Institute of Endocrinology, Bucharest, Romania

Background: Adrenal surgery has been radically changed by laparoscopic approach and we wonder whether the increase in the number of adrenalectomies is entirely justified by better understanding of the pathology and a developed diagnosis method. The type of approach (transabdominal/retroperitoneal) remains still a mater of surgeon’s experience.
Method: In past 6 years we performed 152 laparoscopic adrenalectomies by transperitoneal approach, 24 of them having previous significant abdominal surgery (cholecistectomy, gastric surgery, colectomy, bowel obstruction, exploratory laparoscopy, adrenalectomy). The patients had a variety of adrenal pathologies like Cushing’s disease, Cushing’s syndrome, Conn’s syndrome, incidentaloma, pheochromocytoma and even carcinoma.
Results: Three cases were converted to open approach, only one because of the adhesions. Reasons for conversion were also: spleen infarction and a difficulty in mobilizing the tumor. Operating time was not significantly prolonged because of the adhesions (40–360 min, median time 127 min). Postoperative evolution was simple, with no morbidity or mortality and a fast recovery.
Conclusions: Choosing the type of approach is related to surgeon experience, although 79–94% of surgeons prefer the transabdominal lateral approach. We believe that with an experienced surgical team there is no difficulty in performing adrenalectomy by transabdominal approach, with no significantly prolonged operating time, even when the patient had previous abdominal surgery.

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Particularities of Doctor-Patient Communication, Assessed in 6 Romanian Ambulatory Practices

Gáspárik Andrea Ildikó1, Ábrám Z2, Albert-Lőrincz Enikő3, Török Kinga1

1 University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Hygiene, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Social Work Department, Babeș-Bolyai University, Cluj Napoca, Romania

Introduction: The way doctors collect data, explore patient concerns, discuss and explain the diagnosis will influence the patients’ comfort, satisfaction, attitude and adherence to medical treatment and even their health outcomes. Our aim is to assess structure and patterns of doctor-patient communication in Romanian ambulatory practices.
Materials and methods: We included in our analysis 69 doctor-patient meetings in 6 outpatient clinics (five different specialities, state and private practice), taking place in 3 Romanian cities. Data collection was carried out by non-participatory observation of the time-structure of visits (anamnesis, examination, explanation of diagnosis, treatment-, and lifestyle recommendation, administrative works), proportion of talks and reports belonging to the parts, number of questions asked by each part, and non-verbal behaviour, helping the patient feel comfortable during the visit.
Results: The average length of the meetings was 7.41 minutes. Discussions are less representative in Romanian medical practice. Patients were let to speak about their problems 7 seconds, without interruptions. Administrative duties (registering, writing) took 27% of the time, 42% was represented by examination (physical and instrumental). Explaining diagnosis and treatment accounted for 5% and 9% respectively. There were two doctors (of six) showing different gestures to help the patient feel comfortable during the consultation. Doctors talked 3 times more than patients and had in average 6 questions compared to less than one question, formulated by the patients. Lifestyle recommendations were observed in 2 cases (of the 69).
Conclusions: Although the international literature describes a shift in the doctor’s and patient’s attitude from the traditional paternalistic model towards a partnership, where patients assume a more active role in their healing process, our data suggest a doctor-patient relationship strongly dominated by doctors, a passive behaviour of patients, actually a free-will subordination to the doctor’s high-status (no or few questions, no willingness to participate in decision making).

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Electrophoretic Separation of Proteins from the Drain Fluid by Geometric Electrofocusing in Conjunction with Local Complications in the Surgical Patient

Cozma D¹, Stoian M2, Bacârea Anca3, Ieva Alina4, Iacob Oana3, Şchiopu A3, Copotoiu C1

1 Surgical Clinic 1, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
2 Clinic of Anesthesia and Intensive Care, County Emergency Clinical Hospital, Tîrgu Mureş, Romania
3 Department of Pathophysiology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
4 School of Doctoral Studies, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Introduction: Local postoperative complications are affecting the evolution of surgical patients, which is the main reason why early diagnosis is a priority concern. Our objective was to
Objective: To study the opportunity of protein analysis of the proteins from the drain fluid, as evolution markers of the surgical patient.
Material and method: We have analyzed drain fluid collected after 24 h, 72 h and 5 days after surgery. We have used the following: determination of protein concentration by spectrophotometric analysis at 280 nm and protein separation by geometric electrofocusing (patent no. 109585C1/30.03.1995)
Results: From the analyzed liquids, we obtained variable protein concentrations. In all cases, electrophoretic separation showed the presence of protein fractions similar to those of reference serum.
Conclusion: The analysis protocol allows precise quantitative determination of the proteins from the drain fluid. Geometric electrofocusing, approached for the first time for this specific type of analysis, has proved to be highly effective in terms of quality and affordable due to the low cost.

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Efficacy of Electroresection with the Diathermy Loop for the Treatment of Cervical Intraepithelial Neoplasia

Colțescu F1, Rădulescu Carmen2, Grama O2, Rădulescu C2

Introduction: Recent improvements in the understanding of the natural progression of cervical intraepithelial neoplasia (CIN) and in the knowledge of the treatments of pregnancy related morbidity, in addition to the progression of mean age of first pregnancy, brings out the need to rethink CIN management. There are currently two different modalities in the treatment of cervical dysplasia: local destruction and excision (loop diathermy, cold-knife conisation and laser conisation). The loop electrosurgical excision procedure (LEEP) is the most commonly used technique today for the practice of conisation, regardless of the lesion’s size or level of junction in the endocervix. The aim of our study was to analyse the efficiency of LEEP and the incidence of complications in the per- and post-operative period.
Material and method: We enrolled 49 hospitalized patients who underwent loop diathermy excision of the cervix, in a period spanning two years between January 2009 and December 2011 at the Hospital Saint Die in France.
Results: As far as grading is concerned, 2 patients were CIN 1 (4.54%), 18 were CIN 2 (40.9%) and 24 were CIN 3 (54.54%). In 41 cases (93.18%) the resection was done within safety margins – healthy tissue, in three cases (6.12%) the excision was incomplete. Five patients referred to hospital with postoperative bleeding.
Conclusions: In our experience LEEP could be considered the treatment of choice for cervical dysplasia when colposcopy is satisfactory, because it is effective, simple, fast, inexpensive, unaggressive, has a low morbidity and it permits adequate pathological examination.

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