Category Archives: AMM 2012, Volume 58, Number 4

Liver Metastases: Incidence and Clinicopathological Data

Turdean S1, Gurzu Simona2, Turcu M2, Voidăzan S3, Sin Anca4

1 “Gheorghe Marinescu” Municipal Hospital, Tîrnăveni, Romania
2 Department of Pathology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Departament of Epidemiology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
4 Department of Cellular and Molecular Biology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Aim: To investigate the clinicopathological features of liver metastases diagnosed in Mureș County, Romania.
Material and method: We performed a retrospective study based on data collected from histopathological reports stored in the archives of the Pathology Laboratories of Emergency Mures County Hospital, Romania. We selected those patients’ data that were diagnosed with liver metastases during January 2004 – August 2011. The acquired data were collected and processed statistically by using the GraphPad InStat Demo 3 statistical software.
Results: We identified 748 liver tumours out of which 484 were liver metastases. The liver metastases: primary liver tumours ratio was 1.833:1. In cases of liver metastases, the male:female ratio was 1.45:1. The mean age of male patients was 62.13 (±10.79 years) as for female patients it was 61.61 (±10.82 years). In most of the cases (34.71%) the primary tumor was colorectal carcinoma followed by pancreatic carcinomas (16.52%).
Conclusions: Most cases of liver metastases are carcinomas, whereof the most frequent ones originate from the digestive area, respectively gastrointestinal tract and pancreas. Independently by the primary tumour, liver metastases occur more frequent in males, in their 7th decade of life.

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Intravesical Bacillus Calmette-Guérin (BCG) Immunotherapy for Patients with Non-Muscle Invasive Bladder Tumors

Porav-Hodade D1, Boja R1, Mártha Orsolya1, Chibelean C1, Chiujdea A2, Mălău O2, Schwartz L2

1 Clinic of Urology, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Clinic of Urology, County Emergency Clinical Hospital, Tîrgu Mureş, Romania

Introduction: Intravesical instillations with bacillus Calmette-Guerin (BSG) is currently considered the most effective intravesical therapy for non-muscle invasive bladder tumors. The aim of this study is to present our experience with intravesical BCG immunotherapy instillations in patients with non-muscle invasive bladder tumors.
Material and method: Between September 30, 2005 and March 31, 2012 we performed intravesical instillation with BCG in 183 patients with non-muscle invasive bladder tumors, initiated at 6 weeks after transurethral resection of the tumor. The induction of BCG instillations was administrated according to the empirical 6-weekly induction schedule. Maintenance therapy was scheduled to 3 and 6 months following the instillation with BCG and at every 6 months afterwards for 3 years.
Results: Five patients did not finish the induction therapy protocol and were excluded from the study. The median clinical follow-up was 37 months. Endoscopic examination showed no reccurence in 126 patients. For 52 patients with bladder tumor reccurence, we performed tranurethral resection of the bladder. Histopathological examination demonstrated no progression in 30 cases. For this group of patients we continued the BCG tratment. The other 22 patients with progression of the tumor were excluded from the BCG treatment and received oncological or surgical treatment. The main complications were represented by tuberculization of the bladder, hematuria and fever, BCG treatment was stopped for these patients.
Conclusions: Our results show a low rate of tumor recurrence in patients with non-invasive tumors treated with BCG instillation. Complication rate is low, but the treatment required discontinuation in several patients.

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Cardiovascular Autonomic Neuropathy and Sensorimotor Polyneuropathy in Type 2 Diabetes Mellitus

Moţăţăianu Anca1, Bajkó Z1, Stoian Adina2, Bălaşa Rodica1

1 Department of Neurology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Pathophysiology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Background: The neuropathic complications related to diabetes may affect the somatic, sympathetic and parasympathetic nervous system, causing diabetic neuropathy. The aim of this prospective study was to investigate cardiovascular autonomic dysfunction and to determine the relationships between diabetic cardiovascular autonomic neuropathy (CAN), autonomic symptoms and diabetic sensorimotor polyneuropathy (DPN).
Methods: The prevalence of CAN among 57 patients with type 2 diabetes mellitus (DM) was assessed by the five autonomic function tests by Ewing’s methodology. DPN was diagnosed on the basis of both clinical criteria and electrodiagnostic studies in upper and lower limbs.
Results: Patients with CAN had a longer duration of diabetes (p<0.0001), a poorer glycemic control (p=0.02), and a higher prevalence of DPN (p<0.0001). There were no significant differences in sex distribution, body mass index, lipid profile and blood pressure between patients with and without CAN.
Conclusion: Our results confirmed the associations of CAN with duration of diabetes and poorer glycemic control. The natural progression of CAN is insidious and the symptoms are miscellaneous and manifesting at a relatively late stage. With the aim of preventing CAN, diabetic patients should receive a precocious diagnosis and be instructed for having a good metabolic control.

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Imaging the Adverse and Late Effects in the Treatment of Colorectal Cancer

Jederán Éva, Horváth Katalin, Gődény Mária

Department of Diagnostic Radiology, National Institute of Oncology, Budapest, Hungary

Side effects are common in the clinical practice and its diagnosis and radiologic manifestations are not always evident or known. Adverse effects may cause medical complications of a disease or a procedure and negatively affect its prognosis. Several typical patterns can be recognized on imaging and making a correct diagnosis has relevant clinical and therapeutic implications.
In this article we present a part of our preliminary results of the retro- and prospective study started in 2009 in the National Institute of Oncology. The aim of the study is to evaluate the imaging diagnostic examinations (US, CT, MR, PET/CT) of patients who have been diagnosed, treated and operated in the Hungarian National Institute of Oncology from 01 January, 2008. In this part we analyze the post-therapeutic consequence symptoms, side- and late effects during the treatment of colorectal cancer patients.

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Effect of Dega Osteotomy on the Biomechanics of the Hip Analyzed with the Method of Finite Element Analysis

Incze-Bartha Zsuzsánna, Nagy Ö, László Ilona, Incze-Bartha S

Clinic of Orthopedics and Traumatology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: Hip osteotomies are performed in the treatment of developmental hip dysplasia for anatomical reconstruction of the deformity. Dega osteotomy is an acetabuloplasty indicated in childhood treatment. In this study we performed a finite element analysis of the hip in order to clarify the effect of the Dega osteotomy on biomechanics of the dysplasic hip.
Material and methods: We used the CT data from two children: one with normal hip for reference, and one with dysplasia of the left hip. After the reconstruction of the geometrical models for normal, dysplasic, and post-Dega osteotomy hips, we made a finite element analysis for each model, using hexahedral elements.
Results: In our postoperative model the intrarticular pressure decreased from 5.7 MPa in the dysplasic model to 3.5 MPa. The acetabular contact area in the post-osteotomy model increased two times compared to the dysplasic model.
Conclusions: The positive effects of the Dega osteotomy on the biomechanics of the dysplasic hip is proved in the size and shape of the postoperative contact areas, which are almost the size and shape of the normal hip.

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Subject Specific Modeling of the Forefoot Based on CT 3D Reconstruction

Incze Bartha S, Nagy Ö, Incze Bartha Zsuzsánna

Clinic of Orthopedics and Traumatology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: Developing new surgical procedures and prototyping implants requires a real or adequate virtual testing environment to work in. Due to the unique architecture of the human foot interventions and implants can be tested only on patients and cadavers. We present our own approach for creating the geometrical model based on 3D CT reconstruction.
Material and methods: For the model construction we used the CT data from the foot of a healthy, young patient. The input data consisted from 56 sections from the talar dome to the plantar surface. The slices were segmented, boundary detection was performed, the boundaries were smoothed, NURBS interpolation was performed to obtain 3D surface. The surfaces were closed to solids and the solids edited to obtain the virtual anatomical structures.
Results: Our model is geometrically accurate in the limits of resolution that were given by the CT examination.
Conclusions: Now that we have an available model construction method we can begin enclosing the geometrical model into mathematical environments for finite element analysis. Also, scanning and reconstructing multiple feet with different conditions will help us to understand illnesses and develop new operative techniques and implants.

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Outside over Inside Analysis of Medical Students’ Education Efficacy in Cognitive Domain over a given Physiology Curricula

Gliga M, Sabău M

Department of Physiology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Aim: We tried to correlate, in cognitive domain, the second year medical students’ oral evaluation results to the efficacy of education they were provided, over our medical physiology curricula between 2004 and 2011.
Material and methods: We used the fact that during the mentioned period the curricula configuration for the two semesters of the second year was identical. We also used the fact that, for a given group of students and curricula, education and evaluation were performed by the same teacher. We compared three existing and unmodified configurations: 1. different groups of students, same curricula, different teachers, 2. same group of students, different curricula, same teacher and 3. same group of students, different curricula, different teachers. We also took an inside brief evaluation of students’ skills in cognitive domain at the beginning of the second year and tried to correlate it with final results.
Results: We couldn’t make any correlations because of logical contradictions of the configurations we compared. We couldn’t obtain, as an outside observer, concise information of what levels in cognitive domain students were evaluated on by different teachers. Merely we can say that education of the second year medical students over our physiology curricula cannot be efficient for a large amount of students who do not possess those compulsory cognitive skills that are required to study physiology.
Conclusions: The protocols used between 2004 and 2011 for evaluating medical students’ skills in cognitive domain over second year medical curricula cannot give accurate information for an outside evaluator.

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Antimicrobial Activity of 2% Chlorhexidine

Ghiga Dana1, Bacârea V1, Petrişor M2, Haifa B2, Şchiopu A3

1 Department of Research Methodology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Medical Informatics and Biostatistics, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Department of Physiopathology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Introduction: A great interest regarding 2% chlorhexidine solution is over its efficiency on gram-negative bacteria, but chlorhexidine sensitive microorganisms include gram-positive bacteria, gram-negative bacteria and fungi. The aim of the study was to analyze the antimicrobial and antifungal action of 2% chlorhexidine solution against the microorganisms isolated from infected root canals before and after irrigation. Material and method: Clinical material. We took samples from 20 incisors of 20 patients. Sampling procedure. We followed all the rules necessary for sampling under sterile conditions. Three microorganisms: Enterococcus faecalis, Staphylococcus aureus and Candida albicans were identified from infected root canals, based on culture, and biochemical characteristics and pathogenicity tests. The statistical analysis was performed using a statistical analysis program (SPSS Statistics 16.0). A log10 transformation of the CFU (colony forming units) values was performed to normalize the data.
Results: The frequency of the isolated microorganisms before irrigation with 2% chlorhexidine solution were: Enterococcus faecalis – 3.18±1.84 CFU, Staphylococcus aureus – 1.92±0.79 CFU, Candida albicans – 2.12±1.10 CFU and after irrigation were: Enterococcus faecalis – 0.67±0.20 CFU, Staphylococcus aureus – 0.95±0.26 CFU, Candida albicans – 1.02±0.35 CFU. The difference between the means of isolated germs’ CFU before and after irrigation with 2% chlorhexidine solution is statistically significant (p<0.05).
Conclusions: The use of 2% chlorhexidine solution as endodontic irrigant reduces the number of the studied microorganisms’ colony forming units.

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Influence of Some Flavoring Substances on the Hematological Parameters of Rats

Duca Alina1, Mihele Dana2

1 Department of Clinical Laboratory and Alimentation Hygiene, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
2 “Prof. Dr. Scarlat Longhin” Clinical Hospital of Dermatovenerology, Bucharest, Romania

Introduction: Given the risk of side effects of flavoring substances used in the food industry, their cytotoxic effect on mouse fibroblast cell cultures and the risk of malignant degeneration, in this paper we observed eventual changes to hematological parameters of rats under the influence of flavorings: (±) – limonene p-methyl-1,8-diene (orange flavoring substance), (±) -3,7-dimethyl-6-octenal (lemon flavoring substance), ethyl format (rum flavoring substance) and 4-hydroxy-3-methoxybenzaldehyde (vanilla flavoring substance).
Materials and methods: The changes were followed in red blood cell counts, red cell indices, hemoglobin in erythrocytes, leukocytes, differential blood count, platelet count and platelet indices. For measurements we used white Wistar rats, weighing 240±10g. The flavoring substances were administered in doses of 25 mg/kg orally for 7 days compared to a control group treated with saline solution at a dose of 10 mg/kg orally. Blood was collected after 7 days of treatment in tubes with EDTA-Na 1 mg/2 ml blood and measurements were made with an automated hematology analyzer.
Results: After 7 days of treatment we found the orange and lemon flavoring substances determined a significant decrease in the number of erythrocytes, hematocrit and hemoglobin values, mean corpuscular volume, mean erythrocyte hemoglobin, mean erythrocyte hemoglobin concentration, but the number of leukocytes and platelet count did not change significantly. The vanilla and rum flavoring produced no statistically significant changes in hematological parameters.
Conclusions: The orange and lemon flavoring substances studied after statistical processing of experimental data by Student t-tests and ANOVA has modified significant the hematological parameters (number of erythrocytes, hemoglobin and hematocrit value).

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Cytological, Histological Correlations and Human Papillomavirus Testing in the Diagnosis of Cervical Intraepithelial Neoplasia

Colţescu F1, Hălmaciu Ioana2, Rădulescu Carmen3, Rădulescu C3

1 Department of Obstetrics and Gynecology, County Emergency Clinical Hospital, Târgu Mureş, Romania
2 Department of Anatomy and Embryology, University of Medicine and Pharmacy, Târgu Mureş, Romania
3 Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, Târgu Mureş, Romania

Introduction: Persistent infection with high risk Papillomavirus (HR HPV) is the main risk factor for cervical cancer. Usually there is a period of approximately 10 years since someone gets infected with HPV till the incidence of an invasive cancer. The slow evolution of precancerous lesions allows their detection before the invasive stage. The objective of this study is to evaluate correlations among cytology, colposcopically guided biopsy and HPV testing, HR HPV prevalence and the reliability of cervical-uterine smears as screening method.
Material and method: The study comprises a number of 64 patients who underwent colposcopy, cytodiagnosis and biopsy examinations during January 2010 – December 2011 at Saint Die Hospital (France). Testing for HR HPV was performed especially in case of ASCUS Pap smears.
Results: ASCUS results of cervical-uterine smears corresponded to histological diagnosis of normal aspect and benign lesions in 60% of the cases, in 26.66% of cases with low grade malignant lesions and in 13.33% of the cases with high grade malignant lesions. HR HPV testing was positive especially in patients younger than 30 years (93.33% of patients who performed the HR HPV test), for patients between 30 and 50 years HR HPV was present in 80% of tested patients and for patients over 50 years was present only in 20% of the cases. Neither of the patients who tested negative for HR HPV presented high grade malignant lesions as a result of the biopsy test.
Conclusions: There is a direct correlation between the presence of HPV and grade of malignancy, thus all patients presenting high grade malignant lesions tested positive for HR HPV. HPV testing should not be performed in patients with LSIL results when sampling cervical-uterine smears, because the HPV prevalence is highly increased and a positive HR HPV test result would only create panic in young patients.

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