Category Archives: AMM 2013, Volume 59, Number 1

Chondrodermatitis Nodularis Helicis

DOI: 10.2478/amma-2013-0013

Chondrodermatitis nodularis helicis is a rare and well defined clinical condition, characterized by the appearance of painful nodule or nodules located on the helix. Affects mainly white men, aged 50 and more. The pathogenesis of the disease is unclear. The used treatments gives excellent results, but the disease tends to relapse. We present a clinical case of a young man of 38 years of age with a painful nodule located on the left ear.

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Two Cases of Dorsal Urethral Duplication

DOI: 10.2478/amma-2013-0012

Urethral duplication is a rare congenital anomaly. In addition to a normally urethra, there is an accessory urethra arising from the bladder or the proximal urethra which may open anywhere on the penis or even on the perineum. Many patients with this malformation are asymptomatic. Some patients may complain of intermittent discharge from the accessory urethra, incontinence, infection, double streams or stricture. The duplicated urethra may be complete or incomplete, may be located dorsal, ventral or in Y-type. The treatment of urethral duplication is individualized, depending on the type of malformation. We report two cases of dorsal urethral duplication discovered in two boys.

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Possibilities and Difficulties of Treatment in the Case of a Pregnant Patient with Primary Mediastinal Large B-cell Lymphoma

DOI: 10.2478/amma-2013-0011

Background: There are several histologic variants and clinical subtypes of diffuse large B cell lymphoma, which includes the primary mediastinal large B cell lymphoma (PMBL). In the last 10 years the incidence of diffuse large lymphomas grew significantly.
Case report: We present the case and evolution of an aggressive life-threatening mediastinal B cell lymphoma with respiratory insufficiency, diagnosed in the 27th week of pregnancy. After 4 courses of R-CHOP the clinical status has somewhat improved, but the dyspnea, the facial and neck oedema and the trouble of speech persisted. After the patient was admitted to our hospital, she received DHAP regimen followed by mobilization with G-CSF. Before transplantation we administered another 3 courses of DHAP chemotherapy with spectacular results. We performed autologous hematopoietic stem cell transplantation preceded by BEAM chemotherapy. At present, 5 years post-transplant the patient is well, with no metabolically active disease on the PET-CT performed 3 months ago.
Conclusion: We can conclude that even in very complicated DLBCL cases, with a very good, efficient medical-team work we can salvage lives, in our case both of the mother and the child’s. Even in partially chemo-refractory cases like in the presented one, salvage chemotherapy followed by autologous transplantation can lead to a successful treatment.

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Simultaneous Determination of Atorvastatin and Amlodipine in Industrial Tablets by Apparent Content Curve and HPLC Methods

DOI: 10.2478/amma-2013-0010

Introduction: This study proposes the simultaneous determination of atorvastatin and amlodipine in industrial tablets by a quantitative spectrophotometric method, named the apparent content curve method, test method, and by an HPLC method with UV detection as reference method.
Materials and methods: A synthetic mixture and two fixed medicinal combinations containing amlodipine and atorvastatin were investigated by the apparent content curve method, a simple and relatively inexpensive UV-VIS spectrophotometric method based on a mathematical approach derived from the Lambert-Beer law. The results were compared with those obtained by an HPLC method.
Results: A good correlation of the results was obtained, the difference between the pair results was not significant (p >0.05).
Conclusions: The proposed spectrophotometric method is an easier and cheaper alternative for the quantitative determination of amlodipine and atorvastatin in industrial fixed-dose combinations.

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Lower Lip Reconstruction Using Unilateral Nasolabial Gate Flap (Fujimori Technique)

DOI: 10.2478/amma-2013-0009

Background: In the medical literature there are multiple reconstructive procedures for small and medium size defects of the lower lip, but only a few methods for larger defects involving the whole lower lip. Choosing the repairing procedure for larger lower lip defects must take into account two aspects: flap or flaps used should be local flaps, and suture lines should correspond to the natural facial creases or follow the functional lines of different facial aesthetic units. Finally, the flap or flaps should be large enough to restore the entire postexcisional defect.
However, the more tissue is lost from the lower lip, the more challenging the reconstruction is from a functional and cosmetic point of view.
Material and methods: During the last 2 years in the Oral and Maxillofacial Surgery Department of the County Emergency Clinical Hospital in Tîrgu Mureş, the unilateral Fujimori technique has been successfully used for the reconstruction of large lower lip defects in 4 patients with extended, neglected squamous cell carcinomas involving almost the whole lower lip tissue. These patients underwent complex surgical and oncological treatment. Surgery was performed in two stages: first, excision of the tumor and immediate lip reconstruction, and then removal of submandibular lymph nodes (level I), in the second stage.
Results: The aesthetic and functional recovery of these patients was very good, with no need of other subsequent surgical corrections.
Conclusions: The postoperative reconstruction of large defects of the lower lip is far from optimal, but it is very important to restore an adequate muscle function, the lip continence and a satisfactory facial appearance.

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Household Environmental Tobacco Smoke and Risk of Allergic Sensitization Among Children with Asthma

DOI: 10.2478/amma-2013-0008

Background: Exposure to cigarette smoke is causing health problems, its components are known to possess carcinogenic, mutagenic, cytotoxic or irritant properties. Prevalence of smoking in pregnant women is between 17% and 35% worldwide. Passive smoking is identified as a factor with negative impact on health, and children are especially vulnerable. Children raised in families with smokers have a higher incidence of respiratory infections, recurrent wheezing, bronchitis, nocturnal cough and asthma. The aim of this study was determination of sensitization to various allergens in children exposed to cigarette smoke compared with children not exposed to cigarette smoke.
Material and method: One-hundred eighty children treated in Pediatric Clinic 1 of Tîrgu Mureș were included in the study between 2008–2011. The patients were divided into two groups: 50 children exposed to cigarette smoke and 130 children not exposed. Measurement of lung function was performed in children over 4 years using a spirometer. Serum specific IgE was analyzed to inhalatory and food allergens. Wheezing phenotype was determined in children younger than 4 years and exposure to cigarette smoke was evaluated based on parents’ responses to questionnaires.
Results: There was a significantly greater likelihood of developing sensitivity in children exposed to tobacco smoke than in those not exposed to dermatophagoides pteronissimus, dermatophagoides farinae, milk and grass pollen.
Conclusions: During early childhood both pre- and postnatal tobacco smoke exposure has an adjuvant effect on allergic sensitization inhalatory and food allergens.

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Serum Interleukin Profile in Patients with Graves Orbithopathy

DOI: 10.2478/amma-2013-0007

Background: Graves’ orbitopathy (GO) is considered an autoimmune condition in close relationship with Graves’ disease (GD) affecting the thyroid. Several similarities exist between the two conditions, sharing the common antigen and the characteristics of the inflammation mediated by a number of cytokines. The result of the immune reactions will lead to the expansion of adipose tissue, production of glycosaminoglycans and soft tissue inflammation.
Material and methods: In our study we examined the serum level of interleukin-1 (IL-1), interleukin 2 (IL-2), interleukin-4 (IL-4), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), monocyte chemoattractant protein-1 (MCP-1), tumor necrosis factor-alpha (TNF-α), and interferon-gamma (IFN-γ) in correlation with the activity of disease and smoking habits in 25 patients with GD and GO.
Results: We found that smokers had higher serum IL-6 and lower serum MCP-1, IL-8 and TNF-α level compared to non-smokers. Also, we found a weak positive correlation between serum IL-10, IFN-γ and disease activity (clinical activity score, CAS) and negative correlation between serum IL-1 and activity.
Conclusion: Our findings support the fact that some cytokines (IL-10, IFN-γ, IL-1) play a role in active disease, while others are influenced by environmental factors, such as smoking (IL-6, IL-8, TNF-α). The discrepancy of cytokine profiles may reflect different patient characteristics, such as disease stage and disease activity and determination of serum cytokines would be useful in selecting patients who need more aggressive treatment protocols.

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Research Concerning the Correlations Between Urinary Tract Infections and Congenital Malformations of the Renourinary System

DOI: 10.2478/amma-2013-0006

Introduction: Congenital malformations of the urinary system are risk factors for the development of urinary tract infections (UTI). Besides the severity of the malformation, urinary infection is always associated with poor prognosis for these patients. Late discovery of the malformation background, after several urinary tract infection episodes, contributes to the development of chronic pyelonephritis that may lead to chronic renal failure.
Material and method: The study involved patients with renal and urinary tract congenital malformations treated at the Pediatric Nephrology Department from Tîrgu Mureș over a period of 6 years, who associated urinary tract infection.
Results: Out of the total of 432 patients with congenital malformations of the urinary system, 270 had had at least one or several episode(s) of urinary tract infections in their medical history. Vesico-ureteral reflux and obstructive lesions of the urinary tract were most frequently associated with urinary infections. During the time when no ultrasound screening had been performed, the malformation background was usually diagnosed at the time of the first urinary infection episodes.
onclusions: The incidence of urinary tract infections in patients with renal and urinary tract congenital malformations depends on the type of the underlying malformation, and the time of diagnosis of the malformation background. Prevention of irreversible complications requires early diagnosis of the urinary system malformations that can be performed through ultrasound screening in the neonatal period.

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Aesthetic Principles of the Upper Front Teeth: Application of Golden Proportion (Levin) and Golden Percentage (Snow)

DOI: 10.2478/amma-2013-0005

Objective: The objective of our work is to examine the presence of the much-discussed golden proportion provided by Levin, and of the golden percentage (Snow), on the widths of maxillary anterior teeth, by measurements made on digital images.
Material and method: The material of this study consists of digital photographs taken of subjects with natural and esthetic teeth. We took photos of 68 subjects (35 women and 33 men), between 19 and 26 years. Using a computer program, we made the necesarry measurements, then we made the appropriate calculations of the above theories.
Results: The golden proportion between the lateral and central incisor occurs in a higher proportion than between the canine and the lateral incisor. The values obtained by analyzing the golden proportion differ slightly from those proposed by Snow.
Conclusions: The frequency of the golden proportion is not significant for the groups of teeth mentioned. With small modifications and taking into consideration ethnic differences, Snow’s golden percentage is more valid and applicable than Levin’s golden proportion is.

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Hypolipemiant Treatment: Making the Right Choice for Osteoporotic Patients

DOI: 10.2478/amma-2013-0004

Introduction: It has been shown that dyslipidemia is related to bone mineral density and fragility. Hypolipemiant drugs as statins or fibrates seem to increase the bone mineral density and probably to protect against fractures. The question that arises in this context is whether statins or fibrates have a positive effect on bone fracture repair process and which is their behaviour in an osteoporotic context. Our objective was to study the incidence of osteoporosis, dyslipidemia and of the association of these diseases, and to compare the effect of statins and fibrates on fracture repair in experimental conditions.
Material and method: We studied the incidence of dyslipidemia and osteoporosis in the activity of a private family medicine cabinet. In the experimental part we observed from a radiographic point of view the fracture repair process of rats’ femurs. We analyzed 6 subgroups of 12 rats each: (1) ovariectomized control, (2) ovariectomized treated with statins, (3) ovariectomized treated with fibrates, (4) nonovariectomized control, (5) ) nonovariectomized treated with statins, (6) ) nonovariectomized treated with fibrates. The radiographic aspect has been objectified with a score at 2, 4, 6 and 8 weeks.
Results: From the total of 646 patients included in the study, 193 (29.87%) had dyslipidemia while osteoporosis was diagnosed at 152 (23.53%) patients. 301 (46.6%) patients presented the association of these diseases. Comparing the subgroups of the OVX group, we had the following results: subgroup 1 – 5.5 points, group 2 – 11 points and group 3 – 4.5 points. In the case of the NOVX subgroups, the scores were: subgroup 4 – 7.5 points, subgroup 5 – 10 points and subgroup 6 – 6.5 points.
Conclusions: The fact that the incidence of dyslipidemia is higher than that of osteoporosis is an argument for the necessity of choosing a hypolipemiant treatment that has, at the same time, a protective effect on bone. Hypolipemiant treatment influences the fracture repair process. The positive effect of statins on this process is more important on the ovariectomized group, in contrast with fibrates which have an accentuated effect on the nonovariectomized group and this suggests an interference between hypolipemiant treatment and estrogens level. However, the treatment with fibrates delays the fracture repair, groups (3) and (6) scores being inferior to those of the control group. We sustain the helping effect of statins treatment on fracture repair process.

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