Category Archives: AMM 2013, Volume 59, Number 3

Tattoo-Associated Skin Reactions — Clinical Cases

DOI: 10.2478/amma-2013-0041

Tatooing has been practiced for thousands of years. It has become a common practice for people of Western countries in the last 10–20 years, where approximately 3–5% of the population has at least one tattoo. Various pigmented substances introduced into the skin may cause the occurrence of adverse irritative, immunological, infectious or other reactions of the skin. We present three clinical cases with adverse reactions after tattooing.

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The Role of Erythropoietin in the Treatment of Anemia in Patients with Malignant Lymphoma

DOI: 10.2478/amma-2013-0040

Introduction: Anemia is a common complication of malignant lymphomas, which could be a direct consequence of the disease or secondary to the myelosupressive chemotherapy. The aim of this study was to assess the effect of erythropoietin to treat anemia. The main objectives were to demonstrate increases in hemoglobin levels and the existence of an association between symptom relief and treatment.
Material and method: In the Clinical Hematology and BMT Unit Tîrgu Mureș we performed an analytical, observational study to assess the role of erythropoietin treatment in malignant lymphoma related anemia. This linear, retrospective study included 127 patients diagnosed and treated with malignant lymphoma between January 1st, 2007 and December 30, 2011. The 127 patients were divided into two groups: a group of patients (n = 88) who were treated with erythropoietin and the other group (n = 39) who did not receive this treatment. Patients included in the study received treatment with epoetin beta 40,000 IU/week. We followed the hemoglobin level and the symptomatology at baseline and after 4 weeks.
Results: Patients who received treatment with erythropoietin had a 7.12 times higher possibility of being asymptomatic than patients who did not receive this treatment. The hemoglobin concentration of patients with erythropoietin treatment increased significantly (p <0.0001) compared to the patients who did not receive this treatment.
Conclusion: Effective treatment of anemia is an important aim in the management of patients with malignant lymphomas, because it increases their hemoglobin concentration, decreases the need of transfusion and maintains an acceptable quality of life.

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The Qualitative and Quantitative Determination of the Phenolic Compounds in Polygonum Convolvulus L. Species, Polygonaceae Family

DOI: 10.2478/amma-2013-0038

Introduction: Polygonum convolvulus L. (black bindweed), syn. Fallopia convolvulus (L.) Á. Löve, Polygonaceae family is a plant from the spontaneous flora, spread from the plain zone up to the subalpine zone. The objectives of our researches are the qualitative and quantitative determination of polyphenolic compounds from Polygoni convolvuli herba and the choice of the adequate solvent for obtaining an active pharmacological extract.
Method: The qualitative exam consisted of phytochemical screening and thin layer chromatography. The quantitative determination of the total polyphenols was made through the Folin-Ciocâlteu method.
Results: The flavonoids, the anthocyanins, the tannins and the phenol carboxylic acids (phytochemical screening) were emphasized and the following compounds were identified: rutin, hyperoside, isoquercitroside, quercetin, myricetin, kaempferol and caffeic acid.
Conclusions: In order to establish the technological lab process for obtaining an active pharmacological extract standardized in total polyphenols the adequate solvent is ethanol 50% (v/v).

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Multiple Sclerosis of the Spinal Cord: is Gadolinium Irreplaceable in Assessing Lesion Activity?

DOI: 10.2478/amma-2013-0037

Purpose: To evaluate the relationship between the T2 patterns of spinal cord multiple sclerosis lesions and their contrast uptake.
Material and method: We retrospectively reviewed the appearance of spinal cord lesions in 29 patients (with relapsing-remitting multiple sclerosis) who had signs and symptoms of myelopathy on neurologic examination and at least one active lesion visualized on magnetic resonance examinations performed between 2004 and 2011. We correlated the T2 patterns of lesions with contrast enhancement and calculated sensitivity and specificity in predicting gadolinium enhancement.
Results: Only focal patterns consisting of a lesion’s center homogenously brighter than its periphery on T2-weighed images (type I) correlated significantly with the presence of contrast enhancement (p = 0.004). Sensitivity was 0.307 and specificity 0.929. In contrast, enhancement was not significantly related to uniformly hyperintense T2 focal lesions (type II) or diffuse (type III) pattern defined as poorly delineated areas of multiple small, confluent, subtle hyperintense T2 lesions (p >0.5 for both).
Conclusions: We believe that information about the activity of multiple sclerosis spinal cord lesions in patients with myelopathy may be extracted not only from contrast enhanced, but also from non-enhanced magnetic resonance images.

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Heterozygous Beta-thalassemia, a Genetic Haemolytic Anaemia in Continuous Expansion

DOI: 10.2478/amma-2013-0036

Introduction: Heterozygous β-thalassemia represents the mild form of the β-thalassemic syndromes, being compatible with normal lifetime. The importance of β-thalassemia consists in the fact that it maintains the “defective gene” in the population, favoring the appearance of new cases of Cooley’s anaemia, the severe form of β-thalassemic syndromes. Current data estimate that 7% of the world’s population is bearing β-thalassemia, over 400,000 children with β-thalassemia being born annually, therefore the WHO estimates the doubling of this figure in the coming years.
Material and methods: We carried out a retrospective clinical study of over 450 cases diagnosed with β-thalassemia in the Dolj, Constanța and Vâlcea counties, along a period of 10 years (2001–2010), out of which we analyzed the family tree of 10 cases throughout 3–4 generations, starting from the cases of children diagnosed with β-thalassemia.
Results: The number of heterozygous subjects that emerged over 3–4 generations was of 60 cases with β-thalassemia and 9 cases with Cooley’s anaemia. Thus, starting from the 10 cases of β-thalassemic married subjects (great grandfathers/great grandmothers, grandfathers/grandmothers) along 3–4 generations (over a period of 70–80 years) the number of new β-thalassemia cases was 5.4 times higher.
Conclusions: According to our results, the last generation of the studied children and adolescents shows the presence of a total of 18 subjects with β-thalassemia, suggesting the increasing amount of heterozygotes in the population.

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Pulmonary Tuberculosis Wheezing in Early Childhood

DOI: 10.2478/amma-2013-0035

Background: Primary pulmonary tuberculosis in children and infants can be suggested by the presence of a wheezing, often interpreted as acute bronchiolitis or asthma. The objective of this study is to assess the frequency and mechanism of wheezing in infants and toddlers with tuberculosis and to assess its value as an alarm symptom in children from areas where tuberculosis incidence is high.
Material and method: We carried out a retrospective study in the Pediatric Clinic of the ”Filantropia” Municipal Hospital Clinic of Craiova between 2007–2011. We studied 25 children and infants, who at hospitalization presented signs like: wheezing, cough and dyspnoea.
Results: There were 25 children and infants diagnosed with primary tuberculosis. Twenty-one cases (84%) came from rural areas and 56% (14 cases) occurred in infants. Out of the 25 cases, 22 (88%) presented wheezing, 18 (72%) were accompanied by dyspnoea and 16 patients (64%) presented cough. The majority of cases (16 out of 25, representing 64%) came from families in which a tuberculosis focus was identified during the epidemiological investigation.
Conclusions: The positive epidemiological research, together with other data provided by the clinical, laboratory analyses and the collaboration with other specialties determine the classification of wheezing as a symptom within tuberculosis.

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A Retrospective Longitudinal Study Regarding the Dental Anomalies of Position with Eruptive Etiology

DOI: 10.2478/amma-2013-0034

Objective: Given the high frequency of dental anomalies of position and the lack of preventive measures of surveillance and monitoring of the eruption of permanent teeth, the aim of this study is to evaluate the frequency of dental anomalies of position in children.
Material and methods: We conducted a retrospective longitudinal study in the 2006–2012 period. Data were collected from the medical records and orthopantomography x-rays of 408 patients (230 female and 178 male) who presented to the Pedodontics-Orthodontics Clinic in Tîrgu Mureş. After applying the exclusion criteria, 77 patients remained in the study.
Results: From the 77 patients, 57 had dental inclusions, 15 presented ectopic teeth, dental rotations have been observed in 2 patients, and midline diastema in 5 patients. Regarding sex distribution, there was a higher frequency of dental inclusions in women (39) than men (38). The frequency of dental inclusions, regarding dental groups, in a descending order was: maxillary canine, mandibular second premolar, mandibular canine, maxillary second premolar, mandibular first premolar, maxillary first premolar, maxillary lateral incisor, maxillary central incisor and maxillary and mandibular first molars. The frequency of dental inclusions in the dental support area had the highest rate in the 12–14 years age group.
Conclusions: From all the studied dental anomalies, dental inclusions presented the highest frequency. Regarding the dental support area, most cases of dental inclusion were observed in the 12–14 years age group.

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Particularities of Sleep Habits in School Children from Tîrgu Mureș

DOI: 10.2478/amma-2013-0033

Introduction: The international literature gives us very variable data regarding sleep disorders and the complaints related to this pathology. However, interpreting these data is difficult because of the ethnical and cultural differences and the numerous possibilities of the assessments. In this paper the authors examined and evaluated the main parameters which characterize the sleep habits of a group of children in Romania, as well as the complaints related to it, which could influence the quality of sleeping.
Material and method: Distributing questionnaires amongst children in Tîrgu Mureș. We used different questionnaires, based on the Epworth and Conner’s scores, for children between 11–14 and 15–18 years and for their parents.
Results: The gender ratio was approximately equal, the height and weight of the children was within the framework of Romanian standards. The most frequent nocturnal complaints were: problems with falling asleep, agitation, awakenings during the night. The most frequent daytime complaints: fatigue when in school, difficulty waking up in the morning and mood swings. The results showed significant differences between weekday sleeping hours and weekend sleep time (p = 0.0022).
Conclusion: Sleep habits change with age, which is a physiological effect. Other factors that modify sleeping habits in a negative way and reduce the time spent sleeping, play a crucial role in the occurrence of persistent fatigue, reduced quality school performance and even of a depraved life quality.

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The Therapeutic Management of Retroperitoneal Injuries

DOI: 10.2478/amma-2013-0032

Background: In the retro peritoneum different organs of various origins (vascular, nervous, muscular, fascia, etc.) are located. These represent the source of different surgical conditions that cause, even today, serious problems of early diagnosis and treatment.
Material and method: We have conducted a retrospective study throughout a period of 8 years (2004–2011). We followed the incidence, the treatment and the evolution of several types of retroperitoneal lesions.
Results: In this period 79 cases of retroperitoneal conditions were encountered, representing 0.51% from the total of 15,284 patients admitted and treated within our clinic. The most common cases were those of tumour conditions and retroperitoneal primitive tumours (RPT). Many inflammatory conditions were also encountered. There were a few cases of retroperitoneal overflows or of parasitic diseases and we did not encounter cases of retroperitoneal fibrosis or malacoplaky.
Conclusions: In our study the majority of the retroperitoneal conditions were of tumour nature, especially malignant RPTs. Secondary retroperitoneal tumours (adenopathies, metastases, relapses) were less frequent. The excision of the retroperitoneal tumours is delicate, especially due to the vascular factor caused by anatomical conditions and their own vascularisation. On well-chosen cases we can use minimally invasive surgical techniques (laparoscope, punctures and eco-guided drainages), which enable a favorable post-operative evolution.

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The Incidence and Risk of Inducing Hyperthyroidism Following Amiodarone Treatment

DOI: 10.2478/amma-2013-0031

Introduction: Amiodarone, a frequently used antiarrhythmic drug in cardiology, is very efficient in the treatment of ventricular and supraventricular tachiarrithmyas. The iodine content of amiodarone is 39%. Its chemical structure is similar to tyrosine. It is estimated that 1–23% of patients treated with amiodarone can develop hyperthyroidism. The purpose of this study is to assess and monitor the incidence of hyperthyroidism induced by amiodarone in patients admitted for various types of cardiac dysrhythmias, considering that most of the patients included in the study came from an endemic goitre area.
Material and method: One-hundred patients chosen systematically (62 men, 38 women) from 560 patients treated with amiodarone in the January 1st, 2009 – December 31, 2009 period were assessed (clinically, laboratory findings and imaging studies); their mean age was 64 years (range 50–70 years). In order to identify and diagnose hyperthyroidism, a questionnaire (Newcastle index) was used, also urinary iodine dosage, hormonal dosages (T3, T4, TSH) and thyroid imaging (ultrasound, radioactive iodine uptake test) were used.
Results: The incidence of hyperthyroidism induced by amiodarone in this study was 8%. Hyperthyroidism was more frequent in women (6 women vs. 2 men).
Conclusions: Thyroid hormonal levels have to be determined and a clinical or thyroid ultrasound examination should be made prior to initiating a treatment with amiodarone. At the end of the study, 8 patients, most of them female, were diagnosed with hyperthyroidism.

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