Category Archives: AMM 2013, Volume 59, Number 5

Correlations Between Regional Accumulation of Calcium in the Culprit Arteries and Plaque Burden in Acute Coronary Syndromes

Jakó Beáta1, Benedek Theodora2, Suciu Zsuzsanna2, Benedek I2

1 Clinic of Cardiology, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
2 Clinic of Cardiology, Discipline of Internal Medicine 6, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2013-0063

Introduction: The association between a high calcium score at the level of the unstable coronary lesions and the different characteristic of culprit lesions which result in an acute coronary syndrome (ACS) has not been described yet. We aimed to study the correlation between the accumulation of calcium within the vessel wall of a coronary artery and the plaque burden of culprit lesions that develop an acute coronary event.
Material and methods: A total of 45 patients with ACS (22 unstable angina, 23 nonST elevation myocardial infarction) underwent 64-slice CCTA. In all patients a complex CT analysis of the culprit plaques was performed and the calcium score for each coronary artery was computed.
Results: We found a significant correlation between a calcium score higher than 100 and the plaque volume (r = 0.85. p = 0.01). Selecting a cut-off value of 100 HU for regional calcium score at the level of the coronary artery, we found that those arteries with Ca score higher than 100 presented significantly larger plaque volumes than the ones with calcium score below 100 (110.8 ml vs 82.4 ml, p <0.0001 for left anterior descending artery, 111.09 ml vs 82.5 ml, p = 0.0005 for circumflex artery, and 132.78 ml vs 76.23 ml for right coronary artery).
Conclusion: Our data shows that in ACS, the severity of the culprit lesions correlates with regional accumulation of calcium within the vessel wall.

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Correlations Between Severity of Coronary Calcification and Impairment of Left Ventricular Ejection Fraction

Suciu Zsuzsanna1, Benedek Theodora1, Jakó Beáta2, Benedek I1

1 Clinic of Cardiology, Discipline of Internal Medicine 6, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Clinic of Cardiology, County Emergency Clinical Hospital, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2013-0062

Introduction: 64 multislice CT angiography is a recently introduced imaging technique, increasingly being used as a tool to show the coronary arteries in three-dimensional visualization. One of the advantages of this method is the ability to estimate the degree of calcification of atheromatous plaques via coronary calcium score calculation, which correlates with the severity score of ateromatous systemic burden. The aim of this study was to evaluate the relationship between the severity of coronary calcification, expressed by calcium score, and the left ventricular ejection fraction (LVEF).
Material and methods: This retrospective study included 81 patients with symptoms of angina and ECG modifications (at rest or during exercise). Echocardiography and 64 multislice CT angiography were performed in all patients to assess the LVEF and Ca scoring.
Results: Calcium score was lower than 100 in 62 patients (50.22%), between 100 and 400 in 11 patients (8.91%), and higher than 400 in 8 patients (6.48%). Mean LVEF was 53.52%, 17 patients having an LVEF of less than 50%. In patients with calcium score less than 100, the corresponding ejection fraction was normal: 55.29%, while in coronary arteries with extensive calcifications (calcium score > 400), the LVEF was significantly lower, 50.5% (p = 0.004).
Conclusions: High Calcium score is positively correlated with LVEF reduction, and a high value for calcium score indicates an increased probability of reduced left ventricular ejection fraction.

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Evaluation of Child Self-perception Regarding Their Oro-dental Status

Mártha I. Krisztina1, Roşu Sorana2, Gyergyay Réka3, Vikárius Katalin4

1 Department of Pediatric Dentistry and Orthodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 PhD student, ”Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania
3 PhD student, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
4 Student, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

DOI: 10.2478/amma-2013-0061

Aim: The aim of this study was to evaluate the state of oral health and the self-perception of children regarding their oro-dental status, their knowledge and attitude towards oral health.
Methods: A sample of 130 children (11–14 years) and one of their parents were asked to complete a Child Perception Questionnaire (CPQ11-14) in Sfântu Gheorghe, Romania. From these, 69 children were examined and data was recorded about Decayed-Missing-Filled Teeth (DMFT), oral hygiene, dental malposition and malocclusion, Aesthetic Component of Index of Treatment Need (AC-IOTN). Consent of the parents was obtained. Statistical analyses were performed.
Results: The optimal score of CPQ evaluation is 96 and the maximum score achieved was 93, the minimum was 43. 78.10 average score can be graded as medium. As the data points out, most of the children and their parents have a medium knowledge and self-perception. The clinical examination underline the main problems: dental caries (62%), occlusal coloration (23%), dental malposition (17%), rooftop deep bite (14%), dental rotation and crowding (12%), dental plaque and tartar (10%). As far as the AC-IOTN is concerned, 48 of 69 children have no need for treatment, 18 have a high need for treatment, and 3 have a moderate need for treatment.
Conclusions: Overall, the children and their parents have a poor oral health knowledge, which is reflected in the medium level of the achieved CPQ scores, in the clinical examination and can be associated with high levels of dental caries and malocclusion.

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The Role of Liver Transplantation in the Treatment of Hepatocellular Carcinoma – a Single Center Experience from Budapest

Piros L, Görög D, Fehérvári I, Nemes B, Langer R, Kóbori L

Department of Transplantation and Surgery, Faculty of Medicine, Semmelweis University, Budapest, Hungary

DOI: 10.2478/amma-2013-0060

Background: Liver transplantation for hepatic tumours is known as a proven treatment opportunity. The outcome has improved over the past decades because of the appropriate recipient selection.
Materials and methods: In a single-institution study of 29 consecutive adult patients underwent orthotopic liver transplantation (OLT) between 1 January 2004 and 1 January 2011 in the Semmelweis University, Budapest with the indication of hepatocellular carcinoma (HCC).
Results: The 1-year survival was 85.7% and the 3-year survival was 71.7%.
Conclusions: Further investigations are needed on the field of histological and biological attributes of the hepatocellular carcinoma. Our aim is to find a better and individualized immunosuppressive protocol, which is also protective against malignant tumours.

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Assessing the Patient with Abdominal Obesity: Metabolic and Nutritional Factors

Pop Raluca1,2, Pop M1,3, Dogaru G4,5

1 PhD Student, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Endocrinology Outpatient Clinic, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
3 Radiology Department, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
4 Internal Medicine Department, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
5 Nephrology Department, County Emergency Clinical Hospital, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2013-0059

Background: Abdominal obesity is a confirmed cardio-vascular risk factor and the elements influencing it are subject for research and intervention. The available nutritional evaluation methods are time consuming, subjective and a standardized approach is missing.
Aim: Standardized evaluation of patients with abdominal obesity.
Material and methods: Cross-sectional study on a convenience sample of 85 subjects who presented in the Endocrinology Outpatient Clinic of the Emergency Mures County Hospital between February – April 2013. Variables: age, sex, environment, BMI, waist, blood glucose, triglycerides, HDL-Cholesterol, blood pressure. Each patient filled a food frequency questionnaire.
Results: None of the subjects had a “normal” food pyramid. Sex has no influence on the food pyramid. The meat and protein food group is the only one significantly influenced by the environment (p = 0.04). Patients with dyslipidemia consume lower amounts of sweets (1.13 vs. 1.83 servings, p = 0.007). Patients requiring metabolic treatment have significant higher waist values (101.32 vs. 93.07 cm, p=0.03). Patients with simple abdominal obesity consume significant lower amounts of meat and protein and higher amounts of fruit and vegetables.
Conclusions: A standardized approach to the patient with abdominal obesity using nutritional assessment tools and metabolic evaluation helps to identify those at risk and to give more tailored recommendations.

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Using Abdominal CT Data for Visceral Fat Evaluation

Pop M1,2, Pop Raluca1,3

1 PhD Student, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Radiology Department, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
3 Endocrinology Outpatient Clinic, County Emergency Clinical Hospital, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2013-0058

Background: Quantitative assessment of body fat is important for the diagnosis and treatment of diseases related to obesity, Computed tomography (CT) becoming the standard procedure for measuring the abdominal fat distribution.
Material and method: The retrospective study included 111 inpatients, who underwent routine abdominal CT exams in the Radiology Laboratory of SCJU Tg.Mures (2013). MPR MDCT (SOMATOM AS 64) data was processed using a custom written MATLAB R2009b software, ImageJ being used for tracing of the visceral fat area (VFA). Patient data (including blood glucose, cholesterol and triglycerides) were analyzed using MO Excel and GraphPad Inprism5.
Results: Visceral Fat percentage varied in population from 14.59–68.69 (SD = 11.83) with significant difference between sexes (male vs. female, 46.98 vs. 31.62, p <0.05). Cholesterol values >220 mg% and triglycerides >150 mg% are significantly associated with the VF percent (p <0.05). Overall there is a weak correlation between the lab variables and the measured fat, the strongest one being between triglycerides and the VFA (r = +0.23) and between age and VFA percentage (certain samples).
Conclusions: The technique used should decreases the human error in marking of the fat areas providing a better estimation of the VF/VF percentage. CT measured VF relates with certain lab tests. Further analysis, is required for a better use of CT in obesity related pathology diagnosis and treatment.

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Phytotoxicity Assessment of Certain Phytochemical Products Containing Pyrrolizidine Alkaloids

Şeremet Oana Cristina1, Olaru OT2, Ilie Mihaela3, Negreş Simona1, Bălălău D3

1 Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
2 Department of Botany and Cellular Biology, Faculty of Pharmacy, ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
3 Department of Toxicology, Faculty of Pharmacy, ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

DOI: 10.2478/amma-2013-0057

Introduction: Tussilago farfara (coltsfoot), Petasites hybridus (common butterbur), Senecio vernalis (eastern groundsel) and Symphytum officinale (comfrey) are species traditionally used in phytotherapy that besides the therapeutic compounds contain toxic pyrrolizidine alkaloids (PAs). The aim of the paper is to determine the total PAs content and the phytotoxicity of the above species.
Material and methods: The quantitative determination of pyrrolizidine alkaloids is based on the stoichiometric reaction of protonated alkaloids with methyl orange. In acidic conditions the dye is released from the complex and its color is assessed spectrophotometrically using a linear regression curve of senecionine as a standard. The phytotoxicity was assessed by Triticum bioassay that studies the effect of the extracts (0.001–5.00%, w/v) upon root elongation (inhibitory concentration – IC50) and on the karyokinetic film.
Results: The highest amount of total PAs was found in Senecio vernalis (654.8 ± 35.96 μg/g dry plant) and the lowest in Petasites hybridus. The lowest IC50 was found for Tussilago farfara followed by Petasites hybridus, Senecio vernalis, and Symphytum officinale. The results were supported by microscopic examination.
Conclusions: The results of the spectrophotometric assay are consistent with the ones found in the literature. All extracts inhibited the elongation of the main root of wheat caryopses, however, no correlation between phytotoxicity and the PAs concentration could be emphasized.

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Quantitative Determination of Arsenic in Bottled Drinking Water Using Atomic Absorption Spectroscopy

Guţu Claudia Maria, Bălălău D, Ilie Mihaela, Purdel Carmen Nicoleta, Gubandru Miriana

Department of Toxicology, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

DOI: 10.2478/amma-2013-0056

Background: Many studies have been performed in the past few years, to determine arsenic speciation in drinking water, food chain and environment, arsenic being a well-recognized carcinogenic and toxic agent mainly in its inorganic species. The instrumental techniques used for arsenic determination, such as hydride generation atomic absorption spectrometry (HGAAS), graphite furnace atomic absorption spectrometry (GFAAS) and inductively coupled plasma mass spectrometry (ICP-MS), can provide a great sensitivity only on the total amount.
Objective: The aim of this study was to develop a simple and rapid method and to analyze the concentration of total inorganic arsenic in bottled drinking water.
Methods: Total arsenic was determined in samples from six different types of commercially available bottled drinking water using atomic absorption spectrometry with electrothermal or hydride generation vaporisation. All drinking water samples were acidified with 0.1M nitric acid to match the acidity of the standards.
Results: The method was linear within the studied range (1–5 μg/L, R = 0.9943). The quantification limits for arsenic determination were 0.48 μg/L (HGAAS) and 0.03 μg/L (GFAAS). The evaluated arsenic content in drinking water was within the accepted limits provided by law.
Conclusions: A simple and sensitive method for the quantification of arsenic in drinking water using atomic absorbtion spectroscopy was described, which can be further used in toxicological studies. As an additional advantage, the system is very fast, efficient and environmental friendly.

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Spigelian Port-site Hernia, a Complication after Laparoscopic Cholecystectomy — a Clinical Case Report

Molnar C1, Tîlvescu C1, Neagoe VI1, Butiurca VO1, Molnar CV2, Copotoiu C1

1 Surgery Clinic 1, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
2 Obstetrics-Gynecology Clinic 1, County Emergency Clinical Hospital, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2013-0055

Introduction: Spiegelian hernias are rare entities in abdominal wall pathology (2%). They occur in the semilunar line described by Adriaan van den Spiegel. Klinklosch (1764) defined it as a congenital or acquired defect of the transverse abdominal aponeurosis junction with the Douglas arch. Port-site hernias due to wrong placement of laparoscopic trocars in the right abdominal flank are rare, but possible complications of laparoscopic cholecystectomy.
Case presentation: Our observation shows diagnostic and therapeutic aspects in a patient with port-site Spigelian hernia post laparoscopic cholecystectomy admitted in Surgical Clinic 1, County Emergency Clinical Hospital Tîrgu Mureș in the 28.01.2013 – 30.01.2013 period. Following surgery performed using an open approach, postoperative evolution was favorable, with no signs of recurrence at 9 months postoperatively.
Conclusions: Spigelian port-site hernia post laparoscopic cholecystectomy is a very rare entity, iatrogeny being a certainty in its development.

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The Role of Liver Transplantation in the Treatment of Hepatocellular Carcinoma

Marius Florin Coro

Surgical Clinic 1, County Clinical Hospital, Tîrgu Mureș, Romania

It is known that hepatocellular carcinoma (HCC) is related to different risk factors, primarily represented by infection with hepatitis B or C virus, so in most cases the non-tumoral hepatic tissue is also affected by cirrhosis.
Amongst the therapeutic arsenal of HCC, the liver transplantation (LT) ranks first being the only treatment that offers a complete oncological resection and cure for the underlying liver cirrhosis simultaneously. Studies have shown that patients with LT have a significant better survival compared to those with liver resections [1]. Most patients with cirrhosis have abnormal liver function and are not candidates for resection.
Because there was much controversy regarding guidelines for LT in HCC, an international consensus conference was held in Zurich in 2010 aimed to develop internationally accepted statements and guidelines. The conference report had 37 statements and recommendations [2].[More]

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