Category Archives: AMM 2014, Volume 60, Number 1

Cardiac Computed Tomography Angiography for Imaging Coronary Arteriovenous Malformation: a Case Report

DOI: 10.2478/amma-2014-0006

Background: Coronary arteriovenous malformation is a rare congenital disease consisting mainly in a direct communication between a coronary artery and any one of the four cardiac chambers, coronary sinus, pulmonary arteries or veins. This disease can lead to various cardiovascular events, their severity depending on the degree of the malformation.
Case report: We present the case of a 56-year-old male patient, who was admitted to our institution with dyspnea, palpitation and chest pain, having a history of hypertension and hyperlipidemia, and an abnormal electrocardiogram. Physical examination did not reveal any alterations and the cardiac enzymes were in normal ranges. Cardiac computed tomography was performed before any other invasive studies, with a 64-row scanner (Somatom Sensation multislice 64 equipment, Siemens) after intravenous administration of non-ionic contrast material. CT scan revealed a large (2–2.5 mm) coronary fistula originating from the LAD to the main pulmonary artery, and multiple significant atherosclerotic coronary lesions. Coronary angiography confirmed the arteriovenous malformation between LAD and pulmonary artery, associated with three vascular coronary artery disease.
Conclusions: Cardiac computed tomography angiography can help for a non-invasive diagnosis of the coronary artery malformations, in the same time revealing anatomic details which can be particulary useful for choosing the appropriate management strategy (surgical planning, interventional treatment or optimum medical treatment).

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Therapeutic Option in Patients over 60 Years with Esophageal and Esocardial Cancer

DOI: DOI: 10.2478/amma-2014-0005

Background: Treatment of esophageal and esocardial cancer in patients over 60 years involves a particular management. Considering the comorbidities specific to this category of patients, recent data from the literature indicate an increased incidence of mortality and morbidity following therapy.
Material and method: We retrospectively studied a group of 55 patients admitted to the Surgical Clinic I of the County Emergency Clinical Hospital Tîrgu Mureș, in the January 1st, 2007 – December 31st, 2011 period, diagnosed with esophageal and esocardial cancer. Patients were divided into two groups: group I under the age of 60 years, and group II over this age. Inclusion criteria were age, diagnosis (tumor location), and we followed a series of parameters: demographics, type of surgery, the biological profile of patients, immediate postoperative morbidity and mortality.
Results: No statistically significant differences were observed in terms of demographics: gender (p = 0.78), area of origin (p = 0.69). The number of hospitalization days (p = 0.20) was influenced by the type of surgery, as well as pre- and postoperative comorbidities. Immediate postoperative mortality was 16.56%, the differences between the two groups was not statistically significant (p = 0.58). Parameters with statistical significance were found to be: age (p <0.0001), tumor location, type of surgery (p = 0.0031) and radical versus palliative surgery (p = 0.03).
Conclusions: Therapeutic attitude in patients over 60 years should be correlated with specific particularities to this category. Selection of patients for surgery and type of surgery is dictated by the patient’s condition and quantified by anesthesia and surgery team.

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The Association of Cholelithiasis and Colorectal Cancer

DOI: 10.2478/amma-2014-0004

Background: In the literature there are a number of studies that suggest a possible correlation between cholelithiasis/cholecystectomy and colorectal cancer. The exposure of the colon mucosa to the action of bile acids that potentially have a carcinogenic effect due to the change in anatomy after cholecystectomy, seems to be the explanation of this association. The purpose of this paper was to search for such a correlation in our study group.
Methods: We performed a retrospective cross-sectional study, analyzing the patients admitted to the First Surgical Clinic of the County Emergency Clinical Hospital Tîrgu Mureș, between January 1st, 2005 – December 31st, 2010. Analyzing the medical records, operation protocols and histopathological results, we paid attention to demographics, location of neoplasia, the time elapsed since the cholecystectomy to the discovery of neoplasia, histological types, trying to perform correlations between these parameters and the lithiasic factor.
Results: Out of the 534 patients admitted and operated with the diagnosis of colorectal cancer, 15.6% (n = 83) showed a history of gallbladder stone affection. Most patients came from urban areas, the average age was 67.2 (range 39–88 years), females were more affected. The most common locations were: the sigmoid colon (26.5%), rectum (36.3%) and the most common histological form was moderately differentiated adenocarcinoma.
Conclusions: Similar to other studies, our work suggests a slight increase in the incidence of colorectal cancer in patients that underwent a cholecystectomy, without drawing a firm conclusion. We deem it necessary to see if diet changes of the Romanian population affect this relationship.

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Rectal Cancer — Sphincter Saving Techniques

DOI: 10.2478/amma-2014-0003

Background: Rectal cancer management has as its main component the surgical treatment. The purpose of the paper is to point out the advantages and disadvantages of sphincter saving techniques, respecting the oncological principles.
Material and method: A cross-sectional, retrospective study was performed on a group of 69 patients admitted and surgically treated for rectal cancers in the Surgical Clinic I of the County Emergency Clinical Hospital of Tîrgu Mureș, for a period of one year (April 2012 – April 2013) and to whom rectal resections were performed. We followed the immediate postoperative evolutions in these patients, making a comparative analysis between those with the sphincter saving surgery and those in which other operations were performed.
Results: From the total of 69 patients diagnosed with rectal cancer, sphincter saving procedures with restoration of digestive continuity by coloanal anastomosis were performed in 12 patients (17.39%) using the peranal or transanal approach; in 42 patients (60.86%) anterior recto-sigmoidian resections with low and very low colorectal anastomosis („very low” Dixon procedure) were performed. In 15 cases (21.74%) the Miles type of rectal resections, using the abdomino-perineal way, were performed. Out of the 12 cases with peranal or transanal anastomosis, 4 cases had postoperative complications.
Conclusions: Rectal resection procedures, which are restoring the digestive tract continuity using low anastomosis (colorectal, coloanal, peranal or transanal), are representing viable and „physiological” alternatives, if they respect the oncologic principles. In well selected cases, the immediate postoperative evolution is favorable, relieving the patient from the psychological and physical trauma due to the presence of a colostomy.

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Assessment of Periodontal Status of Surgically Exposed and Orthodontically Aligned Impacted Maxillary Canines

DOI: 10.2478/amma-2014-0002

Aim: The aim of this study was to compare the periodontal status of impacted canines after 5 years following completion of the combined surgical and orthodontic treatment.
Materials and methods: We examined 20 labially impacted canines and 20 palatally impacted canines at 5 years after the end of treatment. We assessed the periodontal status of these teeth.
Results: Different outcomes were found regarding the probing depth and the amount of keratinized gingiva in the two mentioned groups of teeth.
Conclusions: The assessed periodontal indices may signal the appearance of a periodontal disease around the teeth that were surgically and orthodontically treated.

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Anastomotic Leaks after Colorectal Surgery: a Prognostic Score

DOI: 10.2478/amma-2014-0001

Introduction: Anastomotic leaks are one of the most dreaded complications in colorectal surgery. At the ground of this problem remain the nefarious prognostic over the patient’s life, the difficulties in early diagnosis and the optimal choice of therapeutical methods. The goal of our research was to evaluate the significance of possible risk factors in the postoperative evolution of patients following colorectal interventions and to design a prognostic score.
Material and methods: We performed a retrospective study on 298 cases of patients with inflammatory, neoplastic or traumatic lesions for which there was chosen a digestive anastomosis including the colon. The presumed risk factors in our analysis were: age, comorbidity evaluated by Charlson Score, etiology, toxics, use of nonsteroidal anti-inflammatory substances or corticoids, parameters such as leucocytes, hemoglobin, urea, total seric bilirubin, glycaemia, albumins, neoadjuvant therapy, type of suture, quantity of fluids received intraoperatory. All data were analyzed using R-Commander.
Results: All parameters for which we demonstrated a statistical significance (p <0.05) for an unfavorable evolution were included in a prognostic score, designed in correlation with the statistical relation between the factors. We obtained values that certified a strong association (0.75) between a high prognostic score and an increased number of anastomotic leaks.
Conclusions: The practical utility of the score is mainly for the anticipation of postoperative complications. A high level score underlines that prior to surgery it is essential to balance the biochemical abnormalities and to choose properly the moment and type of surgical intervention.

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