Category Archives: AMM 2014, Volume 60, Number 3

Anatomical and Surgical Basis for Adult Living Donor Liver Transplantation with the Right Liver Lobe

DOI: 10.2478/amma-2014-0028

Liver transplantation is now a standard procedure for the treatment of end stage liver diseases. Since 1968 until 2012, a number of 113,627 liver transplantations were performed in Europe, in 28 countries and 153 institutions. Despite these impressive figures the waiting list is growing every year. Transplant surgeons were preoccupied to find new ways to increase the donor pool. Among them: reduced size liver transplantation, split liver technique and more recently living donor liver transplantation. At first in the early `90, living donor liver transplantation was used for pediatric patients because the left lateral hepatic segments were harvested. This graft is too small for the metabolic demands of an adult patient. So the next step was the harvesting of the right liver lobe from the donor and transplantation to adult patients. Living donor liver transplantation has gained fast a wide acceptance but there are a few issues to discuss. The main concern is about the donor safety which is a healthy person undergoing major surgery with potential risks. Also the surgical technique evolved due to a better understanding of the anatomy and physiology of the liver and the right liver graft. We discuss here the anatomical and surgical basis for living donor liver transplantation with the right liver lobe.

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Fanconi Anemia — Case Report of Rare Aplastic Anemia at Child

DOI: 10.2478/amma-2014-0027

Introduction: Fanconi anemia is an autosomal recessive disease characterized by congenital abnormalities, defective haematopoiesis, and a high risk of developing acute myeloid leukaemia, myelodysplastic syndrome and cancers. FA was first described in 1927 by the Swiss pediatrician Guido Fanconi. The diagnosis is based on morphological abnormalities, hematologic abnormalities (pancytopenia, macrocytic anemia and progressive bone marrow failure) and genetic tests (cariograma).
Case report: We present the case of a child with Fanconi anemia. Although skin and bone morphological abnormalities were present from birth, diagnosis was suspected at 11 years old.
Conclusions: Fanconi anemia is a heterogeneous condition that can present a variety of congenital defects but invariably results in defective haemopoiesis, which is the major cause of morbidity and mortality.

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The Oscar Ramirez Procedure, a Solution for Treating Incisional Hernias with Big Abdominal Wall Defect

DOI: 10.2478/amma-2014-0026

Background: Incisional hernias are important complications of abdominal surgery. Normally they are followed by the growth of the hernia sac and an increase of the abdominal wall defect with loss of domain of the herniated organs.
Case report: We report a case of a 51 year old female, admitted in the 1st Surgical Clinic of the County Emergency Clinical Hospital of Tîrgu Mureș with a large median reducible incisional hernia and a wall defect of 10/12 cm. The abdominoplasty was performed using the Oscar Ramirez technique, which consists of a longitudinal incision along the aponeurosis of the external oblique muscle, at approximately 1–2 cm from the external edge of the rectus abdominis. This procedure allows the abdominal wall closure. This case is part of a lot of 4 patients who received this treatment using the aforementioned procedure in the past 2 months. Postoperative recovery was favorable, bowel movements were present on the second day after the surgery, the subcutaneous drains were shortened on the fifth day and removed on the sixth. There were no immediate postoperative complications or up to a month after the surgery. The patient was discharged on the seventh day.
Conclusions: This technique can be used alone in case of large abdominal wall defects, or prequeling an on-lay mesh procedure addressed to a weak abdominal wall, case in which the functional result is superior to a substitutional mesh.

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The Role of Antibiotic Prophylaxis in the Ureteroscopy Treatment for Ureteral Lithiasis

DOI: 10.2478/amma-2014-0025

Introduction: One of the most common pathologies in urological praxis is urinary lithiasis. Extracorporeal shock wave lithotripsy (ESWL) or frequently retrograde ureteroscopy are modern pathways in the treatment of this kind of pathology. There are certain problems which may develop after the ureteroscopy such as infection with fever complication.
Material and method: This retrospective study evaluates 164 patients who underwent ureteroscopy treatment over a period of two years (2011–2012). We compared the infection complication episode (with fever) in 33 (20.12%) patients with antibiotic prophylaxis (group A) versus 131 (79.87%) patients without prophylaxis (group B). Antibiotics used for prophylaxis were: amoxicilinum and clavulanic acid, generation I and II cephalosporines.
Results: Twenty-four (14.63%) patients presented postsurgical fever. Most febrile patients were those with grade II hydronephrosis – 16 (66.66%), of which 2 (6.06%) patients from group A and 14 (10.68%) from group B. From group A, 3 (12%) patients with stones below 10 mm had fever, while 18 (14.87%) from group B developed this complication. Among the patients with stones’ size over 10 mm, 1 (14.28) patient from group A and 2 (25%) patients from group B had fever.
Conclusions: Patients undergoing the ureteroscopy treatment should be investigated before the procedures for the presence of bacteria in order to avoid complications like infection associated with fever. Antibiotic prophylaxis may reduce the incidence of postoperative infection in the ureteroscopy treatment.

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Intra-operator Reliability of a 2D Image Analysing Method for Tooth Dimension Measurements

DOI: 10.2478/amma-2014-0024

Objective: The aim of this study was to evaluate the intra-operator reliability of a 2D image analysis method for tooth dimension measurements.
Methods: Occlusal and vestibular surfaces of teeth from ten study models were captured with a digital camera. Images were transferred on a computer and different tooth dimensions (mesio-distal, occluso-gingival, vestibulo-oral and perimeter) were measured using the Image Pro Insight software. Measurements were repeated after two weeks. Fleiss’ coefficients of reliability were calculated.
Results: A high degree of reliability has been established for every type of measurement: all coefficient values of reliability being not less than 0.95.
Conclusions: The 2D image analyzing system is an adequate alternative for measuring tooth dimensions. All measurements were in the excellent category of reliability. The method allows precise and repeatable measurements, generating an image database as well, available for future studies.

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Development of a Capillary Electrophoresis Method for the Separation of Fluoroquinolone Derivatives in Acidic Background Electrolyte

DOI: 10.2478/amma-2014-0023

Introduction: Antibacterial quinolones class comprises a series of synthetic antibacterial agents, following the model of nalidixic acid. Because of their common 6-fluorosubtituent on the quinolone ring, fluroquinolones are the most potent analogues with extended spectrum of activity and great pharmacokinetic properties. The applicability of capillary zone electrophoresis for the separation of fluoroquinolones in acidic background electrolyte has been studied, our aim being the development of a capillary zone electrophoresis method for the simultaneous separation of six fluoroquinolones and also to optimize the analytical conditions. The six studied fluoroquinolones were ciprofloxacin, enoxacin, enrofloxacin, moxifloxacin, ofloxacin and sarafloxacin.
Material and methods: Preliminary, we studied the electrophoretic behavior of six fluoroquinolones in an acidic pH, which highlighted the possibility of developing a separation method in this area of pH. Electrophoretic parameters influencing separation performance
were studied and optimized.
Results: A fast and reliable method has been developed, using a background electrolyte containing 100 mM phosphoric acid and the following conditions: applied voltage: + 25 kV, temperature: 20°C, injection pressure 30 mbar – 5 sec, UV detection at 280 nm, capillary: 60 cm (52 cm effective length) x 50 μm, analyte concentration: 167 μg/ml. The separation of the studied fluoroquinolones was achieved in less than 8 minutes.
Conclusions: Capillary zone electrophoresis using an acidic background electrolyte proved to be an efficient tool in the separation of fluoroquinolones from different generations. Also the proposed methods are particular environment-friendly replacement and improvement of a common high performance liquid chromatography determination with rapid analysis time without using any organic solvents.


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Treatment Evaluation with Mometasone Furoate, Alone or in Combination with Desloratadine/Montelukast in Moderate Severe Allergic Rhinitis

DOI: 10.2478/amma-2014-0022

Introduction: Allergic rhinitis is one of the most common allergic diseases, characterized by the inflammation of the nasal mucosa. Eosinophils play a predominant pro-inflammatory role in allergic inflammation. This study assesses the effect of mometasone furoate alone or in combination with desloratadine/montelukast in patients with moderate-severe allergic rhinitis.
Material and method: This is a prospective study that took place over 8 weeks on 70 patients diagnosed with moderate-severe allergic rhinitis with sensitization to the pollen of Ambrosia elatior. The patients were evaluated on the basis of their symptoms using the total score of nasal symptoms, the score of individual nasal symptoms and the number of eosinophils in the nasal secretion.
Results: All 3 groups of patients had an improvement on the total nasal symptoms score. However, the combination of mometasone furoate with desloratadine provided statistically significant benefits on the total score of symptoms and on nasal itching as compared with mometasone furoate alone.
Conclusions: The association of mometasone furoate with desloratadine should be considered first-line treatment of moderate-severe allergic rhinitis due to the benefit both on the total symptom score and on of nasal itching.

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Correlation of Serum and Synovial Osteocalcin, Osteoprotegerin and Tumor Necrosis Factor-Alpha with the Disease Severity Score in Knee Osteoarthritis

DOI: 10.2478/amma-2014-0021

Objectives: Study of circulating and synovial levels of osteocalcin, osteoprotegerin and tumor necrosis factor-alpha (TNF-α) in patients with different stages of knee osteoarthritis and correlation analysis of these parameters with disease severity.
Methods: We enrolled 20 patients with different stages of knee osteoarthritis. The IKDC score (International Knee Documentation Comittee, 2000) was determined for each patient. Based on these data patients were divided into two groups: group I (advanced osteoarthritis) and group II (early osteoarthritis). Serum and synovial fluid levels of osteocalcin, osteoprotegerin, TNF-α were determined.
Results: For the entire group the level of osteocalcin in the serum showed higher values than in the synovial fluid. We found statistically significant differences in the serum levels of osteocalcin between the two groups (group I: 2.18 ± 0.54 ng/ml, group II: 6.07 ± 1.98 ng/ml, p = 0.019). Serum and synovial osteocalcin in the whole study lot could not be correlated with the disease score, however we observed a tendency towards significant negative correlation between the serum osteocalcin and IKDC score for group I and between synovial osteocalcin and IKDC score in group II. In the entire group, synovial osteoprotegerin concentration was six times higher than the serum osteoprotegerin level (p <0.0001) and TNF-α showed higher circulating levels than local concentrations.
Conclusions: In the advanced osteoarthritis group the serum and synovial osteocalcin show lower values than in the early osteoarthritis group, which means that as the disease progresses, bone anabolism decreases. In the case of osteoprotegerin, no significant difference between the two groups was detected.

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The Loss of Correction in Thoracolumbar Burst Fracture Treated by Surgery. Can We Predict It?

DOI: 10.2478/amma-2014-0020

Objective: This paper aims to differentially depict potential patterns of the loss of correction in surgically treated thoraco-lumbar burst fractures. These may eventually serve to foreseeing and even forestalling loss of correction.
Methods: The study focused on 253 patients with surgically treated thoraco-lumbar fractures. This cohort of patients was clustered in four subgroups according to the fracture spine segment (T11–L1 or L1–L2) and surgery type (short segment fixation or anterior approach). Relevant recorded and processed data were the fracture level, post-operative (Kpo) and last follow-up (Kf) kyphosis angle values. Correlation, regression and determination testing were performed for the last follow-up kyphosis angle and post-operative kyphosis angle, and regression equations were determined for each subgroup of patients.
Results: The patterns of loss of correction were described through the following equations: Kf = 0.95*Kpo + 3.2° for the T11–L1 level fractured vertebrae treated by posterior short segment fixation; Kf = 0.98*Kpo + 3.4° for the L1–L2 level fractured vertebrae treated by posterior short segment fixation; Kf = 1.1*Kpo + 1.6° for the T11–L1 level fractured vertebrae treated by anterior approach; and Kf = 0.7*Kpo + 2.8° for the L1–L2 level fracture vertebrae treated by anterior approach.
Conclusions: The loss of correction may be predicted, to a certain extent, for thoraco-lumbar fractured vertebrae treated surgically. The best-fit equations depicted for both type of surgery (short segment fixation and anterior approach) and both spinal segments (T11–L1 and L2–L3) are significantly different than the equations delineated for the collapse of non-surgically treated fractures.

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Evaluation of Inflammatory Markers in Pregnant Women at Risk, for the Prediction of Preeclampsia

DOI: 10.2478/amma-2014-0019

Introduction: A low degree of inflammation has been associated with complications in pregnancies, including preeclampsia (PE). The aim of our study was to determine the serum values of high sensitivity C Reactive Protein (hs-CRP) and Interleukin-6 (IL-6) in the first and second trimesters of pregnancy in pregnant women with risk factors for the development of PE, and to evaluate their relevance for the prediction of this disorder.
Material and methods: We performed a prospective longitudinal study on 120 pregnant women, who were divided based on the pregnancy evolution, into two groups: group I – 26 pregnant women who developed preeclampsia and group II – 94 pregnant women with physiological evolution of pregnancy.
Results: Our study has shown an increase in serum levels of hs-CRP and IL-6 in the first and second trimester of pregnancy in patients from group I, significant values being revealed only in the second trimester of pregnancy. The predictive power of the selected inflammatory markers was significant only for values of hs-CRP in the second trimester of pregnancy, while the association with IL-6 increased the prediction.
Conclusions: Increased values of hs-CRP and IL-6 in the second trimester of pregnancy are associated with higher risk for preeclampsia, however the study provided only a modest efficiency of the prediction capacity.

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