Category Archives: AMM 2014, Volume 60, Number 5

Cephalic Duodeno-Pancreatectomy With Pancreatic-Gastric Anastomosis With Double Purse String, in Patient with Lithiasis and Tumoral Jaundice – Case Report

DOI: 10.2478/amma-2014-0047

Introduction: One of the most feared complications after cephalic duodeno-pancreatectomy remains pancreatic fistula. In recent years, various methods of pancreatico-digestive reconstruction were performed in order to reduce the rate of pancreatic fistula. One of these methods is pancreatico-gastric reconstruction by using two purse string threads.
Case report: We present in this article a patient with jaundice with mixed etiology: tumoral and lithiasic. Subjectively, the patient accused sclerose-skin-jaundice, right upper quadrant and epigastric pain, nausea and vomiting. Computed tomography revealed dilatation of intra- and extrahepatic bile ducts, a dilated Wirsung duct and a tumor at the biliopancreatic confluence, leading to a suspicion of vaterian ampulom. Upper endoscopy revealed a tumor protruding in the descending duodenal segment. Intraoperatively a tumor suggestive of vaterian ampulom and duct stones was shown. Surgical treatment consisted of coledocolitotomy, cephalic duodeno-pancreatectomy with pancreatic-gastric anastomosis, performed by using two purse string threads. The postoperative evolution was favorable.
Conclusion: Pancreatico-gastric anastomosis using two purse string threads is a simple, safe and quick procedure, avoiding the application of sutures through the pancreatic parenchyma and thus reducing the rate of pancreatic fistula.

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Surgical treatment of anogenital hemangiomas of infancy

DOI: 10.2478/amma-2014-0046

Introduction Infantile hemangiomas (IHs) are the most common benign tumors of the soft tissue in infants and children and they often represent a serious challenge for the treating physician. Hemangiomas located in the anogenital region represent only about 1% of all IHs, but raise special concerns as they have the propensity to ulcerate. This condition may appear spontaneously, or could result from therapeutic procedures. Ulceration is extremely painful and takes many weeks of conservative therapy to heal.
Material and Methods. The aim of this study is to present the surgical approach of the IHs located in the anogenital area and the outcomes of this treatment option.
Results. During a period of 36 months, 11 children (nine girls, two boys) were referred to our plastic surgery department with hemangiomas involving the anogenital, groin and perineum areas. The average follow-up period was of 8 months, during which 82% of cases experienced complications, especially ulceration. All the target hemangiomas were removed through a lenticular excision and the wound closed with a linear suture.
Conclusions. Our study has shown that surgical excision of a complicated anogenital hemangioma or of a “healthy” hemangioma at high risk for ulceration in the anogenital region is an effective treatment, with fast healing and complete resolution of the pathogenic condition. Lenticular excision and linear closure represent a convenient surgical technique that can be performed as early surgery, during the proliferative stage, or at any time later, when the patient needs treatment, in safety conditions and with good results.

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Meyer’s Loop Anatomy Demonstrated Using Diffusion Tensor MR Imaging and Fiber Tractography at 3T

DOI: 10.2478/amma-2014-0045

Objective: The ultimate anatomy of the Meyer’s loop continues to elude us. Diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) may be able to demonstrate, in vivo, the anatomy of the complex network of white matter fibers surrounding the Meyer’s loop and the optic radiations. This study aims at exploring the anatomy of the Meyer’s loop by using DTI and fiber tractography.
Methods: Ten healthy subjects underwent magnetic resonance imaging (MRI) with DTI at 3 T. Using a region-of-interest (ROI) based diffusion tensor imaging and fiber tracking software (Release 2.6, Achieva, Philips), sequential ROI were placed to reconstruct visual fibers and neighboring projection fibers involved in the formation of Meyer’s loop. The 3-dimensional (3D) reconstructed fibers were visualized by superimposition on 3-planar MRI brain images to enhance their precise anatomical localization and relationship with other anatomical structures.
Results: Several projection fiber including the optic radiation, occipitopontine/parietopontine fibers and posterior thalamic peduncle participated in the formation of Meyer’s loop. Two patterns of angulation of the Meyer’s loop were found.
Conclusions: DTI with DTT provides a complimentary, in vivo, method to study the details of the anatomy of the Meyer’s loop.

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Risk Factors and Diagnosis of Cerebral Venous Thrombosis: Data From a Cohort of 45 Romanian Patients

DOI: 10.2478/amma-2014-0044

Cerebral venous thrombosis (CVT) represents 1% of the total stroke pathology but is a real challenge both regarding the diagnosis and the treatment.
Objective: Evaluate different etiological, demographical, clinical, imaging and therapeutic aspects of CVT.
Material: Prospective study during 4 years. From the total 3658 patients hospitalized with acute stroke, 45 (1.23%) had CVT. For each patient, were recorded: demographic data, symptom of onset, type of onset, daily habits, medical history, neurological examination, brain imaging (CT and MRI with venography). Statistical analysis: data are presented as mean and SD and Student t test was applied.
Results: Mean age was 44.07± 23,12 years; female: male ratio 2.21:1. The most frequent type of onset was acute (77.78%). Headache was found in 80% of cases as initial symptom, followed by neurological focal deficits. As risk factors, thrombophilia was found most often (59.5%), followed by local infections. No risk factors were found in 17.8% of cases. The brain imaging was positive in 29 patients. In 16 cases, the imaging workout was negative and the diagnosis consisted of clinical criteria, risk factors, response to heparin treatment.
Conclusions: CVT is a rare pathology that affects mainly young women and that needs a complex diagnostic evaluation. The patient prototype diagnosed with CVT in our region: female of 44 years old, with an intense acute headache, with MRI showing direct signs of transverse sinus thrombosis, with a thrombophilic state and good response to anticoagulants. Brain MRI is the imaging investigation required but clinical aspects play a decisive role.

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Considerations on Direct Antiviral Agent Therapy in Patients Having Chronic Hepatitis C from Constanta County

DOI: 10.2478/amma-2014-0043

Introduction: Direct-acting antiviral agents (DAA) have a direct action in chronic hepatitis C, their addition to the standard therapy with interferon alfa2 (IFN) and ribavirin (RBV) significantly improving the sustained virologic response (SVR) in this disease.
Objective: The study analyses the results of triple therapy inclduign DAA in terms of tolerability and efficiency.
Material and method: We selected a lot of 24 patients who concluded the DAA administration period, being in the period of finalization of standard therapy at the time of the study. In all the patients clinical and paraclinical assesment was performed including laboratory tests, fibroscan, echography, etc.
Results: The duration of the therapy consisting in association of DAA to the standard treatment was 3 months and led to a remarkable result represented by a high rate of negativation of viremia (83.3%). Among the adverse reactions recorded, the most important were: anemia 17 patients (70.8%), leucopenia 10 patients (41.6%), thrombocitopenia 14 patients (58.3%), hyperbilirubinemia 3 patients (12,5%); hyperuricemia 8 patients (33,3%), hypocalcemia 4 patients (16.6%), loss of weight 4 patients (16,6%), anal pruritus (16,6%); among the 24 patients, 2% did not exhibit any adverse reactions.
Conclusions: Despite of the various adverse reactions recorded, the triple therapy consisting in DAA added to the standard treatment proves its utility, and the high rates of sustained viral reaction justifies its utilization. It is necessary to increase the number of patients who benefit from the advantages of triple therapy, which, after becoming larger available, could become a new standard therapy in patients with viral chronic hepatitis.

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The Behaviour of Composites, Glass Ionomers and Compomers in Erosive Conditions – In Vitro Study

DOI: 10.2478/amma-2014-0042

Objective: The aim of this in vitro study was to evaluate the influence of erosive conditions on the wear resistance of aesthetic direct restorative materials.
Methods: Six dental filling materials were tested: two composites (Filtek Z550 and X-tra fil), two compomers (Dyract Extra and Twinky Star) and two glass ionomers (Ketac Molar and Fuji II LC). Twenty disks (10mm×2mm) of each material were prepared (n=120) and kept in artificial saliva at 37˚C for 24 hours. Specimens were cycled in acidic soft drink (Coca-Cola) 5×/day, for 5’, over 30 days. Initial surface roughness ISR (Ra-μm) and final surface roughness FSR were measured using a profilometer. The wear rate was calculated as difference of final minus the initial roughness (ΔSR=FSR-ISR). For statistical analysis t-test and one-way ANOVA test were used by GraphPad Prism version 5.03 statistical software. The level of significance was set at p<0.05.
Results: The erosive wear rates (mean±SD, µm) after exposure to acidic beverage were: 0.30±0.03 (Ketac Molar), 0.28±0.04 (Fuji II LC), 0.27±0.00 (Filtek Z550), 0.23±0.01 (X-tra fil), 0.20±0.00 (Twinky Star) and 0.14±0.01 Dyract Extra, respectively. There were significant differences between the tested materials (p<0.05).
Conclusions: Dental filling materials had different behaviour under the same erosive condition, however all investigated aesthetic restorative materials showed surface degradation. These findings suggest that erosive wear resistance of tooth coloured restoratives could influence their longevity in intraoral acidic conditions. Acknowledgements: The study was supported by the Internal Research Grant no. 5/30.01.2013 of the University of Medicine and Pharmacy of Tîrgu Mureş.

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Prevalence of Metabolic Syndrome in Psoriatic Arthritis and Rheumatoid Arthritis

DOI: 10.2478/amma-2014-0041

Introduction: The psoriatic patients have an increased number of associated comorbidities. Of these, cardiovascular diseases present the highest incidence and severity. The understanding of the cardiovascular risk in patients with psoriatic arthritis was supported from the rheumatoid arthritis studies that suggested that patients with psoriatic arthritis have a risk of cardiovascular diseases similar to patients presenting rheumatoid arthritis. The presence of the metabolic syndrome further increases the risk of cardiovascular disease. The purpose of this study was to determine the prevalence of metabolic syndrome and its components in two groups of patients: those presenting psoriatic arthritis and those with rheumatoid arthritis.
Material and method: The study included two groups of patients: group one – 40 patients with psoriatic arthritis defined by Moll and Wright criteria, respectively the group two – 51 patients with rheumatoid arthritis defined by American College of Rheumatology (ACR) criteria. The metabolic syndrome was defined according to the consensus definition (incorporating IDF and American Heart Association/National Heart, Lung and Blood Institute -AHA/NHLBI definitions).
Results: We enrolled in the study 91 patients having a mean age of 57.7±10.4SD (54.7±10.2 SD psoriatic arthritis, 60.01±10.0 SD rheumatoid arthritis). The mean disease duration (years) was 4.12±4.1SD for psoriatic arthritis and 6.7±7.8SD for rheumatoid arthritis. The prevalence of the metabolic syndrome was 67.5% in the group with psoriatic arthritis and 37.2% in patients with rheumatoid arthritis. The psoriatic patients had a higher prevalence of impared fasting glucose (52.5% vs 27.4%, p=0.018), and elevated trygliceride values as compared with those presenting rheumatoid arthritis (25% vs 11% p=0.0004).
Conclusions: The prevalence of metabolic syndrome is increased in patients with psoriatic arthritis as compared to patients with rheumatoid arthritis.

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Spatial Memory Deficits in Juvenile Rats With Pilocarpine Induced Temporal Lobe Epilepsy

DOI: 10.2478/amma-2014-0040

One of the most frequent forms of epilepsy in humans is temporal lobe epilepsy. Characteristic to this form of the disease is the frequent pharmacoresistance and the association with behavioural disorders and cognitive impairment. The objective of our study was to establish the degree of cognitive impairment in a rat model of temporal lobe epilepsy after an initial epileptogenic exposure but before of the onset of the effect of long-duration epilepsy.
Methods. For the experiment we used 11 rats. Status epilepticus was induced by systemic administration of a single dose of pilocarpine. The animals were continuously video-monitored to observe the occurrence of spontaneous recurrent seizures; during weeks 9-10 we performed eight-arm radial maze testing in order to assess the cognitive impairment.
Results. Animals developed spontaneous recurrent seizures after a 14-21 day latency with a daily average seizure density of 0.79±0.43 during weeks 9-10. Epileptic rats had significantly more working memory errors per session, more reference memory errors and the number of visited arms was also significantly higher. Accuracy was also lower in the pilocarpine treated group. Interestingly significant differences disappeared after six days of trials.
Conclusions. Our study shows behavioural deficits occurring after 9-10 weeks of epilepsy in the pilocarpine model of epilepsy applied to juvenile rats. In contrast to previous studies, we showed that juvenile rats with short duration of epilepsy are able to learn the behavioural task, therefore a morphopathological and/or behavioural “no-return point” regarding the development of severe cognitive impairment is not reached by status epilepticus alone.

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Romanian Young People’s Drinking Habits

DOI: 10.2478/amma-2014-0039

Objective: Alcohol use can cause social problems. Beside alcoholism the “binge drinking” and the “pre-drinking” could be a harmful form of alcohol use based on scientific literature data. In this study the alcohol use behaviors and associated problems were evaluated among young people aged between 14-30 years.
Methods: The study was carried out using a self reporting questionnaire, containing the Alcohol Use Disorders Identification Test (AUDIT) developed by World Health Organization and 10 more questions. This questionnaire was created in two languages (Romanian, Hungarian) and uploaded to the on-line survey page ( The link was shared at different Facebook groups.
Results: The questionnaire was completed by 933 young people. There was a predominance of females (66.99%) and the participant’s average age was 22.12 years (±2.78). The results show that males’ relative risk (RR) for alcoholism is 7.18 (CI95%, 3.47-14.85). Majority (539; 57.77%) of the participants had at least one time binge drinking, from this 36.66% were occasionally binge drinkers and 21.11% were regular binge drinkers. More males binge drinkers were found then females (RR: 1.72; CI95%, 1.55-1.90). The people who participate in pre-drinking have RR of 2.14 (CI95%, 1.89-2.41) for binge drinking. The binge drinkers have RR of 2.58 (CI95%, 1.78-3.37) for drunk driving.
Conclusions: Binge drinking is a really common habit among young people. Measures to reduce the risk or prevent the harmful consequences of this habit should be employed.

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Tradition in Competition to Food Safety, or “Archaic Science” against Brand Name Products

Traditionally, the homemade beverages or concentrated alcoholic drinks are produced by distilling different types of organic raw materials, most of them from biological sources as cereals grains, fruits and juices (these being the starch sources) [1] but even from wood sources. All these sources produce both ethanol and methanol in different proportions, by fermentation process. The serious health risk of methanol poisoning becomes higher when using wood sources [2].
The European and national regulations for Food Safety do specify strict requirements for producing alcohol drinks, and here are the brand name products, but homemade beverages with over 30% ethanol obtained by repeated distillation in manufactured copper vessels will contain small amounts of methanol. In case that fruit juice is used this amount reaches about 0.2-0.3%, however from fruit pulp the amount may rise to 0.6-0.9% [3].
As the metabolism of methanol is much slower than the one of ethanol, the most common effects caused by exposure to methanol by drinking alcohol beverages become apparent only after several hours. [More]

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