Category Archives: AMM 2015, Volume 61, Number 1

Eficacy of trichloroacetic acid peel versus 15% topical azelaic acid gel in the treatment of acne vulgaris – a comparative study

DOI: 10.1515/amma-2015-0014

Objectives: The aim of this study was to compare the efficacy and tolerability of 20% trichloroacetic acid (TCA) peel with 15% azelaic acid gel, a standard antiacne topical treatment.
Materials and methods: 51 patients aged between 16-40 years, with mild and moderate acne, were randomized into two groups. Before the treatment were investigated the patients clinical features and hygienic habits, the previous antiacne treatments and feed-back to them. No cases under treatment with contraceptive pills or antiacne medication that could interfere with the results, were included. For a period of eight weeks, 27 patients (group A) were treated with 15% azelaic acid gel, twice daily, and 24 patients (group B) underwent four sessions of 20% TCA peels, at 14 days interval. The efficacy was evaluated by acne lesions counting, at baseline and at 8 weeks. Adverse effects incidence (erythema, local skin irritation), as well as the satisfaction degree of patients, were investigated.
Results: Was observed a mean reduction in the number of acne lesions of 32,36% for the group A and 69,36% for the group B. There was no statistically significant difference between the average number of acne lesions before treatment between the two groups. The mean number of acne lesions after the treatment was significantly different (p<0,0001), 20% TCA peels showed superior results than 15% azelaic acid gel. Additionally, 96% of patients who underwent TCA peels were very satisfied with the results obtained.
Conclusions: TCA peel is an efficient and well tolerated method for the treatment of acne vulgaris.

Full text: PDF

Relapsing Polychondritis Possibly Caused by Chronic Infection with Borrelia Burgdorferi: Case Report

DOI: 10.1515/amma-2015-0018

Introduction: Relapsing polychondritis has been described by Rudolph von Jaksch Warthenhorst in 1923 under the name of polichondropathy. Although the etiology is unknown, an autoimmune mechanism is likely due to formation of autoantibodies to type II collagen in the extracellular matrix of the cartilage with its consequent destruction.
Case report: We present a case with relapsing polychondritis according to McAdam and Damiani criteria and with positive Western blot reaction for Ac IgG anti Borrelia burgdorferi. Serological reaction became negative and the patient presented favorable evolution at 6 months follow-up after corticosteroid therapy and antibiotics.
Conclusion: Chronic infection with Borrelia burgdorferi may play a role in relapsing polychondritis determinism

Full text: PDF

A Novel Disease Caused by Increase of the Lifespan: Chronic Cutaneous Insufficiency Syndrome or Dermatoporosis

DOI: 10.1515/amma-2015-0020

Nowadays we are witnessing an increase in the medium lifespan caused by improved living conditions. The main factor in skin ageing is represented by the chronic exposure to ultraviolet radiation, however long term use of systemic or topical corticosteroids could produce similar effects on the skin. Chronic cutaneous insufficiency syndrome or dermatoporosis was described in 2007, being caused by a decreased activity of the hyaluronic acid, the main component of the extracellular matrix. This mechanism translates clinically through atrophy in the forearms or calves. Other injuries develop on this background including skin dissecting hematoma, which is a medical emergency. Therapeutic attitude consists of local application of preparations containing hyaluronic acid and retinaldehyde and discerning use of corticosteroid therapy. Photoprotection has a certain role in preventing the disease. While today dermatoporosis is a little known dermatosis even among dermatologists, in the future we will see a significant increase in the incidence of the disease and its gravity.

Full text: PDF

Continuous Local Analgesia in Postoperative Treatment of Large Incisional Hernias – Preliminary Results

DOI: 10.1515/amma-2015-0019

Background: The incisional hernias are frequent complications after laparotomy. Extended subcutaneous tissue dissection is often necessary for the treatment of large incisional hernias, and this procedure is frequently followed by a high intensity pain in the postoperative period. The aim of this study was to assess the postoperative patient comfort without using major analgesics.
Material and method: we present the preliminary results of an ongoing study from Surgery Clinic 1 of Emergency Clinical County Hospital of Târgu Mures, University of Medicine and Pharmacy Târgu Mures. The study comprises in the intraoperative insertion of a subcutaneous catheter (Pajunk InfiltraLong) placed on lay, through which we administered continuously Ropivacaine 0,5%.
Results: Ten patients have been included in the study by now. For 5 of the patients the wound infiltration was started with 7 ml/h in the first 6 postoperative hours, after which the rate decreased to 5 ml/h until the end of the 72 hours, when the catheter was removed. For 2 patients the wound infiltration was started with 10ml/h in the first 6 postoperative hours, after which the rate decreased to 7 ml/h in the first day, followed by 5 ml/h for the next two days. Two patients needed a minor analgesic in the immediate postoperative period and one patient needed major analgesia in the first 24 hours.
Conclusions: By using this method, postoperative analgesia can be achieved without using major systemic analgesics and a superior patient comfort can be achieved simply by adjusting the infusion rate

Full text: PDF

Predictors of Hepatocellular Carcinoma in Patients with Liver Cirrhosis

DOI: 10.1515/amma-2015-0017

Background and aim: Hepatocellular carcinoma (HCC) is one of the most important health problem, with an increasing incidence worldwide. The aim of the present study was to determine the factors that predict HCC occurrence in a group of patients with liver cirrhosis developed on various etiologies.
Material and Methods: A total of 282 consecutive patients with liver cirrhosis seen between January 1, 2013 and July 31, 2014 were enrolled in a prospective study. Data from patient’s history, physical exams, laboratory tests and abdominal ultrasound were collected.
Results: 282 patients were included in the study with a median age of 59.6 and a male/female ratio of 1.38/1; 12.41% (35) were diagnosed with HCC. Alcohol consumption was documented in 19 cases (54.28%), without statistical association (p=0.621), and 7 (20%) were smokers (p=0.403). According to etiological factors of liver cirrhosis: 7 (20%) had background B virus infection, 15 (42.85%) HCV infection and 11 (31.42%) cases incriminated other causes of cirrhosis (alcohol). Chi2 test identified a statistically significant association between the occurrence of HCC and viral etiology of cirrhosis (p = 0.001, r = 18,830). No statistical association was found between Child Pugh scoring of cirrhosis and HCC (p=0.774) and a statistically significant association but inversely proportional was identified between neoplasia and obesity (p=0.008, r= -0.157).
Conlusion: In conclusion the viral etiology of liver cirrhosis is found to be an important risk factor for HCC, and liver cancer was inversely associated with nutritional status.

Full text: PDF

Influence of Risk Factors and Diabetic Complications on Peripheral Nerve Function in Type 2 Diabetes Mellitus

DOI: 10.1515/amma-2015-0015

Objective: The aim of this study was to evaluate the impact of age, diabetes duration, glycaemic control, existence of cardiac autonomic neuropathy (CAN), retinopathy and of macroangiopathy on the peripheral nerve function in patients with type 2 diabetes.
Methods: One hundred forty-nine type 2 diabetes mellitus patients were assessed with peripheral motor and sensory nerve conduction tests and cardiovascular reflex tests, as well as being evaluated for retinopathy, common carotid artery intimal-media-thickness (IMT) and ankle-brachial index (ABI).
Results: The duration of diabetes has the strongest effect in the reduction of the amplitude of motor response in the peroneal nerve and of the sensory amplitude in the sural nerve. The strongest correlations were found between glycaemic control and decreasing motor amplitude in the median nerve and sensory amplitude in the sural nerve, respectively. The motor and sensory nerve action potential amplitudes were significantly affected in the group of patients with CAN. According to multivariate logistic regression analysis, duration of diabetes and presence of CAN were the most important factors that influenced the motor and sensory nerve function.
Conclusion: The presence of CAN together with diabetes duration and poor glycaemic control were associated with impaired peripheral nerve function, while macroangiopathy does not seem to be associated with the impairment of these electrophysiological parameters.

Full text: PDF

Correlations Between Depression, Cognitive Status, Functional Scores, Disability and Lesion Load in Multiple Sclerosis Treated with Interferon Beta 1a

DOI: 10.1515/amma-2015-0016

Introduction: Depression and cognitive impairment are the most frequent mental disorders in multiple sclerosis (MS) and represent an important cause of morbidity and mortality. The aim of the study was to analyse the main determinants of depression in multiple sclerosis.
Materials and methods: Thirty-two patients with relapsing remitting multiple sclerosis (RRMS), treated with Interferon Beta 1a, without relapses and corticosteroid treatment in the last 30 days, were included in the study. The mean age of the patients was 35.4±9.2 years, M/F ratio 0.33. Depression level was evaluated by the Romanian version of Beck Depression Inventory (BDI) and the cognitive function with Paced Auditory Serial Addition Test 3 (PASAT 3), Symbol Digit Modalities Test (SDMT). The functional status and disability level of the patients were evaluated with Multiple Sclerosis Functional Composite and Expanded Disability Status Scale. In all patients a cerebral MRI with intravenous contrast administration was performed using a 1.5T MRI device.
Results: Twenty-three patients were free of depression (score 1-10), 4 patients presented mild mood disturbance (score 11-16), 3 borderline clinical depression (score 17-20) and 2 moderate depression (score 21-30). The mean BDI score was 8.71±7.16. BDI score correlated significantly with EDSS (R=0.38, p=0.03), PASAT 3 (R=-0.42, p=0.01), SDMT (R=-0.58, p=0.0007), Timed 25-Foot Walk (R=0.43, p=0.01) and 9-Hole Peg Test (R=0.45, p=0.008). From the EDSS functional scores, significant correlations were found with the urinary score (R=0.4, p=0.01) and sensitive score (R=0.49, p=0.004). BDI score correlated significantly with the total number of T2 lesions (R=0.31, p=0.05) while there was no correlation with the number of active lesions.
Conclusions: The main determinants of depression in RRMS patients are the cognitive impairment, the affection of fine hand movements (9-HP), gait impairment (T25FT) and bladder and sensitive dysfunction.

Full text: PDF

The relationship between blood pressure variability and cardiovascular risk factors in patients with primary hypertension

DOI: 10.1515/amma-2015-0022

Objective: The aim of the study is to assess 24-hour blood pressure variability, circadian blood pressure profile and its relation to 24-hour blood pressure and cardiovascular risk factors in primary hypertension without any associated disease versus associated with a disease such as diabetes or chronic kidney disease. Methods: This observational study included 90 hypertensive patients, 49 with primary hypertension without associated disease and 41 patients with primary hypertension and diabetes or chronic kidney disease. Circadian blood pressure profile and 24-hour variability were assessed using ambulatory monitoring. Laboratory data regarding cardiovascular risk factors and demographic data were collected in a questionnaire. Results: The number of dipper patients was higher in the group without associated disease, but the difference was not statistically significant (p=0.27). In both groups a positive correlation was found between 24-hour systolic blood pressure variability and 24-hour systolic blood pressure (p=0.029) and was related to age (p=0.031). In the second group, systolic variability showed a positive correlation with serum triglycerides (p=0.006, r=0.416, CI: 0.1252 to 0.6422). Conclusion: Our findings suggest that systolic blood pressure variability is related to age, systolic blood pressure values and serum lipid levels. To prevent end organ damage in hypertension, the assessment of ambulatory monitoring derived 24-hour systolic blood pressure variability and its reduction may be at least as important as blood pressure lowering.

Full text: PDF

Computer modeling of hippocampal CA1 pyramidal cells – a tool for in silico experiments

DOI: 10.1515/amma-2015-0012

Objective. In silico experiments use mathematical models that capture as much as possible from the properties of the biological system under investigation. Our aim was to test the publicly available CA1 pyramidal cell models using the same simulation tasks, to compare them, and provide a systematic overview of their properties in order to improve the usefulness of these models as a tool for in silico experiments.
Methods. Parameters describing the morphology of the cells and the implemented biophysical mechanisms were collected from the ModelDB database of SenseLab Project. This data was analyzed in correlation with the purpose for which each particular model was developed. Multicompartmental simulations were run using the Neuron modeling platform. The properties of the action potentials generated in response to current injection, the firing pattern and the dendritic back-propagation were analyzed.
Results. The studied models were optimized to explore different physiological and pathological properties of the CA1 pyramidal cells. We could identify four broad classes of models focusing on: (i) initiation of the action potential, firing pattern and spike timing, (ii) dendritic back-propagation, (iii) dendritic integration of synaptic inputs and (iv) neuronal network activity. Despite the large variation of the active conductances implemented in the models, the properties of the individual action potentials were quite similar, but even the most complex models could not reproduce all studied biological phenomena.
Conclusions. At the moment the “perfect” pyramidal cell model is not yet available. Our work, hopefully, will help finding the best model for each scientific question under investigation.

Full text: PDF

The Management of the Patient with Elevated Prostate Specific Antigen and a Negative Initial Prostate Biopsy

DOI: 10.1515/amma-2015-0021

Background: The prostate cancer (PCa) is the second  most  common cancer amongst men. An elevated prostate specific antigen (PSA) level can lead to PCa suspition, thus the confirmation has to be a histopathological one. However, not all increased PSA level means prostate cancer.
Material and Method: This retrospective study presents the results of 422 ultrasound guided prostate biopsy (PB) performed at the Clinic of Urology Târgu- Mureş, between 2011-2012. Inclusion criteria: patients with at least one negative PB and an elevated value of PSA.
Results: In a two year period, from the total of 422 PB (100%), in 179 (42.42%) patients the histopathological result was “negative”. In 154 (86%) of cases ultrasound guided biopsies were performed, mostly with an initial 6 core (98- 54.74% of patients). Average PSA level was 13.45 ng/ml (0.49-100 ng/ml), the histological findings confirmed PCa in 52.58% cases, normal prostatic tissue in 141 cases (78.77%), atypical small acinar proliferation in 12 patients (6.70%), prostate atrophy in 11 males (6.14%), benign prostatic hyperplasia in 10 cases (5.59%) and prostatitis in 5 cases (2.80%). In 30 cases (16.75%) rebiopsy was performed with a number of 10- 12 cores.
Conclusions: In order to increase PCa detection we should perform more cores during PB. In „negative” histopathological cases PSA should be monitorised and the biopsy should be repeated after 6 to 8 weeks from the initial biopsy. Patient’s compliance plays a vital role in the follow-up of the procedure.
Conclusions: ANG-2 serum levels were elevated in sepsis, being well correlated with PCT values and prognostic scores. ANG-2 should be considered as a useful biomarker for the diagnosis and the prognosis of this pathology.

Full text: PDF