Category Archives: AMM 2015, Volume 61, Number 2

Surgical Risk Factors of Patients with Operable Gist

Gabos Gabriella*, Friciu Adina, Diac Raluca, Magdas Annamaria, Crăciun C, Coroș M, Dobru Daniela

University of Medicine and Pharmacy of Tirgu Mureș, România

DOI: 10.1515/amma-2015-0031

Introduction: Gastrointestinal stromal tumors (GIST) are the most frequently mezenchimale tumors of the gastrointestinal tract. This study aims to analyze the results after surgical treatment of GIST and identify key risk factors influencing postoperative course of these patients in order to discover the most effective therapeutic methods to significantly improve postoperative course of these patients.
Methods: We retrospectively reviewed the medical records of all patients who underwent surgical removal of GISTs from 2004-2014. Patient demographics, criterion for admission, surgery, complications, secondary dissemination, histopathological data and clinical course were analized following patient survival at 12, 24, 36 and to 60 months postoperatively. Statistical analysis was performed using the MedCalc software program, and survival analysis was done by Kaplan Meyer.
Results: During this period we analyzed a total of 28 cases, including 13 males and 15 females with age from 33 to 80 years (median, 61). The tumor was located in the stomach (15 cases; 53%), small intestine in ten cases (36%) and other sites in three patients ( 11%). Multivariate analysis revealed that tumor size (P <0,05), criterion for admission (P<0,05) and secondary dissemination (P<0,05) are independed prognostic factors.
Conclusions: Factors like: age and sex of patients, size and tumor site, presence or absence of metastasis, are prognostic risk factors with significant differences in the evolution of patients with operable GIST. The small number of patients and retrospective nature of the study have created difficulties in the estimation where we concluded the need of a prospective multicentric study.

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Office Assessed Blood Pressure and Ambulatory Blood Pressure Monitoring in Chronic Kidney Disease Patients Versus Kidney Transplant Recipients

Tarta DI, Căldăraru Carmen Denise, Tarta Cristina, Frigy A, Carașca E, Carlan Otilia, Dogaru AG

University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0029

How reliable is office assessed blood pressure (BP) in chronic kidney disease (CKD) patients and kidney transplant (KTx) recipients is yet to be determined, although the diagnosis of arterial hypertension has been based on these measurements. The aim of this study was to investigate the potential differences between office assessed BP and ambulatory blood pressure monitoring (ABPM) in CKD patients and KTx recipients.
We conducted a prospective study which enrolled 45 patients. Morning and evening seated office BPs were assessed using a sphygmomanometer at 5 consecutive outpatient visits. A mean systolic BP (SBP) and diastolic BP (DBP) was calculated. Ambulatory blood pressure was measured over 24 hours using a Meditech ABPM-05 device. Office SBP was statistically significant higher in CKD patients than KTx recipients both in the morning and evening (p=0.0433 and p=0.0066 respectively). ABPM showed higher night-time SBPs (p=0.0445) and higher overall, day-time and night-time DBPs in KTX recipients (p=0.0001, p=0.0006, p<0.0001 respectively). In CKD patients, office SBPs and DBPs are significantly higher than overall SBPs and DBPs as assessed by 24hr ABPM. Office BP monitoring as assessed by clinician is acceptable but tends to overestimate BP in both CKD and KTx study groups.

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Association Between Increased Waist Circumference and Depression and Anxiety Trend

Bocicor Andreea Elena1, Buicu Gabriela1,2, Varga Andreea1,3, Tatar R1, Sabau Daniela1,2, Tilea I1,3, Gabos-Grecu I1,2

1 University of Medicine and Pharmacy Tirgu Mures, Romania
2 Psychiatry I Clinic, County Hospital, Tirgu Mures, Romania
3 Cardiovascular Rehabilitation Clinic, Emergency County Hospital, Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0028

Introduction: Abdominal adiposity assessed by increased waist circumference and depression have both a high incidence and prevalence and are associated with increased general mortality and cardiovascular risk. Several studies showed a significant association between abdominal obesity, metabolic syndrome and depression. Early detection of these associations is important for for prevention and treatment of this disease.
Material and method: Eighty patients were enrolled in a cross-sectional descriptive study. Waist circumference was measured in all patients and an increased waist circumference was considered for subjects with values higher than 80 cm in women and higher than 94 cm in men as. Patients completed standardized questionnaires HADS for assessment of depression and anxiety. A depression (D) score higher than 10 points showed a trend to depression while an anxiety (A) score higher than 10 indicated a tendency to anxiety. The association between increased waist circumference, depression and anxiety was studied.
Results: We interviewed 80 patients, 34 (43%) men (mean age 62+/-6.43) and 46 (57%) women (mean age 59+/-5.16). Increased waist circumference was recorded in 22 men, and in 30 women. We noticed a good association between increased waist circumference and both depression (p=0.0006, RR=2.007, 95%CI 1.24-3.24) and anxiety (p=0.017, RR=2.046, 95%CI 1.21-3.45). We found both anxiety and depression risks rather equal in men, while in women we observed a higher depression risk.
Conclusions: Increased waist circumference is associated to depression and anxiety tendency in both genders. Depression trend is more powerful in women, while in men both depression and anxiety seen to have an equal frequency. Psychotherapy should be added to lifestyle changes in patients with abdominal adiposity.

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Comparison Between Clinical and Echocardiographic Findings in Infants and Children Diagnosed with Hypertrophic Cardiomyopathy

Blesneac Cristina¹, Șuteu Carmen1, Togănel Rodica¹, Benedek Theodora², Benedek I²

¹ University of Medicine and Pharmacy Tîrgu Mureş, Department M4, IIIrd Pediatric Discipline
² University of Medicine and Pharmacy Tîrgu Mureş, Department M3, Clinic of Cardiology

DOI: 10.1515/amma-2015-0027

Background: Hypertrophic cardiomyopathy is a rather common hereditary disease with an autozomal dominant character, caused by mutations of genes that code for proteins of the cardiac sarcomere. The observed prevalence of this disease is much lower in pediatric patients compared to adults, because it’s late gene expression. Hypertrophic cardiomyopathy presenting in infancy has been shown to have a very high mortality.
Methods: Thirty-nine patients diagnosed with hypertrophic cardiomyopathy in the IIIrd Pediatric Cardiology Department from Tîrgu Mureș were included in this study. Patients were divided into two groups: group 1 – patients diagnosed during infancy, group 2 – patients diagnosed after 1 year of age. Data regarding familial and personal history, and echocardiographic findings were compared between these two groups.
Results: Group 1 included 17 patients and group 2 – 22 patients. Positive familial history was found in both groups (group 1 – 6 cases, group 2 – 3 cases), all of them in obstructive forms. Syncope was found in four cases, all of them in group 1 (p=0.02; odds ratio 15; 95% CI, 0.7473 to 301.1). While in group 1, asymmetric septal hypertrophy was predominant (64.7%), in group 2 – concentric left ventricular hypertrophy predominated (54.5%). Obstructive hypertrophic cardiomyopathy was found in 14 patients in group 1 (82.4%)compared to 13 patients in group 2 (59.1%). Diastolic function was impaired more predominantly in group 1 (p=0.0274; odds ratio 11.67; 95% CI, 1.526 to 89.17).
Conclusions: hypertrophic cardiomyopathy has an extensive clinical variability with regard to age of onset, severity and progression of disease.

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Epidemiological Characteristics and Prospective 6-Months Follow-up of Children with Pulmonary Arterial Hypertension

Şuteu Carmen1, Blesneac Cristina1, Togănel Rodica1, Benedek Theodora2

1 University of Medicine and Pharmacy Tîrgu Mureş, Department M4, IIIrd Pediatric Discipline
2 University of Medicine and Pharmacy Tîrgu Mureş, Department M3, Clinic of Cardiology

DOI: 10.1515/amma-2015-0026

Introduction: Pulmonary arterial hypertension (PAH) is a rare disease associated with significant morbidity and mortality. Pediatric patients often present with mixted aetiologies. Objectives: To characterize the epidemiology, management and outcome of pediatric PAH.
Methods: Children with PAH were included and followed prospectively for six months. WHO functional class, 6-minute walk test, biomarkers, electrocardiogram, spirometers and echocardiographic parameters were evaluated in progressive PAH group.
Results: Two hundred and four children were included in the study from July 2012 until July 2013, with a mean age of 6.13 years. Transient PAH patients (n=170, 83.33%) included newborns with persistent pulmonary hypertension (n=8, 3.92%) and children with congenital heart defects with systemic-to-pulmonary shunt- flow PAH (n=162, 79.41%) in whom PAH resolved after successful surgery correction. Progressive PAH (n=34, 16.66%) included patients with idiopathic PAH (n=5, 2.45%), Eisenmenger syndrome (n=17, 8.33%) and post-operative PAH (n= 6, 2.94%). Patients with progressive PAH remained stable in regards to clinical status, WHO functional class, 6-minute walk distance, biomarkers, spirometers parameters and echocardiographic parameters with prognostic value.
Conclusions: Pediatric PAH is characterized by various age- specific diagnoses, the majority of which comprise transient forms of PAH. Pediatric PAH associated with congenital heart defects represents a heterogeneous group with highly variable clinical courses. PAH specific therapies may have contributed to disease stability and favorable outcomes.

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European Colorectal Cancer Management: Implemented as it is or Adapted to our National Specificity?

Dobre A, Hintea A, Azamfirei L

University of Medicine and Pharmacy, Tîrgu Mures, Romania

DOI: 10.1515/amma-2015-0025

Objective: We attempt to evaluate how the European treatment guides are implemented in a clinic hospital in Targu Mures and if those rules could be adopted as they are or must be adapted to our national specificity.
Methods: For a number of 441 patients included in the study, the electronic prospectively maintained archive of 3rd Surgery was interrogated for: age, preoperative colonoscopy, postoperative colonoscopies, chemo-radiotherapy enrollment, stage of the disease, type of surgery. Local and regional relapses were assessed and their incidence was related to type of surgery. Survival analysis was done in a simplified manner and differentiated for age below and above 75 years.
Results: Patient’s age distribution revealed a deviation to the right compared with a normal distribution with a median off 64.76±11.47. Colonoscopy was done in only 65 cases, exclusive preoperatively. Chemoradiotherapy was administered in 168 cases, only 12 of them initiated preoperatively. The type of surgery performed was found positively correlate with the stage of the disease. The survival probability for the patients in this study showed a 50% survival rate at 1 year and only 2% at 5 years.
Conclusions: Passive screening age in CRC should be decreased to 55 years. Stage 3 and 4 of disease for CRC are over 70% of cases, like 20 years ago. Survival rate in CRC is far lower than other studies. Integrated CRC management and European practical guides are still “in wishing”
stage.

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Individual Prognostic Factors in Gastric Cancer

Hintea A, Dobre A, Coroș M, Roșca Ancuța, Dobru Daniela

University of Medicine and Pharmacy of Tîrgu Mures, Romania

DOI: 10.1515/amma-2015-0024

Objectives: The objective of this research was to study the prognostic factors in gastric cancer.
Methods: We conducted a retrospective study on 5-year survival in 112 patients with gastric adenocarcinoma operated between 2004-2009. We used the Surgery Clinic I and Health Insurance House databases for study of the following parameters: age, sex, depth of invasion, histological type, surgery, number of lymph nodes excised and reported overrun / removed lymphnodes.
Results: There was no significant survival difference related to gender aspects. We found significant differences in the survival rate in relation to the tumours confined to the mucosa and muscularis mucosae (100% and 60% respectively), compared to the cases with deeper invasion (p<0.05). Intestinal type presented a superior however insignificant prognosis compared to diffuse type (22% versus 5.66%). Five years survival was slightly lower after D1 lymphadenectomy D1 compared to D2 lymphadenectomy (25.92% versus 29.16%). We found large differences among the number of perigastric lymph nodes (between 3 and 42 in groups of 1 to 6) nodules. Survival rates were significantly higher (p <0.05) in patients with overrun lymphnodes between 0 and <20%, compared to those with overrun ones over 20% of all excised nodes (23.07%, 55.55% vs. 3.89%).
Conclusions: Merely the number of removed lymph nodes may be a source of error in staging if not taken into account the groups they belong to; the most constant individual prognostic factors are the depth of invasion and overrun/removed lymph nodes report; D2 lymphadenectomy has superior results in terms of 5 years survival compared to D1 lymphadenectomy, but, at least in our study, the difference was insignificant.

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Pulmonary Arterial Hypertension: A New Challenge

Benedek I

University of Medicine and Pharmacy Tirgu Mures, Romania

Pulmonary hypertension represents a new challenge for the current clinical practice, as recent advances in the field of diagnostic technologies led a to significant increase in the number of patients diagnosed with this disease and in the same time new therapeutic classes proved to have a significant role in improving survival of these patients.
The main types of pulmonary hypertension are the idiopathic form, called primary pulmonary arterial hypertension (PAH) and the secondary one, developed in the evolution of a cardiac disease, in many cases consequence of a congenital heart disease. Once occurred, PAH severely limits the life expectancy. Despite the recent introduction of many new therapeutic agents which are expected to have a revolutionary role in the improvement of life expectancy and quality of life of these patients, PAH continues to be associated with a mortality as high as 35% at 3 years after the diagnosis. The new therapies are mainly represented by vasodilators that target the nitric oxide, endothelin and prostacyclin pathways.
The diagnosis of PAH is usually established when a typical pattern of pre-capillary pulmonary hypertension is encountered in the hemodynamic profile, in the absence of any lung disease. [More]

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Socio-demographic Characteristics of Patients Diagnosed with Advanced Chronic Venous Insufficiency (C4-C6) Correlated with Clinical and Para-clinical Findings

Imre Eniko Reka*, Imre M

University of Medicine and Pharmacy of Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0030

Chronic venous insufficiency’s frequency reaches almost 25% in European countries. The aim of this present study was to assess the correlation between sociodemographic characteristics as well as clinical findings and para-clinical findings of aCVI patients. A total number of 2636 patients diagnosed with CVI were evaluated for over an 8 year time period (2006-2013). In case of 795 of them, diagnosis of aCVI (C4-C6) has been established. The following variables have been evaluated: demographic data, etiology, risk factors, chronic diseases as risk factors, signs and symptoms, laboratory findings and even the therapeutic approach.All the assessed data has been evaluated using descriptive statistics, t-Student test, and chi square test. Also the relative risk (RR) and Odds ratio (OR) has been calculated. The mean age of aCVI patients was significantly higher (p=0.001) than the age of patients with stage C1-3 CVI. A positive correlation (p<0.0001) between combined venous disorders and clinical stage of CVI has been found. Deep vein thrombosis proved to be correlated (p=0.02) with evolution of CVI to venous ulcer (stage C6). Worsening of advanced venous insufficiency was also correlated with presence of peripheral arterial diseases, and/or metabolic diseases (p<0.0001, and p=0.02). Based on our results, the typical profile of a patient with aCVI has been outlined. Using this profile, the general practitioner and even the internal medicine specialist can recognize in advance patients with an elevated risk of developing aCVI, and accordingly can choose a more appropriate  therapeutic approach.  30

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