Category Archives: Original Research

The Detection of Premalignant Gastric Lesions by Conventional and Magnifying Endoscopy

Boeriu Alina1, Dobru Daniela1, Pascarenco Ofelia2, Mocan Simona3, Stoian M4, Georgescu Anca5

1 Department of Gastroenterology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Gastroenterology, Clinical Emergency County Hospital, Tîrgu Mureș, Romania
3 Department of Pathology, Clinical Emergency County Hospital, Tîrgu Mureș, Romania
4 Intensive Care Department, Clinical Emergency County Hospital, Tîrgu Mureș, Romania
5 Clinic of Infectious Diseases, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: Early diagnosis of gastric neoplasia involves both the detection and surveillance of patients with premalignant gastric lesions. Magnifying endoscopy allows the analysis of the fine mucosal structure and microvascular architecture.
Material and methods: The aim of our study is to identify specific patterns associated with premalignant gastric lesions by magnifying endoscopy in conjunction with chromoscopy. We performed conventional upper endoscopies and we selected a number of patients for chromodiagnostic and magnification. We classified the endoscopic patterns in normal and abnormal (modified) patterns. Target biopsies were obtained from magnified areas and we analyzed the correspondence with the histological findings.
Results: We identified specific pit patterns for normal gastric mucosa and for inflamed mucosa. A tubular pattern was associated with the detection of intestinal metaplasia. An irregular pattern and abnormal microvessels were endoscopic findings associated with the detection of high-grade dysplasia. An irregular form of collecting venules was detected in areas with atrophic gastritis.
Conclusions: An initial selection of patients based on conventional endoscopic findings is mandatory. Gastric mucosal changes identified by magnifying endoscopy raise the number of detected premalignant lesions by targeted biopsies. Our work emphasizes the current challenges related to the use of these endoscopic methods.

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Dissection of the Cervico-Cerebral Arteries – Ultrasonographic Characteristics

Bajkó Z, Bălaşa Rodica, Stan Camelia, Moţăţăianu Anca

Department of Neurology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Background: Dissection of the cervical and cerebral arteries represents the leading cause of non-atherosclerotic stroke in young adults. The diagnosis can be difficult as the presentation may be variable. The ultrasound (US) examination is the first diagnostic procedure, because is non invasive and informative.
The aim of this study was to analyse the ultrasonographical characteristics of the cervico-cerebral artery dissections (CCAD).
Patients and methods: We analyzed 8 consecutive cases of CCAD examined in the Ultrasound Laboratory of Neurology Clinic I from Tîrgu Mureş, Romania over a 3-year period. The mean age of the patients was 39.5±12.1 (min. 24, max. 60), the male/female ratio: 1.
Results: In 5 cases the diagnosis was established based on the ultrasound findings, in 2 cases was confirmed by angiography and in one case by MRI angiography. In 3 cases the CCAD occurred at the level of the proximal internal carotid artery (ICA), in 2 cases at distal ICA, in one case the common carotid artery, in 1-1 cases the proximal and distal part of the vertebral arteries. The most frequent ultrasound finding suggestive for CCAD was the hypoechogenic wall haematoma (3 cases). The hyperechogenic intimal flap occurred in 2 cases, the classical double lumen only in one case. In three cases the ultrasound examination revealed only indirect signs of occlusion. In one case the ultrasound findings were not suggestive for ICA dissection, the diagnosis was confirmed based on the angiography findings.
Conclusions: Color duplex ultrasound examination is an important diagnostic method in the diagnosis of CCAD with good sensitivity and specificity. The most frequent ultrasound finding in CCAD is the hypoechogenic mural haematoma. In patients with suspected CAD and negative US, repeated US examinations and further diagnostic imaging, as angiography, MRI, MRI angiography must be performed.

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Specialized Software Engineering in Clinical Trials. GANfort Study

Bacârea V1, Haifa B2, Petrișor M2, Ghiga Dana1, Bacârea Anca3, Muji M4, Mărușteri M2

1 Research Methodology Department, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Medical Informatics and Biostatistics Department, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Physiopathology Department, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
4 Engineering Department, Petru Maior University, Tîrgu Mureș, Romania

Objective: We aim to develop and implement a personalized software to accomplish data quality management in real time, reducing the chance of error in data collection and a “real time biostatistics” software linked to a collector datasheet.
Material and methods: We used C++ for programming, R for statistics and JavaScript (AJAX) for the interface. This application was deve-loped for phase 3 GANfort study. This is a multicentric study. The results presented are simulated.
Results: The application presented below has a datasheet collection view with three tabs and a general presentation of the study and patient. The first tab collects data from the first visit (study inclusion and initiating the treatment), the second tab is for surveillance visit and the third tab generates real time statistic parameters.
Discussions: Using this type of software many methodological problems concerning data management can be avoided. “Missing data” and “outliers” or writing and typing errors become non-existent; typing constraints issued by datasheets and real time biostatistics eliminate them. The data can be introduced in the same time in different places and the matching data is performed simultaneously.
Conclusions: The time consuming data quality management is automatically solved using the software we proposed. Statistical parameters are calculated in real time. The end of data collection coincides with a final report of the study.

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A Randomized Trial of Prophylactic Administration of Phenylephrine vs. Ephedrine for Treatment of Hypotension during Combined Spinal-epidural Anesthesia for Cesarean Delivery

Weisenberg M1, Gorodinsky L1, Ezri T1, Golan A2, Zimlichman R3, Evron S1

1 Department of Anesthesia, Edith Wolfson Medical Center, Holon, Affiliated with Sackler Medical School, Tel Aviv University, Israel
2 Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Affiliated with Sackler Medical School, Tel Aviv University, Israel
3 Department of Internal Medicine and The Brunner Institute for Cardiovascular Research, Edith Wolfson Medical Center, Holon, Affiliated with Sackler Medical School, Tel Aviv University, Israel

Ephedrine and phenylephrine are useful vasopressors for managing hypotension during caesarean delivery. Fetal arterial cord blood pH and fetal acidosis may be related to the choice of vasopressor. The present study was therefore designed to compare arterial cord blood pH and fetal acidosis rates by vasopressor treatment, while maintaining maternal mean arterial pressure (MAP) near baseline values. Fifty one ASA I-II parturients undergoing cesarean delivery (CD) under combined spinal-epidural anesthesia (CSEA) were randomly assigned to prophylactic infusion (20 mL.hr-1) of phenylephrine (100 µg.ml-1, n=25) or ephedrine (3 mg.ml-1, n=26) prior to CSEA. The infusion, was titrated to maintain mean arterial pressure (MAP) near baseline values. The primary outcome was arterial cord blood pH. Fetal acidosis was defined as pH <7.2; maternal hypotension as MAP <70 mmHg; and maternal bradycardia as heart rate <50 bpm. Arterial cord blood pH was 7.32±0.06 in the ephedrine group vs. 7.32±0.05 in the phenylephrine group, p=0.9. Fetal acidosis occurred in one case (4%) in each study group with similar one- and five-minute Apgar scores (all >7). Hypotension episodes were more frequent in patients given ephedrine (10 patients; 38%) than phenylephrine (three patients; 12%), (p=0.03). We conclude that prophylactic ephedrine as compared to phenylephrine administration was associated with a relatively high incidence of hypotension but with similar cord blood pH.

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Management Algorithm for Surgical Patients Infected with Human Immunodeficiency Virus

Zaharia Kézdi Erzsébet Iringó1, Boţianu A2, Ioniţă Alexandrina1, Georgescu Anca1, Incze Andrea1, Şincu Nina1

1 Clinic of Infectious Diseases I, Tîrgu Mureș, Romania
2 Surgery Clinic II, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Objective: The purpose of this study was to establish the risk factors which influence the postoperative evolution of surgical patients infected with human immunodeficiency virus (HIV), and to conceive a management algorithm based upon these factors.
Methods: We have performed a bidirectional transversal study on a group of 73 HIV-positive patients who had undergone 104 surgical procedures during 2006–2010 in the university medical center of Tîrgu Mureş. We studied risk factors such as the number of CD4 T-cells (LTCD4) < 100/µl, anemia, thrombocytopenia, hypoproteinemia, leukopenia, wasting syndrome, ASA (American Society of Anesthesiologists) score, Altemeier class and NNISS (National Nosocomial Infections Survey Systems) score. We defined any registered postoperative complication, as well as all deaths within the first 30 days from surgery as poor outcome. We used GraphPad statistical program, Fisher test for the statistical analysis of data, we interpreted p <0.05 as statistically significant, for a CI of 95%.
Results: We have registered a total of 15 complications, 5 deaths. Risk factors associated with poor postoperative outcome were LTCD4 <100/µl (p=0.03) wasting syndrome (p=0.0001), ASA score > 1 (p=0.01), Altemeier class > II (p=0.0001), NNISS score 1 (p=0.0001).
Conclusions: HIV-infected patients with emergency surgical pathology will benefit of surgical treatment when the anesthetic risk does not overpass the surgical risk, while patients who require elective interventions will be operated after the correction of risk factors.

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Lyme Neuroborreliosis – A Retrospective Study

Țilea Brîndușa1, Țilea I2, Brînzaniuc Klara3, Georgescu Anca1, Gîrbovan Cristina1

1 1st Clinic of Infectious Diseases, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Internal Medicine III, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Anatomy and Human Embriology Department, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Background: Lyme Neuroborreliosis represents the acute or chronic infection of the central nervous system (CNS) and peripheric nervous system (PNS), as a consequence of a systemic infection.
Objectives: to evaluate the epidemiological, clinical, serological and post-therapeutic implications of CNS and PNS damage during Borrelia burgdorferi (Bb) infection.
Material and method: We performed a retrospective study on 23 patients admitted between January 1st, 2009 – December 31, 2010. The patient’s inclusion was made respecting the criteria of the European Center for Diseases Control (ECDC) and the European Union Concerted Action on Lyme Borreliosis (EUCALB). The levels of antiBb antibodies (IgM, IgG) were measured in the cerebro-spinal fluid (CSF) and in the serum using ELISA and Western blot methods. Imaging techniques were used in the case of patients with meningeal and cerebral lesions. The patients were treated with 3rd generation cephalosporins and cyclins. Statistical analysis was performed using the Chi square and Student tests.
Results: Twenty patients (86.96%) were included in the acute phase and 3 patients (13.04%) in the chronic phase of the disease. Meningeal damage was observed in 16 patients (69.56%), cerebral damage in 4 patients (17.39%), cranial nerve lesions in 2 patients (8.69%), radiculoneuritis in 1 patient (4.34%). Serological investigations using the ELISA method revealed the presence of antiBb antibodies in 100% of cases, in the CSF antiBb IgM antibodies were found in 18 patients (78.26%), IgG in 3 patients (13.04%); using the Western-blot method IgM antibodies were found in 20 patients (86.96%) and IgG in 3 patients (13.04%).
Conclusions: Early diagnosis and therapy led to a favorable evolution compared with patients who were treated late, the latter presenting neurological sequelae and relapses.

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Therapeutical Features of Permanent Atrial Fibrillation in Hypertensive Elderly Patients

Toma L1, Baricz Emőke1, Dorgo Monica1, Caraşca E1,2

1 Medical Clinic IV, Tîrgu Mureș, Romania
2 Internal Medicine Departament, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: The atrial fibrillation is a form of arrhythmia, which occurs most frequently among the aged and which often influences the therapy prescribed to them.
Material and methods: The present study addresses to a focus group of 79 hypertensive elderly patients, hospitalized at the Internal Medicine Clinic of Targu Mures during the year 2007. The parameters taken into consideration were distribution by age groups, gender, the existence of atrial fibrillation or other comorbidities and the administrated therapy.
Results: The distribution by age groups and gender reveals a higher number of hypertensive patients between 70 and 75 years and a more frequent affection of male patients. The associated comorbidities to our group of 28 patients with atrial fibrillation were cardiac ischemic disease (13 patients), heart failure (2 patients), both of these (6 patients) and chronic obstructive lung disease (7 patients). The medication administrated for the rate control consists of: beta-blocker in almost 50% of cases (13 out of 28 patients), digitalis (2 patients), and beta-blocker+digitalis for 6 patients. In 7 cases the rate control medication was not required.
Conclusions: The atrial fibrillation is a common condition among the hypertensive elders, and not infrequently associated with other cardiac comorbidities which contribute to the choice of appropriate medication.

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Identification of the Photodegradation Products of the Tricyclic Antidepressant Drugs Clomipramine and Doxepine

Székely P1, Gyéresi Á2, Hancu G2, Laczkó Zöld Eszter3, Vancea Szende4

1 Department of Pharmaceutical Marketing, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Pharmaceutical Chemistry, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Department of Pharmacognosy, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
4 Department of Physical Chemistry, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Objective: Isolation and identification of the photodegradation products of the tricyclic antidepressant drugs clomipramine and doxepine after irradiation with ultraviolet light.
Methods: The photodegradation products were separated by a thin layer cromatographic method, followed by scraping the spots from the chromatoplate and extracting in methanol, which was followed by their identification by mass spectrometry.
Results: In the case of clomipramine seven degradation products were separated and the corresponding m/z values were determined, while analyzing doxepine there have been separated eight degradation products, of which six were identified by their m/z values. The results obtained for clomipramine are in accordance with literature data, except for desmethyl-clomipramine, for which we could not find any reference. Conclusions: The m/z values indicate that the possible degradation products for clomipramine are imipramine, HO-imipramine, desmethyl-clomipramine and HO-imipramine-N-oxide. In the case of doxepine we could identify two possible photodegradation products, HO-doxepine and doxepine-N-oxide.

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Modification of Renal Permeability for Proteins after General Anesthesia with Sevoflurane and Desfluran

Stoian M1, Stoian Adina2, Cozma D3, Brusnic Olga4, Pascarenco Ofelia4, Iacob Oana2, Șchiopu A2

1 Department of Anesthesiology and Intensive Care, County Emergency Hospital, Tîrgu Mureș, Romania
2 Department of Pathophysiology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Surgery Clinic no. 1, County Emergency Hospital, Tîrgu Mureș, Romania
4 Gastroenterology Clinic, County Emergency Hospital, Tîrgu Mureș, Romania

Introduction: Sevoflurane degradation by carbon dioxide absorbents during low-flow anesthesia lead to the formation of a haloalkene called compound A, which causes nephrotoxicity.
Material and methods: We determined proteinuria by spectophotometry at 600 nm, preoperatively and postoperatively at 24 and 72 hours in 52 patients undergoing general anesthesia with sevoflurane and 25 patients undergoing general anesthesia with Desfluran. We selected patients without previous renal disease, with anesthetic risk ASA I–III who underwent major abdominal and thoracic surgery lasting more than 150 minutes and we used a 2 l/minute FGF-fresh gas flow, with a MAC-minimal alveolar concentration of 1.5 to 1.8 for Sevoflurane, and of 6–8 MAC for Desfluran.
Results: Renal permeability is impaired by general anesthesia with Sevoflurane (p ˂ 0.0001) and Desfluran (p > 0,001). The amount of filtered protein has a maximum at 24 hours after surgery with gradual decrease within 72 hours, but without reaching the normal preoperative values.
Conclusions: There is proteinuria after exposure to volatile agents like Sevoflurane and Desfluran recording a maximum in the first 24 hours and there is also a tendency to normalization within 72 hours. We noticed a marked impairment of renal permeability in association with specific groups of pathology as septic patients, diabetics, hypertensives, especially after Sevoflurane anesthesia. There was no-one case of acute renal failure in which to criminalize Sevoflurane or Desfluran.

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The Preventive Surgery of Proximal Aortic Manifestations in Marfan Syndrome

Seres-Sturm L jr1, Suciu H2, Szabolcs Z3

1 Department of Cardiac Surgery, University of Pécs, Hungary
2 Institute of Cardiovascular Diseases and Transplantation, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Department of Cardiac Surgery, Semmelweis University, Budapest, Hungary

Background: Marfan syndrome (MFS) is a genetic connective tissue disease with an incidence of 2–3/10000 individuals resulting in multiple organ system affection, aortic dilatation, dissection and rupture the most severe cardiovascular complications according to natural history. These consequences can be prevented by prophylactic aortic surgery.
Methods: Results are presented of patients (N=22; mean age: 26.95±9.01, min: 9; max: 42; male/female ratio=16/6) underwent elective preventive surgery over a 11 years period.
Results: Preventive operations have zero 30 days mortality and still the best results in approaching normal population life extent compared to the survival of other indication groups. Secondary vascular complications should be monitored life-long after the succesful treatment of the diseased thoracic aorta of Marfan patients due to the systemic property of the extant syndrome.
Conclusions: After identifying the condition and registering people with MFS in a national database, the regular check-ups, preventive operations bear great importance. Timing is crucial for the preventive operation, because the underlying disease (MFS) exposes the aorta to be a “ticking” bomb that can lead to serious consequences like aortic dissection or rupture with possible fatal outcome. Preventive aortic operations at MFS patients enjoy the benefitial outcomes and nature of the management compared to other acute type, emergency or urgent operations. The effective prevention lays on carrying out the prophylactic surgery together with the continuous check-up of the predisposed and operated patients by the help of a professional nationwide register for people with MFS that, if not created yet, should be established as well.

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