Category Archives: Original Research

The Impact of Fetal Echocardiography on Outcome of Patients with Pulmonary Atresia with Ductal-dependent Pulmonary Flow

Muntean Iolanda1, Togănel Rodica1, Gozar Liliana2, Sglimbea Anca1, Suciu H3, Mărginean C4

1 3rd Department of Pediatrics, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Pediatric Cardiology, Institute of Cardiovascular Diseases and Transplantation, Tîrgu Mureș, Romania
3 2nd Department of Cardiovascular Surgery University of Medicine and Pharmacy, Tîrgu Mureș, Romania
4 1st Department of Gynecology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Objective: Pulmonary atresia is a relative rare critical congenital heart defect with ductal-dependent pulmonary circulation. Echocardiography is the gold standard in diagnoses congenital heart defect in newborns, but also is the only diagnostic modality of congenital heart defect in the fetus. The purpose of this study is to demonstrate the impact of fetal echocardiography on outcome of patients with pulmonary atresia with ductal-dependent pulmonary flow.
Methods: A single-institution observational study was made on 19 children diagnosed by echocardiography with ductal-dependent pulmonary atresia in Pediatric Cardiology Department from 1997 to 2010, from which four were diagnosed prenatally by fetal echocardiography. We compared a series of clinical data between the prenatally (group 1) and postnatally diagnosed group (group 2), respectively.
Results: All of the infants diagnosed prenatally were delivered in a center for pediatric cardiology. The prostaglandine infusion, to maintain the patency of arterial duct, was initiated in the first 48 h after birth in every cases of the first group comparing to the second group (range3 h – 37 days) (26.66%) (p=0.03). Also, a significantly higher percent of group 1 managed to get in the cardiac unit in the first 48 h after birth comparing to the second group (range 1–37 days) (p=0.03).
Conclusions: We suggest that fetal diagnosis might improve neonatal outcome because of earlier appropriate therapeutic intervention.

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Risk Assessment of Caries in Pregnancy

Molnar-Varlam C1, Molnar-Varlam Cristina2, Babeț Ioana-Gabriela3, Tohati A4

1 Department of Obstetrics and Gynecology I, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Morphology of Teeth and Dental Arches, Technology of Dental Prosthesis and Dental Materials, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Student, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
4 Department of Comunitary Dentistry, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Objective: The purpose of this study was to evaluate the effects of salivary testing in dental caries assessment and to determine a possible relationship between oral hygiene, diet, salivary cariogenic flora, saliva secretion rate, buffer capacity of saliva, salivary pH and caries incidence during pregnancy. Another objective is to introduce a prevention program in teaching institutions.
Material and methods: The longitudinal and descriptive study was conducted from January 2010 to September 2011. Thirty-five pregnant women, aged between 20–35 years, were examined during the three trimesters of pregnancy in order to evaluate the caries risk factors. The study investigated the Streptococcus Mutans and Lactobacilli count in saliva; the salivary pH and the buffer capacity of saliva by using a salivary testing kit (CRT Bacteria and Buffer). These tests were non-invasive and well-accepted by all women.
Results: The results showed an increase in the number of Streptococcus Mutans and Lactobacilli in the second part of pregnancy (>105 CFU/ml saliva). An exception is the 20–24 years age group, where we observed a decrease in the third trimester. Also, their frequency increases with parity and women’s age. In terms of pH, we observed a decrease in the first trimester (6.35), but in the third trimester the pH was less acid (6.85).
Conclusions: Microbiological evaluations suggest that pregnant women present a high caries risk, but the implementation of preventive measures such as a rigorous hygiene and balanced diet prevent the appearance of new carious lesions.

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Semiautomated Image Analysis of High Contrast Tissue Areas Using Hue/Saturation/Brightness Based Color Filtering

Mezei T1, Szakács M1, Dénes L2, Jung J1, Egyed-Zsigmond I1

1 Department of Pathology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Anatomy and Embryology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: Quantification and morphological assessment of various tissue elements have numerous applications in fundamental and clinical research. Digital morphometry, in contrast to other morphologic methods, uses personal computers and specific software, to perform precise and highly reproducible results. Additionally, it delivers results in mathematical format. The aim of our study was to develop an open access digital morphometry method for measuring different parameters of various high contrast tissue elements and to elaborate a general work-around for digital morphometry study and data management.
Materials and methods: We used three different types of tissue samples and staining procedures: (1) Diffuse Large B-cell Lymphoma specimens, (2) various stage liver fibrosis specimens and (3) transversely sectioned skeletal muscle tissue to develop a digital morphometric analysis. Image analysis was performed using ImageJ software.
Results: We developed an intuitive and easy to use work-algorithm that fits generic demands. We split the algorithm into three phases, each requiring a different approach and workaround. Using the presented method we were able to quantify the proportion of CD34 positive areas in the DLBCL specimens, the vascularity of this type of lymphoma may be quantified; similarly, this method is optimal for determining the extension of fibrosis in liver specimens; and finally, morphometric analysis of striated muscle fibers was achieved.
Conclusions: We conclude that the use of ImageJ with semiautomatic color segmentation is a reliable and practical way of performing various morphometric measurements. In addition, we are confident that such methods of digital morphometry could have future applications in other areas of pathology and histology.

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Development of a Simplified Model of the Hippocampal CA1 Pyramidal Neuron

Metz Júlia, Orbán-Kis K, Szilágyi T

Department of Physiology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Introduction: The hippocampus is critically involved in memory formation for facts and events. Beyond its physiological role the hippocampal region is of a particular interest for scientist and clinicians as well because of its low seizure susceptibility threshold and its possible role in Alzheimer’s disease and schizophrenia. The output of the hippocampus is through area CA1 pyramidal cells, thus the characterization of the pathophysiological integrative properties of its principal neurons, the pyramidal cells is of particular interest. Besides the experimental techniques in neuroscience, a large number of computational studies have been published involving CA1 pyramidal neurons.
Aim: The aim of our study was to develop a compartment model of CA1 pyramidal neurons that reproduces the experimentally observed main electrophysiological properties, with low computational effort.
Material and methods: We constructed a compartmental model of a pyramidal neuron with simplified geometry using the NEURON program. Active conductances were implemented in the soma, axon and dendrites.
Results: We compared our model to other computational models and found that it reproduces the main firing properties of the CA1 pyramidal neurons, with a lower computational cost.
Conclusions: Our model is suitable to be incorporated in a larger neural network.

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The Elastographic Aspect of Liver in Pediatric Patients with Hepatopathies and Malignities Versus Healthy Children

Mărginean Oana1, Baghiu Maria Despina1, Brînzaniuc Klara2, Mărginean Claudiu3, Chinceșan Mihaela1, Pitea Ana Maria1

1 Clinic of Pediatrics, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Anatomy and Embriology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Background: Liver injury in context of chronical diseases, including malignacies, obesity, viral hepatitis, drug-related hepatotoxicity is an important concern for practicing pediatricians. The usual (biochemical) parameters for liver assessment prove to be now insufficient. Nowadays there is a high interest for finding non-invasive methods of hepatic evaluation, as an alternative to liver biopsy. Elastography fills a gap, provi-ding information on the degree of hepatic fibrosis.
Objective: Real-time elastographic assessment of liver tissue in correlation with biochemical parameters in children with hepatopathies and malignancies versus healthy children.
Material and method: Between September 15, 2010 and March 15, 2011 we conducted a prospective study in the Ist Pediatric Clinic Tîrgu Mureș, Romania, including a group of children with various malignancies under/after chemotherapy, a group of children with liver diseases (drug-related hepatotoxicity, obesity, hepatitis) and a control group composed of children with normal biochemical parameters. We assessed the liver tissue elasticity, expressed as SWV (shear wave velocity) on elastography, biochemical parameters, then statistical correlations were performed.
Results: Comparing SWV-values between the three groups, higher speeds were found in groups with liver damage after chemotherapy and those with hepatopathies (p=0.04). Aspartate transaminase (AST, IU) and alanine transaminase (ALT, IU) levels were different in a statistically significant manner between the three groups (p=0.0006 and 0.0002 respectively). In the after-chemiotherapy group significant correlations were obtained between elasticity and AST (p=0.0001).
Conclusions: In children with liver damage, SWV (which is correlated with the degree of liver fibrosis) increase in parallel with transaminases.

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The Study of the Maxillary Growth and Primary Fetal Palate Through Multiplanary Three-Dimensional Ultrasound – Skeletal Rendering

Mărginean C1, Brînzaniuc Klara2, Rozsnyai Klára1, Mühlfay Gh3, Horváth Karin4, Mărginean Oana Cristina5

1 Department of Obstetrics and Gynecology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Anatomy, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Department of Otorhinolaringology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
4 Department of Ophtalmology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
5 Department of Pediatrics, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Introduction: This study aims to suggest a new technique for the ultrasound assessment of fetal facial bones at the end of the first trimester and the beginning of the second gestational trimester.
Material and method: The study was conducted over a period of 6 months, between October 2010 and March 2011, on a number of 52 acquired fetal 3D volumes, stocked by the same operator, on fetuses with normal echo structure, from unique pregnancies. The cohort of 52 fetuses had the gestational age between 12–14 weeks. Ultrasonographies were made at 16–17 weeks and 22–24 weeks. The methodology for the evidence of primary palate and maxillary alveolar used a 3D multiplanary ultrasonography technique “Face Reverse View” with Maxi IP and Skeletal Rendering.
Results: Practically, in all volumes the presence of the jaw with alveolar ridge and primarly palate as single, uninterrupted structure has been documented.
Conclusions: The usage of Skeletal Rendering can provide further information at the level of the cranial bone, especially in the first half of pregnancy.

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Seminoma’s Architectural Variants, Immunophenotype and Differential Diagnostic

Loghin Andrada1, Preda O1, Nicolae Alina2, Aneiros J2, Borda Angela1, Nogales FF2

1 Department of Histology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Pathology, San Cecilio University Hospital, Granada, Spain

Introduction: Although rare, representing only 1–2% of all tumours in man, testicular germ cell tumours (TGCT) are the overwhelming majority (98%) of testicular neoplasms among male patients between 15 to 40 years of age. Due to their increasing incidence and the characteristically young targeted population, they become a problem of public health in some developed countries. Classically, TGCTs are classified in three main groups: classical seminoma, non-seminomatous germ cell tumours (pure or mixed) and the spermatocytic seminoma. As SS is a very rare tumour, with a benign evolution, in practice the main differential diagnosis to be made is between seminoma and non-seminomatous tumours. Distinguishing these two categories is essential as the prognostic and the therapeutic approach is very different: if radiotherapy is the main treatment for seminoma, for non- seminomatous tumour a cisplatin based chemotherapy will be proposed.
Material and methods: This study proposes a morphologic and immunohistochemical evaluation of an important number of seminomas emphasising their unusual architectural features.
Results: The majority of the seminomas (46 cases), either pure or as a component of non-seminomatous germ cell tumours, had a solid architecture. We identified syncytiotrophoblasts cells in only one case in conventional stain and 11 cases were associated with a scattered intertubular spread. Eighteen cases showed unusual patterns: tubular-trabecular (9 cases), microcystic areas (5 cases) and 4 seminomas had focal nuclear pleomorphism. Areas of focal or extensive fibrosis and hemosiderin laden macrophages were identified in 4 cases. IGCNU, conventional seminomas and all the unusual architectural variants of seminoma had the same immunoprofile: positivity for PLAP and negativity for AFP and CD30.
Conclusions: Our study confirms the high architectural variability of seminomas, with unusual histological patterns like intertubular, tubular-trabecular, microcystic and pleomorphic. In the great majority of cases, the diagnosis of seminoma relies on the histological pattern in conventional stain. Only few cases may be prone to be diagnostically challenging, including tumours with unusual patterns. In these circumstances, the use of a panel of antibodies is mandatory for a correct diagnosis.

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Pancreas Injury in Shock

Kovács Judit1, Jung J2, Gurzu Simona2, Azamfirei L1, Copotoiu Sanda-Maria1, Copotoiu Ruxandra1, Szederjesi J1

1 Department of Anesthesia and Intensive Care, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Morphopathology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Background: The causes of acute pancreatitis are well known, and although enzymatic injury is the main factor in its development, pancreatic ischemia due to profound hypoperfusion in cardiogenic or hypovolemic shock patients can be an important etiological factor. The aim of our study was to analyse the histological alterations of the pancreas in patients dying after shock, to study the presence and severity of pancreatic injury.
Material and methods: We studied the morphological alteration of the pancreas, in patients who died after cardiogenic or hypovolemic shock, hospitalized in intensive care units in the County Emergency Hospital Tîrgu Mureș, between 2007–2009.
Results: We examined the structure of the pancreas of 117 patients, 20 showed acute hemorrhagic pancreatic necrosis on autopsy. None of the patients showed typical clinical and laboratory signs for acute pancreatitis. The common findings in these patients were prolonged and severe hypotension, leucocytosis, hyperglycemia and hypocalcemia.
Conclusions: Pancreatitis can occur in patients with shock, due to ischemic injury of the pancreas. It is difficult to diagnose it because clinical signs are altered by the severity of the underlying disease or by analgo-sedation commonly used in intensive care units. We therefore recommend to consider the possible development of acute pancreatitis in patients with shock, in patients with prolonged hypotension, leucocytosis, hypocalcemia, even in the absence of characteristic clinical symptoms and hyperamylasemia.

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Atrial Fibrillation In Acute Myocardial Infarction

Macarie C, Năstase-Melicovici D

Institute of Cardiovascular Diseases, Clinic of Cardiology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Background: Although atrial fibrillation (AF) is a common complication of acute myocardial infarction (MI), patients characteristics and association with outcomes remain poorly defined.
Material and method: A prospective study of 341 consecutive patients admitted to the conducted in the Clinic of Cardiology – Institute of Cardiovascular Diseases Tg Mures – from 31 Jan 08 to 31 Dec 10 with ST-segment elevation myocardial infarction. Patients underwent routine clinical exam, lab tests, echocardiogram.
Results: The incidence of atrial fibrillation complicating myocardial infarction was 11.6%. Statistically significant correlations were found between atrial fibrillation and age (p <0.001), smoking (p <0.01), and mitral regurgitation (p <0.05).
Conclusions: Post-MI AF is more common in older patients, in patients with heart failure, and after more extensive infarction. AF is a common complication of acute MI in smoking patients and in patients with significant mitral regurgitation.

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Attitudes and Preferred Information Sources in Medical Students and Family Doctors Regarding Organ Donation and Transplantation

Jung H1, Egyed-Zsigmond I2, Hecser L1, Brînzaniuc Klara3

1 Institute of Legal Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Pathology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Department of Anatomy, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Background: Organ transplantation is a modern treatment for many patients, however current organ shortage determines the need to identify strategies to eliminate barriers and increase organ donation rate. Aim of the study is to determine present and future health care professionals’ attitude and methods of further knowledge acquisition on the topic of organ donation and transplantation.
Material and method: We performed a cross-sectional survey in a study population consisting of preclinical medical undergraduates and of general practitioner doctors, the self administered questionnaires were anonymously statistically analyzed, the association between variables was considered significant for values p <0.05.
Results: One-hundred forty students and 48 doctors participated in our study, both groups showed positive attitude towards organ donation, 81.4% and 68.8% respectively were willing to donate own organs after death. Previous family discussions determined significant change of attitude among students but not within the group of doctors. Formal earlier education on the topic of transplantation was reported by 25% of the students but by none of the doctors. Preferred information channels are medical journal articles in both groups (37.9% vs. 35%), additionally medical students would prefer lectures and seminars while doctors would like to receive information during conferences and congresses. Internet is chosen (30–32%) over classical mass media.
Conclusions: although health care professionals have a natural inclination towards accepting donation and transplantation, providing information is essential in structuring their attitude in the way of promoting an environment that has a positive influence on organ donation rates.

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