Category Archives: Original Research

Retrospective Analysis of Breast Cancer Patient Data for Identification of Candidates for BRCA Mutation Detection

Dénes L1, Stolnicu Simona2, Pap Zsuzsanna1, Bődi Zsuzsanna3, Fail Ágnes3, Pávai Z1

1 Department of Anatomy and Embryology, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Pathology, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Student, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Introduction: Breast cancer is the leading type of cancer affecting women, with an increasing trend of mortality, and a lifetime risk of more than 10%. There are cases of inherited predisposition, which is mostly caused by mutations of the tumor suppressor genes BRCA1 and BRCA2. The objective of this retrospective study is to identify presumptive candidates for BRCA1 mutation carriers using available clinical, histopathological and immunohistochemical data.
Material and method: We processed the available recorded data of 1334 patients diagnosed with breast cancer between the years 2005 and 2010 from the archives of the Pathology Department of the Clinical County Hospital Tg.-Mures. We considered age under 45, histopathological characterization and available immunohistochemical information.
Results: The main selection criteria (age below or equal to 45 years) excluded the majority from further analysis, while 188 cases (12.35%) remained. After performing distribution into histopathological type groups, we looked at the immunohistochemical data. We obtained 19 ER-/PR- negative cases without Her2/neu information, and only 12 cases could be proven to be triple negative, and thus to be considered as primary candidates for BRCA mutation screening.
Conclusions: We identified a very small number of presumptive BRCA mutation carrier candidates. This is due mostly to the fact that the information available comprised macroscopic and classical histopathological data. Immunohistochemical characterization is not widespread, but this shortcoming will be circumvented by prospective reprocessing of the archived biological materials, in order to characterize the BRCA mutation patterns of our population.

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The Evaluation of the Intramyocardial Coronary Microvasculature Subsequent to Heart Transplantation Using Microscopic and Immunohistochemical Methods

Cotoi OS1, Suciu H1, Sin Anca1, Margaritescu C2, Turcu M1, Stolnicu Simona1

1 University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 University of Medicine and Pharmacy, Craiova, Romania

Introduction: This paper presents some histologic and immunohistochemical aspects of the intramyocardial microvascular network performed subsequently to cardiac transplantation in Romanian patients.
Material and method: We investigated a group of 30 heart transplant patients, aged between 12 and 58 at the time of transplantation, with an average age of 39 years, 23 male and 7 female patients. We studied in these patients the affection of the intramyocardial microvascular network subsequently to cardiac transplantation, using histologic and immunohistochemical standard methods. We followed the occurrence of foam cell arteritis at the level of large epicardial coronary arteries, as a direct sign of chronic rejection, lesions detected post-mortem at necropsy.
Results: In our study the most frequently detected microvascular lesions were the endothelial cell alterations, vascular wall thickening and severe perivascular fibrosis. Ischemia and reperfusion lesions with slight microvascular impairment were present in all patients in the first post-transplant biopsies (first 3–6 weeks). Acute cellular rejection developed in 6 patients in the middle and late period, in these cases we detected vasculitis lesions at the level of endomyocardial biopsies. Chronic rejection has affected three patients, who presented lesions at the level of large epicardial coronary arteries, as well as at the level of the small intramyocardial ones, such as wall thickening or perivascular fibrosis.
Conclusion: Subsequent to heart transplantation, small intramyocardial vessels are affected by immunological (rejection) or non-immunological factors (ischemia and fibrosis). Histologic and immunohistochemical study methods applied at the level of endomyocardial biopsies or post-mortem are useful for accurate assessment of small intramyocardial vessels and their involvement in the viability of the allograft.

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Risk of Addiction and Burnout

Copotoiu Monica1, Ioniță Alexandrina2, Copotoiu Ruxandra3, Copotoiu Sanda-Maria3

1 Clinic of Rheumatology, Emergency County Hospital, Tîrgu Mureș, Romania
2 Department of Anesthesia and Intensive Care, Emergency County Hospital, Tîrgu Mureș, Romania
3 Clinic of Anesthesia and Intensive Care, Emergency County Hospital, Tîrgu Mureș, Romania

Background: A significant problem in medical practice is represented by addiction to chemical substances and frequently to alcohol. The impact of addiction to alcohol in medical professions is similar to others, although there are slightly different circumstances.
Aim: To compare the rate of dependence to different substances in several medical specialties.
Material and method: We ran a survey based on a questionnaire to assess the level of burnout in connection to the habit of using chronic medication, coffee, alcohol and tobacco. The respondents were our colleagues, 70 doctors of different backgrounds: 28 anaesthesiologists, 27 general surgeons and urologists, 15 gastroenterologists and internists, but also emergency physicians. Data were processed with Graph Pad Prism 5.0.
Results: We found a moderate risk of burnout both in anaesthesiologists and surgeons. Anaesthetists tended to use chronic medication more then their colleagues (20%). As for alcohol use, the surgeons seemed to be placed in pole position (22.22%). The internists styled themselves as no chronic users whatever the item investigated.
Conclusions: Alcohol use and chronic medication were associated frequently to burnout. It is important to clarify if the dependence is a reaction to occupational stress to certain individuals or not. Due to the limited number of respondents, our results do not entitle us to take them as a model.

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Follow-up in the Surgical Treatment of Tetralogy of Fallot

Căpîlna R1, Harpa M2, Suciu H3, Căpîlna Brîndușa4, Brînzaniuc Klara5

1 Clinic of Cardiovascular Surgery, County Emergency Clinical Hospital, Tîrgu Mureş, Romania
2 University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Clinic of Cardiovascular Surgery, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
4 Clinic of Pediatrics I, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
5 Department of Anatomy and Embriology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Objective: The purpose of this study is to evaluate the early and intermediate results after total correction of Tetralogy of Fallot in 193 consecutive patients, with a mean age of 29 months, who underwent surgical correction in Transplant and Cardiovascular Disease Institute Târgu Mureș between 2005 and 2011.
Methods: The records of these patients were reviewed. Follow-up was obtained through clinical appointments and telephone questionnaires.
Results: One-hundred forty-four (74%) patients underwent single-stage complete repairs; 49 (25%) patients underwent initial palliative operations (systemic-pulmonary shunt), whereas 40 (20%) of them underwent secondary total corrections. Early and late mortality was 2% (n=4) and 2.5% (n=5), respectively. Mean follow-up was 35 months (range: 4 months to 71 months). Respiratory infection was a risk factor for early mortality (p=0.0032). For the reconstruction of the right ventricular outflow tract we used 21 valved conduits, 68 transannular patches and for the others patients right ventricular patches + pulmonary valvuloplasty/valvulotomy. On late postoperative echocardiography, 59 patients presented moderate pulmonary regurgitation, 21 a small residual ventricular septal defect, 4 severe residual dynamic stenosis of RVOT and 5 calcifications of the transannular patch, for whom we carried out 7 replacements of the pulmonary valve and 14 reconstructions of the right ventricular outflow tract.
Conclusions: Surgical repair of patients with simple or complex forms of tetralogy of Fallot can be achieved with low early mortality. Late mortality and the need for reoperation continue to influence the quality of life for these patients.

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Surgical Treatment for Sequelae of Infantile Hemangiomas: Its Role Within the Therapeutic Management of These Tumors

Bulea Raluca1, Enescu DM1,2, Giuvelea Steluţa2, Stoicescu Simona1,2, Alexandru Raluca2, Ioniţă D2

1 Plastic and Reconstructive Surgery Chair, “Grigore Alexandrescu” Emergency Clinical Hospital for Children, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
2 Clinic of Plastic Surgery, Reconstructive Microsurgery and Burns, “Grigore Alexandrescu” Emergency Clinical Hospital for Children, Bucharest, Romania

Introduction: Infantile hemangiomas belong to the group of vascular anomalies. They have a unique evolution pattern: at birth they are usually unapparent, then an explosive growth follows (proliferative phase). For the next 5–7 years, the involutive phase develops, marking a slow regression of the tumor. The final stage is the involuted phase, which may present with residual scars or sequelae.
Material and methods: The purpose of the present study is to assess the place and role surgical treatment has within the complex therapeutic management of IHs in the stage of sequelae.
Results: During a period of 30 months, we selected 21 children that met our including criteria; the average follow up was of 9 months. Only three patients received no treatment at all during early childhood. Indications for surgical treatment in the stage of sequelae were alopecia, the presence of bulky masses, unaesthetic facial scars, retractile scars, ectropion, pain and functional impairment on the fingers and foot.
Conclusions: Our study has shown that surgical correction can lead to significant improvement of the patient’s appearance and of the functions affected by the hemangioma’s sequelae. For medium sized sequelae, the lenticular excision is the best way to diminish the residual scar. In the case of large sequelae, seriate excision represents a better approach, using sometimes more specific plastic surgery techniques, like local flaps, Z plasty or tissue expansion.

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Study on the Resuscitations Performed in the Emergency Department of the Clinical Emergency County Hospital from Târgu Mureș in 2009

Bratu Simona¹, Copotoiu Sanda-Maria2,3

1 UPU-SMURD, County Emergency Clinical Hospital, Tîrgu Mureş, Romania
2 University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Department of Anesthesia and Intensive Care, County Emergency Clinical Hospital, Tîrgu Mureş, Romania

Objectives: The study assesses the results of the cardiac arrest resuscitations performed by the medical staff of the Emergency Department of The Clinical Emergency County Hospital from Târgu-Mureş in the year 2009.
Method: We conducted a prospective study between 01.01-31.12.2009, including the cardiac arrest cases occurred in the ED or brought with ongoing resuscitation from the pre-hospital setting. For the statistical study we used SPSS program, version 17; the χ2 tests and p values were determined to compare the data.
Results: We had a total of 186 cases of cardiac arrest, representing 0.47% of the total 39.074 patients assisted in the ED in 2009. The gender distribution of the cases showed a higher incidence in male (61%) and the most affected age groups ranged between 60–80 years. The patients with cardiac arrests presented various diagnosis: the highest incidence is acute coronary syndrome 32 patients (17%), followed by sepsis/MSOF 20 (11%), pneumonia/asthma 17 (9%), pulmonary embolism 17 (9%), stroke 13 (7%), etc. We have resuscitated successfully 42 patients, representing 22.58 % of the total 186 cases. All 42 patients were transferred to the hospitals departments. Out of the hospitalized patients, 25 died later on the wards and 17 (40.47%) survived and were discharged home, 6 from the Intensive Care Department and 11 from the Coronary Unit.
Conclusions: The results are comparable with the reported international data. The cases with cardiac arrest due to acute coronary syndrome, ventricular rhythms and those witnessed and treated early in the ED are having a better outcome.

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The Prevalence of Supernumerary Teeth in a Group of Patients in Western Romania

Bratu Dana Cristina1, Bratu E2, Păcurar Mariana3, Popa G1, Pop Silvia3

1 Department of Paedodontics and Orthodontics, Faculty of Dentistry, “Victor Babes” University of Medicine and Pharmacy, Timişoara, Romania
2 Department of Implant Supported Restorations, Faculty of Dentistry, “Victor Babes” University of Medicine and Pharmacy, Timişoara, Romania
3 Department of Paedodontics and Orthodontics, Faculty of Dentistry, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Objective: The objective of this article is to study the types of supernumerary teeth and their prevalence in a group of patients in Western Romania.
Material and methods: The study group consisted of various patients, who attended the Department of Paedodontics and Orthodontics, Faculty of Dentistry, Timişoara, Romania. The number, location, classification, bilateral symmetry and impaction of supernumerary teeth were evaluated. Furthermore, we evaluated the development of these teeth and we also established the therapeutic decision for each clinical case. Final diagnosis was based upon clinical examination, occlusal radiographs, panoramic radiographs or cone beam CT.
Results: From a total of 700 examined patients, with mixed and permanent dentition aged between 6 and 13 years, 21 (3%) patients had supernumerary teeth. A total of 25 supernumerary teeth were recorded. The distribution of supernumerary teeth according to jaws showed a higher prevalence in the maxilla: 80% (n=20) were located in the upper jaw, while 20% (n=5) were found in the mandible. In the upper arch, the most frequent supernumerary teeth were the lateral incisors 45% (n=9), followed by the central incisors (mesiodentes) 35% (n=7). Smaller percentages were located in the premolar region 15% (n=3) and distomolar region 5% (n=1). The distribution of supernumerary teeth according to bilateral symmetry was 24% (n=6) bilaterally and 76% (n=19) unilaterally. Regarding their status, the majority of the supernumerary teeth, 96% (n=24) were erupted and only 4% (n=1) were impacted, being associated with the failure of eruption of the left central incisor. Tooth extraction was the treatment of choice in 100% of the cases. Most of the supernumerary teeth, 96% (n=24) were completely developed and only 4% (n=1) showed an incomplete root.
Conclusions: The prevalence of supernumerary teeth in this study was 3%. This result is comparable to similar studies in the literature, among Caucasians. Future research is required to evaluate a larger group of patients.

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The Use of Surgical Lasers in the Treatment of Oral Leukoplakia

Bögözi B1, Bocskay I2

1 Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Odontology and Parodontology, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Introduction: Surgical lasers are more and more often used in our days in medicine, including oro-maxillo-facial surgery. Because of their many advantages the application of surgical lasers became the elective method in the surgical treatment of oral leukoplakia – according to the recomandation of the WHO.
Material and method: In this paper two clinical cases are presented showing the methods and advantages of using surgical lasers in the treatment of oral leukoplakia. For the surgery a 15 W maximum power Biolitec diode laser was used.
Results and conclusions: The ideal haemostasis during surgery; the shortened intervention (and through this the reduction of physical an psychological stress of the patient); minimal scar tissue formation; the unnecessity to cover sometimes important postoperative defects, reduced risk of dissemination of modified cells are such advantages of the use of surgical lasers, that eliminate the difficulties of classic surgical techniques and lead to spreading of a new concept in the surgical treatment of premalignant lesions of the oral mucosa.

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Clindamycin — an Option for Antibiotic Prophylaxis In Arthroplasty

Bod P, Kurtus I, Incze S, Moldovan Rodica, Vâlcu A, Nagy Ö

Orthopaedics and Traumatology Clinic, Emergency County Hospital, Tîrgu Mureş, România

Introduction: Generally joint arthroplasties, but especially hip arthroplasties, are perhaps the most widespread types of orthopedic surgeries. These types of interventions are special because of the possibility of bacterial complications occurring due to the implant.
Material and method: Between 2008–2009 a total of 48 patients were administered Clindamycin 600 mg iv, as antibiotic prophylaxis, specifying that administration was performed according to the international protocol. During follow-up we monitored the efficiency of perioperative antibiotic prophylaxis in patients by determining the C-reactive protein and the erythrocyte sedimentation rate.
Results: The patients’ postoperative evolution at the site of the surgical wound presented no complications, except two cases of wound dehiscence caused by superficial hematoma which were subsequently solved with a secondary suture.
Conclusions: Clindamycin is used for preventive purposes especially in those protocols where beta-lactam allergy occurs. Clindamycin can also be used instead of cephalosporins in perioperative antibiotic prophylaxis. Our results are in accordance with those met in the speciality literature.

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FLT3 Internal Tandem Duplication and D835 Mutations in Acute Myeloid Leukemia

Bănescu Claudia1, Dobreanu Minodora2, Duicu Carmen3, Benedek I4, Macarie I5, Köpeczi Judit4

1 Department of Genetics, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Clinical Biochemistry, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Pediatric Clinic, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
4 Hematology Clinic 2, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
5 Hematology Clinic 1, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Introduction: FLT3 is a member of receptor tyrosine kinases expressed in leukemic cells. Internal tandem duplications (ITDs) and D835 mutations in FLT3 tyrosine kinase receptor have been shown to confer a bad prognosis in acute myeloid leukemia (AML). The aim of the present study was to determine the incidence of both ITD and D835 mutations in the FLT3 gene, in patients with AML from Tg-Mures, Romania.
Materials and methods: DNA was obtained from peripheral blood samples. ITDs were investigated by polymerase chain reaction (PCR). D835 mutations were analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), with the digestion of restriction endonuclease EcoR V. The amplified and restricted products were finally electrophoresed on agarose gel stained with ethidium bromide.
Results: Alterations in the FLT3 gene were detected in 8 patients out of the 23 cases analyzed. These aberrations included ITD in 4 cases, D835 mutations in 2 cases and both types of alteration (ITD + D835) in 2 patients.
Conclusion: In this study we demonstrated that FLT3 mutations are frequent molecular abnormalities in AML patients with an incidence of 34.8%. Although our data do not support its value as a prognostic factor in AML patients because of the small cohort, further investigation is required.

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