Category Archives: Original Research

Primary Surgical and Non-surgical Treatment of Advanced Stage Laryngeal and Hypopharyngeal Carcinomas

Koltai P1,2, Lengyel Cs1, Remenár Éva1, Boér A1, Kásler M1,2

1 Department of Head and Neck Surgery, National Institute of Oncology, Budapest, Hungary
2 School of Doctoral Studies, University of Medicine and Pharmacy, Târgu Mureș, Romania

In the past two decades, according to studies published in the early ’90s, the standard treatment of advanced laryngeal and hypopharyngeal carcinomas has been changed: instead of radical surgery, larynx-preserving methods came into view. To evaluate our results with this new approach we conducted a retrospective study summarizing the treatment data of the patients who received non-surgical (n=44) or surgical (n=207) therapy for their advanced, resectable laryngeal or hypopharyngeal cancer in the National Institute of Oncology between 2002 and 2007. Non-surgical treatment consisted of platinum base chemoradiotherapy plus salvage surgery if needed, while surgical treatment patients underwent laryngectomy with or without neck dissection followed by radiotherapy or chemoradiotherapy. With non-surgical treatment, the one-year laryngoesophageal dysfunction (LED) free survival (the patient is alive with functioning larynx without local relapse, tracheostomy or feeding tube) is 82.9% (SD=0.0592), at 24 months 79.8% (SD=0.0645). Non-surgical treatment proved to be beneficial regarding distant metastases as well (9.09% in non-surgical and 27.08% in surgical group at two years, respectively). Formation of a second primary tumor was more frequent in the non-surgical group (11.36% vs 8.33%). There was no significant difference in overall survival between treatment groups when stratified according to primary tumor site and stage. The results of larynx preserving treatments conducted in our Institute are similar to those published in the literature, confirming this method as standard therapy in this group of patients.

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Association Between Tooth Agenesis and Polymorphisms of FGFR1, IRF6, MSX1 and PAX9 Genes in Patients from Tîrgu Mureş

Kerekes-Máthé Bernadette¹, Jobbágy-Óvári Gabriella², Székely Melinda¹, Cămărăşan Alina¹, Borş Andreea¹, Mucenic Simona¹, Varga G²

1 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 Mureş, Romania
2 Department of Oral Biology, Semmelweis University, Budapest, Hungary

Aim: Tooth agenesis is the most prevalent congenital malformation in humans. Many studies showed the importance of genetic factors in the emergence of tooth agenesis. MSX1, PAX9, PVRL1, IRF6, FGFR1, AXIN2 are genes involved in tooth agenesis. In this study we attempted to determine genetic traits data of patients from Tîrgu Mureş regarding tooth agenesis.
Material and method: Thirtyfour patients with tooth agenesis and 51 healthy volunteers were examined. Oral mucosal scrapings were collected from all the subjects. DNA was isolated and a genotyping experiment was performed. The procedures included four single nucleotide polymorphisms (SNPs): PAX9 -912 C/T, MSX1 3755 A/G, FGFR1 T/C, and IRF6 A/G.
Results: Besides the dominant allele, we observed the presence of the rare allele as well in each investigated polymorphism. There was a statistically significant difference in the distribution of the FGFR1 T/C gene polymorphisms between the two groups (p=0.02). Differences in the distribution of the IRF6, MSX1 and PAX9 gene polymorphisms were not significant statistically (p>0.4).
Conclusions: Our study showed, that FGFR1 T/C (26190464) polymorphism is a significant risk factor for non-syndromic tooth agenesis, preferential premolar agenesis. PAX9 and MSX1 gene may be associated with syndromes that include tooth agenesis. Further investigations are needed.

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Carotid Angioplasty with Autologous Facial Vein

Jerzicska Ernő, Fărcaș Felix, Győrbíró László

Clinic of Cardiovascular Surgery, County Emergency Clinical Hospital, Tîrgu Mureș, Romania

Introduction: Carotid endarterectomy (CEA) is the „gold standard” for the treatment of carotid stenosises. In this study we evaluate the results after using an alternative patch material for arteriotomy closure.
Material and methods: This study is a retrospective, observational study, in which we have compared 2 groups of 8 patients operated on in our clinic between 2008–2012, the first group of 8 patients with CEA and facial vein patch, the second group of 8 consecutive patients with CEA and PTFE patch.
Results: In the A group there were 6 males, in the B group 5 males. Group A had a median age of 60 years, group B had a median age of 60.5 years. All patients were operated for severe carotid stenosis. We evaluated the time of surgery, which varied for group A between 70 and 85 minutes, with a median of 77 minute, for group B between 75 and 100 minutes, with a median of 88 minutes. We observed a significant difference between the 2 groups regarding the time of surgery, in favour of group A (p=0.010).
Conclusions: The advantages of a autologous venous material are represented by endothelised patch, reduction of desendothelised area, higher resitance to infections. The use of facial vein for endarterectomy patch needs the same incision, elevating the cost-efficency of the procedure, and significantly reduces the operating time compared with PTFE due to a faster achievment of haemosthasis.

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New Onset Diabetes Mellitus in Heart Transplant Recipients

Ispas Mihaela, Deac R, Maloș Mihaela, Chincișan Carmen, Bonț Alexandrina, Scripa Ernestina, Hadadi L

Emergency Institute of Cardiovascular Diseases and Transplantation, Tîrgu Mureș, Romania

Introduction: New onset diabetes mellitus in patients with heart transplant is a known complication with importance in the long term survival.
Material and methods: We have studied the incidence of new onset diabetes in a group of 38 patients with heart transplant that are included database of Emergency Institute of Cardiovascular Diseases and Transplantation, Tîrgu Mureș, between 1999–2011.
Results: The incidence of new onset diabetes was of 24.32% in the 1st month of posttransplant evolution, 22.58% at 1 year of evolution, 18.18% at 3 years of evolution and 10% at 5 years of posttransplant evolution. We have studied these posttransplant complications in relation with the risk factors and the most important complications in the evolution of these patients.
Conclusions: New onset diabetes in heart transplant recipients is a serious complication with high incidence and with serious implications in their evolution, requiring an accurate screening of the recipients in the waiting list and a periodical posttransplant evaluation, an early detection and a prompt and efficient treatment.

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Obesity and Insulin Resistance Status: The Impact of Using Different International Growth Standards in Romanian Children

Duncescu Corina1, Mărăzan Monica1,2, Chirita-Emandi Adela1, Craioveanu Teodora2, Dăescu Camelia1,2, Sabău I2, Micle Ioana1,2

1 “Louis Ţurcanu” Emergency Hospital for Children, Timişoara, Romania
2 1st Pediatric Clinic, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania

Introduction: Worldwide, childhood obesity is on the rise. A lot of debate exists within the scientific community regarding the best way to define overweight and obesity in different populations. Currently, three sets of growth references are in use internationally: the 2007 World Health Organization (WHO) growth standards, the International Obesity Task Force (IOTF) reference, and the 2000 Center for Disease Control and Prevention (CDC) growth charts. We examined the impact of using these international growth references on diagnosing obesity in a group of overweight and obese Romanian children. Afterwards, we evaluated the relationship between diagnosed obesity and insulin resistance status.
Material and method: We studied retrospectively the observation charts of children who had their insulin levels tested in our hospital’s laboratory between January 1st 2008 and December 31st 2009. The study population consisted of 76 children. We analyzed: age, gender, body mass index (BMI), the homeostatic model assessment: insulin resistance (HOMA-IR). We divided the children into two categories according to their HOMA-IR values. We used each of the standards and grouped the study population into two BMI groups: overweight and obese. We used One-Way ANOVA to evaluate the differences between the three definitions.
Results: We found significant differences between the WHO and the IOTF and CDC references. The WHO standards identified the least overweight children with insulin resistance.
Conclusions: Our study shows that using WHO growth standards may be the proper method to diagnose obese children. A large populational study is needed to establish the proper growth references for our population.

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The Use of Heterologous Bovine Pericardium in the Closure of Bronchial Stump After Lung Resections, Experimental Study

Bud V1, Suciu B1, Copotoiu Ruxandra2, Sin Anca3, Cotoi O3, Butiurcă V4, Cordos B5, Brânzaniuc Klara6, Copotoiu C1

1 1st Surgical Clinic, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
2 ICU, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
3 Department of Anatomopathology, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
4 Student, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
5 Veterinarian, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
6 Department of Anatomy, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: There are many authors who have devoted their time and expertise to find creative ways for an ideal suture of bronchial stump. Despite their efforts, the bronchial fistula rate reported in the specialty literature remains high, between 2–16%, depending on the author. There are two methods for closing bronchial stumps: manual and mechanical suture. The aim of this study was to experiment a new technique for closing bronchial stumps after lung resections.
Material and method: In order to carry out this study we used 15 common rabbits. We performed left inferior lobectomy in these rabbits. These rabbits were divided into three groups according to the methods used to close the bronchial stump. We used three methods for closing the bronchial stump: simple running suture, suture of the bronchial stump using two vicryl mesh patches and suture of the bronchial stump using two heterologous bovine pericardial patches.
Results: We did not notice any cases of bronchial stump fistula. The most important changes that appear during the bronchial stump healing are: inflammatory response, angiogenesis, hyperplasia of the smooth muscle fibres, migration of fibroblasts and fibrogenesis.
Conclusions: Healing signs appeared on all examined samples, but they were more intensive in the group where we used the heterologous bovine pericardium for closing the bronchial stump. Some further studies are necessary to examine the effectiveness of the use of heterologous bovine pericardium to protect the bronho-anastomosis.

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Wound Healing Problems in Revision Hip Arthroplasty

Bod P1, Kurtus I1, Incze-Bartha S1, Băţagă T2

1 Orthopedics and Traumatology Clinic, County Emergency Clinical Hospital, Tîrgu Mureş, Romania
2 Orthopedics and Traumatology Clinic, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Background: Per primam healing of surgical wound is obligatory for good results after arthroplasty. Surgical wound complications can lead to deep periprosthetic infection, therefore a devastating complication. Surgical wound healing is affected by multiple factors related to underlying disease, patient comorbidities, lifestyle, nutrition and associated medications. If these are combined, the risk of periprosthetic infection is greater.
Material and methods: We studied wound healing problems on 57 cases of revision hip arthroplasties performed between 2008–2010. The wounds were monitored daily, and the changes were noted and scored.
Results: All the 57 patients presented various predisposing factors for wound healing complications, 12 patients (21.05%) had a two-stage revision and 11 patients (11.29%) presented wound healing problems.
Conclusion: Per primam wound healing is a basic requirement in hip arthroplasty. Any change noted during wound healing should be treated seriously.

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The Prognostic Value of AKIN and RIFLE Classifications in Acute Renal Failure Developing After Cardiac Surgery

Baloş S1, Baloş Monica2, Suciu H3, Deac R3, Kovács Judit4

1 Cardiovascular Surgery, County Emergency Clinical Hospital, Târgu Mureş, Romania
2 Department of Prosthetic Dentistry and Oral Rehabilitation, Faculty of Dental Medicine, University of Medicine and Pharmacy, Târgu Mureş, Romania
3 Department of Cardiovascular Surgery, University of Medicine and Pharmacy, Târgu Mureş, Romania
4 Department of Anesthesia, Intensive Care and Emergency Medicine, University of Medicine and Pharmacy, Târgu Mureş, Romania

Background: Renal dysfunction is common after cardiac surgery, ranging from minor changes in serum creatinine without clinical manifestations to frank anuria and severe metabolic dysfunction. In recent years two scores were developed to diagnose renal dysfunction. The aim of our study was to compare the prognostic value of these scores in acute renal failure associated with cardiac surgery.
Materials and methods: In our prospective clinical observational study we calculated and compared the AKIN (Acute Kidney Injury Network) and RIFLE (Risk, Injury, Failure, Loss, Endstage kidney disease) scores in 178 patients undergoing open heart surgery at the Clinic of Cardiovascular Surgery in Târgu Mureș, Romania, between October 1, 2010 and March 31, 2011, and studied the morbidity and mortality in patients with renal dysfunction in terms of these scores.
Results: According to AKI criteria, we identified 39 patients having high risk for developing renal injury (stage I) (with 16 cases more than with RIFLE criteria, class R), but we observed no differences in the number of renal dysfunction (28 patients) or renal failure (18 patients). The patients enrolled in high risk group according to AKI score, but not with RIFLE criteria, had a good outcome with diuretics and avoidance of nephrotoxic agents. Two patients needed renal replacement therapy, both of them were classified in the renal failure group. Mortality was higher in renal failure according to both RIFLE and AKI criteria.
Conclusions: AKI criteria are more sensitive in identifying patients at risk for renal injury, but the RIFLE criteria are more accurate in the estimation of postoperative morbidity and mortality.

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The Predictive Value of Mannheim Score in Patients with Colon Related Peritonitis

Teleanu G¹, Iordache F², Beuran M2

1 General Surgery Clinic I, Clinical Emergency Hospital Floreasca, Bucharest, Romania
2 Faculty of Medicine, University of Medicine and Pharmacy, Bucharest, Romania

Introduction: The aim of this study, is to confirm the predictive value of the Mannheim peritonitis index at the patients with colonic peritonitis.
Material and method: From January 2003 to October 2007 in Surgical Department of Emergency Hospital Bucharest, 98 cases were studied and the patients were divided into two groups according to the Mannheim Peritonitis Index value 24.
Results: A life table was constructed to compare patients survival rate. Patients with Mannheim Peritonitis Index less than or equal to 24 had a mortality not reach 6% and patients with Mannheim Peritonitis Index greater than 24 had a mortality rate of 45%.
Conclusions: The Mannheim Peritonitis Index is a useful method to determine study group in patients with colonic peritonitis. He has a predictive value of outcome at the patients with colonic peritonitis.

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The Usefulness of Magnifying Chromoendoscopy with Methylene Blue in the Detection of Specialized Intestinal Metaplasia and Dysplasia in Barrett’s Esophagus — a Preliminary Report

Pascarenco Ofelia¹, Dobru Daniela¹, Boeriu Alina¹, Brusnic Olga¹, Galeanu Iuliana², Onisor Danusia³, Stoian M4

1 Department of Gastroenterology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Gastroenterology, Municipal Hospital, Câmpulung Moldovenesc, Romania
3 Department of Gastroenterology, Municipal Hospital, Luduș, Romania
4 Department of Intensive Care, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Background: Barrett’s esophagus appears in relation with gastroesophageal reflux disease, which damages the normal squamous mucosa; the injury heals through a metaplastic process in which columnar cells replace squamous ones. The specialized intestinal metaplasia has a malignant potential, but the diagnosis is often difficult in conventional endoscopy.
Aim: Our purpose was to evaluate the results of magnifying chromoendoscopy using methylene blue in the diagnosis of specialized intestinal metaplasia and dysplasia in Barrett’s esophagus.
Methods: Nine patients with proven or suspected Barrett’s esophagus in conventional endoscopy underwent magnified chromoendoscopy with methylene blue for confirming and/or monitoring the intestinal metaplasia or for detecting dysplasia. Biopsies were taken from sites coloured with methylene blue and from regions with particular patterns according to Endo’s classification.
Results: Specialized intestinal metaplasia was reported in 16 out of 29 biopsies; one biopsy proved low grade dysplasia and two samples showed indefinite for dysplasia. The sensitivity and specificity of methylene blue staining in detection of specialized intestinal metaplasia were 87% and 66% respectively (p=0.005). Taking into consideration Endo’s classification, tubular and villous patterns had a significant correlation with SIM detection (p=0.0004) with a sensitivity and a specificity of 66% and 100%.
Conclusions: Magnifying chromoendoscopy with methylene blue allows targeted biopsies for SIM and dysplasia detection; it also allows the selection of the site of the biopsy according to pitpattern.

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