Category Archives: Original Research

Correlation Between Postoperative Cervical Haematoma in Carotid Surgery and Antiplatelet Treatment

Jerzicska Ernő, Fărcaș Felix, Győrbíró László

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

Introduction: Cervical haematoma is one of the local complications of carotid endarterectomy. Cervical haematoma may determine oesophageal compresion or tracheal deviation. We evaluated the correlation between cervical haematoma and preoperative antiplatelet treatment.
Material and methods: We evaluated retrospectively 100 consecutive patients operated with carotid endarterectomy between 2009 and 2011. Group A of 48 patients had monoantiaggregant preoperative treatment, group B of 52 patients had dual preoperative antiaggregant treatment.
Results: We observed cervical haematomas in 16 patients from the total of 100, 13 of them being in group B. Evaluation of age, sex, surgical technique and local drainage showed no differences between the two groups. The group with monoantiaggregant preoperative treatment had a smaller chance to develop cervical haematoma (p=0.022).
Conclusions: Preoperative antiplatelet treatment is crucial for a succesful carotid endarterectomy procedure. We sustain the use of monoantiaggregant preoperative treatment, which is associated with less cervical haematomas as a local haemorrhagic complication, instead of dual antiaggregant preoperative therapy.

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Laparoscopic Transperitoneal Adrenalectomy for Patients with Previous Abdominal Surgery

Ganescu Roxana1, Paun S1, Beuran M1, Vartic Mihaela1, Paun Diana2, Dumitrache C2

1 Emergency Hospital, Bucharest, Romania
2 ”C.I. Parhon” National Institute of Endocrinology, Bucharest, Romania

Background: Adrenal surgery has been radically changed by laparoscopic approach and we wonder whether the increase in the number of adrenalectomies is entirely justified by better understanding of the pathology and a developed diagnosis method. The type of approach (transabdominal/retroperitoneal) remains still a mater of surgeon’s experience.
Method: In past 6 years we performed 152 laparoscopic adrenalectomies by transperitoneal approach, 24 of them having previous significant abdominal surgery (cholecistectomy, gastric surgery, colectomy, bowel obstruction, exploratory laparoscopy, adrenalectomy). The patients had a variety of adrenal pathologies like Cushing’s disease, Cushing’s syndrome, Conn’s syndrome, incidentaloma, pheochromocytoma and even carcinoma.
Results: Three cases were converted to open approach, only one because of the adhesions. Reasons for conversion were also: spleen infarction and a difficulty in mobilizing the tumor. Operating time was not significantly prolonged because of the adhesions (40–360 min, median time 127 min). Postoperative evolution was simple, with no morbidity or mortality and a fast recovery.
Conclusions: Choosing the type of approach is related to surgeon experience, although 79–94% of surgeons prefer the transabdominal lateral approach. We believe that with an experienced surgical team there is no difficulty in performing adrenalectomy by transabdominal approach, with no significantly prolonged operating time, even when the patient had previous abdominal surgery.

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Particularities of Doctor-Patient Communication, Assessed in 6 Romanian Ambulatory Practices

Gáspárik Andrea Ildikó1, Ábrám Z2, Albert-Lőrincz Enikő3, Török Kinga1

1 University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Hygiene, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Social Work Department, Babeș-Bolyai University, Cluj Napoca, Romania

Introduction: The way doctors collect data, explore patient concerns, discuss and explain the diagnosis will influence the patients’ comfort, satisfaction, attitude and adherence to medical treatment and even their health outcomes. Our aim is to assess structure and patterns of doctor-patient communication in Romanian ambulatory practices.
Materials and methods: We included in our analysis 69 doctor-patient meetings in 6 outpatient clinics (five different specialities, state and private practice), taking place in 3 Romanian cities. Data collection was carried out by non-participatory observation of the time-structure of visits (anamnesis, examination, explanation of diagnosis, treatment-, and lifestyle recommendation, administrative works), proportion of talks and reports belonging to the parts, number of questions asked by each part, and non-verbal behaviour, helping the patient feel comfortable during the visit.
Results: The average length of the meetings was 7.41 minutes. Discussions are less representative in Romanian medical practice. Patients were let to speak about their problems 7 seconds, without interruptions. Administrative duties (registering, writing) took 27% of the time, 42% was represented by examination (physical and instrumental). Explaining diagnosis and treatment accounted for 5% and 9% respectively. There were two doctors (of six) showing different gestures to help the patient feel comfortable during the consultation. Doctors talked 3 times more than patients and had in average 6 questions compared to less than one question, formulated by the patients. Lifestyle recommendations were observed in 2 cases (of the 69).
Conclusions: Although the international literature describes a shift in the doctor’s and patient’s attitude from the traditional paternalistic model towards a partnership, where patients assume a more active role in their healing process, our data suggest a doctor-patient relationship strongly dominated by doctors, a passive behaviour of patients, actually a free-will subordination to the doctor’s high-status (no or few questions, no willingness to participate in decision making).

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Electrophoretic Separation of Proteins from the Drain Fluid by Geometric Electrofocusing in Conjunction with Local Complications in the Surgical Patient

Cozma D¹, Stoian M2, Bacârea Anca3, Ieva Alina4, Iacob Oana3, Şchiopu A3, Copotoiu C1

1 Surgical Clinic 1, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
2 Clinic of Anesthesia and Intensive Care, County Emergency Clinical Hospital, Tîrgu Mureş, Romania
3 Department of Pathophysiology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
4 School of Doctoral Studies, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Introduction: Local postoperative complications are affecting the evolution of surgical patients, which is the main reason why early diagnosis is a priority concern. Our objective was to
Objective: To study the opportunity of protein analysis of the proteins from the drain fluid, as evolution markers of the surgical patient.
Material and method: We have analyzed drain fluid collected after 24 h, 72 h and 5 days after surgery. We have used the following: determination of protein concentration by spectrophotometric analysis at 280 nm and protein separation by geometric electrofocusing (patent no. 109585C1/30.03.1995)
Results: From the analyzed liquids, we obtained variable protein concentrations. In all cases, electrophoretic separation showed the presence of protein fractions similar to those of reference serum.
Conclusion: The analysis protocol allows precise quantitative determination of the proteins from the drain fluid. Geometric electrofocusing, approached for the first time for this specific type of analysis, has proved to be highly effective in terms of quality and affordable due to the low cost.

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Efficacy of Electroresection with the Diathermy Loop for the Treatment of Cervical Intraepithelial Neoplasia

Colțescu F1, Rădulescu Carmen2, Grama O2, Rădulescu C2

Introduction: Recent improvements in the understanding of the natural progression of cervical intraepithelial neoplasia (CIN) and in the knowledge of the treatments of pregnancy related morbidity, in addition to the progression of mean age of first pregnancy, brings out the need to rethink CIN management. There are currently two different modalities in the treatment of cervical dysplasia: local destruction and excision (loop diathermy, cold-knife conisation and laser conisation). The loop electrosurgical excision procedure (LEEP) is the most commonly used technique today for the practice of conisation, regardless of the lesion’s size or level of junction in the endocervix. The aim of our study was to analyse the efficiency of LEEP and the incidence of complications in the per- and post-operative period.
Material and method: We enrolled 49 hospitalized patients who underwent loop diathermy excision of the cervix, in a period spanning two years between January 2009 and December 2011 at the Hospital Saint Die in France.
Results: As far as grading is concerned, 2 patients were CIN 1 (4.54%), 18 were CIN 2 (40.9%) and 24 were CIN 3 (54.54%). In 41 cases (93.18%) the resection was done within safety margins – healthy tissue, in three cases (6.12%) the excision was incomplete. Five patients referred to hospital with postoperative bleeding.
Conclusions: In our experience LEEP could be considered the treatment of choice for cervical dysplasia when colposcopy is satisfactory, because it is effective, simple, fast, inexpensive, unaggressive, has a low morbidity and it permits adequate pathological examination.

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Relationship Between Genotypes of Hepatitis C Virus and the Progression to Cirrhosis in Chronic Hepatitis C Patients

Colțescu Camelia1, Doffoel M1, Habersetzer F1, Oltean G2, Copotoiu Ruxandra3, Georgescu D4, Bățagă Simona4

1 Department of Hepato-gastroenterology, Faculty of Medicine, University Louis Pasteur, Strasbourg, France
2 Department of Internal Medicine, Medical Clinic 1, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Department of Anesthesiology, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mures, Romania
4 Department of Gastroenterology, Medical Clinic 1, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Objective: To assess the influence of the identified genotype on the stage of liver fibrosis at hepatitis C identification and at the 5 years follow up.
Methods: In our retrospective study we enrolled 126 patients with Hepatitis C admitted to the Gastroenterology Unit at the Nouvel Hopital Civil in Strasbourg, France between October 2006 and December 2011. All patients had detectable serum HCV-RNA and had not been transplanted during the 5 years surveillance period. The data collected were analyzed with GraphPad Prism Demo for descriptive and inferential statistics and with StatMate2Demo for power analysis.
Results: In our retrospective study we enrolled 126 patients. Genotype distribution was as follows: genotype 1a, n=23 (18.25%); genotype 1b, n=48 (38.10%); genotype 2, n=17 (13.50%); genotype 3, n=18 (14.29%) and genotype 4, n=20 (15.86%). Fibrosis at diagnosis and follow up was not influenced by the genotype (odds ratio ranging from 0.395 to 5.147 but with a 95% CI below 1), except genotype 1b (odds ratio 2.093 [1.008; 4.348] at follow up).
Conclusions: There is no association between a particular HCV genotype and the fibrosis stage as defined by transient elastography.

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Glycyrrhiza glabra and Glycyrrhiza echinata — Sources of Low Hemotoxic Saponins

Canciu-Dobrea Carmen1, Kaycsa Adriana2, Dehelean Cristina3, Şoica Codruţa4, Antal Diana1

1 Department of Pharmaceutical Botany, Faculty of Pharmacy, “V. Babeş” University of Medicine and Pharmacy, Timişoara
2 Department of Biochemistry, “V. Babeş” University of Medicine and Pharmacy, Timişoara
3 Department of Toxicology, Faculty of Pharmacy, “V. Babeş” University of Medicine and Pharmacy, Timişoara
4 Department of Pharmaceutical Chemistry, Faculty of Pharmacy, “V. Babeş” University of Medicine and Pharmacy, Timişoara

Introduction: Glycyrrhiza glabra L. (licorice) is one of the most used medicinal plats as an expectorant, anti-inflammatory, anti-ulcer, sweetener, antioxidant, antibacterial, antiviral, antimycotic or anti-tumor agent. In our country G. echinata (Russian licorice) is the dominant species of the Glycyrrhiza genus. Several substitution cases were reported between G. glabra and G. echinata in the last years. The aim of this study was to evaluate the surface-active properties, related to the potential toxicity of Russian licorice, using the medicinal species G. glabra as standard. Material and method: Tests were performed according to the methods described by valid Pharmacopoeias. The foam index was identified (FI), followed by the evaluation of haemolysis capacity. A spectrophotometric method, more sensitive than the haemolytic index (HI) was used to determine the 50% haemolytic dose (HD50) of the two vegetal products, ammoniacal glycyrrhizate and G. echinata saponins.
Results: Glycyrrhiza echinata (FI 400; HD50 = 9153±210 μg/ml), G. glabra (FI 250, HD50 = 12382±172 μg/ml) and the tested saponins (ammoniacal glycyrrhizin HD 50 = 63.25±1.4 µg/ml and G. echinata saponins HD50 = 42.5±1.2 μg/ml), had low haemolytic capacity.
Conclusions: The surface-active properties of the tested vegetal products and substances do not create an impediment when using small amounts of the product, creating the perspective of new research on the use of saponins isolated from G. glabra and G. echinata as possible ingredients in parenteral formulation.

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Effects of Generic Medicines Containing Losartan on Health Care Budget in Hungary 2007–2010

Berényi K, Szabó I, Horváth T, Ember I

Institute of Public Health Medicine, University of Pécs, Hungary

Background: Under the legislation which came into force in 2007 (act XCVIII of 2006) regarding several drug-economical regulations, such as the improvement of market share of generic drugs, should have to led to decreased health care expenditures. This study illustrates an exception. Our study’s objective is to highlight a possible cost-increasing effect of the aforementioned law, and to bring the legislators’ attention to the latent problems in our health care system.
Materials and methods: We have used the databank of the National Health Insurance Fund (NHIF) in our analysis. The analysed active substance was selected due to the author’s personal experience with the substance as a sales representative.
Results: Between January 2007 and August 2010 the quantity of administered drugs containing losartan as an active substance measured in packages increased by 18.75x, representing a 26.7x increase measured in DOT (Days of Treatment). The public reimbursement for this substance increased by 548% in the same period.
Conclusion: The legislation resulted in the increase of expenditures in some cases, such as losartan. It is important to pay more attention to the marketing activity of pharmaceutical companies. The change of medicines getting public reimbursement can be another important method for reducing the health care budget.

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Ten Years’ Experience in Early Cerebral Aneurysm Clip Occlusion

Bălașa A, Chinezu R, Ács J, Györki G, Gherman B, Lupșa A, Gherasim DN

Department of Neurosurgery, County Emergency Clinical Hospital, Târgu Mureș, Romania

Background: The study follows the complete series of patients surgically treated in the past 10 years at Targu Mures Neurosurgery Department and the effects of the surgical experience over the clinical outcome.
Material and method: This is a retrospective study including 382 patients operated in our department between 2001 and 2011 by a team of 5 neurosurgeons.
Results: Out of the 382 patients included in the study 62.17% were female, 37.83% were male with a mean age of 51±30 years. The majority of operated aneurysms were located in the anterior circulation: 363 cases (95%) with the following locations: anterior communicating artery, 167 cases (43.65%), middle cerebral artery, 100 cases (26.3%), posterior communcating artery, 61 cases (16%). In the posterior circulation a number of 19 aneurysms have been operated with the majority (7) being top basilar aneurysms. 86.80% of cases have been admitted in Hunt-Hess I-III, 13.2% being in Hunt-Hess IV-V. A number of 244 patients (64%) have been admitted and operated in first 96 hours from aneurysm rupture, 92 patients (24%) have been operated between 5 to 14 days, and the rest of 46 patients (12%) have been operated two weeks after the first SAH. Outcome has been calculated using the GOS scale: 57.23% of patients have been discharged with GOS 5, 17% with GOS 4, 10% with GOS 2 and 3, while overall mortality was 15.8%.
Conclusions: Multimodality and multidisciplinarity treatments of cerebral aneurysms have improved significantly the outcome of patients but still the surgical treatment represents a major option. In our opinion early surgery represents the gold standard in the treatment of cerebral aneurysms.

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Immuno-Morphometric Study of Choroid Melanoma Angiogenesis

Albert A1, Egyed-Zsigmond I2

1 ”Dr. FOGOLYÁN Kristof” Emergency County Hospital, Sfântu Gheorghe,Romania
2 Department of Pathology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: The lack of local epidemiologic data, and the progress of current diagnosis and treatment methods motivated us to evaluate our patients from the perspective of tumor vasculogenesis. The metastatic potential of the choroidal melanoma is well known, and the vasculogenesis is a promoter of it, making early diagnosis and treatment a necessity.
Material and method: In this paper we present 21 cases of choroidal malignant melanoma from 2005 to 2009. For all the patients the treatment was the enucleation of the eye, followed by histopathologic examination and imunohistochimic staining. Tumor vasculature was followed with immune-staining: CD31, CD105, SMA, Collagen IV. The results were digitalized and analyzed with the ImageJ software to demonstrate vasculogenesis.
Results: Vessels with CD31 positivity were dominant at the periphery, while CD105 positive new vessels were predominant centrally in the tumor mass. Collagen IV staining presented fragmentation and pluristratification of the vascular basal membranes, and the vascular smooth muscle was barely noticeable in the central areas.
Conclusions: The lesion of the vascular wall is evident, signaling the modification of the structure and proportion of the elements. The difference between the peripheral and central area is evident, well documented immunohistochemically and morphometrically. The differences are statistically significant.

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