Category Archives: Original Research

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.

Keywords: , ,
Full text: PDF

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.

Keywords: , , ,
Full text: PDF

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.

Keywords: , ,
Full text: PDF

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.

Keywords: , , ,
Full text: PDF

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.

Keywords: , ,
Full text: PDF

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.

Keywords: , , ,
Full text: PDF

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).

Keywords: , , , ,
Full text: PDF

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.

Keywords: , ,
Full text: PDF

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.

Keywords: , ,
Full text: PDF

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.

Keywords: , , , ,
Full text: PDF