Category Archives: Original Research

The Role of Percutaneous Vertebroplasty in Traumatic Fractures of the Thoracolumbar Spine

Székely Gy

Department of Neurosurgery, St. John’s Hospital, Budapest, Hungary

Background: Percutan vertebroplasty (PVP) is a well known minimally invasive method: main indications are vertebral compression fractures, especially of osteoporotic origin. In the last few years PVP is also gained popularity in the treatment of vertebral body instability caused by infiltrative tumor or trauma.
Methods: The author used the method of PVP in treatment of 15 patients with traumatic vertebral fracture. The indication for the surgery were: 1. anterior column traumatic vertebral fractures, 2. preserved posterior wall (towards spinal canal), 3. local pain.
Results: Comparing pre- and postoperative pain, there was a significant improvement on visual analogue scale (VAS).
Conclusion: VP is a feasible method in treating in certain types of traumatic vertebral fractures by abolishing pain soon, superseding the need for spine-stabilizing surgery, facilitating the process of heeling, load ability and return to work, lowering the costs of treatment. PVP can be done as a one-day surgery.

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The Benefits of Ultrasound Electrotherapy in Cervicobrachial Neuralgia

Szasz Simona, Georgescu Lia

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

Introduction: Cervicobrachial neuralgia is a disabling pathology through the 5 syndromes that it can produce. It is very common in rheumatology and rehabilitation services, both in outpatients and in those hospitalised.
Material and methods: We included in the study a total of 100 patients diagnosed with cervicobrachial neuralgia and treated in outpatient Rheumatology Clinic of Tîrgu Mureş between October 2011 and March 2012. All patients underwent different examinations: complex-clinical, radiographic and functional imaging. The treatment of patients lasted for 14 days and assessment was done before treatment and 3 weeks after the beginning of the treatment. For the assessment of patients we used the VAS tool and range of motion of the cervical spine. Statistical data processing was done using Graph Pad software.
Results: Comparing the two study groups there is a much better improvement in terms of pain, joint mobility, and especially myofascial syndrome in patients treated with ultrasound.
Conclusions: Complex physical kinetic treatment leads to pain relief, significantly improving the quality of life; VAS score, range of motion assessment and the presence of myofascial syndrome can be successfully used for monitoring patients diagnosed with cervicobrachial neuralgia.

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Parameters for the Assessment of Pulmonary Vasodilator Therapy in Pulmonary Arterial Hypertension in Children

Şuteu Carmen1, Făgărăşan Amalia2, Muntean Iolanda2, Gozar Liliana2, Paşc Sorina1, Blesneac Cristina1, Togănel Rodica2

1 Cardiology Clinic III – Children, County Emergency Clinical Hospital, Tîrgu Mureş, Romania
2 Cardiology Clinic III – Children, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Introduction: Pulmonary arterial hypertension (PAH) is a rare pathology with different etiologies, representing a cause of morbidity and mortality in the pediatric age group. Most cases of PAH in children are secondary to congenital heart diseases (CHD), followed closely by idiopathic PAH and familial forms. Our objective was to evaluate children with pulmonary arterial hypertension in order to establish which parameter is more useful for the assessment of pulmonary arterial hypertension.
Method: Twenty pediatric patients diagnosed with pulmonary arterial hypertension undergoing pulmonary vasodilator therapy were evaluated between March 2008 and January 2012 in the Pediatric Cardiology Department from Tirgu Mures County Emergency Clinical Hospital. Patients were assessed clinically, the exercise capacity was assessed using the 6-minute walk test, and echocardiography was performed. The initial assessment was considered at the time of initiation of the pulmonary vasodilator therapy, further evaluations being performed at intervals of 3 months.
Results: This study demonstrates the improvement of the functional class and 6-minute walk test, without compromising peripheral oxygen saturation whereas echocardiographic evaluation of patients did not show any echocardiographic parameter to correlate with improved exercise capacity and functional class.
Conclusion: The 6-minute walk test and NYHA functional class represent useful parameters for evaluating the efficiency of pulmonary vasodilator therapy

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Assessment of Medical Students’ Perception on the Healthcare System

Stamatin O1, Poroch V2

1 Department of Oral Rehabilitation, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania
2 Department of General Surgery, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania

Purpose: Major transformations going through the medical system have a significant impact on medical students, future physicians and their perception is a key factor in the ongoing evolution of the medical practice. We assessed medical students’ perceptions on healthcare system, patients care, the ethics of medicine, and the understanding of health policies.
Material and method: We studied data from 415 medical students who completed a survey questionnaire during a period of five months. Applied questionnaire was completed individually with single choice questions and privacy was respected. Students had the opportunity to make comments and sugestions to complex issues.
Results: In terms of professional orientation, an equal number of students opted for a medical and surgical specialty, while for medical research field there were only 10 responses. 91% of students believe that the medical system in Romania is not effective, while 47% considered the system is partially efficient. The perception on the healthcare system worsens as medical students approach their final years.
Conclusions: Students have shown pragmatism regarding the answers that targeted their professional options, the place where they want to practice, their choice of specialty and their perception of the healthcare system. The questionnaire identified major deficiencies in terms of financing of the health system, the ineffective administration of resources, poor management and low wages.

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Helicobacter pylori Infection In HIV-Positive Versus HIV-Negative Patients

Şincu Nina-Ioana1, Băţagă Simona2, Chiriac Carmen1, Ţilea Brînduşa1, Zaharia-Kézdi Iringó1, Incze Andrea1, Tilincă Mariana3

1 Department of Infectious Diseases, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Internal Medicine I, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Department of Cellular Biology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: Responsible for one the most frequent infections worldwide, Helicobacter pylori is involved in the pathogenesis of acute/chronic gastritis, peptic ulcer and gastric cancer. It has been suggested that patients infected with human immunodeficiency virus (HIV) register a lower frequency of Helicobacter pylori infection, due to extensive use of antibiotics for opportunistic infections.
Purpose: a comparison between the frequency of Helicobacter pylori infection in HIV-positive and HIV-negative patients, noting the differences between diagnostic methods.
Material and method: We performed a retrospective, analytical, case-control study, over a period of 40 months, by analyzing 1165 Helicobacter pylori tests (serology or stool antigen) performed in the Laboratory of Infectious Diseases from Clinical District Hospital Mures. Group A included 94 HIV-infected patients, while group B – 1071 non-HIV infected patients. Statistical analysis was performed (Chi2 test, Odds Ratio (OR) calculation) with the help of GraphPad programme.
Results: 45.74% HIV-infected patients and 62.5% HIV-negative subjects had positive Helicobacter pylori tests (either serology or stool antigen), which resulted in a statistically significant negative association between HIV and Helicobacter pylori infection, with p=0.0013 < α=0.05 and OR=0.5046. However, only 8.33% stool antigen tests in HIV-positive and 6.78% in HIV-negative patients were positive for Helicobacter pylori, while 51.21% serological tests were positive in HIV-infected subjects and 69.46% in HIV-negative patients.
Conclusions: Although HIV infection seems to be associated with less Helicobacter pylori positive tests, the clinician needs to consider the existing differences between diagnostic methods.

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Indication for Pediatric Heart Transplantation – Romanian Peculiarities

Sglimbea Anca1, Toma Roxana1, Suciu H1,2, Deac R2

1 Clinic of Cardiovascular Surgery, Tîrgu Mureș, Romania
2 University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Background: Heart transplantation is nowadays a well established and succesfull therapy in both pediatric and adult heart failure. There are several guidelines for adult transplantation, while pediatric transplantation benefits of the indications established in 2007 by the American Heart Association. These are based on western experience and infrastructure. In Romania, this therapy is being performed mainly in the last 5 years, with a small number of patients transplanted.
Methods: We have analyzed the way indication for transplantation has been established in our 5 patients and compared it to the recommendations from the generally accepted guidelines.
Results: There are significant differences regarding age at transplantation, underlying heart disease, as well as stage of heart failure and medical therapy before transplantation. Our patients are older, transplanted mainly for dilated cardiomyopathy, mainly in NYHA functional class IV, but not hospitalized or on intensive care.
Conclusion: There is an imperative need for establishing the number of necessary donor hearts at a national level, as well as starting a vigurouse campaign to increase organ donation in Romania.

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Evaluation of the Effect of Lung Morphometry on the Deposition of Inhaled Particles

Sárkány Z1, Kudela G2, Horváth A3, Balásházy I4, Hofmann W5, Sabău M6

1 University of Medicine and Pharmacy, Târgu Mureș, Romania
2 Faculty of Informatics, Eötvös Loránd University, Budapest, Hungary
3 Chiesi Hungary, Budapest, Hungary
4 Environmental Physics Laboratory, Centre for Energy Research, Hungarian Academy of Sciences, Budapest, Hungary
5 Division of Physics and Biophysics, Department of Materials Research, University of Salzburg, Salzburg, Austria
6 Department of Physiology, University of Medicine and Pharmacy, Târgu Mureș, Romania

Introduction: The human respiratory tract is a complex, asymmetrical, tree-like system of tubular structures, optimized for the transport and distribution of respiratory gases. The objective of this study is to use a computerized lung model to study the effect of lung morphometry on the airway deposition of inhaled particles.
Material and methods: We used a stochastic lung model to simulate the total and regional deposition of 0.01–10 µm particles through oral breathing in sitting condition. The effect of lung morphometry was examined using the same model with a modified algorithm to create a fully symmetrical lung geometry.
Results: Total deposition curves show similar deposition trends for the two models, the symmetric model returning slightly lower deposition values for all particle sizes. In the bronchial region deposited fractions are highly similar, the symmetric model predicting deposition values that are 2.1–4.6% higher for particles in the 0.01–0.1 µm size range. In the acinar region deposition values are up to 27.6% lower in the case of 0.2 µm particles.
Conclusions: Our study suggests that the deposition of inhaled particles is dependent mainly on particle size, and to a smaller extent on the lung geometry the models are built on. Deposition fractions yielded by the two models are highly similar, although there is a shift in the deposition of inhaled particles from the acinar region towards the bronchial region in the symmetric model.

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One-Year Outcomes Using Bevacizumab for Neovascular Age-Related Macular Degeneration

Rusu Monica Blanka1, Egyed ZsI2, Maki Cristina1

1 Ophthalmology Clinic, Tîrgu Mureș, Romania
2 Department of Pathology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Purpose: To report the 12-month anatomic and Early Treatment Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity (VA) response after primary intravitreal bevacizumab (Avastin, Genentech Inc., San Francisco, CA – 2.5 mg) in patients with choroidal neovascularization secondary to age-related macular degeneration.
Methods: One-hundred seventy-two eyes of 164 consecutive patients with choroidal neovascularization secondary to age-related macular degeneration, a mean age of 74.7 years and a minimum of 12 months of follow-up participated in this interventional prospective case series. Patients were treated with at least 3 intravitreal injection of 2.5 mg of bevacizumab. Patients underwent Early Treatment Diabetic Retinopathy Study BCVA testing, ophthalmoscopic examination, optical coherence tomography, and fluorescein angiography at baseline and follow-up visits.
Results: Mean baseline VA was 0.17±0.17 (172 eyes), and mean final VA was 0.15±0.18 (40 eyes) at 12 months. Central macular thickness at baseline by optical coherence tomography had a mean of 386.1±135.8 µm which was significantly reduced to a mean of 281.5±100.3 µm, 313.8±103.3 µm, 296.5±129.6 µm, and 276.8±95.69 µm at 1, 3, 6, and 12 months after initial treatment, respectively (p < 0.0001). No systemic adverse events were observed.
Conclusions: Primary intravitreal bevacizumab at doses of 2.5 mg seems to provide stability or improvement in VA, optical coherence tomography, and fluorescein angiography in subfoveal choroidal neovascularization secondary to age-related macular degeneration at 12 months.

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The Response to Chemotherapy as Prognostic Marker in Multiple Myeloma

Petra Dorina, Oltean G, Demian Smaranda, Candea Marcela, Macarie I

2nd Department of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Objectives: Even though the correlation between the degree of therapeutic response and overall survival was studied for a long time, there are still contradictory opinions. This study intends to evaluate the prognostic value of response to chemotherapy in terms of patient survival and depending on the type of therapy.
Material and method: The study analyses 110 patients diagnosed and treated between January 2006 and September 2012. Descriptive analysis of cases was performed and survival analysis was realised using Kaplan-Meier curves compared to logrank test.
Results: The median survival was 18 months when the patients were treated with vincristine + adriamycin + dexamethasone, 20 months with melphan + prednisone, 71 months with melphalan + cyclophosphamide + vincristine + prednisone (p = 0.020), 33 months with Bortezomib and 4 months with dexamethasone. A percent of 38.18% of patients responded near completely to therapy, partial response occurred in 29.09% of cases and no response/ refractory disease in 32.72%. The patients had a median survival of 62 months for near complete response to therapy, 20 months for partial response and 4 months for no response/ refractory disease (p < 0.0001). The time to disease progression was of 24 months regardless of the used therapy. The most common adverse effect was anaemia.
Conclusions: Lack of response to treatment is a negative prognostic factor in the evolution of multiple myeloma patients.

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Contrast Echocardiography to Evaluate Myocardial Perfusion During Percutaneous Transluminal Septal Myocardial Ablation

Opriș Maria Mihaela¹, Elkahloud A², Maier Anca ², Nistor D², Sîrbu Voichița2

1 Medical Clinic V, Department of Internal Medicine III, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Cardiology Clinic 1, County Emergency Clinical Hospital, Tîrgu Mureş, Romania

Background: Contrast echocardiography is frequently used to enhance endocardyal definition, Doppler signals, and to assess myocardial perfusion in percutaneous transluminal septal myocardial ablation.
Material and method: We followed clinically and echocardiographic 5 female patients with Septal Obstructive Hypertrophic Cardiomyopathy, which observed symptoms despite undergoing maximal medical therapy – angina, functional class NYHA III dyspnea, which underwent septal alcohol ablation. Clinical and echocardiographical examinations were performed at admission, before, during and after the procedure, at discharge, at 6 months and at 1 year. During the ablation contrast echocardiography was used.
Results: Maximum subaortic gradient was reduced by 30 mmHg in all cases, immediately after the procedure, with no increase in further examinations and reduced mitral regurgitation (grade I or minor after the procedure). Symptoms resolved in all patients with NYHA functional class I transition. Transient complications of the procedure in the first 24 hours after ablation were paroxysmal atrial fibrillation in 2 cases, atrioventricular block 2nd degree in 1 case and 3rd degree in 2 cases. Permanent complications were right bundle branch block 3 cases, left bundle branch block 1 case, 1st degree atrioventricular block 1 case.
Conclusions: All 5 patients opted for percutaneous transluminal septal myocardial ablation, although, according to guidelines, they had indication for septal myomectomy. Contrast echocardiography has proven to be a useful addition to percutaneous transluminal septal myocardial ablation.

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