Category Archives: Original Research

The Characteristics of Amiodarone-induced Thyrotoxicosis in a Moderate Iodine Deficit Area

Cota Ancuța-Elena1, Căpraru Oana-Maria1,2, Pașcanu Ionela1

1 Department of Endocrinology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Physiology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2013-0045

Introduction: Amiodarone (AMI), a class III anti-arrhythmic drug, is associated with a number of side effects, including thyroid dysfunction (both hypo- and hyperthyroidism), which is due to amiodarone’s high iodine content and its direct toxic effect on the thyroid.
Objective: To evaluate the incidence of Amiodarone induced thyrotoxicosis (AIT) (type, rate of occurrence) and to identify the risk factors involved in its occurrence.
Material and method: We examined patients treated with amiodarone, between January 2002 and December 2011, who presented to our Department of Endocrinology Târgu Mures for thyroid dysfunctions.
Results: The retrospective study included 87 patients with thyroid dysfunctions; 58 (66.7%) patients had AIT and 29 (33.3%) had Amiodarone induced hypothyroidism (AIH). In the AIT group: 35 were women (60.3%), 23 were men (39.7%); the average age was 61.60 ± 12.39 years. Risk factors identified for the AIT group were male gender (RR = OR = 3.8; Chi-squer = 5.7, p = 0.004) and pre-existing thyroid abnormalities (RR = 2.5, Chi-square = 4.1, p = 0.005). The thyroid dysfunction occurrence was heterogeneous (0.2–183 months). The patients with previous thyroid abnormalities developed earlier thyroid dysfunction compared to those with an apparently normal thyroid gland (22.25 ± 4.14 months versus 32.09 ± 7.69 months, p = 0.02, T test).
Conclusion: In the context of the specific iodine geoclimatic intake and the area of origin, amiodarone – induced thyroid dysfunction spectrum is dominated by thyrotoxicosis. Screening and monitoring of thyroid function for patiens under chronic amiodarone treatment is necessary.

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Clinical and Statistical Study on Canine Impaction

Coșarcă Adina-Simona1, Păcurar Mariana2, Nagy-Bota Monica-Cristina3, Ormenișan Alina4

1 PhD student, Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Pedodontics and Orthodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 PhD student, Department of Anatomy and Embryology, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
4 Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2013-0044

Aim: The aim of this study was to perform a clinical and statistical research on permanent impacted canine patients among those with dental impaction referred to and treated at the Oral and Maxillo-Facial Surgery Clinic of Tîrgu Mureș, over a four years period (2009–2012).
Materials and methods: The study included 858 patients having dental impaction, and upon clinical records, different parameters, like frequency, gender, age, quadrant involvement, patient residence, associated complications, referring specialist and type of treatment, related to canine impaction, were assessed.
Results: The study revealed: about 10% frequency of canine impaction among dental impactions; more frequent in women, in the first quadrant (tooth 13); most cases diagnosed between the age of 10–19 years; patients under 20 were referred by an orthodontist, those over 20 by a dentist; surgical exposure was more often performed than odontectomy.
Conclusions: Canine impaction is the second-most frequent dental impaction in dental arch after third molars; it occurs especially in women. Due to its important role, canine recovery within dental arch is a goal to be achieved, whenever possible. Therefore, diagnose and treatment of canine impaction requires an interdisciplinary approach (surgical and orthodontic).

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Prevalence and Characteristics of Tooth Agenesis in Permanent Dentition of Subjects from Tîrgu Mureş

Kerekes-Máthé Bernadette1, Mártha Krisztina2, Székely Melinda1

1 Department of Morphology of Teeth and Dental Arches, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Pediatric Dentistry and Orthodontics, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2013-0043

Background: Identification of the characteristics of tooth agenesis is an important component in the understanding of the ethiology of this common developmental dental anomaly. The aim of the present study was to determine the prevalence and the characteristics of tooth agenesis among patients from Tîrgu Mureş.
Material and method: The present study is retrospective and descriptive, based on the evaluation of the patient’s dental records from 2004 to 2012 belonging to a pediatric dental office from Tîrgu Mureş. Orthopantomograms and anamnestic data of 947 children and young adults (365 male and 582 female) were analyzed.
Results: The prevalence of tooth agenesis, excluding third molars, was 7.39%. The difference between the genders was statistically not significant (p = 0.09). The most frequently missing teeth were the upper second incisors, followed by the lower second premolars. The difference between the distribution of agenesis in the upper and lower jaws was statistically significant (p <0.0001). The distribution of dental agenesis between the anterior region and the lateral region of the maxilla and the mandible showed significant differences (p <0.0001). Symmetrical distribution of tooth agenesis was found more frequently (54.54%) than assymetrical distribution.
Conclusions: The maxillary anterior region and the mandibular lateral region were the most affected by dental agenesis in the permanent dentition of the studied population. The maxilla was more affected than the mandible and bilateral forms of agenesis were more frequently than unilateral forms. The more extreme forms of agenesis were found amongst female.

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Classical Versus Laparoscopic Approach in Retroperitoneal Lesions — Advantages and Limitations

Crăciun C1, Azamfirei L2, Coroș MF1, Crăciun RC3

1 Surgical Clinic 1, County Clinical Hospital, Tîrgu Mureș, Romania
2 ICU Clinic 1, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
3 ”Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj Napoca, Romania

DOI: 10.2478/amma-2013-0042

Background: At present, the laparoscopic intervention in retroperitoneal primitive tumors, abscesses, haematomas and retroperitoneal effusions is still a challenge. The purpose of this paper is to identify the differences between laparoscopic and conventional surgical interventions in diseases of the retroperitoneum.
Material and method: The study follows a retrospective analysis of various retroperitoneal interventions performed on 62 patients between 2010–2012 in the Surgery Clinic 1 of Mures County Hospital. We have chosen from the casuistry the cases with tumoral diseases or non-tumoral and divided the patients into two groups: group I who had undergone classic interventions and group II who had undergone laparoscopic procedures. We studied the clinical medical records, surgical protocols and anatomopathological results.
Results: For 2010 we extracted 23 cases (39,2% classical interventions), for 2011-21 patients (31,4% classic) and for 2012 -18 cases (29,4% classical interventions). According to the type of the disease, 30 classical interventions were performed for tumoral formations and 21 interventions for non-tumoral formations. Laparoscopic tumoral cases included three tumors and a retroperitoneal metastasis,while the non-tumoral were represented by 7 urohaematic effusions as a result of percutaneous nephrolithotomy procedures.
Conclusions: Laparoscopic surgery of retroperitoneal lesions is minimally invasive, the postoperative evolution of patients is favorable, without major complications.. Classical intervention of retroperitoneal lesions is indicated in large haematomas, abscesses, and big invasive tumors with vascular factor which does not allow the use of laparoscopic technique.

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Correlations Between Regional Accumulation of Calcium in the Culprit Arteries and Plaque Burden in Acute Coronary Syndromes

Jakó Beáta1, Benedek Theodora2, Suciu Zsuzsanna2, Benedek I2

1 Clinic of Cardiology, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
2 Clinic of Cardiology, Discipline of Internal Medicine 6, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2013-0063

Introduction: The association between a high calcium score at the level of the unstable coronary lesions and the different characteristic of culprit lesions which result in an acute coronary syndrome (ACS) has not been described yet. We aimed to study the correlation between the accumulation of calcium within the vessel wall of a coronary artery and the plaque burden of culprit lesions that develop an acute coronary event.
Material and methods: A total of 45 patients with ACS (22 unstable angina, 23 nonST elevation myocardial infarction) underwent 64-slice CCTA. In all patients a complex CT analysis of the culprit plaques was performed and the calcium score for each coronary artery was computed.
Results: We found a significant correlation between a calcium score higher than 100 and the plaque volume (r = 0.85. p = 0.01). Selecting a cut-off value of 100 HU for regional calcium score at the level of the coronary artery, we found that those arteries with Ca score higher than 100 presented significantly larger plaque volumes than the ones with calcium score below 100 (110.8 ml vs 82.4 ml, p <0.0001 for left anterior descending artery, 111.09 ml vs 82.5 ml, p = 0.0005 for circumflex artery, and 132.78 ml vs 76.23 ml for right coronary artery).
Conclusion: Our data shows that in ACS, the severity of the culprit lesions correlates with regional accumulation of calcium within the vessel wall.

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Correlations Between Severity of Coronary Calcification and Impairment of Left Ventricular Ejection Fraction

Suciu Zsuzsanna1, Benedek Theodora1, Jakó Beáta2, Benedek I1

1 Clinic of Cardiology, Discipline of Internal Medicine 6, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Clinic of Cardiology, County Emergency Clinical Hospital, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2013-0062

Introduction: 64 multislice CT angiography is a recently introduced imaging technique, increasingly being used as a tool to show the coronary arteries in three-dimensional visualization. One of the advantages of this method is the ability to estimate the degree of calcification of atheromatous plaques via coronary calcium score calculation, which correlates with the severity score of ateromatous systemic burden. The aim of this study was to evaluate the relationship between the severity of coronary calcification, expressed by calcium score, and the left ventricular ejection fraction (LVEF).
Material and methods: This retrospective study included 81 patients with symptoms of angina and ECG modifications (at rest or during exercise). Echocardiography and 64 multislice CT angiography were performed in all patients to assess the LVEF and Ca scoring.
Results: Calcium score was lower than 100 in 62 patients (50.22%), between 100 and 400 in 11 patients (8.91%), and higher than 400 in 8 patients (6.48%). Mean LVEF was 53.52%, 17 patients having an LVEF of less than 50%. In patients with calcium score less than 100, the corresponding ejection fraction was normal: 55.29%, while in coronary arteries with extensive calcifications (calcium score > 400), the LVEF was significantly lower, 50.5% (p = 0.004).
Conclusions: High Calcium score is positively correlated with LVEF reduction, and a high value for calcium score indicates an increased probability of reduced left ventricular ejection fraction.

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Evaluation of Child Self-perception Regarding Their Oro-dental Status

Mártha I. Krisztina1, Roşu Sorana2, Gyergyay Réka3, Vikárius Katalin4

1 Department of Pediatric Dentistry and Orthodontics, Faculty of Dental Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 PhD student, ”Grigore T. Popa” University of Medicine and Pharmacy, Iaşi, Romania
3 PhD student, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
4 Student, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

DOI: 10.2478/amma-2013-0061

Aim: The aim of this study was to evaluate the state of oral health and the self-perception of children regarding their oro-dental status, their knowledge and attitude towards oral health.
Methods: A sample of 130 children (11–14 years) and one of their parents were asked to complete a Child Perception Questionnaire (CPQ11-14) in Sfântu Gheorghe, Romania. From these, 69 children were examined and data was recorded about Decayed-Missing-Filled Teeth (DMFT), oral hygiene, dental malposition and malocclusion, Aesthetic Component of Index of Treatment Need (AC-IOTN). Consent of the parents was obtained. Statistical analyses were performed.
Results: The optimal score of CPQ evaluation is 96 and the maximum score achieved was 93, the minimum was 43. 78.10 average score can be graded as medium. As the data points out, most of the children and their parents have a medium knowledge and self-perception. The clinical examination underline the main problems: dental caries (62%), occlusal coloration (23%), dental malposition (17%), rooftop deep bite (14%), dental rotation and crowding (12%), dental plaque and tartar (10%). As far as the AC-IOTN is concerned, 48 of 69 children have no need for treatment, 18 have a high need for treatment, and 3 have a moderate need for treatment.
Conclusions: Overall, the children and their parents have a poor oral health knowledge, which is reflected in the medium level of the achieved CPQ scores, in the clinical examination and can be associated with high levels of dental caries and malocclusion.

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The Role of Liver Transplantation in the Treatment of Hepatocellular Carcinoma – a Single Center Experience from Budapest

Piros L, Görög D, Fehérvári I, Nemes B, Langer R, Kóbori L

Department of Transplantation and Surgery, Faculty of Medicine, Semmelweis University, Budapest, Hungary

DOI: 10.2478/amma-2013-0060

Background: Liver transplantation for hepatic tumours is known as a proven treatment opportunity. The outcome has improved over the past decades because of the appropriate recipient selection.
Materials and methods: In a single-institution study of 29 consecutive adult patients underwent orthotopic liver transplantation (OLT) between 1 January 2004 and 1 January 2011 in the Semmelweis University, Budapest with the indication of hepatocellular carcinoma (HCC).
Results: The 1-year survival was 85.7% and the 3-year survival was 71.7%.
Conclusions: Further investigations are needed on the field of histological and biological attributes of the hepatocellular carcinoma. Our aim is to find a better and individualized immunosuppressive protocol, which is also protective against malignant tumours.

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Assessing the Patient with Abdominal Obesity: Metabolic and Nutritional Factors

Pop Raluca1,2, Pop M1,3, Dogaru G4,5

1 PhD Student, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Endocrinology Outpatient Clinic, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
3 Radiology Department, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
4 Internal Medicine Department, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
5 Nephrology Department, County Emergency Clinical Hospital, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2013-0059

Background: Abdominal obesity is a confirmed cardio-vascular risk factor and the elements influencing it are subject for research and intervention. The available nutritional evaluation methods are time consuming, subjective and a standardized approach is missing.
Aim: Standardized evaluation of patients with abdominal obesity.
Material and methods: Cross-sectional study on a convenience sample of 85 subjects who presented in the Endocrinology Outpatient Clinic of the Emergency Mures County Hospital between February – April 2013. Variables: age, sex, environment, BMI, waist, blood glucose, triglycerides, HDL-Cholesterol, blood pressure. Each patient filled a food frequency questionnaire.
Results: None of the subjects had a “normal” food pyramid. Sex has no influence on the food pyramid. The meat and protein food group is the only one significantly influenced by the environment (p = 0.04). Patients with dyslipidemia consume lower amounts of sweets (1.13 vs. 1.83 servings, p = 0.007). Patients requiring metabolic treatment have significant higher waist values (101.32 vs. 93.07 cm, p=0.03). Patients with simple abdominal obesity consume significant lower amounts of meat and protein and higher amounts of fruit and vegetables.
Conclusions: A standardized approach to the patient with abdominal obesity using nutritional assessment tools and metabolic evaluation helps to identify those at risk and to give more tailored recommendations.

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Using Abdominal CT Data for Visceral Fat Evaluation

Pop M1,2, Pop Raluca1,3

1 PhD Student, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Radiology Department, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
3 Endocrinology Outpatient Clinic, County Emergency Clinical Hospital, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2013-0058

Background: Quantitative assessment of body fat is important for the diagnosis and treatment of diseases related to obesity, Computed tomography (CT) becoming the standard procedure for measuring the abdominal fat distribution.
Material and method: The retrospective study included 111 inpatients, who underwent routine abdominal CT exams in the Radiology Laboratory of SCJU Tg.Mures (2013). MPR MDCT (SOMATOM AS 64) data was processed using a custom written MATLAB R2009b software, ImageJ being used for tracing of the visceral fat area (VFA). Patient data (including blood glucose, cholesterol and triglycerides) were analyzed using MO Excel and GraphPad Inprism5.
Results: Visceral Fat percentage varied in population from 14.59–68.69 (SD = 11.83) with significant difference between sexes (male vs. female, 46.98 vs. 31.62, p <0.05). Cholesterol values >220 mg% and triglycerides >150 mg% are significantly associated with the VF percent (p <0.05). Overall there is a weak correlation between the lab variables and the measured fat, the strongest one being between triglycerides and the VFA (r = +0.23) and between age and VFA percentage (certain samples).
Conclusions: The technique used should decreases the human error in marking of the fat areas providing a better estimation of the VF/VF percentage. CT measured VF relates with certain lab tests. Further analysis, is required for a better use of CT in obesity related pathology diagnosis and treatment.

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