Category Archives: Original Research

The Association of Cholelithiasis and Colorectal Cancer

Sărăcuț C, Molnar C, Pantiru A, Russu C, Roșca C, Voidăzan S, Copotoiu C

Surgery Clinic I, County Emergency Clinical Hospital, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2014-0004

Background: In the literature there are a number of studies that suggest a possible correlation between cholelithiasis/cholecystectomy and colorectal cancer. The exposure of the colon mucosa to the action of bile acids that potentially have a carcinogenic effect due to the change in anatomy after cholecystectomy, seems to be the explanation of this association. The purpose of this paper was to search for such a correlation in our study group.
Methods: We performed a retrospective cross-sectional study, analyzing the patients admitted to the First Surgical Clinic of the County Emergency Clinical Hospital Tîrgu Mureș, between January 1st, 2005 – December 31st, 2010. Analyzing the medical records, operation protocols and histopathological results, we paid attention to demographics, location of neoplasia, the time elapsed since the cholecystectomy to the discovery of neoplasia, histological types, trying to perform correlations between these parameters and the lithiasic factor.
Results: Out of the 534 patients admitted and operated with the diagnosis of colorectal cancer, 15.6% (n = 83) showed a history of gallbladder stone affection. Most patients came from urban areas, the average age was 67.2 (range 39–88 years), females were more affected. The most common locations were: the sigmoid colon (26.5%), rectum (36.3%) and the most common histological form was moderately differentiated adenocarcinoma.
Conclusions: Similar to other studies, our work suggests a slight increase in the incidence of colorectal cancer in patients that underwent a cholecystectomy, without drawing a firm conclusion. We deem it necessary to see if diet changes of the Romanian population affect this relationship.

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Rectal Cancer — Sphincter Saving Techniques

Russu C, Molnar C, Pantiru C, Sărăcuț C, Gherghinescu M, Voidăzan S, Copotoiu C

Surgery Clinic I, County Emergency Clinical Hospital, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2014-0003

Background: Rectal cancer management has as its main component the surgical treatment. The purpose of the paper is to point out the advantages and disadvantages of sphincter saving techniques, respecting the oncological principles.
Material and method: A cross-sectional, retrospective study was performed on a group of 69 patients admitted and surgically treated for rectal cancers in the Surgical Clinic I of the County Emergency Clinical Hospital of Tîrgu Mureș, for a period of one year (April 2012 – April 2013) and to whom rectal resections were performed. We followed the immediate postoperative evolutions in these patients, making a comparative analysis between those with the sphincter saving surgery and those in which other operations were performed.
Results: From the total of 69 patients diagnosed with rectal cancer, sphincter saving procedures with restoration of digestive continuity by coloanal anastomosis were performed in 12 patients (17.39%) using the peranal or transanal approach; in 42 patients (60.86%) anterior recto-sigmoidian resections with low and very low colorectal anastomosis („very low” Dixon procedure) were performed. In 15 cases (21.74%) the Miles type of rectal resections, using the abdomino-perineal way, were performed. Out of the 12 cases with peranal or transanal anastomosis, 4 cases had postoperative complications.
Conclusions: Rectal resection procedures, which are restoring the digestive tract continuity using low anastomosis (colorectal, coloanal, peranal or transanal), are representing viable and „physiological” alternatives, if they respect the oncologic principles. In well selected cases, the immediate postoperative evolution is favorable, relieving the patient from the psychological and physical trauma due to the presence of a colostomy.

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Assessment of Periodontal Status of Surgically Exposed and Orthodontically Aligned Impacted Maxillary Canines

Coșarcă Adina¹, Păcurar Mariana², Petrovan Cecilia¹, Ormenișan Alina¹

1 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

DOI: 10.2478/amma-2014-0002

Aim: The aim of this study was to compare the periodontal status of impacted canines after 5 years following completion of the combined surgical and orthodontic treatment.
Materials and methods: We examined 20 labially impacted canines and 20 palatally impacted canines at 5 years after the end of treatment. We assessed the periodontal status of these teeth.
Results: Different outcomes were found regarding the probing depth and the amount of keratinized gingiva in the two mentioned groups of teeth.
Conclusions: The assessed periodontal indices may signal the appearance of a periodontal disease around the teeth that were surgically and orthodontically treated.

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Anastomotic Leaks after Colorectal Surgery: a Prognostic Score

Caziuc Alexandra1, Mironiuc A2

1 First Surgical Clinic, ”Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
2 Second Surgical Clinic, ”Iuliu Hațieganu” University of Medicine and Pharmacy, Cluj Napoca, Romania

DOI: 10.2478/amma-2014-0001

Introduction: Anastomotic leaks are one of the most dreaded complications in colorectal surgery. At the ground of this problem remain the nefarious prognostic over the patient’s life, the difficulties in early diagnosis and the optimal choice of therapeutical methods. The goal of our research was to evaluate the significance of possible risk factors in the postoperative evolution of patients following colorectal interventions and to design a prognostic score.
Material and methods: We performed a retrospective study on 298 cases of patients with inflammatory, neoplastic or traumatic lesions for which there was chosen a digestive anastomosis including the colon. The presumed risk factors in our analysis were: age, comorbidity evaluated by Charlson Score, etiology, toxics, use of nonsteroidal anti-inflammatory substances or corticoids, parameters such as leucocytes, hemoglobin, urea, total seric bilirubin, glycaemia, albumins, neoadjuvant therapy, type of suture, quantity of fluids received intraoperatory. All data were analyzed using R-Commander.
Results: All parameters for which we demonstrated a statistical significance (p <0.05) for an unfavorable evolution were included in a prognostic score, designed in correlation with the statistical relation between the factors. We obtained values that certified a strong association (0.75) between a high prognostic score and an increased number of anastomotic leaks.
Conclusions: The practical utility of the score is mainly for the anticipation of postoperative complications. A high level score underlines that prior to surgery it is essential to balance the biochemical abnormalities and to choose properly the moment and type of surgical intervention.

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The Monitoring of Immunosuppressive Therapy with Tacrolimus in Patients with Kidney Transplant, Based on the Pharmacokinetic Criteria

Stoica Ciprian Mihai1, Căldăraru Carmen Denise2*, Vari Camil Eugen3, Tarța Dorin Ionuț1, Dogaru Maria Titica3, Carașca Emilian4, Dogaru Grigore Aloiziu1

1 Department of Nephrology, University of Medicine and Pharmacy, Târgu-Mureş, România
2 Department of Physiology, University of Medicine and Pharmacy, Târgu-Mureş, România
3 Department of Pharmacology and Clinical Pharmacy, University of Medicine and Pharmacy, Târgu-Mureş, România
4 Department of Internal Medicine IV, University of Medicine and Pharmacy, Târgu-Mureş, România

DOI: 10.1515/amma-2015-0082

Background: Therapeutic drug monitoring (TDM) in patients with Chronic Kidney Disease (CKD) with kidney transplant, represents a major post transplant concern due to the characteristics of this special category of patients, particularities which can generate changes of the pharmacokinetic profile of the administered medication.
Material and methods: The current study is a retrospective pharmacokinetic study, over a period of 50 months, including a group of 36 kidney transplanted patients with CKD. Tacrolimus blood concentration was determined by a validated high-performance liquid chromatography method (HPLC), at a 12 hour time interval from the last administration of the immunosuppressive medication and before the following dose (Residual concentration, Cmin(trough)).
Results: During the monitoring of therapy, based on the pharmacokinetic criteria, 252 measurements of blood concentration were determined, 58 of these being outside the therapeutic window.
Conclusions: The results obtained show that it is mandatory to continue to monitor closely medical therapy based on the pharmacokinetic criteria in view of improving drug administration. The other ways of monitoring therapy: the clinical and biochemical criteria should not be overlooked. In addition, the interindividual variability of patients should be considered, as well as drug interaction which can alter the pharmacokinetics of tacrolimus.

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Prevalence of Physiological, Pathological and Behavioral Risk Factors in Patients Treated with Antidiabetic Sulfonylureas

Confederat Luminita*, Stefan Roxana, Constantin Sandra, Hăncianu Monica, Profire Lenuta

University of Medicine and Pharmacy “Grigore T. Popa”, Iași , Romania

DOI: 10.1515/amma-2015-0080

Diabetes mellitus is an important public health problem because of its increased incidence and its devastating complications. In addition to this, it was observed an increase in prevalence for diabetes risk factors. The aim of this study was to evaluate the frequency of the pathophysiological and behavioral risk factors among patients treated with oral hypoglycemic sulfonylureas.
Material and methods: It were analyzed the observation sheets of 200 patients ambulatory treated at the “Providența” Medical Center.
Results and discussions: Most of the patients were aged over 65 years, being 48.5% women and 51.5% men. The obesity was the most frequent (88%) risk factor in patients; the majority of them were included in the “overweight” and “first- degree obesity” class (72%). Regarding associated comorbidities, hypertension was found in 77% of cases, followed by dyslipidemia. In terms of physiological and behavioral aspects, age and alcohol consumption were predominant.
Conclusions: A significant percentage of diabetic patients treated with hypoglycemic sulfonylureas present a high prevalence of the risk factors and even two or three factors associated.

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The Assessment of Romanian Customers’ Level of Satisfaction with Pharmaceutical Providers

Cherecheș Marius Călin1*, Timofe Mara Paula2, Oniga Ovidiu1

1 Faculty of Pharmacy, ”Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania
2 Cluj School of Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania

DOI: 10.1515/amma-2015-0079

The aim of the current study is to assess the level of satisfaction towards pharmaceutical services among Romanian customers. Moreover, we were interested in building the socio-demographical profile of a Romanian satisfied customer. The study has a transversal design and uses a quantitative approach. Data was collected at the national level in June 2012 by using Computer Assisted Telephone Interviews (CATI) and resulted in 1,478 valid questionnaires. Descriptive statistics were performed in order to properly present the sample of interest according to socio-demographic characteristics, as well as general attitudes towards pharmaceutical market. According to our analysis, only half of the respondents have a favorite pharmacy (50,4%). Regarding their level of satisfaction, the majority of respondents (53%) declared themselves as being quite satisfied with the pharmacy that they usually collaborate with, whereas 42% of respondents are very satisfied with their favorite pharmacies. According to our analysis, the most satisfied customer has the following socio-demographic characteristics: female (N=351), aged between 56 and 70 years old (N=259), having high school as the highest level of education (N=184), living in an urban area (N=343), having a monthly income of 501-1000 RON (N=217), married (N=396), having no chronic disease (N=312), having a family composed of two members (N=185). Customer’s satisfaction represents a personal evaluation on the pharmaceutical services and providers and is an essential part of the quality of health care. Therefore, it is vital to assess the customer’s expectation and satisfaction in order to ensure the success of the pharmaceutical company.

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Association of Heart Failure with Preserved Ejection Fraction and Components of Metabolic Syndrome

Anda-Mihaela Cerghizan1, Simona Bățagă2, L. Cozlea1, I.D. Tarța3, B. Chibelean 4, Carmen Căldăraru5*, G. Dogaru3

1 3rd Internal Medicine Clinic, Faculty of Medicine, University of Medicine and Pharmacy, Tirgu-Mures, Romania
2 1st Gastroenterology Clinic, Faculty of Medicine, University of Medicine and Pharmacy, Tirgu Mures, Romania
3 Department of Nephrology, University of Medicine and Pharmacy, Tirgu-Mures, Romania
4 Department of Urology, University of Medicine and Pharmacy, Tirgu-Mures, Romania
5 Department of Physiology, University of Medicine and Pharmacy, Tirgu-Mures, Romania

DOI: 10.1515/amma-2015-0078

The aim of the current study was to find any possible associations between elements of metabolic syndrome and echocardiographic characteristics (grade of diastolic dysfunction) in normoponderal and overweight patients with heart failure with preserved ejection fraction. A retrospective observational analytical study was performed on 130 patients presenting heart failure with documented ejection fraction over 50%. They were divided into two groups based on their body mass index. The first group included 56 normal weight patients and the second group included 74 overweight patients. Elements of the metabolic syndrome analysed in the current study were arterial hypertension, high triglyceride levels, low HDL-cholesterol and diabetes. None of the components of metabolic syndrome alone had a role in the evolution of diastolic dysfunction in either group. Three or four elements present in obese patients were negatively associated with grade 2 diastolic dysfunction, high values of blood pressure (over 180/110 mmHg) were more often encountered in obese patients with first and second grade of diastolic dysfunction.

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Links Between Surgical Landmarks of the Temporal Bone and Cochlear Implant Approaches

Lostun Gabriel1*, Gușavan Diana Elena2, Genes Ionela1, Lostun Alexandra3, Brînzaniuc Klara4

1 Department of Otorhinolaryngology, University of Medicine and Pharmacy, Tîrgu-Mureș, Romania
2 Department of Radiology, Emergency County Hospital Tîrgu-Mureș, Romania
3 Department of Forensic Medicine, University of Medicine and Pharmacy, Tîrgu-Mureș, Romania
4 Department of Human Anatomy, University of Medicine and Pharmacy, Tîrgu-Mureș, Romania

DOI: 10.1515/amma-2015-0075

Objective: We aimed to underline the surgical importance of the distances between the landmarks of the temporal bone, important for quantifying the benefits and disadvantages of two different cochlear implant techniques.
Methods: We have gathered all data from the Radiology Department in Emergency County Hospital in Tîrgu Mureș, namely computed tomography imagistic studies in order to perform the required measurements, according to pre-defined inclusion/exclusion criteria. The time interval was 5 months.
Results: The comparison between the sets of data shows a good match for the risk/benefit ratio for the two types of technique for cochlear implantation.
Conclusions: The middle cerebral fossa approach for the electrode insertion into the cochlea is a viable and needed surgical technique as the classic approach has reached its boundaries and new challenges appear. As surgical decisions are largely based on radiology data, our work underlines the importance of solving the borderline pathology, the extreme cases and the role of surgery in improving the quality of life for every patient with cochlear implant indication.

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First Study of the Prosthesis Indication Deafnesses in Mureș County

Lostun Gabriel1*, Lostun Alexandra2, Brînzaniuc Klara3

1 Department of Otorhinolaryngology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Forensic Medicine, University of Medicine and Pharmacy Tîrgu Mures, Romania
3 Department of Human Anatomy, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0074

Objective: The aim of this study was to asses the frequency of the deafness pathology in the Ear, Nose and Throat Clinic of the Emergency County Hospital in Tîrgu Mureș and two other private institutions that have an ear linked profile, with a special interest on those with indication for prosthesis. This is a pilot study, being conceived as a part of a larger one used to measure the number of possible cochlear implant recipients nationwide.
Methods: We gathered data from the interval 2011-2013, including in the study all the patients for which an audiometry testing was performed in this time interval. This was followed by a process of selection/exclusion applied to the original group in order to obtain significant statistical data.
Results: The most important part of the study was to quantify the different types of hypoaccusia and the relative number of candidates for various prosthesis available these days.
Conclusions: This study quantifies the rising need for hearing prosthesis and triggers a signal.

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