Category Archives: Number

Comparative Study Regarding Activity of Emergency Dental Offices in Tirgu Mures and Oradea

Dörner Kinga*, Boeriu C, Vass Hajnal, Nagy Melinda, Koszta Zsuzsa, Iurcov Raluca, Székely Melinda

University of Medicine and Pharmacy of Tirgu Mureș, România

DOI: 10.1515/amma-2015-0035

Objective: The purpose of the study was to assess the activity of the Emergency Dental Office of UPU SMURD in Tîrgu Mures since its establishment and also to compare it with the similar unit from Oradea.
Methods: The two-year retrospective and comparative study is a statistical processing of non-personal data regarding the emergency dental services in the UPU SMURD Tîrgu Mures and UPU SMURD Oradea, involving the data collected in the same period at both emergency dental offices. Data based on the records analysis of the patients who were consulted and treated at the Emergency Dental Office in UPU SMURD Tîrgu Mure between February 1, 2012 − February 1, 2014 compared with similar data from Oradea.
Results: Assessing the number of patients presented each month − first and second year − we can see that since the establishment of the Emergency Dental Office in Tîrgu Mure (no=12780), the number of patients showed a linear increase in the first year, and in the second year the constant number of patients present in the studied unit was higher than in the other center from Oradea (no=4886).
Conclusions: The large number of patients and the nature of the cases that were present in the Emergency Dental Office in the UPU SMURD Tîrgu Mure show how necessary the set-up of this unit was.

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Bisphosphonate-Related Osteonecrosis of the Jaws: a real Challenge for Dentists

Albu Ioana-Aurița*, Petrovan Cecilia, Păcurar Mariana, Albu DE, Csinszka K.-Ivacson A, Golu VM, Copotoiu C

DOI: 10.1515/amma-2015-0034

Background: Osteonecrosis of the jaw is a serious complication associated with oral and intravenous bisphosphonate therapy. Its pathogenesis is not well understood and its management is difficult.The aim of ourstudy was to evaluate the awareness of dentists in Târgu Mureș on the possibilities of treating patients who are treated with bisphosphonate in dental offices.
Material and method: We carried out a questionnaire-based study among dentists in Târgu Mureș reaching important issues such as: if the patient is asked if medical history follows / followed treatment with bisphosphonates, if they made surgical treatment in these patients, if they know under what conditions can they perform this treatment, if they deem it is necessary to contact the prescriber before surgical treatment.
Results: Seventy questionnaires were returned. During the medical history most clinicians (60%) asked the patients whether they follow/followed treatment with bisphosphonates and most of them (42.85%) did not perform treatments in these patients. While 85.71% of respondents declared that they do contact the prescriber before performing surgical treatment, 48,57% were not aware under what conditions they could undergone the treatment.
Conclusions: The dentists did not seem to be well informed about this pathological entity, known only since 2003. In the absence of appropriate protocols they could not provide a high quality treatment and in these circumstances they might do more harm than good.

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Immunoexpression of Ki67 and p53 in the Dental Follicles of Impacted Teeth

Fulop Emoke*, Coşarcă Adina, Păcurar Mariana, Ormenişan Alina, Monea Adriana, Grigoraş R, Mocan Simona

University of Medicine and Pharmacy of Tirgu Mureș, România

DOI: 10.1515/amma-2015-0033

Aim. The purpose of this study was to evaluate the morphological aspects of dental follicles associated with impacted teeth and the immunoexpression of Ki 67 and p53, in the remaining epithelium from impacted third molars and canines. Another aspect was to identify the transformation of the remaining epithelium within the odontogenic lesions.
Material and method. We included in the study a number of 100 dental follicles, of which only 62 met the inclusion criteria. The immunohistochemical reactions were carried out in the Immunohistochemistry Lab at the Department of Histology of the University of Medicine and Pharmacy of Târgu Mureş. We counted 100 cells from the remaining epithelial islands from which we determined the percentage of labeled cells for both markers. After this all data were subjected to a statistical analysis.
Results. Out of the 62 specimens 44 were from females and 28 from males. Positive results were obtained for the two markers but not for all cases. We have also found a positive correlation regarding the immunolabeling of the two markers (p=0.002 in canines, p=0.0001 in molars). Median values for ki67 were statistically significantly higher than the values for p53 for both types of dental follicles.
Conclusions. Both markers were expressed in the remaining epithelial islands. The stronger expression of Ki67 in the follicles of impacted molars can demonstrate the
higher frequency of odontogenic cysts in this area.

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Pancreatico-Gastric Anastomosis with and without Sutures: Experimental Swine Model

Tudor A1, Molnar C2*, Copotoiu C2, Butiurca VO3, Nicolescu C1, Tudor Bianca4, Gurzu Simona5

1 M1 Departament, University of Medicine and Pharmacy Târgu-Mureș, Surgical Clinic No. 1, Târgu-Mureș Emergency County Hospital, Romania
2 M5 Department, University of Medicine and Pharmacy Târgu-Mureș, Surgical Clinic No. 1, Târgu-Mureș Emergency County Hospital, Romania
3 Surgical Clinic No. 1, Târgu-Mureș Emergency County Hospital, Romania
4 M2 Department, University of Medicine and Pharmacy Târgu-Mureș, Central Laboratory of Târgu-Mureș Emergency County Hospital, Romania
5 M1 Department, University of Medicine and Pharmacy Târgu-Mureș, Târgu-Mureș Emergency County Hospital, Romania

DOI: 10.1515/amma-2015-0032

Objectives. The aim of our study is to identify a surgical technical that has the lowest rate of pancreatic fistulas in pancreatico-gastric anastomosis following duodenopancreatectomies. We studied pancreatico-gastric anastomosis performed with stitches compared to the ones performed without stitches.
Methods. Our experimental model is based on ten piglets, which were divided into 2 groups.  In the first group (n=5) the pancreatico-gastric anastomosis was done using double purse-string threads one passed through the gastric seromuscular layer and one through the gastric mucosa. In the second group (n=5) the pancreatico-gastric anastomosis was performed using sutures through the stomach and pancreas.
Results. Postoperative amylasemia was higher in the second group. In the first group no pancreatico-gastric fistulas were observed, whereas pancreatic necrosis was observed only at a superficial level of the pancreatic stump. In the second group, two cases had developed fistulas, both bordered by large areas of coagulation necrosis accompanied by pancreatic duct hyperplasia. Duration of the anastomosis was shorter for the first group. Conclusions.
In conclusion, the pancreatico-gastric anastomosis performed using two purse-string suture is a feasible, safe and fast process.

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Surgical Risk Factors of Patients with Operable Gist

Gabos Gabriella*, Friciu Adina, Diac Raluca, Magdas Annamaria, Crăciun C, Coroș M, Dobru Daniela

University of Medicine and Pharmacy of Tirgu Mureș, România

DOI: 10.1515/amma-2015-0031

Introduction: Gastrointestinal stromal tumors (GIST) are the most frequently mezenchimale tumors of the gastrointestinal tract. This study aims to analyze the results after surgical treatment of GIST and identify key risk factors influencing postoperative course of these patients in order to discover the most effective therapeutic methods to significantly improve postoperative course of these patients.
Methods: We retrospectively reviewed the medical records of all patients who underwent surgical removal of GISTs from 2004-2014. Patient demographics, criterion for admission, surgery, complications, secondary dissemination, histopathological data and clinical course were analized following patient survival at 12, 24, 36 and to 60 months postoperatively. Statistical analysis was performed using the MedCalc software program, and survival analysis was done by Kaplan Meyer.
Results: During this period we analyzed a total of 28 cases, including 13 males and 15 females with age from 33 to 80 years (median, 61). The tumor was located in the stomach (15 cases; 53%), small intestine in ten cases (36%) and other sites in three patients ( 11%). Multivariate analysis revealed that tumor size (P <0,05), criterion for admission (P<0,05) and secondary dissemination (P<0,05) are independed prognostic factors.
Conclusions: Factors like: age and sex of patients, size and tumor site, presence or absence of metastasis, are prognostic risk factors with significant differences in the evolution of patients with operable GIST. The small number of patients and retrospective nature of the study have created difficulties in the estimation where we concluded the need of a prospective multicentric study.

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Office Assessed Blood Pressure and Ambulatory Blood Pressure Monitoring in Chronic Kidney Disease Patients Versus Kidney Transplant Recipients

Tarta DI, Căldăraru Carmen Denise, Tarta Cristina, Frigy A, Carașca E, Carlan Otilia, Dogaru AG

University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0029

How reliable is office assessed blood pressure (BP) in chronic kidney disease (CKD) patients and kidney transplant (KTx) recipients is yet to be determined, although the diagnosis of arterial hypertension has been based on these measurements. The aim of this study was to investigate the potential differences between office assessed BP and ambulatory blood pressure monitoring (ABPM) in CKD patients and KTx recipients.
We conducted a prospective study which enrolled 45 patients. Morning and evening seated office BPs were assessed using a sphygmomanometer at 5 consecutive outpatient visits. A mean systolic BP (SBP) and diastolic BP (DBP) was calculated. Ambulatory blood pressure was measured over 24 hours using a Meditech ABPM-05 device. Office SBP was statistically significant higher in CKD patients than KTx recipients both in the morning and evening (p=0.0433 and p=0.0066 respectively). ABPM showed higher night-time SBPs (p=0.0445) and higher overall, day-time and night-time DBPs in KTX recipients (p=0.0001, p=0.0006, p<0.0001 respectively). In CKD patients, office SBPs and DBPs are significantly higher than overall SBPs and DBPs as assessed by 24hr ABPM. Office BP monitoring as assessed by clinician is acceptable but tends to overestimate BP in both CKD and KTx study groups.

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Association Between Increased Waist Circumference and Depression and Anxiety Trend

Bocicor Andreea Elena1, Buicu Gabriela1,2, Varga Andreea1,3, Tatar R1, Sabau Daniela1,2, Tilea I1,3, Gabos-Grecu I1,2

1 University of Medicine and Pharmacy Tirgu Mures, Romania
2 Psychiatry I Clinic, County Hospital, Tirgu Mures, Romania
3 Cardiovascular Rehabilitation Clinic, Emergency County Hospital, Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0028

Introduction: Abdominal adiposity assessed by increased waist circumference and depression have both a high incidence and prevalence and are associated with increased general mortality and cardiovascular risk. Several studies showed a significant association between abdominal obesity, metabolic syndrome and depression. Early detection of these associations is important for for prevention and treatment of this disease.
Material and method: Eighty patients were enrolled in a cross-sectional descriptive study. Waist circumference was measured in all patients and an increased waist circumference was considered for subjects with values higher than 80 cm in women and higher than 94 cm in men as. Patients completed standardized questionnaires HADS for assessment of depression and anxiety. A depression (D) score higher than 10 points showed a trend to depression while an anxiety (A) score higher than 10 indicated a tendency to anxiety. The association between increased waist circumference, depression and anxiety was studied.
Results: We interviewed 80 patients, 34 (43%) men (mean age 62+/-6.43) and 46 (57%) women (mean age 59+/-5.16). Increased waist circumference was recorded in 22 men, and in 30 women. We noticed a good association between increased waist circumference and both depression (p=0.0006, RR=2.007, 95%CI 1.24-3.24) and anxiety (p=0.017, RR=2.046, 95%CI 1.21-3.45). We found both anxiety and depression risks rather equal in men, while in women we observed a higher depression risk.
Conclusions: Increased waist circumference is associated to depression and anxiety tendency in both genders. Depression trend is more powerful in women, while in men both depression and anxiety seen to have an equal frequency. Psychotherapy should be added to lifestyle changes in patients with abdominal adiposity.

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Comparison Between Clinical and Echocardiographic Findings in Infants and Children Diagnosed with Hypertrophic Cardiomyopathy

Blesneac Cristina¹, Șuteu Carmen1, Togănel Rodica¹, Benedek Theodora², Benedek I²

¹ University of Medicine and Pharmacy Tîrgu Mureş, Department M4, IIIrd Pediatric Discipline
² University of Medicine and Pharmacy Tîrgu Mureş, Department M3, Clinic of Cardiology

DOI: 10.1515/amma-2015-0027

Background: Hypertrophic cardiomyopathy is a rather common hereditary disease with an autozomal dominant character, caused by mutations of genes that code for proteins of the cardiac sarcomere. The observed prevalence of this disease is much lower in pediatric patients compared to adults, because it’s late gene expression. Hypertrophic cardiomyopathy presenting in infancy has been shown to have a very high mortality.
Methods: Thirty-nine patients diagnosed with hypertrophic cardiomyopathy in the IIIrd Pediatric Cardiology Department from Tîrgu Mureș were included in this study. Patients were divided into two groups: group 1 – patients diagnosed during infancy, group 2 – patients diagnosed after 1 year of age. Data regarding familial and personal history, and echocardiographic findings were compared between these two groups.
Results: Group 1 included 17 patients and group 2 – 22 patients. Positive familial history was found in both groups (group 1 – 6 cases, group 2 – 3 cases), all of them in obstructive forms. Syncope was found in four cases, all of them in group 1 (p=0.02; odds ratio 15; 95% CI, 0.7473 to 301.1). While in group 1, asymmetric septal hypertrophy was predominant (64.7%), in group 2 – concentric left ventricular hypertrophy predominated (54.5%). Obstructive hypertrophic cardiomyopathy was found in 14 patients in group 1 (82.4%)compared to 13 patients in group 2 (59.1%). Diastolic function was impaired more predominantly in group 1 (p=0.0274; odds ratio 11.67; 95% CI, 1.526 to 89.17).
Conclusions: hypertrophic cardiomyopathy has an extensive clinical variability with regard to age of onset, severity and progression of disease.

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Epidemiological Characteristics and Prospective 6-Months Follow-up of Children with Pulmonary Arterial Hypertension

Şuteu Carmen1, Blesneac Cristina1, Togănel Rodica1, Benedek Theodora2

1 University of Medicine and Pharmacy Tîrgu Mureş, Department M4, IIIrd Pediatric Discipline
2 University of Medicine and Pharmacy Tîrgu Mureş, Department M3, Clinic of Cardiology

DOI: 10.1515/amma-2015-0026

Introduction: Pulmonary arterial hypertension (PAH) is a rare disease associated with significant morbidity and mortality. Pediatric patients often present with mixted aetiologies. Objectives: To characterize the epidemiology, management and outcome of pediatric PAH.
Methods: Children with PAH were included and followed prospectively for six months. WHO functional class, 6-minute walk test, biomarkers, electrocardiogram, spirometers and echocardiographic parameters were evaluated in progressive PAH group.
Results: Two hundred and four children were included in the study from July 2012 until July 2013, with a mean age of 6.13 years. Transient PAH patients (n=170, 83.33%) included newborns with persistent pulmonary hypertension (n=8, 3.92%) and children with congenital heart defects with systemic-to-pulmonary shunt- flow PAH (n=162, 79.41%) in whom PAH resolved after successful surgery correction. Progressive PAH (n=34, 16.66%) included patients with idiopathic PAH (n=5, 2.45%), Eisenmenger syndrome (n=17, 8.33%) and post-operative PAH (n= 6, 2.94%). Patients with progressive PAH remained stable in regards to clinical status, WHO functional class, 6-minute walk distance, biomarkers, spirometers parameters and echocardiographic parameters with prognostic value.
Conclusions: Pediatric PAH is characterized by various age- specific diagnoses, the majority of which comprise transient forms of PAH. Pediatric PAH associated with congenital heart defects represents a heterogeneous group with highly variable clinical courses. PAH specific therapies may have contributed to disease stability and favorable outcomes.

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European Colorectal Cancer Management: Implemented as it is or Adapted to our National Specificity?

Dobre A, Hintea A, Azamfirei L

University of Medicine and Pharmacy, Tîrgu Mures, Romania

DOI: 10.1515/amma-2015-0025

Objective: We attempt to evaluate how the European treatment guides are implemented in a clinic hospital in Targu Mures and if those rules could be adopted as they are or must be adapted to our national specificity.
Methods: For a number of 441 patients included in the study, the electronic prospectively maintained archive of 3rd Surgery was interrogated for: age, preoperative colonoscopy, postoperative colonoscopies, chemo-radiotherapy enrollment, stage of the disease, type of surgery. Local and regional relapses were assessed and their incidence was related to type of surgery. Survival analysis was done in a simplified manner and differentiated for age below and above 75 years.
Results: Patient’s age distribution revealed a deviation to the right compared with a normal distribution with a median off 64.76±11.47. Colonoscopy was done in only 65 cases, exclusive preoperatively. Chemoradiotherapy was administered in 168 cases, only 12 of them initiated preoperatively. The type of surgery performed was found positively correlate with the stage of the disease. The survival probability for the patients in this study showed a 50% survival rate at 1 year and only 2% at 5 years.
Conclusions: Passive screening age in CRC should be decreased to 55 years. Stage 3 and 4 of disease for CRC are over 70% of cases, like 20 years ago. Survival rate in CRC is far lower than other studies. Integrated CRC management and European practical guides are still “in wishing”
stage.

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