Category Archives: Number

Individual Prognostic Factors in Gastric Cancer

Hintea A, Dobre A, Coroș M, Roșca Ancuța, Dobru Daniela

University of Medicine and Pharmacy of Tîrgu Mures, Romania

DOI: 10.1515/amma-2015-0024

Objectives: The objective of this research was to study the prognostic factors in gastric cancer.
Methods: We conducted a retrospective study on 5-year survival in 112 patients with gastric adenocarcinoma operated between 2004-2009. We used the Surgery Clinic I and Health Insurance House databases for study of the following parameters: age, sex, depth of invasion, histological type, surgery, number of lymph nodes excised and reported overrun / removed lymphnodes.
Results: There was no significant survival difference related to gender aspects. We found significant differences in the survival rate in relation to the tumours confined to the mucosa and muscularis mucosae (100% and 60% respectively), compared to the cases with deeper invasion (p<0.05). Intestinal type presented a superior however insignificant prognosis compared to diffuse type (22% versus 5.66%). Five years survival was slightly lower after D1 lymphadenectomy D1 compared to D2 lymphadenectomy (25.92% versus 29.16%). We found large differences among the number of perigastric lymph nodes (between 3 and 42 in groups of 1 to 6) nodules. Survival rates were significantly higher (p <0.05) in patients with overrun lymphnodes between 0 and <20%, compared to those with overrun ones over 20% of all excised nodes (23.07%, 55.55% vs. 3.89%).
Conclusions: Merely the number of removed lymph nodes may be a source of error in staging if not taken into account the groups they belong to; the most constant individual prognostic factors are the depth of invasion and overrun/removed lymph nodes report; D2 lymphadenectomy has superior results in terms of 5 years survival compared to D1 lymphadenectomy, but, at least in our study, the difference was insignificant.

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Pulmonary Arterial Hypertension: A New Challenge

Benedek I

University of Medicine and Pharmacy Tirgu Mures, Romania

Pulmonary hypertension represents a new challenge for the current clinical practice, as recent advances in the field of diagnostic technologies led a to significant increase in the number of patients diagnosed with this disease and in the same time new therapeutic classes proved to have a significant role in improving survival of these patients.
The main types of pulmonary hypertension are the idiopathic form, called primary pulmonary arterial hypertension (PAH) and the secondary one, developed in the evolution of a cardiac disease, in many cases consequence of a congenital heart disease. Once occurred, PAH severely limits the life expectancy. Despite the recent introduction of many new therapeutic agents which are expected to have a revolutionary role in the improvement of life expectancy and quality of life of these patients, PAH continues to be associated with a mortality as high as 35% at 3 years after the diagnosis. The new therapies are mainly represented by vasodilators that target the nitric oxide, endothelin and prostacyclin pathways.
The diagnosis of PAH is usually established when a typical pattern of pre-capillary pulmonary hypertension is encountered in the hemodynamic profile, in the absence of any lung disease. [More]

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Socio-demographic Characteristics of Patients Diagnosed with Advanced Chronic Venous Insufficiency (C4-C6) Correlated with Clinical and Para-clinical Findings

Imre Eniko Reka*, Imre M

University of Medicine and Pharmacy of Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0030

Chronic venous insufficiency’s frequency reaches almost 25% in European countries. The aim of this present study was to assess the correlation between sociodemographic characteristics as well as clinical findings and para-clinical findings of aCVI patients. A total number of 2636 patients diagnosed with CVI were evaluated for over an 8 year time period (2006-2013). In case of 795 of them, diagnosis of aCVI (C4-C6) has been established. The following variables have been evaluated: demographic data, etiology, risk factors, chronic diseases as risk factors, signs and symptoms, laboratory findings and even the therapeutic approach.All the assessed data has been evaluated using descriptive statistics, t-Student test, and chi square test. Also the relative risk (RR) and Odds ratio (OR) has been calculated. The mean age of aCVI patients was significantly higher (p=0.001) than the age of patients with stage C1-3 CVI. A positive correlation (p<0.0001) between combined venous disorders and clinical stage of CVI has been found. Deep vein thrombosis proved to be correlated (p=0.02) with evolution of CVI to venous ulcer (stage C6). Worsening of advanced venous insufficiency was also correlated with presence of peripheral arterial diseases, and/or metabolic diseases (p<0.0001, and p=0.02). Based on our results, the typical profile of a patient with aCVI has been outlined. Using this profile, the general practitioner and even the internal medicine specialist can recognize in advance patients with an elevated risk of developing aCVI, and accordingly can choose a more appropriate  therapeutic approach.  30

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Relapsing Polychondritis Possibly Caused by Chronic Infection with Borrelia Burgdorferi: Case Report

Morariu SH1, Badea MA1, Cotoi OS2, Vartolomei MD3, Badea Iudita-Maria4, Suciu M5, Buicu F6

1 University of Medicine and Pharmacy of Tirgu-Mures, Romania
2 University of Medicine and Pharmacy of Tirgu-Mures, Romania, Department of Pathophysiology
3 University of Medicine and Pharmacy of Tirgu-Mures, Romania, Department of Molecular and Cell Biology
4 Clinic of Anesthesiology and Intensive Care Medicine, Emergency County Hospital of Tîrgu Mureș, Romania
5 University of Medicine and Pharmacy of Tirgu-Mures, Romania, Department of Prosthetic Dentistry and Oral Rehabilitation
6 University of Medicine and Pharmacy of Tirgu-Mures, Romania, Department of Public Health and Medicines Management

DOI: 10.1515/amma-2015-0018

Introduction: Relapsing polychondritis has been described by Rudolph von Jaksch Warthenhorst in 1923 under the name of polichondropathy. Although the etiology is unknown, an autoimmune mechanism is likely due to formation of autoantibodies to type II collagen in the extracellular matrix of the cartilage with its consequent destruction.
Case report: We present a case with relapsing polychondritis according to McAdam and Damiani criteria and with positive Western blot reaction for Ac IgG anti Borrelia burgdorferi. Serological reaction became negative and the patient presented favorable evolution at 6 months follow-up after corticosteroid therapy and antibiotics.
Conclusion: Chronic infection with Borrelia burgdorferi may play a role in relapsing polychondritis determinism

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A Novel Disease Caused by Increase of the Lifespan: Chronic Cutaneous Insufficiency Syndrome or Dermatoporosis

Badea MA1, Morariu SH2, Sin Anca3

1 County Hospital of Tîrgu Mureș, Romania, Dermatology Clinic, Romania
2 University of Medicine and Pharmacy TîrguMureș, Department of Dermatology, Romania
3 University of Medicine and Pharmacy TîrguMureș, Romania, Department of Molecular and cell biology

DOI: 10.1515/amma-2015-0020

Nowadays we are witnessing an increase in the medium lifespan caused by improved living conditions. The main factor in skin ageing is represented by the chronic exposure to ultraviolet radiation, however long term use of systemic or topical corticosteroids could produce similar effects on the skin. Chronic cutaneous insufficiency syndrome or dermatoporosis was described in 2007, being caused by a decreased activity of the hyaluronic acid, the main component of the extracellular matrix. This mechanism translates clinically through atrophy in the forearms or calves. Other injuries develop on this background including skin dissecting hematoma, which is a medical emergency. Therapeutic attitude consists of local application of preparations containing hyaluronic acid and retinaldehyde and discerning use of corticosteroid therapy. Photoprotection has a certain role in preventing the disease. While today dermatoporosis is a little known dermatosis even among dermatologists, in the future we will see a significant increase in the incidence of the disease and its gravity.

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Continuous Local Analgesia in Postoperative Treatment of Large Incisional Hernias – Preliminary Results

Gherghinescu M, Molnar C, Popa D, Russu C, Copotoiu C

University of Medicine and Pharmacy of Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0019

Background: The incisional hernias are frequent complications after laparotomy. Extended subcutaneous tissue dissection is often necessary for the treatment of large incisional hernias, and this procedure is frequently followed by a high intensity pain in the postoperative period. The aim of this study was to assess the postoperative patient comfort without using major analgesics.
Material and method: we present the preliminary results of an ongoing study from Surgery Clinic 1 of Emergency Clinical County Hospital of Târgu Mures, University of Medicine and Pharmacy Târgu Mures. The study comprises in the intraoperative insertion of a subcutaneous catheter (Pajunk InfiltraLong) placed on lay, through which we administered continuously Ropivacaine 0,5%.
Results: Ten patients have been included in the study by now. For 5 of the patients the wound infiltration was started with 7 ml/h in the first 6 postoperative hours, after which the rate decreased to 5 ml/h until the end of the 72 hours, when the catheter was removed. For 2 patients the wound infiltration was started with 10ml/h in the first 6 postoperative hours, after which the rate decreased to 7 ml/h in the first day, followed by 5 ml/h for the next two days. Two patients needed a minor analgesic in the immediate postoperative period and one patient needed major analgesia in the first 24 hours.
Conclusions: By using this method, postoperative analgesia can be achieved without using major systemic analgesics and a superior patient comfort can be achieved simply by adjusting the infusion rate

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Predictors of Hepatocellular Carcinoma in Patients with Liver Cirrhosis

Pop Crina, Kozma B, Drasovean Silvia, Dobru Daniela, Boeriu Alina

University of Medicine and Pharmacy Tirgu Mures, Romania, Department of Gastroenterology

DOI: 10.1515/amma-2015-0017

Background and aim: Hepatocellular carcinoma (HCC) is one of the most important health problem, with an increasing incidence worldwide. The aim of the present study was to determine the factors that predict HCC occurrence in a group of patients with liver cirrhosis developed on various etiologies.
Material and Methods: A total of 282 consecutive patients with liver cirrhosis seen between January 1, 2013 and July 31, 2014 were enrolled in a prospective study. Data from patient’s history, physical exams, laboratory tests and abdominal ultrasound were collected.
Results: 282 patients were included in the study with a median age of 59.6 and a male/female ratio of 1.38/1; 12.41% (35) were diagnosed with HCC. Alcohol consumption was documented in 19 cases (54.28%), without statistical association (p=0.621), and 7 (20%) were smokers (p=0.403). According to etiological factors of liver cirrhosis: 7 (20%) had background B virus infection, 15 (42.85%) HCV infection and 11 (31.42%) cases incriminated other causes of cirrhosis (alcohol). Chi2 test identified a statistically significant association between the occurrence of HCC and viral etiology of cirrhosis (p = 0.001, r = 18,830). No statistical association was found between Child Pugh scoring of cirrhosis and HCC (p=0.774) and a statistically significant association but inversely proportional was identified between neoplasia and obesity (p=0.008, r= -0.157).
Conlusion: In conclusion the viral etiology of liver cirrhosis is found to be an important risk factor for HCC, and liver cancer was inversely associated with nutritional status.

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Influence of Risk Factors and Diabetic Complications on Peripheral Nerve Function in Type 2 Diabetes Mellitus

Bălașa Rodica1, Bajko Z1, Maier Smaranda1, Voidăzan S2, Moțățăianu Anca1

1 University of Medicine and Pharmacy Târgu Mureş, Department of Neurology, Tîrgu Mureş, Romania
2 University of Medicine and Pharmacy Târgu Mureş, Department of Epidemiology, Tîrgu Mureş, Romania

DOI: 10.1515/amma-2015-0015

Objective: The aim of this study was to evaluate the impact of age, diabetes duration, glycaemic control, existence of cardiac autonomic neuropathy (CAN), retinopathy and of macroangiopathy on the peripheral nerve function in patients with type 2 diabetes.
Methods: One hundred forty-nine type 2 diabetes mellitus patients were assessed with peripheral motor and sensory nerve conduction tests and cardiovascular reflex tests, as well as being evaluated for retinopathy, common carotid artery intimal-media-thickness (IMT) and ankle-brachial index (ABI).
Results: The duration of diabetes has the strongest effect in the reduction of the amplitude of motor response in the peroneal nerve and of the sensory amplitude in the sural nerve. The strongest correlations were found between glycaemic control and decreasing motor amplitude in the median nerve and sensory amplitude in the sural nerve, respectively. The motor and sensory nerve action potential amplitudes were significantly affected in the group of patients with CAN. According to multivariate logistic regression analysis, duration of diabetes and presence of CAN were the most important factors that influenced the motor and sensory nerve function.
Conclusion: The presence of CAN together with diabetes duration and poor glycaemic control were associated with impaired peripheral nerve function, while macroangiopathy does not seem to be associated with the impairment of these electrophysiological parameters.

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Correlations Between Depression, Cognitive Status, Functional Scores, Disability and Lesion Load in Multiple Sclerosis Treated with Interferon Beta 1a

Maier Smaranda1, Bălașa Rodica1, Bajko Z1, Maier Anca2, Șchiopu Bianca3, Buruian M4

1 University of Medicine and Pharmacy Târgu Mureș, Department of Neurology
2 Institute for Cardiovascular Diseases and Transplantation TarguMureș, Department of Cardiology
3 Mureș County Clinical Emergency Hospital TârguMureș, Department of Neurology
4 University of Medicine and Pharmacy TârguMureș, Department of Radiology

DOI: 10.1515/amma-2015-0016

Introduction: Depression and cognitive impairment are the most frequent mental disorders in multiple sclerosis (MS) and represent an important cause of morbidity and mortality. The aim of the study was to analyse the main determinants of depression in multiple sclerosis.
Materials and methods: Thirty-two patients with relapsing remitting multiple sclerosis (RRMS), treated with Interferon Beta 1a, without relapses and corticosteroid treatment in the last 30 days, were included in the study. The mean age of the patients was 35.4±9.2 years, M/F ratio 0.33. Depression level was evaluated by the Romanian version of Beck Depression Inventory (BDI) and the cognitive function with Paced Auditory Serial Addition Test 3 (PASAT 3), Symbol Digit Modalities Test (SDMT). The functional status and disability level of the patients were evaluated with Multiple Sclerosis Functional Composite and Expanded Disability Status Scale. In all patients a cerebral MRI with intravenous contrast administration was performed using a 1.5T MRI device.
Results: Twenty-three patients were free of depression (score 1-10), 4 patients presented mild mood disturbance (score 11-16), 3 borderline clinical depression (score 17-20) and 2 moderate depression (score 21-30). The mean BDI score was 8.71±7.16. BDI score correlated significantly with EDSS (R=0.38, p=0.03), PASAT 3 (R=-0.42, p=0.01), SDMT (R=-0.58, p=0.0007), Timed 25-Foot Walk (R=0.43, p=0.01) and 9-Hole Peg Test (R=0.45, p=0.008). From the EDSS functional scores, significant correlations were found with the urinary score (R=0.4, p=0.01) and sensitive score (R=0.49, p=0.004). BDI score correlated significantly with the total number of T2 lesions (R=0.31, p=0.05) while there was no correlation with the number of active lesions.
Conclusions: The main determinants of depression in RRMS patients are the cognitive impairment, the affection of fine hand movements (9-HP), gait impairment (T25FT) and bladder and sensitive dysfunction.

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