Category Archives: Number

The relationship between blood pressure variability and cardiovascular risk factors in patients with primary hypertension

Magdás Annamária1, Benedek I2, Belényi Boglárka3, Carasca C4, Gábos Gabriella5, Incze A1

1 University of Medicine and Pharmacy Tîrgu Mureş – Doctoral School, Department of Internal Medicine IV
2 County Clinical Emergency Hospital Tîrgu Mures, Clinic of Hematology
3 University of Medicine and Pharmacy Tîrgu Mureş, Department of Internal Medicine I
4 University of Medicine and Pharmacy Tîrgu Mureş, Department for Forensics Medicine
5 County Clinical Hospital, Department for Gastroenterology

DOI: 10.1515/amma-2015-0022

Objective: The aim of the study is to assess 24-hour blood pressure variability, circadian blood pressure profile and its relation to 24-hour blood pressure and cardiovascular risk factors in primary hypertension without any associated disease versus associated with a disease such as diabetes or chronic kidney disease. Methods: This observational study included 90 hypertensive patients, 49 with primary hypertension without associated disease and 41 patients with primary hypertension and diabetes or chronic kidney disease. Circadian blood pressure profile and 24-hour variability were assessed using ambulatory monitoring. Laboratory data regarding cardiovascular risk factors and demographic data were collected in a questionnaire. Results: The number of dipper patients was higher in the group without associated disease, but the difference was not statistically significant (p=0.27). In both groups a positive correlation was found between 24-hour systolic blood pressure variability and 24-hour systolic blood pressure (p=0.029) and was related to age (p=0.031). In the second group, systolic variability showed a positive correlation with serum triglycerides (p=0.006, r=0.416, CI: 0.1252 to 0.6422). Conclusion: Our findings suggest that systolic blood pressure variability is related to age, systolic blood pressure values and serum lipid levels. To prevent end organ damage in hypertension, the assessment of ambulatory monitoring derived 24-hour systolic blood pressure variability and its reduction may be at least as important as blood pressure lowering.

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Computer modeling of hippocampal CA1 pyramidal cells – a tool for in silico experiments

Metz Júlia, Szilágyi T, Perian M, Orbán-Kis K

Department of Physiology, University of Medicine and Pharmacy of Tîrgu Mures, Romania

DOI: 10.1515/amma-2015-0012

Objective. In silico experiments use mathematical models that capture as much as possible from the properties of the biological system under investigation. Our aim was to test the publicly available CA1 pyramidal cell models using the same simulation tasks, to compare them, and provide a systematic overview of their properties in order to improve the usefulness of these models as a tool for in silico experiments.
Methods. Parameters describing the morphology of the cells and the implemented biophysical mechanisms were collected from the ModelDB database of SenseLab Project. This data was analyzed in correlation with the purpose for which each particular model was developed. Multicompartmental simulations were run using the Neuron modeling platform. The properties of the action potentials generated in response to current injection, the firing pattern and the dendritic back-propagation were analyzed.
Results. The studied models were optimized to explore different physiological and pathological properties of the CA1 pyramidal cells. We could identify four broad classes of models focusing on: (i) initiation of the action potential, firing pattern and spike timing, (ii) dendritic back-propagation, (iii) dendritic integration of synaptic inputs and (iv) neuronal network activity. Despite the large variation of the active conductances implemented in the models, the properties of the individual action potentials were quite similar, but even the most complex models could not reproduce all studied biological phenomena.
Conclusions. At the moment the “perfect” pyramidal cell model is not yet available. Our work, hopefully, will help finding the best model for each scientific question under investigation.

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The Management of the Patient with Elevated Prostate Specific Antigen and a Negative Initial Prostate Biopsy

Vida AO1,2, Szöllősi A1,2, Maier A1,2, Boja RM1, Mártha Orsolya1,2

1 Department of Urology, Mures County Hospital, Tîrgu Mureș
2 University of Medicine and Pharmacy, Tîrgu Mureș

DOI: 10.1515/amma-2015-0021

Background: The prostate cancer (PCa) is the second  most  common cancer amongst men. An elevated prostate specific antigen (PSA) level can lead to PCa suspition, thus the confirmation has to be a histopathological one. However, not all increased PSA level means prostate cancer.
Material and Method: This retrospective study presents the results of 422 ultrasound guided prostate biopsy (PB) performed at the Clinic of Urology Târgu- Mureş, between 2011-2012. Inclusion criteria: patients with at least one negative PB and an elevated value of PSA.
Results: In a two year period, from the total of 422 PB (100%), in 179 (42.42%) patients the histopathological result was “negative”. In 154 (86%) of cases ultrasound guided biopsies were performed, mostly with an initial 6 core (98- 54.74% of patients). Average PSA level was 13.45 ng/ml (0.49-100 ng/ml), the histological findings confirmed PCa in 52.58% cases, normal prostatic tissue in 141 cases (78.77%), atypical small acinar proliferation in 12 patients (6.70%), prostate atrophy in 11 males (6.14%), benign prostatic hyperplasia in 10 cases (5.59%) and prostatitis in 5 cases (2.80%). In 30 cases (16.75%) rebiopsy was performed with a number of 10- 12 cores.
Conclusions: In order to increase PCa detection we should perform more cores during PB. In „negative” histopathological cases PSA should be monitorised and the biopsy should be repeated after 6 to 8 weeks from the initial biopsy. Patient’s compliance plays a vital role in the follow-up of the procedure.
Conclusions: ANG-2 serum levels were elevated in sepsis, being well correlated with PCT values and prognostic scores. ANG-2 should be considered as a useful biomarker for the diagnosis and the prognosis of this pathology.

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Chronic Hepatitis and Hepatocellular Carcinoma: A New Perspective for an Old Issue

Bățaga Simona

University of Medicine and Pharmacy of Tirgu Mures, Clinic of Gastroenterology

In the past 30 years a major progress was recorded in the management of the liver diseases. At the beginning of the years 1990 we considered most of the liver cirrhosis as alcoholic, as the viral markers were not available. Later on, when the etiology of liver cirrhosis was better established, the reality showed that viral B and C cirrhosis was prevalent in our country.

After 1990 a rigorous screening was implemented for donated blood, which led to a dramatically decrease in the transmission of the B and C hepatic viruses. Another preventive measure introduced by the health societies was to increase the efforts to educate the general public about hepatitis C and B, so that the number of people infected by tattooing or razors has significantly decreased since a more coherent preventive policy was implemented in this respect. After 1990 the antiviral treatment (interferon and molecules) became available.

The paper “Predictors of hepatocellular carcinoma (HCC) in patients with liver cirrhosis” is addressing a very important topic, the etiology of liver carcinoma. This cancer is now the fifth most common type of cancer (in men) and the second leading cause of cancer-related death worldwide (1).  [More]

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The Carbon Dioxide Absorber Based on Lithium Hydroxide

Zilberman P

Hadassah University Medical Center, Har Hatzofim Campus, Anesthesia Department, Jerusalem, Israel

DOI: 10.1515/amma-2015-0023

Carbon dioxide absorbers have been used in anesthesiology for many years. However, this process is not limited to this field of medicine. Removing carbon dioxide from human environment is used in other areas as well: mining industry, submarines, scuba diving, space travel and many others. The rationale to remove carbon dioxide from confined spaces is that cannot be eliminated otherwise. Anesthesia practitioners are well aware of this component of the circle system, the carbon dioxide absorber. In daily practice, the clinician is less concerned with what kind of substance fills the dedicated canister, as this is usually in the care of the maintenance personnel. The appearance of Sevoflurane and Desflurane, with their own chemical characteristics, prompted the clinician to dedicate new attention to these absorbents. The classical substances used for this purpose are different combinations of limes. The practical concern of the anesthesiologist is to notice when the absorbent is consumed and call for its replacement. Still, many other aspects remain: compound A formation with Sevoflurane, carbon monoxide formation with Desflurane and dry absorbent for instance. The latest member of these products in the medical field is the LiOH carbon dioxide absorbent. Although used for many years in the space exploration, its way into the operating room is a rather recent achievement. Special chemical properties and high absorptive capacity make this new type of absorbent an attractive option for modern anesthesia practice. The article below invites the reader through a short journey on the history of the CO2 absorbents and anesthesia circuits, Lithium as a chemical element and, finally, to this new type of absorbent.

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Sphincter Saving Techniques in Low Rectal Cancer Surgical Treatment: Results, Perspectives

Russu C1, Copotoiu C1, Bud V2, Saracut C2, Gherghinescu M1, Molnar Varlam C3, Molnar C1

1 University of Medicine and Pharmacy of Tirgu Mures, Surgical Clinic no. 1, County Clinical Emergency Hospital Targu Mures, Romania
2 County Clinical Emergency Hospital Targu Mures, Romania
3 University of Medicine and Pharmacy of Tirgu Mures, Obstetrics and Gynecology Clinic no. 1, County Clinical Emergency Hospital Targu Mures, Romania

DOI: 10.1515/amma-2015-0013

Objective: Sphincter saving techniques in low rectal cancer represents a challenge for the surgeons in their attempt to preserve the sphincter function and also to respect the principles of oncological surgery, in order to improve the quality of the patient’s life. The paper’s aim is to compare different sphincter saving techniques in regards to the early postoperative results.
Methods: An observational, retrospective study was performed on 76 patients (N = 76) operated for low rectal cancer in the Surgical Clinic no.1 of the Targu Mures Emergency Clinical County Hospital, between January 2010 and October 2014, to whom the rectal resection was followed by a primary restorative technique for preservation of the sphincter function. The immediate postoperative results after different types of sphincter saving procedures were analyzed and compared.
Results: From the studied patients, in 41 cases (53.94%) an anterior rectal resection with low colorectal anastomosis was done („very low” Dixon procedure), for 29 patients (38.15%) a sphincter saving technique with a peranal anastomosis was performed and in 6 cases (7.89%) an intersphinteric rectal resection with coloanal anastomosis was made.
Conclusions: Sphincter saving techniques, if oncological principles are respected, represents a viable option in the treatment of low rectal cancer and brings hope for improving the quality of the patients’ life.

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