Category Archives: Number

Case Report: Endoscopic Management of Sleeve Gastrectomy Fistula

Roşu Alexandra Floriana1*, Ferreira Carlos Noronha2, Ribeiro Luis Carrilho2, Velosa José2, Zlatian Ovidiu Mircea3

1 Gastroenterology Department, County Clinical Emergency Hospital, Craiova, Romania
2 Gastroenterology and Hepatology Department, University Hospital Santa Maria, Lisbon, Portugal
3 Microbiology department, University of Medicine and Pharmacy of Craiova, Romania

DOI: 10.1515/amma-2016-0049

Background. Morbid obesity is an important cause of morbidity and mortality. Bariatric surgery is the best option to manage obesity. Vertical gastrectomy is safe and effective but sometimes complicate with hemorrhage, fistulas and stenosis. Fistulas can be solved by conventional surgery or interventional endoscopy.
Case presentation. We describe a morbidly obese patient with vertical gastrectomy who developed complications after surgery. Immediately after surgery the patient developed sepsis. Upper gastrointestinal endoscopy excluded fistula. One month later a peri-gastric abscess developed due to a fistula orifice in the distal esophagus, treated with argon plasma and two double pigtail plastic stents placed endoscopically to drain the abscess. The stents were removed two weeks later and was placed a covered metallic stent in the distal esophagus. Six weeks later the metallic stent was removed and the orifice closed. Four months later the patient developed sepsis. Computer tomography revealed a subdiaphragmatic abscess and endoscopy revealed a 2 mm fistula orifice at the previous site, treated with argon plasma and two trough-the-scope clips that closed it. There were no further incidents after two years of follow-up.
Conclusions. Early diagnosis and endoscopic approach can resolve these complications without the morbidity and increased mortality risk of surgical re-interventions.

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The Quality of Online Health-Related Information – An Emergent Consumer Health Issue

Nădăşan Valentin*

University of Medicine and Pharmacy of Tirgu Mures, Romania

DOI: 10.1515/amma-2016-0048

The Internet has become one of the main means of communication used by people who search for health-related information. The quality of online health-related information affects the users’ knowledge, their attitude, and their risk or health behaviour in complex ways and influences a substantial number of users in their decisions regarding diagnostic and treatment procedures.
The aim of this review is to explore the benefits and risks associated with using the Internet as a source of health-related information; the relationship between the quality of the health-related information available on the Internet and the potential risks; the multiple conceptual components of the quality of health-related information; the evaluation criteria for quality health-related information; and the main approaches and initiatives that have been implemented worldwide to help improve users’ access to high-quality health-related information.

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The Role of Smoking in the Development of Colorectal Cancer

Dénes Márton István, Borz Cristian*, Török Árpád, Kántor Tibor, Nădășan Valentin, Csibi Mónika, Ábrám Zoltán

University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.1515/amma-2016-0046

Introduction. Smoking is an important public health issue nowadays. It causes a lot of diseases and represents also a source of carcinogenic substances. Recent studies showed an increased incidence of colorectal cancer in smokers. The aim of our study is to assess the association between smoking and colorectal cancer and to establish the prevalence of heavy smokers among the patients operated on for colorectal cancer.
Methodology. We run a retrospective study of the charts belonging to the patients diagnosed with colorectal cancer and operated on in our department between 2004 and 2013. The patients were classified in smokers, former smokers and nonsmokers. The amount of tobacco was evaluated according to the number of smoked cigarettes per day, the smoking period, respectively the pack-years. The data were corroborated with the location of the tumor and analyzed using the online version of Graphpad.
Results. From 982 patients diagnosed with colorectal cancer, we found 297 smokers (30.24%). Among these, 106 patients (35.69%) have smoked for over 30 years, at least 20 cigarettes per day, more than 30 pack-years. The number of heavy smokers was significantly greater (p=0.0001) in the group with rectal cancer compared to the group with colon cancer. The association of smoking with rectal cancer was also important (p=0.0015) among the former smokers.
Conclusions. Smoking is related to higher incidence of colorectal cancer. Our data sustain the hypothesis of increased risk of developing rectal cancer in heavy smokers. We recommend the screening for colorectal cancer among the heavy smoker population.

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Sentinel Lymph Node Mapping In Gastric Cancer Surgery: Current Status

Bara Tivadar Jr1, Bara Tivadar1*, Neagoe Radu1, Sala Daniela1, Gurzu Simona2, Jung Ioan2, Borz Cristian1

1 Department of Surgery, University of Medicine and Pharmacy of Tirgu Mures, Romania
2 Department of Pathology, University of Medicine and Pharmacy of Tirgu Mures, Romania

DOI: 10.1515/amma-2016-0047

Lymphonodular metastases remain an important predictive and prognostic factor in gastric cancer development. The precise determination of the lymphonodular invasion stage can be made only by extended intraoperative lymphadenectomy and histopathological examination. But the main controversy is the usefulness of extended lymph dissection in early gastric cancer. This increases the duration of the surgery and the complications rate, and it is unnecessary without lymphonodular invasion . The identification of the sentinel lymph nodes has been successfully applied for some time in the precise detection of lymph nodes status in breast cancer, malignant melanoma and the use for gastric cancer patients has been a controversial issue. The good prognosis in early gastric cancer had been a surgery challenge, which led to the establishment of minimally invasive individualized treatment and acceptance of sentinel lymph node mapping. The dual-tracer method, submucosally administered endoscopically is also recommended in sentinel lymph node biopsy by laparoscopic approach. There are new sophisticated technologies for detecting sentinel lymph node such as: infrared ray endoscopy, florescence imaging and near-infrared technology, carbon nanoparticles, which will open new perspectives in sentinel lymph nodes mapping.

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The Culprit Coffee Filter and Freezer

Copotoiu Sanda-Maria

Editor-in-Chief

This issue of AMM hosts an article new as to its theme in our journal. It focuses on a continuous risk imbedded in the medication submitted to the over the counter (OTC) regime. Some of the OTC drugs manufactured as combined analgesics contain NSAIDs (nonsteroidal anti-inflammatory drugs) and codeine as phosphate salt. Codeine was used as a local anesthetic, to treat diarrhea, but mostly as a cure for cough. It is common knowledge that the use of codeine is largely spread to the extent that users often obtain it themselves from OTC drugs. The commonest method to extract codeine from pills containing combined analgesics is cold water extraction (CWE). One does not need extensive knowledge or special skills to extract codeine phosphate from OTC pills. The availability of information freely accessible on the Internet as to the methods to extract codeine is appalling. Over 1 690 000 entries on the net searched yesterday offered advice as to how best extract codeine from OTCs. As a matter of fact, it took less than a minute to quickly find an information source that updated me on the methods to extract recreational drugs. There was no warning as to the safety of the source. [More]

Retraction

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Influence of General Anesthesia on Impulsivity and Learning Ability-Experimental Study

Sircuţa Carmen*, Veres Mihaly, Azamfirei Leonard

University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.1515/amma-2016-0045

Objective: To investigate the effect of anesthesia on rats’ ability of learning and over their impulsivity.
Material and Methods: We studied eight Wistar adult male rats, test and drug naive subjects. Animals were separated in two groups, group A and B with four members each. Group A included the anesthetized animals. The combination of ketamine, xylazine and piplophen in 2ml/kg body weight dosage was used and testing was done 24 hours after anesthesia. Group B was taken as control. The study was conducted using the ”Delay discounting” apparatus. Experiments assessing impulsive behavior were conducted using automated operant chambers, equipped with two nose-poke holes (holes where pellets of food were released). Rat’s answer was considered touching the nose-poke hole. One answer was rewarded with pellets of food of 45 mg each (small reward), while another hole released five pellets of 45 mg each (high reward). Both types of rewards were presented immediately after rat’s answer and were followed for a period of 25 seconds timeout. During the training phase, rats were placed in operant chambers 30 minutes per day, 5 consecutive days. The growing percent of preference for greater reward indicates learning.For the testing phase the procedure was similar, but a delay was introduced before the release of the big reward. During this phase, the preference for higher reward was indicative for non-impulsive behaviour.
Results: The results didn’t show significant statistically differences between the two groups.
Conclusions: Anesthesia had no effect on learning ability nor on impulsivity.

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Metastatic Prostate Cancer with Highest Reported PSA Level

Martha Orsolya, Tilinca Mariana*, Tataru Octavian Sabin, Chiujdea Sever, Balan Daniel, Vartolomei Mihai Dorin

University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.1515/amma-2016-0044

Introduction: Prostate cancer is the sixth most common cancer in the world, the second most common cancer among men, and the most common cancer in men in Europe. Metastatic prostate cancer among young patients represents the rarest of the newly diagnosed prostate cancer, with few reports of cases with a longer survival.
Case presentation: We present the case of a 59 year-old male who was referred with back pain over the last month. Digital rectal examination highlighted an enlarged and totally indurated prostate of 4×4.5 cm, while abdomino-pelvic X-rays showed osteoblastic metastases in the spine and pelvis bones. Laboratory examinations revealed a Prostate Specific Antigen level of 7941 ng/ml. Prostate biopsy histology showed a bilateral prostate cancer with a Gleason score of 8. Androgen deprivation therapy and daily administration of biphosphonates were prescribed. After two years of treatment, the Prostate Specific Antigen level decreases to 8 ng/ml.
Conclusions: We reported the highest Prostate Specific Antigen level in a patient under 60 years old with metastatic prostate cancer. Prostate cancer remains an important public health problem due to the aggressiveness of the disease and advanced stage upon diagnosis. Prostate Specific Antigen is mandatory to evaluate, to have a reference level in order to prevent metastatic prostate cancer in young patients at diagnosis.

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Medical Staff’s Opinions Regarding Factors which Influence the Case Management of Children with Insulin-dependent Diabetes Mellitus

Lica Melania Maria1,4*, Jakab Zoltan2, Crainic Maria3,5, Mihai Adriana4,5

1 Clinical Psychology, Paediatric Department, Diabetic Children and Youth Association Mures, Romania
2 Mental Health Centre Tg Mures, Romania
3 University of Medicine and Pharmacy Iuliu Hatieganu, Cluj Napoca, Romania
4 Psychiatric Department, University of Medicine and Pharmacy Tirgu Mures, Romania
5 Institute of Psychotherapy and Personal Development, Tirgu Mures, Romania

DOI: 10.1515/amma-2016-0040

Insulin-dependent diabetes mellitus (IDDM) is a chronic disease with high incidence, especially in children, and for a better outcome the individual case management is required. The patient and his family can experience different levels of anxiety, with negative effects on disease evolution and prognosis.
Objectives: identify relevant factors which influence the case management of children with IDDM. The implementation of the results of this study will help to elaborate an efficient method of intervention for improving the treatment adherence and obtaining a better outcome of IDDM in children.
Methods: A semi-structured interview was done individually to 10 experts in diabetes for collecting their opinion concerning relevant factors that may influence treatment adherence and what are the characteristics of an efficient method of intervention.
Results: Majority of experts considered that the main factor which influences the outcome is doctor-patient relationship. The need of child, to feel that it is understood and protected, was considered that can directly motivate a better self-management and a good outcome. The increase of importance of individual resources of children with IDDM and accent on the quality of life of those children could be considered a starting point for creating a psychological clinic intervention in this field. The results were compared with scientific literature data.
Conclusions: understanding of the causes which have interfered negatively with therapeutic plan is a starting point for develop a clinical – psychological protocol for children with IDDM.

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Maternal Knowledge, Attitudes and Practices Regarding Dietary Fats

Nădășan Valentin*, Sîmpetrean Andreea, Tarcea Monica, Abram Zoltan

University of Medicine and Pharmacy of Tirgu Mures, Romania

DOI: 10.1515/amma-2016-0043

Objective: The purpose of the study was to assess the knowledge, attitudes, and behavior regarding dietary fats among mothers in Romania.
Material and methods: A sample of 305 mothers from Romania were included in a cross-sectional observational study. The online questionnaire addressed their knowledge, attitudes, and practices regarding the dietary fats used in their children’s diet. The frequencies and proportions of the collected variables were calculated based on respondents’ answers.
Results: While almost all the respondents (94.8%) believed that mothers are supposed to know the difference between saturated and unsaturated fats, only less than half of them (39.7%) stated that they know the difference. As far as the types of margarine, although more than half of the respondents (64.7%) believed that mothers should be able to discriminate between the hydrogenated and interesterified margarine, only 11.5% claimed that they are able to discern between them. The actual ability to identify foods rich in saturated fats varied in a great degree from item to item. More common dietary fats such as sunflower oil, corn oil, and lard, were more frequently identified than less common dietary fats such as coconut oil and palm oil. Only 16.4% of the mothers were able to correctly differentiate hydrogenated from interesterified margarine. The most frequently used spreadable fat used in the children’s diet was butter and the most frequently used cooking fats were sunflower oil, olive oil, and butter.
Conclusion: The results of this study might be informative in the development of maternal nutrition education programs.

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A Rare Chromosomal Disorder – 14q Interstitial Deletion Syndrome

Boglis Alina*, Rac Corina Dana, Moldovan Elena, Duicu Carmen, Bănescu Claudia

University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.1515/amma-2016-0041

Introduction: Interstitial deletions of the long arm of chromosome 14q (OMIM 613457) are very rare conditions.
Case presentation: We present a 3-month-old male patient with dysmorphic features and congenital heart defect associated with a small interstitial deletion of chromosome 14q, identified by cytogenetic analysis as 46,XY,del(14)(q11q12). Dysmorphic features included microcephaly, broad nasal bridge, micrognathia, large and poorly folded auricular lobes and long digits. He also present rectus abdominis diastasis and umbilical hernia. The cranial computer tomography showed partial agenesis of the corpus callosum and ventriculomegaly.
Conclusions: Cytogenetic analysis or molecular techniques are necessary to establish the correct diagnosis in patients with multiple congenital anomalies in association with proximal or distal interstitial 14q deletion.

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