Category Archives: Number

Endocrine dysfunction in neurofibromatosis type 1 – an update

Pop Raluca-Monica1,2, Radu Mircea Neagoe3, Kolcsar Melinda4*, Paşcanu Ionela5

1 Research Methodology Department, University of Medicine and Pharmacy Tirgu Mures, Romania
2 Endocrinology Outpatient Clinic, Emergency Mureş County Hospital, Tirgu-Mures, Romania
3 Surgery Department, University of Medicine and Pharmacy Tirgu Mures, Tirgu-Mures, Romania
4 Pharmacology and Clinical Pharmacy Department, University of Medicine and Pharmacy Tirgu Mures, Tirgu-Mures, Romania
5 Endocrinology Department, University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.1515/amma-2016-0003

Background: Neurofibromatosis type 1 is an autosomal dominant disorder associated with multiple neoplasms particularly those of ectodermal origin. Various endocrine pathologies are often present, among them, hyperparathyroidism and follicular thyroid lesion are very rare described and their coincidence in the same patient has not been described in the literature reviewed.
Subject: A 59-years-old woman with clinical manifestation of neurofibromatosis type 1 developed dysphagia, dysphonia, choking sensation. Physical and imagistic examination revealed a multinodular goiter with microfollicular lesion on fine needle aspiration biopsy (FNAB), elevated parathormone levels and severe osteoporosis. The surgically removed thyroid contained a nodule with follicular architecture of uncertain malignant potential; the parathyroid tissue appeared normal.
Discussion and conclusion: This case serves as a reminder to look for non-neurogenic tumors in patients with neurofibromatosis. Clinicians must be aware of the diverse clinical features of this genetic disorder.

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Volemic resuscitation in a patient with multiple traumas and haemorrhagic shock. Anti-oxidative therapy management in critical patients. A Case Report

Bedreag Ovidiu Horea1,2, Rogobete Alexandru Florin1,2*, Sarandan Mirela3, Cradigati Alina Carmen3, Nartita Radu1, Sandesc Dorel1,2, Papurica Marius1,2

1 Clinic of Anaesthesia and Intensive Care, Emergency County Hospital ”Pius Brinzeu”, Timisoara, Romania
2 Faculty of Medicine, ”Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
3 Clinic of Anaesthesia and Intensive Care ”Casa Austria”, Emergency County Hospital ”Pius Brinzeu”, Timisoara, Romania

DOI: 10.1515/amma-2016-0002

A patient with multiple traumas is usually found in severe haemorrhagic shock. In 40% of the cases, the patient with multiple traumas and haemorrhagic shock cannot recover due to secondary injuries and complications associated with the shock. In this paper we present the case of a male patient 30 years old, who suffered a car accident. The patient is admitted in our hospital with haemorrhagic shock due to femur fracture, acute cranial-cerebral trauma and severe thoracic trauma with bleeding scalp wound, associated with lethal triad of trauma. The clinical and biological parameters demand massive transfusion with packed red blood cells (PRBCs), fresh frozen plasma (FFP), cryoprecipitate (CRY) and colloidal solution (CO) sustained with vassopresor for the haemodynamic stabilisation. During his stay in the ICU, the patient benefits from anti-oxidative therapy with Vitamin C, Vitamin E and Vitamin B1. After 14 days the clinical state of the patient improves and he is transferred in Polytrauma Department.

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Incidence of pathogens infections in a Romanian Intensive Care Unit and sensitivity to antibiotics. A prospective single center study

Bedreag Ovidiu Horea1,2, Rogobete Alexandru Florin1,2*, Luca Loredana1, Neamtu Claudiu1, Dragulescu Dorian Mihai1, Nartita Radu1,3, Papurica Marius1,2

1 Clinic of Anesthesia and Intensive Care, Emergency County Hospital ”Pius Brinzeu”, Timisoara, Romania
2 Faculty of Medicine, ”Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
3 Faculty of Chemistry, Biology, Geography, West University of Timisoara, Timisoara, Romania

DOI: 10.1515/amma-2016-0001

Introduction: Nosocomial infections represent one of the biggest challenges faced by clinicians in the intensive care unit (ICU) and is associated with high morbidity and mortality. Infections in ICU are most often very serious and represent often the cause of hospitalization in intensive care clinics.
Aim of the study: This paper presents the incidence of nosocomial infections, and the sensitivity to antibiotics encountered in our ICU.
Material and Methods: This prospective study was conducted for two years at the Clinic of Anesthesia and Intensive Care, Emergency County Hospital “Pius Brinzeu” Timisoara, Romania. All patients admitted to the ICU were analyzed in terms of signs and symptoms of bacterial infections.
Results: A total of 1081 microbiological reports were recorded. Among these, 635 (58.70 %) represented infections in the respiratory tract, 201 (18.60 %) in the bloodstream, 100 (9.30 %) in genitourinary tract, and 10 (0.90 %) in the central nervous system. The top five most frequently identified pathogen in microbiological reports are Klebsiella sp (17.60 %), Acinetobacter sp (14.20 %), Proteus mirabilis (13.80 %), Pseudomonas aeruginosa (12.90 %), Staphylococcus aureus – MSSA (12.80%).
Conclusions: In order to choose empirical treatment, international guidelines should be consulted according to each pathology and adapted to the sensitivity encountered in the microbiology reports of the Critical Care Unit.

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Particular Aspects of a Pancreatic Insulinoma Case

Motoc R1,2, Albu C2, Munteanu Irina2, Dirtu Oana2, Motoc Crina2, Tilea I3,2

1 Internal Medicine Clinic III, Dept. M3, Faculty of Medicine, University of Medicine and Pharmacy Tirgu Mures, Romania
2 Tirgu Mures Emergency Clinical County Hospital, Tirgu Mures, Romania
3 Family Medicine, Dept. M3, Faculty of Medicine, University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0130

With a very low incidence (1-4 cases per 1 million per year), characterized by insulin hypersecretion, independent of the glycemia control system, insulinoma is a rare endocrine tumor, clinical with accentuated neuropsychological symptoms that hampers clinical diagnosis. We present a case of a 33 years old patient with no notable personal history, active lifestyle, non-smoker, a work environment that doesn’t involve professional toxicity; a remarkable family history of a brother with type 1 diabetes mellitus and grandmother with liver adenocarcinoma was noticed; in this particular case Whipple triad was strongly suggestive, gastrointestinal upper-ultrasonography endoscopy with tissue puncture as a tumor diagnostic tool was used and laparotomy was used successfully for removing the tumor, with favorable follow-up.

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Coronary Artery Dissection in the Left Main Treated with Stenting in a Patient with Multiple Re-infarction – Case Report

Nyulas Tiberiu1, Blendea Ciprian1,2, Barcan Andreea1, Bajka Balazs1,2, Korodi Szilamer1, Rat Nora1

1 University of Medicine and Pharmacy of Tîrgu Mureș, Clinic of Cardiology, Tîrgu Mureș, Romania
2 Cardio Med Medical Center, Department of Advanced Multimodal Imaging, Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0129

Introduction: In complex cases of multiple coronary artery stenosis, revascularization strategy could be essential for improving the life expectancy andqualityof life. However, major complications are sometimes encountered during interventions, such as rupture of the atheromatous plaque with consequent dissection of the coronary artery, causing an acute coronary syndrome which requires immediate intervention from the operator. In the absence of an experienced interventional cardiologist a complication like this can be fatal. Case presentation: We present the case of a 67-years old patient, male, with a known history of cardiovascular disease, who presented in our service complaining of chest pain with tightening character, irradiation in the shoulder and left arm, respectively shortness of breath and fatigue. The patient presented a history of multiple infarctions, intervention and stenting on RCA and circumflex artery. Computed Tomographic Coronary Angiography provided detailed information on the location of the target lesions and was followed by a revascularization procedure. However, despite the complex pre-interventional assessment, while trying to engage the guide in the emergence ofthe circumflex artery, atherosclerotic plaque rupture occurred, causing a dissection of the coronary wall which extended retrogradely into the left main, requiring a rapid response from the operator. A coronary stent was implanted into the left coronary artery trunk, treating the dissection. Conclusions: Coronary artery dissection is a very serious complication that can occur during a complex revascularization procedure, requiring immediate intervention in order to save the patient’s life.

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Inferior Vena Cava Hypoplasia Associated with Deep Vein Thrombosis – Case Presentation

Nyulas Tiberiu1, Blendea Ciprian1,2, Rat Nora1, Barcan Andreea1, Korodi Szilamer1, Bajka Balazs1,2

1 University of Medicine and Pharmacy of Tîrgu Mureș, Clinic of Cardiology, Tîrgu Mureș, Romania
2 Cardio Med Medical Center, Department of Advanced Multimodal Imaging, Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0128

Introduction: We present the case of a patient suffering from inferior vena cava hypoplasia complicated with Phlegmasia cerulean dolens. Imaging techniques allow precise diagnosis of inferior vena cava hypoplasia, providing essential structural details on the degree of damage of the vena cava and for the other branches. Case presentation: A 58 years old, obese and diabetic male patient presented with intense pain in the lower limbs, with the onset 24h before presentation. The patient presented generalized edema, cyanosis and functional impotence. Angio CT examination revealed hypoplasia of the inferior vena cava, with extensive DVT (deep vein thrombosis). In emergency conditions, with the agreement of the patient, we initiated the thrombolytic therapy (streptokinase for 72h) associated with anticoagulants (heparin). The evolution was favorable: a significant reduction in leg circumference was recorded, together with pain relief and reduction of local inflammation in the lower limbs. Conclusion: Severe cases of inferior vena cava hypoplasia complicated with deep vein thrombosis can present a good prognosis if appropriate treatment with anticoagulants and thrombolytics is initiated in time.

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Resin-Based Composite and LCU-related Factors Affecting the Degree of Cure. A Literature Review: Part 2. Light Curing Units & Related Factors

Aldossary Mohammed1, Santini Ario 1,2*

1 MClinDent, University of Edinburgh, UK
2 University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0127

In parallel with developments in resin based composite technology, there have been changes in light curing units (LCU). Broadly, there are four categories of LCUs available in the market, with the two commonest used in Dentistry being quartz tungsten halogen (QTH) lamps and light emitting diode (LED) units, though now, QTH is infrequently used in most developed countries.
Argon-ion lasers and Plasma-arc lamps (PALs) had many disadvantages limiting their use. Argon-ion lasers were large devices with increased cost compared to QTHs, [1] PALs had low curing efficiency, increased shrinkage and micro leakage due to fast curing, [2] increased cost, heat and power consumption and decline of lights power output over time compared to QTHs [1,3,4]. [More]

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Scientific Gatekeeping and Exposure

Copotoiu Sanda-Maria

Editor-in-Chief

When reading some of the main medical journals, one realizes that the tasks of the editors imply also an activity known as “scientific gatekeeping”. It basically means a triage of the submited articles to dispose of those who do not comply with the rigours of correct medical research or to strategically avoid alien fields of interest to the journal. Editors are supposed to master clinical and/or basic research in order to fit to the job position and thus take responsibility for these operations. They are also accountable for their actions.
Facts speek for themselves: fraudulent, fabricated articles sieved by the gatekeepers’ selection process; shallow peer-review process; pression exerted in the intent of using influence to promote publication; loading by dues to authors, moods’ driven unfair rejections. Other facts could be added to the list, emerging as mushrooms fueled by frustration. One of them is mannerism in scientific writing. An impeccable form of written study, correct statistics, conforming IRBs end up in being published and often cited when appearing in important journals. Still, not all of them contain significant clinical findings. The package is attractive, the content dull. It is selling though. The terminal phrase “… further studies are needed to confirm our findings” is sometimes just a defensive tool to prevent challenge. I wonder how many of these studies are included in meta-analyses and/or cited and an analysis of this issues would be a step forward in enlighting the scientific writing process. [More]

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Resin-Based Composite and LCU-related Factors Affecting the Degree of Cure. A Literature Review: Part 1. Resin-Based Composites

Aldossary Mohammed1, Santini Ario2*

1 MClinDent, University of Edinburgh, UK
2 University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0126

Resin-Based Composite (RBC) is widely used in Dentistry to restore anterior and posterior teeth. There have been many advances in RBCs development to improve their clinical success rate and overcome the many disadvantages of the first materials. These materials are cured by visible light, and light curing units have also undergone considerable development. Recently, bulk-fill composite materials were introduced to be placed in the cavity in bulk, claiming replacement of the traditional layering technique. In this paper an overview of RBCs, their composition and properties will be presented. [More]

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A One Time Opportunity for Generosity

Copotoiu Sanda-Maria

Editor-in-Chief

Nine eleven celebrated a decade of safe measures taken in order to prevent further useless human losses. Since then, violence against human beings is supposed to be prevented and opposed by security measures. The number of human beings deceased as a result of that terrorism act was appreciated at 2982 (1).
Compared to this devastating attack against humanity, the fact that a number of 6467 patients died in the USA in 2012 while waiting for an available organ passed almost unobserved by the media (2). Still, a number of 22187 organ transplantations were performed from 8143 deceased donors. Summing up the lost human lives in the battle to survive by human organ transplantation, we can easily see that despite the organ shortage, the gift of life allowed 7571 otherwise lost patients to continue to live. To an accountable, it would be a positive balance. When looking at the figures of the waiting list, that is over 120 000 souls, the disparity between need and supply of transplantable organs is impressive (2).
So, are there ways or opportunities to increase organ donation? And doing so, are we at risk of disregarding moral or ethical values? Could we actually harm the donors and/or their families? [More]

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