Category Archives: Number

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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Diagnosis and Treatment Algorythm in Lyme Neuroborreliosis

Țilea Brîndușa1*, Bălașa Rodica1, Fodor Andrea1, Țilea Ioan1

1 University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0125

Lyme neuroborreliosis is an infection of the nervous system caused by spirochetes of the Borrelia burgdorferi sensulato group. Neurological clinical manifestations usually present a steady evolution and are different in patients from Europe compared to those from America, possibly due to vector agents and different bacterial species. Various diagnostic markers were studied in consideration of a clear or possible diagnosis of the disease, because evolution and complications depend on early diagnosis and initiation of therapy. The isolation of the bacterium is difficult, microscopic examination and the bacterial dezoxiribonucleic acid amplification shows low sensitivity. However, the diagnosis of Lyme neuroborreliosis is mainly based on serological methods that have a satisfactory sensitivity and specificity. A correct diagnosis can be performed by strictly respecting clinical guidelines and protocols and carefully interpreting the serological tests. The presence of anti-borrelia burgdorferi antibodies in the cerebrospinal fluid with evidence of intrathecal antibody production is the gold standard diagnosis of Lyme neuroborreliosis. Early administration of antibiotic treatment (third generation cephalosporins, cyclins, aminopenicillins) can produce the remission of neurological symptoms, the eradication of spirochetes in acute phase of the disease, thus avoiding the development of the chronic disease.

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High-on-Aspirin Residual Platelet Reactivity Evaluated Using the Multiplate® Point-of-Care Device

Mărginean Alina1,2*, Moldovan Valeriu1, Mărginean Mihai1,2

1 University of Medicine and Pharmacy of Tîrgu Mures, Romania
2 Emergency Military Hospital “Dr. Constantin Papilian” Cluj-Napoca, Romania

DOI: 10.1515/amma-2015-0124

Objective: The aim of this study was to evaluate the prevalence of aspirin non-responsiveness using whole blood multiple electrode aggregometry and to investigate the role of different clinical and laboratory variables associated with the lack of response.
Methods: The present study included 116 aspirin treated patients presented with acute coronary syndromes or stroke. Response to aspirin was assessed by impedance aggregometry using arachidonic acid as agonist, in a final concentration of 0.5 mM (ASPI test).
Results: In our data set 81% (n=94) were responders and 19% (n=22) non-responders showing high-on-aspirin platelet reactivity. Correlation analysis showed that the ward of admittance, low-density lipoproteins (LDL), concomitant antibiotic treatment, beta-adrenergic receptor blockers, history of myocardial infarction as well as PCI performed on Cardiology patients have different degrees of association with aspirin response.
Conclusion: Concomitant treatment with beta-adrenergic receptor inhibitors, history of myocardial infarction and Cardiology ward admittance significantly increased the chance of responding to aspirin treatment whereas antibiotic therapy and low-density lipoproteins cholesterol seemed to increase the risk of high-on-aspirin residual platelet reactivity.

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The Study of Factors Associated with Severity of In-Stent Restenosis in Patients Treated with PCI for Acute Coronary Syndromes

Blendea Ciprian1, Monica Chitu1, Marius Orzan1,2, Balas Bajka1,2, Adriana Craciun1, Imre Benedek1

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-2015-0123

Introduction: The management of in stent restenosis represents a topic of great actuality and interest, especially since the interventional treatment with stent implantation became largely accepted as the metod of choice in patients with acute coronary syndromes. Identification of certain risk factors that could predict the development of an in stent restenosis and its severity could be extremely useful for the clinical management of these patients.
Methods: We retrospectively analyzed a total of 60 stent restenoses encountered in 57 patients admitted and treated in the Cardiology Clinic of Tirgu Mures. The interval of occurrence of restenosis ranged between 2 months and 37 months postintervention. We monitored the demographic characteristics (age, gender, colesterol, presence of renal insufficiency) and we realized a descriptive qualitative analysis of the angiographic procedural aspects. The in stent restenosis occurred most frequently on left anterior descending artery (63%), followed by the circumflex artery (22.15%) and right coronary artery (14.8%), regardless of the degree of stenosis prior to revascularization.
Results: Statistical analysis using Chi square test revealed no statistically significant differences in terms of the correlation between the incidence of restenosis and gender (p=0.14), treatment with ACE inhibitors (p=0.16), implanted stent diameter (p=0.22) or the type of procedure (ram crossing over a secondary branch being considered as a procedure involved in the genesis of severe restenosis) (p=0.02). We used the t-student test for comparative analysis of the correlation between the continuous variables related to initial native lesion diameter and the degree of restenosis, without finding any a statistically significant correlation between them (p=0.226). However, a statistically significant correlation was found between cholesterol levels and the degree of stenosis (p=0.039). Descriptive analysis of restenosis lesions did not find any statistically significant correlation with the type or degree of stenosis in the native vessel, but showed statistically significant differences when evaluating the geometric assumption of restenosis by intraluminal diameter or intraluminal area (p=0.0018), suggesting that assessment of the degree of restenosis should be performed only by planimetric area.
Conclusions: We can conclude that in stent restenosis represents a plurifactorial phenomenon, that is not conditioned by the severity of the native lesion or by the administration of ACE inhibitors or Spironolactone, however it depends directly on the control of cholesterol values afther the coronary revascularization.

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Rehabilitation in Patients with Anterior Cruciate Ligament Reconstruction Using Auxiliary Platelet-Rich Plasma Therapy

Albu Daniel – Emil1, Copotoiu Monica2, Melinte Răzvan1, Bățagă Tiberiu1, Copotoiu Sanda-Maria3

1 Department of Orthopedic Surgery and Traumatology I, County Emergency Clinical Hospital, Tirgu Mures, România
2 Department of Rheumatology and Physiotherapy, County Emergency Clinical Hospital, Tirgu Mures, România
3 Department of ICU and Anesthesiology I, County Emergency Clinical Hospital, Tirgu Mures, România

DOI: 10.1515/amma-2015-0122

Background: The main target after successful AnteriorCruciate Ligament (ACL) reconstruction is early rehabilitation. New options such as PRP (platelet rich plasma) may improve clinical outcomes. Objective: The aim of our study was to evaluate two consecutive series of patients who underwent ACL reconstruction, one with PRP treatment and one without it.
Material and method: Two groups of consecutive patients underwent arthroscopic ACL reconstruction, using the SemiT and BPTB techniques. Postoperatively all patients included in this study followed the same standardized rehabilitation protocol. In addition, patients in the first group received three intraarticular PRP injections as auxiliary therapy. Injections were performed at week two, four and six. The patients were evaluated at enrolment and every four and twelve weeks using the Tegner Lysholm Knee Scoring Scale (Scoring Scale: poor <65/ fair 65-83 / good 84-90 / excellent > 90). Each patient was operated on and evaluated afterwards by the same team of surgeons.
Results: At 12 weeks interval, Group A had a higher mean clinical score than Group B (94.67 vs 92.50) although marginally not statistically significant (p=0.0503, 95% CI:-4.336 to 0.002911). Regarding pain in patients from Group A compared with patients from Group B, we saw a statistically significant difference at 4 weeks interval (16.90 vs. 18.89, p=0.0370, 95% CI: 0.1260 to 3.842) and no significant difference at 12 weeks interval (21.19 vs. 21.94, p=0.3744, 95%CI: -0.9452 to 2.453). In terms of swelling points scored between the two groups, there was no statistically significant difference at 4 week interval (5.048 vs. 4.00, p=0.1979, 95% CI: -2.667 to 0.5714) but there is a significant difference in favor of patients from Group A at 12 weeks interval (8.475 vs. 5.556, p=0.0002, 95% CI: -4.323 to -1.159).
Conclusions: In the short term, the local treatment showed improvement on the overall clinical status of the patients (less pain, improved mobility, less swelling) undergoing rehabilitation after ACL reconstruction, although further studies are required.

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