Category Archives: Number

Papillary Thyroid Microcarcinomas: a 25 Years Retrospective, Institutional Study of 255 Cases

Zahan Ancuța Elena1,2, Nechifor Boilă Adela3*, Pașcanu Ionela1,2, Voidăzan Septimiu4, Cătană Ramona1, Fișus Andreea3, Borda Angela3,5

1 Departament of Endocrinology, Emergency County Hospital, Tirgu Mures, Romania
2 Departament of Endocrinology, University of Medicine and Pharmacy of Tirgu Mures, Romania
3 Departament of Histology, University of Medicine and Pharmacy of Tirgu Mures, Romania
4 Departament of Epidemiology, University of Medicine and Pharmacy of Tirgu Mures, Romania
5 Departament of Pathology, Emergency County Hospital, Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0108

Background: Papillary thyroid microcarcinoma (PTMC) defines a group of papillary thyroid carcinomas, incidentally discovered, measuring 1 cm or less. The aim of our study was to evaluate the incidence and the pathological characteristics of PTMCs in our institution in the last 25 years, with special emphasis on the prognostic factors related to PTMCs.
Material and methods: We performed a retrospective, cohort study on 255 PTMCs, registered in the Department of Pathology, Tîrgu-Mureş Emergency County Hospital between 1990 and 2014.
Results: A significant increase in the incidence of PTMCs was observed in the 2004-2014 period, compared to 1990-2003 (7.6%, 229 PTMCs/3005 thyroid specimens vs. 1.2%, 23 PTMCs/1885 thyroid specimens). Conventional PTMCs accounted for most of PTMC cases (n=123 cases, 48.2%), followed by the follicular variant of PTC (n=117 cases, 45.9%). The increasing incidence of PTMCs was associated with a significant increase in the routine number of blocks sampled per case over the study period (R2 =0.72, p < 0.001). By means of the univariate and multivariate analysis, three risk factors were predictive for extrathyroidal extension in PTMCs: multifocality (Odds ratio [OR] 4.97, p-0.002), tumor size ≥ 5mm (OR 8.97, p-0.008) and lymph node involvement (OR 17.66 p<0.005).
Conclusion: The incidence of PTMCs has revealed a significant increasing trend in our institution over the last 25 years. Multifocality, lymph node involvement and tumor size ≥ 5mm were found to be risk factors for extrathyroidal extension. These prognostic factors must be evaluated and clearly mentioned in the pathological report, to help a correct estimation of biological potential of the lesion and an appropriate postoperative management.

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The Prevalence and Distribution of High Risk Human Papillomavirus Genotypes in Patients with Dysplastic Lesions: a Population Study

Voidăzan Septimiu, Morariu Silviu-Horia*, Căpâlnă Mihai, Mărginean Claudiu, Dobreanu Minodora

University of Medicine and Pharmacy of Tîrgu Mureş, Romania

DOI: 10.1515/amma-2015-0107

Background. Cervical cancer (CC) is a major public health problem worldwide. Knowledge of human papillomavirus (HPV) genotype prevalence and distribution is important for the introduction of an effective vaccination program and the corresponding epidemiological monitoring. The aim of this study was to identify and analyze the distribution of high-risk HPV genotypes.
Methods. Data were collected from 136 patients for the detection of circulating HPV genotypes, where Pap test results revealed the presence of koilocytes or high risk (HR) dysplastic lesions, elements that raise the suspicion of HPV infection.
Results. HPV infection was identified in 72 (55.4%) of the patients tested, 34 (47.3%) with single infection, and 38 (52.7%) with multiple infections. Twenty-two different types of HPV were identified: 14 high risk HPV types, 7 low risk HPV types, 1 probable high risk HPV type. HPV 16 was the most frequently detected (55.6%) one, it was involved in single (15 cases) and multiple (25 cases) infections, primarily associated with type 18 (12 cases), and type 52 (11 cases). The presence of HPV 18 (29.2%) and HPV 52 (23.6%) was identified after HPV type 16.
Conclusions. Oncogenic HPV genotypes 16, 18, and 52 were most frequently associated in women with dysplastic lesions, which require the use of polyvalent HPV vaccines when assessing cross-protective effects of specific immunoprophylaxis programs.

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The Degree of Satisfaction of Medical Students Regarding Simulation Based Teaching Methods in Anesthesia and Intensive Care

Moldovan Cosmin1*, Szederjesi Janos2, Azamfirei Leonard3

1 Department of Histology, University of Medicine and Pharmacy of Tîrgu Mureș, Romania
2 Department of Anesthesia and Intensive Care I, University of Medicine and Pharmacy of Tîrgu Mureș, Romania
3 Department of Anesthesia and Intensive Care II and Emergency Medicine, University of Medicine and Pharmacy of Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0105

Background: Anesthesia and Intensive Care is a teaching subject that arguably benefits the most from the use of simulation based methods in education. The availability of technically advanced complex simulators allows instructors to develop training scenarios that can be deeply integrated within the teaching curriculum. Aim: The present study aimed to assess whether the students undergoingAnesthesia and Intensive Caresimulation training are satisfied with the perceived educational outcome.
Material and method: We carried out a retrospective transversal study in which we analyzed 256 feedback forms received from medical students between October 2014 and June 2015. The forms contained 5 fixed questions that required rating a certain parameter with grades from 1 to 5.
Results: The simulation sessions used in Anesthesia and Intensive Care training were well perceived by students, over 90% of whom considered that these training session are useful from a professional and career development point of view.
Conclusion: Based on the students’ perception, simulation training sessions in Anesthesia and Intensive Care can be further developed and integrated with the clinical practical content of this subject.

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Internal Structure Quality Control of Solid Pharmaceuticals. A Comparative Study

Imre Silvia1*, Haidu Timea1, Ponta Oana2, Vancea Szende1, Vari Camil-Eugen1, Tero-Vescan Amelia1

1 University of Medicine and Pharmacy Tîrgu Mureş, Faculty of Pharmacy, Romania
2 “Babeş-Bolyai” University, Faculty of Physics & Interdisciplinary Research Institute on Bio-Nano-Sciences, Cluj-Napoca, Romania

DOI: 10.1515/amma-2015-0104

Objective: The aim of the study was a comparative investigation by spectral and thermal analysis in order to asses a number of characteristics of different varieties ofrawmaterials of ursodeoxycholic acid and ibuprofen. The different dissolution behavior of two ursodeoxycholic acid pharmaceutical product by crystallinity pattern was investigated.
Methods: Raw materials of ursodeoxycholic acid and ibuprofen were used. IR spectroscopy, differential scanning calorimetry and X-Ray Diffraction Analysis were applied.
Results: The results show no crystallinitydifferences for different batches of the tested drugs. No solid solid transition was proved during sample preparation for transmission IR analysis.
Conclusions: A combination of two more affordabletests by IR spectrometry and differential scanning calorimetry lead to the same results as X-Ray diffraction analysis for crystallinity similarity assessment of the studied substances. The dissolution differences of test drugs were not related to the polymorphism of the raw materials.

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Helicobacter Pylori and its Determinations on Gastric Biopsies

Fülöp Emöke1*, Marcu Simona Tünde1, Borda Angela1, Voidăzan Septimiu2, Fülöp EF3, Ciorba M3, Mocan Simona4

1 Department of Histology, University of Medicine and Pharmacy of Tîrgu Mureş, Romania
2 Department of Epidemiology, University of Medicine and Pharmacy of Tîrgu Mureş, Romania
3 Department of Internal Medicine, University of Medicine and Pharmacy of Tîrgu Mureş, Romania
4 Department of Pathology, Emergency County Hospital of Tîrgu Mureş, Romania

DOI: 10.1515/amma-2015-0066

Background and Aims. Gastric cancer, because of its aggressive evolution and the high mortality associated with it, remains one of the most debated subjects in medical literature with Helicobacter pylori (HP) as a major risk factor. Chronic inflammation caused by HP infection represents the initial site of the predisposing and afterwards premalignant lesions for gastric carcinoma. The purpose of this study was to evaluate the prevalence of HP infection, of predisposing and premalignant lesions on gastric biopsies, as well as to identify the correlations between them.
Material and method. A retrospective cross-sectional study was performed on gastric biopsies collected endoscopically from a single region, antrum or corpus, and from different regions, between January 2012 and July 2014. Incidence of HP infection, of predisposing and premalignant gastric lesions, the correlation of HP infection and these lesions, were evaluated.
Results. HP infection was diagnosed in 32.81%. Predisposing and premalignant lesions were present in 53.64% of biopsies with most of them in the antrum. HP infection stands out for the under 50 yo group (p=0.001). No correlation between frequency of HP infection and predisposing and premalignant lesions was observed.
Conclusions. Prevalence of HP infection in our study suggests that besides HP infection, other factors are also involved in gastric cancer development. Biopsies from different regions of the gastric mucosa do not offer extra information regarding HP infection prevalence but may be helpful in evaluating incidence and extension of predisposing and premalignant lesions.

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Capillary Electrophoresis in the Analysis of Polyunsaturated Fatty Acids

Hancu Gabriel1, Tero-Vescan Amelia2*, Filip Cristina2, Rusu Aura1

1 Department of Pharmaceutical Chemistry, University of Medicine and Pharmacy Tîrgu Mures, Romania
2 Department of Pharmaceutical Biochemistry, University of Medicine and Pharmacy Tîrgu Mures, Romania

DOI: 10.1515/amma-2015-0103

The aim of this study to inventory the main electrophoretic methods for identification and quantitative determination of fatty acids from different biological matrices. Critical analysis of electrophoretic methods reported in the literature show that the determination of polyunsaturated fatty acids can be made by: capillary zone electrophoresis, micellar electrokinetic chromatography and microemulsion electrokinetic chromatography using different detection systems such as ultraviolet diode array detection, laser induced fluorescence or mass – spectrometry. Capillary electrophoresis is a fast, low-cost technique used for polyunsaturated fatty acids analysis although their determination is mostly based on gas chromatography.

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Tips and Tricks to Manage Vascular Risks Using the Transnasal Endoscopic Approach to Pituitary Adenomas

Chinezu Rareș1,2*, Berhouma Moncef3, Jacquesson Timothée3, Raverot Gerard4,5,6, Jouanneau Emmanuel3,5,6

1 University of Medicine and Pharmacy Tirgu Mures, Tirgu Mures, Romania
2 Clinic of Neurosurgery, County Clinical Emergency Hospital Tirgu Mures, Romania
3 Service de neurochirurgie B, Unité de chirurgie de la base du crâne. Groupement hospitalier Est, Hospices civils de Lyon, Bron, France
4 Fédération d’endocrinologie du pôle Est, Aile A1, Groupement hospitalier Est, Hospices civils de Lyon, France
5 Université Claude-Bernard, Lyon-1, Lyon, France
6 Inserm U1028, CNRS UMR 5292, Centre de neurosciences de Lyon, France

DOI: 10.1515/amma-2015-0100

Objective: The purely transnasal endoscopic approach has taken in the last decade a paramount importance in the treatment of pituitary adenomas, but some authors have been linked it to an increase in vascular complications. The aim of this paper is to provide a stepwise description of the vascular risks and steps required to avoid them.
Method: We present the minimal invasive technique used by the senior author in over 900 transnasal purely endoscopic approaches focusing on the relevant vascular landmarks, preoperative and operative steps taken in order to avoid vascular injury and the management of vascular injury from a multitude of sources.
Conclusion: Endoscopy has brought a wider field of view, with numerous vascular structures well inside the operating field. This represents control but also higher risk. Solid knowledge of the skull base anatomy and proper preoperative imaging coupled with an experienced surgeon can greatly reduce the vascular risks associated with surgery.

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The Prevalence of Chronic Liver Disease: Implications for Renal Impairment

Sala Nicoleta1, Bancu Ligia1*, Ureche Corina1, Botoman Maria1, Simon Ionela1, Ciorba Marius2, Dogaru Grigore3

1 2nd Department of Internal Medicine, University of Medicine and Pharmacy Tirgu Mures, Romania
2 1st Department of Internal Medicine, University of Medicine and Pharmacy Tirgu Mures, Romania
3 4th Department of Internal Medicine, University of Medicine and Pharmacy

DOI: 10.1515/amma-2015-0067

Introduction. Renal disease plays an important role in the prognosis and evolution of chronic liver disease, in particular in its advanced stages. The aim of our study is to analyze the prevalence of chronic liver disease (hepatitis and cirrhosis of different etiologies) and to assess possible correlations between these and impaired renal function.  Material and methods. We conducted a retrospective observational study based on data collected from observation charts of patients admitted to the 2nd Medical Clinic, Emergency County Hospital Tirgu-Mures between January 1st 2012-December 31 2013. In this study we included, based on informed consent, 401 patients with documented liver pathology, with preserved or modified renal function.  Results. Age distribution shows that 41.1% of cases occured between 51 and 60 years of age. Sex distribution shows that 65.3% of cases were male. Toxic cirrhosis was found in 40.8% of males and viral C cirrhosis in 15.1% of women. Toxic cirrhosis associated the following complications: ascites (35.7%), encephalopathy (75%), PAH (68.6%), esophageal varices and upper GI bleed (35.7%). Analyzing the risk factors of renal failure we found that increased mean values of creatinine are associated with viral B cirrhosis (p = 0.02), portal vein diameter (OR 1.37), portal hypertension (OR 1.24), male gender (OR 1.84) and the age group 61-70 yo (OR 1.04).  Conclusions. The current study demonstrated that renal function in chronic liver disease correlates with viral etiology of liver disease, its advanced stage, presence of portal hypertension, older age and male gender.

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Risk Management in Clinical Laboratory: from Theory to Practice

David Remona Eliza1*, Dobreanu Minodora2

1 Department of Medical Biochemistry, University of Medicine and Pharmacy Tîrgu Mureș, Romania
2 Department of Laboratory Medicine University of Medicine and Pharmacy Tîrgu Mureş, Romania

DOI: 10.1515/amma-2015-0086

Clinical laboratory tests ensure approximately 70% of the medical decisions, so that the time until the release of the results and its accuracy are critical for the diagnosis and the efficiency of the treatment [1]. Risk management involves both the anticipation of what could happen erroneous and the assessment of errors’ frequency as well as the consequences or the severity of the effects caused by it, and finally to decide what can be done in order to reduce the risk to an acceptable clinical level. For this reason, organizations should not see the risk management as a compliance issue, but as an integral part of the decision-making process. EP23-A is a guideline of CLSI that introduces the risk management principles in the clinical laboratory and encourages the laboratories to develop plans of risk management which are addressed to the risks of each laboratory. EP18-A2 proposes 2 techniques for identifying and controlling the errors in the laboratory: FMEA (Failure Mode and Effects Analysis) and FRACAS (Failure Reporting, Analysis and Corrective Action System). The European Committee of Experts and Management of Safety and Quality in Health Care proposed to use the quality indicators to identify the critical stages of each process, thus being possible to assess continuously the medical processes with the aim of identifying the errors when they occur. This review summarizes the principles of the risk management in the clinical laboratory, thus it can achieve its aims to report valid, accurate and reliable test results.

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Morpho-Pathological Review on the Healing of Synthetic Vascular Grafts

Russu Eliza1*, Mureșan Adrian Vasile1, Cordoș Bogdan Andrei2, Copotoiu Constantin1, Cotoi Ovidiu Simion3

1 Department of Surgery, University of Medicine and Pharmacy of Tîrgu Mureș, Romania
2 Experimental Research Station, University of Medicine and Pharmacy of Tîrgu Mureș, Romania
3 Pathophysiology Department, University of Medicine and Pharmacy of Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0098

Objective: Tissue integration of vascular grafts partially depends on the host response to injury, which immediately begins after implantation and restoration of the circulation. In an infected environment, the inflammation changes the incorporation patterns. The aim of the study was to observe the tissue incorporation process, in a normal and an infected environment. Methods: We have created an experimental model by performing subfascial implantation of four types of vascular grafts, in rats (woven Dacron®, knitted Dacron®, silver coated Dacron® and expanded Polytetrafloroethylene – ePTFE) and by infecting some of them with three different bacterial strains. We have retrieved the non-infected grafts at two and four weeks after implantation, whilst the infected ones at one, two and three weeks.
Results: Detailed microscopic appearences were analysed. The control and infected groups were compared. Statistical significance was calculated for various corelations. Conclusions: The morphopathological findings showed that the ePTFE graft’s structure was best preserved. Statistical significance existed between the bacterial strain and the degree of inflammation. The silver coated Dacron® was not shown to be superior to the knitted Dacron®. The poorest incorporation was the one of the woven Dacron®.

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