Category Archives: Number

A Short Review of the Experience of the University of Medicine and Pharmacy of Tîrgu Mureş in Medical Simulation

Moldovan Cosmin1*, Szederjesi Janos2, Azamfirei Leonard3

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

DOI: 10.1515/amma-2015-0109

Medical simulation is used in a growing number of medical education institutions all over the world. Since 2013, the University of Medicine and Pharmacy of Tîrgu Mureş has introduced a number of simulation methods into the curriculum of certain subjects, the number of which is expanding. This article sums up some of the knowledge available in the literature regarding medical simulation and presents the general framework under which it is used in medical learning in our University.

Keywords: ,
Full text: PDF

Percutaneous Revascularization in a Case of Vasospastic Angina Associated with Polymorphic Ventricular Tachycardia

Rudzik Roxana, Şuş Ioana *, Hadadi László, Şerban Răzvan Constantin, Dobreanu Dan

University of Medicine and Pharmacy of Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0106

Introduction: Coronary vasospasm is a possible cause of ventricular tachyarrhythmias and is frequently associated with atherosclerotic lesions. The revascularization of mild to moderate coronary artery stenosis which causes symptoms only due to associated vasospasm is still a matter of debate, as the standard treatment of Prinzmetal angina is represented by the long term administration of calcium-channel blockers.
Case presentation: We present the case of a 46 year old woman with an intermediate severity coronary artery stenosis complicated by vasospastic angina and subsequent polymorphic ventricular tachycardia. Although the functional significance of the fixed coronary artery lesion was equivocal at invasive fractional flow reserve measurement, a combined pharmacologic and interventional treatment strategy was chosen with stent implantation and long acting calcium channel blocker administration with a symptom-free, good clinical outcome.
Conclusion: Patients with vasospastic angina and intermediate severity atherosclerotic coronary artery stenoses are at risk of malignant ventricular arrhythmias, therefore myocardial revascularization should be considered in addition to the standard medical treatment.

Keywords: , , ,
Full text: PDF

Combined Myocardial Infarction in a Young Patient with Anomalous Coronary Artery Anatomy: A Case Report

Hadadi László1,2*, Lakatos Éva Katalin1,2, Țăruși Mariana2, Dobreanu Dan1,2

1 Univeristy of Medicine and Pharmacy of Tîrgu Mureș, Romania
2 Emergency Institute for Cardiovascular Diseases and Transplantation of Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0102

Introduction: combined myocardial infarction (MI) is defined as the simultaneous ischemic injury of two different myocardial territories, raising the possibility of multiple culprit lesions. The anomalous origin of a coronary artery could represent an important challenge during percutaneous coronary intervention (PCI).
Case presentation: A 46 year old, smoker Caucasian male presented to a territorial hospital four hours after the onset of severe angina. Consecutive electrocardiograms showed complete atrioventricular block and inferior ST segment elevation (STE), later PQ prolongation with right bundle branch block plus STE in leads V4-V6. After administration of thrombolytic treatment, the patient was transferred to the regional PCI center. Emergent coronary angiography revealed acute occlusion of the left anterior descending artery (LAD) and a thrombus containing, severe stenosis of the anomalously originated right coronary artery (RCA). Rescue PCI with stent implantation in the LAD and RCA was performed nine hours after pain onset. At the 1 year follow-up visit the patient had no angina or heart failure symptoms.
Conclusion: this is the first report of a combined MI caused by acute, sequentially occurring thrombotic occlusion of two coronary arteries, one of them with anomalous origin, in a patient treated by rescue PCI following partially successful thrombolysis.

Keywords: , , ,
Full text: PDF

Recurrent Incisional Hernia Associated with Interferon Treatment for Virus C Hepatitis: Case Report

Gherghinescu Mircea1, Molnar Călin1*, Popa Daniel1, Russu Cristian1, Lazăr Alexandra1, Copotoiu Constantin1

1 University of Medicine and Pharmacy, Tîrgu Mureş, Romania

DOI: 10.1515/amma-2015-0101

Background: Hepatitis C prevalence in Romania is 3.5 %. Nowadays, the treatment of this condition comprise of interferon. One of the interferon’s side effects is the reduction of collagen synthesis, substance that is necessary in the process of abdominal wall healing.
Case report: We report the case of a 56 years old female patient, admitted in our Clinic for a giant, recurrent incisional hernia. The patient’s history was eventful: a hysterectomy for uterine fibroma in 2009, incisional hernia repair in 2010, the treatment with Interferon in 2011 and 2012 for viral hepatitis C. A well represented subcutaneous tissue is observed intraoperator, a wall defect of 15 cm in diameter with a 5 mm thick muscle aponeurosis lay. We performed abdominal wall plasty by components separation technique, reinforced with a polypropylene mesh disposed on lay. Postoperative analgesia was provided by inserting a wound catheter through which Ropivacaine 0,5 % was continuously injected for 72 hours. The postoperative evolution was uneventful, the patient being discharged 7 days after the surgical intervention.
Conclusions: The treatment with Interferon of hepatitis C can favor the recurrence of an incisional hernia. The Oscar Ramirez procedure seemed to be the best choice for surgical treatment of this giant incisional hernia. Postoperative analgesia can be accomplished by a wound catheter through which Ropivacaine 5% is continuously infiltrated.

Keywords: , , , ,
Full text: PDF

Viability Changes in Leucocytes in a Critical Trauma Patient: Monocyte, Lymphocyte, Granulocyte Response to the Acute Phase: Case Report

Benedek Orsolya1, Dobreanu Minodora2*, Azamfirei Leonard3, Veres Mihaly4, Copotoiu Sanda-Maria1

1 University of Medicine and Pharmacy, Tîrgu Mureş, Anesthesia and Intensive Care 1
2 University of Medicine and Pharmacy of Tîrgu Mureş, Laboratory Medicine
3 University of Medicine and Pharmacy, Tîrgu Mureş, Anesthesia and Intensive Care 2 and Emergency Medicine
4 Emergency Clinical County Hospital Tîrgu Mureş, Anesthesia and Intensive Care Clinic

DOI: 10.1515/amma-2015-0099

Trauma affects the activity of the innate immune system. The objective of this case report is to present the case that prompted us to analyse all the peripheral white blood cell lines. A 19 year old male patient was admitted to the Intensive Care Clinic with severe head trauma. The final diagnosis was set to be severe cerebral trauma with subarachnoid hemorrhage, right frontal and temporal cerebral contusions, diffuse cerebral edema, left parietal and temporal fracture, sphenoid hemosinus and right sided lung contusions.
Material and Method: Whole blood was immediatly analyzed by flow cytometry for leukocytes. Apoptosis was detected with Annexin V, necrotic cells were stained with propidium iodide. Samples were drawn three consecutive days.
Results: Lymphocytes, monocytes and granulocytes all showed marked increase in viability and decrease in necrosis during the biological monitoring in correlation with a positive clinical outcome. The most important changes were noted in the monocyte population. Discussion: Although we started out monitoring neutrophil viability and death, this particular case prompted us not to overlook other leucocyte populations.
Conclusion: The apparent positive relationship between this patient’s positive clinical outcome and cellular viability and death changes is promising but they warrant further study.

Keywords: , , , ,
Full text: PDF

Distinct Morphological Features Predictive for Aggressiveness of Papillary Thyroid Microcarcinoma: a Study of 72 Cases and 80 Tumor Foci

Nechifor-Boilă Adela1,2, Zahan Ancuţa Elena1,3*, Căpraru Oana3, Cătană Ramona3, Fişus Andreea2, Berger Nicole4

1 Departament of Histology, University of Medicine and Pharmacy of TirguMures, Romania
2 Department of Pathology, University of Medicine and Pharmacy of TirguMures, Romania
3 Departament of Endocrinology, University of Medicine and Pharmacy of TirguMures, Romania
4 Department of Pathology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, France

DOI: 10.1515/amma-2015-0112

Introduction: In this study, we aimed to investigate the importance of some distinctive morphological parameters in predicting the extrathyroidal extension, as marker of aggressiveness, in a series of papillary thyroid microcarcinoma (PTMC) cases.
Material and methods: All consecutive PTMC cases, sized ≥5mm, registered at the Department of Pathology, Tîrgu-Mureş Emergency County Hospital from January 2002 to December 2013 were re-evaluated. The following histological features were noted: the multifocality, the extrathyroidal extension, the histologic variant, the tumor’s border (well circumscribed versus infiltrative), the PTC nuclear features (well developed versus subtle), the tumor associated stromal reaction (fibrosis/desmoplasia/sclerosis versus none of these changes), the presence of “plump pink” cells, psammoma bodies, intratumoral lymphocytic infiltrate, cystic change, back-to-back arrangement, intratumoral multinucleated giant cells and lymph node involvement.
Results: Our study included 72 PTMC cases, summing up to a total of 80 PTMC foci. We have shown that extrathyroidal extension is significantly associated with the presence of “plump pink”cells (p=0.0019), well developed nuclear features of PTC (p=0.018) and tumor associated stromal reaction (fibrosis/dezmoplazia/sclerosis) (p<0.0001). Other parameters were more prevalent among PTMC foci with extrathyroidal extension, but did not reach statistical significance.
Conclusion: Our results pointed out the importance of a distinct set of morphological microscopical parameters, predictive for extrathyroidal extension in PTMC cases (“plump pink” cells, well developed PTC nuclear features, tumor associated stromal reaction, infiltrative tumor borders and conventional PTC histology). All these parameters are important to be mentioned in the histopathological reports, as they might be associated with a more aggressive biological behaviour.

Keywords: , , ,
Full text: PDF

Diffusion Weighted Imaging in Magnetic Resonance Imaging for Prostate Cancer Diagnosis: Current Efficiency as a Standalone Sequence for an Unenhanced MRI Experience – a Pilot Study

Nechifor-Boilă IA1,2, Borda Angela3, Loghin Andrada3*, Nechifor-Boilă Adela3, Chibelean C2

1 Department of Anatomy, Târgu-Mureş University of Medicine and Pharmacy, Târgu-Mureş, Romania
2 Department of Urology, Târgu-Mureş University of Medicine and Pharmacy, Romania
3 Department of Histology, Târgu- Mureş University of Medicine and Pharmacy, Romania

DOI: 10.1515/amma-2015-0111

Objective: Diffusion Weighted Imaging (DWI) is the main sequence in the multiparametric prostate MRI protocol together with T2 and dynamic contrast-enhanced T1, leading to detection rates up to 60% in prostate cancer diagnosis. However, the use of intravenous contrast can have severe side-effects, making the use of unenhanced MRI sequences essential. The aim of our study was to assess the feasibility and efficiency of DWI as a standalone MRI technique for prostate cancer diagnosis.
Methods: We performed a prospective cohort study at our department (09.2014-05.2015) and formed a study lot consisting in five prostate cancer patients that were scheduled for radical prostatectomy. Multiparametric MRI was performed (with DWI and T2 sequences) and the images were interpreted according to the PI-RADS system. The final histopathological result after prostatectomy served as gold standard.
Results: A series of 9 lesions were detected and analyzed on DWI. At qualitative interpretation, DWI had a sensitivity of 85.7% and a specificity of 50%. The corresponding positive and negative likelihood ratios were 1.71 and 0.286, respectively (p=0.417). ADC analysis revealed a mean value of 1.2*10-3mm2/s for the benign lesions while the corresponding value was 0.8 *10-3 for the malignant ones, regardless of tumor size and Gleason scoring.
Conclusion: DWI is a feasible technique in the current clinical environment, with a good sensitivity and a medium specificity. Furthermore, an association to the anatomical T2 sequence could enhance the diagnostic efficiency of DWI and should be assessed in larger studies.

Keywords: , , , ,
Full text: PDF

Medical Students’ Acceptance of Online Assessment Systems

Petrisor Marius1*, Marusteri Marius1, Simpalean Dan1, Carasca Emilian2, Ghiga Dana3

1 University of Medicine and Pharmacy Tirgu Mures, Department of Medical Informatics and Biostatistics, Tirgu Mures, Romania
2 University of Medicine and Pharmacy Tirgu Mures, Department of Internal Medicine, Tirgu Mures, Romania
3 University of Medicine and Pharmacy Tirgu Mures, Department of Scientific Medical Research Methodology, Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0110

Objective: The increased use of computers in education lead to computerized assessments, especially web-based assessment systems The aim of this study is to evaluate students’ acceptance of being evaluated using an online web-based assessment system.
Methods: A transversal study was performed where a sample of students that used and were accustomed to an online assessment system were asked to fill in a short questionnaire and evaluate its use.
Results: The questionnaire items responses show students’ preference for online assessment, as opposed to other assessment forms, like oral examination or classical pen and paper examination. Also it is noticeable the increase in the student number that prefer the online assessment as we move up through one year of study to the next.
Conclusions: The study revealed a high level of acceptance for the online multiple choice questions test as an assessment method. Students’ opinion is that online tests are better suited for knowledge assessment and are more objective.

Keywords: , ,
Full text: PDF

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.

Keywords: , , , ,
Full text: PDF

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.

Keywords: , ,
Full text: PDF