Category Archives: Number

Sharing Responsibility Does Not Always Make Things Easier

Gabriel M. Gurman

Ben Gurion University of the Negev, Mayney Hayeshuah Medical Center, Israel

Positioning of the patient on the operating table is supposed to be a simple task for the operating room team (surgeon, anesthesiologist, circulating nurse and their aids): once anesthesia induction is performed,in the vast majority of cases in the supine position, and surgical procedure is known, it is simple to decide upon the position the patient during operation.
The main factor for deciding upon the position on the operating table is the need to assure an easy surgical access to the anatomic location of the procedure.
But positioning is sometimes accompanied by complications and most of them are related to nerve injuries.
About 15% of anesthetic malpractice claims in the USA refer to nerve injury during operation [1].
There are two main problems related to nerve injuries during surgery and anesthesia.
First is the fact that in most cases the anesthetized patient is unable to complain about pressure or lack of comfort on his or her limbs.
But the worrying aspect of nerve injury during surgery is that it may occur even when all the precautions have
been taken and the impression is that nothing has been left in order to assure a smooth surgical and anesthetic act. [More]

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How About Investing a Little Bit More in the Bloody Approach?

Sanda-Maria Copotoiu

Editor-in-Chief

Last year Prof Gurman initiated the publication in our journal of a series of happenings in the field of anesthesia
and intensive care. They escalated to an unwanted outcome and the end of every story was decided in the courtroom. This is why the medical cases turned into legal cases.
There is no happy end to a legal case except for the patient to recover and the doctors to acknowledge their good faith and flawless professional behavior. Still, if some wisdom issues from a legal case, there is a positive reflection one can use later on.
The comments an anesthetist would immediately formulate after confrontation with such a case would be self
defendant, and in no case neutral. And the best defense is evidence-based.
When trying to find medical evidence for radial nerve palsy on the net, the first results the Google offered where
583000 entries. When adding anesthesia, the figure dropped to 237000 and further to 2940 if filtered with
an additional noun, positioning. Thus medical literature referring to the reported case is not exotic, and yet few of the titles red and of the articles studied consecutively were relevant to the subject of the research. [More]

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Marfan Syndrome: the Nowadays of a Century-old Disease

Seres-Sturm L jr.1, Deac R2, Szabolcs Z3

1 Department of Cardiac Surgery, University of Pecs, Hungary
2 Cardiovascular and Transplant Surgery Clinic, University of Medicine and Pharmacy Targu-Mures, Romania
3 Department of Cardiac Surgery, Semmelweis University Budapest, Hungary

The review emphasizes the actuality and importance of Marfan syndrome research worldwide. The hundred years old disease has been described mainly by its skeletal, ocular and cardiovascular manifestations, and constitutional type. The underlying gene mutations have been discovered in 1991. The surgical treatment of aortic root dilatation and dissection using Dacron tube reconstruction in emergency and prophylactic surgery has been published in 1955. Nowadays international foundations, database networks subjected Marfan syndrome as a rare disease with privileged research programs. The clinical Ghent nosology of pleiotropic criteria is accepted
world-wide (1996). The research programs are focused on international proposals.

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Successful Treatment with Infliximab in a Case of Crohn’s Disease with Peripheral Arthropathyes

Hodut A, Sabau I, Simedrea I, Belei Oana, Militaru Andrea

First Pediatric Clinic, Faculty of Medicine, University of Medicine and Pharmacy “Victor Babes”, Timisoara, Romania

Introduction: Crohn disease is an inflammatory bowel disease that involves any region of the alimentary tract from the mouth to the anus and it is transmural. Children with early onset are more likely to have colonic involvement. Infliximab constitutes today one of major therapeutic approaches at cases of Crohn’s disease.
Material and methods: We present the case of a 15-year-old female who was admitted in our department presenting pain of the large joints (exacerbated by movement), abdominal pain (epigastric and hypogastric), vomiting, diarrhea. In order to induce remission of the disease, we chose the step-up therapy (the only one accepted in Romania for children with Crohn disease). The initial response to immunosupressant therapy was moderate: no digestive symptoms were present, but extradigestive (articular) symptoms were still present and remission was not obtained (inflammation markers were still present and PCDAI was still above 15). We decided to try to induce remission with Infliximab.
Results: We obtained only temporary improvement of symptoms with “classical” therapy. We had a good response to Infliximab (remission was obtained), but treatment discontinuation without medical advise led to relapse after 9 months.
Conclusions: Infliximab was effective as therapy in Crohn’s disease with peripheral arthropathy, but too soon discontinuation of treatment due to patient’s non compliance determined relapse of the disease.

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Considerations Regarding the Antiinflammatory Action of Soy Total Extract Vs. Soy Isoflavonoid Daidzein on Animal Model

Țiulea Corina1, Peev C1, Feflea S1, Dehelean C2, Mureșan A3, Motoc A4

1 Department of Pharmacognosy, Faculty of Pharmacy, University of Medicine and Pharmacy Victor Babes, Timisoara
2 Department of Toxicology, Faculty of Pharmacy, University of Medicine and Pharmacy Victor Babes, Timisoara
3 Department of Morphopatology, Faculty of Medicine, University of Medicine and Pharmacy Victor Babes, Timisoara
4 Department of Anatomy, Faculty of Medicine, University of Medicine and Pharmacy Victor Babes, Timisoara

Introduction: The aim of this study is to investigate the anti-inflammatory action of daidzein on animal model a less studied isoflavone than genistein on this topic and to compare it’s anti-inflammatory activity with the one of soy total extract.
Material and method: Soybean seeds were grounded and a solvent formed of DMSO-ethanol-water in rapport 5-70-25 v/v/v was prepared. The extraction was made at room temperature using an ultrasonic bath (Falc LCD Series) for 30 minutes, 59 kHz. The solvent was evaporated with a rotary evaporator at 50 ºC. Daidzein was acquired from Extrasynthese (France).Animal studies were conducted on C57BL/6J female mice of 8 weeks. Edema was induced in both ears of each mouse by the topical application of 2 μg TPA dissolved in 20 μL of acetone to both the inner and outer ear surfaces. Thirty minutes after the application of TPA, the inner and outer surface of each ear was treated with 2 mg of soy total extract (group C) and 2 mg of daidzein (group D). Mice were killed after 24 h by cervical dislocation and ears were collected. Ears were weighed and histological analyze were made. For the histological analyze, tissue samples (skin) were fixed in 10% formalin solution and were embedded in paraffin and cut at 4 microns. Finally after deparaffinized the samples were stained with H&E (hematoxylin-eosin) and microscopically analyzed.
Results: The obtained results suggest that both of the samples used for the treatment are active agents against inflammation but with different empowering. Soy total extract is in charge of reducing the massive under epithelial inflammation with numerous granulocytes to a discrete under epithelial inflammatory infiltrate. Daidzein successfully reduced the massive under epithelial inflammation with numerous granulocytes to a discrete under epithelial edema.
Conclusion: Both daidzein and soy total extract present an anti-inflammatory action on animal model but daidzein is a better therapeutic choice since it has a stronger anti-inflammatory action.

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Multiple Sclerosis Brain Lesions: Is Short Tau Inversion Recovery Sequence Suitable in Magnetic Resonance Imaging Evaluation?

Treaba Constantina Andrada1, Buruian M1, Podeanu Maria Daniela1, Macavei I2, Simu IP1

1 Department of Radiology and Imaging, Emergency County Clinical Hospital, Faculty of Medicine, University of Medicine and Pharmacy Targu Mures
2 Department of Neurology, Emergency County Clinical Hospital, Faculty of Medicine, University of Medicine and Pharmacy Targu Mures

Purpose: To compare the sensitivity of Short Tau Inversion Recovery magnetic resonance sequence with Fast Spin-Echo T2-weighted and Fluid-Attenuated Inversion Recovery magnetic resonance sequences in detection and evaluation of multiple sclerosis brain lesions.
Material and method: Fast Spin-Echo T2-weighted, Fluid-Attenuated Inversion Recovery and Short Tau Inversion Recovery sequences were performed in 7 patients with relapsing remitting multiple sclerosis. Qualitative assessment, regarding the number of lesions detected, conspicuity and lesion location was performed on all images in each sequence by two radiologists. Consensus was reached by agreement.
Results: When comparing Short Tau Inversion Recovery sequences with Fast Spin-Echo sequences, Short Tau Inversion Recovery showed 51 lesions more than Fast Spin-Echo sequences and increased the number of lesions detected by 38% in posterior fossa and by 27% in juxtacortical locations. When comparing Short Tau Inversion Recovery sequences with Fluid-Attenuated Inversion Recovery sequences, Short Tau Inversion Recovery sequences showed 72 lesions more than Fluid-Attenuated Inversion Recovery sequences and increased the number of lesion detected by 86% in posterior fossa and by 24% in periventricular areas.
Conclusions: By increasing the sensitivity Short Tau Inversion Recovery sequence might be suitable as an additional sequence in routine magnetic resonance brain examinations in patients with multiple sclerosis. Although Short Tau Inversion Recovery provides essential supplementary information to conventional imaging for the visualization brain lesions in multiple sclerosis, especially in posterior fossa, it is not a substitute for other sequences.

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Evaluation of Diastolic Function in Patients with Aortic Stenosis

Szabados Cs1, Frigy A1, Baricz Emőke1, Szabados Imola1, Vecsei Boglárka2, Incze A1

1 IV. Medical Clinic, University of Medicine and Pharmacy, Targu Mureş
2 Medical Student, University of Medicine and Pharmacy, Targu Mureş

Introduction: Diastolic dysfunction is characterized by an increased resistance to filling with increased diastolic filling pressures. Aortic stenosis has become the most frequent type of valvular heart disease. Aortic stenosis increases diastolic filling pressures due left ventricular hypertrophy.
Material and methods: Our study is a retrospective one, and includes the IV. th Medical Clinic patients discharged in years 2009–2010. Thirty-four patients with severe aortic stenosis (group A), and 21 patients with moderate aortic stenosis (group B) underwent complete paraclinical evaluation.
Results: The mean age in the group A was 70 years, versus 67 years in group B. The left atrium anteroposterior diameter was 46 mm in grop A, and 43 mm in group B. In group A, the mean left ventricular thickness index was 0.51, versus 0.46 in group B. Severe diastolic dysfunction was present in 35% in group A , and in 19% in group B. The most frequent associated pathology was hypertension (35% in group A, 47% in group B).The most common complications were mitral insufficiency (31 patients in group A, 16 patients in group B), pulmonary hypertension (16 patients versus 9 patients).
Conclusions: The severe aortic stenosis was more frequent in advanced ages. The left atrium enlargement, the severe diastolic dysfunction, and a greater left ventricular wall thickness index were more common in patients with severe aortic stenosis. The most common associated risk factors in both groups were hypertension. The mitral regurgitation was more frequent in the severe aortic stenosis group.

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Clinical and Radiographic Evaluation of Direct Pulp Capping Procedures in Permanent Teeth

Sitaru A, Monea Monica, Monea A

Odontology and Periodontology, Dental Medicine Faculty, University of Medicine and Pharmacy Tg.Mureș

Background: The dental pulp can be exposed by trauma or during cavity preparation and the decision between pulp capping and root canal therapy is a clinical issue.
The aim of this study was to evaluate the outcome of direct pulp capping procedures in permanent teeth.
Material and methods: Thirty-nine patients with pulp exposure were evaluated clinical and radiological after direct pulp capping procedure and followed for at least 24 months. The result was considered successful if the tooth tested was vital, without symptoms and no periapical radiolucencie.
Results: The success rate of direct pulp capping was 58.9%, associated more with mechanical exposure than with carious exposure (83.3% versus 48%, p < 0.05) and more with class I occlusal restorations (77.7%) than with proximal restorations (class II 44.4%, class III 41.6%, p < 0.05).
Conclusions: The success rate of direct pulp capping was 83.3% with mechanical exposure and 48% with carious exposure.

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Portal and Hepatic Artery Hemodynamics in Cirrhotic Patiens: Relationship with the Severity of Portal Hypertension and Hepatic Failure

Sârbu-Pop Silvia1, Török Imola2, Macarie Melania2, Georgescu D2, Băţagă Simona2

1 Emergency County Hospital Târgu Mureş
2 First Clinic of Gastroenterology, University of Medicine and Pharmacy Târgu Mureş

The aim of our study was to investigate the value of Doppler ultrasonography of the portal vein and hepatic artery in liver cirrhosis and to detect any relationship between the ultrasonographic changes and the severity of the portal hypertension and hepatic failure.
Methods: The study comprised 112 patients diagnosed with cirrhosis who had different degrees of esophageal varices, no ascites and who had been divided into groups according to Child-Pugh score. We evaluated the portal vein and hepatic artery velocities and we calculated the hepatic artery resistance and pulsatility index.
Results: Our data suggest that in patients with cirrhosis there is a significant correlation between the pulsatility index and the size of esophageal varices (p < 0.0001) and between the portal velocity and the size of esophageal varices (p < 0.0001). We found a significant inverse correlation between the portal velocity and the pulsatility index (r = -0.63) and a negative correlation between the portal velocity and the resistance index (r = -0.23).There was no correlation between the portal velocity and the peak systolic arterial flow (r = 0.017). There were no statistical differences of the studied portal vein and hepatic artery hemodinamics to different stages of liver
disease.
Conclusion: Portal vein and hepatic artery hemodinamics are unrelated to the degree of hepatic failure. In patients with cirrhosis the hepatic artery pulsatility index is correlated with the severity of the portal hypertension respectively with the degree of esophageal varices. Doppler ultrasound determination of these indices may contribute to a non-invasive evaluation of varices.

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Optimization of a Capillary Electrophoresis Method for the Separation of Quinolone Derivatives

Rusu Aura, Hancu G, Gyéresi Á

Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy Targu Mures, Romania

Background: In this work the applicability of capillary zone electrophoresis for the separation of quinolones from different generations has been studied.
Objective: Our aim was to develop a capillary electrophoretic method for the simultaneous separation of four quinolones and also to optimize the analytical conditions.
Material and methods: Capillary electrophoresis (CE) is a family of related techniques that use narrow-bore fused-silica capillaries to perform high efficiency separations of both small and large molecules. For this we chose four quinolones: a naftiridine derivate (nalidixic acid), a pyrido-pyrimidine derivate (pipemidic acid) and two second generation fluoroquinolones with different structures (ciprofloxacin, ofloxacin).
Results: A fast and reliable method has been developed, using a separation buffer composed of 40 mM natrium tetraborate and 5% methanol as organic modifier, with whom we achieved the separation of the studied quinolones in less than 10 minutes.
Conclusions: CE proved to be an efficient tool in the separation of quinolones from different generations.

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