Category Archives: Number

No-reflow in Patients with ST Elevation Acute Anterior Myocardial Infarction

Baba C., Ortan F., Ursu M.

ICCO Clinics Brasov, Interventional Cardiology

Objective: The aim of this study was to assess the prevalence of no-reflow after coronary recanalization in anterior acute myocardial infarction with ST-T segment elevation.
Methods: In a cohort of 80 consecutive patients with anterior acute myocardial infarction who were treated with primary angioplasty, we analysed angiographic and clinical characteristic of patients and the prevalence of pre-infarction angina. Successful angioplasty was defined as Thrombolysis In Myocardial Infarction (TIMI) grade 3 flow and residual stenosis less than 50% after the angioplasty procedure. The phenomenon of no-reflow is defined as inadequate myocardial perfusion through a given segment of the coronary circulation without angiographic evidence of mechanical vessel obstruction.
Results: Successful angioplasty was achieved in 63 patients (78.75%). Mean age and gender were not different from patients with and without TIMI grade 3 flow. The no-reflow phenomenon was more frequently observed in patients with diabetes (29.41% vs 4.76%, p 0.0001). TIMI grade III flow was higher in the patients with pre-infarction angina (42.86% vs 11.76% p 0.02).
Conclusion: The no reflow phenomenon in patients with anterior acute myocardial infarction treated with primary angioplasty is present in 21.25% of patients. Pre-infarction angina is associated with preservation of the microvasculature, reflected by reduced no-reflow.

Keywords: , ,
Full text: PDF

Comparative Study Between Echocardiography and Autopsy Results of Congenital Heart Defects

Imre Ágnes1, Egyed-Zs Imre2, Togănel Rodica2, Cotoi Ovidiu1, Pasc Ana Sorina3, Cucerea Manuela4

1 Morphopathology Departament of County Emergency Clinic Hospital of Tîrgu Mureş
2 University of Medicine and Pharmacy of Tîrgu Mureș
3 Pediatric Cardiology Department of the Emergency Clinic Hospital of Tîrgu Mureş
4 Neonatology Departament of County Emergency Clinic Hospital of Tîrgu Mureş

Background: Congenital heart disease is currently the world’s leading birth defect, with incidence estimated at 8 per 1000 live births. Confidence in the images obtained using echocardiography has continued to increase, with many patients referred for corrective or palliative surgery on the basis of echocardiographic imaging alone. This review outlines the manner in which echocardiography is used to plan and guide congenital heart surgery or intervention, along with some of the advantages and disadvantages of which to be aware.
Aim: To assess the degree of harmonization of echocardiography with postmortem diagnosis in congenital heart disease.
Material and method: We examined the morphology of congenital heart diseases by autopsy in the Morphopathology Department of the County Hospital of Tîrgu Mureş in 2008 and 2009. We analyzed the components of the congenital heart disease and we compared the echocardiographic results with the autopsy results also.
Results: In 2008 and 2009 621 necropsies were carried out, from which 49, meaning 7.89% were diagnosed with simple or complex cardiac malformations; the male-female ration was 1:0.9. We found a few differences between the echocardiography and autopsy results on the following malformations: total anomalous pulmonary venous connection, double outlet ventricle, univentricular heart.
Conclusions: Echocardiography is accepted as the first-line imaging modality for diagnosing most types of congenital heart defects but in some difficult cases surgeons must always keep in mind the possibility of the presence of other heart malformation too.

Keywords: , ,
Full text: PDF

To See or Not to See: Beyond the Open Artery in Myocardial Reperfusion

Dobreanu D.

Tîrgu Mureș University of Medicine and Pharmacy

Acute ST-elevation myocardial infarction (STEMI) is the major cause of mortality and morbidity in industrialised countries. The pathogenesis of STEMI is well know in the present: after plaque rupture and intracoronary thrombus formation, ischemia causes damage to myocytes and coronary microcirculation, soon after occlusion. Thus, the goal of therapy in patients with STEMI is to re-establish a pa-tent infarct-related epicardial artery as soon as possible.
Primary percutaneous coronary intervention (PCI) has now emerged as the optimal mode of reperfusion therapy, if performed by an experienced team within 90 minutes after the onset of symptoms [1]. The Thrombolysis In Myocardial Infarction (TIMI) group has categorized epicardial coronary flow into four grades (0–3) to standardize the angiographic characterization of reperfusion. Primary PCI results in patency of the occluded artery in almost all patients and in restoration of TIMI flow grade 3 (normal epicardial flow) in more than 90% of patients [2].
The restoration of TIMI-3 coronary flow in patients with STEMI is associated with improved survival and enhanced recovery of left ventricular function. This observation has led to the ‘Open artery theory’ explaning that restoration of TIMI-3 flow has been used as the gold standard for reperfusion success [3]. [More]

Keywords: ,
Full text: PDF

New Perspectives: Quinolones as Complexation Agents

Rusu Aura, Gyéresi Á., Hancu G.

University of Medicine and Pharmacy Târgu Mureş, Faculty of Pharmacy, Department of Pharmaceutical Chemistry

Background: Quinolones are synthetic antibacterial agents, with a 4-oxo-1,4-dihydroquinolinic structure, which is based on the nalidixic acid model. The 4-oxo and 3-carboxyl groups confer quinolones excellent chelatation properties with metallic ions.
Aim: To highlight a few theories regarding the complexation phenomenon of quinolones.
Methods: Complexes with metallic ions have been characterized (stoichiometry, in vitro physical-chemicals properties, stability studies, and behavioral studies in different biological mediums).
Results: New availabilities have been identified: bioavailability of the complexed quinolones and formulation of new pharmaceutical products with a superior bioavailability and therapeutic effect; the antimicrobial activity of quinolone complexes; quinolone complexes as antitumor drugs with the aim of obtaining less toxic compounds; understanding the mechanism of action of quinolones, which is a challenge especially regarding their selectivity at the bacterial DNA level; development of new determination methods, based on the complexation of quinolones with metallic ions.
Conclusions: The 21st century may provide new useful therapeutic aspects on the basis of complexation between quinolones and metals.

Keywords: , , ,
Full text: PDF

Erythrodermia Associated to Lung Cancer

Simu Lia-Maria1, Morariu S.H.1, Turcu M.2, Podeanu Maria-Daniela3, Şincu Nina4, Marian D.5

1 Department of Dermatology and Venereology, University of Medicine and Pharmacy Tg. Mureş
2 Department of Pathology, University of Medicine and Pharmacy Tg. Mureş
3 Department of Radiology and Imaging, University of Medicine and Pharmacy Tg. Mureş
4 Department of Infectious Diseases, University of Medicine and Pharmacy Tg. Mureş
5 Department of Surgery, University of Medicine and Pharmacy Tg. Mureş

There are a few skin lesions which are conected with internal malignancies, being important especially if they appear prior to neoplasia.
We are presenting the case of a patient who had desquamative erythrodermia associated to lung carcinoma. The patient was also diagnosed with a cerebral metastasis. The appearance of skin lesions suggested the presence of a subacute immune vasculitis, this was confirmed by immunohystochemical examinations, which revealed a leukocytoclastic vasculitis. Given the fact that previous erythematous lesions improved during the treatment of cerebral metastasis, the reccurence of erythrodermia suggests the evolution of metastasis. On the other hand, we can not rule out the possible role of the received chemotherapy in the development of the vasculitic process. The observation that these events do not occur in all cancer patients leads to the conclusion that the triggering mechanisms responsible for these paraneoplastic syndromes are individually conditioned.

Keywords: ,
Full text: PDF

T-cell/Histiocyte-rich B-cell Lymphoma

Turcu M.1, Horvath Emoke2, Chira Liliana3, Cotoi O.S.4

1 Department of Pathology, University of Medicine and Pharmacy, Department of Pathology, Emergency County Hospital, Targu-Mures
2 Department of Pathology, University of Medicine and Pharmacy, Department of Pathology, Emergency County Hospital, Targu-Mures
3 Department of Pathology, University of Medicine and Pharmacy, Department of Pathology, Emergency County Hospital, Targu-Mures
4 Department of Cellular and Molecular Biology, University of Medicine and Pharmacy, Department of Pathology, Emergency County Hospital, Targu-Mures

Background: T-cell/histiocyterich B-cell lymphoma (T/HRBCL) is an uncommon morphologic variant of diffuse large B-cell lymphoma (DLBCL), representing less than 10% of all DLBCL cases. T/HRBCL has attracted considerable attention as a result of the difficult task of distinguishing it from similar entities, such as nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL), classic Hodgkin lymphoma and peripheral T/cell lymphoma, nonspecific.
Case report: We present the case of a 70-year-old female patient addressing her primary care physician for headaches, nausea and a large, painful tumor in her left axilla. The paraclinical examinations revealed minimal deviations of hematological tests, but showed elevated LDH values. Surgery was performed and a specimen, composed of 13 lymph nodes, (the largest one having the surface diameter of 130 mm) was removed and examined histologically. On microscopic evaluation, the HE stain showed portions of lymph node completely effaced and replaced by a vaguely nodular lymphoid proliferation composed of scattered, large cells, with abundant cytoplasm, multilobated vesicular nuclei and proeminent nucleoli, consistent with lymphocytes and histiocytes. The immunohistochemical study proved the proliferative mass to be constituted of a limited number of large, CD20 positive B-cells, with proeminent nucleolus, in a background of CD3 positive T-cells, together with a variable number of histiocytes, highlighted with CD68. The large B-cells were scattered and did not form any clusters or strips. A diagnosis of T/HRBCL was made.
Conclusion: T/HRBCL is a rare variant of DLBCL, with an aggressive clinical outcome. In such cases immunohistochemical analyses are mandatory to reach correct diagnosis.

Keywords: ,
Full text: PDF

The Detection of Premalignant and Malignant Gastric Lesions by Conventional Endoscopy in a General Population Sample

Boeriu Alina1, Dobru Daniela1, Pascarenco Ofelia2, Mocan Simona3

1 Department of Gastroenterology, University of Medicine and Pharmacy Targu Mures
2 Department of Gastroenterology, Targu Mures County Hospital
3 Department of Pathology, Targu Mures County Emergency Hospital

Background and Aims: The identification of patients with premalignant lesions and endoscopic surveillance could improve the early detection of gastric cancer, with better therapy and prognosis. We performed conventional endoscopy with biopsies to identify the incidence rates of premalignant and malignant gastric lesions and the risk of patients for this pathology.
Methods: A total of 1651 patients were investigated with conventional endoscopy. We took biopsies from 1493 patients. Biopsy specimens were analyzed for gastric inflammation, atrophy, intestinal metaplasia, dysplasia and neoplasia.
Results: We demonstrated that major symptoms had a sensitivity of 95.2%, and a specificity of 54.5% for the detection of gastric neoplasia, with a sensitivity of 61.6% and a specificity of 57.2% for the detection of premalignant lesions. We showed the risk of patients over 45 years, with major or minor symptoms, for premalignant and malignant gastric lesions (p < 0.001; RR = 3.34; 95%CI: 2.41–4.61). We emphasized the importance of histological evaluation by biopsies of entire gastric mucosa in case of polyps, ulcers, gastric atrophy detection or remnant stomach, for the evaluation of premalignant lesions (p < 0.,05). We showed that the prevalence of premalignant lesions increased with age and the presence of Hp infection. We demonstrated the risk of the inflammation in the gastric body for premalignant lesions.
Conclusions: The patient’s symptoms were not predictive of endoscopic and histologic findings. Not only symptoms, but also the age, the presence of Helicobacter pylori infection, the histological detection of the extent and location of gastric inflammation and premalignant lesions define the risk for the dyspeptic patients.

Keywords: , , , ,
Full text: PDF

Bacteriological Study of Urinary Stones

Tudor Bianca1, Toma Felicia1, Boja R.2, Oşan V.2, Cigir Teodora3, Szavuj J.1, Man A.1

1 Discipline of Microbiology, University of Medicine and Pharmacy Tîrgu Mureş
2 Discipline of Urology, University of Medicine and Pharmacy Tîrgu Mureş
3 Laboratory, Mures County Clinical Emergency Hospital, Tîrgu Mureş

Background: Despite modern antibiotic therapy and technological advances in lithotripsy, the presence of infection in patients with urinary stones, as well as with infectious stones is still a significant cause of morbidity and mortality. Recent findings lend more theories as to how infection leads to stone formation.
Aim: The bacteriological study of urine and stone samples from patients with urinary tract infections (UTI) and the correlation of the bacteriological analysis results of stones and urine culture.
Method: We enrolled patients admitted to the urology department of Mures Emergency Hospital, from December 2008 to March 2009; all 50 patients who were diagnosed by the urologist as having urinary stones were included in this study. Bacteriological study was conducted on pre-operative urine and operated renal stones. Pre-operative urine sam¬ples were collected aseptically for macroscopic and micro¬scopic examination. Both pre-operative urine and operated renal stones were processed for bacteriological culture. The isolated microorganisms were identified by standard techniques.
Results: From the 50 patients included in this study, 20 had both infected stones and UTI. While correlating the results of bacteriologi¬cal analysis of stones and urine culture, the same microorganisms from urine culture and stone culture were isolated in 12 (60%) out of 20 cases, but different microorganisms in 8 (40%). The bacteriological study of urine and stone samples revealed that the most common pathogens were E.coli, Pseudomonas aeruginosa.
Conclusion: The incidence of infectious urinary stones in patients with UTI was higher than in the sterile ones. The preponderant identified microorganisms were E. coli, followed by Pseudomonas aeruginosa. In more than half of the cases, the same microorganisms were found both in UTI and within the urinary stones.

Keywords: , ,
Full text: PDF

Evaluation of Pulmonary Vasodilator Therapy with Endothelin-Receptor Antagonist in Eisenmenger Syndrome

Togănel Rodica1, Făgărăşan Amalia1, Muntean Iolanda1, Şuteu Carmen2, Blesneac Cristina3,
Sglimbea Anca1, Gozar Liliana2, Paşc Sorina2, Koncsag-Szasz E.3

1 University of Medicine and Pharmacy Tg. Mures, Department of Paediatric IIIrd
2 Pediatric Cardiology Department, Institute of Cardiovascular Disease and Transplant Tg. Mureş
3 County Emergency Clinic Hospital Tg. Mureş

Objective: To assess the effect of treatment with endothelin-receptor anatagonists on patients with Eisenmenger syndrome, by monitoring oxygen saturation, exercise capacity and echocardiography.
Methods: A total of 14 pediatric patients diagnosed with Eisenmenger syndrome were evaluated clinically by systemic pulse-oximetry, 6-minute walk test and by echocardiography at the beginning of pulmonary vasodilator treatment with endothelin-receptor antagonist, at 3 and 6 months after treatment initiation.
Results: NYHA functional class, systemic arterial blood saturation and distance walked in 6 minutes improved after 3 and 6 months of pulmonary vasodilator treatment. In our study we observed that Tei index right ventricle has improved after 3 months of therapy. We found no statistically significant changes in other ecocardiographic parameters of pulmonary hypertension evaluation.
Conclusions: Endothelin-receptor antagonist improved exercise capacity and hemodynamics, without compromising peripheral oxygen saturation.
Study perfomed in the research project MAMI no. 41-042/2007, financed by the Roumanian Ministry of Education, Research and Youth

Keywords: ,
Full text: PDF

Rheological Behavior of Sodium Valproate Suppositories

Tăurean Alexandrina1, Ciurba Adriana2, Todoran Nicoleta2, Bumb Doina3, Cazacincu R.4

1 Clinical County Hospital Mureş, Pharmacy number 3, Tg. Mureş, Romania
2 Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Medicine and Pharmacy Tg. Mureş, Romania
3 Regional Center of Public Health, Tg. Mureş, Romania
4 Department of Pharmaceutical Industry, Faculty of Pharmacy, University of Medicine and Pharmacy “Ovidius”, Constanţa, Romania

Background: Because the valproic derivates are frequently used in the treatment of epilepsy, bipolar disorders, major depression cases, migraines and other neurological disorders at children, the rectal administration is a real advantage.
Aim: In this study we aimed to assess the influence of the formulation on the rheological characteristics of lipophilic suppository bases Suppocire NAI, Witepsol W35, Massa Estarinum299, Lipex403, containing Cetyl alcohol and Solutol HS15, respectively.
Methods: Spreadability was determined by the Pozo Ojeda-Sune Arbussa method. Half a gram suppository was placed on the bottom plaque of the extensiometer, and the upper plaque was added over it. After equal intervals of time (1 minute) different weights (2, 5, 10, 20, 30, 40, 50, 100, 150, 200, 250, 300, 350, 400, 500 g) were placed. Following each weight addition, the diameters of the obtained circles were measured, and the corresponding area was calculated. The viscosity was determined using the Brookfield (DV-II +Pro) rotational viscosimeter. The measurements were performed at 37±0.5°C and 5, 10, 20, 50, 100, 50, 20, 10, 5 rpm.
Results: The experimental results demonstrated that sodium valproate as active substance induces an increase in viscosity and consequently a decrease in the spreading capacity of the lipophilic suppository bases used. Lipex403 (a base consisting in fatty acids) manifests the lowest viscosity compared to the bases consisting in mixtures of glycerides (Suppocire NAI, Witepsol W35, Massa Estarinum 299). Solutol HS15 as emulsifier determines a higher decrease in viscosities and a better spreading capacity than Cetyl alcohol. Sodium valproate suppositories obtained with Lipex403 as excipient base show plastic flow characteristics without thixotropy.
Conclusions: The experimental results demonstrated that sodium valproate as active substance induces an increase in viscosity and consequently a decrease in the spreading capacity of the lipophilic suppository bases used. Solutol HS15 determines a higher decrease in viscosities and a better spreading capacity than Cetyl alcohol.

Keywords: , , , ,
Full text: PDF