Category Archives: Number

The Role of Sonoelastography in the Differential Diagnosis of Breast Lesions

Gheonea Ioana1, Popescu Camelia2, Bondari A.1

1 Radiology and Imaging Department, University of Medicine and Pharmacy Craiova
2 ENT Department, Emergency Hospital Craiova

Background: Tissue elasticity imaging technology is expected to be a new modality for breast diagnosis, based on hardness as a tissue characteristic that is affected by tissue disease such as cancer.
Aim: To assess the value of sonoelastography in the differential diagnosis of breast lesions.
Patients and method: We included in this prospective study 59 patients diagnosed with breast lesions between January 2009 and January 2010. All the patients were examined in the supine position and the B mode ultrasound image was displayed alongside the elastography strain image. An EUS Hitachi EUB 8500 ultrasound system with an embedded elastography module (Hitachi Medical Systems Europe Holding AG, Zug, Switzerland) and a 6.5-MHz linear probe was used to obtain the B mode and elastography strain images. The elastography strain images were scored according to the Tsukuba elasticity score.
Results: For assessment of sonoelastography role in differential diagnosis of breast lesions, we performed ROC analysis, and we obtained a sensitivity of 89.7%, and a specificity of 92.9% (area under the ROC curve = 0.924, 95% CI = 0.822–0.977 and p = 0.0001).
Conclusions: Elastography is a fast, simple method which can complement the conventional US. Elastography is promising, and with future improvements in the technology, this imaging modality will become an invaluable tool for the diagnosis of breast diseases in the clinical setting.

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Depression and Quality of Life in Elderly Patients with Cluster C Personality Disorder

Echim Iulia1, Nireştean A.1,2, Toma Mirela1, Roșu Codruța1

1 Psychiatric Clinic No II, Târgu Mureş
2 University of Medicine and Pharmacy, Târgu Mureş

Introduction: Health-related quality of life (HRQoL) is an accepted outcome measure in patients with depression.
Aim: Our study aimed at assessing QoL in depressed elderly patients with cluster C PDs, admitted to Psychiatric Clinic No II Targu Mures. Cluster C PDs is the most frequent diagnosis on axis II for depression.
Material and method: A sample of thirty elderly in-patients with cluster C PDs and depression was studied. Mental disorders were assessed based on DSM IV criteria, Hamilton scale of depression and SCID II (structured clinical interview for DSM). QoL was assessed with the aid of the World Health Organization Quality of Life instrument (WHOQoL-Bref), and the Global Assessment of Functioning scale (GAF).
Results: We formed high co-morbidity among depression and cluster C PD, especially dependent PD, which was associated with poor QoL. The WHOQoL physical health and social functioning were significantly associated with GAF. Conclusion and Discussion: PD symptoms in elderly patients appear to operate as co-factor that amplify or exacerbate the impact of depression on long-term functioning and QoL. We conclude that if co-morbid personality disorder is not treated, patients will respond less well to treatment for depression than do those without PD.

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Medico-legal and Social Aspects of Mechanic Asphyxias

Hădăreanu V.1, David Ramona Eliza2

Forensic Medicine Discipline, University of Medicine and Pharmacy, Medical Biochemistry Discipline, University of Medicine and Pharmacy

Background: In the last years, in Mureş county there was ascertained a significant growth of deaths due to anoxias caused by violence.
Aim: This study is an assessment concerning the prevalence and incidence of mechanical asphyxia in Mures county over three years, from 2005 to 2007.
Methods: The study took place at the Forensic Medicine Institute, Tg. Mures, including the analysis of 1926 medico-legal necropsies, 434 cases being violent deaths caused by mechanical asphyxias like: hanging, drowning in water and asphyxia with food bolus.
Results: In the analyzed casuistry was found that there were prevalent the deaths caused by hanging (343 cases), these being followed by the drowning ones (84 cases) and then the mechanical asphyxias caused by food bolus (7 cases). Distribution by sex showed a predominance of deaths in males (352 cases) compared to females (82 cases). Depending on location, deaths in rural location were prevalent to the ones from the urban location.
Conclusions: Concerning mechanical asphyxias predominates the mechanical asphyxia by hanging, which also represents suicide method, the other 2 types of asphyxias (drowning in water and mechanical asphyxia caused by food bolus) being seldom. Death by drowning in water represents a rarer method of suicide and the accidental form is met more during the warm season. Asphyxia with food bolus is produced totally accidental in persons under alcohol influence or total edentate.

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Assessment of the Risk Factors for Deceased Patients in Pediatric Clinic I

Baghiu Despina Maria1, Man Lidia2, Marinescu Simona3, Man A.4

1 Pediatrics Clinic I, UMPh Tg.Mureş
2 Emergency County Hospital Tg.Mureş, Pediatric Clinic I
3 Emergency County Hospital Tg.Mureş, ICU Clinic
4 Microbiology Department, UMPh Tg.Mureş

Purpose: The evaluation of the risk factors in patients deceased in Pediatric Intensive Care Unit (PICU) during January 1 to December 31, 2009.
Material and method: This is a retrospective study in which we evaluated the risk factors of the 29 deceased patients admitted in PICU. We followed the age groups, gender, environment, prior treatments, number of hospitalization days, the patient flow, the associated comorbidities, the mothers’ age and the anatomico-pathological concordances.
Results: From all 29 deceased patients, 34.48% were between 3–12 months, the average age being 27.3 months. 79.31% came from rural areas. The number of deaths was almost equally distributed between sexes. Etiological, nosological, location-related and complication-related consistencies were found. The main cause of death was the respiratory disease. In the cold season, the number of deaths was increased. Most children were admitted in Pediatric Clinic I from other clinics, were hospitalized for more than 72 hours and presented at least one comorbidity.
Conclusions: The main risk factors that concluded in children’s death were: association with at least one comorbidity, the age group of less than 1 year, as well as the patient’s flow through multiple sections. The main cause of death was respiratory infection. Etiological, nosological, location-related and complication-related consistencies were present.

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Vascular Complications – Poor Prognostic Factors in Severe Acute Pancreatitis

Popa D1, Grigorescu Bianca2, Hoffner S1, Copotoiu C1

1 1st Clinic of Surgery, University of Medicine and Pharmacy of Tg. Mures, Tg. Mures Emergency County Hospital Mures
2 Clinic of Anesthesiology and Intensive Care, Tg. Mures Emergency County Hospital

Background: Various complications occur after the onset of acute pancreatitis. Aproximately 9–11% of the patients with severe acute pancreatitis may develop vascular complications such as haemorrhage, ischaemic visceral lessions, tromboses on the portal venous system and formation of aneurysms.
Aim: To determine the incidence of these complication and to analyze the therapeutic approach for these patients.
Method: We realized a retrospective study on 279 patients with severe acute pancreatitis (SAP), defined by the Atlanta criteria. In this group we annalized the incidence of vascular complications, the therapeutic methods for their solving and the risk for developing complications and mortality.
Results: The incidence of vascular events was 14.33%.Hemorrhagic complications had a higher incidence and were present in 32 patients (80%). Only 8 patients (20%) presented major ischaemic events. The most commonly involved organ in ischaemic lessions was the colon.
Conclusions: Vascular complications, although rare (leading to an increased morbidity and mortality), may jeopardize the patients’ life. Their diagnosis and treatement becomes possible only by the clinician vigilance on their potential occurence using modern investigative methods.

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Is Laparoscopic Appendectomy a Safe Procedure?

Maiershon-Simion I.¹, Ezri T.²,³, Dayan K.¹,³, Muggia-Sullam M.¹,³

1 Department of Surgery, E. Wolfson Medical Center, Holon, Israel
2 Department of Anesthesia, E. Wolfson Medical Center, Holon, Israel
3 The Sackler Faculty of Medicine, Tel-Aviv University

Background: Laparoscopic appendectomy (LA) is a common procedure, considered to be a safe alternative to conventional open appendectomy (OA). LA is known to reduce parietal scarring, offers a shortened hospital stay and an earlier return to normal activities. Acute gangrenous and perforated appendicitis may be associated with an increased risk for postoperative complications following laparoscopic appendectomy.
Objective: To determine the complication rate following LA.
Material and methods: Between January 2000 and November 2003, 323 consecutive emergency appendectomies were performed (311 LA, 5 OA and 7 conversions). A retrospective analysis of LA was performed with evaluation of complication rate (fever, pain, intra-abdominal infection or abscess and abdominal wall infection), duration of preceding symptoms, interval between admission and operation, length of the operation, whether the performing surgeon was a resident or a senior surgeon, and the length of hospital stay (LOS).
Results: Two hundred patients (64.3%) were males and mean age was 35 years. Mean waiting time for surgery was 9.4 hours, mean operating time 48 minutes and conversion rate was 2.2%; mean LOS was 3.05 days. Histology showed acute inflammation in 81% (acute appendicitis in 54.34%, phlegomonous appendicitis – 17.36%, perforated or gangrenous appendicitis – 9.00%). There was a 10.6% overall incidence of infectious complications, 9.64% of readmissions and mortality was 0.
Conclusions: It appears that in the current study, the overall complication rate following LA is higher than expected, and tends to be even higher for complicated appendicitis. This needs further evaluation.

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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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