Category Archives: Number

Transchondral Drilling and Osteochondral Autografting (Mosaicplasty) in Knee Articular Cartilage Defects

Ivănescu A1, Melinte R2, Sólyom Á2, Moraru L3, Petrișor M4, Brânzaniuc Klara1

1 University of Medicine and Pharmacy of Tîrgu Mureș, Department of Anatomy and Embriology
2 County Emergency Clinical Hospital Tîrgu Mureș, Orthopedic Clinic II
3 County Emergency Clinical Hospital Tîrgu Mureș, Clinic of Cardiovascular Surgery
4 University of Medicine and Pharmacy of Tîrgu Mureș, Department of Medical Informatics and Biostatistics

Background: The cartilage is a complex and specialized tissue. It is extremely difficult to repair or to replace it, once damaged. The management of cartilage defects remains controversial and over the last five decades various treatment options and surgical techniques have been tried to optimize the clinical outcome.
Objective: The aim of this study is to evaluate, but not to compare the results of two of the most used cartilage repair techniques: trans-chondral drilling and osteochondral autografting.
Material and methods: Between January 2009 and June 2010, we performed 55 transchondral drillings and 10 mosaicplasties on patients with articular cartilage defects of the knee. All patients were followed up at 6 months. Hughston clinical and radiological scales were used to evaluate the patients in the transchondral drilling group.
Results: The Hughston Clinic score was 2 in 2 cases (3.6%), 3 in 5 cases (9.9%) and 4 in 48 cases (86.5%), giving over 95% of good results. The Hughston radiological score was 2 in one case (2%), 3 in 4 cases (7.3%) and 4 in 50 cases (90.7%). In the mosaicplasty group,the average area of the osteochondral lesion covered with autologous osteochondral transplantation ranged from 0.8 to 6 cm2 (average: 2.13 cm2). The diameter of the grafts used ranged from 6 to 10 mm and 1 to 6 grafts were used in each case to achieve >90% covering of the lesion area.
Conclusions: Both techniques offer satisfactory functional outcome and do not compromise the patients’ future options.

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Psychological Autopsy — An Effective Method for the Positive Diagnosis of Suicide in Schizophrenia

Hădărean V2, Sălcudean Andreea1, Gaboș-Grecu I1,2, Gaboș-Grecu Marieta1,2, Buicu Gabriela2, Sălcudean D3, Stanciu Camelia4

1 Psychiatric Clinic 1, Tîrgu Mureș
2 University of Medicine and Pharmacy of Tîrgu Mureș
3 Law firm, Tîrgu Mureș
4 ”Dimitrie Cantemir” University of Psychology, Tîrgu Mureș

Purpose: This paper aims to analyze suicide in schizophrenia in terms of application of psychological autopsy.
Material and methods: We studied 53 persons who committed suicide between 2000–2009. We carried a series of interviews with people close to the persons who committed suicide, to analyze the motivation behind the suicidal act. The method chosen for the interviews was empathic post-suicide listening in parallel with a questionnaire.
Results: Disorganized and paranoid types of schizophrenia have led to most victims. 22.6% of the persons who committed suicide had auditory hallucinations with imperative suiciding character.
Conclusions: Detecting suicidal motivations and their understanding plays an important role in shaping a socio-psychological or a psychopathological profile by interpreting sociological, familial parameters, with emphasis on the personal dynamics of selfdestructing behavior, adult characteristics and identification of the persons with an increased suicide risk.

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Experience and Results After 100 Cases of Hypospadias Operated with Tubularized Incised Plate Technique

Gozar H¹, Gliga V², Patraulea F², Bălă G¹, Turcu Anne-Mary¹, Kertész Zsuzsánna²

¹ County Emergency Clinical Hospital Tîrgu Mureș, Clinic of Pediatric Surgery
² University of Medicine and Pharmacy of Tîrgu Mureș

Aim: To report our experience with tubularized incised plate urethroplasty (TIP).
Material and methods: Tubularized incised plate urethroplasty was undertaken in 100 patients within 0 and 17 years (mean age 5.31 years), during the last two and a half years. All of them had the same procedure performed in the Clinic of Pediatric Surgery Tîrgu Mureş. The patients were followed-up at 2 weeks, 4 weeks, 3 months, 6 months and 1 year.
Results: Overall complications were encountered in 16 cases. We had 40 small patients (0–3 years) with a success rate of 95%, 46 mid age patients (4–11 years) with a success rate of 82.60% and 14 pubertal patients (12–17 years) with a success rate of 71.42%. The operation was performed for the first time in the case of 63 boys (54 had no complications) and it was a re-operation in the case of the other 37 (30 had no complications). Distal and mid shaft hypospadias had similar rate of success (89.58% and 84.61%). In proximal hypospadias, the rate of success was 61.53%.
Conclusions: The tubularized incised plate urethroplasty is a versatile single stage procedure for all types of hypospadias. We consider now that this procedure is the best in the treatment of hypospadias.

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Particularities of Helicobacter pylori Infection in Diabetic Patients

Floarea Ramona1, Georgescu ED2, Frunză-Dumitru Anca3, Mitroi-Maxim Corina1, Maxim RG1

1 ”Carol Davila” University of Medicine and Pharmacy, Faculty of Medicine, Sf. Ioan Emergency Clinical Hospital, Internal Medicine Clinic, Bucharest
2 ”Carol Davila” University of Medicine and Pharmacy, Faculty of Medicine, Sf. Ioan Emergency Clinical Hospital, Department of Internal Medicine, Bucharest
3 ”Carol Davila” University of Medicine and Pharmacy, ”Prof. Dr. N.C. Paulescu” National Institute of Diabetes, Nutrition and Metabolic Diseases, Diabetes Clinic, Bucharest

Introduction: In the last few years many studies were focused on the implications of Helicobacter pylori infection in the evolution of patients with diabetes mellitus. Most of the results are controversial. Our aim was to study the prevalence of the bacterial infection and some of its epidemiological features in diabetic versus non-diabetic patients and the particularities of the association of Helicobacter pylori with diabetes mellitus.
Material and method: We studied 70 consecutive patients with dyspeptic syndrome evaluated with The Leeds Dyspepsia Questionnaire, divided in 2 groups: 35 diabetic and 35 non-diabetic patients.
Results: The prevalence of the Helicobacter pylori infection was similar in our groups (p >0.05). Inside each group, the prevalence of bacterial infection did not differ related to the determination method – serology vs. invasive test (p >0.05). In the diabetic patients we found a positive correlation between the bacterial infection and parameters like family size (>5) (p <0.01). The metabolic control of the diabetics was not influenced by the infection. Regarding diabetes complications, there is significant association of neuropathy with Helicobacter pylori. The eradication rate of infection was similar in diabetic and non-diabetic groups.
Conclusions: The prevalence of Helicobacter pylori infection did not differ in diabetics versus non-diabetics. Both determination me-thods proved similar efficacy for bacterial diagnosis, but is recommended an association of an indirect and a direct method. The bacteria did not influence the glycemic status. Neuropathy is strongly associated with Helicobacter pylori infection.

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Metabolic Profile and the Histological Changes in Patients with Chronic Viral Hepatitis

Crăciun P1, Oltean G2, Georgescu D3, Crăciun Lucia4

1 Chronic Haemodialysis Center, Tîrgu Mureș
2 County Emergency Clinical Hospital Tîrgu Mureș, Medical Clinic I
3 County Emergency Clinical Hospital Tîrgu Mureș, Clinic of Gastroenterology I
4 Sighișoara Municipal Hospital, Integrated Specialty Dispensary

Objective: To evaluate the incidence of steatosis and its correlation with lipidic profile changes comparing the patients with HVB to those with HVC.
Material and method: We enrolled a number of 87 patients who were diagnosed with viral hepatitits B and C between 2004–2008 in Medical Clinic I from Tîrgu Mureș, based on positive test results for HBs antigen and HCV antibody, on the presence of HCV-ARN and on histological features. To all patients it was performed hepatic biopsy and we determined cholesterol, triglyceride, glucose, ALT and AST blood levels.
Results: Steatosis had a higher incidence in patients with HCV infection. The steatosis is correlated with necroinflammation and fibrosis in patients with HVC. In the case of patients with HVB there was no correlation between the steatosis and the grade of fibrosis. The HVC group yielded lower mean values of cholesterol, triglycerides and glicemia than the HVB group. The values of the aminotransferases were increased in patients with hepatic steatosis in both groups.
Conclusions: Hepatic steatosis appears with a higher incidence in patients with HVC and it is correlated with the necroinflammatory and fibrosis scores. There is no correlation between the steatosis and fibrosis stage in HVB patients. Both in HVB and HVC the steatosis is correlated with high values of serum aminotransferases.

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Statistical Study of Pathology Associated to Urethral Infection with Ureaplasma urealyticum and Mycoplasma hominis

Chiujdea Natalia-Simona1, Tilinca Mariana2, Chiujdea A3

1 County Emergency Clinical Hospital Tîrgu Mureş, Clinic of Gynecology II, Laboratory
2 University of Medicine and Pharmacy of Tîrgu Mureș, Department of Cell Biology
3 County Emergency Clinical Hospital Tîrgu Mureş, Clinic of Urology

Introduction: Ureaplasma urealyticum and Mycoplasma hominis are present as part of the normal flora of the urethra, but in some conditions of multiplication they can cause infections of the prostate or sterility.
Material and method: Two-hundred-fifty patients were tested in the laboratory under the proposed criteria of selection.The Stamey test was done for the differential diagnosis of chronic prostatitis. The harvesting was done with Dacron swab, which was then placed in a transport medium. We used the Mycofast Duo kit for the identification and quantification of Mycoplasmas, as well as for the testing of antibiotic susceptibility.
Results: Of the 43 positive cases, 15 presented only Ureaplasma and 28 presented both bacterias. Mycoplasmas were found in 8.57% of urethritis cases and 10.25% of prostatitis cases. 33.33% of patients with a diagnosis of infertility had a positive Mycoplasma test. 23.6% of cases were associated with Gram positive or Gram negative infections and 2 with Chlamydia trachomatis.
Discussions: The incidence of Ureaplasma urealyticum has been reported to be between 9% and 42% in the literature. It is noted this bacteria has a good sensitivity to the new macrolides, josamycine, pristamycine and roxithromycine. However, Doxycycline is still on the first place, azithromycin on the 4th place, and fluoroquinolones have the lowest sensitivity of all.
Conclusions: Our results suggest that infertility in men is significantly associated with the presence of the studied Mycoplasmas. The treatment of urogenital inflammatory disease would require the corroboration of all the results from the Stamey test, stained microscopic examination, testing for Gram positive and negative bacteria – Chlamydia trachomatis and urogenital Mycoplasmas, and an antibiotic or a combination of targeted antibiotics for each pathological strain detected.

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Management of Pediatric Supraventricular Arrhythmias

Borka-Balás Réka1, Gozar Liliana2, Blesneac Cristina2, Baghiu Maria Despina3, Togănel Rodica2

1 Clinical Center Pharmaquest, Tîrgu-Mureş, Romania
2 University of Medicine and Pharmacy, Faculty of Medicine, Cardiology Clinic III – Children, Tîrgu-Mureş, Romania
3 University of Medicine and Pharmacy, Faculty of Medicine, Pediatric Clinic I, Tîrgu-Mureş, Romania

Background: Supraventricular tachycardia is the most common symptomatic arrhythmia in children.
Objective: To evaluate the incidence of supraventricular tachycardia in children, to identify the etiology and the predisposing factors and to propose an effective treatment strategy.
Method: Between January 2004 and December 2009, children with supraventricular arrhythmias treated in Pediatric Cardiology Clinic Tirgu-Mures, were included in this retrospective study. The arrhythmia was diagnosed with clinical examination, 12-leads ECG and/or 24 hours Holter monitoring, echocardiography for identification of associated cardiac malformations. In all cases the followed parameters were: age of onset, predisposing factors, underlying mechanism of arrhythmia, efficacy of treatment.
Results: 87 children with supraventricular arrhythmias with a median age of 9 years were included. Supraventricular tachycardias were the most frequent in children at school age and adolescents (70.1%); the incidence decreased in younger children and infants. Predisposing factors were cardiac malformations, cardiac surgery, dilatative cardiomyopathy, myocarditis. Trigger factors were physical exercises, infections, fever and emotions. The commonest underlying mechanism was atrioventricular nodal reentrant tachycardia (85.71%). The emergency treatment: vagal stimulation successful in 12 patients, medical treatment in 72 patients, electric cardioversion 3 patients. 90% of patients benefits of long-term treatment; the most used were betablockers and class III antiarrhythmics. Only 12% of patients present breakthrough episodes.
Conclusions: The incidence of supraventricular tachycardias in children is high, they are occurring frequently on structurally normal heart, but they have also many predisposing factors. The underlying mechanism is important in selection of effective medication. Class III antiarrhythmics were effective in cases refractory to other medications.

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Mechanical Versus Electrical Dissynchronism in Patients with Heart Failure

Baricz Emőke, Gyalai Zs, Carașca E

University of Medicine and Pharmacy, Faculty of Medicine, Department of Cardiology, Internal Medicine Clinic IV, Tîrgu Mureș

Background: Despite the existence of significant correlation between the mechanical and electric dissynchronism, it is widely known that these two types of dissynchronisms are quite different and there are a number of reasons why mechanical dyssynchronism might be an important variable to measure in addition to electrical dyssynchronism.
Objective: The objective of study was to highlight a group of patients with impaired systolic function who suffer from mechanical dissynchronismin in absence of evident electric dissynchronism (narrow QRS) and who might represent a target group for cardiac resynchronization therapy (CRT).
Materials and methods: We enrolled in study patients with heart failure, NYHA class II-IV and ejection fraction (EF) under 35%, admitted to the Cardiology Department of Internal Medicine Clinic IV. Patients were divided in two groups, according to the duration of QRS complex – one group with wide (≥120 ms) and another one with narrow QRS complex (<120 ms).
Results: Overall, 73.7% of patients had positive criterias for intraventricular dissynchronism – appreciated with ultrasound measurment of septal-to-posterior wall motion delay (SPWMD >130 ms). 10 patients had narrow QRS and 28 had wide QRS. In the wide QRS complex group we found intraventricular dissynchronism at 85.7% of patients, while 14.28% had normal SPWMD. 40% of patients with EF < 35% and narrow QRS had intraventricular dissynchronism.
Conclusions: The duration of QRS complex seems to be an insensitive indicator of ventricular dissynchronism, hence the ultrasound evaluation is recommended for better selection of candidates for CRT.

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Clinical and Epidemiological Considerations on Child Neglect in Pediatric Clinic No. I Tîrgu Mureș

Baghiu Maria Despina1, Borka-Balás Réka2, Mărginean Oana1, Man Lidia1, Moldovan Diana1, Pitea Ana-Maria1

1 University of Medicine and Pharmacy Tg. Mureş, Pediatry I Clinic
2 Clinical Center Pharmaquest, Tîrgu Mureș

Background: Ethic of the care is a necessary condition for a state under the rule of law. Neglect is failure by the caregiver to provide needed, age-appropriate care to a child. Article 89 of law 272/2004 on the protection and promotion of child rights clearly defines child neglect.
Objective: The purpose of the paper is to assess the number of cases of neglected children hospitalised in Pediatrics Clinic I Tîrgu Mureș, and to report and emphasize the ethical importance of this problem.
Material and method: It was a retrospective study based on observation sheets of children admitted in Pediatrics Clinic I Tîrgu Mureș, between 01 January 2001 – 31 December 2008. During this period 728 cases of child neglect were identified.
Results: The incidence of mistreated children was 6.13% (728 cases) with mean age of 4.85 years, from 11.859 admissions in the mentioned period. Increased number of childs nelegt was in rural areas (64.69%) between boys (52.60%).
We considered child neglect in the studied group: accidental poisoning 484 cases (66.48%), malnutrition (19.23%), scabies (8.38%), pediculosis (1.92%), prolonged hospitalization (2.06%), other causes (1.93%).
Conclusions: Mistreated children represented an important share of admissions (6.13%), raising many ethical issues concerning child rights violations. Although that in our country child neglect must be reported to social protection services as required by law, solved cases and prevention measures are sporadic.

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Telemedicine Aids Disaster Preparation in Rural Romania

Boeriu C1, Arafat R2, Gordon P3

1 University of Medicine and Pharmacy Targu Mures
2 Mures County Emergency Hospital
3 Bassett Healthcare, Cooperstown, New York, USA

Background: While Romania was an early adopter of the specialty of emergency medicine in continental Europe, and emergency medicine has been a recognized medical specialty since 1994, the number of trained emergency physicians remains insufficient to staff many of the smaller emergency departments scattered throughout the country.
Aim: In order to cover the lack of specialized personnel, a telemedicine network that links Targu Mures Hospital Emergency Department with 42 other hospitals was created. The paper shows the results of the telemedicine system after its first year of activity and the potential role of it in case of a multiple casualty incident or a disaster.
Method: The total number of patients examined through the telemedicine system over the first year of activity was evaluated. The total number of patients transferred to a higher level hospital after the evaluation was also followed. The impact upon the method of transport employed was also a parameter of interest.
Results: In the first year of operation 255 patients were evaluated through the telemedicine system out of which a total of 216 were transferred to facilities with a higher level of care. Of the 216 patients transferred, 166 were moved via ambulance and 50 were transported by helicopter.
Conclusion: The telemedicine system created in Tîrgu Mureș may potentially serve as a model for other developing countries or regions that are expanding the scope of their disaster preparedness infrastructure or are enlarging the reach of their emergency medical services.

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