Category Archives: Number

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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The Possibilities of Harvesting and the Modalities of Processing Hematopoetic Stem Cells

Ioan Macarie

Hematopoietic stem cells are defined as cells with self-renewing capabilities that can differentiate into multiple cell liniages. In adults, the stem cells are part of the tissue-specific cells into which they are committed to differentiate. The embrionic stem cells are derived from embryos and have the ability to generate any cell in the body.
The adult hematopoietic stem cells are organized in a hierarchic tree, with multipotent, self-renewing stem cells at the base, the committed progenitor cells as the main branches and lineage restricted precursor cells as terminal branches. The lineage restricted stem cells give rise to terminally differentiated cells. The classic paradigm of organ-restricted stem cell differentiation is challenged by the possibility of the hematopoietic stem cells to retain a degree of plasticity that allows them to diffe-rentiate into any cell of the adult human body, according to the microenvironment [1].
The initial source for stem cells was the bone marrow. After transplantation of unselected cells in animals previously conditioned with chemotherapy/radiotherapy treatment there was evidence that not only hematopoietic tissue was generated by the transplanted cells, but also non-lymphohematopoietic tissue, such as hepatocytes, muscle fibers and neuronal tissue.
Since 1990 the main source of stem cells was the periphe-ral blood after mobilization with cytokine (granulocyte colony stimulating factor – G-CSF) with or without chemotherapy. Several investigators reported that human peripheral blood stem cells can generate also non-lymphohematopoietic tissue in the same way the cells from the marrow did.[More]

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Gastric Trichobezoar

Mureșan Simona1, Mureșan M2, Eșianu M2, Bara T2, Bancu Ș2, Dénes L3, Bara T jr2

1 Department of Physiology, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Surgical Clinic II, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Department of Anatomy, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: Trichobezoars arise from the aggregation of ingested hair with other indigestible organic fibers. Trichotillomania, the practice of habitually pulling hair out, in association with habitual ingestion of hair (trichophagia) can predispose to the formation of trichobezoars.
Material and method: We present the case of a 28 year-old woman who was admitted to our clinic for abdominal pains, nausea and weight loss. The clinical examination revealed an abdominal mass in the upper part. The laboratory parameters were normal excepting a mild anemia and hipoproteinemia. A CT Scan of her abdomen showed a markedly distended stomach with a centrally located soft tissue abnormality. The patient underwent exploratory laparotomy and gastrotomy. We found an intragastric mass made up by hair. The trichobezoar was removed intact as a firm black mass and it was confirmed by the microscopic examination.
Results: The patient’s post-operative course was uneventful and she was discharged after 7 days of hospitalisation. We suggested psychiatric counseling.
Conclusions: The trichobezoar appears in young people with psychiatric disorders. Due to its dimensions, the only treatment in this case was open surgery. The after surgery course is usually favorable and needs psychiatric counseling.

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Acute Infusion Reaction to Infliximab in a Case of Crohn’s Disease with Recto-Scrotal Fistula

Hoduț A, Simedrea I, Belei Oana, Militaru Andrea, Bojinescu Raluca, Brad Giorgiana

First Pediatric Clinic, Faculty of Medicine, University of Medicine and Pharmacy, Timișoara, Romania

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 in severe and fistulising cases of Crohn disease. We present the case of a 16 year-old boy who was admitted to our department presenting recto-scrotal fistula, fever, tenesmus, red-bloody stools, pain during and after defecation. In order to induce remission of the disease, we administrated Infliximab. The initial response to therapy was good, but he developed an acute infusion reaction during the administration of the 3rd dose, which forced us to quit this therapy.

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Chronic Vulvar Pain

Guță Camelia-Daniela1, Roșu Lucica2, Cotarcea Smărăndița3, Gavrilă Alice3

1 Department of Laboratory Medicine, “Plus Medica” Diagnostic and Treatment Center, Craiova, Romania
2 Discipline of Bacteriology, Virusology and Parasitology, University of Medicine and Pharmacy, Craiova, Romania
3 Department of Obstetrics-Gynecology, Filantropia Hospital, Craiova, Romania

Background: Chronic vulvar discomfort due to paucity of clinical signs is often associated with the term “vulvodynia”, perceived as a psychiatric problem.
Case report: A 28-year-old female patient presented for a 2-year history of vulvodynia, without any pathologic vulvar aspects. We investigated this syndrome by means of vulvar cytology, vulvoscopy, histology and ViraPap, too.
Results: Our interdisciplinary consultation indicates that vulvar vestibulitis syndrome co-exists with micropapillomatosis labialis (MPL), due to certain types of HPV. A herpes simplex episode occured 4 months after therapy and recurrent vulvovaginal candidiasis, too. During a period of 8 months, clinical examination showed smooth and well-demarcated whitish shiny plaques, that affected the clitoral hood, labia minora, the posterior fourchette and perineum. The clinical picture suggested a vulvar dystrophy.
Discussions: In this case report we intend a multidisciplinary approach to give a physical support to certain cases of vulvodynia, often associated with an expression of a psychological discomfort.

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Routine Immunophenotyping in Acute Leukemia, the Importance of Lineage Assessment

Bacârea Anca1, Dorcioman Bogdana2, Bacârea V3, Tilincă Mariana4, Demian Smaranda5, Șchiopu A1, Băţagă Simona6

1 Department of Physiopathology, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Hematology, County Emergency Clinical Hospital, Tîrgu Mureş, Romania
3 Department of Medical Research Methodology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
4 Department of Cell Biology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
5 Department of Hematology, Medical Clinic I, County Emergency Clinical Hospital, Tîrgu Mureş, Romania
6 Department of Internal Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

We present the case of an adult male patient, where the assessment of cell line could not be done without corroboration of the immunophenotype and cytological analysis. The correct lineage assessment is needed in order to treat the patient correctly. Morphology, cytochemistry, and immunophenotyping were used and the diagnosis we established was B acute lymphoblastic leukemia with aberrant myeloid markers (CD13, CD33). Periodic Schiff Acid stain was very useful to obtain an accurate diagnosis. Adult B acute lymphoblastic leukemia usually has an unfavorable prognosis because of certain cytogenetic abnormalities (Philadelphia chromosome) and different reactivity to treatment. This case strongly supports the continued use of immunophenotyping in the diagnosis and monitoring of acute leukemia and corroboration of different diagnostic techniques for the diagnosis.

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Survival Analysis after Cephalic Pancreatoduodenectomy for Carcinoma of the Ampulla of Vater

Tudor A1, Molnar C1, Man A2, Tudor Bianca2, Roşca C3, Copotoiu C4

1 Department of Anatomy and Embriology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Microbiology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Surgery Clinic 1, Emergency County Hospital, Tîrgu Mureş, Romania
4 Department of Surgery, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Background: Ampulla Vater carcinoma is a rare condition, having the best prognosis in periampullary malignant tumors. The purpose of this paper is to analyze the factors involved in long term survival after duodenopancreatectomy for carcinoma of the ampulla of Vater.
Material and method: This paper is a retrospective study across a 15-year period (1995–2009), during which 130 interventions for ampullary vaterian carcinoma were performed in Surgery Clinic I Tîrgu Mureş and Surgery Clinic III Cluj-Napoca. Cephalic pancreatoduodenectomy was performed in 86 cases, and we have obtained informations regarding late postoperative survival in 63 cases. The data was processed in Microsoft Excel, and the statistical analysis was performed with SPSS v. 17 for Windows. The threshold of significance was p <0.05.
Results: Survival at 5 years after cephalic pancreatoduodenectomy, in the group analyzed (63 cases) was 43.1%. We found a higher percentage of survival rate at 5 years for stage T1 tumors (tumor limited to the ampulla of Vater or sphincter of Oddi) – 68.3%, in the absence of regional adenopathies N0 – 68.3%, well differentiated tumors G1 – 90.5%, in tubulo-papillary adenocarcinoma histological type – 66.6%, in patients without lymphovascular invasion – 91.3% and in those without perineural invasion – 82.3%. Multivariate analysis of prognostic factors shows a high risk of death in the presence of lymphovascular invasion (p = 0.0031).
Conclusions: 1. Survival at 5 years after cephalic pancreatoduodenectomy was 43.1%, which is influenced by tumor extension, the presence of regional lymphadenopathy, the histopathological type of tumor, the degree of tumor differentiation, the lymphovascular or perineural invasion. 2. Multivariate analysis of prognostic factors shows that lymphovascular invasion is statistically significant in postoperative survival.

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