Category Archives: Number

The Role of Acanthosis Nigricans in Identifying Clinical and Metabolic Features of the Metabolic Syndrome in Obese Children

Duncescu Corina1, Mărăzan Monica1,2, Chirita-Emandi Adela1, Craioveanu Teodora2, Dăescu Camelia1,2, Sabău I2, Micle Ioana1,2

1 “Louis Ţurcanu” Emergency Hospital for Children, Timişoara, Romania
2 1st Pediatric Clinic, “Victor Babeş” University of Medicine and Pharmacy, Timişoara, Romania

Background: Acanthosis nigricans (AN) is a dermatologic marker of hyperinsulinemia and has been linked with metabolic syndrome in adults. In children, the relationship between AN and different components of the metabolic syndrome has received mixed research results. We investigated whether the clinical and metabolic profile of obese children with AN was different from those without AN.
Material and methods: We studied retrospectively the observation charts of children who were evaluated in our clinic for obesity and/or anomalies of glucose metabolism from January 1st 2005 to December 31st 2009. The study population consisted of 52 children. The analyzed data included: age, sex, body mass index (BMI), the presence or absence of AN, systolic and diastolic blood pressure, the results of the oral glucose tolerance test, triglycerides and high-density lipoprotein (HDL) cholesterol levels, baseline insulin, the homeostatic model assessment: insulin resistance (HOMA-IR), glicated hemoglobin. We divided our study population into two groups according to the presence or absence of AN. We used One-Way ANOVA to evaluate the clinical and metabolic differences between the two study groups.
Results: We found significant differences between the two groups for BMI, systolic and diastolic blood pressure, triglycerides, HDL cholesterol, baseline insulin and HOMA-IR.
Conclusions: Our study shows that AN seems to be linked with most of the features of the metabolic syndrome in children. The relationship of AN and anomalies of glucose metabolism need further testing.

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The Importance of the Mesorectal Lymph Nodes in Rectal Cancer Surgery

Diac OC1, Diac Raluca2, Copotoiu C3

1 Department of Surgery, Gheorgheni Hospital, Gheorgheni, Romania
2 Department of Internal Medicine, Gheorgheni Hospital, Gheorgheni, Romania
3 1st Surgery Clinic, County Emergency Clinical Hospital, Tîrgu Mureș, Romania

Introduction: Regarding the rate of local recurrences, improvement of survival rates and quality of life, the treatment of rectal cancer has registered a remarkable progress during the last two decades. This was possible through multidisciplinary and gradual development of rectal cancer management, where surgical resection remains the “key factor” and all surgical interventions considered radical involve mesorectal excision. The status of lymph nodes is probably the only and most important marker of global survival in patients with rectal cancer, which is associated with the risk of systemic dissemination rather than local recurrence.
Material and method: The aim of this study was to analyze the importance of mesorectal lymph nodes, in case of rectal cancer disseminated locally and in remote organs, based on treated rectal cancer cases at the 1st Surgery Clinic, Tîrgu Mureș between January 2000 and December 2009. During this period, out of the 618 recorded rectal cancer cases, in 505 cases the patients underwent surgical intervention where besides the rectal tumor, the perirectal lymphatic tissue was also excised.
Results: The performed histopathological examinations revealed in 223 cases lymph node invasion (stage III and stage IV). We also studied different surgical interventions regarding lymph node excision performed during rectal cancer surgery, analyzed the average number of excised perirectal (mesorectal) lymph nodes and the average number of lymph nodes with histopathologically confirmed tumor metastasis resulted from rectal resection.
Conclusion: In our study, we found that in surgical interventions involving resection with anastomosis the average number of lymph nodes per specimen is biger than the number recorded subsequent to abdominoperineal rectal resection.Therefore the resection with mesorectal excision is the best option for rectal cancer surgery any time is possible.

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Study on the Pre-hospital Cardiac Arrest Resuscitations Of the Mobile Intensive Care Ambulance Teams From Tîrgu Mureș, Romania, in 2009

Copotoiu Sanda-Maria1, Bratu Simona2

1 Department of Anesthesiology and Intensive Care, Clinical Emergency County Hospital, Tîrgu Mureş, Romania
2 UPU-SMURD, Clinical Emergency County Hospital, Tîrgu-Mureş, Romania

Objective: To analyze the results of the resuscitation efforts of the SMURD medical teams, in pre-hospital, in 2009.
Methods: We conducted a prospective study between 01/01/2009 – 12/31/2009. We included in the study all the cases with cardiac arrest at the arrival, those that occurred during transport and all the CPR attempts performed together with the first aid teams. For the statistical study we used SPSS program version 17, χ2 test and p values were determined to compare the data obtained.
Results: In 2009, the team had 250 cardiac arrest cases, 16.7% of the total of 1490 calls. Resuscitation was performed on 67.6% of patients.The good outcome of the resuscitation was statistically correlated with the distance to the case p = 0.01.The acute coronary syndrome was responsible for 27% of the cardiac arrest cases, severe trauma for 11%. The initial cardiac arrest rhythm was in 83.2% of cases asystole. BLS was performed, before the arrival of the team, to a number of 41 patients, bystander CPR representing only 2.36%. The SMURD team resuscitated a number of 58 patients in pre-hospital, 34.32% out of the 169 that had CPR, 41 died in the Emergency Department and 17 were hospitalized; 4 patients were discharged in good condition.
Conclusions: The early resuscitation outcome is good, comparable with the international data reported, the rate of late survival is smaller. The proportion of ventricular rhythms with a good prognosis is lower, which correlates with longer distances traveled to the scene and less involvement of the population in BLS.

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Is the Doppler Ultrasound Score More Reliable than the Grey Scale Ultrasound Score in Assessing the Rheumatoid Arthritis Patient’s Joints?

Copotoiu Monica1, Georgescu Lia1, Poór G2, Copotoiu Ruxandra3

1 Department of Rheumatology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 1st Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
3 Department of Anaesthesia and Intensive Care, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Background: Rheumatoid arthritis (RA) is a complex disease with multiple faces, one of them being its activity. At the moment, there are multiple-choice tools to assess the activity of the disease, no one gaining the complete status of “gold standard”. In the evaluation of the disease activity biological and non-biological methods are used and interposed. The methods are more or less subjective, thus the validation of measurements in RA is highly relevant.
Objective: The main objective of the study was to evaluate the reliability of the Doppler Ultrasound score versus the Grey scale ultrasound score in the assessment of the disease activity in rheumatoid arthritis patients.
Methods: A number of 66 patients diagnosed with rheumatoid arthritis were assessed with the B-mode and consequently Colour Doppler ultrasound score system. The joints examined were the second and the third metacarpal (MCP) and proximal interphalangeal joints (PIP) on the dorsal and ventral side. Two thousand twelve images were stored and evaluated on both scales. Data were analysed with GraphPad Prism 5.0. In order to assess the validity of the ultrasound methods used in the study as non-biological markers for the activity of rheumatoid arthritis Pearson correlation, Bland-Altman method and linear regression were used.
Results: A positive correlation was found when analyzed the two methods of assessment of the disease activity in rheumatoid arthritis. A single mismatch was found (Pearson correlation and linear regression) at the level of the second metacarpal on the ventral and right side when compared the Doppler ultrasound versus the Grey scale score, but we presumed that this is due to the particularity of the individual outcome. The Bland-Altman method showed that the Grey scale of quantification overrated the scores versus the Color Doppler Ultrasound scale.
Conclusions: The semi-quantitative Color Doppler method which assesses the intra-joint activity in rheumatoid arthritis patients was validated in our research to be further used. Even though none of the statistic methods used for validating the Doppler score in our study showed significant statistic differences between them, it is for the best to apply all of them for validating any intended method to be used in any study.

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Clinical Presentation of Thyroid Nodules in Patients Submitted to Surgery

Cătană Ramona1, Genes Ionela2, Sala Tatiana3, Borda Angela4

1 Department of Endocrinology, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
2 Department of Otorhinolaryngology, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
3 Department of Surgery, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
4 Department of Histology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Background: Thyroid nodules can be discovered in the most varied circumstances. There are very few published data demonstrating the way in which thyroid nodules come to medical attention. This study aims to evaluate the clinical presentation of thyroid nodular disease, and to assess whether the presence of malignancy influences the presentation.
Methods: This paper is a prospective analysis of 164 patients diagnosed with thyroid nodular disease who underwent thyroid surgery in the two Departments of Surgery of the Tîrgu Mureş Emergency County Hospital. Face-to-face interviews were conducted to obtain data on how these patients with thyroid nodules come to medical attention. The patients were classified in the following categories: no symptoms and no signs; only symptoms, no signs; no symptoms, only signs (cervical tumor); symptoms and signs. The final pathological diagnoses of the thyroid resected specimens were obtained from database registries of the Department of Pathology.
Results: Most of the patients (64.01%) with thyroid nodular disease require a medical advice when they have cervical symptomatology, in the presence or not of a clinically apparent cervical tumor. 23.18% were patients in which the thyroid nodules were found incidentally by imaging tests performed for other purposes. The higher proportion of malignancy was recorded in patients with thyroid evident growth 52.38%.
Conclusion: The presence of a cervical tumor represents a clear invitation to a medical examination. The incidental discovery of thyroid nodules should not be overlooked. The cervical symptoms might have anything to do with the presence or with the size of thyroid nodules.

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Sensitization to Food Allergens in Mureș Region Atopic Children by in vitro Specific Ig E Assay

Căpîlna Brîndușa, Baghiu Maria Despina

Clinic of Pediatrics, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

 

Background: Food allergies are adverse immune reactions to food proteins that affect up to 6% of children. There are little data regarding the frequency of different foods that cause hypersensitivity in Romania.
Objective: To determine the frequency of sensitization to food allergens in children seen in pediatric immuno-allergy services from Tîrgu Mureș, Romania.
Patients and methods: Specific Ig E serum levels to allergens were measured in 113 children in pediatric allergy services and in 36 control children with matching ages. RAST equal or higher than class 1 was considered as positive.
Results: Frequency of positive reaction was significantly higher among atopics (92/113; 81.4%) when compared to controls (8/36; 25.8%). There were little differences according to gender. The frequency of positive reaction to all evaluated allergens was higher among atopics when compared to controls. In relation to food allergens we observed: cow’s milk = 46.9% x 2.8% (p <0.05), egg = 11.5% x 0.0% (p <0.05). With respect to age, food allergen sensitization predominates in young children.
Conclusions: Food allergens were responsible for a significant proportion of sensitization, mainly in infants.

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Histo-anatomical data concerning Robinia Pseudoacacia L. species (Fabaceae)

Călina Cornelia Daniela1, Mitruţ Anca Oana1, Turcu Stiolica Adina1, Bălăşoiu Luiza2, Popescu H2

1 Faculty of Pharmacy, University of Medicine and Pharmacy, Craiova, Romania
2 Faculty of Pharmacy, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania

Introduction: Robinia pseudoacacia L. (Fabaceae), black locust is a honey-bearing tree widespread in Romania from which only flowers and leaves are used in etno-medicine for their soothing, antiseptic and antispasmodic actions; the rest of the plant is toxic.
Material and methods: In this article we present for the first time the histo-anatomical structure of roots, stems and leaves of Robinia pseudoacacia L. species, by using photomicrography technique and staining with genovez reagent.
Results: The research results showed that the root and stem have secondary structure. The leaf has bifacial dorsiventral structure.
Conclusions: Microscopic analysis proved to be a valuable tool, very useful in specifying the characteristic anatomical features of the root, stem and leaf of Robinia pseudoacacia L.

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Study on the Activity of the Cardiac Arrest Teams from the Emergency Department of the Clinical Emergency County Hospital from Tîrgu Mureș, Romania, in 2009

Bratu Simona1, Copotoiu Sanda-Maria2

1 UPU-SMURD, Clinical Emergency County Hospital, Tîrgu-Mureş, Romania
2 Department of Anesthesiology and Intensive Care, Clinical Emergency County Hospital, Tîrgu Mureş, Romania

Objective: To evaluate the activity of the Cardiac Arrest Team (CAT) from the Emergency Department, called to perform resuscitation for patients admitted in different departments of the Clinical County Hospital.
Methods: We conducted a prospective study between 01/01–12/31/2009. We included all the patients we performed CPR on, regardless of indication.
Results: We had a total of 110 cases, representing 0.28% of the 39,074 patients assisted by the department in 2009. We noticed an increased incidence of calls in internal medicine and surgery departments, with 50% and 17% of the cases respectively. The most frequent diagnosis was cardiac arrest for respiratory failure and malignant tumors, each representing 17%, even though malignancy does not have an indication for resuscitation. There was no causal relationship between the outcome of resuscitation and age groups (p = 0.552), type of wards (p = 0.36), or the Basic Life Support (BLS) performed by the staff, before the CAT arrived (p = 0.76). Medical staff from wards started BLS in 40.1% of cases, in 32% of these cases only chest compressions were performed, without ventilation.The proportion of resuscitated versus deceased cases is 49.1% to 50.9%, so immediate results are good, unfortunately the late outcome is bad, 52 cases out of the 54 died later in ICU, 2 patients being discharged in good condition.
Conclusions: CAT should be called according to Do Not resuscitate criteria. Medical staff from the wards should be trained to start CPR and have basic equipment. The early outcome is comparable with the international data, the poor late results binds to resuscitation without indication.

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The Communication Systems Between the Rescue Teams in Case of Disaster. Evaluation of the Awareness of the Health Professionals and the General Public

Boeriu C1, Bacârea V2, Petrişor M3, Ghiga Dana2, Haifa B3, Copotoiu Sanda-Maria4

1 Discipline of Emergency Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Discipline of Methodology of Medical Scientific Research, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Discipline of Medical Informatics and Biostatistics, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
4 Discipline of Anesthesia and Intensive Care, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: The integration of communications and the unified coordination in interventions are essential to reduce the risk of the emergency medical personnel. The purpose of this study is to assess the level of awareness of the population and health professionals regarding the medical emergency and disaster response system as well as the importance of an integrated communication system and coordination of the involved teams.
Material and method: For the purpose of this study two questionnaires were used: initial evaluation and a rewiew. The first questionnaire was applied on a sample of 138 persons, medical personnel from several medical centers in the country (Tîrgu Mureș, Timișoara, Cluj Napoca, București). The second questionnaire was applied on a sample of 120 persons from the general public. The data obtained were statistically analysed using several methods: Friedman test, Kendall tau test, Wilcoxon test, GraphPad Prism 5 and SPSS Statistics 17.0.
Results: The statistically significant difference (p <0.05) among the mean scores obtained by analysing the answers to the first two questions contained in the first questionnaire, shows a poor knowledge related to the emergency response system as well as to the communication systems used in disasters, among doctors and nurses. The answers to the questions contained in the questionnaire applied to the general population revealed a dissatisfaction as well as a lack of knowledge about the existing emergency medical system. The presentation of the Mobile Command Centre led to a better understanding of the emergency response system as well as of the advantages of an integrated communication system in disasters, among the medical personnel and general public.
Conclusions: This study draws attention on the lack of information about the emergency medical system, disaster response and especially on the integration of the communication system between the teams involved in this kind of emergencies. The informative training performed during the second part of the study led to an improvement of the perception regarding the indispensability of an intergated communication system, among the medical personnel and the general public.

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The Detection of Premalignant Gastric Lesions by Conventional and Magnifying Endoscopy

Boeriu Alina1, Dobru Daniela1, Pascarenco Ofelia2, Mocan Simona3, Stoian M4, Georgescu Anca5

1 Department of Gastroenterology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Gastroenterology, Clinical Emergency County Hospital, Tîrgu Mureș, Romania
3 Department of Pathology, Clinical Emergency County Hospital, Tîrgu Mureș, Romania
4 Intensive Care Department, Clinical Emergency County Hospital, Tîrgu Mureș, Romania
5 Clinic of Infectious Diseases, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: Early diagnosis of gastric neoplasia involves both the detection and surveillance of patients with premalignant gastric lesions. Magnifying endoscopy allows the analysis of the fine mucosal structure and microvascular architecture.
Material and methods: The aim of our study is to identify specific patterns associated with premalignant gastric lesions by magnifying endoscopy in conjunction with chromoscopy. We performed conventional upper endoscopies and we selected a number of patients for chromodiagnostic and magnification. We classified the endoscopic patterns in normal and abnormal (modified) patterns. Target biopsies were obtained from magnified areas and we analyzed the correspondence with the histological findings.
Results: We identified specific pit patterns for normal gastric mucosa and for inflamed mucosa. A tubular pattern was associated with the detection of intestinal metaplasia. An irregular pattern and abnormal microvessels were endoscopic findings associated with the detection of high-grade dysplasia. An irregular form of collecting venules was detected in areas with atrophic gastritis.
Conclusions: An initial selection of patients based on conventional endoscopic findings is mandatory. Gastric mucosal changes identified by magnifying endoscopy raise the number of detected premalignant lesions by targeted biopsies. Our work emphasizes the current challenges related to the use of these endoscopic methods.

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