Category Archives: Number

Dissection of the Cervico-Cerebral Arteries – Ultrasonographic Characteristics

Bajkó Z, Bălaşa Rodica, Stan Camelia, Moţăţăianu Anca

Department of Neurology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Background: Dissection of the cervical and cerebral arteries represents the leading cause of non-atherosclerotic stroke in young adults. The diagnosis can be difficult as the presentation may be variable. The ultrasound (US) examination is the first diagnostic procedure, because is non invasive and informative.
The aim of this study was to analyse the ultrasonographical characteristics of the cervico-cerebral artery dissections (CCAD).
Patients and methods: We analyzed 8 consecutive cases of CCAD examined in the Ultrasound Laboratory of Neurology Clinic I from Tîrgu Mureş, Romania over a 3-year period. The mean age of the patients was 39.5±12.1 (min. 24, max. 60), the male/female ratio: 1.
Results: In 5 cases the diagnosis was established based on the ultrasound findings, in 2 cases was confirmed by angiography and in one case by MRI angiography. In 3 cases the CCAD occurred at the level of the proximal internal carotid artery (ICA), in 2 cases at distal ICA, in one case the common carotid artery, in 1-1 cases the proximal and distal part of the vertebral arteries. The most frequent ultrasound finding suggestive for CCAD was the hypoechogenic wall haematoma (3 cases). The hyperechogenic intimal flap occurred in 2 cases, the classical double lumen only in one case. In three cases the ultrasound examination revealed only indirect signs of occlusion. In one case the ultrasound findings were not suggestive for ICA dissection, the diagnosis was confirmed based on the angiography findings.
Conclusions: Color duplex ultrasound examination is an important diagnostic method in the diagnosis of CCAD with good sensitivity and specificity. The most frequent ultrasound finding in CCAD is the hypoechogenic mural haematoma. In patients with suspected CAD and negative US, repeated US examinations and further diagnostic imaging, as angiography, MRI, MRI angiography must be performed.

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Specialized Software Engineering in Clinical Trials. GANfort Study

Bacârea V1, Haifa B2, Petrișor M2, Ghiga Dana1, Bacârea Anca3, Muji M4, Mărușteri M2

1 Research Methodology Department, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Medical Informatics and Biostatistics Department, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Physiopathology Department, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
4 Engineering Department, Petru Maior University, Tîrgu Mureș, Romania

Objective: We aim to develop and implement a personalized software to accomplish data quality management in real time, reducing the chance of error in data collection and a “real time biostatistics” software linked to a collector datasheet.
Material and methods: We used C++ for programming, R for statistics and JavaScript (AJAX) for the interface. This application was deve-loped for phase 3 GANfort study. This is a multicentric study. The results presented are simulated.
Results: The application presented below has a datasheet collection view with three tabs and a general presentation of the study and patient. The first tab collects data from the first visit (study inclusion and initiating the treatment), the second tab is for surveillance visit and the third tab generates real time statistic parameters.
Discussions: Using this type of software many methodological problems concerning data management can be avoided. “Missing data” and “outliers” or writing and typing errors become non-existent; typing constraints issued by datasheets and real time biostatistics eliminate them. The data can be introduced in the same time in different places and the matching data is performed simultaneously.
Conclusions: The time consuming data quality management is automatically solved using the software we proposed. Statistical parameters are calculated in real time. The end of data collection coincides with a final report of the study.

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A Randomized Trial of Prophylactic Administration of Phenylephrine vs. Ephedrine for Treatment of Hypotension during Combined Spinal-epidural Anesthesia for Cesarean Delivery

Weisenberg M1, Gorodinsky L1, Ezri T1, Golan A2, Zimlichman R3, Evron S1

1 Department of Anesthesia, Edith Wolfson Medical Center, Holon, Affiliated with Sackler Medical School, Tel Aviv University, Israel
2 Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Affiliated with Sackler Medical School, Tel Aviv University, Israel
3 Department of Internal Medicine and The Brunner Institute for Cardiovascular Research, Edith Wolfson Medical Center, Holon, Affiliated with Sackler Medical School, Tel Aviv University, Israel

Ephedrine and phenylephrine are useful vasopressors for managing hypotension during caesarean delivery. Fetal arterial cord blood pH and fetal acidosis may be related to the choice of vasopressor. The present study was therefore designed to compare arterial cord blood pH and fetal acidosis rates by vasopressor treatment, while maintaining maternal mean arterial pressure (MAP) near baseline values. Fifty one ASA I-II parturients undergoing cesarean delivery (CD) under combined spinal-epidural anesthesia (CSEA) were randomly assigned to prophylactic infusion (20 mL.hr-1) of phenylephrine (100 µg.ml-1, n=25) or ephedrine (3 mg.ml-1, n=26) prior to CSEA. The infusion, was titrated to maintain mean arterial pressure (MAP) near baseline values. The primary outcome was arterial cord blood pH. Fetal acidosis was defined as pH <7.2; maternal hypotension as MAP <70 mmHg; and maternal bradycardia as heart rate <50 bpm. Arterial cord blood pH was 7.32±0.06 in the ephedrine group vs. 7.32±0.05 in the phenylephrine group, p=0.9. Fetal acidosis occurred in one case (4%) in each study group with similar one- and five-minute Apgar scores (all >7). Hypotension episodes were more frequent in patients given ephedrine (10 patients; 38%) than phenylephrine (three patients; 12%), (p=0.03). We conclude that prophylactic ephedrine as compared to phenylephrine administration was associated with a relatively high incidence of hypotension but with similar cord blood pH.

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No Editorial for a Blurred Window

Sanda-Maria Copotoiu

Editor-in-Chief

A parochial journal like ours sticks to its values. Strives to be acknowledged as a reliable means of communication. As an opportunity to the members of our university to publish their research. And what are exactly our values?
Fairness as to the intent of the research, good faith, correctness and transparency, curiosity, respect for the subjects and equally for the research team members. All post-Hippocratic principles. But just as afterload includes preload, we know that all the ancient Hippocratic principles are in and observed, and followed.
These lines are intended for our readers and authors to let them know that they are welcome to submit their articles, provided they follow the rules. Medical literature is made to be read, articles to be analyzed, sometimes even quoted. Authors are more or less driven by genuine appetite for research. No matter the driving force, a good outcome is to be expected, utilitarians as we often tend to be.
One of my PhD students confessed recently that the more she was involved, the more she became interested in research. Ideas came as she worked and analyzed results. [More]

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Emergency Anaesthesia for Multiple Trauma

Grinţescu Ioana Marina, Ungureanu Raluca, Mirea Liliana

Anaesthesia and Intensive Care Clinic, Clinical Emergency Hospital, Bucharest, Romania

Trauma anaesthesia management is a challenge because we must deal with a critical ill patient with unclear history, injuries and physiologic status. ATLS® protocol is a useful tool in assessing and managing patients with complex and life threatening injuries. Rapid sequence of intubation is the preferred approach for airway control. Many factors combine to increase tracheal intubation difficulty in the trauma patient. Fluid management is especially challenging because of rapid, unpredictable changes in volume status and incomplete pre-operative resuscitation. For severely injured, the damage control resuscitation approach is intended to minimize exacerbating the multifactorial trauma-induced coagulopathy by replacing lost blood with plasma and platelet-containing products (haemostatic resuscitation) instead of using early and large amounts of crystalloids and RBCs (hypotensive resuscitation). This strategy encapsulates also the established concept of damage control surgery in the scope to rapid control the haemorrhage.

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Possibilities and Challenges in the Molecular Diagnosis Of Lysosomal Storage Disorders

Csép Katalin1, Drugan Cristina2, Bănescu Claudia1

1 Department of Genetics, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Biochemistry, University of Medicine and Pharmacy, Cluj-Napoca, Romania

In inherited metabolic diseases, the final diagnosis is generally made by classic biochemical methods, despite the monogenic etiology. In lysosomal storage disorders, the suspected clinical diagnosis is confirmed by enzyme assay, and DNA analysis is not mandatory for the diagnosis or initiation of the treatment. Like in most enzyme deficits, the inheritance is recessive (autosomal or X-linked). Genetic heterogeneity is characteristic, and hundreds of alleles of the same gene may exist, caused by various mechanisms or mutations at different nucleotide levels. Besides the targeted analysis of the most frequent mutations (N370S, L444P, R463C, 84GG, recNciI, recTL) in Gaucher disease carried out in the national diagnostic center, often mutation scanning and sequencing is required. Though data must be carefully interpreted, molecular testing may provide important additional information, and it is the basis of carrier testing and prenatal diagnosis. The genotype-phenotype correlation remains inconclusive in most of the cases, though sometimes it can be used as a prognostic marker.

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Acute Myeloblastic Leukemia: Difficulties of Treatment, Complications and Evolution

Tilinca Mariana¹, Benedek Lázár Erzsébet², Köpeczi Judith Beáta², Bacârea Anca³, Bănescu Claudia4, Benedek I², Bățagă Simona5

1 Department of Cellular and Molecular Biology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Hematology, Bone Marrow Transplantation Compartment, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Department of Physiopathology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
4 Department of Genetics, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
5 Internal Medicine I, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: This paper presents a special case of an acute myeloblastic leukemia accidentally diagnosed on a 57 years old asymptomatic person without occupational exposure, without a medical history, with normal blood count, without thrombocytopenia, as a result of routine hematological tests that reveal the presence of more than 10% blasts on peripheral blood smear.
Material and method: Bone marrow aspirate revealed 80% blasts and flow cytometry confirmed the diagnosis of acute myeloblastic leukemia LAM0. Cytogenetic examination showed normal karyotype 46, XX. The treatment aims to induce, maintain and consolidate remission. Since the classical therapeutical approach with Idarubicine and Cytarabine 3+7 was not tolerated, adjustments were necessary to 2+5, four courses being administered. During the remission period Methotrexate and Purinetol maintenance treatment was administered, it was obtained a tolerable quality of life, the patient resumed his work. The first relapse occurred after approximately one year. Later medical courses were established after chemotherapy protocol with Clofarabine and Cytarabine, but after intolerance, neutropenia, sepsis and death occured.
Results: Because of the severe prognosis and infectious complications the treatment was difficult and dose ajustments were necessary according to patient’s tolerance. Bone marrow transplant was not possible due to the lack of a compatible family donor.
Conclusions: This case of acute myelogenous leukemia treatment reflects the difficulties and complications occurred during the disease evolution. However remission periods with a tolerable quality of life were obtained, duration of treatment was approximately three years until death.

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Multidisciplinary Approach of Breast Cancer. Case Reports

Podeanu Daniela1, Stolnicu Simona2, Georgescu R3, Treaba Andrada1, Șincu Nina-Ioana4, Copotoiu C5, Brînzaniuc Klara6

1 Department of Radiology and Medical Imaging, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Pathology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Surgery Clinic III, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
4 Clinic of Infectious Diseases I, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
5 Surgery Clinic I, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
6 Department of Anatomy, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: Breast cancer is still the world’s most common cancer in women. Multidisciplinary approach represents the gold standard in diagnosis.
Case presentation: In order to emphasize the importance of this issue, we present three of our cases. In these cases of invasive carcinoma, in women ranged from 42 to 54 years, the diagnosis tools were clinical examination, mammography, ultrasound and histopathology. Minimal invasive breast biopsy and preoperative localisation procedures, under ultrasound and stereotactic guidance contributed to preoperative planning.
Conclusions: Interdisciplinary approach in diagnosis provides optimal management of breast cancer.

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Atrial Fibrillation, the First Manifestation of Atrial Myxoma

Opriș Mihaela¹, Maier Anca², Dinesch M², Bilca V³, Moldovan Eugenia4, Mitre Adriana¹, Sîrbu Voichița¹

1 Medical Clinic V, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Clinic of Cardiology, Emergency County Hospital, Tîrgu Mureș, Romania
3 Clinic of Cardiovascular Surgery, Emergency County Hospital, Tîrgu Mureș, Romania
4 Department of Pathology, Emergency County Hospital, Tîrgu Mureș, Romania

Introduction: Atrial myxomas are the most common primary heart tumors. Although quite rare, left atrial myxomas account for 80% of all cardiac tumors. Diagnosis is often difficult due to the wide array of presenting symptoms. This case report discusses an unusual presentation of left atrial myxoma in an elderly patient.
Case presentation: A 73-year old woman with a history of hypertension, dyslipidemia and hyperthyroidism treatment presented to the emergency department with a new onset episode of palpitations. The electrocardiogram revealed atrial fibrillation. Rate control was achieved with beta-blockers and sinus rhythm transition was achieved shortly after admission. Transthoracic echocardiography revealed a heterogeneous mass in the left atria with a villous surface, occupying more than 50% of the left atrial cavity. Surgery was recommended because of the embolic potential of such a mass and tumor excision was performed. Microscopic pathology showed typical histological features of cardiac myxoma with no atypia or malignancy, and the patient was discharged in sinus rhythm 7 days after surgery.
Discussion and conclusions: Left atrial myxoma presenting in the seventh decade of life is rare. Elderly patients often present with non- specific symptoms that are often overlooked in the absence of a supporting cardiac history, which makes an early diagnosis challenging. We conclude that the majority of myxomas mimic many cardiovascular diseases and were detected in symptomatic patients, so a high index of clinical suspicion is important for its early and correct diagnosis. Two-dimensional echocardiography provides substantial advantages in detecting intracardiac tumors.

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Endoscopic Examination: a Present and Future Challenge

Boeriu Alina1, Dobru Daniela1, Mocan Simona2, Pascarenco Ofelia3, Stoian M4, Boeriu C5

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

The detection and surveillance of patients with premalignant gastric lesions could lead to early detection and treatment of gastric cancer. These lesions are mostly diagnosed in random biopsy samples obtained during conventional endoscopy. New endoscopic techniques, such as magnification endoscopy, may help the detection of neoplastic lesions. In this case series, we intended to emphasize the current problems in the detection and surveillance of gastric neoplasic lesions in clinical practice. Four cases with gastritis-like appearance on conventional endoscopy were identified with gastric dysplasia or carcinoma on histopathologic evaluation. We discussed the subjective interpretation of endoscopic findings, the challenges in the surveillance of low-grade dysplasia and the contribution of magnifying endoscopy on diagnostic accuracy. The performance of endoscopic examination and surveillance could be improved by magnified chromoendoscopy with targeted biopsies. An understanding of diagnostic challenges of gastric dysplasia is crucial in clinical management.

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