Category Archives: Number

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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Tumors of the Oro-Facial System

Biriş Carmen1, Brînzaniuc Klara2, Cerghizan Diana1, Jánosi Kinga1, Kovács Alpárd3

1 Department of Prosthetic Dentistry and Oral Rehabilitation, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Anatomy and Embriology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Dentist in private practice

The increasing number of malignant cases in the oro-facial area represents by their increasing number lately a new problem regarding the treatment and diagnosis. This cases present an increased difficulty of diagnostic and treatment, because they are usually diagnosticated in lately stages. Patients are often unaware of the gravity of their situation due to the lack of specific or almost absent symptomatology.
The incriminated factors and co-factors incriminated in the development of the malignant manifestations are of multiple origins: use of tobacco products, especially associated to alcohol abuse, chronical topic irritation of the oral mucosa, genetic predisposition or some types of viruses (human papilloma virus type 16 and 18 and herpes virus). Also factors like: environmental modifications, age, alimentation or pharmaceutical drug usage can be incriminated for the increasing pathology of the last decades, especially in well developed countries both from Europe and North America.
Our presentation is based on the case of a 61 years old male, showing almost the typical premises of a malignant pathology starting from the evolution of the oral lesion and the general and dental pathology status with the correlation of the objective and subjective examination.
The lesion usually benefits of surgical treatment, followed by radiotherapy and oro-facial reconstruction, that can imply both plastic surgery and prosthetic rehabilitation, as was the case of our patient. Of most importance remains the moment of the prosthetic treatment and its correlation with radiotherapy, regarding the tissue modification that irradiation has on this level.

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Remarks on Odontogenesis in Children After Chemo-radiation Therapy

Bică Cristina1, Chinceşan Mihaela2, Păcurar Mariana¹, Molnár Enikő³, Stolnicu Simona4

1 Department of Pediatric Dentistry, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Pediatric Haematology-Oncology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Emergency County Hospital, Tîrgu Mureș, Romania
4 Department of Pathology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: Leukemias are the most frequent forms of neoplasias in children. The oral complications that occur in time, after the specific treatment through chemotherapy or radiotherapy, are represented by the occurrence of multiple carious lesions, disorders of dental eruptions, the premature loss of the primary teeth, anomalies in the development of teeth.
Material and method: Through the clinical examination of the oral cavity and through radiological examination, with the help of the orthopantomogram, we revealed the disorders of dental development consecutive to the cytostatic therapy and radiotherapy in the acute lymphoblastic leukemia.
Results: The specific treatment through chemotherapy and radiotherapy overlapped with important stages of the physiological process of odontogenesis. We noted ageneses, microdontias, precocious eruptions and disorders of the eruption order.
Conclusions: The cytostatic medication and radiotherapy can be followed by anomalies in the development and eruption of the dental buds. The severity of these secondary effects varies according to the patient’s age at the moment of the start of the specific therapy, the stage of dental development, the type of cytostatic medication and the dose and frequency of treatment cycles.

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Management Algorithm for Surgical Patients Infected with Human Immunodeficiency Virus

Zaharia Kézdi Erzsébet Iringó1, Boţianu A2, Ioniţă Alexandrina1, Georgescu Anca1, Incze Andrea1, Şincu Nina1

1 Clinic of Infectious Diseases I, Tîrgu Mureș, Romania
2 Surgery Clinic II, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Objective: The purpose of this study was to establish the risk factors which influence the postoperative evolution of surgical patients infected with human immunodeficiency virus (HIV), and to conceive a management algorithm based upon these factors.
Methods: We have performed a bidirectional transversal study on a group of 73 HIV-positive patients who had undergone 104 surgical procedures during 2006–2010 in the university medical center of Tîrgu Mureş. We studied risk factors such as the number of CD4 T-cells (LTCD4) < 100/µl, anemia, thrombocytopenia, hypoproteinemia, leukopenia, wasting syndrome, ASA (American Society of Anesthesiologists) score, Altemeier class and NNISS (National Nosocomial Infections Survey Systems) score. We defined any registered postoperative complication, as well as all deaths within the first 30 days from surgery as poor outcome. We used GraphPad statistical program, Fisher test for the statistical analysis of data, we interpreted p <0.05 as statistically significant, for a CI of 95%.
Results: We have registered a total of 15 complications, 5 deaths. Risk factors associated with poor postoperative outcome were LTCD4 <100/µl (p=0.03) wasting syndrome (p=0.0001), ASA score > 1 (p=0.01), Altemeier class > II (p=0.0001), NNISS score 1 (p=0.0001).
Conclusions: HIV-infected patients with emergency surgical pathology will benefit of surgical treatment when the anesthetic risk does not overpass the surgical risk, while patients who require elective interventions will be operated after the correction of risk factors.

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Lyme Neuroborreliosis – A Retrospective Study

Țilea Brîndușa1, Țilea I2, Brînzaniuc Klara3, Georgescu Anca1, Gîrbovan Cristina1

1 1st Clinic of Infectious Diseases, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Internal Medicine III, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Anatomy and Human Embriology Department, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Background: Lyme Neuroborreliosis represents the acute or chronic infection of the central nervous system (CNS) and peripheric nervous system (PNS), as a consequence of a systemic infection.
Objectives: to evaluate the epidemiological, clinical, serological and post-therapeutic implications of CNS and PNS damage during Borrelia burgdorferi (Bb) infection.
Material and method: We performed a retrospective study on 23 patients admitted between January 1st, 2009 – December 31, 2010. The patient’s inclusion was made respecting the criteria of the European Center for Diseases Control (ECDC) and the European Union Concerted Action on Lyme Borreliosis (EUCALB). The levels of antiBb antibodies (IgM, IgG) were measured in the cerebro-spinal fluid (CSF) and in the serum using ELISA and Western blot methods. Imaging techniques were used in the case of patients with meningeal and cerebral lesions. The patients were treated with 3rd generation cephalosporins and cyclins. Statistical analysis was performed using the Chi square and Student tests.
Results: Twenty patients (86.96%) were included in the acute phase and 3 patients (13.04%) in the chronic phase of the disease. Meningeal damage was observed in 16 patients (69.56%), cerebral damage in 4 patients (17.39%), cranial nerve lesions in 2 patients (8.69%), radiculoneuritis in 1 patient (4.34%). Serological investigations using the ELISA method revealed the presence of antiBb antibodies in 100% of cases, in the CSF antiBb IgM antibodies were found in 18 patients (78.26%), IgG in 3 patients (13.04%); using the Western-blot method IgM antibodies were found in 20 patients (86.96%) and IgG in 3 patients (13.04%).
Conclusions: Early diagnosis and therapy led to a favorable evolution compared with patients who were treated late, the latter presenting neurological sequelae and relapses.

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Therapeutical Features of Permanent Atrial Fibrillation in Hypertensive Elderly Patients

Toma L1, Baricz Emőke1, Dorgo Monica1, Caraşca E1,2

1 Medical Clinic IV, Tîrgu Mureș, Romania
2 Internal Medicine Departament, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Introduction: The atrial fibrillation is a form of arrhythmia, which occurs most frequently among the aged and which often influences the therapy prescribed to them.
Material and methods: The present study addresses to a focus group of 79 hypertensive elderly patients, hospitalized at the Internal Medicine Clinic of Targu Mures during the year 2007. The parameters taken into consideration were distribution by age groups, gender, the existence of atrial fibrillation or other comorbidities and the administrated therapy.
Results: The distribution by age groups and gender reveals a higher number of hypertensive patients between 70 and 75 years and a more frequent affection of male patients. The associated comorbidities to our group of 28 patients with atrial fibrillation were cardiac ischemic disease (13 patients), heart failure (2 patients), both of these (6 patients) and chronic obstructive lung disease (7 patients). The medication administrated for the rate control consists of: beta-blocker in almost 50% of cases (13 out of 28 patients), digitalis (2 patients), and beta-blocker+digitalis for 6 patients. In 7 cases the rate control medication was not required.
Conclusions: The atrial fibrillation is a common condition among the hypertensive elders, and not infrequently associated with other cardiac comorbidities which contribute to the choice of appropriate medication.

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Identification of the Photodegradation Products of the Tricyclic Antidepressant Drugs Clomipramine and Doxepine

Székely P1, Gyéresi Á2, Hancu G2, Laczkó Zöld Eszter3, Vancea Szende4

1 Department of Pharmaceutical Marketing, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
2 Department of Pharmaceutical Chemistry, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Department of Pharmacognosy, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
4 Department of Physical Chemistry, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Objective: Isolation and identification of the photodegradation products of the tricyclic antidepressant drugs clomipramine and doxepine after irradiation with ultraviolet light.
Methods: The photodegradation products were separated by a thin layer cromatographic method, followed by scraping the spots from the chromatoplate and extracting in methanol, which was followed by their identification by mass spectrometry.
Results: In the case of clomipramine seven degradation products were separated and the corresponding m/z values were determined, while analyzing doxepine there have been separated eight degradation products, of which six were identified by their m/z values. The results obtained for clomipramine are in accordance with literature data, except for desmethyl-clomipramine, for which we could not find any reference. Conclusions: The m/z values indicate that the possible degradation products for clomipramine are imipramine, HO-imipramine, desmethyl-clomipramine and HO-imipramine-N-oxide. In the case of doxepine we could identify two possible photodegradation products, HO-doxepine and doxepine-N-oxide.

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Modification of Renal Permeability for Proteins after General Anesthesia with Sevoflurane and Desfluran

Stoian M1, Stoian Adina2, Cozma D3, Brusnic Olga4, Pascarenco Ofelia4, Iacob Oana2, Șchiopu A2

1 Department of Anesthesiology and Intensive Care, County Emergency Hospital, Tîrgu Mureș, Romania
2 Department of Pathophysiology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Surgery Clinic no. 1, County Emergency Hospital, Tîrgu Mureș, Romania
4 Gastroenterology Clinic, County Emergency Hospital, Tîrgu Mureș, Romania

Introduction: Sevoflurane degradation by carbon dioxide absorbents during low-flow anesthesia lead to the formation of a haloalkene called compound A, which causes nephrotoxicity.
Material and methods: We determined proteinuria by spectophotometry at 600 nm, preoperatively and postoperatively at 24 and 72 hours in 52 patients undergoing general anesthesia with sevoflurane and 25 patients undergoing general anesthesia with Desfluran. We selected patients without previous renal disease, with anesthetic risk ASA I–III who underwent major abdominal and thoracic surgery lasting more than 150 minutes and we used a 2 l/minute FGF-fresh gas flow, with a MAC-minimal alveolar concentration of 1.5 to 1.8 for Sevoflurane, and of 6–8 MAC for Desfluran.
Results: Renal permeability is impaired by general anesthesia with Sevoflurane (p ˂ 0.0001) and Desfluran (p > 0,001). The amount of filtered protein has a maximum at 24 hours after surgery with gradual decrease within 72 hours, but without reaching the normal preoperative values.
Conclusions: There is proteinuria after exposure to volatile agents like Sevoflurane and Desfluran recording a maximum in the first 24 hours and there is also a tendency to normalization within 72 hours. We noticed a marked impairment of renal permeability in association with specific groups of pathology as septic patients, diabetics, hypertensives, especially after Sevoflurane anesthesia. There was no-one case of acute renal failure in which to criminalize Sevoflurane or Desfluran.

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