Category Archives: Number

The Role of Liver Transplantation in the Treatment of Hepatocellular Carcinoma – a Single Center Experience from Budapest

Piros L, Görög D, Fehérvári I, Nemes B, Langer R, Kóbori L

Department of Transplantation and Surgery, Faculty of Medicine, Semmelweis University, Budapest, Hungary

DOI: 10.2478/amma-2013-0060

Background: Liver transplantation for hepatic tumours is known as a proven treatment opportunity. The outcome has improved over the past decades because of the appropriate recipient selection.
Materials and methods: In a single-institution study of 29 consecutive adult patients underwent orthotopic liver transplantation (OLT) between 1 January 2004 and 1 January 2011 in the Semmelweis University, Budapest with the indication of hepatocellular carcinoma (HCC).
Results: The 1-year survival was 85.7% and the 3-year survival was 71.7%.
Conclusions: Further investigations are needed on the field of histological and biological attributes of the hepatocellular carcinoma. Our aim is to find a better and individualized immunosuppressive protocol, which is also protective against malignant tumours.

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Assessing the Patient with Abdominal Obesity: Metabolic and Nutritional Factors

Pop Raluca1,2, Pop M1,3, Dogaru G4,5

1 PhD Student, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Endocrinology Outpatient Clinic, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
3 Radiology Department, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
4 Internal Medicine Department, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
5 Nephrology Department, County Emergency Clinical Hospital, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2013-0059

Background: Abdominal obesity is a confirmed cardio-vascular risk factor and the elements influencing it are subject for research and intervention. The available nutritional evaluation methods are time consuming, subjective and a standardized approach is missing.
Aim: Standardized evaluation of patients with abdominal obesity.
Material and methods: Cross-sectional study on a convenience sample of 85 subjects who presented in the Endocrinology Outpatient Clinic of the Emergency Mures County Hospital between February – April 2013. Variables: age, sex, environment, BMI, waist, blood glucose, triglycerides, HDL-Cholesterol, blood pressure. Each patient filled a food frequency questionnaire.
Results: None of the subjects had a “normal” food pyramid. Sex has no influence on the food pyramid. The meat and protein food group is the only one significantly influenced by the environment (p = 0.04). Patients with dyslipidemia consume lower amounts of sweets (1.13 vs. 1.83 servings, p = 0.007). Patients requiring metabolic treatment have significant higher waist values (101.32 vs. 93.07 cm, p=0.03). Patients with simple abdominal obesity consume significant lower amounts of meat and protein and higher amounts of fruit and vegetables.
Conclusions: A standardized approach to the patient with abdominal obesity using nutritional assessment tools and metabolic evaluation helps to identify those at risk and to give more tailored recommendations.

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Using Abdominal CT Data for Visceral Fat Evaluation

Pop M1,2, Pop Raluca1,3

1 PhD Student, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Radiology Department, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
3 Endocrinology Outpatient Clinic, County Emergency Clinical Hospital, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2013-0058

Background: Quantitative assessment of body fat is important for the diagnosis and treatment of diseases related to obesity, Computed tomography (CT) becoming the standard procedure for measuring the abdominal fat distribution.
Material and method: The retrospective study included 111 inpatients, who underwent routine abdominal CT exams in the Radiology Laboratory of SCJU Tg.Mures (2013). MPR MDCT (SOMATOM AS 64) data was processed using a custom written MATLAB R2009b software, ImageJ being used for tracing of the visceral fat area (VFA). Patient data (including blood glucose, cholesterol and triglycerides) were analyzed using MO Excel and GraphPad Inprism5.
Results: Visceral Fat percentage varied in population from 14.59–68.69 (SD = 11.83) with significant difference between sexes (male vs. female, 46.98 vs. 31.62, p <0.05). Cholesterol values >220 mg% and triglycerides >150 mg% are significantly associated with the VF percent (p <0.05). Overall there is a weak correlation between the lab variables and the measured fat, the strongest one being between triglycerides and the VFA (r = +0.23) and between age and VFA percentage (certain samples).
Conclusions: The technique used should decreases the human error in marking of the fat areas providing a better estimation of the VF/VF percentage. CT measured VF relates with certain lab tests. Further analysis, is required for a better use of CT in obesity related pathology diagnosis and treatment.

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Phytotoxicity Assessment of Certain Phytochemical Products Containing Pyrrolizidine Alkaloids

Şeremet Oana Cristina1, Olaru OT2, Ilie Mihaela3, Negreş Simona1, Bălălău D3

1 Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
2 Department of Botany and Cellular Biology, Faculty of Pharmacy, ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
3 Department of Toxicology, Faculty of Pharmacy, ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

DOI: 10.2478/amma-2013-0057

Introduction: Tussilago farfara (coltsfoot), Petasites hybridus (common butterbur), Senecio vernalis (eastern groundsel) and Symphytum officinale (comfrey) are species traditionally used in phytotherapy that besides the therapeutic compounds contain toxic pyrrolizidine alkaloids (PAs). The aim of the paper is to determine the total PAs content and the phytotoxicity of the above species.
Material and methods: The quantitative determination of pyrrolizidine alkaloids is based on the stoichiometric reaction of protonated alkaloids with methyl orange. In acidic conditions the dye is released from the complex and its color is assessed spectrophotometrically using a linear regression curve of senecionine as a standard. The phytotoxicity was assessed by Triticum bioassay that studies the effect of the extracts (0.001–5.00%, w/v) upon root elongation (inhibitory concentration – IC50) and on the karyokinetic film.
Results: The highest amount of total PAs was found in Senecio vernalis (654.8 ± 35.96 μg/g dry plant) and the lowest in Petasites hybridus. The lowest IC50 was found for Tussilago farfara followed by Petasites hybridus, Senecio vernalis, and Symphytum officinale. The results were supported by microscopic examination.
Conclusions: The results of the spectrophotometric assay are consistent with the ones found in the literature. All extracts inhibited the elongation of the main root of wheat caryopses, however, no correlation between phytotoxicity and the PAs concentration could be emphasized.

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Quantitative Determination of Arsenic in Bottled Drinking Water Using Atomic Absorption Spectroscopy

Guţu Claudia Maria, Bălălău D, Ilie Mihaela, Purdel Carmen Nicoleta, Gubandru Miriana

Department of Toxicology, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

DOI: 10.2478/amma-2013-0056

Background: Many studies have been performed in the past few years, to determine arsenic speciation in drinking water, food chain and environment, arsenic being a well-recognized carcinogenic and toxic agent mainly in its inorganic species. The instrumental techniques used for arsenic determination, such as hydride generation atomic absorption spectrometry (HGAAS), graphite furnace atomic absorption spectrometry (GFAAS) and inductively coupled plasma mass spectrometry (ICP-MS), can provide a great sensitivity only on the total amount.
Objective: The aim of this study was to develop a simple and rapid method and to analyze the concentration of total inorganic arsenic in bottled drinking water.
Methods: Total arsenic was determined in samples from six different types of commercially available bottled drinking water using atomic absorption spectrometry with electrothermal or hydride generation vaporisation. All drinking water samples were acidified with 0.1M nitric acid to match the acidity of the standards.
Results: The method was linear within the studied range (1–5 μg/L, R = 0.9943). The quantification limits for arsenic determination were 0.48 μg/L (HGAAS) and 0.03 μg/L (GFAAS). The evaluated arsenic content in drinking water was within the accepted limits provided by law.
Conclusions: A simple and sensitive method for the quantification of arsenic in drinking water using atomic absorbtion spectroscopy was described, which can be further used in toxicological studies. As an additional advantage, the system is very fast, efficient and environmental friendly.

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Spigelian Port-site Hernia, a Complication after Laparoscopic Cholecystectomy — a Clinical Case Report

Molnar C1, Tîlvescu C1, Neagoe VI1, Butiurca VO1, Molnar CV2, Copotoiu C1

1 Surgery Clinic 1, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
2 Obstetrics-Gynecology Clinic 1, County Emergency Clinical Hospital, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2013-0055

Introduction: Spiegelian hernias are rare entities in abdominal wall pathology (2%). They occur in the semilunar line described by Adriaan van den Spiegel. Klinklosch (1764) defined it as a congenital or acquired defect of the transverse abdominal aponeurosis junction with the Douglas arch. Port-site hernias due to wrong placement of laparoscopic trocars in the right abdominal flank are rare, but possible complications of laparoscopic cholecystectomy.
Case presentation: Our observation shows diagnostic and therapeutic aspects in a patient with port-site Spigelian hernia post laparoscopic cholecystectomy admitted in Surgical Clinic 1, County Emergency Clinical Hospital Tîrgu Mureș in the 28.01.2013 – 30.01.2013 period. Following surgery performed using an open approach, postoperative evolution was favorable, with no signs of recurrence at 9 months postoperatively.
Conclusions: Spigelian port-site hernia post laparoscopic cholecystectomy is a very rare entity, iatrogeny being a certainty in its development.

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The Role of Liver Transplantation in the Treatment of Hepatocellular Carcinoma

Marius Florin Coro

Surgical Clinic 1, County Clinical Hospital, Tîrgu Mureș, Romania

It is known that hepatocellular carcinoma (HCC) is related to different risk factors, primarily represented by infection with hepatitis B or C virus, so in most cases the non-tumoral hepatic tissue is also affected by cirrhosis.
Amongst the therapeutic arsenal of HCC, the liver transplantation (LT) ranks first being the only treatment that offers a complete oncological resection and cure for the underlying liver cirrhosis simultaneously. Studies have shown that patients with LT have a significant better survival compared to those with liver resections [1]. Most patients with cirrhosis have abnormal liver function and are not candidates for resection.
Because there was much controversy regarding guidelines for LT in HCC, an international consensus conference was held in Zurich in 2010 aimed to develop internationally accepted statements and guidelines. The conference report had 37 statements and recommendations [2].[More]

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Considerations Regarding Age at Surgery and Fistula Incidence Using One- and Two-stage Closure for Cleft Palat

Stoicescu Simona1,2, Enescu DM1,2

1 Plastic and Reconstructive Surgery Chair, “Grigore Alexandrescu” Emergency Clinical Hospital for Children, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
2 Clinic of Plastic Surgery, Reconstructive Microsurgery and Burns, “Grigore Alexandrescu” Emergency Clinical Hospital for Children, Bucharest, Romania

DOI: 10.2478/amma-2013-0069

Introduction: Although cleft lip and palate (CLP) is one of the most common congenital malformations, occurring in 1 in 700 live births, there is still no generally accepted treatment protocol. Numerous surgical techniques have been described for cleft palate repair; these techniques can be divided into one-stage (one operation) cleft palate repair and two-stage cleft palate closure. The aim of this study is to present our cleft palate team experience in using the two-stage cleft palate closure and the clinical outcomes in terms of oronasal fistula rate.
Material and methods: A retrospective analysis was performed on medical records of 80 patients who underwent palate repair over a five-year period, from 2008 to 2012. All cleft palate patients were incorporated. Information on patient’s gender, cleft type, age at repair, one- or two-stage cleft palate repair were collected and analyzed.
Results: Fifty-three (66%) and twenty-seven (34%) patients underwent two-stage and one-stage repair, respectively. According to Veau classification, more than 60% of them were Veau III and IV, associating cleft lip to cleft palate. Fistula occurred in 34% of the two-stage repairs versus 7% of one-stage repairs, with an overall incidence of 24%.
Conclusions: Our study has shown that a two-stage cleft palate closure has a higher rate of fistula formation when compared with the one-stage repair. Two-stage repair is the protocol of choice in wide complete cleft lip and palate cases, while one-stage procedure is a good option for cleft palate alone, or some specific cleft lip and palate cases (narrow cleft palate, older age at surgery).

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High Calcium Score Predicts Severity of the Culprit Lesions in Patients with Acute Coronary Syndromes

Jakó Beáta1, Benedek Theodora2, Suciu Zsuzsanna2, Benedek I2

1 Clinic of Cardiology, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
2 Clinic of Cardiology, Discipline of Internal Medicine 6, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2013-0068

Introduction: Coronary calcium score, as determined by Angio CT multislice, has been proved to represent a reliable parameter which reflects the global cardiovascular risk. We aimed to study the characteristics of culprit lesions in Acute Coronary Syndrome (ACS) patients with low versus high calcium score.
Material and methods: A total of 45 patients with ACS underwent 64-slice CCTA. Group 1 – 19 patients with Ca score below 400HU, Group 2 – 26 patients with calcium score >400HU. In all patients a complex CT analysis of the culprit plaque was performed.
Results: There were no significant differences between the groups at baseline as regard to age, gender, cardiovascular risk factors (p>0.2). In patients with high calcium score, culprit lesions presented a significantly larger amount of plaque burden than in patients with low calcium score (82.8ml versus 131.81ml, p <0.0001). This was also true when assessing in a subanalysis different cut-off points for definition of relatively higher calcium score (89.66ml versus 137.93ml, p <0.0001, for calcium score cut off 600HU, 97.88ml versus 137.57ml, p<0.0001 for calcium score cut-off of 1000HU).
Conclusion: Our data shows that patients with high calcium score who develop an acute coronary syndrome present larger atheromatous plaque than those with low calcium scores, and theseverity of the culprit lesions correlates with global cardiovascular risk as expressed by a high calcium score.

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Evaluation of Anthropometric and Biochemical Status in Children with Nutritional Deficiency

Man Lidia1, Pitea Ana Maria1, Chinceșan Mihaela Ioana1, Man A2, Mărginean Oana1, Baghiu Maria Despina1

1 Pediatric Clinic I, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Microbiology, Laboratory Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2013-0067

Objective: To evaluate the anthropometric and biochemical status of children with nutritional deficiency.
Methods: We have conducted a prospective study on 226 children admitted in Pediatric Clinic I, divided into two groups: one group of 49 children with nutritional deficiency (body-mass-index < -2SD) and one control group (177 children). We have followed demographic data, anthropometric indices evaluated as standard deviations (weight, height, middle upper-arm circumference, tricipital skinfold), biochemical proteic status (Insulin-like Growth Factor 1 IGF-1, albumin, total proteins). We also followed parameters of general nutritional biochemistry.
Results: The mean age for underweight children was 5.8 years, lower than in the control group. The weight of the nutritional-deficient group was significantly lower than in the control group, unlike the height (p <0.001). We have also found significant differences in body-mass-index, middle upper-arm circumference and tricipital skinfold, all of them with low SDs in children with nutritional deficiency. Regarding the biochemical markers, we have found significantly higher values of transaminases (p <0.001) and lower IGF-1 (p = 0.02) and total proteins (p = 0.013) in nutritional-deficient group. Most IGF-1 values were in normal range in both groups, but with a higher percent of low values in nutritional deficient children (37.5% vs 14.2%, p = 0.0046). There were no significant differences in height, albumin, cholesterol, triglyceride and glucose levels between the two groups.
Conclusions: The anthropometric measurements are the most precise methods in evaluating the nutritional status. Among the studied biochemical markers, IGF-1, total proteins and transaminases are correlated with nutritional deficiencies.

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