Category Archives: Number

Development of a HPLC-UV Method for Determination of Meloxicam in Human Plasma and Pharmaceutical Dosage Forms

Csifo Enikő, Croitoru MD, Fülöp Ibolya, Muntean Daniela-Lucia

University of Medicine and Pharmacy of Tirgu Mures

DOI: 10.2478/amma-2014-0031

Objectives: A simple, quick and low cost HPLC-UV method for assay of meloxicam in plasma and pharmaceutical dosage forms was developed.
Methods: Separation and assay of meloxicam, using a simple reverse phase HPLC-UV method was achieved using an Agilent Zorbax SB C18 column, with methanol and 1% aqueous solution of glacial acetic acid as mobile phase. Elution was performed with composition gradient, meloxicam being detected at 355 nm with a 5 minutes analysis time. The method was tested on human plasma and pharmaceutical dosage forms.
Results: The retention time of the meloxicam was 3,7 minutes. Regression analysis showed good linearity, with correlation coefficient R= 0,9997; linear regression equation: y = 206,1x –77,5 over the 20-2000 ng/ml concentration range. Limit of detection was determined to be 5 ng/ml and limit of quantification was set at 15 ng/ml. The recovery of the analyte in human plasma was low: 30,50%, however it was reproducible, with a coefficient of variation of 4,83%. The analysis of the tablets resulted in a 85,82% of meloxicam compared to the declared concentration.
Conclusions: The method proposed is quick, simple and adequate for detecting the meloxicam in human plasma. Although the recovery rate was low, it was reproducible, which leads to the fact, that improving extraction procedure can optimize the method.

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New Perspectives in the Management of Aortic Intramural Hematoma – A Literature Review

Pal Kinga1, Rat Nora1, Ferent I1, Jako Beata2, Bajka B2, Benedek I2

1 County Emergency Clinical Hospital, Targu Mures, Clinic of Cardiology
2 University of Medicine and Pharmacy of Tîrgu Mures, Department M3, Discipline of Internal Medicine 6 – Clinic of Cardiology

DOI: 10.2478/amma-2014-0038

Aortic intramural hematoma frequently appear in elderly hypertensive patients who suffered a vasa vasorum rupture into the media, presenting clinical symptoms similar to aortic dissection. The current available data suggest a similar treatment strategy as in aortic dissection, although intramural hematoma is a different pathophysiological entity. The issue of the vulnerable contact of the intraaortic plaque, which is prone to rupture and to trigger the formation of an intramural hematoma, has not been elucidated so far. We present a brief literature review regarding complex plaque analysis, which opens a new area in identification of vulnerable patients with intramural hematoma, important for management of these patients and optimization of their treatment in order to avoid complications.

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Evidence-based medicine

Ario Santini

Edinburgh Dental Institute, The University of Edinburgh

Evidence-based medicine can be defined as the well-conceived and beneficial use of current research knowledge in making decisions concerning patient care.  The concept of evidence-based medicine has two fundamental principles, it is based on best available research studies and the subsequent transfer of their results to use in practice.  It follows that an evidence-based approach has several advantages. Patients are better served because only tested procedures will be endorsed. The standing of the profession will be enhanced because only proven treatments will be offered.
Evidence hierarchies classify the importance and robustness of diverse types of biomedical research. There is no universally accepted hierarchy of evidence, though there is broad agreement on the relative strength of the principal types of research, or epidemiological studies. Randomized controlled trials (RCTs) rank above observational studies, while expert opinion and anecdotal experience are ranked at the bottom. Nonetheless, RCTs are not always the ‘ideal’ way of conducting clinical research. The “ladder of evidence” was developed, to a large extent, for questions related to interventions or therapies. For questions related to the cause, diagnosis or prognosis of a disease, cohort studies or case-control studies will often be more appropriate. It is useful to think of the various study designs, not as a hierarchy but as categories of evidence which will allow the strongest possible, practical and ethical study-design to be chosen.[More]

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Cephalic Duodeno-Pancreatectomy With Pancreatic-Gastric Anastomosis With Double Purse String, in Patient with Lithiasis and Tumoral Jaundice – Case Report

Tudor A, Molnar C, Nicolescu C, Rosca C, Tudor Bianca, Butiurca VO, Copotoiu C

University of Medicine and Pharmacy Tirgu-Mures

DOI: 10.2478/amma-2014-0047

Introduction: One of the most feared complications after cephalic duodeno-pancreatectomy remains pancreatic fistula. In recent years, various methods of pancreatico-digestive reconstruction were performed in order to reduce the rate of pancreatic fistula. One of these methods is pancreatico-gastric reconstruction by using two purse string threads.
Case report: We present in this article a patient with jaundice with mixed etiology: tumoral and lithiasic. Subjectively, the patient accused sclerose-skin-jaundice, right upper quadrant and epigastric pain, nausea and vomiting. Computed tomography revealed dilatation of intra- and extrahepatic bile ducts, a dilated Wirsung duct and a tumor at the biliopancreatic confluence, leading to a suspicion of vaterian ampulom. Upper endoscopy revealed a tumor protruding in the descending duodenal segment. Intraoperatively a tumor suggestive of vaterian ampulom and duct stones was shown. Surgical treatment consisted of coledocolitotomy, cephalic duodeno-pancreatectomy with pancreatic-gastric anastomosis, performed by using two purse string threads. The postoperative evolution was favorable.
Conclusion: Pancreatico-gastric anastomosis using two purse string threads is a simple, safe and quick procedure, avoiding the application of sutures through the pancreatic parenchyma and thus reducing the rate of pancreatic fistula.

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Surgical treatment of anogenital hemangiomas of infancy

Bulea Raluca1,2, Enescu DM1,2, Giuvelea Steluţa2, Stoicescu Simona1,2, Alexandru Raluca2, Ioniţă D2

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

DOI: 10.2478/amma-2014-0046

Introduction Infantile hemangiomas (IHs) are the most common benign tumors of the soft tissue in infants and children and they often represent a serious challenge for the treating physician. Hemangiomas located in the anogenital region represent only about 1% of all IHs, but raise special concerns as they have the propensity to ulcerate. This condition may appear spontaneously, or could result from therapeutic procedures. Ulceration is extremely painful and takes many weeks of conservative therapy to heal.
Material and Methods. The aim of this study is to present the surgical approach of the IHs located in the anogenital area and the outcomes of this treatment option.
Results. During a period of 36 months, 11 children (nine girls, two boys) were referred to our plastic surgery department with hemangiomas involving the anogenital, groin and perineum areas. The average follow-up period was of 8 months, during which 82% of cases experienced complications, especially ulceration. All the target hemangiomas were removed through a lenticular excision and the wound closed with a linear suture.
Conclusions. Our study has shown that surgical excision of a complicated anogenital hemangioma or of a “healthy” hemangioma at high risk for ulceration in the anogenital region is an effective treatment, with fast healing and complete resolution of the pathogenic condition. Lenticular excision and linear closure represent a convenient surgical technique that can be performed as early surgery, during the proliferative stage, or at any time later, when the patient needs treatment, in safety conditions and with good results.

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Anatomical and Surgical Basis for Adult Living Donor Liver Transplantation with the Right Liver Lobe

Borz C, Marian D, Bara T Jr, Jimborean O, Bara T, Márton D

Surgical Clinic 2, County Emergency Clinical hospital, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2014-0028

Liver transplantation is now a standard procedure for the treatment of end stage liver diseases. Since 1968 until 2012, a number of 113,627 liver transplantations were performed in Europe, in 28 countries and 153 institutions. Despite these impressive figures the waiting list is growing every year. Transplant surgeons were preoccupied to find new ways to increase the donor pool. Among them: reduced size liver transplantation, split liver technique and more recently living donor liver transplantation. At first in the early `90, living donor liver transplantation was used for pediatric patients because the left lateral hepatic segments were harvested. This graft is too small for the metabolic demands of an adult patient. So the next step was the harvesting of the right liver lobe from the donor and transplantation to adult patients. Living donor liver transplantation has gained fast a wide acceptance but there are a few issues to discuss. The main concern is about the donor safety which is a healthy person undergoing major surgery with potential risks. Also the surgical technique evolved due to a better understanding of the anatomy and physiology of the liver and the right liver graft. We discuss here the anatomical and surgical basis for living donor liver transplantation with the right liver lobe.

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Meyer’s Loop Anatomy Demonstrated Using Diffusion Tensor MR Imaging and Fiber Tractography at 3T

Goga Cristina1,2,3, Firat Zeynep2, Brinzaniuc Klara1, Florian IS3

1 University of Medicine and Pharmacy Tirgu Mures, Tirgu Mures, Romania, Department of Anatomy
2 Yeditepe University School of Medicine, Istanbul, Turkey, Department of Neurosurgery
3 Cluj County Emergency Hospital, Cluj Napoca, Romania, Department of Neurosurgery

DOI: 10.2478/amma-2014-0045

Objective: The ultimate anatomy of the Meyer’s loop continues to elude us. Diffusion tensor imaging (DTI) and diffusion tensor tractography (DTT) may be able to demonstrate, in vivo, the anatomy of the complex network of white matter fibers surrounding the Meyer’s loop and the optic radiations. This study aims at exploring the anatomy of the Meyer’s loop by using DTI and fiber tractography.
Methods: Ten healthy subjects underwent magnetic resonance imaging (MRI) with DTI at 3 T. Using a region-of-interest (ROI) based diffusion tensor imaging and fiber tracking software (Release 2.6, Achieva, Philips), sequential ROI were placed to reconstruct visual fibers and neighboring projection fibers involved in the formation of Meyer’s loop. The 3-dimensional (3D) reconstructed fibers were visualized by superimposition on 3-planar MRI brain images to enhance their precise anatomical localization and relationship with other anatomical structures.
Results: Several projection fiber including the optic radiation, occipitopontine/parietopontine fibers and posterior thalamic peduncle participated in the formation of Meyer’s loop. Two patterns of angulation of the Meyer’s loop were found.
Conclusions: DTI with DTT provides a complimentary, in vivo, method to study the details of the anatomy of the Meyer’s loop.

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Fanconi Anemia — Case Report of Rare Aplastic Anemia at Child

Deaconu Alina1, Vodă Daniela2, Bulucea D3

1 Children Hospital of Braşov, Romania
2 Department of Medical and Surgical Specialties, Faculty of Medicine, Transilvania University, Braşov, Romania
3 Faculty of Medicine, University Medicine and Pharmacy, Craiova, Romania

DOI: 10.2478/amma-2014-0027

Introduction: Fanconi anemia is an autosomal recessive disease characterized by congenital abnormalities, defective haematopoiesis, and a high risk of developing acute myeloid leukaemia, myelodysplastic syndrome and cancers. FA was first described in 1927 by the Swiss pediatrician Guido Fanconi. The diagnosis is based on morphological abnormalities, hematologic abnormalities (pancytopenia, macrocytic anemia and progressive bone marrow failure) and genetic tests (cariograma).
Case report: We present the case of a child with Fanconi anemia. Although skin and bone morphological abnormalities were present from birth, diagnosis was suspected at 11 years old.
Conclusions: Fanconi anemia is a heterogeneous condition that can present a variety of congenital defects but invariably results in defective haemopoiesis, which is the major cause of morbidity and mortality.

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The Oscar Ramirez Procedure, a Solution for Treating Incisional Hernias with Big Abdominal Wall Defect

Gherghinescu M, Popa D, Panțiru A, Russu C, Roșca C, Benedek Orsolya, Copotoiu C

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

DOI: 10.2478/amma-2014-0026

Background: Incisional hernias are important complications of abdominal surgery. Normally they are followed by the growth of the hernia sac and an increase of the abdominal wall defect with loss of domain of the herniated organs.
Case report: We report a case of a 51 year old female, admitted in the 1st Surgical Clinic of the County Emergency Clinical Hospital of Tîrgu Mureș with a large median reducible incisional hernia and a wall defect of 10/12 cm. The abdominoplasty was performed using the Oscar Ramirez technique, which consists of a longitudinal incision along the aponeurosis of the external oblique muscle, at approximately 1–2 cm from the external edge of the rectus abdominis. This procedure allows the abdominal wall closure. This case is part of a lot of 4 patients who received this treatment using the aforementioned procedure in the past 2 months. Postoperative recovery was favorable, bowel movements were present on the second day after the surgery, the subcutaneous drains were shortened on the fifth day and removed on the sixth. There were no immediate postoperative complications or up to a month after the surgery. The patient was discharged on the seventh day.
Conclusions: This technique can be used alone in case of large abdominal wall defects, or prequeling an on-lay mesh procedure addressed to a weak abdominal wall, case in which the functional result is superior to a substitutional mesh.

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Risk Factors and Diagnosis of Cerebral Venous Thrombosis: Data From a Cohort of 45 Romanian Patients

Bălaşa Rodica1, Daboczi M1, Costache Oana1, Maier Smaranda1, Bajko Z1, Moțățaianu Anca1, Bălașa A2

1 First Neurological Clinic, Regional MS Centre, University Emergency County Hospital, Târgu Mureş, University of Medicine and Pharmacy Târgu Mureș, România
2 Neurosurgery Department, University Emergency County Hospital Târgu Mureş, România

DOI: 10.2478/amma-2014-0044

Cerebral venous thrombosis (CVT) represents 1% of the total stroke pathology but is a real challenge both regarding the diagnosis and the treatment.
Objective: Evaluate different etiological, demographical, clinical, imaging and therapeutic aspects of CVT.
Material: Prospective study during 4 years. From the total 3658 patients hospitalized with acute stroke, 45 (1.23%) had CVT. For each patient, were recorded: demographic data, symptom of onset, type of onset, daily habits, medical history, neurological examination, brain imaging (CT and MRI with venography). Statistical analysis: data are presented as mean and SD and Student t test was applied.
Results: Mean age was 44.07± 23,12 years; female: male ratio 2.21:1. The most frequent type of onset was acute (77.78%). Headache was found in 80% of cases as initial symptom, followed by neurological focal deficits. As risk factors, thrombophilia was found most often (59.5%), followed by local infections. No risk factors were found in 17.8% of cases. The brain imaging was positive in 29 patients. In 16 cases, the imaging workout was negative and the diagnosis consisted of clinical criteria, risk factors, response to heparin treatment.
Conclusions: CVT is a rare pathology that affects mainly young women and that needs a complex diagnostic evaluation. The patient prototype diagnosed with CVT in our region: female of 44 years old, with an intense acute headache, with MRI showing direct signs of transverse sinus thrombosis, with a thrombophilic state and good response to anticoagulants. Brain MRI is the imaging investigation required but clinical aspects play a decisive role.

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