Category Archives: Number

Left Bisegmentectomy for Liver Cirrhosis Associated Primary Hepatic Carcinoma With Preoperative Chemoembolization

Molnar C*, Silaghi C, Rosca C, Marginean L, Butiurca VO, Tudor A, Copotoiu C

University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0009

Introduction: Hepatocellular carcinoma is the most frequent primary malignant tumor of the liver, being linked in 80% of cases with viral hepatitis ”B” or “C”. Treatment remains a challenge especially in cases with associated hepatic cirrhosis, where preoperative arterial chemoembolization followed by liver resection is recommended.
Case report: We discuss the case of a 64 years old cirrhotic patient, diagnosed by echography, computed tomography, magnetic resonance cholangiography with hepatocellular carcinoma (64x52x46 mm). Preoperative chemoembolization was performed with Lipiodol and 5-FU by supra-selective catheterization of left hepatic artery, followed by favorable radiologic response. Two weeks after embolization, the patient was admitted in Surgical Clinic No. 1 Targu Mures where an atypical resection of the left hepatic lobe (bisegmentectomy II-III) was performed with Harmonic Scalpel. Early and late postoperative evolution was favorable.
Discussions: The principle of arterial chemoembolization is based on the fact that vasculature of primary hepatic tumors is predominantly arterial. Arterial obstruction may lead to ischemic necrosis while tumor embolization combination with a chemotherapeutic agent significantly improves its local concentration. Decrease in tumor size and its vasculature allows for safe hepatic resection especially in the cirrhotic liver.
Conclusion: In case of tumoral cirrhotic liver preoperative chemoembolization decreases intra and postoperative bleeding risk, providing a safe and oncological resection.

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Current Surgical Attitude Towards Hydatid Liver Disease – Experience of Ist Surgical Department of the Emergency Hospital of Craiova

Cirju B1, Patrascu St1, Margaritescu D2, Nemes R2, Georgescu I2

1 1st Clinic of Surgery, Emergency County Hospital, Craiova, Romania
2 Department of Surgery, University of Medicine and Pharmacy, Craiova, Romania

DOI: 10.2478/amma-2014-0016

Introduction: The aim of this study is the evaluation of the diagnostic and therapeutic strategy in liver hydatid disease.
Methods: We analyzed 97 cases of liver hydatid cyst (63 females/34 males, aged between 5 and 85 years) hospitalized in the Ist Surgical Department of the Emergency County Hospital of Craiova between 2000 and 2012. The diagnosis was established clinically, by laboratory and imaging tests.
Results: The hydatid cysts were unilocular in 60 cases, the majority (68.31%) being located on the right liver, multilocular in 39 cases, located on both lobes of the liver (9.9%); 17 patients had other locations of the cysts as well (spleen 5 cases, peritoneum 12 cases). Fourty-five (46.39%) cases were uncomplicated and the other 52 cases presented one ore more evolutionary complications: biliary – 44 (43.36%), infection – 15 (14.85%), rupture into peritoneum – 12 cases and bilio-bronchial fistula in 1 case. All patients were operated: 90 patients by open surgery and 7 by laparoscopic approach. Albendazole was administered as prophylaxis of postoperative recurrence. In 73 cases (72.27%) the evolution was favorable. We recorded 26 cases (25.74%) of postoperative complications: infectious – 9 cases, external biliary fistula – 12 cases and general complications in 6 cases. The overall postoperative mortality was 2.06%. We did not register any postoperative complication in the laparoscopic group.
Conclusions: Laparoscopic approach is both safe and feasible, with well codified indications. The most important factor to achieve a successful laparoscopic procedure is the adequate selection of patients. Both intraoperative and postoperative data clearly indicated that the minimal invasive approach provided superior results to open access surgery in terms of complications rate, early recovery and hospital stay.

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Diagnostic and Prognostic Particularities of the Implications of the Presence of Tumor Necrosis Factor Alpha in Patients with Periodontal Disease

Yero Ieremie Lia Maria, Lazăr Luminița*, Ciurba Adriana

University of Medicine and Pharmacy of Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0008

Periodontal disease can have significant effects by increasing the circulating levels of TNF-α, therefore its prevention and treatment is important in maintaining the overall health of the body. Objective: The aim of our research was to assess the differences in the salivary concentration of TNF-α between patients with periodontal disease and those free of the disease and to studz whether it can represent an indicator of the evolution of periodontal disease. We also aimed to assess the practical applicability of the method for the determination of this cytokine in the saliva.
Materials and methods: Our study included two groups of subjects, the first group consisting in patients diagnosed with periodontal disease, while the control group included subjects free of periodontal disease. TNF-α concentration was determined with the ELISA test for human TNF-α and the results were expressed in pg/ mL. The data were statistically processed with GraphPad software and the statistical nonparametric Mann-Whitney test was applied.
Results: We observe nearly double values of the TNF-α salivary level in the group of patients suffering from periodontal disease compared to the subjects free of periodontal disease, which allows us to notice that saliva analysis is a useful and safely enough method for the diagnosis and follow-up in the development of periodontal disease.
Conclusion: The salivary level of TNF-α in patients with periodontal disease is not only an indicator of periodontal disease progression, but also a reflection of the pathogen potential that periodontal disease may have on the overall health of the body.

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Limitations When Use Chloramphenicol-b-Cyclodextrins Complexes in Ophtalmic Solutions Buffered with Boric Acid/Borax System

Todoran Nicoleta, Ciurba Adriana*, Rédai Emőke, Ion V, Lazăr Luminița, Sipos Emese

University of Medicine and Pharmacy of Tirgu Mures

DOI: 10.1515/amma-2015-0007

Chloramphenicol eye drops are commonly prescribed in concentrations of 0.5-1% in the treatment of infectious conjunctivitis. In terms of ophthalmic solution preparation, the major disadvantage of chloramphenicol consists in its low solubility in water. The solubility is increased by substances that form chloramphenicol-complexes, for example: boric acid/borax or cyclodextrins.
Objective: Experimental studies aimed to evaluate the potential advantages of enhancing the solubility and stability of chloramphenicol (API) by molecular encapsulation in b-cyclodextrin (CD), in formulation of ophthalmic solutions buffered with boric acid/borax system.
Methods and Results: We prepared four API-b-CD complexes, using two methods (kneading and co-precipitation) and two molar ratio of API/b-cyclodextrin (1:1 and 1:2). The formation of complexes was proved by differential scanning calorimetry (DSC) and the in vitro dissolution tests. Using these compounds, we prepared eight ophthalmic solutions, formulated in two variants of chloramphenicol concentrations (0.4% and 0.5%). Each solution was analyzed, by the official methods, at preparation and periodically during three months of storing in different temperature conditions (4°C, 20°C and 30°C).
Conclusions: Inclusion of chloramphenicol in b-cyclodextrin only partially solves the difficulties due to the low solubility of chloramphenicol. The protection of chloramphenicol molecules is not completely ensured when the ophthalmic solutions are buffered with the boric acid/borax system.

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Clinical Evaluation of Periodontal Health During Orthodontic Treatment with Fixed Appliances

Hănțoiu T*, Monea Adriana, Lazăr Luminița, Hănțoiu Liana

University of Medicine and Pharmacy of Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0006

Objectives: Fixed orthodontic appliances make daily application of oral hygiene standard procedures more difficult and in time may lead to accumulation of oral biofilms and development of gingivitis and hyperplasia. The aim of the study is to evaluate the periodontal health expressed by clinical indices in patients under orthodontic treatment with fixed appliances, according to different oral hygene maintenance programs.
Material and method: We performed a randomized prospective study on 60 patients with fixed orthodontic appliances (17-25 years of age) devided in three study groups. The clnical indices recorded were: modified gingival index, plaque index and sulcular bleeding index. Statistical analysis or the results were carried out using Student t test.
Results: The patients were randomly divided into three groups: group A-patients were instructed to use electric brush, water flosser and interdental brush, group B- electric brush, interdental brush and fluoride and group C- manual brushing and fluoride. Statistical comparison of the values of the indexes with the Student t test for independent samples showed statistically significant differences in all three groups of patients studied between initial and final values of all recorded clinical parameters.
Conclusions: Fixed orthodontics do not induce periodontal disease if basic principles of oral hygiene are followed in compliant patients, which are correctly instructed to deal with real challenge, represented by complete elimination of debris and bacterial accumulation.

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Botanical Investigation Of Fallopia Dumetorum (L.) Holub (Polygonaceae) And Qualitative And Quantitative Assessment Of Its Polyphenolic Compounds

Olaru OT1, Ancuceanu RV1, Anghel Adriana Iuliana1, Dinu Mihaela1, Seremet Oana Cristina2, Istudor Viorica3

1 Department of Pharmaceutical Botany and Cellular Biology, ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
2 Department of Pharmacology and Clinical Pharmacy, ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
3 Department of Pharmacognosy, Phytochemistry and Phytotherapy, ”Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania

DOI: 10.2478/amma-2014-0015

Background: Considering the continuous need to find new sources of polyphenolic compounds, we performed a pharmacognostical examination of the species Fallopia dumetorum (L.) Holub sin. Polygonum dumetorum L. (Polygonaceae). The plant is common in the plain regions of Romania and has not been exploited therapeutically.
Materials and method: Microscopic examination was performed on cross-sections, surface preparations and on powder obtained from the aerial parts of the flowering plant. Qualitative chemical analysis was realized by phytochemical screening and thin layer chromatography (TLC). Phenolic compounds were assayed by spectrophotometric methods: flavonoids expressed as rutin (with aluminium chloride), phenol-carboxylic acids expressed as chlorogenic acid (Arnow’s method) and proanthocyanidins expressed as cyanidin chloride (in acidic medium, by conversion to anthocyanins).
Results: The species has the following microscopic characters: anomocytic stomata, druses of calcium oxalate, sessile, pluricellular glandular hairs and pollen grains with smooth exine. Polysaccharides, reducing compounds, coumarins, sterols/triterpenes, phenol-carboxylic acids, flavones, proanthocyanidins, tannins and carotenoids were identified by phytochemical screening; chlorogenic acid, caffeic acid, quercetin and stigmasterol/beta-sitosterol were detected by TLC. F. dumetori herba has a content of 1.49 ± 0.105 g% polyphenol-carboxylic acids, 0.40 ± 0.087g% flavonoids and 0.18 ± 0.002 g% proanthocyanidins.
Conclusions: We have characterized pharmacognostically the native species F. dumentorum. Due to its content in phenolic compounds it might serve as a source of polyphenols.

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Experimental Research on the Interactions Between some Anxiolytics and Dietary Sodium Monoglutamate

Buzescu Anca, Cristea Nicoleta Aurelia*, Chiriac Alexandra, Chiriță C

University of Medicine and Pharmacy ”Carol Davila”, Bucharest, România

 

DOI: 10.1515/amma-2015-0005

Objectives: Monosodium glutamate, the salt of glutamic acid, is largely used as a flavour enhancer (E621). In this study, we determine if monosodium glutamate, after repeated oral administration, can induce any degree of anxiety. Taking into account the interdependence between glutamate and GABA neurotransmissions, we studied the possible interactions of monosodium glutamate with some representatives belonging to benzodiazepines therapeutical class, diazepam and alprazolam, used as first line therapy for the treatment of anxiety.
Methods: For determining the degree of anxiety, the specific cross-labyrinth test was used. The medium time spent in the closed-arms of the cross-labyrinth is correlated with increased anxiety and the medium time spent in the opened arms is correlated with a low degree anxiety. NMRI adult mice received 300 mg/kg monosodium glutamate for 21 days, dose representing 1/50 from mice LD50 (15000mg/kg) and twice the maximum admitted dose/ day for human.
Results: When compared to control group, the group receiving monosodium glutamate, showed a not statistically significant slight increase in the degree of anxiety. The groups receiving benzodiazepines presented a significant reduction of the degree of anxiety, proving their anxiolytic effect. The groups receiving glutamate and diazepam or alprazolam, showed a lower reduction of the degree of anxiety, than group receiving only benzodiazepines, phenomenon which proves an antagonism between glutamate and the anxiolytics used in this study.
Conclusions: The oral administration of monosodium glutamate increases slightly, not statistically significant, the degree of anxiety in mice and significantly alters the response to the benzodiazepines therapy, reducing the effect for both alprazolam and diazepam.

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Improved Cardiac Protection with Sabax Cardioplegia in Langendorff Isolated Rat Hearts

Perian M1*, Mărginean M1, Dobreanu D1,2, Scridon Alina1

1 Physiology Department, University of Medicine and Pharmacy of Tîrgu Mureș, Romania
2 Adults Cardiology Department (I), Emergency Institute for Cardiovascular Diseases and Transplantation Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0004

Objective: Cardioplegia is an important step to facilitate cardiac surgery while limiting intraoperative myocardial injury. Although recent advances in cardioplegic arrest methods have significantly contributed to better postoperative outcomes, there is still controversy regarding the optimal composition and temperature of the cardioplegic solution. Accordingly, we aimed to assess whether cold or lukewarm Sabax cardioplegia offer improved myocardial protection compared with the classical Krebs-Henseleit solution.
Methods: The hearts of 40 male Wistar rats were isolated and submitted to constant-flow retrograde perfusion using a Langendorff perfusion apparatus. The hearts were randomly assigned to cold Krebs-Henseleit (K-H), cold Sabax, or lukewarm Sabax cardioplegia. The ECG, heart rates, and left ventricular systolic pressures (LVSP) were recorded pre- and post-cardioplegia. The time needed for cardioplegia induction and post-cardioplegia recovery were also noted.
Results: Both cold and lukewarm Sabax cardioplegia insured faster induction and faster recovery following isothermic reperfusion compared to the standard K-H solution (both p< 0.01). With K-H cardioplegia, the hearts presented a 21.7% force loss after reperfusion (p< 0.001), whilst Sabax cardioplegia was associated with a slight increase in ventricular mechanical activity (3% LVSP increase with lukewarm Sabax cardioplegia, p< 0.001 and 2% LVSP increase with cold Sabax cardioplegia, p = 0.02). With Sabax cardioplegia the hearts displayed considerably less major arrhythmic events and presented less significant bradycardia.
Conclusions: The present data suggest that Sabax cardioplegia may be superior to the classical cold crystalloid K-H solution in preserving mechanical activity of the heart and may provide superior protection against major arrhythmias.

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Cortical Epileptogenesis of Slowly Kindled Freely Moving Rats

Orbán-Kis K*, Száva Iringó, Szilágyi T

Department of Physiology, University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0003

Objective. Epilepsy is a neurological disorder that can be caused by many underlying pathologies. The epileptic and interictal manifestations that appear during the progression of chronic epilepsy are still not understood completely. One of the most frequent forms of this disease is temporal lobe epilepsy in which is clear involvement of the hippocampal formation. In order to study the electrografic progression of untreated seizures we used amygdala kindling in freely moving rats.
Methods. Seven animals were implanted with bilateral hippocampal and prefrontal electrodes. A bipolar electrode, implanted in the lateral nuclei of the left amygdala was used for stimulation. The kindled group of animals was stimulated daily with the minimum current intensity needed to reach the afterdischarge threshold. Behavioral changes during kindling were scored according to the Racine scale.
Results. The average seizure severity on the Racine scale was 2.6±0.4 by day 6 and 4.4±0.6 by day 20. The first spontaneous seizures appeared after 31 days of stimulation. During spontaneous seizures the preictal spike full width at half maximum increased gradually from 51±4msec to 110±5msec (p < 0.05) whereas the amplitude of the negative field potential deflection increased by 62% (p < 0.05).
|Conclusions. Our study showed that the progression of temporal lobe epilepsy, as seen in humans, can be reproduced in the kindling model with high fidelity. This study confirms in vivo the increase in preictal spike duration as well as the increase of the amplitude of negative field potential deflection during the preictal period.

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Augmentation Strategies for Patients with Major Depressive Disorder with an Inadequate Response to Antidepressant Monotherapy

Moica Th1, Gabos Grecu I1,2, Gabos Grecu Marieta1,2, Ferencz Melinda1,2, Buicu Elena Gabriela2,3, Sălcudean Andreea2, Gabos Grecu C1,2

1 Clinic of Psychiatry I, Tîrgu Mureș, Romania
2 University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Mental Health Center, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2014-0014

Introduction: Major depressive disorder is a chronic and debilitating disease characterized by a wide range of emotional and physical symptoms that coexist during a depressive episode and may reoccur at some point during the progression of the disease for the majority of patients. The purpose of the study was to investigate psychiatrists’ experience regarding the response to antidepressive treatment and their options regarding augmentation strategies in depression with incomplete response to antidepressant monotherapy.
Method: We applied an 18-item questionnaire containing multiple choice questions to adult psychiatrists working in ambulatories, hospitals or mental health centers.
Results: Fourty-two psychiatrists have agreed to answer the questionnaire. The majority of them were psychiatry specialists, between 35 and 49 years of age, working in an outpatient unit. For the majority of doctors, SSRIs (Serotonin Reuptake Inhibitors) proved to be the first line treatment both for the first depressive episode and for recurrent depression, followed by SNRI (Serotonin and Noradrenalin Reuptake Inhibitors). Regarding the duration of maintenance treatment for the patients who achieved complete remission after the first episode of depression, the results showed a wide spectrum from 4 to 9 months.
Conclusions: Incomplete response to antidepressive monotherapy is very frequent both for the first depressive episode and for recurrent depression. Given the pharmacological profile that some atypical antipsychotic have, augmentation with atypical antipsychotics in patients with inadequate response to antidepressant monotherapy is a useful therapeutic strategy that should be considered.

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