Category Archives: Number

The Usefulness of White Light Endoscopy, Narrow Band Imaging, and Magnification for the Optimization of Diagnosis in Barrett’s Esophagus

Boeriu Alina1*, Brusnic Olga1, Onișor Danusia1, Pascarenco Ofelia1, Boeriu C2, Dobru Daniela1

1 Department of Gastroenterology, University of Medicine and Pharmacy Tirgu Mures, Romania
2 University of Medicine and Pharmacy Tirgu Mures, Tirgu Mures County Emergency Hospital, Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0002

The diagnosis of dysplasia and early neoplasia in Barrett’s esophagus by conventional endoscopy is based on a four- quadrant random biopsies protocol that is prone to sampling errors. Novel endoscopic techniques have been developed to enhance the detection of premalignant and malignant lesions by real time assessment of microvasculare architecture and mucosal structure. Chromoendoscopy with magnification has improved the visualization of lesions, but the dye application impairs a clear evaluation of vascular network. Narrow band imaging endoscopy enhances vascular imaging by using narrow bandwidth lights, with penetration to superficial mucosal structures. Different classification systems of mucosal and vascular patterns have been developed to improve the diagnostic accuracy of non-dysplastic and dysplastic BE, as well as of early esophageal cancer. This article is focused on both the clinical benefits and controversies surrounding conventional and advanced endoscopic methods used for screening and surveillance of patients with Barrett’s esophagus. Current evidence shows that the adoption of new technology in routine practice requires a high level of performance as well as the standardization of various classification systems.

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The inner representation of the external world – from conditioned reflexes to high level mental functions in the light of Nobel Prizes

Szilágyi T*, Orbán-Kis K

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

 

DOI: 10.1515/amma-2015-0001

In this paper the seminal results of the 2014 Nobel Prize in Physiology or Medicine Laureates are presented. First, a historical review of the development of our knowledge is provided along with the major paradigm shifts, by looking at the Nobel prizes awarded in the field of neuroscience in the last 110 years. We outline the major discoveries that were necessary for humankind to pass through the road leading to the remarkable understanding of high-level mental functions, which led to this year’s Nobel Prize award. Next, the ground breaking discoveries of this year Nobel laureates are presented, which provide insights how neural representations of the environment are formed in the association cortices. These cortical areas are many synapses away from sensory receptors and motor outputs, and their activity do not reflect directly the activation patterns of the receptor population, but depends more strongly on intrinsic cortical computations. We also present how ensembles of specialized cells work together to compute complex cognitive functions and behaviour.

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Luxury and necessity

Sanda-Maria Copotoiu

Editor-in-Chief

Weather is predictable with a certain margin of error. Despite the general predictions, certain meteorological events are necessary. Take for instance the snow. A Christmas without snow is unconceivable in our geographical region. However, as unpredictable as weather seems to be lately, we lived an unprecedented snowless Christmas. Without the joy of winter, we lived the Christmas through the carols. Music and poetry, the hope for redemption. They are a must, the very core and meaning of Christmas, but is it enough to actually get into the magic of Christmas!?
The falling snowflakes are associated with the protection of the nourishing earth. Vanishing beauty and frailty are mandatory for survival.
So do the authors of the articles we publish. They need to publish to fulfill their job positions. They depend on it. It becomes so vain and uncommon to publish for the sake of art. It is paramount also to publish in a well positioned medical journal, that is, bearing a high citation index. However, archiving this is quite a performance merely when the author is a beginner. He needs mentoring and coaching. Our mentors instead, have come to an age characterized by excellent clinical performance, but significantly less communication abilities, be them computer related. [More]

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Implantation of Biventricular Cardiac Devices Using a Double Venous Approach — An Alternative Implantation Technique

Şoşdean Raluca1,2, Pescariu S1,2, Enache B2, Macarie RI2, Marca Raluca2

1 “Victor Babeş” University of Medicine and Pharmacy, Timișoara, Romania
2 Institute of Cardiovascular Medicine, Timișoara, Romania

DOI: 10.2478/amma-2014-0013

Background: A standard technique regarding venous approach for implantation of biventricular cardiac electrical devices used for cardiac resynchronization therapy implementation has not yet been established. We analyzed the safety and efficiency of implanting these devices using a double venous approach (cephalic and subclavian) by comparing it with the simple approaches, in order to overcome some of their inconvenients.
Materials and methods: We retrospectively analyzed all 228 resynchronization patients implanted at the Timișoara Institute of Cardiovascular Medicine between January 1st, 2000 and January 1st, 2013. The 204 patients successfully implanted with biventricular pacemakers or defibrillators were divided according to the implantation techniques, and compared by complication rates and values of acute stimulation-detection thresholds. Group A featured a subclavian approach (48 patients), group B a cephalic approach (81 patients) and group C a double venous approach (76 patients).
Results: Adjusting for age, sex and device type there is no evidence in the data that complication rates are significantly different when using the different techniques: 6 complications (12.5%) in group A, 8 (9.87%) in group B and 5 (6.75%) in group C (p = 0.51). A slight downward trend was observed by using double venous approach. Values of acute stimulation-detection thresholds had no statistically significant differences neither (p = 0.36). Cephalic vein was of high quality in 59.8% of cases.
Conclusions: Subclavian and cephalic double venous approach implantation technique for biventricular devices proved to be feasible and at least as safe as single venous approach using subclavian or cephalic vein alone, and it can be used as a first resort technique.

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Facial Profile Characteristics Evaluation in a Population of Central Romania Region

Chibelean (Cires-Marginean) Manuela, Jurcă Anamaria, Bucur Sorana-Maria, Muica (Nagy-Bota) Monica-Cristina, Păcurar Mariana

Department of Paedodontics and Orthodontics, Faculty of Dentistry, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2014-0012

Objectives: The aim of the study was to evaluate the variables that define the facial profile of a sample of the population in the centre of Romania, and to compare male’s and female’s soft tissue profile. These values could be useful in elaborating the aesthetic objectives for treating the population in this area.
Material and methods: Fifty subjects were included in the study — patients and students of the University of Medicine and Pharmacy of Tîrgu Mureș (29 females and 21 males) between 18 to 28 years of age, having dental class I and a balanced profile. The photographs were taken in the natural head position (NHP). The anthropometric points were recorded and four of the angles that characterize a harmonious profile were traced and measured: the nasofrontal angle (G-N-Nd), the nasolabial angle (Cm-Sn-Ls), the mentolabial angle (Li-Sm-Pg), and the facial angle (G-Sn-Pg).
Results: The values obtained for the two sexes were compared using the t-student test. All angles had values that were larger for females (nasofrontal: females 137.1 degrees, males 135.79 degrees, p = 0.0019; nasolabial: females 105.3 degrees, males 102.19 degrees, p = 0.00002; mentolabial angle: females 126.07 degrees, males 118.27 degrees, p = 0.000009; facial angle: females 170.32 degrees, males 168.85 degrees, p = 0.0033).
Conclusions: Differences between the two sexes were obtained, all angles were statistically significant larger in females. These results show that for the population in the centre of Romania the treatment objectives are different for females and for males. The angular values range between those that characterize the Caucasian population.

 

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Short Segment Fixation Versus Short Segment Fixation With Pedicle Screws at the Fracture Level for Thoracolumbar Burst Fracture

Anghel S1, Márton D2

1 PhD Student, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Clinic of Orthopedics, County Emergency Clinical Hospital, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2014-0011

Objective: The most prevailing surgical procedure in the treatment of thoracolumbar burst fractures, Short Segment Fixation (SSF), is often followed by loss of correction or hardware failure which may be significant enough to require another surgical intervention. In order to take advantage of its benefits but to avoid or diminish the risk and impact of associated drawbacks, some other alternatives have been lately developed among which we refer to short segment fixation with intermediate screws (SSF+IS). This article provides a comparative picture over the effectiveness of the two above-mentioned surgical treatments, focusing on their potential to prevent the loss of correction.

Methods: After a systematic literature review over research papers published between 2000 and 2012, 14 articles which met the criteria were included in the meta-analysis. The relevant data extracted and compared for each subgroup of patients treated either with SSF or SSF+IS, were the weighted averages for the pre-operative, post-operative and last follow up kyphosis angles. We also considered common associated complications, operation time, and blood loss values for each surgical subgroups.
Results: The values for the loss of correction at the last follow-up were: 5.5° for SS and 7.4° for SSF+IS, which didn’t prove to be statistically different. With reference to other parameters, such as operation time, blood loss and correction attainment, the values did not present statistically significant differences, either. Regarding complications, we noticed that both SSF and SSF+IS display a similar incidence for hardware failure, screw breakages, superficial infections, deep venous thrombosis.
Conclusions: This paper concludes that, adding one or two screws at the fractured vertebra level (SSF+IS) does not bring forth a significant improvement compared to the traditional approach (SSF). Apparently, the blood loss depends mostly on the approach type (open or percutaneous) and less on the surgery type.

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The Importance of Identification of M-BCR-ABL Oncogene and JAK2V617F Mutation in Myeloproliferative Neoplasms

Szántó Annamária1,2, Pap Zsuzsanna2, Pávai Z2, Benedek I3, Köpeczi Judit Beáta1,3, Tunyogi Aliz-Beáta1,3, Horváth Emőke4, Lázár Benedek Erzsébet3

1 PhD Student, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Anatomy and Embriology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
3 Hematology and Bone Marrow Transplantation Unit, Tîrgu Mureș, Romania
4 Department of Pathology, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2014-0010

Background: The elucidation of the genetic background of the myeloproliferative neoplasms completely changed the management of these disorders: the presence of the Philadelphia chromosome and/or the BCR-ABL oncogene is pathognomonic for chronic myeloid leukemia and identification of JAK2 gene mutations are useful in polycytemia vera (PV), essential thrombocytemia (ET) and myelofibrosis (PMF). The aim of this study was to investigate the role of molecular biology tests in the management of myeloproliferative neoplasms.
Materials and methods: We tested the blood samples of 117 patients between April 2008 and February 2013 at the Molecular Biology of UMF Târgu Mureş using RQ-PCR (for M-BCR-ABL oncogene) and/or allele-specific PCR (for JAK2V617F mutation).
Results: Thirty-two patients presented the M-BCR-ABL oncogene, 16 of them were regularly tested as a follow-up of the administered therapy: the majority of chronic phase patients presented decreasing or stable values, while in case of accelerated phase and blast phase the M-BCR-ABL values increased or remained at the same level. Twenty patients were identified with the JAK2V617F mutation: 8 patients with PV, 4 with ET, 3 with PMF, 4 with unclassifiable chronic myeloproliferative disease and 1 patient with chronic myelomonocytic leukemia. There was no case of concomitant occurance of both molecular markers.
Conclusions: Molecular biology testing plays an important role in the management of myeloproliferative neoplasms: identification of the molecular markers confirms the final diagnosis, excluding secondary causes of abnormal blood count parameters. Regular monitoring of M-BCR-ABL expression level is useful in the follow-up of therapeutic efficiency.

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Combination of Ropivacaine and Lidocaine for Long Lasting Locoregional Anesthesia

Lazăr Alexandra, Szederjesi J, Copotoiu Ruxandra, Copotoiu Sanda-Maria, Azamfirei L

Department of Anesthesia and Intensive Care, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2014-0009

Objective: The aim of this study was to evaluate the clinical utility of Ropivacaine 0.5% and Lidocaine 0.5% anestethic combination in performing locoregional anesthesia, using either peripheral nerve stimulator or ultrasounds for brachial plexus block.
Study design: A prospective randomized clinical study was performed at the County Emergency Clinical Hospital of Tîrgu Mureș, between January and May 2013 on patients undergoing elective or emergency surgical interventions on upper limbs with locoregional anesthesia. Brachial plexus block with axillary approach was performed in 65 patients using randomly the nerve stimulator or the ultrasound guided technique. The parameters recorded were the duration of the anesthetic technique, the installation time and the length of anesthesia. All anesthetic incidents during and after anesthesia were observed as well. The recorded data were analyzed and statistically processed.
Results: We enrolled 40 (61.5%) patients for the nerve stimulation technique and 25 (38.5%) patients for ultrasound guidance. The quality of the block was acceptable, an inadequate anesthesia was reported in 9 patients (13.8%). The mean time of installation of anesthesia was 34.36 (± 11.56) minutes, time recorded from the initiation of the anesthetic technique until complete motor block. The mean duration of the motor block was 481.3 (± 128.6) minutes which represents over 8 hours. None of the patients required conversion of the anesthesia due to the extended period of the surgical intervention. One patient presented a mild allergic reaction to the anesthetic drugs.
Conclusion: Combination of the ropivacaine and lidocaine can be safely used for locoregional anesthesia, especially in those cases where long surgical intervention time is anticipated or in order to achieve a better postoperative analgesia.

 

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Assessment of Ventricular Dissynchrony in Right Ventricular Single Chamber Pacing using Echocardiografic Parameters

Mitre Adriana, Vita I, Dobreanu D

Clinic of Cardiology, County Emergency Clinical Hospital, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2014-0008

Background: Right ventricular apical pacing has been used since the early years of pace-makers, despite the fact that it determined nonphysiological ventricular depolarization. As medical technologies developed, septal lead implantation became feasible, in order to outrun the above mentioned inconveniences. The question whether the apical or septal lead position is better still gives rise to a lot of controversies. Different echocardiographic parameters are currently used to assess the impact of specific sites of stimulation on ventricular function. The aim of the study was to determine which of the followed synchronicity parameters varied significantly during apical stimulation, compared to septal stimulation in patients requiring single chamber pacing.
Material and method: Fifty-nine patients admitted between January 1st – December 31st 2012 either for battery replacement or for first implant of a single chamber pace-maker were included in this prospective study. Thirty-eight of them had the lead placed in the apex of the right ventricle and 21 on the interventricular septum. All were subjected to echocardiografic examination after device implantation. Measurements included complete chamber and valvular assessment, apart from the synchronicity evaluation, that comprised interventricular mechanical delay (IVMD), septal to posterior wall delay (SPWMD) and electro systolic delays (ESD), in order to assess the presence and compare the relevance of interventricular and intraventricular dissyncrony. All the investigations were in accordance with the Declaration of Helsinki.
Results: Although preejection times were significantly different, there were no statistically significant differences (p = 0.06) between the values of IVMD in the two groups, as well as regarding the longitudinal intraventricular dyssynchrony expressed by ESD. Significant differences appeared though, between the values of SPWMD, reflecting the fact that radial intraventricular dissyncrony is present in apical stimulation.
Conclusions: During apical right ventricular pacing, radial intraventricular dissyncrony appears, while in the case of septal pacing this parameter is close to normal. Surprisingly, although right ventricular pacing determines interventricular and longitudinal intraventricular dissincrony, we found no significant differences in this respect, between apical and septal pacing.

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Unsaturated Heteropolyoxotungstates with Platinum Cation Complexation

Grama Lavinia1, Muntean Daniela-Lucia2, Curticăpean A1

1 Department of General and Inorganic Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Analytical Chemistry and Drugs Analysis, Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2014-0007

 

Background: Polyanions are a special category of coordination compounds with a large development in last years. By coordination of metal oxoions at the lacunary polyoxometalates are obtained new compounds which are studied for theirs possible antitumoral and antiviral activities. The polyoxometalates can bind cations by oxygen atoms from their saturated surface structure or by embedding in vacant sites.
Material and method: The methods used for determining cation coordination with the unsaturated polyoxotungstate are spectrophotometry and conductometry. The solutions used in this study were: for ligand a solution of K27[KAsW40O140] and for cation a solution of K2[PtCl6].
The variation of electrical conductivity of ionic species found in solution, caused by their concentrations, decreases during the complex formation, which was determined by conductometry. The spectrophotometric assay was performed to verify ratios between cation:ligand combination, determined by conductometry.
Results: The graphical representations of conductivity function of number of moles of added titrant solutions emphasize that there are two types of coordination compounds with two different combination ratios ligand:cation at 1:2 or 1:4. The spectrophotometric determination performed, confirmed these ratios.
Conclusions: There are two types of coordination complexes, and the ligand:cation ratios are well known for encrypting polyoxotungstates type used in the study. Besides the main active position SC where K+ alkaline cation is coordinated, it has four active stand side S1–4, which can coordinate metal cations, depending on the size of their cationic radius and the electronic charge they hold.

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