Volume 60, Number 1, 2014
Keywords:
Category Archives: Number
Surgical Management of Renal Hyperparathyroidism: Case Series and Review of the Literature
DOI: 10.1515/amma-2015-0083
Secondary hyperparathyroidism (sHPT) occurs most commonly in the setting of chronic renal failure (CRF) being frequently referred to as “renal” hyperparathyroidism The “classical” medical treatment with oral calcium and vitamin D supplementation is generally sufficient to lower parathyroid hormone levels in the majority of these patients. However, we frequently encounter cases of severe refractory sHPT, a state in which even recently available therapeutic agents, i.e. calcimimetics, new phosphate binders, vitamin D analogues, remain inefficient, thus parathyroidectomy and/ or renal transplant becoming necessary. Three types of surgeries have been proposed in sHPT: two of them are grouped as remnant-conserving techniques, i.e. subtotal parathyroidectomy (sPtx) and total parathyroidectomy with autotransplantation (tPtx+AT), the third one being total parathyroidectomy without autotransplantation (tPtx). There was a continuous debate concerning the best surgical approach in renal hyperparathyroidism, starting very soon after those techniques were described; without pretending to solve these controversies, this paper aims to review the surgical treatment options in sHPT, based on our 5-year experience in dealing with the disease.
Keywords: renal hyperparathyroidism, subtotal parathyroidectomy, total parathyroidectomy with autotransplant
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The Monitoring of Immunosuppressive Therapy with Tacrolimus in Patients with Kidney Transplant, Based on the Pharmacokinetic Criteria
DOI: 10.1515/amma-2015-0082
Background: Therapeutic drug monitoring (TDM) in patients with Chronic Kidney Disease (CKD) with kidney transplant, represents a major post transplant concern due to the characteristics of this special category of patients, particularities which can generate changes of the pharmacokinetic profile of the administered medication.
Material and methods: The current study is a retrospective pharmacokinetic study, over a period of 50 months, including a group of 36 kidney transplanted patients with CKD. Tacrolimus blood concentration was determined by a validated high-performance liquid chromatography method (HPLC), at a 12 hour time interval from the last administration of the immunosuppressive medication and before the following dose (Residual concentration, Cmin(trough)).
Results: During the monitoring of therapy, based on the pharmacokinetic criteria, 252 measurements of blood concentration were determined, 58 of these being outside the therapeutic window.
Conclusions: The results obtained show that it is mandatory to continue to monitor closely medical therapy based on the pharmacokinetic criteria in view of improving drug administration. The other ways of monitoring therapy: the clinical and biochemical criteria should not be overlooked. In addition, the interindividual variability of patients should be considered, as well as drug interaction which can alter the pharmacokinetics of tacrolimus.
Keywords: chronic kidney disease, therapeutic drug monitoring, high performance liquid chromatography, pharmacokinetics
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Imaging Findings of Bisphosphonates-Associated Osteonecrosis of Jaw: Literature Review and Report of 3 Cases
DOI: 10.1515/amma-2015-0081
Purpose: The present study aims radiological aspects of the occurrence of osteonecrosis of the jaw age groups both in receiving i.v bisphosphonates tratment Imaging assessment of bisphosphonates therapy-induced osteonecrosis of the jaw it is important to differentiate neoplastic invasion, osteomyelitis, osteoradionecrosis induced by radiation or bone related pathology of general diseases.
Material and method: We conducted a retrospective clinical study including 22 patients (8 men and 14 women) with various stages of osteonecrosis of the jaw.
Results: Radiological examinations using CBCT are required in all therapeutic approach of osteonecrosis of jaw cases providing accurate informations of position, dimension and the link with anatomical structures.Our study showed that the prevalence of osteonecrosis of mandibular growth is higher in women than in men and the risk of osteonecrosis of the jaw in appearance is depending on age factor witch occurs more often between age 52-59 and 73-80 years old.
Conclusion: The multitude of complications due to treatment with bisphosphonates bind to an early and specialized therapeutic approach. Radiological examinations is a first choice in the detection and early diagnosis of osteonecrosis of the jaw, patients requiring a permanent supervision by the physician and dentist.
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Prevalence of Physiological, Pathological and Behavioral Risk Factors in Patients Treated with Antidiabetic Sulfonylureas
DOI: 10.1515/amma-2015-0080
Diabetes mellitus is an important public health problem because of its increased incidence and its devastating complications. In addition to this, it was observed an increase in prevalence for diabetes risk factors. The aim of this study was to evaluate the frequency of the pathophysiological and behavioral risk factors among patients treated with oral hypoglycemic sulfonylureas.
Material and methods: It were analyzed the observation sheets of 200 patients ambulatory treated at the “Providența” Medical Center.
Results and discussions: Most of the patients were aged over 65 years, being 48.5% women and 51.5% men. The obesity was the most frequent (88%) risk factor in patients; the majority of them were included in the “overweight” and “first- degree obesity” class (72%). Regarding associated comorbidities, hypertension was found in 77% of cases, followed by dyslipidemia. In terms of physiological and behavioral aspects, age and alcohol consumption were predominant.
Conclusions: A significant percentage of diabetic patients treated with hypoglycemic sulfonylureas present a high prevalence of the risk factors and even two or three factors associated.
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The Assessment of Romanian Customers’ Level of Satisfaction with Pharmaceutical Providers
DOI: 10.1515/amma-2015-0079
The aim of the current study is to assess the level of satisfaction towards pharmaceutical services among Romanian customers. Moreover, we were interested in building the socio-demographical profile of a Romanian satisfied customer. The study has a transversal design and uses a quantitative approach. Data was collected at the national level in June 2012 by using Computer Assisted Telephone Interviews (CATI) and resulted in 1,478 valid questionnaires. Descriptive statistics were performed in order to properly present the sample of interest according to socio-demographic characteristics, as well as general attitudes towards pharmaceutical market. According to our analysis, only half of the respondents have a favorite pharmacy (50,4%). Regarding their level of satisfaction, the majority of respondents (53%) declared themselves as being quite satisfied with the pharmacy that they usually collaborate with, whereas 42% of respondents are very satisfied with their favorite pharmacies. According to our analysis, the most satisfied customer has the following socio-demographic characteristics: female (N=351), aged between 56 and 70 years old (N=259), having high school as the highest level of education (N=184), living in an urban area (N=343), having a monthly income of 501-1000 RON (N=217), married (N=396), having no chronic disease (N=312), having a family composed of two members (N=185). Customer’s satisfaction represents a personal evaluation on the pharmaceutical services and providers and is an essential part of the quality of health care. Therefore, it is vital to assess the customer’s expectation and satisfaction in order to ensure the success of the pharmaceutical company.
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Association of Heart Failure with Preserved Ejection Fraction and Components of Metabolic Syndrome
DOI: 10.1515/amma-2015-0078
The aim of the current study was to find any possible associations between elements of metabolic syndrome and echocardiographic characteristics (grade of diastolic dysfunction) in normoponderal and overweight patients with heart failure with preserved ejection fraction. A retrospective observational analytical study was performed on 130 patients presenting heart failure with documented ejection fraction over 50%. They were divided into two groups based on their body mass index. The first group included 56 normal weight patients and the second group included 74 overweight patients. Elements of the metabolic syndrome analysed in the current study were arterial hypertension, high triglyceride levels, low HDL-cholesterol and diabetes. None of the components of metabolic syndrome alone had a role in the evolution of diastolic dysfunction in either group. Three or four elements present in obese patients were negatively associated with grade 2 diastolic dysfunction, high values of blood pressure (over 180/110 mmHg) were more often encountered in obese patients with first and second grade of diastolic dysfunction.
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The Importance of Vascular Endothelial Growth Factor as a Marker of Angiogenesis and Lymphangiogenesis in Non-small Cell Lung Cancer
DOI: 10.1515/amma-2015-0077
Lung cancer is the main cause of cancer death both in men and women. In spite of progress seen in the early diagnosis of lung cancer, and implementation of new treatment principles for these patients, 5 year survival of non-small cell lung cancer patients undergoing surgery is low. Introduction of anti-angiogenic therapy administered concomitantly with conventional chemotherapy agents represented practically the first success seen in the treatment of lung cancer in the last 20 years. The aim of this paper is to review the literature informations about the importance of VEGF (vascular endothelial growth factor) as a marker of angiogenesis in patients with non-small cell lung cancer. Therefore, we practiced a literature review about these topics : the importance of VEGF in tumor angiogenesis and lymphangiogenesis in patients with non-small cell lung cancer and his importance as a prognostic factor at these patients, the prognostic impact of serum levels of VEGF and of the cellular expression of VEGF at these patients and also we reviewed the value of the antiangiogenic therapy.
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Obesity Treatment Strategies
DOI: 10.1515/amma-2015-0076
Obesity is a disease with severe health consequences and increased risk of mortality. The most commonly used criteria to assess the presence and the severity of obesity are body mass index, waist circumference, waist-to-height ratio and the presence of the health conditions caused or worsened by obesity. Worldwide obesity has more than doubled in the last 4 decades. Obesity is the second of the leading preventable causes of death worldwide (after smoking). Obesity has a plurifactorial pathogenesis. The central perturbation consists in the imbalance between calories intake and calories consumption (by inappropriate diet and sedentary lifestyle). Identification of all the ethiological factors is important for treatment and prophylaxis. Weight loss benefits are multiple and important: improvement in glicemic control and in plasma lipid levels, blood presure control, obstructiv sleep apneea reduction, improvement in management of daily activities and profesional performances, increase quality of life, reduction in mortality. Overweight or obese patient will complete a diagnostic and a treatment program. Treatment of obesity claims a targeted multidimensional therapy: weight and lifestyle management, diet, sustained physical activity in daily life, exercise, decrease life stressors, smoking cessation, drug therapy, bariatric surgery psichological, familial and social suport. Weight loss program must be carefully planned, adapted to the patient’s abilities and comorbidities and supervised by a nutritionist and a physiotherapist.
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Links Between Surgical Landmarks of the Temporal Bone and Cochlear Implant Approaches
DOI: 10.1515/amma-2015-0075
Objective: We aimed to underline the surgical importance of the distances between the landmarks of the temporal bone, important for quantifying the benefits and disadvantages of two different cochlear implant techniques.
Methods: We have gathered all data from the Radiology Department in Emergency County Hospital in Tîrgu Mureș, namely computed tomography imagistic studies in order to perform the required measurements, according to pre-defined inclusion/exclusion criteria. The time interval was 5 months.
Results: The comparison between the sets of data shows a good match for the risk/benefit ratio for the two types of technique for cochlear implantation.
Conclusions: The middle cerebral fossa approach for the electrode insertion into the cochlea is a viable and needed surgical technique as the classic approach has reached its boundaries and new challenges appear. As surgical decisions are largely based on radiology data, our work underlines the importance of solving the borderline pathology, the extreme cases and the role of surgery in improving the quality of life for every patient with cochlear implant indication.
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