Category Archives: Number

Is There a Risk Factor More Responsible for Disaster?

Carasca Cosmin1*, Muresan Vasile Adrian2, Tilea Ioan3, Magdas Annamaria4, Carasca Emilian4, Incze Alexandru4

1 County Emergency Clinical Hospital, Tirgu Mures, Romania
2 Surgical Clinic 1, County Emergency Clinical Hospital, Tirgu Mures, Romania
3 Cardiovascular Rehabilitation Clinic, Dept. Family Medicine, Institute of Cardiovascular Diseases and Transplantation Tirgu Mures, Romania,
4 Internal Medical Clinic 4, County Clinical Hospital, Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0054

Background: Risk factors for peripheral arterial disease are generally the same as those responsible for the ischemic heart disease and in both cases are overlapping risk factors involved in the etiology of atherosclerosis, such as smoking, dyslipidemia, diabetes and hypertension.
Case report: We present a case of a 61 years old male, whose ischemic peripheral symptoms began in 2003, at the age of 49, presenting as a Leriche syndrome. The patient was subjected to first revascularization procedure consisting in aortic-bifemoral grafting in the same year. General examination revealed no risk factors except smoking. Only a year after, he returns with critical right lower limb ischemia due to bypass thrombosis, therefore two thrombectomies were performed followed by a right side femoro-popliteal bypassing with Dacron prosthesis. The patient’s condition was good until 2008 when a femoro-popliteal bypass using inverted autologus saphenous vein was imposed due to occlusion of the previous graft. In 2013 the patient was readmitted to hospital with left lower limb critical ischemia. A femoro-popliteal bypass was performed, followed by two thrombectomies and the amputation of the left thigh. Up to this date, the patient kept smoking.
Discussions: Although our patient has a low/medium risk level of atherosclerosis by Framingham score and a minimum Prevent III score, all the surgical revascularization procedures were not able to avoid the amputation.
Conclusions: There are enough reasons to believe that smoking as a single risk factor can strongly influence the unfavorable progression to amputation in patients with peripheral arterial disease.

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Rare Cause of Cephalalgia in a Young Woman – a Case Report

Varga Andreea, Szakacs Xantus Timea*, Gliga Mirela, Podoleanu Cristian Gheorghe Calin, Bocicor Andreea Elena, Carasca Emilian, Tilea Ioan

University of Medicine and Pharmacy Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0045

Background: Young adults meeting hypertension diagnostic criteria have a lower prevalence of a hypertension diagnosis. Headache is a rather common symptom among young people. Fibromuscular dysplasia (FMD) is an idiopathic, segmental, nonatherosclerotic and non-inflammatory disease of the muscular tunica of arterial walls, leading to stenosis of small and medium-sized arteries. Fibromuscular dysplasia is much more common than previously thought and is a treatable cause of secondary hypertension.
Case presentation: We present the case of an 18 y.o. young woman, with headache and high blood pressure. “White coat hypertension” was suspected. Clinical history with abrupt onset and increasingly difficult to treat hypertension especially in women, were suggestive for renal artery stenosis. Renal ultrasound and digital subtraction angiography confirmed the aspect of FMD. Sequential percutaneous renal artery angioplasty was later performed with improved evolution both from the clinical point of view and controlled blood pressure below 140/90 mmHg with minimal antihypertensive regimen. Angio CT exam of neck and brain arteries was performed, no other FMD typical lesions were identified.
Conclusions: Medical treatment is first indicated for the hypertensive patient. In this particular case percutaneous renal artery angioplasty showed significant improvement in reduction of antihypertensive treatment in a young patient with secondary hypertension. Further monitoring and management of this patient will include blood pressure measurements at 3-month intervals and renal function measurements annual, as well as non-invasive duplex ultrasonography at 12-month intervals, follow-up is indefinite. It remains challenging whether the patient can be medically managed on antihypertensive medication alone.

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Study on Changes of the Urea, Serum Creatinine and Glomerular Protein Permeability, after General Anesthesia with Sevoflurane

Stoian Mircea, Stoian Adina*, Costel Dumitru, Tripon Florin, Badea Iudita, Azamfirei Leonard

University of Medicine and Pharmacy of Tirgu Mureș, România

DOI: 10.1515/amma-2015-0053

Introduction: The widespread use of sevoflurane as an induction and maintenance volatile agent of general anesthesia demostrates an increased safety profile. Sevoflurane contact with CO2 absorbents lead to the occurrence of toxic compounds such as Compund A and Compound B . Among the side efffects of Sevoflurane remember the renal toxic effect much discussed in the literature but still unresolved. In previous research we have demonstrated the glomerular protein changes as a result of exposure to Sevoflurane. In the current study we intend to monitor the changes in blood urea nitrogen and serum creatinine after exposure to Sevoflurane.
Material and method: We included in our study 90 patients who were anesthetized in the Department of Anesthesiology of the County Mure Hospital during 01.10.2009-01.10.2014. They had normal values for blood urea nitrogen and serum creatinine and had no preoperative proteinuria. Serum and urine samples were taken preoperatively and at 24 and 72 hours postanesthetic and were analyzed in the laboratory. Proteinuria was determined by spectrophotometry.
Results: After protein quantitative determination by spectrophotometry and statistical anaysis we obtained significant differences by comparing the average preoperative/24 hours total protein (p<0.0001) and 24/72 hours (p<0.0001). There are no significant statistical differences by comparing the blood urea nitrogen at the three intervals (p<0.53) and no statistical changes for mean serum creatinine (p<0.18).
Conclusions: Changes in glomerular filtered proteins following exposure to Sevoflurane demonstrate its toxic effect on glomerular tubules. Lack of perioperative significant wich is why we recommend determining perioperative urinary protein as a marker of glomerular damage.

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Knee Arthroplasty: With or Without Patellar Component?

Sólyom Árpád1, Király Ildikó2, Benedek Csaba2, Fülöp Csongor1, Nagy Örs3, Bățagă Tiberiu1

1 Ist Orthopaedic and Trauma Clinic, Mureș County Emergency Clinical Hospital, Tîrgu Mureș, Romania
2 University of Medicine and Pharmacy of Tîrgu Mureș, Faculty of General Medicine, sixth year medical student, Tîrgu Mureș, Romania
3 IInd Orthopaedic and Trauma Clinic, Mureș County Hospital, Tîrgu Mureș, Romania

DOI: 10.1515/amma-2015-0052

Arthroplasty is used when there is irreversible damage to the articular cartilage of the knee. It involves implanting a bicompartimental (femoral and tibial components) or a tricompartimental (femoral, tibial and patellar components) prosthesis. It is a very invasive and costly operation, so our objective was to evaluate the necessity of the patellar component. Material and methods: We included 39 patients in the study: in 27 cases we used tricompartimental prosthesis, while the other 12 received only the bicompartimental components. Patients were evaluated preoperatively and postoperatively using the International Knee Documentation Comitee score. Results: We’ve found that there is little to no difference between the two groups regarding mobility and complication, however patients with bicompartimental arthroplasty complained of less pain. Conclusion: We’ve found that bicompartimental arthroplasty – being a less invasive procedure – is superior not only in terms of pain management, but is also associated with less bleeding and shorter intraoperative time. The revision is easier and the technique presents also financially advantages, for both the patient and the medical facility.

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Associated Behavioral Risks in a Group of Women During Pregnancy from Mures District

Ruța Florina1, Avram Călin2, Voidăzan Septimiu3, Rus Victoria1*, Georgescu Mihai4, Abram Zoltan5, Tarcea Monica1

1 University of Medicine and Pharmacy Tirgu Mures, Department of Community Nutrition and Food safety
2 University of Medicine and Pharmacy Tirgu Mures, Department of  Medical Informatics and Biostatistics
3 University of Medicine and Pharmacy Tirgu Mures, Department of Epidemiology
4 Regional Emergency Hospital of Tirgu-Mures, Gynecology ward no 1
5 University of Medicine and Pharmacy Tirgu Mures, Department of Hygiene

DOI: 10.1515/amma-2015-0051

Background. It is well-known that the exposure during pregnancy to lifestyle risk factors can affect thehealth both for the mother and the fetus. There are many risk factors for pregnancy, including: smoking, alcohol consumption, sedentary pattern, irregular daily meal serving plan, lack of knowledge regarding health prevention. The main objective of our study was to assess the practices, knowledge and attitudes towards lifestyle risk behaviors during pregnancy in a group of women from Tirgu-Mures area.
Materials and methods. We used a cross-sectional study based on a questionnaire, assessingsmoking behavior and lifestyle patterns during pregnancy, on a group of 481 women from the urban area (58.84%), as well as from the rural area (41.16%) from Mures county.
Results. In the study group, 190 women (39.5%) used to smoke before pregnancy; among which 37.36% continued to smoke even after they found out they are pregnant. In the group of pregnant women that continued to smoke during pregnancy, we have studied other behavioral factors related to lifestyle, identifying the following: 5,73% have been consuming alcohol weekly, 56.33% reduced greatly their physical activity level, 3.63% have been consuming at least 3 cups of coffee a day. During pregnancy, 12.72% did not have a regular, daily meal serving plan, and 67.26% was a little or not at all concerned about their eating habits. Only 30.9% from the smoking pregnant women group have received information from the family doctor (GP) regarding the risk factors of smoking habits, while 38.18% did not receive any information.
Conclusions. Behavioral risk factors in pregnancy have to be followed closely by the HealthCare System in order to avoid complications for the mother and the child. The best way of accomplishing that is through an efficient community intervention.

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The Prevalence of Contact Dermatitis Among Occupational and Work-related Diseases. Correlation between Atopy and Allergic or Irritative Contact Dermatitis

Pitis Codruta-Dana1*, Tataru Alexandru2

1 University of Medicine and Pharmacy “Iuliu Hatieganu” Cluj-Napoca, Occupational Medicine Clinic Cluj-Napoca, Romania
2 University of Medicine and Pharmacy “Iuliu Hatieganu” Cluj-Napoca, Clinic of dermatology, Cluj-Napoca, Romania

DOI: 10.1515/amma-2015-0050

The prevalence of contact dermatitis (CD) in Europe varies between 6.7% and 10.6% depending on the sector of activity. Professional CD (PCD) has an important economic impact – 30% of the budget compensation for occupational disease. In Romania, the prevalence of PCD is underestimated, with an even distribution of cases with respect to the allergic or irritative mechanism. A retrospective clinical study was conducted; target population being the patients admitted in Occupational Medicine Clinic Cluj-Napoca between 2003 and 2011. Objectives of study were: specifying the prevalence range of allergic CD (ACD) / irritative CD (ICD) among occupational/work-related diseases, the distribution of allergic/irritative CD (A/ICD) for different sectors of activity and establishing the correlation between atopy and A/ICD. We have applied allergy skin tests – prick (environmental allergens) and patch (occupational allergens). Inclusion criteria were: -documented occupational exposure at skin allergens/irritants; -the atopy state; -diagnostic established at discharge. Patients with recurrent chronic urticaria, angioedema, hypereosinophilic syndrome have been excluded. Statistical analysis was done using SPSS software. The study indicated a similar prevalence for A/ICD, with similar distribution. Prevalence above average has been recorded in the metallurgy sector (A/ICD), in health care sector (ACD), respectively, textile industry (ICD). The correlation atopy-ACD has proved to be lower compared to previous reports. Regarding ICD, the diagnostic was confirmed frequently to non-atopic persons. We strongly recommend the compliance with a multidisciplinary protocol for the management of A/ICD, individualized for specific activity sectors or even work stations.

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Metabolic Effects of Two Different Doses of Venlafaxine Therapy on Rats

Imre Annamária1, Kolcsár Melinda1*, Groșan Alexandra1, Imre M2, Dogaru Maria Titica1

1 Faculty of Pharmacy, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

DOI: 10.1515/amma-2015-0049

Objectives: Venlafaxine is an antidepressant, categorized as a serotonin-norepinephrine reuptake inhibitor (SNRI) with suspected metabolic side effects. The aim of our study was to assess these metabolic effects in rats, using two different doses of venlafaxine.
Materials: Three groups of Wistar rats have been treated with venlafaxine during seven weeks. The rats have received a daily dose of 10mg/kg (D1) and 40 mg/kg (D2) while the control group (Dc) has received no treatment. Rats were given “ad libitum” access to food and water. The rats were weighted at treatment day 0, 7, 14, 21, 28, 35, 42 and 49. After completion of venlafaxine treatment, the rats were sacrificed, blood was harvested and the following biochemical parameters have been determined from the centrifuged plasma: triglycerides, glucose and total cholesterol levels.
Results: Both the 10 mg/kg and the 40 mg/kg dose venlafaxine therapy resulted in a highly significant increase of rat’s weight. Compared with the control group the mean weight of D1 group has increased with 130.5 ±21.79 g (<0.01) while the mean weight of the second group increased with 94±24.16 g (p<0.01). In addition weight gain of D1 group was significantly higher than that of D2 group (p<0.01). Venlafaxine therapy induced significant increase in serum triglyceride levels (140.04±55.46 mg/dL p<0.01, 83.59±52.85 mg/dL p=0.05). This metabolic effect has been shown to be more evident in case of 10mg/kg dose therapy (p=0.03). Simultaneously, serum cholesterol levels have been reduced, however this decrease proved to be significant only in case of group D2 (p=0.03). Despite of increased triglyceride values, glucose levels were significantly decreased in both treated groups (133.33±36.18mg/dL p=0.05, 118.10±51.98 mg/dL p=0.02).
Conclusions: Our results suggest that venlafaxine administrated to rats has unwished dose related metabolic effects such as significant increase in weight and hypertriglyceridemia, however serum cholesterol and plasma glucose levels appears to be decreased by this medication.

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Specific Characteristics of Head and Neck Squamous Cell Carcinoma in Mures Area

Fejér Enikő Réka1*, Bodi Andrea1, Egyed-Zsigmond Imre2, Jung Ioan2, Voidăzan Septimiu3, Ábrám Zoltán4

1 University of Medicine and Pharmacy of TarguMureş
2 University of Medicine and Pharmacy of TarguMureş. Anatomopathological Department
3 University of Medicine and Pharmacy of TarguMureş, Epidemiology Department
4 University of Medicine and Pharmacy of TarguMureş, Hygiene Department

DOI: 10.1515/amma-2015-0048

Although head and neck cancers have a rising incidence, these diseases are less investigated because of their localisations’ heterogenity. The major risk factors susceptible to influence the evolution of the disease are smoking, alcohol consumption and infection with human papilloma virus. Using data from Mures County Emergency Hospital’s histopathology register, we made a retrospective study of 190 cases from the last two years. Factors of interest included age, sex, localization, histopathological subtype and differentiation grade. Median age at diagnosis was 61.31 years, the disease presenting highest incidence in the 51-60 age subgroup and a clear male predominance (5.75:1). The most frequent localization is lower lip (28%) and the dominant histopathological subtype is cheratinised squamous cell carcinoma (83,8%) and G2 differentiation grade (48,1%). This study supports the finding of increased incidence of cheratinised squamous cell carcinoma in this region. However the literature emphasizes rising incidence of head and neck cancer in younger, we observed that increase in Mures area occurred in 51-60 age group. Lower lip most frequent localization makes possible an early diagnosis.

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How Far We Should Go with Pelvic Lymph Node Dissection on the Controlateral Side in Unifocal Muscle Invasive Bladder Cancer

Vartolomei Mihai Dorin, Chibelean Calin Bogdan*, Voidazan Septimiu, Martha Orsolya, Borda Angela, Boja Radu Mihail, Dogaru Grigore Aloiziu

University of Medicine and Pharmacy of Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0047

Objectives. The purpose of this study was to determine the evolution of patients with unifocal lateral wall MIBC (muscle invasive bladder cancer) after cystectomy with PLND (pelvic lymph node disection) at the Urology Clinic in Tirgu Mures, and to determine tumor stage and lymph node status before and after radical cystectomy with PLND.
Methods. This is a prospective study, conducted between 1 August 2012 to 31 July 2014 at Urology Clinic, with a median follow-up of 14 months (range 7-25). Inclusion criteria were: patients undergone cystectomy with PLND, and unifocal MIBC on the lateral wall of the bladder; exclusion criteria were: multiple bladder tumor, other location and clinical T stage > 3.
Results. Forteen patients met the inclusion criteria, median age was 61 (range 55-72), 85.71 % were male. An increase in T3 patients was noticed from 1 to 5 cases, we noticed a decrease of N0 lymph nodes from 78.6% to 57.1% postoperatively and on the controlateral side the kappa coefficient between the preoperatively and postoperatively negative lymph nodes was 0.63. On the tumor side the most common location for positive lymph nodes was external iliac with 3 nodes (21.4 %) and obturator fossa with 4 nodes (28.6 %) and on the contralateral side 2 positive nodes (14.3 %, obturator fossa, external, internal and common iliac nodes).
Conclusions. In unifocal bladder tumors, located on the lateral wall, PLND could be an alternative with comparable results with extended PLND especially in T1 and T2 patients associated with N0 before and after surgery.

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The Grade of Left Ventricular Diastolic Dysfunction as a Predictive Factor for Permanent Atrial Fibrillation

Cerghizan Anda, Keresztesi Arthur Atilla*, Bataga Simona, Tilea Ioan

University of Medicine and Pharmacy of Tirgu Mures, Romania

DOI: 10.1515/amma-2015-0046

The objective of this study was to find a link between the grade of left ventricular diastolic dysfunction (LVDD) and the progression to permanent non-valvular atrial fibrillation (AF), in a group of patients with left ventricular diastolic dysfunction and paroxysmal or persistent atrial fibrillation.
Methods: A bidirectional study on 57 patients meeting the inclusion criteria was conducted; each patient was admitted in a university -based hospital between January 1st – June, 30, 2013, with a follow up 3 and 6 months later. Permanent atrial fibrillation development was followed.
Results: Out of the 57 patients, 23 had paroxysmal AF and 34 were with persistent AF. After six months, 21 patients progressed to permanent AF, representing 36.84% of the total patients. Female patients with age over 65 had more often atrial fibrillation, but more men progressed to a sustained form of AF. No statistically significant difference regarding the grade of diastolic dysfunction, the left atrial size or volume, or the left ventricular ejection fraction was observed between the patients with progression, compared to those without progression.
Conclusions: The grade of left ventricular diastolic dysfunction did not prove to be a predictive factor for permanent atrial fibrillation, neither the left atrial size or volume, or the left ventricular ejection fraction.

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