ARS Medica Tomitana
vol. X - nr. 3 (38) july - september 2004

Viitorul educatiei academice de nursing in era informatica europeana
Ileana Antohe, Natasa Georgeta Forte Macovei, M. Saarikoski

ABSTRACT. The paper presents the changes in academic nursing teaching which information technology development produced. Computer assisted learning means reassessing and reorganizing the way academic instruction takes place. Students and teachers can do this through new ways information package’s content is structured and also through its flexible, creative and individualized use. Virtual reality is already present in nursing education and develops in Europe through thematic network, academic debate forums and distance IT learning and teaching. All these changes request in Romania a quick adaptation of the educational process and support in nursing, in order to preserve the competitive quality of education.

Aspecte ale imagisticii prin rezonanta magnetica in diagnosticul cancerului mamar
R. Baz, Elena Chiriac, M. Onciu, Liliana Gheorghe

ABSTRACT. Breast MRI is a very useful breast cancer diagnostic tool and is excellent at imaging the augmented breast. MRI can be used effectively to gain information about breast abnormalities detected with mammography, physical exam, or other breast imaging modalities. MRI is also useful in helping to stage breast cancer, evaluate treatment options, and follow-up after treatment has been completed. We’ve investigated 33 women with brest anomalies using a GE Signa Horizon 1,0T MRI unit with a dedicated breast coil. Interpretation was based on lesion’s morphology and enhancement characteristics. Our results confirm de literature data revealing local extension, multicentricity of the lesion, ganglionar and parietal invasion.

Aspecte anatomo-imagistice in patologia splenica
Elena Sapte, Steliana Popescu, P. Bordei, M. Onciu

ABSTRACT. The use of abdominal ultrasonography in emergency pathology has imposed itself like a useful method because of the data obtained as because of it’s facility and noninvasivity. The splenic ultrasonographic examination is part of the basic general abdominal examination. Using ultrasonography we tried to certify and describe the splenic lesions on 75 patients. The splenic pathology was most frequent secondary to a plurivisceral lesion and very rarely as a primitive pathology.

Studiu histologic al uveei, retinei si nervului optic pe animale de laborator
Denislam Dogan, Constantin Farah, Mehedinti Teofil

ABSTRACT. The authors present a histological study of uvea, retina and optic nerve on the laboratory animals (rabbits). The uveal tract is composed of three parts: the iris, the ciliary body and the choroid. It is the middle, vascular layer of the eye, protected externally by the cornea and sclera. It contributes to the blood supply of the retina. The sensory retina may be divided into a central portion (macula), which contains the fovea centralis that functions in photopic vision and into four peripheral quadrants that functions in spatial orientation and in reduced light (scotopic vision) and the optic nerve is composed of the axons of ganglion cells of the retina.

Cauza rara de insuficienta respiratorie acuta. Sindromul Madelung
I. Gh. Comsa

ABSTRACT. Madelung syndrome consists in lipoidic metabolic disorder with accumulation of fat tissue in cervical and thoracic region. Around 200 cases were reported in literature(1,2,5). in Romania, there was only one case reported by ENT Clinic Coltea – Bucharest (4). This paperwork relates about a patient registered in emergency conditions with acute respiratory failure. This required immediate tracheotomy. The cause of respiratory failure proved to be bilateral recurrent nerve palsy generated by a massive cervico-toracal lipomatosis. The exams performed after that expelled all other causes. We practiced a surgical removal of the excessive fat tissue with favorable postoperative evolution. The recurrential palsy passed on, and after 3 weeks the decanulation could be carried out.

Tratamentul cu Peginterferon ALFA -2a in hepatita cronica cu virus C la pacientii cu insuficienta renala cronica - rezultate preliminare
Liliana Tuta, Fl. Voinea

ABSTRACT. The aim of this preliminary study is to evaluate the response to therapy with Pegylated Interferon α-2a (40 kDa) in patients with chronic renal failure (CRF), in different evolutive stages. We have studied 15 patients(9 males, 6 females), with ages between 32 and 57 years.All had increased aminotransferases, anti HVC antibodies and were PCR HCV-RNA positive. We administrated Peg-Interferon alfa-2a 180 μg/week for patients with compensated CRF and 135 μg/week for those with end-stage renal failure. After 12 weeks of therapy we have evaluated the biochemical and virological response. Nine patients continued the treatment until 48 weeks. Biochemical response was obtained in all patients and virological response in 8 cases. Sustained virological response wiil be established by evaluation of PCR RNA-HCV 6 months after the end of treatment.

Consideratii asupra epidemiologiei intoxicatiilor voluntare medicamentoase la copil
Valeria Stroia, Adriana Balasa, Viviana Cuzic

ABSTRACT. This clinical retrospective study, made in Pediatric Department of Clinical County Hospital Constanta, demonstrates the importance of risk factors and the role of precipitating factors for suicide attempts in teenagers. The study group, represented by the teenagers admitted for drug self-poisoning, is analised according to age, sex, social environment, the moment of poisoning, pathological history, life conditions, specialty exams.

Depistarea cu ajutorul colangiopancreatografiei prin rezonanta magnetica a variantelor anatomice ale cailor excretoare biliare si pancreatice – implicarea unora dintre acestea in patogenia pancreatitei acute
Carmen Ciufu, Simona Dima, Cecilia Adumitresi, Cristina Farcas, Ninela Radulescu, Ileana Ion

REZUMAT. Although acute pancreatitis is asociated with risk factors as: biliary lithiasis, hyperlipoproteinaemia, trauma etc. It is thought that inappropriate activation of trypsinogen causes pancreatitis. It is a severe affection with important complications which may cause death in it’s haemoragic form. We studied a number of 15 patients with acute pancreatitis and chronic pancreatitis in an acute stade. In all cases the jonction between the distal common bile duct and pancreatic duct was satisfactory visualised using magnetic resonance cholangiopancreatography (MRCP). MRCP represent an alternative to ERCP in evaluation of the common bile duct and pancreatic duct and their orifices.

Probleme de diagnostic in tumorile renale
Emel Osman, S. Osman

ABSTRACT. Renal tumors, more than ever renal adenocarcinoma, represent a main health problem with an increased frequency above 60 years. To increase the efficiency of the medical intervention, both in prehospital than in hospital, it is necessary to be informed about some clinical and paraclinical aspects related with the incidence of renal tumors. The aim of this study is to analyze some epidemiological data about renal tumors in Urology Department of Clinical County Emergency Hospital of Constanta.

Rezultatele tratamentului cu peginterferon alfa 2a (Pegasys) si Ribavirina (Copegus) la pacientii cu hepatita cronica virala C din Judetul Constanta
E. Dumitru, A. Suceveanu, Luana Alexandrescu, Andra Suceveanu, Mariana Aschie, F. Voinea

ABSTRACT. Background and aims. Combination therapy with peginterferon alpha and ribavirin is the new standard for patients with chronic hepatitis C. The aim of this study was the evaluation of therapeutic response and factors related to it on a group of patients with chronic hepatitis C from the county of Constanta. Methods and patients. The study involved 47 patients that were selected according to the criteria reccomended by the National Health Insurance Company. The therapy consist in peginterferon alpha 2a (Pegasys) and ribavirin (Copegus) 1000 – 1200 mg/day for 12 months; the level of serum RNA-HVC was determined at 3 months and 6 months during therapy. Results. The therapeutic response (clearance of viremia at 3 or 6 months of therapy) was achieved in 29 / 47 patients (62%) and was correlated with a low fibrosis score and the absence of previous interferon therapy. The response was not influenced by the initial level of viremie, transaminases, weight, sex or previuos blood transfusions. Conclusions. The rate of viral clearance was 62% in all patients and even better (75%) in naïve patients, and these results support the recommendation of peginterferon alfa 2a in combination with ribavirin as the initial approach to the patients with chronic hepatitis C. The next phase of this study will be the appreciation of the sustained viral clearance (at least 6 months after therapy).

Comparatie intre administrarea pre- si post-prandiala a insulinei Aspart (Novorapid) la copiii si adolescentii cu diabet zaharat insulino-dependent (Tip 1)
Cristina Maria Mihai

ABSTRACT. Objective—The aim of this study was to compare the glycemic control of preprandial versus postprandial injections of the new rapid-acting insulin analogue aspart in children and adolescents with type 1 diabetes. Research design and methods — Forty-two children (aged 6–12 years) and 34 adolescents (13–17 years) were randomized to preprandial (immediately before meal start) and postprandial (immediately after a meal or a maximum of 30 min after meal start) treatment with insulin aspart (at least thrice daily) as part of a basal/bolus regimen in a multicenter study with an open labeled, two-period cross-over design (6-week periods). Of this group, 49% were boys, 55% were aged 13 years, and duration of diabetes was 4.4 years (range 1.0–9.4). Results—Glycemic control for postprandial treatment was not worse than preprandial treatment as assessed by fructosamine week 0 vs. 6 (mean ± SD, preprandial 367 ± 74 vs. 378 ± 90 µmol/l; postprandial 383 ± 83 vs. 385 ± 77 µmol/l) and HbA1c (preprandial 7.9 ± 1.3 vs. 8.0 ± 1.5%; postprandial 8.0 ± 1.4 vs. 8.3 ± 1.5%, P = 0.14). The only statistically significant finding from the seven-point blood glucose profiles and derived parameters between preprandial and postprandial treatment was a lower postprandial glucose level 120 min after breakfast (mean ± SEM, -2.08 ± 0.74 mmol/l, P = 0.016). The relative risk of hypoglycemia (blood glucose <3.9 mmol/l) preprandially to postprandially was not significantly different (mean 1.1; 95% CI 0.91–1.35; P = 0.31). Overall treatment satisfaction was equally high for both regimens with both patients and parents. Conclusions—Although preprandial administration of insulin aspart is generally preferable, this study shows that in children and adolescents, postprandial administration of insulin aspart is a safe and effective alternative.

Studiul endotelinei-1 serice in socul traumatic la copil
Gabriela Lilios, Catalina Florea, Violeta Sapira, Ileana Ion, Adriana Protopopescu, A. Fono, N. Ceamitru

ABSTRACT. The shock, as ‘’an brutal projection” in the intracellular space of the extracellular space unballances, is a global disturbance,both hemodynamic and methabolic, which appears at a certain threshold of an aggresion and it has tendency at pendulous upkeep. Endothelin-1(ET-1) beside other reglators,such as: bradikinin and angiotensin II participate in differentiate release of adrenaline and/or noradrenaline from suprarenal glands in shock. The aim of our study is to investigate the serum levels of ET-1 in 30 politraumatised children with severe skull traumas which consisted the study group. The serum levels of ET-1 was determined in 2 moments of their postraumatic evolution (in the first 6 hours after injury and after 7 days). The findings have shown a significant statistic growth (Pt<0,05) of the ET-1 levels in serum on children with traumatic shock at the two measurements, comparative with the ET-1 level obtained at healthy group. The growth of ET-1 serum levels appears at 6 hours after trauma and it remains high during the entire study. The early high levels of ET-1 appeared postraumatic, also the persistance of high levels for ET-1 in study group, confirms tisue hypoxic sufference due to persistent vasoconstriction, related to the severity of cranio-cerebral injuries (confirmed through neurological diagnose and CT scan) and other associated lesions.

Particularitatile litiazei biliare la vârstnici
Zizi Niculescu, B. Cimpineanu

ABSTRACT. A frequent pathological condition to the elderly patients is billiary lithiasis, which can be a difficult diagnosis due to atypical symptomatology and severe complications. Acute cholecystitis it is one of the most frequent type of onset of billiary lithiasis . The clinical manifestations could be unspecific at this age due to a difficult anamnesis and poor physical examination. An other type of onset for acute cholecystitis it is represented by diffuse abdominal pain, bowell obstruction syndrome with recent constipation and subfever. Cholestatic jaundice- it is an other type of onset of lithiasis at elderly patients. The jaundice, which is intermmitent and without pruritus, it is secondary to a cholecystitis or angiocolitis, and rarely due to migration of the billiary stones to the coledoc channel with acute pancreatitis. The therapeutical management must be established after a serious evaluation of the benefits and risks of the treatment.

Modificari morfologice in evolutia naturala, postterapeutica precoce si pe termen lung a displaziei luxante de sold
Lidia Chircor, Victorian Pastila, Victoria Sava, Rodica Marinescu, Raluca Ghinea

ABSTRACT. The congenital hip displasy (CHD) is one of the most frequently congenital malformations of the lower limbs. The present study refer to 67 cases with CHD dianosed by clinical and radiological exam between 1998-2004 at the Constanta County Clinic Hospital. The authors use interdisciplinary research of CHD with corelation between: gross anatomy, morphometry, pediatric, orthopedic and radiology data. The incidence of the CHD between 01.1998-01.2004 is 0.07%, sex ratio 3:1 in favour of the female, meaning an inferior value from point of view of incidence rate calculated in greater series In our serye they are 44 cases (69.8%) from primipara women, only 14 cases (22%) are primipara-primigesta and other 12 cases (19%) are new-burn by surgery intervention. The morphological modifications induced by CHD’s evolution have different aspects, depending of each evolution step. in our series, 33% from all cases have associated congenital malformations, confirming the existence of default of the developmental process which is expressed on different anatomical levels in the same time. These results reveal the influence of the mechanic factors from the pregnancy and birth time on the joints and bones’ abnormal growth and development.

Consideratii clinice si epidemiologice asupra antraxului in judetul Constanta
S. Rugina, Irina Dumitru, Claudia Nina Rugina, Elena Dumea, Eugenia Bâsca

ABSTRACT. It is a retrospective study on a period of twelve years performed in Infectious Diseases Clinical Hospital. The diagnosed was based by smear, and culture of vesicular fluid or CSF. During this period 17cases of anthrax in humans were identified. The repartition of cases according to sex groups revealed a high predominance of male cases (13 cases). The disease was most prevalent in 35-44 age group and after 55 years old (6cases). In all cases anthrax was occupational disease and the provenience of patients was rural area. The annual incidence of anthrax was characterized by a low value and irregular frequency of the disease. The most cases were in 1994 (6 cases) and 2004 (5 cases). According to the seasonal repartition, anthrax was most prevalent in the summer months (11 cases). The most frequent clinical form of anthrax was the coutaneous anthrax (16 cases), and only one patient achieved anthrax meningitis. Under specific treatment with penicillin G, all the patients with coutaneous anthrax recovery complete, only the patient with anthrax meningitis died. In Constantza County, anthrax remained sporadic in the last years. After a free period (1999-2003) 5 cases of coutaneous anthrax were registered in 2004.

Factorii de mediu si accidentele vasculare cerebrale
Any Docu Axelerad

ABSTRACT. About the stroke onset influence of weather factors, so if many international studies, like Connecticut, Siberia, Izumi City, France, Canada and Denmark show that is no relationship between the stroke onset and weathers factors like atmospheric pression , temperature, humidity, the present study made in Constanta, on the black sea, proved a real correlation between weather factors and stroke onset.

Inima Societatii Romane de Cardiologie bate in ritm european! Date de la Congresul National de Cardiologie – 2004
Carmen Ginghina

REZUMAT. Desfasurat timp de patru zile in plina toamna aurie (15 – 18 septembrie) la Poiana Brasov, Congresul National de Cardiologie din acest an s-a bucurat de prezenta a 1200 de medici, in majoritate cardiologi dar si internisti, nutritionisti, endocrinologi, nefrologi, neurologi, medici de familie, anestezisti si chirurgi cardio-vasculari. Lucrarile Congresului s-au straduit sa traduca in fapte prin actualitatea si prezentarea moderna a temelor indemnul cuprins in logo-ul Societatii: “Inima Societatii Române de Cardiologie bate in ritm European!” Continutul sau stiintific este dificil de rezumat – in conditiile in care lucrarile cu teme extrem de variate s-au desfasurat in paralel in sase sali. Vom incerca sa punctam informatiile continute in câteva din tipurile de manifestari incluse in programul Congresului si anume: cursuri, conferinte si ateliere.

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