ARS Medica Tomitana
vol. XI - nr. 4 (43) october - december 2005

Particularitati morfologice ale ramificatiei terminale a venei porte
C. Dina, P. Bordei, C. Ionescu

ABSTRACT. On a lot of 48 human livers, fresh and formalin preserved, we evaluated the ending manner of the portal vein and the distribution of the portal venous branches in relation with the hepatic segmentation. Also, we assessed some peculiarities of the ending manner of the portal vein in relation with the morphological human type. Some mentions are made regarding the presence of the ninth hepatic segment. Among the results, we present: bifurcation ending of the portal vein in 29 cases (60,42% of the cases), for the rest of the samples the portal vein ends by trifurcation; when appears, the middle terminal branch of the portal vein remains closer to one of the other two branches, frequently representing the paramedian vein of the corresponding hepatic segment. Also, we noticed the large blood supply of the dorsal hepatic sector (segments I and IX), that receives tributaries from the terminal branches of the portal vein, from the portal vein itself or from its terminal ramification. Among the entire branches distributed to the dorsal sector, always appears one or even two or three branches that shows a significant caliber.

Modificari ale viscozitatii sangvine la pacientii tratati cu Clopidogrel Bisulfat
N. Ceamitru, Ileana Ion, Vera Ilici, Cristina Ceamitru, Alexandra Cojocaru

ABSTRACT. Clopidogrel bisulfate (Plavix) is a selective ADP-induced platelet aggregation inhibitor, acting by direct inhibition of adenosine diphosphate (ADP) binding to its receptor and of the subsequent ADP-mediated activation of the glycoprotein GPIIb/IIIa complex. The changes induced by clopidogrel on blood coagulability may also have hemorheological effects which are not yet fully known. This study, conducted on 15 patients with known history of stroke and preventively administered a daily 75 mg dose of clopidogrel, reveals significant changes of blood rheology. Fibrinogen levels, haematocrit and blood viscosity were measured before and after treatment (on the 7th and 21st day) and the data were statistically analyzed. The changes are more or less relevant after 7 days of treatment, but they become sensitively significant (Pt< 0.05) after a 21-day treatment period.

Extractia endoscopica a calculilor coledocieni: o realitate
E. Dumitru, Violeta Taran, N. Ceamitru, Fl. Voinea

ABSTRACT. Endoscopic retrograde cholangiography plus sfincterotomy and stone extraction is at the moment de therapy of choice for biliary duct lithiasis. The procedure is available in Constanta from 2000, but only in the last two years it becomes widely accepted, together with a protocol between endoscopy department and radiology department of the hospital. The objective was to analyze the results of endoscopic therapy in patients with main bile duct lithiasis, the frequency and type of procedure related complications and the identification of prognostic factors for a successful therapy. This is a two-year retrospective study (2004-2005) on 54 consecutive patients with main bile duct lithiasis. Every patient was sedated with midazolam before endoscopic retrograde cholangiography, then sfincterotomy and extraction of stones was performed. We noticed the diameter of main bile duct dilatation, the number and dimension of the stones, the clinical pattern (jaundice, acute cholangitis, acute pancreatitis). Afterward, we observed the post procedural complications. A univariate and multivariate statistical analysis was done in order to identify the factors associated with success of therapy. Stone extraction was achieved in 47 patients (87%), and this was directly correlated with the diameter of main bile duct, the number of stones and their dimension, but negatively correlated with patient’s age. However, the multivariate analysis identifies only the dimension of stones as an independent prognostic variable. There were four complications (two cases with acute pancreatitis, one case of acute cholangitis and one case of bleeding related to the procedure). Endoscopic retrograde cholangiography, endoscopic sfincterotomy and stone extraction is a feasible therapy for complicated or uncomplicated main bile duct lithiasis and can be performed before, after or independently of colecystectomy.

Utilizarea metodelor morfometrice moderne pentru analizarea structurii microscopice a miocardului
Mirela Cojocaru, Lidia Chircor

ABSTRACT. Morphometric analysis gives a representation of the biologic structure analyzed. The traditional morphometric methods for the study of pathologic hearts can be enhanced using an image analyzer. In this way one can study a large area of the myocardium and collect a very large number of data. This may be a good method to choice for analyses of normal and pathologic human hearts.

Sensibilitatea si specificitatea antigenelor oncofetale in carcinomul hepatocelular
Zizi Niculescu, I. Tofolean, Mihaela Ghinea, B. Cimpineanu, F. Stoian

ABSTRACT. Tumoral markers for hepatocelluar carcinoma are: alfafetoprotein (AFP), carcinoembrionar antigen (CEA) and carbohidrate antigen (CA-125).Depending on the sensitivity of the method of determination, just 60- 95 % of hepatocellular carcinoma are AFP positive. Increased values of AFP, more than 400 ng/ml, are frequent in case of hepatocellular carcinoma on a cirrhotic liver, and are considered with diagnostic value for hepatocellular carcinoma. Due to lack of spcificity, CEA and CA-125 present a reduced diagnostic value for hepatocellular carcinoma diagnosis. Increased values of AFP was associated with high values for CEA and CA-125 in cases with hepatic metastasis due to a gastric or a colonic neoplasm.

Investigatii paraclinice in diagnosticul pozitiv al cancerul de san
Irinel Verman, Natalia Rosoiu, Mariana Aschie, Adriana Ovezea, Victoria Braga, I. Aschie, Iuliana Pestritu

ABSTRACT. The weight of breast cancer of the total cancer in women, the increased incidence and the presence in the medical offices of a great percentage of women with advanced stages of cancer imposes the necessity of application of all investigation methods in order to find an early cancer diagnosis. The present paper is an interdisciplinary research, biochemical data being correlated with nuclear medicine and pathology data evaluating the useful information for the diagnosis, prognostic and therapy monitoring of breast cancer. The study group consisted of 55 patients diagnosed with breast cancer hospitalized in the Surgery Department of the Constanta Emergency County Hospital. 54 patients being confirmed with: nondifferentiated carcinoma 29.09%, trabecular carcinoma 21.81%, invasive ductal, intraductal and adenocarcinoma (10.9 % each). The obtained biochemical data (hemoglobin, ESR, fibrinogen, glycemia, ALP, ALT) offered no specific information for this diagnosis but allowed the evaluation of the biological status in order to adopt and monitor the optimal therapy: 19% of the patients had anemia, 72.72% increased values of ESR, 29% hyperfibrinogenemia; the increased values of ALP in 27.27% of the patients indicate the necessity to investigate the presence of metastases. We conclude that it is necessary to take into account clinical, biochemical, nuclear medicine and pathology data for an early diagnosis of the breast cancer and for using of all the therapy methods (surgery, radio- and chemo-therapy) aiming to positively influence the survival rate and the patients’ quality of life.

Semnificatia microalbuminuriei in diagnosticul nefropatiei hipertensive
Alina Sburlan, Liliana Tuta, M. Toringhibel, Fl. Voinea

ABSTRACT. Microalbuminuria (MA) appears to be a marker of end organ disease in essential arterial hypertension, induced by increased endothelial permeability. Our clinic study evaluates the prognostic significance of MA for early diagnosis of hypertensive nephropathy (HN). Matherial and methods – 1619 patients were enrolled in a prospective study ( study period – 1.12.2000-1.12.2005) rulled out in Constanta County Clinic Hospital, Internal Medicine and Nephrology Departments. Inclusion and exclusion criteria represents Schlessinger criterias for the diagnosis of HN. Only 959 patients respect these criterias and from them 167 (17,41%) had proteinuria and 274 (28,57%) patients had MA. We found significant correlations between MA and high values of systolic blood pressure (BP), diastolic BP, cardiac co-morbidities (74,36% cases), non-dipper pattern of BP, abdominal obesity, hipertriglyceridemia low HDL-cholesterolemia. Conclusions – our study reveals a high incidence of MA on hypertensive patients. Early diagnosis of MA is very important for preventing progressive deterioration of kidney function and to asses the cardiovascular risk.

Epidemiologia infectiei in fractura deschisa de gamba
B. Obada, N. Obada, V. Lupescu

ABSTRACT. The open fracture represent the principal complication of the fractures in the posttraumatic pathology, resulting due to the distruction of soft tissue represented by skin, fasciae and muscles, being interested the vascular and nervous structures too. This distruction of the soft tissue is followed immediately by the focal fracture contamination. So that, any open fracture must be considered dreaded, because the secondry infection with suppurated pseudarthrosis and ostheitis are complications relatively frequency and depend of the treatment quality applied in emergency. That paper follows the correct evaluation of the contamination and infection potential of the fracture. The contamination level and the germs virulence increase proportional with the open fracture type. That aspect impose diferential treatement applied to the open fractures according Gustilo classification and the neglect or minimize of the epydemiologic aspect or the microbe dynamic have grave consequences and hard controllable.

Consideratii clinico-terapeutice in oftalmopatia Graves
D.Denislam, Jurja Sanda, Constantin Farah

ABSTRACT. Graves disease associates thyroid and non-thyroid symptoms and signs, with autoimmune pathogeny, including the ophtalmopathy. The treatment of Graves ophtalmopaty consist of medical imunosupressive therapy, retrobulbar injections and general treatment. Recently, Somatostatin injections proved their efficienty.

Factori generali si individuali care influenteaza evolutia si prognosticul cancerului de orofaringe
I. Gh. Comsa, T. L. Hangan

ABSTRACT. Starting from a disturbing and continuously growing up incidence, the authors are looking to identify environmental, habitual and pathophysiological factors involved in diagnosis, therapy and prognosis of oropharyngeal cancer. This paperwork is based upon ENT Clinic from Emergency County Hospital of Constanta with a statistic counted over 10 years of study. The obtained distributions for the patients with a poor prognosis justify our conclusions that the life style, the use / overuse of toxics and sanitary education level play an important role in etiology and evolution of oropharyngeal cancer. The late diagnosis with a poor prognosis in most of the cases is explained by lack of obvious symptoms and/or the cover up from toxic abuse effects.

Anemia hemolitica autoimuna in leucemia limfatica cronica: particularitati clinice, terapeutice si prognostice
Alina Nicoara, Mihaela Maria Ghinea

ABSTRACT. Nineteen cases of autoimmune hemolytic anemia (AHA) were observed within a series of 206 patients (9%) with chronic lymphocytic leukemia (CLL) followed up in II-nd and I-st Medical Clinic and Oncology – County Hospital, Constanta, within 5 years (january 2000 – january 2005). In two cases, AHA preceded the onset of leukemia, six were observed at the time of CLL diagnosis and 11 during the clinical follow-up. Ninetitwo percent of the patients with CLL / AHA showed active CLL. The antierythrocyte autoantibody was an IgG type in 74%, and an IgM type in 26%. Male gender, age above 65 years and lymphocyte count more than 40.000/mmc, emerged as independent parameters that correlated with an increase rate of AHA at CLL diagnosis. After steroid therapy, 76% of patients achieved a complete response. IgG AHA and the occurence of AHA at the same time of CLL diagnosis emerged as independent factors correlated with a better survival probability of AHA /CLL.

Toxoplasmoza cerebrala la pacientii cu infectie HIV
S. Rugina, Irina Dumitru

ABSTRACT. Objectives. To determine the prevalence rate regarding cerebral toxoplasmosis in HIV infected patients admitted in Clinical Hospital of Infectious Diseases, Constanta. We performed a study on 86 adult patients with HIV infection, hospitalized between 2000-2002 in Clinical Hospital of Infectious Diseases. The diagnosis of cerebral toxoplasmosis was based on neurologic signs and symptoms, significant immunodepression (CD4 < 200/mm3), high titer of IgG antibodies (ELISA) and suggestive pictures on computed tomography (CT) and nuclear magnetic resonance imaging (MRI). From 86 patients with HIV infection, 31 presented neurologic manifestations and positive ELISA reaction for Toxoplasma gondii (titer > 200 EU/ml). All patients presented CD4 < 200/mm3, in 9 cases CD4 < 50/mm3. In 21 patients, CT and MRI showed cerebral mass lesions. Despite treatment, 7 patients died 4-6 weeks after the initiation of therapy with pirimethamine and were confirmed histologically on necropsy. The rest of patients had a good evolution of symptoms. Conclusions. The prevalence rate of cerebral toxoplasmosis in HIV infected patients was 36% in our study. The high prevalence of toxoplasmosis as a cause for neurologic manifestations as well as its high rate of mortality (28%) proves the major implication of this disease in the evolution of HIV infection.

Anemiile megaloblastice – particularitati clinice, paraclinice si terapeutice
Mihaela Maria Ghinea

ABSTRACT. B12 vitamine deficiency anemias are pathological conditions due to poorly synthesis of nucleic acids. Biermer anemia, produced by the lack of intrinsec factor, is the most frequent type of megaloblastic anemia. This research has been conducted in IInd Medical Clinic – County Hospital Constanta – Hematology Department, and 40 patients diagnosticated with megaloblastic anemias were included, within 1.01.2003 -31.12.2005. The purposes of study were to establish clinical, laboratory and therapeutical features of this type of anemia and its practical significance.

Mononucleoza infectioasa in clinica de boli infectioase
Claudia Simona Cambrea, Margareta Ilie, Consuela Marcas, Claudia Nina Rugina, S. Rugina

ABSTRACT. Epstein Barr virus and Cytomegaloviruses are recognised as viruses that can cause mononucleoz-like syndrom (fever, sore throat, ampicillin rash, secondary hepatitis, adenomegaly). Objective: To evaluate the clinical and biological evolution and treatment of infectious mononucleosis due by EBV and CMV. Study about 62 patients hospitalized with infectious mononucleosis in Children Infectious Diseases Department of Clinical Infectious Diseases Hospital of Constanta during a period of 2 years (2004 - 2005). The etiological diagnosis was established on clinical and paraclinical data (serological markers – ELISA method). From the total of 62 patients with infectious mononucleosis 35 cases were hospitalised during year 2004, and 27 cases during year 2005. Patient’s age was between 2 – 17 years. Sex ratio shown a predominant feminine injury (M:F = 1:2.4). For residence point of view the majority of children were from urban area (47/62). There were no chronically cases or deceases. Symptomatic treatment was used in majority of cases. In 17 cases we used Isoprinosine. The length of hospitalization was between 5-10 days. Conclusions: Infectious mononucleosis presented a favourable evolution in almost all our cases. Serological diagnosis establish final diagnosis in this affection.

Principii generale de management prespitalicesc in hemoragiile de cauza obstetricala
Cristiana Geormaneanu, Maria Cernea, Luciana Rotaru

ABSTRACT. Massive ante- and postpartum haemorrhage is a major contributory factor to maternal mortality and morbidity. Adequate management of hemorrhage, requires recognition rapidly of hemorrhage, volemic resuscitation and to correct coagulopathy. In the event of a ante-and postpartum bleeding, the decision to undertake a medical transfer should be made in concertation by the different physicians involved: the hospital that requests the transfer, the Emergency Medical and Mobile Service, the receiver.

Corelatia intre manifestarile clinice si aspectele morfopatologice in artroza de genunchi
Ciobotaru Camelia

ABSTRACT. Objective: Osteoarthritis is the most important kind of arthritis. In this study I tried to find any relationship between clinical changes and MRI changes in patients with knee osteoarthritis. Methods: I have included 24 patients with primary knee osteoarthritis, which have been assessed clinically and MRI. Results: The kind of pain can be important. Thus, pain on flat surface is in relationship with ligament affectation and disability with ligament and menisci affectation Conclusion: It can be a relationship between symptoms, disability and ligament –menisci affectation.

Aspecte clinicoterapeutice ale infectiilor tractului urinar inferior
F. Voinea, E. Caeridin, Claudia Voinea

ABSTRACT. Urinary Tract infections represents one of the most frequent bacterial infection. We have diagnosed cistitis for 457 patients – 73% of UTI and 7 % of total admitted patients. UTI frequence is dependent with sex and age. Increased number has been reported in female (10/1) to male ratio. Acute cistitie for women were secondary to: urinary lithiasis-37 cases, genital infections-59 cases, genital tumors-33 and urologic manuveres 5 cases.

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