ARS Medica Tomitana
vol. XII - nr. 1 (44) january - march 2006

Morphological Aspects Of The Superior Mesenteric Artery And Of Its Collateral Branches, Together With Their Surgical Importance
P. Bordei, S. Paris, D. Iliescu

ABSTRACT. Using as study methods the dissection of human cadavers (adults and fetuses), the plastic injection followed by dissection or corrosion and the evaluation of 40 abdominal angiographies and 15 ultrasound, the authors tried to assess the morphological peculiarities of 105 cases of superior mesenteric arteries. The origin of the superior mesenteric artery was assessed on 31 cases; in 27 of them the origin was located at the level of L1 and in only 4 cases at intervertebral disk D12-L1. Except the four samples when the superior mesenteric artery originated from a celiomesenteric trunk, the origin of the superior mesenteric artery was always under the origin of the celiac trunk and, in relation with the renal arteries, was above their origin. The right collateral branches were evaluated on 68 cases, with two aspects: in 29 samples appeared three branches (the artery of the right colic angle, the middle colic artery and the ileocolic artery) and in 39 cases appeared two branches, the middle colic artery missing. In a single case the artery of the right colic angle originated under the origin of the ileocolic artery. The ileocolic artery ended in bouquet in 11 cases, in a colic branch and a bicecoapendiculoileal branch in 28 cases and in 9 cases in a colicoapendicular and a bicecoileal trunks. The highest variability was encountered in the case of the middle colic artery, evaluated in 64 cases; in 32 of them was unique, in 20 cases was double and in 12 cases was missing. In a single sample the middle colic artery formed individually the transverse paracolic arcade, by anastomoting with the colic branch of the ileocolic artery and with the superior colic branch of the inferior mesenteric artery. In 4.17% of the cases we encountered a second hepatic artery originating from the superior mesenteric artery and, in a single case, a splenomesenteric trunk..

The Incidence And Diagnosis Of Enteromesenteric Infarction
S. Paris

ABSTRACT. Enteromesenteric infarction is an extremely serious affection, which appears with higher frequency in patients over 40 and is frequently associated with other cardiovascular disorders. The study has been done on a group of 67 patients between 1995-2004, whose age was between 35-85. Varying with age, the results show the higher incidence of this affection in age groups between 60 and 70 (46 of the 67 studied cases). In terms of sex, we have noticed a slight preponderance in women (36 cases). When we analyzed the structure in terms of social environment and residence, the studied group was predominantly urban, 73% as opposed to 27% belonging to the rural environment, this being due to the fact that patients living in urban areas see a doctor more often than patients living in rural areas. In terms of the patients’ occupation, the structure of the investigated group shows that the majority of them were pensioners (86.51%). As far as the analysis of the pathological antecedents is concerned, the most frequent affections were the cardiovascular ones: H.T.A., arterial fibrillation, valvular affections, effects of a recent myocardium infarction, cardiac insufficiency. When we analyzed the internal symptomatology of the patients in the studied group at hospitalization, abdominal pain had a frequency of 98.51%, practically being present in the majority of patients, an aspect also pointed out in all specialty literature. The occurrence of hypovolemic shock signs is to be found precociously enough. As far as the diagnosis at hospitalization is concerned, in 46% of the cases the diagnosis was surgical acute abdomen, in 24% of the cases it was obstruction of the bowels and only 11.4% of the patients were suspect of enteromesenteric infarction. In spite of all imagistic, surgical and therapeutic technical progress, enteromesenteric infarction still remains related to an extremely high rate of mortality: 75-80%. There are two explanations for this: the rare occurrence of the affection makes it difficult to be diagnosed promptly and mesenteric ischemia is to be found usually with elderly patients, who have serious cardiovascular chronic affections, are medically compromised and do not tolerate the affection adequately from a physiological point of view.

Plastination at the Anatomy Department of the Faculty of Medicine of Constanta
D. Iliescu, P. Bordei

ABSTRACT. Plastination is a relatively new method for the preservation of perishable biological specimens, especially for soft, putrifiable ones with high water content, for example whole organs like brain, heart, liver, lung, kidney, muscle and joint specimens and body slices in the field of anatomy and pathology. However relatively expensive, plastination offers multiple advantages compared with other preservation methods. Considering the increasing needs of biological specimens to provide a good comprehension to medical students on one side and the decrease of “supply” on the other, plastination provides a constant amount of such specimens, with optical and mechanical proprieties similar to the natural sample. Moreover, due to safety concerns about the utilization of formaldehyde in biology and anatomy classes, plastination minimize the utilization of this chemical for the health of the students as well as teachers. In the Anatomy Department of the Faculty of Medicine of Constanta, the method of plastination was developed since year 2000, by establishing a well organized laboratory, which, for the moment, proves to be the single in our country. The method we applied is the silicone plastination (S10) that addresses to macroscopical samples, such as internal organs (hearts, kidneys) or slices of nervous tissue (brain slices) greater than 10 mm, samples resulted from the dissection process in the Anatomy Department. Surpassing the difficulties of the beginning in small steps, we are now in the position of providing excellent specimens, plastinated by several methods, that respects all the anatomical and preservation criteria of the moment.

The Phenytoin As Teratogenic Agent In Different Strains. Experimental Study
Lidia Chircor, Mirela Cojocaru, Stela Zamfirescu

ABSTRACT. The stage of embryonic development determines the susceptibility to teratogenic factors. The type of malformation produced depends on which organ is most susceptible at the time of the teratogenic action. Exposure of the embryos to the action of phenytoin cause general development retardation, decreased embryo’s survival rate and weight, and induce a pattern of dysmorphogenesis known as the Fetal Hydantoin Syndrome. In the present study we attempt to investigate the effects of late gestational age exposure to phenytoin in mice and to bring some lights on the peculiar teratogenic susceptibility of different strains to the phenytoin. As experimental model we used two different strains: A2G and C57 mice as control groups and as experimental groups phenytoin 6mg/100g body weight in the late gestation period. In each materno-foetal unit was performed morphometric and morphologic exam. The basic sample unit was the litter.The statistical analysis used the litter data. The data obtained reveals appropriate values of implantations’ rate in both A2G and C57 control groups but their susceptibility to the teratogen differ in statistic significant manner. When teratogen dose of phenitoyne was injected into pregnant mice of strain A2G, which have spontaneous rates of oral clefting of 10.4% it caused cleft lip/palate in 96.6%. When teratogen dose of phenitoyne was injected into pregnant mice of strain C57, which have spontaneous rates of oral clefting less than 1%, it caused cleft palate in 20.6% of strain C57. The phenytoin as teratogenic agent accentuate the incidence of cleft lip/cleft palate that occur sporadically without treatment.

Clinical Outcome Of Lupus Nephritis In Constanza County
Liliana Tuta, Onciu Mihai, Felix Voinea, Alina Sburlan

ABSTRACT. Over the last 4 decades, changes in the treatment of lupus nephritis and general medical care have greatly improved both renal and overall survival. Recently, with the addition of immunosuppressive agents such as intravenous pulse cyclophosphamide to therapy, the 5- and 10-year survival rates are documented as high as 85% and 73%, respectively. The aim of study was to evaluate the clinical outcome of lupus nephritis diagnosed and treated in the Internal Medicine Department of the Clinical Emergency Hospital of Constantza county, in the interval of time 2000-2005. Methods: Thirty-two patients with lupus nephritis (LN) were followed up in an interval of time of 5 years. Their status at diagnosis and their treatment schedules and outcome were analysed. 25% had WHO V nephritis. Results: Almost 50%(14/32) of our patients already had clinically manisfested LN when included in the study. About 20% of the patients developed terminal renal failure. The most frequent Three patients died from infections or major cardiovascular events. A high chronicity index in histology and the presence of arterial hypertension or renal failure, or both, at the time of diagnosis were significant risk factors for the development of terminal renal failure in the course of the disease. Conclusions: Kidney damage and chronic histological changes at time of diagnosis were significantly common in our patients. Nine out of 13 were treated with MMF and prednisolone, 3/10 with MMF alone and 1/10 with MMF, prednisolone and cyclosporine.


Survival At Discharge From Hospital After A Cardio – Respiratory Arrest Function EKG Aspects Identified Immediately After Resuscitation And 24 Hours After Resuscitation
RodicaTudoran, M. Toringhibel , Alexandra Cojocaru

ABSTRACT. Cardio – respiratory arrest is one of the most dramatic situations in emergency medicine. Without immediate cardio – respiratory measures, the victims of cardio – respiratory arrests produced in hospital as well as outside the hospital, have no chance of survival. Adult cardio – respiratory arrest is defined as the lack of central, carotidal pulses well as the lack of spontaneous ventilation, after opening the airway to an unconscious patient. It is known that the evolution from the cardio – respiratory arrest to biological death depends on 3 elements: nature of illness that caused cardio – respiratory arrests the moment of beginning cardio – pulmonary resuscitations the mechanism that produced cardiac arrest (arithmic/nonarithmic) and the response to defibrillation. The results of cardio – respiratory resuscitation are strongly influenced by the medical conditions before the arrest, by the process of resuscitation itself, by the complications after the resuscitation which appear to hospitalized survivors. Electrocardiography aspects after resuscitation have great variability in a short time and are important predictors of survival; they are essential in orienting the correct treatment, outside the hospital, in the emergency department, as well as in the intensive care unit.


Peripheral Deep Vein Thrombosis - Imaging Study - Ultrasonography / Phlebography
Elena Chiriac, R. Baz

ABSTRACT. Our purpose - to evaluate the US exam for peripheral deep vein thrombosis (DVT) 11 clinical selected patients were examinated on US ALOKA 4000 with 7,5 Mhz transductor for echo; the US examination included color and spectral Doppler mode. For phlebography we used X-ray equipment ICONOS produced by SIEMENS. The results confirms the literature dates :the US exam offers informations in a good corelation with phlebography results; ultrasound can replace phlebography in many cases; but phlebography is the “gold standard” for DVT.


Metabolic Control During The Menstrual Cycle In Patients With Insulin-Dependent Diabetes
Doina Catrinoiu

ABSTRACT. The impact of menstruation on metabolic control was studied among 20 insulin-dependent diabetics and 20 healthy controls during two menstrual cycles. No systematic fluctuation in glycated protein, blood glucose levels, food intake and body weight could be seen during different weeks in the menstrual cycle. A tendency towards menstruation-related variations in the number of insulin reactions and amount of extra injected insulin was observed in the patient group. Levels of glycated hemoglobin were significantly (p<o,o5) higher during the premenstrual period than during the postmenstrual period of one week, although the difference was small in absolute terms. A lower mood during the premenstrual weeks (indicating premenstruation syndrome) was associated with a high number of hypoglycemic events (p<0,01) a frequently during the menstrual cycle frequent changes in insulin doses (p<0,01). Thus, taken as a group diabetic women do not experience great changes in food intake or metabolic control during the menstrual cycle. This does not exclude the possibility that a small proportion of women have major menstruation related difficulties in controlling their diabetes.

Endarterectomy and Thrombendarterectomy In Patients With Severe Chronic Ischaemia Of the Lower Limbs
Raluca Pasare, Marta Budu, Marta Cristina, Aurelia Terzi, D. Bajan

ABSTRACT. Our survey highlights the surgical treatment options available for the patients with obliterant arteriopathy of the lower limbs in the stage of critical chronic ischaemia or chronic ischaemia stages III or IV. These stages are considered severe ischaemias, in point of their evolution and treatment availabilities. In the same context, such patients usually have associated cardiac conditions that rule out more complex intervention (by-pass with prosthetic graft or with saphenous vein). Accordingly, we have opted to perform a less invasive intervention – endarterectomy and thrombendarterectomy of the femoral tripod. The evolution of these patients was favorable.

The Infection Prophylaxis And The Antibiotic Treatment In The Open Fracture Of The Leg
B. Obada, N. Obada, V. Lupescu, Anca Zugravescu

ABSTRACT. The open fracture means the communication of the fracture site with the outside, secondary to the creation of a continuity solution of the soft tissue cover. This distruction of the soft tissue is followed immediately by the contamination of the fracture site. So , any open fracture is potentially contaminated, but depending of the therapeutic decision we shall take, the fracture site will be infected or not. The fracture site infection is the most dreaded complication, and its late forms, osteitis and supurated pseudarthrosis, are difficult to control and treat. The paper evaluate the general antibiotic treatment, in emergency and later, in relation with the open fracture type and with the result of the bacteriological exam, statistical evaluation of the hospitalized patients in the Constanta Orthopaedic-Traumatology Clinic between 2000-2003 with open fracture of the leg. The antibiotic treatment must be seen like an important therapeutic component and it complete with succes the complex local therapy for the aim of transforming of a high contaminated and unviable wound, into a clean wound with a certain viability. The neglect or minimising of that aspect of the therapy can determine an uncontrolled evolution of the fracture site, both on short term and long term.

Modern Antibiotic Treatment After TUR-P
F. Voinea, Liliana Tuta, E. Caeridin


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.

Clinical And Therapeutic Correlations Of Parkinson Disease
Anca Hancu


ABSTRACT. Parkinson disease is the second as frequency after Alzheimer disease of degenerative diseases of the nervous system (1). The modern pharmacological treatment of the Parkinson disease is with neuroprotective agents and symptomatic therapy. The goal of this treatment is slowing or even stopping the disease progression. The etiology of the disease is still unknown.

Age-Related Macular Degeneration
D. Denislam, Farah Constantin, Sanda Jurja


ABSTRACT. AMD is a degenerative retinal disease that can cause central vision loss. AMD is the leading cause of severe vision loss in people over 50 years of age. Vision loss in AMD occurs when the macula becomes damaged. The macula is a region at the center of the retina where images are focused. It is responsible for perception of images immediately in front of the eye and is necessary for detailed reading or writing and for the appreciation of color. Once one eye is affected, there is a greatly increased risk that neovascular AMD will develop in the fellow eye within 3–5 years. Early diagnosis, referral, and therapeutic intervention reduce the risk of vision loss. Diet and lifestyle changes, antioxidants plus zinc, or zinc alone may slow progression to advanced AMD. Laser photocoagulation and Visudyne® therapy are proven and locally available treatments for patients with predominantly classic and occult subfoveal AMD.

Clinical Prediction Models In Obstetrics And Gynecology
V. I Tica, S. Bafani, Irina Tica, O. Teren, M. Zaher, Monica Vasile


ABSTRACT. The prediction methods allow patients to make the most reliable choices from the different treatment ways, refer to their own poten¬tial outcomes There are 5 types of techniques for the development of a clinical predic¬tion model or rule based on some older methods of statistics like univariate analysis, multivariable analysis (e.g. logistic regression) or newer like neural network, predictive nomogram and CART analysis. Newer predictive methods hold the promise of achieving models that not only extract the most discriminatory potential from the data but also promote the use of the models in the clinical setting.

Results Of ELISA Ig G Tests In Diagnosis In Taenia Echinococcus Infection
Mihaela Botnarciuc, Victoria Braga, Botnarciuc V. Aurelia Baciu, Lavinia Voineagu1, Adina Barbu1.


ABSTRACT. The aim of the study is to evaluate the results of the immunologic tests for detection of Ig G anti – Echinococcus in the diagnosis of T.echinococcus infection. There were investigated 86 pacients, in the period march 2005- march 2006. Among them, 36 were either suspected, or folowed-up after surgery for hydatic cysts. A number of 50 persons, without any suspicion of hydatic disease were also tested and formed the control group. The immunologic diagnosis was performed with ELISA – RIDASCREEN Echinococcus Ig G, Germany. From 33 patients suspected of hydatic cysts 10 pacients had positive results with S.R. (serum ratio) 1,1 - 2,17 and in two cases there were intense positive S.R.›1,5. For the 3 operated patiens the results were intense positive, S.R. between 2.3-3.56. They were retested monthly. There was an increase on IgG level postoperatory, then a constant decrease in 6 months. Conclusions 1. ELISA method for Ig G anti – Echinococcus, is a sensitive and specific method. 2. Detection of Ig G anti – Echinococcus is particulary usefull in the follow up of patients after surgery for hydatic cyst, the success of the treatment being confirmed by the negativation of the tests.

Tuberous Sclerosis Bourneville – Case Presentation
Valeria Stroia, Frecus Corina, Balasa Adriana, Mihai Cristina, Zugravu Adina


ABSTRACT. The authors present a case of an adolescent girl diagnosed at puberty with tuberous sclerosis Bourneville. Tuberous sclerosis Bourneville is one of the most frequent progressive, dominant autosomal inherited neurocutaneous syndromes. Clinical findings include neurological manifestations (seizures, cerebral tumours, mental retardation), cutaneous signs (acromic spots, angiofibromas, shagreen patches, “café au lait” spots), renal manifestations (polykystic disease, adenomas, miomas, fibromas, angiomas, teratomas), heart symptoms (rhabdomyomas and cardiac arrhythmias), retinal hamartomas, lung involvement and bone lesions (diffuse sclerosis, cystic lesions in the bones).




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