ARS Medica Tomitana
vol. XII - nr. 2 (45) april - june 2006

Renal Doppler Ultrasonography In Patients With Essential Hypertension And Renal Involvement
Alina Sburlan, Liliana Tuta, M. Toringhibel, Fl. Voinea

ABSTRACT. Objective: to asses by Doppler sonography the arterial changes in patients diagnosed with essential hypertension (EH) and renal involvement. Material and methods: 316 patients (124 female, 192 male) with longstanding EH and renal involvement [microalbuminuria/proteinuria ± reduced glomerular filtration rate (GFR)] were enrolled in this study. The patients were investigated by standard abdominal sonography (B mode) and a protocol of Doppler sonography examination: velocity, resistive index (RI), systolic curve. According to the value of GFR the patients were divided in 3 groups. Results: group 2 and 3 had significantly more frequent morphological abnormalities and more severe renal macro- and microvascular involvement. A significant percentage of the patients from group 1 had an increased RI of arcuate and intralobar arteries. Conclusions: longstanding EH is associated with renal arterial changes provable by Doppler sonography. The severity of arterial lesions is mirrored by renal morphological abnormalities. Elevated RI is a possible marker of microvascular lesions. Doppler sonography is a usefull method to monitor the EH patients. Atherosclerotic lesions of renal vessels could be either a comorbidity, or the cause of the renal dysfunction in patients with EH and renal failure.

The Course of Treated Depression Across The Life Span (Comments Concerning The Inpatients Admitted In The Constanta Psychiatric Clinic During The Last Year Period)
C. Friedmann

ABSTRACT. As it’s the case with other expert leaders of opinion – the general concern and of course, ours also towards the wide spreading of depressive pathology in our country, too, reflects a real phenomenon with public health reverberations, which can no more to be minimized. Depressive disorders are common, recurrent and chronic, and require treatment interventions. A review of many meta-analyses published world-wide imposes the need for accurate assessment of depression severity, the outcome of the illness according to the life span clinical criteria, including suicidality, etc. The initial focus of treatment is rapid resolution of symptoms during an acute phase of the illness, followed by continuation therapy. Maintenance treatment is indicated if the risk of recurrence is high: the range of available medications is considerable and the benefit/risk ratio is acceptable. Depression is diagnosable across the life span and treatable at every age in spite of some disagreements with regard to young patients. Comorbidity, both psychiatric and medical, need to be assessed, as does the possible presence of two subtypes of depression (psychotic and bipolar) often requiring different interventions. It is expected that the next generation of antidepressive medications would be associated with more specific disease and outcome biomarkers.

Endometrial Biopsy – Therapeutical and Diagnosis Guide For The Premenopausal Abnormal Uterine Bleeding
Mihaela-Elena Radulescu, Gh. Ristescu, N Cernea

ABSTRACT. The abnormal uterine bleeding was frequent in perimenopausal age. We study 164 perimenopausal women with abnormal uterine bleeding who have dysmenorrhea 13%, menorrhagia 47%, metrorrhagia 32%, and amenorrhea 8%. The endometrial biopsy relive proliferative endometrium in 15% cases, secretory endometrium in 7% cases, atrophy in 9% cases, simple endometrial hyperplasia without atypia in 38%, simple endometrial hyperplasia with atypia 4%, complex endometrial hyperplasia without atypia 22% and with atypia 3%, endometrial carcinoma 2%. We recommend progestin therapy for 3-6 months and endometrial biopsy should be performed at the completion therapy to assess response. The treatment for complex atypical hyperplasia and endometrial neoplasia was surgical. Abnormal uterine bleeding in perimenopause needs a complex exploration. Periodic endometrial biopsy is advisable especially in patients treated for atypical hyperplasia because of the presence of undiagnosed cancer, or progression to cancer, and the high recurrence rate after treatment with progestines.

MRI Contribution In Symptomatic Epilepsy Diagnosis
R. Baz, C. Niscoveanu

ABSTRACT. The role of MRI in patients with epilepsy is increasing, and MRI is now essential in the preoperative evaluation of patients with partial seizure. The value of MRI has significantly increased over the last few years, mainly due to technical advances allowing for acquisition of thinner images and 3D acquisitions and also to the increased awareness that some areas of the brain are more commonly the source of epilepsy, including the temporal lobe and hippocampus. The purpose of this article is to analyze the MRI aspects found in patients with new-onset seizures, examined in our department. Our study was conducted over 12 months period, and included 38 patients with ages between 2 and 68 years. MRI exams were realized with a 1,0T GE Signa Horizon installation, after an epilepsy protocol individualized for each situation. The results indicated that, in most cases, the etiology of epilepsy was of tumoral nature, followed, in frequency order, by stroke, vascular malformations, mesial temporal sclerosis, cortical scars and developmental anomalies. In a number of cases MRI examination did not revealed any structural abnormalities. MRI proves to be an efficient tool in evaluating patients with new-onset epilepsy seizures. It is also very helpful in establishing prognosis for remission or intractability.

Evolution Devaforable De La Tuberculose Pulmonaire Chez Un Adolescent Infecte HIV - Presentation Du Cas
Claudia Cambrea, S. Rugina, M. Cambrea, V. Ionescu , Claudia Rugina

RESUME. Pendant les dernières années la tuberculose a connu une recrudescence au niveau mondial, aussi comme conséquence de la pandémie HIV. On observe de plus en plus cas sévères et difficilement a reconnaître dans les conditions de la coexistence de la tuberculose avec l’infection HIV. Un rôle décisif dans ces situations joue le diagnostic par imagerie qui contribue à établir le diagnostic de précision avec l’instruction immédiate de la thérapie correspondante. On présente un cas de tuberculose pulmonaire et extrapulmonaire chez un adolescent infecté HIV, ayant une évolution défavorable. On présente les aspects cliniques, paracliniques et par imagerie initiales et pendant l’évolution de la maladie.

Hemostatic Changes In Patients With Incipient Acute Leukemia
Ioana Coralia Codreanu, Hortensia Ionita

ABSTRACT. Acute leukemias are neoplasic diseases with clonal character of the undifferentiated or partially-differentiated stem cells, characterized by the ending of the differentiation and maturation of these cells, associated with their transfer into the peripheral blood. In the absence of differentiation, the increase of leukemic cells leads gradually to the invasion of the marrow, as well as to the invasion of other vital organs such as the liver, the spleen, the lymphatic ganglions, the central nervous system, etc. and underlies the clinical table of the disease. The infiltration and replacement of the marrow with leukemic cells leads to the occurrence of anaemia, neutropenia and thrombocytopenia. The most common clinical signs of leukemia are connected with the infiltration of the marrow. Consequently, anaemia causes psychical asthenia, physical fatigue, palpitations, neutropenia generates bacterial infections, and thrombocytopenia explains the cutaneo-mucous hemorrhagic syndrome. As for the hemostatic changes occurring in patients with incipient acute leukemia, these can be represented by hypercoagulability, disseminated intravascular coagulation syndrome and secondary reactionary fibrinolysis. They can be determined by the dissemination of procoagulant substances from leukemic blasts which may lead to the installation of consumption coagulopathy, of severe thromboses and hemorrhages. The study was carried out on a batch of 50 patients with incipient acute leukemia and had the purpose of pointing out the importance of diagnosing these troubles in patients with acute leukemia, as well as the need of setting up an appropriate treatment at once.

EKG Aspects Identified After A Cardiorespiratory Arrest, Immediately After Resuscitation And 24 Hours After Resuscitation. Evolution Of The EKG Aspects During The First 24 Hours After Resuscitation
Rodica Tudoran, M. Toringhibel, Alexandra Cojocaru

ABSTRACT. Adult cardiorespiratory arrest is defined as the lack of spontaneous ventilation, after opening the airway, as well as the lack of central, carotidal pulses, to an unconscious patient. No matter the cause of cardio – respiratory arrest (cardiac, no cardiac – no traumatic, traumatic), it is due to one of the following mechanisms: • Ventricular fibrillation (VF) • Ventricular tachycardia (VT) • Asystole • Pulseless electrical activity (PEA) The lack of older ekg-s and anamnesthic datas don’t allow us a correct interpretation of ekg aspects after restablishing spontaneous circulation. Ekg aspects after resuscitation are influenced by: • Particularities of resuscitation • Older cardiac diseases • Acute episode that determined cardiorespiratory arrest Electrocardiography aspects after resuscitation have great variability in a short time. Recurency of ventricular fibrillation after succesfull defibrilation of a cardiorespiratory arrest produced outside the hospital is a frequent event. Cardiac frequency and cardiac rhythm determined immediately after resuscitation are important prediction factors for evolution and survival. ST elevation identified on an ekg after resuscitation is not a predictor for future evolution.

Amyotrophic Lateral Sclerosis With Bulbar Type Onset – Diagnosis Pitfalls
Irene Damian, N. Carciumaru

ABSTRACT. Amyotrophic lateral sclerosis (ALS) is a form of motor neuron disease (MND) and it is characterized by clinical and pathological features of upper and lower motor neuron degeneration. We report the case of a 39 years old female with history of progressive dysarthro-dysphonia followed by twitching and symmetric wasting of intrinsic hand muscles, who has been initially misdiagnosed as multiple sclerosis. The purpose of the presentation is to highlight the importance of an accurate correlation between clinical and neuroimagistical examinations, in order to avoid diagnosis pitfalls and to provide correct therapy and prognosis.

HIV- Associated Nephropathy, Diagnosis And Therapeutical Options
Liliana Tuta, F. Voinea, M. Onciu, Alina Sburlan

ABSTRACT. Objectives: To describe current knowledge on the etiology, pathology, diagnosis, and treatment of HIV associated nephropathy. Methods: A Medline search was performed using the key words “HIV,” “nephropathy,” “renal,” and “kidney.” A further search was performed for each of the currently licensed antiretroviral agents linked to key words “renal” or “kidney” . Results: HIV associated nephropathy is a common complication of HIV in black African and Afro-Caribbean patients and presents with progressive renal failure and heavy proteinuria. As other causes of renal failure are likely to fall in incidence among patients successfully treated with highly active antiretroviral therapy (HAART), HIV associated nephropathy will become increasingly prominent as a cause of renal impairment in HIV infected patients. Recent evidence suggests that HIV associated nephropathy will respond to HAART with a dramatic improvement in renal function. Conclusion: HIV associated nephropathy is a treatable condition. This condition should be actively sought in HIV infected patients if they are to receive the benefits of therapy.

Biochemistry, Nuclear Medicine And Histopathology Investigations In The Diagnosis And Therapy Monitoring Of Gastric Cancer
Irinel Verman, Natalia Rosoiu, Mariana Aschie, Adriana Ovezea, Victoria Braga, I. Aschie, E. Caeridin

ABSTRACT. The gastric cancer is one of the most frequent neoplasia in the world. In our country it is frequent, and due to different medium factors, it appears at an earlier age. The etiology implies a multitude of risk factors. The earlier the risk factors act, the higher the risk for the development of this disease. In this paper we analyzed the influence of family factors and other risk factors for the study group represented by 41 patients diagnosed with gastric cancer. The paper presents interdisciplinary data, correlating biochemical tests (hemoglobin, ESR, fibrinogen, glycemia, total proteins, AST, ALT, total and conjugated bilirubin, Na+, K+), with nuclear medicine (ACE, CA19-9) and histopathology investigations (microscopic examination of the bioptic sample), in order to reveal the importance of these investigations in the diagnosis, prognostic and therapy monitoring. For 5 of the patients we determined the total and reduced glutathione (GSH), in order to explore the oxidative stress and the status of antioxidative system in gastric cancer. The biochemical tests revealed anemia in 41% of the patients; all the patients presented increased values of ESR and fibrinogen, markers of inflammatory process and tissue destruction, and hypoproteinemia. The increased values of ALP in 15.6% of male patients indicate the presence of metastases, confirmed by ultrasound investigation. Determination of tumor markers was performed before and after surgery and chemotherapy; the initial values were increased (ACE: 16.14 - 74.4 U/ml and CA19-9: 89.94 - 254.01ng/ml) and they decreased after therapy indicating a favorable prognostic. The microscopic examination of surgical samples is essential for the positive and stage diagnosis, and the indication for the optimal therapy, combination of surgical with radiation and chemotherapy. The reduced values of GSH indicate the injuries produced by the reactive oxygen species as a result of the action of cytostatic drugs or the presence of hepatic metastases. The biochemical parameters indicate suspect cases and offer information about the general status of the patient, the histopathological investigation is essential in the diagnosis and therapy strategy, while the tumor markers help the diagnosis in early stages and the detection of relapse and metastases, improving the survival rate and the patient quality of life.

Heidelberg Retina Tomograph (HRT) Et Suivi Des Glaucomateux Opérés
D. Denislam, Farah Constantin, Sanda Jurja

RESUME. L’analyse tomographique du nerf optique par le Heidelberg Retina Tomographe (HRT) peut être soumise à des modifications temporaires après chirurgie du glaucome. Cependant, il est primordial de comparer des examens fiables pour assurer un suivi optimal des patients glaucomateux. Le but cette étude a été de déterminer quel était l’impact de la chirurgie hypotonisante sur les mesures HRT. Les résultats montrent des modifications temporaires notables pendant au moins les trois premiers mois. Il est donc préférable d’attendre le sixième mois pour faire une mesure fiable qui sera utilisable dans le suivi du glaucome.

Univariable Analysis As Clinical Prediction Model In Obstetrics And Gynecology
Vlad I. Tica, Stelian Bafani, Irina Tica, Ovidiu Teren, Mohamed Zaher

ABSTRACT. A good prediction gives to the patient the possibility to make the most reliable choices from the different ways of treatment. In univariable analysis, associations between categorical variables and a clinical outcome are ascertained through the use of univariable statistical tests such as the Student / test and chi-square analysis. In this method, 4 variables were found to be associated with cesarean delivery after a trial of labor: previous dysfunctional la¬bor, no previous vaginal delivery, nonreassuring fetal heart tracing on admission, and induction of labor in the current pregnancy. The analysis can be done with statistical techniques that are understandable readily by the audi¬ence and accessible to investigators with basic statistical computer packages. Univariate analysis has important advantages (strengths): is a simple statistic method and have easy clinical application.

The Alimentation With Meet – Only Benefits?
Floarea Damaschin

ABSTRACT. It’s well known the fact that in last time the development of food technology has determinate the modification of the nutritional rationaments which have determinate the population often to confuse the proteins with the meet, the fish, the milk and the eggs. The information of the population on the benefits but also on risks which result from the high consume of meet it’s very important for the keep and recoverment of health. The statistic studies (which include groups of vegetarians) sustain that the diminish of meet consume, fats and radiated products would go to the diminish of pathology that is registries in present.

The Mechanism Of Cell Death As An Important Step In Cardiac Development
Mirela Cornelia Cojocaru

ABSTRACT. This study tries to evidentiate apoptotic cells at the level of the heart, as a normal phenomena involved in the developmental remodeling of cardiovascular tissues. We studied myocardial samples obtained from human aborted foetuses, with the age between 16 and 34 weeks. The samples were stained conventionally with hematoxylin-eosin (H-E), Masson’s tricrome and immunohistochemical method.The analyse of the obtained images oriented us to conclude that the apoptosis normally appears during the heart development contributing to the elimination of unwanthed cells. We must consider the signifiance of the elimination of apoptotic cells in the context of the rates of cellular proliferation within the tissue.

Radiating Fractures Towards Skull Base
M. Popa

ABSTRACT. Our research was based on necroptic material from 623 forensic cases that were diagnosed with fractures of the skull, in a 5 years period, at the Department of Forensic Medicine of Constanta. Autopsy, light microscopy, radiological and computerized tomography examinations were among the methods used in our study, and the study data was statistically processed. In 198 cases fractures were radiating at the base of the skull (31,8% of total). 124 cases out of these (62,6%) also showed fractures that interested the petrous portion of temporal bone. We discovered radiating fractures that crossed the base of the skull in a number of 108 corpses (17,3% of total), out of these 86 cases (79,6%) with a transversal orientation; in 71 of this cases (65,7%) the fracture line crosses the base of the skull through the body of sphenoid bone.

PSA In Differential Diagnosis Of BPH/Prostatic Cancer – Clinical Study
F. Voinea, Liliana Tuta, E. Caeridin

ABSTRACT. Prostate-specific antigen is one of the most significant urooncological discoveries of the past decade. This marker has been known since Wang’s publication in 1979. By now, PSA has become a routine examination of prostatic tumorous patients. Being indispensable for diagnosis and determination of the stage, it is the most important diagnostic mean of the checking up of patients. Its widespread use has renddered possible the diagnosis in an early stage of a tumor spreading on an organ, and the early recognition of recurrence following radical prostatectomy. The PSA value of 18% of BPR patients lies between 4 and 10 nglml. Despite all this, PSA is solidly here to stay in urology. The fact that PSA has replaced osteoscintigraphy in the checking up of patients, is significant also from a material point of view. Measured by us was the PSA concentration of 113 patients with histologically proved prostatic hyperplasia, who were treated at this institute between September 2003 and May 2005.The mean value of PSA of males changes according to age brackets as follows: 0,654 between 20 and 30, but 1,154 between 60 and 70.PSA can be repeatedly measured, with a new determination 6 weeks later showing a fluctuation of 1 or 2%. Annual concentration growth in 3%.The introduction of the use of PSAD opens up a new dimension in the demarcation of the local prostatic cancer and BPH.

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