ARS Medica Tomitana
vol. XII - nr. 4 (47) - october - december 2006

Vertebral Canal Stenosis Following Osteochondrosys - A Case Study
Madalina Iliescu, Viorel Lucescu

ABSTRACT. This study was performed on a 36 years old female patient, with gallbladder lithiasis (colecistectomy at the age of 29 and repeated bilateral renal lithiasis after extracorporeal shockwave lithotripsy - ESWT), complaining, about 3 years ago, after a hard physical effort, of acute lumbar pain that radiate along the right lower limb (S1 root), and without cease under medical treatment. Several hospitalizations in our clinic occurred, with the diagnosis of stenosis of the vertebral canal following mixed type osteochondrosys, central and foraminal, with irritative syndrome at S1. The association with a syndrome of generalised hypermobility, present in our case, may suggest the coexistence of a connective tissue malfunction and the possibility of the implication of such element into the etiology of the secondary spinal canal stenosis.

Angiogenesis and Tumoral Location in Primary Breast Cancer Patients: an Analysis of 145 Needle Core Biopsies
S. Vamesu

ABSTRACT. Angiogenesis is essential for tumor growth and metastasis. In breast carcinoma diagnosed on core biopsy (145 patients) microvessels were counted and the density of microvessels were graded to investigate how tumor angiogenesis correlates with tumoral location. The number of microvessels was counted manually using light microscopy in a subjectively selected hot spot (in the most active areas of neovascularization per 400x field) without knowledge of the outcome in the patient or any other pertinent variable. The tumours were classified as high or low MVD, based on a cut-off value (32,89474 microvessels / mm2). The primary tumor was located most frequently in the upper outer quadrant (65,52%) and least in the lower inner quadrant (6,9%). When the mean values of MVD of the groups defined by tumor side (right vs left) were compared, no significant difference was noted (P = 0,063082). MVD didn’t show a relationship with groups defined by tumor side (P = 0,161011). When the mean values of MVD of the various groups defined by tumor location were compared, no significant difference was noted (P = 0,110559). MVD did show a relationship with groups defined by tumor location (P = 0,016632). When were compared the microvesel density between inner versus outer quadrants a significant difference was noted (P = 0,0476). When were compared the microvesel density between upper versus lower quadrants no significant difference was noted (P = 0,195061). Assessment of tumor angiogenesis may therefore prove valuable in predicting regional metastasis and local recurrence.

Genotype - Phenotype Correlations and Specific Aspects of Genetic Counseling in Malformative Syndromes
Anca Popescu, Irina Durbala

ABSTRACT. Congenital malformations (birth defects) represent structural or functional anomalies, clinical expressed to any age. They are produced by genetic or non-genetic factors before birth and they are transmitted or not through generations. The association of several minor or major malformations, with the same pathogenic mechanisms represent a malformative syndrome. Our aim was to establish some correlations between the phenotype (clinical signs) and genotype (the karyotype anomalies) to 16 patients with different malformative syndromes. We’ve realized the genetic evaluation and the karyotype by lymphocyte culture. The conclusions emphasized the importance of prophylaxis and of genetic counseling because of difficulties in establishing the diagnosis and the etiology of malformative syndromes.

Some Biochemical Data About the Evolution of Blood Enzymes CK, AST and LDH in Ischemic Heart Disease
Irinel Verman, Mihaela Basa, Natalia Rosoiu, Elvira Craiu, Victoria Braga

ABSTRACT. The purpose of this study is to approach the value of laboratory data requested in clinical diagnosis, prognosis and treatment of myocardial infarction (MI), the final stage in the development of ischemic heart disease when irreversible cell death occurs. Enzyme activities of CK, AST and LDH, were assessed in 100 patients: 50 hospitalized for myocardial infarction and 50 with angina pectoris (72 men aged 38 to 70 years and 28 women aged 35-72 years). Relevant clinical information, biochemical determinations and details of evolution and treatment were followed from the medical files. The biochemistry tests were performed in the Clinical laboratory of the Constanta County Hospital and Emergency Military Hospital, using the routine methods. The highest incidence of MI is present in men (76%) and the most affected age groups are 50-59 years (36% from total) and older than 60 years (28%). In the MI etiopathogenesis important risk factors are represented by the family history (69%), stress (51%), and obesity (68%). The MI is accompanied by specific elevations with characteristic evolution of serum enzymes activities: total CK and CK-MB isoenzyme (with a value of 78.44% higher than normal upper limit), AST (71.3% more than reference range) and LDH increased up to 68.65% more than normal maximal limit. The electrophoresis of LDH showed the increase of LDH1 and LDH2 isoenzymes, with an inversed ratio LDH1/LDH2. The most useful enzymes for diagnostic purpose in a patient with suspected myocardial infarction are CK for early confirmation of the diagnosis and LDH for those patients (often with atypical clinical feature) that may present several days after the supposed infarct. The association of these three enzymes activity with a specific dynamic evolution represents an important criterion for the diagnosis of myocardial infarction that does not have an electrocardiographic image (approximately 10%). It is important for all the patients to be monitored for some other biological parameters such as serum glucose, fibrinogen, C reactive protein (CRP), ESR, WBCs counting, coagulation tests, serum total cholesterol, LDL-C, HDL-C and triglycerides dosing for the risk evaluation for MI. The overall aim of the treatment is to prevent death from cardiac arrhythmia by administration of appropriate drugs and to limit the rise of myocardial infarction. Following the suitable therapy, the general state of patients was improved after one week approximately. At the time of discharge, the serum enzymes activities for some patients were still over the superior normal limit, but the control after 4 weeks has shown total recovery.

A Morphometric Approach to Intramural Arterial Network of the Salpinx
T. Leonte, M. Onciu

ABSTRACT. The aim of this study is to emphasize those aspects of microscopic salpingeal arterial distribution which are important to tubal clinical approach and to the functions of the oviduct. A morphometric protocol was used to measure and/or calculate the vascular digital parameters of the salpingeal intramural arteriolar network, exposed by stained tubal cross-sections. A pattern of the intramural arterial distribution was established, resulting in the release of a vasculo-nervous based theory of the salpingeal functional architecture. Vascular ageing processes were numerically assessed and a vascular related theory of age induced female infertility of tubal origin was released.

Histological Study of Uterine Cervix Before and After Menopause Onset
Emma Gheorghe, Mihaela Hincu, G Nicola

ABSTRACT. The aim of the present study is to describe the morphological differences in the structure of uterine cervix before and after menopause onset. For this study we used 20 pieces of human uterine cervix from patients subjected to hysterectomy in the Obstetrics-Gynecology Clinique, County Hospital of Constanţa. The specimens were divided into 2 groups: group A composed of 10 specimens harvested from women of 20-40 years of age, and group B composed of 10 specimens harvested from women over 50 years of age. The specimens were prepared with classical histological technique of paraffin embedding. Serial sections were stained with using hematoxylin-eosin, trichromic Goldner-Szekelly and orcein techniques in order to observe the general structure of uterine cervix. The images were captured from the microscope using a videocamera, a capture board and a computer. The obtained data were interpreted and represented in graphics. The study showed that the uterine cervix of women in post-ovulatory period undergoes certain characteristic histological changes. The modification affects all the three layers of uterine wall and is mainly characterized by atrophy and hyaline degeneration. The histological modifications of the uterine cervix lead to physiological alteration of the organ. With aging, under neuro-endocrine influences, the entire female reproductive system is modified.

Painful Shoulder - Shoulder Rehabilitation
Adriana Clipa

ABSTRACT. The scapulo-humeral periarthritis is a clinical syndrome well defined by pain, stiffnes and functional impotence of the shoulder joint, associated with different degrees, in relation with the pathological processes that involves the structures surrounding the joint and the joint capsule. In this paper we analyze the efficiency of rehabilitation in order to decrease shoulder pain, increase range of motion and strength on patients with simple painful shoulder. Our study was performed on 48 patients evaluated through goniometric measurements of active shoulder range of motion, muscular testing and plain shoulder x-rays and treated in Clinical Emergency Hospital of Constanta between 1st of January-15th March 2006.The patients were divided into three study groups: group A received oral non-steroid anti-inflammatory drugs (NSAIDs); group B- physical and kinetical therapy and group C received combined treatment (physical and kinetical therapy + NSAIDs). The combined rehabilitation treatment applied on patients on group C leads to a rapid improvement of shoulder pain with diminish of functional impotence of the shoulder joint and allowing to this patients to return to normal activity as soon as possible.

Is Glycemic Control Necessary During Cataract Surgery?
D. Denislam, Farah Constantin, Sanda Jurja

ABSTRACT. Cataract surgery is performed on diabetic patients when their blood glucose level is well controlled. If blood glucose is not well controlled, however, medical treatment is performed and surgery is delayed. This article discusses perioperative blood glucose control for diabetic patients undergoing small-incision phacoemulsification cataract surgery and the best strategy of controlling blood glucose before and after surgery. Rapid preoperative glycemic correction should be avoided on patients with moderate-to-severe nonproliferative diabetic retinopathy because it may increase the risk of postoperative progression of retinopathy and maculopathy. To achieve good visual outcome, surgery may need to be performed on patients with moderate-to-severe nonproliferative diabetic retinopathy or maculopathy.

Ocular Involvement in Cutaneous Leishmaniasis - A Potential Public Health Problem
Sanda Jurja, Gabriela Lilios, A. Fono

ABSTRACT. Leishmanioses are a group of parasitic diseases that affect man and other mammals. They are caused by different species of trypanosomatids of the genus Leishmania Ross, 1903 and have tegumentary and/or visceral manifestations. Because the disease seems to be present more and more frequently, it is absolutely compulsory to be able to recognize the lesion, in order to take the most adequate and quick measures for preventing more severe eye damages. Several strategies are used to control the disease. The paper presents the case of a patient with ocular involvement cutaneous leishmaniasis.

The Utility of Prediction Methods in Obstetrics
Vlad Tica, Stelian Bafani, Irina Tica, Ovidiu Teren, Mohamed Zaher

ABSTRACT. Prediction methods have been planned to identify prediction model applications in Obstetrics, their usefulness in planning intervention trials, creating benefit or risk indicators, estimating the population burden of the disease, and designing prevention strategies. These powerful tools are also useful to identify ways to improve current and future obstetrical prediction methods and to identify research needs and population data resources for future disease prediction modeling and validation and, than, to disseminate this information to the scientific community. We present in the article some of the data are in favor of the benefits of using prediction methods in various sub-domains of obstetrics, like (without covering the entire field) pathological pregnancy, fetal well-being or distress and obstetrical analgesia.

Technique of Vaginal Suspension After Hysterectomy
L. Irimiea, R. Stanca, H. Riad, A. Spyrou

ABSTRACT. The authors are proposing improving the technique of vaginal suspension after hysterectomy by using the elements of fixation of the uterus and the lombo-ovarian ligaments, adapted to the case. Study design. Two groups of 15 patients with forms of prolaps and urinary incompetence who have undergone a total hysterectomy with bilateral anexectomy, the groups benefited by vagina suspension by 2 different procedures, the procedure proposed by the authors and Aldridge. Comparative function exploration clinical data analysis before and after two months after surgery yield a better result improving pelvic status.

Association Between Nuchal Cord And Placental Abruption
L. Serbanescu, V.I. Tica

ABSTRACT. This study analyzed the association between nuchal cord and placental abruption. It was done in Constanta Clinical Hospital between 1996 and 2006 and the data were collected from the birth files. The incidence of nuchal cord was 20 per 100 births and the incidence of placental abruption was 0.56 per 100 births. The nuchal cord was regarded in 10.67 per 100 placental abruptions. The total number of cases of nuchal cord in association with placental abruption was 27: 17 with simple nuchal cord, 8 with double nuchal cord and 2 with triple nuchal cord. The total number of placental abruptions was 253. The maternal mortality was 1.58% and the fetal mortality was 22.56% after placental abruption. We didn’t regarded maternal or fetal mortality in the group of nuchal cord complicated with placental abruption. The association between placental abruption and nuchal cord doesn’t increase the gravity of the cases when the birth is finished with caesarian section.

Neurologial Causes of Acute Stroke Worsening
Anca Hancu, Steliana Popescu, Daniela Zguma, M. Kaivanifard

ABSTRACT. We presented the neurological causes of stroke worsening of acute stroke of 59 patients in the hospitalization period, admitted in the first six months of 2006 in Neurology Department of Constanta (the average of hospitalization was 12 days). Usually its necessary further investigation for determination of the causes of worsening. Some of them are reversible, under medical treatment and/or neurosurgical intervention: cerebral edema, obstructive hydrocephalus, epileptic seizures and wrong diagnosis; and some of them are irreversible: stroke progression, stoke recurrence and hemorrhagic transformation of ischemic stroke.

Clinical and Terapeutical Aspects of Small Bowel Obstruction
C. Grasa, V. Sarbu, D. Costea, T. Florea, Monica Grasa

ABSTRACT. A simple obstruction is one in which there is interference with passage of intestinal contents and no other complicating factor. Strangulation obstruction has the additional complication of some interference with the blood supply to the obstructed segment of bowel. A high small bowel obstruction is one in which the predominant problem is a loss of gastrointestinal contents from the upper GI tract, and the fluid and electrolyte derangements therefore are dependent on those losses. In a low small bowel obstruction, distention of the small bowel and the accumulation of intestinal contents within the bowel are dominant features. The study is a retrospective one, performed on 82 patients with small bowel obstruction hospitalized and operated between January 1st, 1999 and December 31st, 2003 in the 2nd Clinic of Surgery of the County Hospital of Constanţa, Romania. Symptoms of small bowel obstruction were represented by pain in most of the cases (70%), vomiting (60%), lack of tranzit (31%) and abdominal distension (45%). Only rarely patients present only one symptom, in most of the cases they have associated accuses. Most frequent causes of small bowel obstruction were represented by mechanical obstruction. This was encountered in 91% of cases in our statistics. There are three mechanism of producing this type of obstruction. The main one was located outside the intestinal wall (83% of causes) and it was represented by eventrations, adhesive bands, internal and external hernia. More rarely (13% of cases), the cause was a lesion which affected the intestinal wall like tumors or mesenteric artery trombosis. Only in 4% of the cases there were encountered causes located inside the lumen, like gallstone obstruction.

The Arterial Flow Reestablishment in Critical Chronic Ischaemia - In Obstructions of the Femoral - Poplitheal Segment - Using Leveled Endarterectomies Technique
Marta Budu, O. Unc, Madalina Fanaru, Cristina Tapalaga, Aurelia Terzi, D. Bajan, Raluca Pasare

ABSTRACT. In the last five years, in the 2nd Surgery Clinic from Emergency Clinical County Hospital Constanta, has been performed in order to reestablish the arterial flow in the lower limbs, a new and lesser used technique. The technique consists in discovering the femoral tripod, the superficial and the deeper femoral artery. At this level one can make 2, 3 or 4 arteriotomies, where after administrating heparin i.v. can be performed endarterectomies or trombendarterectomies which have as result good flows and, especially good reflows from deeper femoral artery and from above the arteriotomy. The election place for arteriotomy was chosen after analyzing the arteriography before the intervention. Postoperative was always administrated sodium heparin continuously (by injector, then fractionated at each 4 hours), the doses being adjusted depending on the clotting markers. After 6 days begins the association of the sodium heparin with an oral anticlotting drug (Trombostop or Sintrom). Analyzing the statistics we drawn a few conclusions, regarding the advantages and disadvantages of this technique.

Therapeutical Management in Locally Advanced Colon Cancer
R. Popescu, V. Sarbu, T. Iusuf, Manuela Minca, Cristina Dan

ABSTRACT. Locally advanced colon cancer is defined as a tumour which invades the neighbouring structures and organs, having a distinctive surgical approach and evolution. On a trial of 169 patients with locally advanced colon cancer, authors present personal experience in comparison with literature data, regarding therapeutical strategy: the operability at the moment of intervention, the types of operations, the postoperative attitude, especially the chemotherapy for residual tumoral tissue and the overall survival.

The First Breast Reconstructions After Radical Mastectomy for Breast Cancer Performed in Constanta
O. D. Unc, V. Sarbu, I. Iordache, Marta Budu, Lizica Itu, Diana Nicolaescu

ABSTRACT. The current treatment for breast cancer is the surgical one. After radical mastectomy the following techniques are used for immediate or delayed reconstruction of the breast: placement of prostethic devices and autologous reconstruction. For the first time in Constantza, in the Second Surgery Clinic of Departmental Hospital, our general surgery team performed a breast reconstruction after the patient has been operated for a breast cancer. We report practically the first two cases of breast reconstruction with latissimus dorsi miocutaneous flap made in 2005.This technique used the reconstruction with latissimus dorsi miocutaneous flap and we prefer it better than the other ones not only because of physiological reasons but also for oncological and psychological ones. We consider that this technique is quite simple and needs an increasement in its usage, even though we have to cross some psychological obstacles for the patients and for the doctors who are taking care of breast cancer patients.

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