ARS Medica Tomitana
vol. XIII - nr. 2 (49) - april - june 2007

The Maternal-Foetal Units'Development Rate In Experimental Hydantoin Treatment
K. Chrysosthomos, Lidia Chircor, M. C. Tanasi

ABSTRACT. In the light of accumulated observations on the effects of hydantoin the authors wish to evaluate the effects of hydantoin on the maternal-foetal units' development rate. As experimental model we used two different strains according to the international rules of animal care: A2G mice control groups and A2G mice hydantoin groups i.v. injected with 25mg hydantoin day 1-5 of gestation,./100g.body weight. Statistical comparison were performed between the control group and treated groups by student's unpaired t-test; the level of significance chosen for all results was t<0.05. Parametric data including number of live fetuses/maternal unit, body weight, abnormalities, were evaluated. The results reveal morphological landmarks of intra-uterine growth retardation as decreased length and weight, micrognatia, microcephalia, micromelia of the hydantoin groups. Decreased body weight of the maternal-foetal unit and decreased live-fetuses number were observed following early neonate exposure to the hydantoin (t<0,05). The malformed tissues of the phenytoin groups has peculiar microscopic aspects as vascular ecstasy, vascular ecotypes, aglutinated red blood cells and some time hematoma which was in a position to inhibit the normal growth of the tissue in the phenytoin groups. This findings allow the authors to conclude that i.v. hydantoin treatment in the early gestational period may modify the normal development process and decrease the maternal-foetal developments' rate while induce general development retardation and abnormal morphogenesis.

Lysine-Decarboxylase Expression Assay In Escherichia Coli Strains Isolated In Romanian Seaside From Marine And Drinking Water
Emilia Panus, Natalia Rosoiu, Carmen Chifiriuc, Anca Mihaela Israil, Otilia Banu

ABSTRACT. This paper presents data obtained on 99 Escherichia coli strains isolated from marine samples prelevated from Mamaia, Eforie and Costineşti resorts, and 48 isolated from drinking water samples from Constanta. The lysine-decarboxilation is one of the identification tests of germs from Enterobacteriaceae Family, Escherichia coli being a part of this Family, with a lot of human pathogen and human conditioned-pathogen species. In acid medium, the bacteria that generate specific enzyme, lysine-decarboxilase, decarboxilate the lysine and produce cadaverine – a biogenic extremely toxic dyamine. This reaction require the presence of the coenzyme that is the pyridoxine phosphorylatte derivate (B6 vitamin), more exactly piridoxal-phosphat (PALPO). When MOLER medium is air-contact preserved by a mineral oil layer, the glucose fermentative-degradation is certain (versus oxidative) and this prevent the apparition of alkaline metabolites by peptone oxidation. Initially, the bacteria acidify the medium by glucose fermentation and create favorable conditions for the activity of specific decarboxilase, which, in the second phase, alkaline the medium through the amines generated from amino acids. In absence of glucose fermentation, the decarboxilation reactions are not so favorable. The presence of lysine-decarboxilase enzyme on Escherichia coli can be a biochemical marker for the pathogeneses establishment of this bacterium.

Experimental Study Considering The Influence Of Hypersodium Diet On Serum Iron Concentration
N. G. Airinei, Raluca Airinei, Cecilia Adumitresei, G. Badiu

ABSTRACT. The animals (guinea pig) with a hypersodium food intake have shown a significant increase of serum iron. This excess of sodium may possible influence the intestinal absorption of iron and/or on hemolysis, date which suggest a possible interrelation sodium-iron.

Twins birth defects study
Anca Popescu

ABSTRACT. Congenital malformations represent defects in morphogenesis during early fetal life, due to genetic, environmental or both these factors. Twins have an increased frequency of congenital birth defects: CNS, cardiovascular and digestive systems defects occur more commonly in twins than in the single child pregnancy. Multiple births have important economic implications, more frequent and longer hospitalizations than singletons and a higher contribution to hospital costs in the first years of life. A retrospective study of 16.798 consecutive births during 4 years (2003 – 2006) was realized for survey the incidence of minor and major malformations in still born and live twins vs. singletons. The distribution of birth defects, gestational age, birth weight, radiological, biochemical and genetic investigations (karyotype) were also recorded in certain cases.

Bacteria with Nosocomial Potential Isolated From Intensive Care Units Of The Emergency Clinical Hospital Constanta
Adina Barbu, Mihaela Botnarciuc

ABSTRACT. The purpose of our study is to determine the incidence in clinical specimens of the bacteria with high potential of determining nosocomial infections in Pediatric and Adults Intensive Care Units. There were received and examined various specimens. Positive cultures were obtained in 22,79 % of cases. There were 192 bacterial strains, 121 strains of Gram negative bacilli: E.coli, Klebsiella, Pseudomonas, Alcaligenes and Acinetobacter and 71 strains of pathogenic cocci: Staphylococcus, Enterococcus and β-haemolytic streptococci. Sensitivity tests showed the presence of bacterial strains with high resistence to all groups of antibacterial drugs in adults Intensive Care Unit, but the highest resistence and and more extended upon large and various antibiotic groups, including Imipenem, was remarked at the bacteria isolated from pediatric Intensive Care Units.

Actual Incidence and Characteristics of Pseudomonas aeruginosa in Clinical Emergency Hospital Constanta
Mihaela Botnarciuc, Adina Barbu

ABSTRACT. The purpose of our study is to evaluate the incidence of Pseudomonas in clinical specimens and the sensitivity to the usual and reserve antibacterial drugs, in order to apreciate its importance as nosocomial pathogen and the actual level of resistance to antibiotics. The research was done during the period June 2006 -July 2007. We found 132 strains of Pseudomonas aeruginosa in various specimens from patients hospitalised in the Emergency Clinical Hospital Constanta and 10 strains isolated from ambulatory patients. The departaments with the most important number of cases were: Urology (24 strains), Surgery (24 strains), Medical pathology (16 strains), ICU (14 strains). The most frequent localizations were: wounds (54 cases), Urinary (40 cases) and respiratory (22 cases). The significant difference in the number of strains isolated in hospitalized patients comparative to ambulatory patients and the origin of specimens show the importance of Pseudomonas in nosocomial infections. Strains isolated from all departamens showed high level of resistance to large spectrum penicillines and cephalosporines. Resistance to aminogycosides and fluoroquinolones was lower. Imipenem and Meropenem were the only efficient tested drugs for an important number of strains.

Idiopathic Thrombotic-Thrombocytopenic Purpura - Case report
Tatiana Adam, F. Voinea, Anca Hancu

ABSTRACT. The thrombotic-thrombocytopenic purpura (TTP) is a syndrome of intravascular aggregation of thrombocytes. The disease belongs to the group of thrombotic microangiopathies. Thrombotic microangiopathies (TMA) are microvascular occlusive disorders characterized by hemolytic anemia caused by fragmentation of erythrocytes and thrombocytopenia due to increased platelet aggregation and thrombus formation, eventually leading to disturbed microcirculation with reduced organ perfusion. In 1982, TTP was found to be a defect in the “processing” of unusually large (UL) von Willebrand factor (VWF) multimers. By 1998, the cause of TTP was known to be either familial absence or acquired inhibition (by autoantibody) of plasma VWF-cleaving metalloprotease. It is presented the case of a 52 years old man with idiopathic fulminatory form of TTP, who died 4 days after the onset of the illness. The diagnosis was confirmed by morpho-pathological examination by the presence of microthrombosis at the level of small and medium vessels of the basal nucleus, of the myocardium, of the kidneys and also by the presence of severe hemorrhagic pancreatitis. Prompt recognition and treatment are vital, because high mortality occurs due to these disorder. Improving the management of these disease is required considering their high morbidity and mortality.

The Influence Of C Virus Genotype And Host Individual Factors In Cronic C Hepatitis In Dobrogea Area
A.P. Suceveanu, Andra-Iulia Suceveanu, E. Dumitru, Luana Alexandrescu, Fl. Voinea

ABSTRACT. Medical literature offers us only few epidemiological data about the distribution of HCV genotypes in Est-European region. High incidence of chronic viral C hepatitis obliges to more epidemiological studies in this area, to genotype HCV and to identify the genotype influence in treatment management. We studied the genotype of HCV in Dobrogea area and we analyzed host and virus characteristics and their implication in response to treatment. We studied the HCV genotype of 64 patients diagnosed and treated with Peg-IFNs and Ribavirin for 48 weeks in Gastroenterology Department of County Hospital of Constanta, between 2004-2007. We studied the correlation between age, gender, BMI, history of HCV infection, viral load, viral genotype and sustained response to treatment. HCV genotype 1b was present in 95.31% of patients. Favorable prognostic factors were: age <27 years (p=0.39), female gender (p=0.025), BMI<25kg/m2(p=0.023), low viral load, under 680.000cp/ml(p=0.036), short history of infection (p=0.041). Genotype 1b had a negative impact in viral sustained response to treatment. Young age, female gender, low BMI and short history of infection are positive prognostic factors for good response to treatment.

Relation Between The Knee Degeneration And The Knee Swelling, Baker Cyst, Vizualized Degenerative RMI Modifications
Camelia Ciobotaru

ABSTRACT. At present, it is considered that osteoarthritis is an „articular insufficiency” being the result of the interaction of some multiple factors, including the articular integrity, genetic background, local swelling, mechanic factors and cell and biochemical processes.By this paperwork I tried to emphasize the correlation between the clinic exam, MRI modifications of the knee joint, post traumatic and osteoarthritis. The study has been realized on 50 patients, udnergoing a clinic and RMI examination, having the diagnosis of knee liquid accumulation. The articular sweeling in ostheoarthritis reflects the presence of the intraarticular liquid accumulation, the most frequent complication of a knee suffering of ostheoarthritis is the Baker synovial cyst, appearing because of a big quantity of intraarticular liquid accumulation, the ligament degeneration is also reflected by the presence of articular difformities as genu flexum genu varum or genu valgum. The presence of the overflown intraarticular liquid at the MRT examination is correlated with the presence of pain while resting, the risk of not experiencing an articular swelling, in the presence of a small quantity of overflown liquid rather than experiencing a swollen knee without overflown liquid.

The Misgav Ladach Method - A simplified Cesarean Section
M. Stark

ABSTRACT. A simplified and concise procedure, the Misgav Ladach method for cesarean section is introduced. This method is a result of the search for evidence-based steps. Since the introduction of this operation it has been practiced and studied in many hospitals around the world. Without exception all these studies proved benefits of this method, although not always in the same parameters. For the first time a meta-analysis of results of 11 studies was undertaken. It was showed that the Misgav Ladach method for cesarean section is quicker to perform, results in less need for analgesics, febrile morbidity and blood loss. Women operated in this method experienced a faster recovery.

Epidemiology And Predictive Factors For Hepatocellular Carcinoma In Dobrogea
Laura Mazilu, Andra Suceveanu, A. Suceveanu, Fl. Voinea

ABSTRACT. High incidence and mortality rates due to HCC reported in Eastern Europe during last decade suggest that we need more epidemiological studies regarding risk factors for occurrence of HCC in this geographical area. The aim of our study was to investigate local predictive risk factors for HCC in Dobrogea. We retrospectively studied 298 patients diagnosed with HCC admitted in Gastroenterology and Oncology Departments, County Hospital, Constanta, during last 10 years (1997-2007). We correlated the occurrence of HCC to age, sex, provenience, body mass index, alcohol intake, tobacco use, diet, history of viral chronic hepatitis (HBV, HCV), liver cirrhosis, comorbidities. The increase incidence of chronic viral hepatitis, with or without signs of liver cirrhosis, had correspondent in incidence of liver cancer, demonstrating the highest implication in hepatocellular carcinoma etiology (p<0.001). Also, alcohol intake (>100ml/day/> than 5 years) and metabolic disorders such as obesity (BMI> 30kg/m2) and diabetes mellitus showed to be important predictive risk factors for HCC in our area (p<0.05). All these parameters were significantly more important in HCC in males over 60 years (p<0.01). Our study results demonstrate once again the importance of surveillance of all patients presenting risk factors for HCC using simple methods such as US or αFP to decrease morbidity and mortality due to this pathology.

Comparative Study Of Two Groups Of Patients Diagnosed With Ectopic Pregnancy And Treated With Methotrexate
L. Irimiea, R. Stanca, H. Riad

ABSTRACT. The authors utilized a predictive table score for selecting 152 patients with extra uterine pregnancy, for conservative medical treatment with methotrexate, to improve the prognosis of the reproductive function and conserve the fallopian tubes. This group was further divided into two groups. The first group was treated with a multiple doses of methotrexate, the second group with single dose of methotrexate. A comparative analysis showed the superiority of a predictive score utilized for the selection of 152 patients, diagnosed with ectopic pregnancy, for the multiple doses routine in the cases with high pretheraputic predictive score, however the results are approximately the same in predictive score smaller than five. Therefore the routine of treatment can be established according to the pretheraputic predictive score.

Les Hernies Etranglees De L'Aine De L'Adulte: Une Serie Africaine De 228 Observations
M. Dieng, B. El Kouzi, O. Ka, I. Konaté, M. Cissé, A Sanou, Y. Sanoussi, A. Dia, CT. Touré

ABSTRACT. Incarceration is the main complication of groin hernia in adults. There is a controversy on its management particularly the using of mesh or not. Aim. In this survey we report our experience in the management of strangulated groin hernia and there mode of presentation in adults. Material and method. It is a retrospective study carried out from January 1997 to June 2002, during which 228 files of patients operated for Incarcerated groin hernia were analysed. The epidemiological, clinical and managements aspects were reported. Results. The average age of the patients was 45.2 years. There were 220 men (96%) and 8 women (4%). The inguino-scrotal hernia was found in 176 cases (77.2%), the inguinal hernia in 46 cases (20.1%), and the femoral hernia in 6 cases (2.7%). In 145 cases (63.6%) the hernia was on the right side and on the left side in 83 cases (36.4%). The average duration of symptoms prior to presentation was 24 hours. An oblique skin incision was done in 140 cases (61.4%), a transversal incision was performed in 87 cases (38.2%) and midline laparotomy in 1 case (0.4%). Small bowel resection was required in 16 cases (7%). The Bassini procedure was carried out in 158 cases (69%) and the modified Mac Vay procedure in 70 cases (31%). The average duration of hospital stay was 3.6 days. One death was noted (0.4 %). Morbidity rate was 8.3% (19 cases). The following complications were seen: bowel injury (2 cases), caecal injury (1 case), bladder injury (1 case), post operative wound infection (5 cases), post-operative pain (5 cases), delay bowel movement (2 cases) and scrotal haematoma (3 cases). Recurrence was noted in 8 cases (7.4%) among 108 patients followed up during a mean period of 42 months. Conclusion. In this survey; the mortality rate is very low; the rate of bowel resection is low. Despite the current tendency to use prosthetic mesh in emergency, traditional procedures especially the Bassini operation gives good results in the African context.

The Implication Of Axial Valves Number In The Appearance Of The Primitive Hydrostatic Varices On The Greater Saphenous Vein
Marta Budu, D. Bajan, Madalina Fanaru, Cristina Tapalaga, O. Unc, Raluca Pasare

ABSTRACT. The etiopatogenical factors which are involved in the appearance of primitive hydrostatic varices are well known from medical literature: the quality of the venous wall, the insufficiency of the conjunctive tissue, pregnancy, prolonged orthostatism. The ostial and axial valvular system status is also involved in the determinism of primitive hydrostatic varices. A low number of axial valves increase the chances of varicous disease, due to a higher pressure on the subjacent valve and the venous wall. In order to clinically prove this fact, a study has been performed, involving 112 patients admitted and operated for primitive hydrostatic varices. The study concluded that there is a correlation concerning the determinism between the reduced number of the axial valves in the greater saphenous vein and the appearance of systematized primitive hydrostatic varices on this vein.

Type 2 Diabetes Mellitus In Youth
Cristina Maria Mihai

ABSTRACT. In children and adolescents, obesity has increased over the past 10 years. While genetics plays a role in this trend, it is also likely that increased fast food consumption and a more sedentary lifestyle are contributing factors. For most physicians and health care providers, evaluating and treating a child or adolescent with type 2 diabetes is a new challenge. We present an adolescent girl evaluated for obesity, complicated with type 2 diabetes. Early intervention and management strategies could prevent these complications. The best strategy to prevent type 2 diabetes in the pediatric population is to identify children and adolescents with obesity that are at risk and then intervene with regular exercise and healthy eating. Changes in lifestyle and food consumption are the major factors of a dramatic increase in type 2 diabetes in children and adolescents. In this case we initiated specific strategies against obesity and type 2 diabetes based on a team effort (parents, health providers, school personnel, and motivated patient).

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