ARS Medica Tomitana
vol. XIII - nr. 3 (50) - july - september 2007


Identification Of Yeasts From Genital Specimens And Their Sensitivity To Various Antifungal Agents Using Candifast Kit
Mihaela Botnarciuc, Adina Barbu, V. Peţeanu, Mihaela Peţeanu, Aurelia Baciu

ABSTRACT. We used CANDIFAST kit (International Microbio-France), for the identification of the pathogenic yeasts in vaginal specimens and testing their sensitivity to various antifungal agents. Yeasts infections are the second most frequent type of vaginal infections, after bacterial vaginosis. They can produce severe discomfort, but rarely occasional infection cause serious treatment problems, if diagnosed. On the contrary, recurrent yeast infection are difficult to prevent and knowledge of appropriate antifungal dugs to use is very important. The study was realized during one year, September 2006-September 2007. We analised 80 specimen of vaginal secretions, that had positive cultures on Sabouraud gelose. All the specimens were collected from women with clinical spimtomatology of infection present. From 80 isolated strains, 71 were identified as Candida albicans, 6 strains identified as Saccharomyces sp., 2 strains as Candida glabrata and 1 strain as Candida krusei. The sensitivity to antifungal drugs was good, in vitro, for Nystatine, Econazole , Clotrimazole and Flucytosine. We found important resistance in vitro to Ketoconazole.

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.

An Asymptomatic Parasited Jejunal Stromal Tumor !
O. Armstrong , E. Cassagnau, E. Fanara , B. Buecher, E. Frampas , P.A. Lehur

ABSTRACT. Gastrointestinal stromal tumors (GIST) may be hard to diagnose and to manage, their prognosis isn’t always clear.The fortuitous discovery of an unique jejunal localization in a young healthy man reminds us the importance of a surgical treatment. This complete treatment, with no effraction of the tumor , remains the basis of the tumor’s management.The histological and especially histochemical exam specifies the characteristics and brings us prognostic elements we discuss here. All the problem for this large and potentially malignant tumor is the risk of reccurence in the follow up. The discovery of Schistosoma mansoni’s eggs within the tumor is remarkable but can be easily explained

Utilising the RMI (Risk of Malignancy Index) Combined With Power Doppler In The Preoperative Evaluation Of Adnexal Masses
R. Stanca, L. Irimiea, H. Riad

ABSTRACT. Objectives: to investigate the potential efficiency of combining the risk of malignancy index (RMI),CA 125 and ultrasound finding, with the power Doppler to detect ovarian cancer in patients with adnexal masses pre and post menopause. Design: prospective study. Methods: patients admitted to the gynecological department with adnexal masses palpated during bimanual examination and were proposed for laparatomy were further evaluated with ultrasound imaging power Doppler and cancer antigen CA125 for discrimination of malignant and begin ovarian tumors.The prediction was compared to the histological finding post operator. Results: out of 187 patients admitted over 36 months period, 54 of those were predicted with malignant ovarian tumor, 51 of those were confirmed histological. 133 were predicted with begnin ovarian tumor, 119 of those were confirmed histologicaly.Conclusion: combining risk of malignancy index, CA 125, morphologic ultrasound with power Doppler increase the probability of positive discrimination between malignant and begnin adnexal masses.

Cryoglobulinemia During Chronic Viral Hepatitis
Tatiana Adam, E. Dumitru, F. Voinea

ABSTRACT. The aim of the research was to highlight the place of cryoglobulinemia during the chronic viral hepatitis, its clinical and paraclinical particularities. This research is based on a prospective study and a retrospective one and it had been rolling throughout a period of seven years. The study group was formed of 390 patients diagnosed with chronic viral hepatitis (B, C, B+D, B+C+D), from which 205 were male (52,5%) and 185 were female (47,4%). The extrahepatic manifestations were found in 148 patients from a group of 390 patients, which represents a percentage of 37,9%. The results showed a frequency of cryoglobulinemia of 25% of the entire study group. The clinical manifestations of cryoglobulinemias were: cutaneous manifestations (purpura, nodular lesions, ulcerations, necrosis, acrocyanosis), Raynaud syndrome, arthralgia, asthenia, glomerulonephritis, neurological manifestations (polyneuropathy, polyradiculoneuritis). We noticed that there is no relationship between the degree of the cryoglobulinemic syndrome and the level of the cryocrit. The presence of cryoglobulins has been associated with a more intense cytolitic syndrome, without histological correspondence, the necrotic-inflammatory activity and the fibrosis being comparable in these two groups. The frequency of cutaneous vasculitis during the chronic viral hepatitis was of 5,6% per entire group. The type of renal involvement was glomerulonephritis and from the total of 18 cases, 15 cases (83,3%) developed within the framework of a cryoglobulinemic vasculitis. The comparison between the group with vasculitis and the group without cryoglobulinemic vasculitis led to the conclusion that the presence of vasculitis does not influence the degree of liver lesion regarding its functionality.

Prognostic Factors For Fibrosis Progression In PatientsWith Chronic Hepatitis C Relapses To Treatment
A. P. Suceveanu, Andra-Iulia Suceveanu, E. Dumitru, Luana Alexandrescu, Fl. Voinea

ABSTRACT. Studies about natural history suggest that only 5% – 20% of infected persons develop cirrhosis during the first 20 years of HCV infection. Knowledge of the natural history and prognosis of chronic hepatitis C is important, particularly because current associated therapies with PEG-IFNs and Ribavirin are expensive, difficult to tolerate and limited in efficacy. The aim of our study was to assess the rate and predictors of fibrosis progression of in chronic hepatitis C relapses to treatment patients. We studied 35 patients from 211 relapses patients diagnosed and treated in our clinic and had undergone 2 liver biopsies between 2004 and 2006. Liver biopsy specimens were scored using 2 scoring systems. We compared our results to those of other similar cohort studies. Host and virus factors were studied to detect the asso¬ciation with progression of fibrosis. The degree of fibrosis had worsened on the second liver biopsy in only 2 patients, with the mean ISHAK scores increasing from 2.3 to 2.5. In contrast, the average necro-inflammatory score remained unchanged 8.7. One patient showed histological progression to cirrhosis under treatment. Only factors correlated with worsening in fibrosis score were: serum ALT and AST values at the time of initial biopsy. Age, sex, ethnicity, estimated duration of infection, age at the onset of infection, alcohol consumption, serum bilirubin level, albumin level prothrombin time and initial histological scores did not correlated significantly with progression of fibrosis. Progression of fibrosis was minimal in patients with mild degrees of HAI initial liver biopsy and accelerated in those with bridg-ing necrosis and sub-massive necrosis. Progression of fibrosis was found in 2 cases and correlates best with elevated serum ALT levels and degree of periportal necrosis on liver biopsy. There was no association of severity of fibrosis progression with other factors.

Prevalence Of Diabetes Mellitus In Chronic Hepatitis B
Aurora Banta, Luana Alexandrescu, E. Dumitru

ABSTRACT. Viral hepatitis B affects 350 million peoples, 0.4-30% may present extrahepatic manifestation (glomerulonephrites, diabetes mellitus, poliartherites nodosa,..). Our aim was to evaluate the prevalence of diabetes mellitus in patients with chronic hepatitis B and the relationship with liver fibrosis. Diabetes mellitus was present in 17.7% (51/288) and more frequent in older patients (over 40 years) and men. It was associated with high level of ASAT, ALAT, GGT, dyslipidemia and severe fibrosis(>2). Although diabetes is more frequent in patients with severe fibrosis, there are not sufficient dates in literature to sustain if this precedes, accelerates or follows liver progression. We evaluated the prevalence of diabetes in patients with viral B infection and possible association with serum ALAT, ASAT, thrombocytes levels and fibrosis grade. Our study included 288 consecutive patients diagnosed with viral B hepatitis, with age between 18 and 78 years old.

Analysis Of Ploidy Heterogeneity Of Colorectal Adenocarcinomas Using Flow Cytometry
Georgeta Cozaru, Andra Suceveanu, Fl. Voinea

ABSTRACT. Since cancers consist of predominant sub-clones with proliferative advantage due to clonal expansion, we attempted to analyze the clonal expansion of colorectal adenocarcinomas within a tumor by measuring DNA ploidy by flow cytometry. DNA heterogeneity of colorectal adenocarcinomas has been investigated by flow cytometry. DNA ploidy and cell proliferation were studied by means of flow cytometry in 150 patients with colorectal adenomatous polyposis who had undergone polipectomy. The relationships between ploidy and some clinico-pathological variables were analyzed. Flow cytometric analysis of DNA content in the 150 tumors showed that 122 were aneuploid (81.3%) and 28 were diploid (18.7%). No more than four different sub-clones were observed in any one tumor. The present study demonstrates a high incidence of aneuploidy and a high degree of intra-tumor ploidy heterogeneity in colorectal adenocarcinomas. Our results suggest that the biological characteristics of malignant cell populations are variable.

Osteoporotic Vertebral Fractures
V. Orbeanu, B. Obadă

ABSTRACT. Osteoporosis makes your bones weak and more likely to break. Anyone can develop osteoporosis, but it is common in older women. As many as half of all women and a quarter of men older than 50 will break a bone due to osteoporosis. Kyphoplasty and percutaneous vertebroplasty are new treatment for osteoporotic compression fractures of the spine.

Vincristine effect on seizure treshold in mice
B. Pavel, I. Savu

ABSTRACT. Objective: in this study we wished to investigate vincristine effect on hipoglicemic seizure treshold in mice.Material and Method: we used 62 mice divided in two lots, 31 mice per lot.One lot was martor and the other lot recieved vincristine two weeks, twice per week.After that, hipoglicemic seizure treshold was determined.Results: seizured toxic dose 50%, of insulin was 3 u.i/bw in vincristine lot, than 5 ui/bw in martor lot.Motor activity wasn’t influenced by vincristine administration.Conclusion: vincristine has a neurotoxic effect in mice.We had a mortality of 29% in vincristine lot, greater than other studies.

Tuberous Sclerosis Bourneville Complex
Alina Martinescu

ABSTRACT. Tuberous sclerosis complex (TSC) is an autosomal dominant multisystem neurocutaneous syndrome affecting cellular differentiation, proliferation, and migration early in development, resulting in a variety of hamartomatous lesions that may affect virtually every organ system of the body. The diagnosis is based on clinical criteria. Tuberous sclerosis complex exhibits an autosomal dominant inheritance pattern, with a high spontaneous mutation rate. Two distinct genetic loci responsible for tuberous sclerosis complex have been identified: one on chromosome band 9q34 (TSC1 mutations present in 10-20% of affected individuals) and another on chromosome band 16p13 (TSC2 mutations are present in 80-90% of cases). Recent research has begun to identify phenotypic differences as they may relate to particular genotypes. The TSC2 gene is contiguous with the gene producing polycystic kidney disease PKD1. Individuals with features of both TSC and polycystic kidney disease likely have deletions spanning both genes. E.I. proband, 16 years old, was clinical, paraclinical and genetic investigated. Based on clinical and paraclinical dates established the diagnosis of tuberous sclerosis Bourneville.

Congenital Syphilis: An Important Problem Of Public Health In The County Of Constanta
Gh. Nicola, Ştefania Ghilea

ABSTRACT. The incidence of infections with sexual transmission (I.T.S.) in Romania is rather high. Nowadays, in our country, from all I.T.S., it is compulsory to report the cases of congenital syphilis, gonorrhea and AIDS. From these, the incidence of syphilis can be considered an indicator to the evolutional tendency of this category of diseases. According to the data of the Ministry of Health, the incidence of syphilis doubled in the year 2000 (45,17 new cases at 100 000 inhabitants) in contrast to 1989 (19,8 cases at 100 000 inhabitants). It is considered that the official existing data reported are below the real number of cases, realizing the evident tendency of the sick people with I.T.S. not to address the specialty cabinets. An important growth of the incidence of syphilis was registered, at the national level, starting with the year 1989. The ascendant tendency has continued up to now. In the county of Constanta, the phenomenon began to take shape in the year 1982 and has had a continual growth for two decades.

Cerebral opportunistic infections in adolescents HIV+
Valentina Lăcurezeanu, Simona Claudia Cambrea, S. Rugină

ABSTRACT. Background: The Neurological impairment is dramatic with HIV infected patients in an advanced stage of AIDS. The neurological impairment more frequent met in practice were: cerebral toxoplasmosis, CMV encephalitis, TB meningitis and meningitis with Cryptococcus neoformans. Methods: Retrospective, descriptive study on 44 cases with advanced HIV infection associated and neurological manifestations, hospitalized between 2002 - 2006. In this study there are presented 20 cases of cerebral toxoplasmosis, 9 cases of CMV encephalitis, 8 cases of meningitis with Cryptococcus neoformans, and 7 cases of TB meningitis. The biological and imagistic (CT/MRI and cerebral scintigraphy) diagnosis had an essential role for setting an accurate diagnosis and prescribing appropriate therapy. Results: There are presented some clinical aspects, the benefits of the imagistic and serologic diagnosis as well as the evolution of 44 HIV infected patients with cerebral infections. The evolution was favourable under etiologic treatment and ARVT in 23, 6 cases of meningitis with Cryptococcus neoformans, 6 cases with TB meningitis and 7 cases of CMV encephalitis. There were registered 12 deceases. Conclusions: Incidence of neurological impairment in children and adolescents HIV+ was 8.59%. Cerebral opportunistic infections were present at low CD4 count (< 100 cells/mmc). Imaging diagnosis related with clinical and laboratory findings was essential in diagnosis of cerebral toxoplasmosis, CMV encephalitis and complicated TB meningitis.

The Value Of 24-Hour Esophageal Ph-metry In DiagnosisOf Recurrent Wheezing In Children
Adriana Bălaşa, Valeria Stroia

ABSTRACT. 24 hour esophageal pH-metry (pH probe) is the gold standard method to establish the diagnosis of gastroesophageal reflux. 25- 75% of asthmatic children have abnormal pH probe studies, and 50% of those have overt symptoms of acid reflux. Silent reflux disease is reported in the pediatric literature to range from 45% to 75% of asthmatic children. This study was done in Pediatric Department based on the measurement of the distal esophageal pH-metry parameters in 16 children, aged 2 months to 16 years, during an one year period. 7 of them were infants and 9 were children. Including criteria were wheezing, recurrent cough and/or digestive simptomatology such as vomiting, chronic abdominal pain, heartburn. We used a romanian ph-metry device, (DxC91), obtained data beeing transfered on a computer. There were evaluated specific parameters as the following: percentage of total time pH < 4.0, total number of gastroesophageal reflux episodes, number of reflux episodes longer than 5 minutes, the longest reflux episode. The results demonstrate that gastroesophageal reflux is correlated with bronhial obstruction, manifested as persistent or recurrent wheezing (3/7 infants admitted for recurrent wheezing). Only 4/8 of patients tested positive by 24-hour esophageal pHmetry had a suggestive simptomatology for GERD, demonstrating the possibility of occult gastroesofageal reflux in patients with respiratory symptoms. The authors discuss the most important cases.

Atypical Onset Of Diabetes In A Teen-Girl - Case Presentation
Cristina Maria Mihai

ABSTRACT. A 15 year old girl, previously healthy, presented with sudden onset of right-sided chorea. Investigations revealed an undiagnosed diabetes with absent ketones and normal serum osmolality. Achievement of normoglycemia with insulin therapy determined the involuntary movements to regress completely within a day. The direct effect of hyperglycemia could be the pathogenesis of the chorea in our patient.

Facultuy of Medicine
Constanta

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Ovidius University
Constanta

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