ARS Medica Tomitana
vol. XIII - nr. 4 (51) -october - december 2007

Antibodies To Cyclic Citrullinated Peptides In Patients With Extra-articular Manifestations In Rheumatoid Arthritis
Loredana Hânzu-Pazara, Camelia Pană, Maria Şuţa, Carmen Ciufu, Gabriela Lilios

ABSTRACT. Rheumatoid arthritis (RA) is a systemic autoimmune disease with a prevalence of 1% world wide. The poor prognosis has led to an emphasis on early diagnosis and aggressive treatment. However, the American College of Rheumatology (ACR) classification criteria are not very well suited to diagnosing RA at an early stage because non-clinical measures are often not fulfilled. Therefore, a reliable and specific test early in the disease would be very useful for identifying patients with RA before the occurrence of joint damage, and enable targeting the use of potentially toxic and expensive drugs at those patients where the benefits clearly outweigh the risks. Detection of antibodies to citrullinated peptides as in the anti-CCP assay provides an additional serological test to assist in the diagnosis of RA. Sensitivity of anti-CCP is close to that of rheumatoid factor, with a higher specificity for distinguishing between RA and other rheumatic diseases. The objective of our study was to analyze antibodies to cyclic citrullinated peptides (anti-CCP) and rheumatoid factor in patients with active, severe extra-articular rheumatoid arthritis (ExRA) compared with controls without ExRA. Conclusion: Rheumatoid factor is strongly associated with severe ExRA manifestations in patients with rheumatoid arthritis, and a similar association exists for anti-CCPs. This suggests a role anti-CCP in the pathogenesis of ExRA and the use of these antibodies in clinical practice should make it easier for rheumatologists to reach judicious treatment decisions.

Severe Adverse Events Of Biological Agents In The Treatment Of Rheumatic Diseases

Maria Şuţa, Cristina Duminică, Doiniţa Oprea, Ana-Maria Ramazan, R.Ş. Şuţa

ABSTRACT. Biologic therapy represents a relatively new pharmacologic treatment for the management of severe, active rheumatoid arthritis (RA), psoriatic arthritis (PsA),and ankylosing spondylitis (AS) resistant to standard therapy. Although trial based evidence and clinical experience to date are encouraging, there is still insufficient information on the long term safety and continuing efficacy of biological agents in the general population with rheumatoid arthritis.

Clinical And Etiological Considerations About Urinary Tract Infections
Irina Magdalena Dumitru, S. Rugină, Claudia Nina Rugină

ABSTRACT. Urinary tract infections represents a significant problem of morbidity in all speciality of medicine because they are frequent and can be associated with all kind of diseases. This study has the objective to make an analysis of the cases admitted to our hospital in the last years for urinary infections. There were identified 154 cases of urinary infections admitted in our hospital between 2005 – 2006. The analysis of cases shows a higher prevalence of urinary infection in adults compared with children. Identification of the etiological agent for urinary infections by uroculture revealed a strong predominance of Escherichia coli (74% of cases). Escherichia coli has a good sensibility to fluorochinolones, but a small sensibility to large-scale used nalidixic acid and cotrimoxazole

Incidence And Management Of Side Effects In Associated Peg-Interferon Alpha2B And Ribavirin Therapy For Chronic Hepatitis C
Andra-Iulia Suceveanu, A. Suceveanu, Fl. Voinea

ABSTRACT. Therapy for chronic hepatitis C has improved over the last decade, such that sustained virological response can now be achieved in over 50% of individuals treated with the combination of long-acting pegylated interferon alfa-2b and ribavirin. Although these newer agents are significantly more effective, they still have side effects. Many reviews focused on the management of side effects showed a better adherence and sustained virological response to therapy with these agents. Our study confirmed that side effects were less frequently present in treatment with pegylated interferon alfa-2b than in standard interferon alfa-2b. The adherence to therapy was more than 75%; also much better in pegylated interferon alfa-2b treated patients. Causes of discontinuation or withdrawal to therapy due to side effects were also fewer. The sustained virological response was achieved in 56% of patients treated with pegylated interferon alfa-2b and ribavirin compare to 34% in standard interferon and ribavirin. A regularly and complex clinical and biological evaluation and a good management of any side effect appeared during therapy, can lead to our goal, a better adherence to therapy and a better sustained virological response.

The Value Of Orthopedic Treatment For Closed Distal Radius Fractures
B. Obadă, N. Obadă, V. Orbeanu, M. Enescu

ABSTRACT. Our study propose to prove the importance of the orthopedic treatment for the fractures of the distal radius using the evaluation of the cazuistry of Orthopedic-Traumatology Clinic of Constanta Emergency Clinical Hospital during 2006-2007, 123 patients with distal radius epiphysis fracture. The orthopedic treatment in such fractures can obtain full or almost full functional recovery and it have lesser complication than any type or surgical treatment. The reasons that the surgical treatment is choisen for distal radius fractures is the better anathomical remake of the bone, but in reality, the complications which appear after openning the fracture site and the functional recovery which is not superior, should reconsider the treatment options. The orthopedic treatment for the closed distal radius fractures are the optimal choice when it is applied coorectly.

Aspects Of Materno-Fetal Risks In Grand Multiparas’ Pregnancies
S. Bafani, V. Tica, M. Beghim, V. Cristurean

ABSTRACT. A retrospective analysis from January 2006 to June 2007 in the Dept. of Obstetrics & Gynecology I of University Regional Emergency Hospital Constanţa was carried out. In this period of time, 6972 women were admitted for delivery. Of these, 179 (2.55 %) were grand multiparas - defined as mothers of parity greater than or equal to 5. History, labor and delivery as well as postpartum and neonatal courses were recorded using computerized records for statistical calculations. The incidence of placenta praevia was decreased among the grand multiparas as was the number of cesarean sections, particularly those of the primary emergency type. We can conclude that, with few exceptions, the grand multiparas can be safely delivered by means of modern obstetric management and may not, in and of itself, be a major obstetrical risk factor.

Placental Abruption And Twin Gestations
L. Şerbănescu, V.I. Tica

ABSTRACT. This population-based epidemiologic study analyzed the incidence and evaluates the risk factor profiles for placental abruption in twin gestations. Data were collected from Constanta Hospital birth files between1996-2006. Abruption was recorded in 5.6 per 1,000 singleton births and 14 per 1,000 twin births. The main risks factors identified for abruption in twin births, was the preterm rupture of membranes and the arterial hypertension. We conclude that abruption is twice as likely to occur in twins as in singletons, more dangerous, in correlation with the retro placental hematoma and with differing risk factor profiles.

Patophisiological Aspects In Perinatal Asphyxia
Mimi Inceu, T. Beiu

ABSTRACT. The aim of this study is to review the hypoxic ischemic encephalopathy cases of Constanta’s Maternity between 2000 and 2005 and also understand the screening and adjust therapy to maintain an excellent outcome when asphyxia occurs in the new born period and recognize a patient with asphyxia complications and understand the importance of neuropathologycal results. A retrospective and prospective study was made on a period of six years (January 2000 and January 2005) on number 60 dead newborns in Contanta maternity, having the possibility of comparison with 90 newborns in Neonate Intensive Care Hospital Ottawa, having the observation reports as material. Results: The ratio between death at normal age gestation and death at prematurely born babies was 35/14 in Ottawa and 32/28 in Constanta. Asphyxia in babies born after a 27 weeks gestation period produces lesions like edema and hemorrhage in the lateral ventricles, the germinal matrix, and the subarahnoidian posterior fosa while asphyxia in babies born at term produces lesions like edema, anoxic ischemic encephalopathy and infarcts in the right parietal lobe. Conclusions: The clinical diagnosis was in total concordance with the neuroanatomopathological diagnosis. The cerebral lesions of the prematurely born babies are different from the ones observed in the newborns at term. Varying degrees of impairment may result from diffuse or localized injury to the cortex.

Diagnostically And Therapeutically Difficulties In Diaphragmatic Breaches
Mihaela Pirvu, V. Sarbu, D. Toldisan, T. Iusuf

ABSTRACT. Diaphragmatic traumas are graves injury by physiological impact for breath, homodynamic function, and digests. Placed between thorax and abdominal cavity, diaphragm could be broken in both thoracic trauma and abdominal trauma, in most case in complex trauma. In this study is synthesized the experience of our clinic in this field. About etiopathogeny we can mention car crashes, aggressions, domestics’ accidents. Diagnosis was suggested anamnestic, by known pathogeny, susspectable clinic and radiological confirmed, but there were situations when we confronted with this diagnostic only intraoperatively. Diaphragmatic breaches - are secondary thoracic, abdominal or both contusions, associated with a lot of anther injury visceral, limbs or cranio-cerebrals. In this situation attention of surgeon can be removing from the diaphragmatic breaches, and this must be introduced in diagnostic algorithm to any polithraumatisation.

General And Individual Factors Involved In The Evolution And The Prognosis Of Oropharyngeal Cancer
G. I. Comşa, L. T. Hangan

ABSTRACT. The authors are looking to identify environmental, habitual and pathophysiological factors involved in diagnosis, therapy and prognosis of oropharyngeal cancer. This paperwork is based upon Constanta ENT Clinic statistics over 10 years. Our conclusions emphasize on life style, use and overuse of toxics and sanitary education level. The late diagnosis with a poor prognosis in most of the cases is explained by lack of obvious symptoms.

Otogenic Brain Abscess In Children

Cristina Laza, G. Comşa, M. Sar, O. Carp

ABSTRACT. Nowadays the extended use of antimicrobial agents had led to a substantial decrease of intracranial complications of suppurative chronic otitis. However there are still some isolated cases recorded mainly in neglected or immuncompromised patients. The purpose of the present study was to present 3 cases of otogenic brain abscess in children diagnosed and treated in our department in last 3 years. This was a retrospective study .3 patients 2 male and 1 female ,aged from 13-16 years diagnosed with brain abscess complicating chronic otitis media were enrolled. All patients were from families with social problems. In 2 cases the first diagnosis was encephalitis evolving to cerebral abscess. Abscesses were located in 2 cases in the posterior cerebral fossa nearby the ear infection and the imaging studies CT and RMI were essential for the diagnosis. The medical and surgical treatment is discussed. Two patients were submitted in a two step procedure with separate operations for the ear –radical mastoidectomy and craniotomy by neurosurgeon as a first step or after 2 weeks of evolution. The third patient was operated by the oto-surgeon with radical mastoidectomy but the family refuses the neurosurgical treatment and they remove the girl from the hospital. In the others cases the prognosis was very good with complete remission and no complications. There must be a high index of clinical suspicion for intracranial complication patient suffering from neglected chronic suppurative otitis media. The management of these life-threatening infections depends on the localization and dimensions of the lesions, as well as the level of medical alert and consequently on the right and timely diagnosis. After following the necessary diagnostic steps, there are more than one treatment option based on cooperation of otorhinolaryngologist and neurosurgeon.

Spiders – Are They Harmless Or Not?
Rodica Tudoran, Alexandra Cojocaru

ABSTRACT. Spiders are ancient animals with a history going back many millions of years. They are abundant and widespread and are natural controllers of insect populations. Wherever you live, you’re always close to a spider. Spiders belong to the class Arachnid. The first Arachnid is thought to have been a Scorpion like creature from about 500,000,000 years ago. There are more than 34 000 species of spiders worldwide, of wich only a few produce medically significant envenomations in humans; sometimes their venom has a high degree of toxicity and may even determine death. Fortunately, most of them are harmless for human. Britain has more than 600 species of spiders, all of them harmless to man. They prey on other creatures, have eight legs and a body divided into two parts: a combined head and thorax and a large abdomen. Most spiders have eight eyes, arranged in two rows of four. The management of these life-threatening infections depends on the localization and dimensions of the lesions, as well as the level of medical alert and consequently on the right and timely diagnosis. After following the necessary diagnostic steps, there are more than one treatment option based on cooperation of otorhinolaryngologist and neurosurgeon.

Massive Middle Cerebral Artery Infarct
Anca Hâncu, H. B. Davidescu, Daniela Zguma, M. Kaivanifard

ABSTRACT. Malignant infarction of the middle cerebral artery – is a large hemispheric infarction associated with massive, so-called malignant, space-occupying cerebral edema leading to raised intracranial pressure, midline shift, and, in the worst case, herniation with subsequent death. Clinical deterioration with decreasing levels of consciousness and evolvement of brain stem signs usually occurs within 2 to 5 days following symptom onset.

The Incidence Of The Congenital Malformations In The Digestive System
Mirela Urucu, T. Beiu

ABSTRACT. The congenital abnormalities represent 10 % of the total amount of the decease causes in the neonatal period. Of the total congenital abnormalities 3% are major and 12% are minor. The causes of the abnormalities are genetic and have multiple factors. The genetic factors are usually linked with the environmental factors. The prenatal diagnosis of the congenital malformations and the recovery therapy measures are highly important. The primary prophylaxis (avoiding teratogen factors, detecting the families with high malformation risk, prevention of the birth of an individual with malformation) and the secondary prophylaxis are objectives that have to be continually observed by the obstetricians. The pregnancy interruption is justified in the incurable malformations. The emergency type malformations must be solved within the first hours from birth, while the non emergency ones in the first months of years of live. We have a retrospective study on a one- year period (2004-2005), within the Pediatric Surgery Clinic of the Constanta Emergency County Clinical Hospital regarding the incidence of congenital digestive malformations. The most frequent congenital digestive malformations have been represented by cheilo- and palatoschizis (52%) and pyloric hypertrofic stenosis (17%). The congenital digestive malformations show the same frequency for both sexes are more frequent in the urban environment and the responsible etiology has multiple factors. The early diagnosis and the surgical intervention realized in due time can solve most of the cases of congenital digestive malformations. Most often, the diagnosis of these malformations is given after birth, because a high percent of the pregnant women are not followed up during pregnancy, and fromthose registered as pregnant; a great deal do not make fetal echographies. The patient’s education regarding the necessity of medical tests during pregnancy, as well as malformation prevention, is desideratum that should constantly be kept in mind, in order to reduce congenital malformations.

Cardiovascular Adverse Reactions Of Glucocorticoid Pulse-Therapy In Rheumatoid Arthritis Patients

Luminiţa Matei, Maria Şuţa, Cristina Duminică, Doiniţă Oprea, Ana-Maria Ramazan, R. Şuţa

ABSTRACT. Rheumatoid arthritis patients have important clinical benefits from glucocorticoid therapy. Pulse-therapy represents an alternative to high-dose daily therapy, as an intention to minimize side effects. Severe cardiovascular events, including sudden cardiac death have been described after pulse-therapy, but there is no clear evidence regarding the frequency of such events, particularly in rheumatoid arthritis patients. This is a prospective observational study that evaluates the cardiovascular adverse reactions of glucocorticoid pulse-therapy (125 mg methylprednisolone infusions for 3 consecutive days) in 14 rheumatoid arthritis patients, using clinical, biochemical, conventional electrocardiography and continuous 24-hour cardiac rhythm monitoring parameters. The adverse events recorded were: asymptomatic severe blood pressure raise (2 patients, previously hypertensive), angina and asymptomatic unsustained ventricular and supra-ventricular tachycardia (1 patient, with known coronary heart disease). Severe cardiovascular complications of glucocorticoid pulse-therapy seem to be related to underlying comorbidities. Low risk patients allow just clinical supervision during infusions, including blood pressure measurement and can probably be managed as day-hospitalization. Patients with known cardiovascular disease need closer follow-up, at least clinically, if not cardiac rhythm monitoring.

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