ARS Medica Tomitana
vol. XIV - nr. 1 (52) - january - march 2008

The Existing Relations Between The Large Hepatic Veins, The Terminal Branches Of The Portal Vein And The Human Morphological Types
P. Bordei, E. Dumitru, C. Dina, D. Iliescu

ABSTRACT. The study was performed on 20 hepatic ultrasounds, in order to evaluate some morphological peculiarities of the hepatic veins and of the portal venous branches and of their relations, according to the sexes and to the morphological human types. In order to determine the morphological type we performed 4 measurements: thoracic length (Tl), thoracic breadth (Tb), abdominal length (Al) and abdominal breadth (Ab); those 4 groups of data were introduced in two primary relations (Tb)/(Ab)=I and (Tl)/ (Al)=L and a secondary relation I/L that provided the morphological type index. This one was between 2.52 and 3.79, in females between 2.60 and 3.79 and in males between 2.52 and 3.63. Among our results, we quote: the middle hepatic vein may end either into the inferior vena cava (11 cases) or into the left hepatic vein (9 cases); a single case of trifurcation of the hepatic portal vein in female of sagittal type; 2 cases with 2 right hepatic veins, both of sagittal type, one in female and one in male; the right hepatic vein showed a larger caliber than the left one in 14 cases and larger than the middle hepatic vein in 18 cases; the left hepatic vein showed a larger caliber than the right one in 17 cases; the left branch of the portal vein was larger than the right one in 12 cases; in a single case, in a female of sagittal type, the two branches of the portal vein showed a similar caliber; the right hepatic vein showed a larger caliber than the right branch of the portal in 9 cases. In both sexes the sagittal type showed a larger number of morphological peculiarities, both in what concerns the hepatic venous branches and the portal ones: multiple right hepatic veins, terminal trifurcation of the portal vein, larger dimensions, numerous collateral and terminal branches. The differences between sexes were usually dimensional and mostly in caliber.Key words: germ cell, seminoma, testicular tumors, immunohistochemistry

Anatomo-Clinical And Immunohistochemical Characteristics Of Germinative Testicular Tumors
I. Poinăreanu, Mariana Aşchie, Anca Dobre, Anca Florentina Papuc, Antonela-Anca Crăciun, Andreea Ilieşiu

ABSTRACT. Germinative testicular tumoral pathology affects especially active sexual men who have the capacity of reproduction. The paper is justified by trying to improve management in this complex pathology group with majore risks, having the purpose of a fast psycho-social integration for the orchidectomised patient, after post surgical treatment, taking into consideration the histopathological and immunohistochemical tumoral type.We chose to study patients with malignant testicular tumors from 2000 to 2007, hospitalized in surgery departments of SCJU Constanta 68 cases with malignant testicular tumors. The diagnosis was established on the basis of case history, paraclinical investigations, histopathological and immunohistochemical exams. The tumoral markers serological increased don`t have the positive diagnosis certitude compared with immunohistochemical markers applied and highlighted on the paraffin blocks.

The Role Of Gene Expression Profiles In Classification of Breast Carcinomas
Anca Papuc, Mariana Aşchie, Anca Dobre, I. Poinăreanu, Andreea Ilieşiu, Antonela Anca Crăciun

ABSTRACT. Breast carcinomas represent an important health problem. Understanding the development of breast cancer from precursor is critical for clinical treatment and prevention, however little is known of the molecular events involved in the progression to cancer. The advent of gene expression microarray technology provides a new powerful tool to assist in determination of diagnosis, prognosis and treatment. In this paper, we present the recent DNA microarray studies that describe how gene expression profiling is being used to classify specimens of breast carcinomas based on molecular properties of the tumor and to identify gene expression patterns related to clinical outcome. In present, data are available that show that gene expression profiles can be used to distinguish cell type-specific gene clusters (stromal, epithelial, mesenchymal and proliferation status) and to classify breast tumors as basal-like, luminal-like, ERBB2 overexpressing and normal breast-like. Profiles associated with good prognosis and poor prognosis of young axillary node negative patients have been identified. The microarray technology will become in the near future a molecular complement to histopathology and immnuhistochemistry.

Multiple Myeloma Associated To Hodgkin Lymphoma In A Immunodeficinet Pacient – Case Report
Anca Dobre, I. Poinăreanu, Mariana Aşchie, Anca Papuc, Victoria Braga, Anca Crăciun, Andreea Ilieşiu

ABSTRACT. Multiple Myeloma and Hodgkin Lymphoma are malign proliferations of blood cells (plasma cells and lymphocytes) originated in bone marrow or limphonodules and characterized by rising number of morphology and function normal or pathological cells. The association of the 2 diseases in one patient is very rare, till now being described only 16 cases in literature. Case particularity is given by association of the 2 diseases in an immunodeficient patient (liver cirrhosis and diabetes mellitus). The diagnostic is difficult because hematological and biochemical changes are not specific to identified disorders. Even paraclinical exams show nonspecific changes, microscopically examination elucidate the diagnostic. The presented case is a clear example of complex diagnostic in which usual clinical and paraclinical exams raise the suspicion of an association between a chronic disease (liver cirrhosis previously diagnosed in this patient) and a malign disorder. In this context bone marrow biopsy and lymph nodule histopathological examination certificate the existing malign disease (Hodgkin Lymphoma) superposed to a chronic disease (liver cirrhosis and diabetes mellitus) and permitted discovery of the association between Hodgkin Lymphoma and another hematological malignancy (Multiple Myeloma) in the same patient.

The Significance Of Thrombelastography In Monitoring Patients Receiving Fibrinolytic Drugs
Florina-Mădălina Bâtcă, Ileana Ion, Elvira Craiu, Cecilia Adumitresi, Cristina Farcaş, Ninela Rădulescu, Carmen Ciufu, Loredana Hanzu-Pazara

ABSTRACT. The purpose of the present study was to high-light the haemostatic changes using thrombelastography in patients with myocardial infarction receiving streptokinase and heparin.
The results showed that the streptokinase induces more brutally and fast the state of hypocoagulation even in the first 24 hours after the installation of the heart-attack, while the heparin treatment provides slow a state of minimal hypocoagulation, but so necessary to prevent the thrombotic complications of myocardial infarction. The study demonstrates the efficiency of the treatment in both approaches and declares the thrombelastography a non-invasive method, as the standard method to evaluate the patients suffering from myocardial infarction, congestive heart failure or even patients prepared for heart transplant.

The Correlation Between Noise Exposure And Urinary Vanillylmandelic Acid Elimination On Seamen
Ninela Rădulescu, Ileana Ion, Cecilia Adumitresi, Cristina Farcaş, Carmen Ciufu, Loredana Hânzu-Pazara

ABSTRACT. Noise is the most commun hazardous agent at workplaces and it is defined as a sound whitch bothers, irritates, which is unpleasant and can damage hearing. The degree of the negative effects of noise depends on its intensity, spectrum of frecvency, nature, duration and individual sensibility. The measured values of sound intensity within vessel compartmens (engine room, main deck) are different with a higher level in the engine compartment (LEX, 8h = 87 dB(A)). The aim of the study was to establish the corellation between noise exposure and urinary vanillylmandelic acid (VMA) elliminations on seamen. VMA, methabolic result of catecholamins, represents an biochemical indicator for acute stress. Urinary determinations for VMA took place at the beginning and the end of the voyages and two month after returning, using 24 hour urine samples. The incresed VMA values, at the beginning, and especially the end of the voyages can be explained as a result of an important stimulation of the simpatho-adrenergic system induced by the specific conditions onboard shipping vessels

Celiac Disease Detected At Endoscopy
E. Dumitru, Luana Alexandrescu, Andra Iulia Suceveanu, Fl. Voinea, Mariana Așchie

ABSTRACT. Endoscopy provides an opportunity to diagnose suspected and unsuspected celiac disease. The aim of the study was to evaluate the frequency and describe the clinical and paraclinical characteristics of patients with gluten-induced enteropathy. This is a retrospective study on patients undergoing upper gastrointestinal endoscopy for evaluation of diarrhea or suspected malabsorption, who had endoscopic signs in the duodenum suggestive of celiac disease and in whom villous atrophy was confirmed. Patients were assessed for anemia, nutritional deficiencies, parameters of calcium metabolism and malignancies. Five patients (four women and one man) were identified among 1894 patients undergoing endoscopy between January 2006 and December 2007, representing a rate of 1 per 379 endoscopies. The duodenal abnormalities were reduced or absent folds and mosaic appearance. Assessment revealed weight loss and iron deficiency in 4, hypocalcemia, hypoalbuminemia and hypokalemia in 3, osteoporosis in one and osteopenia in another one. None had malignancies associated with celiac disease. Conclusions: Celiac disease can be diagnosed at endoscopy by recognition of changes in the duodenum. When detected, patients have one or more manifestations of the disease. Celiac disease is more common in our county than previously considered and endoscopy provides an opportunity to establish the diagnosis.

Decreased Renal Function In Elderly Patients Affects Cardiovascular Drug Prescribing
Liliana Tuţă, Alina Sburlan, M. Țoringhibel, F. Voinea

ABSTRACT. Age is well recognized as a powerful prognostic factor in the setting of cardiovascular disease. The growing elderly population has increased rates of morbidity and mortality owing to cardiovascular disease; however, proven therapies for prevention and treatment are often underused in older patients, largely because physicians fear. Advancing age is associated with a number of physiologic and pathophysiologic changes that impact the toxic effects, efficacy and dosing of many medications. Decreases in lean muscle mass affect the volume of distribution, and reductions in hepatic and renal functions affect the metabolism of many medications. The strong association between renal and cardiovascular disease makes recognition of renal dysfunction and appropriate dose adjustment particularly important the estimation of renal function, and unique considerations related to prescribing medication for elderly patients with concomitant renal and cardiovascular disease.

Particularities Of Diagnosis In Geriatric Population Presenting To The Emergency Department With Abdominal Pain
Rodica Tudoran, Alexandra Cojocaru

ABSTRACT. Currently, patients over 65 years of age represent about 20% of Emergency Department visits. In 2000 in America there were more than 12,4% of people with age 65 or older; this percentage is expecting to increase to 15% by 2010 and 25% by 2050. As the proportion of elderly continues to grow, Emergency Department visits will increase. Abdominal pain is one of the most important and severe complaint among these patients, so early and correct diagnosis and treatment is neccesary to improve outcome. Elderly patients tend to have atypical presentation of abdominal pain, as well as increased mortality and morbidity; their signs and symptoms might be modified by previous surgeries or preexisting abdominal conditions. The geriatric population must be evaluated and examined carrefully, in order to establish the diagnosis and treatment and to decide if the case will be manage on an outpatient basis. As much as one third of the cases will return to the Emergency Department after being treated because they continue to feel bad and have abdominal symptoms.

Study About Serological Markers In Viral Hepatitis
S. Rugină, Elena Dumea, Claudia Nina Rugină, Faisal Osama

ABSTRACT. This study analyzed a lot of patients hospitalised with suppose viral hepatitis in one year. There were 318 cases of acute viral hepatitis A, 149 cases of acute viral hepatitis B, 64 patients with AntiVHC positive, 180 patients with AgHBs positive, 4 with AntiVHD positive. Acute viral hepatitis represents an important part of infectious diseases pathology and hospitalization cases and represents the majority of positive tested cases. In acute A hepatitis there is a relatively equal sex repartition and predominance of urban medium. The medium age of patients with acute viral hepatitis A was 14.86 years old and patients with school age represent majority. Our data confirm seasonal repartition of A virus with predominance of autumn and winter months. The medium age of the patients with acute B hepatitis patients was 27.64 years old which represent active sexual age and there is no representative peak of cases in any month. From patients with Ac VHC positive (64) 15.3 % were diagnosed with acute form. The medium age of this lot of patients was 46.78 years old. 6.25 % of patients present co infection with B and C viruses and 2.48 % of patients’ present co infection with B and D viruses. There were 180 cases with AgHBs positive. 161 patients had chronic form of hepatitis B. There is a predominance of men (M: F= 1.57) with AgHBs positive. The medium age of this lot of patients was 34.41 years old. 17% of chronic hepatitis B was in replicative stage.

Our Experience Upon The Treatment Of The Supra And Intercondylar Femural Fractures 33c Type

B. Obadă, N. Obadă, V. Orbeanu, B. Caraban, M. Enescu

ABSTRACT. Aim of treatment – To obtain functional and anathomical results as good as possible, with risks as low as possible. During 2001-2005 there were treated susgical 39 persons with articular fractures of the lower extremity of femur, supra and intercondylar fractures, 33C according AO/ASIF classification: 33C1-20, 33C2-13, 33C3-6. These fractures were produced by high energy traumatisms at younger people (<50 years 16 cases) and on osteoporotic bone at elder patients (>50 years – 23 cases), from which men were 17 and women 22. For the treatment of the 33C type fractures were used: 95º angle condylar blade plate – 28 cases, dynamic condylar screw (DCS) – 5 cases, retrograde locking nail - 6 cases. The decision choice was aacording to the following criterions: the anatomic type of fractures (AO/ASIF), the technique possibilities, special situations. Results and discussions: The evaluation of the results was made using the Schatzker and Lambert criterions and were very good in 7 cases (17.94%), good 20 cases (51.28%), satisfactory 6 cases (15.38%), unsatisfactory 6 cases (15.38%).

Angiomas In Dermatological Pathology, Statistical Assessment Of Different Clinical Types
G. Nicola, Emma Gheorghe, M. Sowlati

ABSTRACT. Angiomas are grouped into dermal and hypodermal hyperplasy, they may consist either of simple angiectasis or well differentiated multiple veins, or through angioformation cellular proliferation, with neoformation of vein which reached in avans maturation.1 There are mentioned several classification, histologic and ethiological, which undertake telangiectasis nevi, mature capillary telangiectasis, without cellular proliferation (pure capillary angioma ) and real angioma or hemangiomas, benign vascular tumor (Nödl hemangioblastom), formed by immature celluar mesenchime or by endothelial proliferation and by well differentiated capillary.2,3 Exist numerous intermediate histological images, which do not correspond by clinical forms. Although, is difficult to appreciate the embrioplasic process or other implicated factor.

Pancreatic Pseudocyst In Chronic Pancreatitis: Surgical Treatment
N.I. Berevoescu, S.Simion, A. Croitoru, S. Bacaliuc

ABSTRACT. The purpose of this paper is to evaluate the short and long term results of the surgical procedures done for pseudocysts associated to chronic pancreatitis. Between 1996-2007, 39 patients (31 male, 8 female), ages between 32 and 58, were hospitalized and surgically treated in the Surgical Wing of Colentina Clinical Hospital for pseudocysts associated to chronic pancreatitis. After the paraclinical and clinical evaluation, patients with pancreatic pseudocysts received pseudocystduodenostomy (2 cases, 5.1%), pseudocystgastrostomy (4 cases, 10.3%), pseudocystjejunostomy (17 cases, 43.6%), cephalic pancreatoduodenectomy (5 cases, 12.8%) and distal pancreatectomy (DuVal`s procedure) (11 cases, 28.2%).The postoperatory mortality was null and postoperatory morbidity was 37.5% for resection procedures and 17.39% for internal drainage. At 36 months after the intervention, pancreatic resections provided pain relief in 81% of the cases while internal drainage interventions only in 60.87% of cases. Moreover, the internal drainage interventions had a reccurence rate of 17.4%. All this surgical procedures generally resolve the pseudocyst-a complication of chronic pancreatitis, but comparative to the internal drainage the pancreatic resections offer a better pain management on the long term.

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