ARS Medica Tomitana
vol. XIV - nr. 4 (55) - october - december 2008

Dynamic Study Of The Female Levator Ani Muscle Using MRI 3D Vectorial Modelisation
V. Delmas, J. Lopater, O. Ami, A. Bénézit, R. Pessis, J.-F. Uhl, M.-T. Iba-Zizen, E. A.Cabanis

ABSTRACT. Purpose : The levator ani muscle fulfills a major role in the female pelvic floor. It is mainly involved in pelvic prolapsus and stress urinary incontinence pathophysiology. An anatomical and morphological study was performed using dynamical 3D vectorial reconstruction MRI. The aim of this study is to analyze the contraction of each fascicle of the levator ani muscle: iliococcygeus and pubococcygeus. Material and Method : Three healthy voluntary continent nulliparous women (from 19 to 22 years old) underwent a dynamical pelvic MRI. Coronal T2-weighted pelvic magnetic resonance were obtained with the subjects in the supine position, in function relax, holding back and Valsalva strain effort. The three-dimensional vectorial models were reconstructed by manual segmentation from the source images, and were set up on bony anatomic marks. Iliococcygeus and pubococcygeus volumes were measured in the three positions. Volumetrics, displacement and dynamic morphing changes were studied on a 3D vectorial animation software. Results : The urogenital hiatus extended holding back (men +4,31mm) more than in strain effort (mean +2,78mm). The Iliococcygeus lowered (mean -3,95mm) and deviated outward (mean +3,01mm). Conclusion : Basic tonus of iliococcygeus muscle gives it a dome shape, and its reflex contraction against abdominal strain allows anal and urinary continence. The levator ani is more than a pelvic diaphragm; it is a truly dynamical pelvic floor. Its support points on a stiff osseous frame allow the levator ani muscle to retain pelvic organs. The levator ani muscle seems to prevent the anus prolapse during the stress strain.

Artery Cerebri Longa
D.Şt.Antohe, M.Moraru, H.Varlam

ABSTRACT. Due to their complicate early morphogenesis and complex definitive anatomy, the anterior cerebral and anterior communicating arteries are known for their variability. The purpose of our study is to investigate and to classify the variations as number and origin of A. cerebri longa, their most long collateral branch. The anatomical material studied consists of 156 adult brains (312 hemispheres) harvested from patients dead by nonneurological diseases. The brains were 10% formaline fixed for six month and the arterial polygon of Willis was dissected by means of Zeiss surgical microscope. The images of the targeted area were recorded on a Sony video line or with Sony 717 digital camera. Our study pointed out the great variability of A.cerebri longa. From the viewpoint of number we have demonstrated the presence of multiple cerebri longa arteries which were classified as dominant and accessories. The origin of unique or multiple arteries was reported to the segments of anterior cerebral artery and we have realized a map of variants. The anatomy of the anterior cerebral, anterior communicating arteries and of their branches is considerably complicate and the surgery of this area is extremely difficult. The arterial patterns we have described might contribute to establishment of a anatomical variants library that have to express the anatomical status of romanian population.

Changes Of β And γ - Globulin Fractions In Simultaneous Exposure To Gamma Radiation And Hyperbarism
Monica Vasile, O. Teren, Ileana Ion, G. Turcu

ABSTRACT. Hyperbaric exposure gives rise to an increase of oxygen free radicals concentration in living organisms. Meanwhile the exposure of the organism to gamma radiations, accidentally or during radiological treatment provides the same effects. Nowadays studies describe treatment methods, where treatment with radiation is followed by hyperbaric therapy with an increase concentration of oxygen. Our study presents the cummulative effects of hyperbaric exposure and therapeutical gamma irradiation. The results we got from both exposures evidence that the cumulative exposure to those two factors gives rise to a significant change in electrophoretical fractions: significant damage of alpha and beta proteins.

The Diagnosis And Treatment In Small Intestine Obstruction - Clinical Study -
C. Grasa, D. Costea, V. Sârbu, T. Iusuf, A. Ivanoschi

ABSTRACT. In theory, the differentiation of small versus large bowel obstruction and simple versus strangulated versus closed loop all should be very simple. In point of fact, this separation can be extremely difficult, and almost every reported study has demonstrated the fallacy of various signs that have been reputed to make the differentiation. Incarceration in a fixed space is usually due to an abdominal wall hernia. Intra-abdominal defects and traps, congenital or acquired, are also sites of potential incarceration. Once entrapped, impaired venous return and torsion may rapidly lead to infarction of the segment. Symptoms of small bowel obstruction were represented by pain in most of the cases (70%), vomiting (60%), obstipation (31%) and abdominal distension (45%). Only rarely patients present only one symptom, in most of the cases they have associated accuses. Obstipation was recorded in only 31% of the cases because obstruction were at a high level and the passage of flatus and stool may continue for some time after complete obstruction because of peristalsis distal to the point of obstruction.

Expresion Of Immunohistochemical Markers In Thyroid Tumours
Andreea Ilieşiu, Mariana Aşchie, I. Poinăreanu, Ghiulendan Iacub, Anca Florentina Papuc, Antonela-Anca Crăciun, Gabriela Bălţătescu, Anca Dobre, Jadranka Stanisici

ABSTRACT. Thyroid cancer has an increase incidence and prevalence.The management of differentiated (papillary and follicular) thyroid cancer is a challenge because there have been no prospective randomized trials of treatment and none are likely to be done, given the typically prolonged course and relative infrequency of these tumors. To examine the immunohistochemical alterations associated with the histological dedifferentiation of thyroid carcinomas, we performed staining for galectin-3, cytokeratin 19, p53, and Ki-67 in papillary carcinoma (PC), follicular carcinoma (FC), follicular adenoma (FA), and nodular hyperplasia (NH).The expression of these markers are are characteristic for the differential diagnosis between benign and malignant thyroid tumors.We examined 94 thyroid tumors removed the Clinics of Endocrinological Surgery of C.I.Parhon Institute and Departments of Surgery of SCJU diagnosed in the Department of Pathology and with diagnoses confirmed according to the criteria provided by the WHO classification. All of the patients had been operated between 2002 and 2008.

Renal Oncocytoma - Case Report And Review Of The Literature
Ghiulendan Iacub, Mariana Aşchie, Andreea Ilieşiu, I. Poinăreanu, Jadranka Stanisici, Antonela-Anca Crăciun, Anca Dobre, Anca Florentina Papuc, Gabriela Bălţătescu

ABSTRACT. Oncocytomas are usually benign tumors that occur in various organs but especially in the kidneys. Renal oncocytomas may resemble renal cell carcinoma clinically and pathologically, and this resemblance may lead to radical nephrectomy. Differentiating oncocytoma from renal cell carcinoma mimics, particularly chromophobe renal cell carcinoma, can be difficult but it is essential, considering their differing biological potentials. The numerous reported studies on distinguishing these two entities have been based on morphological, histochemical, immunohistochemical, ultrastructural, and cytogenetic features. We report a case of renal oncocytoma at a 49 year old woman and we make a short review of the literature.

ABO System - Effect On Blood Rheology?
Loredana Hanzu-Pazara, Cristina Ceamitru, Carmen Ciufu, D. Jugănaru, N. Ceamitru

ABSTRACT. ABO system has some significant polymorphic influences on blood haemorrheology (clotting and viscosity). Research on the structure and function of erythrocytes proteins has also been greatly aided by the exhaustive work already performed in blood group antigen serology, which allows recognition of variant and null phenotypes. Associations between the ABO phenotype and variations in blood rheology have been also reported in high blood pressure, stress, diabetes, heart attack and deep venous thrombosis, cancer and thyroid disease, kidney failure and malignant melanoma. There is evidence that the rheology of blood may play a role in a variety of chronic anxiety states. Because of its simplicity and elegance, it is very likely that the red cell will continue to provide deep insights into complex issues the nature of membrane perturbations in many other diseases. The study was performed on a group of 75 healthy subjects, with ages 18 to 35, randomly chosen as male/female. Patients had different blood types, had no pathological history and were in apparently perfect health status. Statistical data show differences between viscosity values measured in the four different blood types. Type O revealed the lowest values for blood viscosity, implying the lowest capillary resistance and the most fluent blood flow. The blood type that implied distinct hemoreologic aspects is group B. Data obtained from subjects with this type presented significant viscosity differences comparatively with O and A (Pt < 0.05).

Pneumosinus Dilatans Frontalis – Case Report
Cristina Otilia Laza, S. Mostafa

ABSTRACT. Pneumosinus dilatans is a rare pathology usually involving the frontal sinus ,but is possible a ethmoidal, sphenoidal or a maxillary involvement.It means a progressive enlargement usually bilateral but sometimes unilateral with normal lining mucosa ,no signs of infection and the sinus content just air. The cause of these disease is not known, there are a few theories like an obstruction of the naso-frontal duct with increased intrasinus pressure.The symptoms are poor most of the cases frontal bossing is the first sign or it is a radiological discovery. The author present a case of pneumosinus dilatans frontalis with a sudden discovery because of a spontaneous palpebral and orbital emphysema.

Antibiotic Susceptibility Of Enteroccocus Spp. Isolated From Urine
Monica Daniela Doşa, Ana Maria Herţa

ABSTRACT. During the last years, increase of enterococcal infections has been observed.The aim of this study was to analyse the antibiotic susceptibility of Enterococcus spp.isolated from urine.The study was realized during one year 2006-2007, on 23 positive cultures with Enterococcus spp.from 360 urinary tract infections, of ambulatory patients.The isolates were tested against penicillins, macrolides, quinolones,oxazolidindione and others.The good sensitivity of isolated strains of Enterococcus spp. to penicillins, make those to be the first choice for treatment.The good sensitivity of Nitrofurantoin, can be considered as a good alternative therapy in enterococcal UTI.The resistance of enterococci to quinolones, may be due to a widespread usage of these antibiotics for UTI as first line treatment.

Psychiatric Disorders Related To Interferon Therapy For Chronic Hepatitis
Diana – Liliana Bandrabur

ABSTRACT. Improved interferon therapy for chronic hepatitis C (long acting pegylated interferon α-2b and ribavirin) with effective virological response in over 50% of treated patients still can cause significant psychiatric side effects among others. Good patients’ compliance, adherence of the treatment guarantees succesful cure and a better quality of life. Therapy withdrawal due to side effects complicates hepatitis C evolution and prognosis. Psychiatric disorders related to interferon therapy or withdrawal include cognition, mood and personality disorders, brief psychosis and suicide. The aim of the study is focussing on case management, treating and managing psychiatric side effects of interferon therapy and enabling patients to finish IRN therapy, making risk-benefit assesment regarding interferon α (IRNα) treatment of patients with chronic hepatitits C virus infection.

Callus Stimulation With Bone Substitute (Preliminary Study)
B. Obadă, Stela Zamfirescu, N. Obadă, V. Orbeanu, V. Lupescu

ABSTRACT. The paper want to evaluate a new method of consolidation stimulation or to relaunch it, which use a bone substitute with strong osteoconductive properties, made calcium sulfate-based. The patients group consist of 4 cases of leg open fractues and 1 pseudarthrosis case after a closed diaphiseal cominuted femur fracture. The method of consolidation stimulation consist of combined using of an autologus cancellous graft, a bone marrow aspirate from iliac crest and the calcium sulfate pellets. All the cases had a favourable evolution to consolidation in a short period of time. The Osteoset pellets is an osteoconductive bone substitute, and the callus stimulation properties had maximum eficacity, in the presence of celular graft brought by the spongious graft and the bone marrow aspirate. The use of bone substitute with osteoconductive properties is necessary for bone loss more than 2 cm, associated with autologus cancellous graft and bone marrow aspirate. The using of the Osteoset pellets serves as biologic matrix for the stem cell action and for the growth factors delivred by the autologus graft and by the bone marrow aspirate.

Cardiovascular Dysfunction In Cirrhosis
Zizi Niculescu, Mihaela Ghinea

ABSTRACT. Patients with cirrhosis have hemodynamic alterations characterized by increased cardiac output, decreased arterial pressure and peripheral resistance.The observation of a “hyperdynamic”state in the circulation of these patients, was followed by the description of a novel type of “cardiomyopathy”, with specific functional and electrocardiographic characteristics. The prevalence of cirrhotic cardiomyopathy remains unknown at present. Although nowadays cirrhotic cardiomyopathy is considered to be a well described clinical entity, its clinical significance in cirrhotic patients remains unclear.It is generally latent, but shows itself when the patient is subjected to stress such as exercise, drugs, hemorrhage and surgery. There have been efforts to correlate the cardiovascular disturbances with the etiology or the severity of the hepatic failure, often with controversial results. Because of the marked paucity of treatment studies, current management recommendations are empirical, nonspecific measures.

Improving Breast Cancer Staging: Role Of Breast MRI
Laura Mazilu, R. Baz, Andra Iulia Suceveanu

ABSTRACT. MRI has been shown to accurately define the extent of cancer within breast parenchyma and fat. In addition to size and multifocality, the presence of skin and chest wall involvement can significantly change surgical treatment. Assessment of disease extent is important for surgical planning, staging for prognosis, and consideration for preoperative chemotherapy. In posterior lesions, especially in those close to the chest wall musculature, this information may not be available from conventional diagnostic studies, such as mammography, prior to surgery. Thus, it is critical to map the extent of disease so that the appropriate management is planned. Our objective was to determine the accuracy of MRI for this purpose. Fifty-one women diagnosed with stage IIB-IIIB palpable breast cancer between 2004 and 2007 and admitted in Oncology Department were prospectively enrolled in a study investigating the effects of neoadjuvant chemotherapy on tumor imaging. MRI positively diagnosed pectoralis major invasion in 3 cases (5.88%) and skin invasion in 1 case (1.96%) which were negative by clinical examination, mammography and ultrasonography. Our study demonstrates that MRI improved breast cancer staging by providing valuable information about cancer extent.

Terebrant Palpebral Basocellular Epithelioma - Case Presentation
C. Farah, D. Denislam,H. Mrini, Fildis Mrini, G. Emirali

ABSTRACT. The basal cell carcinoma is the most common malignant tumor of the eyelid (85-90%) arising from the basal cell layer of the epidermis. Although its destructive and invading character, usually the tumor doesn’t invade the lymph nodes and does not metastasize and it has an exclusive local malignancy. We present a case of carcinoma that has passed in the terebrant form because of the patient’s repeated postponements of the optimal therapeutic attitude (in 2001, 2003, 2005) . Because of the carcinoma’s actual phase, the functionality and the esthetic outcome pass in the second place ( being a mutilant surgical procedure), the vital character of oncological surgery becomes the main priority.

Rectocolectomy With Coloanal Anastomosis For Low Rectal Tumors
R. Soră, T. Iusuf, V. Sârbu, R. Popescu, Cristina Cristache, Raluca Pasăre, V. Niaman

ABSTRACT. The present paper wants to show the experience of the 2nd Clinic of Surgey from the Clinical District Hospital of Constanta, the differentiated treatment of distal rectal caner. Our work represents a 2 years study of 18 cases with colorectal resection followed by coloanal anastomosis. There are papers that show good results with local treatment in first stage cancers (contact radiation therapy, electrocoagulation or local excision). Unfortunately, the cases reported in our clinic are in the advanced stages of rectal cancer and therefore too voluminous to receive local treatment.The principal problems of rectum resection with coloanal anastomosis or low colorectal anastomosis are the indication and the distal limit of resection in safe tissue(for oncological reason). Surgery seems to have only a palliative role in both situations if the cancer is in an advanced stage.

Failure To Recognize Fetal Alcohol Syndrome In Newborns
Cristina Maria Mihai

ABSTRACT. The fetal alcohol syndrome occurs in infants whose mothers abusea lcohol during pregnancy. Identifying alcohol-exposed newborns is difficult. Currently, there is no systematic approach, nor definitive laboratory tool to diagnose such cases. In the past 2 years, we studied the medical records of 8 infants with clinical characteristics associated with fetal alcohol syndrome, presented in our department for failure to thrive, seizures, minor respiratory and digestive diseases, and mental retardation. Physical examinations of these infants revealed primary features consistent with a diagnosis of fetal alcohol syndrome in all: depressed nasal bridge, anteverted nostrils, long and hypoplastic philtrum, thin upper vermilion, mid-face hypoplasia. Early identification of an alcohol-exposed newborn infant with physical characteristics, could receive intensive follow-up and have appropriate guidance

The Management Of Open Fractures In The Patient With Multiple Trauma
V. Orbeanu, B. Obadă, S. Ureche

ABSTRACT. Open fractures are complex injuries that involve both the bone and surrounding soft tissues. Management goals are prevention of infection, union of the fracture, and restoration of function. Achievement of these goals requires a careful approach based on detailed assessment of the patient and injury. The classification of open fractures is based on type of fracture, associated soft-tissue injury, and bacterial contamination prese The associated soft-tissue injury may also cause delayed union, stiffness, and other problems. Treatment options for open fractures depend on two major factors: the soft tissue problem and the skeletal problem.

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