ARS Medica Tomitana
vol. XV - nr. 2 (57) - april - june 2009


The Origin Of The Inferior Mesenteric Artery In Relation With The Vertebral Column
Sakher H., Ionescu C., Bărdaş M., Bordei P.

ABSTRACT. We evaluated the aortic origin of the inferior mesenteric artery in relation with the vertebral column on a total of 56 cases of abdominal aorta angiographies and CT exams and also the distances between this origin and the origins of the superior mesenteric and renal arteries and to the aortic bifurcation. In most of the cases (60.71% of the cases), the inferior mesenteric artery originates from the aorta at the level of L3, the distance between the origins of the inferior mesenteric and renal arteries was between 4.5 to 6.5 cm and between the origins of the two mesenteric arteries was around 5 to 8.2 cm.

Red Blood Cells Response To Hyperbaric Hyperoxic Environment
Cecilia Adumitresi, N. Ceamitru, Ileana Ion, Ninela Rădulescu, Cristina Farcaş, Carmen Ciufu, Loredana Hânzu

ABSTRACT. Objectives: The use of respiratory gas mixtures in hyperbaric conditions, during simulated diving, following high oxygen partial pressure in pulmonary alveoli and the increase of the plasma oxygen concentration, revealed an accident risk, deriving from oxygen toxicity. Our study aims to measure those parameters that emphasize intricate effects of hyperbaric environment over the red blood cells of exposed organisms, induced by its characteristic hyperoxic aggression. Material and methods: Experiments were performed on Guinea pigs exposed to a pressure of 6 ATA. The breathing mixtures were represented by plain air and by a mixture of 32% oxygen with 68% nitrogen (Nitrox I). We assessed the number of red blood cells, their minimal and maximal osmotic fragility and estimate the percentage of erythrocytes glucose involved in pentose phosphate pathway, by measuring erythrocytes Glucose-6-phosphate dehydrogenase activity. Results: We obtained significant changes of the measured parameters and noticed specific responses regarding the use of different specific oxygen concentration in the respiratory mixtures. Conclusions: Hypebarism induced by the 6 ATA pressure simulated exposure, using air and nitrox as respiratory mixtures, produces increses of ROS production and significant responses of red blood cells number and their osmotic fragility. The increase of plasma oxygen concentration following the use of Nitrox as a respiratory mixture (oxygen concentration in this mixture being 32%) during simulated diving lead to additional changes. Erythrocytes Glucose-6-phosphate dehydrogenase is part of the antioxidant protective system associated to cells ability to neutralize oxidation stress, in order to avoid their irreversible denaturation, beeig itself a possible target.

Cytological Aspects In Different Types Of Vaginitis
Monica Daniela Doşa, V.Tica

ABSTRACT. The aim of this study was to investigate the correlation between the types of vaginitis and the cervical vaginal smears type. Vaginal infections are one of the most common types of infections in the world. This study is a retrospective review of data collected during a period of 5 months, on 400 smears, collected from ambulatory pacients. Cervical smears were interpreted using the Bethesda criteria, vaginal slides by gram method, very practical for diagnosis of vaginitis in ambulatory. The study shows that the incidence of different types of vaginitis was modified, less frequent are the parasitar infections, more frequent are the infections with candida or bacteria. Most of fungal and bacterian vaginitis were correlated with normal or inflammatory cytological aspects, while more frequently the trichomonas infections was correlated with cell atypia.

Multidrug Resistant Acinetobacter baumanii Isolated In Intensive Care Unit Of The Emergency Clinical Hospital, Constanta
Victoria Braga, Mihaela Botnarciuc, Lavinia Voineagu, Adina Barbu

ABSTRACT. The aim of this study was to realize an updated map of the presence of Acinetobacter species, specially A. baumanii in isolates from patients hospitalized in I.C.U of the Emergency Clinical Hospital Constanta, to identify the resistance profiles, the presence and characters of multidrug resistant strains. Clinical specimens, obtained during 6 months period from all hospital departments, were cultured on conventional media, identification of species and sensitivity tests were performed on VITEK 2 System version 02.01 n, from Bio-Merieux. During a 6 months period we isolated 68 strains of Acinetobacter baumanii , 2 strains of Acinetobacter haemolyticus and 2 strains of Acinetobacter junii. Acinetobacter baumanii was isolated from 20 bronchic aspirates, 18 wound secretions,10 I.V. cathethers and blood cultures, 8 peritoneal fluids, 4 cerebrospinal fluids, 2 urine samples and 2 pharyngeal exudates. The majority of the patiens with positive samples for A. baumanii were from Intensive Care Unit ( 44), Plastic surgery, Neurosurgery and General surgery (14), Oncology and Pneumology ( 6), Obstetric-Gynecology (2) and Pediatrics (4). The majority of the isolates – 50 strains were multidrug resistant, being sensitive only to Netilmicin . These were all ICU strains, Plastic surgery and Neurosurgery strains. Another phenotype of resistance was noticed in 4 strains, sensitive to aminoglycosides and fluoroquinolones. Finally, a group of 14 strains were senstive to aminoglycosides, fluoroquinolones and some beta-lactamines (CFT, CFP, PIP, PIP+TAZ).

Correlations Between Generalized Osteoporosis And Demographic, Clinical And Biological Variables At The Patients Diagnosed With Rheumatoid Arthritis
Adrian Mitroi, Maria Şuţa

ABSTRACT. Osteoporosis is recognized as an extraarticular complication in rheumatoid arthritis. The objective of this paper is to examine the frequency of osteoporosis and the relation between osteoporosis and demographic and clinical variables in patients with RA. Bone mineral density (BMD) in the femural neck, total hip, and spine L2-L4 was measured in 56 patients with RA hospitalized in the Rheumatology Clinique of Clinical Emergency County Hospital of Constanta. All of the patients fulfilled the 1987 ACR revised criteria for rheumatoid arthritis. BMD was measured using dual-energy x-ray absorptiometry (DXA) equipment (Lunar – General Electric). The patients with osteoporosis and those without osteoporosis were bivariately correlated to age, body mass index, menopause, disease duration, Health Assessment Questionnaire (HAQ), disease activity score (DAS), presence of rheumatoid factor(RF), erythrocytes rate of sedimentation (ESR), ever/current use of corticosteroids. The mean age of patients was 55.84 ± 12.43 years. The mean duration of RA was 10.20 ± 3.83 years. 11 patients had normal value of T-score, 24 patients had osteopenia, and 21 patients (37.5%) had osteoporosis; 13 patients (23.21%) had femur osteoporosis and 16(28.57%) patients had lumbar osteoporosis. Our patients present 11 fractures. Osteoporosis is significantly associated with older ages, menopause, low body mass index, duration of RA, HAQ, DAS, and ESR. Treatment with corticosteroids represents a risk factor only for patients with localized osteoporosis at the lumbar level. RF did not represent a risk factor for osteoporosis.

Nonalcoholic Fatty Liver Disease And The Metabolic Syndrome
R-S. Şuţa

ABSTRACT. Non-alcoholic fatty liver disease (NAFLD) is the most common hepatic disorder in western countries, and its incidence is increasing. (NAFLD) has been associated with the insulin-resistance syndrome, at present defined as the metabolic syndrome, whose limits were recently set. We assessed the prevalence of the metabolic syndrome in 200 consecutive patients with central obesity on the basis of 3 or more criteria out of 5 defined by the U.S. National Institutes of Health (waist circumference, glucose, high-density lipoprotein [HDL]-cholesterol, triglycerides, and arterial pressure), the prevalence of NAFLD and the correlation between those two conditions. The prevalence of the metabolic syndrome increased with increasing body mass index, from 6% in normal-weight subjects to 62% in obesity (p-value<0.0003-Fisher exact test). Non-alcoholic fatty liver disease defined as brightness and posterior attenuation assesses by ultrasound had a total prevalence of 55% in the group considered and 63% of patients with metabolic syndrome were identified as having NAFLD, with a strong correlation between the two conditions (OR, 2.33; 95 CI, 1.3-4.1, p-value <0.003- Fisher exact test). When analysing NAFLD according to classes of BMI we found that NAFLD had a statistically significant higher prevalence (p-value < 0.00008 – Fisher exact test) in obese patients with no difference related to gender. The increasing prevalence of obesity, coupled with diabetes, dyslipidemia, hypertension, and ultimately the metabolic syndrome puts a very large population at risk of forthcoming liver failure in the next decades.

Upper Gastrointestinal Bleeding In Children
Adriana Bălaşa,Valeria Stroia, Adina Ungureanu

ABSTRACT. Upper gastrointestinal bleeding (UGIB) is a relatively common and occasionally fatal emergency that may occur in all age groups. The authors analyzed a number of 44 cases of children with upper gastrointestinal bleeding (age range 6 month-16 years, mean age 10,8 years) during a period of 3 years, admitted in Pediatric Department of Clinical County Hospital Constanta, Romania. Hematemesis (38 cases) and melena (20 cases) were the most common presenting symptoms, followed by abdominal pain (16 cases), vomiting (8) and hematochezia (1case). The size of hemorrhage was detected by upper digestive endoscopy in 20/22 procedures performed (90,9%). There were no complications related to upper digestive endoscopy. Gastroduodenitis with erosions and duodenal ulcer were the most important cause of upper gastrointestinal bleeding. Esophageal varices are the major and dangerous causes of upper gastrointestinal bleeding in children. Treatment consisted in substitution with blood products, antisecretory agents in all cases, oral iron therapy, endoscopic treatment. Complications attributable to upper gastrointestinal bleeding were: hypotension (6 cases), decreased Hb concentration (28 cases), need for transfusions (6 cases) and death (1 case). Conclusions: The etiology of upper gastrointestinal bleeding varied in children. Upper digestive endoscopy improves diagnostic accuracy of upper gastrointestinal bleeding.

Demographic And Clinical Aspects Of Hiv Infected Children - 3 Case Presentations -
Viviana Cuzic, Ramona Stoicescu, Adriana Balasa, Valeria Stroia

ABSTRACT. In many parts of the world, HIV/AIDS is steel seen as a death sentence, a disease from which there is no recovery. But with the ever-improving availability of antiretroviral therapy, HIV is increasingly recognized as a chronic rather than terminal illness. This transition requires considerable adjustments, especially in the pediatric and adolescent populations. Patients with a chronic illness such as HIV/AIDS face unique challenges that make their lives more difficult. It is important to understand the long-term effects these challenges can have on the children and their caregivers, whether that´s their parents, extended family, or others in the community. With proper support from their health care providers and their community, the burden of childhood with HIV/AIDS will seem less great. Education and support are the tools that help children and adolescents with HIV survive into psychologically healthy adulthood. Our study was conducted over 13 years period and included 153 patients diagnosed with HIV infection in the Pediatric Department of the County Hospital of Constanta. We analyzed demographic, social and clinical aspects of the pediatric human immunodeficiency virus (HIV) infection.

Amyotrophic Lateral Sclerosis – Atypical Form. A Case Report
N. Cârciumaru, D. Naum, Adriana Cuciureanu, Stela Dachi

ABSTRACT. Amyotrophic lateral sclerosis (ALS) is a devastating disorder of the anterior horn cells of the spinal cord and the motor cranial nuclei that leads to progressive muscle weakness and atrophy. Although major recent advances have shed light on its etiology, the key mechanisms in both familial and sporadic ALS remain unknown. No cure is known. The authors present a case of women diagnosed at middle age with Amyotrophic lateral sclerosis with unusual presentation. Neurological examination revealed weakness, wasting and fasciculation of distal muscles. Neuroimaging data were insignificant but electrodiagnostic studies were in favor of motor neuron disease.

Clinical and Imagistic Correlation in Middle Cerebral Artery Ischemic Stroke
Anca Hâncu, A. Vlăsie, Tatiana Adam, Masoud Kaivanifard

ABSTRACT. In our country stroke is the third commonest cause of death (after heart disease and all cancers), is probably the commonest cause of severe disability, and accounts for a large proportion of healthcare resources. Acute stroke is an emergency. Ischemic stroke is the most frequent neurologic disorder and can be caused by occlusion of a cerebral artery (thrombosis or embolism), decresed cerebral perfusion pressure secondary to decreased blood pressure, redused cerebral vascular lumen due to vasoconstriction, vascular permeability disturbances, increased blood viscosity and other circulatory abnormalities. A thorough medical evaluation is required for the diagnosis and management of cerebrovascular injury. The history should include age, family history, handedness, comorbidities, medications, time of onset, and prior pattern of neurologic deficits. History, physical examination, imaging studies determines risk factors, localize lesions, delineate underlying pathophysiologic conditions and guide treatment. Infarcts are most easily seen on CT after a few days or in the chronic phase, when they may become hypodense and well defined. The clinical and imagistic correlation in middle cerebral artery ischemic stroke is very important for both acute management and secondary prevention.

Successively Neoplasm In Breast Cancer
I. Iordache, V. Sârbu, O.Unc, Dana Pleş, Irina Călin, Liliana Steriu, B. Kabtour, Diana Nicolaescu, Cristina Lazăr, Monica Iordache

ABSTRACT. The purpose of our work consists of analyzing the phenomenon about succession in time in particular forms of neoplasm after a breast cancer that has been surgical removed. Our study was achieved on a group of 15 patients which have been experienced a radically mastectomy with axilar limphadenectomy for breast cancer as part of Surgery Clinic II of Clinical Hospital Constanta. This patients returned in our clinic after a certain period of time for a parasternal neoplasm of another cancer located somewhere at the abdominal level. This distribution of cases depending on the location of the second cancer was the following: - 8 patients showed a parasternal cancel located on a distance from the first cancer; - 2 patients showed a peritoneal cancer; - 2 patients showed an ovary cancer associated with breast cancer somewhere in his evolution; - 1 patient showed a cancer located on the large intestine; - 2 patients showed a gastric cancer. The debate has the purpose to examine the circumstances which could encourage the development at the same patient, in certain variable periods in time of several cancers located in different organs. The main conclusions of this study are the following: - the phenomenon of cancer’s succession after a breast cancer it certainly exist, but it’s influenced by the biology of interactions between host organism and cancer. - the maximum risk concerning the appearance of a secondary breast cancer is between 2-4 years and 6-8 years since the diagnosis of breast cancer was revealed. - this succession of sundry cancers must be took into consideration when we put the diagnose of a breast cancer.

Ovarian Metastasis Of Hepatocellular Carcinoma: A Case Report
Irina Călin, I. Iordache, Liliana Steriu, B. Kabtour, Diana Nicolaescu, Dana Pleş, O.D. Unc

ABSTRACT. The extrahepatic spread of hepatocellular carcinoma (HCC) is uncommon. Hepatocellular carcinomas rarely metastasize to the ovaries. We report here a case of hepatocellular carcinoma with metastasis to the ovary in a 50-year-old woman. She had been diagnosed with hepatocellular carcinoma (HCC) one year and nine months prior and subsequently underwent a surgical resection (atypical right hepatectomy and cholecystectomy). The main differential diagnosis involved ovarian metastasis of the hepatocellular carcinoma, the hepatoid carcinoma of the ovary with liver metastasis, and a hepatoid yolk sac tumor. Diagnosis in such cases should be reached by careful clinical evaluation and a thorough pathologic examination accompanied by a histochemical and immunohistochemical work-up.

Problems In The Laparoscopic Approach Of Liver Hydatid Cyst
LiIiana Steriu, I. Iordache, Dana Ples, Irina Calin, B. Kabtour, Alexandra Unc, Diana Nicolaescu, O. D. Unc

ABSTRACT. Hydatid disease is a zoonosis caused mainly by Taenia Echinococcus. Surgery remains the mainstay of treatment for hydatid cyst especially by laparocopy surgery other than open surgery. In the last decade, with increased use, the laparoscopic treatment of hepatic hydatid disease has been refined and standardized. This retrospective study includes 45 patients with hepatic hydatid cyst (HHC), 10 patients whom were treated by laparoscopic surgery, 8 women and 2 men, representing 22.22% of all patients with HHC. Treatment of the liver hydatid cyst by laparoscopy has confirmed its use in liver hydatid cyst that it became safe and effective in selected patient and offers all the advantages of laparoscopic surgery. The minimally invasive method shortens the postoperative hospitalization period, reduces the number of complications, decreases the hospitalization costs and facilitates a quick social and professional reintegration

Clinical And Evolutive Aspects In Malignant Melanoma In Men
I.V. Iordache, I. Bordeianu, B. Caraban, Adriana Enache

ABSTRACT. The malignant melanoma is defined as a neoplasm of the melanocytic system that has a rapid lymphatic and blood invasion. The incidence in Europe is 3-5 per 100.000. The clinical evaluation according to the „ABCDE” system can be useful. The regional implication of the lymphatic nodules is the most important prognosis factor in patients with malignant melanoma. All statistical studies have shown that the posterior region of the thorax represents the most frequent area of apparition for malignant melanoma in men. This is also one of the major severe causes: the metastasis can occur in multiple lymph nodules both anterograde and retrograde.

Primary Outcomes Of The Methotrexate Treatment According To The Initial Value Of HCG
Aneta Tomescu, C.L. Tomescu, Dana Pleş, Nicoleta Tomescu

ABSTRACT. Medical treatment of ectopic pregnancies is common. Primary outcomes of conservative methotrexate treatment are represented by success and failure rates according to the initial value of HCG (Human Chorionic Gonadotropin Hormone.). We performed a retrospective study in two Clinical Hospitals of Obstetrics and Gynecology in Bucharest (Gheorghe Polizu Hospital) and in Constantza (Clinical County Hospital) in order to compare the primary outcomes(success rate, failure rate) depending on initial HCG level. The lower the initial value of HCG is, the higher the success rate becomes and viceversa; the higher the initial value of HCG is, the higher the failure rate becomes and viceversa. At values of over 15000 mIU/ml, the failure and success rates are 50%. The initial value of HCG represents a prognosis factor for the development of the disease for the conservative treatment with methotrexate. A high serum chorionic gonadotropin concentration is the most important factor associated with failure at treatment with single-dose protocol and multiple-doses protocol.

Phacoemulsification – Modern Cataract Surgery In Constanţa
Constantin Farah

ABSTRACT. The only effective treatment for cataract is surgery. Modern cataract surgery using a single technique and therefore called ultrasonic phacoemulsification. Myth laser in cataract surgery is just a myth, that talking technique using ultrasound only. Phacoemulsification is a modified version of extracapsular cataract extraction (ECCE) and is the most common surgical procedure for removing cataracts. The difference with phacoemulsification is that the cataract is broken into tiny pieces that are suctioned from the eye through a smaller incision than that required by other forms of cataract surgery. The advantages of cataract surgery by phacoemulsification is the insertion of the intraocular lens through a small incision, which is self-sealing. After cataract surgery is performed, the wound complications are minimized. Healing and rehabilitation are faster with this procedure, and there is little, if any, discomfort. This surgical technique performed in Department of Ophthalmology Constanta, because surgical techniques have improved and this is the reason that I chose to write this paper.

The Role Of Statins In The Therapeutic Approach Of Rheumatoid Arthritis
Şuţa Maria, Cojocaru Lucia

ABSTRACT. Rheumatoid arthritis is associated with increased cardiovascular mortality and morbidity. An extensive in vitro data, experimental studies, and more recently few clinical trials have strongly sugessted statin to possess an important role in rheumatoid arthritis mainly mediated by their anti-inflammatory and immunomodulatory properties. These anti-inflamatory properties together with the vasculoprotective effects may render statins an attractive adjunct therapy in rheumatoid arthritis.

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Constanta

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