ARS Medica Tomitana
vol. XV - nr. 3 (58) - july - september 2009


Stress Factors In The Magistrate’s Activity
Monica Silvia Ciocoiu, S. V. Ciocoiu, Mirela Cojocaru

ABSTRACT. It has been performed a study concerning the stress factors of the magistrates, in order to be informed on their contribution over the health risks. It was studied a sample of 176 people, representative for the magistrates in Constanta County, including 92 judges and 84 prosecutors, 70 men and 106 women, with ages between 20-60 years old and seniority in magistracy work of 1-25 years. The method consisted in visiting their workplaces, conversations with magistrates and the application of a questionnaire containing 77 potential stress factors, classified in 5 categories from which 56 were declared as stressing. All the magistrates mentioned the existence of certain stressors relating to their work. In different proportions were mentioned various physical-chemical factors, relating to the organizational structure and the professional climate, of the magistrate’s role in the professional activity and individual factors relating to the interaction between the professional and the socio-family environments. There were analyzed the types and the frequency of stressors in each category and the ways of preventing and fighting against them.


Cytohistologic And Immunohistochemical Survey Of Granular Tissue In 3th Degree Burnt Tegumentary Wounds
Rodica Mehedinti, Mihaela Hîncu, Adina Braga, Zizi Niculescu, Irina Durbală

ABSTRACT. The structuring of the vascular system both during embriogenesis and in postnatal life relies on two processes: vasculogenesis and angiogenesis. While vasculogenesis structures blood vessels by multiplying the differentiating angioblasts, angiogenesis involves the emergence of new vascular buds out of pre-existent vessels under the impulse of angiogenetic factors wherein the newly built solar plexus is repeatedly being submitted to inductions and remodelling which results in structuring a vascular system of various diameter and function. The skin is the most frequently affected organ by exposure to the action of thermic agents, all its elements participating at various degrees in the general reaction to aggression of the cutaneous organ. Angiogenesis is essential in the healing process of lesions, being activated for a certain amount of time and later on inhibited by very precise adjusting mechanisms. When such mechanisms are rendered inefficient, angiogenesis underlies certain pathologic conditions such as juvenile hemangiomas, growth and tumoral metastases, etc. Our survey is meant to contribute to submitting new data on the structure and development of granulation processes with burnt lesions and cellular interrelations set up in the course of the local restoring process.


Perinatal Outcome of Twins Pregnancies Related to Chorionicity
Anca Popescu, Alina Martinescu

ABSTRACT. Twin gestation represent high-risk pregnancies. The risk of perinatal morbidity and mortality in twins is 3–7 times higher than in singletons. In comparison to dichorionic twins, monochorionic twins are at increased risk for perinatal mortality and serious morbidity. In both type of twins growth discordance can occur. To assess the rate of perinatal mortality depending of chorionicity and for establishing the perinatal outcome in twins we studied 50 pairs of twins (MZ and DZ) with several variables such as placentation, gestational age, birth weight, maternal age, mode of delivery and the presence of discordant growth.


Particularities of Debut in Hirschsprung’s Disease
V. Broască, Iuliana Dimofte, A. Prună, Beatrice Severin

ABSTRACT. Hirschsprung’s Disease is a birth defect that affects about one out of 5,000 newborns and it should be considered in any child who has a history of constipation dating back to the newborn period.The diagnostic steps include a careful history and physical examination, radiographic studies, anorectal manometry and a rectal biopsy. The only way to treat this disease is through surgery. Prognosis is very good. Most infants with Hirschsprung’s disease achieve good bowel control after surgery, but a small percentage of children may have lingering problems with soilage or constipation.We made a study with 21 cases treated in Clinical County Emergency Hospital Constanta and we analysed the symptoms and evolution. The diagnosis methods comprised clinical and paraclinical examination . As a method of statistics analyzes we used the percentage method. The particularity of disease is the early debut with a high frequency for the neonatal period. The predominant symptom in cases of our group was severe constipation associated with varying degrees of abdominal distension.


Allele And Genotype Frequencies Of HLA-DRB1 and DQB1 Loci In A Type 1 Diabetes Pediatric Study Group
Irina Durbală

ABSTRACT. The association of type 1 diabetes with certain alleles of class II major histocompatibility complex loci is well known. The main genetic determinants are alleles at HLA-DRB1 and DQB1 loci, having either susceptible or protective effects. The aim of the study was to characterize our group of children with type 1 diabetes in respect with HLA-DRB1 and DQB1 alleles. Molecular genotyping was performed in 62 type 1 diabetes patients registered at the Pediatric Clinic of the Emergency Clinical Hospital Constanţa and 59 healthy subjects, first degree relatives of the patients. The frequencies of HLA class II alleles and genotypes were inferred from the results and the presence of high-risk, neutral, and protective genes as defined by the last report of the Type 1 Diabetes Genetic Consortium was analyzed.


Colonic Adenocarcinoma Associated With Ovarian Bilateral Tumor – Case Report
Mariana Aşchie, Anca-Florentina Papuc, Antonela-Anca Crăciun, Anca Chisoi, I. Poinăreanu, Andreea Ilieşiu

ABSTRACT. In medical literature there are mentioned some hereditary syndromes clinically manifested throughout synchronic tumors: Lynch II Syndrome (presence of many types of cancer: mammary, colonic, stomachic at the members of the same family) or LiFraumeni Syndrome (environmental dependency genetic predisposition at more types of cancer: breast, colon, rectum, ovarian). The authors report 55 years female’s case, hospitalized in Surgical Clinic I of Emergency Clinical County Hospital Constanta, in March 2009 suffering from increased abdominal volume. Clinical and paraclinical examination reveals abdominal mass and surgery is decided. Gross examination of sampled specimens shows anexial bilateral tumor associated with sigmoidian mass. Microscopically were identified ovarian serous papillary adenocarcinoma and colonic anaplazic carcinoma. Immunohistochemistry reveals p53 ++, CK7++, CA125++, CK20-, CEA-, MUC2- for the ovarian tumors and p53+, CK7++, CK20++, CA125-, CEA++ and MUC2++ for the colonic tumor, profile that confirms the diagnosis of ovarian and colonic synchronous tumors. The increased level of serological tumoral markers doesn’t have the positive diagnosis certitude compared with immunohistochemistry markers applied on the paraffin blocks.


First Trimester Miscarriage – Histopathologic Features
Coralia Victoria Ştefănescu, Mariana Aşchie

ABSTRACT. The miscarriage stands for the most frequent pregnancy complication – from 20 to 40 percents of cases (according to various studies). Since the complete mechanisms of the lesions it’s still unknown we could talk about a relative inefficiency of the therapeutical approach and the lack of a real prevention algorithm of the pregnancy loss. Various pathologic lesions were found on the biopsies from the pregnancy loss cases but there’s no consensus of the description. We try to classify the lesions found on 131 tissue samples of first trimester miscarriage. Despite the fact that no specific aspects were described – such as acute inflammation, chronic villitis or choriodeciduoamnionitis - we strongly advice that the histological examination of tissue from pregnancy loss should remain part of routine clinical practice mainly due to medico-legal implications.


Biochemical Analysis Of The Serum And Ascitic Fluid In Hepatic Cirrhosis
Georgeta Irinel Verman, Mihaela Basa, Natalia Rosoiu, Dana Pleş

ABSTRACT. The aim of this study was to evaluate the biochemical parameters both in serum and ascitic fluid collected from patients with hepatic cirrhosis of different causes. Methods: Samples from 15 patients, 55-83 years old, diagnosed with cirrhosis due to alcohol use or viral infection HVB and HVC, were analyzed for hepatocytolysis (ALT, AST, AST/ALT, LDH, Fe), cholestasis (BT, conjugated and nonconjugated bilirubin, GGT, ALP), inflammation (protein electrophoresis), protein synthesis deficiency (cholinesterase, albumin), glucose metabolism (glucose and amylase), lipid profile (CT, TG), urea, creatinine, uric acid (renal function), and CPK. Results: AST and ALT in the ascites are in the reference interval even in the patients with higher than normal values in the serum. AST/ALT>2 because of the mitochondria disturbances due to alcohol or other extrahepatic lesions. The ALT is less sensitive in the alcoholic cirrhosis than AST. The ratio in the ascites is correlated with the values in the serum. Cholestasis tests have lower values in ascites than in serum. The synthesis of albumins is disturbed. The ratio between the serum and ascites albumins is >1,1 in portal hypertension. cholinesterase activity and cholesterol concentation in the serum are decreased proportionally with the hepatic insufficiency, with an unfavorable prognosis. The cholesterol in the ascites had a limit of 45-48mg/dl corresponding to the cirrhosis (as compared to the ascites due to malignancies). TG in ascites are lower than in serum. Urea, creatinine and uric acid values in ascites are correlated with those in serum with high values for uric acid.


Metabolic And Hemodynamic Tolerance Of Glucocorticoid Pulse-Therapy In Patients With Chronic Inflammatory Rheumatic Diseases
Luminiţa Matei, Maria Şuţa, Cristina Duminică, R. Ş. Şuţa

ABSTRACT. Glucocorticoid treatment is of major importance for joint inflammation and life-threatening extra-articular involvements control in patients with inflammatory rheumatic diseases. Significant side-effects of glucocorticoids represent a limitation for this treatment. Pulse-therapy is an alternative to high-dose daily therapy, as an intention to minimize side effects. This is a prospective observational study that evaluates the short-term metabolic and hemodynamic tolerance of glucocorticoid pulse-therapy in 31 patients with inflammatory rheumatic diseases. We recorded clinical and biochemical parameters (cardiac failure symptoms and signs, serum glucose, potassium for all the patients; and natriuretic peptide for the patients with heart disease) before and after 125 mg methylprednisolone infusions for 3 consecutive days. We found an increased level of serum glucose after pulse-therapy in 2 patients, both with previous diabetes or impaired fasting glucose. Serum potassium slightly decreased as a mean value; none of the patients had hyperpotassemia, and the lowest recorded value represented only mild hypopotassemia. Two patients had significant increase in natriuretic peptide, but none had deterioration in the clinical symptoms and signs of cardiac failure. Methylprednisolone pulse-therapy was generally well tolerated in patients with inflammatory rheumatic diseases. Potassium level must be checked before treatment and caution is needed in patients with previous glucose metabolism disturbances. There was no hemodynamic deterioration, even in patients with advanced cardiac failure.

Correlations Between Plasma Levels Of NT-proBNP, Troponin T And Reperfusion In Patients With ST Segment Elevation Myocardial Infarction
A. Rusali, Lucia Cojocaru, Elvira Craiu

ABSTRACT. The main vasodilatator and diuretic system, but also with antiproliferative effects, is represented by natriuretic peptides (NP). They are important, especially through the role in the diagnosis of asymptomatic ventricular dysfunction and diastolic dysfunction, in the prognosis, including sudden death prediction, and also in the evaluation of therapy efficiency. The aim of our study was to identify the existency of correlations between the plasma levels of NT-proBNP during hospitalization in patients with STEMI and levels of troponin and also the presence or absence of ST segment elevation resolution after thrombolisis. It is a prospective, randomized study, which included 35 patients with STEMI. In the study group we correlated plasmatic levels of NT-proBNP harvested during hospitalization with those of troponin T determined 24 hours after admission and also with the presence or absence of ST segment elevation reduction after thrombolisis. We noticed a relation of direct proportionality between NT-proBNP levels and troponin T (NT-proBNP Q1/ Q2/ Q3Troponina T >3 μg/ml (nr pacienti) 3/13/18). The analisis of the study group showed a relation of inverse proportionality between the plasma levels of NT-proBNP afetr 24 hours from the begining of the acute coronary event and the decrease in amplitude of the ST segment after thrombolisis (NT-proBNP Q1/ Q2/ Q3 Rezolutie ST<50% (nr pacienti) 3 / 9 / 15). Plasma levels of NT-proBNP are correlated with statistical semnificationwith palsma levels of troponin T after AMI and also with the succes or failure of thrombolisis represented by the modifications in amplitude of the ST segment elevation.

Variation Of Body Temperature During Mud Pack. Experimental Study And Statistical Calculus Of Efficiency Of Therapeutic Application
Mariana Panaitescu, Olga Surdu, Maria Şuţa

ABSTRACT. In this paperwork are presented the results of an experimental study realized on a batch of 20 subjects: 10 men and 10 females, made in Techirghiol Balneal and Rehabilitation Sanatorium, between February – June 2009. During this study were measured the body temperature, the radial pulse, the blood pressure and the oscilometric index before and after the hypertherm mud application (mud pack/wrapping) in first, fourth, eighth and twelfth days of the cure. In this paper we present the variation of the temperature before and after mud application.In order to evaluate the range of efficiency were made statistical calculus on medium variation of obtained data. The results show that in first and fourth days determined parameters present important variation and at the end of cure - twelfth days – they are in physiological limits. The high level of determined parameters are explained by effects of mud and salt water on the thermoregulation and blood circulation function.

Primary Results Of Methotrexate Treatment In Tubal Ectopic Pregnancy
Aneta Tomescu, C.L. Tomescu, Dana Pleş, Nicoleta Tomescu

ABSTRACT. Ectopic pregnancy is a major cause of morbidity and mortality in reproductive age women. Surgical treatment was replaced recently by medical conservative treatment such as methotrexate therapy. Primary outcomes of conservative methotrexate treatment are represented by success and failure rates. We performed a retrospective study in two Obstetrics and Gynecology Clinic Hospitals in Bucureşti (Gheorghe Polizu Hospital) and in Constantza (Clinic County Hospital) in order to compare the efficacy of methotrexate single-dose (Constanţa) versus multi-doses (Bucharest). A total of 238 patients admitted in the both hospitals (137 in Bucharest and 101 in Constanţa) were treated with methotrexate. The success rate for Bucureşti was 78.84%, for Constantza was 76.23%, and for the entire study, 77.73%. Failure rate, Bucureşti 21.16%, Constanţa 23.77%, total failure rate 22.27%. Succes rate is higher by 2-3 per cent in Bucharest than in Constanţa, which suggests that multi-dose treatment is apparently superior to single dose treatment. The number of surgical procedures does not appear to depend on the type of treatment because the number of surgical procedures after methotrexate treatment in the two hospital is similar (11.67% in Bucharest and 11.88% in Constanţa).

Thyroid Undifferentiated Carcinoma – Case Presentation
Silvia Savin, A. Berro, T. Ş. Niţu, A. Miga, Maria Mihaela Tomiţă, M.I. Savin

ABSTRACT. With the exception of epithelial origin, thyroid undifferentiated carcinoma are tumors which do not present elements of cellular differentiation manifesting an extreme evolutionary agressivity being the most lethal lesion among all endocrine glands tumors (from the moment of their apparition with rare exceptions the survival rate with or without treatment does not exceed 6 to 12 months). Often it appears in elders with preexisting goiters which relatively suddenly (weeks or months) begin to grow and develop compression phenomena (dyspneea, dysphagia and dysphonia). The tumors expand to a diffuse mass, often irregular, compact, immobile which grows rapidly reaching an impressive volume, invading extra glandular tissue and determining multiple compression phenomena (coughing, dyspneea, dysphagia, dysphonia, stridor) and local pain. The laterocervical adenopathy and even the mediastinal and supraclavicular ones have the same clinical characters as the thyroid tumor often the adenopathy being one with the tumor. Metastasis, in 50% of cases being present from the first consultation, often multiple (brain, bones, lungs), are also present adding to the rapid deterioration of the general health state with important weight loss. Death occurs rapidly through respiratory obstruction and the general expansion of the cancer. We present the case of an 83 years old patient diagnosed with anaplasic thyroid neoplasia checked in The Surgery Clinic II of the Emergency Clinical County Hospital to whom we performed total thyroidectomy and neck modified radical resection. The described clinical forms evolution was not favorable, she deceased 3 months post surgery from respiratory insufficiency on the account of pulmonary metastasis.

Etiopathogenic Datas On Thoracic Trauma
Mihaela Pirvu, V. Sârbu, D. Toldişan, Diana Nicolaescu, I. Lupu, Ghiulserin Nurla, Dana Pleş, C. Popa

ABSTRACT. The high frequency of autonomous thoracic trauma or within politrauma has reached impressive numbers, with significant economic and social repercussion. The economic development, the urbanization, the enhancement and the development of circulation determined that in the last decades the thoracic trauma have a significant role in the surgical emergencies. The great majority of thoracic trauma are the result of car crashes, followed by work accidents, falls from height or the same level, sports accidents, etc The existence of important visceral lesions can be recognized by predicting similar lesions according with the lesional mechanisms. A high degree of suspicion is the key to early diagnosis and this has to be confirmed or excluded by apropriate and available investigations such as radiography or computed tomography. In this study we tried to make a clasification of thoracic trauma by etiopathogenic criterias which is important in the diagnosis, early treatement and favorable prognosis.

Middle Ear Barotraumas – Classification Aspects
Oana-Gabriela Enache, V. Loghin

ABSTRACT. Human body easily bears low and smooth pressure variations. The easier access to scuba diving and to air travel as well as the advancement (development) of a newer medical branch – hyperbaric oxygen therapy – expose the human body to pressure variations, to whom it is not accustomed. As a result the number of middle ear barotraumas has increased. The paper presents a short remember of etiopathogeny, clinical aspects and treatment in middle ear barotraumas. The authors propose a more facile classification of middle ear barotraumas, which allows the establishment of treatment algorithms, useful especially for the “first contact physician”.

Bacterial Meningitis - Evolution, Prognosis
Stela Halichidis

ABSTRACT. I studied bacterial meningitis evolution, excepting those with mycobacterial etiology, because bacterial meningitis are still severe diseases, because their high mortality and sequelles. I studied 216 cases of bacterial meningitis (excepting those with mycobacterial etiology and those on HIV-infected patients), registered in Clinical Infectious Diseases Department, during 3 years.. The majority of the patients were completely cured (67,59%). 25,93% of cases remained with sequelles and 6,48% of patients died. In Constantza, the fatality rate of bacterial meningitis is placed between 3,85 and 9,23.

Giant Testicular Tumor
F. Voinea, O. Azis, Liliana Tuţă, Claudia Voinea

ABSTRACT. The authors present a 55 years male, which was operated for left inguinal hernia two years ago. Clinical examination of scrotal area finds a gigantic tumor, about 20/15 cm, which is painful, firm, bounded, smooth faced. No left inguinal lymph nodes were found. Tumor markers had normal values. CT exam reveals hepatic and splenic hemangioma. We performed left inguinal orchiectomy. Postoperative evolution was good. Tumor markers are normal after 30 days.

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