ARS Medica Tomitana
vol. XV - nr. 4 (59) -october - december 2009


Experiemntal Study In Vitro Of Renal Pelvis In Children
R. Anastasescu, T. Merrot, P. Alessandrini, B. Mazets

ABSTRACT. The aim of this study is to show the mechanic activity of renal pelvis in vitro in children with ureteropelvic junction obstruction. The effects of classic neuromediators of the central autonomic nervous system were determined. Samples of renal pelvis were taken during surgery for ureteropelvic junction obstruction in 19 patients (12 males and 7 females) aged from 20 to 68 months (mean 38 ± 33). Specimens of distal parts of the renal pelvis were prepared (1 to 3 per patient), then immersed in the recording chamber filled up with physiologic oxygen enriched prewarmed solution. One end of the specimen was pinned on the bottom of recording camber, the other one being connected to a force transducer. The specimens of distal renal pelvis experienced spontaneous rhythmic contractions in 14 of 19 cases. Mean frequency of of contractions was 10.5 ± 4 contractions/min. (range: 3 to 18). We’ve also noticed a gradient of contractions frequency between proximal and distal parts of studied specimens. Spontaneous activity wasn’t abolished by tetrodoxine (1 to 3 µMol). Perfusion of noradrenalin (0.1 to 1 µMol) induces increase of contractions frequency (+ 18%). These effects seemed to be due to the activation of α-adrenergic receptors. Perfusion of acetylcholine (1 µMol) induces the same effect, but less important (+7%). This study clearly proves the existence of a functional pacemaker located on the distal area of renal pelvis in children with ureteropelvic junction obstruction. The agonist adrenergic and cholinergic effects suggest that the autorythmic activity of renal pelvis could be modulated by autonomic nervous system. These preliminary results justify a new approach in the study of mechanisms of functional ureteropelvic junction obstruction.

Morphometry Of The Pulmonary Trunk And Pulmonary Arteries
M. Cambrea, J.P. Francke, C. Dina, C. Ionescu, P. Bordei

ABSTRACT. The authors evaluated the dimensions (length, caliber) of the pulmonary trunk and of the two pulmonary arteries, right and left, assessing also the pulmonary trunk bifurcation compared with the bifurcation of the trachea and the relations of the pulmonary arteries with corresponding main bronchi. The pulmonary trunk, with a variable length of 2.5 – 5.8 cm, has a caliber of 2.02 - 2.49 cm, and its bifurcation is formed at an angle of 30 - 1080. Until the emergence of the first branch, the right pulmonary artery has a length of 1.2 – 2.8 cm, showing, at the origin, a caliber of about 1.29 to 2.04 cm. The left pulmonary artery had a length of 1.5 - 2.7 cm, with a caliber between 0.86 to 2.27 cm. Comparing the right to left, the left pulmonary artery, in 12 cases, had a larger caliber than the right pulmonary one.

The Splenic Artery And Its Ending Manner
Loredana Surdu, G. Peri, D. Iliescu, P. Bordei

ABSTRACT. The place and ending manner of the splenic artery represent primordial factors that condition the procedure of partial splenectomy. Most of the authors report as frequent the extrahilar ending location of the splenic artery (distributive type, in 76.14% of the cases), at different levels: body of the pancreas (5.68% of the cases), tail of the pancreas (27.28% of the cases) and within the pancreatico-splenic segment (43.18% of the cases). The splenic artery divided within the hilum in 20.45% of the cases and in 3.41% of the cases the terminal division was performed within the spleen. Most often, the splenic artery ended by bifurcation (77.27% of the cases), trifurcation (15.91% of the cases) and, in 6.82% of the cases ended by 4 or 5 branches. The terminal branches of the splenic artery were arranged upon acute angles (73.86% of the cases), 900 angles (12.5% of the cases) or obtuse angles (13.64% of the cases). The terminal distribution of the splenic artery, the presence of the non-vascular planes and the absence of large anastomoses are factors that favors and suggest the segmental splenectomy in cases when the spleen integrity is preserved at least 50% of its total.

Professional Hearing Changes On Maritime Navigating Personnel
Ninela Rădulescu, Ileana Ion, N. Ceamitru, Cecilia Adumitresi, Cristina Farcaş, Carmen Ciufu, Loredana Pazara

ABSTRACT. Professional exposure to noise higher than 87 dB can lead to diseases (hypoacusia, professional deafness through sound trauma) but, in the same time, also to diseases related to profession (high blood pressure, digestive diseases, neuroses). The measured values of sound intensity within vessel compartments (engine room, main deck) are different with a higher level in the engine compartment [LEX, 8h = 87 dB (A)]. The survey concerns a batch of 80 navigators (deck and engine crew), selected according to the level of exposure to noise and length of service on the basis of an anamnestic questionnaire that applies to the persons exposed to noise and vibration. Our study showed a significant difference in the incidence of noise-induced hearing loss between engine and deck crew, also in correlation with the length of work (P < 0,05). Audiometrical determinations carried out at the beginning and the end of voyages showed that hearing changes were significant especially among engine crew.

Alimentary Skills- Epidemiological Study Made In 2009 Among Students From Faculty Of Medicine
Floarea Damaschin, Beatrice Severin

ABSTRACT. Health is a state of well in a very relative equilibrium. On its disturbance contribute the new way of eating, and the new existential way by which media influences without measure the individual life. Modern human diet is characterized by choice, often manipulated by advertising, for meat and meat products, option which has the effect of grant a role and a secondary place in vegetable and fruit consumption. It gives a little importance to meals, to their quality, to their serving program, and most often the meal occurs in a hurry. These are some reasons for which we eat precipitated, eat too much, digest poorly, sleep poorly and finally we spoil our health and shorten our days. Based on these considerations, we conducted an epidemiological study among students in fourth-year at Faculty of General Medicine. In the study it was applied a questionnaire including data that helped in the assessment of the body mass index. The calculation method used was the percentage. Analyzing the results of the questionnaire on food habits- applied of fourth-year students of the Faculty of Medicine Constanţa we have found that breakfast is served currently by a smaller percentage and most of the respondents consume usually dietary fats, white bread, pastry and sugar. A rate of 33% of students is outside the normal index calculated for body weight. Concluding we can say that food habits of these students are in a worryingly large percentage – pathogenic!

Satellite Communication Of Medical Data Transmission From Black Sea Boat
L.T. Hangan, C.N. Grasa, C. Chiru

ABSTRACT. This paperwork presents an application of real mobile telemedicine using a satellite link over INMARSAT and THURAYA network. A medical team from Constanta was on board of a rescue boat in Black Sea, sending medical data from ultrasound examinations, by means of internet with live bi-directional audio-video transmission, to another medical team located in Constanta’s School of Medicine and Fundeni Medical Institute. The result of our tests shown a reliable and very modern method of communication for medical performance, yet the price of data traffic (cost of send/received megabyte) forbid the use in routine applications. The use of this type of telemedicine is pointed toward oil platforms where rough sea has practically no impact on satellite visibility.

Investigation Of Klebsiella Pneumoniae Isolates In County Hospital Of Constanţa
Lavinia Voineagu, Adina Barbu, Mihaela Botnarciuc, Victoria Braga, B. Niţu

ABSTRACT. A retrospective analysis of microbiology data from County Hospital of Constantza was performed. Adult and children hospital patients with positive clinical cultures for Klebsiella spp. In 2009 (117 isolates) were included. The proportions of isolates not susceptible to specific antimicrobial agents were compared between patients from different departments. Additional analyses examined temporal trends in the frequency of resistance and the frequency of resistance among in bacteria isolated from different types of samples. Results: Heterogeneity was observed in the frequency of resistance among different bacteria between older and younger patients, between different departments and between different types of samples. Klebsiella pneumoniae isolates were more likely to be resistant to antibiotics when obtained from urine. Results were variable when resistance to fluoroquinolones, cephalosporins and imipenem were compared . Conclusions Overall, older patient age or very young was not uniformly associated with a greater likelihood of antimicrobial resistance among Klebsiella spp. Variability in the frequency of resistance show the dependence of the period of infection. Appropriate use of antibiotics is needed to manage infected patient effectively.

Potential Management Strategies For Non-Alcoholic Fatty Liver Disease
F. Voinea, R. S. Şuţa, Cristina Duminică

ABSTRACT. Estimates of people suffering from overweight (one billion) and obesity (300 million) are increasing. The accumulation of triglycerides in the liver, in the absence of excess alcohol intake, has been described in the early sixties. It was not until 1980, however, that Ludwig et al named this condition nonalcoholic steatohepatitis (NASH). Subsequently, nonalcoholic fatty liver disease (NAFLD) has been used as a general name for conditions ranging from simple steatosis through steatohepatitis to end-stage liver disease (cirrhosis). Many studies have demonstrated the significant correlation with obesity and insulin resistance. Other studies have revealed a significant correlation between hepatic steatosis, cardiovascular disease and increased intima-media thickness. WHO estimated that at least two million patients will develop cirrhosis due to hepatic steatosis in the years to come. Longitudinal cohort studies have demonstrated that those patients with cirrhosis have a similar risk to develop hepatocellular carcinoma as those with other causes of cirrhosis. Taken all together, NAFLD has become the third most important indication for liver transplantation. Therefore, training programmes in internal medicine, gastroenterology and hepatology should stress the importance of diagnosing this entity and treat properly those at risk for developing complications of portal hypertension and concomitant cardiovascular disease. This review will focus on the readily available therapeutic options of this disease.

Chronic Autoimmune Thyroiditis – Epidemiological And Clinical Aspects
Ioana Cristina Buzoianu, E. Circo

ABSTRACT. The chronic autoimmune thyroiditis are heterogeneous entities by the functional, lesional and evolutive point of view. The pathogeny of chronic autoimmune thyroiditis is complex, involving humoral and cell mediated autoimmune mechanisms which cause thyroid and cell destruction and dysfunction. This study tries to estimate the trend of the incidence and the epidemiological and clinical aspects of chronic autoimmune thyroiditis in an iodine-replete area (Constanta County). We studied by a retrospective point of view, the cases treated at the Endocrinology Department – County Clinical Hospital of Constanta, between 2006-2008. The study group consists of 310 cases of chronic autoimmune thyroiditis. The number of the cases of chronic autoimmune thyroiditis represents 13,88% of the total number of patients treated in the Endocrinology Department between 2006-2008. Average age was 47,84 ± 21,08 years and sex ratio was F/M = 286/24. The study group was distributed in 3 groups after the morpho-functional criteria: chronic autoimmune thyroiditis with goiter – 72,97% of the cases, atrophic autoimmune thyroiditis – 18,91% of the cases and asymptomatic autoimmune thyroiditis – 8,12% of the cases. 27,09% of chronic autoimmune thyroiditis cases revealed the association with other autoimmune diseases (type 1 diabetus mellitus, vitiligo, ovarian failure, Addison disease, rheumatoid poliarthritis). The muslim patients represented 10% of the patients with chronic autoimmune thyroiditis. This study reveals the relations between the variety of clinical expression of CAT and the ultrasonographical characteristics of CAT. In our study we also realize a territorial distribution of CAT cases in Constanta county. The ultrasonographical screening of CAT cases with goiter revealed that: 8,62% of patients have goiter 0 degree, 48,27% of patients have goiter Ist degree, 39,65% of patients have goiter IInd degree and 3,46% of patients have goiter IIIrd degree. The description of hypoechogenity pattern was: circumscribed hypoechogenity – 57,96% of chronic autoimmune thyroiditis cases, lobar hypoechogenity – 26,99% of chronic autoimmune thyroiditis cases and diffuse hypoechogenity – 15,05% of chronic autoimmune thyroiditis cases. In a territory with normal iodine intake and a subendemical evolution of goitrogenous process (like Constanta County), environmental polluting agents, climatic factors and individual factors may lead to variations in the autoimmune thyroidian process.

Incidences Of Peritoneal Carcinomatosis In Constanta County
Sirma Tomos, Fl. Voinea

ABSTRACT. We chose to realize a statistical study of peritoneal carcinomatosis diagnosed between 1998-2008, in Oncology Department of County Hospital, Constanta, following a few parameters, such as: sex, age, tumor localization and social background. Beside the particulars regarding sex, age and the social background, the etiology of peritoneal carcinomatosis shall be emphasized and the respective occurrences among the Turkish-Tatar community from Constanta county, due to genetic differences but especially due to the specific food habits of this ethnic group (the lack of pork consumption on account of religious motivations on the one hand, and ethanol consumption on the other hand). Actually, in our study we have considered the Muslim patients (who, in fact, overlap with the ones belonging to the Turkish-Tatar ethnic group). There were 363 cases of peritoneal carcinomatosis. From our study resulted that 2,139/ 100.000 Turkish-Tatar ethnic minority could develop peritoneal carcinomatosis (vs. 4,524/100.000 romanian per year). We can conclude therefore that the incidence of peritoneal carcinomatosis is lower for Muslims on the territory of Constanta county. The etiology of peritoneal carcinomatosis was, in the case of our study, the following: 37.5% of the patients had gastric ulcer as a starting point, 17.6% pancreatic cancer, 16.3% of the patients had colorectal cancer as a starting point for peritoneal carcinomatosis, 14.3% hepatic cancer and 14.3% ovarian cancer.

Wilson’s Disease And Thalassemia Trait – An Unusual Association. Therapeutic Perspectives
Corina Frecus, Cristina Mihai, Valeria Stroia

ABSTRACT. The authors present a case of a child diagnosed with two autosomal recessive disorders: Wilson’s disease and minor thalassemia. Wilson’s disease should be considered in children and teenagers with unexplained acute or chronic liver disease, neurological symptoms of unknown cause, acute hemolysis, psychiatric illnesses, behavioral changes, Fanconi Syndrome or unexplained bone disease. Minor thalassemia should be considered in children with hypochromic microcytic anemia, with serum iron level normal or elevated. More than 90% of persons with beta-thalassemia trait have diagnostic elevations of HbA2 between 3,4-7%.

Surgery In Advanced Gastric Cancer: A Systemic Review And Meta-Analysis Based On Aggregate Data
C. V. Batală

ABSTRACT. Neoplasia is one of the main causes of mortality and morbidity, defying permanent progress was registered in this area. Although we understand more today than yesterday and less as tomorrow, the hope is that eventually we will find the solution to one of the biggest challenges that medicine can know: cancer. In a period of 10 years (1998-2008), the Department of Surgery II Clinical Emergency County Hospital of Constanta, in patients operated for gastric cancer, 33% were total gastrectomy, with multiorganic surgical implications. Late diagnosis of gastric cancer remains strong number of patients with advanced forms of disease. Adopt an interventionist attitude is fully justified by extending and improving quality of life of patients. Working with experts in cancer network is essential, but unless the act of surgery, none of therapeutic modalities has significant impact in terms of saving these patients.

From Signs And Symptoms To Diagnostic In Proctology
Cristina Cristache, T. Iusuf, A. Ionescu, Luana Alexandrescu

ABSTRACT. The hemoroidal signs and symptoms are alarming for the pacient, this beeing the reason for consulting the practitioner. The incomplete examination and the certain presence of the hemoroidal lesions is the reason for which these patients are labeled with hemoroidal disease and treated accordingly, delaying the diagnosis of the real colo-rectal lesions. Our presentation shows the results from a proctology clinic. The presentation is a 3 year retrospective study (1.01.2006 - 31.12.2008) on a 4500 examinated patients, of which, at 840 patients taken into evidence for hemoroidal disease in different stages, was performed flexible rectosigmoidoscopy up to 60 cm. The results showed: 23 cases of tumors, 64 cases of colonic polips and also lesions of diverticulosis, rectocolitis, Crohn disease or vascular displasia. By presenting these results we pleed for the complete examination of all patients with signs and symptoms, even in the presence of dignosticated lesions, for the benefit of patients.

A Retrospective Overview Of The Thyroid Gland Surgery In Constanţa’s
Surgical Clinic II

Silvia Savin, V. Sârbu, A. Berro, T. Ş. Niţu, A. Miga

ABSTRACT. Different studies reported an increase rate of the thyroidian pathology incidence and thyroidian cancer prevalence, in the last years. Aim: to evaluate the surgical indications, procedures and results for thyroid pathology. Methods: retrospective study performed in The 2nd Surgical Clinic Constanţa. Results: During the last 7 years, 309 patients with different thyroid diseases were operated in our clinic. From these, 48,86% (N=151) were operated for nodular goiter, 16,82% (N=52) for hyperthyroidism, 10,67% (N=33) for thyroid neoplasm and 23,62% (N=73) for thyroiditis. Differentiated thyroid cancer represents 93,93% from all the thyroid cancers and occult carcinoma frequency was 6,06%. Total or near total thyroidectomies were performed at 87,87% of the patients with thyroid cancer. The postoperative morbidity consisted in hemorrhage (1 case) and recurrent nerve palsy (4 cases). The most common form of hyperthyroidism was Graves’ disease – 42,30% (N=331), followed by multinodular toxic goiter – 34.61 (N=220) and functional autonomous nodule – 23,07% (N=112). Total and near total thyroidectomies were performed in 29 cases (55,76%) and subtotal thyroidectomies in 23 cases (44,24%). Postoperative recurrent nerve palsy was noted in 1 case. Conclusions: Differentiated thyroidian cancer has a significantly increasing rate, in the last years, especially due to occult carcinoma. Fine needle biopsy and frozen section exams are very useful and have to be performed in all the cases. The correct treatment is a single definitive operative approach – total or near total thyroidectomy. The postoperative follow-up is coordinate by endocrinologists.

Rare Cause Of Small Bowel Obstruction: Gallstone Ileus. Case Report
Elena Pismiha, F. Botea, C. Grasa, Cristina Dan, R. Dedu, V. Sârbu

ABSTRACT. Gallstone ileus is a rare complication of cholelithiasis and is an uncommon cause of intestinal obstruction. We herein present a case of a 77 year-old woman admitted for signs of intestinal obstruction with critical general status. The diagnosis of gallstone ileus was made by abdominal ultrasound which showed pneumobilia, combined with plain abdominal radiography which revealed signs of small bowel obstruction and ectopic stone located in the intestinal area, thus replacing the computed tomography. During surgery, besides the occlusive gallstone, an additional gallstone with similar diameter was found in the small bowel lumen, which would had been led to recurrent postoperative intestinal obstruction if undetected. The unfavorable postoperative course due to medical complications confirms the poor prognosis in such cases.

Congenital Hypothyroidism – A Case Presentation
Mihai Larisia, Roxana Miron, Adriana Asanache, Viviana Cuzic, Mariana Ştirbu, Adriana Apostol, G. Pârvu

ABSTRACT. Congenital hypothyroidism (CH) is a condition of thyroid hormone deficiency present at birth. Approximately 1 in 4000 newborn infants has a severe deficiency of thyroid function, while even more have mild or partial degrees. Treatment should be started as soon as diagnosis is confirmed. The goal of therapy is early, adequate thyroid hormone replacement. The authors present a 3 month old male child diagnosed as congenital hypothyroidism most likely due to dyshormonogenesis with sepsis, confirmed by serum T4 and TSH levels.

Pellagroid Erythema - Etiology And Clinical Aspects
G. Nicola, Emma Gheorghe, Ramona- Elena Pestrea

ABSTRACT. Pellagroid erythema represents a deficiency photodermatosis manifested by erythema,vesicles and hyperpigmentation in the areas exposed to UV radiation. It is found at people who excessively eat corn (polenta contains zeina devoided of tryptophan) and insufficient protective food (meat, milk, vegetables- important sources of Zn), thus reaching a vitamin deficiency, being involved in particular vitamins PP (niacin), B1, B2, B6, B12 and Zn. The two major factors involved in the etiopathogeny of pellagroid erythema are alcohol and exposure to UV radiation. Chronic alcoholism produces enteropathy with disturbances in tryptophan absorption. The release of substances with histamine action causes vasodilation and development of erythema, pellagroid erythema primary skin lesion, the other two being hyperpigmentation and hyperkeratosis. The three injuries play the role of fotoprotector screen. The current study followed a group of 71 patients diagnosed with pellagroid erythema. The study was conducted between 01.01.1999 - 31.12.2008 in the Department of Dermato-venereology of the County Emergency Clinical Hospital Constanţa. Of the 71 patients studied during the 10 years, 64 (90.14%) have alcoholic etiology, from which 39 men (60.94%) and 25 women (39.06%). Sex ratio of patients in the studied group was 6:4 (male: female), reflecting the growing share of consumption of ethanol among the female population. Age group most affected is 40-49 years, 32 patients (45,07%). The appearance of cutaneous manifestations is in close correlation with the season, most cases occur during summer (June, July, August-53 cases-74,65%) due to intense sunlight.

Wallenberg Syndrome – A Case Report
N. Cârciumaru, D. Naum, Adriana Cuciureanu, Stela Dachi

ABSTRACT. Described for the first time in 1895 by Adolf Wallenberg, this syndrome represents a neurological disorder caused by a stroke in vertebral and posterior-lower cerebral arterys. This syndrome is most common at persons after 40-years old, with multiple vascular risk factors (high blood presure, high level of cholesterol, diabetes).This syndrome needs a symptomatic treatment in order to prevent the complications. We present the case of a 60 years old man with Wallenberg Syndrome, a very instructive case semiological specking and applying a topografic thincking we can explain all the simptoms of the patient.

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