ARS Medica Tomitana
vol. XVI - nr. 3 (62) - july - september 2010


Perinee Feminin: Un Plâtre De Dissection Anatomique « Sciences Et Pedagogie » Du Milieu Du 20ème Siecle
Patrice Le Floch-Prigent

RESUME. Le but de cette étude était d’apprécier la véracité anatomique d’une pièce représentant la dissection d’un périnée féminin, en plâtre, colorié de la collection «Sciences et Pédagogie» appartenant aux collections pédagogiques des laboratoires d’anatomie, 45 rue des Saints Pères, Paris 6ème ; d’en déterminer les techniques de présentation et de fabrication. La pièce a été observée après mensurations, et enfin des prises de vues photographiques numériques sous divers angles ont été effectuées.

Etude Du Développement Des Efférences Nerveuses Cérébrales Par Tracking De Fibres In Utero Exemple De L’agénésie Du Corps Calleux
O. Ami, Mylène Mabille, Anne-Elisabeth Mas, K. Lbiati, Catherine Fallet, Odile Plaisant, R. Frydman, D. Musset, V. Delmas

RESUME. L’IRM en diffusion permet de mettre en évidence les fibres nerveuses. Son application chez le fœtus in utero en est à ses débuts. Le but de ce travail est d’en montrer la faisabilité en clinique humaine. Cette étude portant sur l’exemple du développement du corps calleux  aide à  comprendre le développement du cerveau normal et pathologique.  Il s’agit d’une étude préliminaire ; des applications multiples pourront être proposées dans l’avenir.

Variants Of Origin Of Renal Arteries
Raluca Talpeş, C. Dina, C. Ionescu, P. Bordei

ABSTRACT. We followed the origin of renal arteries from the aorta against the vertebral spine, against the other arterial trunks having their origin in the aorta in the vicinity of renal arteries (celiac trunk, higher mesenteric artery, medium suprarenal arteries and gonadal arteries), on what part of the aorta they split, as well as the level of the origin of the two renal arteries comparing right to the left. Using as working methods dissection, injection of contrast substances and plastic masses, the study was completed by the follow up of renal arteries per ecographies, angiographies, angio CT and RMN. The origin of renal arteries from the aorta against the vertebral spine, was found to range between the interval higher margin of vertebra L1 – lower margin of vertebra L2, not finding cases of high or low ectopic renal arteries. Most frequently, the origin of renal arteries was met at the level of L1, within a percentage of 68.64% of the cases, the percentage reaching 83.43% of the cases and if we also add the origin of renal arteries at the level of intervertebral disk L1-L2, the percentage reaches 83.84% of the cases. Right renal arteries had their origin at the level of vertebra L1 within a percentage of 73.86% of the cases and left arteries within a percentage of 62.96% of the cases. In comparison to the other big arteries of abdominal aorta, one must note the fact that on the right side we met two cases in which the renal artery had its origin above and at the level of the higher mesenteric artery and on the left side four cases in which the renal artery had its origin at the same level with the medium suprarenal artery. Most frequently renal arteries had their origin on the lateral side of the aorta (62.37% of the cases), within almost equal percentages against the two parts of the body, 62.24% of the cases on the right side and 62.5% of the cases on the left side. Followed in the order of frequency: antero lateral side (15.59% of the cases), postero-lateral side (14.52% of the cases) and the anterior face (2.15% of the cases). Comparing right to the left, we found in 71.43% of the cases that the right renal artery had its origin located much higher, in 17.05% of the cases the two renal arteries had their origin from the aorta located at the same level and in 10.92% of the cases the left renal artery had its origin located much higher in comparison to the right renal artery.

Resistance To Antifugals Of Stephanoascus Ciferrii And Cryptococcus Laurentii Strains Compared With Candida Albicans
Mihaela Botnarciuc, Victoria Braga, Lavinia Voineagu, Adina Barbu, Mirela Tătaru

ABSTRACT. The aim of this study was to analize the resistance to antifugals of Stephanoascus ciferrii and Cryptococcus laurentii strains compared with Candida albicans strains isolated in Emergency Clinical Hospital Constanta, Romania. Clinical specimens, obtained during 6 months period from various specimens, were cultured on conventional media, identification of species and sensitivity tests were performed on VITEK 2 Bio-Merieux. Sensitivity is determined for fluconazole, voriconazole, amphotericin B and fluocytozine. We isolated 60 strains of Candida albicans, 12 strains of Stephanoascus ciferrii and 8 strains of Cryptococcus laurentii. Two strains of Cryptococcus laurentii were resistant to fluconazole and amfotericin B and two strains to flucytozine. Two strains of Stephanoascus ciferrii were resistant to amfotericin B. Candida albicans showed a similar resistance pattern with Cryptococcus laurentii, but the percentage of resistant strains was much lower in. No tested strain were resistant to voriconazole.

Screening For Autoimmune Thyroid Diseases  – Study On A Group Of Patients From Constanţa County
Ioana Cristina Buzoianu, E. Circo

ABSTRACT.The autoimmune thyroid diseases (AITD) are complex diseases believed to be caused by the combined effects of multiple susceptibility genes and environmental triggers. Whether or not healthy adults in the community would benefit from screening for autoimmune thyroid disease is controversial. Screening for thyroid dysfunction can be performed using the medical history, physical examination, or any of several serum thyroid function tests. The thyroid stimulating hormone (TSH) is usually recommended because it can detect abnormalities before other tests become abnormal. The American Thyroid Association currently recommends that everyone over 35 years of age be screened with a TSH test every 5 years, and the American Association of Clinical Endocrinologists recommends that all women be tested for hypothyroidism by 50 years of age (sooner if they have a family history of thyroid disease) as well as those who are or planning to become pregnant in order to detect thyroid problems. The aim of our study was to determine the prevalence of abnormal thyroid function and thyroid autoimmunity in a study group of patients from Constanta county, apparently healthy, who have family history of thyroid diseases (Graves disease, Hashimoto thyroiditis, atrophic autoimmune mixedema). We measured serum concentrations of serum thyrotropin (TSH), total and free thyroxine (T4) and antithyroperoxidase antibodies (TPOAb) in the study group (150 selected subjects relatives with the patients diagnosed with autoimmune thyroid diseases). We used a comprehensive questionnaire to obtain complete personal and parental medical history for each subject. The study reveals that the relatives of patients with AITD have increased prevalence of  TPOAb associated with hypothyroidism or normothyroidism – 18%. The prevalence of hypothyroidism (serum TSH levels of 5mU/l or greater) in our study group  was 7,33%. These results emphasize the importance of screening for autoimmune thyroid dysfunctions in patients apparently healthy with family history of thyroid diseases.

Posttherapy Follow-Up Of Patients Diagnosed With Colorectal Cancer With Currative Visa Treatment
Maria Gălan, Andra-Iulia Suceveanu, Laura Mazilu, A. Suceveanu, Fl. Voinea

ABSTRACT.Knowing that CRC is the 2nd worldwide cause of mortality and the disease prognosis depends on the moment of tumor diagnosis and treatment, the follow-up period after surgical treatment is crucial to improve the prognosis.  Our study proposed to early detect relapse or recurrence of the CRC in patients diagnosed in Gasytroenterology and Oncology Departments of Emergency Hospital of Constanta Couny in order to reffer them to secondary ablative treatments to ameliorate the mortality and to improve the prognosis. 107 patients were followed between January 2006 and December 2009, tracking the minimum interval of 12 months and the maximum of 48 months, using fizical exam, US and CEA level. Were registered 26 tumor recurrences (24.29%), after a mean follow-up of 16.38±8 months (range 6-36 months) (95% CI, 13.15-19,62). 15 patients presented with liver metastases, 4 with other sites of metastasis and 7 with multiple colorectal recurrences. Recurrences were diagnosed by symptoms in 4 patients (peritoneal damage), increased levels of CEA in 15 patients (57.69% of relapses) and routine US in 7 patients (26.92% of relapses). Tumor relapse rate was recorded at a rate of 24.29% and was generally smaller compared to the 35-40% reported in the literature. Prognosis of CRC treated on the basis of modern chemotherapy protocols is clearly shown to be significantly improved compared with classic chemotherapy and the follow-up monitoring period is crucial to improve this prognosis.

Aspects Of Boutonneuse Fever In Children From Constanţa County
Claudia Simona Cambrea, Margareta Ilie, Doina Tănase, Ioana Creţu, Consuela Marcaş, Simona Diaconu

ABSTRACT. The disease caused by Rickettsia conorii is known by various geographically recognized names, including Mediterranean spotted fever, boutonneuse fever, Kenya tick typhus, Indian tick typhus, Israeli spotted fever, and Astrakhan fever. Retrospective analysis of 73 children and 28 adolescents hospitalized with boutonneuse fever in Children Infectious Diseases Clinic of Constanta. Retrospective analysis of boutonneuse fever hospitalized in Children Infectious Diseases Clinic during a period of 7 years (2003 – 2009). We evaluate demographic, clinic, serologic and therapeutic data. During a period of 7 years (January 2003-December 2009) in Children Infectious Diseases Clinic we followed 101 cases of boutonneuse fever. From the total of cases 64.35% were from urban area, 52.47% were girls. The majority of cases were registered in warm season. The eschar (tache noir) was present in 64 patients. Fever had a 6 days mean duration and disappears often in first 3-4 days of etiologic treatment. Maculopapular rash with nodular boutonneuse lesions was detected in 76 cases, 5 having petechial lesions. Serological diagnosis was accomplished in 62 patients. Etiologic treatment was done for 5-7 days with Chloramphenicol -59 patients, Azithromycine -18 cases, Clarithromycine -12 cases, Ciprophloxacine and Tetracycline -6 cases each. Mean duration of the illness was of 7 days. From the total of cases with boutonneuse fever childrens represents 14.42%. Boutonneuse fever is a problem of actuality in the urban areas, of our county, especially in warm season. The epidemiological and clinical diagnosis, confirmed by ELISA for R. conorii requires beginning of etiologic treatment.

The Role And The Place Of The Occult Hemorrhage In The Colon Cancer Diagnosis
P. Mimiş, I. Bordeianu, I. V. Iordache

ABSTRACT. The author presents the results of a prospective study, applied randomly to a number of 2237 patients hospitalized and investigated between 2005 and 2009 in the Medical section of the Emergency Hospital Targoviste, study for which a screening test was used for the precocious screening of CC OH test in stool. Although relatively controversial, because of the increased percentage of falsely positive and negative results, with a predictable value, relatively modest, but at the same time advantageous due to the fact that it is easy to accept, it offers valid and reproducible results, with an optimum cost/efficiency ratio, the OH test, in the absence of a national screening program for CC, completed as necessary with other screening tests, such as flexible rectal sigmoidoscopy, barium contrast radiography with double contrast, CLNS (“golden contrast”), completed by endobiopsy, tumor markers (CA-19-9), CT, it proves to be extremely useful through recorded results at the end of the study. Not only for the group A = asymptomatic patients = but also for the group B = patients with suggestive digestive symptoms for a colon neoplasia =, the percentage of the incipient curative CC cases with a favorable prognostic was significantly increased: group A = 100% and group B = 44.64%.

Particularities Of Diagnosis At Children With Recurrence Urinary Tract Infections And Vesicoureteral Reflux
Anca Gabriela Bădescu, Larisia Mihai, C. Tica,  V. Tode, C. Ionescu

ABSTRACT. Vesicoureteral reflux (VUR) is characterized by the retrograde flow of urine from the bladder to the kidneys. VUR may be associated with urinary tract infection (UTI), hydronephrosis, and abnormal kidney development (renal dysplasia). The relation of these conditions to VUR is discussed in this article. In 2007 we annalized a number of six patients for vesicoureteral reflux, hospitalized in the Pediatry Clinic I belonging to Emergency Hospital Constanta.Investigations Protocol for diagnosis purpose:General Clinical examination, laboratory and imaging studies, child follow up. All children diagnosed with Vesicoureteral reflux have ben hospitalized with Urinary tract infection. All Urinary tract infection were with E.Coli. This paper tries to draw a signal allarm on the importance of correct diagnosis and treatment of relaps urinary infections, on the private fond of associated urinary malformations, especially RUV and long term prognosis for renal functions of the future grownup.

Mini Invasive Approach In Ureteral Strictures After Failed Pelviureteric Or Ureterovesical Reimplantation In Children
R. Anăstăsescu, T. Merrot, Kathia Chaumoître, M. Panuel, P. Alessandrini

ABSTRACT. The aim of this study is to assess the morbidity and success rate of percutaneous treatment of the postoperative ureteric strictures in children. Between January 1994 and December 2003, 12 children were treated by antegrade percutaneous balloon dilation for postoperative ureteric strictures. Stenosis occurred at the pelviureteric junction in 5 cases and ureterovesical junction in 7 cases. The 10 boys and 2 girls were between 3 months and 14 years old (mean age 5 years ± 4,7). General anesthesia was used in 10 cases for nephrostomy catheter placement. Five ureteral stent were used additionally to nephrostomy drainage 6F catheter. Both nephrostomy and ureteric stents were kept for 28,5 ± 12 days, then removed after control antegrade pyelography. Dilation was technically successful in 9 of our patients. Two peroperative complications occurred. Postoperative results were evaluated by ultrasonography, intravenous urography, antegrade pyelography and DTPA renography that confirmed no obstacle in all 5 cases of pelviureteric stricture with a follow-up of 4 ± 2,9 years and in 4 cases of ureterovesical junction with a follow-up of 4,7 ± 2,8 years. Three unsuccessful results were reported: in 2 cases the guide wire couldn’t be advanced over the stenotic ureterovesical junction and in one case an early restenosis occurred that eventually required surgery. Although the main treatment of the postoperative ureteral strictures is surgical, the percutaneous antegrade balloon dilation seems to be an alternative to surgery with a low morbidity rate and short hospitalization period.

Surgical Treatment Of Large Parietal Defects In Emergency Surgery
D.O. Costea, V. Sârbu, C. Grasa, A. Ivanoschi, D. Băjan, Andreea Cristina Costea

ABSTRACT. Large parietal defects are complications of abdominal surgery, which raises serious surgical problems, especially concerning the management of complications and pathology associated with the problems generating these defects. Our study concerns the parietal defects (incizional hernias, hernias, eviscerations) with associated complications, the latter being in fact the reason for the presentation of the patient in the emergency service. We used the term that defines the size of muscular aponeurotic  damage shape MTD (maximum transverse diameter), a relatively recent concept, which aims to quantify the size of the parietal defect. We considered the large diameter parietal defects (MTD) over 15 cm. The objective of the intervention is to restore local anatomy of the small abdominal defects by simple abdominal muscle tendon rehabilitation. Instead, for large or complex defects, only count the possibility of rehabilitation of the parietal contency; this querry  is impossible without alloplastic surgery, but stability of the result made the difference between different surgical options. Surgical treatment consists of restoring the local anatomy, such as release of adhesions and interviscerale potentially occlusive clamps and those of the great omentum and viscera, on this occasion will be new material to raise the epiplooic “hot” region. In particular, the neoplazic patients have the risk of local recurrence, so far, we had not to reoperate the patient for this reason.

Management Of Bladder Extrophy – Our Experience
Mioara Georgescu, M. Ardelean, C. Tica

ABSTRACT. Bladder exstrophy represents a spectrum of genitor-urinary malformations ranging from epispadias to exstrophy of the cloaca. Even it is rare (the incidence has been estimated between 1/10000 and 2.5/100000), this disorder imposes significant physical, functional, social, sexual, and psychological problems on patients and their families. This study is a retrospective review of 9 patients with bladder/cloaca exstrophy admitted for treatment and follow up studies in the Clinic of Pediatric Surgery of Constanta County Hospital from January 2004 to March 2010. The data collected for every patient included: information about family’s medical history, the pregnancy and delivery, clinical aspect and associated malformations, evaluation of the renal function, surgical strategy, and postoperative complications, psycho-social and sexual adjustment. As a conclusion we can resume that there is no gold standard procedure to treat this complex malformation therefore the surgeon must individualize the reconstruction strategy in order to preserve normal kidney function, to develop adequate bladder function, including urinary continence and to provide acceptable appearance and function of the external genitalia.

Carpal Tunnel Syndrome
S. C. Băncilă, I. Bordeianu, I. V. Iordache

ABSTRACT. This paper aims to highlight a number of important issues (from the authors’ point of view) for the correct treatment of patients with carpal tunnel syndrome. This retrospective study was conducted in the Department of Rheumatology of Colentina Clinical Hospital, on a group of 20 patients diagnosed with carpal tunnel syndrome in the clinic between 2007-2010. For the patients studied were drawn up “study records” which included the following: year; gender; age; origin (urban or rural); main diagnosis; affected nerve; comorbidities; length of stay in the clinic; occupation; dominant arm; conservative / surgical treatment applied. The profile of the patient in the Department of Rheumatology has the following main characteristics: with polyarthritis, female, at postmenopause, of urban origin, with bilateral carpal tunnel syndrome, for which is applied a conservative treatment finally completed with a surgical one.

Polypropylene Mesh, A Technique Of Prosthesis Suspension Of Urethra
F. Danteş

ABSTRACT. Stress urinary incontinence (SUI), is defined by the International Continence Society (1999) as the involuntary loss of urine. The tension free vaginal tape technique was introduced into clinical practice in 1994-1995. The TVT-like operations presented here differs significantly from traditional anti-incontinence surgical procedures; they are based on PappaPetros integral theory. The research included 96 patients and it was conducted in the Department of Surgery of the University Hospital CFR Constanta. TVT-like procedures represent reconstructive surgical procedure of the female urinary tract with low cost, short time learning teaching period and very good reproducibility for gynaecology surgeons.

Clinical Biological Evolution Of Adult Patients Suffering From Juvenile Idiopathic Arthritis
Ana-Maria Ramazan, Maria Şuţa, Cristina Duminică

ABSTRACT. Articular pain is found in 1% of children every year and approximately 1% of these children develop chronic arthritis. Juvenile idiopathic arthritis, also called juvenile chronic arthritis (in Europe) and juvenile rheumatoid arthritis respectively (in North America) is a chronic inflammatory disease that afflicts joints and extra-articular tissues. This study is a retrospective observational study (initial assessment upon onset), but also a prospective study (subsequent assessments). Adult patients from Constanţa County with diagnosis of juvenile onset-chronic inflammatory rheumatisms were included. Each type of onset was retrospectively determined, according to the reviewed ILAR criteria of 2001. The diagnosis of ankylosing spondylitis was given to patients who met the modified New York criteria. The patients were assessed through anamnesis and through a clinical examination during two study visits and the following were included: overall assessment of doctor and patient, analogue visual scale, fatigability assessment, number of painful joints, number of swollen joints, functional assessment, disease activity assessment. Patients included in the study underwent routine laboratory analyses, but also acute phase reactant tests (ESR, C-reactive protein), immunological tests (latex rheumatoid factor) and the HLA-B27 was also determined. It was noticed that females were predominant only in terms of polyarticular forms, while the onset average age was younger in systemic forms. The follow-up period of subgroups ranged between 10 and 15 years from the onset.40% of the patients had articular restriction of movement. Patients with systemic forms that were associated with enthesitis ran a high risk of developing ankylosing spondylitis during the following 10-15 years. As regards the assessment of the ability to carry out daily activities performed by the doctor according to the Steinbrocker functional classes, it was noticed that 46.2% of patients fell into the functional classes III and IV, especially in polyarticular forms. Remission with or without treatment could be noticed in 31.1% of patients included in the group, especially in systemic arthritis and in arthritis with enthesitis. Our study extended over an average follow-up period of 10-15 years and it showed that the remission rate was moderate (31%), while dysfunctionality was quite significant (46.2%), especially in polyarticular forms, even if the signs of activity were minimum.

 

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