ARS Medica Tomitana
vol. XVI - nr. 4 (63) october - december 2010

Biomechanical Response Of The „In Vitro” Lumbar Vertebral Segments To Axial Loading
Mădălina Iliescu, P. Bordei, B. Rădoiu, Mirela Cotrumba, I. Duţă

ABSTRACT. Due to the structural complexity and the mechanical proprieties, the intervertebral disc (IVD) represents one of the "key" elements within the etio-pathology of the low back pain (LBP). The biomechanical response and changes within the IVD to the axial loading (compression) transforms the IVD into the main "shock absorber" and motion granting structure of the vertebral column. Thus, any changes that may include discal degeneration may alter the load path in compression, with direct effect on the mechanically induced lesions and tissue injury. Eleven human specimens, extending from L1 to L5 were used to study the biomechanical behavior under axial load. They were stripped of all surrounding tissue; only the vertebro-disco-ligamentary complex was preserved. The loads were applied using variable couples and displacements and the resistive response were measured. All the process was performed with the aid of a universal stress test machine under traction and compression, type LBG 200. Stress displacement curves were obtained, leading to findings and assessments regarding the behavior of the lumbar segment under compression. Three models of stress compression response were assessed, each model corresponding to a specific type of stress. These results support future research aimed at quantifying the disc mechanics of healthy tissue, in the attempt of developing strategies of prevention and intervention within the management of low back pain.

Anatomical Variants Of Anterior Cerebral Artery: A Risk Factor For Cerebral Ischemia
I. Bulbuc, P. Bordei, Mariana Bărdaş, Steliana Popescu, Raluca Talpeş, Gabriela Butoi, C. Ionescu

ABSTRACT. The cerebral ischemic disease is one of the commonest causes of disability and death. This study try to determine one of the risk factors implied. Intracranial arterial variation is relatively common in general population and could be just an incidental finding or could lead to various neurological manifestations from minor recurrent headache to the stroke onset. Anterior cerebral artery (ACA) A1 segment hypoplasia or agenesis is a fetal variant of the Circle of Willis. We found these anatomical variations in 6% cases of the general population, according to angiograms, and anatomical reports. The aim of our study was to determine the clinical manifestations of A1 ACA hypoplasia or agenesis. We examined 170 acute ischemic stroke patients and also patient suffering from chronic cephalgia. Most of the cases were studied by cerebral magnetic resonance angiography and also by CT cerebral angiography and digital subtraction angiograms for the patients with clinical neurological onsets. For comparison, a risk factor-matched control group was recruited without any clinical neurological symptoms. The most common ischemic event was ipsilateral striatal lacunar infarctions with or without calosal or frontal lobe involvement. Based on our results, A1 hypoplasia/agenesis leads to impairment of blood flow thru Willis circle. This risk is especially pronounced for strokes involving perforating arteries.

Antioxidant Defense Potential in Patients with Chronic Renal Failure
Lavinia Voineagu, Ileana Ion, Adumitresi Cecilia, Victoria Badea, Liliana Tuţă, Alina Dobrotă

ABSTRACT. Healthy people are protected against free radicals by several defense mechanisms. Reduced GSH is the most important intracellular scavengers of free radicals. GSH serves as a reductant in oxidation reactions resulting in the formation of GSSG. Thereby decreased GSH levels and increased GSSG levels may reflect depletion of the antioxidant reserve. In this study, reduced glutathione (GSH), oxidized GSH (GSSG), and the GSH redox ratio (GSH / GSSG) were all measured as markers of oxidative stress in blood from 23 patients with chronic renal failure (CRF). One group of healthy subjects was used as controls. Compared with controls, the patients with renal insufficiency had a lower levels of GSH. The GSH was found to be significantly depressed in renal failure group relative to controls (p<0,0005). The GSH / GSSG ratio was lower too in patients with CRF. We found significant differences between controls and group with renal failure respect to GSSG (p<0.0002) activities. The results suggest that the antioxidant defense system was significantly disturbed in the kidney. GSH correlated with higher GSSG and lower GSH / GSSG show that an impaired antioxidant defence and oxidative stress are related in patients with CRF.

Morphological And Immunohistochemical Characteristics Of Breast Carcinoma
Mariana Aşchie, Mariana Deacu, Mădălina Boşoteanu, Anca Mitroi, Anca Nicolau, Anca Chisoi,
I. Poinăreanu, Andreea Ilieşiu, I. Popescu, Simona Dima

ABSTRACT. Carcinoma of the breast is one of the most common human neoplasms, accounting for approximatevely one quarter in all cancers in females. In order to determine specific prognostics factors we established histopathologic, morphometric and immunohistochemical characteristics of breast carcinoma. In our study we investigate 128 cases diagnosed with breast carcinoma in which we established microscopic characterization, computer assisted morphometric profiles by determine the mean values for nuclear area, cellular area and N/C ratio with Lucia Net Software and immunohistochemical profiles (expression of proliferation markers, steroid receptors and c-erbb2). The histological types of breast carcinoma were: in situ ductal carcinoma (4%) , invasive ductal carcinoma (75%) and invasive lobular carcinoma (21%). According to histological differentiation: 10% were G1, 43% were G2 and 47% were G3. Morphometric analysis revealed that mean nuclear area and N/C ratio increase concordant with grading but mean cytoplasmatic area has no characteristic variation. Immunohistochemical expression of ER was positive in 85% and negative in 15%, for PR was positive in 88% and negative in 12% and the expression of c-erbb2 was positive in 67% and negative in 33%. Ki67 was intense positive in 7%, moderate positive in 35% and weak positive in 7% of cases. P53 was positive in 95% cases and negative in 5% of cases. The expressions of proliferation markers correlate with carcinoma grading. Poorly differentiated and triple negative carcinoma (ER, PR and HER2) with intense expression of proliferation markers and increase mean nuclear area have negative prognosis.

Clinico-Morphologic Correlations In Colorectal Carcinoma
C. Ghiţă, Mariana Aşchie, I.D. Vilcea, I. Vasile, C. Mirea, C. Mesina, D. Enache

ABSTRACT. Colorectal cancer represents an important epidemiologic problem due to its incidence in general population. There are several factors influencing the colorectal cancer prognosis, one of the most important being related to the morphologic characteristics of the tumor. This study was performed on 457 large bowel resection specimens, over a 10 years period. Most of the tumors were located in the rectum (39.82%) and the distal colon (30.63%); there were 122 proximal cancers (20.2%) and no increased in incidence for proximal cancers was recorded over the studied period. Also, proximal cancers correlated with a greater length of the resection specimen and a bigger distance from the tumor limits to the resection specimen edge than other location. Tumor diameter was usually bigger than 4 cm (66.08% of cases); the size for proximal cancers was 5.81±1.98 cm, bigger than average size for all tumors (4.83±1.53 cm). Most of the tumors were in T3 stage (70.89%), and had a mixed pattern of macroscopic growth; ulcerative and infiltrative macroscopic forms were more advanced at the time of diagnosis than polypoid ones.

The Risk Factors Associated With Non-Vertebral Fracture At The Patients Diagnosed With Rheumatoid Arthritis
A. Mitroi, Maria Şuţa

ABSTRACT. The aim of this paper is to study the frequency of non-vertebral fracture at the patients with RA and to emphasize the correlations between non-vertebral fractures and clinical, paraclinical and therapeutic variables. The study contains 129 women diagnosed with RA who have been hospitalized in two rheumatology clinics. The diagnosis of non-vertebral fracture was accomplished by patients' enquiry. The variables were analyzed with bivariate analysis and logistic regression. The patients mean age was 62.74 ± 7.54 years. The mean body mass index was 27,78 ± 4,37 kg/m2 and mean duration of postmenopausal period was about 16.40 ± 8.18 years. 44% of patients had osteoporosis. 19% of patients had fragility non-vertebral fractures and the most frequent localization was the forearm (9%). 44% of patients were in therapy with methotrexate. 37% of patients were in treatment with prednisone in last 12 months and 58% of them had ever taken prednisone. The non-vertebral fractures associated with older ages, the duration of postmenopausal period, the osteoporosis presence at the lumbar level, the age of RA beginning, the presence of extra-joint manifestation and the methotrexate therapy. Fragility non-vertebral fractures are not signs to worry at the patients with rheumatoid arthritis.

The Role Of Contrast Ultrasonography (Ceus) In Early Detection Of Small Hepatocellular Carcinoma (Hcc) In Patients At Risk
Andra-Iulia Suceveanu, Z. Mandalenakis, A. P. Suceveanu, Laura Mazilu, E. Dumitru, Maria Şuţa, Irinel Raluca Parepa, Liliana Ana Tuţă, Fl. Voinea

ABSTRACT. Detection and characterization of focal liver lesions developed on cirrhotic liver represents the objective of screening and surveillance programs in HCC. The main objective of this study was to determine the role of CEUS in early detection of small nodules in patients with liver cirrhosis discovered by standard ultrasound screening program and to prove the role of this simple, non-invasive and cost/efficient method in the management of HCC diagnosis. 136 cirrhotic patients diagnosed by conventional US with focal liver lesions smaller than 2cm during surveillance program, were explored using three other imagistic techniques such as: CEUS, contrast-enhanced CT and contrast-enhanced MRI. Results were compared with biopsy. We calculated sensibility, specificity, VPN, VPP PDRL, NDRL and accuracy for all methods. We also compared area under curve (ROC) for each method. Sensibility and specificity of CEUS, contrast-enhanced CT and contrast-enhanced MRI were: 72.92%, 88.88%, 95%, respectivelly, 98.3%, 96.3% 99.13%, with more than satisfactory results for CEUS. Area under curve corresponding to contrast-enhanced MRI was significantly larger than that correspondig to other two imagistic methods (p=0.0381, respectivelly p=0.0492), contrast-enhanced MRI recording the most accurately small HCC diagnosis. Comparing the area under the ROC curve for contrast-enhanced CT and CEUS, we did not find significant differences in identifying HCC smaller than 2 cm. In conclusion, we can assert that CEUS may be part of the investigative panel of HCC, and can successfully replace at least contrast-enhanced CT in the diagnosis of small HCC, its advantages being accessibility, short time to explore, the possibility of repeated testing and not finally, the lowest price.

Diagnosis And Management Of Lung Cancer In Clinical Pneumology Hospital Of Constanţa
Ariadna Petronela Fildan, Elena Danteş

ABSTRACT. Lung cancer is the most common cause of death from cancer in the developed countries. Discovering early stage of the disease influences the prognostic of the ill patients. The research was conducted in the Clinical Pneumophtisiology Hospital of Constanta. The study included 378 patients (292 men) with lung cancer. We followed the demographic details, smoking history, duration of presenting simptoms, time from presentation to diagnosis, diagnostic investigations and initial treatment plan. Histological or cytological confirmation was obtained in 258 cases (68,25%), of which 50.3% were squamous, 18,6% adenocarcinomas, 15% small cell, 5% large cell and 12% undifferentiated. The treatment was done according with oncologic specialist indications.

Malignancies In HIV Infected Patients
Irina Magdalena Dumitru, Roxana Carmen Cernat, E. Dumitru, S. Rugină

ABSTRACT. Patients infected with human immunodeficiency virus (HIV) have an increased risk of developing cancers. This study will review and discuss management issues for the malignancies in HIV infected patients. Retrospective study on 402 HIV infected adults patients, in evidence in AIDS Regional Center, Constanta. In the last 3 years, 19 patiens (8 females and 11 males, 7 naive ARV treatment and 12 experienced patients) were diagnosed with malignancies, giving a prevalence of 4.72%. The HIV-related malignancies were: 3 Kaposi sarcomas, 2 primary brain lymphomas, 3 abdominal lymphomas, 4 other non-Hodgkin's lymphomas, Hodgkin's disease (1 case), primary lung carcinoma (3 cases), 1 case with mediastinal metastasis, pancreatic adenocarcinoma (1 case), brain tumor (1 case) and renal cell carcinoma in 1 case. Non-HAART treated patients tended to develop Kaposi Sarcoma and experienced patients tended to develop lymphoma. AIDS-related malignancies were found in 12 patients (63%), 7 patients had non-AIDS-defining malignancies (37%). Also, patients with more than 10 years of being diagnosed with HIV were 2 times more likely to be admitted with malignancy especially non-AIDS-defining malignancies than those with a more recent diagnosis. Three patients received treatment for their malignancy, in two cases occured surgical interventions. Despite the therapy, 16 patients died in short time after diagnosed.

Non-Variceal Upper Gastrointestinal Bleedings' Prognostic Perspective In Constanţa Clinical County Hospital
Chrysosthomos Kapetanos, Andra Suceveanu, A. Suceveanu, F. Voinea

ABSTRACT. The non-variceal Upper Gastrointestinal Bleeding (nUGB) has not recognised certain risk factors that could predict the evolution of the nUGB (1,2). The authors wish to determine the trend of the prognostic of the nUGB at Constanţa Clinical County Hospital in the last decades. The case-control study was carried out concerning patients diagnosed as nUGB and hospitalized at the Constanţa Clinical County Hospital in the Surgery Department between the years 1991-1995 (series A - 50 patients), and in the years 2002-2006 (series B –52 patients). The method uses the anamnesis study, clinical and Para clinical exams including endoscopic examination, the indication for surgery with intent of surgical hemostasis, data concerning the actual nUGB and nUGB evolution data (cured, relapse of bleeding, death). Statistical comparison were performed using the test t (Student), χ2 test and multiple linear regression test. The bleeding relapse rate for the nUGB patients is maintained unmodified in the last decades inthe population of the Constanţa County Clinic Hospital area. Mortality rate at 30 days expressed as a percentage is 10% for patients hospitalized in the years 1991-1995; 5.76% for patients hospitalized in the years 2002-2006. Surgery with intent of surgical hemostasis at the nUGB patients decreased from 12% in the years 1991-1995 to 5,9% in the years 2002-2006.

Minimal Transcutaneous Osteosynthesis Of Metacarpal Fractures
I. Bordeianu, I. V. Iordache, B. M. Caraban, Raluca Laura Stefănescu

ABSTRACT. The authors present a retrospective study of minimum transcutaneous osteosynthesis in metacarpal fractures (closed and open) over a period of five years. The study group included patients older than 16 years having fractures of metacarpals 2-5, given the fact that metacarpal fractures are a distinct pathological entity. The group includes a total of 154 patients of both genders with fractures of metacarpals 2-5 (closed and open - simple fractures or other injuries associated with soft tissue), all fractures being placed in 2/3 distal region of metacarpals. All patients received minimal transcutaneous osteosynthesis after the reduction of bleeding focus with proximo-distal "passed" pins. The study data show that the proposed surgical procedure is one efficient in terms of results achieved, in terms of cost and reducing hospitalization time and in terms of occurrence of incidents or postoperative complications. The procedure brings a minimum of "foreign" material in the fracture focus, allowing reshuffling of bone in good condition and thus not being predisposed to complications. The authors, after a decade of experience, recommend this therapeutic procedure especially when the technical equipment and possibilities do not permit, economically speaking, other sophisticated and expensive procedures.

Acute Diverticulitis, Diagnostic Problems, Therapeutic Indications And Treatment
Cristina Cristache, T. Iusuf, R. Niamani, Raluca Pasăre, D. Băjan, A. Ivanoschi

ABSTRACT. Diverticular disease with its complications, is a very common pathology with increasing frequency, but occasionally poorly diagnosed and treated as specified more or less well defined. This paper work is a retrospective study on the basis for a period of 10 years, between 1.01.2000 and 1.01.2010, on a group of 186 patients who had hospital discharge diagnosis of acute diverticulitis. There were correlations between the admission diagnosis, surgical and pathological diagnosis but also between the therapeutic approach adopted and its immediate results. It appears that in only five cases of admission diagnosis was acute diverticulitis, the diagnosis being well documented. Otherwise, admissions were through emergency, most being labeled as subocluzive syndromes or peritonitis, rectal bleeding, ischiorectal flegmon or pelvisubperitoneal abcess. Treatment was conservative in 62 cases, 124 were operated. The study give light to some ideas showing diagnostic possibilities, problems of indication and surgical therapeutic approach:
• Patients with diverticulosis are poorly diagnosed, followed and treated by existing methodologies; • Investigations of modern imaging (virtual colonoscopy) came too soon in use;
• The lack of accurate diagnosis, emergency surgery, worsens the prognosis and requires conservative attitudes or a 2-3 steps treatment.

Perspectives D'avenir Pour Le Traitement Des Acouphènes
D. Dincă, C. Aftenie

RÉSUMÉ. L'acouphène est une perception auditive « parasite » dont la nature peut être objective ou subjective. Il est parfois associé à une hyperacousie. Tout acouphène impose une démarche diagnostique visant à déterminer une éventuelle étiologie spécifique imposant un traitement adapté à la pathologie sousjacente, mais aussi à éliminer une éventuelle étiologie grave. Une collaboration fructueuse entre praticiens issus d'horizons différents (oto-rhino-laryngologistes, neurologues, psychiatres, psychologues, audioprothésistes) éventuellement regroupés au sein de structures multidisciplinaires comparables à celles dédiées aux patients douloureux chroniques (les centres de la douleur) devrait s'instaurer à l'avenir. La perception d'acouphènes dans une ambiance sonore très atténuée est fréquente, présente chez environ 70 % chez des sujets normaux. En matière d'acouphène chronique, si de nombreuses molécules sont utilisées en pratique quotidienne pour faire face à la demande pressante des patients, leur prescription n'a jamais été sérieusement étayée par des études cliniques randomisées contre placebo. Aujourd'hui s'ouvrent deux nouvelles voies de recherché : un traitement médicamenteux administré directement dans l'oreille et une méthode de stimulation magnétique.

Pregnancy Epulis - A Case Presentation
Loredana Mitran, M. Mitran, P.D. Pană, Irina-Maria Gheorghiu, Daniela Safta, B. Marinescu

ABSTRACT. Hormonal changes during pregnancy can lead to a series of transformations at the level of the gums, for example, gum hypertrophy. This can take the form of a tumour-like growth (localized hyperplasic lesions of the gingiva or epulis) and disappears spontaneously after delivery.

Children's Urinary Infections – Clinical, Etiological And Therapeutical Correlations
Valeria Stroia, Adina Ungureanu, Mihai Larisia, Corina Frecuş

ABSTRACT. Urinary tract infections (UTIs) represent one of the most common infections in children. There are important issues related with the presence of an underlying malformative uropathy. Our retrospective study involved 248 patients diagnosed with UTIs in Pediatric Department of Clinical Emergency County Hospital Constanta for a period of 2 years. Upper UTIs appeared more frequently in girls (sex ratio 1:3,4), with ages 7-16 years (49%), and associated an urinary tract malformation in 12% of cases. According to topography, 62% were lower and 38% were upper UTIs. Escherichia coli was mainly involved as etiological cause (45%), followed by Proteus spp. (21%) and Klebsiella spp. (15%). UTIs raises special issues concerning treatment in children.

Complications Of Laryngeal Surgery
Rodica Ion, G. I. Comşa

ABSTRACT. Surgical treatment offer chance to cure laryngeal cancer but unfortunately different complications may occur. This paperwork is a retrospective study, of 1998 - 2008 period includes 509 patients with laryngeal cancer hospitalized in Constanta ENT Clinic . A number of 344 patients received surgical treatment. Some patients suffered complications. Parameters of the study covered analysis of complications related to surgical treatment. From total of the 344 surgeries, 252 were total laringectomy, 90 partial laringectomy and 70 cases received reconstructive laringectomy. There were counted a total of 121 intraoperative complications, postoperative early and late, and adverse effects of postoperative irradiation(radiodermitis and skin radionecrosis). It was registered intraoperative and early or late postoperative complications related to tracheostomy or laryngectomy as: bleeding; damages the thyroid gland; subcutaneous emphysema; seroma and postoperative hematoma; suppurative wound; necrosis of peristomal soft tissues; impossible decannulation. Complications of laryngeal surgery may be intraoperative, early or late postoperative. They may be related to tracheotomy act, or laryngectomy itself. Surgical treatment offer chance to cure laryngeal cancer but unfortunately different complications may occur.

Infuence Of Peloidotherapy On Calcium/Magnesium Balance
T.-V. Surdu, Ileana Ion , Olga Surdu

ABSTRACT. The mud is made of ground, rocks of pastous consistency. Some of the healing effects of the mud are known empirically from the antiquity, others have been described and studied recenty, but a lot of them have remained even today at the stage of sumarry explanation. In the deffiniton given by International Society of Medical Hydrology, the mud (peloids) are: substances formed in natural conditions under the influence of geological processes and which in smoothly devided state and in mixture with mineral water are used in medical practice as general applications (mud bath or mud wrapping) or as local procedures. Peloidotherapy actions on neuro-endocrine, metabolic and immune system and balances the homeostasis. In this paper work is presented the dynamic variation of serum levels of calcium and magnesium during peloidotherapy. Blood sample prelevations ware made before the treatment, just after the first mud application, at 24 hours after the first mud application and at the end of the balneal treatment. At the end of cure we record a diminution of the plasmatic level of ionic calcium in physiological limits and insignificant statistically. The level of total plasmatic calcium, have the same value as at the begining of the treatment. Analysing the chart of the ionic magnezium evolution and comparing with the chart of the ionic calcium evolution we observe that they have the same appearance. During mud therapy serum levels of calcium and magnesium present variations in physiological limits.

Surveillance Of Blood Donors' Health- A Prerequisite To Ensure Blood Safety
Alina Mirella Dobrota, Ileana Ion

ABSTRACT. Blood donor management is a modern concept including all the activities related to blood collection for therapeutic use in a blood establishment. It assumes a complex approach of the prospective and registered blood donors' population in a given region, with the final purpose of ensuring the appropriate blood supply for patients in need. Monitoring the prospective donors' eligibility rates and the spectrum of the deferral reasons provides valuable information on the donors' health status. A healthy and well-informed donors' database still represents one of the blood quality and safety corner stones, besides the introduction of very sensitive and specific testing. The current study presents the results of a 2 years retrospective analysis of the deferral reasons registered in the Regional Blood Transfusion Centre of Constanta. The data show that the hemoglobin level is by far the most frequent reason for deferral, both for men and women, urban or rural population, either first time or repeat/ regular donors. The results have been used to improve the strategy for a better donor management in Constanta county.

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