ARS Medica Tomitana
vol. XVII - nr. 2 (65) april - june 2011


Adrenal Dysfunction In Trauma Patients
Alexandra Cojocaru, E. Circo

ABSTRACT. Relative adrenal insufficiency is considered a life threatening event, especially when associated with a serious event like trauma. Recognition and treatment of relative adrenal insufficiency is a challenge for clinical practitioner. Multiple tests have been developed to diagnose adrenal insufficiency, but the most commonly used test in the intensive care unit is the adrenocorticotropic hormone (ACTH) stimulation test. Although diagnosing adrenal insufficiency continues to be difficult in the critically ill patient, administration of highdose corticosteroids, defined as methylprednisolone 30 mg/kg/day or more (or its equivalent), over a short period of time provides no overall benefit and may even be harmful; however, administration of low-dose corticosteroids for a longer duration decreases both the amount of the time that vasopressors are required and mortality.

Magnetic Resonance Urography In Neonates And Infants With Congenital Urinary Tract Malformations
Irina Dinu, N. Ciufu, Carmen Ciufu, Loredana Pazara, R. Anastasescu

ABSTRACT. Our objective was to establish the utility of dynamic magnetic resonance urography (MRU) in neonates and infants with congenital urinary tract malformations detected by ultrasound in prenatal period. Forty-five infants (age range 7 days to 2 years, mean age 6,4 months; male/female ratio 35/10) underwent MRU using T1 3D weighted contrast enhanced dynamic sequence and a T2 weighted sequence. In all cases the results has been compared with the findings of prenatal ultrasound (n=45), intravenous urography (n=32) and scintigraphy (n=40). MRU was performed with just oral sedation in all patients younger than one year (n=34), 11 older patients needed intravenous sedation. Magnetic resonance urography was superior to ultrasound examination in all cases of ureteral pathology. Dynamic MRU gadolinium enhanced assessed the intravenous urography (IVU) criteria of obstruction. MRU results superposed with IVU and most of scintigraphic findings. MRU is the best method to depict both parenchymal and urinary tract anatomy better than intravenous urography and ultrasound and also gives functional details. For these reasons MRU can replace IVU in many cases.

Evolution Of Nitrite Poisoning In The County Of Constanta In Relation To Water Quality
Beatrice Severin, Ileana Ion, Floarea Damaschin, Valentin Broască, Elena Mocanu, Stela Costache

ABSTRACT. Water is an essential element for public health and quality of life and access to safe drinking water is a human right, a primary requirement for the development and civilization. Nitrates are a part of chemical substances with harmful action on the body, and their presence in water should not exceed a maximum limit. To study their effects on the body we have conducted a retrospective epidemiological study on nitrite poisoning cases admitted to the Constanta County Hospital during 2000-2010. Data were taken from hospital archives. For a better interpretation of statistical data we correlate this information with analysis of water chemical and microbiological quality. The information was taken from the archives of the Public Health Department. The study showed that the incidence of nitrate poisoning in the county of Constanta in the 2000-2010 periods is decreasing. Unfortunately nor in our country nor in Europe there is no system for tracking and reporting of health affected by nitrates from water, than in acute poisoning.

Autoimmune Thyroid Diseases And Their Relation To Type 1 Diabetus Mellitus
Rusali Lavinia Maria, Voinea Claudia, Circo Eduard

ABSTRACT. Autoimmune thyroid diseases are often associated with other autoimmune diseases. Establishing the frequency of type 1 diabetus mellitus among patents with autoimmune thyroid diseases and its effect on the evolution of the diabetus mellitus. Our study is a prospective one and has been done on 245 patients, among witch 104 patients with Graves disease (81 women and 23 men) and 141 patients with chronic autoimmune thyroiditis (123 women and 18 men). All patients have been tested for TSH, FT4 levels and the presence of thyroid antibodies (TRAb for graves disease patients and TPO antibodies for Hashimoto’s thyroiditis patients). In the Graves patients group the prevalence of type 1 diabetus mellitus was of 3,84% (4 patients), of these three beeing women (3,75% of the total women with Greves disease) and only one men(4,34% from the total men with Graves disease). In the group with Hashimoto’s thyroiditis patients the prevalence was of 6,38% (9 patients), seven of the beeing women (5,69% from the total of women with Hashimoto’s thyroiditis) and two men (1,11% from the total of men with chronic autoimmune thyroiditis). The association of the autoimmune thyroid diseases and type 1diabetus mellitus is quite frequent. The most often association is that of Hashimoto’s thyroiditis and type 1 diabetus mellitus, with a higher prevalence in women compared to men.

Late Results Of Total Hip Arthroplasty In Adult Avascular Necrosis Of The Femoral Head
Zugravu Ana Georgiana, Lupescu V.

ABSTRACT. We have analyzed 107 total hip prostheses in patients with avascular necrosis of the femoral head at 10 years from implantation. The assessment was done at 6 months, 1 year, 5 years and 10 years, using clinical criteria(Harris score) and radiologic criteria. We have used 93 cementless total hip prostheses(press-fit) and 14 cemented total hip prostheses for avascular necrosis stage 3-6 Steinberg. After implantation, the Harris score improved, all patients having scores in between 75 to 90, and they maintained these values until 10 years. We appreciate that the cementless total hip replacement is the solution for avascular necrosis stage 3-6.

Transvaginal Ultrasonography and HCG Serum Concentrations Levels Role in Ectopic Pregnancy Diagnosis Determination
C.L. Tomescu, Aneta Tomescu, Nicoleta Tomescu

ABSTRACT. Ectopic pregnancy diagnosis is difficult for gynecologists, although benefiting from the advantages of complex clinical investigations. Most complex diagnosis is with normal pregnancy. Any treatment of ectopic pregnancy should not be started before a positive diagnosis. For relevant results HCG serum level must be determined in dynamics at internment and after 48th hours. HCG serum level is not a prognostic factor for major complication of ectopic pregnancy, tubal rupture, but is a prognostic factor for the success rate of conservative treatment with methotrexate. Transvaginal ultrasonography diagnostic role is very important and should be pointed out that a “empty” womb calls for the diagnosis of ectopic pregnancy as well as ectopic tubal mass and presence of peritoneal fluid in the pouch of Douglas. Transvaginal ultrasonography investigates for ectopic tubal mass, presence of peritoneal fluid, presence of embryonic heart rate. Gestational age was calculated according to amenorrhea period, data obtained from transvaginal ultrasonography and HCG serum levels.

Cardiovascular Risk And Professional Factors
Livia Pădure, Irina Eşanu

ABSTRACT. Our study aims to identify the correlation between occupational factors and cardiovascular risk, assessed in terms of metabolic syndrome frequency. We analyzed lifestyle and the prevalence of obesity, hypertension and metabolic syndrome. An unhealthy lifestyle, characterized by inadequate diets and inactivity can lead to excessive accumulation of fat, hypertension, the apoptosis of pancreatic beta cells or the disturbance of lipid metabolism, with a high predictive power for the metabolic syndrome. The study was conducted on a range of 836 subjects, transport workers who responded to a questionnaire-based interview, then underwent blood pressure and anthropometric measurements. For subjects with BP≥ 140/90 mmHg and/or WP ≥ 94 cm study protocol was extended to include laboratory tests of fasting plasma glucose, HDL cholesterol, triglycerides. Study results showed that transport workers have an unhealthy lifestyle and an increased prevalence of obesity, hypertension and metabolic syndrome. Research has shown the existence of a direct relationship between the lifestyle of transport workers and high prevalence of obesity, hypertension and metabolic syndrome.

Metaplastic Ossification In Nasal Polyps With Histologic Presence of TGFβ-1. Case Report
Dincă D., Teren O.

ABSTRACT. Metaplastic ossification is a rare event in nasal polyps. The purpose of this paper was to review the CT scan and to study the expression and significance of TGFβ 1 in surgical specimen obtained from a patient with ossified nasal polyp. The CT scan revealed a severe left-sided septal deviation with septal spur, bilateral middle meatal polyps. Endoscopic surgery allows for complete removal of the calcified nasal mass, including its site of origin, which minimizes the rise of recurrence. The specific immunostaining of TGFβ 1 expressing cells in nasal mass was similar to that of eosinophils, their positivities were sifnificantly correlative. The patient remained symptom-free at the 1-year follow-up. Better characterizing the properties of TGFβ-1 in this process would require further in vitro studies with progenitor cells.

Partial Laryngectomy Versus Total Laryngectomy
Alina Lavinia Antoaneta Oancea, C.R.Popescu

ABSTRACT. Objective: There are many possibilities for laryngeal surgery in various pathological situations. Romanian reality conquers the world literature, the percentage of total laryngectomy exceeds that of the partial laryngectomy. The purpose of this paper is to present a comparison of the two types of treatment. Material and methods: Between 1.01.2006 – 31.12.2008, in the ENT Clinic of Colţea Clinical Hospital were operated by open surgical techniques 412 patients with larynx neoplasms. Careful preoperative selection is of outmost importance for the clinical outcome of patients. Postoperative follow up was between 2 years and 8 month and 5 years. Results: Death rate for the 412 operated of laryngeal neoplasms is 7%, which was 27.6% and 72.4% for partial to total.Conclusions: Partial laryngeal surgery should be applied to patients selected by the rigors of cancer.

Best’s Disease – Case presentation
Farah Constantin , Carmen Todiras, D. Denislam

ABSTRACT. Best disease is also called Best vitelliform macular dystrophy. It is an eye disease that is slowly progressive and usually starts becoming an issue when someone is a child or young adult. It is characterized by a loss of central vision. The severity of vision loss is quite variable. Usually Best disease affects both eyes, but occasionally it can be unilateral. Additional lesions outside the macula of non-foveal lesions have been found in some cases. Visual prognosis will be unfavorable due to natural disease progression, but in this case visual prognosis was favorable due to intravitreal Avastin injection, maintained until complication may reoccur (choroidal neovascularisation, neurosensory epithelium serous detachment) – needs patient monitoring to 6 months.

Diagnostic Criteria Of Portal Hypertension
Adriana Omocea, Victoria Ulmeanu

ABSTRACT. The markers for clinically significant portal hypertension are: esophageal varicose and gastric varicose, digestive hemorrhages due to varicose rupture, splenomegaly, ascites, portal encephalopathy. This is the reason why the monitoring of portal hypertension is necessary mostly to the patients suffering of clinically significant portal hypertension. The study had prospective characteristic, on a sample of 314 hospitalized to The Medical Clinic II of the Constanta County Emergency Hospital, in the period of September 2007- September 2010. The selection of the hepatic cirrhosis patients has been done based on the clinical data and laboratory tests, which allowed the elaboration of a diagnosis of the etiology, stages and complication occurred in time.

Myocardial Revascularization Without Cardiopulmonary Bypass
Marta Budu, E. Oclei, Nicoleta Arhire, D. Arhire

ABSTRACT. For myocardial revascularization, the bypass grafting using cardioplegic arrest and cardiopulmonary bypass, continues to comprise the majority of open-heart procedures performed. In November 2010 in aour clinic we performed 6 off-pump coronary artery bypass grafting. Difficult patients most likely to benefit from off-pump surgery include those with severe left ventricular dysfunction, renal insufficiency, atherosclerotic disease of the ascending aorta, severe chronic obstructive pulmonary disease, and those grafted emergently after an acute myocardial infarction. In this technique optimal target-vessel exposure and three-dimensional stabilization are essential for successful off-pump bypass surgery. For manipulate the heart and expose the coronary arteries are used deep pericardial sutures for cardiac distraction and exposure or, more commonly, apical suction devices. The advantage of these devices is that they maintain the normal geometry of the heart and avoid compression of the right ventricle. This improves hemodynamic stability when grafting difficult arteries, especially in patients with reduced ejection fractions. Stabilization of the target vessel for the anastomoses is obtained by using a two-armed suction stabilizer. These stabilizers consist of pods of suction cups within the prongs of the stabilizer that immobilize the target area by creating a vacuum between the epicardial surface and the stabilizer arm. This allows for construction of the anastomoses to take place in a motionless field, recreating the same visual image seen in an arrested heart. We concluded that postoperative recovery after off-pump bypass grafting is faster and the costs are smaller.

The Reverse Sural Fasciocutaneous Flap – Its Use In Managing Soft Tissue Loss Over The Ankle - Case Report
Cornelia Panchici, V. Orbeanu, C. Prapurgel

ABSTRACT. Soft tissue loss over the ankle or the calcaneous region, either of traumatic origin or as associated pathology of the diabetic foot, represents a challenge for the plastic surgeon in his/her cover attempt. The reverse sural flap is a fasciocutaneous axial flap of type A, with proven reliability and usefulness in this kind of pathology involving anatomical areas considered to be “difficult” to treat(until 1990 those areas had as elective treatment the free flap coverage).

Breast Core Needle Biopsy
Irina Călin, Liliana Steriu, B. Kabtour, O. D. Unc

ABSTRACT. Core biopsy is a quick and effective tool in evaluating and diagnosing suspect lumps or masses. The results of a core biopsy usually take only days to return. This may allow a quick diagnosis, meaning that cancer is detected early, giving more options for treatment. Core biopsy is also very good at determining whether a lump is benign, potentially avoiding the need for surgery.

A Rare Case of Hernia in Children – Case Presentation
C. Tica, F.D. Enache, A. Beşleagă, C. Ionescu, D.Teacă, A. Savin

ABSTRACT. A one month old male baby with a bilateral pseudotumor on both flanks was the first case of Spiegelian hernia treated in our Clinic. The pathogenesis of these rare hernias is discussed, there are only a few cases described in the literature. Surgical intervention was performed on both sides with very good results on long term.

Kerion Celsi In A Three Years Old Child
G. Nicola, Andreea-Raluca Vladuță, M. Sowlati

ABSTRACT. Pilomycoses are diseases of the hairy parts of the tegument localized on the scalp (Tinea capitis) and beard (Tinea barbe). Tinea capitis it’s a follicular epidermomycosis which is subdivided into two categories: dry and inflammatory (Kerion celsi), frequently found in children. The clinical and paraclinical analysis of Tinea capitis for a correct diagnosis and appropriate preventive measures. Case presentation of a three year old child with rural background which was admitted through the emergency department for the appearance on the scalp, following a trauma, of a tumoral formation “haematoma-like” which was proved to be a Kerion celsi mycoses type. Feature of this case is represented by the slight confusion with an infected epicranian haematoma. However, clinical date in conjunction with mycological examination can orient toward the correct diagnosis of pilomycoses. Correct treatment instituted includes local hygiene measures with antiseptics and oral therapy with antifungal which leads to a rapid improvement in the patient’s clinical condition. Clinical appearance, location and clinical context in which such a condition appeared can misguide diagnosis in absence of paraclinical examinations (mycological and microscopic examinations). Prophylactic measures and health education are essential in mentioned pathology prevention.

Laparoscopic Umbilical Hernia Repair
Liliana Steriu, Irina Calin, Basem K., Unc O.D.

ABSTRACT. A hernia is a defect in the abdominal wall, in which the inside layers of the abdominal muscle have weakened resulting in a bulge or tear. There is no acceptable nonsurgical medical treatment for a hernia. There are two main options for hernia repair: open surgery and minimally invasive surgery (laparoscopic surgery). Laparoscopic hernia repair is a relatively new surgical technique to fix tears in the abdominal wall (muscle) using small incisions, a patch (mesh), and special cameras to view inside the body. The laparoscopic repair of umbilical hernias was designed to minimize operative trauma to the patient and became the new standard for repairing the abdominal wall hernias.

Facultuy of Medicine
Constanta

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Ovidius University
Constanta

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