ARS Medica Tomitana
vol. XVII - nr. 3 (66) july - september 2011


Morphometry Of The Upper Urinary Pathways
Daniela Glodeanu, R. Baz, D. Iliescu, C. Ionescu, P. Bordei

ABSTRACT. The study was performed on 87 cases using as study methods the dissection, the plastic injection and especially CT urography. Regarding the minor calyces, we found a length of 0.3 to 2.5 cm length, their width being 0.2 to 1.3 cm, the shortest, but the thicker the lower ones. Minor calyces dimensions are reduced when they confluence in bouquet. The superior major calyx showed a length of 0.8 to 2.8 cm and width from 0.3 to 0.89 cm. The minor middle calyces were between 0.5 to 1.8 cm long and 0.2 to 0.4 cm width. They were larger when the major middle calyx is formed of a single minor calyx. When major middle calyx is formed from two or three minor calyces, their dimensions are smaller. For the inferior major calyx we found a length of 0.5 to 1.5 cm and 0.52 to 1.2 cm wide. In one case we found one with a width of 0.25 cm, which is thinner than the superior major calyx and equal to the middle one. For the renal pelvis we found a length between 1.05 to 2.45 cm and width 0.8 to 1.8 cm. The ureter had a length of 19.5 to 27.8 cm; the lumbar ureter was 8-13 cm in length, 5-9 cm for iliac ureter and 4-5 cm for the pelvic ureter. The caliber was from 0.3 to 0.35 cm in the lumbar and iliac ureter, diminishing for the pelvic ureter (retrovesically) from 0.21 to 0.29 cm and 0.11 to 0.18 cm at the entrance into the urinary bladder. During the peristaltic dilation, its size reaches 0.41 to 0.51 cm. The distance between the calyces and the renal margins was between 1.75 to 31.5 cm; between the superior calyx and the lateral renal border was 2.05 to 29.5 cm on the left, with higher values for right kidney: 2.5 to 2.6 cm. Between the superior calyx and the medial renal border was a distance of 2.1 to 2.55 cm. Between the middle major calyx and the lateral renal border we found a 2.4 to 2.55 cm distance, and between the inferior major calyx and the lateral renal border we found a 1.5-2.2 cm distance.

Water Quality In Constanta County
Beatrice Severin, Floarea Damaschin, Ileana Ion, V. Broască Madar, Elena Mocanu, Stela Costache

ABSTRACT. “Water quality” is a technical term that is based upon the characteristics of water in relation to guideline values of what is suitable for human consumption and for all usual domestic purposes, including personal hygiene. Components of water quality include microbial, biological, chemical, and physical aspects. The study is based on data taken from the archives of the Public Health Department – Constanta about water monitoring in period 2006-2010. As a method of statistics analyzes we used the percentage method. In rural areas are recorded most cases of deviation of sanitary water quality. Considering that rural population is almost one third of our county population, the risk for affecting the body through water consumption is very serious!

The Cubital Tunnel Syndrome
S. C. Băncilă, I. Bordeianu

ABSTRACT. This paper is meant to underline a series of important aspects (for the author) regarding the correct approach of the patient suffering from the cubital tunnel syndrome. The retrospective study is carried out within the Rheumatology department of the Clinical Hospital Colentina on a lot of 14 patients diagnosed with cubital tunnel syndrome, who visited the clinic during the period 2007-2010. The patients who were part of the study were drawn up “study sheets” which included the following: year; gender; age; social background; main diagnosis; affected nerve; comorbidities; period of admission into hospital; occupation; dominant arm; conservation/surgical treatment applied. The profile of the patient visiting the Rheumatology department is as follows: patient with polyarthritis and diabetes, gender: male, from the urban area, with the cubital tunnel syndrome existing at the level of the right upper dominating limb, for which a conservation treatment is applied being completed in the end with a surgical treatment.

Evaluation Of Maternal-Fetal Characteristics In The Circumstances Of Iodine Deficiency In A Group Of Pregnant Women In Vâlcea Area
Ileana Coamesu, E. Circo

ABSTRACT. Scope and objectives of the study The present study proposed to identify the evolutive characteristics of maternal-fetal complications associated with the thyropathies occurred as an expression of iodine deficiency in a group of pregnant women from Valcea area. Subjects and methods Pregnant women have been monitored quarterly and 6 months post-partum during March 2008 – April 2010 and newborns - at birth. The final processing included 50 pregnant women and their newborns, by: evaluation of thyroid status of newborns through TSH within the newborn screening program for congenital hypothyroidism and evaluation of pregnant women early and perinatal obstetrical characteristics and of neonatal characteristics in relation with thyroid functional status (normal thyroid, clinical hypothyroidism, subclinical hypothyroidism, hypothyroxinemia). Results. Discussions The percentage of newborns with neonatal TSH values higher than 5 µUI/ml, of 28.7% in the analyzed group, corresponded to a moderate iodine deficiency but it reached 44.4% for newborns of pregnant women with values of urinary iodine below 150 µg/l, corresponding to a severe iodine deficiency. The highest percentage of pregnant women with risk of miscarriage in quarters I and II was in the group with clinical hypothyroidism, of 28.51%. The percentage of pregnant women with risk of preterm birth was similar in the group with clinical and subclinical hypothyroidism, of 14.28%. The highest percentage of pregnant women with perinatal obstetrical pathology was found in the group with clinical hypothyroidism and in the group with maternal hypothyroxinemia (uterine hypotonia 28.57% versus 10%, postpartum hemorrhage 28.57% versus 10%, secondary anemia 57.1% versus 20%). The lowest average birth weight was in the group of pregnant women with normal thyroid and the highest – in the group of pregnant women with hypothyroxinemia, with minimal dispersion of 3122-3331 g. APGAR score below 9 had the highest percentage in the newborns from mothers with hypothyroxinemia, 20%. We found in newborns from mothers with subclinical hypothyroidism the most frequent neonatal pathology: umbilical cord pathology (28.57%), congenital malformations, amniotic fluid pathology (14.28%), prolonged icterus (14.28%). The analysis of the interrelation between obstetrical and neonatal pathology has been performed in relation with the thyroid functional and autoimmune status (normal thyroid, clinical hypothyroidism, subclinical hypothyroidism, hypothyroxinemia), concentration of urinary iodine, of iodine deficiency grade. Conclusions The high level of involvement of maternal hypothyroxinemia, of clinical and subclinical hypothyroidism in early and perinatal obstetrical pathology, in the variation of newborns parameters and in neonatal pathology has been demonstrated.

Post Operatory Pain Assessment In Pediatric Surgery
Mihaela Coşofreţ, Nida Boşnac, R. Asan, F. Enache, C. Tica

ABSTRACT. Post operatory pain assessment study monitored a group of patients using assessment scales according to the protocol used painkiller category, minor and major surgery. The study group consisted of 47 patients aged 0 - 192 months, divided into four age groups and two categories according to surgical complexity. The measurement scales used in the post operatory pain evaluation study are: DAN, EVA, and CHEOPS. At the age category, the assessment shows DAN lower score averages in children treated with meperidine and paracetamol compared to those treated with paracetamol, statistically significant differences due to surgical category. For the categories A, B, and C age group there were found statistically significant differences in pain scores according to the protocol used analgesic, but no clinical differences were found due to different type of surgical procedures (major, minor, plastic). Pain scores were significantly lower with epidural analgesia than the others following the analgesic protocol, in the D age group.

Surdités D’origine Génétique
D. Dincă, C. Aftenie

RESUME. Le but de ce travail est de passer en revue les différents types de surdités d’origine génétique. Les auteurs détaillent les surdités de perception, syndromiques et isolées, puis les surdités de transmission. Les surdités de perception syndromiques représentent 30 % des surdités génétiques. Les surdités de transmission sont dominées par les aplasies d’oreilles. L’aplasie majeure est caractérisée par une malformation du pavillon et/ou du conduit auditif externe, associée à des malformations de l’oreille moyenne. En revanche, l’aplasie mineure correspond à une malformation de l’oreille moyenne, parfois associée à des malformations de l’oreille externe souvent minimes. Pour chaque type de surdité les auteurs proposent un bilan systématique.

Gastrointestinal Stromal Tumors – Role Of Imaging Methods
R. Baz, C. Nişcoveanu

ABSTRACT. Gastrointestinal stromal tumors (GISTs) have been distinguished morphologically, immunohistochemically, and genetically from other gastrointestinal-tract spindle cell neoplasms. The objective of this study was to correlate clinical and imaging findings with morphology and immunohistochemistry to diagnose GISTs. We reviewed the data from 18 cases of GIST diagnosed and treated in our hospital, between January 2007 and November 2010. Small bowel was the site of origin for more than one half of cases, followed by the stomach. The majority of GIST’s were exophytic with regular contour and good enhancement. Imaging findings correlated with hystopatological and imunohistochemical features. Metastases were found in 6 patients, with predominance in the liver. Imaging methods are useful in GIST detection, evaluation of local and distant invasion, as well as in treatment follow-up.

Incidence Of Postoperative Nausea And Vomiting After Paediatric Tonsillectomy And/Or Adenoidectomy Surgery With Sevoflurane Or Remifentanil–Sevoflurane
D. Dumbravă

ABSTRACT. Adenotonsillectomy has become a less common procedure during the past decades, because the indications for this surgery have changed. With more effective antimicrobial therapy, the percentage of patients with recurrent infection as the indication for surgery has declined, and the percentage of patients with obstructive symptoms has increased; today, 75% of tonsillectomies are performed to remove obstructions. With this change has come a greater appreciation that adenotonsillar hypertrophy may lead to obstructive sleep apnea (OSA) and, in the extreme, to cor pulmonale. Because of the need to prevent cor pulmonale in patients with OSA, the adenotonsillectomy population has become younger; 60% of children operated on for obstruction are younger than 8 years of age. Of children younger than 3 years who require tonsillectomy, 81% have an obstruction. Postoperative nausea and vomiting (PONV) is a major concern in paediatric outpatient surgery and may increase patient discomfort, delay patient discharge, and increase the cost of patient care. The incidence of PONV after tonsillectomy and/or adenoidectomy surgery is relatively high, compared with other outpatient surgeries, particularly in children. In this prospective, randomized, double-blind study, we evaluated and compared the incidence of postoperative nausea and vomiting (PONV) after tonsillectomy and/or adenoidectomy surgery with two different anaesthetic methods, sevoflurane or remifentanil–sevoflurane.

Edmondson-Steiner Grading Increases The Predictive Efficiency Of α-Fetoprotein Level In Diagnosis Hepatocellular Carcinoma
Elena Mocanu, Mariana Aşchie, V. Broască, G. Becheanu, Beatrice Severin

ABSTRACT. Serum alpha-fetoprotein (α-fetoprotein, AFP) is frequently used for the diagnosis of hepatocellular carcinoma (HCC). Alpha-fetoprotein is a glycoprotein, belonging to the intriguing class of onco-development protein. Generally designated as tumour marker, AFP is recognized as an important blood component, having specific diagnostic utilities. Mean elevated AFP levels in all HCC patients were, 421±59 μg/ml (range 157–4019 μg/ml) in males and 163±32 μg/ml (range 101–2341 μg/ml) in females. The AFP level in hepatocellular carcinoma was discovered to decline as the age increased. It also appeared to be related to the tumor cell type; the relatively immature cell type was more frequently associated with a higher AFP level. It is concluded that AFP is a significant markers for hepatocellular carcinoma, helpful in assessing problems in management of HCC and monitoring treatment regiments. In addition, AFP is also an indicator of HCC risks mostly in patients with cirrhosis and HCV/HBV infections.

Varicose Vein Treatment With Endovenous Laser
Marta Budu, E. Oclei, Nicoleta Arhire, D. Arhire

ABSTRACT. Chronic venous disorders of the lower extremity are common problems caused by venous hypertension. Venous hypertension is usually the result of incompetent valves in one or more of the saphenous veins and their primary tributaries. In patients with saphenous vein incompetence, treatment begins with the elimination of these incompetent pathways. Until recently, the best way to accomplish this was with ligation of the saphenous vein at its deep vein junction and removal of the abnormal saphenous vein segments; this procedure is known as high ligation and stripping. We decided to perform a new tehnique, to 20 patientes whit chronic venous disorders of the lower extremity and that is endovenous thermal ablation whit endovenous laser. This procedure was associated with high success and low complication rates. The procedure was performed with local anesthetic and low sedation. The patients are fully ambulatory following treatment and the recovery time is short. In this article we will describe the tehnique in detail.

Extension Limits Of Horizontal Supraglottic Laryngectomy
Alina Lavinia Antoaneta Oancea, C. R. Popescu, P. Bordei, S. V. G. Berteşteanu

ABSTRACT. Based on anatomical data described have changed the indication for surgery from total laryngectomy in supraglottic horizontal laryngectomy with base of tongue resection.. The purpose of this paper is to present the conditions that led to this decision and results. Material and methods: Between 1.01.2006 – 31.12.2008, in the ENT Clinic of Colţea Clinical Hospital were made 38 horizontal supraglottic laryngectomies of which 7 cases were selected that have changed the indication for surgery in total laryngectomy with supraglottic horizontal laryngectomy with base of tongue resection. Careful preoperative selection is of outmost importance for the clinical outcome of patients. Postoperative follow up was between 3 years and 11 month and 5 years. Results: All patients are alive, decannulated, oral feeds and are fully socially integrated.Conclusions: In the light of anatomical structures analysis, indications of partial laryngeal surgery may be extended where it is now accepted only total laryngectomy.

Principles Of Nonchirurgical Treatment In Gonarthrosis
V. Orbeanu, A. Covaleov, Silvana-Crina Alecu

ABSTRACT. Arthritis, chronic progressive disease is the second major cause of disability after cardiovascular diseases, are the most common articular pathology in the world affecting more than 60% of the population over 60 years. Prechirurgical stage of gonarthrosis use pain-killers, anti-inflammatory, viscoelastic and condroprotector drugs, gymnastics, recovery and physio-climatic spa treatments. This scheme and hospital outpatient treatment of stage I and II of gonarthrosis successfully used (WOMAC scale, QOL and adapted FAC) in recent years in our clinics.

Cardiovascular Risk And Professional Factors
Livia Pădure, Irina Eşanu

ABSTRACT. Purpose: 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. Methods: 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. Results: Study results showed that transport workers have an unhealthy lifestyle and an increased prevalence of obesity, hypertension and metabolic syndrome Conclusions: Research has shown the existence of a direct relationship between the lifestyle of transport workers and high prevalence of obesity, hypertension and metabolic syndrome.

Evaluation Of Clinical Response And Leptin Level At The Patients With Knee Ostheoarthritis Treated With Mud
Elena Valentina Ionescu, Maria Şuţa, Lucian Petcu

ABSTRACT. It is well known that the pathogenic mechanism of osteoarthritis is still incompletely understood. However, during its study, various risk factors have been identified. One of them is obesity, which plays an important role, both by its mechanical role, and through numerous biologically active substances that the fat tissue secretes. One of them is the leptin, that has gained valences in recent years, being increasingly important in this context. A group of patients suffering of knee osteoarthritis have been studied both in terms of clinical response quantified by visual analogous scale for pain and the serum level of leptin at the application of peloidotherapy. All patients were hospitalized in Balneal and Rehabilitation Sanatorium from Techirghiol for a period of two weeks. At all patients were evaluated clinical response and serum level at leptin after natural treatment with sapropelic mud. During this period, significant decreases were registered for both parameters.

Intratubal Administration Of Methotrexate For Conservative Purpose – Personal Surgical Procedure
C. L. Tomescu, Aneta Tomescu

ABSTRACT. In patients where conservative medical treatment with methotrexate failed, surgical intervention was necessary. The personal surgical method was performed on a number of 9 patients; the surgical intervention was a conservative method – salpingorrhaphy. In order to prevent persistent gestational trophoblastic disease and tubal clogging, a polyethylene catheter is introduced in the oviduct until it reaches the ostium of the Fallopian tube, without exceeding it. In order to ensure a rigorous haemostasis, the Fallopian tube and the polyethylene catheter are sutured together. The level of HCG is measured in the fourth and seventh day postoperative: if the levels of HCG are higher than 1000 mUI/ml, if they plateau or if they increased, methotrexate is administered intraluminally through the polyethylene tube, according to the following scheme: - 50 mg of methotrexate are dissolved in 10 ml of physiological saline solution, and injected through the polyethylene catheter, for 5 days. 10 mg per day in 2 doses (5 mg in the morning and 5 mg in the evening) - If the values of HCG decrease to an adequate level and there is no risk of persistent trophoblastic disease, the polyethylene catheter is kept for 8-12 days, afterwards it is extracted by traction. If the values do not decrease accordingly, the intraluminal administration of methotrexate is resumed after a 3 day break. This method was used on a number of 9 patients; 4 of them had been treated with methotrexate before the surgical intervention and pertain to the study, and 5 of them had been operated on for complications of ectopic pregnancy and were suitable for this kind of surgical intervention. No postoperative complications or deaths were recorded.

Particularities In The Surgical Treatment Of Advanced Local Colorectal Cancer
G. Ştefan, V. Sârbu

ABSTRACT. Surgery is the main therapeutic option against colorectal cancer, followed by radiotherapy and chemotherapy. Many factors determine the choosing of the type of intervention, among the most important being the location of the tumor, the stage in which it is (tumor extent), the presence and scale of the complications, and the area of the patient. In the case of rectal cancer, the objective of conserving the anal sphincter must not compromise the curative resection. The surgical treatment of advanced local colorectal cancer maintains its primary role. The surgical treatment represents the main pillar of the therapeutic arsenal for the patients diagnosed with colorectal cancer. The current tendency in the treatment of advanced local colorectal cancer, regardless of its location, is the aggressive surgical ablation, with an extent to the tissues affected by the neoplasm, in order to reduce the tumor mass and to increase the efficiency of the complementary treatment.

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Constanta

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