ARS Medica Tomitana
vol. XVII - nr. 1 (64) january - march 2011

Variations Of The Traject Of Single And Double Renal Arteries
Raluca Talpeş, J.P. Francke, I. Iorga, D. Iliescu, C. Ionescu, P. Bordei

ABSTRACT. We studied the direction of the renal arteries on 212 cases of single and 28 cases of double renal arteries, using as study method the dissection (performed on eviscerated anatomical samples and human cadavers), plastic injection followed by corrosion and the study of simple and angio-CT angiographies. In the case of single renal arteries we described five different patterns of traject, the most common path being the obliquely descending (infero-lateral) traject, found in 94 cases (44.34% of cases). Of these, 59 cases showed a linear path, 35 cases showed a sinuous traject and in 9 cases they showed a traject similar to the Greek gamma letter, something which was not cited in the studied literature. Those were followed, in order of frequency, by: a. horizontal traject in 62 cases (29.25% of cases) among which 46 cases showed a linear path and 16 cases a sinuous one: b. an obliquely ascending traject in 27 cases (12.74% of cases), 21 of them linear and 6 sinuous; c. a traject like an “Italic S” in 18 cases (8.49% of cases), with a reversed “S” on the right; d. “Z” shape traject in 11 cases (5.19% of cases), with a reversed “Z” on the right. When double renal arteries occurred, we describe three different patterns of traject: 1. similar traject (parallel) in 11 cases (39.29% of cases), 8 of them with a linear path and 3 showing a sinuous traject; 2. converging traject in 10 cases (35.74% of cases), in 8 of them the arteries crossed one another at different levels between aorta and kidney; 3. divergent traject in 7 cases (25% of cases), with several aspects: a. both arteries oriented oblique infero-laterally in 3 cases; b. one artery is obliquely ascending and the other obliquely descending in three cases; c. an artery oriented oblique infero-laterally and the other is oriented upon a “Z” shaped trajectory, as seen in one case.

The Correlation Between Personality Types And Hearing Stress For Seafarers
Ninela Rădulescu, Ileana Ion, Cecilia Adumitresi, Cristina Farcaş, Carmen Ciufu, Loredana Hânzu-Pazara

ABSTRACT. Excessive exposure to noise has always been equated with hearing loss. The aim of the study was to establish the relations between the type of personality and noise levels onboard shipping vessels for the maritime navigating personnel. We determinated the types of personality for the studied batches (deck and engine crew) using specific questionnaires (questionnaire outlining the type of personality - JUNG typology test - , questionnaire on evaluation of the stress scale Holmes and Rahe - questionnaire psycho – social -). Also, we measured noise levels in different vessels compartments usingsound level meter NL22-Rion Japan, coupled with the frecvency analyser at 1/1 and 1/3 octave for the frecvency field 12,5 Hz – 10 KHz.

Study Of Biochemical Parameters Of Lipid Methabolism In Pacients With Depression
Domnica Samargiu, Diana-Lilia Bandrabur, Cristina Laura Tatu, Natalia Roşoiu

ABSTRACT. Depression is a very frequent affective illness that affects all social environments and age categories, its incidence rate being continually increasing. Today the neurochemical base of depression is a complex one and its appearance is not the result of a single type of deficit. The purpose of this study was the determination of the biochemical parameters of lipid methabolism – serum total lipids, serum total cholesterol, LDL-cholesterol, HDL-cholesterol and triacylglycerols – in order to establish correlations between the quantitative modifications of those parameters and the severity of depression symptoms, marked through the scores obtained on Hamilton depression scale. The analysis oh the results showed that neither the increasing nor the decreasing of those parameters do not influence the maintaining or the intensifying of depression symptoms.

Non - Alcoholic Fatty Liver And Rheumatic Diseases
Daniela Ghiduş, Claudia Mihailov, Mihaela Nicoleta Ion, Natalia Roşoiu

ABSTRACT. Pathogenic mechanisms that lead to the emergence and development of non alcoholic fatty liver to steatohepatitis and cirrhosis are still not completely elucidated. The prevalence of non alcoholic fatty liver at patients with inflammatory diseases is not well known. The possibility of a link between inflammation and non-alcoholic fatty liver can influence the monitoring and management of patients diagnosed with rheumatic diseases. Study evaluates the lipid profile, hepatic cytolysis syndrome and inflammatory syndrome at 23 patients diagnosed with rheumatic disease (RA, SA, SEL), which combines non alcoholic steatosis. The study has highlighted the changes of biochemical parameters syndromes: AST, ALT, total cholesterol, triglycerides, fibrinogen and ESR. Inflammatory syndrome associated with mixed dyslipidemia with or without cytolysis syndrome could represent a risk of occurrence and development of fatty liver in rheumatic disease and need to be considered in the management and treatment for these kinds of diseases, therefore further studies are needed in this direction.

Modern Methods Of Treatment In Primary End Metastatic Liver Tumors
Z. Mandalenakis, Andra Iulia Suceveanu, A. P. Suceveanu, Laura Mazilu, Maria Şuţa, Irinel Parepa, Doina Catrinoiu, Fl. Voinea

ABSTRACT. Surgical treatment represents still a rare indication in primary or metastatic liver tumors treatment. We aimed to study palliative percutaneous treatment methods, such as radiofrequency (RF) or percutaneous alcoholisation, in case of impossibility of surgical resection, both in terms of primitive liver tumors, as well as in the case of secondary ones. We also studied the impact on survival and mortality of studied methods by comparing with a control group. 26 patients of the total of 47 studied were treated by percutaneous alcoholisation and 3 patients underwent radiofrequency ablation. We noticed a clear improvement in survival rates in patients treated by any ablative method, percutaneous alcoholisation or RF, comparative to untreated patients (p = 0.0023, 95% CI 0.775-0.995). According to liver damage, patients diagnosed with liver cirrhosis Child A-B and treated by different methods had a superior survival rates than patients untreated (p=0.0200, 95% CI 0.173-0.999). All treated patients had better survival rates than untreated ones, regardless the applied method. Tumor size, number of tumors, the level of AFP and liver function were predictive factors for better response to ablative treatment methods. The recurrence rate was higher in patients with secondary tumors after RF. Complications after ablative treatment methods applied in our patients were fewer, not severe and without life threatening.

The Use Of FEV1-Body Mass Index Corellation In Evaluating The Severity And Prognosis Of COPD
Veronica Mănescu, Oana-Cristina Arghir , Maria Şuţa, T. Hangan

ABSTRACT. The purpose of this study is to quantify the value of two parameters: Forced Expiratory Volume at second 1 (FEV1) and Body Mass Index (BMI) when establishing the COPD diagnosis for patients aged between 40 and 65. 105 COPD diagnosis patients aged between 44 and 65 have been evaluated using the value FEV1 in GOLD and BODE classifications and the value IMC within BODE classification. Using value FEV1 within GOLD classification, the patients manifesting severe obstruction (51.4%) and very severe obstruction diagnosis have been identified (30.4%). Using the value FEV1 within BODE classification led to identifying additional patients with very severe diagnosis (17%). The parameter IMC within BODE classification allowed to identify the underweight or normal weight patients who are expected to experience a negative evolution of COPD. For COPD diagnosis patients with BMI <20% kg/m2 and FEV1 < 30% (10.4% of all patients studied) the negative forecast is imminent and they require respiratory rehabilitation. The patients with malnutrition BMI <20% experience reduced capacity to perform physical activity and a dramatic reduction in FEV1.

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.

Complex Traumatisms Of Extremities “Eclectic Surgical Behaviour”
I. Bordeianu, I. V. Iordache, I. C. Bratu, B. M. Caraban

ABSTRACT. This paper presents the experience of Surgical Clinic of Plastic and Reconstructive Microsurgery of Constanta County Emergency Hospital regarding the specific behavior in the complex traumatisms of extremities, and brings theoretical and practical explanations concerning the definition of “complex traumatisms”. The specific behavior uses to “classical” principles of active delayed emergency but adopting an eclectic behavior of giving up to the other “outdated” postulates, everything in order to improve the anatomical-functional and cosmetic results after complex traumatisms, which is demonstrated by the patients studied.

The Role Of Ultrasound In The Determination Of Portal Hypertension
Adriana Omocea, Victoria Ulmeanu

ABSTRACT. Portal Hypertension is a particular problem in medical practice due to morbidity and mortality caused in the cirrhotic patients. Although the prognosis of these patients has improved in the last few decades, in portal vein hypertension cases occur some great life-threatening situations for the patients: different types of upper digestive haemorrhage like: rupture of esophageal varices, spontaneous bacterial peritonitis (SBP), hepatic encephalopathy and deficient hepatitis evaluated through Child-Pugh criteria, associated with other diseases: cardiovascular, pulmonary, diabetes mellitus, hepatocellular carcinoma. The study had prospective characteristic, on a sample of 314 hospitalised to the Medical Clinic II Of the Constanta County Emergency Hospital, in the period of 2007-2010.

Comparing The Diagnostic Methods Of Clinically And Dermoscopy Pattern In Nodular And Elevated Pigmented Skin Lesions
T. Poalelungi, I. Bordeianu

ABSTRACT. Nodular and elevated pigmented skin lesions can be difficult to distinguish clinically from melanoma. The aim of this study was to evaluate how dermoscopy can be useful in diagnosing pigmented skin lesions such as: pigmented basal cell carcinoma, angiokeratoma and melanoma. Three patients with pigmented skin lesions were analysed both clinically and dermoscopy. The results, in this limited setting, show that dermoscopy has real advantages over clinical assessment when diagnosing pigmented skin lesions in order to indicate which lesion is melanoma and which is not.

The Current Therapeutical Management Of Anastomotic Leakage After Colorectal Surgery
R. Popescu, V. Sârbu, T. Iusuf, Iulia Munteanu, I. Iordache, Cristina Dan, Alina Vîncă, M. Hriţcu

ABSTRACT. Anastomotic leakage in colorectal surgery is associated with increased morbidity and mortality, poor functional outcome and risk of permanent stoma formation. The therapeutical management of colorectal fistulas must insures the patient the support until spontaneous closure or until the patient becomes fit for a definitive surgical procedure. The authors present the current therapeutic possibilities, conservative or surgical, in the management of postoperative colorectal fistulas. Over the past year, from the Clinic of Surgery Constanţa, were selected 95 patients who underwent surgery for colorectal pathology (colorectal cancer, diverticulitis, colonic polyposis), 68 elective cases (71,57%) and 27 (28,42%) in emergency conditions. The median age was 62,3 years (range between 26 - 91 years). Most of anastomotic leakages occurred between the 5-th and the 7-th postoperative day, with limits between the 3-rd and the 15-th day. Anastomotic fistulas were identified at 13 patients (13.68%), most of them operated for rectosigmoidian cancer, mid and low rectal cancer. 9 patients were treated in a conservative manner with spontaneously closure of the fistula and 4 patients required reoperation for septic complication. The mortality rate was 23.07%. Once anastomotic leakage occurs, a concerted effort and complex therapy should be undertaken to effectively treat the leak and the resulting sepsis. Minor leaks can be managed conservatively with successful results using antibiotherapy, electrolyte replacement and nutritional support measures. Development of peritonitis in evolution of a fistula patient demands reintervention, taking down the anastomosis and colostomy. Early diagnosis and urgent therapeutic intervention are required in order to avert life-threatening conditions that may be caused by anastomotic leakage.

Sphenoidal Tumor With Pituitary Involvement-Case Presentation
N. Cârciumaru, A. Barbu, D. Naum, Ana-Maria Ionescu

ABSTRACT. We present a 59-year-old woman case, brought by her family for headache, left face paresthesias, horizontal double vision and bilateral laterocervical adenopathy. Neurological examination reveals bilateral horizontal double vision by bilateral paresis of VI cranial nerve, global hypoesthesia in the superior 2/3rd of the left face, left corneean reflex is abolished. MRI examination shows sphenoid bone tumor with pituitary invasion, temporal durra thickening. Under treatment evolution has been slightly positive. The patient has been guided to neurosurgery unit of the Bagdasar Arseni Hospital for surgical management of the tumor.

Complications Of Midline - Open Tracheotomy In Adults
D. Dincă, C. Aftenie

ABSTRACT. Objectives/Hypothesis: Percutaneous tracheotomyis progressively replacing open tracheotomy as a consequence of promising results of comparative studies. However, this comparison has four considerable weaknesses: 1) selected indications (high-risk patients excluded for percutaneous tracheotomy); 2) varying spectra of complications included in different studies; 3) varying operative settings (experienced surgeons exclusively, surgeons in training, or both); and 4) missing differentiation between different surgical techniques. Retrospective evaluation of all complications following 42 consecutive surgical tracheotomies (midline-open technique) performed by different surgeons and surgeons in training at one academic institution. Complications were classified and compared to results in the literature. Rates of 19.05% minor and 2.3% major complications and 0% tracheotomy-related mortality were registered. The most prevalent complications were local wound infections (9.52%), intra- and postoperative hemorrhages (7.14%), and no cartilage damage. No significant difference was found for high risk patients and emergency tracheotomies. Our study demonstrates that open tracheotomy is a safe procedure, particularly if performed in high-risk patients even by inexperienced surgeons. Therefore, we emphasize the advantages of the midline-open tracheotomy in an academic teaching hospital setting.

Treating Dento-Alveolar Anomalies Class I According To Angle And Using The Damon 3 Self-Ligating System (ORMCO)
S. Mocanu

ABSTRACT. In practice, the prevalence of the canines’ vestibular position is generally covered and features of their position are certain, according to epidemiological research. Studies made on 96 patients have revealed that the reason why canines are situated in a vestibular position is the lack of another place for them in the dental arch, which is due either to the early loss of temporary teeth, or to the discrepancy between the size of the teeth and the size of the jaws. Such anomaly is hereditary and most importantly, the lack of a place in the dental arch for the canines becomes more noticeable as years go by, making it hard to observe the ‘self-control’ of the vestibular position of the canines.

Dysphagia In Forestier Syndrome
Cristina Laza, D. Dincă, M. Sarv, M. Seceleanu

ABSTRACT. Dysphagia is a frequent complaint in elderly patients.At this age, neurological and tumoral causes predominates. Diffuse idiopathic skeletal hyperostosis (DISH), alsoknown as Forestier disease, first described in 1950 by J. Forestier is a rare cause of dysphagia caused by large calcification along the anterior and lateral sides of the vertebral bodies produces the appearance of candle wax dripping down the spine. Most patients are free of symptoms, so that DISH is usually discovered fortuitously upon plain radiographs of the spine obtained for another reason. A few patients experience spinal pain, spinal stiffness, or dysphagia. The mechanism of dysphagia is interference with the esophageal peristaltism. We report a case in which the diagnosis was made upon evaluation for dysphagia in an old patient The diagnosis requires imaging but also other causes especially tumors must be excluded.

Assessment Of The Severity Of Hand Injuries
Raluca Laura Ştefănescu, I. Bordeianu, Doina Dumitrescu

ABSTRACT. Purpose – the authors stress the advantages of using a descriptive scoring system in the objective assessment of the severity of hand injuries. Material and method - This paper stands for a retrospective study of the patients with complex trauma of the hand admitted to the Department of Plastic Surgery of the Universitary Emergency Hospital Bucharest from January 2006 to December 2008. A total number of 709 patients were surveyed. The causes of injury, the mechanism involved, the victim variables and an unitary diagnosis code were recorded. The injuries were further graded using MHISS (the Modified Hand Injury Severity Score), the evaluation being done for 3 categories of lesions upon trauma level: forearm, hand or both. Conclusions - An evaluating score such as MHISS allows us to take into account the severity of injury and the hand function after recovery, setting in the same time a reasonable final goal for treatment and rehabilitation. Correct and thorough documentation and evaluation of injury represent the key for achieving a complete diagnosis and a cost-effective surgical strategy.

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