ARS Medica Tomitana
vol. XVII - nr. 4 (67) october - december 2011

Anatomical Considerations On The Portal Veins Of The Caudate Hepatic Lobe
Veronica Iorga, C. Dina, C. Ionescu, D. Iliescu, P. Bordei

ABSTRACT. Our study was performed on 52 cases, using as study methods the dissection of human livers harvested from adults who had no history of liver disease, injection of contrast substance followed by radiography and plastic injection followed by corrosion with NaOH. We evaluated the following morphological features: the number and origin of portal venous branches for the caudate lobe, their size and the topography of the caudate lobe areas that they supplied. We divided the surface of the caudate lobe into three sectors: right, middle and left, studying the portal venous branches they received. Thus, for the right side of the caudate lobe, the venous branches had their origins as follows: most often, in 90.38% of the cases, they originated from the right terminal branch of the portal vein, in 5.77% of cases the origin was located at the bifurcation of the portal vein and in 3.85% of the cases the right branches originated from the portal vein trunk. In 17.31% of the cases the right branches participated to the supply of the middle area of the caudate lobe. In 5.77% of the cases, the right side showed two large branches (with a caliber of 2-3 mm), which in two cases originated from the right posterior branch and in one case a branch originate from the portal trunk and the other from the right posterior branch. For the middle part of the caudate lobe, the venous branches, most often, had their origins, in 26.92% of cases, from the right terminal branch of the portal vein, in 25% of cases had their origins from the terminal division of the portal vein, in 21.11% of cases the middle venous branches started from the hepatic portal trunk and in 13.46% of cases from the left terminal branch of the portal vein; in 9.61% of the cases they originated from the middle portal vein (when the portal vein trifurcated). In 15.38% of cases there were two middle branches. For the left part of the caudate lobe, the venous branches had their origin, most frequently - 71.15% of cases, from the transverse portion of the left portal branch; among those, 50% of the cases showed a single venous branch while 21.15% of cases showed two venous branches 2 - 4 mm apart; in 21.15% of the cases the origin of the left branch was the portal vein trunk, toward its base and in 7.69% of the cases the origin of the left caudate branch was at the level of the portal bifurcation. The left branch also supplied the middle sector in 6 cases (11.54% of cases) and in one case the middle branch started from the leftone.

The Morphometry Of The Common Hepatic Artery At Its Origin
Nuţi Bârsan-Constantin, Cristina Chiriloaie-Popescu, C. Dina, P. Bordei, D. Iliescu

ABSTRACT. The study was performed on 280 cases from 128 human cadavers (adult, eviscerated organic subdiaphragmaticblocks and fetuses), 68 abdominal aortic angiographies, 60 angioCT’sand 24 ultrasounds. We used the dissection on adult and fetal cadavers, plastic injection (Technovit7143) on the organic blocks and fetal cadavers, followed by dissection or corrosion with NaOH. Since the hepatic artery caliber variation is related to its origin, we evaluated the origin of the common hepatic artery on 256 cases, studying its morphometry in relation with the variations. The origin from a celiac trunk that ends through a classic trifurcation at the same level was encountered in 61 cases, situations where the three branches formed highly variable angles. The most usualcommon hepatic artery origin was from a hepatosplenic trunk.The origin of the common hepatic artery from a hepatogastrictrunkwas in 14 cases, splenic artery having the origin from the aorta and between the left gastric and hepatic arteries appearing an angle of 90 to 1000. The aortic origin of the common hepatic artery was assessed in 51 cases, the abdominal aorta and hepatic artery forming an angle of 25 to 400. In 14 cases the origin of the common hepatic artery was the superior mesenteric artery, the arteries forming an acute angle with the originating mesenteric trunk. The origin of the common hepatic artery from a celiomesenterictrunk was in 4 cases, 3 of them with an angle of 85, 87 and 900between hepatic and splenic arteriesand in one case an angle of 1800, with the left gastric artery as bisector of this angle. The caliber of the hepatic artery at its origin was between 3.4 to 6.3 mm and is different according to its origin. We always found the common hepatic artery caliber larger than the left gastric artery, in a few cases the caliber of this artery are closer to the one of the hepatic artery, especially in cases where there were two arteries.

Stress Evaluation In Acute Ischemic Stroke
Anabella-Cristiana Ştefănescu, Ileana Ion, Ildiko Toldişan, Cecilia Adumitresi, Ninela Rădulescu, Cristina Farcaş, Mădălina Oniceanu, R. Chirică, Loredana Hânzu-Pazara, Carmen Ciufu, Monica Tudorache

ABSTRACT. Despite of the fact that medicine is progressing with an amazing speed nowadays, the cerebro-vascular diseases still represents one of the main causes of long term morbidity. An important complication that accompanies the cerebro-vascular disease is the autonomic nervous system dysfunction. The aim of this study was to demonstrate the involvement of the catecholamine and vanilmandelic acid in the occurrence of non-neurological clinical features associated to the neurological ones in patients with acute ischemic stroke, in the first 24 hours from onset. In the study were involved 20 patients admitted in Constanta Clinical Hospital, department of Neurology.

Food Poisoning Still Present
Floarea Damaschin, Beatrice Severin, Elena Margean

ABSTRACT. Food borne illness or “food poisoning,” occurs when food contaminated with bacteria or other pathogens, such as parasites or viruses, is consumed. Typically, food becomes contaminated with a microbial pathogen as a result of improper food processing, handling, preparation and/or storage. We realized an epidemiological study regarding the cases of food poisoning among the Constanta County’s citizens, between 2008 and 2010. We used data from the archive of Hospital for Infectious Diseases – Constanta. We have performed a retrospective study for the period between 2008 and 2010. As a method of analysis we used retrospective statistical method.Food poisoning is a common, yet distressing and sometimes life-threatening problem for millions of people throughout the world.

HLA Class I And II Genotyping In Graves Disease A Case - Control Study From Dobrogea
Alina Martinescu, Irina Franciuc, E. Circo

ABSTRACT. Association of the major histocompatibility complex (MHC) class II-encoded HLA-DRB1-DQA1-DQB1 haplotype with Graves’ disease (GD) has been known for several years. Recent evidence from other autoimmune diseases has suggested that the HLA class I encoded HLA-B/-C molecules could be conferring HLA-DRB1-DQA1-DQB1 independent effects on disease. The aim of this study was to determine the effect of HLA-Cw and HLA-DRB1 in GD in a group of 112 patients with GD and 89 control subjects from Dobrogea. The method used for the assignment of alleles at HLA-DRB1 and Cw loci was molecular genotyping, primarily by the sequence specific oligonucleotide hybridization method, and when required, by the sequence specific primers method. From HLA class II genes, we found in our study HLA-DRB1*03 and *04 as predisposing alleles, (pc=5.95x10-4 and Pc =4.79x10-4 respectivly). We also demonstrated the strongest association (pc=1.87x10-8) with HLA-Cw*07 predisposing alleles. We failed to demonstrate Cw*03 and Cw*16 genotypes as a protective alleles. Class II loci could still has effects on GD, but they appear smaller than the HLA-C association. A full investigation of the MHC region, including all class I and II loci is now required.

Relationship Of Ultrasound Pattern To Histopathologic Findings In Hepatocellular Carcinoma
Elena Mocanu, Mariana Aşchie, V. Broască, G. Becheanu

ABSTRACT. Hepatocellular carcinoma (HCC) represents the fifth most common cancer in the world, and the third most frequent oncological cause of death. In this series of 40 patients with single HCCs, 30 (75%) of the lesions were hypoechoic, 7 (17.5%) were hyperechoic and 3 (7,5%) were isoechoic. Hypoechoic US pattern was found in 24/30 (80%) and in 6/30 (20%) patients over or under the age of 69 yrs. Furthermore, both hypoechoic and hyperechoic tumors tended to be associated with somewhat lower AFP serum levels and cirrhosis related to HBV. The prevalence of well-differentiated and moderately-differentiated tumors was aproximatly identical (42,8%) in the hyperechoic subgroups. Most HCCs emerging in cirrhotic livers will be characterized by decreased echogenicity on US.

Role Of Breast MRI In Evaluation Of Response To Neoadjuvant Chemotherapy In Patients With Breast Cancer
R. Baz, C. Nişcoveanu, Laura Mazilu, Cristina Stici, T. Macovei

ABSTRACT. Assessment of the extent of residual tumor after preoperative (neoadjuvant) chemotherapy by conventional techniques (physical exam, mammography, and sonography) is relatively inaccurate. Breast magnetic resonance (MRI) has been proposed to evaluate the extent of tumor after completion of neoadjuvant chemotherapy and to determine which patients have become eligible for breast-conserving therapy. The aim of our study was to determine the accuracy of clinical examination, mammography, sonography, and MRI in predicting residual tumor after neoadjuvant chemotherapy for breast cancer, as compared with gold standards of pathology. Fifty-one women diagnosed with stage IIB-IIIB palpable breast cancer between 2004 and 2007 and admitted in Oncology Department were prospectively enrolled in a study investigating the imaging aspects of residual tumors after neoadjuvant chemotherapy. Fourty-three patients completed the protocol. Of the four methods, MRI agreed with pathology significantly more often (P < 0,0001). Our study demonstrates that MRI appears to provide best correlation with pathology, in patients undergoing neoadjuvant chemotherapy, thus establishing which patients have become eligible for breast-conserving therapy.

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.

Delorme Technique In Rectal Prolapse
M. D. Hriţcu, Alina-Ioana Vîncă, Cristina Cristache, A. R. Niamani, R. D. Soră, Mihaela-Denisa Pîrvu, T. Iusuf

ABSTRACT. Prolapse of the rectum is a distressing condition which causes discomfort during bowel action. Occasionally it is surprisingly well tolerated for many years. Rectal prolapse is six times more common in women than in men but is not associated with childbirth or parity. Nearly all elderly patients with rectal prolapse have a history of constipation and prolonged straining at stool, which stretch the pelvic floor and anal sphincter mechanism. Most adult patients present with a prolapse which reduces either spontaneously or with manual assistance after defecation. Only occasionally is the prolapse irreducible. Prolapse causes discomfort, and trauma to the prolapsed mucosa results in bleeding and discharge of mucus. Three quarters of these patients also have fecal incontinence. In some patients the prolapse extrudes on minimal straining (when standing up, coughing, or sneezing). Prolapse in younger patients is often associated with straining at stool, solitary rectal ulcer, perineal descent, and rectocele. There are three main types of rectal prolapse: complete prolapse, incomplete prolapse, and concealed prolapse. The paper presents the indications, the surgical steps, the results and the advantages of Delorme technique in rectal prolapse, illustrated by operatory images from the 3-case-experience of the 2nd Surgery Clinic of the Emergency Clinical County Hospital of Constanţa.

Clinical And Laboratory Diagnosis Particularities Of Advanced Local Colorectal Cancer
G. Ştefan, V. Sârbu

ABSTRACT. The clinical diagnosis of colorectal cancer is, usually, a late diagnosis as only in the advanced phases of the disease the clinical expression is capable of asserting the diagnosis. In the three studied groups, the diagnosis of colorectal cancer was based on anamnesis data, clinical data, laboratory and imagistic data (radiologic, ultrasound, and endoscopic data), as well as on cytological and microscopic data. Even with the progress recorded in the last decades in colorectal cancer diagnosis and treatment, this disease’s mortality rate continues to remain high, even in the developed countries.

Anxiolytics Can Decrease Cardiovascular Events During Upper Gastrointestinal Endoscopy (UGIE) In Elderly Patients
A. P. Suceveanu, Irinel Parepa, Laura Mazilu, Andra-Iulia Suceveanu

ABSTRACT. Although UGIE is usually considered to be a safe procedure, arrhythmias and ischemic events occur in 38.5% to 75%, especially in elderly people, with heart disease. Cardiovascular events occurring during endoscopy have been attributed to fear, anxiety and catecolamines secretion. We aimed to study if there are any changes on ECG and clinical status in elderly patients diagnosed with cardiovascular diseases, using anxiolytics prior to UGIE. We compared two groups of 45 patients each, aged over 60’s, matched by sex, BMI, severity of cardiac disturbances, ECG features. Patients from the first group received anxiolytics one hour and a half before UGIE. We compared the frequency and severity of ECG changes occurred during endoscopy. ECG recordings were made starting one hour prior to the procedure, during UGIE and within one hour after the procedure using the Holter ECG recorder. Severe arrhythmias and symptomatic ischemic attacks occurred less frequently in patients with coronary artery diseases treated with anxiolytics before UGIE (p=0.0318, 95% CI 13.224-67.253, respectively p=0.0435, 95% CI 22.224-56.253). Our study results confirm that anxiolytics administrated one hour and a half before UGIE can counteract fear and anxiety, triggers for arrhythmia and underlying ischemia, in elderly patients with heart disease.

Incidence Of Laringeal Cancer In County Hospital – Constanţa
D. Dincă, C. Aftenie

ABSTRACT. The incidence of laryngeal cancer is higher in men than in women. These cancers usually manifest themselves during the second half of life. All patients in study with larynx cancer have a history of heavy tobacco and alcohol use. Cigarette smoke, in particular, is a risk factor for cancer of the larynx. A retrospective medical record review of 14 patients all males with previously untreated laringeal cancer who were diagnosticated at Department of ENT – Head and Neck Surgery, Emergency Hospital Constanţa County, between january - october 2011, was performed.

BMI Calculator In Microsoft Excel
S. Chirilă, L.T. Hangan, L. Gurgas

ABSTRACT. Body mass index is a commonly used index to classify overweight and obesity in adults. The main objective of this study is to clarify the importance of assessing the category of weight a patient belongs to and provide the necessary tools for a fast and easy way to do that. A short review of the risks for a patient with an above to normal BMI is conducted, emphasizing on the idea that a overweight and obesity are a major risk factor for the onset and prognostic of several non-communicable diseases, with a major impact like hypertension, diabetes etc. Also a review of several studies about weight loss and health benefits is conducted. In the second part we present a simple way to build a program that will help physicians to calculate very accurately and very fast the BMI for any patient. Moreover, we intend to provide this tool as freeware software through our University site.

Clinicopathological Features In Women Diagnosed With Lung Cancer In Clinical Pneumology Hospital Of Constanţa
Ariadna Petronela Fildan, Elena Dantes, Oana Cristina Arghir, Luiza Velescu, Maria Şuţa

ABSTRACT. There are few reports witch to assess differences in clinicopathological parameters between women and men with lung cancer. This paper focuses on the demographic factors (gender, age, cigarette smoking) and factors connected with disease (histology, stage and survival) in lung cancer patients hospitalized in Clinical Pneumology Hospital of Constanta. Methods – Data were recorded on all patients with newly diagnosed lung cancer who presented at Clinical Pneumology Hospital of Constanta over a 5 years period. There were 90 women and 388 men with lung cancer. Women were older than men (67.48 versus 60.99 years; P <0.001). Age >70 years was more frequent in women than in men (35.5% versus 18%; P <0.001). Women with small-cell lung cancer (SCLC) and adenocarcinoma were significantly younger than women with squamous cancer (60.2 and 62.5 versus 68 years; P = 0.05). Also, men with adenocarcinoma and SCLC were younger than men with squamous cancer (59.6 and 60.2 versus 62.3 years; P = 0.05). Squamous cancer was the predominant type of lung cancer in men (38.1%) and adenocarcinoma (28.8%) was more frequent in women. Women were more frequently non-smokers than men (35.5% versus 3.1%; P <0.001). Adenocarcinoma patients smoked less intensively than patients with squamous and SCLC both in women (31.4 versus 35.8 and 33.7 packs/year; P <0.02) and in men (38.2 versus 42 and 41.9 packs/year; P <0.002). A significantly higher percentage of women than men with disseminated diseases was observed (20.3% versus 13.9%; P <0.001). Five years survival was higher for women than men (14.2% versus 8.9%). Lung cancer was four times more frequent in men than in women. Women with lung cancer were older than men and smoked less intensively. Over-representation of adenocarcinoma was observed in the women. Women with lung cancer had a better survival than men.

Lately And Recently Postoperative Results In Suture-Excision Of Perforated Ulcer
R. Sora, C. Lazar, I. Lupu

ABSTRACT. The study wants to show the follow up results of the teamwork composed by surgeon, gastroenterologist, endoscopist and radiologist in patients with suture-excision for perforated ulcer who recevied a postoperative treatment with proton pump inhibitors. With this treatment we try to reduce surgical reintervention in peptic ulcer disease.In modern countries who have a well established system of ensurances, the perforation in peptic ulcer disease is very rare. In Romania, this complication is still present due to the late presentation of the patient, and due to the fact that our system of ensurance doesn`t oblige the patient to do periodically investigations.

The Value Of Surgical Treatment For The Dupuytren Disease
I. C. Bratu, I. Bordeianu

ABSTRACT. We present a retrospective study concerning the surgical treatment of the Dupuytren disease, developed on the casuistry of the Reconstructive Microsurgery and Plastic Surgery Clinic of the Constanta County Emergency University Hospital during the period 2006-2010 comprising a number of 102 patients. The inclusion criteria for the group were not restrictive and all the patients hospitalized with the Dupuytren disease who received surgical treatment were included. The results of the study have shown that the disease predominantly affects males, with ages between 50-60 years old and that the surgical treatment (specifically adapted to the clinical form of the disease and related disorders) was the chosen treatment and that it was very effective according to the postoperative functional results and to the lack of relapses.

Clinical And Epidemiological Considerations About Thrombolytic Regimens Prescribed To STEMI Patients In Dobrogea Region Between 2008-2011
Merdinian Liviu, Rusali Andrei, Broască Valentin, Cojocaru Lucia, Craiu Elvira

ABSTRACT. The cardiovascular mortality and mainly the coronary heart disease remain a public health issue worldwide. Current data places Romania as a „leader” in a chart concerning the cardiovascular morbidity and mortality alongside countries from former USSR, Bulgaria, Ukrain. The study was developed in the Cardiology Clinic of the Emergency Clinical Hospital of Constanta County during January 2008 – December 2011.A number of 1320 STEMI pacients were enrolled and monitored during this period of time. 603 of these patients received thrombolytic therapy. We noticed that in the case of reteplase treted pacients the average age was the lowest (56.4 years).The thrombolytic regimens of streptokinase - 1.5 million IU of streptokinase over 1 h and 1.5 million IU of streptokinase over 1/2 h – have been administered to pacients with an average age of 60.86 and 60.73.The 750.000 IU of streptokinase over 10-15 min regimen was used in the case of patients with the highest average age of 61.36 years. Streptokinase’s most used regimen was 1.5 million IU of streptokinase over 1 h.Streptokinase’s less used regimen was 750.000 IU of streptokinase over 10-15 min, being the only regimen not specified in the ESC guidelines for STEMI treatment.

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