Archive issue

1. Echocardiographic Assessment of Postmyocardial Infarction Diastolic Dysfunction

Despina Toader(1), Rodica Musetescu(2), Ionut Donoiu(2)

Diastolic dysfunction has a major impact on the symptoms, treatment and prognosis of patients with coronary artery disease, and in systolic and diastolic heart failure, independent of the etiology. In coronary artery disease, left ventricular diastolic dysfunction is more frequent and patients with diastolic heart failure and coronary artery disease have a higher mortality than patients with isolated diastolic heart failure. Diastolic dysfunction appears early after myocardial infarction, but there is limited information related to the exact moment or to prognosis. It is believed that left ventricular dilation after the infarction contributes to the appearance of the signs and symptoms of diastolic heart failure, with increased mortality, independent of the systolic function. Echocardiography is the main non-invasive method for the assessment of diastolic function. We aim to make an up-to-date review of the echocardiographic methods and parameters of diastolic dysfunction, and of their importance in post-myocardial infarction patients.

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2. Capsule Endoscopy - Diagnostic Role in Obscure Gastrointestinal Bleeding

Vere CC, Cazacu S, Streba CT, Sima F, PArvu D, Ionescu A

Obscure gastrointestinal bleeding accounts for over 5% of the total gastrointestinal bleedings. Due to the nature of the lesions and to the fact that about 5% are located in the small bowel, it is one of the most important indications of capsule endoscopy. Capsule endoscopy is a safe, non invasive diagnostic tool, mainly used to investigate small bowel lesions. It has a very high diagnostic yield especially if the bleeding is ongoing. Several studies prove this technique to be superior to other methods for the detection of suspected lesions and the source of bleeding. Capsule endoscopy has been shown to change the outcome in patients with obscure gastrointestinal bleedings, especially if used in conjunction with double balloon enteroscopy.

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3. The Differential Diagnosis of Chronic Pancreatitis

D.I. Gheonea(1), P. Vilmann(2), A Saftoiu(1), T. Ciurea(1), D. Pirvu(1), Mihnea Ionescu(1)

BACKGROUND Chronic pancreatitis is an inflammatory disease of the pancreas with a physiopathology that is yet to be fully understood, with a multifactorial etiology, of which alcohol abuse causes the majority of cases. PATIENTS AND METHOD We included 80 patients diagnosed with chronic pancreatitis, admitted in the Gastroenterology Clinic of the University of Medicine and Pharmacy Craiova. In each patient, demographic parameters, family and personal history were recorded. All patients were initially evaluated by transabdominal ultrasound. In selected cases other imagistic methods were used: computed tomography, endoscopic ultrasound with fine needle aspiration, endoscopic retrograde cholangiopancreatography. RESULTS The mean age in the studied group ranged between 26 and 76 years with a mean age of 52.9 years. The male to female ratio was 3.6:1. The most frequent presenting symptom was abdominal pain (93.75%), followed by fatigue (70%), anorexia (50%); fewer patients presented with emesis, loss of weight, diarrhea, meteorism and flatulence. The most frequent etiologic factor of chronic pancreatitis in the studied group was alcohol abuse. Using imaging methods the following complications of chronic pancreatitis were diagnosed in the studied group: complicated or uncomplicated pseudocysts (31.57%), pancreatic cancer (18.75%), obstructive jaundice (10%), segmental portal hypertension (2.5%), and pseudoaneurysm (1.25%).CONCLUSSIONS Transabdominal ultrasound is quite accurate in diagnosing chronic pancreatitis and its morbidities and its non-invasiveness makes it the method of choice in the initial assessment of the disease. EUS has the advantage of visualizing not just the modifications of the pancreatic ducts, but also the parenchyma. Moreover, it can be used as EUS-FNA in order to increase the sensitivity of the differential diagnosis between pseudotumoral chronic pancreatitis and pancreatic cancer.

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4. Study of Cerebral Vascular Manifestations to a lot of Chronic Alcoholic People

Adriana Nicolaescu(1), Simona Gusti(2), Andritoiu A.C. (3), Aristida Georgescu(4)

The authors studied the electrical and cerebral irrigation to a lot of 41 male patients with chronic alcoholism, 25- 55 year old, using non-invasive methods: EEG and vascular Doppler ultrasound method (D). The selected patients were hospitalized for the first time and they had no clinical or biological symptoms of liver or nervous system disorders. We determined the systolic and diastolic blood pressure and the cardiac rate, in clino and ortostatism. We recorded the EEG with a Bioscript 2000. We used a echo-Doppler Aloka colour and Angio Power with a sonde of 4,5 MHz and a Siemens Sonoline versa Plus Doppler colour and Angio Power with a sonde of 7,5 MHz for registration of common carotidian D. curves. We analyzed the D. curves parameters to the studied lot and by comparison to a control lot of 40 healthy people who did not consume alcohol. We remarked a decrease of diastolic pressure and a vaso- motor tonus lability. We remarked an increase of resistance index with 17% explained by the presence of generalized and cerebral hyper tonicity. On the EEG we remarked a theta waves with 12% incidence (insignificant correlation r =0,24, with systolic speed).

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5. Considerations Regarding Therapeutic Behaviour in Candida Vaginitis

V. Gheorman, R. Pana, Anca Patrascu, Lavinia Maria Gheorman

The work draws the attention to an issue of the day regarding gynecology medical practice. There are mentioned some information items regarding candida albicans. The study refers to a group of 350 de patients with recurrent candida vaginitis. The completely different behaviour of usual antifungicals in treating this affection is presented.

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6. Direct and Indirect Signs of Imagistic Diagnosis in Prolactinomas

Simona Bondari(1), Dana-Maria Albulescu(2), Adriana Iliescu(1)

Nowadays, imagistic methods constitute a real progress in pituitary adenoma diagnosis. Computer tomography is a valuable device in appreciating both the direct and indirect signs of the imagistic diagnosis of the sellar region pathology of pituitary adenoma type. Possibility for that bony structures frequently presented in the cases of the pituitary adenoma should be correctly evaluated constitutes an important favor of that method. Also, acquisitions in a coronal plane with reconstruction in a sagittal, axial and 3D planes give that imagistic method an important play as concerning a correct diagnosis working out with consequence at implications in the subsequent therapy. The present study show the computer tomographic aspects in the prolactin secreting pituitary adenomas.

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7. Cytological Identification of the (Pre)Cancerous Cervical Lesions within a Clinically Asymptomatic Female Population

Mihaela Muntean

The study was carried out on 1637 clinically asymptomatic women who voluntarily requested the Babes - Papanicolaou cytological examination in our laboratory (throughout a two-year period: 2007 - 2008). 1470 smears presented NLIM modifications, 7 presented ASCUS, 3 - ASC-H, 119 - LSIL, 21 - HSIL, 8 SIL borderline, 6 had AGC-NOS and 3 had carcinomatose.

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8. Experimental Study Forensic and Criminology to Determine Firing Distance Away from the GSR Analysis of Specific Microscopic Colored with Rhodizonat of Na

Rata H. M.

he intention of this experiment was, if a connection can be made between the microscopic distribution of GSR at derm level and firing distance. So, we used 125 experimental shooting on pig case on which the firing distance was predetermined. After the shooting, took place the derm was cropped with the adjoining tissue and microscopic exam using a specific pigment with sodium rhodizonate. The results that have been obtained were compared with the results of another experiment published in specialty journals. From present data, as a result we notice that the analyses of histopathology entrance wounds tissue using this coloring is a very useful forensics and legal medicine solution in firing distance estimated.

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9. Immunohistochemical Evaluation of Hormone Receptors with Predictive Value in Mammary Carcinomas

Plesan D.M.(1), Claudia Valentina Georgescu(2), Stela Ciobotea(3), Nicoleta Patrana(3), Mitroi Laura(3), Plesan C.(4)

AIMS. Immunohistochemical evaluation of hormone receptors (ER, PR) and correlation of immunohistochemical and morpho-clinical data. METHOD. The study was performed on paraffin-embedded and HE stained tissues originating from 100 cases of invasive mammary carcinoma. Monoclonal antibodies anti-estrogen and anti progesterone receptors were used for the immunohistochemical study. The detection system was EnVision HRP and the visualization system was 3-3’ diaminobenzidine tetrahydrochloride (DAB). The evaluation of the result was performed using the Allred score. REZULTS. The majority of the studied cases (57%) expressed both types of hormone receptors and in 32% of the cases the hormone receptors were completely absent. The rest of the cases presented a heterogeneous phenotype: 7% presented the ER-/PR+ type and 4%, the ER+/PR- type. Compared with the classical phenotype (ER+/PR-), ER+/PR- tumors were more frequent at patients over 50 years. The tumors with ER+/PR- were larger than the ER+/PR+ and they were of the invasive ductal carcinoma type with an Allred score for ER under 6. CONCLUSION. The predictive value is amplified when the ER status is correlated with the PR status because the heterogeneous phenotypes are identified, especially the ER+/PR- phenotype which have an aggressive behavior and the lowest response to tamoxifen therapy.

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10. Possibilities of Achieving an Efficient Endodontic Treatment

Oana Diaconu, Marilena Bataiosu, Iren Moraru, Mihaela Tuculina, Lelia Gheorghita, Victoria Andrei

Aims: The study aims to emphasize the possibility of realizing a superior and yet not expensive, very accessible mechanical root canal treatment using ProTaper Manual needles. Materials and methods: The study was realized on 56 extracted teeth, most of them multi-rooted and curved and some single-rooted. The access path was created using Kerr Ni-Ti flexible needles under permanent irrigation with 2% sodium hypochlorite (NaOCl), until ISO 15 or 20 dimensions were reached; effective preparation of root canals was realized by techniques of crown-down and compensated forces when using the ProTaper Manual system. Discussions and conclusions: Preparation of root canals should confer an appropriate form to them and facilitate adequate action of irrigation and disinfection solutions in order to deeply penetrate the root canal system and to determinate its efficient filling. The design of these needles allows ideal preparation of root canals with diverse anatomical configurations. The manual use of the ProTaper system provides more predictability, high tactile control, and guarantees the achievement of a more appropriate anatomical form than any other manual steel endodontic instrument.

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11. Pseudomyxoma Peritonei

Maria Homeag(1), Viorela Enachescu(1), Luci Elena Pavel(1), B. Zaharia(2), N. Manescu(3)

The authors report a case of a 60 years old Romanian male with peritoneal pseudomyxoma that was discovered to have a primary location in the greater omentum. Pseudomyxoma peritonei arising into the greater omentum is very rare. It is an original case report and the new data represents a well-balanced summary of a timely subject, with reference to the literature. This it is a significantly advance in our understanding of a particular disease etiology. Until now, only a few primary greater omentum pseudomyxoma peritonei have been described. Clinical and pathologic findings of this case are presented and the topic of primary location in the great omentum of pseudomyxoma peritonei was reviewed. Preoperative ultrasound examination showed the presence of an “eyes of net” tumoral-mass formation, in the greater omentum, and a fluid collection was found in the abdomen (Morrison space and the pouch of Douglas). Notwithstanding, diagnosis of pseudomyxoma was preoperatively considered less probable due to the rarity of the affection and the advanced age. During laparotomy, the presence of the large mass observed at the ultrasound examination was revealed. Mucinous ascites was present with invasive mucinous implants in the peritoneum and in the greater omentum. Operation consisted in the total removal of the mass followed by evacuation of the mucinous ascites. Histological examination confirmed the clinical diagnosis of pseudomyxoma peritonei.

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12. Possible Correlation between Diabetic Retinopathy and Atherosclerosis in Type 2 Diabetes Mellitus

Tomina Popescu(1), Christina Pritulescu(1), Maria Mota(2)

Diabetes and especially type 2 diabetes is currently a global problem for public health, through the epidemic evolution that this disease gained, but especially through the macro and micro-vascular complications, diabetic retinopathy being one of the first signs of micro-vascular damage. The fact that retinal changes may be a signal for cardio vascular events is not yet clearly demonstrated and is a theme which can offer us big surprises in the future.

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13. Recently Immunization and Anesthesia of the Children

Adriana Popa, Anca Malos, Daniela Cernea

Many children presenting for medical or surgical procedures which require general anesthesia can be recently vaccinated. There is no direct evidence of any major interaction between immunization and commonly used anesthetic agents and techniques in children, but is a theoretical risk associated with anesthesia and surgery in recently immunized children. The current evidence does not provide any contraindication to the immunization of healthy children scheduled for elective surgery. Respecting a minimal delay of 2 days (inactivated vaccines) or 14-21 days ( live attenuated viral vaccines) between immunization and anesthesia may be useful to avoid the risk of misinterpretation of vaccine-driven adverse events as postoperative complications.

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