Archive issue

Current Health Sciences Journal

vol. 37 no. 1, 2011

1. Arrhythmia Risk Stratification after Myocardial Infarction


Summary Post-myocardial infarction ventricular arrhythmia and sudden cardiac death risk remain important issues in these patients. In high-risk post-myocardial infarction (MI) patients prophylactic implantable cardioverter defibrillators (ICD) may significantly improve survival. Risk stratification studies of post-MI patients will allow ICD therapy to be applied in a more cost-effective manner. We present some key features of non-invasive and invasive methods of risk assessment relevant to the assessment of the arrhythmic risk after myocardial infarction.

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2. Contributions to the Study of Depressive Phenomenon in Medical Students


Although the educational environment is unanimous recognized worldwide as having a high vulnerability to mental disorders, there is a lack of studies on a large scale concerning this matter in our professional literature. The investigation intended to prove the existence and epidemiological-clinical characterization of the depressive phenomenon in a local medicine faculty, with reference to a group of young people of similar age from non medical branches. The prospective study, compared and randomized, initiated in the Faculty of Medicine in Craiova (target group, 655 subjects), in 2008, had as control group young people of similar age belonging to the local academic and non-academic environment (310 subjects). The Zung Depression Scale (SDZ) has been used both anonymous and voluntary. At the Faculty of Medicine, the prevalence of students with scores higher than SDZ scale cutoff (i.e. ? 50) was 28,2 ± 5,5%, and the level of the control group was 18,2 ± 2,8% (chi2= 8,88, p=0,002). Female medicine students were more significantly affected than the control group (153/512 vs. 52/231 - chi2 4.33 p = 0,037). The prevalence of responders with scores SDZ ? 50 for the Medicine group showed in both genres maximum values at the extremes of educational cycle (30,7% in the 1st and 2nd years, and 31,4% in the finishing years) and a minimum in the transition period (22,2%).For the Faculty of Medicine, compared with control groups, there has been a prevalence of the scores compatible with the mild forms of depression. There have been highlighted both individual and socio professional group particularities in circulating and aggregating the depressive symptoms in variable size clusters, from those with non clinical significance to those compatible with clinical and sub-clinical depression

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3. Clinical and Morphological Aspects of Sinovitis in Early Rheumatoid Arthritis


The earliest joint changes in rheumatoid arthritis occur in the synovial membrane, leading to development of an unsuppurated proliferative synovitis. This study is based on 33 cases of early rheumatoid arthritis for which we have investigated a series of clinical and morphological parameters. For the examined cases we found that the disease incidence reached its maximum in fifth and sixth decades of life, predominantly in females, over half of cases being diagnosed in the first six months from the onset of the disease. Histopathological study of synovial membrane samples showed characteristic morphological changes but unspecific for the disease, represented by the synoviocytes proliferation, inflammatory infiltrates, fibrinoid necrosis, fibroblasts proliferation and vascular changes. Reaching composite histological score may be useful by providing some information on the severity of the disease

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4. Chronic Venous Insufficiency - Clinical-Evolutional Aspects


Chronic venous insufficiency (CVI) is one of the most common diseases in the world. CEAP classification succeeded for the first time to objective scientific bases of chronic venous insufficiency. It is still perfectible. Having as aim the identification of the clinical-evolutional aspects of the chronic venous insufficiency we have undertaken a retrospective study for a period of 6 years, from 1st January 2004 to 31st December 2009, on 864 patients hospitalised in the Dermatology Clinic of Craiova, whom indicated chronic venous insufficiency. Results. In the group of patients, prolonged standing was found in 67.8% of patients (Chart 6). Determinants of chronic venous insufficiency were: varicose disease - 582 cases; deep thrombophlebitis - 273 cases; venous dysplasia - 9 cases. Given the CEAP classification, in the group hospitalized patients, we encountered the following situation: stage C4 (pigmentation, varicose lesions, lipodermatosclerosis and white atrophy of Milian) - 42 cases; stage C5 (healed venous ulcer) - 63 cases; stage C6 (active venous ulcer) - 759 cases.

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5. Ocytocic Effect OF Angiotensin II and the Cyclic Ovarian Function - Study on Rat Myometrium


Myometrium is able to develop an intense spontaneous activity, without any external influences. However, endocrine environment can modulate, especially during pregnancy, the morphological and functional characteristics of the uterus. OBJECTIVES: The aim of this study is to quantify the impact of cyclic ovarian function on angiotensin II (AGII)-induced contraction of non-pregnant rat myometrium.  MATERIALS AND METHOD: The experiments were performed on rat uterine strips, females being previously included in three separated groups, conform on their ovarian cycle phases: estrum, diestrum and proestrum. The AGII-induced ocytocic effect was compared with the spontaneous activity, by measuring 4 parameters: a)the mean and b)the maximal amplitude of the oscillations, c)their frequency (number/10min.) and d)the area under the contraction curve, during 10 minutes. REZULTS: Spontaneous activity was characterized: 1)in estrum by: a)1,86g, b)2,17g, c)15/10min, d)239g.s.; 2)in diestrum by: a)1,63g, b)1,78g, c)11/10min, d)165g.s.; 3)in proestrum by: a)1,47g, b)1,53g, c)3/10min., d)40g.s. AGII increased the contractility (quantified through area under the curve) with: 462% in estrum, 358% in diestrum and 1.202% in proestrum. DISCUSSIONS:  Uterine spontaneous activity is maximal during estrum, this property being necessary for a rapid ascent of the sperm cells through female genital ways and for ovocytes capitation by the tubes. The minimal values were recorded in proestrum, the genital smooth muscle needing a rest period before its hyperactivity during estrum and, eventually, before a gestation. The diestrum was characterized by a medium intensity, together with a strong steadfastness of the uterine contractility. AGII-induced contractions followed very straightly the specific particularities of the spontaneous activity, excepting in proestrum, where its ocytocic effect was maximal. This last fact is the result of two phenomenon: 1)the automatic activity in  proestrum is very weak and 2)during this period only the spontaneous depolarizing mechanisms are strongly inhibited, but not the force generating systems. CONCLUSIONS: Spontaneous and AGII-induced uterine contractility are strongly dependent on cyclic ovarian secretion. Despite in humans, the rat myometrium is far more sensible to the oscillatory  hormonal plasma levels. It is no correlation between uterine contractility during different ovarian phases in human and rats, probable due to a completely different distribution and variability of the specific receptors.

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6. Primary Small Cell Carcinoma of the Esophagus: Clinico- pathological Features and Therapeutic Options


Primary esophageal small cell carcinoma (SmCC) is a rare disease with a poor prognosis despite agressive multimodality combination treatment. This article presents the case of a 76-year old women diagnosed with pimary esophageal SmCC. The diagnosis was established by upper gastrointestinal endoscopy with biopsies that confirmed an esophageal SmCC positive to synaptophysin, chromogranin, CD56, TTF-1, and cytokeratin 8/18. Further staging procedures included CT, PET and EUS, followed by combination chemotherapy and radiotherapy. Restaging was then performed, again with PET and CT of the thorax, abdomen and pelvis. This was then followed by salvage esophagectomy due to the presence of residual tumor. Surgical pathology confirmed a 3 cm SmCC, with invasion of the submucosa and lymphovascular invasion. In conclusion, the article describes the rare occurrence of esophageal SmCC, together with the algorithm of diagnosis and staging based on state-of-the-art imaging methods. This was followed by combination chemoradiotherapy and surgical esophagectomy as the standard of care in this aggressive disease.

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7. Tuberous Sclerosis Associated with Bilateral Ovarian Dermoid CystsTitle


Summary Tuberous sclerosis complex is an autosomal dominant multisystem disorder that causes tumors to form in many different organs, primarily in the brain, eyes, heart, kidney, skin and lungs. We present the case of a 24 years old woman, who fulfilled the diagnostic criteria for definite tuberous sclerosis, based on Revised Diagnostic Criteria for Tuberous Sclerosis Complex, with histologically confirmed subependymal giant cell astrocytoma, and multiple hypomelanoic macules shown on skin examination. The patient was also diagnosed with bilateral ovarian dermoid cysts which is a rare condition. To the best of our knowledge, there are not published cases of tuberous sclerosis associated with bilateral ovarian dermoid cysts

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8. Pharmacodynamic and Pharmacokinetic Interactions of Class III Antiarrhythmic Drugs


The desirable and undesirable effects of a drug are generally related to its concentration at the sites of action, which in turn is related to the amount administered (dose) and to the drug`s absorption, distribution, metabolism, and/or excretion,  and also drug–drug interactions. The class III antiarrhythmic drugs include amiodarone, sotalol, bretylium, dofetilide, ibutilide and azimilide. Class III antiarrhythmic drugs may interact with other drugs by two major processes: pharmacodynamic and pharmacokinetic interactions. In this review are described the interaction between classes III of antiarrhythmic drugs and other classes antiarrhythmics.

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9. The Triage In The Emergency Units

Luciana Rotaru

The transfer of the triage from the field to the emergency department appears as a necessity to compensate the imbalance between available resources at the moment of patient arrival to the ED and the patients needs at the same moment. The result is to "filter" the patients  trough a system to identify these who require immediate attention and high level of the medical effort; for all the rest of cases it will exist a stratification in time and resources management for each patient. The permanent changes of the acuity scales in triage lead to a better repartition of the resources and this situation leads its self to a continuous triage shifts changes.

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