I. Benedek jr²., Theodora Benedek², I. Kovács², Claudia Matei¹, Monica Chitu¹, Diana Horga¹, I. A. Sârbu-Pop², Sz. Madaras², Melinda Kurtinecz¹, Zsuzsanna Suciu², I. Benedek¹

¹ Emergency County Hospital Tg Mureș, Cardiology Clinic

² Medicine and  Pharmacy University Tg Mureș, Discipline of Internal Medicine 6

Purpose: Our  study aims to evaluate the  role of Computerized 3D  Echocardiography(C3DE) in the  complex, objective assesment of

LV remodelling in postinfarction phase, based on objective parameters.

Methods: Gr.  1–28 patients with AMI  treated with primary PCI.  A subgroup(1A-9 patients) of these patients benefited of intracoro- nary  stem cell  injection. Gr.  2–26 patients with late  interventional reopening of a chronic occluded coronary artery. In all patients we performed C3DE at the  time of randomisation (baseline) and  at 6 months follow-up, with complex analysis of segmental volumes and  kinetics and  the  following indexes were  calculated for assesment of LV remodelling. Index of segmentar dilatation (ISD); Remodelling index(RI)

Results: Ejection fraction(EF) increased from  42.5% to 45.2% in group 1 compared to an increase from  41.2% to 44.3% in Group 2. At 6 months follow-up we  recorded a regression of RI in gr.1  with 32.75% for infarcted segments, and  in gr.2 a regression of 17.25% in the  infarcted segments. In the  stem cell subgroup the  regression of RI was 34.5% for infarcted segments.

Conclusions: The computerized analysis of the remodelling process shows that  regression of the remodelling process is clearly supe- rior in patients with primary PCI in both infarcted and  noninfarcted segments. Also, it proves the  role of C3DE in showing the  possible role of stem cell therapy in recovery of LV function after  AMI.

Theodora Benedek², I.A. Sârbu-Pop², Claudia Matei¹, Monica Chitu¹, I. Kovacs², Diana Horga¹, Melinda

Kurtinecz¹, Zsuzsanna Suciu², Sz. Madaras², I. Benedek¹

¹ Emergency County Hospital Tg Mureș, Cardiology Clinic

² Medicine and  Pharmacy University Tg Mureș, Discipline of Internal Medicine 6

Purpose: The  aim  of our  study was to  use  the  Computerized 3D  Echocardiography (C3DE)  in complex and  objective assesment of left atrial  (LA) remodelling extension in two different treatment strategies (rate  control versus rhythm control) in atrial  fibrillation (AF). Methods: 31  patients with AF, gr.1  – 16  pts  converted to sinus rhythm 3 months before examination, and  gr.2  – 15  pts  with no con- version to  sinus rhythm, who received medical therapy for  rate  control. In all patients we  performed a computerized analysis of  LA shape, geometry and  volumes, using an adapted Qlab software in which reference points were  identified at pulmonary vein insertions and  mitral annulus, followed by manual adjustment of LA tracing borders. A 3D spatial model of LA and  a volumetric contraction-filling curve of LA were  obtained in this  way  for  each patient. In parallel, we  performed the  standard C3DE for  assesment of left ventricular function.

Results: LA  maximum volumes were  54,5 ml  in gr.1  and  66.5 ml  in   gr  2 (p=0.02). LA  .   maximum diameters were  43 mm in gr.1  compared with 52 mm in gr.2  (p=0.02). Contraction curves of the left ventricle showed a superior ejection fraction in the rhythm control group – 54%, compared with the  rate  control group with an EF of 44% (p<0.001).

Conclusions: C3DE could represent a useful method for assesment of LA remodelling process in Atrial  fibrillation. The data obtained in our  study with this  method support the  superiority of conversion to sinus rhythm as a therapeutic option in patients with AF.

Claudia Matei¹, Theodora Benedek², Monica Chitu¹, I. Kovacs², I. A. Sârbu-Pop², Sz. Madaras², Diana

Horga¹, Melinda Kurtinecz¹, Zsuzsanna Suciu², I. Benedek¹

¹ Emergency County Hospital Tg Mureș, Cardiology Clinic

² Medicine and  Pharmacy University Tg Mureș, Discipline of Internal Medicine 6

Objective: We  wanted to evaluate left ventricular geometry, contraction synchronism and  myocardial viability, in order to identify the target area for therapeutical intervention and  to evaluate myocardial function post revascularisation.

Methods: We  evaluated 44  post myocardial infarction patients, divided into  three  groups, according to the  treatment performed. We used computerised three-dimensional echocardiography to  asess global and  segmentar ventricular function before and  after  revas- cularisation and  transplantation, and  during the  follow-up at 3 months. For  myocardial viability dobutrex test  associated with three- dimensional echocardiography analysis was performed.

Results: We obtained an improvement of ejection fraction in all groups, with better results in stem cell transplantation group. We also evaluated the  improvement of contractility index and  decrease of dys-syncronism index in all patients.

Conclusions: Computerised three-dimensional echocardiography is an objective method to evaluate the target areas for intervention in postmyocardial patients. Revascularisation of occluded arteries improves ejection fraction and  the  quality of life.

I. Benedek¹, Gabriela Kozma¹, Monica Chitu¹, I. Kovacs², A. Sârbu², Melinda Kurtinecz¹, Claudia Matei¹, Zsuzsanna Suciu², Diana Horga¹, Sz. Madaras², Theodora Benedek²

¹ Emergency County Hospital Tg Mureș, Cardiology Clinic

² Medicine and  Pharmacy University Tg Mureș, Discipline of Internal Medicine 6

Within the  cardiology community there  continues to be confusion regarding the  indications for percutaneous interventions in patients with chronic total occlusions and  skepticism with regard to  the  ultimate impact revascularization has  on patient outcomes. It is not  surprising that  most interventionists try to avoid these potentially long procedures that  can  be costly and  expose the operator to higher radiation doses; and  with success rates that  are perceived as insufficient to justify the  effort. They  present the  lowest procedural suc- cess rates, highest X-ray exposure times and  higher risks  for complications and  re-occlusion. Our  casuistry shows that  association of different techniques can  lead  to repermeabilisation of chronic total occlusion with good patency rates.

Sz. Madaras², Theodora Benedek², I. Kovacs², I. A. Sârbu-Pop², Monica Chitu¹, Melinda Kurtinecz¹, Claudia Matei¹, Zsuzsanna Suciu², Diana Horga¹, I. Benedek¹

¹ Emergency County Hospital Tg Mureș, Cardiology Clinic

² Medicine and  Pharmacy University Tg Mureș, Discipline of Internal Medicine 6

Purpose: We followed the evolution of mortality in Acute Coronary Syndromes (ACS) in a territory of 1 million  inhabitants with low-adher- ence  to European guide-lines, in a period of 5 years. During this time all the ACS cases were  included in a Regional Registry of ACS. Methods: The  registry included 13  hospitals. Data were  collected, centralized and  processed in the  Clinic of Cardiology from  Târgu Mureș. Population groups: Group 1– patients presented in territorial hospitals without percutaneous coronary intervention (PCI) facili- ties;  Group 2 – patients presented directly to the  interventional center.

Results: The  registry included a total number of  3.764 patients with ACS. The  percentage  of  reperfusion therapy in  Group 1  was

9.15% in 2004, increasing up to 17.16% in 2008. Only  0.3% of these patients were  sent for primary PCI in the  first  year, this  percent- age  increasing to  5.6% in the  last  year.  In Group 2, reperfusion therapy was possible in 99.39% of cases, consisting in primary PCI in 76.96% cases, facilitated PCI  in 15.75% cases and  thrombolysis in 6.6% cases. Mortality rates in Group1 showed a continuous decrease, from  20.77% in 2004 to 14.2% in 2008, correlated to the  increase of reperfusion therapy. In Group 2 global mortality was

6.6% for patients arrived in time for PCI,  compared with 17.65% for patients with late arrival.

Conclusions: We succeeded to decrease mortality rates in acute myocardial infarction (AMI) after  a complex educational and  organi- zational activity. Still,  the  percentage of reperfusion therapy in the  territorial hospitals remains low  in this  region with low  adherence to European guidelines, reflected in high  mortality rates.

I. A. Sârbu-Pop², Theodora Benedek², I. Kovacs², Monica Chitu¹, Melinda Kurtinecz¹, Claudia Matei¹, Zsuzsanna Suciu², Diana Horga¹, Sz. Madaras², I. Benedek¹

¹ Emergency County Hospital Tg Mureș, Cardiology Clinic

² Medicine and  Pharmacy University Tg Mureș, Discipline of Internal Medicine 6

Background: Pulmonary veins  have  been demonstrated to play  an important role in generating atrial  fibrilation. Ablation for atrial  fibril- lation has  become a widely accepted and  practiced treatment for this  arrhythmia. While  this  treatment has traditionally been reserved for second-line therapy in patients who have  failed drug therapy, ablation is now being contemplated for first-line treatment.

Material and methods: Circumferential ablation around pulmonary vein  ostia by  CARTO system was performed in 2 patients with paroxysmal atrial  fibrillation. A  3D  electroanatomic map of  the  LA  including the  PV  ostia was  constructed with a  nonfluoroscopic navigation system (Carto, Biosense Webster). Left- and  right-sided PVs  were encircled by  continuous radiofrequency ablation lines.  Ecocardiographic evaluation of the  left atrium was performed before the  procedure and  at follow-up. Follow-up was performed twice a year.

Results: Follow-up at 24 months showed the presence of sinus rithm in both patients 1 beeing without antiarrhythmics. The quality of life was improved in both patients. No complications were  noted during the procedure. At 24 months follow-up we noticed a reduction in left atrium dimension from  43mm to 39mm in one  case and  from  59mm to 56mm in the  other case. No  clinical signs of pulmonary vein  stenosis were  observed during follow up.

Conclusions: Even  if our  experience is limited our  data sugest that  pulmonary vein  isolation is an effective procedure to cure  AF and  it is reasonable that  atrial-fibrillation ablation shoud be   used as a first-line option for selected patients with this  disease.

Theodora Benedek², Claudia Matei¹, Monica Chitu¹ ,I. Kovacs², I. A. Sârbu-Pop², Diana Horga¹, Melinda

Kurtinecz¹, Zsuzsanna Suciu², Sz. Madaras², I. Benedek¹

¹ Emergency County Hospital Tg Mureș, Cardiology Clinic

² Medicine and  Pharmacy University Tg Mureș, Discipline of Internal Medicine 6

Purpose: Indication for late  reopening of coronary arteries after  Acute Myocardial Infarction (AMI) is based on identification of viable, hibernated myocardium. When standard imaging techniques like SPECT or PET  are not  available, Computerized 3D  Echocardiogra- phy  (C3DE)  associated with Dobutamine stress test  could represent an alternative  to identify areas of viable myocardium as a target area for intervention.

Methods: 11  patients with history of acute coronary syndromes: 6 cases with AMI  treated conservative for  late presentation and  5 patients with unstable angina (UA). In all cases we  performed C3DE at baseline and  after  each 3 minutes of injection of Dobutamine in doses of 5, 10,  20,  and  30  micrograms/kgc/min, and  we  obtained computerized contraction curves for each myocardial segment. Results: After injection of  Dobutamine, C3DE clearly identified the  exact localisation and  extension of  the  contraction abnormality, represented  as a spot on  the  polar map of contraction and  an averaged drop of 56% of the  maximal contraction amplitude on  the contraction curves of ischaemic segments compared with an increase of 52.3% for  nonischaemic segments (p<0.001). In post AMI patients, C3DE showed preserved myocardial viability after  injection of Dobutamine, with an increase of 35.2% of the  contraction am- plitude on the  curve of segmental contraction in infarcted segments, compared with an increase of 54% for  non-infarcted segments (p=0.02).

Conclusion: Association of C3DE with Dobutamine stress echo could represent a valuable diagnostic tool  for complex and objective assessment of myocardial ischemia and  viability.

Emese Sipos, Adriana Ciurba, Emőke Rédai, Nicoleta Todoran, Katalin Cseh

Department of Pharmaceutical Technology, University of Medicine and Pharmacy Tg. Mures, Romania

In the course of the experiments we tried to obtain a suitable composition for retard theophylline tablets. For this purpose, hydrophilic matrix tablets were prepared, using four different substances: two synthetic (Carbopol 940, Carbopol 974) and two semisynthetic macromolecules (methylcellulose and sodium carboxymethylcellulose) as matrix formers. These tablets were tested to determine mechanical strength and were submitted to the disintegration test. The dissolution test was performed for all formulations in parallel with an industrial theophyilline tablet as reference. The results show that Carbopol 940 and sodium carboxymethylcellulose in 10 % concentration can be successfully used to formulate retard theophyilline tablets.

Alina Balint1, B. Tőkés2

1 Department of Analytical Chemistry and Instrumental Analysis, Faculty of Pharmacy, University of Medicine and Pharmacy Târgu Mureș
2 Department of Physical Chemistry, Faculty of Pharmacy, University of Medicine and Pharmacy Târgu Mureș

It is known that chemical and pharmacological properties depend largely on the chemical structure of compounds involved. In this paper we propose to make a correlation between the ability to capture free radicals and chemical structure of substances that have antioxidant properties. We studied free radicals, reactive oxygen species in particular, extremely reactive, both involved in cell destruc- tion but also regulate biochemical processes at cellular level. As a source of free radicals was used Fenton reaction, to generated OH• free radical and as traps some beta adrenergic substance. The measurements were carried out with a Radiometer POL110 polaro- graph and a Brucker ER200 combined with high performance liquid chromatography and infrared spectrometry. In accordance with kinetic parameters, half-wave potential measurement, and electronic resonance spectra interpretation, we can concluded that OH• free radical attack occurs predominantly by hydroxylation of aromatic system in beta blockers molecule, but important influence has the position of grafted aromatic groups. The possible products can be separated and identified by high performance liquid chroma- tography and IR methods.

F. Berneanu, S. Popşor, Kinga-Mária Jánosi

Department of Prosthodontics and Oral Rehabilitation, Faculty of Dental Medicine, University of Medicine and Pharmacy, Târgu Mureș

Few studies have documented the impact of complete dentures on patients oral health-related quality of life.
Objectives: The purpose of this study was to investigate the relationship between gender, age, socio-economic status and denture satisfaction and oral health-related quality of life.
Method: A descriptive study was conducted with the participation of 63 patients. These patients were selected from the treated pa- tients list from our department and from private practice. All patients completed an informed consent form and were interviewed using the OHIP-EDENT (Oral Health Impact Profile for Edentulous Patients). Patients also completed a global rating of satisfaction for their maxillary and mandibular dentures respectively using a Likert scale response.
Results: 19% of the investigated population was male. Statistical analyses comparing gender, employment and education with the oral health-related quality of life demonstrated a weak relationship. However, a significant relationship was found between age and oral health-related quality of life, with patients younger than 60 years having higher impact scores in the psychological disability and social disability domains than patients older than 60 years. Patients who were dissatisfied with their maxillary and mandibular dentures scored significantly higher in all domains compared to patients who were satisfied. There was also an improvement in OHIP-EDENT scores following placement of new complete dentures.
Conclusions: This study shows that levels of denture satisfaction are significantly related to oral health-related quality of life and that new complete dentures influence the oral health-related quality of life of patients.