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

Over  the  course of   the  last  decade , in comparing the  first  set  of  TransAtlantic Inter- Society Consensus (TASC)  guidelines to  the second there  was significant movement toward expanded management of  a variety of  peripheral disease morphologies—including occlusions—using endovascular techniques. With  recent advances in technology many  endovascular specialists routinely consider minimally invasive options for  TASC C  and  TASC D lesions as  well.This  minimally invasive procedure carries a lower morbidity and  mortality and  shorter hospital stay  compared with surgery and  should be the  first  treatment option in all patients who would otherwise be offered bypass surgery or amputation, as failure  rarely precludes surgery. When antegrade recanalization fails or is not  feasible other approaches to  endovascular  recanalization can  be  explored. In this  article we  describe three  cases of  successful recanalisation of complex lesions involving total occlusions of the distal aorta, iliac arteries or infrainguinal vessels via retrograde arterial access through popliteal or posterior tibial  arteries, alone or in combination with other vascular approaches in patients without other revascularization alternatives or with high  surgical risk.

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Anca Bacârea1, Bogdana Dorcioman2, I. Macarie3, V. Bacârea2,4, Minodora Dobreanu1

1 University of Medicine and Pharmacy Tărgu-Mureș – Clinical Laboratory
2 Emergency Clinical Hospital Mureș
3 University of Medicine and Pharmacy Târgu-Mureș, Mureș – Medical Clinic I
4 University of Medicine and Pharmacy Târgu-Mureș, Mureș – Medical Research Methodology

Aim: Our aim is to present a case report in which immunophenotyping allowed us to establish the diagnosis and follow up the disease. Material and methods: We present the case of a 50 year old female, without significant medical history, with alteration of general state of health, fatigability. Cell blood count showed: leukocyte number = 1090/microL, thrombocyte number = 160000/microL, Hb =
11,3 g/dl, Hct = 33,6 %. Morphologic examination of bone marrow indicated the presence of 52% atypical cells, possible blast cells, with Auer roads and some cells with monoblastic morphology. Peroxidase reaction of blast cells was 65% positive.
Results: Diagnosis of acute myeloid leukemia was confirmed by immunophenotyping: a population with dim expression of CD45 which expressed the phenotype CD34+, HLA-DR+, CD13+, CD33+, CD117+, CD36+, CD11c+. The diagnosis was AML, with cor- respondent FAB M4. We repeated immunophenotyping to confirm remission.
Conclusions: We acquired 100000 events and the evidence of only 3% mieloblasts and high cellular bone marrow with signs of normal differentiation, allowed us to confirm the remission.

Zsuzsanna Incze-Bartha, O. Nagy, Ilona László, A. Kovács, S. Incze-Bartha

University of Medicine and  Pharmacy Tg.  Mureș, Clinics of Orthopedics and  Traumathology

The  surgical management of patients with neglected developmental dysplasia of the hip (DDH)  after  the age  of 6 has been the subject of controversy. We  present 1 case of neglected hip  dislocation that  was treated one-stage hip reconstruction (open reduction, pelvic osteotomy and  derotational subtrochanteric osteotomy). Patient 12 years of age. Pre-  and  postoperative with the help  of CT slides we reconstructed the hip in 3D,  and  calculated the achieved contact area between the two bones. The results have  been very good. With one-stage osteotomy from  high  dislocation of the hip we  created an almost normal hip  articulation. Our  conclusion is that  neglected DDH cases, after  8 years old  should be considered for complex surgical treatment, instead of leaving the  patient untreated, until  they  need a total hip replacement.

Ionela Genes¹, Ghe. Mühlfay¹, Lucia Muică¹, Beáta Ágota Baróti², Paula Morar², Liliana Nemeş², D. Popa³, Ramona Teodora Cătană⁴, Vasilica Lăcrămioara Ciomârtan⁵

¹ ENT  Department, ENT  Clinic, Emergency County Hospital, Târgu Mureș

² Radiology and  Medical Imaging Clinic, Emergency County Hospital, Târgu Mureș

³ Anatomy Department, Faculty of Medicine, University of Medicine and Pharmacy, Târgu Mureș

⁴ Endocrinology Department, Emergency County Hospital, Târgu Mureș

⁵ National Institute of Statistics, Statistical Direction of Bacău

Diffuse, large  B-cell lymphoma is the  most common non-Hodgkin’s lymphoma subtype. The  authors present the  clinical case of  a young patient diagnosed with primary diffuse large  B-cell lymphoma originating in  the  left  palatine  tonsil. The  particularities of  this case are the  young age  of the  patient, the  unusual onset of the  disease, late diagnosis and  rapid development with severe respiratory distress which required emergency tracheotomy. After obtaining the pathology result and  receiving a proper treatment, the  patient’s evolution was favourable.

Emilia Olar1, A. Boțianu2, A. Dobrică2, P. Boțianu2

1 Respiratory medicine departament, Municipal Hospital, Luduș
2 Surgical Clinic II, Faculty of Medicine, University of Medicine and Pharmacy, Târgu Mureș

We present the case of an 18-year-old female patient with complicated appendectomy, who developed postoperative stercoral fistula with generalised peritonitis, right pulmonary abscess and bilateral empyema. She was referred to Surgical Clinic II, 7 days after sur- gery with respiratory failure and sepsis. In first stage a median laparatomy was performed finding a large lession on the last ileal loop with multiple intraabdominal abscesses solved by debridement and two layers suture, evacuation of abscesses, toilette and multiple drainages. Two weeks after, an one-stage bilateral thoracotomy was performed: on the righ side for multiloculated empyema through intrapleural rupture of a right interhepato-phrenic abscess with extended diaphragmatic necrosis, communicating with the left pleural space, middle lobe and basal pyramide abscesses solved by Frazer Gurd decortication, evacuation of subdiaphragmatic abscess, applasitation-plication of the basal pyramide abscess and of the middle lobe abscess, plombage with Tachosil, closure of diaphragm; on the left side a multiloculated empyema was found solved by Frazer Gurd decortication. On the right side the patient has developed an apical and paramediastinal residual cavity solved by a thoracopleuroplasty on 6 ribs, muscular plombage with serratus anterior and two intercostal flaps. The patient was discharge after 85 days of hospitalisation. This case is interesting due to major abdominal and thoracic complications after appendectomy and transdiaphragmatic passage of contrast fluid in right pleural space because of large area of diaphragmatic necrosis to where it passed on left pleural space through mediastinal necrosis.

Raluca Marian¹, Manuela Cucerea², Simon Marta², Anca Sin¹, Monika Rusneac³

¹University of  Medicine and   Pharmacy Tg.  Mureș, Celular And Molecular Biology

²University of  Medicine and   Pharmacy Tg.  Mureș, Regional Neonatal Intensive Care  Unit  Tg.  Mureș

³ Regional Neonatal Intensive Care  Unit Tg.  Mureș

Introduction: The  trisomy of chromosome 13  is the  most severe of the  autosomal trisomies with an incidence of 1:5000 births. Ele- ments of diagnosis are: cranial and  central nervous system (CNS)  malformations, ocular, skeletal, heart and genital defects.  Mortality is high  especially in the  first  months of life.

Material and methods: the  authors describe 5 clinical cases of trisomy 13  (3 males, 2 females) diagnosed in Mureș Regional Inten- sive  Care  Unit  between January 2006-December 2009.

Results: Four  cases were  born prematurely. Heart malformations were  described in 100% of patients: 1 case of Fallot Pentalogy, 2 cases of double outlet right ventricle (one  with single atrium and  one  with pulmonary hypoplasia) and  2 cases with atrial  sept defect, ventricular sept defect and  persistent ductus arteriosus. All cases had  central nervous system malformations: 4 cases with agenesis of corpus callosum and  one  case with semilobar holoprosencephaly. Other findings: bilateral cleft  lip and  palate – 2 cases, microphthal- mia  - 3 cases, anophthalmia – 1,  umbilical hernia – 3 cases, aplasia cutis – 3 cases, polidactily – 2 cases, cryptorchidism 2 cases, hydronephrosis 2  cases, duodenal stenosis – 1  case. Of  the  5  cases described, 4  died within 2  months of  life.  The  diagnosis was confirmed by karyotyping: 47,  XY +13 or 47,  XX+13.

Conclusions: due  to severe defects and  high  mortality, prenatal diagnosis is extremely important; the opinion of the authors is that  no medical or surgical manoevers should be performed to support or prolong the  life of children with proven trisomy 13  syndrome.

Mariana Cojocaru

“Carol Davila” University of Medicine and  Pharmacy, Bucharest, Romania

Background: Autism is  one  of  the  most common neurodevelopment disorder  characterized by  deficiencies in  social  interactions and  communication skills, as well  as repetitive and  stereotyped patterns of behavior. Recent epidemiological data show that  autism is observed in 1 child in 300. In 10-25% of the  cases, autism is linked to chromosomal abnormalities. Twin studies help  to identify the relative contributions of genetic liability and  environmental risk  factors for autism.
Case presentation: A pair  of  4-year-old twin boys was investigated. One  twin was early  diagnosed as  autistic  disorder based on the  language delay. Chromosome analysis in cultured peripheral blood lymphocytes from  parents and twins was performed following standard protocols. The  twin zygosity was determined according to blood test: ABO blood type system, Rh blood group system and  HLA  haplotype. There  was no family history of autism.
Conclusion: Our  patient appeared to be a sporadic case of autism. In the  future, the  patient will require molecular genetic testing for confirming the  diagnosis, long-term follow-up and  treatment of manifestations if necessary.

Phenotypic expression at the time of first presentation and also in the evolution of autosomal dominant polycystic kidney disease may differ considerably among patients who belong to the same families.
The paper presents four member of the same family with autosomal dominant polycystic kidney disease. The ages at onset of first symptoms, the type of first symptoms, the progression to end stage kidney disease were very different between family members.
Moreover, two cases were misdiagnosed until end stage renal disease was confirmed.
In the paper, a brief discussion about the clinical manifestations of autosomal dominant polycystic kidney disease and about the differential diagnosis of renal cysts is provided.

Carmen Caldararu, G. Dogaru, Mirela Gliga

INTRODUCTION: Surgery procedure applatissation-plication in the treatment of pulmonary abscesses is highly recommended on patients with critical state which do not tolerate a major lung resection. MATERIAL AND METHOD: We present a 35 old patient, treated conservative for 2 months for purulent cough, thoracic pain, fever (left pneumonia). In evolution she developed a left giant pulmonary abscess and she is admitted to our Clinic for surgical treatment. We performed abscess sequential applatisation-plication, Botianu procedure, without direct closure of the bronchial fistulae.  RESULTS: Postoperative evolution was uneventful with complete symptoms resolution and with general state improvement.  CONCLUSIONS: Without extensive pulmonary resection the anesthetically and surgical risks are reduce, this procedure being in concordance with principles of modern thoracic surgery: respect for the pulmonary parenchyma.

Alexandra Butiurca, A. Boţianu, P. Boţianu, A. Dobrică, Iringó Kézdi, V. Damian, L. Gyorbiro

Mónika Szilveszter, I. Szmolka, Z. Pap

Poland’s syndrome is a rare congenital malformation, characterized by three permanent unilateral deformity: simple syndactyly located on the 2.-3rd fingers on hypoplastic hand, brachydactyly and ipsilateral aplasia of pectoralis major muscle. They were described in some cases as chromosomal anomaly and immunological deficiency, so it might be associated with hematological malignancy as well. Based on such a case admitted to the Sfantu Gheorghe County Hospital, the authors’ purpose is to present this condition and also to make some considerations on particular aspects of the hospitalized case.