MEDICAL CONNECTIONS | CONEXIUNI MEDICALE® ASSISTANT EDITORS Blaga Vasile (Electronic Version) Andó Ottó (Print Version) Oană Cristian Sever (Editorialist) Stăncioiu Tudor (Dental Medicine)
EDITOR IN CHIEF Koren Rumelia ASSISTANT EDITOR IN CHIEF Bumbuluţ Călin
EDITORIAL BOARD Bauer Adalbert (SCM Satu Mare, România) Lup Liliana (Synevo Satu Mare, România) Bidilean Nicolae (Emergency County Hospital, Kesler Gavriel (Israel) Satu Mare, România) Kiss Ladislau (Emergency County Hospital, Boros Melinda (Bucureşti, România) Satu Mare, România) Borcean Gheorghe (Caransebeş Hospital, România) Mihalca Man Sorina (Emergency County Hospital, Brândeu Ioan (Emergency County Hospital, Satu Mare, România) Satu Mare, România) Neumann Gad (Hasharon Hospital, Tel Aviv, Israel) Cârstea Constantin (CMI Braşov, România) Negru Alina (SCM Satu Mare, România) Cojocaru Manole (Titu Maiorescu University, Rath-Wolfson Lea (Hasharon Hospital, Tel Aviv, Israel) Bucureşti, România) Rădulescu Viorel (CMI Olt, România) Comăneanu Raluca Monica (Titu Maiorescu University, Roatiş Marius Dinu (Emergency County Hospital, Bucureşti, România) Satu Mare, România) Cornean-Santa Corina (Emergency County Hospital, Rusu Cristian Bogdan (Emergency County Hospital, Satu Mare, România) Satu Mare, România) Feciche Bogdan (Emergency County Hospital, Shvero Kesler Dana (Hadassa University, Jerusalem, Israel) Satu Mare, România) Trip Gheorghe (Emergency County Hospital, Grosz Gyula (SCM West Satu Mare, România) Satu Mare, România) Gruzman Carlos (Hasharon Hospital, Zilahi Karoly (SCM Praxis, Bixad, România) Tel Aviv, Israel) Zeidman Aliza (Hasharon Hospital, Tel Aviv, Israel) Horber Orsolya (SCM Praxis Bixad, România) Virag Tiberiu (CMI Satu Mare, România) EDITOR College of Physicians Satu Mare Satu Mare, 23 Eroilor Revoluţiei Pl. www.colmedsm.ro email: [email protected]
ASSOCIATED EDITOR Satu Mare Association of Family Physicians Affiliated with National Society of Family Medicine/ General Medicine Satu Mare, UK 30 Bobocului St. www.amfsm.ro, email: [email protected]
PARTNERSHIP EXTERNAL PARTNERSHIP Titu Maiorescu University, Bucharest Vasile Goldiş Hasharon Hospital, Faculty of Medicine and Dental Medicine Western University of Arad Rabin Medical Center 67A Gheorghe Petraşcu St. 94 Revolutiei Blvd., Arad, Romania Affiliated with Sackler School of Medicine, www.utm.ro, email: [email protected] www.uvvg.ro/en/, email: [email protected] Tel Aviv University, 7 Keren Kayemet St., Petah Tikva 49372, Israel www.clalit.org.il
EDITORIAL OFFICE 23 Eroilor Revoluţiei Pl., 440055, Satu Mare, Romania, Tel/Fax: 0040261-710456, 0040361-408164 http://www.conexiunimedicale.ro/ ISSN online 2068 – 8369
ISSN 1843 – 9306
Journal included in The Schedule of Medical Publications of CMR, 5 credits CMR for subscribers Indexed in Index Copernicus®, CNCS B+ Category, Code 944
Medical Connections/Conexiuni Medicale® is a trademark of College of Physicians Satu Mare and Satu Mare Association of Family Physicians Printed at TIPOOFFSET, Fabricii st, No. 93-103, Cluj Napoca, Tel.: 0040264-456071, Fax: 0040264-595711
SCIENTIFIC AND PEER REVIEW BOARD | COLECTIV ŞTIINŢIFIC ŞI DE RECENZIE Acad. Prof. Univ. as. Dr. Virgil Enătescu (Emergency County Hospital, Satu Mare, Romania) Acad. Prof. Univ. Dr. Doina Onicescu (Titu Maiorescu University, Faculty of Medicine and Dental Medicine, Bucharest, Romania) Acad. Senior Scientific Researcher Dr. Sorin Riga (Prof. Dr. Al. Obregia Clinic Hospital of Psychiatry, Bucharest, Romania) Acad. Senior Scientific Researcher Dr. Dan Riga (Prof. Dr. Al. Obregia Clinic Hospital of Psychiatry, Bucharest, Romania) Prof. Univ. Dr. Vasile Astărăstoae (Gr. T. Popa University of Medicine and Pharmacy, Iaşi, Romania) Prof. Univ. Dr. Rumelia Koren (Hasharon Hospital, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Israel) Prof. Univ. Dr. Petru Armeanu (Titu Maiorescu University, Faculty of Medicine and Dental Medicine, Bucharest, Romania) Prof. Univ. Dr. Ilie Constantin (Victor Babeş University, Faculty of Medicine, Timişoara, Romania) Prof. Univ. Dr. Gheorghe Ionel Comşa (Ovidius University, Constanţa, Romania) Prof. Univ. Dr. Constantin Dumitru (Titu Maiorescu University, Faculty of Medicine and Dental Medicine, Bucharest, Romania) Prof. Univ. Dr. Rivka Gal (Hasharon Hospital, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Israel) Prof. Univ. Dr. Doina Lucia Ghergic (Titu Maiorescu University, Faculty of Medicine and Dental Medicine, Bucharest, Romania)
Prof. Univ. Dr. Tuvia Hadar (Beilinson Hospital, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel) Prof. Univ. Dr. Gheorghe Manole (Titu Maiorescu University, Faculty of Medicine and Dental Medicine, Bucharest, Romania) Prof. Univ. Dr. Dorel Augustin Manu (Titu Maiorescu University, Faculty of Medicine and Dental Medicine, Bucharest, Romania) Prof. Univ. Dr. Dan Mănăstireanu (Titu Maiorescu University, Faculty of Medicine and Dental Medicine, Bucharest, Romania) Prof. Univ. Dr. Elena Moldoveanu (Titu Maiorescu University, Faculty of Medicine and Dental Medicine, Bucharest, Romania) Prof. Univ. Dr. Adriana Stănilă (Victor Papilian Faculty of Medicine, Sibiu, Romania) Prof. Univ. Dr. Maria Lidia Nica Udangiu (Titu Maiorescu University, Faculty of Medicine and Dental Medicine, Bucharest, Romania) Prof. Univ. Dr. Dan Florin Ungureanu (Titu Maiorescu University, Faculty of Medicine and Dental Medicine, Bucharest, Romania) Conf. Univ. Dr. Ghinescu Minerva (Titu Maiorescu University, Bucureşti, România) Conf. Univ. Dr. Mircea Sorin Sabău (University of Medicine and Pharmacy Târgu Mureş, Romania) Ş. L. Dr. Anca Ciurea (Iuliu Haţieganu University, Faculty of Medicine, Cluj Napoca, Romania) Ş. L. Dr. Virgil Radu Enătescu (Eduard Pamfil Universitary Clinic of Psychiatry, Timişoara, Romania)
The Medical Connections/Conexiuni Medicale® is indexed in Journals Master List of Index Copernicus® CNCS B+ Category, Code 944 © Copyright Medical Connections/Conexiuni Medicale, Satu Mare, 2013 No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means without prior permission in writing of Medical Connections/Conexiuni Medicale®. Permission is not however required to copy abstracts of papers or of articles on condition that a full reference to the source is shown. Correspondence regarding permission to reprint all or part of any article published in this journal should be addressed to the Editor, e-mail: [email protected]
MEDICAL CONNECTIONS | CONEXIUNI MEDICALE® EDITORI ADJUNCŢI Blaga Vasile (versiunea electronică) Andó Ottó (versiunea tipărită) Oană Cristian Sever (editorialist) Stăncioiu Tudor (Medicina Dentară) COMITET EDITORIAL Kesler Gavriel (Israel) Bauer Adalbert (SCM West Satu Mare, România) Kiss Ladislau (Spital Judeţean de Urgenţă, Bidilean Nicolae (Spital Judeţean de Urgenţă, Satu Mare, România) Satu Mare, România) Mihalca Man Sorina (Spital Judeţean de Urgenţă, Boros Melinda (Bucureşti, România) Satu Mare, România) Borcean Gheorghe (Spital Municipal Caransebeş, România) Neumann Gad (Spital Hasharon, Tel Aviv, Israel) Brândeu Ioan (Spital Judeţean de Urgenţă, Negru Alina (SCM Satu Mare, România) Satu Mare, România) Rath-Wolfson Lea (Spital Hasharon, Tel Aviv, Israel) Cârstea Constantin (CMI Braşov, România) Rădulescu Viorel (CMI Olt, România) Cojocaru Manole (Universitatea Titu Maiorescu, Roatiş Marius Dinu (Spital Judeţean de Urgenţă, Bucureşti, România) Satu Mare, România) Comăneanu Raluca Monica (Universitatea Titu Maiorescu, Rusu Cristian Bogdan (Spital Judeţean de Urgenţă, Bucureşti, România) Satu Mare, România) Cornean-Santa Corina (Spital Judeţean de Urgenţă, Shvero Kesler Dana (Universitatea Hadassa, Satu Mare, România) Ierusalim, Israel) Feciche Bogdan (Spital Judeţean de Urgenţă, Trip Gheorghe (Spital Judeţean de Urgenţă, Satu Mare, România) Satu Mare, România) Grosz Gyula (SCM West Satu Mare, România) Zilahi Karoly (SCM Praxis, Bixad, România) Gruzman Carlos (Spital Hasharon, Tel Aviv, Israel) Zeidman Aliza (Spital Hasharon, Tel Aviv, Israel) Horber Orsolya (SCM Praxis Bixad, România) Virag Tiberiu (CMI Satu Mare, România) Lup Liliana (Synevo Satu Mare, România) EDITOR ŞEF Koren Rumelia EDITOR ŞEF ADJUNCT Bumbuluţ Călin
EDITOR Colegiul Medicilor Satu Mare Satu Mare, P-ţa Eroilor Revoluţiei nr.23 www.colmedsm.ro email: [email protected]
EDITOR ASOCIAT Asociaţia Medicilor de Familie Satu Mare Afiliată la Societatea Naţională de Medicina Familiei/ Medicină Generală Satu Mare, str. Bobocului UK 30 www.amfsm.ro, email: biro[email protected]
PARTENER PARTENER EXTERN Universitatea Titu Maiorescu Bucureşti Universitatea de Vest Vasile Goldiş Hasharon Hospital, Rabin Medical Center Facultatea de Medicină şi Medicină Dentară din Arad Afiliat la Sackler School of Medicine, str. Gheorghe Petraşcu 67A 94 Revoluţiei Blvd., Arad, România Universitatea Tel Aviv www.utm.ro, email: [email protected] www.uvvg.ro/en/, email: [email protected] 7 Keren Kayemet St., Petah Tikva 49372, Israel www.clalit.org.il
REDACŢIA P-ţa Eroilor Revoluţiei nr 23, 440055, Satu Mare, Romania, Tel/Fax: 0261-710456, 0361-408164 http://www.conexiunimedicale.ro/ ISSN online 2068 – 8369
ISSN 1843 – 9306
Revistă inclusă în Nomenclatorul Publicaţiilor Medicale ale CMR, 5 credite CMR pentru abonaţi Indexare în Index Copernicus®, CNCS categoria B+, cod 944
Medical Connections/Conexiuni Medicale® este marcă înregistrată a Colegiului Medicilor Satu Mare şi a Asociaţiei Medicilor de Familie Satu Mare Tipărit la TIPOOFFSET, str. Fabricii, Nr. 93-103, Cluj Napoca, Tel.: 0040264-456071, Fax: 0040264-595711
Contents EDITORIAL ......................................................................................................................................................... 7 ORIGINAL ARTICLES Measurement of Serum Matrix Metalloproteinase-9 in Patients with Early Rheumatoid Arthritis Cojocaru Manole, Rusu Elena, Cojocaru Inimioara Mihaela, Siloși Isabela .................................................. 9 Obesity – Risk Factor in Operated Lumbar Disc Herniation Constantinescu Dan Aurelian, Sfîrlea Marius, Maghiar Adrian Marius ..................................................... 13 Anatomic Variants of Origin, Number and Course of the Renal Arteries. An Anatomical Study Stanca Vasile Dan, Precup Dorel, Popescu Andrada, Manea Cristian Nicolae, Coman Ioan ......................... 19 Apendectomy ‘Single Incision Laparoscopic Surgery’ (SILS) – Our Beginning Experience Sfîrlea Marius, Maghiar Adrian, Maghiar Teodor, Ciurtin Dan, Macovei Codruţa, Dejeu George, Borza Ciprian, Berdea Daniela, Rahotă Daniela ...................................................................................... 25 Ovarian Pathology Surgically Removed in Pregnancy. A Ten Years Retrospective Analysis Based in Histopathological Diagnosis Furău Cristian George, Ciobanu Gheorghe, Furău Gheorghe, Dașcău Voicu, Onel Cristina, Tataru Ana Liana, Stănescu Casiana ....................................................................................................... 31 GENERAL REVIEW Doxorubicin Induced Cardiomiopathy and Early Diagnostic Procedures Pușchiţă Maria, Pop-Moldovan Adina, Lala I. Radu ................................................................................ 37 Oral Mucosal Disorders Associated with Hepatitis C Virus Infection: Oral Lichen Planus Gheorghe Carmen, Mihai Lelia, Părlătescu Ioanina, Ţovaru Șerban .......................................................... 41 Transforaminal Lumbar Interbody Fusion (TLIF) – Current Concepts and Development of a New Implant to Restore Lordosis Magureanu Mihai, Vermesan Dinu, Prejbeanu Radu, Haragus Horia, Nitescu Simona, Avram Cecilia Roberta, Aiordachioae Gigi Adrian .................................................................................... 45 Methods of Care in Acute Respiratory Failure of Infant and Toddler Badiu Tișa Ioana, Nanulescu Mircea, Miu Nicolae, Samașca Gabriel, Pop Claudia, Coblisan Petronela . ..... 51 MEDICINE AND ART Chamber of Art and Curiosities from Ambras Castle Bumbuluţ Călin, Bumbuluţ Andrei, Oprea Andrea, Koren Rumelia .......................................................... 55 MEDICAL EVENT 10th Edition of Satu Mare Medical Days Bumbuluţ Călin ..................................................................................................................................... 59
GUIDANCE FOR AUTHORS ............................................................................................................................... 63
Cuprins EDITORIAL ....................................................................................................................................................... 67 ARTICOLE ORIGINALE Determinarea metaloproteinazei-9 matriceale în serul pacienţilor cu poliartrită reumatoidă la debut Cojocaru Manole, Rusu Elena, Cojocaru Inimioara Mihaela, Siloși Isabela ................................................ 69 Obezitatea – factor de risc al herniei de disc lombare operate Constantinescu Dan Aurelian, Sfîrlea Marius, Maghiar Adrian Marius ..................................................... 73 Variante anatomice de origine, număr și traseu ale arterelor renale. Un studiu anatomic Stanca Vasile Dan, Precup Dorel, Popescu Andrada, Manea Cristian Nicolae, Coman Ioan ......................... 79 Apendicectomia „Single Incision Laparoscopic Surgery” (SILS) – Experienţa noastră de început Sfîrlea Marius, Maghiar Adrian, Maghiar Teodor, Ciurtin Dan, Macovei Codruţa, Dejeu George, Borza Ciprian, Berdea Daniela, Rahotă Daniela ................................................................................................ 85 Patologia ovariană tratată chirurgical în timpul sarcinii. Analiză retrospectivă pe 10 ani bazată pe diagnoscticul histopatologic Furău Cristian George, Ciobanu Gheorghe, Furău Gheorghe, Dașcău Voicu, Onel Cristina, Tataru Ana Liana, Stănescu Casiana ....................................................................................................... 91 REVISTĂ GENERALĂ Cardiomiopatia indusă de doxorubicină și metode de detecţie precoce ale acesteia Pușchiţă Maria, Pop-Moldovan Adina, Lala I. Radu ................................................................................ 97 Afecţiuni ale mucoasei orale asociate cu infecţia cu virus hepatitic C: lichenul plan bucal Gheorghe Carmen, Mihai Lelia, Părlătescu Ioanina, Ţovaru Șerban ........................................................ 101 Fuziunea intervertebrală lombară transforaminală (TLIF) – concepte curente și dezvoltarea unui nou implant pentru restaurarea lordozei Magureanu Mihai, Vermesan Dinu, Prejbeanu Radu, Haragus Horia, Nitescu Simona, Avram Cecilia Roberta, Aiordachioae Gigi Adrian .................................................................................. 105 Metode de îngrijire în insuficienţa respiratorie acută a sugarului și copilului mic Badiu Tișa Ioana, Nanulescu Mircea, Miu Nicolae, Samașca Gabriel, Pop Claudia, Coblisan Petronela .... 111 MEDICINA ȘI ARTA Cabinetul de artă și curiozităţi de la castelul Ambras Bumbuluţ Călin, Bumbuluţ Andrei, Oprea Andrea, Koren Rumelia ........................................................ 115 EVENIMENT MEDICAL A X-a ediţie a Zilelor Medicale Sătmărene Bumbuluţ Călin ................................................................................................................................... 119
STANDARDE DE PUBLICARE ........................................................................................................................... 123
www.colmedsm.ro Colegiul Medicilor Satu Mare
Colegiul Medicilor Satu Mare este o persoană juridică autonomă, neguvernamentală, apolitică şi fără scop patrimonial. Este într-o largă accepţiune o organizaţie profesională liberală şi reuneşte peste 626 de medici. Colegiul Medicilor Satu Mare crede că poate reuşi urmând trei principii: să vorbească doar când are ceva important de spus, să nu critice până când nu are soluţii şi să nu propună decât soluţii rezultate din sfatul colectiv. Forţa Colegiului Medicilor constă în prezentarea în faţa societăţii ca o voce autentică, permanent validată, a tuturor membrilor săi.
Satu Mare College of Physicians is an autonomous legal entity, non-governamental, apolitical and non-profit. In a widley acception it is a liberal professional organization and brings together over 626 doctors. Satu Mare College of Physicians believes it can succeed by following three principles: to speak only when he has something important to say, to make no critics until he has solutions and to propose only solutions resulted from a of collective advice. The force of Physicians College consist in showing in front of the society an authentic voice, always validated, from all its members.
Eroilor Revoluţiei Pl. no.23, 440055 Satu Mare, Romania. Tel./Fax: +40-261-710456, +40-361-408164, e-mail: [email protected]
EDITORIAL
ARE YOU A GOOD DOCTOR?
Are you a good doctor? This question is more and more often asked by patients, government, health insurance houses and journalists. Compensations for damages and claims against physicians are increased worldwide. Cases, well-publicized, brought into attention of investigators current practices of various hospitals, laboratories or individual physicians. Malpractice tends to become an industry. However Romanian society does not seem willing to have a serious debate about the type of doctor that she wants and what to expect from him. The steady growth of costs in health care, but also with training of doctors’, forces us to examine these issues in order to find a solution. One way to define a good doctor presumes that he must have the skills of an applicative scientist: good clinical experience and the best scientific evidence. The good doctor must have good clinical judgment and good knowledge of the latest scientific researches, and to apply them in a creative way in the care of his patients. Another way to define a good doctor comes directly from Socratic dictum “know thyself ” and it entered in the forgotten tradition of medical school. The importance of vocation in medicine and personal qualities that it presumes - telling the truth, the open mind to doubt, research and learning from mistakes were lost, drowned in the mass of knowledge and technical skills taught in faculties. The inner life of many physicians is complicated by a struggle with conflicting information, incoherent feelings and thoughts. If this is the norm, then any opportunity to reflect on the good and the bad aspects of inner self will help doctors to become better practitioners. However the proliferation of control organizations and agencies either of the state, or of the civil society, demonstrate that professional consciousness and reflective introspection are not sufficient safeguards to define a good doctor. Perhaps rational monitoring systems are needed if we start from the premise that any doctor is fallible and could become a problem-doctor. Imagine a city of 50,000 inhabitants (the approximate number of doctors in Romania) where nobody commits any
criminal act, nobody goes crazy, nobody is deceived, no one is corrupt, no one loses his competencies and no one is abusing by his position. The city could rightfully be called Utopia! Governments in countries with more complex societies began with a generation ago to define variables related to process and outcome to prove clinical competence and markers to prove compliance with good practice guides and with operating regulations. These variables tend to become “surrogate” instrument measures for the definition of good practitioner of medicine. However the term “good doctor” can be limited only to prove competence and performance? At the end, when we attach the adjective “good” at the noun “doctor” much of its meaning is related to what we mean through a physician. And that brings us to education and training, knowledge, skills and values that we send to students and residents in college and in residency. So in case of doctors the term “good” means increasingly more to meet certain standards of competence. We can light the meaning of “good doctor” otherwise, i.e. trying to see what a “weak” doctor is. This is a doctor credited with good intentions but insufficient or inadequate in terms of knowledge and skills required in the job. In this case the weak doctor will be detected by performance monitoring medical procedures. He is essentially recoverable because once identified the “weakness” and given his good intentions, he can always be sent to a training course without being humiliated. Instead what can we say of a “bad” doctor? This is a doctor who despite higher professional knowledge and skills, is driven, at least occasionally, by the bad intentions, undesirable social values and suspect motives. The label “bad” doctor implies serious moral defects, although they can coexist with good professional aspects. So performance monitoring medical procedures is not very useful in detecting of the “bad doctor”. And to make things even more complicated, varieties of the good doctor, weak and bad can coexist in the same person, manifested at different times. This does not mean that being a good doctor is an unattainable ideal. 7
EDITORIAL
MEDICAL CONNECTIONS • NUMBER 4 (32) • DECEMBER 2013
It means instead that the purpose of medical education is to “ally” the scientist’s applied professional competence with reflective capabilities of the humanist’s. This
difficult task lies primarily at the trained doctors to be professional role model to students and residents, as a true spiritual mentor. Sever-Cristian Oană, MD
8
ORIGINAL ARTICLES
MEASUREMENT OF SERUM MATRIX METALLOPROTEINASE9 IN PATIENTS WITH EARLY RHEUMATOID ARTHRITIS Cojocaru Manole1, Rusu Elena2, Cojocaru Inimioara Mihaela3, Siloşi Isabela4 1
Department of Physiology, Dr Ion Stoia Clinical Center for Rheumatic Diseases, Faculty of Medicine, Titu Maiorescu University, Bucharest, 2Department of Biochemistry, Faculty of Dental Medicine, Titu Maiorescu University, Bucharest, 3 Gheorghe Marinescu Department of Neurology, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, 4Department of Immunology, University of Medicine and Pharmacy, Craiova, Romania Address for correspondence: Cojocaru Manole 5 Thomas Masaryk St., Sector 2, Postal Code 020983, Bucharest, Romania Email: [email protected] Received: 06.10.2013 Accepted: 25.11.2013 Med Con December 2013 Vol 8, No 4, 9-11
Abstract Background: Matrix metalloproteinases (MMP) are expressed in joint tissues of patients with rheumatoid arthritis (RA). Objectives: To analyze the level of serum matrix metalloproteinase-9 (MMP-9), its clinical significance and the role of MMP-9 in cartilage destruction in RA Materials and methods: Serum levels of MMP-9 were investigated in 90 patients with early RA (M/F 36/54), with mean of age 36.4±12.7 years (ranges from 23.4 years to 61.7 years); mean of arthritis duration 5.3±4.5 months (ranges from 3 months to 9.7 months) and 100 healthy controls (M/F 37/63) with mean of age 35.8±11.2 years (ranges from 23.4 years to 52.8 years). Serum MMP-9 was tested using by enzyme-linked immunosorbent assay (ELISA). Serum MMP-9 concentrations were expressed in ng/mL). All values reported are expressed as mean±SD. ANOVA on ranks with the Dunn correction for multiple comparisons and Mann-Whitney nonparametric tests were used to compare differences between groups. The results were statistically analyzed by Student t test and a p
EDITOR IN CHIEF Koren Rumelia ASSISTANT EDITOR IN CHIEF Bumbuluţ Călin
EDITORIAL BOARD Bauer Adalbert (SCM Satu Mare, România) Lup Liliana (Synevo Satu Mare, România) Bidilean Nicolae (Emergency County Hospital, Kesler Gavriel (Israel) Satu Mare, România) Kiss Ladislau (Emergency County Hospital, Boros Melinda (Bucureşti, România) Satu Mare, România) Borcean Gheorghe (Caransebeş Hospital, România) Mihalca Man Sorina (Emergency County Hospital, Brândeu Ioan (Emergency County Hospital, Satu Mare, România) Satu Mare, România) Neumann Gad (Hasharon Hospital, Tel Aviv, Israel) Cârstea Constantin (CMI Braşov, România) Negru Alina (SCM Satu Mare, România) Cojocaru Manole (Titu Maiorescu University, Rath-Wolfson Lea (Hasharon Hospital, Tel Aviv, Israel) Bucureşti, România) Rădulescu Viorel (CMI Olt, România) Comăneanu Raluca Monica (Titu Maiorescu University, Roatiş Marius Dinu (Emergency County Hospital, Bucureşti, România) Satu Mare, România) Cornean-Santa Corina (Emergency County Hospital, Rusu Cristian Bogdan (Emergency County Hospital, Satu Mare, România) Satu Mare, România) Feciche Bogdan (Emergency County Hospital, Shvero Kesler Dana (Hadassa University, Jerusalem, Israel) Satu Mare, România) Trip Gheorghe (Emergency County Hospital, Grosz Gyula (SCM West Satu Mare, România) Satu Mare, România) Gruzman Carlos (Hasharon Hospital, Zilahi Karoly (SCM Praxis, Bixad, România) Tel Aviv, Israel) Zeidman Aliza (Hasharon Hospital, Tel Aviv, Israel) Horber Orsolya (SCM Praxis Bixad, România) Virag Tiberiu (CMI Satu Mare, România) EDITOR College of Physicians Satu Mare Satu Mare, 23 Eroilor Revoluţiei Pl. www.colmedsm.ro email: [email protected]
ASSOCIATED EDITOR Satu Mare Association of Family Physicians Affiliated with National Society of Family Medicine/ General Medicine Satu Mare, UK 30 Bobocului St. www.amfsm.ro, email: [email protected]
PARTNERSHIP EXTERNAL PARTNERSHIP Titu Maiorescu University, Bucharest Vasile Goldiş Hasharon Hospital, Faculty of Medicine and Dental Medicine Western University of Arad Rabin Medical Center 67A Gheorghe Petraşcu St. 94 Revolutiei Blvd., Arad, Romania Affiliated with Sackler School of Medicine, www.utm.ro, email: [email protected] www.uvvg.ro/en/, email: [email protected] Tel Aviv University, 7 Keren Kayemet St., Petah Tikva 49372, Israel www.clalit.org.il
EDITORIAL OFFICE 23 Eroilor Revoluţiei Pl., 440055, Satu Mare, Romania, Tel/Fax: 0040261-710456, 0040361-408164 http://www.conexiunimedicale.ro/ ISSN online 2068 – 8369
ISSN 1843 – 9306
Journal included in The Schedule of Medical Publications of CMR, 5 credits CMR for subscribers Indexed in Index Copernicus®, CNCS B+ Category, Code 944
Medical Connections/Conexiuni Medicale® is a trademark of College of Physicians Satu Mare and Satu Mare Association of Family Physicians Printed at TIPOOFFSET, Fabricii st, No. 93-103, Cluj Napoca, Tel.: 0040264-456071, Fax: 0040264-595711
SCIENTIFIC AND PEER REVIEW BOARD | COLECTIV ŞTIINŢIFIC ŞI DE RECENZIE Acad. Prof. Univ. as. Dr. Virgil Enătescu (Emergency County Hospital, Satu Mare, Romania) Acad. Prof. Univ. Dr. Doina Onicescu (Titu Maiorescu University, Faculty of Medicine and Dental Medicine, Bucharest, Romania) Acad. Senior Scientific Researcher Dr. Sorin Riga (Prof. Dr. Al. Obregia Clinic Hospital of Psychiatry, Bucharest, Romania) Acad. Senior Scientific Researcher Dr. Dan Riga (Prof. Dr. Al. Obregia Clinic Hospital of Psychiatry, Bucharest, Romania) Prof. Univ. Dr. Vasile Astărăstoae (Gr. T. Popa University of Medicine and Pharmacy, Iaşi, Romania) Prof. Univ. Dr. Rumelia Koren (Hasharon Hospital, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Israel) Prof. Univ. Dr. Petru Armeanu (Titu Maiorescu University, Faculty of Medicine and Dental Medicine, Bucharest, Romania) Prof. Univ. Dr. Ilie Constantin (Victor Babeş University, Faculty of Medicine, Timişoara, Romania) Prof. Univ. Dr. Gheorghe Ionel Comşa (Ovidius University, Constanţa, Romania) Prof. Univ. Dr. Constantin Dumitru (Titu Maiorescu University, Faculty of Medicine and Dental Medicine, Bucharest, Romania) Prof. Univ. Dr. Rivka Gal (Hasharon Hospital, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Israel) Prof. Univ. Dr. Doina Lucia Ghergic (Titu Maiorescu University, Faculty of Medicine and Dental Medicine, Bucharest, Romania)
Prof. Univ. Dr. Tuvia Hadar (Beilinson Hospital, Rabin Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Israel) Prof. Univ. Dr. Gheorghe Manole (Titu Maiorescu University, Faculty of Medicine and Dental Medicine, Bucharest, Romania) Prof. Univ. Dr. Dorel Augustin Manu (Titu Maiorescu University, Faculty of Medicine and Dental Medicine, Bucharest, Romania) Prof. Univ. Dr. Dan Mănăstireanu (Titu Maiorescu University, Faculty of Medicine and Dental Medicine, Bucharest, Romania) Prof. Univ. Dr. Elena Moldoveanu (Titu Maiorescu University, Faculty of Medicine and Dental Medicine, Bucharest, Romania) Prof. Univ. Dr. Adriana Stănilă (Victor Papilian Faculty of Medicine, Sibiu, Romania) Prof. Univ. Dr. Maria Lidia Nica Udangiu (Titu Maiorescu University, Faculty of Medicine and Dental Medicine, Bucharest, Romania) Prof. Univ. Dr. Dan Florin Ungureanu (Titu Maiorescu University, Faculty of Medicine and Dental Medicine, Bucharest, Romania) Conf. Univ. Dr. Ghinescu Minerva (Titu Maiorescu University, Bucureşti, România) Conf. Univ. Dr. Mircea Sorin Sabău (University of Medicine and Pharmacy Târgu Mureş, Romania) Ş. L. Dr. Anca Ciurea (Iuliu Haţieganu University, Faculty of Medicine, Cluj Napoca, Romania) Ş. L. Dr. Virgil Radu Enătescu (Eduard Pamfil Universitary Clinic of Psychiatry, Timişoara, Romania)
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MEDICAL CONNECTIONS | CONEXIUNI MEDICALE® EDITORI ADJUNCŢI Blaga Vasile (versiunea electronică) Andó Ottó (versiunea tipărită) Oană Cristian Sever (editorialist) Stăncioiu Tudor (Medicina Dentară) COMITET EDITORIAL Kesler Gavriel (Israel) Bauer Adalbert (SCM West Satu Mare, România) Kiss Ladislau (Spital Judeţean de Urgenţă, Bidilean Nicolae (Spital Judeţean de Urgenţă, Satu Mare, România) Satu Mare, România) Mihalca Man Sorina (Spital Judeţean de Urgenţă, Boros Melinda (Bucureşti, România) Satu Mare, România) Borcean Gheorghe (Spital Municipal Caransebeş, România) Neumann Gad (Spital Hasharon, Tel Aviv, Israel) Brândeu Ioan (Spital Judeţean de Urgenţă, Negru Alina (SCM Satu Mare, România) Satu Mare, România) Rath-Wolfson Lea (Spital Hasharon, Tel Aviv, Israel) Cârstea Constantin (CMI Braşov, România) Rădulescu Viorel (CMI Olt, România) Cojocaru Manole (Universitatea Titu Maiorescu, Roatiş Marius Dinu (Spital Judeţean de Urgenţă, Bucureşti, România) Satu Mare, România) Comăneanu Raluca Monica (Universitatea Titu Maiorescu, Rusu Cristian Bogdan (Spital Judeţean de Urgenţă, Bucureşti, România) Satu Mare, România) Cornean-Santa Corina (Spital Judeţean de Urgenţă, Shvero Kesler Dana (Universitatea Hadassa, Satu Mare, România) Ierusalim, Israel) Feciche Bogdan (Spital Judeţean de Urgenţă, Trip Gheorghe (Spital Judeţean de Urgenţă, Satu Mare, România) Satu Mare, România) Grosz Gyula (SCM West Satu Mare, România) Zilahi Karoly (SCM Praxis, Bixad, România) Gruzman Carlos (Spital Hasharon, Tel Aviv, Israel) Zeidman Aliza (Spital Hasharon, Tel Aviv, Israel) Horber Orsolya (SCM Praxis Bixad, România) Virag Tiberiu (CMI Satu Mare, România) Lup Liliana (Synevo Satu Mare, România) EDITOR ŞEF Koren Rumelia EDITOR ŞEF ADJUNCT Bumbuluţ Călin
EDITOR Colegiul Medicilor Satu Mare Satu Mare, P-ţa Eroilor Revoluţiei nr.23 www.colmedsm.ro email: [email protected]
EDITOR ASOCIAT Asociaţia Medicilor de Familie Satu Mare Afiliată la Societatea Naţională de Medicina Familiei/ Medicină Generală Satu Mare, str. Bobocului UK 30 www.amfsm.ro, email: biro[email protected]
PARTENER PARTENER EXTERN Universitatea Titu Maiorescu Bucureşti Universitatea de Vest Vasile Goldiş Hasharon Hospital, Rabin Medical Center Facultatea de Medicină şi Medicină Dentară din Arad Afiliat la Sackler School of Medicine, str. Gheorghe Petraşcu 67A 94 Revoluţiei Blvd., Arad, România Universitatea Tel Aviv www.utm.ro, email: [email protected] www.uvvg.ro/en/, email: [email protected] 7 Keren Kayemet St., Petah Tikva 49372, Israel www.clalit.org.il
REDACŢIA P-ţa Eroilor Revoluţiei nr 23, 440055, Satu Mare, Romania, Tel/Fax: 0261-710456, 0361-408164 http://www.conexiunimedicale.ro/ ISSN online 2068 – 8369
ISSN 1843 – 9306
Revistă inclusă în Nomenclatorul Publicaţiilor Medicale ale CMR, 5 credite CMR pentru abonaţi Indexare în Index Copernicus®, CNCS categoria B+, cod 944
Medical Connections/Conexiuni Medicale® este marcă înregistrată a Colegiului Medicilor Satu Mare şi a Asociaţiei Medicilor de Familie Satu Mare Tipărit la TIPOOFFSET, str. Fabricii, Nr. 93-103, Cluj Napoca, Tel.: 0040264-456071, Fax: 0040264-595711
Contents EDITORIAL ......................................................................................................................................................... 7 ORIGINAL ARTICLES Measurement of Serum Matrix Metalloproteinase-9 in Patients with Early Rheumatoid Arthritis Cojocaru Manole, Rusu Elena, Cojocaru Inimioara Mihaela, Siloși Isabela .................................................. 9 Obesity – Risk Factor in Operated Lumbar Disc Herniation Constantinescu Dan Aurelian, Sfîrlea Marius, Maghiar Adrian Marius ..................................................... 13 Anatomic Variants of Origin, Number and Course of the Renal Arteries. An Anatomical Study Stanca Vasile Dan, Precup Dorel, Popescu Andrada, Manea Cristian Nicolae, Coman Ioan ......................... 19 Apendectomy ‘Single Incision Laparoscopic Surgery’ (SILS) – Our Beginning Experience Sfîrlea Marius, Maghiar Adrian, Maghiar Teodor, Ciurtin Dan, Macovei Codruţa, Dejeu George, Borza Ciprian, Berdea Daniela, Rahotă Daniela ...................................................................................... 25 Ovarian Pathology Surgically Removed in Pregnancy. A Ten Years Retrospective Analysis Based in Histopathological Diagnosis Furău Cristian George, Ciobanu Gheorghe, Furău Gheorghe, Dașcău Voicu, Onel Cristina, Tataru Ana Liana, Stănescu Casiana ....................................................................................................... 31 GENERAL REVIEW Doxorubicin Induced Cardiomiopathy and Early Diagnostic Procedures Pușchiţă Maria, Pop-Moldovan Adina, Lala I. Radu ................................................................................ 37 Oral Mucosal Disorders Associated with Hepatitis C Virus Infection: Oral Lichen Planus Gheorghe Carmen, Mihai Lelia, Părlătescu Ioanina, Ţovaru Șerban .......................................................... 41 Transforaminal Lumbar Interbody Fusion (TLIF) – Current Concepts and Development of a New Implant to Restore Lordosis Magureanu Mihai, Vermesan Dinu, Prejbeanu Radu, Haragus Horia, Nitescu Simona, Avram Cecilia Roberta, Aiordachioae Gigi Adrian .................................................................................... 45 Methods of Care in Acute Respiratory Failure of Infant and Toddler Badiu Tișa Ioana, Nanulescu Mircea, Miu Nicolae, Samașca Gabriel, Pop Claudia, Coblisan Petronela . ..... 51 MEDICINE AND ART Chamber of Art and Curiosities from Ambras Castle Bumbuluţ Călin, Bumbuluţ Andrei, Oprea Andrea, Koren Rumelia .......................................................... 55 MEDICAL EVENT 10th Edition of Satu Mare Medical Days Bumbuluţ Călin ..................................................................................................................................... 59
GUIDANCE FOR AUTHORS ............................................................................................................................... 63
Cuprins EDITORIAL ....................................................................................................................................................... 67 ARTICOLE ORIGINALE Determinarea metaloproteinazei-9 matriceale în serul pacienţilor cu poliartrită reumatoidă la debut Cojocaru Manole, Rusu Elena, Cojocaru Inimioara Mihaela, Siloși Isabela ................................................ 69 Obezitatea – factor de risc al herniei de disc lombare operate Constantinescu Dan Aurelian, Sfîrlea Marius, Maghiar Adrian Marius ..................................................... 73 Variante anatomice de origine, număr și traseu ale arterelor renale. Un studiu anatomic Stanca Vasile Dan, Precup Dorel, Popescu Andrada, Manea Cristian Nicolae, Coman Ioan ......................... 79 Apendicectomia „Single Incision Laparoscopic Surgery” (SILS) – Experienţa noastră de început Sfîrlea Marius, Maghiar Adrian, Maghiar Teodor, Ciurtin Dan, Macovei Codruţa, Dejeu George, Borza Ciprian, Berdea Daniela, Rahotă Daniela ................................................................................................ 85 Patologia ovariană tratată chirurgical în timpul sarcinii. Analiză retrospectivă pe 10 ani bazată pe diagnoscticul histopatologic Furău Cristian George, Ciobanu Gheorghe, Furău Gheorghe, Dașcău Voicu, Onel Cristina, Tataru Ana Liana, Stănescu Casiana ....................................................................................................... 91 REVISTĂ GENERALĂ Cardiomiopatia indusă de doxorubicină și metode de detecţie precoce ale acesteia Pușchiţă Maria, Pop-Moldovan Adina, Lala I. Radu ................................................................................ 97 Afecţiuni ale mucoasei orale asociate cu infecţia cu virus hepatitic C: lichenul plan bucal Gheorghe Carmen, Mihai Lelia, Părlătescu Ioanina, Ţovaru Șerban ........................................................ 101 Fuziunea intervertebrală lombară transforaminală (TLIF) – concepte curente și dezvoltarea unui nou implant pentru restaurarea lordozei Magureanu Mihai, Vermesan Dinu, Prejbeanu Radu, Haragus Horia, Nitescu Simona, Avram Cecilia Roberta, Aiordachioae Gigi Adrian .................................................................................. 105 Metode de îngrijire în insuficienţa respiratorie acută a sugarului și copilului mic Badiu Tișa Ioana, Nanulescu Mircea, Miu Nicolae, Samașca Gabriel, Pop Claudia, Coblisan Petronela .... 111 MEDICINA ȘI ARTA Cabinetul de artă și curiozităţi de la castelul Ambras Bumbuluţ Călin, Bumbuluţ Andrei, Oprea Andrea, Koren Rumelia ........................................................ 115 EVENIMENT MEDICAL A X-a ediţie a Zilelor Medicale Sătmărene Bumbuluţ Călin ................................................................................................................................... 119
STANDARDE DE PUBLICARE ........................................................................................................................... 123
www.colmedsm.ro Colegiul Medicilor Satu Mare
Colegiul Medicilor Satu Mare este o persoană juridică autonomă, neguvernamentală, apolitică şi fără scop patrimonial. Este într-o largă accepţiune o organizaţie profesională liberală şi reuneşte peste 626 de medici. Colegiul Medicilor Satu Mare crede că poate reuşi urmând trei principii: să vorbească doar când are ceva important de spus, să nu critice până când nu are soluţii şi să nu propună decât soluţii rezultate din sfatul colectiv. Forţa Colegiului Medicilor constă în prezentarea în faţa societăţii ca o voce autentică, permanent validată, a tuturor membrilor săi.
Satu Mare College of Physicians is an autonomous legal entity, non-governamental, apolitical and non-profit. In a widley acception it is a liberal professional organization and brings together over 626 doctors. Satu Mare College of Physicians believes it can succeed by following three principles: to speak only when he has something important to say, to make no critics until he has solutions and to propose only solutions resulted from a of collective advice. The force of Physicians College consist in showing in front of the society an authentic voice, always validated, from all its members.
Eroilor Revoluţiei Pl. no.23, 440055 Satu Mare, Romania. Tel./Fax: +40-261-710456, +40-361-408164, e-mail: [email protected]
EDITORIAL
ARE YOU A GOOD DOCTOR?
Are you a good doctor? This question is more and more often asked by patients, government, health insurance houses and journalists. Compensations for damages and claims against physicians are increased worldwide. Cases, well-publicized, brought into attention of investigators current practices of various hospitals, laboratories or individual physicians. Malpractice tends to become an industry. However Romanian society does not seem willing to have a serious debate about the type of doctor that she wants and what to expect from him. The steady growth of costs in health care, but also with training of doctors’, forces us to examine these issues in order to find a solution. One way to define a good doctor presumes that he must have the skills of an applicative scientist: good clinical experience and the best scientific evidence. The good doctor must have good clinical judgment and good knowledge of the latest scientific researches, and to apply them in a creative way in the care of his patients. Another way to define a good doctor comes directly from Socratic dictum “know thyself ” and it entered in the forgotten tradition of medical school. The importance of vocation in medicine and personal qualities that it presumes - telling the truth, the open mind to doubt, research and learning from mistakes were lost, drowned in the mass of knowledge and technical skills taught in faculties. The inner life of many physicians is complicated by a struggle with conflicting information, incoherent feelings and thoughts. If this is the norm, then any opportunity to reflect on the good and the bad aspects of inner self will help doctors to become better practitioners. However the proliferation of control organizations and agencies either of the state, or of the civil society, demonstrate that professional consciousness and reflective introspection are not sufficient safeguards to define a good doctor. Perhaps rational monitoring systems are needed if we start from the premise that any doctor is fallible and could become a problem-doctor. Imagine a city of 50,000 inhabitants (the approximate number of doctors in Romania) where nobody commits any
criminal act, nobody goes crazy, nobody is deceived, no one is corrupt, no one loses his competencies and no one is abusing by his position. The city could rightfully be called Utopia! Governments in countries with more complex societies began with a generation ago to define variables related to process and outcome to prove clinical competence and markers to prove compliance with good practice guides and with operating regulations. These variables tend to become “surrogate” instrument measures for the definition of good practitioner of medicine. However the term “good doctor” can be limited only to prove competence and performance? At the end, when we attach the adjective “good” at the noun “doctor” much of its meaning is related to what we mean through a physician. And that brings us to education and training, knowledge, skills and values that we send to students and residents in college and in residency. So in case of doctors the term “good” means increasingly more to meet certain standards of competence. We can light the meaning of “good doctor” otherwise, i.e. trying to see what a “weak” doctor is. This is a doctor credited with good intentions but insufficient or inadequate in terms of knowledge and skills required in the job. In this case the weak doctor will be detected by performance monitoring medical procedures. He is essentially recoverable because once identified the “weakness” and given his good intentions, he can always be sent to a training course without being humiliated. Instead what can we say of a “bad” doctor? This is a doctor who despite higher professional knowledge and skills, is driven, at least occasionally, by the bad intentions, undesirable social values and suspect motives. The label “bad” doctor implies serious moral defects, although they can coexist with good professional aspects. So performance monitoring medical procedures is not very useful in detecting of the “bad doctor”. And to make things even more complicated, varieties of the good doctor, weak and bad can coexist in the same person, manifested at different times. This does not mean that being a good doctor is an unattainable ideal. 7
EDITORIAL
MEDICAL CONNECTIONS • NUMBER 4 (32) • DECEMBER 2013
It means instead that the purpose of medical education is to “ally” the scientist’s applied professional competence with reflective capabilities of the humanist’s. This
difficult task lies primarily at the trained doctors to be professional role model to students and residents, as a true spiritual mentor. Sever-Cristian Oană, MD
8
ORIGINAL ARTICLES
MEASUREMENT OF SERUM MATRIX METALLOPROTEINASE9 IN PATIENTS WITH EARLY RHEUMATOID ARTHRITIS Cojocaru Manole1, Rusu Elena2, Cojocaru Inimioara Mihaela3, Siloşi Isabela4 1
Department of Physiology, Dr Ion Stoia Clinical Center for Rheumatic Diseases, Faculty of Medicine, Titu Maiorescu University, Bucharest, 2Department of Biochemistry, Faculty of Dental Medicine, Titu Maiorescu University, Bucharest, 3 Gheorghe Marinescu Department of Neurology, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, 4Department of Immunology, University of Medicine and Pharmacy, Craiova, Romania Address for correspondence: Cojocaru Manole 5 Thomas Masaryk St., Sector 2, Postal Code 020983, Bucharest, Romania Email: [email protected] Received: 06.10.2013 Accepted: 25.11.2013 Med Con December 2013 Vol 8, No 4, 9-11
Abstract Background: Matrix metalloproteinases (MMP) are expressed in joint tissues of patients with rheumatoid arthritis (RA). Objectives: To analyze the level of serum matrix metalloproteinase-9 (MMP-9), its clinical significance and the role of MMP-9 in cartilage destruction in RA Materials and methods: Serum levels of MMP-9 were investigated in 90 patients with early RA (M/F 36/54), with mean of age 36.4±12.7 years (ranges from 23.4 years to 61.7 years); mean of arthritis duration 5.3±4.5 months (ranges from 3 months to 9.7 months) and 100 healthy controls (M/F 37/63) with mean of age 35.8±11.2 years (ranges from 23.4 years to 52.8 years). Serum MMP-9 was tested using by enzyme-linked immunosorbent assay (ELISA). Serum MMP-9 concentrations were expressed in ng/mL). All values reported are expressed as mean±SD. ANOVA on ranks with the Dunn correction for multiple comparisons and Mann-Whitney nonparametric tests were used to compare differences between groups. The results were statistically analyzed by Student t test and a p
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