Import of malaria in a Romanian Western County

BACKGROUND: Malaria is not a serious concern in Romania nowadays although 30-60 imported cases are diagnosed yearly, especially in travellers from Africa. Timis, the most extensive of the Romanian counties, is the western gate of the country from where a lot of people travel abroad. The aim of this study is to overview all the imported cases of malaria diagnosed in our county and to describe two recent severe cases. METHODS: We retrospectively analyzed both the medical records of 28 malaria patients treated between 1974 and 2007 at Victor Babes Hospital of Infectious Disease from Timisoara, Romania, and the results of 6 blood examinations performed in the last decade in the parasitological laboratory of Victor Babes University of Medicine and Pharmacy from Timisoara. A comparison between the two recent severe cases was made, emphasizing on the clinical aspects, complications and the laboratory test results. RESULTS: Most of the patients (55.38%) were in the age group of 20-29 years; 85.71% of the patients were males; Plasmodium falciparum was found in 75% of the cases. CONCLUSIONS: Findings of our study have shown that P. falciparum is the main malaria species in Timis County, outlining the difficulties in the diagnosis and management of the imported cases.     

Improved bowel preparation increases polyp detection and unmasks significant polyp miss rate

AIM: To retrospectively compare previous-day vs splitdose preparation in terms of bowel cleanliness and polyp detection in patients referred for polypectomy. METHODS: Fifty patients underwent two colonoscopies: one diagnostic in a private clinic and a second for polypectomy in a University Hospital. The latter procedures were performed within 12 wk of the index ones. Examinations were accomplished by two experienced endoscopists, different in each facility. Twenty-seven patients underwent screening/surveillance colonoscopy, while the rest were symptomatic. Previous day bowel preparation was utilized initially and splitdose for polypectomy. Colon cleansing was evaluated using the Aronchick scale. We measured the number of detected polyps, and the polyp miss rates per-polyp.RESULTS: Excellent/good preparation was reported in 38 cases with previous-day preparation(76%) vs 46 with split-dose(92%), respectively(P = 0.03). One hundred and twenty-six polyps were detected initially and 169 subsequently(P 0.0001); 88 vs 126 polyps were diminutive(P 0.0001), 25 vs 29 small(P = 0.048) and 13 vs 14 equal or larger than 10 mm. The miss rates for total, diminutive, small and large polyps were 25.4%, 30.1%, 13.7% and 6.6%, respectively. Multivariate analysis revealed that split-dose preparation was significantly associated(OR, P) with increased number of polyps detected overall(0.869, P 0.001), in the right(0.418, P = 0.008) and in the left colon(0.452, P = 0.02). CONCLUSION: Split-dose preparation improved colon cleansing, enhanced polyp detection and unmasked significant polyp miss rates.     

Parathormone and 1,25(OH)2D3 but not 25(OH)D3 serum levels, in an inverse correlation, reveal an association with advanced stages of colorectal cancer

Experimental, epidemiologic, and clinical trial data indicate the antineoplastic effects of calcium and vitamin D in large-bowel neoplasia. The aim of this study was to determine serum levels of vitamin D metabolites and parathormone (PTH) in patients with colorectal cancer (CRC) and to extract conclusions comparing their different levels in serum with healthy individuals. Group 1 (cancer patients) was consisted of 140 patients with CRC with clinical stages Duke’s A: 12, B: 52, C: 62, and D: 14. Serum levels of 25(OH)D₃, 1,25(OH)₂D₃, and PTH were determined in all patients. The findings are: (a) No significant difference was found in the serum levels of 25(OH)D₃ in each Duke’s clinical stage in cancer patients, (b) serum 1,25(OH)₂D₃ levels decreased with advanced cancer stages, and (c) serum levels of PTH showed a corresponding increase. Low serum levels of 1,25(OH)₂D₃ on one hand and increased levels of PTH in patients with CRC on the other might be strongly related to the carcinogenetic process.     

Comparison of intra-aortic computed tomography angiography to conventional angiography in the presurgical visualization of the Adamkiewicz artery: first results in patients with thoracoabdominal aortic aneurysms

Introduction

The aim of this study was to compare the sensitivity of intra-aortic computed tomography angiography (IA-CTA) to that of regular spinal digital subtraction angiography for the presurgical location of the Adamkiewicz artery (AKA).

Methods

Thirty patients (21 males, 9 females; mean age 64 years) had an IA-CTA for the location of the AKA before surgery of aneurysm (n?=?24) or dissection (n?=?6) of the thoracoabdominal aorta. After femoral artery puncture, a pigtail catheter was positioned at the origin of the descending aorta. CT acquisition was performed with an intra-aortic iodinated contrast media injection (15 mL/s, 120 mL). The visualization of the AKA and the location of the feeder(s) to the AKA were independently evaluated by two observers. Interrater agreement was calculated using a kappa test. Spinal angiogram by selective catheterization was systematically performed to confirm the results of the IA-CTA.

Results

The AKA was visualized by the IA-CTA in 27/30 cases (90 %); in 26/31 (84 %) cases, the continuity with the aorta was satisfactorily seen. Interrater agreement was good for the visualization of the AKA and its feeder(s): 0.625 and 0.87, respectively. In 75 % of the cases for which the AKA was visualized, the selective catheterization confirmed the results of the IA-CTA. In the remaining 25 % of the cases, the selective catheterization could not be performed due to marked vessels’ tortuosity or ostium stenosis.

Conclusion

IA-CTA is a feasible technique in a daily practice that presents a good sensitivity for the location of the AKA.     

Silicone rubber mould cast polyethylmethacrylate-hydroxyapatite plate used for repairing a large skull defect.

INTRODUCTION: Reconstruction of the cranial vault is performed for various reasons and precise repair of the defect is important. A modified method of cranioplasty is presented using three-dimensional (3D) models and polyethylmethacrylate mixed with hydroxyapatite, cast in a silicone rubber mould. PATIENT AND METHOD: A large custom made cranial implant was produced using data acquired from 3D computer tomography, rapid prototyping and cast in a silicone rubber mould. This plate was then applied to a 53 year-old man who had undergone a decompressive fronto-parieto-temporo-occipital craniotomy. The bone flap had been lost due to infection. The cranioplasty was performed at 1 year after the initial operation. RESULTS: The cranial plate fitted precisely into the defect and needed no correction at the time of surgery. The stability of the reconstruction plate was increased by the presence of thin margins allowed by silicone rubber elasticity. No complications occurred and the final functional and aesthetic results were good. CONCLUSION: The use of 3D imaging and rapid prototyping allow precise repair of large skull defects, with good aesthetic and functional results. At the same time, silicone rubber moulds permit the production of very thin details needed not only for cosmetic reasons but for reconstruction plate stability as well.     

Distortion of laser welded titanium plates

The distortion of laser welded titanium plates was assessed for different operating conditions of the laser welding device, and with different welding parameters (in terms of weld point and prewelding). In this study, Nd : YAG laser welding device was used to join the titanium plates. The results showed that distortion increased stepwise after each welding point along the welding zone (one-side welding), but decreased consecutively as the welding proceeded on the second side of the weld (two-side welding). In the case of one-side welding, the dependence of distortion on current and spot diameter presented maxima--due to changes in the welding pool characteristics. For two-side weld the same parameters exercised little influence on its distortion recovery, due to the effect of solidified weld pools from the first side. Current and spot diameter determined the weld pool, which in turn regulated distortion based on shrinkage. Four-point prewelding significantly decreased the final distortion for both one- and two-side welds. Alternating two-side welding of prewelded assembly showed lower distortion than a classic two-side weld.