[Comparison of nalbuphine and pentazocine in the treatment of postoperative pain by self-administration]. / Comparaison de la nalbuphine et de la pentazocine dans le traitement de la douleur postopératoire par auto-administration.

The side-effects of two opioid agonist-antagonists, nalbuphine and pentazocine, were assessed when used for patient-controlled postoperative analgesia. Forty ASA I or II patients scheduled for upper abdominal surgery were randomly allocated to two equal groups. The anaesthetic technique was the same for all the patients: premedication with atropine and diazepam, induction with thiopentone and suxamethonium and maintenance with fentanyl, pancuronium, nitrous oxide and halothane. Patient-controlled computer assisted analgesia (On-Demand Analgesia Computer) was started in the recovery room at least 2 h after the last administration of fentanyl. The parameters used were: a routine hourly dose (the half of that received during the previous hour), with on demand delivery of nalbuphine (15 micrograms.kg-1) or pentazocine (45 micrograms.kg-1) aliquots respectively, with a refractory period between two demands of 4 min and a total hourly maximum dose of 16 mg and 48 mg respectively. The following parameters were measured before the start of self-administration, and every hour afterwards for 24 h: systolic (Pasys) and diastolic blood pressures, heart rate, pressure-rate product (PRP), respiratory rate, end-tidal CO2 and pain (by way of a three point scale). Analgesia was assessed on a four-point scale every 6 h. The total doses of nalbuphine and pentazocine administered were 94 +/- 43 mg and 251 +/- 150 mg respectively. The only parameters significantly different between the two groups were Pasys and PRP, being higher in the pentazocine group. There were no significant differences in the side-effects (drowsiness, nausea, vomiting, headache, amnesia, logorrhoea and urine retention). All patients in both groups were satisfied with this technique.(ABSTRACT TRUNCATED AT 250 WORDS)

[Measurement of respiratory effects of propofol by indirect spirometry]. / Effets respiratoires du propofol mesurés par la spirométrie indirecte.

The effects of a continuous steady rate infusion of propofol on spontaneous ventilation were studied in eight unpremedicated ASA 1 male patients. All were non smokers, aged 29 +/- 8 years, and weighed 67 +/- 9 kg. After an initial 1 mg.kg-1 bolus, they received 10 mg.kg-1.h-1 propofol for 10 min, followed by 8 mg.kg-1.h-1 for a further 10 min, and then 6 mg.kg-1.h-1 during the whole study period. Endotracheal intubation was carried out using lidocaine for local anaesthesia. Spontaneous ventilation was assessed during three periods of five minutes: in the awake subject, using indirect spirometry (measurement of variations in chest circumference) and direct spirometry separately, and then, in the anaesthetized subject, using both methods simultaneously. This study aimed: a) to compare the results obtained with the two methods, b) to characterize the effects of propofol anaesthesia on chest wall mechanics using the partitioning of ventilation between rib cage and abdomen provided by the non-invasive method, and c) to assess abdominal compliance by means of a gastric balloon catheter. There was an increase in rib cage ventilation in the awake state, induced by the apparatus for direct spirometry (mouth piece, nose clip). This explained that the ventilatory depression induced by propofol anaesthesia was more pronounced when measured by the direct method. The major determinant of this depression was a shortened inspiratory time, and, to a lesser extent, a decreased mean inspiratory flow rate. By contrast to inhalational anaesthesia, rib cage ventilation was preserved during propofol anaesthesia. The decrease in abdominal ventilation was partly related to a lowered abdominal compliance, suggesting recruitment of the abdominal muscles.

[Variability of cardiac rate in patients with obstructive sleep apnea/hypopnea]. / Variabilitatea frecventei cardiace la pacientii cu sindrom de apnee/hipopnee obstructiva în somn.

BACKGROUND: Obstructive sleep apnea-hypopnea syndrome (OSAHS) is characterized by repeated breathing pauses caused by upper airway collapse during sleep, leading to intermittent hypoxemia, sleep fragmentation and autonomic dysfunction. The gold standard for the treatment of OSAHS is ventilation with continuous positive airway pressure (CPAP). AIM: To study the effect of CPAP on autonomic dysfunction in patients OSAHS, by assessing the heart rate variability (HRV) parameters before the initiation of CPAP and under CPAP during the first week and at 3 months. MATERIAL, METHODS: We have assessed HRV parametrs by 24 hours ECG Holter monitoring in 42 patients with moderate and severe OSAHS (apnea-hypopnea index AHI > or = 15/h) without other causes of autonomic neuropathy. The assessment was made at diagnosis, during the first week of CPAP use and at 3 months of CPAP use. RESULTS. Both time domain and frequency domain HRV parameters decreased significantly during the first week of CPAP use and increased back to normal values at 3 months. Initially and during the first week of treatment, HRV parameters correlated negatively with the severity of OSAHS expressed by AHI. CONCLUSIONS: Patients with OSAHS present an alteration of HRV, proportionally with disease severity. The decrease in HRV is revealed by the absence of apneas during the initiation of CPAP. After 3 months of CPAP treatment, the HRV parmeters are normalized independently of the disease severity.

[Clinical and paraclinical features in diabetic patients cholecystectomized for gallstones]. / Aspecte clinico-paraclinice la diabeticii colecistectomizati pentru litiaza biliara veziculara.

UNLABELLED: Gallstones and diabetes mellitus represent a major economic burden especially when surgical treatment is involved. AIM: The purpose of our study is to identify particular laboratory, imaging and pathological aspects that correlate with gallstones in diabetic patients that undergo cholecystectomy. MATERIAL AND METHOD: This retrospective study enrolled 234 subjects diagnosed and treated through cholecystectomy for gallstones during 01.01-31.12.2008 at the 1" Surgical Clinic, Iasi "St. Spiridon" Hospital. The subjects were divided into 2 groups comprising 62 patients diagnosed with diabetes mellitus and gallstones (group i), respectively 172 patients diagnosed only with gallstones (group II). RESULTS: There is a statistically significant difference between the two groups regarding ASA class (p = 0.002), body mass index, leukocyte count, serum amylase (p = 0.001) and alanine-aminotransferase levels. Ultrasound examination revealed thickness of the gallbladder wall as an edematous aspect at 29.03% of the diabetic patients vs 13.95% nondiabetic patients and cholesterolotic appearance at 6.45% diabetics vs 2.91% nondiabetics. Pathological examination identified chronic cholecystitis at 88.96% of the diabetic and 70.97% of the nondiabetic patients; there was no significant difference regarding the gallbladder pathological aspects. CONCLUSION: Diabetes mellitus does not appear to modify substantially the pathological course in patients with gallstones. There is a greater surgical risk for diabetic patients, possibly due to higher body weight and older age in this group and an increased risk for hepatopancreatic lesions.

[Metabolic profile of patients with cholesterol gallstone disease]. / Profilul metabolic al pacientului cu litiaza biliara colesterolica.

UNLABELLED: Metabolic syndrome is a clustering of cardiovascular risk factors as well as associated co morbidities, including cholesterol gallstones disease.The aim of our study is to prove the association between metabolic syndrome and cholesterol gallstones, to identify the main risk factors for this association and to trace the particularities of the metabolic syndrome in such patients. MATERIAL AND METHOD: Our cohort study enrolled 449 subjects, 312 patients diagnosed with metabolic syndrome and gallstones or cholecystectomy (group 1) and 137 patients diagnosed only with metabolic syndrome (group 2), hospitalized in the Respiratory Rehabilitation Medical Clinic between 2007-2009. RESULTS: 85.25% of the patients with metabolic syndrome and cholesterol gallstones and 79.92% of the patients with metabolic syndrome alone had a body mass index (BMI) > or = 25 Kg/m2. Univariate and multivariate logistic regression were used to calculate the risk of gallstone disease associated with different metabolic syndrome variables. Waist circumference, BMI, fasting glycemia, insulinemia and insulin resistance index (HOMA-IR) registered statistical significant differences between the two study groups and were significantly associated with a higher risk of cholesterol gallstone as well as were blood pressure values > or = 130/85 mmHg. The presence of 4 or 5 components of the metabolic syndrome increased the risk of gallstone disease by 3 times (OR = 3.3, p < 0.001) compared to a 2 times higher risk (OR = 2.1, p = 0.02) in case of increased insulin resistance; there was no statistical significance for any of the lipid parameters. CONCLUSION: In our study, cholesterol gallstones appeared strongly associated with anthropometric measurements, fasting glycemia and insulin resistance index, as well as with the presence of metabolic syndrome as defined by the new clinical definition, despite the negative results for the lipidic components. These findings are consistent with the hypothesis that insulin resistance plays an important role in the pathogenesis and that cholesterol gallstone disease belong to metabolic syndrome.

[Correlation between atherosclerosis--coronary disease and insulin resistance, regarded as the basis of metabolic syndrome]. / Interrelatia ateroscleroza--boala coronariana si insulinorezistenta, considerata ca substrat al sindromului metabolic.

AIM: To analyze the components of metabolic syndrome from patients with cardiovascular disease (myocardial infarction). MATERIAL AND METHOD: Two groups of patients are included in this study-patients who have myocardial infarction (35) and patients who have myocardial infarction associated with diabetes mellitus (47). Patients, male and female are between 43 and 86 years. For these patients was studied: the presence of dyslipidemia, the control of diabetic disease, the pancreatic secretion (insulinemia, C peptid), the index of the insulin resistance, presence of obesity and HBP, proinflammatory status, value of homocystein and of GGT. RESULTS: The most frequent component of metabolic syndrome was dyslipidemia. More patients had abnormal value of glycemia, the expression of an inefficient control of diabetic disease. Low levels of pancreatic secretion were found frequently in patients with glycoregulation disorder. Pathological value of insulin resistance index was found in the majority of patients with diabetes mellitus. CONCLUSION: the patients with metabolic syndrome had a high risk of cardiovascular disease due to metabolic disorders (dyslipidemia, hyperglycemia) and proinflammatory status.

[Ambulatory blood pressure monitoring (ABPM) in elderly]. / Evaluarea prin monitorizare continua a hipertensiunii arteriale la vârstnici.

AIM: Comparison of blood pressure values measured by two methods. MATERIAL AND METHOD: 94 hypertensive patients (66 women and 28 men in relation to 2.36/1) were assessed classically and also by ABPM. For statistic evaluation we have used t - Student test, chi2 test, Pearson correlation coefficient and variation coefficient (cv%). RESULTS: It shows significant differences between mean values of systolic and diastolic blood pressure obtained by the 2 methods. CONCLUSIONS: ABPM measured values are more accurate compared to clinic, bringing also information on pattern hypertensive therapy.

[Home control of high blood pressure]. / Controlul terapeutic al hipertensiunii arteriale la domiciliu.

UNLABELLED: Control of blood pressure is far from satisfactory, reaching approximately 13% in Romania according the SEPHAR study. AIM: Assessment of blood pressure control in elderly by blood pressure monitoring at home. MATERIAL AND METHOD: 64 hypertensive patients (36 women and 28 men) with mean age of 76.3 years which blood pressure has been normalized by admitting in hospital were followed for a period of three months, by self-measuring blood pressure at home (twice a week). RESULTS: In the first week after hospital discharge the mean systolic pressure was 158 +/- 17.06 and after adjustment of treatment was 136.76 +/- 11.36 mmHg. To the end of the study blood pressure was controlled at a rate of 81.25%. CONCLUSIONS: To increase the percentage of therapeutic control of blood pressure at home, small changes in drug dosage are needed.

[Chronic miocardial infarction among patients with diabetes mellitus or impaired glucose tolerance]. / Infarctul de miocard la pacientul cu diabet zaharat sau cu prediabet.

UNLABELLED: Chronic myocardial infarction represents one of the most important problems of actual clinical medicine because their incidence is growing especially at young adults (< 45 years) and their mortality with no treatment is high in first month after acute myocardial infarction (50%). When cardiovascular disease is associated with diabetes mellitus, evolution of patients is more serious. AIM: To compare the disease evolution for two groups of patients--one with patients who have purely chronic myocardial infarction and other with patients who have chronic myocardial infarction associated with glycoregulation disturbances (diabetes mellitus, impaired glucose tolerance or impaired fasting glucose). MATERIAL AND METHOD: The study group included 205 patients with chronic myocardial infarction; the study was a retrospective analysis of the clinical and biochemical parameters of patients. RESULTS: The patient age was between 37-89 years (the middle age was 65 years) and the predominant environment was urban. All of the patients have chronic myocardial infarction and 60% of them have associated glycoregulation disturbance. The majority of hospitalised patient was symptomatic and the major symptoms where chest pain and dyspnoea. Most patients had abdominal obesity associated with hypertension and tachycardia. The most frequent component of metabolic syndrome was hypertension. More patients had abnormal value of glycaemia, the expression of an inefficient control of the diabetic disease. High level of the serum cholesterol and triglycerides was found more frequently. Hypercholesterolemia was a predominant expression of dyslipidemia in discordance with literature dates for diabetic patient. A different degree of renal failure was found, frequently in patients with glycoregulation disturbances. The electrocardiograms revealed that the majority of patients have a complete (transmural) myocardial infarction and the most frequently localisation was the previous one. The clinical manifestation-breathing and ecocardiographical aspects (law value of EjF and abnormal parietal kinetic) expression of the cardiac failure was found in 46% patients more frequently in diabetic disease. The complication of myocardial infarction -post infarction angina, ventricular aneurism, and arrhythmia -appears more frequently among patient with glycoreglation disturbance. The other vascular territories affected by ATS where cerebral arteries and peripheral arteries. CONCLUSION: This study confirms the unfavourable evolution of myocardial infarction in diabetic patient.

[Treatment with statins and angiotensin-converting enzyme inhibitors in degenerative aortic stenosis--an up-date]. / Tratamentul cu statine si inhibitori ai enzimei de conversie in stenoza aortica degenerativa--up to date.

UNLABELLED: Degenerative aortic stenosis (AoS) is the most common valvular disease in adults; that's why, the aortic valve replacement is one of the most frequent cardiac surgical procedures. The etiology of degenerative AoS is actually well known, the primary lesion being aortic sclerosis. Aortic sclerosis shares many pathological features and risk factors with atherosclerosis and, because atherosclerosis may be prevented and/or reversed by cholesterol lowering, there has been postulated that cholesterol lowering therapy using statin drugs could modify the course of aortic sclerosis/stenosis. Some studies also demonstrated the implication of renin-angiotensin-aldosterone system in the degenerative aortic disease, and the use of angiotensin-converting enzyme inhibitors could also be used to delayed or even reverse the evolution of Ao sclerosis/stenosis. The paper reviews the latest literature date about the definition and prevalence of aortic sclerosis and stenosis as well as medical treatment of degenerative AoS. CONCLUSIONS: Treatment with statins has not proved effective in preventing the progression of lesions valves but have an important role in patients with associated coronary artery disease. Angiotensin converting enzyme inhibitors does not influence the progression of lesions valves, but may play a role in cardiac remodeling.

[Clinical characteristics of depressive disorders in hypertensive patients]. / Particularitati clinico-evolutive ale tulburarilor depresive la pacientii hipertensivi.

UNLABELLED: There is an interrelation between the psychic and the somatic affectation in the case of the patients suffering of essential high blood pressure that associates the depressive disorder. OBJECTIVES: Our study aims to compare two groups of patients in regard to the level of depression and anxiety, and to underline the clinical and the evolutional characteristics of the depressive disorder in the case of patients suffering from essential high blood pressure. MATERIAL AND METHODS: The study has been realized on 200 patients divided in 100 patients suffering of depression and 100 patients suffering of depression and HBP. There has been used the anamnesis, the HAMD and the HAMA. RESULTS: We have noticed that the level of depression is significantly increased in the group with depression and HBP by comparison with the group of those without HBP (t = -4.539, p = 0.000 < 0.05). The clinical manifestations and the evolution of the depressive syndrome, for the HBP, are polymorph and presents a nucleus around which are associated series of affective, vegetative and organic states. CONCLUSION: The progression of the HBP leads to the intensification of the neuropsychical disorders and backwards--the negative evolution of depression can lead to the increase of the blood pressure values, frequently causing hypertensive crises.

[Arterial media calcification in patients with type 2 diabetes mellitus]. / Calcificarile vasculare mediale la pacientii cu diabet zaharat tip 2.

Arterial calcification was previously viewed as an inevitable, passive, and degenerative process that occurred at the end stages of atherosclerosis. Recent studies, however, have demonstrated that calcification of arteries is a complex and regulated process. It may occur in conjunction with atherosclerosis or in an isolated form that is commonly associated with diabetes and renal failure. Higher artery calcium scores are associated with increased cardiovascular events, and some aspects of arterial calcification are similar to the biology of forming bone. Arterial calcification can thus be viewed as a distinct inflammatory arteriopathy, much like atherosclerosis and aneurysms, with its own contribution to cardiovascular morbidity and mortality. Current research involves efforts to define the complex interactions between cellular and molecular mediators of arterial calcification and, in particular, the role of endogenous calcification inhibitors. This review discusses the clinical relevance, cellular events, and suspected molecular pathways that control arterial calcification.

Relationship between osteopontin and vascular calcifications in type 2 diabetic patients.

AIM: To measure circulating osteopontin levels in a cohort of type 2 diabetic patients and to determine whether osteopontin could be associated with lower limb arteries calcifications, either intimal (atherosclerotic) or medial (mediacalcinosis). METHODS: Osteopontin was measured in 60 patients with type 2 diabetes who were subdivided in three groups: group 1 (n=19) was characterized by the absence of peripheral vascular calcifications on plain soft tissue radiograms; group 2 (n=18) presented intimal calcifications without mediacalcinosis; in group 3 (n=23), mediacalcinosis was the dominant pattern. RESULTS: Osteopontin levels were significantly higher in patients with mediacalcinosis (558 ng/ml [140-2289], median [range]) than in subjects without vascular calcifications (337 [134-841], P = 0.024) or in individuals with intimal lesions (340 [140-1154], P = 0.05). No correlation was observed between osteopontin, glycaemic control or HOMA test results. Osteopontin was correlated with creatinine clearance (P = 0.037). CONCLUSION: In type 2 diabetic patients, circulating levels of osteopontin were higher in the presence of medial calcifications than in subjects without vascular lesions or in individuals with calcifications limited to the intimal

[Complementary therapies in the treatment of bronchial asthma]. / Tratamente complementare în astmul bronsic.

The clinical and paraclinical benefits of drugs that are not included in the standard therapy strategies, to patients suffering from bronchial asthma, are illustrated in a particularly rich specialty literature. Magnesium, furosemide, heparins, antioxidative drugs, nitric oxide donor substances have real qualities, that make them useful in the management of patients suffering from asthma. The tremendous amount of studies that inspired this work suggests that, for the asthmatic patients, there are other alternative therapies, which can be administrated as adjuvant medication to the classical medication. At the same time, unconventional treatments are a solution worth considering for treatment-resisting cases, for cases in which side reactions develop to the standard therapy, and a source of inspiration for future research.

[Carotid atherosclerotic alterations revealed at ultrasonographic examination in patients with coronary heart disease]. / Modificari aterosclerotice carotidiene evidentiate la examinarea ultrasonografica la pacienti coronarieni.

UNLABELLED: Carotid ultrasound examination is a noninvasive method with large indications in the evaluation of atherosclerotic lesions at cardiac patients. The aims of the study were: the ultrasound assessment of extra cranial carotid system at patients with coronary heart disease; relationship with the cardiovascular risk factors, lipid profile and echocardiographic data. METHODS: There were studied 47 patients with coronary heart disease (angina, myocardial infarction, ischemic cardiomyopathy, CABG). The evaluation included cardiovascular risk factors, clinical examination, serum lipids and glucose, echocardiographic data. The ultrasound examination of the carotid arteries included the measurement of the diameter and intima-media thickness (IMT) of the common carotid arteries, the presence and location of atherosclerotic plaques and the presence and severity of carotid stenosis. RESULTS: There was a significant increase of the diameter and IMT with age (p=0.009 respectively p=0.05). Males had a greater medium diameter than women (7.8 +/- 0.9 mm vs. 7.3 +/- 0.8 mm, p=0.04). There was no significant relationship between the cardiovascular risk factors (smoking, arterial hypertension, diabetes mellitus, dyslipidemia) and IMT. The thickness of the interventricular septum (at the echocardiographic examination) correlated with the IMT (p=0.03). All the patients with myocardial infarction revealed carotid atherosclerotic plaques and most of the smokers had carotid plaques (88.9% vs. 44.8%, p=0.03). Patients with carotid plaques were older (60.9 +/- 10.1 vs. 54.8 +/- 6.1, p=0.02). CONCLUSIONS: The incidence of carotid atherosclerosis increases with age; the carotid diameter is greater at males and older patients; IMT is influenced mainly by age; carotid plaques are present mainly at older patients, at smokers and those with myocardial infarction and can be considered an additional risk factor for vascular

[Systemic lupus erythematosus with neurologic onset and secondary antiphospholipid syndrome. A Case Study]. / Lupus eritematos sistemic cu debut neurologic si sindrom antifosfolipidic secundar. Caz clinic.

A 39-years-old woman was admitted to our hospital with musculoskeletal complaints (myalgias and symmetric arthralgias in proximal interphalangeal, metacarpophalangeal joints of the hands and in knees), systemic symptoms like fever, fatigue, malaise and a six months previous history of a transient ischemic attack. The presence of antibodies to double-stranded deoxyribonucleic-acid (DNA) and antiphospholipid antibodies led to the diagnosis of systemic lupus erythematosus with secondary antiphospholipid syndrome. Cerebral infarction develops significantly more often in patients with lupus and antiphospholipid antibodies, but other clinical syndromes are associated with lupus anticoagulant: cognitive dysfunction, seizures, polyneuropathy, aseptic meningitis, myelopathy.

[The influence of intermediate physical training on some non-enzyme antioxidants of oxidative stress, in moderate hypertension]. / Influenta antrenamentului fizic recuperator pe termen mediu asupra unor antioxidanti neenzimatici de stres oxidativ în HTA moderata.

A group of patients with moderate hypertension (149-150/90-99 mm Hg) performed physical exercise for 3 months; we determined the oxidative stress in blood samples, by calculating the level of some biochemical markers, non-enzyme antioxidants, glutathione (GSH), total -SH groups (G-STH), nonprotein -SH groups (G-SHNP), their G-SHT/G-SHNP ratio, uric acid, malondialdehyde (MDA) and comparing the results with the values obtained from a group of healthy subjects. We found an increased oxidative stress at the HTA patients, with initial (Vi) decreasing values of GSH and uric acid, and with higher values of MDA. After the 3 months (Vf) of physical training, the oxidative stress improved, with increasing GSH, uric acid and decreasing MDA, compared to normal subjects. The initial values of G-SHT, G-SHNP and their ratio, increased, but decreased after 3 months, with an inverse aspect to GSH. The clinical study proved that after 3 months of physical exercise, there wasn't any increased oxidative stress at the HTA patients; however, the oxidative stress is present, proved by the values of MDA, significantly higher compared to the normal subjects.

[The detection of dysplastic lesions of the gallbladder mucosa in polypoid cholelithiasis]. / Evidentierea leziunilor displazice din mucoasa veziculei biliare în colecistitele calculoase polipoide.

AIM: To investigate the hyperplastic and/or dysplastic lesions in the gallbladder mucosa. METHODS: We used the immunohistochemical Ardeleanu-Hsu-Bussolati and Gugliotta methods, with avidin and peroxide biotin, adapted in the laboratory of University Hospital "St. Spiridon" Iasi. There were studied ten cases of polypoid cholelithiasis, with the following markers: Ki67, PCNA, and p53. RESULTS: The immunohistochemical methods using Ki67, PCNA and p53 protein allowed the evaluation of the abnormal proliferation abilities characteristic for some hyperplastic or dysplastic lesions, found in our cases of cholelithiasis. CONCLUSIONS: The utilization of these markers permitted us to establish a good correlation between the high activity of Ki67 and the morphological aggression indicators in hyperplastic and dysplastic gallbladder epithelium. There is also a correlation between the percentage of the cells marked with anti-PCNA antibody and the existence of p53 protein in these lesions.