Camelia Ciobotaru, Madalina Iliescu and Oana Arghir
Although the knee osteoarthritis is often benign, severe degenerative modifications can determine serious malfunction. In joints affected by arthritic processes, Sodium hyaluronate is found in reduced concentrations, the normal articular cartilage being replaced by fibrocartilage .
The present concepts suggest that osteoarthritis is not a predictable stage in ageing and prophylactic and therapeutic approaches could be taken in the future
Ozone Therapy is thought to be a non-pharmacological therapy, which makes use of oxygen and ozone, It is based on the ozone characteristics, such as the antibacterial and antimycotic, anti-inflammatory and immunomodulatory, of systemic modulation of homeostasy and of the optimization of the way the organs and systems function, but also of tissue bionourishing. Some of the beneficial effects of the ozone are: the enhancement of the oxygen supply in the tissues affected by inflammation and pain, the increase of the blood stream and the removal of the metabolic waste in the joints affected, the obstruction of the substances which maintain the inflammation and pain, an immunomodulatory action upon the whole body, the stimulation of the health improving mechanisms in the body, a mio-relaxing action and thus, a better joint mobility and a better body system functioning
Madalina Iliescu, P. Bordei, Sandica Albina and C. Ionescu
Low back pain is today a remarkably serious problem, not only in terms of health, but also socially and populationally, and it is, in most developed countries, a leading cause of disability. By its morphological features, the intervertebral foramen turns out to be the key in trying to manage the pathology of lumbar spinal region. We evaluated morphometrically the lumbar intervertebral foramen on 70 isolated lumbar vertebrae and 11 spinal blocks; the latter were sectioned to obtain easy access to components and dimensional values able to provide additional results, considered statistically and compared with literature. The results, presented in tables and graphics, are discussed in relation with actual literature.
Lupu Andreea, Ionescu Elena Valentina, Iliescu Madalina Gabriela, Botnarciuc Mihaela, Iliescu Dan Marcel and Ion Ileana
Degenerative low back pain is one of the most important causes of disability worldwide, and it also has a negative impact on the economy, due to the high cost of medical care required for this pathology. It has an increased prevalence among the population, between 80-85%, it affects population between 45 and 65 years old, and the most frequent cause is the mechanical one, with degenerative syndromes on the first place. Balneal treatment is a complex treatment with multiple benefits for patients with degenerative low back pain syndromes, and in the recent years this topic is intensely studied due to its benefits, as well as the increased addressability of the patients for this type of treatment. Our study evaluated 99 patients with low back pain divided into 2 groups of patients admitted for 2 weeks to Balneal and Rehabilitation Sanatorium of Techirghiol, who performed balneal treatment with hot mud baths and cold mud baths, but also classic rehabilitation treatment (electrotherapy, masotherapy, kinetotherapy, thermotherapy). The aim of the study was to evaluate the characteristics of degenerative low back pain syndromes on patients under balneal treatment, and for the patients from our study the most frequent pathology was Spondilosis, female patients was predominantly affected than male patients, with high education level and from urban residence.
Madalina Iliescu, R. L. Craciun and Angelica Nela Stavar
Introduction: Liver represents the main place of drug metabolisation. Drugs and toxic substances reach the level of liver after absorption at gastro-intestinal level. Drug hepatotoxicity represents an important chapter of iatrogenic pathology, because the hepatic lesions induced by drugs include extremely diverse clinical, biological and histological expressions that can take the aspect of any form of acute or chronic hepatobiliary disease. Hepatic lesions induced by drugs (LHIM) represent a histological and/or biochemical alteration caused and attributed to the consumption of a drug. Hepatic elastography (Fibroscan) represents a noninvasive method of quantification of hepatic fibrosis.
Material and method: We carried out a retrospective study and longitudinally prospective study that included a set of patients under treatment with Methotrexate, amounting to 76, divided into 2 subsets: a subset consisting of patients with hepatitis to Methotrexate, subset 1, of 23 patients, a subset of patients under treatment with Methotrexate but with normal hepatic samples, subset b, of 53 patients.
Results: We carried out fibroscan at all the patients treated with Methotrexate, obtaining a medium score of fibrosis of 6.23 for the subset a with hepatitis at Methotrexate and of 5.33 for the subset b with normal hepatic samples. We made a correlation between the cumulated dose of Methotrexate and the change of hepatic samples.
Conclusions: There is a significant correlation between hepatic fibrosis induced by Methotrexate and the cumulated dose of Methotrexate. The possibility of utilization of fibroscan which is a completely painless method, reproducible, for the monitoring of the treatment with Methotrexate both at patients with changed values of the hepatic tests as weir as those with normal values must be considered.
Arghir Oana-Cristina, Trenchea Mihaela, Iliescu Mădălina, Galie N. and Ciobotaru Camelia
A 74 year old Caucasian man, presents with a 6 week history of right sided chest pain including traumatic related painful right shoulder. Shoulder minor contusion was diagnosed and partial managed by symptomatic treatment associated to rehabilitation. The pain was initially eased with nonsteroidal anti-inflammatory drug (NSAID) use and finally changed worsening. He has evidence of moderate COPD on spirometry and has been commenced on inhalers. An invasive primitive adenocarcinoma lung cancer was confirmed by chest CT scan and lymphnode biopsy through mediastinoscopy
B. Obada, Madalina Iliescu, Al O. Serban, Crina Alecu-Silvana and M. Zekra
The study was aimed to identify the role of surgical treatment of tibial plateau fractures, its functional outcome and complications. Demographic data for the patients and details of current clinical and radiological follow-up findings were obtained to assess range of motion, clinical stability, alignment of the knee, and posttraumatic arthrosis (Kellgren/Lawrence score). 64 cases of tibial plateau fractures treated by different surgical methods and variuos implants type were studied from 2013 to 2015 and followed-up for minimum period of 6 months. The systematisation of the casuitry was made using Schatzker and AO classifications. The treatment methods consist of: percutaneous cannulated cancellous screws, ORIF with buttress plate with or without bone grafting, locking or nonlocking plates, external fixator. As complications we found: redepression 4 case, malunion 2 cases, knee stiffness 9, wound dehiscence in 1 cases and non-union or infection in none of our cases. The average flexion of the injured knee was significantly lower in comparison with the contralateral side (124.9°/135.2°). Knee stability did not differ statistically significantly. There were no signs of posttraumatic arthrosis in 45% of cases, mild signs in 30%, clear signs in 18%, and severe signs in 7%. As conclusion we found that surgical management of tibial plateau fractures will give excellent anatomical reduction and rigid fixation to restore articular congruity, facilitate early motion and reduce arthrosis risk and hence to achieve optimal knee function. The choice of optimal surgical methods, proper approach and implant is made in relation to fracture type according Schatzker and AO classification.
Andreea Lupu, Sandica Albina, Ramona Balta, Alina Lupsa and Madalina Iliescu
Diffuse idiopathic skeletal hyperostosis is a non-inflammatory disease, that affects mostly males and the principal manifestations are calcification and ossification of spinal ligaments, calcification of the tendons and ligaments in the vertebral body insertion. Clinical manifestations of the disease are mainly in the thoracic spine, but it may involve also the cervical and the lumbar spine. Extraspinal involvements are frequently present at patients with diffuse idiopathic skeletal hyperostosis. Spinal stenosis is associated with this disease.
The present case is of a 56 years old man, initially diagnosed with Ankyloses spondylitis, who was under a treatment with Sulfasalazin for approximately 7 years, afterwards the diagnosis was infirmed and he was diagnosed with “Diffuse idiopathic skeletal hyperostosis”.
The patient has multiple extra spinal manifestations of the disease (shoulders, elbows, hips, knees), cervical and lumbar spinal stenosis with clinical manifestations and imagistic confirmation, and also treated in neurosurgical service for several times, for the lumbar spine pathology. Particularities of this case are related with the delay of a correct diagnosis which means that the anterior treatments, both medical and surgical are under the questions.
Doiniţa Oprea, Elena Valentina Ionescu, Liliana Elena Stanciu, Carmen Oprea, Ruxandra Badiu and Mădălina Gabriela Iliescu
Background. Rheumatoid arthritis (RA), met in the literature also as chronic evolving polyarthritis, is a chronic inflammatory disease, which typically involves the small and medium joints, with a symmetric distribution. Clinical studies shown that a proportion of patients with RA, without measurable rheumatoid factors are a distinct entity from those patients with seropositive RA. Around one third of patients with RA are seronegative for those two serological markers, the rheumatoid factors (RF) and anti-citrullinated peptide antibodies (Anti-CCP). Hands are the most frequently affected in both seropositive and seronegative RA and the first joints involved in the inflammatory process are the metacarpo-phalangeal joints, IFP joints and the radiocarpian joint. The big joints become later symptomatic, after the small joints are affected. Materials and methods: 66 patients files and the personal records of the patients consecutively admitted in the Rheumatology Department of the Clinical Emergency County Hospital Constanta. Patients from county Constanta were included in the study, with diagnosis of rheumatoid arthritis (diagnosis confirmed at least 2 years ago), including both forms (seropositive and seronegative) of the disease. The complete clinical exam was done for the patients included in the study, following the identification of the active joint disease. The mechanical status of the joint was observed by a single evaluator for each of those 66 patients with RA, with special focus on the presence of the deformities / ankyloses of the hands joints. Therefore, there were evaluated: the mobility (the number of the joints with limited movements), deformities, ankyloses (the number of the joints without mobility). The joint mobility was assessed by counting the hand joints with limited movements and the worsening of the prehension function. The presence of the following hand deformities was followed: fingers in “swan neck”, “fusiform fingers”, the thumb “in Z”, and the aspect of “hand in the shape of a camel back”. For evaluating the painful or swollen joints we used: the 28 joint index, the overall evaluation of the disease activity - by the patient (Patient Global Assessment-PGA) and by the doctor (Medical Doctor Global Assessment- MDGA), the score of disease activity DAS 28 (DAS28 - Disease Activity Score 28), the index of the clinical activity of the disease (Clinical Disease Activity Index- CDAI), as well as the simplified index of activity of the disease (Simplified Disease Activity Index-SDAI). It was determined for each patient the plasma RF and anticitrullinated peptide antibodies. Results and discussion. As expected, there is a bigger frequency of female patients in both forms of the disease (seropositive and seronegative) and regarding males the recurrence is approximate equal between those two groups. By comparing the frequency of the joint deformities at hand level between the 2 groups of patients included in the study (seropositive PR and seronegative PR), we saw a superiority of these (with all their forms) in the patients with seropositive polyarthritis. Conclusions. The clinical study done in this work is completing the data offered by the studies of some dedicated authors, who analysed the characteristic elements of rheumatoid arthritis depending on seropositivity. Our results confirm the idea that seronegative rheumatoid arthritis has a more gentle clinical evolution and is a less destructive form of disease.
B. Obada, Mădălina Iliescu, Al. O. Serban, Camelia Tecu and Anca Nicolau
The aim of the study was to determine prospectively the importance of synovial fluid white cell count and intraoperative frozen and permanent sections analysis (number of polymorphonuclear leukocytes per high-power field) in the diagnosis of septic total knee arthroplasty. There were studied prospectively 72 patients who needed a revision total knee arthroplasty between 2013-2015. 30 patients were diagnosed with prosthetic joint infection due to high rates of ESR (93%) and CRP (90%) and preoperative positive culture from aspirated synovial fluid and 42 patients were considered to have aseptic failure according to negative preoperative culture from joint aspirate. For all the patients was analysed synovial fluid white cell count and histopathological aspect of intraoperative frozen and permanent sections of periprosthetic tissue. The results showed a median value of 13800 of sinovial white cells count for infected knee and 92 for noninfected knee. 90% of the patients with joint infection had more than 5 polymorphonuclear leukocytes per high power field on intraoperative frozen sections and 83% on permanent sections. None of the patients from aseptic group had more than 5 polymorphonuclear leukocytes per field on permanent sections. The erythrocyte sedimentation rate and C-reactive protein level can be supplemented with cultures of aspirated joint fluid and fluid white cell count to confirm the diagnosis of periprosthetic infection. When the preoperative diagnosis remain unclear, the histological examination of frozen or permanent sections of periprosthetic tissue with at least 5 polymorphonuclear leukocytes per high power field, is predictive for the presence of infection.