1st Medical Clinic

Cluj-Napoca, Romania

1st Medical Clinic

Cluj-Napoca, Romania
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Chira R.I.,1st Medical Clinic | Chira R.I.,University of Medicine and Pharmacy, Cluj-Napoca | Calauz A.,Pneumophthisiology Clinical Hospital | Manole S.,University of Medicine and Pharmacy, Cluj-Napoca | And 5 more authors.
Journal of Gastrointestinal and Liver Diseases | Year: 2017

Congenital extrahepatic portosystemic shunt (Abernethy malformation) is a rare condition characterized by developmental abnormalities of the portal venous system resulting in the diversion of the portal blood from the liver to the systemic venous system through a complete or partial shunt of the portomesenteric blood. We report the case of an 18 year-old female examined for abdominal pain, presenting cholestasis syndrome and an elevated serum aspartate aminotransferase level. Liver ultrasound examination revealed the absence of the portal vein with a complete extrahepatic shunt of the portal blood, multiple focal liver lesions, and multiple associated vascular anomalies. A surgical portosystemic shunt and a secondary portosystemic shunt due to portal vein thrombosis were excluded, enabling the diagnosis of a congenital portosystemic shunt. A complex investigation also discovered bone anomalies, and the liver biopsy of the dominant focal lesion revealed adenoma. On a short-term follow-up under hepatoprotective medication, the biochemical parameters improved mildly; however, the size of the main focal lesion increased. Congenital absence of the portal vein often remains an incidental diagnosis. In experienced hands, ultrasonography can diagnose it, but a comprehensive thoraco-abdominal evaluation is compulsory, considering the many potential associated anomalies. In these patients, development of adenomatous liver lesions secondary to Abernethy type Ib malformation represents an indication for liver transplantation. © 2017, Romanian Society of Gastroenterology. All rights reserved.


Zimmermann A.,1st Medical Clinic | Grigorescu-Sido P.,Victor Babes University of Medicine and Pharmacy Timisoara | Alkhzouz C.,Victor Babes University of Medicine and Pharmacy Timisoara | Patberg K.,1st Medical Clinic | And 6 more authors.
Hormone Research in Paediatrics | Year: 2010

Background: Classic 21-hydroxylase deficiency (21HD) presents some traits of the metabolic syndrome. Aim: To characterize discrete alterations of lipid and carbohydrate metabolism in children and young adults with classic 21HD, which could predict early atherogenesis. Patients and Methods: Twenty-seven Caucasian patients with classic 21HD (4-31 years); 27 sex-, age- and BMI-matched controls. Clinical parameters, hormonal status and genotype were assessed in all patients. Lipid parameters, including relative (%) and absolute (mg/dl) small-dense low-density lipoproteins subfractions (sd-LDL) were measured in patients and controls. Oral glucose tolerance tests were performed in both groups. Results: sd-LDL (%) was significantly higher in patients than controls (39.7 ± 5.9 vs. 35.5 ± 5.7%; p = 0.008). The same applies for absolute sd-LDL (mg/dl) (42.6 ± 11.9 vs. 36.4 ± 7.5; p = 0.029). HDL-cholesterol was lower in patients (p = 0.032). Fasting glucose and insulin were significantly higher in patients. Similar differences were noticed for HOMA-IR (p = 0.001), IRI (p = 0.001) and HOMA-B (p = 0.002). IRI correlated directly and significantly with the total hydrocortisone dose and the duration of treatment. Fasting glucose correlated with absolute sd-LDL. No obvious differences were seen between clinical forms or genotype groups. Conclusions: Substitution therapy should be adapted particularly at young ages to prevent early atherogenesis and cardiovascular risk in later life. © 2010 S. Karger AG.


Manzat Saplacan R.M.,1st Medical Clinic | Manzat Saplacan R.M.,University of Medicine and Pharmacy, Cluj-Napoca | Mircea P.A.,1st Medical Clinic | Mircea P.A.,University of Medicine and Pharmacy, Cluj-Napoca | And 2 more authors.
Clujul Medical | Year: 2015

Colorectal cancer is a major cause of cancer-associated deaths in the world. Early detection would be greatly enhanced if accurate and cost-effective diagnostic biomarkers for this disease were accessible. The development of such a blood test will evidently lower the screening costs in regards of colorectal cancer detection. Lately, it has been suggested that microRNA diagnostic biomarkers are feasible new screening methods for colorectal cancer. This review summarizes the diagnostic potential of circulating microRNA biomarkers in relation with colorectal cancer, as well as current methods to detect them.


Vlase L.,University of Medicine and Pharmacy Iuliu Hatieganu | Popa A.,University of Medicine and Pharmacy Iuliu Hatieganu | Neag M.,1st Medical Clinic | Muntean D.,University of Medicine and Pharmacy Iuliu Hatieganu | And 2 more authors.
Clinical and Experimental Pharmacology and Physiology | Year: 2012

1.Our objective was to evaluate a possible pharmacokinetic interaction between zolpidem and fluvoxamine in healthy volunteers. 2.The study consisted of two periods: Period1 (reference), when each volunteer received a single dose of 5mg zolpidem; and Period2 (test), when each volunteer received a single dose of 5mg zolpidem and 100mg fluvoxamine. Between the two periods, the subjects were treated for 6days with a single daily dose of 100mg fluvoxamine. 3.Pharmacokinetic parameters of zolpidem given in each treatment period were calculated using non-compartmental analysis and the data from two periods were compared to determine statistically significant differences. 4.In the two periods of treatments, the mean peak plasma concentrations (C max) were 56.4±25.6ng/mL (zolpidem alone) and 67.3±25.8ng/mL (zolpidem after pretreatment with fluvoxamine). The t max, times taken to reach C max, were 0.83±0.44 and 1.26±0.74h, respectively, and the total areas under the curve (AUC 0-∞) were 200.9±116.8 and 512.0±354.6ngh/mL, respectively. The half-life of zolpidem was 2.24±0.81h when given alone and 4.99±2.92h after pretreatment with fluvoxamine. 5.Fluvoxamine interacts with zolpidem in healthy volunteers and increases its exposure by approximately 150%. The experimental data showed the pharmacokinetic interaction between zolpidem and fluvoxamine, and suggest that the observed interaction might be clinically significant, but its relevance has to be confirmed. © 2011 The Authors. Clinical and Experimental Pharmacology and Physiology © 2011 Blackwell Publishing Asia Pty Ltd.


Vlase L.,University of Medicine and Pharmacy, Cluj-Napoca | Popa A.,University of Medicine and Pharmacy, Cluj-Napoca | Neag M.,1st Medical Clinic | Muntean D.,Babes - Bolyai University | And 2 more authors.
Journal of Clinical Pharmacology | Year: 2011

The objective of this study was to evaluate the pharmacokinetic interaction between zolpidem and carbamazepine in healthy volunteers. The study consisted of 2 periods: period 1 (reference), when each volunteer received a single dose of 5 mg zolpidem, and period 2 (test), when each volunteer received a single dose of 5 mg zolpidem and 400 mg carbamazepine. Between the 2 periods, the participants were treated for 15 days with a single daily dose of 400 mg carbamazepine. Pharmacokinetic parameters of zolpidem administered in each treatment period were calculated using noncompartmental analysis. In the 2 periods of treatments, the mean peak plasma concentrations (Cmax) were 59 ng/mL (zolpidem alone) and 35 ng/mL (zolpidem after pretreatment with carbamazepine). The tmax, times taken to reach Cmax, were 0.9 hours and 1.0 hour, respectively, and the total areas under the curve (AUC0-∞) were 234.9 ng•h/mL and 101.5 ng•h/mL, respectively. The half-life of zolpidem was 2.3 and 1.6 hours, respectively. Carbamazepine interacts with zolpidem in healthy volunteers and lowers its bioavailability by about 57%. The experimental data demonstrate the pharmacokinetic interaction between zolpidem and carbamazepine and suggest that the observed interaction may be clinically significant, but its relevance has to be confirmed. © 2011 The Author(s).


Saplacan R.M.M.,1st Medical Clinic | Catinean A.,1st Medical Clinic | Manole S.,University of Medicine and Pharmacy, Cluj-Napoca | Valean S.D.,1st Medical Clinic | And 2 more authors.
Medical Ultrasonography | Year: 2011

We report the clinical observation of a 58-year old patient who presented with upper abdominal pain and a small ecchymosis located in the umbilical area. Personal history of the patient revealed ischemic heart disease and chronic atrial fibrillation. He was under treatment with oral anticoagulants (coumarins). The clinical data and especially the imaging investigations led to a diagnosis of gastric wall hematoma, possibly occurring post-traumatically in a patient under anticoagulant treatment. A conservative therapeutic approach was adopted and ultrasound surveillance. After 6 months the gastric parietal collection manifested complete resorption, spontaneously. In relation to the case presentation, we also discuss some issues on the frequency, diagnosis and therapeutic attitude in this rare complication of anticoagulant therapy.


Vlase L.,University of Medicine and Pharmacy, Cluj-Napoca | Popa A.,University of Medicine and Pharmacy, Cluj-Napoca | Neag M.,1st Medical Clinic | Muntean D.,University of Medicine and Pharmacy, Cluj-Napoca | Leucuta S.E.,University of Medicine and Pharmacy, Cluj-Napoca
Clinical Drug Investigation | Year: 2012

Background: Phenytoin is an inductor of the main metabolizing enzyme of ivabradine and it could influence its pharmacokinetics. Changes in ivabradine pharmacokinetics could have clinical significance regarding the safety of the treatment. Objective: The study objective was evaluation of the pharmacokinetic interaction between ivabradine and phenytoin in healthy subjects. Methods: A single dose of ivabradine 10 mg was administered alone or in combination with phenytoin 150mg to 18 healthy subjects in a two-treatment study design, separated by 5 days in which the phenytoin alone was administered at a dose of 150mg twice daily. Plasma concentrations of ivabradine were determined during a 12-hour period following drug administration, using a high-throughput liquid chromatography coupled with mass spectrometry analytical method. Pharmacokinetic parameters of ivabradine administered in each treatment were calculated using non-compartmental analysis and compared to determine if the differences were statistically significant. Results: In the two treatment periods, the mean ±SD peak plasma concentrations (Cmax) were 18.6 ± 8.0 ng/mL (ivabradine alone) and 6.5 ± 3.1 ng/mL (ivabradine after pre-treatment with phenytoin). The mean ±SD times taken to reach C max (tmax) were 1.2 ± 0.7 h and 0.8 ± 0.6 h, respectively, and the total areas under the plasma concentration-time curve from time zero to infinity (AUC∞) were 62.3 ± 18.7 ng•h/mL and 19.2 ± 17.0 ng•h/mL, respectively. Statistically significant differences were observed for the Cmax and AUC ∞ of ivabradine when administered alone or with phenytoin, whereas for tmax and the half-life the differences were non-significant. Conclusion: This study showed that phenytoin has an important effect on the pharmacokinetics of ivabradine in healthy subjects, reducing its bioavailability by approximately 70%. © 2012 Springer International Publishing AG. All rights reserved.


Vlase L.,University of Medicine and Pharmacy, Cluj-Napoca | Popa A.,University of Medicine and Pharmacy, Cluj-Napoca | Neag M.,1st Medical Clinic | Muntean D.,University of Medicine and Pharmacy, Cluj-Napoca | Leucuta S.E.,University of Medicine and Pharmacy, Cluj-Napoca
European Journal of Drug Metabolism and Pharmacokinetics | Year: 2011

Our objective was to evaluate a possible pharmacokinetic interaction between zolpidem and ciprofloxacin in healthy volunteers. The study consisted of two periods: Period 1 (reference), when each volunteer received a single dose of 5 mg zolpidem and Period 2 (test), when each volunteer received a single dose of 5 mg zolpidem and 500 mg ciprofloxacin. Between the two periods, the subjects were treated for 5 days with a single daily dose of 500 mg ciprofloxacin. Plasma concentrations of zolpidem were determined during a 12-hour period following drug administration. Pharmacokinetic parameters of zolpidem administered in each treatment period were calculated using non-compartmental analysis and the data from two periods were compared to determine statistically significant differences. In the two periods of treatments, the mean peak plasma concentrations (Cmax) were 75.73 ± 28.34 ng/ml (zolpidem alone) and 80.58 ± 22.40 ng/ml (zolpidem afterpre-treatment with ciprofloxacin). The tmax, times taken to reach Cmax, were 0.91 ± 0.42 and 1.44 ± 0.61 h, respectively, and the total areas under the curve (AUC0-∞) were 300.2 ± 115.5 and 438.1 ± 142.6 ng h/ml, respectively. The half-life of zolpidem was 2.39 ± 0.53 h when administered alone and 3.34 ± 0.87 h after pre-treatment with ciprofloxacin. These differences were statistically significant for Cmax, tmax, AUC 0-∞, half-life and mean residence time. Ciprofloxacin interacts with zolpidem in healthy volunteers, raising its bioavailability by about 46%. This magnitude of effect is likely to be clinically significant. © Springer-Verlag France 2010.


PubMed | 1st Medical Clinic
Type: Journal Article | Journal: Journal of gastrointestinal and liver diseases : JGLD | Year: 2010

The AIM of this study was to assess the long-term evolution of chronic hepatitis B acquired in childhood.The study was carried out in 2007 - 2008 on a group of 77 adult patients who were diagnosed with chronic hepatitis B in childhood. The actual assessment included epidemiological, clinical, biological and virological data, ultrasound examination in all patients and liver histology in 3 patients.From the 77 patients, 69 were HBeAg positive and the other 8 patients were anti-HBe positive when the diagnosis was made in their childhood. Thirty-seven patients from the HBeAg positive group and 2 patients from the anti-HBe group had been treated in childhood with IFN-alpha and the other 38 patients remained untreated (32 patients with HBeAg positive and 6 patients anti-HBe positive). Overall, 78.26% seroconverted to anti-HBe (87.50% untreated and 70.27% of patients treated with IFN). After a median follow-up period of 13 years, 36 patients from the HBeAg positive group (48.65% of treated patients and 56.25% of untreated ones) became inactive carriers. Seroconversion to anti-HBs, in the HBeAg positive group, occurred in 10.14% of cases (8.1% in treated patients) without statistical significance. Three patients from the whole group developed cirrhosis but none developed hepatocellular carcinoma.The long-term outcome in our patients with CHB acquired in childhood did not differ between treated and untreated patients.

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